Since April 2007, people with Medicare, caretakers and family members, counselors, advocates and even insurance sales agents have been telling us about their own experiences with private Medicare plans. These stories reveal the truth about private plans, showing the real frustrations and problems ordinary people face in these plans.
Some people are satisfied with the plans in which they are enrolled. But many others have encountered problems, from fraudulent marketing to misleading information to denials of coverage. These stories forcefully counter the propaganda from insurance companies and their powerful lobby. They are evidence of the need for Congress to take action against the privatization of Medicare.
Read people's stories by clicking on a topic below.
I signed up for a Medicare Advantage Private-Fee-For-Service plan in June 06 for $84 per month. The brochure from insurance company sounded great with all the co-pays. My doctor would not accept the insurance and told me no doctor in town would! To see for myself, I called all doctors. My doctor was right. I had to pay for visits out of pocket. I called the insurance company's customer services 6 to 8 times to find a doctor that would take my insurance. In December 2006, I called CMS to tell them I did not want this insurance company for 2007 nor any thing connected to them. I now have a drug plan with the same insurance company that I did not want. I had too much trouble with them, but CMS is pushing the insurance.
(Submitted March 3, 2008)
My father currently has a Medicare Advantage plan. He had a stroke 6 weeks ago and was receiving physical therapy from an acute facility. He was moved to a sub acute facility to continue his recovery. He is receiving less than half the therapy he was receiving. I am being told that he will not be covered for the 100 days allowed by Medicare, because the HMO will not approve it. I want to dis-enroll him from the Medicare Advantage plan, but am being told I can not at this time. What can I do to protect him?
(Submitted May 6, 2008)
I signed my mom up for a Medicare Advantage Plan on the premise that her primary care physician participated in the plan. He was listed in the book, on the website, and verified when the representative came to the house to sign her up. Also, the benefits card she received in the mail had his name on the card as her PCP. However, he does not participate (as of 2005!) and she has since run up $600 in bills that the Medicare Advantage plan will not pay. I have had MANY conversations with the Medicare Advantage plan to resolve the issue. They insist he is on the plan but his claims officer states their claims have been repeatedly denied and she has worked tirelessly to try and help my mom navigate the system. Sadly, the doctor's office has advised us to look for a plan doctor to take care of her. This has caused my mother MUCH anguish over losing her trusted physician that has taken care of her for the past 20 years.
(Submitted May 8, 2008)
New York, NY
I'm a social worker in a senior subsidized-housing complex. An 88-year-old woman noticed problems with her insurance only when she received a large bill from a doctor. When she went to recertify for Medicaid, she was told she had to sign up for a Medicare Advantage plan, and did not really understand what this meant. They do not cover all of her doctors. We had a lot of difficulty getting her dis-enrolled. After several phone calls and faxing a letter, she was dis-enrolled, and was left without any prescription drug insurance for a month.
(Submitted January 29, 2008)
It has been 5 months since I became eligible for Medicare and signed up for my Advantage Plan. When I initially enrolled I specified that I wanted the Advantage Plan Premium deducted from my Social Security check. This has still not happened, despite repeated emails to both Medicare and the Advantage Plan. Advantage Plan staff have been in contact with me—telling me that they are "working on it", but no results.
(Submitted March 15, 2008)
My monthly premiums were deducted directly from Social Security, and yet my Medicare Advantage plan continued to send monthly invoices demanding payment. This continued for one full year, despite phone calls, and letters written to the Medicare Advantage plan. Medicare never sent the premiums in that were taken from the social security benefits, and finally the policy was cancelled due to nonpayment! Now, we are without any prescription coverage. And after the cancellation, Medicare refunded the money it had sat on for a year. This system is an absolute mess.
(Submitted April 25, 2008)
As an insurance agent dealing with Medicare Advantage plans I was given a presentation kit from WellCare with a page/slide on their MOOP [Maximum Out-of-Pocket Limit]. There is an asterisk next to the information on the MOOP referring to small print at the bottom of the page. The asterisk refers to a statement that says that Part B drugs are not included in the MOOP. I pointed this out to my colleagues and we all agreed we would not present this plan to clients.
When I attended a broker meeting last year for Universal Health Care (based in Florida) the company representative went through the summary of benefits for their plans. The SOB included a long list of services for which the MOOP applies, but I noticed there was no mention of radiation or chemotherapy. I asked the company rep why these expensive services were not on the list and he hemmed and hawed and then admitted that those services are not included. I turned to my colleagues and said out loud that I would not sell this plan.
Not all brokers/agents selling Medicare Advantage plans are sleazy, but I'm not so sure about the insurance companies. I just don't understand how Medicare allows the insurance companies to offer plans that leave enrollees exposed to 20% of the cost of radiation and chemotherapy—even if they have a MOOP in their plans. Nobody expects to be diagnosed with cancer, but when they do they are probably very surprised to find their Medicare Advantage plan will cost them thousands of dollars.
(Submitted August 7, 2008)
I signed up for Medicare Advantage at presentation in which the person spoke about 10 minutes and then had an emergency and had to leave. I did question the fact that the hospital that most of the doctors in the area used was not on the plan. I was told it was in the process of being signed up as we spoke. There were other lies about long term care and other health care providers. They also lied about the states and the counties in Florida that had Medicare Advantage at that time. So people signed up because of those lies. When I called the plan that administered the program, all I got was ignored, put on hold, and told other things. The written material was totally different from what we were told at the presentation. I told Medicare about it but, I believe I mistook them for someone who cares. I was ignored.
(Submitted January 4, 2008)
I sell Medicare Advantage plans. I could not agree more that unscrupulous agents should be dealt with harshly. However, the vast majority of agents I have encountered here in MN do lookout for their client's best interest. Unfortunately there will always be a few bad apples that ruin the experience for others. Medicare Advantage plans are not for everyone, nor are Medicare Supplements. To make blanket statements that one is always better than the other is irresponsible.
(Submitted April 8, 2008)
Brown Deer, WI
I have an 87 year old neighbor whose husband was put into a nursing home on April 2, 2007. In November this gentleman called my neighbor about health coverage, she told him all she needed was prescription coverage. He came and met with her without anyone else being present. What he signed her up for was an HMO program, not just coverage for prescriptions. I took her to the emergency room twice and pulled out that card and she grabbed it back saying it was for only prescriptions. I did not find out it was an HMO until she entered the hospital after her husband passed away on April 2, 2008. She entered the hospital with a urinary tract infection and extreme edema, and she upon release was to go to a rehab service. There was very few where she could go. She ended up in a facility and has been there four weeks and is worse off now than when she entered. This neighbor has no blood relatives my husband and I had been helping her out for a year for free, but for this to happen to someone I think is a disgrace. The people who lie about these policies should be sent to jail.
(Submitted May 14, 2008)
My husband signed up with a private insurance company as a secondary plan and Medicare as primary plan. In fact, we find that the private insurance company is primary. My husband has recently been diagnosed with colon cancer that has spread to his lymph nodes and into his liver. He has had surgery to remove half of his colon and lymph nodes. The doctor has referred him to a cancer center which we find is not in the network, in our area or else where. We have called to have it switched back to traditional Medicare which the center will accept but are told we cannot switch till November which is 6 months from now. We have explained to them that this cannot wait that long—that is half of the time he has been given and they have as much as told us they don't care if he dies. We feel we have been lied to and now my husband can have no treatment till November. This really isn't fair to him.
(Submitted May 11, 2008)
I bill Medicare claims for a Home Health Agency in Ohio. I am seeing MANY patients being hoodwinked into HMOs which prohibits them from access to regular Medicare coverage. In many cases I believe hey are enrolled under false pretense and then call the HMO to cancel. At this point the HMO drags their feet. This is a SERIOUS problem due to the fact that Medicare will not pay for ANY Home Care services as long as the HMO is listed as "primary" in the Medicare data bank. This does not happen until the HMO and patient submit dis-enrollment forms to Medicare. This can take some time and we find the HMOs most un-helpful and slow to update the info. The same applies for patients who enroll in Medicare D for prescription coverage. The HMO basically states they're a Prescription plan only and the patient loses their Medicare coverage.
(Submitted January 24, 2008)
Although I have read about difficulties with Medicare Advantage plans, I have had [here in Western Pennsylvania Pittsburgh area] a very good experience. Even with a switch in coverage between my first year and my second year I have had a good experience. My change from the first year was to access a larger network. My second year was a price hike. All were excellent policies. The hospital systems in our area are also excellent. I would consider myself high risk and have had many operations. I have yet to encounter any hindrances with coverage.
(Submitted April 10, 2008)