The airwaves are flooded right now with ads from insurance brokers wanting to sell healthcare
plans because open enrollment for Medicare closes tomorrow, December 7.
Many of the ads are for plans through private insurers called Medicare Advantage.
56% of Wisconsinites are in Medicare Advantage plans which have grown in popularity because
of marketing and because many plans charge no premiums and offer benefits not offered
in traditional Medicare like dental, vision and hearing coverage for no additional cost.
It's easy to see why such plans are attractive to seniors but there's a bill in Congress
called the Save Medicare Act designed to make clear the Advantage plans are not what
they say they are.
Wisconsin District 2 Congressman Mark Pocan is sponsor of the bill and thanks very much
for being here.
Yeah, thanks for having me for a weekend.
So what does the bill make clear the Advantage plans are not what they say they are?
How does it do that?
It's largely educational at this point to make sure people understand that only Medicare
is Medicare.
Some very smart lobbyists a few decades ago got a bill that allowed these plans to be called
Medicare Advantage.
We don't allow you to call yourselves the United States Postal Service and pizza delivery.
We don't allow you to use any other federal program in a private company's product but
that's exactly what Medicare Advantage plans are as a private alternative to Medicare and
they are in some cases for people you know advantageous right they think that they can
get dental, vision or hearing which we should cover in Medicare and we don't and they can
get that through that plan or they can have a gym membership or something else that gives
them a little extra.
The problem is then there's the rest of the story.
You know a lot of the complaints that we get in my office are from people who have
Medicare Advantage programs who for example need health care suddenly they may not maybe
in their 60s when they signed up but by their 70s or 80s they do and you have to get prior
authorization.
Now you don't do that with Medicare but often it gets denied millions of cases a year do
and the odd part is when they get appealed over 85% of those are overturned.
So really it's just nickel and diming trying to save some money by the insurance companies
but it's delayed health access for people who have those plans.
Also if you are out of network you're traveling and there's no one in network you have to
pay out a pocket.
There's a lot of little fine print and we just want people to think about it and understand
only Medicare that you've paid for all your life is Medicare.
There are alternative programs sometimes they work well for people but often by the complaints
we get in the office they don't.
How confusing is this for people looking to sign up?
Intentionally very confusing right?
You know there's the fact that the loan in the name is Medicare Advantage and when I
ask people in town halls how many people are on Medicare how many are Medicare Advantage
people really don't know Medicare is in the name and they assume that's what they have
and yet it is a private insurance alternative and again for some people especially the younger
folks in their 60s it might be just fine but it's also hard once you're on that to
then suddenly go back to Medicare that's not easy either because it's made complicated
by again some pretty smart and I'm guessing wealthy lobbyists back when this law became
in place.
So again a lot of this is education we just want people to realize look very closely
look at your health situation do you travel then maybe those plans aren't as good.
Do you have a health concern or a future something genetically in your family that
maybe you don't want to wait for prior authorization or they make you do something other than what
your doctor and you have decided is your best care they might make you stage up to that
and lost time is lost health.
So I just want people to be well aware of what decision they're making it's in the
other thing you don't forget is Medicare doesn't advertise like these Medicare Advantage plans
so the only thing you see are private plans advertising and the federal government doesn't
operate like a business so we don't do the same thing and sometimes people don't get
a chance to really know what Medicare is and understand that difference.
Do these plans end up in the end being more expensive not withstanding some of the perks
like zero premiums and coverage for these other things.
It's generally more expensive in terms of your health right if you can't get the care
you need right away like you would with Medicare that could cost you if you have to wait three
to six months longer because they're making do other treatments first or they denied it
and you have to appeal it three to six months on some types of health care could literally
be if not your life at least you're the quality of your life and that's the complaints we
get all too often and then some people you know signed up in their 60s that was worked
out fine and now in their upper 70s they need health care it's really hard to go back to
Medicare and that's also part of the problem.
So there's a whole lot we're working on this a lot of us in Congress are working on
this right now trying to make it work better and my hope is that that will happen at some
point down the road but for now just having the right information allows you to make the
best choice for you and your loved ones.
No traditional Medicare has so many parts to it at extra cost.
What about a way to simplify and streamline that?
Trust me there's I would love to do some changes to Medicare.
I'd like to include dental vision here because clearly that is health care and there's some
other things that we'd like to do as well but you know Congress isn't exactly a fast
moving body there's a reason why sloths look at us and wonder why we're moving so slow
right.
That's just part of the reality.
So until we get to those things that's why these Medicare Advantage programs can look better
but again looks can be deceiving if you have to get prior authorization and if you get
turned down like millions of people do a year and you lost that ability to get quick
care is that really in your best interest if you're traveling to California and you're
out of network and now everything is completely out of pocket is that in your best interest
and there's so many other examples like this that we get calls into our office every single
week.
All right Congressman Mark Polcan thanks very much sure thank you.
Sir yeah no problem yeah this is one it's it's interesting unfortunately we were working
on something I think we got it in under the wire this summer they started working on it
and but we're trying to find an alternative because one of the parts that people like
is there's no donut hole you don't have to pay that extra insurance.
So we actually have a test pilot program they're doing to test just that because right now
what I didn't mention I probably should have is those Medicare Advantage programs actually
right now cost us more than Medicare and if you took that savings you could actually
then expand Medicare by just taking the amount that we're spending right now by spending
more on these other plans.
So there's a whole lot in this area that's worth talking about yeah yeah and front and
center right now too with what happened in Manhattan yeah yeah well and these are twice
as profitable as normal health insurance too Medicare Advantage.
So the industry loves these and like I said those lobbyists are probably very wealthy
who somehow Congress into calling a plan Medicare Advantage because we don't allow anywhere
else that I know of you can take a federal program name and put it into a private program
because it's unbelievably confusing it is it is all right well thank you thank you so
much nice to talk with you yeah take care thank you we'll see you later bye bye.