>> The airwaves are flooded right now with ads from
insurance brokers wanting to sell health care plans, because
open enrollment for Medicare closes tomorrow, December 7th.
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 two Congressman Mark
Pocan is sponsor of the bill. And thanks very much for being
here. Fredricka.
clear? The advantage plans are 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, is 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. membership or something else
that gives them a little extra. The problem is then there's the
rest of the story, and 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 due. 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 of 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, just the fact that the loan in the
name is Medicare Advantage. And when I asked people in town
halls how many people are on Medicare, how many on Medicare
Advantage, people really don't know if Medicare is in the name,
and they assume that's what they have. And yet it is a private
insurance alternative. And agai, 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 as good. Do you have a health
concern or a future, something genetically in your family that
it 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 and the other thing
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 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,
notwithstanding 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 3 to 6 months longer because they're
making you do other treatments first or they denied it, and you
have to appeal it 3 to 6 months on, some types of health care
could literally be, if not your life, at least your 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, it 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.
>> Now, traditional Medicare has so many parts to it at 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 and hearing
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
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've lost
that ability to get quick care, is that really in your best
interest? If you're traveling in 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 >> All right. Congressman Mark