What Medicare Beneficiaries and Deer Have in Common

Medicare open enrollment started Oct. 15 and ends Dec. 7. During that seven-and-a-half-week period, nearly 70 million seniors will sign up for or renew their Medicare health insurance coverage. They’ll either sign up for or renew their traditional Medicare coverage. Or they’ll either sign up for or renew their coverage through a Medicare Advantage (MA) plan run by a commercial health insurance company.

Another thing started in October and runs through December. That’s deer hunting season here in the Midwest where I live.

The choices Medicare beneficiaries and deer make during that three-month period will decide whether they live to see another open enrollment and deer-hunting season, respectively. For deer, it’s bounding around mating with other deer while trying not to get shot by a hunter or hit by a truck on a rural road. For Medicare beneficiaries, it’s picking between traditional Medicare or MA.

Medicare beneficiaries who pick an MA plan are a lot like deer who walk out into the open to lick a salt block or chase another deer across a highway without looking both ways. They’re risking their lives.

We already know that MA plans deny more claims than traditional Medicare. A study published in Health Affairs in June said MA plans initially deny 17% of provider claims for services to patients, or about twice the rate of traditional Medicare. Although MA plans reverse 57% of those initial denials, the denials can delay medically necessary care. The other 43% may end up denying medically necessary care.

Now we know that MA plans give their members fewer choices of providers thanks to a new analysis by the Kaiser Family Foundation (KFF).

KFF researchers dug into the provider directories of 4,200 MA plans with a total of 20.3 million enrollees from 2022. Here’s what they found:

• The typical MA plan enrollee had access to just 48% of the physicians available to traditional Medicare enrollees in the same market.
• That percentage dropped to 37% if the enrollee lived in a county with the highest percentage of people of color. It was 52% if the enrollee lived in a county with the lowest percentage of people of color.
• 14% of all physicians, or about one in seven, who accepted Medicare patients were not in any MA provider network at all.
• MA enrollees’ access to in-network medical specialists varied by specialty from a low of 61% for neurology to a high of 72% for ophthalmology.

“Most Medicare Advantage insurers use provider networks, along with other tools, such as prior authorization, to help manage utilization and lower costs,” the researchers said. “While these practices may contribute to insurers’ ability to offer extra benefits and reduce cost sharing, they may also impose barriers to care by restricting choice of physicians, hospitals, and other providers, introducing additional complexity in comparing and choosing plans, and creating potential for disruption in care arrangements for patients when their hospitals and physicians are no longer in-network.”

That’s research-speak for “you’re screwed,” especially if you get sick and need care right away but signed up for an MA plan because of the free health club membership.

Be smarter than a deer. Choose traditional Medicare.

To learn more about this topic, please read:

• “Where Spending More Means a Lot Less”
• “Sorry, Dr. Oz, the Bloom May Be Falling Off the Medicare Advantage Enrollment Rose”
• “Having a Good Laugh Over Medicare Advantage Letters”
• “Medicare Enrollment Trends in Four Charts”