Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

[TygrBright]

17. Yet another reason to slog through the difficult process of getting regular Medicare.

They make getting "Advantage" plans incredibly easy, with sales people pestering you from six months to the day before you turn 65. They send snail mail, they call, they offer "free" consultations and "assistance" navigating your Medicare startup, they have glitzy sales materials and they'll walk you through every step of the process with wonderful helpfulness.

They have endless patience with your questions and will comb through databases and plan guides to determine exactly what particular thing is theoretically covered at what level under what circumstances and for how long. They'll compare pharmacopeias and coverage levels between Advantage plans for particular medications. They'll identify network providers for you and help you figure out whether your specialist is in-network for which plans for hours on end, if need be. They'll do whatever it takes to get you to sign up...

...until you tell them you don't want an Advantage plan, you just want plain old Medicare. Part A and Part B, plus a Part D for prescription drug coverage and maybe a Medigap supplemental plan.

They'll try to talk you out of it by pointing out all the "extras" that the Advantage plans offer, and how CHEAP they are and how EASILY everything can be set up and "customized" for you, and it's all combined into ONE plan, no need to manage Part B plus Part D plus a supplemental plan, just one plan, one payment, and easy-peasy extra stuff!

And if you say "Nope, just want Medicare, Part A and Part B, plus Part D for prescriptions and maybe a Medigap supplemental plan" they drop you like a hot potato and leave you to the mercy of government websites where the most help you get is FAQ pages and plan comparison pages, but no live human beings to actually answer your questions.

But it's still worth it. Stick with it. Use the government sites. Put up with the inconvenience of having to wait and spend another couple of months going back and forth to get your auto-pay set up for Part B. Once you are signed up for "real" Medicare, you're in charge of your care, there are no networks to traverse, no pre-authorizations to see a specialist, etc. Yes, sometimes it can be hard to find a provider with a caseload that will allow them to take another Medicare patient, but it's still WAY easier than navigating the thorny thickets of "Advantagedom" where AI monsters lurk everywhere.

helpfully,
Bright