US Rep. Mark Pocan on Medicare Versus Medicare Advantage

Frederica Freyberg:
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.

Mark Pocan:
Yeah, thanks for having me, Frederica.

Frederica Freyberg:
So what does the bill make clear the advantage plans are not what they say they are? How does it do that?

Mark Pocan:
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. 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, 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 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 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.

Frederica Freyberg:
How confusing is this for people looking to sign up?

Mark Pocan:
Intentionally, very confusing, right? You know, there’s the fact alone in the name is Medicare Advantage. And when I ask 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 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 then 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. 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 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.

Frederica Freyberg:
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?

Mark Pocan:
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 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.

Frederica Freyberg:
Now, traditional Medicare has so many parts to it at extra cost. What about a way to simplify and streamline that?

Mark Pocan:
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 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’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.

Frederica Freyberg:
All right. Congressman Mark Pocan, thanks very much.

Mark Pocan:
Sure. Thank you.