Is a Medicare Advantage Plan Right for You?

Source: Kaiser Family Foundation

Medicare’s annual Open Enrollment period, October 15 - December 7, gives people 65 years of age and older and those with certain health conditions the opportunity to change their Medicare plan for the following year. There are other enrollment periods: Initial Enrollment (with or without Part B), Medicare Advantage Open Enrollment, Special Enrollment, and enrollment for special situations, such as being under 65 with a disability.

The annual Open Enrollment period allows Original Medicare recipients to change their Part D drug plan or switch from Original Medicare to a Medicare Advantage plan. Medicare Advantage recipients can change from one Medicare Advantage plan to another or switch to Original Medicare. 

Certain aspects of Original Medicare and Medicare Advantage plans are confusing. Here is a closer look at the commonalities and differences between them. 

Original Medicare and Medigap Plans

Original Medicare is managed by the Centers for Medicare and Medicaid Services (CMS) under the supervision of the Department of Health and Human Services. Funding comes from several sources: two dedicated trust funds held by the U.S. treasury; payroll taxes; premiums paid by Medicare recipients; and congressional allocations. It has three parts: Part A, which covers hospital care; Part B, which covers preventative and medically necessary care; and Part D, which covers prescription drugs.

Original Medicare Part A has no premium for most retirees and covers all hospital costs for the first 60 days of your hospital stay after you pay the $1,632 deductible. After that, you will be responsible for increasing costs after each subsequent 60-day period. These benefits and costs are not assessed annually but are based on benefit periods, which begin on the day of hospital admission and end after 60 consecutive days without inpatient hospital care. 

Part B pays 80% of the Medicare-approved amount for each outpatient service provided by healthcare providers. This Medicare-approved amount is typically much lower than the charges you see on your Medicare Summary Notice and is the amount that providers agree to accept as payment. After you pay your annual deductible of $240 for 2024, you will only be responsible for 20% of the Medicare-approved amount from those providers who agree to be paid directly by Medicare.

Part B has a monthly premium cost of $174.70 for recipients whose 2022 modified adjusted gross income was $103,000 or less (single) or $206,000 or less (married, filing jointly). 

Many Original Medicare beneficiaries choose to buy a Medigap plan that covers their annual deductible and the remaining 20% of the Medicare-approved amount. You can check out available plans in your area by setting up/logging into your online Medicare account or simply logging on to Medicare.gov. Monthly premiums vary by plan.

Part D drug coverage plan premiums also vary by plan and most I saw listed on the Medicare website had a deductible of $590. Premiums ran the gamut from $12.40 to $107.50 per month. Beginning in 2025, Part D out-of-pocket expenses will be capped at $2,000.

Original Medicare does not cover long-term care, dental, eye, and hearing care. A detailed list of non-covered items can be found here.

It is important to sign up for Original Medicare during the Initial Enrollment Period, which begins three months before your 65th birthday and ends three months after the month of your birthday. If you delay, you may be assessed substantial penalties.

Medicare Advantage Plans (Part C)

These plans are offered by private insurers that contract with CMS to administer the Medicare program for their enrollees. According to the Kaiser Family Foundation, nearly 33 million people, 54% of the Medicare-eligible population, are currently enrolled in Medicare Advantage plans, compared to 24 million in 2020.

Medicare Advantage plans must cover the same services as Original Medicare, though most offer additional benefits such as eye, hearing, and dental care.

The number of Medicare Advantage plans available is dizzying. The average Medicare recipient can choose from 43 plans offered by various private insurers. By entering  Shutesbury’s zip code on Medicare.gov, I was shown 21 Medicare Advantage plans available for Franklin County and only three Medigap plans. 

Nationally, huge health insurance companies dominate the Medicare Advantage market. In 2024, UnitedHealthcare boasted 29% enrollment of Medicare-eligible beneficiaries, followed by Humana (18%), Blue Cross Blue Shield affiliates (14%), and CVS Health (12%).  

There are several reasons for Medicare Advantage plans’ popularity and most hinge on the differences between Original Medicare and Medicare Advantage.

1. Many Medicare Advantage plans offer $0 monthly premium plans that include benefits not available with Original Medicare alone. Though enrollees still  pay the $176.70 Medicare Part B monthly premium, they avoid the added cost of a Medigap plan.

2. Some Medicare Advantage plans also include drug coverage for a $0 premium.

3. Enrollee out-of-pocket expenses are limited in Medicare Advantage plans, unlike Original Medicare.

4. Medicare Advantage plans have high visibility. Unlike Original Medicare, Medicare Advantage plans are heavily marketed to seniors because of their profitability to insurers. Insurance brokers make hefty commissions and referral fees from insurers to sell Medicare Advantage plans, which incentivizes them to push those plans to prospective enrollees.  

Source: Pinnacle Financial Services

How can insurers afford to offer so many extras? The answer is complex, but simply put, insurers receive substantial payments from CMS to cover these costs. Various factors, including benchmark bids, quality incentives, rebates, and risk adjustments, contribute to insurers' per-enrollee payments. In 2019, the total amount provided to Medicare Advantage plan providers was approximately $12,000 per enrollee per year.

The Dark Side of Medicare Advantage Plans

There are downsides to Medicare Advantage plans, for both beneficiaries and taxpayers in general. Here are a few of the biggies.

1. In-network provider lists are often limited. Obtaining care outside the plan’s network can be costly–more so than with Original Medicare, which allows you to see the 98% of providers that accept Original Medicare patients.

2. Prior authorizations are up. This technique is increasingly being used by Medicare Advantage insurers to limit care, particularly for pricey services. In 2019, 75% of Medicare Advantage enrollees were in plans requiring prior authorization; in 2024, it is 99%. Though few enrollees appealed their denial in 2022, over 83% of those appealed denials were subsequently overturned.

3. Medicare Advantage plans with $0 premiums may have high drug deductibles (if they offer prescription drug plans) and high deductibles (more than $10,000) for both in- and out-of-network care before the plan starts paying for your care. 

4. In most states (fortunately, not in Massachusetts) switching to Original Medicare from Medicare Advantage allows Medigap plans to deny coverage for preexisting conditions, which they cannot do during the Initial Enrollment period. 

5. The quality of Medicare Advantage plans, as reflected in CMS’ annual star ratings, has been decreasing since 2022, when the average rating was 4.37. For 2025, the average rating is 3.92.

Large Medicare Advantage insurers have faced congressional scrutiny over the past few years due to questionable business practices that cost taxpayers billions annually. A recent investigation by the Permanent Subcommittee on Investigations revealed that UnitedHealthcare, Humana, and CVS have misused the prior authorization process to deny post-acute care to vulnerable enrollees. The Office of the Inspector General also found that Medicare Advantage plans overcharged CMS by diagnosing enrollees as severely ill to receive higher payments, despite no additional testing or follow-up care being provided to those patients.

As in most things in life, due diligence is required when deciding on the Medicare plan that best fits your needs. Medicare.gov provides an excellent search tool that allows you to personalize your search and review relevant plans quickly and easily.

Racial Covenants Lurk in Local Property Deeds

Ames Homestead Deed 1958

Discriminatory language persists in real estate deeds across the United States and Massachusetts is no exception. Though most property owners are unaware of this issue, so-called “racial covenants” disallow the transference of properties to specific groups of persons. Such language is embedded in many Massachusetts deeds–including some right here in Shutesbury.

Lake Wyola Deeds with Racial Covenants

After hearing that some deeds for properties on Lake Wyola have racial covenants, I did some research on Masslandrecords.com. I found that in Shutesbury, covenants were inserted into some deeds to prevent ownership by “anyone other than persons who are of the Caucasian race”.

Searching randomly revealed that many properties on and around Lake Wyola were originally part of two large sets of land plans filed by two specific landowners. One is the “Harriet E. Ames Homestead Lots”, encompassing several lots on Shore Drive and North and South Laurel. The other plan, called “Great Pines, Shutesbury Mass.”, represents land owned by Paul H. Henley and includes much, if not all, of Lake Drive and Great Pines (open the plans in a new window or tab to enhance readability).

Ames Homestead Plan 1952

Great Pines Plan 1938

Deeds stemming from these plans included the restrictions, “The premises shall not be sold to, or occupied by, anyone other than persons who are of the Caucasian race”, or “That no part of the land hereby conveyed, or the improvements thereon, shall ever be sold, leased, traded, rented or donated to any other than the Caucasian race.” 

How Racial Covenants Became Institutionalized

Restrictive deed covenants prevent many people, including those of Irish, Italian, or Polish heritage, from owning, leasing, or occupying certain properties. The majority of these covenants also bar Black individuals from doing so. This practice can be traced back to the Great Migration (1910-1970) when African Americans moved north to seek opportunities and escape segregation. The resulting racial tensions led to the widespread use of racial covenants that excluded "non-Caucasians." These covenants were heavily used by developers and realtors and were even encouraged by the U.S. Federal Housing Administration to promote "neighborhood stability".

Several court cases and laws over the years have supported such covenants, at least privately. While 1917’s Buchanan v. Warley noted that zoning based on race was unconstitutional, it did not include private deed restrictions. The 1926 Corrigan v. Buckley decision affirmed the legality of such covenants, and the 1948 Shelley v. Kraemer case asserted that while the 14th Amendment had been violated, racial covenants could still be privately enforced even if state and federal entities could not do so.

The Fair Housing Act of 1968 prohibits housing discrimination based on race, color, national origin, religion, sex, familial status, or disability, thus making racial covenants illegal and unenforceable. Still, these covenants continue to exist and, in some predominantly white areas, appear to add value to the properties to which they are attached.

Follow the Money

The persistence of this ingrained form of racism may seem surprising until one realizes that racial covenants were a profitable venture for many white individuals and businesses. Developers and real estate agents played a key role in establishing and perpetuating this practice, promoting properties with racial covenants to white individuals as a means of safeguarding their investment. William Leavitt, the developer credited with popularizing the concept of suburbia after World War II, implemented racial covenants in all of his numerous Levittown developments. By the 1960s, Leavitt had amassed wealth of over $100 million.

 

For some white homeowners, racial covenants have effectively increased home values. Studies have revealed that homes with covenants in Minneapolis have values that are 20% higher than similar homes without covenants. A research project by the University of Minnesota’s Mapping Prejudice Project revealed nearly 560 deeds with racial covenants in the suburbs surrounding Boston. Notably, many of these communities are affluent and have populations that are approximately 90% white.

Renouncing Discriminatory Deed Covenants

Some property owners have used their outrage over racial covenants to push state governments to allow homeowners to void or redact such language in their deeds. Currently, 34 states and Washington, D.C. have laws addressing the remediation of racial covenants. Most allow property owners to simply void the language, while others have a procedure to remove the covenant entirely. 

Massachusetts law allows for voiding such covenants but does not remove them, which provides for repudiation without denying their historical existence. A bill that would expunge such language has stayed in committee for nearly two years.

The complaint process is free, but, like all state laws concerning racial covenants, it depends on the deed owner conducting their own research. For many property owners, being able to reject racially discriminatory deed covenants legally is valuable enough to justify the effort.

Note: This blog uses the AP style whereby Black is capitalized and white continues to be non-capitalized when referring to race.

Massachusetts POST Commission Criticized Over Database Transparency

Photo by Andrew Valdivia on Unsplash

Established by legislated police reform in the wake of George Floyd's murder in 2020, the Massachusetts Peace Officer Standards and Training (POST) Commission’s goal is “to improve policing and enhance public confidence in law enforcement by implementing a fair process for mandatory certification, discipline, and training for all peace officers in the Commonwealth.”

The POST Commission is responsible for creating and managing a statewide police officer certification process, including retraining in case of certification suspension or decertification. They also collaborate with the Municipal Police Training Committee to establish "use of force" regulations.

The most anticipated part of the new law was the creation of a database, accessible to the public, that would include complaints against police officers and any subsequent disciplinary action. 

Rollout Hiccups

The Commission’s database was launched online in August 2023, a year later than planned, providing the public with its initial access to police disciplinary records dating back to 1984. It contained a little over 3,400 records out of an original 36,000–a discrepancy described by the Commission’s Executive Director as weeding out those involving “minor matters”. This practice did not appease some law enforcement groups who felt some database entries dealt with inconsequential issues that caused embarrassment for the officers involved.

However, some news outlets noted that important information was missing–such as reports concerning misconduct by several police chiefs.

In a recent (paywalled) Boston Globe article, Commission officials acknowledged information gaps and strengthened regulations regarding disciplining departments and officers who withhold complaints from the Commission. Officials also noted that the database contained information that should not have been included while excluding relevant data.  

Shortcomings of the POST database

The Commission updated the database on August 19, 2024, adding approximately 600 new complaints. While generally lauded by the media and civil rights groups, concerns were raised over including “sustained” allegations only and the ambiguous language used to describe many offenses. Often, the database characterizes offenses as “other misconduct” without further commentary.

The Officer Disciplinary Records Database webpage lists the specific types of misconduct complaints that will be added to the database: 

• Reports alleging bias on the basis of race, ethnicity, sex, gender identity, sexual orientation, etc.

• Complaints regarding use of excessive, prohibited, or deadly force

• Actions that resulted in serious bodily injury or death including officer-involved shootings

• Truthfulness or professional integrity (misrepresenting or falsifying reports or evidence)

• Criminal misconduct (felonies, misdemeanors)

• Other misconduct (unprofessionalism, policy violations, conduct unbecoming, conformance to rules, etc.)

It also notes that certain information, such as data regarding police officers who resigned or retired in good standing, or “unfounded or non-sustained complaints” is not included in the database.

While it makes sense to list only infractions supported by evidence, the vagueness of the language used in the database limits its usefulness to the general public. 

A database search shows the phrase “Other Misconduct” dominates each page, showing up 4,986 times throughout the document’s 567 pages. “Allegation Details” are often scanty or non-existent, giving readers little or no understanding of the nature of the offenses. In some cases, the wording used in the description is difficult to understand; in others, the allegation details appear to be listed in the “Allegation Subtype” column.

Reporting Methods for POST Complaint Submission

There are two ways complaints are submitted to the Commission: through the state’s approximately 440 Law Enforcement Agencies (LEA),  or the public complaint form. According to the articles referenced in this post, both methods can potentially cause confusion or errors in the database.

LEA Reporting

In each case, the reliability of the information submitted is crucial. For LEAs, cases are processed before being submitted to the database, meaning the agency or department has already decided on the case. This means that descriptions of offenses can vary between cases and departments. It also means that the Commission cannot know if all the relevant information is being submitted for each case – or if entire cases are being omitted.

Other reasons submissions from LEAs can create database omissions are that cases have yet to be completely processed, or departments and agencies are still learning what is appropriate to submit and what is not. 

Complaints by the Public

Complaints by members of the public are submitted via the Police misconduct complaint form. While the LEA and public forms list the types of misconduct noted above, not all the descriptions on the public complaint form are fully explained (“other misconduct”) or are left out entirely (“misconduct”).

The form indicates that after a complaint is submitted, the Commission will notify the relevant agency or department and determine whether to conduct its own investigation or wait for the involved entity to do so. The Commission can then accept the entity’s decision or conduct its own investigation and take disciplinary action if necessary.

It's unclear how, or if, complaints submitted by the public are listed on the database, as the word "public" does not appear in any of the "Reporting Agency" columns. Since the Commission can simply accept the results of the complainee’s investigation, it's possible that these submissions do not proceed to the point where they would be included in the database.

Conclusions

Despite the deficiencies of the POST Commission database, it is a huge win for transparency and the right of residents and taxpayers to gauge whether public servants are performing their duties lawfully.

The database is new, and growing pains are to be expected. The Commission has shown a willingness to listen to concerns and address them, a process that should continue to improve its usefulness to all stakeholders.