Medicare: Choice or Complexity

By Kathryn Ruscitto, Advisor

Tuesday, December 28, 2021

Recently we have seen select physician groups and hospitals saying no to certain Medicare plans. Reimbursement and access barriers for patients are often cited as the tipping points for providers exiting the networks.

For consumers, the complexity of choosing between a traditional Medicare plan and a Medicare Advantage Plan — combined with the rejection of certain plans by providers — further adds to the frustration felt by many patients.

Each year, in late fall, consumers are allowed to switch healthcare plans and are flooded with print and electronic marketing from insurers offering a variety of enticements and coverage options. New enrollees to Medicare must consider and sign up immediately or incur future penalties. Consumers switching between Original Medicare and an Advantage Plan must carefully consider what options they gain or lose. Additionally, people who travel and live in different places face another set of complexities.

There is no point at which patients and providers are connected in this conversation other than knowing whether the insurer being considered is in the network. Yet when choosing a policy, understanding how a physician functions within the plan or providers are paid is at the core of Medicare.

Kathryn Ruscitto, Advisor

Peering Up Ahead

Health2047, a Silicon Valley subsidiary of the AMA, aims to transform health care at the system level and sees continued reimbursement for telehealth as key to moving toward a value-based payment arrangement, which has been an important lesson learned over the past two years. The AMA ponders:

  • How much are payers willing to reimburse on a fee-for-service basis?
  • How much will the industry adopt value-based payment?

Costco recently launched a service for its members to help them better understand their Medicare choices — which is what brought me to this subject. For all its complexity, Medicare is a unique program that offers a great deal of choice, and as the population ages, will continue to be a primary payer for providers, who should understand the importance of the educated consumer. Perhaps the best contribution we all can make as employers and providers is helping to promote the services and programs that support consumers in making informed Medicare choices.

Kathryn Ruscitto, Advisor, can be reached at or at