Former Philadelphia Mayor Michael Nutter wants to make his second act helping the city's seniors access health care, but patient advocates and policy experts say he's sending the wrong message.
In an Oct. 2 opinion column in the Philadelphia Inquirer, Nutter wrote that "far too many seniors in Philadelphia are still struggling with paying their medical bills," and described "a solution for this dilemma" — Medicare Advantage.
"The problem," Nutter wrote, "is that not enough of our seniors sign up for Medicare Advantage."
Specifically, he touted the Medicare Advantage offerings of Clover Health, a start-up insurance company that is new to Philadelphia's Medicare marketplace for 2019 and that has contracted Nutter as a paid adviser.
With the annual Medicare open enrollment starting Oct. 15, marketing that targets seniors and their caregivers is in full swing. But patient advocates and policy experts took issue with the op-ed, which they said didn't adequately disclose Nutter's financial relationship with Clover and offered bad advice.
"Medicare Advantage may or may not be the right choice for seniors, including low-income seniors. It really depends on their individual needs and circumstances," said Tricia Neuman, a senior vice president at Kaiser Family Foundation.
Nutter said in an interview that he just wanted to tell people about the option.
"There's a ton of information out there. Everyone's personal circumstance and situation is different," Nutter said. "I think everyone should at least check out Medicare Advantage and if you are interested in Medicare Advantage, I think Clover Health offers a plan that could very well be good for you."
He learned about Clover Health from friends and said working with the company is a way to continue serving Philadelphia seniors. The idea to write a column came out of an early meeting he had with Clover leaders.
Some Medicare enrollment specialists, however, think his column failed to emphasize that choosing a Medicare plan is a complex decision that depends on your preferences, location, health, income, the specialists you need, even the prescription drugs you take.
"It's just so important for people to choose the right plan. It's a personal decision and there are a lot of factors to consider," said Diane Menio, executive director for the Center for Advocacy for the Rights & Interests of the Elderly (CARIE) in Philadelphia.
Medicare Advantage plans are sold by private insurance companies as an alternative to original Medicare. They typically include prescription drug coverage and may offer other benefits, such as vision and dental.
Many do not have a monthly premium, which can make them seem like a better deal — and for some seniors, they may be the best choice.
But Medicare Advantage plans manage their costs by giving customers access to a more limited network of doctors than traditional Medicare, which can be used anywhere in the country. Co-pays and other co-insurance costs also vary by plan.
"You can't assume just because it's zero premium that it's the best plan," said Darlene Sampson, director of the Pennsylvania Department of Aging's APPRISE Program, which offers free health insurance counseling to seniors.
"I would never tell someone one is better than the other because it's circumstantial," she said.
People with traditional Medicare may also buy a supplemental plan to cover out-of-pocket costs and a prescription drug plan. Those can be costly.
But many low-income seniors are eligible for federal subsidies that reduce co-pays for medications and, in some cases, cover the cost of premiums and deductibles entirely, which means that the more flexible option of traditional Medicare could actually be more affordable, Neuman said.
During the annual open enrollment period for Medicare, insurers pump lots of money into marketing to try to attract new members or get people to switch plans, so seniors need to read carefully before signing up.
A strong campaign is especially important for companies that are new to a competitive market, said Bill Melville, a principal analyst specializing in Medicare for Decision Resources Group, a health-care industry consulting firm.
"Getting mentioned in an op-ed in a paper — that's good publicity," Melville said.
Clover has about 30,000 members in New Jersey, Georgia, Texas and Bucks County. Its 2018 New Jersey plans were rated three out of five stars by the Centers for Medicare and Medicaid Services; the Bucks County plans weren't star-rated last year.
The company declined to discuss enrollment goals for Philadelphia.
It's not unethical or uncommon for former public officials to endorse health-care products, said Arthur Caplan, a New York University ethicist who previously was at the University of Pennsylvania. But Nutter should have specified in the column that he is being paid by Clover.
"He has to be a little cautious in how he moves on to selling health-care products to older people. They're likely to trust him as objective, when he may, in fact, be making money," Caplan said.
Nutter declined to disclose his financial terms with Clover.