By Marie Hilliard, RN

When they reach retirement age, many Catholics are deluged with mail and TV commercials regarding Medicare Part C (Medicare Advantage) plans. Unfortunately, it can be difficult to find any guidance regarding the moral positions of the various private sector Medicare insurance companies. But we Catholics do, as we must, concern ourselves with these corporate moral positions. As we think about the information we need to choose a Medicare Advantage plan, many questions come to mind, including, Is it possible to choose a plan that doesn’t offer any immoral services? What moral principles can people use to help make this decision? There’s bad and good news. Unfortunately, most, if not all, commercially available plans offer immoral procedures, and your premiums will support these indirectly to some extent. However, this represents a very remote level of cooperation with the immoral activities, and Catholics can morally choose the Medicare Advantage plan that best meets their health needs.

It would be very difficult to opt out of morally problematic prescriptions and procedures within the Medicare Advantage program. If you are in one of the federal exchanges under the Affordable Care Act, which is a separate program, you should be able to opt out of abortion coverage in the plan. But I know of no Medicare Advantage plan itself that excludes the morally problematic coverage. Employers who provide insurance coverage through self-insured plans or by contracting with insurance companies and who have faith-based objections to contraception, abortion, and abortifacients are able to be exempt from providing them to employees. And non-publicly traded businesses that have a moral objection can do the same at the moment. But as a consumer, regardless of the plan, you could ask the plan coordinator if you can opt out as a retiree. It becomes difficult because some of the medications may have other, morally appropriate uses also. If they say no, you should express your objection, but it would be morally OK to enroll.

All that being said, the degree of cooperation in evil by being a recipient of a Medicare Advantage plan is what we call remote mediate material cooperation, which is morally justified in the absence of alternatives. Material cooperation indicates you might have provided some material means, like money, to what is morally illicit, but you don’t intend the evil acts to occur. Mediate means you have not caused anything to happen, because you haven’t contributed an essential circumstance for that to occur. And remote doesn’t pertain to physically near or far but connotes that the degree of assistance you’re providing is so remote that it’s tolerable from a moral perspective. Again, I know of no program—unless your employer who arranged the Advantage program has the ability to opt out—that doesn’t provide some morally illicit procedures and medications. Again, when enrolling you could ask the point of contact if you could opt out of contraceptives, abortifacients, and abortion. I believe it may be easier to opt out of abortion drugs and devices. If you cannot, you have not engaged in illicit immoral cooperation, because one needs to look at the proportionate benefit. There is an obligation to take care of the temple of the Holy Spirit that is your body, and the degree of cooperation in evil is very remote.

The premiums that you pay mix with the millions and millions of dollars that insurance companies receive. Its proportionate contribution to what is morally illicit is very little compared with the benefit that you receive from the insurance. It’s no different from walking into a pharmacy where your prescriptions are being filled when you know that same counter is filling prescriptions for morally illicit things. So be at peace in terms of receiving the insurance coverage that you need. Again, state your objection if you hear that you are unable to opt out.

Marie Hilliard, JCL, PhD, RN, is a senior fellow at The National Catholic Bioethics Center.

Ethically Choosing a Medicare Advantage Plan