'Our Seniors Deserve Better': Jayapal Demands End of All Medicare Privatization Schemes

[douglas9]

The Congressional Progressive Caucus chair's call follows a report further detailing how Medicare Advantage plans overbill the federal government to boost profits.

Rep. Pramila Jayapal on Monday called for an end to all Medicare privatization schemes following a Washington Post report spotlighting how Medicare Advantage plans are distorting patients' medical records to overbill the federal government and boost their profits.

"Medicare Advantage plans regularly deny needed care to seniors and frequently create fake illnesses to defraud the government," Jayapal (D-Wash.), the chair of the Congressional Progressive Caucus, wrote in a social media post.

"This is a clear-cut example of why we must end Medicare privatization programs."

"This is a clear-cut example of why we must end Medicare privatization programs," added Jayapal, the lead sponsor of the Medicare for All Act in the House. "Our seniors deserve better."

Privately run Medicare Advantage (MA) plans have long been notorious for the practice of upcoding, whereby large insurers and other MA firms make enrollees appear sicker than they actually are in order to reap larger payments from the federal government—even as they refuse to provide necessary care for tens of thousands of patients each year.

The Post on Sunday detailed the case of Kathy Ormsby, a former employee of the Palo Alto Medical Foundation who blew the whistle on the firm's efforts—alongside its parent affiliate Sutter Health—to pressure doctors into adding false diagnoses to patients' medical histories.

"The point of larding the medical records with outdated and irrelevant diagnoses such as cancer and stroke—often without the knowledge of the patients themselves—was not providing better care, according to a lawsuit from the Justice Department, which investigated a whistleblower complaint Ormsby filed," the Post noted. "It was to make patients appear sicker than they were."


https://www.commondreams.org/news/2022/06/07/our-seniors-deserve-better-jayapal-demands-end-all-medicare-privatization-schemes

[AllaN01Bear]

1. should have never happened , but raygun wanted it . so did the insurance cos .

[jimfields33]

32. Reagan destroyed so much

Hard to belief that his policies have been driving the United States for close to 50 years. He must have been some president to get so much done and then six administrations following just keep them and didn’t change any of it. Weird!

[Demsrule86]

2. NO. And we will lose votes because of this. I can't afford traditional Medicare. Jaypal should

stop it...it is a midterm and millions used Advantage plans. I looked at Medicare and the plans that folks have here are likely grandfathered in and not available to new Medicare recipients. Does she understand that many folks can not afford traditional Medicare...you want to do this...then make Medicare better first or please go away.

[jimfields33]

7. I'm 13 years from Medicare but I do know a lot of people on Medicare advantage

I never hear negatives from them. They get 25 dollars a month for groceries which has helped big time during these times. I’m not sure this should be part of the democratic platform at least not now.

[Demsrule86]

17. That is only if you are low income and have won of the older plans...and believe me

depending on the state (Ohio forget it) you may or may not receive help.

[xmas74]

37. I work in a hospital where I exclusively handle Medicaid.

I receive referrals every single day from social workers inquiring if I can get their Advantage patients qualified for secondary Medicaid. Why? Because Advantage never covers their bills-not by a long shot.

Heart attack, stroke, any reason to have a few days stay in the hospital and I'll be contacted because they know what will happen.

If you're low income and receive Medicare apply through your state for a QMB or SLMB. They both use funds to assist low income seniors in paying their monthly premium for Medicare.

[Demsrule86]

51. There is no $25.00s for groceries in any current plan.

[jimfields33]

59. Yes there is. I promise you there is

[karynnj]

9. You have a point, but there are things that need to be fixed

The overselling Medicare needs to stop. In addition, it might be good if Medicare defined packages for Medicare Advantage like they do for Medigap. All Medigap plans with the same letter provide exactly the same thing making selecting a plan easy.

I agree with another poster that the name should be changed. In addition, there should be some regulation on the constant misleading ads. We have all heard them. You might be missing some Medicare options. See if people in your zip code qualify. They then speak of money back to your SS, drugs, dental etc.

It sounds like all these are additions to the Medicare you have. Not said is that you lose anything. As Medicare pays a significant part of this, they should demand the right to be able to create an explanation of these options for an informed choice, There is nothing wrong with a cheaper discounted more comprehensive (but more limited in other ways) plan as long as it is easy to see the trade offs.

[Demsrule86]

18. You add up Medigap, Part B (which my Advantage plan gives me back $100.00)

and pharmaceuticals and deductibles...premiums, vision, and dental costs, Medicare is expensive and then there are the copays...and believe me there are copays and out-of-pocket...It is very expensive as I said before. Fix original Medicare and people will choose it but, don't throw seniors off of Medicare Advantage and then they get little to no health care because they can't afford the premiums or the rest of the stuff. We will lose the election if we continue down this road. Jayapal should stop it right now.

[Ms. Toad]

34. There are not copays and out-of-pocket (beyond a small deductible) unless you choose them.

The best (non-grandfathered plan) is capped at $233 total out-of-pocket expenses for the entire year. No copays. No coinsurance. ($233 is this year's deductible - it is set annually)

The next cheapest plan has $233 + $20 copays for doctor's visits. That's it. No copays for hospitalization, no copays for ambulances, no copays for diagnostic tests, no copays for emergency room or urgent care, etc.

The break even point for the two premiums in the reasonably priced plans was 5-8 office visits a year. You can choose to pay a flat $8 -$13 more a year in premiums (and have no office visit copays) OR you can gamble that the number of visits would be fewer - and save the $8 - $13/month

My father chose to gamble - and so far it has paid off for him. 25 years in, he is so far ahead that even if he goes to once-a-month visits for the rest of his life he's still ahead.

My spouse and I each have chronic conditions. She's already above the cut-off point. I'm at 7 visits this year, and am guaranteed to have 6 more. So we're both paying $8-$13/month over the plan my father is on. So far, that choice is saving us money (and would have saved us even more over the $0 premium Medicare Advantage plan which charges $5 for regular office visits - but $40 for specialists)

[Demsrule86]

53. That is simply untrue. The best plans start with about $400 per month...they can be way

higher too. I looked into it extensively...and there are deductibles and limitations for how much will be paid and out of pocket as well in many if not most plans.

[Ms. Toad]

54. The best plan currently available

Has a $233 deductible. That's it. No limitation on payments. No other copays or coinsurance. I am on that plan. It costs about $200 when you buy it from the most expensive insurance company. I pay less than $100. The plan is plan G, from AARP. If I wanted gym, dental, and vision, it would be slightly more than$100.

In a prior thread, I gave you information for all NE Ohio plans - all of the data (plan names, rates. Insurance companies) so you can fact check me. Instead, you continue to post misinformation, without a single example of any plan that costs as much as you claim is the minimum, or has a limitation on payments. (Medicare advantage plans, on contrast, do frequently have caps on payments )

[Demsrule86]

58. Medicare...now the plans I saw except or high deductible G were on average $200.

when you add back the Medicare part B which I think was around 170.00 I am up to 370. And I still need a pharmaceutical plan, dental, and vision. Please note that plan F is not available for me and others who don't already have it. When hubs needs a plan, we will pay double. We just can't afford it. And when I looked at Ohio...finally found a site that put numbers in...you could spend a little over $100 and up to $900 for plan G...which was the best plan...N was a bit cheaper but less coverage. I don't want to argue about this...suffice to say, I was shocked at how costly Medicare really was. And unless you could get help because of low income...if you have a moderate income, it is very expensive. They have 'starting at' premiums but from what I saw the lower premiums were the high deductible plan G.

[Ms. Toad]

60. Please provide even a single plan which is over $200.

when you purchase the plan during your initial or special enrollment period for Part B.

In another thread, I gave you all the data for every single plan for NE Ohio - none were over $200.

The only difference between Plan F and Plan G is that you pay $233 more on Plan G (7th row in your chart). Since Plan F typically costs about $300 more than Plan G, it would be silly to even consider purchasing Plan F. My spouse, who was eligible, rejected that option.

I don't want to argue with you either - but your information is seriously misleading, and I don't want people to give up the best bargain around for senior healthcare based on your assertions that the cheapest plans available are crap and are more than double the actual rates which are available.

My guess is that when you searched today, you entered your actual Medicare Part B start date coupled with a date at least 6 months after that (i.e. today's date), so you are being quoted prices outside of the initial enrollment period. Those prices are based on health (or a general assessment of average health at that age), not on the guaranteed issue rate. To find the actual price for a person just entering the Medicare system, the dates have to match (you have to be within 6 months of enrolling in Part B to get guaranteed issue prices).

Here is AARP's Plan G (grand total out-of-pocket for the entire year: $233). Since you are focused on gym, dental, vision, etc - this "wellness" plan includes that. As you can see the premium is $103/month. (When I was shopping near the end of 2021, it was just under $100. Until 2022, ALL AARP plans included wellness - and they were still the cheapest provider.)



I'm on the regular plan G (no wellness). Here is the quote for it.



The plans range from $40.38 (Plan K with wellness) to $137.04 (Plan F with wellness). Those prices assume entering at age 65 - premiums do go up by age so that when you are in your 80s the premium is 1.5 to 2 times your premium at age 65. AARP does not appear to offer a high deductible plan.

Here's the entire AARP rate structure as of late December. (I pulled this structure for every single plan available in NE Ohio - that is the basis of the information I gave you previously). The slightly higher prices are because they do not include a discount for automatic payment ($2-$4/month & households - 2-5%, IIRC). Note the comment about "standard rate" - what that means is that if you don't enroll during your guaranteed issue period and have certain health conditions, you don't get these rates. Also note, that aside from the grandfathered plans, NONE of them exceed $200 - even at the top of the chart. These plans all include "wellness" - the plan I'm on (without "wellness&quot didn't have a published chart at the time I did my research - it was added right at the end of December):



What you were likely finding is the late enrollment structure (you started in MA and tried to switch after 6 or more months):



The structure is designed to use a carrot (guaranteed issue + low premiums) to entice people to pay a little more in their generally healthier, younger years, to ensure costs are reasonable as they age and get sicker. And a stick (premiums which are 1.5 - 2.5 higher) to punish people who choose to skip coverage when they are healthy (or to join a $0 premium MA plan) and who try to jump into the system when their expenses get to high to manage.

Unfortunately - they really need to be much clearer and much more vocal about what people are giving up by not entering original Medicare right away. What is going on now is that people like you - who are investigating the late entry premiums mistakenly believe that everyone entering Medicare now pays that much. The information is confusing, hard to find, their staff doesn't know the answers, and aside from the Kaiser Family Foundation, I haven't found any clear statement about the consequences of starting with MA and trying to switch later. That information ought to be prominently featured on the Medicare website, written in language a 10th grader can understand.

My drug premium is $12.40/month, my spouse's is $8.10. If you have drug coverage in a Medicare Advantage plan, that coverage is subject to all the same rules mine is (donut hole, no cap on expenses) - AND - you have the disadvantage that you are stuck with whatever drug costs they choose to impose. You may be stuck choosing between crappy drug costs to get better medical coverage, or vice versa, because the two are joined at the hip.

We can shop separately every year for a drug plan which gives us the cheapest medication costs. My spouse and I are on different plans, because we need different drugs covered. I think my total costs are ~$500; my spouse's are ~$900 (including premiums). Both are significantly lower than our costs when our drug coverage was coupled with medical coverage.

So - yes, you may have cheaper premiums, but you have considerably more out-of-pocket expenses than I do. I have already saved money comparing the total (Premium + out-of-pocket expenses) compared to what I would have paid on the "free" Medicare Advantage plan, and since I will have no more medical expenses outside of prescription meds, that gap will only grow. There are years that won't be true - but looking at billed expenses for the past several years (as I did when I decided which was the better option), I will be ahead more years than not on original Medicare (comparing total costs to total costs). In the years when I would have been ahead on a MA plan, the costs are still close.

[Demsrule86]

25. Are you aware that some Medigap plans have no out of pocket limits? Did you

know that many don't cover any of the costs of part A or part B...and there are costs associated with going to the hospital...I looked into it extensively. And I simply can't afford original medicare with all the add-ons I have to pay for and deductibles and out-of-pocket costs.

[karynnj]

35. What does that have to do with regulating Medicare advantage?

I did not say that Medicare plus medigap is the solution for everyone. My mention of medigap was to defend Medicare defining basic MA plans or at least setting a standard for how plane are explained.

Most Medigap plans have out of pocket maxes. Others have maximum per dr visit, hospital etc. People choosing those may, just like you, be making that decision knowing they have the finances to self insure for that amount in return lower premiums. premiums.

Note that MA has things they don't cover. Just as in the medigap situation, you could hit the unusual situation.

[Demsrule86]

52. You don't really understand. People like me are buying advantage because we simply can't

afford original Medicare. The wrap premiums are high, you pay Part A and B
( I get $100 back from B)...with an advantage plan, you don't. You have to buy additional products like pharmaceutical coverage, vision, and dental. It simply cost too much; if I bought one of the shittier original plans, I would not be able to afford healthcare and would likely not go to the doctor. I would spend thousands for care I could not afford to access. I also get gym memberships...pretty much any gym in my area and money on a monthly basis for over-the-counter drugs and other medical necessities.

[karynnj]

56. Reread what I wrote

It was because I knew there were people chose MA because it was the better choice for them that I recommended changes to protect both the subscribers and Medicare itself. What I would recommend is two changes:

1) Regulate the MA ads to insure that people understand that they are opting out of traditional Medicare when they choose MA.
2) To protect Medicare, insure that companies writing MA policies do not over bill Medicare or refuse coverage for things that Medicare decides to be covered.

On DU alone, there have been threads that spoke of MA limiting coverage compared to what Medicare itself provides. However, MA is clearly a cheaper alternative to get medical care, vision, dental and drugs. As such, it is no surprise that for some extremely expensive services, it will provide less. If you are basically healthy and have pretty much just routine medical costs, a good MA plan makes sense if that is what is affordable.

In fact, if you want MA to continue to exist, you should want something similar to what I was suggesting.

[House of Roberts]

14. Thanks for helping to bankrupt real Medicare so it goes away for all.

The purpose of the Republican attack on Medicare is to end it AND Social Security PERMANENTLY!

The real goal is to end FICA. When they do, the employers will pocket the entire amount and give workers nothing for their old age. Their excuse will be that you were living on the take-home pay you had, so you don't need the rest. This is why they block raising minimum wage. When wages go up, FICA collection goes up.

Why do you think every time workers start to gain, they scream INFLATION!, and the Fed kills the economy to push workers back down again?

[Demsrule86]

19. I guess I should fall on my sword and not have health care so all of you can 'save' Medicare.

No, I think not and this is a fight that can't be won without fixing original Medicare. We will lose elections if we are seen as trying to do away with Advantage. I also get monthly money to buy over-the-counter medical stuff and a free gym membership to any gym around here. I pay $70.00 per month for this...lesser coverage under original Medicare would cost me about $400. I can't afford that. And with original Medicare, I am not including part B, pharmaceuticals, vision, dental (have to buy private). Oh, and the $70.00 per month under Advantage is what is left of part B which my plan pays for...I pay no premium. Sorry no.

[House of Roberts]

26. Sounds like you're on a Medicaid subsidy

is all you put out is $70 a month.

There's no way you'd owe $400 a month if you qualify for Medicaid.

[Demsrule86]

30. I have Medicare Advantage and they charge no premium, and pay $100.00 of my Part B and

all of Part A. I have no co-pays for my primary and $25.00 specialist. My max out of pocket is $1600 I think...around that anyway. But consider I would be paying $1200 in Part B payments if I had original medicare. I also, get money for over-the-counter pharmaceuticals, free gyms, vision and dental...I get one check-up a year and original Medicare doesn't cover that as I recall. I don't have any subsidies and will never get any in Ohio. I pay the 70 for Part B...and that is it.

[xmas74]

39. Depending on your income

You might qualify for a QMB for your premiums. I file them every day for clients.

I hope nothing major ever happens to you. Advantage plans don't pay all that well for major events. I know- it's part of my job to help those Advantage patients get a secondary when they're hospitalized. I file several every day.

The moment an Advantage pt is brought in our hospital contacts my department. They know from experience that it's not enough coverage.

[Demsrule86]

50. Actually, I have used my Advantage plan for heart issues that were caused by Covid...and I

had no problem. It was very expensive. And since I can't afford the premiums for original Medicare for a decent plan...I would be screwed if I got sick even if I had original Medicare. I would pay for one of the shittier original Medicare plans which would be what I could afford...And I would not get decent well care so what choice is there?

[xmas74]

57. Then you were lucky.

I receive far too many referrals every day from my hospital about qualifying a patient for Medicaid as a secondary because they have an Advantage plan. At this time I'd say nearly 40% of my referrals are secondary, which is an insane amount. It's time I could be spending on assisting pregnant women, children and others in qualifying for Medicaid as a primary. It takes twice as long and there's more paperwork involved in getting Medicaid as a secondary for Advantage patients under an ABD.

I hope you never need it but odds are you will.

[Ms. Toad]

31. Stop repeating false claims about original medicare

As I have repeatedly told you, the only difference between the grandfathered plans and the current plans: $233 in coverage. That's it. Period. The only thing it is impossible to cover in the new plans, which it was possible to cover in the old plans, is the annual deductible (currently $233).

I even went to the trouble of providing detailed data - and you have yet to provide contrary data, based on actual premium/plan research. Yet you continue to make false allegations about both the cost and coverage of original Medicare.

My parents (25 years ago) - and my spouse (this year) - had full access to the purportedly fantastically better grandfathered plans. Only one of them chose the grandfathered plan because the added premium cost of the grandfathered plans was more than the benefit. My mother is the sole one of the three who chose the grandfathered plan - because she didn't want to have to think about paying anything more than premiums. The remaining 2 did the research, compared overall costs for the year, and chose one of the plans still available to everyone.

I didn't have the option of a grandfathered plan, but wouldn't have chosen one had it been available. I have the ability to do basic arithmetic. I would not have chosen to pay ~$300 more in premiums to save $233 in out-of-pocket costs.

I am on original Medicare - as of 1/1 (so none of the purported fancy-schmancy grandfathered plans). My plan is as close to the grandfathered plan as I could purchase (leaving me with a maximum of $233 out-of-pocket expenses).

So far this year, I've had $33,551 in medical expenses this (and will have a few thousand more by Friday when I have my quarterly and annual scans for the two cancers in active follow-up). My total medical spend is $1823.60 (6 months of premiums + $233). My total medical spend for the year (regardless of how much more medical care I need) will be $3414.20 (12 months of preiums + $233).

The $0 premium Medicare Advantage plan from the same insurance company so far this year would have cost me $1020.60 in premiums, alone (Part B premium of $170.10 x 6 months). In addition, my out of pocket expenses so far this year would have been roughly $1445. That brings my total spend under the $0 premium Medicare Advantage plan to $2465. 60. (Already $642 MORE than the best currently available original Medicare supplement at the 6 month mark.) Each additional medical encounter for the remainder of the year under a Medicare Advantage plan will cost $$, until I spend $4,500 (the out-of-pocket max). Friday's visits will cost $290. That brings me to $3776.20 for the year in known expenses (Friday's visits + the remaining 6 months of Medicare Part B). That means even with zero medical expenses beyond Friday, by the end of the year I will have spent $362.1o MORE on my $0 premium Medicare Advantage plan than on my $95 premium origtinal Medicare plan.

And it gets worse.

My total medical spend on the comparable $0 premium Medicare Advantage plan will continue to grow with each medical encounter - as high as $6541.20 - $170.10/month + $4500 in max out-of-pocket expenses (That is potentially $3400 MORE for the $0 Medicare Advantage plan than for my ~$95 Medicare Supplement plan - based on actual expenses to date, and known expenses for the remainder of the year.)

I didn't choose the most expensive plan for the comparison - I chose a $0 premium plan offered by the insurer whose Medicare Supplement plan was the cheapest. So the cost/benefit should be equivalent.


The problem most people I have had specific conversations with about the "high" costs of original Medicare believe the costs are exorbitant because they chose the cheapest alternative at the time they enrolled in Medicare (Hey - insurance for "free," why not?)

They never seriously explored the comparison between the two until being diagnosed with a serious illness which resulted in out-of-pocket costs of up to $11,300 for one or more years. (Note: The plan I used for comparison does not pay for out-of-network care at all, and has a lower than permitted cap on out-of-pocket expenses). Once they realize they can't keep paying the full out-of-pocket max each year, they explore trying to get back to original Medicare (for which the maximum out-of-pocket on the two most popular plans is $233 and $233 + $20/doctor's visit). They are either denied coverage (or find their coverage limited to lower-quality plans which have higher out-of-pocket costs) OR are offered a plan at ~5 times the cost had they enrolled at the time they enrolled in Medicare.

The pricing is intentionally designed to make it more expensive to decide, when times get tough, to opt into original Medicare. The los cost for both Medicare and Medicare supplement plans is maintained by having everyone who is eligible opt into the system - whether they currently need lots of care or not. (Same theory for the mandatory enrollment in an ACA plan - unless everyone is enrolled, the price of care for those enrolled will force premiums out of the affordable range.) That opt-in date is when you are initially eligible. After that - it's just like trying to find insurance before the ACA with a pre-existing condition: It's not available OR they charge you an arm and a leg.

The problem is that the process (and consequences of not opting in) are so hidden that the plan is not an effective carrot. If you don't know you are giving up a once-in-a-lifetime opportunity when you opt out of original Medicare it shifts more people into the facially attractive $0 premium Medicare Advantage plans. Most people are still relatively healthy at age 65 and can't imagine ever needing enough medical care to hit the out-of-pocket maximum, the premiums for the plans are hard (sometimes impossible) to get without engaging an insurance agent (who makes her money by selling the plans - so has a motivation to sell a more expensive plan), and most people don't have a solid enough handle on their actual expenses to do the numbers (like I did above) to compare total out-of-pocket expenses for the year. So they are comparing premium to premium - not total cost to total cost.

Original Medicare doesn't need major fixes. It does need to be tweaked so it treats dental, vision, and hearing as the medical problems they are. And - applicable to both Medicare Advantage and original Medicare - drugs need to be treated as part of the basic plan (not an add-on, uncapped plan, with a donut hole).

In addition, they need to develop educational tools which are readily available, geared to no more than a 10th grade comprehension level, and delivered to everyone on their 64th birthday (in time for ample consideration of the once-in-a-lifetime decision on their 65th birthday). Further, becasue the information is hidden - and of such poor quality that three of us with JDs each originally misunderstood parts of the program (and one still has some serious misunderstandings which I hope don't come back to bite her in the butt) - there should be an amnesty program to allow anyone stuck with only expensive options for original Medicare to enroll at the initial enrollment price for their age (without taking health status into account).

[Celerity]

46. They would be replaced with far better options. But, none of this will happen anyway, the for profit

healthcare systemic controllers will fight it all to the death, and they have enough Congress members under their whip hand to make sure the grift and theft and misery and death keeps 'a churning along, like a.....

[Liberal In Texas]

3. I think at the very least the name "Medicare" shouldn't be allowed as a name for Advantage

plans. Too many people (some of them here) don't understand that this is private insurance with coverage and denial of coverage just like the private insurance that they've been unhappy with during their pre-65 years.

[Ms. Toad]

38. I'm more concerned about the advertising and heavy sell -

which does not inform those opting out of original Medicare of the life-long consequences of opting out.

Opting out of original medicare is permanently opting in to the same insurance scenario which existed before the ACA - no guaranteed issue for a Medicare Supplement plan, and premiums based on how sick/healthy you are.

For people without significant health problems at age 65, the $0 premium seems like a no-brainer. When I initially started reviewing my options when I was notified in late October that I was being involuntarily retired in April, I assumed I would choose a Medicare Advantage plan.

Then I did a deep dive and discovered the life-long consequences. My daughter and I have been trapped in the nightmare of pre-existing conditions governing access to healthcare. She is still trapped in the high max-out-of-pocket costs each and every single year. No way was I going to opt into that at 65 - when my health care costs can be expected to increase over time. And (contrary to some literature available) you can't just switch to original Medicare when you feel like it.

Opting into Medicare Advantage when you enroll in Medicare means:

1. Your option to enroll in original Medicare is extremely limited. After that initial enrollment period (at 65 or when work insurance ends if you work past 65):

A. No insurer is obligated to offer you a Medigap plan at all.
B. If the insurer chooses to offer you a Medigap plan, they can charge you a premium based on your actual health. (The numbers I've run into are around 5 times the cost of a premium if you enroll during the initial enrollment period).

2. You may be happy with Medicare Advantage now - BUT - the cap on out-of-pocket for the year can be as high as $11,300 (currently). My daughter's billed medical expenses each and every year are $200,000. That means she would be paying $11,300 each and every year in out-of-pocket expenses. People usually try to switch when they run into that kind of cost and are looking to lower their annual out-of-pocket costs by returning to original Medicare (with out-of-pocket caps as low as $233/year). It is only then that people discover the consequences of the choices they made years earlier: as unhappy as those costs might make them, the only solution at that point will be to accept premiums in the range of $500-$1000/month (if they can get someone to offer them a plan) OR to pick and choose among the Medicare Advantage plans to see if they can find one with a reasonable premium with a lower the annual out-of-pocket cap.

Think about the extremely heavy marketing for Medicare Advantage plans. Have you seen any similar marketing for Medigap or Medicare Supplement plans? That, alone, should tell you which one is more profitable for the insurance companies (and which is least likely to benefit their customers).

[Tree Lady]

40. it's all very confusing and they don't tell you enough when you are 64

to make a proper choice. I went for regular medicare because we have a supplement through my husbands old job.

But still I am finding out that some around here take Medicare Advantage and not regular medicare so some things aren't covered. I went to get a PAB test because I had some that were off in the past and medicare covered the test but not the doc appt for it and I had to pay $200. Which I though was crazy!! So changing doctors next time. I was told if I had advantage it would be covered.

So this could be why people are choosing it because more places take it.

[Ms. Toad]

43. Virtually every place takes Medicare.

As of 2020, fewer than 10,000 providers in the entire country (less than 1%) have opted out.

Medicare Advantage generally limits the places you can go to a specific network (and a specific state). You are far more likely to encounter doctors or other providers who aren't covered (but, if you're used to insurance, that's something you've likely been checking so it's not a surprise).

Did you find out if they have opted out of Medicare (they don't want to be bothered with it) - or merely opted out of assignment (you get to do the paperwork and you may have to pay a bit more, but it's mostly covered)?

If your doctor doesn't take assignment, you may have to pay the full bill up front and submit the claim to Medicare. Their "excess charge" cannot be more than 15% of what Medicare pays. (In other words - you might be out 15% of the Medicare costs). Some states prohibit excess charges (Ohio is one of those), and some Medigap plans cover the excess charges. So if I went to a non-assignment doctor in Texas (not entirely hypothetical, since the best place for sarcoma care is MD Anderson in Texas). Texas permits permits excess charges. I might have to pay the full amount, would have to submit paperwork myself and get reimbursed directly by Medicare and my supplement plan, but the excess charges would be paid by my supplement plan. Still better than Medicare Advantage - since my Ohio MA plan would not be likely to pay for a Texas provider.

If the doctor has just opted out of Medicare - you may be out of luck for the visit. (you can check here to confirm your doctor is an opt-out doctor: https://www.medicare.gov/forms-help-resources/find-providers-whove-opted-out-of-medicare)

The test might still be covered if the doctor sends it out to a separate lab, although anything performed in the office may not be.

You're right - it is very confusing. I'm a JD, and one of my jobs when I was a practicing attorney was to read through government regs and other documentation. I and two of my co-workers retired this spring - one of whom teaches administrative law; the other who teaches a code-based subject.

We all messed up as we muddled our way through enrolling in Medicare. I was first - and it took me some hefty arm-twisting (and him hiring a Medicare guide) before I got the one who teaches administrative law to understand that there are hefty penalties associated wtih making a late choice to go with original Medicare. (He initially believed the only consequence was 6 months during which pre-existing conditions might not be covered - he didn't realize he might not even be able to get insurance. He ultimately arrived at the same conclusion I had.) Still in discussion with the second one (who enrolled in a MA plan and has decided she'll just think about it after she retires).

Fortunately, my poor choice had no consequences. Not a single person in Medicare, Social Security, or the state SHIP program warned me about the potential gap in coverage until after my initial attempt to enroll in Part B was rejected and the person rejecting it explained that when your enrollment periods overlap (initial + special), the rules for initial - which impose up to 3 months delay in enrollment - govern (Special enrollment allows for immediate enrollment). After the problem was identified, they all told me I was out of luck - because the most common description of special enrollment imposes a 1-month delay. Fortunately my experience in reading regulations saved the day - while a 1-month delay is most common, it is not mandatory. It was just dumb luck, though. My special enrollment period ended 12/31, so I could use my initial enrollment period starting 1/1. If I'd been born 5 days later - in October - they would have been right and I would have been unable to get coverage for January (even though it was losing job-related insurance which triggered the special enrollment period).

If the three of us very smart people - each of whom have experience mucking about in either statutes or federal law and regulations - get things wrong - it is way too complex for the average person to make an informed choice.

But if people are chooing MA because they believe it is more universally accepted - they are misinformed (and another reason more and clearer education is needed). Medicare acceptance is near-universal. You just appear to have gotten a stinker).

[kentuck]

4. Medicare could do a better job defining what they offer in comparison.

When people have prescriptions that cost over $600 dollars, for example, they are susceptible to the ad jobs of the Medicare Advantage companies. They do not know that they can afford the Medicare plan by itself.

[Demsrule86]

8. I researched the plans extensively and Medicare is becoming more and more unaffordable.

I don't think those already on it get that. And we will now be accused of trying to get rid of Medicare...not a good look in a midterm.

[House of Roberts]

15. Medicare has to go up as the Advantage plans steal from it.

Medicare is cheaper to the system than Advantage plans.

[Demsrule86]

27. I don't think that is true. I looked online and I see a Thom Hartmann article and much written

those who think like Jayapal about this but not one bit of proof...and honestly, original Medicare doesn't work for many. You can't even do family premiums under Medicare which ups the costs so much...the whole plan needs an update IMHO.

[Ms. Toad]

33. Did you resesarch them BEFORE you enrolled, or only as an option to switch

from Medicare Advantage to original Medicare?

Stop implying that those of us who are promoting original Medicare "don't get it," are on grandfathered plans, etc. That's just nonsense. Most of just have a bit of money savvy, or experience with chronic illness, so what we get are the consequences of enrolling in a plan with a large out-of-pocket cap.

I enrolled in Medicare on January 1 of this year - so while I'm **now** already on it, I made my decision during the most recent annual open enrollment period for Medicare Advantage - not years ago when these supposedly much cheaper, much better plans were available. What is available now is essentially what was available 25 years ago when my parents enrolled in Medicare. I'm on a plan one step better than my father's and one step below my mother's (the best supplement plan ever available). My mother's plan is the only option not available to me. That plan was avaialble to my spouse. It would have saved her a grand total of $233 in out-of-pocket expenses each year. For that savings, she would have needed to spend about $300. It makes no sense to spend $300 to save $233. So that super-fantastic grandfathered plan is not even a loss, at all, for anyone handy enough with a calculator or mental arithmetic to multiply 12 by the ~$50 higher monthly premium.

I rejected Medicare Advantage plans because I am not willing to accept up to (currently) potentially $11,300 in out of pocket expenses each and every year until I die (the cost for declining original medicare during your once-in-a-lifetime enrollment period). A $0 premium plan is only affordable if you have the ability to pay the deductible, coinsurance, and copays for the actual care you use. All cost comparisons need to include both premiums (Part B and either MA premium OR the supplement premium) and your share of the actual medical expenses. As noted in an earlier post - at 6 months, because my out-of-pocket costs are capped at $233 for the entire year, I have already saved about $300 (total costs) over the $0 premium Medicare Advantage plan. That savings will only grow as I continue to be provided with no-additional-cost medical care (for which, under a MA plan, I would continue to accrue costs until I hit the out-of-pocket max of $4,500 on the plan I used for comparison purposes).

It IS unaffordable to try to switch AFTER enrolling in Medicare Advantage. That is by design, because Medicare supplement premiums would be unaffordable if you could just go without insurance until you really needed it. That design is poorly implemented - since even very bright, very educated people have a hard time deciphering the consequences of opting out of original Medicare.

[Demsrule86]

49. I don't have an 11,000 deductible first of all...it is just over $1200. And the savings on

My $100 repayment for Part B covers most of it. Also, if you switch plans during the fall, there is no issue with moving from advantage to Original I know because I looked at every plan after reading some of these sorts of posts. The bottom line is I can't afford Orginal. And hubs will soon be on Medicare...when that happens we would be looking at$1200 to $1400 every month for something decent...we can not do that. We don't have the money. I would appreciate it if Jayapal would turn her attention to fixing original Medicare rather than tossing millions off of the Advantage plans.

[Demsrule86]

20. I compared plans as I wanted original Medicare when I go on it, but it was too much money.

You can compare them...lots of info out there but the bottom line is original medicare is increasingly unaffordable for many seniors. We have a generation retiring now who were promised pensions and they were taken away.

[Ron Green]

6. One risk pool is a health care system. Multiple risk pools is an investment scheme.

We have enough investment schemes in this country; we need a health care system.

Private “Medicare” schemes are precisely what’s wrong with American medical coverage: Like car-based suburbs, they’re what we’ve been sold and therefore all we know.

[Indykatie]

10. I Love My Medicare Advantage Plan as Do Millions of Others

My premium under the MA arrangement is much less than I was paying for Medicare A and D with better coverage on my drugs and no deductible on any physician visits. I do pay a $25 or $35 co-pay though.

This call for elimination of privatized Medicare is representative of my problem with the Progressive caucus. They often take national positions that make it hard for Dems to win in districts that aren't deep blue. They all hail from Blue districts so their far left positions don't hurt them but make it difficult for Dems to win in purple districts. They don't flip any districts and don't seem to care sometimes about growing the broader Dem coalition.

[House of Roberts]

16. Folks always love getting more than traditional Medicare

and think they are beating the system.

I hope you love it when the Repukes kill it all and you have nothing.

[Demsrule86]

23. Well that will be your fault as well won't it...it seems you think keeping original Medicare

exactly as it was even though millions can't afford it and will lose coverage is OK. I promise you if that were to happen you would lose it too.

[House of Roberts]

28. I never advocated keeping Medicare as it is.

I don't even know what you think Medicare 'was', but if all were on regular Medicare, it would be lower cost for all.

It's the ripping off of Medicare funds by the profiteer private companies that will bankrupt the system, then it will go away.

[Demsrule86]

29. Well it seems to me it should be updated and improved first so that millions of people don't

suffer if they are tossed off of Medicare Advantage...some will die. As they can't afford a supplement or pharmaceutical...(and then they pay a penalty for life assuming they don't die.)

[kcr]

36. The problem is

The updating and improving will never happen while schemes like Advantage are eating away at it. Part of the improving and updating has to include ditching for-profit schemes like Advantage.

[Demsrule86]

21. I am progressive and I agree...why not call for improvements on original Medicare instead of

throwing millions of seniors to the wolves...really. It is just so aggravating and this is during a midterm...some in deep blue districts don't understand politics because they don't have to.

[Demsrule86]

24. I agree...the ones I have asked about their plans are grandfathered in on better rates than

anyone just starting out. I live Advantage too.

[Ms. Toad]

41. Nonsense.

Rates are not "grandfathered" in. Plans are, but there is no significant change in coverage available for those enrolling today - as opposed to 25 years ago. (The only grandfathered plan not available to new enrollees covers a grand total of $233 more/year)

Whether you timely enrolled and have been enrolled for years - or you are newly enrolling during an initial or special enrollment period, you get the guaranteed issue premium which matches your age. The only time you get a different premium is if you enroll late.

So a new timely enrollee at 94 (they were working and had work-based health insurance until age 94) would pay the exact same premium my father is paying after having been enrolled for 25 years.

[Demsrule86]

44. If you have a plan...like G for example...you can still have and are grandfathered in...

This was a good plan from what I can tell. However, it is not available for a new person or one that doesn't already have it. Original Medicare is too expensive. I can afford to spend more than $600.00 dollars in premiums, pharm, and Medicare B, and then, there are still deductibles and some wrap plans have no out-of-pocket max. Make it better so more people can afford it

[Demsrule86]

47. Keep in mind that the plans are very different now than they were when said 94 year old

man first collected because many if not most are now not available to any person who doesn't have the plan and thus is not grandfathered in. I looked at the money needed. I don't have probably close to $700.00 dollars laying around in order to have original Medicare, with a wrap, pay Part B (I have $100.00 refunded from part B), pay for a decent pharmaceutical plan, pay for vision, pay for dental and then there are deductibles and some out of pocket costs are unlimited. So fix Original Medicare because if Advantage is dumped and millions lose access to health care in the real world, people will die and we will lose elections. I have no premium for my Advantage...have a small out-of-pocket...get dental, vision, and gym memberships, and get $100.00 off of part B.

[Magoo48]

11. Yes, yes, fucking yes!

[Hotler]

12. End it now. nt

[Demsrule86]

22. You don't have the votes...thank God.

[CousinIT]

13. I agree. Medicare Advantage and ACO REACH should be ENDED. NOW.

They are sucking all the money out of Medicare for corprat profit by inflating diagnoses and also DENYING SENIORS CARE.

UNBELIEVABLE Biden supports this crap!

[Wounded Bear]

42. Medicare coverage should be expanded so that Advantage plans are not needed...nt

[Demsrule86]

45. So extend it. Until then leave Advantage alone as millions depend on it and if you look at

politics, advocating for it's destruction will cost us votes and probably elections.

[spanone]

48. ...K&R...

[brooklynite]

55. And.....?

Has he come up with the legislation to eliminate them?

[NCLefty]

61. If it stops all of those Medicare spam/commercials at enrollment time, I'm all for it.