Medicare Advantage sucks- ask Scott Adam's of Dilbert

[Henry203]

He can’t get treatment from Kaiser. My wife has cancer and we she has Medicare with a supplement. No problem ever getting treatment. Go ask Dr. Oz and ask him how great MA is .

[Klarkashton]

1. Tough ass Dilbert.

Free Market republicans get what they wanted.

[nilram]

4. He's a dick and it's a good illustration of MA also being crappy.

[RockRaven]

2. He was on the Tr*mp train very early, praising his political/persuasion acumen to the skies

back in 2015/2016. And he did it in the very cowardly "I'm not saying I agree with everything he says" kind of way.

So regardless of the reason (and fuck cancer) seeing him beg The Dotard to care about him and help him is eye-rollingly funny. You didn't ever really understand this guy, Scott. Like, not even a little.

[Bernardo de La Paz]

3. He is using his prominence to ask tRump for special treatment (medicine) bc he feels entitled. . . . . nt

[markodochartaigh]

5. "Medicare" Advantage plans

are health insurance plans. They are run by insurance companies. Insurance companies are run to make a profit. Even if parts of an insurance company or its plans are technically non-profit, they still must generate the revenue to pay for their administration and management and the costs to run them.

Insurance companies make their money not by paying for health care, but by denying and delaying health care, as well as from government support and charging a premium to cover the expenses and profits of the insurance company.


https://www.marketplace.org/story/2024/12/13/why-do-so-many-americans-get-their-health-care-claims-denied

https://pmc.ncbi.nlm.nih.gov/articles/PMC10391242/

[Silent Type]

8. Yet, over 50% of Medicare beneficiaries choose MA, primarily because of perceived premium cost savings, some

extra limited benefits maybe even cash, etc.

[leftstreet]

10. Also because it says "Medicare"

If it was called United Healthcare Advantage, or Blue Cross Advantage, would people think twice before choosing it?

[Silent Type]

12. Yeah, I know, the critics are so much smarter than those who choose MA. Maybe you ought to fight for improving

traditional Medicare, rather than trying to take away benefits from people who have decided they'd be better off on MA. Lots of Dems on that list.

[markodochartaigh]

15. Its ironic.

For some short term gains people are weakening real Medicare since "Medicare" advantage costs the government more than real Medicare.

Of course many seniors just financially don't have any choice.

[Silent Type]

7. Traditional Medicare has some coverage policies too. Hope Adams gets treatement needed, even though he's a trumpster.

Coverage Criteria: Medicare coverage usually requires that the treatment is considered medically reasonable and necessary for the individual patient.

This generally means patients must meet specific clinical criteria, which often include:
Having prostate-specific membrane antigen (PSMA)-positive metastatic castration-resistant prostate cancer (mCRPC).

Prior treatment with an androgen receptor pathway inhibitor (e.g., abiraterone, enzalutamide) and taxane-based chemotherapy.

Confirmation of PSMA-positive lesions via a PSMA PET/CT scan.
_____________________________________

From a treatment center:

WHO IS A CANDIDATE FOR PLUVICTO?
Men with metastatic, castrate-resistant prostate
carcinoma (mCRPC) are potential candidates for
Pluvicto™.

In other words, these are men whose prostate
cancer has progressed despite prior therapies such as
surgical resection, radiation therapy, androgen receptor
pathway inhibition, and/or taxane-based chemotherapy.

PET/CT imaging with PSMA is required to confirm that
the metastases will accumulate PSMA, and therefore
respond to Pluvicto™.

https://www.ausrad.com/wp-content/uploads/2022/07/ARA-PSMA-Pluvicto-PATIENT-Flyer-July-2022.pdf

[TexLaProgressive]

9. I agree that most Medicare Advantage plans are scams

However as a Verizon retiree our plan is excellent. I had Chemo, surgery and immunotherapy besides being on an insulin pump. My wife received excellent care after suffering a stroke, both hospital and rehab. None off this put us in the poorhouse.

This time of year there's a constant barrage of ads for MA plans that sound too good to be true.

[Ms. Toad]

11. The treatment was approved.

It is a scheduling issue. That is unrelated to Medicare Advantage, outside of Kaiser - which has a very limited network. But even with Kaiser you can get out of network care covered as in network.

This is speaking from personal experience with Kaiser.

[Henry203]

13. Scheduling issue

Is what you get with Kaiser. If he was in medicare with a supplement a major hospital would have him scheduled.

[Ms. Toad]

18. Correct - but it is still not the usual problem with Medicare Advantage.

The most common problem with MA plans is a refusal to approve a particular treatment at all. In any other MA plan, he could go to a different in-network hospital and get it scheduled.

Kaiser is an odd universe (even as a typical insurance plan, because it is an extremely closed network - so you are generally stuck with whenever they can schedule you in. You have no option to go to a different in-network hospital. (the schedule problem).

But even with Kaiser, I have had success in getting another hospital approved to be paid as if it was in network. But it requires persistence and an understanding of how to make the argument for the out of network coverage.

[Silent Type]

14. A Redditor did some research. The drug costs $122k for dose he needs, he's worth at least $20M

So, he could go anywhere and have it done, with or without his insurance.

[markodochartaigh]

16. From that it sounds like he is a genuine

Libertarian. He is against his tax dollars paying for other people but, although he can well afford it, he wants his needs to be taken care of out of the common pot.

Absolutely standard Libertarian behavior from what I have seen.

[DET]

17. End of the Road

People generally receive more than one dose of Pluvicto - up to six. It’s expensive and it’s not a cure. Enhanced life expectancy is generally measured in months, not years. And the treatment can be brutal. Pluvicto can be obtained overseas at a much lower cost. This is a last ditch effort by Adams to get a little more time. Personally, I don’t think it’s worth it, but we’re not at the end of the road yet.

Trump isn’t going to do a damn thing to help Adams unless he sees some personal benefit for himself. Adams would probably be better off getting treatment overseas, although that could be difficult if he’s in really bad shape.