Medicare Advantage Overbills Taxpayers by $140 Billion a Year--Enough to Wipe Out Medicare Premiums
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Source: Common Dreams
A report published Wednesday estimates that privately run, government-funded Medicare Advantage plans are overcharging U.S. taxpayers by up to $140 billion per year, a sum that could be used to completely eliminate Medicare Part B premiums or fully fund Medicare's prescription drug program.
Physicians for a National Health Program (PNHP), an advocacy group that supports transitioning to a single-payer health insurance system, found that Medicare Advantage (MA) overbills the federal government by at least $88 billion per year, based on 2022 spending.
That lower-end estimate accounts for common MA practices such as upcoding, whereby diagnoses are piled onto a patient's risk assessment to make them appear sicker than they actually are, resulting in a larger payment from the federal government.
But when accounting for induced utilization—"the idea that people with supplemental coverage are likely to use more health care because their insurance pays for more of their cost"—PNHP estimated that the annual overbilling total could be as high as $140 billion.
"This is unconscionable, unsustainable, and in our current healthcare system, unremarkable," says the new report. "Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare, siphoning money from vulnerable patients while delaying and denying necessary and often lifesaving treatment."
Read more: https://www.commondreams.org/news/medicare-advantage-overcharging
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moose65
(3,454 posts)Here comes a bunch of comments from DUers on how "fantastic" their Medicare Advantage plans are in 3...2...1....
gab13by13
(32,324 posts)moose65
(3,454 posts)It is a stealth program that is eating up more and more Medicare enrollees. I think 50% of Medicare users are now enrolled in MA.
I can't stand all the commercials. Joe Namath, Jimmie Walker, and other washed-up celebrities hawking a product that they probably don't even use... ugh.
Stargazer99
(3,517 posts)Stage 2b cervical cancer.
Sure a local in-network doctor is qualified to treat it but they rarely see this condition (may have never actually treated anyone). With the choice of a Supplemental plan, went to a World class hospital (Mayo) and was treated by a team of doctors one of which sees later stage cervical cancer all of the time.
That is when you realize how important choice is. I was able to see the best.
10 years cancer free....
Stargazer99
(3,517 posts)that can afford exceptional care and don't have a thought for others-typically Republican
Joinfortmill
(21,169 posts)
Pinback
(13,600 posts)Unless I misinterpreted the post (or the poster conflated “Medicare Supplemental” and “Medicare Advantage”), this is a plan that provides additional coverage to patch the gaps in basic traditional Medicare.
The insurance industry relies on the public’s confusion to sell more Medicare Advantage plans. It’s important to know the difference before signing up.
https://www.forbes.com/health/medicare/medicare-advantage-vs-medicare-supplement/
https://www.newsweek.com/how-medicare-advantage-scams-seniors-opinion-1759368
INdemo
(7,024 posts)complain about is the current high premiums. However everthing is 0 copay after Medicare deductible is used.
I have known those that have MA and they lost their life savings to pay for cancer treatments that Medicare Advantage denied them.
DownriverDem
(7,014 posts)I have BCBS of Michigan Medicare Advantage PPO. Does regular Medicare give dental, hearing and vision benefits? Does it have an over the counter card benefits? So tell me why I'm being screwed.
moose65
(3,454 posts)Every time there's a post about Medicare Advantage, someone says the exact thing that you said. Tell me - do you pay a premium at all? If not, your dental, hearing, and vision care are being subsidized by everyone else.
That's a feature of Medicare Advantage. Some people get these fantastic benefits at the expense of others, and that's to make us fight with each other instead of the real enemy here - those for-profit insurance companies.
I believe that EVERYONE should get the benefits that you have. Don't you?
know is I was warned by one of my doctors don’t get on MA because they will not pay for some of my medications I take. Apparently she had found this to be true for other patients of hers.
DownriverDem
(7,014 posts)My medications are paid for except for Eliquis. A lot of the cost is paid for though. They are one of the drugs that the price will be negociated. My husband's are all paid for. I think it depends on where you live.
DownriverDem
(7,014 posts)No I don't pay a monthly premium. In Michigan it depends on what county you live in. Yes I do think everyone should get the benefits I get. So do you want me to give up what I have?
TBA
(893 posts)Probably not this group, but I interact with seniors on a regular basis and I am continually shocked at how little they know about SS and Medicare.
I've heard so many stories... bad decisions they cannot change, missing out on a higher benefit amount, just taking the local HMO's advantage plan because they don't even know there are options - "It's been ok so far".
Please make sure your elder loved ones are educated. It sounds cheesy but there are some really good YouTube content creators that break it all down.
Over the years, so many things have been added to Medicare that it's hard to understand any of it. And I guess that's the goal - confuse people so much that they don't even know what they're signing up for!
My parents are both in their 80s and have been on Medicare for almost 20 years. I never gave it a second thought, really, until this year when my dad broke his hip. In dealing with the hospitals and rehab, I found out that they, yes, are on a Medicare Advantage plan from United Health Care. I don't have any horror stories, but I was expecting one at any moment.
Rhiannon12866
(255,538 posts)The simple solution to the Medicare Advantage problem is to kill off the program. It was just a Trojan horse to privatize Medicare.
How Medicare Advantage Scams You & The Country - Thom Hartmann
Medicare Advantage is a disadvantage for people who think they are getting real Medicare from the Government. The only advantage is to the the people who want tp profit off you and exploit the entire country.
How Medicare Advantage Could Stop Medicare for All - Thom Hartmann
The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich (The Thom Hartmann Hidden History Series)
Thom tells stories about folks who thought they had healthcare, but found out the expensive way, that they were not covered. Why? Thom’s new book answers the questions.
ancianita
(43,307 posts)
Bluethroughu
(7,215 posts)Rick Scott is a Senator.
There is a problem here costing this country lives, money, and lost production which is money. More money than these companies are stealing!
Psychopaths stealing from our country, DOJ needs to get a handle on this.
Money and malpractice seems important to me.
ancianita
(43,307 posts)It has to be some division of the DOJ, imo. The evidence is there, and the 'billers' need to pay up, pay back, or be banned from taking government money.
Bluethroughu
(7,215 posts)If you worked for a company as a CEO and that company had government contracts, and the company overbilled three times, you are out and never allowed to work for a company that has government contracts.
ancianita
(43,307 posts)other executive agency?
Bluethroughu
(7,215 posts)And gives DOJ to enforce.
ancianita
(43,307 posts)There are as many cheats as there are DOJ employees, which means this problem can be monumentally stressful. And easier said here than done there.
https://en.wikipedia.org/wiki/United_States_Department_of_Justice
Law enforcement agencies
Several federal law enforcement agencies are administered by the Department of Justice:
United States Marshals Service (USMS) – The office of U.S. Marshal was established by the Judiciary Act of 1789. The U.S. Marshals Service was established as an agency in 1969, and it was elevated to full bureau status under the Justice Department in 1974.[35][36]
Federal Bureau of Investigation (FBI) – On July 26, 1908, a small investigative force was created within the Justice Department under Attorney General Charles Bonaparte. The following year, this force was officially named the Bureau of Investigation by Attorney General George W. Wickersham. In 1935, the bureau adopted its current name.[37]
Federal Bureau of Prisons (BOP) – the Three Prisons Act of 1891 created the federal prison system. Congress created the Federal Bureau of Prisons in 1930 by Pub. L. No. 71–218, 46 Stat. 325, signed into law by President Hoover on May 14, 1930.[38][39][40]
National Institute of Corrections (NIC) – Founded in 1974, the National Institute of Corrections is organized under the Federal Bureau of Prisons and has a legislatively mandated mission to assist state and local correctional institutions, and to manage the American Federal Prison System by keeping records of inmates.
Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) – Except for a brief period during Prohibition, ATF's predecessor bureaus were part of the Department of the Treasury for more than two hundred years.[41] ATF was first established by Department of Treasury Order No. 221, effective July 1, 1972; this order "transferred the functions, powers, and duties arising under laws relating to alcohol, tobacco, firearms, and explosives from the Internal Revenue Service to ATF.[42] In 2003, under the terms of the Homeland Security Act, ATF was split into two agencies – the new Bureau of Alcohol, Tobacco, Firearms and Explosives (ATF) was transferred to the Department of Justice, while the Alcohol and Tobacco Tax and Trade Bureau (TTB) was retained by the Department of the Treasury.[41]
Drug Enforcement Administration (DEA) – Created in 1973 as part of the war on drugs, the DEA was formed from various previously existing law enforcement agencies that were parts of either the Department of Justice, Department of the Treasury or the Food and Drug Administration. The DEA enforces the Controlled Substances Act and also interdicts foreign drug trafficking.
Office of the Inspector General (OIG) – The Office of Inspector General performs basic internal auditing functions, and has the power to make arrests and prosecute members of the Department of Justice who are found to be in violation of laws regulating conduct of government officials.
Stargazer99
(3,517 posts)Joinfortmill
(21,169 posts)so, I'm not just going in for a cold. My costs are always near to zero. My out of pocket costs for the stenting was $365.00, the cost for one night in the hospital. My doctor was one of the best in the country. Just saying, people. There are good Advantage plans out there. Choose a national option like Aetna or Humana.
Now what they are billing Medicare is another story and something I know nothing about.
Oppaloopa
(956 posts)90.000 for a breast lump removal relased the same day. They paid medicare 16,000 dollars my share was 2,500
Joinfortmill
(21,169 posts)If memory serves, what they billed was much higher than what they received. My understanding is that they can 'write-off' the difference. But that is the extent of my knowledge.
moose65
(3,454 posts)As far as I know, MA plans are not fee-for-service, like traditional Medicare is. With MA plans, the insurance companies get a set amount per patient every year, regardless of how healthy or unhealthy that patient is. That is where the overpayments happen.
It's been a known fact for years. In the debate over Obamacare, remember when Romney and the Republicans claimed that the Affordable Care Act cut $700 billion from Medicare? That was a scare tactic - those "cuts" were actually on Medicare Advantage plans, which were being overpaid even back then.
Joinfortmill
(21,169 posts)But I've had a MA plan for 10 years. Folks do sometimes pay premiums and co-pays depending on the plans. I posted a Medicare brochure from Medicare.gov as an fyi.
moonshinegnomie
(4,022 posts)5x the amount of the overage. a second time 10x. a third time they are fined 25x the amount of the overage,removed from the program and the entire top executive team as well as the corporate board of directors are permanently banned from the nusiness as well as serving as execuctive of any publicly traded company.
ancianita
(43,307 posts)Stargazer99
(3,517 posts)cactusfractal
(578 posts)Insurance executives, I mean.
Pearls get clutched when I say what needs to be done to these thieves, but that doesn't mean it needs to be done any less.
🪑
Both the ceos and members of congress should be harassed whenever they appear in public, for stopping us from getting universal healthcare.
Lonestarblue
(13,480 posts)Our for-profit healthcare system is contributing to shorter life spans, high maternal death rates, and substandard care in many cases. Yes, many people who are relatively healthy and rarely travel outside their communities are satisfied with Advantage plans, but those plans are designed to reward insurance companies by provided the lowest service possible.
Past studies have reported that universal healthcare would be too costly for the US. I don’t see how removing some of the profit raked in by insurers would add to costs. Administrative costs could certainly be reduced for both state and federal governments, which now administer several different programs. And no one should assume that people would not pay premiums. Employer-sponsored health plans require premiums and copays. A basic plan could be provided for everyone, with anyone wanting extra coverage buying a supplemental policy, just as I have with original Medicare.
It is the greed of the very wealthy and big corporations that fund Republican politics that keeps us from providing better healthcare for all citizens.
Scottie Mom
(5,838 posts)canuckledragger
(1,992 posts)Yes, Canadians won't lose their homes going in for an appendix operation...hospital stays and operations are covered by our universal health plan...but drugs are not.
Being a diabetic I'm tied to my employers' health care plan for drugs, as what I'm on would be unaffordable otherwise.
dlk
(13,247 posts)Election periods, COBRA not creditable coverage, although the same employer coverage is creditable, guaranteed issue period limitations, lifetime Part D penalties… Unless the rules are simplified, we need to do a much netter job educating seniors about Medicare.
Insurance companies are businesses that exist to make a profit, first and foremost, with their CEO’s being paid millions of dollars for essentially paper-pushing. It’s a given there would be massive corruption when billions of dollars are at stake. It’s a feature, not a flaw of the system.
Some things shouldn’t be for-profit, healthcare, especially.
Old Crank
(7,078 posts)want to do to shoplifters. Shouldn't we be taking care of the CEOs of these companies?
You want to see howls from the Republicans?
Bluethroughu
(7,215 posts)Ask Rick, the prick, Scott.
bucolic_frolic
(55,142 posts)No different than vehicle inspections where everything fails.
bucolic_frolic
(55,142 posts)Your money ... gone ... UP the corporate ladder, to the wealthy CEO and shareholders. Presto!
AllyCat
(18,842 posts)to make you sick”.
Bluethroughu
(7,215 posts)
area51
(12,691 posts)and uneducated people not pressuring their reps/senators.
Bluethroughu
(7,215 posts)
Stargazer99
(3,517 posts)Bluethroughu
(7,215 posts)Since the early 2000s. I'm sure it correlates to Bush's Medicare bill.
Farmer-Rick
(12,667 posts)They take 1.45%, double that if you dare to be self employed, out of your wages to pay for your Medicare. Then they take another $2,000 a year, when you can no longer work and every cent counts.
I have health insurance that covers everything but I still have to pay for Medicare. I have never used Medicare in the last 2 years and hope never to. Yet I get to pay premiums to them out of my Social Security. Then Advantage comes along and steals all the money they squeeze out of us.
A wealth extraction system designed to be corrupt and to pass on wealth to the filthy-rich. Thank your local oligarch.
Stargazer99
(3,517 posts)Farmer-Rick
(12,667 posts)You paid all your life. Now, you have to pay premiums? They started this premium payment nonsense in President W's little bombshell the 2003 Medicare Modernization Act, designed to help financially stabilize the program on the backs of the middle class. It use to be only the very rich paid a very small monthly premium. Now everyone pays but mostly the middle class pays.
"2007: Medicare beneficiaries with higher incomes must start paying higher premiums for Part B, called the Income-Related Monthly Adjustment Amount, which was established by the 2003 Medicare Modernization Act " https://www.aarp.org/health/medicare-insurance/info-2023/history-of-medicare.html
I pay and I am far from rich. I make below the average income in the US. So clearly the premiums are not based solely on high incomes anymore.
You shouldn't have to pay either. The rich should pay it for the privilege of extracting our national wealth.
MichMan
(17,151 posts)Chart in the link below
https://www.thebalancemoney.com/current-and-historical-medicare-part-b-premiums-2388483
Farmer-Rick
(12,667 posts)But in 1970, the middle class paid about 0.045 of their income for premiums to Medicare.
Today, the middle class (using $45,000) pays about 0.36 of their income for premiums to Medicare. About a 14% increase.
While today the rich making about $500,000 in income pays only 0.08 of their income for premiums to Medicare. About 78% less as a ratio of their income than a middle class person.
And that's not even including the taxes the middle class pay into it that the filthy-rich manage to avoid.
So, yeah the Medicare premium is just another burden on the ever shrinking middle class.
moose65
(3,454 posts)Another common myth. People don't understand how Medicare funding works, just like they don't understand how Social Security works.
The 1.45% that was taken out of your checks while you were working was not to pay for YOUR healthcare. That money was used to pay for Medicare services for the people who were on Medicare at that time. And now that you're retired, the 1.45% that current workers pay is used to pay for YOUR healthcare, whenever you need it. There isn't some account deep in a vault in DC that has your name on it and the money you paid in deposited there. You're not getting your own money back in retirement.
It's insurance. When you pay ANY kind of insurance premium, the money you pay isn't used just to pay claims that you might have - it's used to pay claims for anyone in that insurance pool. It's called sharing the risk! I have paid homeowner's insurance premiums for 20 years now, and have never filed a claim. All the money I've paid in premiums isn't sitting somewhere just waiting for me to use it. And if I never use it, I won't get my money back, either.
Farmer-Rick
(12,667 posts)It's not like Social Security. But most people think of it as paying it forward for themselves. And you have no choice but to pay in.
I didn't want to go into such exacting detail for such a minor point.
moose65
(3,454 posts)It's insurance, too. You don't get your own money back in retirement.
The money you paid into Social Security was used to pay benefits to retired people at that time.
AllyCat
(18,842 posts)How droll.
Stargazer99
(3,517 posts)AllyCat
(18,842 posts)Astonishing how many people think this is because of “government regulation” when I talk to them about this. Poor people. Unhealthy lifestyles. Waiting lines.
sarcasmo
(23,968 posts)
mackdaddy
(1,976 posts)I have straight Medicare +G +D and still need dental. And it costs me several hundred per month.
Obviously I am on a list of people on this and get call after call asking me about my insurance and I qualify for 'new' no premium Medicare Advantage plans. They never tell you about the downside if you ever actually have to use it.
I would say over half the calls end up being robocall dead air though where you answer and just nothing, all with spoofed local area code numbers of course. When they do come on they can barely speak english.
That is who I want to trust my health information to. NOT.
MichMan
(17,151 posts)How is that categorized as overbilling?
rlegro
(342 posts)Medicare Advantage is neither Medicare nor advantageous, in the long run. At some point, if most Medicare-eligible citizens choose Advantage plans, Medicare will be bankrupted. Then, as the right-wing plotters expected all along, the private health insurers will simply keep rolling along, only jacking up rates because they no longer get Medicare subsidies or -- more important -- they are not limited by Medicare pricing and policy feature rules. It's a long con. Just like so-called private school voucher programs that suck money out of already ailing public schools to pay high tuition for students opting into private classrooms. It is unsustainable, but the mid-term result will be that public schools fail at a higher rate, "proving" that government is bad and public stuff should all be privatized. This is so obvious it makes my eyes hurt. [Disclaimer: I'm on Medicare with a standard, non-Advantage supplement plan, and I get good care and lots of choices. I don't get dental -- big deal. I can, however, walk into any hospital or doctor's office or emergency office anywhere and not only get treatment but also am assured my insurance will apply. No in-house limits. And I can change my supplemental coverage annually. Medicare produces a handy assessment of pros and cons for each and even rates them in and estimates my annual out-of-pocket costs for each.
Worst of all, though, is that Advantage providers are free to spend millions convincing people they offer the best deals (costs which must be accounted for along with the fact those providers are for-profit) but they get to bamboozle people into thinking they are some kind of special government "Medicare" program. Nope, Advantage was wedged into Medicare by crafty Republicans and it's been eating away at the program ever since.
jaxexpat
(7,794 posts)This is because to get it passed through congress at all, the opposition required placation. The program is intentionally confusing, riddled with ambiguities and fraught with camouflaged language. It has not been repaired of these problems because to do so would expose it to total annihilation by those same interests who profit from its inherent and ultimately very profitable confusion. Every time it has been updated it has embedded additional traps which encourage abuse and misuse, compromising its effectiveness.
There are crooks afoot in this and they're in plain sight. Careers have been launched in its midst.
PortTack
(35,820 posts)Joinfortmill
(21,169 posts)
Martin68
(27,749 posts)each year to guide us through the process of evaluating our Medicare providers when it's time to consider if any changes are warranted to changing premiums and services. They all advise, in no uncertain terms, that Medicare Advantage is a ripoff and a con (although they don't use those exact words for liability reasons.)
LetMyPeopleVote
(179,869 posts)I get a ton of calls of people trying to get me to switch to an advantage plan. The fact that they can use so many telemarketers means that these plans are scams
JohnnyRingo
(20,870 posts)It costs little to nothing and covers regular check ups and prescriptions like vitamins.
But when things go south, and they eventually do, you find yourself needing "out of network" care or an RX that has an $8000 gap on coverage. For the blood pressure med Eliquis that costs $550 a month OTC. COPD inhalers cost $10 a day.
