Biden administration seeks to crack down on private Medicare health plans
Source: Washington Post
The Biden administration is proposing a fresh crackdown on private health plans that have grown to cover half of the people on Medicare, restricting marketing practices as part of an effort to help consumers in the federal insurance system for older and disabled Americans get the health services they need.
Under a draft rule issued Monday by the federal Centers for Medicare and Medicaid Services, Medicare Advantage plans would be required to work harder to encourage customers to make use of extra benefits available to them, rather than the companies merely invoking them as a selling point.
The proposal also would help Americans with Medicare drug benefits gain access to biosimilars, less expensive versions of biologic drugs made from living cells or other organisms.
Older Americans choosing Medicare coverage “should not be subject to practices playing fast and loose with marketing rules,” Health and Human Services Secretary Xavier Becerra said during a Monday press briefing to outline the proposal.
Read more: https://wapo.st/3FPjtxC
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former9thward
(33,424 posts)I have a Medicare Advantage plan and I am constantly getting emails, phone calls and text messages urging me to take advantage of various benefits that I am not using. Maybe it is an issue with some, I don't know.
vapor2
(4,506 posts)
Jack from Charlotte
(2,372 posts)2 separate issues. Insurance company fraud problems...... and my insurance deal and coverage. If there's fraud.... bust their friggin asses. I constantly see people mixing up these issues.
When I became eligible for Medicare I evaluated the Advantage Plans and the medigap plans.
I chose what's best for me.... in my opinion. I expect the govt to regulate companies they do business with. If they don't regulate and enforce properly that should be fixed by the govt.
If there were credible accusations against certain companies when I was deciding that would have influenced my company selection but I chose what's best for me and my family and am still convinced I chose correctly.
ancianita
(43,307 posts)And what its real costs to the economy (and national security) are in preventing Medicare For All.
LisaM
(29,633 posts)I still work and have work insurance, even though I am eligible for Medicare. I was told that everyone is automatically enrolled in Medicare at age 65. But, I don't think that's true. We had a presentation at work about all these different choices and it was a blur, mixing up letters and numbers (if you are in Group 1 you can do A or B, if you are in Group 2, you can choose B or C, etc.) Now it's enrollment time and I am completely lost as to what to do (starting with, why is there even an enrollment period, especially for Medicare? Why can't I sign up any time?)
I am not stupid, but this is one of those things that's blindingly obvious to some people and fraught with multiple hurdles for others. It's paralyzing me at work because tomorrow is that last day and I am lost. I tried to go into the portal, but it won't let me select "no changes". I have to go into each item separately and I can't tell if I am re-upping coverage or deleting it. And why is there a shopping cart? And does $0 mean I don't pay or that I just eliminated my coverage?
UGH
former9thward
(33,424 posts)Some work locations with work insurance may sign their employees up to Medicare when they get to 65 to reduce their health care costs. I have no idea if your work does that. But other than that you are not automatically signed up for Medicare when you get to 65. You have to apply for it.
doc03
(39,085 posts)advantage plans. Plan A.B C D F then you have to try and find a separate drug plan. I don't understand either one
I pay $125 a month for Medicare Advantage. Then I know other people that pay nothing and have vision, hearing and dental
I get none of those. I talked to salesperson for a supplement plan, all plans cost more than what I pay and I would have to buy a drug plan. I was so confused I just stuck with what I have.
MOMFUDSKI
(7,080 posts)have Advantage Plans because they can’t afford $250/mo for a supplement and $$$ taken off the top of their SS checks.
jimfields33
(19,382 posts)Obviously they are happy with them. We like choice on our party.
Kingofalldems
(40,276 posts)jimfields33
(19,382 posts)Kingofalldems
(40,276 posts)on private health plans that rip off senior citizens. If you like your plan--hurray for you. I support the President on protecting vulnerable seniors.
jimfields33
(19,382 posts)Why did you assume that without thinking it through?
Riverman100
(283 posts)My aetna medicare advantage plan is GREAT!
Postal Grunt
(255 posts)Mrs PG and I are currently enrolled in an Aetna Medicare Advantage program through my membership in the National Association of Letter Carriers. There are some positive features in the plan. However, should you need to go into a hospital or rehabilitation facility, be prepared to see denials of treatment. Be prepared to work closely with your doctor's office so that you can appeal the denial and the next denial because their first impulse and second impulse is to say no. It's particularly aggravating because their decisions are made by people who are miles away and have no particular knowledge of your health and medical history. It's an educational experience.
True Blue American
(18,579 posts)Also when you hit the so called doughnut hole on drugs after a hospital stay the prices are horrific.
The President is now going after the 10 worst. There will be more to come[. b]If we keep him in office!
lastlib
(28,258 posts)It ought to be illegal.
done sailed quite awhile ago.
lastlib
(28,258 posts)
RobinA
(10,478 posts)but I am not hopeful.
kacekwl
(9,144 posts)just can't afford Medicare supplements.
erronis
(23,869 posts)the insurance companies just take the word "Medicare" out of their advertising - or even better say "For Profit Medicare-like insurance"
This is all build on a scam by the insurance companies to compete with the government real Medicare program. Some may do well by some of their clients, but too many will make a profit off of healthcare issues when the clients are the most vulnerable.
I'm glad you and others have landed in some sweet spot with minimal payments. Hope you never have anything that ends up "out of network" or "denied".
MOMFUDSKI
(7,080 posts)happy with it. Know many people who have the same. Why would I switch?
SharonAnn
(14,172 posts)They're great if you're in good health and don't need much. It's when you really need them that many fall short.
MOMFUDSKI
(7,080 posts)The insurance company was billed $88K and I paid an $88 co-pay. I am happy. Sorry.
Ive had health issues for years. Aetna never let me down.....
Jack from Charlotte
(2,372 posts)in a smaller town. Needed ambulance and a Cath lab to insert a stent and then another stent. Needed a cardiologist to be in charge of everything post stents. Had some very serious side effects and some additional specialists needed to treat me. 4 days in a cardiac room at a hospital. I had no chance to shop around for hospitals, or specialists or anything to do with networks. Didn't need to as my Advantage insurance covered everything.
Here's the bottom line for the very good care plus all follow up care including 36 cardio Rehab sessions which cost my insurance company about $150 per session so another $5,400.... The total amount that UHC paid was right at $45,000. My portion of that? $2,500. That's about 5.5%. Medicare only pays 80% of medical care. So my portion of that, 20%, would have been $9,000 under straight medicare. So I got a pretty good deal, don't you think?
And if you pay $200 per month for your medigap insurance you paid per year as as my entire $45,000 claim.
Army Brat
(151 posts)If so, you are lucky. I believe our lowest offered is around 5k. We were able to get Medigap policies for around $75 a month, so that's where we are starting out. I know these premiums go up with age.
Obviously, people have had good experiences with MA. But others have ran into situations where they did not. I just wonder how many have been fortunate "so far".
sl8
(17,110 posts)As I understand it, there's a deductible for Part A (inpatient) treatments, but not a 20% copay.
Butterflylady
(4,584 posts)On one of the meds for my chemo due to breast cancer. Did better with just old Medicare. The OP is right, wait till you need a life sustaining medicine that is very expensive they'll say it isn't covered.
elocs
(24,486 posts)But I live in anticipation of when I need expensive treatments. Bottom line: I'm so poor that there's no way I could afford traditional Medicare and the Advantage extra things help put food on my table and eventually will pay for my power bill so it has been a blessing for me.
WyLoochka
(1,664 posts)or other similar top providers who don't accept Medicare Advantage.
elocs
(24,486 posts)WyLoochka
(1,664 posts)Per Becker's
"This year, eight major U.S. health systems have canceled their Medicare Advantage contracts, often citing low reimbursement rates and prior authorization hassles.
The following health systems are calling it quits with Medicare Advantage plans this year:
1. Two physician groups affiliated with San Diego-based Scripps Health filed termination notices with Medicare Advantage plans used by thousands of San Diego County patients, effective Jan. 1, 2024.
2. Mayo Clinic in Jacksonville, Fla., and Scottsdale, Ariz., warned patients that it plans to no longer accept most Medicare Advantage plans. If patients with those plans seek care, it will be considered out of network.
3. Corvallis, Ore.-based Samaritan Health Services ended its Medicare Advantage contracts with UnitedHealthcare, effective Jan. 9, 2024.
4. Cameron, Mo.-based Regional Medical Center terminated contracts with Cigna's Medicare Advantage plans in 2023 and plans to drop Aetna and Humana in 2024.
5. Stillwater (Okla.) Medical Center called it quits with in-network Medicare Advantage plans, blaming rising operating costs and a high prior authorization denial rate.
6. Starting in January, Brookings (S.D.) Health System will no longer be in network with Medicare Advantage plans.
7. Oregon-based St. Charles Health System is urging patients not to enroll in Medicare Advantage this year as it reevaluates its participation in contracts.
8. Louisville, Ky.-based Baptist Health Medical Group failed to agree with Humana's Medicare Advantage plans terms, alerting patients to seek other coverage options. "
https://www.beckersasc.com/asc-coding-billing-and-collections/8-health-systems-calling-it-quits-with-medicare-advantage-what-ascs-should-know.html#:~:text=Mayo%20Clinic%20in%20Jacksonville%2C%20Fla,be%20considered%20out%20of%20network.
Jack from Charlotte
(2,372 posts)and am very happy with mine, as well.
Attilatheblond
(8,876 posts)because the doctors they use are suddenly NOT 'in the network'. They are not getting younger and are a little less competent as each year goes by, IOW, less and less able to muddle thru the fine print to make sure they are not getting screwed. Several have faced all sorts of hurdles and problems to get necessary treatments as their health declined.
Not gonna fall for all the marketing myself. In fact, I wish there was a way to 'opt out' of getting the 5-10 mailings per week from all these companies. If they weren't making a LOT of money on selling these plans, they would not be marketing so hard in mail and on TV.
pazzyanne
(6,759 posts)I have been using a PPO Advantage plan since 2013 with a fatal auto-immune, chronic kidney disease, and type two diabetes without any problem. I cannot afford Traditional Medicare with a Medicare supplemental and Part D. My doctors and specialists are all in network. They may want to get help choosing their medical plan,
Attilatheblond
(8,876 posts)MichMan
(17,149 posts)Not only that, they allow you to enroll in them from there.
If the Federal government calls them Medicare, surely the insurers can as well.
dflprincess
(29,341 posts)For that bit of false advertising.
Silent Type
(12,412 posts)"The roots of Medicare Advantage (also known as Medicare Part C) go back to the 1970s. At that time, beneficiaries could receive managed care through private insurance companies. It was not until 1997 that the program, then called “Medicare Choice,” became official with the passing of the Balanced Budget Act."
https://www.retiremed.com/library/blog/brief-history-medicare-medicare-advantage#:~:text=The%20roots%20of%20Medicare%20Advantage,of%20the%20Balanced%20Budget%20Act.
"The M+C program in Part C of Medicare was renamed the Medicare Advantage (MA) Program under the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), which was enacted in December 2003."
https://www.cms.gov/medicare/enrollment-renewal/health-plans
vapor2
(4,506 posts)But MA is still privatized and is more like an HMO. CLEARLY our health care system is broken and needs to be fixed.
pazzyanne
(6,759 posts)Choose your company and plan carefully! Never opt for an Advantage HMO!
CousinIT
(12,533 posts)
nilram
(3,549 posts)I'm trying to read this slowly. To my eye, they're saying the advertisements for Advantage plans are overstating their benefits. I'm in favor of truth in advertising.
The Biden administration is proposing a fresh crackdown on private health plans that have grown to cover half of the people on Medicare, restricting marketing practices as part of an effort to help consumers in the federal insurance system for older and disabled Americans get the health services they need.
Under a draft rule issued Monday by the federal Centers for Medicare and Medicaid Services, Medicare Advantage plans would be required to work harder to encourage customers to make use of extra benefits available to them, rather than the companies merely invoking them as a selling point.
The proposal also would help Americans with Medicare drug benefits gain access to biosimilars, less expensive versions of biologic drugs made from living cells or other organisms.
Older Americans choosing Medicare coverage “should not be subject to practices playing fast and loose with marketing rules,” Health and Human Services Secretary Xavier Becerra said during a Monday press briefing to outline the proposal.
Voltaire2
(15,377 posts)Which in the case of a government healthcare system like medicare is ridiculous.
Of course the government has to regulate any private operation profiting from a public program. Medicare Advantage is a classic case of siphoning off public funds for private profit. Strictly regulating that program is essential. The incentive for all MA programs is, like all private health insurance, to provide the least service for the most money. How people don't understand this is beyond me.
Farmer-Rick
(12,663 posts)Are not taken automatically out of your Social Security, just your basic Medicare payments are.
I guess you could ask Social Security to take them out? I asked Social Security to take 10% out each month to pay for all the taxes. I didn't look that closely at the withholding form to see if it covers other stuff.
dflprincess
(29,341 posts)Doesn't necessarily mean you're happy with it.
Pressure needs to be brought to improve traditional Medicare so it covers more at a fairer price. The problem is, having AARP in bed with UnitedHealth Group won't help any efforts to change.
LiberalFighter
(53,544 posts)ariadne0614
(2,174 posts)Could it be that they are denying coverage to pay for TV commercials and CEO salaries?
Emile
(42,281 posts)brother's Advantage plan is doing to him.
ariadne0614
(2,174 posts)vapor2
(4,506 posts)erronis
(23,869 posts)A bit of it excerpted:
"Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American healthcare," says a new report from Physicians for a National Health Program.
Jake Johnson
Oct 04, 2023
40
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."
MichMan
(17,149 posts)Would they rather have people denied services ?
stopdiggin
(15,462 posts)sounds like a certain degree of hype and spin being used to massage a particular argument.
Let's see - "A health care system on solid financial ground - is one in which patients are actively encourage not to use that system." Super!
ArkansasDemocrat1
(3,213 posts)I called them Inhumana.
Rebl2
(17,738 posts)That is what my father in-law. He developed lung cancer at about 73 yo and the only thing they did was radiation. No chemo. They said he was in remission and I now question that because it came back a few years later and had spread. They tried chemo but it continued to spread. My mother in-law (who was younger when she developed it) who also had lung cancer had different insurance. Totally different experience. They did surgery to remove part of lung where cancer was, then followed up with chemo and radiation and survived for over 20 years. She passed 13 years ago, but not from cancer.
My feeling was if you are over 70, Humana, or as you say inhumana, and you get cancer they are less likely to give you the treatment you need. They don’t want to waste money on you if you are over 70 and have a serious medical condition.
Jack from Charlotte
(2,372 posts)Who is this "they" that you speak of? Weren't doctors treating your relative? Did doctors come to you and say, "we want to do this, whatever treatment.... but Humana said, no? Sorry."
Rebl2
(17,738 posts)that take their marching orders from higher ups in Humana. He just did not receive the same kind of treatment that my mother in-law received from her doctors. The insurance company she had allowed more treatment options than Humana did. They were nasty to my husband by saying they were going to throw his dad out on the street because they wanted the bed. He hadn’t been in the hospital just a couple of days. My husband told them to just give him time to make arrangements with hospice and find someone who could help get him back to his house. It was sad and maddening.
dflprincess
(29,341 posts)announced it will no longer accept Humana Advantage plans. Apparently too much hassle dealing with the company
Backseat Driver
(4,671 posts)iPhone and streaming...worked like a charm; saved money for now - bye-bye MA advertising/soliciting; car warranty scammers, you won a cruise" and election polls/solicitations (most just type STOP to end from that burner, at least) when settings are changed back to get a call-back, just don't answer those you don't recognize) and change the settings back immediately after your call-back. Contact list" only calls are put through and when you surf, use private browser pages "on-line" and a calendar-NOT reminder apps/calls. It's really quiet around here, LOL!
Emile
(42,281 posts)I said did I call you wanting information? Click
Rebl2
(17,738 posts)haven’t gotten near as many of these calls this year as in years past.
Skittles
(171,698 posts)the whole point of these "perks" is to get people away from original Medicare so they can GET RID OF MEDICARE
Lonestarblue
(13,474 posts)far more than original Medicate as insurers have learned how to fake diagnoses and expenses.
MOMFUDSKI
(7,080 posts)Medicare and offer what Advantage Plans do now!!! What is so hard?
Emile
(42,281 posts)My brother's Advantage plan is killing him.
My brother was in the hospital for two months with complications from his Leukemia. After everything failed, doctors concluded his thyroid was not allowing medications to improve his health. So they scheduled a total thyroidectomy, removal of the entire thyroid. Medicare Advantage denied this life saving surgery and a week later kicked him out of the hospital and put him in a nursing home. Two weeks in the nursing home and the nursing home is fighting with his Advantage plan because they want him out of there too.
MOMFUDSKI
(7,080 posts)regular Medicare for chronic conditions such as your brother. He may have to pay the standard cost of Medicare to get the proper care for himself.
Emile
(42,281 posts)Last edited Tue Nov 7, 2023, 09:31 AM - Edit history (1)
and it's his fault for falling for an Advantage plan. He was diagnosed with leukemia at age 71 and been on an Advantage plan for six years!
erronis
(23,869 posts)Care to divulge your ties to the industries?
MOMFUDSKI
(7,080 posts)with what I chose. We all have the option.
pazzyanne
(6,759 posts)Skittles
(171,698 posts)MA "offers" perks because THEY ARE STIFFING THE TAXPAYERS
*NOTHING IS FREE* and the whole point of MA is to ultimately GET RID OF MEDICARE
MOMFUDSKI
(7,080 posts)stiffing me.
delisen
(7,365 posts)I suppose you are being consistent with your beliefs.
If you care also about others and the long term potential for Medicare to survive you might consider looking at how the massive costs of Medicare Advantage are threatening the survival of Medicare while not improving health overall.
Elessar Zappa
(16,385 posts)‘I got mine so screw everyone else”. Very Republican attitude.
Skittles
(171,698 posts)yes INDEED
pazzyanne
(6,759 posts)lots of studying plans to find what's best for you.
area51
(12,690 posts)Our govt. does indeed have bills in the senate and house that will fix Medicare to cover things which traditional Medicare won't cover. But because too many in congress are on the take, they'll keep accepting bribe money from insurance cos. and won't vote the bills into law.
Farmer-Rick
(12,663 posts)But when I had to go on Medicare they denied my therapist because she didn't have the credentials required by Medicare. But all the therapists who had the required credentials, were booked up solid with huge waiting lists.
Turns out the legislation to allow Medicare to accept my therapist's credentials has been in a subcommittee for years. Broken Congress, broken federal programs.
MOMFUDSKI
(7,080 posts)To each his own opinion.
nevergiveup
(4,815 posts)and I have to end up going to private insurance I am going to scream so loud they will hear me in Moscow. 
reACTIONary
(7,162 posts)... it's your choice.
Emile
(42,281 posts)will be thrilled their private insurance Advantage plans replaced and destroyed the socialist Medicare.
RobinA
(10,478 posts)Medicare Advantage plans, so why would they want to destroy Medicare? I'm sure there are Congresspeople who don't get the math, but surely the insurance companies know where all that money is coming from.
Emile
(42,281 posts)I was born in 1958. Medicare took effect in 1966. My father was a physician. Medicare was dinner table conversation at my house starting when I was in elementary school.
I was born in 1951. My father was a WW2 combat veteran and General Motors union worker, mother died of cancer when she was 45. Healthcare was always a conversation at our house. My brother is dying of leukemia complications at age 76 from Medicare Advantage denial decisions.
pazzyanne
(6,759 posts)There's a big difference between MA companies and between HNO's and PPO's
Emile
(42,281 posts)Last edited Wed Nov 8, 2023, 08:22 PM - Edit history (1)
I'm not about to ask him or his wife if he is on a HNO or PPO. Whatever Advantage plan he is on it SUCKS!
Edited to tell you my wife says he is on a Humana PPO plan.
DownriverDem
(7,014 posts)costs me $0 per month & includes dental (husband just got a crown & it was covered) vision & hearing. There is Part D/prescriptions too. It comes with an Over the Counter card that is reloaded every quarter. It's BCBS of Michigan Medicare Advantage PPO.
SharonAnn
(14,172 posts)Discharge early from the hospital, no stay in rehab, go home and take care of yourself after surgery or other treatments.
Skittles
(171,698 posts)and the ultimate goal of these plans is to get rid of Medicare
TomSlick
(13,013 posts)When the bills get high, Advantage plans will deny coverage.
What is really needed is to scrap Medicare altogether to be replaced with national health care - like every other industrialized state. Of course, that will not happen anytime soon.
elocs
(24,486 posts)I've had an MRI, CT scans, an EMG and other test done as well, no problem.
Tell me, since I am very poor, how many years should I overpay with traditional Medicare in anticipation that I might get seriously injuries or I'll?
My obligation and common sense healthcare choices will never be done to please DU but to do what is best for myself.
TomSlick
(13,013 posts)My mother - who is not completely competent - was persuaded by that "nice young man that called" to switch to an Advantage plan - dumping a good Medicaid gap policy I had set up - without talking to me. Yes, it is an insurer whose name you would recognize.
They have denied doctor ordered hospital and rehab care because the plan's doctor decided it wasn't necessary. The plan doctor was confident that my father did not need hospitalization after a fall induced brain bleed. The hospital gave in and released him home - he was back in the hospital with heart issues two days later. When he was moved to rehab, the plan doctor opined that he would be better at home despite the fact that he could not transfer unassisted from the bed to a bed-side toilet.
Advantage plans are fine until the policy holder becomes a money drain. The problem is you cannot know the dollar amount at which you are considered a liability until you reach it.
Good luck.
Demobrat
(10,299 posts)But I could have. I signed up for a MA plan because my longtime primary and the excellent hospital she’s affiliated with were in the network. That, and the $0 premium.
All was well, or so I thought, until I called to schedule my yearly mammogram. I was told the hospital was no longer in the network. Contract negotiations, doncha know. I had to go to a clinic across town. Okay, no biggie, BUT the only hospital I was left with access to was the local two-star with a terrible reputation. Scary.
So I decided to switch to traditional Medicare with the help of an agent. He took one look at my 30 page application and said it was pointless for me to even apply. But, he said, there is one insurance company that’s taking people without medical questions. Anthem Blue Cross of California. And the premium is comparable to everyone else’s.
Okay, I said, how can they do this? By charging people up the wazoo when they get older, he told me.
So I signed up for the policy, got it, and then when my birthday rolled around I was able to use something called the birthday rule to switch to another carrier. Of course if the agent had not known about all this I would have had no clue.
Yes, I could have switched to another MA plan during open enrollment, but if I had needed to go to the hospital before then I could not have gone to any of the world class facilities where I live. All of whom take Medicare. Because I chose an Advantage Plan. I would have ended up in the death pit.
So now I dig in my pocket to pay the Plan G premium. The peace of mind is worth it.
RipVanWinkle
(268 posts)I know a lot of people are happy with their MA plans. If you're happy with MA, fine.
There are at least two problems with MA. I've heard that 30% of those who switch to MA don't like their plan. If you make the switch from traditional Medicare to MA, and you find out that you don't like MA, it is very difficult to switch back to traditional Medicare.
The second problem is that MA companies are over-billing the government.
Medicare Advantage should really be called Medicare Disadvantage.
elocs
(24,486 posts)
SunSeeker
(58,274 posts)
llmart
(17,614 posts)I would say this - there is no such thing as a zero monthly payment for an insurance policy where there isn't going to be some other way that a private insurance company will eventually get their money and then some from you.
Did you ever hear the phrase, "If it sounds too good to be true, then it probably isn't?" Buyer Beware.
With the exception of one year, I've had a Supplemental G Plan since I went on Medicare. I'm extremely healthy and 74. I've always been extremely healthy. However, some instinct told me after that first year on an Advantage plan that maybe I better spring for the higher premiums of a Supplemental Plan which I did. Without going into the specifics, I will tell you that if I had kept my Advantage plan I would have been stuck with $24,000 to pay for my year long treatment. To this day, I tell people who are getting ready to go on Medicare, do NOT think you are immune from needing extensive care even if you are fit and healthy.
Skittles
(171,698 posts)SOMEONE is paying, NOTHING IS FREE
elocs
(24,486 posts)But then what do I know? I know that I'm poor and couldn't begin to afford traditional Medicare, so I'm glad I have a choice. Isn't choice wonderful? I thought Democrats were supposed to like choice?
Scottie Mom
(5,838 posts)Why would a PRIVATE HEALTH INSURANCE PROGRAM want to in essence pretend that it is a SUCCESSFUL GOVERNMENTAL HEALTHCARE PROGRAM?
Need I say more?
MichMan
(17,149 posts)Scottie Mom
(5,838 posts)Why is it OK to trick people into thinking they have the real thing?
justaprogressive
(6,903 posts)I'm going to repeat that for those of you on drugs...
Medicare Part C is a SCAM!
That is all.
Susan Calvin
(2,438 posts)I'll tell you the first thing I want, for what it's worth. I want them to be forced to stop using Medicare in their plans' names, since they are not in fact Medicare.
MichMan
(17,149 posts)Not only that, they allow people to sign up for them there.
Susan Calvin
(2,438 posts)
QED
(3,349 posts)Luckily, I'm very healthy but am recovering from a shoulder injury requiring doc follow ups, PT, and meds. The transition from my employer's plan to Medicare has been smooth. So far so good.
My former employer has a consultant who made the recommendations for me based on my meds & situation. I have A, B, D, & G. My drug plan is through WellCare for $7.40/month and my Rx copays have been a total of about $15/month. For G I have Physicians' Mutual. It's $164/month.
So with Part B, D, & G my total monthly cost is about $325.
I also have dental through my pension plan - they "pay" me the premium then deduct it from my monthly check so it's a wash.
I went with G because of the network situation - it seemed to be the best option if I choose to travel.
PatrickforB
(15,424 posts)
JenniferJuniper
(4,571 posts)Because it isn't, and so many people I talk to don't seem to understand this. This is the right wing's way of finally fully privatizing Medicare.
My sister is a discharge nurse at a large hospital in Boston. Says due to restrictions and coverage denials, rehab centers always give priority to patients not on Advantage plans and it is often hard to place people with "Medicare" C.
mymomwasright
(442 posts)Why can't a consumer advocacy group or something put a constant running add to briefly explain that the commercials they are seeing are insurance adds?
moreland01
(870 posts)So I REALLY appreciate this discussion and hearing both sides. Thank you all! I'm learning so much.
PortTack
(35,820 posts)Overpayment to these advantage plans…then what??!!
Privatized senior care offered by Medicare Advantage insurance plans has led to higher costs for Medicare and is a drain on the Medicare trust fund, according to the report, “Profiting at the Expense of Seniors: The Financialization of Home Health Care,” authored by CEPR co-director Eileen Appelbaum and Rosemary Batt, the Alice Cook Professor of Women and Work in the ILR School. The study also finds that these plans diminish the amount and quality of care provided to patients.
In contrast to traditional Medicare, in which Medicare both administers and pays for the care seniors receive, Medicare Advantage (MA) is a program operated by private insurance companies and paid for by Medicare. Initially established with the idea that privatized care would lend itself to preventative care and keep seniors healthier for longer, the report finds the opposite is true. Large Medicare Advantage insurers have “gamed the system,” Batt said.
“The evidence shows that the Medicare Advantage plans cost much more than the traditional Medicare plans because they use many financial tactics to increase their profits,” said Appelbaum, an economist; Batt and Appelbaum are longtime collaborators. In 2020 alone, large MA insurance plans received an estimated $12 billion in overpayments, according to the Medicare Payment Advisory Commission.
https://news.cornell.edu/stories/2023/11/report-medicare-advantage-plans-cost-more-provide-less
RainWalker
(605 posts)There's so much happening in the world right now that a lot of very important things aren't being given attention. This is important and this is why it's so important we win I 2024. There's no way Trump or any Republican would ever do something like this.
Thank you for sharing.
wryter2000
(47,940 posts)If it’s not Medicare make them stop using the term
ancianita
(43,307 posts)Medicare Choice and signed by Bill Clinton
ancianita
(43,307 posts)Last edited Tue Nov 7, 2023, 08:04 PM - Edit history (1)
Medicare Advantage is absolutely not Medicare. From its beginning, Medicare has allowed private companies to offer plans that essentially compete with it, but for decades they belonged to obscure corners of the market.
Medicare Advantage was rolled out by Bush and Republicans through their Medicare Modernization Act of 2003.
It was their big chance for the GOP to finally privatize Medicare, even through one bite at a time, through the medicare Part C provision. Medicare Advantage phased in what's kown as risk-adjusted large batch payments to insurance companies offering Advantage plans.
For-profit insurance companies, a few non-profit HMO's operate under looser rules than Medicare.
MA don't get reimbursed directly on a person-by-person, procedure-by-procedure basis. Instead, every year, Advantage providers submit a summary to the federal government of the aggregate risk score of all their customers and are paid a lump sum.
The higher their risk score, the larger the payment. A plan with mostly very ill people in it will get much larger reimbursements than a plan with mostly healthy people, since the former is more costly, etc, etc.
Profit-seeking insurance companies have found a number of ways to raise their scores without raising their expenses. Classic strategies of tying folks into in-network providers, denying procedures routinely during first-pass authorization attempts, etc, etc.
The way Medicare Advantage rips everyone off is that it will promote annual home visits by a nurse or physician's asst as a 'benefit' of the plan. But what the companies are doing, is trying to upcode their customers to make them seem sicker than they are to increase their overall medicare reimbursement risk score. "Heart failure" can range from severe & expensive condition to a barely perceptible tic on an EKG that represents little/no threat to a person for years; or "depression," so variable that it won't get reimbursement if it lasts less than 2 weeks; the temptations to claim 'risk' become a business model.
In 2004, the Center for Public Integrity published an investigative report, "Why Medicare Advantage Costs Taxpayers Billions More than it Should." Here are a few points:
-- Risk scores of MA patients rose sharply in plans in at least 1,000 counties nationwide (out of 4,000 counties) between 2007-2011, boosting taxpayer costs by more than $36 billion over the same care for patients in standard Medicare.
-- In more than 200 of those counties where risk scores rose, the cost of MA plans was at least 25% higher than standard Medicare coverage.
-- Risk scores rose twice as fast for people on a MA plan as for those who weren't.
-- Patients, the report explains, never know how their health is rated because neither the MA plan or Medicare share the risk scores with them, the process being so arcane and secretive that it's unfathomable even to health care professionals.
-- By 2009, govt officials were estimating over 15% of total MA payments were inaccurate, about $12 billion that year (the year I quit my MA plan).
-- The report shows how CMS has estimated that faulty risk scores triggered nearly $70 billion in what officials deemed "improper" payments in MA plans from 2008 - 2013.
-- BUT CMS decided not to chase after overcharges from 2008-2010 though the agency estimated through its sampling that CMS had made more than $32 billion in "improper" payments to MA over those 3 yrs. CMS didn't explain its reasoning. But expensive, time-consuming audits have been suggested; it really looks like CMS has become some kind of cheerleader for MA plans at the expense of original Medicare, with employees who go along to get along (maybe with the idea of leaving the govt system for a job in the private MA system).
--A third of all MA plans nationwide don't include any of the National Cancer Institute centers.
Meanwhile, millions are spent every fall on TV, direct mail, Internet ads for MA plans. Where does all that $$ come from? The same place that pays $1billion in income to the CEO of United Healthcare, and $100 million to senior executives-- denying claims -- while collecting risk adjustment claims from our tax dollars.
Bernie Sanders' Medicare For All plan (a great one) eliminates the two problems of MA plans and that stupid and costly 'medigap' crap that Republicans put into their "Medicare modernization" law back in the day.
These are notes from Hartmann's The Hidden History of American Healthcare: Why Sickness Bankrupts You and Makes Others Insanely Rich -- but he lays out so much more about MA plans, I just couldn't cover it all.
MichMan
(17,149 posts)
AllaN01Bear
(29,483 posts)
mackdaddy
(1,976 posts)I just stopped answering my home phone and let everything go to answering machine. My home phone is basically useless.
Advantage plans do have Drug, dental and vision also rolled into them as well as apparently no monthly cost where standard Medicare you have to buy these extra coverages plus a larger monthly charge.
Of course when you actually have to use them there is no pre-approval or in/out of network shenanigans and larger copays you can run into with the Advantage private insurance.
If they would cover dental and drugs in lower the monthly pay they would make Advantage much less apparently attractive.
Hekate
(100,133 posts)
The Bopper
(311 posts)What has happened with mine is the inability of going to the closest hospital and the problem of being forced to change doctors for “in network ” coverage. The extras, such as dental and vision is very restricted to whom you can go to. Under a past coverage I was forced to go to an MRI provider that literally charged 500% more than a past clinic I had used. Oh yeah, when you hit the proverbial “donut hole” your $35 co-pay goes up to $235. They “give” you the cheaper and many times unneeded “extras” and jack you around on the others. After you’re on an Advantage plan for a couple of years, you’re not allowed to go back to regular Medicare it appears.