Here is the Truth: Medicare Advantage Is Neither Medicare Nor an Advantage

[douglas9]

"During my two decades in the industry," writes Potter, "I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare — real Medicare."

Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.

But here is the truth: Medicare Advantage is neither Medicare nor an advantage.

And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.

During my two decades in the industry, I was part of an annual collaborative effort to persuade lawmakers that Medicare Advantage was far superior to traditional Medicare—real Medicare. We knew that having Congressional support for Medicare Advantage was essential to ensuring ever-growing profits—at the expense of seniors and taxpayers. We even organized what we insiders derisively called “granny fly-ins.” We brought seniors enrolled in our Medicare replacement plans to Washington, equipped them with talking points, and had them fan out across Capitol Hill.

https://www.commondreams.org/opinion/is-medicare-advantage-a-scam

[bullimiami]

1. A solution is to let people choose each year during open enrollment. Managed or Medicare.

They would get in line pretty quick if people weren’t locked in.
That’s a real scam.

[Irishxs]

12. Love My Medicare Advantage Humana

Must disagree with you. Humana Gold Plus is wonderful and I wouldn’t trade it.

[PortTack]

16. Just so you know, they over charge Medicare and with fewer enrolled in MC it WILL bankrupt

The fund. If something is too good to be true..it probably is.

[moose65]

22. Then I hate to say it, but you're one of the ones who have been scammed

Last edited Sat Jan 14, 2023, 02:16 PM - Edit history (1)

These plans seem wonderful, especially in those commercials that play over and over and over again. And they are very careful to put, in the tiny fine print, that Medicare Advantage isn't a government program, even though most people think it is. Government programs don't need to advertise - when was the last time you saw an ad for Social Security? That's right - never!

Your plan may be very good for you, right now. But it might not always be! Medicare Advantage plans are paid a fixed amount each year per person, regardless of how much care is actually performed. The payment was $12,000 in 2019. Younger seniors - those aged 65 - 69, generally don't require as much care as older people. If a person doesn't use $12,000 worth of care in one year, then the insurance company keeps the remainder as pure profit.

Also, almost all Advantage plans are either HMOs or PPOs, so they have networks of providers and can deny payment for out-of-network services. Traditional Medicare does not - you can see any doctor or go to any hospital in the entire country that takes Medicare, which is almost all of them. You also have to get pre-clearance for certain procedures under Advantage plans.

Those plans have been around since the 1970s, but were first used by people with rare conditions who needed specialized care. Then in 2003, under W. Bush (surprise) a law was passed that caused enrollment in Advantage plans to skyrocket. Soon, almost half the enrollees in Medicare will be under Advantage plans.

Medicare Advantage is a scam that seeks to extract profits for private companies by taking from the Medicare trust fund.

[MichMan]

23. It was authorized in 1997 as part of the Balanced Budget Act and signed by President Clinton

Originally called Medicare+Choice.

[link:https://en.wikipedia.org/wiki/Balanced_Budget_Act_of_1997|

[dpibel]

31. Do you know where Medigap comes from?

As far as I can see in this thread, everyone who's in on the "Advantage is a scam" revelation takes it as a given that you need to be on Medicare PLUS Medigap.

You are aware, aren't you, that Medigap isn't a government program?

You are aware, I trust, that any company that offers Medigap takes in a premium and whatever part of the premium it doesn't pay out in benefits is...wait for it...pure profit.

While we're at it, check out post 27 in this thread. That's a person who was warned not to get Medicare Advantage. Her reward for sticking with Medicare which (at least according to the advocates here) covers EVERYTHING was to have to track down a nonprofit to cover the cost of her meds.

That is not a totally convincing argument in support of the proposition that, if you have Medicare, all your worries are over.

Another thing that gets lost in these Medicare-Advantage-bashing threads is the assumption that a couple hundred bucks a month is a no-brainer. But this is the USA, where the majority of people can't cover a thousand-dollar emergency. To those people $100 to $250 a month (the range of Medigap premiums in my state) could be downright unaffordable.

And if you can't afford Medigap and you get seriously ill under traditional Medicare, you're broke damned fast.

If I had my druthers, we'd have Canadian-style healthcare coverage, and all this would be moot.

But as it sits, I'm not sure the Medicare+Medigap crew is living in the same world as some of the rest of us.

[Zorro]

42. Absolutely spot on

And don't forget the additional monthly Medicare Part D cost in addition to that monthly Medigap premium -- plus the higher costs of prescription drugs under Part D, as opposed to the zero prescription drug costs in many Medicare Advantage plans.

[Jack from Charlotte]

25. I also, have had nothing but good experiences with my United Healthcare Advantage plan...

Don't understand people complaining about these plans that are required to provide 100% of what Medicare provides plus whatever extras. I have 2 gym memberships both paid for. Get free annual eye exams plus $200 per year toward new glasses from about 5 or 6 glasses companies. I get up to $1,000 per year toward my dental checkups/repairs. I have 4, Tier 1 generic prescriptions all no charge from the UHC mail order Rx company. I could get them from Walgreens, CVS for about a $10 co-pay but why? I get $50 per quarter to spend on over the counter medical stuff. Vitamins, bandages, etc.

I've had 2 back surgeries. One cost me $950 for everything including surgeons follow ups. The 2nd surgery cost a total of $400. The post surgery PT guy costs me a $35 copay per visit. The copay for any specialist is $30. Copay for my own, non specialist doc is zip/zero.

UHC also provides incentives for doing healthy things. $30 if you get an annual physical, $10 if you get a flu shot, $40 if you get a colonoscopy or the home, fecal test and some others.

Total Annual max cost after which everything else is covered $4,400.
Total Annual premium - Zero

[moose65]

29. Wait a minute...

You don’t pay ANY premium at all? How did you manage that?

How would you feel about a new program called Social Security Advantage in which Social Security gives a set amount each year to a private financial company to handle for you? Would that be all right?

[phoenix75]

33. That's an interesting analogy moose65

and the parallel would be spot on. It speaks volumes.
P.S. I hope no one in DC ever seriously comes up with such an idea!

[moose65]

36. Uh oh

I hope they aren’t reading these comments - I know they’re too dumb to think of it on their own!

Not really though. They are always looking for ways to privatize and profit from government.

Wasn’t it Arizona who sold their state capitol building to a private company and then leased it back? 😆

[dpibel]

34. Wow. Medicare sends you money?

That's the only way your analogy makes sense.

You don't handle your medical expenditures under Medicare. So Medicare Advantage doesn't change the status quo the way your hypothetical changes Social Security.

[moose65]

37. You talking to me?

I didn’t say anything about sending ME money directly.

Medicare sends a set amount to Medicare Advantage to handle medical claims.

So what if Social Security sent a set amount each year to some private financial firm to invest.

Isn’t that the same thing? In both cases a private company is getting money from a government program and skimming off profits from it.

[phoenix75]

39. Since I also am not sure who your reply was for ....

Of course Medicare doesn't send us money. The point the post was posing, as I understood it, was simply to pose the hypothetical situation of the financial industry becoming involved in Social Security in some shape, form, or fashion like the insurance industry has become involved in Medicare.

[Jack from Charlotte]

51. Medicare doesn't send me money but....

my plan has lots of extra health related benefits. Annual free or cheap eyewear. The Over-the-counter quarterly allowance. Some rewards for doing healthy things like workouts, colonoscopies etc.

[Skittles]

59. yeah they may work for you now

but their ultimate goal is to get rid of Medicare and then we all know what will happen with those "wonderful plans"

[Zorro]

43. We pay no monthly premium for our MA plan

It's not that unusual.

Many of the complaints I read center on how people won't be able to see any doctor anywhere who takes Medicare; but I wonder -- realistically, does one really want to see any doctor anywhere, or their primary care physician? It may matter in an emergency away from home, but my MA plan states that it will reimburse for valid emergency treatments outside their network (just as many employer health plans do).

I also wonder just how many people who claim MA plans are a "scam" actually are Medicare-eligible and have made the decision to stay only with Medicare Plan B and forego either Medicare Part C (Medicare Advantage) or an alternative Medigap insurance plan plus Medicare Part D (prescription drug plan). People in different situations may choose different solutions, but our MA plan really is outstanding.

[moose65]

44. Then who pays your premium?

Do you have some union-negotiated plan? Someone somewhere is paying your premium, if you’re not.

[Zorro]

45. You don't get it

It is a Medicare Advantage plan with a ZERO monthly premium. It is available to anyone in my area who chooses it. It is not some union benefit.

[moose65]

46. Don't you still have to pay your Part B premium?

Do you have a deductible and co-pays?

[Zorro]

47. Everyone eligible for Medicare pays Part B out of their SS

unless they're indigent or just contrary; but I pay no additional monthly premium for my Medicare Advantage plan. I have no co-pays for visits to my primary care physician, and only a $10 co-pay for seeing a specialist, and all referrals have been approved almost automatically in every case.

[Jack from Charlotte]

53. Same here.... No premium, no co-pay to see my Doc, $30 co-pay for a specialist......

Medicare pays my insurance company (UnitedHealth Care) to administer the plan. United is obligated to cover everything strait Medicare offers. United offers the extras to get me to enroll which makes them money.

I don't get anyone saying they have an advantage plan and says its a sham.

Again,

Go look at the options offered by my plan and company. AARP is it's sales wing.


https://www.aarpmedicareplans.com/health-plans/plan-summary/28226/119/2023?product=MA

[Jack from Charlotte]

50. That's essentially what has happened.....

The deal is the insurance company does all the claim administration for a set fee. Administration is a huge cost to Medicare.

Here are the AARP/UHC Plans for my zip code. It's priced by zip code since medical prices vary according to your location.

These are simple and way better than straight Medicare.


https://www.aarpmedicareplans.com/health-plans/plan-summary/28226/119/2023?product=MA

[moose65]

52. Is UHC a non-profit?

I think I remember seeing that somewhere, but I'm not sure.

[Jack from Charlotte]

54. Hell no......

They make money by administering the plans of people they sign up, like me. Administration costs in health insurance like Medicare is a huge cost.

[friend of a friend]

41. If you travel out of your area and get sick but not too sick,

does your Medicare Advantage pay your medical bills?

[Jack from Charlotte]

55. I haven't been sick out side my home area but.....

I'm in the process of seeing a back surgeon a few states away. I called my plan to check eligibility and it's not a problem. The Doc is in a big group of surgeons which are on my companies eligibility list so it's no different than being at home.

[Jack from Charlotte]

56. I haven't been sick out side my home area but.....

I'm in the process of seeing a back surgeon a few states away. I called my plan to check eligibility and it's not a problem. The Doc is in a big group of surgeons which are on my companies eligibility list so it's no different than being at home.

[Stainless]

26. Sorry Irishxs

You have swallowed the Kool-Aid. Medicare Advantage is pure unadulterated bullshit that has been foisted on the public by greedy insurance companies.

Wait till you need a new or special life-saving medicare approved procedure performed and your insurer says you need to see other specialists and must make a co-pay whenever you do. Or wait till they don't approve your procedure at all!

With my Medicare Supplement plan I can chose any Doctor and I never pay a copay. I've never had to pay out-of-pocket for my medical care.

[dpibel]

35. Ummm...you do pay for your Medigap, right?

I think there's a slight disconnect here.

Paying out-of-pocket for your Medicare Supplement plan actually is paying out-of-pocket for your medical care.

And it works like any other form of insurance: You will come out ahead if you need a lot of medical care that would require copays. If you don't, the insurer keeps the difference.

As for "they don't approve your procedure at all," how do you figure that works? Medicare Advantage plans are required to provide every bit of coverage that traditional Medicare provides.

The credible argument against Advantage is that it is generally limited to in-network providers.

That really shouldn't be much of an adjustment for most Americans, because almost everyone has health insurance during their working years that is network-limited.

For that matter, doctors are not required to accept Medicare, and some don't.

The big bogey man that I see in these threads is, "What if you have the cancer and the very best specialist in the world is out of network under your filthy Advantage plan?" The answer to which is: Not everyone actually can get the best doctor in the world. And it's not a given that that doctor accepts Medicare.

[moose65]

38. Not really

The insurance companies who offer Medicare Advantage aren’t doing it out of the goodness of their hearts. They’re doing it because it’s profitable for them. If it wasn’t, they wouldn’t spend the massive amounts they do on all that advertising with Joe Namath and Jimmie Walker 🙄

This is similar to private prisons. They get paid a set amount for a certain number of prisoners and they cut corners and provide the bare minimum in order to make a profit.

How would you feel about private, for-profit fire departments?

[Jack from Charlotte]

58. I haven't been turned down yet ever for any specialist.....

I have a bad, painful back that hasn't been fixed by 2 surgeries. I was sulking to my main Doc and he insisted I keep trying to get fixed by going to a Orthopedic Surgical group that he thought was the best in Charlotte and maybe the whole state. I'm covered. $30 copay to see the surgeon. Had four fresh MRI's. Total MRI cost $230. That's $57.50 per MRI.

How much is your monthly premium? My wife has a supplement plan partly subsidized by the big bank she worked for. Still pays $250 or some such monthly premium. That's $3,000 per year. Mine is zero. Zip nada, nix.

[hlthe2b]

2. marked to read later today... k&r

[phoenix75]

3. A very interesting article....

In regard to the overall health care system that we now have, would a universal public single payer system that would cover everyone regardless of age, and also eliminate insurance company participation altogether, be a viable solution?
What are your thoughts?

[Ligyron]

49. Heck yeah it would.

This has been addressed repeatedly and the fact that the US spends more for healthcare than any other 1st world nation for worse outcomes ought to clench the deal right there. The difference we can safely assume, I believe, is going into the pockets of profit insurance corporations who can somehow afford to spend millions advertising and still bride politicians to never let this happen.

Just the administration and paperwork required in our for profit system is an industry in itself and represents much of the cost by for all involved. Doctors have to practically employ an entire workforce just to code, charge and then eventually get paid by the multiple insurance companies their patients use. Plus, doctors have to carry incredibly expensive liability insurance, yet another cost that could be eliminated or at lest greatly reduced.

Then there's all the fraud and waste with coding scams etc. It's a no brainier really.

[multigraincracker]

4. Giving up your freedom to choose and

get the best care you can for a hundred bucks a month.

[delisen]

5. Medicare Advantage is a Republican scam for Big Business

Medicare Advantage companies are feeding off government funds.Medicare is funded by workers.

Most of us who are in Medicare Advantage do not realize that the programs are hollowing out Medicare, are not saving money, and not resulting in improved health overall. They are creating wealth for supposed capitalist enterprises we don’t need.

The Medicare Advantage Industry was the Republican deliberate alternative to improving and expanding benefits under Original Medicare. It introduced a new level of profit (both direct and indirect) motive to a class beyond the direct service medical providers.

If “Medicare for All” becomes just “Medicare Advantage for All” we will not be winners, we will be losers as workers paying higher taxes to fund to same health care industry we have been fighting for decades, an industry that provides us with among the most costly health care and poorest health in the modern world.

[PortTack]

17. Exactly!

[c-rational]

19. +1

[wryter2000]

6. God, I hate these things

The commercials make it sound as if you still have Medicare, and you can tell they have to be lying about the coverage. No insurance company gives stuff away.

[SCantiGOP]

7. The woman who ran my HR Dept

She knew more about insurance than anyone I ever knew. She would tell people who asked for advice that Medicare when they were nearing retirement that she would never recommend any Medicare Advantage plans.

[Rebl2]

8. I have regular

Medicare because a doctor warned me not to choose one of those advantage plans. It won’t cover some of the medication I take. I have a question though about those plans. Once you are in an advantage plan, can you change to regular Medicare in open season in November/December?

[vsrazdem]

14. You can switch in your first 12 months of signing up for Medicare without underwriting.

Once you get past the first year, any time you want to switch, even during open enrollment, you will be required to undergo underwriting and if you have certain conditions, they will not accept you. Same goes for switching your Medigap policy.

[mn9driver]

18. I think you can always go from an Advantage plan back to Medicare. The catch:

Once you’ve had your initial enrollment, you *might* be denied access to some Medicare Supplement plans based on pre existing conditions.

At least, that was how it was explained to me.

I strongly recommend talking to a Medicare advisor. They aren’t allowed to make a recommendation, but they are experts in how all the different options fit together and the pros and cons of all of them. And in my experience, they don’t charge you for the information.

[NJCher]

21. thanks to you and vsrazdem

because that was my question. I guess once you're in one, you can't get out until the next enrollment period?

I did a search and found tons and tons of bogus insurance company pages acting like they're Medicare. Ugh!

Here's a genuine Medicare page, however. I want to figure out how to get back into Medicare.

https://www.medicare.gov/sign-up-change-plans/joining-a-health-or-drug-plan/special-circumstances-special-enrollment-periods

I wish there was a "to do" checklist for people who are in these Advantage plans to change over. It seems like there is a lot to think of because in addition to getting back into Medicare, there is still the supplemental coverage for the 20% that Medicare doesn't cover. A policy has to be found for that.

[Freddie]

9. My daughter is an RN Case Manager

For home care. Believe me nurses HATE the advantage plans as they second-guess care recommendations and fight every step of the way so the patient gets less care. Traditional Medicare does not. DH and I are going on a traditional-with-supplement plan soon on her recommendation.

[appleannie1]

10. I refused to get it

The daily phone call during sign up season to me are harassment. I have gotten so I hit the button to answer then hit the button to hang up.

My health insurance is part of my late husband's pension where he worked before retiring. It is a group plan and the company takes my half of it out of my pension money each month. No other plan would cost me less or fund my medical needs better.

My husband fought cancer for 5 years. The total costs of his medical care was well over a million dollars. It did not cost us a cent. I have no co-pay for doctor visits and never received a bill when I needed stents placed in my arteries. It does not cover dental, eye or hearing aids. I just got hearing aids for both ears for a little over $200, have false teeth so don't need dental care and wear reading glasses from Wally World. Why in all that is hellish would I want one of their plans?

[ashredux]

11. It is a private plan....there ain't no free lunch...you don't get more for nothing

[Farmer-Rick]

13. Thanks for posting this.

Surprising how many folks think it's a good thing.

They get Medicare Supplements mixed up with Medicare Advantage. Supplements are fine. Advantage is a scam.

And Medicare Advantage does nothing to give a clear understanding of exactly what they do and who pays them. They'll tell you it depends on which Advantage program you pick. But it really doesn't. The programs are about 95% alike. And they don't really supplement Medicare.

"Medicare Advantage is a money-making scam. I should know. I helped to sell it." From the link.

[RocRizzo55]

15. It's all a scam

Designed to enrich the medical-industrial complex.

[Lonestarblue]

20. The thing to remember about Advantage plans is that the insurance company is making the

decisions about your medical care. Under original Medicare, you and your doctor are deciding your medical care. Many people still get good care through Advantage plans; many do not. The federal government has also found that they pay higher costs for those on Advantage plans than on original Medicare, thus depleting the fund and adding to costs from general revenues.

The Medicare Advantage plans are estimated to pass 50% of all enrollees in both Medicare and Advantage this year. When the insurance companies gain a larger share, we will see Medicare disappear and more restrictions on our healthcare by insurance executives. Not a future I want.

[MurrayDelph]

24. We're retirees who love to travel

Before she was old-enough for Medicare, my wife got sick while we were traveling cross-country, and we had to deal with finding in-Network providers in states we've never been to.

Now we're on a Medigap policy, so we can go anywhere as needed and don't have to get the insurance company's permission before seeing specialists when needed.

[greatauntoftriplets]

28. My sister fell in another state and cut her chin several years ago.

She went to the ER where she had stitches. Fortunately, everything was covered because of her Medigap policy.

[greatauntoftriplets]

27. Several medical providers have warned me against the Advantage plans.

As someone with an extremely rare autoimmune condition, having one might have limited my treatment options. As it is, standard Medicare has turned me down on paying for a biologic because it was an off-label use. The doctor arranged for a foundation to provide the medication, which is about $2,500 a dose. Strangely enough, insurance did cover the in-hospital infusions.

As of Monday, I'm supposed to start another biologic that is a shot. The doctor is giving me the samples he receives because he knows that insurance won't pay because it's again an off-label use.

[dpibel]

30. I must be missing something

Your doctor warned you off Medicare Advantage.

But regular Medicare is not covering your treatment.

I thought this thread was all about how Medicare Advantage covers hardly anything at all and real Medicare covers everything, no questions asked.

[greatauntoftriplets]

32. Not if it's off label, used for a purpose other than the one in Medicare's formulary.

Medicare Advantage wouldn't cover it either. If I was under 65 and still covered by a company group policy, it wouldn't be covered by that. It's one of the downsides of the American healthcare system. The moral of the story is to never get an "orphan" disease.

https://www.merriam-webster.com/medical/orphan%20disease

[Uncle Joe]

40. It's a major advantage for the corporate media and the oligarchs that own them.

Thanks for the thread douglas