PSA - If you enroll in Medicare Advantage, you could be stuck for life

[Celerity]

93. types of financial and patient abuse in Medicare Advantage

https://prospect.org/health/medicare-advantage-is-a-massive-scam/

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One rip-off strategy insurers use is improperly denying claims. A recent investigation from the Department of Health and Human Services inspector general found that among Advantage companies, 13 percent of prior authorization denials were improper, along with 18 percent of payment claim denials—or about 85,000 requests and 1.5 million payments, just in 2019. Paying lots of claims adjusters to fake up reasons to deny necessary treatment is a big reason why Advantage companies spend nearly 14 percent of their money on administration, as compared to traditional Medicare’s 2 percent.

Another strategy is rigging the risk pool. Advantage companies are notorious for pushing doctors to “upcode” as many diagnoses onto their patients as possible, thus increasing their risk score and payment, without having to pay for more treatment. That tactic alone cost the government $9 billion in 2019.

All this (plus a bunch of other complicated scams) means that Advantage enrollees receive something like 10 to 25 percent less in health care spending, but the program costs the government about 3 percent more per person than traditional Medicare. This absurd situation is actually getting worse. One recent study found that Advantage plans cost the government $106 billion in overspending from 2010 to 2019, and nearly a third of that came in just the last two years. The price tag is predicted to balloon to $600 billion over the next nine years. One would think that the Biden administration would be looking to reverse course, but it isn’t. On the contrary, as Caress notes, it has so far proceeded with a Trump-era plan to privatize the remaining shreds of Medicare by letting private companies serve as payment middlemen through something the Trump team called “direct contracting.”

After an outcry from progressives, the administration altered the privatization plan, mainly changing the name (it’s now called ACO REACH), with the supposed goal of achieving “equitable outcomes.” But as Diane Archer explains at Social Security Works, at bottom it’s still the same idea, with a lot of obvious loopholes for quick profits by denying care, pushing more people into Advantage plans, gaming risk scores, and so on. Unless Biden changes his mind, America is going to let a bunch more foxes into the Medicare henhouse, including private equity firms, and half-heartedly try to limit the damage to the taxpayer with a bunch of ultra-complicated regulations of the type that are failing right before our eyes.

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I am glad your Medicare Advantage works for you, but on balance, the concept and its actual practices are terrible policy IMHO. Introducing the profit motive (which too often manifests itself in outrageous cases) as a fundamental bedrock for what is a basic human right is just something I do not, at my very core, agree with at all.

Btw, I have used the US healthcare system myself. I lived in LA for several years whilst I read for my MBA) and I had no issues with the care (I was listed on my father's employer's (a global financial firm) US health insurance for CA, Kaiser Permanente, so had no costs that I had to bear myself). I completely realise that my US situation was not that of a normal US adult as I was still on my parent's insurance. I also am far too young for Medicare. I also have US-based family and friends who have had horrid times with their healthcare, especially insurance and providers and the billing interlocks.