Holy shit. Be prepared for the consumer to get screwed on your healthcare advantage programs.

[Tadpole Raisin]

154. That's a practical fallacy!!

Medicare gives them a certain amount of money per patient and the MA plans ‘manage’ the care. If they get $3000 from Medicare (or whatever the amount is) and only spend $1000 on them, MA pockets the rest. Their admin costs (read profit) are much higher than MC as well.

There are some requirements but they have never been required to explain their denials and give justification for denying something as not medically necessary. There has been talk of requiring that MA plans pay something like ~ 95% of funds received on care but good luck getting that passed in Congress.

Years ago Medicare HMOs went to senior centers where they knew a lot of the healthy seniors were and tried to get people to sign up. The healthy people loved it. The HMO people were getting massive bonuses. It’s obscene.

There are plenty of congressional hearings on this and Elizabeth Warren has been on the forefront. Google or YouTube Medicare Advantage Congressional hearings. Funny I think a lot of Rs skip those hearings. I wonder why