Perhaps ALL those added benefits are gonna bite the dust - SOON
I found this article to be very interesting from the Medicare Advantage viewpoint to the Medicare Supplemental (Medigap) viewpoint.
Maybe we just need to get back to the basics of Medicare -
- only cover what is deemed to be covered by Medicare (CMS) [medicslly necessary]. No more gym memberships of whatever type - premium or sub-premium or ground roots. No more dental, vision or hearing coverage. Got a problem with this coverage - change the law. No more OTC benefits or Part B premium rebates, unless one is approved for a Medicare Savings Program.
- no more Medigap coverage unless it comes with an adequate high deductible - perhaps like the High Deductible plans - < $ 2800 or so. No more 1st dollar coverage or even after the Part B deductible. Coverage is the same, deductible would be the same - or perhaps we could have one where the deductible is higher to give some options.
- Medicare Advantage plans would have to end their negotiations with providers and services to be NO LOWER than what Traditional Medicare pays. This should help keep providers in their networks.
- Medicare Advantage plans can also work with a disclosure form like Traditional Medicare uses - The Advance Beneficiary Notice of Non-Coverage. Medicare.gov - Your Protection
- If either Medicare Advantage or TraditionalNo more Medicare determine a need for prior approval, it should go to an unbiased 3rd party for consideration - the denier should present the medically unnecessary evidence of coverage best practices with the denial request. Same would be true of ending a Rehab session earlier than the plan of care calls for - and yes, there should be a written plan of care included, signed by the patient or their designate when admitted for rehab.
- Personally I am a fan of managed care - it has always served me well and kept down my medical cost and for those of other to whom I had oversite. I believe that we should have to have a referral from our primary care physician to see a specialist if they so deem it to be necessary. A lot of stuff one’s personal care physician can handle and if they see the need for a referral, they can get you in to see the referred specialist faster. So we should do away with self-referrals. But on the other hand, a person should be able to pick their own personal care physician and since we have a shortage, we should be able to get a specialist who agrees to act as our personal care physician but in those instances where they are only performing what a PCP does, that is what Medicare will pay them for this service - not their special rate.
Here’s my beginning list - add to or discuss any of them - I am all ears.