Advantage plans hurt Medicare

[RickR55843]

Please respond to the concerns mentioned in this article:

https://www.dailykos.com/stories/2022/8/5/2114705/-Stop-the-Medicare-Advantage-Scam-Before-Medicare-...

I've always trusted AARP to be an honest advocate for seniors but this information is very disturbing!

Is AARP just an insurance salesman or a true advocate for seniors and medicare???

[JamesD81836]

MA plans over bill Medicare plain and simple. 

Those chickens may be coming home to roost as CMS has stated they will begin to act on audits going back over a decade.  Humana for one has already begun to squawk like a chicken over this.  Lobbyists for these companies will be greasing palms to put an end to it.  

Nothing is free.  The money is coming from somewhere. 

[jp2306867]

This article link below is interesting re: Medicare Advantage plans and how the current ads to scare seniors are misleading.

https://news.bloomberglaw.com/health-law-and-business/insurers-put-millions-in-mediscare-ads-to-save...

[Tonster521]

@JamesD81836 If you follow the billing practices of medical providers including labs and durable medical equipment companies, you will find over charging in Traditional Medicare as well. Medicare Eligible folks do not get balanced billed if the provider accepts Assignment. If the provider does not accept Assignment, you will be balanced billed. So, folks need to be careful regarding the Assignment of Medicare Benefits. It should be noted that MA manages health costs as well as health care. From other past threads, folks have posted about heath care that is denied by MA Plans and/or Providers. The reasons for the denials are important. Is it diagnostic or routine care? Is it medically necessary or not? Does the provider simply refuse to treat the patient? And so on. At any rate, the question that needs to be answered is "Does the Managed Care approach which MA Plans use hold costs to a reasonable annual increase (less than double digits)?" I believe it does. Managing fees/costs and medical care has to have a positive effect on reducing the ever increasing cost of health care. One example is reducing the number of Emergency Room visits at a hospital for care that can be provided by a Primary Care Physician. With MA Plans, folks need to select a Primary Care Physician. With Traditional Medicare, folks do not. The savings may be hundreds if not thousands of dollars per case. Those savings are passed to all of us via the Part B premium we are required to pay. With regard to audits, I am in favor of such activity for both Traditional Medicare and MA . Over charging is common in the Medical Billing business.

[bigw55]

Your reply makes little sense. If a provider accepts assignment that still means you’re liable for the part B copay. 
Furthermore, any trip into a hospital E/R would be billed under BOTH part A and B. Not just part B. As a side note:  Many, if not most E/R department’s were contracting out there E/R services, so even if the hospital were in network, the physician usually wasn’t.  

[Tonster521]

@bigw55 As you probably know, with Traditional Medicare, you are responsible for a deductible, copay, and/or coinsurance. So, a provider who does not accept Assignment and overcharges will probably balance bill you for the amount over the Medicare approved amount for the service rendered. This amount is in addition to any remaining deductible, copay and/or coinsurance as required by the Traditional Medicare Plan.

Generally, Medicare Part A covers the Emergency Room only if admitted to the hospital. Otherwise, it is processed through Part B. Medications may be processed through Part D. Here is an article that provides some info on Emergency Rooms https://www.medicalnewstoday.com/articles/does-medicare-part-a-cover-emergency-room-visits Hope this helps.

[GailL1]

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@JamesD81836 wrote:

 . . . . Nothing is free.  The money is coming from somewhere. 

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The money comes from Medicare  - they are part of Medicare - Medicare Part C 

CMS makes the rules for them and monitors them.

HHS.gov What is Medicare Part C?

Nothing is gonna happen anytime soon.

KHN 1/30/2023 - Government Lets Health Plans That Ripped Off Medicare Keep the Money

CMS has proposed some changes to them but they won’t take affect until 2024.’

KHN Morning Brief - Medicare Advantage changes begin in 2024 - 

I’m posting all of the news sources on this since some of them have a paywall.

[JamesD81836]

https://www.nytimes.com/2023/01/30/upshot/medicare-overbilling-biden-rule.html

I'm glad you approve of the Government being fleeced.  Audits that show huge over billing has taken place over the last 10 or so years is part of that 'monitoring'.

And did you think you were telling me something with that snarky response?  You believe you are posting to children here? lol

[Tonster521]

@GailL1 I am providing a link to an article from a few days ago regarding an effort by some Representatives to rename Medicare Advantage. https://www.thinkadvisor.com/2023/02/01/fight-to-rename-medicare-advantage-gets-new-push/ You may already know of this effort. This can't be the solution to save Medicare. If so, we are in trouble. 

[jp2306867]

The article mentioned is compelling. It states: 

"Seniors buying Medicare Advantage plans often think — even though they know they’re getting the plan through an insurance company — that they’re somehow still in Medicare or backstopped by Medicare. The reality is they’re neither.

With Medicare Advantage, they’re at the total mercy of the insurance company providing the Advantage plan. They can deny care (and frequently do), refuse to pay for tests, and even refuse to authorize or pay for surgeries and other life-saving procedures."

Many seniors are happy with their Medicare Advantage plan. There are currently no plans to do away with them that I know of. However the REACH program takes seniors out of the traditional Medicare plan they chose and puts them into an Advantage plan without their knowledge or consent. Why is their choice negated? Why is AARP not opposing this? It appears that money is the reason.

[JonRet]

The ACO REACH program is NOT the same as Medicare Advantage.  MA is functionally a one-way ticket after the 1st year as going back to Medicare Traditional leaves one subject to underwriting for a Medicare Supplement (denial or MUCH higher premiums).  MA can restrict folks to ONLY using providers within their MA network, but beneficiaries in ACO REACH retain the option to go to any provider that accepts Medicare.

See this CMS FAQ, particularly Q 11 & 12:

aco-reach-genfaqs

[Maidenwarrior]

I wrote a written inquiry to AARP sometime last year inquiring as to how and why they made the decision to promote UHC.  I got a canned response saying AARP has not received any complaints from it's members regarding the services UHC provides.  My question was ignored.  One would like to think that AARP engaged in due diligence when they selected UHC, but likely it has to do with contributions that UHC makes to AARP.  Interestingly, my pension plan promotes UHC.  If enough AARP members banded together and requested transparency from AARP, perhaps our questions would be answered.  I don't think any of us believe there won't be some corruption/fraud in these programs, but we do have a right to know how it is AARP is such a supporter of UHC.

[MichaelB757163]

I agree.......

[c754286h]

See the NYT article on the billions in suspected medicare fraud from United Heathcare (UHC) and other insurers. The government pays more for sicker patients so doctors are incented to fake illnesses. Why does AARP support UHC when they are embroiled in lawsuits. C 'mon AARP take the high road.

[bigw55]

Exactly. Is this a pay to play ploy on  AARPs behalf?  
How can you help bankroll this sort of fraud and at the same time consider yourself an advocate for seniors?

[john258]

One thing left out so far is cost of program. At the start of the Advantage programs Medicare paid the carriers the amount it cost medicare to provide the service plus 15%. The ACA was to reduce that to zero, but I think it only cut it to 10% so far. That means everyone paying a medicare tax is paying more due to the advantage programs. Those that want to save Medicare money should be against the advantage programs until that difference reaches zero.

[GailL1]

@RickR55843 

All Medicare beneficiaries have to decide for themselves what is the best way for them to get their Medicare benefits.

Medicare Advantage plans are part of the Medicare system and both the Traditional program and Medicare Advantage as well as all Part D programs are regulated and monitored by CMS.gov. under the Dept of Health and Human Services.

Many beneficiaries like their Medicare Advantage plan and they also have the option of changing every year to another if their needs change.  The % of beneficiaries choosing a MA plan as the manner in which they get their benefit is about 35_40% of all beneficiaries in the program.

Many beneficiaries aren't poor but yet live on a budget and feel that they cannot afford a Medicare Supplemental (Medigap) plan with a monthly premium that escalates over time.  Thus they opt for a MA plan so that they know their cost and can plan for these cost.

Having Traditional Medicare WITHOUT a Medicare Supplemental (medigap) plan leaves ones open to a lot of out of pocket cost since Traditional Medicare has NO limit on out of pocket cost - but Medicare Advantage DO!

Medicare Advantage plans cover the EXACT same things as Traditional Medicare except in a different way.

• We could talk about MA discounts or savings for people under a specific income (Medicare Savings Program)  
• We could talk about Medicare Advantage plans offering some added benefits which some people need - which aren't offered by the Traditional program.
• We could talk about dual eligibles (people who have Medicare and Medicaid) and how special managed care MA plans helps them.
• We could talk about programs such as Accountable Care Organizations, Medicare Direct Contracting Entities and how all these also help certain beneficiaries.  

All of these special programs are designed & regulated by CMS.gov.  to help specific sets of beneficiaries depending upon their needs and their income.

One thing that the Medicare program has to watch and many of the rules surrounding the  program takes into consideration - they do not want beneficiaries signing up for a MA plan and then perhaps years later begin to need lots and lots of care, switching  from a MA plan to Traditional Medicare - that's the reason for the rules on when one can get a Medigap plan are limited and sometimes costly if one wants to do it and if they can (underwriting applies).

[cat0w]

@RickR55843 

Are you on Medicare?

I am and I have a Senior Care Advantage Plan. I don't want anyone messing with my plan. I pay extra money to have it, but I don't make any co-pays when I visit a doctor. I do have very reasonable co-pays on my prescriptions. I also have dental coverage and visit my dentist two times a year. For a cleaning and checkup, I don't pay anything. I also get an eye exam once a year and again I have no money out of my pocket.

I don't care for the ads on TV but then I already have my plan.

A person gets what they pay for. Be sure to check out the plans they offer and ask for information about what coverage is provided with each plan. 

I should be getting information about my plan for next year soon and what the cost will be.

I also get $30 every quarter to spend on over the counter drugs. This is placed on a card. It does not roll over, so I try to spend all of it.

[john258]

A few comments on your post. Many people moving to advantage plans pay less or the same. You Insurance Carrier gets 15% more from medicare to provide the same base benefits as it costs medicare to provide them. That means we all pay more so there can be a Medicare Advantage program.  I get free eye exam for glasses each year which is part of eye discount program in my advantage plan.

I am in an Advantage program also which has no network and is set up so my employer can pay some of the plan costs for me. I save money because of that. The end of co-pays is included on many services also. Most of my drug costs are fully covered by my employer using special funding. I have no coverage gap on drugs.

Dental is offered in many of the plans. A lot of the dental is  really dental discount not insurance. I have  dental also and it has both discount and insurance in it. Cleanings and checkup 2 times per year is normal. If I use in network dental a 40% discount starts out. Insurance then kicks in and i pay part.

No a person does not get what they paid for in the case of advantage plans. We all pay more for some to have them. The $30 per quarter is usually part of the discount programs used by Carriers, and cost the Carriers little if anything to provide. How do I know that. Years ago I put programs like that together.

The cheapest coverage comes when all are covered under the same plan with one source as the pure rating tables can be used in pricing.

We all need to understand what is really going on.

[WebWiseWoman]

Good post "Rick",

Please note the disparaging "concerns" are only in the comments; those comments refer to UHC association, not AARP.

UHC has been a strong sponsor of AARP activities for decades; while I don't approve, I do understand the necessity. 

So, my thought is consider the information as biased until you form your truth...

Additionally, it seems AARP has been receiving some very pointed jabs recently (e.g... WSJ Oped today on the AARP | Constant spam texts after joining AARP ); not sure why but seems targeted, so I worry...

#StaySafe