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Stealth Medicare privatization scheme: 350,000 seniors have found themselves enrolled w/o consent

A new report from The Lever just revealed how the stealth Medicare privatization scheme is working, and how 350,000 seniors have found themselves enrolled in privatized Medicare plans without their consent. This exposé shows the damage that the DCE/REACH scheme, which began under the Trump administration and was re-named without reform under the Biden administration, has already done to the Medicare system. While traditional Medicare plans have overhead of just 2 percent, investor filings brag that between 13 and 30 percent of the money corporate Medicare plans charge goes directly into profits.
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The program has no Congressional input, approval or oversight. The General Counsel for the Health and Human Services Department warned that it appeared the new project was set up to benefit specific companies. Since resigning from Medicare two officials involved with planning the scheme have opened businesses that will benefit from Direct Contracting. Medicare admits previous attempts to save money and improve care have failed, costing taxpayers tens of billions of dollars.
Instead of canceling the program, Medicare renamed the scheme calling it ACO REACH, but the same flaws exist.  Medicare expects to cover all traditional Medicare beneficiaries with this plan by 2030, effectively privatizing Medicare.
If the ACO REACH program continues seniors will have their care radically changed, their choices undermined, services denied and care rationed while increasing the chance of bankrupting Medicare. Healthcare should be between patients and their doctors, not companies that have profit as their motive.

Honored Social Butterfly

To date, I cannot say whether this type of MEDICARE INNOVATION will work out financially.  Or if providers will participate in it in good numbers but I do know that around my area seniors - both those on participating Medicare Advantage plans and Traditional Medicare - are LOVING how this program works especially in area where providers were limited previously and all the special benefits that are being offered to them based on their needs.  Their docs are signing up for participation and then the beneficiary, stays with their doc or the beneficiary is making the choice to change their doc are signing up themselves for this program themselves by leaps and bounds!  

 

If the doc signs up for this program - then I believe that Medicare beneficiaries that want to stay with the doc - has to participate or find themselves another doc.

 

As an aside, in 2022, 28 MILLION seniors have signed up for Medicare Advantage plans - that means MA represents 48% of Medicare beneficiaries. The Stats- That has been growing and growing and will continue to grow - and you know why, I assume.

 

The concept is to treat the whole patient - to meet their needs and not just medical - needs like getting to their appointment, having onsite test and imaging, making sure that they do what the doc orders, so follow up care - be that making sure that the diabetic is eating proper meals or that they understand and can follow the orders of the doc.  Then there is some of these type groups that are even setting up things like social group activities to help with mental health.  

 

I am seeing Medicare beneficiaries loving their newfound process of care - total care.

 

As with anything that is creative and innovative in health care (casting a wide net) - the final measure is to see if it works for the beneficiaries, their health within a reasonable cost.  IOW, being effective.

 

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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May I suggest you read the New York Times ' The Cash Monster Was Insatiable':How Insurers Exploited Medicare for Billions, October 8, 2022. It reviews dozens of fraud lawsuits, inspector general audits and investigations by watchdogs to show how major Medicare Advantage health insurers exploited the program to inflate their profits by billions of dollars.

 

 https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud- allegations.html 

Honored Social Butterfly

I hope you realize that the Advantage programs cost more than normal Medicare. The govt paid carriers 15%more than it cost Medicare to provide the same coverage. That has decreased some and I think it might be as low as 10% now. If you want to control medicare costs reduce that to 0 and then talk about how good it is.

A lot of the extra benefits provided by the Carriers cost them nothing, and they use them with their group policies, and other policies. Dental can be one of them as there are many discount dental programs around. I have dental insurance through my former employer which they carried over to their Adv. plans. They have a 20% discount in the dental rate to start before they apply the insurance savings. Gym membership is another big discount program they use. 

Lets take the 20% to zero and see what happens.

Honored Social Butterfly

For those on Traditional Medicare - with or without a supplemental plan.

Medicare.gov - Coordinating Your Care

from the link:

 

Medicare wants to be sure that all doctors have the resources and information they need to coordinate your care. Coordinated care helps prevent:

  • Getting the same service more than once (when getting the services again isn't needed)
  • Medical errors
     

Medicare's coordinated care programs include:   [click on each type for a better definion of them from Medicare.gov]

Note

If your doctor participates in these programs, you can still see any doctor or health care provider who accepts Medicare. Nobody—not your doctor, not anyone—can tell you who you have to see. Your Medicare benefits will also stay the same.

 

For those on a Medicare Advantage plan who participates in one of these Coordination of Care program - networks still apply.

 

They may be an option for you -

If you have a chronic disease and especially if you are in an underserved area, these programs may give you some extra needed benefits - like transportation to/from appointments, inhouse labs and other diagnostic test, counseling services for you, your family or caregiver on your care and chronic condition, a visiting health nurse to monitor your progress and your condition after being released from a care facility like a hospital or SNF.  Some of these may also waive the 3-night hospitalization rule to qualify the beneficiary for rehab in a SNF.

 

Coordination of Care is important especially when a beneficiary is trying to manage a chronic condition alone or with other health conditions.  

Talk to your doctor especially if your doctor is going to participate in one of these type programs.

You (or your designated representative) can make your own decision as to the care you think is the best for you and your condition.

 

 

 

It's Always Something . . . . Roseanna Roseannadanna
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 Privatization brings large profits for the private medical providers and a contraction of choices and quality.  The primary motivation is to create a good return to shareholders, more wealth for a few, not the best healthcare to patients.  Healthcare should not be run in a for-profit model.  Medicare is run very efficiently.  Nothing is perfect.  Fix what needs fixing under the current model.

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