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info about traditional Medicare vs Medicare Advantage plans

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Regular Contributor

info about traditional Medicare vs Medicare Advantage plans

Check out the website pnhp.org. AARP promotes United Healthcare for reportedly over $800 million in revenue so they are unlikely to provide seniors with the info that is on this site. For example:

Medicare Advantage: Bad for Patients, Great for Profiteers
Medicare Part C, also known as Medicare Advantage or MA, is a
privately administered program in which the federal government
gives a regular lump sum of money to a third party (generally a
commercial insurer) to “manage” patient care. This is radically
different from the way Traditional Medicare (TM) pays providers,
and gives the insurers running MA an irresistible financial incentive
to delay, deny, and otherwise skimp on care.
MA is growing, to the detriment of patients everywhere.
Although the program has existed since 2003, it has expanded
enrollment significantly in the past decade. This year, Medicare
reached an alarming milestone, as data confirmed that more than
50% of all Medicare beneficiaries were enrolled in an MA plan.

Honored Social Butterfly

Why exactly do you think Medicare Advantage plans were built into the Medicare program as Part C Medicare?  

They were offered as an alternative manner of getting ones benefits and to protect the beneficiary from any medical financial difficulties.

 

MA plans offer a financially feasible Medicare plan for seniors who don’t want or can’t afford a Medigap plan which attaches to the Traditional Medicare program to help with the out of pocket cost a beneficiary has in the Traditional program.

 

See what happens when a senior has Traditional Medicare WITHOUT a Medigap plan attached to it or they aren’t dual eligible.( Medicare/Medicaid)

 

MA plans are managed care plans and most of the seniors that pick getting their benefits this way, like them and learn how they work - plus if one finds out they don’t like one, they can switch to another insurer or type plan.

 

MAPD plans will continue to grow within Medicare in participation -  

 

Came back to edit and add:  Traditional an MA plans both cover the same things - just in a different processing way.  MA plans do watch their claims closer because they are managed care - but if a treatment, test, lab, image, etc isn’t covered on a MA plan then neither is it covered under Traditional Medicare.  

That’s why we have National Coverage Determinations and MA plans use this too.

CMS.gov - Medicare Coverage Determination Process

 

If you or others have a problem with the way MAPD work - then contact CMS / HHS or the Legislature - BECAUSE THEY CONTROL THEM - the government makes the rules which these MA insurers have to follow.

 

It's Always Something . . . . Roseanna Roseannadanna
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Regular Contributor

Government approved these plans thanks to lobbying efforts by the insurance companies that wrote the rules to benefit their bottom line, not to benefit seniors. A medigap policy is necessary to cover the 20% that traditional Medicare does not cover. Seniors who choose traditional Medicare do need to be aware of this. They also need to be aware of the downsides to Medicare Advantage plans which the marketing ads they see on TV do not disclose. Seniors need information so they can choose what is best for them. Unfortunately, seniors cannot depend on either AARP or the insurance companies to provide that information.

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