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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 11 of 22

rker321

Perhaps I can shed  a little light on this although I didn't start the thread.

 

We hear from the left, mostly, that the Medicare program pays more to Medicare Advantage plans than what they spend in the traditional program per beneficiary.

Since inception of Medicare Part C, in the 90's, there have been several reasons for this.  To name a few -

1.  To prevent adverse selection of beneficiaries.  That is to say, to keep relatively healthy beneficiaries from choosing a MA plan only to switch to traditional Medicare when they get sick and need lots of care.

2.  To encourage MA insurers to stay in certain marketplaces, specifically in some rural areas where there are fewer providers and health care cost are higher.

 

You see government has limited ways to encourage certain behavior, money enticement being the greatest.

 

In trying to explain byrondennis's original post, another reason why some insurers were paid more was because some Union and employer retiree plans were mixed into this mix of MA insurers, known as groups plans.  So even though these group plans had somewhat of a captive market, they were figuring their plans just like those in the individual MA marketplace and were given these advantages of payments.

 

Most of these type group plans are concentrated in certain heavy unionized state.  Michigan being one of several.  You can reference my KFF link which I posted in this thread if you need a more detailed explanation.

 

This bonus money to these group plans has been known for several years.  MEDPAC has included this in their review of Medicare cost containment for several years.  So it seems that many politicians on the left wanted to cut the amount that was paid per beneficiary to the INDIVIDUAL MA marketplace insurers, they resisted any cost modifications to these GROUP MA plans because of pressure from their union/employer base.

 

In 2016, CMS decided to change how these group plans were paid at much displeasure from these unions and employers with retiree MA GROUP coverage.

These payments per beneficiary whether in the group or individual MA marketplace help to keep down the premiums paid by the beneficiary.  The changes to these group plans are to take place this year (2017) and in (2018).

 

Now how this change in payment model will affect retirees in these group MA plans, I don't know for sure - their premiums could rise or some extra (outside of specific Medicare benefit coverage) benefits might be modified or dropped - but this should place these plans on a more even stance with those MA plans in the individual MA marketplace.

 

I have tried to explain this to my understanding as simply as I can, just hitting the highlights, without links which you requested.

 

 


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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 12 of 22

Gee,   what a disaster of a thread.

I still would like an answer to the topic of this thread. As to why I should hate my Medicare Advantage plan.

And please don't tell me to go anywhere and research whomever put out this topic has the responsibility to explain in lay terms to all.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 13 of 22

byrondennis 

Seems within the Medicare Advantage analysis which Kaiser Family Foundation does each year, they say something similar to Modern Healthcare but it seems that Medicare has just slowed the process of implementing from one year to two years.

 

Per KFF

KFF Medicare Advantage 2016 Spotlight: Enrollment Market Update

"While the national share of Medicare Advantage enrollees in group plans has never been very large, in some states, the share of Medicare Advantage enrollees in group plans is much larger than average, including West Virginia (54%), Michigan (49%), Kentucky (41%), Illinois (41%), and Maryland (31%). In Ohio, enrollment in group plans dropped between 2015 and 2016, due to the Ohio Public Employees Retirement System’s decision to terminate its group Medicare Advantage plan, and instead provide a defined contribution that its retirees can use to help pay for an individual Medicare Advantage, Medigap, or other Medicare supplement plan.

 

Historically, group Medicare Advantage plans have received higher Medicare payments, on average, than plans in the individual Medicare Advantage market. However beginning in 2017, CMS will be changing its payment methodology for group plans with the goal of more closely aligning payments with the average individual plan bid. This change will be fully phased-in by 2018 and is expected to lower payments to group plans as the Medicare Payment Advisory Commission (MedPAC) has recommended in the past."

 

 The final ruling is to be issued tomorrow as to how this change will work 

per this 02/01/2017 Modern Healthcare article (at the very bottom of the article)

 

http://www.modernhealthcare.com/article/20170201/NEWS/170209988

Lefties are sticking together -

 

"AHIP, President and CEO, Marilyn Tavenner,had said the policy had the potential to disrupt care for the more than 3.6 million beneficiaries enrolled in these plans."

 

Disrupt Care ????????????

 

 

 


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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 14 of 22

@mickstuder wrote:


I need to apologize in advance for being a Tad off topic - But Just Curious..............................I'm not Bright enough to understand most of the major points in this Post - But

 

Are you speaking - "in the First Person" - either Singular or Plural when you write?

 

1. "are only for cutting the public Part C Medicare Advantage plans poor people like me can buy."

 

2. "the sweet deal union members get that the rest of us poor people are not eligible for."

 

3. "roughly divided between those for we real people and those the left has rigged in its favor."

 

 Again, Just Curious - because I read somewhere that the Average Household Income if you combine all the cities & towns on Cape Cod is - $85,000

 

AND

 

The Average Household Income for all cities & towns in Massachusetts is $68,000 and in fact according to my modest research there are only 6 States out of all 50 where the average household income is higher then Massachusetts

 

Where I come those incomes are not considered POOR

 

And these numbers are from 2010..........................

  


Huh? "Me" is first person singular and "we" is first person plural. Is that your question?

 

Your Cape Cod (and Massachusetts) averages look way wrong but since you provide no source (like almost everyone on this comment board), it's kind of hard to tell you why. Most important are they indexed to cost of living?

 

You're off by 50% or so according to the local Patch (see https://patch.com/massachusetts/beaconhill/heres-what-new-census-data-says-household-incomes-massach...) but I would not put much faith in that information either. Tens of thousands of very rich legal residents of Cape Cod live 6 months a year in Florida and Arizona or somewhere else warm (or go there for three months). Take them out of the average (and out of other demographic measurements like people per square mile, etc.) and you find the rest of us on Cape Cod to be relatively rural and poor... It's not Appalachia mind you... you find that in the Berkshires of Massachusetts when those New York City people go back to Manahattan in September.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 15 of 22

@GailL1 wrote:

In April 2016, CMS issued a new payment methodology for those Medicare Employer Retiree Medicare Advantage Plans to make the payment disbursement fairer.

 

This was to be effective for this year, 2017.  I assume nothing changed to prevent it from moving forward although the unions did gripe about it.  They have been getting a sweet deal.

 

CMS 04/2016 Newsroom Release -Medicare Advantage Payments to Medicare Employer Retiree Plans

 

As I understand it, from reading this release, Medicare Advantage insurers will now bid for these employer based (Union) plans and these cost will be figured as normal Medicare Advantage plans are now.

 

Is that the way you understand it, byrondennis?


Gail

 

That was my understanding but I saw this article in ModernHealthcare recently which said the opposite (or at least something quite different). I asked the ModernHealthcare journalsit about why his understanding was different than mine (obviously he does this stuff full time so I tend to go with what he says) and this was his reply:

 

  • "For 2017 half of these plans were cut. Last year, they said they wanted all such plans to be cut in 2018. Now they are saying we are taking comments on if we should  hold it at 2017 breakdown which only said half would be cut."

Apparently far leftists like Dingell (and I assume -- like last year -- the Acorn union, SEIU) are objecting to any further cuts. Whichever, the left has cheated me for years and wants to keep cheating me.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 16 of 22

@byrondennis wrote:

Every far leftist in the country -- starting with former President Obama -- repeats the lie over and over that public Part C Medicare Advantage plans cost the government much more per person than traditional fee for service (FFS) Medicare costs per person. Here's Obama telling the lie (see Note). Here's Minority Leader Pelosi (when she was Speaker). Here's Hillary Clinton (even though Bill signed the Medicare health plan program into law). Here's John Dingell. (You won't find Chuck Shumer saying it because he won a Medicare Advantage award from the insnurance industry.) 

dingell.jpg

 

Now why would I include John Dingell, some Congressperson few have ever heard of, in that litanty of far leftist saints. That's because the Dingells -- who have been sent to Congress by Michigan for three generations (I know the Congresswoman is John's wife but she is a different generation) -- are only for cutting the public Part C Medicare Advantage plans poor people like me can buy. As this recent letter shows, the Dingells are against cutting the leftist Medicare Advantage, the sweet deal union members get that the rest of us poor people are not eligible for. The big leftist lie in all Medicare reform debates is that they leave out the fact that there are really mutliple Medicares, roughly divided between those for we real people and those the left has rigged in its favor.partcpercent.jpg 

So when the left lies and claims that public Part C Medicare Advantage plans cost the government much more per person than traditional fee for service (FFS) Medicare costs per person we find out two things:

  • Part C does not cost much more per person. Over its history, given the number of people using Part C now versus the number using Part C one or two decades ago, the program costs less per person (while delivering much better insurance and almost half the price) 
  • But there is a part of Part C that does cost substantially more per person. It is a special deal (called the Employer Group Waiver Plans program) that was primarily put in for unions (see any of MedPAC's annual reports to Congress, page 359 in this year's version). This is the part of Medicare Advantage leftists like the Dingells love.

NOTE: This speech is one of the places where Obama also told his fib about his mother's health insurance and her eventually fatal cancer. In this speech, Obama pulled a Clintonian "it all depends on what the definition of is is" and didn't claim she was refused insurance because of a pre-existing condition. Instead Obama just said that his mother was "worried about being refused." In reality, according to Politifact quoting the New York Times, she never had any issue with her health insurance. 


I need to apologize in advance for being a Tad off topic - But

 

Just Curious..............................I'm not Bright enough to understand most of the major points in this Post - But

 

Are you speaking - "in the First Person" - either Singular or Plural when you write?

 

1. "are only for cutting the public Part C Medicare Advantage plans poor people like me can buy."

 

2. "the sweet deal union members get that the rest of us poor people are not eligible for."

 

3. "roughly divided between those for we real people and those the left has rigged in its favor."

 

 Again, Just Curious - because I read somewhere that the Average Household Income if you combine all the cities & towns on Cape Cod is - $85,000

 

AND

 

The Average Household Income for all cities & towns in Massachusetts is $68,000 and in fact according to my modest research there are only 6 States out of all 50 where the average household income is higher then Massachusetts

 

Where I come those incomes are not considered POOR

 

And these numbers are from 2010..........................

 

 

 

 

 

 

 

 

( " China if You're Listening - Get Trumps Tax Returns " )

" )
" - Anonymous

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 17 of 22

@GailL1 wrote:

In April 2016, CMS issued a new payment methodology for those Medicare Employer Retiree Medicare Advantage Plans to make the payment disbursement fairer.

 

This was to be effective for this year, 2017.  I assume nothing changed to prevent it from moving forward although the unions did gripe about it.  They have been getting a sweet deal.

 

CMS 04/2016 Newsroom Release -Medicare Advantage Payments to Medicare Employer Retiree Plans

 

As I understand it, from reading this release, Medicare Advantage insurers will now bid for these employer based (Union) plans and these cost will be figured as normal Medicare Advantage plans are now.

 

Is that the way you understand it, byrondennis?

 

 


There are quite a few good places one can go to learn the subject and how to fit them altogether. He might start with his local AARP Office as I am sure they can point him to one in his area. I would suggest the same thing to anyone who relies only on what they read in an article and think that reflects the total effect on health care rather than looking further to see how all the various parts fit in with each other. To make matters worse a lot of people who do not understand the subject want to give advice to others on what they should do, and when they do that they can hurt a lot of people.

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 18 of 22

Gail, the poster that you are asking that question posted a convoluted post that people that are not verse in the Health Insurance system is very difficult to understand.

He is saying as to why I should hate my  advantage health insurance. so. why should I?

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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 19 of 22

In April 2016, CMS issued a new payment methodology for those Medicare Employer Retiree Medicare Advantage Plans to make the payment disbursement fairer.

 

This was to be effective for this year, 2017.  I assume nothing changed to prevent it from moving forward although the unions did gripe about it.  They have been getting a sweet deal.

 

CMS 04/2016 Newsroom Release -Medicare Advantage Payments to Medicare Employer Retiree Plans

 

As I understand it, from reading this release, Medicare Advantage insurers will now bid for these employer based (Union) plans and these cost will be figured as normal Medicare Advantage plans are now.

 

Is that the way you understand it, byrondennis?

 

 


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Re: Leftists Hate Medicare Advantage Except for the Leftist Medicare Advantage

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Message 20 of 22

Sooo now the Right is claiming the Private Sector controlled Part C  (Medicare Advantage) is less attractive than what the nasty, inefficient Government has to offer, and it's the DEMOCRATS fault, even when GOPers control the Government?

 

Fact is, the cost per person decrease for Medicare Advantage is because President Obama stopped allowing the medical service providers to charge Medicare Advantage up to 135% of reasonable and proper compensation for a number of procedures. Now they only get 100% of the reasonable and proper reimbursement, and the decline in costs below the FFS rate is because they don't offer the same coverage.

 

If that's really a problem, switch back from Medicare Advantage next open season,but in the meantime, stop pretending the Medicare Advantage is a better deal because somehow it's less Government.

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