STATNEWS: Health insurers are painting a misleading picture of Medicare Advantage savings, experts s

[SheltieLover]

https://www.statnews.com/2022/09/26/medicare-advantage-report-misleading-experts-say/

The health insurance industry is continuing its campaign to convince the public that Medicare Advantage saves taxpayers money, but experts say federal data still concludes the exact opposite — and that the program as currently designed is a drain on Medicare’s trust fund.

More at link. Apologies I cannot seem to copy more.

[Timewas]

1. tried it

Several years ago and my bills for any services were way higher under an advantage plan than straight medicare and the advantage plan cost more when all numbers were in than medicare by itself.

[SheltieLover]

6. Ty for sharing!

Your experience is pretty common from what I've read.

[Ms. Toad]

2. I've actually been impressed at the pushback this year - unlike last year when everything I saw

was pushing Medicare Advantage.

[jimfields33]

12. I wonder if the Democratic Party should add this to their platform?

Ban Medicare advantage and force everybody back onto traditional Medicare. That might just get us the additional seats we need to keep the majority in the House.

[Ms. Toad]

14. Given the pushback here from Democrats who believe Medicare Advantage is a better option -

(largely because of it's zero premium and/or cash-back options, plus a lot of misunderstanding about Medicare Supplement plans), I think it might actually lose us seats. Take a look at some of the threads touting either original Medicare, or Medicare Advantage. You will find a ton of misinformation out there about original Medicare - which I have corrected more times than I can count - and they are not only not budging, they continue to post wildly inaccurate information about the costs of Medicare - and how much better the plans used to be (they weren't).

So I'd push first for creating a comprehensive source for accurate information, written at a 5th-6th grade level.

The long-term consequences of starting with Medicare Advantage are not clear even to people who teach administrative law, contracts, and have at least college + JD. Three of us retired this year - each of us initially made at least one significant error along the way. I spent about 200 hours doing the research and making my choice. A second hired an agent who sells multiple plans to advise him. The third shot from the hip. Fortunately, for the first wo of us, the errors didn't cost us anythihng. I'm afraid the third is now in a Medicare Advantage plan, which she believes is not one. If she develops a chronic illness, it will cost her a lot.

We have a lot of advertising hype to overcome before banning Medicare Advantage will help, rather than hurt, the party that pushes it.

[ProfessorGAC]

30. We Both Went Nedicare & A Supplemental

The advantage plans are too network based & it seemed like more red tape.
We've had no issues at all with traditional Medicare & a supplement plan.
Admittedly, I've only been Medicare eligible for a year, but my wife's disability made her elig8ble 7 or 8 years ago.
I just have suspicions about Advantage because of how hard the insurers push it.

[Ms. Toad]

31. You are right to be suspicious -

They push what makes money for them.

Your wife might have been better off with a MA plan. My BIL is in that situation - until 65, the supplement folks don't have to issue you a policy, and if they do they can charge you an arm and a leg for it. (Some states may have rules that prohibit that kind of price gouging - but not Ohio.) Once you age into Medicare, you have guaranteed issue, and a community rating for premiums.

I've run into a few quirks, but it's largely just (1) learning a new system or (2) stupid providers who can't bill the right folks.

The only thing I thought might be major turned out not to be. I was hospitalized, but classified as under observation even though I was there for far longer than 24 hours. Because of that classification Part B covered it, rather than Part A. That throws drug coverage into a tizzy. Anything you can self-administer is covered by your Part D plan - so all of my routine meds were rejected by Part B. I was afraid I'd have to jump through major hoops to get them covered (or pay an arm and a leg), but they took care of it behind the scenes and I didn't have to pay a penny.

Otherwise - I pay my monthly premiums, and paid $233 way back in January. Everything else is "free."

[ProfessorGAC]

33. She's Over 65 Now

So, disability rules no longer apply.
But, she went this route when I was covering myself with an individual plan (after one quarter on plan from the company & 18 months of COBRA upon retirement).
It was the best deal financially & we're not eligible for any subsidies under ACA. (Income is too high for that.)
We're very pleased with our plans.
I still don't get why Medicare never covered dental. It's not like seniors don't need dental care.
But, we have a plan for that, too.
Oh, and; we both have a PDP. Right now I don't benefit much from it (my meds are cheap at retail), but my wife's plan is a big net positive.

[Ms. Toad]

34. We're buying most of our drugs outside of the plan.

We're saving about $1000/year buying them at Costco. Their standard drug prices for over half of our drugs are cheaper than the most economical plan (overall). That may change for my spouse for next year. She was just put on Jardiance - on her current plan, it will drop her into the donut hole, and she'll emerge out the other side before the end of the year (and the Costco/GoodRx prices aren't much of a break. We're about to shop for next year's plan - looking for something which puts the total cost for Jardiance at under the donut hole limit for the year (ballpark $4,400). We may not find one. But there's only one more year to worry about drug costs after emerging from the donut hole, and two more years to worry about the donut hole at all.

[ProfessorGAC]

35. Yeah, That's Steep

My meds are more like $40-50 retail for 90 days. I pay $8-12.

[Ms. Toad]

36. My total medication costs for the year are about $150.

The insurance costs about the same.

My spouse's, on the other hand, are about $550/year - befrore Jardiance. Jardiance costs about $550/month - so at about 6 months she'll drop into the donut hole on her current plan. (Her share before the donut hole is $49/month - but the donut hole threshold counts both the insurer's and our costs - so we'll be looking for an insurance company which has negotiated a monthly total cost in the range of $350.)

[Demsrule86]

42. No it wouldn't. Plenty of people like their Advantage plans and forcing them back on what is

a more expensive plan that reduces coverage will not help us win anything.

[spanone]

3. 'Medicare' should not allow the insurance companies to use the 'Medicare' name in ads.

It's misleading.

[underpants]

4. Good point.

I’d guess they made sure they could when W got his health legislation thru. The donut hole.

[SheltieLover]

7. I agree!

[Ms. Toad]

15. Unfortunately, all of those plans are actually under the Medicare umbrella.

The formal name for Medicare Advantage is Medicare Part C. (And original medicare is typically Medicare parts A & B with a Medicare supplement.)

Both the Medicare Advantage plan and the Medicare Supplement plans are regulated are governed by Medicare law.

The difference is that Medicare Supplement (part of original Medicare) offers a few clearly defined, limited versions of coverage of the portion not paid by Medicare. Insurance companies have zero leeway to refuse to pay, demand prep-authorization, etc. If Medicare pays the claim, Medicare Supplement pays the prescribed amount the plan requires. E.g. ours pays every penny except for the annual deductible of (this year) $233. Essentially - the insurance company just writes the check to the provider.

Medicare Advantage, in contrast, acts pretty much like a standared insurance company (denying claims, requiring pre-authorization, limiting geographic regions, , requiring exhorbitant out-of-pocket expenses.

But - whether we like it or not, the Medicare Advantage plansy are Medicare (part C) plans - and they are required by law to label themselves Medicare Advantage (or Medicare part C).

[GoodRaisin]

40. Well, they are allowed to do the same thing other advertisers do in their ads.

Lie.

[Samrob]

5. Actually, the Feds should stop them from using Medicare in their ads. They are not government.

My Aetna agent explained it all to me when I asked questions about it thinking I might sign up. It may not be a "scam" but it really is not what they lead you believe they are. AND you lose some Medicare benefits by signing up,

[SheltieLover]

8. Sounds awful but they sure advertise a lot!

Thx for sharing!

[chriscan64]

22. We get swamped with those annoying commercials.

The part that infuriates me the most is when they use the phrase "Adds money back to your Social Security check." In reality it is a reimbursement for premiums you have paid, but the words "adds money" make it sound like a bonus. Nobody says, "adds money back". It's like plus minus. It is designed to sound like they said, "adds money to your Social Security check." It crosses the line of ethics and stays just inside the line of legality.

[SheltieLover]

23. And during enrolment period the mailers...

[PoindexterOglethorpe]

11. Exactly what Medicare benefits do you lose by signing up for

an Advantage Plan?

[Ms. Toad]

17. The right to have all but 20% of your costs covered.

The right to coverage anywhere in the United States.

The right to go to any doctor you choose (anywhere in the US), without any referrals at all.

The right to coverage for tests which typically require pre-authorization, no questions asked (E.g. MRIs, expensive genetic testing, etc.)

The right to a guaranteed-issue, community rated premium. (i.e. the right to purchase a plan at all, and the right to have the premium for that plan based on the community health - rather than your own.

Just to name a few off the top of my head.

[PoindexterOglethorpe]

28. I don't seem to have given up any of those things.

[Ms. Toad]

32. Unless you are in a state which provides an exception,

you certainly gave up the last - the right to guaranteed issue, community rated premium for a supplement. If you try to switch to original medicare now, in all but a few states (I only know of a limited exception in one state), the insurance company can flat out reject you. If they don't reject you, they can charge you an arm and a leg.

You also almost certainly gave up the 2nd (the right to go to any doctor in any state). Virtually all MA plans are geographically limited, and many have a limted network.

Most also require pre-approval for certain things (MRIs are one such thing for which pre-approval is nearly always required). Medicare requires none.

[Ms. Toad]

20. While they are not issued by the government - they are regulated as a Medicare Part C plan,

(and sometimes Part D) and have to follow those rules.

Both orginal Medicare (Medicare Parts A, B, and a Medicare Supplement Plan) and Medicare Advantage (Part C) are a hybrid of government and insurance benefits.

Medicare Supplement Plans (which cover part or all of the 20% not covered by Medicare) are issued by insurance companies. They have very litle leeway - there are a limited number of plans (identified by letters designating standard coverage). They can charge what the market will bear, but essentially they get information from Medicare as to whether the charge was covered and, if so, they pay the prescribed portion of the remainder. For the plan I chose, that means they pay everything after the annual deductible. For other plans, you may be required to pay a co-pay for office visits, or a coinsurance portion of the remaining 20%.

Medicare Advantage plans include a limited version of what would have been covered by Medicare, and all of your care is managed by the insurance company including, some times, drug coverage. They are allowed to limit your coverage (either by geography or by provider). While they are required to cover the same treatments, they are allowed to impose their underwriters between you and the provider - which can delay urgently needed treatment. If my doctor, for example, decides I need an MRI, Medicare pays for it. No questions asked. If a Medicare Advantage doctor decides I need an MRI, the insurance company goes through its standard approval process. Same for treatment for fast-moving cancer. If I need to see a super-specialist for my sarcoma (My variety is 1/50th of 1% of all cancers - i.e. very rare, and seeing one of perhaps 25 high volume treatment centers in the US is widely viewed as the difference between survival or not) in Texas (the best treatment center), I pick up the phone and make an appointment. A Medicare Advantage patient can be denied treatment by that high volume center, or run through the standard ringer to be able to see an out-of-state, out-of-network provider. Because of all of these limitations, Medicare Advantage plans can be cash cows for the insurers.

[keithbvadu2]

9. DU has had some discussions on Medicare Advantage.

DU has had some discussions on Medicare Advantage.
.
https://www.democraticunderground.com/100216622964

Katie Porter leads letter urging Biden not to dump more money into Medicare Advantage

After reading up on it, MA is more of a HMO and it was less risky to pay the Part B for better coverage.

https://www.democraticunderground.com/10142909182

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds
---------
https://www.democraticunderground.com/1017732643

Get Medicare! No to Medicare Advantage. It's perfume-covered doo-doo that'll bankrupt or kill you.

https://egbertowillies.com/2022/04/30/get-medicare-no-to-medicare-advantage-its-perfume-covered-doo-doo-thatll-bankrupt-or-kill-you/
--------------------
https://www.democraticunderground.com/1261935
advice

[SheltieLover]

10. Ty for sharing!

I personally don't think it should be allowed if for no other reason than that these private ins companies charge Fed much more money.

I get ads all the time offering "free groceries," etc., etc.

[jimfields33]

43. I know seniors will get 150 bucks a month from the advantage grocery program

It keeps him from eating dog food. They seem grateful.

[Straw Man]

13. I'm kind of stuck with an Aetna Advantage plan ...

... because my employer picked up the cost for me as a retirement incentive. So ... watching with interest.

[William769]

16. Medicare Advantage savings is just like the Republican party.

They get what you're paying for.

[Demsrule86]

24. I have a WellCare Advantage plan that I like. It covers $100.00 of my Part B, and

has covered all my covid-related illnesses...for example, I spent 8 days in the hospital, had multiple cardiac tests including a nuclear stress test, sleep apnea test, ultrasound of the heart, more bloodwork than I thought possible...wore a cardiac monitor for two weeks. I also got glasses, generic prescriptions are free, my Eliquis since Covid left me with A-Fib is $30 a month (over $500.00 medication), had my hearing tested, and have coverage go for gyms.

I simply could not afford the original medicare. My husband is not eligible for Social Security yet, he has been laid off for months with spinal issues, we are going for disability but so far have been turned down. We are living off of savings. I had planned to go back to work this year but unfortunately, I caught Covid and it was a bad case. I would have paid a premium original Medicare, had to get pharmacy coverage which is expensive, and paid out-of-pocket costs, Plus $100. more for plan B. I pay no premiums with the Advantage plan. You can't just use Medicare, you need a wrap plan which is private insurance as well so I don't see the difference really. I would not have health care if I had to go with original Medicare. I simply couldn't afford it. And I am not the only one in this situation. It is unfortunate.

[Demsrule86]

25. I have received excellent care with my Advantage plan...I can see benefits in both.

[dalton99a]

18. Kick

[former9thward]

19. Who are the "experts" saying this?

I went to the link and there is nothing about the "experts".

[Ron Green]

21. A single risk pool is a health care system. Multiple risk pools is an investment scheme.

We have enough investment schemes in this country; we need a health care system.

“Medicare advantage” “plans” are private insurance policies marketed with the theft of the word “Medicare.” They’re based on a lie, and designed to move taxpayer money into (wealthy) private hands.

[Demsrule86]

26. Well since one needs a wrap plan which is run by insurance companies...how is it different?

[Ron Green]

27. The insurance companies are totally unnecessary;

if we see medical care as a commodity, it’s different from if we see it as a right.

[Demsrule86]

29. Original Medicare uses insurance companies for wraps. Maybe that should change but I doubt it

will.

[Ron Green]

39. Of course it never will. This country doesn't have enough political will to run

real passenger trains, much less have universal health care.

[Demsrule86]

41. I get the differences between original and Advantage but the both use insurance and Original

would have cost me quite a bit more than the advantage plan. I think we should have some sort of plan that covers everyone...all ages. The ACA can be used to get there eventually.

[Ron Green]

44. Hence my first post: One Risk Pool.

Everybody in, nobody out.

It’s not rocket science; it just values people over profit.

[Celerity]

37. Medicare Advantage Is a Massive Scam

The program rips off both the taxpayer and its own enrollees.

https://prospect.org/health/medicare-advantage-is-a-massive-scam/



If you’ve ever watched cable news, where the average viewer is in their late sixties, you’ve probably seen an advertisement for a Medicare Advantage plan. They usually star some washed-up celebrity whose career peaked right around when today’s retirees were young adults (think Jimmy Walker or Joe Namath). And they always make a lot of big promises about how great Medicare Advantage coverage is. There’s just one problem: The sales pitch is an abject lie. Medicare Advantage is much worse than traditional Medicare for people on the program and costs a great deal more to boot. But unless the Biden administration changes course, private companies will soon devour the rest of the program.

Medicare Advantage plans are typically a combination of “Medigap” plans, which cover services not included in the government plan like vision and dental, plus a privatized version of traditional Medicare. About 28 million American seniors are now on Advantage plans, or about 40 percent of the whole program. As Barbara Caress explains in the Prospect, it was set up back in the late 1990s as a way for those wonderful private insurance companies we all know and love to work their free-market magic on one corner of the system America carved out as publicly run. Once we got business involved, surely the quality of coverage would improve and costs would go down, right?

The problem with this logic, as people realized even back in the glory days of neoliberalism, is that there are a lot of perverse financial incentives in health insurance, particularly when it comes to seniors. Half the reason the government set up Medicare in the first place was that as people reach the end of life, they tend to become sick and require more treatment than they can personally afford. In the pre-Medicare days, private companies did all they could to keep them off the insurance rolls.

Introducing the profit motive into Medicare has led to considerable hoop-jumping just to prevent such cravenness. For instance, if the government were to calculate the average per-person cost of Medicare and pay private companies that much per enrollee, companies would scramble to snap up all the younger, healthier seniors with relatively few problems, and cream off some easy profits. As Matt Bruenig explains, that’s why the Centers for Medicare & Medicaid Services maintains a gigantic database of every single one of the roughly 64 million Medicare enrollees, and assigns them all a risk score based on their demographic and health characteristics. Advantage companies then get paid, in theory at least, according to how sick their risk pools are.

snip