I have no problem using my MA plan as a snowbird in NY or FL. Spent 4 decades in healthcare and neither is perfect, and both have issues. The biggest problem we had with Medicare, MA, and private insurance was the SLOOWWWW play. It often seems like the deny claims for as long as possible so they can hold onto money longer and gain interest, etc. Then there's the Medicare RAC audits which cover many years, they start out claiming you own a ton of money from overpayments, etc., and if you did your paperwork right, you end up owing little to nothing!!! If you don't keep your paper straight, you pay BIG!!! The main difference between Medicare and MA is Medicare doesn't require preauthorization and MA's sometimes do but they still cover the same things. MA are required to cover whatever Medicare covers, but they through in dental, vision, etc. as inducements. Medicare and MA generally use the same guidelines for what is and is not covered, e.g. if Medicare won't authorize a procedure for something, chances are good MA won't either; that's just the way it works. So, what's the fix? I suspect it'll end up being Case Rate, no more prior authorization, etc., e.g. stage IIB lung cancer and you (hospital, clinic, etc.) get paid $60k and the care which they and the patient pick. I would like to see legislation for prompt pay, but insurance companies have generally shot it down. Slow pay cases should include significant interest as a penalty.
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