Medicare Advantage takes another big hit

[RVRoadie]

Just got my Florida Blue Medicare Advantage plan for 2016.

Tier 1 drug copays (used to be $0) go from $5 to $14 per month. Similar increases in the rest of the schedule.

Specialist copay goes from $35 to $50.

Killing Medicare Advantage was one of the goals of the ACA, and this administration is well on their way to meeting that goal.

Time for me to to go back to the VA.

[2BNTV]

I noticed the increases too, so I will be searching for a better Medicare Advantage Plan

SS book just arrived and CarePlus, (HMO), has a 88% member approval rating.

Preferred Care Partners, (HMO), has a 86% member approval rating.

FL Blue, (HMO), has a 81% member approval rating. FL Blue may have to go and if my doctor is not covered in the other plan I select, so be it.

There's always UHC, if one wants to stay in TV network, of doctors.

Research, research, research, needs to be done to get a better plan with a competent PCP.

[delima2000]

Humana prescription drugs part d also went up per monthly payments. Mine was 15.00 and some change to 18.00 and some change. Deductable also,went up

[gomoho]

Would be interested to hear if and how much the supplements went up.

[sirknor]

These plans change every year. That's why they have a period to change. United healthcare has very minor changes for 2016. Some are better. Now no cost for hearing exam. Check it out. Stay flexible and get the best plan for you.

[Villager Joyce]

These plans change every year. That's why they have a period to change. United healthcare has very minor changes for 2016. Some are better. Now no cost for hearing exam. Check it out. Stay flexible and get the best plan for you.

You nailed it.

[dillywho]

The biggest problem I see with the drug increases is that they are absolutely unnecessary. The same goes for drug costs, period. Thank the drug companies for that one. Drug companies try to justify their pricing by claiming they need to pay for research. Practically every commercial break on TV is touting some drug; the same for magazines. How is that paying for research? They could do a multitude of research with the money they spend on that! All those ads are not cheap and we, the consumer, are paying for it with our dollars; sometimes with our health. If your doctor does not "know if xxdrug is right for you", then maybe it's time to find another doctor.

As for HMO's, I will never participate in another if there is anyway to avoid it. I do not want any doctor telling me that I cannot go to a specialist or which one I have to use if I do get "permission". Many times with those, it is not even the doctor but some insurance person making the decision. I had that experience back home when I retired and had to go the HMO route since I was still eligible for company insurance and too young for Medicare. My doctor knew how to beat them at their own game, though. Long story short, they denied an MRI. When he called back to have me admitted to the hospital in order to isolate my problem, they did an about-face and I got the MRI as out-patient. Fancy that!

We are enrolled in PPO's and can stay in network or go out, our choice. I am willing to pay a little more to get the doctors and care I want without having to go the "Mother, may I?" route.

[blueash]

When Medicare Advantage plans were introduced they were promoted as a way to save the Medicare plan money. They would only have in network quality doctors, hospitals and labs and do things to encourage patients to stay healthy. The advantage plan was paid a monthly amount from the government and whatever savings they generated was bonus for the carrier. The system was adjusted over 10 years ago with the payments to the Advantage plans increased. By 2009 the average Medicare advantage patient was costing the government 14% more than a person on traditional Medicare. That is a HUGE amount of money. So the promise that the Advantage plans would save Medicare money became completely disproven. The law was changed so that over the next several years the advantage plan must come in line with the traditional plan cost. This can be done by increasing cost to the consumer, decreasing expenses by narrowing networks or doctor/hospital/lab payments, decreasing overhead, cutting CEO pay (never) or however the Advantage plan chooses, but they must get their costs in line with traditional Medicare costs. The ACA also requires the carrier to spend at least 85% of the premium on medical costs and gives bonus payments for companies with high quality ratings. While certainly everyone would like to pay less and get more from their carrier, it is not the government's obligation to provide a better than Medicare plan at a higher cost to the taxpayer to those who want it.

[golfing eagles]

The biggest problem I see with the drug increases is that they are absolutely unnecessary. The same goes for drug costs, period. Thank the drug companies for that one. Drug companies try to justify their pricing by claiming they need to pay for research. Practically every commercial break on TV is touting some drug; the same for magazines. How is that paying for research? They could do a multitude of research with the money they spend on that! All those ads are not cheap and we, the consumer, are paying for it with our dollars; sometimes with our health. If your doctor does not "know if xxdrug is right for you", then maybe it's time to find another doctor.

As for HMO's, I will never participate in another if there is anyway to avoid it. I do not want any doctor telling me that I cannot go to a specialist or which one I have to use if I do get "permission". Many times with those, it is not even the doctor but some insurance person making the decision. I had that experience back home when I retired and had to go the HMO route since I was still eligible for company insurance and too young for Medicare. My doctor knew how to beat them at their own game, though. Long story short, they denied an MRI. When he called back to have me admitted to the hospital in order to isolate my problem, they did an about-face and I got the MRI as out-patient. Fancy that!

We are enrolled in PPO's and can stay in network or go out, our choice. I am willing to pay a little more to get the doctors and care I want without having to go the "Mother, may I?" route.

Unfortunately, it's not that simple. Beyond the TV advertising cost, there are armies of drug reps going from office to office touting their version of a drug is better than the other guy's, complete with incentives to influence the prescriber. However, like the old saying goes, you have to spend money to make money. The goal of all this product promotion is to increase sales, and since big pharmaceutical companies have astute business people in charge, I doubt they would be running their advertising at a loss. Remember, drug costs are incremental---it takes about $750 million to make the first pill, and then 1/100 of a cent for the rest. So sell 750 million pills---$1/pill, 7.5 billion pills--10 cents a pill. This results in lower costs to the consumer (even if you don't believe it) It's also good for the employees, the stockholder, and the economy if general. The cost that they cannot control is product liability. I'd like to know the advertising cost for "1-800-BAD-DRUG", because ultimately you are paying for that as well
Now before you think I'm in the drug companies pocket, no, far from it. They do some real slimy things, such as distribute their research, development and marketing costs across the domestic market only. This is why, prior to going generic, Lipitor cost $1.75/pill in the US, 0.84 in Canada and 0.38 in India. They then turn to Congress whenever price regulation comes up and plead poverty based on their R&D&Marketing costs. They also have a tendency to cherry pick their data, which may be why certain drugs get yanked within months of their original release.
But all that aside, we are far better off with the pharmacology of today than we were 50 years ago
As far as HMOs and insurance prior authorization for procedures goes, this is just a cost cutting measure. They will make me personally get on the phone with their medical director after denying a test. It takes time , but no biggie. I have never had a test denied after speaking to them. Either they already know the test is indicated and are just going thru the motions, or in many cases just don't know, in which case I'll talk over their heads for a while and they'll approve it.
As far a dentists go, they are not regulated to any degree and can charge whatever they want, so all you can do is find one that you trust

[golfing eagles]

When Medicare Advantage plans were introduced they were promoted as a way to save the Medicare plan money. They would only have in network quality doctors, hospitals and labs and do things to encourage patients to stay healthy. The advantage plan was paid a monthly amount from the government and whatever savings they generated was bonus for the carrier. The system was adjusted over 10 years ago with the payments to the Advantage plans increased. By 2009 the average Medicare advantage patient was costing the government 14% more than a person on traditional Medicare. That is a HUGE amount of money. So the promise that the Advantage plans would save Medicare money became completely disproven. The law was changed so that over the next several years the advantage plan must come in line with the traditional plan cost. This can be done by increasing cost to the consumer, decreasing expenses by narrowing networks or doctor/hospital/lab payments, decreasing overhead, cutting CEO pay (never) or however the Advantage plan chooses, but they must get their costs in line with traditional Medicare costs. The ACA also requires the carrier to spend at least 85% of the premium on medical costs and gives bonus payments for companies with high quality ratings. While certainly everyone would like to pay less and get more from their carrier, it is not the government's obligation to provide a better than Medicare plan at a higher cost to the taxpayer to those who want it.

Absolutely, positively, 100% on the mark. Now add to this the concept of 540 billion over the next 5-10 years being diverted from medicare, including advantage plans , to obamacare programs and these plans will be lucky to survive. Many "gurus" don't think they will

[CFrance]

When Medicare Advantage plans were introduced they were promoted as a way to save the Medicare plan money. They would only have in network quality doctors, hospitals and labs and do things to encourage patients to stay healthy. The advantage plan was paid a monthly amount from the government and whatever savings they generated was bonus for the carrier. The system was adjusted over 10 years ago with the payments to the Advantage plans increased. By 2009 the average Medicare advantage patient was costing the government 14% more than a person on traditional Medicare. That is a HUGE amount of money. So the promise that the Advantage plans would save Medicare money became completely disproven. The law was changed so that over the next several years the advantage plan must come in line with the traditional plan cost. This can be done by increasing cost to the consumer, decreasing expenses by narrowing networks or doctor/hospital/lab payments, decreasing overhead, cutting CEO pay (never) or however the Advantage plan chooses, but they must get their costs in line with traditional Medicare costs. The ACA also requires the carrier to spend at least 85% of the premium on medical costs and gives bonus payments for companies with high quality ratings. While certainly everyone would like to pay less and get more from their carrier, it is not the government's obligation to provide a better than Medicare plan at a higher cost to the taxpayer to those who want it.
Thank you for a good and true explanation. Hats off to you.

[dillywho]

Unfortunately, it's not that simple. Beyond the TV advertising cost, there are armies of drug reps going from office to office touting their version of a drug is better than the other guy's, complete with incentives to influence the prescriber. However, like the old saying goes, you have to spend money to make money. The goal of all this product promotion is to increase sales, and since big pharmaceutical companies have astute business people in charge, I doubt they would be running their advertising at a loss. Remember, drug costs are incremental---it takes about $750 million to make the first pill, and then 1/100 of a cent for the rest. So sell 750 million pills---$1/pill, 7.5 billion pills--10 cents a pill. This results in lower costs to the consumer (even if you don't believe it) It's also good for the employees, the stockholder, and the economy if general. The cost that they cannot control is product liability. I'd like to know the advertising cost for "1-800-BAD-DRUG", because ultimately you are paying for that as well
Now before you think I'm in the drug companies pocket, no, far from it. They do some real slimy things, such as distribute their research, development and marketing costs across the domestic market only. This is why, prior to going generic, Lipitor cost $1.75/pill in the US, 0.84 in Canada and 0.38 in India. They then turn to Congress whenever price regulation comes up and plead poverty based on their R&D&Marketing costs. They also have a tendency to cherry pick their data, which may be why certain drugs get yanked within months of their original release.
But all that aside, we are far better off with the pharmacology of today than we were 50 years ago
As far as HMOs and insurance prior authorization for procedures goes, this is just a cost cutting measure. They will make me personally get on the phone with their medical director after denying a test. It takes time , but no biggie. I have never had a test denied after speaking to them. Either they already know the test is indicated and are just going thru the motions, or in many cases just don't know, in which case I'll talk over their heads for a while and they'll approve it.
As far a dentists go, they are not regulated to any degree and can charge whatever they want, so all you can do is find one that you trust

I agree that we are better off with the pharmacology of today than we were 50 years ago. That being said, I still think all the advertising to consumers is not their best use of their monies. (All the Viagra and Cialis commercials, especially come to mind. No, I am not prudish; just not convinced that those need all the advertising dollars.) Working with the doctors is one thing; having consumers that involved is another. Maybe they just need to do a better job with the doctors. I have no problem with OTC drugs that do not require a doctor's prescription, but do advise that you check with your doctor before using them in their ads.

Too much of the time, drugs are not allowed by insurance or the cost is so prohibitive it is ridiculous. I was in a pharmacy once when a fellow came in to pick up his cancer script which was some outrageous amount and not covered by insurance. He told the pharmacist that he could in no way afford the medicine, remarked that he guessed he would just die, left it on the counter, and walked out. Sad, in such a country of plenty.

It takes my husband about 15 minutes to reach the "donut" hole every year. I just thank God that so far we are fortunate enough to be able to pay. One really expensive drug has been around for years and has yet to go generic. He was on this drug for at least 4 years before we moved here and that will soon be 12. The VA will no longer provide it because it remains so expensive.

The primary doctor we had in the HMO in Amarillo was forced by the HMO to drop many of his patients because he was making too many referrals. He only referred my husband for a colonoscopy after an initial sigmoid that revealed a polyp. They denied it. Only after my husband called them and raised holy he** did they finally approve the procedure. They found four others further into the colon that were on the verge of becoming cancerous and caught just in the nick of time. Too me, that is not good medicine. It may cut costs, but just how many lives does it cut short--to say nothing of costing more in the long run?

I just love good discussion, don't you? Thanks. :BigApplause:

[golfing eagles]

I agree that we are better off with the pharmacology of today than we were 50 years ago. That being said, I still think all the advertising to consumers is not their best use of their monies. (All the Viagra and Cialis commercials, especially come to mind. No, I am not prudish; just not convinced that those need all the advertising dollars.) Working with the doctors is one thing; having consumers that involved is another. Maybe they just need to do a better job with the doctors. I have no problem with OTC drugs that do not require a doctor's prescription, but do advise that you check with your doctor before using them in their ads.

Too much of the time, drugs are not allowed by insurance or the cost is so prohibitive it is ridiculous. I was in a pharmacy once when a fellow came in to pick up his cancer script which was some outrageous amount and not covered by insurance. He told the pharmacist that he could in no way afford the medicine, remarked that he guessed he would just die, left it on the counter, and walked out. Sad, in such a country of plenty.

It takes my husband about 15 minutes to reach the "donut" hole every year. I just thank God that so far we are fortunate enough to be able to pay. One really expensive drug has been around for years and has yet to go generic. He was on this drug for at least 4 years before we moved here and that will soon be 12. The VA will no longer provide it because it remains so expensive.

The primary doctor we had in the HMO in Amarillo was forced by the HMO to drop many of his patients because he was making too many referrals. He only referred my husband for a colonoscopy after an initial sigmoid that revealed a polyp. They denied it. Only after my husband called them and raised holy he** did they finally approve the procedure. They found four others further into the colon that were on the verge of becoming cancerous and caught just in the nick of time. Too me, that is not good medicine. It may cut costs, but just how many lives does it cut short--to say nothing of costing more in the long run?

I just love good discussion, don't you? Thanks. :BigApplause:

Even better because you know what you are talking about:mademyday:

I've never been a fan of direct to consumer drug marketing, ever since Merrill-Dow put out that 1st vaguely veiled trental commercial 30 years ago. It's confusing to patients, doesn't really enhance patient care, and in many cases you are right--I also consider it a waste of money. But the executives at the pharmaceutical company must disagree. Now, however, the ads are ridiculous, both in number and scope. After listening to their endless list of "side effects", I'll bet patient compliance with their prescription meds has taken a quantum drop. Heck, if I didn't know better I wouldn't take what I take either. I find it amazing that most of the ad focuses on the 2-3% "side effects" rather than the 98% effect that the drug was designed for. Coincidentally, I just returned from my pharmacy where my wife's meds cost over $400/month out of pocket
The colonoscopy story is ridiculous, I've never seen a denial for a procedure that had a 100% indication. I suspect the 1st representative was , well to put it politely, confused. I also think your husband shouldn't have had to be the one arguing, his doctor should, and frankly, we get better results. I'm really amazed at that denial, and that was from a privately employed worker at a private insurance company that has some vested interest in customer satisfaction--after all they have competition. A little scary to think what will happen when government bureaucrats run the whole show.

[Mikeod]

Even better because you know what you are talking about:mademyday:

I've never been a fan of direct to consumer drug marketing, ever since Merrill-Dow put out that 1st vaguely veiled trental commercial 30 years ago. It's confusing to patients, doesn't really enhance patient care, and in many cases you are right--I also consider it a waste of money. But the executives at the pharmaceutical company must disagree. Now, however, the ads are ridiculous, both in number and scope. After listening to their endless list of "side effects", I'll bet patient compliance with their prescription meds has taken a quantum drop. Heck, if I didn't know better I wouldn't take what I take either. I find it amazing that most of the ad focuses on the 2-3% "side effects" rather than the 98% effect that the drug was designed for. Coincidentally, I just returned from my pharmacy where my wife's meds cost over $400/month out of pocket
The colonoscopy story is ridiculous, I've never seen a denial for a procedure that had a 100% indication. I suspect the 1st representative was , well to put it politely, confused. I also think your husband shouldn't have had to be the one arguing, his doctor should, and frankly, we get better results. I'm really amazed at that denial, and that was from a privately employed worker at a private insurance company that has some vested interest in customer satisfaction--after all they have competition. A little scary to think what will happen when government bureaucrats run the whole show.
Not to mention how much time is wasted in the exam room discussing why the heavily advertised drug is not being prescribed. Everyone wants the one they saw on TV, not the one that has been used effectively and safely over the years. A new drug was not added to our formulary unless and until it demonstrated a definite and significant advantage in its class.

[RVRoadie]

When Medicare Advantage plans were introduced they were promoted as a way to save the Medicare plan money. They would only have in network quality doctors, hospitals and labs and do things to encourage patients to stay healthy. The advantage plan was paid a monthly amount from the government and whatever savings they generated was bonus for the carrier. The system was adjusted over 10 years ago with the payments to the Advantage plans increased. By 2009 the average Medicare advantage patient was costing the government 14% more than a person on traditional Medicare. That is a HUGE amount of money. So the promise that the Advantage plans would save Medicare money became completely disproven. The law was changed so that over the next several years the advantage plan must come in line with the traditional plan cost. This can be done by increasing cost to the consumer, decreasing expenses by narrowing networks or doctor/hospital/lab payments, decreasing overhead, cutting CEO pay (never) or however the Advantage plan chooses, but they must get their costs in line with traditional Medicare costs. The ACA also requires the carrier to spend at least 85% of the premium on medical costs and gives bonus payments for companies with high quality ratings. While certainly everyone would like to pay less and get more from their carrier, it is not the government's obligation to provide a better than Medicare plan at a higher cost to the taxpayer to those who want it.

Medicare Advantage was a creation of congress to compete with Traditional Medicare, giving consumers a choice. The facts you are reporting are from CMS and the President, both of whom would like nothing better to kill off Medicare Advantage and bring back the 25 million Medicare Advantage seniors to the system they control. They are succeeding.

[golfing eagles]

Not to mention how much time is wasted in the exam room discussing why the heavily advertised drug is not being prescribed. Everyone wants the one they saw on TV, not the one that has been used effectively and safely over the years. A new drug was not added to our formulary unless and until it demonstrated a definite and significant advantage in its class.

Exactly---hours and hours and hours talking to a brick wall because they "saw it on TV". Very hard to control this in an office setting. On the other hand , I was chairman of our hospital's pharmacy and therapeutics committee for many years, and the same criteria you just mentioned was employed. A lot easier to dictate drug choices to a captive audience , especially when you don't carry that drug.

[dillywho]

Exactly---hours and hours and hours talking to a brick wall because they "saw it on TV". Very hard to control this in an office setting. On the other hand , I was chairman of our hospital's pharmacy and therapeutics committee for many years, and the same criteria you just mentioned was employed. A lot easier to dictate drug choices to a captive audience , especially when you don't carry that drug.
:MOJE_whot::MOJE_whot::BigApplause::BigApplause:

[dillywho]

Even better because you know what you are talking about:mademyday:

I've never been a fan of direct to consumer drug marketing, ever since Merrill-Dow put out that 1st vaguely veiled trental commercial 30 years ago. It's confusing to patients, doesn't really enhance patient care, and in many cases you are right--I also consider it a waste of money. But the executives at the pharmaceutical company must disagree. Now, however, the ads are ridiculous, both in number and scope. After listening to their endless list of "side effects", I'll bet patient compliance with their prescription meds has taken a quantum drop. Heck, if I didn't know better I wouldn't take what I take either. I find it amazing that most of the ad focuses on the 2-3% "side effects" rather than the 98% effect that the drug was designed for. Coincidentally, I just returned from my pharmacy where my wife's meds cost over $400/month out of pocket
The colonoscopy story is ridiculous, I've never seen a denial for a procedure that had a 100% indication. I suspect the 1st representative was , well to put it politely, confused. I also think your husband shouldn't have had to be the one arguing, his doctor should, and frankly, we get better results. I'm really amazed at that denial, and that was from a privately employed worker at a private insurance company that has some vested interest in customer satisfaction--after all they have competition. A little scary to think what will happen when government bureaucrats run the whole show.

I think that whole outfit was, as you put it, "confused". Case in point:

I got a "survey" from them which was equally as ridiculous. They asked how much I drank on a weekly basis. Nothing about what I drank, when I drank, etc. Their response was that I "might need to talk with my doctor since it appears I may have an alcohol abuse problem." My doctor was the one in the first place who suggested I have a glass of wine in the evenings with dinner (we called it supper, but whatever).

Another question asked if I had had a hysterectomy, partial or total? I checked total. The response was that I "might need to talk with my doctor since I might benefit from hormone replacement therapy." Never asked if I had been prescribed HRT!

I returned said "survey" and told them not so politely, I'm afraid, what I thought of their survey and why. It was a total waste of my time, money, and their resources, which I also pointed out in my remarks.

Unfortunately, they had no competition in the area at that time. Our other choice was Cobra with no company participation for retirees. We could only take either for 10 years or to age 65, whichever occurred first.

If HMO's are designed to cut costs and increase efficiency and they are operated like that, then the design has failed miserably.