Originally Posted by nn0wheremann (Post 2114136)

All Medicare claim processing is done by private sector contractors. Some Federal workers do audits and policy work, and initial application to determine entitlement.

Originally Posted by skyking (Post 2113921)

???? You have no idea how Medicare Advantage works.

1. They are paid a monthly per Capita amount not per service billed.
2. The plans do not maintain medical records. The contracted providers do.
3. If the plans are paid a fixed amount (based on age and sex of the beneficiary) they have no incentive to "provide unnecessary services" or medications.
4. Plans are typically paid 95% or less of average cost per beneficiary in the county of residence.

There is so much over utilization in healthcare that they can provide free extra benefits by managing utilization and quality.

Originally Posted by MidWestIA (Post 2114027)

Only if there are not many massive med bills -

The government pays Medicare Advantage plans a set rate per person, per year (around $12,000 in 2019, not including Part D–related expenses) under what is called a “risk-based” contract. That means that each plan agrees to assume the full risk of providing all care for that inclusive amount.

Originally Posted by Happydaz (Post 2113709)

I was taking with a friend today and I had mentioned that Advantage plans cost the Medicare program more per patient than regular Medicare. He was very surprised to hear that since Advantage plans were originally developed to save money as regular Medicare costs were at that time increasing at a rapid rate. These Advantage plans were supposed to save the Medicare fund money by having drug choice restrictions, physician choice restrictions, specialist access restrictions, etc. Unfortunately, due to bonus payments and other unseen costs the average Advantage patient costs Medicare $321 more than a regular Medicare part B patient!

Originally Posted by mtdjed (Post 2113828)

I thank you for bringing this topic to attention. I did a Google search and found an interesting article which describes the process. As any article could be subject to being biased and incorrect, one must be suspect to the article and to interpretation. The article is on this link.

Why Medicare Advantage costs taxpayers billions more than it should – Center for Public Integrity

So, my simplistic interpretation is "Fraud", not by users or providers, but rather by the Medicare Advantage Programs providing the networks. Apparently, the initial program was meant to eliminate fraud by individual claims and this program was conjured up to eliminate that. Seems that the original program was a one cost covers all and some Advantage programs cherrypicked participants to sign up only the healthiest to minimize costs. The program was then changed to add a risk factor for severity of participants needs. Supposedly, that has been abused by some Advantage programs by getting higher funding for participants with higher risks.

Seems that the other benefits offered such as freebies are not the driver since they are not covered by Medicare.

Again, this is my interpretation of the article (which may or may not be true). I would expect the normal on line experts will be around to correct my interpretation and the source that I found.

I am not a user of Medicare Advantage. I have original Medicare and a Supplement program which also now pays for Gym membership. Supplement payment is now about $160/Month. Gym membership was $55/Month and now is free, covered by the Supplement which is still $160 / Month. Hmm! Wonder where that extra $55 came from. Maybe the theory is that I am heathier and require less medical care

Originally Posted by MSGirl (Post 2114171)

Where can we find this information?

Originally Posted by TedfromGA (Post 2114165)

When you think about gov't and related costs for any gov't program you just have to wonder....

I've been to the CMS headquarters (7500 Security Boulevard, Baltimore, MD 21244). It is massive - 3 huge multi floor buildings full of people. You have got to wonder what they all do!

If you could gather all the real estate and people asssociated with administrating CMS it would be mind blowing - you might conclude their must be a better way....

Originally Posted by MSGirl (Post 2114175)

Which Supplemental plan do you have? My mother had Plan F, which cost her close to $300 per month. Do you also have Part D ( the drug plan) ? What do you pay for that? Do you have a supplemental dental and optical plan as well?

Originally Posted by MSGirl (Post 2114175)

Which Supplemental plan do you have? My mother had Plan F, which cost her close to $300 per month. Do you also have Part D ( the drug plan) ? What do you pay for that? Do you have a supplemental dental and optical plan as well?

Originally Posted by kathyspear (Post 2114454)

One factor in setting the premium is the age at which the plan was initiated. I (stupidly) stayed on hubby's work insurance until I was 68 or 69. I pay about $200 per month for Florida Blue plan G. It would be less if I had signed up at 65.

FWIW, switching to traditional Medicare and FL Blue was a great move for me. I have had significant medical bills this year and have paid nothing out of pocket other than my plan G deductible which is about $200 per year.

k.

Originally Posted by Hardlyworking (Post 2114474)

So, $2600 then. Not bad. Did you have any issues getting through underwriting?

Originally Posted by kathyspear (Post 2114673)

Not that I recall. I signed up for FL Blue when I signed up for Medicare Part B. I did it online and I don’t recall what all they asked me. Maybe underwriting doesn’t apply if you sign up for both at the same time even if you are older than 65. I don’t know.

k.