[Notsocrates]

Originally Posted by Happydaz

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!

You don't understand how it works.

CMS uses the premium it deducts from your Soc. Sec. benefit and pays private insurers to assume the risk of covering you. The insurers collect premiums, write policies and pay bills following Medicare standards.

[allsport]

Originally Posted by retiredguy123

I don't know where to start. Have you considered the Federal salaries and benefits to process all of the Medicare Part B claims? And, have you considered that the Medicare Advantage plans are managed by private companies who have a profit a motive to reduce fraudulent claims? What incentive do Federal employees have to deny fraudulent claims? And, have you considered the fact that a patient, who has Medicare Part B and a Medicare supplement has no copay and, therefore, has no incentive to shop for the lowest cost option, and no incentive to reduce treatments or expensive medical supplies or devices. Medicare Advantage plans have all of these incentives to moderate the cost of medical care.

Keep on drinking from that fountain, they have you fooled. The problem is the congress not the employees who will not permit drugs to be negotiated and thank the Repubs for living off big pharma because that is the root of the problem. The employees want fraud pointed out as badly as you do but congress is in the way. The VA negotiates drug prices, just saying. That part of the government got smart.

[jammaiora]

Originally Posted by Happydaz

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!

Medicare Advantage programs should cost more because retirees get more coverage - vision, dental, no cost primary doctor visits. Do some research to find out if overall in the end they save money for the system. By the way, both workers and employers contribute to FICA, so what's your point?

[Joeint]

Originally Posted by retiredguy123

I don't know where to start. Have you considered the Federal salaries and benefits to process all of the Medicare Part B claims? And, have you considered that the Medicare Advantage plans are managed by private companies who have a profit a motive to reduce fraudulent claims? What incentive do Federal employees have to deny fraudulent claims? And, have you considered the fact that a patient, who has Medicare Part B and a Medicare supplement has no copay and, therefore, has no incentive to shop for the lowest cost option, and no incentive to reduce treatments or expensive medical supplies or devices. Medicare Advantage plans have all of these incentives to moderate the cost of medical care.

Have you considered fraud in advantage plans
Billing for services not rendered.
Altering medical records.
Use of unlicensed staff.
Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
Kickbacks and bribery.
Providing unnecessary services to members.

[retiredguy123]

Originally Posted by Happydaz

There is a recent article published in Forbes Magazine (June 15, 2022) on Medicare Advantage Plans. It says Medicare Advantage patients cost on average 4% more per year than what an average patient costs on traditional Medicare. The article has a lot of other interesting information as well. I am no expert and and I was only posting this because I was so surprised when talking to my friend that these Advantage plans weren’t saving money over traditional Medicare.

A regular Medicare patient with a supplement policy has zero copays when they receive almost any treatment. If the Government wanted to substantially reduce the cost of the program, they would require patients to have "skin in the game" by requiring copays and offering incentives for the patient to find less expensive treatments and to avoid unnecessary treatments..

I remember visiting my mother one time when she had a 6 foot high stack of blood sugar testing supplies in her kitchen. Her vision was so bad that she was not able to test her sugar level. But, since she had no copay, she had no reason to stop the deliveries, and she didn't know how to stop them anyway. During the last 4 months of her life, a primary care doctor visited her in the hospital or nursing home every day, 7 days per week, and billed Medicare for an office visit. My mother never hired this doctor, but assumed that she worked for the hospital. The doctor never prescribed anything or provided any treatment.

[rsmurano]

A supplement plan (plan f/g/n etc..) is far superior than advantage plans and will save you money each year.
The biggest thing that most people don’t know is that once you go with an advantage plan (say at 65), you probably won’t be able to switch to a supplemental plan in the future so your stuck with the advantage plan forever. If you have ANY precondition or have some issue the prior 2 years before applying for a supplement, they won’t accept me. I know it happened to me. I had a plan g supplement and when I moved to florida I went shopping for another plan g plan from florida. I didn’t get accepted even by the same company that I had the current plan g because I had some issues the prior months of applying. I was screwed. I did talk with my out of state plan g provider and they said I don’t need a new plan since any supplement plan is good country wide. Staying with my out of state plan, I’m saving over $50 a month over what a florida plan would cost

[mike519]

Originally Posted by retiredguy123

I don't know where to start. Have you considered the Federal salaries and benefits to process all of the Medicare Part B claims? And, have you considered that the Medicare Advantage plans are managed by private companies who have a profit a motive to reduce fraudulent claims? What incentive do Federal employees have to deny fraudulent claims? And, have you considered the fact that a patient, who has Medicare Part B and a Medicare supplement has no copay and, therefore, has no incentive to shop for the lowest cost option, and no incentive to reduce treatments or expensive medical supplies or devices. Medicare Advantage plans have all of these incentives to moderate the cost of medical care.

Medicare Is More Efficient Than Private Insurance

https://www.healthaffairs.org/do/10....110920.013390/

Medicare administrative costs are about 2% while private health insurance companies have 12% to 18% in administrative costs.


If we got rid of the private health insurers, we would save $500 billion a year just in administration costs.

[retiredguy123]

Originally Posted by Joeint

Have you considered fraud in advantage plans
Billing for services not rendered.
Altering medical records.
Use of unlicensed staff.
Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
Kickbacks and bribery.
Providing unnecessary services to members.

I don't disagree, but at least with the advantage plans, there is a profit motive, copays, and a financial reason to avoid unnecessary treatments. With regular Medicare, there are no copays, and the Government employees, who approve claims, have no incentive to reduce cost.

[kingofbeer]

$321 per year
The federal government spent $321 more per person for beneficiaries enrolled in Medicare Advantage plans than for those in traditional Medicare in 2019, a gap that amounted to $7 billion in additional spending on the increasingly popular private plans that year, finds a new KFF analysis.

[aldeana]

Generally claims are not processed by Medicare, but they contract with private companies that specialize in claims processing for Medicare, Medicaid, and other entities. In FL, it is done by First Coast Service Options, based in Jacksonville. They have been doing this for over 50 years. If you have a Medigap policy, the part not paid by Medicare usually gets automatically crossed over to the Medigap carrier. Another comment to an earlier statement: some Medigap policies DO have a copay. There have been concerns that Medicare Advantage plans end up costing Medicare more $$, but actual numbers are hard to find.

[Keefelane66]

Don't worry too much Sen Rick Scott proposal is to do away with Social Security and Medicare and raise taxes.
Examining Rick Scott's Claim That Medicare, Social Security Will Soon Go 'Bankrupt' - FactCheck.org

[skyking]

???? Traditional Medicare plans are administered by "Medicare Intermediares", often the state Blue Cross plan. The 2% is the government's cost to bill and maintain enrollment/eligibility records. Not comparable.

[skyking]

Originally Posted by Joeint

Have you considered fraud in advantage plans
Billing for services not rendered.
Altering medical records.
Use of unlicensed staff.
Drug diversion (e.g. dispensing controlled substances with no legitimate medical purpose)
Kickbacks and bribery.
Providing unnecessary services to members.

???? 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.

[retiredguy123]

Originally Posted by skyking

???? 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.

Thanks. And, if the advantage plans are actually costing the taxpayers more money than regular Medicare as claimed, why doesn't the Government reduce the per Capita amount paid to the insurers?

[OhioBuckeye]

Anything I get online that’s a deal, it always seems like if it’s to good to be true it probably is. Seems like there’s always a catch to all deals. Some people don’t understand their explanation, which that’s my problem. But thanks for clearing that up for me!