[Rainger99]

I think this is the article that the OP was referring to. It is put out by the Kaiser Family Foundation.

Higher and Faster Growing Spending Per Medicare Advantage Enrollee Adds to Medicare’s Solvency and Affordability Challenges | KFF.

[Topspinmo]

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!

IMO Heath care is so —— up in this country and government spends trillions of taxpayers money all pocketed by insurance and CEO’s millions in bonus. But the insurance industry knows who to pander to to get there way. IMO nothing going to change unfunded health care debt will continue to rise and money will be printed and flow.

IMO all private insurance Outlawed, need single payer to government. At least the government will be making the billions or trillions and not private insurance Ponzi schemes.

[Luggage]

Costs are in contracts and the government knows exactly what they're going to pay each year. If you don't like it you can write to your congressman. Another reason we have advantage plans is that the insurance companies need to get their hooks into some of the money we pay for medical for senior citizens that is the big problem in America between both sides of the aisle, one wants for private businesses to succeed the other one wants everything in government to be by the government.

[PugMom]

Originally Posted by donfey

Sounds like a sales pitch to me. We use Medicare Advantage, exercise it through (But not restricted to) The Villages Healthcare, and spend less that the stated $321 out of pocket PER YEAR! Everyone is different, of course, and each should do their own homework.

same here. it covers everything we need from major surgery to walk-in visits. all i can say is it works for us

[Hardlyworking]

Originally Posted by PugMom

same here. it covers everything we need from major surgery to walk-in visits. all i can say is it works for us

This topic isn’t really about what you spend, it is about what Medicare spends.

[Davonu]

I’ll admit I haven’t read the entire thread, but it seems like a bit of a no-brainer…

Advantage plans provide coverage above regular Medicare. They are going to cost more.

[DDToto41]

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.

Lets start by saying United Healthcare had an advertisement on tv that said they have 70,000 people to help 70,000,000 customers. At an average of $50,000 each that means $3,500,000,000 is paid out in wages before they pay anything else. For them to make a profit what will yours or the governments cost be?

[Keefelane66]

Originally Posted by DDToto41

Lets start by saying United Healthcare had an advertisement on tv that said they have 70,000 people to help 70,000,000 customers. At an average of $50,000 each that means $3,500,000,000 is paid out in wages before they pay anything else. For them to make a profit what will yours or the governments cost be?

That's an estimated $3,500,000,000 rolled back into the economy isn't capitalism grand.

[NAB20]

Originally Posted by Happydaz

Let me clarify my topic. I am not talking about how much a Medicare Advantage plan or Medicare-MediGap plan costs an individual patient nor how much these plans reimburse a medical provider or hospital. I am referring to the cost these two plans cost CMS, the government Medicare program that our Medicare taxes and other funds are used to pay out for claims. What it comes down to is Medicare Advantage plans cost the Medicare fund more than regular Medicare. Medicare Advantage plans were supposed to cost less but due to unexpected bonuses and other costs, Medicare has had to pay $321 (recent 2019 data) more per patient than regular Medicare. Since Advantage plans restrict doctor choice, drug choice, require specialist referrals and were paid a set amount of money per patient, they were seen as a way for the government to save money over regular Medicare. Advantage plans are administered by insurance companies and they are extremely profitable. The Advantage plans also offer a lot of freebies, like low premiums and low co pays, free gym memberships, free over the counter drugs, etc. so they are attractive to individuals signing up as they may cost them less up front, but our Medicare fund pays more. This may mean that Advantage plans may come under scrutiny by Congress.

Understood. Your original post was clear. It is interesting that when the federal government comes up with a plan that pushes services to the private sector, it becomes more costly for the taxpayers. It belies the theory that private sector is the better way to go with healthcare. It just adds more profit layers between the patient and the doctor. I also believe that the Advantage plan model has been the cause of so many doctors retiring as soon as they can.

[retiredguy123]

Originally Posted by DDToto41

Lets start by saying United Healthcare had an advertisement on tv that said they have 70,000 people to help 70,000,000 customers. At an average of $50,000 each that means $3,500,000,000 is paid out in wages before they pay anything else. For them to make a profit what will yours or the governments cost be?

There are only 28 million people enrolled in all of the Medicare Advantage programs combined, which is about 45 percent of the total number of people on Medicare (traditional plus advantage). So, there are less than 70 million people enrolled in the entire Medicare system. The 70 million number must include a lot of people who are not on Medicare. I don't know how many Federal Government employees work on Medicare, but, when you include their salary, current benefits, and lifetime pension after retirement, they cost taxpayers a whole lot more than $50,000 each. It is probably closer to $150K each.

[MidWestIA]

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.

[craigrmorrison]

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.

Thank you for your input.

Are you taking into consideration the costs of benefits included in a Medicare Advantage plan and NOT with traditional Medicare or a Medigap (aka Supplement)?

For example Prescription Drugs (Part D); preventative dental, vision and hearing; over the counter allowances; fitness memberships and personal emergency response systems are included (albeit co-pays or co-insurance may apply).

Counting all the cost/benefits would be a fair comparison.

[Quixote]

Originally Posted by rjm1cc

Mine does not if you refer to the monthly premium. It could if you include deductibles and co pays and are a heavy user of the plan.

What would be the point of NOT including ALL expenses when considering this versus that program? I don't have the education, skills, and competencies to evaluate this issue on a macro level; all I can consider are the costs to my family and myself. One of the primary factors in my son and daughter-in-law choosing to leave the country three years ago (taking with them their particular skills and competencies) was the realization that it would cost them nearly $25,000/year in premiums and deductibles for catastrophic coverage before they would actually receive a dollar in coverage. To them—and to us even though we miss them—a no-brainer.

Originally Posted by mtdjed

.... 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 healthier and require less medical care

This is exactly our situation—and it works well for us. Our Supplement premium is a little higher; we are in a plan that offered extensive benefits (e.g., overseas coverage) that has been eliminated but into which we are grandfathered, the large portion of which is covered by a previous employer who managed to eliminate some benefits. Fortunately they cannot touch this benefit or our dental and vision benefits, as these were union negotiated.

Originally Posted by allsport

You do not pay more, the government pays more to the program with the intent of cutting your costs by managing your care and not permitting you choice in your care. The program takes the money that should go to people who are signed up for the care. It is the first step in privatization and should never be chosen as your plan. They get the people with gimmicks that are not health related.

IMHO, a good way to describe the enticements is "gimmicks." Then there are those folks who are healthy who need medical services so infrequently and thus feel that an Advantage plan is more than adequate. Denial is a useful defense mechanism, but there are no promises that we will die healthy (other than possibly in an accident), and inevitably most of us are ill with something from which we inevitably die—not anything that anyone enjoys considering—but there it is....

[craigrmorrison]

Originally Posted by Davonu

I’ll admit I haven’t read the entire thread, but it seems like a bit of a no-brainer…

Advantage plans provide coverage above regular Medicare. They are going to cost more.

Yes, please remember their is always a cost of goods sold and a selling price in business.

Members of a Medicare Advantage plans, with a zero premium, are on a pay-as-you-go basis. Usually no deductibles with co-pays or co-insurance due per visit/treatment. There is also a maximum out of pocket cost that acts as a safety net (not to exceed) for those accumulating large cumulative medical costs.

[nn0wheremann]

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.

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