[spinner1001]

Medicare Advantage plans with lots of free benefits have been too good to be true. Now the business shake out is happening from MA plans to MA providers.

Note: This story does not relate to traditional Medicare.

[tophcfa]

Originally Posted by spinner1001

Medicare Advantage plans with lots of free benefits have been too good to be true. Now the business shake out is happening from MA plans to MA providers.

Note: This story does not relate to traditional Medicare.

Totally not surprising, nothing that appears too good to be true lasts. It is doubtful future plans will be as good for the policyholders, but they should at least be better for the taxpayers. If we were in a MA plan, I would review the policy changes very closely during the annual enrollment period.

[MX rider]

Originally Posted by tophcfa

Totally not surprising, nothing that appears too good to be true lasts. It is doubtful future plans will be as good for the policyholders, but they should at least be better for the taxpayers. If we were in a MA plan, I would review the policy changes very closely during the annual enrollment period.

We've been on UHC Advantage for a few years now and really like it. But we're curious to see what the plan looks like this fall when it's time to renew. Hopefully they keep the wellness benefits, dental and vision.

But time will tell, hopefully we'll have other MA options if needed.

We did our research when we started on medicare, so we''ll just do it again.

[Rainger99]

The article stated that Humana is projecting a loss of as many as 500,000 members from its plans sold directly to seniors.

I will be taking a hard look this fall to see if the MA plans are taking away the advantages.

If Medicare Advantage takes away the advantages, it will be hard for them to stay in business.

[tophcfa]

Originally Posted by MX rider

We've been on UHC Advantage for a few years now and really like it. But we're curious to see what the plan looks like this fall when it's time to renew. Hopefully they keep the wellness benefits, dental and vision.

But time will tell, hopefully we'll have other MA options if needed.

We did our research when we started on medicare, so we''ll just do it again.

You seem very well researched, so you probably already know this. If you are healthy, with no preexisting conditions, you still have an opportunity to switch to a Medigap plan during open enrollment without having to worry about being denied through the medical underwriting process. As we all age, you never know when that window of opportunity will suddenly get slammed shut.

[Rainger99]

Interesting study on prior authorizations.

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 | KFF

Key points

Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023

In 2023, insurers fully or partially denied 3.2 million prior authorization requests, which is a somewhat smaller share (6.4%) of all requests than in 2022 (7.4%)

A small share of denied prior authorization requests was appealed in Medicare Advantage (11.7% in 2023)

Though a small share of prior authorization denials were appealed to Medicare Advantage insurers, most appeals (81.7%) were partially or fully overturned in 2023. That compares to less than one-third (29%) of appeals overturned in traditional Medicare in 2022.

[Aces4]

Originally Posted by Rainger99

Interesting study on prior authorizations.

Medicare Advantage Insurers Made Nearly 50 Million Prior Authorization Determinations in 2023 | KFF

Key points

Medicare Advantage insurers made nearly 50 million prior authorization determinations in 2023

In 2023, insurers fully or partially denied 3.2 million prior authorization requests, which is a somewhat smaller share (6.4%) of all requests than in 2022 (7.4%)

A small share of denied prior authorization requests was appealed in Medicare Advantage (11.7% in 2023)

Though a small share of prior authorization denials were appealed to Medicare Advantage insurers, most appeals (81.7%) were partially or fully overturned in 2023. That compares to less than one-third (29%) of appeals overturned in traditional Medicare in 2022.

I fully believe fewer procedures are offered/provided to MA recipients. That would account for authorization denial numbers, patients were probably critical in the first place.

[BrianL99]

Originally Posted by tophcfa

If you are healthy, with no preexisting conditions, you still have an opportunity to switch to a Medigap plan during open enrollment without having to worry about being denied through the medical underwriting process.

I don't have a clue what the underwriting standards are, but the % of Medicare Eligible people with "no pre-existing conditions", is miniscule.

[OrangeBlossomBaby]

Originally Posted by tophcfa

Totally not surprising, nothing that appears too good to be true lasts. It is doubtful future plans will be as good for the policyholders, but they should at least be better for the taxpayers. If we were in a MA plan, I would review the policy changes very closely during the annual enrollment period.

The policyholders ARE taxpayers.

If health insurance was required to be non-profit, instead of commercial profit-making corporations, premiums would be lower, coverage would be higher, and taxpayers wouldn't need to pay so much for the benefit. Sadly though, whenever someone brings up the concept, someone else screams "socialism!" and everyone loses. Except shareholders and the CEO.

[spinner1001]

Originally Posted by OrangeBlossomBaby

The policyholders ARE taxpayers.

If health insurance was required to be non-profit, instead of commercial profit-making corporations, premiums would be lower, coverage would be higher, and taxpayers wouldn't need to pay so much for the benefit. Sadly though, whenever someone brings up the concept, someone else screams "socialism!" and everyone loses. Except shareholders and the CEO.

You forgot much less efficient and run by the federal government.

[Stu from NYC]

Originally Posted by spinner1001

You forgot much less efficient and run by the federal government.

People forget how inefficient socialism is.

[tophcfa]

Originally Posted by OrangeBlossomBaby

The policyholders ARE taxpayers.

If health insurance was required to be non-profit, instead of commercial profit-making corporations, premiums would be lower, coverage would be higher, and taxpayers wouldn't need to pay so much for the benefit.

Yes, Medicare policyholders are indeed taxpayers, or at least they should be or they would be on Medicaid. The point is, Medicare Advantage policyholders cost the taxpayers 22% more per policyholder than Medicare policyholders that go the supplement plan option. So the point that MA plans are not good for taxpayers is valid. And yes, traditional Medicare, with a supplemental plan, is much closer to being non profit than the Medicare Advantage option, which is run by private insurance companies optimizing the inefficiencies of the government. With traditional Medicare and the supplemental option, premiums are typically not lower, but the coverage is significantly higher and the taxpayers supporting that option are not getting screwed nearly as hard.

So in summary, your points listed above are all valid except for the lower premiums argument. With the government option, premiums are higher, because the government isn’t getting screwed by private insurance companies driving costs up by 22% more per policyholder. That’s why the Medicare Advantage experiment is failing miserably for taxpayers, and changes will be necessary. The whole train wreck happening with the Villages Health will be the poster child for these changes that will be a coming. Stay tuned.

[rsmurano]

No corporations or businesses should be non-profit, every corporation needs capital and shareholders provide this money and these shareholders need to get reimbursed.
Not sure if people realize this but you will not get anywhere in life without investing your money during your working years, and a good portion of it, I put away 60% of our paychecks in stocks/401k’s.
Receiving a paycheck will only get you so far and nowhere in your retirement years.

[USOTR]

We've been using Humana and been very pleased with it.

[elle123]

Originally Posted by spinner1001

Medicare Advantage plans with lots of free benefits have been too good to be true. Now the business shake out is happening from MA plans to MA providers.

Note: This story does not relate to traditional Medicare.

Doesn't The Villages developers specialize in "Advantage Medicare?" I heard they made a killing...