[Dusty_Star]

Some say that Medicare Advantage is a failed experiment. Patients get delayed & denied care, the taxpayers are paying mightily for the winners: the insurance company executives. They also say it should be discontinued or dramatically reformed.

MA was sold heavily to Congress by insurance company lobbyists on the basis that it would save money over traditional Medicare.

Is Medicare Advantage a Failed Experiment? Experts Debate - MedCity News

[Mrprez]

If they discontinue the program then everyone on MA should be allowed into a MediGap program with no underwriting.

[retiredguy123]

Medicare Advantage may be a failed experiment, but so is Traditional Medicare. Medicare fraud is rampant. My mother spent her last 4 months in the hospital or various nursing homes. One medical doctor, who my mother never hired, followed her everywhere she went and billed Medicare for an office visit every day, 7 days per week. She was never hired, and never prescribed any medical treatment. Apparently, she posed as a hospital doctor and got my mother's SSN from her chart. Every day, she would make the rounds visiting her many "patients" in nursing homes and hospitals. Medicare has no checks and balances to determine if a provider was ever even hired by the patient. If they get a bill, they just pay it. At least Medicare Advantage providers have a profit motive to reduce fraud.

The only way to make the system more efficient is to require patients to have "skin in the game" by requiring all patients to pay a copay based on a percentage of the treatment. They need to eliminate free treatments where the patient has no incentive to reduce the cost.

[GoRedSox!]

I don't think that Medicare Advantage is correctly labeled an experiment, they have been around for over 25 years. Over 50% of all Medicare enrollees are on Medicare Advantage Plans. Most people say they are happy with their MA plan, at least as many as say they are happy with traditional Medicare.

[Stu from NYC]

We are very happy with our advantage plan

[PugMom]

it works for me. i've been able to get the care i need, when i need it, for what i want. i've never been denied, never had to sacrifice care. i'm leery of some of these stories, -they appear to be looking for some gut reaction, typically in a sensational way.

[justjim]

Let’s take Aetna (my employer’s Medicare Advantage plan) and I believe only second in Medicare plans to United Health Care the largest. Aetna net income in 2023 was just south of 6 billion dollars. With that much money at stake, the insurance companies are not going away quickly or quietly. CVS Health acquired Aetna for a sum of 69 Billion. Bottom line, instead of regular Medicare paying claims they pay the insurance companies to manage them. Cheaper for taxpayers?

The United Health Care Group revenue was over 189 billion dollar. There are costs but that is a lot of revenue. UHC reported 22 billion in profits in 2023. The CEO of UHC total compensation was 23.5 million. Obviously there is money to be made in health care insurance.

[gatorbill1]

Very happy with UHC Advantage Plan. Have never been denied any treatment needed - and it costs a lot less than a supplement plan.

[rustyp]

51% of seniors on MA plans in 2024 - I'll take my chances. Odds or on my side when a change occurs of who the vote getters protect.

[GoRedSox!]

Health Insurance companies really depend on Medicare Advantage to drive profits. They make MUCH more from a Medicare member than they do from a fully-insured member.

[Sabella]

Medicare advantage plans are very good but the older you get and the sicker you get and the more medical care you need that’s when they’re not good and a lot of things get denied that you would’ve had with original Medicare.

[La lamy]

I've never heard of medicare advantage patient being delayed or denied care. I've seen a lot of lives saved through quick emergency response or months of various treatments to fight cancer successfully. Does the OP have an agenda for spreading this 'info'?

[wsachs]

Originally Posted by GoRedSox!

I don't think that Medicare Advantage is correctly labeled an experiment, they have been around for over 25 years. Over 50% of all Medicare enrollees are on Medicare Advantage Plans. Most people say they are happy with their MA plan, at least as many as say they are happy with traditional Medicare.

I have BCBS Medicare Advantage PPO from MI. It's great. Had it for over 25 years.

[rsmurano]

Want some proof of denials? Here are a couple but I bet you can find many hundreds of these complaints if you search:

https://www.finance.senate.gov/imo/m...0Advantage.pdf

https://legislature.idaho.gov/wp-con...%20Denials.pdf

By repeatedly denying claims, Medicare Advantage plans threaten rural hospitals and patients, say CEOs

Why does Medicare Advantage routinely deny reimbursements for necessary care? - Quora

Medicare Advantage plans are popular, but some seniors feel trapped when ill : Shots - Health News : NPR

https://crr.bc.edu/criticisms-of-med...ting-continue/

[nancyre]

My husband was told there was NO rehab that would accept Humana that could handle a patient on PD Dialysis. I later found that there was a way to make it happen but the discharge planners at Leesburg Hospital instead pushed him out without a plan. FYI 6 months Multiple hospital visits 2 almost immediate discharges at Lessburg and 3 months out having gone to Shands we find he had Pancreatic Cancer, gone under 3 months later. But can you imagine being told there is no place that will take his insurance. Meanwhile no body wanted to recognize that the VA would be paying the bill. It was just no Humana approved place.
BTW there is a BIG difference between a Medicare Advantage HMO & a PPO.