[golfing eagles]

Originally Posted by JMintzer

Doc,

Like you, I was in practice (I still am, albeit part time) for almost 40 years...

But I'm going to have to disagree with you on this one. If it were a simple "coding error", then the non-advantage plans would also deny the care (which they don't).

We call to get pre-authorization all of the time. They pre-authorize the care, then they deny payment, stating the pre-authorization was never actually a promise to pay.

Now, granted, we've also occasionally had that happen with commercial insurance companies, but it much, much more rare...

You haven't had care denied by straight Medicare, supplements, and private insurance????? OMG are you lucky. We had 5 FTEs dealing with all those problems---fighting denials cost us over 1/4 million/year-----which is a fraction of what it cost the government to create those denials in the first place. A vicious circle with no winners.

[JMintzer]

One other thing to consider is that once you are in an Advantage plan, it can be quite difficult to go back to traditional MC (if that is what you choose to do).

Traditional MC cannot deny coverage for new patients, but those who chose to go with an Advantage plan may have to go thru an underwriting process to re-enroll in traditional MC...

Just food for thought...

[golfing eagles]

Originally Posted by JMintzer

I've been investigated by Medicare 4 times. The first time, I owed them about $114.00..

The 2nd time, THEY owed ME about 95.00...

The 3rd time, I owed them about about $34.00. For a grand total of about $50... All of them were simple coding errors...

How many thousands of dollars did the spend to recoup $50?

The last investigation?

They accused me of treating a dead person.

No, I may hav nodded off a time or two in Med school, but I'm pretty sure I was awake during the "How to tell if your patient is ALIVE" lecture!

Turns out, I did a wound care consult on a patient during my lunch hour. Later that evening, around 8-9 pm, the patient coded and died...

I had to go to medical records, dig up the chart and copy the entire day's progress notes, including the vital signs taken in the am, lunch time, my consult, early evening vital signs , as well as the "code blue" event...

I sent it all to Medicare and received a very formal letter that simply said, "Never mind"... No apology, "Oops on our part, sorry for the stress we put you thru..."

It was kinda' like getting a threatening letter from the IRS, when the error was on their part. Not good for the heart!

Yep, that's fun too. Fortunately, the only time a Medicare audit found anything wrong with my billing they stated I coded a 99213 and it should have been a 99214---they sent me a check for $46. Like you, I wonder how much it cost HCFA to give me that $46.

[golfing eagles]

Originally Posted by JMintzer

One other thing to consider is that once you are in an Advantage plan, it can be quite difficult to go back to traditional MC (if that is what you choose to do).

Traditional MC cannot deny coverage for new patients, but those who chose to go with an Advantage plan may have to go thru an underwriting process to re-enroll in traditional MC...

Just food for thought...

I think they allow it once, but that's it.

[MX rider]

Originally Posted by Karmanng

those stories are actually true my parents were on the advantage plans and they changed there drs all the time towards the end......I wont go with that plan just because of that plus you cant go to alot of places either with advantge such as mayo clinic...........most hospitals and drs are actually trying to get out of the ma plans fyi

Like some here you're painting with a broad brush and thats not accurate. Some MA plans are much better than others.

Many people on here have had major medical issues and are happy with their MA plan coverage, despite you telling them they shouldn't be. I'll take their word for it.

[JMintzer]

One more thing, the wife and I enrolled in MC this past Fall.

I had CFBS thru my office that covered us and my employees.

Since I was a small business, the only thing available was thru the "Affordable Care Act".

I was paying over $1300/month for my self and my wife (over $2600 total), with a $4000 deductible...

My employees cost the same per person... Luckily, they also went on Medicare about a year ago...

Since October, we now pay $174/month each, plus another $225-ish) for AARP UHC.

Our Part D is $0.40 (yes FOURTY CENTS)/month. I pay ZERO for my BP meds (2 low dose diuretics) and $9 and change for my 3 month supply of cholesterol meds. My wife pays a bit more for her cholesterol meds (different meds)...

Since October, I've had a metric ton of tests, scans, etc, a 3 day hospital stay for a GI bleed (all healed), and an Aortic Valve replacement...

Total out of pocket cost? $0.00

Of course, YMMV...

[JMintzer]

Originally Posted by golfing eagles

You haven't had care denied by straight Medicare, supplements, and private insurance????? OMG are you lucky. We had 5 FTEs dealing with all those problems---fighting denials cost us over 1/4 million/year-----which is a fraction of what it cost the government to create those denials in the first place. A vicious circle with no winners.

Did you miss the last sentence of my post?

"Now, granted, we've also occasionally had that happen with commercial insurance companies, but it much, much more rare..."

[LG999]

Originally Posted by 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

We have had Medicare Advantage plans since we retired over ten years ago. We have used UHC except for one year when we had Aetna, which was pretty good too.We are happy with the plans especially this current one. We have both worked for companies that offered excellent medical insurance and this UHC advantage plan surpasses those employer plans.

Perhaps Advantage plans do not address the needs of people who need expensive medications or have medical conditions that are expensive to deal with.

If you are pretty healthy Advantage plans can work for you. I use Latanoprost eye drops for glaucoma which have a $0 copay. I do not use any other prescription meds. All of my surgeries & hospital bills have been covered. I pay a low co-pay for doctor visits but my PCP is $0 no matter how many times I see her. Gym memberships are $0. There are other freebies. I can't complain.

[Stu from NYC]

Originally Posted by LG999

We have had Medicare Advantage plans since we retired over ten years ago. We have used UHC except for one year when we had Aetna, which was pretty good too.We are happy with the plans especially this current one. We have both worked for companies that offered excellent medical insurance and this UHC advantage plan surpasses those employer plans.

Perhaps Advantage plans do not address the needs of people who need expensive medications or have medical conditions that are expensive to deal with.

If you are pretty healthy Advantage plans can work for you. I use Latanoprost eye drops for glaucoma which have a $0 copay. I do not use any other prescription meds. All of my surgeries & hospital bills have been covered. I pay a low co-pay for doctor visits but my PCP is $0 no matter how many times I see her. Gym memberships are $0. There are other freebies. I can't complain.

You can when they run out of money

[golfing eagles]

Originally Posted by Stu from NYC

You can when they run out of money

They won't. Governments love to control people above all else. By limiting choices, they maintain control, so you can bet they will throw whatever money is needed in the direction of advantage plans.

[SusanStCatherine]

So you can easily go from a traditional Medicare supplement to an Advantage plan without medical underwriting. But not the other way. So one of the best things about the Affordable Care Act (ACA or Obamcare) was the elimination of preexisting conditions. Achieve Medicare age and now preexisting conditions come into play again (unless you live in one of four states where your premiums are higher for this privilege). So many different plans and different rates it is a wonder a person of much below average intelligence can navigate. Plan F is not available to new enrollees. What else will change in the future? If you are currently paying higher rates anticipating future medical needs you are not going to want all the people who savined money on Advantage plans in their healthier younger years to be allowed back to regular Medicare when they get sicker. But hey, things can change at any time.

[Rzepecki]

NRLN President's Forum
Authors Conclude
Medicare Advantage
Should be Abolished

An analysis in the JAMA (Journal of the American Medical Association) Internal Medicine on June 10 concluded: "We think the time has come to declare MA [Medicare Advantage] a failed experiment and abolish it. That would allow redeploying the $88 billion taxpayers will overpay MA this year to upgrade benefits for all Medicare beneficiaries."

The conclusion was based on the high cost of MA compared to traditional Medicare. For example:

Medicare Payment Advisory Commission (MedPAC), the nonpartisan agency reporting to Congress, recently estimated that MA overpayments added $82 billion to taxpayers' costs for Medicare in 2023 and $612 billion between 2007 and 2024. Two insurer strategies drive MA overpayments: diagnosis upcoding and avoiding enrollees who are ill and do not contribute to profits.

Although MA insurers must accept all applicants in counties where they offer a plan, they are also free to withdraw from counties where they are accumulating unprofitable enrollees.

Only 2% of Fee-for-Service (FFS) Medicare expenditures go for overhead. But MA insurers incur extra expenses for television advertisements, health care network management, benefit design, executive salaries, health care utilization review, prior authorization, and shareholder profits, driving their overhead up to 14%.

This is according to a report from Milliman, an international actuarial and consulting firm, on MA financial results for 2022. Milliman estimates applied to subsequent years' payments, MA overhead for 2007 to 2024 totals $592 billion--equivalent to 97% of taxpayers' $612 billion overpayments to them during that period.

The authors closed their analysis stating, "A smarter, thriftier way to expand benefits and lower out-of-pocket costs is possible for all Medicare beneficiaries, but first, we must eliminate MA and double down on traditional Medicare, covering all enrollees in an expanded and improved Medicare program. That would be a good deal for patients and taxpayers."

The NRLN has advocated for 10 years that it is time to end taxpayer rebates to the healthcare insurance industry for MA This year rebate payments will equal 17% of every benefit dollar Medicare pays to private insurers. Private plans hold a 54% share of the Medicare market but Medicare payments per enrollee are 22% higher than we pay for Fee-for-Service (FFS) enrollee. Income taxes paid support 76% of Medicare B and D.

Yet 301 bipartisan members in Congress lobby for more rebates hoping they can eliminate the "third rail" risk and gain votes from 33 million over age 65 retirees in MA in their states. They don't care about the other 27 million seniors back home who don't get over $2,000 a year in rebate paid extra benefits. These 27 million are actually more in need according to MedPAC. Private plan insurers focus on enrolling younger, more healthy retirees.

Congress' own commission, MedPAC, produced a report and charts in 2020 showing members of Congress that 25% of the FFS beneficiaries over age 65 account for 85% of Medicare spending! MedPAC's report states that "Costly beneficiaries tend to be those who have multiple chronic conditions, are using inpatient hospital services, are dually eligible for Medicare and Medicaid, and are in the last year of life."

The NRLN and most Americans support competition from private healthcare plans and the NRLN understands the financial challenges ahead for Medicare and the federal budget. However, we do not support MA taxpayer bonuses and rebate subsidies, or anti-competitive restrictions placed on original Medicare FFS just to preserve the notion that private insurance plans may be more cost effective or provide better care than FFS, when the record shows they are not.

We have repeatedly pointed out to members of Congress that the chronic benefits provided to the 33 million enrollees in MA plans are denied to the 27 million participants in traditional Medicare. If Congress is going to continue funding MA with taxpayer money, those in traditional Medicare should receive the same benefits.

Bill Kadereit, President
National Retiree Legislative Network

[Pennyt]

Originally Posted by 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

I have traditional Medicare and my agent told me to not switch to an Advantage plan because everyone will be required to be on Advantage plans in the future. He said I'd be able to stay on traditional if I kept it. I go to doctors at Moffitt Cancer in Tampa and they do not accept Advantage plans. He thought traditional Medicare was better.

[M2inOR]

RE: National Retiree Legislative Network

What is missing is how the cancellation of Medicare Advantage and using the funds to "fix" traditional Medicare will actually be accomplished.

The Federal government gives Medicare Advantage providers a fixed amount per year, per client. This enables the provider to have a budget to fund a care team that is at the ready to service it's clients. There are also incentives in place to reward providers for keeping their clients healthier.

Yes, of course there are inefficient providers who don't have any idea how to have a profitable business. No provider can afford to operate a business that continually loses money treating its patients.

Someone complained that their doctors were always changing. You might want to consider using a provider that knows how to better operate their business providing healthcare.

For me, I want the best doctor available to treat me when needed. I don't need to see the same person each and every time. Fortunately for me my PCP is available when I make appointments for the future. And if I need someone ASAP, Villages Health delivers; a simple call tells me where to go if someone is needed immediately. This may be someone on my PCP's team, an urgent care clinic, or an emergency room. Fortunately the latter can be whomever is convenient.

Don't forget, the Federal Government has deep pockets, but the depth is not infinite.

[Stu from NYC]

Originally Posted by golfing eagles

They won't. Governments love to control people above all else. By limiting choices, they maintain control, so you can bet they will throw whatever money is needed in the direction of advantage plans.

At some point all of these deficits causing more and more borrowing is going to reach a point where nobody is going to want to finance them.

We will probably long gone but this cannot go on forever