[Topspinmo]

Laughing out loud! ACA was supposed fix healthcare. It might have had chance if they would have read it before they passed it. IMO and I can have one IT just MADE it worse…….>

[Topspinmo]

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.

Kickbacks?????

[golfing eagles]

Originally Posted by 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

Bottom line: An opinion from someone who probably also has an agenda.

[golfing eagles]

Originally Posted by Pennyt

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.

NOT TRUE. Both Moffit and Shands are in network for the Florida Blue advantage plan.

[golfing eagles]

Originally Posted by Topspinmo

Kickbacks?????

More like the quote from Star wars episode 3------"All those who have power are afraid to lose it"

[SusanStCatherine]

Originally Posted by Mrprez

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

I agree no underwriting. But the premiums should be higher compared to those already paying higher Medigap premiums. Maybe a sliding scale based on age.

[SusanStCatherine]

It does not seem right that some retirees are only given the choice of an Advantage plan. Medical and employer relationship should have been decoupled a long time ago.

[SusanStCatherine]

Originally Posted by JMintzer

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...

Ah. The Affordable Care Act which was supposed to make health care affordable. We suffered for many years with the same high premiums but our deductibles were higher. Our employers did not offer healthcare. So basically paying an extra $30K per year and not have anything covered since the deductible was so high. It truly caused us financial distress. Rates are not determined by gender or health status or preexisting conditions - but wait - rates determined by age! And oh my gosh are the rates astronomical the years leading up to Medicare.

[SusanStCatherine]

Hospitals (and doctors) across the country are dropping access to Medicare Advantage plans and a simple internet search will show that this is true. Virtually all hospitals accept Medigap policy.

[SusanStCatherine]

The Pharmaceutical companies are way too powerful. The pharmacy benefit managers dictate what drugs go on the formulary and are available to you. So the formulary is based on maximum profit, not the most therapeutic drugs. There are no drugs on my formulary for my condition below tier four. I filed an exception and pre-approval and was granted it. What did that buy me? A chance to pay full price for the drug until my deductible is met and then I can pay half price for it. The half price they quoted me is more than the GoodRx price of $75 and this is a generic.

[Stu from NYC]

Originally Posted by Topspinmo

Laughing out loud! ACA was supposed fix healthcare. It might have had chance if they would have read it before they passed it. IMO and I can have one IT just MADE it worse…….>

Remarkable how few people who voted for it took the time to read what they were voting for

[golfing eagles]

Originally Posted by Stu from NYC

Remarkable how few people who voted for it took the time to read what they were voting for

You’re forgetting “you have to pass it to find out what’s in it “😂😂😂

[JMintzer]

Originally Posted by SusanStCatherine

Ah. The Affordable Care Act which was supposed to make health care affordable. We suffered for many years with the same high premiums but our deductibles were higher. Our employers did not offer healthcare. So basically paying an extra $30K per year and not have anything covered since the deductible was so high. It truly caused us financial distress. Rates are not determined by gender or health status or preexisting conditions - but wait - rates determined by age! And oh my gosh are the rates astronomical the years leading up to Medicare.

When the ACA was first passed, my deductible a $7K/year. And, like you, since my deductible was so high, the only thing covered was my yearly physical and my wife's yearly physical and mammogram... Everything else was "out of pocket"...

Only be choosing a lower coverage level was I able to reduce my deductible to $4K, and keep my premium increase to a less insane amount.


However, my monthly premiums increased...

[JMintzer]

Originally Posted by golfing eagles

NOT TRUE. Both Moffit and Shands are in network for the Florida Blue advantage plan.

What other Advantage Plans do they accept?

[JMintzer]

Originally Posted by golfing eagles

You’re forgetting “you have to pass it to find out what’s in it “😂😂😂

I'm still ****ed about that comment...