Medicare Advantage is overbilling Medicare by 22%

[Nevilledog]

https://www.morningstar.com/news/marketwatch/2024032679/medicare-advantage-is-overbilling-medicare-by-22

'A difference that translates into a projected $83 billion in 2024,' one report found

If Joe Biden or Donald Trump or anyone else wants to know how to "cut" tens of billions from the Medicare budget without taking a single nickel from seniors, an obscure government body just revealed how.

But nobody seemed to notice.

The body in question is called the Medicare Payment Advisory Commission, or MedPac. It is an independent, authoritative body that advises Congress on Medicare. It was set up by the Balanced Budget Act of 1997, back when people in Washington were actually doing their jobs.

It just published its latest report to Congress, entitled "Medicare Payment Policy." And the key thing everyone needs to read is on page "XXV," which is how they used to say "25" in Rome.

It reads: "We estimate that Medicare spends approximately 22 percent more for MA enrollees than it would spend if those beneficiaries were enrolled in FFS Medicare, a difference that translates into a projected $83 billion in 2024."

*snip*

[Voltaire2]

1. MA is a pork barrel for plutocrats.

It should be abolished. Expand Medicare coverage instead.

[NewHendoLib]

2. how else can they pay for their endless TV, mailer and phone call ads

[Biophilic]

3. Medicare advantage really has to end somehow.

It steals from the government and the individuals enrolled at the same time. I’ve gotten so that I almost growel at the sales woman in cvs. I’ve talked with her a time or two. Doesn’t matter that’s her paycheck. I understand and try to avoid her now. But, damn, it pisses me off.

[Emile]

4. Destruction of Medicare if allowed to continue.

[JenniferJuniper]

11. That's the plan. As my avatar once sang,

If you can't afford our bills, don't you tell me that your ill,
Cause that's the free enterprise way.

[former9thward]

5. Medicare MA has more benefits for enrollees than regular Medicare.

So of course it costs more money. MA has vision, dental and hearing benefits. Regular does not. Those benefits cost money.

[TwilightZone]

7. Yep.

There are so many wrong assumptions and false assertions in the article that it's not worth the time.

Not that that will stop most people from believing it anyway.

[RobinA]

17. I've Mostly Given Up

this discussion. If people want to believe that Medicare Advantage customers are dying in the streets, have at it. If people want to believe the nonsense that Advantage plans limit treatment but traditional Medicare never does, I hope you never come face to face with the fact that this is laughably untrue. People need to make the decisions that work for them.. Retirement unless you are wealthy - it's pretty much a crap shoot based on how your health turns out and how long you live. We try to do the best we can.

[Demobrat]

8. And many more restrictions on where and how

people can receive care. Advantage plans might be right for some people and not for others, but it seems pretty obvious that they are blatantly bilking our oh-so-bilkable government.

[Marcus IM]

6. Cue the "I love my advantage plan" crowd.

[JenniferJuniper]

9. But, but, but I got 1k in yearly dental coverage!

Sure, I may end up 3 hours from home if I need a post-hospital rehab at one of the worst places in the state. But I'll have clean teeth.

[Hermit-The-Prog]

10. Gotta pay for skyscrapers, yachts, and CEO bonuses somehow.

[dalton99a]

12. Kick

[PortTack]

13. Designed to slowly bankrupt tradition medncare...and if allowed to continue it will

[RussellCattle]

14. Created so that stockholders can maximize their dividends by increasing profits.

[no_hypocrisy]

15. Medicare fraud by a different name . . . . .

[RobinA]

18. I Have To Wonder

if anyone has researched the amount of traditional Medicare fraud that happens with traditional Medicare and its private supplements versus Medicare Advantage. Honestly curious. I am in a situation where my company will offer me a retirement medical plan that is an Advantage plan at considerably less money than if I choose traditional Medicare plus supplement. As I failed miserably at becoming wealthy, I will be OK in retirement, but every penny I spend to keep myself afloat is another penny not spent on enjoying retirement.

[no_hypocrisy]

20. Consider this:

You enroll in Medicare Advantage. And everything's fine for a few years.

One day, you have an inexplicable pain in your lower back. It gets worse. You go to an orthopedist, who orders a CAT Scan and you're diagnosed with bone cancer.

Obviously, you want to have your pain and the cancer treated. But MA will choose to pay for only the pain. You're stuck with your cancer which grows and metastasizes to your lymph nodes and/or an organ. You're going to suffer and die because you were given the ability to treat it financially.

Please understand, yes, you pay more for Traditional Medicare, but TM will pay for virtually all medical care. (It won't pay for elective surgery like cosmetic or liposuction and dental work.)

[karynnj]

21. Your example is over the top, but does explain the difference

Last edited Wed Mar 27, 2024, 12:31 PM - Edit history (1)

I assume it would cover cancer treatments that it approves. The problem might be with which doctors and where.

Like Robin, I could have chosen a MA plan sponsored by the company I retired from in 1998. When I retired, the company gave lifetime medical to me and my family. At the time, juggling 3 children 8 to 13 years old, it was that provision that made the offer too good to not take. When we hit Medicare age, the plan gave us $2700 for me and $1500 for my husband to use on any medical premiums a year instead of being on their medical plan. About three years ago, they offered an attractive MA plan which I rejected. Last fall, they sent the MA stuff again with 2 changes: They discontinued the health account and offered the MA plan and they required you to opt out!!!

In the letter, they explained this as doing what is good for the shareholders and retirees. How beneficial to the company is suggested by the fact that they did not just end the subsidy, but made this opt out, which suggests that even without the cost of the subsidy they did better with people on their plan ... or may thought they would in the future. As many MA plans are for profit, this could be true.

While many of retirees who have already been on Medicare enough to realize how much better it was than even what was considered very good group health insurance, people at that company approaching Medicare will not have that experience. They will see the choice as a free or nea rly free MA plan with lots of included goodies. (They would have to pay part B) What they are giving up will not be obvious, but it is real.

While my former company may be trying to change a liability to a profit, it would have come at a potential cost for me. In the small print, they admit they can change the network etc in the future. That is a BIG deal because once you leave your medigap plan, you will not be accepted back if you have medical problems. Now, it is likely that it is when you have a problem that you might regret having agreed to the MA plan.

From people I know on Medicare/Medigap, medical costs for hospital stays, expensive tests and procedures, rehab stays etc are paid without any trouble.

[RobinA]

22. Nice Scare

but not my experience. I know people who have both kinds of plans and I've never heard of them not treating cancer. I have heard of both kinds of insurance denying certain things, AND causing elderly folks absolute hell on Earth to try to negotiate the process, but I've had private medical insurance my entire life and the problems of Advantage plans sound pretty much like the problems of any private insurance.

Any actual evidence that Advantage plans don't treat cancer will, of course, be given due attention.

[Emile]

16. I had four Advantage scam phone calls yesterday. Make

these scammers stop calling.

[dalton99a]

19. The healthcare industry should be nationalized

to get rid of the murderous greedy bloodsucking leeches

[Nanjeanne]

23. Its not enough that the taxpayers subsidize private insurance Medicare Advantage plans - but they rip us off in addition

[republianmushroom]

24. Just a little greed.

[Vinca]

25. The GOP wants to go pure Medicare Advantage if they agree to Medicare at all.

It's a total rip off, just like big pharma charging a fortune for drugs decades after they're pure profit.

[Midnight Writer]

26. Rick Scott approves this message.

[Silent Type]

27. Maybe if Congress actually wanted to understand why over 50% of Medicare beneficiaries choose Medicare Advantage,

they'd do something to make the original program better for beneficiaries.

There are lots of people who cannot pay an extra $200+ for a supplement and drug plan a month, can't bypass a quarterly food allowance, can't bypass a few hundered to several thousand dollars for dental coverage, etc.

Instead of bashing poor people for selectin MA, maybe you ought to call your Congressperson and tell them to improve original Medicare or keep funding the extra benefits for Medicare Advantage.

I really don't give a damn if a private insurance company gets a few extra percent in profits if they are providing plans that poor people can afford. Most can't afford original Medicare and the necessary supplement and drug plan, and forgoe dental and vision coverage (even if limited).