The Medicare Advantage ripoff every American should know about

[justaprogressive]

President George W. Bush and Republicans (and a handful of on-the-take Democrats) in Congress created the Medicare Advantage scam in 2003 as a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies.

Those companies, and their executives, then recycle some of that profit back into politicians’ pockets via the Citizens United legalized bribery loophole created by five corrupt Republicans on the Supreme Court.

Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs. These ripoffs — that our federal government seems to have no interest in stopping — are draining the Medicare trust fund while ensnaring gullible seniors in private insurance programs where they’re often denied life-saving care.
Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.As a result, Medicare Advantage programs make the greatest profits for their CEOs and shareholders when they actively refuse to pay for care, something that happens frequently. It’s a safe bet that nearly 100 percent of the people who sign up for Advantage programs don’t know this and don’t have any idea how badly screwed they could be if they get seriously ill.

[link:https://www.rawstory.com/medicare-advantage-2665824037/|

[Freddie]

1. My daughter is a home-care RN case manager

HATES the Advantage plans. The bean counters second-guess decisions about care needed, number of visits allowed etc., and make her fight to get patients the care they need. Traditional Medicare does not. DH and I just went on Medicare and took her advice, traditional with an AARP supplement.

[dalton99a]

69. I suspect many folks were duped into signing up.

I know someone who just had their physical therapy cut short by their Medicare Advantage HMO - an elderly woman who had a shoulder injury and couldn't drive. The ortho surgeon said it was pretty bad but didn't need surgery - try physical therapy first. The woman had no transportation and the HMO said at-home therapy would be out of network. After weeks of denials and appeals, the HMO relented and allowed her so many at-home sessions - and then cut her off. Now she is appealing again. Her primary doctor and ortho surgeon and physical therapist all had to write more letters to say it was short-sighted and stupid.

The problem is corporate greed.

[Silent Type]

82. Traditional Medicare has tight limits on physical therapy too.

[dalton99a]

85. The problem is the network limitation

that her MA HMO uses to categorically deny and then limit a badly needed service

Medicare allows home health services as long as you're homebound and the doctor approves (up to a limit obviously - what the MA HMO is doing here is a fraction of what is available to regular Medicare folks)

MA is great if you are in good health, live in an urban area (or have a car), only need routine care, and have money set aside for out-of-pocket expenses (unless you also qualify for Medicaid)

[Silent Type]

101. And traditional Medicare is good if you have $250 to $400 a month for

supplement, drugs, dental, etc. Lots of people don’t.

[MichMan]

2. Medicare Part C was actually created in 1997

The introduction of Medicare Part C in 1997
Medicare Part C was introduced through the Balanced Budget Act of 1997, with coverage beginning in 1999. Medicare Part C plans, today sometimes called Medicare Advantage plans, are offered by private insurance companies that contract with Medicare.

Medicare Advantage plans work with a network of providers. Their coverage model is more similar to employer coverage than original Medicare.

These plans must offer at least the same coverage as original Medicare, and they often include additional coverage for services that Medicare doesn’t cover, such as dental, vision, and prescription drug costs.

https://www.healthline.com/health/medicare/medicare-history#:~:text=Medicare%20Part%20C%20was%20introduced%20through%20the%20Balanced,Advantage%20plans%20work%20with%20a%20network%20of%20providers.

[Silent Type]

14. Thanks for posting. Folks forget this was started under Clinton.

[Farmer-Rick]

34. Yeah, I thought it was before W

He just made it really worse.

W added more scammy stuff, increased premiums for Medicare to the middle class by 14% as a portion of income while the filthy-rich pay 78% less as a portion of their income. Isn't that when they put that weird donut hole in drug coverage in 2003? Where they paid until you reached like $2,000 and then they stopped paying until you reached like $4,000?

And there you see the inflation that Republicans are blind to. When you pay a whole lot more for government services it also causes inflation. Look at how much your car registration, drivers license and titles have gone up in the last 2 years, especially if you live in a red state/district.

[Ms. Toad]

66. While it is true that they are required to offer at least the save coverage,

As a practical matter, they don't.

Most patients who know how to fight the system are ultimately able to get care. Unfortunately, the delay often causes physical/health damage and emotional damage because of the uncertainty. These real impediments to recovery come on top of the time and energy it takes to fight to get access to what Medicare covers without a fight.

[CaptainTruth]

71. It seems "offer" and "provide" are different things in this case.

[dalton99a]

73. Yep.

I know people who suffer because of this:
https://democraticunderground.com/1016365493#post69

[Stargazer99]

3. I told all of you last month that Medicare Advantage plans will eventually deny care

for increased profits-capitalisim in action-they got you stupid and cowed and you just take it...time for the common man to raise hell

[MOMFUDSKI]

4. We need National Health Care for all.

My hairdresser has traditional Medicare and is paying a ton of money each month for the privilege of choosing her own doctors. They aren’t helping her but she has a “thing” about staying within a Network which Advantage requires. I have Advantage which costs me $0 per month and I am just fine. Just depends where you want to spend your money. The fight continues.

[lostnfound]

6. Why bother having insurance at all?

How lucky to get “$0 coverage.”

Do Medicare advantage companies insure people who get lung cancer or MS for $0?
Do you care? Does your hairdresser care?

You are so lucky to get $0. That’s what matters, to most people.

[MOMFUDSKI]

7. Not lucky. I made a choice.

My $88,000 spine surgery in February cost me $88 total. Just had a free crown put on my tooth last week. Paid $550 for a double root canal few months ago because I used my $750 credit card from my Advantage Plan toward the total cost. Will be making an appointment with my eye doc soon which will cost me nothing. Regarding getting cancer or MS my agent said if one is quite sick that would be when one would want traditional Medicare. No one knows what the future will bring.

[IbogaProject]

26. Catch is Medicare Advantage is permanent

You can't get out of it, ane once you have serious illness I doubt it's easy to switch providers. A new front in this mess is state governments pushing their retiree healthcare onto them.

[DownriverDem]

49. In Michigan

you can switch until Dec 7th for 2024.

[IbogaProject]

53. But I think you have to pay back supplemental premiums

You can't switch back to traditional for free you can switch MA plans, maybe with an underwriting gate to go through.

[DownriverDem]

59. I pay $0

monthly. All the negative comments here don't make sense to me.

[IbogaProject]

64. You'd have to pay back premiums to return to traditional medicare

The back premiums I'm referring to are the monthly Medicare ones you've skipped. Yes you pay less now, but the true test of it's value will be as you mature further and need more care. I'm not criticizing you I'm just warning others to research that issue and weigh the costs and risks.

[DownriverDem]

68. Maybe but

I like the benefits of dental, vision, hearing and the Over the Counter card.

[moose65]

79. You don't pay anything at all??

Not even the Part B premium?

[Skittles]

119. if it is zero for you, it means someone else is paying for it

NOTHING in healthcare is FREE

[Ms. Toad]

76. It can vary some by state,

You are entitled to return to Medicare. In most states you are NOT entitled to a supplement/medigap plan.

Guaranteed issue is only a federal right during your initial enrollment period. That means they can flat out refuse to issue you one at a later time. In that case, if you are moving to traditional Medicare because you are very sick - you may be worse off, since you're salary on traditional Medicare is 20%. 20% of a costly illness is more than must people can afford.

If they choose to issue you a policy, they can set the price based on your then current health status - so the premiums will be much higher than the community based premiums that you are entitled during your initial enrollment period.

States are allowed to give you more rights (like extending the guaranteed issue right to late enrollment, or prohibiting premiums based on your then current health). As a practical matter, most don't grant you additional rights.

I've only found one state where you are entitled to a late enrollment medigap policy at the same rate as those who started in traditional Medicare (Illinois), and even there you were only entitled to that option if you chose the right Medicare advantage plan when you initially enrolled.

[ret5hd]

8. Tell me about the hairdresser paying to...

see her preferred doctors.

Do the doctors she prefers not accept Medicare?

[MOMFUDSKI]

10. They accept Medicare and probably some accept Advantage also.

She is paying traditional Medicare monthly premium plus they are taking X amount right off the top of her SS check. Her own docs may not be IN NETWORK with an Advantage Plan. One must choose a doc in network when on an Advantage Plan.

[ret5hd]

16. I am not an expert on the subject...

but I thought Medicare A and B were free.

Then, one could pay for a supplemental plan like in G.

Is that incorrect?

[MOMFUDSKI]

35. Not free because of the

dollar amount taken right off the top of your SS check each month. You don’t have to get a supplement if you don’t want to.

[Rebl2]

61. If you

go to SS and look up your account, it will show you what the amount is they take out for your part B. It shows you how much you get in social security and once they make the decision in November, the amount you will get next year.

[Attilatheblond]

43. Part B comes out of one's monthly Social Security benefit

Part A is not billed to people.
Since B comes out of SS monthly payment, many assume they are not paying for part B because they don't see a bill for it.

I have A, B, and stayed in the federal employees group plan, which costs but is good insurance. Plus, being as it is a HUGE group, Blue Cross/Blue Shield seems disinclined to jerk us around. Aside for $5 Rx co-pays, I have yet to see ANY bill for medical service, including ER visit with many tests, regular doctor visit, lab work, and a long run of physical therapy sessions. My Blue plan also pays me back a good share of what Medicare took out of my monthly Social Security. That plan also has a HUGE network, almost any practitioner who takes Medicare is fine with my Blue policy and they are always expanding the network, provide a lot of perks and give great service when you call.

[Rebl2]

47. A is free

B you pay a premium. I think mine is $160. I also have retirement supplement through my husbands employer-Blue Cross/Shield Fed. Yes it’s kind of expensive but it’s for two of us. Part D nor advantage plans will pay for one of my medications.

[moose65]

28. I have a question for you

When you say "it costs me $0 per month," do you mean that you have no Part B premium? You don't pay a cent for Medicare at all?

I have seen several posts like yours and it's never clear if it means that you pay nothing. If you don't pay your Part B premium, then who does? Do you have some kind of union benefit or pension plan that pays it for you?

I am genuinely curious - not attacking you at all. I just want to know!

[MOMFUDSKI]

42. I am not on the government Medicare Plan.

Therefore the government does not withhold any money from my SS check. We are currently in the “Open Enrollment” period. Do yourself a favor and attend a local Advantage Plan session. Usually held at a restaurant with several Advantage Plan agents explaining how it works. Ask all the questions you have. Educate yourself

[moose65]

54. Are you sure it doesn't come out of your SS check?

As far as I know, EVERYONE has to pay the Part B premium.

I just don't understand how all of that can be free to you. Don' you see what a scam that must be, then? If you're getting it all for free, SOMEONE is paying for it and it's not you, apparently.

This is part of the plan, I guess. They offer extra benefits to some people so that you will defend it no matter what.

[ShazzieB]

107. My understanding is the same, as far as the part B premium goes.

And I'm pretty sure you have to enroll in parts A and B before you can get either a Mecicare supplement/Medigap plan (WHY are there are two names for the same thing, btw?) or MA.

I cannot vouch for all of these assertions with 100% certainty, because the whole damned Medicare thing is so fricking confusing, but that's my understanding, FWIW.

[Mister Ed]

74. I'd say, do yourself a favor and *don't* attend a dog-and-pony show at a local restaurant.

Last edited Sat Oct 7, 2023, 01:34 PM - Edit history (1)

Instead, go out to Medicare's website (medicare.gov) and use the find-and-compare feature that's provided. That's the place to educate yourself about your options for both Medicare Advantage and Supplemental Medicare policies.

Attending an Advantage Plan session at a local restaurant will get you a free dinner and a sales pitch, either soft-sell or hard-sell. That's not necessarily a bad thing. The agents who are there to pitch their products may have some very good options to offer you, but they can't offer you anything else but what they have, and what they have might not be right for you.

The find-and-compare feature at medicare.gov works very well, and will show you all of your options.

[dalton99a]

86. People are not aware of the commissions involved

https://nccagent.com/blog/retire-selling-medicare/

[Mister Ed]

113. Thanks, that's excellent information. Do you know who gets the commission if...

...if I select a policy through the medicare.gov website, as I'm planning to do during this open enrollment season? Does the commission just go to whatever insurance company I select?

[dalton99a]

115. The insurance company saves money if you don't use an agent/broker/sales rep

because they don't have to pay a commission to them. (It is the insurance company that pays the commission, not you or the government). Your premiums are the same regardless of whether you use them. You cannot negotiate or get a lower price by not using them. The best strategy is to research everything for yourself and know all your options BEFORE talking to them. (Many of them are great people, but there are a lot of smooth-talking opportunistic dumbasses who don't know much more than you.) If you know what you want, online signups are easy. And you can always change your mind within the enrollment window.

[Mister Ed]

116. Thank you! n/t

[Ms. Toad]

80. You are. You just don't know it.

The fact that you don't know this is a pretty strong recommendation not to attend a MA dog and pony show (especially not as your primary source of information in making this critical decision), since you came away fundamentally misunderstanding what MA is.

Medicare advantage administers your parts A, B, and (in most cases) passed D benefits.

You must have Medicare Part A (Hospital Insurance) and Part B (Medical Insurance) to join a Medicare Advantage Plan.

https://www.google.com/url?sa=t&source=web&rct=j&opi=89978449&url=https://www.medicare.gov/Pubs/pdf/11219-understanding-medicare-part-c-d.pdf&ved=2ahUKEwj55oDxoeSBAxWUK1kFHdi9ATkQFnoECA8QBg&usg=AOvVaw06eLA0NqOlW0UAxSTbgvqd

The administrator is given a fixed amount for your care, and they are required to cover everything Medicare covers, because they are Medicare. They are given the flexibility to manage it - by limiting the doctors you see, requiring pre-approval, etc. If they save money by doing that, they can return it to you in the form of added benefits - including (in some cases) cash back to your SS benefits.

So, bottom line, Medicare Advantage requires enrollment in Parts A and B (and paying any associated premium). This is usually done by deducting it from your SS check, so you don't see it happening.

[Farmer-Rick]

39. You don't pay the premium????

I thought everyone did.

Check any SocSec you might get. They will take it directly out of your SocSec check, even if you don't authorize it. According to the government Web site you do pay premiums.

"You must keep paying your Part B premium to stay in your plan."

https://www.medicare.gov/basics/get-started-with-medicare/medicare-basics/what-does-medicare-cost#:~:text=Medicare%20Advantage%20Plan%20(Part%20C)%3A&text=You%20must%20keep%20paying%20your,pay%20out%2Dof%2Dpocket.

[gab13by13]

5. Medicare Advantage Plans are private insurance, period.

Medicare Advantage plans get a lump sum of money up front so the only way that private corporation can make money is to deny benefits, to deny care.

[MOMFUDSKI]

9. I see all kinds of Specialists and pay $25 copay.

In the waiting room I am sitting side by side with traditional Medicare patients. Who is getting the better care?

[Ms. Toad]

87. I am one of those traditional Medicare patients.

My copay is $0.

The difference in care, however, comes less in standard office visits than in complex care requiring specialized tests/medication.

When I need an MRI, the doctor orders it - and I get it. Same day if appropriate. You will have to wait 10 days, because your MA plan will require pre-approval.

In the 10 days prior to the MRI, my sarcoma doubled in size. It is an extremely aggressive cancer, and any delay before surgery increases the risk of metastasis.

I don't need chemo (partly because my tumor was still small enough to pose a significant risk of metastasis). But because your surgery was delayed 10 days while waiting for the MRI, your tumor is large enough that your Doctors believe you need chemo.

Chemo, especially for rare cancers where evidence of effectiveness is not strong because there are too few patients to study. Your MA plan may initially deny treatment, because there is insufficient data to show it will change the outcome (death).

Had I needed chemo, since the medication is a treatment covered by Medicare I would have gotten it right away. You appeal and 3 months later the denial is reversed. By now, however, the metastasis has made you so sick that it is impossible for you to recover.

Meanwhile, because I got treatment while I was still relatively healthy, I recovered.

In many cases, delays are not merely inconveniences - they impact care, sometimes in outcome-determinative ways. So I'm getting better care. (And cheaper care.)

To be clear - I do have sarcoma. It did double in size in 10 days. It is an aggressive, rare cancer for which there is not definitive evidence regarding chemo. Even a few days delay prior to treatment can mean the difference between life and death. I've changed the scenario a bit because I transitioned to Medicare partway through treatment. So I was not on Medicare when this adventure started.

There was a 10-day wait period imposed for the MRI by my traditional insurance plan (after which MA is modeled - and denials are higher by MA plans than by regular insurance). Because I knew time was critical, I got around it by agreeing to pay out of pocket if insurance ultimately denied it. Not everyone can afford to do that - and among people I know of with the disease, most people just accept the delay. While I did not need an MRI for my sarcoma while on Medicare, I have had at least two on Medicare. Neither required pre-approval. Neither delayed treatment.

I did not need chemo. But in the support group I'm in, insurance denials are frequent for exactly this reason - it's to rare to have good data. Ultimately many are approved, but the delay makes the treatment far less effective. As the article suggests, this kind of care - which is required to be covered if Medicare covers it - is nearly always ultimately approved. But it often imposes a delay which makes the overall care inferior. (The denials by MA plans are significantly higher than ordinary insurance.)

[justaprogressive]

114. Precisely!

things that should be decided between you and your doctor....aren't!

[sinkingfeeling]

11. Not exactly true. They can make a profit if the number

Of members use much less than average medical services surpasses those that use extensively expensive services.

I have an Advantage plan that is for retired employees of my old corporation only (run by United Healthcare). I use less than $1500 a year, including pharmacy. We, retirees, are incented to NOT take regular Medicare by receiving $1300 a year to use for co-pays, premiums, and other medical expenses. We also get a discounted Part B, $20 less a month.

The company contributes $0 if you sign up for regular Medicare.

[MOMFUDSKI]

12. Part of the Advantage thingy is

the government agrees to give money to an Advantage Plan that winds up with a lot of really sick people in the group. Advantage Plans take people out of the group of people eligible for Medicare benefits.

[Skittles]

103. the government gets RIPPED OFF by "Advantage"

https://www.commondreams.org/news/medicare-advantage-overcharging

stop saying zero dollars, if you're not paying for it THE REST OF US ARE

[dpibel]

84. So are Medicare Supplement plans

Somehow, these ongoing arguments fail to include that people who are awfully happy with traditional Medicare are paying at least a couple hundred bucks a month for supplemental coverage (which is the only way to get to "I'm on regular Medicare and I pay zero for all my care&quot plus Part D.

And that coverage is, believe it or not, private insurance and it's profitable, or they wouldn't be offering it.

[meow2u3]

13. Remember this about Medicare Advantage

Health insurance companies designed Medicare Advantage to take advantage of people on Medicare.

[Attilatheblond]

48. Yep. And those insurance companies bombard us with ads to herd people into plans without good info

Sales people who work for the insurance companies, not 'representatives' who provide you with the best info.

[Farmer-Rick]

102. OMG and they are relentless about robo calls,

Unsolicited calls and junk mail. Especially when you first go on Medicare. It's constant nonstop harassment targeting people who are not in the prime of their life. I hated it.

I would spend hours blocking calls from insurers in the advantage program. Yeah, hours. As soon as I blocked one, they would get another number. If not for call blocking, my phone would ring every 3 minutes. I timed it. I'm surprised they had any budget remaining for paying medical costs of their customers after having spent so much on on unsolicited ads.

I would never use their crappy advantage program just because of their horrible advertisement high pressure tactics. I think only time share salesmen are worse.

[dalton99a]

15. Kick

Last edited Sat Oct 7, 2023, 10:26 AM - Edit history (2)

https://pnhp.org/system/assets/uploads/2023/09/MAOverpaymentReport_Final.pdf

Our Payments, Their Profits

By our estimate, and based on 2022 spending, MA overcharges taxpayers by a
minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion.
By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by
a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By
comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall
federal spending on Part D drug benefits cost approximately $126 billion. Either of these—
or other crucial aspects of Medicare and Medicaid—could be funded entirely by eliminating
overcharges in the Medicare Advantage program.

Medicare Advantage, also known as MA or Medicare Part C, is a privately administered
insurance program that uses a capitated payment structure, as opposed to the fee-for-service
(FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care
of beneficiaries, the federal government gives a lump sum of money to a third party
(generally a commercial insurer) to “manage” patient care.

Although private insurers have been involved in one form or another since the early days of
Medicare, it is only since the establishment of Medicare Advantage in the Medicare
Modernization Act of 2003 that such participation has grown significantly. Since 2007, the
share of beneficiaries enrolled in MA has nearly tripled, and the program now manages the
care of more than half of all eligible beneficiaries. (1)

Proponents of managed care have long maintained that programs like MA reduce expenditures,
improve quality of care, and enable consumer choice. The reality is just the opposite. The data
show that privatized Medicare has not once yielded savings for the program; conservative
estimates by the Medicare Payment Advisory Commission (MedPAC), an independent agency
created to advise Congress on the Medicare program, show that payments to MA plans over the
past two decades have always been higher than they would have been for patients in Traditional
Medicare. (2) Despite this additional spending, MedPAC could not say conclusively whether
care outcomes fared better under MA. (3) And while patients in Traditional Medicare have
access to nearly all doctors and hospitals across the country (4), those in MA must contend with
heavily limited networks (5) and arcane prior authorization procedures, calling into question
which “choices” consumers are ultimately able to make.

...

[Silent Type]

17. As of 2023, the majority of Medicare beneficiaries are in Medicare Advantage Plans. Most are there

because it's what they can afford.

Typically, those on traditional Medicare shell out another $200 to $300 a month on a Supplement and Drug Plan. And, MA enrollees get some -- even if limited -- coverage for dental, hearing, vision, some pay $50 or so a month toward food, etc.

Yeah, we all hate the ads with aging, of dying, celebeties.

And guess what, even if you are in traditional Medicare, most of the administration is performed by private insurance companies who pay the claims, enroll doctors and other healthcare providers, answer beneficiary questions, audit providers, etc. And, of course, the supplements and drug plans are private companies.

Point is, you ain't escaping private for-profit companies.

I have traditional Medicare now, because it is the most flexible. But I can forsee a day when I take Medicare Advantage because I can't afford the $300+/month in premiums and forgone extra benefits. If Kaiser moves into my area, I'll sign up.

I'd love Medicare-for-All, or something similar, but I don't see that happening anytime soon.

[paleotn]

27. Contracting back office work isn't the point being made in the original post.

And there's significant debate as to whether that contracting actually saves the feds any money. Management of traditional Medicare is still a federal government function.

[Silent Type]

33. Traditional Medicare is administered by insurance companies since inception. That's a fact.

[paleotn]

46. Back office. Management is through the federal government.

Original Medicare is coverage managed by the federal government.

https://www.medicare.gov/what-medicare-covers/your-medicare-coverage-choices/how-original-medicare-works

[Silent Type]

50. Back office-- everything including coverage, claims, credentialing of doctors, notifications, etc.

They do everything but write the laws.

[paleotn]

60. Contracting for certain services is a different animal entirely compared to Advantage funding.

You're mixing apples with oranges. My original point. The feds contract tons of services and products. I should know. I've worked in DoD programs for years. Advantage is funding and structured quite differently than normal government contracting for goods and services, opening new ways for insurance companies to cut corners at the federal government's expense. That's the point of the original post

[Silent Type]

65. I think they point of the OP was to bash Medicare Advantage and those that choose it. That's usually

the case.

Until something changes -- which I don't foresee -- MA is the only option for a lot of people. And they are not stupid, or ill-informed for choosing it.

[paleotn]

91. And I think you're wrong.

The point was to bash some of the insurance companies taking advantage of a badly designed paradigm.

[Silent Type]

100. Glad you are so much smarter than the 51% who choose MA.

[DownriverDem]

18. Does Medicare give you

dental, vision, hearing and an Over the Counter card? If there are problems, it needs to be fixed. I pay no monthly fee except what is taken out of SS. In Michigan it depends on what county you are in for what you get. I don't feel ripped off at all.

[orthoclad]

36. What in the world is an over the counter card?

They return a fraction of what you give them in order to buy cough syrup?

[DownriverDem]

45. It covers lots of stuff

like vitamins, toothpaste, mouthwash, pain relievers, & yes cough syrup etc. I don't give them anything. In 2024 it is $125 quarterly from my plan - Blue Cross Blue Shield of Michigan Medicare Advantage PPO. It rolls over too. I don't know what you are talking about.

[SalamanderSleeps]

19. Bottom Line.

If you sign up for a "private fee for service" plan that is funded by Medicare the insurance company receives a year's worth of funding from the government whether you need health care, or not.

The insurers are guaranteed a steady stream of the collective pool of funds. And thus deplete the fund for their exclusive gain.

Rich guys stealing from little folks.

Is anyone seeing a pattern here?

Medicare "Advantage" my ass.

It may provide some benefit to some people, but it was designed to siphon off Medicare funding that everyone spends their working lives contributing to.

[moose65]

37. True

To me, it seems like it's another way to make us fight with each other, so that we don't fight the real enemy here: the for-profit insurance companies.

Thing is, these MA companies are overpaid so much that they can afford to throw people little bones here and there.

For example, the amount paid to Medicare Advantage per person was almost $12,000 in 2021. They get this amount whether the patient is sick or not, or if the patient has very little medical expense. Therefore, they target the younger set of Medicare enrollees, who have fewer expenses overall. And if they don't spend the entire amount on care, then guess what?? They get to keep the extra amount as pure profit to pay to their executives and share holders.

With that extra money, they are able to give a few more benefits, so that people will say "I love MY Advantage plan!!!!!"

And they continuously mislead people into thinking that MA is "just Medicare." If it's "just Medicare" then why isn't EVERYONE getting those dental and vision benefits??

[Silent Type]

52. Yet, it is chosen by 51% of beneficiaries. Good to know we are smarter than all those stupid people.

Do I need a sarcasm thingy?

[Attilatheblond]

57. Thank you!

That's it in a nutshell. If it wasn't profitable for the insurance companies, they wouldn't be doing it. It's that simple. More corporate welfare for private companies with grossly overpaid executive officers, and money to shareholders. Defeats the whole purpose of the Medicare program, but gobbles up public money.

Also, all the ads and such create chaos, confuse many, get people to just buy the sales pitch to 'get it over with'.

[orthoclad]

20. We need health care, not "insurance"

This stupid insurance model results in the US having low life expectancy and the most exorbitantly expensive medical care in the world. The US ranks behind Ecuador in life expectancy. (see recent WaPo articles I posted).
https://democraticunderground.com/?com=view_post&forum=1016&pid=365307

Pay doctors and nurses, not bean counters and Wall Street. Focus on health, not on emergency interventions, treating health care like car accidents. Retrain the insurance specialists and managers in useful occupations, like we suppsedly did with steelworkers and miners.

No other country has such a silly care model. We need a National Health system. Call it Medicare for all, or whatever, but we need to stop enriching parasites at the cost of our lives.

[DownriverDem]

22. It needs to be fixed

instead of attacking folks who take Medicare Advantage because of the benefits they give. I get dental, vision, hearing and an over the counter card that is loaded quarterly. The comments here are too negative including how much folks pay monthly.

[paleotn]

29. I don't see anyone attacking those who chose Advantage. Just the private entities running them.

If it's cheaper, be sure it will come at a cost. There's no free lunch.

[DownriverDem]

63. The comments are way too negative

and I feel it does attack us on MAs. If you don't want it, don't take it.

[orthoclad]

32. We need to completely replace the insurance model

with a health care model.

It will cost a fraction of what we spend with better outcome. Look at any other "developed" country.

[SouthernDem4ever]

38. Agreed. Insurance should not be a "for profit" system

Because it is no longer insurance, but just another investment vehicle for wealthy people to deny care to others.

[orthoclad]

56. We need to drop the "insurance" model altogether

"Health" means thriving, not just fixing things when they go wrong, like fender-benders or crashes.

But there's more money to be made in the insurance model.

[Joinfortmill]

21. I suspect this is more complicated than most of us realize...

I'm too old and too tired to get into a debate, but I will say this, which I have said many times before, because this topic keeps coming up. I've had an Advantage plan for 10 years. It's a choice. But, if you initially choose an Advantage plan you will likely be forced to stay with them unless your advantage plan leaves your area. If that happens, and it sometimes does, you will again have the option of choosing traditional Medicare. I always choose a PPO and one of the national plans: Aetna, Humana, United Healthcare, etc. Now, is original Medicare better than Advantage plans? I don't know. Possibly, in some instances, certain procedures/medications are not covered. But I would hazard to say that 95% are covered.

I had a large unruptured brain aneurysm that needed to be coiled with 2 stents. Procedure took 3.5 hours, was done in a hospital under general anesthesia with an overnight stay. Costs were staggering (188k), but were all paid by my insurance company with the exception of the hospital bed, which was $365 required by Medicare. Now, the fees paid were not the entire amount charged by the physicians, etc. But they had contracted to accept the fees the insurance companies were willing to pay. They write-off the remaining amounts.

As for National Health care. I'm in a group of survivors of brain aneurysms with members from other countries, including countries with National Health care. These folks wait months, not weeks, months to get an appointment with a specialist. So it's not all rosy in other places, either.

I'd still place my bets on the U.S.A. for healthcare. I am a walking, talking example of it. I was over 70 years old when I had this procedure and my doctor is a damn rock star to me. Just saying, people.

[SouthernDem4ever]

40. I am glad yours was a success story.

[paleotn]

23. What a minute. Weren't these private entities supposed to profit from efficiency alone?

Seems I remember that from the debate over all this in the W years. They were so super duper efficient compared to the "bloated" federal government that they could provide the same level of service at the same cost and make a nice profit in the process. Gee, guess that wasn't so.

So now they're overcharging and denying claims to make an extra buck. Add natural human greed to the fact that private entities aren't as efficient at doing things as some would claim and you end up where we are.

[Traildogbob]

24. I love my Advantage plan

It’s free!! They also cover my dogs, My Home, my Auto, my appliances, my groceries, and my hair cuts. Plus they put cash into my Social Security. I had a billion dollar head transplant and paid zero. I got this mountain bike for $11.00 with zero shipping. This sign up period they offer to cover my Sat TV, Cell phone plan and yard maintenance. “I only Pay For What I Need.’ Plus they gave me an Emu.
And if I live in the right States they cover Weed for pain, and happiness. Does traditional do ANY of that? I love JJ, Namath, and Shatner. They ALL have Advantage.
Who Pays the trillions for Advertisement? Tax payer fools that don’t sign up.
Traditional Medicare is like the DNC, just don’t Message well.

[moose65]

41. Hahahaha!!

Your comment just made my day!!

Have you considered a career in Medicare Advantage commercials?? I think they hire people who AREN'T washed-up celebrities, too!!

[Traildogbob]

72. Yea, I think

Some post here every time a negative news report is posted.
I got scammed into a plan. At retirement it is confusing with all the INS people coming at you.
I am lucky to have a State Teachers Retirement plan that WAS with Blue Cross Blue Shield. 70/30 but it’s some cap coverage and great Med coverage.
I am a Veteran with 30 percent disability. They see me for all other medical needs and require insurance for those, they only take what insurance pays.
At retirement and Agent with Blue Cross came to my house to sigh me up for a state retirement additional plan for free. Part of my retirement she said. After two years a the VA called me and said if I did not change my policy they would have to change my VA coverage. It was a Damned Advantage plan that over road my Medicare, and Retirement plan for gap.
Never told they had signed me into the Ad scam. It took me 6 months of letters documentation and the VA writing and fighting for me to get my Medicare back and drop the Advantage plan.
All that was 3 years ago. 2 years ago the State dropped BCBS and changed all coverage for current employees and retirees to a Medicare Advantage plan. I was told if I stay with 70/30 I would not be in Advantage. We will see. So when I see these pro advantage posts about major coverage for nearly free. I want to ask then to “check all the boxes with stop lights”.
Advantage lied and nearly screwed me out of my earned veteran benefits and retirement gap plan. I hate them passionately. They plan to destroy Medicare and are well on their way. After they succeed we will be screwed with a monopolized for profit system that will kill us all.

[dalton99a]

75. +1. MA companies are very aggressive in their campaigns to lure and entrap retirees

It is a gold mine

[Traildogbob]

77. We are the prey

For most all scammers. Easy Pickens. I am concerned with all the States changing all their employees and retirees over to Advantage. Zero options for them to not join. But for BCBS covering earned benefits for 30 years service for State Employee's, to send BCBS Advantsge agents to retirees to lie them into their scam is really sick. And to screw over the Veterans and their VA care is another level. But typical for GQP loving CEO’s.
Yea, I passionately hate Advantage.

[1WorldHope]

88. My husband doesn't have part B taken out of his SS because he uses the VA for physicians visits.

After doing that for 10 years he could not go back to regular part B without paying a percentage for each mo. or year, I can't remember, that he did not take part B. I took an advantage plan without realizing it was the boogie man of privatization. At the time I didn't want to spend money on supplemental insurance, or part D. If I tried to go back then I would also have to pay a penalty. It's a bugger. You're screwed if you do and if you don't.

[Traildogbob]

93. You are correct

The whole system is geared toward profiteering. Don’t get sick and we are good. We all deserved what elected (???) pricks get for minimal years service. If I read correctly last week, Boebert gets life long care after two terms. Four freaking years. There is nothing more sick and in need of care than US health care.
I was impressed last week while picking up script at CVS. Big posters at check out alerting “sign up period” for Medicare, not Advantage, and Obamacare. Actually calling it Obamacare still. Credit where it is due. Was originally meant as a dig on the policy.
But look at the bright side, after trump is reinstalled, after just 2 short weeks he will give us the greatest health care, the likes of which the world has ever seen, even better than Advantage with free stuff packed in. 2 weeks. It may be the end of Advantage, or any care, it will be so fantastic.
Sarcasm emoji needed ???

[Skittles]

104. *SNORT*

[dalton99a]

110. Most brokers would choose traditional Medicare for themselves

“When we did focus groups with brokers, many said they are paid more to put people into Medicare Advantage plans, sometimes much more,” Jacobson said. But “if they were going into Medicare tomorrow, most of them said they would choose to be in traditional Medicare.” These brokers do not get any commission for helping someone enroll in original Medicare. Likewise, they said most Part D prescription plans don’t offer commissions; for those that do, the rate is low. As for Medigap policies, an agent might get some money for signing people up, but agents say it’s not as much as what they get for a Medicare Advantage enrollment.

https://www.aarp.org/health/medicare-insurance/info-2023/will-original-medicare-survive-medicare-advantage.html

[DownriverDem]

25. I have

Blue Cross Blue Shield of Michigan Medicare Advantage PPO. I like the benefits of dental, vision, hearing and an over the counter card that is loaded quarterly.

[tiredtoo]

30. Have been vigorously trying

to get this information to all. Hopefully some will see the light!
I have medicare and a supplement plan. My wife died of cancer 7 years ago. She received all the treatments available at the time. She had numerous ct scans and MRI's. She had two 10 day stays in hospital. Out of pocket cost $0. I had an abdominal aorta aneurysm that required 3 operations to repair. Two vascular attempts and finally open surgery. This also required hospital stays and various scans. Out of pocket costs $0. Cannot even imagine what the costs would have been with an advantage plan or even if they would have covered it.

[MOMFUDSKI]

55. Advantage Plans have a yearly $$$ limit

of out-of-pocket costs. Somewhere around $4000. I would have to look it up

[tiredtoo]

67. they also have limits on what they pay out and/or cover.

look that up also.

[Skittles]

105. or they will outiright deny care based on some weird algirithm

you know, an algorithm that is based on increased profits

[Ms. Toad]

89. Just like any other insurance, It depends on the plan.

The maximum permitted is $8300 in network/$12,450 out of network. Plans are allowed to set lower caps, but not higher.

My max out of pocket on standard Medicare + medigap plan is the annual deductible. $233 this year if I recall correctly.

[Cheezoholic]

31. Some red states, such as IN, that took the expanded medicaid option

force you to take a Medicare Advantage model, with most requiring income adjusted payments and/or work requirements depending usually on age. Folks between 55 and 65 here don't have those requirements. However you still have an insurance company (can pick from 3) running the show. After a heart attack, I was denied Entresto and Jardiance as one of the meds my cardiologist wanted me on and had to go with Farxiga which is the cheapest. There are 2 other drugs I pay cash for they won't cover (100 a month). There have been several things they refuse to cover and its frustrating for many of my physicians. It also gets people used to the Medicare Advantage model and they usually just slide into that at 65. A lot of the increase in Advantage plan holders happen this way.

But it's the same reason I had issues with employer provided insurance, the damn insurance company has the final say on treatment. To me no matter what kind of insurance you have they need to get out of the way between you and your Dr. Health treatments driven by profits instead of care are just wrong.

[moose65]

44. What is "expanded medicare"??

Do you mean Medicaid??

[Farmer-Rick]

51. It has to be Medicaid

The states don't administer Medicare...thank the imaginary being in the sky.

[Cheezoholic]

58. Yes, spellcheck dambit lol

[Ms. Toad]

90. States cannot remove your right to standard Medicare. N/T

[bucolic_frolic]

62. What are the choices?

I think they tell us to choose Medigap, or Advantage? Is there a third choice? Is it for poor people - Original Medicare only?

Medigap is expensive, Advantage is "free" monthly or reduces the Part B monthly premium. Can you choose neither of the above? I have no idea. But once on Advantage, you lose Medigap as a choice?

[Ms. Toad]

92. Medical is not expensive.

My premium is about $100 a month for the Cadillac medigap plan. My 91 year old father pays about twice that (due to age-related premium increases).

That takes care of all of my Medicare covered expenses, except for $226 this year ($233 last year).

Everyone who has claimed premiums are expensive - and quotes rates of $300+ has been incorrect when I searched the plans available in their state. I haven't found any state yet that didn't have several of the most comprehensive plans available for under $150.

Plans that have copays for doctor visits, or plans that include coinsurance for other care are even cheaper.

In most states, you do lose your right to a medigap plan if you don't buy it when you are first eligible. In most states they will actually issue you coverage - but they will charge you more. In Illinois there are one or two MA plans that allow you to switch at any time, with no surcharge. That's the only state I'm aware of.

[bucolic_frolic]

117. Thanks for that!! Helps to plan ahead!

I think they told me you can get a Medigap plan but must pass a physical in re: preexisting conditions if you want to drop MA.

You can also get a Medigap plan if you have employer health care plan at any time and come off of that.

Still not clear if having neither is an option for early years of Medicare, or if it is only a strategy for those who can afford neither. I think they said that only carries 80% coverage.

[Ms. Toad]

118. It isn't really an option, if you can guarantee your health.

MA plans can be swapped annually. You can also add them if you start out with none (but only during open enrollment - so if you get a catastrophic illness in January you'll be stuck with that 20% expenses for most of a year before you can get on a plan. So if you're going with MA, at least get a cheap/free one when it becomes available to make sure you have something to fill in the 20% (it is 80% coverage).

My spouse didn't sign up for a Medigap plan until she was 70 because she was covered on my plan. So she was entitled to guaranteed issue (they can't deny her) at the community rates (no physical to decide how much to charge her).

I don't recommend going with MA - for the first reason you mentioned. Generally, when people think about switching from MA plans to Medigap plans is when the expenses get too high on MA (because you have a chronic or expensive illness, and are hitting the out of pocket maximum each year). The problem is that you may fail the physical (and not be able to get a plan at all) - AND - even if yoyu can get a plan it will be much more expensive because they can base the charge on your current health (and even if you get better it will be high for the rest of your life).

It even gets a bit more complicated - because once you get into the Medigap plans you can't change to a different one without a physical (and potentially higher charges). So the choice really is whether at any point before you die you will need a Medigap plan - and if so, you need to choose the one you will ultimately need now.

MA plans have three distinct disadvantages: limited networks, potentially high out of pocket maximums, and lots of gatekeeping that delay or deny care.

If you ever have a rare condition, it helps to be able to go to the people who specialize in those diseases. I have a sarcoma (rare, aggressive cancer) - the best place is in Texas. It is an aggressive enough cancer that time is of the essence, and there's not a lot of data for some of the potentially valuable plans.

Limited networks: Most MA plans would not allow me to go to Texas, since I live in Ohio - and the network would be limited to Ohio. On my Medigap plan I can go anywhere in the US and have some coverage outside of the US. (And that's just the out-of-state restrictions. Even within the state, my network might not have covered the Cleveland Clinic, where I get my care.)

Potentially high out of pocket maximums: So far my sarcoma isn't very costly - but some people have millions of dollars of expenses each year. Even the best MA plans have an out-of-pocket max that you have to pay before the money drain stops for the year. And then it starts again the next year. Insurance plans are built on the premise that big expenses don't come along very often - so you can manage up to $8000 in a single year. But when your expenses are high enough that you hit $8000 every year it is not really sustainable. There are plans with lower caps - but other coverage may not be as good. And with a chronic illness it is an every year expense.

Gatekeeping: Medicare/Medigap cover expenses largely without question or pre-approvals. So when I needed an MRI before surgery I was able to get it immediately. On MA I would have had to have pre-approval adding a potentially deadly delay (even if it was approved). If it was denied, and I had to appeal to get it it would have been months (even more likely to be deadly).

[PoindexterOglethorpe]

70. I have an Advantage Plan.

I pay zero extra for it.

Three years ago I had a heart attack, got a stent, three days in hospital. The final bill was around $80k. I paid nothing out of pocket.

A few weeks ago I fell and broke an arm. The ER bill wound up at something like $7,000. I had a $25 co-pay. Same cost for a follow up visit.

I wonder what the out of pocket for those two things would have been if I only had traditional Medicare.

Plenty of in-network providers.

I get so tired of the trashing of Advantage Plans here.

[moose65]

78. You're another in a long line of MA defenders

But don't you see what everyone else sees? If you're getting something for "zero extra," then why isn't EVERYONE getting that?

It's a scam to turn people against each other, and it seems to have worked on you in the intended manner.

When you say "zero extra" what does that mean? You pay the part B premium, and then that's it? You never pay for anything else?

[Silent Type]

81. Other people are getting it, that's why they choose MA. If majority of beneficiaries choose it ,

maybe you are the one not seeing it. It's good for a lot of people.

[Ms. Toad]

95. Advertising is powerful persuader.

A lot of people choose things that are against their interests because of advertising - especially things which provide instant (well advertised) gratification, when the costs are delayed, less tangible (and not advertised at all).

MA plans spend a ton on advertising, because MA plans are very lucrative for them. There is virtually no advertising for Medigap plans, even though they are sold by the same companies - because there is very little profit. When companies make a higher profit that means more if the money they receive goes into their pockets than into care for you.

Unfortunately, the bulk of the diminished care/higher costs don't show up until it is too late to make a choice that gives you the full benefit for your investment you have made in Medicare over your lifetime.

[Silent Type]

98. Saves Medicare beneficiaries money. That's a good thing.

[Ms. Toad]

108. But it doesn't

MA plans cost more per patient than original Medicare. $321 per patient than Medicare, and the gall is growing

And, as MA patients get sicker MA plans shift more and more $$ costs to the patient, because MA patients can be required to pay up to $8000+ each and every year even if they stay in network.

And sicker patients also incur more of the less tangible costs, which arise from the gate-keeping requirements that delay treatment.

[Silent Type]

109. Not to patient/beneficiary. You've heard DUers right here with heart surgery,

brain surgery, cancer, etc., who still swear by Medicare Advantage, and rebut the costs. Who are we going to believe?

[Ms. Toad]

111. n 1 is an anecdote.

Not only that, but the reports are generally anecdotes of single large expensive medical events - or straightforward short term cancer care.

I can match them anecdote for anecdote with experiences of others with chronic illnesses who are facing financial ruin because of Medicare advantage, and a friend of mine who earns a living selling insurance has a lot more. She actively steered me away from MA plans, even though she personally benefits more when she sells MA than Medigap plans, because of how many of her MA clients return to her, begging her to find a way to undo their choice after it is too late.

[Silent Type]

112. Wish the MA is bad, bad, bad crowd would get on CMS to investigate and fine

these plans for all the horrible things they supposedly do. CMS has the authority.

I’m glad you have what works best for you. But that ain’t everybody under the cruddy system we have.

I have traditional Medicare right now because it’s best for me. I foresee the day when MA makes more sense. If Kaiser were in my area, I’d sign up immediately. Even if they deny my brain surgery at 90, maybe I shouldn’t risk becoming a vegetable with questionable surgery.

[moose65]

96. Yeah, it's good until it isn't

Since these are private plans, the companies can choose to leave a state if they think their bottom line will be affected.

Look, I don’t blame you for selecting a plan that you think is best for you.

However, don’t you see that when the percentage of enrollees reaches a certain level (70 percent or whatever they decide), who do you think is going to have a plan to force everyone else onto Advantage plans (all except for the highest risk/sickest patients). Those folks (who are not profitable and thus less desirable for the insurance companies) will be left on the remnants of Medicare and the rest of us will be back in the private for-profit insurance world.

[Silent Type]

99. The big ones seldom leave. And even if they do, you can enroll in traditional

Medicare if they leave.

[Ms. Toad]

94. $233 if it was the first care for 2022, $226 for 2023.

$0, if I had had any earlier care in the year.

Traditional Medicare is typically Part B plus a supplement/medigap plan to pay part, or all of the remainder.

But an even starker contrast comes when you consider the real costs associated with delay of care when it matters, which is the point of this thread.

[XanaDUer2]

83. My Medicare starts Dec

I thought about it, and chose traditional. My dr warned me off MA.

I've chosen my Part D.

[Progressive dog]

97. The 140 billion dollar figure is way high.

According to the CBO, the difference between cost advantage plans and original medicare is 4%. That calculates that the government must be spending 25 x $140 billion or $3.5 trillion dollars just on the 42 percent of medicare recipients choosing advantage plans.

The Medicare Payment Advisory Commission estimates that the federal government pays Medicare Advantage plans an average of 4 percent more than it would cost the Medicare FFS program to cover a similar beneficiary (Medicare Payment Advisory Commission, 2022). Three main factors account for the fact that payments to Medicare Advantage plans exceed FFS costs.

Medicare advantage plans allow seniors to receive more coverage and put a yearly cap on part a and b costs. My advantage plan also provides dental, vision, $103 per quarter for OTC, and drug coverage.This costs me nothing beyond the part B medicare fee. I checked the medicare supplement plans and the cost is much higher.

[tiredtoo]

106. Based on all the comments on this thread

It appears we actually know very little about Medicare and advantage versus supplemental plans. Hopefully we all have the coverage that suits us best and will not be restricted to purchase a specific plan.