It's Now Open Season on Seniors: 'Medicare Disadvantage.' Unsolicited Calls, Aggressive Ads

[appalachiablue]

- Daily Kos, Oct. 15, 2023. Ed.

(Photo and caption: A health insurance claim form is seen on a medical-bill.jpg * Denied and Delayed Claims are part of the MA business model)

We are beginning to be besieged with ads, mailings, phone calls, etc. for Medicare “Disadvantage” plans. Don’t be fooled - it’s a scam to funnel people into private insurance — not Medicare. And it’s an assault on traditional Medicare with the goal to completely privatize a very popular government program.

There is a reason why 250,000 retired New York City employees fought back against a plan to move them into a Medicare Advantage plan - they were concerned about limited access and higher costs. In August, a judge banned the city from making this switch. Vermont’s retired state employees are currently in a battle to prevent a shift to an MA plan. A similar fight is being waged in the state of Delaware.

California’s Scripps Health recently notified 30,000 patients they would no longer accept MA insurance because $75 million of services were denied by these companies. Mayo Clinic also notified their FL and AZ patients that MA would no longer be accepted. On Oct. 4, PNHP (Physicians for a National Health Program) issued a report that estimated that Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. These overcharges could have paid for Part B premiums or Part D drug benefits. Either of these— or other crucial aspects of Medicare and Medicaid—could be funded entirely by eliminating overcharges in the Medicare Advantage program. pnhp.org/…

On Oct. 8, 2022, the New York Times published an article entitled “The Cash Monster was Insatiable: How Insurers Exploited Medicare for Billions.” The article details the deceptive practices used: overstating the severity of illnesses or adding new ones, inflating bills, limiting choice, requiring pre-authorizations, denying care, delaying payments, etc. UHC, the largest insurer, was accused of fraud by insiders and the government, and overbilling by the Inspector General. www.nytimes.com/…https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html

- More, https://www.dailykos.com/stories/2023/10/15/2199518/-It-s-Now-Open-Season-on-Seniors
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- *NPR: Medicare shoppers often face a barrage of unsolicited calls and aggressive ads. Medicare Open Enrollment Starts, Oct. 16, 2023,
https://www.npr.org/sections/health-shots/2023/10/16/1205798647/open-enrollment-medicare-advantage-plans-help

[The_Casual_Observer]

1. Medical care for elders isn't a matter of insurance risk.

It's 100% risk. The idea that it's a profit maker is absurd and unsustainable. Private plans are bullshit.

[dchill]

2. K&R!

[MichMan]

3. City and State retirees over 65 should be required to take standard Medicare instead of MA

Based on their lawsuits against being moved to MA plans.

If it's considered good enough for all the rest of us, it should be good enough for government employees.

[Progressive dog]

4. If you are a senior, every year at least

you can change MA providers or even return to original medicare.
Forty percent of seniors are not idiots, they are choosing MA plans because their calculations show an advantage.

If you have a Medicare health plan, start the appeal process through your plan. Follow the directions in the plan's initial denial notice and plan materials. You, your representative, or your doctor must ask for an appeal from your plan within 60 days from the date of the coverage determination.

from medicare.gov

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).Dec 7, 2022

https://www.cbo.gov/budget-options/58626

[Silent Type]

6. +1. Don't believe the 51% of Medicare beneficiaries who choose Advantage Plans are as stupid as some

here seem to believe.

Should point out, though, that except for a few states, you cannot switch back to Medicare without undergoing underwriting after the first 12 months. After that, there is no guaranteed issue of a supplement/medigap policy, so if you have a costly medical history, you might be denied a supplement or have to pay a much higher premium than normal. Traditional Medicare without a supplement and drug plan is a quick route to bankruptcy.

(There are two other ways-- You lost your Medicare Advantage plan because you moved outside the plan’s service area, or the plan stopped operating where you live.)

I doubt Medicare Advantage Plans will be banned, especially now that the majority of Medicare beneficiaries choose them (plus, this was not a GOPer Plan, it was signed by Clinton).

I saw a plan the other day that has a small premium (like $50/mo), $3000 in dental benefits, $400 a year for OTC meds, some hearing aid coverage, annual out-of-pocket max, etc. That's tempting for people on a low income. Most Advantage plans are not that good, but they do offer some benefits that traditional Medicare will not cover. But, that plan better than most I've seen.

[Progressive dog]

9. No, there is no guarantee of a medigap policy

Companies issuing medigap policies are allowed to profit off seniors0. and somehow that's okay. Somehow, some people think it's also okay to just end Advantage plans and leave all those seniors with no other option than to rely on Medicare alone. Medicare is a Federal program, it doesn't matter where in the USA you live. My Medicare Advantage plan has no premium. $412 in OTC, some vision, some dental, no deductible for primary care, and all my doctors and nearby hospitals are in the plan. I have a yearly cap on my Part A and B cost of $7,500.
I am not low income and bought a FFS advantage plan which included drugs when I started on Medicare. This is the fourth advantage plan I've had since I retired. Either they dropped my area or my doctors. The plan I have now has changed ownership three times, but so far it has kept all the providers that I use.
During open enrollment, each year, you can choose to switch back to original medicare

[pnwmom]

12. The seniors to choose Medicare Advantage plans aren't idiots, but they're wrong.

They may like the freebies in the beginning, but these companies are making their high profits for a reason. It's not because they're giving the seniors better care.

[Progressive dog]

18. They are getting better care

It is simple, they get the same care, from the same doctors. They can choose which advantage plan they want and compare the cost to original medicare. Then there is extra care (vision, dental, and even hearing) extras.The care costs less to the plan since they can negotiate with suppliers and in return guarantee patients.The companies offering medicare sell policies through ACA, medicaid, tricare,and private. Volume drives the cost down.

FACT

What's a MAC and what do they do? A Medicare Administrative Contractor (MAC) is a private health care insurer that has been awarded a geographic jurisdiction to process Medicare Part A and Part B (A/B) medical claims or Durable Medical Equipment (DME) claims for Medicare Fee-For-Service (FFS) beneficiaries.Sep 6, 2023

https://www.cms.gov/medicare/coding-billing/medicare-administrative-contractors-macs/whats-mac
So, why don't we just get rid of all those programs that use insurance companies to process claims?

[pnwmom]

19. Medicare Advantage Plans often Deny Needed Care, Federal Report Finds

https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

[Progressive dog]

23. I have never been denied any necessary care.

BTW I believe that the report is not from the government.
https://crr.bc.edu/advantage-plans-deny-6-of-treatments/

[pnwmom]

24. Your belief is wrong. The report was produced by the Inspector General's office of HHS.

You have been lucky in your care so far. But multiple investigations over the years have shown serious problems in the care other Medicare Advantage enrollees have received.

From the NY Times link I gave you before:

The new report, from the inspector general’s office of the Health and Human Services Department, looked into whether some of the services that were rejected would probably have been approved if the beneficiaries had been enrolled in traditional Medicare.

Tens of millions of denials are issued each year for both authorization and reimbursements, and audits of the private insurers show evidence of “widespread and persistent problems related to inappropriate denials of services and payment,” the investigators found.

The report echoes similar findings by the office in 2018 showing that private plans were reversing about three-quarters of their denials on appeal. Hospitals and doctors have long complained about the insurance company tactics, and Congress is considering legislation aimed at addressing some of these concerns.

[Progressive dog]

25. I have no problem fixing problems with

medicare advantage.

[pnwmom]

27. You made the broad claim that Medicare Advantage holders are getting better care

based on your satisfactory experience with one plan and your particular medical circumstances.

Unfortunately, many MA holders are less lucky. They are limited in their choice of doctors and find that the insurance company, rather than their own doctor, is the one deciding whether they need an MRI or a particular treatment.

[Progressive dog]

29. Fortunately, they all have the choice of leaving the plan

or appealing the plans ruling. or not joining in the first place. There is a lot of medicare fraud, too.

The FY 2020 Medicare FFS estimated improper payment rate is 6.27 percent, representing $25.74 billion in improper payments. This compares to the FY 2019 estimated improper payment rate of 7.25 percent, representing $28.91 billion in improper payments.

That would be payments to providers for services not provided or exaggerated. The insurance companies denial of 6% apparently includes 20% of the bad claims.

[Scottie Mom]

5. The Insurance Companies' plan to bankrupt Medicare is Medicare Advantage

How in the hell does private insurance have the ability to label this bullshit with the word "Medicare?"

[Silent Type]

7. Simple, it was passed by Congress and signed by Prez Clinton. At time, it was called Medicare Part C

[Scottie Mom]

8. I really resent the use of that word for Private Medical Insurance. EOM

[blue neen]

10. Yes.

Agree 100%.

[erronis]

11. This: If you choose Medicare Advantage you may not be able to get medigap coverage

in the future if you want to go back to real Medicare.

And being stuck with the "donut-hole" costs not covered by pure Medicare would bankrupt many seniors.

[Demobrat]

13. Advantage plans are all good

as long as the care you need is in the network. A friend of mine is battling stage 3 colon cancer. He was lucky. He chose traditional Medicare with a supplement. The first surgeon he met with referred him to a specialist who was not in the MA network in his area. If he had gone with MA he would be doomed.
Of course if nothing bad ever happens MA plans are fine.

[pnwmom]

20. Progressive Dog at #18 insists you have access to all the same doctors! There are so many

advantage plan holders who will have to learn the hard way.

[Demobrat]

26. I hope they don't.

That $7500 yearly out of pocket maximum could really hurt if a serious health problem kicks in. I can understand why some people choose Advantage Plans. Premiums are low and there’s some help with OTC meds etc. The trade off is that you’re limited to a network and the insurance company decides what care you get.
Some people will never be negatively affected by that. Some will.

[slightlv]

14. I just went through updating mine and hubs' plans.

We're mostly on it for our scripts. His are going to be free, because of the low tier they're on. I wasn't so lucky. A few of mine are of a higher tier -- and "controlled" substances at that.

I got tricked into MA the first time around, and can attest to the validity of not being able to go back to Medicare without it costing an arm and leg afterwards - and that's if you can even find a medigap program that will take you. This time around, it wasn't so tear-your-hair-out frustrating, but it did take us two days to get us updated to programs that "fit" our needs and lifestyle.

I thought it was Bush who signed on for the MA plans. I didn't realize it was Clinton.

[Qutzupalotl]

16. Bush did Part D, IIRC.

Republicans wrote and passed it, so it was not properly funded.

[MurrayDelph]

17. I hate that effing donut hole.

My wife has an esoteric condition that requires one expensive prescription. Next year she goes into the hole in March and back out again in August.

My treatments are more-common, but still expensive, so I go into the hole in July and don't come out.

[mnhtnbb]

15. If you want your health care managed by an insurance

company, then go with a MA plan. If you want to make your own decisions, in consultation with the physicians of your choice, then go with traditional Medicare and a gap policy.

It's that simple. All you have to do is Google 'Medicare Advantage horror stories' to get a long list of the problems and pitfalls of MA plans should you be unlucky enough to experience the woes of any serious health issues developing as you age, or even befall you as a result of accident.

NYTimes published a good article here: https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

I am a retired hospital administrator. As much as I dislike shelling out for dental and vision care every year, I know those costs won't bankrupt me. I have traditional Medicare and a BCBS Federal gap policy, which I will stick with to the grave.

[pnwmom]

21. Thanks, mnhtnbb.

What advice would you have for someone who's been happy on their former employer's Supplement plan, but that employer has just announced it is switching everyone to an Advantage plan -- unless an employee says no. Is there a place to compare major supplement plans?

[Demobrat]

22. All supplement plans with the same letter offer the same coverage.

All Plan G’s are the same etc. Only difference is the premium

[pnwmom]

28. Do you have any advice about deciding? nt

[Demobrat]

31. I did end up working with a broker

who specializes in Medicare. I went with the AARP United Healthcare Plan G because he told me the other options, Anthem and Blue Shield, charge higher rates when you get older. At 65 they were pretty close, within a few dollars.
On edit: my plan covers everything except a $250 yearly deductible. I did not leave off a zero.

[pnwmom]

32. Thanks! nt

[airplaneman]

36. G does not pay the Medicare A and B deductible which in 2023 are:

Medicare Part A deductible is $1,600 per benefit period and the Part B annual deductible is $226
A is hospital inpatient and B is outpatient care. Your welcome.
-Airplane

[trof]

30. So much disinformation on this thread.

(Disclaimer: I am not an idiot.)

Miz t. and I have been on MA for three years.
We love it.
We have saved thousands of dollars.
We have the same doctors and the same good healthcare we had before going on MA at a fraction of the cost.

Zero co-pay for PCP visits.
$25 for specialists.
Dental and vision coverage.
Zero deductible, zero monthly premium.
Free annual home wellness visit from nurse practitioner with follow-up recommendations for my PCP.

My insurance company (UHC) WANTS us to be healthier and that's a win-win. We feel better/live longer and cost them less in claims.
We're just fine with that.

[pnwmom]

33. Yeah, coming from the MA proponents.

I'm glad it's worked out for you, but it hasn't for many. And anyone who's healthy now could find themselves with cancer or another serious illness and suddenly realize that the freebies aren't worth the limitations in their choice of doctors (even if it's not affecting you now) or the insurance company's denials of physician-recommended care.

This is about an investigation by the Inspector General for HHS.


https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

[trof]

34. I'm being treated for prostate cancer and colon cancer.

And hypertension, hypothyroidism, benign prostate hypoplasia, macular degeneration, COPD, sleep apnea, osteoarthritis and atrial bibulation.

How that for a list of ailments?
I have absolutely no complaints about the quality of cost of my treatments.
We have still saved thousands.

[pnwmom]

35. I'm glad it's worked out for you. But that's a roll of the dice I wouldn't advise

anyone to take. Too many people have ended up with bad policies and insurers trying to prevent them from getting needed care.

[Joinfortmill]

38. Me too, but I will add

You need to do your homework. I always choose a PPO, which allows folks to go out of network, doesn't require a referral to see a specialist and doesn't require you have a primary care doctor. I also always choose a well known national provider like Aetna or Humana. One caveat, if you choose Plan C, it does limits your ability to change your mind and get traditional Medicare to a few specific circumstances.

[PoindexterOglethorpe]

37. I keep on reading posts here on DU talking about the horrors

of Medicare Advantage plans. Somehow, I don't see such stories elsewhere. And I'm one with an Advantage Plan that has paid a hospital bill for a heart attack of some $80,000, and an ER visit that was billed at $7,000. Zero payment for the first, a $25.00 cost for the second. Yeah, Advantage plans are terrible.

Meanwhile, people with regular Medicare seem to be constantly dinged for far more costs. What am I missing here?

[Joinfortmill]

39. Me too. Had a brain aneurysm fixed.

Cost almost as much as my condo. Had one of the best neurosurgeons in the country. Covered everything except $350 for hospital bed. It is important, however, to pick a reputable company.