Hardly a week goes by but what I read something critical of Medicare Advantage (MA) plans. MA plans have become somewhat politicized with Democrats preferring government-run (traditional) Medicare, while Republicans like the idea of competition among private plans. Here is the thing that critics forget: MA plans are popular with seniors. They are growing and now cover more than half of all people enrolled in Medicare, about 31 million seniors and disabled individuals.
Medicare Advantage plans are managed by insurance companies. MA plans receive subsidies based on enrollees’ health status so it makes sense for insurers to try to identify everything possible wrong. Risk adjustment is not an exact science and critics worry insurers take advantage of it even though the purpose of risk adjustment is to compensate insurers for risk. By that measure it works pretty well.
A Commonwealth Fund report claims MA plans tend to enroll healthier seniors but finally concedes there is not much difference between the populations, access to care or quality of care. Medicare Advantage is popular because medical costs are more predictable, and insurers tend to provide enrollees with additional benefits not available in traditional Medicare. Many MA plans have zero premiums, lower cost-sharing and added benefits like vision and sometimes even dental. That’s a far better deal for most seniors than traditional Medicare with its 20% cost sharing.
Kaiser Health News reports that although Medicare Advantage is increasingly popular with seniors, it is less well-liked by hospitals and doctors. Why would this be? Traditional Medicare sets prices lower than what private insurance pays but traditional Medicare tends to pay everything billed to it. Private insurers require more accountability than traditional Medicare.
But even as enrollment soars, so too has friction between insurers and the doctors and hospitals they pay to care for beneficiaries. Increasingly, according to experts who watch insurance markets, hospital and medical groups are bristling at payment rates Medicare Advantage plans impose and at what they say are onerous requirements for preapproval to deliver care and too many after-the-fact denials of claims.
The insurers say they’re just trying to control costs and avoid inappropriate care. The disputes are drawing more attention now, during the annual open enrollment period for Medicare, which runs until Dec. 7.
The inspector general’s office found that 13% of the denied requests for treatment it reviewed and 18% of denied claims were for care that should have been covered.
Stated another way, the inspector general found that 87% of requests for treatment that were denied should have been denied, while 82% of denied claims should have been denied.
Near the end of the article KHN admits that Medicare Advantage plans enjoy popular support among lawmakers because the plans are popular among enrollees. Per beneficiary cost is slightly higher for MA plans but research has shown that much of the difference is delivered to enrollees in the form of enhanced benefits. Studies going back a decade or two found that private Medicare plans provided seniors nearly $1,000 a year more benefits than traditional Medicare. Also tucked away near the end of the article was the tidbit that hospitals and physician groups publicly claiming they’re going to drop Medicare Advantage is a negotiating tactic to win concessions on fees and payment promptness.
Most experts expect MA plans to continue to expand as more and more seniors are attracted by the benefits. Furthermore, doctors and hospitals are unlikely to drop MA plans because Medicare is the bread & butter of most health care providers. Very few hospitals could stay in business boycotting Medicare Advantage beneficiaries.
Traditional Medicare pays 80% without Pre-Authorization and Medicare Supplements pay the remaining 20% and deductibles and are cheap at about $100 a month at 65. Covered seniors have a ZERO deductible that pays 100% at the hospital of their choice. Now your mother is safe and will not die just because the insurance company wants to save money on her medical care to increase profits. NOW if your Mother gets cancer she can go to MD Anderson Cancer Hospital and survive like Rep. Chip Roy (R-TX).
Then scamming Devon comes along and lures your sweet Mother into Devon’s Deadly and Dangerous Medicare Advantage HMO that pays NOTHING to a non-network hospitals. Devon lures your sweet Mother with $500 worth of dental “Discounts” that are really worth nothing.
Devon doesn’t inform your Mother that if she gets cancer she will not be able to be treated at the MD Anderson Cancer Hospital which may result in your Mother’s death. Devon just always leaves out that fact. Devon doesn’t care because he gets his money every month for luring other people’s Mothers and Grandmothers into danger and possibly death!
If we knew how many poor seniors have died because their cost-saving HMO refused a better hospital then we could scream [Murderer] at Devon when the number hit 1 million dead seniors. But if the number of dead seniors on Medicare Advantage plans who died was just 895,000 so far then Devon could report that number on articles like this.
Devon wants us all to believe 895,000 dead grandmothers is just a statistic. These ECON people are heartless.
Devon should have a WARNING: Sure you could save your $100 a month on your Medicare Supplement premium by switching to a Hillary-style HMO that pays NOTHING at MD Anderson Cancer Hospital. Devon’s $500 in Dental Discounts anybody can get with a FREE GoodRx Card. Devon doesn’t believe in Full and Proper Disclosure. Where are these Medicare Advantage salesmen’s ethics? I don’t know.
My name is Devon and I trick nice Mothers and Grandmothers into switching off of the steadfast security of Traditional Medicare and into dangerous and deadly Hillary-style HMOs. Devon scams poor seniors by making them believe that a dental discount has value. All Devon is really doing is lying through his teeth and a pile of 895,000 dead grandmothers is too high a price.
Yes Devon, every time you tell your free dental thing and ZERO premiums for MA HMOs you should mention the copays could be $7,000 every year after year. Which is much more that $100 a month premium and ZERO deductible that pays 100% with Traditional Medicare.
Don’t let your Mom listen to Devon, he could trick her into danger.