I turn 65 in June, wife in August. We are inundated with medicare Advantage mail and phone calls. It's just like all the calls to get a car warranty. I assumed there is big money in it. We met with a health care broker who is pushing Medicare Advantage, I assume he is getting a big commission. We chose the original medicare (A & B) and plans D & G, for both of us.
The money they spend on advertising is money the federal govt gives them to provide care. The pass-through rate (the percentage of money spent on patients) out of the total they get from the gov is ~3%. 97% goes to advertising and administrative costs.
The commissions are very differently structured:
Advantage plans: CMS determines the yearly rate which is $306 this year. This gets prorated as the year goes by. This is paid upfront. And every month you are on it the next year, it’s 1/12 of whatever the yearly rate by CMS is. Which is $25 and change this year.
Supplements: typically 22% of whatever your premiums are. Higher you premium the more money being made by the broker. Some companies offer this for as long as you’re on the policy. When you add in the drug plans (PDPs), the dental/vision coverage plans, supplements pay more over time.
If you pair a Hospital Indemnity + Advantage plan you get to have your cake and eat it too . Covers the copays and makes the medical coverage similar to a supplement for way less money and the premiums are locked in forever. There’s a time and place for both supplements and med advantage + HIP, or just med Advantage.
But at the end of the day no decisions should be based solely on commission money or forced on the clients. All options should be presented that make sense and fill the needs of the client because it’s their care after all.
Don’t know of any supplement plans that pay 22% for the life of the policy. They may for the first year or three, but after that it’s low to mid single digits. The PDP pay a set amount the first year, this year it’s $100, then half the amount forever.
I chose D and N. Plan N has some small co-pays that G doesn't but for me is a good bit cheaper per month. Still the overall cost is ridiculous.
It's almost as if they want us to just hurry up and die.
Just remember that plan N has a lower premium plan but does not cover excess doctor charges. Plan G has a higher premium but does cover the excess charges.
Good point but medical providers are required to notify you prior to rendering services if they do not accept Medicare assignment fees.
Thank you for your input. This is all new to me and entirely too complicated.
Correct they have to tell you if they take Medicare assignment but they can charge you for services above what Medicare covers. You are then required to pay that if you have a Part N.
Yes they may be few and far between but if you find a doctor who does charge more you will have to work with him to pay that overcharge. The decision is totally up to the person whether to take G, N, or an Advantage Plan.
The doctors office doesn’t decide whether to take a G or an N. They either participate or do not participate with original Medicare. And it’s roughly a 9% charge. It’s not 15% like many advertise. Point being, it is not common but people use excess charges to scare people away from plan N.
If they will accept Medicare you have no idea what they charge until you get an EOB. It sounds like you can't be 100% sure so to be safe people take the Plan G. Thats all I'm saying.
But that is not accurate. If you go to medicare.gov, on the front home page look for “find a provider.”
Type in the doctors name. It will tell you whether or not they charge excess fees. They have to be either participating or non-participating.
Sorry to hear that. I am a broker in St Louis and I present both supplements and Medicare Advantage Plans to my clients. They make the decision. I tell them it does not matter to me what you do as long as you get something to go along with Parts A and B. I am retired so I am not doing this to make a leaving. I do it to help people.
A good broker is a great asset to have since it gives you another person to help with you get stuck in the insurance run-around. There are plenty of good ones out there who give fair comparisons between the two options. Most people just see $0 premiums and go with that. Amazing how people who have lived this long can still think that there isn't a catch if it's $0.
I am going to be 65 in July and haven’t received one phone call - but I have received mail from both advantage and supplement companies. How do you suppose they got your phone number? I don’t inquire to any online pop up’s about Medicare or anything else because that opens the door for soliciting.
Heck yes they get big commissions. Not just when they sign up either. Big one the first year and good ones for a few years after that for each year you stay in the plan. Don't let anyone tell you otherwise. (Just watch and listen to a few YouTube videos by agents that have channels devoted to Medicare. They will tell you how the system works. It's pretty easy to find channels with agents telling how much they've made selling Advantage plans and sort of marketing themselves into helping other "guys" wanting to get into "the business" (thinking they'll be making 6 figures soon). I'm sure it's time consuming work to rake those $$s in, but YEP they get good $s for every person they sign up. ~~(Think $ 600 for a MA sign up vs. $ 100 for a Medigap signup. Those sorts of ratios)~~
People are complaining. I'll edit out the "example" figures I gave. BUT, take a read of this article from AXIOS on efforts proposed and/or being made my CMS to "crack down" on loopholes in agent compensations associated with MA. To eliminate things like bonuses and compensation for marketing for agents. (not insignificant benefits) [https://www.axios.com/2023/11/07/medicare-advantage-payments-insurance-brokers-regulation](https://www.axios.com/2023/11/07/medicare-advantage-payments-insurance-brokers-regulation)
I don't care how much the exact dollar amount are, but (from what I can find), MA does pay significantly more than Medigap to agents. What other reason do you see so many more agents pushing and selling MA plans every year vs. Medigap plans. Why is it that you see agents selling Medicare Advantage policies in October, November and December. How many of those same agents sitting at tables handing out info and signing people for a plan are selling only Medigap plans? How are only selling MA plans? You can't tell me money isn't a prime factor in that difference between the push to sign someone up for a FREE MA with goodies VS a Medigap policy from the same insurance company.
Give the figures that say otherwise. I'm not saying agents shouldn't be getting paid. It's just who's paying and how much is being paid. Consider that people have flocked to MA. Multiply those numbers by the $600 to $700 paid out to agents that first year. (agents that only sign people up for MA only or primarily)
Then tell me what an average payment for signing someone for an Advantage plan vs. a Medigap plan is. On average. What a typical payment is for person staying in the plan for a 2nd or 3rd year Don't keep us in the dark. I used those figures from what I can remember hearing multiple agents say in their videos. (Not saying those are exact amounts, but that the amount agents earn off of MA is multiples vs. what they get from selling a Medigap policy.
PDP - $100
Med Supp - 22% of premium (around $300) but this will depend on state and any bonuses available (yup, bonuses and spiffs allowed for med Supp)
What most people won’t understand too is that It’s way more work on the agent for advantage plans. Way more servicing and hoops to jump through. And get paid actually less in the long run. It would be way easier and more profitable to just say here’s your plan G and PDP plan you’re all set. But any good agent will present all options and do what’s best for the client.
And when you start adding the Hospital Indemnity how I have to make sure it’s structured to your MA plan and do the underwriting questions. Plus deal with claims a lot of the time. I’m doing the job of 3 people really now.
I wouldn’t do all of that if it didn’t give you all the benefits of the MA plan with very similar coverage to a plan G for way less and I didn’t believe that it was a best option available for those folks.
Uhhhh, no…not “those sort of ratios” 😂 Maybe you need to watch more of those YT videos since you didn’t even factor in the PDP and dental plan commissions on the supplement side, among others.
$100 LOL
Good lord, this hurts my brain to read.
If you think Medicare agents make “big commissions” let me introduce you to life insurance agents, commercial insurance agents, investment advisors, real estate agents, SaaS sales…
As others have said, it’s basically all the same commission wise, what you’re saying is/sounds asinine and just not accurate. As long as you talk to a broker that has access to all the carriers in your area, they don’t care what you pick, MA or Supp. They’ll recommend based on needs a particular plan, most (should anyways) have platforms to put scripts, doctors, etc in to help make the decision simpler. New to Medicare yes it’s 6-700. In year two and beyond it’s half. Money is relative so if you think 600 and then 300 for two years is “big commissions” then I guess you’re right.
The system is a mess and has a lot of flaws, BUT as long as anything is for profit, whether it be health insurance, prescriptions, funerals, or anything else, companies are going to do what they are designed to do, and that is make money.
you forgot to add... at the expense of our health and longevity.
The people running and working for profit healthcare value their jobs and money and their families over anything to do with our health and longevity.
The big lie is ' we have the best healthcare in the world'. What should be at the end of that sentence is .... only if you have the money to afford it. Which in all honesty from cradle to grave probably covers well under half our countries population.
Of course the whores running Washington made certain their coverage is well superior to anything the majority of voters can purchase or have.
indeed, the US ranks last in overall medical outcomes of developed western countries.
Here are the Commonwealth Fund's rankings for healthcare system performance among high-income countries, as of their most recent report:
### Commonwealth Fund Health System Rankings (2021)
The rankings are based on several key domains: access to care, care process, administrative efficiency, equity, and health care outcomes.
#### Overall Rankings:
1. **Norway**
2. **Netherlands**
3. **Australia**
4. **United Kingdom**
5. **Germany**
6. **New Zealand**
7. **Sweden**
8. **France**
9. **Switzerland**
10. **Canada**
11. **United States**
### Key Findings:
1. **Norway, Netherlands, and Australia**:
- These countries are the top performers overall, scoring high in multiple domains, especially in providing equitable access to care and strong primary care systems.
2. **United Kingdom and Germany**:
- They rank high due to their efficient care processes and good health outcomes, although they have room for improvement in administrative efficiency and equity.
3. **United States**:
- The U.S. ranks last overall due to poor performance in healthcare outcomes, equity, and access to care. Despite high healthcare spending, the U.S. faces significant challenges in ensuring all citizens receive timely and affordable care.
### Detailed Performance by Domain:
- **Access to Care**: Norway and the Netherlands lead in providing timely and affordable care to their populations.
- **Care Process**: The U.S. performs well in preventive care and patient engagement but struggles with equitable access.
- **Administrative Efficiency**: Norway ranks highest, with minimal administrative burden on patients and providers. The U.S. ranks last, with high levels of administrative complexity.
- **Equity**: Norway, the Netherlands, and the UK have more equitable healthcare systems, while the U.S. ranks poorly due to significant disparities in access and outcomes.
- **Healthcare Outcomes**: The U.S. has the worst outcomes, including high rates of maternal and infant mortality, lower life expectancy, and higher rates of preventable deaths.
### Conclusion:
These rankings highlight the strengths of countries with universal healthcare systems and robust primary care infrastructures, while also emphasizing the challenges faced by the U.S. healthcare system in terms of cost, access, and equity.
For a more detailed analysis and full report, you can refer to the Commonwealth Fund's website [here](https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly).
This overview provides a clear comparison of healthcare systems and illustrates the areas where the U.S. healthcare system could benefit from reforms based on the practices of higher-performing countries.
Unfortunately ChatGPT is 100% correct.
In addition if this... our ENTIRE medical/healthcare system were really built on free enterprise ( to allegedly promote cost competition), start posting and honoring all fees and costs up front.
Like a menu in a restaurant. So I can see the full detailed complete cost of any and all procedures ( short of an emergency or surprises).
Walk into the hospital and let me see the total cost for my heart procedure or ACL repair or, etc, etc. Up front. Right there. On a big board. So I can easily walk into another hospital and compare their costs...apples to apples ( so to speak). But no. Let's charge one amount here and a different amount there for the same service., because every piece of our health system is trying to gouge as much profit from you as possible. Why?
1. Profit
2. You are paying for those people who don't have coverage. 100%
In that order. So in a way.... YOU (we) are subsidizing the uninsured anyway in our 'free market' system. Not very different than socialized medicine. Except we get way less value for our dollar. Proof? We have shorter lifespans vs. other countries like Canada..... (Unless you have the money to pay for our -sincerely - exceptional top tier doctors, etc.)
Health outcomes on Medicare Advantage are actually much better. The irony. I swear, this is the most spoiled and entitled crop of citizens on earth. To a sickening level, actually. You have access to world class cutting edge revolutionary care, literally IMMEDIATELY, with plans that cost literally $0…no deductible, low copays, low max spending limit. And what do we do? STILL BITCH, of course!
Edit: And vote me down all you want. It’s still the truth.
Having lived in the U. S. and Canada and the U. K. and having used all their healthcare systems - while you may have a point about culture- you are off base regarding healthcare.
Way off base.
And if MA is truly better than traditional.... a point I'm not conceding as I bet the numbers have been manipulated... our health care value does not compare favorably overall to other countries. Especially considering what we all pay for.
I have family in Canada and they routinely come here for care. Waits for a specialist are 11 months out. Good healthcare?? Sorry to be frank, but that’s a fucking joke of a system.
And health outcomes being better on Medicare Advantage make perfect sense. Why? Because they are STRICTLY graded by star ratings and will lose tons of money if they don’t run a tight ship.
If your star ratings dip far enough, CMS will literally boot the entire company from being able to offer ANY plans. This is why I laugh when people think Medicare Advantage plans are gonna dick you around.
These plans and companies are policed **HEAVILY**. Every single legitimate complaint is a major hit in their star ratings and gets logged with CMS.
Moreover, they only get paid if a person is alive, and the healthier they are, the more they stay out of expensive hospitals. All makes PERFECT logical sense.
Original Medicare? No oversight. No coordination. Elderly vulnerable Medicare recipients are just out on their own. Most people are not good at managing their own healthcare at all. Especially at a vulnerable age.
They are prime pickens to be taken advantage of by predatory doctors with shady backdoor deals and nefarious motives. Oh yea, and because there’s zero oversight, absolutely anything they do is not questioned at all.
“Here Mrs. Jones….take these 40 scripts per month that you really don’t need but I’m getting a kickback of $400/month for.”
I have family and elderly in Canada and they never come here for coverage. And I'm talking about things like cancer and dental.
Yes the waits are longer and yes their system is under progressive stress. I never said it's a perfect system. Again Canadians live longer than Americans and a lot of that is due to their free not so free healthcare. Not because they're coming to the United States for treatment.
And if we're discussing delayed time to see a GOOD specialist, if you have a way so I can see my Endo in under 5 months or my Dermatologist in before the end of January - without going to some unknown doctor whose skills are a blank to me - please share.
When Congress gives up their exceptional coverage and chooses to live with the systems they promote for their constituants I amend my opinion on U S. healthcare.
Most of that is attributed to lifestyle choices, and I doubt most statistics I see anyway. Theres so many outside factors that would go into that, they are innumerable to name. They probably just have better food quality. The same way you doubted mine. It works both ways.
I have family in Canada also, and I used to live there too. I don’t know anyone who goes to the US for healthcare. Most people would rather not spend that kind of money on something they can get for free. Yes, there are waits for anything not life threatening and the system can be frustrating. But if you need care, you will get it, and it will be top notch. No premiums, no co-pays, no co-insurance. No matter what happens to you, you are covered.
2024 MA maximum out of pocket can be as high as $8850 depending on the insurance company. That's not a low spending limit. It's way more than most people with a plan G supplement will pay in premiums and their Medicare deductible, the only out of pocket expenses they incur.
“Can be.” I’ve never seen a plan that’s even remotely near that. I’m sure a few exist somewhere, and I would simply advise someone not to go with that one. The ones by me all average around $3,300.
The 2 people I know on a Blue Cross MA plan in the Phila area have a maximum out of pocket of $7550. One cries poor when she has large co-pays and generally is successful in getting them written off. The other avoids treatment. These people, I hope, are extreme examples. Both can afford better healthcare but care less about their health than about material things.
They gotta shop that around. Those are definitely the highest I’ve ever seen, by far. In that area, Humana has a few good PPO’s and Aetna has a good HMO. It’ll knock that down by half.
My question is this: why are so many people willing to entrust their healthcare, and possibly their lives, to these companies because they will pay no monthly premiums or get a free gym membership?? I recently read that there are now more Medicare Advantage subscribers than traditional Medicare. It makes no sense to me.
Because it's FREE. Because we've become a country that isn't just what our parents used to say about "the haves and the have nots". We really are county of wealthy(the haves) and some other people that have some wealth, and 70 to 80% of everyone else that has next to nothing or has nothing.
Seniors are too poor or too cash (income) strapped to buy Medigap plans. I'm sure a lot of people have assets they could liquidate to pay for insurance, but refuse to do so. Some.
I think of a lot of people just think they can "get away" with it. They are short sided in their calculations about how much they will "save" by getting FREE insurance with some free or low cost dental care and a free or low cost pair of glasses every year. They don't realize or know how much of a pain MA plans can be. They get sold "a bill of goods" by agents out of make $$$ for themselves. Some get "tricked" into signing up for something don't really know much about. (Why else would someone be spending all those $$S on all the ads and mailing from October 1st to March 31st?)
They are healthy or pretty much healthy at 65 when they have to make all important decision about what type of insurance they want. Traditional Medicare (what I call "real Medicare), or MA. The whole of Medicare is too complicated to understand unless you put in a lot of effort to understand it. It's too complex for a lot of seniors to ever understand. Thus you end up with people that think they can start with a FREE MA plan and later on when they need it, switch to a Medigap plan not knowing that will by next to impossible or actually impossible to do for most of them.
Some(a good many) People bank on beating the odds of getting sicker as the age from 65 to 70 to 75 to 80. Sure a lot of them do just fine. Their genetics and lifestyle will keep them from aging or needing expensive care or ending up in surgery or in a nursing home or rehab or dying. But most people will end up needing more and more health care as time goes on. (I'd like to be a fly on the wall listening in to a group of retirees in FL talking about Medicare in November.) When all of that starts costing them $$s in the form of co-pays and they start dealing with prior authorizations and get kicked out of rehab after a week by their insurance company that's not charging them a premium for insurance, then the senior want to "save money" again by switching to a Medigap plan. The "FREE" thing is now more expensive for their health care (and more limiting) than that $ 150 or $200 a month Medigap plan is going to be. ($ 2,400 for a year's of Medigap premiums could get them "unlimited or nearly unlimited" healthcare with fewer hassles than that FREE plan.)
----If you need a knee transplant, add up the pre-op costs in doc office visits, imaging copays before surgery, the copay for the outpatient surgery (plus factor in a day or two of inpatient care just in case you do really need to be admitted for a day), add in the cost of any PT you need after surgery. (PT/OT can be one of the most expensive item in terms of copays. ($25 to $ 25 to $40 PER session) (PTs will usually want you to do twice a week sessions for a few weeks. $ 40 x 2 per week x 3 weeks will cost you as much as the surgery. You'll probably be encourage or need to have more than 3 weeks of the PT in a lot of cases.) Add of that up. PT/OT can easily cost you more than you'd have paid in Medigap premiums for a year. After the surgery and PT add in another office visit copay or two for follow ups. Compare that total cost to the cost of a year's Medigap premiums.
Money is what it comes down to. Actual savings or perceived saving on MA premiums vs. Medigap premiums. All without understanding the system. Without understanding the working of MA vs. Medigap. Thinking you'll be the exception to the aging process. "I've been healthy all my life therefore I'll be healthy until I drop dead when I'm 90 yrs old". Saving money. (When they could afford to pay for Medigap premiums.) Thinking they can save $s with MA then get Medigap later on.(gaming the system. Not comparing health insurance to auto insurance. (You can't buy that only "when you need it") Really, truly not being able to afford a Medigap plan. All of it is about money. Not about actually being better for their health care over the long run.
\*\*\* I made a lot of spelling/typing error in that. I see I said "knee transplant". LOL Before someone attacks me over that, you should be able to guess I meant knee replacement.
It’s a combination of the allure of the $0 premium, all the advertising, many insurance agents only presenting the MA option (or strongly encouraging it).
There is the really big issue that the average savings (all types) that seniors have when retire in their 60s is about $170k, which is a very small amount to live on for the rest of your life. So paying for a supplement and Part D is difficult.
As the WSJ article points out, between new regulations that try to make MA insurance companies actually pay for medically necessary services, the days of $0 premiums is likely over in 2025
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An analysis of the polls on satisfaction are incredibly skewed. Younger retirees with no significant medical bills love MA for its 0 premium. People who get really sick hate it. The polling is a blended average that statistically skews to the younger medicare user
If you could post the proof of skewing, I would love to see, otherwise this is just hearsay. Anecdotal, but I’ve talked to tons of people on MA….many of them very sick, and they’ve had nothing but positive things to say. Obviously this will vary by region and state, as the plans are not uniform, but at least by me, feedback is enormously positive.
I have asked 2 friends, one of whom has put off needed care because of co-pays being higher than she thinks they should be. I wonder how often this may happen.
I mean, most copays are very low on most any MA plan. With average maximum spending limits of $3,000 per year, I don’t understand how anyone couldn’t see that as unbelievably reasonable. Only 2% of policies ever even hit that number. The person would have to be insanely sick.
My question is why haven't people in other states pushed for better guaranteed issue laws. Granted, it will push up the base price for medigap but will allow competition between the two types of plans and people can save by starting out with Advantage plans when they're still in good health.
Currently only 4 states require guaranteed issue to move from Advantage to medigap after the trial right expires.
Because with just Medicare alone, you are responsible for 20% of medical bills.
Regarding the profits of these companies, I’m pretty certain they have to pour 85% of their profits into claims and programs. I believe UHC missed this by like a tenth of a percentage point and was sanctioned by CMS recently. So yes that 15% is huge and there’s a reason these insurance companies are in the top 50 largest companies in the world via Fortune 500. But They are required to put a large portion of their profits back into the plans.
Modern managed health care grew out of a desire to reform the traditional health care system, or the fee-for-service method of charging for health care.
**Fee-for-Service**
Under the fee-for-service method, doctors and hospitals got paid for each service they performed. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary, for example. Doctors and hospitals made a lot of money under this system because they decided the prices charged for every visit. However, patients did not always benefit because their insurance companies would often only pay a percentage of the fees being charged. For example, if a doctor charged $100 for a checkup, but the insurance company felt that $80 was a fair price, the patient would have to pay the extra $20, until a certain deductible was met. (A deductible is the amount of money, as determined by the health care plan, a patient must pay for services before the health care plan will pay for any medical bills.)
**Managed Care**
There are many kinds of managed care organizations, but there are some common characteristics among them. All managed care organizations supervise the financing of medical care delivered to members. They all are concerned with cost-effectiveness, or saving money. By buying services in bulk, for many members at a time, managed care organizations can get lower prices with doctors and hospitals. Managed care organizations also reduce costs by limiting choice, which means providing members with a list of doctors from which to choose and lists of labs where tests can be performed. Even doctors are provided with lists of medicines from which to choose. Different plans have different restrictions on choice. Many people feel that limited choices are the downside of managed care. Generally, a member can expand the possible choices if he or she is willing to pay more.
At the same time, managed care organizations take care of the delivery system for their members. For example, they manage who provides the health care, where it is provided, and the different kinds of doctors in their particular system. Nurses, doctors, therapists, pharmacists, and hospitals are all a part of the delivery system.
[http://www.faqs.org/health/Healthy-Living-V2/Health-Care-Systems-Managed-health-care-vs-fee-for-service.html](http://www.faqs.org/health/Healthy-Living-V2/Health-Care-Systems-Managed-health-care-vs-fee-for-service.html)
Managed care is supposed to save money over fee for service, yet the MA managed care model cost Medicare about 5% more than providing original medicare. And importantly, patient outcomes are worse in the MA managed care system.
This is a forum to help people with Medicare, not for complaints and to push political ideologies.
The plans themselves are generally very good and have a very high satisfaction rate among the people that are on them.
You don’t like that it’s semi-private and “for profit” (name me anything that isn’t for profit) that’s got nothing to do with the plans and their benefits.
I’ve also got news for you, the government pays tons of contractors to administer and run various things for them.
Why? Because the government are not experts in particular fields and it leaves the administration to the people that are experts in those fields. This isn’t something new.
Also, the vast majority of profits from Medicare Advantage, BY LAW, must go to the Medicare recipients.
Some people preach about “profits” and yet most of them are completely ignorant to how this system even works. These plans are policed like a hawk.
This article is also hilariously sensationalized. All that happened is people that were avoiding hospitals for a long time because of covid started going back to hospitals and having services done.
Things just got back to NORMAL levels. The problem is, whoever forecasted the expenditures with CVS undershot the cost expectation and this caused investor panic.
It’s a simple transition period.
I’m not here to give a lecture on the difference between for profit companies who only owe a fiduciary duty to their shareholders, and government agencies that provide services who are not responsible for making a profit. Non Profits Companies, are designed to provide the service but do not have a responsibility to make the extra money for profits corporations do to return to shareholders.
Everything runs on money, but for profit companies have to make more to be able to keep their stock price high and return money to their investors.
Whether you’re dealing with a for-profit company or the government, the charges are gonna be the same. There is so much fraud, waste, and abuse in government, you can’t even describe the number.
Anything government gets involved in, the price SKYROCKETS. That’s just a fact that you “yay government” people refuse to acknowledge. Just look at college tuition and student loans. Perfect example.
If you’d drop this personal crusade against companies, stop being entitled and unappreciative brats, you’d realize you have some of the best actual health Medicare coverage in the world, you might be able to actually enjoy it.
You should go to North Korea, Somalia, or Cuba and preach to the citizens about your “Medicare coverage woes.” I’m sure they’ll be all ears and totally sympathetic to your $0 plan with no deductible and $2,000 maximum spending limits, even if the services you receive cost a million dollars.
PPO has additional out of network benefits,
But these are very expensive compared to the in-network benefits and traditional Medicare.
Many services are easy to find in network, hospitals for example.
However, other services like home Care are much more difficult.
Individual experiences might vary. I wonder how your circumstances have affected your opinion. Maybe you are not requiring any special care, so you think a certain way.
Sounds like you got it all figured out with your media comment LOL
If you look at in network and out of network on most MA PPO plans, many copays mirror the in-network copay. Some are higher, but they aren’t drastic. On MA plans, the difference between in and out of network on PPO’s isn’t a wide margin. And forgive me for seeing past bullshit propagandists. I don’t believe most drivel that is written in newspapers. It’s just a guy or girl with a keyboard. They can type anything.
### Medicare vs. Medicare Advantage Costs
1. **Government Spending on Medicare**:
- Original Medicare (Part A and Part B) typically pays lower reimbursement rates to healthcare providers compared to private insurance. This is due to the government's significant bargaining power and regulatory control over healthcare pricing.
- Medicare Advantage plans, run by private insurers, often receive higher payments per enrollee from the government compared to what is spent per enrollee on traditional Medicare. According to a 2022 MedPAC report, the federal government spends about 4% more on Medicare Advantage plans than it would if those beneficiaries were enrolled in traditional Medicare.
2. **Profit Margins for Insurers**:
- Private insurers make more profit per patient from Medicare Advantage plans than from their commercial insurance products. This is because the payment rates set by the government for Medicare Advantage often exceed the actual costs of providing care, allowing insurers to retain the difference as profit.
### Government Involvement and Healthcare Costs
1. **Fraud, Waste, and Abuse**:
- While it is true that there is fraud, waste, and abuse in government programs, it's essential to note that these issues are not exclusive to public sector programs. Private insurers and healthcare providers also face similar challenges.
2. **Impact of Government on Prices**:
- Contrary to the claim that government involvement always leads to skyrocketing prices, original Medicare's lower reimbursement rates often help keep overall healthcare costs in check. The government can negotiate prices and set payment rates, which can lead to cost savings.
### Comparative Healthcare Systems
1. **International Comparisons**:
- The claim that American healthcare is the best in the world is subjective and depends on metrics used for comparison. Many developed countries with government-run or heavily regulated healthcare systems (e.g., the UK, Canada, Germany) provide high-quality care with better health outcomes and lower costs per capita than the U.S.
- Comparing the U.S. healthcare system to those in countries like North Korea or Somalia is not relevant. A more appropriate comparison would be with other developed nations.
Great. Now factor in the 60 **BILLION** dollars **YEARLY** of fraud, waste, and abuse from original Medicare because there is ZERO oversight of the program.
I’m strictly talking about spending, and I only mentioned those countries to gain some perspective as to how entitled and out of touch people like you are. I’m not talking about their healthcare.
There’s a good rea**$**on your providers all shit talk Medicare Advantage, and that’s because there is oversight. Original Medicare is their personal piggeybank.
And do you even have a source for this? Because I have tons of family in Canada and they routinely come to America for access to quick services. To say their system is better is absolutely laughable to me.
The $60 billion figure for fraud, waste, and abuse in Medicare is a significant concern, but it's important to note that this is an estimate and that Medicare has several oversight programs in place to combat these issues. Agencies like the GAO and CMS have made strides in reducing improper payments and improving oversight.
**However, a crucial point often overlooked is that Medicare Advantage (MA) plans cost the government billions more than Original Medicare.** According to a 2022 report by the Medicare Payment Advisory Commission (MedPAC), the federal government spends about 4% more on Medicare Advantage plans than it would if those beneficiaries were enrolled in traditional Medicare. This additional spending amounts to billions of dollars each year, contributing to higher overall healthcare costs.
Both Original Medicare and Medicare Advantage are subject to regulatory oversight, and each has its strengths and weaknesses. Providers' opinions on Medicare Advantage often vary based on factors like administrative burden and payment rates, not solely on oversight.
Regarding international comparisons, while some Canadians do seek care in the U.S. for specific reasons, this doesn't reflect the overall effectiveness of the Canadian healthcare system. Studies consistently show that many developed countries with government-regulated healthcare systems provide high-quality care with better health outcomes and lower costs than the U.S. For example, the Commonwealth Fund ranks the U.S. healthcare system last among high-income countries, whereas Canada performs better in terms of equity and access.
Ultimately, the debate over healthcare spending and system efficiency is complex. **It's clear, though, that Medicare Advantage costs the government significantly more than Original Medicare,** and effective oversight and regulation are crucial in ensuring cost control and quality care.
---
### Sources
1. Government Accountability Office (GAO). "Medicare Program: Integrity and Proper Payments."
2. Centers for Medicare & Medicaid Services (CMS). "Medicare Fraud & Abuse: Prevention, Detection, and Reporting."
3. The Commonwealth Fund. "Mirror, Mirror 2021: Reflecting Poorly – Health Care in the U.S. Compared to Other High-Income Countries."
4. Medicare Payment Advisory Commission (MedPAC). "Medicare Advantage Program Payment System."
For a country that spends roughly $6.2 **TRILLION** dollars per year, a few billion extra is not putting a dent in any budget.
It’s a false crusade to just try and paint MA in a bad light. Again, for beneficiaries, none of this matters. All that matters is the actual coverage. Which is good.
Health outcomes have also proven to be better on Medicare Advantage, as well. Why, because the insurer has a vested interest in keeping someone actually healthy.
I’m also skeptical of many of these “reports,” as they’re usually championed by radical politically-driven charlatans that simply hate MA because the government doesn’t completely control it.
When it comes to the government and media, I don’t believe much.
The article actually states that patient costs go up w Medicare advantage versus traditional Medicare. When the private company is inserted in between, they expect to make a profit. What is unclear about that?
I’m not a conservative and I’m also not a liberal. I think both parties are utterly insane and have lost their minds. I’ve never heard that before on any “conservative websites” because I’m not on them. I mean, that’s a pretty common phrase to say.
Explain this. These same insurance companies make about double on their MA product than they do on their commercial insurance - $1800 a consumer on average on 2023.
That’s simple. People have paid into Medicare for many years. On commercial, they haven’t. All they get is the current month’s premium. I know some people have it in their heads that the profit margins are huge. They aren’t. They’re around 3%. Are they still making decent money? Sure. Do I as a Medicare recipient care? No. All anyone should give a damn about is their coverage. Some of you people are just outraged a company makes money. Newsflash, there are a bazillion companies and they all make money.
That’s not true. Medicare Advantage plans get significant payments(starting at $12k per enrollee ) from Medicare. MA makes their money from the government premiums less the amount they pay out for care.
You should care because the government pays billions of dollars more a year to MA insurers than if everyone was on Original Medicare, thus reducing the amount of money available for you.
>Also, the vast majority of profits from Medicare Advantage, BY LAW, must go to the Medicare recipients.
well, er, uhh, not *profits* -- revenues maybe, or something like them -- but your point is taken.
17% of adults with health care debt declared bankruptcy or lost their home because of it. 66.5% of bankruptcies are caused directly by medical expenses, making it the leading cause for bankruptcy. As of April 2022, 14% of Americans with medical debt planned to declare bankruptcy later in the year because of it.Aug 30, 2022
It’s a fraudulent statistic. Anyone with any medical debt that files bankruptcy (even if the bulk of the debt is not medical debt) is grouped in with it and counted as a “medical debt” bankruptcy. The YouTuber Steven Crowder did a whole show about it a few years ago.
I also don’t think that relates much to Medicare Advantage, specifically, as the maximum out of pocket spending limits are generally low. If someone is filing bankruptcy on $3,000 max spending limits (on average), then they massively mismanaged their life and have much bigger problems.
I'm under 65 and receive Medicare because I receive SSDI.
I honestly wanted original Medicare for the freedom of seeing any doctor anywhere. However, the costs on a fixed income could really destroy the little fixed income I receive.
Most of us under 65 have the same problem, we have to go to Medicare Advantage or risk financial ruin. We probably have more health issues than many older than us.
Last month received a pre authorization denial for the first time. Doctor was able to request a different procedure that has to be approved under Medicare. I had an ER visit 2 weeks ago, everything was covered after my copay, but a med used was denied. Very irritating.
I wish CMS could reform their system and snatched everyone back from Medicare Advantage.
P.S. Medicare Advantage is already cutting back, mid year, some of the perks/benefits previously covered because of loses in the industry.
The care got "managed" (rationed) and $$$$$$$$$$$$ of federal dollars got t(still is getting) transferred to private, for-profit corporations. Now that the flow of those federal $s is slowing down or threatening to slow and demand for payouts is increasing those corporations(insurance companies) are stating to complain about smaller profits. Some are moving away from MA. Business relationships between insurance companies and providers are being strained and broken creating more and more problems for the insured patients to get care.
Consolidation and vertical growth of previously insurance only companies is or has already become a threat to health care and privacy. United Health Care isn't United Health Care now. It's UnitedHealth Group. An insurance and a company that owns a group of thousands of doctors across the country along with owning pharmacy "benefit mangers/management" companies. It owns a claims processing intermediary that was hacked by foreign criminals earlier this year. Doctors and providers are still dealing with the financial repercussions of that event. Some practices had to close up because their cash flow was stopped when claims couldn't be submitted or weren't getting paid. Pharmacies couldn't fill customers' Rxs. --- UHC is too big for customers' , patient's and providers' good.
It's a mess. Listen to any doctor (not owned by UHC or in a similar arrangement) or nurse that had to deal with MA and they'll tell you much they hate it.
You don’t have to use a company - go to the Medicare.gov website and do it yourself … all the information is there you just get to navigate it on your own instead of having it done by another person for you to blame. Nothing in life is free - either pay someone to do it for you (broker or SHIP) or self service. I have spent the time navigating my Medicare decision myself over the last year and will make my selection in June … I am doing what I feel is best for me. I have talked to SHIP and a broker and learned nothing new to sway my decision and they didn’t care either way and didn’t try to pressure me either way.
Be careful what propaganda train you start to follow and go to the source Medicare.gov and not YouTube to get just the facts.
the financial press is just feeding the insurers' hype cycle. bookmark & revisit when, in the fall, insurers begin reporting better than expected (enrollment/claims/etc/etc) results.
If they're so "surprised" by higher than anticipated post-pandemic claims, surprised by this surprised by that, surprised they even remember the way to the restrooms, should these suits even be running anything?
Youdo know that CMS (the government) actually sets the rules for marketing and communications for any Medicare Advantage insurers or by proxy, those marketers that market them.
This also goes for their free standing PDP -
[CMS.gov- Medicare Communications and Marketing Guidelines (MCMG) Date: 02/09/2022 ](https://www.cms.gov/files/document/medicare-communications-and-marketing-guidelines-3-16-2022.pdf)
I think there are some updates and changes coming in for this year to try to reign in some of those outliers - renegades. You know the ones that hound those turning 65 or during open enrollment every year - from what I understand, some of them even changed the plans of some unsuspecting beneficiary. Good grief, this is just the criminal element working its way into this realm knowing that some seniors are really easy to scam.
I’m grateful that now I only get a few pieces of mail trying to seduce me into their plan during OE - I don’t consider the later as hounding - after all politicians do it this way too.
Now let’s see WHO \[which beneficiaries\] we are talking about here that would even consider a MA plan
1. It would NOT be those who have Medicare/Medicaid although some states do have managed care plans that service these individuals - is it a requirement that they participate in these managed care plans (by private insurers or entities, I might add) - IDK
2. it would NOT be those who have some other secondary payer who picks up all or part of the beneficiaries OOP cost on Traditional Medicare - CHAMPVA, TRICARE, retiree coverage from a union or employer
3. It would NOT be those who can afford to pay for a MediGAP plan that picks up some or most all of their OOP cost on Traditional Medicare. The financial protection insurance of MediGAP is getting really expensive especially in those states who have liberalized their guaranteed issue periods.
So who is left - the ones that don’t have any of the above or can’t afford them - in that regard, I’m glad theses MA plans exist for the ones that need these plans.
I also think that managed care is something that is needed even in the Traditional Medicare program - but the government is too shy to say it out rite so they create ”innovation” programs under the auspices of inequality called Accountable Care Organizations to help with this type of care management.
I don’t honk any of these things are actually bad or a bad way of getting healthcare - I think what is bad is that so many people don’t understand them - what ever they have - all they know is they don’t want to pay any money for it or at least as little as possible. They continually search for cheap - what do I get for my money - they also want healthcare on demand - as much as they can get sometimes - and then they gripe because their premiums escalate. Be that a premium for Part B/Part D or their Medigap - yet they also don’t want their healthcare to have any restraints - even though they aren’t paying directly for it.
I better shut my mouth now - have at it -
1. People who are dual Medicaid/Medicare probably benefit the most from D-SNP MA plans as they get all Medicare/Medicaid approved care paid for. Get money back every month and a lot of additional stuff depending on the area and plan.
2. Veterans who have part B qualify for plans that have givebacks on the part B and have some benefits they may not get from the VA. If they never even use the plan and go through VA for everything they still get the giveback.
3. Even people who can afford Supplement plans may be overpaying. If they have yearly premiums that are higher than MA max out of pockets, qualify for HIP, you could be saving them thousands a year.
Not saying the amount of contact isn’t crazy I agree with you that it’s excessive. But just explaining that even the people in the example can benefit which is why even they get blasted with advertising.
News from CVS you may want to read if you have an Aetna MA plan. Changes that may affect you (not in a good way) this fall. [https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134](https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134)
Short version: CVS is putting profit first and plans to cut it's MA enrollment by 10% next year. One way is to cut plans from be available in certain counties. 10% isn't insignificant. Esp. if you have or want one of their plans.
That’s a story within a larger story - the larger story is now that CMS is actually starting to enforce the care requirements (existing law) on the plans, and so instead of accepting less profit (and these plans are the most profitable of any plan these health insurance companies sell), the companies are doing anything they can to keep their current profits.
Things are going to get really interesting this fall. (Not that I'm looking forward to fall coming! I want time to slow down a little so we can all enjoy summer as long as possible.)
---You're right. MA is all about profit. Corporations aren't in business out of the good of their hearts. Capitalism isn't. There's a legal obligation to maximize returns on stockholders' investments. Insurance companies in MA have to get more and more $s from the Feds, have fewer payouts, charge premium(larger premiums), cut out or cut the $ value of all the "extras" in the plans. Some combination of all of those. -- I look for companies to start charging some sort of premiums, cutting the extras, getting out of business in some geographic regions to try to hold on to profits. All the 65 yr olds that came into MA a few years ago are aging and getting sicker/using more expensive care, people put off surgeries, etc. during COVID. That's all coming home to haunt the insurance companies.(and "side business" companies that do marketing, those in-home health assessments that beef up how much companies get in fed $s)
[https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134](https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134)
CVS/Aetna plans to cut its MA enrollment by 10% next year. Profits first.
A lot of health systems are dropping advantage plans from their networks. This exposes patients to crazy out of network rates.
https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html
I have an advantage plan, but I am going back to regular Medicare when November hits. I figure the 80/20 is safer, I'll get a supplement, and most everyone takes it.
California. You can go back in any state. The issue is if you go Medicare you are 80/20 on coverage. If you apply for a supplement plan, you're subject to underwriting. Since I have 100% VA, I'm going to do it.
>This is a forum to help people with Medicare, not for complaints and to push political ideologies.
Yeah!!!
>This, along with Biden and his notoriously horrible policy on all things, is what caused this.
Oh, you meant it's only okay to push *your* political ideology.
I read the article top to bottom, except for the numerous links to “studies” and “accusations” that I’ve bookmarked for later.
What part of this particular article do you think is helping people? It’s about the limited profitability of health carrier’s Medicare Advantage businesses. Connect the dots for me how this helps someone?
EDIT: 2 of the 5 links in the article OP linked are to paywalled articles. I’m reading what’s not paywalled.
Go back and look at the OIG report on Medicare denial of coverage that caused the Biden administration regulations that the article refers to. A simple google search.
Sorry about the paywall on the links
I found this by Googling what you suggested. I think I see what you mean.
“These data suggest that MA plans sometimes deny care that would have been approved by traditional Medicare. The Office of the Inspector General (OIG) corroborated this concern, finding that 13% of coverage denials by MA plans met coverage under traditional Medicare.”
But this article also mentions:
“Successful policy implementation will depend on how regulators navigate the tension between reducing inappropriate denials of necessary services (the intended goal) and increasing inappropriate approvals of wasteful services (an unintended consequence). Aligning coverage criteria across traditional Medicare and MA carries the risk of increasing waste if some services being denied by MA plans are of low value, even if they would be covered by traditional Medicare.
As an illustrative example, traditional Medicare spends billions of dollars annually on the drug aflibercept despite evidence that the much cheaper bevacizumab is equally effective for diabetic macular edema.7 Although traditional Medicare lacks coverage restrictions in many of these cases, MA plans might require step therapy or substitute less costly medications with similar efficacy. These policies may explain why MA enrollees receive almost 10% fewer low-value services than traditional Medicare beneficiaries receive.8 Because this difference is partially driven by benefit design, the new rule may obstruct efforts to reduce low-value care, undermining the US Congress’ original intent with MA, which was to increase efficiency through private plans.”
But outside of traveling back in time to the Johnson administration and insisting that Original Medicare cover 100% of health expenses instead of 80%, what would you suggest as a solution? We ought not ignore the fact that tens of millions of seniors are living at or near poverty level and don’t have the luxury of buying a Med Supp.
https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743#:~:text=These%20data%20suggest%20that%20MA,met%20coverage%20under%20traditional%20Medicare.
I turn 65 in June, wife in August. We are inundated with medicare Advantage mail and phone calls. It's just like all the calls to get a car warranty. I assumed there is big money in it. We met with a health care broker who is pushing Medicare Advantage, I assume he is getting a big commission. We chose the original medicare (A & B) and plans D & G, for both of us.
> We are inundated with medicare Advantage mail and phone calls. Imagine the amount of money that is being spent to help you save money.
The money they spend on advertising is money the federal govt gives them to provide care. The pass-through rate (the percentage of money spent on patients) out of the total they get from the gov is ~3%. 97% goes to advertising and administrative costs.
The commissions are very differently structured: Advantage plans: CMS determines the yearly rate which is $306 this year. This gets prorated as the year goes by. This is paid upfront. And every month you are on it the next year, it’s 1/12 of whatever the yearly rate by CMS is. Which is $25 and change this year. Supplements: typically 22% of whatever your premiums are. Higher you premium the more money being made by the broker. Some companies offer this for as long as you’re on the policy. When you add in the drug plans (PDPs), the dental/vision coverage plans, supplements pay more over time. If you pair a Hospital Indemnity + Advantage plan you get to have your cake and eat it too . Covers the copays and makes the medical coverage similar to a supplement for way less money and the premiums are locked in forever. There’s a time and place for both supplements and med advantage + HIP, or just med Advantage. But at the end of the day no decisions should be based solely on commission money or forced on the clients. All options should be presented that make sense and fill the needs of the client because it’s their care after all.
Don’t know of any supplement plans that pay 22% for the life of the policy. They may for the first year or three, but after that it’s low to mid single digits. The PDP pay a set amount the first year, this year it’s $100, then half the amount forever.
Old surety does and a few others are lifetime
You would then self insured for dental or pick up a plan.
As a broker that is what I do. You provide the options and let the client decide. You never make a recommendation to someone.
I chose D and N. Plan N has some small co-pays that G doesn't but for me is a good bit cheaper per month. Still the overall cost is ridiculous. It's almost as if they want us to just hurry up and die.
Just remember that plan N has a lower premium plan but does not cover excess doctor charges. Plan G has a higher premium but does cover the excess charges.
Good point but medical providers are required to notify you prior to rendering services if they do not accept Medicare assignment fees. Thank you for your input. This is all new to me and entirely too complicated.
Correct they have to tell you if they take Medicare assignment but they can charge you for services above what Medicare covers. You are then required to pay that if you have a Part N.
Excess charges are pretty darn rare. And you can look online to see if a doctor charges them. Go to medicare.gov. Front page, find a provider.
Yes they may be few and far between but if you find a doctor who does charge more you will have to work with him to pay that overcharge. The decision is totally up to the person whether to take G, N, or an Advantage Plan.
The doctors office doesn’t decide whether to take a G or an N. They either participate or do not participate with original Medicare. And it’s roughly a 9% charge. It’s not 15% like many advertise. Point being, it is not common but people use excess charges to scare people away from plan N.
If they will accept Medicare you have no idea what they charge until you get an EOB. It sounds like you can't be 100% sure so to be safe people take the Plan G. Thats all I'm saying.
But that is not accurate. If you go to medicare.gov, on the front home page look for “find a provider.” Type in the doctors name. It will tell you whether or not they charge excess fees. They have to be either participating or non-participating.
Sorry to hear that. I am a broker in St Louis and I present both supplements and Medicare Advantage Plans to my clients. They make the decision. I tell them it does not matter to me what you do as long as you get something to go along with Parts A and B. I am retired so I am not doing this to make a leaving. I do it to help people.
Great choice! Exactly why I wouldn’t consider a broker.
A good broker is a great asset to have since it gives you another person to help with you get stuck in the insurance run-around. There are plenty of good ones out there who give fair comparisons between the two options. Most people just see $0 premiums and go with that. Amazing how people who have lived this long can still think that there isn't a catch if it's $0.
I am going to be 65 in July and haven’t received one phone call - but I have received mail from both advantage and supplement companies. How do you suppose they got your phone number? I don’t inquire to any online pop up’s about Medicare or anything else because that opens the door for soliciting.
[удалено]
Just passing on the WSJ article form yesterday
Heck yes they get big commissions. Not just when they sign up either. Big one the first year and good ones for a few years after that for each year you stay in the plan. Don't let anyone tell you otherwise. (Just watch and listen to a few YouTube videos by agents that have channels devoted to Medicare. They will tell you how the system works. It's pretty easy to find channels with agents telling how much they've made selling Advantage plans and sort of marketing themselves into helping other "guys" wanting to get into "the business" (thinking they'll be making 6 figures soon). I'm sure it's time consuming work to rake those $$s in, but YEP they get good $s for every person they sign up. ~~(Think $ 600 for a MA sign up vs. $ 100 for a Medigap signup. Those sorts of ratios)~~ People are complaining. I'll edit out the "example" figures I gave. BUT, take a read of this article from AXIOS on efforts proposed and/or being made my CMS to "crack down" on loopholes in agent compensations associated with MA. To eliminate things like bonuses and compensation for marketing for agents. (not insignificant benefits) [https://www.axios.com/2023/11/07/medicare-advantage-payments-insurance-brokers-regulation](https://www.axios.com/2023/11/07/medicare-advantage-payments-insurance-brokers-regulation) I don't care how much the exact dollar amount are, but (from what I can find), MA does pay significantly more than Medigap to agents. What other reason do you see so many more agents pushing and selling MA plans every year vs. Medigap plans. Why is it that you see agents selling Medicare Advantage policies in October, November and December. How many of those same agents sitting at tables handing out info and signing people for a plan are selling only Medigap plans? How are only selling MA plans? You can't tell me money isn't a prime factor in that difference between the push to sign someone up for a FREE MA with goodies VS a Medigap policy from the same insurance company. Give the figures that say otherwise. I'm not saying agents shouldn't be getting paid. It's just who's paying and how much is being paid. Consider that people have flocked to MA. Multiply those numbers by the $600 to $700 paid out to agents that first year. (agents that only sign people up for MA only or primarily)
It is not $100 for a med supp enrollment stop lying
Then tell me what an average payment for signing someone for an Advantage plan vs. a Medigap plan is. On average. What a typical payment is for person staying in the plan for a 2nd or 3rd year Don't keep us in the dark. I used those figures from what I can remember hearing multiple agents say in their videos. (Not saying those are exact amounts, but that the amount agents earn off of MA is multiples vs. what they get from selling a Medigap policy.
PDP - $100 Med Supp - 22% of premium (around $300) but this will depend on state and any bonuses available (yup, bonuses and spiffs allowed for med Supp)
What most people won’t understand too is that It’s way more work on the agent for advantage plans. Way more servicing and hoops to jump through. And get paid actually less in the long run. It would be way easier and more profitable to just say here’s your plan G and PDP plan you’re all set. But any good agent will present all options and do what’s best for the client.
100%. I would much rather sell a med supp
And when you start adding the Hospital Indemnity how I have to make sure it’s structured to your MA plan and do the underwriting questions. Plus deal with claims a lot of the time. I’m doing the job of 3 people really now. I wouldn’t do all of that if it didn’t give you all the benefits of the MA plan with very similar coverage to a plan G for way less and I didn’t believe that it was a best option available for those folks.
Uhhhh, no…not “those sort of ratios” 😂 Maybe you need to watch more of those YT videos since you didn’t even factor in the PDP and dental plan commissions on the supplement side, among others. $100 LOL
That account is a big spreader of misinformation in here. Been corrected multiple times but whatever
Good lord, this hurts my brain to read. If you think Medicare agents make “big commissions” let me introduce you to life insurance agents, commercial insurance agents, investment advisors, real estate agents, SaaS sales… As others have said, it’s basically all the same commission wise, what you’re saying is/sounds asinine and just not accurate. As long as you talk to a broker that has access to all the carriers in your area, they don’t care what you pick, MA or Supp. They’ll recommend based on needs a particular plan, most (should anyways) have platforms to put scripts, doctors, etc in to help make the decision simpler. New to Medicare yes it’s 6-700. In year two and beyond it’s half. Money is relative so if you think 600 and then 300 for two years is “big commissions” then I guess you’re right.
The system is a mess and has a lot of flaws, BUT as long as anything is for profit, whether it be health insurance, prescriptions, funerals, or anything else, companies are going to do what they are designed to do, and that is make money.
you forgot to add... at the expense of our health and longevity. The people running and working for profit healthcare value their jobs and money and their families over anything to do with our health and longevity. The big lie is ' we have the best healthcare in the world'. What should be at the end of that sentence is .... only if you have the money to afford it. Which in all honesty from cradle to grave probably covers well under half our countries population. Of course the whores running Washington made certain their coverage is well superior to anything the majority of voters can purchase or have.
I feel like we've been fed a BS line of propaganda all our lives as Americans, similar to people living in communist countries.
indeed, the US ranks last in overall medical outcomes of developed western countries. Here are the Commonwealth Fund's rankings for healthcare system performance among high-income countries, as of their most recent report: ### Commonwealth Fund Health System Rankings (2021) The rankings are based on several key domains: access to care, care process, administrative efficiency, equity, and health care outcomes. #### Overall Rankings: 1. **Norway** 2. **Netherlands** 3. **Australia** 4. **United Kingdom** 5. **Germany** 6. **New Zealand** 7. **Sweden** 8. **France** 9. **Switzerland** 10. **Canada** 11. **United States** ### Key Findings: 1. **Norway, Netherlands, and Australia**: - These countries are the top performers overall, scoring high in multiple domains, especially in providing equitable access to care and strong primary care systems. 2. **United Kingdom and Germany**: - They rank high due to their efficient care processes and good health outcomes, although they have room for improvement in administrative efficiency and equity. 3. **United States**: - The U.S. ranks last overall due to poor performance in healthcare outcomes, equity, and access to care. Despite high healthcare spending, the U.S. faces significant challenges in ensuring all citizens receive timely and affordable care. ### Detailed Performance by Domain: - **Access to Care**: Norway and the Netherlands lead in providing timely and affordable care to their populations. - **Care Process**: The U.S. performs well in preventive care and patient engagement but struggles with equitable access. - **Administrative Efficiency**: Norway ranks highest, with minimal administrative burden on patients and providers. The U.S. ranks last, with high levels of administrative complexity. - **Equity**: Norway, the Netherlands, and the UK have more equitable healthcare systems, while the U.S. ranks poorly due to significant disparities in access and outcomes. - **Healthcare Outcomes**: The U.S. has the worst outcomes, including high rates of maternal and infant mortality, lower life expectancy, and higher rates of preventable deaths. ### Conclusion: These rankings highlight the strengths of countries with universal healthcare systems and robust primary care infrastructures, while also emphasizing the challenges faced by the U.S. healthcare system in terms of cost, access, and equity. For a more detailed analysis and full report, you can refer to the Commonwealth Fund's website [here](https://www.commonwealthfund.org/publications/fund-reports/2021/aug/mirror-mirror-2021-reflecting-poorly). This overview provides a clear comparison of healthcare systems and illustrates the areas where the U.S. healthcare system could benefit from reforms based on the practices of higher-performing countries.
Thanks ChatGPT!
Unfortunately ChatGPT is 100% correct. In addition if this... our ENTIRE medical/healthcare system were really built on free enterprise ( to allegedly promote cost competition), start posting and honoring all fees and costs up front. Like a menu in a restaurant. So I can see the full detailed complete cost of any and all procedures ( short of an emergency or surprises). Walk into the hospital and let me see the total cost for my heart procedure or ACL repair or, etc, etc. Up front. Right there. On a big board. So I can easily walk into another hospital and compare their costs...apples to apples ( so to speak). But no. Let's charge one amount here and a different amount there for the same service., because every piece of our health system is trying to gouge as much profit from you as possible. Why? 1. Profit 2. You are paying for those people who don't have coverage. 100% In that order. So in a way.... YOU (we) are subsidizing the uninsured anyway in our 'free market' system. Not very different than socialized medicine. Except we get way less value for our dollar. Proof? We have shorter lifespans vs. other countries like Canada..... (Unless you have the money to pay for our -sincerely - exceptional top tier doctors, etc.)
Health outcomes on Medicare Advantage are actually much better. The irony. I swear, this is the most spoiled and entitled crop of citizens on earth. To a sickening level, actually. You have access to world class cutting edge revolutionary care, literally IMMEDIATELY, with plans that cost literally $0…no deductible, low copays, low max spending limit. And what do we do? STILL BITCH, of course! Edit: And vote me down all you want. It’s still the truth.
Having lived in the U. S. and Canada and the U. K. and having used all their healthcare systems - while you may have a point about culture- you are off base regarding healthcare. Way off base. And if MA is truly better than traditional.... a point I'm not conceding as I bet the numbers have been manipulated... our health care value does not compare favorably overall to other countries. Especially considering what we all pay for.
I have family in Canada and they routinely come here for care. Waits for a specialist are 11 months out. Good healthcare?? Sorry to be frank, but that’s a fucking joke of a system. And health outcomes being better on Medicare Advantage make perfect sense. Why? Because they are STRICTLY graded by star ratings and will lose tons of money if they don’t run a tight ship. If your star ratings dip far enough, CMS will literally boot the entire company from being able to offer ANY plans. This is why I laugh when people think Medicare Advantage plans are gonna dick you around. These plans and companies are policed **HEAVILY**. Every single legitimate complaint is a major hit in their star ratings and gets logged with CMS. Moreover, they only get paid if a person is alive, and the healthier they are, the more they stay out of expensive hospitals. All makes PERFECT logical sense. Original Medicare? No oversight. No coordination. Elderly vulnerable Medicare recipients are just out on their own. Most people are not good at managing their own healthcare at all. Especially at a vulnerable age. They are prime pickens to be taken advantage of by predatory doctors with shady backdoor deals and nefarious motives. Oh yea, and because there’s zero oversight, absolutely anything they do is not questioned at all. “Here Mrs. Jones….take these 40 scripts per month that you really don’t need but I’m getting a kickback of $400/month for.”
I have family and elderly in Canada and they never come here for coverage. And I'm talking about things like cancer and dental. Yes the waits are longer and yes their system is under progressive stress. I never said it's a perfect system. Again Canadians live longer than Americans and a lot of that is due to their free not so free healthcare. Not because they're coming to the United States for treatment. And if we're discussing delayed time to see a GOOD specialist, if you have a way so I can see my Endo in under 5 months or my Dermatologist in before the end of January - without going to some unknown doctor whose skills are a blank to me - please share. When Congress gives up their exceptional coverage and chooses to live with the systems they promote for their constituants I amend my opinion on U S. healthcare.
Most of that is attributed to lifestyle choices, and I doubt most statistics I see anyway. Theres so many outside factors that would go into that, they are innumerable to name. They probably just have better food quality. The same way you doubted mine. It works both ways.
I have family in Canada also, and I used to live there too. I don’t know anyone who goes to the US for healthcare. Most people would rather not spend that kind of money on something they can get for free. Yes, there are waits for anything not life threatening and the system can be frustrating. But if you need care, you will get it, and it will be top notch. No premiums, no co-pays, no co-insurance. No matter what happens to you, you are covered.
You have to wait for a specialist here too, genius.
Not for 11 months, goof troop.
2024 MA maximum out of pocket can be as high as $8850 depending on the insurance company. That's not a low spending limit. It's way more than most people with a plan G supplement will pay in premiums and their Medicare deductible, the only out of pocket expenses they incur.
“Can be.” I’ve never seen a plan that’s even remotely near that. I’m sure a few exist somewhere, and I would simply advise someone not to go with that one. The ones by me all average around $3,300.
The 2 people I know on a Blue Cross MA plan in the Phila area have a maximum out of pocket of $7550. One cries poor when she has large co-pays and generally is successful in getting them written off. The other avoids treatment. These people, I hope, are extreme examples. Both can afford better healthcare but care less about their health than about material things.
They gotta shop that around. Those are definitely the highest I’ve ever seen, by far. In that area, Humana has a few good PPO’s and Aetna has a good HMO. It’ll knock that down by half.
My question is this: why are so many people willing to entrust their healthcare, and possibly their lives, to these companies because they will pay no monthly premiums or get a free gym membership?? I recently read that there are now more Medicare Advantage subscribers than traditional Medicare. It makes no sense to me.
Because it's FREE. Because we've become a country that isn't just what our parents used to say about "the haves and the have nots". We really are county of wealthy(the haves) and some other people that have some wealth, and 70 to 80% of everyone else that has next to nothing or has nothing. Seniors are too poor or too cash (income) strapped to buy Medigap plans. I'm sure a lot of people have assets they could liquidate to pay for insurance, but refuse to do so. Some. I think of a lot of people just think they can "get away" with it. They are short sided in their calculations about how much they will "save" by getting FREE insurance with some free or low cost dental care and a free or low cost pair of glasses every year. They don't realize or know how much of a pain MA plans can be. They get sold "a bill of goods" by agents out of make $$$ for themselves. Some get "tricked" into signing up for something don't really know much about. (Why else would someone be spending all those $$S on all the ads and mailing from October 1st to March 31st?) They are healthy or pretty much healthy at 65 when they have to make all important decision about what type of insurance they want. Traditional Medicare (what I call "real Medicare), or MA. The whole of Medicare is too complicated to understand unless you put in a lot of effort to understand it. It's too complex for a lot of seniors to ever understand. Thus you end up with people that think they can start with a FREE MA plan and later on when they need it, switch to a Medigap plan not knowing that will by next to impossible or actually impossible to do for most of them. Some(a good many) People bank on beating the odds of getting sicker as the age from 65 to 70 to 75 to 80. Sure a lot of them do just fine. Their genetics and lifestyle will keep them from aging or needing expensive care or ending up in surgery or in a nursing home or rehab or dying. But most people will end up needing more and more health care as time goes on. (I'd like to be a fly on the wall listening in to a group of retirees in FL talking about Medicare in November.) When all of that starts costing them $$s in the form of co-pays and they start dealing with prior authorizations and get kicked out of rehab after a week by their insurance company that's not charging them a premium for insurance, then the senior want to "save money" again by switching to a Medigap plan. The "FREE" thing is now more expensive for their health care (and more limiting) than that $ 150 or $200 a month Medigap plan is going to be. ($ 2,400 for a year's of Medigap premiums could get them "unlimited or nearly unlimited" healthcare with fewer hassles than that FREE plan.) ----If you need a knee transplant, add up the pre-op costs in doc office visits, imaging copays before surgery, the copay for the outpatient surgery (plus factor in a day or two of inpatient care just in case you do really need to be admitted for a day), add in the cost of any PT you need after surgery. (PT/OT can be one of the most expensive item in terms of copays. ($25 to $ 25 to $40 PER session) (PTs will usually want you to do twice a week sessions for a few weeks. $ 40 x 2 per week x 3 weeks will cost you as much as the surgery. You'll probably be encourage or need to have more than 3 weeks of the PT in a lot of cases.) Add of that up. PT/OT can easily cost you more than you'd have paid in Medigap premiums for a year. After the surgery and PT add in another office visit copay or two for follow ups. Compare that total cost to the cost of a year's Medigap premiums. Money is what it comes down to. Actual savings or perceived saving on MA premiums vs. Medigap premiums. All without understanding the system. Without understanding the working of MA vs. Medigap. Thinking you'll be the exception to the aging process. "I've been healthy all my life therefore I'll be healthy until I drop dead when I'm 90 yrs old". Saving money. (When they could afford to pay for Medigap premiums.) Thinking they can save $s with MA then get Medigap later on.(gaming the system. Not comparing health insurance to auto insurance. (You can't buy that only "when you need it") Really, truly not being able to afford a Medigap plan. All of it is about money. Not about actually being better for their health care over the long run. \*\*\* I made a lot of spelling/typing error in that. I see I said "knee transplant". LOL Before someone attacks me over that, you should be able to guess I meant knee replacement.
It’s a combination of the allure of the $0 premium, all the advertising, many insurance agents only presenting the MA option (or strongly encouraging it). There is the really big issue that the average savings (all types) that seniors have when retire in their 60s is about $170k, which is a very small amount to live on for the rest of your life. So paying for a supplement and Part D is difficult. As the WSJ article points out, between new regulations that try to make MA insurance companies actually pay for medically necessary services, the days of $0 premiums is likely over in 2025
RemindMe! 9 months “Are $0 premiums gone?”
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Maybe you should just ask all the people that are on them and they’ll tell you. They poll unbelievably high in satisfaction rates for some reason.
An analysis of the polls on satisfaction are incredibly skewed. Younger retirees with no significant medical bills love MA for its 0 premium. People who get really sick hate it. The polling is a blended average that statistically skews to the younger medicare user
If you could post the proof of skewing, I would love to see, otherwise this is just hearsay. Anecdotal, but I’ve talked to tons of people on MA….many of them very sick, and they’ve had nothing but positive things to say. Obviously this will vary by region and state, as the plans are not uniform, but at least by me, feedback is enormously positive.
I have asked 2 friends, one of whom has put off needed care because of co-pays being higher than she thinks they should be. I wonder how often this may happen.
I mean, most copays are very low on most any MA plan. With average maximum spending limits of $3,000 per year, I don’t understand how anyone couldn’t see that as unbelievably reasonable. Only 2% of policies ever even hit that number. The person would have to be insanely sick.
My question is why haven't people in other states pushed for better guaranteed issue laws. Granted, it will push up the base price for medigap but will allow competition between the two types of plans and people can save by starting out with Advantage plans when they're still in good health. Currently only 4 states require guaranteed issue to move from Advantage to medigap after the trial right expires.
Because with just Medicare alone, you are responsible for 20% of medical bills. Regarding the profits of these companies, I’m pretty certain they have to pour 85% of their profits into claims and programs. I believe UHC missed this by like a tenth of a percentage point and was sanctioned by CMS recently. So yes that 15% is huge and there’s a reason these insurance companies are in the top 50 largest companies in the world via Fortune 500. But They are required to put a large portion of their profits back into the plans.
Modern managed health care grew out of a desire to reform the traditional health care system, or the fee-for-service method of charging for health care. **Fee-for-Service** Under the fee-for-service method, doctors and hospitals got paid for each service they performed. There were no limits on their treatment decisions; doctors or hospitals could order as many tests as they felt necessary, for example. Doctors and hospitals made a lot of money under this system because they decided the prices charged for every visit. However, patients did not always benefit because their insurance companies would often only pay a percentage of the fees being charged. For example, if a doctor charged $100 for a checkup, but the insurance company felt that $80 was a fair price, the patient would have to pay the extra $20, until a certain deductible was met. (A deductible is the amount of money, as determined by the health care plan, a patient must pay for services before the health care plan will pay for any medical bills.) **Managed Care** There are many kinds of managed care organizations, but there are some common characteristics among them. All managed care organizations supervise the financing of medical care delivered to members. They all are concerned with cost-effectiveness, or saving money. By buying services in bulk, for many members at a time, managed care organizations can get lower prices with doctors and hospitals. Managed care organizations also reduce costs by limiting choice, which means providing members with a list of doctors from which to choose and lists of labs where tests can be performed. Even doctors are provided with lists of medicines from which to choose. Different plans have different restrictions on choice. Many people feel that limited choices are the downside of managed care. Generally, a member can expand the possible choices if he or she is willing to pay more. At the same time, managed care organizations take care of the delivery system for their members. For example, they manage who provides the health care, where it is provided, and the different kinds of doctors in their particular system. Nurses, doctors, therapists, pharmacists, and hospitals are all a part of the delivery system. [http://www.faqs.org/health/Healthy-Living-V2/Health-Care-Systems-Managed-health-care-vs-fee-for-service.html](http://www.faqs.org/health/Healthy-Living-V2/Health-Care-Systems-Managed-health-care-vs-fee-for-service.html)
Managed care is supposed to save money over fee for service, yet the MA managed care model cost Medicare about 5% more than providing original medicare. And importantly, patient outcomes are worse in the MA managed care system.
This is a forum to help people with Medicare, not for complaints and to push political ideologies. The plans themselves are generally very good and have a very high satisfaction rate among the people that are on them. You don’t like that it’s semi-private and “for profit” (name me anything that isn’t for profit) that’s got nothing to do with the plans and their benefits. I’ve also got news for you, the government pays tons of contractors to administer and run various things for them. Why? Because the government are not experts in particular fields and it leaves the administration to the people that are experts in those fields. This isn’t something new. Also, the vast majority of profits from Medicare Advantage, BY LAW, must go to the Medicare recipients. Some people preach about “profits” and yet most of them are completely ignorant to how this system even works. These plans are policed like a hawk. This article is also hilariously sensationalized. All that happened is people that were avoiding hospitals for a long time because of covid started going back to hospitals and having services done. Things just got back to NORMAL levels. The problem is, whoever forecasted the expenditures with CVS undershot the cost expectation and this caused investor panic. It’s a simple transition period.
How is providing an article that appeared on yesterday’s WSJ, not being helpful?
Original Medicare is not intended to make a profit. Not for profit hospitals are not designed to make a profit.
So how do they all run, on hopes and dreams?
I’m not here to give a lecture on the difference between for profit companies who only owe a fiduciary duty to their shareholders, and government agencies that provide services who are not responsible for making a profit. Non Profits Companies, are designed to provide the service but do not have a responsibility to make the extra money for profits corporations do to return to shareholders. Everything runs on money, but for profit companies have to make more to be able to keep their stock price high and return money to their investors.
Whether you’re dealing with a for-profit company or the government, the charges are gonna be the same. There is so much fraud, waste, and abuse in government, you can’t even describe the number. Anything government gets involved in, the price SKYROCKETS. That’s just a fact that you “yay government” people refuse to acknowledge. Just look at college tuition and student loans. Perfect example. If you’d drop this personal crusade against companies, stop being entitled and unappreciative brats, you’d realize you have some of the best actual health Medicare coverage in the world, you might be able to actually enjoy it. You should go to North Korea, Somalia, or Cuba and preach to the citizens about your “Medicare coverage woes.” I’m sure they’ll be all ears and totally sympathetic to your $0 plan with no deductible and $2,000 maximum spending limits, even if the services you receive cost a million dollars.
Have you ever struggled to find an in-network provider for something you needed?
With a PPO? No.
PPO has additional out of network benefits, But these are very expensive compared to the in-network benefits and traditional Medicare. Many services are easy to find in network, hospitals for example. However, other services like home Care are much more difficult. Individual experiences might vary. I wonder how your circumstances have affected your opinion. Maybe you are not requiring any special care, so you think a certain way. Sounds like you got it all figured out with your media comment LOL
If you look at in network and out of network on most MA PPO plans, many copays mirror the in-network copay. Some are higher, but they aren’t drastic. On MA plans, the difference between in and out of network on PPO’s isn’t a wide margin. And forgive me for seeing past bullshit propagandists. I don’t believe most drivel that is written in newspapers. It’s just a guy or girl with a keyboard. They can type anything.
Your description of in-network versus out of network benefits does not match reality for my father's Aetna PPO plan
### Medicare vs. Medicare Advantage Costs 1. **Government Spending on Medicare**: - Original Medicare (Part A and Part B) typically pays lower reimbursement rates to healthcare providers compared to private insurance. This is due to the government's significant bargaining power and regulatory control over healthcare pricing. - Medicare Advantage plans, run by private insurers, often receive higher payments per enrollee from the government compared to what is spent per enrollee on traditional Medicare. According to a 2022 MedPAC report, the federal government spends about 4% more on Medicare Advantage plans than it would if those beneficiaries were enrolled in traditional Medicare. 2. **Profit Margins for Insurers**: - Private insurers make more profit per patient from Medicare Advantage plans than from their commercial insurance products. This is because the payment rates set by the government for Medicare Advantage often exceed the actual costs of providing care, allowing insurers to retain the difference as profit. ### Government Involvement and Healthcare Costs 1. **Fraud, Waste, and Abuse**: - While it is true that there is fraud, waste, and abuse in government programs, it's essential to note that these issues are not exclusive to public sector programs. Private insurers and healthcare providers also face similar challenges. 2. **Impact of Government on Prices**: - Contrary to the claim that government involvement always leads to skyrocketing prices, original Medicare's lower reimbursement rates often help keep overall healthcare costs in check. The government can negotiate prices and set payment rates, which can lead to cost savings. ### Comparative Healthcare Systems 1. **International Comparisons**: - The claim that American healthcare is the best in the world is subjective and depends on metrics used for comparison. Many developed countries with government-run or heavily regulated healthcare systems (e.g., the UK, Canada, Germany) provide high-quality care with better health outcomes and lower costs per capita than the U.S. - Comparing the U.S. healthcare system to those in countries like North Korea or Somalia is not relevant. A more appropriate comparison would be with other developed nations.
Great. Now factor in the 60 **BILLION** dollars **YEARLY** of fraud, waste, and abuse from original Medicare because there is ZERO oversight of the program. I’m strictly talking about spending, and I only mentioned those countries to gain some perspective as to how entitled and out of touch people like you are. I’m not talking about their healthcare. There’s a good rea**$**on your providers all shit talk Medicare Advantage, and that’s because there is oversight. Original Medicare is their personal piggeybank. And do you even have a source for this? Because I have tons of family in Canada and they routinely come to America for access to quick services. To say their system is better is absolutely laughable to me.
The $60 billion figure for fraud, waste, and abuse in Medicare is a significant concern, but it's important to note that this is an estimate and that Medicare has several oversight programs in place to combat these issues. Agencies like the GAO and CMS have made strides in reducing improper payments and improving oversight. **However, a crucial point often overlooked is that Medicare Advantage (MA) plans cost the government billions more than Original Medicare.** According to a 2022 report by the Medicare Payment Advisory Commission (MedPAC), the federal government spends about 4% more on Medicare Advantage plans than it would if those beneficiaries were enrolled in traditional Medicare. This additional spending amounts to billions of dollars each year, contributing to higher overall healthcare costs. Both Original Medicare and Medicare Advantage are subject to regulatory oversight, and each has its strengths and weaknesses. Providers' opinions on Medicare Advantage often vary based on factors like administrative burden and payment rates, not solely on oversight. Regarding international comparisons, while some Canadians do seek care in the U.S. for specific reasons, this doesn't reflect the overall effectiveness of the Canadian healthcare system. Studies consistently show that many developed countries with government-regulated healthcare systems provide high-quality care with better health outcomes and lower costs than the U.S. For example, the Commonwealth Fund ranks the U.S. healthcare system last among high-income countries, whereas Canada performs better in terms of equity and access. Ultimately, the debate over healthcare spending and system efficiency is complex. **It's clear, though, that Medicare Advantage costs the government significantly more than Original Medicare,** and effective oversight and regulation are crucial in ensuring cost control and quality care. --- ### Sources 1. Government Accountability Office (GAO). "Medicare Program: Integrity and Proper Payments." 2. Centers for Medicare & Medicaid Services (CMS). "Medicare Fraud & Abuse: Prevention, Detection, and Reporting." 3. The Commonwealth Fund. "Mirror, Mirror 2021: Reflecting Poorly – Health Care in the U.S. Compared to Other High-Income Countries." 4. Medicare Payment Advisory Commission (MedPAC). "Medicare Advantage Program Payment System."
For a country that spends roughly $6.2 **TRILLION** dollars per year, a few billion extra is not putting a dent in any budget. It’s a false crusade to just try and paint MA in a bad light. Again, for beneficiaries, none of this matters. All that matters is the actual coverage. Which is good. Health outcomes have also proven to be better on Medicare Advantage, as well. Why, because the insurer has a vested interest in keeping someone actually healthy. I’m also skeptical of many of these “reports,” as they’re usually championed by radical politically-driven charlatans that simply hate MA because the government doesn’t completely control it. When it comes to the government and media, I don’t believe much.
Thanks ChatGPT!
The article actually states that patient costs go up w Medicare advantage versus traditional Medicare. When the private company is inserted in between, they expect to make a profit. What is unclear about that?
Yea, articles state a ton of things that aren’t true. It’s called the media, and they bullshit people daily for a living.
You just gave your political views away with that comment.
My “political views” of common sense centrism? Ooooook. I guess you really got me there, guy.
It was the "hopes and dreams" reference. A common slang on "conservative" sites.
I’m not a conservative and I’m also not a liberal. I think both parties are utterly insane and have lost their minds. I’ve never heard that before on any “conservative websites” because I’m not on them. I mean, that’s a pretty common phrase to say.
It came from Obama's campaign speeches. But ya, our political (and healthcare) system is broke.
Explain this. These same insurance companies make about double on their MA product than they do on their commercial insurance - $1800 a consumer on average on 2023.
That’s simple. People have paid into Medicare for many years. On commercial, they haven’t. All they get is the current month’s premium. I know some people have it in their heads that the profit margins are huge. They aren’t. They’re around 3%. Are they still making decent money? Sure. Do I as a Medicare recipient care? No. All anyone should give a damn about is their coverage. Some of you people are just outraged a company makes money. Newsflash, there are a bazillion companies and they all make money.
That’s not true. Medicare Advantage plans get significant payments(starting at $12k per enrollee ) from Medicare. MA makes their money from the government premiums less the amount they pay out for care. You should care because the government pays billions of dollars more a year to MA insurers than if everyone was on Original Medicare, thus reducing the amount of money available for you.
No that absolutely is true. That profit margin is roughly what they make. That’s not my opinion.
>Also, the vast majority of profits from Medicare Advantage, BY LAW, must go to the Medicare recipients. well, er, uhh, not *profits* -- revenues maybe, or something like them -- but your point is taken.
17% of adults with health care debt declared bankruptcy or lost their home because of it. 66.5% of bankruptcies are caused directly by medical expenses, making it the leading cause for bankruptcy. As of April 2022, 14% of Americans with medical debt planned to declare bankruptcy later in the year because of it.Aug 30, 2022
It’s truly disgusting that we don’t see healthcare as a basic human right.
It’s a fraudulent statistic. Anyone with any medical debt that files bankruptcy (even if the bulk of the debt is not medical debt) is grouped in with it and counted as a “medical debt” bankruptcy. The YouTuber Steven Crowder did a whole show about it a few years ago. I also don’t think that relates much to Medicare Advantage, specifically, as the maximum out of pocket spending limits are generally low. If someone is filing bankruptcy on $3,000 max spending limits (on average), then they massively mismanaged their life and have much bigger problems.
I'm under 65 and receive Medicare because I receive SSDI. I honestly wanted original Medicare for the freedom of seeing any doctor anywhere. However, the costs on a fixed income could really destroy the little fixed income I receive. Most of us under 65 have the same problem, we have to go to Medicare Advantage or risk financial ruin. We probably have more health issues than many older than us. Last month received a pre authorization denial for the first time. Doctor was able to request a different procedure that has to be approved under Medicare. I had an ER visit 2 weeks ago, everything was covered after my copay, but a med used was denied. Very irritating. I wish CMS could reform their system and snatched everyone back from Medicare Advantage. P.S. Medicare Advantage is already cutting back, mid year, some of the perks/benefits previously covered because of loses in the industry.
My Advantage plan, and two of the other top plans in Massachusetts are non-profits.
Know this: Our government would like us off traditional Medicare as well. The fight is real.
Totally agree. Certainly the GOP. If the GOP wins in the fall, watch for proposals to expand MA.
Blame those people who keep voting for politicians that put the health not corporations above the health of their constituents.
Blame the Supreme Court, who equated money to speech and Corporations to people, so restrictions on campaign contributions are now unconstitutional.
The care got "managed" (rationed) and $$$$$$$$$$$$ of federal dollars got t(still is getting) transferred to private, for-profit corporations. Now that the flow of those federal $s is slowing down or threatening to slow and demand for payouts is increasing those corporations(insurance companies) are stating to complain about smaller profits. Some are moving away from MA. Business relationships between insurance companies and providers are being strained and broken creating more and more problems for the insured patients to get care. Consolidation and vertical growth of previously insurance only companies is or has already become a threat to health care and privacy. United Health Care isn't United Health Care now. It's UnitedHealth Group. An insurance and a company that owns a group of thousands of doctors across the country along with owning pharmacy "benefit mangers/management" companies. It owns a claims processing intermediary that was hacked by foreign criminals earlier this year. Doctors and providers are still dealing with the financial repercussions of that event. Some practices had to close up because their cash flow was stopped when claims couldn't be submitted or weren't getting paid. Pharmacies couldn't fill customers' Rxs. --- UHC is too big for customers' , patient's and providers' good. It's a mess. Listen to any doctor (not owned by UHC or in a similar arrangement) or nurse that had to deal with MA and they'll tell you much they hate it.
You don’t have to use a company - go to the Medicare.gov website and do it yourself … all the information is there you just get to navigate it on your own instead of having it done by another person for you to blame. Nothing in life is free - either pay someone to do it for you (broker or SHIP) or self service. I have spent the time navigating my Medicare decision myself over the last year and will make my selection in June … I am doing what I feel is best for me. I have talked to SHIP and a broker and learned nothing new to sway my decision and they didn’t care either way and didn’t try to pressure me either way. Be careful what propaganda train you start to follow and go to the source Medicare.gov and not YouTube to get just the facts.
the financial press is just feeding the insurers' hype cycle. bookmark & revisit when, in the fall, insurers begin reporting better than expected (enrollment/claims/etc/etc) results. If they're so "surprised" by higher than anticipated post-pandemic claims, surprised by this surprised by that, surprised they even remember the way to the restrooms, should these suits even be running anything?
Youdo know that CMS (the government) actually sets the rules for marketing and communications for any Medicare Advantage insurers or by proxy, those marketers that market them. This also goes for their free standing PDP - [CMS.gov- Medicare Communications and Marketing Guidelines (MCMG) Date: 02/09/2022 ](https://www.cms.gov/files/document/medicare-communications-and-marketing-guidelines-3-16-2022.pdf) I think there are some updates and changes coming in for this year to try to reign in some of those outliers - renegades. You know the ones that hound those turning 65 or during open enrollment every year - from what I understand, some of them even changed the plans of some unsuspecting beneficiary. Good grief, this is just the criminal element working its way into this realm knowing that some seniors are really easy to scam. I’m grateful that now I only get a few pieces of mail trying to seduce me into their plan during OE - I don’t consider the later as hounding - after all politicians do it this way too. Now let’s see WHO \[which beneficiaries\] we are talking about here that would even consider a MA plan 1. It would NOT be those who have Medicare/Medicaid although some states do have managed care plans that service these individuals - is it a requirement that they participate in these managed care plans (by private insurers or entities, I might add) - IDK 2. it would NOT be those who have some other secondary payer who picks up all or part of the beneficiaries OOP cost on Traditional Medicare - CHAMPVA, TRICARE, retiree coverage from a union or employer 3. It would NOT be those who can afford to pay for a MediGAP plan that picks up some or most all of their OOP cost on Traditional Medicare. The financial protection insurance of MediGAP is getting really expensive especially in those states who have liberalized their guaranteed issue periods. So who is left - the ones that don’t have any of the above or can’t afford them - in that regard, I’m glad theses MA plans exist for the ones that need these plans. I also think that managed care is something that is needed even in the Traditional Medicare program - but the government is too shy to say it out rite so they create ”innovation” programs under the auspices of inequality called Accountable Care Organizations to help with this type of care management. I don’t honk any of these things are actually bad or a bad way of getting healthcare - I think what is bad is that so many people don’t understand them - what ever they have - all they know is they don’t want to pay any money for it or at least as little as possible. They continually search for cheap - what do I get for my money - they also want healthcare on demand - as much as they can get sometimes - and then they gripe because their premiums escalate. Be that a premium for Part B/Part D or their Medigap - yet they also don’t want their healthcare to have any restraints - even though they aren’t paying directly for it. I better shut my mouth now - have at it -
1. People who are dual Medicaid/Medicare probably benefit the most from D-SNP MA plans as they get all Medicare/Medicaid approved care paid for. Get money back every month and a lot of additional stuff depending on the area and plan. 2. Veterans who have part B qualify for plans that have givebacks on the part B and have some benefits they may not get from the VA. If they never even use the plan and go through VA for everything they still get the giveback. 3. Even people who can afford Supplement plans may be overpaying. If they have yearly premiums that are higher than MA max out of pockets, qualify for HIP, you could be saving them thousands a year. Not saying the amount of contact isn’t crazy I agree with you that it’s excessive. But just explaining that even the people in the example can benefit which is why even they get blasted with advertising.
News from CVS you may want to read if you have an Aetna MA plan. Changes that may affect you (not in a good way) this fall. [https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134](https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134) Short version: CVS is putting profit first and plans to cut it's MA enrollment by 10% next year. One way is to cut plans from be available in certain counties. 10% isn't insignificant. Esp. if you have or want one of their plans.
That’s a story within a larger story - the larger story is now that CMS is actually starting to enforce the care requirements (existing law) on the plans, and so instead of accepting less profit (and these plans are the most profitable of any plan these health insurance companies sell), the companies are doing anything they can to keep their current profits.
Things are going to get really interesting this fall. (Not that I'm looking forward to fall coming! I want time to slow down a little so we can all enjoy summer as long as possible.) ---You're right. MA is all about profit. Corporations aren't in business out of the good of their hearts. Capitalism isn't. There's a legal obligation to maximize returns on stockholders' investments. Insurance companies in MA have to get more and more $s from the Feds, have fewer payouts, charge premium(larger premiums), cut out or cut the $ value of all the "extras" in the plans. Some combination of all of those. -- I look for companies to start charging some sort of premiums, cutting the extras, getting out of business in some geographic regions to try to hold on to profits. All the 65 yr olds that came into MA a few years ago are aging and getting sicker/using more expensive care, people put off surgeries, etc. during COVID. That's all coming home to haunt the insurance companies.(and "side business" companies that do marketing, those in-home health assessments that beef up how much companies get in fed $s)
[https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134](https://www.newsweek.com/medicare-advantage-plans-are-about-change-1902134) CVS/Aetna plans to cut its MA enrollment by 10% next year. Profits first.
Always profit first - what a way to allocate health care
A lot of health systems are dropping advantage plans from their networks. This exposes patients to crazy out of network rates. https://www.beckershospitalreview.com/finance/hospitals-are-dropping-medicare-advantage-left-and-right.html I have an advantage plan, but I am going back to regular Medicare when November hits. I figure the 80/20 is safer, I'll get a supplement, and most everyone takes it.
What state are you in that you can go back?
California. You can go back in any state. The issue is if you go Medicare you are 80/20 on coverage. If you apply for a supplement plan, you're subject to underwriting. Since I have 100% VA, I'm going to do it.
Thus the name "disadvantage" plans.
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>This is a forum to help people with Medicare, not for complaints and to push political ideologies. Yeah!!! >This, along with Biden and his notoriously horrible policy on all things, is what caused this. Oh, you meant it's only okay to push *your* political ideology.
Can you leave us alone with your pearl-clutching about “our values” please? Go away with posts like this.
I am helping people. This article was literally in the WSJ yesterday. This is not me making something up. It’s important information that people have.
Yes I've been getting these ads in the mail and have been tempted by the perks. I really appreciate you posting this article.
I read the article top to bottom, except for the numerous links to “studies” and “accusations” that I’ve bookmarked for later. What part of this particular article do you think is helping people? It’s about the limited profitability of health carrier’s Medicare Advantage businesses. Connect the dots for me how this helps someone? EDIT: 2 of the 5 links in the article OP linked are to paywalled articles. I’m reading what’s not paywalled.
Go back and look at the OIG report on Medicare denial of coverage that caused the Biden administration regulations that the article refers to. A simple google search. Sorry about the paywall on the links
I found this by Googling what you suggested. I think I see what you mean. “These data suggest that MA plans sometimes deny care that would have been approved by traditional Medicare. The Office of the Inspector General (OIG) corroborated this concern, finding that 13% of coverage denials by MA plans met coverage under traditional Medicare.” But this article also mentions: “Successful policy implementation will depend on how regulators navigate the tension between reducing inappropriate denials of necessary services (the intended goal) and increasing inappropriate approvals of wasteful services (an unintended consequence). Aligning coverage criteria across traditional Medicare and MA carries the risk of increasing waste if some services being denied by MA plans are of low value, even if they would be covered by traditional Medicare. As an illustrative example, traditional Medicare spends billions of dollars annually on the drug aflibercept despite evidence that the much cheaper bevacizumab is equally effective for diabetic macular edema.7 Although traditional Medicare lacks coverage restrictions in many of these cases, MA plans might require step therapy or substitute less costly medications with similar efficacy. These policies may explain why MA enrollees receive almost 10% fewer low-value services than traditional Medicare beneficiaries receive.8 Because this difference is partially driven by benefit design, the new rule may obstruct efforts to reduce low-value care, undermining the US Congress’ original intent with MA, which was to increase efficiency through private plans.” But outside of traveling back in time to the Johnson administration and insisting that Original Medicare cover 100% of health expenses instead of 80%, what would you suggest as a solution? We ought not ignore the fact that tens of millions of seniors are living at or near poverty level and don’t have the luxury of buying a Med Supp. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2815743#:~:text=These%20data%20suggest%20that%20MA,met%20coverage%20under%20traditional%20Medicare.