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Not that this is a great surprise but a sad state affairs for those who are enticed by the “low” premiums with added benefits but feel eventually trapped by MA when they need it the most. For the folks in NY (in this article) who are lucky enough to be able to switch from MA to Original Medicare. I can’t imagine for those in states where they can’t switch and are truly trapped.
We are waiting to hear how the insurance companies and state insurance regulators interpret the Section 1557 of the Inflation Reduction Act legislation that goes in to effect in 2025 that could put the kabash on medicare supplement underwriting all together.This would be good for some people but it will make it more expensive for most.
I was able to read the article. I noticed most of the examples given were in states where people can switch plans more easily. Many states people who want to go back to traditional Medicare from a MA plan have to undergo underwriting for the gap part . And guessing the sickest would not be able to pass. Chris
You are referring to Medigap supplemental policies not Medicare. States don’t regulate Medicare.
I believe there are only four states where you can switch without underwriting. My state is not one of them, and I fail underwriting because of rheumatoid arthritis.
Our relative with the ALS is starting to navigate long term disability now that his FMLA is almost over. He and his wife are choosing COBRA for now, but it is $1100/mo for both of them. I am guessing at some point he will go on Medicare, but not sure how that would work? He is 60. Chris
Medicare Advantage plans exist only because to the political philosophy that private enterprise operates more efficiently than government bureaucracy. But the reality is that companies that receive payments from the government are only extraordinarily capable of gaming the system.
Want to save the U.S. taxpayer some change? Medicare Advantage plans overcharge the system by an average of $1,000 per enrollee due to “up coding” and other practices. There are about 34 million Medicare Advantage enrollees. That’s $34 billion in extra cost. Medicare Advantage cost per enrollee is about 6% higher than traditional Medicare. Since the only reason to have Medicare Advantage was to reduce the cost of Medicare, there is no reason to ever pay more for it. Solution: Cap the average per enrollee payment to the Medicare Advantage plans to no more than the per enrollee cost of traditional Medicare. Prediction: a lot of unemployed Medicare Advantage plan executives.
True, but also 34 million very unhappy seniors who don’t care how they get “free” coverage and extra benefits. Medicare Advantage was a product of insurance company lobbying and politicians who want Medicare to be privatized.
Stand by, there is a move underway to make MA the default for Medicare enrollment.
agree with you 100% on the “MA being a product of lobbying and folks wanting to privatize”.
re making MA the default, I am afraid of this too based on how the political winds are blowing.
The Medicare advantage policy is just like my work health insurance which worked well for 45 years. I remained with the same company in my Medicare Advantage coverage and still have the same doctors and hospitals as when I worked. Each person has different needs and we don’t all want to be subjected to one plan.
Yes, it works until it doesn’t when you may want to see a certain specialist or be treated at Cleveland Clinic or Sloan, etc. with basic Medicare you can go anywhere at any time with no pre-approval required.
But the real collective issue for all is they are overpaid by Medicare thus shifting our tax dollars to profit for insurers.
Put them on an equal playing field and then let them compete. In theory, their management of care should save them money, in theory.
It sounds like the government control of expenses is the problem as they determine the rules under which Medicare Advantage operates.
I agree with you that some folks might be happy with MA (and yes they are similar to the workplace but remember during our working year we are/were all a lot younger and hence likely in less of a need for medical care). There is no universal one-size-fits-all. I am glad it is working for you. But if you ever find it not working, you’re kind of stuck (unless you’re lucky enough to be living in one of 4-5 states that allow you to switch to original and get Medigap without underwriting).
BUT I disagree with you re “govt control of expenses is the problem”. I think (and this is backed by data) the problem is the need for the insurance companies to generate increasing quarterly profits and they do whatever it takes (from denying service to over charging the government). Like Dick said earlier, MA works really well until you really need it. Again just look at the empirical data and many articles written on this.
Dick, I believe what you said in your last paragraph. We are new Medicare enrollees this year and when I was doing research on the Medicare dot gov site and went to the different company web sites to compare offerings, almost all of them automatically took me to their MA page first. Ended up going with a broker to be sure we got what we wanted. Chris
Also told Spouse at open enrollment this year to not answer any texts or calls, even from our parts D and G providers. I did all the research and we didn’t need to change anything. They are sneaky. Chris
A great place for the govt to make changes and reduce the potl problems on the horizon!
Nothing that we do in healthcare seems to improve things. Everything seems just to improve the bottom lines of the leaches in the healthcare industry.
Well, that’s not fair or accurate. However, you’re right that nothing we have done has worked – based on how we define that.
I started managing health benefits in the 1970s and over the years tried every new and old idea to manage costs, I was on boards organizing HMOs, tried to leverage the value of outpatient care, promoted second opinions and gave employees choice including FSAs and HSAs.
Healthcare is not like buying any other service, it doesn’t respond to competition or supply and demand the same. Increase the supply and the demand goes up because to a large extent suppliers control demand. It’s as if a car maker sold the car and then told you how many miles to drive and what fuel to use.
Choice among the population be it a large employer or a state is not a good idea because people naturally decide what they perceive is in their best interest. Americans want the most and best health care someone else’s money will buy. They oppose any restrictions or limits.
Health care is expensive for many reasons and it’s not the fault of health insurance – except it insulates us from costs. Large employers covering millions of Americans don’t even use insurance, they are self – insured and the insurance company pays claims and has no stake in the cost of those claims.
We allow direct to patient Rx advertising which only one other country does. It works it creates demand.
The US population health status (obesity, etc) is a factor, our demand for convenience and the “best” and latest technology is a factor. More equipment has to be used so more scans and MRIs are ordered.
Physicians themselves estimate that up to 25% of all care provided is unnecessary, but the risk of being sued makes providing more necessary.
The way we pay for medical training is a factor. Our tendency to get to a specialist for care as soon as possible is a factor as is our demand for the latest technology.
Cost shifting from Medicaid and Medicare to employer and private plans creates an unfair playing field. The uninsured are a factor.
At this point there is only one option that will assure universal coverage, fair distribution of costs across the population and to the extent we actually want it, management of costs and that is a form of Medicare for every resident. Everyone in the same pool, risk and cost sharing based on ability to pay and funded by a combination of dedicated taxes, premiums and cost sharing at the point of service.
No, it’s not socialized medicine and no, it will not bankrupt us because the costs are already there in one way or another. Yes, to manage costs there must be better oversight for abuse, unnecessary care and fraud, better than what Medicare does now.
And by the way, patients are participants is much of the fraud and abuse that exists. Ever know a senior who goes to a podiatrist to have their toenails cut? Much, if not most of that, is fraud.
I am not sure why, but the staff at the specialty hospital our family member with the ALS is a patient, are not supposed to clip his nails? The only thing I can think of is that they are not licensed nail technicians for their state? Who knows? Chris
The conditions eligible for toenail clipping are spelled out in Medicare coverage. Don’t know about your situation. Isn’t the real question, why would they charge separately to do so for a confined patient?
Advantage plans may be cheaper, but once you get sick you will pay the price for that. Plus, we like to choose our own doctors and not have to beg for approval before a procedure. I’m very happy that we have Traditional Medicare with our F supplements (no longer offered – G is best now).
That article appears to be behind a pay wall. However, I am with Original Medicare and Medigap precisely because I didn’t trust an Advantage plan to provide the care I needed and wanted if I really got sick.
My agent won’t even sell MA plans
Medicare Advantage should not exist. Several studies and ongoing investigations show Medicare spends more paying them than traditional Medicare and are simply overpaying.
Look at it logically. How can such plans provide extra benefits, charge no premium in some cases, cover all Medicare services and still make a profit?
Here is a good read on the problems.
They either are paid too much or manage care to the point of limiting services covered or both. And they sometimes use internal deductibles. The extra services they provide are very limited mostly to preventive services. Many people like them – until they can’t get a referral or where they want to go for services is not in the network.