Forcing People Out of Traditional Medicare and into Medicare Advantage.
This was always the plan? The plan did not include forcing people out of traditional Medicare and into Medicare Advantage.
No mistake on the date on this Copied and Pasted Angry Bear post from almost two years ago. Nancy Alt, Andrew Sprung, and Angry Bear were sounding the alarm in 2019 about trump’s move to privatize Medicare using Medicare Advantage plans and by placing traditional Medicare users into these commercial insurance plans.
Without using tax funds to back Medicare Advantage, there is no way Medicare Advantage can compete with traditional Medicare. Oh wait there are some ways and that is to make up the differences by cutting back on the care and service to users and increasing fees for that service to those who are in need of the care (which it does now). Many people who have gone to Medicare Advantage plans come back to traditional Medicare. Typically, they have to go through an examination to secure the MediGap Insurance again. Medigap covers the 20% gap in Part B as well as the ~$1450 Part A deductible and other things too. The comeback s occurs because of care costs and reduced care in Medicare Advantage.
Mind you, there is waste in Medicare. Former Medicare Director Dr. Donald Berwick stated it may be as much as 30% in the treatment of Medicare participants and doctors know it. Even at that percentage, commercial healthcare insurance is more expensive. Just to start, 15-20% of commercial healthcare insurance cost-waste is solely in the processing of insurance claims.
Most recently, plans were released detailing the placement of traditional Medicare participants into Medicare Advantage plans with no exceptions. This will occur in and around selected metropolitan areas. Plans to do so were started by trump and his CMS administrators and are now being touted as being Joe Biden’s plan. It is not and there is evidence the president has put a hold on this going forward. Which makes sense as this action is a huge give away to commercial interests and the healthcare insurance industry.
Some people (when you question them) will tell you the costs and/or prices of Medicare and MediGap insurance is private information for an individual. This is readily available and public information. You can look up MediGap prices for the multiple plans (N, etc.) being offered. You can also find pricing for Part D (pharma) plans. Your monthly payment for Medicare is public domain also which can be deducted automatically from SS or you can pay it yourself. I will be posting on Medicare and what is going on in greater detail later.
In the short of it, I find all the noise being toos up to cloud the issue made as being deliberately deceptive or the result of a lack of knowledge.
Trump’s Executive Order, Backdoor Privatization of Medicare – Updated
run75441 | October 3, 2019 8:52 pm
HEALTHCARE HOT TOPICS POLITICS
“Trump’s Executive Order is Backdoor Privatization of Medicare,” Social Security Works, Nancy Altman, October 3, 2019
Thursday and I had to search around for someone who is an expert on Medicare Advantage Plans and Original Medicare. Nancy is one of those experts. Friday and Andrew Sprung has his commentary Trump’s Bid To Destroy Medicare up on xpostfactoid blog.
Commercial Healthcare Insurance has been become more and more expensive over the years with copays increasing, deductibles increasing, and premiums going up. Todays commercial healthcare insurance costs a single person ~$7200 and a family ~$20,000 with the single person paying 18% of the premium and a family paying 31% of the premium. Approximately 36 million people make less than $25,000 annually (retail workers, personal care attendants, warehouse workers and others as well). In a crude calculation, xpostfactoid: “The past ten years of healthcare cost increase relative to wage increase might cost a full-time average wage earner with family coverage $3,000-$4,000 this year in added costs and decreased wages, or, say, 6-8% of income.”
Today’s Employer sponsored Healthcare Insurance is unsustainable. The same holds true for Medicare Advantage plans due to the Commercial healthcare Insurance offering it as well. There are few controls which can be applied on the commercial side of the healthcare industry which is why there is a big push for true single payer healthcare of which Medicare and Medicaid are. If you wish more detail on how commercial healthcare insurance has exploded in cost, my earlier post Health Benefits for 2019: Premiums Inch Higher, Employers Respond To Federal Policy offers more detail pictorially and in verbiage.
As I have written other times, Medicare and Medicaid have been instrumental in reducing excessive U.S. healthcare costs. Medicare and Medicaid set the prices paid to providers with provider input and commercial healthcare insurance uses those prices to set their payouts. Medicare hospital rates are an approximate half of those paid on average by commercial healthcare insurance. Rates paid to physicians average about 78% of commercial insurance rates. In high-demand specialties and in regions with fewer providers; commercial healthcare insurers often pay four, five and six times Medicare rates. If you remember from Kocher and Berwick’s article, they proposed setting commercial Healthcare (while it still exited in the interim) payouts at 120% of Medicare rates.
This action by Trump and Republicans is a huge giveaway to the commercial healthcare insurance sector and the healthcare industry. Right now Medicare Advantage uses Medicare rates. If they can beat Medicare Rates, they keep the difference. If they can not meet the rates, the consumer pays the difference. What Trump has done is reverse the format. Medicare Advantage Negotiated Rates will be used to set Medicare Fee For Service rates to providers.
Past the leap is the President of Social “Security Works” Nancy Altman’s statement on Trump’s Executive Order talking about Trump’s lies.
(Washington, DC) — The following is a statement from Nancy Altman, President of Social Security Works, on the Medicare executive order Donald Trump is signed today:
“Medicare Advantage is a hustle designed to allow for-profit corporations to suck up public dollars. For years, Republicans have shoveled money into Medicare Advantage plans and allowed them to offer benefits that traditional Medicare is forbidden from covering. This is a ploy to push seniors into Medicare Advantage plans instead of traditional Medicare. Medicare Advantage is stealth privatization intended to undermine traditional Medicare, which is an effective, popular government program and therefore loathed by Republican ideologues.
Under the Trump Administration, the thumb on the scale has turned into an entire arm. They’ve been flooding seniors’ inboxes with advertisements for Medicare Advantage. What these emails don’t mention is that Medicare Advantage plans often have narrow networks, restricting which doctors and hospitals patients are allowed to use. Worse, a recent government report found tt Medicare Advantage plans improperly deny care “in an attempt to increase their profits.” It’s no surprise that older, seniors are more likely to drop Medicare Advantage plans.
Medicare Advantage plans are also a terrible waste of public dollars. They have overcharged Medicare by $30 billion in the past three years alone.
Today’s executive order is yet another giveaway to the corporations that run Medicare Advantage plans. Ironically, the Trump Administration is framing the executive order as an attack on Medicare for All. In fact, the massive flaws of Medicare Advantage epitomize the need to get for-profit greed out of health care by improving Medicare and expanding it to cover all Americans.
Medicare, like Social Security, works. Republicans want to privatize both of them. We have to stop them and instead, expand both.”
The data is out there. I have brought much of it here to Angry Bear. Andrew Sprung at Xpostfactoid is an expert as well as others. If you have a question ask. If I can not answer it, I can find out.
Run75441 (Bill H)
Must strongly disagree with this post. With traditional Medicare, there is no out-of-pocket limit and you have to buy a (not cheap) private Medigap or Supplement plan to get one — and it’s usually several thousands of dollars annually. That is by far the single most important element of any health insurance plan. “No out-of-pocket limit? Sorry, but you are going to have to pay for that $1.5 million cancer treatment — if you want to live, that is.” You also need to buy a private Part D plan if you want drug coverage. Most MA plans cover these as part of a single plan, and most plans being purchased are for zero premiums. The majority also cover eye, hearing and dental care as well.
So seniors are being “forced” into these plans? Well, they have been growing rapidly every year for 17 years, and now account for almost half of all Medicare coverage. Could it possibly be because these benefits are wrapped into a single plan? Should I care if insurance companies have learned how to make a profit on administering Medicare and give me more benefits for less cost than the combination of traditional Medicare, plus a supplemental policy and a Part D plan? Recall that Obamacare made a huge reduction in the premium that could be charged for the administrative function. Why shouldn’t we say, more power to them, sometimes capitalism works — especially when it is well regulated by government to keep them in line, as these plans seem to be?
And yes, they do pay what Medicare requires them to pay. I have had a group negotiated policy for many years with a $300 deductible and a $1000 annual out-of-pocket maximum (top that, anyone!) from UHC, the progressives’ supposedly worst nightmare of an insurance company. They have been fine. If they make a mistake — maybe once in about 10 years — they fix it. If you think it might be a mistake but it isn’t, they explain it. 99.999% of the time they pay it at the correct Medicare rate.
For actual facts, see:
https://www.kff.org/medicare/issue-brief/a-dozen-facts-about-medicare-advantage-in-2020/
Urban…Most plans medex or medigap that I am familiar with do not cost thousands per year, more like a thousand or so. Do you have a link that provides stats? Also, the process of pre-approval of tests is much less, particular procedures can be quite problematic and out of network medical help quite expensive
Well Urban:
Been busy writing more on healthcare, Medicare, and the issues with Medicare Advantage.
I asked a simple question of one writer at a different site about the cost of Medicare. A simple question which the writer and the blog owner could not answer. Instead, I was the recipient of an uncalled diatribe from the blog owner.
My knowledge on healthcare is recognized and this person knows it is substantial. Instead, the writer’s alter ego launched a series of non sequiturs rather than answer my question which was related to the topic. It is probable, neither knew the answer.
To your point(s) on MA. It is commercial insurance which is the wrong direction to be taking, taking with Medicare, and taking to improve the provision of healthcare to all. It is another commercial ripoff.
The same org. uses this information (you provided) to “hawk” their MA plan. KFF also writes on the issues with MA to which there are far more greater issues than with traditional Medicare. Medicare pays a premium to MA plans based upon “risk.” Unfortunately when the risk increases for those with pre-existing conditions, MA does not cover the increased risk even though it is compensated for it by Medicare. Instead, it charges subscribers unjustified costs already paid for by Medicare in the form of Co-pays, etc.
Then there is the little issue of overcharging Medicare an approximate $30 billion due to doctors running up the number(s) of supposed patient ailments. These charges have been accumulating over the years. Medicare should demand it back or disqualify the company from selling MA plans.
Medicare is far more efficient in providing care
There is more than just these issues.
By no means is this a justification of MediGap plans. The US needs to go to Single Payer and disavow itself of commercial healthcare insurance, eliminate the additional costs, and improve the care to its citizens by providing equitable healthcare to all.
It still remains there being a plan to “force” people off of traditional Medicare into Medicare Advantage plans.
I am with Kaiser (Denver, Colorado) for Medicare Advantage.
I think it is great.
Have “tested” it with colon cancer surgery and chemo. And, 3 surgeries for perianal abscess.
Mrs Fred & I have been on Medicare Advantage since age 65, because it simplifies matters & includes prescription coverage. Mrs Fred had handled her mother’s regular Medicare coverage for many years and was not happy with it. (At the time I enrolled, I was advised that Advantage plans in some states were not good, but those in Massachusetts were very good. So, I went with that despite warnings from physician friends who warned against. And we’ve stayed with it.)
Fred:
As you age, I hope you will not experience the same issues as what others have who are in MA programs. Medicare is single payer with a commercial policy attached called MediGap. There is also Part D. Medicare will payout each and every time as long as covered with no increase in cost to you. You may incur premium increases on MediGap but will not pay more for the procedure.
Medicare Advantage is commercial insurance and suffers the same cost issues as what is incurred by commercial healthcare plans of a 15-20% cost which yields “no” care and is administrative costs. This is not found in Medicare.
You may (and probably will be) be hit with increased copays, etc. as you age even though MA is paid a premium by Medicare to cover you which is based upon your health risk. Many have had issues with MA which exceeds the numbers having issues with traditional Medicare.
If you do return to Medicare, you may not be able to secure MediGap without a physical exam. In the end, commercial MediGap may exclude coverage for health issues found which they would have to cover if you enrolled shortly after being eligible for Medicare.
Both Dan and I are compromised and have are bills covered for a minimal monthly cost for MediGap and Part D (for me). This is “NOT” an endorsement for commercial healthcare insurance. 100% Single Payer is the way to go which should be akin to what I experience now at more cost.