MAHA
Look, if they were serious about making America healthy, here is a short list of things Congress and the Administration can do:
• restore and expand Medicaid benefits;
• restore and expand SNAP;
• eliminate the Medicare Advantage plans;
• support and expand childhood vaccinations;
• replace our current nightmare of private insurance with single-payer, like all the other industrialized nations on the planet;
• stop vilifying artificial fluoridation of water.
Eliminating food dyes and replacing high fructose corn syrup with cane sugar are mostly just fake news gimmicks. Meaningful improvement in public health costs money.
Real sugar in soda isn’t public health
Agreed–
* Tax sweetened, salty and fatty snacks and drinks and use the proceeds to increase food stamp funding.
* Tax advertising on unhealthy snacks and drug advertising and use the proceeds to lower drug costs.
* Restore home economics, particularly home meal preparation, to high school curricula as an alternative to fast food.
That would eliminate too many profit making opportunities and scams; unAmerican!
Do not try to take away my Kaiser MA plan.
@Dave,
This Kaiser MA plan?
Potential Overpayments and Risk Adjustment:
• The Justice Department has investigated Kaiser Permanente for allegedly inflating risk scores in their Medicare Advantage plans, which can lead to higher payments from the government.
• One lawsuit alleges that Kaiser providers submitted inaccurate diagnosis codes, representing active treatment for cancer when the patient’s condition was resolved, cured, or irrelevant. This practice could result in overpayments to Kaiser Permanente.
Access to Care Concerns:
• Some studies indicate that Medicare Advantage enrollees, including those in Kaiser plans, may have less access to certain types of care compared to traditional Medicare.
• One study found that MA patients undergoing complex cancer surgery had higher short-term mortality rates and less access to experienced hospitals.
• Kaiser Permanente’s predominantly HMO-based network can restrict access to out-of-network providers, potentially limiting patient choice.
•For individuals with complex or chronic conditions, the limitations of Kaiser’s integrated network might pose challenges, especially if they require specialized care outside of Kaiser’s providers.
• While Kaiser’s Medicare Advantage plans in some areas offer out-of-network coverage, it can be limited and costly.
Other Criticisms:
• Some reports suggest that Kaiser’s plans may have higher maximum out-of-pocket costs than other plans.
• Kaiser’s Medicare Advantage plans have received below-average overall star ratings from the CMS in some areas.
Personal Experience:
We do not use Medicare Advantage. We do carry Plan N Medicare Supplemental Insurance. We were with United Healthcare and recently changed to Cigna. Why?
This year United Healthcare took a sizeable jump from $185 to $228/month (~ 23% increase) for my wife. Little bit greater percentage for me. $185 was expensive enough and I decided to test the market.
Looked up on the list of companies advising on Supplemental insurance, etc. and covering Plan N and Plan G Medicare insurance. Chose United Medical Advisors and one other firm. Asked for the latest rates. Did the healthcare review for each of us.
We went from the new United Healthcare rate of $228 (UH) to ~95.00 /month with Cigna. An ~ 58% decrease for at least one year. There will probably be an increase next year.
The size and the amount will cause us to decide. Previously with United Healthcare, the increases were much smaller over the years so I did not care. This increase caught my eye.
Medicare Advantage is a rip off (period). Healthcare Insurance is a rip off (period). Regular Healthcare Supplemental Insurance is also a rip off (period). You still have a large swath of freedom with Supplemental healthcare insurance as compared to Medicare Advantage healthcare insurance. The costs for it will be less for that insurance alone.
You will not have health clubs or other amenities. You will have a degree of freedom not found in Advantage plans. Understand what you are getting into before you leap and check it yearly. For Jan, that is and ~$1500 savings yearly (true savings + plus cost avoidance).
Forget the Advantage plans.
I didn’t think people were allowed to discard their Medicare Advantages plan. You can switch Advantage Plans but not back to basic Medicare, except for when the MA plan is discontinued by the insurer.
My wife and I have a Medicare F high deductible Supplemental Plan. It costs $155 per month for the two of us combined. That’s at least a couple hundred dollars per person per month less than the zero deductible plan. While it is no longer available, we were grandfathered in. The N and G Plans replaced it and are not as good. The downside of the F Plan is that you have to pay copays. According to my calculations, you come out ahead until the monthly premiums plus copays equal the deductible. It turns out that Medicare covers so much that the premiums plus copays never reached that level, even though my wife needs a lot of medical care, some of it for quite serious conditions.
@John,
From what I see, you can switch from MA to classic Medicare.
https://www.kff.org/faqs/medicare-open-enrollment-faqs/how-can-i-switch-from-medicare-advantage-to-traditional-medicare-is-there-a-form-i-need-to-fill-out/
Switching from Medicare Advantage to Original Medicare may be problematic outside of 12 months.
Switching back to Original Medicare from a Medicare Advantage plan can indeed present challenges when it comes to obtaining a Medigap (supplemental) policy. Specifically, you may lose guaranteed-issue rights, potentially facing higher premiums or even denial of coverage due to pre-existing health conditions if you switch outside of specific enrollment periods.
Here’s a more detailed explanation:
1. Guaranteed-Issue Rights:
2. Medical Underwriting:
3. Timing is Crucial:
If you’re switching from a Medicare Advantage plan to Original Medicare for the first time, you may have a trial period (usually 12 months) to switch back to your previous Medigap policy if the same company still offers it.
C &P and I am not going to fix it as everything is jumbled together/
A Bit more detail on MA Plans”
Unlike Original Medicare (Parts A and B), which generally allows you to see any doctor or hospital that accepts Medicare nationwide, MA plans typically operate with network restrictions.
Here’s why and how this can happen:
Before choosing a Medicare Advantage plan, it is important to carefully review the plan’s network, understand its rules regarding referrals and prior authorization, and confirm that your preferred doctors and hospitals are included in the plan’s network.
Also MA plans are more expensive
I recently met a fellow who had sold Medicare Advantage plans for many years. He asked what plan I had. I said basic Medicare. He said I did the right thing…
John:
Absolutely you did. Angry Bear has been talking about the disadvantages of Medicare Advantage for years. Maggie Mahar was the person who led the charge. Unfortunately, she left. Kip Sullivan was here also. I talked to the issues too. MA plans fleece the patients.