A better name for the program is Medicare Disadvantage. Costs the government more and the dollars that go to patients is less. Traditional Medicare is more efficient and although not perfect it is more equitable.
Sadly, there IS an oversight committee called MedPAC - they have been raising these concerns and issues (at least in the report I read from 2024). Congress isn't listening.
There is also a reintroduction bill called Medicare for all act right now in both houses of this 119th Congress. The work and research is complete for caring for all by getting profit and waste out of health care. This act cares for us from birth to passage no pun intended.
They need to shut down the Medicare Advantage nonsense completely, and put all the money the insurance industry has been sucking out of the Medicare system back into traditional Medicare. I'm betting we'd have enough money to pay for all us retired folks' healthcare WITHOUT needing any (expensive) Medigap supplements! Anytime the insurance industry (in ANY field) gets involved, all they do is find ways to game the system and increase their profits at our expense.
A bit insane to think Republicans will help healthcare in America. Refer to current republicans 1116 page bill that passed with one vote under Mike Johnson that has displayed certain flags outside his office in OUR national capitol.
Now that more than half of all Medicare beneficiaries are enrolled in a Medicare Advantage (Medicare Part C) plan, they really have no choice but to start cutting MA payments to achieve their spending targets. Patients have a stronger attachment to their doctors than to their insurers — which with very few exceptions are not really "health" plans. The gamble was always that beneficiaries would see their MA plan as providing their medical care—not just the coverage for their medical care. But the reason people enroll in MA plans is that it is cheaper than buying Medicare Supplemental (MediGap) insurance. It is MediGap premiums that have driven beneficiaries into MA.
Hi. I wish there was such strong commitment to patient’s doctors. I was awakened when I was in practice, when this started accelerating years ago, patients would change offices to follow a $10 less expensive insurance with a different set of clinicians. Or their employer would change plans. Now there is such turnover in office staff that keeping the same clinician is a true prize, and encouraged.
Of course Medigap is underwritten by the same insurers that give us Advantage. What better way to attract to a no premium plan with “extras” then to raise Medigap costs.
The blame for all this is an unregulated system bribing our law makers. It is the sudden massive surge of patient dissatisfaction stirred to the forefront by the killing of a UHC executive that has awakened some in Congress to act, to save their own butts. Let the showdown begin!
And again I am in total support of a universal healthcare one payer program, like all other advanced countries in the world provide.
Hi there! Good comments. My mom was a nurse and have family members who are physicians and physician assistants. I've worked for hospitals, insurers, and the federal government (50+ years).
Part of the problem with MediGap is that it is caught in a selection spiral: younger and healthier beneficiaries have generally elected to enroll in MA leaving MA with older and more expensive members. (Plus, no argument from me, that MA was/is unfairly subsidized.)
Another part of the problem has been the corporatization of medical practice into behemoth "health care systems" (I use the term loosely) that all-too-often operate with a too-strong profit motive which weakens the attachment between doctors and patients.
The sad thing is that what needs to be done isn't really all that complicated, but neither will it be universally popular. Hence the absence of consensus. I completely support universal coverage—but I'm not sure what that would look like as way medical care is organized, financed, and delivered is a reflection of the way the economy generally operates.
You are correct about MA ditching the more complicated patients. Of course the problem is switching to Traditional Medicare from Advantage with an underwriting process for the 20% Medigap coverage.
I have had Traditional Medicare for 23 years now. It is fantastic coverage for the most part. It takes a little work each year figuring out best Medigap and Part D meds coverage, but I consider that minor compared to the massive denial system of MA.
I joined a medical practice maybe ten years ago and was told I would not be accepted unless I changed coverage to MA. I refused and only through some back room pressure was I let in. So as you probably understand the large practices are in cahoots in the ripoffs, with pressure to over code and bonuses for proper behavior. It isn’t just insurers that have corrupted this system. Unfortunately.
The first visit was supposedly a Medicare Annual assessment. So against my written check box against a preventative physical (which is not covered by TM but is by MA), my 45 minute visit was upwards of $650 charge: a charge for an initial Medicare Annual assessment, a charge for a physical exam, and a complicated office visit because we discussed a few of my chronic medical issues. Then I got privately billed for the physical exam not covered. When I objected, it was written off. And the in-house lab tests showed uncoupling to charge for each individual test in a panel.
Reminiscing on my early days in practice, an OV was $15 and a physical exam (1 hour) was $65! It is so much more complicated now.
This company denies a majority of their inpatient hospital admissions . How do I know , well cause when your sitting in a chair up to 10 or more hours a day doing chart review, and you are sending the majority of not all to medical director review not because they don’t meet for inpatient level of care payment but because their is a 124 diagnosis escalation list. They are smart . You cannot say I am escalating this because it’s on a list you have to put Level of care Met but it also meets observation level of care. Well that is ridiculous. If it meets inpatient it does not meet their hospital policy guidelines. It’s the way the escalation is hidden from agencies and the general public. That list just got increased hence codeword for we need to make more money. It is reported they pay 98% of their claims. Course they do. You get admitted with a hospital admit and they whittle down that claim to mere peanuts with the member and the provider eating that claim and they did pay something on it. But no one asks how much of that claim was paid. Who was responsible for the amount that wasn’t paid. The industry is asking the wrong question s. That’s why they asked the security and exchange to block the request from their own investors on their utilization review activities . That would have been the nail in their coffin.’
I just want to laugh AND cry here. The Republicans have always hated Medicare and looked for ways to eliminate it.
And they have always favored making money and supporting those who do that over any responsibility to their own constituents. So now they are beginning to be concerned about the vast profits and poor care in the huge health care management corporations?
Please tell the readers that Medicare Advantage operates off the same SECRET Provider Contracts that all of private health insurance uses. So we can't go after one without going after both. And Government can't interfere in a private contract. So the issue is the contractual structure of private insurance, i.e., contract law 101
Medicare Advantage is simply Private Insurance turned loose on the elderly.
Let’s see if Republicans are really serious about reining in Medicare Advantage. Sadly too many U.S. Senators have their elections supported by these big insurance firms and it is hard for them not to be corrupted by the insurance company lobbies, and individual firms. Furthermore, too many politicians believe the unproven assertion that competition improves both healthcare and costs. That is a bold-faced lie to the American taxpayers, and we The People know it. Healthcare is a social service not something to exploit patients and the Medicare Trust Fund. I have yet to see our politicians in Washington, D.C. do anything but piecemeal and ineffective measures while allowing costs to rise. When are politicians going to demonstrate integrity and stop kicking the can down the road???
I have my concerns with all of it. As an RN our healthcare systems are full of gaps and wounds. We don’t focus on prevention at all. They complain it’s costing too much and we have volumes of evidence of what works. But they chose secondary and tertiary delivery over preventative care. Insurance companies waste MDs time with denying
A better name for the program is Medicare Disadvantage. Costs the government more and the dollars that go to patients is less. Traditional Medicare is more efficient and although not perfect it is more equitable.
Well, I guess a lesson to be learned is innovation without oversight can lead to abuse. Something to keep in mind as we keep "fixing " things.
Sadly, there IS an oversight committee called MedPAC - they have been raising these concerns and issues (at least in the report I read from 2024). Congress isn't listening.
There is also a reintroduction bill called Medicare for all act right now in both houses of this 119th Congress. The work and research is complete for caring for all by getting profit and waste out of health care. This act cares for us from birth to passage no pun intended.
They need to shut down the Medicare Advantage nonsense completely, and put all the money the insurance industry has been sucking out of the Medicare system back into traditional Medicare. I'm betting we'd have enough money to pay for all us retired folks' healthcare WITHOUT needing any (expensive) Medigap supplements! Anytime the insurance industry (in ANY field) gets involved, all they do is find ways to game the system and increase their profits at our expense.
A bit insane to think Republicans will help healthcare in America. Refer to current republicans 1116 page bill that passed with one vote under Mike Johnson that has displayed certain flags outside his office in OUR national capitol.
Now that more than half of all Medicare beneficiaries are enrolled in a Medicare Advantage (Medicare Part C) plan, they really have no choice but to start cutting MA payments to achieve their spending targets. Patients have a stronger attachment to their doctors than to their insurers — which with very few exceptions are not really "health" plans. The gamble was always that beneficiaries would see their MA plan as providing their medical care—not just the coverage for their medical care. But the reason people enroll in MA plans is that it is cheaper than buying Medicare Supplemental (MediGap) insurance. It is MediGap premiums that have driven beneficiaries into MA.
Hi. I wish there was such strong commitment to patient’s doctors. I was awakened when I was in practice, when this started accelerating years ago, patients would change offices to follow a $10 less expensive insurance with a different set of clinicians. Or their employer would change plans. Now there is such turnover in office staff that keeping the same clinician is a true prize, and encouraged.
Of course Medigap is underwritten by the same insurers that give us Advantage. What better way to attract to a no premium plan with “extras” then to raise Medigap costs.
The blame for all this is an unregulated system bribing our law makers. It is the sudden massive surge of patient dissatisfaction stirred to the forefront by the killing of a UHC executive that has awakened some in Congress to act, to save their own butts. Let the showdown begin!
And again I am in total support of a universal healthcare one payer program, like all other advanced countries in the world provide.
Hi there! Good comments. My mom was a nurse and have family members who are physicians and physician assistants. I've worked for hospitals, insurers, and the federal government (50+ years).
Part of the problem with MediGap is that it is caught in a selection spiral: younger and healthier beneficiaries have generally elected to enroll in MA leaving MA with older and more expensive members. (Plus, no argument from me, that MA was/is unfairly subsidized.)
Another part of the problem has been the corporatization of medical practice into behemoth "health care systems" (I use the term loosely) that all-too-often operate with a too-strong profit motive which weakens the attachment between doctors and patients.
The sad thing is that what needs to be done isn't really all that complicated, but neither will it be universally popular. Hence the absence of consensus. I completely support universal coverage—but I'm not sure what that would look like as way medical care is organized, financed, and delivered is a reflection of the way the economy generally operates.
You are correct about MA ditching the more complicated patients. Of course the problem is switching to Traditional Medicare from Advantage with an underwriting process for the 20% Medigap coverage.
I have had Traditional Medicare for 23 years now. It is fantastic coverage for the most part. It takes a little work each year figuring out best Medigap and Part D meds coverage, but I consider that minor compared to the massive denial system of MA.
I joined a medical practice maybe ten years ago and was told I would not be accepted unless I changed coverage to MA. I refused and only through some back room pressure was I let in. So as you probably understand the large practices are in cahoots in the ripoffs, with pressure to over code and bonuses for proper behavior. It isn’t just insurers that have corrupted this system. Unfortunately.
The first visit was supposedly a Medicare Annual assessment. So against my written check box against a preventative physical (which is not covered by TM but is by MA), my 45 minute visit was upwards of $650 charge: a charge for an initial Medicare Annual assessment, a charge for a physical exam, and a complicated office visit because we discussed a few of my chronic medical issues. Then I got privately billed for the physical exam not covered. When I objected, it was written off. And the in-house lab tests showed uncoupling to charge for each individual test in a panel.
Reminiscing on my early days in practice, an OV was $15 and a physical exam (1 hour) was $65! It is so much more complicated now.
Yes and we can get peoples employers and state retirement systems off this merry go round.
This company denies a majority of their inpatient hospital admissions . How do I know , well cause when your sitting in a chair up to 10 or more hours a day doing chart review, and you are sending the majority of not all to medical director review not because they don’t meet for inpatient level of care payment but because their is a 124 diagnosis escalation list. They are smart . You cannot say I am escalating this because it’s on a list you have to put Level of care Met but it also meets observation level of care. Well that is ridiculous. If it meets inpatient it does not meet their hospital policy guidelines. It’s the way the escalation is hidden from agencies and the general public. That list just got increased hence codeword for we need to make more money. It is reported they pay 98% of their claims. Course they do. You get admitted with a hospital admit and they whittle down that claim to mere peanuts with the member and the provider eating that claim and they did pay something on it. But no one asks how much of that claim was paid. Who was responsible for the amount that wasn’t paid. The industry is asking the wrong question s. That’s why they asked the security and exchange to block the request from their own investors on their utilization review activities . That would have been the nail in their coffin.’
I just want to laugh AND cry here. The Republicans have always hated Medicare and looked for ways to eliminate it.
And they have always favored making money and supporting those who do that over any responsibility to their own constituents. So now they are beginning to be concerned about the vast profits and poor care in the huge health care management corporations?
Hah.
My what a shock! 😮
The only thing they seem to care about is more loot 💰 for the shareholders!
The ONLY thing surprising about any of this is that Republicans are pretending to give a damn 🙄
Free groceries, free eye glasses, 👓 free dental care, etc. are included in some Medical Advantage plans.
All these freebies are advertised instead of we may deny medical care and we may make you jump through hoops to receive medical care.
So glad to read this - thank you Wendall for your efforts - this is no small lift - keep up the great work!
Good news Wendell. Thank you for all you do.
Mr. Potter
Please tell the readers that Medicare Advantage operates off the same SECRET Provider Contracts that all of private health insurance uses. So we can't go after one without going after both. And Government can't interfere in a private contract. So the issue is the contractual structure of private insurance, i.e., contract law 101
Medicare Advantage is simply Private Insurance turned loose on the elderly.
Let’s see if Republicans are really serious about reining in Medicare Advantage. Sadly too many U.S. Senators have their elections supported by these big insurance firms and it is hard for them not to be corrupted by the insurance company lobbies, and individual firms. Furthermore, too many politicians believe the unproven assertion that competition improves both healthcare and costs. That is a bold-faced lie to the American taxpayers, and we The People know it. Healthcare is a social service not something to exploit patients and the Medicare Trust Fund. I have yet to see our politicians in Washington, D.C. do anything but piecemeal and ineffective measures while allowing costs to rise. When are politicians going to demonstrate integrity and stop kicking the can down the road???
I have my concerns with all of it. As an RN our healthcare systems are full of gaps and wounds. We don’t focus on prevention at all. They complain it’s costing too much and we have volumes of evidence of what works. But they chose secondary and tertiary delivery over preventative care. Insurance companies waste MDs time with denying
Medicare Advantage is what happens when you “privatize”. Private equity solutions help nobody.
Argh