Not surprising, but definitely disappointing. Another example of the financial market players choosing profits over the well-being of the American taxpayer and senior citizen.
You're doing yeoman's work to highlight the human impact of our corporatized health system. Keep the faith, brother!
Whoever controls the message will control the people.....Ever since Reagan repealed the Fairness Doctrine in the 80's the media, newspapers,cable etc has been controlled by the Oligarch class. Now we even have a President attacking any information he doesn't agree with. Most Americans have no idea how awful our For Profit Healthcare is.
This really is an outrage. Thanks for keeping us informed and out of the dark. Really appreciate your ongoing efforts. I'd love to see this topic in your next video! (Love the videos.)
The hospital that I've worked at for over 39 years quit accepting MA about 2 years ago. One of the problems was with prior authorization in order to transfer patients to a nursing home. These patients were ending up in the hospital days longer than regular Medicare patients and causing some other patients to be transferred out to other hospitals because we were full. We even had to have staff that only worked on MA patients since we had trouble getting paid in a timely manner.
Other hospitals in my state have also quit accepting MA.
Medicare Advantage plans are still gaming the system. A diagnosis of myasthenia gravis that came out of thin air was added to a patient's medical record. In 2025, the company dropped that plan and offered the patient a more expensive one. I told the patient that being dropped was a golden opportunity to change to original Medicare and obtain a supplemental plan, which they did.
On this, it is possible I don't understand exactly what was said.
"MedPAC, the independent congressional agency that advises Congress on Medicare, projects that for 2026, Medicare Advantage payments will run $76 billion — or 14% — above what traditional Medicare would spend on the same beneficiaries, after accounting for health status, coding differences, and geographic factors."
If I understand standard Medicare vs. Medicare Advantage, Medicare Advantage is at least kind of comprehensive, in that out-of-pocket maxes are there. They are not in standard Medicare, and thus, people have to pay an extra 20% that the government doesn't pay for a Medigap, which might be like 20% of the government cost for the standard Medicare.
(What I had understood about costs is that the government actually paid a little more per person for a Medicare Advantage than standard Medicare, maybe 5%, justified by the comprehensiveness not in standard Medicare.)
So, the deal for the consumer getting a Medicare Advantage is that it's usually cheaper for them than a standard Medicare plus Medigap. At the cost, to them, of a lot more prior-authorization problems.
Now, with your $76 billion = 14% number, it sounds like maybe the Medicare Advantages are upcoding so much that the "5% more" that I had thought is really like "14% more".
Thus, my understanding, as best I can get without really researching numbers, is that the article is asserting not that the government paying more for Medicare Advantages is not justified by the MA comprehensiveness vs. standard Medicare, but rather that is paying more more than it thinks. (14% more rather than 5% more.)
I meant that in the sense that the MA's have an out-of-pocket max. (And only that sense.)
Standard Medicare has about a 20% copay uncapped, without an out-of-pocket max. (Which a person normally, if they can afford it, and have not been blocked by a pre-existing condition exclusion, will pick up a medigap (out of their own pocket) in order to remedy. Then, with the medigap, the standard Medicare plus medigap has an out-of-pocket max, which is in fact, quite low.)
My use of "comprehensive" on the Medigap was meant in terms of what the government was paying for. Basically, that the government, even without the studies showing the effects of upcoding, already knew it was paying somewhat more for Medicare Advantage, justifiable based on the part it was paying for having an out-of-pocket max, with the standard Medicare alone that it was paying a little less for not having an out-of-pocket max.
Thank you! I found another tricky thing insurers like MA are doing. I work in a hospital. Physicians are required to estimate length of stays and document that in the initial H and P. This estimate is also posted on a general summary page on EHR. This allows the hospital to plan discharges and prioritize logistics for patient care. This info is not a part of a patient's permanent record but initial H and P is.. However what has happened is insurers are now anchoring their payment to the hospital based on an estimation on length of stay. For example, a patient is estimated to be in the hospital about 4 days. But issues or complications arise and the stay becomes a 10 day stay. The insurer will only pay for 4 based on the initial "estimation" and hospital gets shorted. So now the estimation has been removed, but impacts planning, discharge and patient expectation and need for post hospital care. One can assume what type of insurers are doing this.
Are you sure this article was peer-reviewed? It looks like it was published in a part of Health Affairs, called Health Affairs Forefront. This may not have been peer-reviewed. I don't think that everything published in Health Affairs is peer-reviewed.
Im so glad i have traditional Medicare
With a medigap, I hope!
Of course!
Not surprising, but definitely disappointing. Another example of the financial market players choosing profits over the well-being of the American taxpayer and senior citizen.
You're doing yeoman's work to highlight the human impact of our corporatized health system. Keep the faith, brother!
Whoever controls the message will control the people.....Ever since Reagan repealed the Fairness Doctrine in the 80's the media, newspapers,cable etc has been controlled by the Oligarch class. Now we even have a President attacking any information he doesn't agree with. Most Americans have no idea how awful our For Profit Healthcare is.
This really is an outrage. Thanks for keeping us informed and out of the dark. Really appreciate your ongoing efforts. I'd love to see this topic in your next video! (Love the videos.)
I hope to see a condensed version of your article in the WSJ op-ed pages soon. Yeoman’s work indeed, Mr. Potter!
TGIF
Reminder in 1965 private health insurance industry decided to drop persons as they aged. That is the reason for beloved traditional Medicare
There is a well traveled past billboard here in our city reminding people “Medicare advantage is not Medicare”.
Oh this comment got me blocked & reported quickly
The hospital that I've worked at for over 39 years quit accepting MA about 2 years ago. One of the problems was with prior authorization in order to transfer patients to a nursing home. These patients were ending up in the hospital days longer than regular Medicare patients and causing some other patients to be transferred out to other hospitals because we were full. We even had to have staff that only worked on MA patients since we had trouble getting paid in a timely manner.
Other hospitals in my state have also quit accepting MA.
Medicare Advantage plans are still gaming the system. A diagnosis of myasthenia gravis that came out of thin air was added to a patient's medical record. In 2025, the company dropped that plan and offered the patient a more expensive one. I told the patient that being dropped was a golden opportunity to change to original Medicare and obtain a supplemental plan, which they did.
On this, it is possible I don't understand exactly what was said.
"MedPAC, the independent congressional agency that advises Congress on Medicare, projects that for 2026, Medicare Advantage payments will run $76 billion — or 14% — above what traditional Medicare would spend on the same beneficiaries, after accounting for health status, coding differences, and geographic factors."
If I understand standard Medicare vs. Medicare Advantage, Medicare Advantage is at least kind of comprehensive, in that out-of-pocket maxes are there. They are not in standard Medicare, and thus, people have to pay an extra 20% that the government doesn't pay for a Medigap, which might be like 20% of the government cost for the standard Medicare.
(What I had understood about costs is that the government actually paid a little more per person for a Medicare Advantage than standard Medicare, maybe 5%, justified by the comprehensiveness not in standard Medicare.)
So, the deal for the consumer getting a Medicare Advantage is that it's usually cheaper for them than a standard Medicare plus Medigap. At the cost, to them, of a lot more prior-authorization problems.
Now, with your $76 billion = 14% number, it sounds like maybe the Medicare Advantages are upcoding so much that the "5% more" that I had thought is really like "14% more".
Thus, my understanding, as best I can get without really researching numbers, is that the article is asserting not that the government paying more for Medicare Advantages is not justified by the MA comprehensiveness vs. standard Medicare, but rather that is paying more more than it thinks. (14% more rather than 5% more.)
Please correct me, someone, if I misunderstand.
I’m curious to know how you perceive MA plans to be more comprehensive than traditional Medicare.
MA also offers dental and hearing coverage
I meant that in the sense that the MA's have an out-of-pocket max. (And only that sense.)
Standard Medicare has about a 20% copay uncapped, without an out-of-pocket max. (Which a person normally, if they can afford it, and have not been blocked by a pre-existing condition exclusion, will pick up a medigap (out of their own pocket) in order to remedy. Then, with the medigap, the standard Medicare plus medigap has an out-of-pocket max, which is in fact, quite low.)
My use of "comprehensive" on the Medigap was meant in terms of what the government was paying for. Basically, that the government, even without the studies showing the effects of upcoding, already knew it was paying somewhat more for Medicare Advantage, justifiable based on the part it was paying for having an out-of-pocket max, with the standard Medicare alone that it was paying a little less for not having an out-of-pocket max.
A true bro and thank you.
Vote this current administration out.
Wall Street Journal editorial board has had a major shift since its DEI hiring of reporters from Politico… hmmmm!
Thank you! I found another tricky thing insurers like MA are doing. I work in a hospital. Physicians are required to estimate length of stays and document that in the initial H and P. This estimate is also posted on a general summary page on EHR. This allows the hospital to plan discharges and prioritize logistics for patient care. This info is not a part of a patient's permanent record but initial H and P is.. However what has happened is insurers are now anchoring their payment to the hospital based on an estimation on length of stay. For example, a patient is estimated to be in the hospital about 4 days. But issues or complications arise and the stay becomes a 10 day stay. The insurer will only pay for 4 based on the initial "estimation" and hospital gets shorted. So now the estimation has been removed, but impacts planning, discharge and patient expectation and need for post hospital care. One can assume what type of insurers are doing this.
Holy cow! The WSJ board self-snitched with the “ideological, no matter the facts” tagline. They are ideologues who don’t care about the facts
Are you sure this article was peer-reviewed? It looks like it was published in a part of Health Affairs, called Health Affairs Forefront. This may not have been peer-reviewed. I don't think that everything published in Health Affairs is peer-reviewed.
Not my field, though.
Really the health insurance industry is going after all assets and moving on to future generation’s assets.