Researcher: Medicare Advantage Plans Costing Billions More Than They Should

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    • #461289
      eridani
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      • Total Posts: 11,670

      https://khn.org/news/article/medicare-advantage-overpayments-cost-taxpayers-billions-researcher-says/

      Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, said his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.

      Nearly $34 billion of that new spending came during 2018 and 2019, the latest payment period available, according to Kronick. The Centers for Medicare & Medicaid Services made the 2019 billing data public for the first time in late September.

      “They are paying [Medicare Advantage plans] way more than they should,” said Kronick, who served as deputy assistant secretary for health policy in the Department of Health and Human Services during the Obama administration.

      Medicare Advantage, a fast-growing alternative to original Medicare, is run primarily by major insurance companies. The health plans have enrolled nearly 27 million members, or about 45% of people eligible for Medicare, according to AHIP, an industry trade group formerly known as America’s Health Insurance Plans.

      Comment by Don McCanne of PNHP: We have been witnessing the privatization of the Medicare program through the introduction of the private Medicare Advantage plans, and, more recently, the Direct Contracting Entities as a means of converting much of the remaining traditional Medicare program into private plans.

      We have recently been inundated with heavy marketing of these plans during the open enrollment period, promising eligible Medicare beneficiaries much better benefits at considerably lower costs.

      Better benefits? Look at the report on services provided by home health agencies, the type of services the marketing suggests are superior when provided by the Medicare Advantage plans. This study showed that services were emphatically inferior to services provided under the traditional Medicare program.

      And lower costs? The other report cited above indicates that Medicare Advantage plans were overpaid by tens of billions of dollars.

      When there is a popular movement to eliminate private plans and establish a single payer Medicare for All program, it is ironic that our government is establishing policies to suppress our existing Medicare program and replace it with private plans when the evidence is that they are a major source of much of the detrimental dysfunction in health care financing.

      What we need is an equitable, publicly administered and publicly financed health care program for everyone: a single payer, improved Medicare for All. But we do need to consider getting rid of the politicians who want to use our public funds to support the private health plans while suppressing our public programs.

      Jesus: Hey, Dad? God: Yes, Son? Jesus: Western civilization followed me home. Can I keep it? God: Certainly not! And put it down this minute--you don't know where it's been! Tom Robbins in Another Roadside Attraction

    • #461311
      Bernie Boomer
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      • Total Posts: 663

      ever has days when he just stands and stares at a wall in frustration?

      His job is absolutely Sisyphean and he has my absolute sympathy. I remember trying to convince a friend to stick with traditional Medicare, but she was so sucked in by the bells and whistles of the “Silver Sneakers” perk of an Advantage plan that it was a fruitless attempt on my part.
      A “free gym membership!” was enough to convince her to sign up for crappy healthcare coverage.

      • #461318
        Utopian Leftist
        Participant
        • Total Posts: 1,092

        there isn’t really any choice.

        Straight Medicare never pays more than a percentage of the medical bills, even if you have the additional assistance of Medicaid. Even for a routine checkup, you could be saddled with hundreds or thousands of dollars in medical bills. With the advantage plan, I get zero copays for doctor visits OR for specialists. That is for me the difference between paying thousands of dollars per year (which I don’t have anyway) or paying ZERO for my health care. I’m not saying I’m happy with the current system. Just that straight medicare is not the solution.

        Obviously, what we really is need single-payer Medicare for all, as Bernie has promoted it, with no co-pays. And of course, these plans vary. I think these plans probably stick it to you when you need long-term hospitalization. I had one advantage plan where in a single year my copays went from 0 to $40 per visit. That adds up quickly, so I simply changed to a different insurance company. But as long as it keeps my copyas at zero, I will use an advantage plan, regardless of the free gym membership, chiropractic, Acupuncture, or other additional benefits that are sometimes available.

        “It is no measure of health to be well adjusted to a profoundly sick society.” ~ Krishnamurti
        "Given the choice between a Republican and a Democrat who acts like a Republican, the voter will choose a Republican every time." ~ Harry Truman

    • #461329
      soryang
      Participant
      • Total Posts: 2,314

      Medicare doesn’t pay for drugs. This is the major deficiency among others that gives the insurance companies leverage. you can pay extra for a medicare supplement to get the drug coverage that you already know you must have, or you can get the medicare advantage plan and get drug coverage without the extra monthly payments. Of course, you give up other coverages to get it. There is an aspect of gambling when picking a plan in anticipating needs for the next year.

      Changing from ACA to MC advantage was a royal pain in the ass. the insurance company phone banks are staffed by underpaid unqualified personnel for the most part. I filled three large trash cans with their promotional mailers in the last two months. Their service once you find a plan sucks. you have to coordinate your own care. they transfer their administrative burden to the “beneficiary.” when you call they say “you can do it online” or transfer you to the wrong office after being on hold for a half an hour. the whole system sucks.

      Meanwhile they’re raking in billions of dollars while providing as little service as possible with all the legal snares and traps of dealing with insurance companies and medical providers.

      惑世誣民 혹세무민

    • #461433
      snot
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      • Total Posts: 1,494

      is the main reason Advantage plans are any good – i.e., if traditional Medicare were eliminated as an alternative, benefits under Advantage plans would quickly be slashed; i.e., it’s a bait-and-switch situation.

      I stuck with traditional plus supplements (Medigap and Rx).  It’s a bit of a pain, and I’m not sure how the total cost compares to an equivalent Advantage plan, but I don’t think it’s much if any more, and in any case it’s a lot cheaper than Obamacare was, and it’s worth it to me to help preserve traditional Medicare and stick it to Big Insurance.

      Plus I understand that if you stick with traditional Medicare, you can always switch to Advantage, but once you go to Advantage, you can’t go back to traditional.

      Destruction is easy; creation is hard, but more interesting.

      • #461457
        djean111
        Participant
        • Total Posts: 7,996

        Although an advantage plan might imply differently, who knows.

        https://www.medicare.gov/sign-up-change-plans/types-of-medicare-health-plans/medicare-advantage-plans/join-switch-or-drop-a-medicare-advantage-plan

        How to switch
        If you’re already in a Medicare Advantage Plan and want to switch, follow these steps:

        To switch to a new Medicare Advantage Plan, simply join the plan you choose during one of the enrollment periods. You’ll be disenrolled automatically from your old plan when your new plan’s coverage begins.

        To switch to Original Medicare, contact your current plan, or call us at 1-800-MEDICARE.

        Unless you have other drug coverage, you should carefully consider Medicare prescription drug coverage (Part D). You may also want to consider a Medicare Supplement Insurance (Medigap) policy. Remember, you may only be able to switch at certain times of the year.

        America is not a country, it's just a business. (Brad Pitt, Killing Them Softly)

        Everything I post is just my opinion, and, honestly, I would love to be wrong.

        A YouTube comment – we need new conspiracy theories – the old ones have all come true.

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