When Will the Medicare Advantage Bubble Burst?
Recording spreads awareness to rein in the Medicare Advantage (MA) privatized system, and protect traditional Medicare funding.
1. Explains overpayments & profits of Medicare Advantage (MA) health plans, and the legally required return of some profits to enrollees.
2. Medicare Advantage (MA) enrollees have low premiums and broader benefits compared with the TM because the plans are overpaid, not because they are more efficient or altruistic. See slides # 8. Ranking of MA plan attributes, and see slide # 9. MA Coverage negatives including unexpected claim denials, high costs, and delayed payments.
3. See slides # 10, 11 & 12. On Claim Denial & Over Charge Options. This response process is applicable to any claim/medical billing surprises or denials.
4. Below is a supplement to the recording and PowerPoints:
Enrollees in TM (Traditional Medicare) can choose any providers — primary care doctors, specialists and hospitals. MA (Medicare Advantage plans) limit these choices.
Medicare sets payment rates, and the rules for health care providers. Studies suggest that MA prices paid by insurers were close to Medicare Fee–For-Service prices, and were similar in and out of network. Most Health providers accept Medicare payments without additional charges to enrollees.
In TM you don't need referrals to see any medical provider, and you don't have to worry about your doctor leaving a plan's network. TM rules do not interfere with medical decisions, and do not have financial incentives to deny services.
Medigap private insurance is only supplemental to traditional Medicare (TM). Medigap policies help cover some of TM out-of-pocket costs, such as deductibles, copayments, and coinsurance, and may pay charges over Medicare payments.
MA plans can limit your choice of doctor, have financial incentives for doctors to deny services, and can deny, delay, or limit services (for example, discharging from a hospital or skilled nursing facility before your provider thinks you're ready to leave).
A report from MedPage Today on a hearing held in the US Senate on 05/17/23 describes a half-dozen examples of Medicare beneficiaries who were abused by their MA plan. Sen. Bumenthal (D-CT) is quoted saying Medicare beneficiaries who enroll in MA plans "face denials in the middle of major medical crises, forcing them and their loved ones to fight even as they are fighting for their lives. -----"It's fine, so long as you don't need it for the big stuff"; Congress Hearing Explores Medicare Advantage Routines That Deny, Delay Needed Care | MedPage Today
I welcome your comments on your MN based TM with a supplement, and on your MA plan experience.
~ UMRA Financial & Legal Group, Andy Whitman, FLG facilitator, [email protected], 612-747-6015.
Presenters
Kip Sullivan, JD, a prolific author and health policy advisor to the nonprofit organization Health Care for All Minnesota, and nationally.
Robert Hall, CFP, Carlson MBA (Ret.) an advisor and lecturer in Carlson School Personal Finance and Risk Management courses.
Andy Whitman, JD, PhD, Professor of Finance, The Carlson School, UMN.
When will the Medicare Advantage bubble burst?
Mon, May 8, 2023, 1pm
Join Zoom link, 1pm - 2:30 pm (no need to register, just use this link)
Presenters:
Andy Whitman, PhD., UMN professor of insurance
Kip Sullivan, author and health policy advisor to Health Care for All Minnesota
Bob Hall, CFP (retired)
Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy
By Reed Abelson and Margot Sanger-Katz
The Biden administration has proposed changes to how it would pay private Medicare Advantage plans. “We need strong oversight of this program,” Dr. Meena Seshamani, the director of the Center for Medicare, said of Medicare Advantage. [See additional references below.]
Why the Medicare Advantage (MA) plans are so overpaid. Kip (20 minutes)
- History of the privatization of Medicare
- Favorable selection: Enrollees in Medicare Advantage are healthier; sicker enrollees are driven away.
- But CMS/HCFA was never able to "risk adjust" premium payments to MA plans downward to match the lower cost of MA enrollees.
- After 2006, "improved" risk adjustment introduced a new way for MA plans to profit: Upcoding
MA plan profits so large they had to return Billions in premium "over charges". Andy (5 minutes)
MA enrollees don't know what their coverage is until they need it! Andy (5 minutes)
- Claim denials not challenged
- Fraud in challenged claim denials
- Actions when claims are denied
Experience in Medicare Advantage - "To Good to Be True?" Bob (5 Minutes) '
UMN's Retiree Medicare Advantage choice? Andy (5 minutes)
- Dangers of relying on outside entities to explain employee choices
- Medicare Advantage (MA) or Traditional Medicare
- Long Term Care Insurance
- Engaging a Financial Planner
Terminating MA plan overpayment is essential to protecting the Medicare trust funds. Kip (5 minutes)
- Medicare trustees predict Medicare Part A will be in the red by 2028
Please send questions and comments that we can address to Andy Whitman [email protected]
References
Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds - The New York Times (nytimes.com)
Opinion | For seniors, Medicare Advantage plans come with big disadvantages - The Washington Post
Medicare Plan Commissions May Steer Beneficiaries to Wrong Coverage | MedPage Today
Did Your Health Plan Rip Off Medicare? | Kaiser Health News (khn.org)
Medicare Advantage Plans Fielded 35 Million Prior Auth Requests in 2021 | MedPage Today
How Insurers Exploited Medicare Advantage for Billions - The New York Times (nytimes.com)
Almanac | Mike Hatch versus Blue Cross | Season 2001 | Episode 6 | PBS
Upcoming Events
UMRA's special event for this winter will again be a celebration of brighter days and the approaching end of winter. We'll have food, fellowship, and music provided by Urban Sound, one of the U of M’s premier student a cappella ensembles.
Our February 3 hike will be around Lake of the Isles in Minneapolis, with an option to add Bde Maka Ska, weather permitting. No matter how far we hike, let’s go to Isles Bun & Coffee for treats after the hike. Their buns are delicious!
Cabinets of Curiosity will seek out the University of Minnesota Herbarium on the St Paul Campus. Collections Manager Tim Whitfeld will share his knowledge of that amazing collection and explain its critical importance in the 21st century. Botanists study these pressed plants, individually and collectively, to establish a history of plant life, often over centuries, because they contain compelling evidence of the ever modulating geographical distribution of plants and evidence of how climate, pests, and other factors have changed species over time.
"Things that drive me crazy" will be the theme when the UMRA Photo Club meets on February 11. Newcomers are welcome.
Many life challenges that get in the way of quality of life and good health at home have little to do with medical issues. Cathy Lauring, our presenter for UMRA’s February 18 workshop, will explore a variety of resources to assist in keeping us healthy at home—including physical, emotional, cognitive, and financial services.
John Bantle will lead the discussion of A Walk in the Woods: Rediscovering America on the Appalachian Trail by Bill Bryson when the UMRA book club meets via Zoom on February 21.
Join UMRA members to watch two of the best hockey teams in the nation. UMRA has negotiated a discounted ticket price of $33.
Barbara Klick, RN, MBA, the presenter for UMRA’s February 25 Forum, has decades of experience working in human and veterinary medicine, and will bring her wisdom and perspective to our discussion about what we can learn from our pets about facing end-of-life challenges and decisions.
The Fourth Friday Book Club will meet via Zoom on February 28 from 2 to 3:30 p.m. CST to discuss The Adventures of Huckleberry Finn by Mark Twain.
Will Craig discusses using local sources for family history.
The UMRA Hiking Club will explore wildlife along the Mississippi River in Fort Snelling State Park. The 3.9-mile Pike Island Loop is generally considered an easy route and takes just over an hour. Hikers can leave at that point, or stay to add another short loop. The trail is located below the bluff on which the historic fort sits. The last time we were there we saw a lot of deer, and the river always provides fascinating views.
The University of Minnesota Archives, with its major holdings largely tucked away in two huge underground caverns along the Mississippi River under the West Bank campus, holds the essential records of our University of Minnesota’s past. University Archivist Erik Moore will explain the holdings and role of our extensive university archive and bring out a sampling of what it holds. At the end of our visit, he will conduct a tour of the literally cool caverns (Minnesota Library Access Center), revealing where these precious materials are housed, including the original tapes of KUOM, now Radio K.