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.