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
Our July 15 "hike" is going to be a kayaking adventure on Bde Maka Ska (formerly Lake Calhoun) and Lake of the Isles! If you don't have a kayak (or paddleboard), Wheel Fun Rentals, located next to the new concession stand rents single kayaks at $15 an hour and double kayaks at $25. The second hour is free if we rent before noon. Life jackets are provided with the rental.
Laura Ericksen will lead the discussion of How Stella Learned to Talk by Christina Hunger, a true story by a speech-language pathologist who taught her dog, Stella, to communicate using buttons associated with different words.
Our August 5 hike will be a reprise of our hike last summer at William O'Brien State Park. This is a beautiful park with a winding trail and a great view of the countryside. The hike is about 5.5 to 6 miles and we'll go at a moderate pace with frequent water breaks. After the hike, we will eat lunch at Rustic Roots Winery, a half mile north of the park.
Kathy Cramer will lead the discussion of The Bookbinder by Pip Williams, a book set in 1914 Oxford chronicling the life of Peggy who works in the University bindery, but craves a life beyond binding books but to being a scholar herself.
Enjoy a two-hour cruise on the Jonathan Padelford, leaving from the Harriet Island dock in St. Paul, boarding time at 5:30 p.m. We will have a brief program on board by Patrick Nunnally from the River Life Program of the Institute on the Environment.
August 31 is the due date for annual reports and updates. Annual Reports, Toolkits, web page updates, operating document updates and archives collections are all due each year on this date.
Autumn is a wonderful season in Minnesota so plan to join UMRA at the Andersen Horticultural Library at the Minnesota Landscape Arboretum. Kristen Mastel, head librarian and curator, will reveal its treasure trove of publications and artifacts relating to plant history, horticulture, and natural history. After the tour, those who are interested may stay to eat lunch together, sitting outside if the weather is nice. Later, you are invited to a one-hour tram tour of the entire Arboretum that includes natural areas of flowering shrubs, bogs, and forests, family garden and landscaping showpieces, and the red barn farm
After a summer break the UMRA Photo Club will next meet September 10, 2024 in the meeting room of the Hennepin County St. Anthony Branch Library. For those interested in lunch, meet at the Great Dragon at 11:30 am. For September the THEME will be Curves
We will continue to discuss the pros and cons of Medicare Advantage. You will also hear about notable non-health plan and non-broker resources.