EVENT SUMMARY: | FINANCE AND LEGAL GROUP
The following article summarizes the original event which is listed below the summary.

When Will the Medicare Advantage Bubble Burst?

May 8, 2023, at 1pm
 

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.

Event recording
Click on , then    to view recording in full screen.

 


 


FINANCE AND LEGAL GROUP

When will the Medicare Advantage bubble burst?

Mon, May 8 2023, 1pm

Location
By Zoom
 

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)

This workshop looks at a troubling issue, described in the March 22, 2023, article 

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

Event Date: April 15, 2024, at 9:30am

Join us for a 4 to 5 mile hike at one of the most popular parks in the West Metro, Richardson Nature Center in Bloomington.  It is located at the north end of Hyland Lake Park Reserve at 8737 East Bush Lake Road in Bloomington.  This trail is mostly dirt and grass with some paved areas.  Enjoy the park's wildlife and celebrate Tax Day with your UMRA hiking friends!


Event Date: April 15, 2024, at 10am

UMN Technology Commercialization facilitates the transfer of UMN innovation beyond the research lab by helping our diverse researchers in development of new products and services that benefit the public good, foster economic growth, and generate revenue to support the University's mission.


Event Date: April 16, 2024, at 11am

How did children’s mental health become a public health crisis? How can you tell the difference between developmentally appropriate misbehavior and behavior that needs professional intervention? For answers to these and other questions, we invited Sarah Jerstad, clinical director of psychological services at Children's Minnesota, to be our guest speaker for UMRA’s April 16 workshop. 


Event Date: April 19, 2024, at 2pm

Joni Mitchell will lead the discussion of The Scarlet Letter by Nathaniel Hawthorne when the UMRA book club meets via Zoom at 2 p.m. on Friday, April 19.


Event Date: April 23, 2024, at 11am

Generative artificial intelligence (AI) has attracted substantial debate recently because it can be used in many contexts, including educational settings to do things such as answer exam questions and write papers. But what is generative AI? And how can we know if it’s a good thing or a bad thing? Law School Professor Daniel Schwarcz will enlighten us during UMRA’s Luncheon Forum on April 23.


Event Date: April 24, 2024, at 10am

UMRA’s spring Armchair Traveler Program from 10 to 11:30 a.m. on Wednesday, April 24, will take us to South Korea with Marilyn DeLong and to Germany with Lynn C. Anderson. Please mark your calendars and save the date. 


Event Date: April 26, 2024, at 2pm

Silk Parachute, an anthology of essays and the 40th of 44 published books by author John McPhee, will be the topic of discussion when UMRA’s Fourth Friday Book Club meets via Zoom from 2 to 3:30 p.m. CDT on April 26.


Event Date: May 6, 2024, at 9:30am

We are so fortunate to have former Arboretum Director and UMRA member, Peter Moe lead this approx 3.7 mile hike at the Minnesota Landscape Arboretum!  We will meet on the welcoming terrace and travel through the Arboretum's Display Gardens, Sensory Garden, Woodland Wildflower Garden,  Shade Tree Exhibit, Tall Grass Prairie, Rhododendron Garden, 1920 Red Barn and the Bee and Pollinator Discovery Center, Sphagnum Bog and Green Heron Pond, Display Gardens and many other gardens and plant collections. 


Event Date: May 6, 2024, at 12:45pm

This session will continue the discussion begun in the May 8, 2023 session.  See that article for details.


Event Date: June 14, 2024, at 7:10pm

UMRA will be celebrating U of M Days with the Alumni Association.  The Minnesota Twins will be playing the Oakland Athletics on Friday evening, June 14, 7:10 PM.  


Event Date: June 17, 2024, at 11am

Picnic under the covered, open-air Como pavilion, gaze at the water, spy some birds, catch up with friends and former colleagues, and meet new members. We’ll have lunch with plenty of time for visiting and then compete in teams as we are challenged by our Quiz master(s)!


Event Date: June 24, 2024, at 8am

Healthy aging, mindfulness, fighting ageism, and more will be the focus of the third annual Age-Friendly University Day to be held on the U of M Twin Cities campus.