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Has Achieved Nirvana
Picture of wtg
posted
quote:
Medicare Advantage may now provide health coverage to more than half of the nation's seniors, but that is not stopping health systems from pushing back against the growing and controversial program.

Hospitals have been dropping Medicare Advantage plans over high claim or prior authorization denial rates since at least 2018, but it was an uncommon move until recently. Some systems have noted that most MA carriers have faced allegations of billing fraud from the federal government and are being probed by lawmakers over high denial rates.


https://www.beckershospitalrev...icare-advantage.html


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When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier

 
Posts: 38217 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
Has Achieved Nirvana
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quote:
‘It was stunning': Bipartisan anger aimed at Medicare Advantage care denials

A bipartisan group of lawmakers is increasingly concerned that insurance companies are preying on seniors.


https://www.politico.com/news/...ns-congress-00128353


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When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier

 
Posts: 38217 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
Has Achieved Nirvana
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Medicare Advantage. It's not Medicare. And it's not an advantage.
 
Posts: 25309 | Registered: 31 March 2007Reply With QuoteReport This Post
Minor Deity
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We chose traditional Medicare with a supplement and a part D plan largely for that very reason, along with travel coverage.

I have since seen friends and family have to jump through unreasonable hoops to get their needed treatments approved by Advantage plans.

We pay more in premiums but I think it's worth it.


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"A mob is a place where people go to get away from their conscience" Atticus Finch

 
Posts: 13649 | Registered: 20 April 2005Reply With QuoteReport This Post
Has Achieved Nirvana
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Same here, Mik. If I get sick the last thing I want is a hassle getting care I need.


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When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier

 
Posts: 38217 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
Minor Deity
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I have one and it’s been fine, and added bonus $50 a month to spend at CVS. I haven’t had the nerve to see if I can use that to purchase wine sold at my local CVS.


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Be calm, be brave, it'll be okay.

 
Posts: 17729 | Location: Maine | Registered: 20 April 2005Reply With QuoteReport This Post
Minor Deity
Picture of Mikhailoh
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Do it! Wine is healthy. Michael Corleone said so.


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"A mob is a place where people go to get away from their conscience" Atticus Finch

 
Posts: 13649 | Registered: 20 April 2005Reply With QuoteReport This Post
czarina
Has Achieved Nirvana
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A friend of mine has been in the hospital for the past six weeks. On November 1 he went in for a hernia repair. They punctured his esophagus with the tube they put down his throat--the hole was the size of an egg--and before they discovered it all kinds of stuff that went down his throat ended up in his chest cavity. He was moved to the ICU and put on a ventilator. Once they got the esophagus opening closed, they had to put him under again to lavage his lungs, because he couldn't cough or clear his throat due to the pain of all the tubes stuck in his chest to vacuum out the crap in there.

I spoke to him yesterday (he's 3,000 miles away or I'd be visiting him every day) and for the first time since this nightmare began he had been able to get himself out of bed and sit upright in a chair--and was totally exhausted from it.

Thankfully he signed up for Medicare before this happened and chose Plan G for his medigap plan. He won't owe anything, and will not have to fight with private insurers.

It's too early to talk about suing the hospital and the anesthesiologist for malpractice--he has to get well first. But believe me, we are thinking about it.

You can be doing just fine and feel like going with Medigap would be a waste of money--until you no longer are. Who wants to deal with fighting insurance companies while trying to just survive?

I am grateful that I don't have to step up to fight that fight for him because of the insurance choices he made.


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fear is the thief of dreams

 
Posts: 21539 | Registered: 18 May 2005Reply With QuoteReport This Post
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Minor Deity
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Yeah, we want nothing to do with Medicare Advantage.


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“It's hard to win an argument with a smart person. It's damn near impossible to win an argument with a stupid person." -- Bill Murray

 
Posts: 13890 | Location: The outer burrows | Registered: 27 April 2005Reply With QuoteReport This Post
Has Achieved Nirvana
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It's the privatization of Medicare, and I don't think the public would have accepted it if we had been given a choice.
 
Posts: 25309 | Registered: 31 March 2007Reply With QuoteReport This Post
Minor Deity
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Ahh, but we are being told how much money we will get for choosing it!

The insurance companies are paid a fixed amount per subscriber. I'm sure there are calculations for outliers, but the bottom line is they are incented to deny care. Not a good model.


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"A mob is a place where people go to get away from their conscience" Atticus Finch

 
Posts: 13649 | Registered: 20 April 2005Reply With QuoteReport This Post
Has Achieved Nirvana
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We do get a choice, but some people can't afford the traditional Medicare option, so MA gives them a certain level of coverage at a much lower cost. I think that a lot of people don't understand the tradeoffs they make when choosing, and they find out what they've given up in flexibility and options at a time when they need them the most.

Whether health care should cost so much is part of another discussion.


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When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier

 
Posts: 38217 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
czarina
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The important point to remember is that once you choose MA, you can't switch over to the Medigap plans without undergoing underwriting, and they don't have to accept you.


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fear is the thief of dreams

 
Posts: 21539 | Registered: 18 May 2005Reply With QuoteReport This Post
Has Achieved Nirvana
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Good point. You're only guaranteed acceptance into any plan for the first six months after you qualify for Medicare. After that, you're in the underwriting pool...


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When the world wearies and society ceases to satisfy, there is always the garden - Minnie Aumônier

 
Posts: 38217 | Location: Somewhere in the middle | Registered: 19 January 2010Reply With QuoteReport This Post
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