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Signing On To Medicare Advantage?  Don’t!

Or at least, take a moment to learn about the privatization of Medicare, commonly called Medicare [Dis]Advantage.

Or at least, take a moment to learn about the privatization of Medicare, commonly called Medicare [Dis]Advantage.

By

If you are enrolled in Medicare, or about to become of age to do so, you are likely receiving flyers through the post office or seeing endless ads on TV trying to lure you into a Medicare Advantage (MA) plan. We are entering a period called open season, a term reminiscent of hunting season but with MA you are the target and private insurers are out to get you and cash in on the process. Bait traps are legal for these poachers who literally steal between $124 and $140 billion dollars from Medicare each year. This money could have gone directly to pay for treatment of Medicare patients, but instead it flows into the coffers of private insurance companies.

I have written about MA before on this site. You can read those pieces below at LINKS. If you also want a quick tour d'horizon of MA and its brazen daylight robbery of Medicare, you should watch this 40 minute video “Don’t let naked profiteering destroy our Medicare” by Dr. Ed Weisbart, who explains the inherent problems with Medicare Advantage. Better to spend 40 minutes now watching the video than to spend years fighting your MA private plan for payment for treatment you need and your doctor has prescribed.  


HANDING PUBLIC HEALTH CARE TO PRIVATE INSURERS: The Dangers of So-Called “Medicare Advantage” is a flyer put out by Physicians for a National Health Plan. The flyer brings to the fore three points:
 

"DECEIVING TAXPAYERS.  Reports from journalists, researchers, and government agencies have shown that health insurance companies, like UnitedHealth and Cigna, overcharge Medicare by giving patients exaggerated or entirely false diagnoses. Several companies have been fined, or sued, and agreed to large settlements. MA insurers are taking your tax dollars for conditions they aren’t even treating.
 

"DENYING TREATMENT. Investigations into MA claim denials found that insurers were inappropriately denying treatment and  tests that should be covered under Medicare. Physician surveys show that these practices often cause patients to suffer unnecessarily, and can even be life-threatening. In some cases, MA insurers were found to spend just seconds on each claim, and even denied claims using artificial intelligence instead of medical experts.
 

“DISMANTLING MEDICARE. Over 50% of Medicare beneficiaries now have for-profit corporations in charge of their care through MA. Insurance companies are paid handsomely for these plans, and much of that money goes to corporate profits instead of care. The companies running MA plans want to take over Medicare entirely, leaving you with no option but to give your money to private insurers.”
 

Instead of Medicare Advantage from insurance privateers, you can opt for a Medigap policy if you fulfill certain criteria. This is especially easy and advantageous for those who are just signing up for Medicare. Obtaining Medigap coverage in later years is possible but coverage is likely to be more restrictive and expensive. You can learn more about Medigap coverage at the Medicare.gov site Get Medigap Basics.

Don’t fall prey to the MA pamphlet scammers and the TV hucksters. Be informed. 

Related Links

Comments by Readers

Dick Conoboy

Oct 19, 2023

Dear Readers,

I recieved some feedback on another social network site complaining that my article did not address the needs of the poor to whom the so-called zero dollar plans are attractive.

BARRIERS TO CARE IN MA

  • MA plans have highly limited networks. 35% of enrollees are in a plan that covers less than 30% of physicians in their county.
  • On average, plans cover less than half (46%) of physicians in a county.
  • Specialty and surgery coverage is even lower in MA. Psychiatry was the lowest, with only 23% of psychiatrists in a county covered on average. 20% of plans offered a choice of fewer than 5 cardiothoracic surgeons.
  • MA plans often require prior authorization for necessary care, with over 35 million requests submitted in 2021.
  • These requests are frequently denied, but when appealed, 82% of denials are overturned.
  • Despite this, only 11% of requests are ever appealed.
  • Some insurers have used artificial intelligence to systematically deny requests.
  • Government investigations found that around 1 in 7 denials in MA should have been covered and would have been covered by Traditional Medicare.
  • Those with complex or high-cost care needs often must leave MA because of narrow networks, prior authorizations, and other denial strategies. Among those in long-term nursing home care from 2010-2011, 17% switched from MA to TM, and only 3% switched from TM to MA.
  • Among those using short-term nursing home care, 9% switched from MA to TM, while 4% did the reverse. For those using home-based care, the numbers were 8% vs. 3%.
  • MA beneficiaries are more likely than TM beneficiaries to enter lower-quality nursing homes.
  • High-need patients with multiple chronic conditions, and those who are dually eligible for Medicare and Medicaid, have substantially higher rates of MA disenrollment than patients without these conditions.
  • Patients in their last year of life switch from MA to TM at a rate more than double those of other patients.
  • MA often touts its extra benefits like vision and dental as a reason to join, but these benefits are often highly limited. 59% of MA beneficiaries are in a dental plan that limits insurer coverage to $1,000.32% of MA beneficiaries with hearing benefits face both insurer spending limits as well as visit frequency limits.

This article may also be informative regarding zero dollar MA insurance. 

Are Some Medicare Advantage Plans Free? Zero-Dollar Monthly Premiums Explained

 

 

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