Medicare Advantage Private Option Is Gaining Popularity, and Critics - NYT

[Tactical Peek]

Medicare's Private Option Is Gaining Popularity, and Critics

As more Americans sign up for Medicare Advantage, detractors worry that it’s helping private insurers more than patients.

By Mark Miller

Feb. 21, 2020


. . . “When we talk about Medicare for all or public options,” said Tricia Neuman, director of the Medicare policy program at the Kaiser Family Foundation, “people may not realize that we already have a Medicare program that is coming to be dominated by some very large private insurance companies.”

. . . The rise of Advantage has also been aided by changes in federal law and regulation in recent years. And under the Trump administration, critics say, Medicare’s administrators have been tipping the scales improperly in favor of Advantage.

. . . Under President Trump, some critics contend, the Centers for Medicare and Medicaid Services, which administers Medicare, has become a cheerleader for Advantage plans at the expense of original Medicare.

. . . If the Centers for Medicare and Medicaid Services is tipping the scales, it would be a violation of federal law, Mr. Lipschutz argued.


https://www.nytimes.com/2020/02/21/business/medicare-advantage-retirement.html


Not good.

[riversedge]

1. Trump has been trying to privitized Medicare-this is how he is doing it.

[El Supremo]

3. You're way behind the times.

Bush Jr. and the Repukes privatized a big chunk of it many years ago.

[El Supremo]

2. I've known how bad Advantage is for 13 years.

It also has been dominated by health companies like Kaiser Permanente.

I want to chose my OWN doctor!

[virgogal]

4. I am in an Advantage plan and it always included my doctors.

[yellowdogintexas]

6. Kaiser is weird. They employ the doctors and patients can only see

those doctors. They are a pure HMO. Advantage plans have HMO networks and PPO networks but they all have networks. You are lucky that your doctors are in your plan.

However, if you have to have treatment when you are out of your network area the coverage will be very different.

[displacedtexan]

9. KP in San Francisco is amazing. I choose the doctors & the facilities.

There are 3 campuses with free shuttle service. My friend at NASA in Maryland, however, has to drive an hour to get KP service.

[unc70]

7. Also in Advantage plan - no prob with doctors

I am in a $0 premium Aetna MC Advantage plan. Only out of plan issue I have had was when I was treated in another state. Had to pay out-of-network copay. They did change their preferred pharmacy list, so I had to change my default drug store. The differences in drug copays is about $600/year for me.

[greatauntoftriplets]

5. They advertise heavily.

[Desert grandma]

10. I will never use an advantage plan.

Last edited Mon Feb 24, 2020, 02:46 PM - Edit history (1)

You are limited to their provider network. There might be $0 premiums but there are co pays for many procedures and for hospital stays. We have original Medicare and a wonderful supplement that has barely increased in price in the 7 years we have had it. We pay no co-pays for any procedures or hospital stays. We do not need to obtain authorization for specialists or procedures as long as Medicare covers them. The bonus though is that with the supplement we have we could get care at any of the major medical centers that take Medicare. This includes the Mayo and Cleveland Clinics. The other thing that many people do not realize is that if you go on an advantage plan and then change your mind and want to go back to original Medicare and a Supplement, the supplement providers will make you go through underwriting. This could be problematic for people with preconditions. While the Affordable Care Act prohibits insurance coverage due to preconditions, that rule does not apply to Medicare Supplement (Medigap) Plans.

[greatauntoftriplets]

11. I won't either.

[Grasswire2]

12. all true

And the disadvantage of an "advantage plan" is that the government doesn't specify the benefits, as it does with Medigap, which is the best coverage of all. The insurers in advantage plans make up their own benefits packages, some of which may be worthless.

[Desert grandma]

15. Bingo!

Medigap and Supplement plans are interchangeable terms I think. And, You are so right. We have plan G which covers the 20 percent of the medical cost that Medicare does not cover . No co-pays and no co-insurance. We pay the first $195 (part B deductible) and everything else is paid. "Advantage" plans are run by Insurance companies, where as original Medicare and Medigap (supplemental plans) are government regulated. BIG difference!

[Hoyt]

8. Medicare Advantage, previously called Medicare Plus Choice, started under Clinton.

It”s advantage is that it saves Medicare beneficiaries money on supplemental and drug coverage. You give up some choice in providers, depending on plan.

I had Kaiser awhile, and liked it, but moved out of their coverage area.

[pnwmom]

13. There is another way they're doing it -- by starving the Medicare system of staff.

In Trump's first year he slashed staffing and offices for Medicare and he's continued since then.

I saw the results firsthand recently when I accompanied a relative to sign up for Medicare (after spending an hour on the phone to learn that it wasn't possible to sign up on line or on the phone.). We were there three hours, spoke to 2 people, and at the end all we had accomplished was getting an appointment for a few weeks from now (not even a Medicare #.)

It was like something out of Kafka's The Castle -- and it wasn't always this way. It was easy when our parents signed up for Medicare.

[Tactical Peek]

14. Morning kick. n/t