Thu Apr 28, 2022, 06:24 AM

Sgent (5,814 posts)

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

Source: NY Times

Every year, tens of thousands of people enrolled in private Medicare Advantage plans are denied necessary care that should be covered under the program, federal investigators concluded in a report published on Thursday.

The investigators urged Medicare officials to strengthen oversight of these private insurance plans, which provide benefits to 28 million older Americans, and called for increased enforcement against plans with a pattern of inappropriate denials.

Advantage plans have become an increasingly popular option among older Americans, offering privatized versions of Medicare that are frequently less expensive and provide a wider array of benefits than the traditional government-run program offers.

The industry’s main trade group claims people choose Medicare Advantage because “it delivers better services, better access to care and better value.” But federal investigators say there is troubling evidence that plans are delaying or even preventing Medicare beneficiaries from getting medically necessary care.

Read more: https://www.nytimes.com/2022/04/28/health/medicare-advantage-plans-report.html

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59 replies	Author	Time	Post
Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds (Original post)	Sgent	Apr 2022	OP
Private insurance companies are in the business of making money	Deminpenn	Apr 2022	#1
Stick with Medicare....there is no private plan that is cheaper and better...	ashredux	Apr 2022	#2
These are Medicare supplement plans unless I'm reading this wrong	Bengus81	Apr 2022	#31
I read it as Medicare Advantage, it was a way the Right tried to "Privatize" Medicare	ashredux	Apr 2022	#33
Medicare Advantage is entirely different from Medicare Supplement aka Medigap plans	progree	Apr 2022	#34
the good part of Medigap plans....	Grasswire2	Apr 2022	#52
Car insurance ads pull this shit and it drives me crazy	aocommunalpunch	Apr 2022	#3
I understand what you are saying, however, Progressive has been very good to us.	Ferrets are Cool	Apr 2022	#7
I have AAA membership plus their auto insurance policy	FakeNoose	Apr 2022	#25
I can't stand Joe Namath and the Dyn-O-Myte guy	gab13by13	Apr 2022	#4
I think Joe Namath has had more tv exposure time in the ads than as a football star.	keithbvadu2	Apr 2022	#23
and they never call it "Medicare Advantage"	RussBLib	Apr 2022	#30
The premiums are low?	Bengus81	Apr 2022	#32
Are you speaking of Medicare supplements or Advantage?	DuaneT	Apr 2022	#39
What are the lifetime penalties in some plans you speak of?	DuaneT	Apr 2022	#41
Medicare Advantage Plans suck "literally"	PdamnedQ	Apr 2022	#5
Good to know.	Delphinus	Apr 2022	#8
Check out Medi-Gap, it's better than MA.	gab13by13	Apr 2022	#12
I had friends that had the Med Advantage and it cost them their	INdemo	Apr 2022	#16
Was there a seminar	Delphinus	Apr 2022	#27
My Brother had a supplement policy and told me about the plans	INdemo	Apr 2022	#35
I have done all the work	Casady1	Apr 2022	#40
Bless you!	Delphinus	Apr 2022	#46
and not once	Casady1	Apr 2022	#47
It was Clinton that originally got the ball rolling on Medicare Advantage and Bush with the Medicare	DuaneT	Apr 2022	#42
you get it	Skittles	Apr 2022	#51
Like a mass of tangled fishing line and they are telling us how to cast.	twodogsbarking	Apr 2022	#6
Fought with insurance companies for years.	The Jungle 1	Apr 2022	#9
Same here!	Fritz Walter	Apr 2022	#20
Before I got on Medicare my premiums were about $400	leftyladyfrommo	Apr 2022	#28
Never get a Medicare Advantage plan if you travel frequently.	kellytore	Apr 2022	#10
One of the main reasons I never got an Advantage plan	Ohioboy	Apr 2022	#14
No kidding! Usually when you are travelling it's an emergency. You don't have time	Emile	Apr 2022	#38
A doctor or hospital does not have to be in network if it is a bonifide emergency.	DuaneT	Apr 2022	#44
Okay. . .	Emile	Apr 2022	#45
While true	Sgent	Apr 2022	#59
Of course they were. It's a private, for profit industry.	paleotn	Apr 2022	#11
I like how certain supplemental plans are designed to make you pay more than if you paid yourself	Ohioboy	Apr 2022	#13
Original Medicare needs to add vision and dental coverage and also get rid of the Advantage plans.	Lonestarblue	Apr 2022	#15
Exactly!	Wuddles440	Apr 2022	#18
MediGap is the way to go.	Raven123	Apr 2022	#17
My experience has been that Medigap is great but a	leftyladyfrommo	Apr 2022	#29
yes, it costs more to get actual care	Skittles	Apr 2022	#50
I get actual care. I have never been refused anything.	leftyladyfrommo	Apr 2022	#53
read the original article	Skittles	Apr 2022	#55
My husband and I have Plan F.	murielm99	Apr 2022	#56
I Am Now Experiencing This First Hand.	panfluteman	Apr 2022	#19
I have done all the work	Casady1	Apr 2022	#43
Got a friend struggling with this now. His local doctor is on the plan, but	Midnight Writer	Apr 2022	#21
Wow a 100 mile roundtrip just to do a blood test. My doctor is a vampire	Emile	Apr 2022	#58
Kick	dalton99a	Apr 2022	#22
After reading up on it, MA is more of a HMO and it was less risky to pay the Part B for better cover	keithbvadu2	Apr 2022	#24
"Medicare Advantage" is converting seniors from their gov't Medicare coverage into a private plan	FakeNoose	Apr 2022	#26
I agree	moose65	Apr 2022	#54
+1.	Emile	Apr 2022	#57
I have been rather lucky then with my Humana plan as they so far have yet to deny anything.	cstanleytech	Apr 2022	#36
I tried to warn so many about this. Only two people I know out of dozens believed me. nt	Samrob	Apr 2022	#37
Message auto-removed	Name removed	Apr 2022	#48
NO SHIT	Skittles	Apr 2022	#49

Response to Sgent (Original post)

Thu Apr 28, 2022, 06:34 AM

Deminpenn (14,904 posts)

1. Private insurance companies are in the business of making money

They don't make money, in their model that's the difference between premiums+gov't reimbursement and expenses, if they pay for expensive care and procedures.

Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds

1. Private insurance companies are in the business of making money

2. Stick with Medicare....there is no private plan that is cheaper and better...

31. These are Medicare supplement plans unless I'm reading this wrong

33. I read it as Medicare Advantage, it was a way the Right tried to "Privatize" Medicare

34. Medicare Advantage is entirely different from Medicare Supplement aka Medigap plans

52. the good part of Medigap plans....

3. Car insurance ads pull this shit and it drives me crazy

7. I understand what you are saying, however, Progressive has been very good to us.

25. I have AAA membership plus their auto insurance policy

4. I can't stand Joe Namath and the Dyn-O-Myte guy

23. I think Joe Namath has had more tv exposure time in the ads than as a football star.

30. and they never call it "Medicare Advantage"

32. The premiums are low?

39. Are you speaking of Medicare supplements or Advantage?

41. What are the lifetime penalties in some plans you speak of?

5. Medicare Advantage Plans suck "literally"

8. Good to know.

12. Check out Medi-Gap, it's better than MA.

16. I had friends that had the Med Advantage and it cost them their

27. Was there a seminar

35. My Brother had a supplement policy and told me about the plans

40. I have done all the work

46. Bless you!

47. and not once

42. It was Clinton that originally got the ball rolling on Medicare Advantage and Bush with the Medicare

51. you get it

6. Like a mass of tangled fishing line and they are telling us how to cast.

9. Fought with insurance companies for years.

20. Same here!

28. Before I got on Medicare my premiums were about $400

10. Never get a Medicare Advantage plan if you travel frequently.

14. One of the main reasons I never got an Advantage plan

38. No kidding! Usually when you are travelling it's an emergency. You don't have time

44. A doctor or hospital does not have to be in network if it is a bonifide emergency.

45. Okay. . .

59. While true

11. Of course they were. It's a private, for profit industry.

13. I like how certain supplemental plans are designed to make you pay more than if you paid yourself

15. Original Medicare needs to add vision and dental coverage and also get rid of the Advantage plans.

18. Exactly!

17. MediGap is the way to go.

29. My experience has been that Medigap is great but a

50. yes, it costs more to get actual care

53. I get actual care. I have never been refused anything.

55. read the original article

56. My husband and I have Plan F.

19. I Am Now Experiencing This First Hand.

43. I have done all the work

21. Got a friend struggling with this now. His local doctor is on the plan, but

58. Wow a 100 mile roundtrip just to do a blood test. My doctor is a vampire

22. Kick

24. After reading up on it, MA is more of a HMO and it was less risky to pay the Part B for better cover

26. "Medicare Advantage" is converting seniors from their gov't Medicare coverage into a private plan

54. I agree

57. +1.

36. I have been rather lucky then with my Humana plan as they so far have yet to deny anything.

37. I tried to warn so many about this. Only two people I know out of dozens believed me. nt

49. NO SHIT