Barack Obama, while campaigning in Iowa, has spoken out against the Medicare Advantage plans. Medicare Advantage is part one of the corporate welfare provisions in George Bush’s Medicare plan which provides subsidies to insurance companies to treat Medicare patients. Despite cherry picking the healthiest patients, it is significantly more expensive to treat Medicare patients under these plans. The plans engage in misleading sales tactics to get seniors to sign up without realizing what they are doing. The Des Mones Register reports:
The nation must stop health insurance companies from defrauding senior citizens, presidential candidate Barack Obama told residents in Des Moines on Friday.
The Illinois senator’s remarks came in response to a recent study and a government report that conclude Medicare’s private plan alternative – called Medicare Advantage – costs taxpayers more money, can increase premiums paid by seniors and, in some cases, has left people to find they do not have a doctor who accepts the coverage in their area.
The study, done by George Washington University professor Brian Biles, estimates that the average Medicare Advantage client will cost taxpayers $1,074 more in 2007.
The program was designed to reduced costs, largely through increased competition.
Medicare Payment Advisory Commission, an independent group that advises Congress, recently reported that the government pays 12 percent more on average to private Medicare plans than to treat comparable beneficiaries through traditional Medicare.
Elimination of excessive subsidies to the program would save nearly $150 billion in 10 years, which could improve total Medicare coverage and lower prescription drug costs, Obama said.
“The reason we don’t do something like that is because we are not setting the agenda in Washington – the insurance companies and the drug companies are,” Obama said. “And that’s what people want to turn the page on. They want a system that’s sensible and fair to everybody.”
Other deleterious affects of Bush’s Medicare plans has been the prescription drug plan which is designed more to channel money to hte pharmaceutical companies than to provide true prescription drug coverage, and annual increases in the Medicare deductible.
Related Post: Medicare Disadvantage
Why not take the wasted money from Medicare advantage plans and let CMS run Part D of Medicare. I did not say do away with Medicare Advantage, but do away with overpayments. This money could be used by CMS#1.To get better prices for prescriptions. #2. Do away with that God foresaken donut hole.#3. Lower premiums and copays and quit punishing seniors for not signing up for a voluntary drug program @1% per month. How is this voluntary??
Also, If you were 85 years old would you rather have a health club membership or your prescriptions paid for?
Allen,
The plan is voluntary. The penalty you mention is for higher premiums if they wait to sign up until a later year. (This is also for the Medicare D Plan). If they never sign up, they never pay this penalty. If they do sign up later, it makes sense to charge a higher premium when they are older than they would have paid if they signed up younger.
Hopefully those 85 year old who sign up for a plan with a health club membership are also getting prescription coverage. Most Medicare Advantage plans do include prescription coverage but in rare cases I have seen people who do not receive prescription plans.
I certainly agree with your key point of eliminating the subsidies paid for Medicare Advantage and using that money for the main Medicare Plan.
Looks like CMS is making it hard for a crook to make a living with the way they have structured how commissions will be paid on Medicare Advantage Plans. Plus with all the marketing restrictions these folks that actively market these plans, can go back to whatever they were doing before they started scamming Seniors.
I have been in the insurance business since 1967. when the medicare advantage plans came out I saw right away that they were going to be for a tiny select group of people at best, but I gave them a try anyway……after three months and over 100 presentations…TRUTHFUL PRESENTATIONS… I did not find a single customer who would take one of these “free” policies !! Today I make a pretty good living switching dis-gruntled, lied to, pissed-off people back to traditional medicare and a supplement, unfortunately, many have suffered a health change while on the plan and cannot get a supplement plan…and that’s a tragedy !
Finally some light at the end of the tunnel. Simply put, Medicare Advantage plans are private insurance companies that Medicare pays to take the risk off the back of Medicare. It has failed at saving Medicare money. It has proven to cost Medicare more in the long run.
My husband is on Medicare and I signed up for a traditional supplement for him. Right now we pay out about $1800 a year for that supplement and never pay another dime of medical bills. He can go to any specialist he chooses* and in any state in the U.S. He pays no deductibles and no copays because that is what the supplement is for. We also pay out about $400 a year for part D drug insurance and for our plan, any generics are free. (Brand names and very expensive brand names have tiers of copays.
My brother has a MA plan. Well, he has had 2 of them because the first one “quit doing business in our state”. So he had to choose a different one. He was not made aware by his insurance agent that he really was’nt with Medicare at all. He thought he was really getting a good price on a supplement because he had to pay some small copays. He is lucky he has not had anything but routine office visits and yearly lab work. Lucky so far.
My husband has a chronic, serious illness. We wouldn’t touch a MA plan with a 10 foot pole.
I know some people with serious financial constrictions need to choose MA plans and hope for the best. But I am glad we can afford the $1800**, knowing there will be no additional costs or devastating surprises.
* Maybe we are lucky to be in Wisconsin where 95% plus of doctors and clinics accept what Medicare pays. I think the comment that only 10% of medical providers would accept Medicare patients is a real load of bull.
** Yes, it goes up some every year…
well I have been in the Medicare Supplement business for 11 years, and am also certified by CMS to sell the advantage plans.
One thing everyone leaves out, the past year or so, all new Medicare recipients who join these “advantage” plans receive a phone call from the company. On a recorded line, they are asked if they understand that the plan is NOT a medicare supp, and that they will no longer use their medicare card. if they do not answer yes twice then they are not enrolled!
Having said that, I agree that these plans should be abolished. They DON’T work, many doctors refuse them (especially the PFFS crap), the benefits change YEARLY (copays and out of pocket expenses go up drastically), etc.
I am a conservative and usually vote republican, but these plans have to go. They are garbage.
I wonder if how often these calls really get through, and if so whether the people really understand them. I’m still seeing patients signed up in Medicare Advantage plans who have no understanding of what they signed up for.
I am an insurance broker and help people enroll into Medicare Supplemental and Advantage plans also.
Obama may be right citing the study. The HMO plans, at face value, offer incredibly good benefits. However, I found out the hard way that many of the doctors listed on insurance company’s list of providers do not accept the said plans. Private practices and hospitals don’t all accept all MAPDP’s also (HMO, PPO, PFFS).
Insurance companies don’t always do a good job a coordinating the application process (i.e. Anthem BC of California).
Rx plans really don’t need to have a “doughnut hole”. coverage can be universal.
Don’t need to have all insurance companies to sell all plans. Selecting a few companies would eliminate unecessary fixed cots. For examples, there are insurance companies who sell the same or with lesser coverage for $125/month compared to another company that sells the same type of plan but with better benefits for $0(zero)/month to the insured.
(excuse grammatical or spelling errors because I am not bothering with that at this time). Thank you.
YOUR FORMER EMPLOYER CAN FORCE YOU OFF ORIGINAL MEDICARE & ONTO MEDICARE ADVANTAGE, WITH A SMALLER NETWORK, LACK OF ACCESS TO PROVIDERS, OUTRAGEOUS OUT OF NETWORK COSTS, AND LOSS OF YOUR 2nd SUPPLEMENT !!! Did you know that don’t get to choose whether you want Original Medicare or Medicare Advantage? Your former employer does, and you have to go to Medicare Advantage, which is really private Medicare DISADVANTAGE, to keep you supplement, if they chose it. Medicare Advantage, has to give similar services, but not all the same services, nor pay the same rate, nor have all the Medicare providers. They can operate it as a PPO (Preferred Provider Organization), which will probably and most assuredly be a much, much smaller network. They do not have to have all the Original Medicare providers, or even a small part of them. The Advantage Plan need meet only “CSM ratios”, Central Medicare Services Ratios, which means so many providers of a certain types within so many minutes, of so many plan participants. Since each of these private plans is small, with a small number of participants, when compared to Original Medicare, you could end up with a very small network. Say there are 5 nursing homes in you town, and 2 aren’t in you plan, and 2 are full; you end up in the worst nursing home in town. Remember the farther you live away from your former employer, the less of a network you will probably have, since it’s based on the number of participants in a given area. Also you could have problems going to specialists and better hospital outside your home area. Say you need to go Sloan Kettering or John Hopkins, if they’re not in your plan, even through they take Original Plan, then you could end up paying say 30 to 40 % more to go there, than those with Original Medicare. So in order to Original Medicare providers not in you Medicare Advantage network, you will have many additional charges. There will probably be double coinsurance charges, double deductible, double Out Of Pocket Maximum , same as out of network costs in other private insurances. Also the Medicare Advantage Plan can add other out of Network fees. You will also be paying the difference between the Medicare Advantage rate and the Original Medicare rate, if out of network. Of greater concern is that no one will be setting usual and customary charges when out of network, which means you could have to pay and additional 20% to 35% of the bill. All this to use a provider, that everyone gets to go to if they have original Medicare, but we have to pay more with Medicare Advantage. It would work the same way with a Medicare Advantage Private Fee for Service Plan (PFFS) if you go to an Original Provider who doesn’t take their rates, then we have to pay the difference, to use an Original Medicare provider under Medicare Advantage, than when using that provider under Original Medicare with a supplement from our former employee. Lastly the network or Medicare Advantage provider can be changed yearly by your former employer, so you really can’t count on anything. Also Original Medicare allows a second supplement, and Medicare Advantage does not. Original Medicare has a really broad network, all providers in the country who accept Medicare, so it’s near impossible to be out of network, and have all those extra costs. Medicare Advantage costs us more of our tax dollars, while the Medicare DIS- Advantage companies make outrageous profits on our tax dollars just to give out our own tax dollars and supplement premiums, and severely limit our access to many of the Original Medicare providers. We lose choice and it costs us more.
This note only applies to some people, but constituted another take away of benefits that applies only to couples, where the spouses both worked and carried insurance on themselves and each other, one through one former employer and the other through another employer related plan. With Traditional Original Medicare when they retired, Medicare, of course, is the primary payer and pays first, and then through a Traditional Coordination of benefits, the private plans through the employer pays second, and the spouse’s plan pays 3rd, if there is anything left to pay. (This reverses for your spouse). This situation continues even, after both are on Medicare. In other words, Traditional Original Medicare allows 2 supplements. However, Medicare Advantage does not allow 2 supplements so you are forced to drop either your spouse’s insurance or yours. So after both have worked a lifetime for their employers, and earned both supplements, Medicare Advantage won’t let you have the 2nd supplement.
So just by forcing retirees on to Medicare Advantage, former employer’s supplement has not only changed its benefits, but denied participants the right to participant in Traditional Original Medicare, and for those who had a 2nd supplement (for which their spouse worked) forced them to lose it. It messed up 2 to 3 insurances for each participant, with the stroke of a pen. Medicare Advantage rules steal the second supplement from participants, while providing a smaller network. Only the insurance companies win.
Well folks. Just keep paying those medicare taxes and now you can get taxed more so that insurance companies can reap huge profits and TELL YOU WHERE YOU CAN GET SERVICES!!!!!
I have been in the medicare business for 20 years+and I have to agree with the doctor. They are a huge waste of taxpayer money. And yes I offer med advantage but I never put them into one unless they absolutely positively demand to be put in one. All you agents out there selling them like they are free should be writing your congressman to scrap them. You should be outraged As I said at the beginning of this, YOU ARE PAYING MEDICARE TAXES and it is going to private insurance companies for HUGE profits, and then the plan tells you where you can get services and every year they are reevaluated and they can change your BENEFITS. Do you really think they will make them better? NO!!!!! Just like the part D A lot of companies covered in the gap and one they figured out how to make more money and screw the consumer, none of them now cover the gap. What was meant to provide seniors with affordable drug coverage now cost them more to be ripped off.
And yes there are still MAJOR abuses and people still not knowing what they are in untiil it is too late. I personally know of a client in a company I used to work for that had a med supp that paid %100 of his gaps on a supplement He dropped it to join a med advantage plan with a zero premium with a $5ooo out-of-pocket maximum. Four months later he had bypass surgery and his portion of the bill came to $29,000!!!!!!!! He took it to his attorney and the attorney said “YOU HAVE TO PAY IT”!!!!!!! So now he is back on his supp and will never leave again. And the only reason he could get back on that plan is because he hadn’t been in it for at least a year.
If you are out there selling them, STOP> I have heard many horror stories from all over the country cause I sell in about 30 states. The only complaint I ever hear about a medicare supplement is that it is getting too high. If you can’t afford a supplement, just go without. Many Doctors, and I’m sure Dr Ron has done this, just settle for what medicare will pay if they can’t afford it cause it is better that trying to deal with a penny pinching company who makes up their own rules on a med supp. (Yes I have heard from folks who had med adv plans that said no co-paysd for anything and when they have chiropractic that was covered by medicare, they are now not getting it paid. And yes this was a lady who was misled and didn’t know she had lost her medicare. But even upon reviewing her plan it said ZERO co-pays for EVERYTHING) Medicaid is out there to help those who can’t afford squat cause they blew all their $ instead of saving for retirement and that will always be a fact of life. So contact your representative and tell them you are tired of paying medicare taxes and funding Insurance companies record profits
and for my next trick try looking at these sites
http://www.suddenlysenior.com/.....ories.html
http://suddenlysenior.com/Medi.....tages.html
Well the time has come for Medicare Advantage to go. I just had a lady tell me that Care Improvement Plus a special needs plan had raised her husbands premium to a staggering $518.00 per month. Where is the savings? This represents half of his SS check. This stuff must go.
Allen,
The question is whether she was given honest information about the plan and costs. A high cost plan in itself isn’t bad provided that the plan provides services which justify the cost, and provided the patient was informed about the costs when making the choice.
This plan was bought several years ago and the cost was around $114.00 the new cost you see is a rate increase to $518.00. If this person was on the original medicare at his age of 77 I could sell him a plan J for around $170.00 per month and a part D for $48.00 , for a total of $218.00. This would eliminate copays for part A and B and provide equal drug coverage. This person has been on the medicare advantage plan for more than a year and health problems have tied my hands as far as offering original supplemental coverage. What I did do was to call a friend of mine who offers the disadvantage insurance. She will put him on a plan for less. Hopefully, these plans will terminate and all will be on original medicare soon.
That is quite a jump in the rate, especially considering the relatively short time these plans have been around.
It is my understanding that this outfit is doing this to get rid of these people on this particular plan. Their next plan is $349.00 per month. Anyway you slice it these things are not beneficial to the beneficary.
I am getting emails from marketers that promote the Medicare Advantage plans, saying that insurance agents should contact their senators to keep these plans. They say that it will force seniors to go back on Medicare as it was and these folks just can’t afford this. Sinse when is it the tax payers job to pay for everything that comes along? For the one’s that can’t afford,what is Medicade for? The marketers really do not have but one thing on their mind and that is the money they make. Why can’t Medicare administer part D? When my policyholders ask me about part d I refer them to medicare.1-800-medicare. I let Medicare sell this stuff , so when something goes wrong with the private insurer,which it will, I am not in the middle. I would like to see these over paid Advantage plans go away. Medicare could take the over payment and use them to lower the cost of part d, negotiate drug prices and do away with the donut hole. If our government thinks that medicare should offer extra benefits like dental,glasses and a health care membership at you local Gym, then add it to the original medicare. I believe that if the average taxpayer found out that they were paying for Gym memberships for 80 year old people they would freek out. The time to stop these government give aways is now! The other problem with our health care which is very seldom mentioned is the high cost of medical care. My wife had a deviated septum repaired as an out patient. A 40 minute procedure. The bill $31,841.25 . With our group insurance she paid a $75.00 copay. Healthcare can not be changed until these prices have been brought under control.
The above blog consists of an argument between a MD and sales people for Medicare Advantage Plans. Who do you think is telling the truth, a MD who has had to prove his intelligence and sales people for private insurance plans with a highly biased point of view!! Sales people get this straight, Medicare Advantage plans are a sneaky backdoor attempt by Republicans to privitize Medicare. Unthinking Medicare beneficiaries sign up for these plans when “extra benefits” are offer to them, by sales people at the expense of regular Medicare beneficiaries and the taxpayer. The insurance pool for regular Medicare decreases as well increasing costs for regular Medicare beneficiaries. What is it about the fact that it costs the taxpayer 12% more per Advantage Plan beneficiary that you can’t understand? Obama and Ron Chusid are right on and voters like me are going to put you out of business! Get real jobs.
I recently set my mom who had mild dementia up with an interfaith senior center in her community. She had an affordable apartment for seniors in their complex. Mom had a Medicare Advantage plan at the time. This center was ready to provide her with a three days a week home aide and at home physical therapy in her apartment. To receive these services she needed to get off her Medicare Advantage plan which denied these services and enroll in original medicare. Everything was set up and ready to go. A social worker visited her at home and confirmed her eligibility. Every time I set this up for her, she would get a phone call from the Advantage plan scaring her back into the Advantage plan. They were very aggressive in retaining her, and she couldn’t understand that this was the reason she didn’t have the same home care other residents who were on original medicare received. It was a nightmare as I lived a state away from her and we were unable to receive these services which medicare original would have provided. Sadly this went on for months, until her dementia worsened and she is now in a nursing home. In order to get into the nursing home, the admission director had us immediately get her off the Advantage Plan and enroll in original medicare. . From that point on the gates opened and she has been flooded with compassionate care and excellent medical services. I was blown away by the quality of care she is now receiving and sleep well knowing she is safe. Had it not been for the Medical Advantage Plan she could have had a much easier time while she was still living at home. Having seen this play out in my family, the services provided by medicare original are first rate.
How about using Original Medicare and an old fashon Medicare Supplement?
What any individual should to is different from what should be done based upon public policy concerns. While the subsidies to Medicare Advantage programs should be ended, any individual consumer is best off looking for the deal that’s best for them as long as MA plans do exist. Compare both Medicare with supplements and Medicare Advantage plans.
It is necessary to take a close look at actual costs of the plan and what you will receive. Only benefits which will actually be used should be considered, as opposed to many of the gimmicks used by some Medicare Advantage plans.
It is also necessary to take a close look at the policies of a MA plan before signing up should it appear to be better than Medicare with supplement. This includes knowing if the doctors and hospitals you are interested in participate and if there will be any problems should you be in a different part of the country part of the year.
Needless to say, it is necessary to take a close look yourself. While hopefully most insurance salespeople are offering honest and correct information, there has been plenty of evidence of fraudulent sales tactics going on. Comments above in this thread alone show that there are people selling plans without really understanding how Medicare works.
I to sell Medicare Advantage Plans ( pffs). I do not make false claims when I present them either. I show my customers their options. I compare cost. I check with their hospitals and doctors to ensure that the plan will be accepted prior to enrollment. I have help so many people who could not afford traditional medicare supplements. You people just dont like the fact that you cant control health care. Why dont you ask people what they want instead of making their mind up for them. My customers are so happy now and they actual go to the doctor more now than they ever did before.
By the way, to even concerned the idea that medicare can take the extra money and provide 100% coverage instead of 80% is just plan dumb. That cant happen..impossible. Think about it, give the goverment more money to budget, please, as if. We see how well spent the money they have now is. INSURANCE COMPANIES DO BETTER MANAGING MEDICAL BILLS AND PREMIUMS! THAT’s Their buisness.
Amber,
This has nothing to do with controlling health care or preventing people from making up their own mind. The problem with people making up their own mind comes into play from the many cases found of people being signed up for plans without their knowledge.
You are missing the main point of Medicare Advantage Plans receiving subsidies which could better be spent on all Medicare beneficiaries. The extra money would not be enough to eliminate the 20% copay under Medicare, but the money could make a real difference. If private insurance companies can really do better, why do they need subsidies, and why does it cost so much more to care for patients under private insurance plans than under Medicare?
I haven’t read all of your posts, but I will say this: I am paying $729/quarter for my Medicare Supplement. I am now in the Gap on my prescription plan for which I am paying $86/mo. And the govt is taking around $90/mo out of all of our soc. security checks. But, dispite paying $419/mo for insurance, I am now in the Donut hole or Gap and will be paying 100% of my meds for the rest of the year. Just one generic med is $279/mo at Walgreens. Due to my retirement income, I don’t qualify for the medicaide deal covering part of it. On the other hand, my girlfriend who has an Advantage Plan is going through a nightmare trying to get a biopsy on her large lung nodule. If I hadn’t made a bunch of calls for her she would still not even have an appt. with the thoracic surgeon, after about 7 weeks. Part of this was the referral process and having been sent to a reg. surgeon needlessly before the Thoracic one. Also, I guess there had to be approval for her cat scans? Finally, one concern I have is that part of the not returning calls, etc. was that the busy providers were giving preferential treatment to those on regular medicare. That is a scary thought, eh? One reason I think that might be true, was that one surgical office staff said that they only see one lung patient a week because they spend extra time with them. WTF?? So, someone is to sit around with lung cancer waiting for their turn while the surgeon continues to see people with gallstones, etc? Thank you for viewing both sides of the picture. Bottom line is this: Can you afford over $400/mo for healthcare? If so, I believe you will get much better treatment.
Break out all the facts you want. There are good MA Plans and bad ones. I do MA Plans and Medigap Plans. If Obama gets rid of Advantage Plans, how will seniors that DON’T qualify for a medicare supplement fair? Let’s not forget medicare is struggling and will need to continue to cut back more and more. 20% of $100,000 is a lot for a senior to pay. When they have to cut back, look for 20% to be more, deductibles to be more, and more than likely when I get of age, medicare will not exist. I say leave them. If someone does not want them, they don’t have to get them.
If Medicare is struggling that is more reason to get rid of the subsidies to Medicare Advantage plans and reduce this unnecessary expense.
If the concern is to reduce out of pocket expenses for seniors, it is better that the money be used to reduce out of pocket expenses for all Medicare patients. Use the money to roll back the increased deductible that was put into place when Medicare D was started, and use the money to get rid of the donut holes.
Quit the scare stories to sell your plans. Nobody has to pay “20% of 100,000.” That’s now how the co-pay works. It only applies to certain out patient services with the co-pay for hospitalizations being much less (assuming they don’t have s supplement to cover it). It sounds like you are using scare stories to get money out of seniors so you can earn a commission.
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Some people would like to buy a supplement but there is a monthly payment they don’t want to pay. Medicare advantage has no monthly premium and will never cost you anything if you never use it. Why pay for something you never use. That is the reason to sign up for Medicare Advantage. Original Medicare has deductables and 20 percent co-insurance so it aint free.
Not true. Some Medicare Advantage plans have no premiums but they are typically limited plans, often with lots of hidden costs. I’ve seen many Medicare Advantage plans with significantly higher copays than with traditional Medicare–it is necessary to be very careful when shopping.
In addition, some Medicare Advantage plans place a lot of restrictions, such as which doctors people can see. I’ve seen cases of patients traveling out of state and getting stuck with the entire bill because the Medicare Advantage plan wouldn’t pay for out of network costs.
Of course all Medicare Advantage plans have the problem that extra money in subsidies is being paid to the insurance companies to increase their profits–money which is better spent on actual health care.