Medicare Advantage programs receive 13% to 19% more to take care of Medicare patients than is paid through the government program. I just had a patient come in saying that their Medicare Advantage plan will stop operating as of January as they no longer find it profitable despite these higher payments. There was also another plan which I had patients in which stopped operating as of January of this year. I’m glad to hear that they are going away as a few times they have refused to pay for lab tests which were needed, and which Medicare would pay for. Most likely their denials were motivated purely by financial considerations as opposed to medical need.
So much for the greater efficiency of the free market, alon g with the idea that it is government, and not private plans, which “ration” health care.
I’m sure there are isolated situations where any health plan does something distasteful, however, Medicare Advantage has saved seniors millions of dollars. I was a party to one case where Medicare A/B left a beneficiary $10000+ in bills where Medicare Advantage would have left a $550 bill. However, you will never hear about these situations on a website such as this.
So much 4 free market health care – profitability (scams) & private insurance, enriched by Medicare Advantage http://bit.ly/dqhLZ #health
I am not only talking about “isolated situations.” The problem with Medicare Advantage plans is a problem with the entire system as it wastes money on subsidies which primarily increase the profits of insurance companies.
You are right–you will not hear about claims that a MA plan has saved thousands of dollars because web sites such as this strive to present accurate information. Such claims are a common scam used by sellers of MA plans who typically compare the full hospital charges and falsely claim that someone on Medicare would have to pay 20% which is not really the case.
Ron is right and this is not new news. I wonder if Dave has an ulterior motive for supporting MA’s. I have a relative who handles insurance for a large grocery chain in this area. As I was retiring she advised me not to get a MA because they are, as Ron says, a scam.
“I wonder if Dave has an ulterior motive for supporting MA’s.”
Most likely he sells them. I have received lots of comments on earlier posts on Medicare Advantage Plans, generally from links from boards used by people who sell insurance.
I’m not actually saying they are a scam–but a lot of people have been screwed in them making many feel this way. As public policy they are a bad idea as they cost more to care for patients than under the government program. There are a lot of dishonest sales people who sign up people without their knowledge or provide dishonest information. From the comments in earlier threads, it is also clear that many of the people who sell the plans are very ignorant as to how Medicare works. They have no concept of how Medicare actually pays on hospitalizations.
That said, if you are looking for your own personal plan then they might be worth considering. For an individual you may or may not get a better deal than if you go with Medicare and a supplemental plan. While they are bad public policy, when purchasing a policy for yourself this isn’t really an issue.
One thing to be careful of is that any doctors you want to see participate in the particular plan, and that there are provisions for travel. I recently had a patient with serious medical problems come to see me after moving to the area and give their conventional Medicare card. It turned out that she was really in a Medicare Advantage plan which would not pay because she was out of network. As her network doe s not extend out here (and she did not take my advice to drop the plan and go to regular Medicare if they would not cover her after moving) she simply stopped obtaining medical care. Several months later she wound up critically ill. At least at that time the MA plan agreed to pay for her extended hospitalization. It would have actually been cheaper for them if they had paid for routine care which would have prevented the need for the hospitalization.
The sad fact is that so many people simply don’t know the right questions to ask, probably because they have never had to think about coverage out of network or limits to coverage or prescription coverage. I will say that’s one area of Medicare that needs redesigning.
Note those are problems with Bush’s Medicare D program–not the original Medicare program.
You’re right. I’d also like to add that the folks who don’t know what to ask or what to look for are more likely to be victimized by, if not scams, unethical insurance reps.
The fundamental problem with most privatization schemes (such as Medicare Advantage) is that they are far more wasteful and corruption prone than the government agenecies (allegedly corrupt and wasteful) they are intended to replace. Rather than true ‘privatization’ (which would involve selling the agency in question to businessmen and letting them run it privately, direct to the consumer, which is entirely impossible in most of these cases), they consist of the government calling in private business to run something for them at a fee.
Think about this: in order for private business to make a profit doing this, they must collect more from the government than the cost of operating the business. Which means they must often collect more money from the government than the government was, itself, spending in order to post profits. Or else they must cut costs which undermine the service being provided.
There are also other inherent dangers in these schemes.
Generally speaking, regardless of whether or not programs like MA are or are not scams against the end user (and, scam or not, they are frequently inferior to the original government ‘product’), privatization schemes ARE scams. Against the government.
“Think about this: in order for private business to make a profit doing this, they must collect more from the government than the cost of operating the business…”
Conservatives often claim that private companies are always more efficient than government, and by their logic a government run health plan should not be able to compete with private plans.
The reality is that health care is not something which the market handles well, largely as insurance companies turn to denying care as a way to increase profits. Arguments based upon cost, and conservative arguments about Medicare, are a poor argument against health care reform. If we were to decide based purely upon cost we should scrap the private insurance companies and turn to a single payer plan–which is hardly what conservatives arguing about cost really want.
I agree completely, Ron. Indeed, this is the basis of my argument for far more comprehensive reform (coupled with the need to separate health care costs from American business for economic reasons) than being discussed now. Which is, of course, an entirely different discussion.
Conservatives don’t really want a small government or a government that doesn’t redstribute wealth, at least not the conservatives in Washington. They want a government just the right size to redistribute tax-payer dollars to private business (particularly corporate business) because that’s where the tax-payer dollars are. Unfortunately, the conservatives who think this way are not all Republicans. Supply side economics has a lot of traction in Democratic circles too.