Medicare Advantage crackdown!

[Greenbeard]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem. Now comes the regulatory crackdown:

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers (Published 2023)

The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.

www.nytimes.com

This on the heels of other bad behavior being exposed and some degree of crackdown on other behaviors:

Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (Published 2022)

The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.

www.nytimes.com

U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans (Published 2022)

Proposed regulations would crack down on misleading ads for the private plans and would enhance scrutiny of denials for coverage of medical care.

www.nytimes.com

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

 

[Fearandloathing]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem. Now comes the regulatory crackdown:

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers (Published 2023)

The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.

www.nytimes.com

This on the heels of other bad behavior being exposed and some degree of crackdown on other behaviors:

Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (Published 2022)

The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.

www.nytimes.com

U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans (Published 2022)

Proposed regulations would crack down on misleading ads for the private plans and would enhance scrutiny of denials for coverage of medical care.

www.nytimes.com

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

You have listed every reason why Canada nationalized health care in the late 1960's'

Profit is good when there is competition. The health field in most cases are private and need profit to survive. However, with health care, like dentistry, it's easy to cheat, advise new meds (for a kick back) and providing services that are marginally needed but profitable. And even with competition, the prices rise as doctors and medical clinics consider posted rates a "suggestion".

I bet if you ask enough people in one day, you will hear a half a dozen horror stories.

 

[notquiteright]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem. Now comes the regulatory crackdown:

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers (Published 2023)

The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.

www.nytimes.com

This on the heels of other bad behavior being exposed and some degree of crackdown on other behaviors:

Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (Published 2022)

The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.

www.nytimes.com

U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans (Published 2022)

Proposed regulations would crack down on misleading ads for the private plans and would enhance scrutiny of denials for coverage of medical care.

www.nytimes.com

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

BUT BUT BUT.... COMMIE!!!!!!!!!

 

[BirdinHand]

Step 1: Remove ALL advertising of these Medicare advantage plans and also pharmaceuticals from tv. Since my in laws are staying with us, I have heard and seen more drug and Medicare ads than I ever knew existed (they watch daytime tv)

Only the US and New Zealand- out of the entire world allow direct to consumer advertising of pharmaceuticals.

 

[Helix]

We need a single payer system that covers everyone.

 

[Chomsky]

We need a single payer system that covers everyone.

Bingo!

 

[Lovebug]

We need a single payer system that covers everyone.

That was easy. Too bad we won't move anything for the next two years, not with the clown show in the House.

 

[Callen]

Perhaps Medicare Advantage subsidies to providers should be eliminated as part of the desired spending cuts after all it was never part of the original deal. I'm sure Republicans here would welcome that.

 

[Helix]

That was easy. Too bad we won't move anything for the next two years, not with the clown show in the House.

It will probably take decades.

 

[DrewPaul]

We need a single payer system that covers everyone.

Make it mandatory for everyone (all US citizens, rich, poor famous regardless of nationality or political office) to receive the same healthcare through a single payer and I will be 100% on board with it. What I suspect will happen is the rich, famous or people in public office will receive the best of the health care while the rest of us get in line and get what's left over.

When I was a sailor in the USN I was onboard a small ship. But we all ate really good. One reason because we all got the same food. E1 to the Captain.

 

[Greenbeard]

We need a single payer system that covers everyone.

Most single-payer advocates start, at least rhetorically, by invoking Medicare. But this is Medicare!

Perhaps Medicare Advantage subsidies to providers should be eliminated as part of the desired spending cuts after all it was never part of the original deal. I'm sure Republicans here would welcome that.

Nah, when the ACA cut the then-extravagant subsidies that Medicare Advantage enjoyed to bring the program in line with traditional Medicare's costs, the right screamed bloody murder. That was going to destroy the program!

2011:

Obamacare and Medicare Advantage Cuts: Undermining Seniors’ Coverage Options

Medicare Advantage (MA) plans are private insurance options available to Medicare beneficiaries. The Patient Protection and Affordable Care Act (PPACA)[1] cuts deeply into the projected payments to MA plans. Millions of Medicare beneficiaries enrolled in MA plans, or who would have been enrolled...

www.heritage.org

They were exceptionally wrong.

2023:

Medicare Advantage enrollment surpasses 30 million

Nearly half of all Medicare beneficiaries are enrolled in Medicare Advantage programs. Insurers hailed the milestone, but lawmakers have pressed for reforms, citing delays in approval for treatments.

www.chiefhealthcareexecutive.com

 

[Callen]

Most single-payer advocates start, at least rhetorically, by invoking Medicare. But this is Medicare!



Nah, when the ACA cut the then-extravagant subsidies that Medicare Advantage enjoyed to bring the program in line with traditional Medicare's costs, the right screamed bloody murder. That was going to destroy the program!

2011:

Obamacare and Medicare Advantage Cuts: Undermining Seniors’ Coverage Options

Medicare Advantage (MA) plans are private insurance options available to Medicare beneficiaries. The Patient Protection and Affordable Care Act (PPACA)[1] cuts deeply into the projected payments to MA plans. Millions of Medicare beneficiaries enrolled in MA plans, or who would have been enrolled...

www.heritage.org

They were exceptionally wrong.

2023:

Medicare Advantage enrollment surpasses 30 million

Nearly half of all Medicare beneficiaries are enrolled in Medicare Advantage programs. Insurers hailed the milestone, but lawmakers have pressed for reforms, citing delays in approval for treatments.

www.chiefhealthcareexecutive.com

It's like so many other things ......I am OK cutting back on funding for your priorities but don't dare mess with mine.

 

[MaryP]

We need a single payer system that covers everyone.

I agree, but I have a Medicare Advantage plan where I pay no premium, I do not pay my Medicare premium, I have no copays for doctor visits or tests. I have supplemental coverage for dental and vision, never pay more than $4 for a prescription, and get $125 of free OTC products every 3 months from CVS delivered by mail. Some of this is because I am low income (not MedIcaid), and I need to find doctors in the network to have 0 copays, but I am really happy with my coverage--and the low cost. I hope this isn't going to mess things up.

 

[Gateman_Wen]

We need a single payer system that covers everyone.

 

[multivita-man]

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

Here's a better idea: get rid of privatization.

 

[multivita-man]

We need a single payer system that covers everyone.

Precisely,

And we could still have private medicine, private insurance, private whatever for people who can pay for it

 

[Helix]

Precisely,

And we could still have private medicine, private insurance, private whatever for people who can pay for it

Yep. However, I'd like for the basic coverage to be pretty comprehensive.

 

[cpwill]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem.

Interesting. The other week you were bragging to me how Medicare costs have been falling relative to earlier projections.

So, that coincided with an expansion of the portion of the Medicare populace that was choosing a more privatized option?

Huh. Well Whattya know

 

[Greenbeard]

Interesting. The other week you were bragging to me how Medicare costs have been falling relative to earlier projections.

So, that coincided with an expansion of the portion of the Medicare populace that was choosing a more privatized option?

Huh. Well Whattya know

Unfortunately it still costs the taxpayers more if a beneficiary chooses Medicare Advantage over traditional Medicare, as it always has. But the ACA eliminated most of the disparity (i.e., Medicare Advantage was ~18% more expensive than traditional Medicare when the ACA passed and fell to <2% more expensive thanks to its reforms—reforms that you folks claimed would obliterate Medicare Advantage). At the moment it’s somewhere around 4% more expensive than traditional Medicare, largely due to the fraud this thread is about.

Medicare Advantage has always pushed Medicare spending above what it would be in the absence of that privatized component, never below. So its swelling enrollment is a net negative for the program’s finances, unfortunately.

 

[notquiteright]

Step 1: Remove ALL advertising of these Medicare advantage plans and also pharmaceuticals from tv. Since my in laws are staying with us, I have heard and seen more drug and Medicare ads than I ever knew existed (they watch daytime tv)

Only the US and New Zealand- out of the entire world allow direct to consumer advertising of pharmaceuticals.

When you turn 65 your mailbox both snail mail and Email will overflow with advertising. Watch certain channels and the enrollment period commercials are nonstop....

All I can say is I'm so grateful both my wife and I qualify for VA medical....

 

[BirdinHand]

When you turn 65 your mailbox both snail mail and Email will overflow with advertising. Watch certain channels and the enrollment period commercials are nonstop....

All I can say is I'm so grateful both my wife and I qualify for VA medical....

It is ridiculous.

Yes, people need to be reminded when enrollment periods are.

But the non-stop ads with “have you taken advantage of”. “You may be entitled to”

It is simply predatory on seniors.

 

[ttwtt78640]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem. Now comes the regulatory crackdown:

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers (Published 2023)

The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.

www.nytimes.com

This on the heels of other bad behavior being exposed and some degree of crackdown on other behaviors:

Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (Published 2022)

The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.

www.nytimes.com

U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans (Published 2022)

Proposed regulations would crack down on misleading ads for the private plans and would enhance scrutiny of denials for coverage of medical care.

www.nytimes.com

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

All the links are behind a paywall. I’ve read about this from another source (see below) and it was based on rather old (2013 and before) data and listed two (out of ???) MA plan providers as being ‘major offenders’.

https://www.npr.org/sections/health-shots/2022/11/21/1137500875/audit-medicare-advantage-overcharged-medicare

 

[ttwtt78640]

It is ridiculous.

Yes, people need to be reminded when enrollment periods are.

But the non-stop ads with “have you taken advantage of”. “You may be entitled to”

It is simply predatory on seniors.

My girlfriend and I like our WellCare MA ‘give back’ plans which pay us (each) 95$/month. I don’t see that as being “predatory”.

 

[noonereal]

Lots of privatization of government programs and functions these days, and Medicare is no exception. For decades Medicare has allowed enrollees to choose regulated private insurance plans that gets a premium from Medicare (and often the enrollee). But that opens up dangers of legislative lobbying, regulatory capture, and even outright fraud. In the 2000s, private plans were (intentionally) substantially overpaid relative to traditional Medicare, but the Affordable Care Act put an end to that gravy train and ended those overpayments. Even so, many of the private insurers participating in Medicare Advantage have seemingly continued to take more money than they should, now by misrepresenting how sick their enrollees are.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions (Published 2022)

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

www.nytimes.com

Medicare Advantage enrollment has been growing steadily in recent years and now for the first time enrolls half of Medicare beneficiaries, raising the stakes on this problem. Now comes the regulatory crackdown:

New Medicare Rule Aims to Take Back $4.7 Billion From Insurers (Published 2023)

The government plans to aggressively audit Medicare Advantage plans for overbilling but may face lawsuits.

www.nytimes.com

This on the heels of other bad behavior being exposed and some degree of crackdown on other behaviors:

Private Medicare Plans Misled Customers Into Signing Up, Senate Report Says (Published 2022)

The report by Senate Democrats points to widespread misbehavior by the plans and the marketing firms they hire.

www.nytimes.com

U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans (Published 2022)

Proposed regulations would crack down on misleading ads for the private plans and would enhance scrutiny of denials for coverage of medical care.

www.nytimes.com

In all the time it's existed, the privatized portion of Medicare has never saved the taxpayers money. It's never even been at parity with traditional Medicare, though it got close in the aftermath of the ACA's reforms. Can we regulate our way to making privatization work better?

I won't go near Advantage plans.

 

[noonereal]

My girlfriend and I like our WellCare MA ‘give back’ plans which pay us (each) 95$/month. I don’t see that as being “predatory”.

What does this mean? Is this Massachusetts?
How and why do you get cash back, specifically?