Medicare Advantage Growth Driving Up Federal Spending

[Greenbeard]

When it comes to long-term federal spending obligations and the debt picture, Medicare has always been the story. And the spectacular savings (cumulative trillions of dollars so far) in Medicare savings that have been achieved since the Affordable Care Act passed in 2010 are also a key part of that story.

A Huge Threat to the U.S. Budget Has Receded. And No One Is Sure Why.

Well, I'm pretty sure why, but I guess others are still wondering what odd thing happened in 2010 to make both Medicare and the entire American health care system more sustainable. Anyway, the New York Times clues in today on "the most important thing that has happened to the federal budget in...

debatepolitics.com

Some of the savings in that law came from fixes to the way payments to insurers participating in Medicare Advantage, the privatized part of the program, are determined. Those payments were significantly inflated back when the ACA passed, with private insurers being paid ~18% more than traditional Medicare paid for the same care. Even as the ACA reduced those overpayments, enrollment in Medicare Advantage has grown (contrary to conservatives' predictions a decade ago). When the ACA passed, 26% of Medicare beneficiaries were in Medicare Advantage; this year 52% are.

With a majority of beneficiaries now enrolling in those private plans, it raises the stakes on the fact that, whack-a-mole-style, those insurers have again been finding ways to game the system to inflate their payments. And that's generating some tension between some of the commissioners of MedPAC, the group of experts convened by Congress to serve as its advisory body on Medicare payment policies.

MedPAC Report on Medicare Advantage Growth, High Costs Generates Kerfuffle

A Medicare Payment Advisory Commission (MedPAC) meeting turned unusually contentious Friday as one member, Brian Miller, MD, MPH, of Johns Hopkins University in Baltimore, accused panel leadership of issuing a negative status report opens in a new tab or window on Medicare Advantage (MA) plans' market dominance, saying it had been "hijacked for partisan political aims to justify a rate cut to Medicare Advantage plans."

The subject of his ire was a slide presentation that is posted for the public -- and a lengthy report that only commissioners can read -- highlighting growing concerns with the rapidly increasing amounts of Medicare funds now flowing to MA plans. The slides showed that MA plan "coding intensity" and "favorable selection" increased spending to MA plans -- $82 billion in 2023 alone -- above what Medicare paid for care to fee-for-service beneficiaries.

The analysis detailed the numerous ways that MA plans generate higher revenue, including enrolling people who are relatively healthy, known as favorable selection. They then vigorously scan patients' medical histories and charts to code for health factors that generate higher per-capita payments, known as coding intensity, often spending less on services. Coding intensity is also the difference between a risk score that a beneficiary would receive in an MA plan versus in fee-for-service.

The report said that coding intensity has increased over the years, with many of the biggest MA plans appearing to do the most. It also noted that a few plans now dominate the MA plan market, and that three companies -- UnitedHealthcare, Humana, and CVS Health -- enrolled 58% of all MA enrollees in 2023.

Hard to see how we tackle spending and debt--and build on the impressive savings that have been achieved to date--without again addressing the extra payments that Medicare Advantage insurers are getting from the taxpayers.

 

[Ishm]

When you have a for profit health care system we shouldn't be surprised when companies find a way to extend their profits at the public expense.

 

[dockside]

When it comes to long-term federal spending obligations and the debt picture, Medicare has always been the story. And the spectacular savings (cumulative trillions of dollars so far) in Medicare savings that have been achieved since the Affordable Care Act passed in 2010 are also a key part of that story.

A Huge Threat to the U.S. Budget Has Receded. And No One Is Sure Why.

Well, I'm pretty sure why, but I guess others are still wondering what odd thing happened in 2010 to make both Medicare and the entire American health care system more sustainable. Anyway, the New York Times clues in today on "the most important thing that has happened to the federal budget in...

debatepolitics.com

Some of the savings in that law came from fixes to the way payments to insurers participating in Medicare Advantage, the privatized part of the program, are determined. Those payments were significantly inflated back when the ACA passed, with private insurers being paid ~18% more than traditional Medicare paid for the same care. Even as the ACA reduced those overpayments, enrollment in Medicare Advantage has grown (contrary to conservatives' predictions a decade ago). When the ACA passed, 26% of Medicare beneficiaries were in Medicare Advantage; this year 52% are.

With a majority of beneficiaries now enrolling in those private plans, it raises the stakes on the fact that, whack-a-mole-style, those insurers have again been finding ways to game the system to inflate their payments. And that's generating some tension between some of the commissioners of MedPAC, the group of experts convened by Congress to serve as its advisory body on Medicare payment policies.

MedPAC Report on Medicare Advantage Growth, High Costs Generates Kerfuffle





Hard to see how we tackle spending and debt--and build on the impressive savings that have been achieved to date--without again addressing the extra payments that Medicare Advantage insurers are getting from the taxpayers.

I had Medicare Advantage for several years when I first was covered, due to my not understanding that it is an HMO. Instead of your doctor calling the shots, a claims adjuster will decide whether you need treatment A or treatment B. A couple of times, our only local hospital was not in it's preferred provider group and at times I had a very difficult time finding a specialist for certain health issues that were part of the network. And, once, when I needed a CT scan, immediately, my doctor spent two hours on the phone trying to get permission from my carrier. The CT clinic told me to go to the hospital ER and they would send me over for the scan which the insurer couldn't deny. I ended up having emergency surgery that night, thank goodness.

IMO, it's a scam. Having to get the insurer's permission to perform tests that needed to be done immediately to save my life is outrageous. Luckily, I was able to change to regular Medicare and would never go back to MA. A cheap premium insures cheap coverage. If you expect to be healthy until the day you die (who is that prescient?) it might pay. But, for the elderly, it's horrible once you get into your 70's. And, then, if you are not healthy, you may not find a Medicare Supplement insurer who will insure you (you can still get regular Medicare which has deductibles and co-pays - at least that's my understanding).

 

[Pyrite]

Thanks for this update. Every once in a (great) while, I've come across references to Medicare Advantage fraud.

https://www.washingtonpost.com/business/2022/06/05/medicare-advantage-records-fraud/

June 5, 2022

...Medicare Advantage, which is run by outside companies under contract with the government, was added to traditional Medicare in 2003 with the support of Republicans in an effort to improve care and lower costs through privatization. But it is costing taxpayers increasingly more money to run than traditional fee-for-service Medicare, according to MedPAC, a government watchdog panel. The higher cost, what MedPAC labels “excess payments,” reached $12 billion in 2020 out of total program costs of $350 billion and are projected to top $16 billion next year, MedPAC said in March.

The aggressive billing tactics stem from incentives built into Medicare Advantage. Under the program, companies are paid a flat fee per month to provide whatever care is required for a patient based on age, gender, geography and health risk factors. To compensate plans and providers for potential costs of care for individual patients with conditions such as diabetes, heart disease or cancer, Medicare boosts the monthly payment to Medicare Advantage plans under a “risk adjustment” for each additional condition. The system differs from the traditional “fee for service” payment, in which Medicare pays hospitals and doctors directly each time they provide a service.

If companies add more risk adjustment codes to a Medicare Advantage beneficiary’s medical record to receive higher payment — but don’t spend money on the additional care — they make more money....

...[T]he government considers it improper — potentially even fraudulent — for providers to add codes for medical conditions that have been resolved or have no bearing on a patient’s current health....

 

[Greenbeard]

IMO, it's a scam. Having to get the insurer's permission to perform tests that needed to be done immediately to save my life is outrageous. Luckily, I was able to change to regular Medicare and would never go back to MA. A cheap premium insures cheap coverage. If you expect to be healthy until the day you die (who is that prescient?) it might pay. But, for the elderly, it's horrible once you get into your 70's. And, then, if you are not healthy, you may not find a Medicare Supplement insurer who will insure you (you can still get regular Medicare which has deductibles and co-pays - at least that's my understanding).

There's definitely been growing evidence that there are issues with it that need to be addressed as soon as possible.

Seniors stuck in Medicare Advantage nightmare: 'designed to confuse' us

A growing number of Americans are finding insufficient coverage options or jaw dropping medical bills after unknowingly signing up for Medicare Advantage.

www.newsweek.com

Older Americans Say They Feel Trapped in Medicare Advantage Plans - KFF Health News

As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.

kffhealthnews.org

The Great Medicare Advantage Marketing Scam

How for-profit health insurers convince seniors to enroll in private Medicare plans

prospect.org

Denied by AI: How Medicare Advantage plans use algorithms to cut off care for seniors in need

A STAT investigation found artificial intelligence is driving Medicare Advantage denials to new heights, cutting off care for seniors.

www.statnews.com

‘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

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

Hospitals and Doctors Are Fed up With Medicare Advantage - KFF Health News

Medicare Advantage plans are pretty popular with both lawmakers and ordinary Americans — they now enroll about 31 million people, representing just over half of everyone in Medicare, by KFF’s count. But among doctors and hospitals, it’s a different story. Across the country, provider grumbling...

kffhealthnews.org

 

[jonny5]

When it comes to long-term federal spending obligations and the debt picture, Medicare has always been the story. And the spectacular savings (cumulative trillions of dollars so far) in Medicare savings that have been achieved since the Affordable Care Act passed in 2010 are also a key part of that story.

All the ACA did was move the cost. Since 2009 medicare spending has doubled. Other healthcare spending has tripled.

Coverage obtained through the marketplaces established by the Affordable Care Act or through the Basic Health Program—$1.1 trillion (4 percent)

In 2023, federal subsidies for health insurance are estimated to be $1.8 trillion, or 7.0 percent of gross domestic product (GDP). In CBO and JCT’s projections, those net subsidies reach $3.3 trillion, or 8.3 percent of GDP, in 2033.

Federal Subsidies for Health Insurance: 2023 to 2033

In 2023, federal subsidies for health insurance are estimated to be $1.8 trillion, or 7.0 percent of gross domestic product (GDP). In CBO and JCT’s projections, those net subsidies reach $3.3 trillion, or 8.3 percent of GDP, in 2033.

www.cbo.gov

 

[Greenbeard]

All the ACA did was move the cost. Since 2009 medicare spending has doubled.

All real Medicare cost growth since the ACA passed in 2010 has been due to enrollment growth (i.e., people aging into it). Unavoidable, unless someone invents an anti-aging ray. Of course, this is now threatened by the Medicare Advantage cash monster.

Amazingly, not only did real Medicare per beneficiary cost growth abruptly stop its 45-year climb when the ACA passed and hasn't resumed since (see below), excess cost growth in the American health care system as a whole averaged zero in the decade-plus after the ACA passed (and that's counting the 2020 surge in health spending during the pandemic)--something unprecedented over any ten-or-more-year period.

This is the biggest budget win of our lifetimes.

 

[Mircea]

When it comes to long-term federal spending obligations and the debt picture, Medicare has always been the story. And the spectacular savings (cumulative trillions of dollars so far) in Medicare savings that have been achieved since the Affordable Care Act passed in 2010 are also a key part of that story.

Nice propaganda.

Medicare Part A is not part of the federal budget, never has been part of the federal budget, isn't part of the "debt picture" and you cannot show any proof it is.

The SMI Trust Fund is used for Medicare Part B and Part D. That is funded in part by the General Fund and in part by deductions from Social Security checks for those who are enrolled in those programs. Medicare Part D is purely voluntary. Medicare Part B is also "voluntary." You can opt out and not be covered but if you want back in you pay your premium plus a penalty and a multiplier for each year you opted out and you pay that penalty until you die meaning you will always pay a higher premium than everyone else as a penalty for having opted out.

Medicare Part C is also known as Medicare Advantage. It is not funded by the federal government but Medicare does negotiate the costs. You pay that out of your own pocket.

The "spectacular savings" you claim has little to do with the ACA and more to do with common sense.

In Europe, when you have a 78 year old bed-ridden patient in a LTC facility who will be bed-ridden until they die they do not get a hip replacement.

In the US, when you have a 78 year old bed ridden patient, hospitals heroically bill Medicare for a hip replacement even though the patient has no idea they had a hip replacement and even if you told them they'd forget 2 minutes later and they ain't gonna be doing the Charleston or the Jitterbug or the Macarena any time soon.

It had long been known that nearly half of spending from Medicare Part A was in the last 6 months of an elderly person's life and the outcome was going to be death no matter how much money was spent.

The ACA gave Medicare the power to refuse reimbursement unless it was justified and hospitals got the message real quick-like. Now there's a new word in everyone's vocabulary: Palliative Care.

The ACA did not lower the cost of medical care which has been and continues to be the problem because unlike Europe, you have hospital monopolies which creates redundancy and and redundancy is incredibly expensive.

You also fail to understand that no one in the US has had health insurance since 1954 thanks to the American Hospital Association and your Congress and State legislatures.

Insurers by law are required to issue fee-for-service health plan coverage which is magnificent but it ain't insurance and they're required by law to use the community rating scheme which soaks younger and/or healthier people to subsize the married with children crowd and older people and soaks the younger married without children crowd to subsize the cost of the marrieds with children and the elderly.

Where you have only the elderly then the healthy elderly get taken to the cleaners to subsidize the the elderly that practically live in the hospital.

That's the system your government and the AHA created so why are you mad?

 

[Superfly]

I’m on a Medicare Advantage plan. I’ve haven’t been on it but for a month or so, so I haven’t had an issue yet. The way I understand, I can always revert back to Medicare if I don’t like it.

So far, so good. Costing me less per month, plus I get vision, dental, and hearing included.

 

[jonny5]

All real Medicare cost growth since the ACA passed in 2010 has been due to enrollment growth (i.e., people aging into it). Unavoidable, unless someone invents an anti-aging ray. Of course, this is now threatened by the Medicare Advantage cash monster.

Amazingly, not only did real Medicare per beneficiary cost growth abruptly stop its 45-year climb when the ACA passed and hasn't resumed since (see below), excess cost growth in the American health care system as a whole averaged zero in the decade-plus after the ACA passed (and that's counting the 2020 surge in health spending during the pandemic)--something unprecedented over any ten-or-more-year period.

This is the biggest budget win of our lifetimes.

Except again, they just moved the alleged savings over to insurance subsidies. Federal health outlays went from 700bn in 2009 to 1.7 trillion today, thats more than double. And of course since its all debt funded, the interest on that debt will be with us forever and keep growing. By 2053, federal health care will account for every dollar of taxes.

Rising Health Care Costs per Person. The average growth rate of federal health care spending per beneficiary has slowed in recent years, from 5.6 percent over the 1988–2005 period to 2.2 percent from 2007 to 2019. However, over the second and third decades of the projection period, such costs (adjusted for demographic changes) continue to increase faster than the 3.3 percent growth rate of potential GDP per person—1.0 percent faster for Medicare and 1.1 percent faster for Medicaid, on average. That growth in health care costs per person accounts for over two-thirds of the increase in spending, measured as a percentage of GDP, on the major health care programs between 2023 and 2053.

The 2023 Long-Term Budget Outlook

At a Glance Each year, the Congressional Budget Office publishes a report presenting its projections of what the federal budget and the economy would look like over the next 30 years if current laws generally remained unchanged. The long-term budget projections typically follow CBO’s 10-year...

www.cbo.gov

 

[reflechissez]

I’m on a Medicare Advantage plan. I’ve haven’t been on it but for a month or so, so I haven’t had an issue yet. The way I understand, I can always revert back to Medicare if I don’t like it.

So far, so good. Costing me less per month, plus I get vision, dental, and hearing included.

Depending on how long you will have been on the advantage plan, you may not be able to get medigap insurance. I think you're still good if you switch back within a year.

 

[PeacefulWarrior]

By 2053, federal health care will account for every dollar of taxes.

Thats awesome.

I hope there isnt a dime left over for the phony "wars" heh heh heh heh.

I totally support it!

 

[dockside]

I’m on a Medicare Advantage plan. I’ve haven’t been on it but for a month or so, so I haven’t had an issue yet. The way I understand, I can always revert back to Medicare if I don’t like it.

So far, so good. Costing me less per month, plus I get vision, dental, and hearing included.

I had Medicare Advantage for 8 years. It took me that long to realize it was no bargain. My spouse had open heart surgery and 4 months of treatment (5 more surgeries) for resulting MRSA and his co-pays added up to over $4,000. We changed to regular Medicare and our bills (co-pays) have plummeted, altho' we had to wait 3 months with no supplemental coverage. Advantage is only good for those in excellent health who have few, if any, visits to a physician and/or hospital. As one ages, that becomes very unlikely as our bodies wear out. But then, it may not be possible to find a supplemental insurer that will take you due to your health. So, take advantage of the low premiums and few co-pays for a few years, but be sure to switch to regular Medicare A and B before those years of natural deterioration start to show up. That is, if you can predict the future.

 

[dockside]

I had Medicare Advantage for 8 years. It took me that long to realize it was no bargain. My spouse had open heart surgery and 4 months of treatment (5 more surgeries) for resulting MRSA and his co-pays added up to over $4,000. We changed to regular Medicare and our bills (co-pays) have plummeted, altho' we had to wait 3 months with no supplemental coverage. Advantage is only good for those in excellent health who have few, if any, visits to a physician and/or hospital. As one ages, that becomes very unlikely as our bodies wear out. But then, it may not be possible to find a supplemental insurer that will take you due to your health. So, take advantage of the low premiums and few co-pays for a few years, but be sure to switch to regular Medicare A and B before those years of natural deterioration start to show up. That is, if you can predict the future.

Another thing, Medicare Advantage plans are HMOs. I had to shop and shop to find a doctor to treat me for a condition because no local doctor qualified to treat it was in the insurer's "preferred provider" group. A couple of insurers (I changed them every couple of years) even removed our only local hospital on their list of local providers as they could not agree on contact terms. No one tells you these things, however. I found out the hard way.

 

[Superfly]

Depending on how long you will have been on the advantage plan, you may not be able to get medigap insurance. I think you're still good if you switch back within a year.

Thanks. Yeah I’ll know within a year if I’m going to be able to deal with them.

 

[Superfly]

I had Medicare Advantage for 8 years. It took me that long to realize it was no bargain. My spouse had open heart surgery and 4 months of treatment (5 more surgeries) for resulting MRSA and his co-pays added up to over $4,000. We changed to regular Medicare and our bills (co-pays) have plummeted, altho' we had to wait 3 months with no supplemental coverage. Advantage is only good for those in excellent health who have few, if any, visits to a physician and/or hospital. As one ages, that becomes very unlikely as our bodies wear out. But then, it may not be possible to find a supplemental insurer that will take you due to your health. So, take advantage of the low premiums and few co-pays for a few years, but be sure to switch to regular Medicare A and B before those years of natural deterioration start to show up. That is, if you can predict the future.

I’m not in great health, either. Heart problems. But I have Tricare as secondary so I don’t have to worry about copays.

 

[Greenbeard]

Except again, they just moved the alleged savings over to insurance subsidies. Federal health outlays went from 700bn in 2009 to 1.7 trillion today, thats more than double.

In the Long-Term Budget Outlook fifteen years ago, CBO thought federal spending on health care (back then still just Medicare and traditional Medicaid) last year would be 6.8% of GDP. In the absolute best case scenario, with an unprecedented zero excess cost growth in the intervening years, they thought it could be 5.8% of GDP.

In reality, we did have zero excess cost growth and even though we subsequently expanded federal spending on health care to encompass Medicare and traditional Medicaid and expanded Medicaid and ACA marketplace subsidies (expanding coverage to tens of millions of Americans), federal spending on health care last year was . . 5.8% of GDP. Which is to say, even with the expansion of federal health care subsidies under the ACA, we've performed at the best-case scenario for a world without the ACA's new subsidies. At least as far as Long-Term Budget Outloks go.

Meanwhile, total health care costs today are more than six percentage points of GDP lower than expected in that 2009 CBO Long-Term Budget Outlook. In reality, they're at the same level today that they were fifteen years ago.

By 2053, federal health care will account for every dollar of taxes.

Fifteen years ago, the CBO was saying federal health care spending (again, comprising only Medicare and traditional Medicaid, not the new ACA coverage categories) in 2053 would comprise 12.6% of GDP. As of late year, they were projecting 2053 federal health spending (now consisting of Medicare and traditional Medicaid and expanded Medicaid and ACA marketplace subsidies) will be 8.6% of GDP.

We expanded coverage and lopped off over a third of long-term health care spending growth in the process. Like I said, biggest budget win of our lifetimes.

 

[ttwtt78640]

My girlfriend and I each have WellCare Medicare advantage ‘give back’ plans which pay us (each) $95/month (by taking less out of our monthly SS retirement benefits). I haven’t seen WellCare mentioned in the news for doing anything unethical with its Medicare advantage plans. The only problem I’ve had was difficulty getting a new primary care provider (PCP) assigned to me when my current PCP left the WellCare provider ‘network’.

 

[jonny5]

In the Long-Term Budget Outlook fifteen years ago, CBO thought federal spending on health care (back then still just Medicare and traditional Medicaid) last year would be 6.8% of GDP. In the absolute best case scenario, with an unprecedented zero excess cost growth in the intervening years, they thought it could be 5.8% of GDP.

In reality, we did have zero excess cost growth and even though we subsequently expanded federal spending on health care to encompass Medicare and traditional Medicaid and expanded Medicaid and ACA marketplace subsidies (expanding coverage to tens of millions of Americans), federal spending on health care last year was . . 5.8% of GDP. Which is to say, even with the expansion of federal health care subsidies under the ACA, we've performed at the best-case scenario for a world without the ACA's new subsidies. At least as far as Long-Term Budget Outloks go.

Meanwhile, total health care costs today are more than six percentage points of GDP lower than expected in that 2009 CBO Long-Term Budget Outlook. In reality, they're at the same level today that they were fifteen years ago.



Fifteen years ago, the CBO was saying federal health care spending (again, comprising only Medicare and traditional Medicaid, not the new ACA coverage categories) in 2053 would comprise 12.6% of GDP. As of late year, they were projecting 2053 federal health spending (now consisting of Medicare and traditional Medicaid and expanded Medicaid and ACA marketplace subsidies) will be 8.6% of GDP.

We expanded coverage and lopped off over a third of long-term health care spending growth in the process. Like I said, biggest budget win of our lifetimes.

Hypothetical spending. No matter how you sugar coat it with theoretical savings relative to GDP, tripling healthcare spending in 10 years is not a budget win. And doubly so when its primarly debt funded and redistribution of wealth.

And thats before you even get to personal spending which is another 2 trillion on top of that.

In 2018, U.S. households allocated an average of 8.1 percent of spending to healthcare—a noticeable proportion of their total spending. The share spent on healthcare has increased over time, rising from 5.9 percent in 2004. Dollars spent on healthcare have also increased from $2,574 in 2004 to $4,968 in 2018 (93 percent), or about 4.7 percent annually on average during this period.1 From 2017 to 2018, dollars spent on healthcare grew 0.8 percent, and 6.9 percent from 2016 to 2017.

How have healthcare expenditures changed? Evidence from the Consumer Expenditure Surveys : Beyond the Numbers: U.S. Bureau of Labor Statistics

This Beyond the Numbers article analyzes the consumer spending patterns on major healthcare components across income quintiles, age, race and ethnicity, and homeownership status of consumer units (CUs) from 2004 to 2018. Using data from the Consumer Expenditure Surveys (CE), this article also...

www.bls.gov

So in addition to my having to spending 10,000 a year on health insurance, I ALSO have to pay the 1.7 trillion in taxes (or debt) for everyone elses healthcare. That is neither a budget win for me or the country.

 

[post]

I had Medicare Advantage for several years when I first was covered, due to my not understanding that it is an HMO. Instead of your doctor calling the shots, a claims adjuster will decide whether you need treatment A or treatment B. A couple of times, our only local hospital was not in it's preferred provider group and at times I had a very difficult time finding a specialist for certain health issues that were part of the network. And, once, when I needed a CT scan, immediately, my doctor spent two hours on the phone trying to get permission from my carrier. The CT clinic told me to go to the hospital ER and they would send me over for the scan which the insurer couldn't deny. I ended up having emergency surgery that night, thank goodness.

IMO, it's a scam. Having to get the insurer's permission to perform tests that needed to be done immediately to save my life is outrageous. Luckily, I was able to change to regular Medicare and would never go back to MA. A cheap premium insures cheap coverage. If you expect to be healthy until the day you die (who is that prescient?) it might pay. But, for the elderly, it's horrible once you get into your 70's. And, then, if you are not healthy, you may not find a Medicare Supplement insurer who will insure you (you can still get regular Medicare which has deductibles and co-pays - at least that's my understanding).

I am required to obtain a stress test that uses nuclear medicine technology to obtain approval of my cardiologist for hip replacement surgery because
I cannot perform conventional stress test. I have a cardiologist because a cardiogram performed during an annual physical a few years ago was obviously flawed but my PCP referred me as a precaution.

The street price for the stress test is $18,000. Even more absurd than the $4.00 two liter bottle of Diet Dr. Pepper, @Publix, post pandemic.
With any service in which insurer payments are a sizeable component, the recipient of the product or service is no longer regarded by the
provider as being the customer. The customer is whoever pays the most often. In the auto collision repair business the customer is Allstate and State Farm. The person provided the service may not have another repairable vehicle collision for five or ten years.

Next week, insurers with largest market share will be paying for the bulk of vehicle repairs. Medical and vehicle repair bills are intentionally complex so there is more expertise required to obtain full payment than the person receiving care or repairs once every few years could ever hope to master or even want to.

The medical provider or vehicle repairer are not reimbursed for the time and effort pursuing full payment but the insurance claims processing departments are incentivized financially to make full payment to providers unlikely.

 

[Greenbeard]

Hypothetical spending.

Yes, that's what the Long-Term Budget Outlook is. It's a forecast. And that forecast has brightened considerably since the ACA passed.

No matter how you sugar coat it with theoretical savings relative to GDP, tripling healthcare spending in 10 years is not a budget win.

Spending relative to GDP is what matters, not the nominal dollar numbers you seem fixated on. If health care spending doubles but GDP and income double over the same period, then it doesn't matter that you're spending twice as many nominal dollars on health care at the end of that period, health care is no less affordable than it was at the start. That's why we look at spending as a percentage of GDP. Which for health care is, remarkably, the same today as it was fifteen years ago. That's why trillions of dollars (to date) in federal budget obligations have melted away in the ACA era.

 

[Pyrite]

<snipped>

Older Americans Say They Feel Trapped in Medicare Advantage Plans - KFF Health News

As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.

kffhealthnews.org

Thanks, especially, for this article. A couple of years ago I read that it can be impossible for someone to switch from a Medicare Advantage plan to traditional Medicare - but the reason wasn't provided. KFF explains why:

“The problem is that once you get into Medicare Advantage, if you have a couple of chronic conditions and you want to leave Medicare Advantage, even if Medicare Advantage isn’t meeting your needs, you might not have any ability to switch back to traditional Medicare,” [Brown University School of Public Health Asst. Prof. David] Meyers said.

Traditional Medicare can be too expensive for beneficiaries switching back from Medicare Advantage, he said. In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care, Meyers said.

To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or a private Medigap policy. If they are low-income, Medicaid may provide that supplemental coverage.

But, Meyers said, there’s a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.

Only four states — Connecticut, Maine, Massachusetts, and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease....

 

[Pyrite]

<snipped>

Medicare Part C is also known as Medicare Advantage. It is not funded by the federal government but Medicare does negotiate the costs. You pay that out of your own pocket.

<snipped>

Medicare Advantage programs, like traditional Medicare, are indeed funded by the Federal Government / US taxpayers:

Older Americans Say They Feel Trapped in Medicare Advantage Plans - KFF Health News

As enrollment in private Medicare Advantage plans grows, so do concerns about how well the insurance works, including from those who say they have become trapped in the private plans as their health declines.

kffhealthnews.org

January 5, 2024

...Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses...

What to Know about Medicare Spending and Financing | KFF

This brief provides an overview of Medicare spending and financing, based on the most recent historical and projected data from the Medicare Trustees and the Congressional Budget Office (CBO). The brief highlights trends in Medicare spending and key drivers of spending growth, including higher...

www.kff.org

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January 19, 2023

...Payments to Medicare Advantage plans for Part A and Part B benefits nearly tripled as a share of total Medicare spending between 2011 and 2021, from $124 billion to $361 billion, due to steady enrollment growth in Medicare Advantage plans and higher per person spending in Medicare Advantage than in traditional Medicare....

Funding for Medicare, which totaled $888 billion in 2021, comes primarily from general revenues (46%), payroll tax revenues (34%), and premiums paid by beneficiaries (15%)....

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Medicare Advantage Plans Often Deny Needed Care, Federal Report Finds (Published 2022)

Investigators urged increased oversight of the program, saying that insurers deny tens of thousands of authorization requests annually.

www.nytimes.com

...The federal government pays private insurers a fixed amount per Medicare Advantage patient....

 

[American]

When you have a for profit health care system we shouldn't be surprised when companies find a way to extend their profits at the public expense.

Profit has benefitted medical advancements for over half a century.

 

[jonny5]

Yes, that's what the Long-Term Budget Outlook is. It's a forecast. And that forecast has brightened considerably since the ACA passed.



Spending relative to GDP is what matters, not the nominal dollar numbers you seem fixated on. If health care spending doubles but GDP and income double over the same period, then it doesn't matter that you're spending twice as many nominal dollars on health care at the end of that period, health care is no less affordable than it was at the start. That's why we look at spending as a percentage of GDP. Which for health care is, remarkably, the same today as it was fifteen years ago. That's why trillions of dollars (to date) in federal budget obligations have melted away in the ACA era.

Federal healthcare spending relative to GDP doesnt really matter . Every real dollar taken from me and spent on someone else who didnt earn it, matters. Not how small those dollars are relative GDP. And those dollars have TRIPLED since the ACA was passed. And so has my direct cost of healthcare. It may be more affordable for those Im paying for, but it certainly isnt for me.

In GDP terms or real terms the problem has gotten worse and is only getting worse. More of GDP being taken and spent on healthcare, more real dollars being taken and spent on healthcare.

In 2009 the govt spent 700bn on healthcare, today they are spending 1.7 trillion.
In 2009 the govt spent 4% of GDP on healthcare, todays its 6%

In 10 years theyll have spent another 14 trillion on healthcare!