Viewing a single comment thread. View all comments

Quercus_ t1_ixa6zjz wrote

Reply to comment by gizmozed in Hidden audits reveal millions in overcharges by Medicare Advantage plans by rustyseapants

I did the homework. My Kaiser Advantage plan is a substantially better deal than anything else I could do. And that's even before I apply the significant benefit of no paperwork, no billing tracking, no claim submissions, and so on.

That's the benefit to me personally. Whether it's a benefit to the US government is an entirely different question.

54

Elder_sender t1_ixah6gm wrote

So you get downvoted for offering personal experience that counters baseless conjecture. Makes sense to me /s

12

crustyrusty91 t1_ixbk5qd wrote

When I was a practicing attorney, I assisted seniors with figuring out their health care options. I can confirm that Medicare Advantage is almost always a bad idea. It might seem like a better option at first, but they scam you in ways that aren't readily apparent during enrollment (frankly, every private insurer is trying to scam you).

  • Prior authorization - most advantage plans require preauthorization before allowing you to receive care. This is a key point where they will try to screw you over even though your doctor may actually disagree with their determination.
  • Networks - advantage plans have networks like a typical insurance plan. Traditional Medicare does not - most providers will accept Medicare. Very few have opted out. Good luck finding skilled nursing care that is covered and in-network on your advantage plan.
  • Profit motive and administrative overhead - come on. They are trying to make a buck and are far less efficient than traditional medicare.
27

Flaky_Bee_2599 t1_ixd0exx wrote

Off the top of my head:

  • Medicare Advantage Plans have max OOPs
  • Medicare advantage plans most often have Copays when seeing doctors and specialists instead of coinsurance
  • Medicare advantage plans have much more robust prescription coverage plans than traditional Medicare.

Also, you can switch back and forth every year during open enrollment. Making blanket statements about how Medicare Advantage is bad is silly.

5

NonDopamine t1_ixdccg3 wrote

Most states do not allow you to switch back to regular Medicare without underwriting (read: unless you are healthy). I have been through this mess with both my parents. Medicare Advantage plans look great until you actually need them to pay for your healthcare and then then you aren’t allowed to switch back to a regular Medicare plus supplement plan. It is a nightmare.

That being said most seniors can’t afford regular Medicare supplement plans anymore so the long game to completely privatize Medicare is just about to come to fruition.

6

Flaky_Bee_2599 t1_ixdjrp0 wrote

Medicare plus supplement will require medical underwriting. Regular Medicare won't. Medicare supplement is, as you say, much more expensive than Medicare Advantage plans.

Also, it's not a game to "completely privatize" Medicare. It's called a public option. The idea that having a choice is inherently bad is more of a political opinion than a fact.

4

Formergr t1_ixcpmu6 wrote

> Traditional Medicare does not - most providers will accept Medicare. Very few have opted out.

A ton of providers have opted out of Medicare, what are you talking about? It’s a huge problem with regard to getting needed care by specialists in many areas of the country.

ETA: the MA plans still absolutely are evil, but going the traditional Medicare route also has shortcomings.

−2

crustyrusty91 t1_ixcv8n9 wrote

Maybe things have changed in the last two years, but this was my understanding:

> One percent of all non-pediatric physicians have formally opted-out of the Medicare program in 2020, with the share varying by specialty, and highest for psychiatrists (7.2%).

https://www.kff.org/medicare/issue-brief/how-many-physicians-have-opted-out-of-the-medicare-program/

8

madmouser t1_ixdbk5b wrote

I may be being pedantic, but after reading that article it looks like there should be a fourth category: providers who do no accept Medicare under any circumstances. I see two types of opt-in and one opt-out, but no "we don't accept it, period." And the weasel words "formally opted out". What about informally opting out by just not taking on Medicare patients at all?

Edit: this article says that 1/3 of all primary care doctors will not accept any new Medicare patients. https://www.hlc.org/news/more-physicians-no-longer-seeing-medicare-patients/

2

Keylime29 t1_ixdce0h wrote

That’s cuz Kaiser. Kaiser can very good

1