The Sickest Patients Are Fleeing Private Medicare Plans--Costing Taxpayers Billions
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People in the final year of their lives left Medicare Advantage for traditional Medicare at double the rate of other enrollees from 2016 to 2022, the Journal’s analysis found. Those private-plan dropouts—300,075 during that time span—often had long hospital and nursing-home stays after they left, running up large bills that taxpayers, not their former insurers, had to pay.
They cost the federal government an average of $218 a day during that period. That is more than seven times the cost of a typical Medicare recipient, and about twice the cost of other recipients in the last year of their lives. The Journal’s analysis excluded hospice expenses, which traditional Medicare typically covers for all patients.
Medicare Advantage insurers collectively avoided $10 billion in medical costs incurred by the dropouts during that period, the analysis found. If those beneficiaries had stayed in their plans, the government would have paid the insurers about $3.5 billion in premiums, meaning the companies netted more than $6 billion in savings during that period.
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The insurers use some of the same money-saving tactics they use with their non-Medicare customers, such as requiring referrals from primary-care doctors or approvals from insurers for many services, and including only certain hospitals and doctors in their networks. In 2022, Medicare Advantage insurers denied 3.4 million requests for services, according to an analysis by the health-policy nonprofit KFF.
Traditional Medicare requires preapproval for only a small number of services, including surgeries that could be cosmetic—a type of care not covered by the program.
More.
https://www.wsj.com/health/healthcare/medicare-private-plans-insurers-389af1a0?st=rQyJRV&reflink=desktopwebshare_permalink
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but honestly it sounds like the people themselves are ditching MA because, well, too often they suck
I mean, once you've had cancer, let alone twice, you're never completely free of knowing it can strike again, but it diminishes your quality of life if you let the fear consume you. Fortunately, she hasn't. Here, at age 70, six years after defeating "the Murderer," you wouldn't know what she has gone through.
of contention for that.
There is an also a Medicare Savings Program where the state pays for Medicare B and copays (but it isn’t insurance) and some states that have that don’t require an asset test so that is sometimes an option if the income is in range.
I still have half a brain but negotiating this maze every year is insane. I also fear for those who may lose assistance if the new administration really does try to cut programs to pay for their tax cut. Pretty sure that would make us both crazy (or maybe we’re already there!).
I'm trying to do my open enrollment. One medication that I depend on to function is now OOP @ more than $1900.00/mo. I was paying for it @ btwn 500 to 600/month depending on the month already when it was covered. Now, I don't know what I'm going to do. Not one plan covers it this year. I have a call in to my doctor and have not heard back. I'm going to wait one more day and call back. I'm not hopeful.
Where you can get back on regular Medicare.
- if you are in a guarantee issue state they allow you to switch back to regular Medicare at specific times (Conn, ME, MA, and NY). Supplement prices in these states are higher because you are allowed to leave your advantage plan (you can switch every year) and the prices are community based - the same for 65 or 85. So a plan N could easily be $200/month. In other states the supplement is much less because if you don’t switch from advantage back to a supplement in the first 12 months you are out of luck.
- if you move out of the area maybe!
Supplements can be tricky and since different states have different rules, the preexisting conditions may not be covered for 6 months or you may fail the underwriting questions.
Criminies, a friggin PhD is needed to make sense of all these rules.
