7 Questions to Ask to Protect Yourself from Medicare Advantage Scams: Open Enroll Oct 15- Dec 7

[appalachiablue]

- Common Dreams, Nov. 21, 2023. Ed. By Diane Archer. - To ensure you have good coverage for both current and unforeseeable health needs this open enrollment period, you should choose traditional Medicare.
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During this Medicare Open Enrollment period, ask yourself these 7 questions. And, please know that you can always call the Medicare Rights Center at 1-800-333-4114 or your SHIP—State Health Insurance Assistance Program—for free, unbiased advice on any of your Medicare questions.

Q. What’s the biggest difference between traditional Medicare and a Medicare Advantage plan? To ensure you have good coverage for both current and unforeseeable health needs, you should enroll in traditional Medicare. In traditional Medicare, you and your doctor decide the care you need, with no prior approval. And, you have easy access to care from almost all doctors and hospitals in the US with no incentive to stint on your care.

In a Medicare Advantage plan, a corporate insurance company decides when you get care, often requiring you to get its approval first. Medicare Advantage plans also restrict access to physicians and too often 2nd-guess your treating physicians, denying you needed care inappropriately. The less care the Medicare Advantage plan provides, the more the insurance company profits. You will pay more upfront in traditional Medicare if you don’t have Medicaid and need to buy supplemental coverage, but you are likely to spend a lot less out of pocket when you need costly care.

Regardless of whether you stay in traditional Medicare or enroll in Medicare Advantage, you still need to pay your Part B premium.

Q. Should I trust an insurance agent’s advice about my Medicare options? No. Unfortunately, insurance agents are paid more to steer you away from traditional Medicare and into a Medicare Advantage plan, even if it does not meet your needs. While some insurance agents might be good, you can’t know whom to trust. Keep in mind that while Medicare Advantage plans tell you that they offer you extra benefits, you still need to pay your Part B premium, and extra benefits are often very limited and come with high out-of-pocket costs; be aware that many Medicare Advantage plans won’t cover as much necessary medical and hospital care as traditional Medicare.

For free independent advice about your options, call the Medicare Rights Center at 1-800-333-4114 or a SHIP... - Read More,
https://www.commondreams.org/opinion/protect-yourself-from-medicare-advantage
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* CMS.gov - Medicare Open Enrollment -
- When’s the Medicare Open Enrollment Period? Every year, Medicare’s open enrollment period is Oct. 15 - December 7.

Medicare health and drug plans can make changes each year—things like cost, coverage, and what providers and pharmacies are in their networks. Oct.15 to Dec. 7 is when all people with Medicare can change their Medicare health plans and prescription drug coverage for the following year to better meet their needs...
https://www.cms.gov/priorities/key-initiatives/medicare-open-enrollment-partner-resources

[Attilatheblond]

1. If the big insurance Advantage providers weren't making tons of $ on this

they wouldn't be spending so much on advertising via TV and all the print materials we end up being deluged with this time of year! And how would they make all that money that makes the marketing worthwhile? Limiting what they pay out, IOW, limiting what services they will cover. IOW, bean counters making medical decisions with the cover of doctors in the employ of the companies pretending they are making decisions for your health and not the bottom line of the companies who pay them.

If they weren't raking in a ton of money, they wouldn't be bombarding us with BS ads to stampede us into thinking they are on our side.

[appalachiablue]

2. Unfortunately many people don't get the heavy

marketing, that it's from enormous profits made from deception and scamming. It says a lot about our messed up system that's so predatory and money driven. It ruins lives.

[thesquanderer]

6. re: "they wouldn't be spending so much on advertising"

I think I may have figured that one out.

At least since the Affordable Care Act, there is a limit to how much profit these companies can make (as a percentage of revenue), which was presumably done to put some kind of brakes on the sheer profit motive. BUT... marketing is an expense. So let's say their corporate profits are capped at 10%... but they discover they are on track to make 15%. They might have to give up that excess to the pool where excess profit goes... BUT if they instead spend that extra 5% profit on advertising, it's not profit anymore, it's an expense. So instead of "giving away" the excess 5%, they use it for marketing to get more customers. All that marketing, then, basically costs them nothing, because if they didn't spend that money on some legit expense, they would just have to give it up.

I think this is basically right, but it's only my own conclusion after reading some basic info about the profit structure of MA. If anyone has more detail (including correction, if I'm missing something), chime in...

[Attilatheblond]

8. Makes a good deal of sense, actually

Well done, and thanks for additional insight.

Do not forget, insurance companies, health, life, home, auto, do not sit on the monthly premiums we pay them. That money is generally invested on Wall Street. When the Street pays off well, they get a lot of bang for their (our) bucks. When the market falls and stays down for a spell OUR insurance rates generally go up.

[tonekat]

3. Medi-Gap plans are better

Advantage plans are just another insurance plan. Or, do as a friend does and find a practice that accepts Medicare. She has to make appointments 3 months in advance due to demand, so she goes to Urgent Care for unexpected illness.

[Rhiannon12866]

4. The TV ads are back, inundating the airwaves yet again. Joe Namath and company...

[PortTack]

5. Medicare advantage plans are bankrupting Medicare by overcharging billions of dollars more than

Regular Medicare. There are other problems as well
When something looks to good to be true, it usually is

I’ve been bashed for brining this up saying it’s a broad statement devoid of facts. As I have posted this same thing many times WITH LINKS I will just let the doubting reader look it up for themselves. HINT: There’s a great NPR story on it

[Silent Type]

7. Traditional Medicare with Medigap and drug plan is way to go IF you can afford it. Unfortunately, if you can't afford

$200 a month for MediGap and $40 or so a month drug plan, MA is about the only option unless you qualify for Medicaid.

And, giving up $1500 a year in dental coverage, $300 a year for OTC meds and food, meals for a few weeks after a major surgical procedure, etc., is tough for someone living on $1500 a month.

That's why over 50% of Medicare beneficiaries now select Medicare Advantage.

It's good Daily Kos, CommonDreams, etc., are here to tell all those people how stupid they are. [Do I need a sarcasm thingy?]

PS: I hate the ads too. But once about 60% of Medicare beneficiaries have MA, companies will cut back on advertising because they've captured the market of people who feel MA is best for them. And, you can bet any future attempts to improve Medicare will have to involve these type plans, or it will be a non-starter for enough Congresspeople to block legislation. So, we'll all go nuts -- railing against the damn insurance companies -- and 20 years from now we'll still be sitting here in the same situation as now.

Oh, for those who dislike prior-authorizations, traditional Medicare is now requiring authorization for these procedures, with more on-line for future.
https://www.cms.gov/data-research/monitoring-programs/medicare-fee-service-compliance-programs/prior-authorization-and-pre-claim-review-initiatives/prior-authorization-certain-hospital-outpatient-department-opd-services

[anciano]

9. Although I am in favor of a single payer universal system,

the reality is that here in the US the insurance industry is making billions of dollars each year from our current system and I am not naive enough to believe that they are going to give that up. And with the increasing enrollment in Advantage plans, they will very soon be the dominate controlling factor of the Medicare program. So it seems that any major reforms for the protection and benefit of participants are at this point no more than wishful thinking. Sad indeed, but reality. It's always about the money.

[liberalla]

10. Bookmarking

[japple]

11. A dermatologist in NW GA (and other locations) overcharged Medicare, Medicaid and other

government payors. I used this dermatology practice many years ago when I first moved to the area, but stopped using them because the doctor was such a jerk. He had a good staff, but he acted like such a clown and I felt demeaned every time I saw him. He was on the Medicare/Medicaid gravy train and got caught. I now use a different practice with much better results.

"have agreed to pay $6.6 million to resolve allegations that they violated the False Claims Act by knowingly submitting false claims to federal healthcare programs for Mohs Micrographic Surgeries and other dermatological procedures.”

https://www.dailycitizen.news/news/local_news/doctor-with-office-in-dalton-settles-false-claims-case/article_5204f25a-257e-11ee-b8cd-97d5d23bf435.html

[PoindexterOglethorpe]

12. There seems to be a lot of misinformation here.

I have an Advantage plan, and I've never needed prior approval for anything I've needed. My out of pocket costs have been minuscule in the 10 years I've been on that plan. Let's see, heart attack, stent, then a three day stay in the hospital. I paid a couple of hundred dollars. Broken arm, which resulted in ER visit, then follow up with an orthopedist, and then one round of physical therapy, which I could have cancelled and saved the $25.00 co-pay but felt I really ought to check in with someone who knew more than I did. I always heal really fast, and I knew I didn't need PT as I'd (this is three weeks after the break) had gained full mobility in the arm, and no longer had any pain) but I figured it wouldn't hurt to have someone who knew more than I did, check it out.

Why, oh why, oh why do people here keep on starting these threads to trash Advantage plans? What is in it for them? What is their agenda? How is my Advantage plan hurting them?