MEDICARE: Delays, Denials, Growing Privatization Leading to Harmful Outcomes in Healthcare

[appalachiablue]

'Delays, denials, debt and the growing privatization of Medicare,' The Guardian, June 3, 2024. - Medicare Advantage enrollees report treatment denials and delays in payment, leading to harmful outcomes in healthcare 🥼
--------
Jenn Coffey was sick, on several medications, and in and out of the hospital around 2016 when she made a decision that she has come to regret. Having fought off breast cancer, the former emergency medical technician faced numerous complications, and was diagnosed with two rare diseases: complex regional pain syndrome and small fiber neuropathy. “I was terrified,” she said.

“I went into the hospital as a fully functional EMT and came out in a wheelchair, to go on disability income, and I lost everything. I lost my house, I lost everything.”

Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits.

With monthly premiums of $18.50 per month on average, Medicare Advantage often looks like a frugal alternative.

However, private insurers keep premiums low by limiting providers and using byzantine cost containment tools such as prior authorization. For Coffey, switching proved more expensive, as her Medicare Advantage provider, UnitedHealthcare, denied requests to cover treatments, medications and infusions she required.

Coffey used to be a Republican state representative in New Hampshire. “I changed a lot over these years,” she said. “I used to think we could fix healthcare.” Her experience with Medicare Advantage is not unusual. Private insurers now cover roughly half of the nation’s 68 million Medicare beneficiaries. Their dominance of this space has grown rapidly over the past two decades – at the expense of patient care, according to healthcare activists and patients, as corporations often deny medical care directed by doctors...
https://www.theguardian.com/us-news/article/2024/jun/03/medicare-advantage-privatization
--------
Also: Reagan, Deregulation & America's Exceptional Rise in Health Care Costs: NYT
https://www.democraticunderground.com/1016377845

[Skittles]

1. cue the apologists to show up

you know, the ones who don't care about the privatization of Medicare

*edited to add I do agree that original Medicare needs some tweaking

[jimfields33]

5. I'm not an apologist. In fact, I'm not even eligible for a decade plus.

But I really don’t like the bashing of Medicare advantage because President Clinton signed it into law. There is no way, he thought this would screw the elderly. In fact traditional Medicare can be pricy as well. But you don’t hear stories about that.

[William769]

28. I adore President Bill Clinton!

Last edited Tue Jun 4, 2024, 02:36 PM - Edit history (1)

With that said, no man is perfect.

[Voltaire2]

31. The delusion that the 'private sector' is better

at everything was and is widespread.

[appalachiablue]

6. Ik, thanks for posting. Privatization is a con, scam.

[Skittles]

7. the goal of privatization is to maximize proffits for private corporations

they don't give a DAMN about anyone's health

[appalachiablue]

9. Absolutely, it's ALL about money and profit. ETA Reagan started

all of this greed nightmare we're living in, with deregulation, more. NYT article added above.

[Skittles]

13. it kills me to see Dems pimping for privatization

I am also disappointed at the feeble efforts being made to stop the corruption.

[Voltaire2]

30. Exactly.

[wryter2000]

2. They need to take Medicare out of the name

It’s not Medicare. Fewer people would fall for it if they knew it wasn’t Medicare.

[gab13by13]

3. Exactly,

What is being described is Medicare Advantage plans that are sucking Medicare dry.

I have never had an issue with Medicare. I have talked with the people at the hospitals and they all say they love dealing with Medicare.

Go with Medi-Gap if you need a supplement.

[Skittles]

4. Medigap can be quite pricey

What the Advantage scam says is HEY, look at this DEAL we are giving you - cheaper and with EXTRA STUFF! It works fine if you stay healthy.....what people don't understand is these companies have INCENTIVE to deny you care, which pretty much EVERYONE will eventually need.

[Silent Type]

10. Disagree that people who choose MA are so stupid they can't make rational decisions, poor maybe.

People’s circumstances differ.

And, at least for First Lady in article, traditional Medicare wouldn’t have covered her treatments either because they weren’t FDA approved.

[Skittles]

12. not stupid

but most of them are not getting the overall picture

https://captimes.com/opinion/dave-zweifel/opinion-marketing-scams-suck-seniors-into-medicare-advantage-morass/article_2554c6f0-bae2-11ee-b3d8-a7749ae23037.html

[Silent Type]

15. Well, the overall picture is not just you are dumb if you buy MA to the 51% of beneficiaries who voluntarily choose it.

[Skittles]

19. orignal Medicare needs some updating

but "Advantage" is NOT the answer - it's a SCAM - the more people get on MA, the more Medicare drifts toward COMPLETE PRIVATIZATION - and you KNOW what will happen then

[wryter2000]

33. I didn't understand for the longest time

That Medicare Advantage wasn’t Medicare. It’s also easy to confuse with medigap insurance. Truth in advertising would be nice.

[Silent Type]

36. Well, you can blame Bill Clinton who signed the original legislation Part C, then became Medicare Choice+, then MA.

[wryter2000]

38. okay, I'll blame him

They need to change the name.

[duckworth969]

16. Exactly

[Silent Type]

8. Guess I'm an "apologist." From another article on the first lady, traditional Medicare likely would have denied

her treatments too because they were not FDA approved. Traditional Medicare rarely covers non-FDA treatments.
———

[Talking about pain diagnoses, etc.] “Though it was discovered over 200 years ago, to date it does not have a single solitary treatment approved by the FDA. United Healthcare Medicare DisAdvantage loves to use that against me and as a reason to refuse to cover the lifesaving treatments which I have to have.”

https://medium.com/@jenncoffey/a-personal-story-about-a-medicare-advantage-denial-written-for-psara-education-fund-18c9679d3f25

Again, doubt original Medicare would have covered it.

I did not research the other patients.

[Skittles]

11. you need to keep researching

these Advantage scam companies are seeing RECORD PROFITS which is the entire goal of the privatization of Medicare

[Silent Type]

14. Maybe, what you/others should do is call their Congresspeople and tell them to stop forcing people into MA

that has lower premiums, limited dental (but sometimes as much as $3000 annually), grocery allowances, vision, maximum out-of-pocket costs, etc., by putting those benefits into traditional Medicare.

Until then, I'm going to respect peoples choices, and question articles like this that are misleading. Further, if the stories in the article are even close to truth, attorneys would be suing the living heck out of insurance companies.

Hope you noticed Guardian -- which I usually like, but not as sole source -- totally left out bit about FDA approval.

BTW: I have traditional Medicare, but suspect I'll be forced into an MA plan within next few years.

[Skittles]

18. I've done plenty

these scammers are DISGUSTING and they should not be allowed to continue with their deceptive advertising

[Silent Type]

20. So, take the benefits they want away from 30+ Million even though traditional Medicare isn't meeting needs.

Sorry, we’ll just have to disagree.

I’d much prefer original Medicare have those benefits, but it’s not going to happen. So, I support MA until the government changes things, which doesn’t look likely. YMMV.

[Skittles]

21. READ ALL OF IT

IT IS COSTING ALL OF US

https://captimes.com/opinion/dave-zweifel/opinion-marketing-scams-suck-seniors-into-medicare-advantage-morass/article_2554c6f0-bae2-11ee-b3d8-a7749ae23037.html

Original Medicare needs to be updated but the money to do so is being siphoned away to enrich corporations

done here because it is POINTLESS arguing with people who cannot see that privatization of Medicare is BAD

[Silent Type]

23. If the only way to get these benefits to people is to pay a little extra, I'm fine with that

if it helps people.

I’ll cheer if we get those benefits in traditional Medicare. But until that occurs it’s harsh to say, sorry poor people, but we are going to take those benefits away and charge you $250+ a month for a MediGap and drug plan.

[markodochartaigh]

22. The reason that they have those "benefits that they want"

is because they don't actually have Medicare type insurance which will pay for far more, and far more reliably, than their advantage plan will. Of course, until the insurance is really needed for something extremely expensive, they don't know what they don't have. It is like your car insurance giving you a free car wash every month. But when your car is totalled by an uninsured driver all you get is enough money for a down-payment on a bicycle. Insurance can look great if you never have to use it.

[Silent Type]

24. Absolutely incorrect. MA has to pay at least the same benefits as Medicare. And Medicare

would have denied the first woman’s treatment that is not FDA approved.

[markodochartaigh]

29. Rather than bore you with anecdotal stories of patients and

providers that I personally know, I will post an informative link from an organization working to save Medicare.


https://pnhp.org/taking-advantage/

[Silent Type]

35. Familiar with organization. They, like OP article, miss the fact that the woman's treatment would not have been covered

under traditional Medicare either because the treatments aren't FDA approved.

[delisen]

32. Not going to happen.?

The advantage programs are and have been siphoning off billions from original Medicare. Yes they are busting the Medicare budget and that is a major reason original Medicare has not been able to compete.

My Medicare Advantage program and possibly yours are extremely costly to Medicare although they were supposed to save money. The money savings never happened but the programs have ballooned and are costing Medicare billions unnecessarily.

If they continue as is, they will destroy Medicare and then will be able to squeeze their members even more and increase profits even more. No one will be able to stop them. We will have been divided and conquered.

These companies are not capitalist enterprises. These are simply feeding off taxpayers. They saw a pot of money in Medicare and they wanted it for themselves….and they got congressional Republicans to hand over our money to them

[AverageOldGuy]

17. It's not as though you were not warned . . .

. . . Yes, I know, the Medicare advantage ads flood the cable TV channels that old people watch. I know. My wife of 58 years, who is now 82 and slipping mentally, watches old cowboy movies and shows over and over -- we are in a rural VA county and depend on DirecTV, which has a few channels dedicated to old "westerns." She's even memorized the dialogue in some of them. Still, it makes her happy.

These channels are awash in Medicare advantage; funeral and final expense "life insurance;" car breakdown insurance; Camp LeJeune water lawyers; and other scams. The advertisers know where their audience is and know how to grab them.

At least once a day I must explain to her why we stick with standard Medicare and TriCareForLife. She is insulin dependent diabetic who takes a handful of meds twice daily along with five injections of two types of insulin daily. She has had both knees replaced, two session of foot and hand surgery, shoulder surgery -- cost us ZERO. Her meds cost us on average $85 per month.

The truth about the scam that is Medicare Advantage is all over the 'net and needs only a simple Google search to find.

[littlemissmartypants]

25. The employees at Medicare don't call nonstop every day of the week at dinner time trying to sell you a plan.

They won't fill your mailbox with "LAST CHANCE" to enroll mailers every week either.

They don't have the time or the money or the inclination because they are actually trying to help people and keep the real Medicare afloat.

I'm sorry, but don’t people even think anymore? I just don't remember so many people being so gullible in the past. Have we become a nation of idiots?

[William769]

26. I cannot say this enough and I will keep saying it till I'm blue in the face

Medicare advantage plans have only one job, to make money. The only way they can make money is to cost those who they insure to lose money and or benefits.

I equate Medicare advantage plans to HMO'S of the 90's. Think I'm still wrong? Think of prison privatization. Think I'm still wrong? You have my sympathies.

For the record, I do have as a primary full Medicare, and I carry a supplemental as a secondary.

[cstanleytech]

27. I switched to one myself because they offered dental and eyeglass coverage which I could not have afforded otherwise.

[Skittles]

41. that's how they entice people to MA

when they enough people on "Advantage" plans, they will kill Medicare and turn it ALL over to private insurance

[sinkingfeeling]

34. Just a question: how was she even on Medicare anything at 52?

"Coffey, 52, had been selling her belongings and raising money on GoFundMe to cover her medical care. To make things cheaper, she shifted her disability plan from traditional Medicare – a government-run health insurance program for older and disabled people – to Medicare Advantage, a program under which private health insurers contract with the Medicare program to provide health benefits."

[William769]

39. Social Security Disability, if approved, can be had at any age.

People on Social Security or Social Security Disability will get Medicare after 24 months.

I got Social Security Disability at age 42, I started receiving Medicare at age 44.

[Silent Type]

37. Guess we need to repeal ACA since the plans are private, as are medigap and drug plans. AND

traditional Medicare is administered at the local level by-- private insurance companies. Private Insurance companies pay and adjudicate provider claims, audit services, answer your questions, send you notifications, monitor quality, credential providers, make coverage decisions, etc.

[William769]

40. Oy vey.