Medicare Advantage is not Medicare: it’s private health insurance for seniors that’s largely paid for with our tax dollars. They make their money by routinely denying claims…
A few years back I didn’t read the fine print. A medication I was on was cheaper under MA and I made the switch. After a couple of years of hearing horror stories, I wanted back in to traditional Medicare. THEY WOULDN’T TAKE ME! Why not? Seems my medical history had some mention of “arthritis”. OMG! I am not seriously arthritic. I ride my bike 70 miles a week. But “arthritis” was a magic word that let them deny coverage.
What people, particularly those nearing retirement age, need to know is that it’s only when you first go on Medicare that the insurance companies can’t consider “preexisting conditions”. If you go onto Medicare Advantage and then try to get back in to traditional Medicare they can reject for preexisting conditions.
I got lucky though. There is a loophole. If you move to a different state, which, as it happened, I did, then they can’t reject for preexisting conditions. The same company that initially rejected me now accepted me once a broker pointed this out.
Steve thanks for sharing. Can you clarify a bit, because what you wrote makes it sound like our government Medicare rejected you. It's likely it was your private insurance gap-policy where they could then reject your purchase of a policy to cover what Medicare doesn't pay.
Many people don't understand that Medicare (from the government) only pays 80%, so people purchase (from private insurers) a "gap" policy to cover the rest. This is where the problem is when you try to go back and forth from Advantage to regular Medicare. Those PRIVATE insurers are allowed to use pre-existing conditions to reject or charge more.
And thanks for the hot tip about how moving made a difference!
Perfect explanation. And it's perfectly awful that they do this. Just like Thom says, if profit is involved, it becomes all about rejecting people or care for their medical conditions. We need a law. We need single payer for everyone.
Steve please clarify your situtation I am confused
First you switeched from Medicare to MA because of a cheaper medication under MA.
Then when you discovered that MA was a rip off, Medicare wouldn't take you back because of a pre existing condition (arthritis) . First question: How did they know that if it isn't in your medical records?
Lastly: How did moving to a different state,exempt you from Medicare rules?Medicare is Federal, not state, nor is it regulated by any state. It is simply a single payor program.
Thus not subject to state Insurance regulators.
It sounds to me like you were denied by Medicare Advantage for a pre existing condition, and to my knowledge Medicare doesn't deny for pre existing conditions (I will research that, trust me) My initial search reveals that Medicare will cover pre existing conditions.
Your experience reads to me as though you
1. Left Medicare for MA
2. Tried perhaps to leave your MA advantage program for another MA advantage program
3. Were denied, until you moved to another state.
I don't know rules for private insurance including so called medi-gap. I have such, a Group plan through CalPers, and everything is covered I haven't paid one cent, though I have been treated for cancer, in fact I had a CT Scan yesterday and an MRI on Saturday, and get the same ever six months, including a visit with my oncologist, and I have been in remission for four years. I am pre diabetic and get blood tests and a follow up with my PCP every six months as well, and haven't paid a cent, nor had a procedure denied.
I really don't understand your situation, especially since a state insurance regulator has no jurisdiction or say over Medicare, only private insurance companies.
You have correctly understood what I said. I joined MA in '21, got out in '23 after moving in late '22.
They knew about my arthritis from my medical records.
Your 3 point summary is incorrect on point 2. I never tried to or wanted to enroll in another MA program.
How did moving to a different state exempt me from that rule? I don't know what to tell you except that it DID! I was working with a broker, who said my condition didn't seem so bad and that she'd try to get me in a traditional Medicare plan. And then, I just happened to mention that I'd recently moved from Illinois to Arizona, and she said "Oh! That changes everything." And she got me into the plan I originally chose (actually, it was slightly more expensive, since I no longer had "guaranteed-issue" rights, but with the same company).
That is what happened. I am neither a lawyer nor an insurance administrator and I was surprised as hell that it happened, but it did!
Your question got me to research exactly what happened because I don't quite understand it myself.
"Please note that if you have Medicare Part C and there aren’t any Medicare Advantage plans available in the new service area that you’re moving to (or you don’t want to enroll in one), you can also choose to return to Original Medicare. You can then sign up for a stand-alone Medicare Part D prescription drug plan, and you might be able to buy a Medicare Supplement insurance plan."
Note the "(or don't want to enroll in one)". Weird, I know, but we live in weird times.
You can blame Biden until the cows come home, but as long as money is (anonymous) speech and corporations can exploit the rights of citizens, this will not get better.
(Unless we could convince Putin to tell Trump and his Congressional whores that Medicare for all would be good for Mother Russia.)
People who spot Medicare violations may be eligible for Medicare fraud rewards under the False Claims Act qui tam provision, which pays whistleblowers (also known as qui tam relators) between 15 and 25 percent of what the government collects based on their report of Medicare fraud (or Medicaid fraud). CMS (Center for Medicare Services) pays a monetary reward for information that leads to the recovery of at least $100 of Medicare funds from individuals and entities that are engaging in, or have engaged in, fraud. https://www.law.cornell.edu/cfr/text/42/420.405
DOJ is all over the Medicare Advantage program.
E.G. The Cigna Group, headquartered in Connecticut, has agreed to pay $172,294,350 to resolve allegations that it violated the False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare. https://www.justice.gov/opa/pr/cigna-group-pay-172-million-resolve-false-claims-act-allegations
Humana has become the latest insurer to be sued over allegedly using artificial intelligence to deny care, with a class action lawsuit claiming the company's nH Predict AI model was used to deny care to Medicare Advantage members.
What really throws people off is the mountain of ADVERTISING. It is crazy and just as you said that is coming out of the pockets of seniors that cannot afford much to begin with. It's the Advantage ads on TV and the private medi-gap insurers that I am talking about.
The mountain comes in paper ads to your home for the dozens of private insurance policies that cover what Medicare doesn't pay for. Government Medicare only pays 80% for a lot of things. Gap policies are sold by insurance companies to cover the difference or part of it.
When you try to switch from Advantage to Medicare the government doesn't do anything different, but the private medi-gap insurers can then ask you for records and they can also reject you for pre-existing conditions. The exception is they cannot do this when you first buy a gap policy at 65.
THIS sucks---there ought to be a law. Silly me, the Republicans wouldn't want to pass anything to help or protect old people now would they!?
The Medicare disadvantage ads, are ubiquitous during Open Enrollment season, Oct to November, and they prey on the gullibility of the elderly, by using worn out, thread bare, celebrities that need attention or money to live, like Joe Namath to sell their defective product
The problem is the people that fall for the ads. The TV is full of them, I buy nothing as seen on TV, and if I am using it, then I stop the moment I see an ad.
Johnson and Johnson is supposedly a respected firm, but we have lately found out that their bath and baby powders cause cancer.
There is a serious defect in the minds of humans, that enable them to fall for bullshit and propaganda, especially when it is coming from an "authority", and in our celebrity culture people think that an actor or singer or a skate boarder is an authority, they have an actor put on a lab coat, hang a stethoscope round their neck and voila "authority speaks"
My mother was one such, she was terrified of authority, she made friends with a crossing guard in front of her house, and bragged about it like she had befriended the President.
later the crossing guard stole the collection of gold coins, left her by her third husband, and she was so needy for approval that she showed her collections to everyone.
I am a veteran using the VA as my healthcare provider. I am also a retired electrician with employer based health insurance. When I retired I had around 25 thousand in my flex fund account to where I used the flex fund to pay my premiums. A couple years ago my employer base healthcare provider decided to not self administer our healthcare and hand administering the fund to a for-profit private insurance company. Some how when the for-profit took over. Retirees were automatically put into their Medicare advantage program. When I discovered my Medicare was captured into an advantage program I screamed blood murder to the VA, my employer based benefits administrator and the for-profit insurance company to take me off and return me to my original Medicare. The VA reassured me as long as I use the VA my Medicare is not endangered being turned into a Medicare advantage. My employer administrator redirected me to the for-profit's sales team telling me how great and easy to enjoy they are. Last summer my flex fund ran out of funds and understood not paying would cancel policy. But in December I decided to get a flu and covid shot at Walgreens. Last week I received a letter from the for-profit insurance company stating their processed the cost of my flu and covid shots. I decided to complain directly to Medicare. After explaining my situation the Medicare person, she told me to call my employer benefits administrator and ask for the magic words or have them dis-enroll me from the Medicare advantage program. And getting back on orginal Medicare. No loss of benefits. The employer base benefits administrator emailed me (even though they are not suppose to and I should figure it out by going to their website) a 'RetireeFirst Insurance Cancelation Request' form. The administrator wanted this corrected just as much as I did because they were improperly billing them for my Medicare advantage coverage. I mailed the form to Retireefirst LLC, located Mount Laurel, New Jersey. And sent a scan of form back to employer based benefit administrator. She responded by saying she will senting it asap to the for-profit healthcare insurance company. It will be interesting to see if I can get back on orginal Medicare or if the for-profit rejects request. Hope my comments help anyone else who had their Medicare captured without their knowledge and permission.
As someone intimately involved in providing health care and noticing who gets the “best” access, I can tell you , from personal experience too, that regular Medicare is the best coverage one can have. Unless you work for a large corporation that covers hundreds/thousands of employees ( they get discounted excellent plans) nothing is better. The medigap usually comes out of one’s social security monthly payment and many will add a prescription plan ( also paid from the soc sec dispersement). The Advantage plan is really a scam ( that you “W”) that Bush gave the insurers for financial support. The promise is that everything is covered except that it has to be approved and by the facilities and professionals on their panels. You want to go to MD Anderson for your cancer treatment, good luck. You want the best orthopedic surgeon in your town replacing your hip, again best to you. The politicians that passed this should be made to have only the Advantage plan for their health care.
I have Medicare A & B. My cardiologist mis-coded a test, and under his direction, I appealed the charge. It was denied, not by Medicare, but by a company called Noridian, and I was forced to pay the full price of the test. Apparently I was enrolled in a test program called "Supplemental Medical Review Contractor" without my knowledge or approval, and Noridian is now in charge of approving my appeal. This test program is separate and apart from the Medicare Advantage world. I cannot find a way to remove myself from this test program and return to regular Medicare approval of my prescribed care.
I can't understand why Medicare disapproved the diagnosis.
I recently called Medicare and reported fraud. Somehow my medicare number go out, and Medicare was billed, as was my secondary, for self administered COVID tests and $5,000 worth of incontinence supplies (I have problems but pissing my pants is not one of them)., two testing companies billed for COVID self tests one of which is Southern Labs LLC, in Alabama and Alexandria DME, in Kentucky billed for incontinence supplies.
Medicare sent me a new Card and number, just in time, because Southern Labs tried to bill Medicare a second time.
I get CPAP supplies through Adept Health and I suspect that is where my Medicare number was compromised. I advised Adept Health that Medicare was made aware and is investigating.
Provider miscoding frequently happens. I dealt with it for my mom when she was alive and now I occasionally get hit with it. Most of the time I see it as a Medicare Part B denial on a Medicare MSN. The MSN shows the codes the provider used and I cross check it on the internet. Bingo - obvious miscode, usually a one alpha numeric typo. Wait and do nothing. The provider gets the denial notice from Medicare and they usually realize the mistake and that’s the end of it. Occasionally, they don’t and a bill would show up for my mom years ago or me now. I call the provider, give them all of the information including what the test or procedure was for, and tell them the code they should have used. Solved.
Aside from characterizing this website w/o any persuasion, please explain how the US health care system is better or comprehensive or prevents bankruptcy compared to Western European countries such as Netherlands, Germany or Switzerland to name a few.
Thanks, Thom. This is a really important subject to educate people on. Especially those approaching 65 yrs old or renewing their medicare yearly plan. All the tv adds and mail the insurers put out is very misleading to most people. This is intentional on the private insurers part. My own daughter is selling(new,stay home job for her) these advantage plans. Being innocently ignorant of the true grift of these plans, she believes they are a good deal. I have tried to educate her that the very best option is to insist on regular government Medicare part B, and supplement it with a Medigap plan, which she also has the ability to sell through the private insurer. These Advantage plans offer lots of perks to lure people in but, beware of the hidden high deductibles and think carefully about all those pre-approvals that Thom is trying to warn us about. I have read that if you sign up for a Advantage plan the government pays the private insurer a whole years worth of your premium up front. It's no wonder they will do anything possible to keep as much of that money in their greedy little hands as possible.
What a litany of hair-tearing complicated problems and choices and surprises, even before the denials of care! I was caregiver to two aunts and my mother, all "managed care Medicare supplements" two different providers. I can run a repeating script in my head of the Social Workers explaining that such-and-such provider was notorious for kicking patients out of post-hospital rehab. ASAP.... The actual doctors ducked contact with me: what a terrible career as a physician, to be helpless to make care decisions, knowing your employer is harming people not ready for discharge. But patients and their caregivers are harmed by just the stress of the hassles! There was none of that when I had my appendix out in Great Britain in 1964. My parents asked the staff, where was the billing office, they had American insurance. It was kindly explained, there was no billing, no billing personnel, no office or supplies. Everybody there just had the job of taking care of people, even the random American tourist kid.
Biden has already been increasing premiums and privatizing Medicare. So a slow death or a rapid one I suppose. Although as Martin Luther King Jr astutely pointed out if your priority is destroying people and countries around the world, and that certainly is Biden's, you will never have the things you need in your own country. Apparently that point escapes Biden liberals.
Barry, I realize you have an agenda here to spew hatred on Biden but if you are going to troll and spread hate you might as well at least be honest about it. Increases to Medicare are written into law and happen no matter who the president is. I believe it was Reagan who started charging a premium to Medicare and if wealthy people have to pay more for their premiums, so be it. They get all the loop holes and pay less tax or NO tax anyway. Let’s level the playing field.
No agenda regarding Biden, Trump or any other president if they are doing what they say and working in the interest of the public good. I didn't tell Biden to completely avoid diplomacy with Putin, who he has known for decades, so he could funnel weapons to Ukraine, or to assist Netanyahu in a genocide, or to fistbump "pariah" MBS. These things are not my doing, Biden has chosen to do them and the results have been disastrous. As for Medicare, I am just referring to some journalism I read back in 2022: https://www.levernews.com/biden-hikes-medicare-prices-and-funnels-profits-to-private-insurers/
Now very recently for election season he has proposed reducing Medicare Advantage payments whcih is good, but this has not taken effect and I am skeptical of his bait and switch tactics as evidenced by his stances on the war in Yemen (reversed), pipeline expansion (reversed), drilling permits (reversed), police reform (reversed) and so on. I am not supposed to be working for Biden, he is supposed to be working for me and my patients. When he is not, I will call him out.
I also got a reduction in premium on the Medicare advantage plan that I have. It’s because of this that I signed up in the first place. Maybe when right wing congress will actually vote to make Medicare better I will go with that but they will NEVER do that. Biden is working within the confines of the structure that was created by republicans and at least trying to pass some benefits along to consumers. I know these plans don’t work for everyone because they can deny claims. Why private insurers and essentially get away with murder is beyond me. Perhaps more regulations are needed to constrain them. But we know that’s never something republicans will vote for and they still have a majority in the house. You seem to think that a president can have a bill drawn up with everything he personally wants in it without any compromise to the other side. It’s not the way things work.
HA, you’re funny. “ Diplomacy with Putin”. The only person to have diplomacy with Putin is Trump in the effort to take over the world. “ funneling weapons to Ukraine “, this was voted in bipartisan support. No underhanded attempt here that you are trying to accuse. Putin has already said he will take Ukraine then move into Finland, Poland, and Sweden next, then we will be pulled into a war with Russia. I guess that’s what you want. I believe him when he says that. As far as Medicare, my Medicare didn’t go up, other than the regular increase that we always get. While I don’t agree with everything Biden has done I think you need to look at who supports advantage plans and who started them. It wasn’t democrats. I realize Biden is not far enough left for you and I would agree with that to some degree but guess what, this is the structure we have and it is the one we need to work with. If you think at this point in time it’s a good idea to undermine votes for Biden (because he will be the nominee) you are only giving votes to Trump. I would rather work in the direction of moving the party further left and work with what we have.
You need to watch some journalism regarding the context of Ukraine and the negotiations that were taking place in March between Zelensky and Putin. You have been propagandized into thinking Putin's a madman, while the people of Yemen, Iraq, Afghanistan, and Gaza/The West Bank to name a few have a first-hand reason to think Biden is one. This is not offering "support" for Putin, he's an imperialist oligarch just like Biden. This could be helpful to stop the cheerleading and start some critical thinking: https://www.youtube.com/watch?v=AP1vJ-56uyo
No shit, Barry. This is not news to anyone. We are ALL aware what Netanyahu is doing. He was Trumps buddy, remember? But how much of this “aid” is written into LAW? I’m sure you don’t know. Also please explain WHY none of the Arab nations that surround Israel AND Gaza will take in Palestinians? They are ALL Arab after all.
Not everyone is “propagandized”, like you accuse, just because they don’t agree with you. Thats a childish stance. I read books and know some degree of history. Perhaps you should read books and get a deeper education yourself and stop assuming you know everything and that people you disagree with know nothing. I am always willing to learn something new and change position but when it’s presented with arrogance I’m less likely to listen at all.
Biden has nothing to do with Medicare Premiums Boris. You really are a Putin troll, and a Trump troll. Go get lost. Spread your lies and disnfo elsewheres.
I've been a Medicare recipient since 2004,and the premiums have gone up and down 2023 they went down from 2022 $170.10 to $164.90, this year they have gone up $5 and it is all based on cost of providing services, none of it for profit.
The decision as to the price of Medicare is not made by by Biden, but is an actuarial decision.
Man, this time you really pissed me off, such a blatant lie and disinfo.
Don’t feed the trolls. I’m not sure if “JennyStokes” is a real person or not. She claims to live in Europe. If so, she must have a LOT of time on her hands to troll issues specific to the US that have nothing to do with Europe.
A big weakness of Substack is that one can’t block trolls or other annoying people who have no idea what they’re talking about.
Don't bother, blocking only means that you can't see her comment.
Rohn Kenyatta has blocked me, the result is that he can't see my comments, but others can, it also means that I can't like a comment of his, and occasional y I do. I don't dislike Rohn Kenyatta, and often agree with some of what he says, except that he looks for insult and injury and has a huge chip on his shoulder, which works against his cause which I assume to be anti racism and black equality. I may be wrong, as assume means making an ass out of u and me. Maybe his leifmotif is flipping the bird to whitey, venting his anger for being born black and the way whites have treated blacks (and other minorities).
Who knows, but he has blocked me and can't see my posts, but others can, and for that reason I don't block anyone.
I think Biden is trying to avoid a larger war, that incidentally, he didn’t start. What do you think Putin will do if we don’t protect Ukraine? I do believe we should not fund Netanyahu’s destruction of Palestine.
Oh, you most definitely are a troll. You comment here everyday with the sole purpose of spreading hate. If you had something interesting to say I might listen. Otherwise NADA!
I have yet to read a study published in a reputable refereed medical journal that did not suggest that Medicare Advantage programs are a scam. Often that is because of promising one coverage, then disallowing it when you actually need it, or forcing subscribers to go to particular healthcare groups that might not be one's primary care physician's first choice.
Medicare, like most government service programs is better at running itself than privatizing services. Charter schools also re-appropriate tax dollars for a fee, yet there is scant proof that they produce students with better achievement test scores - like Advantage, they just cost more so that somebody makes a profit off the taxbase.
Hospitals and large physicians groups in California have been pulling out of Aetna and Anthem Medicare Advantage plans because they are tired of the hassles, the slow pay on claims, patients complaining, and long pre-approval wait times.
Not surprised. Pre-retirement, pre-Medicare I had both Aetna and Anthem insurance at various times. They changed their formulary and approved list multiple times a year. Ended up using GoodRx too.
A big problem is Big Pharma buying up the generic makers or paying generic makers not to make a generic of a big brand name drug that’s about to lose patent protections. The drug name is slightly changed, called generic version of xyz, and the price stays at 90% of top tier drug cost or sometimes, since only one generic maker, the price goes up higher than original top tier brand name.
Well all this happened during the open enrollment period in '22. My MA plan continued through 12/31/22. The MA was dropped 1/1/23 and a Medicare Supplement plan began.
As this came up in another comment, I'm not sure about your point 2: I was always in MEDICARE. But I was trying to switch from Medicare Advantage (aka Medicare Part C) to a traditional Medicare supplement arrangement (Part B). I was denied this at first, but was still in Medicare, and would have had to pay out of pocket whatever Medicare didn't cover unless I could obtain Part B coverage which was possible only because I moved. Medicare denied me nothing. The Part B plans were denying me until I told them that I'd moved to a different state.
A few years back I didn’t read the fine print. A medication I was on was cheaper under MA and I made the switch. After a couple of years of hearing horror stories, I wanted back in to traditional Medicare. THEY WOULDN’T TAKE ME! Why not? Seems my medical history had some mention of “arthritis”. OMG! I am not seriously arthritic. I ride my bike 70 miles a week. But “arthritis” was a magic word that let them deny coverage.
What people, particularly those nearing retirement age, need to know is that it’s only when you first go on Medicare that the insurance companies can’t consider “preexisting conditions”. If you go onto Medicare Advantage and then try to get back in to traditional Medicare they can reject for preexisting conditions.
I got lucky though. There is a loophole. If you move to a different state, which, as it happened, I did, then they can’t reject for preexisting conditions. The same company that initially rejected me now accepted me once a broker pointed this out.
Steve thanks for sharing. Can you clarify a bit, because what you wrote makes it sound like our government Medicare rejected you. It's likely it was your private insurance gap-policy where they could then reject your purchase of a policy to cover what Medicare doesn't pay.
Many people don't understand that Medicare (from the government) only pays 80%, so people purchase (from private insurers) a "gap" policy to cover the rest. This is where the problem is when you try to go back and forth from Advantage to regular Medicare. Those PRIVATE insurers are allowed to use pre-existing conditions to reject or charge more.
And thanks for the hot tip about how moving made a difference!
You're right! MEDICARE didn't reject me. The private Part B Medicare Supplement plans (aka "traditional Medicare") rejected me.
Perfect explanation. And it's perfectly awful that they do this. Just like Thom says, if profit is involved, it becomes all about rejecting people or care for their medical conditions. We need a law. We need single payer for everyone.
Happy Bike-Trails Steve!
Steve please clarify your situtation I am confused
First you switeched from Medicare to MA because of a cheaper medication under MA.
Then when you discovered that MA was a rip off, Medicare wouldn't take you back because of a pre existing condition (arthritis) . First question: How did they know that if it isn't in your medical records?
Lastly: How did moving to a different state,exempt you from Medicare rules?Medicare is Federal, not state, nor is it regulated by any state. It is simply a single payor program.
Thus not subject to state Insurance regulators.
It sounds to me like you were denied by Medicare Advantage for a pre existing condition, and to my knowledge Medicare doesn't deny for pre existing conditions (I will research that, trust me) My initial search reveals that Medicare will cover pre existing conditions.
Your experience reads to me as though you
1. Left Medicare for MA
2. Tried perhaps to leave your MA advantage program for another MA advantage program
3. Were denied, until you moved to another state.
I don't know rules for private insurance including so called medi-gap. I have such, a Group plan through CalPers, and everything is covered I haven't paid one cent, though I have been treated for cancer, in fact I had a CT Scan yesterday and an MRI on Saturday, and get the same ever six months, including a visit with my oncologist, and I have been in remission for four years. I am pre diabetic and get blood tests and a follow up with my PCP every six months as well, and haven't paid a cent, nor had a procedure denied.
I really don't understand your situation, especially since a state insurance regulator has no jurisdiction or say over Medicare, only private insurance companies.
You have correctly understood what I said. I joined MA in '21, got out in '23 after moving in late '22.
They knew about my arthritis from my medical records.
Your 3 point summary is incorrect on point 2. I never tried to or wanted to enroll in another MA program.
How did moving to a different state exempt me from that rule? I don't know what to tell you except that it DID! I was working with a broker, who said my condition didn't seem so bad and that she'd try to get me in a traditional Medicare plan. And then, I just happened to mention that I'd recently moved from Illinois to Arizona, and she said "Oh! That changes everything." And she got me into the plan I originally chose (actually, it was slightly more expensive, since I no longer had "guaranteed-issue" rights, but with the same company).
That is what happened. I am neither a lawyer nor an insurance administrator and I was surprised as hell that it happened, but it did!
Your question got me to research exactly what happened because I don't quite understand it myself.
I found this: https://www.ehealthinsurance.com/medicare/states/moving-another-state/, which says:
"Please note that if you have Medicare Part C and there aren’t any Medicare Advantage plans available in the new service area that you’re moving to (or you don’t want to enroll in one), you can also choose to return to Original Medicare. You can then sign up for a stand-alone Medicare Part D prescription drug plan, and you might be able to buy a Medicare Supplement insurance plan."
Note the "(or don't want to enroll in one)". Weird, I know, but we live in weird times.
Sorry Steve I am still confused
Let me go point by point, tell me where I am wrong
1 You enrolled in MA in '21. you moved in late '22 and in'23 you dropped your MA plan.
Is that correct?
2. After dropping your MA advantage plan you tried to re enroll in Medicare.
Is that correct?
3. When you tried to re enroll in Medicare they denied you because of a pre existing condition
Is that correct?
This is true. Glad you brought up this point!
Thanks Thom. Sure wish MSM would cover something as consequential as this. The question of “who will inform the people?” is forefront in my mind.
You can blame Biden until the cows come home, but as long as money is (anonymous) speech and corporations can exploit the rights of citizens, this will not get better.
(Unless we could convince Putin to tell Trump and his Congressional whores that Medicare for all would be good for Mother Russia.)
People who spot Medicare violations may be eligible for Medicare fraud rewards under the False Claims Act qui tam provision, which pays whistleblowers (also known as qui tam relators) between 15 and 25 percent of what the government collects based on their report of Medicare fraud (or Medicaid fraud). CMS (Center for Medicare Services) pays a monetary reward for information that leads to the recovery of at least $100 of Medicare funds from individuals and entities that are engaging in, or have engaged in, fraud. https://www.law.cornell.edu/cfr/text/42/420.405
DOJ is all over the Medicare Advantage program.
E.G. The Cigna Group, headquartered in Connecticut, has agreed to pay $172,294,350 to resolve allegations that it violated the False Claims Act by submitting and failing to withdraw inaccurate and untruthful diagnosis codes for its Medicare Advantage Plan enrollees in order to increase its payments from Medicare. https://www.justice.gov/opa/pr/cigna-group-pay-172-million-resolve-false-claims-act-allegations
DOJ has a health care fraud unit. https://www.justice.gov/criminal/criminal-fraud/health-care-fraud-unit.
Humana has become the latest insurer to be sued over allegedly using artificial intelligence to deny care, with a class action lawsuit claiming the company's nH Predict AI model was used to deny care to Medicare Advantage members.
What really throws people off is the mountain of ADVERTISING. It is crazy and just as you said that is coming out of the pockets of seniors that cannot afford much to begin with. It's the Advantage ads on TV and the private medi-gap insurers that I am talking about.
The mountain comes in paper ads to your home for the dozens of private insurance policies that cover what Medicare doesn't pay for. Government Medicare only pays 80% for a lot of things. Gap policies are sold by insurance companies to cover the difference or part of it.
When you try to switch from Advantage to Medicare the government doesn't do anything different, but the private medi-gap insurers can then ask you for records and they can also reject you for pre-existing conditions. The exception is they cannot do this when you first buy a gap policy at 65.
THIS sucks---there ought to be a law. Silly me, the Republicans wouldn't want to pass anything to help or protect old people now would they!?
The Medicare disadvantage ads, are ubiquitous during Open Enrollment season, Oct to November, and they prey on the gullibility of the elderly, by using worn out, thread bare, celebrities that need attention or money to live, like Joe Namath to sell their defective product
The problem is the people that fall for the ads. The TV is full of them, I buy nothing as seen on TV, and if I am using it, then I stop the moment I see an ad.
Johnson and Johnson is supposedly a respected firm, but we have lately found out that their bath and baby powders cause cancer.
There is a serious defect in the minds of humans, that enable them to fall for bullshit and propaganda, especially when it is coming from an "authority", and in our celebrity culture people think that an actor or singer or a skate boarder is an authority, they have an actor put on a lab coat, hang a stethoscope round their neck and voila "authority speaks"
My mother was one such, she was terrified of authority, she made friends with a crossing guard in front of her house, and bragged about it like she had befriended the President.
later the crossing guard stole the collection of gold coins, left her by her third husband, and she was so needy for approval that she showed her collections to everyone.
The number of ads is astounding! I have friends barraged by these junk supplemental plan ads starting when they turn 59!
You know only companies with very deep pockets can afford that much advertising.
Next is PhRMA. I started a spreadsheet of drugs advertised mostly on MBNBC, and already at 108
I am a veteran using the VA as my healthcare provider. I am also a retired electrician with employer based health insurance. When I retired I had around 25 thousand in my flex fund account to where I used the flex fund to pay my premiums. A couple years ago my employer base healthcare provider decided to not self administer our healthcare and hand administering the fund to a for-profit private insurance company. Some how when the for-profit took over. Retirees were automatically put into their Medicare advantage program. When I discovered my Medicare was captured into an advantage program I screamed blood murder to the VA, my employer based benefits administrator and the for-profit insurance company to take me off and return me to my original Medicare. The VA reassured me as long as I use the VA my Medicare is not endangered being turned into a Medicare advantage. My employer administrator redirected me to the for-profit's sales team telling me how great and easy to enjoy they are. Last summer my flex fund ran out of funds and understood not paying would cancel policy. But in December I decided to get a flu and covid shot at Walgreens. Last week I received a letter from the for-profit insurance company stating their processed the cost of my flu and covid shots. I decided to complain directly to Medicare. After explaining my situation the Medicare person, she told me to call my employer benefits administrator and ask for the magic words or have them dis-enroll me from the Medicare advantage program. And getting back on orginal Medicare. No loss of benefits. The employer base benefits administrator emailed me (even though they are not suppose to and I should figure it out by going to their website) a 'RetireeFirst Insurance Cancelation Request' form. The administrator wanted this corrected just as much as I did because they were improperly billing them for my Medicare advantage coverage. I mailed the form to Retireefirst LLC, located Mount Laurel, New Jersey. And sent a scan of form back to employer based benefit administrator. She responded by saying she will senting it asap to the for-profit healthcare insurance company. It will be interesting to see if I can get back on orginal Medicare or if the for-profit rejects request. Hope my comments help anyone else who had their Medicare captured without their knowledge and permission.
Hoping you as a Veteran, capital V for valuable get what this nation owes you: The Best medical care plus more.
And thank you for your service.
Federal appeals court rules Trump doesn't have broad immunity from prosecution FEBRUARY 6, 2024 10:06 AM ET. NPR.
https://www.npr.org/ 2024/02/06/1223904739/trump-immunityruling
As someone intimately involved in providing health care and noticing who gets the “best” access, I can tell you , from personal experience too, that regular Medicare is the best coverage one can have. Unless you work for a large corporation that covers hundreds/thousands of employees ( they get discounted excellent plans) nothing is better. The medigap usually comes out of one’s social security monthly payment and many will add a prescription plan ( also paid from the soc sec dispersement). The Advantage plan is really a scam ( that you “W”) that Bush gave the insurers for financial support. The promise is that everything is covered except that it has to be approved and by the facilities and professionals on their panels. You want to go to MD Anderson for your cancer treatment, good luck. You want the best orthopedic surgeon in your town replacing your hip, again best to you. The politicians that passed this should be made to have only the Advantage plan for their health care.
I have Medicare A & B. My cardiologist mis-coded a test, and under his direction, I appealed the charge. It was denied, not by Medicare, but by a company called Noridian, and I was forced to pay the full price of the test. Apparently I was enrolled in a test program called "Supplemental Medical Review Contractor" without my knowledge or approval, and Noridian is now in charge of approving my appeal. This test program is separate and apart from the Medicare Advantage world. I cannot find a way to remove myself from this test program and return to regular Medicare approval of my prescribed care.
I can't understand why Medicare disapproved the diagnosis.
I recently called Medicare and reported fraud. Somehow my medicare number go out, and Medicare was billed, as was my secondary, for self administered COVID tests and $5,000 worth of incontinence supplies (I have problems but pissing my pants is not one of them)., two testing companies billed for COVID self tests one of which is Southern Labs LLC, in Alabama and Alexandria DME, in Kentucky billed for incontinence supplies.
Medicare sent me a new Card and number, just in time, because Southern Labs tried to bill Medicare a second time.
I get CPAP supplies through Adept Health and I suspect that is where my Medicare number was compromised. I advised Adept Health that Medicare was made aware and is investigating.
Provider miscoding frequently happens. I dealt with it for my mom when she was alive and now I occasionally get hit with it. Most of the time I see it as a Medicare Part B denial on a Medicare MSN. The MSN shows the codes the provider used and I cross check it on the internet. Bingo - obvious miscode, usually a one alpha numeric typo. Wait and do nothing. The provider gets the denial notice from Medicare and they usually realize the mistake and that’s the end of it. Occasionally, they don’t and a bill would show up for my mom years ago or me now. I call the provider, give them all of the information including what the test or procedure was for, and tell them the code they should have used. Solved.
@Gary. You should have 1. Gotten a lawyer and 2. Appealed.
We had the same happen to us. Got them to change the coding.
This may be a scam pulled by the medical provider. We were charged $155. After the code was changed the provider was paid a total of about $30.
The healthcare system in the US is deeply BROKEN!
Another example of the "free market" at work. like our government and judicial system, we have the best health care that money can buy.
The more money you have the better the health care, no money no health care.
The motto for those that aren't wealthy, is get sick and die soon, after expending your labor, to keep the machine churning.
I am not able to like your comment. I wonder why?
This is an elitist liberal site.
Aside from characterizing this website w/o any persuasion, please explain how the US health care system is better or comprehensive or prevents bankruptcy compared to Western European countries such as Netherlands, Germany or Switzerland to name a few.
Since I live in France and have lived in the US I know the healthcare system is awful in the US.
Thanks, Thom. This is a really important subject to educate people on. Especially those approaching 65 yrs old or renewing their medicare yearly plan. All the tv adds and mail the insurers put out is very misleading to most people. This is intentional on the private insurers part. My own daughter is selling(new,stay home job for her) these advantage plans. Being innocently ignorant of the true grift of these plans, she believes they are a good deal. I have tried to educate her that the very best option is to insist on regular government Medicare part B, and supplement it with a Medigap plan, which she also has the ability to sell through the private insurer. These Advantage plans offer lots of perks to lure people in but, beware of the hidden high deductibles and think carefully about all those pre-approvals that Thom is trying to warn us about. I have read that if you sign up for a Advantage plan the government pays the private insurer a whole years worth of your premium up front. It's no wonder they will do anything possible to keep as much of that money in their greedy little hands as possible.
What a litany of hair-tearing complicated problems and choices and surprises, even before the denials of care! I was caregiver to two aunts and my mother, all "managed care Medicare supplements" two different providers. I can run a repeating script in my head of the Social Workers explaining that such-and-such provider was notorious for kicking patients out of post-hospital rehab. ASAP.... The actual doctors ducked contact with me: what a terrible career as a physician, to be helpless to make care decisions, knowing your employer is harming people not ready for discharge. But patients and their caregivers are harmed by just the stress of the hassles! There was none of that when I had my appendix out in Great Britain in 1964. My parents asked the staff, where was the billing office, they had American insurance. It was kindly explained, there was no billing, no billing personnel, no office or supplies. Everybody there just had the job of taking care of people, even the random American tourist kid.
Biden has already been increasing premiums and privatizing Medicare. So a slow death or a rapid one I suppose. Although as Martin Luther King Jr astutely pointed out if your priority is destroying people and countries around the world, and that certainly is Biden's, you will never have the things you need in your own country. Apparently that point escapes Biden liberals.
Barry, I realize you have an agenda here to spew hatred on Biden but if you are going to troll and spread hate you might as well at least be honest about it. Increases to Medicare are written into law and happen no matter who the president is. I believe it was Reagan who started charging a premium to Medicare and if wealthy people have to pay more for their premiums, so be it. They get all the loop holes and pay less tax or NO tax anyway. Let’s level the playing field.
No agenda regarding Biden, Trump or any other president if they are doing what they say and working in the interest of the public good. I didn't tell Biden to completely avoid diplomacy with Putin, who he has known for decades, so he could funnel weapons to Ukraine, or to assist Netanyahu in a genocide, or to fistbump "pariah" MBS. These things are not my doing, Biden has chosen to do them and the results have been disastrous. As for Medicare, I am just referring to some journalism I read back in 2022: https://www.levernews.com/biden-hikes-medicare-prices-and-funnels-profits-to-private-insurers/
Or this: https://www.statnews.com/2022/04/04/medicare-advantage-pay-increase-2023/
Now very recently for election season he has proposed reducing Medicare Advantage payments whcih is good, but this has not taken effect and I am skeptical of his bait and switch tactics as evidenced by his stances on the war in Yemen (reversed), pipeline expansion (reversed), drilling permits (reversed), police reform (reversed) and so on. I am not supposed to be working for Biden, he is supposed to be working for me and my patients. When he is not, I will call him out.
I also got a reduction in premium on the Medicare advantage plan that I have. It’s because of this that I signed up in the first place. Maybe when right wing congress will actually vote to make Medicare better I will go with that but they will NEVER do that. Biden is working within the confines of the structure that was created by republicans and at least trying to pass some benefits along to consumers. I know these plans don’t work for everyone because they can deny claims. Why private insurers and essentially get away with murder is beyond me. Perhaps more regulations are needed to constrain them. But we know that’s never something republicans will vote for and they still have a majority in the house. You seem to think that a president can have a bill drawn up with everything he personally wants in it without any compromise to the other side. It’s not the way things work.
HA, you’re funny. “ Diplomacy with Putin”. The only person to have diplomacy with Putin is Trump in the effort to take over the world. “ funneling weapons to Ukraine “, this was voted in bipartisan support. No underhanded attempt here that you are trying to accuse. Putin has already said he will take Ukraine then move into Finland, Poland, and Sweden next, then we will be pulled into a war with Russia. I guess that’s what you want. I believe him when he says that. As far as Medicare, my Medicare didn’t go up, other than the regular increase that we always get. While I don’t agree with everything Biden has done I think you need to look at who supports advantage plans and who started them. It wasn’t democrats. I realize Biden is not far enough left for you and I would agree with that to some degree but guess what, this is the structure we have and it is the one we need to work with. If you think at this point in time it’s a good idea to undermine votes for Biden (because he will be the nominee) you are only giving votes to Trump. I would rather work in the direction of moving the party further left and work with what we have.
You need to watch some journalism regarding the context of Ukraine and the negotiations that were taking place in March between Zelensky and Putin. You have been propagandized into thinking Putin's a madman, while the people of Yemen, Iraq, Afghanistan, and Gaza/The West Bank to name a few have a first-hand reason to think Biden is one. This is not offering "support" for Putin, he's an imperialist oligarch just like Biden. This could be helpful to stop the cheerleading and start some critical thinking: https://www.youtube.com/watch?v=AP1vJ-56uyo
No shit, Barry. This is not news to anyone. We are ALL aware what Netanyahu is doing. He was Trumps buddy, remember? But how much of this “aid” is written into LAW? I’m sure you don’t know. Also please explain WHY none of the Arab nations that surround Israel AND Gaza will take in Palestinians? They are ALL Arab after all.
Iran is NOT Arab nor is Turkey or Yemen!
Not everyone is “propagandized”, like you accuse, just because they don’t agree with you. Thats a childish stance. I read books and know some degree of history. Perhaps you should read books and get a deeper education yourself and stop assuming you know everything and that people you disagree with know nothing. I am always willing to learn something new and change position but when it’s presented with arrogance I’m less likely to listen at all.
FYI, I never said I supported Netanyahu. You make too many assumptions.
Link please?
Biden has nothing to do with Medicare Premiums Boris. You really are a Putin troll, and a Trump troll. Go get lost. Spread your lies and disnfo elsewheres.
I've been a Medicare recipient since 2004,and the premiums have gone up and down 2023 they went down from 2022 $170.10 to $164.90, this year they have gone up $5 and it is all based on cost of providing services, none of it for profit.
The decision as to the price of Medicare is not made by by Biden, but is an actuarial decision.
Man, this time you really pissed me off, such a blatant lie and disinfo.
And how has Biden done that?
Don’t feed the trolls. I’m not sure if “JennyStokes” is a real person or not. She claims to live in Europe. If so, she must have a LOT of time on her hands to troll issues specific to the US that have nothing to do with Europe.
A big weakness of Substack is that one can’t block trolls or other annoying people who have no idea what they’re talking about.
But they can ban them. Robert Reich has banned, at least two Right Wing disrupting trolls.
I’ll try to block her to clean up the comment thread at least for me.
Go ahead................
Don't bother, blocking only means that you can't see her comment.
Rohn Kenyatta has blocked me, the result is that he can't see my comments, but others can, it also means that I can't like a comment of his, and occasional y I do. I don't dislike Rohn Kenyatta, and often agree with some of what he says, except that he looks for insult and injury and has a huge chip on his shoulder, which works against his cause which I assume to be anti racism and black equality. I may be wrong, as assume means making an ass out of u and me. Maybe his leifmotif is flipping the bird to whitey, venting his anger for being born black and the way whites have treated blacks (and other minorities).
Who knows, but he has blocked me and can't see my posts, but others can, and for that reason I don't block anyone.
KL Pierce.
Is it wrong for people to be interested in other nations politics?
As it is I do live in France and what happens in the USA affects the world.
You are a moron.
You with your bloody wars.
Never has the US in recent History been attacked.
Here in Europe we are in the middle of everything the US decides to do.
Yes, I agree
So basically you want people to vote for warmonger Biden so that Americans have decent medical care which they should have had already. Hmmmm
I think Biden is trying to avoid a larger war, that incidentally, he didn’t start. What do you think Putin will do if we don’t protect Ukraine? I do believe we should not fund Netanyahu’s destruction of Palestine.
I think you need to read more.
Putin will stay where he is but keep the lands Russia has one. Not to mention that Ukraine was/is a despotic regime.
Jenny Stokes take your hateful trolling somewhere else. Not interested!
Don't read it if you don't want to.
Very democratic of you to call me a troll because you don't like my comment.
Oh, you most definitely are a troll. You comment here everyday with the sole purpose of spreading hate. If you had something interesting to say I might listen. Otherwise NADA!
Ah, so voting AGAINST Biden will give Americans the decent health care they should have had already? How, exactly?
Voting in the US is a misnomer.
If you vote for a Dem. or a Repug. you will not get what you want.
Biden has has 4yrs to do this!
Yep you can blame this on congress BUT it's YOU the people who have gotten into this mess.
Since Reagan you have not bothered to vote. I suggest you go and look at the voting record of the USA.
What has that got to do with anything?
I have yet to read a study published in a reputable refereed medical journal that did not suggest that Medicare Advantage programs are a scam. Often that is because of promising one coverage, then disallowing it when you actually need it, or forcing subscribers to go to particular healthcare groups that might not be one's primary care physician's first choice.
Medicare, like most government service programs is better at running itself than privatizing services. Charter schools also re-appropriate tax dollars for a fee, yet there is scant proof that they produce students with better achievement test scores - like Advantage, they just cost more so that somebody makes a profit off the taxbase.
Hospitals and large physicians groups in California have been pulling out of Aetna and Anthem Medicare Advantage plans because they are tired of the hassles, the slow pay on claims, patients complaining, and long pre-approval wait times.
I had Aetna Supplemental - it was horrible !!!! Their drug plan was such a joke that GoodRx was cheaper.
Not surprised. Pre-retirement, pre-Medicare I had both Aetna and Anthem insurance at various times. They changed their formulary and approved list multiple times a year. Ended up using GoodRx too.
A big problem is Big Pharma buying up the generic makers or paying generic makers not to make a generic of a big brand name drug that’s about to lose patent protections. The drug name is slightly changed, called generic version of xyz, and the price stays at 90% of top tier drug cost or sometimes, since only one generic maker, the price goes up higher than original top tier brand name.
As of January 1, 2024 Scripps Health (doctors and hospitals) will no longer accept ANY Medicare Advantage HMO plans.
Well all this happened during the open enrollment period in '22. My MA plan continued through 12/31/22. The MA was dropped 1/1/23 and a Medicare Supplement plan began.
As this came up in another comment, I'm not sure about your point 2: I was always in MEDICARE. But I was trying to switch from Medicare Advantage (aka Medicare Part C) to a traditional Medicare supplement arrangement (Part B). I was denied this at first, but was still in Medicare, and would have had to pay out of pocket whatever Medicare didn't cover unless I could obtain Part B coverage which was possible only because I moved. Medicare denied me nothing. The Part B plans were denying me until I told them that I'd moved to a different state.