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.
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.)
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!?
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.
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.
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.
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.
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.
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.
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.)
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!?
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.
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.
The healthcare system in the US is deeply BROKEN!
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.
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.
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.
Amen