Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs…
The Medicare Advantage scam is completely insidious and shows the sophisticated engines behind wealthy Americans who seek to siphon everything from disadvantaged Americans until they are dead or have lost trust with everything around them. The worst part is that they are wolves in sheep's clothing and perverting the real reason Medicare was created just to do this elaborate highway robbery. Another great newsletter that also reveals the way our age of privatization has demeaned a generation that grew up with efforts to support the middle class but were then hoodwinked into giving away those benefits based on a cheap, but elaborate lie.
Remember who controls Congress, do you think Republicans give a ..........., they benefit from AHIP (Association of Health Insurance Providers) money. Apparently some Democrats as well. We have the best Congress money can buy, especially after Citizens United and all of the other court rulings Thom has mentoned.
Our senator, former governor Rick Scott, father of the concept to sunset all benefits, like Sovial Security, Medicare, and VA, was responsible for $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs.
I have kin that in the panhandle, and it is the rednecks in the panhandle, the old geezers who live in the Villages and Cuban, class of millionaires, right wingers and mafia that vote Republican I know all about Rick Scott, and the fact that he was elected, indicates how fucked up in the head are those who vote for him, and now Rhonda Santis
America spends half as much money on the Ukraine war as the Medicare advantage plans overcharge. You never hear anything out of the Republicans about that or the news media. It looks like the death panels the right wingers have been so afraid of have arrived and just like everything else, they made it happen. The GOP voters keep electing con men and blaming hippies!
Mr. Johnson, if there were a contest to determine the best, most concise, biting comment: I would vote #1 for "The GOP voters keep electing con men and blaming hippies."
Robert p123, Medicare advantage overcharges 140 billion per year and the Ukraine war is costing America $60 billion per year. So, yes privatizing Medicare is costing America about twice as much!
Mediicare advantage. Starting next week, private health insurance corporations will launch a multimillion-dollar propaganda campaign aimed at seniors, hoping to convince them to ditch traditional Medicare and sign up for expensive, ineffective private plans.
So, anything published by private health insurance corporations should be considered a LIE until proven true. That's the message I get. Shame that our healthcare has been so privatized that it cannot be believed.
I am well aware of this ripoff and want to see it banned, but I don’t see it happening anytime soon. Sometimes it seems our chief achievement as a nation is to find new ways to monetize human suffering and difficulties.
3. Some beneficiaries have the capacity to get bounties for reporting Medicare fraud. Some law firms Qui tam is a provision of the False Claims Act (FCA) allowing whistleblowers to report fraud on behalf of the US government and receive a share of the recovered funds. Fraud includes abuse of disaster relief loans, over billing, kickbacks, false statements, and upcoding in healthcare, among many others. https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd032207att2.pdf
4. Where I live many medical providers are in denial and offer only "concierge" Medicare services. This may/may not open themselves as accomplices to fraud by Medicare Advantage fraud schemes.
5. IMHO the DNC should station volunteers at bankruptcy court to interview MAGATS who were screwed by their medical insurance companies and publish them. As Thom reported, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”
6. IMHO the Medicare base should be expanded, Lower eligibility to 62. Medicare Part B premiums would drop and the Medicare trust fund could be managed.
Great info, thanks, But remember the DNC also benefits from donations from AHIP, and there is always post retirement jobs as lobbyists and jobs in the industry.
Donald Rumsfeld worked for Searle, the chemical company that developed aspartme, a cancer causing . addictive drug, that is sold without a scrip, and in Snapple,. Diet Coke and Diet Pepsi, it also causes diabetes and weight gain.. Then he got a job as Sec of Defense,under Dubya.
Rumsfeld was not a Congress Critter, but his case shows the power and influence of PhRMA, and of course AHIP.
If I recall correctly, the Medicare Trust Fund is comprised of Government Securities solely.
And Bush raided the Trust Fund, I don't know if it was ever repaid. I doubt it, and that is what threatens Social Security, you don't see the corporate media talking about that do you, because their CEO's salary depends on withholding information and lying to the public.
What this discussion leaves out is the huge MA carrot of subsidized incentive: when anyone signs up for a Medicare Advantage plan their up front, out of pocket expenses (deductibles, copays, and premiums) are much lower than in traditional Medicare. Also their benefits seem expanded (e.g.with a "silver sneakers" program - also used to select healthier - less expensive- enrollees). Only when they get sick do they find their access to specialist care is limited, insurance approval is needed for certain expensive tests and medicines - and may be denied, and care away from home may be difficult.
Thom: Love your work but your staff didn't do any homework on this one. There are a lot of un-substantiated claims here about MA & MAPD plans. Sure, the system is not perfect but until we get to Universal Healthcare, it is a great option for Seniors.
1st) Let me say it is not "real" medicare it is "Original" Medicare. 2nd). Do these detractors in your comments know what Original Medicare covers? Let me just say it's Not much! For example: Medicare Part A is about hospital care. It is $0 per day for days 0-60 after you meet the $1,600 deductible. After days 61-90, it is $400 co-insurance PER DAY! After 90 days, it is $800 per day and each day counts against your 60 lifetime days of post 90 day hospital stays. Hit day 61 of post 90 day hospital stay and you are paying everything. For everyone's edification, here's an example of how bad it could be for some seniors.
The Original Medicare deductible is NOT for the year but is per event. If you go into the hospital for 4 days, you have a $1,600 deductible. If you return to the hospital within 60 days with the same issue you are good BUT if it is past 60 days OR it is for a different issue it is another another $1,600 deductible. 2 short term hospital stays would be $3,200. Original Medicare does not include drugs so you will need to sign up for a drug plan where the premium can be anywhere from $10-$100 a month with a $300-$500 deductible. OMC covers drugs while in the hospital. Once you are out of the Hospital, I'm sure you will quickly blow through your $500 drug deductible meaning your Grandmother with 2 hospital stays in a year is at a minimum of $3,500-$3,700 or let's say $300 a month. Know anyone on Social Security that can afford another $300 a month? I don't.
There are $0 Premium MAPD plans (which includes a drug plan) out there that have $0 hospital (yes, in-network, of course) stays from day 1 without limit. And tons of other benefits to help Seniors stay active and healthy like "Silver Sneakers" free gym memberships and free PERS (personal emergency response system) and a # of free rides to DR's and/or grocery stores.
Yes, I am a Medicare Insurance agent and I love it. After struggling to help my Mom, I got my license to help other Seniors with their Medicare. I review Seniors' plans to make sure they are using their current benefits and help them find something better if their needs have changed.
I'm also a long time Bernie Liberal and will be the 1st one in line voting for Universal Healthcare. All I'm saying is "let's not burn down the house until we another place to live." And let's not scare our Seniors into remaining on Original Medicare and possibly sending them into financial ruin. I wouldn't want that for my Mom. Bless -Eric
PS: Don't forget those 3 politicians in the Video will never be on Medicare because they'll have lifetime government health insurance. Did any of them mention "universal healthcare" as the solution? NO they didn't! Just another bunch of political whiners without a solution. CUT the WASTE out of the over $2 Billion PER DAY Military budget and we'll have more than enough money to fund Universal Health Care. Now that's a solution!!!!
You make some interesting points, but I didn’t see you mention Part B covers. The advantage plans have been overcharging Medicare for years, by at least 15%, by using “creative billing” , essentially meaning “over billing” that is difficult to detect. Like you go to a doctor solely for a sore throat, and the plan bills fir the throat checkup, plus Hypertension and diabetes ( other health concerns) even though they were not addressed or even mentioned.
There has been much comment about Medicare Advantage programs. One of the problems with traditional Medicare is that in order to have full coverage, one must spend hundreds of dollars above and beyond the amount of Medicare premium deducted from Social Security. These hundreds of dollars are also paid to private insurance companies. I cannot afford the hundreds of dollars extra for traditional Medicare. Before I was eligible for Medicare, I went for some years with no health insurance. I have written to my congress person about this problem. If you really want to solve the problem, write to your congress person. Otherwise just calling those of us on Medicare Advantage programs victims has little meaning and is degrading.
What do you do about prescriptions and non-hospital medical care? I pay $116/month for a basic BCBS "medigap" plan and $35/month for prescription drug coverage. My drug needs have been minimal, and for me the main advantage of both Medicare and Medigap has been optometry and ophthalmology. (My eyes s*ck, and since I had not one but two retina reattachment surgeries -- on the same eye -- when I was uninsured, I would not want to repeat the experience.)
I am talking about the monthly premiums. I explored switching to traditional Medicare about five years ago and it would have cost me over $300 per month for all the supplements necessary to part B and D.
Please clarify your statement that you spent hundreds of dollars for Medicare. I think that you mean that since you don't have a secondary, Medicare Gap, policy you spend 20% of the bill, and Medicare pays 80%, that's in the modified enabling legislation. I think, could be wrong, that this is an artifact of Dubya and a Republican controlled house and a 50/50 senate.
Harry Reid was notorious for his lack of spine, and always caved to the Republicans.
Bernie had the answer, single payor, not socialized medicine, which I agree is horrible. just as horrible as for profit hospitals and medical centers.
About five years ago, I explored going from Medicare Advantage to traditional Medicare. The result of that exploration was that if I had switched to traditional Medicare, it would have cost me over $300 per month in premiums paid to private insurance companies for parts B and D and Medigap.
Yup, I refuse Medicare Advantage. But, you don’t just refuse it once, the “do not call” list does not apply to them. You can get as many as 10+ calls PER DAY every year during enrollment. I am disgusted by this entire sham.
Thank you. I will give that a go. Sadly, our state “enjoys” a Republican super majority. There was a time when we maintained a healthy split. Then the DNC changed their funding structure, abandoning states like mine.
One of the problems I’ve encountered is that many, if not most, public retirement programs offer Medicare Advantage plans through private insurers but not Medigap policies. Although I ended up going outside my retirement plan to sign up for traditional Medicare, most of my public employee friends unknowingly signed up with an Advantage plan and now cannot go back because of penalties imposed after the initial enrollment period. I’m wondering if anyone knows why public retirement organizations do not offer Medigap policies?
This is a great example of outsourcing public sector functions to the private sector, especially how this whole mess has evolved to cancerous effect over the years. Since enough of our public sector decision-makers are serving their private sector plutocrats, this shit is not going to get better anytime soon, even if some of the big hospital systems eschew MA. Our elected officials must nullify the powers of corporate personhood and promote the general welfare of our citizens, or they will fail to satisfy their Constitutional purpose. We just need to elect a super majority of competent progressives to be able to do it.
Military housing is privatized. When I enlisted and until I retired. Enlisted and family housing (on base or post) was managed by the Colonel or Lt Colonel in charge of Housing. When you vacated quarters for any reason, you woul have to get clearance from an inspector who performed a white glove inspection of everything, including inside, outside and behind appliances.
Your choice DIY or hire one of the cleaners that was approved by the Housing office.
Then, under political pressure, housing was outsourced to for profit companies and the housing ran down, to the point that it is mildew infested, falling apart.
Enlisted housing, aka barracks, is not being maintained, as funds were diverted and commanders, which could be an O-3, are responsible for inspecting, but there are no funds for repairs and maintenance. And barracks are now unsafe. DOD solution, privatize the upkeep of the barracks. I can imagine next step is to withhold maintenance costs from privates, corporals and buck sergeants, pay, those that aren't married and are authorized to live off base.
Living off base, in rented quarters was once affordable, but these days most posts and bases are situated where the cost is not covered by the Basic Allowance for Quarters.
When a person enlists or is drafted, the DOD has incurred an obligation to ensure that you are fed, clothed and housed. To live off base and be reimbursed, requires an enlisted to obtain their commanders permission to marry, and then must apply for BAS (Basic allowance for subsistence) and BAQ. I understand that these days the BAQ rate varies from base/post to base/post, depending on the cost of housing in the area.
I checked google and Vandenburg AFB, CA is the most expensive and pays the highest BAQ.
Roger Old Dave, that until our Congress critters nullify Corporate person hood, nothing will happen, and so long as megadonors have a say, especially with the Republican party, I don't see much happening.
And until at least 5 SCOTUS judges are removed, they will most assuredly rule that any law passed by congress to limit the power of the oligarchs, will be nullified,
IMHO the House does not approve or have any say,in appointment of Judges, the corollary is that the appointing authority (the Senate) alone can removed the judges.
Jacobin (which I just started reading regularly) just did a piece on this too, so I hope the word is getting around once again. I'm still shocked by the number of liberals and progressives I know who go on about how great Medicare Advantage is. I don't know how to get through to them one on one, but maybe the most recent report(s) will have an effect.
I attended a continuing legal education course on elder law. One other problem with Medicare Advantage is that if you travel and develop health issues, you might have to get care from an out of network provider.
Or if you live in a county which has only one Medical provider, and have to travel hours to another, like myself
Medicare advantage operates like private insurance, and unless you have a Cadillac plan, some services will be denied.
I have medicare, a secondary, (Medicare stop gap) most of which is paid for by my former employer (Cal Pers). It is a group plan, and the only reason I have it, because I was a shop foreman and part of the negotiating team, and wouldn't leave the table until the employer agreed (the rest of the team wanted to go home, but peer pressure has no effect on me. 2 years later, after I retired, the new negotiating team caved and the employer, reduced contributions,reimbursing the retiree with a check, which is reduced about $5 s year.
6 years of treatment and follow ups for brain and lung cancer, cost me nothing, but it would have cost over $100,000. Cheaper to buy a Medicare stop gap plan,
The real and only alternative is Bernies single payor plan.
When I went on Medicare, Med Advantage had no providers in my area either so I never considered it. Good job on the negotiating, sir, and too bad your successors didn't have your commitment or persistence. And yes, single-payer is the ONLY sane way to go. Who knows, maybe it'll even include dentistry!
I knew Medicare advantage was a scam, because it was a private insurance plan, and they are all scams. What I pay for my secondary is a crime, between my contribution and my employers contribution It costs over $300 a month,but because it is a group plan, managed and brokered by CalPers, it covers everything that Medicare doesn't.. As a backup I have Tricare for Life, which costs nothing. I stay with CalPers as secondary because there are some providers that aren't registered with TriCare. Tricare is the Dept of Defense program and it too has degenerated, if an active duty service member is enrolled they they have to pay a subscription.
It wasn't that way when I retired.
Service pay and benefits have gone to hell, since I retired, thanks to a Republican Congress, and when Democrats control congress, they leave shit in place, because they have other priorities. It is always about the money.
Too many Dems get too much money from Big Pharma and Big Insurance. IIRC the AMA helped sink Clinton's attempt at a sane health-care plan in the early/mid '90s, but in the decades since they seem to have realized that the pharmaceutical and insurance industries have been screwing doctors too.
Yep, but need a refresher on Clinton. I do remember Newt Gringrich trying to impeach and remove him over oral sex,and after that he fulfilled the billionaire and corporate agenda,maybe that is how he beat back Gingrich's attempt. Every time it is sex and greed that trips these people up,including Gaetz and Boebert, not to mention Hunter and Menendez, and who could forget Anthony Weiner's weener pics.
It is America's fault, we keep electing these incompetent, avoracious, self serving, perverts.
Because the right sequence of words come out of their mouths, and too lazy to pay attention and do some critical thinking.
Possibly depending on their plan. If there is no in-network facilities in the area you've traveled to, some plans will still cover it. And there are plans that offer up to $100,000 per year for care outside the United States. It's not all bad. Find an agent that will listen to your needs and find the right plan for you.
Just watch what happens once Medicare is drained dry and destroyed. These Advantage plans will absolutely lose their advantage! We will be back to the old days of being unable to afford insurance.
I know there's been a lot of scare about Medicare going away. However, keep in mind, those big companies do make money and they give a lot to politicians so I don't see them letting Medicare go away. Not if they can make money.
I think I lost my original, longer comment. If so: my wife and I are in relatively good health at 78 and 80, respectively. We have had both choices and find MC, a secondary(medigap; supplementary; whatever!) and a Part D to be too much money in premiums, deductibles and formularies constantly changing copay amounts. Our MA plan has worked financially and medically for us both for several years now. Maybe we’re just lucky but it’s hard to fork over the money every month versus an MA plan that charges zero for those things. And its formulary seems to be more inclusive. So where’s the problem?
From what I hear, the plans are good as long as we are not very sick, but that they don’t cover serious illnesses very well. That’s worrisome. Also, the plans are treating us well while they are new and still subsidized by the government. That is supposed to phase out soon.
Richard, I'm in the same boat as you are. I save about $300 Dollars a month using Medicare Advantage. Now I am in pretty good health. Also my plan is good out of state. I have had no problem getting approval for specialists as long as they are in network. Also I'm in an HMO. The insurance agent did tell me I should change to regular Medicare if I start having a lot of Medical problems.
I am pretty sure our Aetna PPO MA Plan (in some FL counties as is in ours) would treat an out-of-state claim as out-of-network and even in a FL county where Aetna does not write. What you stated prompts me to check that out again. And you received the same advice from your agent as we did. Thanks for heads up!
I said years ago that these plans were designed to kill and replace Medicare. GW Bush convinced congress to approve this Trojan Horse system. The time is rapidly approaching when Medicare will be drained dry. Act now, or our senior health insurance is doomed
My spouse and I are both on Medicare for several years now, not some private, rip off 'Advantage' program. We have had zero issues, no problems with receiving care and no issues with medial billings. We owe thanks to Thom for making us aware of the scam. One way to determine the focus of a conservative rip off is the name they give to it. It's always the opposite of what they want to accomplish. "Advantage"? Yeah, for the investor class.
the C in CMS which administers Medicare. The secondary and Part D plans are all provided by the private insurance industry. So how is Medicare, Medicare only? The Insurance Industry has its hands in the whole healthcare law anyway and no matter which choices we make. And we’re not getting away alive!
The Medicare Advantage scam is completely insidious and shows the sophisticated engines behind wealthy Americans who seek to siphon everything from disadvantaged Americans until they are dead or have lost trust with everything around them. The worst part is that they are wolves in sheep's clothing and perverting the real reason Medicare was created just to do this elaborate highway robbery. Another great newsletter that also reveals the way our age of privatization has demeaned a generation that grew up with efforts to support the middle class but were then hoodwinked into giving away those benefits based on a cheap, but elaborate lie.
Does no-one have a brain in the US.
Get out on the streets and write to your Congress person.
Remember who controls Congress, do you think Republicans give a ..........., they benefit from AHIP (Association of Health Insurance Providers) money. Apparently some Democrats as well. We have the best Congress money can buy, especially after Citizens United and all of the other court rulings Thom has mentoned.
They won’t listen to you if you can’t write them a check.
And not just a check, but with 4 - 6 figures. Politicians take the commoner for granted.
I've tried to contact my two Democratic senators, and unless the Topic is one of their own choosing, don't bother.
Senators and Congress critters will ignore you if you aren't in their state or district.
Our senator, former governor Rick Scott, father of the concept to sunset all benefits, like Sovial Security, Medicare, and VA, was responsible for $631 million in civil penalties and damages arising from false claims the government alleged it submitted to Medicare and other federal health programs.
https://www.justice.gov/archive/opa/pr/2003/June/03_civ_386.htm
The voters of Florida knew that, yet he was elected.
I have kin that in the panhandle, and it is the rednecks in the panhandle, the old geezers who live in the Villages and Cuban, class of millionaires, right wingers and mafia that vote Republican I know all about Rick Scott, and the fact that he was elected, indicates how fucked up in the head are those who vote for him, and now Rhonda Santis
Our Congress used to work for the American people. Now, we can't be sure who they work for.
America spends half as much money on the Ukraine war as the Medicare advantage plans overcharge. You never hear anything out of the Republicans about that or the news media. It looks like the death panels the right wingers have been so afraid of have arrived and just like everything else, they made it happen. The GOP voters keep electing con men and blaming hippies!
Mr. Johnson, if there were a contest to determine the best, most concise, biting comment: I would vote #1 for "The GOP voters keep electing con men and blaming hippies."
So Medicare Advantage overcharges cost Americans twice as much as the war in Ukraine??
Robert p123, Medicare advantage overcharges 140 billion per year and the Ukraine war is costing America $60 billion per year. So, yes privatizing Medicare is costing America about twice as much!
Mediicare advantage. Starting next week, private health insurance corporations will launch a multimillion-dollar propaganda campaign aimed at seniors, hoping to convince them to ditch traditional Medicare and sign up for expensive, ineffective private plans.
https://www.levernews.com/insurers-are-gaming-medicare-to-the-tune-of-140_billion/?link_id=10&can_id=c21edc35afceb939e29222ede000e0fb&source=email-propaganda-watch-medicare-edition-2&email_referrer=email_2071282&email_subject=propaganda-watch-medicare-edition
https://secure.actblue.com/donate/ssw_open-enrollment?link_id=1&can_id=c21edc35afceb939e29222ede000e0fb&source=email-propaganda-watch-medicare-edition-2&email_referrer=email_2071282&email_subject=propaganda-watch-medicare-edition&refcodeEmailReferrer=email_2071282
So, anything published by private health insurance corporations should be considered a LIE until proven true. That's the message I get. Shame that our healthcare has been so privatized that it cannot be believed.
I am well aware of this ripoff and want to see it banned, but I don’t see it happening anytime soon. Sometimes it seems our chief achievement as a nation is to find new ways to monetize human suffering and difficulties.
1. Medicare Advantage is not Medicare and the advantage goes to the insurance industry.
2. Cigna Group 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
3. Some beneficiaries have the capacity to get bounties for reporting Medicare fraud. Some law firms Qui tam is a provision of the False Claims Act (FCA) allowing whistleblowers to report fraud on behalf of the US government and receive a share of the recovered funds. Fraud includes abuse of disaster relief loans, over billing, kickbacks, false statements, and upcoding in healthcare, among many others. https://downloads.cms.gov/cmsgov/archived-downloads/smdl/downloads/smd032207att2.pdf
4. Where I live many medical providers are in denial and offer only "concierge" Medicare services. This may/may not open themselves as accomplices to fraud by Medicare Advantage fraud schemes.
5. IMHO the DNC should station volunteers at bankruptcy court to interview MAGATS who were screwed by their medical insurance companies and publish them. As Thom reported, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”
6. IMHO the Medicare base should be expanded, Lower eligibility to 62. Medicare Part B premiums would drop and the Medicare trust fund could be managed.
Great info, thanks, But remember the DNC also benefits from donations from AHIP, and there is always post retirement jobs as lobbyists and jobs in the industry.
Donald Rumsfeld worked for Searle, the chemical company that developed aspartme, a cancer causing . addictive drug, that is sold without a scrip, and in Snapple,. Diet Coke and Diet Pepsi, it also causes diabetes and weight gain.. Then he got a job as Sec of Defense,under Dubya.
Rumsfeld was not a Congress Critter, but his case shows the power and influence of PhRMA, and of course AHIP.
If I recall correctly, the Medicare Trust Fund is comprised of Government Securities solely.
And Bush raided the Trust Fund, I don't know if it was ever repaid. I doubt it, and that is what threatens Social Security, you don't see the corporate media talking about that do you, because their CEO's salary depends on withholding information and lying to the public.
Thanks 😊
What this discussion leaves out is the huge MA carrot of subsidized incentive: when anyone signs up for a Medicare Advantage plan their up front, out of pocket expenses (deductibles, copays, and premiums) are much lower than in traditional Medicare. Also their benefits seem expanded (e.g.with a "silver sneakers" program - also used to select healthier - less expensive- enrollees). Only when they get sick do they find their access to specialist care is limited, insurance approval is needed for certain expensive tests and medicines - and may be denied, and care away from home may be difficult.
And once we are all suckered in and Medicare is drained dry, watch how all our attractive benefits disappear.
Thom: Love your work but your staff didn't do any homework on this one. There are a lot of un-substantiated claims here about MA & MAPD plans. Sure, the system is not perfect but until we get to Universal Healthcare, it is a great option for Seniors.
1st) Let me say it is not "real" medicare it is "Original" Medicare. 2nd). Do these detractors in your comments know what Original Medicare covers? Let me just say it's Not much! For example: Medicare Part A is about hospital care. It is $0 per day for days 0-60 after you meet the $1,600 deductible. After days 61-90, it is $400 co-insurance PER DAY! After 90 days, it is $800 per day and each day counts against your 60 lifetime days of post 90 day hospital stays. Hit day 61 of post 90 day hospital stay and you are paying everything. For everyone's edification, here's an example of how bad it could be for some seniors.
The Original Medicare deductible is NOT for the year but is per event. If you go into the hospital for 4 days, you have a $1,600 deductible. If you return to the hospital within 60 days with the same issue you are good BUT if it is past 60 days OR it is for a different issue it is another another $1,600 deductible. 2 short term hospital stays would be $3,200. Original Medicare does not include drugs so you will need to sign up for a drug plan where the premium can be anywhere from $10-$100 a month with a $300-$500 deductible. OMC covers drugs while in the hospital. Once you are out of the Hospital, I'm sure you will quickly blow through your $500 drug deductible meaning your Grandmother with 2 hospital stays in a year is at a minimum of $3,500-$3,700 or let's say $300 a month. Know anyone on Social Security that can afford another $300 a month? I don't.
There are $0 Premium MAPD plans (which includes a drug plan) out there that have $0 hospital (yes, in-network, of course) stays from day 1 without limit. And tons of other benefits to help Seniors stay active and healthy like "Silver Sneakers" free gym memberships and free PERS (personal emergency response system) and a # of free rides to DR's and/or grocery stores.
Yes, I am a Medicare Insurance agent and I love it. After struggling to help my Mom, I got my license to help other Seniors with their Medicare. I review Seniors' plans to make sure they are using their current benefits and help them find something better if their needs have changed.
I'm also a long time Bernie Liberal and will be the 1st one in line voting for Universal Healthcare. All I'm saying is "let's not burn down the house until we another place to live." And let's not scare our Seniors into remaining on Original Medicare and possibly sending them into financial ruin. I wouldn't want that for my Mom. Bless -Eric
PS: Don't forget those 3 politicians in the Video will never be on Medicare because they'll have lifetime government health insurance. Did any of them mention "universal healthcare" as the solution? NO they didn't! Just another bunch of political whiners without a solution. CUT the WASTE out of the over $2 Billion PER DAY Military budget and we'll have more than enough money to fund Universal Health Care. Now that's a solution!!!!
You make some interesting points, but I didn’t see you mention Part B covers. The advantage plans have been overcharging Medicare for years, by at least 15%, by using “creative billing” , essentially meaning “over billing” that is difficult to detect. Like you go to a doctor solely for a sore throat, and the plan bills fir the throat checkup, plus Hypertension and diabetes ( other health concerns) even though they were not addressed or even mentioned.
There has been much comment about Medicare Advantage programs. One of the problems with traditional Medicare is that in order to have full coverage, one must spend hundreds of dollars above and beyond the amount of Medicare premium deducted from Social Security. These hundreds of dollars are also paid to private insurance companies. I cannot afford the hundreds of dollars extra for traditional Medicare. Before I was eligible for Medicare, I went for some years with no health insurance. I have written to my congress person about this problem. If you really want to solve the problem, write to your congress person. Otherwise just calling those of us on Medicare Advantage programs victims has little meaning and is degrading.
I have traditional Medicare. I do not spend hundreds of dollars extra. Ever.
What do you do about prescriptions and non-hospital medical care? I pay $116/month for a basic BCBS "medigap" plan and $35/month for prescription drug coverage. My drug needs have been minimal, and for me the main advantage of both Medicare and Medigap has been optometry and ophthalmology. (My eyes s*ck, and since I had not one but two retina reattachment surgeries -- on the same eye -- when I was uninsured, I would not want to repeat the experience.)
I am talking about the monthly premiums. I explored switching to traditional Medicare about five years ago and it would have cost me over $300 per month for all the supplements necessary to part B and D.
Please clarify your statement that you spent hundreds of dollars for Medicare. I think that you mean that since you don't have a secondary, Medicare Gap, policy you spend 20% of the bill, and Medicare pays 80%, that's in the modified enabling legislation. I think, could be wrong, that this is an artifact of Dubya and a Republican controlled house and a 50/50 senate.
Harry Reid was notorious for his lack of spine, and always caved to the Republicans.
Bernie had the answer, single payor, not socialized medicine, which I agree is horrible. just as horrible as for profit hospitals and medical centers.
About five years ago, I explored going from Medicare Advantage to traditional Medicare. The result of that exploration was that if I had switched to traditional Medicare, it would have cost me over $300 per month in premiums paid to private insurance companies for parts B and D and Medigap.
Yup, I refuse Medicare Advantage. But, you don’t just refuse it once, the “do not call” list does not apply to them. You can get as many as 10+ calls PER DAY every year during enrollment. I am disgusted by this entire sham.
Write to your Congress person!
Thank you. I will give that a go. Sadly, our state “enjoys” a Republican super majority. There was a time when we maintained a healthy split. Then the DNC changed their funding structure, abandoning states like mine.
Do try and get your friends to do the same?
Good luck.
I have written my Congress people before. What I get is why they think they’re right and I’m wrong. So...
I think maybe you should say something like: IF you don't answer me why should I vote for you.
Interested to see if this will work?
One of the problems I’ve encountered is that many, if not most, public retirement programs offer Medicare Advantage plans through private insurers but not Medigap policies. Although I ended up going outside my retirement plan to sign up for traditional Medicare, most of my public employee friends unknowingly signed up with an Advantage plan and now cannot go back because of penalties imposed after the initial enrollment period. I’m wondering if anyone knows why public retirement organizations do not offer Medigap policies?
Wow. I didn't know that. Someone somewhere must be working on this -- I hope?
This is a great example of outsourcing public sector functions to the private sector, especially how this whole mess has evolved to cancerous effect over the years. Since enough of our public sector decision-makers are serving their private sector plutocrats, this shit is not going to get better anytime soon, even if some of the big hospital systems eschew MA. Our elected officials must nullify the powers of corporate personhood and promote the general welfare of our citizens, or they will fail to satisfy their Constitutional purpose. We just need to elect a super majority of competent progressives to be able to do it.
Military housing is privatized. When I enlisted and until I retired. Enlisted and family housing (on base or post) was managed by the Colonel or Lt Colonel in charge of Housing. When you vacated quarters for any reason, you woul have to get clearance from an inspector who performed a white glove inspection of everything, including inside, outside and behind appliances.
Your choice DIY or hire one of the cleaners that was approved by the Housing office.
Then, under political pressure, housing was outsourced to for profit companies and the housing ran down, to the point that it is mildew infested, falling apart.
Enlisted housing, aka barracks, is not being maintained, as funds were diverted and commanders, which could be an O-3, are responsible for inspecting, but there are no funds for repairs and maintenance. And barracks are now unsafe. DOD solution, privatize the upkeep of the barracks. I can imagine next step is to withhold maintenance costs from privates, corporals and buck sergeants, pay, those that aren't married and are authorized to live off base.
Living off base, in rented quarters was once affordable, but these days most posts and bases are situated where the cost is not covered by the Basic Allowance for Quarters.
When a person enlists or is drafted, the DOD has incurred an obligation to ensure that you are fed, clothed and housed. To live off base and be reimbursed, requires an enlisted to obtain their commanders permission to marry, and then must apply for BAS (Basic allowance for subsistence) and BAQ. I understand that these days the BAQ rate varies from base/post to base/post, depending on the cost of housing in the area.
I checked google and Vandenburg AFB, CA is the most expensive and pays the highest BAQ.
Roger Old Dave, that until our Congress critters nullify Corporate person hood, nothing will happen, and so long as megadonors have a say, especially with the Republican party, I don't see much happening.
And until at least 5 SCOTUS judges are removed, they will most assuredly rule that any law passed by congress to limit the power of the oligarchs, will be nullified,
IMHO the House does not approve or have any say,in appointment of Judges, the corollary is that the appointing authority (the Senate) alone can removed the judges.
This is very disturbing, but I'm utterly grateful to have it explained like this.
Jacobin (which I just started reading regularly) just did a piece on this too, so I hope the word is getting around once again. I'm still shocked by the number of liberals and progressives I know who go on about how great Medicare Advantage is. I don't know how to get through to them one on one, but maybe the most recent report(s) will have an effect.
I attended a continuing legal education course on elder law. One other problem with Medicare Advantage is that if you travel and develop health issues, you might have to get care from an out of network provider.
Or if you live in a county which has only one Medical provider, and have to travel hours to another, like myself
Medicare advantage operates like private insurance, and unless you have a Cadillac plan, some services will be denied.
I have medicare, a secondary, (Medicare stop gap) most of which is paid for by my former employer (Cal Pers). It is a group plan, and the only reason I have it, because I was a shop foreman and part of the negotiating team, and wouldn't leave the table until the employer agreed (the rest of the team wanted to go home, but peer pressure has no effect on me. 2 years later, after I retired, the new negotiating team caved and the employer, reduced contributions,reimbursing the retiree with a check, which is reduced about $5 s year.
6 years of treatment and follow ups for brain and lung cancer, cost me nothing, but it would have cost over $100,000. Cheaper to buy a Medicare stop gap plan,
The real and only alternative is Bernies single payor plan.
Feckless and stupid shop stewards.
When I went on Medicare, Med Advantage had no providers in my area either so I never considered it. Good job on the negotiating, sir, and too bad your successors didn't have your commitment or persistence. And yes, single-payer is the ONLY sane way to go. Who knows, maybe it'll even include dentistry!
I knew Medicare advantage was a scam, because it was a private insurance plan, and they are all scams. What I pay for my secondary is a crime, between my contribution and my employers contribution It costs over $300 a month,but because it is a group plan, managed and brokered by CalPers, it covers everything that Medicare doesn't.. As a backup I have Tricare for Life, which costs nothing. I stay with CalPers as secondary because there are some providers that aren't registered with TriCare. Tricare is the Dept of Defense program and it too has degenerated, if an active duty service member is enrolled they they have to pay a subscription.
It wasn't that way when I retired.
Service pay and benefits have gone to hell, since I retired, thanks to a Republican Congress, and when Democrats control congress, they leave shit in place, because they have other priorities. It is always about the money.
Too many Dems get too much money from Big Pharma and Big Insurance. IIRC the AMA helped sink Clinton's attempt at a sane health-care plan in the early/mid '90s, but in the decades since they seem to have realized that the pharmaceutical and insurance industries have been screwing doctors too.
Yep, but need a refresher on Clinton. I do remember Newt Gringrich trying to impeach and remove him over oral sex,and after that he fulfilled the billionaire and corporate agenda,maybe that is how he beat back Gingrich's attempt. Every time it is sex and greed that trips these people up,including Gaetz and Boebert, not to mention Hunter and Menendez, and who could forget Anthony Weiner's weener pics.
It is America's fault, we keep electing these incompetent, avoracious, self serving, perverts.
Because the right sequence of words come out of their mouths, and too lazy to pay attention and do some critical thinking.
Joe Manchin anyone?
Possibly depending on their plan. If there is no in-network facilities in the area you've traveled to, some plans will still cover it. And there are plans that offer up to $100,000 per year for care outside the United States. It's not all bad. Find an agent that will listen to your needs and find the right plan for you.
Just watch what happens once Medicare is drained dry and destroyed. These Advantage plans will absolutely lose their advantage! We will be back to the old days of being unable to afford insurance.
I know there's been a lot of scare about Medicare going away. However, keep in mind, those big companies do make money and they give a lot to politicians so I don't see them letting Medicare go away. Not if they can make money.
I think I lost my original, longer comment. If so: my wife and I are in relatively good health at 78 and 80, respectively. We have had both choices and find MC, a secondary(medigap; supplementary; whatever!) and a Part D to be too much money in premiums, deductibles and formularies constantly changing copay amounts. Our MA plan has worked financially and medically for us both for several years now. Maybe we’re just lucky but it’s hard to fork over the money every month versus an MA plan that charges zero for those things. And its formulary seems to be more inclusive. So where’s the problem?
From what I hear, the plans are good as long as we are not very sick, but that they don’t cover serious illnesses very well. That’s worrisome. Also, the plans are treating us well while they are new and still subsidized by the government. That is supposed to phase out soon.
Richard, I'm in the same boat as you are. I save about $300 Dollars a month using Medicare Advantage. Now I am in pretty good health. Also my plan is good out of state. I have had no problem getting approval for specialists as long as they are in network. Also I'm in an HMO. The insurance agent did tell me I should change to regular Medicare if I start having a lot of Medical problems.
I am pretty sure our Aetna PPO MA Plan (in some FL counties as is in ours) would treat an out-of-state claim as out-of-network and even in a FL county where Aetna does not write. What you stated prompts me to check that out again. And you received the same advice from your agent as we did. Thanks for heads up!
I said years ago that these plans were designed to kill and replace Medicare. GW Bush convinced congress to approve this Trojan Horse system. The time is rapidly approaching when Medicare will be drained dry. Act now, or our senior health insurance is doomed
Doomed! So correct.
My spouse and I are both on Medicare for several years now, not some private, rip off 'Advantage' program. We have had zero issues, no problems with receiving care and no issues with medial billings. We owe thanks to Thom for making us aware of the scam. One way to determine the focus of a conservative rip off is the name they give to it. It's always the opposite of what they want to accomplish. "Advantage"? Yeah, for the investor class.
Another point: Cigna Insurance accounts for
the C in CMS which administers Medicare. The secondary and Part D plans are all provided by the private insurance industry. So how is Medicare, Medicare only? The Insurance Industry has its hands in the whole healthcare law anyway and no matter which choices we make. And we’re not getting away alive!