Why Medicare Advantage costs taxpayers billions more than it should

[Moonglow]

NO we do not need to destroy 1,400 companies that employ 450,000 people and PAY $100 billion a year in taxes. That is so stupid and for what reason?

Because they are fucking evil?

Guy, you've never had to fight with an insurance company to get treatment AFTER they have your money. I have. My solution would to abolish private insurance and then harvest their executives for transplant organs, the only time those fucks would have ever contributed anything positive to health care in this country.

No the solution is already in existence for doctors that are under federal contract and it is known as the1946 Federal Tort Claims Act. "
And 90% of doctors surveyed AGREE!
Nearly $850 BILLION A year...in wasted duplicate testing, referrals all known as "DEFENSIVE MEDICINE PRACTICE"!

well, of course, Doctors would be LOVE to be free of fear of being held accountable for their own incompetence.

96,000 Americans die every year because of medical mistakes. Thousands more are maimed because of bad practices.

Everytime I see two doctors consulting to gether, it makes me wonder why they don't invest in mortuaries..

Hmmm... so these doctors are in favor of reducing their source of gross revenue, i.e. patient care ? Does that make sense?

It must make sense, they are the best at killing folks legally..

 

[Penelope]

MA plans are an excellent option to Medicare Supplement plans.

They function essentially as a PPO or HMO for those who don't need or don't want to pay for a Medicare Supplement PLUS a PDP.

They give seniors a choice in how they cover themselves.

All Americans should be in the Medicare/Medicare Supplement/Medicare Advantage system.

No, we need to go to single payer, and get private insurance companies out of health care altogether.

NO we do not need to destroy 1,400 companies that employ 450,000 people and PAY $100 billion a year in taxes. That is so stupid and for what reason?
Less then 2 million people that are not insured THAT WANT to be insured!
No the solution is already in existence for doctors that are under federal contract and it is known as the1946 Federal Tort Claims Act. "
And 90% of doctors surveyed AGREE!
Nearly $850 BILLION A year...in wasted duplicate testing, referrals all known as "DEFENSIVE MEDICINE PRACTICE"!

Read the below study where 90% of physicians surveyed say they order $850 billion a year in wasted duplicate tests, referrals all out of FEAR of being SUED!
--- Emergency medicine, primary care, and OB/GYN physicians are most likely to practice defensive medicine.
--- 79 to 83% of surgeons and OB/GYNs have been named in lawsuits.
http://www.jacksonhealthcare.com/media/8968/defensivemedicine_ebook_final.pdf

So why do people like you defend this wasteful practice which insurance companies don't care they just pay the claims and raise the premiums.

If lawyers were taxed like tanning salons were in Obamacare 10% that $27 Billion a year in tax would pay a $5,000 premium for each of the 5 million supposedly mean tested
Americans that don't have insurance.
PROBLEM solved!

Look at doctors as private detectives and look at ones body as a mass of chemical reactions constantly changing. Meds are the greatest expense of healthcare and late stage diagnosis of disease.

Does one want a doctor to treat the symptoms by writing a script, without finding the reason for the symptoms?
All meds have side effects, and then we need a second med to treat the side effect of the first. Most meds are
not necessary, now they have a OIC med, opiate induced constipation med, probably rewrapped and renamed laxative which costs more than a regular laxative. That patient needs to get off of opiates unless in hospice, etc., certainty not working on construction jobsite like the commercial. (what a hoot).

This is all about tort reform which lawyers are more than happy to file a suit, I agree. Diagnostic tests and lab work is not the cause of high cost of health care.

A patient needs to decide first if they would have surgery. Say you have neck pain, and you can have an MRI which most likely will show something if one is over 40, are you willing to have surgery, if not, do not get the MRI.

I am not going to go on any osteoporosis medication so I refuse to have a bone scan. Mammograms can also cause cancer, and I have not had a mammogram for a long time, but I have my physician do a breast exam and I check my own. I don't know how many times I had to have a repeat a mammogram because of a suspected area and the repeat didn't show anything. There is no sense in looking for something unless one has symptoms, but a good doctor will order tests not meds , if he doesn't run. Antibiotics are over prescribed, and they have side effects.

 

[debbiedowner]

In South Florida, one of the nation’s top privately-run Medicare insurance plans faces a federal investigation into allegations that it overbilled the government by exaggerating how sick some of its patients were.

In the Las Vegas area, private health care plans for seniors ran up more than $100 million in added Medicare charges after asserting patients they signed up also were much sicker than normal — a claim many experts have challenged.

In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious diseases — even though the plan couldn’t prove the patients in fact had those diseases.

These health plans and hundreds of others are part of Medicare Advantage, a program created by Congress in 2003 to help stabilize health care spending on the elderly. But the plans have sharply driven up costs in many parts of the United States — larding on tens of billions of dollars in overcharges and other suspect billings based in part on inflated assessments of how sick patients are, an investigation by the Center for Public Integrity has found.

Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year.

Why Medicare Advantage costs taxpayers billions more than it should

Its time to get rid of the middle man and get rid of health insurance companies. How is the gov. subsidizing private companies (usually public corps) any different than subsidizing health care for its citizens and these companies make millions.
Yes Medicare pays Medicare Advantage plans money each month for each person they sign up. In most places citizens still need to pay their Medicare part b payment out of their SS checks and a payment to the Medicare Advantage company and most plans have copays and OOP max.

WE are being screwed every which way , we pay taxes to subsidize the health insurance companies and make their CEO's rich. BCBS in MI made 17 million last year if I remember right.

" Many seniors choose the managed-care Medicare Advantage option instead of the traditional government-run Medicare program because it fills gaps in coverage, can cost less in out-of-pocket expenses and offers extra benefits, such as dental and eye care."

MA plans are bullshit. They are mostly closed HMO plans with NO out of area coverage except for Emergency. They typically charge no premium.

No they are NOT Health Maintenance Organizations!
They manage the Medicare beneficiary like me on the $800/month paid them by Medicare. And they do it BETTER then traditional FISS Medicare!
Again you have such little knowledge compared to mine. It is pathetic.

Yes, there are many that are HMO's and some PPO's. Too bad but the industry is slowly going towards the HMO's. I believe in another thread you mentioned you were on optimum or optima? I believe most of them are HMO's.

Someone who has to continually tell someone they have knowledge, has none.

 

[Mac1958]

In South Florida, one of the nation’s top privately-run Medicare insurance plans faces a federal investigation into allegations that it overbilled the government by exaggerating how sick some of its patients were.

In the Las Vegas area, private health care plans for seniors ran up more than $100 million in added Medicare charges after asserting patients they signed up also were much sicker than normal — a claim many experts have challenged.

In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious diseases — even though the plan couldn’t prove the patients in fact had those diseases.

These health plans and hundreds of others are part of Medicare Advantage, a program created by Congress in 2003 to help stabilize health care spending on the elderly. But the plans have sharply driven up costs in many parts of the United States — larding on tens of billions of dollars in overcharges and other suspect billings based in part on inflated assessments of how sick patients are, an investigation by the Center for Public Integrity has found.

Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year.

Why Medicare Advantage costs taxpayers billions more than it should

Its time to get rid of the middle man and get rid of health insurance companies. How is the gov. subsidizing private companies (usually public corps) any different than subsidizing health care for its citizens and these companies make millions.
Yes Medicare pays Medicare Advantage plans money each month for each person they sign up. In most places citizens still need to pay their Medicare part b payment out of their SS checks and a payment to the Medicare Advantage company and most plans have copays and OOP max.

WE are being screwed every which way , we pay taxes to subsidize the health insurance companies and make their CEO's rich. BCBS in MI made 17 million last year if I remember right.

" Many seniors choose the managed-care Medicare Advantage option instead of the traditional government-run Medicare program because it fills gaps in coverage, can cost less in out-of-pocket expenses and offers extra benefits, such as dental and eye care."

MA plans are bullshit. They are mostly closed HMO plans with NO out of area coverage except for Emergency. They typically charge no premium.

No they are NOT Health Maintenance Organizations!
They manage the Medicare beneficiary like me on the $800/month paid them by Medicare. And they do it BETTER then traditional FISS Medicare!
Again you have such little knowledge compared to mine. It is pathetic.

Yes, there are many that are HMO's and some PPO's. Too bad but the industry is slowly going towards the HMO's. I believe in another thread you mentioned you were on optimum or optima? I believe most of them are HMO's.

Someone who has to continually tell someone they have knowledge, has none.

There's no doubt that HMOs are more restrictive than PPOs, for example. But that will probably have to be the trade-off going forward, unless you're willing to slip into single payer. Controlling the delivery process is how HMOs keep their costs down while still allowing for quality.

There used to be an MA plan called PFFS, Private Fee for Service, that had no restrictions at all, as long as the provider accepted the plan. That fell apart because they were BADLY over-utilized. The HMO is the opposite end of the spectrum in terms of market delivery, but at least it still allows for market innovation and competition, unlike single payer.
.

 

[Redfish]

to the OP

Yes, there is fraud and mismanagement under medicare advantage. But not as much as within basic medicare or any program managed by the government.

under MA, the government gives insurance companies a fixed amount per patient per month to cover the patient's medical expenses. It works great, and yes, the insurance companies make a profit on it (call it a management fee if it you don't like the word profit).

There is usually a small monthly premium and some plans include some dental, glasses, and hearing provisions.

The government is probably coming out ahead vs some form of single payer run by a beaurocracy like the VA.

 

[Penelope]

to the OP

Yes, there is fraud and mismanagement under medicare advantage. But not as much as within basic medicare or any program managed by the government.

under MA, the government gives insurance companies a fixed amount per patient per month to cover the patient's medical expenses. It works great, and yes, the insurance companies make a profit on it (call it a management fee if it you don't like the word profit).

There is usually a small monthly premium and some plans include some dental, glasses, and hearing provisions.

The government is probably coming out ahead vs some form of single payer run by a beaurocracy like the VA.

Providers commit fraud when submitting bills to Medicare and Medicaid, but the MA company is the one who frauds Medicare. Company verses individual provider.

 

[Doc1]

In South Florida, one of the nation’s top privately-run Medicare insurance plans faces a federal investigation into allegations that it overbilled the government by exaggerating how sick some of its patients were.

In the Las Vegas area, private health care plans for seniors ran up more than $100 million in added Medicare charges after asserting patients they signed up also were much sicker than normal — a claim many experts have challenged.

In Rochester, New York, a Medicare plan was paid $41 million to treat people with serious diseases — even though the plan couldn’t prove the patients in fact had those diseases.

These health plans and hundreds of others are part of Medicare Advantage, a program created by Congress in 2003 to help stabilize health care spending on the elderly. But the plans have sharply driven up costs in many parts of the United States — larding on tens of billions of dollars in overcharges and other suspect billings based in part on inflated assessments of how sick patients are, an investigation by the Center for Public Integrity has found.

Dominated by private insurers, Medicare Advantage now covers nearly 16 million Americans at a cost expected to top $150 billion this year.

Why Medicare Advantage costs taxpayers billions more than it should

Its time to get rid of the middle man and get rid of health insurance companies. How is the gov. subsidizing private companies (usually public corps) any different than subsidizing health care for its citizens and these companies make millions.
Yes Medicare pays Medicare Advantage plans money each month for each person they sign up. In most places citizens still need to pay their Medicare part b payment out of their SS checks and a payment to the Medicare Advantage company and most plans have copays and OOP max.

WE are being screwed every which way , we pay taxes to subsidize the health insurance companies and make their CEO's rich. BCBS in MI made 17 million last year if I remember right.

" Many seniors choose the managed-care Medicare Advantage option instead of the traditional government-run Medicare program because it fills gaps in coverage, can cost less in out-of-pocket expenses and offers extra benefits, such as dental and eye care."

MA plans are bullshit. They are mostly closed HMO plans with NO out of area coverage except for Emergency. They typically charge no premium.

No they are NOT Health Maintenance Organizations!
They manage the Medicare beneficiary like me on the $800/month paid them by Medicare. And they do it BETTER then traditional FISS Medicare!
Again you have such little knowledge compared to mine. It is pathetic.

You are either an idiot or a liar. They are indeed for the most part HMO's

 

[Doc1]

MA plans are an excellent option to Medicare Supplement plans.

They function essentially as a PPO or HMO for those who don't need or don't want to pay for a Medicare Supplement PLUS a PDP.

They give seniors a choice in how they cover themselves.

All Americans should be in the Medicare/Medicare Supplement/Medicare Advantage system.
.

The ONLY reason to buy one is that you cannot afford a regular supplement.

 

[Mac1958]

MA plans are an excellent option to Medicare Supplement plans.

They function essentially as a PPO or HMO for those who don't need or don't want to pay for a Medicare Supplement PLUS a PDP.

They give seniors a choice in how they cover themselves.

All Americans should be in the Medicare/Medicare Supplement/Medicare Advantage system.
.

The ONLY reason to buy one is that you cannot afford a regular supplement.

That's up to the individual.

Either way, it's an improvement over basic Medicare, and the PDP is usually included.
.

 

[Doc1]

MA plans are an excellent option to Medicare Supplement plans.

They function essentially as a PPO or HMO for those who don't need or don't want to pay for a Medicare Supplement PLUS a PDP.

They give seniors a choice in how they cover themselves.

All Americans should be in the Medicare/Medicare Supplement/Medicare Advantage system.
.

The ONLY reason to buy one is that you cannot afford a regular supplement.

That's up to the individual.

Either way, it's an improvement over basic Medicare, and the PDP is usually included.
.

You are correct, basic Medicare alone is simply not good coverage

 

[JoeNormal]

The insurance companies give so much to Congress .. makes that difficult for congressmen to give up.

And that's the problem. The Health Insurance INdustry wouldn't last one day without government support, and single payer would be cheaper and more humane. But as long as both parties are on the take, this isn't going to get fixed

So what do you do with 492,000 people that work in the health insurance business and will get 99 weeks at $400/week in unemployment insurance? How will you make up the $100 Billion a year in lost tax revenue paid to the federal government, state governments, local property taxes, all the empty office buildings.

When the Berlin Wall fell and 'peace reared its ugly head', tons of engineers and defense workers had to retool themselves. And guess what, we did.

 

[Doc1]

The 3 main MAPD type plans are: HMO, HMO-PPO and straight PPO. HMO normally costing the least and being the most restricted.

 

[debbiedowner]

Doc do some companies where you're located still have the PFFS? Humana still offer's them in certain parts of the country.

 

[JoeB131]

So your premise is a "Single payer" would cut ALL health care costs to 10%. Is that right?
With this as a resulting health care facility and health care right?

Please, liar. This is a propaganda picture, not any representative of fine hospitals in countries like Japan or Canada which provide better treatment than ours.

Someone needs to tell the insurance industry to hire better shills than you.

 

[debbiedowner]

So your premise is a "Single payer" would cut ALL health care costs to 10%. Is that right?
With this as a resulting health care facility and health care right?

Please, liar. This is a propaganda picture, not any representative of fine hospitals in countries like Japan or Canada which provide better treatment than ours.

Someone needs to tell the insurance industry to hire better shills than you.

I have seen this before in different forums, he's not a shill for the insurance industry it seems from another thread he posted in he's trying to build up his particular company, in hopes one of you will message him and hopefully he can sell you a plan later on in the year during annual election period for Medicare Advantage.

 

[JoeB131]

I have seen this before in different forums, he's not a shill for the insurance industry it seems from another thread he posted in he's trying to build up his particular company, in hopes one of you will message him and hopefully he can sell you a plan later on in the year during annual election period for Medicare Advantage.

Wouldn't surprise me. Most anti-Single Payer types don't even try to defend the insurance industry. They just claim that single payer will be worse if you just pretend Canada doesn't exist.

 

[healthmyths]

I have seen this before in different forums, he's not a shill for the insurance industry it seems from another thread he posted in he's trying to build up his particular company, in hopes one of you will message him and hopefully he can sell you a plan later on in the year during annual election period for Medicare Advantage.

Wouldn't surprise me. Most anti-Single Payer types don't even try to defend the insurance industry. They just claim that single payer will be worse if you just pretend Canada doesn't exist.

I'm anti-one size fit all person. I believe in unique characteristics and not cookie-cutter approach dictated by cubicle workers telling me how much
health services I can have.
So consequently in a nation of 320 million DIVERSE ethnic, life-style people that have come to a country that encourages "diversity" it is nearly
an impossibility to have a "single payer" system UNLESS we all wear the same uniform, get paid a universal salary and have NO chance to be
the unique personality that America was founded on.

So with that premise, explain where we have a problem with health insurance in this country today?
We have 91% of Americans covered by employer, Non-group, Medicaid,Medicare, other public.
Health Insurance Coverage of the Total Population

And of the supposedly 46 million uninsured Americans that Obama LIED about?
FACTS!!!

 

[JoeB131]

I'm anti-one size fit all person. I believe in unique characteristics and not cookie-cutter approach dictated by cubicle workers telling me how much
health services I can have.
So consequently in a nation of 320 million DIVERSE ethnic, life-style people that have come to a country that encourages "diversity" it is nearly
an impossibility to have a "single payer" system UNLESS we all wear the same uniform, get paid a universal salary and have NO chance to be
the unique personality that America was founded on.

okay, let's unpack that little bit of stupidity. What you are saying is that some people are more deserving of good health care than others.

You see, I'd rather have a system run by a cubicle workers whose bosses I can vote out if they don't perform, than one run by cubicle workers whose bosses make eight figure salaries if they can figure out ways to cheat me after they have my money.

So with that premise, explain where we have a problem with health insurance in this country today?
We have 91% of Americans covered by employer, Non-group, Medicaid,Medicare, other public.

And we have 9% who aren't. And that is after the ACA. More to the point, before the ACA, we had 46 million people with no insurance, and 25 million with inadequate insurance.

 

[healthmyths]

I'm anti-one size fit all person. I believe in unique characteristics and not cookie-cutter approach dictated by cubicle workers telling me how much
health services I can have.
So consequently in a nation of 320 million DIVERSE ethnic, life-style people that have come to a country that encourages "diversity" it is nearly
an impossibility to have a "single payer" system UNLESS we all wear the same uniform, get paid a universal salary and have NO chance to be
the unique personality that America was founded on.

okay, let's unpack that little bit of stupidity. What you are saying is that some people are more deserving of good health care than others.

You see, I'd rather have a system run by a cubicle workers whose bosses I can vote out if they don't perform, than one run by cubicle workers whose bosses make eight figure salaries if they can figure out ways to cheat me after they have my money.

So with that premise, explain where we have a problem with health insurance in this country today?
We have 91% of Americans covered by employer, Non-group, Medicaid,Medicare, other public.

And we have 9% who aren't. And that is after the ACA. More to the point, before the ACA, we had 46 million people with no insurance, and 25 million with inadequate insurance.

What 46 million uninsured Americans?
Please explain how there ever were AFTER reading the FACTS!!!

 

[JoeB131]

What 46 million uninsured Americans?
Please explain how there ever were AFTER reading the FACTS!!!

Sorry, I ignore that horseshit.

look, guy, I hate to break it to you, but the GOP isn't going to repeal ACA. Ever. Not after Cleetus and Bobby-Sue in Jesus-Land realized that was the only thing getting them affordable health care.