Daily Kos warns us frequently of the risk Republicans pose to the continuation of Medicare. They have assaulted Medicare for years, a stealth assault with advantage plans, and we are frighteningly close to a tipping point.
Thom Hartmann recently wrote an excellent piece on the dangers of advantage plans. MUST READ material for anyone who is 63 or 64! If you don't know the scam and sign up for advantage, you could have just made a life changing mistake:
Stop the Medicare Advantage Scam Before Medicare is Dead
m.dailykos.com/…
By Thom Hartmann
The TV ads are slick, you get a lot of free stuff. Each year, we will buy you $200 worth of vitamins (from unknown brands at highly inflated prices), but when you get cancer, and need to go to Sloan Kettering, we say HELL NO, it's out of network.
Want to switch to regular Medicare? NO, the only time you can buy Medicare gap insurance is when you first sign up.
And when you first sign up, get the G level plan, don't skimp, because you can downgrade, but not upgrade without underwriting.
This morning, the New York Times has an article that more people will be on advantage plans in 2023 than real Medicare:
The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
You ask what is the danger of going on an advantage plan?
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.
NY times
The basic business model of these plans is to sign up as many as possible, try to make them sicker on paper than they really are, then deny care, and contract with doctors who are inexpensive, and in many cases, not the best. (See Thom Hartmann above for more indepth).
Basically the government pays more to advantage than to regular Medicare, which is bankrupting our system. It is also making insurance companies rich, so they can further bribe Republicans, a vicious circle.
The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.
Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.
NY times article above
The fraud in Medicare advantage plans per year exceeds the budgets of many agencies:
Medicare Advantage Overbilling Exceeds Entire Agency Budgets
Medicare Advantage
overbilling
Between $12 and $25 billion
Children’s Health
Insurance Program
U.S. Customs and
Border Protection
Federal Bureau of
Investigation
Environmental
Protection Agency
Note: Figures represent outlays in the 2020 fiscal
NY times, above link
I turn 65 in 14 months, and have started doing my research because I have 3 chronic conditions, an active brain tumor, diabetes, and foot structural problems.
I basically wanted to budget, what is my out of pocket cost going to be for Medicare, for gap insurance, and my exposure to deductibles and co pays. My job positions have overseen risk management for companies, so I am fluent in medical care insurance.
I have never been more frustrated in my life than trying to get information on gap plans. When you pull up an individual insurer, before you get the information you want, you will get transferred over to advantage plans, because they make more money on them.
I cold called two brokers, to ask about gap plans. Both of them tried to pressure me on advantage, because they make more money on them. After adamantly stating, "There is no f***ing way I am going on an advantage plan," I got the quote I called for.
Medicare part A
Covers hospitalization
The Medicare Part A inpatient hospital deductible that beneficiaries pay if admitted to the hospital will be $1,600 in 2023, an increase of $44 from $1,556 in 2022. The Part A inpatient hospital deductible covers beneficiaries’ share of costs for the first 60 days of Medicare-covered inpatient hospital care in a benefit period. In 2023, beneficiaries must pay a coinsurance amount of $400 per day for the 61st through 90th day of a hospitalization ($389 in 2022) in a benefit period and $800 per day for lifetime reserve days ($778 in 2022). For beneficiaries in skilled nursing facilities, the daily coinsurance for days 21 through 100 of extended care services in a benefit period will be $200.00 in 2023 ($194.50 in 2022).
Part A Deductible and Coinsurance Amounts for Calendar Years 2022 and 2023
by Type of Cost Sharing
|
|
2022
|
2023
|
Inpatient hospital deductible
|
$1,556
|
$1,600
|
Daily coinsurance for 61st-90th Day
|
$389
|
$400
|
Daily coinsurance for lifetime reserve days
|
$778
|
$800
|
Skilled Nursing Facility coinsurance
|
$194.50
|
$200.00
|
Enrollees age 65 and over who have fewer than 40 quarters of coverage and certain persons with disabilities pay a monthly premium in order to voluntarily enroll in Medicare Part A. Individuals who had at least 30 quarters of coverage or were married to someone with at least 30 quarters of coverage may buy into Part A at a reduced monthly premium rate, which will be $278 in 2023, a $4 increase from 2022. Certain uninsured aged individuals who have less than 30 quarters of coverage and certain individuals with disabilities who have exhausted other entitlement will pay the full premium, which will be $506 a month in 2023, a $7 increase from 2022.
www.cms.gov/…
Gap plans will cover the deductibles and coinsurance.
Medicare part B
Medicare Part B covers physician services, outpatient hospital services, certain home health services, durable medical equipment, and certain other medical and health services not covered by Medicare Part A.
Medicare website
The premium for 2023 is $164.90 and the deductible is $226, which gap coverage doesn't cover.
For low income, there are programs to help, and for high income, surcharges. See Medicare website for these.
I would recommend gap coverage, since part B has a 20% co pay without caps, and part A has a new deductible with each new series of hospitalization.
In Orange County,CA the best plan G gap coverage is $149 month. This goes up slightly with age.
The percentage of advantage plans is expected to exceed 60% of Medicare within 10 years. Most people are not aware that an advantage plan is a private insurance plan, and when you sign up, you cannot go back and get the gap insured. Through these advantage plans, the Republicans are silently moving us toward private insurance. We need to vote on this issue and let our politicians know we don't like being scammed.
STOP REPUBLICANS BEFORE MEDICARE IS GONE!