Re: It's time to stop the Medicare 'Advantage' scam before Medicare is dead

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Sorry to hear about your health woes Rolandson, hope you're doing better. Until the two billionaire funded political parties start talking seriously about health care, we'll continue to have the same system. Medicare Part C , which is Medicare Advantage exists because Congress no matter which party controls it, likes the program and isn't seriously talking about changing it.
"Everyone is entitled to their own opinion, but not their own facts." - Daniel Patrick Moynihan

Re: It's time to stop the Medicare 'Advantage' scam before Medicare is dead

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Last week another "mal semana en Roca Negras" - fresh out of hospital noon yesterday after two ER clinic visits and finally transport to hospital 11th thru 14th. ER clinic would not give saline drip due to nationwide shortage of same. Second visit to ER clinic ended up with them transporting to hospital. I was pretty much out of it as dehydrated from vomiting and in immense pain. When the EMS came to take me to hospital I kept asking them not to forget my "Glocks" as I could not for some reason say "Crocs" - EMT's got a chuckle out of that. LOL First thing hospital did was IV saline almost by time my head hit pillow.
In line with this thread - Medicare and MediGap F got me thru all this with not one mention of copays or how I was gonna pay the bill - was all one transition to transition to transition and discharge from hospital took all of 3 minutes while they explained my discharge paperwork and what I was to do once home. Have heard not one word about cost or payments - which is norm with my Medicare/MediGap F. Rolandson mentioned that he could not get any coverage other than Plan C due to prior disease - that did not stop me from getting my Plan F and I've had some bad shit before long ACA prevented insurance not covering prior. So I salute Obama for that one thing in ACA. Again, without modern medicine, treatments, Medicare/MediGap, I would not be participating in this thread.
Believe me, I understand end of life, cause I know I'm terminal from old age alone, not to mention my various ailments. Whether my lung disease infections are cured or not they surely have shortened my life span by years according to infectious disease Doc. I'm 1.5 years into the expected 5 year life expectancy of diagnosed lung infections. I reiterate, trying to stay positive is difficult at times, but wallowing in self pity, just ain't my thing. The hardest thing for me has been learning I have to rely on others for things I used to do with hesitation on my own without thinking. My SIL just installed driver/passenger side steps on my old 1998 F150 so I can still climb into my truck, which had become overly difficult due to back problems. I was supposed to be in OR tomorrow for more back surgery, but it had to be postponed due to the shit that happened last week. Two steps forward three steps back. God I hope turd gets his ass beat to a pulp next month!! FDT and end of rant.
"Being Republican is more than a difference of opinion - it's a character flaw." "COVID can fix STUPID!"
The greatest, most aggrieved mistake EVER made in USA was electing DJT as POTUS.

Re: It's time to stop the Medicare 'Advantage' scam before Medicare is dead

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Hope you get better soon Wino, yes another bad week at Black Rock. People can't move back and forth between Medicare Advantage and Medigap plans. There is a window when someone reaches 65 they must enroll in Part A and Part B Medicare and within 60 days enroll in a Medigap plan. Some states have exceptions, but if you don't do it when first eligible the door closes or pre-existing conditions can then be considered by Medigap providers. Health care in the US is mainly controlled by the states, though Medicare and Medicaid are primarily federal programs.
"Everyone is entitled to their own opinion, but not their own facts." - Daniel Patrick Moynihan

Re: It's time to stop the Medicare 'Advantage' scam before Medicare is dead

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highdesert wrote: Wed Oct 16, 2024 7:59 am Hope you get better soon Wino, yes another bad week at Black Rock. People can't move back and forth between Medicare Advantage and Medigap plans. There is a window when someone reaches 65 they must enroll in Part A and Part B Medicare and within 60 days enroll in a Medigap plan. Some states have exceptions, but if you don't do it when first eligible the door closes or pre-existing conditions can then be considered by Medigap providers. Health care in the US is mainly controlled by the states, though Medicare and Medicaid are primarily federal programs.
With many Advantage plans dropping coverage and patients - should this happen, then one is free to choose another Advantage or a MediGap without penalties. Anyone losing an Advantage Plan may be lucky and apply for better coverage thru MediGap. Gonna cost more, no doubt, but the burden of prior approvals and rejections are gone and one can go to any Doc or medical facility that accepts Medicare.
"Being Republican is more than a difference of opinion - it's a character flaw." "COVID can fix STUPID!"
The greatest, most aggrieved mistake EVER made in USA was electing DJT as POTUS.

Re: It's time to stop the Medicare 'Advantage' scam before Medicare is dead

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IG Report Highlights Medicare Advantage Rip-Offs Trump Would Make Even Worse

An inspector general report published Thursday estimates that the U.S. federal government delivered around $7.5 billion in potentially improper payments to for-profit Medicare Advantage companies last year, a finding that came as allies of Republican nominee Donald Trump are pushing to make privatized MA plans the default enrollment option for the nation's seniors.

The new report from the Office of Inspector General (OIG) for the U.S. Department of Health and Human Services focuses specifically on health risk assessments (HRAs) and chart reviews, mechanisms that MA companies use to gauge enrollees' health and help determine the size of payments the insurers receive from the federal government.

The OIG report characterizes MA companies' use of HRAs and chart reviews as "questionable," noting that the program's insurers have a history of making patients appear sicker than they are to receive larger payments from Medicare.

"Diagnoses reported only on enrollees' HRAs and HRA-linked chart reviews, and not on any other 2022 service records, resulted in an estimated $7.5 billion in MA risk-adjusted payments for 2023," the report states. "The lack of any other follow-up visits, procedures, tests, or supplies for these diagnoses in the MA encounter data for 1.7 million MA enrollees raises concerns that either: (1) the diagnoses are inaccurate and thus the payments are improper or (2) enrollees did not receive needed care for serious conditions reported only on HRAs or HRA-linked chart reviews."

The report raises particular concern about the validity of HRAs and chart reviews conducted at patients' homes "because these tools are often administered by MA companies or their third-party vendors and not enrollees' own providers."

Last year, according to the OIG report, "in-home HRAs and HRA-linked chart reviews generated 63% of the estimated $7.5 billion in risk-adjusted payments."

"Any inaccurate diagnoses from these in-home HRAs and associated chart reviews may have resulted in overpayments to the MA companies," the report states. "For diagnoses that were accurate, enrollees may have gone without needed care."

Diane Archer, senior adviser on Medicare at the progressive advocacy group Social Security Works, told Common Dreams that "we need to stop paying MA insurers more for their sickest patients when they don't provide them with needed care."

"We need to penalize them in meaningful ways for ripping off taxpayers and harming their patients," said Archer. "We need to stop assuming that the insurers are managing people's care. They are overcharging the government and denying needed care, sometimes indiscriminately, to boost their profits."

"If Trump's plan takes effect, the number of Medicare Advantage policies UnitedHealth controls is expected to reach 15.6 million."

Medicare Advantage, a privately run program funded by the federal government, has faced growing scrutiny in recent years as enrollment in the program has surged. More than half of the Medicare-eligible population in the U.S. is enrolled in a Medicare Advantage plan, according to KFF, resulting in massive profits for insurance giants.

The new OIG report found that just 20 MA insurers—including UnitedHealth, Cigna, and Humana—accounted for 80% of the $7.5 billion in government payments stemming from HRAs and chart reviews last year.

"One top MA company, UnitedHealth Group, Inc., stood out from its peers, especially in its use of in-home HRAs and HRA-linked chart reviews to generate risk-adjusted payments," the report says.

UnitedHealth is one of the insurance behemoths that stands to benefit most from a plan crafted by Trump allies that would funnel more seniors into MA plans, which are notorious for denying necessary care and overcharging Medicare to the tune of tens of billions of dollars per year.

People's Action estimated in a report published last week that UnitedHealth could see its revenue from Medicare Advantage double to $274 billion annually if Trump wins next month's election and enacts Project 2025's proposal to make the privatized plans the default enrollment option for new Medicare beneficiaries.

Democratic nominee Kamala Harris, for her part, has called for an expansion of traditional Medicare to cover home health services as well as hearing and vision—benefits that are key selling points of MA plans.

Sulma Arias, executive director of People's Action, warned in an op-ed for Common Dreams on Thursday that Trump's "only plan for healthcare in a second term is to privatize."

"If Trump's plan takes effect, the number of Medicare Advantage policies UnitedHealth controls is expected to reach 15.6 million," Arias wrote. "One out of every three Medicare Advantage policyholders is denied care by private insurers like United every year. Under Trump's plan, UnitedHealth alone would deny care to as many as 5.2 million people."

"This ability to deny care," Arias added, "is what makes Medicare Advantage plans far more profitable to private insurers than any other plans they offer."
https://www.commondreams.org/news/medic ... oject-2025

Having worked in healthcare as an RN and the last part of my career in Home Health I have seen just what is being described. I have seen agencies add in more complaints than what the doctor has asked for the agency to treat to increase the billing income. I have seen where patients were not home bound as required by Medicare still being treated and Medicare being billed. I was taught you don't add in a diagnosis that you aren't actively treating just to get more money. The Advantage plans are some of the worse about doing just that. Another issue with the MA plans is all the "Extra Benefits" you can get such as Gym Access and other "Free Stuff" . Somebody has to pay for it and that is Medicare. Best thing we could have happen is to have a national health plan as the Regular Medicare for all people as many other countries have it and the people get excellent treatment.
Facts do not cease to exist because they are ignored.-Huxley
"We can have democracy in this country, or we can have great wealth concentrated in the hands of a few, but we can't have both." ~ Louis Brandeis,

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