Since I am an old person I have been keeping a close eye on anything that might help inform my fellow retirees about Medicare…..
It is a new year and some new stuff around Medicare…..new for 2025….
Prescription drug costs for millions of Americans with Medicare coverage are getting a lot cheaper in 2025.
New cost-saving provisions of the Inflation Reduction Act took effect Wednesday for Medicare enrollees. Chief among them: Out-of-pocket costs for prescription drugs are now capped at $2,000 through Medicare Part D, the optional prescription plan associated with the federal insurance program for people over 65 and younger Americans with disabilities.
“Before I took office, people with Medicare who took expensive drugs could face a crushing burden, paying $10,000 a year or more in copays for the drugs they need to stay alive,” President Joe Biden said in a statement Tuesday, touting the benefits of one of the largest legislative packages of his presidency. “This week, we take another step closer to an America where everyone can afford the quality health care they need.”
According to the Centers for Medicare & Medicaid Services (CMS), about 66 million Americans are enrolled in Medicare, and about 52 million of them have Part D prescription coverage. Most enrollees spend far less than $2,000 a year on their prescriptions, but officials estimate the new cap will help 19 million people save an average of $400 a year.
https://money.com/medicare-prescription-cost-cap/
Let’s talk about the big scam that will get worse…Medicare Advantage….
Trump’s Medicare czar is going to be the quack Dr. Oz, who relishes the idea of everyone having to take out a Medicare Advantage plan….
He has even said the the uninsured do not deserve to live (paraphrase)….
Mehmet Oz, President-elect Donald Trump’s pick to lead the Centers for Medicare and Medicaid Services, once said the uninsured “don’t have a right to health,” only the “right to access a chance to get that health.”
“Because they don’t have the right to health, but they have the right to access a chance to get that health,” he added.
This is the type of douchbags Trump wants in control of your life.
But I digress…..what about those scams , the Medicare Advantage plans?
I have tried to keep my fellow retirees informed about the scams that are targeting them…..
Medicare Advantage Plans
And the news just keeps coming and is as usual under-reported….
Donald Trump promises he will “not cut one penny” of Medicare, but like most elected Republicans he’s a strong proponent of Medicare privatization. During his first administration, Trump issued an executive order that said Medicare Advantage, the privatized version of Medicare, “delivers efficient and value-based care through choice and private competition.” Mehmet Oz, the TV doctor Trump nominated to run the Centers for Medicare and Medicaid Services, disparages traditional Medicare and has called for massive expansion of Medicare Advantage. By remarkable coincidence, as of 2022 Oz owned a reported stake of $550,000 in UnitedHealth, Medicare Advantage’s largest participant.
There are many things the private sector does better than the federal government, among them enriching shareholders like Oz. But the private sector does not provide health care more efficiently than the public sector. That’s been demonstrated over and over, yet nobody wants to believe it. A report published Wednesday by The Wall Street Journal summarizing a year’s worth of its investigations indicates that where Medicare Advantage really excels is in the filing of fraudulent claims.
Congress created Medicare Advantage in 1997 to demonstrate for good and all, damn it, that the market economy could be more cost-effective at delivering doctor and hospital care. The privatization program succeeded in winning over the public: 54 percent of the Medicare-eligible population chooses Medicare Advantage.
Medicare Advantage looks to people over 65 like a better deal because it covers things traditional Medicare doesn’t, such as visits to the dentist or the eye doctor. Some plans even cover acupuncture! But if you get seriously ill and need to be referred to a specialist, Medicare Advantage isn’t so great. An April 2022 study by the Health and Human Services Department’s inspector general found that 13 percent of the referrals denied under Medicare Advantage would have been approved under traditional Medicare.
https://newrepublic.com/article/189804/privatizing-medicare-advantage-scam-claims-fraudulent
There is so much reporting that does not make the national news on these plans…..senior need to be aware of the pitfalls….
Medicare Advantage plans may seem like a good idea. Most of the time, it seems like you’ll be able to save money and may have additional benefits. However, these plans often come with significant downsides that can hinder you from getting the care you need. This could lead to a negative impact on your health and your finances. Below is a list of Medicare Advantage nightmares, some with real-life stories, to keep you in the know. Being aware of these hidden dangers could save you a lot of heartache.
Please if you are considering one of these plans do some research other than listening to an agent who is only interested in how much he can make off you….
I Read, I Write, You Know
“lego ergo scribo”
I hear so much re dangers of Medicare Advantage and am afraid to swicth over from my regular Medicare supplemental. Seems Advantage plans even with very highly rated companies have pitfalls. My Medicare supplemental went up for this year to $514 per month . Then I must also buy a part D drug plan at about $600 for the year and meds are not free. I have no co-pays for anything (doctor, hospital tests) with Aetna supplemental and always excellent communications/explanations. However, 12 x$514 is a crusher. I suppose as I am a cadiac patient, cancer, and respitory patient at 75 what I have is the best deal I can get and perhaps el supremo compared to traps of Advantage plans but they are tempting.
I have more pitfalls of these plans….in a post soon…..chuq
that will be appreciated
Coming soon. chuq
O.K., here is one old person’s (Me) thoughts as you have requested —Medicare Advantage (MA) plans, also known as Medicare Part C, are private insurance plans approved by Medicare to provide benefits to enrollees. While marketed as a way to bundle Medicare benefits (Parts A, B, and often D) with additional perks like vision, dental, or gym memberships, they have been criticized for exploiting their subscribers in several ways. Here’s how the system is sometimes seen as a “scam” by critics:
—
1. up front Appeal vs. Hidden Costs
– **Marketing Tactics**: MA plans often advertise low or $0 monthly premiums, which sounds appealing to individuals on a fixed income.
– **Hidden Costs**: These plans shift the financial burden to out-of-pocket expenses. Enrollees may face high copayments, deductibles, or coinsurance when accessing care, especially for unexpected or severe health conditions. Some plans also limit coverage until a substantial deductible is met.
—
### 2. **Restricted Provider Networks**
– **Limited Choices**: Unlike Original Medicare, MA plans often limit enrollees to a network of specific doctors and hospitals. If a subscriber wants or needs to see a specialist or provider outside the network, they may face either no coverage or significant out-of-pocket expenses.
– **Bait and Switch**: Providers may be listed as “in-network” when signing up, but networks can change yearly, forcing enrollees to switch doctors or pay more.
—
### 3. **Denials and Delays in Care**
– **Prior Authorizations**: Many MA plans require prior authorization for treatments, tests, or even prescriptions. This creates hurdles, delays care, and can discourage enrollees from pursuing needed medical treatment.
– **Denial Rates**: Studies show MA plans frequently deny claims or prior authorizations for services that would have been covered under Original Medicare.
—
### 4. **Focus on Healthy Enrollees**
– **Cherry-Picking**: MA plans are incentivized to attract healthier individuals who are less likely to need expensive medical care. This is achieved by offering perks like free gym memberships or minor benefits that appeal to active, healthier seniors.
– **Avoiding High-Risk Patients**: Plans may make it difficult for individuals with chronic or severe conditions to get the care they need, pressuring them to switch back to Original Medicare (which they may do at a financial disadvantage due to penalties or lack of Medigap options).
—
### 5. **Government Overpayments and Misuse of Funds**
– **Risk Adjustment Manipulation**: MA plans are paid a fixed amount by Medicare for each enrollee, with higher payments for individuals with more severe health conditions. Some plans exaggerate patients’ diagnoses to receive inflated payments from the government, diverting funds that could go toward patient care.
– **Profit Over Care**: MA plans are run by private insurance companies, which prioritize shareholder profits. Administrative costs and profits can take precedence over patient services.
—
### 6. **Difficulty in Switching Back**
– **Lock-In Effects**: Subscribers often find it hard to switch back to Original Medicare with Medigap coverage because Medigap plans may deny coverage or charge significantly higher premiums based on age or preexisting conditions if the individual didn’t initially enroll when first eligible.
—
### 7. **Misleading “Extra Benefits”**
– **Low-Value Add-Ons**: Perks like dental or vision coverage are often minimal, covering only basic services (e.g., one dental cleaning per year or limited eyeglass frames). More comprehensive services require significant out-of-pocket costs.
– **Short-Term Savings, Long-Term Costs**: While these plans might save money on premiums, they can lead to higher long-term costs for medical services, making them less advantageous for those who develop significant health issues.
—
### 8. **Annual Plan Changes**
– **Unpredictability**: MA plans change benefits, networks, and costs annually. What works one year may not be the same the next, forcing enrollees to scrutinize and potentially change plans each enrollment period to maintain the same level of care.
—
### In Summary
Medicare Advantage plans are designed to appear cost-effective and comprehensive, but they often prioritize profit over patient care. By exploiting government payments, restricting access, and shifting financial risk to subscribers, these plans can take more advantage of enrollees than provide meaningful advantages. Critics argue the system benefits insurance companies at the expense of the most vulnerable—those who need significant medical care.
Like I stated scams. chuq
Medicare Advantage (MA) plans, also known as Medicare Part C, are private insurance plans approved by Medicare to provide benefits to enrollees. While marketed as a way to bundle Medicare benefits (Parts A, B, and often D) with additional perks like vision, dental, or gym memberships, they have been criticized for exploiting their subscribers in several ways. Here’s how the system is sometimes seen as a “scam” by critics:
—
### 1. **Upfront Appeal vs. Hidden Costs**
– **Marketing Tactics**: MA plans often advertise low or $0 monthly premiums, which sounds appealing to individuals on a fixed income.
– **Hidden Costs**: These plans shift the financial burden to out-of-pocket expenses. Enrollees may face high copayments, deductibles, or coinsurance when accessing care, especially for unexpected or severe health conditions. Some plans also limit coverage until a substantial deductible is met.
—
### 2. **Restricted Provider Networks**
– **Limited Choices**: Unlike Original Medicare, MA plans often limit enrollees to a network of specific doctors and hospitals. If a subscriber wants or needs to see a specialist or provider outside the network, they may face either no coverage or significant out-of-pocket expenses.
– **Bait and Switch**: Providers may be listed as “in-network” when signing up, but networks can change yearly, forcing enrollees to switch doctors or pay more.
—
### 3. **Denials and Delays in Care**
– **Prior Authorizations**: Many MA plans require prior authorization for treatments, tests, or even prescriptions. This creates hurdles, delays care, and can discourage enrollees from pursuing needed medical treatment.
– **Denial Rates**: Studies show MA plans frequently deny claims or prior authorizations for services that would have been covered under Original Medicare.
—
### 4. **Focus on Healthy Enrollees**
– **Cherry-Picking**: MA plans are incentivized to attract healthier individuals who are less likely to need expensive medical care. This is achieved by offering perks like free gym memberships or minor benefits that appeal to active, healthier seniors.
– **Avoiding High-Risk Patients**: Plans may make it difficult for individuals with chronic or severe conditions to get the care they need, pressuring them to switch back to Original Medicare (which they may do at a financial disadvantage due to penalties or lack of Medigap options).
—
### 5. **Government Overpayments and Misuse of Funds**
– **Risk Adjustment Manipulation**: MA plans are paid a fixed amount by Medicare for each enrollee, with higher payments for individuals with more severe health conditions. Some plans exaggerate patients’ diagnoses to receive inflated payments from the government, diverting funds that could go toward patient care.
– **Profit Over Care**: MA plans are run by private insurance companies, which prioritize shareholder profits. Administrative costs and profits can take precedence over patient services.
—
### 6. **Difficulty in Switching Back**
– **Lock-In Effects**: Subscribers often find it hard to switch back to Original Medicare with Medigap coverage because Medigap plans may deny coverage or charge significantly higher premiums based on age or preexisting conditions if the individual didn’t initially enroll when first eligible.
—
### 7. **Misleading “Extra Benefits”**
– **Low-Value Add-Ons**: Perks like dental or vision coverage are often minimal, covering only basic services (e.g., one dental cleaning per year or limited eyeglass frames). More comprehensive services require significant out-of-pocket costs.
– **Short-Term Savings, Long-Term Costs**: While these plans might save money on premiums, they can lead to higher long-term costs for medical services, making them less advantageous for those who develop significant health issues.
—
### 8. **Annual Plan Changes**
– **Unpredictability**: MA plans change benefits, networks, and costs annually. What works one year may not be the same the next, forcing enrollees to scrutinize and potentially change plans each enrollment period to maintain the same level of care.
—
### In Summary
Medicare Advantage plans are designed to appear cost-effective and comprehensive, but they often prioritize profit over patient care. By exploiting government payments, restricting access, and shifting financial risk to subscribers, these plans can take more advantage of enrollees than provide meaningful advantages. Critics argue the system benefits insurance companies at the expense of the most vulnerable—those who need significant medical care.
good ingo thanks
The BBC reported yesterday that Trump will cancel that $2000 cap introduced by Biden. That could leave you open to an unlimited increase in charges.
Best wishes, Pete.
Yep….this will hurt the idiots that voted for him the most. chuq
I think this legislated by congress as law and so he cannot change or delete it. It would be suicidal for republicans to do such a thing as will cost many thousands of votes .
Republicans will never have to worry about votes again because we have seen our last election.