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justaprogressive

(2,505 posts)
Sat Dec 7, 2024, 11:47 AM Saturday

The Medicare Advantage trap: What they don't tell you [View all]

When George W. Bush and congressional Republicans (and a handful of bought-off Democrats) created Medicare Advantage in 2003, it was the fulfillment of half of Bush’s goal of privatizing Social Security and Medicare, dating all the way back to his unsuccessful run for Congress in 1978 and a main theme of his second term in office.

Medicare Advantage is not Medicare. These plans are private health insurance provided by private corporations, who are then reimbursed at a fixed rate by the Medicare trust fund regardless of how much their customers use their insurance. Thus, the more they can screw their customers and us taxpayers by withholding healthcare payments, the more money they make.

With real Medicare, if your doctor says you need a test, procedure, scan, or any other medical intervention you simply get it done and real Medicare pays the bill. No muss, no fuss, no permission needed. Real Medicare always pays, and if they think something’s not kosher, they follow up after the payment’s been made so as not to slow down the delivery of your healthcare.

With Medicare Advantage, however, you’re subject to “pre-clearance,” meaning that the insurance company inserts itself between you and your doctor: You can’t get the medical help you need until or unless the insurance company pre-clears you for payment.


https://www.rawstory.com/raw-investigates/medicare-advantage-2670357750/
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Thank you for posting this. I tried to read this article on Rawstory but there is a paywall. OMGWTF Saturday #1
Try this: Ocelot II Saturday #3
I don't particularly like RawStory as a source. Here is the original. ... aggiesal Sunday #85
Thank you. I seldom, if ever, click on a Raw Story link, except dmr Sunday #99
I don't understand why they are allowed to call it a Medicare plan. It should be called privatized senior insurance. Walleye Saturday #2
Technically the Advantage plans offer the same level of service as Original Abnredleg Saturday #5
Yep, my advice is stick with it, maybe get a supplement if it looks feasible, but not a Medicare advantage Walleye Saturday #6
You will also need a DownriverDem Saturday #29
Yep, I'm afraid so Walleye Saturday #35
There are some plans with no premiums up front SCantiGOP Saturday #63
Out of pocket expenses for plan d are now capped at 2000 Voltaire2 Sunday #106
I am 81 and have used only real Medicate, including through cancer treatments for Trust_Reality Saturday #8
The problem is Medicare Advantage plans are allowed to interpret and decide - and they have the final say dalton99a Saturday #9
Are you eligible for Tricare for Life? COL Mustard Saturday #16
I can't say enough good things about the combination of Medicare and Tricare for Life Susan Calvin Saturday #74
I'm still working COL Mustard Saturday #77
Get a supplemental plan that covers the other 20 percent Desert grandma Sunday #90
Because it is literally authorized and governed by Part C of the Medicare statute. Ms. Toad Saturday #81
Do any other private insurers get that part C label? leftstreet Wednesday #148
If Congress passes specific legislation authorizing a Medicare W, and the president signs it, then yes they would. MichMan Wednesday #154
Thx leftstreet Wednesday #155
All private insurers whose plans comply with the Medicare Part C rules (as an alternative to original Medicare) Ms. Toad 15 hrs ago #163
There is coverage as long as you are profitable dalton99a Saturday #4
Wow. ShazzieB Saturday #67
Not quite accurate to say that: "(regular) Medicare always pays". Occasionally they don't. marybourg Saturday #7
It's Not Accurate RobinA Saturday #83
Link to Thom Hartmann's original article erronis Saturday #10
Thank you for posting the original, Erronis Bumbles Saturday #17
Hartmann's post very helpfully supplied by another DUer erronis Saturday #18
And we are forced to have it... Quanto Magnus Saturday #11
And for people over the holidays meeting relatives markodochartaigh Saturday #12
someone has to pay for the 24/7 tv commercials, the annoying calls, and the mailings rampartd Sunday #126
80/20 rule kkmarie Sunday #130
Maybe there is a loophole markodochartaigh Sunday #134
I had a Medicare plan with a UHC supplemental plan for several years Erda Saturday #13
Glad you have had a good experience with an "Advantage" plan. erronis Saturday #20
My elderly mother had the same BuddhaGirl Saturday #23
Miledigap plans are good. That's different from Medicare Advantage. Beck23 Saturday #27
bingo.... markie Sunday #108
My mother has Humana Advantage. SamKnause Saturday #28
100! Wow!! CrispyQ Saturday #46
I'm very happy with my Kaiser Advantage plan. CrispyQ Saturday #32
Wish I had Kaiser here. When I lived in Atlanta, I had Kaiser. They really pushed you to get preventive exams, vaccines, Silent Type Saturday #36
I have Kaiser Senior Advantage and have been happy with it. Both my parents also had Kaiser skylucy Saturday #78
Don't get cancer Henry203 Saturday #42
My spouse has had a good experience with UHC Advantage thru AARP. Beartracks Saturday #60
K&R SheltieLover Saturday #14
It's confusing as hell. milestogo Saturday #15
No, I get tons of emails from CMS/Medicare to look at my open-enrollment options erronis Saturday #21
Another advantage over boonecreek Saturday #19
Medicare advantage plans are all scams LetMyPeopleVote Saturday #22
Advantage plans have networks, either HMO's or PPO's dlk Saturday #24
Original Medicare will not deny treatment Beck23 Saturday #25
Absolutely false. See post #26. Silent Type Saturday #37
Where the fuck do people get this idea? OilemFirchen Saturday #54
My wife's cancer treatment Henry203 Sunday #113
First off, Clinton signed legislation for Part C. And it is not true that Medicare pays for anything a doctor Silent Type Saturday #26
I started buying insurance in 2001. It was horrific. My daughter had to have extensive Henry203 Saturday #47
It's all going to change DownriverDem Saturday #30
I had a bad experience with my mom's Medicare Advantage plan with Aetna. yardwork Saturday #31
Some doctors don't accept Medicare DavidDvorkin Saturday #33
Never heard of any doctor refusing Medicare. Emile Saturday #56
My wife's DavidDvorkin Saturday #69
If you say so. Emile Saturday #75
Normally Henry203 Sunday #116
It's the doctor she had been going to for years DavidDvorkin Sunday #124
If you look at the stat's Henry203 Sunday #128
An oral surgeon Zambero Sunday #115
It's a problem. . . . h2ebits Sunday #131
99.9% of doctors accept Medicare dalton99a Saturday #58
it's the other way around Skittles Sunday #103
When I researched it, snot Saturday #34
Over half of Medicare eligible beneficiaries choose MA plans, primarily because of cost. I do agree a Public Option Silent Type Saturday #38
The Advantage cos. do all they can to make their plans appear attractive, snot Saturday #41
So you think 31 million people are stupid? Maybe if original Medicare met their needs, Silent Type Saturday #48
Maybe not stupid but ignorant. Brenda Sunday #109
Actually, it might be an opportunity if your MA plan is eliminated. Then, you have a guaranteed right to return to Silent Type Sunday #132
"Choose another MA plan" Brenda Wednesday #156
Plenty of people do fine on MA, as DUers have posted, even though cancer, heart disease, Silent Type Wednesday #157
Insurance companies Henry203 Saturday #50
Whoever convinced you of all this was lying. OilemFirchen Saturday #57
The first warning about Medicare Advantage misanthrope Sunday #100
I think anyone campaigning on eliminating people's MA plans would face a lot of resistance MichMan Saturday #45
Totally agree. Maybe someone in Congress will realize that if they put those benefits in original Medicare and Silent Type Saturday #52
People are brainwashed Henry203 Sunday #117
That's essentially what Gallup called it. But thanks for responding. Silent Type Sunday #133
You loved Kaiser? Henry203 Wednesday #146
Glad your wife has survived. As others here on DU and elsewhere have posted, there ain't much evidence of Silent Type Wednesday #147
so Henry203 Wednesday #149
Hospitals and doctors bill those huge amounts to insurance, even Medicare, knowing that they will have Silent Type Wednesday #150
So it is OK Henry203 Wednesday #151
If you want quality care from Kaiser, it is. No one makes you sign up. Did your friend Silent Type Wednesday #158
i was with Blue Cross when this happened Henry203 Wednesday #159
Got it. In 2013 we didn't have pre-existing condition protection. Sorry about you daughter though. Silent Type Wednesday #160
Eleven years Henry203 Wednesday #161
Eat the rich and their enablers... problem solved NotHardly Saturday #39
My Medicare Advantage is just fine, thank you. I will be damned if I am going to pay 100, 200 a month more valleyrogue Saturday #40
You better Henry203 Saturday #51
Can I ask what your maximum annual out of pocket expense is? Sucha NastyWoman Saturday #70
Around $400. Henry203 Sunday #112
Is that the amount you have ACTUALLY paid in a year or the amount you could POTENTIALLY pay Sucha NastyWoman Sunday #119
My wife has cancer Henry203 Sunday #121
I thought Medicare Advantage only covered 80% of chemo treatments. Sucha NastyWoman Sunday #122
I have Medicare with a supplement Henry203 Sunday #123
the entire point of MA is to eventually GET RID OF MEDICARE Skittles Sunday #86
You better not get cancer Henry203 Sunday #118
Plus Advantage is costing the government more than traditional Medicare surfered Saturday #43
Good argument for Original Medicare w/o Supplement OKnow Saturday #44
I haven't read the link yet, but I have only regular Medicare and had surgery that required follow-up PE and Vinca Saturday #53
I think that dr. is nuts bagimin Saturday #80
Totally fed up with the so called "Advantage" Plan ReRe Saturday #49
No way am I again having an HMO determine my care. LiberalBrooke Saturday #55
The fact that they push this "advantage" so hard indicates how profitable it must be for them. patphil Saturday #59
Spot on Picaro Saturday #61
If you have original Medicare plus a supplement the insurance company that sold you the supplement MUST PAY their part Sucha NastyWoman Saturday #62
What percent of the eligible population does not have original Medicare, with or without a supplement? LAS14 Saturday #64
I am on an Advantage Plan. How can I get out and use traditional Medicare? Evolve Dammit Saturday #65
In most states you have to be approved to change to a supplement plan Sucha NastyWoman Saturday #73
Think I missed this years "enrollment period. December 7. Went with an advantage plan as it is free (no monthly premium) Evolve Dammit Sunday #125
You can easily choose original medicare at annual enrollment Desert grandma Sunday #97
Thanks for this! ShazzieB Saturday #66
My Friend F 72y/o Will Be Retiring Soon And Will Be Looking For A Medicare Plan..... global1 Saturday #68
About Medicare and pre-clearance Progressive dog Saturday #71
Medicare Advantage started in 1997 Progressive dog Saturday #72
Thank you for the correction - Ms. Toad Saturday #82
I have had a Kaiser Medicare Advantage plan for the past five years. Never denied anything. Sibelius Fan Saturday #76
The coming admin. SayItLoud Saturday #79
Look. Morbius Sunday #88
correct, their "healthcare plan" is to TURN IT ALL OVER TO PRIVATE INSURERS Skittles Sunday #101
Traditional Medicare doesn't include dental or vision coverage GoreWon2000 Sunday #84
that's how they entice people into the scams Skittles Sunday #87
Dental and Vision are cost prohibitive without insurance GoreWon2000 Sunday #89
there are some who don't fall for the scam Skittles Sunday #91
You didn't answer my question GoreWon2000 Sunday #92
I have extra insurance plans that cover them Skittles Sunday #93
You're paying more GoreWon2000 Sunday #94
like I said, THAT'S HOW THEY ENTICE PEOPLE Skittles Sunday #95
Traditional Medicare never addressed dental and vision coverage GoreWon2000 Sunday #96
Even though I pay more monthly for a supplement its more cost effective for me in the long run indigovalley Sunday #129
Your supplement is good for people in your situation GoreWon2000 Sunday #138
I pay for both Henry203 Sunday #120
I don't pay any extra premium for Medicare Asvantage GoreWon2000 Sunday #139
THANK YOU so much for this info. nt Raine Sunday #98
I knew a lady we rented a home from in 2005. She signed her mom up for that... C Moon Sunday #102
If it looks too good to be true...it probably is! PortTack Sunday #104
It seems like every other ad on TV is a Medicare Advantage ad. Jeebo Sunday #105
they drive me crazy (close to the title of a great 80s song btw) when I watch American streams Celerity Sunday #107
not specifically medicare, but.... thought of this markie Sunday #110
I have an appointment tomorrow wolfie001 Sunday #111
I didn't realize Medicare Advantage was a Bush thing MadameButterfly Sunday #114
Medicare C was signed into law by President Clinton in 1997 MichMan Sunday #135
I can't find those or the post that said it was signed into law by Bush MadameButterfly Sunday #141
Posts # 26 & #72 MichMan Sunday #142
I found it. post 85, the Tom Hartman report MadameButterfly Sunday #143
Correct, Clinton signed it into law; Bush just changed the name of it after it was already implemented MichMan Sunday #144
No thanks to either of them MadameButterfly Sunday #145
The commission an agent is paid by the insurance companies for selling a policy can be twice as much Sucha NastyWoman Sunday #127
People have a choice to get a MA plan or not MichMan Sunday #136
it should be criminal mike_c Sunday #137
I have a question - my friend tells me he signed up for a Medicare Advantage plan walkingman Sunday #140
🚩 thanks I need to start brushing up on this stuff underpants Wednesday #152
Medicare Advantage was always a solution looking for a problem. VMA131Marine Wednesday #153
This is a REALLY excellent thread! A KEEPER, most definitely. calimary 22 hrs ago #162
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