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Let's talk Medicare part C. Phone lines are open now.
Let's talk Medicare part C. Phone lines are open now.
By PhiloBeddo
6 Dec 2024 10:18 am in No Holds Barred Political Forum
11 Dec 2024 10:13 am
Buffalo » 11 Dec 2024, 6:11 am » wrote: ↑ Nothing. My mother at 69 had lung cancer with medicare and a supplement that paid what medicare didn't. Probably close to $200,000.00. It took 2 years but she died from the treatments (chemo and radiation) and was miserably sick for most of those 2 years because of the treatments.
My 52 year old wife died a horribly sick and painful death from lung cancer although she got all the treatments of modern medicine (chemo and radiation).
No thanks!!! The billions of dollars in cancer is in the treatment, NOT the cure!!!
I said how much if you are on JUST Original Medicare. Why does your mother need a supplement? Advantage plans replace Medicare. When your moms supplement hits $400/m, will it still be a good value?
Very sorry to hear about your wife. I can't imagine how painful that must have been. For both of you.
11 Dec 2024 10:16 am
Buffalo » 10 Dec 2024, 4:21 pm » wrote: ↑ Medicare advantage programs are extremely profitable to health insurance corporations, or they would not offer them.
"Medicare pays insurers a set amount per enrollee per month, which varies depending on the county in which the plan is located, the health status of the plan’s enrollees, and the plan’s estimated costs of covering Medicare Part A and Part B services.
The plans use these payments to pay for Medicare-covered services, and in most cases, also pay for supplemental benefits, reduced cost sharing and lower out-of-pocket limits, which are attractive to enrollees. Plans are able to offer these additional benefits, often without charging an additional premium for Part D prescription drugs or supplemental benefits, because they receive an additional $2,329 per enrollee above their estimated costs of providing Medicare-covered services. This portion of plan payments, also called the rebate, has increased substantially in the last several years, more than doubling since 2018. At the same time, Medicare Advantage plans can use cost management tools, such as prior authorization requirements, which can impose barriers to receiving care, and limited networks of providers, which can restrict beneficiary choice of physicians and hospitals. More than half (56%) of Medicare Advantage beneficiaries are enrolled in HMO plans that typically do not cover out-of-network services.
While data on Medicare Advantage plan availability, enrollment and plan offerings is robust, the same cannot be said about service utilization (especially for supplemental benefits) and out-of-pocket spending patterns (though some of this data is starting to be collected), which would allow assessment of how well the program is meeting its goals in terms of value and quality and help Medicare beneficiaries compare coverage options. As enrollment in Medicare Advantage and federal payments to private plans continue to grow, greater transparency and more comprehensive information will become increasingly relevant for people with Medicare program oversight."
Medicare Advantage in 2024: Premiums, Out-of-Pocket Limits, Supplemental Benefits, and Prior Authorization | KFF
Why are you posting to me how Advantage plans work? Been enrolling people since 2006, so I'm pretty sure I know how they work.
3 questions. How much profit do they make. %, NOT dollar amount. How much is too much profit, and 3rd, is it ok if the insurance company loses money?
11 Dec 2024 10:40 am
I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?EDC4ALL! » 11 Dec 2024, 11:16 am » wrote: ↑ Why are you posting to me how Advantage plans work? Been enrolling people since 2006, so I'm pretty sure I know how they work.
3 questions. How much profit do they make. %, NOT dollar amount. How much is too much profit, and 3rd, is it ok if the insurance company loses money?
Advantage plans are a rip-off of taxpayer money.
11 Dec 2024 1:13 pm
Buffalo » 11 Dec 2024, 11:40 am » wrote: ↑ I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?
Advantage plans are a rip-off of taxpayer money.
one could say Medicare is a rip off of tax payer dollars too. I make my money by making sure people don't **** up and buy the **** plans that you are complaining about. Just like ANY insurance agent does. It's the same for home, auto, life, commercial. Just because you can go on the internet and purchase insurance, doesn't mean you have any **** clue what you are doing. AND, IF you have some problems you can call your agent and they can help you correct things. If you only knew how many people called me AFTER they **** up and bought the wrong coverage.
11 Dec 2024 1:17 pm
Buffalo » 11 Dec 2024, 11:40 am » wrote: ↑ I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?
Advantage plans are a rip-off of taxpayer money.
So you want to DEMEAN people for making a living in the protection business- ie Insurance??
So you make a CLAIM that Advantage plans are a rip off, but you can't tell me WHO is getting harmed here AND how anyone is getting "ripped off".
IF the beneficiaries are getting MORE benefits, LESS costs, and the Government payments are actually ABOUT THE SAME as someone on Traditional Medicare, who got "Ripped off"??
You're sounding like a **** LWNJ who has some crusade to destroy the things that are actually helping people on this one.
Liberals are spoiled children, miserable, unsatisfied, demanding, ill-disciplined, despotic & useless. Liberalism is a philosophy of sniveling brats ~O'Rourke
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
The Democratic Party seems intransigent on their position of keeping the party ‘woke,’ detached, exclusionary, and totally insane.
11 Dec 2024 1:31 pm
Buffalo » 11 Dec 2024, 11:40 am » wrote: ↑ I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?
Advantage plans are a rip-off of taxpayer money.
how much money do you make? I suppose if you wanted you could Google each CEO and find out what they make. I imagine it's quiet a lot. Have you ever run a corporation that employs over 440,000 people around the world?
11 Dec 2024 1:35 pm
Buffalo » 11 Dec 2024, 11:40 am » wrote: ↑ I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?
Advantage plans are a rip-off of taxpayer money.
Here. I did it for you. Feel better now?
https://www.fiercehealthcare.com/payers ... ers-earned
11 Dec 2024 1:38 pm
Buffalo » 11 Dec 2024, 11:40 am » wrote: ↑ I don't give a **** about their profits!!! How much do you make selling the ****? How much do the CEO's make? How much do the executives make whose sole job is to figure out ways to deny claims?
Advantage plans are a rip-off of taxpayer money.
UHC employs over 440,000 people worldwide. If the CEO worked for free, and split his salary between ALL the employees, they would get less than $100 ea.
11 Dec 2024 1:40 pm
You need to do some research and learn what you are talking about, ****!!! You must be one of those free loaders that want to get something for nothing.*Beekeeper » 11 Dec 2024, 2:17 pm » wrote: ↑ So you want to DEMEAN people for making a living in the protection business- ie Insurance??
So you make a CLAIM that Advantage plans are a rip off, but you can't tell me WHO is getting harmed here AND how anyone is getting "ripped off".
IF the beneficiaries are getting MORE benefits, LESS costs, and the Government payments are actually ABOUT THE SAME as someone on Traditional Medicare, who got "Ripped off"??
You're sounding like a **** LWNJ who has some crusade to destroy the things that are actually helping people on this one.
The taxpayers are the ones getting harmed!!!
Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have. Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone as of 2019. $10 BILLION a year will cause Medicare to go broke!!!
The insurance lobby, though, is powerful and owns many politicians. Efforts by the CMS to audit insurance programs like medicare advantage by the CMS have been met with strong opposition.
I paid into the Medicare system since 1968 and I like it. Hospitals cannot get by with overbilling, which they do on a regular basis. All minor and major medical bills I have had that Medicare only paid 80%, I can pay out the 20% monthly at less that private insurance premiums. Why do freeloaders like you have a problem with paying for your own ****?
Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.
It is getting worse by the year!!!
Opinion | Medicare Advantage: The Scam You Can't Afford to Ignore | Common Dreams
My brother is a medical doctor and he sees the scam!!!
11 Dec 2024 1:44 pm
Thanks for what you do!EDC4ALL! » 11 Dec 2024, 2:13 pm » wrote: ↑ one could say Medicare is a rip off of tax payer dollars too. I make my money by making sure people don't **** up and buy the **** plans that you are complaining about. Just like ANY insurance agent does. It's the same for home, auto, life, commercial. Just because you can go on the internet and purchase insurance, doesn't mean you have any **** clue what you are doing. AND, IF you have some problems you can call your agent and they can help you correct things. If you only knew how many people called me AFTER they **** up and bought the wrong coverage.
We have used a Broker for the last 15 years when it comes to Medicare for the folks. It really helps weed out a lot of plans that are not the right fit.
I have about a year till I have to start taking a hard look at those plans.
11 Dec 2024 1:44 pm
Buffalo » 11 Dec 2024, 2:40 pm » wrote: ↑ You need to do some research and learn what you are talking about, ****!!! You must be one of those free loaders that want to get something for nothing.
The taxpayers are the ones getting harmed!!!
Officials have known for years that some Medicare Advantage plans overbill the government by exaggerating how sick their patients are or by charging Medicare for treating serious medical conditions they cannot prove their patients have. Health insurers that treat millions of seniors have overcharged Medicare by nearly $30 billion the past three years alone as of 2019. $10 BILLION a year will cause Medicare to go broke!!!
The insurance lobby, though, is powerful and owns many politicians. Efforts by the CMS to audit insurance programs like medicare advantage by the CMS have been met with strong opposition.
I paid into the Medicare system since 1968 and I like it. Hospitals cannot get by with overbilling, which they do on a regular basis. All minor and major medical bills I have had that Medicare only paid 80%, I can pay out the 20% monthly at less that private insurance premiums. Why do freeloaders like you have a problem with paying for your own ****?
They (Officials) claim that. Who are these officials? the insurance company DOES NOT initiate the claim. Are you saying that the insurance company makes up claims and the Federal government has no way to check that? The CLAIMS prove how sick they are.
11 Dec 2024 1:49 pm
The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs — both to individual customers and to Medicare itself — that every American should know about.
The report, titled Our Payments, Their Profits, opens with this shocking exposé:
“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program.
“Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”
With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.
With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.
https://www.commondreams.org/opinion/me ... -is-a-scam
MEDICARE ADVATAGE PLANS ARE A GODDAMN RIP OFF!!!
The report, titled Our Payments, Their Profits, opens with this shocking exposé:
“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program.
“Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”
With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.
With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.
https://www.commondreams.org/opinion/me ... -is-a-scam
MEDICARE ADVATAGE PLANS ARE A GODDAMN RIP OFF!!!
11 Dec 2024 1:51 pm
And you help perpetuate that ripoff!!! I would care if all medicare advantage plans were outlawed. But money talks especially when it is other people money and not your own!!!EDC4ALL! » 11 Dec 2024, 2:31 pm » wrote: ↑ how much money do you make? I suppose if you wanted you could Google each CEO and find out what they make. I imagine it's quiet a lot. Have you ever run a corporation that employs over 440,000 people around the world?
11 Dec 2024 1:53 pm
Hospitals are known for exaggerating medical issues for their own benefit, too!!!EDC4ALL! » 11 Dec 2024, 2:44 pm » wrote: ↑ They (Officials) claim that. Who are these officials? the insurance company DOES NOT initiate the claim. Are you saying that the insurance company makes up claims and the Federal government has no way to check that? The CLAIMS prove how sick they are.
My brother is a medical doctor, he sees this EVERYDAY!!!
11 Dec 2024 1:54 pm
The CMS!!! Why do you think medicare advantage insurers balk at audits?EDC4ALL! » 11 Dec 2024, 2:44 pm » wrote: ↑ They (Officials) claim that. Who are these officials? the insurance company DOES NOT initiate the claim. Are you saying that the insurance company makes up claims and the Federal government has no way to check that? The CLAIMS prove how sick they are.
They also DENY claims!!!
11 Dec 2024 1:58 pm
Insurance is a protection racket just like the mafia!!!*Beekeeper » 11 Dec 2024, 2:17 pm » wrote: ↑ So you want to DEMEAN people for making a living in the protection business- ie Insurance??
So you make a CLAIM that Advantage plans are a rip off, but you can't tell me WHO is getting harmed here AND how anyone is getting "ripped off".
IF the beneficiaries are getting MORE benefits, LESS costs, and the Government payments are actually ABOUT THE SAME as someone on Traditional Medicare, who got "Ripped off"??
You're sounding like a **** LWNJ who has some crusade to destroy the things that are actually helping people on this one.
11 Dec 2024 2:02 pm
Fuelman » 11 Dec 2024, 2:44 pm » wrote: ↑ Thanks for what you do!
We have used a Broker for the last 15 years when it comes to Medicare for the folks. It really helps weed out a lot of plans that are not the right fit.
I have about a year till I have to start taking a hard look at those plans.
Since ALL the plans cover the same as far as medical goes, I use a different system. 1) what doctor/system do you use now, and what doctor/system might you want to use in the future. (are you a snowbird?). This is followed CLOSELY by what drugs you are taking. Sometimes if a person is taking an expensive drug, one company may cover that better than the rest. If you are taking tier 3 & 4 drugs, it's usually better to have a plan that has set copays not co-insurance. ( this is a % of an unknown dollar amount). 3rd/4th is customer service and agent support. Sometimes a smaller more local company will have much better customer support. They might sell in a smaller area just in you State, so they can't piss people off with crappy overseas call centers, lose business, and make it up in another State.
Companies that don't have their own agents, tend to treat their agents better by giving us fast support and help fix customer problems quicker. The bells and whistles (dental, vision, otc) are the LAST thing that you consider. They ALL offer some, and if one plan has a big dental benefit, they had to take that money from other places. United (biggest company of all) has very good customer service and since (at least in Wisconsin) they don't have any agents, they really help independent agents with any problems that MIGHT arise. The star rating is somewhat of an indicator of quality (5 star is best), but as long as its a 4.5 star it's ok.
11 Dec 2024 2:06 pm
From the article"
"Not only is the Medicare Advantage scam a screw job for healthcare providers and people who are on the programs and are unfortunate enough to get sick, it’s also preventing Americans from getting expanded benefits from real Medicare.
As the PNHP report notes, for real Medicare to provide comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system around $84 billion a year, according to the Congressional Budget Office.
Instead, though, the Medicare system is burdened with at least that amount of money in over-payments to Medicare Advantage providers — over-payments that have no health benefit whatsoever and merely inflate the companies’ profits.
A hundred billion dollars in excess profits can be put to a lot of uses, and the health insurance industry is quite good at it. The former CEO of UnitedHealth, “Dollar” Bill McGuire, for example, made off with over $1.5 billion dollars for his efforts.
And, because five corrupt Republicans on the Supreme Court legalized political bribery with their Citizens United decision, some of these companies allocate millions every year (a mere drop in the bucket) to pay off loyal members of Congress and to dangle high-paying future jobs to high-level employees of CMS who have the power to keep the gravy train going and thwart prosecutions.
As PNHP noted:
“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment. While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve improved Medicare for All.”
"Not only is the Medicare Advantage scam a screw job for healthcare providers and people who are on the programs and are unfortunate enough to get sick, it’s also preventing Americans from getting expanded benefits from real Medicare.
As the PNHP report notes, for real Medicare to provide comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system around $84 billion a year, according to the Congressional Budget Office.
Instead, though, the Medicare system is burdened with at least that amount of money in over-payments to Medicare Advantage providers — over-payments that have no health benefit whatsoever and merely inflate the companies’ profits.
A hundred billion dollars in excess profits can be put to a lot of uses, and the health insurance industry is quite good at it. The former CEO of UnitedHealth, “Dollar” Bill McGuire, for example, made off with over $1.5 billion dollars for his efforts.
And, because five corrupt Republicans on the Supreme Court legalized political bribery with their Citizens United decision, some of these companies allocate millions every year (a mere drop in the bucket) to pay off loyal members of Congress and to dangle high-paying future jobs to high-level employees of CMS who have the power to keep the gravy train going and thwart prosecutions.
As PNHP noted:
“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment. While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve improved Medicare for All.”
11 Dec 2024 2:12 pm
then don't have it. Pay your own way. If you kill someone in an accident and can't pay, you go to prison for life. Get cancer/stroke/heart attack and can't pay....no care for YOU! Your house burns down....sucks to be you. live in a tent in the forest.
11 Dec 2024 2:14 pm
Buffalo » 11 Dec 2024, 2:51 pm » wrote: ↑ And you help perpetuate that ripoff!!! I would care if all medicare advantage plans were outlawed. But money talks especially when it is other people money and not your own!!!
what do all the people on Advantage plans do then? Go on Medicare and face thousands of dollars in out of pocket costs? A supplement only works if you can **** AFFORD IT!
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