Liberal Forum

*Beekeeper » 10 Dec 2024, 6:48 am » wrote: ↑

10 Dec 2024, 6:48 am

As a FYI, CMS, who handles Medicare and Medicade Administrative procedures, ONLY has about 6,800 employees. 

The OTHER 500,000 are through CONTRACTS WITH INSURANCE COMPANIES to administer claims and cut checks for the Government. THEY have nothing to do with the delivery of medical care either. And the REASON costs have increased and the admin side has tripled is BECAUSE of the VOLUME OF REGULATIONS that obammycare placed on MEDICAL CARE PROVIDERS- ie, electronic records requirements, CODING requirements, etc.

So please, learn something BEFORE you open your clap trap and dig a deeper hole.

You are correct Sir!        

DeezerShoove » 09 Dec 2024, 5:01 pm » wrote: ↑

09 Dec 2024, 5:01 pm

Well, I will investigate this a little further.
Of course I'll do it without the ax to grind you obviously have firmly in hand.

One thing that really pissed off someone was trying to switch from the AARP partner plan (UHC) to Mutual of Omaha.
He had cancer and was treated, but then a couple years later was refused.
Wouldn't be accepted by the next plan he wanted to get into during open enrollment.
Is that UHC or Mutual of Omaha or the cancer or his age . . . what?

It certainly does not fit your claims.
He said he was trying to go back into Traditional Medicare from Advantage.
It is all interesting stuff to me.

Open Enrollment does NOT give you the right to go to Original Medicare AND a Supplement without health questions. You CAN go back to Original Medicare without any health questions. Other than a few qualifying events that give you a SEP (special enrollment period), once you have a Med Sup for 6 months, you are no longer guarantee issue. (no health questions). All the enrollment periods have NOTHING to do with Medicare Supplements. Period.

EDC4ALL! » 09 Dec 2024, 3:50 pm » wrote: ↑

09 Dec 2024, 3:50 pm

Where a Supplement policy earns it worth is if you need a Part B drug or extensive outpatient treatments. These are cancer infusions (chemo) and treatments for infusions for Crohns, RA, and other autoimmune system problems. 

The word "Advantage" In Medicare Advantage doesn't mean the advantage over Original Medicare and a Medicare Supplement, it means the whats the advantage of a Medicare Advantage plan over Original Medicare. For starters, Original Medicare doesn't have a maximum out of pocket. Get cancer and you could be out tens of thousands of dollars. Advantage plans are nothing more than a private insurance company administering Med A, B, and usually D. They all cover EXACTLY the same thing. They all get paid by the Feds the EXACT same amount per month per enrollie based on region (approx $700-$800 in Wisconsin, $1300 for chronic illnesses), and they all keep the maxiumum amount of .15 on the dollar to pay my comission, adminstration, and marketing. If one plan has really good dental ($3500-$5000 in benefits) the plan will always make you pay more somewhere else to offset the dental bennies.

Great!!! But advantage plans do nothing to lower the cost of medical care, dental or vision!!!  Why can I go (and I did) to Mexico and get a full mouth full of dental work 24 crowns done at 1/3 the cost in the US?  $5000 in the US would not even begin to cover $35,000.00 for full implants.
Medical prices for all services are intentionally ridiculously inflated by hospitals and specialists. 

My 93 yearold father contracted influenza B last June.  He was in the local hospital ER for 12 hours.  At 9PM the second shift doctor told me that they were going to have to send by ambulance him to their bigger hospital in a town 70 miles away because they had not heart interventionalist. I questioned why his heart was an issue and he told me to go home and get some rest and go see him in the morning.  Well, When I did I found out thst instead of an ambulance they care flighted him by helicopter (70 miles!!!).  Their original charge for the flight was $98,000+.  His Medicare paid them $8,900+, so his part was a little over $1,800.00.  When I questioned why a helicopter  instead of an ambulance because there was no real medical emergency, I got no answer.  At the bigger hospital he was treated with Tamiflu and NEVER saw a heart doctor!!!  They sent him home in 3 days with a bill of over $25,000.

My point is that his whole ordeal was done for MONEY not Medical CARE!!!  He could have been treated the same at the local hospital THAT IS OWNED BY THE BIGGER HOSPITAL 70 MILES AWAY!!!

Do your medicare advantage plans do anything to lower those ridiculous costs?   
 

EDC4ALL! » 10 Dec 2024, 10:21 am » wrote: ↑

10 Dec 2024, 10:21 am

Open Enrollment does NOT give you the right to go to Original Medicare AND a Supplement without health questions. You CAN go back to Original Medicare without any health questions. Other than a few qualifying events that give you a SEP (special enrollment period), once you have a Med Sup for 6 months, you are no longer guarantee issue. (no health questions). All the enrollment periods have NOTHING to do with Medicare Supplements. Period.

That's the point I was probably hearing all the flak about.

In order to "enjoy" all the facets of a program, you need the entire package.
Original Medicare is not worth it without the supplement so why even consider it?

You finally got to the giant crater that fails the "going back to traditional medicare".
You basically cannot without being underwritten. As I was told by the bitchy old guys...


Thanks for the info.   

Buffalo » 10 Dec 2024, 11:30 am » wrote: ↑

10 Dec 2024, 11:30 am

Great!!! But advantage plans do nothing to lower the cost of medical care, dental or vision!!!  Why can I go (and I did) to Mexico and get a full mouth full of dental work 24 crowns done at 1/3 the cost in the US?  $5000 in the US would not even begin to cover $35,000.00 for full implants.
Medical prices for all services are intentionally ridiculously inflated by hospitals and specialists. 

My 93 yearold father contracted influenza B last June.  He was in the local hospital ER for 12 hours.  At 9PM the second shift doctor told me that they were going to have to send by ambulance him to their bigger hospital in a town 70 miles away because they had not heart interventionalist. I questioned why his heart was an issue and he told me to go home and get some rest and go see him in the morning.  Well, When I did I found out thst instead of an ambulance they care flighted him by helicopter (70 miles!!!).  Their original charge for the flight was $98,000+.  His Medicare paid them $8,900+, so his part was a little over $1,800.00.  When I questioned why a helicopter  instead of an ambulance because there was no real medical emergency, I got no answer.  At the bigger hospital he was treated with Tamiflu and NEVER saw a heart doctor!!!  They sent him home in 3 days with a bill of over $25,000.

My point is that his whole ordeal was done for MONEY not Medical CARE!!!  He could have been treated the same at the local hospital THAT IS OWNED BY THE BIGGER HOSPITAL 70 MILES AWAY!!!

Do your medicare advantage plans do anything to lower those ridiculous costs? 

would doctors in the US work for the same wage as Docs in Mexico? In Mexico, can you sue a provider for millions if you think they screwed up? When it comes to the latest and greatest medical technology, who has the better equipment? In 2011 before Act 10 passed here in Wisconsin, a City of Milwaukee health insurance plan for a family that was offered through WEAC, (Wisconsin teachers union insurance) cost almost $29000. There were NO insurance companies involved. All administered by the Union. WTF?????? Talk about a scam.
As far as do Medicare Advantage plans cut costs? To Who? The beneficiary is better off with an Advantage plan over just Medicare. It puts a cap on your out of pocket, and offers some dental, vision, OTC, and fitness membership. NONE of which Medicare can do. Since around 2012, the max out of pockets and all the copays have been going down, and all the "bells and whistles" have gone up. (dental,vision,OTC). They have been doing this with what ever money the Feds give them. In the meantime Bidens new laws have raised all the out of pocket costs for Original Medicare.

And you are correct, the hospitals and doctors **** up. Can you show me that the same thing doesn't happen in other countries? I don't know how to cut and paste on my wife's old Chromebook, but I Google deaths in England due to lack of care.
In 2022 120,695 people in ENGLAND (social medicine) died due to lack of care.

EDC4ALL! » 10 Dec 2024, 1:33 pm » wrote: ↑

10 Dec 2024, 1:33 pm

would doctors in the US work for the same wage as Docs in Mexico? In Mexico, can you sue a provider for millions if you think they screwed up? When it comes to the latest and greatest medical technology, who has the better equipment? In 2011 before Act 10 passed here in Wisconsin, a City of Milwaukee health insurance plan for a family that was offered through WEAC, (Wisconsin teachers union insurance) cost almost $29000. There were NO insurance companies involved. All administered by the Union. WTF?????? Talk about a scam.
As far as do Medicare Advantage plans cut costs? To Who? The beneficiary is better off with an Advantage plan over just Medicare. It puts a cap on your out of pocket, and offers some dental, vision, OTC, and fitness membership. NONE of which Medicare can do. Since around 2012, the max out of pockets and all the copays have been going down, and all the "bells and whistles" have gone up. (dental,vision,OTC). They have been doing this with what ever money the Feds give them. In the meantime Bidens new laws have raised all the out of pocket costs for Original Medicare.

And you are correct, the hospitals and doctors **** up. Can you show me that the same thing doesn't happen in other countries? I don't know how to cut and paste on my wife's old Chromebook, but I Google deaths in England due to lack of care.
In 2022 120,695 people in ENGLAND (social medicine) died due to lack of care.

If you have a medical emergency in the US you cannot be denied care at a hospital ER due to EMTALA.

Health Insurance corporations are ripping the taxpayers off!!!
"Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, says his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.Nearly $34 billion of that new spending came during 2018 and 2019, the latest payment period available, according to Kronick. The Centers for Medicare & Medicaid Services made the 2019 billing data public for the first time in late September."They are paying [Medicare Advantage plans] way more than they should," says Kronick, who served as deputy assistant secretary for health policy in the Department of Health and Human Services during the Obama administration.
....
Yet critics have argued for years that Medicare Advantage costs taxpayers too much. The industry also has been the target of multiple government investigations and Department of Justice lawsuits that allege widespread billing abuse by some plans.
...
 

Kronick called the growth in Medicare Advantage costs a "systemic problem across the industry," which CMS has failed to rein in. He says some plans saw "eye-popping" revenue gains, while others had more modest increases. Giant insurer UnitedHealthcare, which in 2019 had about 6 million Medicare Advantage members, received excess payments of some $6 billion, according to Kronick. The company had no comment.
...
Kronick says that if CMS keeps the current coding adjustment in place, spending on Medicare Advantage will increase by $600 billion from 2023 through 2031. While some of that money would provide patients with extra health benefits, Kronick estimates that as much as two-thirds of it could be going toward profits for insurance companies.

The cost of Medicare Advantage plans to the U.S. government is exploding : Shots - Health News : NPR

 Yet, health insurance corporation CEOS are some of the highest paid CEOS in the US.  What does that tell you? Partially by DENYING AS MANY CLAIMS A THEY CAN.  Oh, wait, you sell the rip off ****!!!

Health insurance CEOs rake in millions: Here's the top 10 list

 The equipment in the dental office in Mexico I have been going to for 25 years is as modern as any dental office I have seen here.  The dentist, Dr. Portales, I saw before he was killed in a motorcycle accident between Austin and San Antonio several years ago had his degree from the UNIVERSITY OF TEXAS DENTAL SCHOOL hanging on the wall.  His widow still runs the dental clinic.  

What my Medicare doesn't pay for, I PAY FOR out of my own pocket!!!

The really not so poor and poor get their medical care for FREE!!!


Health Insurance and Health Care are not the same thing...

Buffalo » 10 Dec 2024, 2:07 pm » wrote: ↑

10 Dec 2024, 2:07 pm

If you have a medical emergency in the US you cannot be denied care at a hospital ER due to EMTALA.

Health Insurance corporations are ripping the taxpayers off!!!
"Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, says his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.Nearly $34 billion of that new spending came during 2018 and 2019, the latest payment period available, according to Kronick. The Centers for Medicare & Medicaid Services made the 2019 billing data public for the first time in late September."They are paying [Medicare Advantage plans] way more than they should," says Kronick, who served as deputy assistant secretary for health policy in the Department of Health and Human Services during the Obama administration.
....
Yet critics have argued for years that Medicare Advantage costs taxpayers too much. The industry also has been the target of multiple government investigations and Department of Justice lawsuits that allege widespread billing abuse by some plans.
...

they are providing MORE benefits than Original Medicare.....one would think it would cost more. Why doesn't Original Medicare have a cap on a patients medical bills, but they require Medicare Advantage plans to have one?

EDC4ALL! » 10 Dec 2024, 2:28 pm » wrote: ↑

10 Dec 2024, 2:28 pm

they are providing MORE benefits than Original Medicare.....one would think it would cost more. Why doesn't Original Medicare have a cap on a patients medical bills, but they require Medicare Advantage plans to have one?

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
 

EDC4ALL! » 10 Dec 2024, 1:33 pm » wrote: ↑

10 Dec 2024, 1:33 pm

In Mexico, can you sue a provider for millions if you think they screwed up? .

The  epidemic of ridiculous malpractice awards are another example of...........

 

Buffalo » 10 Dec 2024, 2:07 pm » wrote: ↑

10 Dec 2024, 2:07 pm

Kronick called the growth in Medicare Advantage costs a "systemic problem across the industry," which CMS has failed to rein in. He says some plans saw "eye-popping" revenue gains, while others had more modest increases. Giant insurer UnitedHealthcare, which in 2019 had about 6 million Medicare Advantage members, received excess payments of some $6 billion, according to Kronick. The company had no comment.
...
Kronick says that if CMS keeps the current coding adjustment in place, spending on Medicare Advantage will increase by $600 billion from 2023 through 2031. While some of that money would provide patients with extra health benefits, Kronick estimates that as much as two-thirds of it could be going toward profits for insurance companies.

The cost of Medicare Advantage plans to the U.S. government is exploding : Shots - Health News : NPR

 Yet, health insurance corporation CEOS are some of the highest paid CEOS in the US.  What does that tell you? Partially by DENYING AS MANY CLAIMS A THEY CAN.  Oh, wait, you sell the rip off ****!!!

Health insurance CEOs rake in millions: Here's the top 10 list

 The equipment in the dental office in Mexico I have been going to for 25 years is as modern as any dental office I have seen here.  The dentist, Dr. Portales, I saw before he was killed in a motorcycle accident between Austin and San Antonio several years ago had his degree from the UNIVERSITY OF TEXAS DENTAL SCHOOL hanging on the wall.  His widow still runs the dental clinic.  

What my Medicare doesn't pay for, I PAY FOR out of my own pocket!!!

so if you get cancer and need chemo while on Medicare....how much will you pay out of your pocket?

If we keep going this way as a society as people get "Desparate" got nothing else 2 loose anymore "cap" a CEO Excutive too.

But what can State do just prosecute send ya up Red Granite Correctional Institute throw ya in the hole leave the lights on 24/7 so ya cant sleep.

No windows on cells nor daylight dont know what time of day it is.

After awhile ya learn the feeding schedule can sort of tell time.

They give ya just pen guts write and draw with think ya gonna make a shank or weapon stab people.

This is somehow more "Human" way of treating people but I cannot tell ya how many time I wake up just wish I was "Dead".

Oh dont cause any trouble the Prison Guards will "Suit" up extract ya from your cell , strip search yeah bend them butt cheeks 4 them give ya a suicide coat/jacket with velcro & lock ya in a cold cell , feed ya pbj sanwhiches 2/3 days straight.

If ya really "Crazy" the call up Medical send a Psychatrist.

Then youll be requested put your hands thru chow door & cuffed strapped 2 the door & doctor puts a needle up your @$$ and youll pass out 2/3 days whatever that shot is.
 

Later on I just layed on the concrete floor read the books and old magazines they gave me.

Once the Sargent beat on my cell door with a Mag-Light said turning on the water wanna take a shower .

I said gonna be here another afew years or so what do I care what I smell or look like.

He said in awhile the "Swampy" coming by change out sheets ,blankets and uniforms have your stuff ready throw out the chow door in awhile.
 

This is doing "Hard-Time" Green Bay a mentally ill person.

The guards had their orders & regulations.

They really did not want too nor feel good about that but he hadda be removed from cell strapped to a wheelchair & refuse himself medical treatment.

https://youtu.be/2bhhzQ3uPUY?feature=shared

Green Bay State Prison Wisconsin "DOC".

Even very good wages & State Insurance & Pension plan nobody lasts.

A "former" C/O says youll become a drunk working here & be divorced in 5 years if ya last that long.

https://youtu.be/7z6KzQDq7a8?feature=shared

Wisconsin DOC back 1980s/1990s lacked prison beds & farmed out inmates down south a private prison company.

An inmate took a barbell smashed a CCA Officers Skull Open killed him & CCA did not renew their contract State Of Wisconsin after that.

So in the late 1990s thru 2000s Wisconsin went on a brand new prison building spee make up 4 that.

Since then basic laws like marijuana have been reduced 2 local authorities usually a fine & short County Jail terms not the "Big-House"
 

I do think prisons should really be run by former "Convicts" they got the mentallity having done time & more Institutional know-how thy system then fresh "Co/Graduates" plus older inmates can be "Mentors"

BUT State Law says "Convicted Felons" need not apply heck ya cant even work at a County Jail
 

I am ashamed myself to even admit I know the insides a Correctional Institution.

But I was younger got into drugs and my own freinds set me up offered cops testify against me in court for a plea deal set me up.

I took the Doc bus ride but was a "turning" point in my life too

When I got out said just a stupid job better than being locked up in jail.

Other times I looked back thought I had the Life in Prison they fed me & took care of me.

Somedays I remininsce out on the rec-yard off Sturtevant playing softball & some the charecters I met walking around telling war stories.

Got "Parole" eventually & stayed out 2 this day.

But somehow a piece of me still lives there.

Even Swift Transportation my employee # was a digit or 2 shy my DOC booking number their own way screwing with ya too

EDC4ALL! » 10 Dec 2024, 10:31 pm » wrote: ↑

10 Dec 2024, 10:31 pm

so if you get cancer and need chemo while on Medicare....how much will you pay out of your pocket?

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!!!