The October, 2022 Kiplinger Retirement Newsletter was clear on what's been happening to new Medicare Advantage beneficiaries: being denied access in record numbers. Indeed, according to Kiplinger, at a rate nearly twice that before the pandemic struck in 2020. Why? Because the number of new Advantage beneficiaries has itself nearly doubled, meaning the extension of the same benefits meant decrease in profits. (Recall Medicare Advantage is the privatized version of Medicare.)
Now, the latest (June, 2026) Kiplinger Retirement Report exposes continued problems with Medicare Advantage. Before we get to those, please recall (WSJ Exchange, (April 18-19, p.B12) - that:
"For two decades, making money in Medicare Advantage followed a simple formula: Sign up seniors and document as many diagnoses as possible. The more codes for patient sickness on paper, the more the government paid."
There in blunt, no-nonsense words is the template for Medicare Advantage wasting money in colossal fashion: by deliberately running up the diagnoses for seniors which the government must then cover to fill up the insurers' coffers. Recall also, that the Biden administration had begun to put a check on this money grab i.e. (ibid.)
"Starting in 2024 the Biden administration phased in a new payment model, V28, which reduced or eliminated the impact of certain diagnostic codes."
So the imposition of a check on running up diagnoses has led to a curbing of profits and in turn continued denials. As the Kipler Report puts it:
"Hospitalized Medicare Advantage Beneficiaries who need follow up care in a rehab facility are frequently denied approval by insurance providers, according to data from the American Medical Rehabilitation Providers Association."
The logic of the providers here appears to be that since denial of front-line access (in 2022) came under scrutiny, denial of rehab services has become the go to strategy. But according to the Report denial of coverage for rehab services is possible:
"Because of the onerous requirements for prior approvals, which are usually not required for traditional Medicare."
Indeed not. So when Janice needed extended rehab after her first hip replacement ten years ago, it was done (via traditional Medicare) no questions ut asked.
But for MA beneficiaries denied rehab approval:
"while appeals are often successful, the time lost by the pre-approval and appeal process can affect patient health and recovery prospects suffered in the meantime."
In Janice's case, for both her hip replacements, the consequences of any rehab delays would have been severe. Another reason we both agreed that traditional Medicare was the only option for our ongoing medical needs - including my prostate cancer treatments.
See Also:
by Diane Archer | April 8, 2023 - 6:05am | permalink
Excerpt:
The corporations that run Medicare Advantage plans are engaged in widespread waste, fraud and abuse, resulting in tens of billions of dollars of overpayments to them every year. The advocates and government agencies overseeing Medicare Advantage have spent nearly two decades reporting on this fraud and waste and urging Congress to overhaul the program. Few in Congress or the administration were listening. Now, the Biden administration is finally taking action, but it’s only a first step.
by Wendell Potter | January 15, 2023 - 7:23am | permalink
Excerpt:
Right now, well-funded lobbyists from big health insurance companies are leading a campaign on Capitol Hill to get Members of Congress and Senators of both parties to sign on to a letter designed to put them on the record “expressing strong support” for the scam that is Medicare Advantage.
But here is the truth: Medicare Advantage is neither Medicare nor an advantage.
And I should know. I am a former health-care executive who helped develop PR and marketing schemes to sell these private insurance plans.
And:
Excerpt:
Congress must pass a law to stop the deceptive advertising of Medicare Advantage plans. Only Medicare should be able to call itself Medicare.
Unless you’ve been out of the country for the past few years, you’ve seen the ads on TV featuring Joe Namath, Jimmy Walker, or William Shatner hawking so-called “Medicare Advantage” plans.
Medicare Advantage is not Medicare.
It’s private health insurance being offered to people over 65, with the bill paid for by Medicare. Once you get on an Advantage plan it’s very difficult to get off, and if you’ve been on for more than a year you may not be able to go back to regular Medicare with a Medigap plan at all.
And:
Excerpt:
In my multiple writings on the Medicare Advantage scam, the most common two responses I get (besides, “Thanks, you may have saved my life!”) are, “I’ve never had a problem with my Advantage plan,” and “If it’s so bad, how come so few people are saying so?”
Both are honest, good-faith questions and highlight how easy it is for insurance companies to get away with their Medicare Advantage scams. The answer to both boils down to the unique nature of insurance being the only “product” we buy where we have no idea if it’s any good until something bad happens — which can take years.
Every state in the union has an insurance commissioner. But why?
Why would any state go to the trouble and expense of creating a new layer of bureaucracy?
We don’t have “auto dealership commissioners” or “big-box retailer commissioners”: only insurance has an elected or appointed overseer.
Why would a state want to elect or appoint a very well-paid person to a new position in state government? Why would they appropriate money for a staff, for offices, in some cases even for buildings for a state insurance commissioner?
It turns out the answer is quite simple. One of the easiest scams in the history of scams, going all the way back centuries before Alfred Ponzi set up shop in Pie Alley, is done with insurance.
Here’s how it works.
If you have insurance, you send them a check every month. You think you’re covered and they’ll be there for you when you need them.
But you have no way of knowing if they’ll really be there for you when you need them because you’ve never used the service in a real health crisis.
No comments:
Post a Comment