- 29,524
Scare tactics.
Medicare Advantage Plans being dropped left and right
- Thread starter Robduq23
- Start date
- 29,524
I have those. I didn't do AHIP this year, but did the certs for Aetna and UHC. I just finished ACA cert. That's enough certs for me.
InsuranceGuy29
Guru
- 410
Completely unethical yellow journalism and scare tactics. Gee, I can't imagine why there's people who hate Medicare Advantage (even though they've never been on it) when you've literally got this amazing "jOurNaLisM" and upper hospital administration staff encouraging people to upend and leave their entire insurance plan simply because they, THE HOSPITAL, is not happy with something. Yes, totally ethical. ((eye roll))
This rag is also designed for "Healthcare decision makers"....aka "Hospital Chairman, CEO's, Presidents, etc." Most of these sociopathic goofs are no different from criminal Wall Street tycoons that rob your pensions and 401k's, left and right.
In my area, Aetna has 100% of hospitals in the entire area "in-network." Humana also has most of them "in-network," as well. If you scroll down in the article, you'll see they aren't de-contracting with Medicare Advantage, as a whole. Specific companies are named.
So no, hospitals are not "dropping Medicare Advantage, left and right." A FEW hospitals and a FEW health groups dropped a FEW companies' Medicare Advantage plans in a FEW small micro-areas of the country. This stuff happens sometimes. Hospitals get dropped, new ones come on board. Better deal is worked out, old ones reappear. Lather, rinse, repeat.
But I know the supplement-only agents, upper hospital administration greedy sleaze balls, and chiropractors who charge you and insurance $275/visit to massage your shoulders for 2 minutes are gonna use this yellow journalism well. They've been circle-jerking to Mayo Clinic for the past month, as if they're the only good hospital in existence. That was like their "Super Bowl win."
The fact is, these entities are just pissed off that Medicare Advantage is now based upon a "Healthy Outcomes" model and not a "Fee-For-Service" model, where they run your bill up
like a drunken crooked mechanic with a gambling problem. You go in only needing an oil change and you end up leaving with a new engine that you didn't need, and a $6,000 bill. That's fee-for-service.
It incentivizes healthcare providers to milk you for every test and service available. Whereas "Healthy Outcomes," they are graded and rewarded on actually keeping you healthy. That's what this whole hissy fit is actually about.
Hospitals really need to drop this "We are Jesus Christ, the Lord and Savior. Follow me, my child" act. Hospitals and medical groups are businesses that are in the business of making money. If the shamdemic didn't open peoples eyes to that, nothing will. I'm also not saying insurance companies are saints, but they have a vested interest in keeping you healthy, because it saves them money, and you (indirectly).
Healthcare providers like original Medicare because it's an unchecked piggyback of taxpayer money. Just Google "Medicare Fraud" and then click on "News" for a real eye-opener. Literally the first story......"Medical Group fined for Medicare fraud is laying off workers." If you keep wondering why your taxes and medical costs keep going up, this is mostly why. Original Medicare SHOULD have some oversight. It's insane that it doesn't.
This rag is also designed for "Healthcare decision makers"....aka "Hospital Chairman, CEO's, Presidents, etc." Most of these sociopathic goofs are no different from criminal Wall Street tycoons that rob your pensions and 401k's, left and right.
In my area, Aetna has 100% of hospitals in the entire area "in-network." Humana also has most of them "in-network," as well. If you scroll down in the article, you'll see they aren't de-contracting with Medicare Advantage, as a whole. Specific companies are named.
So no, hospitals are not "dropping Medicare Advantage, left and right." A FEW hospitals and a FEW health groups dropped a FEW companies' Medicare Advantage plans in a FEW small micro-areas of the country. This stuff happens sometimes. Hospitals get dropped, new ones come on board. Better deal is worked out, old ones reappear. Lather, rinse, repeat.
But I know the supplement-only agents, upper hospital administration greedy sleaze balls, and chiropractors who charge you and insurance $275/visit to massage your shoulders for 2 minutes are gonna use this yellow journalism well. They've been circle-jerking to Mayo Clinic for the past month, as if they're the only good hospital in existence. That was like their "Super Bowl win."
The fact is, these entities are just pissed off that Medicare Advantage is now based upon a "Healthy Outcomes" model and not a "Fee-For-Service" model, where they run your bill up
like a drunken crooked mechanic with a gambling problem. You go in only needing an oil change and you end up leaving with a new engine that you didn't need, and a $6,000 bill. That's fee-for-service.
It incentivizes healthcare providers to milk you for every test and service available. Whereas "Healthy Outcomes," they are graded and rewarded on actually keeping you healthy. That's what this whole hissy fit is actually about.
Hospitals really need to drop this "We are Jesus Christ, the Lord and Savior. Follow me, my child" act. Hospitals and medical groups are businesses that are in the business of making money. If the shamdemic didn't open peoples eyes to that, nothing will. I'm also not saying insurance companies are saints, but they have a vested interest in keeping you healthy, because it saves them money, and you (indirectly).
Healthcare providers like original Medicare because it's an unchecked piggyback of taxpayer money. Just Google "Medicare Fraud" and then click on "News" for a real eye-opener. Literally the first story......"Medical Group fined for Medicare fraud is laying off workers." If you keep wondering why your taxes and medical costs keep going up, this is mostly why. Original Medicare SHOULD have some oversight. It's insane that it doesn't.
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InsuranceGuy29
Guru
- 410
It's like the old saying goes, and like I always say....you just can't fix "stupid." Some people just love unnecessarily throwing money away. God forbid they're even open to new information. They just heard "them there devil Advantage plans are bad," usually from some beedy-eyed shill like Westfall (I'm not even saying his first name because he doesn't deserve the free publicity), so it must be true. Those "in the know," here, know who he is.
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- 2,230
It's Chris Westfall ... Yep, I said it.
And they say that if you say his name three times while looking in a mirror ......
Oh my God, someone else who sees through all the bullshit.
- 2,230
Over 85,000 members on the Forum and now there are two of y'all. Kinda reminds me of a Joe Biden rally.
I would imagine they all just got sick of stupid people and went elsewhere which is what I should do too. Can’t fix stupid like my other MA buddy said. Ha Think how boring this forum would be with 100% Med Sup agents that only offer 1 product. Should change it to Med Sup Senior Insurance forum.
It's interesting how people are labeled as "dumb or stupid " when they are interested in allowing their doctor to direct medical care without interference from an outside party who has never examined the patient nor read their medical chart . . . but by inference, those who buy health insurance based on price and "free stuff" are smart.
I thought all MAPD patients are happy happy happy?
1. Pave a way for unhappy MA enrollees with "reasonable buyer's remorse" to leave their MA plans and have a "special election period" to buy a supplemental plan that picks up traditional Medicare's 20% Part B co-pays and hospitalization deductibles.
Beneficiaries have limited periods in which they can buy a supplemental plan without medical underwriting. Those periods are generally limited to their first 6 months of eligibility or, if they leave traditional Medicare later for an MA plan, they have a one-time 12-month period in which they can go back to traditional Medicare and get their supplemental plan back if it is still available.
"I'm in a state that does not have guaranteed issue rights to supplement outside of very restricted periods," said Gina Upchurch, RPh, MPH, founder and executive director of Senior PharmAssist, a nonprofit in Durham, North Carolina. "We see a lot of people that really cannot make the selection to go back" to traditional Medicare with a supplement plan because they would have to undergo medical underwriting, she said.
"If a member attests to a reasonable buyer's remorse, they [should] have guaranteed issue to go back to traditional Medicare" with a supplemental plan. "That's ideal from a public policy [standpoint]," said Scott Sarran, MD, MBA, consultant and principal at Triple Aim Geriatrics.
(In other words, say goodbye to your commissions)
4. Mandate that beneficiaries have a reliable way to compare plans in terms of prior authorization review and compliance with various rules, perhaps requiring that such information be displayed on the Medicare Plan Finder, said Sarran.
"It should be clear to a prospective member making a buying decision how Plan X compares to Plan Y and their percent of denials, percent of overturns, maybe any corrective actions that have been taken against the plan, [and] enforcement actions by CMS," he said. Rather than having plans specify which specialty providers they include, perhaps requiring them to "highlight exclusions from their network might be an interesting approach," said Sarran. "And you could require listed exclusions on [the Medicare] Plan Finder of cancer centers, of teaching hospitals, of major hospital systems with large market shares. Again, we want an informed consumer. Industry can't reasonably argue against an informed consumer making good, informed decisions, so how do we enable that?"
8. Find ways to make sure beneficiaries know what they are giving up when they enroll in an MA plan with respect to being constrained to narrow provider networks and accepting delays or denials of care because of prior authorization.
"Anything we do that helps people understand what they're giving up and what they're getting I think is an absolutely central principle," said Betty Rambur, PhD, RN, professor of nursing at the University of Rhode Island.
"It's important that Medicare beneficiaries know what their trade-offs are; those trade-offs are often not clear," Miller said.
(in other words, let's be real and have more disclosures to really educate consumers on MAPD plans.)
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