Medicare Advantage Plans To Be Squeezed Next Year, Reduce Benefits

[goillini52]

Are you saying every provider near you is no longer in network with your Aetna plan?

No, just one Hospital/Medical Group. and their doctors left the network.

 

[somarco]

just one Hospital/Medical Group. and their doctors left the network.

That makes more sense. That is a danger in using a provider that is affiliated with a hospital and you have a managed care plan.

Rachel and I have the same PCP. The glass partition for the office staff always has a list of plans/carriers they will not accept. Over the last few years the list has been growing.

That PCP practice is owned by a large, local hospital.

 

[agentjhc]

Seems like all network changes should have to occur effective 1/1 of the upcoming year...none of this middle of the year stuff

 

[somarco]

Seems like all network changes should have to occur effective 1/1 of the upcoming year...none of this middle of the year stuff

Is that speculation or something you have read?

 

[scagnt83]

No I’m not “telling myself that.” If you did some research you’d see it’s an actual fact. And a 3% profit for administering an entire Medicare program for tons of seniors in the country, with most benefits having to go to the beneficiary BY LAW? I also see literally nothing wrong with
that as well. Otherwise what’s the point? A company has to make SOME profit. GOD FORBID! Clutch those pearls! I’m sure you, Mr. Charity, would wake up and go to work for free tomorrow. Also, care to chime in on the $60 billion dollars YEARLY that is wasted on fraud, waste, and abuse on original Medicare because there’s no oversight at all? Because if we’re gonna bring up costs, that MASSIVE amount is somehow always conveniently left out.

The limit on profit margins is exactly why the cost of care is not being controlled by these private entities. The only way to increase profits (which the shareholders require or they fire the execs in charge) is to increase the cost of care. There are only so many sick people, if you need more profits, and cant create more sick people, you increase the price of being sick.

And why on earth would we support a health system who's entities REQUIRE the amount of care and cost of health care to increase?

The goals should be a decrease in care/spending... aka, healthier outcomes. And that should be the main driver of government subsidies for healthcare.

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You are welcome to cite factual studies showing better health outcomes for those on MA vs. Medicare..... I will wait...

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As to the rest of your rant.... read to comprehend, and we might be able to have an adult discussion.

 

[agentjhc]

Is that speculation or something you have read?

It was poorly worded. That’s my belief as to how it should be. They should only occur on 1/1. Adjust contracts in the future. Only fair to consumers. Announce in September. Otherwise. Give an SEP.

 

[somarco]

They should only occur on 1/1. Adjust contracts in the future. Only fair to consumers. Announce in September. Otherwise. Give an SEP.

That is counter to how all the other managed care contracts operate. Not just Medicare, but also EGH and Obamacare.

While it is common for provider changes to happen when the contract expires, a provider may withdraw from the contract (usually with impunity) at any time . . . and the carrier can also "fire" providers at any time.

 

[goillini52]

That makes more sense. That is a danger in using a provider that is affiliated with a hospital and you have a managed care plan.

Rachel and I have the same PCP. The glass partition for the office staff always has a list of plans/carriers they will not accept. Over the last few years the list has been growing.

That PCP practice is owned by a large, local hospital.

Our PCP has that list too. It includes Humana and UHC Medicare Advantage plans.

 

[renee15]

meanwhile, Modern Healthcare's reporting some insurers may increase benefits thanks to revisions & re-running of star rating computations:

Elevance, Aetna among insurers to benefit from higher star ratings (6/17 MH)

so confusing....

Aetna gets $1.90 member more and that is for 2024 year. There were some calculation errors for 2024

 

[InsuranceGuy29]

The limit on profit margins is exactly why the cost of care is not being controlled by these private entities. The only way to increase profits (which the shareholders require or they fire the execs in charge) is to increase the cost of care. There are only so many sick people, if you need more profits, and cant create more sick people, you increase the price of being sick.

And why on earth would we support a health system who's entities REQUIRE the amount of care and cost of health care to increase?

The goals should be a decrease in care/spending... aka, healthier outcomes. And that should be the main driver of government subsidies for healthcare.

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You are welcome to cite factual studies showing better health outcomes for those on MA vs. Medicare..... I will wait...

---

As to the rest of your rant.... read to comprehend, and we might be able to have an adult discussion.

Incorrect. Medicare Advantage carriers are IMMENSELY controlled by CMS star ratings. By law, they can only slash benefits so much (not much), and even if they do, there are IMMENSE monetary penalties for doing so.

They can't just arbitrarily decide to start slashing everything to save money because it's counterproductive. They can make these costs up in other areas of their company (if they're a smart company who is well-diversified) but not on Medicare Advantage.

I'm also not doing homework for you. You have Google. Search "Medicare Advantage Health Outcomes." You're a big boy. You can do it. Among the sources are the very reputable Harvard.

Learn the basics of how Medicare Advantage works, and then we can have an adult discussion.