Medicare Advantage Plans To Be Squeezed Next Year, Reduce Benefits

[scagnt83]

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.

Reading comprehension my friend. I never said they can slash benefits.

Fixed profit margin, forced by shareholders to increase profits.... inability to create more sick people.... the only option is to increase the price of being sick.

Hence our out of control medical costs.

I never once said they can slash benefits.

 

[InsuranceGuy29]

Reading comprehension my friend. I never said they can slash benefits.

Fixed profit margin, forced by shareholders to increase profits.... inability to create more sick people.... the only option is to increase the price of being sick.

Hence our out of control medical costs.

I never once said they can slash benefits.

"Healthier outcomes" is literally how Medicare Advantage operates. Once again, you show literally zero understanding of how Medicare Advantage operates. Providers are graded on how HEALTHY they keep their patients. Original Medicare is "fee-for-service." Which means there are no cost controls at all, and providers run peoples bills up like crooked auto mechanics, many times billing people for things they don't need. This is why original Medicare fraud, waste, and abuse is up to 60 BILLION dollars, YEARLY. Medicare Advantage drives provider bills DOWN and controls costs and has oversight, which is why it gets badmouthed by providers. I'm not trying to be rude, but you have no understanding of this system at all.

 

[scagnt83]

"Healthier outcomes" is literally how Medicare Advantage operates. Once again, you show literally zero understanding of how Medicare Advantage operates. Providers are graded on how HEALTHY they keep their patients. Original Medicare is "fee-for-service." Which means there are no cost controls at all, and providers run peoples bills up like crooked auto mechanics, many times billing people for things they don't need. This is why original Medicare fraud, waste, and abuse is up to 60 BILLION dollars, YEARLY. Medicare Advantage drives provider bills DOWN and controls costs and has oversight, which is why it gets badmouthed by providers. I'm not trying to be rude, but you have no understanding of this system at all.

You ignored the part where you said I accused MA of "slashing benefits. When did I say that? You did a whole rant about it.....

The premise of MA is to cut costs. The issue with MA is how they go about cutting costs. Private Insurance has driven up costs, not brought them down.

There is fraud within MA. Its just the insurers doing it instead of individuals. Denying claims, denying life saving tests, etc. All in the name of corporate profits. All at the expense of sick people.

You are one angry individual. I feel sorry for you and whatever you are going through internally.

 

[InsuranceGuy29]

You ignored the part where you said I accused MA of "slashing benefits. When did I say that? You did a whole rant about it.....

The premise of MA is to cut costs. The issue with MA is how they go about cutting costs. Private Insurance has driven up costs, not brought them down.

There is fraud within MA. Its just the insurers doing it instead of individuals. Denying claims, denying life saving tests, etc. All in the name of corporate profits. All at the expense of sick people.

You are one angry individual. I feel sorry for you and whatever you are going through internally.

I don't believe I ever said you said anything about slashing benefits, but it's all tied together, which is why I brought it up. You imply that Medicare Advantage insurers are just gonna pad their packets any way possible, and I'm telling you (for example) they cannot, by law. That's my main point in all of this.

I also don't understand how you think this leads to higher costs of care. Doctor wants $150 per visit. MA insurer says....how about no...we'll give you $75. Average copay for a person is $0-$10 for a doctor visit.

If healthcare providers relied solely on the government....Medicaid/original Medicare, most would be out of business with the doors closed. That's just a fact. They operate at a loss by taking Medicaid and original Medicare.

A private insurer's interests align with a beneficiary's interests....which is to keep people healthy and keep them out of expensive hospitals. This also controls costs. MA focuses on their ACTUAL health. Original Medicare does not. There is fraud everywhere in life. Good luck rooting it all out, but at least there is oversight and checks and balances inside the MA system.

It's actually a good system. Insurance companies keep healthcare providers in line and CMS keeps insurers in line. Checks and balances. Is it gonna root out all fraud? Of course not. Is it gonna IMMENSELY cut it down? Yes.

You seem to think companies that operate MA are solely private and can just arbitrarily do whatever they want. And this could not be further from the truth. It's a hybrid of semi-private and public. There are a million and one government rules and laws.

If they slash benefits a lot, star ratings take a huge hit, they lose tons of money from that. If they screw people around, star ratings take a huge hit, they lose tons of money from that. If they keep it up, CMS yanks them from the program completely....all money is gone.

And sorry if you aren't used to dealing with someone who is direct. I'm not angry at all. I'm simply giving you facts and you don't like them because you're team government 1000%. I feel sorry that you can't handle directness and the truth.

 

[scagnt83]

I don't believe I ever said you said anything about slashing benefits, but it's all tied together, which is why I brought it up.

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.

 

[scagnt83]

You imply that Medicare Advantage insurers are just gonna pad their packets any way possible, and I'm telling you (for example) they cannot, by law. That's my main point in all of this.

That is my main point as well.

They cant increase profit margin.

They cant increase the amount of sick people.

They are forced by shareholders to increase profits.

The only solution is to increase the cost of care.

Same with major medical.

 

[scagnt83]

I also don't understand how you think this leads to higher costs of care.

I am aware.

 

[scagnt83]

And sorry if you aren't used to dealing with someone who is direct. I'm not angry at all. I'm simply giving you facts and you don't like them because you're team government 1000%. I feel sorry that you can't handle directness and the truth.

Paper facts and real world results are two different things.

I have been a business owner for 18 years.

I have sold health insurance (and many other lines) for a decade longer than you have. And it's clear you do not understand some basic concepts of the situation and it's real world impact.

I support private enterprise, even within healthcare.

I no longer support for profit health insurance entities for primary care coverage. Despite still being active in the group market. This is due to almost 20 years of experience in the health market. But it is the system we have and the deal we are currently dealt.

I support the free market. (which our healthcare and health insurance system has not been for the past 30 years)

Read to understand, not to argue. That is the first step.

 

[scagnt83]

It's actually a good system. Insurance companies keep healthcare providers in line and CMS keeps insurers in line. Checks and balances.

Thats the funniest thing Im going to hear all year

 

[InsuranceGuy29]

That is my main point as well.

They cant increase profit margin.

They cant increase the amount of sick people.

They are forced by shareholders to increase profits.

The only solution is to increase the cost of care.

Same with major medical.

Well, who is to blame for that? The government. They're the ones that have been slashing into their minimal 3% profits left and right. Why? Who knows.

It's not saving the government much. I know anti-business people think it's an outrage that businesses make profits, but they do have to make something for what they're doing. Which is administering an entire program for an entire country.

If this does anything, it's only leading to insurers focusing even more on keeping people healthy. These insurers now have entire departments and task forces on doing so for their beneficiaries.

They're also expanding their own clinics that are much more affordable for beneficiaries and just as good as very expensive hospitals and lab/testing places. This drives costs down for themselves and for Medicare beneficiaries.

They can easily make it up lost profits in other ways in the company. MA is one insurance line. These companies have life insurance, hospital indemnity, under-65 healthcare exchange, investment departments, dental/vision/hearing, annuities.

Are some benefits going to get cut as a direct result of what the government has recently pulled? Yes...is it gonna be insanely drastic...no. Again...that all goes back to the current misguided government administration and their crusade against MA and private business.

Healthcare providers (doctors, hospitals, clinics, etc.) are the ones demanding higher costs for care, not insurers. Healthcare providers also need to keep the lights on, as well.

Insurers don't want their people sicker because sicker people cost a lot of money. This is where you're especially confused. You honestly think insurers want people that are sicker? They want their beneficiaries to be the opposite of this.