Spin how you may..

[Packerland]

So let me break down the article in the wide world words of AI ..

The article discusses the debate over Medicare and Medicare Advantage plans. Nikki Haley, in a recent political debate, advocated for expanding Medicare Advantage, which is growing rapidly and popular among low-income seniors due to lower premiums (not sure I agree since the average person on Medicare makes $85,085 and a person on a MAPD average income is $76,720) and additional benefits like vision and dental care. A study by Avalere, a healthcare consulting firm, found that traditional Medicare has higher utilization rates for skilled nursing and hospital inpatient care compared to Medicare Advantage.

Medicare spending is largely driven by hospitals, and while the Centers for Medicare and Medicaid Services (CMS) has implemented models like accountable care organizations to reduce hospital admissions, Medicare Advantage plans have been more effective. This is attributed to private insurers’ financial incentives to keep patients out of hospitals by improving treatment adherence and care coordination.

However, the Biden Administration is trying to limit the growth of Medicare Advantage (typical ploy for a Socialist Progressive administration that wants to control everything) by restricting marketing and reducing payments for high-risk patients, driven by an ideological preference for government-controlled healthcare. As an alternative, the Administration is imposing price controls and cutting physician fees, which is leading doctors to leave private practice for hospitals, increasing healthcare spending. Haley suggests that encouraging private competition is a better approach than the Democrats’ preference for price and reimbursement controls.

 

[InsuranceGuy29]

Bottom line is, Medicare Advantage has a financial incentive to keep you healthy and living long. Medicare Advantage is much more focused on preventing problems, which is the intelligent way to go about medical care and life as a whole.

The healthier the person is, the more they stay out of the unGodly costly hospitals, and the longer they live. Which increases the length of time MA insurers receive payment. A person's personal health goals and the insurers goals are extremely aligned. This is a "healthy outcomes model."

Original government Medicare doesn't care how healthy you are or how long you live. In fact, they hope you kick the bucket much sooner. Why? Because you're no longer a contributor to the system, you're now a (mostly) vested beneficiary and a "taker" in their eyes. Bottom line, you now cost them A LOT of money.

The insurers addition/intervention is the only thing that actually makes Medicare good.

Doctors and hospitals love original Medicare because they can run your bill up to insane levels, all while not really caring how healthy you are. They're more concerned about cashing in on every service they provide and their lucrative deals with prescription drug companies to dump an unending amount of prescriptions in your system. Most of which lead to more problems, which causes a nightmare domino effect. Not saying all prescriptions are bad, but many are.

 

[AgentGeneral]

Example of how a Humana DSNP helped a 29 yr old female on disability.

She received superb help on her DSNP. She was on many meds and treatments for seizures/schizencephaly. Gained a ton of weight from meds. Miserable and not getting any healthier. Docs just kept right on prescribing, ordering tests, labeling and mislabeling Dx. Getting worse with every med prescribed.

Put on Humana DSNP Sept 2021. Had her home wellness check up fairly quickly after enrolling her. Received (key piece here, and she accepted) help from a nutritionist and dietician. Using her food card, learned to buy and prepare healthy foods. Checked in regularly with dietician and nutritionist, more for guidance and accountability. Young lady followed the advice. Came off half a dozen meds onto one med specific for only the seizures.

Lost more than 80 lbs to date. Back to work and college and being productive in society. Saw her the other day. I know her very well.

She will probably be off DSNP and disability in another year after she finishes college.

Of course many won't follow or accept the guidance, but many will. And many others simply cannot by no choice of their own. But free reign on making them "guinea pigs" with a blank check sure as hell doesn't help one iota.

I do see value in MAPD. It's not much just showing one example, but there are plenty out there if you pay attention. Being so negative (some of the agents in here, particularly the Med supp only) isnt cool.

Encourage the wellness check ups, encourage the clients to use the resources provided wisely.

This young lady's docs, pharma aren't making more and more and more off her, nor are they able to keep her in the cycle of medical abuse and power. She's more empowered now. Learning a new way to cope with her disability. Might not have happened without her little nasty evil DSNP enrollment.

Of course it took her to want to get better and to stop being aloof (meds made her too tired to move) and to accept the help, but you know what I mean.

Notice I mentioned accountability up above. I won't get into all of what I mean by "accountable". It would take a few books to go into all that, but its lacking in many ways with clients, patients, docs, big pharma and health care systems, politicians.

No, I don't think MAPD is perfect. However, I sure as hell dont think med supp/PDP is either.

 

[rmhaire]

Original government Medicare doesn't care how healthy you are or how long you live. In fact, they hope you kick the bucket much sooner. Why? Because you're no longer a contributor to the system, you're now a (mostly) vested beneficiary and a "taker" in their eyes. Bottom line, you now cost them A LOT of money.

I didn't realize that I was such a drain on Society. Maybe I need to switch my plan G to one of those Golden Goose Advantage plans ... or maybe not.

According to a recent study by the Kaiser Foundation, the federal government paid $321 more per year for each MA beneficiary than original medicare. They paid $11,844 per MA beneficiary in 2019. Per beneficiary spending was $11,523 for OM.

The feds spent $348 billion on MA plans in 2019 and that amount is expected to increase to $664 billion in 2029.

Here's an excerpt from the study:

Under a different scenario, if the growth in per person spending on beneficiaries in Medicare Advantage were held to the same rate of growth in spending on beneficiaries in traditional Medicare, then total Medicare program spending would be $183 billion lower than projected between 2021 and 2029, the analysis finds.

Doctors and hospitals love original Medicare because they can run your bill up to insane levels, all while not really caring how healthy you are.

And Advantage plans don't? Uh Oh. Another excerpt:

Additionally, Medicare Advantage plans have come under scrutiny over inaccurate coding practices that contribute to higher risk scores for their enrollees, and higher payments from Medicare.

 

[ValeRosso]

Apparently there is legislation in the works for MAPD and banning the use of tools to deny care via an algorithm.if that passes, it will help millions of people.

“Biden Administration is trying to limit the program’s growth by restricting plan marketing and reducing payments for treating higher-risk patients under the guise of rooting out waste, fraud and abuse.”

Yeah, reduce what doctors get paid by Medicare even more, that’ll show em! *rolleyes*

 

[somarco]

Apparently there is legislation in the works for MAPD and banning the use of tools to deny care via an algorithm.if that passes, it will help millions of people.

“Biden Administration is trying to limit the program’s growth by restricting plan marketing and reducing payments for treating higher-risk patients under the guise of rooting out waste, fraud and abuse.”

Yeah, reduce what doctors get paid by Medicare even more, that’ll show em! *rolleyes*

And Congress has promised to balance the budget since the 90's . . . not holding my breath on either.

Lot's of hot air and false promises from DC that somehow never lives up to the promise.

Hope I didn't burst your bubble, but NEVER believe what you are told because it is all lies and BS

 

[axeman462]

And Congress has promised to balance the budget since the 90's . . . not holding my breath on either.

Lot's of hot air and false promises from DC that somehow never lives up to the promise.

Hope I didn't burst your bubble, but NEVER believe what you are told because it is all lies and BS

this coming from a guy who implicitly trusts the government with his healthcare!

 

[sshafran]

Example of how a Humana DSNP helped a 29 yr old female on disability.

She received superb help on her DSNP. She was on many meds and treatments for seizures/schizencephaly. Gained a ton of weight from meds. Miserable and not getting any healthier. Docs just kept right on prescribing, ordering tests, labeling and mislabeling Dx. Getting worse with every med prescribed.

Put on Humana DSNP Sept 2021. Had her home wellness check up fairly quickly after enrolling her. Received (key piece here, and she accepted) help from a nutritionist and dietician. Using her food card, learned to buy and prepare healthy foods. Checked in regularly with dietician and nutritionist, more for guidance and accountability. Young lady followed the advice. Came off half a dozen meds onto one med specific for only the seizures.

Lost more than 80 lbs to date. Back to work and college and being productive in society. Saw her the other day. I know her very well.

She will probably be off DSNP and disability in another year after she finishes college.

Of course many won't follow or accept the guidance, but many will. And many others simply cannot by no choice of their own. But free reign on making them "guinea pigs" with a blank check sure as hell doesn't help one iota.

I do see value in MAPD. It's not much just showing one example, but there are plenty out there if you pay attention. Being so negative (some of the agents in here, particularly the Med supp only) isnt cool.

Encourage the wellness check ups, encourage the clients to use the resources provided wisely.

This young lady's docs, pharma aren't making more and more and more off her, nor are they able to keep her in the cycle of medical abuse and power. She's more empowered now. Learning a new way to cope with her disability. Might not have happened without her little nasty evil DSNP enrollment.

Of course it took her to want to get better and to stop being aloof (meds made her too tired to move) and to accept the help, but you know what I mean.

Notice I mentioned accountability up above. I won't get into all of what I mean by "accountable". It would take a few books to go into all that, but its lacking in many ways with clients, patients, docs, big pharma and health care systems, politicians.

No, I don't think MAPD is perfect. However, I sure as hell dont think med supp/PDP is either.

But she can't go to Mayo.

 

[straightnochaser]

this coming from a guy who implicitly trusts the government with his healthcare!

It's incredible isn't it..

 

[AgentGeneral]

But she can't go to Mayo.

Haha.

And the same people ripping on MAPD people for buying into it, are the same people STILL buying into the notion that those centers of excellence are the end all be all. Why? bc of simple marketing that's been going on since Coca Cola and Cocaine broke out of the minds of some nutty mugs. No better than us perhaps, just believe that in their own mind. You know, do what's right, help the people, but lets not help ALL people, only the ones that fit into our mindset.

Me thinks some horizons need to be broadened.

Some people are still living in 1990 and using the same sales tactics many people have already evolutionized out of...