34 Million Seniors in Medicare Advantage Plans Face Rude Awakening

[douglas9]

October 15 marks the first day of open enrollment in Medicare Advantage (MA) plans – a time that will deliver chaos and confusion for many of the 34 million seniors who depend on these plans to pay their healthcare bills. It’s yet another reminder that Medicare wastes billions of dollars funneling public money to private companies that are primarily driven by profit-seeking.

Last year, more MA members than expected used their benefits to get necessary medical care. One might assume that companies would expect beneficiaries to use health care services. But after years of making outsized profits, the insurance companies that own these plans are reacting to this by downsizing plans, cutting benefits, increasing copays, and raising prescription drug deductibles. In other words, Medicare Advantage beneficiaries are being penalized for using the health care that they pay for.


Insurers are Dropping Plans and Slashing Benefits

Having spent decades luring enrollees and collecting premiums, two of the biggest health insurers in the MA marketplace, CVS and Humana, are scaling back, slashing benefits, and canceling plans with too many members who used their health benefits. They are closing less profitable health plans that serve half a million or more seniors, forcing them to sign up for other more expensive or less generous coverage. Humana is set to leave 13 markets around the country, affecting 560,000 beneficiaries or 10 percent of its plan members. The reason for exiting? The CFO herself, Susan Diamond, said the specific markets just aren’t profitable. CVS Chief Financial Officer Tom Cowhey sent a similar message at a conference last month: “Could we lose up to 10 percent of our existing Medicare members next year? That’s entirely possible. And that’s okay because we need to get this business back on track.”

https://www.counterpunch.org/2024/10/17/34-million-seniors-in-medicare-advantage-plans-face-rude-awakening/

[Stargazer99]

1. I TOLD YOU A LONG TIME AGO-and they have made it where you cannot get out once you are part of

this medicare advantage program. This is why profit motive medical care should NEVER be allowed. They got you cornered and you are going to be bled...they must be laughing all the way to the bank. Capitalism is an evil system hurting the least powerful in the system like animals out in the wild and I call that evil to hurt the most vulnerable.

[douglas9]

2. How and when can I switch from Medicare Advantage to traditional Medicare?

https://www.kff.org/faqs/medicare-open-enrollment-faqs/how-can-i-switch-from-medicare-advantage-to-traditional-medicare-is-there-a-form-i-need-to-fill-out/#:~:text=If%20you're%20already%20in,each%20year%20to%20do%20this.

[Stargazer99]

3. I was told that they have made it that once you are on one of the medicare advantange programs

you can't get off. I hope that information was wrong but I would not be surprised that for profit programs have not made it so and if Republicans get in you can bet they won't let you off the advantage programs

[Voltaire2]

5. You can be denied access to medigap insurance.

From the link:

Depending on how long you have been enrolled in Medicare Advantage, Medigap insurers may not be required to sell you a policy unless you meet the medical underwriting requirements

[LiberalArkie]

6. Getting off is no problem. You will be back to only the bare Medicare with the 20% match (I think)

Not bad for wealthy people with a lot in the bank to pay for the matching.

[EYESORE 9001]

7. It can be a problem switching to medical if you have lots of health problems already

And with even the high-deductible Plan F, max out-of-pocket is $2,500. Additionally, Medicare advantage plans can deny coverage if they feel like it, as they do in about 15% of claims. Talk about a ‘death panel’. Original Medicare can’t deny a claim if the doctor or hospital participate in Medicare. Now is not the time for hibbity-jibbity, what with open enrollment just starting.

[LiberalArkie]

16. Yes, that is the problem. But going to "regular Medicare" is not a problem.

I am stuck with the part C as I ended up getting priced out of decent medicare supplements. But I am starting to love my BlueCross Arkansas HMO plan.

But I am pretty damn healthy 76 year old guy NOW.

[doc03]

18. We were duped into Medicare Advantage by our union. That was 14 years ago.

The steel mill I had worked in had shut down and I didn't know what a rip-off MA was at the time.
They offered us this MA plan that our leaders said was great and we had to sign up for it then
and if we didn't, we couldn't get back on. Several years ago I talked to an insurance person about going on a
supplement plan but found that my premiums would be about 150% of what I pay now plus because I
would also have to get Medicare Part D for drugs I would have to pay about double for getting on it at my age.
I don't know if our union leaders didn't know what a rip-off it was at the time, or they were paid to sign us up.
If your doctor refers you to a specialist, you have to go to a web site and check if they are in the network or not. Under
Medicare you pay 20% but MA is 10% so if they aren't in network you pay 20% so MA is no advantage. They have made the
supplement alphabet plans so confusing people like myself out of frustration just end up falling for the MA.

[droidamus2]

22. Depends

I was recently notified my insurance was being discontinued and one of my options was to convert back to regular medicare. One area where you had to pay attention was a cutoff date for I think it was the drug coverage that if you missed it you had to pay a penalty which you pay if you choose to convert back.

[Voltaire2]

36. If you were in MA for 18 months or more

while you can go back to Medicare A,B and D, you may be denied medigap insurance for pre-existing conditions.

For absolutely corrupt reasons the ACA reforms that abolished pre-existing condition exclusions does not apply in this case.

[hot2na]

14. The problem is not Medicare but private advantage plans and supplemental plans

Please do not confuse the issue with Medicare itself. Anyone can switch from Medicare Advantage to real Medicare at the open enrollment period each year, however, be prepared to pay a high premium for a PRIVATE Medicare supplemental plan if you do.

If you enrolled in (real) Medicare during your initial enrollment, then Medicare protects from gouging by private medicare supplemental insurance companies. If you enroll in (fake) Medicare Advantage that is where you are screwed because when you figure out the scam and want to change to traditional Medicare, its the private supplemental plans that will charge very high premiums. You are basically at the mercy of the private insurers as Medicare can only protect against gouging to those who enrolled in traditional Medicare during their initial enrollment period.

I cannot emphasize this point enough.

[DownriverDem]

15. Many folks can't

afford supplemental plans and drug plans. That is why they go with a MA plan. Fix Medicare and stop attacking those who picked the best for them.

[moreland01]

17. They're attacking

The existence of Medicare Advantage, not those who chose those plans.

[Doc Sportello]

29. That's often not how it comes across

There have been numerous threads on this subject and invariably there are posts that reek of victim shaming. And sometimes it is ouright calling people out for having an MA plan. People choose them because there can be several hundred dollars difference in having the plans and for many that is the difference in making it from month to month. And every time one of these posts are made there is little or no acknowledgement of that fact.

[DownriverDem]

32. Yep

Medicare folks do not understand how the plans work. Many of the attackers are union retirees with a monthly health care benefit. I wish they would just stop attacking folks who are doing the best they can.

[moreland01]

37. My husband turns 65

in January so I've been studying the topic for 2 years. A lot of things I learned came from DU and I'm very grateful for that.

"Victim shaming"? I'm sorry you feel like a victim.

Everything I've read so far is informative but, admittedly, does lay into MA plans in general, with quite a few people defending MA plans. I need to hear both sides. It never crossed my mind that if my husband chose an MA plan he would be subjected to "victim shaming". What I heard is more like what I would consider warnings, pitfalls, or stories from actual victims who were denied approvals, etc.

I'm kind of surprised that people who are happy with their MA plans would even bother to read the threads on original Medicare since they studied both options and made the choice that's right for them. Your body, your choice!

[Doc Sportello]

43. Sorry you didn't understand

I don't "feel" that way. I based my opinion on, as I said, numerous threads and posts on this subject. I didn't defend MA plans or even said I had one. I pointed out a major reason retired people get them is their economic situation. I've read some on here defend them but not anywhere the number of attacks on them, and very obvious shaming of those who have to choose them from a few.

[DownriverDem]

31. Not true

I've had a MA plan for 5 years and get attacked every year by Medicare folks who fight this every year. I'm for Medicare for All, but like the benefits of my MA plan. Dental, vision, hearing and a over the counter card is a benefit that many folks need.

[Dyedinthewoolliberal]

19. Anything named Medicare XXX is not really medicare.

They are all private insurers taking advantage of people with tricky marketing. Medicare should be enlarged to accommodate those with medical issues. MA IS a supplemental plan. It is not Medicare.

[DownriverDem]

34. Do you understand

why folks go with MA plans? We don't care if it's not Medicare. We care about the monthly cost. When are folks like you going to wake up and fight to fix Medicare and not attack those who are doing the best they can?

[markodochartaigh]

39. It is really confusing, and it is meant to be.

My sister is a nurse practitioner, she spends several hours every week wrangling with "Medicare" Advantage companies. She is well aware of the difference. Recently her old office manager retired. Her office manager is a Republican who bought into the whole Advantage scam. She only had about one good year of retirement before she had multiple health problems. My sister tells me every week about the latest difficulties she is having with her Advantage plan. And yet, my sister sometimes slips and calls the Advantage plan "her Medicare plan".

[mdbl]

10. The same can be said for the entire insurance industry

Any rates of return should be regulated to a moderate level and exec salaries should be held to a certain amount to allow the highest benefits to the policy holders.

[multigraincracker]

4. The phone calls have started.

I hang up and dial the number on caller ID and get this number is no longer in service. Just ask the caller if you can have a number and extension you can call him back at. They are calling from a spoofed phone number.

[Lonestarblue]

8. Our healthcare system is a disgrace and getting worse.

We need to start lobbying Congress to get rid of Advantage programs. They are bleeding Medicare funds dry with overcharges and denying care based on insurance execs’ bonuses.

[erronis]

21. A lot of the senior staff in CMS (the US agency that administers Medicare and Medicaid) are planted

by the insurance companies. There have been several attempts to fix the problems within CMS that have been stalled by these staff and appointees who use the government/business revolving door frequently.

[NHvet]

9. By them cancelling MA plans

Doesn't that open the window for those on those MA plans to jump back onto Original Medicare? I know that you have 18 months upon reaching 65 to jump back and forth between plans. I thought that one could come back if their plan got cancelled. Not sure, others may have more input. Anyone coming of age for Medicare, don't be duped by the jingles that you'll get more for zero $$ with a MA plan. Nothing is ever free. Between BIG out of pocket upfront co-pays and that extra layer of bureaucrats looking over treatment costs isn't worth it.

[Bumbles]

11. Erronis warned me about this long ago.

I'm glad I heeded his warning and was never tempted.

[lark]

12. Shit, guess I need to check this out. I was just assuming continued coverage with similar benefits.

I haven't got my Medicare Advantage comparison book yet, I use that to get my choices down to 1 or 2 then make calls to determine the important details. Humana has been good to me, no problems like I had on Wellcare. I hope my plan hasn't changed subsstantially.

[markodochartaigh]

13. The US

does not have a health care system. The US has a profit making system which produces as much profit as possible while producing as little health care as possible as a byproduct.

[barbaraann]

38. Wow! That's close to what I have said for decades.

I say we don't have a health care system. We have an asset extraction system based on health care.

[ancianita]

20. I would suggest that MA people switch to Medicare's supplement with United Healthcare's Plan F.

It's offered through AARP, but one doesn't have to be a member of AARP to get it. No co-pays, no hidden fees, it covers any doctors and treatments anywhere in the U.S. I've had it for 10 years -- and while traveling -- and it's worked very well.

[Auggie]

23. Or Plan G for younger folks

Almost as good as Plan F.

[ancianita]

24. Sure, whatever the most benefits that are affordable. (Hope you're not being sarcastic, cuz I've not heard of Plan G.)

[Auggie]

27. No sarcasm. Plan F was phased out a few years ago.

I love it for the reasons you mention.

[yorkster]

30. Plan F is being grandfathered. I think.

Maybe G is the new version for people just starting on Medicare?

[ancianita]

40. I hear you. I'll take your word for it.

Makes sense to me that G could be its substitute.

[yorkster]

44. When we first went on Medicare about 12 yrs.

ago, our local council on aging had very in-depth advice. Got a real comparison of various supplemental plans and prescription plans and their costs, plus pros and cons. Highly recommend that as at least one source . Good luck to you.

[ancianita]

45. Yes, that's when I signed off Medicare Advantage and onto United Healthcare Plan F through my pension fund.

I'm already enrolled, luckily, so am leaving things as they are, thanks.

[QED]

26. I have Plan G and so far, so good.

I barely made the Medicare deductible last year though.

BTW, WellCare for Part D has no monthly fee and only one of my scripts has a co-pay of $6/90 day supply.

[SheltieLover]

33. Might vary by state, but Farm Bureau Plan F was the cheapest by hundreds per month for Plan F when I signed up a few yrs

ago.

I suggest everyone contact their local Senior Center and/or Council on Aging. The folks from the Council on Aging can tell you to the penny what your Gap plan and/or Part D will cost you, then they can sign you up and set it up to come out of your SS monthly direct deposit.

Mine was something like around $125/month for the plan I chose, while others were nearly $400 for the same, exact coverage! (Unlike with Plan D drug coverage, ALL Gap plans must offer identical coverages within each category. In other words, all Plan Fs have identical covergae, etc.)

I hope this is helpful.

[ancianita]

41. Thank you. Great post because it's so helpful!

[SheltieLover]

42. You are most welcome!

[Jacson6]

25. I was on MA years ago.

I dropped it and went back to Medicare. If you ended up in the out of network hospital You were doomed financially. Now Medicare has lower costs over all and you can pay the 20% due with a monthly payment over time.

[niyad]

28. My agent told me yesterday all the things my plan reduces for next year. So

far, just annoying, as I don't use most of them. I commented to my new PCP that I would have thought the insurance company would love me, since I am not really costing them anything silly me. She explained that they are not GETTING anything, as I questioned why they were "recommending" that a woman my age see their pcp, nitbannually, not every six minths, but every three months. We agreed that is utter BS.

[nbsmom]

35. The State Health Insurance Assistance Program (SHIP) can help.

SHIP is your local State Health Insurance Assistance Program. SHIP provides unbiased help to Medicare beneficiaries, their families, and caregivers. Whether you are new to Medicare, reviewing Medicare plan options, or have questions on how to use your Medicare, SHIP can help.

You can learn more about SHIP here: https://www.shiphelp.org/

Since I’m in California, I know more about HICAP. (HICAP is part of the State Health Insurance Assistance Program (SHIP).)

HICAP offers a variety of services, including:

Counseling on Medicare, Medicare supplement insurance, managed care, and long-term care planning

Help with disputed or denied Medicare-related medical bills

Representation in administrative legal hearings

Community education on Medicare and health insurance issues

Right now, HICAP is offering webinars for people who are trying to figure out what to do with their MA plans (go back to traditional Medicare, get a supplement, etc.)

[ThoughtCriminal]

46. I may choose to bail on my MA plan this year

I joined last year because it was the only plan offered through through my state retirement system. The state subsidizes the premiums so it cost almost nothing and it has been good. But it looks life the premiums are going to go up next year - like $100 more per month and I do not think the subsidy will increase at all.

If I'm going to pay $100 a month, I think I would be better off with Medicare, a supplement, and a drug plan. No significant medical problems yet, so I don't think underwriting will be a problem.