The showdown underscores just how important — and lucrative — Medicare Advantage has become to insurers and doctors’ groups that are paid by the federal government to care for older Americans. Roughly $400 billion in taxpayer money went to these private plans last year. Profits on Medicare Advantage plans are at least double what insurers earn from other kinds of policies, according to a recent analysis by the Kaiser Family Foundation.
Without reforms, taxpayers will spend about $25 billion next year in “excess” payments to the private plans, according to the Medicare Payment Advisory Commission, a nonpartisan research group that advises Congress.... NYT
Friday, March 25, 2023
First let's post the link Marianne's appearance on Brian Lehrer show Thursday morning - she took everything thrown at her and educated Brian and the listeners. A transcript may be available. Must listen - https://www.wnyc.org/story/nyc-retirees-speak-out-about-health-plan-changes.
One thing has become increasingly care - switching us out of traditional medicare to MedAdv will raise healthcare costs by billions. Thursday's NYT has an explosive article in the print section which I am reproducing below, with the charts that show how they make money by upcoding. Like my blood tests show some sugar escalation - they will take that and get more money from medicare by classifying me as pre-diabetic.
It would significantly lower payments — by billions of dollars a year — to Medicare Advantage, the private plans that now cover about half of the government’s health program for older Americans. The change in payment formulas is an effort, Biden administration officials say, to tackle widespread abuses and fraud in the increasingly popular private program. In the last decade, reams of evidence uncovered in lawsuits and audits revealed systematic overbilling of the government. A final decision on the payments is expected shortly, and is one of a series of tough new rules aimed at reining in the industry. The changes fit into a broader effort by the White House to shore up the Medicare trust fund.. NYT March 23, 2023
Norm Scott: UFT member since 67. Wearing a UFT logo and hope no lawyers contact me. Healthcare: MAP isn’t Medicare. If I were to pay someone to go to the grocery store for me, that’s kind of like what Aetna is going to do with our healthcare. If you don’t understand that healthcare hasn’t increased in cost because of profits and denial of benefits…I hear some people say I don’t really care about it – it’s just politics. I’m really disturbed by the fact that I may not have access to my doctors. I’ve got doctors for every part of my body. I’m getting calls from all over the country by people saying they might not get access to doctors. 60% of people are now on MAP. But what happens when it’s 80 and 90%? I’m sorry to say but this union is acting like the Republicans – the Republicans will end up killing Medicare. Mulgrew talks about representational voting at MLC, but not in the UFT. Even though Retiree Advocate got about 1/3 of the vote in the retiree chapter election, we get no say at all – not a single delegate. We think there should be a vote on questions of healthcare. We are starting a petition campaign, where if we get 1/3 of this body, we can get a referendum to vote on any healthcare changes. You might win that vote anyways – why not support it. Give members a choice to vote.
- The showdown underscores just how important — and lucrative — Medicare Advantage has become to insurers and doctors’ groups that are paid by the federal government to care for older Americans. Roughly $400 billion in taxpayer money went to these private plans last year. Profits on Medicare Advantage plans are at least double what insurers earn from other kinds of policies, according to a recent analysis by the Kaiser Family Foundation.
- Older Americans have flocked to Medicare Advantage, finding that many policies offer lower premiums and more benefits than the traditional government program. The insurers receive a flat rate for every person they sign up — and get bonuses for those with serious health conditions, because their medical care typically costs more. But numerous studies from academic researchers, government watchdog agencies and federal fraud prosecutions underscore how the insurers have manipulated the system by attaching as many diagnosis codes as possible to their patients’ records to harvest these bonus payments. Four of the largest five insurers have either settled or are currently facing lawsuits claiming fraudulent coding. Similar lawsuits have also been brought against an array of smaller health plans.
https://www.nytimes.com/2023/03/22/health/medicare-insurance-fraud.html
Biden Plan to Cut Billions in Medicare Fraud Ignites Lobbying Frenzy
The Biden administration has proposed changes to how it would pay private Medicare Advantage plans, setting off a lobbying frenzy.
