This article by Rachel Cohen from The Intercept is one of the best I've read on the bait and switch to Medicare Advantage as it exposes the flaws.What it doesn't address is WHY are unions doing this? And it you are far from retirement be worried - cost savings on your backs will be next. The goal of the Dems, Rep and unions seem to be to wipe out public insurance plans: the UFT is “generally at the beginning” of the trend.
UPDATED WITH COMMENT BELOW FROM RETIRED UFT MEMBER WHO HAS FAVORED A MEDICARE ADV PROGRAM
Generally a well-balanced read, Ms. Cohen's. One fact wrong: managed care, in the form of HMOs (the first form of Medicare Advantage) began in the 1970s, not 2000, then was formalized in a 1997 Budget Act and revised thereafter. They are now what's known as Part C, though that term is not much used. "Original Medicare" was set up in 1965 as Parts A and B. MAs manage Parts A and B in private structures and are required by law to offer nothing less than Original Medicare. In many ways they offer more.Secondly, Ms Cohen is not factually wrong here, but makes it seem as if there's something wrong with having to get a referral for specialized care. Primary physicians can handle a lot of ailments. People frequently self-diagnose an illness and traipse off to a specialist when the primary could have handled it. Not only that, once the referral is made to the specialist, they don't have to keep visiting the primary to get additional care from that specialist. When the referral period is "up," they just have to call the primary for another referral. The primary's involvement becomes virtually nil. And what's more: the primary is keeping records of your whole health picture, which is not a specialist's job. There's an advantage to having one doctor know the whole of a patient instead of just his sinus cavities....
UA (https://underassault.blogspot.com) https://wikis. westchesterlibraries.org/sbic/ demystifying-medicare/
Here are key excerpts with the full article below the break.
One study Meyers worked on found that Medicare Advantage beneficiaries were more likely to enter lower quality nursing homes than those on traditional Medicare. Other research by Meyers found that about 30 percent of Medicare Advantage plans have narrow primary care networks, and even more have narrow psychiatry as well as mental and behavioral health options. Limiting provider options is “one way plans can save money,” Meyers said.
“We’ve gotten some verbal assurances from the unions, like Mulgrew said Memorial Sloane Kettering would accept Medicare Advantage, but let’s see that in writing,” said Eber. “No one has given us a written explanation of how the city expects to save $600 million, yet the vendor is going to make a profit and retirees won’t pay the price.”
studies have shown that individuals in Medicare Advantage plans tend to utilize fewer health care services, including preventative care. “This suggests that some of the tools that Medicare Advantage plans are using to control costs are pretty blunt instruments,”
This past spring, in an annual federally mandated analysis on Medicare, the Medicare Payment Advisory Commission wrote that “the current state of quality reporting in [Medicare Advantage] is such that the Commission can no longer provide an accurate description of the quality of care.”
“They’ll be saving money on the backs of retirees.”
A deputy commissioner from the Mayor’s Office of Labor Relations acknowledged that such pre-approval from insurance would likely be required for municipal retirees under a shift to Medicare Advantage. Cost savings often come from making it harder for patients to access services.
Diane Archer, president of Just Care, which offers health and financial information to seniors, said if New York City moves forward with the shift, “they’ll be saving money on the backs of retirees” who need expensive care. Corporations and unions nationwide have been able to avoid an outcry over similar cost-cutting moves “because the majority of people they’re moving are in good health and value what appears to be additional benefits; they generally don’t understand the financial and administrative barriers to care they will face when they need costly care.”
“Unions can negotiate something better for their retirees than people can get on their own in the Medicare marketplace, but I don’t think it will be anywhere as good as what they have now,” said Archer. “Mulgrew explains that people will still have premium-free care, but he doesn’t explain that they could have out-of-pocket costs that will be prohibitive if they develop a complex condition.”
New York City labor groups aren’t the first unions to look to Medicare Advantage as a way to cut costs. Experts predict that there could be a marked increase across the country over the next few years as local budgets come under more strain.
Alex Lawson, executive director of Social Security Works, noted that Medicare Advantage is being considered at a time when organized labor is under attack from multiple levels, including over pensions and retiree health care. Unlike traditional Medicare, Medicare Advantage invests heavily in sales representatives who market their products nationwide. “They always have an answer, but it’s just like if you’ve ever been pitched to buy a timeshare,” Lawson said. “Yeah, those people make a good pitch; it doesn’t change the fact that it’s just a hustle.
the UFT is “generally at the beginning” of the trend.
Health care researchers say it’s not necessarily true that New York City retirees will be worse off under Medicare Advantage, but the lack of good data makes it hard to be confident. “Surprisingly little is known about how much Medicare Advantage enrollees pay out of pocket for the services they receive overall, across plans, according to health condition, or in comparison to beneficiaries in traditional Medicare (with or without supplemental coverage),” wrote Kaiser Family Foundation researchers in the New England Journal of Medicine in 2018.
Jason Abaluck, an economist at Yale whose research found great variation among Medicare Advantage plans, told The Intercept the existing evidence “is not completely clear that [New York City retirees] will not have a more efficient plan and of the same quality” under Medicare Advantage.
