Medicare advantage plans VS Medicare

[liquidshadow22]

Can anyone expand on the diff btw commercial medicare adv plans and Medicare? Also type of patients typically socioeconomic /demographic etc

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[splik]

Medicare advantage plans are big business for insurance companies. There has been exponential growth in this scam over the past decade. 42% of patients with medicare now have a medicare advantage plan. The reason many patients do this is because the plan will pay the 20% of the costs that medicare won't (the alternative is to have a medigap plan or to pay it yourself), or because they had a job with retirement health insurance benefits (like a VA job etc) that include a medicare advantage plan. However these plans are costlier to the taxpayer and and offer fewer benefits.

For those who are cash only in PP but have not opted out of medicare, the advantage (pun intended) of MA plans is that it is as if they don't have medicare at all and you can charge them whatever you like.

For private practitioners, MA is the worst of both worlds. You have to adhere to medicare regulations while accepting commercial plans, and being paid medicare rates. This may not be bad for people who accept insurance in areas where commercial plans otherwise reimburse less than medicare (which appears to be becoming more common).

 

[Atreides]

Yeah, just read an article today about Medicare advantage plans and how big of a scam they are: Major Insurers Are Scamming Billions from Medicare, Whistle-Blowers Say

 

[SpinDktr]

I work in geriatric psychiatry exclusively. It amazes me that so many people sign up for these plans. United Healthcare and Humana seem to be the worst offenders; often wanting patients discharged from inpatient after only a few days. These are frail older adults with chronic mental health issues. Straight medicare is really the better option for most people, and I really try to encourage this; the incentive for most people looking at advantage plans is reimbursement for medications, but they don't realize that the advantage plan will short them in so many other ways.

 

[calvnandhobbs68]

I work in geriatric psychiatry exclusively. It amazes me that so many people sign up for these plans. United Healthcare and Humana seem to be the worst offenders; often wanting patients discharged from inpatient after only a few days. These are frail older adults with chronic mental health issues. Straight medicare is really the better option for most people, and I really try to encourage this; the incentive for most people looking at advantage plans is reimbursement for medications, but they don't realize that the advantage plan will short them in so many other ways.

Yeah this is pretty similar to the managed medicaid plans in many states now. Private insurers skimming off government funding and then passing it along by reimbursing us less and shorting patients for coverage.

 

[dantt]

For private practitioners, MA is the worst of both worlds. You have to adhere to medicare regulations while accepting commercial plans, and being paid medicare rates. This may not be bad for people who accept insurance in areas where commercial plans otherwise reimburse less than medicare (which appears to be becoming more common).

Sometimes you even get paid below Medicare rates, or even capitated.

 

[Orgone]

... Private insurers skimming off government funding and then passing it along by reimbursing us less and shorting patients for coverage.

I believe the proper term for this is "utilizing private sector scale and efficiency to deliver more robust, cost-effective, and personalized health care."