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An interesting story describing the use if predictive technology by Medicare Advantage Plans to cut off nursing home care of patients who need it. Multiple vignettes describing UHC’s use of NaviHealth to deny / cut off coverage that would normally be covered by traditional Medicare. And, the new rules effective Jan 1 that limit the ability of Medicare Advantage Plans to use such technology.
PS: Everything I have read on the Medicare Advantage Plans is negative and indicative of how poor the involvement of these for-profit companies in healthcare decisions is for the government and the people. But, they have big lobbies, money and media that it buys and political backing from the politicians who are either too afraid and/or benefit from the lobbying money. Here is a link to KFF discussion and podcast on this topic.
I never considered an Advantage plan because I travel all over the country (and abroad) and need something that covers me nationwide, so I never paid much attention to Advantage advertising or discussions about it. Yes, I am noticing lately a lot of negative press about Advantage. But nevertheless, per latest data, 51% of Medicare-aged people are enrolled in Advantage plans, and 23% in Medigap supplements (17% are on Medicaid).
If people start switching to Medigap supplements in large numbers due to negative experiences with Advantage, maybe that would keep Medigap premium cost lower? When the number of people paying into an insurance pool increases, the premiums decrease (that is also why the high health insurance premiums for the general population would decrease if everyone using health services were required to pay some amount of premium in order to receive health care - that is what enables healthcare systems in Western Europe to offer universal coverage).
In many states people can’t switch back to Medicare from an advantage plan after 90 days without passing medical underwriting. People take them because often they don’t have a monthly premium but do have large amounts you can pay out of pocket if you have a serious illness.
They also are allowed to do step therapy for a serious condition. By the time you get to the step you originally needed you are probably dead. Google this if you are not familiar. You also can’t go out of network and I know 2 people that are only alive because they were able to go out of state for treatment.
An interesting story describing the use if predictive technology by Medicare Advantage Plans to cut off nursing home care of patients who need it. Multiple vignettes describing UHC’s use of NaviHealth to deny / cut off coverage that would normally be covered by traditional Medicare. And, the new rules effective Jan 1 that limit the ability of Medicare Advantage Plans to use such technology.
I see red when I read stories like these, which mirror reports from posters on CD experiencing the exact same thing. Particularly disappointing, for me, is to read Security Health, a Wisconsin MA owned by the very well-regarded Marshfield WI Clinic, is an offender. Marshfield is the go-to place for northern rural people when one needs specialized care. My 80 y/o Rhinelander cousin routinely travels to Marshfield for treatment. Naively, I had expected that Marshfield would put the welfare of its patents first. We have other practice-sponsored MAs in rural WI, which do provide excellent care and are specific to people in their geographic area.
Fwiw, I did until this year have a statewide MSA (Medicare Savings Account) through Security Health - a form of Advantage, with no first dollar coverage until the $5,500 deductible has been satisfied. Plan would deposit approximately $2k into an MSA each year as a partial offset to the deductible. The two or three small claims submitted to them for processing over the years, resulted in one denial as deemed not medically necessary which puzzled and irritated me. Never pursued the denial because deductible had not been met so reimbursement was irrelevant. But, that denial was the canary in the coal mine, always bothered me.
This year, bc of my age, not wanting to be at the mercy of an Advantage decider going forward, I returned to Original Medicare with a high-deductible Medigap supplement. Conveniently, Security discontinued its MSA on 12/22, so I had guaranteed issue for a Medigap exactly when I had determined to switch. Never have had any health issues, underwriting wouldn't have been a problem, but the timing of the plan discontinuance certainly was serendipitous.
I never considered an Advantage plan because I travel all over the country (and abroad) and need something that covers me nationwide, so I never paid much attention to Advantage advertising or discussions about it. Yes, I am noticing lately a lot of negative press about Advantage. But nevertheless, per latest data, 51% of Medicare-aged people are enrolled in Advantage plans, and 23% in Medigap supplements (17% are on Medicaid).
If people start switching to Medigap supplements in large numbers due to negative experiences with Advantage, maybe that would keep Medigap premium cost lower? When the number of people paying into an insurance pool increases, the premiums decrease (that is also why the high health insurance premiums for the general population would decrease if everyone using health services were required to pay some amount of premium in order to receive health care - that is what enables healthcare systems in Western Europe to offer universal coverage).
They could be on Advantage because it's cheaper.
A friend of mine switched last year because one of those medicare parts went up a lot so she switched.
Well, for how long could United Health Group remain in the top 10 companies of the S&P 500 if it switches gears and stops ripping off Medicare? I mean, gosh, its market cap is only $473 billion dollars. /s
AARP should be sanctioned.
They could be on Advantage because it's cheaper.
A friend of mine switched last year because one of those medicare parts went up a lot so she switched.
It's cheaper until it isn't. Skilled nursing is denied bc of an algorithm and you're not fit to care for yourself, so remain at the facility and shell out $10k from your own pocket for the privilege, as cited in the WaPo article. Similar experiences cited here on CD.
When people are at their weakest and most vulnerable they've been forced to fight these unnecessary battles. It's still all about the bottom line. Clearly it became so much of a problem, CMS had to address it.
UHC is not the only offender. Humana and others have also made the news over the years.
In many states people can’t switch back to Medicare from an advantage plan after 90 days without passing medical underwriting. People take them because often they don’t have a monthly premium but do have large amounts you can pay out of pocket if you have a serious illness.
They also are allowed to do step therapy for a serious condition. By the time you get to the step you originally needed you are probably dead. Google this if you are not familiar. You also can’t go out of network and I know 2 people that are only alive because they were able to go out of state for treatment.
You may know 2 people, but I know many people who are very happy with their MA plans. These are intelligent people who are familiar with plan deductibles and MOOP. They are not people who get giddy with delight when listening to TV ads. These are considered decisions.
They have looked at many different plans and have opted into MA willingly and knowingly.
They can go out of network and are covered outside their home area.
You are listening to the hype by the alarmists. There are many different plans with many different provisions.
It's cheaper until it isn't. Skilled nursing is denied bc of an algorithm...
Actually, it is denied by a Medical Director at the insurer.
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