#medicare advantage is a scam

[scottguy]

Article: The Medicare Advantage Trap

The Medicare Advantage Trap

It's a SCAM. They get a fixed amount and thus have nothing but incentive to deny your claims.

Don't choose this! (It may seem cheaper now but will cost your time, money, and possibly your life.)

[progressivegraffiti]

Take Advantage of Medicare Open Enrollment to Dump a Medicare Advantage Plan

Get real #Medicare during #MedicareOpenEnrollment, instead of a cheap #MedicareAdvantage plan.

Some very smart and knowledgeable people say Medicare Advantage is a scam. If it is, the Advantage scam is heavily supported by the U.S. Government. And now, NPR reports that Advantage plans even drag their feet to pay small, rural hospitals. Put that information in context, with a little background… Medicare is government healthcare. Medicare Advantage is private health insurance.…

[misfitwashere]

If You Don't Know Medicare Advantage Is a Scam, You're Not Paying Attention

We’re on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Don't be fooled about what it is—and who is profiting.

Thom Hartmann

Oct 07, 2023

Common Dreams

President George W. Bush and Republicans (and a handful of on-the-take Democrats) in Congress created the Medicare Advantage scam in 2003 as a way of routing hundreds of billions of taxpayer dollars into the pockets of for-profit insurance companies.

Those companies, and their executives, then recycle some of that profit back into politicians’ pockets via the Citizens United legalized bribery loophole created by five corrupt Republicans on the Supreme Court.

Just the overcharges happening right now in that scam are costing Americans over $140 billion a year: more than the entire budget for the Medicare Part B or Part D programs. These ripoffs — that our federal government seems to have no interest in stopping — are draining the Medicare trust fund while ensnaring gullible seniors in private insurance programs where they’re often denied life-saving care.

Real Medicare pays bills when they’re presented. Medicare Advantage insurance companies, on the other hand, get a fixed dollar amount every year for each of the people enrolled in their programs, regardless of how much they spent on each customer.

As a result, Medicare Advantage programs make the greatest profits for their CEOs and shareholders when they actively refuse to pay for care, something that happens frequently. It’s a safe bet that nearly 100 percent of the people who sign up for Advantage programs don’t know this and don’t have any idea how badly screwed they could be if they get seriously ill.

Not only that, when people do figure out they’ve been duped and try to get back on real Medicare, the same insurance companies often punish them by refusing to write Medigap plans (that fill in the 20% hole in real Medicare). They can’t do that when you first sign up when you turn 65, but if you “leave” real Medicare for privatized Medicare Advantage, it can be damn hard to get back on it.

The doctors’ group Physicians for a National Health Program (PNHP) just published a shocking report on the extent of the Medicare Advantage ripoffs — both to individual customers and to Medicare itself — that every American should know about.

The report, titled Our Payments, Their Profits, opens with this shocking exposé:

“By our estimate, and based on 2022 spending, Medicare Advantage overcharges taxpayers by a minimum of 22% or $88 billion per year, and potentially by up to 35% or $140 billion. By comparison, Part B premiums in 2022 totaled approximately $131 billion, and overall federal spending on Part D drug benefits cost approximately $126 billion. Either of these — or other crucial aspects of Medicare and Medicaid — could be funded entirely by eliminating overcharges in the Medicare Advantage program. “Medicare Advantage, also known as MA or Medicare Part C, is a privately administered insurance program that uses a capitated payment structure, as opposed to the fee-for-service (FFS) structure of Traditional Medicare or TM. Instead of paying directly for the health care of beneficiaries, the federal government gives a lump sum of money to a third party (generally a commercial insurer) to ‘manage’ patient care.”

With real Medicare and a Medigap plan, you talk with your physician or hospital and decide on your treatment, they bill Medicare, and you never see or hear about the bill. There is nobody between you and your physician or hospital and Medicare only goes after the payment they’ve made if they sniff out a fraud.

With Medicare Advantage, on the other hand, your insurance company gets a lump-sum payment from Medicare every year and keeps the difference between what they get and what they pay out. They then insert themselves between you and your doctor or hospital to avoid paying for whatever they can.

Whatever you decide on regarding treatment, many Advantage insurance company will regularly second-guess and do everything they can to intimidate you into paying yourself out-of-pocket. Often, they simply refuse payment and wait for you to file a complaint against them; for people seriously ill the cumbersome “appeals” process is often more than they can handle.

As a result, hospitals and doctor groups across the nation are beginning to refuse to take Medicare Advantage patients. California-based Scripps Health, for example, cares for around 30,000 people on Medicare Advantage and recently notified all of them that Scripps will no longer offer medical services to them unless they pay out-of-pocket or revert back to real Medicare.

They made this decision because over $75 million worth of services and procedures their physicians had recommended to their patients were turned down by Medicare Advantage insurance companies. In many cases, Scripps had already provided the care and is now stuck with the bills that the Advantage companies refuse to pay.

Scripps CEO Chris Van Gorder told MedPage Today:

“We are a patient care organization and not a patient denial organization and, in many ways, the model of managed care has always been about denying or delaying care – at least economically. That is why denials, [prior] authorizations and administrative processes have become a very big issue for physicians and hospitals...”

Similarly, the Mayo Clinic has warned its customers in Florida and Arizona that they won’t accept Medicare Advantage any more, either. Increasing numbers of physician groups and hospitals are simply over being ripped off by Advantage insurance companies.

Not only is the Medicare Advantage scam a screw job for healthcare providers and people who are on the programs and are unfortunate enough to get sick, it’s also preventing Americans from getting expanded benefits from real Medicare.

As the PNHP report notes, for real Medicare to provide comprehensive vision, dental, and hearing benefits to all Medicare recipients would cost the system around $84 billion a year, according to the Congressional Budget Office.

Instead, though, the Medicare system is burdened with at least that amount of money in over-payments to Medicare Advantage providers — over-payments that have no health benefit whatsoever and merely inflate the companies’ profits.

A hundred billion dollars in excess profits can be put to a lot of uses, and the health insurance industry is quite good at it. The former CEO of UnitedHealth, “Dollar” Bill McGuire, for example, made off with over $1.5 billion dollars for his efforts.

And, because five corrupt Republicans on the Supreme Court legalized political bribery with their Citizens United decision, some of these companies allocate millions every year (a mere drop in the bucket) to pay off loyal members of Congress and to dangle high-paying future jobs to high-level employees of CMS who have the power to keep the gravy train going and thwart prosecutions.

As PNHP noted:

“Medicare Advantage is just another example of the endless greed of the insurance industry poisoning American health care, siphoning money from vulnerable patients while delaying and denying necessary and often life-saving treatment. While there is obvious reason to fix these issues in MA and to expand Traditional Medicare for the sake of all beneficiaries, the deep structural problems with our health care system will only be fixed when we achieve improved Medicare for All.”

We’re on the edge of the open enrollment period for Medicare, and the Advantage scammers will be carpet-bombing America with advertisements over the next few months. Representatives Pocan, Khanna, and Schakowsky have introduced the “Save Medicare Act” that would ban Advantage companies from using the word Medicare in their advertising.

They made a video about it that’s well worth sharing with friends and family:

As Schakowsky, Khanna, and Pocan note, “Only Medicare is Medicare.” Don’t be fooled by the Medicare Advantage scam.

And now that you know, pass it on and save somebody else’s health!

[ms-cellanies]

I am enrolled in Medicare Advantage. Frankly I don't know if I should change next year or not. So far I've been fortunate that I haven't had to pay any big bills. I've stayed out of the hospital but as I get older & older it's highly likely I will have serious health issues that require going to the hospital.

ALL AMERICANS SHOULD HAVE MEDICARE FOR ALL THAT IS RUN BY OUR GOVERNMENT & NOT BIG INSURANCE COMPANIES.

[aunti-christ-ine]

...especially when the insurance con artists call their scam "Medicare Advantage" (aka "Medicare Part C") and make it sound like it's actually a part of our government's Medicare! Liars!

We must Repeal and Replace the for-profit Health Insurance Companies with singlepayer Medicare For All universal healthcare! We need Singlepayer NOW !!! ~*~*~ and, btw ~*~*~ Big Pharma sucks!

[pscottm]

The Medicare Advantage ripoff every American should know about - Raw Story

In case you ever thought George W Bush was a good Republican.

Know your history.

[meandmybigmouth]

the government has never seen a scam of the american people they didn’t like! especially when it “trickles? down to the right places!

[luulapants]

For everyone in the notes of the wood glue post asking if they can borrow my dad, please know that this week he spent forty minutes on the phone explaining to me (again) about how cardiologists are all part of a scam to sell Medicare Advantage plans. He had heart surgery this year. He will not go to the cardiologist because they are a scam.

What I'm saying is I'm implementing a "no returns" policy. He's your problem now. He needs his dentures redone. He cannot move away from the Chicago suburbs because Jewel Osco brand lime seltzer is the only thing he will drink. Good luck.

[dxsturbia]

So what happens is you get your state insurance Medicare Medicaid what have you

And I don’t know if you’ve ever rented anything like property of any kind

But what they’re gonna do is set you up with a business basically you have this many units to your insurance policy and every policy is the same or at least that’s what they’re telling me

And you’re gonna go find a temp agency and they are going to play the role of your human resources department. They’re going to be accounting and payroll.

And what should happen is that if for some reason, my primary provider is unavailable, I am able to contact the agency on a PRN basis to have someone contracted out to fill in the gap for whatever reason my chosen provider isn’t available

What’s happening right now is that I sign up with the agency they do all of my paperwork, my payroll all of that I am only allowed to pay my staff what 11.45 per hour at this point

I am only able to provide them with 21.75 hours per week because that’s all the time I have to rent from the temp agency

I cannot provide them with medical benefits. I cannot provide them with vacation or sickleave. I am responsible for being able to staff in case of an absence, but listen I can’t just hold somebody in emergency position. They are required to work a certain amount of time per week otherwise they will be removed from I don’t Know exactly what it is at this agency but my last one it was 16

So I either hire family or I go live in a home because nobody’s got the gas money to do their jobs without taking on five or six different clients and I am a demanding client and may not seem so because I don’t have the luxury of having every need met

Family doesn’t come because they hate me. They’re not getting paid enough for this either so they’re going to scam the Clock too

And everyone has abandoned Anissa to her own devices again anissa doesn’t have any devices. The state of Missouri does.

Everyone knows it and they’re taking full advantage of it. I need there to be consequences for that real ones.

I need the rights to my life under the American Constitution whether or not I can get off this rat wheel that is the benefit line

Everybody does it and it’s always OK until I do it because I’ve actually got the right to it and it’s a social structure so if you want to keep it, you gotta help

I need advocates ones that are allowed to act as advocates. I need lawyers that work with ADA cases that can take ADA money.

I need people to let the system work

I need to be able to not let people twist up my money so that when they need more of it, I can actually get it

[amarisbella21]

Common Medicare Mistakes And How To Avoid Them

Navigating Medicare can be a daunting task, especially for first-time beneficiaries. Here are some common mistakes people make and how to avoid them.

Missing Initial Enrollment Period

One of the most significant mistakes is missing the Initial Enrollment Period (IEP). This period starts three months before you turn 65 and lasts for seven months. Failing to enroll during this window can lead to delayed coverage and potential penalties.

How to Avoid It:

Stay informed about your IEP and mark your calendar. If you’re still working and covered by an employer plan, understand how that affects your Medicare enrollment.

Not Understanding Coverage Options

Many beneficiaries don’t fully understand the differences between Medicare Parts A, B, C, and D. This can lead to inadequate coverage or unnecessary expenses. For example, some may enroll in a Medicare Advantage Plan without realizing it may limit their provider choices.

How to Avoid It:

Take the time to educate yourself about the various parts of Medicare. Consider meeting with a Medicare counselor or attending a local seminar to clarify your options.

Ignoring Preventive Services

Medicare covers a range of preventive services, but many beneficiaries don’t take advantage of these offerings. Services like screenings, vaccinations, and annual wellness visits are often overlooked.

How to Avoid It:

Review the list of covered preventive services on the Medicare website and schedule regular check-ups with your healthcare provider. This proactive approach can catch potential health issues early and may save you money in the long run.

Not Reviewing Annual Changes

Medicare plans can change annually, affecting coverage, premiums, and out-of-pocket costs. Failing to review these changes can lead to unexpected expenses.

How to Avoid It:

Each fall during the Medicare Open Enrollment Period (October 15 to December 7), review your current plan. Compare it with other available options to ensure you have the best coverage for your needs. Use the Medicare Plan Finder tool to help compare plans.

Overlooking Extra Help Programs

Some individuals may not realize they qualify for financial assistance programs, such as Extra Help for prescription drug costs. This can lead to higher out-of-pocket expenses for medications.

How to Avoid It:

Explore available programs that can assist with costs. Check the Social Security Administration website or contact your local State Health Insurance Assistance Program (SHIP) for guidance on financial assistance.

Falling for Scams

Unfortunately, Medicare fraud is a reality. Beneficiaries may receive unsolicited calls from individuals posing as Medicare representatives, asking for personal information.

How to Avoid It:

Be vigilant and protective of your personal information. Medicare will never call you for your details. If you receive a suspicious call, report it to Medicare.

Conclusion

Avoiding these common Medicare mistakes can help you make informed decisions and optimize your coverage. Understanding your eligibility for medicare is crucial. By staying informed, seeking help when needed, and being proactive in your healthcare choices, you can navigate Medicare more effectively and ensure that your healthcare needs are met without unnecessary costs or complications. Always remember that it’s never too late to seek assistance, and local resources are available to help guide you through the complexities of Medicare.

[jamejest]

Sneaky Medicare Advantage SCAM You Need to Know About!

[mongowheelie]

It's called Medicare Advantage and it's a nightmare! You only have to see the hundreds of ads on TV to know something isn't right! They make it sound good like with vision care and dental, but the don't mention you have to get pre-clearence for everything, which means they can deny care and medications for diseases and injuries you had before to switched from Medicare to Medicare Advantage! Beware!

[mediproassurance]

Medicare insurance agent near me Tampa Florida

Medicaid is a state and federal program that provides health coverage to low-income individuals and families. Eligibility and benefits vary by state.

Key differences between Medicare and Medicaid

Medicare is primarily for older adults and certain younger individuals with disabilities, while Medicaid serves those with limited income and resources.

Can you have both?

Yes, some individuals qualify for both Medicare and Medicaid. These individuals are known as "dual-eligibles" and may receive additional benefits through Medicaid.

11. How to Avoid Medicare Scams

Medicare scams are unfortunately common, but you can protect yourself with the right knowledge.

Common Medicare scams

Scams often involve fraudulent claims or attempts to steal your Medicare number. Be wary of unsolicited calls or offers that seem too good to be true.

How to protect yourself

Never give out your Medicare number over the phone unless you initiated the call. Review your Medicare statements regularly for any suspicious charges.

Reporting Medicare fraud

If you suspect fraud, report it to Medicare or the Office of Inspector General. Protecting your information is key to avoiding scams.

12. The Future of Medicare

Medicare is likely to undergo changes as the population ages and healthcare needs evolve.

Upcoming changes in Medicare

Future changes may include modifications to coverage, costs, and eligibility criteria as the government seeks to sustain the program.

Potential reforms

Reforms may address the financial sustainability of Medicare, particularly in light of rising healthcare costs and an aging population.

The impact of demographics on Medicare

As the baby boomer generation ages, Medicare will face increasing pressure to serve a larger population, potentially leading to changes in benefits or eligibility.

13. Expert Insights on Medicare

To provide a deeper understanding of Medicare, we consulted healthcare professionals and policy experts.

Interviews with healthcare professionals

Experts suggest that the complexity of Medicare often requires individuals to seek professional advice to navigate their options effectively.

Insights from Medicare policy experts

Policy experts highlight the importance of staying informed about changes in Medicare to make the most of the benefits available.

14. Practical Tips for Maximizing Your Medicare Benefits

Maximizing your Medicare benefits can help you save money and improve your healthcare experience.

How to save on Medicare costs

Consider using preventive services covered by Medicare, shop around for Part D plans that cover your medications at the lowest cost, and explore Medigap options to reduce out-of-pocket expenses.

Making the most of preventive services

Medicare covers many preventive services at no cost, such as screenings and vaccines. Utilizing these can help you stay healthy and avoid more significant healthcare issues down the line.

Coordinating Medicare with other insurance

If you have other insurance, such as employer coverage or a retiree plan, coordinating it with Medicare can ensure that you minimize out-of-pocket costs and avoid coverage gaps.

15. Conclusion

Medicare is a complex but essential program for millions of Americans. Understanding the different parts of Medicare, the associated costs, and how to choose the right plan is critical to ensuring you receive the healthcare coverage you need. Whether you opt for Original Medicare, Medicare Advantage, or a supplemental Medigap plan, staying informed and taking advantage of available resources can help you make the best decisions for your health and financial well-being.

[scottguy]

Factchecked: Trump and Biden’s presidential debate claims | US elections 2024 | The Guardian

This Guardian article is a good start but... here are facts left out of this article that matter.

Trump accused Biden of having an open border while Trump DIRECTED Republicans to kill a bill for funding border security that was SO strict that many Democrats opposed it. Republicans had a chance to FIX the "crisis" but didn't strictly to be able to continue whine about the issue.

Trump, himself, added to the "super predator" myth by falsely accusing the black young men who were initially blamed for a rape in Central Park but later found to be innocent. Trump is well known for racism in his family business and in all his political views, especially regarding immigrants.

Trump promised a "big beautiful healthcare plan" while in office and never delivered because it was simply a lie acknowledging what people want but which Trump doesn't know how to and/or doesn't care enough to deliver.

Trump has a long, well-documented history of lying as well as cheating his business associates. He had over 2,000 civil suits over various business matters before Trump ever ran for office.

Trump sabotaged Biden and Afghanistan by letting about 500 Taliban terrorists out of prison. With that many ruthless Taliban criminals loose the regular army surrendered rather than die at their hands.

Republicans and Trump plan to cut Social Security and Medicare. They want to reduce benefits and make people work longer. They want to privatize Medicare. Early "Medicare Advantage" private plans have turned out to be massive scams for seniors.

Biden has a plan to simply raise the cap that Reagan put on Social Security taxes so the rich pay what they can easily afford. That tax doesn't kick in until your income is over $400,000 a year.

Republicans are literally planning to end abortion nationwide. See Heritage Foundation Project 2025.

Republicans are planning a christofascist state. See Heritage Foundation Project 2025.

Trump promised during a speech to be "a dictator from day one." That statement is the antithesis of the values that America was founded upon. Trump is openly anti-democracy and pro-totalitarian state.

Republicans are fully supportive o Trump's open plans to end democracy.

The founding fathers never imagined that half of America, one entire party would be SO corrupt as to support a man like Trump.

People who think that "It can't happen in America" are thinking of a past America where Republicans believed in democracy.

The Democrat party, if we are just half of government, won't have sufficient power to stop an out-of-control Republican president.

If you think the courts will intervene you haven't been following the huge number of blatantly partisan rulings by judges whose sentiments lie with Trump.