Private insurers have exploited Medicare for millions while applying roadblocks to needed care.

Over the years I have warned patients about private insurers and the push to have everyone use a Medicare Advantage (part C) plan.  These plans offer the same hassles and pitfalls that you had prior to joining Medicare, with delays, recertification requirements, smaller networks, and no out-of-network coverage but you get a free gym membership. While the deals sound enticing with the barrage of mail you receive, the truth is that Medicare parts A and B with a Medicare supplement are far superior coverage-wise than any Advantage plan.

While it is true that it is a social plan, Meaning that it is administered by the government through CMS, it is also true that most doctors accept it, all hospitals accept it nationally, and they have out-of-network benefits and also a drug benefit which as of the beginning of the year allows Medicare to negotiate drug prices. Medicare also caps what doctors can charge both in and out of the network which prevents price gouging, a common problem when searching for popular providers who don’t participate.

Medicare is now the only carrier that can effectively negotiate hospital prices nationally and the savings with the new drug price negotiation abilities make it an even better value.

As a consumer, you should be concerned with a recent NY Times article that shows how private insurers had gamed the system to extract more money than they actually were owed by gaming Medicare solely to increase profits, with no benefit to the consumer. They also, as reported in the NY Times that insurers have lied to consumers regarding the size of their networks and in some cases, moved them to Advantage plans without their consent, something I have personally witnessed with some older patients.

Still, want that free gym membership?   United Medicare supplement includes it with their Medigap coverage.

To get the best value out of Medicare premiums, you should join Medicare at the age of 65 and coverage begins at the beginning of your birthday month.   You are likely to see your health insurance costs drop by half of what they are now if you pay for them.

Why doesn’t the government offer an opportunity for those over 60 to buy into Medicare?   It likely has to do with the lobbying that is done by regular insurers to prevent it.  They know that it is bad for their business model, but it is great for you.

Smart consumers stick with Medicare as a primary when they become 65 years of age.  Some large groups such as for example NJ have used Aetna’s Medicare advantage promising to offer the same coverage as they did, especially for chiropractic patients.   As of this year, they have been nothing but a headache for their participating doctors and their patients.   Check to see if you have other options before allowing this to happen to you.   You probably can avoid these types of arrangements that save the state money while affecting the quality of your insurance.

Check out the article in the NY Times.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions

By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most large insurers in the program have been accused in court of fraud.

By Reed Abelson and Margot Sanger-Katz Oct. 8, 2022

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

Each of the strategies — which were described by the Justice Department in lawsuits against the companies — led to diagnoses of serious diseases that might have never existed. But the diagnoses had a lucrative side effect: They let the insurers collect more money from the federal government’s Medicare Advantage program.

Read more