Older Americans say they feel trapped in Medicare Advantage plans
text.npr.org
text.npr.org
But, Meyers says, there's a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or can base their prices on medical underwriting.
They were, perhaps, deceived by the Medicare Advantage insurers.
(I’m sure you know that, but replying here because it makes the thread cleaner)
It's like if your car insurance covered getting a new one if the old one is at EOL. Imagine a cost of that and also the level of willingness to participate by the ones who just bought their first car with cash.
Congratulations to the US people for discovering a model less efficient than socialism.
I'd say that any sensible reform must intrinsically be based on some combination of a whole-society pool and individual payers. These highly broken approaches of provider networks and custom negotiated pricing need to be completely eliminated. Insurance should then be an optional thing only meant for people who prefer to financialize their life (like pet insurance), and should cover a formulaic amount of any bill from any licensed provider.
Except that’s not how insurance is supposed to work. If everyone is assured the ability to buy into the pool the pools premiums are supportive of everyone, even humans.
The issue though is we allow nonhumans like MBAs and accountants to decide who gets health care and who doesn’t.
What you characterize as profit is rational acts of individual actors to join a risk pool similar to theirs in cost per unit risk. Only a lunatic would agree to buy into insurance pool that charges similar premiums for wildly different known risks. You are asking people to do the insane.
Like, I have a voluntary insurance for my children which covers periodic health checks and doctor appointments and maybe even ambulances, but it definitely does not cover surgery. That's what state medicine is for.
I’d also note that MA plans are absolutely not incentivized to deny necessary care. If they refuse to grant a PA to treat your actual cancer, they will lose a ton of money when you go to the hospital. It’s part of the entire point of MA incentive structures. They are incentivized to deny unnecessary care (low back scans and a lot of other unnecessary radiology, for instance, that traditional fee-for-service incents providers to order needlessly).
This is a shockingly poor article from NPR.
Needing to use insurance or state care on a regular basis for normal care is symptom of a disease, that the system is so over regulated a normal person can't just pay cash for regular care like I can do in Mexico. When you can buy a Z-pak or penicillin OTC with a yo quero you've reached the first level of medical nirvana.
I make a good wage but in USA with good insurance it would take me a days pay for same here after passing all the regulatory hurdles and costs and being billed for a doctor and that doctors malpractice risk overhead etc ad nauseum.
So basically what happened is these seniors wanted the better benefits when younger and then didn’t want them when they were older because their health status changed.
To me it seems like a bit “get your cake and eat it too”. What they want to do is get the benefits that traditional Medicare doesn’t provide, then later switch and get the benefits that Medicare Advantage doesn’t provide.
Problem is that it’s two different insurers, so the risk pool is separate. The 2nd insurer (Medigap) is basically saying “hey, you haven’t been paying into our plan all this time, so we can’t take you on now, with much higher expected payouts, without increasing your premium substantially”.
It’s not that different than Americans who elect NOT to get Medicare when they hit 65 (thus saving on premiums) then later on complain they have to pay a penalty when they decide they suddenly want it at 75.
I mean this seems like a “buyer beware” situation. When you’re selecting Medicare Advantage or traditional Medicare, plan for the long haul. Don’t just think about which one is better for you right now.
My parents are on a Medicare Advantage plan. They like it fine, but I wouldn’t do it to save a few bucks on the front end. They also recommended we get an ARM when we refinanced in 2021 (we didn’t obviously). Goddamn boomers.
The problem seems to be that the law that forbids insurance companies from considering pre-existing conditions doesn't apply to them.
Once you have a disqualifying health condition (and since Medicare is for the old and disabled, this is most people), you are stuck. If your Medigap provider raises their premiums above the rest of the market, you can’t switch to another one. If you miss a premium payment and get dropped by the plan, too bad, so sad, Medicare Advantage is your only practical option now.