Will All Seniors Eventually Have No Choice but Medicare Advantage?— MedPAC chair discusses need to fix MA's confusing limitations, upcoding, and rising costs, by Cheryl Clark, Contributing Writer, MedPage Today January 25, 2024
Anyone already on Medicare with a Supplemental Plan (before MA plans, often called Medigap Plans) and thinking of switching to a Medicare Advantage Plan - or those about to sign-up for the first time should read this interview with Michael Chernew (*). They also should consider taking the additional time to go through the numerous replies, all from medical professionals, to get a perspective of MA plans from that point of view.
(*) Michael Chernew, PhD, chairs the influential Medicare Payment Advisory Commission (MedPAC), an independent 17-member panel appointed by the U.S. Comptroller General to advise Congress on Medicare policy.
I have kept my Part F Supplement and will never change unless Medicare forces me to. The subject in the question posed to Chernew that is reproduced below should, by itself, give anyone with even the possibility of a future serious or chronic medical condition ample reason to avoid MA plans. (It seems pretty obvious any MA "advantages" were not really designed to benefit patients.):
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"Clark: Let's shift to some of the unintended or perhaps unappreciated consequences of majority MA enrollment. Physicians at large academic hospitals that specialize in certain conditions or diseases are excluded from MA networks. Patients can't get a consult at the Mayo Clinic in Arizona and Florida, and they can't get cancer care at Sloan Kettering. I have friends who have had symptoms that doctors in their MA networks couldn't diagnose, but the expert was at UC San Diego. They had to fork over $900 for an out-of-network visit. What do we say to these centers when 70% or 80% of the Medicare population can't benefit from their expertise? I don't think many realize that when they enroll."
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Here is the link to the entire interview:
Will All Seniors Eventually Have No Choice but Medicare Advantage?— MedPAC chair discusses need to fix MA's confusing limitations, upcoding, and rising costs, by Cheryl Clark, Contributing Writer, MedPage Today January 25, 2024
Click on the "comments" box at the end of the article for pop-up access to them.
As noted by commenter, Brant_S_Mittler_MD_JD, Chernew is another example of the revolving doors between government regulators, x-political appointees, lifetime politicians, paid lobbyist, and the special interests they all now serve. As always, follow the money and you will discover who benefits the most.
Always Be S&W, Ciao - Capt'n cujoe
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Dog of Terror and Medicare Advantage Plan Knowledge,
I took standard Medicare for the reasons mentioned....not sure how it would go when I need Cleveland Clinic, and whether I could be treated without a hitch... pricey, but will continue for now...
I want to see the MD that I want to see....not a network that tells me only this group, or that individual... also, our regional MA plan will only allow treatment very locally... no more Cleveland Clinic...
Chernew seems to say that despite false advertising, limited choices, overbilling/aggressive coding, and questions on covering costs, that MA is the best choice... he can keep that nonsense...
Chernew can put it with the similar nonsense about not knowing if his dad was on a MA plan or not? Really? That is a bit like Tim Geithner (aka "Turbo Timmy") claiming that he didn't know he owed taxes on his overseas income when working for the IMF - even tho' his salary was negotiated to compensate for that??
As for consults/treatments in out-of-state medical facilities, you will likely have to pay up for that on the supplement portion. It's one of the curses of insurance plans being regulated at the state level. However, at least you will get to maintain you relationship with CC without having to pay 100% out of pocket.
However, the real medical Rubik's Cube is the separate Part D drug portion that you have to reevaluate every year, as premiums, deductibles, & drug formularies change yearly. (Even generics move around in the drug tiers plan-to-plan and year-to-year.) Add in the varying front-end deductibles, the cost in the coverage "donut hole" (not at all related to those savory ones you might get at Krispy Kreme or DD's), and finally the "catastrophic phase" that maxes out-of pocket cost at something around $12.5 K for 2024, and you have yourself a plan structure that could have only been devised by the drug & insurance special interests and approved by career-politicians in DC. Here is an excellent summary of the Medicare's Part D drug benefit for the current year:
Also, I give much credit to the dot-gov Medicare site as being very useful in comparing total yearly cost for various Part D plans, If you know what drugs you will be taking, you can input that info and select several plans and get total out-of-pocket comparisons; i.e., premiums + drug cost + deductibles for the entire year. Here is the link to that site, which is via zip code state & county-specific:
The only problem with that evaluation tool, is that you have to know in advance what meds you will be on for the entire year - and not many of us can be sure we know that. Also note that higher plan premiums are no guarantee of lower overall costs, esp. when on-patent drugs (usually tier 3 & 4 drugs) are involved. Abiraterone is a good case in point, and last time I checked, Mark Cuban's Cost Plus on-line service is probably a much cheaper way to obtain a year's supply than is any Part D Plan. (Every so often, one of the world's billionaires can surprise us by actually doing something to help their less-fortunate brothers & sisters.)
So, anyone taking Abi should price-compare with Cuban's Cost Plus, which has no subscription charge and minimal shipping charges, before using any government-provided/sponsored or private drug insurance. Cost Plus' drug cost search shows the retail price, the cost to manufacture, and your cost. A check today indicates the following pricing for a 90-day script of 250 mg *:
Retail = $3279.60
Mfg Cost = $73.80
Cost Plus = $90.50
* Curiously the costs for a 90-day script of Abi 500 mg tabs is MUCH higher that just taking 2 x 250 mg??; i.e., $522.50 vs $181.00 (~2 x $90.5)??
Last year I used ScriptCo on-line pharmacy and even after adding quarterly charges for the service, they still beat the total cost of using my Part D "place-holder" plan. (A "place-holder" plan is needed to avoid the Medicare yearly "penalty" for not using the program. That penalty also applies to Medicare itself, so caveat emptor when thinking of not signing up for either or not maintaining continuous coverage. I know first-hand, as I have a yearly surcharge fee added to my monthly Part D premium for not having signed up on year one.)
This year Wellcare is offering a zero-premium plan that includes the 3 generic drugs I am currently using. However, as dutasteride is a tier 2 drug in their formulary and finasteride a tier 1, I would have to switch to get all 3 at the $45 / quarter pricing - and avoid paying full price for dutasteride, since only tier 1 drugs are outside of the initial phase deductable. Assuming continual use of my current drugs (and even with the quarterly/yearly subscription charge at ScritpCo), the total price for the year will be less by using ScriptCo - regardless of a switch from dutasteride to finasteride.
I am already supplied with meds through the end of May and will cost-compare all the on-line pharmacy options for the rest of the year. BTW, my latest check indicated that with continuous use of my current scripted meds for the rest of 2024, Cost Plus might be even beat the costs via my zero-premium Part D Plan.
So, welcome to the Medicare Zoo, Don Pescado. Your "Dangerous" moniker will come in handy as you negotiate the Medicare Maze. I suggest you try to maintain a healthy measure of good humor, as the goal is to get to the best healthcare we need at the very time we need it most. Your personal insights into the inner-workings of our healthcare system should be very helpful in doing that.
Yes, original Medicare and Medigap are better. I have great confidence in the ER people of the bank (the largest bank you've never heard of) that provides my retiree health insurance and they have been of that opinion for at least the 25 years since I retired, refusing to support MA.
The entire insurance industry is pushing to end Medicare and one way to do that is get everyone on a Medicare advantage (MA) plan. Medicare advantage plans are NOT Medicare, there are private insurance plans issued by insurance companies. Once on an MA you are at the mercy of the insurance company. The company can change your policy whenever they want.
You can't turn on your TV without seeing ads for MA's. They make the policies sound great, dental, eye care, no premium. Once on an MA you can't switch to a supplement plan.
When the pool of members on supplement plans becomes too low to support, the government could end Medicare.
Magnus - !00% right on target. Anything out of DC right now is just election-year profiling. MA seems to me to have all the negatives of universal care without any of it's benefits. I guess we should just enjoy what we have while we still have it.
The advent of direct-to-consumer drug ads in the US was probably the sign that our health care system was doomed to go downhill from there. BTW, where the heck were the docs and the AMA when that legislation was proposed??
Magnus -- by some miracle, back in 2017 I was able to switch to Plan F supplemental from the MA plan I signed up for in 2016. Whew. Maybe I should shut up before they force me back on MA.
Not sure how I did it. I worked through the same broker who initially signed me up for the Medicare Advantage plan. Did I get in under the wire? I find all of this Medicare stuff confusing.
I started on the cheap-ass Medicare Advantage at age 65. When I was diagnosed at age 66 I switched to Medicare Supplemental Plan F and I thank my lucky stars that I did. Not so sure that I would be able to switch to that plan these days if I hadn't already done so. I had my younger wife start with Plan F when she reached Medicare age. She doesn't have cancer but has plenty of medical issues.
BTW, I used one of those Medicare brokers/advisors to help me navigate the Medicare choices and that worthless fool put me into a MA plan? I dealt with him again in switching to Plan F. I didn't know any better back then. I guess he has incentives to steer people into MA. And here I thought he was a swell guy.
Oh, and now I recall my experience with MA when first diagnosed with prostate cancer. My urologist couldn't get approval for a silly-ass eligard prescription. I had to get on the phone with the insurance company for hours to press for answers. WTF -- an ADT prescription couldn't be more SOC. What was the hang up? It was never explained but I had to deal with that delay of many weeks for something that should have been immediately approved. Yeah, add that stress to the stress of just having been diagnosed with cancer. Crazy.
PS: the edit function not working the same on this site? I had to reply again to myself before 'more V' (edit) would work ?????
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