Not only are MA plans under multiple investigations over concerns they are overpaid by Medicare, but then there is this as well. Choice in health care never works well and is never fair to everyone.
Keep in mind that the Trump administration would like to make Medicare Advantage the default enrollment for Medicare as part of a strategy to privatize the program. That is a very bad strategy.
Patricia Greene had spent a month recovering from a devastating stroke when her Medicare Advantage insurer, a unit of UnitedHealth Group, decided to stop paying for her nursing home.
The 85-year-old was so weak and fragile, her son said, that she couldn’t even get herself out of bed. Her family felt she wasn’t ready to leave the facility in New York City’s Queens borough.
So she dropped her UnitedHealth coverage and enrolled in the traditional version of Medicare run directly by the federal government.
That decision saved UnitedHealth tens of thousands of dollars in the months that followed, billing records show, and shifted onto taxpayers the cost of later hospital and nursing home care in what turned out to be the final months of her life.
A Wall Street Journal analysis of Medicare data found a pattern of Medicare Advantage’s sickest patients dropping their privately run coverage just as their health needs soared. Many, like Greene, made the switch after running into problems getting their care covered…
As recipients get sicker, though, they may have more difficulty accessing services than people with traditional Medicare. That’s because the insurers actively manage the care, including requiring patients to get approval for certain services and limiting which hospitals and doctors patients can use.
Source: The Sickest Patients Are Fleeing Private Medicare Plans—Costing Taxpayers Billions, The Wall Street Journal, 11/12/24 By Anna Wilde Mathews, Christopher Weaver and Tom McGinty
QUINNSCOMMENTARY 
Last I heard, the premium paid to Medicare Advantage is risk adjusted – so, any selection issues are, at most, short term in nature. The reality is that Medicare issues tens of billions of dollars in claims payments that should not have been paid. You prefer that status quo?
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The fact is several investigations show games are paid with risk adjustment and MA are overpaid. How can they provide the services claimed, charge no premium I’m many cases and still make a profit? They are either over paid and/or withhold coverage for services through excessive managing care.
No doubt Medicare makes erroneous payments and takes too long to catch fraud.
Not the status quo, but eliminate MA and enhance Medicare claim management.
The Trump administration wants the other direction toward privatization starting with make MA the default option for a Medicare.
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Sorry, traditional Medicare claims administration is done by many of the same insurance organizations as those who sell Medicare Advantage, and commercial health coverage.
The problem is simply that the insurance companies hands are tied when it comes to traditional Medicare. Why go back to a system with tens of billions a year of fraud – a system that will definitely be impacted by political considerations? You say reform medical claims management, but, there is no chance Congress will approve something like that.
Health Reform (Essential Health Benefits) is a great example – states are ever increasing mandates so as to make health coverage ever more expensive, instead of searching for a more effective solution.
Consolidate to a single system and nothing will be excluded and government will use that one single system to buy votes. Think otherwise? Look at the Inflation Reduction Act. Look at the Medicare Modernization Act.
Take away competitor plans to traditional Medicare and that will worsen, not improve, medical coverage. You think something created in the 1960’s makes a lot of sense today, that the last 60+ years haven’t changed medicine? Why go back?
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Then just continue as we are with no complaints about coverage, cost, managed care. Its seems the US is unique among developed nations.
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“… Then just continue as we are with no complaints about coverage, cost, managed care. Its seems the US is unique among developed nations. …”
The solution is not the status quo – that’s the crap that has dramatically worsened our deficits and national debt.
And, the solution is not single payer. Even Vermont tried (with the Obama Administration’s full support) and failed to pull that off – because the cost to fulfill everyone’s desires would have more than doubled Vermont’s state budget.
https://www.vox.com/2014/12/22/7427117/single-payer-vermont-shumlin
There are solutions, even solutions permitted within PPACA – we surely don’t need England where the national health service performance prompts millions to secure private insurance.
Keep in mind that the only reason Medicare “succeeds” is because one in five covered individuals is also covered under Medicaid, and, because Medicare consistently shifts the true cost of services to people whose medical coverage is not subject to government price fixing. Rand confirms, over and over, that employer-sponsored plans pay, on average, 250+% more than Medicare allows, for the exact same services, from the exact same providers, on the exact same day in the exact same facilities.
If everyone is covered in a single payer system, who will they shift the costs to next – the French, or, like the cost to build the border, the Mexicans?
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How is it costing taxpayers billions when the patient is eligible for Medicare anyway. MA or plain Medicare would have been responsible and the only cost in question would have been the premiums MA gets for running their end.
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