Older Americans say they feel trapped in Medicare Advantage plans(text.npr.org)
text.npr.org
Older Americans say they feel trapped in Medicare Advantage plans
https://text.npr.org/1222561870
47 comments
Ah this old pre-existing condition scam.
It's a fundamental problem with insurance: if you don't control for continuous coverage, rational customers will free-ride by paying (in this case, for the more expensive coverage) only when they know they're going to use it.
That’s not the preexisting condition scam, that’s the rationale behind enrollment periods. The pre existing condition scam is where you can’t change your insurance because you’re a human being and therefore experience poor health at some point. The rationale for the scam is they don’t want to insure people known to need care, and by denying coverage to people who experience being human, they can improve their profits by eliminating humans requiring care from their premium pool.
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.
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.
The way insurance is supposed to work is by people pooling risk to mitigate rare or unexpected losses into predictable ones.
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.
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.
“Known” is the operative word. If you blind the insurer to risks and require them to accept everyone then the pool stays a random distribution. Allowing the insurer to cherry pick is the problem. Once you’ve blinded the insurer no one is doing the insane.
The whole idea of medical insurance is insane. It is OK for scheduled issues but not for covering shots to the moon.
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.
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.
That’s where regulation comes in. In my country it’s mandatory for every citizen to have a base insurance package and it’s mandatory for every insurance company to accept every individual for that same base package, regardless of preexisting conditions. The minimum contents of the base package are determined by the government, the prices and extras are up to the insurance companies to decide. Every calendar year people are allowed to switch to a different insurance company, or make changes to their add-on packages and options, forcing the companies to compete while being able to lock in their clients for a year for some predictiveness. In effect that means that everyone is insured against rare and expensive diseases, while still keeping it relatively affordable, because the pool also includes healthy individuals with extremely low risk profiles. Add-on packages don’t have to follow the same rules, but the base package makes sure that people won’t go into massive debt for being unlucky, which is in my opinion essential for a humane society, no matter how this problem is solved, whether it’s commercial like here, or public like elsewhere. If all is left to the market without regulation, those benefits are lost. Some people might call that freedom, but I disagree.
More directly, yours is a wealth redistribution scheme from parents to elderly non-parents to produce healthy young people at the bottom of the pyramid mostly at their own cost so they can turn around and subsidize people who never raised up this distribution mechanism. An interesting system that is collapsing in much of Europe due to the free rider effect. Why have kids when some other schmuck will foot the bill and the output will lower my insurance premium in what becomes effectively a regressive tax.
imtringued(2)
It's nowhere near as much of a problem when there can be a specific cause of loss with a well-defined date. I'd say the fundamental problem is that healthcare consumption doesn't really lend itself to being insurable due to this and a few other qualities. So as the government keeps pushing more nonsensical top-down policies trying to make healthcare fit into an inappropriate model, the market gets ever more distorted and the perverse incentives continue to grow.
But they had Medicare Advantage plans, they weren't free-riding.
They were, perhaps, deceived by the Medicare Advantage insurers.
They were, perhaps, deceived by the Medicare Advantage insurers.
We're talking about why preexisting conditions screens happen in underwriting Medigap.
Which doesn't explain why insurance companies are allowed to charge more for preexisting conditions in this situation, even though they aren't generally allowed to.
They are. Try to buy insurance outside of open enrollment without a qualifying life event; you can, but only from insurers who underwrite against preexisting conditions. That's for the same reason: because otherwise, people would just forego insurance until they needed it.
It’s also the reason for the coverage mandate (and penalty “tax”) under Obamacare.
(I’m sure you know that, but replying here because it makes the thread cleaner)
(I’m sure you know that, but replying here because it makes the thread cleaner)
Wouldn't that be the rational approach? Otherwise, insurance is still a tax on young and fit to finance the medical treatment of the old and unfit. At which point it's socialism but less efficient.
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.
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.
You're spot on, but it's even worse than that - since these pools are administered/owned by private companies, their incentive is to collect money from people while they're young and healthy, only to push them out once they're no longer young and healthy!
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.
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.
At the youngest adult ages that contribute most to premium reductions productivity is largely a function of investment of the parent, so it may be even more dire than you phrase it. Its effectively a transfer of wealth of investment from parents who have just spent 18 years producing a taxpayer to unhealthy non-parents who comparatively took little of the risk and cost but equally gobble up gains to the risk pool. Another words, it is a regressive tax that rewards goading others into taking on parental responsibilities while taking on none yourself.
The issue isn’t Medicare Advantage, it’s Medigap regulations. If a person can demonstrate continuous coverage, there’s no reason that they shouldn’t qualify (I mean, ideally, obviously they aren’t in reality).
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.
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.
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Aren't these the same older Americans who keep voting for people who promise to abolish any attempts at improving the American healthcare debacle?
A significant number, yes. Because "socialism".
I mean look at beaglebeaches. He seems more concerned with the hypothetical fairness or unfairness of "redistribution" rather than whether he will get effective care for a reasonable price.
I go to the wild West of Mexico when I need healthcare. Because it is basically unregulated, I don't need to use my shitty health insurance, and because private doctors are available I'm not subject to whims from goons from the state.
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.
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.
You absolutely can pay cash for medical services in the US, it's referred to as paying out of pocket.
Sure but the regulatory barriers are so high it's not fiscally practical for a normal person. I can walk into a pharmacy in Mexico and buy a Z-pak for strep; even for a poor Mexican that's easily obtainable all without insurance or state care.
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.
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.
I'm not sure what you mean by high regulatory barriers. I make an appointment, the very next question is "do you have insurance?" When the answer is no they inform me what it will cost, I pay with a credit card at thet time services are rendered and thats all there is to it.
Whats regs got to do with it?
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What are the difference between the regulatory barriers in mexico and the us that result in such a large difference of out of pocket cost?
That's cool. Where in Mexico?
Medicare Advantage plans have to provide at least a government defined baseline of service, but they can jiggle things around to offer better coverage for some things (like lower copay on medicine for chronic conditions) at the expense of others (doctors in network).
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.
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.
This doesn’t seem like a “Medicare Advantage” problem. It seems like these folks didn’t want to pay the 20% co-insurance for government Medicare and now don’t like the trade off they made.
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.
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 medical underwriting on Medigap plans also affects people who have the foresight to choose Original Medicare with Medigap.
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.
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.
They want to switch from Medicare Advantage to Medigap plans, which also cover the 20% co-insurance.
The problem seems to be that the law that forbids insurance companies from considering pre-existing conditions doesn't apply to them.
The problem seems to be that the law that forbids insurance companies from considering pre-existing conditions doesn't apply to them.
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.