Tag Archives: Medicare Advantage

[unable to retrieve full-text content]There are changes coming to the Medicare market place and Medicare Advantage. “Market exits by Humana, Aetna, and UnitedHealthcare will collectively affect nearly 70% of those 1.8 million individuals.” The remainder of the 1.8 million will be looking at new plans with the same insurance provider. The market exit may be faced with new companies […] The post Heathcare Insurance Companies Abandoning Medicare Advantage appeared first on...

Decoding Medicare Advantage by Andrew Sprung xpostfactoid Can STAT’s exposure of UHC’s exhortations to goose Medicare Advantage enrollees’ risk scores spur action to reduce MA overpayment? Load these Codes It is beyond reasonable doubt that the federal government’s payments to Medicare Advantage plans are grossly inflated by the plans’ gaming of the program’s risk adjustment system, designed to deter plans from cherry-picking health...

by Matthew Cunnigham – Cook The problems with Medicare Advantage is coding and pricing for care. And Fee for Service participants pay for the MA costs even though they do not use MA. “When accounting for favorable selection of enrollees in MA and higher MA coding intensity, we estimate Medicare spends approximately 22 percent more for MA enrollees. This spend is more than if those beneficiaries were a part of FFS Medicare. The difference...

Pretty much a rewrite to provide simpler reading and a better understanding for readers. My rewrite did not make it much shorter. It is taken from a recent 2025 Health Affairs article. The main thrust of this article being commercial Medicare Advantage insurance companies taking advantage of government payments for healthcare to Medicare patients. The other part being CMS doing more to resolve the issues. MA Coding for patients is set the year before...

Don Berwick says MA growth “should be slowed or stopped” Obama CMS Chief Don Berwick: Medicare Advantage Plans Game the System, MedPage Today, Cheryl Clark Ok, this is a long one. It is easy to follow. Donald Berwick is worthwhile read. As written several times on Angry Bear, the biggest driver of healthcare cost is “pricing” increases as reflected in hospitals, pharmaceuticals, and healthcare insurance. It was Dr. Donald Berwick while...

It never ends as commercial interests keep trying to horn in on healthcare for the old geezers like myself. Except, it is not person related healthcare. It is related to the size of your wallet. More on Medicare Advantage by Jake Johnson at Common Dreams. ~~~~~~~~ A right-wing coalition’s proposal to make Medicare Advantage the default enrollment option would be a “clear handout to the private insurance industry,” said one critic. ‘Hell No’:...

Ran across two articles on conservatives, a presidential candidate, and the US Gov. pushing people towards Medicare Advantage plans. I thought I could combine both articles on one post using snippets of information from each. It was too exhausting to do so. I will keep them separate and write each independent of the other. Since I have been writing on healthcare for a while, I typically add my own comments as taken from other sources. This...

Once again, there are efforts made to the US Senate urging Senators to support Medicare Advantage plans. The facts against Medicare Advantage for seniors have been stated over and over again by Kip Sullivan, myself, and others as well. PNHP President has authored a counter letter to the Senate explaining some of the issues and problems with Medicate Advantage. Many of which come to bear once the enrollee is a part of the Advantage programs....

After doing some quick scanning of articles on the topic of Medicare Advantage plan disenrollment, I found many leave Medicare Advantage because of complex healthcare conditions. Either a change in health leading to such or an inability to get the care they need. Medicare Advantage plans notoriously deny care as a method to delay care and gain greater profitability. There is more to my explanation than what I have said. Medicare Advantage...

Industry has been talking about AI (Artificial Intelligence) for a while now. And of course, industry has been looking to reduce the amount of labor input with AI. Having used computerized systems such as MRPII, ERP, etc., I have always followed the wisdom of people such as Oliver Wight and George Plossl. The system is as accurate as the input to it. Which means, you have to check your work. A system can also be used to intentionally mislead in its...