Today I helped someone who's 90 year old mother is on a UHC Medicare retiree plan from a major corporation. How ironic. The mother is a patient in a rehab facility and receiving PT. UHC just denied providing more days in rehab because it's "not medically necessary" even though the primary care doctor said she should stay in the facility for another 90 days. Her offspring is jumping through hoops trying to appeal the UHC denial.
Why would a Medicare Advantage plan deny and make it difficult to get medical care? It's all about making money. The primary way Medicare Advantage plans make money is by "managing care". That's a clever way of saying they make sure the amount of care their policy holders receive in claim payouts does not exceed the amount of money allotted to provide medical services.
At the beginning of every year, Medicare gives Medicare Advantage plans a fixed amount of money to use for each policy holder. If the policy holder doesn't need much medical attention, then the Medicare Advantage plan gets to keep the money. If the policy holder gets very sick, the Medicare Advantage plan does everything it can to discourage the policy holder from continuing in the plan and/or carefully "manages" the policy holder's treatment. The plan could make the case to Medicare for getting more money for a very sick policy holder, but it's a lot easier to "manage" the treatment. Often, the plan become so ornery in that management, the policy holder decides to switch to original Medicare. Perhaps a deliberate strategy? Sick policy holders are not good for business.
Original, traditional Medicare is a federal government insurance pool. The federal government is not about making money, it's about providing healthcare. In fact, when analysis is done, the federal government is more cost effective at providing healthcare coverage than Medicare Advantage plans.
In the following analysis, Kaiser Foundation found people more often switch from Medicare Advantage to original Medicare than the other way around. It most often happens when people also have Medicaid. Then they don't have to worry about being able to buy a Medicare Supplement plan (aka medigap) to cover coinsurance and deductible costs. Medicaid does it. The rules for getting medigaps vary from state to state. Many states don't prevent insurance companies from denying or doing underwriting to significantly raise the premium of a medigap if someone switches from a Medicare Advantage plan to original Medicare. Do you know the rules in your state?
If you have original, traditional Medicare with a medigap, you have the best health insurance insurance money can buy. Isn't that the most important thing to have at this stage of our lives? Don't throw it away because IBM is telling you some BS about their UHC Medicare Advantage plans. Next thing you know, Joe Namath is going to appear on their brochures.
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