IBM Medicare Advantage 2023 Fortune article: Corporate MA plans less regulated than market MA plans

 There is a lot in this article that I didn't know and it made me wince because there is less government oversight for corporate sponsored Medicare Advantage plans than the plans available for purchase in the open market.  It is yet, another reason to be very wary of  IBM's forced march to use their plans:

https://fortune.com/2022/03/02/employers-medicare-advantage-health-insurance-retirees/

Updated 11/2/2022:

Even when there is government oversight for Medicare Advantage plans, they still try to make money any way they can:

https://www.medicarerights.org/medicare-watch/2022/04/28/government-watchdog-reports-medicare-advantage-denying-or-delaying-medically-necessary-care

Updated again on 11/6/2022:

Finally, some congressional representatives, like Ron Wyden, are demanding more oversight of insurance companies selling Medicare Advantage plans. 

Unfortunately, there is NO oversight for Corporate Sponsored Medicare Advantage plans. Corporate Sponsored MA plans can promise you trips to the moon (which is equivalent to guaranteeing access to any Medicare doctor anywhere in the country) in the literature they mail to you because it isn't "marketing material".  These plans are not for sale in the general marketplace so they can say "yes we cover it" to any question you ask!  Don't believe anything unless they agree to write it in the policy they issue to you.  Then you have a better chance of overturning a denial (and they will deny), by pointing to your policy.

The LA Times has a nice summary of the newest congressional assessment of how vile insurance companies are in their marketing practices for Medicare Advantage plans and there is a link to the congressional report in the article:

https://www.latimes.com/world-nation/story/2022-11-06/medicare-enrollees-warned-about-deceptive-marketing-schemes

Updated 11/16/2022:  Newsweek opinion piece that is scathing about Medicare Advantage plans:

https://www.newsweek.com/how-medicare-advantage-scams-seniors-opinion-1759368

I heard another tragic Medicare Advantage story this past week.  The details are not worth writing about.  The denial of payment for a post treatment expense is about $90,000. They are telling the policy holder to pay that amount of money to a hospital because there wasn't a "pre-authorization" granted for the treatment.  That says it all.  How is that even possible? It's a Medicare Advantage Plan!

IBM Medicare Advantage 2023 - NYC retirees story: they are trying to stop it!

Updated 12/03/2022 

NYC tried and failed to push city their retirees into Medicare Advantages plans.  It took a lot of organizing and a law suit, but they did it!  Here's a history of the situation.  The third link is the latest update.  NYC lost an appeal November 2022. The fourth link is a new law suit to stop NYC from requiring copayments:

https://www.thecity.nyc/2022/3/3/22960355/retired-nyc-workers-medicare-switch-court-win 

https://www.thecity.nyc/2022/7/19/23270753/health-insurers-kill-medicare-plan-change-city-job-retirees

https://www.nydailynews.com/news/politics/new-york-elections-government/ny-nyc-medicare-advantage-appeal-retired-municipal-workers-20221122-6qfqcwtfezbyvads4jvhbvfc44-story.html

https://nypost.com/2022/11/29/nyc-retirees-sue-adams-administration-for-55m-over-15-health-care-copays/

I don't know if this will make a bit of difference, but there is a campaign on change.org organized by an IBM retiree who is trying to fight the change:

https://www.change.org/p/stop-ibm-from-selling-our-pensions-forcing-retirees-to-select-only-ibm-benefit-plans

Updated 3/23/2023

NYC unions and government continue to battle with retirees over the switch to Medicare Advantage.  The retirees keep fighting back.  This Brian Lehrer program on WNYC was broadcast today about the fight.  It's really sad.  Even with an ironclad contract, retirees have to fight like hell to try to stop the transition to Medicare Advantage.  This is the broadcast:

https://www.wnyc.org/story/the-brian-lehrer-show-2023-03-23

IBM Pension Transfer 2023 GET YOUR RECORDS NOW!

 For all of us, but particularly for people who are being moved to Prudential/MetLife annuities, be sure to get the information about your pension that is stored in www.netbenefits.com just in case something goes wrong or the information gets lost.  I just downloaded the following documents:

Pension Summary

Pension beneficiary

Post Employment Plan Book for 2021

Group Life Insurance (Death Benefit) document

IBM Medicare Advantage 2023 How Insurance Companies Suck Billions Out of Medicare

This morning on the front page of the New York Times there is an in depth article by Reed Abelson about how insurances companies manipulate Medicare insurance claims to get BILLIONS of dollars from Medicare.  This is not new news.  It is a topic that has been ranted about by various media publications for YEARS. Nothing will likely change as a result of this report, but it will help you understand why I rant about these plans.  If you have a subscription to NYT here is a link to the article:

https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html?smid=nytcore-ios-share&referringSource=articleShare

For people who don't have a NYT subscription, it describes how companies like United HealthCare and Anthem do everything they can to upgrade Medicare claim codes so that they can improve the payout they get from Medicare for a policy holder by presenting the policy holder as being sicker than they really are. Medicare will then provide additional funding over and above the initial allotment to the insurance company because the claims indicate the policy holder is really sick. 

It might or might not affect the money the doctor charges the policy holders unless the procedure (such as a chemo treatment) requires a policy holder to pay "coinsurance". Then, the doctor also gets more money from the policy holder. Coinsurance is when the policy holder pays a percentage of the fee for service instead of a "fixed amount" for the treatment.  

Example, people will say they have a copay of $30 when they go to see a specialist.  It doesn't matter how long it takes to see the specialist.  It can be a 5 minute office visit or a 15 minute visit, the copay is still $30. However, if the policy holder has a coinsurance procedure that is "upgraded" in terms of the complexity of the treatment, it will increase the coinsurance payment for the policy holder.  Example again, the doctor visit includes a biopsy which the doctor upgrades from being a simple lab test to a more complex, but unnecessary lab test. The policy holder coinsurance will then also be higher. It's why providers are sometimes complicit in the claim code scheme.

While this exploitation is disgusting and, per the article, sucking billions of dollars out of Medicare funds, it does not address the  impact on the policy holder per the coinsurance problem. Nor does it go into the other favorite way Medicare Advantage plans make money.  That's by sucking money out of the policy holders via denials of claims. The way they suck money out of the policy holder is more subtle.  If the policy holder pays the doctor bill when the claim is denied, then the Medicare Advantage plan doesn't have to pay the doctor. They will keep more of the allotment of money provided by the government at the beginning of the year to cover claims for the policy holder. As I have said in the past, 50% of denials are overturned if the policy holder appeals. Sadly, appealing is complicated and often people don't have the mental capacity to appeal.  Insurance companies know this and exploit it.

Again, all of this has been an issue for years.  Complain, complain, complain to your congressional representatives about how their inaction is hurting all of us.  This issue is political party agnostic.  They all get huge donations from these insurance companies and don't do anything because they don't want to lose that money.

Added on 10/10/2022:  

In 2018 PBS did a wonderful documentary on how Medicare Advantage plans suck money out of Medicare.  I wrote about it at the time, but am including it in this post in case it was missed:

PBS documentary about how companies that offer Medicare Advantage plans have been pushing doctors in their networks to use more serious diagnosis codes so the insurance companies can increase the amount reimbursement they get from the federal government.  Companies like United Healthcare are now being sued by the government for BILLIONS of dollars in over-payment of claims.  Here is a link to the program:  https://www.pbs.org/video/medicare-advantage-taking-advantage-aldeae/

Added on 2/27/23:

Kaiser Foundation published a article detailing changes the current administration is trying to make to reign in money given to Medicare Advantage plans to pay policy holder claims.  It is very technical, and also worded carefully so as to not alienate the insurance industry, perhaps because the Kaiser Foundation is funded by a Kaiser endowment fund.  They also get grants from state governments, the very same governments that have been systematically pushing their state retirees onto Medicare Advantage plans. In any case, we all need to try to understand how our tax dollars are spend on Medicare Advantage plans. The way I see it,  Medicare Advantage plans should have never been allowed to exist because all they do is suck money out of Medicare trust funds any way they can.. 

https://www.kff.org/policy-watch/is-the-biden-administration-proposing-cuts-to-medicare-advantage/

This analysis from Action Now, a non-partisan foundation, also did a nice job explaining how CMS is trying to rein in the excesses of Medicare Advantage sucking money out of Medicare trust funds:

https://actionnowinitiative.org/medicare-advantage/

Updated 3/28/2023

This is a detailed description of how Medicare Advantage companies suck money out of the federal Medicare program.  It is sooooooo complicated.  I did not understand much of it but maybe you will.  Why does the federal government allow it?  MA is killing Medicare:

https://www.healthaffairs.org/content/forefront/born-third-base-medicare-advantage-thrives-subsidies-not-better-care

IBM Medicare Advantage Brochure Assessment & another sad story

 The brochure arrived yesterday.  I have two comments on it.  

They say you can "go back" to Original Medicare with a Medicare Supplement plan if you decide you don't like the United HealthCare plan. There is a footnote to that statement that refers you to www.medicare.gov to look at "guarantee issue".  First off, going back to Original Medicare isn't at your whim. That is usually possible to do once a year, during Medicare Fall Open Enrollment (Oct 15- Dec 7th), or if you move to a new state.  The bigger issue is rebuying the Medicare Supplement plan. Depending on what state you live in, you might not be able to rebuy the Medicare Supplement plan. That's what "guarantee issue" means.  Some states allow you to reenroll in a Medicare Supplement plan without underwriting or age rated adjustments.  Most states leave it up to the insurance company to decide if they even want to sell you a policy and, if they do, at whatever price they want. There is no cap on out of pocket cost if you use Original Medicare without a Medicare Supplement plan so, unless you also have Medicaid, you need a Medicare Supplement plan.  

My second comment is there is nothing in the brochure about how often United HealthCare denies claims if you have already received treatment, or requires pre-approval before you can be treated.  That information is available from Kaiser foundation and it is not good.  I have written over and over again about the nightmare of pre-procedure and post-treatment denials.  They say wonderful things in the brochure like they will provide unlimited "Skilled Nursing Facility" days for rehabilitation. What they don't say is the probability of receiving unlimited SNF days is slim to none.  They typically deny more SNF coverage after about 10 days (that's the pattern I have seen) and say it's because more treatment is not medically necessary. Then you are in the cycle of needing to appeal.

Another sad story from this past week about a Medicare Advantage plan. A man, in his nineties, went to the ER because he was having significant heart problems.  The ER doctor immediately admitted him to the hospital.  The staff cardiologist monitored him for several days and stabilized him.  When he got the first denial of payment for treatment from his Medicare Advantage plan, they not only denied the hospital treatment as not being medically necessary, they said the provider was out of network. The man was looking at a bill of about $11,000. He didn't focus on the denial of treatment, he focused on the out of network statement.  He called the Medicare Advantage plan and they said they had made a mistake and the hospital treatment was in-network.  They adjusted the claim amount to $6,000 and then denied the claim, again, saying it was not medically necessary. When treatment is denied, the policy holder is responsible for the full amount of the treatment and it does not count toward the MA plan deductible.  The man now has 60 days to appeal.  It must be a written appeal. He needs to get a letter from his provider to attest to the fact that the treatment was medically necessary.  Needless to say, he was totally overwhelmed with what he has to do to fight to get the MA plan to pay the claim while struggling with his medical problems.  Having to battle with a behemoth  insurance organization is the last thing in the world he needs to worry about. This reporting by Axios is about Medicare Advantage denials.

  https://www.axios.com/2022/04/29/medicare-advantage-debate-rekindled-by-report-on-coverage-denials