KeskusteluPro and Con

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Muokkaaja: lokakuu 8, 2022, 11:20 am

All kinds of mail and TV commercials attempt to lure people off traditional Medicare to private/HMO/ Advantage medicare...8 of 10 of the largest have been accused of fraud. BTW "upcoding" is a good word to keep in mind if ever your MD bills you for a service that is inflated from what you received--it has a lot of legal oomph!

Mark Miller @RetireRevised | 8:29 AM · Oct 8, 2022:
Retirement columnist for @ReutersMoney, @Morningstarinc & @wealth_mgmt. ...

The @nytimes just dropped a major investigation on how Medicare Advantage insurance companies inflate profits by billions of dollars through upcoding of patient illnesses.

‘The Cash Monster Was Insatiable’: How Insurers Exploited Medicare for Billions
By next year, half of Medicare beneficiaries will have a private Medicare Advantage plan. Most {8 of 10} large insurers in the program have been accused in court of fraud.
Reed Abelson and Margot Sanger-Katz | Oct. 8, 2022

UnitedHealth Group -- 27.1% of market
Humana -- 17.4%
CVS Health -- 10.7%
Elevance Health -- 6.5%
Kaiser Permanente -- 6.1%
Centene -- 5.0%
Blue Cross Blue Shield of Mich. -- 2.2%
Cigna -- 1.9%
Highmark -- 1.3%
Scan Group -- 0.9%

...Medicare Advantage, a private-sector alternative to traditional Medicare, was designed by Congress two decades ago to encourage health insurers to find innovative ways to provide better care at lower cost...

The government pays Medicare Advantage insurers a set amount for each person who enrolls, with higher rates for sicker patients. And the insurers, among the largest and most prosperous American companies, have developed elaborate systems to make their patients appear as sick as possible, often without providing additional treatment, according to the lawsuits.

As a result, a program devised to help lower health care spending has instead become substantially more costly than the traditional government program it was meant to improve.

...inflated bills...efforts to overdiagnose their customers crossed the line into fraud....

huhtikuu 3, 10:35 am

Vincent Rajkumar @VincentRK | 4:39 PM · Apr 2, 2023
Editor-in-Chief, Blood Cancer Journal; Giants of Cancer Care Award; Professor, Mayo Clinic {A BIG proponent of affordable drugs}

Thanks to the Inflation Reduction Act, 2 big changes coming up for Medicare Part D beneficiaries.

1) Starting 2024, once you pay ~$3250 out of pocket, you won’t have any more copays. The 5% copay you currently pay will go away. This is HUGE.

2) Starting 2025, your annual copay max will be capped at $2000 for Medicare Part D.

Once you spend that much out of pocket, you won’t have any more copays for Part D prescription drugs.

Patients with cancer spend huge amounts in copays currently. The drug Revlimid I prescribe costs $17,000 for 21 day supply.

5% of $17,000 every month is a massive amount of money for most.

Revlimid is not unique. EVERY new cancer drug is expensive and will be expensive for the 10 plus years of patent life.

So these changes will be a huge benefit for patients....

elokuu 29, 5:50 pm

Joe Biden @JoeBiden | 3:51 PM · Aug 29, 2023:
Medicare can now negotiate lower costs for these prescription drugs thanks to my Inflation Reduction Act:


Every single Republican in Congress voted against this.

Biden administration names 10 prescription drugs for first-ever Medicare price negotiations
"Today is the start of a new deal for patients," Biden said at the White House.
Alexandra Hutzler | August 29, 2023,