Talk:Medicare Advantage

Excessive External Links

Is anyone looking into it? I believe one step towards reducing the amount of external link would be to only link to main sites and not to individual pages across said sites. For example, there are several links to pages on medicare.gov, but the link to the main page would be sufficient. Puceron (talk) 06:19, 14 November 2008 (UTC)

I agree that there are too many links to government websites, but the others are a valuable resource to Medicare Advantage participants and potential participants, such as those just reaching 65. --DThomsen8 (talk) 14:49, 22 September 2009 (UTC)

Criticism Section

This article should talk about how Medicare Advantage is less efficient than Medicare because of administration overhead.

(above comment unsigned)

I agree entirely. This article is all rosewater. Recent debates in the health care reform process have shown how the 1997 Medicare Advantage deal in Congress simply followed the disastrous "privatization/deregulation" zeitgeist of recent decades (the same thinking that brought us the current Great Recession). The insurance lobby got Congress to cut private insurers a fat slice of our perfectly-serviceable Medicare system, letting them run up the administration overhead referred to above while simultaneously slashing the number of doctors willing to accept MA patients. This Wiki piece ought to be able to provide balance without bias. Presently, as another user has remarked, it reads like a PR release from Kaiser. At least check [1] TravChar (talk) 18:40, 5 December 2009 (UTC)

One source?

All the footnoted sources for this article are from one entity, Kaiser, and, as such, would seem to be inappropriately biased in its point of view, potentially differing very little from a Kaiser promotional ad.

There needs to be more balanced sourcing and analysis of the relative strengths and weaknesses of Medicare and its Advantage alternatives.cetaylor 08:16, 21 August 2009 (UTC)

More information is needed, and from more than one source. For example, some Medicare Advantage plans are offered through employers or former employers, reducing the premium costs for participants. --DThomsen8 (talk) 14:46, 22 September 2009 (UTC)

I think you're mistaking the Kaiser Family Foundation for Kaiser Permanente, which is the Health Maintenance Organization (HMO). These are two entirely separate organizations. The Kaiser Family Foundation is is well-respected, non-profit think tank and health advocacy organization EastTN (talk) 21:06, 14 December 2009 (UTC)

It's still only a single source, and the article is still one-sided by not mentioning the known flaws of Medicare Advantage. 75.76.213.106 (talk) 01:23, 22 December 2009 (UTC)

Medicare Advantage experts from the Kaiser Family Foundation updated this article in March 2015 and pulled on a variety of sources, including the work of the Foundation which is a nonprofit, nonpartisan, trusted source of facts, data and analysis on health policy issues that inform all sides of debates and discussions. --Robin Sidel, Kaiser Family Foundation 14:52, 18 March 2015 (UTC) — Preceding unsigned comment added by Rsidel (talk • contribs)

An update by KFF is better than an update by some other organizations I could think of, and KFF is a useful source of information. But I would not accept your claim that it is a source of all sides of the debate. For example, I searched the kff.org site for "Krugman", and found nothing. I searched for "single payer", and found very little. In fact, I found a KFF article dismissing single payer http://kff.org/health-reform/perspective/pulling-it-together-on-health-reform-will/ (without bothering to quote any of the demonstrators who were hoping to get your attention). You are entitled to invite the National Federation of Independent Business (which I think is pretty far right) and not Physicians for a National Health Program to your briefings, but if you do you can no longer truthfully say that you inform "all sides" of debates. You should correctly say that you inform mainstream sides of the debate.

As for Krugman, this entry is indeed missing an important balancing of the strengths and weaknesses of Medicare Advantage. The best accessible source I can think of is Paul Krugman's column in the New York Times. He is after all a Nobel laureate in economics, a tenured professor at Princeton, and one of the most popular columnists in the New York Times, and irrefutably a WP:RS. One of Krugman's significant contributions to the debate is to critique the conservative claims that Medicare Advantage, because it is privatized, will be more efficient and cheaper than government-run Medicare. If the free market is so much more efficient, Krugman argued, why did Medicare Advantage have to get 15% more than government-run Medicare? If anybody wants to follow this up, I suggest you start by searching the New York Times for "Krugman" AND "Medicare Advantage". Another place to look would be Elisabeth Rosenthal's series on health care in the New York Times. --Nbauman (talk) 01:17, 20 March 2015 (UTC)

Effects of the health care reform

This section refers to "Trustees" but nowhere in the article is it made clear who/what a Trustee is. 142.254.54.221 (talk) 10:49, 15 February 2017 (UTC)

2017 Medicare Advantage Enrollment Numbers Incorrect

According to the actual source behind footnote #4, the "8 million members" only refer to Humana members of both Medicare Advantage and Medicare Part D plans, not Medicare Advantage plan enrollees nationwide.

The parts in question:

Speaking to shareholders gathered at Humana's downtown Louisville headquarters, Broussard emphasized that Humana Inc. (NYSE: HUM) would focus on "quality membership growth" in Humana's Medicare Advantage and Medicare Part D plans. Medicare Advantage is [...]. Medicare Part D is [...]. Humana provides these privately administered Medicare plans to over 8 million members, according to a recent filing with the U.S. Securities and Exchange Commission.

Someone will probably have to review at least the other figure citations in this sentence to make sure similar errors don't exist (a quick glance at the 2015 numbers and they already seem wrong, the cited article was written in May 2014). On an unrelated note, the sentence itself doesn't really fit in with the rest of the paragraph or the paragraph immediately preceding it, both of which focus on the Medicare Advantage enrollment process and not the numbers themselves. --Dypsonian (talk) 07:22, 7 July 2017 (UTC)

References

Overall percentages; ordinary doctor visits

I came to this page, and read the whole thing, hoping to find out what percentage of current Medicare recipients are on Medicare Advantage vs. traditional Medicare. Although there are one or two absolute numbers ("x millions"), this is meaningless to me; nowhere did I find a percentage, and I'll have to look elsewhere.

On a more minor note, early in the article I saw this sentence, about core/traditional Medicare: "Part B provides payments to physicians and surgeons in hospitals and skilled nursing facilities, as well as for medically necessary outpatient hospital services such as ER, laboratory, X-rays and diagnostic tests, certain preventative medical services, and certain durable medical equipment and supplies."

I think this is a little misleading as it seems to leave out ordinary doctor-office visits, not in the "preventative services" category -- for example, you get the flu and you go to your doctor's office. It's not "outpatient hospital services" but it seems to me (as a classic Medicare recipient) to be covered. I'm not absolutely sure so I didn't edit the sentence -- my doctor's office happens to be in the "outpatient" building of a hospital complex, so maybe that's why it's covered for me? But I suspect that Part B covers that for everyone and so "ordinary doctor visits" or something like that should be added to the sentence.

External links modified (January 2018)

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Large Sept 30 edits hard to review

Dennisbyron (talk · contribs), I'm inclined to revert a couple of these large September 30 edits since they move so much around that it's hard to evaluate. Also, in this edit I noticed that you deleted various stuff without explaining why, including the sections on utilization management, appeals (which I added), stars in rating systems, and competition. These are all important areas that need to be discussed, not just removed. Please ping me when you respond. Ideally you should re-add a bunch of the stuff you deleted. If you do not respond, I may go ahead and revert your changes per WP:BRD. Also, I was thinking about adding more about how payments are calculated using How Medicare Advantage Plans Are Paid: The Devils–and the Insights–Are in the Details but since this article is in flux I will hold off. II | (t - c) 04:40, 14 October 2019 (UTC)

Deleted large portion of entry--no references

I deleted the Program Structure section because it contained no references and lacked neutrality: 1 It was 1800+ words with no references or sources cited. 2. It presented a completely inaccurate information about the role of private organizations in administer Medicare and Medicare Advantage. It served as an opinion piece promoting the of the Medicare Advantage program rather than a neutral informative explanation of it.

I deleted all of the Usage section below the description of current enrollment figures that were supported with cited sources. Deleted all non-referenced comments about usage for lack of citation and lack of neutrality. That section was speculative and opinion-based, addressing potential future enrollment in Medicare and Medicare Advantage programs rather than presenting neutral information about known or past usage statistics.

I deleted the entire History section because it was no supported by references other than two minor, narrow citations. One citation was an outdated, incomplete reference that addressed a disputed matter about financing statistics rather than the History of the program.

Genwicky (talk) 02:43, 13 November 2021 (UTC)

I had Medicare complete and now I have Medicare advantage will somebody please tell me what is going on

I had Medicare complete and now I have Medicare advantage will somebody please tell me what is going on 2601:581:4602:2DF0:B50B:9EC:C948:A93A (talk) 19:28, 23 June 2022 (UTC)

New York Times story

This article in the NYT focuses on overbilling, but gives a good background on Medicare Advantage. Note that CMS had no way to systematically look for fraud; these were Justice Department suits in response to whistleblower complaints for which the whistleblower gets a reward.

https://www.nytimes.com/2022/10/08/upshot/medicare-advantage-fraud-allegations.html

‘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 large insurers in the program have been accused in court of fraud.

By Reed Abelson and Margot Sanger-Katz

New York Times

Oct. 8, 2022

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....

The popularity of Medicare Advantage plans has helped them avoid legislative reforms. The plans have become popular in urban areas, and have been increasingly embraced by Democrats as well as Republicans...

“You have a powerful insurance lobby, and their lobbyists have built strong support for this in Congress,” said Representative Lloyd Doggett, a Texas Democrat who chairs the House Ways and Means Health subcommittee.

Some critics say the lack of oversight has encouraged the industry to compete over who can most effectively game the system rather than who can provide the best care.

“Even when they’re playing the game legally, we are lining the pockets of very wealthy corporations that are not improving patient care,” said Dr. Donald Berwick, a C.M.S. administrator under the Obama administration, who recently published a series of blog posts on the industry.

Nbauman (talk) 15:46, 8 October 2022 (UTC)

STAT article

Here's an article in STAT, one of the more independent and critical news sources on the health industry. It's behind a paywall, but it is a WP:RS which makes the argument that Medicare Advantage (1) is a drain on Medicare's trust fund and (2) is not saving taxpayers money, as it was supposed to do.

Health insurers are painting a misleading picture of Medicare Advantage savings, experts say

Bob Herman

By Bob Herman

STAT

Sept. 26, 2022

The health insurance industry is continuing its campaign to convince the public that Medicare Advantage saves taxpayers money, but experts say federal data still concludes the exact opposite — and that the program as currently designed is a drain on Medicare’s trust fund.

America’s Health Insurance Plans, the industry’s primary lobbying group, funded a new report that was conducted by actuaries at Wakely Consulting Group. AHIP claims the report proves Medicare Advantage — the controversial, private alternative to original Medicare that has become a cash cow for insurers — is “saving Americans billions of dollars every year.” The actuaries, however, never use that language in the report. Nbauman (talk) 15:58, 8 October 2022 (UTC)

Footnote 1 incorrect

It doesn’t document the sentence in the text: “ Sponsors are allowed to vary the benefits from those provided by Medicare's Parts A and B as long as they provide the actuarial equivalent of those programs.” I can’t find where the author got that info from. p.61 of Medicare and You 2024 book says: “Medicare Advantage Plans provide all of your Part A and Part B benefits, except for certain costs of clinical trials (clinical research studies), hospice care, the cost of getting a kidney transplant (like expenses for a living kidney donor), and, for a temporary time, some new benefits that come from legislation or national coverage determinations. Contact your plan if you have questions about covered services.“ Juliwoo (talk) 13:43, 31 August 2024 (UTC)

Difficult to parse sentence

Here's the sentence:

Those who do not pay a Part D Late Enrollment Penalties [sic] ....

Reading this sentence without "looking ahead" makes it sound like it's about to tell you the consequences for failure to pay the late enrollment penalty. This should be rephrased to avoid this. Fabrickator (talk) 20:49, 13 December 2024 (UTC)

Goodman Institute

I agree with the concerns about claims from Goodman Institute. Did the government actually fine an insurance provider $200 million because average time to answer a phone was 8 seconds? I don't doubt that an insurer was fined that amount, nor that it sometimes took as long as 8 seconds for their phone system to "answer" the call, but the claim as stated is highly implausible and must cause legitimate concern that this is a highly dubious source. Fabrickator (talk) 15:49, 14 December 2024 (UTC)

@Jborgzz: Thanks for explaining your edit better. I agree that the Goodman Institute: run by John C. Goodman, who authored the source article that Jborgzz removed shouldn't be considered Reliable for facts. ---Avatar317^(talk) 21:02, 14 December 2024 (UTC)