Medicare "Advantage" plans

I've been meaning to do a post on Medicare Advantage plans (MAPs) for a long time now. Here in Southern California we are bombarded by a plague endless commercials for how great MAPs are. All along I suspected they were a profitable smoke and mirrors and ripoff industry. This NYT article gets right to my suspicions:

‘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.

The health system Kaiser Permanente called doctors in during lunch and after work and urged them to add additional illnesses to the medical records of patients they hadn’t seen in weeks. Doctors who found enough new diagnoses could earn bottles of Champagne, or a bonus in their paycheck.

Anthem, a large insurer now called Elevance Health, paid more to doctors who said their patients were sicker. And executives at UnitedHealth Group, the country’s largest insurer, told their workers to mine old medical records for more illnesses — and when they couldn’t find enough, sent them back to try again.

In theory, if the insurers could do better than traditional Medicare — by better managing patients’ care, or otherwise improving their health — their patients would cost less and the insurers would make more money.

But some insurers engaged in strategies — like locating their enrollment offices upstairs, or offering gym memberships — to entice only the healthiest seniors, who would require less care, to join. To deter such tactics, Congress decided to pay more for sicker patients.

Almost immediately, companies saw ways to exploit that system. The traditional Medicare program provided no financial incentive to doctors to document every diagnosis, so many records were incomplete. Under the new program, insurers began rigorously documenting all of a patient’s health conditions — say depression, or a long-ago stroke — even when they had nothing to do with the patient’s current medical care.

 

Why are there so freaking many obnoxious, deceptive commercials hawking MAPs? Not surprisingly, money is why:

MAPs are like an HMO and if you use a doctor outside the system, you pay for most of it. If your plan does not have specialist you might need, you are stuck or pay yourself. From what I've heard anecdotally, MAPs limit end of life care as much as they possibly can. The point is making money, not providing services.

With MAPs, the advantage is with the insurance company, not the insured person or the US taxpayer.