Medicare Advantage Plans Taking Advantage Of Some Seniors

An older woman holding her hand out to someone


Medicare Advantage Plan members have more than doubled since 2007 according to a study done by the Kaiser Family Foundation.  However, they are not always the great deal as they seem on the surface.  The Wall Street Journal recently profiled Bob Miller who had surgery on one eye but just a few weeks later when he was scheduled to have surgery on the other eye, he was informed the night before that the surgery was canceled because his Medicare Advantage plan refused to cover it.  Unfortunately, you will not be able to figure out if some plans are covering your planned medical care until you fill out the medical preauthorization form and send it in.  Miller eventually got the cataract surgery but had to wait several weeks.  “Prior authorization policy when levelled in such a heavy handed and irrational way is an undeniable power grab by insurers to really put profits over patients,†said Alice Epitropoulos, the ophthalmologist who performed the surgery on Miller.

Medicare Insurers Took $9.2 Billion In Federal Payments In One Year Via Controversial Billing Practices : By Derek Baine

A building with the capitol in the background.


There seems to be no end to the tricks insurers will come up with in order to suck more money out of Medicare.  According to the findings of the Office of Inspector General of the Department of Health and Human Services, it analyzed 20 companies and investigators found that one received about 40% of the questionable payments, or $3.7 billion, while enrolling only 22% of Medicare Advantage customers.  It wouldn’t name the company, but BMO Capital Market looked at federal data and showed that the enrollment share closely matches UnitedHealth Group Inc. during the period the investors looked at.

https://www.wsj.com/articles/most-of-9-2-billion-in-questionable-medicare-payments-went-to-20-insurers-federal-investigators-say-11632303001