Very interesting to pair hospital systems dropping out of MA plans with the STAT exposé on denial-via-algorithm. As to stopping the MA juggernaut, though: I was surprised to read recently, via a study by Lanlan Xiu et al., that MA growth is primarily a result of people switching *into* MA from FFS:
"We found that switching from fee-for-service Medicare to MA more than tripled between 2006 and 2022, whereas switching from MA to fee-for-service Medicare decreased, with the change rates accelerating since 2019. The share of switchers among all new MA enrollees rose from 61 percent in 2011 to 80 percent in 2022."
I fear that the premium difference btwn MA and FFS + Medigap (for those who don't get an employer-sponsored supplement) is just too great for many people to withstand, especially as their resources dwindle. Most MA enrollees pay only the Part B premium, $164/month this year, as opposed to Part B + Part D (say $30-40/month) and Medigap (say $100-200/month). As the STAT indicates, it's all too often "pay now or pay later" (via MA OOP exposure and denied care), but $164 vs. $320/month is a deal that many can't refuse.
"The word" will start to spread - Medicare Advantage is great if you are healthy and don't need services - however, once you go past your budget, the cut in services is drastic, and the consequences for not switching to traditional Medicare are pretty severe for costs.
To your point on Medigap, My wife and I pay $334/month for United Healthcare Plan N and $28 per person for Part D today. It appears United Healthcare is changing their Part D coverage and changing from $28 to $47 (have to call on this one) per person. We carry 4 years of Long Term Care also for about $200/month total.
If that leap is for real, I would wonder what is causing it. We never get to the deductible ($400 next year) n Part D.
Oregon’s Samaritan Health is hardly dumping MA. They are merely booting UHC. They want to move everyone to their very own MA plan. Why leave capitated money on the table?
Huh. $334/month for two, right? My wife just started Plan N (UHC) in NJ for ~$120/month, which seemed low to me: I guess it rises with age, as both our parents were paying +/- $200/month. Re the Part D: is it feasible to switch?
I'm kind of surprised that LTC is as low as that: I've assumed there's no feasible pricing for it.
I am 75 and my wife 74. I think the $334 per month is ok as we can go anywhere. When my platelets disappear, I eventually get Rituxan (4 doses a week a part) to reverse it. So far it works. There is no argument on this cost. Next level is NPlate.
I have to check out UHC Part D to find out what they mean. They have exceptions but they are not clear. There is no reason why we can not switch Part D plans.
I have had the LTC plan for >20 years so we got in early. So far it covers most (95% or so percent) of the cost. It is just for 4 years.
I am in AZ now, the land of old people. Not rich. Just planned my past resources well,
I have worked globally for roughly half of the 40-something years I have been in supply chain / manufacturing. Part of this was in medical supplies/pharma for a major company. When you call UHC, you go to customer service in the Philippines. Great people to work with, understand English and speak it quite well. On my side zero-ability to speak their language. I do better with German.
I spend more time explaining to them my desire for more cost information than if I go directly to a US representative. UHC has no way to get around this and it can be frustrating for older people who lack patience or are knowledge-limited. That is one issue I have with UHC.
The most recent booklet they send out for Part D plans has 2023 plans at $28.20 and the 2024 plans at $47.10 or ~67% increase. What they are doing here is eliminating the Deductible if you take this plan. For some drugs such as Metoprolol Succinate, it is now a Tier 1. Co-pay (which I think is ridiculous) is still $2/30 day supply. The basic plan is now $39.30 per month and there is a $410 deductible and for the Succinate you pay $24/90 day supply.
The excuse given? According to the person I talked to, the cost is due to the increase in the catastrophic coverage. Cost-sharing will be $0 for all formulary drugs in 2024. In 2025, the Coverage Gap (Donut Hole) is eliminated. Out-of-pocket spending for Part D formulary drugs - RxMOOP - is set at $2,000 for 2025. After reaching RxMOOP, beneficiaries will have a $0 copay for all formulary drugs.
Oh and the excuse? UHC has to get its money lost from somewhere.
If I am wrong here, please add to this. "Understanding the 2024 Medicare Part D Donut Hole," for some of this. About 90 minutes were spent talking to people 13 hours away by jet, getting transferred from one person to another in the US, and reviewing the cost factors for each of three common drugs I take (plus my wife. Total cost for us? An additional $382/year for common meds.
Merrill:
If there is no problem, I am going to put much of this over at Angry Bear, an economics blog that has been around a long time.
Very interesting to pair hospital systems dropping out of MA plans with the STAT exposé on denial-via-algorithm. As to stopping the MA juggernaut, though: I was surprised to read recently, via a study by Lanlan Xiu et al., that MA growth is primarily a result of people switching *into* MA from FFS:
"We found that switching from fee-for-service Medicare to MA more than tripled between 2006 and 2022, whereas switching from MA to fee-for-service Medicare decreased, with the change rates accelerating since 2019. The share of switchers among all new MA enrollees rose from 61 percent in 2011 to 80 percent in 2022."
I fear that the premium difference btwn MA and FFS + Medigap (for those who don't get an employer-sponsored supplement) is just too great for many people to withstand, especially as their resources dwindle. Most MA enrollees pay only the Part B premium, $164/month this year, as opposed to Part B + Part D (say $30-40/month) and Medigap (say $100-200/month). As the STAT indicates, it's all too often "pay now or pay later" (via MA OOP exposure and denied care), but $164 vs. $320/month is a deal that many can't refuse.
Link to the study re MA switching: https://www.healthaffairs.org/doi/10.1377/hlthaff.2023.00224#:~:text=We%20found%20that%20switching%20from,to%2080%20percent%20in%202022.
"The word" will start to spread - Medicare Advantage is great if you are healthy and don't need services - however, once you go past your budget, the cut in services is drastic, and the consequences for not switching to traditional Medicare are pretty severe for costs.
Andrew:
To your point on Medigap, My wife and I pay $334/month for United Healthcare Plan N and $28 per person for Part D today. It appears United Healthcare is changing their Part D coverage and changing from $28 to $47 (have to call on this one) per person. We carry 4 years of Long Term Care also for about $200/month total.
If that leap is for real, I would wonder what is causing it. We never get to the deductible ($400 next year) n Part D.
Oregon’s Samaritan Health is hardly dumping MA. They are merely booting UHC. They want to move everyone to their very own MA plan. Why leave capitated money on the table?
Huh. $334/month for two, right? My wife just started Plan N (UHC) in NJ for ~$120/month, which seemed low to me: I guess it rises with age, as both our parents were paying +/- $200/month. Re the Part D: is it feasible to switch?
I'm kind of surprised that LTC is as low as that: I've assumed there's no feasible pricing for it.
Andrew:
I am 75 and my wife 74. I think the $334 per month is ok as we can go anywhere. When my platelets disappear, I eventually get Rituxan (4 doses a week a part) to reverse it. So far it works. There is no argument on this cost. Next level is NPlate.
I have to check out UHC Part D to find out what they mean. They have exceptions but they are not clear. There is no reason why we can not switch Part D plans.
I have had the LTC plan for >20 years so we got in early. So far it covers most (95% or so percent) of the cost. It is just for 4 years.
I am in AZ now, the land of old people. Not rich. Just planned my past resources well,
Andrew/Merrill:
I have worked globally for roughly half of the 40-something years I have been in supply chain / manufacturing. Part of this was in medical supplies/pharma for a major company. When you call UHC, you go to customer service in the Philippines. Great people to work with, understand English and speak it quite well. On my side zero-ability to speak their language. I do better with German.
I spend more time explaining to them my desire for more cost information than if I go directly to a US representative. UHC has no way to get around this and it can be frustrating for older people who lack patience or are knowledge-limited. That is one issue I have with UHC.
The most recent booklet they send out for Part D plans has 2023 plans at $28.20 and the 2024 plans at $47.10 or ~67% increase. What they are doing here is eliminating the Deductible if you take this plan. For some drugs such as Metoprolol Succinate, it is now a Tier 1. Co-pay (which I think is ridiculous) is still $2/30 day supply. The basic plan is now $39.30 per month and there is a $410 deductible and for the Succinate you pay $24/90 day supply.
The excuse given? According to the person I talked to, the cost is due to the increase in the catastrophic coverage. Cost-sharing will be $0 for all formulary drugs in 2024. In 2025, the Coverage Gap (Donut Hole) is eliminated. Out-of-pocket spending for Part D formulary drugs - RxMOOP - is set at $2,000 for 2025. After reaching RxMOOP, beneficiaries will have a $0 copay for all formulary drugs.
Oh and the excuse? UHC has to get its money lost from somewhere.
If I am wrong here, please add to this. "Understanding the 2024 Medicare Part D Donut Hole," for some of this. About 90 minutes were spent talking to people 13 hours away by jet, getting transferred from one person to another in the US, and reviewing the cost factors for each of three common drugs I take (plus my wife. Total cost for us? An additional $382/year for common meds.