Health insurance has always been cyclical — companies go all-in on certain business lines when they’re profitable and get out when they’re not — but next year will mark a particularly drastic turning point for Medicare Advantage, the form of Medicare run by private companies that contract with the government. When insurers release their 2025 plan offerings on Oct. 1, there likely will be fewer choices and freebies.
“They don’t want these patients anymore,” said Jared Holz a health care sector strategist with Mizuho Securities.
Ditching Medicare Advantage patients could cause a serious problem for patients with pre-existing conditions. (Which is probably most Medicare patients.)
Traditional Medicare Part B only covers 80% of expenses after the deductible. So-called “Medigap” insurance is underwritten by commercial insurance companies. They can’t deny coverage if insurance is bought when a person first becomes eligible but they do underwriting and can deny coverage if the application is made after the original enrollment period.
Losing Medicare Advantage may leave many unable to get Medigap insurance.
Wendy
“Losing Medicare Advantage may leave many unable to get Medigap insurance.
Wendy”
I listened to you and intercst on Medicare vs Advantage, went with Medicare and Medigap, even though Advantage might have been cheaper initially. Don’t want to deal with in or out of network.
That’s not true. If Medicare Advantage is no longer offered in your zip code, that gives you the opportunity to buy a Medigap plan without medical underwriting. You just can’t switch out of Medicare Advantage on your own to move to Medigap, if there are other MA plans available to you.
I think this is good news for the beneficiaries affected. They now how the opportunity to move to a plan without the 15% Medicare Advantage skim rate.
Be careful getting your information from United Healthcare, a for-profit insurer who’s financial interests are in opposition to your own. The best source for correct info is Medicare.gov
In this case, if United Healthcare telling you that you can’t get a Medigap plan without medical underwriting if you’ve been dumped from MA, that’s not correct.
You crack me up when you repeatedly tilt at this particular windmill.
The “opportunity” to move is going to cost the vast majority of people a lot more money. They could not care less about the skim rate when they were paying NOTHING in the first place in most cases.
There are a lot of problems with Medicare Advantage but NO ONE that has one would say that getting it for free is one of those problems.
In 2024, most people (75%) enrolled in individual Medicare Advantage plans with prescription drug coverage (MA-PDs) pay no premium other than the Medicare Part B premium ($174.70 in 2024) (Figure 1).
It’s just arithmetic. If 15% is being skimmed off to overhead & profit in Medicare Advantage** versus 1.3% in traditional Medicare, you’re getting less health care services with Medicare Advantage. Plus you’re paying higher deductibles and copays if you get sick.
“Free” Medicare Advantage is like the free steak dinner you get from an annuity salesman or financial advisor – if you sign up, it’s going to be your most expensive meal of the year.
**Note: It’s probably closer to 20% when you include the $50 Billion worth of upcoding fraud by MA insurers and the price gouging on generic drugs in the “free” Part D drug plan included in many Medicare Advantage policies.
This is absolutely valid, but if you are just this side of poverty (where you would otherwise qualify for Medicaid), Medicare Advantage is a great deal for the purchaser (especially as it is at no additional cost for most) even when it is not a great deal for the government.
Your gripe should be with the skim the government pays, not with the consumer - who for the most part pays nothing.
That proverbial free steak dinner is a great deal if you are hungry and can’t otherwise afford to eat. Why would cheer someone losing a free steak dinner?
The MA ads that flood TV usually start out asking “are you covered by both Medicare and Medicaid”, then proceed to tout all the “free” benefits you can obtain by switching to their MA plan. It may be “free” to the patient, but someone is paying the extra cost…“daddy, where do Trillion dollar deficits come from?”
Actually very few people who buy MA get their “free benefits”.
{{ KFF, an organization focused on health policy, reported that 71% of Medicare Advantage plans were offering a meal benefit in 2023. Each plan sets its own conditions for meal benefits, }}
Very few people with a grocery benefit are successful in collecting it – and it might only be $25/month.
You really have to admire the inventiveness of all the scams the for-profit insurers are running within Medicare Advantage. Even the Nigerian princes are in awe.