METARs have discussed many times how Medicare Advantage (MA) denies patients care while traditional Medicare pays up without denials. (Though that may change.) From the standpoint of patient care, Medicare wins over MA.
You would think that denying patient care would cause MA companies to charge the government less, but NOOOO…
CMS Paying More for Medicare Advantage Patients Compared to Traditional Enrollees
by Cheryl Clark, Medpage Today, January 20, 2026
The Centers for Medicare & Medicaid Services (CMS) is continuing to pay Medicare Advantage (MA) plans more – $76 billion more in 2026 – than if those same patients were enrolled in traditional fee-for-service Medicare…
The report attributed the difference in spending between MA and traditional Medicare to two factors: MA plans’ “coding intensity,” the practice of aggressively categorizing patients as having higher risk scores, which may not reflect actual services or costs, and “favorable selection,” the tendency for healthier, less costly patients to enroll in MA plans rather than fee-for-service plans…
Andy Johnson, PhD, a principal policy analyst for MedPAC, noted that “MA plans have a financial incentive to document more diagnoses than providers in fee-for-service Medicare, leading to larger MA risk scores and greater Medicare spending when a beneficiary enrolls in MA.”… [end quote]
Read the article if you want to raise your blood pressure.
Wendy
I have lots of political opinions on this, but as we are doing macroeconomics all I have to say is that from investment POV the USA is becoming simply insane, subject to wild irrational policy tugs this way or that having nothing to do with national well-being and lots to do with powerful corporations and alliances reaping short term profits while mal-management of Health Eduation Welfare and Patriotism in the USA collapse into ruinous stupidity…. incoherent angry stupidity.
This is maybe more appropriate on the Retirement board, but I already posted this segment there. For most people, Medicare Advantage isn’t a good deal. It appears at first to be, but as time goes on (and you inevitably have more issues), it’s not. And the extra charged the government is profit from the insurance company offering the Advantage plan.
Relatively healthy people sign up for Medicare Advantage for the low price and the extras (like dental and eye care). But when they get sick they transfer to Medicare.
Wendy
If you watch the video I linked (only about half an hour), he explains that, too. I’ll summarize that bit. When you hit 65, you get Medicare without any health assessment to determine your premium. If you do an Advantage plan, and then later try to go to regular Medicare, your premium WILL be affected by the health assessment. So, in principle, you can go back. But, in practice, you’re trapped with Advantage because you probably won’t be able to afford the Medicare premiums.
Are you sure you’re talking about traditional Medicare (part A and B)…..or premiums for a Medicare supplemental plan to go with that. To the best of my knowledge, it’s this supplemental that’s subject to insurance company underwriting/health assessment to determine premiums after a certain age, because….it’s offered by insurance companies.
You can’t get a Medigap plan in most states without medical underwriting if you switch back to traditional Medicare after one year. So only the relatively affluent have the option to switch back.
Unfortunately, yes. The Medi-gap policy also has underwriting. But if you switch from Advantage to regular Medicare (after -I think- a 1 year grace period on Advantage), you go through underwriting.
Watch the video. It’s enlightening, humorous, and maddening, all at the same time.
No. Medicare Part A and B doesn’t have medical underwriting if you switch back during an open enrollment period. Only a Medigap plan is subject to medical underwriting in most states.
If I remember correctly, a Dem from a northeastern state wouldn’t vote for the ACA unless there wasn’t a “public option” because some big medical insurance company was in his state. Forget his name. He was moderately liberal otherwise, but fully in the pocket of Big Med-Insurance.
OK. I last watched the segment when it came out last fall. Sorry if I mis-remembered something. I do remember that switching back to regular Medicare often was not an option because of the underwriting requirements after more than 1 year on an Advantage plan.
I did watch the video yesterday during a brief sit-down from grandma duties (I never regret time spent with John Oliver…..it’s not like he thinks I’m dumb enough on the topic of saturated vs unsaturated fats to talk nonsense with complete confidence )…..but, as mentioned upstream, it was the potentially prohibitive premiums from a supplemental plan that was considered the stumbling block and not an increase in the Part A or B premiums. A supplemental plan is not mandatory.
In fact, we’ve had whole threads on whether the need for a supplemental plan is as necessary as imagined with thanks to @intercst …..along with mention of the need to keep a close eye on the accuracy of your medical history recorded with your PCP (this is where the information for insurance underwriting for the over 70s as first timers or MA refugees comes from, BTW…..my account on this reality disappeared with theTMF switcheroo)
Here’s the thing……the issues arise when you get sick. It seems to me that if an individual is stuck on the idea of cost savings because they’ve only experienced rude good health with excellent lifestyle choices over, say, the previous half century and expect it to continue (like, say dh and I as we turned 65)….go with traditional Medicare anyway. You’ll be no worse off if the worst does happen……you’ll have a co payment for the treatment you receive vs possibly finding that treatment is denied or even unavailable if MA has been dropped by providers or institutions in your area
The laziest thinkers on this side of the pond make comments about our military budget means we can not afford socialized medicine. Those marroons comment further that the EU countries have socialized medicine because we pick up their military budget.
If you do not understand what I am alluding to you have no clue about basic accounting and econ.
We are paying more for the military and our healthcare than the Europeans. You have been bulled for decades. No surprise! America!
We have friends from my home town, a woman I went to school with, who is very political. She backed Lieberman. She brought up his name back in 2010 and I exploded with some nasty comment.
I explained why. This is it. He was a drain on CT and other states for the tech industry.
Google AI
Senator Joseph Lieberman strongly opposed requiring companies to expense stock options in the 1990s, arguing it would harm job creation, capital raising, and competitiveness, successfully pressuring the FASB to back down from an earlier proposal by passing a Senate resolution against it. He introduced legislation, like the Equity Expansion Act of 1993, to stop mandatory expensing, believing it was an abstract accounting issue with severe public policy consequences, though the FASB eventually required it years later after the tech bubble burst.
Not speculation anymore…Kaiser Permanente will settle a $556 Million whistleblower suit for precisely this.
”In the largest Medicare Advantage fraud settlement to date, Kaiser Permanente has agreed to pay $556 million to settle Justice Department allegations that it billed the government for medical conditions patients didn’t have.”
)…..but, as mentioned upstream, it was the potentially prohibitive premiums from a supplemental plan that was considered the stumbling block and not an increase in the Part A or B premiums. A supplemental plan is not mandatory.