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6 episodes with traditional medicare
4 episodes with traditional medicare
3 episodes with traditional medicare
2 episodes with traditional medicare
2 episodes with traditional medicare
2 episodes with traditional medicare
2 episodes with traditional medicare
2 episodes with traditional medicare
2 episodes with traditional medicare
In this debut episode of Quality Talks With Peggy O'Kane, Founder and President of NCQA, Peggy is joined by Dr. Sachin Jain, CEO of SCAN Group and SCAN Health Plan, to explore a provocative question: Why isn't health care better at getting better?Measuring—Not Missing—What Matters: Anxieties about access and affordability plague everyday people. But quality measurement's focus is elsewhere. Is health care chasing the wrong metrics and missing the big picture? The Complacency Crisis: Sachin says the core issue is a reluctance to embrace real reform, noting the industry's tendency to want improvement without being willing to change fundamental practices. He calls for a bolder approach. Rethinking Medicare & Medicare Advantage: Sachin challenges rosy view of traditional Medicare, and describes how a legal battle over a flawed Medicare Advantage star rating raised questions about how measuring quality affects care. Simplifying for Impact: Sachin proposes focusing on three or four areas, emphasizing patient experience, ease of access and basic care for common conditions. He urges cost transparency, simpler administrative processes and renewed competition.Key Quote:“ If we all just took care of our own part of the ecosystem, we'd get 20, 30% better. But instead, the most industry talking points are about, ‘Hey, we don't get paid enough for what we do.' Everyone who's making money claims that they're losing money on X, Y, or Z lines of business. Everyone complains about regulatory capture, so there's just a bit of having normalized the abnormal. And I think that that's the thing we have to undo if we're going to actually make the kinds of forward progress that we're hoping to make as an industry.”-Sachin Jain, MDTime Stamps:(01:44) Inspired by Our Mentors in Health Care(04:27) How Does Health Care Get Better?(7:28) The Trap of Toxic Positivity (11:34) Misplaced Nostalgia for Traditional Medicare(18:05) The Stars Program Controversy(22:13) Simplifying Health Care MeasurementLinks:Connect with Sachin Learn More About SCANConnect with PeggyLearn More About NCQA
Data scientist Emily Hadley on navigating AI in healthcare, offering practical advice for maintaining patient agency amid algorithmic decision-making. Summary This interview with data scientist Emily Hadley examines the intersection of artificial intelligence and healthcare through a deeply personal lens. Hadley's journey began when her own health diagnosis coincided with her graduate studies in analytics, revealing how algorithm-driven systems often affect patient care—especially through insurance claim denials and clinical documentation. The conversation offers practical guidance for patients navigating AI-influenced healthcare, including reviewing AI-generated clinical notes for accuracy, challenging algorithmic insurance decisions, and insisting on human intervention when automated systems fail. Hadley advocates for preserving patient agency and rights within increasingly automated systems while highlighting how algorithm review boards are striving to provide governance in this largely unregulated space. The interview concludes with resources for staying informed about developments in healthcare AI, emphasizing that while AI tools are rapidly advancing, patient advocacy remains vital. Click here to view the printable newsletter with images. More readable than a transcript, which can also be found below. Contents Table of Contents Toggle EpisodeProemA Data Scientist AwakesBuilding Guardrails with AI GovernanceHallucinations and Validation with AI in ResearchPrompt Engineering-Conversational AIVerification and VigilanceStaying InformedReflectionRelated episodes from Health Hats Please comment and ask questions: at the comment section at the bottom of the show notes on LinkedIn via email YouTube channel DM on Instagram, TikTok to @healthhats Production Team You know who you are. I'm grateful. Podcast episode on YouTube No video Inspired by and Grateful to Eric Pinaud, Laura Marcia, Amy Price, Dave deBronkart, Links and references Prompt Engineering Algorithm Review Boards at RTI Dave deBronkart's Patient's Use AI Episode Proem This year, I switched from Medicare Advantage to Traditional Medicare. I still needed to purchase a supplemental commercial plan to cover what Medicare Part B didn't. However, the supplemental commercial plan denied some services the previous Medicare Advantage plan covered. Why? What algorithms did each plan use to determine coverage? How can I manage this? Welcome to the third installment of Artificial Intelligence Can Work for You. We've explored how I use AI in my podcast productions and delved into some AI basics with Info-Tech leader Eric Pinaud. I asked Emily Hadley, a data scientist at RTI specializing in AI algorithms for insurance coverage decisions, to join us. Early in her graduate studies, Emily was diagnosed with Crohn's disease. This led to her interest in studying insurance algorithms. A Data Scientist Awakes Health Hats: How did you gain expertise in AI? Emily Hadley: Great question. I was diagnosed right as I started a graduate program in analytics. In my undergraduate studies, I studied statistics in public policy. I liked the idea of using data to shape how policymakers make decisions, especially in the US. I had done some work with AmeriCorps and then went to grad school to really hone those skills. Being diagnosed at the same time that I was in grad school meant that I was navigating to new, informative, and educational areas. And I think that that's when I really came to realize the power of data and the power of AI in shaping the way that organizations and people make decisions. We live in a really algorithm-fueled society. We constantly encounter technology and AI systems, even when we don't realize it. An example I give is that I've faced many problems getting insurance to cover the things it is supposed to. I didn't realize until a couple of years ago that this is ...
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This time on Code WACK! What could another Trump presidency mean for the rise in Medicare private plans and what would that mean for patient care and financial waste in our healthcare system and for the Medicare Trust Fund? To find out, we recently interviewed Dr. Diljeet Singh, an integrative gynecologic oncologist and incoming president of Physicians for a National Health Program [PNHP]. With more than 25,000 members across the United States, PNHP advocates for a universal, comprehensive, single-payer national health program. This is the second episode in a two-part series.
This time on Code WACK! What could another Trump presidency mean for the rise in Medicare private plans and what would that mean for patient care and financial waste in our healthcare system and for the Medicare Trust Fund? To find out, we recently interviewed Dr. Diljeet Singh, an integrative gynecologic oncologist and incoming president of Physicians for a National Health Program [PNHP]. With more than 25,000 members across the United States, PNHP advocates for a universal, comprehensive, single-payer national health program. This is the second episode in a two-part series. Check out the Transcript and Show Notes for more!
This time on Code WACK! What could another Trump presidency mean for the rise in Medicare private plans and what would that mean for patient care and financial waste in our healthcare system and for the Medicare Trust Fund? To find out, we recently interviewed Dr. Diljeet Singh, an integrative gynecologic oncologist and incoming president of Physicians for a National Health Program [PNHP]. With more than 25,000 members across the United States, PNHP advocates for a universal, comprehensive, single-payer national health program. This is the second episode in a two-part series.
The shocking shooting death of UnitedHealthcare's chief executive in Midtown Manhattan prompted a public outcry about the problems with the nation's health care system, as stories of delayed and denied care filled social media. Meanwhile, President-elect Donald Trump continues to avoid providing specifics about his plans for the Affordable Care Act and other health issues.Alice Miranda Ollstein of Politico, Sandhya Raman of CQ Roll Call, and Rachel Cohrs Zhang of Stat join KFF Health News' Julie Rovner to discuss these stories and more. Also this week, Rovner interviews Francis Collins, who was the director of the National Institutes of Health and a science adviser to President Joe Biden. Plus, for “extra credit,” the panelists suggest health policy stories they read this week that they think you should read, too: Julie Rovner: KFF's “Medicare Spending was 27% More for People Who Disenrolled From Medicare Advantage Than for Similar People in Traditional Medicare,” by Jeannie Fuglesten Biniek, Alex Cottrill, Nolan Sroczynski, and Tricia Neuman. Alice Miranda Ollstein: CNN's “Most Women in the US Aren't Accessing Family Planning Services, Even as Abortion Restrictions Grow,” by Deidre McPhillips. Sandhya Raman: Stat's “Spending Less, Living Longer: What the U.S. Can Learn From Portugal's Innovative Health System,” by Usha Lee McFarling. Rachel Cohrs Zhang: ProPublica's “‘Eat What You Kill,'” by J. David McSwane. Visit our website for a transcript of the episode. Hosted on Acast. See acast.com/privacy for more information.
The insurance companies are desperate to convert as many seniors as possible from Traditional Medicare to Medicare Advantage scam to pad their profits. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE
Signing up for a Medicare Advantage could be a Mistake. Join Kay Tillow, Hamza Jamal, and Evan Hawthorn to learn the difference between it and Traditional Medicare. Single Payer Radio airs on Forward Radio, 106.5 FM, WFMP-LP Louisville, and on our website, forwardradio.org, every Monday at 2pm and repeats on Tuesday at 7am and Wednesday at 11 am. - Contains no copyrighted music
Mark Miller, Morningstar contributor, talks about the new $2,000 out-of-pocket cap for Medicare Part D coming in 2025. Plus, learn what you should know before switching between Medicare Advantage and traditional Medicare during open enrollment.Traditional Medicare vs. Medicare AdvantageWhy Seniors Shouldn't Just Roll Over Their Plans in 20252025 Medicare Part D ChangesMedicare's New Prescription Payment PlanWhat Should Seniors Do If Their Medicare Advantage Plan is Being Eliminated?What You Need to Know About Switching Between Traditional Medicare and Medicare Advantage Where You Can Go to Get Help Choosing a New Medicare Plan Read about topics from this episode. Medicare Open Enrollment: What to Know as You Enroll for 2025I'm 65 and Still Working. Should I Enroll in Medicare?Are Consumers Better Off With Medicare Plus a Medigap Plan? What to watch from Morningstar.A Better Way to Use Leverage in Your ETF PortfolioApple Earnings Are on Deck. Will Apple Intelligence Help Drive iPhone Sales?Is Your Portfolio Built to Withstand a Market Rotation?Inherited IRA Rules: What You Need to Know Before 2025 Read what our team is writing:Mark MillerIvanna Hampton Follow us on social media.Facebook: https://www.facebook.com/MorningstarInc/X: https://x.com/MorningstarIncInstagram: https://www.instagram.com/morningstar... LinkedIn: https://www.linkedin.com/company/5161/
A caller to Politics Done Right told our audience that her mother was switched from Traditional Medicare to Medicare Advantage without her consent. Here is what you should know. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE
Journalist & Author Judah Freed almost died because he initially chose Medicare Advantage. Luckily, he was within 3-days in which he could enroll in Traditional Medicare. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE
We continue e to expose the various Medicare Advantage schemes that private health insurance companies use to take advantage of seniors' traditional Medicare. Subscribe to our Newsletter: https://politicsdoneright.com/newsletter Purchase our Books: As I See It: https://amzn.to/3XpvW5o How To Make America Utopia: https://amzn.to/3VKVFnG It's Worth It: https://amzn.to/3VFByXP Lose Weight And Be Fit Now: https://amzn.to/3xiQK3K Tribulations of an Afro-Latino Caribbean man: https://amzn.to/4c09rbE
Matt wants to know how to tell if he's being scammed by his dentist. To find the answer, we open up the surprising history of dentistry, ask why it seems so different from internal medicine, and drill down on why dental insurance doesn't really feel like insurance. Host Jonquilyn Hill talks with journalist Mary Otto and Dr. Lisa Simon, DMD, MD, to find the answers. We want to hear your questions. Call us at 1-800-618-8545, or email us at askvox@vox.com Extra reading: Teeth: The Story of Beauty, Inequality, and the Struggle for Oral Health in America Dental Use and Spending in Medicare Advantage and Traditional Medicare, 2010-2021 | Health Policy Credits: Jonquilyn Hill, host Sofi LaLonde, producer Andrea Kristinsdottir and Cristian Ayala, engineers Carla Javier, supervising producer Katherine Wells, editor Learn more about your ad choices. Visit podcastchoices.com/adchoices
The SCAN Group, which offers Medicare Advantage plans along with primary care and other services to older adults, recently released its first-ever Environmental, Social and Governance report. The purpose was to showcase the ways in which the organization is supporting employees, members, patients and communities, and advancing social aims for the company. Among the company's points of pride is its work to address homelessness among older adults, according to Jain. It offers many clinical programs for the older population, including an Independence at Home program. With the release of the MA rate for 2025, the Centers for Medicare & Medicaid Services is sending a message that it would like to cut payment to MA plans. The SCAN Group's MA model is different than other MA companies in that it enables providers to actually own the risk themselves. Jain's interest in social justice originated, in part, from his parents who grew up at the time of Indian independence and his early exposure to inequality and racism, he said.Follow us on social media:X (formerly Twitter): @McKHomeCareFacebook: McKnight's Home CareLinkedIn: McKnight's Home CareInstagram: mcknights_homecareFollow SCAN Group on social media:X (formerly Twitter): @SCANHealthPlanLinkedIn: SCANShow contributors:McKnight's Home Care Editor Liza Berger and Sachin Jain, MD, CEO, SCAN Group
Health Affairs' Jeff Byers interviews Jack Hoadley from Georgetown University about the final rule for the Medicare Advantage and Medicare Part D programs for 2025.Read the new Health Policy Brief on digital inclusion.Join us for our ONC 20th anniversary event on May 9.Finish the sentence and win an online journal subscription for a year: You're a health policy wonk if...Become a Health Affairs Insider to read our newsletters on drug pricing, antitrust, and more.Related Links:Differences in Use of Services and Quality of Care in Medicare Advantage and Traditional Medicare, 2010 and 2017 (Health Affairs)Increased Medicare Advantage Penetration is Associated with Lower Postacute Care Use for Traditional Medicare Patients (Health Affairs)DTC Companies Double Down on Medicare Advantage Supplemental Benefits (Health Affairs This Week)
As the healthcare landscape evolves, the importance of adopting value-based care strategies in the Traditional Medicare program becomes increasingly evident. This podcast episode is going to provide you with invaluable ...
I don't know about you but I'm FASCINATED with Medicare Advantage (MA). Massive growth, fueled by its shrewd marketing of added benefits beyond traditional Medicare. But also chaotic, messy, a program in need of reining in. It's a bit of the wild west. I like some things about MA, including its emphasis on preventative care and aligning patients outcomes with rewards. But I'm also routinely disappointed by its excesses and denial of medically necessary care. Some days MA seems poised to overtake and end traditional Medicare. But every time I think that, another shoe drops. Intensive audits from the OIG, and sharp criticism from the likes of former CMS administrator Don Berwick. Two weeks ago we saw the nation's largest ACO get hit with a whistleblower lawsuit for alleged upcoding abuses. To get a big picture overview and figure out where we are with the program I invited 4Sight Health's David Burda to join me on the podcast. David is 4SightHealth's news editor and columnist and hosts a podcast, the 4sighthealth roundup, covering MA and other adjacent topics. Listen in as we discuss: David's journalism background and eventual path into covering healthcare MAs rapid adoption: Will it continue until Medicare is phased out—or is a reckoning coming? The problems with MA: Gaming of risk adjustment/upcoding to make patients appear sicker, denial of medically necessary care, prior authorization nightmares, and sky-high insurer profits What MA is doing well, should be preserved, and what needs reform Is healthcare compatible with a free-market economy and shareholder ROI? How David stays on top of the torrent of healthcare news, and his cool addition to the #OTR Spotify playlist Additional reading from 4sighthealth: What Will Happen to Traditional Medicare? https://www.4sighthealth.com/ken-terry-what-will-happen-to-traditional-medicare/ Spy vs. Spy? More Like Medicare vs. Medicare Advantage https://www.4sighthealth.com/spy-vs-spy-more-like-medicare-vs-medicare-advantage/
JAMA Health Forum Editor John Ayanian, MD, MPP, and Deputy Editor Melinda Buntin, PhD, speak with Rachel A. Prusynski, DPT, PhD, of the University of Washington about differences in the use and outcomes of home health services provided to beneficiaries in traditional Medicare and Medicare Advantage. Related Content: Differences in Home Health Services and Outcomes Between Traditional Medicare and Medicare Advantage
This time on Code WACK! Why is tying a medical provider's pay to the outcomes of their patients a bad idea? Why else should we be concerned about Accountable Care Organizations and the privatization of traditional Medicare? To find out, we spoke to Dr. Ana Malinow, who spent three decades working as a pediatrician with immigrant, refugee and underserved children before retiring as Clinical Professor of Pediatrics from the University of California San Francisco School of Medicine. She's past president of Physicians for a National Health Program and is currently a lead organizer for National Single Payer and The Movement to End Privatization of Medicare. This is the second episode in a two-part series with Dr. Malinow. Check out the Transcript and Show Notes for more!
This time on Code WACK! You've probably heard about the dangers of Medicare Advantage, but did you know that traditional Medicare is being privatized too? How is this corrupting our healthcare system even more and what does this mean for patients? To find out, we spoke to Dr. Ana Malinow, who spent three decades working as a pediatrician with immigrant, refugee and underserved children in Ohio, Texas, Pennsylvania, and California before retiring as Clinical Professor of Pediatrics from the University of California San Francisco School of Medicine. She's past president of Physicians for a National Health Program and is currently a lead organizer for National Single Payer and The Movement to End Privatization of Medicare. This is the first episode in a two-part series with Dr. Malinow.
This time on Code WACK! You've probably heard about the dangers of Medicare Advantage, but did you know that traditional Medicare is being privatized too? How is this corrupting our healthcare system even more and what does this mean for patients? To find out, we spoke to Dr. Ana Malinow, who spent three decades working as a pediatrician with immigrant, refugee and underserved children in Ohio, Texas, Pennsylvania, and California before retiring as Clinical Professor of Pediatrics from the University of California San Francisco School of Medicine. She's past president of Physicians for a National Health Program and is currently a lead organizer for National Single Payer and The Movement to End Privatization of Medicare. This is the first episode in a two-part series with Dr. Malinow. Check out the Transcript and Show Notes for more!
This time on Code WACK! You've probably heard about the dangers of Medicare Advantage, but did you know that traditional Medicare is being privatized too? How is this corrupting our healthcare system even more and what does this mean for patients? To find out, we spoke to Dr. Ana Malinow, who spent three decades working as a pediatrician with immigrant, refugee and underserved children in Ohio, Texas, Pennsylvania, and California before retiring as Clinical Professor of Pediatrics from the University of California San Francisco School of Medicine. She's past president of Physicians for a National Health Program and is currently a lead organizer for National Single Payer and The Movement to End Privatization of Medicare. This is the first episode in a two-part series with Dr. Malinow.
Nationally syndicated financial columnist and author Terry Savage joins John to talk about why you need to be very vigilant about bank fraud, and the disadvantages of Advantage plans. And as always, Terry answers all of your financial questions.
This is episode 107, “A Traditional Medicare Benefit.” Do not miss this episode as host Joe Sparks explains why Medicare makes it easier to move to a different state.
Barbara's Medicare Advantage left her with thousands of dollars to pay. She was still healthy and migrated to Traditional Medicare with an affordable Medigap plan. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message Support this podcast: https://podcasters.spotify.com/pod/show/politicsdoneright/support
With 1 out of every 3 U.S. health care dollars emanating from Washington, the federal government is the single largest payer of health services in the United States and accounts for nearly half of all national health spending. As our country ages, these forces are accelerating, with Medicare spending alone projected to increase by 7.5% annually through 2031. Healthcare companies that depend on government revenue – or are downstream from it – must begin to view policymakers as among their most important customers. Impactful organizations that will succeed in the new era of value-based care will learn how to leverage the unparalleled value of internal advocacy. By creating extraordinarily powerful messaging for policymakers to understand what is needed for value-based innovation, we exercise our right to form a more perfect union. While healthcare will never be perfect, we must still strive for perfection – that is at the heart of value-based care transformation in our country! On the Race to Value this week, we interview Andrew Schwab – a value-based care leader, an intentional strategist, and a master of Washington's internal game. He brings a bold, brash, no-holds-barred approach to government affairs by coaching and mentoring forward-thinking organizations ready to invest in their internal policy teams so they can thrive in a new era of value-based care. Prior to establishing his own firm, Platform Government Strategies, Andrew advocated in-house on behalf of both nonprofits and private sector organizations. Most recently, Andrew established Oak Street Health's first government affairs function that put them at the center of the national value-based care conversation and contributed to their recent acquisition by CVS Health. Episode Bookmarks: 01:30 The federal government is the single largest payer of health services and accounts for nearly half of all national health spending. 02:00 Healthcare companies that depend on government revenue must begin to view policymakers as among their most important customers. 02:30 Introduction to Andrew Schwab and his public affairs consulting firm, Platform Government Strategies. 05:30 The glacial pace of the value-based care movement. Is there truly bipartisan consensus on the aims of health value? 07:00 2030 Medicare VBC Goal (“The government is putting its thumb on the scale for value-based care.”) 08:15 The 1st Amendment right to petition government for redress of grievances (“Advocacy and lobbying are quintessentially American.”) 09:00 “Elected officials and appointed regulators in Washington D.C. and in state capitals react to a different set of incentives.” 10:00 Explosive growth of the Medicare Advantage program. 11:00 Consumer-centric innovation and higher quality of care in MA plans. 11:30 Political controversy with MA (e.g. PE-backing, overpayment concerns, risk adjustment gaming, “perverse business model”) 13:00 Critics of MA ranging from physicians and hospitals protecting the “sanctity of fee-for-service" to those leery of privatization. 13:30 The incredible popularity of MA and the research showing it has superior outcomes. 14:00 Mitigating the potential for upcoding with the new V28 risk adjustment methodology being implemented over next 3 years. 15:00 MA is paid more than Traditional Medicare, but it offers more in terms of benefits (e.g. hearing, dental, vision, population health interventions). 16:00 Private equity investment and payvider innovation (e.g. Oak Street Health, VillageMD, Centerwell, Archwell). 17:00 The importance of Patient-Reported Outcome Measures since process measures alone don't achieve patient-centeredness. 19:00 “Outcomes should be the most important metric by which we judge the health of our healthcare system.” 20:00 “We need to put providers that participate in value-based relationships at the center of advocacy pushes in Washington and in state capitals.” 21:00 If we are incentivized to keep patients healthy and out ...
Choosing between Traditional Medicare and Medicare Advantage is hard, but the stakes are even higher for cancer patients. Does the flexibility to choose any hospital or doctor under traditional Medicare outweigh Medicare Advantage's enhanced benefits like dental, vision and OTC drugs?In this episode of CareTalk, John and David weigh the pros and cons of Medicare Advantage for cancer patients.TOPICS(01:52) How Medicare Works(03:17) What is Medicare Advantage?(04:12) Traditional Medicare vs Medicare Advantage(06:01) Access to Specialized Cancer Care(08:30) Importance of Cancer Research Centers (12:32) Drug Coverage Differences(16:30) Switching Medicare Plans(18:29) Weighing Cancer RiskGET IN TOUCHBecome a CareTalk sponsorGuest appearance requestsVisit us on the webSubscribe to the CareTalk NewsletterShop official CareTalk merchFOLLOW CARETALKSpotifyApple PodcastsGoogle PodcastsFollow us on LinkedIn#healthcare #healthcarepolicy #healthcarebusiness #healthcaretechnology #medicareadvantage #medicare #healthinsurance #oncologySupport the showCareTalk: Healthcare. Unfiltered. is produced by Grippi Media Digital Marketing
It can be challenging to keep track of the differences between the various parts of Medicare. With so many different parts and coverage choices, it's understandable to get confused and overwhelmed.See omnystudio.com/listener for privacy information.
GOP politicians and pundits are attempting to blame Democrats for McCarthy's ouster. Medicare Advantage ripoff would pay for Traditional Medicare premiums. Neil Aquino talks to the local candidates. --- Send in a voice message: https://podcasters.spotify.com/pod/show/politicsdoneright/message Support this podcast: https://podcasters.spotify.com/pod/show/politicsdoneright/support
Today John, Ben, and special guest Bryan Gay from Boomer Insurance discuss Medicare and Medicare Advantage, shedding light on a topic often overshadowed by federal employee health benefits. They start by breaking down Medicare, comparing it to just another insurance company, and exploring the distinctions between Medicare Part A and Part B. You'll gain valuable insights into the affordability and comprehensive coverage provided by Medicare, as well as discover the out-of-pocket limits associated with this healthcare option. Access the full show notes at Mason & Associates, LLC
This time on Code WACK! How do Medicare Advantage plans use pre-authorizations and claim denials to maximize their profits at the expense of senior citizen's lives? And how are health insurers getting away with this? To find out, we spoke to Diane Archer, founder and president of Just Care USA, an independent digital media hub covering health and financial issues facing boomers and their families. Miss Archer is the past chair of the Board of Consumer Reports, currently serves as a senior advisor at Social Security Works and as a member of the board of the Center for Health and Democracy. Check out the Transcript and Show Notes for more!
We are on an enlightening journey to transform American healthcare in the race to value. Medicare Advantage increasingly stands out as a superior vehicle for value transformation due to its ability to catalyze care delivery innovation through full-risk capitation. By promoting coordinated care and integration among healthcare providers, MA plans foster a patient-centric approach that improves overall care quality and health equity. Additionally, these plans prioritize preventive care and wellness initiatives and enable early identification and management of chronic disease, ultimately reducing healthcare costs. By incentivizing providers to prioritize outcomes over volume, Medicare Advantage is our path forward to a uniquely American healthcare system that we can be proud of. Joining us this week on the podcast is Don Crane, former CEO of America's Physicians Groups. In this episode, he shares his valuable insights and expertise on Medicare Advantage and how it will shape our future in healthcare transformation. Join us as we explore the challenges and opportunities that lie ahead for Medicare Advantage and discuss the potential impact on the healthcare landscape! Episode Bookmarks: 01:30 Introduction to Don Crane (Former President and CEO of APG) and the potential for Medicare Advantage to transform American healthcare. 03:30 Support Race to Value by subscribing to our weekly newsletter and leaving a review/rating on Apple Podcasts. 04:00 Don Crane joins the Race to Value again as returning guest. (Check out his prior episode on Primary Care Transformation!) 05:00 The explosive growth of MA and the evidence showing that MA plans deliver better economic and clinical outcomes. 06:30 How a capitation in Medicare Advantage enables population health outcomes through effective SDOH interventions. 08:00 The criticisms of Medicare Advantage from notable thought leaders Richard Gilfillan and Don Berwick. 09:30 Protection of the Medicare Trust Fund is the common point of agreement between MA proponents and opponents. 10:00 Don addresses the criticisms of risk adjustment gaming and the program's overall spend. 10:45 Is it necessarily a bad thing if MA costs more than Traditional Medicare if it provides better care outcomes and supplemental benefits? 11:30 “Spending more on Medicare Advantage makes all the sense in the world to me if it provides better outcomes and value for seniors.” 12:00 The perspective from seniors enrolled in Medicare Advantage on the appropriateness of spending for supplemental benefits. 12:30 “The astronomical growth of Medicare Advantage should be celebrated.” 13:00 The V28 HCC changes to the Risk Adjustment model for payment year 2024 will decrease the number of codes by more than 2,000 from the HCC model. 14:00 The adverse impacts of risk adjustment coding changes will increase administrative complexity and hurt seniors by reducing MA funding to the tune of $10B. 15:45 The need to evaluate both Traditional Medicare and MA to determine the best path forward. 16:30 Risk adjustment is grounded on the premise of fairness to both the payer and provider and should prevent both over- and under-payment. 17:30 “Risk adjustment is such an important ingredient in capitated payment models and provides a business case for addressing inequities in underserved communities.” 18:30 Concerns about the elimination of risk adjustment and how that will adversely affect sicker patent populations through “cherry picking” during MA enrollment. 19:30 Don compares the bad actors in MA who perform upcoding to the overpayments and overutilization that occurs in Traditional Medicare. 20:00 Is the potential for upcoding exaggerated by detractors of Medicare Advantage? 20:30 Eliminated risk adjustment in Medicare Advantage is an example of throwing out the baby with the bathwater. 21:00 How Star Ratings work in Medicare Advantage to unlock bonuses and rebates when improving care quality.
Today on the podcast we welcome back Mark Miller, who is an author, columnist, and a nationally recognized expert on trends in retirement and aging. His latest book is called Retirement Reboot: Commonsense Financial Strategies for Getting Back on Track. Miller's work considers retirement holistically, including healthcare and Medicare, Social Security, retirement investing, midlife careers, and housing. He is a regular contributor to Morningstar.com, and he also writes about retirement matters for Reuters, The New York Times, and WealthManagement.com. In addition to Retirement Reboot, Miller has written several other books, including The Hard Times Guide to Retirement Security and Jolt: Stories of Trauma and Transformation. Additionally, Miller has his own podcast and newsletter, both of which are called Retirement Revised.BackgroundBioRetirement Reboot: Commonsense Financial Strategies for Getting Back on Track, by Mark MillerThe Hard Times Guide to Retirement Security: Practical Strategies for Money, Work, and Living, by Mark MillerJolt: Stories of Trauma and Transformation, by Mark MillerThe State of Retirement“Toward a New Social Insurance Era,” by Mark Miller, WealthManagement.com, Dec. 23, 2022.“Retirement Planning Amidst Inflation,” by Mark Miller, WealthManagement.com, Oct. 13, 2021.“The Inflation Reduction Act's Impact on Retirees,” by Mark Miller, Morningstar, Aug. 16, 2022.“How to Cope With Medicare's Rising Costs,” by Mark Miller, The New York Times, Dec. 21, 2021.“Social Security Benefits' 2023 COLA: Is It Enough?” by Mark Miller, Morningstar, Nov. 9, 2022.Delaying Retirement“Kerry Hannon: Remote Work Trend Benefits Older Workers,” The Long View podcast, Morningstar, Oct. 21, 2020.“For Disabled Workers, a Tight Labor Market Opens New Doors,” by Ben Casselman, The New York Times, Oct. 25, 2022.“Returning to Work but Close to Retirement? Adjust Your Plan,” by Mark Miller, Reuters, April 21, 2022.“Why Working Till Whenever Is a Risky Retirement Strategy,” by Mark Miller, The New York Times, May 16, 2019.“How Have Older Workers Fared in the Pandemic-Induced Downturn?” by Mark Miller, Morningstar, June 2, 2021,CoGenerateMedicare, Healthcare, and Long-Term Care“Optimizing Social Security for Clients,” by Mark Miller, WealthManagement.com, Sept. 29, 2022.“Social Security's Cost-of-Living Increase Largest in Four Decades, Estimate Says,” by Mark Miller, The Seattle Times, Sept. 14, 2022.“Social Security Doomsayers Are Wrong Again, but Reform Choices Loom,” by Mark Miller, Reuters, Sept. 16, 2021.“A Quiet Experiment Is Testing Broader Privatization of U.S. Medicare,” by Mark Miller, Reuters, Jan. 14, 2022.“Big Changes May Be Coming to Traditional Medicare,” by Mark Miller, Morningstar, April 22, 2022.“Medicare's Private Option Is Gaining Popularity, and Critics,” by Mark Miller, The New York Times, Dec. 3, 2022.State Health Insurance Assistance Program“Medicare vs. Medicare Advantage,” by Mark Miller, WealthManagement.com, March 24, 2020.“How to Evaluate Medigap Plans,” by Mark Miller, Morningstar, March 2, 2022.“The Financial Health of Medicare and Social Security: A Closer Look,” by Mark Miller, Morningstar, June 29, 2022.“Long-Term-Care Coverage Is Trending in the Wrong Direction,” by Mark Miller, WealthManagement.com, June 13, 2022.Housing and Other Debt“Should You Pay Off Your Mortgage?” by Mark Miller, Morningstar, Oct. 8, 2021.“Waiting for the Reverse Mortgage Surge,” by Mark Miller, WealthMangement.com, Feb. 8, 2022.Retirement Complexity“‘The Cash Monster Was Insatiable': How Insurers Exploited Medicare Advantage for Billions,” by Reed Abelson and Margot Sanger-Katz, The New York Times, Oct. 8, 2022.“U.S. Health Officials Seek New Curbs on Private Medicare Advantage Plans,” by Reed Abelson and Margot Sanger-Katz, The New York Times, Dec. 17, 2022.
You've just turned 65 or you're about to. That means you have to make some important decisions about health care. You may decide to sign up for an Advantage Plan when you sign up for Medicare at age 65. But that's not the only choice you have for additional coverage. We'll talk about another option today on MoneyWise. MEDIGAP POLICIES A Medigap policy is one more piece of the insurance jigsaw puzzle you may want to consider. It could save you thousands in medical bills. Medigap is an extra form of health insurance you can buy if you already have Medicare. Like a Part C Medicare Advantage Plan, a Medigap policy will help you pay some of the costs that aren't covered by Medicare Parts A and B where you still have to pay deductibles, copays and coinsurance for approved medical care and services, which can add up quickly. A Medigap plan is a private insurance policy that can help you pay for some of the out-of-pocket costs that aren't covered by Medicare. The premium would be in addition to your Medicare Part B premium and Part D prescription drug premium. One important thing to remember is that you can't have a Medicare Advantage plan and Medigap insurance. You have to choose one or the other to supplement basic Medicare. WHICH OPTION IS BEST? So which one is better for you? It depends on your finances and health circumstances. Comparing the two, Medigap coverage will usually have a higher monthly premium, but lower out-of-pocket expenses. Medicare Advantage plans generally cost less and cover more services. You might look at it this way: If you're in good overall health, you might choose a Medicare Advantage plan. But if you have a covered condition that requires frequent medical services with co-pays, Medigap might be the way to go. Something else to consider: Traditional Medicare and Medigap policies cover you for any doctor or facility that accepts Medicare. But Medicare Advantage plans usually limit you to the doctors and facilities in their network. So Medigap costs more, but you get to choose your doctor, and that's a very attractive feature for folks with a pre-existing condition. WHO IS ELIGIBLE FOR A MEDIGAP POLICY? If you're 65 or older and eligible for Medicare and you already have Medicare Parts A and B, you can get a Medigap policy. But again, not if you already have a Medicare Advantage plan. You can't have both. Now, when it comes to what's covered by a Medigap plan, things can get a bit confusing. Again Medigap plans in general cover deductibles, copays and coinsurance costs. But there are actually many different types of Medigap plans, and each is identified by a letter: A, B, D, G, K, L, M and N. Each plan provides a different level of supplemental coverage to Medicare. You have to pick the one that best meets your needs. Fortunately, you can find a comparison of the different Medigap plans at Medicare.gov. And this should help simplify your decision. All Medigap policies have standardized coverage. Every company offering Medigap L, for example, has to cover the same things. The only difference will be the price. So after you choose the lettered plan that works best for you, just shop for the lowest price in your state. HOW MUCH DOES MEDIGAP COVERAGE COST? It varies depending on your state and the plan you choose, but the average for 2023 is $155 a month. However, that's only for an individual. Under the rules, your spouse would have to have a separate plan. One other thing to keep in mind, with a Medigap plan, you may also want to get separate Medicare Part D coverage, because it doesn't cover prescription drugs. If you decide to go with a Medigap plan, you can sign up for any plan offered in your state during the six months after you enroll in Medicare Part B. That initial enrollment window is crucial because during that period, you're eligible for any plan even if you have health problems. The company has to take you on and they can't charge you extra for a medical condition. After six months, however, you no longer have that guarantee. Now there's one more thing you should know about healthcare coverage now that you're turning 65. We mentioned that you can't have both Medicare Advantage and Medigap coverage. However, if you already have Medicare Advantage and you'd like additional coverage, you can check out a medical cost sharing ministry. For example, with Christian Healthcare Ministries, you can have both a Medicare Advantage plan and CHM coverage, which costs about the same as a Medigap plan. On today's program, Rob also answers listener questions: ● How do you determine whether to take a pension as a monthly payout or a lump sum? ● Does it make sense to tap home equity to pay off credit cards? ● Is this a good time to invest more money into the market? ● How do you get started with a budget when you're behind on everything? RESOURCES MENTIONED: ● Christian Credit Counselors ● Connect with a MoneyWise coach ● MoneyWise App Remember, you can call in to ask your questions most days at (800) 525-7000 or email them to Questions@MoneyWise.org. Also, visit our website at MoneyWise.org where you can connect with a MoneyWise Coach, join the MoneyWise Community, and even download the free MoneyWise app. To support this ministry financially, visit: https://www.oneplace.com/donate/1085/29
Social Security myths are dispelled. And traditional Medicare v. Medicare Advantage Plans is explained. Nancy Altman, a 40 plus year veteran of Social Security laws shares details about bad actors in Medicare Advantage Plans and 4 things to think about when choosing between traditional Medicare and Medicare Advantage Plans.Being Well Informed is a program designed to share information on trending topics. Currently our podcast/tv program airs weekly. Our podcast is also featured on Amazon Music, Podbean, Spotify, iHeart Radio, You Tube, Google Podcasts, Apple Podcasts, and many other platforms.
You've just turned 65 or you're about to. That means you have to make some important decisions about health care. You may decide to sign up for an Advantage Plan when you sign up for Medicare at age 65. But that's not the only choice you have for additional coverage. We'll talk about another option today on MoneyWise. MEDIGAP POLICIES A Medigap policy is one more piece of the insurance jigsaw puzzle you may want to consider. It could save you thousands in medical bills. Medigap is an extra form of health insurance you can buy if you already have Medicare. Like a Part C Medicare Advantage Plan, a Medigap policy will help you pay some of the costs that aren't covered by Medicare Parts A and B where you still have to pay deductibles, copays and coinsurance for approved medical care and services, which can add up quickly. A Medigap plan is a private insurance policy that can help you pay for some of the out-of-pocket costs that aren't covered by Medicare. The premium would be in addition to your Medicare Part B premium and Part D prescription drug premium. One important thing to remember is that you can't have a Medicare Advantage plan and Medigap insurance. You have to choose one or the other to supplement basic Medicare. WHICH OPTION IS BEST? So which one is better for you? It depends on your finances and health circumstances. Comparing the two, Medigap coverage will usually have a higher monthly premium, but lower out-of-pocket expenses. Medicare Advantage plans generally cost less and cover more services. You might look at it this way: If you're in good overall health, you might choose a Medicare Advantage plan. But if you have a covered condition that requires frequent medical services with co-pays, Medigap might be the way to go. Something else to consider: Traditional Medicare and Medigap policies cover you for any doctor or facility that accepts Medicare. But Medicare Advantage plans usually limit you to the doctors and facilities in their network. So Medigap costs more, but you get to choose your doctor, and that's a very attractive feature for folks with a pre-existing condition. WHO IS ELIGIBLE FOR A MEDIGAP POLICY? If you're 65 or older and eligible for Medicare and you already have Medicare Parts A and B, you can get a Medigap policy. But again, not if you already have a Medicare Advantage plan. You can't have both. Now, when it comes to what's covered by a Medigap plan, things can get a bit confusing. Again Medigap plans in general cover deductibles, copays and coinsurance costs. But there are actually many different types of Medigap plans, and each is identified by a letter: A, B, D, G, K, L, M and N. Each plan provides a different level of supplemental coverage to Medicare. You have to pick the one that best meets your needs. Fortunately, you can find a comparison of the different Medigap plans at Medicare.gov. And this should help simplify your decision. All Medigap policies have standardized coverage. Every company offering Medigap L, for example, has to cover the same things. The only difference will be the price. So after you choose the lettered plan that works best for you, just shop for the lowest price in your state. HOW MUCH DOES MEDIGAP COVERAGE COST? It varies depending on your state and the plan you choose, but the average for 2023 is $155 a month. However, that's only for an individual. Under the rules, your spouse would have to have a separate plan. One other thing to keep in mind, with a Medigap plan, you may also want to get separate Medicare Part D coverage, because it doesn't cover prescription drugs. If you decide to go with a Medigap plan, you can sign up for any plan offered in your state during the six months after you enroll in Medicare Part B. That initial enrollment window is crucial because during that period, you're eligible for any plan even if you have health problems. The company has to take you on and they can't charge you extra for a medical condition. After six months, however, you no longer have that guarantee. Now there's one more thing you should know about healthcare coverage now that you're turning 65. We mentioned that you can't have both Medicare Advantage and Medigap coverage. However, if you already have Medicare Advantage and you'd like additional coverage, you can check out a medical cost sharing ministry. For example, with Christian Healthcare Ministries, you can have both a Medicare Advantage plan and CHM coverage, which costs about the same as a Medigap plan. On today's program, Rob also answers listener questions: ● How do you determine whether to take a pension as a monthly payout or a lump sum? ● Does it make sense to tap home equity to pay off credit cards? ● Is this a good time to invest more money into the market? ● How do you get started with a budget when you're behind on everything? RESOURCES MENTIONED: ● Christian Credit Counselors ● Connect with a MoneyWise coach ● MoneyWise App Remember, you can call in to ask your questions most days at (800) 525-7000 or email them to Questions@MoneyWise.org. Also, visit our website at MoneyWise.org where you can connect with a MoneyWise Coach, join the MoneyWise Community, and even download the free MoneyWise app. To support this ministry financially, visit: https://www.oneplace.com/donate/1085/29
You've just turned 65 or you're about to. That means you have to make some important decisions about health care. You may decide to sign up for an Advantage Plan when you sign up for Medicare at age 65. But that's not the only choice you have for additional coverage. We'll talk about another option today on MoneyWise. MEDIGAP POLICIES A Medigap policy is one more piece of the insurance jigsaw puzzle you may want to consider. It could save you thousands in medical bills. Medigap is an extra form of health insurance you can buy if you already have Medicare. Like a Part C Medicare Advantage Plan, a Medigap policy will help you pay some of the costs that aren't covered by Medicare Parts A and B where you still have to pay deductibles, copays and coinsurance for approved medical care and services, which can add up quickly. A Medigap plan is a private insurance policy that can help you pay for some of the out-of-pocket costs that aren't covered by Medicare. The premium would be in addition to your Medicare Part B premium and Part D prescription drug premium. One important thing to remember is that you can't have a Medicare Advantage plan and Medigap insurance. You have to choose one or the other to supplement basic Medicare. WHICH OPTION IS BEST? So which one is better for you? It depends on your finances and health circumstances. Comparing the two, Medigap coverage will usually have a higher monthly premium, but lower out-of-pocket expenses. Medicare Advantage plans generally cost less and cover more services. You might look at it this way: If you're in good overall health, you might choose a Medicare Advantage plan. But if you have a covered condition that requires frequent medical services with co-pays, Medigap might be the way to go. Something else to consider: Traditional Medicare and Medigap policies cover you for any doctor or facility that accepts Medicare. But Medicare Advantage plans usually limit you to the doctors and facilities in their network. So Medigap costs more, but you get to choose your doctor, and that's a very attractive feature for folks with a pre-existing condition. WHO IS ELIGIBLE FOR A MEDIGAP POLICY? If you're 65 or older and eligible for Medicare and you already have Medicare Parts A and B, you can get a Medigap policy. But again, not if you already have a Medicare Advantage plan. You can't have both. Now, when it comes to what's covered by a Medigap plan, things can get a bit confusing. Again Medigap plans in general cover deductibles, copays and coinsurance costs. But there are actually many different types of Medigap plans, and each is identified by a letter: A, B, D, G, K, L, M and N. Each plan provides a different level of supplemental coverage to Medicare. You have to pick the one that best meets your needs. Fortunately, you can find a comparison of the different Medigap plans at Medicare.gov. And this should help simplify your decision. All Medigap policies have standardized coverage. Every company offering Medigap L, for example, has to cover the same things. The only difference will be the price. So after you choose the lettered plan that works best for you, just shop for the lowest price in your state. HOW MUCH DOES MEDIGAP COVERAGE COST? It varies depending on your state and the plan you choose, but the average for 2023 is $155 a month. However, that's only for an individual. Under the rules, your spouse would have to have a separate plan. One other thing to keep in mind, with a Medigap plan, you may also want to get separate Medicare Part D coverage, because it doesn't cover prescription drugs. If you decide to go with a Medigap plan, you can sign up for any plan offered in your state during the six months after you enroll in Medicare Part B. That initial enrollment window is crucial because during that period, you're eligible for any plan even if you have health problems. The company has to take you on and they can't charge you extra for a medical condition. After six months, however, you no longer have that guarantee. Now there's one more thing you should know about healthcare coverage now that you're turning 65. We mentioned that you can't have both Medicare Advantage and Medigap coverage. However, if you already have Medicare Advantage and you'd like additional coverage, you can check out a medical cost sharing ministry. For example, with Christian Healthcare Ministries, you can have both a Medicare Advantage plan and CHM coverage, which costs about the same as a Medigap plan. On today's program, Rob also answers listener questions: ● How do you determine whether to take a pension as a monthly payout or a lump sum? ● Does it make sense to tap home equity to pay off credit cards? ● Is this a good time to invest more money into the market? ● How do you get started with a budget when you're behind on everything? RESOURCES MENTIONED: ● Christian Credit Counselors ● Connect with a MoneyWise coach ● MoneyWise App Remember, you can call in to ask your questions most days at (800) 525-7000 or email them to Questions@MoneyWise.org. Also, visit our website at MoneyWise.org where you can connect with a MoneyWise Coach, join the MoneyWise Community, and even download the free MoneyWise app. To support this ministry financially, visit: https://www.oneplace.com/donate/1085/29
Our episode today focuses on a disease that's a significant problem in the US. 15% of US adults or 37 million people, are estimated to have this disease and as many as 9 in 10 adults with this disease do not know they have it. This disease is prevalent in the 65+ population. As of 2018 Medicare was spending $70B annually on the treatment of this disease which represents almost 24 % of spending for this age group. If you haven't yet figured out which disease I am referring to, its Chronic Kidney Disease or CKD. The 21st Century Cures Act brought renal diseases to the forefront and allowed Medicare Beneficiaries with ESRD to enroll in a Medicare Advantage plan. Previously, these beneficiaries were required to stay on Traditional Medicare which often resulted in suboptimal outcomes. In addition, CMS has launched several innovative payment models in an attempt to help providers focus more on prevention and curbing progression of renal disease. As a result, many health plans and renal providers are now focused on more effectively managing renal conditions and improving outcomes. With us today is Michael Uchrin, CEO of Monogram Health, a Nashville based company that helps patients with renal disease live their best lives. The team at Monogram Health is focused on making treatments as accessible and convenient as possible to the member, by offering in-home services. Michael will help educate us on the changes that are afoot and how companies like Monogram Health are improving outcomes and lowering costs. Show Notes: Book - -Relentless: From Good To Great To Unstoppable by Tim Grover. Nashville Healthcare Council Fellows Program: https://healthcarecouncilfellows.com/
Today we're tackling Medicare Advantage, which is the option Medicare enrollees have to use a private insurance company to administer their Medicare benefits instead of the traditional public Medicare program. Almost HALF of all Medicare beneficiaries are now enrolled in Advantage plans, which represents a historic level of privatization of the almost 60-year program. Just this weekend, the New York Times published a blockbuster front-page report on everything that is wrong about Advantage plans. We'll get into all of that with our guest, Dr. Susan Rogers. Dr. Rogers spent most of her career at Stroger Hospital of Cook County (fka Cook County Hospital, the basis for blockbuster TV drama "ER") where she was a Primary Care Physician in a neighborhood clinic before becoming a hospitalist and Director of Medical Student Programs for the Department of Medicine. She is a past co-president of Health Care for All Illinois. She retired in 2014, and is now president of Physicians for a National Health Program (PNHP), a national organization of over 25,000 physicians and health professionals whose mission is to advocate for Single Payer Healthcare/Medicare for All. https://youtu.be/oi1BUAhbx3U Show Notes Dr. Rogers tells us her advocacy for Medicare for All grew from her experience training and working at a large public safety net hospital where providers and patients made decisions about care based on need, not ability to pay. It was the best way to learn to provide care, and the best way for patients to receive care. What's the difference between Medicare and Medicare Advantage? We dig into Medicare Advantage (aka Medicare Part C) plans, and how they differ from the traditional public Medicare program. Traditional Medicare is funded by payroll taxes. Hospital coverage (Part A) is free for eligible people. There are no networks. It's a fee-for-service plan, so providers are paid for each service they provide that's medically necessary. The narrative began in the 1980's that fee-for-service was responsible for "overuse" of healthcare services. (To paraphrase Minnesota single payer hero Senator John Marty: as if people go get an extra colonoscopy just because it's paid for.) The solution was to put private insurance between the doctor and patient to prevent overuse. Medicare Advantage evolved from the introduction of private insurance into the Medicare system, resulting in every insurance company in America skimming massive profits off the top of a taxpayer funded federal program, while providing no actual care. Medicare Advantage plans are required to cover all medically necessary care, but the definition of medically necessary is defined by the insurance company based on cost, not by the physician based on medical expertise. Medicare Advantage replaces the doctor/patient relationship with someone in an insurance company office - potentially with no healthcare training - deciding what's medically necessary. Gillian shares some stories from Healthcare-NOW members who have been enrolled in Medicare Advantage plans. Common themes were delays in care, denial of coverage, limited networks, and limited pharmaceutical formularies. These features (not bugs) of Medicare Advantage can lead to serious, even deadly deterioration of a patient's health. We also heard stories of patients in need of specialty care for conditions like cancer, but few of the large academic centers or cancer institutes accept Medicare Advantage plans. The overhead cost to run traditional Medicare is about 2%. That means approximately 98% of the money in the traditional Medicare pot goes to providing care to enrollees. By law, Medicare Advantage plans only have to spend 85% of their pot on patient care, and they can keep the other 15% (this is how they afford huge executive salaries, among other "overhead.") They make that 15% slice of the pie more profitable by delaying and denying care as well as by fraudulently overc...
On today's episode, I share with you a high-level overview of the process our firm offers retirees each fall, called our Medicare Readiness Report™. In short, this is a simplified one-page report that cuts to the chase, showing prices and coverage for option #1, which we refer to as Traditional Medicare, compared with option #2 of Medicare Advantage. This one-page report only highlights the information that is most helpful, so you don't have to listen to a sales-pitch or read the 124 pages of your Medicare & You handbook. Be sure to take advantage of the Medicare Readiness link below if you'd like to receive your own report, personalized to your age, zip code, prescriptions and more! Schedule an Intro Call with Loren Resources mentioned on today's show: Medicare Readiness Report™ (complete to receive yours) Prescription Drug "Cheat-Sheet" Medicare Advantage "Cheat-Sheet" 7 Medicare Questions "Cheat-Sheet" What is a Fiduciary? About Me Podcast Page For questions, comments, or to receive your own RETIREMENT RISKS ANALYSIS, you can start with a 2 minute quiz here: Share More & Get in Touch You can also find Loren at shermanl@integrityguidance.com Additional Resources Discussed on the Show Healthy, Wealthy, & Wise YouTube
The takeover of management of many sectors of healthcare by Wall St. Private Equity firms, Hedge Funds and other corporate investors over a period of decades, coincides with worsening U.S. health outcomes - e.g., reduced life expectancy and increased maternal and child mortality. In order to inflate profits, investment management firms commonly cut staffing, pay, benefits, and short equipment, even as some board-certified emergency physicians are replaced with less qualified practitioners. Such tactics as "surprise billing," "upcoding" or exaggerating patient condition for greater profit, "fee-splitting" and corporate practice of medicine are commonly employed to extract greater profits. Traditional Medicare is currently targeted in a program initiated by the Trump administration, whose "Direct Contracting Entities" (DCEs) place profiteering middlemen between traditional Medicare recipients and their doctors. DCEs have been rebranded by the Biden administration the "REACH" program, with the same goal to privatize traditional Medicare, moving traditional Medicare recipients without their consent or knowledge into privatized coverage with private equity or other for-profit corporate entity. Call to end the effort to privatize traditional Medicare: Message Line of HHS Secretary Becerra: 202-205-5445. White House Message Line: 202-456-1111.More Podcasts at: Truthseekers - Health Justice Podcast - Examining the false corporate narrative surrounding U.S. health insurance reform.Podcast home: https://www.youtube.com/channel/UCw__m5s6qrfljXiBxmD9oMgSupport the show (https://www.denveropenmedia.org/podcast/library#truthseekers)
On this edition of the podcast, we’re going to talk about Medigap - one of the most important types of Medicare insurance, and perhaps one of the least understood. For people enrolled in traditional Medicare, Medigap is used to cover out-of-pocket costs, and caps your total out-of-pocket liability.Traditional Medicare offers much more flexibility in how you access care when compared with Medicare Advantage plans, which typically use managed-care provider networks. However, Advantage plans come with a built-in cap on out-of-pocket costs--a feature that you won’t find in traditional Medicare. Some traditional Medicare enrollees receive supplemental gap insurance as a retirement benefit from their former employers to cover some of those out-of-pocket costs. And low-income seniors get help from Medicaid. But for everyone else, it's important to understand the ins and outs of Medigap--when to buy it, the plan options, and how to go about selecting a plan.I spoke recently about Medigap plans with Bethany Cissell. Bethany is an expert on Medigap at Allsup, a company that provides fee-based assistance with Medicare plan selections. Fee-based help is one way you can get guidance on Medicare plan selections of all types. The most common choice is your State Health Insurance Assistance Program, or SHIP. These are free counseling services that you’ll find in every state, and I’ll provide a link alongside the podcast that can help you find yours. I spoke with Bethany about the choice between traditional Medicare with a Medigap, versus Medicare Advantage. We also discussed all those notorious Medigap letter options you can choose, and how plans are priced.Click on the player icon at the top of this post to listen to the interview. The podcast also can be found on Apple Podcasts and Stitcher.More Medigap resourcesHow to evaluate Medigap coverage - my latest column for Morningstar.com.Overview of Medigap plan options- a table created by the Medicare Rights Center.Financial advisors step it up on Social Security techFinancial advisors have long understood the importance of Social Security in their clients’ retirement plans. Now, an increasing number are using sophisticated strategies for optimizing those benefits and turning to software for help.The trend is evident in the substantial increase in market penetration of Social Security optimization software, which jumped to 45% of advisors last year, up from 17% in 2020, according to the T3/Inside Information Advisory Software Survey. Some of that growth reflects Social Security features bundled into mainstream financial planning software, but use of stand-alone solutions is growing as well.Learn more in my latest column for WealthManagement.com.What I’m readingSenior communities add tech assistance as a perk . . . The system still fails small 401(k) plans . . . Young women are saving for retirement sooner than previous generations. Subscribe at retirementrevised.substack.com
Last week, Medicare announced the next phase of its plan to transform traditional Medicare. Critics argue that the planned transformation of the fee-for-service program will amount to a dramatic expansion of privatization. And, if you are enrolled in traditional Medicare, or expect that you will be in the future know this: no matter if you want it or not, Medicare plans to enroll you in this new model by the end of this decade, as early as next year in some cases. Millions of retirees have opted out of traditional Medicare over the past two decades. Instead, they have joined Medicare Advantage, which is a privatized, managed-care version of the program. But the choice between those two options might not be in their hands much longer.Medicare has been quietly testing a new model for traditional fee-for-service Medicare. Medicare enters into contracts with healthcare provider groups that receive a flat annual payment to provide care for enrollees in the traditional program. Up until this point, Medicare called the health care contractors involved in this experiment “Direct Contracting Entities,” but starting next year they will be known as Accountable Care Organizations, or ACOs.The concept of ACOs is not new - many health care experts say they have the potential to improve health care by incenting healthcare providers to work together as teams. But this particular version of ACOs is drawing criticism from some health policy experts, who view it as unwarranted - and unwise - further privatization of Medicare.The new model launching next year is called ACO REACH. The word REACH is an acronym, standing for Realizing Equity, Access, and Community Health. Medicare is pitching the program as a way to advance health equity for underserved communities. And that’s a very laudable goal. But ACO Reach providers actually will have much in common with Medicare Advantage, Like Advantage plans - which usually are HMOs or PPO plans - ACO Reach plans will create networks of preferred healthcare providers, and they can retain as profit the portion of the annual per-patient payments that are not spent on healthcare.A big worry here is the rush of private equity firms and other investment groups into the business, which points to even more privatization of Medicare than we’ve seen already. And here’s something important to know if you are enrolled in traditional Medicare, or expect that you will be in the future. Medicare plans to enroll everyone who uses traditional Medicare in an ACO by 2030. And starting next year, if you live in an area where a REACH ACO operates, you can be assigned to one without your consent.This week on the podcast: Joining me on the program this week to talk about the REACH ACO model is Dr. Ed Weisbart. Ed is a family medicine practitioner. And he chairs the Missouri chapter of Physicians for a National Health Program, a national group of 21,000 physicians and other health professionals who support single-payer national health insurance. PNHP has taken a leading role in opposing Medicare’s ACO plans.I’ve been really surprised that this topic hasn’t surfaced much in general media yet, considering its importance to millions of seniors. After Medicare announced its plans for ACOs last week, it seemed like a good idea to turn up the volume a bit. Click the player icon at the top of this post to listen to the podcast. The podcast also can be found on Apple Podcasts and Stitcher.Further reading on Medicare ACOsA quiet experiment is testing further privatization of Medicare Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 1: The Risk-Score Game.Medicare Advantage, Direct Contracting, And The Medicare ‘Money Machine,’ Part 2: Building On The ACO ModelBiden Pursues Trump Plan That Creates Big Profits by Denying Health CareTrump-era Medicare program under increased scrutinyPhysicians for a National Health Program - page of resources on ACO Reach.What I’m readingIRS releases long-awaited Secure Act RMD regulations . . . Medicare’s finances and the saga of the Alzheimer’s drug Aduhelm . . . The pandemic pummeled long-term care – it may not recover quickly. Subscribe at retirementrevised.substack.com
In this episode, you'll hear about: Why there's a need to factor in health care costs for retirement income.Medicare details, costs and deadlines.Traditional Medicare vs. Medicare Advantage plans.HSAs and Medicare.How Medicare surcharges are calculated.About the WealthWatch video library.Related Article: Medicare do-over seasonRelated Article: Medicare premiums, IRMAA surcharges to rise in 2022This season is brought to you by RealizedRealized strives to put you in control of managing your investment property wealth. Our goal is to help bridge the gap between investment property ownership and sophisticated wealth management, helping you meet your income needs in retirement and pursue your investment goals across generations. Using the principles of Investment Property Wealth Management(R), Realized transforms your individual investment properties into diversified real estate portfolios, customized to your unique income needs, risk appetite, and investment goals. For more information, visit www.Realized1031.com/RepairShop to learn more.Guest Bio: Peter Stahl has more than 30 years of experience in the financial services industry, where he has built a recognized track record of integrity and success. He has delivered training and resources to financial advisors and their clients across the United States and internationally.Since 2012, Peter has focused his efforts on educating financial advisors and consumers on health care challenges during retirement, equipping them to find solutions. An author and sought-after speaker, Peter makes navigating through a complex and ever-changing health care landscape comprehensible to all.Peter lives with his wife and five children in the Philadelphia suburbs.
As US hospitals recruit nurses from overseas, the countries they leave behind struggle with shortages. Traditional Medicare beneficiaries are excluded from new at-home covid test coverage. And IBM sells its Watson Health assets to a private equity firm.
“Direct contracting" is the latest in a long line of insidious tactics pushing Medicare towards privatization. Today we're chatting with Dr. Claire Cohen, MD from Physicians for a National Health Program about direct contracting entities: what they are, how they threaten beneficiaries of traditional Medicare, and what is being done to stop them. Show Notes Dr. Claire Cohen is an African American child and adolescent psychiatrist who has been practicing in Pittsburgh since 1984. She grew up in Philadelphia, PA and attended Hahnemann Medical College (now Drexel University Medical School) there and did her General Psychiatry Residency at the University of Chicago. She then moved to Pittsburgh to do her Child and Adolescent Fellowship at the University of Pittsburgh's Western Psychiatric Institute. She fell in love with Western Pennsylvania and has practiced here ever since. She has worked in a variety of settings, including community mental health clinics, partial hospitals, school-based settings and, currently, an inpatient hospital setting. In addition to her career, Dr. Cohen has always been very active in her community. In the late 1980s, she was involved in supporting the strike of the Pittston coal miners. In the 1990s, she was a member of the group that fought to get a Civilian Police Review Board in Pittsburgh. More recently she has been involved in efforts to stop the school-to-prison pipeline on the Pittsburgh Public Schools , a founding member of the Pittsburgh Green New Deal, on the advisory board of the Pittsburgh Black Workers Center and fighting for Medicare For All as a member of Physicians For A National Health Program, the Western PA Coalition for Single Payer Healthcare, and National Single Payer. She is also on the Medicare 4 All Committee of Democratic Socialists of America. What is a Direct Contracting Entity and how is it different from traditional Medicare? Dr. Cohen tells us that Direct Contracting Entities are groups of doctors, hospitals, or other healthcare providers that form “preferred provider” networks. Medicare pays DCEs a monthly amount per patient to cover a defined portion of each seniors' medical expenses. Virtually any type of company can apply to be a DCE, including commercial insurers, venture capital investors, and dialysis centers. Traditional Medicare spends about 98 cents of every dollar on direct patient care. Existing Medicare Advantage programs operated by private insurance companies only have to spent 85 cents of every dollar on direct patient care. The Trump administration developed the DCE program, allowing them to spend only 60 cents of every dollar on direct patient care, and keep the rest as profit. In order to get seniors in these plans that are obviously inferior, they decided they'd sneak them into the plan without their knowledge or consent. The Trump adminsitration piloted this DCE program in 10 large cities which happened to have large BIPOC populations, and enrolled those seniors in the program involuntarily. The Biden administration changed the DCE model a bit, but it is continuing. Now patients receive a letter that informs them of their enrollment in the DCE. The only way to get out is to change to a doctor who is not part of a DCE. Wall Street and CMS aim to have every doctor signed up with a DCE by 2030, which means complete privatization of Medicare. How do DCEs make money? They're allowed to spend less on patient care than Medicare Advantage or traditional Medicare, leaving more profitDiagnostic upcoding: if the patient has hypertension, they might say the patient has malignant hypertension, if the patient is pre-diabetic, they'll code the patient as diabetic, in order to get larger reimbursements from CMS. (This is also a well-documented problem with Medicare Advantage, which serves 42% of Medicare enrollees.)Cherry picking: they push legitimately sicker patients into traditional Medicare,
My guest is Dr. Roger Fowler, Vice President, and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health in Irving, Texas.As an expert in population health, quality, and healthcare reform, Dr. Fowler offers a rich perspective on the historical events that underpin our current state of U.S. healthcare. His belief is that we must move away from payment systems that reward the quantity of procedures performed, and move toward those programs that reward excellent outcomes for patients and the community.Dr. Fowler describes how quality measures themselves have their origins in the way insurance companies ranked desirable vs. undesirable physicians based on each physician's claims data. It was all about costs. The use of the term Medical Loss Ratio (MLR) is an important reminder of the insurance industry's perspective about medicine vs. the perspective we as physicians have. MLR means that the resources spent on providing medical care for patients is the Loss referred to in this acronym. A family medicine physician for 40 years, Dr. Fowler says when he first heard medical care referred to as a loss it was like fingernails on a blackboard for him.Dr. Fowler has compelling stories of how the healthcare system goes haywire. He talks about the unintended consequences of early “hospitalization insurance” and EMTALA regulations and he laments the various ways unscrupulous characters cash in on patients' vulnerabilities. His expertise and patience almost meet their match with my ignorance about Medicare programs. He labors to help me understand some of the key points of Medicare Advantage, Traditional Medicare, ACOs, Shared Savings programs, and more. After we finished our conversation, I requested a CME certificate.As a patient advocate and expert on population health and quality, he is passionate about getting to a reasonable level of spending on primary care (currently only 5-6% of U.S. healthcare spending is on primary care). He believes doubling the dollars spent on primary care would make significant inroads to address U.S. cost and quality woes.See the newsletter episode #34 for a glossary of some of the terms discussed: https://bit.ly/LTLmoreinfoMeet Roger Fowler, MDDr. Fowler is the Vice President and Chief Medical Director of Quality, Performance and Innovation with CHRISTUS Health, an international not-for-profit health system with hospitals, clinics, physicians and staff in five states and in Latin America.Dr. Fowler envisioned, launched and provided leadership for the department of Population Health for the Trinity Clinic in Tyler, Texas, before that organization merged with CHRISTUS Health. Ultimately, he became the Chief Medical Director of Population Health and Health Plans, and CMO for the CHRISTUS Health Quality Care Alliance (ACO) and CHRISTUS Quality Network (CIN). Most recently Dr. Fowler assumed leadership for the Pharmacy and Quality Improvement departments for the health plan and the Medical Management Department.Dr. Fowler has a broad history of administrative and governance roles, including chairman of the Trinity Clinic board for five years. He began his career as a family medicine physician in a solo practice in 1981 in Kilgore, Texas, providing full spectrum family medicine care. He is a husband, father, grandfather and has been a runner for 43 years.https://www.linkedin.com/in/roger-n-fowler-md-faafp-14513236/RogerNFowler@gmail.comhttps://bit.ly/JAMAarticleEP34https://bit.ly/AAFP_articleEP34SIGN UP FOR OUR NEWSLETTER: https://bit.ly/LicensedToLeadSignup
Josh (@DrJIsrael) is joined by Mike Stanzione, Director of Medicare Advantage @AledadeACO. They discuss the differences between “Traditional” Medicare and Medicare Advantage (including additional benefits offered through Medicare Advantage), some controversies about Medicare Advantage and how Aledade is bringing valued based care to patients in the Medicare Advantage program.
What's the latest move to sell off traditional Medicare to venture capital and private equity? How will this affect your health care? Join host Brenda Gazzar and Dr. Ed Weisbart, board member of Physicians for a National Health Program (PNHP), to learn about "direct contracting entities." What are they? How do they make money? Why is this a problem? And what can we do about it?
What's the latest move to sell off traditional Medicare to venture capital and private equity? How will this affect your health care? Join host Brenda Gazzar and Dr. Ed Weisbart, board member of Physicians for a National Health Program (PNHP), to learn about "direct contracting entities." What are they? How do they make money? Why is this a problem? And what can we do about it?
What's the latest move to sell off traditional Medicare to venture capital and private equity? How will this affect your health care? Join host Brenda Gazzar and Dr. Ed Weisbart, board member of Physicians for a National Health Program, to learn about "direct contracting entities" or DCEs What are they? How do they make money? Why is this a problem? And what can we do about it?
The Friday Five for October 8, 2021: Medicare Advantage Plan Recommendations for 2022 Illustrating Dental, Hearing, and Vision OOP Cost for your Clients Best and Worst State for Medicare Part D Costs Learning from the Facebook Outage Pre-AEP Mental Health Check Register for your FREE RitterIM.com account Mentioned in this episode: 12 Cheapest States for Prescription Drugs 12 Most Expensive States for Prescription Drugs Apple's Tim Cook talks mental health and 'mindless scrolling' Dental, Hearing, and Vision Costs and Coverage Among Medicare Beneficiaries in Traditional Medicare and Medicare Advantage Effective Sales Strategies for Your Second Medicare AEP During the COVID-19 Pandemic Facebook's outage frustrates advertisers heading into the holiday season Get Your Medicare Advantage Sales Contracts Here – Recommendations for 2022 (Listen|Read) Small business owners reveal just how much the Facebook outage affected them Small Business Owners Who Depend On Social Media Are Exploring Other Options After The Facebook Outage These 4 Red Flags Might Mean You're Due For A Mental Health Check-In More episodes you'll like: October 1, 2021 | The Friday Five 5 Insurance Marketing Tips to Help Agents Stand Out from the Crowd Do's and Don'ts of Medicare Compliance International Podcast Day 2021 What Can MAPD Insurance Agents Do Prior to AEP? Articles to Share with Your Clients: 6 Ways to Boost Lung Health The Value of Working with an Insurance Agent Using Basil in Your Cooking Ritter Insurance Marketing eBooks & Guides: Agent Survival Kits: Beginners or Experts Modern Medicare Marketing for Today's Agents The Complete Guide on How to Sell Medicare Advantage Plans The latest from Ritter's Blog: Get Your Medicare Advantage Sales Contracts Here — Recommendations for 2022 The Ritter Platform Launches Provider Lookup, FastTrack, & Lead Sharing for the 2022 AEP Selling Life Insurance to Clients with Budget Concerns Subscribe & Follow: Apple Podcasts Google Podcasts Overcast Podbean Spotify Stitcher Connect on social: Facebook LinkedIn Twitter YouTube Instagram Sarah's LinkedIn Sarah's Instagram
Episode 19 of Retire Hour. Larry Kloefkorn, of Market Advisory Group, joins Matt Goolsby in the studio to talk about tax concerns that were brought up in a recent client meeting and what tools are available to help reduce your tax burden. Medicare Open Enrollment is starting soon, and Bill Vawter, of Market Medicare Advisors, recommends taking a look at both Traditional Medicare and Medicare Advantage to see which would work best for you. Joshua Cicora, CPA with Market Tax Services, goes over some proactive advice to better control your tax picture going into and during retirement. Gerald Eidelman, of Eidelman Law Firm, talks about the importance of understanding how your property is titled and avoiding costly mistakes when making changes.
Traditional Medicare can be complicated. We know that Medicare Part A covers hospitalization and Medicare Part B covers Doctors and other skilled care. What is less clear is what's free, what's not, and how much out of pocket exposure do we have. This conversation is all about how Medicare Supplement Insurance policies work and why most people get them (to cover what could be a huge financial liability). Featuring: Randy Schrupp, MO Licensed Insurance Agent Moderator: Ted Gottlieb, CSA
This short podcast summarizes how "Traditional Medicare" is structured by breaking it down into its essential parts - Part A (Hospitalization Coverage) and Part B (Medical Coverage). We discuss how Part A is FREE (for most), but comes with out of pocket expenses. Part B is optional but essential. Other videos in our collection go into Drug Plans, Medicare Supplement Plans, and Medicare Advantage Plans. Watch the whole series of 5 and you'll be well informed. Featured Speaker: Randy Schrupp Moderator: Ted Gottlieb, CSA
Join Jae Oh and me as we discuss Alabama in our state-by-state analysis of the various Medicare options in each state. Over the course of these episodes, we'll discuss Traditional Medicare, Traditional Medicare with Part D and Medigap, i.e., Medicare Supplements, and Medicare Part C, i.e., Medicare Advantage. Jae Oh, CFP, is an expert contributor on www.mymedicareanswers.com, a website powered by Humana, one of the nation's largest carriers of Medicare plans. Mr. Oh is the author of a top-rated, top-selling book on Medicare, titled Maximize Your Medicare (2018 Edition): Understanding Medicare, Protecting Your Health, and Minimizing Costs, available in print and ebook formats. I highly encourage you go sign up for his newsletter at www.maximizeyourmedicare.com --- Support this podcast: https://anchor.fm/josh-scandlen-podcast/support
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