A legal Medicare scam

Joan McCarter of Daily Kos reported that Biden is starting to campaign on behalf of Democrats for the midterm election in less than three months. Biden is talking about the Inflation Reduction Act, the mini Build Back Better bill he campaigned on. And he’s making one point clear: As he discusses the various parts of the bill he says “Every single Republican—every single one—voted against” it. Biden’s approval rating has been going up since he tested positive for COVID about a month ago. Signing this bill is helping that rise. Alas, it’s still in the low 40s. In another post McCarter reported that Democrats need to emphasize one more aspect of their opponents. Republicans are siding with the super wealthy and special interests – the extreme MAGA agenda. Josh Shapiro, the AG of Pennsylvania and nominee for governor is naming that other aspect. McCarter wrote:

They are dangerous. They pose a real threat to the physical safety of teachers, librarians, health care workers, LGBTQ people, Jews, and Black and brown people, not to mention their newest targets: federal law enforcement personnel.

That new law Biden is campaigning on has a big chunk of money to upgrade the IRS and hire more workers. Bill in Portland, Maine, in his Cheers and Jeers column for Kos, quoted NBCNews which said Sen. Rick Scott is warning people not to take those IRS jobs because when Republicans take control of Congress the jobs will be eliminated. McCarter explained why the IRS needs that money for upgrades. They’re still 10.2 million paper returns behind. Their computers are 2001 models. They can’t scan paper returns, so have to enter numbers by hand. As for personnel, they’ve lost 20% of their staff since 2010 and one-third is eligible for retirement. Then McCarter reported on what else Scott said. He’s demonizing the IRS the same way Republicans have begun to demonize the FBI. That will prompt their base to start attacking IRS agents and offices. They’ve already started attacking the FBI. Which brings another meaning to eliminating the job. In a Ukraine update from a couple days ago Mark Sumner of Kos wrote about another huge explosion deep in Crimea. This one blew up a stockpile of ammunition and equipment near a railway. A nearby electrical substation also went boom. That’s important because the rail line is electric. As before, this is a long way from Ukrainian held territory. It isn’t out of range from long range missiles, but there is no evidence missiles were used. The earlier explosion at a Crimean air base left a lot of speculation as to how it happened. I had written about that few days ago. This time, as the New York Times reported, a Ukrainian official said the explosions were because of “an elite Ukrainian military unit operating behind enemy lines” – it was sabotage. That can’t look good for Russia. It means Russia’s control of Crimea isn’t all that good. Julia Davis of The Daily Beast tweeted a video and a link to a recent article with the words:

Meanwhile on Kremlin-controlled Russian state TV: top propagandist Vladimir Solovyov bemoans the search of Mar-a-Lago and says, “I’m very worried for our agent Trump.” Russian talking heads conclude that their favorite Presidential contender is royally screwed and ponder whether he might even be included in a future prisoner swap.

In an article posted two weeks ago (just after my vacation) Thom Hartmann of the Kos community and author of the Hartmann Report wrote about the Medicare Advantage plans being a scam. It’s a scam making insurance companies rich, a scam that is legal. You can blame Bush II for this situation. Advantage plans (and I’m on one) are not Medicare. They are funded by Medicare but are really private insurance plans with all the scary problems of regular insurance plans. That is hidden because they can brand their product as “Medicare Advantage.” Since they are private insurance plans they can deny care, including life-saving care. Yes, they can deny care that Medicare covers. There are also a lot of copays and deductibles. Another aspect is these insurance companies are paid not by the doctor visit, test, or hospital stay. They’re paid by the “risk score,” by how sick the patient is – and they routinely lie about it. When I was first on my Advantage plan I was called with an offer where a doctor would come to my house and do a complete physical and check for things in the house that might be injurious to me. I said no – they likely would find something. I later found out that’s the point – they would find something. And for every tiny something, either in my physical self or in my home, they could “upcode” me, declare I’m sicker, more of a risk, than I actually am. The insurance company gets more money from Medicare without much more in expenses. A 2014 report from the Center for Public Integrity showed that Advantage plans cost taxpayers billions more than they should. They overcharge without consequences. An example of denial of care is the experience of “Sam.” He had a really high prostate PSA number, a sure sign of cancer that was likely aggressive. But the Memorial Sloan Kettering Cancer Center – the best in the country – was not one his Advantage plan included. That plan included none of the cancer centers in NYC where Sam lives and a third of all Advantage plans nationwide don’t include any national cancer centers. And here’s the kicker. If one first signs up with an Advantage plan then tries to go to regular Medicare with a supplemental plan any condition first uncovered while on the Advantage plan can be declared a pre-existing condition and not covered. That may lock a person into an Advantage plan. My experience with my Advantage plan is mixed. So far they haven’t denied any specialist or test, though some of the tests included a copay and some low cost medications aren’t covered. However, they say if a doctor or a facility is not in network I have to pay 30% of whatever the doctor or facility bills (Medicare requires I pay only 20%). They have no idea what might be billed so can’t offer a price comparison. A big part of that is finding out whether a doctor is in network or not. The insurance provides a website to see if a doctor is in network. But I’ve had a case where the website says the doctor is not (because the name doesn’t come up) yet the doctor’s office says she is. Then there is the hassle of of that website giving me the name of every doctor with a particular specialty (which can be a long list) yet have a hard time telling me which of those doctors are members of my health system (where all my records are). I want out of this particular plan. Then I’ll have to choose between a different Advantage plan or a Supplement plan. I searched for “switching Medicare advantage to supplement” and one of the sites that came up is medicare.gov. Best to go straight to the source. This is some of what it has to say about switching. First, one must dump the Advantage plan and go back to straight Medicare. That is always possible.

Once you’ve returned to Original Medicare, you can apply for a Medicare Supplement plan anytime you want – but your acceptance into a plan isn’t always guaranteed. For example, if you have health problems, the insurance company can base its decision on your health history in a process known as medical underwriting. The company can decide not to sell you a plan, or to charge you more because of your health condition.

That underwriting is not necessary if one first enrolls in a supplement plan. When dropping an Advantage plan one will likely need to enroll in Medicare D prescription drug plan. The corporation I retired from (gosh, 15 years ago!) contracted with a company that helps their retirees navigate through the Medicare morass. I had long talks with them before signing up to my current plan and I anticipate I’ll have long hours with them this fall. I long for the day when American health care for everyone is as simple as: “You see a doctor. You’re covered.”