MAGA is coming for Medicare & Will Require Prior Approval in 6 state pilot program. Thanks again MAGA! I'm SURE older folks will STILL VOTE MAGA?

[DrPepper12]

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. The new model relies on an additional set of private companies for traditional Medicare that have a very clear incentive to deny care.

Private plans under Medicare Advantage have become increasingly popular, with a little more than half of older Americans and people with disabilities eligible for the program and some 34 million enrolled. But many are willing to forgo some of the additional benefits the private plans offer, like dental checkups and gym memberships, to avoid having to jump through numerous administrative hoops to get care.

How insurers make their decisions remains opaque. A spokesman for Health and Human Services, which oversees the Medicare agency, declined to identify which companies had submitted applications for the contract.

People enrolled in traditional Medicare who live in Arizona, New Jersey, Ohio, Oklahoma, Texas and Washington State will be included in the pilot experiment, which is expected to start in January and last for six years.

I'm so surprised they lied & betray their cult

Don't fuck w/ seniors - red or blue - they ALL vote!

It's just a pilot not a slippery slope or privatization

[WindAtMyBack]

Since you didn't actually say what this is program is, I looked it up.

1) This plan is only for traditional Medicare, NOT Advantage plans which already have a prior approval process.

2) This plan ONLY targets a limited number of specific procedures that are prone to abuse and are of questionable benefit. Everything else is unaffected.

3) This does not affect Advantage plans, which are already private insurance companies, and already require prior approval.

( This is lengthy. But Medicare is very complicated. )

When people reach the age for Medicare (65), figuring this stuff out is overwhelming. So here is a basic summary.

Medicare is the national health care system for older people. It typically starts at age 65. There are limited exceptions for younger people.

If you are collecting Social Security at the time you turn 65, enrollment in Medicare is automatic. I don't know how it works if you are not getting SS. I assume you have to enroll manually.

You are not technically "required" to enroll in Medicare, but they REALLY want you to do it. It is automatic. If you don't want it, you have to opt out. To opt out, you have to go to a Medicare office in person and talk to someone who basically asks, "Do you really want to do this? Are you absolutely positive?".

Now it gets more complicated.

Medicare has two basic parts.
Part A which is for hospitalization.
Part B which is for normal office visits and outpatient procedures.

Part A is "free", meaning you paid into it your whole life, so there is no additional cost when you enroll.

Part B is NOT free. I think it currently cost about $176 a month. This is also automatic and is deducted from your Social Security check. You can opt out of Part B separately from Part A (which is what I did initially).

Skipping Part C for now.

Part D is for prescription drugs.

You can choose to keep your basic Medicare, OR you have a couple of other options.

"Supplement" plans don't replace your basic Medicare, but supplement it. It covers co-payments, deductibles, and stuff like that. This is often called "Medigap". You pay a fee for a supplement plan. It's basically additional private insurance that you pay for.

Advantage plans.
An Advantage plan is the same thing as Medicare Part C.
These plans "replace" basic Medicare - both Part A and Part B. They might also include Part D.

They don't really replace it though. The government just contracts private insurance companies to implement it. It is still Medicare, and still covers all the stuff that traditional Medicare covers, plus some extra perks and coverage. The perks are required by the government.

There is a huge variety of extra perks and extra coverage. They usually include lower co-payments, lower out-of pocket, and an out-of-pocket cap. (Basic Medicare has no out-of-pocket cap which makes it very risky if you have expensive medical costs.)

The OP already mentioned a couple of other perks, such as dental or gym memberships. ( Look up "Silver Sneakers" to learn about the gym membership. )

A perk that I can get on my plan is an Apple smart watch up to $300 value. Another common perk is "free" over-the-counter stuff from the pharmacy - everything from eye drops, to lotions, to blood pressure checkers.

The thing is that Medicare and Advantage plans are EXTREMELY wasteful, like pretty much everything else the government does.

[OneViewpoint]

Anyone who reaches retirement age and escapes our corrupt private health insurance program and then signs up for a Medicare Advantage Plan is a moron. Those plans are the result of lobbying by the private health insurance industry to weasel their way into Medicare and the huge market for senior healthcare. Out of pocket costs are actually huge and denial of coverage is the path to profits with customers who die on a regular basis.

Medicare Advantage Plans ARE NOT Medicare.

They are the same FOR PROFIT private health insurance that has kept you poor your entire working life.

Sadly, most of our population are too stupid to realize that Medicare has been already been corrupted with Capitalism. Fuck em. Let them choose poverty and death.

[Anonymous]

Medicare is unaffordable to taxpayers due to obesity.

[DrPepper12]

RFK is on the case!

[Opinion Owner]

The issue starts at home. If you are eating double and triple portions of what you should every day you will become obese.

[Bricealan]

@DrPepper12 Exactly WHAT cult' are you referring too? Jim Jones had a cult, and they all died in Africa... Branch Dividian was a cult, and they set their building on fire and all burned to death... THOSE were Cults

Are you even sure what constitutes a 'cult'... you should know that before you make that statement on here like MANY others that do not even know what a 'cult' is?

[blackeagle007]

lol shut up you tool

[DrPepper12]

@blackeagle007 TY @blackeagle007 😂

[Avicenna]

Ah, yes, leftist propagandists still trying to lie to us.

Pepper, the federal government itself admits we have huge unfunded liability for Medicare:

https://fiscal.treasury.gov/files/reports-statements/financial-report/2023/02-15-2024-FR-(Final).pdf

So what do you suggest we do about it?

[DrPepper12]

Let's start with no cap on payroll tax. 🤔

[Dargil]

Completely false

[DrPepper12]

Not just a river In Egypt...

[Dargil]

Wadi Mukattab? I think not.

[Miristheiss]

Wokie strikes again.

You should go work for MSNBC.

[FunkyMonkee]

And then you woke up from your little fever dream.

[exitseven]

Social Security and Medicare will not be touched. Medicare Advantage is NOT Medicare.

[Anonymous]

don't care. let the young inherit the country and fix up the mess you created

[RedInnocent69]

My surprise just won’t stop laughing

[seeyounexttuesday]

Ok, and?