Data show clear economic divide between MA and FFS Medicare enrollees

[Northeast Agent]

https://www.fiercehealthcare.com/pa...e-between-ma-and-ffs-medicare-enrollees-white

MA enrollees have less money and face greater challenges in overcoming the social determinants of health (SDOH) than enrollees in fee-for-service (FFS) Medicare, Boris Vabson, Ph.D., one of the white paper’s co-authors, told Fierce Healthcare.

“Medicare Advantage is an upscale version of Medicaid in the sense that it provides more benefits,” said Vabson, a researcher and health economist at Harvard Medical School. “It provides lower cost sharing. There are some restrictions in Medicare Advantage that aren’t in fee-for-service Medicare. But for someone who may be economically disadvantaged, it’s a really great deal to enroll in Medicare Advantage.”

 

[somarco]

But for someone who may be economically disadvantaged, it’s a really great deal to enroll in Medicare Advantage.”

I don't follow this.

Low/no premiums are great for those with low gunwales, but if they can't afford care, what good is it?

Seems like the health care equivalent of "buy here pay here" car lots. We can put you in a car today but when it breaks down you may not be able to pay for the repair.

 

[StephanieCJ]

There are people who simply will not pay the premium for a MS, (for various reasons). In that case, MA is better than nothing to put a cap on possible expenses. For people who qualify financially for other assistance, it can be a good option to add quality of life items (such as food and dental) while not costing them anything extra.

 

[yorkriver1]

The medical debt of lower income, but those not low enough for Medicaid is a big difficulty. I do know of someone who could only afford an MAPD who received help for their cancer treatment bills from the hospital, probably based on income only unlike Medicaid.
This is a circumstance that reminds me Aged Blind and Disabled Medicaid (over 65 or on Medicare for disability) has a much more strict income and asset requirement than the Medicaid for adults 19 to 64. This is the next glitch that needs adjusting.
Also spent a few minutes earlier today with advice to a former ACA client who now has a good state job, granted not big income, but some benefits. Income of course is considered "affordable" for ACA as larger enterprises (over 50) are monitored for the rules requiring "affordable" plans, usually more owed out of pocket on medical expenses than the more costly plans. The advice was to keep contacting the hospital about the application made for assistance with bills earlier this year. Had to explain that Medicaid could be accessed after a level of money owed, probably several thousand dollars.. Some services that aren't from the hospital may not have such a program. In my state income under 200% of Federal Poverty Level can apply to the hospital to have their hospital bills waived. Some health systems include doctors and some don't.

 

[InsuranceGuy29]

There are people who simply will not pay the premium for a MS, (for various reasons). In that case, MA is better than nothing to put a cap on possible expenses. For people who qualify financially for other assistance, it can be a good option to add quality of life items (such as food and dental) while not costing them anything extra.

I agree and I’d also add that the way the author is (maybe slyly) trying to insinuate that Medicare Advantage is basically a form of Medicaid for the poor is absolutely beyond laughable.

Like it or not, Medicare Advantage plans have only gotten better every year. Many of them are now phenomenal.

I can only speak for me personally, but if I was retiring, had the money for a supplement, and was going onto Medicare, I would personally choose Medicare Advantage for myself.

Is that gonna be the right fit for everyone in every state? Of course not. But there’s no way in hell I’m burning an extra $250-$300 per month on insurance premiums (when you factor in the extra dental/vision and PDP plan you need to purchase) if I don’t have to.

Me personally, I’m taking it, investing it, growing it, and using it to pay for any medical costs that may arise in the future.

The Advantage plans still need to cover absolutely everything original Medicare covers, and (as we all know in here) gives many extra forms of coverage.

Another key component no one talks about is many plans also give unlimited hospital days coverage, and original Medicare does not.

People act as if getting a supplement means you are just covered on absolutely everything, no matter what you have done, and you can have anything done with no restrictions.

Uh no, that’s actually not the case at all. There are a lot of restrictions of coverage on original Medicare. All the supplement does is cover you MONETARILY for the huge 20% original Medicare leaves you vulnerable to. It doesn’t mean you’re getting anymore coverage though.

But as far as the actual coverage they provide, there are restrictions and even some prior authorizations that are always conveniently left out.