Medicare Advantage contracts are {CONTRACTS} between and individual and an insurance company that is why in early years DOI in states were not monitoring them. The DOI in states got involved when complaints came in from citizens being ripped off. Have agood weekend and I am sure we will discuss again on another topic
BREAKING NEWS: Healthcare Bill Passed
- Thread starter Pangaea
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- 2,908
Ummm. I don't know. That is what DOI's do is to monitor contracts and related marketing practices between private carriers and individuals.
I am not up on the history of MA's but I would guess that the lack of state regulation had more to do with the fact that when a person has an MA they are technically still part of Medicare even though it is not Original Medicare. Thus, under the Supremecy Clause of the Constitution it is an area regulated by the Feds unless they choose to allow the states to regulate or mix and match as with med supps.
As noted, I am not familiar with some aspects of their history so I can adjust my thinking with additional information.
This has nothing to do about health insurance but I have a story for you..In the 1960's there was a company called the Jewel Box''major jeweler" They had a MQP program for their Managers before they could actually run their first store..They would drop these guys off in a remote area with only a knife and 48 hrs later would go back and get them. If they could withstand that type of situation then they were given a store. Now if that happened today I can see the media jump on it. There was also a company I worked for that had a 2 week version of this. Then you were promoted or fired depending on how you did. I say this to remind everyone that alot of things we are concerned about really are just a small blimp on a screen. I have enjoyed this forum. hope to hear from medicare Solutions soon
- 11,996
Exactly. HMO's and PPO's have to file networks. The biggest change to PFFS plans is now they have to play by the same rules and file a network (unless there aren't two network plans in the county they are in).
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What do you think insurance is? It's a contract between an individual or business and an insurance carrier. Why do you need an insurance license to sell it if it's not insurance? The reason why the state insurance departments may have not been monitoring them early on was, as Winter was thinking through, mostly a turf war because CMS was federal so they thought they should regulate it and the states realize that insurance is their job to regulate so they agreed to cut the baby in half. Any problems CMS has with the plan performance they regulate and anything having to do with the agents and the health insurance company licensing the states regulate.
That all being said, I wasn't in this business in 1985 when MA launched and I haven't done enough research to know who was regulating it then. Given the inaccuracy of most of the comments you've made in this and any other discussion about MA I'm not sure that the states weren't regulating it then.
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- 11,996
Hey medicare Solutions you have got to be a Yankee. That is the only way I can rationize your smart [] comments. So if you like to insult people then I just gave you a reason. Luckily for you you are in cyberspace and that is where you belong.
It's way less personal than you think. I'm even more fun in person!
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