Medigaps Going Up. What Happens to MA Premium?
- Thread starter brooks
- Start date
- 11,996
Bob, you're talking out of your a ss. You don't even know what an ASO is, isn't that a group health thing and right up your ally?
You bowing out because you can't admit that you're wrong?
You bowing out because you can't admit that you're wrong?
MPS, call it whatever you wish. If you want to believe the plan is fully insured, then in your world it is.
Of course that makes it subject to Obamacrap rules including MLR.
I was writing ASO plans, with and without agg cover, before you were born.
Of course that makes it subject to Obamacrap rules including MLR.
I was writing ASO plans, with and without agg cover, before you were born.
- 11,996
At least one of us is an ***, my money is on Bob.
- - - - - - - - - - - - - - - - - -
Bob, no matter how old you are the math is the math. If the carriers were only getting paid their admin, were helping reduce costs by managing them the way they are now, and Medicare was assuming 100% of the risk there would be a cost savings.
- - - - - - - - - - - - - - - - - -
Bob, no matter how old you are the math is the math. If the carriers were only getting paid their admin, were helping reduce costs by managing them the way they are now, and Medicare was assuming 100% of the risk there would be a cost savings.
Last edited:
- 11,996
Dude, you're dumb as a bag of hammers. I don't want them fully insured, quite the opposite, I want them ASO with the carriers actually managing the claims with the types of policies and practices they're using now.
SrFinAdvisor
New Member
- 19
The original idea was that these plans would save money vs what is spent under original FFS Medicare. You can trace it all the way back to the '70's in CA. (Kaiser Permente)
The plans were paid a capitation rate that was approx 95% of what FFS Medicare was spending. The plans spread across the country, but began to fail by the mid '90's because the payments were not keeping up.
You can track a whole series of bills designed to expand these plans (such as the BBA in '97, the MMA in '03), or shrink them (such as MIPPA in '08). These plans have expanded and contracted like a pendulum on a clock. The current direction is shrinking. The payments are getting smaller, more plans will be exiting next year, and managed care will be the only thing standing (PFFS is dead).
The main point...follow the money..It has become obvious that the idea is a failure. It only works when we overpay for the coverage. Or another conclusion is that the government would rather let the private companies do the dirty work of rationing care that is inevitable here.
The plans were paid a capitation rate that was approx 95% of what FFS Medicare was spending. The plans spread across the country, but began to fail by the mid '90's because the payments were not keeping up.
You can track a whole series of bills designed to expand these plans (such as the BBA in '97, the MMA in '03), or shrink them (such as MIPPA in '08). These plans have expanded and contracted like a pendulum on a clock. The current direction is shrinking. The payments are getting smaller, more plans will be exiting next year, and managed care will be the only thing standing (PFFS is dead).
The main point...follow the money..It has become obvious that the idea is a failure. It only works when we overpay for the coverage. Or another conclusion is that the government would rather let the private companies do the dirty work of rationing care that is inevitable here.
- 11,996
It may be obvious, but that doesn't mean it's true. The root problem here is that we're not comparing apples to apples. We're comparing apples platypus eggs. In a fair fight private sector would save piles in actually managing the care over what the government is spending in their recklessly lackadaisical approach to just paying claims and not making any meaningful attempt to actually cut down on spending. Tell UHC they can administer the Original Medicare benefit for every member that is on it for 95% of what Medicare projects the cost to be and there is a good chance they'd sign off on a deal like that and everyone would win, but that's not at all the the direction we're headed in. From the court of public opinion's perspective MA is a failed venture, and I have to agree, but not because it isn't viable. The reason why it's a failed venture is that the carriers have been constantly struggling with the three ring circus and madness that is the entirety of having a Medicare contract. Filing for state insurance licenses, building provider networks, hiring companies to help do health assessments to ensure extra compensation, helping folks get enrolled in LIS so they can get more subsidy money from the government, dealing with the insanity that is the witch hunt of finding the evil insurance agents, constantly redesigning benefits before the loss ratios even begin to hit, shifting reimbursement from county to county, unfair competition, fair competition, ridiculous enrollment rules, and the list goes on! The reason why it has failed is because it has never been given a fair shake at it, not because it only works when we overpay for the coverage. That is a total and complete fallacy.
Not that I have an opinion on such things
Similar threads
