![]() According to federal audits, the practice of “upcoding” crossed the line into fraud. This occurs in part because a bonus system awards extra dollars to plans that achieve high quality ratings from Medicare.Īdvantage plans have also been found to submit to Medicare inflated bills that over-diagnose their patients. Payments by the federal government to Advantage plans average 102 percent of its spending on the fee-for-service traditional program, and that contributes to higher overall Medicare spending. The shift will also mean higher costs for taxpayers and all Medicare beneficiaries, some experts say. A federal investigation concluded last year that tens of thousands of people in Medicare Advantage plans were denied necessary care that should be covered. These include the requirement to use physicians and hospitals in their plan’s narrower network, and reduced access to care in some instances. Retirees who are shifted into Medicare Advantage plans may not fully understand the major differences from traditional Medicare. And enrollment is projected to cross the 50 percent threshold as soon as this year, according to K.F.F. Nearly half of Medicare beneficiaries were enrolled in Advantage plans last year, more than double the rate in 2007. Advantage is an alternative to traditional Medicare offered by insurance companies, and it uses managed-care techniques to control costs. The growth is part of a bigger story about Medicare Advantage expansion. And roughly 44 percent don’t give retirees a choice to use traditional Medicare within their programs. ![]() Half of large employers offering benefits to Medicare-age retirees have contracts with Medicare Advantage plans, nearly double the share in 2017, according to the Kaiser Family Foundation. Many employers have dropped these benefits over the past several decades, and those that still offer them are shifting retirees into Medicare Advantage plans at a rapid pace. It pits the drive to control health care costs against retired workers’ pocketbook and health concerns. The fight in New York City is a highly visible example of a nationwide shift in the way some retirees receive health insurance benefits from former employers, both in the public and private sector. Their battle has continued into this year, with a group representing city workers voting Thursday to approve the latest Advantage proposal. ![]() The city’s plans for Medicare Advantage became bogged down in litigation and political battles, with the opposition led by a group of New York City retirees who organized to fight not only the city but their own unions. Bentkowski’s surgery was covered under traditional Medicare. “They just give you the runaround - how am I going to join the plan when I don’t know what it will cover?” But after hours on the phone with the insurance company, he was told that it couldn’t give him an answer until he enrolled. “I was panicking about what might happen if I moved over to this new plan, since I was only a month away from the surgery,” Mr. Aiming to save $600 million annually, they were negotiating to shift 250,000 retirees out of traditional fee-for-service Medicare into a privately operated Medicare Advantage plan. But with his transplant approaching, the city, and a coalition of its labor unions, had thrown Mr. New York City has long provided its retired employees with comprehensive health benefits that pay for most of their Medicare costs. ![]() He needed a transplant, and in the fall of 2021, he found a donor after waiting for years - but he was unsure whether Medicare would cover his surgery. Bob Bentkowski, a retired New York City firefighter, has a rare, painful disease that caused his kidneys to swell almost to the size of basketballs. ![]()
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