Key Points
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President Trump made a major announcement about Medicare Advantage at the end of January.
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The announcement could impact the benefits retirees receive in negative ways.
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There could be hidden silver linings in the announcement.
In late January, the Trump Administration announced that it was planning on raising rates paid to Medicare Advantage health plans by less than 1/10 of a percent in 2027. This is a significantly lower increase than health insurance companies anticipated, particularly given that the Administration increased payments by 5.06% in 2026.
This announcement was mostly bad news for retirees, although it’s a bit of a mixed bag. Here’s why.
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This is why the Trump Administration’s announcement is bad news for retirees
The Centers for Medicare & Medicaid Services (CMS) indicated they’ll be raising rates by 0.09%. These are the rates the government pays to private health insurers to provide Medicare Advantage coverage for seniors who opt out of traditional Medicare.
Advantage Plans often cover more than traditional Medicare does, typically including options like vision care and hearing care. They generally also require lower coinsurance costs from retirees.
Unfortunately, the low proposed increase has caused many insurers to threaten that they will cut services for seniors. Some have even said they may be forced to pull out of offering certain Medicare Advantage plans altogether or raise premiums they charge retirees.
None of that is good for seniors.
There could be some good news for retirees
On the flip side, the Trump Administration’s moves could have some benefits, too, as the Administration wants to tighten the reins on Advantage Plans, in part because these plans have been raking in profits — sometimes with sketchy business behaviors.
Some plans have also been engaged in practices designed to pad their bottom lines, including chart reviews that can result in new medical diagnoses being added to patient accounts, even if patients haven’t asked their doctors to treat the medical issues. This results in the plans getting paid more, which is potentially a waste of taxpayer money.
The Trump Administration wants to end this practice, in addition to keeping reimbursement rates lower this year. If the Administration successfully cracks down on abuses in Medicare Advantage, it could make the program more sustainable over the long haul.
Plus, Advantage Plans repeatedly threatened cuts when the Biden Administration only offered small payment increases. Those cuts largely didn’t materialize because Advantage plans still remain very lucrative for insurers.
If cuts do happen, Medicare retirees could also switch back to traditional Medicare. This could be a silver lining, as Advantage plans often heavily market to seniors and tout benefits without mentioning issues like narrow networks and pre-authorization requirements.
There are issues with seniors switching back to traditional Medicare, as most will need Medigap plans to cover some costs that original Medicare doesn’t. This usually means they must go through traditional underwriting for Medigap plans since they didn’t sign up during initial enrollment.
However, if Medicare Advantage plans are withdrawn from their areas, as some insurers are threatening they may do, this opens up Guaranteed Issue windows, which would allow some beneficiaries to avoid medical underwriting.
Ultimately, it remains to be seen if the low increase actually happens, as it’s not final yet. Even if it does, that doesn’t mean the dire consequences Advantage plans are warning about will actually happen. The result could simply be that costs get more under control.
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“Some plans have also been engaged in practices designed to pad their bottom lines, including chart reviews that can result in new medical diagnoses being added to patient accounts, even if patients haven’t asked their doctors to treat the medical issues. ”
OH, so now I see why the clinic I go to insists that I come in every three months, and they are constantly fabricating diagnosis on my chart. I have complained about this, as if I needed to get a new provider, they may not accept me. Or, if I wanted to change insurance companies, they may refuse to insure me. But, even though I’ve been upset over these fake diagnosis, the clinic only removed one. The last time I was there, the doctor wrote that I had kidney damage due to high blood pressure. I DO NOT have high blood pressure. And all my blood work and urinalysis are normal and good.
I have wondered if they get more money if I have more things “wrong” with me. The only thing that is true, is that I do have type 2 diabetes, and I have worked very hard to get my A1c to 4.9. Only take 5 units of insulin a day, and take no other medication, at 74. This is so upsetting. I wonder who I could contact about this. I called Humana and told them, but nothing was done.
I heard that in China, you only pay your doctor when you’re well.
False, I teach in China. You pay for all services up front.
Humana never cared about any of this. It has always been a rip-off organization the 5 years I worked there as an MD. I had to delete diagnoses on charts frequently.
And we just joined Humana… denied what UHC had approved a month prior…
Yet another reason why the USA is ranked 40th (last time I checked) in overall health care internationally by the WHO. How the mighty have fallen….
Rankings by the WHO are a joke. Anyone that believes the WHO is an ethical humanitarian organization obviously forgot about the pandemic.
In the past 20% of medical costs were conceivable since bills were not out of hand. Now that medical services and procedures have skyrocketed out of control, the 20% should be significantly reduced if not eliminated. Seniors paying 20% of a $150,000 surgery will be responsible for 30K plus RX, there is no cap to their annual expenses. Horrible debt. Original Medicare should pay all medial expenses since the gov’t is already taking 203.00 each month out of our Social Security checks for the premium.
Advantage Plans often cover more than traditional Medicare does, typically including options like vision care and hearing care. They generally also require lower coinsurance costs from retirees? FALSE
The vision and hearing care offered is like crumbs, it is not worth it for what you really get. It is not full coverage for the services, and you can only go to the doctors they say you can (in network). Advantage plans (which are not real Medicare) often deny coverage for seniors when they need it most. With Real Medicare you can choose any doctor, any hospital in the country, and NEVER need preapproval like an advantage plan!
Medicare Advantage plans are great and give more benefits than traditional Medicare.
medicare advantage plans are no good for nobody at all the public are being robbed by them stay with a regular medicare plan , end of story . nobody should be telling Seniors what to do
Medicare Advantage plans are great and give more benefits than traditional Medicare.
My MAJOR health insurance company cut all their Medicare Advantage Plans. I had to find a new plan and it offers less coverage and costs more. Trump is evil. Trump is a selfish, corrupt, convicted felon, con man, child rapist, liar, douche bag who only cares about himself, and is raping and robbing us all blind, while on an unstoppable crime spree. I hate him with every fiber of my being.
This is not the place for hate speech……you can always leave the country if it’s so bad.
TDS much? Listening to propaganda is never healthy and will cause you to make poor decisions.
Anthem dropped advantage plans so I switched to United Health. I need my membership for the YMCA to be paid. The water aerobics and strength training are great for seniors. I love swimming, Our group is emblematic of the Y culture.
Don’t let your insurance talk you into letting someone come to your home for health screening. they charge Medicare over $300.00 for their 45 minute visit. Does not do anything different than an annual office visit.
MEDICARE ADVANTAGE IS NOT THE PLAN IF YOU HAVE MULTIPLE MEDICAL ISSUES REQUIRING TREATMENTS. THEY WILL NOT COVER OR DEMAND YOU GO TO A PHYSICIAN OF THEIR CHOICE. I HAVE LUPUS, RHEUMATOID ARTHRITIS,
AUTOIMMUME DISEASES, SQUAMOUS CELL CANCER REQUIRING NOW RADIATION THERAPY. THE SICK PATIENT CAN ONLY BENEFIT FROM TRADITIONAL MEDICARE. I AM A RETIRED NURSING MANAGEMENT NURSE. IF I DID NOT HAVE MY MEDICARE POLICY, I WOIULD BE DEAD ALREADY!
Partly or in entirety, a body riddled with disease is usually a result of not living in a healthy healthy manner regarding diet , exercise, and bad recreational habits and neglecting to make necessary changes. Do not blame Medicare for your medical problems. It is not perfect but it better than paying retail. Been in Advangage 15 years and have had no problems getting a referral getting seen by a doctor who doesn’t take it.
I am a retired goverment worker and have been on Medicare and GEHA for years. Recently switched to an Advantage plan administered by United Heath Care. I was nervous about making the switch but so far so good plus they take $80 a month less out of my Medicare payments. Not really sure what the downside is but I was assured that I could switch back if I was not satisfied with the Advantage plan. Did I make a mistake?