Private Health Insurer Calls itself Medicare to Take Advantage of You (w/ Alex Lawson)

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There are a lot of people confused with Medicare and Medicare Advantage, a knock off for profit health insurance coverage, that wants to cut into medicare.

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27 thoughts on “Private Health Insurer Calls itself Medicare to Take Advantage of You (w/ Alex Lawson)

  1. Thank you for this interview, I have posted this on my Facebook page as most seniors do not understand this. They all think they’re on regular Medicare.

    • what is an elective surgery to you? I am a very experienced claims processor (40 years) in a wide variety of coverages. Elective surgeries are body modifications of any kind unless result of accident or illness, ( these are pretty much universally excluded in the exclusions/limitations section of a policy ) Surgeries which may be medically necessary may be postponed if the patient wants to wait (like joint replacements, hernias, etc) Non life threatening or causing lots of pain and the patient elects to put them off. These are kind of elective but not on the same level as above.. I have Medicare traditional and I don’t want folks having surgeries just to make themselves look good as it just increases the amounts paid out which contributes to increased premiums and deductibles.

      Now I think traditional Medicare for All is The Way to Go. When I was a claims analyst for the Part B carrier back in the 70s the plans were administered by insurance companies, which had to bid every 3 years for contract renewal. Non profit to the carrier but a 3 to 5% administrative expense was given to them for the cost of doing business. Government was not managing the claims at all; we processed per the Manual. A very large book .
      If everyone is on the plan, risk is spread due to sheer numbers and a much younger and healthier client base. Deductibles and co insurance are so much less than commercial plans. I would suggest an income adjustment for the copays . Rather than 100% coverage I would prefer a maximum annual Out of Pocket amount. That could easily be adjusted for income

      One of the things I love about traditional Medicare is the lack of networks, so if you live in one state and need medical care somewhere else your coverage, copays and out of pocket is the same. It should definitely be offered to everyone who wishes to have it: exchanges, employers, individuals etc.

      Medicare has the lowest cost per claim, lowest error percentage, fastest turnaround time, highest customer satisfaction in the industry.

    • +Claire Wood Basically an elective surgery is a surgery that you don’t need, meaning that you can wait months to get it for free by Medicare since you’re not gonna die, while organ transplants and other surgeries that are needed now or else you die are medically necessary surgeries and not elective ones…Got it? Lol Also I agree, Medicare for all is the way.

  2. I just keep my regular Medicare.  I didn’t trust the advantage plans. I felt like there was something sneaky about the Advantage Plans. Thanks for the info and explanations !

    • elaine goad Me, too. I do have a Medicare supplement. And they pay for everything together. I don’t trust the so-called Medicare Advantage. Their ads are not very clear about what they really are. Sneaky. And the younger people don’t know any better, when they are old enough to get on Medicare. But you can change over to regular Medicare.

  3. This guy is so right. They always deny care. I worked member services medicare advantage plans. They deny claims, set up ridiculous rules, high deductibles with drugs. Those on these plans now have two premiums. They pay for advantage plans and they pay for medicare.

    I remember one member had a bad stroke. She was in rehab and then transferred to a nursing home. Nursing home didn’t have equipment to help her and her health went downhill. To make matters worse, every 20 days, she was transferred to a new facility. Lack of consistent care made her worse. Rehab manager estimated that it would take about 3 weeks in rehab for her to recover enough to go home. Insurance denied rehab services three times.

  4. Fraudulent and treasonous behavior may get you elected to the presidency. Rapists having blubbering tantrums confirmed as Supreme Court Justices. Patenting voting machines in China may buy your disgusting father the presidency for an additional four years. Why not this, too? The disabled and elderly are no longer protected in this country.

  5. I see constant ads for MA plans like that Humana dude and it is all garbage. But Medicare for all is NOT the solution. It is unconstitutional for the feds to be invovled. I am on Obamacare, but few that have it can afford the deductibles, and the subsidys are crazy free money to insurance companies…

    • the “Feds” only write the policy Trained claims analysts administer Medicare per the rules. I did this for 7 1/2 years. Back then we were employed by an insurance carrier but they made no profit from it; just an overhead to cover administrative costs. I loved it, this was from 1975 to 1983. Now there is a central claims administration but I suspect the claims people have all worked in medical insurance.

  6. This a bunch of lies!
    Medicare Advantage gets far better outcomes than “straight” Medicare and the plans CANT “fire” patients under almost any circumstances… far from it.
    As for “denials”, I’m glad it denies at least some of the wasteful things that so many try to rip the system off with.

  7. medicare advantage plans cover you the same or better than medicare…They do not compete with medicare they run your nmedicate program……medicare covers 80% of your expenses, the medicare advantage plans help cover the gap…..I like thom hartmann but he is 100% wrong on this….read medicare and you basics……they CANNOT deny claims that medicare approve..

  8. You probably do not know but there isn’t any out of pocket maximum with original medicare…a 200K hospital with original medicare costs the insured 40K , medicare advantage plans do have Max out of pockets that range from 5k-6700….Medicare Advantage plans are MEDICARE Part C that cover your A B D components all in one place…..the person Thom interviewed is devoid of fact…..Medicare Advantage and Medicare Supplements are designed to help cover that 20% exposure from Medicare in fact close to 60% of enrollees have Advantage Plans or Supplements…..The statement that they do not pay claims that Medicare would cover is bereft of any reality….the following is from medicare.gov
    you can get your Medicare benefits through Original Medicare, or a Medicare Advantage Plan (like an HMO or PPO). … Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved byMedicare. Medicare pays these companies to cover your Medicare benefits.  here is the link https://www.medicare.gov/sites/default/files/2018-07/11474.pdf                I love you thom but speak to someone who actually understands the product…………

  9. I have Kaiser Permanente Advantage Plan and highly recommend it. I disagree with Thom on this in this case. Kaiser is a non profit company. Thom does not mention that with his Medicare plan he has “supplemental insurance” which he pays 2 to 300 per month to one of the major for profit insurance companies. He is supporting some CEO’s multi million dollar salary. Oregon and Washington DC have KP and he should check into it. 5 or 6 other states have it. I had surgery 3 months ago and total bills was less than $600. Normal years I pay only the monthly Medicare fee and not the 2 to 300 extra per month. If traveling out of a KP area you can use any Urgent Care for $60 copay or $80 for an ER. Also has very good Pharm plan. You also get free health club card that covers literally thousands of health clubs for free. I use the local 24 Hour Fitness regularly. If I had to join (pay) it would cost me $90 per month. Plus I can use other clubs when I travel or any 24 where I travel. I have used this when camping and traveling just to take showers. Again I highly recommend KP.

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