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Medicare Advantage in Podcasts

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Medicare Advantage, a private health insurance plan that contracts with Medicare to provide benefits.

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15 mentions

Mentions in Podcasts

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

Insurers have defended their practices. They've argued that some of their practices lead to diagnosing patients with serious conditions sooner so they can get the treatment that they need. They argue that their practices lead to better outcomes for patients and end up costing beneficiaries less than traditional Medicare.

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

And in Medicare Advantage, the incentives are basically to make patients look sicker on paper because insurance get paid more when they do that.

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

As they went through the data, something stood out to Chris. There were diagnoses on patients' records that were put there by insurers. This is important because of how Medicare Advantage works. For certain kinds of diagnoses, many of which are expensive to treat, the private insurer gets an extra payment from the government. That payment is meant to cover the cost of treatment.

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

In 2023, the investigations team got their hands on Medicare data that goes back about a decade. The information included things like service charges and other records.

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

Medicare Advantage cost the federal government more than $460 billion last year. That's a lot of money.

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

Welcome to The Journal, our show about money, business, and power. I'm Jessica Mendoza. It's Friday, June 6th. This is Medicare, Inc. Part 1. How private insurers pocketed billions from Medicare. So, Ana, Chris, why did you guys want to look into Medicare Advantage in the first place?

The Journal.
Medicare, Inc. Part 1: How Insurers Make Billions From Medicare

In total, what we determined was that Medicare Advantage insurers over a three-year period had got paid $50 billion for diagnoses that they alone added to patients' records. And what astounded me was basically the magnitude and just the total amount of dollars that they were getting from sort of chasing that incentive to make people be sicker on paper.