Government crackdown and legal entanglements take all the fun out of the Medicare Advantage plan bonanza.
By Wolf Richter for WOLF STREET.
Humana is one of the big health insures with Medicare Advantage Plans that have come under intense scrutiny from this Administration, from the prior administration, from Congress, from legal actions, and from investigative reports in the media, amid allegations of dramatically overbilling Medicare. These insurers are facing a full-blown government crackdown.
But it was so sweet while it lasted, generating huge profits, big revenue gains, and a massive run-up of the price of the stock: Humana’s shares – along with others in that arena – shot higher and higher from 2017 through 2022. But amid that crackdown, revenue growth has stalled over the past few quarters, and Humana posted a big loss in February.
Humana’s shares [HUM], which started cratering in November 2022, have now entered our pantheon of Imploded Stocks, for which the minimum requirement is a plunge of 70% from the more or less recent all-time high. Its shares today fell 1.8% to $166.01, down by 71% from the all-time high on November 3, 2022, and down by 37% from a year ago, and pretty exactly back where they’d first been 11 years ago, in March 2015 (data via YCharts).
This is what happens when corporate revenue growth, profits, bonuses, and lucrative stock-based compensation plans depend on overbilling the government, and the government finally belatedly gets tired of it, and cracks down.
Medicare Advantage plans are a semi-privatization of Medicare under which the government pays the health insurer a monthly amount for each of their enrollees, and the insurer then pays for the treatment of the enrollee (the enrollee pays for Medicare Part B and some also pay a premium for the Advantage Plan). Advantage Plans include prescription drug benefits and assorted other benefits, caps, and reductions.
The monthly amount that the government pays to the insurer for each enrollee rises with the health problems the enrollee has. So, inevitably… if the insurer “finds” more and bigger health problems, or exaggerates existing health problems, they can claim substantially higher monthly fees, even if those health problems don’t exist, or never get treated. And the government pays them for it.
This type of overbilling led to higher costs for Medicare, and part of those were passed on and led to higher Medicare Part B premiums that seniors pay. According to a report by the US Congress Joint Economic Committee earlier in March, “in 2025 the federal government paid Medicare Advantage insurers an estimated $76 billion to $84 billion more than it would have cost to cover the same beneficiaries in Traditional Medicare.”
The committee found that “overpayments increased Part B premiums by $212 per enrollee in 2025, totaling $13.4 billion in higher premiums.”
And it found that since 2016, these overpayments “have added an estimated $82 billion to Part B premiums.”
But every dollar that was overpaid by the government added to the revenues and profits of the insurers. And the incredible trajectory of their stocks from 2017 through 2022 shows that.
And there are other aspects, as the Medicare overbilling scandal has metastasized. For example, a federal court ruled last week that Humana, CVS Health subsidiary Aetna, and Elevance Health, must face a civil lawsuit that alleges, based on a whistleblower that came forward in 2021, that the insurers paid “hundreds of millions” in kickbacks between 2016 and 2021 to online brokerages to steer people to their Medicare Advantage plans – because those Advantage Plans were so immensely lucrative to the insurers.
Humana has also gotten caught up in allegations that it had been overbilling the government for Medicare Part D (prescription drugs) plans, and settled a number of those cases, including for $90 million in 2024, a whistleblower case brought by one of its former actuaries.
But as far as investors and Wall Street analysts are concerned, the bigger the Medicare overbilling, the better because it made everyone a lot of money. Just don’t get caught.
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THANKS for helping put the spotlight on these egregious MedicareAdvantage Plan practices. It really is scandalous and sad.
Just like the fraud in MN, CA and elsewhere in various gov’t connected programs…this graft has been going on for a long time.
Gov’t is and has been part of the problem: both from management and oversight povs.
and yet my wife paid nearly $5,000 for copays, office visits in 2025
under advantage by United
Who would you propose cover the elderly instead? Do you think any private company would be insane enough to cover what are essentially ticking time bombs of catastrophic healthcare costs?
Even that paragon of free markets, Ayn Rand, went on Medicare when the free market rightly told her there was no profit in covering an elderly person who smoked like a chimney. If government is the problem, what is the solution for her and people like her?
Slogans are nice for winning elections. The hard part is the details, as Reagan learned when he exploded budgets after he got elected. If government was the problem, why did he increase spending?
Thanks wolf
Are there any good providers of this stuff?
Everyone I know who is on any kind of Medicare plan loves it, compared to what they had before — and the costs involved.
This isn’t about enrollees being unhappy, it’s about the government getting screwed. Enrollees got some of the benefits because plans were able to fund them by screwing the government.
Medicare is complicated and confusing, and everyone has to make their own careful decisions. Advantage plans differ, as do providers. There are also difference by state. These are very complex decisions.
You might want to ask people in your area what plans they’re happy with.
I’ve been on medicare a couple of years, and the supplemental medicare coverage insurance, “Plan G” costs a little more than the advantage plans, but is far superior IMHO. It basically covers everything covered by medicare but pays the 20% not paid by medicare for parts A & B. There is no underwriting whatsoever with Plan G supplemental plans. Very simple.
Humana Medicare Advantage customer here. Don’t have too many issues with the company itself. Have serious issues with the claims processing intermediary, Optum. Those folks are constantly harassing me to schedule appointments with my GP. I block all their calls. I’ll see the doc when I need to see him, not before. If I need a referral to see a specialist, they want to send me to providers about 20 to 30 minutes away despite the fact that my PCP is little more than a mile away. Can’t afford to schedule appointments with these referrals…but I’ll bet they’re charging Medicare for every one of them.
Humana does pick up the tab for just under half of the Part B premium. No other insurer offers that option in my area. Only issue with Humana is with Rx copay. Have to jump thru hoops every year to get my generic Rx reclassified in a lower Tier. Silly.
I have a Humana Advantage plan. It’s a PPO plan that returns $90/month to my SSA benefit. I pay -0- for meds. My out of pocket in the past year consists of $35 for an Opthamologist , and $117 for a dental crown
Our system favors wealthy, educated, geezers like me. Health care can’t be good under capitalist models because more supply just increases demand! We would save lots by nationalizing it, despite all the problems inherent in that. Having a healthier population is integral to national security.
I have shorted hum twice… Once post unh news 358+…the 2nd time 304+ was in anticipation of bad news specific to hum. They were the last co to disclose.
It was odd to see the mkt assuming hum were good actors in this.
They all hire from each other..they all do the same things… Fraud
Get BC/BS so you can pick your out of service area provider if need arises. Extremely important if you’re not close to a regional medical Center like TMC in Houston, Stanford in Wolf’s neighborhood, Cleveland Clinic. Medical tourism is alive and booming within the US. It’s your life and you must be proactive and find the best provider for your situation and hound your local provider for a referral. My own provider is the largest in Hawaii and denied my referral. I went to MD Anderson direct and they had me approved for out of service area in one day.
Biggest recent bummer was the significant yearly cap increase for Advantage customers. Mine is now over 7K, They also take nearly $500/mo from SS extra because I still work and make North of the cut off line. And SS is taxed both ways. 15.4% off my income for SS/MC and then taxed on it when I get it.
But it comes in handy if you have a medical incident over $10k per year which happens once you get over 50 or so.
In the end you have some choices:
Spend it
Leave it to your spouse
Leave it to your kids
Leave it to your dog
Spend some of that hard earned coin on your own health because life above ground is waaaaay better than ashes in an urn for most people. And grandkids in the yard is still a great way to enjoy the sunset years.
Guess who made his name in the Medicare fraud game? Florida senator Rick Scott! But no one cares.
Yup, former HCA ceo that saw his company split in 3 cuz of fraud in the great state of Florida
I do. I HATE Rick Scott. He also scammed the state twice with his railroad. He turned down federal funding for rail because that would be “socialist” and then turned around and state subsidized his buddy’s rail system.
Give the kid the damned Nobel Peace Prize……
Or that phony Nobel Econ Prize if you think “conservatively”……..
And don’t go moral on me unless you have killed while others are trying to kill……you for God and country…..aka….”served”…..
(which you have not……Wolf)
R.D. Laing’s famous quote on experience, highlighting the fundamental, unbridgeable gap between subjective realities, is:
“I cannot experience your experience. You cannot experience my experience. We are both invisible men.”
Cheers to best efforts!
Time for a slap on the wrist.
Fraud of this magnitude will probably force the board of directors to cut CEO’s bonus by 20%.
Forget that, if they know how to look out for #1 then investors reward you!
Haha
You know just don’t go full Nahhhzeee, never go full Nahhhzeeee 😂
75% of the Humana CEOs pay is stock, so a 70% slide in the share price has serious financial ramifications.
Yeah. A couple of feet off the new yacht “MY ADVANTAGE”.
…plus a pardon and lobbying gig.
Once again, no one will go to prison and might even run for elected office afterwards.
Those of us who have been to places with national healthcare like Taiwan know the benefits. These plans work because of caps on medical procedures, doctor’s visits, imaging/diagnostics, and medicine all of which are nonstarters in the US because of profiteering.
Lastly, tover 40% of the US population is obese. Diabetes, obesity, and blood pressure are lifestyle diseases that waste resources on people who choose to be unhealthy. Why should we subsidize their behavior?
But look at where all the innovation in new medicines happen. It’s like 98% in the us because our system rewards innovation.
Medicine has to overcome the fact that Americans don’t do what they are supposed to.
Don’t check your blood pressure
Don’t eat right
Don’t exercise
Smoke
Drink
And American medicine still keeps you lousy lots alive most of the time.
That used to be true, no doubt, but I think you would be surprised at the health care innovation happening outside of the U.S. nowadays.
There was once a time where U.S. healthcare drove innovation for the rest of the world, but that mostly came from government granted R&D. All of that has been cut to the bone. All that is left is the corporate grift part
The entire food system in the US subsidizes unhealthy food. Look into other countries vs how the US subsidizes HFCS and other cheap carbohydrates. But ok let’s blame the consumers when they choose the cheaper option.
Garbage in. Medical care out. It’s a circle you-know-what…
I have a coworker that raves about the healthcare systems in Asia. He is bumming about an upcoming trip plan: turns out their energy comes through the strait of Hormuz.
Regardless, the lack of bureaucracy and profiteering: ACTUALLY leaves room for patient care! No need for a half dozen trips and referrals, JUST to get the diagnostic procedures accomplished!
They literally just, use the available technology to scan and test people for illness, on the FIRST visit!
In our systems, the doctor’s orders literally go to FINANCE, first, then to a care provider (yeah, “medical system”). Insurance stocks shouldn’t even be a thing, let alone a”guaranteed profit”.
Whose risks are we “sharing” in?
Also FWIW: NOT over a 40% obesity rate in USA, more like 37%… because ultra processed “food” is cheap (and the poisonous ingredients not yet illegal).
Diabetes is not necessarily a lifestyle disease.
Not necessarily, but insulin resistance is.
Howdy Youngins. Always pay attention to every credit card charge. Humana also charges credit cards yearly renewal fees for policies that did not exist. BOA card services makes it extremely difficult for the card holder that notifies them about fraudulent charges. They protect the merchant first…Long wait times for customer service centers …. Certain claims must be called in and you will wait and wait and wait…..
That’s why use an Amex
As a long time user of BOA for business, I have had excellent customer service with regards to fraudulent charges. I will add, in the last few years there have been an increasing number of fraudulent charges, all resolved quickly. It requires weekly, if not daily inspection of the account. With everything so digital there is a thief at every keystroke! Be vigilant!
But Medicare for all. Ugh.
Talk about a golden goose for fraudsters.
The government just as much to blame.
No legitimate oversight and out dated tech. Employees dont care.
Just waiting for that pension.
Taiwanese health care?
Caps on procedures?
Go for it.
Hope u like dying waiting for that procedure past your cap.
That view is simply not born out by the facts.
Sure, there are always stories of all sorts of Medicare fraud in everyone’s news feed (especially those with suspect news sources), but the point of those stories is people actually getting caught! Sure it is easy to defraud in the short term, but long term they get caught (unless younare Rick Scott…..).
The bigger point though is that even with all of the supposed fraud, Medicare is still cheaper to operate than any insurance plan. By far and it isn’t even close.
It amazes me how many people do not realize the societal costs of our broken health-care/insurance system outside of Medicare. Outside of Medicare, the U.S. has some of the most expensive healthcare in the world with mediocre results. We should be doing so much better based on how much it costs all of society.
Very fact based.
Our Healthcare is best available.
Where else is better?
The issue is poor food source and obesity. Travel abroad then return and you’ll notice fat America more clearly.
Plus a broken payer system which the ACA tipped over the edge.
Medicaid and Medicare get raped by the billions annually by fraud of many types because it is so easy and nobody gets caught.
Our healthcare may be the best available but our health *insurance* is just about the worst available.
The reason you don’t see these headlines with private insurance is because this type of fraud and gouging is perfectly legal there.
The government goes after fraud in Medicare because it comes out of their (ie we the taxpayers’) money. But if you’re a small business buying insurance for your employees and you know they’re raking you over the coals, you can’t launch an investigation. The only thing you can do is switch insurances, to someone who is probably doing the same thing.
Do you really think that Humana or HCA or any of these insurance companies who get caught committing fraud in their Medicare Advantage plans somehow behave perfectly ethically in their private insurance plans? The absence of large lawsuits against their private insurance plans is *exactly* the evidence you need to show why we need Medicare for all, or at least more regulation of private plans. Only a real naif would believe that it shows rather that they behave in some perfectly ethical way when managing their private plans.
It’s always amazing to me how so many Americans have this knee-jerk negative reaction to single-payer healthcare, mostly seems to be born out of tropes they’ve swallowed somewhere.
Having lived in Taiwan for 30 years, I can tell you first hand that the health care system here is completely awesome. You have no idea, not the first clue. I pay like US$200 a month to insure my family of four, which covers all the basics and a lot more. I can see any doctor or get any procedure any time I want, I mean they might have to schedule it if it’s major, but there are no absurd long wait times here like you hear about in some other single-payer countries, doesn’t work like that. (“Caps on procedures”…? 30 years here and I don’t even know what that is supposed to mean.)
It is not free unlimited health care, there are co-pays and such but they are tiny by US standards. If I go see a doc with a cold or flu I might pay like US$10, which might include the meds or if you get antibiotics or something special I might have to kick in another 20. I had half my thyroid taken out a few years ago, the government insurance covered basics but I was given the option of paying extra for them to use special equipment to reduce discomfort, I chose to pay the extra and guess what, another form of government insurance (Labor Insurance, which anyone with a job pays into) ended up covering the extras, the whole surgery with several days in the hospital afterwards cost me like $200. Had my gall bladder out a few years and same deal, there were a few extra costs I woulda had to pay but this time the group insurance through my employer covered basically all of that.
How do they do it? Cutting out insurance companies, and the incentive for doctors to bill more must be a huge part of it. Doctors here do make less, or rather they have to see more patients to raise their income. It’s not perfect by any stretch — but it’s so much better than the US, it’s completely laughable to hear an American just dismiss it out of hand. Sorry but that is ignorance talking. The US could learn from other places, it could do so much better, but so many Americans are determined not to even consider it.
Finally I’ll just add, if you think taxes must be higher here, wrong again: my effective income tax rate is under 5%.
As a former Humana actuary (unfortunately, I am not the aforementioned whistleblower), this is not at all surprising. I’d love to see a study that shows what portion of healthcare spending goes where – @Wolf let me know if I can help! I would bet the amount that goes to doctors and actual providers of care (not admin/IT/coding staff at the hospital conglomerates) has got to be a laughably small percentage, if not a rounding error.
The whole system is broken way beyond repair and this is just one tiny example of how the industry is set up to scrape every last extra dollar possible out of the system for as long as possible.
The good news is that health insurance is so convoluted that not even AI can take away those jobs :D
If the current broken system gets just a little more expensive, people will find it cheaper to just go see a doctor and pay cash, old-school style. Cut out the insurers and all the middlemen. At least for anything routine, non-catastrophic.
The only real reason we have a system that requires a gazillion middlemen just to get stitches, antibiotics or even a basic chest Xray… is to pretend someone else is paying, and to do it in such a complicated way that the real profiteering parasites can hide themselves, while spooning out a few bribes to their pet politicians to make the system even more lucrative for themselves.
Except that doctors and hospitals charge you 10x what they charge insurance.
Its actually the opposite in some cases. You can cash pay for an MRI $300 less than some deductibles and most insurances pay $1200. Just one example.
They only charge you 10x if you don’t do your homework. Your local used car dealership used to do the same thing, but they could only get away with 2x. It’s pretty sad that used car salesmen are more honest than medical providers!
All medical care providers should be required to have open published pricing, available to all – just like what you see at any store. And they shouldn’t be able to charge you for anything without your advance consent – just like at any restaurant or other service business.
@Bagehot’s Ghost,
Correct about paying cash for basic care. I’ve been using Direct primary care for several years now and it is great.
Direct primary care is paying a monthly fee to a Primary Care physician. That fee gives you unlimited access to that physician. I can see him once or ten times in a given month – the fee is the same. The monthly fee is paid out of pocket – he does not bill insurance.
My direct primary care doctor has been helpful in many ways. For example, he knows basic dermatology is has performed several dermatological services on me (i.e., cryotherapy, mole removal etc.) at no extra charge.
Another difference is his office environment. It is quiet and relaxed, and the appointments are not rushed. I can specify either a half hour or full hour appointment for each visit. Compare that to the hectic and time-pressured situation of the insurance-based practices.
As an unfortunate Humana customer, this year’s premium increase was 32.7%! I will be moving on next year
ouch!
Howdy Andy. Some plans have no open enrollment period. You can change anytime of the year. They hide and confuse US on purpose.
A court appointed receiver is needed to untangle the mess created by Humana and it’s BOD’s. Disgorge those high falutin’ salaries and bonuses.
BK Courts are notoriously corrupt and rigged.
Disagree with your assessment of the Banko Courts. Humana would not be a bankruptcy candidate at present anyway. Receivership is a remedy not limited to such courts.
Any system needs a certain amount of operational types to make sure there are facilities, equipment, etc and that the highly skilled are properly compensated. Like oil in an engine. Unfortunately, too many of these people think they are the engine when they really are just mucking it up.
If Medicare advantage costs more than Medicare B, why even offer it? The concept was to bring in private industry to lower costs. But if they are not in competition with B or other providers, then the incentive is to just bill, bill, bill.
They do offer lower costs to enrollees. It’s just that the government made itself very vulnerable to getting ripped off, and it did.
One can only wonder how much fraud could be found if you had a real DOGE department with a way for whistle blowers to easy pass information along to be investigated. In fact, you could possibly offer reward money that’s based on the amount of fraud uncovered. Start paying people to narc.
This is what happens wen lobbyists put on the full court press and the public goes MAGA on a President who in the end was nothing better than a slimy used car salesman that would sell a total lemon to a single Mom with 3 kids on a 15% car loan.
Sure, just sell the US healthcare system to for profit Wall St. grifters. I am amazed at all the college educated idiots that still think Obama walks on water.
Be brave. If you fell for the Health Insurance = Health Care” big lie you can admit it here. Heck, most Americans still don’t know the difference. Personally, my list of friends with Obummercare insurance that were denied treatment and died grows ever longer.
“I am amazed at all the college educated idiots that still think Obama walks on water.”
🤣 Obama did it 🤣
You got the wrong President. Medicare Advantage is a Republican thingy. They used to be called Medicare+Choice in the 1990s. Then under Baby Bush Republican, in 2003, the plans were revised to be roughly what they’re today and re-named Medicare Advantage. Privatizing is a Republican thingy. They wanted to privatize Social Security too at the time, but then the stock market crashed 50% and that put an end to it.
Baby Bush Republican also presided over the creation of the high-deductible health insurance plans, for which Obama-did-it gets blamed, which my wife and I have had since 2006. High-deductible health insurance plans were later incorporated into the ACA (Obama). They come with a Health Savings Account (HSA), to which the contributions are tax deductible, like an IRA account. For 2026, the tax-deductible HSA contributions are capped at $4,400 for self-only coverage and $8,750 for family coverage. And you can invest this money tax free until you need it.
But unlike IRAs, the money in an HSA is NEVER taxed if you take it out to pay for your healthcare.
This system provides cheap healthcare for people with high incomes that can benefit from the big fat tax deduction because they can afford to max out the HSA contributions, and that can invest this money in their HSA accounts in their younger healthier years. Our HSAs are now chockful, and they pay for all our out-of-pocket healthcare expenses. My wife still contributes to hers as she still has a high-deductible health insurance plan. When she broke her hip a couple of years ago, she hit her $4,500 max out of pocket, which she paid for with her HSA card. And when you look at her HSA balance now, you can barely see the dip. I can no longer contribute because I’m on Medicare. What a bummer! Thank you Baby Bush Republican!
Never underestimate how Republicans tilt everything in favor of people with high incomes. And that’s not fair. And Obama-did-it still gets blamed for the wonderful Baby Bush Republican high-deductible health insurance plans with HSAs. The guy can’t catch a break 🤣
Ah but remember in the context of attempting to axe the ACA, they had “concepts of a plan” of their own.
Retired in 2000 with pension and Healthcare. 8 years later went on Medicare. The wife followed some years later. The Healthcare company offered an advantage plan and I signed up. Since that time I noticed everything began to get cheaper. During my younger days I always paid a larger portion. Today many of our drugs are free. I can also say even including Medicare costs overall are less.
Not complaining but think something has gone wrong. Waiting for the other shoe to drop, this just maybe the start.
George Washington Plunkitt ‘I Seen My Opportunities and I Took ‘Em:”.
Plunkitt of Tammany Hall; a series of very plain talks on very practical politics, delivered by Ex-senator George Washington Plunkitt, Recorded by William L. Riordon
you can read it here:
http://www.gutenberg.org/files/2810/2810-h/2810-h.htm
“The fish stinks from the head” (or “rots from the head down”) is a proverb meaning that an organization, group, or society’s problems, corruption, or failures are caused by poor leadership at the top. Of course in democracy majority of envious people elect poor leadership.
I respect Mr. Wolf’s reporting; however, I cannot see anything wrong here. Just regular Capitalism on the billing end and probably downsized medical claim processing with draconian worker metrics, maybe AI as well.
I’m glad this is happening to them. But I work for one of the highest volume hospitals in the State of California and this is a current practice for hospitals everywhere. We have a whole team of people dedicated to combing through patient’s charts for their hospital visit aimed at finding ways for the hospital to extrapolate more CMS reimbursement at the expense of the patient and ultimately the rest of all us taxpayers. All I wanted to do was deliver patient care. It’s disgusting what executives are doing behind closed doors. Healthcare is revolting. I hope this practice can come under scrutiny as well.
I don’t think there is any other place in the United States where Medicare and Medicaid fraud is more rampant than in Miami, Florida. Here, clinics fight tooth and nail for every available senior, luring them with parties, cash debit cards, over treatments and meds. They provide elders with nice places to spend the day, dance and socialize. Medical care always comes last and nobody seem to care about.
Wow, amazing article and information. I would like to clarify something about single payer (in BC, anyway). It isn’t perfect, that is for sure. They have to triage procedures so the more seriously sick or injured go to the head of the line. There are limitations. For example, a spine injury will displace a hip replacement surgery booking. In emerg, a heart issue or head injury is dealt with immediately, and those waiting for something not so serious get to wait a little longer. But the facilities and staff have the same accreditation, equipment, and qualifications that other 1st world systems have. All, for less than half per capita spending of that what is spent in the US system.
Anyway, here is the point. My care is free to me, for doc visits, prescriptions, hospital stays, surgeries, whatever. There is no monthly premium to pay. But the money comes from somewhere….. ponied up through Federal transfer payments and Provincial govt. budgets. All tax payer dollars. Therefore, the costs are part of our higher tax rates, and in sin taxes embedded in higher liquor prices. But because the middleman does not exist, and there is no profit incentive, the ultimate costs are much lower. However, just because it is less expensive does not mean people use it willy nilly. No one likes going to the doctor or getting jabbed at the lab, at least I never met anyone who does.
Recent personal example. I just had a full lab workup as part of my preventative maintenance plan. (what I call it). On April 17th I will go see my doctor for a short visit to discuss my health where I will have to explain to him why I am still 10 lbs over weight. :-) I am not on any meds, but lab results indicate a rise in Cholesterol so maybe a statin is looming. He’ll decide. If I do need a med there will be no charge. I’m 70.
From this user standpoint I have never ever even thought about what my healthcare costs. And I do not use it anymore that what I absolutely have to. It is just how we live. About 10-12 years ago we had a grad student here from Texas. She was part of a crew studying some stickleback (small fish) found in our pond. She fell and broke her wrist and was freaked out because she was not a resident and would have to pay full shot at the hospital. That aft she returned full of beaming smiles. She said the total charge for her exam, X Ray, and cast was about 1/2 of what just her co pay would have been if she broke her wrist at home, in Texas.
Transparency. I can find out exactly what my, or any doctor, bills the medical system for their services. In fact, years ago the stats would be published in the local paper. Each doctor, unless on staff (salary) at a facility is a personal corporation. It used to be about 1/2 of what was billed would pay for their office overhead. However, that has really changed over time with the Govt now picking up many costs associated with their personal clinics. And, Doctors now have a pension plan contribution in addition to their excellent earnings.
The main point is that medical care here is considered to be a human right, part of citizenship. I also know doctors that have dropped patients for them not holding up their part of the health bargain. My old neighbour was obese. She was told to lose weight or find another doctor. Another neighbour smoked like a chimney and was told to quit smoking. The system has expectations.
That sounds amazing and sadly I doubt I will ever see a system like that in the US in my lifetime.
It really didn’t take a government inquiry to know that the Medicare Advantage plans were a financial windfall for the insurance companies. Just watch the TV ads. You will see loads of ads for advantage plans, and zero ads for Supplemental insurance plans.
Or watch your mailbox. Right before I turned 65, mine was flooded with Medicare Advantage offers.
Total waste of time and money, as far as I was concerned.
I signed up for traditional Medicare. Three years later, I’m still on it. No complaints.
AND least we forget, if it is going to cost the private insurers, like Humana, money they deny the coverage.
IF you have a lot of health issues and or you travel around the country, go with regular Medicare with a secondary insurance, (high deductible might be best). You need a part D drug plan too.
WHY. You can see any doctor or specialist or hospital anywhere in the country without permission from some bean counter.