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My My own Medicare “TV Commercial”

Sincere Post Here to Hopefully Help Others Make a Decision for Medicare*

  • This is coming from someone with many years experience in the health insurance business and also is aware of how the super polished advertisements you see on TV by the main health insurance payers and eHealth dotcom, which push Medicare Advantage. Spoiler: This unpaid “Commercial” is for Traditional Medicare with Medigap Plan.

3 False Narratives:

Proponents for MA will:
1: Try to convince you that they have large provider networks to ensure your claims get approved.

REFUTE:
However, many provider groups have chosen to no longer contract with Medicare Advantage due to the slowness of payers to pay them and also the many hoops the providers have to jump through. Also, many Provider Directories are out of date and there is constant movement.

Short of it is, if you sign up again with Medicare Advantage, you might receive a “surprise” bill in the mail that your health services were provided by someone no longer in their network.

But with Traditional Medicare with a Medigap Plan you do not have to worry about any such “surprises.” Because in essence every licensed provider is considered in-network, so to speak.

Proponents for MA will:
2: Erroneously contrast themselves against Traditional Medicare with the dental, optical, aspect and also bait you in with “everything is rolled up into one neat package” speel and also offer you all kinds of extraneous stuff like free gym memberships, free grocery debit card, etc.

REFUTE:
First of all, purchasing dental and optical insurance separately is not terribly expensive nor difficult. And it is not difficult to sign you up for Traditional Medicare and to purchase you a Medigap plan, without needing to undergo underwriting if your MA plan was terminated at no fault of your own.

As to free gym memberships and free grocery debit cards, those are niceties but true purpose of health insurance is covering any expensive unexpected health claims covered. Think unexpected catastrophic things such as Cancer, Cardiovascular Issues, Organ Transplants, Rare Diseases, Knee Replacements, Diabetes, etc. Will for-profit health insurance have your health outcomes in mind or their profits? And I assume you don’t want any surprise bills that could bankrupt you.

eHealth dotcom, will:
3: Tell you that they are paid by the health insurance corporations to compare and offer their plans, which is true. However…

REFUTE:
EHealth completely omits mentioning Traditional Medicare and does not offer any comparison nor offer assistance to switch over to Traditional Medicare with a Medigap plan. They are financially biased towards MA plans.

Disclaimer: I am not a licensed agent for Medicare. These are my own personal opinions. Please make decisions for what plan works best for you.

Traditional Medicare with Medigap Plan
https://www.medicare.gov/providers-services/original-medicare

#Advice #ConsumerFinance #Healthcare #Insurance #Medicare

Single payer healthcare

Moving to government run Medicare for All would completely eliminate the private health insurance industry. It would wipe out hundreds of BILLIONS in market value, cut approximately 2 MILLION jobs and devastate the commercial real estate market.

#Healthcare #Medicare

Sad, angry.

Another round of layoffs feared in 2027....and now Sharp no longer accepts Medicare Advantage plans??

Quality clinical staff have left SMV (lay-offs, quitting). More unit consolidation, elimination of programs.

So this is optimizing healthcare!!?? :-(

Yet the Sharp Experience event still happened....something is really wrong here.

#Layoffs #Medicare #Healthcare #Morale #Program

Monopolies are a Breakdown in the Free Market

Therefore, it is critical that we find a way to breakdown the Monopolistic Predatory Abuse of the 5 Major Private Health Insurance Corporations (e.g., Humana, United, Elevance/Anthem, Cigna, Centene) that use Government Funded (Tax Payer) Dollars to continuously delay and deny legitimate lifesaving healthcare to the elderly, disabled, and indigent on Medicare Advantage plans.

#Government #Healthcare #Insurance #Medicare

Half of Medicare Advantage stars thresholds harder to reach in 2027

The CMS released draft star ratings, including the thresholds for reaching those ratings, to plans earlier this week. The grading sheet got stricter, which doesn’t bode well for insurers.

Entire Article Regarding the above Teaser
https://www.healthcaredive.com/news/medicare-advantage-stars-cutpoints-2027-cms/829963/

CMS Facts Sheet for 2027
https://www.cms.gov/files/document/2027-medicare-advantage-part-d-landscape-state-state-fact-sheets.pdf

#CMS #Healthcare #Insurance #Medicare

Trinity Health Cuts Staff Due to Federal Legislation

Trinity Health has announced the layoff of 557 employees, directly attributing the decision to federal cuts in Medicare and Medicaid. These cuts stem from the One Big Beautiful Bill Act, which significantly reduces Medicaid funding over the next decade. This legislation places millions at risk of losing health coverage and increases uncompensated care costs for providers. In Michigan, 23 healthcare providers are already facing service cuts or closure due to these changes. The article criticizes Senator Mike Rogers for supporting the bill despite its projected impact on Michigan residents.

Livonia, Michigan

https://michiganadvance.com/2026/09/23/trinity-health-layoffs-expose-the-danger-of-the-one-big-beautiful-bill-act/

#Layoffs #Healthcare #Medicare #Michigan #Government

Humana to either buyout or merge with Centene— Have been colluding all along with MANY ex-Humana Leaders to work for Centene to “Set Things Up!”

Centene is being setup to get bought out by Humana. They are in talks as I type this. Their major footprint is Medicare. Centene has a very small Medicare footprint, but a very large Medicaid footprint. Meaning, Centene needs to adjust their business model in order to stay in business. All Centene’s eggs are in one basket, and there’s no diversification in their portfolio. They can’t compete against UHG or Elevance, without increasing their membership portfolio. Therefore, the only option, merge or get bought out. It’s gonna happen…Just watch!

#Acquisition #BusinessDevelopment #Healthcare #Medicare

Medicare Star Ratings coming out in October

The federal government's (CMS) will very soon be releasing the official Medicare Star Ratings in October.

If any of you employees own Humana stock, this might be a good time to pullback, sell, and lock in your profits.

There is an extremely low percentage of members enrolled in plans rated 4 stars or higher.

#Advice #Medicare #Profit #Stock

600k Members Receiving Letter Due to Humana exiting Plans

Hello Humana,

I stumbled across this site and just wanted to tell you that I am one of the 600,0000 (600k) members that received a letter today that you are exiting my plan and that my Medicare coverage has been terminated.

I am hopping mad! I mean, what kind of looney tunes circus are you guys running there anyway!!!

#EmployeeRelations #Exit #Health #Layoffs #Medicare

early retirement

we’ve been told in the utilization review department in Medicare that we have too much staff but that’s OK because we’re all going to be trained on epic so too much staff right now is a good thing for coverage. That sounds like we will have layoffs of all the extra staff after epic is put in.really hoping they’ll be an early retirement package offer. Does anyone have any news?

#EarlyRetirement #Layoffs #Medicare #Training #Utilization

Healthcare Provider Faces Cuts

INTEGRIS Health is implementing workforce reductions and closing several clinics. These actions are a direct response to anticipated significant cuts in Medicaid and Medicare funding. The organization expects an annual revenue loss of approximately $130 million once the new legislation is fully enacted. These changes will occur over the next three to six months. INTEGRIS Health stated these steps are necessary to ensure its long-term sustainability and mission.

Oklahoma City, Oklahoma

https://okcfox.com/news/local/integris-health-announces-layoffs-clinic-closures

#Healthcare #Medicare #WorkforceReduction

Health insurers are dropping Medicare Advantage plans — and nearly 3 million older Americans will be affected

https://finance.yahoo.com/healthcare/articles/health-insurers-dropping-medicare-advantage-100000446.html

Thousands of seniors are receiving notification that their Medicare Advantage plan won't be available next year, and there's nothing they can do about it except find another option.
One in 10 Medicare Advantage policyholders face forced disenrollment this year, according to an analysis by researchers at the Johns Hopkins Bloomberg School of Public Health. That's as many as 2.9 million Americans.

#Healthcare #Insurance #Medicare #News #Retirement

What are some of the most unethical things humana has done?

Humana's most severe legal and ethical controversies involve systemic denial of patient care using flawed predictive algorithms and major Medicare fraud settlements. Critics and lawsuits target its utilization of automated tools to prematurely cut off necessary rehabilitation and nursing care for elderly patients, alongside multi-million dollar federal fraud recoveries.

Systematic Care Denials via Algorithms

  • The nH Predict Tool: Humana faced major class-action lawsuits for using an algorithmic model called nH Predict (developed by NaviHealth) to systematically forecast and cut off coverage for post-acute rehabilitation and skilled nursing facility care.
  • Impact on Patients: Lawsuits allege the algorithm superseded individual doctor evaluations, leading to wrongful, repetitive denials of medically necessary care for vulnerable seniors who were forced to pay out-of-pocket or forego treatment.

Medicare and Billing Fraud Settlements

  • Part D Bid Fraud ($90 Million Settlement): Humana paid $90 million to resolve a landmark whistleblower lawsuit brought by a former actuary. The suit accused Humana of keeping two sets of books and submitting fraudulent, inflated bids to the Centers for Medicare & Medicaid Services (CMS) for prescription dr-g contracts from 2011 to 2017.
  • Overcharging Federal Audits: Federal audits by the Office of Inspector General (OIG) have repeatedly caught Humana overcharging Medicare by tens to hundreds of millions of dollars through unsupported risk-adjustment diagnoses.
#InformationManagement #Updates #Company #Medicare

93% Wrong, But Make It Efficient

Think this is getting added to the TriZetto algorithm? 😂

Centene denied 15% of standard Medicare Advantage prior auth requests in 2025.

Then 93% of the denials that were appealed got overturned.

But it was “one person at a time.” 😬

Centene also had the highest ACA denial rate listed at 25%.

Hard not to look at numbers like that and wonder whether the system is designed to get the right answer the first time, or just make people fight hard enough to get there.

Maybe the next efficiency initiative is getting rid of the members who keep appealing. 🤡

https://www.beckershospitalreview.com/finance/payers-ranked-by-prior-authorization-denial-rates/

#Efficiency #Healthcare #Medicare

UCare Cuts Over 100 Jobs

UCare is laying off more than 100 employees this fall. This action follows the company's decision to end its Medicare Advantage contracts. UCare plans to shift its members to a different organization. The terminations will begin on October 1st. This move is part of a larger transition for the health plan.

Minneapolis, Minnesota

https://www.kare11.com/article/news/local/ucare-announces-layoffs-for-100-positions/89-f36222ef-5707-4235-ae2b-8ef46ee8f031

#Layoffs #Healthcare #Medicare #Minnesota #Termination

Why is Via Benefits trying so hard to reach me?

Via Benefits is leaving messages that Wells Fargo authorized them to call me about Medicare. I did search and found them to be some sort of insurance advisory company. Before I call them back, does anyone have any experience with Via Benefits? Seems fishy, lots of companies want to “help” us Senior folks with Medicare.

Maybe they have a free knee brace offer that has a stage coach logo?!

#Benefits #Medicare #Insurance #RetirementBenefits

UHC Medicare Advantage PPO question

I got surplused 7/31, meet the MR75 and am eligible for Medicare. Retirees can sign up for company sponsored Medicare advantage PPO with $150 deductible and $900 out of pocket max for free. Seems like a great deal. Anybody else doing it, or are there other, better plans out there?

#Medicare

Layoffs

Centene started with layoffs in 2021 after acquiring WellCare, due to promising most of WellCare employees to keep there jobs. When Centene decided to rebrand their Medicare product (AllWell) to WellCare a decline started. After acquiring WellCare, members talked to people all over the USA, not just in the state they lived, this also caused a decline on membership. Cut the fat at the top, let the company go back to the way it was ( talk to people in your state that know your state and resources). Centene was a great company to work for until 2021, acquiring WellCare.
These are my thoughts and observations!

#Layoffs #Acquisition #Medicare #Leadership #Culture

Inquiring minds want to know...

My PL informed us today that two members of our team (PDM in a Medicare market covering two states) took the VSP. Don't know who yet, but I'd imagine that info is coming soon. I'd say we have a fairly small team; eleven, counting me and our PL. What do you all think are the chances of more people getting axed when the layoffs begin? Prior to the last "reorganization," the team was only one state with six people counting me/PL, but we merged with another at that time. From what I've read here, there are some big ops-related changes re: Medicare coming, but I've not heard anything official yet.

#VSP #Medicare #Team

Humana Q2 Earnings Call Coming up Next Week

I wonder what kind of malarkey the CFO & CEO are putting together to make Humana look so good. Wonder if they will say anything about all the qualified and experienced workers they are displacing.

Humana, and all of these large for-profit health insurance corporations, need to have their Medicare & Medicaid contracts taken away by the government. These corporations have milked and taken advantage of a system that has propped up these corporations that are not only fulfilling their end of the bargain.

The whole reason for these cooperations administering Medicare Advantage, in lieu of Traditional Medicare was to help keep costs from getting out of hand by guarding against fraud, waste, and abuse. But instead of fulfilling THAT mandate, these corporations are lining c-suite executives and shareholder’s pockets with millions of dollars, all the while in denying catastrophic health claims to the elderly, poor, and disabled AND displacing its own American citizen workforce with cheaper temporary H-1B Visas. And these corporations are not even dealing with the fraud, waste, and abuse. But they are denying legitimate claims.

These for-profit corporations would not even exist if not propped up by American tax payer monies. And yet they continue to layoff their very own country’s (Americans) workers, some of which even served their country during wars. This is a slap in the face to this country!

#CorporateCulture #EmployeeRelations #Healthcare #Layoffs #Medicare

Medicare & Medicaid Need to Be Administered by Non-Profits & Not-For-Profits

All of these large for-profit health insurance corporations such as Humana, Cigna, Centene, Elevance, etc. really need to go under or have the government completely remove their contracts for administering Medicare & Medicaid and those contracts need to be granted to non-profit and not-for-profit companies.

Shareholders and large banking firms never should have gotten their greedy fingers into heath insurance, which is intended to be a lifesaving and quality of life industry for our elderly seniors (and also the poor and disabled), which are human-beings, our brothers and sisters, that deserve our love and respect.

#Advocacy #Healthcare #Insurance #Medicare #NonProfit

Disloyalty to Employees

To all my peeps who were treated with disloyalty by Humana and forced out, keep in mind open enrollment for Medicare Advantage plans is just around the corner, beginning October 15th.

So, be sure to give you best sales pitch on social media and to all your elderly friends to why Traditional Medicare is better and why they should switch over this year and drop Medicare Advantage.

Let’s face it, we all really knew Traditional Medicare was better, especially in regards to what health insurance should be most concerned with, which is covering a person in the unfortunate situation where they have a catastrophic health issue. Not about dental or vision appointments.

#EmployeeRelations #Medicare #HealthInsurance #Morale

The Main Problem with Suggested Solution

The main problem is that our government contracts public traded corporations such as the above mentioned to take tax payer government funds and allow these companies to make administrative decisions on what claims get paid or not. The main issue with that is these are profit-based corporations required to put shareholders profits before members. The Medicare & Medicaid Members are secondary to them in regards to being their customer. The shareholders are their priority customer.

It is time for the government to drop these public stock traded health insurance corporations and find a way to contract with not-for-profit, non-public-stock-traded, companies to administer Medicare Advantage and Medicaid.

#Accountability #AdviceToManagement #CorporateCulture #Healthcare #Medicare

Mr. Hochradel

https://www.beckerspayer.com/workforce/elevance-sues-former-chief-execution-officer-over-noncompete-agreement/

Elevance Health is suing a former senior executive, alleging he violated a noncompete agreement when he joined Medicare Advantage insurer Alignment Healthcare weeks after resigning.

The complaint was filed June 5 in an Indiana federal court and names Shane Hochradel, who previously served in a variety of executive roles at Elevance starting in 2021, most recently as chief execution officer. Mr. Hochradel notified Elevance of his resignation on May 8 and started June 1 as COO at Alignment.

Elevance argues Alignment is a direct competitor in the Medicare Advantage market, with both insurers operating plans in Arizona, California, Nevada and Texas. Mr. Hochradel’s employment and stock award agreements barred him from taking a competing position for 12 months after his departure, according to the complaint. Elevance says that as chief execution officer, he led the company’s transformation team and helped develop a three-year plan to use artificial intelligence to cut costs and compete against rivals, including Alignment. Elevance alleges he cannot do his new job without drawing on that knowledge.

“Hochradel inevitably will use Elevance Health’s confidential information in his executive-level position at Alignment,” the complaint states.

Elevance also claims Mr. Hochradel did not notify its chief human resources officer that he was in talks with Alignment until after he accepted the role, a step his stock agreements required. The company said it learned of his new role on May 11 and reminded him of his contractual obligations, then informed Alignment of those obligations the following day.

Elevance is seeking compensatory damages and repayment of stock gains tied to equity that Mr. Hochradel exercised or vested over the prior 24 months, plus attorneys’ fees and costs. The suit is at least the fourth Elevance has brought against departing executives over noncompete agreements in recent years. In January, the company sued four former leaders at its Puerto Rico subsidiary who left for rival insurer Triple-S Salud, seeking more than $1.08 million in combined stock repayments. In September, it sued a former senior underwriting executive who joined health benefits company Gravie. And in 2023, Elevance sued its former west region Medicare president after she left for Molina Healthcare. A judge declined to block that move and the case was later settled.

At the Becker's 5th Annual Fall Payer Issues Roundtable, taking place November 2–3 in Chicago, payer executives and healthcare leaders will come together to discuss value-based care, regulatory changes, cost management strategies and innovations shaping the future of payer-provider collaboration.

#NonCompete #Lawsuit #COO #Confidentiality #Medicare

Presbyterian Reduces Workforce, Discontinues Many Medicare Advantage Offerings

Presbyterian Healthcare Services announced 150 layoffs. These layoffs affect administrative roles. The affected positions are not in hospitals or clinics. The organization will also discontinue most Medicare Advantage plans in 2027. Direct patient care roles will remain unaffected.

Albuquerque, New Mexico

https://www.koat.com/article/presbyterian-layoffs-albuquerque-new-mexico/71475392

#Healthcare #Layoff #Layoffs #Medicare #NewMexico