Thread regarding Optum layoffs

Are you buying this?

A new report released by the bipartisan Senate Joint Economic Committee (JEC) on Tuesday found that overpaying for Medicare Advantage (MA) plans caused Medicare Part B premiums to rise across the board.

According to the JEC’s report, overpayments to MA plans caused standard monthly Medicare Part B premiums to go from $185 in 2025 to $203 in 2026.

The report defined “overpayments” as the difference between what the federal government government paid for MA plans versus Traditional Medicare (TM) plans. When payments to MA plans exceeds those for TM plans, premiums go up for both groups.

In 2025, MA plans were paid $84 billion more than it would have cost to cover the same amount of beneficiaries with TM plans, an average of 120 percent more.

Medicare Part B covers medically necessary services like doctors visits, supplies and some outpatient prescriptions as well as preventive services. Roughly 63 million people are enrolled in Medicare Part B and a little more than half are on Medicare Advantage, which combines both Part A and Part B.
The JEC further noted that the burden of MA overpayments are spread unevenly across the country as some districts and states have lower rates of MA enrollment. The report gave the example of Wyoming, where only 21 percent of Medicare beneficiaries are enrolled in MA, estimating that payers in the state will pay $25.4 million in excess premiums, with most of that from TM enrollees.

“Let’s be honest about the math, when Medicare Advantage is overpaid, that money doesn’t just disappear, it shows up in the Medicare Part B premiums seniors pay every month, including those paid by traditional Medicare beneficiaries who are not getting extra benefits,” said JEC Chair David Schweikert (R-Ariz.) said in a statement.

“If Congress is serious about affordability, fiscal responsibility, and fairness, we must take a hard look at Medicare Advantage and make sure the rules are the same for everyone,” he continued.

“Today, between aggressive upcoding, questionable quality bonuses, and structural overpayments in Medicare Advantage, seniors who stay in traditional Medicare are effectively subsidizing the system. That’s not sustainable, it’s not fair, and it can be reformed.”


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| 1 view | | 8 replies (last March 14) | Reply
Post ID: @OP+1kkhzq6gt

8 replies (most recent on top)

@dy ok show me where regular Medicare offers dental and vision I’ll wait

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Post ID: @fg+1kkhzq6gt

@b0 that is 100 % incorrect

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Post ID: @dy+1kkhzq6gt

This argument (which I've read and seen supported multiple times) can only be made by those who understand ZERO about Risk Adjustment / ICD10/CMS documentation guidelines! #Spoileralert.... the documentation requirements for solid risk adjustment documentation are significantly higher and more specific than any traditional Medicare program asks for. THIS is why there is such a wide gap between the two. The system is too complex and complicated for any general practice provider (or even any specialist) to have the time to learn it, understand it nor feel it's worth their while to document specifically and with care unless they are somehow slightly incentivized to do so. MA advantage plans are paid higher for the same member profile bc without a provider working with a MA plan as a contracted member there is ZERO reason for them to take the time to learn and understand all of the coding nuances and rules for every diagnosis presented. The result??? Documentation and code assignment is generic and not specific, which results in a lower reimbursement for care for each complex patient. Why would any provider take the time to document and re-assess each ICD 10 diagnosis specifically if it didn't somehow benefit them or their patients??? This is where the system is currently inherently flawed. Specific and accurate documentation and coding diagnoses is a patient safety issue in my mind. Specific and accurate diagnoses and documentation that aligns with CMS ICD10 coding guidelines is best practice. it's just a shame that the result right now is to compare apples to oranges. They aren't the same. Period.

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Post ID: @b3+1kkhzq6gt

MA plans cost more because there is more benefits… do you guys not know that?

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Post ID: @b0+1kkhzq6gt

I love how the guy who was in charge of it at UHC is now in charge of all of UHC, good times.

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Post ID: @ax+1kkhzq6gt

Of course. Dear leader and his cronies need more lobster, ice cream machines, and vacations on the taxpayer's dime.

Are we great yet?

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Post ID: @ap+1kkhzq6gt

https://thehill.com/policy/healthcare/5777186-medicare-advantage-overpayments-raise-premiums/

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Post ID: @a7+1kkhzq6gt

I would like to see the math. Doesn’t quite add up in my mind, but maybe it does.

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Post ID: @a1+1kkhzq6gt

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