Subject: Re: Don't delay your retirement, anything could h
<< Who knows, maybe we found the one company & plan that is great while all the others are terrible? >>

I'm going to be somewhat vague in my post because it involves a
software company that I recently sold. I was a principal and the CTO.

We were an early adopter with Medicare Advantage plans on behalf of
our geriatric patient populations, which were split between traditional
Medicare and many of the major Medicare Advantage companies, including
Humana. Because our providers were early adopters, we negotiated
favorable rates. Our initial experiences were mostly positive.

There was a lot of variability between each of these companies
on what medical services they would cover, what documentation they would
require, and their timeliness of responses for approval. Moreover, even
if we would receive approval one month, those same conditions might
be denied a month later.

If there was an overall trend, it would be that we could see everything
shifting to providing less medical care -- even if there was not outright
denial of care -- just by inserting delays into the process. We found
ourselves in a bit of an informational "arms race", updating our software
rules specific to each insurer and their ever-evolving timelines. (*)
Denials would often contradict clinical judgment and require complex
appeals to overturn, so our software had to be calibrated to anticipate
these situations.

As Charlie Munger would have advised, look at the incentives. Many of our
patients were directly marketed by people working for the Medicare
Advantage companies. These people can usually only switch back to traditional
Medicare during the open enrollment period (October 15 - December 7.) They
are often at an informational disadvantage when making this decision.

In summary I'm not going to make a blanket statement about Medicare Advantage,
but my multi-year experience with lots data points would be that I would
probably default to traditional Medicare if I still lived in the US. There
are perverse incentives in the process that I don't see likely to be resolved.

-Rubic


(*) As a computer nerd, I actually enjoyed these challenges.