Stir Fry Miles, Points and Money
2024年3月24日星期日
美国老年人说他们感觉被困在医疗保险优势计划(Medicare Advantage Plans)中
Older Americans Say They Feel Trapped in Medicare Advantage Plans
In 2016, Richard Timmins went to a free informational seminar to learn more about Medicare coverage.
“I listened to the insurance agent and, basically, he really promoted Medicare Advantage,” Timmins said. The agent described less expensive and broader coverage offered by the plans, which are funded largely by the government but administered by private insurance companies.
For Timmins, who is now 76, it made economic sense then to sign up. And his decision was great, for a while.
Then, three years ago, he noticed a lesion on his right earlobe.
“I have a family history of melanoma. And so, I was kind of tuned in to that and thinking about that,” Timmins said of the growth, which doctors later diagnosed as malignant melanoma. “It started to grow and started to become rather painful.”
Timmins, though, discovered that his enrollment in a Premera Blue Cross Medicare Advantage plan would mean a limited network of doctors and the potential need for preapproval, or prior authorization, from the insurer before getting care. The experience, he said, made getting care more difficult, and now he wants to switch back to traditional, government-administered Medicare.
But he can’t. And he’s not alone.
“I have very little control over my actual medical care,” he said, adding that he now advises friends not to sign up for the private plans. “I think that people are not understanding what Medicare Advantage is all about.”
Enrollment in Medicare Advantage plans has grown substantially in the past few decades, enticing more than half of all eligible people, primarily those 65 or older, with low premium costs and perks like dental and vision insurance. And as the private plans’ share of the Medicare patient pie has ballooned to 30.8 million people, so too have concerns about the insurers’ aggressive sales tactics and misleading coverage claims.
Enrollees, like Timmins, who sign on when they are healthy can find themselves trapped as they grow older and sicker.
“It’s one of those things that people might like them on the front end because of their low to zero premiums and if they are getting a couple of these extra benefits — the vision, dental, that kind of thing,” said Christine Huberty, a lead benefit specialist supervising attorney for the Greater Wisconsin Agency on Aging Resources.
“But it’s when they actually need to use it for these bigger issues,” Huberty said, “that’s when people realize, ‘Oh no, this isn’t going to help me at all.’”
Medicare pays private insurers a fixed amount per Medicare Advantage enrollee and in many cases also pays out bonuses, which the insurers can use to provide supplemental benefits. Huberty said those extra benefits work as an incentive to “get people to join the plan” but that the plans then “restrict the access to so many services and coverage for the bigger stuff.”
David Meyers, assistant professor of health services, policy, and practice at the Brown University School of Public Health, analyzed a decade of Medicare Advantage enrollment and found that about 50% of beneficiaries — rural and urban — left their contract by the end of five years. Most of those enrollees switched to another Medicare Advantage plan rather than traditional Medicare.
In the study, Meyers and his co-authors muse that switching plans could be a positive sign of a free marketplace but that it could also signal “unmeasured discontent” with Medicare Advantage.
“The problem is that once you get into Medicare Advantage, if you have a couple of chronic conditions and you want to leave Medicare Advantage, even if Medicare Advantage isn’t meeting your needs, you might not have any ability to switch back to traditional Medicare,” Meyers said.
Traditional Medicare can be too expensive for beneficiaries switching back from Medicare Advantage, he said. In traditional Medicare, enrollees pay a monthly premium and, after reaching a deductible, in most cases are expected to pay 20% of the cost of each nonhospital service or item they use. And there is no limit on how much an enrollee may have to pay as part of that 20% coinsurance if they end up using a lot of care, Meyers said.
To limit what they spend out-of-pocket, traditional Medicare enrollees typically sign up for supplemental insurance, such as employer coverage or a private Medigap policy. If they are low-income, Medicaid may provide that supplemental coverage.
But, Meyers said, there’s a catch: While beneficiaries who enrolled first in traditional Medicare are guaranteed to qualify for a Medigap policy without pricing based on their medical history, Medigap insurers can deny coverage to beneficiaries transferring from Medicare Advantage plans or base their prices on medical underwriting.
Only four states — Connecticut, Maine, Massachusetts, and New York — prohibit insurers from denying a Medigap policy if the enrollee has preexisting conditions such as diabetes or heart disease.
Paul Ginsburg is a former commissioner on the Medicare Payment Advisory Commission, also known as MedPAC. It’s a legislative branch agency that advises Congress on the Medicare program. He said the inability of enrollees to easily switch between Medicare Advantage and traditional Medicare during open enrollment periods is “a real concern in our system; it shouldn’t be that way.”
The federal government offers specific enrollment periods every year for switching plans. During Medicare’s open enrollment period, from Oct. 15 to Dec. 7, enrollees can switch out of their private plans to traditional, government-administered Medicare.
Medicare Advantage enrollees can also switch plans or transfer to traditional Medicare during another open enrollment period, from Jan. 1 to March 31.
“There are a lot of people that say, ‘Hey, I’d love to come back, but I can’t get Medigap anymore, or I’ll have to just pay a lot more,’” said Ginsburg, who is now a professor of health policy at the University of Southern California.
Timmins is one of those people. The retired veterinarian lives in a rural community on Whidbey Island just north of Seattle. It’s a rugged, idyllic landscape and a popular place for second homes, hiking, and the arts. But it’s also a bit remote.
While it’s typically harder to find doctors in rural areas, Timmins said he believes his Premera Blue Cross plan made it more challenging to get care for a variety of reasons, including the difficulty of finding and getting in to see specialists.
Nearly half of Medicare Advantage plan directories contained inaccurate information on what providers were available, according to the most recent federal review. Beginning in 2024, new or expanding Medicare Advantage plans must demonstrate compliance with federal network expectations or their applications could be denied.
Amanda Lansford, a Premera Blue Cross spokesperson, declined to comment on Timmins’ case. She said the plan meets federal network adequacy requirements as well as travel time and distance standards “to ensure members are not experiencing undue burdens when seeking care.”
Traditional Medicare allows beneficiaries to go to nearly any doctor or hospital in the U.S., and in most cases enrollees do not need approval to get services.
Timmins, who recently finished immunotherapy, said he doesn’t think he would be approved for a Medigap policy, “because of my health issue.” And if he were to get into one, Timmins said, it would likely be too expensive.
For now, Timmins said, he is staying with his Medicare Advantage plan.
“I’m getting older. More stuff is going to happen.”
There is also a chance, Timmins said, that his cancer could resurface: “I’m very aware of my mortality.”
KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.Subscribe to KFF Health News' free Morning Briefing.
2023年10月31日星期二
美国富人家庭这样规避遗产税
美国富人家庭这样规避遗产税
一场前所未有的放弃财富的热潮正在兴起,而放弃财富恰恰是为了保护财富。在特朗普减税政策到期前,美国富人们纷纷利用起赠与和朝代信托。
2023年10月2日星期一
Get at least $1.50/gallon cashback on gas with Upside mobile app!
Image 1 |
Image 2 |
- 7HZAJW (If you entered this during registration, you don't need to add it again)
- SHOPPERS35
- USHIP35 (This code has expired, no need to add it)
- GOPUFF35
- AMEX35
- PERKSATWORK230
Image 3 |
2023年9月5日星期二
用Upside这个手机App加油可以拿到至少每加仑$1.50的回扣
图1 |
图2 |
- 7HZAJW (注册时如果输入了,就不用再输入了)
- SHOPPERS35
- USHIP35 (这个code过期了,不用输入了)
- GOPUFF35
- AMEX35
- PERKSATWORK230
图3 |
2023年8月29日星期二
Get at least $1.50/gallon cashback on gas with Upside mobile app!
Image 1 |
Image 2 |
- 7HZAJW (If you entered this during registration, you don't need to add it again)
- SHOPPERS35
- USHIP35 (This code has expired, no need to add it)
- GOPUFF35
- AMEX35
- PERKSATWORK230
Image 3 |
2023年8月28日星期一
用Upside这个手机App加油可以拿到至少每加仑$1.50的回扣
图1 |
图2 |
- 7HZAJW (注册时如果输入了,就不用再输入了)
- SHOPPERS35
- USHIP35 (这个code过期了,不用输入了)
- GOPUFF35
- AMEX35
- PERKSATWORK230
图3 |
2023年7月6日星期四
Chase Ink Preferred Business Card商业信用卡100000点的开户奖励(此卡对旅游特别友好)
通过推荐链接(里面有几种卡可以选择,选CHASE INK PREFERRED BUSINESS申请)申请Chase Ink Preferred Business卡并得到批准以后,在三个月之内消费8000美元可获得100000点。100000点可以直接换成$1000。如果用点数在Chase旅游门户网站购买机票或订旅馆和用钱在别的地方买没区别,并且有25%的优惠,$1000就相当于$1250。
信用卡详情
- 有95美元的年费,不能免除。
- 没有国外交易费。
- 有Primary汽车租赁保险,前提是因商业目的出行。这个福利是租车的时候不买保险,自己的车险不会被波及到,直接用这张卡的保险就可以;而一般信用卡的汽车租赁保险都是Secondary的,会先用自己的车险,然后才能用信用卡的保险,所以租的车有赔偿事故会影响到自己的保险信用。
- 有$600手机保险,使用此卡付手机月费,可获得手机损坏及被盗的保险,单次赔付上限为$600,deductible是$100。
- 有购买保护福利(Purchase Protection),既购买的商品120天内被盗或损坏可以获得最高$10000/次的赔偿。
- 该卡可按以下比率赚钱:
- 旅行、邮费、网络、电信、社交网络广告、搜索引擎的消费都可得3倍(3%)积分( travel, shipping purchases, Internet, cable and phone services, advertising purchases made with social media sites and search engines)。
- 其他所有消费可得1倍(1%)积分。
- 点数可以转换成航空公司或旅馆的点数,也可以在家属之间转。
- 由于有25%的旅游兑换奖励,在Chase的旅游门户网站上兑换积分的价值为1点值1.25美分。
- Chase 5/24规则适用于此卡,就是如果你过去两年内申请过5张或以上任何银行的信用卡,则不能申请此卡。
- 申请商业信用卡的时候可以用自己的个人SSN,只要报至少$10000商业收入就可以了。如果第二年不想接着交年费可以在第一年年底的时候关掉这张信用卡。关卡之前记住把自己赚的点数花掉或者转给别的帐号。
- 旅程取消/中断保险:如果您的旅行因疾病、恶劣天气和其它承保情况而被取消或缩短,您可以获得每次旅行最多5000美元的预付、不可退款的旅行费用补偿,包括客票、旅游和酒店。
- 行李丢失保险:如果您或您的直系亲属托运或随身携带的行李因承运人损坏或丢失,每位乘客最多可获得3000美元的赔偿。
- 行李延误保险:在客运公司行李延误超过6小时的情况下,为您报销洗漱用品和衣物等必需品的费用,5天内每天最高100美元。
- 旅程延误补偿:如果您的普通承运人旅行延误超过12小时或需要过夜,您和您的家人可获得未报销的费用,如膳食和住宿,每张票最高500美元。
- 旅行和紧急援助服务:如果您在外地遇到问题,请致电福利管理员,以获得法律和医疗转介或其他旅行和紧急援助(您将负责获得的任何商品或服务的费用)。
2023年5月8日星期一
Rakuten:新用户用推荐链接加入可以得到40美元的奖励
用这个推荐链接在东部时间2023年5月15日午夜之前加入Rakuten的话,可以获得$40返利奖励。
Rakuten是一个第三方购物返利网站。我以前推荐了一些我用过的,信用比较好的网站。Rakuten也是其中一个我用得比较多的。
下面是这次返利奖励的注意事项:
- 点击推荐链接到达Rakuten的页面,然后在Rakuten页面上点击Join Now链接成功注册为Rakuten的新会员。
- 要得到$40的开户奖励,你需要在开户90天内登录进入Rakuten网站,搜索找到你想从那里购物的商家,点击商家链接进入商家网站购物。90天内从各个商家的购物总额(不包括税)满$40以后,Rakuten会把$40奖励放入你的Rakuten账号。你得到的奖励第一次会在购物的15天之内支付,以后的奖励每三个月支付一次。支付会以你选择的方式寄给你或存入你的银行。
- 注意:购买gift card一般不算购物,拿不到奖励。
2023年4月18日星期二
Chase Sapphire Preferred Card (CSP) 蓝宝石信用卡80,000点的开户奖励(此卡对旅游特别友好)
通过推荐链接申请Chase Sapphire Preferred卡并得到批准以后,在三个月之内消费4,000美元可获得80,000点。80,000点可以直接换成$800。如果用点数在Chase旅游门户网站购买机票或订旅馆和用钱在别的地方买没区别,并且有25%的优惠,$800就相当于$1000。
信用卡详情
- 有95美元的年费,不能免除
- 没有国外交易费
- 有Primary汽车租赁保险,就是租车的时候不买保险,自己的车险不会被波及到,直接用这张卡的保险就可以;而一般信用卡的汽车租赁保险都是Secondary的,会先用自己的车险,然后才能用信用卡的保险,所以租的车有赔偿事故会影响到自己的保险信用。
- 有50美元的年度酒店积分奖励 (这是每一个卡会员年,而不是日历年。必须通过Chase旅游门户网站预订)。
- 该卡可按以下比率赚钱:
- 通过Chase旅游门户网站预订的旅行,可获得5倍积分。
- 餐饮/流媒体服务/在线杂货3倍(不包括Target、沃尔玛和批发俱乐部)。
- 旅游2倍
- 其他所有消费的1倍
- 10%的周年纪念积分奖励。当你每年交了年费以后,Chase将提供10%的消费奖励。例如,如果你花费25,000美元,你将获得2,500个奖励积分。 这是在支付年费后的奖励,并不适用于开户奖金。
- 点数可以转换成航空公司或旅馆的点数,也可以在家属之间转。
- 由于有25%的旅游兑换奖励,在Chase的旅游门户网站上兑换积分的价值为1点值1.25美分。
- 如果你在过去48个月内收到过任何蓝宝石系列信用卡的开户奖励,则不能申请此卡。
- Chase 5/24规则适用于此卡,就是如果你过去两年内申请过5张或以上任何银行的信用卡,则不能申请此卡。
- 旅程取消/中断保险:如果您的旅行因疾病、恶劣天气和其它承保情况而被取消或缩短,您可以获得每人10,000美元、每次旅行20,000美元的预付、不可退款的旅行费用补偿,包括客票、旅游和酒店。
- 汽车租赁碰撞损失豁免权:拒绝租赁公司的碰撞保险,并从您的卡中扣除全部租赁费用。保险是主要的,对于美国和国外的大多数租车,提供不超过车辆实际现金价值的盗窃和碰撞损害赔偿。
- 行李延误保险:在客运公司行李延误超过6小时的情况下,为您报销洗漱用品和衣物等必需品的费用,5天内每天最高100美元。
- 旅程延误补偿:如果您的普通承运人旅行延误超过12小时或需要过夜,您和您的家人可获得未报销的费用,如膳食和住宿,每张票最高500美元。
- 旅行和紧急援助服务:如果您在外地遇到问题,请致电福利管理员,以获得法律和医疗转介或其他旅行和紧急援助(您将负责获得的任何商品或服务的费用)。