Humana cutting back.....

[CKN]

Private health insurance not Medicare, he isnt 65 yet. It's actually in the OP post for anyone reading the compete story.
I have a family member in NJ same deal, private health insurance until they reach 65 is costing them $27,600.00 a year once they hit 65 it will go down to (current rate) $2,100.00 a year @ $175. a month

I agree it's the most whacked out story I ever read... but this is a link from that story.
https://www.healthcaredive.com/news/humana-exits-employer-insurance/643521/

I retired at 55 years of age. Anybody retiring early knows (or should know) Healthcare out of pocket is going to be a major factor. I didn't quite pay $27,000/a year-but it's not too far off from what I paid. It cost me thousands of thousand of dollars until I reached Medicare age. I'm on an Advantage Plan now.

 

[alarmguy]

And what do you think Medicare Advantage is? Plan C is a Medicare plan in name mostly. You are paying for what amounts to a private health insurance plan with all of the limitations and costs that go with it. Medicare A & B is the only real Medicare.

The article is poorly written. On the one hand, it states that Humana is "all in" on "MA" (I assume MA stands for Medicare Advantage), then, on the other hand, it states that Humana "slashed its plan presence for next year."

You need to read the story. They are fully going into government programs, that is medicare. Government pays Humana for every Advantage C plan that they give someone. Since government pays, they also must approve each medicare advantage C plan.

I agree, poorly writing is an UNDERSTANDMENT!!!!! The writer is clueless and tripping over their own words. You have to click on all the links to re-write the correct story in your head! *LOL*

But here is the link to the question you asked me. It's really why so important now a days in the misfit media to REALLY examine what we read. These misfits even supplied the link I am quoting from!

"No other Humana health plan offerings are materially affected. The company remains committed to the long-term growth of its core Insurance lines of business, including Medicare Advantage, Group Medicare, Medicare Supplement, Medicare Prescription Drug Plans, Medicaid, Military and Specialty (Dental, Vision, Life, etc.), as well as its CenterWell healthcare services business."

HERE IS THE SOURCE;
https://humana.gcs-web.com/news-rel...er-group-commercial-medical-products-business

As always just discussing!!!

 

[SC Maintenance]

Here is one of likey thousands of examples. A prescription medicine that is manufactured in Canada and sells in Canada for $15 USD, sells for in the U.S. for $800 USD. Americans are not allowed to buy the exact medication in Canada for $15 USD.

There are no competitors in Canada. There is only the public health sector. They negotiated the $15.

I can go to Germany and get a CT scan, out of pocket, is $700 on the same Siemens machine they have here. There are no competitors, only the German government. The no insurance cost here is about $3000. My insurance paid about $1000, which is some amount higher than what medicare pays. Almost all negotiated in network insurance costs are based on some multiple above Medicare - aka private insurance subsidizes medicare for the most part.

Back to the the pharma side - Canada negotiates prices as a Nation (public health care). Your $800 med in the USA is likely we are subsidizing it for the world, including medicare. What is the medicare price of that drug. There is most likely only one supplier of that drug, so more competition in the USA won't help. All you could do is make the patent last less time, but then no one would develop the drugs.

I don't know the answer, but we had supposedly more competition before. It was better for some, but they would not cover others with a pre-existing condition. So it depended on who you were.

 

[Pablo]

You're reading inaccurate headlines and I suspect almost everyone else. It's why NOT TO TAKE ANY HEADLINE as accurate.
One would think Humana is cutting back on Medicare plans. 100% INCORRECT! HUMANA IS GOING ALL IN ON MEDICARE PLANS AND DROPPING EMPLOYEE HEALTH INSURANCE PLANS.
(ps not yelling and not directed at you, trying to catch the attention of others "headline reading" and thinking Humana is cutting out medicare when they are growing their medicare programs and exiting employee health plans.

Perfect example of pop tart media reporting, most likely the writer believes there own incorrect headline.

BTW- nothing wrong with companies making profits. It's what a free country is about. Want to be free? No complaints from me. Medicare is an incredible efficient health insurance machine. Love it and I know many others who do. Actually I dont know anyone who doesnt. Much better than ANY company insurance which Humana is getting out of.

I like how I said the same thing in less words. Might take some critical thinking though.

 

[SC Maintenance]

A better written article - so we can stop arguing poorly written symantics.

"Humana expects to exit Medicare Advantage markets in 2025, company executives told investors. "

https://www.beckerspayer.com/payer/...-some-medicare-advantage-markets-in-2025.html


There leaving some markets. There overall stragegy of selling MA remains intact, only in fewer places - presumably the more profitable ones, given it was an investor press release.

 

[alarmguy]

Here is one of likey thousands of examples. A prescription medicine that is manufactured in Canada and sells in Canada for $15 USD, sells for in the U.S. for $800 USD. Americans are not allowed to buy the exact medication in Canada for $15 USD.

The prescription medication would not exist if corporations are not allowed a free market to profit on the drug. Why would they invest tens of millions of dollars to develop drugs otherwise?

BTW- https://www.canadapharmacy.com/ is only one source of many.

I also did the work for others in here - https://www.canadapharmacy.com/prescription

 

[mk378]

Pharma companies spend more on TV commercials than private R&D into new drugs. Most medical research is funded by governments.

 

[SC Maintenance]

The prescription medication would not exist if corporations are not allowed a free market to profit on the drug. Why would they invest tens of millions of dollars to develop drugs otherwise?

This is correct.

Except under the current system the US consumers pay for most of it, and the rest of the world gets a free ride.

Again, I have no idea what the solution is.

 

[mk378]

Use a Return On Investment model to regulate what they can charge for patented drugs that they invested something to develop. The USA is the only major country that does not in some way regulate the price of prescription drugs.

 

[SC Maintenance]

Pharma companies spend more on TV commercials than private R&D into new drugs. Most medical research is funded by governments.

Big pharma really doesn't develop much. Small companies do - usually under private equity.

When they have some level of success, they usually get acquired by one of the big guys. So the R&D shows up as an acquisition cost, not R&D.

There are a variety of reasons structurally in the capital markets and liability world for this model. My only point is be suspect of any statistic that talks about R&D costs in pharma, because private equity do not disclose there costs usually.

 

[John105]

https://www.healthcaredive.com/news/humana-membership-losses-medicare-advantage-plan-cuts/722619/

Got to keep that profit up! How dare people use their healthcare. When they do they risk getting benefits reduced or plans being dropped.

Really all insurance works as such. And key word is profit. Wouldn’t want to break even and have a patient benefit or live longer. How much do all the corny commercials cost? Couldn’t those funds be used to benefit mankind

 

[alarmguy]

A better written article - so we can stop arguing poorly written symantics.

"Humana expects to exit Medicare Advantage markets in 2025, company executives told investors. "

https://www.beckerspayer.com/payer/...-some-medicare-advantage-markets-in-2025.html


There leaving some markets. There overall stragegy of selling MA remains intact, only in fewer places - presumably the more profitable ones, given it was an investor press release.

wow, some of the craziest reporting I ever saw. Good post.
Taken from that=
"Humana — the second largest provider of MA plans in the U.S. — has gone all-in on government plans, refocusing its business entirely on MA and Medicaid last year. Medicare is its biggest bet: Individual and group MA plans make up 38% of Humana’s members, but 86% of its premium revenue."

So depending on reimbursement rate next year which they will not know until later this year, they may cut back in certain markets to maintain that high rate of return, I can guess what markets they would get out of and it wont be the Carolinas. I dont know, kind of sounds like business as usual for an insurance company. I would also suggest rattle the saber in the hopes of getting higher government reimbursements.

 

[John105]

This may be out of left field but we have a friend who works in nuclear radiology. He says they have no clue what any treatments they provide costs, but they maintain 3 sets of books.

 

[alarmguy]

Really all insurance works as such. And key word is profit. Wouldn’t want to break even and have a patient benefit or live longer. How much do all the corny commercials cost? Couldn’t those funds be used to benefit mankind

Of course the word is profit, good for them and why they are in business. No one has to buy their Medicare products which are fantastic compared to corporation health plans.

Taxing Pro Football leagues could benefit mankind too.

 

[SC Maintenance]

How do these medicare advantage companies make money?

Is it like traditional insurance, they collect premiums and pay out, and hopefully pay out less than the premiums? However in this case some percentage of the premiums comes from Medicare?

 

[John105]

Of course the word is profit, good for them and why they are in business. No one has to buy their Medicare products which are fantastic compared to corporation health plans.

Taxing Pro Football leagues could benefit mankind too.

What’s interesting is when interests are “aligned.” Such as with life insurance. Policy holder wants to live. Insurance co. Wants the policy holder to live.

With health care overall they are. But they are not. Policy holder wants to see a doctor if sick. It couldn’t be more obvious that insurance doesn’t want that. Doctor is a last resort. The pre existing conditions clause that used to exist was so blatant. You could actually pay a premium for 18 mos and treatment is excluded. I hope that clause doesn’t come back.

 

[alarmguy]

What’s interesting is when interests are “aligned.” Such as with life insurance. Policy holder wants to live. Insurance co. Wants the policy holder to live.

With health care overall they are. But they are not. Policy holder wants to see a doctor if sick. It couldn’t be more obvious that insurance doesn’t want that. Doctor is a last resort. The pre existing conditions clause that used to exist was so blatant. You could actually pay a premium for 18 mos and treatment is excluded. I hope that clause doesn’t come back.

It never applied to Medicare. Pre-existing clause only took effect if you did not currently carry health insurance in most cases. This was to prevent people from not having health insurance and then sign up if they got sick. Clearly that wasnt fair to existing responsible policy holders.
However I do agree 100%, some companies also applied this clause to anyone with any condition whether they had insurance or not. That is all done away with in the ACA.
These rules never applied with Medicare, at 65 you are in regardless of your condition.

I just found this and you (and others might like it) Good read, I found it interesting too. I really dont take a position on anything, Im just happy, VERY happy with the system. My net cost for medical care is almost zero dollars per year and god forbid if I need a $500,000 procedure I might have to pay as much as $4000 of it.
I dont know how a system can work better. 65 and older, you got medical care, period. Im looking forward to shopping and seeing if I want a new plan starting 2025 as I do every year. Which every one will work better for me in any given year will be it. I suspect I will keep Aetna though. My net cost so far this year is $0.00 Assuming I dont have cancer.

Although some will look at this as good, I can see it might cost me money when government demands more services from plans. I wish they would leave well enough alone. I think it is good removing some incentives to sell specific plans. Many do not know, those ads are not paid for by insurance companies. Those ads are by private companies selling insurance. You can go right to the source and buy a plan on the medicare website/
https://fortune.com/well/article/medicare-changes-2025/

 

[SeaJay]

Our corporations are as corrupt as our government.

I am not sure that a commercial insurer simply non renewing insurance coverage is indicative of a corrupt corporation.

 

[SammyChevelleTypeS3]

"Humana Managed Care" is what I opted for a few years back. I was already on Medicare along with company (partly paid) supplemental policy that I could select each year. I would have to present Medicare as primary and then other as supplemental. It was kind of a pain. Then got chance to take Humana Managed Care. I hand in one card and all is taken care of. One co-pay. Just like my Medicare monthly payment is taken out of social security , so is the payment for the Humana plan which is about $50 a month after my former employer pays their contribution. It is all so easy for me. No hassles at all. I know Humana and Medicare just paid a fortune for my care from Nov 2023 thru April 2024. All sorts of tests and Emergency room visits. An ambulance ride. More test and scans etc. Several kidney surgeries, plus bladder stones removal. Prostate and hernia surgery as well. I do not think I even paid $2000 in copay for all of that. One thing I do not like about Humana. They will not leave one alone. They either call or do computer phone calls all of the time trying to change where I get medication from. They also allow some other company to harrass you about allowing someone you do not even know to come into your home for a fitness evaluation. I finally just do not answer the phone calls.

 

[wag123]

One thing I do not like about Humana. They will not leave one alone. They either call or do computer phone calls all of the time trying to change where I get medication from. They also allow some other company to harrass you about allowing someone you do not even know to come into your home for a fitness evaluation. I finally just do not answer the phone calls.

Here, Here! They bug me every day... by phone call, text, mail, and/or email.