Medicare Advantage - Don't do it

[Martin]

I have a chronic gastro problem that requires me to see a gastroenterologist on a regular basis with intermittent testing done.

I had an upper endoscopy earlier this year, Charges to insurance were something like $18,000 for an outpatient procedure that took 15-20 minutes. I had to pay $1800 out of pocket in copays. I have an "Affordable" Care Act plan that costs $1300/month before subsidies and maybe $900/month after subsidies. That's with no spouse or children on the plan, just me.

I just called today to schedule my next office visit with the gastroenterologist, with whom I have been a patient for nearly ten years. Her next available appointment is five months away.

So I pay $900/month net for insurance that still charges a fortune if I actually need anything done, and for a doctor who is barely available.

The system is completely broken.

Holy crap!

I had an upper endoscopy in September. I have an Aetna health plan through work ($789.00 per month for a family of 3 including 1 smoker, and a $4,000.00 in-network deductible). We've met our deductible for the year. I just checked my explanation of benefits for the upper endoscopy: $5,042.29 total (surgery center, gastroenterologist, pathology & pathologist, anesthesia and anesthesiologist). Insurance paid $3,122.90 and my share is $0.00.

$18k is robbery.

Martin

By the way, my new Aetna MA plan is $0.00 per month with a $3,000 in network deductible.

 

[Andysu]

Holy crap!

I had an upper endoscopy in September. I have an Aetna health plan through work ($789.00 per month for a family of 3 including 1 smoker, and a $4,000.00 in-network deductible). We've met our deductible for the year. I just checked my explanation of benefits for the upper endoscopy: $5,042.29 total (surgery center, gastroenterologist, pathology & pathologist, anesthesia and anesthesiologist). Insurance paid $3,122.90 and my share is $0.00.

$18k is robbery.

Martin

By the way, my new Aetna MA plan is $0.00 per month with a $3,000 in network deductible.

may as well go out and rob a bank , it is daylight highway robbery and i really know it's free , well without developed free mind of some 250,000 years ago we wouldn't be reading this post none of this electronically stuff would exist
it pisses me off even for vet costs , sick social society of greed
leave usa come to the uk get nhs for free , bring your pets pdsa all you need is pay small contribution , yeah deep cut finger nhs will fix it and that's it , usa cost deep cut $1000 , join armed forces finger blown off , medic ! its done for free ? now ain't that strange ? you ask i give you the answers

come on your the dude , think of that rug how it was invented though dreaming and imagination for free , for free , for free without which and the tools are our hands to draw it on paper , paper pencils all came from free mind for free long , long ago for free , wake up everyone , wake up

 

[xanalog]

...leave usa come to the uk...

Ha?
Thank you for the warm-invite... but... I'm inclined to decline.

 

[xanalog]

Below is a graphic showing how medical insurance company stock valuations increased from 2010 to some date in early (the seventh?) Nov. 2025 week since the "Affordable Care Act" (ACA) was signed into law (March 2010) by the President at that time. It seems that the ACA has been very relevant to their value. This despite how in this time period of 2025 to market close 07 Nov. 2025 (year to date data) the United Health Group company's stock price is down almost 36%, Cigna stock is down almost 4%, Molina stock is down almost 47%, Centene stock is down almost 38%, Elevance (Anthem) stock is down about 13% and then Humana stock price is only down about 1/4%; Aetna is now a part of CVS' holdings so my free stock app has no entries for Aetna.
...

I hope we are not including ACA (w/extended benefits) in the same conversation about Medicare here.

What I see (and take) from your graph is that within the 'medical insurance' sector there are 7+1 companies as major players:
Such stiff competition -in this sector- is what a *mostly-capitalistic society practices for the prosperity of such companies and [hopefully] yielding better services and prices for citizens.
Remembering also that this medical-insurance sector and the whole pharmaceutical industry has allowed us to live decades longer, than anyone could have speculated.
The good investment may be to either take (stock) ownership in such companies or work for them, or both.
These companies, in the health and services, are some of the most vibrant, secure, good paying employment, which have resisted the high unemployment numbers for the last few presidencies (excluding, of course, our spiked federal employment figures).

Of course, there is much concern for waste and potential abuse but I won't post the AI reply numbers/figures. I spent about 30 minutes in engaging with AI for the facts but I was encouraged to post this reply only because one statement that Claude provided actually shocked me:

...The 2% figure likely refers to the administrative costs of traditional Medicare, which are indeed very low. According to the Centers for Medicare & Medicaid Services (CMS), Medicare’s administrative expenses are approximately 1–2% of total spending, making it one of the most efficient health systems in the world....

Really?

*I stated it as "mostly-capitalistic', simply because the mandates from the federal government play a giant big role in this sector and how these companies must revise their playbook, at the yearly whim of the federal government.

OT: None of the above is meant to be political reflection points.

 

[Soandso]

I hope we are not including ACA (w/extended benefits) in the same conversation about Medicare here.

What I see (and take) from your graph is that within the 'medical insurance' sector there are 7+1 companies as major players:
Such stiff competition -in this sector- is what a *mostly-capitalistic society practices for the prosperity of such companies and [hopefully] yielding better services and prices for citizens.
Remembering also that this medical-insurance sector and the whole pharmaceutical industry has allowed us to live decades longer, than anyone could have speculated.
The good investment may be to either take (stock) ownership in such companies or work for them, or both.
These companies, in the health and services, are some of the most vibrant, secure, good paying employment, which have resisted the high unemployment numbers for the last few presidencies (excluding, of course, our spiked federal employment figures).

Of course, there is much concern for waste and potential abuse but I won't post the AI reply numbers/figures. I spent about 30 minutes in engaging with AI for the facts but I was encouraged to post this reply only because one statement that Claude provided actually shocked me:

Really?

*I stated it as "mostly-capitalistic', simply because the mandates from the federal government play a giant big role in this sector and how these companies must revise their

Often some of the same medical insurance companies that provide plans to ACA are also providing plans for Med.Advantage. [The screen shot graphic starts from ("after") the year of enactment of the ACA ("Obamacare") and indicates what those stock valuations have registered.] I see no way to parse if Med.Advantage has been that trend's most contributing factor in light of Medicare's (CMS) setting one governmental cost guard rail of regulating there were no more than 3 consecutive year of greater than 15% profit for any one particular MedAdvantage plan which any of those insurers operate or rebates are due back to CMS.

 

[Power Pop 23]

It seems potential new benefits from GLP-1 medications are being discovered regularly.

GLP-1s show promise in treating alcohol and drug addiction

A popular class of therapies for treating diabetes and obesity may also have the potential to treat alcohol and drug addiction, according to a new paper published in the Journal of the Endocrine Society.

www.endocrine.org

I am cautiously optimistic they will significantly reduce the cost of health care.

 

[amper42]

It seems potential new benefits from GLP-1 medications are being discovered regularly.

GLP-1s show promise in treating alcohol and drug addiction

A popular class of therapies for treating diabetes and obesity may also have the potential to treat alcohol and drug addiction, according to a new paper published in the Journal of the Endocrine Society.

www.endocrine.org

I am cautiously optimistic they will significantly reduce the cost of health care.

I'm cautiously optimistic GLP-1 will be found to have serious health consequences within the next 10 years.

 

[Power Pop 23]

I'm cautiously optimistic GLP-1 will be found to have serious health consequences within the next 10 years.

I prefer to hope not.

 

[Soandso]

…GLP-1 …serious health consequences ….

Quote from the discussion section in the recent report referenced below of 3 cases of overlooked side effects =

 

[RDoc]

leave usa come to the uk get nhs for free

UK doesn't allow continuous long term stays for US citizens. I've looked.

 

[Soandso]

UK doesn't allow continuous long term stays for US citizens. I've looked.

If you are a USA citizen would you prefer to be in the free UK NHS?

 

[Canuck57]

If you are a USA citizen would you prefer to be in the free UK NHS?


View attachment 491523

View attachment 491524

This study/analysis ranks UK third and the USA tenth. My country is ranked seventh, we need to improve our health care system.

 

[Soandso]

This study/analysis

Which report(s) is being referred to ?

 

[Soandso]

Which report(s) is being referred to ?

Cancer drug access in the USA is quite notable;

Quote:

Quote:

Quote:

Quote:

 

[Canuck57]

Which report(s) is being referred to ?

The study explains in detail what was compared, how the data was gathered and the conclusions.

Abstract​

• Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement.
• Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes.
• Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower.
• Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.

 

[Soandso]

The study explains in detail what was compared, how the data was gathered and the conclusions.

Abstract​

• Goal: Compare health system performance in 10 countries, including the United States, to glean insights for U.S. improvement.
• Methods: Analysis of 70 health system performance measures in five areas: access to care, care process, administrative efficiency, equity, and health outcomes.
• Key Findings: The top three countries are Australia, the Netherlands, and the United Kingdom, although differences in overall performance between most countries are relatively small. The only clear outlier is the U.S., where health system performance is dramatically lower.
• Conclusion: The U.S. continues to be in a class by itself in the underperformance of its health care sector. While the other nine countries differ in the details of their systems and in their performance on domains, unlike the U.S., they all have found a way to meet their residents’ most basic health care needs, including universal coverage.

Am I missing the comment number which names that study's Title? Would you be so good as to state the study's title now. When it's screen shot abstract promotes "equity" and "administrative efficiency" among it's 5 "measures" it would be best to know what the authors are actually qualifying.

In comment #134 I've posted a European based study showing clearly the benefit of being in the USA health care system if the subject is prostate cancer ("P').

And a bit earlier (comment #131) data demonstrates that blogged anecdotal claims UK medical services wait list times are considerable actually is true, but getting worse. Yet apparently according to the study you refer to the UK is one of the top 3.

 

[Canuck57]

Introduction​

Mirror, Mirror 2024 is the Commonwealth Fund’s eighth report comparing the performance of health systems in selected countries. Since the first edition in 2004, our goal has remained the same: to highlight lessons from the experiences of these nations, with special attention to how they might inform health system improvement in the United States.

While each country’s health system is unique — evolving over decades, sometimes centuries, in tandem with shifts in political culture, history, and resources — comparisons can offer rich insights to inform policy thinking. Perhaps above all, they can demonstrate the profound impact of national policy choices on a country’s health and well-being.

In this edition of Mirror, Mirror, we compare the health systems of 10 countries: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, the United Kingdom, and the United States. We examine five key domains of health system performance: access to care, care process, administrative efficiency, equity, and health outcomes (each is defined below).

Despite their overall rankings, all the countries have strengths and weaknesses, ranking high on some dimensions and lower on others. No country is at the top or bottom on all areas of performance. Even the top-ranked country — Australia — does less well, for example, on measures of access to care and care process. And even the U.S., with the lowest-ranked health system, ranks second in the care process domain.

Nevertheless, in the aggregate, the nine nations we examined are more alike than different with respect to their higher and lower performance in various domains. But there is one glaring exception — the U.S. (see “How We Conducted This Study”). Especially concerning is the U.S. record on health outcomes, particularly in relation to how much the U.S. spends on health care. The ability to keep people healthy is a critical indicator of a nation’s capacity to achieve equitable growth. In fulfilling this fundamental obligation, the U.S. continues to fail.

 

[Soandso]

… promotes "equity'' …it would be best to know what the authors are actually qualifying.

As for equity this (2025) analysis from Australia describes that the outcome of enrollment equity did not result in what was projected. If Australian "equity" of enrollment is weighted equally as 4 other areas (see above comment #135) giving Australia a top 3 "health system" it places that ranking methodology in question.



QUOTE:

 

[Canuck57]

Here is another study by the US, Peter G. Peterson foundation. The founder was republican and it claims to be a non-partison organization.

How Does the U.S. Healthcare System Compare to Other Countries?

Despite higher healthcare spending, America’s health outcomes are not any better than those in other developed countries.

www.pgpf.org

 

[Soandso]

Introduction​

Mirror, Mirror 2024 is the Commonwealth Fund's …

QUOTE: - from The Commonwealth Fund which it should be mentioned works to promote so-called "universal healthcare" and objects to the currently elected USA federal administration's attitude to aspects of the previous administration's Affordable Care Act.

There are 430 Million people residing in the USA as of 2025. Additionally an unknown number of people in prior years crossed the USA's borders without residency rights. In the USA hospitals are prohibited by law from refusing emergency room and if medically necessary hospitalization irregardless of the patient's documentary status or whether they have current medical insurance. Thus many USA hospital emergency room services have been utilized as primary care stations without prior-referral/authorization/co-pay by anyone outside of the medical insurance system.

If I was surveyed today I could attest positively to USA medical care having just come home from anesthetized out-patient surgery that cost me $0.00 co-pay, and being non-emergency was convenient to schedule at my convenience after insurer (Med.Advantage) had promptly pre-approved; making today the 3rd time this month (Nov.2025) I'd benefited from medical specialists treatments that were all easy for me to access.


QUOTE:

Also from the cited Commonwealth Fund report we see USA does exceptionally well limiting hospital adversity in heart attack/failure/pneumonia/major surgery and delivers high quality care.