Is Traditional Medicare transitioning to be like Medicare Advantage?

[JLW]

Like millions of older adults, Frances L. Ayres faced a choice when picking health insurance: Pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage.

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensifiedafter the murder of a UnitedHealthcare executive last December.…

The Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.L_ZA.095JZYck6sPh&smid=url-share

*********************

This has been part of the GOP agenda for years: Do away with traditional Medicare and have private health insurers determine what medical procedures you can and can not have. These insurance companies act as a true death panel. For those currently enrolled or want to be enrolled in traditional Medicare this is not good news.

 

[1srelluc]

Huh, looks like most of the political heavy hitters that received Insurance money were dems.

The top 20 is evenly divided.

Most of the gop ones are gone, dead, or on their way out.

Insurance Recipients

See aggregated party breakdowns and incumbency status of recipients of contributions from Insurance industries/interest groups for every election cycle from 1998 to 2024.

www.opensecrets.org

 

[Winston]

Like millions of older adults, Frances L. Ayres faced a choice when picking health insurance: Pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage.

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensifiedafter the murder of a UnitedHealthcare executive last December.…

The Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.L_ZA.095JZYck6sPh&smid=url-share

*********************

This has been part of the GOP agenda for years: Do away with traditional Medicare and have private health insurers determine what medical procedures you can and can not have. These insurance companies act as a true death panel. For those currently enrolled or want to be enrolled in traditional Medicare this is not good news.

Medicare Advantage needs to go. Granted, it was an experiment, the experiment failed. I get the government's perspective. Throwing the risk of health care expenses to private insurers instead of the government, I get it. But for the consumer, and the government, it hasn't turned out that well.

 

[debbiedowner]

Like millions of older adults, Frances L. Ayres faced a choice when picking health insurance: Pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage.

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensifiedafter the murder of a UnitedHealthcare executive last December.…

The Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.L_ZA.095JZYck6sPh&smid=url-share

*********************

This has been part of the GOP agenda for years: Do away with traditional Medicare and have private health insurers determine what medical procedures you can and can not have. These insurance companies act as a true death panel. For those currently enrolled or want to be enrolled in traditional Medicare this is not good news.

You can't get a private Medicare Advantage plan unless you're paying the Part B premium.

CMS is going to test in 6 states next year the pre auth model and if it's works it will probably get introduced nation wide.

 

[WorldWatcher]

So the GOP is bringing on death panels...

...... ...... But the death panels will be AI.

WW

 

[debbiedowner]

Here's your Medicare premiums for 2026 and deductibles. Not to mention if you have a supplement and Part D they are more than likely going up in 2026.

2026 Medicare Parts A & B Premiums and Deductibles | CMS

2026 Medicare Parts A & B Premiums and Deductibles2026 Medicare Part D Income-Related Monthly Adjustment AmountsOn November 14, 2025, the Centers for Medicare & Medicaid Services (CMS) released the 2026 premiums, deductibles, and coinsurance amounts for the Medicare Part A and Part B programs...

www.cms.gov

 

[JustAGuy1]

Like millions of older adults, Frances L. Ayres faced a choice when picking health insurance: Pay more for traditional Medicare, or opt for a plan offered by a private insurer and risk drawn-out fights over coverage.

Private insurers often require a cumbersome review process that frequently results in the denial or delay of essential treatments that are readily covered by traditional Medicare. This practice, known as prior authorization, has drawn public scrutiny, which intensifiedafter the murder of a UnitedHealthcare executive last December.…

The Centers for Medicare and Medicaid Services plans to begin a pilot program that would involve a similar review process for traditional Medicare, the federal insurance program for people 65 and older as well as for many younger people with disabilities. The pilot would start in six states next year, including Oklahoma, where Ms. Ayres lives.

The federal government plans to hire private companies to use artificial intelligence to determine whether patients would be covered for some procedures, like certain spine surgeries or steroid injections. Similar algorithms used by insurers have been the subject of several high-profile lawsuits, which have asserted that the technology allowed the companies to swiftly deny large batches of claims and cut patients off from care in rehabilitation facilities.

The A.I. companies selected to oversee the program would have a strong financial incentive to deny claims. Medicare plans to pay them a share of the savings generated from rejections.

https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.L_ZA.095JZYck6sPh&smid=url-share

*********************

This has been part of the GOP agenda for years: Do away with traditional Medicare and have private health insurers determine what medical procedures you can and can not have. These insurance companies act as a true death panel. For those currently enrolled or want to be enrolled in traditional Medicare this is not good news.

Tell us what you think Traditional Medicare is?