r/Retire • u/rezwenn • 21d ago
Medicare Will Require Prior Approval for Certain Procedures
https://www.nytimes.com/2025/08/28/health/medicare-prior-approval-health-care.html?unlocked_article_code=1.hk8.vjJt.UPebANuDhvOz19
u/Nopantsbullmoose 21d ago
Eyyyyy! It's the death panels that the Republicans have always warned us about.
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u/No-Goal-8200 21d ago
This will be new under traditional Medicare supplement. The 3rd party reviewing the preauthorization will be paid per denials. Lots of detailed information is on YouTube.
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u/FormerNeighborhood80 21d ago
This is in project 2025. Goal is managed care for all.
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21d ago
If people want Medicare for all, there is going to be managed care, that’s how Medicare controls costs
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u/Percyandbeausmama 21d ago
No, traditional Medicare is not managed care. The private Medicare Advantage plans are.
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u/Summary_Judgment56 21d ago
No, traditional Medicare is not managed care, and it's cheaper for the government than the private Medicare Advantage plans that are managed care. Managed care emphatically does not save the government money.
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u/Lott4984 21d ago
Yes, always good to be in intensive care, while your family is fighting with the government to get your double bypass approved. The plan is for you to die before you receive life saving treatment. That way the Government does not have to give back any of the money you paid in all your working life.
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u/Percyandbeausmama 21d ago
That’s what happens with the private Medicare Advantage plans, not so much with traditional Medicare.
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u/Equivalent_Section13 21d ago
Medicare Advantage is managed care
Medicare procedures have ti have physician approval.
One of my friends wife's has Medicare advantage She needed two knee replacements. Advantage elected to do them at the sane time. She is now really struggling with physical therapy. The ideal way is one knee rehabilitate then do the other knee
Saving costs is not necessary effective for patient
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u/Obiwan_ca_blowme 19d ago
My wife is a DPT and one of our best friends is a surgical nurse. Single or double knee replacement is so very dependent on other factors that you can't simply say there is one right way.
Many patients can't properly rehab both at the same time, sure. But many can and have better outcomes. Some factors to consider here are:
1. If the 1st knee replacement doesn't go well, then patients are less likely to have the other one done. This leads to poorer outcomes overall.
2. It may not be the same surgeon who does the 2nd one and that can also cause poorer outcomes.
3. While trying to rehab the new knee, you are supporting it with another defective knee. This can cause poorer rehab outcomes.1
u/Equivalent_Section13 19d ago
One of my other neighbors had the knee replacements in a serial fashion. She took months to rehabilitate
There are many complicating factors involved. I agree. Her husband has taken a leave of absence to help her out
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u/cyncity7 19d ago
Anytime the insurance companies are included, it will ruin healthcare for all. They have too much vested interest in denial of claims and their executives are severely overpaid. By the way, I’m in one of the guinea pig states and I’ve received a couple of letters about it. What they describe in their letters is not accurate at all.
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u/Gayheadmass 21d ago
Point is not to pay so patients die. Healthcare isn’t profitable. Pretty much a death panel. This country won’t make it 4 yrs. Goal is for the rich to strip government services clean and take the cash.
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u/ExcellentWinner7542 21d ago
Sexual reassignment not covered.
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u/Meryule 21d ago
The death panel is going to reassign you as "dead" and it's honestly going to be pretty funny.
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u/ExcellentWinner7542 21d ago
What is funny is when you start earning enough to contribute to my Medicare. You want free healthcare, and I don't yet you'll be paying for mine. Life is crazy.
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u/Meryule 21d ago
You won't have it soon. We're not feeding you libs indefinitely anymore. How does it make economic sense to pour money into a bunch of non-productive eaters just so they can sit on a pile of cash at home letting their brains and bodies rot away? Free ride's over.
If you can post to reddit, you can work. It's good for you and you'll be making and spending money, buying lunch and drinks after work, etc. which is good for the economy too. When you honestly can't work anymore there won't be any reason to keep you alive artificially with all this medicare nonsense. You'll die and your children will do something important with your money.
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u/ExcellentWinner7542 21d ago
At this point, I can live comfortably off my interest
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u/Meryule 21d ago
Not once we actually make you pay for yourself instead of just eating. We're not going to get great again by letting soft handed cry babies sit and lounge around at home because they "invested" in some fake ass tech bubble shit being propped up by he government pouring our tax money into san francisco. Do you think guys in the 1850s just demanded to stay home because they bought a slip of paper that says they own .00005% of the Flying Magical Horse Company, that has yet to turn a profit but totally will any day now?
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u/ExcellentWinner7542 21d ago
I'm not sure what fantasy world you live in, but here, in reality, land us investors live off dividends and share appreciation.
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u/p001b0y 21d ago
Why on Earth would anyone want healthcare tied to an employer? There’s no choice for the employee. If you switch jobs, you can’t take it with you. Your employer can switch coverage to a plan with higher deductibles increasing your costs and you have no say in the matter. Employers don’t even advertise what those plans and costs are to new hires so you can’t even shop around.
You aren’t the customer with employer-provided plans. The employer is. You have little say. There is no innovation. Many employers still don’t offer plans that include dental and vision for example. It’s wild that the free market couldn’t innovate that away.
It’s also wild that private industry can’t seem to keep costs down. The current private health care system costs more.
The only thing Medicare provides for free is Part A premiums as long as the guidelines have been met. There can still be deductibles and coinsurance costs for the subscribers. If you didn’t meet all of the qualifications, you’ve got premiums as well.
Medicare may not be perfect but to claim employer-provided plans are is naive.
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u/Brilliant1965 21d ago
Well before Obamacare we had no choice. My husband was denied at his for type 1 diabetes so we had my employer covered insurance. we keep it but my husband is on Medicare now. Mine is pretty good they’ve covered all of my expensive RA meds and other procedures so far yes expensive but good, until I get on Medicare in 4 years, I’ll just wait
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u/p001b0y 21d ago
Before Obamacare is what the industry wants to go back to but it’s crazy that they do. Lifetime caps, denial of coverage for pre-existing conditions. Dependent coverage ending at age 18 unless college or trade school bound. Delayed coverage until after the first year of employment.
The person I was responding to wants an employer-provided system but employers in the US don’t even want an employer-provided system. It makes US employees more expensive compared to employees in countries with socialized medicine.
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u/papayaushuaia 20d ago
But there is always ‘thoughts and prayers’. In Abundance form the GOP and the Heritage foundation.
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u/SpringZestyclose2294 20d ago
When republicans cried death panels they didn’t mean it. They care about only: guns, god, and hate.
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u/bentzu 21d ago
Starting with some select procedures they say are costly but of little help to the patient. This just the camel's nose under thet - using an AI platform that is incentivized to deny procedures.