Medicare Advantage at a disadvantage in health debate

[clear eye]

Source: Wall Street Journal

By Robert Schroeder, MarketWatch
WASHINGTON (MarketWatch) -- Senate Finance Committee Chairman Max Baucus promises that the huge health-care reform bill his committee will vote on next week will protect Medicare benefits for seniors. But not everyone agrees, and a fight is brewing as lawmakers prepare to take the legislation to the floors of the House and Senate.

At issue is Medicare Advantage, a popular federal government-subsidized program that allows seniors to choose health plans run by insurance companies. Currently about 10 million people - close to a quarter of the 45 million seniors getting Medicare - have signed up for Medicare Advantage...

...Obama isn't proposing taking away any traditional Medicare benefits. But he and Democrats want to cut more than $100 billion in payments to Medicare Advantage plans over 10 years to help pay for their proposed health-care overhaul. Obama and Democrats say that the Medicare Advantage plans, on average, cost the government 14% more per beneficiary than traditional Medicare.


Read more: http://www.marketwatch.com/story/medicare-advantage-at-disadvantage-in-health-fight-2009-10-08

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I looked up what "cuts in Medicare" were being referred to in news articles. Although there will be some loss of covered preventative care including some types of exams and gym memberships, it doesn't appear that the heart of the program is in any way endangered.

We gotta be grateful for small blessings, I guess.

[Vinca]

1. I wonder how many seniors will be grateful to get out of Medicare Advantage.

I was under the impression that once you signed up for it, you were stuck whether you liked it or not. I know I've heard complaints about care being denied and other "big insurance" related complaints.

[clear eye]

4. I haven't read about anything in the proposed bills

that would allow members to opt out of a Medicare Advantage program any easier just b/c it won't cover a few things it used to. Have you?

Don't you just have to wait to the end of the year to switch back to gov't Medicare? Obviously, I'm no Medicare expert.

[Nina65]

20. Medicare Advantage

Vinca,
You can switch Medicare plans every year during the annual enrollment period. If you are looking for Medicare options available in your area, I recommend the search tool at <a href="http://www.PlanPrescriber.com">PlanPrescriber.com</a>. By entering your zip code, you receive all the Medicare plans available in your area. Then, you can do a plan comparison. I use PlanPrescriber.com every year and find it very helpful. Hope you find it just as beneficial.

[postulater]

2. People with regular Medicare pay about $6

for a chiropractic visit.

The same visit with Medicare Advantage is usually a $30 copay.

Not what I call an advantage.

[imdjh]

8. Advantage is safer because it has a low total out of pocket. It also costs $100/mo about.

[postulater]

9. Yeah. guess it just depends on your needs.

[zelda7743]

17. Not necessarily safer

I do billing for skilled nursing facilities. I routinely have to send residents with Managed (Medicare Advantage) plans to collections because they can't pay their copays or because the Managed plan has decided that they aren't going to cover the services (even after giving prior authorization). I have never had to send a regular Medicare resident to collections. No one predicts that they will end up in a skilled nursing facility, but one stay can bankrupt an older person if the right coverage is not in place.

[Ruby the Liberal]

3. It is my understanding that MA covers the 20% gap that Medicare won't pay

Are they proposing closing/narrowing that gap, or just dropping the subsidy?

[clear eye]

5. My impression is that they are just denying coverage for some things

that the privately based Advantage programs covered as an inducement to sign up, that the standard gov't Medicare doesn't. It shouldn't affect the gap on covered items one way or the other.

Purveyors of Medigap coverage, like AARP, should profit from this as people who used to sign up for Advantage programs to get the various preventive checkups, will soon only have those things covered by buying that coverage in a separate Medigap plan. Those of us not able to afford Medigap insurance will likely make do w/o the checkups.

[Ruby the Liberal]

7. Ah. Thanks!

:hi:

[TheCowsCameHome]

6. Is MA another form of supplemental insurance to be used with plans A & B?

I've been told MA has it's downside, but don't know first-hand.

[clear eye]

10. No, it replaces standard Medicare if you so choose

w/ a private plan that has to conform to the costs and coverage Congress dictates. It was an effort by the previous administration to turn over tax money associated w/ Medicare to private cos. Sort of like paying Haliburton to feed the U.S. military in Iraq instead of the military itself. Those cos. bargained to have a few subsidized bells & whistles that standard Medicare didn't have as an inducement to seniors to risk being covered by a private co. (w/ all their history of claim denials) rather than the gov't.

It's those bells and whistles that appear to be being cut.

Of course we can never relax our vigil on maintaining Medicare, even when the country is trying to get affordable, decent coverage for the rest of us. Just Google the term "IMAC".

[TheCowsCameHome]

11. Thanks for that.

Right now I'm leaning toward the original Medicare + plan B.

[Psephos]

13. Except for drug coverage, MA was enacted under the Balanced Budget Act of 1997

Under that legislation, it was known as Medicare Part C.

Part D (prescription coverage for seniors) was added in 2003 to the Part C plans.

[OHdem10]

12. Most people on MA are on it because of costs. These are HMOs

No matter how one tries to slice it. Now that people are
used to Medicare Advantage, they will find it frustrating
to be paying twice as much for their premiums. Yes, at
least 2 times as much unless they have the highest end HMO.
Just so we are honest.

[shraby]

14. We didn't take Advantage because we would have to

pay 20% of the 20% that Advantage covered. We went with another company that covers in full the 20% that Medicare doesn't cover and also any out of pocket costs incurred with Medicare. No costs besides the premium whatsoever so far. When we go to the doctor or hospital, we don't want to even think about having a bill come that WE have to pay and wonder how much we'll get stung.

[FreeStateDemocrat]

15. What is the name of the medicare supplemental policy that is working for you ?

[shraby]

16. We went with American Family. The agent is local and

we can talk to him at any time we want. We have the rest of our insurance with them and have known him for a long time. I'm sure if we ever have a problem, we can yell and be heard.
I really would like to see Medicare for all though. It would be cheaper and everyone would be covered.
The most important part until then, is get someone you can walk into their office and yell if you're not happy. Much better than being put on hold forever until you forgot what you called for...and if you do remember, you still get no satisfaction.

[DavidDvorkin]

18. It's not "popular". It's necessary

for most people.

Medicare coverage should be complete. No supplementary insurance should be necessary.

Medicare should also cover everyone, regardless of age, and it should be financed from general revenues. But that's a different argument.

[damntexdem]

19. It certainly should be. It's a big giveaway to the insurance industry.

A program paying average Medicare costs for private coverage can work, as prior programs, like TEFRA HMOs, did. Or if private companies can't profit at Medicare rates, too bad. But paying higher rates for Advantage premiums simply makes no sense -- except to those whose concern is for-profit insurers' bottom lines.

[roseBudd]

21. Medicare Advantage is a tax payer giveway to the for profit insurers

The Republicans sold it as a savings on administrative costs. Big surprise it is not.

http://www.lasvegassun.com/news/2009/jan/16/medicare-advantage-plans-may-lose-some-federal-cas/

In 2006 the federal government spent $60 billion on the Medicare Advantage plans, according to a report last month from the Government Accountability Office. In 2007 the spending increased to $77 billion. The GAO estimates in 2008 the expenditures increased to $91 million, the report said.

“Payments to (Medicare Advantage) organizations are, in part, based on the projected expenditures organizations submit in their bids for providing Medicare-covered services, as well as actual enrollment and beneficiary health status,” the report said. “Once Medicare payments are determined, they are not modified based on differences between actual and projected expenses.”

The GAO analyzed data collected from health maintenance organizations, private fee-for-service plans and preferred provider organizations.

“There was a consistent pattern of actual profits being higher than projected and medical expenses being lower than projected,” the report said. Although companies on average estimated that they would spend 86.9 percent on medical expenses, they actually spent 83.3 percent. Companies also reported higher than estimated earnings, the report said.