Democrats: Private Medicare plans waste billions

[OhioChick]

Source: Reuters

Wed Dec 9, 2009 5:46pm EST

WASHINGTON (Reuters) - Private health insurance companies that offer alternative Medicare coverage funnel billions of dollars toward company profits and marketing efforts rather than to patient care, U.S. Democrats said in a report released on Wednesday.

A number of insurers, including Humana Inc and UnitedHealth Group Inc, offer such plans known as Medicare Advantage as an alternative to traditional fee-for-service Medicare coverage for the elderly and disabled.

"But as this report shows, Medicare Advantage insurers are squandering billions of dollars on overhead costs -- in fact, they spend 10 times the amount per beneficiary as traditional Medicare," said House Energy and Commerce Committee Chairman Henry Waxman.

The report comes as lawmakers push forward on legislation to overhaul the nation's healthcare system, including cuts to Medicare Advantage and other industry reforms. The House, which passed its version of the bill in early November, is awaiting a final plan from the Senate before a bill can be sent to the White House.



Read more: http://www.reuters.com/article/idUSTRE5B83TG20091209?type=politicsNews

[Demeter]

1. But Don't Let Us Confuse Your With Facts, Congressperson.

[rockymountaindem]

2. What are they going to do about it?

Force more dependence on the private market?

[Frances]

3. I wish they would abolish Medicare Advantage

which was a Repub attempt (successful attempt) to give billions of dollars to the insurance companies.

I have original Medicare.

[tritsofme]

4. That would piss off a lot of seniors.

Abolishing popular government programs doesn't generally endear you to voters, and doesn't happen very often in Washington, even if it is the right thing to do.

[Frances]

5. I don't think most people who are on Medicare Advantage

would be unhappy with regular medicare. I think they are in the advantage programs because of marketing, not because the Medicare Advantage is superior to medicare.

[stlsaxman]

6. Exactly.

[tritsofme]

7. They may not be unhappy.

But forcing seniors to change what they are comfortable with could cause major political consequences, and this is why it will not be done.

[JDPriestly]

20. The report suggests imposing a requirement that the companies

spend 85% of premiums on direct health care services for seniors. That would help seniors a lot.

Many seniors pay premiums and deductibles on the advantage and supplemental plans. I know someone who pays over $300 per month for a supplemental plan. No Medicare Advantage plans are available to her apparently.

[Lugnut]

15. I would love to have traditional Medicare coverage.

The only reasons my husband and I opted for an Advantage plan was the premium cost and available expanded services. We at least have basic dental, eyeglass, hearing aid and prescription coverage in our plan. Buying coverage for those add-ons in addition to a traditional Medigap policy is unaffordable for us.

Our Advantage plan is far from perfect for several reasons. The provider list is a bit sparse and the premiums are going up 32% for 2010. Some co-pays are changing although not a lot. Right now it still works for us.

[quiller4]

31. Some Medicare Advantage programs include dental. Regular

Medicare does not. Buying dental insurance as a senior is expensive. The dental and vision coverage in Group Health's Medicare Advantage is one of the reasons it is popular with low income seniors in the Pacific Northwest.

When Medicare was first adopted it was assumed the covered seniors would all have dentures. That was true for the most part in the mid 1960s but is no longer the case.

[Psephos]

33. Self-delete n/t

[jwirr]

8. I for one want to know how to get out of my Medicare Advantage

and back to the original plan which is the original Medicare. The problem is that when you join Medicare Advantage you are actually opting out of Medicare and into the private market but they do not tell you that.

The letters I got about it actually are printed so they look like Medicare correspondence. It is a total fraud. They got our names because we were forced to choose a plan D insurance plan and from then on they started the pressure to join their advance plan. I am also convinced that when a company raises it's premiums it is because you have not joined the advance part of their insurance.

[morillon]

12. I think you can get back to it, but you can do it only once.

Do you have an Area Agency on Aging in your area?

http://www.n4a.org/about-n4a/?fa=aaa-title-VI

My mother does volunteer work for her local AAA, and she has been involved in helping people navigate the various landmines with Medicare Part D and so forth. Your local AAA should be able to answer this, but if not, PM me and I'll ask Mom.

She has been covered by a combination of Medicare plus a supplemental plan paid for as part of her retirement package from her former employer, but starting in 2010, the plan administrators are forcing everyone off the supplemental and onto Medicare Advantage. She told them to stick it and went with a supplemental through AARP. There was no way in hell she was going to Medicare Advantage after all she'd heard about it.

[Frances]

23. My supplemental is with AARP

I got it when I turned 65 so I got a discount for joining early plus another discount because my husband has it. We both have the cadillac version (Part J) which has been wonderful for us. The premium is more expensive than the other options, but we have never had to pay a co-pay for any doctor or hospital visit. My husband has poor health and we have saved tons of money by paying that higher premium.

We don't have eyeglass coverage, but we get glasses at a good price at Sears with our AARP discount.

We also don't have dental insurance; we bought it a separate policy at one time but didn't like the list of dentists, so I pay the dentist out of pocket.

[jwirr]

25. I don't think that the advantage plan is a supplement. It actually takes

over the administration of Medicare.

[laughingliberal]

29. Correct. nt

[SoapBox]

13. Call Medicare now!

...if you want out of a Medicare Advantage plan, then, with all due urgency, CONTACT Medicare directly for help, while the OPEN enrollment period is on (ends 12/01/09):

http://www.medicare.gov/

"For general Medicare information, ordering Medicare booklets, and information about health plans, contact 1-800-MEDICARE (1-800-633-4227) 24 hours a day, 7 days a week for assistance. English and Spanish-speaking customer service representatives at this number can answer questions about the Original Medicare Plan and provide up-to-date information regarding the health plans available in your area. TTY users please call 1-877-486-2048."

My Mom is in a Medicare Advantage plan here in the Los Angeles area. It has the AARP name on it, with Secure Horizons as the main insurance company (a United Healthcare company) AND THEN she is in a "group". This works like an HMO (we need to stay within the group of doctors, etc.)

We love it! It's easy...it's almost one stop shopping...and we've had great treatment by the doctors. She has a LOT of specialists and this system makes it simple.

I cannot even begin to imagine that I would need to be out searching, looking for individual doctors and offices...what a mess.

SO...I hope that she out lives any dramatic (if) changes to Advantage plans.

[JDPriestly]

21. I've explained the difficulty that seniors would have finding appropriate

medical care in L.A. with standard Medicare. What a nightmare. Kaiser does not have the problems that the other plans have according to the report.

http://energycommerce.house.gov/Press_111/20091209/MedicareAdvantageReport120909.pdf

[quakerboy]

17. What do the plans offer that is not in medicare?

Since they pretend to be medicare, why cant the real medicare just take the programs over and offer the same for less? Who would be discomfited? Who would even know?

[JDPriestly]

22. Seniors in big cities like L.A. would be lost trying to get medical

care with just Medicare. That is the problem.

Kaiser works like a small, single payer system. You get a doctor (an internist or GP) and from there your medical care is coordinated by that doctor. You go to the one or two facilities for all your care. It is sort of like a community clinic except that there is a hospital, great specialists of all kinds, and you get your prescriptions filled at your clinic. So far I love it. My doctors have done a great job. But then, I have not needed heart surgery or cancer treatments or anything particularly complicated.

They use nurse practitioners very well and give you tips on the internet and in e-mails. It's very well organized.

[Frances]

24. I had good luck when I belonged to Kaiser (pre-Medicare)

and Kaiser treated my husband well when he was taken there (the nearest hospital) after cardiac arrest.

However, Kaiser is not perfect. They really messed up on kidney transplants a few years ago.

[hollowdweller]

16. Yeah and rescind the Bush Tax Cuts

And that would pay for health care reform

[Bitwit1234]

9. I have been saying the Advantage Plans are what is stripping

money from Medicare. Our clinic won't accept them. Not only are they more costlier they are slow slow pay, or they don't pay at all. Yep these are bush and the republicans ideas to try to privatize all of medicare.

[bread_and_roses]

10. And yet they want to MANDATE that we all buy private insurance?

...gee, that's real sensible.

[Overseas]

11. We let the Republicans get away with calling their fake plan "Medicare" Advantage.

I can't believe we allowed that to happen. We had known for a long time that Republicans hated Medicare and wanted to privatize it.

And furthermore, when attempts are made to fix the fake Medicare Advantage plan, the GOP rails against "cuts to Medicare".

:crazy:

[Thothmes]

30. President Clinton signed the legislation

in 1997

[Omaha Steve]

14. K&R!

[aquart]

18. Uh huh. So now we're gonna do lots more of that?

Ain't we just the smartest?

[JDPriestly]

19. Kaiser Medicare Advantage was not included in this study.

The Committee excluded Kaiser Foundation Health Plan, Inc. from its calculation because of the company’s unique role as an insurer that directly provides health care to its subscribers.

http://energycommerce.house.gov/Press_111/20091209/MedicareAdvantageReport120909.pdf

That is my plan. It is considerably cheaper and better than the others in my opinions. Not everyone agrees with me. It may be doctor-owned. That's my impression at any rate.

[quiller4]

32. Group Health which operates similarly to Kaiser was also excluded.

[Demeter]

26. no kidding

[EFerrari]

27. No one could have imagined.

[Cleita]

28. Not only that, they stiff the health care providers so often that most doctors, who do take

traditional Medicare in my area, won't take them. It would be nice if that money would be used by Medicare instead to cover the 20% copay on traditional Medicare and update physician and hospital reimbursement in todays dollars.

[No Elephants]

34. Um. Democrats have had the majority in Congress since 1/07. This is 12/09.