Medicare actuary: Reform will cost some seniors

[Recursion]

Source: Politico

A Medicare official concedes that seniors may have to dig deeper into their wallets next year thanks to the health care law.

The new analysis obtained by POLITICO finds the health care overhaul will result in increased out-of-pocket costs for seniors on Medicare Advantage plans.

Richard Foster, the actuary for the Centers for Medicare and Medicaid, also tells Senate Republicans that the overhaul will result in “less generous benefit packages” for Medicare Advantage plans next year. Foster is independent from the administration and non-partisan.

Democrats have long contended that Medicare Advantage plans – private insurance alternatives to Medicare – overpay private insurers, increasing premiums for everyone, and needs to be reformulated.


Read more: http://www.politico.com/news/stories/1010/43529.html#ixzz12M3YMr2B

Read more: http://www.politico.com/news/stories/1010/43529.html#ixzz12M3Vqycw

Read more: http://www.politico.com/news/stories/1010/43529.html

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A more honest headline might be "Medicare Advantage Plans To Stop Getting Absurdly High Subsidies", but whatever.

[Sinistrous]

1. I am under the impression that "Medicare Advantage" plans are

supplements that cover the portion of the charges that Medicare does not pay. The characterization that they are "alternatives" to Medicare is inaccurate. And, they are private insurers I don't think they are paying other private insurers.

[SharonAnn]

2. You're wrong. They are alternatives to regular Medicare.

If you're on regular Medicare, you will probably want a "Medicare Supplement" plan.

But Medicare Advantage plans replace Medicare coverage.

[roseBudd]

25. Medicare Advantage is a cash cow for Humana & Wellpoint, it costs taxpayers 14% more than

traditional Medicare. Taxpayers pay private insurers $965 a month per 10.2 million seniors

[marybourg]

3. No. You are confused between Medicare Advantage and Medigap.

The description of Medicare Advantage in the OP is accurate. What you describe is "Medigap" insurance.

[pattmarty]

12. No. A "supplement" is another plan to cover the costs that Medicare........

.......does not cover. The Advantage plans are private plans that the govt pays your 96.00 a month to and also pays the Advantage insurer on top of that. That is where the "savings" comes into play. They will cut subsidies to the private Advantage plans.

[Sinistrous]

13. I stand corrected. Thank you to all who replied.

[joeglow3]

4. Define "Absurdly High Subsidies."

I ask this honestly because a couple friends of ours own their own practice and severly limit the number of medicare patients they will see, as they lose money every time they see one. The do not make LESS money, but flat out lose money before paying themselves a dime.

Medicare reimbursement rates are too low, so I support raising them. However, has medicare advantage gone too far???

[Recursion]

6. Medicare Advantage is run through private insurers, and usually pay doctors a bit more

Which means doctors are more willing to take the patients (that, I suppose, is the "Advantage").

You're getting to another troubling issue, though: many providers lose money on Medicare and Medicaid patients, which means the rest of us are paying an additional subsidy for Medicare and Medicaid through our insurance policies.

[EC]

5. It's been a few years since I was in insurance, but as I

remember Advantage was more expensive than other plans that are available..most that the agency I worked for came in asking about Advantage and left buying into other plans instead...

[elleng]

7. No surprise here. We KNEW that Medicare Advantage would take a 'hit.

[Recursion]

8. Yep. Probably just as well

People who want private insurance in their old age can bloody well pay for it themselves.

[elleng]

9. Yes, but I'd leave out the 'bloody well.' Its an option that should exist

for those who would like it and can afford it, and I see nothing wrong with the option OR with those who want and can't afford it.

[Iowa]

24. Nah... it's nothing but a way to privatize Medicare.

[JDPriestly]

16. We do pay extra for Medicare Advantage.

In fact my very elderly mother pays $300 per month EXTRA for her Medicare Advantage. Medicare also costs seniors $100 or so a month plus co-pays and medication costs. It is not free. Meanwhile, the average Social Security benefit is less than $1200 per month. Try paying your rent, your insurance and eating on that amount of money. It is not easy. Seniors are not milking the system. Very few of us have decent pensions, and we get no interest on what we were able to save.

[pattmarty]

10. You're right. The "Advantage" plans are already subsidized by.........

...........the govt. My wife is on disability and gets Medicare and she took the "traditional" and got a plan to make up the difference so we don't have to pay. That fucking plan from United Healthcare costs us an additional $255 per month. Medicare DOES NOT pay all costs. I think most here know that, but I'm sure there are a lot of people out there that don't. Fuck the Advantage plans, they are just a way to eventually privatize Medicare.

[JDPriestly]

17. Our Kaiser Advantage Plan is not as expensive as United's or Aetna's.

I wouldn't know what to do without it, and I cannot afford to pay more than I already pay.

The new healthcare legislation does nothing to lower the costs of healthcare. It simply shifts a larger portion of those costs to seniors, although, overall, seniors need the most healthcare and have the lowest incomes to pay for it. This is shameful.

[pattmarty]

19. I'm not sure it it shifts a larger portion onto seniors, but it WILL NOT.......

...........lower costs or stabilize costs for ANY segment of the population. We could have done a lot better than this abortion. If the Republicans were to pass a health insurance bill, this would be it.

[pnwmom]

22. You're comparing the Advantage plan to a Medigap plan.

The correct comparison is fee-for-service Medicare to Medicare Advantage.

[JDPriestly]

29. As I said below, Kaiser is rated No. 1 among health insurance companies

in California -- by Consumer Reports. I agree with that assessment.

Kaiser is doctor owned, I believe. They only accept seniors who are on Kaiser Senior Advantage. Their insurance in general is less expensive than other insurance in my experience.

In L.A. so many doctors do not accept Medicare patients that I would feel lost without Kaiser Medicare Advantage.

If you live in a small town in Iowa or Illinois, the choice of doctors is not such a problem. You know your doctors and they probably take Medicare patients as a matter of course. Here, in L.A., it is hard to get to your doctor and then if you had to choose specialists and find doctors who take Medicare, it would be very difficult. I would really miss my Kaiser Medicare Advantage.

If all doctors were on the same public health care plan -- that is if we had single payer, it would not make any difference. I would not know how to choose a doctor in L.A. if I had to choose from those who accept Medicare.

[pnwmom]

30. Kaiser took Medicare patients before Kaiser Advantage

ever existed. Why do you think they wouldn't if there was no Medicare Advantage?

[JDPriestly]

32. Kaiser does not operate on a fee for services basis.

They operate on a sort of HMO fee for membership basis. Medicare (without any additional pension plan that provides their health insurance membership) is a fee for services plan.

Are you sure that Kaiser accepted Medicare's fees for services patients prior to Medicare Advantage? Remember, seniors with some sort of continuation of insurance based on their years of employment may have been relying on some employer's or pension plan above and beyond Medicare. Few people retiring now enjoy such plans.

[sinkingfeeling]

11. Well since Medicare Advantage is one of the worse cost drivers of Medicare, they need to be

reformulated. And by the way, I don't trust anything that politico prints.

[williesgirl]

14. I'm on one of those plans this year - Cigna Medicare Access - and

they notified me 2 months ago that it won't be offered next year. In addition to the $215/month I pay for Medicare, I've paid $48/month for that one. My Medicare premium is so high because I took money out of my 401K to help my disabled daughter get her house. That's considered income, so I pay thru the roof now.

I loved this year's plan. Both my daughter and I are on it (separate policies). All our docs accept it and there's been zero hassle getting things paid. Not so with the plan we had prior to this.

I'd love to keep it, but ...

[pnwmom]

23. Are you sure that's not a Medigap plan? That's a different

thing from Medicare Advantage, which is a private substitute for regular government run Medicare.

[JDPriestly]

15. No. Politico is probably right on this one sorry to say.

The Democrats have been extremely unwilling to come out and say just how much the cuts to Medicare Advantage will cost seniors.

It is outrageous. If they are going to increase the costs of Medicare Advantage plans like the Kaiser plan in California, they should accordingly increase our Social Security.

It is hard for me in my late 60s to find my way through the medical maze as my health concerns increase. I cannot imagine trying to get appointments with specialists in Los Angeles without a Medicare Advantage plan once I am in my late 80s.

Young, healthy people just do not understand how aging affects one's ability to cope. Democrats in Congress need to be more up front and honest about how this will affect the Medicare Advantage plans.

A lot of doctors in Los Angeles refuse to take Medicare patients -- and I am somewhat afraid of being treated by those who do unless I know about them -- and I do not know anything about the doctors. That is why Medicare Advantage is so important to me.

[pnwmom]

18. Medicare Advantage is a managed care, private insurer plan that

has been shown over the years not to be cost effective. Why should the government make higher payments for Medicare Advantage recipients than they do for regular Medicare patients when there is no better outcome?

The problem of doctors not taking Medicare patients is a separate issue; not all doctors will take Medicare Advantage patients, either. And the doctors in that managed care system aren't necessarily better than those outside of it.

http://en.wikipedia.org/wiki/Medicare_(United_States)

The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.

[JDPriestly]

28. Kaiser does not accept patients who are not members of Kaiser.

Consumer Reports rates Kaiser in California as No. 1.

As far as I know, Kaiser only takes Kaiser Advantage patients, not regular Medicare patients.

[pnwmom]

31. Before Medicare Advantage existed, Kaiser, and other managed health

care plans, DID take Medicare patients.

[JDPriestly]

33. See my response above. Kaiser is not fee for services. It is a membership

HMO-type plan. Medicare is a fee for services plan. You may be thinking of seniors who were enrolled in Kaiser by some sort of employer's retirement plan. That was not Medicare.

Kaiser has offered a Medicare Advantage Plan that has been reasonably priced for seniors. I am afraid that plan will become too expensive for many of us and that we will not be able to get good doctors for the price that ordinary Medicare pays -- not in cities like Los Angeles in which the cost of living is very, very high.

[pnwmom]

34. I know what Kaiser is, it's like Group Health here in Seattle,

another managed care system. And they both accepted seniors before Medicare Advantage came along.

[JDPriestly]

35. But how much did they charge?

I don't think they accepted seniors at the rates they charge with Medicare Advantage.

[pnwmom]

36. I don't know about Kaiser, but Group Health's

advertising made it sound like they didn't charge extra. But who knows, maybe they did.

[pnwmom]

20. Medicare Advantage plans aren't cost effective, according to the GAO.

They cost more than regular Medicare without delivering better health care overall. (The higher premiums are due to administrative expenses, profit, etc.)

That's why Dems are taking another look at them.

http://en.wikipedia.org/wiki/Medicare_(United_States)

With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as "Medicare+Choice" or "Part C" plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, "Medicare+Choice" plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as "Medicare Advantage" (MA) plans.

Traditional or "fee-for-service" Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships.<10> In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a "network" of providers that patients can use. Going outside that network may require permission or extra fees.

SNIP

Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that "their most important reason for leaving was due to problems getting care."<15> There is some evidence that disabled beneficiaries "are more likely to experience multiple problems in managed care."<16> Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.<17> On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have "potentially avoidable" admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.<18><19>

In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data was not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.<20>

Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.<21> Others have reported that minority enrollment is not particularly above average.<22> Another study has raised questions about the quality of care received by minorities in MA plans.<23>

The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.

[jwirr]

21. We were told this was coming. It is actually a good thing in some

cases. Those eligible for Medical Assistance should not be on the Advantage plan because Medicaid/Medicare pay the same thing and cost less. The Advantage plans con these people into believing there is some kind of advantage to belong to their plan instead of outright medical assistance.

[Recursion]

26. Yeah, I wasn't posting this as an "OH NO!!!"

Just as a, "yep, it's what the bill said would happen."

There are positives and negatives to private and public insurance; unfortunately Medicare Advantage seems to come with a disproportionate amount of the "bad" side of both.

[bemildred]

27. Get rid of "Medicare Advantage" programs, and this "problem" will go away too. nt