By Washington Post - Wed., July 16, 2008
WHY DID President Bush veto the Medicare bill, only to be swiftly overridden by both houses of Congress? It's not because he disagrees with the fundamental purpose, to reverse a 10.6 percent cut in Medicare payments to doctors. The administration's main beef is paying the cost, $13.8 billion over five years, by reducing projected payments to Medicare Advantage plans. These are the private plans -- HMOs or preferred-provider networks -- set up to compete with traditional fee-for-service Medicare, in which seniors go to doctors of their choice who accept Medicare reimbursements.
Medicare Advantage plans, which currently enroll about 20 percent of Medicare beneficiaries, could be a cost-effective alternative to traditional Medicare. The problem is that these plans now enjoy an undue advantage: They are paid, on average, 13 percent more per beneficiary than traditional Medicare costs. Numerous experts have recommended leveling the playing field between private plans and traditional Medicare. The legislation takes a few small, sensible steps in that direction.
How small? The savings from Medicare Advantage plans would amount to less than 2 percent of the money the government is projected to spend on them in the next five years. The Congressional Budget Office projects that enrollment in Medicare Advantage plans would still grow by 25 percent over that period. The changes would eliminate double payments for educational activities (since the plans don't engage in these) and impose new requirements on so-called private fee-for-service plans, which operate much like traditional Medicare but end up costing more.
The president said he vetoed the bill because "taking choices away from seniors to pay physicians is wrong." But no choices are taken away. The changes in the costly private fee-for-service plans, for instance, apply only in areas where at least two other Medicare Advantage plans are operating. Enrollment in these plans is projected to grow 39 percent by 2013 under the new rules. The CBO estimates only that the slightly more level playing field would result in about 2 million fewer seniors choosing the private plans than would have otherwise. It's telling that not even lawmakers of his own party were cowed by the president's effort to scare seniors.
Read more in the Washington Post
Showing posts with label Medicare Advantage Plan. Show all posts
Showing posts with label Medicare Advantage Plan. Show all posts
Wednesday, July 16, 2008
Saturday, August 25, 2007
Medicare's missing $34 million
Star-Telegram - Thu, Aug. 16, 2007
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Imagine if $34 million slipped through your fingers. For Medicare officials, no imagination is required. Medicare Advantage patients should have received that amount of additional benefits or reduced premiums from companies administering the alternative Medicare program, the federal Centers for Medicare & Medicaid Services determined after reviewing 2003 audits of the companies. But in May, the federal agency gave up trying to recover the money, saying it lacked the legal authority. A recent government audit says the agency does have the authority, but it needs to say so when writing contracts with the companies. Read full Government Accounting Office report.
Thursday, July 26, 2007
Medicare Disadvantage- Privatized Health Care For Seniors Can Leave Them In The Dark As Insurance Companies Reap A Windfall
CBS/AP - WEST HAVEN, Conn., July 16, 2007
CBS) It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older.
But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry.
It was the winter of 2003 when Congress, in the dead of night, overhauled Medicare.
"This prescription drug benefit is a good deal for all seniors," said Rep. Dennis Hastert, R-Ill.
But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors.
A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage.
"I'd rather go back to the old-fashioned Medicare," Cohen told Keteyian.
Cohen, an 86-year-old who lives in Connecticut, says he switched to an advantage plan only after a salesman assured him he would be completely covered while staying in Florida.
But after breaking his leg in that state, Cohen began to believe he had been sold a bill of goods.
"There was something radically wrong," Cohen said. "They wouldn't give me any home therapy, claiming that it wasn't covered."
But that's only part of the problem. With traditional Medicare, there's one plan for everyone, everywhere. Private Medicare Advantage offers as many as 50 different plans, causing untold confusion over coverage, premiums, co-pays, provider networks.
"These insurance benefit packages are very complicated. Almost nobody without really technical sophistication can figure out exactly what they are buying," said Robert Hayes, who runs the Medicare Rights Center.
Hayes said every year his staff fields thousands of calls from seniors scared to death they've made the wrong choice.
Not only are private plans more confusing, they are more expensive to taxpayers.
In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more.
FYI: Find out more about private medicare and how to find help navigating the system.
The head of Medicare insists private plans give you more for your money.
"I think there is a lot more that we could do in regular Medicare that we aren't doing currently, that some of the Medicare Advantage plans are able to do because of how the payment structure works," Leslie Norwalk told Keteyian.
But how much of that money is going back into the pockets of the insurance companies?
"Well, it's required by law: 25 percent goes back to the federal treasury, 75 percent goes back to the beneficiary," Norwalk said.
So the insurance companies are doing this, what, out of the kindness of their hearts, asked Keteyian?
"There, there would be, I'm sure, some small amount to administer the additional benefits," Norwalk said.
But CBS News has found that's not always the case. An independent report found when it comes to the fastest-growing plans, known as private fee-for-service, half of that extra money goes back to the insurance companies. All these private Medicare plans are expected to cost taxpayers an additional $54 billion over the next five years.
"Taxpayers are losing; people in Medicare are losing," Hayes said. "And the structure of Medicare as a national treasure that we need to rely on moving forward, is being undermined."
So much so that key Congressional Democrats now want to cut payments to private plans. The insurance industry is fighting back with a direct mail campaign urging seniors to contact their representatives.
Ironically, Cohen got one of the letters. On the back, his very personal feelings about his Medicare Advantage plan.
"This plan is worthless," he wrote.
See broadcast and read more
© MMVII, CBS Interactive, Inc. All Rights Reserved.
CBS) It was the summer of 1965 when Medicare was created to provide government-sponsored health care for seniors. Today some $381 billion tax dollars a year are spent on Americans 65 and older.
But in recent years, more and more Americans — 8.3 million and rising — are getting Medicare through private insurance companies. Tonight, CBS News chief investigative correspondent Armen Keteyian takes a closer look at the program critics charge has turned into a disadvantage for seniors, and a windfall for the insurance industry.
Fast Fact
Three independent reports found private insurance companies are paid, on average, 12 percent more than what it would cost the federal government — in some cases, 50 percent more.
It was the winter of 2003 when Congress, in the dead of night, overhauled Medicare.
"This prescription drug benefit is a good deal for all seniors," said Rep. Dennis Hastert, R-Ill.
But buried inside the bill was another deal — one that CBS News investigation has discovered was not necessarily a benefit for seniors.
A large portion of one of the most successful public programs in history was quietly placed in the hands of private insurance companies. The goal of Medicare Advantage: to provide seniors with more benefits, like vision and dental care, and control rising costs. But today, for seniors like Aaron Cohen, it's become Medicare Dis-Advantage.
"I'd rather go back to the old-fashioned Medicare," Cohen told Keteyian.
Cohen, an 86-year-old who lives in Connecticut, says he switched to an advantage plan only after a salesman assured him he would be completely covered while staying in Florida.
But after breaking his leg in that state, Cohen began to believe he had been sold a bill of goods.
"There was something radically wrong," Cohen said. "They wouldn't give me any home therapy, claiming that it wasn't covered."
But that's only part of the problem. With traditional Medicare, there's one plan for everyone, everywhere. Private Medicare Advantage offers as many as 50 different plans, causing untold confusion over coverage, premiums, co-pays, provider networks.
"These insurance benefit packages are very complicated. Almost nobody without really technical sophistication can figure out exactly what they are buying," said Robert Hayes, who runs the Medicare Rights Center.
Hayes said every year his staff fields thousands of calls from seniors scared to death they've made the wrong choice.
Not only are private plans more confusing, they are more expensive to taxpayers.
In fact, three independent reports found private insurance companies are paid, on average, 12 percent more than what it cost the federal government to run Medicare — in some cases, 50 percent more.
FYI: Find out more about private medicare and how to find help navigating the system.
The head of Medicare insists private plans give you more for your money.
"I think there is a lot more that we could do in regular Medicare that we aren't doing currently, that some of the Medicare Advantage plans are able to do because of how the payment structure works," Leslie Norwalk told Keteyian.
But how much of that money is going back into the pockets of the insurance companies?
"Well, it's required by law: 25 percent goes back to the federal treasury, 75 percent goes back to the beneficiary," Norwalk said.
So the insurance companies are doing this, what, out of the kindness of their hearts, asked Keteyian?
"There, there would be, I'm sure, some small amount to administer the additional benefits," Norwalk said.
But CBS News has found that's not always the case. An independent report found when it comes to the fastest-growing plans, known as private fee-for-service, half of that extra money goes back to the insurance companies. All these private Medicare plans are expected to cost taxpayers an additional $54 billion over the next five years.
"Taxpayers are losing; people in Medicare are losing," Hayes said. "And the structure of Medicare as a national treasure that we need to rely on moving forward, is being undermined."
So much so that key Congressional Democrats now want to cut payments to private plans. The insurance industry is fighting back with a direct mail campaign urging seniors to contact their representatives.
Ironically, Cohen got one of the letters. On the back, his very personal feelings about his Medicare Advantage plan.
"This plan is worthless," he wrote.
See broadcast and read more
© MMVII, CBS Interactive, Inc. All Rights Reserved.
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