As for Medicare, the Ryan-Romney — pardon me, Romney-Ryan — claims are simply absurd. They want credit as the ticket willing to face up to the imperative of entitlement cuts, particularly in Medicare and Medicaid. They support a radical change in the structure of Medicare, to a premium-support, aka voucher, system. And then they have the nerve to criticize Obama, who wants to keep the Medicare system intact, for $716 billion in savings. As The Washington Post’s Wonkblog showed, two-thirds of the Obama reductions come from either curtailing the costly Medicare Advantage program, which has subsidized private insurers, or cuts in hospital reimbursements.
Video: ObamaCare Guts Medicare Advantage
Rep. Issa Subpoenas HHS Records On Medicare Advantage Program
CQ HealthBeat: HHS Inspector General Raps CMS On Medicare ID Theft Protection Federal Medicare officials reported 14 breaches of medical information in two years affecting nearly 14,000 beneficiaries, but they failed to notify those affected in a timely way and often did not give them much information about the violation, the Office of Inspector General for the Department of Health and Human Services said in a new report. In response to worries about medical identity theft, the government has set up a database with the Medicare ID numbers of 284,000 beneficiaries and 5,000 providers that have been involved in medical identity theft in the past or are regarded as vulnerable. But Medicare contractors have problems using the database, and few remedies are available for those whose numbers have been compromised, the OIG report said (Norman, 10/22).
The impact of Obamacare cuts on Medicare Advantage Plans
The PPACA, as amended, also introduces MA bonuses and rebate levels that are tied to the plans’ quality ratings. Beginning in 2012, benchmarks will be increased for plans that receive a 4-star or higher rating on a 5-star quality rating system. The bonuses will be 1.5 percent in 2012, 3.0 percent in 2013, and 5.0 percent in 2014 and later. An additional county bonus, which is equal to the plan bonus, will be provided on behalf of beneficiaries residing in specified counties. The percentage of the “benchmark minus bid” savings provided as a rebate, which historically has been 75 percent, will also be tied to a plan’s quality rating. In 2014, when the provision is fully phased in, the rebate share will be 50 percent for plans with a quality rating of less than 3.5 stars; 65 percent for a quality rating of 3.5 to 4.49; and 70 percent for a quality rating of 4.5 or greater.
ICYMI: Health Affairs Article: Medicare Advantage Provides Higher
A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare. Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare. This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Turning 65: Finding a Medicare Advantage Plan
This is the fifth in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future. Here are the first, second and third posts and fourth posts in this series. Ah, those Medicare Advantage (MA) plans!’ The government can’t seem to decide if it loves or hates them.’ On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. ‘ So it seemed like I was being encouraged to select an MA plan. ‘ ‘ ‘ On the other hand, Congress with a big nudge from the president, whacked reimbursements to MA plans, cutting out the overpayments they’d been receiving for years.’ It was costing the government far more to fund the benefits to seniors who picked them than it cost to provide the traditional program.’ Lower payments, experts believe, could cause some MA plans to disappear. While government is betwixt and between on MA plans, I am not.’ I know I would not feel comfortable in a restricted provider network, which is the crux of most of these MA plan arrangements.’ ‘ But I approached the selection process with an open mind, taking a careful look at what’s available and evaluating the advice for selecting one.’ As with Medigap policies and the prescription drug plans that go with them, there were too many choices and too many data points for the average senior to comprehend, let alone make the ‘right’ decision that the marketplace model says will appear, like magic. I understand why seniors fall for misleading or deceptive sales pitches.’ We need a helping hand but all too often whoever is extending it doesn’t have our best interests at heart.’ I had heard lots of these pitches before’the kind where a seller invites seniors to a local restaurant, then glosses over the negatives and highlights insurance deals for a very low or no monthly premium with drug coverage, gym memberships, and vision and dental care thrown in to boot.’ Appealing, no? Now it was time for me to cut through the hype. First, I started my review with the sales brochures I received for MA plans.’ ‘ The giant in this universe, UnitedHealthcare/AARP, sent its brochure in an enticing envelope.’ A big red banner screamed ‘$0 premium Medicare health plans’ ‘enough to make me rip it open.’ The insurer’s Medicare Advantage Guide said that although costs vary by plan, all of United’s MA plans have annual limits on out-of-pocket expenses ‘so you can budget for health care expenses and limit your out-of-pocket costs each year.” That didn’t mean much since I don’t know what illnesses might befall me.’ Marketing jargon, really, but apparently it works. Another sales piece in the mailing gave concrete info about United-AARP’s MedicareComplete Plan 1 (an HMO) with its out-of-pocket limit of $5,900.’ And the other United-AARP offerings?’ For those I had to turn to the government’s Medicare & You handbook where I ran smack into the bizarre world of MA plans.’ It turned out there were also two PPO plans offered through United-AARP.’ Since PPOs are less restrictive than HMOs, I wouldn’t lose my Medicare benefits by going out of network as I would with an HMO. I learned that there were also three other AARP’ HMO choices’the MedicareComplete Essential HMO with an out-of-pocket limit of $5,900; the MedicareComplete Plan 2 which carried an out-of-pocket limit of $4,200; and the MedicareComplete Mosaic with its limit of $2,900.’ ‘ It’s not uncommon for one insurance company to offer several different Medicare plans with fanciful names, which further confuses consumers. All had no monthly premiums, but they paid different amounts for what’s called durable medical equipment, like oxygen, and for critical treatments like chemotherapy drugs.’ ‘ I also discovered that the United-AARP MedicareComplete Essential HMO did not cover drugs, which would force me into shopping for a drug plan, another headache I didn’t need. The United-AARP MedicareComplete Mosaic seemed ideal with its low out-of-pocket maximum, low copayments for doctor visits, and low coinsurance for the expensive stuff like chemo drugs and medical equipment.’ But based on the sales brochure they mailed to me, which were all about Plan 1, it was not the plan United-AARP was encouraging me to buy.’ ‘ With Plan 1, I would be on the hook for more out-of-pocket expenses’meaning that the carrier would pay less and profit more.’ No wonder they were pushing it.’ A second United-AARP mailing also pushed Plan 1. However, both brochures did disclose a significant variable to look at when choosing an MA plan’the copayments for inpatient hospital stays.’ I knew these copays are often hidden in the fine print, and consumers frequently don’t learn of them until they land in the hospital.’ They are clearly a negative for MA plans.’ FYI:’ Medigap policies pay the copayments for hospital stays, which give them an edge in this department.’ ‘ The copay for Plan 1 was fairly hefty’$175 each day up to $1,400 per stay.’ These could add up for a sick person who had multiple admissions. Emblem Health also sent some Medicare insurance mailers, mostly trying to get me to access their website with my own personal password, which was good for a limited time only.’ They were looking for sales prospects, and I didn’t want to become one, especially since I wasn’t interested in watching some NBA hall of famer on a how-to video telling me how easy it is to choose Emblem’s Medicare options.’ But acting like an average senior who had heard of Emblem Health might, I thought I better take a look at the Emblem plans for New York City. It turns out Emblem offers three HMOs and four PPOs.’ The penalty for being able to go out of network in a PPO is steep. They came with high out-of-pocket maximums’$2,500 for going out of network and $6,700 for staying in network, or a’ $10,000 combined maximum.’ Even though two had no monthly premiums, and two had premiums of less than $100, I didn’t go further with Emblem. While sales people push MA plans with low or no monthly premiums, the premium is not the only thing to consider.’ It’s the mix of policy elements that ultimately determine whether a plan is a good or bad deal.’ And then of course, there’s the unknown of your future health status to consider.’ You need to know how the combination of premiums, in- and out-of-network hospital copays, out-of-pocket limits, drug copays, coinsurance for chemotherapy drugs, and copays for doctor visits interact to determine what a plan will really cost.’ The trade-off for a no-premium plan may be hidden’and high’hospital copays, very high out-of-pocket limits, or the obligation to pay 20 percent of chemotherapy bills.’ It boils down to a game of ‘name your poison.’ I also looked for MA plan information on the Medicare.gov website but did not find it helpful.’ Both the handbook and website gave star ratings for MA plans but they seemed to measure different things, further confusing shoppers who might want to use them.’ The government handbook gave the United-AARP CompleteMosaic plan one star for Member Satisfaction.’ That might be important to know.’ At the same time the government website gave the same plan an overall rating of three stars.’ This certainly raised some questions for me about the usefulness of these stars as a shopping tool. Having done lots of homework, it was time to select a plan to cover Medicare’s gaps.’ Was I going to try one of those Medicare Advantage PPO plans that seemed to offer flexibility and let me keep the doctors that I like?
Using Medicare Advantage to Gain Political Advantage
It is almost certainly true that quality suffers when reimbursement rates are reduced. It is also appears to be true that competition amongst private providers in Medicare Advantage is leading to efficiencies that aren’t present in traditional Medicare, which we should probably take as a lesson. It is also often the case that when the government pays more for something, it spends more, and when it pays less for something, it spends less. But what all this really reveals is the folly of trying to control health spending through government-designed payment schemes.
Obamacare’s to cut $200 billion from Medicare Advantage to fund Medicaid.
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Issa plans subpoena of Advantage pilot documents
The House Oversight and Government Reform Committee will subpoena documents from HHS relating to the department’s $8 billion Medicare Advantage pilot program after the department failed to produce documents requested nearly five months ago to the committee’s satisfaction. The move to a compulsory order followed repeated requests for HHS to voluntarily produce documents detailing its internal deliberations on a pilot program launched in 2010 that provides bonus payments to most Medicare Advantage plans, according to a letter dated Friday (PDF) from Rep. Darrell Issa (R-Calif.), the panel’s chairman. The program, an amended and much more expensive version of a pilot authorized by the Patient Protection and Affordable Care Act, drew scrutiny from the oversight panel after the nonpartisan Government Accountability Office found this year that the pilot lacked a legal basis and recommended HHS shut it down. Issa wrote HHS Secretary Kathleen Sebelius on Oct. 19 that the subpoena was needed after 1,300 pages of documents the department sent the day before “were of no assistance to the committee’s investigation.”
Medicare Advantage in PPACA: Undermining Seniors’ Coverage Options
Seniors Forced Back into Poorly Performing Traditional Medicare. Large reductions in MA will force a mass migration back into the traditional FFS program, which is the source of many problems observed in American health care. Medicare FFS provides strong incentives for fragmented care that is poorly coordinated across institutions and provider settings. The result is an emphasis on volume instead of quality care for patients. Moreover, downsizing the role of MA plans will make it more difficult to pursue the kinds of structural changes that are needed to ensure that Medicare can be financially sustained over the long term.
Understanding Medicare "Cuts"
Medicare Advantage is a 15-year failed experiment in privatization. Running Medicare through private insurance companies was supposed to save money through the magic of the marketplace; in reality, private insurers, with their extra overhead, have never been able to compete on a level playing field with conventional Medicare. But Congress refused to take no for an answer, and kept the program alive by paying the insurers substantially more than the costs per patient of regular Medicare. All the ACA does is end this overpayment.
More on Proposed Cuts to Medicare Advantage: Seniors Would Save Far More Than They Lose
“It turns out that the additional benefits and flexibility created by recent increases in MA payment rates simply weren’t worth very much to seniors,” Frakt writes. “Consumer surplus loss associated with cuts in payments to MA plans will be only 14 cents per dollar saved. . . the truth is that under Obama’s plan a small fraction of Medicare beneficiaries will lose their MA benefits and/or face higher costs. However, the potential savings are enormous and research shows that the benefit cuts needed to achieve them will not be terribly missed.”