Patients Conned Into Inferior, But More Expensive, Coverage In Bush’s Medicare Program

I’ve frequently written about one of the consequences of George Bush’s Medicare changes which gets less attention than the prescription plan. The same act provided for additional payments to private insurance companies to cover Medicare patients under Medicare Advantage plans. The New York Times questions these plans. I’ve found that patients often wind up in these plans without understanding what they signed, and this problem is also noted in this report:

Insurance companies have used improper hard-sell tactics to persuade Medicare recipients to sign up for private health plans that cost the government far more than the traditional Medicare program, federal and state officials and consumer advocates say.

Insurance agents, spurred in some cases by incentives like trips to Las Vegas, have aggressively marketed the private plans, known as Medicare Advantage plans. Enrollment in them has skyrocketed in the last year, and Medicare officials foresee continued rapid growth in the next decade.

Many patients wind up with poorer coverage than they had under Medicare, with increased out of pocket expenses. I had one patient complain to the person who sold him the insurance policy that his copays are higher. He was told that this shouldn’t matter as his doctor didn’t have to charge him the copay. While exceptions can be made for financial hardship. routinely failing to collect Medicare copays is in violation of Medicare rules.

Besides costing patients more, these plans also cost the government more, even though Medicare Advantage typically cherry pick the healthiest Medicare patients in order to maximize their profits:

Moreover, those plans may be more expensive than traditional Medicare for some patients, because the co-payments for some services may be higher. The Medicare Payment Advisory Commission says that the cost to the government is also higher because it pays the private fee-for-service plans, on average, 19 percent more than the cost of traditional Medicare.

Richard S. Foster, chief actuary for the Medicare program, said “the additional payments to Medicare Advantage plans, above and beyond the costs” of traditional Medicare, were causing higher premiums for all beneficiaries and speeding the depletion of the Hospital Insurance Trust Fund for Medicare.

There can be additional problems if a patient requires nursing home care:

Private plans generally provide all the services of traditional Medicare, and many offer extra benefits, but the co-payments may be different. Thus, Mr. Slabach said, under traditional Medicare, a beneficiary does not have any co-payment for the first 20 days in a skilled nursing home, but some private fee-for-service plans charge $100 a day, and that charge comes as a shock to some patients.

I have one patient who is having increased problems since he lost his Medicaid when he got signed up for a Medicare Advantage plan. He’s now in a sort of limbo, unable to get into the nursing home he desires which is closer to his family due to being in a Medicare Advantage plan, but would not have had these problems if he remained in traditional Medicare and Medicaid.

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