Posts filed under ‘Access to Health Care’
In yesterday’s Wall Street Journal, Cong. Paul Ryan weighs in yet again on “entitlement” reform. Suddenly the debate in DC is changing from demolishing Health Care Reform to the traditional Republican targets: Medicare and Social Security.
Here are Mr. Ryan’s suggestions:
• “Reform Medigap plans to encourage efficiency and reduce costs.”
What does this mean? Whose costs would be reduced and where would we find the alleged efficiency? Since we’ve heard this refrain before we know the answer: This proposal would cost older and disabled beneficiaries more. It would require them to pay more for Medicare Part B if they want “first dollar” coverage from a Medigap plan. The efficiency mentioned is based on the assumption that people will forego this kind of Medigap coverage as a result of the increased cost and then forego unnecessary health care that they would obtain if they had full Medigap coverage.
This is suggestion is based on so many false premises it’s hard to know where to begin. Importantly, Medigap policies only make payment for health care that Medicare has already determined meets coverage criteria and is medically necessary and reasonable. Medigap insurance is there to cover some of the Medicare cost-sharing for this necessary care. Without the Medigap coverage the “efficiencies” and savings Mr. Ryan lists would come as a result of older and disabled people foregoing care that is by definition necessary and reasonable.
• Combine Medicare Parts A and B so the program is less confusing.
We are all for making Medicare less confusing. The Medicare Part C and D systems, added to Medicare in 2003, dramatically increased the complexity of the program and decreased the ability of people to understand and use Medicare. But Mr. Ryan does not suggest reducing reliance on the expensive and redundant Parts C and D. He suggests combining Parts A and B. Again, we have heard these proposals before. In the guise of adding simplicity, they increase costs to the older and disabled people who rely on Medicare. While reducing costs for inpatient hospital care, especially for longer stays, the proposals to combine Parts A and B increase beneficiary costs for those services that people need far more frequently: doctors’ care and other outpatient and community-based health services.
If negotiations are returning to the ceaseless discussions about so-called entitlement reform, (which always makes me wonder who’s entitled and what do we mean by reform), we should be serious. The standard should be what’s best for older and disabled beneficiaries and the budget – regardless of the interests of insurance and pharmaceutical industries.
Anyone who truly wants to simplify Medicare and reduce costs, both worthy goals, should bring these suggestions to the table:
Combine Parts B and D. Do away with the expensive costs associated with running a Medicare prescription drug program only through private plans – or at least give people the choice of getting drug coverage through Part B, in the traditional Medicare program.
• Prohibit Medicare from paying any more for the medications it covers than Medicaid pays. The Congressional Budget Office reports this would save at least $140 billion over ten years.
• Reduce the dependence on private Medicare Part C plans.
These private plans are more expensive to taxpayers and provide less value for beneficiaries.
Case in point: Out of the blue, Connecticut residents learned today that one of the largest Medicare Advantage plans, United Healthcare, is dropping 2250 physicians from its network. This means a lot fewer providers will be available for thousands of older and disabled people – as a result of one non-appealable decision made in the best interest of private profit, not Medicare beneficiaries. Medicare Part C adds complexity and costs and should be scaled back accordingly. Beneficiaries should be encouraged to stay in traditional Medicare, which includes all physicians who participate in the program nationwide and is less expensive for taxpayers.
If Mr. Ryan and his colleagues really want to save money and reform Medicare and Social Security, while maintaining their core missions, it can be done. Let’s talk seriously – if there’s the will, there’s a way.
Senator Ted Cruz’s long speech on the Senate floor against “Obamacare” (the Affordable Care Act)might have been a remarkable spectacle and certainly led to a lot of press coverage. But many of his statements do real harm. Declarations like “you don’t want an IRS agent deciding if your mom lives or dies,” lead to people calling our office in fear that they will lose their health insurance. (For the record, people on Medicare will stay on Medicare.) The relentless efforts by Senator Cruz and others to turn people against Obamacare, to the point of telling them not to sign up for health insurance they may desperately need, brought to mind a contrast with the implementation of Medicare Part D, the prescription drug benefit that was passed under President George W. Bush.
In 2006 people were starting to enroll in Medicare Part D. It was not the drug benefit that many of us in the Medicare advocacy world wanted. It was administered by numerous private insurance companies rather than being a straightforward, public Medicare benefit. Its structure was difficult to explain, with a big “donut hole” that left many vulnerable people with high out of pocket costs. It prohibited Medicare from negotiating lower drug prices from manufacturers. We voiced these complaints and advocated for a different kind of drug coverage. But Part D was the drug benefit we got. It was the law, and we knew people on Medicare who were in desperate need of prescription drug coverage, even if that coverage was imperfect. Many of us had clients who split pills, skipped doses, or had to choose between medicine and food.
So we went to trainings, gave talks at senior centers, helped people choose plans, and helped resolve problems that prevented some from getting their medications smoothly. Once Part D got started – and it was a rocky start – we even filed lawsuits to make sure that people were actually getting the Part D benefits they were supposed to get, improving the existing program. We did not try to prevent Part D’s implementation, “defund” it, spread falsehoods about it, or try to make it fail.. We tried to make sure people could make the best possible use of Part D, because people needed their medications. We did and still do advocate for changes to Part D (like closing the donut hole, finally being accomplished by Obamacare!). Today there are millions of people who need health insurance and cannot get it. Obamacare will help them get that insurance. (Luckily, there are also people working hard to enroll the uninsured.) This new program may not be perfect, but obstructing its implementation, scaring away people who truly need insurance coverage, placing political gain over the urgent medical needs of real people – those tactics should be out of bounds.
And we quote:
“Private insurers’ Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012
Instead of being more efficient, private insurers have cost Medicare almost $300 billion more over the life of the program
A study published online today finds that the private insurance companies that participate in Medicare under the Medicare Advantage program and its predecessors have cost the publicly funded program for the elderly and disabled an extra $282.6 billion since 1985, most of it over the past eight years. In 2012 alone, private insurers were overpaid $34.1 billion.
That’s wasted money that should have been spent on improving patient care, shoring up Medicare’s trust fund or reducing the federal deficit, the researchers say.
The findings appear in an article published in the International Journal of Health Services by Drs. Ida Hellander, Steffie Woolhandler and David Himmelstein titled “Medicare overpayments to private plans, 1985-2012: Shifting seniors to private plans has already cost Medicare US$282.6 billion.”
Hellander is policy director at Physicians for a National Health Program (PNHP), a nonprofit research and advocacy group. Woolhandler and Himmelstein are professors at the City University of New York School of Public Health, visiting professors at Harvard Medical School and co-founders of PNHP.”
We have to say, Forbes has it right! The co-pay for Medicare home health care proposed in the President’s budget is a big mistake. It will not save money, will harm people with chronic conditions, and will increase avoidable hospitalizations. It isn’t even a good tool for fighting fraud – if that is the goal.
Far from getting too much care, our experience is that thousands of people with multiple sclerosis, Parkinson’s disease, ALS, paralysis, and other long-term conditions, struggle to get the home care they DO need. A little bit of nursing and/or therapy, along with hands-on health aide services, often means the difference between staying home and requiring a hospital stay or nursing home placement. For most Medicare beneficiaries with chronic conditions, home health care is more humane, more effective and less expensive.
If fraud is the concern, fight it. Don’t add co-pays or other barriers for those who really do need home care and qualify for Medicare coverage.
As we said in today’s Politico Op Ed, it’s time to support Senator Rockefeller’s bill – and all serious efforts to reduce what Medicare pays for prescription drugs. High time. There are over 50 million people with Medicare. Why would we not insist on lowering drug prices for all of them? It would save Medicare $141 Billion over ten years. Wal-Mart knows the value of negotiating low prices for vast numbers of people, and is sure to do so. So should Medicare.
This week, the Supreme Court is set to hear oral arguments in two cases relating to the Defense of Marriage Act (DOMA), the law prohibiting the federal government from recognizing same-sex marriages. DOMA has serious implications for same-sex couples regarding the benefits they earn, including Medicare. How same-sex couples qualify and pay for Medicare is directly impacted by DOMA – and has serious financial ramifications for these couples.
Access to Medicare is generally achieved by reaching age 65 and accruing 10 years (40 quarters) of Social Security-covered employment, or by being the spouse of a worker who is age 65 who has accrued 40 qualifying quarters. Because the federal government cannot legally recognize the validity of a same-sex married couple under DOMA, same-sex spouses with no work history, or fewer than 40 qualifying quarters, cannot acquire Medicare coverage on the basis of their spouses’ work history. In order to have access to Medicare coverage that would be available to an individual in a mixed-gender marriage, a spouse in a same-sex marriage must pay hefty out-of-pocket premiums to buy into Medicare Part A. In 2013, the monthly Part A premium is $248 for beneficiaries with 30 to 39 quarters of qualifying work history, and $451 for those with less than 30 quarters in the system.
Simply put, DOMA often causes same-sex couples to pay significantly higher out-of-pocket costs for Medicare than they would if they could legally marry in their states and if their marriages were recognized federally. Though some progress has been made by the Department of Health and Human Services in recognizing the rights of same-sex couples regarding hospital visitation, DOMA still presents them with significant barriers to affordable health care under Medicare.
The Supreme Court’s rulings on DOMA will have serious implications for same-sex spouses and their families. Ironically, this is LGBT Health Awareness Week. We hope the Supreme Court will mark the occasion with a decision that recognizes the full and equal rights of Americans in same-sex marriages.
Misconceptions and misinformation about the Affordable Care Act are still too many to innumerate. However, as advocates for Medicare beneficiaries and a strong Medicare program, we can tell you that the Affordable Care Act (ACA) is good for beneficiaries and good for the stability of a full and fair Medicare program. ACA has already added significantly to Medicare-covered preventive services – with no beneficiary cost-sharing, continues to reduce the cost of prescription drugs for people under Medicare Part D, is phasing out wasteful overpayments to private Medicare Advantage plans and added over a decade to Medicare’s long-term solvency.
Happy Anniversary, ACA. As my grandmother would say, “You should live and be well!”
The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. The counterpart to this notion, caps on outpatient therapy, has created significant barriers to necessary care for thousands of our clients with long-term and chronic conditions. We have no doubt that episode caps would be harmful to some of those in greatest need of home care. Thus, we are adamantly opposed to such limits in the home health context.
The Center has long opposed Medicare home health co-payments, and continues to do so. Like caps, co-payments will limit access to in-home care for those most in need of these services. However, we are increasingly concerned about proposals to introduce home health payment limits. There is no question that home health payment limits would be disproportionately harmful for people with conditions such as traumatic brain and spinal cord injuries, Alzheimer’s, Parkinson’s disease, MS, and other such illnesses and disabilities. Without the possibility for ongoing home health care, these individuals may well need costly nursing home or hospital care.
• Our client, Mrs. Berkowitz, who is 81 years old and receives skilled physical therapy and home health aide services for her Multiple Sclerosis and related health needs, will require a nursing home if payment caps are instituted for Medicare home health.
Payment caps contradict and undermine growing efforts to promote better care, at lower costs, by encouraging and investing in home and community-based services.
Payment caps would also undermine the settlement just arrived at with the U.S. Department of Health and Human Services in the national class action law suit, Jimmo vs. Sebelius. The Jimmo Settlement makes it clear that Medicare coverage is available for home health patients who need skilled nursing or therapy to maintain or slow deterioration of their conditions. Jimmo holds the promise of continuing care at home for people with long-term conditions who would otherwise often need more intense and expensive institutional care. Medicare home health payment caps, however, would create a barrier to this care and provide a disincentive to home health agencies to offer care to this particularly vulnerable population.
Medicare was in the spotlight in the Vice Presidential debate as the candidates outlined their respective plans for the program millions of American families rely on. Unfortunately, some pervasive myths were also highlighted regarding the impact of health care reform and the Ryan plan on Medicare and the 49 million Americans who count on it. [Check out the Center for Medicare Advocacy's Facebook and Twitter pages (Follow @CMAorg) for a full list of Medicare Myths and Facts from the debate.]
One of the myths that was repeated during the debate is the familiar claim that the Affordable Care Act cuts Medicare by $700 billion – the same claim that has been debunked time and again. In fact the $700 billion in savings are largely a result of rolling back unnecessary, wasteful overpayments to private Medicare insurance plans. Congressman Ryan’s budget plans have included these same $700 billion reductions; however, instead of ending overpayments to private insurance companies with the savings, Ryan’s plans would give private insurance companies an even larger share of Medicare expenditures.
The Ryan Plan to end Medicare would provide each individual with an annual allowance with which to purchase a health plan in the private market, would raise costs for current and future beneficiaries, and would repeal important Medicare benefit improvements, added by the Affordable Care Act (ACA). The ACA Medicare improvements include extending the solvency of the Medicare Trust fund, lowering prescription drug costs, adding new coverage for preventive services, and eliminating cost-sharing for most such services, such as mammograms and prostate screenings.
Mr. Ryan and other policy-makers often talk about waste, fraud, and abuse in Medicare. Yet too often these same policy-makers plan to extend private Medicare to restructure the entire Medicare program. They claim this will save money for Medicare, taxpayers, and beneficiaries. But a new study, once again, confirms just the opposite.
In a forthcoming issue of the International Journal of Health Services, researchers report that “Medicare has overpaid private insurers by $282.6 billion, or 24.4 percent of all MA payments, since 1985. In 2012 alone…MA plans are being overpaid by $34.1 billion, or 6.2 per¬cent of total Medicare spending”. This means nearly a quarter of all payments to private insurance companies in Medicare, subsidized with taxpayer dollars, have been unnecessary overpayments that have gone to profit margins and administrative costs, not health care services. Talk about waste!
The authors of the International Journal study conclude that the decades-long experiment with privatizing Medicare should end. Instead, policies should be developed to focus on the real issues of overall health costs and access to coverage. However, if the Ryan plan takes effect, the wastefully expensive private Medicare program will be expanded. Meanwhile, the cost-effective traditional Medicare program will be allowed to wither, and beneficiaries will become responsible for dramatic increases in out-of-pocket costs.
Mr. Ryan’s plan continues wasteful overpayments to private insurance companies at the expense of beneficiaries and taxpayers. It is not a plan to preserve Medicare, protect older and disabled people, or reduce health care costs.
This week, the Center for Medicare Advocacy’s founder and executive director, Judith Stein, was invited to speak before a House Policy and Steering Committee at a forum on Medicare to voice the concerns of beneficiaries and their families about the Ryan Medicare plan. Speaking alongside a health economist, a veteran medical provider, and a teacher whose family relies on Medicare and Medicaid for critical care, Ms. Stein spoke and answered questions from the Committee about the loss of coverage, higher costs, and limitations on choice that current and future beneficiaries would face under the Ryan plan. This Alert features excerpts from the testimony, as well as highlights from the subsequent Question and Answer portion of the forum.
Leader Pelosi and members of the Committee, thank you for holding this important Forum and for honoring me with the opportunity to appear before you.
I am Judith Stein, founder and executive director of the Center for Medicare Advocacy, Inc. Founded in 1986, the Center is a national, nonprofit, nonpartisan organization headquartered in Connecticut and Washington, DC, with offices around the country. I have been representing Medicare beneficiaries since 1976. My organization has represented tens of thousands of Medicare beneficiaries − more, I believe, than any other organization in the country. I know the value of Medicare, and its challenges as well as anyone.
Medicare was enacted in 1965 because private insurance failed older people. For over 47 years, Medicare has provided guaranteed benefits that have enhanced health security and financial stability when people need it most – when they are older or disabled and also sick or injured. It has been so successful that this population is now almost uniformly insured − although only 50% of people 65 or older were insured when Medicare began.
I’ve seen Medicare coverage save lives and bring peace of mind to families. I also know how Medicare has changed since I began my work representing Medicare beneficiaries. While coverage has been enhanced over the years, Medicare has also become ever more complex and difficult to navigate as private plan options have been introduced, swarmed in and out, and premiums have been income-based. While we are regularly told that “one-size fits all” does not serve people well, this was simply not the case for the traditional Medicare program. In fact, for decades the guaranteed, universal Medicare program fit most very well.
Today, the myriad Medicare choices, complex decision-making, and plan variations baffle many, often leading to inertia, and poor planning. Many people simply do not choose at all, and those who do, often stick with their initial choice, even as their plan offerings and their health needs change. Further, most people want choice of doctors, hospitals, and other health care providers, not insurance plans. Ironically, private Medicare plans reduce physician and health care provider choices far more than the traditional program.
Unfortunately, Congressman Paul Ryan proposes, and the House has twice passed, yet another effort to privatize and fragment Medicare – this time on a grand scale. The Ryan Plan would provide each beneficiary with a set annual allowance, or voucher, with which to purchase an insurance plan in the private market. While we have not seen details about the Ryan voucher system, the outlines we have seen would increase costs to beneficiaries. Regardless, of its details, the Ryan Plan would not impact the current deficit, since we are told it would not begin until 2022 at the earliest. (The 2011 Ryan Plan called for the change to Medicare to commence in 2023.)
The certitude that competition in the private market will reduce Medicare costs is belied by past experience and numerous studies. As former Medicare and Medicaid Administrator Bruce Vladeck has said, “private plans have not saved Medicare a nickel.” When the private Medicare+Choice program was tried under Mr. Vladeck’s leadership, Medicare paid private plans 95% of what it cost to cover a similar beneficiary in traditional Medicare. The idea was to test the truth of the belief that private plans could provide health insurance more cost-effectively than traditional Medicare. While dozens of private plans entered the Medicare market, they left in droves when it became clear they could not, in fact, compete with traditional Medicare.
In 2003, Congress authorized the Medicare Advantage program, which paid private plans approximately 14% more than the traditional Medicare per beneficiary cost. Not surprisingly, private plans reentered the market, but at a terrible cost to the Medicare program, all beneficiaries, and taxpayers. The Congressional Budget Office estimated that these payments would amount to $150 billion over a ten-year period.
Further, if traditional Medicare is forced to compete with private insurance, private plans will work to minimize their spending and woo the healthier, least costly beneficiaries. If older, more vulnerable, more expensive beneficiaries remain disproportionately in traditional Medicare it will not be sustainable and will wither on the vine. This increased fragmentation of Medicare and Medicare’s 49 million customers will also reduce its bargaining power, thereby limiting its ability to help drive down health care costs. Yet reducing health care costs is a key to reducing the federal deficit.
Certainly Medicare could be made more financially viable. Reducing payments to private Medicare plans is one sure way to start this important effort. However, the Ryan Plan does not propose this path. Instead, its “Path to Prosperity” would increase the age of Medicare eligibility and provide individual, defined contribution vouchers to older people − gutting the community Medicare program that has ensured access to health coverage for generations. This approach would increase costs and reduce coverage for people with Medicare and their families. Yet, according to the Kaiser Family Foundation, about half of people with Medicare live on incomes of $22,000 or less – just under 200% of the federal poverty level. They simply can not afford the additional costs projected under the Ryan Plan, costs which are tantamount to imposing a health insurance tax on older and disabled Americans.
The Ryan Plan is based on the belief that private is better. But Medicare controls health spending better than private insurance. Competition among private health insurance companies has not driven costs down either in the private Medicare Advantage program or for individual and employer-based policies for those under 65. As discussed above, Medicare has included private plans for decades, but they cost Medicare more than the same coverage under the traditional Medicare program. Medicare administrative costs are a fraction of those for private insurance. And, over the next ten years, Medicare spending is expected to grow at rates of 3.1% compared to 5% for private insurance plans. Thus, the traditional Medicare program, which the Ryan Plan would dismantle, shows greater promise for controlling costs than turning the program over to private insurance companies.
One last reality check: Mr. Ryan’s plan would affect current and near-term retirees, despite promises to the contrary. The Ryan Plan would immediately repeal health care reform, which greatly improves Medicare coverage for prescriptions and preventive care, saving people with Medicare a total of about $4 billion on drugs and increasing their access to preventive care. Repealing health care reform would retract these benefits. It would also reinstate the wasteful overpayments to private Medicare Advantage plans that were rolled back by the Affordable Care Act. Since all beneficiary premiums are set as a percentage of the costs of the entire Medicare program, these overpayments would translate into higher out-of-pocket costs for everyone with Medicare.
We recognize our responsibility to add constructively to the conversation. It’s fair enough for those who favor the Ryan Plan to ask, “Well what would you do?” Thus, the Center for Medicare Advocacy offers six key recommendations to keep Medicare solvent while it continues to provide fair, defined health coverage. These recommendations, unlike the Ryan Plan, do not shift costs to beneficiaries, and do not unnecessarily restructure the Medicare program. They promote choice and competition while shoring up the solvency of the Medicare Program.
“Protecting” Medicare by shifting costs from the federal government to beneficiaries and their families through the creation of a private Medicare voucher system is a perversion of Medicare’s purpose. Medicare was enacted to protect older, disabled people and their families from illness and financial ruin due to health care costs. The Center for Medicare Advocacy’s recommendations promote financial solvency without doing it at the expense of beneficiaries.
The Ryan Plan would enrich insurance companies while leaving beneficiaries with inadequate purchasing power in an increasingly expensive health care market. It would end Medicare and begin a new private system that would be more expensive and more costly for older and disabled people. It would limit people’s choice of physicians and health care providers. We welcome the opportunity to examine Medicare’s challenges and successes. But for the 49 million American families who rely on Medicare now, and for all those who will someday, we look for a debate based in fact not preferences. Simply stated, you can’t save Medicare by ending it. The Ryan Plan will end Medicare.
For a full transcript of the testimony, see: http://www.medicareadvocacy.org/2012/10/04/cma-in-action-judith-stein-testifies-in-congress-on-the-ryan-plan-to-end-medicare/.
For more information, contact executive director Judith Stein (email@example.com) at (860) 456-7790.
To stay up to date on all the Medicare myths this election season, see our “Medicare Myths and Truths” chart at: http://www.medicareadvocacy.org/medicare-facts-fiction-quick-lessons-to-combat-medicare-spin/.
Highlights from the Question & Answer Session
Members of the Committee asked panelists to respond to questions and comments including:
Q: I see a train wreck, a continuing train wreck of seniors, on the highway of despair. (Panelists were then asked to comment)
Ms. Stein: “The Kaiser Family Foundation tells us that about half of Medicare beneficiaries have an annual income of $22,000 a year or less. I really do think it’s no wonder the country thinks Congress is out of touch with what’s really happening in this country… . Medicare is in jeopardy and it’s for philosophical reasons, I believe. [The Ryan Plan is] simply not the most cost-effective way to do what is being proposed and it will absolutely put us back to where we were in 1965.
It is a train wreck waiting to happen and we have to get people to hear that. And, yes [Congressman Larson, in answer to your earlier question,] it is personal. I’m a breast cancer survivor. I know what it’s like to be perfectly healthy one day, and the next day to be maybe, maybe dying. How can you plan for this? And how can I plan to know that I can take care of my mother and maybe my children and grandchildren. This is a personal matter. [The Ryan Plan] is a train wreck. It is not best for the people or the fiscal solvency of this country. So why is it being proposed? Because there’s a preference for privatization and fragmenting Medicare. But privatizing this system will not help older people, their families, disabled people, or the deficit. So on all points, I’m very worried about it.
Q: How does the Romney/Ryan plan limit people’s choices?
Ms. Stein: We need to look at what we actually know, because this is not something new. Current private plans (Medicare Advantage) and private plans in the past have all had the impact of fragmenting the risk pool. The widest network (and most effective risk pool) is traditional Medicare. As soon as you enter into a private plan you will have a limited network with a limited choice of doctors and health care options.
Traditional Medicare, which, if we encouraged it for most of those with Medicare, has the best bargaining power of any health system in the country, and so it can bring down costs if we allow it (such as requiring negotiations on prescription drugs under Part D). When you fragment Medicare as we have been doing since the 1990s, you reduce the risk pool and the buying power of Medicare and thereby reduce its impact on reducing health care costs – for everyone throughout the country, not just for Medicare beneficiaries.
One of the things we can do is look at this plan from past history. We already know what happens. We know that only 10% of beneficiaries in private plans make a change in their plans after they make their initial choice … it’s a mind-boggling set of options – it’s not just one or two choices. Ideally, an individual should review their plan and potentially change it every year, but only 10% do this.
So what happens is that – even if you could predict what health choices you will need – and you don’t really know – most people don’t make a choice so we find that people call the Center because the choice they made is no longer effective … many people choose private plans when they are healthier and then when they are diagnosed with a disease or condition and want to see the best doctor or specialist for that disease, they find that they can not do so under their plan. If they were in traditional Medicare they could still get the care they want and need.
We know from experience that private plan options in Medicare are not the best for any number of reasons, including costs and services for people. They simply do not provide as many health care options or providers as traditional Medicare does.
 For example, a recent study finds that less than 10% of people with Medicare Part D enroll in what would be the most cost-effective plan for them. (National Bureau of Economic Research, “Plan Selection in Medicare Part D,” (June 2012).
 Medicare Payment Advisory Commission (MedPAC). According to the Centers for Medicare & Medicaid Services, in 2012 Medicare Advantage plans are paid on average 7% more than similar beneficiary services would cost in traditional Medicare.
 Congressional Budget Office; Health Care Affairs, (9/20/2011).
 Kaiser Family Foundation analysis of Medicare Trustees Report 2012.