Posts filed under ‘Public vs. Private Health Coverage’
We are troubled by both the scale of estimated improper payments to Medicare Advantage plans due to inappropriate upcoding – at a rate of 9.5% or $14.1 billion in 2013 – and CMS’ lack of progress on recouping and deterring such payments.
We hope that policymakers who protect MA profit at all costs, while at the same time often proposing to shift more costs on to the majority of beneficiaries in traditional Medicare – take heed of this GAO report and ensure that the recommendations are implemented.
Read the GAO report at: http://www.gao.gov/assets/680/676441.pdf
We agree it’s important to find a permanent solution to the physician payment formula (“Sustainable Growth Rate” or SGR), but the Bill passed by the House of Representatives today is not the answer. It isn’t balanced. It asks too much from beneficiaries without providing enough in return. It asks nothing from pharmaceutical or insurance companies. It continues the ever-increasing privatization of Medicare by increasing costs for beneficiaries for traditional Medicare and Medigap plans. It adds unnecessary costs for the Medicare program and taxpayers.
Of the portion of the SGR costs that will be off set, roughly half (approximately $35 billion of the total $70 billion over 10 years) would come from Medicare beneficiaries through changes that will increase their out-of-pocket costs for health care, including:
• Adding deductibles to Medigap plans purchased by new Medicare beneficiaries starting in 2020;
• Further means-testing premiums for higher-income beneficiaries; and
• Overall increases in Part B premiums.
While the SGR package would make the low-income, Qualified Individual (QI), program permanent, which we strongly support, and would minimally increase and temporarily extend important funding for beneficiary education and outreach, it does not address other key issues that serve as barriers to care. For example, instead of repealing the annual outpatient therapy caps, the process to seek an exception to the cap is extended for another two years. Instead of addressing hospital Observation Status, the Bill further extends enforcement of the so-called “two-midnight” rule.
In short, Medicare beneficiaries would pay too much, with too little in return. Major drug and insurance industries pay nothing, and stand to gain a great deal. As the SGR debate moves to the Senate, we hope further balance and improvements for beneficiaries will be made.
Since 1965, Medicare has opened doors to health care and increased economic security for hundreds of millions of older people, people with disabilities, and their families.
2015 will also usher in a new Congress. Many of its leaders and members will likely champion plans to further privatize Medicare. These proposals will likely surface despite increasing reports that Medicare costs and the federal deficit are declining, and that traditional Medicare costs less than private Medicare. Once again we will likely hear about plans to transform Medicare to “Premium Support” (a voucher towards the purchase of private insurance). We will probably read about proposals to increase the age of Medicare eligibility, decrease the value of Supplemental Medicare Insurance (Medigap), redesign Medicare to make it “simpler” (but less useful for most beneficiaries). We urge you to listen carefully for these and other such plans. And respond!
Since 1986, the Center for Medicare Advocacy has been on the front lines, advocating for people who depend on Medicare and for a comprehensive Medicare program for future generations. As we mark Medicare’s 50th anniversary, help us ensure its promise to advance access to healthcare. Help us explain what’s true and what’s not, where real savings exist, and when the true interests of beneficiaries are at stake. Help us ensure a real Medicare program lasts for another 50 years.
Be part of our Medicare Truth Squad. Ask us if you have questions. Spread the word – on Twitter, Facebook – in conversations! The future of a comprehensive Medicare program may depend on it.
”The private Medicare program has been a boon for insurers the past several years, offering sizable volumes and steady profit margins. … “ It will expand in the future as Baby Boomers join Medicare Advantage plans. (Modern Health Care 12/18/2014)
Why is this allowed to continue? How can we justify cutting Medicare coverage for older and disabled people while providing ever-increasing profit margins for private insurance companies?
Wake up people!
This is a scandal. Medicare Advantage plans continue to fail beneficiaries and cost taxpayers. Why don’t more people get it – or act to do something about it?
For more, see:
U.S. Finds Many Failures in Medicare Health Plans
“Federal audits found many coverage denials for medical services and prescription drugs are poorly…” @nytimes http://t.co/59LKyqkJSe
CMS has decided to raise rates for private Medicare Advantage (MA) plans. This is contrary to its earlier announcement that private Medicare reimbursement rates would be reduced to reflect slower per capita growth in Medicare and health care. Politicians from both parties and insurance companies called for this change and, unfortunately, CMS reversed course.
So, private Medicare will continue to cost more than it would cost to serve similar beneficiaries in traditional Medicare. While this may be good for insurance companies that offer MA plans, it is not good for Medicare, the vast majority of Medicare beneficiaries, or taxpayers.
Why should we spend more of our limited public funds on private Medicare when traditional Medicare costs less? Why should taxpayers ensure private profits to deliver public Medicare coverage? After all, the experiment in privatizing Medicare was originally intended to see if a private model would cost less, while providing the same or better coverage than traditional Medicare. That was not to be.
Private plans left the market when their reimbursements were capped at or below the per capita rate of public Medicare. CMS failed to learn from that experiment, and maintain the cost of traditional Medicare as the maximum taxpayers would pay for private plans. Instead, since the Medicare Act of 2003 we actually pay private plans more than traditional Medicare. This result is not good for the financial security of the Medicare program or for the federal budget deficit. It’s not good for the vast majority of beneficiaries who continue to choose the traditional Medicare program. It’s not even best for many MA enrollees, particularly those with long-term and chronic conditions, who often get less coverage than they would in traditional Medicare. And remember, by design MA plans have limited networks, so private MA enrollees have fewer choices in physicians and other health care providers than they’d have in traditional Medicare.
The Center for Medicare Advocacy continues to call for parity in payments between private Medicare plans and traditional Medicare. It’s the best deal for taxpayers, the Medicare program, and the vast majority of Medicare beneficiaries. Common sense should prevail.
On April 1st Representative Paul Ryan rolled out yet another “Path to Prosperity,” as he annually calls his budget. Unfortunately, the budget is a repeat of past year plans and is not a path to prosperity for most Americans – or for Medicare.
Once again, Rep. Ryan’s budget proposes a private approach to Medicare:
For future retirees, the budget supports an approach known as ‘premium support.’ Starting in 2024, seniors (those who first become eligible by turning 65 on or after January 1, 2024) would be given a choice of private plans competing alongside the traditional fee-for-service Medicare program.
Rep. Ryan has proposed “premium support” for future Medicare participants many times in the past. While his budget assures us that “this is not a voucher program,” it is, once again, a proposal to pay a certain amount towards private insurance for Medicare beneficiaries. Ironically, Mr. Ryan states such insurance plans “would be available in a newly created Medicare Exchange.” This is ironic because the proposal is remarkably similar to the Affordable Care Act marketplace that is so maligned by Mr. Ryan and his colleagues.
Rep. Ryan suggests that changing Medicare to premium support is needed because
the government has been … a clumsy, ineffective steward of value. Controlling costs in an open-ended fee-for-service system has proved impossible to do without limiting access or sacrificing quality.
In fact, over the last few years traditional Medicare per-capita cost growth has declined, leading the way to parallel reductions in the rise of overall healthcare costs.
The unnecessary costs for the government, taxpayers, and all Medicare beneficiaries that need controlling are the hundreds of billions of dollars in excess payments to private Medicare Advantage plans under Medicare Part C and private pharmaceutical companies under Medicare Part D. These unnecessary private industry payments are the real threat to Medicare’s future. If Mr. Ryan’s goal is really to save money and preserve a strong Medicare program, he would look to these cost overruns for savings. He certainly would not propose further privatizing Medicare.
However, the latest Path to Prosperity does again seek to privatize Medicare. At the same time it would reduce Medicare’s value to older people and people with disabilities by:
- Increasing the age of eligibility to 67.
- Charging more for Medigap coverage.
- Combining Parts A and B cost-sharing, thereby increasing costs for most beneficiaries.
- Increasing premiums for more beneficiaries.
Regrettably, the Ryan plan may provide a continued path to prosperity for private insurance and pharmaceutical companies, but it is a dead end for Medicare, older people and people with disabilities.