Most of us breathe a sigh of relief when we reach Medicare age because we think we will have coverage until we die. And we will. But we may not get all the options we want. Medicare Open Enrollment period officially opens Saturday October 15th, but the insurance companies that administer the Medicare program announced their 2012 plans and rates this past weekend. There was good news and bad news.
Whether you are 16 or 66, getting dumped is a humiliating and frustrating experience. Last week, some residents of my county received a letter from their insurance company saying that their Medicare managed care plan will no longer be offered here next year. Yep. Dumped by Anthem Blue Cross.
In some places around the country, there will be no real choice of managed care options in 2012. In my county only one managed care plan will be offered and it will cost $192 a month. Other counties that Anthem dumped will be left without any managed care plans at all. It's not just California, though. Medicare beneficiaries in Virginia saw Optima drop out of the market for 2012, citing $20 million losses for that managed care business, and 500,000 enrollees in states offering Coventry or WellCare will also see their managed care options reduced.
Will more insurance companies drop their managed care business when they realize they cannot continue to make the same profits they have been making? Perhaps. Even though the number of plans dropping out of the market is small this year, is it a national trend? Actually, so far it is nothing like a national trend.
In fact, earlier this month, federal officials said they expected a 10 percent increase in enrollment in Medicare Advantage plans, and they said premiums will be 4 percent lower on average in 2012 with benefits remaining consistent with 2011 plans. Which is all well and good if you live in a place where there is still a lot of competition for you as a Medicare beneficiary. But if you do not?
You still have basically three choices when you are eligible for Medicare. You can go "bare" and take what the "original" Medicare offers in terms of insurance and pay whatever extra is charged; you can buy what is called a "supplement' or gap plan that fills in the holes of what Medicare doesn't pay for but costs anywhere from $50 to $300 a month depending on your age, where you live, type of plan, etc. Or you can enroll in a "Medicare Advantage" plan (MA), which is the name of the managed care option Medicare offers, with monthly premiums that range from zero to $300 or more, again depending on where you live and your age.
The Bush Administration pushed the concept of managed care in 2003 when the Medicare+Choice plan (implemented in 1997) became Medicare Advantage and the government sweetened the pot for insurance companies by paying them more than Medicare paid for its original program.
A Medicare Advantage benefit costs the government 14 percent more than exactly the same benefit offered through regular Medicare. In some parts of the country, the difference is as high as 20 percent. That extra money is being eaten up in marketing and administrative costs, and in profits to the insurance companies. According to the U.S. Department of Health and Human Services, all Medicare beneficiaries, including those enrolled in regular Medicare, are paying for these overpayments through higher premiums. HHS says that this year these subsidies are adding about $3.60 per month to premiums.
As a part of health reform, Medicare decided to require these insurance companies to compete for the business, instead of simply accepting whatever they bid. And it is true that health reform set in motion a process by which that 14% overpayment would be reduced over a period of years to the level of what the government pays for original Medicare .
It's a reasonable question to ask -- why should where you live, or where you have to live, be a punishment for the beneficiary if the plan you have is suddenly dropped? Who can you blame in this type of situation? Unfortunately, there are no real evildoers to blame. Every one of the players acts pretty rationally, given the rules. The problem is -- we need to change the rules to make it more fair for everyone.
It's small comfort to be at the mercy of these plans, even with reassurances from the Federal government that these plans are here to stay and the fact that most Medicare Advantage plans are still offering affordable programs. The lonely Medicare beneficiary who can't move to a "better" reimbursed county is stuck with the options the market offers them. And the market does not work perfectly for health care. The rules of the market are to maximize your profit. Even with our very own single payer, government-run, "socialist" program Medicare, we are still at the mercy of the market and will be as long as we have a private sector delivery and insurance system. It's important not to forget that the Republicans would put us all at the total mercy of the market with their voucher proposals for Medicare.
I don't mean to sound whiny about this. I feel incredibly fortunate to have Medicare, and if it weren't for the heroics of my local congressman Sam Farr (D- Monterey) and the vigilance and work of the Medicare staff, I would not have a set of supplemental plans to choose from and plans would be charging even more than they do. But it does kind of make you wish you lived in Vermont, doesn't it? Taking the profit out of health care. Now that's a concept.
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Open Enrollment-2011 - Medicare.gov
Understanding Medicare Enrollment Periods
Medicare.gov – the Official U.S. Government Site for Medicare
This is the official U.S. government Medicare handbook: Open ...
I told my Mother what she said and Mom says No Shit Sherlock. Then Mom says "you better not put me in a nursing home ". I can only assume that once in the Nursing Home the Insurance Company would be off the hook and not have to worry about paying for my Mothers care.
I did feel a little intimindated at what I took as a threat that I was some how Neglecting my Mother. But my Mother has all her facilities even if she forgets where she put them sometimes and I will follow her wishes.
Sorry HMO you have a furture expense with my Mother deal with it !!!!!
Obamacare fell MISERABLY SHORT by not offering a Public Option.
Perhaps, it's a promise the liberals can extract out of O in exchange for a potential 2nd term.
THAT'S MY BOTTOMLINE.
How could he have thrown so many Insurance Company Employees out of work in a few months ? The Blue Dogs punched so many holes in Health Care Refrom I am suprized anything made it thru.
Want the Public Option get rid of Blue Dogs and regain the Congress is all I can say.
We also need a Infustructure Bank that Americans can use where Consumer Protection are the main product.
Let the Commerical Banks take care of Business we need the American Bank for the people to invest in their own Country.
The way health care costs are going, it can only be a matter of time before many medical treatments are outsourced - OVERSEAS ! Imagine Insurance companies offering a choice of partially funded local treatment or near full traement overseas !
Actually, there are some other problems with "capitaldysfunction's' solution. Under Part A, a 20% co-pay is not an issue (that is a "feature" of Original Medicare Part B). When it comes to Original Medicare Part A, the geographic restrictions, lack of lifetime limits and the potential high co-pays for a long stay in a skilled nursing facility are the "features" he has to worry about.
Also you should have explained to him more clearly that Original Medicare Parts A and B are just as involved with private insurance companies as Parts C Medicare Advantage (MA) and D. The great protester "capitaldysfunction" -- why isn't he out occupying something -- is going to be shocked when he gets that first Medicare statement from Blue Cross, or Wellpoint, or ???? depending on where he lives.
As for his criticism of George Bush, "capital dysfunction" is equally misinformed. . Part C MA has been around for 20 years or more. In 2003 the Republicans improved it such that subscriptions to Part C MA have grown from 11% of the Medicare population to 25%. Us seniors love it. And Part C only uses 22% of the resources of the Medicare Trust fund even though it serves 25% of us. Doesn't sound like a fiscal problem to me.
(And oh by the way, most Part C MA plans are already the same accountable care organizations promised in PPACA that "capitaldysfunction" probably thinks is the greatest idea since sliced bread.)
First, in general -- unless you are disabled -- nothing to do with Medicare should ever happen at your house. If someone suggest they will come to the house, report them to HHS. Call or go to your local senior center and ask for the SHIP volunteer. Or call 1-800-MEDICARE and talk to a person there (who will often refer you to SHIP so you may as well start there).
Second, whatever you think of Bush, MA could very well be the right decision for you. The 14% figure is a canard thrown out by leftists who oppose anything the Republicans did between 1995-2006. It refers to reimbursement formula for each individual MA participant but not to the cost of the program to the government. The government actually only spends about 22% of its annual Medicare funds on MA even though 25% of us seniors belong to MA plans.
Even if you don't want to believe that statistic (which you can look up on MedPac), MA is almost always less expensive for you. The key is whether you are happy with the doctors and hospitals that particpate in MA in your county.
SINGLE PAYER IS THE ANSWER.
Everything else is smoke and mirrors and kicking the can down the road.
WHEN WILL WE, AS APEOPLE, WAKE UP ?
'Liver cancer drug 'too expensive'
'NICE said Nexavar's benefits did not justify its high cost
'Cancer patients have asked for immediate access to the £200m cancer drug fund after the NHS refused to pay for a new medicine.
'The fund is to be set up next year by the government to give patients access to treatments the NHS cannot afford.
'But the Pamela Northcott Fund wants it set up sooner after the watchdog NICE blocked use of the drug Nexavar.
'NICE said the drug, which extends life by less than three months on average, was too expensive at £27,000 a patient.
'Only about 20% of patients are alive one year after diagnosis, dropping to just 5% after five years.'
-- http://news.bbc.co.uk/2/hi/health/8367614.stm”
Needless to say, the US pays more than the UK, on a per capita bases.
$4487 x 60 years (age) = $268,380 - tht's the amount the UK saves per capita over the 60 years.
Republicans hate this, too socialistic, which is ironic since we're all socialists anywa to a certain extent which is also a consept they hate. The beauty would be that Libertarians coud live their dream and not participate if they wanted to. They just wouldn't be able to get free care when they get sick.
Medicare reimbursement rates are generally structured on the premise that paying the average rate would be too profitable for the hospitals et al., but that paying the incremental cost for the additional patient is fair. That means that on an average, per patient basis, the hospital needs to look for additional value from privately-insured patients.
Where Medicare offers an outstanding value is in its administrative costs. They're considerably lower than those of insurers, largely because, as the author points out, there's no profit being made.
The challenge is that that thorny difference between the incremental and the average cost. If Medicare were to insure everyone, hospitals would have to be reimbursed at the level of the average cost in order to make ends meet. That would mean a big increase in Medicare's reimbursement. How do we get there? Well, by offering the equivalent of an insurance product at zero profit, Medicare could be an affordable option for under-65s. Additionally, everyone would save on administrative costs by skipping the expensive insurance reimbursement system.