Article - July 13, 2008 - Anderson Independent Mail

An ailing program: Medicare needs more safeguards to prevent fraud

How the U.S. Senate’s most recent vote will affect your household depends upon who you ask — and to whom you are listening.

Both Sens. Jim DeMint and Lindsey Graham opposed the measure that restores a 10.6 percent cut in reimbursement fees that doctors receive for Medicare patient treatments. While they agreed that reimbursements should not be cut, the question was how to pay for restoring the cuts that took effect July 1.

What the Senate passed makes eliminating the cuts possible by cutting payments to private insurance plans under Medicare Advantage, which DeMint claims will “force 2.3 million seniors, including over 65,000 seniors in South Carolina to lose their private health care coverage under Medicare.” The e-mail from his office also notes that “Medicare Advantage … provides a higher quality of care for lower premiums than traditional Medicare.”

Not necessarily.

A March report from U.S. News & World Report claims there might not be much advantage in Medicare Advantage over traditional Medicare.

It cites a report from the Government Accountability Office that says seniors in some plans actually might pay more, with the hardest hit being the sick.

“According to the (GAO) report, 19 percent of seniors in Medicare Advantage plans were projected to face higher out-of-pocket costs for home health services.” Sixteen percent, the GAO said, would face higher costs for inpatient services. And 9 percent were expected to pay more for nursing facility care.

And finally, 52 percent of Medicare Advantage plans “didn’t have an annual out-of-pocket maximum to cap beneficiaries spending.” If such a maximum did exist, the GAO report says, it often “did not apply to many products and services such as certain cancer and other drugs covered under traditional Medicare Part B.”

Almost half of the beneficiaries were in plans with this exclusion, and 23 percent of the plans excluded treatment by specialists.

The most disturbing item we found in the report was the government pays, on average, 13 percent more to care for a Medicare Advantage enrollee than if that person was under traditional Medicare.

Admittedly, the GAO report notes that some of the services it analyzed will not be utilized — when the person enrolls in a plan. But when making a coverage decision, it suggests that it’s best to think about what future needs would be rather than present situations.

Back to DeMint for a moment. His e-mail also included the statement that “the Senate just voted to gut (Medicare Advantage) and force seniors into government-run plans.”

Enter a June 26 report from the Los Angeles Times that states the GAO report on Medicare Advantage covering data from 2005 (presumably the latest numbers available for such a study) said private insurers actually spend less on medical services than projected and recorded larger profits — an extra $1.14 billion for a single year.

Full story


Page Information

  • 4 months ago [history]
  • View page source
  • You're not logged in
  • No tags yet learn more

Wiki Information
Update to PBwiki 2.0

An entirely new PBwiki experience, including folders and easier editing.

Convert Now for Free | Learn more