Medicare Advantage
If you're under 65, chances are you don't know a lot about a program known as Medicare Advantage. But you will be hearing a lot more about it soon. It has become a major front in the growing war that the insurance industry is waging on the Obama Administration's health reform effort. On Tuesday, the health insurance lobby launched a seven-figure ad campaign in at least a half-dozen states warning: "Congress is proposing over $100 billion in cuts to Medicare Advantage. ... Many seniors will see cuts in benefits."
So what should you know about Medicare Advantage?
The first thing to know, as Ezra Klein has noted, is that Medicare Advantage is not the same thing as Medicare. It is an option that Medicare beneficiaries have had since the 1970s to get their coverage through private insurance companies, rather than the government. It was a big favorite of the Republicans who ran Congress during the 1990s. They poured much more money into the program in hopes that more seniors would sign up with the insurance companies that were promising better service at lower prices. And it has proven to be a pretty sweet deal, at least for the insurance companies and the beneficiaries. For the government--well, not so much.
As Phillip Rucker writes today in the Washington Post, some Medicare Advantage programs offer seniors lots of goodies that Medicare doesn't, from gym memberships to free aspirin and band-aids. And the federal government is picking up much of the tab, paying 14% more in subsidies per Medicare Advantage recipient than it does for individuals with standard Medicare. No surprise that the number of Medicare beneficiaries enrolled in private plans has nearly doubled since 2003, to 10.2 million.
It is particularly appealing to healthier seniors. They are more likely to be in the market for, say, gym memberships. And because they go to doctors and hospitals less often, they are less troubled by the fact the Medicare Advantage charges fees for each visit, as well as higher co-pays. Sicker (and more expensive) patients are more likely to stick with traditional Medicare, and pay for supplemental coverage through that program.
But Medicare Advantage has legions of critics, both on Capitol Hill and among health care experts, who say it wastes money and doesn't provide the efficiencies it promises. That's why it was one of the first places Congress looked when it was searching for ways to wring some savings out of the system. Still, the new insurance industry ads are likely to have an effect, because if there's anything politicians know, it is that it is perilous to mess with a popular senior program.
The classic example was the Medicare Catastrophic Coverage Act of 1988, which at the time had seemed like a good idea. But it turned out seniors didn't want to pay extra for the additional coverage it provided; at one point, House Ways and Means Chairman Dan Rostenkowski saw his car surrounded by a mob of elderly Chicago constituents. He fled, and they literally chased him down the street.
Will these new ads have that kind of backlash? No one can say yet. But a word of advice to lawmakers: You might want to pack your running shoes the next time you go home. Elderly people can run faster than you think -- especially if they've been going to the gym.
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1
So the ads will be about Medicare Advantage but I'm supposing that they are hoping people hear "CUTS IN MEDICARE advatage."
It's called hoping the listener "Pulls a Scherer"
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1.1
PNNTO, I tweeted SG that there was a spot where he was needed. He responded in the Another Mainer thread.
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1.2
Thanks ivy, SG's response about Lieberman was all I could hope for. And more.
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2
So what should you know about Medicare Advantage?
I see you follow this with no information about how only 10-20% of the corporate welfare the government provides insurers to operate Advantage plans goes toward health care, and the rest is siphoned off for profit.
Yes, I suppose we really shouldn't know about this, because it is another depressing data point about how much corruption there really is in the halls of Congress.-
2.1
Karen, Pafro is right and this is really, really important. The only thing that's being cut in Medicare advantage is the profits of the insurance companies.
Karen, neither you, Phillip Rucker or Ezra mention this. I love you for all your work on health care, but you can't miss these critical facts!
We need to cut costs everywhere we can. We have to fight misinformation everywhere we can. We know we can't trust WaPo - it's a newspaper for a company town, and the company is K Street, not the government.
We need you on this, Karen.
Thanks.
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3
Are we talking about 10.2 million with MA? With so many uninsured how do we get into sweetheart deals for some constituents? I know the seniors lobby is a lethal force so you are right to sound a note of caution.
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4
I have a BC-BS Medicare supplement provided by my former employer. It gives me a rebate of $150 if I complete 120 gym visits, as my old BC-BS plan did. My gym (at my local community center) started a Silver Sneakers program geared to a Medicare Advantage program. Lots of new people joined the gym at that point, only a half dozen are left after a year.
I think it's a waste of money - band-aids, for Pete's sake???
This was another profit center for insurance companies that counted on scared low information seniors.
I lost my dental insurance when I retired, so I looked into an AARP plan because I have a lot of expensive dental work to maintain. When I checked what I pay for rountine visits against the premiums, I discovered that it would be cheaper for me to cover the catastrophe that happens once in five years or so than to buy the insurance.
My hip replacement didn't cost me a cent through regular Medicare and my supplement plan. Sorry to babble on, this is a subject that irks me!
Hope you're all well, KT
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5
Thanks, KT. I hope you're feeling better. Please recover soon. Perhaps you can have mimosas (aka The Breakfast of Champions) with your breakfast or lunch? Vitamin C + germ-killing alcohol = perfect tonic. Or are you still at home writing from the laptop with “The Young and the Restless” on tv? As for Med. Adv., my parents are checking this out. Pardon my cynicism of insurance cos., but is this program airtight in avoiding pre-existing / denied claims / raising fees crap that comes with regular insurance? (not rhetorical, I don't know) This kinda sounds like a HC exchange, or am I wrong? …but in any case, do get well quickly, please.
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6
Thanks, decon and ivy, for your good wishes. i'm back at the office, though not yet 100% better. it somehow felt appropriate to be watching the senate finance committee vote while i was huddled under the covers, feverish and slightly high on cold medication. also, i got to watch the wedding episode of "the office" at least five times, thanks to the fact that my cable system now has nbc on demand.
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7
Well we are starting to see some more balanced reporting from the TIME "All-Star Liberal" league of reporters. Yippee!!
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I guess we shall see a ton of those ads running in those States with the highest precentages, will we not Karen?
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Per the map you linked, they are Pennsylvania, Colorado, Minnesota, Florida, California, Nevada, Oregon, and Arizona. Perhaps those States also with the most Seniors as residents across the country as well.
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Once this ad starts, you can bet your liberal butt Karen, Seniors will begin calling and writing their Senators voicing their concern and out-rage. I can see it now.
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Granny will be riding her reindeer down to Washington to tell "Santa Claus" the Congressman to simply "stay away from my Medicare". Democrats are doomed!!
Yippee!! -
8
Interesting post KT - thanks.
Always interesting that Republicans are against wasteful government spending except when they're for it.
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8.1
I think the Republicans have been pretty disappointed as well with how this worked out. I don't think they expected it to be used to provide traditional fee-for-service medicine, but rather, to move seniors into more of a managed care model. And they also expected the subsidies to come down.
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8.2
Karen, you know that there is very little evidence for your statement. There is literally hundreds of examples of elected Republicans dishonestly equating a cut to Medicare Advantage with a cut to traditional Medicare. I doubt you have that much (quotable) ammo for your claim that Republicans are unhappy with Medicare Advantage.
And just yesterday we learned that high-profile Republican strategist Alex Castellanos (who wrote an important 'just say no to health care reform' brief for GOP members of Congress) is doing the ad buy for the insurance companies that are trying to protect their welfare. He is doing this GOP = AHIP routine all while acting like an independent pundit on the increasingly disgraceful CNN. -
8.3
pafro....true, but Dems also characterize a smaller increase in Medicaire spending as a "cut" in Medicaire to scare seniors, so it goes both ways
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9
"It is particularly appealing to healthier seniors. They are more likely to be in the market for, say, gym memberships. And because they go to doctors and hospitals less often, they are less troubled by the fact the Medicare Advantage charges fees for each visit, as well as higher co-pays."
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Isn't this the goal? Get people to live healthier lifestyles?
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Plus each plan differs as well Karen. You should do a little more research. Security Blue for instance has a very low monthy payment, and provides for nearly 99% coverage of all expenses. I just read the flyer my Mother just got for the 2010 year. She will have a $20.00 per doctor visit, and a $300 dollar per hospital stay expense. No co-pays.
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Plus she can also get a Silver Sneaker gym membership!!
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All for a low monthly payment of $69.00.
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This provides for someone like my mother who worked all of her adult life, paid in thousands and thousands of dollars to Medicare which she should be getting the benefit from now when she is retired.
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But, Barack Obama and the rest of the dirty old Democrats in the House and Senate want to take it away from her to redistribute to those who probably haven't even been in this country more than a few months, let alone an entire lifetime.
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Do you want someone like my 80 year old mother to eat dog food Karen, is that why you support the Democrat Health Care Reform Plan???-
9.1
Gotta love how rusty comes out in favor of "socialized medicine" as soon as it starts to benefit him or a relative......
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9.2
I think the $20 per doctor visit is usually referred to as a co-pay.
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9.3
'Do you want someone like my 80 year old mother to eat dog food Karen...'
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Shame on you Karen! Rusty is going to let his mother eat dog food if you don't support government subsidized health care for her. And it's going to be all your fault. After all, it's society's responsibility to take care of Rusty's mother -- not Rusty's.
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Hang in there Rusty. Keep up that good fight against socialism. -
9.4
Hey Rusty,
If Karen keeps supporting the 'Democrat Health Care Reform Plan' you may have to man up and help your mother. You don't want her to have to eat that dog food. Given the tough economy, you may have to make sacrifices and give up some luxuries.
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You could sell your computer to raise money to buy your mom food. She will probably appreciate it. I know the rest of us will. -
9.5
I'm relatively new to leaving comments on this or other blogs. I notice that when rustyreturns makes a comment, which usually is accurate, many L/P [short for liberal/progressives] like to pile on and attempt to put rusty down. He usually has the facts. You usually have BS. I find it amazing that L/P, who make up at most 20% of the US population, always believe they are smarter than the other 80%. What you really want is a Socialist Government system like they have in Western Europe. Have you ever noticed that the countries of Eastern Europe, who have actually lived under Socialism in the past, want nothing to do with it.
The vast majority of Americans will never accept Socialism because they love their freedom too much.
The L/P may have highjacked the Democratic party but they will not highjack the country.
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10
I think I finally understand Republican principles. They seem to have (principled) opposition to the following:
* government-provided health care,
* government-paid health care,
* public insurance option,
* reducing or eliminating Medicare benefits,
* Medicare cost increases,
* eliminating Medicare Advantage, and
* Medicare Advantage cost increases.Also:
* Patients given carte blanche to have medicines, tests and procedures,
* doctors given carte blanche to order medicines, tests, and procedures,
* bureaucrats getting between doctors and patients
* rationing medical care, and
* studying evidence-based medicine.Plus:
* providing free health insurance to illegal immigrants, or
* charging illegal immigrants for health insurance.And:
* government bureaucracy,
* a streamlined single-payer system,
* government waste, and
* negotiating the lowest prices for medical goods and services.And finally:
* doctors making end-of-life decisions for patients,
* families making end-of-life decisions for patients,
* doctors providing end-of-life counseling to patients so that patients can make informed decisions,
* pulling the plug on brain dead patients, and
* forcing hospitals to keep indigent patients alive.or, in other words:
* doing nothing,
* doing something, and
* reducing insurance company profits-
10.1
'I think I finally understand Republican principles'
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Your conclusions are dead on. However, Rusty's post above demonstrates that republican principles look more like:
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Oppose:
* government-paid health care -- except for me
* Medicare benefits -- except for me
* Medicare cost increases -- except for me
* Medicare Advantage -- except for me
* Medicare Advantage cost increases -- except for me
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And reduce my taxes. Get someone else to pay for it.
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11
How about we provide better health care to everyone instead of kissing the butt of certain people. Give us a public option.
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12
Has Rusty just been caught with his pants down??
It's not a pretty sight.
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12.1
He's like the Larry "I'm not gay, I just like gay sex" Craig of socialized medicine.
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13
And just a couple days ago Rusty was all for mandating the purchase of health insurance before he was against it. It was like Kerry all over again. I once again wonder if he's sane.
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14
"But Medicare Advantage has legions of critics, both on Capitol Hill and among health care experts, who say it wastes money and doesn't provide the efficiencies it promises."
Wow earth shattering news! A government program that wastes money and is inefficient. WHoever would have thought that would happen. Way to solve it? Let's start another one about 10 times the size.
Gotta love liberal intellectual thought. Sorry I know its an oxymoron.
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14.1
What in God's name are you blabbering about, freeper?
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Medicare Advantage isn't inefficient because it is a "government program". It is inefficient compared to a government program -- Medicare -- because it is run by private insurers.
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And since you apparently can't read the above post, "It was a big favorite of the Republicans who ran Congress during the 1990s." It is the GOP and Blue Dog Democrats, not "liberal intellectuals", that are preserving this bloated, inefficient and wasteful program, with full-on, scare-the-pants-off-Granny tactics because it is a gift to their corporate masters.
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square1
Last I checked it was Medicare Advantage was passed by Congress in the 1970s which mean passed by liberlas since they controlled both Houses of Congress. Medicare Advantage and every other Medicare plan has oversight by Congress. So were Democrats negligent all that time? And all of Medicare is bloated and inefficient despite liberal insistence otherwise.
http://www.heritage.org/Research/HealthCare/wm2505.cfmMay have been a favorite in the 1990 of Republicans and Blue Dog Democrats but the liberal Dumocrats had nearly 20 years to rid of it. Yet they didn't. Why? Because liberals have never met a spending program they didn' t like unless it was for defense.
Can liberals get any dumber?
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16
That's what happens when you read your talking points from a script and cue them up from a small selection of keywords. You get revealed to be an idiot.
No wonder he thinks that liberals are arrogant!-
16.1
That's what happens when you read your talking points from a script and cue them up from a small selection of keywords. You get revealed to be an idiot.
No wonder he thinks that liberals are arrogant!That is only because they are as your post reveals yet again!
Liberals don't have scripys I guess. Get that delusion alive
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17
It was a big favorite of the Republicans who ran Congress during the 1990s. They poured much more money into the program in hopes that more seniors would sign up with the insurance companies.
Reading comprehension. It's not just for intellectuals anymore!
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17.1
"It was a big favorite of the Republicans who ran Congress during the 1990s. They poured much more money into the program in hopes that more seniors would sign up with the insurance companies."
Didn't conservatives always give money to the evil insurance companies. How does one define "pour" or is that more liberal poetic license?
Maybe libs will get some of that reading comprehension now that its not fo rintellectuals any more
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18
Still no impetus to get rid of all the legislation currently limiting competition and choice among consumers. Why can't I buy insurance in another state? Why do I have to carry pregnancy insurance if my wife and I have NO intentions of having another child? There is all kinds of legislation mandating certain coverages and limiting how you may buy it that are driving up the cost. All of this legislation was put into law by the same government that you suddenly believe is gonna figure this healthcare thing out. They didn't know or didn't care about the impact then, why do you think it's gonna be any different now? Ohhhh, because you personally like the guy pushing it. Oh, ok.
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18.1
Personally, xxception, I have no problems whatsoever allowing insurance markets to go national, so to speak. However, there is one issue that I'm worried about; most people still get their insurance through their jobs. As long as that is the case, and insurance companies make a large majority of their sales to employers, rather than individuals, I'm not sure how much leverage the free market will have. While I like the idea, and I think it should be tested, I'm not (yet) convinced that national marketplace will have a sufficient impact on prices to limit reform to that area. If I'm worrying over nothing, and this plan is tried and works, I would be happy to admit I was worrying over nothing.
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18.2
ohiolib....the reason it is that way is the government has written tax law so that there was an incentive (taxwise) for the companies to provide the insurance. you can't deduct the cost of it, but companies can. change the tax law to allow individuals to deduct this and not companies and it reverts back.
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19
The plan still doesn't look like a viable option, alternative, or justification.
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20
Could someone tell me why the U.S. lets its corporations have voices in the public sphere again, especially in situations where there is a clear conflict of interest?
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20.1
Hear, Hear! This should be the major talking point.
Thanks for bringing it up.
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21
Medicare Advantage plans are attractive to seniors because of the "extras" not present in traditional Medicare/Medigap policies. They present well. But the devil is in the details.
Try using your MA plan at Mayo or Cleveland Clinic, or at most university medical centers. You'll be out of luck. That's because these centers will not accept the low reimbursement of most MA plans, which by law constitutes 100% of the reimbursement receivable by any provider who accepts.MA payment.
Far better to use tradional Medicare coupled with a Medigap F plan that covers the "excess" charges of 15% that most of the first class insitutions cited above demand, and which constitute their reasons for not accepting MA plans..
Add to that the fact that almost every provider accepts Medicare (good luck on even finding a list of approved providers from your MA plan), and the reality is clear: MA plans have lots of bells and whistles; just don't get really, really sick while you have one.
ps: My Medigap policy also enrolls me in the Silver Sneaker health club program, so there's no reason to go to a MA plan in order to get that benefit.
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I am one of many seniors who uses a Medicare Advantage plan frequently because of my health situation. I disagree with the statement in this article that says “Medicare Advantage charges fees for each visit, as well as higher co-pays.” In fact, I found the opposite to be true. When I first enrolled in my Medicare Advantage plan, I did a zip code search using the tool at PlanPrescriber.com. I then did a comparison of all the plans available in my area. The Medicare Advantage plan I selected gives me better, more extensive coverage and has lower co-payments and deductibles compared to traditional Medicare with add-on coverages like Plan D Prescription Drug and Medigap. I suggest seniors go to PlanPrescriber.com and do a plan comparison or talk to one of their representatives because a Medicare Advantage plan might be the best, less costly plan for them in the area where they live.
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23
For some reason, the link to PlanPrescriber was not included in my comments. So I am trying it again and hopefully the link will appear below. I hope other seniors find PlanPrescriber.com as helpful as I have in choosing a Medicare plan.
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23.1
So which one do you work for, planprescriber.com or an insurance companay? The website initially asks for personal information so that an insurance agent can call you. We're not all stupid, tricia65.
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Important and informative article as usual, Karen. A couple of points about the following passage:
The classic example was the Medicare Catastrophic Coverage Act of 1988, which at the time had seemed like a good idea. But it turned out seniors didn't want to pay extra for the additional coverage it provided; at one point, House Ways and Means Chairman Dan Rostenkowski saw his car surrounded by a mob of elderly Chicago constituents. He fled, and they literally chased him down the street.
Will these new ads have that kind of backlash?
One, I hope you're not suggesting that it wasn't a good idea just because seniors were bamboozled into opposing it and two, you left out any description of the ads, i.e. industry's lying scaremongering, that gave us that era's version of town hall slobbering anger.
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25
I opted for the medicare advantage program for my first year of elegibility. I will not be signing up the 2nd year.
Unlike tricia65 standard Medicare will be less expensive for me. My payments for special services (such as Physical therapy and mental health services) will be at least half of what I am now paying and I won't pay the addtional monthly fee to be enrolled.
In addition, now I see that the advantage program is away for insurance companies to make money off of people like me on a fixed income. This is my small attempt to make a statement.
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