The GAO Finds Fault With Medicare Advantage
A new report finds that there may not be much advantage after all in Medicare Advantage plans over traditional Medicare, at least for certain seniors. The managed-care plans offered by private insurers are touted for offering extra benefits—vision, hearing, and dental coverage, for example—despite having lower premiums and out-of-pocket costs. What's not to like? Some 9 million seniors, about a fifth of all Medicare beneficiaries, have signed up. But last week the Government Accountability Office announced that seniors in some plans might actually pay more for certain services.
Unfortunately, the seniors likely to be hardest hit are the sick. According to the report, 19 percent of seniors in Medicare Advantage plans were projected to face higher out-of-pocket costs for home health services than under traditional Medicare in 2007, while 16 percent faced higher costs for inpatient hospitalization services. Nine percent were projected to pay more for care in a skilled nursing facility.
The report also found that 52 percent of Medicare Advantage plans didn't have an annual out-of-pocket maximum to cap beneficiaries' spending. And the out-of-pocket maximum, if it did exist, often didn't apply to many products and services, such as certain cancer and other drugs covered under traditional Medicare Part B (40 percent of beneficiaries were in plans with this exclusion), outpatient substance abuse counseling (24 percent of beneficiaries), and treatment by physician specialists (23 percent).
The program is a political football. Though it was originally envisioned as a potential way to save the Medicare program money, the government pays on average 13 percent more to care for a Medicare Advantage enrollee than it would if that person were in traditional Medicare. This report only fans the flames of critics who maintain that the government is getting little bang for its buck. "Overpayments fatten company profits, even as many seniors face higher costs in MA plans than they would in traditional Medicare," said Rep. Pete Stark (D-Calif.), chairman of the House Ways and Means Subcommittee on Health, in a press statement following the report's release.
It's unlikely that seniors, whatever sort of Medicare plan they're enrolled in, will need many of the services described by the GAO report in any given year. About 1 in 5 Medicare beneficiaries was admitted to the hospital in 2002, according to the Kaiser Family Foundation. Only 6 percent had a home health visit; even fewer—4 percent—visited a skilled nursing facility. Depending on the fine print of a plan, a Medicare Advantage plan may be a good option, say experts. But it's important to think ahead. When researching Medicare plans, people tend to focus on what their needs are at that point rather than on what the plan will cover if they have a stroke or break a hip, says Tricia Neuman, director of the Medicare Policy Project at Kaiser. That kind of thinking can be hazardous to your wallet and your health.
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The Idiot in PA
Medicare advantages are a disadvantage and costing americans a lot of money each year they can not afford! If someone took medicare A and B at 65 years old and bought and F supplement from Banker's Life at the age of 65, they wouldn't be paying $300 per month! I am now 92 and I have had Banker's since I was 65. I have had several heart operations, both hips replaced, and a knee replacement. With a Medicare advantage plan I would have paid out of pocket close to $50,000 or more over these years but instead I am still paying the same price a 65 year old getting on the policy today pays. I am pay $181.54 per month. It would take me 25 years of my premium to equal the amount I would have paid for having an advantage plan over the course of 10 years. 25 years!!!! Please tell me what the value in Medicare Advantage is again?
And by the way Tom in PA I was very healthy when I signed up for my supplement! I had no idea I would need this many surgeries by 92. Thank god one of Banker's agents talked me about the risks of a medicare advantage plan.
I have my life that is the most important thing. I really dont think I would still be here if I was on an advantage plan.
You are putting your life in danger with an advantage plan!!!!
Please
I had a family member pass awway a few years ago. Six months later we found out that she may have had an option at a special clinic in Houston Texas that has a great success rate for recovery. We were told it was not an option because the clinic was not in her provider area. My family sure would have loved to have the chance to know if they could have helped her. Had she been on traditional medicare with a supplement she would have had 100 percent coverage. Advantage plans save money and cost lives.
blah blah blah to the agent in south carolina
obviously, you are both small time insurance agents...i own a general agency in philadelphia and we provide supplements and advantage plans to seniors. depending upon the case, a supplement will be better in certain cases and advantage plans will be better in others. to generalize plans is irresponsible and misleading. there are some outstanding MA programs out there that offer all of the additional perks that supps dont offer as well as have a plan out of pocket limit at $4,0000. that is very affordable considering alot of the supp plans can be over 200/month for seniors over 70 years old, compared to 39/month for the plan i described above. the bottom line is, they need to put more restrictions on the shitty agents like you too with your limited knowledge and perspective on MA plans. furthermore, have of the senior market can not afford nor qualify for supplements because of their health. speak the truth and dont favor the program that you are selling. the way they can fix this problem is putting out of pocket maximums on plans to assure stability in annual costs. MA's are an outstanding product in densely populated urban areas like philadelphia. granted, your hick town in south carolina does not have enough people to create networks for hmos and thus they are confused...the same way most people in south carolina would be confused if you asked them what is 2+2. you have no idea about the insurance business...just your small world you live in.
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