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Beach Reading
August 2, 2007 Volume 7, Issue 30
Your Weekly Medicare Consumer Advocacy Update
When senators break for their August vacations tomorrow, they should ...
Volume 7, Issue 30
Your Weekly Medicare Consumer Advocacy Update
When senators break for their August vacations tomorrow, they should bring along copies of the Children's Health and Medicare Protection (CHAMP) Act, legislation passed just yesterday by their colleagues in the House. There are many great provisions in it, not only for the five million children who will get health insurance under the bill, but also for people with Medicare. This landmark legislation:
Eliminates the doughnut hole in Part D drug coverage for millions of older adults and people with disabilities living on less than $1,276 per month.
The bill substantially raises the amount of financial assets a person can have and still qualify for Extra Help under the Part D drug benefit. (Individuals can have up to $17,000 in savings, couples can have up to $34,000 and life insurance and 401k plans will not count.)
Low-income people with Medicare will no longer be penalized for having spent a lifetime working to have very modest savings for their retirement. Pays the Part B premiums, which are expected to exceed $100 per month next year, for these low-income people with Medicare.
The CHAMP Act ensures that everyone eligible for Extra Help is also eligible for the Medicare Savings Programs, which pays the Part B premium.
Makes Medicare coverage of mental health services, like counseling, more affordable. The bill ends discriminatory treatment of mental illness under Medicare by providing parity in coverage with physical ailments. Medicare will pay 80 percent of the cost of mental health services, the same rate that applies for doctor's visits. Ensures access to doctors under Medicare.
The bill averts a scheduled 10 percent cut in Medicare payments to doctors in 2008 and another 5 percent cut slated for 2009. The cuts threatened to force doctors to stop treating people with Medicare.
Worried about the cost of these improvements?
The bill shores up Medicare's financing by phasing out overpayments to private Medicare plans, which cost taxpayers on average 12 percent more than providing care through Original Medicare. Insurance companies, who have reaped record profits from their Medicare subsidies, tried unsuccessfully to derail the House bill by threatening to slash benefits if their overpayments were eliminated. The House bill takes steps to avert that prospect by ensuring that all plans spend a minimum of 85 percent of the money they receive from Medicare and plan enrollees on medical care. The CHAMP Act also includes provisions designed to end the deception and fraud that has characterized the marketing of private Medicare plans.
Tonight, the Senate is expected to pass its bill to expand health insurance for low-income children. Unfortunately, the Senate legislation includes none of these much-needed improvements to Medicare. When they come back from recess in September, the Senate and the House will have to reconcile these two bills and vote on a common piece of legislation. In the meantime, senators should take a close look at the CHAMP Act; it's a good read and an even better deal for people with Medicare.
Medical Record
"The CHAMP Act also protects Medicare from privatization and promotes fiscal responsibility by reducing overpayments to private plans. Existing overpayments to private plans cost taxpayers tens of billions of dollars. According to non-partisan analysts, private plans are paid, on average, 12% more than traditional Medicare--and overpayments to certain plans exceed 50%. These overpayments are the result of a decade-long campaign by President Bush and Republicans in Congress to privatize Medicare by undermining traditional Medicare and promoting private insurance. Republicans believe that the greater the number of beneficiaries enrolled in private plans, the easier it will be to privatize Medicare. Full-fledged privatization would eliminate Medicare's guaranteed benefit and force beneficiaries to fend for themselves. The result will be higher costs, fewer benefits, and less health care for seniors and people with disabilities" ("Current Legislation--Children's Health and Medicare," House Speaker Nancy Pelosi's web site, August 2, 2007).
"Humana Inc., the second-largest provider of Medicare Advantage health plans, said earnings more than doubled as the company increased enrollment in the sponsored coverage by 18 percent and profit margins swelled" ("Humana Second-Quarter Profit More Than Doubles," Bloomberg.com, July 30, 2007).
"I was being scheduled for bladder surgery so I asked the representative if there would be continuity of service and could I continue follow-up with my own urologist. He said yes. After I had bladder surgery and was sent home with an in-dwelling catheter, the plan would not allow the nurses caring for me to continue because their company was not on the plan. When I requested a nurse from their company plan to visit, I was advised she would come out as soon as possible. Thank God, my husband was a retired army nurse, [and] he did my cleansing and catheter cares. I had to return to my surgeon to have my suprapubic catheter removed because no nurse was visiting my home. Three weeks after my catheter removal, the nurse showed up for her first visit" (Story submitted to the Medicare Private Health Plan Monitoring Project, Medicare Rights Center, 07/03/2007).
Looks like things are as they should be. The MA plans are taking and will continue to take a hit. With 3 million being taken off the MA plans by 2012, that pretty well spells the future. Supps are the best if they can afford them. MA's only as a last resort.
Great article..thanks for the information PD
If or when the government makes adjustments and does not "over pay" for MA plans, then they will just adjust their premiums to what they were prior to the MMA (Medicare Modernization Act). Prior to that, a HMO in KC was anywhere from $30-$50 per month, when now they are $19 and $0.
MA's in HMO / PPO markets will not go anywhere. They have been in KC for about 16 years (since 1991). However, I am interested to see what will happen in the rural PFFS markets.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
If or when the government makes adjustments and does not "over pay" for MA plans, then they will just adjust their premiums to what they were prior to the MMA (Medicare Modernization Act). Prior to that, a HMO in KC was anywhere from $30-$50 per month, when now they are $19 and $0.
MA's in HMO / PPO markets will not go anywhere. They have been in KC for about 16 years (since 1991). However, I am interested to see what will happen in the rural PFFS markets.
[COLOR=blue]Midwest, I am curious, why do you feel or think that MAs PPO and HMO Programs are not affected by what's happening on the PFFS side?[/COLOR]
[COLOR=#0000ff]Could you please ellaborate and also provide anything in writing? Btw, you say they've been around for 16 years in KC? What about the other states they're slotted in, if you happen to know, if applicable? Tx.[/COLOR]
HMO and PPO plans were here long before the PFFS plans. Since they have been around for so long prior to overfunding, I do not see them going anywhere. HMO and PPO plans also have not been halted like PFFS plans.
I do not know what other states they are slotted to be in. I heard somewhere that to make a HMO work you would need at least a population of 800,000. Most of your major metros have a HMO or PPO in place.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
HMO and PPO plans were here long before the PFFS plans. Since they have been around for so long prior to overfunding, I do not see them going anywhere. HMO and PPO plans also have not been halted like PFFS plans.
I do not know what other states they are slotted to be in. I heard somewhere that to make a HMO work you would need at least a population of 800,000. Most of your major metros have a HMO or PPO in place.
Good stuff. Tx. for the reply. Okay so one last question. In your opinion, with all that is going on right now with Medicare Advantage Plans and what Congress is trying to do, HMO and PPO plans will also be affected as well, correct? I ask this b/c they are a type of MA plans. That's why I pose this question.
Good stuff. Tx. for the reply. Okay so one last question. In your opinion, with all that is going on right now with Medicare Advantage Plans and what Congress is trying to do, HMO and PPO plans will also be affected as well, correct? I ask this b/c they are a type of MA plans. That's why I pose this question.
It seems to me that he is saying that the HMO and PPo's in his city have been around way before the overfunding. So, I am guessing that his opinion would be that there will not be an affect on those plans except they will go back to thier original premium.
Gosh I hope I'm right. I have been studying this thread for a while.
Senior, I want to lean that way too but HMO and PPO programs are a type of Medicare Advantage Program so that's why I am wondering and if this is not the case, then what!??!! Is it so that these programs are pulling funds from an entire different bucket with no holes?
If all this happens and the overfunding ends, then I can assume that premiums for all the plans will increase. However, I do not think that they will be out of reach for most.
Also, if this does all go through, it would not have an effect since most of the 2008 plans are inplace.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
Here's what I'm banking on. AARP said they would intro a 2-yr MA plan, remember? Rollout should be soon...prob Sept-Oct. So AARP is very attuned to what is in place NOW for the next 2 yrs...thru 2009. Even if Congress trims budget, just the X-tra features would be dropped like $100 allowance for glasses, dental and gym. And zero-premium will continue for this coming year...2008
Hey Midwest, tx. I agree about 2008. I was curious about the next say oh... maybe 5 plus years ahead is all. I know that's a far stretch to guesstimate but I thought I'd bounce that off you.
Doc, AARP is trying to def. plan on more than one year out. They are a 'moving' forward 'planning' company. One thing is for sure... it's going to get more 'doggy dog' out there.
"The CHAMP Act also protects Medicare from privatization and promotes fiscal responsibility by reducing overpayments to private plans. Existing overpayments to private plans cost taxpayers tens of billions of dollars. According to non-partisan analysts, private plans are paid, on average, 12% more than traditional Medicare--and overpayments to certain plans exceed 50%. These overpayments are the result of a decade-long campaign by President Bush and Republicans in Congress to privatize Medicare by undermining traditional Medicare and promoting private insurance. Republicans believe that the greater the number of beneficiaries enrolled in private plans, the easier it will be to privatize Medicare. Full-fledged privatization would eliminate Medicare's guaranteed benefit and force beneficiaries to fend for themselves. The result will be higher costs, fewer benefits, and less health care for seniors and people with disabilities" ("Current Legislation--Children's Health and Medicare," House Speaker Nancy Pelosi's web site, August 2, 2007).
LOL, yea, its all about privatization! We all know that the Government is much better handling such things then say private sector is. Yea, before the modernzation act Medicare was in fine shape, and I'm sure some believe this will save Medicare, yea sure and I have a bridge to sell ya! What a joke this is.
According to the Champ Act (HR 3162) the overfunding would be a phase-out over the next 4 years to 2011, where they will fund the plans at 100% of the FFS cost across the country.
What I gather from this, is MA plans will have a steady rise in premium over the next 4 years, but will not go away.
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"Government's view of the economy could be summed up in a few short phrases: If it moves, tax it. If it keeps moving, regulate it. And if it stops moving, subsidize it." Ronald Reagan
The Champ Act
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