Fwd: The Fine Print

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Asclepios

Your Weekly Medicare Consumer Advocacy Update

The Fine Print

April 26, 2007 • Volume 7, Issue 17

When people with Medicare choose to enroll in private health plans, they

do so in response to the plans’ promise of lower costs than Original

Medicare, the promise of comprehensive health care and the promise of

secure and reliable coverage. But, as the Medicare Rights Center (MRC)

has seen, for too many older adults and people with disabilities private

Medicare Advantage plans represent broken promises rather than better

health coverage.

People with Medicare have the option of signing up for privately run

health plans, such as HMOs, for their health coverage instead of Original

Medicare. Medicare Advantage plans have proven to be quite profitable for

insurance companies, which receive billions of dollars in subsidies from

the government. On average, Medicare Advantage plans cost taxpayers 12

percent more than the cost of care for an individual in Original

Medicare.

Aiming to hang on to these earnings, the insurance industry and its

supporters insist that Medicare Advantage plans are better for people

with Medicare because they provide more affordable and more generous

benefits than Original Medicare.

However, a new report documenting MRC’s work assisting individuals

enrolled in Medicare Advantage plans paints a very different

picture.

The problems encountered by people seeking help from MRC caseworkers, as

well as from counselors and advocates around the country, show that

Medicare private health plans frequently promise more than they actually

deliver. Instead of lower out-of-pocket costs for standard Medicare

benefits, many plans require additional copayments not found in Original

Medicare. Plan members find themselves facing numerous and confusing

prior authorization requirements before they can get the health care they

need; without getting approval, plans can deny coverage of

treatment.

Plan members also face network restrictions on the doctors and other

providers they can see, while before, under Original Medicare, they had

access to almost any doctor and health care facility. Further, the

promised “extra benefits,” which plans cite as justification for the

government’s overpayments, often turn out to be limited in what members

actually receive.

By the time people enrolled in private plans discover these unexpected

barriers, it is often too late: they are “locked in” to the plan for the

rest of the year.

Unlike Original Medicare, private health plans have failed to deliver the

stability and reliability they promised and have misled people with

Medicare about the advantages of signing up. Yet they continue to pocket

generous payments from the government. Lavishing insurance companies with

extra taxpayer dollars for unreliable products is not the right way to

improve health coverage for people with Medicare.

Tell

us about your experience with Medicare private health plans.

Medical Record

“Plan members may find they cannot go to the specialist or hospital

recommended by their doctor, the nursing home they stayed at last time

they needed skilled nursing facility care, or other providers of their

choice. Problems arise when the provider is not in the plan’s network,

has dropped out of the network or is dropped from the network by the

plan. To add to the problem, while health care providers can drop out of

a plan’s network at any time, members are usually locked in to the plan

for a year”

(“

Too Good to Be True: The Fine Print in Medicare Private Health Plan

Benefits,” Medicare Rights Center, April 2007).

“My husband and I had to enroll in a Medicare Advantage plan when our

retiree insurance plan made us switch. We each have to meet a $250

deductible before we can get coverage. We are one of the better off

families. Yet between prescriptions and insurance premium costs, we can’t

afford medical care. Right now I can’t afford to get a colonoscopy my

doctor has recommended because my husband’s doctor has recommended an

echocardiogram for him; we haven’t met our deductibles and we simply

don’t have the money for both” (Story submitted to the

Medicare Private Health Plan Monitoring Project, Medicare Rights

Center, April 18, 2007).

“Facing pressure both from the health insurance industry and from

beneficiaries accustomed to receiving extra benefits, congressional

leaders devised the Medicare Modernization Act to make things only worse.

They began by throwing money at the private insurers. So instead of

saving 5 percent by contracting out, taxpayers are now paying 12 percent

more per beneficiary to the private plans. That means the government is

paying private insurers almost $1,000 more per enrollee than it would

cost to keep the beneficiary in the traditional plan”

(“

Doctoring Health Care, II,” American Prospect, January 7,

2007).

* * * *

Medicare Part D Appeals Help for Advocates is here!

MRC’s new “Medicare Part D Appeals: An advocate’s manual to navigating

the Medicare private drug plan appeals process” offers an

easy-to-understand, comprehensive overview of the entire appeals process,

including real-life case examples, a glossary of important appeals terms,

a sample protocol for advocates, and links to important resources.

Register for a

FREE

copy of this great resource.

* * * *

Medicare Private Health Plan Monitoring Project

The Medicare Rights Center (MRC) would like to hear about your

experience, or that of someone you know, enrolled in a private health

plan. With information about what the issues are with Medicare Advantage

plans, we will be able to demand that those problems be fixed.

Submit your story at

http://www.medicarerights.org/maplanstories.html.

* * * *

The Louder Our Voice, the Stronger Our Message

Asclepios ­named for the Greek and Roman god of medicine who, acclaimed

for his healing abilities, was at one point the most worshipped god in

Greece­is a weekly e-newsletter designed to keep you up-to-date with

Medicare program and policy issues, and advance advocacy strategies to

address them. Please help build awareness of key Medicare consumer issues

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subscribe today.

* * * *

The Medicare Rights Center (MRC) is the largest independent source

of Medicare information and assistance in the United States. Founded in

1989, MRC helps older adults and people with disabilities get good,

affordable health care.

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