MediGap Plans & Medicare Advantage Plans

[Guest guest]

Other TFCs may have received the email from Medicare Rights Center but in case

not, I am sending along this part of that email which is pertinent to past

discussions about MediGap plans and Medicare Advantage Plans:

There are fundamental

differences between the MediGap market and the market for private Medicare “Advantage” plans

that undermine the commission structure developed by the Centers for Medicare

and Medicaid Services.

·

An agent selling a MediGap plan knows the benefit

package will be just as good two or six or ten years from today, because the

benefits are standardized and mandated by law. Premiums can go up, but even

these are subject to state regulation.

·

Not so with Medicare

Advantage plans. Every year the benefits can change. Premiums can go up, but so

can copays for hospital stays. The annual cap on out-of-pocket spending can

double, or even disappear. The incentives for the plan are to shift costs onto

the sick and keep premiums low enough to attract new healthy members. What

seemed at the outset like a suitable plan for someone living with multiple

chronic conditions can devolve over time into a benefit package riddled with

holes.

There are other problems with

the rules established by CMS. Insurance companies can still provide higher

commissions to push low-value plans over plans that offer greater financial

protection for the enrollee (and greater financial risk for the company). After

all, it takes more work to cajole or trick someone into a lousy deal.

The solution to these problems

lies in establishing a minimum standard for the financial protection provided

to enrollees in Medicare Advantage plans, standardizing the benefit packages to

make facilitate comparison and providing some guarantee of year-to-year

continuity in coverage.

The current

situation—where only the fine print of benefit packages can reveal the

traps that are set for cancer patients and others with high-cost

illness—is unacceptable, both to people with Medicare and to the honest

brokers trying to find the best plans for their clients. CMS took a step today

toward choking off the cash flow to predatory agents. It should take the next

step and weed out unscrupulous plans.

Asclepios

Your Weekly Medicare

Consumer Advocacy Update

New Rules for Medicare

Private Health Plans

September 18, 2008 • Volume 8, Issue 38

Daryl Battin, LICSW

Financial Coordinator/Social Worker

Lahey Clinic Kidney Transplant

41

Mall Road, Burlington,

MA 01805

Ph: /FAX:

Page:

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