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News of the Day ... In Perspective


Abuses found as “private plans” chase Medicare beneficiaries

As enrollment in Medicare Advantage plans has burgeoned, federal and state officials are concerned about “abusive” hard-sell tactics (Robert Pear, NY Times 5/7/07). As one agent told seniors at a promotional meeting in Tucson, Ariz., the plan makes “a ton of money” from Medicare.

Although managed care is supposed to save money, the federal government pays the plans an average of 112 percent of what the traditional plan spends per beneficiary. Equalizing payments between fee for service and managed care would save Medicare $65 billion over 5 years, according to the Medicare Payment Advisory Commission (AM News 5/14/07).

Insurers tout the extra benefits on which seniors are claimed to rely: “coordinated care” and discounts on eyeglasses, hearing aids, and dental care. But federal agents say that the fastest growing type of Medicare Advantage plan does not coordinate care, does not save money for beneficiaries, and has been at the center of marketing abuses, Pear writes.

One woman complained that she did not sign up but the agent forged her signature.

Cancer patients who signed up in Albuquerque found that they suddenly had copayments of $1,250 every 3 weeks for their chemotherapy.

Patients with plans promising access to “any doctor or hospital”—that will agree to provide care on terms set by the plan—may find that they have less access to care as doctors decline to see them.

The Any Any Any plan offered by Universal Health Care Insurance Co. in Florida and seven other states got off to a fast start, enrolling 85,000 people. Enrollments had to be temporarily postponed as of Feb 14 because the Florida insurance commissioner said it did not have enough reserves to comply with Florida law. The commissioner recommended liquidating the company. (Kris Hundley, St. Petersburg Times 3/23/07 and 3/24/07).

Up to 25,000 beneficiaries, one-third of the total, had bailed out of the Any, Any, Any during March (Carol Gentry, Tampa Times 4/12/07).

Robert O’Malley, a spokesman for Universal, said, “Our plan was much more popular than we expected,” Pear reports.

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