Some question private Medicare plans' advantage

http://finance.yahoo.com/news/Some-question-private-apf-1720689342.html?x=0&sec=topStories&pos=4&asset=&ccode=

Some question private Medicare plans' advantage

Seniors, advocates say private Medicare plans put profits above care; Washington mulls changes

* By Matt Sedensky, Associated Press Writer
* On Sunday August 30, 2009, 12:00 am EDT



MIAMI (AP) -- Cecile Sangiamo liked her health insurance -- until she needed to use it.

The 72-year-old Clearwater, Fla., resident had been on the federally subsidized, privately run Medicare Advantage policy through WellCare Inc. for about three years when she started having pain that made it hard to walk.

Her doctor's referral to an orthopedic specialist was denied by the insurer. Her out-of-pocket costs were higher than she was initially told. And when Sangiamo needed surgery, she said, WellCare offered some unexpected medical advice.

"Take pills and use a walker," Sangiamo remembered being told by the insurer, which declined to comment on the case. "I wanted to say, 'I'll take the walker and bang you in the head with it.'"

--snip--

no government bureaucrat every wrote her and told her no.

It is only with the help of a feckless, corporate media they are able to repeat this lie over and over with impunity.

that usually tote the RW propaganda line.

WellCare Health Plans, Inc.

http://www.wellcare.com/

May 5, 2009 ... WellCare Health Plans, Inc. announced May 18, 2009 that it has resolved an informal investigation by the U.S. Securities and Exchange ...

NEW YORK (Reuters) - WellCare Health Plans Inc (WCG.N) said on Monday it will pay a civil penalty of $10 million to resolve a U.S. Securities and Exchange Commission probe into the company's financial filings.

According to the SEC, WellCare materially overstated its publicly reported net income, stemming from a scheme to withhold money from Florida healthcare programs.

WellCare earlier this month agreed to pay $80 million to settle healthcare fraud allegations in a case that had left a cloud over the company since agents raided its Florida offices in 2007.

WellCare did not admit or deny the SEC allegations.

http://www.reuters.com/article/ousiv/idUSTRE54H5GU2009051

As much as medicare is flawed, it is nothing compared to this.

of...that and trust the private market...well look at all the good they did...hey look a bureaucrat taking the decision away from the doctor.

That part of medicare should be reformed; it would be helpful to make Medicare easier to understand too. That said, it's a sound system that just needs some improvement and expansion to all Americans.

enrolled in some Medicare Advantage Plan and are quite satisfied.

Move across the country and you find more satisfied than not.

You will find anecdotal cases in plans where people are ticked.

The Problem the Dems face with Medicare Advantage.
Even if Seniors did not like the idea, now they are in the plan
and understand how it works, --many like it. The Message
they now have is. We are going to stop funding it. You
will have to Pay More. At the present, in Most cases Medicare
Advantage is considerably less expensive than Medicare.

The Senate has not explained to Millions on Medicare Advantage
why it is a good thing to pay more and get the same or pay more
and get less.

Here is an even bigger problem. Doctors do not take you if
your primary Ins. is Medicare. Government does not pay Medicare
Doctors adequately. Some Seniors have Medicare Advantage
because it is Private Insurance and therefore Doctors accept
them as patients.

Kaiser's Senior Advantage......? A lot of my friends say they love it, but when ever I've gone to Kaiser, I have not been happy. Now I have a private chiropracter who takes Medicare, if I went to Kaiser, I could not see her.

13% over the cost of traditional Medicare. Furthermore, the GAO found that these plans actually cost many seniors MORE out-of-pocket expenses than traditional Medicare. Who is most likely to get hit with out-of-pocket expenses? People who are sick and actually NEED good coverage.

At a time when we constantly hear that Medicare is going broke, how can we justify subsidizing the PROFITS of these private insurance companies only to have them turn around and hit financially vulnerable seniors when they get sick?


http://health.usnews.com/blogs/on-health-and-money/2008/03/06/the-gao-finds-fault-with-medicare-advantage.html


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.

I had a so called "supplement" plan for years, then dropped it because it was too expensive to pay for myself, previously had been covered by employer. I sat down the other day and compared my out of pocket costs for my Dr office visits and a few other small things I had used my insurance for and I find that I paid out almost twice as much for similar treatment with the extra "supplement" insurance than without it.. plus paying 170 a month for the insurance. Medicare by itself works just fine.

hospital bills and the private Medicare insurance is there to pick up the slack.

I am on medicare but it is my secondary insurer. My mil law pays 185 per month for the AARP supplemental insurance.

I may be switching to Medicare as my primary soon.

I need to look into this.

I am not absolutely sure about other ones but that was how mine worked... it looks to me as if while I am using straight medicare without a supplement the DR and hospitals can only charge whatever medicare says they can charge while with a supplement they can and from what I see they do charge more for things if you have the supplement than if you don't have it... in fact it is really hard to figure some of these bills out ... I went in for some respiratory tests about 6 months ago and am just now getting some of the bills, they come in from different places and it is hard to remember which ones I have already received and paid and which ones are new (as in first I have received them even though they are 6 months old) so it takes a little digging to figure it out. But in a straight medicare deal they are supposed to be able to only charge what medicare allows and then medicare gives them 80% in fact medicare has set amounts they pay for set procedures, that is what the will pay no matter what the hospital or dr charges as in medicare pays $80.00 so you would think hosp. was $100.00 but not always true...