Private HMOs Costing Medicare $5.2 Billion More than Traditional Programs

[BurtWorm]

Giving the lie again to the truism that bottom-line-based health care is an effective and efficient health care delivery system.

http://www.newsday.com/news/health/wire/sns-ap-private-medicare-plans,0,7281867.story


Study: Private Medicare Costs $5.2B More
By THERESA AGOVINO
AP Business Writer

November 30, 2006, 12:15 AM EST
NEW YORK -- Medicare beneficiaries enrolled in private, managed care plans cost the government 12.4 percent more than those in the traditional program last year, for a total cost of more than $5.2 billion, according to a study released Thursday.

Payments to what are called Medicare Advantage plans amounted to $922 per beneficiary over what a comparable enrollee would have spent in the traditional fee-for-service program, said a study by the Commonwealth Fund, a private foundation supporting independent research on health and social issues. There are 5.6 million Medicare beneficiaries enrolled in the Advantage plans.

The report concluded that the policies which create the extra payments should be re-examined because the money might be better used for other purposes. Stuart Guterman, senior program director of the Fund, said the money could be used to provider richer benefits to beneficiaries or for lowering their monthly premiums.

"The question isn't whether the private plans are good or bad. The question is: Is the best use of money?" Guterman said.

Karen Ignagni, president and CEO of America's Health Insurance Plans, said the report overstates the payment amounts and that her organization is attempting calculate its own estimate. The Fund conducted its analysis using data from the Medicare Payment Advisory Commission, an independent federal body. But Ignagni has objections to the way the commission tallies its data.

[Rosemary2205]

1. My mom switched to one of those plans

for economic reasons as soon as they were available in her state. On traditional medicare she had to also carry a $122 a month supplemental insurance plan. That's $1464 a year of additional spending. Now if the government spends an additional $922 a year to get her the same coverage she was getting previously with traditional plus supplemental then I see that as an overall $500+ a year savings.

[Gloria]

2. The test will be when she needs something that the HMO will not

allow her to get without a fight....

Traditional is still offers the most freedom in terms of healthcare decisions.....

[Rosemary2205]

3. I don't believe that can happen with medicare.

According to the information my mother was given, the Feds have mandated that no medicare HMO can deny any treatment that is covered under traditional medicare. As for delay in care because of an HMO questioning medical necessity.... I will say when she had right mastectomy it took 4 full days of the doctor's assistant to fight with the HMO. But after there was no more rangeling and the bills were paid within 30 days. When her left side was done 4 years previous it was just done and then it took 9 months of fighting with medicare to get it paid.

In Mom's area there are bookoos of doctors that are dropping traditional medicare patients but keeping HMO medicare patients because of less administrative headaches.

[jwirr]

4. My daughter is very disabled and we have had to get special

permission both in the traditional and new drug program. There are some procedures that states wanted an explanation for. Usually it did not take long. With *ss's new drug program they would not give her 100mm dilantin for epilepsy - they wanted generic. We simply adjusted her meds so that she used 30mm instead. They finally realized that we needed the 100mm and conceded.