Sunday, February 24, 2008

Medicare - Medicare Advantage Plans - Whose "Advantage"?

Would someone out there please help me? Politicians are saying words matter. I am trying to understand to whose “advantage” Medicare Advantage Plans incur – Medicare recipients, politicians, health plans, doctors, or Medicare itself?

As things now stand, only one of five Medicare seniors has signed on to Medicare Advantage Plans, and many find the new plans, introduced on January 1, 2006, as confusing, limiting, and underpaying.

From the national marketing HMO marketing push and the furor in Congress, it would appear politicians and HMOs embrace Advantage Plans. For politicians there’s lots of lobbying money to be had, and for HMOs there’s $54 billion more than with traditional fee-for-service Medicare. What’s not to like? Furthermore, sales agents receive $200 to $500 for each Medicare Advantage patient they sign up, and private plans receive 11 percent more than with FFS Medicare.

Doctors view Medicare Advantage Plans differently. They see them as a Medicare zero sum game. The $54 billion that goes to the Advantage Plans comes up of their pockets in the form of 10% Medicare fee cuts this year and 15% next year. If these cuts go through, AMA online surveys indicate 60% of doctors will limit the number of Medicare patients they see. Finally, in another AMA survey of 2022 doctors, 50% of doctors said Advantage plans denied services typically covered by Medicare, and 50% also their payments were less than traditional Medicare.

To whose “advantage” are Medicare Advantage Plans,? Regardless if you define advantage as superior position, factors favoring some, and as being taken advantage of, the health plans seem to be in the advantageous driver’s seat.

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