So
often we hear opponents of the Single Payer Federal Medicare program
say: “Don’t Let the Federal Government Stand between You and Your
Doctor.” Or, “get government
out of the way and let the private sector handle Medicare.”
But,
in 2003, when Congress created Medicare Advantage it took away the
oversight power from state regulators, and their legal authority to
impose sanctions on Medicare
Advantage carriers when abuses occur.
This
lack of state supervision has allowed insurance companies to expand
their role as gatekeepers between the patient and their doctors
including overbilling of providers.
The Center for Public Integrity investigation published in June of
2014, “found as much as $70 billion of improper payments to Medicare
advantage plans from 2008 through last year.”
Congress
granted the oversight authority of Medicare Advantage plans to the
understaffed and underfunded government run Centers for Medicare and
Medicaid Services organization
(CMS), but the agency cannot keep up with the demand for audits.
In
March of 2014, CMS officials said they were “constrained in the number
of program audits we can conduct each year due to limited resources.”
According to the Center
for Public Integrity’s August 2014 report, “The agency is only able to
audit about 30 Medicare Advantage companies a year, about one in ten of
the 300 operating.”
Recently,
we received a call from a Medicare Advantage beneficiary in Kansas City
telling us her doctor would not accept her Advantage plan. Then she
scheduled an appointment
at the Cleveland clinic, and her Medicare Advantage carrier said they
won’t pay because the clinic is an out of network facility.
Traditional
Medicare (the government kind) will pay anywhere in the United States
wherever a medical provider accepts Traditional Medicare.
More
benefit payment problems with private Advantage plans are now occurring
around the country because lack of state regulation.
The
Center for Public Integrity reported in an August 19, 2014 article,
“When Minnesota retiree Doug Morphew needed surgery last year, he
expected his Humana Medicare
Advantage plan to step up and pay the lion’s share of the bill.”
Morphew
said, “The health plan had told him over the phone he would owe just
$450 for the two days he spent in a St. Paul hospital recovering from
the operation to repair
an aortic aneurysm.”
“Less
than a month later, Humana hit him with a bill for $6,461.66 claiming
the surgery was not covered because the hospital was “out of network,”
the article stated.
In
an interview with the Center for Public Integrity, Morphew said,
“Humana paid the bill, but only after several months of fighting with
them after he filed an affidavit
with the Minnesota Attorney General’s office last year.”
“It was a nightmare,” Morphew said.
This
is just one example of why, our Kansans to Preserve Medicare group
opposes The Health Care Compact bill passed by the Kansas legislature in
April of 2014, to grant
private insurance companies the authority to take away the management
of Medicare from the Federal government for the 450,000 Medicare
beneficiaries living in Kansas.
Any
politician advocating this non-sense of removing Kansas from the
Federal Medicare program must be challenged. Every Medicare beneficiary
should stand up and be counted
to protect their guaranteed Medicare benefits already in place.
Even
though we have very few of our 500 coach members on Medicare Advantage
plans, we will no longer recommend these plans for any of our new
members because insurance
companies along with some members of Congress advocating these
Advantage plans, have now turned the private side of Medicare into a
Medicare Advantage insurance market.
It
is a product sale that provides a substantial source of income for the
carriers. Membership is growing in these plans because of generous tax
payer subsidies provided
to the insurance carriers which allow them to attract new members with
additional benefits not provided to those enrolled in Traditional
Medicare plans.
Some
members of Congress who want to privatize Medicare are looking the
other way, and allowing lobby pressure to cloud their judgment, but fill
their campaign coffers
with lobby contributions, as they continue to offer generous tax payer
subsidies to Medicare Advantage providers without addressing the
fairness issue for Traditional Medicare members who do not receive these
extra overpayments and extra benefit perks.
Buyers
beware as you watch the “Too Good to be true” Medicare Advantage
commercials on T.V. coming soon. Medicare Advantage plans do have
maximum out of pocket risks
of up to $6700.
If
you want to lower your premiums, you can get a Medicare Supplement high
deductible insurance plan for $35 per month under Traditional Medicare
with a maximum out of
pocket risk of $2140, and avoid the “out of network” provision, and go
to any doctor of your choice in America who accepts Medicare.
Larry Weigel
The MEDICARE Coach™
1011 Poyntz Ave
Manhattan, KS 66502
To receive blog update alerts, send your email address to
larryw@keatinginc.com
We have partnered with the Kansans to Preserve Medicare group and now
their list has grown to more than 550 members. Very few Medicare
members are aware of the Health Care Compact Bill and
need to know, so please forward these email updates to your Medicare
friends and encourage them to get involved. Or, go to our website
www.mymedicarecoach.com
to read past posts about Medicare issues affecting Kansans and Medicare
beneficiaries living in the other eight states who are part of the
compact group. (Utah, Texas, Oklahoma, Missouri,
Indiana, Alabama, South Carolina and Georgia.)
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