Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. His Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, appears here at Time Goes By twice each month.
If you are of a certain age and participate in Medicare, you should have received your copy of Medicare And You 2010. And if you are like me, you’ve put it aside without reading it. My wife says that’s “a man thing,” not reading the instructions for the new gadget or stopping to ask for directions.
Well, this year it would be a mistake not to look at the manual a bit more closely than usual. For things are changing – for the better, I think – and there are signs of that change in the free 127-page booklet. (If you haven’t received it, call 1-800-MEDICARE or download it here [pdf].
On page 11 in my edition is something new and unusual for a manual devoted to Medicare and us older types: the gift of health insurance from the Democratic Congress and Obama administration to our children and grandchildren. That’s explained briefly on page 84, in which we’re told that if we know of children under 18 who are uninsured in families (of four) earning less than $44,500, they are eligible for free or low-cost medical and dental care, prescription drugs and more.
This expanded ($30 billion) Children’s Health Insurance Program (CHIP), to serve four million more youngsters, became law last February just after Obama’s inauguration. President Bush had vetoed the bill in 2008 because, he said, it would put us on the road to socialized medicine.
If you or your grandchildren aren’t afraid of that road and need more information, they can call 1-877-KIDS-NOW (1-877-543-7669).
There’s also new or better coverage for outpatient mental health and preventive services such as smoking cessation counseling and an EKG as part of a “Welcome to Medicare” physical exams for newcomers to the program. (You will have to pay the 20 percent co-insurance.) And each of the health insurance reform proposals include more benefits for Medicare, partly paid for by ending insurance industry subsidies for private coverage.
Thus, on the eve of the annual open season (November 15 through December 31), when you can choose, change or renew your current Medicare-based insurance, I’m here to make a pitch to newcomers or those of you with private Medicare Advantage plans to strongly consider returning to or staying with original Medicare Part B, which covers most outpatient services.
Among the reasons: Private coverage premiums are rising by 12 percent, more doctors and hospitals are quitting some insurers because they pay too slowly, second-guess medical decisions, argue about coverage or limit coverage choices to providers and hospitals in the insurer’s network. The Centers for Medicare and Medicaid Services report that companies covering seven percent of Medicare Advantage beneficiaries are getting out of the business (each contract lasts only a year). You’re supposed to be notified of this.
In addition, I’ve learned not to trust these plans when they are really needed. I’ve had to threaten to publicize an insurer’s refusal to cover a surgery because it was to be done by a surgeon out of the network who happened to be the best person for the procedure that had been recommended by a referring neurologist. Private insurers may use the least expensive surgeons, not necessarily the best.
But the most essential reason for sticking with traditional Medicare is simple and not abstract: Let’s strengthen one of the two most important American social insurance programs while we have a friendly administration. The primary reasons Medicare is facing financial troubles may be traced to efforts by hostile lawmakers and the so-called Medicare Modernization Act of 2003, that gave us the private Part D drug program and its doughnut hole.
The Act also raised Part B premiums for more affluent beneficiaries, which imposed the first ever means test and undermined the principle of universality, and it set limits on the growth of the Part B budget (which Democrats have stopped).
But most destructive of all are the billions spent from Medicare to provide private Medicare Advantage coverage to one-fifth (10 million) of Medicare’s 46 million subscribers. It was the hope and purpose of the insurance companies and their congressional allies that they could raise that number to at least half. That’s why Obama and the committees working on health reforms would, over time, end the nearly $30 billion a year subsidy paid to insurance companies and reverse the trend towards privatization.
One of my favorite groups, the Center for Medicare Advocacy, explained in a recent newsletter:
“The fact is that a large proportion of Medicare spending goes directly to private insurance plans under the completely private portions of Medicare – the Medicare Advantage and Medicare Prescription Drug programs...Thirty-four percent of Medicare payments are made to private insurance companies for the private portions of Medicare.
“Moreover, 77 percent of the costs of the private Medicare Prescription Drug program are paid out of general government revenues...The first year after private Medicare Advantage was introduced with subsidies way over [14 percent] and above the actual cost to traditional Medicare to treat a Medicare beneficiary, the solvency projection of Medicare dropped by eight years...
“Meanwhile, private health insurance companies’ profits, paid in large part by taxpayers, are increasing astronomically.”
Here is a short video from the National Committee to Preserve Social Security and Medicare about the wasteful Medicare Advantage subsidies to private insurers"
As you might expect, the insurance companies and Republicans, showing sudden concern about the future of Medicare, are fighting Democratic efforts to end the subsidies for Medicare Advantage. To its credit, even AARP, which earns $500 million in royalties for selling these plans, has joined in efforts to force the private companies to compete on a “level playing field” with Medicare and a public option, if there is one, in the health reforms.
(My hope is that AARP would also help end the private Part D drug program it gave us and place it under Medicare).
Unfortunately, many of those 10 million Medicare beneficiaries in Medicare Advantage plans will be reluctant to give them up, although they may have no choice if the subsidies are cut. What’s the alternative? Here’s where this open season and the Medicare manual may help.
Medicare Advantage plans, which include drug coverage, are convenient because only one policy is needed. But, as I said, they require you use providers in their network, you need referrals, they tend to desert you if you have catastrophic health problems and those co-payments each time you visit a provider can mount up.
Take a look, then, at the section on the eight or ten Medigap plans. They are uniform throughout the country and range from the most basic, which pays the 20 percent co-insurance for Part B plus the deductibles, to more expensive that cover much more.
A Medigap plan, which would provide coverage for any participating doctor, lab or hospital anywhere in the country, plus an inexpensive Part D drugs-only plan, may not cost you much more than a Medicare Advantage plan. But it would be safer for you – and for Medicare.
Need help? Write me at saulfriedmanATcomcastDOTnet