Baltimore Sun Editorial: Medicare Waste

Baltimore Sun:


Private health insurance plans that serve nearly a fourth of all Medicare beneficiaries, including more than 40,000 in Maryland, were set up under the assumption that the private companies could provide the same services as Medicare at a lower cost. Instead, many have significantly increased costs without improving care, a new analysis of the Medicare Advantage program shows.It's time for the multibillion-dollar waste to end. Congress should act early next year to reduce these payments to private insurance companies to the level of traditional Medicare. That could save $160 billion over the next 10 years, money that would be better spent offsetting the soaring costs of Medicare as a flood of baby boomers join the program. Enrollment in private Medicare fee-for-service plans has exploded to 2.3 million recently from just 26,000 at the end of 2003. That growth has driven up costs because the government pays the private insurers 13 percent on average more than it would spend for the same number of beneficiaries receiving traditional Medicare. In Maryland, the extra money raked in by the insurance companies added an estimated $28.7 million to the cost of Medicare last year - $16 million to private insurers and $12.7 million in increased premiums paid by seniors participating in Medicare Part B, according to the analysis by the USAction Education Fund for Progressive Maryland, a liberal advocacy group here.
In a campaign debate this fall, President-elect Barack Obama described the extra costs as a "giveaway" to private insurers. And former Sen. Tom Daschle of South Dakota, who has been picked by Mr. Obama to become secretary of health and human services, recently warned that such overpayments to insurance companies are threatening Medicare's solvency.

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Medicare rates to stay the same for 2009

According to Elder Law Answer, it was announced recently that Medicare's monthly premium will stay the same for the first time in eight years. The monthly premium will remain the same, totaling $96.40 a month.

This fee covers portions of fees related to physicians services, outpatient hospital services, and other items.

More advertising dollars going to Medicare Advantage

In a recent study done by the Kaiser Family Foundation, detailed here at the Washington Post, they found that insurers spent three times more money promoting comprehensive Medicare plans rather than stand alone drug plans. The study was conducted between October 1 and December 31, 2007, with an increased effort looking at what's going on with Medicare marketing practices. For the most part, the commercials emphasized the benefits centered around preventative care, vision and hearing benefits.

Restrictions placed on cold calls by insurance agents

Effective October 1, insurance agents will no longer be able to cold call the elderly and disabled when trying to sell prescription drug plans. According to the AP, this new law will be enforced by an increased amount of surveillance on the agents as well as reviews of media and print ads published by those.

The new restrictions include:

- No unsolicited contacts with beneficiaries, such as visiting their home or calling them. The prospective customer must initiate the contact.

- No selling of other insurance products, such as annuities or life insurance, to beneficiaries.

- No free meals at promotional or sales events.

- New requirements for training or testing of agents.

Penalties for breaking these law could result in up to $25,000 worth of fines.

Medicare Hospice Protection Act

US Representative Maurice Hinchey has introduced a new bill to Congress to block a new bill from the Bush administration. According to The Ithaca Journal, a bill going into affect October 1 will begin reducing Medicare reimbursement rates by $2.2 billion over the next five years. This could result in hospice patients loosing their hospice care across the country, as it could cost certain hospices $50,000 next year across the country, and as much as $150,000 over the next three years. Hinchey is encouraging Congress to swift action due to the tight time frame they’re working with.

Welcome to Doughnut Hole Season

In a recent article at the Dallas Morning News, they discuss the current stress one in five seniors is now facing until the end of the calendar year. Doughnut Hole Season is the time of year when low co-payments reach their gap in the drug coverage provided by Medicare, and, as a result, they are faced with staggeringly high payments for their medication. In 2007, 3.4 million seniors faced this situation.

Through the current program, seniors are responsible for full costs once all of Medicare’s payments (co-pays and deductibles) have reached $2150. They do not pick up payments again until citizens spending exceed $5726. However, only one in five will reach this amount.

Humana looses some Medicare Enrollees

As a result of premium bids that are higher than low income, government assigned members of Medicare, Humana expects to loose 10% of them at the beginning of 2009. However, according to the Wall Street Journal, they believe this could be positive for Humana due to the fact that higher prices would increase the bottom line, shares dropped 5% to $41.75 when it was announced that this could lead to a los of 380,000 eligible Medicare members. To ensure drug coverage for these dropped Medicare enrollees, the government will automatically re-enroll them in private drug care provider programs.

CDC and Columbia find no link between autism and MMR vaccine

According to this post at the Wall Street Journal Health Blog, the Center for Disease Control and Prevention and Columbia University did a study that found that there is no connection between the Measles, Mumps and Rebella vaccine and autism.

The two researchers conducted a study based on:

The measles virus from the vaccine could reproduce in the intestinal tract, leading to inflammation and bowel permeability. That leaky bowel could permit the release of chemicals that would make their way to the nervous system, causing trouble.

When conducting the research, they looked at children with gastrointestinal problems who had autism and children with gastrointestinal problems with no autism. Studies showed there was no difference between the two sets of children.