Medicare on Main Street
For the more than 11 million Medicare beneficiaries enrolled in Medicare Advantage (MA) plans, the President’s government takeover of health care law will be particularly onerous. Medicare Advantage plans are private plans which receive capitated monthly payments (adjusted for demographics and health status) which generally offer expanded benefits and lower cost sharing compared to traditional fee for service (FFS) Medicare. The popularity of MA plans as an alternative to FFS Medicare is evident in its enrollment more than doubling since 2005 from 5.3 million to 11.1 million beneficiaries.
A new report from the Medical Industry Leadership Institute and Carlson School of Management, “What Changes will Health Reform Bring to Medicare Advantage Plus Benefits and Enrollment?”, explains with a state-by-state analysis how access for MA beneficiaries will change dramatically in coming years as a consequence of $206 billion in payment cuts to MA plans in the new law.
According to the report: “MA plans will have to cut healthcare benefits, increase cost sharing, or increase premiums (or some combination thereof)…with lower payments and fewer enrollees, fewer MA plans will be able to stay solvent…Medicare beneficiaries will either lose their MA coverage altogether…or be faced with higher out of pocket costs and/or benefit reductions.
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In other words, many of those who would have chosen MA under prior law may be unable to enroll in their preferred (or perhaps any) MA plans or will no longer find it attractive to do so due to the reduced benefits or higher costs. In the latter case, those who would otherwise have preferred an MA plan will instead find themselves under Medicare FFS—which will also be subject to substantial cuts.”
For those MA enrollees forced into FFS, they may no longer be able to see their MA doctors. “Some physicians are members of particular MA plan provider networks established by insurers, but do not accept Medicare FFS patients. These providers are available only through MA plans.”
So the notion that Medicare FFS participants can see any doctor is simply not true for yet another reason beyond doctors limiting access to current Medicare patients, refusing new Medicare patients, or “opting out” of Medicare altogether.
The report concludes “by 2017, when the changes are fully phased-in, enrollment [in MA plans] is projected to be 50 percent lower, the average would-be beneficiary will lose $3,700 in benefits…and the number of [MA plan] choices available in the average county will be reduced by about two thirds.”
Is this the kind of “change we can believe in” President Obama was referring to during his 2008 campaign?
Key Take-Aways
Ø Medicare Advantage (MA) is a popular alternative to traditional Medicare Fee for service (FFS). Ø The President’s government takeover of healthcare law cuts $206 billion in funding from MA plans. Ø MA beneficiaries may be forced into FFS plans or less desirable MA plans.
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For additional information, contact:
The House Republican Conference Policy Office
