In response to the Healthcare Leadership Council (HLC) article regarding Medicare Advantage Continues To Benefit Seniors — for Now, there are a few things left unsaid that may have a great impact and change the perception that some may think the Affordable Care Act (ACA) will diminish these options that benefit seniors.
If you haven’t read the hyperlink I have attached,….. Read it. Ok,…..that’s a little harsh. No one is “Forcing” seniors out of popular MA-PD plans. That is not the “true” issue here. What is, however, is the result of individual agents/brokers convincing Medicare beneficiaries of enrolling into a plan that unfortunately doesn’t meet their health care needs specifically; thus leading to financial responsibility that, one, the beneficiary was unaware they had, or two, were under they impression that their current provider would cover. The idea that “it is wrong to disrupt the elderly’s existing health coverage” would be a good argument to adjust the current health care reform bill, if Medicare beneficiaries’ health coverage were working effectively and efficiently. It, however, is not.
Medicare MA plans are designed to include all of the same benefits as Medicare A+B, and may include Rx drugs. The only difference, however, is that the beneficiaries’ health care management is administered by the insurance provider. Not to mention, even though Medicare no longer is the administrator of the beneficiary’s health care, they still pay the independent provider for overseeing the provision of care for that same beneficiary. This, HLC, neglected to mention continues to draw from the federal budget allocated for Medicare beneficiaries nation wide causing even more stress on the government funded social insurance. That being said, the beneficiary is responsible for cost-sharing/co-payments for Medicare covered services provided. These programs, as the previous article has conveyed, can be cost effective for seniors who are still relatively healthy and see a physician only a couple times a year. Enrollment into MA-PD plans saves these beneficiaries the cost of spending hundreds a month on supplemental coverage, Rx drug plan premiums and their Medicare Part B Premium/and or deductible. Hence the appeal to these plans, however, there is a downside….
“Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius recently released a new report showing that the government’s health care fraud prevention and enforcement efforts in taxpayer dollars in the 2011 Fiscal year. This is the highest annual amount ever recovered from individuals and companies who attempted to defraud seniors and taxpayers or who sought payments to which they were not entitled.”
Due to the cost-sharing/co-payments beneficiaries are responsible for, there is still some responsibility borne to the insurer to coordinate benefits (entitled to the beneficiary) with Medicare. When the responsibility of submitting claims forms are left to the provider of these services, for example primary care physicians or specialists, this CAN and HAS been the result; Seniors being taking advantage of and in many cases overcharged for services they might be entitled to. Because of the ACA the Department of Human Health Services (HHS) has diligently overseen the government’s administration on fraud, waste and prevention which is now being closely monitored. Theoretically, this should improve a beneficiaries’ overall experience in an MA plan, and allow for more distribution of Medicare/Medicaid funding to those who really need it.
By no means is the quality of coverage going to be decreased if a Medicare beneficiary opts to enroll back into Original Medicare A+B, unless the provider of services is taking shortcuts to cut costs for providing care. The Affordable Care Act has been implemented to increase care across the senior population, not diminish its quality. That would not make any sense. The essence of this reform is to improve quality by cutting down on fraud and putting back into the Medicare funding program what was taken from it illegally and with reckless abandon…..beneficiaries’ and taxpayers hard earned dollars. Access to more funds can lead to a variety of improvements within the Medicare/Medicaid programs such as increased reimbursement rates, quicker access to patient records by sharing of private health information (PHI) within a secured virtual database, etc.
What we need to understand, and respect is that health care is an ever-changing environment that constantly requires innovative and effective implementation to improve the quality and efficiency of providing care. To be honest, its mainly a trial and error process that we must be patient with. Im not saying we are to drag our feet in coming up with useful solutions, but we must allow some time to analyze the “ripple effect” of what we are trying to accomplish. With regards to the patient experience, we will get a better understanding of what works and what doesn’t, and use this vital information to improve the entire process holistically from initial contact to final disposition.