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Medicare News
Medicare Rights Center Finds Problems with Care from
Private Health Plans
Advocacy group calls for Congress to end the
'Overpayments'
April 30, 2007 Senior citizens and disabled
Americans discover a host of problems, including unanticipated costs and
barriers to getting care, when they get sick and need care through their
Medicare private health plans, according to a new report from the
Medicare Rights Center.
Theres a striking pattern to the problems we hear
from people enrolled in Medicare private health plans, said Robert M.
Hayes, president of the Medicare Rights Center, a national consumer
service organization. Too many people face a dangerous game of Russian
Roulette, especially when they fall seriously ill, said Mr. Hayes.
In its report
Too Good to Be True: The Fine Print in Medicare Private Health Plan
Benefits, the Medicare Rights Center describes the typical problems
encountered by private health plan members and cites case examples
gleaned from thousands of calls to the groups national consumer
hotlines.
People in Medicare private health plans do not
discover their plans restrictions and hidden costs until they are
enrolled and get sick, the Medicare Rights Center reports. Many older
and disabled Americans in private plans discover that their doctors are
not in the plans network, their care is not covered away from home
including emergency care, and there are high copays for hospital
admissions and other health services.
The Medicare Rights Center categorizes the
experiences of its clients in its report:
1. Care can cost more than it would under Original
Medicare;
2. Private plans are not stable;
3. Difficulty getting emergency or urgent care;
4. Continuity of care is broken;
5. Members have to follow plan rules to get covered care;
6. Choice of doctor, hospital and other providers is restricted;
7. Difficulty getting care away from home;
8. Promised extra benefits can be very limited;
9. People with both Medicare and Medicaid can encounter higher costs.
Private health plans cost taxpayers more than
Original Medicare, and all too often they dont deliver what they
promise, said Mr. Hayes. The Bush Administration and certain members
of Congress must shed their ideological illusions about Medicare private
health plans, stop the overpayments and let the private health plans
compete fairly with Original Medicare on a level playing field.
The federal government pays private health plans
between 12 and 19 percent more than it would cost Medicare to serve the
same people, according to the Medicare Payment Advisory Commission.
People with Medicare have the option of enrolling
in Original Medicare or joining a Medicare private health plan such as a
HMO, PPO, or private fee-for-service plan. About 19 percent of the 43
million Americans with Medicare are enrolled in Medicare private health
plans. Most people with Medicare are locked into their plans and cannot
switch back to Original Medicare until the following calendar year.
Too Good to Be True: The Fine Print In Medicare
Private Health Plan Benefits is available online at
http://www.medicarerights.org/MA_care_problems.pdf.
Medicare Rights Center (MRC) says it is the largest
independent source of health care information and assistance in the
United States for people with Medicare. Founded in 1989, MRC helps older
adults and people with disabilities get good, affordable health care.
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