Editor, Times-Union: As a local health care provider of Medicare certified home health care services, we serve many seniors, most of whom have some form of insurance that promises to pay for these services. Prior to the advent of Medicare Advantage plans, traditional Medicare was the primary payer source for the vast majority of those requesting these services.
Traditional Medicare paid, and still pays, for these services at 100 percent, with no deductibles or co-pays. Low-income seniors, in particular, have full access to these critical services when skilled needs arise that threaten their ability to remain in their homes where they prefer to be as they rehabilitate, and where they plan to stay after rehabilitation. Now comes Medicare Advantage with a bewildering array of plans, that began as a political effort to privatize Medicare, with co-pays and deductibles, some of them fairly substantial, to force seniors to become “consumers” of health care services. Translation: If they can’t afford the co-pays and deductibles, then they will elect to not utilize services, thereby holding costs down, which we are now beginning to see.
The only connection between Medicare and the Medicare Advantage plans is Medicare reimburses the insurance companies offering these plans at 120 percent of charges, a hefty price for Medicare to pay out for reducing services. The current administration has introduced legislation in the Affordable Care Act that will significantly reduce this reimbursement beginning in 2013, forcing many of these plans to either significantly raise premiums, deductibles and co-pays, or simply cease to exist, as some have already elected to do. Should this occur, seniors who are not aware of these changes may be stuck with these plans for another year should they miss the de-enrollment period beginning Oct. 15 and ending Feb. 14.
It is our experience that many of our senior clients who have these Medicare Advantage plans were either not aware of the co-pay and deductible components, or thought they were obtaining a supplement plan that complemented their traditional Medicare plan. Unfortunately, the realization of their predicament comes at the most inopportune time: when they most need it. Our two best pieces of advice are 1) contact Medicare at 1-800-Medicare (1-800-633-4227) for information, and 2) beware of consigning your medicare benefits over to insurance companies without careful scrutiny and family discussion.
James L. Anderson Sr. CEO, Health Force of Indiana Warsaw
