Make us your home page
Instagram

Today’s top headlines delivered to you daily.

(View our Privacy Policy)

Better coverage for well retirees?

New research finds that many seniors who switch from their HMO-style Medicare Advantage plan to traditional Medicare have higher levels of significant health problems. That's fueling concerns that the private plans cater to more profitable, healthy beneficiaries but don't provide the most attractive care for the very ill.

More than 13 million people, a quarter of all Medicare beneficiaries, are enrolled in the private plans, which often offer lower premiums than traditional Medicare, as well as perks such as free gym memberships.

The federal government pays the plans a set fee for each enrollee, which some advocates say gives the plans incentive to skim off the lowest risks and leave the expensive patients to traditional Medicare.

A study released last week by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services, adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage in 2007. They used an average of $1,021 in medical services each month, while patients who remained in traditional Medicare the entire time cost $710 a month.

A Harvard study in the December issue of the journal Health Affairs found that people leaving Advantage plans were "much more likely than other beneficiaries to report health declines." Neither that study nor Riley's determined what motivated the changes.

"It may just be a benign motivation, that patients, when they're sick, want the freedom to go where they want," said Robert Berenson, a senior fellow at the Urban Institute.

In 2006, Medicare tried to crack down on switches by limiting them to once a year rather than monthly, an effort that has suceeded in reducing cherry picking, several studies found.

"CMS reviews these plans every single year specifically to make sure they are not discriminating against any kind of beneficiaries," said Robert Zirkelbach, a spokesman for America's Health Insurance Plans. He also noted that other independent studies have found Medicare Advantage plans do a superior job in caring for enrollees. A report in the December Health Affairs found that people in the private plans were less likely to end up in the emergency room and get elective surgeries, and more likely to get certain recommended types of care.

Also, an analysis of patients in Florida, California and New York by the federal Agency for Healthcare Research and Quality determined people in private managed care plans were less likely to end up in the hospital.

But Riley's study noted the health law's reduction in payments to Medicare Advantage plans. "This may intensify pressure on plans to encourage selective disenrollment," he wrote. "Chronically ill enrollees may be more inclined to disenroll if access to care deteriorates or if plans cover a smaller portion of the costs of their care."

Kaiser Health News is an editorially independent program of the Henry J. Kaiser Family Foundation, a nonprofit, nonpartisan health policy organization.

Better coverage for well retirees? 02/06/13 [Last modified: Wednesday, February 6, 2013 9:08pm]
Photo reprints | Article reprints

© 2017 Tampa Bay Times

    

Join the discussion: Click to view comments, add yours

Loading...
  1. Here kitty, kitty ...

    Blogs

    In a toned down version of the annual rookie dress-up day based on MLB's new anti-hazing policy, Rays rookie players and staff - plus second-year LHP Blake Snell - donned DJ Kitty onesies for the trip to New York.

    Rays rookie players and staff - joined here by Alex Colome - sporting their DJ Kitty onesies before the flight to New York.
  2. Pasco residents affected by Irma invited to town hall meeting

    Local Government

    NEW PORT RICHEY — Representatives from Pasco County Emergency Management and the Federal Emergency Management Agency will play host to a town hall-style meeting from 6 to 8 p.m. Monday in the first-floor boardroom of the West Pasco Government Center, 8731 Citizens Drive, New Port Richey

    Sandra Cunningham assesses the damage a water oak did to her Church Avenue home when it crashed into her bedroom roof during Hurricane Irma.
  3. Lightning's Nikita Kucherov has a lot to say — about moving on to a much better season

    Lightning Strikes

    TAMPA — Nikita Kucherov sits back in his stall and smiles.

    Laughs a little, too.

    Tampa Bay Lightning right wing Nikita Kucherov (86) prepares for a faceoff during the first period of Friday's  (9/22/17) preseason game between the Tampa Bay Lightning and the Nashville Predators at Amalie Arena in Tampa.
  4. Clearwater man shot, seriously injured

    Crime

    CLEARWATER — A shooting Sunday morning in unincorporated Clearwater left one man seriously injured, according to the Pinellas County Sheriff's Office.

  5. Mother of double amputee Ireland Nugent to lose her own lower right leg

    Human Interest

    Ever since Ireland Nugent lost both her lower legs in a lawn-mowing accident five years ago, the Clearwater girl has inspired her mother, Nicole Del Corpo-Nugent, with the courage she has shown in overcoming the tragedy.

    Nicole Del Corpo-Nugent, left, looked on as her daughter Ireland threw out the first pitch when the Tampa Bay Rays played the Houston Astros at Tropicana Field on June 22, 2014. Jerry Nugent held his daughter for the pitch. Now Nicole Del Corpo-Nugent is facing surgery to amputate her own lower right leg due to a rare infection. WILL VRAGOVIC  |  Times (2014)