Fwd: Turn Off the Spigot

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Asclepios

Your Weekly Medicare Consumer Advocacy Update

First Steps

December 11, 2008 • Volume 88, Issue 49

The Government Accountability Office has discovered that in 2006

insurance companies pocketed as profits $1.3 billion in Medicare

subsidies that should have paid for extra benefits for enrollees in

Medicare private health plans.

President-elect Barack Obama has already promised to cut wasteful

spending on these so-called Medicare Advantage plans. The Obama

administration should also make sure that the subsidies given these plans

pay for a decent set of benefits. In particular, all plans should provide

a comprehensive out-of-pocket limit on medical services, a vital

financial protection for enrollees who need high-cost care.

Requiring a decent minimum benefit standard for Medicare Advantage plans

is just one of ten administrative steps the designated Secretary of

Health and Human Services Tom Daschle and his health care team should

enact. In a memorandum to the Obama transition team released today, the

Medicare Rights Center recommends that the new administration:

Require Medicare Advantage plans that serve people with low incomes

or chronic illnesses to provide adequate care coordination. Allow state insurance departments a greater role in preventing and

punishing abusive marketing by Medicare Advantage plans. Prevent pharmacy benefit managers from inflating the price of drugs

under the Part D prescription drug benefit. Stabilize Part D drug coverage for low-income people with Medicare. Ensure that low-income people with Medicare are enrolled in drug

plans that best meet their needs. Allow prescription drug plans to cover uses of drugs that are

supported by clinical evidence in peer-reviewed medical journals. Strengthen consumers’ ability to appeal when coverage of medically

necessary medicines is denied by Part D drug plans. Require Part D drug plans to automatically reimburse low-income

enrollees for excess premiums and copayments paid. Collect data from Part D plans to ensure appeals and transition

policies prevent disruptions to drug regimens.

The new Obama administration has the legal authority to enact all these

measures administratively, without legislation from Congress. These are

vital first steps to ensuring that people with Medicare receive the care

they need from these private plans and that taxpayers get their money’s

worth.

Medical Record

“The GAO said that Medicare Advantage insurers generated $50 billion

in revenue during 2006. On average, plans earned profits of 6.6 percent

and they had projected to the federal government that they would earn

profits of 4.1 percent. The insurance plans also spent less covering

medical expenses than anticipated, with 83.3 percent of revenue going to

medical expenses. They had projected that nearly 87 percent of revenue

would go to expenses.â€

(

Medicare insurers’ profits exceed expectations, Associated Press,

December 2008)

“From day one, we look to the Obama Administration to reverse the

Bush Administration's failure to protect the interests of Medicare

consumers. The new president and his health care team should be ready to

promulgate sensible rules that, together with smart enforcement, will

force improved care and enhanced value from private Medicare health and

prescription drug plans.â€

(

Medicare Rights Center Details Plan to Obama Health Team to Protect

Medicare Consumers, M. , December 2008)

“A mandatory cap set at the average annual premium for Medigap plan

F, which covers all cost-sharing under A and B, would ensure that the

cost-sharing obligations under Medicare Advantage plans do not discourage

enrollment by people with disabilities and older, less healthy

beneficiaries who tend to pay more than the average cost of Medigap

premiums. The average annual plan F premium, projected to reach $2,329 in

2011, is also comparable to the average out-of-pocket cap found in

employer-sponsored health plans,â€

(

Improving the Medicare Program for Beneficiaries: Administrative

Recommendations for the Incoming Administration, Medicare Rights

Center, November 2008)

* * * *

Medicare Part D Appeals Help for Advocates Is

Here!

Medicare Part D Appeals: An advocate’s manual to navigating the

Medicare private drug plan appeals process by the Medicare Rights

Center offers an easy-to-understand, comprehensive overview of the entire

appeals process, including real-life case examples, a glossary of

important appeals terms, a sample protocol for advocates, and links to

important resources.

Register for a

FREE

copy of this great resource.

* * * *

Medicare Part D Monitoring Project

The Medicare Rights Center would like to hear about your experience, or

that of someone you know, enrolled in a private drug plan. With

information about what the issues are with Medicare Part D, we will be

able to demand that those problems be fixed.

Submit your story at

http://www.medicarerights.org/partdstories.html.

* * * *

The Louder Our Voice, the Stronger Our Message

* * * *

Asclepios—named for the Greek and Roman god of medicine

who,, acclaimed for his healing abilities, was at one point the most

worshipped god in Greece—is a weekly e-newsletter designed to keeep you

up-to-date with Medicare program and policy issues, and advance advocacy

strategies to address them. Please help build awareness of key Medicare

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subscribe today.

* * * *

The Medicare Rights Center is a national, nonprofit consumer

service organization that works to ensure access to affordable health

care for older adults and people with disabilities through counseling and

advocacy, educational programs and public policy initiatives.

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