The Widdershins

Archive for August 20th, 2012

Except he didn’t.

The number that he “stole” changes from talking head to talking head.

Note Widdershins:  I am not fond of the Affordable Care Act or Obamacare.  I’d much rather have had single payer or Medicare for All.  However, I dislike scare tactics and lies even more and the Republicans are becoming bullshit artists when it comes to Medicare and Obamacare.

Now to listen to Romney, Ryan, and their minions it was downright thievery!  He just took that money and he plopped it into his Obamacare plan.  Except he didn’t.  What he did do was to cut payments to Medicare Advantage Plans.  The Advantage plans are sort of like an HMO or PPO organization.  Here’s a brief description of the plans from the Medicare government site.

Can you get your health care from any doctor, other health care provider, or hospital?

In HMO Plans, you can’t get your health care from any doctor, other health care provider, or hospital. You generally must get your care and services from doctors, other health care providers, or hospitals in the plan’s network (except emergency care, out-of-area urgent care, or out-of-area dialysis). In some plans, you may be able to go out-of-network for certain services, usually for a higher cost. This is called an HMO with a point-of-service (POS) option.

Also, you have to choose a primary doctor and you’ll have to get a referral from your primary doctor to see a specialist.

Here is some info on the Medicare PPO Plans:

A Medicare PPO Plan is a type of Medicare Advantage Plan (Part C) offered by a private insurance company. In a PPO Plan, you pay less if you use doctors, hospitals, and other health care providers that belong to the plan’s network. You pay more if you use doctors, hospitals, and providers outside of the network.

Can you get your health care from any doctor, other health care provider, or hospital?

In most cases, you can get your health care from any doctor, other health care provider, or hospital in PPO Plans. PPO Plans have network doctors, other health care providers, and hospitals.

Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more.

Here’s a little bit of history on Medicare Advantage Plans from wiki:

 With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original  Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Medicare Advantage plans are offered through private companies known as Medicare Advantage Organizations (MAO)

I recall seeing some plans that advertised there was no premium required other than your normal medicare premium that was deducted from your Social Security check.  And they had perks too!  You could get, say, a gym membership included when you joined, or “free” vision care or discounts.  A lot of folks thought that was a pretty good deal.  No extra premium and you just had a small co-pay when you went to your (in network) doctor.  However, there are some “catches” to the Advantage plans:

Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower co-payments for doctor visits.

I knew a woman whose mother was in the hospital after a fall and upon discharge, the docs decided she needed some skilled nursing care for a month.  She had a Medicare Advantage plan and that plan would only cover 14 days worth of skilled nursing care.  In addition, it had stricter limits on in-home physical therapy care.  They had little choice at the time but to go along with what would be paid but at the earliest time she could, this lady changed back to traditional medicare with a supplement that covers the deductibles.  Now talk about “rationed” care!!

So why is Obama going after Medicare Advantage Plans?  Because like Willie Sutton said “that’s where the money is”, or at least some of it.  No, it’s because the payment formulas that were created in 2003 overpaid the M.A. plans by an average of 12 percent over traditional MedicareThese formulas change in the PPA law that was enacted in 2010.

The health reform law of 2010 revised the methodology for paying plans and reduced the benchmarks. For 2011,benchmarks were frozen at 2010 levels. Beginning in 2012, reductions in benchmarks will be phased-in over 3 to 6 years. The benchmarks will range from 95% of Medicare fee-for-service costs in the top quartile of counties with relatively high percapita Medicare costs (e.g., Miami-Dade), to 115% of fee-for-service costs in the bottom quartile of counties with relatively low Medicare costs (e.g., Boise). Plans with higher quality ratings will begin to receive bonus payments added to their benchmarks in 2012, based on provisions in the health reform law and a CMS demonstration. Rebates will be reduced for all plans, but plans with higher quality ratings will keep a larger share of the rebate than plans with lower quality ratings.

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