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Medicare News
Congress Must Standardize Medicare Private Health
Plans like Medigap Plans
Report by consumer groups says it will help
informed consumer choices
 Sept. 17, 2007 - Congress must require that the
dizzying array of benefit packages available through Medicare private
health plans be standardized, to help Americans with Medicare make
informed decisions about choosing a health plan and to protect them from
unexpected, high out-of-pocket costs, according to the California Health
Advocates and Medicare Rights Center in a new report.
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"Medicare private health plan benefits need to be
standardized so that older Americans and those with disabilities have
the right information to make apple-to-apple comparisons among their
many health plan options," said Clare Smith, president and CEO of
California Health Advocates, a Medicare advocacy organization.
"The consequences of a wrong plan choice can be
devastating to consumers' health and their pocketbook, especially since
plan choices are often irreversible."
The lack of standardization in private health plan
benefit packages make it difficult or impossible for consumers to
compare Original Medicare with a Medigap supplement and Medicare private
health plans, as well as between the widely varying benefits of private
plans, the consumer advocates report in "Informed Choice: The Case for
Standardizing and Simplifying Medicare Private Health Plans."
"It's time for Congress to step in to protect
Americans with Medicare as Congress did when it regulated the sale of
Medigap plans," said Robert M. Hayes, president of the Medicare Rights
Center, a national consumer group.
"Standardizing plan benefit packages will ensure
that plan benefit designs are transparent and will curtail the rampant
market deception faced by older Americans."
Congress mandated standardization of the Medicare
supplemental insurance plans in 1990.
"Informed Choice: The Case for Standardizing and
Simplifying Medicare Private Health Plans" illustrates these serious
deficiencies in the 2007 benefit packages of Medicare private health
plans that consumers may not know about until they are enrolled in a
plan and get sick:
● consumers suffering from chronic illness can
incur widely varying levels of cost-sharing under different plans;
● many plans do not provide a limit on enrollees’
annual out-of-pocket spending for medical services or exempt certain
services, such as chemotherapy, from such limits;
● many plans charge more than Original Medicare
for specific services, such as inpatient hospital care, nursing home
stays or home health care.
Before deciding on a health plan, consumers need to
consider provider access; utilization restrictions on medical care;
out-of-pocket costs, including plan premiums, copayments and coinsurance
for medical services; and drug coverage through either a private health
plan or stand alone plan, the groups report.
The California Health Advocates and Medicare Rights
Center recommend that the National Association of Insurance
Commissioners establish an expert panel including state insurance
regulators, consumer representatives and representatives from both the
plans and the Centers for Medicare & Medicaid Services to develop model
regulations. The development of standard benefit packages should seek
to accomplish these goals:
● Make it easier for consumers to compare a
limited number of alternative plans;
● Protect consumers against catastrophic medical
expenses, regardless of the type of illness, site or type of medical
service;
● Ensure that out-of-pocket costs for individual
medical services, such as home health services or inpatient services,
are equivalent to or less than the out-of-pocket costs imposed by
Original Medicare.
"Informed Choice: The Case for Standardizing and
Simplifying Medicare Private Health Plans" was released following a
National Association of Insurance Commissioners’ public hearing on
problems surrounding the regulation of Medicare private plans. Both the
California Health Advocates and Medicare Rights Center testified at the
hearing.
The report is available online at
http://www.medicarerights.org/MRC-CHA_MAstandardization.pdf.
Editor’s Notes:
Sources of information -
California Health Advocates is dedicated to
Medicare beneficiary advocacy and education efforts for Californians.
(www.cahealthadvocates.org)
Medicare Rights Center is the largest independent
source of health care information and assistance in the United States
for people with Medicare.
(www.medicarerights.org)
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