Healthcare: Insureres Dropping Medicare Plans
The Journal says, "Most of those beneficiaries are enrolled in a type of Medicare Advantage plan called Private Fee for Service, where enrollment has surged from about 820,000 three years ago to more than 2.44 million today. PFFS enrollees, unlike those under other Medicare Advantage plans, can see any doctor they like as long as he or she accepts payments through their plan. Medicare Advantage plans are subsidized by the federal government and run by insurance companies; most operate with networks of providers."
This inevitably means restrictions on which doctors these seniors will be able to see. How does this reconcile with President Obama's pledge to allow you to keep your current doctor if you're happy with that doctor? If you're able to choose from a list of doctors now, and that list gets cut, you have fewer choices and the doctor you currently have and like may not still be on the list.
"Congress, alarmed by the high cost of PFFS plans, voted in 2008 to require the plans to establish networks of providers beginning in 2011. Companies such as Humana Inc., which has established networks that can cover at least 80% of PFFS enrollees, are doing just that. But Medicare officials acknowledged Thursday that others are pulling out. Plans with a total enrollment of 667,000 people are scheduled to be canceled next year, they said."
"WellCare Health Plans Inc., for example, is canceling its PFFS plans for about 110,000 enrollees. Spokeswoman Amy Knapp said the company saw expanding networks to meet the new requirements as an unwise investment. The company, she said, will focus on its HMO and prescription-drug plans."
And that's the bottom line, isn't it? These are private companies in business to make a profit, and as such they have to make investment decisions that benefit the bottom line.
"The changes are adding fodder to the health-care debate. President Barack Obama and Democrats in Congress have proposed more than $100 billion in payment cuts to private Medicare plans over 10 years to help pay for expanding coverage to the uninsured. They argue that the private insurers are overpaid -- Advantage plans cost the government 14% more on average per beneficiary than traditional Medicare -- and the cuts will help control Medicare costs."
http://online.wsj.com/article/SB125443003194657369.html?mod=WSJ_hpp_sections_news
Published by AC Writer
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