The biggest Democratic lie about Part C goes like this:
“If you have a Medicare Part C Advantage plan, you do not have original Medicare Parts A and B…”
This is totally false. Seniors should read the Medicare and You booklet they received recently from the Centers of Medicare/Medicaid Services (CMS). This year CMS made it clearer than ever how the various Parts of Medicare work together. But it has never been true that going on Part C kicks you off Parts A and B.
Not only do you have Medicare Part A and B IF you have a Part C Medicare health plan, but you HAVE to have Medicare Parts A and B in order to sign up for a Part C Medicare health plan (and of course you have to keep paying your Part B premium unless you are low-income senior that qualifies for “free” Medicare).
The major difference between someone using only Parts A/B Original Medicare (or even just A) a la carte and someone using a Part A/B/C health plan is that
- the senior on a Medicare health plan receives coordinated accountable healthcare on a capitated basis (almost always in an HMO) just like Obamacare wants to give non-seniors
- the senior on Original Medicare receives uncoordinated expensive care on a fee for service basis.
Both plans are administered by private insurers. Because Original Medicare is so bad, almost all seniors on Original Medicare also buy private insurance from a former employer, a spouse’s or their own current employer, or a Medigap plan.
Another recurring Democratic lie goes like this:
“(In) 1997, the government attempted to privatize Medicare with the creation of Medicare Part C plans…”
The government didn’t attempt to “privatize” anything to do with Medicare in 1997 (or in 2003 when the law related to Medicare Part C health plans was further amended). Part C Medicare health plans are not “private;” that’s why it’s called Medicare Part C; it is “Part” of Medicare.
All the 1997 law did was formalize Medicare health plans -- mostly HMOs -- that had existed as Medicare demonstration projects since the early 1980s. What the 1997 law and 2003 amendment do was add exactly the same global payment concept and accountable (integrated, coordinated) care organization concept to Medicare that underlies Obamacare. Medicare has had the two concepts that everyone thinks is so great in Obamacare (and in RomneyCare) for 30 years, the first 15 years informally and the last 15 years formally under the name Part C Medicare health plan. These classic HMOs under Medicare cost the government 5% less than classic uncoordinated fee for service care paid for under Medicare Parts A and B.
(But HMOs are not for everyone and people have different opinions about whether they are good or bad. Particularly make sure a favored doctor is in-network before signing up.)
From the government’s perspective, the basic ideas that underlay Part C Medicare health plans in terms of how they are funded by the government were proposed by two former Democratic staffers in 1995 (one had been on President Carter’s staff and the other on Tom Daschle’s Health Committee staff in Congress). In their proposal, the two Democrats called the idea “premium support.” The Democratic idea was embraced by the Republicans in 1997 and 2003 and – as mentioned above – by the Democrats in Obamacare. (But for some reason, now that the Republicans want to expand it even further, it is a bad idea according to the same Democrats.)
Some of these Democrats claim:
“... if you have a Medicare Part C Advantage plan that is the actuarial equivalent of original Medicare Parts A and B, by definition, it will have less coverage than a combination of original Medicare Parts A and B along with a Medicare supplement/Medigap policy.”
All Part C Medicare health plans include the catastrophic coverage that Original Medicare lacks. The combination of Original Medicare and Medigap plans typically do not include catastrophic coverage, the one thing that makes insurance insurance. (A few Medigap plans elsewhere in the United States do offer catastrophic coverage but neither of the Massachusetts' Medigap plans do.) So if nothing else, Part C Medicare health plans offer more coverage -- not less -- simply based on its catastrophic coverage. But there are many other benefits that make up for the deficiencies in Original Medicare such as the lack of an annual physical in Original Medicare. Often the plans include the dental and optical coverage as well.
-- Dennis Byron
