I was involved in a respectful set of back and forth comments recently on a wonky healthcare web site. We were discussing Original Medicare vs. Medicare Advantage, primarily -- on my part -- that Original Medicare is mispositiond as an alternative to when it is really the ante for all . other types of Medicare insurance. During the back and forth a leader of the Doctors against Insurance Company lobby popped in with this orthogonal comment:
"Part C Medicare Advantage plans are private plans. They are not part of Part A and Part B programs, nor Part D. A patient enrolled in a private Medicare Advantage plan is prohibited from using Part A and Part B. If a person goes outside of the plan network, he cannot ask the Part A or Part B providers to bill the traditional/original/FFS Medicare program. The private Medicare Advantage plan might authorize care outside of its network, but that care would still be covered by the private plan and not the traditional program. If the Medicare Advantage program includes drug coverage, then the enrollee is prohibited from using a Part D drug plan. If he attempts to do so, he is disenrolled from the Medicare Advantage program and reassigned to the traditional Medicare program."
The above comment by the Doctors against Insurance Company lobby is its typical one-sided and years-old misrepresentation of all portions of Medicare, done because the lobbyist group, perhaps accidentally, locked itself years ago into the bad proposition that everyone should have Medicare.
It is a bad proposition because Medicare Parts A and Part B by themselves are very bad insurance, with no catastrophic coverage or annual out of pocket spend limits to protect one on the high side and many other shortcomings on the low side. (What the Doctors against Insurance Companies lobby really means -- if you read its substantive proposal -- is that everyone should have Medicaid. But that’s a losing political message on many levels.)
As for the specifics of the above screed from the lobbyist:
- Part C is Part of Medicare. The word Part – with an upper case P -- in the title means it is public. When the U.S. Census Bureau counts people’s insurance status, it – correctly -- counts those with Part C as being on public insurance. Part C Medicare health plans are administered by private insurers just as Medicare Part A, Medicare Part B, Medicare DME, Medicare Part D, Obamacare, some Medicaid, and many other beneficiaries’ plans are administered. To even mention the private vs. public nature of the administration is desperate rhetoric by the Doctors against Insurance Companies lobby.
- Part C plans are mostly but not totally networked plans. So of course – mostly -- you cannot go to a provider that is not part of the network. I can only assume that is the major concern of the Doctors against Insurance Companies lobby. They must spend millions checking Medicare cards or something... making them late for tee times. But the networked aspect of Part C Medicare has nothing to do with Part C or with Medicare. That is the way networked plans work.
- The networked plan idea is so well thought of by wonks, and fee for service insurance is so disliked by wonks, that – to the best of my knowledge – all Obamacare plans are networked plans. In fact many fee for service Original Medicare Part A and Part B beneficiaries have been put into networks – called Accountable Care Organizations because of the bad rap HMOs got 30 years ago – without their knowledge (but, unlike Part C beneficiaries, they can go out of the ACO without penalty)
I do agree that it is unfair that a person on capitated-fee Medicare gets a slightly higher share of the trust fund money than a person on fee for service Medicare. This slightly higher share is an average of all 15,000,000 people on Part C driven primarily by special needs Medicare Advantage plan beneficiaries and beneficiaries of Medicare Advantage plans chosen for the beneficiary by former employers or unions. The higher share is only very slightly related to the average non-special-needs Medicare beneficiary choosing a Part C plan as an individual.If you are on classical Medicare HMO, you receive only a very slight additional subsidy on top of what you neighbor on traditional fee for service Medicare receives.
United States law says we should not be treating one class different than the other but the Obama administration has consistently broken that part (and many other parts) of United States law. So, sue ‘em!
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