Unexpected Costs And Obstacles To Care Are Common Experiences For Americans Enrolled In Medicare Private Health Plans, Consumer Service Group Reports
"There's a striking pattern to the problems we hear from people enrolled in Medicare private health plans," said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service organization. "Too many people face a dangerous game of Russian Roulette, especially when they fall seriously ill," said Mr. Hayes.
In its report "Too Good to Be True: The Fine Print in Medicare Private Health Plan Benefits", the Medicare Rights Center describes the typical problems encountered by private health plan members and cites case examples gleaned from thousands of calls to the group's national consumer hotlines.
People in Medicare private health plans do not discover their plans' restrictions and hidden costs until they are enrolled and get sick, the Medicare Rights Center reports. Many older and disabled Americans in private plans discover that their doctors are not in the plan's network, their care is not covered away from home - including emergency care, and there are high copays for hospital admissions and other health services.
The Medicare Rights Center categorizes the experiences of its clients in its report:
1. Care can cost more than it would under Original Medicare;
2. Private plans are not stable;
3. Difficulty getting emergency or urgent care;
4. Continuity of care is broken;
5. Members have to follow plan rules to get covered care;
6. Choice of doctor, hospital and other providers is restricted;
7. Difficulty getting care away from home;
8. Promised extra benefits can be very limited;
9. People with both Medicare and Medicaid can encounter higher costs.
"Private health plans cost taxpayers more than Original Medicare, and all too often they don't deliver what they promise," said Mr. Hayes. "The Bush Administration and certain members of Congress must shed their ideological illusions about Medicare private health plans, stop the overpayments and let the private health plans compete fairly with Original Medicare on a level playing field."
The federal government pays private health plans between 12 and 19 percent more than it would cost Medicare to serve the same people, according to the Medicare Payment Advisory Commission. People with Medicare have the option of enrolling in Original Medicare or joining a Medicare private health plan such as a HMO, PPO, or private fee-for-service plan. About 19 percent of the 43 million Americans with Medicare are enrolled in Medicare private health plans. Most people with Medicare are locked into their plans and cannot switch back to Original Medicare until the following calendar year.
"Too Good to Be True: The Fine Print In Medicare Private Health Plan Benefits" is available online at http://www.medicarerights.org/MA_care_problems.pdf.
Medicare Rights Center (MRC) is the largest independent source of health care information and assistance in the United States for people with Medicare. Founded in 1989, MRC helps older adults and people with disabilities get good, affordable health care.
http://www.medicarerights.org
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