Medicare Advantage Plan Eliminations Pose Detriment To Elderly Health
By: Health Insurance
Submitted: 2009-10-14 08:28:50 | Word Count: 605
Some health insurers have begun eliminating certain Medicare gap coverage policies to some elderly Americans. The cost-slashing move to eliminate some Medicare Advantage plans has the potential to affect millions.
Nearly 11 million Americans qualify for Medicare and?many of those?use Medicare Advantage plans. This figure does not take into account the countless more who would have been eligible for the program.
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Medicare is the federal?health insurance program for which the elderly pay premiums. However, its coverage has certain parameters and creates gaps in coverage. Medicare Advantage programs are subcontracted to private insurance firms. The companies process paperwork, manage care, fill in the gaps, and provide services such as drug and dental plans. Insurers, in turn, charge premiums and co-pays to people who buy the policies.
Private for-profit insurers are paid by the federal government an average of 12 percent more than it would cost to fund a typical Medicare program.
Opponents of the cuts say the biggest detriment for subscribers will be diminished health and quality of life.
"I'm a breast cancer survivor," said 74-year-old Sheila Tower in a statement as she discussed how her insurance coverage with Medicare Advantage saved her life.
Tower credits her plan-provided care case?coordinator with helping her coordinate all her?doctor visits, chemotherapy, referrals and paperwork. "I'm alive because of this and I wanted my legislators to know first hand, this is not a place to make any cost cuts," she said.
Her husband, Arthur, 84, who suffers from Parkinson's disease, agrees.
"We are both enrolled in Medicare Advantage and our care is preventative in that we are able to discuss our medical concerns and diagnosis before they get to the critical stage, saving us time and money, adding to the quality of our lives," Tower was quoted as saying. "We have peace of mind and less stress."
However, stress is exactly what many elderly are experiencing right now, at least for those who have been?notified that their coverage will be eliminated or who have gotten a letter that doesn't seem to represent the government's aims.
Having the elderly fend for themselves or pay for the difference may not seem like "brotherly love." According to published reports, in the Philadelphia area alone cuts by Independence Blue Cross affect nearly a third of its 133,500 individual Medicare Advantage subscribers.
Insurance giant Aetna is cancelling policies for 6,500 individuals in the region, or 19 percent, and 1,000 in nearby New Jersey counties, or about 12 percent. Often the elderly have a tough time paying for the medical care they are getting. Wiping out these programs could make a bad situation worst.
Both Blue Cross and Aetna are eliminating plans that serve elderly subscribers poor enough to qualify for Medicaid. Aetna's plan serves 1,000; the Independence Blue Cross plan serves 19,000.
With additional out-of-pocket costs, poor or destitute seniors run the risk of not having access to affordable, coordinated, preventative care. They also risk not receiving the broad range of health services vital to an aging population such as prescriptions, vision, hearing, dental, fitness, and mental health. Longer, more serious illnesses and a subsequent rise in hospital admissions could result.
Health officials and medical personnel say these areas have the highest costs with the potential of taxing the already burdened system.
