By Brandon Moseley
Alabama Political Reporter
On Friday, U.S. Representative Mike Rogers (R) from Saks sent an email to constituents warning of the consequences of deep cuts to the popular Medicare Advantage program that were passed by the then Democratically controlled Congress in 2010 to partially pay for President Obama’s controversial healthcare insurance reform legislation, the Patient Protection and Affordable Care Act of 2010, popularly referred to as Obama Care.
Congressman Rogers wrote, “Across East Alabama, so many of our seniors depend on Medicare to help provide their health care coverage. Medicare Advantage, or Medicare Part C, is a program that allows seniors to enroll in plans provided by private insurance companies so they can stay in their current networks and keep the doctors they like and trust. Almost 30 percent of all Medicare beneficiaries participate in Medicare Advantage. Across Alabama, it’s about 24 percent.”
Representative Rogers wrote, “But Alabama seniors enrolled in Medicare Advantage plans will soon face some of the same consequences of Obamacare that millions of other Americans are. The president’s health care law included $716 billion in future Medicare spending reductions with a lot of these cuts coming from Medicare Advantage. The Centers for Medicare and Medicaid Services (CMS) recently released their proposed rate changes for Medicare Advantage which could reduce payments by up to 3.55 percent.”
Rep. Rogers wrote, “Alabama seniors have a right to be concerned about these provider cuts. They could result in less coverage or fewer benefits. They could impact which doctors continue to participate in the plans. Just last week, I co-signed a letter to CMS Administrator Marilyn Tavenner expressing concerns about future reimbursement reductions in Medicare Advantage and their impact on our seniors.”
Rep. Rogers said, “I of course am a strong opponent of the law, and believe this is just another example of why Obama Care does not work. Seniors could now risk higher out-of-pocket expenses to keep their current Medicare Advantage plans, or could be forced out of their plans all together, losing their current networks, providers and doctors. Sound familiar?”
The conservative Congressman concluded, “President Obama said if you like your health care plan, you can keep it. Once again, with these pending Medicare Advantage cuts, that statement just doesn’t seem to tell the whole story.”
Original Medicare only pays about 80% of a beneficiary’s healthcare costs. Under original Medicare there is an annual part B deductible, then Medicare pays 80% of the costs of approved doctor bills and other charges after the deductible is met. Unfortunately there is not a maximum out of pocket cost in original Medicare. With Medicare A (the hospital insurance portion of the program) there is a large deductible to pay to utilize the benefit. That however is a three month deductible. So once a Medicare beneficiary pays it, it is effective for 90 days no matter how manry times that person may go in and out of the hospital.
Outside of that period of time, the deductible resets and has to be paid again. Once in the hospital, Medicare pays all of the Part A charges for up to 80 days. After that it begins charging a per day copay. There are also copays and deductibles in the Medicare prescription drug program (Medicare Part D) which can only be accessed through a third party healthcare insurance company. For these reasons most Medicare beneficiaries enroll in either a Medicare Advantage plan (Medicare Part C) or a Medicare Supplement and a stand alone Medicare Part D plan in addition to their Medicare Part B plan.
Poor seniors often get both Medicare and Medicaid. Many seniors confuse the two and use the term wrong. With a Medicare Supplement, Medicare pays 80% of the Part B expenses and all the required Medicare Part A charges. The Medicare Supplement picks up all or part of the Medicare Part A and B copays and deductibles.
With Medicare Advantage plans, beneficiaries are enrolled in an HMO or PPO network where doctors and hospitals that agree to take the insurance plans charge the copays and deductibles approved under the plan and take the terms offered by the Insurance Company. All Medicare Advantage plans have a maximum out of pocket cost and many also have the Medicare Part D plan embedded in the plan. As insurance companies receive smaller amounts from Medicare, they will have to pass on more costs to the Medicare beneficiary, cut reimbursements to doctors and hospitals, or stop offering that plan.
Congressman Mike Rogers represents Alabama’s Third Congressional District.