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Private insurers' Medicare Advantage plans cost Medicare an extra $34.1 billion in 2012
Date:5/10/2013

uaranteeing large profits. Although private plans must accept all seniors who choose to enroll, they cherry-pick by selectively recruiting the healthiest seniors through advertising, office location, etc. They also induce sicker ones to disenroll by making expensive care inconvenient.

  • They recruit otherwise healthy seniors with very mild (and inexpensive) cases of sometimes serious conditions automatically triggering higher premiums for these beneficiaries from the risk-adjustment scheme implemented in 2004, but escaping payments for expensive care. For instance, many seniors have very mild cases of arthritis, heart failure and bronchitis that require little or no treatment.

  • They enroll patients who get most of their care free at the Veteran's Administration.

  • They heavily lobby Congress to raise their reimbursement. The insurance industry successfully induced Congress and the Bush administration to add bonus payments to Medicare Advantage premiums beginning in 2003.

    Since the study was completed, the industry has again successfully lobbied the administration to raise payments to Medicare Advantage plans, reversing a planned cut of 2.2 percent in reimbursement rates and instead obtaining a 3.3 percent increase. Stock prices of private insurers soared over the announcement.

    "We've long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee-for-service Medicare, but no one had added up the total extra cost to the taxpayer since contracting with private insurers began 27 years ago," said Dr. Ida Hellander, lead author of the study. "Nor has anyone systematically examined the many ways that private insurers have gamed the system to maximize their bottom line at taxpayers' expense."

    "In 2012 alone, private insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee," Hellander said.

    Co-author Dr. Steffie Woolh
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  • Contact: Mark Almberg
    mark@pnhp.org
    312-782-6006
    Physicians for a National Health Program
    Source:Eurekalert

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