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Free Perks With Medicare Advantage Plans Aren't Really Free

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By Philip Rucker
Washington Post Staff Writer
Thursday, October 15, 2009

TUCSON -- Patrick Higney, 66, doesn't want to give up the freebies that come with his zero-premium Medicare Advantage plan: free aspirin and free Band-Aids, a free blood pressure machine and a free ear thermometer.

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Nancy Smyth, 68, wants to keep the free gym membership that comes with the Medicare Advantage policy she bought from Health Net, a private HMO. And John Kizer, 72, hopes his plan will continue to offer free prescription eyeglasses and free hearing aids.

"Everybody's trying to save their little kingdom," Kizer, a retired dairy farmer, said last week after receiving a flu shot. The shot was free, of course.

Seniors in this Sun Belt retirement haven and across the country revel in the free perks that private insurance companies bundle with legally mandated benefits to entice people 65 and older to forgo traditional Medicare and sign up for private Medicare Advantage policies.

The trouble is, the extra benefits are not exactly free; they are subsidized by the government. And some of the plans pass their costs on to seniors, who pay higher co-pays and additional fees to get care.

"It's a wasteful, inefficient program and always has been," Sen. John D. Rockefeller IV (D-W.Va.) said at a recent hearing. At its core, Rockefeller added, Medicare Advantage is "stuffing money into the pockets of private insurers, and it doesn't provide any better benefits to anybody."

President Obama has proposed cutting more than $100 billion in subsidies over 10 years, a contentious component of health-care reform that will be fought in earnest as the bills move through Congress. But unlike some issues that touch off partisan sparring, Medicare Advantage has an unlikely band of bipartisan defenders who have already battled to restore $10 billion of the proposed reductions.

In a health-care debate defined by big numbers and confusing details, the prospect of losing benefits such as a free gym membership through the Silver Sneakers program is tangible, and it has spooked some seniors, who are the nation's most reliable voters and have been most skeptical about reform.

Medicare Advantage was established in the 1970s (under a different name) when private insurers convinced Congress that they could deliver care at lower costs than Medicare. The program blossomed in the late 1990s when Congress bolstered it with millions in additional federal subsidies to for-profit HMOs. It has proven popular among younger, active seniors who had managed-care plans as workers, and about a quarter of Medicare's 45 million beneficiaries are enrolled.

Many private plans require no additional monthly premiums, yet the government pays an average of $849.90 in monthly subsidies to insurance companies for a person on Medicare Advantage, according to the Kaiser Family Foundation. That is about 14 percent more than the government spends on people with standard Medicare, according to the nonpartisan Medicare Payment Advisory Commission.

"The promise of Medicare Advantage and Medicare HMOs was to save the government money, to save consumers money, all the while providing additional benefits and coordinating care," said Joseph Baker, president of the Medicare Rights Center. "That promise has been unfulfilled overall because the plans are overpaid by the federal government at this point."

The insurance industry, foreseeing a loss in profits, warns that cuts would hurt seniors by increasing their premiums or co-payments and taking away some benefits. America's Health Insurance Plans (AHIP), an industry trade group, on Tuesday launched ads in several states citing a projection by the nonpartisan Congressional Budget Office that "many seniors will see cuts in benefits."


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