As Avik Roy put it – ”In 1965, government experts projected that in 1990, on an inflation-adjusted basis, Medicare would cost $12 billion. In reality, Medicare in 1990 cost $107 billion. Oops.” This is still happening today, Medicare advantage programs are pushing their recipients to get tests and go for visits that they don’t need (numbers can’t be properly projected for as long as this system remains), as explained at the tucsoncitizen.com.
It’s about money
The reason Medicare Advantage (MA) plans are sending doctors and nurses to people’s homes has to do with getting more money from Medicare. Medicare pays Arizona Advantage plans around $800 per month for each person enrolled with them. However, MA plans get more money for sicker members. This is called “risk adjustment”, and it is very important since MA plans are now being paid a lower base rate than they were a few years ago. MA plans can get more money up front if they are able to identify members with serious health issues like diabetes and heart conditions, and this is the reason for the house calls.
It’s about stars (stars/ratings were introduced for political reasons) – See the GAO.Gov Study
The house calls are also about the Medicare star rating system. The ratings go from one to five stars and are based on more than 30 criteria such as: surveys of members and their satisfaction with the plan; telephone customer service; managing chronic illnesses of members; how many members get screening tests and flu shots.
Most of the Medicare Advantage plans in Arizona get 3 to 3.5 stars, meaning they are average. The more stars a plan gets, the more bonus money it receives from Medicare. One plan in Tucson got four stars this year. In Phoenix, Cigna gets 4.5 stars. The plans have until 2014 to get to 4 stars and keep getting bonus money from Medicare.
Medicare is not going to be sustainable (or at least very cost-effective/affordable and high-quality) for as long recipients are going to be ‘encouraged’ on spending more when there is no reason to. Forbes.com - ”true reform must end: with an eye toward giving patients a more direct role in paying for the care they receive.” Regulations should be set-up for those sort of shenanigans, it’s really just about the money.
Recent reports of the health care costs of retirement are staggering. Some estimates say that a retired couple who is not on an employer-sponsored benefit plan can expect to spend an average of $240,000 on health care during their retirement phase of life. Keep in mind these estimates are based on what some people typically spend, not necessarily what you spend. Find more in the article by Ann Carnns below originally posted on bucks.blogs.nytimes.com.
Health Care Costs of Retirement for Medicare Recipients
Medical costs continue to loom large over retirement, a report from Fidelity Investments says.
A 65-year-old couple retiring this year without any employer-based health coverage would need an estimated $240,000 to cover medical costs through retirement, according to Fidelity’s latest estimate. That’s a 4 percent increase from last year’s figure. (The number has increased by 50 percent since 2002, when Fidelity first calculated the cost at $160,000.)
The estimate assumes the couple is covered by traditional Medicare, the federal health plan for the elderly. The estimate is based on life expectancies of 17 years for men, and 20 years for women.
The estimate takes into account Medicare premiums, deductibles and co-insurance — the share of medical costs paid by the patient — for medical care as well as for prescription drugs. It also takes into account some services that may be excluded by Medicare, like routine vision and hearing exams, eyeglasses and hearing aids.
Before you panic about the health care costs of retirement, take into consideration your general health, how often you visit the doctor, and your current medications.