How will health care reform affect Medicare?

Coverage » Some answers are clear now; time will tell on others.
This is an archived article that was published on in 2010, and information in the article may be outdated. It is provided only for personal research purposes and may not be reprinted.

Like a third of Utahns on Medicare, Jack Sweetring prefers to receive his medical benefits through a private health plan.

And with the federal government set to help pay for health care reform by reducing its payments to insurers who offer those private plans, called Medicare Advantage, the Taylorsville octogenarian is worried.

"There's been a lot of rumors with the passing of 'Obamacare' ... that we're eventually going to lose the advantage portion of Medicare," Sweetring said.

The short answer is: It is unclear what will happen to Medicare Advantage plans, since those decisions are left to the private insurers who sell them. But the law also makes changes to Medicare, including improving all seniors' prescription drug coverage, that are known.

Here's how the law affects Medicare:

Since there will be $400 billion in future cuts in Medicare reimbursements, mainly to hospitals, will there be cuts in benefits?

Groups that advocate for seniors, including AARP and Medicare Rights Center, say no. Hospitals agreed to the reductions. In exchange, most Americans will have to have health insurance instead of using the emergency room for care and sticking hospitals with the bill.

"All guaranteed Medicare benefits are protected in this bill," said David Certner, AARP's legislative policy director.

Starting next year, the law also provides a 10 percent bonus through Medicare to primary care doctors and general surgeons practicing where they are in short supply, including most Utah counties.

How will benefits change?

Starting next year, annual wellness visits and certain preventive services, such as cancer screenings, will be free. Medicare beneficiaries will no longer have to pay deductibles and co-insurance for that care.

And 18 months after enactment, the law says Medicare beneficiaries will have access to a comprehensive health risk assessment and a free personalized prevention plan.

What will happen to Medicare Advantage?

Today, Medicare pays private insurers an average of 14 percent more than it spends to care for people enrolled in traditional Medicare.

The overpayments help lower premiums and co-insurance costs, and provide extra benefits like vision and dental coverage, even gym memberships.

The law would nearly eliminate the overpayments, saving $132 billion over the next decade.

For people enrolled in Medicare Advantage plans today -- 91,000 Utahns -- premiums and benefits will stay the same through the end of the year, says Mike Fierberg, a spokesman for the federal Centers for Medicare & Medicaid Services [CMS].

But costs could increase and extras may be eliminated next year, when payments to insurers are to be frozen at 2010 levels. The payments will start to drop in 2012.

Premiums will likely go up next year -- as they did this year.

A spokesman for Regence BlueCross BlueShield of Utah, the No. 2 provider of Medicare Advantage in the state, couldn't say how the prices or plans will change, or whether the company will stop offering Medicare Advantage plans.

"We don't know at this time the answers to any of those questions because there is so much additional work that will be done in interpreting this law," Mike Tatko said in an e-mail.

The effects should become clear in the fall: Fierberg said insurers must submit their 2011 coverage plans to CMS in June. Customers will be notified in writing of changes soon after. Insurers cannot offer fewer benefits than the original Medicare plan.

Bonus payments will continue to insurance companies that provide high-quality plans -- based on such measures as how chronic care is managed and customer satisfaction. No plan offered in Utah met those conditions in 2009.

How will Medicare prescription-drug benefits change?

The changes are immediate and are being touted as a major win for seniors.

Medicare Part D enrollees in the "doughnut hole" of drug coverage -- who must pay $3,610 in drug costs before they are covered by Medicare's catastrophic coverage provision -- will get a $250 rebate this year.

It hasn't been announced how seniors can apply for the rebate.

Next year, seniors in the hole would get a 50 percent discount on brand-name drugs and a 7 percent discount on generics.

The discounts grow so that by 2020, consumers will pay the standard 25 percent for drugs, instead of 100 percent. Once they spend a certain amount on drugs, they would pay just 5 percent.

Individuals earning over $85,000 and couples over $170,000 will pay more in drug plan premiums starting next year.

Sources: Kaiser Family Foundation, Medicare Rights Center, The George Washington University School of Public Health and Health Services, Salt Lake Tribune interviews.


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