The Elderlaw Forum: Medicare Advantage Plans: ‘privatization trojan horses?’
Aug 03,2007 00:00 by Professor_Michael_Myers

Fasten your financial life-jackets Medicare beneficiaries!   Nearly nine million of you have enrolled in private Medicare Advantage health plans.   Turbulent seas lie ahead!

You are leaving traditional Medicare and the stability of social insurance.  You are—for better or worse, depending upon your instincts for privatization—en route to something called “defined contribution Medicare,” whereby Medicare will pay a fixed benefit and send you shopping for coverage in the private insurance market.  

Medicare Advantage plans are essentially bait-and-switch “Trojan Horses” that over the next five years will deliver hundreds of billions of tax dollars to private health insurers to entice seniors away from traditional Medicare through tax-subsidized plans that replace Medicare A and B, and Part D and Medigap coverage.     

Insurers can provide expanded benefits at lower premiums because of generous federal subsidies.  This gift-wrapped subsidy will cost taxpayers an estimated $54 billion over the next five years.  Medicare Advantage enrollment is expected to reach 25 percent by 2010. 

In the meantime, before buying a Medicare Advantage plan, heed this advice:  Personally contact your community hospital, your primary physicians, and their network of specialists to confirm whether they will accept your Medicare Advantage card.  A Missouri couple who contacted the USD Senior Legal Helpline failed to do so and found themselves barred from their local network of healthcare providers.

They enrolled in a Medicare Advantage policy called “Smart Value Plan,” offered by Anthem Blue Cross Blue Shield and sold by Ashby’s Covenant Insurance.  They were told “there should be no problem” with its acceptance by local providers.   But when the husband, 76 and diabetic, sought emergency care at the community hospital, his Smart Value card was rejected.  It was also rejected by his orthopedic surgeon.

They have asked to be disenrolled from the Medicare Advantage plan but find themselves entangled in a bureaucratic quagmire, leaving them without coverage as pharmaceutical and outpatient billings accumulate.  On their behalf, I wrote Anthem, Ashby’s and Medicare, contending they had  been defrauded;  that both Anthem and Ashby’s knew or should have known that local providers were not Medicare Advantage providers. 

Again: prior to enrolling in a Medicare Advantage plan, verify its local coverage.  And, in the long run, keep your eye on the Medicare privatization scam. 

(Pro bono legal information and advice is available to persons 55 and older through the USD Senior Legal Helpline, 1-800-747-1895; mmyers@usd.edu.  Opinions solely those of the author and not the University of South Dakota).