weekly blog--one for the ages
The New York Times reports that a former well-placed official at UnitedHealth Group asserts that the big insurance companies have been systematically bilking Medicare Advantage programs by making patients look sicker than they were to game the payment system. The sicker the patient, the more they made. The Government Accountability Office reported last year that the Centers for Medicare and Medicaid Services had identified $14.1 billion of overpayments to insurers in 2013, and did not have a clear plan for recovering the money.
CNBC reports that forty percent of Medicare enrollees who earn below $24,000 annually (15 million elderly and disabled Americans) spend 20 percent or more of their income on monthly premiums and out-of-pocket health expenses. Lower-income people are also the least likely to be able to afford supplement Medigap insurance that can help control health costs.
Overall, excluding premiums, average out-of-pocket costs for people on Medicare are $3,024 per year. 5.4 million Medicare beneficiaries do not have any supplemental coverage and spent an estimated $5,374 on out-of-pocket costs in 2016 compared to $2,587. For low-income people with high medical needs, out-of-pocket costs averaged more than $7,000 annually if they lacked supplemental coverage.
AARP reports that the new Republican health care bill (AHCA) would reduce Medicare’s revenue and hasten the program’s insolvency by as much as four years, and weaken its ability to pay for future services.
MarketWatch reports that the component of the AHCA legislation that restructures Medicaid would impact nearly 7 million people ages 65 and older. For these low-income seniors, Medicaid covers Medicare cost-sharing (such as premiums and deductibles), services that Medicare does not cover (such as vision and hearing) and long-term care. Under current Medicaid arrangements, states and the federal government share the financing of benefits. The new AHCA would replace the matching arrangement with a set amount per enrollee which would vary by state. Essentially, the cost of insuring seniors will likely increase faster than the federal payments for seniors, leaving the state responsible for an increasing share of Medicaid costs.