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The government's quiet plan to privatize basic Medicare.
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If you are retired, entitled to Medicare and choose traditional Medicare as opposed to some market-based Medicare Advantage program, the government may move you to a private plan anyway, without your agreement.
It is part of a little known plan by the U.S. government to test of a new privatized model for traditional fee-for-service Medicare.
In 38 states Medicare can now contract with healthcare provider groups that receive a flat annual payment to provide care for those in traditional Medicare.
As a retired Illinois teacher I have chosen to enroll in the state’s retirement Medicare Advantage (MA) program.
I have been satisfied with the program, partly because it is subsidized by the state from payments I made when I was as an active teacher. The subsidy has reduced my premium costs to the state’s Medicare Advantage. My costs to the state program are negotiated by Central Management Services and can differ from what is offered in the marketplace. CMS can bargain lower premiums because they are bargaining on behalf of tens of thousands of retired teachers.
Some teachers do not want to be tied to Medicare Advantage and are not pleased that the state subsidy can only be used thru that state’s MA program.
But currently many of those in a fee-for-service with traditional Medicare are being placed in these experimental Direct Contracting Entities (DCEs) in 38 states where the pilot test is under way.
DCEs are groups of doctors, hospitals, or other healthcare providers. What DCEs have in common with Medicare Advantage is that they are networks of healthcare providers that retain as profit the portion they receive that is not spent on healthcare.
This become an incentive to restrict access to appropriate medical care and services.
If you are enrolled in traditional Medicare and live in an area where a DCE operates, you can be assigned to one without your consent.
Being aligned with a DCE does not change the set of Medicare benefits that you are entitled to, but it can use the techniques of managed care already prevalent in Medicare Advantage to limit access to services it deems unnecessary, and to use financial incentives to encourage use of in-network providers.
MA plans receive billions of dollars in overpayments. One recent study estimated that Medicare overpaid Advantage plans by more than $106 billion from 2010 through 2019.
Switching seniors to Medicare Advantage plans has cost taxpayers tens of billions of dollars more than keeping them in original Medicare, a cost that has exploded since 2018 and is likely to rise even higher, new research has found.
Richard Kronick, a former federal health policy researcher and a professor at the University of California-San Diego, said his analysis of newly released Medicare Advantage billing data estimates that Medicare overpaid the private health plans by more than $106 billion from 2010 through 2019 because of the way the private plans charge for sicker patients.
Among the fifty were Chuy Garcia, Danny Davis, Jan Schakowsky and Marie Newman, all from Chicago.