AMA, AARP Hold Briefing Discussing Issues Related To Medicare Advantage Plans

Main Category: Medicare / Medicaid / SCHIP
Also Included In: Primary Care / General Practice
Article Date: 15 Oct 2007 - 9:00 PDT

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The American Medical Association and AARP on Wednesday -- as part of their effort to encourage Congress to cut Medicare Advantage plan reimbursements -- held a briefing that highlighted problems with private fee-for-service plans in rural areas of the U.S., CQ HealthBeat reports (Carey, CQ HealthBeat, 10/10).

The Senate Finance Committee is drafting legislation that would decrease Medicare Advantage plan payments to provide funding to prevent a scheduled 10% cut in Medicare reimbursements to physicians. About 1.7 million of the 8.9 million MA plan beneficiaries are enrolled in private fee-for-service plans and most of those beneficiaries live in rural areas, panelists at the briefing said. MA plans on average receive payments equal to 112% of the rate paid to traditional Medicare, and MA private fee-for-service plans are reimbursed at 119% the rate of traditional Medicare, according to the Medicare Payment Advisory Commission.

At the briefing, the groups said MA plans often reimburse rural providers at lower rates than traditional Medicare. In addition, the groups said MA policies are complex and beneficiaries do not understand elements of the plans, particularly the higher-cost sharing that might be required for certain services, such as cancer treatment or home health care. Brock Slabach, a board member of the National Rural Health Association, added that many MA private fee-for-service plans do not comply with a 1997 rule that requires cost-based reimbursements for critical access hospitals. He said the plans also have burdensome pre-certification requirements and delay payments or pay incorrect amounts for services. Such problems could hinder rural providers' ability to provide services, he said.

Supports of MA plans argue that they offer additional benefits to beneficiaries, which America's Health Insurance Plans says provide seniors with an average of $1,032 in savings.

On Monday, AMA and AARP announced a television advertising campaign to encourage Congress to cut $54 billion from MA plan reimbursements and to use the funds to prevent the scheduled physician payment cut (CQ HealthBeat, 10/10).

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