B.y In 2025, Medicare subscribers taking expensive medicines will find significant financial relief.
However, the 35 million people enrolled in traditional Medicare programs do not have access to the same relief for hospital, outpatient, home care, and nursing home care, and if they become seriously ill. may be exposed to unlimited costs. No supplementary compensation.
“Many people don’t know that traditional Medicare doesn’t have a catastrophic out-of-pocket limit,” said Christina Bokti, director of health policy at research firm West Health. from,” he said. “People don’t realize it until they enroll in Medicare,” she said.
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This issue is especially important as the annual Medicare enrollment, which ends December 7, is underway. She says more than one in five of those who choose Medicare Advantage, an alternative to traditional Medicare run by health insurance companies, chooses it for out. Out-of-pocket limits offered by insurers, according to a new study from the Commonwealth Fund.
Adding a co-payment cap to the main Medicare program costs taxpayers much like drug costs. The majority of Medicare patients don’t reach that ceiling, according to a recent estimate by the Urban Institute. But Medicare policy experts say there is growing momentum for such caps on all services. This is also to level the playing field with Medicare Advantage and, most importantly, to help millions of older people and people with disabilities feel safer when their health changes. I have. .
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“Even if the cap is not reached, the financial comfort that people get from having a cap on out-of-pocket expenses is truly invisible and important and cannot be overlooked. Commonwealth Fund Medicare.
Almost all private health plans have an annual out-of-pocket limit. That is, after someone pays the specified cap amount, the insurance company or employer pays the full amount of the medical expenses. Medicare had caps over 30 years ago, but they were short-lived. Congress passed legislation in 1988 to limit Medicare deductibles and copayments for hospital and physician care. MPs repealed the law less than a year after facing public backlash.
Opinion polls at the time showed that many senior citizens did not understand what the new law contained. But they knew it meant higher taxes for them.
“Many seniors resented the idea of paying additional taxes to fund new insurance,” the researchers wrote in 1990 Health Issues. Not only did they bear the brunt of the funding, but the benefits of the new law added little to their existing coverage.
Coverage gaps still exist because Congress has virtually stayed away from the issue since. Retiree coverage, if you’re eligible for Medicaid at the same time, or by purchasing a Medigap plan separates a few major options.
Be aware that people who initially choose a Medicare Advantage plan but later decide to go for traditional Medicare may be barred from the Medigap market, depending on where they live. please give me.
But as Commonwealth Fund research and federal registry data show, millions of people who don’t have a viable or affordable option for additional coverage have legal limits on out-of-pocket costs. I am drawn to Medicare Advantage where I need it. Patients who choose these plans get ahead of the national network of traditional Medicare doctors, hospitals, and other providers in exchange for that security blanket. According to the Kaiser Family Foundation, the average maximum out-of-pocket cost for Medicare Advantage plans this year is about $5,000, and in-network care won’t allow him to exceed $7,550.
“For better or worse, Medicare Advantage was a way for the government to increase benefits for Medicare recipients without requiring legislative change by Congress,” said an industry-funded group that supports Medicare Advantage. said Susan Denzer, CEO of a group of American physicians.
Setting out-of-pocket limits similar to Medicare Advantage for all Medicare services would cost billions of dollars. Because the taxpayer, not the patient, will be covering the majority of the catastrophic event. A calculator made by West Health estimates that the $5,000 limit will increase his Medicare spending by $10 billion in 2023.
However, some proposals suggest that adding a copayment cap to Medicare could save governments and taxpayers money. When combined with other changes that shift spending out of Medicare. Up to $7,000, according to the Congressional Budget Office’s 2020 report, Medigap plans cover a certain amount of personal deductibles and coinsurance Combined with policies to ban the
Health insurers aren’t keen on adding maximum copays to traditional Medicare. This makes the program more attractive, which may cause people to drop out of Medicare Advantage and Medigap plans. STAT reached out to the largest insurance lobbying groups, including America’s Health Insurance Plans, the Better Medicare Alliance, the Alliance for Community Health Plans, and AARP, but they were all skeptical about capping traditional Medicare costs. There were no supporting groups.
AHIP released a report last month that out-of-pocket costs like Medicare Advantage would make federal spending on traditional Medicare higher. Does this group support adding caps to traditional Medicare to compete with Medicare Advantage? increase.
“If Congress should consider strengthening the original Medicare basic benefits, it would be more cost effective to align with the payment structure under the MA program and be fair to Americans who choose MA. Existing structures should be included in the MA benchmark,” AHIP said in a statement.
The Better Medicare Alliance did not explicitly endorse any out-of-pocket limits for traditional Medicare beneficiaries. In a statement, it said it wanted financial protection for older adults, but said, “The out-of-pocket limit itself is in Adjusted Whole-Medicare Advantage Person Care.
The Alliance of Community Health Plans has not taken an official position on maximizing traditional Medicare copayments. [we] Instead of traditional Medicare volume-based care, we advocate for next-generation programs. ”
AARP, which makes money from selling Medigap plans and has financial ties to UnitedHealth Group, the country’s largest Medicare Advantage insurer, declined to comment.
Congress isn’t trying to address this gap, but it doesn’t make us less concerned about the 17% of patients in the traditional Medicare program (roughly 5-6 million).
“Many Americans cannot afford or are unwilling to purchase additional insurance. [Medicare Advantage] We have health insurance and want to stay in traditional Medicare,” said Bokti of WestHealth. It will be a burden.”
