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Medicare, Health Insurance

Medicaid in Nursing Homes

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Nursing Home Issues

Other Consumer Issues:

A Few Current Issues

1. Complexity of choices Medicare Advantage was intended to help control the costs of Medicare, but the generous payment structure seems to have had the opposite effect. In addition, MA has become so complex that, instead of holding down costs for beneficiaries as competition is supposed to do, there is some evidence that the opposite is true: Medicare beneficiaries are so overwhelmed by the confusing array of options that some throw up their hands and others make choices not in their best interests. Having so many possibilities also increases the opportunity for companies to game the system, while eliminating the economies of scale that might occur if there were fewer companies competing. A handful of companies dominate the market, but many others continue to operate. CMS has taken some steps to address some of these issues. (See Changes)
2. Drug prices The fact that Medicare is prohibited from negotiating directly with drug companies, in contrast with the control exercised over payments to other providers, is a major issue with critics. They point to the success the Veterans Administration has had in holding costs down as an example of what could be achieved by direct negotiation. The financial clout and power of lobbyists for the pharmaceutical companies, however, is a huge obstacle to removing the prohibition.
3. Limits on payments for mental health treatment As of 2009, copayments for mental health treatment amounted to 50% of charges, rather than 20% as for most other kinds of treatment. Mental health visits can also be relatively expensive, and require regular visits. The reimbursement calculation is expected to change in 2010. (See Changes)
4. Unless there is meaningful health care reform that addresses the problem, retirees under 65, or those over 50 or 55 who have lost employer health benefits will continue to have a hard time finding affordable health insurance. Alabama residents who have had employer-provided coverage and have taken advantage of Cobra may be able to obtain coverage by applying (must be done within 63 days from end of Cobra coverage) through the Alabama Health Insurance Program (AHIP). Information at http://www.alseib.org/healthinsurance/ahip/
   
   For those who do not meet those guidelines, check with ALFA insurance, which offers health insurance underwritten and administered by Blue Cross. A person in poor health is likely to be rejected, but it is a possibility for healthy seniors. See www.alfains.com or call 334-288-3900.

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