Congress should find ways to improve the Medicare Advantage private fee-for-service program, not starve an option that beneficiaries clearly value, an insurance company executive says.
Catherine Schmitt, a vice president at Blue Cross and Blue Shield of Michigan, Detroit, defended the Medicare private FFS program here today at a hearing of the House Ways and Means Committee health subcommittee on the program.
Rep. Pete Stark, the chairman of the subcommittee, convened the hearing in the wake of press reports suggesting that aggressive marketers have contributed to recent rapid growth in Medicare private FFS plan enrollment by misrepresenting the plans.
Enrollment in the private FFS plans has increased to 1.5 million today, from about 200,000 in 2005.
Supporters of Medicare Advantage private FFS plans say that they can offer the same kinds of extras, such as health screening benefits, that Medicare Advantage managed care plans provide, and that they can give plan members the flexibility to use any doctor or hospital that is willing to accept the plan members’ coverage.
Critics of the private FFS plans say that the plans cost the federal government about 19% more per beneficiary than the traditional Medicare plan, and that private FFS plan members often have a difficult time finding providers who are willing to accept their insurance.
Stark said he believes some Medicare private FFS plans may be trying to scare away sicker beneficiaries by imposing higher out-of-pocket costs than traditional Medicare for services such as home health care.
Schmitt said she is appalled by reports of marketing abuses but wants members of Congress to understand that Medicare private FFS plans can be especially valuable in rural areas, because they can bring popular Medicare Advantage program features, such as health screening benefits, to communities in which setting up a managed care plan provider network is difficult or impossible.
Schmitt warned against taking support away from the private FFS program and other Medicare Advantage programs.
In the 1990s, when Congress restricted funding for the old Medicare plus Choice private plan program, the program “became unsustainable in many counties after years of medical cost increases outstripped growth in plan payments,” Schmitt testified, according to a written version of her remarks. “The result was widespread loss of coverage for Medicare beneficiaries.”
Meanwhile, officials at America’s Health Insurance Plans, Washington, have sent the Ways and Means health subcommittee leaders a letter describing a new set of Medicare plan marketing principles that the AHIP board has adopted.