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Consumer Advocate: Shopping Not Easy for Medicare Enrollees

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Current Medicare program rules place sharp limits on enrollees who would like to do their best to hold down their health care expenses.

Bonnie Burns, a policy specialist at California Health Advocates, Scotts Valley, Calif., a nonprofit advocacy and education group, talks about the limits in a comment on efforts to help consumers become better health care shoppers.

Recently, some have suggested that consumerism could be one way to hold down Medicare costs without hurting the quality of care.

In the real world, Medicare program rules discourage efforts to shop for care based on price by using a federal formula to set prices, Burns says.

Providers cannot normally waive or reduce enrollees’ out-of-pocket costs, and a provider who did try to reduce the enrollees’ out-of-pocket costs could end up having to pay federal penalties, Burns says.

“Similarly providers cannot waive or reduce cost-sharing amounts owed in a Medicare Advantage plan either,” Burns says.

The health care industry should be able to save a great deal by attacking redundancy and administrative costs, but, given the pricing system that is now in effect, there is no practical, legal way for Medicare enrollees to play a role by dickering with their doctors, hospitals and clinics, Burns says.

- Allison Bell

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