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How will reducing subsidies to Medicare Advantage plans affect me? - page 3 / 7

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Healthreform.GOV

| Health Insurance Reform and Medicare: Making Medicare Stronger for America’s Seniors

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Problem with the Status Quo:

Prevention costs seniors money and is underused. Many seniors do not receive recommended preventive and primary care, leading to less effective and more expensive treatments. For example, 20 percent of women age 50 and over did not receive a mammogram in the past two years, and 38 percent of adults age 50 and over have never had a colonoscopy or sigmoidoscopy.15 Seniors in Medicare must pay 20 percent of the cost of many preventive services on their own. For a colonoscopy that costs $700,16 this means that a senior must pay $140 – a price that can be prohibitively expensive.

Health Insurance Reform Solution:

Make preventive services free. Under health insurance reform, a senior would not pay anything for a screening colonoscopy or other preventive services. Reform will eliminate any deductibles, copayments, or other cost-sharing for obtaining preventive services, making them affordable and accessible.

Problem with the Status Quo:

Preventable fraud and abuse raise Medicare costs. Fraud and abuse raise Medicare costs for all seniors and taxpayers. Beneficiaries pay the costs of Medicare dollars lost to fraud through increased premiums. At the beginning of September, the Department of Health and Human Services and the Department of Justice announced the largest health care fraud settlement in history; Pfizer agreed to pay $2.3 billion for illegal marketing practices. This historic settlement will return nearly $1 billion to Medicare, Medicaid, and other government insurance programs.17

Health Insurance Reform Solution:

Aggressively attack fraud and abuse. Health insurance reform will increase funding to fight fraud and abuse in Medicare, increase penalties for those found guilty, and impose tougher screening of providers to prevent those who have abused the program from providing care to beneficiaries in the first place. Current proposals to reduce fraud and abuse in health insurance reform legislation could save over a billion dollars over the next 10 years.18

Will health insurance reform actually improve my care?

Problem with the Status Quo:

There are persistent gaps in quality. Medicare currently does not place enough of an emphasis on improving quality of care. For example, nearly 20 percent of Medicare patients who are discharged from the hospital end up being readmitted within 30 days.19 The Medicare Payment Advisory Commission (MedPAC) estimated that Medicare spent $12 billion on potentially preventable hospital readmissions in 2005, which would be more than $15 billion today.20 And one in seven Medicare beneficiaries experiences a complication while in the hospital.21 A renewed focus on health care quality and patient safety under health insurance reform will improve patient health and decrease preventable treatment costs.

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