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Planned Medicare Advantage Cuts Get Mixed Reaction in Maine
02/24/2014   Reported By: Patty B. Wight

On Friday, the Obama administration announced that it plans to cut funding to the Medicare Advantage program in 2015. The cuts are part of the Affordable Care Act. And while some say the move will take money away from some effective health programs, others say it's needed to bring overall health care costs down. Patty Wight reports.

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Medicare Advantage is a private version of Medicare, through which insurance companies contract with the government to provide Medicare benefits. Portland-based Martins Point Health Care is one of those contractors, with their Generations Advantage program. And COO Larry Henry gives a thumbs down to the proposed 2 percent cut to the program.

"Well, as a health plan that covers nearly one out of 10 Medicare beneficiaries here in the state of Maine, these cuts are troubling," Henry says.

Troubling because they will likely result in higher premiums for consumers, says Henry. But health advocates like Wendy Wolf, of the Maine Health Access Foundation, say the cuts are warranted.

"When the Affordable Care Act was passed, one of the things that the legislation intended to do is bring down health care spending. And one of the ways that it was aiming to do this, was to look for areas where we're overpaying," Wolf says.

One of those places, says Mitchell Stein of Consumers for Affordable Health Care, is Medicare Advantage. If the program had lived up to its original intent, says Stein, it would never have faced the chopping block, because the whole idea behind it was to give private insurance companies a chance to do things more efficiently than the U.S. government.

"Unfortunately, over time, the private insurance companies have successfully lobbied," Stein says, "and now collect much more than the government spends on regular Medicare beneficiaries."

Stein says Medicare Advantage entices healthy seniors into their plans by offering extra benefits, such as gym memberships. And while that sounds nice, Wendy Wolf of the Maine Health Access Foundation says it's a benefit that probably shouldn't be included.

"I'll admit that I would love to have a plan that pays for my gym membership - I exercise every day," she says. "But there's a lot of data that shows that paying for a gym membership doesn't really get people to go to the gym, and go to the gym with a frequency that actually makes them healthier."

It's this type of "extra," says Mitchell Stein, that insurance companies may have to pull back on. But he says those with Medicare Advantage plans shouldn't worry about losing their base benefits.

"This isn't a cutback in what Medicare is providing to the enrollees," he says. "What this is is an attempt to really reign in the insurance company profits and make Medicare the equitable program it was designed to be."

And it's important to remember, says Anne Smith of Legal Services for the Elderly, that the Affordable Care Act has actually improved Medicare benefits, "both in the orginal Medicare and Medicare Advantage plans," Smith says. "People are now able to get free preventative benefits, where that wasn't the case before the Affordable Care Act."

Even so, Larry Henry of Martins Points says good Medicare Advantage plans aren't comparable to regular Medicare, and that's the problem with trying to bring payments in line. Whereas Medicare is a fee-for-service model, Henry says Martins Point's Generations Advantage plans use a so-called " coordinated care" model.

"Providing value-added services that try to help members stay healthy, get healthier, avoid readmissions - you know, nurses that are making phone calls to, and on behalf of, seniors - those kind of services aren't in traditional Medicare, and we believe they're so important," Henry says.

Henry points out these proposed cuts are on top of others, and the cumulative effect makes it more challenging to provide stable, quality health care plans. He says he hopes that the cuts will ultimately be reduced.


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