Reply With Quote4. "Don't expect a five-star plan."
Medicare's Five-Star Quality Rating System is designed to rank Medicare sold by private insurers. Often called Medicare Advantage plans, these policies offer Medicare Part A (hospital insurance) and Part B (medical insurance) coverage and sometimes extras like vision and dental coverage. They also often come with prescription drug coverage, or Medicare Part D. The star system is designed to recognize the best private policies with five stars. Medicare enrollees who couldn't find a five-star program during the open enrollment period that ended Dec. 7 can still sign up for one through Feb. 14.
But that's if you can find one of these policies in your area. "There are not a lot of these to choose from," says Adrienne Muralidharan, the senior Medicare specialist at Allsup, a site that provides Medicare resources. In fact, as of Nov. 30, five-star Medicare Advantage plans were available in just 10 states, according to an analysis by Allsup. The reason: It's hard to earn five stars. Plans are graded on several counts including customer service, how many doctors are in your network and prescription drug coverage.
A spokesman for CMS offers a similar explanation saying that "achieving a 5-star rating is Medicare's highest mark of excellence, and can only be obtained by those plans that are truly providing the highest quality care to beneficiaries."
Despite that fact that there aren't many five star plans now, Medicare is now creating new incentives and systems to increase the number of higher rated plans, says Baker of the Medicare Rights Center. "You see how consumers flock to cars that Consumer Reports rates highly," he says. "The expectation is that will happen in the Medicare Advantage market as well."
5. "We're not popular with many doctors."
Many doctors limit the number of Medicare patients they will treat, according to a new study. Roughly one in five physicians across all disciplines restrict the number of Medicare patients they will take on at a given time, according to a 2010 study by the American Medical Association. For primary care physicians, this number jumps to 31%.
These doctors often restrict the number of Medicare patients they will accept because they feel Medicare payment rates are too low (85% of overall physicians and 83% of primary care physicians, according to the study) and that the "ongoing threat of future payment cuts makes Medicare an unreliable payer" (78% and 82%, respectively), the AMA study showed. "A lot of doctors are just sick of hearing about these rate cuts," says Muralidharan. "They figure it's not worth it."
But despite the restrictions, Baker points out that most doctors do take Medicare. Typically doctors who won't accept Medicare are concentrated in specialties like neurology. And, they are often located in urban areas like New York and San Francisco, where a large number of consumers can afford to pay medical bills out of pocket. "Some doctors leave, but it's often the same doctors who stop taking insurance entirely," Baker says. "We haven't seen a significant number of doctors across the board stop taking Medicare entirely." A spokesperson for CMS says that "the number of doctors currently participating in the Medicare program is at an all-time high."
6. "We get ripped off a lot."
Last year, the Centers for Medicare and Medicaid Service saw "improper payments" for Medicare totaling $47.9 billion, according to testimony by Daniel R. Levinson, the inspector general of the U.S. Department of Health and Human Services. True many of these mistakes are due to clerical snafus such as eligibility errors and miscoded claims. But there is a growing body of evidence that shows fraud is a major contributor. The National Health Care Anti-Fraud Association estimates that at least 3 percent of the total spending on health care -- or more than $60 billion each year -- is lost to fraud. "Although it is not possible to measure precisely the extent of fraud in Medicare and Medicaid, everywhere it looks the Office of the Inspector General continues to find fraud against these programs," Levinson said in his testimony.
Medicare fraud takes many forms. Some of the most common include health-care providers manipulating payment codes to inflate reimbursement amounts or to bill for unnecessary or never-performed services. One of the costliest Medicare rip-offs involves pharmaceutical or medical technology companies "knowingly selling unsafe or ineffective pharmaceuticals, medical equipment, devices and other technologies," says Ken Nolan, a partner at Nolan & Auerbach, a health-care fraud law firm with offices in three states. "Medicare is susceptible to fraud not only because of its size and complexity, but because the system itself makes it easy to defraud the government," says Nolan. "Most of the scrutiny, if any, is made after payment is made -- not before as in traditional business transactions."
A spokesman from CMS says that the "Administration is doing a great deal to fight fraud and errors" and notes that this week the Department of Justice announced that it has recovered more than $2.9 billion from health-care fraud.
The Raiding Continues even today!
