curbs on private insurance plans that are popular with seniors in
Medicare, but have been criticized for marketing abuses and high
costs to the government.
winnowing the number of versions of a plan that insurers can offer,
protecting patients with chronic diseases from excessive copayments
and banning a practice by some plans that can add even more to the
costs of brand name drugs.
there is less confusion and more transparency, so consumers can
make well-informed choices,” said Jonathan Blum, who runs the
Medicare division that oversees private plans.
effort to put its stamp on private plans in Medicare, which
flourished under Republicans but are seen by some Democrats as
undermining the traditional program. The plans are offered by major
insurers such as United Healthcare and Humana.
marketplace so it’s easier for folks to compare plans,” said Paul
Precht, policy director of the Medicare Rights Center, an advocacy
group. Stronger minimum standards for the plans mean “when you get
sick, it’s harder to stick you with higher costs,” he
added.
medical coverage through such plans, and another 17 million are
signed up in private drug plans. Every year, they get the
opportunity to sign up or change plans during an open enrollment
period.
proposed payment cuts of 3.75 percent overall to private medical
plans that serve seniors. Insurers claim the cut could be as high
as 5 percent for some plans, and they’ll have to pass on the cost
through higher premiums or fewer benefits.
annual “call letter,” a contracting document that sets the rules
for insurers wanting to offer coverage in 2010. Insurers must
submit their bids by June 1.
of Medicare plans is meant to cut down confusion, not reduce
choice. Most insurers offer several variations on a basic plan.
Nearly 1,400 plans out of some 7,000 have fewer than 10 members,
officials said. Medicare will closely scrutinize the private plans’
bids for 2010 to eliminate offerings that only tweak a basic
plan.
make selecting a plan much more difficult,” said a Medicare
statement.
pricing policies that try to shift costs to beneficiaries with
chronic illnesses.
design their Medicare coverages. Some, for example, offer plans
that charge much higher copayments for a nursing home stay, cancer
drugs or kidney dialysis than does the traditional Medicare
program. That sends a signal to patients that people with those
conditions are not welcome. The administration said it will limit
copayments to the amounts charged under traditional
Medicare.
some prescription drug plans use to increase patients’ costs for
brand name drugs. In addition to a higher copayment for the brand
medication, these plans also tack on the difference between the
cost of the brand drug and a generic version. While higher
copayments will still be allowed, plans will no longer be able to
pass on the difference between the underlying costs of the brand
and generic medications.
