November 2009: The debate continues over Medicare Advantage and whether or not private Medicare plans are a good thing for seniors and/or Medicare. Plan information is now available on the Medicare.gov website where you can compare the details of plans offered in your state and county.
Seniors in Arizona are facing substantial changes in their plans in 2010, including a $36 monthly premium for a plan that has always been $0. Doctor visit co-pays have gone up about $5 in every plan offered in Tucson, AZ. Hospital co-pays that would be $900 in 2009 will be $2,000 next year. Seniors are advised to get sick before the end of this year to save money. (Just kidding.)
I decided to take a look at plans in Florida, where Medicare pays insurance companies the highest amount for seniors enrolled in Medicare Advantage plans, and I was shocked to see that seniors in Florida are not facing the same cost increases as older citizens in Arizona. In fact, for seniors enrolled in most HMO Medicare Advantage plans in Florida, their healthcare is practically free!
Let’s look at plans offered by the same company, Humana, in both Arizona and Florida. I was shocked by the differences.
| Humana Gold Plus HMO Pima County Arizona |
Humana Gold Plus HMO Dade County Florida |
|
| Monthly premium | $0 | $0 |
| Hospital stay | $195/day, days 1-7, $0 days 8 + | $0 (no limit to days in hospital) |
| Doctor office visit | $10 primary doctor, $35 specialist | $0 |
| Outpatient surgery | $35 – $150 | $0 – $50 |
| Labs, x-rays, radiology | $10 – $150 | $0 – $50 |
| Annual max-out-of-pocket | $5,000 | $3,400 |
| Average Medicare payment per enrollee | $797 per month | $1,013 per month |
Senator Kyl of Arizona has been a vocal defender of Medicare Advantage plans, saying seniors in his state should not lose the benefits and choice offered through private Medicare plans. Senator Ben Nelson, a Democrat from Florida, added an amendment to the Senate Finance Committee healthcare bill that would protect added benefits in Medicare Advantage plans such as free gym memberships, dental and vision services.
Senator Kyl seems to be protecting choices for Arizona seniors that are mediocre at best, while Senator Nelson’s constituents have the gold standard in healthcare plans.
It would seem that companies like Humana are taking advantage of high fee-for-service costs for Medicare beneficiaries in states like Florida. Because Medicare Advantage plans are based on the fee-for-service averages in a state, Humana is able to offer managed care plans that have excellent benefits for enrollees. The problem is that this does not save Medicare money, which was the original purpose for allowing private insurance companies to offer and manage Medicare Advantage plans.