Changing Your Medicare Without Your Consent Devereaux: The Latest Assault on Medicare

As we age, birthdays seem to be less a cause for celebration than a reminder of lost youth and increasing ailments and limitations.

As a family physician in Giles County, I learned that for many of my patients, turning 65 was actually a welcome event because it brought retirement and the opportunity to benefit from the Unquestionably the most popular health insurance in the country, traditional health insurance.

For a modest premium and additional coverage provided by a supplemental policy, my patients were often surprised to learn that almost all of their medical expenses were covered (except for some prescription costs) and that they could go to any health insurance provider or hospital in the country to worry about. These patients were often very relieved to find that after paying a small annual deductible, there was no longer a co-payment and they were no longer limited to the care of a health system or a doctor. specifically.

Unfortunately, traditional health insurance, which is chosen by 60% of the elderly, is the target of a pilot program initiated by the Innovation Center of the Center for Medicare and Medicaid Services (CMS) during the Trump administration called Direct health insurance contract.

This program has been given the green light to enroll up to 30 million of the current 36 million beneficiaries of traditional health insurance without their consent to a new arrangement with a direct contracting entity (DCE).


These new organizations would be insurance companies, for-profit health care groups, and even non-medical businesses that would receive a flat monthly fee for providing care rather than charging for care rendered as is the custom with the world. traditional health insurance.

These ELDs have generated a lot of interest from Wall Street investors because they would be allowed to spend as little as 60% of their payments on patient care and could keep the rest for profits and expenses. In comparison, traditional health insurance pays 98% of its expenses for patient care, with only 2% spent on administrative costs.

With this change, your doctor or health care organization would have an incentive to suspend or restrict care in order to maximize their profit, which cannot happen in traditional health insurance since care providers are not paid only for services rendered.

Additionally, DCEs would have a mechanism to maximize their monthly payments through a process known as upcoding, where patients are matched with additional diagnoses to maximize Medicare payments.

Have you ever wondered why your medical records often contain many diagnoses that are unrelated to your practice or hospital visit? This practice is a sneaky way to increase revenue for insurance companies and health care systems and increase the costs taxpayers bear for Medicare.

Surprisingly, this pilot program is taking place without any approval from our elected representatives in Congress.

Most legislators and other policy makers are unaware of this attack on Medicare although recently 54 members of Congress sent a letter to the Secretary of Health and Human Services Xavier Becerra calling at the end of the Direct health insurance contract program.

This isn’t the first time we’ve seen the health insurance industry try to take advantage of Medicare.

Most doctors who treat Medicare patients aren’t big fans of insurance companies that already have a large stake in Medicare in the form of Medicare Advantage plans.

These plans were supposed to save the government money by allowing insurance companies to “manage” their patients’ Medicare coverage for a monthly fee. Instead, these companies have profited mightily from practices that restrict care and charge patients more.

In 2019, Medicare Advantage plans cost the government $7 billion more than traditional health insurance, according to an independent analysis by the Kaiser Family Foundation. Insurance companies profit from marketing these plans to younger, healthier seniors.

The Federal Office of General Accounting is currently investigating the phenomenon of many patients abandoning these plans for traditional health insurance as their health deteriorates in the last years of their lives.

The last thing we need is an attack on traditional health insurance by insurance companies and others. Wall Street investors whose priority is to maximize profit rather than the welfare of Medicare beneficiaries. It’s time for the elders to say both Congress and the Biden administration to stop this latest attempt to privatize Medicare.

Devereaux is a member of Physicians for a National Health Program. He lives in Pembroke.

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