November 2016 Issue [Report]
“Don’t Touch My Medicare!”
Is the beloved program on its last legs?
by Trudy Lieberman,
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The deductible for 2016 is $1,288 per benefit period; coinsurance is $322 per day for hospital stays lasting from sixty-one to ninety days.
This year, most people pay $121.80 for their Part B premium, as well as 20 percent coinsurance and a separate deductible—currently $166—for all Part B services.
Overall, MA plans are able to provide traditional Medicare coverage for 6 percent less than the government, but, Berenson points out, the data is misleading because MA plans attract healthier beneficiaries who need less care: “We are trying hard to adjust payments for health status, but so far we haven’t been successful enough to adjust for the favorable selection MA plans enjoy.” Furthermore, he adds, the plans’ ability to manage their costs is helped by government regulation that permits them to pay hospitals the lower Medicare rates, not the 75 percent higher rates carriers pay for their commercially insured patients.
The saga of I.C.D.’s is far from over. Michael Gold, president of the Heart Rhythm Society, a professional organization for doctors who specialize in cardiac arrhythmias, said the DOJ settlement was disappointing. Insisting that the guidelines are outdated, the group is now pushing for reconsideration of Medicare’s national coverage determination to give doctors more “flexibility”—a euphemism for more money. It has been reported that Medicare is reviewing its decision.
When contacted by Harper’s Magazine, an AHIP representative simply affirmed that the Coalition for Medicare Choices “speaks on behalf of its two million members and the millions of beneficiaries who depend on the program for their health-care needs.”