Democratic Underground Latest Greatest Lobby Journals Search Options Help Login
Google

Administration Releases Regulations To Scale Back Unfair Insurance Practices

Printer-friendly format Printer-friendly format
Printer-friendly format Email this thread to a friend
Printer-friendly format Bookmark this thread
This topic is archived.
Home » Discuss » Archives » General Discussion: Presidential (Through Nov 2009) Donate to DU
 
ProSense Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 06:44 PM
Original message
Administration Releases Regulations To Scale Back Unfair Insurance Practices

Administration Releases Regulations To Scale Back Unfair Insurance Practices

Last year, the Government Accountability Office (GAO) released a report revealing that Medicare Advantage Private-Fee-For-Service Plans (PFFS) — which are responsible for nearly half of the recent growth in MA enrollment — have exposed beneficiaries to serious financial risks. If beneficiaries in PFFS plans did not contact their plans before obtaining services to ensure that the service was covered, they may have had to “pay for the entire cost of the service if the coverage was later denied” and PFFS plans charged exorbitant cost-sharing to beneficiaries who did not “prenotify” a plan before obtaining services.

On Monday, the Center for Medicare and Medicaid Services (CMS) released new rules that would limit some of these predatory practices. Insurers participating in the Medicare Advantage must:

    - Cap out-of-pocket charges

    - Have more than 10 beneficiaries or they will be eliminated

    - Scale back their charges if they do not cap beneficiaries’ annual out-of-pocket costs at $3,400 or less, or if they charge beneficiaries more than traditional Medicare for
    ..services such as dialysis and home health care.

    - Not charge sick, low-income beneficiaries more than what they would contribute under traditional Medicare
The administration has proposed eliminating the government’s 13-17 percent overpayments to private insurers participating in Medicare Advantage, noting that the companies are funneling the extra money into profits, and failing to improve care quality. This might encourage bloated private plans that can’t compete with Medicare to pull-out. But then, why should the federal government continue over-paying private insurers, if that same level of care could be provided at a cheaper rate?

Opening up the process to competitive bidding might require some seniors to switch policies, but only if their plan chooses not to bid or cannot provide services at the the market-driven rate. Even then, beneficiaries wouldn’t lose their Medicare benefits (they will continue to receive Medicare, albeit with some disruption as they move back to fee-for-service or find another MA plan), just the extra benefits that some Medicare Advantage plans provide.

UPDATE For more on the new regulations, click here.





Printer Friendly | Permalink |  | Top
Kdillard Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 06:49 PM
Response to Original message
1. Excellent move in the right direction.
Printer Friendly | Permalink |  | Top
 
liberal N proud Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 06:50 PM
Response to Original message
2. What? No "no bid contract"
:bounce:
Printer Friendly | Permalink |  | Top
 
karynnj Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 08:36 PM
Response to Original message
3. This sounds like a good step in the right direction nt
Printer Friendly | Permalink |  | Top
 
babylonsister Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 09:50 PM
Response to Original message
4. Rec'd for some good news. nt
Printer Friendly | Permalink |  | Top
 
firedupdem Donating Member (1000+ posts) Send PM | Profile | Ignore Wed Apr-01-09 11:39 PM
Response to Original message
5. Rec'd. Another good move. n/t
Printer Friendly | Permalink |  | Top
 
avaistheone1 Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-02-09 12:19 AM
Response to Original message
6. Sounds like the goverment is doing a good job with this.
:applause:
Printer Friendly | Permalink |  | Top
 
SpartanDem Donating Member (1000+ posts) Send PM | Profile | Ignore Thu Apr-02-09 12:56 AM
Response to Original message
7. nice to see
an Admin where regulation isn't a four letter word.
Printer Friendly | Permalink |  | Top
 
DU AdBot (1000+ posts) Click to send private message to this author Click to view 
this author's profile Click to add 
this author to your buddy list Click to add 
this author to your Ignore list Sun Nov 03rd 2024, 07:06 AM
Response to Original message
Advertisements [?]
 Top

Home » Discuss » Archives » General Discussion: Presidential (Through Nov 2009) Donate to DU

Powered by DCForum+ Version 1.1 Copyright 1997-2002 DCScripts.com
Software has been extensively modified by the DU administrators


Important Notices: By participating on this discussion board, visitors agree to abide by the rules outlined on our Rules page. Messages posted on the Democratic Underground Discussion Forums are the opinions of the individuals who post them, and do not necessarily represent the opinions of Democratic Underground, LLC.

Home  |  Discussion Forums  |  Journals |  Store  |  Donate

About DU  |  Contact Us  |  Privacy Policy

Got a message for Democratic Underground? Click here to send us a message.

© 2001 - 2011 Democratic Underground, LLC