New Study Questions Part C Private Pay Plans
Opponents of Medicare privatization praised a study released last week that questions whether private fee-for-service (PFFS) plans yield their much-touted cost savings and adequately serve the elderly and people with disabilities compared with traditional Medicare.
Prepared by the pro-Medicare Center for Medicare Advocacy, the study examined the PFFS plan options in Medicare Part C. PFFS The report found that people in these plans "may not have the same access to providers that they would have under traditional Medicare." It also concluded that consumer protections in PFFS plans may not be as good as in other Part C plans and that services may cost more than under traditional Medicare.
PFFS plans are required to provide the medically necessary health-care services of traditional Medicare. They also do not require people covered by PFFS plans to use a network of providers. But, the CMA's study points out, providers who otherwise accept Medicare patients can refuse to treat PFFS participants, which means beneficiaries could find their access to medical care unexpectedly restricted. CMA points to reports that some PFFS enrollees have had trouble finding physicians who would accept their insurance.
CMA's researchers also found that there is no limit to what PFFS patients can be charged on top of the regular Part B premium. "Although PFFS plans typically adopt Medicare billing practices," the study claims, "a PFFS plan enrollee could potentially pay much more for identical services than a beneficiary in traditional Medicare . . ."
CMA researchers are alarmed that patients in PFFS plans can be hit with deductibles, co-payments, and co-insurance amounts that depart from Medicare practice. They can also face premium charges for what the plans calls "extra" benefits, which can include prescription medications.
The full report is available at www.medicareadvocacy.org/MA_PFFSPrimerForAdvocates.pdf
This article originally appeared in the May 2007 issue of HME Business.