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Friday, September 25, 2009

Private Medicare Cheated My Elderly Mother Out of Stroke Care/Arizona Medicare Advantage

posted by 26Dems

President Obama has called for cuts in private Medicare Advantage plans because costs have ballooned nearly 20% since the Medicare Advantage program began. Medicare Advantage costs the government an average of 14% more. The Bush administration encouraged the expansion of this program ostensibly to provide more choices, but the effect was to increase insurance company profit. Seniors were wooed into these plans with promises of extra coverage for eyeglasses and in some cases dental care and health club memberships.

Now Republicans are scaring seniors that they will lose benefits if the Democrats make "cuts" to Medicare. What they are really afraid of is losing the government's welfare subsidy for private insurance companies. Indeed seniors should consider the consequences of allowing a private corporation to take charge of care when you are healthy, and then deny you care or give you inadequate care when you have a heart attack stroke, cancer or anytime when your medical needs cost them too much money.

A Real Life Senior Horror Story

My active 80-year old Mother signed up for a Cigna HMO in the early 90's. She complained that her doctor didn't accept what Medicare set for payments requiring her to pay extra. Cigna invited her to a dinner and made attractive promises that she wouldn't have to pay a dime for anything extra. Then--she had a stroke. Her speech slurred and one side of her face drooped. Her right arm was partially paralyzed. Proudly independent, but legally blind, she found herself helpless and depended on neighbors around her to take her to the clinic. She could not speak clearly. Cigna doctors saw her and prescribed aspirin and sent her home. They set no further appointments, nor recommended any CT scans or blood tests. Finally when my mother had regained her speech, she phoned me. I tried to get copies of her medical records. Cigna refused. I then took steps to restore her membership in traditional Medicare. Her regular doctor ordered an MRI and found that she had suffered a rather severe stroke. With proper medical care she lived another 6 years. Had my mother not had someone to look out for her the insurance bureaucrat administering Medicare + Choice rationed care might have "killed Granny" sooner.

In 2007 Linda Brown of the Arizona Advocacy Network wrote an article published in the Tucson Citizen "The Public Cost of Privatized Medicare."At that time 37.5% of eligible Arizonans were enrolled in private Medicare plans, one of the highest rates in the nation. In 2005 nationally 88% of Medicare enrollees were served by traditional Medicare. Only 12% selected Medicare Advantage plans. According to a Kaiser Family Foundation report Medicare HMO's have been available since the 70's and the Balanced Budget Act in 1997 expanded to Medicare+Choice.

Seniors in Pima County face bewildering choices if they decide they want to enroll in a private plan. Insurance marketing and PR often influence seniors to make a hurry-up choice without comparison to what benefits they would get under traditional Medicare.

49 plans are offered in Pima County in 2009. These include Health Maintenance Organizations (HMO); Private Fee for Service (PFFS); Preferred Provider Organization (PPO); Special Needs Plans (SNP). According to the State Health Insurance Assistance Program (SHIP) seniors should evaluate these plans on cost, choice of doctor, benefits prescription coverage, flexibility and convenience. Download the (SHIP) pamphlet for more information.

A truly independent evaluation of health risks of signing up for a Medicare Advantage plan vs traditional Medicare requires counseling for consumer and health protection.

Contact Pima Council on the Aging for advice.