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Consumer
group testifies that CMS’ lax oversight of
Medicare Private Health Plans results in
significantly more out-of-pocket costs for
Americans with Medicare...Congress must end
Medicare private Fee-for Service Plans’
exemptions from Bid and Benefit Packages
Review --
New York, NY, October 16, 2007 –Today the Medicare Rights Center testified before
Congress that the Centers for Medicare and
Medicaid Services’ failure to audit Medicare
private health plans, or to impose penalties
on plans when audited, results in older and
disabled Americans in the plans not getting
the health benefits they are entitled to
receive and taxpayers not getting what they
pay for.
Paul Precht, Deputy Policy Director at the
Medicare Rights Center, a national consumer
service organization, testified that the
sickest Americans enrolled in Medicare
private health plans pay much more for their
health care than if they had Original
Medicare.
People who receive chemotherapy, inpatient
hospital care, home health care and skilled
nursing care through Medicare private health
plans incur greater out-of-pocket costs than
they would through the public Medicare
program and cannot insure themselves against
these prohibitive costs.
The Medicare Rights Center is calling for
the Centers for Medicare and Medicaid
Services to use its legal authority to
prohibit plans from designing benefit
packages that penalize sick people enrolled
in the private plans or force them out of
the plans entirely.
The Medicare private fee-for-service plans
are exempt by Congress from the same review
of plan bids and benefit packages that
Medicare HMOs and other types of Medicare
private health plans are required to get.
This means that Congress, people with
Medicare and taxpayers have no idea if they
are “getting their money’s worth,” testified
Mr. Precht.
The Medicare Rights Center recommends that
Congress remove these special exemptions for
the Medicare private fee-for-service plans.
The Medicare Rights Center is also calling
for Congress to require the Medicare private
health plans to standardize their benefit
packages just as Congress required the
standardization of Medigap plans to prevent
confusion, and deceptive and fraudulent
marketing practices.
The national consumer group also testified
that the Centers for Medicare and Medicaid
Services’ oversight of the Medicare private
health plans’ appeals and grievances
processes is sorely lacking. A recent review
found that 94 percent of plans audited
failed to meet such CMS requirements.
A copy of the Medicare Rights Center’s
testimony before the joint
hearing on “Statutorily Required Audits of
Medicare Advantage Plan Bids” before
the United States House of Representatives
Committee on Ways and Means and the
Subcommittees on Health and Oversight is
available at
http://www.medicarerights.org/PrechtTestimony101507.doc
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