What’s going to happen to Medicare? Part 2

Published 7:00 am Friday, February 24, 2017

By Trudy Lieberman

Director of the Rural Health News Service

It’s too early to say whether Congress will push for premium support this year.

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Democrats have already signaled they will fight back. It’s more likely that other changes could slip through that would radically alter Medicare and force beneficiaries to pay a lot more for their care.

One of them is a change in the rules on balance billing: physicians charging seniors and disabled people on the program more than what Medicare will pay. Most doctors accept Medicare’s payment as payment in full.

Those who don’t can charge patients only 15 percent more than Medicare’s payment. This limit offers protection against the high balance billing charges patients with other kinds of insurance are facing.

The nominee for Secretary of Health and Human Services Tom Price is no fan of the 15 percent rule and once proposed eliminating it, which may explain why he has gotten such a strong endorsement from the American Medical Association.

The AMA has called Price a leader in developing public policy to advance patient choice and “reduce excessive regulatory burdens.” Many doctors who work with Medicare patients would like to charge as much as they want.    

Congress may try to shift costs another way. The objective is to reduce what the government pays for beneficiaries’ care by making them pay more themselves.

One solution is to combine the deductibles for hospital and physician care into one, and impose an out-of-pocket spending cap for beneficiaries still enrolled in traditional Medicare. Two-thirds of beneficiaries are. Currently no such cap exists. (Seniors in MA plans do face such caps – last year as high as $6,700.)

If seniors in the traditional program also buy a Medigap plan, it’s possible they have what’s called “first dollar coverage.” That means medical expenses are covered from the beginning.

Congress has already begun to take that protection away. Beginning in 2020 insurers can no longer sell certain Medigap plans that provide for the first dollar coverage beneficiaries want. However, if you have such a policy, you can keep it.

Medicare does face some long-term funding shortfalls, and so far the acceptable solution is to require that seniors pay more rather than raise taxes for everyone or impose cost controls with teeth, which doctors, hospitals, drug companies, and other healthcare providers don’t want.

I will explore all that, including negotiating pharmaceutical prices, in a future column.