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Private fee-for-service Medicare | from Boston Globe
http://www.boston.com/business/healthcare/articles/2007/10/24/seniors_healthcare_choices_expand/?page=1
Seniors' healthcare choices expand
Private Fee-For-Service Medicare [that] often provides advantages for members compared with traditional Government-Administered Medicare...but there are Hidden Drawbacks that Insurance Companies and the Government don't publicize.
By Jeffrey Krasner, Globe Staff | October 24, 2007
Massachusetts Health Insurers are promoting a new type of Medicare Coverage for Seniors in 2008 that potentially offers better coverage than traditional government-sponsored Medicare.
The new plans, called Private Fee-For-Service, also raise questions about the Long-Term Direction of Medicare because they cost MORE than traditional coverage but are NOT held to Higher Quality and Efficiency Standards.
Under traditional Medicare, Seniors CHOOSE their doctors and hospitals, and are typically responsible for a 20 Percent CoPay regardless of the service.
The government handles the billing.
Private Fee-For-Service is similar, except the plans are set up and administered by Insurance Companies.
Copayments are often lower than 20 percent, and insurers sometimes add benefits.
Though they have proliferated nationwide since the Medicare Modernization Act was passed in 2003, there weren't any Private Fee-For-Service plans in New England until January.
Harvard Pilgrim Health Care led the way in Massachusetts, switching all its Medicare coverage to Private Fee-For-Service this year.
It has about 20,000 members in the plan, called First Seniority Freedom.
For 2008, Blue Cross Blue Shield of Massachusetts and Tufts Health Plan are adding Private Fee-For-Service alongside more standard coverage like Medicare HMOs.
The pitch to Seniors is that the Private Plans offer more Benefits than traditional Medicare, such as coverage for Dental, Vision, and Hearing Services.
Also, they don't restrict members to particular doctors or hospitals.
They also do not require subscribers to choose a primary care physician or get a referral to see a specialist.
For 2008, Harvard Pilgrim Health Care is expanding its Fee-For-Service plans to members throughout Massachusetts, New Hampshire, and Maine.
"Harvard Pilgrim was one of the first health plans in this region to realize that a Private Fee-For-Service plan offers Medicare Beneficiaries great choice and comprehensive coverage," chief executive Charles D. Baker said in a statement.
Blue Cross Blue Shield of Massachusetts, the state's largest insurer with about 3 million members, is introducing a Private Fee-For-Service plan called Blue Medicare PFFS.
For seniors who don't receive health benefits from their former employers, the monthly premium is $27.
The many types of Medicare coverage can be confusing.
A 1997 federal law allowed Private Insurance Companies to offer new types of Medicare coverage.
In addition to HMO networks, they began selling Medicare coverage through Preferred-Provider Organizations, which are less restrictive than HMOs.
Together, the options are called Medicare Advantage.
Private Fee-For-Service plans are the fastest-growing type of Private Medicare.
As of February, they accounted for 18 percent of Medicare Advantage beneficiaries nationwide, and are growing faster than other Private Medicare plans.
"The Open Access is what makes this attractive to folks," said Patty Blake, vice president of senior products for Tufts Health Plan.
But freedom from networks can also have disadvantages.
For instance, doctors aren't required to accept the coverage, so a Senior may be unable to get care from a specific doctor
"It's like gold to say that members can see any provider they want," said Cindy Parks Thomas, a senior scientist at the Heller School for Social Policy and Management at Brandeis University in Waltham.
"But what looks good in marketing materials may not be as |  | asked by grandpa24551, 10/26/2007 |
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