[Writer Name]

[Supervisor Name]

Medicare and Medicaid

[Date]

Medicare and Medicaid

Introduction

This paper intends to discuss the topics of Medicare and Medicaid. Granted, Medicare is complicated stuff, with several types of coverage you can mix and match. Privately run Advantage plans replace the traditional government program with a PPO, HMO, or other network for doctors and hospitals; most plans also include prescription drugs, and many offer dental, vision, or hearing benefits as well. Unlike the government program, with its set premiums and co-insurance rates, Advantage plans vary widely in cost, with different premiums, co-pays, and other out-of-pocket charges.

Obama care would add 17 million people to the Medicaid rolls from 2014 to 2019, more than half of the 30 million uninsured Americans projected to gain coverage under the bill. That would be significant enough. But, intentionally or not, the proponents of Obama care overestimated the private-insurance count and underestimated the Medicaid count. Many Medicaid recipients will not trigger the bill's generous federal matching payments The purpose of this paper is to make the reader aware about the significance of Medicare and Medicaid along with their future implications.

Discussion

Medicare

Granted, Medicare is complicated stuff, with several types of coverage you can mix and match. Privately run Advantage plans replace the traditional government program with a PPO, HMO, or other network for doctors and hospitals; most plans also include prescription drugs, and many offer dental, vision, or hearing benefits as well. Unlike the government program, with its set premiums and co-insurance rates, Advantage plans vary widely in cost, with different premiums, co-pays, and other out-of-pocket charges (Allen & Ochinko Pp. 1-51).

Trouble is, many agents, in their rush to sign up enrollees and pocket fat commissions, fail to explain those crucial details, says LaNelle Godsey, director of Tennessee's fraud-fighting Senior Medicare Patrol. Under a rate schedule set by CMS, agents earn a typical $403 for every new Advantage customer, then $202 a year for the next five years for each renewal (the rates are even higher in a few states), vs. just $53 for signing up seniors for Medicare prescription-drug plans, which are also offered by private insurers. Or, Godsey says, some agents, particularly those selling multiple plans from multiple companies, may simply not take the time to learn the details of the plans (Holahan & Garrett Pp. 15-20).

The consequences of not spelling out the specifics can be severe, as some enrollees in Oakland insurer Arcadian Health's Advantage plan learned the hard way, according to a CMS investigation last year. In one case, CMS found, a cancer patient complained that an Arcadian agent told her--wrongly--that her oncologist was in the network. In the weeks it took to cancel the Arcadian plan and reinstate traditional Medicare, the patient went without chemotherapy treatment and her cancer progressed, CMS said. In another instance an agent wrote in the name of a primary doctor on an application form, telling the customer she could switch to her preferred doctor after enrollment. But it turned out her doctor didn't accept Arcadian insurance, CMS said. After finding ...