A Brief Note On Medicare And Private Plans

1596 Words Oct 7th, 2015 7 Pages
Medicare was enacted in 1965 to provide health insurance for patients 65 and older. Since the 1970’s, Medicare has included private plans.1 This portion of Medicare has had different names: Medicare Part C, then Medicare + Choice, then Medicare Advantage (MA).2 Private plans in Medicare fail to reduce cost, worsen access and have variable influence on the quality of care that is provided to enrollees as compared to traditional fee-for-service Medicare (FFS Medicare). Expansion of the role of private plans in the Medicare environment can prove to be toxic. In the same vein, premium support for private plans would undermine our existing institution. Other solutions should be sought to improve care and decrease spending in Medicare.
Medicare private plans have dramatically changed since their beginnings. Congress initially allowed HMOs to contract with Medicare2, but now allows other insurance plans such as preferred provider organizations (PPOs) and private fee-for-service organizations (PFFS) to contract. A central theme in the interaction of private plans with Medicare is based around payment by Medicare to these private plans to take eligible patients. The Tax Equity and Fiscal Responsibility Act, the Balanced Budget Act, The Medicare Prescription Drug, Improvement and Modernization Act, and now the Patient Protection and Affordable Care Act (PPACA) have changed Medicare payments to private plans1 to ensure enough private players in the market to drive competition while…
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