Reporting
Jon Delano
PITTSBURGH (KDKA) ―
Just when you would expect less confusion in your life, seniors often face a bewildering assortment of health insurance options.
Since 1965, Medicare has provided some coverage for seniors -- but it has lots of gaps in coverage, high deductibles and costly co-pays.
So in recent years, the government -- through rules and lots of money -- has encouraged private insurance companies to step in.
Now a new administration may be questioning the cost of this approach.
"In Allegheny County, over 50 percent of Medicare beneficiaries are enrolled in a Medicare Advantage plan, so this is actually an area where, nationally, has one of the highest percentages of people enrolled in Medicare Advantage plans," says Cathy Batteer of UPMC Health.
A majority of seniors here opt for a private insurance program called Medicare Advantage instead of the traditional government Medicare program.
"It's a combination of extra benefits that Medicare doesn't cover, lower out of pocket costs," adds Batteer.
Batteer says for a little more than the monthly Medicare fee, seniors can get a lot more benefits, lower co-pays and minimal deductibles.
Over at Highmark -- the area's largest insurer of over a quarter million local seniors -- Tim Lightner echoes the same about Medicare Advantage.
"They provide benefits that individuals are not entitled to through traditional Medicare -- there's vision, dental, hearing benefits -- and they also include a prescription drug benefit which is of great value to a lot of seniors," says Lightner.
But the government -- which regulates Medicare Advantage -- has announced some changes for 2010.
"The changes that we see so far are not really earth-shaking and what we were the most worried about," notes Jim McTiernan at Triad USA, a company that advises organizations about health insurance.
McTiernan says most of the changes will not affect local seniors. The insurance companies agree.
"We don't think will have a big impact on our members in that a lot of the changes being proposed, we already have in place," says Highmark's Lightner.
What would really worry insurance providers is a cut in medical reimbursements.
"That could have some profound changes actually to the Medicare Advantage plans," says Batteer.
So while these recently announced rules may not affect local seniors all that much, the insurers are waiting for more important reimbursement rules that are expected from the Obama administration next week.
Because the Bush administration favored the insurance companies with more Medicare dollars, they were able -- insurers say -- to offer more services to seniors at reduced rates.
But at a time of record budget deficits, it's not clear yet that President Obama will follow that same course.
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