Medicare pamphlet now includes caveats on private plan benefits

Responding to criticism from congressional Democrats and beneficiary advocates, the Centers for Medicare and Medicaid Services (CMS) has revised a Medicare handbook to include more information about extra costs that can be associated with private health plans.

The handbook, entitled “Medicare & You,” is delivered to every beneficiary each year and includes a wide range of information about the program’s benefits and enrollees’ options for coverage under traditional Medicare, private Medicare Advantage plans, private Medicare Part D prescription-drug plans and other types of private coverage.

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The guide underwent substantial revisions for the 2006 edition to reflect the introduction of Part D and concurrent changes made to expand Medicare Advantage.

Critics, however, accused the Bush administration of using the handbook as a political tool to promote Medicare Advantage, a program that most Republican policymakers support because it gives the private sector a larger role in administering Medicare benefits.

Administration officials repeatedly rejected the charge that politics played any role in the development of the handbook and defended its accuracy. But the 2008 edition is considerably more cautious in its descriptions of the upsides and downsides of selecting Medicare Advantage over the traditional, government-run Medicare program.

Acting CMS Administrator Kerry Weems told The Hill that the revisions reflected the input of congressional aides, who were given an advance preview of the guide in April. Weems noted that the handbook was essentially completed before he took the helm at CMS in September.

Lawmakers complained in previous years that they were not given an advance look or that CMS disregarded their input. This year, Weems said, “There was a more conscious effort … to take those comments into account.”

Senate Finance Committee Chairman Max Baucus (D-Mont.) is one of the lawmakers who has been the most vocal about CMS’s perceived promotion of private plans and was critical of the earlier editions of “Medicare & You.” An aide to Baucus said the 2008 version is more balanced in its descriptions of Medicare Advantage and traditional Medicare.

“I think this year they have made substantive changes to it,” the Baucus aide said. “They’ve neutralized it.”

The different editions of the handbook all make clear that beneficiaries who sign on to private health plans can only visit doctors and hospitals that have agreed to terms with the insurance company. But the earlier versions include less information about the differences between the deductibles and other out-of-pocket costs associated with private plans, as compared to traditional Medicare.

The Baucus aide credited CMS with providing more information about the differences in out-of-pocket costs between Medicare Advantage plans and traditional Medicare.

The evolution of “Medicare & You” over the last three years is evident in its descriptions of Medicare Advantage, as these typical passages illustrate.

In 2006, the handbook reads: “Medicare is working with your Medicare Advantage Plan or other Medicare Health Plan to help them provide even more coverage or lower the cost of your existing coverage.”

In 2007, the text is more conditional: “Your costs may be lower than in the Original Medicare Plan, and you may get extra benefits.”

This year’s edition is more explicit about the fact that the benefit packages and out-of-pocket spending for medical services can be very different from plan to plan: “These plans must cover medically necessary services. However, plans can charge different copayments, coinsurance, or deductibles for these services.”

One Medicare beneficiary advocate commended CMS for the new emphasis on cost sharing but said the handbook remains too favorable to Medicare Advantage over traditional Medicare.

The handbook “says in several places that Medicare Advantage plans have different cost sharing from traditional Medicare. They even admit that the cost sharing can be higher or lower than traditional Medicare,” Vicki Gottlich, senior policy attorney for the Center for Medicare Advocacy, wrote in an e-mail.

Nevertheless, Gottlich maintained that the guide is not adequately balanced.

“The handbook still has a bias towards private plans,” Gottlich wrote. Calling traditional Medicare a “health plan” alongside Medicare Advantage and other private plan options is misleading, she wrote. “Traditional Medicare is not a health plan in the same way … and should not be described as such,” she wrote.

The open enrollment period for Medicare Part D and Medicare Advantage started on Thursday. People on Medicare will have until the end of the year to choose their coverage options; Medicare Advantage enrollees also can change plans once between Jan. 1 and March 31, 2008.