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Medicare Handbook Misleads Seniors About Private Plan Costs, Democrats Charge

By John Reichard, CQ HealthBeat Editor

October 26, 2006-- The Bush administration is using the "Medicare and You" handbook as a marketing tool for private plans rather than making sure it gives seniors and the disabled a balanced view of their 2007 coverage options, four Democrats charged in a letter to HHS Secretary Michael O. Leavitt this week.

Mailed to some 43 million Medicare beneficiaries to explain their coverage options for next year, the handbook sugarcoats the costs associated with HMOs, PPOs, and other private plans offered in the Medicare Advantage (MA) part of Medicare, the Democrats said.

The handbook hypes cost savings associated with MA plans as compared with "Original Medicare," but it does not point out that the plans can require cost-sharing amounts higher than amounts in the traditional part of the program, said the letter, which was sent Wednesday. Sens. Max Baucus of Montana and John D. Rockefeller IV of West Virginia and House members Charles B. Rangel of New York, John D. Dingell of Michigan, Pete Stark of California, and Sherrod Brown of Ohio signed the letter.

MA plans can charge more for services than traditional Medicare, the Democrats claimed. "A recent study by the Commonwealth Fund found that some MA plans charge as much as $300 per day for hospital care and $5,600 for cancer chemotherapy," the letter said. "For beneficiaries in poorer health who get admitted to a hospital several times a year or need cancer care, MA costs could be far higher" than in traditional Medicare, the letter said.

A statement in the handbook that beneficiaries who are happy with current coverage need not make a change in 2007 is "improper" because "virtually all plans make changes to their premiums, covered benefits, and cost sharing from year to year," the letter adds.

The wording of the handbook also might make seniors less vigilant than they should be about potential changes in prescription drug plan formularies of covered drugs, the letter suggested. It implies that changes only occur "as a result of changes in drug therapies or as new medical knowledge becomes available," the letter said. "This is untrue. Drug plans can and do change their formularies for business and other reasons, and beneficiaries should know this," the Democrats said.

Although the language in the handbook is too late to change, "equally biased and problematic" language on Medicare Web sites "could be corrected virtually overnight," according to the letter.

The Centers for Medicare and Medicaid Services issued a statement Thursday saying that the handbook was tested extensively with beneficiaries to ensure that it presented material "in a clear, comprehensive, and objective manner." The agency said that in preparing the handbook, it relied on advice from various groups including outside organizations that help beneficiaries enroll in the drug benefit.

HHS spokeswoman Christina Pearson added that "throughout this process, we've sought and incorporated input from those outside the department and are always willing to consider constructive suggestions. That said, the characterization of the language in the 'Medicare & You' handbook runs counter to the comments we've received from hundreds of beneficiaries, organizations and officials."

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