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April 05, 2012 01:00 AM

MedPAC urges new fee for Medigap plans

Rich Daly
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    Hackbarth

    Congress should add a new charge for Medicare beneficiaries who buy supplemental insurance, according to a recommendation from its advisory panel.

    The size of the fee for Medigap plans was not specified but left up to the secretary of HHS, according to a unanimous recommendation by the panel (PDF). Medicare Payment Advisory Commission members and other health policy experts have frequently criticized such plans as cost drivers for Medicare because they often cover all out-of-pocket costs for beneficiaries, which critics contend leads to overutilization of healthcare services.

    “There needs to be a recognition that their private decisions have implications for the Medicare and for taxpayers,” Glenn Hackbarth, chairman of MedPAC, said. “The vast majority of the cost of the beneficiary's decision to buy supplemental coverage is in fact borne by the Medicare program and the taxpayers who finance it.”

    Other panel members, who emphasized other parts of the recommended design benefit—such as creation of an out-of-pocket maximum for beneficiaries—said the recommendation was not motivated by a desire to reduce costs.

    “This whole effort is not motivated by a desire to achieve savings, but it's really motivated by a desire to have a benefit package that works for beneficiaries,” Michael Chernew, a panel member and professor in the Department of Health Care Policy at Harvard Medical School, said before the vote.

    Other changes recommended as part of an overhaul of the overall Medicare benefit package included adding deductibles for hospital and physician services and allowing the secretary to charge more or less cost sharing for specific services based on any evidence that those services add “value.”

    The combined changes may not end up reducing Medicare costs, according to MedPAC staff, as they aim to prevent high out-of-pocket costs and to create incentives for beneficiaries to choose care supported by a solid evidence base.

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