News As Obamacare goes into effect, new criticisms leveled

[WhoWee]

Sorry - here's a working link:

https://www.cms.gov/ManagedCareMarketing/Downloads/2011_MMG_060410.pdf

Skim from page 145 to 165 - just for fun.

 

[ParticleGrl]

It's not clear how much of "insurance's" overhead is due to Medicare/CMS and state regulations compliance - any idea?

I have no idea how you could begin to pull it from the data in the report. I know the administrative cost data does not include the marketing costs, etc, but it certainly includes the cost of complying with regulations.

On the flip side, the cost of overseeing the regulations shows up in the medicare administrative costs.

Either way, since its once yearly, and more or less cost-fixed, I'd be willing to bet its a very small percentage of administrative costs on both sides.

 

[nismaratwork]

There is a lot of information to consider - a quick CMS link - a few downloads:

https://www.cms.gov/ManagedCareMarketing/03_FinalPartCMarketingGuidelines.asp

"Downloads
2012 Revised Draft Medicare Marketing Guidelines Memo, 1/06/2011 [pdf, 62Kb]

2012 Draft Medicare Marketing Guidelines [zip, 1Mb]

2011 Medicare Marketing Guidelines Memo, 6/04/2010 [pdf, 223 Kb]

2011 Medicare Marketing Guidelines [pdf, 1.5Mb]

Allowable Use of Medicare Beneficiary Information Obtained from CMS & Prohibition on Using Federal Funds for Non-Plan Related Activities [zip, 73Kb]

Clarification of MMG and Appeals Related Error in Annual Notice of Change/Evidence of Coverage Templates [pdf, 76Kb]

Clarification of Medicare Marketing Guidelines Requirements and Outbound Enrollment Verification Policy [pdf, 81kb] "

Thank you very much! To say that I have reading to do would be a grotesque understatement, but you've given links to someone who will read this. I still think you could put something together that would be a valuable guide, but this is certainly a fantastic place to start.

 

[mheslep]

On asymmetry of information, we seem to agree- correct me if I'm wrong?

If you standby your original claim on the subject no we do not agree. I granted asymmetric info exists, it creates challenges, and went on to provide some examples of how people routinely work around them. You stated information for patient-doctor is "completely" asymmetric , which I read as saying no work arounds are possible, especially if one goes on to conclude there "there is no market for healthcare." because of asymmetric information.

I'll get back to the rest of your reply time permitting.

 

[mheslep]

Medicare loses about 4% in overhead, to insurance's 11%. Further, look at:

http://www.cms.gov/NationalHealthExpendData/downloads/tables.pdf

Some more research on the subject will show you otherwise. That CMS overheard figure was the first go-to figure cited during the US healthcare legislation debate and it was shown to be at least superficial, and possibly misleading:

1. The CMS table gives 6.6% as the overhead figure in 2009, though I'd also read 3-4% elsewhere. Where did you get 4%?

2. Medicare doesn't include the huge fraud costs in that figure, some $60 billion last year according to AG Holder and the WSJ. To prevent that, Medicare would have have to staff a lot more qualified medical personnel - just like the private insurers do.

Advocates of government-run health insurance like to point to Medicare's low administrative costs (which, as I noted yesterday, is a controversial claim). But even if that factual claim were true, the argument would hardly be dispositive as to the greater efficiency of a publicly run system. As I put it in my recent Times article, "True, Medicare’s administrative costs are low, but it is easy to keep those costs contained when a system merely writes checks without expending the resources to control wasteful medical spending."
...
By taking the fraud and abuse problem seriously this administration might be able to save 10% or even 20% from Medicare and Medicaid budgets. But to do that, one would have to spend 1% or maybe 2% (as opposed to the prevailing 0.1%) in order to check that the other 98% or 99% of the funds were well spent. But please realize what a massive departure that would be from the status quo. This would mean increasing the budgets for control operations by a factor of 10 or 20. Not by 10% or 20%, but by a factor of 10 or 20.

http://gregmankiw.blogspot.com/2009/07/costs-versus-efficiency.html
http://online.wsj.com/article/SB124649425934283347.html
http://www.usdoj.gov/opa/pr/2009/May/09-ag-491.html

3.Medicare serves a market, the elderly, that has a high medical cost per patient, and since overhead scales on a per-patient basis, overhead is lower for the elderly:

Medicare beneficiaries are by definition elderly, disabled, or patients with end-stage renal disease. Private insurance beneficiaries may include a small percentage of people in those categories, but they consist primarily of people are who under age 65 and not disabled. Naturally, Medicare beneficiaries need, on average, more health care services than those who are privately insured. Yet the bulk of administrative costs are incurred on a fixed program-level or a per-beneficiary basis. Expressing administrative costs as a percentage of total costs makes Medicare's administrative costs appear lower not because Medicare is necessarily more efficient but merely because its administrative costs are spread over a larger base of actual health care costs.

http://www.heritage.org/Research/Reports/2009/06/Medicare-Administrative-Costs-Are-Higher-Not-Lower-Than-for-Private-Insurance This last one is not about overhead, but still goes to an evaluation of efficiency:
4. Medicare costs shifts onto the private system, paying only 85-95% of the going health care rate.
https://www.physicsforums.com/showpost.php?p=2344564&postcount=799

 

[ParticleGrl]

1. The CMS table gives 6.6% as the overhead figure in 2009, though I'd also read 3-4% elsewhere. Where did you get 4%?

I got it from the CBO report linked above.

2. Medicare doesn't include the huge fraud costs in that figure, some $60 billion last year according to AG Holder and the WSJ. To prevent that, Medicare would have have to staff a lot more qualified medical personnel - just like the private insurers do.

To my knowledge, this keeps getting revised down, so its not quite 60 billion. Further, that fraud number includes privately administered plans like medicare advantage. Look at http://paymentaccuracy.gov/high-priority-programs

Consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost.

3.Medicare serves a market, the elderly, that has a high medical cost per patient, and since overhead scales on a per-patient basis, overhead is lower for the elderly:

I dealt with this above, by using the CBO numbers to compare Medicare Advantage (which are private) plans to traditional Medicare. The numbers are still the same.

Also, overhead doesn't scale on a per patient basis, as I discussed above. If you only insure a pool of 22 year olds who never file any claims, you can push your overhead costs down to 0. It scales on a per claim basis.

especially if one goes on to conclude there "there is no market for healthcare." because of asymmetric information.

I concluded that all of the points together- extreme inelasticity, lack of consumer choice, large asymmetry of information, add up to create a market that doesn't operate efficiently, and shouldn't be expected to.

 

[WhoWee]

Further, consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost.

Let's take a look at how that 14% breaks down - specifically, what benefits are most likely to have a problem? Is any of it allocated to prescriptions? The "traditional fee-for-service" plan is Original Medicare - no prescription coverage included.

 

[ParticleGrl]

Let's take a look at how that 14% breaks down - specifically, what benefits are most likely to have a problem? Is any of it allocated to prescriptions? The "traditional fee-for-service" plan is Original Medicare - no prescription coverage included.

Fraudulent and improper payments are extremely had to estimate. It is my (admittedly limited) understanding that accurate numbers for improper prescription payouts haven't been compiled, which is also why medicare D improper payment numbers don't exist.

If someone else has these numbers, chime in.

 

[nismaratwork]

I'm just accepting that here, I can only read and learn... I'm so far out of my depth I can't see daylight.

 

[WhoWee]

Fraudulent and improper payments are extremely had to estimate. It is my (admittedly limited) understanding that accurate numbers for improper prescription payouts haven't been compiled, which is also why medicare D improper payment numbers don't exist.

If someone else has these numbers, chime in.

Are you suggesting these are estimates - rather than hard data? (my bold)

"Consider that medicare advantage has an improper payment rate of about 14%, compared to traditional fee-for-service improper rates of about 10.5%. The privately administered plans are seeing more fraud, not less, despite higher overhead cost. "

Also, please note the private plans operate under significant regulatory and compliance cost as noted in earlier posts.

Does anyone know what CMS means when they categorize something "an improper payment"? (Hint - look up medical billing/coding) Also look up the MIPPA/HIPPA and ARRA funding references posted earlier.

 

[WhoWee]

BTW - please also note MEDICARE ADVANTAGE plans pay INSTEAD of Medicare - excessive cost in a MAPD does not increase the cost to Medicare. Again, Medicare pays a FIXED amount to the private carriers each month for the MAPD's.

 

[nismaratwork]

BTW - please also note MEDICARE ADVANTAGE plans pay INSTEAD of Medicare - excessive cost in a MAPD does not increase the cost to Medicare. Again, Medicare pays a FIXED amount to the private carriers each month for the MAPD's.

OK... how the hell are elderly and sick people supposed to figure out ANY of this? I'm catching up, but I'm healthy and interested and I still find it painful to read through. When you add these twists and turns, why the hell is Medic.* considered a liberal "gift" to anyone?! Bankrupting ourselves while turning healthcare into something we need CPAa to slog through ist nicht KOSHER!

 

[ParticleGrl]

Are you suggesting these are estimates - rather than hard data? (my bold)

Please review the link above, for full information on methodology. The way to estimate fraud and improper payment rates is by careful auditing of a representative pool of beneficiaries, and extrapolation of those results to the whole.

Does anyone know what CMS means when they categorize something "an improper payment"?

It includes legitimate accounting mistakes and fraud, again see the link above. Its also worth noting that dropping the improper payment numbers to 0 won't recover the full amount. i.e. if a doctor erroneously receives $2000 instead of $1000, its an improper payment of $2000. However, only $1000 is recoverable.

please also note MEDICARE ADVANTAGE plans pay INSTEAD of Medicare - excessive cost in a MAPD does not increase the cost to Medicare.

The fixed payment from medicare for advantage plans is risk adjusted. Private companies get more money from medicare for sicker people- more cost on the private side will eventually lead to more cost on the public side.

 

[WhoWee]

I'm going to throw some gasoline on this fire:

https://www.humana-medicare.com/Plans/compare/details.aspx

"Physician and Hospital Costs:

Explains details for Physician and Hospital Costs Primary Care Physician: Specialist: Hospitalization:


$0.00 Copay per visit $0.00 Copay per visit $0.00 per admission

Amounts apply after any applicable deductible.


--------------------------------------------------------------------------------

Outpatient Mental Health Care
General
Information for Outpatient Mental Health CareAuthorization rules may apply.
In-Network
Benefits for Outpatient Mental Health Care$0 copayment for each Medicare-covered individual or group therapy visit.
Outpatient Services/Surgery
General
Information for Outpatient Services/SurgeryAuthorization rules may apply.
In-Network
Benefits for Outpatient Services/Surgery$0 copayment for each Medicare-covered ambulatory surgical center visit.
$0 copayment for each Medicare-covered outpatient hospital facility visit.
Ambulance Services
General
Information for Ambulance ServicesAuthorization rules may apply.
In-Network
Benefits for Ambulance Services$0 copayment for Medicare-covered ambulance benefits.
Emergency Care
General
Information for Emergency Care$35 copayment for Medicare-covered emergency room visits.Worldwide coverage.If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit
Outpatient Rehabilitation Services
General
Information for Outpatient Rehabilitation ServicesAuthorization rules may apply.
In-Network
Benefits for Outpatient Rehabilitation Services$0 copayment for Medicare-covered Occupational Therapy visits.
$0 copayment for Medicare-covered Physical and/or Speech and Langauge Therapy visits.
$0 copayment for Medicare-covered Cardiac Rehab services.
Durable Medical Equipment
General
Information for Durable Medical EquipmentAuthorization rules may apply.
In-Network
Benefits for Durable Medical Equipment$0 copayment for Medicare-covered items.
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
General
Information for Diabetes Self-Monitoring Training, Nutrition Therapy, and SuppliesAuthorization rules may apply.
In-Network
Benefits for Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies$0 copayment for Diabetes self-monitoring training.
$0 copayment for Nutrition Therapy for Diabetes.
$0 copayment for Diabetes supplies.
Colorectal Screening Exams
In-Network
Benefits for Colorectal Screening Exams$0 copayment for Medicare-covered colorectal screenings.
Immunizations
In-Network
Benefits for Immunizations$0 copayment for Flu and Pneumonia vaccines.
No referral needed for Flu and pneumonia vaccines.
$0 copayment for Hepatitis B vaccine.
Mammograms (Annual Screening)
In-Network
Benefits for Mammograms (Annual Screening)$0 copayment for Medicare-covered screening mammograms.
Inpatient Hospital Care
In-Network
Benefits for Inpatient Hospital CareNo limit to the number of days covered by the plan each benefit period.
$0 copaymentExcept in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Skilled Nursing Facility (SNF)
General
Information for Skilled Nursing Facility (SNF)Authorization rules may apply.
In-Network
Benefits for Skilled Nursing Facility (SNF)Plan covers up to 100 days each benefit period
No prior hospital stay is required.
$0 copayment for SNF services
Home Health Care
General
Information for Home Health CareAuthorization rules may apply.
In-Network
Benefits for Home Health Care$0 copayment for each Medicare-covered home health visit.
Chiropractic Services
In-Network
Benefits for Chiropractic Services$0 copayment for each Medicare-covered visit.Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers."




This Medicare Advantage Plan is for Medicare beneficiaries in Puerto Rico.
This is the link to the plans detailed Summary of Benefits - please review.

https://www.humana-medicare.com/BenefitSummary/2011PDFs/H4007012SBOSB11.pdf

 

[nismaratwork]

Chiropractic with HOME HEALTH!

Unless I'm missing details here, that list doesn't seem reasonable for the government to provide, and I do believe in the idea of the dreaded, "public option". I'm not for the public "magic" option though... holy <censored> mother of <worse> <incompressible swearing>.

What genius put that together... oh right... committees. "A cul-de-sac down which ideas are lured and then quietly strangled." (John A. Lincoln)

 

[WhoWee]

Chiropractic with HOME HEALTH!

Unless I'm missing details here, that list doesn't seem reasonable for the government to provide, and I do believe in the idea of the dreaded, "public option". I'm not for the public "magic" option though... holy <censored> mother of <worse> <incompressible swearing>.

What genius put that together... oh right... committees. "A cul-de-sac down which ideas are lured and then quietly strangled." (John A. Lincoln)

The benefits in Puerto Rico are quite generous, the Miami-Dade county plans and some of the Katrina-impacted areas in LA are also quite favorable.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

 

[nismaratwork]

The benefits in Puerto Rico are quite generous, the Miami-Dade county plans and some of the Katrina-impacted areas in LA are also quite favorable.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

I see another problem there... Miama-Dade is "pill central"... coincidence?

 

[Al68]

...When you add these twists and turns, why the hell is Medic.* considered a liberal "gift" to anyone?! Bankrupting ourselves while turning healthcare into something we need CPAa to slog through ist nicht KOSHER!

I can answer that one. Making politically advantageous "entitlements," as well as the tax code, too complicated to understand allows power hungry politicians to deceive people about them, and any potential changes to them, in order to gain political power. Sounds cynical, I know.

Personally, I think congress should repeal the entire U.S. code, effective after a year, and adopt a policy that no law can pass that can't be read aloud during session. Then they can re-enact whatever portion of the U.S. code they think is important enough, or they can simplify enough, to read aloud, or allow exceptions only with a 3/4 vote in both houses.

And laws that cannot be reasonably understood by those they apply to should be prohibited with no exception. As many times as I've heard "ignorance of the law is no excuse", how is ignorance of the law optional, given the law? The laws are purposely designed to make ignorance of them mandatory, which effectively gives government unlimited power to prosecute people at will, despite the fact that there is no reasonable reason to expect them to know what is or isn't illegal in many cases.

 

[nismaratwork]

I can answer that one. Making politically advantageous "entitlements," as well as the tax code, too complicated to understand allows power hungry politicians to deceive people about them, and any potential changes to them, in order to gain political power. Sounds cynical, I know.

No... that sounds just about right based on observation and human nature.

Personally, I think congress should repeal the entire U.S. code, effective after a year, and adopt a policy that no law can pass that can't be read aloud during session. Then they can re-enact whatever portion of the U.S. code they think is important enough, or they can simplify enough, to read aloud, or allow exceptions only with a 3/4 vote in both houses.

And laws that cannot be reasonably understood by those they apply to should be prohibited with no exception. As many times as I've heard "ignorance of the law is no excuse", how is ignorance of the law optional, given the law? The laws are purposely designed to make ignorance of them mandatory, which effectively gives government unlimited power to prosecute people at will, despite the fact that there is no reasonable reason to expect them to know what is or isn't illegal in many cases.

This is where I'm less effective... you seem to be adressing elements of the problem, but how to make it happen?

 

[WhoWee]

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

 

[nismaratwork]

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

Ah yes... and yet so hard to apply in politics. You try, and suddenly you're a "technocrat", or one of O'Reilly's "pinheads". How can the scientific method be implemented when the culture of at least one party is essentially anti-intellectual when they sell to the south/mid-west?

 

[ParticleGrl]

Unless I'm missing details here, that list doesn't seem reasonable for the government to provide, and I do believe in the idea of the dreaded, "public option".

First, why not? The private company thinks it can turn a profit on the spread between what medicare will pay them and what services the beneficiary will actually use.

Second, and this is important- the same thing that is driving medicare costs up is ALSO driving up private costs. The data shown earlier actually demonstrates that private costs are going up FASTER than medicare costs. Its important to realize that we don't simply have a medicare problem, we have a HEALTH CARE problem.

And, we aren't alone, many countries are feeling the strain of rapidly escalating costs.

The solution to the healthcare issue is simple. Use a proven method to solve the problem - here's one:

http://teacher.pas.rochester.edu/phy_labs/appendixe/appendixe.html

I could not agree more. Luckily this is built right into the new law. The creation of large data sets on which to perform evidence based analyses will allow for the identification of effective treatments. The problem with medicare is the same as the problem with healthcare- the costs are growing too rapidly to be sustainable. Hopefully, scientifically identifying effective treatments will turn this around.

My point is that Medicare pays a fixed premium to this carrier. The costs associated with use of the benefits are paid by the insurance company.

Its worth noting, of course, that the private carrier is turning a profit with this type of plan. I also don't understand what your point is with this plan? Some medicare advantage plans pay out to much? Some private companies create lavish plans in order to extract more medicare dollars? Puerto Rico has a different risk analysis?

 

[Al68]

How can the scientific method be implemented when the culture of at least one party is essentially anti-intellectual when they sell to the south/mid-west?

Just the south/midwest? How about the whole nation? The messages of the Democratic Party are consistently and specifically tailored for constituents who are ignorant about the issues, in every state.

 

[WhoWee]

Its worth noting, of course, that the private carrier is turning a profit with this type of plan. I also don't understand what your point is with this plan? Some medicare advantage plans pay out to much? Some private companies create lavish plans in order to extract more medicare dollars? Puerto Rico has a different risk analysis?

Every Medicare Advantage plan must address the same coverage issues as explained in the Summary of Benefits shown above. The plans must be submitted and approved by the CMS/Medicare. To claim the companies "create lavish plans in order to extract more medicare dollars" - please be more specific. How much more does Medicare pay for this very generous plan in Puerto Rico?

Again, the national average cost to Medicare for a Medicare Advantage (Part C) plan approximates $10,000 per year - this includes the plan shown.

A "lavish" plan that has a $0 deductible and $0 co-pay for a hospital stay and doctor visits is clearly going to cost the insurance carrier more money to service.

 

[ParticleGrl]

To claim the companies "create lavish plans in order to extract more medicare dollars" - please be more specific. How much more does Medicare pay for this very generous plan in Puerto Rico?

No doubt, this plan gets more than the national average, as its riskier to the insurance company. But I didn't actually make the claim, I asked you- what is your point? This plan exists, what conclusions am I supposed to draw from it?

 

[nismaratwork]

Just the south/midwest? How about the whole nation? The messages of the Democratic Party are consistently and specifically tailored for constituents who are ignorant about the issues, in every state.

Yes, but ignorance does have a regional componant.

 

[WhoWee]

No doubt, this plan gets more than the national average, as its riskier to the insurance company. But I didn't actually make the claim, I asked you- what is your point? This plan exists, what conclusions am I supposed to draw from it?

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Perhaps I should have posted a plan to compare it with - here's a $0 premium plan from the Cleveland, OH area - hospital is $220 per day for the first 8 days:

"Physician and Hospital Costs:

Explains details for Physician and Hospital Costs Primary Care Physician: Specialist: Hospitalization:


$10.00 Copay per visit $40.00 Copay per visit $220.00 per day, days 1-8

Amounts apply after any applicable deductible.


--------------------------------------------------------------------------------

Outpatient Mental Health Care
General
Information for Outpatient Mental Health CareAuthorization rules may apply.
In-Network
Benefits for Outpatient Mental Health Care$40 copayment for each Medicare-covered individual or group therapy visit.
Outpatient Services/Surgery
General
Information for Outpatient Services/SurgeryAuthorization rules may apply.
In-Network
Benefits for Outpatient Services/Surgery$150 copayment for each Medicare-covered ambulatory surgical center visit.
$50 to $200 copayment or 20% of the cost for each Medicare-covered outpatient hospital facility visit.
Ambulance Services
General
Information for Ambulance ServicesAuthorization rules may apply.
In-Network
Benefits for Ambulance Services$100 copayment for Medicare-covered ambulance benefits.
Emergency Care
General
Information for Emergency Care$50 copayment for Medicare-covered emergency room visits.Worldwide coverage.If you are admitted to the hospital within 24-hour(s) for the same condition, you pay $0 for the emergency room visit
Outpatient Rehabilitation Services
General
Information for Outpatient Rehabilitation ServicesAuthorization rules may apply.
In-Network
Benefits for Outpatient Rehabilitation Services$40 to $150 copayment for Medicare-covered Occupational Therapy visits.
$40 to $150 copayment for Medicare-covered Physical and/or Speech and Langauge Therapy visits.
$40 to $150 copayment for Medicare-covered Cardiac Rehab services.
Durable Medical Equipment
General
Information for Durable Medical EquipmentAuthorization rules may apply.
In-Network
Benefits for Durable Medical Equipment20% of the cost for Medicare-covered items.
Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies
General
Information for Diabetes Self-Monitoring Training, Nutrition Therapy, and SuppliesAuthorization rules may apply.
In-Network
Benefits for Diabetes Self-Monitoring Training, Nutrition Therapy, and Supplies$0 copayment for Diabetes self-monitoring training.
$0 copayment for Nutrition Therapy for Diabetes.
$0 to $10 copayment or 20% of the cost for Diabetes supplies.
Colorectal Screening Exams
In-Network
Benefits for Colorectal Screening Exams$0 copayment for Medicare-covered colorectal screenings.
Immunizations
In-Network
Benefits for Immunizations$0 copayment for Flu and Pneumonia vaccines.
No referral needed for Flu and pneumonia vaccines.
$0 copayment for Hepatitis B vaccine.
Mammograms (Annual Screening)
In-Network
Benefits for Mammograms (Annual Screening)$0 copayment for Medicare-covered screening mammograms.
Inpatient Hospital Care
In-Network
Benefits for Inpatient Hospital CareNo limit to the number of days covered by the plan each benefit period.
For Medicare-covered hospital stays:
Days 1 - 8: $220 copayment per day
Days 9 - 90: $0 copayment per day
$0 copayment for each additional hospital day.Except in an emergency, your doctor must tell the plan that you are going to be admitted to the hospital.
Skilled Nursing Facility (SNF)
General
Information for Skilled Nursing Facility (SNF)Authorization rules may apply.
In-Network
Benefits for Skilled Nursing Facility (SNF)Plan covers up to 100 days each benefit period
No prior hospital stay is required.For SNF stays:
Days 1 - 8: $0 copayment per day
Days 9 - 100: $50 copayment per day
Home Health Care
General
Information for Home Health CareAuthorization rules may apply.
In-Network
Benefits for Home Health Care$0 copayment for each Medicare-covered home health visit.
Chiropractic Services
General
Information for Chiropractic ServicesAuthorization rules may apply.
In-Network
Benefits for Chiropractic Services$10 copayment for each Medicare-covered visit.Medicare-covered chiropractic visits are for manual manipulation of the spine to correct subluxation (a displacement or misalignment of a joint or body part) if you get it from a chiropractor or other qualified providers."

Here is the Summary of Benefits link:

https://www.humana-medicare.com/BenefitSummary/2011PDFs/H8953002SBOSB11.pdf

The residents of Puerto Rico would clearly pay less for medical services than the people of the Cleveland, OH area - even though both would enjoy a $0 premium. Unfortunately, we don't know the contract amount for either plan.

 

[ParticleGrl]

I posted the plan to demonstrate the rich benefits - $0 deductible and lots of $0 co-pays. I don't believe the insurance companies are in favor of this plan structure - regardless of the contract amount.

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

 

[nismaratwork]

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

That... is a very good point.

 

[WhoWee]

Then why do they offer it? If they couldn't make money with it, they wouldn't offer it.

It seems there are 25 total Medicare Advantage plans with prescription benefitss included, available in Puerto Rico.

http://www.medicare.gov/find-a-plan/results/planresults/plan-list.aspx