Medicare Advantage

Republican lawmakers rebuked the Obama administration Tuesday for telling health insurance companies to stop warning the elderly they would lose benefits in healthcare legislation. At least one prominent insurer has misrepresented the pending bills to frighten older Americans, the administration said. But GOP leaders said the companies, whose income could be reduced by the legislation, were entitled to free speech and political debate. The Senate's GOP leader, Mitch McConnell of Kentucky, said citizens and companies had "a fundamental right to talk about legislation they favor or oppose."

The Bush administration says its newly announced 17% increase in next year's Medicare premiums, on top of the 13.5% hike it imposed this year, will actually help seniors. "Medicare beneficiaries are ... paying a little more in premiums," said Medicare/Medicaid head Dr. Mark McClellan, "but they're getting more savings." McClellan's assumption is, to put it politely, hypothetical.

Not all sick patients are expensive. At 82, Bettie Lowden is about as chronically ill as they come. In addition to heart failure, she has diabetes and a history of heart attacks and strokes. Yet Medicare spends less than $1,000 a month on her care, or about half the agency's outlay for the average congestive heart failure patient for hospitalizations alone. Lowden belongs to Cerritos-based CareMore Health Plan Inc., a private Medicare Advantage contractor. Medicare pays CareMore a set monthly fee of $700 to $950 per patient.

After days of delay, Senate Democrats pushed ahead Thursday with their drive to pass a healthcare bill by Christmas, approving the first amendment to their giant bill: a measure to expand women's access to preventive services such as mammograms. The proposal by Sen. Barbara A. Mikulski (D-Md.), which passed on a largely party-line 61-39 vote, would authorize the federal government to require insurers to cover women's preventive care and screenings without co-payments. The amendment is expected to cost about $940 million over 10 years.

Some reader questions about the healthcare legislation in Congress: If the Senate bill is estimated to cost $ 848 billion over the next decade, how can Democrats say it will cut the federal budget deficit by $130 billion? The Congressional Budget Office says that the government will take in more in revenues from taxes and fees -- and save money by trimming the fat out of Medicare -- than it will spend extending health coverage to more Americans. Under the Senate plan, a tax on high-cost insurance plans is expected to generate about $150 billion over the next decade.

Big changes are coming to Medicare benefits received through some private plans, so experts urge participants not to wait for enrollment season this fall to learn what they'll need to do. The changes affect private insurers that provide coverage to Medicare enrollees under programs known as Medicare Advantage plans, which can sometimes offer a larger array of benefits for certain enrollees.

Health insurance giant Aetna Inc., trying to capitalize on growing enrollment in Medicare and Medicaid, has agreed to acquire Coventry Health Care Inc. for about $5.7 billion in cash and stock. The Hartford, Conn., company and nation's third-largest health insurer said the Coventry deal will allow it to add more than 5 million new members, many of them in faster-growing Medicare Advantage and Medicaid managed-care plans. Other insurers have been striking similar deals as they seek to take advantage of Medicare's growth as more baby boomers retire and the federal healthcare law adds an estimated 15 million Americans to the Medicaid rolls starting in 2014.

The battle over healthcare entered a new, more frenzied stage Wednesday, as lawmakers and powerful interest groups jockeyed for advantage now that most believe some form of an overhaul will ultimately be signed into law. The Senate Finance Committee's passage Tuesday of a sweeping healthcare bill -- with the support of all of its Democratic members, plus Republican Olympia J. Snowe of Maine -- offered powerful evidence that a moderate legislative blueprint...

My mother turned 65 this summer, an event Medicare marketers ensured she would not overlook. In the months before her birthday, slick brochures flooded her mailbox, touting Medicare health plans whose names alone promised virtues such as choice, value and advantage. Choosing a good plan was important. My mother, Harriet, suffers from Parkinson's disease and other ailments and takes more than a dozen medications every day.