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Medicare Advantage Plans Backed by Program's Elderly Recipients

By Justin Blum

Oct. 24 (Bloomberg) -- Insurance companies including Humana Inc. and UnitedHealth Group Inc. brought senior citizens to Washington to lobby for Medicare-sponsored health plans that Democrats say are paid too much by the government.

More than 350 people enrolled in the privately run plans from 22 states came on the trip, which included visits to lawmakers and a rally today at a Capitol Hill hotel.

Congress has been debating whether to cut payments to companies that offer the Medicare Advantage plans. The policies provide benefits for the elderly that traditional Medicare doesn't, such as lower out-of-pocket expenses. The insurers are paid on average 12 percent more than the government spends to provide Medicare services directly.

``Keep our plan in effect, and don't take anything away from us,'' said Brenda Wheaton, 68, of Winchester, Virginia, in an interview after the rally. ``It's time that seniors were given a benefit and respect and a hand, if needed.''

Wheaton said her Humana plan costs her less than traditional Medicare and pays for additional services, including a gym membership. The retired legal secretary said she decided to attend the rally after getting an automated phone call from Humana.

About 8.8 million of Medicare's 43 million members have joined Advantage plans, which cost about $76.3 billion a year. Patients don't always realize that some plans may limit their choice of doctors and hospitals or require them to pay higher co- payments, lawmakers have said.

Health-insurance agents have tricked elderly customers into signing up for policies they can't afford and that can cut off access to longtime doctors, according to state insurance regulators who testified before Congress this year.

Industry Growth

Medicare Advantage sales fueled the growth in the insurance industry last year, according to Sally Rosen of A.M. Best Co., the insurance-rating service based in Oldwick, New Jersey. Some companies have profit margins of more than $1,200 a year for each Advantage enrollee.

AARP, the largest lobbying group for older Americans, wants to reduce payments to insurers for the Advantage programs, saying the money should be used to keep down Medicare premiums.

``We believe that the $54 billion in excess payments over the next five years can be better spent improving the Medicare program,'' said Andrew Nannis, a spokesman for the group, in an interview.

Retirees attending today's event said the government should pay for the coverage, even if it costs taxpayers more.

``I've saved a lot of money,'' said Charles Vandegriffe, 77, of O'Fallon, Missouri, in an interview after the rally.

`Don't Mess With It'

Vandegriffe, who has never had a traditional Medicare plan, said he has heard ``horror stories'' about them and planned to tell lawmakers to preserve Advantage.

``Don't mess with it,'' said Vandegriffe, a retired computer specialist. ``Don't be cutting our care. We've earned it.''

Ted Johnson, 84, of Buffalo, New York, said he and his wife, Yvonne, switched to a Humana plan from traditional Medicare and concluded the Advantage plan offered lower costs and better care.

``It was expensive, and they were not paying a big share'' under the traditional plan, said Johnson, a retired engineer, in an interview after the rally.

After switching to the Advantage plan, he said he had both knees replaced and then went to physical therapy, all at an out- of-pocket cost of about $2,500.

Mohit Ghose, a spokesman for America's Health Insurance Plans, an insurance industry trade group, said he wasn't sure how much his association and insurers paid to bring the seniors to Washington.

The visit included transportation, hotel accommodations, meals and a bingo game last night.

To contact the reporter on this story: Justin Blum in Washington at jblum4@bloomberg.net.

Last Updated: October 24, 2007 17:08 EDT

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