Cuts in Medicare Advantage program could affect 130,000 Nevada patients

By Jackie Valley

Wednesday, April 1, 2015 | 2 a.m.

Alfredo Alvarez, 71, typically visits two doctors a week. A diabetic, Alvarez has had triple-bypass heart surgery, diverticulitis and back surgery.

He pays $107 a month for Medicare Advantage — and says the money is well worth it.

That’s why he recently fired off a letter to U.S. Sen. Harry Reid opposing cuts to the Medicare program that insures seniors through private health plans.

“It has been a godsend,” said Charlotte Alvarez, 63. “It’s like a well-oiled machine the way it works. It makes it really easy.”

Local doctors say some of the plans’ benefits could end if the federal government approves a proposed 1 percent payment reduction to health providers in 2016. The Centers for Medicare and Medicaid Services is expected to announce its decision April 6.

Providers already have weathered cuts of almost 10 percent as part of the phase-in of the Affordable Care Act. A third year of slashes would be too much, critics say.

The program has faced greater scrutiny due to rising costs to taxpayers.

Private Medicare Advantage plans rely on monthly payments from the government based on the “risk score” of individual enrollees. The sicker the patient, the larger the flat monthly rate. But critics say the formula is flawed. The Center for Public Integrity found it triggered widespread billing errors and overcharges.

Medicare Advantage supporters say the proposed cuts would hurt the 16 million seniors and disabled people enrolled. About 130,000 Nevadans have Medicare Advantage plans, which offer less out-of-pocket costs, coordinated care and an emphasis on preventive medicine, said Dr. Tracy Wakefield, medical director for HealthCare Partners Nevada. More than a third have incomes of less than $20,000.

“Really, they’re getting a bigger bang for their health-care buck,” she said.

America’s Health Insurance Plans, a trade association that represents the health insurance industry, said cuts could lead to benefit reductions and premium increases of up to $20 per month.

Wakefield said it’s too early to know exactly which benefits could be dropped from plans, but one possibility is eliminating care managers who help patients with multiple medical conditions stay on top of their care and appointments.

“Without access to this type of coordinated care, patients are going to have more issues, more returns to the hospital — things that cost everyone overall more,” Wakefield said. “The thing we want to do is prevent people from ending up in the hospital.”

Alvarez said he’s worried about how potential premium increases would affect seniors like his mother-in-law, who receive only Social Security income.

“They don’t have any other way to come up with more money,” he said.

Earlier this month, more than 200 members of Congress signed a letter to the Centers for Medicare and Medicaid Services voicing their opposition to the cuts. Wakefield urged citizens to do the same by writing letters to their members of Congress.

“We’re all optimistic it can be stopped,” she said. “Like anything else, it is important to make your voice heard to prevent these type of drastic cuts to a very essential program.”