Curt Calcaterra: The advantage in Medicare Advantage plans
I write in response to Nancy Spillane’s letter published Oct. 21. While I agree there is often excessive profit by private insurers and too much cost for Medicare beneficiaries, let’s not be quick to lay the blame on Medicare Advantage plans.
Let me share my perspective. Before moving to Steamboat full time two years ago, I practiced internal medicine in St Louis, Missouri, for 34 years. I served a senior population, many of whom were entirely dependent on Social Security for their income. They had difficulty affording the several hundred-dollar premiums private insurers charged for Medigap policies under traditional Medicare. Facing the high deductibles and copays these plans required sometimes kept them from seeking care in a timely manner, often resulting in worsening of their medical conditions.
Frustrated with this high cost and low value care, our medical group created one of the first physician-founded Medicare Advantage plans, Essence Health Care, more than a decade ago. Unlike traditional Medicare, our plan focused on prevention and early disease treatment.
We sought out and treated those high medical risk patients in our practice who most needed but often did not seek care. We developed disease management programs and gave our patients 24-hour phone access to their doctor, thereby reducing the need for expensive ER visits and hospital stays. Our plan eliminated the need for our patients to spend hundreds of dollars on Medigap policies, offering full coverage with no premium. Our plan also provided gym memberships, dental and vision care not covered under traditional Medicare.
I believe the future of senior health care lies in Medicare Advantage plans that emphasize wellness. By focusing on population health, these plans along with government sponsored Accountable Care Organizations for traditional Medicare beneficiaries can achieve a healthier senior population at a lower cost. However, they must in my opinion be led by medical providers, not insurance executives in order to reach this goal.
We are quite fortunate to live in a community where through exercise and healthy lifestyle, our seniors are among the healthiest in the nation. We should be rewarded with a Medicare Advantage plan that provides enhanced benefits and greater access to our medical providers all at a reduced cost. Given our aging population and the call for expansion of Medicare by political candidates the future need for plans like these will become even greater.
Curt E Calcaterra, M.D.
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