Kristine Grow, the spokesperson from the Coalition for Medicare Choices, joins Suzanne to talk more about Medicare Advantage. Suzanne asks about dual eligibility.
Grow says, "People who are dual eligible qualify for both Medicare and Medicaid, and this can get confusing because a lot of Americans aren't quite sure what the differences are. Medicare is for people 65 and older, or who have certain disabilities. Medicaid is eligible for low-income Americans, two million Veterans, moms, their children, and about 12 millions are eligible for both programs. They have very serious health conditions, they need a lot of protection. So, they're a very important population that has a lot of chronic conditions, greater levels of disability, and they're more likely to need nursing home care as well.
Medicare Advantage serves a lots of them through SNIP or special-needs plans, lots of care coordination and services for care. A lot of plans have special programs specifically designed for people with diabetes, and it's not just to cover their insulin. There are a lot of other illnesses and a lot of other conditions that come along with being a person who has diabetes, to manage your chronic condition. As your condition may get more serious, to take care of those illnesses as well, help you with healthier eating programs and a lot of other things to help get your blood sugars a little bit more stable and take care of you in the longer run. You have a lot of different doctors that you need to see."
Suzanne asked why sometimes you have to switch medicines in order for it to be covered under Medicare Advantage. Kristine explained, "That's because these Medicare Advantage plans are offered by health insurance providers. It's a public/private partnership between the federal government and health insurance providers and the job of the health insurance provider is to negotiate lower costs for you, whether that's through lower premiums, or through lower out of pocket costs. When you get the care that you need, various drug manufacturers are the ones that are setting the price for these medications. I think we can all agree that they need to lower these prices that they charge from a very high price.
"No matter how much you negotiate, you're never going to get an affordable price for a lot of seniors who are on a limited income, but the health insurance providers do a great job of negotiating those lower prices. And they do that through tools that are available to them, such as a formulary which they may say, depending on other drugs that are available, if you have drugs that have the same efficacy, you can get a much cheaper price for it if you get this version of it, and it's a way to get the drug makers to compete with one another. So, the drugs that are delivering the same kind of clinical outcome can be charged at a cheaper price. So it's kind of like that negotiation between say, a brand name tissue or a generic tissue. You get the same value out of it, you just get a very good price for it as well. So there's a lot of that negotiation that happens.
Visit MedicareChoices.org to learn more about Medicare Advantage and the Coalition for Medicare Choices.
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