There's good news and bad news on Hillary Clinton's newly announced "Medicare for More" plan. While it could cover up to 13 million people, some of whom may already be covered elsewhere, it could also end up raising costs for some.
An analysis of the plan by consulting firm Avalere Health found that close to 13 million Americans age 50 and older who are currently uninsured, or who have individual coverage purchased through the private market, inside and outside the exchange, could be eligible for coverage under the Clinton plan.
However, coverage could end up costing more for some of those participants under the "unusual structure of the Medicare fee-for-service program," resulting not just in higher costs but also more benefit limits than insurance products available on the exchange.
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Avalere analysts found that "[s]pecifically, when compared to products sold through insurance exchanges, … traditional, fee-for-service Medicare tends to offer a broader network of providers and lower deductibles relative to unsubsidized exchange products."
But a significant difference between the exchanges and Medicare is that "employer and exchange plans both feature an annual cap on how much consumers could pay in out-of-pocket costs ($6,850 for an individual in 2016)," the report said. "However, Medicare does not include any out-of-pocket cap, so beneficiaries with high healthcare costs could pay more out-of-pocket with Medicare coverage compared to employer or exchange plan coverage."
While Clinton's proposed plan could potentially broaden coverage to millions who currently remain insured even under the Affordable Care Act, there are other possible issues with "Medicare for More." Coinsurance costs for physician visits could be higher, since Medicare charges beneficiaries 20 percent of the total cost for all Part B services — and Medigap coverage, which would help reduce such costs, is also expensive.
In addition, there's the little matter of drug coverage, which also "could be less generous under Medicare." According to the analysis, "While drug coverage varies widely by plan, formulary breadth in Medicare Part D plans is more limited than in silver exchange plans on average. For instance, across 22 classes of commonly used drugs, formularies for exchange plans cover 85 percent of all drugs, while Medicare Part D plans cover only 70 percent."
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