Legislation Would Allow Medicare-Eligible Elders to Negotiate Private Contracts with Doctors

Medicare eligible-elders would be able to negotiate private contracts with doctors under new legislation proposed by Senator Lisa Murkowski.

Murkowski says Senate Bill 1042 called the Medicare Patient Empowerment Act would allow patients to see any physician they choose, even if that doctor has opted out of taking Medicare patients.

Currently elders find that increasing numbers of doctors refuse to see them once they turn 65 and here’s why. When a person who has private insurance turns 65, Medicare automatically becomes the primary insurance, whether you want it to or not and private insurance becomes secondary. If the newly minted Medicare recipient can find a physician who will see them, Medicare sets a rate of reimbursement based on what they deem reasonable. If the doctor says the office visit is 100 dollars, Medicare may say, we think that visit is worth 50 and we’ll pay roughly 80% of that 50. Then the secondary insurance pays the remaining 20% of the 50 dollars, leaving the physician on the hook for the rest of their overhead. Under Murkowski’s plan, a person can enter into a contract, negotiate the total fee amount with a doctor and pay out of pocket, what Medicare and secondary insurance doesn’t pick up. Murkowski says right now, it’s illegal for doctors to negotiate lower fees with patients.

Murkowski says that hurts seniors who have paid in to Medicare for years and should be able to access it. Under her plan, doctors would legally be able to negotiate the fee above the amount allowed by Medicare.

James Jordan is the executive director of the Alaska State Medical Association. He says Anchorage is a good example of a growing problem. The city’s population is rapidly aging and by 2020, he says the Medicare beneficiary population is expected to double.

There are countless stories in Alaska and especially Anchorage where seniors have been turned away by 50 or more doctors when they become Medicare recipients. Murkowski says this is not wholesale reform of Medicare but she says for too many seniors in Alaska, they’re getting 100% of nothing right now. She says the lowest income people who are Medicaid eligible would not benefit from this legislation. But the people in the middle are the ones that AARP Alaska spokeswoman Ann Seacrest is concerned with.

Seacrest says bottom line, the reimbursement system needs a fix. She says this is a band aid.

The American Medical Association is endorsing Murkowski’s Medicare Patient Empowerment Act. A companion bill is in the U.S. House sponsored by Republican Congressman Carl Rosen, a doctor from Georgia.

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Lori Townsend is the news director and senior host for Alaska Public Media. You can send her news tips and program ideas for Talk of Alaska and Alaska Insight at ltownsend@alaskapublic.org or call 907-550-8452.

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