U.S. seeks to shift some Medicare costs to private insurers

December 21, 1990|By New York Times

WASHINGTON -- In an effort to shift federal costs to private health insurers, the Bush administration is proposing new measures to compel Medicare beneficiaries to file claims with any private insurers before the government pays anything for services provided by doctors or hospitals.

That is what they are supposed to do under current law, but in practice Medicare pays many claims that have already been paid by private insurers or should have been.

Several million of the 30 million elderly people enrolled in Medicare are also employed and have private health insurance through their employers.

To guarantee that people with both Medicare and private health insurance use the private coverage first, the Office of Management and Budget wants to create a giant computer clearing house with information on the health insurance coverage of all Americans.

Before paying claims for Medicare, Medicaid or veterans' health benefits, the government would check the computer to see if a person had private health insurance to cover any of the cost.

The proposal, intended to save $600 million to $1 billion a year, is one of many approved by the budget office this week for inclusion in President Bush's 1992 budget, to be proposed to Congress in early February.

Confidential budget documents show that the budget office, headed by Richard G. Darman, is proposing a wide range of cutbacks and savings in Medicare and Medicaid beyond those recently approved by Congress in a five-year "deficit reduction" plan.

The proposals are estimated to save $2.9 billion in 1992 and $19.6 billion over five years. There is no indication of how Bush would use the savings.

Under current law, Medicare is not supposed to pay for an item or service if payment "has been or could be made" under an employer's group health plan, under workers' compensation or under an auto insurance policy.

Medicare claim forms ask patients if they have private health insurance.

Patients, doctors and hospitals are supposed to file claims first with private insurers, using Medicare as a secondary source to help pay medical bills not covered by an employer's health plan.

In practice, however, patients often fail to disclose their private insurance, so Medicare erroneously pays some claims already paid by private insurers or it pays claims that should be paid by private insurers and then never collects reimbursements.

Under the new plan, designed to eliminate duplicate payments, the government would save what the private insurers pay.

Under federal law, employers with 20 or more employees must offer workers and their spouses 65 years old and over the same health insurance benefits offered to younger workers and spouses.

So private insurers could not simply refuse to insure elderly workers if the government established the clearinghouse.

The proposal would not affect private health insurance sold as a supplement to Medicare. Such Medigap policies pay for goods and services not covered by Medicare.

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