Premium Assistance for Coverage in Exchanges

Health Reform Subsidy Calculator

Kaiser Family Foundation

An example for a 50 year old with a family of four, with income at 401% of federal poverty level:

$93,934 – Projected income in 2014

$16,858 – Unsubsidized health insurance premium in 2014

N/A – Maximum % of income the family has to pay for the premium

$16,858 – Actual family required premium payment

$0 – Government tax credit

$12,500 – The maximum out-of-pocket costs the person/family will be responsible for in 2014 (not including the premium)

$29,358 – Premium plus out-of-pocket costs

31% – Percent of income for premium plus out-of-pocket costs

http://healthreform.kff.org/SubsidyCalculator.aspx

This calculator is useful for determining anticipated individual and family costs for insurance premiums plus out-of-pocket expenses for plans obtained through the insurance exchanges, if execution of the program is optimal.

Uncertainties arise since 1) premiums are not guaranteed and could be much higher if private insurers fail to restrain cost increases, and 2) out-of-pocket costs could be much higher based on plan design, limitations of provider networks, and expenses for disallowed services and products.

Furthermore, most individuals and families will not even be allowed to purchase plans through the exchanges.

What kind of reform is this? We could have covered everyone without the need to create personal financial hardship had we adopted a single payer national health program. In fact, we can still do that.

By Theda Skocpol
Health Affairs
July 2010

Abstract

As with all major social legislation, years of decisions and disputes over implementation lie ahead for the Patient Protection and Affordable Care Act. Opponents at the state and national levels may seek the law’s judicial overturn or repeal. However, a far more serious effort to undermine the law will come about through challenges to various administrative arrangements, taxes, and subsidies to fund expansions of coverage. The redistributive aspects of health reform will be especially at risk, as business interests and groups of more-privileged citizens press for lower taxes, looser regulations, and reduced subsidies for low-income people.

The Staying Power Of Redistributive Reform

As the New York Times reporter David Leonhardt has observed, the new health reform legislation “is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.” The American rich have been getting richer; meanwhile, in contrast to the situation in many other nations attempting to mitigate rising market inequalities, the U.S. government in recent decades has exacerbated them through tax cuts that disproportionately benefit the rich. But the 2010 health reform promises subsidies to millions of working people of modest means, whose employers do not provide health insurance and who cannot afford to buy it themselves in the existing marketplace. Most of the revenues to pay for coverage expansion come from Americans making more than $250,000 a year, as well as from fees on businesses and cuts in subsidies to private insurers involved in Medicare.

Anti-Reform Interests

Cheering as this aspect of reform may be to analysts concerned about rising inequality in the United States, the political storms to come should not be underestimated. Many aspects of the U.S. political system give vastly disproportionate leverage to the privileged and well-organized wealthy interests. These are the very groups and interests that Obama is asking to pay for health care for their less-fortunate fellow citizens. They don’t like it, and they have potent weapons at their disposal to fight back: money for media campaigns, legions of lobbyists, and now, with the recent Supreme Court Citizens United decision that the government may not ban political spending by corporations in elections, an unlimited ability to contribute to candidates.

With every resource at their disposal, these groups will weigh in as regulations are written at the federal level—and also as rules for insurance exchanges are devised in multiple states. They will use the system to elect representatives, senators, governors, and state legislators who share their sympathies. They will lobby politicians’ staffs to make changes in taxes, subsidies, and rules. Much of this will happen out of public view; it will be complicated and might not gain much attention from the news media.

Subtle Efforts To Undermine The Law

In the end, the clamorous campaign to have provisions of health reform declared unconstitutional may distract attention from subtler efforts to undermine the law. We will not know for a decade or so how far opponents will succeed in stripping away fees and higher taxes on the privileged, undercutting regulations on private insurers, and reducing redistributive subsidies to the less privileged. But we can predict that much of the intended redistribution will be reversed, because it is so easy and tempting for public officials of either party to enact tax breaks for the rich or to adjust regulations and subsidies as demanded by well-heeled business interests. Each individual change will seem small enough so that particular legislators, even Democrats, can rationalize their votes, but the changes will add up.

Redistribution

The generational redistribution implied in the new health reform will also work to the advantage of those who seek leverage to reverse key provisions. Americans slated to get more help tend to be younger and poorer. Meanwhile, seniors on Medicare, especially rich ones, are not only relatively satisfied with the pre-2010 status quo, but they are also responsive to claims that reforms will hurt their health care. Senior citizens are reliable voters, and over the coming months, they may become even more anxious if discussions are launched about how to cut the deficit by reducing spending growth on Social Security or Medicare. Republicans may face difficulties if they have to explain how the nation can simultaneously oppose any tax increases and prevent cuts to Medicare. In short, the arguments they are using now to fight “Obamacare” may come back to haunt them.

But the logic here may be political, not fiscal. The preferred course for both Republicans and the increasing numbers of senior citizens who may vote for them in 2010 and 2012 may be to get rid of or greatly reduce federal subsidies for the uninsured. These subsidies could shrink well before they are delivered in 2014 and beyond, thus making reform much less redistributive in the end.

Battle Is Not Over

In short, the bitter U.S. war over comprehensive health reform is far from finished. It remains to be seen if the promise of the legislation can be realized in a polity divided by class and generation. A century-long quest for reform may have achieved an uneasy breakthrough. But no one who follows the politics of U.S. health care should think that the battle is over.

(Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard and an internationally recognized analyst of comparative and American politics. Skocpol’s books on social revolution and the state are considered fundamental texts and have been translated into several languages.)

http://content.healthaffairs.org/cgi/content/full/29/7/1288

Comment: 

By Don McCanne, MD

Today’s comment is very brief in order to give you more time to read these important excerpts from Theda Skocpol’s article. The redistributive aspects of any health financing reform are absolutely crucial, yet under the Patient Protection and Affordable Care Act, redistribution is at great risk. A single payer national health program would have much greater immunity against the vicious but opaque assault that will be taking place under the current law.

The Political Challenges That May Undermine Health Reform

By Theda Skocpol
Health Affairs
July 2010

Abstract

As with all major social legislation, years of decisions and disputes over implementation lie ahead for the Patient Protection and Affordable Care Act. Opponents at the state and national levels may seek the law’s judicial overturn or repeal. However, a far more serious effort to undermine the law will come about through challenges to various administrative arrangements, taxes, and subsidies to fund expansions of coverage. The redistributive aspects of health reform will be especially at risk, as business interests and groups of more-privileged citizens press for lower taxes, looser regulations, and reduced subsidies for low-income people.

The Staying Power Of Redistributive Reform

As the New York Times reporter David Leonhardt has observed, the new health reform legislation “is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.” The American rich have been getting richer; meanwhile, in contrast to the situation in many other nations attempting to mitigate rising market inequalities, the U.S. government in recent decades has exacerbated them through tax cuts that disproportionately benefit the rich. But the 2010 health reform promises subsidies to millions of working people of modest means, whose employers do not provide health insurance and who cannot afford to buy it themselves in the existing marketplace. Most of the revenues to pay for coverage expansion come from Americans making more than $250,000 a year, as well as from fees on businesses and cuts in subsidies to private insurers involved in Medicare.

Anti-Reform Interests

Cheering as this aspect of reform may be to analysts concerned about rising inequality in the United States, the political storms to come should not be underestimated. Many aspects of the U.S. political system give vastly disproportionate leverage to the privileged and well-organized wealthy interests. These are the very groups and interests that Obama is asking to pay for health care for their less-fortunate fellow citizens. They don’t like it, and they have potent weapons at their disposal to fight back: money for media campaigns, legions of lobbyists, and now, with the recent Supreme Court Citizens United decision that the government may not ban political spending by corporations in elections, an unlimited ability to contribute to candidates.

With every resource at their disposal, these groups will weigh in as regulations are written at the federal level—and also as rules for insurance exchanges are devised in multiple states. They will use the system to elect representatives, senators, governors, and state legislators who share their sympathies. They will lobby politicians’ staffs to make changes in taxes, subsidies, and rules. Much of this will happen out of public view; it will be complicated and might not gain much attention from the news media.

Subtle Efforts To Undermine The Law

In the end, the clamorous campaign to have provisions of health reform declared unconstitutional may distract attention from subtler efforts to undermine the law. We will not know for a decade or so how far opponents will succeed in stripping away fees and higher taxes on the privileged, undercutting regulations on private insurers, and reducing redistributive subsidies to the less privileged. But we can predict that much of the intended redistribution will be reversed, because it is so easy and tempting for public officials of either party to enact tax breaks for the rich or to adjust regulations and subsidies as demanded by well-heeled business interests. Each individual change will seem small enough so that particular legislators, even Democrats, can rationalize their votes, but the changes will add up.

Redistribution

The generational redistribution implied in the new health reform will also work to the advantage of those who seek leverage to reverse key provisions. Americans slated to get more help tend to be younger and poorer. Meanwhile, seniors on Medicare, especially rich ones, are not only relatively satisfied with the pre-2010 status quo, but they are also responsive to claims that reforms will hurt their health care. Senior citizens are reliable voters, and over the coming months, they may become even more anxious if discussions are launched about how to cut the deficit by reducing spending growth on Social Security or Medicare. Republicans may face difficulties if they have to explain how the nation can simultaneously oppose any tax increases and prevent cuts to Medicare. In short, the arguments they are using now to fight “Obamacare” may come back to haunt them.

But the logic here may be political, not fiscal. The preferred course for both Republicans and the increasing numbers of senior citizens who may vote for them in 2010 and 2012 may be to get rid of or greatly reduce federal subsidies for the uninsured. These subsidies could shrink well before they are delivered in 2014 and beyond, thus making reform much less redistributive in the end.

Battle Is Not Over

In short, the bitter U.S. war over comprehensive health reform is far from finished. It remains to be seen if the promise of the legislation can be realized in a polity divided by class and generation. A century-long quest for reform may have achieved an uneasy breakthrough. But no one who follows the politics of U.S. health care should think that the battle is over.

(Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard and an internationally recognized analyst of comparative and American politics. Skocpol’s books on social revolution and the state are considered fundamental texts and have been translated into several languages.)

http://content.healthaffairs.org/cgi/content/full/29/7/1288

Comment: 

By Don McCanne, MD

Today’s comment is very brief in order to give you more time to read these important excerpts from Theda Skocpol’s article. The redistributive aspects of any health financing reform are absolutely crucial, yet under the Patient Protection and Affordable Care Act, redistribution is at great risk. A single payer national health program would have much greater immunity against the vicious but opaque assault that will be taking place under the current law.

The Political Challenges That May Undermine Health Reform

By Theda Skocpol
Health Affairs
July 2010

Abstract
As with all major social legislation, years of decisions and disputes over implementation lie ahead for the Patient Protection and Affordable Care Act. Opponents at the state and national levels may seek the law’s judicial overturn or repeal. However, a far more serious effort to undermine the law will come about through challenges to various administrative arrangements, taxes, and subsidies to fund expansions of coverage. The redistributive aspects of health reform will be especially at risk, as business interests and groups of more-privileged citizens press for lower taxes, looser regulations, and reduced subsidies for low-income people.
The Staying Power Of Redistributive Reform
As the New York Times reporter David Leonhardt has observed, the new health reform legislation “is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.” The American rich have been getting richer; meanwhile, in contrast to the situation in many other nations attempting to mitigate rising market inequalities, the U.S. government in recent decades has exacerbated them through tax cuts that disproportionately benefit the rich. But the 2010 health reform promises subsidies to millions of working people of modest means, whose employers do not provide health insurance and who cannot afford to buy it themselves in the existing marketplace. Most of the revenues to pay for coverage expansion come from Americans making more than $250,000 a year, as well as from fees on businesses and cuts in subsidies to private insurers involved in Medicare.
Anti-Reform Interests
Cheering as this aspect of reform may be to analysts concerned about rising inequality in the United States, the political storms to come should not be underestimated. Many aspects of the U.S. political system give vastly disproportionate leverage to the privileged and well-organized wealthy interests. These are the very groups and interests that Obama is asking to pay for health care for their less-fortunate fellow citizens. They don’t like it, and they have potent weapons at their disposal to fight back: money for media campaigns, legions of lobbyists, and now, with the recent Supreme Court Citizens United decision that the government may not ban political spending by corporations in elections, an unlimited ability to contribute to candidates.
With every resource at their disposal, these groups will weigh in as regulations are written at the federal level—and also as rules for insurance exchanges are devised in multiple states. They will use the system to elect representatives, senators, governors, and state legislators who share their sympathies. They will lobby politicians’ staffs to make changes in taxes, subsidies, and rules. Much of this will happen out of public view; it will be complicated and might not gain much attention from the news media.
Subtle Efforts To Undermine The Law
In the end, the clamorous campaign to have provisions of health reform declared unconstitutional may distract attention from subtler efforts to undermine the law. We will not know for a decade or so how far opponents will succeed in stripping away fees and higher taxes on the privileged, undercutting regulations on private insurers, and reducing redistributive subsidies to the less privileged. But we can predict that much of the intended redistribution will be reversed, because it is so easy and tempting for public officials of either party to enact tax breaks for the rich or to adjust regulations and subsidies as demanded by well-heeled business interests. Each individual change will seem small enough so that particular legislators, even Democrats, can rationalize their votes, but the changes will add up.
Redistribution
The generational redistribution implied in the new health reform will also work to the advantage of those who seek leverage to reverse key provisions. Americans slated to get more help tend to be younger and poorer. Meanwhile, seniors on Medicare, especially rich ones, are not only relatively satisfied with the pre-2010 status quo, but they are also responsive to claims that reforms will hurt their health care. Senior citizens are reliable voters, and over the coming months, they may become even more anxious if discussions are launched about how to cut the deficit by reducing spending growth on Social Security or Medicare. Republicans may face difficulties if they have to explain how the nation can simultaneously oppose any tax increases and prevent cuts to Medicare. In short, the arguments they are using now to fight “Obamacare” may come back to haunt them.
But the logic here may be political, not fiscal. The preferred course for both Republicans and the increasing numbers of senior citizens who may vote for them in 2010 and 2012 may be to get rid of or greatly reduce federal subsidies for the uninsured. These subsidies could shrink well before they are delivered in 2014 and beyond, thus making reform much less redistributive in the end.
Battle Is Not Over
In short, the bitter U.S. war over comprehensive health reform is far from finished. It remains to be seen if the promise of the legislation can be realized in a polity divided by class and generation. A century-long quest for reform may have achieved an uneasy breakthrough. But no one who follows the politics of U.S. health care should think that the battle is over.
(Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard and an internationally recognized analyst of comparative and American politics. Skocpol’s books on social revolution and the state are considered fundamental texts and have been translated into several languages.)
http://content.healthaffairs.org/cgi/content/full/29/7/1288

Today’s comment is very brief in order to give you more time to read these important excerpts from Theda Skocpol’s article. The redistributive aspects of any health financing reform are absolutely crucial, yet under the Patient Protection and Affordable Care Act, redistribution is at great risk. A single payer national health program would have much greater immunity against the vicious but opaque assault that will be taking place under the current law.

The Political Challenges That May Undermine Health Reform

By Theda Skocpol
Health Affairs
July 2010

Abstract

As with all major social legislation, years of decisions and disputes over implementation lie ahead for the Patient Protection and Affordable Care Act. Opponents at the state and national levels may seek the law’s judicial overturn or repeal. However, a far more serious effort to undermine the law will come about through challenges to various administrative arrangements, taxes, and subsidies to fund expansions of coverage. The redistributive aspects of health reform will be especially at risk, as business interests and groups of more-privileged citizens press for lower taxes, looser regulations, and reduced subsidies for low-income people.

The Staying Power Of Redistributive Reform

As the New York Times reporter David Leonhardt has observed, the new health reform legislation “is the federal government’s biggest attack on economic inequality since inequality began rising more than three decades ago.” The American rich have been getting richer; meanwhile, in contrast to the situation in many other nations attempting to mitigate rising market inequalities, the U.S. government in recent decades has exacerbated them through tax cuts that disproportionately benefit the rich. But the 2010 health reform promises subsidies to millions of working people of modest means, whose employers do not provide health insurance and who cannot afford to buy it themselves in the existing marketplace. Most of the revenues to pay for coverage expansion come from Americans making more than $250,000 a year, as well as from fees on businesses and cuts in subsidies to private insurers involved in Medicare.

Anti-Reform Interests

Cheering as this aspect of reform may be to analysts concerned about rising inequality in the United States, the political storms to come should not be underestimated. Many aspects of the U.S. political system give vastly disproportionate leverage to the privileged and well-organized wealthy interests. These are the very groups and interests that Obama is asking to pay for health care for their less-fortunate fellow citizens. They don’t like it, and they have potent weapons at their disposal to fight back: money for media campaigns, legions of lobbyists, and now, with the recent Supreme Court Citizens United decision that the government may not ban political spending by corporations in elections, an unlimited ability to contribute to candidates.

With every resource at their disposal, these groups will weigh in as regulations are written at the federal level—and also as rules for insurance exchanges are devised in multiple states. They will use the system to elect representatives, senators, governors, and state legislators who share their sympathies. They will lobby politicians’ staffs to make changes in taxes, subsidies, and rules. Much of this will happen out of public view; it will be complicated and might not gain much attention from the news media.

Subtle Efforts To Undermine The Law

In the end, the clamorous campaign to have provisions of health reform declared unconstitutional may distract attention from subtler efforts to undermine the law. We will not know for a decade or so how far opponents will succeed in stripping away fees and higher taxes on the privileged, undercutting regulations on private insurers, and reducing redistributive subsidies to the less privileged. But we can predict that much of the intended redistribution will be reversed, because it is so easy and tempting for public officials of either party to enact tax breaks for the rich or to adjust regulations and subsidies as demanded by well-heeled business interests. Each individual change will seem small enough so that particular legislators, even Democrats, can rationalize their votes, but the changes will add up.

Redistribution

The generational redistribution implied in the new health reform will also work to the advantage of those who seek leverage to reverse key provisions. Americans slated to get more help tend to be younger and poorer. Meanwhile, seniors on Medicare, especially rich ones, are not only relatively satisfied with the pre-2010 status quo, but they are also responsive to claims that reforms will hurt their health care. Senior citizens are reliable voters, and over the coming months, they may become even more anxious if discussions are launched about how to cut the deficit by reducing spending growth on Social Security or Medicare. Republicans may face difficulties if they have to explain how the nation can simultaneously oppose any tax increases and prevent cuts to Medicare. In short, the arguments they are using now to fight “Obamacare” may come back to haunt them.

But the logic here may be political, not fiscal. The preferred course for both Republicans and the increasing numbers of senior citizens who may vote for them in 2010 and 2012 may be to get rid of or greatly reduce federal subsidies for the uninsured. These subsidies could shrink well before they are delivered in 2014 and beyond, thus making reform much less redistributive in the end.

Battle Is Not Over

In short, the bitter U.S. war over comprehensive health reform is far from finished. It remains to be seen if the promise of the legislation can be realized in a polity divided by class and generation. A century-long quest for reform may have achieved an uneasy breakthrough. But no one who follows the politics of U.S. health care should think that the battle is over.

(Theda Skocpol is the Victor S. Thomas Professor of Government and Sociology at Harvard and an internationally recognized analyst of comparative and American politics. Skocpol’s books on social revolution and the state are considered fundamental texts and have been translated into several languages.)

http://content.healthaffairs.org/cgi/content/full/29/7/1288

Today’s comment is very brief in order to give you more time to read these important excerpts from Theda Skocpol’s article. The redistributive aspects of any health financing reform are absolutely crucial, yet under the Patient Protection and Affordable Care Act, redistribution is at great risk. A single payer national health program would have much greater immunity against the vicious but opaque assault that will be taking place under the current law.

Medicare Rights Center
Summer 2010

This report analyzes data and case notes from the 475 cases presented in 2009 by consumers who called us about disenrolling from Medicare private health plans.

Reasons for Disenrollment (percentage of calls)

24.8% – Provider access problems
21.5% – Misinformation/marketing abuse
19.4% – Coverage problems for medical services
19.4% – Systems/data transfer problems
8.6% – Cost-sharing too high
7.2% – Part D coverage problems
3.2% – Premium increase

Provider Access Problems

The consumer problems in this category incorporate a wide range of provider access issues. They include general complaints and lack of understanding about the limits on provider access imposed by network-based plans, as well as specific concerns, such as the potential interruption of a valued relationship with a doctor who is being dropped from the plan’s network. Provider access problems are often prompted by an acute episode of illness or diagnosis; consumers seek to disenroll when their current plan will not cover care from a home health agency, skilled nursing or other rehabilitation facility, or from a particular specialist, such as a facility or doctor specializing in cancer treatment. This category also includes cases where consumers were misinformed about the limits on provider access before joining.

Disenrollment Due to Cancer 
 
Cancer diagnoses are implicated in a relatively small percentage — less than 5 percent — of the disenrollments, but these cases are some of the most heart-wrenching and most difficult to resolve for Medicare Rights Center caseworkers.

The majority of cancer disenrollment cases — 63.6 percent —  however, involve provider access. The limitations of the private plan networks become apparent after the consumer is referred to a hospital or cancer specialist that is out of network. Treatment of rare or advanced cancers in particular triggers referrals to specialty facilities, such as M. D. Anderson in Houston or Memorial Sloan-Kettering in New York City. During the open enrollment periods, the disenrollments are generally effective the following month. When a person is diagnosed with cancer outside of the open enrollment periods, however, rules that lock consumers into their Medicare Advantage plans for the year generally prevent disenrollment (unless the case also concerns misrepresentation or marketing fraud, as is sometimes the case), and therefore may impede access to the most appropriate cancer treatment facility.

http://www.medicarerights.org/pdf/Why-Consumers-Disenroll-from-MA.pdf

Comment: 

By Don McCanne, MD

This survey does not quantify the extent of patient dissatisfaction with Medicare Advantage plans since it was limited to individuals calling the Medicare Rights Center to find out about disenrolling from the private Medicare Advantage plans. But it does provide us with an understanding of why patients want out of their plans. First and foremost patients complain of a “lack of understanding about the limits on provider access imposed by network-based plans.”

The second most common complaint was about misinformation and marketing abuse. This was the primary reason for provider access complaints – the Medicare beneficiaries did not understand that their access would be limited to physicians in plan networks.

This has certainly been infuriating for those who have lost their choice of physicians by enrolling in the Medicare Advantage plans, but it has much greater implications under the Patient Protection and Affordable Care Act. Virtually all plans will have network-based restrictions.

President Obama promised us choice of health plans, but the marketing of his proposal was silent on the fact that virtually all of the plans would have limited access – limited choice of physicians and hospitals – because of provider network restrictions.

With the traditional Medicare program, everyone has free choice of their health care professionals and institutions. That should have been a prime goal of health care reform. It still can be should we decide to enact a single payer national health program – an improved Medicare for everyone.

Why Consumers Disenroll from Medicare Private Health Plans

Medicare Rights Center
Summer 2010
This report analyzes data and case notes from the 475 cases presented in 2009 by consumers who called us about disenrolling from Medicare private health plans.
Reasons for Disenrollment (percentage of calls)
24.8% – Provider access problems
21.5% – Misinformation/marketing abuse
19.4% – Coverage problems for medical services
19.4% – Systems/data transfer problems
8.6% – Cost-sharing too high
7.2% – Part D coverage problems
3.2% – Premium increase
Provider Access Problems
The consumer problems in this category incorporate a wide range of provider access issues. They include general complaints and lack of understanding about the limits on provider access imposed by network-based plans, as well as specific concerns, such as the potential interruption of a valued relationship with a doctor who is being dropped from the plan’s network. Provider access problems are often prompted by an acute episode of illness or diagnosis; consumers seek to disenroll when their current plan will not cover care from a home health agency, skilled nursing or other rehabilitation facility, or from a particular specialist, such as a facility or doctor specializing in cancer treatment. This category also includes cases where consumers were misinformed about the limits on provider access before joining.
Disenrollment Due to Cancer
Cancer diagnoses are implicated in a relatively small percentage — less than 5 percent — of the disenrollments, but these cases are some of the most heart-wrenching and most difficult to resolve for Medicare Rights Center caseworkers.
The majority of cancer disenrollment cases — 63.6 percent —  however, involve provider access. The limitations of the private plan networks become apparent after the consumer is referred to a hospital or cancer specialist that is out of network. Treatment of rare or advanced cancers in particular triggers referrals to specialty facilities, such as M. D. Anderson in Houston or Memorial Sloan-Kettering in New York City. During the open enrollment periods, the disenrollments are generally effective the following month. When a person is diagnosed with cancer outside of the open enrollment periods, however, rules that lock consumers into their Medicare Advantage plans for the year generally prevent disenrollment (unless the case also concerns misrepresentation or marketing fraud, as is sometimes the case), and therefore may impede access to the most appropriate cancer treatment facility.
http://www.medicarerights.org/pdf/Why-Consumers-Disenroll-from-MA.pdf

This survey does not quantify the extent of patient dissatisfaction with Medicare Advantage plans since it was limited to individuals calling the Medicare Rights Center to find out about disenrolling from the private Medicare Advantage plans. But it does provide us with an understanding of why patients want out of their plans. First and foremost patients complain of a “lack of understanding about the limits on provider access imposed by network-based plans.”
The second most common complaint was about misinformation and marketing abuse. This was the primary reason for provider access complaints – the Medicare beneficiaries did not understand that their access would be limited to physicians in plan networks.
This has certainly been infuriating for those who have lost their choice of physicians by enrolling in the Medicare Advantage plans, but it has much greater implications under the Patient Protection and Affordable Care Act. Virtually all plans will have network-based restrictions.
President Obama promised us choice of health plans, but the marketing of his proposal was silent on the fact that virtually all of the plans would have limited access – limited choice of physicians and hospitals – because of provider network restrictions.
With the traditional Medicare program, everyone has free choice of their health care professionals and institutions. That should have been a prime goal of health care reform. It still can be should we decide to enact a single payer national health program – an improved Medicare for everyone.