Tuesday, May 6, 2014


Bottom line


Medicare Advantage programs - and they all seem similar in this respect - allow customers roughly US$115/year toward corrective lenses, with frames, or contact lenses.

The lenses are "plain vanilla," no polycarbonate, no line-less bifocals, no tints, no, no, no.

Installed in a pair of Chinese frames.

One pair. $115.

Compare this to non-Advantage plan glasses.

In my area, there are at least two chains offering two pair for $69.

Same plain vanilla lenses.

Same made-in-China frames (albeit with a wider selection that I saw at two Advantage-approved vendors).

And a "free" eye exam in thrown in.

Even Sears has a two-for-$75 offer on tv. (Whatever happened to Roebuck?)

I'm curious.

If I can get TWO - count'em, 2 - pair of plain vanilla lenses in made-in-China frames for $69, why do Medicare Advantage providers charge $115 for a pair of glasses AND pay more for an eye exam?

Medicare claims to be on the outlook for fraud.

Medicare claims to be on the outlook for cost savings.

I pay slightly more than $100/month for Medicare. That money is then paid to the Advantage plans.

IN ADDITION to my monthly payment, Medicare pays ADDITIONAL MONEY to the Advantage plan based on several variables, including the Medicare (geezer) population served by the Advantage plan.

Like newspapers that make their money on advertising with rates based on circulation, Advantage plans make their money by head count, not on an individual's monthly payment to Medicare.

Consider the competition for customers in geezer-heavy geographic areas, both in terms of advertising and in rates. In South Florida, the competition is fierce and the rates available to customers ranges from zero additional dollars to whatever the market will bear; elsewhere - in rural Maryland, for example - rates start with an added cost to the covered geezer of from about $50/month to whatever the market will bear.

Why, then, don't the Advantage providers contract with the "discount" companies? There are several that are nationwide, or nearly nationwide. It seems that the Advantage providers could negotiate a discounted price - say $50 in lieu of $69 - and still make their profits, albeit with only a slightly reduced margin. Medicare, likewise, could reduce its payments to the Advantage providers.

This also could apply to Obamacare.

Advantage-contracted optometrists and opticians may take umbrage at the idea that a discount optometrist and optician may be eligible for Advantage dollars. Most discount opticians accept prescriptions from any optometrist, so Advantage-contracted optometrists would face the loss only of their related optician business. (On a personal note, I found an optometrist with whom I think I can have a good, long-term relationship.)

The "bottom line" question is: If a "discount" optician (chain or independent) can offer eye exams and TWO PAIR of glasses, albeit "plan vanilla," for $69, why is Medicare allowing Advantage providers to pay a non-competitive price for simple lenses in Chinese frames?



America's Best

Eye Lab

Sears' Optical - offer may be time-limited

Visionworks - offers vary by location

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