Many other states are looking at shifting their dual eligible populations to either the fully capitated system that California has adopted or managed fee-for-service plans.
The tragedy is that Medicare Advantage architecture is far from perfect and HHS could save money if it wanted to, in particular by targeting the private fee-for-service plans that mimic all of traditional Medicare's dysfunctions except with an element of private profit.
If you were to rank the worst products currently sold by HMOs, these limited benefit plans would have to be up there with Fee-For-Service Medicare Advantage plans.
Medicare has many other flaws such as its encouragement of open-ended, fee-for-service benefits a model that nearly all employer health plans abandoned more than a decade ago.
While hospital care does carry significant copays and deductibles, the vast majority of beneficiaries (about 88 percent of fee-for-service Medicare beneficiaries) have supplemental coverage of some kind (mainly Medigap, retiree plans, or Medicaid) to cover hospital copayments.