RALEIGH -- Bonnie Lee Smith, a retired medical imaging technician, should have plenty of health-insurance coverage: She qualifies for Medicare because of her age and for Medicaid because of her income.

But Smith, 81, says she has had no primary physician since her previous doctor's office said it won't accept her coverage under a privately run Medicare plan.

"I'm just trying to figure my way through the maze," said Smith, a stomach-cancer survivor.

Evercare, the plan that covers Smith, is one of about 50 Medicare Advantage policies offered by insurance companies in North Carolina. These plans, which cover about one in five Medicare recipients, replace traditional Medicare and usually offer additional coverage such as dental, vision or fitness benefits.

But nationally, Medicare Advantage plans are the subject of fierce debate as Congress attempts to craft a health care reform bill. Supporters say they offer extra benefits that seniors love, and opponents call the average 14 percent extra they cost per recipient a giveaway to insurance companies. State regulators say people with Medicare Advantage insurance have often had problems finding doctors and hospitals to take the coverage.

The Senate Finance Committee plan under debate last week would cut more than $120 billion in subsidies to the plans beginning in 2011.

In his Sept. 10 health-care address, President Barack Obama called Medicare Advantage plans "unwarranted subsidies in Medicare that go to insurance companies — subsidies that do everything to pad their profits and nothing to improve your care."

Republicans in Congress oppose Obama's plan to cut the subsidies, citing the many Medicare recipients who choose the plans. They describe attempts to cut subsidies as paying for reform "on the backs of seniors."

Insurance companies say Medicare Advantage brings greater choice to recipients and competition to the market. Sen. Richard Burr said in a recent letter to constituents that he "cannot accept cuts to Medicare Advantage," which he called an extremely popular program.

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