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For more than 40 million senior citizens, questions about the health care overhaul come down to one word — Medicare. There are proposals to slow the growth of Medicare over the next decade by cutting $400 billion or $500 billion. About a quarter of those savings would come from something called Medicare Advantage. It's a popular program that allows seniors to choose privately-run health plans. The plans offer all the services covered by Medicare, plus extra benefits such as dental and vision care. The possibility of cuts to those plans has stirred up senior citizens and left Democrats in a tight spot, as NPR's Greg Allen reports.

GREG ALLEN: Nationwide, about a quarter of senior citizens are enrolled in Medicare Advantage plans. Here in Florida, the plans are even more popular — nearly a third of the state's 3 million-plus seniors are enrolled in one plan or another. In Delray Beach, Bob Goldstein is a pharmacist who's 72 years old and still working. To understand why Medicare Advantage plans are so popular, just listen to what he gets from his plan, which is run by Humana.

Mr. BOB GOLDSTEIN (Pharmacist): There are no deductibles. There's no 20 percent copay. Traditional Medicare would have deductibles. It would only pay 80 percent and I'd be responsible for the 20 percent. If I chose to, I would have to buy supplementary insurance, which for my wife and myself would probably cost over $5,000 a year.

ALLEN: Goldstein's plan gives him generic prescription drugs for free, and it pays his membership at a local health club. The problem is that for the government, Medicare Advantage plans have steadily gotten more expensive. Across the country, the government is now paying, on average, 14 percent more for Medicare Advantage plans than it spends on traditional Medicare.

Ms. MARSHA GOLD (Senior Fellow, Mathematica): It makes no sense.

ALLEN: Marsha Gold is a senior fellow with Mathematica, a policy group that studies the healthcare system. Gold says, Medicare Advantage plans were created to offer choice for senior citizens and to introduce some competition for traditional Medicare.

Ms. GOLD: The whole point of this was to have there be a level playing field. Why should you be giving them more money? So, a lot of people have recommended that they take the money away.

ALLEN: Democrats see the cuts as a way to slow down the rising cost of Medicare. But opponents say the cuts will force providers to eliminate some benefits to seniors. Bob Goldstein says as a pharmacist, he sees many senior citizens who, like him, are happy with their plans, and are worried about what changes may be coming.

Mr. GOLDSTEIN: Anything that would hinder that plan could be financially disastrous to them because these people are on a fixed income.

ALLEN: For those who may not have been paying attention, some insurance companies have been working to spread the word. Humana sent a mailer recently to its Medicare Advantage customers, warning them that members may lose benefits if Congress makes cuts to the program. That created its own mini-firestorm, with the Obama administration sending a letter to Humana directing it to stop lobbying its customers, followed by charges of censorship by Republicans. Robert Zirkelbach, with the trade group America's Health Insurance Plans, says Humana was just trying to make sure its members knew that Congress was considering cutting more than one hundred billion dollars from the program.

Mr. ROBERT ZIRKELBACH (America's Health Insurance Plans): If those cuts are enacted, seniors are going to experience benefit reductions. They're going to see their premiums increase. And, in some parts of the country, the Medicare Advantage program may go away entirely.

ALLEN: Advocates of a health care overhaul dispute that. Len Nichols, a health care economist with the New America Foundation, says private providers make big profits from the plans. He believes they should be able to operate the plans and maintain most benefits without an unfair subsidy from the federal government.

Mr. LEN NICHOLS (Health Care Economist, New America Foundation): The plans should be able to deliver the benefits they're giving now at lower cost. The overpayment is going into profit. And that's really what the dispute is about.

ALLEN: Medicare Advantage is an issue that's gotten the attention not just of senior citizens but also Congress.

Senator BILL NELSON (Democrat, Florida): It's certainly a concern of this senator.

ALLEN: Florida Democrat Bill Nelson says while it cuts funds from the Medicare Advantage program, Congress must also protect senior citizens.

Sen. NELSON: That they not have something taken away from them that they have come to expect and to rely on in Medicare.

ALLEN: Nelson is offering an amendment that would preserve Medicare Advantage programs and their benefits in areas where the plans cost the government less than traditional Medicare, that includes Florida and nearly a million Medicare Advantage customers who are Nelson's constituents. Nelson's amendment would add tens of billions of dollars to a health care overhaul. So far, it's been resisted by other Democrats on the Senate Finance Committee. If it doesn't pass in committee, he says he'll offer it on the Senate floor.

Greg Allen, NPR News, Miami.

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