The Medicare Payment Advisory Commission wants a copayment to discourage misuse of home health care services.

The congressionally appointed commission voted 13-1 to recommend that lawmakers impose the new charge. Two commissioners abstained and one was absent.

According to the Associated Press, home health services, which are currently covered under Medicare, cost taxpayers approximately $20 billion a year.

The co-pays, commission chairman Glenn Hackbarth said, would help avoid the benefit turning into a “long-term care social support system.”

Concerns with Medicare fraud and a tight budget have motivated the commission to look for cuts. Home health care was originally considered a “cost saver.” Now increasing costs and big differences in how communities around the country use the benefit have given lawmakers reason to make changes.

Exemption from the recommendation would include low-income patients covered by Medicaid, as well as those just discharged from the hospital. According to the AP, more than 30 million beneficiaries in traditional Medicare would be directly subject to the fee.

The recommendation was strongly opposed by AARP lobbyists who support a strong network of home providers to assist the more than 3 million seniors and disabled people on Medicare who are not able to easily leave home.

In September, AARP strongly supported The Home Health Care Planning Improvement Act of 2010, House Bill 4993 and Senate Bill 2814, which was a bi-partisan effort to expand the roles of nurse practitioners and physician assistant to allow them to certify home healthcare plans for Medicare patients.

In rural parts of the country, areas where the nation suffers from shortages of physicians, many Americans see nurse practitioners as their primary care provider.

If you are new to Medicare, you will be covered with a one-time “Welcome of Medicare” exam.

After you’ve had Part B for 12 months, you can schedule a yearly “Wellness” visit to develop or update a prevention plan just for you. You’ll pay nothing for this exam if the doctor accepts assignment. This exam is covered once every 12 months.

According to Joe Baker, president of the Medicare Rights Center, as a result of health reform, people with Medicare will no longer have to pay coinsurance, copays, or deductibles for preventive services that are given a grade A or B by the United States Preventive Services Task Force. 

At your annual visit, Baker says, you can expect the doctor to take your family history, collect information about your current health condition, the drugs you are current taking, check blood pressure, and screen you for “conditions related to cognitive impairments.”

The changes made in Medicare continue to show a shift in focus to prevention and wellness. Other services which are covered include other preventative services such as:

• Diabetes screening
• Diabetes services and supplies
• Testing for heart disease
• Mammogram screening
• Pap smears and pelvic exams
• Colon cancer screening
• Prostate cancer screening
• Flu shots
• Hepatitis B vaccine
• Medical nutritional therapy

For a complete list of Medicare preventative services (and a printable checklist), click here.

Medicare Advantage health plan members can disenroll and return to Original Medicare from January 1 to February 14, 2011. This period is called the Medicare Advantage Disenrollment Period (MADP).

Regardless of whether your current Medicare Advantage plan included Part D drug coverage (PDP), you may disenroll during the MADP and will be eligible for a Special Enrollment Period (SEP) to enroll in Part D prescription drug plan. The effective date of a disenrollment request using MADP will be the first of the month following the date of the request. For example, a request made in January would be effective February 1.

Current Medicare Advantage-only (MA) plan members have three options:

1. Disenroll from the MA-only plan and return to Original Medicare
2. Disenroll from the MA-only plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-only plan

Current Medicare Advantage with Part D prescription drug (MA-PD) plan members have three options:

1. Disenroll from the MA-PD plan and return to Original Medicare
2. Disenroll from the MA-PD plan, return to Original Medicare AND use the SEP to enroll in a PDP plan
3. Request enrollment in a PDP, resulting in automatic disenrollment from the MA-PD plan

Current Medicare Advantage-only Private Fee-For-Service (PFFS) plan members (PFFS plans without Part D prescription drug coverage) have two options:

1. Disenroll from the PFFS plan and return to Original Medicare
2. Disenroll from the PFFS plan, return to Original Medicare AND use the SEP to enroll in a PDP plan

NOTE: PFFS members must first request disenrollment from the plan before requesting enrollment in a PDP.

If you have questions, call the Health Plan One Medicare expert at 1-800-328-7305.

Becoming sick with infection while in hospital isn’t just inconvenient: it is costly and can be deadly. According to the Center for Disease Control, HAIs set hospitals back $45 billion and are responsible for nearly 100,000 people annually.

To fight back, the University of Maryland’s Medical Center has hired four “infection preventionists” to patrol the university medical center and inspect the work of everyone from ICU doctors to janitors. Their job is to interact closely with staff, to ensure they are doing everything they can to avoid bringing these bugs to uninfected patients.

Part of the solution to keeping infections down is making hospitals more efficient.  By automating patient information, medical centers and hospitals reduce the chances that patients have to catch a bug.

Additionally, the lag time between acquiring test results and the exchanging of that information can mean inadvertent exposure by other patients and staff.  Patient flow automation software – being used in the University of Virginia (UVA) Medical Center and Methodist Healthcare System in San Antonio, Tex., among others – increases efficiency and may help to reduce the severity of exposure to HAIs.

For patients with Medicare, this increased vigilance is critical: according to the Associated Press, “Medicare has begun cutting payments to hospitals with high rates of certain infections, cuts that will increase by 2015 under the new health care law.” To keep funding in place, hospitals need to get the bugs under control.

11.3 million of the 46 million Medicare beneficiaries are cheering, because President Obama announced premiums for Medicare Advantage plans will be less costly next year. Meanwhile, enrollment next year should go up 5%.

MA plans (or Part C) are run by private insurance carriers but partially paid for by the government. They are more comprehensive plans than traditional Medicare. In additional to inpatient hospital or skilled nursing facility stays, MA plans also have dental and eye care. Medicare plans don’t have these extras, and Medicare recipients either do without these services or pay full price.

This news comes as a surprise because just yesterday, it was announced that premium costs for privately purchased individual and family insurance plans have gone up in the past year, and will likely continue to rise.  The New York Times reports that “…commercial insurance premiums for many people under 65 and many small businesses are increasing 10 percent to 25 percent or more.”

More surprising is the MA Plans will offer some additional benefits to seniors, as required by the Patient Protection and Affordable Care Act. These include an end to a cap on lifetime coverage. Some ‘luxury’ benefits such as discounted gym memberships, are gone.

“Despite the claims of some, Medicare Advantage remains strong and a robust option for millions of seniors who choose to enroll or stay in a participating plan today and in the future,” Donald Berwick, head of the Centers for Medicare and Medicaid Services (CMS), said in a statement. “The Affordable Care Act gave us new authority to negotiate with health plans in a competitive marketplace. As a result, our beneficiaries will save money and maintain their benefits.”

In other words, the government strong-armed private industry to not increase the premiums or cost sharing, even though CMS reimbursements increase was well below the medical trend costs.

The health care reform law gave power to CMS to reject potentially new plans, and also gave them the ability to negotiate with insurance carriers over the benefits of their MA products.  Medicare officials said they rejected 7 plans offered by 3 companies, but most insurers re-jiggered close to 300 plans to be acceptable to the government. The most common rejected proposal included an increase to seniors’ out of pocket expenses that created a profit for the insurance carrier.

This is good for the consumers, short-term, for sure. They get more services for less money. But in the long run, will it last?

Medicare Insolvency Pushed Back 12 Years

Trustees of Medicare reported Thursday that cost-cutting measure in The Patient Protection and Affordable Care Act of 2010 have pushed Medicare’s impending insolvency off another 12 years. Because of these provisions in the law, Medicare’s hospital insurance trust fund should remain solvent until 2029. Both the 75 year shortfall for the hospital fund and the projected costs of the Medicare Supplementary Insurance program were further brought down. The trustees warned that though these projections are an improvement over last year’s estimates, additional reforms will be necessary for the programs to be financially sustainable.

The trustees further estimate a new tax on so-called Cadillac insurance plans (the priciest health insurance coverage generally held by highly paid managers and executives) which goes into effect in 2019 will improve Social Security’s finances in the long-term. In the short-term however, Social Security’s financial stability appears tenuous as this year for the first time benefits paid will exceed revenue. Because of the recession this day has come 6 years earlier than previously estimated. The trustee’s report projects that the program’s finances will return to equilibrium for the next several years as the economy climbs slowly out of the downturn. However, the problem of the aging Baby Boom generation remains and though the economy is strengthening more enrollees will soon increase the program’s deficits.

Estimates show that Social Security’s current payroll tax and interest revenue will cover benefits through 2024, but after that the program will begin drawing from its trust fund. This trust fund is not actually a money reserve but rather a complex accounting device which tracks the accumulated surplus. The estimated date by which this fund will empty remains the same as last year’s estimate – 2037. After 2037, payroll tax income to the program will cover only 75% of promised benefits. As a result, unless we want to see reduced benefits and higher taxes to cover the program, America cannot rest on the laurels of this latest reform and must urgently push for entitlement reform to ensure both Medicare and Social Security remain solvent.

Though the bill allocates in the neighborhood of $27 billion, it does not add to the deficit as the money generated by spending cuts and by closing a business tax loophole will cover the cost. The measure was approved by a 61 to 39 vote in the Senate last week. The majority was comprised of 57 Democrats, 2 Independents, and the ladies from Maine – Republicans Susan Collins and Olympia Snowe. 39 Republicans voted against the bill, many on the basis that it is a breach of ordinary federal-state relations.

The House has been called back early from its six-week August recess to vote on the measure tomorrow. Democratic Party leaders expect the House vote to go smoothly with an easy approval. However, though the bill does not increase the deficit some representatives whose districts are vulnerable this fall feel they’re again being asked to “walk the plank” with their party on an unpopular economic-stimulus issue. Vulnerable Democrats are especially irritated at being called back from vacation given they’re already defending their seats because of Senate inaction during the dragged out healthcare debate and budget debates. As a result of this many House Dems have become less responsive to party whips, making estimating a vote count difficult.

Though most legislators agree that states burdened with budget gaps desperately require the funds to keep teachers employed and Medicaid enrollees in the program, Republicans contend that calling House members back from recess to vote on a bill that stalled after two weeks of partisan posturing will reinforce popular perception of Dems as ineffective leaders. This narrative that Dems are haphazard and not unified in their approach to the recession and unemployment will likely be reinforced by Friday’s monthly jobs report, GOP spokespeople argue.

State Aid Bill Extends Funds for Medicaid

Conversely, House Democratic leaders see the bill as a win-win worth the admittedly messy passage as it will create jobs and respond to urgent budget concerns without raising the deficit.

As the health care debate raged onwards in 2009, the number of uninsured American adults rose by 3 million from 2008. Overall, approximately 46.3 million people in this country do not have health insurance covered.  In Texas, over one out of every four people was uninsured in 2009, compared to the 15.4 percent nationally.

The Center for Disease Control (CDC) survey found that almost 60 million people went without health insurance for at least part of the year, and 33 million of the uninsured had gone without for over a year.  People who were fortunate to keep their private coverage ended up paying more, while high-deductible plans also grew in popularity—especially among people who purchase their own health insurance plans.

3 Million More Uninsured in 2009

Fewer children are going without health insurance plans because they are enrolled in public policies.  See my previous article onCHIP and enrollment strategies the government may be using to get more kids into the program. However, almost one third of Americans between the ages of 18 and 24 did not have health insurance, the highest percentage of any other age group. Still, the fact that the ranks of the uninsured actually expanded in 2009 are worrisome to me.

Although individuals can still pay out of pocket for services, health insurance remains the most crucial portal to receiving adequate health care.  People who are enrolled in health insurance plans, regardless of the level of coverage, have far more access to preventative medical services. There is no denying that adequate medical care is expensive—rising medical costs in addition to the economy make insurance critical to obtaining health services.  If you are uninsured, you are more apt to delay health care until your illness is severe. According to research by the Harvard Medical School, around 45,000 Americans die every year because they are uninsured and therefore cannot receive adequate health care.

This study highlights the importance of health insurance in the United States today.  For the most part, people without health insurance are more likely to have lower incomes, and face an uphill battle when it comes to paying for care out of pocket.  Increasing rates of uninsured Americans is undoubtedly linked to the recession, which keeps them away from receiving the care they need. The fact that so many Americans remain uninsured—whether by choice or by economic necessity—proves very relevant to the 2010 Affordable Care Act. Escalating rates of un-insurance and skyrocketing medical costs are huge problems in the United States today.

When 2014 rolls around, enrolling the uninsured in new health insurance plans will be a daunting task.  The Affordable Care Act will broaden insurance to over 30 million citizens, who will likely need a little prodding when it comes time to enroll.  Canvassing campaigns in low-income neighborhoods aim at enrolling uninsured children in CHIP or Medicaid,working as a test run for the 2014 expansion of health insurance coverage.

As in my last blog about Massachusetts Health Care Reform, it is not the broader coverage that I am concerned about. Hopefully, the government will take cues from Massachusetts and ensure that the reform will not grow so costly that expenses outweigh coverage benefits.

According to Mike Lillis from THE HILL’S Healthwatch blog, a recent study by the National Council on Aging (NCOA) discovered that few seniors knew about and understood the ins and outs of health care reform.  The NCOA distributed a 12 question survey to 636 seniors. No senior got all the survey questions right, indicating the widespread lack of knowledge about reform.

Response to The Hill's Healthwatch Blog

The NCOA reported that more than 40 percent of respondents believed that the Affordable Care Act would reduce their Medicare benefits—even though that’s not the case at all.  Almost 40 percent of the seniors surveyed didn’t even know how to respond to that question—another scary fact. Less than 20 percent of those seniors understood that the Affordable Care Act did not slash payments to doctors who primarily treat Medicare beneficiaries. Finally, only about a third of those surveyed had heard bout the free annual wellness appointment now supplied by Medicare.

Most seniors were aware of the new law’s basics: for example, more than 40 percent of the seniors answered that the Affordable Care Act would extend health coverage to more Americans. Many respondents were well aware of the government’s initiative to close the “doughnut hole,” or prescription drug coverage gap.

Lillis argues that such misinformation may pose a threat to the Democrats in the upcoming midterm elections in November.  The Affordable Care Act is on the hot stove of American politics, and with widespread misunderstanding of the law, the Democrats may have difficulty using health care reform to sway voters.  Seniors are important to the success of the Democrats in November.

However, providing seniors with resources that they trust is another matter unto itself. According to the NCOA, seniors simply did not trust the information they had about the new health care reform.  Seniors felt that information about the Affordable Care Act was biased and unreliable, pushing the agenda of one group or another. Political jargon can often clutter the facts, making it difficult for all people, including seniors, to seek unbiased information about the reform. Ultimately, seniors—and citizens in general—deserve accurate information about the laws so that they can understand the law’s impact on them and formulate their own thoughts and opinions about reform. Perhaps the NCOA’S new program, “Straight Talk for Senior on Health Reform” can improve seniors’ understanding of health reform—and possibly impact November’s results?