Archive for Medicare News

Patrick McHugh | 05/30/2013
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Closing the Donut Hole, What will it cost?

The Affordable Care Act, a major reform signed into place in 2010 by President Obama, is supposed to help control rising healthcare costs over years to come. One of the initiatives is to have the donut hole, a coverage gap in Medicare Part D, closed 100% by the year 2020. In 2013, you reach the coverage gap when you and your plan have spent $2970 and get out of it when you have spent $4700 out-of-pocket for your prescription drugs.

This is great news for those who reach the donut hole, around 3.4 million according to a HealthView Services article, but there are 27.5 million people every year who do not reach the coverage gap. Once the gap is closed in 2020, the 27.5 million people will begin incurring a percentage of the costs pushed off to those who did reach the coverage gap. Instead of the donut hole, there will be a 25% cost sharing for all brand name and generic drugs.

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

 

Category: Medicare News, Prescription Drug Coverage | Tags: , ,
Ann Cooke | 05/06/2013
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Understanding Medicare – One Plan at a Time

Understanding the Medicare process and enrolling in the plans that are right for you can be a daunting task. In this series of posts we’ll be taking a close look at each of the Medicare plans with the hope of providing the information to make this necessary step of life a bit easier.

Medicare – Part A - Hospital Insurance 

Parts A, B, and D of Medicare all serve a different purpose. Part A provides hospital insurance.  Almost everyone over the age of 65 is eligible to receive it, but some may have to pay for it.

Eligibility/Enrollment

If you qualify for Social Security benefits, you receive Medicare Part A coverage at no cost. If you never paid Medicare tax while working, you are not eligible to receive Part A free of charge but, you still may qualify to purchase coverage.

You are eligible for free coverage and will be automatically enrolled if:

  • You are 65 years old and are receiving Social Security or Railroad Retirement Board  (RBB) benefits
  • You are under 65 and have been receiving Social Security Disability benefits for 24 months(24 month waiting period is waived for sufferers of Lou Gehrig’s Disease (ALS))
  • You have End-Stage Renal Disease (ESRD) and meet certain requirements

In order to be eligible to purchase Part A, you must fall into one of these categories:

  • U.S. Citizen or Permanent Resident and at least 65 years old
  • Younger than 65 years old and your Part A coverage ended because of employment

To sign up to purchase Part A, you should contact the Social Security Administration office three months prior to your 65th birthday and tell them you’d like to enroll. You can also sign-up online at www.socialsecurity.gov/retirement. After enrolling, you will receive your Medicare Card and your coverage will begin the first day of the month that you turn 65. You can sign up during the seven month period that starts three months before your birthday and ends four months after. For information on the cost of purchasing Part A, visit – http://www.medicare.gov/your-medicare-costs/part-a-costs/part-a-costs.html

What does it Cover?

As the name implies, Part A – Hospital Insurance covers expenses incurred from hospital visits. Coverage includes:

  • Inpatient hospital care
  • Skilled nursing facility care
  • Home health care
  • Hospice care
  • Inpatient care in a Religious Nonmedical Health Care Institution

If you have questions choosing a Medicare plan that offers the coverage you need, contact us at MedicareSolutions at 1-800-328-7305 where a licensed sales agent will immediately assist you.

Category: Medicare News, Medicare Tips, Original Medicare | Tags: , , ,
admin | 07/17/2012
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Are You Ready For Annual Enrollment?

The Annual Enrollment Period is quickly approaching. This is the period of time where you can make changes to you Medicare coverage. Between October 15th and December 7th every year, you may join, drop, or switch Medicare Prescription Drug and Medicare Advantage plans. You may also choose to revert back to original Medicare Part A and B and leave third party coverage altogether. The changes you make will be effective for the following year, so it is very important that you make sure that you are satisfied with any changes you plan to make. Weighing your option in Medicare is difficult, especially when you are altering an existing Medicare plan. We at Medicare Solutions have put together a short list of questions to help you evaluate your current plan. That way you can make any necessary changes with confidence.

  • Are your monthly medications the same or have others been added that could possibly put you in the ‘donut hole’ sooner than expected?
  • Are you seeing the doctors you need or want to see? Are you visiting the doctor more frequently?
  • Are your copays manageable based on your habits or are they putting you over budget? Are the remaining copays after your Medicare discount still too high for your budget?
  • Are you seeing doctors that are within your network? If you are seeking treatment outside your network, how much extra is it costing you?
  • Does your plan charge a monthly premium? (In addition to your Part B premium)
  • Do you find yourself with a new diagnosis that requires extra benefits that were not included in your original policy choice?
  • Are you utilizing vision, hearing, dental and/or wellness health programs that may or may not be embedded in your policy?

If you are realizing that you aren’t satisfied with your current plan, don’t worry. You have plenty of time to explore different options and make any necessary changes. If you are not satisfied with your current Medicare Advantage plan, Prescription Drug plan, or even Original Medicare plan, then you may choose to do one of the following during the Medicare Open Enrollment Period.

  • Change from Original Medicare to a Medicare Advantage Plan.
  • Change from a Medicare Advantage Plan back to Original Medicare.
  • Switch from one Medicare Advantage Plan to another Medicare Advantage Plan.
  • Switch from a Medicare Advantage Plan that doesn’t offer drug coverage to a Medicare Advantage Plan that offers drug coverage.
  • Switch from a Medicare Advantage Plan that offers drug coverage to a Medicare Advantage Plan that doesn’t offer drug coverage.
  • Join a Medicare Prescription Drug Plan.
  • Switch from one Medicare Prescription Drug Plan to another Medicare Prescription Drug Plan.
  • Drop your Medicare prescription drug coverage completely.

Are you satisfied with your Medicare plan? Are you having second thoughts about your current coverage? Let us know in the comments section!

 

Category: Compare Medicare Plans, Medicare Advantage, Medicare News, Medicare Tips, Original Medicare, Prescription Drug Coverage | Tags: , , , ,
ElizabethGHoward | 02/15/2011
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Hospital Study: Greater spending linked to higher mortality

Hospital Study: Greater spending linked to higher mortality
Hospital Study: Greater spending linked to higher mortality

An extensive study of Medicare patients in California hospitals found that the more money spent on the care of the patients, the lower the mortality rate, according to Health Leaders Media.

The study, which was limited to patients with six common medical conditions, was published in this month’s Annals of Internal Medicine.

 

The study found that higher patient survival was linked with higher spending for each of the diagnoses.

Data was analyzed from Medicare patients who suffered from stroke, pneumonia, hip fracture, congestive hearth failure, gastrointestinal hemorrhage and acute myocardial infarction. The scope of the study included spending data from 208 hospitals over 9 years.

According to the study, during 1999 to 2003, for example, patients admitted with acute myocardial infarction to California hospitals in the highest quintile of hospital spending had lower inpatient mortality than did those admitted to hospitals in the lowest. The prediction of inpatient deaths would increase by 1,831 if all patients admitted with acute myocardial infarction were cared for in hospitals in the lowest quintile of spending rather than the highest.

John Romley, of the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California, is lead author of the study. He says he and his colleagues worked to control factors like patient health status and hospital teaching affiliation.

The study contradicts findings from a previous Dartmouth Atlas of Health Care that spearheaded much of what is being looked at in healthcare reform regulations, that expensive care is not necessarily better care, and may in fact be worse care.

“If the results are real … that would suggest these reductions across the board in hospital spending might lead to worse outcomes for some patients,” Romley told Reuters Health. That doesn’t mean cuts wouldn’t still be cost-effective, if money elsewhere could better improve public health. But, he added, “it is important to understand the trade-offs.”

Category: Medicare News, Senior Healthy Living | Tags: , , , , , ,
ElizabethGHoward | 02/02/2011
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Medicare Advisory Panel recommends co-pay for home health

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.

Category: Medicare News, Senior Healthy Living | Tags: , , , , , ,
ElizabethGHoward | 01/25/2011
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Home kidney dialysis now covered by Medicare

Your kidneys are workin' it!

New Medicare payment rules for kidney dialysis are making it easier for patients to have their treatment at home.

The changes, which just went into effect, are motivating more clinics to teach the do-it-yourself form of dialysis using specially designed portable equipment.

Some patients may be nervous or intimated at the thought of home dialysis. Currently, only 8 percent of kidney patients do dialysis at home and many patients do not know that have that option.

Home dialysis includes an intensive training program. People who prefer the home program, according to physorg.com, cite the convenience as a major factor in choosing home dialysis. The possibility of traveling with the machine gives them more freedom, as well as setting a more flexible schedule.

Despite concerns about infection and control in the home environment, a study published last year in The Archives of Internal Medicine found that patients “with end-stage kidney disease who have dialysis at home fare just as well as their counterparts who do hemodialysis,” traditionally performed at a dialysis center.

One additional key factor that is boosting home treatment is that new Medicare rules also pay physician reimbursement for patient education. This means that the home care training is no longer a burden to the system, but a covered cost.

As for the patients, Dr. Leslie Spry of the National Kidney Foundation says, once they “experience the difference between home and in-center dialysis most will not return to in-center treatment.”

Spry is a consulting physician for the National Kidney Foundation. In 2003, he also established at the first home hemodialysis program in the Midwest at his home clinic, the Dialysis Center of Lincoln in Nebraska.

To learn more about home kidney dialysis, check out this handy, downloadable comparison chart.

New to dialysis and Medicare? For a checklist of questions for your treatment plan and physician, click here.

Category: Medicare News, Senior Healthy Living | Tags: , , , , , , , , ,
ElizabethGHoward | 12/15/2010
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Time to Make the Switch!

tax

Medicare Advantage Disenrollment Period Begins in January

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.

Category: Medicare News, Medicare Tips | Tags: , , , , , ,
ElizabethGHoward | 12/02/2010
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Why the Courts Matter to American Health Care Reform

scales

With a new slate of Republicans in office, the Obama administration is already facing an uphill battle in continuing to push through the Patient Protection and Affordable Care Act, the new health care law.
But it’s the judicial branch, not he the legislative branch, where the disputes are cropping up. In Virginia, a federal judge plans to soon reject the law as unconstitutional. Should his court succeed, enforcing the law would be impossible until higher courts get involved. During that time, the entire states such as Virginia will be in health care limbo.
These judicial acrobats add to the pressures the administration is already facing from health care industry lobbyists who want to reduce the impact of the law, and many states that are rejecting the law entirely.
The unexpected side effect of this judicial rejection of the health care law – primarily its constitutionality (requiring that all Americans have health care insurance) according the New York Times article – is “(n)ot only would an adverse ruling confuse Americans and attack the law’s underpinnings, it could frustrate the steps hospitals, insurers and government agencies are taking to carry out the law.”
Particular to this judicial conversation is a new question the high court has not addressed: can the government require citizens to buy a commercial product, which health care coverage currently is?
No matter which way the courts decide, all parties agree it is a highly-politicized legal issue, which has strong and powerful voices on both sides of the legislative fence.

Category: Medicare News | Tags: , , , , ,
KatieParker | 09/23/2010
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Ride the Medicare Advantage Roller Coaster

Enrollment Goes up and Premiums Go Down In 2011

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?

Category: Medicare News | Tags: , , , , , , , ,
Mona Lisa Vito | 08/16/2010
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Healthcare Reform Extends Medicare’s Solvency by 12 Years

As discussed my previous blog post in July, both Social Security and Medicare are facing serious financial troubles in the near future as a result of Baby Boomers aging into the programs and rising healthcare costs. Medicare has specifically had a bleak outlook for the next few decades as reports in recent years indicated the program will face insolvency if its obligation to provide benefits to a growing pool of enrollees is not balanced by an increase in tax revenues.

social security running out of money, entitlement reform, medicare's impending insolvency, when will medicare run out of money, medicare's solvency extended 12 years, cadillac insurance tax, tax on cadillac plans, patient protection and affordable care act of 2010

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.

Category: Medicare News | Tags: , , , , , , , , ,
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