NewRetirement Retirement News Digest : Medicare

Medicare Maze

jberman — Thu, 19 Nov 2009 02:01:00 GMT

The Wall Street Journal, November14th, 2009

When Doug Foth, a retired accountant in Grandview, Wash., got ready to sign up for Medicare last summer, he recruited his daughter, a human- resources manager, to help him.

"We went through the Medicare Web site pretty thoroughly, and when we got done, I'm not sure I knew any more than when I started," says Mr. Foth, 68 years old. "It's very complex."

He turned to one of a handful of services that have started up, or expanded, in the past three years to help older adults choose from a growing number of Medicare options. He paid $150 to a new service called Allsup Medicare Advisor to sort out the possibilities—and got help fending off a penalty for signing up after age 65.

Tomorrow marks the start of the six-week "open enrollment" season for Medicare, during which people who use the health-insurance program can make changes to almost every part of their coverage (with the exception of Part A, which is basically hospital insurance).

The addition of Medicare's prescription-drug benefit in 2006 and the widespread loss of corporate retiree health benefits have made those choices more complicated—and potentially more expensive—both for current and would-be beneficiaries.

That's why more services are stepping in to offer advice. Some charge a fee; others are free to consumers but get commissions from insurers. Still more services, mainly supported by the government and nonprofit groups, provide more-limited online tools or telephone counseling at no charge.

Where to start? Read through "Medicare & You 2010," the government's overview of the program and your primary options. (Go to medicare.gov and look under "Learn More.")

At that point, if you need help, you might want to combine free tools with advice from a paid service. Here are some possibilities.

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Covering the Bases: Understanding the options if you're new to Medicare

jberman — Tue, 17 Nov 2009 10:35:00 GMT

Annapolis Capital, November 15th, 2009

Q: I am new to Medicare. I have my Medicare Part A and Part B. I elected a Medigap plan to complement my Medicare A and B. However, I am not on any medicines and so do not see the advantage for enrolling in Medicare Part D. What are the advantages of having Part D?

A: Insurance is a contradiction. You pay good money for something you hope you never need. We pay homeowner's insurance and hope we never have a fire. We pay auto insurance and hope we never have a car accident. Health insurance is the same. We pay our premiums and hope we never are in need of a doctor or a hospital.

The same is true of Medicare Part D. Many people are not taking any prescriptions. However, it is advisable they consider Part D. Many people are aware that if they delay in enrolling in Medicare Part D they will incur a penalty if they enroll at a later date.

However, the more concerning scenario are the "healthy" people who forgo Medicare Part D and then have an unfortunate, unexpected illness. The most poignant illustration is a "healthy" person who is newly diagnosed with an illness such as cancer, diabetes and/or heart disease. The medical treatment of such illness can be extremely expensive. By having prescription insurance, you are protecting yourself if you need high-cost medicines.

Q: I am new to the area. I have original Medicare and Medigap supplemental insurance. I have already contacted Medicare to change my Part D to a Maryland plan. My question is, how do I find a doctor in this area?

A: Medicare has a wonderful database of providers. You may call 800-MEDICARE and they can assist you with finding a doctor. You may also log on to www.medicare.gov and click on "Find a Provider in Your Area." This tool allows you to search by location and by specialty.

Q: My mother was admitted to a rehabilitation facility after her hospitalization for her broken hip. She remained there for 35 days. I was told her Medicare Part A covered up to 100 days of rehab. However she received a bill for $2,002.50 for days 21 through 35. Why?

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Seniors get new health options

jberman — Tue, 10 Nov 2009 10:25:00 GMT

Detroit Free Press, November 9th, 2009

Seniors looking to buy supplemental Medicare policies may have to do more work to learn about them. They often aren't widely advertised by leading insurers.

But several companies new to the business hope to capitalize on complaints that the state's leading insurer, Blue Cross Blue Shield of Michigan, doesn't widely advertise its money-losing Medigap policies.

"We have real customer service with low wait times," said Joan Budden, chief marketing officer for Priority Health, which has new supplemental Medicare, or Medigap, plans.

Aetna and Blue Care Network, a Blue Cross subsidiary, also have new Medigap plans for 2010.

Medicare supplemental plans are policies that help pay for doctor visits and medical services not typically covered by basic Medicare Part A and B coverage.

Their appeal is that they usually have no co-pays, and they pay for care in broader areas of a state or in another state where a person may live part of the year.

Medigap policies "are good for people who are frail and who have high medical needs," said Jennifer Houghton, a Medicare specialist with the Area Agency on Aging 1B in Southfield.

Insurers take on Blue Cross

George Williston considered buying a Blue Cross Blue Shield of Michigan supplemental Medicare policy. But he had such trouble finding information about the plans on the company's Web site that he decided to keep looking.

"I consider it a disgrace for a nonprofit organization," said Williston, 82, of Hastings, a retired nonprofit executive.

This year, Williston and other seniors will have more choices as insurers introduce new Medigap products to compete with Blue Cross, which is seeking a 36.7% rate hike to offset mounting losses selling the Medicare product.

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AARP endorses plan for health care reform

jberman — Tue, 10 Nov 2009 10:24:00 GMT

Nevada Appeal, November 8th, 2009

After a lifetime of hard work, no older American deserves to spend their later years struggling with medical bills, foregoing or cutting prescription drugs to make them last or avoiding preventative or basic care because they can't afford the out-of-pocket costs. That is why AARP has been fighting so hard to ensure older Americans are getting the health care coverage they deserve.

After carefully reading both the Affordable Health Care for America Act and the Medicare Physician Payment Reform Act (HR 3962 and HR 3961), AARP's all-volunteer national board has endorsed these bills because they meet the critical needs of older Americans and future generations.

For the more than 45 million Americans in Medicare — 320,000 in Nevada — the House plan makes prescription drugs more affordable by completely closing the dangerous gap in prescription drug coverage known as the doughnut hole, and allowing Medicare to negotiate with drug companies to reduce prescription drug costs.

Right now, the law does not allow Medicare to negotiate prices, and the program must accept the prices given by the pharmaceutical manufacturers. The House bill changes that.

The bill also adds preventive benefits like free cancer screenings, cracks down on waste and fraud, protects the traditional Medicare benefits people in the program rely on and ensures seniors get access to the doctor of their choice or can find a new doctor when they need one.

For all Americans — including more than 70,000 uninsured Nevadans age 50 to 64 who often struggle to find affordable insurance — the House plan makes coverage more affordable by strictly limiting how much more insurance companies can charge based on age.

The House plan guarantees that you'll never be denied affordable coverage because of your health or age. AARP has fought to prevent anyone from coming between you and your doctor; and we've fought to make sure your health care does not take a back seat to insurance company profits.

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Nearly 65? Time for the Medicare Maze

jberman — Thu, 05 Nov 2009 09:52:00 GMT

The New York Times, October 14th, 2009

NOW that you’re about to retire, there’s good news and bad news about your health insurance. The good news: When you turn 65, you’re eligible for Medicare — all in all, a pretty affordable way to get coverage for doctor bills, hospitalizations and, more recently, prescription drugs. The bad news: You’ve got a big job ahead of you, sorting through the Medicare bureaucracy.

For someone new to the system, the hundreds of options Medicare provides can be daunting. “We’ve seen C.P.A.’s get stymied,” said Paul Gada, personal financial planning director at Allsup, a provider of Social Security and Medicare consultation services that is based in Belleville, Ill. “The process can be difficult for even the most savvy individuals.”

More important, the choices you make now as a new retiree may have consequences down the line when your health care and financial needs change. Confusing as Medicare may be, it is better to learn the ins and outs of the system early than to try to figure it out 20 years from now. The newly eligible have a seven-month period to enroll, starting three months before their 65th birthday. And numerous resources are available to help both newcomers and veteran Medicare users.

Not long ago, retirees simply went to their local Social Security office and signed up for Medicare A, which covers hospitalization, skilled nursing facilities, hospice and some home health care. Then they signed up for Medicare B, which provides coverage for doctor’s fees for a premium ($96.40 a month in 2009). That was the end of it.

Big changes in the way Medicare is distributed have made signing up a lot more complicated. In addition to A and B, enrollees can now buy prescription drug coverage under Medicare D. Dozens of private insurance plans offer Medicare D coverage, and the plans can differ widely in both premium costs and the drugs they cover.

The government also allowed private insurers to offer Medicare Advantage plans, which combine A, B and D benefits, often under a network like an H.M.O. or P.P.O. Many offer extras like dental, vision and wellness coverage. Hundreds of different Medicare Advantage plans are sold today, and depending on where you live, you could have dozens of choices.

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65 and Up and Looking for Work

jberman — Wed, 04 Nov 2009 10:31:00 GMT

The New York Times, October 24th, 2009

It is well known that during the nation’s gale-force recession, many older Americans who dreamed of retirement continued to work, often because their 401(k)’s had plunged in value.

In fact, there are more Americans 65 and older in the job market today than at any time in history, 6.6 million, compared with 4.1 million in 2001.

Less well known, though, is that nearly half a million workers 65 and older want to work but cannot find a job — more than five times the level early this decade and this group’s highest unemployment level since the Great Depression.

The situation is made more dire because of numerous recent trends: many people over 65 have lost their jobs as seniority protections have weakened, and like most other Americans, a higher percentage of them took on debt than in previous generations.

The expectation once was to pay off your 30-year mortgage before you retired, or come close. Instead, the level of indebtedness among older Americans has risen faster than in any other age group, partly because so many obtained second mortgages to take money out of their homes.

This financial squeeze is one reason President Obama has proposed giving a special $250 one-time payment to all Social Security recipients.

Many out-of-work older Americans complain that they face foreclosure or have had to give up their car.

“It’s a big deal for a lot of these people not to find a job,” said David Certner, legislative policy director for AARP. “That so many of them are still trying to find work shows how bad the economic situation is. A lot of people normally give up at that age.”

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Choosing a Policy to Cover What Medicare Doesn’t

jberman — Wed, 04 Nov 2009 10:18:00 GMT

The New York Times, October 14th, 2009

PEOPLE over 65 should buy a Medigap policy, consumer advocates say, but picking a Medigap plan can be difficult, and at least one important health care bill heading for a vote in the Senate could make it even harder.

The plans, which are sold by private insurers, are supposed to help fill the considerable gaps that deductibles and co-payments leave, the difference between what Medicare enrollees receive from the government and what they owe doctors and hospitals. Medigap offerings come in a dozen different varieties, labeled Plans A to L.

Choosing a plan is particularly tricky for consumers because monthly premiums for identical coverage can vary by hundreds of dollars from one company to another. Rates also vary by area of the country and age of the enrollee, and in many cases by gender. Still, the advantages of the coverage, for everyone who can afford it, make the hard work of shopping around a good investment.

Why buy a Medigap policy when you turn 65 and become Medicare-eligible, even if you don’t expect to need it for years? A reason, of course, is that people cannot anticipate what might befall them. Consumer advocates also point out that under some state laws, those who delay end up paying higher monthly rates or being rejected for health reasons.

Adding complexity to the calculation is the possibility that Congress may cut back on the current 100 percent coverage of medical bills for people who wait to buy their first Medigap policy. The Senate Finance Committee, looking ahead to 2015, is calling for new co-pays for doctors’ visits under Medigap. If the provision is adopted, new purchasers might be charged $5 for a visit to a primary care doctor and $15 or $20 for a specialist, committee aides say. The change is intended to discourage medically unjustified visits.

Darlene Mastro, who had retired early, said she “couldn’t wait” to be 65 and eligible for Medicare. But when she telephoned the local offices of several companies to ask about Medigap insurance, she was disappointed by the response.

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Now Is the Time to Weigh Medicare Options

jberman — Wed, 04 Nov 2009 09:31:00 GMT

The New York Times, October 31st, 2009

MEDICARE recipients, it’s your turn.

For the last few weeks, my Patient Money colleague Lesley Alderman and I have been giving advice on how to navigate the open enrollment season for employee health benefits. But Medicare enrollees must also do this annual drill, and in some ways their task can be more complicated.

While employees now typically face a dwindling number of options, Medicare recipients may have the opposite problem — a potentially overwhelming welter of choices. They may need to sort through dozens, even hundreds, of choices during the annual enrollment period, which runs Nov. 15 through Dec. 31.

Those already enrolled in Medicare, of course, might not need to do anything. Assuming the coverage they have now is not changing, and it’s working for them, they can probably stand pat. That might be particularly true for the 35 million people whose main coverage comes directly through the government. In that case all they may need to worry about is their Medicare D prescription drug plans provided by private insurers, if they have such coverage; about 17.5 million of these people in traditional Medicare have the separate drug coverage.

But as I explain below, there are various reasons that staying put might not be a good idea. And making a change means coming to grips with an array of Medicare options that has been expanding at a bewildering rate in the past decade.

There is the traditional Medicare A, which covers hospitalizations and is provided at no charge to enrollees, and Medicare B, which covers fees from doctors and other health care providers and requires a monthly premium. (Because there will be no Social Security cost-of-living increase in 2010, premiums for most current B enrollees will stay the same as for 2009, at $96.40 a month. However, most new enrollees will pay 15 percent more than that, $110.50 a month.

Seniors can also choose from a vast number of specialized plans from private insurers. There’s the Medicare D drug coverage, for example. But there are also fuller private-carrier packages called Medicare Advantage, which often bundle Medicare A and B with a drug plan, along with extra benefits like dental, vision and wellness coverage.

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Medicare: What to expect, what you should know

jberman — Tue, 03 Nov 2009 01:34:00 GMT

Detroit Free Press, November 1st, 2009

QUESTION: What kinds of changes are we seeing in Medicare this fall in Michigan?

ANSWER: There are two primary changes. The first is there are fewer plans being offered and secondly the prices of the plans being offered are increasing.

Q: Without exception?

A: Almost across the board except for a handful of plans with little change.

Q: Why are prices going up?

A: The insurance companies say the prices are going up to reflect increased prices in the marketplace.

Q: What do we know about the Medicare choices seniors in Michigan have made in the past? What percentage is in Medicare Advantage plans and so on?

A: In the past, Michigan was pretty lucky because relatively three quarters of the population were in some type of retiree plan sponsored through their former employer. However, that trend is changing as many of the employers are dropping, reducing or changing the structure of their employee health benefits.

Q: So more people have to purchase their own Medicare plan?

A: Yes.

Q: Is there still a lot of confusion?

A: Yes. There are some people new to this whole process because their retiree benefits are changing. But each year there are changes in the plans, too. Sometimes the plans changing have huge changes or they are exiting the marketplace. I think there was a misconception in the public that 'Once I get into a plan, I'm set, if not for life but at least a few years.' There can be drastic changes.

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Medicare Fraud: A $60 Billion Crime

jberman — Tue, 27 Oct 2009 00:50:00 GMT

CBS News, October 25th, 2009

Of all the problems facing the United States right now, none are more important than health care.

President Obama says rising costs are driving huge federal budget deficits that imperil our future, and that there is enough waste and fraud in the system to pay for health care reform if it was eliminated.

At the center of both issues is Medicare, the government insurance program that provides health care to 46 million elderly and disabled Americans. But it also provides a rich and steady income stream for criminals who are constantly finding new ways to steal a sizable chunk of the half trillion dollars that are paid out each year in Medicare benefits.

In fact, Medicare fraud - estimated now to total about $60 billion a year - has become one of, if not the most profitable, crimes in America.

This story may raise your blood pressure, along with some troubling questions about our government's ability to manage a medical bureaucracy.

If you want to find Medicare fraud, the first place you should look is South Florida, where 60 Minutes and correspondent Steve Kroft were told it has pushed aside cocaine as the major criminal enterprise.

It's a quiet crime - there are no sirens or gunfire. The only victims are the American taxpayers, and they don't even know they are being ripped off.

FBI Special Agent Brian Waterman, who 60 Minutes rode with for several days, told us the only visible evidence of the crimes are the thousands of tiny clinics and pharmacies that dot the low-rent strip malls.

You don't even know they're there because there's never anyone inside. No doctors, no nurses and no patients.

"This office number should be manned and answered 24 hours a day," Waterman explained, standing outside one of those small, unstaffed businesses.

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Medicare Basic 2010 Premiums Sport Asterisks

jberman — Fri, 23 Oct 2009 09:22:00 GMT

US News & World Report, October 23rd, 2009

The official 2010 Medicare premiums and deductibles for Part A (hospital services) and Part B (doctor and non-hospital expenses) have been released by the Centers for Medicare & Medicaid Services (CMS). It would be difficult to make up a scenario more confusing than the one facing Medicare beneficiaries. Even CMS says it hopes some of the announced rate changes never come to pass, and it supports a Congressional proposal to avoid any increases in premiums next year for these basic services covered by Medicare. Until Congress decides otherwise, however, here is how 2010 looks:

Part A. In addition to inpatient hospital services, Part A covers qualifying expenses in skilled nursing facilities, hospice, and some home health services. People with at least 40 quarters of employment don't have to pay Part A premiums, and that's 99 percent of us. Everyone, however, faces deductibles. For 2010, they will include $1,100 for a hospital stay, up $32 from $1,068 this year. For longer hospital and nursing-home stays, beneficiaries must pay $275 a day for days 61 through 90 (up from $267 this year). If you need to stay longer than 90 days, there is a lifetime reserve bank with 60 days. For these reserve days, the 2010 deductible is $550 per day, up from $534 this year. Daily co-insurance for days 21 through 100 in a skilled nursing home will be $137.50 in 2010, up from $133.50 in 2009. (Medicare does not cover longer nursing-facility stays.)

Part B. In addition to physician services, Part B covers qualifying out-patient hospital care, durable medical equipment, and some other services. There's a Part B deductible, which is being raised to $155 next year from $135 this year. But it's in the premium calculations for 2010 that Part B gets very complicated.

There is a rule that Part B premiums for most people (73 percent of all Medicare beneficiaries) can't rise by more than the rate of increase in the annual COLA for Social Security recipients. In 2010, there is no COLA because of low rates of inflation. So under this "hold harmless" clause, the $96.40 monthly rate charged this year will stay the same in 2010. However, Medicare does need to raise its rates. That's because another rule says that Part B premiums paid by beneficiaries must equal at least 25 percent of total Part B expenses; the other 75 percent is paid directly by the government. Because of continuing healthcare price inflation, CMS must hike Part B premiums on the other 27 percent of recipients to make sure the program continues to collect 25 percent of its overall expenses in premiums.

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Basic Medicare Premium to Rise 15% Next Year

jberman — Wed, 21 Oct 2009 01:15:00 GMT

The New York Times, October 19th, 2009

The basic Medicare premium will shoot up next year by 15 percent, to $110.50 a month, federal officials said Monday.

The increase means that monthly premiums would top $100 for the first time, a stark indication of the rise in medical costs that is driving the debate in Congress about a broad overhaul of the health care system.

About 12 million people, or 27 percent of Medicare beneficiaries, will have to pay higher premiums or have the additional amounts paid on their behalf. The other 73 percent will be shielded from the increase because, under federal law, their Medicare premiums cannot go up more than the increase in their Social Security benefits, and Social Security officials announced last week that there would be no increase in benefits in 2010 because inflation had been extremely low.

Kathleen Sebelius, the secretary of health and human services, urged the Senate to approve a bill, already passed by the House, to block the scheduled increase in Medicare premiums.

“We are in tremendously difficult economic times, and seniors are being hit particularly hard,” Ms. Sebelius said. “The last thing seniors need right now is a substantial increase in their Medicare premiums, and many seniors will see such an increase if no action is taken.”

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Medicare Advantage at a disadvantage in health debate

jberman — Sat, 10 Oct 2009 09:59:00 GMT

Market Watch, October 8th, 2009

Senate Finance Committee Chairman Max Baucus promises that the huge health-care reform bill his committee will vote on next week will protect Medicare benefits for seniors. But not everyone agrees, and a fight is brewing as lawmakers prepare to take the legislation to the floors of the House and Senate.

At issue is Medicare Advantage, a popular federal government-subsidized program that allows seniors to choose health plans run by insurance companies. Currently about 10 million people - close to a quarter of the 45 million seniors getting Medicare - have signed up for Medicare Advantage.

Members typically get all their Medicare-covered health care through the plans, and the coverage can include prescription drug benefits. There are generally lower co-payments than in regular Medicare -- although enrollees may have to pay a monthly premium to get the extra benefits. Read more from Medicare.gov.

But proposed cuts to the Medicare Advantage program have health insurers and some seniors worried, and at least one amendment to the finance panel's overhaul bill seeks to cushion the blow as money for private plans faces the chopping block. Whether the amendment, offered by Sen. Bill Nelson, D-Fla., makes it into a final bill is now an open question. House legislation also proposes cuts to the program.

A vote on the Senate Finance Committee's bill is set for Tuesday, Senate Majority Leader Harry Reid, D-Nev., said Thursday. The measure costs $829 billion over 10 years, reduces the deficit by $81 billion and covers 94% of Americans. See full story.

President Barack Obama and congressional Democrats want to cut as much as $500 billion from Medicare over the next 10 years to help pay for insuring more Americans.

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Medicare cuts need not hurt seniors

jberman — Sat, 03 Oct 2009 09:28:00 GMT

Baltimore Sun, October 1st, 2009

All of the health care reform plans propose serious cuts in the Medicare program. Seniors' concerns about those cuts jeopardize passage of any plan.

The Medicare prescription drug benefit is expected to cost $395 billion over the next 10 years. But the law prohibits Medicare from negotiating drug prices. Consequently, Medicare must pay whatever the drug manufacturers charge. This subsidy is really a tax on us.

The essence of government procurement is competitive bidding, where contracts are awarded to the lowest responsible bidder. The Department of Veterans Affairs, which buys drugs for veterans through competitive bidding, sets a precedent. Medicare should be allowed to buy drugs through competitive bidding also.

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Insurers Drop Some Medicare Plans As Rules Tighten

jberman — Sat, 03 Oct 2009 09:24:00 GMT

The Wall Street Journal, October 1st, 2009

More than 660,000 seniors next year will lose the private Medicare plans they now have because some insurers are dropping coverage in response to tougher federal requirements.

Most of those beneficiaries are enrolled in a type of Medicare Advantage plan called Private Fee for Service, where enrollment has surged from about 820,000 three years ago to more than 2.44 million today. PFFS enrollees, unlike those under other Medicare Advantage plans, can see any doctor they like as long as he or she accepts payments through their plan. Medicare Advantage plans are subsidized by the federal government and run by insurance companies; most operate with networks of providers.

Congress, alarmed by the high cost of PFFS plans, voted in 2008 to require the plans to establish networks of providers beginning in 2011. Companies such as Humana Inc., which has established networks that can cover at least 80% of PFFS enrollees, are doing just that.

But Medicare officials acknowledged Thursday that others are pulling out. Plans with a total enrollment of 667,000 people are scheduled to be canceled next year, they said.

WellCare Health Plans Inc., for example, is canceling its PFFS plans for about 110,000 enrollees. Spokeswoman Amy Knapp said the company saw expanding networks to meet the new requirements as an unwise investment. The company, she said, will focus on its HMO and prescription-drug plans.

UnitedHealth Group Inc. is no longer offering PFFS plans to some 2% of its members in markets where no other UnitedHealth Medicare Advantage plan is available.

According to the Centers for Medicare and Medicaid Services, the federal agency that manages Medicare, beneficiaries can choose other private plans or go back to traditional Medicare. The agency said 99% of beneficiaries have access to at least one Advantage plan offered in their area.

Medicare announced Thursday that the premiums for Medicare Advantage plans are rising to an average of $39 a month from $32 a month this year. Premiums for standalone drug plans will be $30 a month on average, up $2 from this year.

The changes are adding fodder to the health-care debate. President Barack Obama and Democrats in Congress have proposed more than $100 billion in payment cuts to private Medicare plans over 10 years to help pay for expanding coverage to the uninsured. They argue that the private insurers are overpaid -- Advantage plans cost the government 14% more on average per beneficiary than traditional Medicare -- and the cuts will help control Medicare costs.

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