Bipartisan Deficit Commision Unlikely To Make Big Medicare Changes

Topics: Health Costs, Medicare

Oct 01, 2010

National Journal: "For all of the attention surrounding President Obama's bipartisan commission on deficit reduction, the country's biggest cost centers — health care in general and Medicare specifically — will likely remain unscathed when the panel offers its recommendations in December. The reason is simple: When congressional Democrats crafted the health care reform package, which became law a little more than six months ago, they did so by squeezing Medicare as much as they could politically … The Democrats' nifty feat of taking out more than $500 billion from Medicare, mostly by reducing provider payments and changing how the system pays private health insurance companies, has handcuffed the Republican budget hawks who serve on the panel. The cuts have left them nibbling around the edges in an attempt to reduce the nation's $2.5 trillion health care tab" (DoBias, 10/2). This is part of Kaiser Health News' Daily Report - a summary of health policy coverage from more than 300 news organizations. The full summary of the day's news can be found here and you can sign up for e-mail subscriptions to the Daily Report here. In addition, our staff of reporters and correspondents file original stories each day, which you can find on our home page.

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Medicare Advantage Plans - Advantages to Seniors

Some Medicare Advantage Plans have gotten a bad rap lately, but that may have been because of the overzealous marketing efforts of a few people, rather than the actual plans. All Medicare Advantage plans must be approved by the Center for Medicare and Medicaid (CMS). They must provide services that are equal to, or better than, services provided by the traditional Medicare Part A and Part B. Of course, the point of these plans is to provide services that will provide advantages over Part A and Part B!

What is the Problem With Medicare Advantage?

The recent flak over Medicare Advantage Plans is over the type of plan called PFFS (Private Fee For Service). These plans allowed access to "any doc", or the enrolled person's choice of Medicare care. The problem there was that the doctor or other medical provider had to accept and bill to the plan. Since some of the plans were very new, medical providers like doctors, hospitals, and therapists did not have the plans yet. This caused problems because the enrolled people needed to file the bill with the insurance companies instead of having the medical provider do it. Indeed, this did cause problems for many Medicare recipients.

What about other Medicare Advantage Plans?

Medicare Health Maintenance Organizations (HMO) and Medicare Preferred Provider Organizations (PPO) have been around a long time. Both of these types of Medicare Advantage plans use networks of doctors and other medical providers that have already agreed to participate in the plans. As long as plan members use their identification card, they are not experiencing a lot of billing problems. In general Medicare PPO and HMO members are expressing great satisfaction with their health plans.

A combination of private competition and federal incentives allow private plans to offer health plans that do deliver quality health care and save Medicare recipients money. The networks, once thought to be restrictive, actually ensure that medical providers understand and agree to the system so that system works more smoothly. These plans usually include the Part D or prescription part of Medicare too!

Who is Happiest With Medicare Advantage Plans?

Medicare Advantage plans appeal to people with moderate incomes. Medicare supplements can be a burden for seniors and disabled people on fixed incomes. However, many seniors with larger incomes also participate in Medicare Advantage plans because they come from the same companies that used to carry their old group or individual health plans, and they are comfortable with the medical providers in the network!

Medicare Advantage plans also provide satisfaction to those with specialized or chronic needs. Plans are available that address chronic conditions such as diabetes or heart problems, or those in nursing homes. Some plans even address the needs of caregivers!

You have choices about how to get the most out of your Medicare benefits!

M Katz is a licensed Texas insurance agent, who has been certified to work with many Medicare Advantage Plans. In her experience, the vast majority of her clients who chose Medicare Advantage plans or Medicare Supplements with traditional Medicare were satisfied because they chose the right plan for their own needs.

We have helped thousands of seniors and disabled people make the most of their Medicare benefits. If have questions about Medicare Benefits, consult with the Medicare Health Plan Experts at Trusted Senior Specialists Medicare Plans!

SSDI & Medicare - A Beginner's Guide

Figuring out how the Social Security Disability Insurance (SSDI) and Medicare programs are related can be confusing to anyone who isn't currently enrolled in these programs. This article provides basic information on SSDI and Medicare eligibility and benefits. In addition, this guide will show you how to apply for and receive the right benefits for your situation.

Defining the Programs

SSDI is a payroll tax-funded, federal insurance program that was established in 1954. A portion of the FICA taxes taken out of your paycheck are set aside for this disability insurance program, which provides monthly income to people who are unable to work due to a severe disability.

Medicare is another federal insurance program, but is health insurance instead of disability insurance. It is available to all individuals age 65 and older as well as those who have been receiving SSDI cash benefits for 24 months. The program is made up of many parts - Medicare Part A consists of hospital benefits; Medicare Part B is medical benefits; Medicare Part C (Medicare Advantage) provides extra coverage and is provided by private insurance companies; and Medicare Part D is voluntary prescription drug coverage.

Determining Eligibility - How to See if You Are Entitled to Benefits

Eligibility for each program depends on several factors. For SSDI, there are three general qualifying criteria: 1) you must have worked and paid into the program (through your payroll taxes) for five of the last 10 years, 2) you also must have been disabled before reaching the full retirement age of 65-67, and 3) you must meet Social Security's definition of "disability." The Social Security Administration (SSA) has a process to determine who's eligible for benefits. By evaluating your income, limits of your disability, past job history and more, the SSA determines whether or not you're qualified to receive disability insurance.

There are several ways people can become eligible for Medicare. Anyone who turns 65 is automatically eligible for benefits. If you get Social Security retirement benefits or receive benefits from the Railroad Retirement Board (RRB), you will be considered eligible as well. Additionally, if you're awarded SSDI benefits for something other than Lou Gehrig's disease (ALS), you will become eligible for coverage 24 months after the date of entitlement to cash benefits. If you are awarded SSDI and have ALS, you will automatically be eligible for Medicare once you begin receiving SSDI benefits, and if you have kidney failure, you'll be able to enroll in Medicare three months after starting dialysis.

Specific Benefits You Can Receive

Social Security Disability Insurance allows you to receive a regular monthly income, results in eligibility for Medicare benefits (as explained earlier), and allows possible extension of your COBRA benefits, protects your retirement and long-term disability benefits, plus allows for dependent benefits and return-to-work incentives.

Medicare has many parts to cover specific healthcare costs. Medicare Part A covers inpatient care in hospitals and provides patients with a stay in a semi-private room, complete with meals, general nursing, and drugs. Part A also covers the cost of a blood transfusion if the hospital must purchase blood for you, up to 100 days per each benefit period in a skilled nursing facility, and hospice care for those with a life expectancy of six months or less due to a terminal illness. Part A coverage costs nothing, except for your deductibles or copayments, and coverage gaps must be paid by you or covered by other insurance.

Medicare Part B covers doctors' visits and services, outpatient care, rehabilitative care under a physical therapist, occupational therapist, or speech-language pathologist, and some preventative services like flu shots and mammograms. The monthly cost (or premium) for Part B coverage is tied to your annual income and adjusted each year. Most will pay the standard Part B premium of $96.40 per month in 2009 (if your annual income is not more than $85,000 as a single taxpayer or $170,000 if filing a joint tax return).

Medicare Advantage (Part C) plans at a minimum cover everything offered by traditional Medicare (Parts A and B). They also may offer additional benefits not covered by traditional Medicare like dental care, vision screening, prescription drugs and other services that would otherwise need to be provided under a supplemental insurance policy (Medigap).

Your out-of-pocket costs are likely to be less with a Medicare Advantage plan than if you use traditional Medicare and a Medigap policy. Everyone in a Medicare Advantage plan pays at least the same monthly premium as those enrolled in Medicare Part B. Your premiums may cost more depending on the benefits provided by the plan.

Medicare Part D (prescription drug coverage) provides brand-name and generic prescription drug coverage. These plans are provided by private companies that are approved by Medicare. Part D coverage is optional and available to those enrolled in traditional Medicare (Parts A and B) or Medicare Advantage plans that don't offer prescription drug coverage. Costs, extra benefits and details vary by plan.

Work With a SSDI & Medicare Advisor Service to Maximize Your Benefits

Don't stay confused trying to figure out the complex rules of these programs on your own - let those who understand it best help you maximize your benefits. Medicare & SSDI programs can be confusing with all of the different program requirements and eligibility criterion. Working with an SSDI expert and Medicare Advisor Service can help you determine the best coverage for your specific needs to ensure you get all of the benefits you are entitled to receive.

Jim Allsup writes for Allsup, a nationwide provider of Social Security Disability, Medicare and workers' compensation services for individuals, employers and insurance carriers. Allsup provides a Medicare Advisor service to help you select the Medicare plans that are right for you.

Medicare Complete - Is it a Medicare Supplement Or Medicare Advantage Plan?

If you watch TV, you probably have seen one or more advertisements for Medicare plans. Many of these plans are offered by United Health Care. They offer Medicare supplements, also known as Medigap, and Medicare Advantage Plans. But which type of plan is Medicare Complete?

Many people refer to all Medicare plans offered by private insurance companies as supplements. But this is not the case. Medicare supplements and Medicare Advantage Plans are two distinct types of plans. This misunderstanding leaves people confused about Medicare Complete. Before we unravel the mystery of Medicare Complete, let's take a look at the difference between a supplement and an Advantage plan.

Medicare supplement - A supplement or Medigap insurance is an insurance policy that is offered by a private insurance company to fill the gaps left by Medicare. When Medicare was enacted in 1966, it was not meant to be totally comprehensive coverage. The beneficiary is responsible for a certain level of cost sharing. In general terms, the beneficiary is responsible for a hospital deductible, co-pays after extended hospital stays and 20% of outpatient expenses.

Medicare Advantage Plan - An Advantage Plan is also offered by a private insurance company, but instead of filling the gaps left by Medicare, the Advantage Plan is another way to receive your Medicare benefits. Insurance companies contract with and are approved by CMS (Centers for Medicare and Medicaid Services) to administer your Medicare. Plans are required to meet certain criteria, and in many cases offer benefits beyond conventional Medicare. You may still have cost sharing, but it is in the form of deductibles, co-pays and co-insurance. Plans typically include a maximum out-of-pocket expense. Advantage Plans often include Part D prescription drug coverage.

Setting the record straight. Medicare Complete is a Medicare Advantage Plan. Offered in some service areas as a PPO and offered in others as a HMO, Medicare Complete does not fill the gaps left by Medicare, but rather is an Advantage Plan with predetermined out-of-pockets costs. Unlike a standardized supplement, Medicare Complete may have varying levels of coverage and benefits depending on the plan's service area. You may have a regional PPO plan available in your County, while someone in a neighboring County may have Medicare Complete available as a HMO plan.

If you are looking for a plan that includes Part D drug coverage and a low monthly cost, then you may want to take a look at Medicare Complete when you are comparing Medicare Advantage Plans. If on the other hand, you don't mind a higher monthly premium and are looking for a plan that will fill the gaps left by Medicare, you may want to consider a Medicare supplement.

Determining if Medicare Complete is right for you.

Here are some things to consider when determining whether Medicare Complete is the best plan for your needs.

Is the plan affordable? This means affordable, not only as far as any premium that may be required (there may not be one!), but also the amount of cost sharing that may be required to use the plan.
Do you feel comfortable with the plan's provider network? In many service areas Medicare Complete has a strong network, but you need to investigate this for yourself.
Does the plan offer as many extra benefits as other Advantage Plans that may be available to you? Many plans offer dental, vision, hearing and in many cases the Silver Sneakers program.
Do you feel that the maximum amount out-of-pocket that you could incur is reasonable compared to paying a higher monthly premium for a supplement? If the maximum annual amount is high and you have several costly health conditions, you may want to consider whether a supplement would be a better option.

Choosing a Medicare Advantage Plan is an important decision, but armed with the right information, it does not need to be overwhelming. Now that you know that Medicare Complete is an Advantage Plan, it is up to you to do your homework and determine if the plan is right for you.

David Forbes is President of Alliance Marketing Associates, Inc. David offers helpful advice on topics related to insurance for seniors, including finding an affordable Medicare Plan.

Sign up for your Free Mini-Course on Medicare Plans at http://www.affordablemedicareplan.com/

Medicare Open Enrollment is Coming So Get Ready!

Are You Ready For Medicare Open Enrollment?

When Medicare Open Enrollment rolls around, it is time to consider your health and prescription plans for next year. According to the US Center for Medicare and Medicaid, Medicare Open Enrollment is from November 15th to December 31 this year. Even if you are content with your current Medicare health and prescription benefits, you want to make sure that the plan will be very similar next year. Because plans do change, and the period after Medicare Open Enrollment is when those changes will show up.

How To Prepare For Medicare Open Enrollment

The Medicare websites gives some great tips to evaluate your current Medicare health and prescription plans, and they are pretty simple.

Gather Information About Your Health Needs. This includes your current prescription list, your medical providers, and any notices you have received from Medicare, Social Security, and any private health or prescription insurance companies about changes to your plan.
Compare plans in your local area for cost, coverage, and customer service. You can do research by using the Medicare website, contacting a local insurance agent who is a specialist on various Medicare Health and Prescription Plans, and also by asking people you know and trust about their experiences.
Decide if you would like to keep your current coverage or make a change.
If you decide to consult an insurance agent, look for a Medicare specialist who is appointed and certified with multiple area plans. If you find an agent who only represents one company they may be less motivated to give you a balanced view. Of course, you may end up purchasing from one company, but it would be best to do your shopping with a consultant who is not motivated to only push one plan.

Understand the differences between Medicare Advantage Plans and Medicare Supplements. This subject still causes confusion. And no, there is no one right answer for everybody. Some people feel as if Medicare Advantage plans are only for seniors with moderate to low incomes, but some individuals with very high incomes are very satisfied with Medicare Advantage. On the other hand, some people, especially those who do not live where a doctor network is convenient, may be happier with a very flexible plan like some Medicare Supplements, even though they cost more. Of course, on still another hand, some Medicare Advantage plans will work with any doctor who accepts the plan, so they can be very flexible too!

I do not mean to be confusing here, but I do mean to illustrate that the variety of Medicare Health and Prescription plan choices makes choice complex. If you have questions, do not hesitate to consult Medicare or a private Medicare Specialist. An insurance agent who specializes in Medicare health plans should not charge you anything. They earn a living with commissions from the various companies when they do sell a plan. If you can find an agent who is appointed and certified with all, or most, of the local plans, they will not be motivated by that commission to select one plan over another. They should be motivated to find the best plan for you, and keep you as a valuable client!

Do you need to find a Medicare Health Plan?

It only takes a moment to Compare Medicare Health Plans. Our forms are simple and free, and they will show you the options in your local area.

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Can You Find Medicare Health Supplement Quotes Online?

Do You Want To Compare Medicare Supplements

Before you shop for a Medicare supplement, make sure you understand the basics.

Supplements, as the name suggests, are meant to supplement the original Medicare Part A and Part B that most US seniors get. The original plan provides health insurance, but does not cover everything. It also requires members to pay deductibles and copays. These our of pocket expenses, that beneficiaries have to pay, are considered "gaps" in coverage. That is why these plans are called Medi-Gap or medigap plans sometimes. There are standard levels of plans which will be the same no matter which insurer sells them. They have very plain names like Plan A or Plan L. They have different coverage levels and benefits, according to which plan you choose but a Plan F will always be a Plan F. They are sold by private insurance companies, and not by the government. The government regulates them and sets the rules. Different insurers may have different premium schedules. Premiums can also vary by your age and where you live. There is competition between the private insurance companies. Even though the plans are standardized, some insurers may offer something called value added services to their supplements. These services do not typically come at a cost. Some popular examples of these benefits could be a health club membership, vision care discounts, or a 24/7 nurse hotline. Insurers may use these benefits to compete in the market, but they do not have any thing to do with the standardized plan. Even if you have a Medicare supplement, you will also probably have to sign up for a Medicare RX (PART D) plan to cover prescription drugs. Medicare Advantage (MA) plans are different than Medicare supplements. If you are not sure which one you want, please take the time to learn the differences.

That may have seemed like quite a long list just to cover the basics. You do have a lot of choices in the way you make the best use of your Medicare benefits today, but those choices can be confusing. It can be stressful and confusing if you have to set a lot of appointments with multipe insurance agents in order to compare plans and companies.

Which Plan Is Best For You?

However, there may be an easier way to shop and compare. Keep in mind that the best Medicare supplement for you will be an individual choice. Rates and insurers will vary by where you live too. Your own best choice will depend on your health needs, budget, and lifestyle.

This means that the great choice you older sister made may not even be sold where you live, If it is, it may come with a very different price or value added benefits. I think it is great to ask trusted friends and family how satisfied they are with their companies, but in the end, you must choose the best senior health plan for yourself.

Comparing Medicare Health Supplement Choices Online

Online health quote forms are very common today. You can take a few minutes to complete a simple form and get competitive quotes and plans to review in the comfort of your own home.

Are You Shopping For Medicare Health Insurance?

Take a few minutes to get Medicare Health Insurance Supplement Quotes with our safe and free online quote forms.

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