How Medicare is Failing Diabetic Americans

Bill was 67-year old real estate agent. He was semi-retired. He like showing houses because he had lived in the same small town his whole life. People trusted him. But one day he got a diabetic foot infection. He called his primary care doctor and was referred to a podiatrist. But the podiatrist didn't have any more "Medicare appointment slots" available until the end of the month. While waiting for the appointment, the infection got worse. So instead of high quality care, Bill got an amputation. Now he sits in a wheelchair, wishing he could sell houses.

Retired Americans often view Health Care paid for by Medicare as one of the few perks of retiring. After a lifetime of working hard, raising children, and paying into the System, Medicare is one of the few reliable ways to get a return. But unfortunately for those who are diabetic, Medicare can be bad for your health. It's just math; not enough money equals not enough high quality medical care.

The recent attempted resurrection of President Obama's Health Care reform efforts speak to the broken system. The fact is that Medicare is an expensive program. Since 2002, Medicare has been short of money. There is only just so much money to go around. All of the federal mandates that have been written into law to save money are simply killing diabetics. As long as you understand why, you'll be able to get quality care even if you do have Medicare.

1. Difficult to Find a Medicare Doctor.

Since 1986 Medicare has set all doctor fees. Doctors don't decide how much they get paid, Medicare decides. Adjusted for inflation, over the last eight years, Medicare Has reduced fees about 20% every year. On March 1, 2010 doctors took another hit when Congress let another 21.2% reduction in doctor pay take effect. Imagine if at your job every year you get 20% less pay instead of a raise. How long would it take you to look for another job? Obviously your doctor can't just switch careers, but he can stop taking Medicare.

In some places this means less doctors are available to accept new patients. If you live in San Francisco, the cost of living may be twice that in rural Ohio. But incredibly, doctors seeing patients in San Francisco get paid comparable fees by Medicare. So your doctor has to either learn to live poor or see twice as many patients.

2. Doctors Who Accept Medicare are Swamped.

In 2008, the president of the American Medical Association (AMA) was testifying in front of Congress about declining care for Medicare patients and the problem of Medicare cuts. The AMA President informed congress that the vast majority of doctors in the United States would simply opt-out of Medicare and stop providing care for Medicare patients. Senator Stark replied that since Medicare started reducing payments to doctors many years ago, doctor's have simply seen more and more patients each year to make up for the lost revenue.

But it is now clear that doctor's can't keep seeing more and more patients. Sixty patients in a day is just plain bad medicine. Seven minutes of time in a room with a patient is not enough time to understand blood sugar readings, sugar pills, insulin shots, hypertension, peripheral vascular disease and explain diabetic foot care. It just isn't enough time to practice good medicine. Too many patients and not enough time is a prescription for a diabetic disaster.

3. Less Pay for Medicare Diabetes Doctors.

Many people don't think pay should have anything to do with the quality of the care. But the reality is, it just comes down to math. If your doctor accepts Medicare, but has to see 60 patients a day, you won't get much time. I actually have a doctor friend who says, "I just tell Medicare patients they get two problems to talk about during a visit. Just two," she said holding up two fingers.

But what if you have high blood pressure, diabetes, and you also have a little sore on your foot? If you can only talk about two problems, you'll ignore the diabetic foot ulcer. And if that diabetic foot sore turns in to a diabetic foot infection, you just might wind up with an amputation.

When you are allowed the time you need to talk to your doctor, you would and should talk about all of your health concerns. This of course is the way medicine used to be. The fact that most patients don't know is that your doctor is obligated ethically and in many cases legally to hear about all of your health problems that need to be treated. So if you doctor says, "We'll have to discuss that next time," just insist that he hear you out.

4. Medicare is Decreasing Services.

If you have diabetes you will be sent to a lot of different specialists. Studies have shown that having diabetes make you four times more likely to have a heart attack. You are also way more likely to develop kidney trouble, blindness, or diabetic foot infections that lead to amputation. To make sure everything is working right, your primary care doctor will likely send you for "consultations" with other diabetes specialists like podiatrists, cardiologists, opthalmologists and nephrologists.

A consult is a visit to a specialist requested specifically by your primary care doctor. The problem is that Medicare simply stopped paying "consult codes" this year. So don't expect a specialist to take any extra time explaining your health problems to you or your primary care doctor. And don't be surprised if these specialists don't work you into their schedules very quickly. They simply are making money like the once were.

Once upon a time, house calls were common, but now very few doctors who accept Medicare can afford to make house calls. There is just no way they can take the time to drive from house to house with the low rates medicare pays. This is obviously a big problem for an elderly diabetic who may have poor eyesight or an open wound on the foot. If you can't see because of your blindness and aren't supposed to walk on the foot with an open sore, how can you easily get to the doctor's office?

5. No Diabetes Prevention.

It is simply a fact that the problems related to poorly managed diabetes are preventable. Blindness, kidney failure, and diabetic leg amputations are all preventable. Doctors fully understand how elevated blood sugar levels damage the eyes, kidneys and feet. Doctors also fully understand how preventative care can prevent this damage. But Medicare won't pay for intensive diabetic foot monitoring programs. It has been shown that close monitoring of diabetic foot skin temperatures can prevent diabetic foot sores. But this sort of close monitoring by a diabetic foot expert isn't a service that Medicare will pay for. As a result, it is a service that isn't offered to you by your doctor.

So now that you know the Top 5 Reasons Medicare is bad for your diabetes, what can you do about it? First keep in mind that most doctors decided to become doctors because they really and truly want to help people stay healthy and happy. Remember that your doctor is on your team. But feel free to remind him or her that you need help, even if it might take a little extra time. In most cases your doctor will listen.

You've got to ask tons of questions. Take a list of questions so that you can stay on track and get all of your concerns dealt with in a short doctor visit. Ask your doctor about performs house calls. If not, find one that does. Even if you have to pay for it, having a doctor come to your home is an amazing convenience. Make sure you ask your doctor about any new treatments that are available, but not covered by Medicare. If you don't ask, many docs will simply not take the time to offer all available treatments if they aren't covered.

Diabetes is a serious disease. Many patients with diabetes will die from health complications directly attributable to poorly controlled blood sugar. Given that most of these problems can be managed and prevented, you owe it to yourself to insist on the very best care from your doctor.

Dr. Christopher Segler is a podiatrist in the San Francisco Bay Area. He offers House Calls for diabetic foot exams, Diabetic Foot Emergencies, and Diabetic Foot Wound Treatment. Serving San Francisco, Marin, Palo Alto, and Walnut Creek. You can learn more about house calls as solution to foot pain at San Francisco Podiatrist housecalls or visit the best info on San Francisco Podiatry.

Will Health Care Reform Kill Medicare Advantage?

It has been six months since the highly contested Patient Protection and Affordable Care Act, also called health care reform, became law. Polls show that people remain worried about how the law will affect their health care. There is a lot of talk about big cuts in Medicare, and seniors are worried their coverage will be reduced or that their doctors will no longer accept Medicare. Should they be worried?

The worst news is for people who love their Medicare Advantage plans. This program pays private insurance companies to enroll seniors in managed-care networks. Many plans offer more benefits than "plain" Medicare, such as dental and vision coverage and health club memberships.

The problem with Medicare Advantage is that taxpayer's aren't getting their money's worth from the program. Much of the recent increases in Medicare costs can be traced to overpayments to insurance companies offering the subsidized plans.You've heard that Medicare is going broke? Well, Medicare Advantage is a big reason for that.

A Medicare Advantage benefit costs the government 14 percent more than exactly the same benefit offered through regular Medicare. In some parts of the country, the difference is as high as 20 percent. That extra money is being eaten up in marketing and administrative costs, and in profits to the insurance companies.

According to the U.S. Department of Health and Human Services, all Medicare beneficiaries, including those enrolled in regular Medicare, are paying for these overpayments through higher premiums. HHS says that this year these subsidies are adding about $3.60 per month to premiums.

But there is no proof that the program is providing better health care than regular Medicare; just that it's more expensive. And for this reason, most of the cuts to Medicare provided in the health care reform law are cuts to Medicare Advantage, not regular Medicare.

These cuts won't go into effect all at once. In 2011, the subsidy going to private insurance companies will be frozen at 2010 levels. After that, the payments will be reduced an average of 12% per year, until costs are more in line with the cost of regular Medicare. Beginning in 2014, the private insurers offering Medicare Advantage plans must maintain a "medical loss ratio" of at least 85%, which is a fancy way of saying that 85 percent of the subsidies and premiums they receive must be paid out in benefits. On the other hand, companies that meet certain benchmarks for quality of service are eligible for a bonus.

Bottom line: according to the Congressional Budget Office, by 2019 the private insurance companies offering these plans will receive $136 billion less than they would have received at the current level of subsidy.

Naturally, the private insurance companies do not like this one bit, and they say they will drop out of the program if these cuts aren't repealed. And when those Medicare Advantage taxpayer subsidies stop being a cash cow for those companies, they might very well drop out of the program. Companies that stay in the program probably will eliminate some of the extra benefits that make Medicare Advantage popular.

Some seniors will be unhappy about this, but it's important for them to understand why it is happening -- Medicare Advantage as it is has been dragging the entire Medicare program closer and closer to bankruptcy.

Before the Medicare program began in 1965, only 56 percent of people over age 65 had any health insurance. Today, without Medicare, the percentage of seniors with health insurance would be very tiny, indeed. It's a sad fact that in our autumn years, nearly all of us will suffer increasing problems with our health. Some ailments -- arthritis, heart disease -- are common, and some are rare, such as mesothelioma cancer, rarely diagnosed before the patient is 50. Either way, senior health care is expensive, and private insurance companies don't want seniors as customers -- unless taxpayers are supplying the profits.

In 2009, while health care reform was being hotly debated in Congress and town hall meetings all over America, some insurance companies deliberately misinformed their customers about what the bill would do to their Medicare Advantage Plans. One major Medicare Advantage provider sent out a letter to its Medicare Advantage customers claiming that Congress and President Obama would cut "important benefits and services" provided by Medicare.

Remember the stories about silver-haired grandmothers marching in protests with signs saying "Keep Government Out of My Medicare"? People laughed at them, but it's possible those were misinformed Medicare Advantage customers.

But the Patient Protection and Affordable Care Act is not cutting any benefit from Medicare. In fact, it is adding a few new benefits. Beginning this week, Medicare patients will not have to pay a co-payment to the doctor for preventive care or for an annual checkup. The health care reform law also will gradually close the infamous "doughnut hole," the gap in Medicare Part D prescription drug coverage that costs some Medicare patients thousands of dollars every year.

Last year, the trustees of the Medicare program announced that by 2017, the part of Medicare that pays hospital bills would be out of money, and Medicare would have to stop paying those bills. This year, the same trustees said the hospital fund should be good until 2029, thanks mostly to the health care reform bill. This tells us the struggle to save the program isn't over, but we're moving in the right direction.

As we get closer to the November midterm elections, watch out for politicians citing the cuts to Medicare Advantage as a reason to repeal the health care reform bill. Without those cuts, Medicare itself is in grave danger.

Barbara O'Brien is a concerned citizen who writes the popular political blog, The Mahablog.

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!

The Medicare Factor in Long Term Care Planning

Medicare and Health Insurance History in the United States With a vision to provide a universal health plan, such as Medicare, the United States does not truly have a national health care plan. Even though universal health care, another name for national health care plans, has its conception in the 20th century, the United States has shied away from its inception. In fact, the United States is one of the few industrialized countries that do not offer true, government provided universal health care.

The first private health insurance programs created nation wide was the Blue Cross plans. Originally paid by individuals on prepaid bases for certain hospitals, this was later changed to include any sponsored hospital. The individual would provide a monthly payment that ensured he was cared for a specified number of days.

The Blue Shield plan was another plan created during the 1940s. It allowed the prepayment for doctor services. The plan’s creation provided an alternative to a national health care plan. The Blue Shield and Blue Cross plans eventually merged, forming what we call today Blue Cross Blue Shield.

There are varying reasons that a national health care insurance plan has not taken hold in the United States. As the American Medical Association has opposed the establishment of a national plan, the employer sponsored insurance plan has added the catalyst to not create a national plan. Since the employers can write off the plans provided to their employees, Congress has not received any push to change the concept of employer-sponsored plans.

The closest conception of universal health care the United States institutionalized is Medicare. Medicare was created in 1965.

Then Came Medicare

So how did Medicare take hold? Though it is not a true national health care plan for everyone, only for those over 65, it is because of President Lyndon B. Johnson and a majority of Democrats in both houses of Congress that the plan came into existence.

Attempting to provide a plan comparable to the private sector, the creation of Medicare part A came about. By mimicking the current plans, Medicare part A provided a determined amount of hospital care. Any more care beyond what the plan stated was to be paid by the patient.

The disadvantage to a plan such as this is the increasing expense of hospital care. The costs paid by the insured are now at a level to completely destroy financially that individual. In other words, as expenses have increased with hospital care, Medicare Part A has not kept pace. Therefore, any difference in cost is paid for by the patient.

This realization gave way to catastrophic plans. These plans allow the insured to pay for some of the upfront costs up to a predetermined out-of-pocket limit. Once that is reached, the insurance pays 100% of the cost. Unfortunately, Medicare has not evolved into this type of arrangement.

As such, we are beginning to see the bankruptcy of the plan, as well as the bankruptcy of the insured attempting to cover their part of the insurance plan.

Medicare part B evolved into a plan to encourage doctors to be paid by the federal government with the attempt to not institute price controls by the same. Under the original intent, Medicare part B paid for 80% of a doctor’s services while the patient paid the other 20%, and any fees above the reasonable costs.

However, the plan has degenerated into a government price control plan, where the government dictates to doctors what they will be paid for services the doctors provide.

Medicare Eligibility

Medicare enrollment takes place only one time during the year. The time frame usually is between October and December of the year prior to its activation for an individual. To learn more of the enrollment process for Medicare, read this publication: http://www.medicare.gov/Default.asp .

Most individuals understand that to enroll one must be age 65 years or older. However, most may not know that they also must be eligible for receiving Social Security or Railroad retirement. Furthermore, the individual does not need to be receiving either one of the retirement payouts, but one must be eligible to receive them.

In short, you can receive Medicare without receiving Social Security or Railroad Retirement income. You probably know someone who has decided to continue working. As such, they have delayed their receipt of government retirement payouts. However, to ensure a medical benefits plan, they have signed up for Medicare.

When you sign up for Social Security or Railroad retirement at age 65, or decide to receive payments at 65, you are automatically enrolled in Medicare Part A and Part B.

If an individual under 65 is disabled, and has applied for and receives Social Security disability for two years will receive Medicare. Furthermore, if a person of any age with end-stage renal disease may also receive Medicare.

Anyone born after 1938 will not receive their full retirement benefits from Social Security until the age of 67. Due to this, most individuals may decide to continue working. As such they will not apply for Social Security at the age of 65, thus not automatically receiving Medicare Part A.

Or, if the person is under a group plan, he or she may be forced into enrollment in Medicare at the age of 65. The person will not lose their group coverage, but it will be shared with Medicare.

I Have A Group Plan

Returning to the previous situation where an individual continues to work, or not retire, and not having a group plan, he or she may not receive a reminder to sign up for Medicare Part A. Fortunately, there will not be any penalties. However, he or she will only be allowed to sign up during a specified period during the year.

As for Medicare Part B, there is a penalty. You must sign up for Medicare Part B either three months before or after your 65th birthday. Otherwise, a penalty will be assessed against the premiums. However, if a person is covered under equivalent group coverage or is on Medicaid, the penalty is waived.

Though Medicare Part A is paid via payroll deductions and there is not cost when implemented, this is not the case with Medicare Part B. Medicare Part B is a cost-sharing plan.

The premiums for Medicare Part B are $88.50 (for year 2006). However, these premiums increase every year as the cost of medical services increase. Beginning in 2007, for those individuals in high-income brackets, they will pay a higher premium as a percentage for Medicare Part B.

The increases are phased in over a five-year period. The increases are scheduled as such:

income of: $80,000 -$100,000: 65% subsidy
income of: $100,000-$150,000: 50% subsidy
income of: $150,000-$200,000: 35% subsidy
income above: $200,000: 20% subsidy
If you are married, the incomes are twice what are depicted. However, for both individuals and married couples, the income ranges increase annually based on the Consumer Price Index (CPI).

I’m Not Eligible for Social Security

What about those individuals who are not eligible for Social Security and their spouse is not eligible either? That person can still get Medicare but will pay a premium, which may be equivalent to the Medicare Part A premium.

Eligibility for Social Security requires at least 10 years, or 40 quarters, under the system or paying into the system.

You do not have to participate in the Medicare program. However, if a person does not participate in Part A, they are not allowed to participate in Part B. If the person, though, must pay premiums for Part A, they can elect not to, and instead purchase Part B. It also works the other way. If you do not desire to participate in Part B, you do not have to.

To sign up for Part B, it must be done so during the first three months before the month of an individual’s 65th birthday, or three months after. This equates to seven months to sign up (3 months before and after, and the individual’s birthday month).

If an individual does not sign up for Medicare Part B during the initial period, they are penalized. The penalty is 10% for each full 12-month period the individual does not sign up. A person can sign up for Part B between January 1 and March 31 if they do not sign up during their initial enrollment period – the seven months mentioned earlier.

Can I Afford Not To Have Medicare Part B?

But what of the individual who cannot afford the premiums for Medicare Part B? Most individuals who are affected in this manner may be able to receive assistance through Medicaid or a state’s Medicare Savings Program. Normally, someone must meet the state’s requirement of limited income and resources. The plan will pay for Medicare premiums and possibly Medicare deductibles and coinsurance.

A situation which may help with understanding may include a person who receives Medicare Part A (which the Medicare Savings Program might pay the premium) and

He or she has resources equal to or less than $4,000; a couple would be $6,000. The resources may include monies in checking or savings account, stocks or bonds.

He or she has a monthly income of less than $1,068; a couple would be $1,426 (as of 2005; Alaska and Hawaii have higher limits).

If you are an individual that is 65 or older and still working with a group insurance plan, there are solutions to Medicare Part B. Most individuals under this scenario will continue with their group plan and use Medicare Part A as their secondary, or supplemental, insurance. However, they may not need the Part B.

But what if they do need Part B? As mentioned earlier, would they not be penalized if they signed up later? There are special rules for someone under a group insurance plan that allows them to sign up for Part B without a penalty.

If an individual is retired but has continued with a group plan under an agreement with the company, there are waivers to allow for coverage of Part B. However, the waiver only takes effect if the person loses their group coverage in the future.

If you are one of the aforementioned individuals who need to take advantage of these waivers for Medicare Part B, then you will need to apply during the Special Enrollment Period.

Study Up So You Don’t Have To Pay Up

Make sure you go to the Medicare link (http://www.medicare.gov/Default.asp) and read what you are entitled to. I don’t like that word, entitlement, but you have paid for Medicare so use it. Just don’t abuse it. Make it part of your Long Term Care Planning so you can make it through your golden years.

T. Sydney Shinn Home Health Care Solutions [http://www.home-health-care-solutions.com]

A developer of technical health care solutions, a Crown Ministries budget counselor, and a family man, Mr. Shinn understands the challenges of today's families. After taking care of his own father for five years, he created Home Health Care Solutions to to provide the material that families need to make informed decisions on home care options.

Wonder if a loved one will be able to continue to live in their home as they mature? Discover information for families and seniors about in home care giving, in home care services, mental and hospice care, legal and financial planning to ensure that the elder family member is able to live in their home forever. The site provides guidance in preparing the retiree, family, caregiver and senior family member.

The New Medicare Prescription Drug Plan Pitfalls

Coverage for the New Medicare Prescription Drug Plan begins on January 1, 2006. Many seniors are feeling confused and concerned about this plan. Here are some of the pitfalls associated with this plan that Medicare eligible individuals will want to be aware of.

1. To join the Medicare Prescription Drug Plan (Medicare Part D) you must choose one Prescription Drug Plan from dozens of plans that are available (there are up to 50 plans in some states). Once you have chosen a plan you are "locked-in" until the enrollment period the following year.

2. Prescription Drug Plan (PDP) providers can change the particulars of their plans at any time with a short warning period for plan enrollees. These changes can include changes to which drugs are covered under the plan, which pharmacies are in the plans network, the charges associated with being a part of the plan and any other detail of the plan. These changes are at the discretion of the plan administrator and can be implemented at any time.

3. For 2006, once you have used $2250 worth of medications, you are 100% responsible for paying for the full amount of the drug until you reach the $5100 Catastrophic coverage limit. This range between $2250 and $5100 where you have to pay for 100% of your drug expenditures is known as the "donut hole".

4. At its greatest level of savings Medicare provides a 49% savings. This is only 7% better than the average savings experienced with a licensed Canadian pharmacy. This greatest savings occurs when people spend exactly $2250 on medication in one year (if you spend more or less than that the savings go down). That means that the greatest savings anyone on Medicare can experience above a Canadian pharmacy's average savings is $157.50 annually (7% of $2250) or $13.13 a month. Is $13 a month worth the risk of being "locked-in" to paying monthly premiums for a plan that can be switched on you at any time. (Note: Some people can save more than 49% if they spend well over $7100 per year. This is in the catastrophic coverage range).

5. If you do not sign up with at Medicare Prescription Drug Plan before May 15th, 2006 then you will be penalized with a cumulative 1% increase to your premiums for every month that you do not enroll in a plan after that date. This penalty is the governments way of forcing people, who do not really need a drug plan, into joining a plan and thus "subsidizing" the Medicare program. 1% of the average plan is 32 cents. So for every month after March 15th, 2006 that people are not in a plan, 32 cents will be added to your monthly premium or basically $1 for every 3 months you do not join. This penalty is however applied to your premium for all future monthly premiums. What many seniors groups are advocating is for people to wait until the May 15th, 2006 deadline and then join the cheapest possible plan (approx. $10 monthly premium) and still order medicines from a licensed Canadian pharmacy like Universal Drugstore.

6. Average monthly premiums, the annual deductible and the Out-Of-Pocket expenditure limits are expected to increase substantially every year. This means you will be required to spend more and more money every year that you are part of the Medicare prescription plan.

7. Unless you are spending more than $800 on medications in 2006 there is no real savings with the Medicare Prescription Drug Plan. This required minimum amount of expenditure to experience savings will increase every year as the annual deductible, the monthly premiums and the Out-Of-Pocket expenditure limits are also increased every year.

8. It will be extremely time consuming and difficult to decipher myriad plans available in each state (all providing different coverage) and to try and figure out which plan is best for you personally. This will be twice as hard for a couple as the prescription drugs used by each person in the couple will be different and therefore they may require different plans. Even once a plan is chosen, there is still the risk of having the plan changed once you have made your decision and you are "locked-in".

9. Drug companies stand to make a ton of money off of the Medicare program. That is why they spent millions of dollars lobbying to get the legislation passed to make Medicare Part D a reality. It is also why Senator Bill Tauzin, a major advocate and motivating force behind getting the Medicare Prescription Drug Plan passed, is now a $2 million a year executive in Big Pharma's trade organization. On Sept. 5, 2003, Sen. John R. McCain (R-Ariz.) told the New York Times, "There's no doubt in my mind that the drug industry got everything it wanted and more," he said. "It perhaps should be called the 'Leave-No-Lobbyist-Behind Bill.' "

10. Plan providers have the ability to negotiate better drug pricing with the drug companies but they do not have to pass the savings on to the consumer or the government.

11. If you join a Medicare Prescription Drug Plan (PDP) at any time after Dec 31, 2005 your coverage is not available to you until the first day of the following month.

12. Action is required to enroll in Medicare Part D (the Prescription Drug Plan part) unlike Medicare parts A and B which are automatic. You are not simply enrolled in the best plan for you. You have to wade through piles of information to decide what is best for you.

13. It is very difficult for persons who qualify for Medicare Part D to be sure if their drugs will be covered under their plans formulary (which can change at any time anyways.) A formulary is a list of drugs covered under particular drug plan.

14. You may not qualify for Medicare Prescription Drug Benefits if your annual income is too high or if you own too many assets.

15. Different plans will have different monthly premiums. The plan you need may have a really high monthly premium. $32.20 is simply the "predicted" average monthly premium.

16. Will your plan cover temporary-use medications (such as antibiotics or heartburn medications) or only chronic medications (such as drugs used for diabetes or heart conditions)?

17. Plans with lower monthly premiums may have higher deductibles and co-pays.

18. Payments for drugs which are not on your plans formulary are not counted towards your Out-Of-Pocket expenditure limit.

19. Payments made by insurance plans do not count towards your Out-Of-Pocket expenditure limit

20. Is your regular pharmacy included in your plans network of pharmacies? Like many people you have most likely come to rely on a pharmacist that knows you and your medical conditions well. However, you may be forced to go to another pharmacy if your pharmacy is not included in your plans network of pharmacies.

21. How many days of medicine can you get at one time? Do you need to keep going back to the pharmacy every month or can you get 90 days?

22. Will your drug be covered by your plan the next time you go into your pharmacy?

23. Does your plan require step-up therapy or prior authorization? Step-up therapy means using drugs in a series of stages or steps in order to treat your condition. For example if you have GERD your plan may not cover Nexium unless you have previously tried ranitidine (Zantac) and/or omeprazole (Prilosec) first. Prior Authorization means that for certain drugs, your plan will not cover the drug without first reviewing your medical and drug history to determine if your treatment steps have been appropriate.

24. The Prescription Drug Plan providers stand to make a ton of money from the Medicare program (drug companies stand to make the biggest windfall).

25. Net cost to the government for Medicare Prescription Drug Benefits is estimated to go from $37.4 Billion in 2006 to $109.2 Billion in 2015 (estimate by Health and Human Services department). However, much higher estimates of the costs of Medicare Part D can also be found from non-government resources. Two years ago Congress reluctantly approved for the plan at a cost of no more than $395 billion dollars over 10 years. A few months later the cost ballooned to $534 billion and earlier this year it shot to $795 billion. Big Pharma is the biggest recipients of the increased dollars added to the costs of this program.

26. Plan may force you to use generics when you are used brand name medications and may not be able to tolerate generic versions.

27. The appeals process for some plans is very confusing and convoluted. (You can appeal to your plan if your drug is not covered.)

28. Many of the big pharmaceutical companies are now making anyone eligible for Medicare Part D, ineligible for their assistance programs. These companies are effectively forcing seniors into a "voluntary" program that may not be right for them. The AstraZeneca Foundation was the first to take such steps.

29. Many people are finding it difficult to obtain accurate, updated lists of what medications each plan will cover.

30. Medicare's own hotline can only answer general questions. For more specific questions you must contact each individual insurance provider.

31. Many people have waited 30 minutes or more when calling the Medicare hotline to get information that they need.

32. Rep. Dan Burton (R-Ind.) in a 60 Minutes segment televised March 14, 2004 said, "Seniors, when they find out what's in that bill, are going to be very angry. The problem is, they're not going to find out about it until after this next election."

Jeremy Cockerill is a licensed Canadian pharmacist who owns and operates htttp://www.UniversalDrugstore.com/ , one of the top Canadian mail-order pharmacies. Mr. Cockerill graduated from the Faculty of Pharmacy at the University of Manitoba with Honors in 1998. Mr. Cockerill recently won the 2005 Manager of the Year award from the Manitoba Customer Contact Association. Mr. Cockerill has been studying the new Medicare Prescription Drug plan since early 2005.

Supplement For Medicare

Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior's medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.

Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual's needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to "pay out" more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.

With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that...a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.

http://www.texaslowcosthealthinsurance.com, Medicare resources

What is a Medicare Supplement?

A Medicare Supplement (also called "Medigap Insurance") policy is private health insurance specifically designed to supplement the Original Medicare Plan. This means it helps pay some of the health care costs ("gaps") that the Original Medicare Plan doesn't cover (like coinsurance and deductibles). Medicare Supplement policies may also cover certain things that Medicare doesn't cover. If you are in the Original Medicare Plan and you buy a supplement policy, then both plans will pay their share of the Medicare-approved amount for covered health care costs. Medicare Supplement policies are sold by private insurance companies.

A supplement policy is not a "Medicare Advantage" (like an HMO or PPO) because it's not a way to get Medicare benefits. Insurance companies can sell you only a "standardized" Medicare Supplement policy. Standardized supplement policies are identified by letters (A through L). In some states, like Texas or Louisiana, you may be able to buy another type of Medicare Supplement policy called Medicare SELECT. Each type of supplement policy offers the same basic benefits, no matter which insurance company sells it. Usually the only difference between policies sold by different insurance companies is the cost. Medicare Supplement policies must follow Federal and state laws. These laws are designed to protect you.

What Medigap Policies Do Not Cover

Medicare Supplement policies do not cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and private-duty nursing. Any new supplement policy is guaranteed renewable. This means the insurance company cannot cancel your policy as long as you pay the premium. Although some policies sold in the past covered prescription drugs, no new Medicare Supplement policies are allowed to include prescription drug coverage. If you want prescription drug coverage, you may want to join a Medicare Prescription Drug Plan (Part D) offered by private companies approved by Medicare.

When is the Best Time to buy a Medicare Supplement?

The best time to buy a supplement policy is during your open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you are both age 65 or older and enrolled in Medicare Part B. During this period, an insurance company can't use medical underwriting. This means it can't refuse to sell you any supplement policy it sells, make you wait for coverage to start, or charge you more for a policy because of your health problems. If you buy a supplement policy when you have a guaranteed issue right, the insurance company can't use a pre-existing condition waiting period at all.

Note: You can send in your application for a Supplement policy before your open enrollment period starts. This may be important if you currently have coverage that will end when you turn age 65. This will allow you to have continuous coverage. It is very important to understand your open enrollment period. During this period you can buy any supplement policy the company sells. If you apply for coverage outside of your open enrollment period, there is no guarantee that an insurance company will sell you a policy. After your open enrollment period ends, insurance companies are allowed to use medical underwriting to decide whether to accept your application and how much to charge you for the policy.

Comparing Medicare Supplement costs

The cost of supplement policies can vary widely. There can be big differences in the premiums that different insurance companies charge for exactly the same coverage. As you shop for a policy, be sure you are comparing the same type of Supplement policy.

What is Medicare SELECT?

There is another type of supplement policy called Medicare SELECT that is sold in some states, including Texas and Louisiana. Medicare SELECT can be any of the standardized Supplement Plans A through L, however, you must use specific hospitals and, in some cases, specific doctors to get your full insurance benefits (except in an emergency). Medicare SELECT policies generally cost less than other Medicare Supplement policies, however, if you don't use a Medicare SELECT hospital or doctor for non-emergency services, you will have to pay some or all of what Medicare doesn't pay. Medicare will pay its share of approved charges no matter which hospital or doctor you choose.

What is The Best Way to Find the Correct Medicare Supplement? The best way to find the best policy for your particular situation is to consult a professional who specializes in Medicare Supplements.

David Hecker is a Licensed Insurance Agent based in Longview TX. He specializes in Medicare Products. He is licensed in Texas, Louisiana and Arkansas. He can be reached at (903) 918-9091. E-mail: dhecker@cablelynx.com or on the web at: http://www.tx-medicaresupplement.com To receive your "Free" e-mail newsletter about Medicare Supplements, send an e-mail request to: dhecker@cablelynx.com