Monthly Archives: December 2009

Pork in the Health Care Reform Bill and Medicare

Posted on by
Reply

With the passage of the new senate health care reform bill and its move from a private committee to the public light, now gives analysts some time to see what is in the bill and what pork was added to buy the votes it needed to pass. In terms of Medicare, many people are also concerned that even though there are higher tax rates for Medicare, there will also be cuts to service.

It looks like doctors and hospitals in a number of states will be getting paid more, as senators traded their vote on the health care reform issue in return for pork for their state.

Pork Report: Medicare and Medicaid Bribes

In return for the votes of the Senators from North Dakota, Byron Dorgan and Kent Conrad, an amendment was added to the bill, which requires higher payments from Medicare to hospitals in their state. This amendment, dubbed the Frontier Amendment, will funnel $650 million more into the hands of doctors and hospitals in North Dakota over the next 10 years.

In return for the votes of the senators from Hawaii and Michigan, doctors will also earn more for their Medicare Payments, while also reducing costs for Blue Cross and Blue Shield, a major insurance company, in Michigan.

The votes from Vermont and Massachusetts senators were also similarly won, with larger payments going towards Medicaid. Vermont is expected to take in a $250 million windfall.

There is also an Amendment that will funnel $100 million dollars into one of several prospective states, in order to build a new hospital/research center. While the winner of this bride is not known yet, it was promoted by Senator Dodd, in the hopes of funneling it into his home state of Connecticut.

In what is now being called the “New Louisiana Purchase,” senator Mary Landrieu in Louisiana was paid off with a $300 million expansion to Medicaid Funding.

While there is still much to review, it is clear that the Pork was effective, securing the necessary votes to pass what is being referred to as health care reform. Despite these big payouts to increase payments to doctors and hospitals, there are still a number of cuts to Medicare Funding, including some reductions in how Medicare Advantage Plans will be paid.

While there are certainly a number of good points to the Health Care Reform Bill passed by the Senate, it ultimately ends up forcing people to buy into private insurance companies, while providing few mechanisms to actually ensure that the private insurance companies do not simply raise their premiums.

All of the good in this bill could have been made without funneling money into the corporations, who indecently spent around $700 million bribing our political leaders for the last two years. However, they do not work for us, so we will get reform in the sense of raising bonuses for the health insurance CEO’s.

Medicare Part B Benefits

Posted on by
Reply

Part B Medicare Benefits cover a variety of procedures that are not covered under Part A Benefits. Like other Medicare Benefits, those who are working are able to put off enrolling for Part B Benefits, which are optional, however those who are not working and do not enroll will face a 10% increase in premiums each year.

To Enroll in Medicare, including Part B Benefits, you can visit their site here.

While Part C is used to cover prescription medicine, Part B will cover medication that is given by a doctor. It also covers some doctors visits, x-rays, blood tests, chemotherapy, ambulance transportation, and a number of other outpatient treatments, such as vaccination for the flu.


Durable Medical Equipment

One of the most important parts of Part B Benefits, however, is the coverage of Durable Medical Equipment. Durable Medical Equipment refers to a number of different types of home medical equipment, such as hospital beds and wheelchairs, as well as things like eye glasses, oxygen equipment, and prosthetics.

In most cases, Medicare will cover 80% of the cost of the equipment, with the insured being responsible for the remaining 20%. It is almost always necessary to have a doctors prescription and certain types of equipment will also require a Certificate of Medical Necessity, which is simply a much more detailed prescription that outlines the specific conditions the patient has. Certain equipment will have some extra requirements that the patient must meet, such as someone who wants to have their mobility scooter covered would need to use it all of the time, both at home and away, and not merely when away from home.

While the majority of medical equipment covered under Part B Benefits is covered up to 80%, this is not the case with all types. Lift Chairs, which are basically recliners that act as a standing aid, are one example, as they are only partially covered. They also require a Certificate of Medical Necessity, which among other things, requires that the patient can not stand from any chair in their home. Usually Medicare will be reimbursed for about $300, which covers the cost of the lifting mechanism, but the entire chair is not covered. Getting reimbursement is not always easy either.

Other items, specifically those that involve home modification are not usually covered under Medicare Part B. For example, widening the doorways for a wheelchair user or installing an elevator would not be covered.

Cost of Part B Benefits

A monthly premium is required for those wishing to use Part B Benefits, which is usually around $100. However, since 2007, the premium is also based off of income and whether the insured is married, with a higher income meaning a higher premium and can be as high as $300.

In addition to a monthly premium, the patient must also pay a yearly deductible if they use these benefits, which was around $130 in 2009. There is also a copay required for most items, which is usually 20% of the cost of the item, with Medicare paying the other 80%. However, as stated above, some items, like lift chairs Medicare, are only partially covered under Medicare. However, blood work and other laboratory services are often covered completely. A 15% surcharge is added if the physician is not certified by Medicare.

Medicare Part C Benefits: Medicare Advantage Plans

Posted on by
Reply

Medicare is a socialized insurance program that is funded by the Federal Government and was first established during the 1960’s. Originally, Medicare included two Parts, Part A and Part B, and was both funded and administered over solely by the Government. However, beginning in 1997, a new part of Medicare was added that allowed those on Medicare to opt to use a private insurance plan, instead of the traditional federally run plans. These plans are called Medicare Advantage Plans and are under Part C of Medicare Benefits.

What Are Medicare Advantage Plans?

The idea behind Medicare Advantage Plans is that the actual plan itself is run by private insurance companies. The plans are still funded by the Federal Government, but are actually administered over by the private health industry. Medicare Advantage(MA) Plans, were added onto Medicare as part of the Balanced Budget Act of 1997 and in 2003, Prescription Drug Coverage was added as part of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003.

Like traditional Medicare Plans, such as Part A Benefits, the insured usually has to pay a premium when using an MA plan. MA plans are also required to cover anything that regular Medicare would, but are given a good deal of leeway in how they implement their insurance program. So, for example, an MMA plan is required to help cover the cost of a doctors visit, but they may require a higher co-pay than traditional Medicare.

Many Medicare Advantage Plans will also cover some things that traditional Medicare does not, in an effort for the Private Insurance Companies to get people to use their programs.

Dangers of Using Medicare Advantage Plans

Since the private insurance companies run MA plans and are allowed to make some changes to what they charge or how they cover certain things, it is important to be very careful when choosing a plan. It is important to compare the benefits and costs of the plans to traditional Medicare, taking into account the needs of the insured. It is also important to compare the different Medicare Advantage Plans available, as they can differ too.

Again, because MA Plans are run by Private Insurance instead of the Government, many patients find that they have difficulty getting items covered and must fight the insurance companies, who are, after-all, out to make a profit. Each year, a great deal of those who signed up for MA plans, wooed by the extra perks, like dental coverage, decide to switch to the Federally run programs, with about a third of these people citing problems getting coverage through the private insurance companies.

Cost to the Taxpayers

In addition to many finding that the for-profit Medicare Advantage Plans do not provide adequate coverage and making claims is often met with resistance from the private insurance industry, these plans are also much more expensive to the taxpayers.

On average during 2005, these plans cost the taxpayers about 12.5% more than traditional Medicare, with the private insurance companies usually earning at least 6% profit.

When you take into account the fact that so many people are dissatisfied with MA plans and the added cost to tax payers, it makes it very hard to support allowing Private Insurance to become involved with Medicare. However, as can be seen from the current health care debate, Private Insurance Lobbyists have a very deep hold on the Senate and the President.

Medicare Part D Benefits-Prescription Medicine

Posted on by
Reply

Medicare went into effect during the mid-sixties and for about forty years, did not provide any real coverage for prescription medicine. This changed on 01 January, 2006, when coverage of prescription medicine was added as a result of the Medicare Prescription Drug improvement and Modernization Act that was passed in 2003, but did not go into effect right away.

Today, Prescription Drugs and Medications are offered as Part D Medicare Benefits, which helps cover the cost of some medications.

Who is Eligible for Part D Benefits?

Enrollment in Part D Benefits is not required and instead is offered as a voluntary plan for those who are eligible to receive Medicare. However, those that do not enroll in it right away when they first become eligible, may face an increase of premiums if they decide to enroll later. Usually, a 1% increase in Part D premiums is added for each month that a patient does not enroll in Part D.

Who Runs Part D Prescription Plans?

While Medicare is, of course, funded federally, Part D is actually run by private insurance companies that are reimbursed through Medicare. There are two basic options, which allow a patient to either enroll in a Medicare Advantage Plan, which will mean that their entire Medicare Benefits will be administered by private insurance companies, or they can opt for a stand-alone Prescription Drug Plan, leaving their other benefits, like Part A and Part B, to be administered by the Government.

It is important to note that Medicare Advantage Plans are given some leniency in how they offer Medicare Benefits. They are still required to cover everything that Medicare Covers, but the private insurance companies are given flexibility in how they offer this coverage. In the end, this means some plans might offer lower co-pays for hospital stays, while offering higher rates on other things like durable medical equipment. As a result, before signing up for a Medicare Advantage Plan, it is imperative to compare its coverage and premiums both to traditional Medicare, as well as other Medicare Advantage Plans.

How Much Does Medicare Part D Cost?

In terms to the cost of premiums and out of pocket expenses, there is a deductible of around $275 that must be met, as well as a limit of about $2,500 that is the ceiling of how much medication will be covered each year. Of this $2,500, the patient must pay 25% or about $625.

After the initial ceiling of $2,500 is reached, the patient then must cover the next $2000 out of their own pocket, but once their total prescription costs is over $4300, Medicare will offer the patient a discount on their generic and brand name medications. Of course, this coverage gap, which is often called the Donut Hole, sneaks up on many patients, who are not completely aware that of the initial $2500 limit.

As a result of the coverage gap, many people find that it is very important to budget their medications throughout the year, paying for less expensive generics out of pocket and only using Medicare for their more expensive medications. This makes a lot of sense when you consider that Target and a few other larger companies often offer $4 generics, which would end up costing a lot more with Medicare.

Are All Drugs Covered by Part D Benefits?

No, only drugs that have been approved by the Federal Drug Administration(FDA) will be covered. There are also a number of medications that have been approved by the FDA, but are not covered by Medicare. This includes barbiturates, drugs like Viagra or those used to induce female fertility, drugs for hair growth, drugs to help with weight loss or weight gain, and prescription strength vitamins.

Problems with Part D Benefits

One of the biggest problems with Part D is that the government is literally not allowed to negotiate the cost of medications with the Prescription Drug Makers. Instead, in what is surely an indication of how important corporate lobbying is, Medicare must pay what ever the prescription drug makers require, even though other organizations, like the Veterans Administration(VA), pay a great deal less for the same drugs.

Also, when you take into account the Donut Hole, which means that Medicare will only cover the first $2500 and then offer assistance for anything over $4500, it ends up leaving the average citizen holding the bag as it were. It also means that if someone spends $4500 a year on medication, the true discount by using Medicare is only 50% of the cost.

There have also been studies that those who use Medicare Advantage Plans are 40% more likely to die than those who use similar plans offered by the VA, in what could be a strong argument against using a for profit health-care system. Source.

Part A Medicare Benefits

Posted on by
Reply

Medicare is an insurance program that is offered and run by the Federal Government, primarily intended for those over 65, although people with certain medical conditions, like acute renal failure, are also covered. Medicare Benefits are divided into 4 Parts, with Part A covering hospital related costs.

Part A Medicare Benefits are primarily intended to cover the cost of overnight hospital stays. The amount of the cost that is covered varies, depending on the length of the hospital stay and will also sometimes cover the cost of temporary stays at a nursing home.

While I the hospital, Part A Benefits extend to all costs, including medical tests, doctors costs, and incidentals, like food and board.

Requirements for Coverage of Semi-Long Term Care
In order for an extended stay at a nursing home or assisted care facility to be covered, it is necessary for the patient to have had a previous hospital stay for the same problem, which lasted at least full days, not including the day the patient was released. Also, the treatment must be for rehabilitation or to help manage a disease in order to be covered. Further, it is imperative that the assisted living facility offers skilled care, meaning that the workers must be registered nurses.

Length of Stay Covered By Medicare

Medicare will usually cover stays of up to 100 days, providing the above requirements have been met. The first 20 days are paid for by Medicare, with the following 80 days requiring a copay of around $134 per day.

If the patient uses their Part A Benefits, even partially, they must wait 60 days before they ca receive another full 100 day hospital stay.

Premiums and Deductibles

Providing the Medicare Recipient has paid payroll taxes for more than 13 years, there is monthly premium to receive Part A Benefits. However, those who have only paid in between 10 and 13 years will need to pay a deductible of $233 and those with less than 10 years paid into Medicare must pay $423 a month to receive Part A Benefits.

The required deductible, however, is the same for both and depends on how long the senior is in the hospital. For example, hospital stays between 1 and 60 days require a deductible of around $1000. After that, it drops down to about $260 per-day for the next 30 days. Then, stays between 91 and 150 days require a $534 deductible per-day. After 150 days, the patient will no longer be able to receive benefits.

If a stay at a skilled nursing facility is required, the patient’s first 20 days are covered by Medicare and there is a $133 deductible after that. Stays must be no longer than 100 days at a skilled-nursing home.

Determine Eligibility for Part A Benefits

To determine if you are eligible for Part A Benefits, you can visit Medicare Site and use their Part A Benefits Eligibility Tool