Every year there are a few changes to Medicare that Medicare recipients should know about. With all the confusion about health care reform, the information for 2010 is as important as ever.
One of the things that will happen in 2010, unfortunately – but not totally unexpectedly – is that the Premiums for Medicare Part B will rise. Since income determines your premiums, if you are single and your income is less than $85,000 your premiums will go up from the 2009 figure of $96.40 to $110.50 per month in 2010.
It becomes a bit confusing when it comes to filing a joint tax return. If filing joint and your income is $170,000 or less, each beneficiary will pay $110.50 per month. The individuals who file a single return and whose income is between $85,000 to $170,000 will pay $154.70 per month.
This is the same for those filing jointly whose income is between $170,000 and $214,000. If your information isn’t listed here, you can check with Centers for Medicare and Medicaid (CMS) or www.medicare.com, or in the Medicare and You booklet which has a chart explaining premiums.
As for Medicare part A and B there are also changes coming. Medicare Part A which covers hospital bills has a deductible that will go up from $1,068 in 2009 to $1,100 in 2010. It is important to be aware that this deductible applies to every hospital visit, so each time you are in the hospital, then out for 60 days and have to go in after the 60 days is up, you are charged with another deductible. If you go back into the hospital within the 60 days, you don’t get charged again for the deductible.
Part B covers medical expenses and will go up in 2010 from $135 per year to $155 per year.
If you have a Medigap policy, it is important to know that Part J will be discontinued as of June 2010. If you already have the policy, however, you can keep it and maintain it if you pay the premiums and keep the coverage in force.
Most likely Plan J will become very expensive – in fact, it will be more expensive than people can afford to pay – especially as they sign up for Medigap policies, which are much more affordable. As this happens more and more – less people using Part J because they go to Medigap or pass away – the rates for Part J will continue to rise, eventually making it too expensive for most seniors to enroll in. Plan J will eventually be eliminated along with Plans E, H and I.
If you have to get coverage, the minimum suggested is Plan C. In addition, if you need more coverage, 100 percent coverage is offered after basic Medicare through Plan F. Plan C and Plan F will continue to be available and the government will be adding Plans M and N. There is no information on the approximate cost or which states they will be available in.
Plan M will pay up to half of the deductible for Part A if you go into the hospital.
Regarding office visits, Plan N will have a co-payment of $20 per office visit and a sliding scale of up to $50 for emergency room visits. Plan K and L will also stay available, but offer benefits that are somewhat limited.
The various plans are created and offered by the federal government. The issue is that these plans are available, whether or not they are available in your state is up to the Insurance Commissioner in your state, so different states can have different plans available.
Regardless of any changes or proposed changes, your coverage will stay the same for a while. Medigap plans will not have changes until June 1, 2010, so you can purchase any of the plans available in your state until then.
It used to be that doctors made house calls. This was essential because there were few doctors that were responsible for vast areas. People would send for the doctor if a person was sick, and there was nothing left to do but for the doctor to make a house call to help the patient.
As communication grew along with communities and towns house calls increased for a while, then decreased with the advent of medical centers and hospitals. There were still house calls, however, there were more and more people going to doctor’s offices, clinics and hospitals.
Then came the era of cities that had organizations and health departments, making the era of house calls nearly a thing of the past. There was one group, however, that still fared better with house calls. This group includes seniors and individuals with disabilities.
Many of these individuals have too many health issues to run back and forth to the doctor’s office. They are elderly and/or disabled. As a result, home health care has been the main means by which they are taken care of. They have nurses and other health practitioners come to their homes to address their health issues. These visits are covered by Medicare.
Lawmakers are now looking into home visits or good old-fashioned house visits to these same patients by their doctors. Some doctors are already providing house visits to their more elderly or sick patients because it is easier and better for the patient to be able to stay at home rather than use precious little energy to prepare for a visit to the doctor’s office and the accompanying travel.
There are house call programs in various parts of the country and many physicians are beginning to rally Congress toward funding house calls. The bonus to this is that it will keep many people out of the hospital – an extremely high expense – and it will provide them with personal, high quality care while saving Medicare millions of dollars.
Doctors who are already doing this are trying to get other doctors to do the same. In addition, these current doctors are trying to encourage other doctors to lobby with them as well. After all, the Veteran’s Administration already provides home care to over 3 million people and this has helped many individuals and conserved costs, while delivering personal care.
Time will tell whether home health visits by physicians will be included in Medicare benefits, but if it is, according to many physicians, these visits could be a cost saver and a lifesaver.
The Medicare open enrollment cycle for existing beneficiaries occurs annually during the last six weeks of the year (November 15th through December 31st). The changes made during this time period will go into effect January 10th of the New Year.
During this time period, Medicare beneficiaries have the choice to go with traditional Medicare only, a Medicare supplement insurance plan or to sign up for a Medicare prescription drug plan.
After the beneficiary has made a decision, he or she has until March 31st to switch plans. If not change his made before this date, the plan will remain intact until the following year's open enrollment season.
Users have the ability to keep their existing Medicare Advantage plans by doing nothing. To make changes, users can enroll at Medicare.gov or call 1-800-MEDICARE. What should you do before making a decision?
First off, be sure to review your current health and prescription drug plans. The costs for plans will change annually so you need to know your current benefits and pricing. You can then compare your existing Medicare plan with other ones to see if you can find a better choice. If you want to keep the existing plan, you do not have to do anything. It will rollover at the end of the open enrollment period.
If you decide to make a change to your health insurance plans, it is best to do it as soon as possible. This will help you avoid any confusion at your local pharmacy when the new plans go into effect in January.
When you have chosen the new plan (if you do), you should join with one of the following methods:
Sign Up with a Paper Medicare Application: The company that is handing your plan will have an application. You can fill it out and send it back by mail, fax or possibly email.
Visit the Plan Website: Find the website for the plan you have chosen and complete an online application.
Go to the Medicare Website: There are many drug plans available on the official Medicare website. There is a chance though that the plan you have chosen will not be available here so you may have to use another application choice.
You Can Call the Company Directly: If you have the phone number for the Medicare drug plan company you can normally call and enroll by phone.
Call Medicare: As a final resort, you can call Medicare at 1-800-MEDICARE and enroll by phone. This is by far the most difficult and time-consuming option and should be kept as a last resort.
What Information is needed to join a Medicare Drug Plan?
If you are ready to join, you will need the following items to complete your enrollment:
Your personal information (full name, address, date of birth, etc.)
The information on your Medicare Card
The premium payment option
Any other insurance information.
Your social security number (optional)
Your Email address (optional)
A Name and Phone Number for an Emergency Contact
The contact information for the nursing home or assisted living facility you reside in (if applicable)
Once you have completed the Medicare open enrollment application process, you will receive a packet of information from the company you have enrolled with. The materials they send will include a membership card, a handbook, a list of covered prescription drugs, a directory of approved pharmacies, the appeal or complaint procedure instructions and other related details of the plan.
In closing, it is important to devote some time each fall to finding the best Medicare health insurance plan for you and your significant other. No matter your ultimate choice, it is important that you compare all your options before making a final decision.
Medicare and Medicaid. You can't pick up a newspaper, look at the news or listen to the radio without hearing about these programs.
The problem is that everything you hear is different depending upon who is saying it. Some of the pundits and politicians have been talking about doing away with the programs and starting over. Others have been trying day and night to bolster and save these essential services and have said that if Medicare, Medicaid and healthcare are balanced right, the programs would save enough money to grow and thrive in the future.
For those of you who depend on Medicare or Medicaid the first thing to remember is that after eons of wrangling about all the programs, lawmakers are getting closer to determining the issues and figuring out answers. According to the lawmakers, Medicare and Medicaid will be saved, and though some things may change, overall, things will be changed - most likely for the better.
Many individuals who are recipients of Medicare or Medicaid are rightly worried. When you hear so much confusing and contradictory information about a program that is your lifeline, it is certainly scary.
To relieve some of the fear and misunderstandings involved here is some positive information regarding Medicare and Medicaid. Lawmakers on both sides of the question have said that they will save Medicare and Medicaid, and the President has said that he will not pass a bill unless this happens. Also, even though there has to be some tough accounting involved, everything that needs to be done to make sure that Medicare and Medicaid are solid and workable and continue covering the millions of seniors and other individuals that depend on the services that these programs provide.
Lawmakers are getting closer to passing the bill and when that happens, everyone will be able to breathe easier and hopefully, put the confusion behind them.
There are a million ideas about what overhauling the healthcare system will bring about for everyone and for every program involved in the healthcare system itself. One of those programs is Medicare, and they have some feelings and ideas about what possible changes might mean.
The secretary of Health and Human Services, Kathleen Sebelius, who oversees the federal Medicare program, issued a report on Thursday, to help keep seniors and Medicare recipients from worrying about anything that might be coming in the future.
The title of the report is “Protecting Coverage and Strengthening Medicare.” The report addresses various issues and also states that proposals that are being worked on by lawmakers in Washington will help seniors. These proposals, Sebelius says, will keep Medicare from bankruptcy and will help senior with issues including trying to lower the out-of-pocket costs and copays for prescription drugs and make them more affordable for seniors.
“Health insurance reform will protect the coverage seniors depend on, improve the quality of care and help make Medicare strong,” Ms. Sebelius said. It will not be an easy task to convince seniors to count on or support healthcare reform, especially since there are still some big questions they face and there are still issues at loom large as lawmakers try to address and fix them. In addition, there are several sides to this situation and Medicare is only one part of a major problem in the overall healthcare system.
Too many seniors are hearing information that is the exact opposite from what Ms. Sebelius has said in her report. New York Times reporter Robert Pear pointed out in an article last week, that older Americans have some reason to be concerned. On the other hand Secretary Sebelius argues that if the government does nothing, seniors who rely on Medicare will be worse off.
“The status quo is unsustainable and unacceptable for seniors,” she said. She has said this and so have many lawmakers in Washington, yet, round two of the battle is just beginning and there are many lawmakers who are looking toward Medicare to save money. At this point we can wait and see if what Secretary Sebelius has said is right.
September will be the most difficult month regarding healthcare reform for the Obama administration and the advocates of comprehensive health reform. They knew that it would be a tough month but knowing it and going through it is two different things. This administration and advocates are going through it.
Lawmakers are returning from a break and the President is returning from his vacation. Healthcare reform is not an easy task and has been a tough fight.
On top of everything else, Ted Kennedy – the Lion of the Senate – has now passed away.
Senator Kennedy had served for over 45 years and was a guiding light for lawmakers that were on both sides of the aisle. He was able to explain his point of view tactfully and respectfully so that even those who didn’t agree would still at least listen – and some of them actually heard him and adjusted their thinking on whatever subject was at hand. Of course, there were those times when he could be quite forceful and absolutely nobody missed the point.
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Now that lawmakers and the President are getting back to action, we will see what happens with these bills. One of the important issues when it comes to health insurance reform is the changes to Medicare.
We have been told that seniors and individuals with disabilities will not lose their benefits; however, there is a lot of spirited debate debating regarding their Medicare coverage.
One approach would be decrease the cost of reform as well as lessening its scope and spend around $600 billion to around $800 billion during the next ten years instead of over $1 trillion which has been proposed as a possibility. Doing this would make it easier on the finances of the federal government, but would be more difficult to actually put into place than doing a comprehensive overhaul of the whole system. Using the lesser figures would actually create a kind of hodge podge of a fix and would not fix two essential issues with the system we have now. There are two many people without health insurance and too many others are getting to the point where, not only can they not afford it, but it is not taking care of their needs at the prices they are paying now.
If there becomes a situation where reform cuts out subsidizing employers regarding health insurance, many people could not afford it anymore. They would be obligated to purchase insurance on their own. If they did not, there is a possibility that they would be fined.
Coverage could be offered to various groups depending on the situation, and hopefully, in time, other groups could be added. The hard part would be who would get this coverage. It is obvious that Medicaid is essential to individuals at or close to the poverty level. Having that program stay solid and be offered to all at that level would be an expensive proposition – around $40 billion in the next ten years. Yet going without it would cause extra problems – people at the poverty level who could not receive Medicaid could end up at the ER for things that could have cost the government hundred or thousands of dollars less had they been covered by Medicaid and allowed to simply see a doctor or a clinic. Essentially, if people in this position are not covered by Medicaid, they still get sick and the bills for those ER visits and other medical services for those who are not covered by Medicaid are partially absorbed by the hospitals as a loss and, you guessed it, paid by the government, thus affecting our taxes.
Medicare is another program that is essential to save. As Boomers are becoming retirement age they will be ready to enroll in hordes, so they will need to be able to have this coverage. Most Boomers are a little more prepared for retirement than the last generation, so there may be a little breathing room as they transition, however, Medicare must be fixed and saved, and the President has promised not to cut this program, rather to save it and make it work.
The challenge now is for congress to find a way to make sure the uninsured are insured, find the money to pay for comprehensive healthcare reform and save these two programs – Medicare and Medicaid – while working to make all this affordable while moving into the future.
For now, we are all waiting to see what congress comes up with.
Seniors throughout he country are extremely concerned and worried about their Medicare benefits. Everytime they hear the words "healthcare reform" they cringe, worried that as money continues to get tighter and cuts are made to many programs, they will lose critical and essential benefits that in many cases keep them alive and out of the hospital.
At a telephone town meeting Tuesday, President Obama answered questions from mostly seniors. One of the things that he said to reassure these older Americans regarding their Medicare benefits was, “Nobody’s trying to change what does work in the system,” Obama told the estimated 180,000 listeners. “We are trying to change what doesn’t work in the system.” There have been many delays when it comes to the healthcare issues, people are getting quite nervous and confused. “Nobody is talking about cutting Medicare benefits. I just want to make that absolutely clear,” the President said emphatically. When he introduced President Obama, AARP CEO A. Barry Rand said: “There’s a lot of misinformation about health care reform—even on what AARP stands for, and what AARP supports. This town hall is part of our ongoing effort to debunk myths and provide accurate information.” He added: “I want to make it clear that AARP has not endorsed any particular bill or any of the bills being debated in Congress today. We continue to work with members of Congress on both sides of the aisle and with the administration to achieve what is right for health care reform.” AARP president Jennie Chin Hansen also cited confusion expressed in questions that have come from thousands of members who have participated in previous AARP town halls. “Like, will the government tell my doctor how to practice medicine?” The idea behind this unique town hall meeting was to calm the fears of individuals - particularly seniors - who are nervous, or downright frightened, about what will happen to their Medicare and Medicaid benefits and ultimately to their health. The president said that overhauling the healthcare system is a high priority, however it is not an easy task and he wants to make certain that it is done right. “I know there are folks who will oppose any kind of reform because they profit from the way the system is right now. They’ll run all sorts of ads that will make people scared.” He pointed to the past and reminded people that this has all happened before, it is not just unique to our time or the current situation. “Back when President Kennedy and then President Johnson were trying to pass Medicare, opponents claimed it was socialized medicine,” he said. “When you look at the Medicare debate, it is almost exactly the same as the debate we’re having right now. Everybody who was in favor of the status quo was trying to scare the American people saying that government is going to take over your health care, you won’t be able to choose your own doctor, they’re going to ration care.” He also added this thought: “You know what? Medicare has been extraordinarily popular. It has worked. It has made people a lot healthier, given them security. And we can do the same this time.”
As the saying goes, stuff rolls down hill. In the situation with all the budget constraints on the federal government, comes constraints on the state and local government. Healthcare is definietly no exception. Lawmakers in Washington are looking at some very deep cuts when it comes to many programs and trying to figure out how to keep them from being deeper than they already are.
One of the programs that is being looked at piece by piece and line by line is Medicare. There will definitely be cuts to that program, period. As a result, as things roll down hill, Medicaid, which is a state program but bolstered by federal dollars, is taking a big hit, too.
Not only are some Medicaid benefits being cut way back, but getting into the program, which is already on the difficult side, has become much tougher indeed. It seems as though unless you are in the most dire straits getting approved for Medicaid is extremely difficult. Even if you are in dire straits and the rope you are hanging onto is beginning to fray - a lot - it is still difficult to get approved.
Consider the case of a 60 year old woman who was disabled in an accident. Her doctors took her off work indefinitely and she has no income except for $200 of assistance money which will run out very soon because of the new cuts from 18 months down to 12. She has no money to go to the doctor and has applied for Medicaid. She suffered injuries in the accident - which happened at work - but Worker's Comp is fighting against paying because she had some pre-existing conditions. Of course, what 60 year old man or woman doesn't? Meanwhile, she is in constant pain, in need of surgery and walking around on crutches or a cane with a fractured hip and two badly injured knees just for starters. She has high blood pressure (which has sent her to the ER 6 times in 3 months because it was at stroke level or higher), osteoporosis, arthritis, degenerative disc disease and possibly diabetes. She has doctor's letters, medical records and more that were sent to Medicaid. She applied for Medicaid and was turned down.
This individual did everything by the book and is having to go through hoops all over again trying to get help. This is before the new budget cuts that are on the way.
This is not to say that Medicaid is unfair or that it is a bad program. It is a good program and was designed for people like this 60 year old lady who has fallen through the cracks - badly. Each state deals with their own Medicaid program so it can be a little easier or a little harder depending on the state a person is in. Even if you have all your ducks, doctor's notes and medical information in a row, it can be tough to get Medicaid.
Do not give up, re-apply, call and talk to your worker and do whatever is necessary to give them the information so that you will get approved. Eventually, most people do get approved. It is simply a tedious road sometimes to getting the coverage you need.
There have been discussions about how to make Medicare work better since the beginning of time, or at least since the beginning of Medicare. There are always at least two types of people when it comes to any situation - optimists and pessimists. Somewhere in the middle lie the realists, and somewhere in another part of the middle lie the critics.
These days, with a new president and congress left with billions, no, make that trillions of dollars in debt to unscramble, there are some major, essential programs that are being looked at under the proverbial microscope. One of those programs is Medicare.
Trying to balance trillions of dollars in debt while keeping as many essential programs in tact is basically a difficult, if not impossible, task. However, the attempt is being made.
In fact, the situation is so important and so serious that week after week since before this president took office, there have been new proposals on his desk, new meetings, new debates and new issues regarding Medicare and the cuts that will surely have to happen to keep the program solvent.
One of the problems is that for as many individual lawmakers that there are working on this, there are just as many opinions as to what should stay, what should go, and what could be reshaped and trimmed a little but not deleted from the program. Then there's the factor of who's on the right, who's on the left and who is trying to be bipartisan.
The biggest issue with Medicare is that some of the cuts being suggested involve ongoing care for those who are seniors and those who are disabled. This may not sound too bad, except that ongoing care is the backbone of health care. If a senior on Medicare is able to have ongoing care through the same doctor, statistics show that they will usually stay out of the hospital or, at least, they will be in the hospital less often. Statistics also show that if seniors are able to access as many outpatient opportunities as possible, this will also prevent serious health issues that would land them in the emergency room or the hospital - possibly for a long, expensive stay.
Some of the smaller things that are being considered to be cut and not just trimmed could be the difference between the continual care that seniors and individuals with disabilities need and having to more frequently go to the emergency room or have a hospital stay. Instead of saving money, this would end up costing more in the long run - and maybe even in the short run. Most outpatient procedures and services are nowhere near as costly as even one trip to the emergency room, much less a stay in the hospital for a few days or weeks. Outpatient care has proven to be preventative in most cases, and it is important for lawmakers to really look at the long term consequences as to what they are or are not cutting.
This, as lawmakers and the president know, is an urgent situation. That is why they are working on it day and night and will most likely not pass any new legislation until after the August break. They know that they have to get this right, and it is good to know that they are working hard to try to do so. Let's just hope they don't miss the forest for the trees.
When looking for information to write each week there is a process of combing every piece of news and information possible. Right now, it is a critical time for the folks that depend on Medicaid or need to get it. I have friends with serious disabilities who have been denied in applying for Medicaid coverage.
We are not talking about small disabilities. We are talking about traumatic brain injury, degeneration or deterioration of joints and spines so they are unable to sit or stand for long periods and either use a cane, but usually a wheelchair.
It is unbelieveable that in this day and age they can't get the help they need. However, with the news that Medicaid may get a boost and be able to help more people, possibly those who are truly disabled and living under the poverty level, barely hanging on, would be able to be approved the next time around.
I am including the article below because I feel it will be encouraging to those people who are disabled and stuck right now. It was written by Michelle Diament from disabilityscoop.com and I feel it was worth reprinting. I hope it is encouraging to those who are trying to get Medicaid.
July 14, 2009
There was a health care reform bill introduced Tuesday by Democratic leaders in the House of Representatives. The bill would expand Medicaid and require mental health coverage for all Americans, however it leaves long term care quite lacking.
The bill was brought forth collectively by three House committees — Education and Labor, Ways and Means and Energy and Commerce — which have jurisdiction over health care.
As currently written, the bill would allow Americans to keep their current health insurance coverage and doctor, but would also provide a so-called “public option,” essentially a government-run insurance program that individuals or business could buy into.
Mental health coverage would be required under the bill no matter which insurance option is selected. Plus, insurers will not be allowed to deny anyone coverage due to a preexisting condition.
Medicaid would be expanded under the House bill to include families with incomes at or below 133 percent of the federal poverty level. Furthermore, reimbursement rates for primary care services provided to people on Medicaid would increase, with the federal government picking up the tab.
“We can’t afford to leave people in a system that looks to recruit the healthy and leave the sick uninsured, underinsured or uncertain about their insurance,” said Rep. John Dingell, D-Mich. “The current broken health care system will not fix itself and the people who made billions from it have no reason to change their ways unless we make them.”
Long-term care is not emphasized in the House bill. Neither the Community Living Assistance Services and Supports (CLASS) Act — which would create a government long-term care insurance program — or the Community Choice Act — which would allow people with disabilities the option to use Medicaid funding to pay for community-based rather than institutional care — are included.
Just last week Health and Human Services Secretary Kathleen Sebelius sent a letter to a Senate committee expressing the Obama Administration’s support of including the CLASS Act in health care reform legislation.
House committees will consider this proposal beginning this week. In order for any changes to take place, legislation must be approved by the House and Senate and be signed into law by the president who has indicated he would like to wrap up health care reform before Congress leaves for its August recess.
Medicaid is a program for individuals who can't afford to pay for medical care. You may be covered by Medicaid if you have high medical bills; you receive Supplemental Security Income (SSI); or you meet certain income, resource, age, or disability requirements.
This is the official idea behind Medicaid. It was designed to help take care of medical costs that you can't manage on your own due to one or some of the reasons above.
Medicaid differs a little from state to state. It's foundation is the same, however, it depends on the state's terms, conditions and budget.
The following is a description of Medicaid coverage in one particular state:
In general, the following services are paid for by Medicaid, but some may not be covered for you because of your age, financial circumstances, family situation, transfer of resource requirements, or living arrangements. Some services have small co-payments. These services may be provided using your Medicaid card or through your managed care plan if you are enrolled in managed care. You will not have a co-pay if you are in a managed care plan.
smoking cessation agents
treatment and preventive health and dental care (doctors and dentists)
hospital inpatient and outpatient services
laboratory and X-ray services
care in a nursing home
care through home health agencies and personal care
treatment in psychiatric hospitals (for persons under 21 or those 65 and older), mental health facilities, and facilities for the mentally retarded or the developmentally disabled
family planning services
early periodic screening, diagnosis, and treatment for children under 21 years of age under the Child/Teen Health Program
medicine, supplies, medical equipment, and appliances (wheelchairs, etc.)
clinic services
transportation to medical appointments, including public transportation and car mileage
emergency ambulance transportation to a hospital
prenatal care
some insurance and Medicare premiums
other health services
If you are eligible for Medicaid, you will receive a Benefit Identification Card which must be used when you need medical services. There may be limitations on certain services.
For you to use your Benefit Identification Card for certain medical supplies, equipment, or services (e.g., wheelchair, orthopedic shoes, transportation), you or the person or facility that will provide the service must receive approval before the service can be provided (prior approval).
The information above is a sample of what types of services a person can expect from Medicaid, and in many cases these services help provide what Medicare does not, so that the cost of medical care is not overwhelming for a senior or other individual.
If you think you qualify for Medicaid, contact your state's Medicaid office to begin the process of finding out. Even with budget cuts, Medicaid can help defer medical costs not paid by Medicare.
There is a lot of controversy these days about what should go and what should stay in the huge U.S. budget which affects each state's and county's budget. Somewhere in that mirage of confusion, site Medicaid.
Though many of the proposed Medicare cuts and the ones already in progress are frightening and difficult, at best, to deal with, the thought of more Medicaid cuts puts more pressure on the people that need the program most.
Seniors and individuals with very low income often depend on Medicaid to get basic medical care. Nothing fancy or frilly. A few doctor's visits, maybe some tests and some medication. Medicaid is what is supposed to help these individuals who can't afford Medicare Supplements and who need to have regular medical care - even minimal care - to stay reasonably healthy.
When hearing what people on Medicaid have to say, they say it is a lifesaver - literally - in many cases. They say that without it they would be in a hospital somewhere very sick or dying at the state's expense. The unfortunate situation is that as budgets get leaner, criteria for people to qualify for programs gets tighter and more people who need this help are left out.
The problem is that rather than helping keep the benefits for people, once someone has lost them, the state and county end up paying untold thousands of dollars for emergency room visits that take the place of doctor visits. Keeping people on Medicaid and allowing new ones to get on it save the state and county money, short term and long term.
There is a lady who is 59 years old and lives with her children. Her only income is assistance since she is too young for Medicare and she has a disability that will probably continue the rest of her life. She has applied for Medicaid which she said was an escapade of jumping through hoops, and after she turned in every single paper (about 1/2 inch worth) she was denied. The woman can hardly walk. Her blood pressure is out of control, she has been in and out of the emergency room because her blood pressure has been so high they are worried about her having a stroke, and instead of accepting her to Medicaid to get the care she needs, she was turned away. So at age 59 she goes to sleep, fearful that she won't wake up, and there's nothing she can do unless things get so bad she goes back to the emergency room.
There are seniors that are worse off, who choose between groceries and medicine and use less of both, keeping them hungry, undernourished and undermedicated, while their condition gets worse.
In these times, it is understandable for cutbacks to happen. It is simply a matter that some of them don't make sense. In the richest country in the world we are letting seniors and others starve and suffer just to save a few dollars - and then it cost thousands more to care for the individuals anyway.
It is important for everyone to have a chance to feel as good as possible and get good care. Hopefully as budget cuts continue, the president and lawmakers will remember that there are people living on much less than $250,000 or even $25,000 per year through no fault of their own. It is important to think about their dignity and well being when putting programs on the chopping block.
I saw this article while reading The Seattle Times. I read papers around the nation regularly to see what people have to say about the healthcare situation we are in as a nation. There are as many millions of opinions as there are people and lawmakers are playing tug of war with the situation. The problem with that -at least the biggest problem - is that they have the best healthcare in the world.
If they get a hang nail, a hernia or a heart attack their healthcare will cover it. The rest of us who are not covered like that or not covered at all can be having a stroke going into the hospital and being questioned as to whether we have insurance or not while we can't hold our head up in a wheelchair. This happened to my friend just before she fell out of the wheelchair, had an aneurysm, went into a coma and died a month later. She was 42 years old.
Here is the story from The Seattle Times:
Then there are the common people like us. Some of us have no healthcare because we make just a couple of dollars too much for Medicaid. OK. If that is so, than let us pay the two
Richard H. Cooper wrote in The Seattle Times about the need to fix Medicare before letting government undertake another program.
I agree with all his points about improvements needed to this program. However, I believe there is a way to fix it and do health-care reform at the same time.
There's already House Bill 676, the new-and-improved Medicare Act. This bill will put everybody in Medicare, and as we know, the bigger the pool, the less the cost.
By having only one nonprofit financing mechanism for our health care, we can save huge amounts of money. Imagine all the premiums now going to for-profit insurance companies whose goal is to make as much money as possible, not make our population healthier.
Also by having one financing mechanism, we can save huge amounts of money for practitioner's by reducing administration and overhead costs.
Secure public coverage for all will also mean a lot of people will retire that now just work for health benefits, and some will start businesses and provide more jobs because the burden of health-care coverage is lessened.
We already have a mechanism for employers and employees to pay a Medicare tax, so it can easily be adjusted to cover all and substitute for paying premiums. And with a tax, one pays according to income as opposed to with a premium. It's a fair and simple way of reforming our health-care system.
But most important of all, this system gives us the most bang for the buck, and I do not want my tax dollars to subsidize for-profit health care.
Recently, we have all been overwhelmed with talk about the proposed healthcare reform that many Democrats want to pass. President Barack Obama and volunteers that comprise of e-mail lists of the volunteers used during the elections and supporters of Barack Obama during the campaign have been on a major mission to pursuade patients, doctors, and politicians to join them.
The idea is to “cover all Americans”, mostly through government mandates to purchase insurance.
We currently have little information but still, there are already many supporters of the plan, but some others are not comfortable with parts of the proposed plans. Many who support the plan bring up the fact that there are many in this country who are uninsured.
This is where Medicare and Medicaid come up.
Medicare is a system of insurance that assists the elderly who are eligible for social security payments. While no system is infallible, many who are on Medicare are satisfied with it. For the elderly who wish to get what they consider better care, they are able to get supplemental insurance from many private insurers, often at a discount. Many senior citizens choose this option, and many who live in a single-payer system would also prefer to supplement their insurance with this option. Medicare is also available to the disabled.
Medicaid is a health insurance program for low-income people. States are required to cover many that wish to have insurance whose income is at or below the poverty level. They may cover those that make more as well, and often cover people with higher income levels if they are minors, are pregnant, infants, and others, and are required to cover children under 6 and pregnant women who make 133% of the poverty level or below. Children in foster care and some children who are adopted also receive Medicaid. Most states go beyond these federal mandates and choose to cover a much wider group of people.
The idea that all people who do not have insurance are too poor to afford it is not entirely true. Those that are too poor to afford insurance are covered by a state program, in the same way that people that are too poor to afford food are covered by programs to assist in that matter.
There may be some who have fallen on hard times and have bills to pay, but the idea of “repossessing” medical care will remain in science fiction movies and has not been a way of life for the American people, and people have bills of all sorts, not just those that are medical. The idea that someone is too poor to afford medical care, either in insurance form or with actual doctors, is more of a matter of personal opinion, as most who are actually poor are already covered with a government program.
This is where the issue comes in. I had a friend with two children and a mother who was ill. She took care of all of them - alone. They all went without health insurance for several years, even though the mother was very ill and had been in a serious accident leaving her with brain damage. With all that, high blood pressure and some other serious problems, the mother was denied medicare. The friend, who was taking care of her family made just enough so that they couldn't get medical help but she didn't qualify at work. When her son had to have emergency knee surgery, they finally gave her CHIP for her kids and gave her mother PCN which is a very, very, very scaled down version of Medicare - totally bare bones. Basically, it helped with her prescriptions.
At any rate, people think that the poor and the elderly are all insured and taken care of. That is not true. It is a fact that over 50% are, but it is also a fact that those who make even $10 too much are often denied care even if their doctor pleads for it.
Hopefully everyone from the president down on the left or the right will leave politics out of the heathcare issue and make sure everyone who needs it is taken care of with the new legislation.
This is a question that keeps going back and forth between all of the individuals who are working hard to come to a solution to the healthcare and Medicare woes. Each side of the issue feels strongly about their position.
One side says that Medicare needs to be done away with or completely changed. They feel it has too many flaws and issues, as well as financial deficits, so that we might as wel start from the beginning and build something new.
The other side feels that the foundation of Medicare is perfectly fine and started out differently than it is being used now. Still, the foundation could still be used now with a few changes to make it work better.
From a lot of articles I have read, though there are flaws in Medicare and the need to be adjusted, as most or at least half of the the individuals involved in the debate agree, the foundation is solid, and after all, it has worked for several decades.
Part of the issue, of course, is that the beginning, there were a lot fewer Medicare recipients at that time. In addition, the costs of medical care were far lower than they are today. So lawmakers have been working on both ends of the issues - trying to get healthcare costs under control while at the same time, trying to make sure that Medicare recipients get their needs met to the extent possible.
This can be a model for healthcare reform from the standpoint because if the foundation for Medicare is used to build upon to reform healthcare, it could eliminate some or most of the flaws as well as making medical care available for all.
Time will tell how all the situation works out for both Medicare and Helthcare reform. Hopefully the reforms will result in at least basic medical care for all, which is something that is sorely needed in this country.
It's no secret that Medicare has problems to be fixed. However, the issue regarding oxygen support for patients on Medicar who need that type of treatment to basically stay alive is confusing Medicare recipients. The gist of the proposal by President Obama and his team working on Medicare and Healthcare reform is that first of all, patients will continue receiving their oxygen.
This is an important point, since the way it sounds as lawmakers are hashing ths out is that patients coule lose their oxygen care. This should not happen. It is an issue to be hashed out with oxygen providers and not patients. What is actually proposed is that from the time that individuals on Medicare begin oxygen, suppliers and providers will provide it at their regular prices for the first three yeas that it is being provided.
Once the three years are up, the providers will continue providing oxygen services at a lower price for two years and then they will go back up to their regular price, or if there is enough money by then, they may receive a slightly higer price because they hung in there and kept providing services at the lower price for those two years. This is the part where it gets sticky because, as you can imagine, suppliers and providers aren't too happy about getting a dock in pay.
As part of the Medicare reform, the President and lawmakers are trying to figure out this part of the deal for oxygen suppliers. They are trying to make it affordable for suppiers and providers to be able to continue suppling oxygen to their customers.
After those two years at a decreased amount in pay to the providers and suppliers, the price, as we mentioned above, will go back up to the prevailing price or possibly a little higher, as a sort of bonus for the sacrifice made during those two years. The important thing about all of this is that Medicar recipients who rely on oxygen services will continue receiving them.
Most oxygen service companies do not just serve Medicare recipients meaning that they have income from other sources, plus they get to know their Medicare clients over the years, so most of them will continue to help them because we are all human trying to help one another. The President and lawmakers are trying to take the money they have for Medicare services and, instead of making huge cuts in one area, they are trying to make smaller cuts in several areas so that providers including oxygen suppliers, home health care, doctors, nurses, technicians, hospitals and more, can continue to provide services.
They are trying to find a way to make it affordable to the healthcare providers without taking those services away from Medicare recipients that depend on them. As for oxygen services, if you are on Medicare and receive oxygen services, they will remain uninterrupted. Three years down the road, you may have to switch providers if your provider is not willing to take a cut in pay, however, you will still have services - just from another company.
Also, since the President and lawmakers are still working on this, it may actually turn out better than some people think. After all, if I provide you services at a good price for three years, then take a cut in pay for two years knowing that after that, I will be providing for you at a higher price after those two years and there will be no more cuts, I am not going anyplace because I have a loyal, long term client that I may be serving for 10 or 20 years. When I look at it that way, what's two years at a lower pay? So, those of you on Medicare using oxygen services, don't start worrying.
The government is trying to figure out a fair way to keep your services going. You will not have to give up your oxygen. Your provider may have to be willing to be more flexible during those two years if possible, or you will get a new provider. So try not to worry and just breathe a little easier.
Medicare has evolved into a program rather different now than when it started. It covers over 40 million seniors and it has changed the way it is administrated. In addition, poor oversight has caused cutbacks and tight budgets which means that there are cutbacks in services, cutbacks in payments to doctors, hospitals and other medical professionals.
Yet, Medicare still moves on. They have been predicting its demise for years but it is still here. Now, don't get me wrong. It is obvious that Medicare has some serious financial issues. It is also possible that in the years between now and the time the program is supposed to run out of money, there are many things that can be done to straighten out the program by creating better oversight regarding fraud and abuse, creating better incentives for doctors in the program to stay - especially some of the great doctors that are treating Medicare patients at a fracthion of the price that they treat their private patients. This is a sacrifice financially because they care about their Medicare patients.
I have talked to doctors and other healthcare professionals who treat Medicare patients. Some of these have a patient load of 50% Medicare patients. I know of a few that treat nearly all Medicare patients because they have no place else to go. The majority of doctors say they can't afford to take on any new Medicare patients. The sad part of the situation is that with the right "tweaks" many doctors could take a few Medicare patients each. If a doctor is taking home $250,000 per year and took 10% Medicare patients, it wouldn't make him or her go broke, it would bring in extra money and it would help elderly people who need medical care. If he Medicare system could help devise a way where doctors got something out of treating Medicare patients and send out information about this to every doctor in the country, more doctors would be able to take a few Medicare patients and more elderly would be receiving continuous treatment. This would save money for the system because even if these doctors who took 10% of their caseload as Medicare patients and received a small bonus or other perk for doing so, the majority of patients would stay healthier longer and avoid costly trips to the emergency room or costly stays in the hospital or long term care. Medicare pays for these. If a doctor could help Medicare patients stay healthier and out of the hospital, perhaps he/she could receive a bonus which could come from a small percentage of what was saved for Medicare by keeping the patient healthy and at home. So the doctor gets $1,000 and Medicare saves $10,000 to $50,000. That sounds like smart finance and a win-win situation for everyone.
The elderly depend on Medicare. Some still have the means for private insurance, but even so, their Medcare benefits help defray other costs. There are ways to make sure that doctors can afford to treat Medicare patients and make enough money for it to work while at the same time actually saving Medicare money.
I am not privvy to the information being discussed in the battle over Medicare, Social Security and Healthcare by lawmakers on the hill in D.C. I just know that if I can think up something this basic, the leaders who are far more savvy than I am should be able to come up with a solution to keeping our elderly covered by Medicare and our doctors willing to take Medicare patients. There is enough time for these intelligent thinkers to come up with a plan that will work for everyone. This is not a maybe. This is a moral imperative.
It's no secret that Medicare has some problems and flaws, and it's no secret that some pundits and lawmakers would like to just toss it in the trash and start over - or not. The unfortunate part about eliminating Medicare is the millions of seniors it would affect - seniors who depend upon Medicare to survive - literlly.
Many seniors live on Social Security and bring in well under $1,000 per month to pay all their bills including their rent. They can barely afford to keep the lights on and food on their table, and the only way for them to get medical care is through Medicare.
Even with its flaws, Medicare helps millions of the most vulnerable among us. What would you do if you had diabetes, were 70 years old and had no place to go for treatment and no way to get medication that basically would keep you alive? What about if this was your parent and you didn't have the money to help because you lost your job, your savings and your retirement in the recent downturn in the economy? That's a pretty difficult question to ponder because in many situations we are talking about life and death.
Then there is the next group in their 40's or 50's where Medicare will be critical to them soon - especially if they already have high blood pressure, diabetes, heart problems or other serious issues. What will they do if lawmakers eliminate Medicare? What if they don't have the money to get care for their medical conditions. I have a mother who helped people get assistance for many years and it was gruesome. It isn't getting more fun as the financial and other problems have gotten worse.
I have read many theories on what to do with Medicare. The most of them made good points on cutting out fraud and waste and changing the system so that those that do certain things to both treat their patients well and keep costs down (it is possible) receive bonuses, while those who don't measure up not only don't receive bonuses but get deductions in pay. If they really don't measure up, they can be investigated and possibly eliminated from being able to be a provider in the Medicare system.
As for fraud and waste, these issues have been handled internally like the fox guarding the hen house, for many years. It is time for an outide independent entity to keep track of checks and balances and make sure they are real. If a medical supply company or doctor's office or hospital orders a certain amount of a particular product or suppy, there should be an outside middleman making sure that what's ordered is received and is paid for to the penny. Just eliminating this kind of fraud will save Medicare according to the CMS at least one billion dollars per year. Think of how many services that would provide.
There wil be no easy fixes, but there are fixes and if the best and brightest lawmakers unite, regardless of party or who likes who, Medicare can not only be fixed - and this may take some time and a lot of work - but the foundation is good, the model is right and Medicare can be fixed before the money runs out, leaving enough for our children and grandchildren rather than leaving them nothing.
It is estimated that the number of internists will decline substantially by 2025, and the Medicare Payment Advisory Commission indicates finding a new primary physician is becoming more difficult for seniors—meaning that Medicare recipients should begin as early as possible for the best doctor and get established and comfortable with that doctor.
According to MedicareSupplementPlans.com: Many Medicare recipients, are having a difficult time finding a new primary care physician. A 2008 survey conducted by the Medicare Payment Advisory Commission (MedPAC) found that by 2025 there will not be enough primary care physicians. In addition, an estimate from the American College of Physicians (ACP) that there won’t be enough internists to go around by 2025. Let's add one more issue: the ACP also indicates that current internists are becoming less willing to accept new Medicare patients.
According to Alan Weinstock, an insurance agent at MedicareSupplementPlans.com, many physicians are no longer taking Medicare because reimbursement rates and too much paperwork. With all these trends converging at once, Weinstock believes Medicare recipients need to shop early to find the best doctor—before they turn 65. "It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts."
“The impact on seniors of physicians opting out of the Medicare program hasn’t been a serious problem yet,” said Weinstock. “But if large numbers of physicians join the group that is opting out, it may be difficult for seniors to have access to affordable health care.”
This is why it is important for the 40 million Americans who have Medicare insurance or those who will be starting Medicare soon to start early in their hunt for a physician who still accepts Medicare. Many of the physicians who accept Medicare now may not accept new Medicare patients but will still continue to take Medicare as payment for the patients they already have if a good relationship is established. It is equally important that seniors take the time to determine the best Medicare supplement insurance coverage, since Medicare often does not cover all health care costs.
Robert Dowell of Visalia, Calif., understands full well the need to have someone knowledgeable when searching for the best Medicare supplement plan. “It’s traumatic turning 65 and entering an unknown area of new healthcare. So many questions…wondering if you asked the correct ones and were given all the correct facts.” But Dowell found all the answers he needed at MedicareSupplementPlans.com and says that now he “has a clear path on how to control my health needs.”
If you are a Medicare recipient now or will be soon, check with your doctor or a recommended doctor and check with the references in this article so that you will be prepared with a doctor who will accept Medicare benefits as payment for your treatment.
This seems to be a week for special stories that need to be told and need to be heard. There are many stories about problems with Medicare, just as there have been many successes with Medicare, as well. The fact that Medicare is in trouble in various ways is not news. We have been hearing this for decades, yet, it has taken until now - where Medicare is in a crisis - for lawmakers to sit down and really pull up their sleeves and put in the work to try to stabilize not only Medicare, but Social Security and the entire healthcare system.
It doesn't matter who is to blame or how many presidents back contibuted to the mess rather than fix it. For years it has been known that if a pet project needs funding all congress has to do is tap into Medicare or Social Security funds. Lawmakers know it and the public knows it. Just the charges alone for a pill or a pillow show that there should be more control over the system and more regulations between Medicare and the pharmaceutical companies as well as other vendors. Now we are all dealing with the results.
Below is a story I read that shows the results of a system that has been poorly managed - and, at times, not managed at all. I am leaving the story as written, as it speaks for itself. This is why we have to fix the system. There is no alternative.
My Medicare Experience
by jboettner
05/19/2009 01:02:14 PM EST
My father passed away last July 2008. Even though he is gone, I thought people should know about a couple major issues we encountered with Medicare.
First of all, my father was in rehab recovering first from hip replacement surgery, then from revision surgery. When Dad was a few weeks from discharge, he fell down and broke the same injured leg, and extended his recovery time indefinitely.
The problem is under Medicare patients only have 100 days to utilize rehab facilities, once 100 days were exhausted, my father's care immediately jumped to $200/day.
In addition, I found a source of VA medical supplies from a friend who died; we thought we'd ease the burden on Medicare with the second hand supplies.
I was very impressed with the quality of the VA equipment. But Dad's nurse determined that he needed a special pillow for his wheelchair, and the only way he could get the special pillow was to get a Medicare supplied wheelchair. As we found the Medicare wheelchair was not only inferior to the VA wheelchair, but as far as the "special pillow," about the only thing special was the $500 cost!
As we get ready to launch this major effort to reform healthcare, I just thought you should be aware that private industry seems to have also co-opted Medicare.
Apparently there is a 60 day period between medical events required to qualify for another 100 day rehab period. This would have been nice to know, but even if we did I doubt the outcome would've been different.
When we can approve $500 for a pillow when the patient can get it for free, plus deny a free wheelchair from the VA - in better shape and better quality than the one being provided by the facility through Medicare and forced on the patient - this shows why Medicare is in the mess it is in. This hapens thousands of times over. It is time for it to stop
Every year there are a few changes to Medicare that Medicare recipients should know about. With all the confusion about health care reform, the information for 2010 is as important as ever.
It used to be that doctors made house calls. This was essential because there were few doctors that were responsible for vast areas. People would send for the doctor if a person was sick, and there was nothing left to do but for the doctor to make a house call to help the patient.
When you have chosen the new plan (if you do), you should join with one of the following methods:
