Search Results for ‘medicare benefits’
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.
June 30th, 2009
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.
Copyright © 2009 The Seattle Times Company
June 23rd, 2009
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.
June 11th, 2009
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.
May 27th, 2009
With the healthcare system -including Medicare - being as out of kilter as it is, there have been many suggestions as to how to make it work more efficiently and turn it into a system that can last and help many more people for a long time.
Social Security and Medicare work beautifully for the majority of enrollees and they provide at least some security and medical care to millions of American families who would otherwise go without, especially now in hard economic times.
More and more people are asking President Obama to look into supporting a "single payer'' health plan, assuring universal health care in this country.
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Usually, the single payer is a government agency that provides one-stop health coverage. In contrast, the American system of paying for health care has been called a chaotic maze of health providers, private insurance plans with wide variations in coverage, deductibles, co-pays, and a confusing and frustrating situation for the individuals who need the coverage and are trying to figure it out.
Many lawmakers are saying that an effective way for the U.S. to move toward a single payer plan would be to expand Medicare to everyone. The smart idea in this is that it would not be free. If you are working, some of your taxes could pay for the premium, and there are other ways to offset the expenses.
At present, the White House stated that a single payer system was not acceptable to the Obama administration.at this time
because the goal of the president's health care reform objective was "to cut costs for families that are watching their premiums and their co-payments and their deductibles skyrocket.''
Experts who have compared the various plans say a government-run single payer plan would be less expensive than private insurance. There would be less overhead and no marketing costs and no compulsion to rack up profits.
There are some 47 million people without health insurance -- and thousands more are losing their health benefits with their jobs.
There are a number of proposals being presented in Congress that would provide health insurance coverage for every person in the United States. They would provide all necessary medical care including prescription drugs, hospital, surgical, outpatient services, primary and preventive care, emergency services, as well as dental, mental health, physical therapy, hearing and vision aids and long term care. And though each one is a little different in the details, 6 or 7 of these proposals are for single payer plan.
May 7th, 2009
The current administration is trying to create big changes in Medicare as they try to overhaul and reform the healthcare system. This could mean something quite new for seniors and may be a template for reforming healthcare in this country in general.
The idea is to create less waste in the entire healthcare system and strengthen Medicare, as well as covering the uninsured.
Medicare covers about 45 million Americans who are elderly or disabled, and its policies are followed by many private insurance companies when they set up their internal systems. The new approach and ideas for seniors would helMedicare p medical professionals stress and help patients with follow-up care by their family doctors and nurses so that more chronically ill patients could avoid being hospitalized and re-hospitalized when chronic problems such as high blood pressure get out of control.
There would be changes for doctors and hospitals, too. Primary care doctors who care for patients on a more constant basis would be paid more, while specialists would be watched more closely, especially as they order more tests and procedures. Hospitals could have to pay penalties if they did not provide adequate follow-up care, therefore having the same patients continually being readmitted for the same problem.
Medicaid would also see similar changes, which would affect most of the 50 million low income people that they cover.
“Medicare is going to be the driver to achieve quality reforms, in large part because the other players tend to follow Medicare,” said Sen. Max Baucus, D-Mont., the Finance Committee chairman. Baucus aims to have a bill on the Senate floor this summer that would restrain costs and cover the estimated 50 million uninsured.
The committee meetings that are slated will iron the details out, and some of the meetings have already started. This effort is aimed at helping even out who pays for these benefits and how. The sickest 10% of the patients account for nearly 2/3 the cost that Medicare spends per year. These are frail individuals who usually have more than one serious chronic condition such as high blood pressure, diabetes and heart disease. The cost is so high because they are seeing several specialists for each issue. If the changes that are being examined can be put into place, they could be seeing one doctor who could control and coordinate the other treatment they receive, eliminating duplicate procedures and eliminating waste.
If and when lawmakers are able to straighten the health care fragmentation out, it is very possible that everyone could get good care and save money at the same time.
April 28th, 2009
The Obama administation has taken an important first step toward reducing what are basically a set of handouts to private insurers, embedded in the Medicare system. These government subsidies to private industry enrich insurance companies at the expense of taxpayers and beneficiaries. The particular handouts in question come in the form of subsidies to so-called Medicare Advantage plans. As the Wall Street Journal reported on Monday:
The federal government made good on its plan to cut 2010 payments for private Medicare plans, diminishing the subsidies to health insurers sooner than the industry originally expected.
The cuts, announced late Monday by the Centers for Medicare and Medicaid Services (CMS), are slightly less severe than the 5% reduction the federal agency signaled in February, but still raise concerns about what has been a critical source of profit growth for many health insurers. Reimbursements to private insurers that administer so-called Medicare Advantage plans would fall by as much as 4% to 4.5% next year.
There have been numerous acknowledgements that the Bush Admiistration pushed for private insurance companies to become more and more involved and imbeded in the system and it is beyond time that everyone has had enough.
Here is th description of the genesis of Medicare Advantage plans in more detail in a post back in January on a blog called Unsilent Generation:
Medicare Advantage (MA) plans–-which offer managed care run through private insurers, paid for by the federal government–-are the point of the stake that conservatives have long been trying to drive into the heart of traditional Medicare (which, for all its shortcomings, is the closest thing to a single-payer program that this country has ever seen). Columnist Saul Friedman recently wrote about the history of of this effort, recalling a 1995 press briefing in which Dick Armey, Newt Gingrich’s collaborator on the “Contract With America,” announced their intent to “wean our old people away from Medicare.” The first step was to introduce private Medicare HMOs–-what later evolved into Medicare Advantage plans, with a big boost from the Republicans’ 2003 Medicare bill.
MA plans have come under increasing fire for their hard-sell tactics to elderly Medicare recipients, shoddy coverage, and rip-offs of the public purse. “Competition” from the private plans was supposed to reduce growth in Medicare spending–but in fact, they cost the government more. A September 2008 report from the Commonwealth Fund calculated that “payments to MA plans in 2008 will be 12.4 percent greater than the corresponding costs in traditional Medicare–-an average increase of $986 per MA plan enrollee, for a total of more than $8.5 billion. Over the five-year period 2004-2008, extra payments to MA plans are estimated to have totaled nearly $33 billion.”
If the Commonwealth Fund’s figures hold true for this year as well, then by my calculations the Medicare Advantage plans are still getting a subsidy of some 8 percent over traditional Medicare, even after a 4 percent cut. (In fact, the baseline payments to private plans will still go up slightly in 2010, but they’ll be offset by adjustments in other areas—so the 4 percent is just an estimate.) Nonetheless, the insurance companies are already whining about (and lobbying against) the cuts, claiming that they will harm the 10 million Medicare beneficiaries who’ve been convinced to switch to private plans. According to Reuters:
Analysts say the new rates will force insurers to cut benefits for elderly and disabled patients enrolled in Medicare Advantage plans or increase premiums in order to maintain profit margins.
That last phrase, of course, is key: It’s the profit margin that matters to these companies, which is why they shouldn’t be in the Medicare business in the first place—especially if they require extra government subsidies just to make enough money to satisfy their greed. The insurers know that in order to maintain their high profits, they’ll now be “forced” to cut the benefits on their private plans, and more and more Medicare patients will just switch back to conventional, government-run Medicare.
That can’t happen soon enough. The government’s next step should be to boot the insurance companies out of the Medicare Part D prescription drug program, which would likewise save the taxpayers a bundle while improving benefits to the old and disabled. I’d love to see this done before I fall into the coverage gap, which usually happens around August. But to accomplish this change, Congress will need to act—and they’ll have to battle Big Pharma as well as the insurance giants. So I’m not holding my breath.
quotes and other information courtesy of Mother Jones
April 13th, 2009
On Sunday, March 29, the Star-Ledger ran "book-end" op-eds on healthcare reform. They quibble about the cost and benefits of Obama's plan. Neither addresses a superior plan that is already before Congress but is being kept "off the table" in most discussions of healthcare reform.
President Obama insists that some consumers like their current health insurance. Most are probably unaware that illness and medical debt are the single biggest cause of personal bankruptcy in the United States, or that three out of four of those households had health insurance when illness or injury first struck. They do not realize that they will not be able to keep their plans if they lose their jobs.
In the United States, most young adults get their health insurance from their employer. If they lose their job, they have to buy health insurance, a huge expense when their income has vanished. What's worse, the high cost of health insurance has been chasing jobs away. Health insurance companies have been making money on employers of all kinds in the United States. Unlike Medicare, which has an overhead of only 3%, the insurance companies skim about 30% off the top, to pay for executive salaries and bonuses, shareholders' profits, and the cost of a wasteful bureaucracy. Many employers can't afford this, especially if they are competing with foreign companies that have efficient national health insurance. So employers from large industries to small businesses to nonprofits like your child's school have to make the nearly impossible choice between cut benefits or cutting staff.
Many citizens feel that the obvious solution is to expand and improve Medicare to cover everything for everyone: 100% of all medically necessary care, including prescription drugs and long-term care. By cutting out the private insurance companies, we could cover everyone at a reasonable cost: 90% of American families would end up paying less than they are paying now.
The United States National Health Care Act or the Expanded and Improved Medicare for All Act (H.R. 676) would be funded by a payroll tax: 4.5 percent from employers and 3.3 percent from employees. There would also be a one third of one percent tax on stock transactions and a small increase in income tax for the top income earners. So most unemployed and retired people won't have to pay a cent.
If Medicare for All is enacted, most Americans will never see another medical bill or pay for another prescription drug. They won't have to sell their home to buy long-term care for a disabled family member. All we need to do is get the House of Representatives to pass H.R. 676, and the Senate to pass the companion bill S. 703, and the President to sign it.
"But it will never pass," people say, "because Congress is in the pockets of the health insurance industry." The truth is that we can get this legislation passed. Pollsters report that most people want a "single-payer" plan like H.R. 676. Strong majorities of doctors and nurses support it. Most employers, from big manufacturers to small businesses to your children's school or your church, would save money on health insurance, while providing better health coverage to their employees. Medicare for All will help make American businesses competitive again. If patients, doctors and nurses, and most employers want this bill to pass, who can stand in its way? And why -unless you are a lobbyist for an insurance company - would you want to?
Nevertheless, getting Medicare for All will be an uphill struggle. The single-payer option is being swept "off the table" by the likes of Max Baucus, Senate Finance Committee Chair and recipient of over $2 million in campaign contributions from the insurance and healthcare industries in the last election. Fortunately, members of the House of Representatives face reelection every two years. If your Representative doesn't support H.R. 676, find someone who will and get that person elected in 2010. Senators serve longer terms, but the principle is the same. Ask Senators Lautenberg and Menendez to cosponsor S.703.
To get involved, connect with groups like Physicians for a National Health Program (www.pnhp.org) or Healthcare-Now! (www.healthcare- now.org). Beware of groups that are really fronts for the insurance companies. Learn the facts of healthcare reform options. Talk to your friends, relatives, coworkers and neighbors. Get organized, and get active. Together, we can do it!
Some quotes and material from Geoff Thomas at oped.com The views expressed in this article are the sole responsibility of the author, Geoff Thomas, and do not necessarily reflect those of this website or its editors.
April 13th, 2009
The new present and Congress are under a lot of pressure to clean up a lot of messes. The fact that most of these messes started long ago and far away under other administrations is somewhat irrelevant. The main issue is that right now, the economy is in a mess and it is affecting a lot of things, not the least of which is Medicare.
AIG has long been a staple in the financial area. The main problem is that as the government continues to try to shore up medicare, help it go further and help it assist more people who depend on Medicare benefits to stay healthy - or even stay alive - AIG has been finding ways to get money in sneaky and unscrupulous ways over and over. In addition, AIG has managed to get millions and milllions of dollars from the government to keep runing, because AIG is connected to tons of financial institutions that everyone seems to be worried will go under if AIG does, since AIG is the sugar mama.
The latest information on AIG after they have taken plenty of money to continue operating, they have been and continue to pass out millions in bonuses and "retention" money, as well as tell the overnment and everyone who will listen that this is someting they must do and that "legally" they can't get out of the situation.
Meanwhile, Medicare is struggling to take care of those other millions of people - you know, the ones wh depend on them to get o stay healthy. Lawmakers and the president are doing all they can to get Medicare on more stable fotting. The unfortunate thing is that this whole mess started in preious adminisrations and
for the most part, until this administration there has been little effort to really examine AIG or Medicare.
The Obama administration has made its share of mistakes and misjudgements, however, let's be fair - they inherited a miss that has been growing and growing, as well as getting messier. more complicated and more sinister over the previous years. Now it is up to the current administration to get this fixed. At least this administration is really trying to get it right. There are some lawmakers on both sides of the aisle that are trying to put bipartisanship aside and work on these urgent issues.
If the rest of the lawmakers could simply put their partisinship aside and worry aboutfixing the problems rather than blaming people, a lot coud be fixed faster. Things will get fixed, there will be mistakes and oversights along the way, and these, also, will be ixed.
It's time to continue trying to make Medicare run as it should and stop shoveling money to corporations who are - and have been - using it on unncessary luxuries while those who are struggling can't even get basic, decent medical care.
It will take some time, and at east for the first time in nearly a decade, there is a trye effort to fix these issues and put the oney where it should be. Now, if we could just get everyone to stop playing the blame game and clean up the mess, things would go faster and and definitely turn out better.
March 19th, 2009
President Obama's budget chief has made it clear to health insurance executives that the fun is over and it’s time to get serious.
On Tuesday, White House Budget Director Peter Orszag said the government will no longer overpay companies that offer Medicare Advantage plans, the privately run portion of the government health program for seniors.
Companies like Humana Inc. and UnitedHealth have been defending their plans for over a decade, pointing out that in their opinion, they offer lower premiums and extra benefits compared with government-run Medicare. More than 10 million of the 44 million seniors enrolled in Medicare are signed up for Medicare Advantage.
The problem is that industry executives have long known that the government spends significantly more money on Medicare Advantage than its own plan. When private insurers first entered the Medicare program in the late 1990s, many lawmakers assumed companies would lower costs with their managed-care strategies. Instead, over a decade has passed and the government is spending about $1.30 per Medicare Advantage patient versus $1.00 per patients who are enrolled in traditional Medicare. The cost burden falls on taxpayers as well as patients in regular Medicare, who pay higher premiums.
"I believe in competition. I don't believe in paying $1.30 to get a dollar," Orszag told conference attendees, including representatives from Aetna Inc., WellPoint Inc. and Cigna Corp.
Orszag's address came less than a week after President Obama kicked off his health reform effort with a massive summit at the White House. Orszag showed little intention of compromising on the Medicare Advantage issue.
Under President Obama's recent budget proposal, Medicare Advantage companies would have to compete to offer their services in different parts of the country. The government payment for each region would be based on the average bid submitted by companies, saving $177 billion over 10 years, according to the White House. Under the existing system, payments are calculated annually using a preset formula.
Orszag reiterated Tuesday that the best chance to solve the country's current health care predicament is to eliminate billions of dollars worth of wasteful spending. He pointed out that different regions of the country spend vastly different sums on seniors in Medicare, without showing much difference in health outcomes.
Insurers are not the only group being asked to change how they do business. As part of his economic stimulus package, Obama provided $1.1 billion in funding for research comparing the effectiveness of various medical treatments. By rewarding physicians for using the most efficient practices, the administration hopes to reduce health care costs.
"We are pushing hard on changing incentives for providers so that we are rewarding better care and not more care," Orszag said.
Some quotes from The Associated Press.
March 11th, 2009
Most of us hope we and our loved ones won't end up in the hospital. In the event that we do, we have the hope that we will get through what we are in the hospital for and go home better off than we came to the hospital for.
The remarkable thing that many people don't know is that nearly 100,000 people per year get terrible infections in the hospital and die from them. One out of 20 patients get infections that they contracted in the hospital and some patients survive but have to be on medication for months or years, or even end up with long term or permanent illnesses or disabilities due to these infections.
What are some of the ways to avoid this situation? Several things have been suggested. A 2005 report showed that hospitals could charge the cost of health care-associated infections to third-party payers such as Medicare and Medicaid. Medicare has changed its rules in response to these concerns and will no longer reimburse hospitals for the excess costs associated with the care of patients who contract a hospital-associated infection. But now hospitals have no incentive to accurately report their infection levels. If Medicare were to provide hospitals with more resources for infection control, rather than just penalize them for caring for very sick patients who contract a hospital-associated infection, hospitals might perform better. Really? Why not just perform better and be more careful now?
Last month, the U.S. Department of Health and Human Services released a plan urging hospitals and other health care facilities to adopt increased use of sterile techniques and follow strict protocols to prevent such infections. These include guidelines on the proper insertion of catheters and disinfection of ventilators, as well as practices that minimize risk of infection before, during and after surgery.
The University of Maryland Medical Center screens all patients at high risk for MRSA when they are admitted. Screening includes patients in intensive care units and those who have been in another health care facility during the past year. The tests are repeated during the hospital stay. Isolation precautions are instituted for those who test positive for MRSA. During the past year, the hospital has performed more than 33,000 MRSA screening tests. This aggressive action has slashed the hospital's rate of MRSA infection by more than 30 percent and has saved lives.
Patients with health care-associated infections move among hospitals, other health care facilities and nursing homes, and can spread the infections regionally. That means that a specific hospital does not necessarily receive all of the benefits from its infection control activities.
What's the solution? Infection control efforts should be a coordinated effort involving hospitals and HHS and the Centers for Medicare and Medicaid Services. Hospitals could be provided with tools and incentives to work together so that they can coordinate infection-control measures. If regional coordination existed, infections wouldn't just be transferred from one place to the next.
Health care-associated drug-resistant infections are a complex problem. The overselling and overuse of antibiotics, as well as the lack of new antibiotics in the research pipeline, are driving the high rates of resistant infections. Timely prescribing of antibiotics can help reduce infections in hospitals, but we have to work to reduce overprescribing as well. Hopefully government and hospitals will work together to come up with a policy that will bring this situation under control.
February 26th, 2009
This is a story about a man named Don. It really happened, and it really happened to Don.
Don really enjoys playing his guitar.
Tuning it, he says, is so much easier than getting into tune with his Medicare prescription provider, called Medco, (one of the largest Medicare medication distributors), which kept telling pharmacies Don's benefits had ended.
He recalls his first trip to the pharmacy this year.
"I gave them my card, they looked it up and they said that's been terminated."
Since Don needs seven different prescriptions every month for his heart, blood pressure, and diabeties, he started getting concerned, as those bottles were nearly empty. Many of us can relate to that situation. I get nervous when the number of pills I have left gets low , especially if my doctor is out of town, I don't have a new prescription or my check hasn't arrived. I take 6 different pills every day for heart, blood pressure and a few other issues.
Back to Don. He kept calling Medco. Over and over until it was ridiculous.
"I probably made 35 calls to them."
Medco kept telling Don he wasn't covered, while Medicare kept telling him he was.
"I was getting really frustrated about it."
Then he thought the frustration would finally end, when he got this letter from Medco, which said he was covered.
But despite that letter, the pharmacist said his records showed Don still wasn't.
"I call Medco and I fight with them on the phone about it, they keep telling me I'm terminated."
Now, Don really started getting worried. When you are in a situation like this it seems like you get stuck in the middle and everybody is going back and forth with no end in sight.
He says he certainly can't afford the $700 it would take every month to buy his meds without Medicare's help.
"I just figured I'm going to have to quit taking them and take my chances, whatever."
Most local news channels in every city and state have some sort of consumer problem solvers segment where the news channel will help you with your problem. Don definitely had a problem and it could have turned out to be fatal for him. With his pills running out, Don finally called the 2News problem solvers, and they contacted both Medicare and Medco.
Later that very same day, Medco called Don, to clear up his situation.
"They just wanted me to know that they had updated everything in my file and the card is now working and I could go pick up my prescriptions anytime I wanted to."
Finally, Don finds himself in perfect harmony, with his music, and his meds. If you find yourself in a similar situation, don't give up. Keep trying to deal directly with your drug company, medicare and your pharmacy. If that doesn't work, do what Don did and get extra help. There is usually a way to work it all out.
February 19th, 2009
On July 1, 2006 the Deficit Reduction Act went into effect. The act required all immigrants to give proof of legal immigration or citizenship when they are applying for Medicaid for the first time. This applies to children, as well. Most legal immigrants cannot receive Medicaid benefits for the first five years that they are in the U.S. Undocumented immigrants can only receive emergency Medicaid services.
Once the bill became law, it also restricted citizens, as well. Medicaid enrollment has declined since the law was enacted, partially because even U.S. citizens are finding it difficult to locate some of the documents required to enroll for Medicaid services. This is because some of the documents need to be original documents, and it can be difficult to obtain original documents in many cases.
As far as Medicaid goes, they receive matching federal funds to help run the program and pay claims. As a result, even if they wanted to assist individuals without documentation it would be a problem for Medicaid both in a financial sense and in a legal sense.
The rules for Medicare and Medicaid are so stringent that CMS has instituted a rule that even requires child welfare agencies to document citizenship for children being placed into foster care. There are some issues where people receive extra time to provide documentation, however, they are limited and must adhere to very specific rules and time frames.
Once an individual has completed the documentation process and is approved for coverage, they will be covered retroactively to the date of the application or to the month of the application depending on the state they are living in and a few other variables. Trust me when I tell you that this can be a true adventure that seems to take forever. Just when you think you have sent in everything that is needed you get a letter or phone call asking for more. Just take a deep breath and send the requested paperwork in. Be prepared for at least a couple of follow-up requests. As long as you comply with the requests, you will get the coverage you applied for and qualify for.
The primary types of identification include a state driver’s license, Certificate of Naturalization, Certificate of Citizenship or a U.S. passport. Secondary types of identification for naturalized citizens include a U.S. Birth Certificate, data verification with Systematic Alien Verification for Entitlements (SAVE) documentation, or documentation and data match with a state verification agency, as well as other documents.
It is important to know the law, your rights, your responsibilities and your entitlements in order to receive the benefits you need. You can research them on the web by going to the CMS website.
February 11th, 2009
As the new administration takes on the responsibility of fixing some of the issues left behind from the old administration, it has become apparent that this will be no easy task.
Everybody from people on main street to the people on Wall Street have known for quite some time that things have needed to change. Main street is just trying to survive, and as the economy has gotten worse many on main street are losing the battle of surviving financially.
Folks on Wall Street are not immune, either. They may not feel the pinch as much, but many of them have lost millions and more. Some of the wealthiest people in the world have committed suicide due to the fact that they lost so much money, yet they were still some of the very richest people in the world even after they lost the money.
One of te issues that begs to be cleaned up is Medicare and Medicaid. With general budgets out of control and lawmakers divided as to how to fix a number of programs, especially healthcare, this is a battle that will be hard fought.
As it is, people can barely keep up with various premiums and copays. Time will tell what affect lawmakers will have in trying to adjust benefits and premium so that people can still afford Medicare and Medicaid and not lose some of the services they need.
Even though there have been promises of non-partison ways to work on the many serious issues facing Congress, from the beginning there has been a tremendous divide between Republicans and Democrats. In fact, trying to fix the economy by passing a bill was a tremendous task. The President and many of the Democrats adjusted the proposed bill over and over to accommodate Republicans. In the end however no Republicans voted for the bill. In other words, the President and the Democrats could hav left the original bill the way they wrote it rather than take the time to give the Republicans the changes they asked for and not get any support anyway. That would have saved a lot of time and delivered a more solid bill, according to the Democrats.
The President and Congress are trying to fix the Medicare Mess as well as the entire financial situation that has gone from bad to worse. Here's hoping that this can be done sooner rather than later from Main Street to Wall Street.
February 11th, 2009
If you are covered under Medicare, you will see that it doesn’t entirely cover all the expenses that you may incur during hospitalization or medical treatment. Because of this, you may want to purchase one of the Medigap plans that AARP has to offer.
Basically, Medigap is also known as Medicare Supplement Insurance. What this kind of insurance does is that it will be able to fill in the gaps that Medicare has. It will be able to cover the expenses you incur during medical treatment that Medicare does not cover. With it, you can be sure that you will be able to save a lot of money.
However, you need to remember that there are quite a lot of plans that AARP offers in their Medigap health insurance program. You need to know what kind of health insurance plan is right for you in order for you to save money and get the most out of your health insurance plan in case you need it.
There are basically 12 plans that AARP Medigap offers.
If you need basic benefits more than the extra benefits, you may want to get plans A to J. Here, you will benefit from Medicare Part A coinsurance plus 365 additional days after Medicare benefits.
For people who needs preventive health services, plans K to L is for you. Here, you will be able to benefit from Medicare Part A coinsurance and it will be able to cover 50 to 75 percent of hospice cost sharing, three pints of blood every year and it will also be able to cover 50 to 75 percent of Medicare Part B coinsurance.
These are the things that you have to know about AARP Medigap Plans. By choosing the right plan, you will be able to make use of the benefit and also save money on premiums.
December 6th, 2008
Many people are confused about Medicare and Medicaid including the question of what the differences are between the programs. There are some major differences between the two, but they are easy to sort out.
Medicare is a program that is funded by the federal government as an entitlement program, which mainly focuses on the older population. It is a social insurance program for individuals age 65 and over and it also covers medical bills of many individuals with disabilities. Medicare also covers individuals of all ages with end stage renal (kidney) disease.
There are several parts to Medicare. Part A covers hospital bills, Part B covers medical insurance and Part D covers prescriptions. There are other parts, as well, and they act as supplements, however, that discussion is for a different article.
Medicaid is different from Medicare in several ways. Medicaid is also an entitlement program, however, Medicaid is not funded only by federal government, there is a state component as well, and in some states, counties pay part of the cost, too.
Medicaid is based on need and social welfare, with eligibility based on income. If a person has limited income and/or limited financial resources, Medicaid covers a broader amount of services than Medicare does. It usually covers children, pregnant women, parents of eligible children, seniors and individuals with disabilities. Though poverty is used to determine eligibility, a person must fall into one of the other coverage groups in addition to being determined eligible due to being in poverty. Medicaid benefits are paid directly to the provider of services. So, if you go to the doctor, the doctor gets the payment, if you go to the pharmacy, Medicaid pays the pharmacy directly. In addition to covering individuals who meet financial requirements, in some states Medicaid covers individuals who cannot otherwise afford insurance.
Some individuals qualify for coverage by both programs. For more information regarding Medicare and Medicaid, go to www.medicaid.gov or www.medicare.gov or simply go to Google or another search engine and type in Medicare or Medicaid and you will get pages of information.
December 4th, 2008
Many cities and towns throughout the country are issuing warnings for seniors and individuals with disabilities about scams aimed at them – especially during this open enrollment period which lasts until the end of the year.
Some of these scams involve people calling Medicare recipients and telling them that they are from Medicare and they are calling to warn the recipient that their benefits will cancel in 30 days. The callers also tell recipients that in order to keep their Medicare benefits, they need to give the callers personal information bank account numbers, social security numbers and Medicare number. Callers will also say that updating this information is free.
These types of scams are becoming more and more common throughout the country. People prey on the elderly and on individuals with disabilities, and these people sound so authentic that they often get the information they are asking for. Once they have this personal information they use it in a fraudulent way.
No matter where you live, Do NOT give out ANY personal information – especially social security numbers, bank account numbers and Medicare or other information that should remain private and protected.
Actual Medicare or Social Security representatives will NEVER ask you for personal information and they will NEVER ask you to pay them over the phone. They may verify your information, but if they are authentic, they already have the information and are trying to make sure that you are who you say you are. In addition, they usually only ask for the last 4 digits of your Social Security number. Medicare sends out information about bills and statements to recipients if there are any amounts due. Most of the time the amount would be set up in advance to be deducted from your bank account and you would receive statement in the mail showing the deduction. Official Medicare, Social Security and banking information is usually sent to you in writing in a statement or letter. If they need information from you, they usually ask for it in writing.
If someone calls you trying to get information that is private, do not give it to them. Try to get their name and number and report them to your local police or sheriff’s department.
Keep yourself and your private, personal information safe. Don’t let scammers trick you into revealing and sharing information that should stay private.
December 1st, 2008
Medicare is a program designed for seniors and for individuals with permanent disabilities who are younger than the 65 age requirement to sign up for Medicare benefits. Having Medicare benefits helps many millions of people offset medical expenses that they would otherwise have to pay themselves.
There can be issues regarding Medicare, however. With open enrollment period upon us for choosing the type of coverage and supplements that would be best for you, it is a confusing time. However, there is information and there are seminars available to help guide you through the process and help you to pick the most appropriate coverage.
There is another issue regarding Medicare which affects younger individuals who become disabled. The issue is the 2 year waiting period. The waiting period has been around for years and here is how it works.
At any time, about 1.5 million disabled people are waiting to qualify for Medicare coverage. About 40% of these individuals are uninsured during at least part of that wait and 25% percent do not have insurance for the whole 2 years. Some of the rest who are waiting to become eligible might get coverage through Medicaid, but many end up depleting their savings and assets on private insurance and medical bills because Medicaid will only pay if the person is nearly destitute and has no other way to pay for medical care.
A new bill is being sent to lawmakers to help change the situation. Several legislators presented a bill to begin shortening the waiting period gradually over the next 10 years until the waiting period is short enough and other assistance is in place so that people are not stranded without medical coverage. The reason for reducing the wait gradually is that if it was reduced all at once, it would be too taxing on the system.
This has been a long time coming and it may seem that gradually reducing the waiting period over 10 years is also a long time. That is true in some ways, but considering that the waiting period has been a huge issue for decades, at least there is progress. Maybe things will go faster now that serious attention is beginning to be given to the situation.
November 14th, 2008
Medicare can help offset medical expenses, which is a good thing. However; there are gaps in coverage with Medicare, and they need to be filled. One way to fill these gaps is to take the money out of your pocket, your bank account your life savings or your retirement.
Especially if you have the original Medicare plan, you need to look into supplements, also called Medigap. These will help you pay for expenses that are not covered and pay for some – or most, or all – of those costs.
There are 12 Medigap policies and each is a little different and covers different things. The premiums can differ a lot, as well, so it is essential that you thoroughly check each company selling these supplemental policies to make certain which covers offered through
Study each Medigap plan before deciding which one to select. This is extremely important, particularly because there are so many people on Medicaid and/or Medicaid who don’t understand how the program works and often don’t realize that their billing. Information you receive could make a vast difference as to whether your medical bills will be covered and how much you could save by only having to pay a basic and affordable for the most part.
Why not find out what benefits you qualify for and which ones are right for you? Study all the Medigap plans to figure out the differences and which one would suit you the best. You can check the internet for a vast amount of information, you can talk to someone by calling 1-800-MEDICARE, and you can call your local insurance agent.
Whatever you decide, it is essential to find out what coverage is available and how it works, as well as, which plan will work best for you.
October 31st, 2008
There are over 44 million individuals who depend upon Medicare to cover the majority of their medical bills. The problem that the majority of people have with Medicare is that it is confusing and hard to understand.
There is hope for Medicare beneficiaries and it will come through in November and December. Open enrollment period for Medicare runs from November 15th to December 31st. Any new coverage or options that a Medicare beneficiary opts for will go into effect on January 1, 2009.
It makes sense that people want to understand at least the basics about Medicare as Open Enrollment time approaches. They need to have and understand accurate information so they can figure out if they should change coverage.
Realizing the situation, Health Alliance Plan (HAP), out of Detroit, Michigan, is offering help in the form of a DVD entitled “Making Medicare Work for You.” An article in the Wall Street Journal describes the DVD as a helpful tool to research Medicare, and goes on to state that HAP's new "Making Medicare Work for You" DVD offers helpful information. Local experts, including a physician, a pharmacist and a representative from the Area Agency on Aging 1-B Medicare Medicaid Assistance Program, explain the basics of Medicare, options for extra coverage, how to choose a plan and more. "Making Medicare Work for You" also explains the "A-B-C-s" of Medicare, what Original Medicare doesn't cover, and what to do when your employer cancels your retiree health benefits. The DVD also covers the importance of preventive services and managing chronic conditions.
"This DVD was created for the general public, and is meant to be useful resource for anyone trying to better understand Medicare," said Karen Wintringham, vice president, Medicare and Public Sector Programs. "The DVD also explains how to prepare for the open enrollment period and what to consider when making your decision about a plan for the coming year."
In addition to the DVD, a videotape of the information is available. To get information or obtain a DVD or videotape of “Making Medicare Work for You" Call 1-800-971-7878, or TDD at 1-313-664-8000.
October 30th, 2008
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