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.
.
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.”
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.
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.
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
When you have one pot of money and it is finite, it can be hard to split it up in a way that makes everyone happy. Let's take what the government is going through with the budget right now. It would be great if they had unlimited amounts of money, if the automakers and banks weren't in big trouble and if Medicare/Medicaid and Social Security were at least stable.
But the picture isn't that pretty, and the fact that we are in the middle of a recession doesn't help either. Add to that bad mortgages, foreclosures all over the place and handing over money to the banks without an accounting of where it has gone and the picture gets worse.
As to the banks supposedly showing profits recently from the bailouts, take a look at Dr. Martin Weiss’ article, Big bank profits are bogus! Massive public deception! He writes, “Was the bad-debt disease magically cured? Did the economy miraculously turn around? Not quite. In fact, we have overwhelming evidence that the condition of the nation’s banks has deteriorated massively since then.
“How can our trusted authorities be so blatantly deceptive and still keep their jobs? Perhaps you should ask Fed Chairman Ben Bernanke. Not long ago, for example, he declared that the total losses from the debt crisis would not exceed $100 billion, while conveying the hope that most of those losses could be soon written off. Also around that time, the International Monetary Fund (IMF) estimated the losses would be $1 trillion, with only a small percentage written off. The IMF’s latest estimate: $4 trillion in losses, with only one-third of those written off so far. Bernanke’s error factor: He was 4,000 percent off the mark, in a world where 50 percent errors can be lethal.”
And the critics talk of Medicare’s $1 trillion in costs last year to cover 42.5 million seniors. This cost was inflated by the privatized HMOs, PPOs inserted into Medicare along with the rule that Medicare could not bargain with Big Pharma on drug pricing as does Medicaid. These are a few of the negative impacts inflicted on Medicare by the Bush administration and others. In fact, Medicare began in 1964 under Lyndon Johnson as a classic single-payer health insurer. Listen closely, President Obama. It was only later that the privateers were ushered in to gobble up 12.6 percent of its premium revenue for “administration.” What if Medicare got some of that bank bailout money?
Yet the Times reports, “as a result, the administration said, the Medicare fund that pays hospital bills for older Americans is expected to run out of money in 2017, two years sooner than projected last year. The Social Security trust fund will be exhausted in 2037, four years earlier than predicted, it said.” The question is to whom will that money run out to?
Though there are many priorities here, this is a country that touts taking care of the neediest among us first. "Give me your poor...your huddled masses..." The country was founded on these ideas. All of the rest of this stuff we are dealing with now came later and some of it did not have to come at all.
The new president has said that this is our time, this is the time for change. It seems that he and lawmakers are trying to figure out what to change first and how to do it so that everyone comes out at least somewhat stable. I wouldn't want to be in their position - the president and lawmakers were left with quite a mess to clean up and figure out and it hit them all at once. It doesn't matter who is or was to blame. The blame game can go back decades and waste time that we don't have. It is time to fix things once and for all, and it is time for everyone to stop whining and get the job done.
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.
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.
There is a lot of confusion regarding the difference between “original” Medicare and Medicare Advantage. This article will discuss the basic differences to help you understand what coverage is available and which plans are appropriate for you.
Medicare is made up of two basic categories Medicare (Original Plan) and Medicare Advantage Plan. Both plans have supplemental categories including Part A, B, C, and D.
The original plan includes Part A. You an add part B and D if you choose to. You will automatically be enrolled in original Medicare when you turn 65, unless you decide to choose Medicare Advantage (Part C). The Original Medicare Plan is managed by the federal government as a fee-for service plan with various options and co-pays.
The Medicare Advantage plan combines Part A and Part B and is provided by and managed by private insurance companies. If Part D coverage, which covers prescription drugs, is not included with the plan you purchase, you can purchase it as a separate supplement.
If you choose to Medicare Advantage plans, there are several types of coverage, including HMO, PPO, plans that include private fee-for-service, and Medicare special needs plans.
Part A covers hospital expenses and does not charge a premium. It also covers inpatient care in skilled nursing facilities, critical care hospitals, regular hospitals, hospice services and hoe health care services.
Part B pays for medically necessary services and supplies covered by Medicare. There is a premium for this coverage for most people. Part B covers outpatient, doctors, physical and occupational therapists and additional home health care.
Part C I the Medicare Advantage Plan which covers Part A and B. Though it is provided by private insurance companies, it is still overseen and approved by Medicare. With this program you may have lower costs and usually receive extra services.
Part D is prescription coverage which is a stand-alone plan. Most people pay a premium for this coverage and all medically necessary drugs are covered. There are different plans that cover different drugs. It is important to compare plans to be sure what coverage is best for you.
To be certain that you have the correct coverage, it is best to contact Medicare at 1-800-MEDICARE r visit them on the web at www.medicare.gov.
Many individuals receiving Medicare benefits rely on home health care as one of the main benefits they receive. Home Health Care for these individuals – usually seniors or individuals with disabilities – is their lifeline and an essential link in their services and well-being.
The Center for Medicare and Medicaid Services (CMS) has once again recognized the Joint Commission’s deeming authority for accrediting Home Health Care.
This is important to beneficiaries because more than 2.4 elderly individuals and individuals with disabilities receive Home Health Care services. In order to be able to provide such services, agencies need to be accredited and “deemed” as meeting Medicare and Medicaid requirements and standards. When a Home Health Care agency has “deemed status” by the Joint Commission, research shows that the particular agency usually exceeds the standards set out for Home Health Care Providers by CMS, providing a higher level of service.
Because more and more individuals and patients are trying to get treatment as outpatients and stay in their homes rather than hospitals, the partnership between the public CMS and private Joint Commission has become essential in helping to set the highest standards, therefore encouraging and ensuring the highest quality services.
The Joint Commission, which started granting deeming authority in 1993, accredits over 3,800 organizations. Accreditation is voluntary, and Home Health Care Agencies can seek deemed status by the Joint Commission, but it is not a requirement. They can also seek accreditation by state surveyors on behalf of CMS.
The Joint Commission works to continuously improve the quality of services to the public. It evaluates and accredits over 15,000 health care programs in the country, including hospitals, home care organizations, assisted living, ambulatory care services and laboratories. It also accredits organizations dealing with specific health issues, such as stroke centers, and it is a non-profit organization.
As you may or may not know, Medicaid is different than Medicare. With Medicare, when you turn 65 years of age, if you are receiving Social Security Benefits, you are almost always automatically enrolled in Medicare.
Medicaid is different. Information about whether or not you are eligible is determined by your state’s Department of Children and Families. This department helps determine whether children and/or their families have an income under a certain amount so that they can qualify for coverage.
Also, if you are on SSI or SSDI, you can get information through the Social Security Administration. Another important resource is your local Health Department or Department of Workforce Services. These two departments usually have information and phone numbers, as well as websites that will direct you to your state’s program. You will be able to discuss your individual situation with a representative who will help you with the qualification and enrollment process.
Most states also have a Social Security Insurance related fact sheet that will give you information about Medicaid eligibility for disabled, blind and aged individuals, including any Medicare cost-sharing information for Qualified Medicare Beneficiaries, Specific Low Income Beneficiaries and other Qualified Individuals.
It is also easy to find Medicaid information for your state by typing Medicaid in (your state’s name) into Google or other search engine. This will pull up several sites. Beware, however, to be careful that you are not searching sites that charge you or sites that are trying to sell you information or legal services. You should not have to pay for information regarding Medicaid eligibility.
