Posts tagged 'Medicare beneficiary'

Leavitt Asks for Medicare Help from Lawmakers

Mike Leavitt, head of Health and Human Services wrote to lawmakers a few days ago asking for their help in healing Medicare.  In the position he is in, he should know what some of the essential issues are that face Medicare and he has some straightforward ideas as to how to address these issues and begin fixing them.

Leavitt started out by stating that Medicare has done a great deal of good over the years, and this is important for all of us to remember.  Medicare in and of itself is a good program, but the world, the United States, and the economy today is far different than it was 43 years ago when Medicare first began.  In addition, medical costs have skyrocketed for many reasons including new treatments for diseases such as cancer, heart disease, diabetes and others.  Many incredible medical discoveries have been made, however, the costs of caring for individuals with ongoing medical issues – especially critical issues – is much more prohibitive than in the past. 

Today’s Medicare has more beneficiaries and fewer workers to fund the program.  In addition, the costs of the funding will fall to our children and grandchildren, and if lawmakers – on both sides of the aisle – are not moved to fix the problems inherent in the system sooner, rather than later, the burden on the next generations will be overwhelming. 

Leavitt states that in 1970 the cost per Medicare beneficiary was about $2,000 and now, in 2008, it is about $10,000.  To make matters worse, there are over double the amount of Medicare beneficiaries now as there were before.  Add to this the fact that health care costs have doubled but Medicare costs have quadrupled and baby boomers haven’t yet retired, and this is a recipe for disaster.

It is estimated that in the next 20 years the U.S. will be spending more on Medicare each year than on national defense.  Families who are now spending about 23% of their wages on medical care will be spending over 40% of their wages on medical care, and Medicare will account for about 23% of that price tag.  Add to that the fact that in 1970, about 4 workers paid for each Medicare beneficiary, and currently, less than 4 workers pay for each beneficiary.  Then, looking 20 years ahead, only 2 to 2 and 1/2 workers will pay for each beneficiary, which means that workers will carry a heavy burden and the Medicare system may not be able to handle the toll of paying claims for all the beneficiaries enrolled in it.

Mr. Leavitt is urging Congress to consider these critical issues carefully and act on them in a bipartisan effort to fix as much of the problem as possible before it is too late.  After all, it is our children and grandchildren, as well as their children and grandchildren who will be forced to deal with the problem if it is not dealt with now.

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Skilled Nursing Rehab and Medicare

Understanding how Skilled Nursing Rehab works and where Medicare fits in is extremely important.  There are a lot of facts that can affect your situation and create some serious issues for you if you or someone in your family needs this type of care.

The way Medicare handles Skilled Nursing Rehab is that the original Medicare plan pays 100% of the first 20 days.  Most of the time, if there is any improvement that the facility can say is enough improvement; Medicare will try to have you discharged within those first twenty days.

After the first 20 days, the Medicare beneficiary pays $128 and Medicare pays the remainder of the day’s bill for up to 100 days.  Looking at these figures, this is where supplemental insurance becomes very important.  This could be a Medigap/Medicare Supplement plan or it could be an employer retiree plan.  This type of plan will pay most or all of the $128 per day out-of-pocket expenses that are your responsibility. 

Because Medicare is a health insurance plan that provides medical benefits, in order to receive those benefits, they have to determine that there is a medical need.  If you are in a medical facility or skilled nursing rehab center, Medicare has determined the need, they will pay their share, however, when your condition improves, they will not continue to pay. 

Sometimes and individual or family does not agree with the decision that the person is ready to be released even though that person has improved. If that happens, it is important to very firmly and specifically relate your concerns to staff, the social worker, the doctor and the social worker.  If the person has had a stroke and is still unable to get in and out of the house safely, still have severe balance issues or other barriers, specifically let the facility and all the individuals we mentioned know.

Regardless, it is very important to study the issue of Skilled Nursing Rehab and Long Term Care very carefully.  Take the tie to do some research on the net, through your doctor and even at your local hospital and find out what good policies are available and how they work.  Be prepared so that if you or your family is ever in the situation where you need this type of coverage, you will be ready.

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