When you need treatment for mental health issues there are multiple different types of treatment you may need and places you may need it. Medicare benefits will usually pay for much of this treatment under your policy but you must be aware of what type of treatment you are getting and when. If you are being treated in a hospital this is one type of coverage, when you are being treated outside of a hospital this is Medicare Part B coverage.
If the service you need takes place outside of a hospital it is referred to as “outpatient” treatment, which is what Medicare Part B is for. One type of treatment that is outpatient and covered under this Medicare coverage is psychotherapy provided by a medical professional. This type of therapy can be of the group variety or individual and just depends on what your doctor feels is necessary.
It is always important to contact your preferred medical professional and see if they accept Medicare insurance before you go for your visit. You don’t want to be left to pick up the full cost of the medical bill because you didn’t do your homework. Medicare Part B can help cover your mental health needs, but only if you make sure your professional is covered first.
When you have Medicare coverage and suffer from a mental health condition there may be times where it seems like there is nothing you can do. There are specific things that are and are not covered by Medicare in relation to mental health coverage and you must know the difference in order to be covered. In addition to certain types of treatments being covered, there are also specific times when certain types of providers are covered.
Medicare assists with providing coverage to you when you visit psychiatrists, clinical psychologists, clinical social workers, clinical nurse specialists, nurse practitioners, and physician’s assistants. Even if the professional you want to see is one of these that are listed, you should still call ahead to the provider to make sure that they accept Medicare assignments before going in for treatment.
Doctors and other medical professionals are freely open with this information if you call and ask as they want patients, but even more, patients who will pay. If you have the Medicare coverage to cover mental health evaluations you should contact a medical professional right away and see if they cover the type of treatment that you need.
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.
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.
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.
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.
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.
Dual eligibility is a term that is heard but not always understood by Medicare beneficiaries. What it basically means to have dual eligibility is that a person qualifies for both Medicare and Medicaid.
To qualify for dual eligibility an individual must meet the requirements for both Medicare and Medicaid. Most individuals meet the requirements for only one or the other; however there are quite a number of people who also meet Medicaid guidelines based on income and assets.
Some people qualify for Medicare and partial dual eligibility, meaning that they have Medicare coverage and can also have Medicaid coverage if they pay a very small monthly premium for it. Others qualify for total dual eligibility, meaning that they can be covered by both Medicare and Medicaid and because their income and assets are below a certain point, they do not have to pay any Medicaid premiums.
The importance of having both Medicare and Medicaid is that they cover different things, and when an individual – especially with a low income – qualifies for both through dual coverage, they are basically covered for hospital care as well as doctor visits and medication with low or no copayments. In addition, certain features of dual coverage may help pay your Medicare Part D coverage premiums.
If you have questions about dual coverage, how it works, whether your state provides it and whether you qualify, you can get information from your local health department. You can also find an excellent explanation of how dual coverage works on the Centers for Medicare and Medicaid Services (CMS) website.
Aside from war, the economy and taxes, Medicare is a glaring issue on the agenda of both Barak Obama and John McCain who are running for president. There has been a tremendous amount of information being tossed about,especially Medicare coverage and he costs related to them.
We have been carefully checking statements and information that both candidates have put out for the public. Even if the new president can successfully address the issues of war, the economy and taxes, as well as lost jobs and a budget that is a mess, one of the difficult issues that will still need to be dealt with is Medicare. Health care costs are rising rapidly and Baby Boomers are beginning to look at Medicare for coverage which will add to the number of people Medicare must cover.
John McCain has said that repairing the Medicare system will be extremely difficult. It will be more difficult to fix than reforming the Social Security System. He has also said that he wants to see changes in the Medicare system to pay providers for disease prevention and care coordination. If he becomes president he would also like to see a zero tolerance policy to deal with Medicare fraud and would not pay for preventable medical mistakes or mismanagement. He has said, “What we have to do with Medicare is have a commission – have the smartest people in America come together and come up with recommendations.”
Barak Obama, on the other hand, proposes a plan to increase Social Security taxes on people earning more than $250,000 per year. The change would not be immediate, but would take a decade or possibly more to implement. Obama feels that a program like this would keep the Social Security program stable and sound financially.
In addition, Barak Obama opposes proposals that would give a portion of Social Security money in personal investment accounts. This type of privatization is not a good idea. Obama does, however, want to reduce Medicare costs. He wants the federal government to be able to negotiate with pharmaceutical companies for lower, much more affordable prescription drug prices. He wants the “donut hole” in Medicare prescription coverage to be closed. Currently there is a coverage gap called the donut hole that leaves seniors very vulnerable by forcing them to pay for their prescriptions once they reach a certain limit. Often, this leaves vulnerable seniors on limited incomes to often pay out thousands of dollars that they cannot afford. As a result, many of these seniors are not able to afford their medications, so they just go without.
Obama has stated : "Privatizing Social Security was a bad idea when George Bush proposed it, and it is a bad idea today."
During the past few years, Medicare Advantage has become a more integral part of seniors’ health planning. Using basic Medicare and adding Medicare Advantage has been helpful to many Medicare beneficiaries including giving them some perks, such as gym memberships which could otherwise cost thousands of dollars. The added benefit to both seniors and Medicare is that the extras, such as gym membership encourages healthy living and can help prevent illness.
It is important that individuals who are thinking of enrolling in Medicare Advantage compare rates and coverage carefully. Since Medicare Advantage is private insurance and is not offered through Medicare, there can be issues that arise. Instead of paying your claims directly, the government pays private companies to do this through the Medicare Advantage plans.
Over 10 million seniors are enrolled in Medicare Advantage. Experts advise that especially during these difficult financial times seniors should look beyond some of the perks offered and compare private coverage to their traditional Medicare coverage.
There are various problems that seniors run into when they have left traditional Medicare for private coverage. One of the most common problems is that many physicians don’t accept Medicare Advantage; therefore many seniors are finding that they are in a position where they have to change doctors. For many, this can be traumatic for many reasons. Finding a new doctor who doesn’t know you (and who you don’t know) can be quite an ordeal. It has taken some people several months to either find a new doctor or go back to their old Medicare plan. Some individuals have had to go without medication during that period of time.
Many individuals are happy with Medicare Advantage. It is important, however, to determine what the plusses and minuses would be for you. Just because the agent tells you that you can continue with your old doctor, does not mean that it will be possible for your doctor to continue seeing you. Also, some individuals are finding that some medications and other out of pocket expenses are not covered as well as they were by their old Medicare policy, therefore costing them more money.
Before you change your coverage make sure you research to determine what will happen to your benefits in advance.
Studies that were just completed showed some interesting – and critical – facts about hospital care for those on Medicare.
Just as there are differences in the quality at various restaurants and hotels from 5 stars on down, the same is true of hospitals. There are hospitals that provide the best service and they are considered 5 star hospitals and there are hospitals that run all the way down to 1 star. The ratings are based on performance and outcomes.
The studies show that hospitals that treat mainly individuals on Medicare do not do nearly as good of a job as the ones that treat individuals with other forms of healthcare coverage.
The 11th Annual HealthGrades Hospital Study in America found that nearly 240,000 deaths of people covered by Medicare could have been prevented between 2005 and 2007 if the patients had been treated in higher level rather than lower level hospitals. This number represents 12% of all Medicare patient deaths.
Overall death rates declined during that period, however, the hospitals performing at the 5 star level reduced deaths much more quickly than those performing at lower levels. The higher performing hospitals had substantially fewer deaths than the lower performing ones.
The study did not publish names of individual hospitals, however the conclusion was that the best place to have treatment or surgery was in the “rust belt” the area of the Midwest where General Motors and Ford are located, which includes Illinois, Indiana, Michigan, Ohio and Wisconsin. The worst place for good outcomes was the Deep South, especially in Alabama, Kentucky, Mississippi and Tennessee.
Most of the deaths were related to preventable issues that are caused by the hospital in the vast majority of cases. The hospitals that performed more surgeries did better at controlling these issues. The more experience a surgeon has, the better choices they make and the less complications arise.
The study concluded that the chances of a death in the lowest rated hospitals is 70% higher than that in a 5 star hospital. The chances of death in a 3 star – or middle grade - hospital are 50% higher than in a 5 star hospital.
If you have to go to the hospital be sure to check the quality rating before you go, if possible. Before an emergency presents itself, check the ratings for all the hospitals in your area.
To check hospital ratings, you can look on the web at www.HealthGrades.com, a website designed to help people find hospital performance.
Seniors enrolled in Medicare should receive Medicare information in the mail regarding their benefits in October. They should receive a letter and information telling them what they are covered for, what supplements they are enrolled in (if any) and any changes to their premiums and/or their coverage.
It is important to take the time to carefully read this information and make certain that you understand it. It will tell you what your 2009 premiums will be and will tell you what is covered, including prescriptions.
Prescription coverage will be very important to check over carefully. You could currently be covered for all of your medications, but there could be changes in coverage that might cover every medication except for one. This does not always happen, but it could.
In the event that one of your prescription medications is not covered it is important that you check with your doctor and see if there is an alternative or substitute prescription that would work in its place. Then you will have to check to see if the alternative or substitute medication is covered. If you can’t find a suitable alternative medication, you may have to check for a different supplement that will cover the medications you need.
Other things to consider are how much the premiums will increase, if any. Check to see if your co-pays will increase, as well. The more you know about your coverage, the better decisions you and your doctor will be able to make regarding your ongoing treatment.
The fact that this information is being sent to you in October gives you time to get the facts you need about your coverage before the open enrollment period for Medicare Part D, which is from November 15th through December 31st. That is the time during which you can switch plans if you need to, without any penalties for pre-existing conditions or other issues.
If you receive Medicare, be on the watch for your letter describing your current coverage in October. If you don’t receive it, call 1-800-MEDICARE. You can call the Seniors Health Insurance Information Program (SHIIP) at 1-800-443-9354 or check with them on the web at www.ncshiip.com. They are an organization that specifically helps seniors with insurance and Medicare questions and issues.
Medicare is a system that is supposed to help seniors deal with medical issues by providing coverage for healthcare costs. As an individual works month after month and year after year, they pay into the Medicare system and the payments are taken out of each of their paychecks. The idea is that when they are at the point of retirement, the coverage that they have been paying for all those years that they worked will be there to take care of their health needs.
In theory, this works well, and until recently, Medicare has taken care of millions of seniors. Currently, there are about 44 million people enrolled in Medicare. Most of them have the coverage they need, however, during the past decade or so, Medicare has run into various financial issues, creating a situation in which seniors must pay for some of their coverage.
In addition, though the Medicare system has been overhauled to work better with regard to claims and paperwork, it become more sluggish regarding approvals and claim processing, and it has made it difficult for seniors to get good care and for physicians to give good care. The main reason for this is that many physicians have to wait extremely long periods of time to get paid by Medicare for the patients that they treat.
In fact, some physicians have had to stop treating patients covered only by Medicare or they have at least had to stop taking any new patients covered by Medicare. It is simply too long to wait for payment, and many physicians are experiencing financial trouble as a result.
One such provider is an ophthalmologist in Santa Cruz, California. Dr. Joshua Babad treats many patients covered by Medicare. He cares for his patients and knows they need his help. After all, Santa Cruz is not a large town, and even in large towns, there are not a lot of providers – especially eye doctors – who accept Medicare.
Dr. Babad has tried to do his best for his patients, and in doing so, has ended up over $50,000 in debt. He has had to use retirement money to pay expenses while waiting for Medicare to pay him for legitimate services rendered. In addition, his wife has a brain tumor, so he is struggling with serious family medical and financial issues on top of his long wait for payment. He wonders if Medicare is trying to discourage doctors from treating the elderly or disabled who depend on Medicare for their medical needs.
Dr. Babad has practiced in the same location for over 30 years. He has contacted Medicare, as well as his state representatives to try to deal with the situation. He has stated that if he had to depend on only Medicare, he would have gone bankrupt a long time ago. There are other providers in the general area who are experiencing similar issues with Medicare. Medicare’s response to recent contact is that they have communicated with Dr. Babad and his situation will be corrected soon.
In the meantime, many seniors and their providers continue to struggle with delays and hope that they can continue working together toward good health care while Medicare gets its act together.
It is no secret that there are some serious issues that need to be addressed regarding Medicare. Lawmakers are looking for financial solutions, auditing solutions, quality control solutions and other changes to make sure that the Medicare system becomes sound again and is there to support seniors when they need it.
There have been problems with fraudulent and erroneous claims front and center in the news lately. On top of Medicare paying out billions of dollars that should not have been paid out for claims from phony doctors and patients for phony equipment and services, the Centers for Medicare and Medicaid Services (CMS) has been using their own Medicare officials to do the audits to figure out what types and amounts of fraud were actually perpetrated.
The lawmakers and oversight commissions have come back and stated that the Medicare auditors actually were not the right auditors for the job, were not following the strict guidelines regarding audits and, in the end, needed to be audited themselves because their figures were not accurate. Without following the correct guidelines, much of the fraud was missed. In addition, sending someone from their own agency to audit themselves isn’t a real effective or efficient way to find errors or fraud.
Currently, there are more issues that have arisen. One issue that has created problems for years is the sluggishness of the claims process and the payment process. Medicare beneficiaries and their medical providers are frustrated as they wait month after month for claims to be paid while expenses pile up, making it hard for everyone involved.
The latest situation – which has cost Medicare more money that it doesn’t have to spare and didn’t need to spend – involves overpayments for medication. Because the Medicare system is so slow, Medicare missed the opportunity to pay for less expensive generic drugs rather than brand names. Medicare was so far behind that they did not enter the generic alternatives into their computer systems when they became available, thus paying the higher prices.
One of the main medications, a cancer drug, was paid for at double the generic price because of a two-month delay in entering the new information into the system. The system had no idea that generics were even available for this particular medication, according to the inspector general’s office. There are also overpayments for other drugs that have generic counterparts.
With Medicare’s financial woes, they should be at least working faster to save themselves money. When confronted with the information about the overpayment, Medicare acknowledged that they should input information in a timelier manner so that it will reflect current market prices.
With lawmakers and others trying to save Medicare, it’s time for Medicare to help save itself.
In 2006 Medicare made it mandatory for all pharmacies accepting Medicare as payment for prescriptions become ready for E-Prescriptions. Two years later, currently in 2008, Medicare is offering doctors who use E-Prescriptions when prescribing prescription medications, a bonus for five years, beginning in 2009.
Because there have been so many errors when it comes to writing and reading prescriptions, and too many of these errors have been fatal, Medicare is doing all it can to get physicians and their offices on board with writing E-Prescriptions, including offering the financial incentive.
This creates extra money for the doctors, less problems for the pharmacies and more safety for the patients. That is one side of the situation.
The other side of the situation is that in order for the doctors to be able to write E-Prescriptions, it will involve them buying software and other programs, which will involve them spending extra money.
Though the doctors will be receiving a 2% bonus during the first two years, it is estimated that the cost of the system alone – up front and in advance of bringing in any money – is anywhere from $2,000 to $4,000, which is a good sized investment in an already thinly-stretched medical practice whose Medicare reimbursements usually do not even cover the costs of services to the patients these doctors serve who are using Medicare as payment.
We are not talking about huge, upscale, overpriced practices here. We are talking about practices where doctors, nurses, physician’s assistants and others work hard and try to stretch every Medicare dollar in an effort to continue serving as many patients on Medicare as possible. To a practice such as this, even $1,000 can be a tremendous amount of money. Even though the doctors will receive the bonus, it may take time for them to recoup the money.
If there is a way for the doctors to sign on to the E-Prescription system and overcome the barrier of the initial cost, it will be a win-win situation for all, especially their patients. It may take some time for everything to fall into place, however, if even half of the doctors who take Medicare as payment work with E-Prescriptions, many patients lives will be safer because of it.
With identity theft running rampant throughout the world, guarding Social Security numbers and other personal and pertinent information has become essential.
Private insurers issue identification cards, and they used to place the individual’s Social Security number on the cards as part of the identification or as the identification number itself. In recent years, this practice has been discontinued because too many people have had their numbers and identification stolen.
In fact, Medical Identification Stealing and Fraud has become the fastest growing form of identification theft in recent years. This being the case, Medicare has been asked by the Social Security Administration, Congress and the public to remove these numbers from their identification cards, however, so far, they have resisted doing this.
Why the resistance, especially since others have already willingly complied? One reason is that it is inconvenient. The other is that at this point, the Social Security Administration is not allowed to force Medicare or the Centers for Medicare and Medicaid Services (CMS) to remove this information.
CMS has said that the risk of identity theft by using the individual’s Social Security number on Medicare identification cards and other information is not that great. Yet, statistics show that this is not the case. There is a great risk, and predators are taking advantage of this information constantly. In addition, CMS also says that if they started to issue new Medicare cards all of a sudden, it could worry, startle or upset Medicare beneficiaries.
It seems that if there was a nice letter sent to each beneficiary announcing a newly designed card would be coming in the mail within 10 days or two weeks, it might be accepted as good news, especially if the letter explained that the individual’s Social Security number would no longer be on the Medicare card, thus protecting the individual. It would seem that this would be well received as a positive message and a positive action by a government agency – CMS – whose job it is to look out for the interests of its clients – Medicare beneficiaries.
There seem to be a lot of good options available for government decisions about situations such as this. It doesn’t have to be complicated. It is simply a matter of opting to consider the privacy and safety of Medicare beneficiaries, rather than the convenience for the CMS agency.
Private Fee-For-Service Plans are Medicare Supplemental Plans that are offered by private insurance companies as part of Medicare Advantage. There are some policies that are excellent and offer good coverage but not all of them offer what individuals need. Though many plans sound great, it is essential that Medicare recipients thoroughly research any plans that they are thinking about purchasing.
The way that Private Fee-For-Service (PFFS) plans work is that Medicare pays insurance companies for coverage for Medicare recipients. The Medicare recipient can then go to any Medicare-approved provider who will accept the plan’s payment. The important difference between PFFS and original Medicare is that there is no limit to the co-payments, nor is there a limit to the premiums that can be charged. This is an area that it is very important to look closely at, because this means that the Medicare recipient in this situation will have to share a portion of the costs involved and this can add up. Medicare allows providers to charge up to 15% above the plan’s payment amount for services.
The Medicare Rights Center has reported that even though the plans seem like they have some advantages, there are often more disadvantages with Medicare Advantage than the older, original basic Medicare. Care can be more expensive due to higher co-payments, and many doctors and health care centers that accept basic Medicare as payment will not accept Medicare Advantage.
Another issue is that Medicare Advantage has been looked at very closely because of aggressive – and sometimes fraudulent – marketing and sales practices. Many Medicare recipients are being pressured and tricked into changing coverage, and, as a result, have been put in a situation where they are not better off at all. In fact, in many cases, they are receiving a plan that does not cover them as well as the coverage they are replacing.
If you are thinking of enrolling in a PFFS plan, it is important to do some research to be sure it is legitimate and advantageous. One of the best ways to protect yourself is to look at the cost of co-pays, premiums and extra coverage and make sure you can afford them. Also, be sure you are comfortable with the individual and company you are buying from, and don’t hesitate to check them out.
To be certain that you are purchasing what you truly need, contact Medicare at www.medicare.gov, www.cms.gov , or call them at 1-800-MEDICARE to talk to trained individuals who will answer your questions and help you to look carefully and understand the coverage you have now and the coverage that is proposed.
When we look at the Medicare system of healthcare for individuals age 65 and above, it is important to look at the amount of coverage seniors receive, the amount of co-pays and other out-of-pocket expenses they are responsible for and just how it all works in today’s economy.
With the economy as it is currently, it has become very difficult for individuals and families to pay for the very basics, much less any extras. Because costs have escalated enormously – especially during the past couple of years – people, especially seniors, have to make some truly difficult choices as to what they can and cannot pay for, and how it is possible to find the funds to do so.
Unfortunately, Medicare has become one of those things that seniors have to make difficult choices about. With over 44 million individuals on Medicare, there is a lot involved in these choices. For instance, AARP has stated that most beneficiaries of Medicare are under the false impression that the program is all-inclusive and pays for everything. They do not realize that most Medicare recipients are paying at least 25% out of pocket for medical care.
If that isn’t bad enough, there is talk of raising the premiums for the plan. So, in addition to paying co-pays for everything from doctor visits to prescriptions to hospital and nursing home stays, the monthly amount to keep individuals covered through Medicare could go up, too.
Every year for the past five years, Congress has raised the premiums for Medicare in order to cover payments to physicians. Rather than fixing the system, Congress has continued to raise the premiums that seniors have to pay. Unfortunately, this has put any seniors at risk and in a situation where they need to choose between medicine and medical care they need and food, shelter and clothing.
It is right and fair for seniors to pay their share; however, it is not fair that the costs continue to rise constantly. Congress needs to look for another way to cover these expenses and find a way to give seniors a break. They are looking at different ways to get this done.
If you are a Medicare recipient or will be one soon, it is important to do your research, find out what is best for you, and determine what you can afford. Visit www.medicare.gov or www.keepmedicarefa.org for information on Medicare coverage and premiums, plus the efforts to keep premiums fair and affordable
