Medicare News

Medicare Part B: Do You Know what You are Paying for?

We all know that Medicare and Medicare Part B are a maze of uncertainty for even the most well schooled government officials, but do you have any idea what you are paying for?  Do you know what Medicare Part B is really offering you and what you are getting in return for your money?

Seniors and other qualified participants in Medicare are worried for good reason about the constant changes involved in Medicare, specifically with Medicare Part B.  With a monthly premium of around $100 and a yearly deductible of around $155 this can be a pricey bit of insurance, but are you covered if you go to the doctor you choose?

Insurance professionals are urging the qualifying participants to ask many questions and do much research when deciding on what Medicare Part B plan you will use.  The reason is plain and simple, with as much as these plans change it is essential that you know you can go to the doctor in your area or who fits your needs.

Medicare Part B may be especially difficult for those who live in rural areas and may be miles and miles from their physician.  If you don’t do your due diligence when choosing your Part B provider you may be stuck driving for hours to see your physician, which will cost you even more.

Medicare Part A: How much are you Really Covered?

The horror stories associated with uninformed decisions when enrolling for Medicare are plentiful, but what about the horrors of the unknown for automatic coverage, such as Medicare Part A.  This coverage is basically provided automatically for those who qualify, yet there are a myriad of unknowns as to what it really covers in the event of an untimely hospital visit.

Consider the following scenario: Louise is admitted to the hospital after a nasty fall and has to stay for 31 days to fully recover and go through rehabilitation.  Louise assumes that Medicare Part A will cover her for up to 100 days in the hospital as the language reads in her policy, but she then receives a bill for $1,335 for her stay.  Why?

Medicare Part A does in fact cover you for up to 100 days in the hospital, however, only the first 21 days are provided free of charge.  For each day after that the patient is charged a co-pay of $133.50 per day, which in Louise’s case is 10 days at $133.50 per day, totaling $1,335.

If you are worried about being in the same position then it might be worth your time to look into Medicare Part A a little further with a professional and consider the possibility of adding supplemental insurance to your Medicare coverage.

Incentives Benefit Medicare Treatments

The CMS has successfully demonstrated that providing financial incentives for health care improvement improves not only the quality of health care but also reduces costs. Three demonstrations – one for hospitals, one for small and solo physicians and one for large physicians have yielded demonstrable results.

The programs that test value based purchasing have yielded encouraging results. The purpose of these demonstrations is to tie Medicare payments to efficiency and quality. Participating hospitals are showing a continued increase in quality. For small and solo physicians also a rewards program has been set up for providing high quality care for patients with chronic illnesses.
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13 million uninsured young adults may benefit from health reform proposals

The Congress has before it a set of comprehensive proposals related to health reform. The implementation of these proposals could mean that uninsured young adults from ages between 19-29 could get insurance. In addition those young adults who are currently insured would not lose their insurance.

This information has been detailed in a new Commonwealth Fund report. The report talks about how stable, affordable coverage can be given to all young adults. This would be possible if health coverage is extended by expanding Medicaid. In addition a health insurance exchange could help this process.
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The New Medicare Scam

As the government works towards a public health insurance program, one more recent event has reignited the question of the efficacy of a Medicare like program. Medicare has been subject to fraud since a long time and the volume of fraud is staggering. Recently a Medicare scam has come to light involving doctors and others in Houston, Boston, Louisiana and New York.

Over 30 Suspects have been arrested and more are being sought for arrest. The scam involved arthritis kits that were never used by several patients. Some of the patients they were prescribed for were dead. Some patients felt the “arthritis kits” were unnecessary and some never received them. Each kit was billed for $3000 to $4000.
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New Oxygen Supplier Rules A Source Of Worry

More than one million people depend on Medicare to pay for home oxygen therapy. New, complex rules that aim to reduce costs are confusing  these people. According to WSJ, the new rules underline how complicated and difficult it will be to control the costs of Medicare. The new rules began to affect patients on Jan 1. Under these rules the suppliers will be paid the current rate for the first 3 years. After this, suppliers will have to provide oxygen for 2 more years at a reduced payment rate.
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Medicare Coverage To Be Amended To Protect Patient Healthcare

A new bill called The Medicare Prompt Pay Correction Act has been introduced by the U.S. Senate. This bill is a companion to HR 1392. HR 1392 has 45 co-sponsors currently. Senator Arlen Specter and Pat Roberts introduced the bill. It is meant to correct medicare reimbursement problems connected with cancer drugs. In addition it seeks to provide relief to the national problem in the area of cancer care treatment delivery. Most patients are currently treated in community oncology clinics close to their homes.

As a part of the effort to reduce cancer and fight it, community cancer clinics play a vital role. This is especially so when access to large centers is restricted. With the help of this legislation Medicare beneficiaries will be ensured access to potentially life saving cancer drugs.
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Health Care News Flashes

According to the Chicago Tribune Americans feel entitled to the best health care. Americans are spoled according to the Tribune. Meanwhile Medicare might use the reverse Dutch Auction to set up competition for doctors in regions that are oversupplied. Meanwhile in chatter is the fact that health care reform might go nowhere until the cost is brought to light.

In a survery by the Register in a recent Iowa Poll, it shows an 80 percent satisfaction by the people surveyed with their current health plan. So is there really a crisis?

According to Forbes there are heavy political risks around health care and Obama’ popularity could reduce through future events. The time to act is now. Regressive taxation is being criticized as a disproportionate amount of tax would come to those earning less.

In other news, Obama is open to using Medpac to set Medicare payment rates. Medpac is in a better position to make nuanced medical payment decisions critics say. The power to set reimbursement rates would be transfered from Congress to Medpac as a result of this decision.

Three Years Into A Medicaid Experiment, Measurements Are Tough

After about 3 years of a Medicaid Privatization program that according to former Gov Jeb Bush from Florida, could be a national model, crucial data to measure the program’s effectiveness seems to be missing. The number of approvals and denials of patient treatments and prescriptions seem to be missing as well. This comes from an AP/Miami Herald Report.

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N.J. May Lose $97 Million In Medicare Cuts

Under new rules for Medicare payment, that are to take effect this October, New Jersey may lose about $97 million in federal funds next year. Over the next 5 years N.J. stands to lose over $500 mn in federal funds. This data is based on analysis by the New Jersey Hospital Association.

The Health Economics department of the NJHA examined 3 provisions of a proposed rule. This rule was released on May 1 and is to be finalized in August 1. When the federal fiscal year starts – on October 1, it is to take effect. The NJHA said that the news was devastating for state hospitals.

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Long Term Study Validates CT Scan Efficacy

CT Scans are efficient for diagnosis of chest pains. This has been validated by a long term study. The study on the efficacy of Computerized Tomographic Angiography or CTA shows that the test is safe and effective in diagnozing the level of threat posed by cardiovascular disease. The scenario of the testing is patients coming to the hospital with chest pain.

The research has been conducted by the University of Pennysylvania school of medicine. The study was presented on May 15 Friday of 2009 at the annual conference of the Society for Academic Emergence. 8 million Americans come to hospital emergency every year complaining of chest pain. It is a common as well as expensive complaint. Only between 5 and 15 percent of these people had cardiac diseases.
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The Best Medicare Fraud Office is Cuomo’s

According to the HHS, the NY Attorney Generals fraud control unit for Medicare is the best in the U.S. This, according to a NY Daily News report. An excellent ability to detect and investigate Medicare fraud was displayed by Cuomo’s office according to the HHS.

These are the figures for 2008. 143 convictions were won which is the highest total in 5 years.$263 mn was recovered in damages and civil restitution. For every federal dollar spent on the investigations the return was $6.64 says the HHS.
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Is CMS Equipped To Overhaul Medicare

This is the question Max Baucus is asking.  A massive overhaul of the Medicare system should perhaps be entrusted to a new entity, he suggested. According to him some “very thoughtful people in healthcare” were not certain that CMS was the best for the job.  They might not be able to put new programs together and develop designs according to some.

According to William Corr, on the subject of leadership, Secretary Sebelious is trying to bring outstanding leaders into the program. After several months perhaps different things would be said about the direction CMS is taking.

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Future Salary Cap Concerns Florida Group

FAC or Florida Association of Counties is at work to undo a proposed state budget provision. The provision seeks to cap salaries in county health departments of future employees.

According to FAC, physicians and dentists would not be attracted by uncompetitive salaries. Last month it came to light that some physicians and dentists earned well over $200,000 and just below half a million based on their contracts with health departments.
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Low Reimbursement Affects Physicians and Patients

It seems like you may not be able to get see a physician in the future even if you have coverage. This is due to many doctors opting out of one insurance plan or the other. Government plans are a big no-no for doctors. According to Mark Siegel from the Langone Medical Center many physicians have discontinued accepting Medicare beneficiaries as patients.

The reason is the lower reimbursements and also the delay in payments. The problem is greater in the case of Medicaid. HMO’s are showing issues in this regard as well. According to Seigel, patients do not get the care they need in any of the plans currently out there. Nowadays the care is growing even more expensive and requires too many approvals.
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Nursing Home Care Standard Low For Hispanics

According to research, nursing homes whose patients were mainly Hispanic provided a lower standard of nursing care than nursing homes that served primarily white patients.  This was published recently in the Journal of American Medical Directors Association following Brown University research.

Bed sores were more prevalent in Nursing Homes with a high concentration of Hispanic patients compared to those which had a few Hispanic patients. The research was led by Michael Gerardo. He along with associated professors said that more research was needed to corroborate the findings. The main aim of the research was to find out the basic cause of disparities between nursing homes.

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Recession Hits Hospitals In Illinois

The economic crisis has affected Illinois hospitals deeply. This is the findings of a survey by the Illinois Hospital Association. According to the survey, hospitals which had tough times before the onset of the recession now face newer issues. Due to this even patients are affected. Apart from being crucial to the health and well being of patients, hospitals are also large employers and play an important role in the circle of money.

Because recession hits Illinois hospitals hard, they lose financial stability and also they are now not able to care for patients as well. Even day to day operations cannot be well met by Illinois hospitals. 32 percent of Illinois hospitals said that the recession had a moderate effect on day to day operations of the hospital. Fully 17 percent said there was a significant effect of recession on day to day operations.
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Osteoporosis Testing Jeopardized

THe Medicare Fracture Prevention and Osteroporosis Testing Act of 2009 has been introduced by Congress. This has been done to reduce the burden osteoporosis delivers on the exchequer. The house version of the act was introduced by Shelly Berkley and Michael Burgess. Blanche Lincoln and Olympia Snowe introduced the Senate version.

Drastic cuts in Medicare reimbursement for the gold standard for osteoporosis diagnosis, DXA, are sought to be reduced by the DXA task force. The task force comprises of a number of organization. Bone density measurements detect osteoporosis. It is critical to detect this treatable condition as early as possible. 44 million Americans have low bone mass. It is often discovered after breaking bones and the cost of such injuries amounts to several billion dollars a year.
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Health Insurance For Pink Slips In California

Now, workers in California who have been given pink slips can avail of health insurance. The welfare state has been defined differently by different schools of thought. Usually it implies helping out the economically and socially disadvantaged. Populist and pro-people measures are being adopted by a number of states including California.

This state has voted to make health insurance affordable to those who have lost their jobs. State law will now conform to the federal stimulus package. There is a specification though, this law applies to those workers who have lost their jobs between Sep 1, 2008 and Dec 31, 2009.
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Open Enrollment Period To Make Changes Ends March 31

The period for individuals enrolled in medicare plans for making changes to 2009 benefits ends Tuesday, March 31. Next, you will be able to change is in November. The changes thus made will come into effect on Jan 1 2010. So it is a good idea to review your plans now.

The current benefit packages and their real value would have show itself to seniors. This applies to filling prescriptions, seeing physicians and reviewing the packet of information provided by insurers.
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Campus Birth Control May Get A Discount

College campus birth control may become more inexpensive. The 2009 federal budget bill signed by President Obama may make this a reality. This, according to a report coming in from the Kansas City Star. There will be once again incentives for pharmaceutical companies to give discounts on contraceptives. These discounts were lost some time back under a deficit reduction law. Read more…

Alabama to be part of national initiative to insure uninsured children

Only Eight states have been selected to participate in a new 4 year 15 million dollar initiative. The grant initiative aims to enroll more children and retain eligible children in Medicaid as well as ALLKids.

The PEAK project will be lead by the Alabama department of public health and the Alabama Medicaid agency. PEAK is an acronym for Perfecting Enrollment for Alabama’s kids. The funding and support for the grant is provided by the Robert Wood Johnson Foundation.
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CHIP, Medicaid Restrictions Lifted For Documented Immigrant Children

A 50-23 vote approved a bill in Utah state house. The bill is HB171 and does away with the 5 year residency requirement for documented immigrant children. They can now receive Medicaid and CHIP coverage. After passing the preliminary vote, the bill needs to pass a second vote following which it will be be passed to Governor Jon Huntman Jr. for his signature.

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Audit Finds Irregularities in New York Medicaid Payments

28 mn in Medicaid payments were made to 20000 people who were getting benefits in other states in New York, it has been revealed. This has been revealed by New York Comptroller Thomas DiNapoli. According to him the onus was on the department to do a better job to make sure that counties checked properly the federal records. This would ensure that those getting benefits in New York were not getting them elsewhere.
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Lessons From Medicare

Inclusive engagement in health care reform is welcome. The March 5 Health Care Summit from President Obama’s camp is one such step. People with varying interests and stakes in health care reform can meet and discuss to arrive at a positive transformation of the health care system in America. This will hopefully result in Universal Affordable Health Care.

Health care reform discussions are ongoing and decisions are being made. In the middle of this the Center for Medicare Advocacy reminds how Medicare can teach the provision of Universal Health Care, affordably.
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