Trending Information About Medicare in Texas

In Texas, eligibility for Medicare supplemental plans varies with age – there are rules for each of the plans. However, before we plunge into the rules, you should know that when you first activate Part B, there is a window for open enrollment for a Medigap plan without having to go through any form of health underwriting. As long as you are a Part B holder, you’ll be guaranteed access to any plan for six months beyond the effective date of their Plan B. Everyone is granted this special application window, regardless of when they first obtain Medicare.  The eligibility rules determine which plans each of the two groups can access. There is, however, a limit for the plans offered to those below 65.

How Eligibility Rules Work

For age 65 or older who are on Medicare in Texas, have access to all 10 supplement plans – Plan A through Plan N. Plan F being the most popular is the highest-deductible option available because it includes all deductibles and co-insurance you would have paid. Nonetheless, membership for Plans G and N is on the rise as they are offering a relatively low premium for a little cost-sharing with beneficiaries.

For folks under age 65, there is a clause. A great number of these people have access to just Plan A, and the reason for this is because each insurance company can decide on the supplement plans they want to offer to the public. The only supplement plan they are required by law to offer to all is plan A.

These insurance companies are aware that those under 65 must have got Medicare due to some form of major health issues, so they anticipate these people to use benefits more frequently, and this will cost more money to the company. Thus, since Plan A has fewer benefits and more cost-sharing on the part of the policyholder, most insurance carriers decide to offer just Plan A to individual below 65.

Well, you should also know that Plan A supplement still has many benefits. Just that it doesn’t cover deductibles or skilled nursing co-insurance, but it’s still great as it covers a very important gap – 20% co-insurance for Part B outpatient care that you would have paid. It is really great because Part B covers items such as radiation, chemotherapy, and dialysis and not just doctor regular visits. Without Plan A coverage, thousands of dollars would be spent on a major health condition.

This plan A is still very suitable for those who are uncomfortable with network-based advantage coverage, probably want access to more than one doctor and hospital considering that a standard supplement plan allows the beneficiary to see any doctor that accepts the original Medicare. However, due to the increasing rate of all supplement plans, it may be inconvenient for a younger Medicare beneficiary to keep up with the increasing rate of their Plan A for many years, and their health condition in most cases prevent them from getting access to a lower-priced company because they are unable to pass through health underwriting.

The great news is that when a beneficiary gets to age 65, they will receive another enrollment window which will give them the opportunity to switch to any other supplement plans they wish to obtain. Knowing the eligibility rules of the supplements is almost impossible for the average individual, so it would save much of your time if you consult an independent insurance agent for help in understanding your qualifications and eligibility for the next open enrollment window.

Learn more about Texas Medicare Supplemental Insurance rates, plans, and more at http://www.emedicare-supplemental-insurance.com/medicare-supplement-plans-texas.  Our Texas Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans in Texas.  To talk to an expert in Texas Medicare coverage toll free 888.404.5049 today!

 

Big changes expected in many 2018 Medicare Advantage plans

As if there isn’t enough to worry about when it comes to finding health insurance, add this item to the list: Medicare Advantage.

Changes in plan structures and a dearth of insurers in rural areas may leave consumers with fewer choices and more confusion in the upcoming Medicare open enrollment period, which begins October 15.

Medicare Advantage plans, offered by private insurers, provide traditional Medicare coverage and often offer additional benefits such as dental, vision and Medicare Part D prescription drug coverage. Premiums, deductibles and co-pays vary significantly from plan to plan, so comparing costs and coverage each year — even if you are already enrolled — is critical.

Medicare Advantage is different from Medigap, which is designed to help fill the gaps in traditional Medicare coverage.

In the recent past, some Medicare Advantage plan members have been struggling to find the care they need, especially those who have acute or chronic illnesses. About one-third of people eligible for Medicare enroll in Advantage plans.  A recent Government Accountability Office report found that a large number of Medicare Advantage enrollees, especially those in poor health, drop out of the plans because they have trouble getting access to the care they need. Of the 126 Medicare Advantage plans studied, the GAO found 35 of them had disproportionately high numbers of sick people dropping out.

If you are part of a Medicare Advantage plan or considering Medicare Advantage in the upcoming sign up period, or if you are taking care of a loved one with MA coverage, here’s a preliminary glimpse at what you need to watch out for in the year ahead.

Look for changes in your existing plan. If you’re already enrolled in a Medicare Advantage plan, your insurer will likely send you information soon regarding 2018 plan details. Read this carefully. “Just because a plan works for you this year doesn’t mean it will necessarily work for you next year.” warned David Lipschutz, an attorney at the Center for Medicare Advocacy. Many insurers change their cost-sharing, premiums and prescription drug formularies (the list of drugs covered by the plan) each year, Lipschutz explained. Look closely at any changes your plan is implementing and compare that to other plans available in your area. Existing Medicare enrollees and first-time shoppers can compare Medicare Advantage plans and traditional Medicare on Medicare.gov.

Check your health network. Like all health insurance plans, Medicare Advantage insurers negotiate with hospitals, doctors and other health care providers to find the lowest cost providers each year. Those networks — both health maintenance organizations and preferred provider organizations — are subject to change every year. In recent years, these provider networks have become smaller, with fewer specialists. These changes were among the main reasons Medicare Advantage enrollees dropped out of their plans, according to the GAO report. Always check to make sure the network on your plan or the plans you are considering include the providers you need to stay healthy. And check to see if more of the providers you need are available to you through traditional Medicare.

Rural consumers may be out of luck. Much has been said about rural counties left with only one or no insurance options on the Obamacare exchanges. State insurance commissioners, insurers and others have been working hard to successfully fill those gaps. In the meantime, the real dearth of coverage may exist among Medicare Advantage insurers. According to a recent report from the Kaiser Family Foundation, 147 counties, across 14 states have no Medicare Advantage insurer this year.

If you live in an area with no Medicare Advantage insurer you’ll need to take the time to thoroughly understand traditional Medicare coverage and decide if a Medigap policy is right for you.

Get help while you still can. Your State Health Insurance Assistance Program (SHIP) can help you sort through your Medicare options and compare Medicare Advantage plans. SHIPs are funded through the federal government and provide free health care counseling for Medicare recipients. The Trump Administration’s budget proposal would cut funding for SHIPs entirely, Lipschutz said. He suggested starting your health plan search now while this resource is still available.

Original Source: https://www.cbsnews.com/news/medicare-advantage-plans-2018-finding-health-insurance/

Original Date: Aug 28 2017

Original Author: Walecia Konrad

 

Medicare Is in Deep Trouble: Here’s How to Rescue It

medicare-is-in-trouble

Medicare’s trust fund will run out of money in just over 10 years, according to a new report from the program’s trustees. Once that happens, the federal government won’t collect enough in payroll taxes to cover beneficiaries’ hospital bills.

Congress could hike taxes to cover the shortfall. Or it could ration care to save money.

Or it could modernize and restructure Medicare — by giving beneficiaries means-tested vouchers to buy private insurance. Doing so would protect taxpayers now, preserve the program for future generations and even provide higher-quality care to seniors.

Medicare actually consists of multiple programs that pay for health care for 57 million seniors and people with disabilities.

Beneficiaries don’t pay premiums for Part A, which covers inpatient hospital care. It’s funded primarily by payroll taxes.

For much of the program’s history, the government collected more in payroll taxes than it paid out to hospitals. These surpluses went into a “trust fund,” where they were invested in U.S. government bonds.

But with Part A spending per beneficiary rising 3.5 percent annually — faster than tax revenue is growing — those surpluses have turned into deficits. Since 2010, Part A has spent $105 billion more than it collected in taxes. The trust fund has covered these deficits.

By 2029, the fund will be exhausted. Payroll taxes will only cover about 88 percent of Part A costs.

Costs in Medicare Part B, which pays for doctors’ visits, are also surging. The trustees estimate that Part B spending per beneficiary will increase 5.2 percent annually for the next decade.

Unlike Part A, beneficiaries pay premiums for Part B coverage. But these premiums account for only 23 percent of the program’s costs. The rest comes out of the federal Treasury.

Last year, Medicare cost $349 billion more than it collected in payroll taxes and premiums. This spending squeezes funding for other priorities, like defense and scientific research.

These deficits will explode in the future. Medicare faces $65 trillion in unfunded liabilities.

Despite its astronomical price tag, Medicare actually underpays health care providers. It reimburses hospitals at just 60 percent of private insurers’ reimbursement rates. In 2016, hospitals lost 9 cents for every dollar they spent treating Medicare beneficiaries, according to the Medicare Payments Advisory Commission.

By 2040, half of doctors will lose money treating Medicare patients. Seventy percent of skilled nursing facilities and 80 percent of home health agencies will be in the same position.

That doesn’t bode well for patients. The trustees’ report notes that providers will either have to “withdraw from serving Medicare beneficiaries” or “shift substantial portions of Medicare costs” to other patients — like those with private insurance.

Medicare desperately needs a revamp. Its biggest problem is that seniors have no incentive to control their health care spending, since the government picks up most of the tab.

Vouchers would enable poor and middle-income seniors to pick from a variety of private health plans, with different premiums, deductibles, and co-pays. They’d have an incentive to choose wisely, since they’d be spending their own money on top of whatever they received as a voucher.

And by means-testing the vouchers, the government would no longer waste billions subsidizing health insurance for the rich, who don’t need taxpayer-funded assistance.

This idea has attracted bipartisan support in the past. Indeed, three decades ago, a group of congressmen from both sides of the aisle proposed the concept — but were one vote short of being able to make a recommendation to Congress. The Bipartisan Policy Center and Committee for a Responsible Federal Budget have also voiced support for a voucher system.

Furthermore, it’s already working in another part of Medicare — the Part D prescription drug program. Under Part D, seniors shop for the privately administered drug coverage that meets their needs and budget. Competition among insurers helps keep costs low. The federal government subsidizes the plans to keep them affordable for beneficiaries.

From 2004 to 2013, the program cost $349 billion less than initially projected. Ninety-five percent of seniors report that their Part D coverage meets their needs.

Medicare‘s spending isn’t sustainable. Congress can stave off massive tax hikes and benefit cuts by voucherizing the program — and injecting some much-needed competition into the health care market.

Original Source: https://morningconsult.com/opinions/medicare-deep-trouble-heres-rescue/

Original Date: Aug 23 2017

Original Author: Sally Pipes

The History of Medicare Supplemental Insurance in Arizona

Arizona medicare blog

There are several types of Medicare insurance plans in Arizona, and choosing the right one for you should not be difficult. For you not to make mistakes and to make the very best decision, you need to know the basics of health insurance and the important considerations you should take when selecting an Arizona health insurance provider. Here are some pointers.

First, you should understand what Medicare insurance is. Medicare insurance is a must for everyone and for a very good reason: it blankets you against the high costs of treatment and hospitalization. When you have Medicare insurance, your health insurance provider (also called the insurer) pays the medical costs you may incur when you become sick or injured. Surveys show that about 85% of Americans are covered by health insurance, which is provided by their employers, themselves, or government agencies.

You should also understand the different types of Arizona health insurance. Just like in most other states, health insurance in Arizona generally comes in three categories.

Individual and family coverage is a type of plan that insures a principal and his or her dependents. A father or mother of a household, for example, can act as the principal, and his or her children are considered dependents. A medical insurer will assess the medical history of the principal and all dependents before agreeing to provide insurance.

There are also small business health plans in Arizona, available to small companies with two to fifty employees. Unlike individual and family coverage, small business health insurance is not medically underwritten. Employees of the business need not be subjected to medical exams before insurance is granted, provided that the company complies with certain requirements.

Finally, there is the Medicare supplement available to individuals with Medicare. There are certain times when Medicare offers guaranteed issue opportunities, and you should take advantage of such opportunities if you don’t want to have to go through medical evaluation in order to get coverage.

Preliminary procedures for each plan vary, but as a general rule, you will be asked to fill out a comprehensive medical history form and write down all the ailments you have ever been treated for; identify your family’s history of diseases; declare if you smoke and if you are over- or underweight; and respond to many other health-related questions. Also, remember that different insurance plans vary in terms of coverage and cost. Consult a licensed health insurance agent or do thorough research before signing up for any plan.

At eMedicare Supplemental Insurance we specialize in selling supplemental plans. We understand choosing the right plan can be tedious. That’s why we have a number of different ways to access information. You can read more about supplemental plans and even get a free quote at http://www.emedicare-supplemental-insurance.com/arizona-medicare-supplement-plans or call and talk with a licensed agent at 888-404-5049. We hope to help you soon!

What Makes Medicare Supplemental Insurance in Tennessee So Great

Whenever you retire from active service, you will face many important personal decisions. That is why the State of Tennessee and POMCO are working together to help make one of those decisions (the Medicare supplemental insurance) easier for you. As a retiree, you may be eligible for The Tennessee Plan.Tennessee medigap

This plan is designed specifically for teachers, retired state employees, and local government employees and their eligible dependents and spouses. The Tennessee insurance plan helps fill the Medicare coverage gap when one has obtained Medicare coverage, one needs The Tennessee Plan to help cover most of the expenses that Medicare insurance does not cover.

If one is eligible, they can enroll in the Tennessee Plan coverage, mostly known as Medigap Coverage. Tennessee Plan is a standard Medicare supplemental insurance policy that is designed to fill in the coverage gaps in the Medicare Part A & B coverage.

The Tennessee department of commerce and Insurance has made it easy for you to save money and get discount health insurance. In Tennessee, there are eight basic kinds of health coverage:

  1. Major medical: Covers most health care services

 

  1. Short term major medical: Covers everything included with major medical except pre-existing health conditions; short term major medical usually lasts for six months

 

  1. Hospital and Surgical: Covers inpatient and some outpatient hospital and surgical care; doesn’t include prescription medication coverage

 

  1. Hospital Indemnity: Covers a predetermined amount of the daily cost of a hospital stay

 

  1. Hospital, medical, and surgical indemnity: Offers a mixture of what hospital and surgical indemnity policies cover; doesn’t cover major medical emergencies

 

  1. Cancer, heart attack, and stroke: Covers only those three conditions and shouldn’t be used as your only medical policy

 

  1. Accident: Covers accidental injuries and shouldn’t be used as your only health insurance policy

 

  1. Supplement: Supplement policies act to cover everything that isn’t covered by your major medical or hospital coverage, as well as Medicare

How does having this information benefit you? Well, it’s much easier to obtain Tennessee affordable health insurance premiums if you first know what kind of policy you need. For example, if you’ve just lost your medical benefits due to being laid off from work, you might want to search for cheap health insurance quotes in Tennessee for short term major medical policies. If you can’t yet afford a major medical plan but want protection against the unexpected, you may want to try to save money and get discount health insurance in Tennessee for accident coverage.

In Tennessee, affordable health insurance premiums are just around the corner when you already know what medical coverage you want. Armed with this knowledge, you can begin your search for cheap health insurance quotes in Tennessee with a clear picture of what you want, and what you’re willing to pay.

Learn more about Tennessee Medicare Supplemental Insurance plans, rates and more at http://www.emedicare-supplemental-insurance.com/tennessee-medicare-supplement-plans. Our Tennessee Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans in Tennessee.  To talk to an expert in Tennessee Medicare coverage toll free 888.404.5049 today!

Introduction to Medicare Supplement Insurance in New York

New York Supplemental Insurance

If for one reason or another, you end up without access to group insurance coverage through an employer, all is not lost. You have the option to purchase an individual health policy from a private insurance company. Although individual medical insurance may be expensive, it’s worth investigating the options.

New-York-Medicare

Coverage availability and premiums will vary from state to state. It may depend on whether or not your particular state has enacted laws that prohibit the rate modification based on your medical condition.

For instance, the state of New York, health insurers that offer individual health coverage may not turn down a candidate because of poor health. Nor can they base their premiums on factors such as gender, occupation, age or health status. New York enjoys what is called community rating. Premiums are based on how many individuals in the family and in what part of the state you live.

Choosing a new health plan isn’t easy. There is no one plan that fits everyone. The best health plan for you may not be the best for someone else. In order to find a health insurance plan that fits you and your budget, you can access instant quotes and health plans online.

New York Health Insurance Plans

Are you looking for just the basics or a more comprehensive health plan? A basic plan covers you for hospitalization and surgery in case of major accident or sickness. These plans typically have a lower price tag than those with more comprehensive coverage.

Many basic plans can be customized by adding on extra benefits such as preventative care, doctor visits, prescription drugs, maternity, small accident or injury, and routine office visits.

By comparing several health insurance plans you can get a good idea of what’s available to you. If you don’t require much medical care, an (HDHP) High Deductible Health Plan may be a good choice for you. These plans allow you to choose a deductible from $500 to over $5000. A higher deductible will get you a lower monthly premium for medical coverage.

New York Free Instant Health Insurance Quotes

Learn more about New York Medicare Supplemental Insurance plans, rates and more at http://emedicare-supplemental-insurance.com/New-York-medicare-supplement-plans. Our New York Medicare Supplemental Insurance brokers will help you compare Medicare Supplemental Insurance rates and plans in New York.  To talk to an expert in New York Medicare coverage toll free 1-877-202-9248 today!

Medicare Supplement Insurance – What, Why and Who?

Medicare Supplemental question

The main idea behind Medicare supplement insurance was to offer extra coverage above and beyond regular Medical care parts A & B for qualified people aged 65 and above or folks on disability under the age of 65.

Medicare Parts A & B are really good coverage on their own.

Part A helps pay for medical services while confined in a hospital setting and covers 80% of those services after a deductible is met ($1132 in 2011). The deductible is a “per benefit period” deductible which in most cases means you’ll have to meet the deductible each time you have a hospital stay.

Medicare Part B helps pay for your outpatient medical services. This would include things like primary care and specialist physicians and lab work, x-rays, outpatient surgeries, emergency room visits, and most other medical services in which you don’t have to spend the night in a facility. This works like Part A in that you have a deductible ($162 in 2011) and then Medicare pays 80% of most services. The part B deductible, however, is an annual deductible and only needs to be met once per calendar year. Medicare also has something called excess charges which allow a doctor to charge up to 15% over Medicare’s rates.

What is Medicare Supplement Insurance? This insurance is private coverage that picks up those gaps in coverage left by Medicare and is therefore often called “Medigap” or “Gap insurance”. So, these plans can cover all, or some, of the deductible, coinsurance, and excess charge gaps in regular Medicare.

Why should I buy Medicare supplement insurance? Although it’s not necessary to buy this type of insurance, it can be a very valuable policy in helping protect your assets and also lends a significant amount of “peace of mind” that you won’t be hit with major medical bills. It has been noted that about half of all bankruptcy is related to a person’s inability to pay for medical services received. Medicare supplement insurance can help you avoid that situation.

Who should I buy Medicare supplement insurance from? The great thing about Medicare Supplement Insurance is that they are standardized. So, once you identify which plan is best for you, you can shop the market to see who can offer the best rates.

You can pretty much feel comfortable going with whoever is offering the best rate for the plan you feel most comfortable with. You might use the services of a Medicare supplement insurance agency to identify the rates from several companies and maybe get some experienced details on which companies might be better for the long term.

Shopping for Medicare supplemental insurance can be tough, that’s why we have made a ton of information available to you. Our main website http://www.emedicare-supplemental-insurance.com is a good place to start with not too much information that won’t overwhelm you. After that you can move on to our blog that has a ton of information like general Medicare information to state specific supplemental information. If you are still wondering or just would like to talk to some one you can call us directly at 888-404-5049.

Medicare Scare Tactics

TV ads from a Democratic group warn seniors that “right now, your Medicare coverage is in danger,” claiming “deep, automatic cuts” could be made by “unelected Washington bureaucrats.” But those cuts, according to current estimates, wouldn’t be implemented until 2023, and they would amount to .002 percentage points of Medicare growth that year.

tactics-chess-medicare

It’s true that more automatic cuts to the growth of spending are expected in future years. But like many political messages about Medicare, these ads feature scare tactics — warning of cuts that could “restrict access to doctors” and “deny care” — when we don’t yet know what any cost-cutting would entail.

The ads, from Majority Forward, a 501(c)(4) formed to support Democratic candidates and affiliated with the Senate Majority PAC, are airing in Montana and North Dakota, in support of Democratic Sens. Jon Tester and Heidi Heitkamp. Another ad on this topic — featuring circling sharks to represent the “bureaucrats” who “want to take a bite out of your Medicare” — is airing in Indiana, in support of Democratic Sen. Joe Donnelly. All three ads say these senators are working to stop these cuts, and they have co-sponsored legislation that would do so.

What the ads don’t say is that these reductions to Medicare growth are now several years away.

The TV ads are referring to the Independent Payment Advisory Board, or IPAB, which was created by the Affordable Care Act as a way to slow the growth in Medicare spending. The ACA, signed into law in March 2010, called for a 15-member panel that would be tasked with cutting the growth of Medicare if spending on the program exceeded certain targets.

The IPAB has been the target of criticism. Two months ago, we saw a $2 million ad buy from a group called Healthcare Leadership Council, a coalition of insurers, health clinics, pharmaceutical companies and others, urging a repeal of the board.

The idea was controversial from the start — former Republican vice presidential nominee Sarah Palin called the board a “death panel” in 2010, while Republicans, including House Speaker Paul Ryan, repeatedly said it was made up of “unelected, unaccountable bureaucrats,” language that’s echoed in the ads supporting Democratic senators.

Fiscal groups such as The Concord Coalition and the Committee for a Responsible Federal Budget have supported IPAB, saying that it’s necessary to find ways to control growing health care costs and that the board can operate without the political pressure rampant in Congress. “Ultimately, in a country struggling mightily with unaffordable health care costs now, and destined to struggle even more in the future, IPAB is one of the institutions that gives some hope that if we figure out how to control costs, we just might be able to put that knowledge to use,” Joshua Gordon, policy director at The Concord Coalition, wrote in a guest column for CNN Money in 2011.

But so far, there is no board: It doesn’t have any members and hasn’t done anything. The supposed “bureaucrats” who “want to take a bite out of your Medicare,” as the Majority Forward ad in Indiana says, don’t even exist yet.

If the board is created in the future, the law stipulates that the president must consult with congressional leadership and appoint members with the “advice and consent of the Senate,” a March 2017 Congressional Research Service report on the IPAB says. The IPAB members must “possess recognized expertise in health finance and economics, actuarial science, health facility management, health plans and integrated delivery systems, and reimbursement of health facilities,” the CRS report explains, and include representatives of consumers and the elderly.

The board hasn’t been needed because Medicare spending growth has remained below targets set by the ACA that would trigger IPAB action. And the latest report by the Medicare trustees says the IPAB isn’t expected to be triggered until 2021, with any required cuts implemented two years later.

Here’s how the trigger works: The actuary for the Centers for Medicare & Medicaid Services estimates per capita Medicare growth, and each year those estimates are published in a report from the Medicare trustees. The IPAB determination looks at a five-year projected average — the per capita growth for two years prior, the current year and two years later. Cuts would be required under the law if that rolling average exceeded the target. That target has been tied to inflation and medical care inflation, but next year, the target changes to the growth of per capita gross domestic product plus 1 percentage point.

Once triggered, the IPAB must issue recommendations the following year on how to cut spending to keep growth below the savings target established by the actuary. And if there’s no board, the secretary of health and human services instead would make the recommendations for cuts.

The cuts would then be implemented the year after that, though Congress can choose to implement its own changes to keep spending below the target. Congress can’t change the fiscal targets in other legislation, either, unless a three-fifths majority in the Senate waives that requirement.

Last year, the Medicare trustees report estimated that the IPAB would be triggered in 2017 for the first time, requiring a 0.2 percentage point cut in Medicare spending growth, “a relatively small difference,” CMS Chief Actuary Paul Spitalnic said at a Brookings Institution event last June in explaining that the projection could change. And it did with the 2017 report, released July 13. The IPAB wasn’t triggered, and now isn’t expected to be until 2021, with savings implemented two years later.

The estimated difference between Medicare growth and the IPAB target is even smaller — 0.002 percentage points.

Medicare trustees report, July 13, 2017: As a result of the other savings provisions incorporated into current law, the Trustees estimate that the IPAB provision will reduce Medicare growth rates for the first time in 2023, and by only 0.002 percent in that year. In addition, the Trustees project that rates will be reduced by similar small amounts in 2026, 2027, 2028, 2030, 2033, and 2035

It’s certainly possible that that gap could widen, or go away, or that the IPAB could be triggered sooner.

What Could the IPAB Cut?

How “deep” could these cuts be? And could they “restrict access to doctors … deny care and cost you and your family more,” as the TV ads say? We can’t predict what action the IPAB provision could spark in the future, but the board is limited in what it can do. It can’t increase beneficiaries’ premiums or cost-sharing, or restrict benefits, but it could reduce payments to health care providers.

Medicare spending totaled $678.7 billion in 2016 — about 15 percent of the total federal budget — and the health care program covered 56.8 million people, 84 percent of them age 65 and older and 16 percent people with disabilities. The current projections for IPAB cuts would involve well under 1 percent of Medicare spending. Of course, the cuts could be larger in the future, and accumulate over time. But the IPAB is limiting to cutting no more than 1.5 percent of total Medicare payments in a given year, even if the gap between spending growth and the target is larger, a 2011 analysis by the Kaiser Family Foundation explains.

The Affordable Care Act stipulates that the board “shall not include any recommendation to ration health care, raise revenues or Medicare beneficiary premiums” or “increase Medicare beneficiary costsharing (including deductibles, coinsurance, and copayments), or otherwise restrict benefits or modify eligibility criteria” (page 490).

The Kaiser Family Foundation analysis says that any recommended reductions would then come from “Medicare Advantage, the Part D prescription drug program, skilled nursing facility, home health, dialysis, ambulance and ambulatory surgical center services, and durable medical equipment.” Payments to health care providers, including hospitals could also be cut, starting in 2020.

Juliette Cubanski, associate director of KFF’s Program on Medicare Policy, told us in a phone interview that beyond “basic guidelines,” the ACA “left a lot of latitude” for the board.

She said it was “a bit of a stretch” to draw conclusions about how any cuts could affect access to doctors and medical care without knowing more specifically what the board or HHS secretary might have in mind. Even small spending reductions can lead to big battles, however, when it comes to Medicare.

“Depending on where those cuts are made, it could affect some providers more than others, if indeed they go for provider cuts to achieve the savings,” said Cubanski, who holds a Ph.D. in health policy from Harvard.

Majority Forward’s support for the ad points to a February letter to Congress from the Healthcare Leadership Council, signed by many health care organizations across the country, warning that cuts to provider payments “would be devastating for patients, affecting access to care and innovative therapies,” as some physicians wouldn’t accept new patients under lower rates.

The 2011 KFF analysis, which Cubanski co-authored, said there was “ambiguity” in the law that could lead to IPAB proposals that could affect Medicare beneficiaries.

Kaiser Family Foundation, “The Independent Payment Advisory Board: A New Approach to Controlling Medicare Spending”: Despite efforts to limit the reach of IPAB with respect to beneficiaries, there is some ambiguity in the ACA that could leave room for proposals that could directly or indirectly affect beneficiaries. The statute explicitly takes benefits, premiums, cost sharing, and “rationing” out of the scope of IPAB’s general authority, which appears to remove beneficiary issues from consideration. Yet, it is not entirely clear which proposals would be outside the scope of IPAB’s authority. …

If IPAB recommends policies that squeeze Medicare payment rates without equal pressure being placed on private payment rates, there is some concern that Medicare beneficiaries would be at greater risk of having access problems, as providers become more inclined to serve other patients. While the ACA requires that proposals achieve the savings target “…while maintaining or enhancing beneficiary access to quality care…” there is no further clarification of how this is to be determined.

The law allowed for a joint resolution to abolish the IPAB this year — and such resolutions were introduced in the House and Senate. But they needed to be approved by three-fifths of each House by Aug. 15. There are other pieces of legislation, two in the Senate and one in the House, that would repeal IPAB provisions from the Affordable Care Act. All of these measures were introduced in February and referred to committee.

Tester and Heitkamp are co-sponsors of the Democratic Senate bill and, along with Donnelly, co-sponsors on the joint resolution.

These TV ads warn that “right now, your Medicare coverage is in danger.” Actually, “right now,” we don’t know what will happen if IPAB is triggered and we could be several years away from finding out.

Interestingly, to support that line about Medicare being in “danger,” Majority Forward pointed to the Medicare trustees’ estimate that the trust fund for Part A, which pays hospital expenses, would be depleted in 2029. If Congress doesn’t act to shore up financing, the tax revenue for Part A would cover only 88 percent of costs, the trustees said. But the “automatic cuts” the ad warns about would improve Medicare’s finances.

Original Source: http://www.factcheck.org/2017/08/medicare-scare-tactics/

Original Date: August 11 2017

Original Author: Lori Robertson