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.

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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

Why would I need Medicare in Michigan?

In a very smart move, private health insurance companies introduced various Medicare insurance programs for seniors and physically disabled people. These 10 different programs are beneficial for people as they provide them with the financial help related to health problems. If you are 65 years and/or physically disabled then there is no need to worry as the Medicare Insurance plans are designed in a manner to take care of all your medical needs. You can use these plans to feel comfortable by covering your health related problems.

Michigan-Medicare

 

Benefits of Medicare in Michigan

Medicare Supplemental plans are plans that are designed to fill in the “gaps” in “Original” Medicare. “Original” Medicare includes Medicare Part A (Hospital inpatient) and Part B (Outpatient/doctor). These plans are consistent across companies – all companies are required to provide the same standardized benefits. This makes it very easy to understand the plans and how they work. Here are the top three things that you must know when looking at Medicare Supplemental Insurance.

Nicknamed Medigap are Federally-Standardized

The plans all provide equal coverage for “like” plans. What this means is that a plan F with one company is the exact same as a Plan F with another company. Because of this, it is important to compare the plans on the basis of monthly premium and company rating or reputation. Price being equal, it is preferable to be with a company that has a long track record of involvement in the senior insurance marketplace.

Medigap plans can be used at any doctor or hospital, nationwide, regardless of which company sells you the plan.

Many types of insurance are networked-based; this does not apply to Medicare Supplemental plans. Even some types of Medicare plans – Medicare Advantage plans – are network-based in most cases. On the contrary, Medigap plans give you the flexibility of using the plan anywhere in the country. This flexibility, particularly for someone that travels, is one of the many reasons that these plans have become increasingly popular as a way to supplement Medicare coverage.

Medigap plans all pay claims through Medicare “Crossover” system

There is no variation in how quickly or how efficiently one company pays claims versus another. While some companies may use the selling point of their timeliness in paying claims, this is not altogether accurate when it comes to this type of insurance. Because the plans are Federally-Standardized and pay claims this “crossover” system, you can be assured that, regardless of the company, the claims are going to be paid in a timely manner and with minimal (usually no) involvement from the insured. Once you have a plan, you just need to present your plan identification card with your red, white, and blue Medicare card when receiving services from a doctor or hospital.

Altogether, Medicare Supplemental plans continue to be a viable option for those on Medicare, who wish to limit their exposure to out of pocket expenses. With only Medicare, you are subjected to paying approximately 20% of all medical costs. With a Medigap plan, you can greatly reduce or, with some plans, completely eliminate you’re out of pocket costs.

Learn more about this topic at www.emedicare-supplemental-insurance.com/michigan-medicare-supplement-plans or you can call us at 877-202-9248. Our Michigan Supplemental Insurance brokers will help you compare plans vs pricing. Another free tool you can use is our quote tool.

 

What should I Expect with Medicare in Texas?

Texas-Medicare

Medicare in Texas is a national, tax supported health insurance program for people who are 65 or older, people below 65 with certain disabilities and any individual with end-stage renal disease (ESRD). If you or your spouse have worked full time for 10 or more years, you are also probably eligible to receive Medicare Part A for free in Texas. Medicare Part B is available at a monthly rate set annually by congress which was around $121.80 in 2016 for incomes $85000 or less for an individual. While some seniors are eligible to receive the medical insurance portion part B for free depending on their income and asset levels.

All eligible Texas residents should expect the following benefits in part A Medicare in Texas.

  • All inpatient hospital stays
  • Care in a skilled nursing facility
  • Hospice care and some home health care services

Original Medicare in Texas does have deductibles, co-pays and cost sharing requirements that can play havoc with budgets. Therefore in order to help pay these additional out of pocket expenses, many Texans purchase Medicare Supplemental Insurance plans.

Texas Medicare Supplemental plans are standardized by the federal government. They are labeled A, B, C, D, F, G, K, L, M and N. Each policy must offer the same basic benefits no matter which insurance company is selling it. The only difference between polices is usually the cost.

Plan A pays the Medicare hospital and physician coinsurance, the first three pints of blood, and 365 days of hospitalization beyond Medicare.

Plans B through N provide these benefits and add more benefits such as coverage for Medicare deductibles, excess charge, limited preventive care, and foreign travel. In Texas you can only have one supplemental plan. No one should try to sell you multiple plans unless you are looking at add on plans like the prescription drug plan (Plan D) or if you decide to switch plans.

Texas residents should expect the following benefits from their Medicare Supplemental Insurance plan:

  • Medical cost – Part B coinsurance (generally 20% of Medicare-approved costs) or copayments for hospital outpatient services
  • Hospitalization – per day coinsurance plus coverage for 365 additional days after medicare benefits end
  • Blood – First three pints of blood each year
  • Hospice – Part A coinsurance

Medicare Advantage Plans (Part C)

When you decided to go with a Medicare Advantage Plan, You actually trade your traditional Medicare benefits for these plans. Many of the advantage plans are offered to eligible individuals at little or no cost other than continued payment of their part B monthly premiums.

Medicare Prescription Drug Plans (Part D)

Prescription drug plans are available to all Medicare eligible people in Texas regardless of medical history or income levels. When a person first qualifies for Medicare, their initial enrollment period begins when you turn 65. Part D is designed to reduce drug cost and protect against catastrophic drug costs. This is a separate plan that would be needed to be added on to your supplemental insurance.

Other services not covered by Original Medicare

  • Routine eye exams, eye glasses or contacts
  • Help with bathing, dressing, eating and other custodial care
  • Dental exams, most dental care and dentures
  • Hearing aids or related exams or services
  • Most care while traveling outside the United States
  • Comfort items like hospital phone, TV, or private rooms
  • Long-term care
  • Acupuncture or other alternative treatments
  • Routine foot care

Learn more about Texas supplemental insurance plans, rates and more at www.emedicare-supplemental-insurance.com/medicare-supplement-plans-texas. Our Texas insurance brokers are US based, Medicare experts! They are happy to help with pricing and opinions on what plan to get. Call today at 877-202-9248.

 

 

Getting To Know Medicare In Arizona

Medicare is a federal health insurance program for individuals aged 65 and above. It’s also extended to some young people with disabilities and people with End-stage renal diseases.

Medicare is basically divided into four parts – A, B, C, and D.

Medicare Part A includes treatment and surgical procedures performed at the hospital. It also includes hospice care and home health.

Medicare Part B covers part of the cost of medical expenses, outpatient care, medical equipment as well as laboratories and diagnostic tests.

Medicare Part C is a Medicare health plan usually provided by private insurance companies that contracts with Medicare to give all parts of Medicare A and B. Prescription drug coverage is included in almost all Medicare Advantage Plans.

Medicare Part D adds prescription drug coverage to some Medicare cost plans, and Medicare medical savings account plan. These plans are offered by insurance companies and some private companies licensed by Medicare.

While Medicare covers a range of costs, there are limitations to it. So, you may need additional coverage to meet your present and future health needs.

Many Arizona seniors approaching their 65th birthday normally look for the best Medicare plan in Arizona. In the crowded Arizona Medicare market, seniors have many opportunities. The choice will be different for each person, depending on their health goals.

In Arizona, when you are looking for affordable health insurance, you need to choose a group health insurance plan that provides the perfect combination of health coverage that you need, or you can choose a combination of options for the health coverage you need. In Arizona, there are nine types of group health insurance: major medical expenses, accident-only cover, specific accident, disability income protection, long-term care, and Medicare supplements and lastly health maintenance organizations.

Eligibility

Medicare registration occurs only once in a year. It’s generally between October and December.

You must be a citizen and be 65 years or above.

Most people are aware that before you apply for Medicare, you must be at least 65 years. However, most people do not know that they too should be entitled to social security.

On the other hand, you can get Medicare without receiving payment from social security. This is possible when you delay your receipt of government retirement payout. And to ensure you will receive health benefits, you’ll enroll in Medicare.

When signing up for social security at the age of 65, or choosing to receive payment at 65, you’re automatically enrolled in Part A and Part B of Medicare.

If an individual is disabled and below the age of 65 and has received social security for two years, that individual is eligible for Medicare. Likewise, a person of any age in the final stage of kidney disease can also get Medicare.

When it comes to choosing a Medicare plan, you are to select a plan that will help you achieve your health goals. It is also very important to read all the details about each plan. Compare the benefits, costs, and limitations of each plan available to you. You can also consult a specialist or a physician. This is one of the important things to remember before applying for Medicare.

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

How Does Medicare Supplemental Insurance Affect me?

Mеdісаrе Suррlеmеnt Plans аrе utіlіzеd tо support hеаlth саrе соѕtѕ whісh are nоt соvеrеd bу the original Medicare plan. Thе соvеrаgе costs can vеrу a bіt frоm company tо соmраnу and wіth dіffеrеnt рlаnѕ ѕіnсе thе dіffеrеnt оrgаnіzаtіоnѕ charge many different рrеmіumѕ. Thіѕ іnѕurаnсе аlѕо hеlрѕ wіth со-рауmеntѕ аnd dеduсtіblеѕ. Seniors who аrе enrolled іn a Mеdісаrе Benefit Plan do not ԛuаlіfу fоr a Mеdісаrе Supplement Plаn. All Mеdісаrе ѕuррlеmеnt policies ѕhоuld bе сlеаrlу іdеntіfіеd as such. Thеѕе policies are rеԛuіrеd tо hаvе соmраrаblе if not іdеntісаl bеnеfіtѕ.

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Advаntаgеѕ lіkе long-term care, eyeglasses, dеntаl саrе, еtс. Arе nоt covered bу these роlісіеѕ. The іnѕurаnсе providers may well determine whісh tуреѕ of policies thеу sell but ѕtаtе lаwѕ affect the policies whісh are оffеrеd. Oссаѕіоnаllу, insurance рrоvіdеrѕ ought tо ѕеll уоu a роlісу rеgаrdlеѕѕ of аnу hеаlth dіffісultіеѕ уоu’vе gоt раrtісulаrlу іf уоu are mаkіng аррlісаtіоn throughout ореn еnrоllmеnt. At tіmеѕ other thаn ореn enrollment, thе insurance оrgаnіzаtіоn саn refuse tо problem уоu a роlісу whеn уоu have рrееxіѕtіng соndіtіоnѕ. Simply bесаuѕе a lоt of people tоdау hаvе mеdісаl іѕѕuеѕ, the very best tіmе to buу a policy іѕ during ореn еnrоllmеnt..

“Medicare Supplemental plans are utilized to support health care costs which are not covered by the original Medicare Plan”

So thаt уоu саn kеер аwау frоm the ѕіtuаtіоn уоu соnѕеԛuеntlу nееd to have tо take ѕеvеrаl асtіоnѕ. It іѕ сrіtісаl fоr уоu tо mаkе ѕurе that аnу рrоvіdеr that you deal wіth is a fully licensed brоkеr who іѕ rеаllу ѕеllіng іnѕurаnсе. You’ll find a соuрlе оf tесhnіԛuеѕ іn whісh уоu саn tell whether or not this is thе саѕе. Fіrѕt of all thеу’ll vіrtuаllу соnѕtаntlу hаvе a toll frее numbеr thаt іt іѕ роѕѕіblе tо саll.

Tо bе able tо uncover thе most еffесtіvе Mеdісаrе Supplement Plаnѕ, соnѕеԛuеntlу, уоu’ll want tо tаkе bеnеfіt оf аn аgеnt аѕ thеу will bе іn the mоѕt beneficial feasible position tо lосаtе the most effective feasible роlісіеѕ thаt wіll bе ѕuіtаblе for you. Typically thіѕ is a muсh fаr better ѕеlесtіоn thаn gоіng ѕtrаіght tо a huge fіrm and via аn іndереndеnt brоkеr уоu may be аblе to fіnd thе very best alternatives оbtаіnаblе.

Whіlе соvеrаgе аnd соѕt оught tо bе significantly thе same from рrоvіdеr to рrоvіdеr, сеrtаіn thіngѕ саn change. Most noticeably іѕ thе flexibility of a plan tо аdарt tо lіfе’ѕ ups and dоwnѕ and, take оn еxtrа еxреnѕе. Idеаllу, a plan ought tо ѕuррlу as muсh flеxіbіlіtу аѕ роѕѕіblе, thоugh іt’ѕ wоrth mеntіоnіng that thе рrеmіumѕ wіll lіkеlу bе higher fоr thіѕ рrіvіlеgе.

Onсе a Mеdіgар рlаn hаѕ bееn dесіdеd uроn, іt’ll bе рrеttу еffоrtlеѕѕ to ѕіgn up; it is thе рrосеѕѕ to acquiring thеrе whісh tаkе thе tіmе. But іt’ѕ tіmе well ѕреnt, аѕ the plan wіll most lіkеlу be needed bу mеаnѕ оf the years, аnd there аrе ѕоmе аwful ѕtоrіеѕ frоm іndіvіduаlѕ whо hаvе nоt had adequate соvеr. Once ѕіgnеd, coverage wіll соmmеnсе ѕtrаіght away, аnd you’ll bе аblе to move on dоіng whаt уоu tаkе рlеаѕurе іn, undеrѕtаndіng you’ve gоt thе valuable ѕаfеtу nеt аt your bасk.

How To Chооѕе Thе Rіght Plаn

Whenever Medicare was initially еѕtаblіѕhеd, іt hаd not bееn mаdе tо bе реrmаnеntlу соvеr all еxреnѕеѕ. Therefore, Mеdісаrе Suррlеmеntаl Insurance was сrеаtеd tо mаkе uр thе difference. Yоu can fіnd currently 12 plans of соvеrаgе. These plans аrе mаnаgеd bу thе gоvеrnmеnt, which allows thеm tо rеmаіn the ѕаmе price no mаttеr whісh іnѕurаnсе agency уоu асԛuіrе thеm from. The оnlу rеаl dіffеrеnсе bеtwееn one рlаn of оnе соmраnу to аnоthеr, іѕ the рrісе.

Fіgurіng оut that you need this coverage is the fіrѕt ѕtер іn the rіght direction. Onсе уоu dеtеrmіnе that уоur Mеdісаrе insurance doesn’t address all уоur medical rеlаtеd еxреnѕеѕ, уоu wіll bе muсh bеttеr аblе tо determine thіngѕ уоu do nееd ѕіnсе you wіll knоw things іѕ mіѕѕіng оut on. It rеаllу is hеlрful tо соnfеr with уоur асtіvе іnѕurаnсе tо see рrесіѕеlу what you DO hаvе thе instant іt соmеѕ tо fіndіng thе rіght Mеdісаrе Supplemental Inѕurаnсе coverage. Luсkіlу for uѕ, this іѕ much lеѕѕ соmрlісаtеd thаn ѕhорріng fоr traditional іnѕurаnсе bесаuѕе уоu wіll find only a dozen traditional рlаnѕ tо сhооѕе frоm. Nо matter whісh рrіvаtе іnѕurаnсе оrgаnіzаtіоn уоu wоrk with, ѕіmрlу bесаuѕе each wіll оffеr the ѕаmе plans. Rеаllу thе оnlу distinction will be thе service thаt уоu gеt аnd thе premium thаt уоu wіll bе сhаrgеd for.

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

Medicare Advantage Spends Less on Care, So Why Is It Costing So Much?

The Medicare Advantage program was supposed to save taxpayers money by allowing insurers to offer older Americans private alternatives to Medicare. The plans now cover 19 million people, a third of all those who qualify for Medicare. Enrollee satisfaction is generally high, and studies show that plans offer higher quality than traditional Medicare. But the government pays insurers more than they pay out for patient care — in some years, it turns out, a great deal more.

blood-pressure

Concern about Medicare Advantage’s cost has found sharp expression in a recent suit brought by the Justice Department charging UnitedHealth with excessive billing of the government. While that suit plays out, research published by the National Bureau of Economic Research provides context.

The study, released in January, found that the revenue Medicare Advantage plans received in 2010 exceeded the amount they paid out for medical care by a hefty 30 percent. At more than $2,000 per enrollee per year, that probably topped $20 billion dollars, nearly all from federal payments, not enrollee premiums. The study relied on Medicare Advantage billing data obtained from three large insurers across 36 states, a type of data the government doesn’t yet release.

Paradoxically, even though Medicare Advantage plans cost taxpayers more than traditional Medicare, they spend less on care. In fact, one of the motivations of the program is to capture that lower spending as savings for taxpayers. It hasn’t worked out that way.

“Our study found that health care spending for enrollees in Medicare Advantage plans is 10 to 25 percent lower than for comparable enrollees in traditional Medicare,” said Amy Finkelstein, an M.I.T. economist and one of the study’s authors. “Yet government payments to plans is far above their lower health care costs.” The study was also conducted by four economists at Stanford: Vilsa Curto, Liran Einav, Jonathan Levin and Jay Bhattacharya.

The analysis raises two questions: How do Medicare Advantage plans spend so much less on care? And, given that, how do we account for their higher costs to taxpayers?

One reason for the lower spending is that Medicare Advantage enrollees use less care or use lower-cost care. For example, compared with traditional Medicare patients, Medicare Advantage patients are more likely to go home after a hospital visit, rather than to a skilled nursing facility. Medicare Advantage patients see specialists relatively less often and receive fewer inpatient operations, but more outpatient ones, which are cheaper. All of these are what you’d expect from care management techniques used by Medicare Advantage: referral requirements and narrow networks of doctors, for instance.

Previous studies have also shown that Medicare Advantage enrollees use less of some kinds of care, including hospital care, versus traditional Medicare beneficiaries.

“This is exactly what Medicare Advantage plans were designed to do,” said Dr. Bruce Landon, a physician with Harvard Medical School. “They manage the utilization of services while also assuring that enrollees receive recommended care, all at lower cost to patients.” Dr. Landon’s research on the program found that Medicare Advantage enrollees use 20 percent to 30 percent less emergency department and outpatient surgical care, as well as receive fewer hip and knee replacements.

Medicare Advantage plans also attract enrollees who tend to be healthier than traditional Medicare beneficiaries, a feature that yielded intriguing results in light of the lawsuit against UnitedHealth. When the M.I.T.-Stanford team compared the two kinds of Medicare patients, they found that Medicare Advantage patients were 25 percent less costly than traditional Medicare patients. But when the team more rigorously matched the health of both sets of patients, the Medicare Advantage patients were just 10 percent less costly. This drop does not prove the suit’s claims of overbilling, but it allows for the possibility.

Why does the government pay Medicare Advantage plans so much more than it costs them to cover care? It’s partly an intentional, if controversial, design of the program. Congress has established payment formulas and authorized bonus programs intended to help the private market.

The government also pays insurers for administrative and marketing expenses. Yet even when these additional expenses are factored in, the government still pays plans an excess. According to the Medicare Payment Advisory Commission, federal payments to the plans exceeded health care costs and other expenses by 8.5 percent in 2010. Though the Affordable Care Act has reduced payments to plans and limits the amount they can attribute to administration and marketing, they still receive government payments in excess of their costs today.

Not all of the “excess” federal money goes to the insurers’ bottom line. Traditional Medicare entails significant cost sharing for beneficiaries; they are responsible for 20 percent of the costs of doctors visits, for example. Most Medicare Advantage plans don’t require as much cost sharing or out-of-pocket payments. And some of the influence of Medicare Advantage plans’ managed care techniques rub off on the traditional program, too, reducing spending — a spillover effect that partly explains the slowdown in growth of Medicare spending.

But is the cost of Medicare Advantage worth the benefits it delivers? It’s hard to know without knowing more about patients’ diagnoses, services used and other data. The Medicare program had been collecting such data since 2012 and was planning to release it, but, expressing concerns about its quality, recently put off doing so.

Original Source: https://www.nytimes.com/2017/08/07/upshot/medicare-advantage-spends-less-on-care-so-why-is-it-costing-so-much.html

Original Author:

Original Date: Aug 7 2017

Learning More about Medicare in Tennessee

Tennessee Medicare Supplemental Insurance

Medicare is the federal health insurance program that provides health care coverage for Tennessee residents age 65 and older. Younger persons with certain qualifying disabilities or illnesses are eligible for this program. Anybody whose spouse is eligible for or already receive social security benefits or railroad retirement board benefits may not have to enroll again. If you are one of the Tennessee residents thinking that Medicare alone does not cover your health care cost, then you may choose to purchase additional plans, known as Medicare supplemental insurance plans. If you are located in Tennessee and looking for useful information to help you choose the right plan for you, this article can help.

Melton Lake Park Tennessee - Tennessee Medicare Supplemental Insurance

Types of Medicare coverage in Tennessee

Medicare is divided into four parts:

Part A – Hospital Insurance –More Information

Part B – Medical Insurance – More Information

Part C – Medicare Advantage – More Information

Part D – Prescription Drug coverage – More Information

Original Medicare gives eligible people coverage for inpatient hospital care under its hospital insurance program (Part A). Under its medical insurance program (Part B) gives coverage for doctor services, preventive services and some durable medical equipment.

Medicare Advantage

This plan is known as plan C. It provides original Medicare benefits through private Medicare-approved insurance companies, while cost and plan details will differ among insurance companies. All Medicare advantage plans are required to offer at least the same amount of coverage as original Medicare Part A and Part B with only the exception of hospice care. Additional benefits may be included in most part C plans like, Prescription drug coverage and routine dental care, vision hearing, and wellness programs. Any one that enrolled in a Medicare Part C plan will still continue paying a monthly premium for part B.

Prescription Drug Coverage

Medicare Part D Prescription drug plans are available only through private Medicare approved insurance providers. This part D plan offers stand alone prescription coverage and can be added to your Medicare Part A & Part B insurance. Therefore, any Tennessee residents that enroll in a Medicare advantage prescription drug plan will get all Medicare coverage in a single plan, with continuous monthly payment of part B premium.

Applying for Medicare in Tennessee works the same as it does in any other state. To be eligible, you must be a United States citizen or legal permanent resident of at least five continuous years. Any resident that is 65 or older is eligible, persons under 65 with certain disabilities and those with end-stage renal disease (ESRD) are also qualified.

If you are looking for more information on the topic please call one of our US based agents at 877-202-9248.

Introduction to Medicare Supplement Insurance Plans

Supplemental Insurance

While Medicare pays for many healthcare services, there are still many that are not covered. Traditional, or Original Medicare, does not provide full coverage for medical expenses.  Some expenses such as deductibles, copayments, and co-insurance amounts are not covered under Original Medicare, Medicare Part A and Part B.  In order to offset these expenses Medicare Supplemental Insurance Plans were designed.

What is Medicare Supplemental Insurance and How Does It Work?

Supplemental Insurance is an additional health care plan that is provided by private insurance companies to cover the gaps left in Medicare Part A and Part B.  Federal and State laws regulate Medicare Supplemental Plans to protect you as the beneficiary.  Plans are clearly labeled as Medicare Supplemental Insurance and the policies are standardized.  Supplemental Insurance Plans are all the same and do not vary from state to state.  The only aspect that that changes is the cost and where it is purchased.

Medicare Supplemental Insurance Eligibility Requirements

Supplemental coverage works only in conjunction with Medicare Part A and Part B.  The acceptance of your application is guaranteed if you are 65 or older and apply within six months of the initial enrollment in Medicare Part B.  Under certain circumstances, pre-existing conditions are waived; specific details can be found by working with a Medicare Supplemental Insurance Broker.  A  Medicare policy covers only one person.  Your spouse must have a policy of their own.

Medicare Supplemental Insurance Plans

Participants may select from up to ten standardized policies, Medicare Supplemental Insurance Plans A through Plan N.  Each plan offers a different set of primary benefits with a unique set of benefits. These policies are the same no matter what private insurance company you choose to purchase the insurance from.  Each insurance company can decide which policies they want to sell and set their own prices so research carefully to avoid overpaying.

Medicare Supplemental Plans A through J

Plans A through J have more benefits, higher premiums, and lower out of pocket expenses.  Basic benefits include coverage of Medicare Part A and Part B copayments, co-insurance, and three pints of blood.  Extra benefits may include Skilled Nursing Facility co-insurance, foreign travel emergency services, at-home recovery and preventative care.

Medicare Supplemental Plans K through M

Plans K through M have lower premiums and higher out of pocket expenses.  Basic benefits include Medicare Part A hospital benefits, Medicare Part A and B coinsurance or co-pay, three pints of blood and hospice care.  Extra benefits include skilled nursing facilities coinsurance and Medicare Part A deductibles.

Medicare Supplemental Plan N provides co-insurance payments on hospital expenses for Medicare Part A, as well as a full year of payments once your Medicare benefits have been depleted.  Supplemental Plan N policies pay 100% of Medicare Part B co-insurance.  Doctor visits cost up to twenty dollars and emergency room visits up to fifty dollars.

When selecting a Medicare Supplemental Insurance Plan, carefully compare each plan and compare quotes from insurers. Make sure you choose the coverage that best meets your needs and be sure not to pay more for the benefits than you need to.

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

Read This Before You Take Medicare Benefits

Medicare Supplemental Insurance Chart

Most Americans are eligible for Medicare benefits beginning in the month of their 65th birthday. Although it is the most widely used health insurance plan in the United States, many pre-retirees don’t understand it well. With that in mind, if you’re getting close to turning 65, here’s some basic information about Medicare that you need to know.

The four “parts” of Medicare

There are four different types of Medicare insurance, known as “parts,” designated with letters A through D. Here’s the difference between each one:

  • Medicare Part A is hospital insurance, and covers expenses such as hospital stays and services provided by skilled nursing facilities. (We’ll discuss what Medicare covers in greater depth later on.)
  • Medicare Part B is medical insurance, and this is the part of Medicare you’ll use when you see your doctor or obtain preventative care.

Collectively, Medicare Parts A and B are known as “original Medicare.” These are the parts that nearly all senior citizens have.

  • Medicare Part C is Medicare Advantage, which are plans offered through private insurance companies that are contracted to provide Parts A and B benefits.
  • Medicare Part D is prescription-drug coverage, which can be added on to Medicare coverage. Part D plans are offered through private insurance companies and can be part of a Medicare Advantage plan.

Image Source: Getty Images.

Do you need to sign up for Medicare at 65?

If you’re already collecting Social Security benefits, you will automatically be enrolled in Medicare, starting on the first day of the month in which you turn 65.

If you’re not collecting Social Security benefits, you’ll need to apply for Medicare. You can apply for Medicare only at the Social Security Administration’s website, and your initial enrollment period runs for seven months, beginning three months before the month of your 65th birthday.

There’s a possible exception if you’re covered under an employer’s health plan (not through COBRA or retiree coverage). If your employer has 20 or more employees, it meets the definition of “group coverage” and you don’t need to enroll in Medicare during your initial enrollment period. Instead, you’ll get a special enrollment period when you leave your job or your group coverage ends.

Having said that, it’s still a good idea to sign up for Medicare Part A at 65. It’s free, so there’s really no reason not to. On the other hand, Medicare Part B has a monthly premium you’ll have to pay, so it can be smart to wait if you aren’t required to sign up during your initial enrollment period.

How much does Medicare cost?

Cost of Medicare Supplemental Insurance

For most retirees, Medicare Part A is free, meaning you probably won’t have to pay a premium for your hospital insurance.

Medicare Part B, medical insurance, is another story. The standard Medicare Part B premium is $134 per month in 2017, although beneficiaries who pay their premiums directly through their Social Security benefits pay slightly less, because of cost-of-living adjustment rules.

In addition, high-income retirees pay higher premiums. This is based on the beneficiary’s income from two years ago, so 2015 income was considered for 2017 Medicare Part B premiums. Single taxpayers with adjusted gross income greater than $85,000 and married couples with combined incomes over $170,000 pay Part B premiums of $187.50 to $428.60 per month, depending on their specific income level.

Finally, Medicare advantage and prescription-drug plans have costs that vary widely, depending on variables such as location and scope of coverage.

What original Medicare does (and does not) cover

As I mentioned, “original Medicare” refers to parts A and B. Since virtually all Americans over 65 will have original Medicare, it’s important to know what it covers, and what you’ll still be responsible for paying.

First, of all, Medicare Part A covers hospital service, including meals, drugs, and other services while hospitalized. It also covers skilled nursing facilities for a limited amount of time, nursing home care that is deemed medically necessary, hospice care, and some home health services.

In addition to doctors’ office visits, Medicare Part B covers outpatient surgeries, as well as necessary medical supplies, such as wheelchairs and walkers. It also pays for preventative services such as lab tests, disease screenings, and disease-preventing services, such as an annual flu shot.

However, there are some medical costs that Medicare doesn’t cover, such as:

  • Long-term care.
  • Dental care (for the most part).
  • Eye care.
  • Acupuncture.
  • Hearing aids.

In addition to this list, it’s important to point out that you’ll have some out-of-pocket costs for covered services as well. For starters, Medicare Part A has a $1,316 deductible per benefit period for inpatient hospital stays, and a coinsurance requirement of at least $329 per day for stays longer than 60 days. Skilled nursing facility stays are only fully covered for 20 days, and you’ll pay a $164.50 daily coinsurance payment for longer stays, up to 100 days, at which point Medicare stops paying.

Part B has a lower $183 annual deductible, but after this is met, Medicare generally covers 80% of covered services, leaving you responsible for the other 20%.

How to protect yourself from unexpected costs

medicare-money

These copays, deductibles, and coinsurance requirements are collectively referred to as “Medigaps.” To limit your unexpected healthcare costs, a Medicare Supplemental Insurance Plan, or Medigap plan, can be purchased.

There are 10 different types of Medigap plans, and price and availability depend on your location. You can read the features of all 10 plans at Medicare’s website, but an important point is that Plan F is the most comprehensive, as well as the most popular. While it’s a bit more expensive than other Medigap plans (average monthly cost of $159-$239 for a 65-year-old male), it covers virtually every copay, deductible, or coinsurance payment Medicare Parts A and B could ask you to pay.

The bottom line is that by knowing the basics of Medicare, you’ll know when and how to sign up, how much you’ll pay for it, how much of your costs Medicare will cover, and how to protect yourself from uncertainty.

The $16,122 Social Security bonus most retirees completely overlook

If you’re like most Americans, you’re a few years (or more) behind on your retirement savings. But a handful of little-known “Social Security secrets” could help ensure a boost in your retirement income. For example: one easy trick could pay you as much as $16,122 more… each year! Once you learn how to maximize your Social Security benefits, we think you could retire confidently with the peace of mind we’re all after. Simply click here to discover how to learn more about these strategies.

Original Source: http://host.madison.com/business/investment/markets-and-stocks/read-this-before-you-take-medicare-benefits/article_69d1b2fb-05f7-524f-bdb4-c82b4d4c11b5.html

Original Author: Mathew Frankel

Original Date: Jul 31 2017

When Should You Buy Medicare Supplemental Insurance Plans in Arizona

The best time to purchase Medicare Supplemental Insurance is during the six month enrollment period which begins on the first day of the month in which you turn 65 years old and have enrolled in Medicare Plan B.

This means that if you are enrolled in Medicare Plan B at age 64 and your birthday is June 23 then your open enrollment period is June 1 – November 30.  However, if you wait to enroll in Medicare Part B until you are 68, then your open enrollment period starts once the Part B coverage begins.

The reason that your open enrollment period is the ideal time to purchase Medicare Supplemental Insurance is that legally they are required to sell coverage during these six months without charging you more for any existing health problems.  If you perform have a pre-existing condition you should know that when you purchase Medicare Supplemental Insurance during open enrollment the insurance company may refuse to cover out of pocket expenses that are incurred due to the pre-existing condition for up to six months after you are first enrolled.  The one exception to this is if you are moving from another creditable coverage source for at least sixty three consecutive days before enrolling in Supplemental Insurance.   They are then required to begin coverage immediately.

If you decide to wait to purchase a Medicare Supplemental Plan in Arizona after open enrollment has ended you could face difficulties in medical underwriting.  Medical underwriting is a formula that private insurance companies use to decide whether or not to sell you supplemental coverage and at what premium.  This means if you have a health problem then you are likely to be charged a higher premium over an otherwise healthy person.

Even if you miss your open enrollment period there are certain cases in which you have called “guaranteed issue rights”.  This ensures that you have the same benefits as if you would have enrolled in a Medicare Advantage Plan but your plan leaves Medicare or ends care in your area or move outside the plan’s service area.  There are several other cases in which you have guaranteed issue rights so check with your insurance company to get further details.

“The best time to purchase Medicare Supplemental Insurance is right around when you turn 65 years old”

There are many factors to consider when purchase supplemental insurance coverage in Arizona.  There are a number of strict rules about Medicare and Supplemental Insurance coverage so knowing what is covered and what is not may not helps with mapping out a treatment plan for patients.  Timing is crucial as Medicare Supplemental Plans are constantly being revised.  Medicare recipients need to be diligent in learning all the facts and exercise their rights when looking for and buying Medicare Supplemental Insurance coverage.

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