They call it healthcare reform, but under the new law some Medicare beneficiaries and providers will cover more of the costs. So, it’s not really cost reform; it’s cost reallocation? Well maybe it’s a little of both.
Since its enactment, spending on
That’s why there’s a big push for continuing retirement healthcare reform. The Patient Protection and Affordable Care Act (ACA) implemented in 2010 is expected to reduce overall spending on
Under the new law,
Beginning in 2015, there will be a 15-member Independent Payment Advisory Board (IPAB) charged with recommending
And under the new law there will be more enrollees who fit the high-earner income levels requiring them to pay higher premiums for
Then there are incentive plans intended to improve the quality and coordination of care, produce efficiencies and, ultimately, program savings. And if you’ve been to a hospital lately, you know firsthand the need for improvement. What we wouldn’t do for better communication among providers, and between providers and patients. And whether you were the patient or a visitor, you can’t help but long for better quality care. Let’s face it, if you end up in the hospital today, you had better have an advocate to help oversee your stay, or it’s very possible you will end up with an infection, won’t make a full recovery or could even become a statistic.
When it comes to possible efficiencies, just think about the hospital billing process. After a hospital stay, you get separate bills for doctor and hospital services. You may even get bills from doctors you didn’t even know treated you or what they treated you for. That bill may arrive months later. And there is really no way to verify that you received the service. Nor is there a way to challenge the amounts you’re being charged. Come on! Is it really $10 for an aspirin? Really? Can you say “simple fraud prevention?” Clearly, reforms are needed. The reality of a hospital stay doesn’t look anything like what you see on TV. And every business can find ways to implement best practices and become more efficient. It’s just a question of what should be changed and how it will be paid for until the associated savings are realized. Implementing efficiencies is one of the few areas where true cost savings are possible. But watch out for the tendency to cut costs by simply shifting them to the patient, doctor or back to
There are also provisions in the law that will increase
The law even includes provisions that produce revenue for
In addition to monthly premiums,
So, while overall the new law should save the
Some proposals for additional reforms expand caps on
And no matter which course is chosen, or which political party gets to set the course, it is very clear that someone will pay more.
For people 65 and older, get reliable information about
This article will evaluate the challenges associated with
Health care spending currently accounts for 16% of the gross domestic product of the United States (Getzen, 2007). New technology and higher incomes have increased overall healthcare spending and driven up costs. The question raised, is how
Background and Significance
The bulk of today’s
Legislative action on
The executive branch also plays a major roll in the determination of alternate
The federal government stands to win by moderating uncontrolled growth in the
Politicians are another group affected by policies on reimbursement cuts. Their role is fairly complex as their duties and functions are reflective of the competing interests of different populations, groups, and political parties. Expenditure reduction and reimbursement cuts affect a wide range of constituents in different manners. The role of
Third party payers are heavily influenced by
Physicians and hospitals stand to lose in the short-term. The healthcare community is at odds with current reimbursements models and believes that further cuts will significantly erode revenues. A study featured in Pain Physician acknowledges that “physicians in the United States have been affected by significant changes in the pattern[s] of medical practice…and escalating healthcare costs have focused concerns about the financial solvency of
Various groups are involved in seeking solutions to this problem including the
Each time that you get a paycheck there is a small amount taken out for your Social security benefits. These payroll deductions pay for your federal Medicare health insurance benefits. When you retire from the workforce at age 65, or earlier due to a disability, your Medicare coverage begins. It also covers your children under the age of eighteen if you die before retirement. You will receive Medicare even if you are a millionaire provided you paid in enough quarters. It does not depend on your assets or income. Bill Gates will get his coverage.
Medicare coverage is not complete and there can be co-pays. Most retirees buy supplemental insurance for some of the services that the basic Medicare benefits do not provide. Medicare covers hospital stays and limited skilled nursing facilities under “Part A.” Doctors, outpatient care, and medical supplies are covered under “Part B.” The two biggest gaps in Medicare coverage are long term care and prescription drugs. You cannot double dip and if you collect coverage from another source, Medicare does have some reimbursement rights.
Some days I think that Congress named our two very different national health care programs “Medicare” and “Medicaid” just to confuse us.
Medicaid on the other hand is a welfare program that is not funded through Social Security. It comes from our general taxation with about half paid by each state and the balance paid for by Congress. Each state designs its own program. Medicaid covers many more services than Medicare and there are no co-pays. Medicaid covers hospitals, doctors, drugs, x-rays and long term nursing home care.
The key to be eligible for Medicaid is that you must be very poor. Your income and resources must be below a threshold set by the federal government and adjusted every year. You must also be able to prove that you are a U.S. citizen. Aliens cannot receive Medicaid benefits.
While Medicaid will cover long term nursing home care if your family member meets the Federal medical need guidelines, there are certain hooks. Medicaid can assert a payback lien against some future earnings, inheritances, gifts, lawsuit winnings and your estate. You will also be ineligible if you gave anything away during the five years before you apply. The period of time that you are ineligible is based on how much you gave away. Some transfers to spouses or disabled children are exempt from the penalty rules.
Surprisingly, Congress took some care not to impoverish a healthy spouse or disabled children who remain at home in the community. A home, a car and approximately $100,000 can be kept back for them when a disabled spouse goes to a nursing home. Congress also allows some limited asset protection planning and has sanctioned the use of “Special Needs Trusts” in a law called “OBRA 95.”
The rules are all laid out in 95,000 pages of books cutely called the “POMS.” You can read them all at http://www.ssa.gov. It does help to have a little working knowledge of your family’s federal health benefits and the difference between Medicare and Medicaid. The rules cited in this article are very general and it is important to have exact guidance for each particular case.
At initial glimpse it may seem incredibly bewildering to figure out the differences among a number of
The coverage and costs vary with distinct sorts of schemes. Moreover reflect on that fees possibly will grow yearly, and advantages can be added or withdrawn. This is why it is important to keep in the know with the latest information on health insurance in California.
Part A is referred to as hospital cover. It will insure the receiver for the bulk of in-patient hospital treatment, together with some forms of in patient home care and plus hospice treatment. To be entitled to this assistance devoid of footing a monthly fee, you will require to be holding 40 or more quarters of Social Security credits. If you possess less than this total, though more than thirty, then you can acquire
The rate of this premium is $110 in 2010, however in the order of 73 percent of
It is important to realize that
You will be offered the
If you are opting for such a scheme then you need to examine the costs with care as lots may be more pricey for certain aspects. And numerous
Part D of
The health of an individual is almost like the primary source of everything that he or she has. When your body is not functioning properly and you are suffering from various debilitating conditions, chances are you will not be able to carry out your work properly which will greatly affect your daily living. Because of this, it is a big must for you to get a partner which will be able to help you secure your health conditions. And one of these is the
A Quick Glimpse
As a whole, whenever you buy your Medigap policy, there is a minimum of two components in the policy,
To clear some issues, Medigap policy does not have anything to do with the coverage that you can claim from your employer for this is not
Getting your own
The benefits received by those on
In 1997, as part of the Balanced Budget Act of 1997, people who receive
Both Part C and Part D benefits are relatively new, and as far as laws goes are still in their infancy. As they continue to develop it is likely they will change and transform into a more lean and scaled down model.
With so many prescription plan choices, it can be hard fo beneficiaries to find the best one. Here are some things to consider.
- Where do you live? Your own choices will be affected by the plans that are sold in your area. The convenience of actually getting prescriptions filled by a particular plan will also be a big factor for many older or disabled people.
- What type of medicine do you need to take? Different plans cover prescription medicine in different ways. You want to maximize benefits that will help you save money on the drugs you need to take.
- The monthly premium should also be considered. Premiums vary a lot.. I have seen some for less than $15 a month, while others may cost more than twice that much.
The monthly premium can be an important thing to think about for many people who must lived on a limited income. Cheaper plans can be very attractive. However, be wary because some low priced plans may be able to keep premiums low because of restrictions on covered drugs or covered drug stores.
Convenience Of Buying Prescriptions Under The Drug Plan
For example, some large chains have branded Part D plans. These plans are fairly cheap. But they restrict preferred coverage to their own pharmacies. If it is not convenient to pick up drugs at one of these stores, they may not really save money in the long run. Convenience is not a trivial matter to many seniors and disabled people who have trouble finding transportation. In some cases, it may be better to pay a little more for a plan that is more flexible.
Overall Out Of Pocket Drug Costs
The actual out of pocket drug costs, even with coverage, will probably be more important than the monthly premium. It would not make sense to save $10 a month on a drug plan premium, but then pay $50 a month more for prescriptions! It is also important to consider how much you will have to pay for your medicine every month.
If you are looking for a new Part D plan, or if you are helping somebody else look for one, there are some tools that can help you make a good choice.
Some people would rather talk to or email a local agent. You can find some online
It has been six months since the highly contested Patient Protection and Affordable Care Act, also called health care reform, became law. Polls show that people remain worried about how the law will affect their health care. There is a lot of talk about big cuts in
The worst news is for people who love their
The problem with
According to the U.S. Department of
But there is no proof that the program is providing better
These cuts won’t go into effect all at once. In 2011, the subsidy going to private insurance companies will be frozen at 2010 levels. After that, the payments will be reduced an average of 12% per year, until costs are more in line with the cost of regular
Bottom line: according to the Congressional Budget Office, by 2019 the private insurance companies offering these plans will receive $136 billion less than they would have received at the current level of subsidy.
Naturally, the private insurance companies do not like this one bit, and they say they will drop out of the program if these cuts aren’t repealed. And when those
Some seniors will be unhappy about this, but it’s important for them to understand why it is happening —
In 2009, while
Remember the stories about silver-haired grandmothers marching in protests with signs saying “Keep Government Out of My
But the Patient Protection and Affordable Care Act is not cutting any benefit from
Last year, the trustees of the
As we get closer to the November midterm elections, watch out for politicians citing the cuts to
Senior health should be a concern to all of us because none of us can escape the effects of aging. The senior population is increasing steadily. Today there are around 50 million seniors in the United States. By 2036 there will be over 80 million. In 1940 someone at the age of 65 could plan on living another 14 years. Today a 65 year old can expect to live 20 more years. The point here is that senior health care has made it possible for the elderly to live longer. Although it is certainly wonderful that seniors are living longer lives, problems have arisen as it pertains to the financial burden it has created.
A recent study suggested that over 13 million seniors are financially unprepared for retirement. 9 out of 10 seniors rely on social security for support. It is believed that 50% of seniors have no private pension option and over 30% do not have savings sufficient enough to cover their needs. Those seniors having to file bankruptcy due to skyrocketing medical debt is on the rise. Today the majority of seniors depend on the medicare program for
However, the number of seniors on
Beyond the medical costs associated with senior health there are the problems seniors face with simply growing old.
It is important that seniors are encouraged to not give up on life. They need the social support system that is often lost in the shuffle because their children lead busy lives. Seniors need to stay proactive and engage in as many activities as possible to get the social support they need. It is also vital that seniors follow a proper diet and exercise. Seniors should exercise 3-5 times per week, 30 minutes per event. This is a very good for disease prevention. It will allow the senior to feel good about themselves and provide them with more energy and enthusiasm.
Seniors are living longer. Sure the cost of living longer is going to be enhanced, but seniors can still live happy in their twilight years. With exercise, diet, regular screenings, and a proper social support system in place they can be some of the best years of their lives.
For those who are enrolled in the Medicare program the coverage may simply not be enough. That is why there are Medicare Supplemental Insurance or Medigap programs in place. If you are unsure of whether or not you need Medigap insurance for your Medicare program please read what is contained below.
What is Medicare
Medicare is an entitlement program created by the federal government as its principal health care plan for seniors. To qualify for Medicare all you need to do is reach the age of 65, become permanently disabled or have end stage renal disease. Medicare was originally created to help our elderly with the burden of paying for health care. Medicare is not free however; recipients pay a monthly premium as well as portion of the cost of services they receive as a co-payment or deductible amount.
Medicare also does not cover certain needed services such as nursing homes and in-home health care. To pay for services that are not covered by Medicare most recipients turn to private insurance policies that are called Medigap. What are the gaps in coverage?
Medicare Part A
There are actually quite a few gaps in Medicare coverage you should be aware of depending upon which Medicare program you are enrolled in. Medicare Part A coverage is known as hospital coverage because it takes care of such things as inpatient hospital and skilled nursing, home health and hospice.
What Medicare currently does not cover however is:
The hospital deductible: This is the amount you must pay for your hospital stay before Medicare will cover the rest. The amount as of last year was over $1000.00
The hospital coinsurance coverage: Medicare covers your hospital stay in full, besides the deductible, for the first 60 days of your stay. However after the 60 days are up if you still need to be in hospital Medicare will no longer cover all of the charges but will charge you a daily coinsurance payment.
Hospital services: Once you have been in hospital for 150 Medicare will no longer bear any of the cost
Skilled Nursing facility: Medicare covers a skilled nursing facility stay for up to 20 days, if you need skilled care beyond that you will need to pay a daily coinsurance amount
Skilled nursing facility services: If you need to be in a nursing home for more than 100 days, Medicare will not cover any of the expenses.
Home health aide services: While Medicare will defray some of the cost of occasional home health aide services it does not cover extended services.
Home health aide or nursing services: Medicare will not cover home health aide or home health nursing unless skilled care is necessary.
Medicare Part B
Although Medicare Part B was created to be Medicare’s premier supplemental insurance it ended up becoming more of an outpatient and preventative medicine type of coverage. The types of coverage Part B covers is durable medical equipment, supplies the physician uses, prosthetic devices, and ambulance services. Just like with Part A there are gaps in the coverage here as well, although not as many.
Deductible: Medicare Part B has a flat yearly deductible that must be met before any services are covered under Medicare. While minimal in cost the amount last year was $135 and goes up each January 1.
Part B coinsurance coverage: While Medicare Part A covers 80% of the items that Part B takes care of neither covers all and there is a 20% coinsurance payment you must cover.
Any person who is eligible and enrolled in the Medicare program needs a Medigap or Medicare supplemental insurance to help defray the costs missed by Medicare Part A and Part B.