Medicare Information

Medicare is a federal program for hospital and medical needs for individuals over 65 years of age. The program offers many great benefits to seniors. This article contains general Medicare information on what is covered under Medicare Parts A and B. Medicare Parts C (Medicare Advantage Plans) and D (Medicare Prescription Drug Coverage) are not discussed below. For additional Medicare information visit www.medicare.gov.

Medicare Part A
Medicare Part A is actually “Hospital Insurance.” It helps cover your inpatient care in hospitals and skilled nursing facilities. It also covers hospice care and some home health care. The program is premium-free if you meet certain conditions; individuals who don’t qualify can still buy in for a monthly premium of $423 in 2008.

Medicare Part A Helps Cover Your:

Hospital Stays: Semiprivate room, meals, general nursing, and other hospital services and supplies. This does not include private duty nursing, or a television or telephone in your room. It also does not include a private room, unless medically necessary.

Skilled Nursing Facility Care: Semiprivate room, meals, skilled nursing and rehabilitative services, and other services and supplies are covered, but only after a related 3-day hospital stay. Medicare does not cover “custodial care.” Custodial care is care that helps you with usual daily activities such as walking, eating, or bathing. This type of care is often given in a nursing home but is not covered by Medicare. Other payer sources would pay for custodial care such as private pay, Medicaid, HMO or insurance.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Hospice Care: Medical and support services from a Medicare-approved hospice for people with a terminal illness, drugs for symptom control and pain relief, and other services not otherwise covered by Medicare. Hospice care is given in your home. However, short term hospital and inpatient respite care (care given to a hospice patient by another caregiver so that the usual caregiver can rest) are covered when needed.

Blood: Pints of blood you get at a hospital or skilled nursing facility during a covered stay.

Medicare Part B
Medicare Part B is “Medical Insurance” and helps cover your doctors’ services, outpatient hospital care, physical and occupational therapists, and some home health care. Part B helps pay for these covered services and supplies when they are medically necessary. You pay the Medicare Part B premium of $96.40 per month (higher if income is higher than Medicare limits; see www.medicare.gov) in 2008.

Medicare Part B Helps Cover Your:

Medical and Other Services: Doctors’ services (not routine physical exams), outpatient medical and surgical services and supplies, diagnostic tests, ambulatory surgery center facility fees for approved procedures, and durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers). Also covers second surgical opinions, outpatient mental health care, outpatient physical and occupational therapy, including speech-language therapy.

Clinical Laboratory Services: Blood tests, urinalysis, and more.

Home Health Care: Part-time skilled nursing care, physical therapy, occupational therapy, speech-language therapy, home health aide services, medical social services, durable medical equipment (such as wheelchairs, hospital beds, oxygen, and walkers) and medical supplies, and other services.

Outpatient Hospital Services: Hospital services and supplies received as an outpatient as part of a doctor’s care.

Blood: Pints of blood you get as an outpatient or as part of a Part B covered service.

Medicare Also Helps Cover:
Ambulance services (when other transportation would endanger your health).
Artificial eyes.
Artificial limbs that are prosthetic devices, and their replacement parts.
Braces – arm, leg, back, and neck.
Chiropractic services (limited), for manipulation of the spine to correct a subluxation.
Emergency care.
Eyeglasses – one pair of standard frames after cataract surgery with an intraocular lens.
Immunosuppressive drug therapy for transplant patients as long as you are covered by Medicare (transplant must have been paid for by Medicare).
Kidney dialysis.
Macular degeneration of the eye (“wet” age-related) treatment, using ocular photodynamic therapy with verteporfin.
Medical nutrition therapy services for people with diabetes or kidney disease with a doctor’s referral.
Medical supplies – items such as ostomy bags, surgical dressings, splints, casts, and some diabetic supplies.
Outpatient prescription drugs (very limited). For example, some oral drugs for cancer.
Preventive services.
Prosthetic devices, including breast prosthesis after mastectomy.
Second opinion by a doctor (in some cases).
Services of practitioners such as clinical social workers, physician assistants, and nurse practitioners.
Telemedicine services in some rural areas.
Therapeutic shoes for people with diabetes (in some cases).
Transplants – heart, lung, kidney, pancreas, intestine, bone marrow, cornea, and liver (under certain conditions and when performed at approved facilities).
X-rays, MRIs, CAT scans, EKGs, and some other diagnostic tests.
Medicare Health Plans (like an HMO) may include extra benefits such as prescription drugs, dental care, routine physical and vision services. Medicare has a very informative website where you can obtain more Medicare information about questions and coverage. Go to www.medicare.gov to learn more.

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Medicare payment to medicare Advantage Plans

November 24, 2008
Studies Say Private Medicare Plans Have Added Costs, for Little Gain
By ROBERT PEAR
WASHINGTON — Private health insurance plans, which serve nearly a fourth of all Medicare beneficiaries, have increased the cost and complexity of the program without any evidence of improving care, researchers say in studies to be published Monday.

The studies, questioning the value of some private plans for Medicare beneficiaries and taxpayers, were issued as President-elect Barack Obama and Congressional Democrats take aim at the plans and consider cutting the payments they receive.

Enrollment in private Medicare plans has nearly doubled in five years, to 10.1 million.

In one study, Marsha Gold, a senior fellow at Mathematica Policy Research, says that private Medicare Advantage plans “are now widely available nationwide,” even in rural areas, as Congress intended when it revamped the program in 2003.

But the study, to be published in the journal Health Affairs, says that 48 percent of the additional enrollment comes from a type of plan that mimics traditional Medicare and generally does little to coordinate care. Enrollment in these “private fee-for-service plans” has shot up to 2.3 million, from 26,000 in December 2003.

In a separate article, two analysts from the Medicare Payment Advisory Commission, Carlos Zarabozo and Scott Harrison, said that growth in private plans had driven up costs because the government pays them 13 percent more on average than what it would spend for the same beneficiaries in traditional Medicare.

The commission, an independent federal panel that advises Congress, has expressed concern about the disparity for years.

“The higher payment rates have financed what is essentially a Medicare benefit expansion for Medicare Advantage enrollees, without producing any overall savings for the Medicare program, and with increased costs borne by all beneficiaries and taxpayers,” Mr. Zarabozo and Mr. Harrison write.

The annual open enrollment period began on Nov. 15. Beneficiaries can sign up for private plans offered by companies like UnitedHealth and Humana and by many Blue Cross and Blue Shield companies.

Under the formula adopted in the 1980s, Medicare paid private plans 95 percent of the projected cost for each beneficiary in traditional Medicare, on the theory that the private plans would save money by coordinating care and being more efficient.

The private plans, which frequently offer additional benefits like vision and dental care, have proved popular. Over the years, Congress has increased payments to private plans, as an incentive to enter more markets.

Beneficiaries choose from an average of 35 private Medicare Advantage plans in each county, Mr. Zarabozo and Mr. Harrison report. But they say, “Payment increases have been so large that plans no longer need to be efficient to offer extra benefits.”

Payments to health maintenance organizations are, on average, 12 percent higher than what the government would spend for beneficiaries in traditional Medicare, they write, while payments to private fee-for-service plans were 17 percent higher.

Insurance company executives and Bush administration officials defend the role of private plans.

“Medicare Advantage plans are offering an average of over $1,100 in additional annual value to enrollees in terms of cost savings and added benefits,” said Kerry N. Weems, the acting administrator of the Centers for Medicare and Medicaid Services.

Karen M. Ignagni, president of America’s Health Insurance Plans, a trade group, said two types of plans — H.M.O.’s and preferred provider organizations — had produced tangible benefits by coordinating care. As a result, she said, disease is detected earlier and people have fewer visits to hospital emergency rooms.

But, Ms. Gold said, “these are not the types of plans that have been growing most rapidly.” Instead, the private fee-for-service plans are growing fastest, and they, she said, “are not set up to coordinate care.”

The Medicare Payment Advisory Commission has said the payments to private plans should gradually be reduced to the level of traditional Medicare.

In a campaign statement, Mr. Obama declared, “We need to eliminate the excessive subsidies to Medicare Advantage plans and pay them the same amount it would cost to treat the same patients under regular Medicare.” In a debate on Oct. 15, Mr. Obama described the subsidies as “just a giveaway” to private insurers.

Similar views have been expressed by former Senator Tom Daschle of South Dakota, who is Mr. Obama’s choice for secretary of health and human services. “Medicare’s solvency is now threatened by overpayments to private insurers,” Mr. Daschle said in a book published this year.

Medicare anaylis

Howard McGowan





--------------------------------------------------------------------------------
From: Pam Edwards
To: maldensenior@gmail.com; howard_m_02148@yahoo.com; hcmgowan@hotmail.com
Sent: Friday, November 14, 2008 12:03:59 PM
Subject: FW: new alliance calls for repeal of harmful provisions in 2003 Medicare Law



Pam Edwards, Community Organizer
Mass Senior Action Council
topamedwards@hotmail.com
781-864-2596





--------------------------------------------------------------------------------
From: rand@mindspring.com
Subject: new alliance calls for repeal of harmful provisions in 2003 Medicare Law
Date: Fri, 14 Nov 2008 10:48:53 -0500


A new alliance calls for repeal of harmful provisions in 2003 Medicare Law
The groups proposed six-part plan aims to reverse damage and preserve Medicare.

Read the new Alliance to Restore Medicare's "Call to Action" below and visit its website at:
http://www.alliancetorestoremedicare.org

A Call for Action:
To Restore and Ensure Medicare's Health

Background
Medicare, the federal social insurance program guaranteeing health care to older people and people with serious disabilities, has been treasured for decades by most Americans. But a law enacted five years ago is now undermining it. A multi-prong assault on Medicare is under way. It must be halted and reversed.

Developed with stealth and marketed deceptively, the so-called "Medicare Modernization Act" of 2003 (MMA) is looting Medicare's trust funds and undermining the public's confidence in Medicare as it chips away at this efficient, publicly accountable program, aiming to atomize it by gradually moving its beneficiaries into the profit oriented private insurance market.

The 1965 creation of the Medicare program was one of the most far-reaching and successful initiatives of the vision of a Great Society. By providing health care coverage to older Americans through a government-based program, the United States advanced the nation's aspiration to end poverty and promote equality. The Medicare program currently provides 43 million older adults and people with disabilities access to care and security from the costs of serious illness.

Since Medicare's creation, its foes have searched for ways to make it more profitable for private health insurance companies, even though it might thus become less secure for the people it covers. These companies see Medicare as a highly lucrative financial opportunity, not as the bedrock of reliable coverage for older Americans and people with disabilities. Actions that would undermine its social insurance principles have often been masked by the pretense of saving it.

Five years ago, these opponents of public health insurance figured out how they could ruin traditional Medicare over the course of a few years. They succeeded in turning their scheme into law in 2003 when Congress passed, and the President signed, the MMA.

A new and much needed Medicare prescription drug benefit, Medicare Part D, was the bait to win the MMA's adoption. Part D's design, however, brought into Medicare an inefficient, costly, and confusing reliance on private plans. Meanwhile, the drafters also added numerous other provisions calculated to undermine Medicare and to benefit private corporations. These provisions dramatically increased the role of private Medicare plans and provided a tremendous new source of public Medicare funds for private industry.

The attacks on the structure and inclusiveness of Medicare reflect many opponents' hostility to all public health insurance. Traditional public Medicare is seen as a threat – an example of a successful government program that might be extended to everyone. Rather than identifying and addressing the causes of medical cost inflation, opponents of traditional Medicare have actually increased costs enormously, enacting over $150 billion in overpayments to private Medicare plans. Ignoring these unnecessary, lavish expenditures, they then proceed to highlight future expenses facing Medicare and assert that such costs would make universal health care unaffordable.

But there is new hope. Recognizing that beneficiaries and doctors are more important than overpayments to private Medicare plans, Congress recently overrode a presidential veto and cut some of those overpayments. Next, Congress needs to undo all of the damaging provisions of the Medicare Modernization Act. Otherwise, the nation could still lose not only Medicare, our only national health insurance, but also the possibility for universal health coverage.

We call on the Congress and the next President to undo the MMA's damage. The accompanying appeal lists six steps vital for preserving Medicare as the successful program that brought health care to older and disabled people and for safeguarding its political viability as an essential element of the foundation for universal coverage.

We welcome other organizations to join us in this effort.

An Appeal to Congress and the President Elect: Save Medicare

To ensure that Medicare will continue to provide health care access to older Americans and people with disabilities, the Alliance to Restore Medicare asks Congress and the president elect to commit to:

Creating a prescription drug benefit entirely within the original Medicare program, without relying on private insurance. That will allow people to stay in traditional Medicare and get all their benefits there, including prescription coverage. To control costs, require Medicare to negotiate the prices it pays for drugs.

Ending the overpayments to private "Medicare Advantage" plans. These billions of dollars in subsidies come at the expense of all Medicare beneficiaries and taxpayers. Together with inflated prescription drug prices, they threaten to drain Medicare's trust funds.

Eliminating the "premium support" voucher experiment that is due to start in 2010. This experiment will force beneficiaries in at least six U.S. metropolitan areas to use a voucher to shop among coverage options, in a market where subsidized private plans compete with traditional Medicare on price. Premiums will then inevitably rise for those who opt to remain in traditional Medicare while healthier people move into cheaper private plans.

Ending the new higher-income premiums now being phased in for Part B (which covers outpatient, physician and lab services). The higher premiums can be triple the regular premium. General federal tax revenues pay three-fourths of the cost of Part B. Beneficiaries have already paid graduated income taxes throughout their working lives. Higher premiums for some will erode universal support for Medicare.

Repealing the MMA's arbitrary 45% cap on the share of Medicare costs the government is allowed to pay using general revenues. Meanwhile, reject legislation designed to implement the cap. The cap won't control costs – just shift them to beneficiaries and providers. It was intended as just another means to whittle away at Medicare.

Launching a congressional study of Medicare's long-term finances. Start by exploring why the cost of the average patient's care is rising so fast in all of U.S. health care. Look for over-pricing of goods and services, obstacles to effective coordination of care, delivery of inappropriate care and unproven treatments, payment incentives that lead providers to over-treat, and waste inherent in reliance on private insurance programs, such as Medicare Advantage and the Part D drug plans. Then propose ways to control costs and, if necessary, to adjust Medicare's financing fairly and equitably so that its financial integrity is ensured and beneficiaries get the health care they need without undue financial stress.


--------------------------------------------------------------------------------
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REPEAL HARMFUL PROVISIONS 2003 MEDICARE LAW

From: rand@mindspring.com
Subject: new alliance calls for repeal of harmful provisions in 2003 Medicare Law
Date: Fri, 14 Nov 2008 10:48:53 -0500


A new alliance calls for repeal of harmful provisions in 2003 Medicare Law
The groups proposed six-part plan aims to reverse damage and preserve Medicare.

Read the new Alliance to Restore Medicare's "Call to Action" below and visit its website at:
http://www.alliancetorestoremedicare.org

A Call for Action:
To Restore and Ensure Medicare's Health

Background
Medicare, the federal social insurance program guaranteeing health care to older people and people with serious disabilities, has been treasured for decades by most Americans. But a law enacted five years ago is now undermining it. A multi-prong assault on Medicare is under way. It must be halted and reversed.

Developed with stealth and marketed deceptively, the so-called "Medicare Modernization Act" of 2003 (MMA) is looting Medicare's trust funds and undermining the public's confidence in Medicare as it chips away at this efficient, publicly accountable program, aiming to atomize it by gradually moving its beneficiaries into the profit oriented private insurance market.

The 1965 creation of the Medicare program was one of the most far-reaching and successful initiatives of the vision of a Great Society. By providing health care coverage to older Americans through a government-based program, the United States advanced the nation's aspiration to end poverty and promote equality. The Medicare program currently provides 43 million older adults and people with disabilities access to care and security from the costs of serious illness.

Since Medicare's creation, its foes have searched for ways to make it more profitable for private health insurance companies, even though it might thus become less secure for the people it covers. These companies see Medicare as a highly lucrative financial opportunity, not as the bedrock of reliable coverage for older Americans and people with disabilities. Actions that would undermine its social insurance principles have often been masked by the pretense of saving it.

Five years ago, these opponents of public health insurance figured out how they could ruin traditional Medicare over the course of a few years. They succeeded in turning their scheme into law in 2003 when Congress passed, and the President signed, the MMA.

A new and much needed Medicare prescription drug benefit, Medicare Part D, was the bait to win the MMA's adoption. Part D's design, however, brought into Medicare an inefficient, costly, and confusing reliance on private plans. Meanwhile, the drafters also added numerous other provisions calculated to undermine Medicare and to benefit private corporations. These provisions dramatically increased the role of private Medicare plans and provided a tremendous new source of public Medicare funds for private industry.

The attacks on the structure and inclusiveness of Medicare reflect many opponents' hostility to all public health insurance. Traditional public Medicare is seen as a threat – an example of a successful government program that might be extended to everyone. Rather than identifying and addressing the causes of medical cost inflation, opponents of traditional Medicare have actually increased costs enormously, enacting over $150 billion in overpayments to private Medicare plans. Ignoring these unnecessary, lavish expenditures, they then proceed to highlight future expenses facing Medicare and assert that such costs would make universal health care unaffordable.

But there is new hope. Recognizing that beneficiaries and doctors are more important than overpayments to private Medicare plans, Congress recently overrode a presidential veto and cut some of those overpayments. Next, Congress needs to undo all of the damaging provisions of the Medicare Modernization Act. Otherwise, the nation could still lose not only Medicare, our only national health insurance, but also the possibility for universal health coverage.

We call on the Congress and the next President to undo the MMA's damage. The accompanying appeal lists six steps vital for preserving Medicare as the successful program that brought health care to older and disabled people and for safeguarding its political viability as an essential element of the foundation for universal coverage.

We welcome other organizations to join us in this effort.

An Appeal to Congress and the President Elect: Save Medicare

To ensure that Medicare will continue to provide health care access to older Americans and people with disabilities, the Alliance to Restore Medicare asks Congress and the president elect to commit to:

Creating a prescription drug benefit entirely within the original Medicare program, without relying on private insurance. That will allow people to stay in traditional Medicare and get all their benefits there, including prescription coverage. To control costs, require Medicare to negotiate the prices it pays for drugs.

Ending the overpayments to private "Medicare Advantage" plans. These billions of dollars in subsidies come at the expense of all Medicare beneficiaries and taxpayers. Together with inflated prescription drug prices, they threaten to drain Medicare's trust funds.

Eliminating the "premium support" voucher experiment that is due to start in 2010. This experiment will force beneficiaries in at least six U.S. metropolitan areas to use a voucher to shop among coverage options, in a market where subsidized private plans compete with traditional Medicare on price. Premiums will then inevitably rise for those who opt to remain in traditional Medicare while healthier people move into cheaper private plans.

Ending the new higher-income premiums now being phased in for Part B (which covers outpatient, physician and lab services). The higher premiums can be triple the regular premium. General federal tax revenues pay three-fourths of the cost of Part B. Beneficiaries have already paid graduated income taxes throughout their working lives. Higher premiums for some will erode universal support for Medicare.

Repealing the MMA's arbitrary 45% cap on the share of Medicare costs the government is allowed to pay using general revenues. Meanwhile, reject legislation designed to implement the cap. The cap won't control costs – just shift them to beneficiaries and providers. It was intended as just another means to whittle away at Medicare.

Launching a congressional study of Medicare's long-term finances. Start by exploring why the cost of the average patient's care is rising so fast in all of U.S. health care. Look for over-pricing of goods and services, obstacles to effective coordination of care, delivery of inappropriate care and unproven treatments, payment incentives that lead providers to over-treat, and waste inherent in reliance on private insurance programs, such as Medicare Advantage and the Part D drug plans. Then propose ways to control costs and, if necessary, to adjust Medicare's financing fairly and equitably so that its financial integrity is ensured and beneficiaries get the health care they need without undue financial stress.

The fiscal year 2008 budget included over $60.5 million to fund Prescription Advantage.

This funding level for Prescription Advantage is based on Medicare Part D providing the primary prescription drug coverage for most of the program’s members and Prescription Advantage providing supplemental assistance with Part D premiums, co-payments, deductibles and coverage gaps. Prescription Advantage will continue to provide primary coverage for members not eligible for Medicare.
Please note: The legislation which funds Prescription Advantage requires the Executive Office of Elder Affairs to operate the program within its appropriation for the current fiscal year; thus, during the course of the year, the Plan may be required to impose cost containment measures”.
Posted by Malden Senior at 9:29 AM 0 comments
Labels: .MALDENSENIORS.univerasl health.insurance companies

The Campaign for Medicare

Beginning in 1952 the Truman Administration, through Federal Security Administrator Oscar Ewing, had begun advocating medical care for the aged—what would become Medicare. This was a retreat from Truman’s earlier calls for universal health care for all Americans. The implacable opposition of the AMA and other pressure groups made universal health care an impossible goal. By scaling back the ambition of the health care plan to encompass only aged Americans receiving Social Security, the Truman Administration hoped to mollify the conservative opposition.

In 1952 the first bill was introduced in Congress to create a Medicare program. The AMA immediately announced its opposition and worked tirelessly and successfully to prevent any such program from advancing in the Congress.

In 1958 the debate over Medicare acquired new intensity as Congressman Aime Forand (D-RI) introduced a bill in the Ways and Means Committee that was drafted by the Medicare-advocates who, in 1965, would play key roles in the eventual enactment of the legislation. The Forand bill was the most serious effort to introduce Medicare, and the AMA mobilized a massive campaign against it, quintupling its lobbying budget to fight Forand. Ultimately, Forand’s bill was bottled-up within the House Ways and Means Committee, but its popularity with both politicians and some segments of the public (labor united behind the idea of Medicare for the first time for example) gave the AMA a real scare.

By 1960 the two groups had been at loggerheads for nearly a decade and a compromise to the conflict was proposed by Senator Robert Kerr (D-OK) and Representative Wilbur Mills (D-AR). The Kerr-Mills bill—which like the Forand bill was also drafted in part by Medicare-advocate Wilbur Cohen—sought to substitute for a federal Medicare program covering aged Social Security beneficiaries, a state-based welfare program covering only the medically indigent and the aged on state welfare rolls. This scaled-back scheme was enacted into law in September 1960.

The Kerr-Mills plan had important differences from Medicare. First, it was a welfare benefit, limited in its scope to those able to demonstrate lack of financial means. Second, the programs would be state-based, rather than federal. But most importantly, the program would be entirely optional for the states. If a state chose not to construct a health care program under Kerr-Mills, they were free to ignore the law. Senator Pat McNamara (D-Mich.)—who was an opponent of Kerr-Mills—complained at the time, “The blunt truth is that it would be the miracle of the century if all of the states—or even a sizeable number—would be in a position to provide the matching funds to make the program more than just a plan on paper.”17

On its face, Kerr-Mills had the potential to be more generous in some ways than a Medicare-type program. At the time, there were 2.4 million seniors receiving state old-age assistance, and an estimated 10 million medically indigent who were not on state welfare rolls but who were unable to pay their own medical bills. Some or all of this population might be covered, depending upon the decisions of the individual states. This contrasted with the 14 million Social Security beneficiaries at the time. So in terms of scope, Kerr-Mills was likely to be a somewhat smaller program. But in terms of types of services, and the generosity of coverage, Kerr-Mills was virtually unlimited, with the federal government pledging to pay from 50% to 80% of the costs of whatever programs the various states created. But 50-80% of nothing is still nothing; so if a state failed to create a program—or created a very stingy one (as is typical for welfare benefits)—the theoretical federal support would be likely to not come to very much. Indeed, by 1963 there were still 18 states which had never implemented Kerr-Mills, three years after the legislation was enacted, and five large industrial states with only 32% of the medically-indigent were receiving nearly 90% of the federal funds expended under the program.18

Initially, even this truncated approach to social provision was bitterly resisted by the AMA. If Truman’s universal health care plan was socialism through and through; the scaled-back Medicare proposals were just socialism’s foot in the door; and even a Kerr-Mills program would just be socialism-lite. But finally, the AMA bowed to political realities and dropped its opposition to Kerr-Mills.

At this point, in 1961-62, Kerr-Mills was the AMA’s fall-back position in its continued opposition to Medicare legislation. The AMA’s argument was that Medicare was unnecessary because Kerr-Mills was a sufficient solution to the problem of medical care for the elderly. Given the limitations of Kerr-Mills, it is not surprising that the program failed to accomplish very much in the five years before it was repealed. A cynic might suspect that failure to accomplish very much was probably just what the AMA hoped for.

In the subsequent political battles over Medicare, the AMA would deploy an alternative strategy, rather than relying on support of the Kerr-Mills legislation. Following the 1964 presidential election, the AMA developed an alternative to Medicare which they labeled “Eldercare.” This scheme was essentially Kerr-Mills on steroids. It promised much more generous benefits than Medicare, but again limited to only the welfare population rather than to all aged Social Security beneficiaries.

In any case, the passage of Kerr-Mills in 1960 did not end the pressure for a Medicare program—as the conservatives and the AMA wished and hoped. After all, the non-indigent elderly were still in need of health care coverage and still unlikely to be able to purchase it in the marketplace. Studies at the time reported that the aged used medical services at a rate twice that of the non-aged; that three-fifths of the aged had less than $1,000 in liquid assets; and that nearly 54% of the aged lacked any form of health insurance. While opponents of Medicare disputed the precise statistics, it was clear to virtually everyone that the aged had medical-care problems that far exceeded those of the average American.

Following the defeat of the Forand bill, and the election of John Kennedy in November 1960, Medicare’s backers crafted a new version of the legislation, introduced by Clinton Anderson (D-NM) in the Senate and Cecil King (D-CA) in the House. The bill had the President’s backing and thus had acquired a sudden new dimension of political heft missing during the Eisenhower years. The AMA was thus understandably panicked by the appearance of the King-Anderson bill, after having tried to compromise Medicare out of existence with the Kerr-Mills strategy.

King-Anderson was, in terms of the Medicare program we know today, half-Medicare. It proposed to cover the costs of hospital and nursing home care, but not surgical costs and not out-patient physicians’ services. In this respect, it was scaled-back slightly from the Forand bill, which in addition offered coverage of surgical expenses. This scaling-back was a futile effort to lessen resistance to the idea of government-provided health insurance coverage.

So as 1961 dawned, the Kerr-Mills bill was established law, and the first King-Anderson legislation was pending in the Congress. The election of John F. Kennedy added new pressure to the push for King-Anderson and advocates for Medicare were optimistic that the 1961-62 session of Congress would see increased pressure for the enactment of Medicare in the form of the King-Anderson bill. Medicare was by no means a done-deal in 1961-62, even absent the AMA campaign against it. But the AMA campaign was a significant force of opposition striving to block Medicare during this period.

It is important to bear this history in mind when considering Operation Coffeecup, and Reagan’s subsequent positioning on Medicare, because it is this history that Reagan was to mythologize.


Coffee-Klatch Politics

Medicare Drug pricing

Medicare Drug Coverage Will Be Pricier Next Year
Posted by Jacob Goldstein
Seniors will pay more to get prescription drug coverage from Medicare next year. The feds said so last month, but a new report from the consulting shop Avalere Health parses the numbers a bit differently, and suggests that the rise will be a bit steeper than the feds suggested.

The WSJ has the story. Among the report’s findings:

The average premium for all standalone drug plans will increase 24%, to $37 a month, up from $30 this year.
The average premium for the 10 most popular plans will rise 31%.
There’s wide range of price increases. The premium for Humana’s popular basic plan will rise to $40.83 in 2009 from $25.52 this year, an increase of more than 50%. But UnitedHealth’s AARP “preferred” plan, another popular option, will rise by 15.5%, to $37.
Seniors who can’t manage a price increase should shop around this fall; even if your plan’s premium is going up, there may be a cheaper plan out there that would work for you. Insurers will start advertising their plans Oct. 1, and the six-week enrollment period begins in mid-November.


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Comments
Report offensive comments to healthblog@wsj.com
my wife and i only take generics. #4.00 at wall Mart ,so if the encrease for the plan goes up 20 or 30%, i will just cancel my plan.

Comment by justin deoliveira - September 26, 2008 at 9:06 am
Agree with Justin. Hit the $2500 medigap because I had $4 copay but druggist charged insurance another $20. Found 9 of my 10 meds were generics, $4 each at Walmart. Will cancel the prescription plan.

Comment by George Westmoreland - September 26, 2008 at 9:20 am
Is there a reason the biggest purchaser of medicines in the U.S. does not bargain with the pharmaceutical companies?
The VA does and saves signifcant money (and does not compromise the health of their patients. Maybe the US could have Wall Mart manage medicare part D.

Comment by richard reimer - September 26, 2008 at 9:25 am
$4..target also ..and we get our lipitor from india…works great except we are both wearing sari`s now!

Comment by bil - September 26, 2008 at 9:39 am
Law prohibiting Medicare price contracting with Big Pharma and the failure to use generic drugs when equivalent is the cause of this increase in cost of Part D. What about “the least of our brethren?

Comment by Victor L Kovner MD FACP - September 26, 2008 at 9:46 am
Walmart is destroying the retail pharmacy industry. They are doing what walmart does and that is bringing down small shops in any market they move into. Walmart is causing job loss which is fueling the economies downward spiral.

Please don’t jump the gun in canceling your prescription coverage, its called insurance for a reason. You never know what may happen and not every generic is $4.00s at walmart. Plus your doctor may believe that you need a brand name drug is what will save your life, then you will be wishing you had your insurance.

Comment by mike - September 26, 2008 at 10:15 am
Staying away from the medicare,pharmacy, and the doctors office. My husband and I both have been using the monavie active for about 4 months now and are having wonderful results more energy that is not pitched during the day but is fresh and steady. The monavie has seems to have helped my husband with his shoulder too he now can sleep better with no pain in his shoulder keeping him up at night, he fought this for about 3years all they the doctors would talk about is surgery and shots he started with monavie and it was all gone, all i would say is this product is worth a try and using it seems to have worked for us very well, we purchased ours on a website www.mymonavie.com/ctconrad just make sure you keep it in the fridge once you open it. hope this helps you out. God Bless.

Comment by retiredfornow - September 26, 2008 at 1:14 pm
The post show the confusion and misunderstanding of both health care and insurance. Insurance was never intended to cover all the cost and Wal Mart can’t fill every prescription with a generic for $4.00.I would advise everyone to look at the price they are paying for their other drugs. That $4.00 might not be such a value. What many people don’t know,even though the governmet does not get the best price, the Pharmacy Benefit Plans do and no one knows how much. Lets also deal in facts, no PBM is playing a pharmacy $24.00 for a $4.00 at Wal Mart.

Comment by Clinical Pharmacist - September 26, 2008 at 6:21 pm
I have never paid one red cent to medical “science.” And I’m 65. I believe doctors are the agents of the devil and you are committing the greatest sin of idolatry by going to them. God says He’s healer and to go to him in James 5:14. Doctors aren’t metnioned. They are the real quacks! They did not take the beating Jesus Christ did so you could be healed. But go ahead and spend over 1 trillion a year and get sicker! Spend most of it in the weeks before you die, YOU STUPID COWARDS!

Comment by Harold Reimann - September 28, 2008 at 1:19 pm
Oh, I forgot where you can go for the truth. eli3.tripod.com.

Comment by Harold Reimann - September 28, 2008 at 1:19 pm
Harold Reimann,

May god help you! You need all the help you can get.

And when your day comes, do us all a favor will you, squirm into your corner and die your death. Please don’t relent on your certain beliefs and go see a doctor or a hospital.

Comment by Anonymous - September 28, 2008 at 2:32 pm

Medicare Premiums 2009

For Most, Medicare Premiums Won't Rise in 2009
Medicare premiums will hold steady in 2009 for the vast majority of the 44 million U.S. beneficiaries, the first time since 2000 that rates haven't gone up.

Monthly premiums for about 95 percent of elderly and disabled Medicare recipients will be $96.40 next year, the Centers for Medicare and Medicaid Services reported Friday.

The announcement may seem surprising, given the fact that medical costs continue to outpace inflation. But Medicare officials said many unusual factors contributed to what will be just the sixth year without a premium increase since Medicare began in 1965.

Premiums have risen in recent years - more than 17 percent in 2005 - in part because Medicare had to build up reserves to offset changes made by Congress to adjust physician payments. Those reserves finally have reached adequate levels.

"It was painful to catch up, but now we have one year in which we can get rid of the catch-up amount and use that to offset the premium increases that otherwise would have happened," said Richard Foster, Medicare's chief actuary, estimating that next year's increases would have been about 8.5 percent.

In addition, the government also discovered an accounting error that benefits next year's rates.

Read Full Article (SFGate)

Medicare Fix payments

Because Medicare payments fixed and insurers, the only way primary care doctors can generate revenue is to take on more patients, which means spending less time with each—often no more than 15 minutes. “The commonest complaint you hear from patients is: ‘I don’t have enough time with the doctor yo dicuss  conditions in 15 minutes.”

Medicare Advantage Plan cost to taxpayers

Medicare Advantage Plans Cost $8.5 Billion More than Traditional Medicare in 2008
Private Medicare Advantage (MA) plans will be paid an average 12.4 percent more per enrollee in 2008 compared to what the same enrollee would have cost in the traditional Medicare fee-for-service program. The cost to Medicare, according to a new report from The Commonwealth Fund, will be $8.5 billion in 2008, pushing the extra cost from 2004 to $33 billion.

Even if the payment reductions to MA plans mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) – scheduled to take effect beginning in 2010 – had been fully in place in 2008, MA plans still would have been paid 10.6 percent more than expected fee-for-service costs.

Extra payments to MA plans will amount to $986 over fee-for-service costs for each of about 8.7 million Medicare beneficiaries enrolled in Medicare Advantage plans, according to the estimate by Brian Biles, professor of health policy at George Washington University, and colleagues.

The total will be more than $8.5 billion in 2008 – up from $3.9 billion in extra payments, or $795 per MA enrollee in 2004. Extra payments to MA plans between 2004 and 2008 will total nearly $33 billion.

The bulk of these extra payments were mandated by the Medicare Modernization Act of 2003, which was intended to expand the role of private plans in Medicare in an effort to reduce growth in Medicare spending. Since 2004, MA plan enrollment has increased from 4.8 million to the current 8.7 million.

Read Full Article (SeniorJournal.com)

Marketing Prescrription Drug Benefit

September 5, 2008, 8:50 am
Marketing of Medicare Prescription Drug Benefit Is a Mess
Posted by Jacob Goldstein
Seniors who’ve tried to wade through all the marketing brochures for Medicare prescription drug plans know how confusing they can be. As it turns out, those brochures do a pretty poor job of meeting the guidelines laid out by the feds.

A report out yesterday from the inspector general’s office in the Department of Health and Human Services found that 85% of marketing materials didn’t meet guidelines set out by the Centers for Medicare and Medicaid Services. Whoops.

The report puts part of the blame on CMS; the model marketing documents CMS gave to insurers isn’t consistent with the agency’s own guidelines, the report says. The template doesn’t include required information on the subsidy available to beneficiaries with low incomes, for example. CMS says it has made corrections to its model documents.

Another problem is that most marketing documents that are produced by an insurer in conjunction with a pharmacy fail to mention — as required — that other pharmacies are also available.

The problems have some folks in Congress pretty peeved. “This report reveals a near-total failure by CMS, where officials have insisted that they can regulate the marketing of plans to seniors as well as or better than experienced state insurance agencies,” Sen. Max Baucus, a Montana Dem who has been active in policing Medicare marketing, said in a statement yesterday. “The evidence now shows that’s not the case.”

Photo by Aaron Fulkerson via Flickr

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Comments
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bush and mcsame should be proud of this horlick

Comment by SICKETTE - September 5, 2008 at 9:57 am
It is sad that a program so many people need is being abused by those only looking for a quick buck.I could have made more money selling these plans than filling prescriptions and providing patinet care. CVS knew what they were doing when they purchased Caremark. Now many people think they have to go to CVS if they have a CVS Caremark plan. Maybe one day people will learn how to think and not allow all of these abuses to continue under the guise of free enterprise.

Comment by COMMUNITY PHARMACIST - September 5, 2008 at 5:23 pm
Interesting that this article points out the lack of meeting guidelines AND the WSJ article that mentioned marketing materials that failed to meet the guidelines completely GLOSSED OVER the fact that not only does CMS provide the templates for said marketing materials but they must also approve any and all marketing materials sent out by healthplans. Hmmm……..

Comment by healthplan employee - September 5, 2008 at 6:12 pm
There are too many plans to choose from. It’s confusing to just about anybody. There should be 3 plans - basic, medium, high. Also, the aggressive marketing makes it even more confusing. Also, formularies are not readily available to the patient, the doctor and the pharmacist to review. The way it is now, the Medicare prescription drug benefit is free enterprise out of control. It needs to be controlled, at least a little bit.

Comment by Primary Care Physician - September 5, 2008 at 8:04 pm
I agree that figuring out Medicare Part D is too confusing for the average senior but:

1) Before Medicare Part D most seniors had no access to coverage for prescription drugs whatsoever

2) anyone with access to Medicare.gov can figure out within a few minutes which plan will equate to the lowest out-of-pocket expenses, assuming the person’s prescriptions don’t change.

A decent insurance agent or non-profit organization can help seniors determine which plan makes the most sense every year, since they can change dramatically

Comment by orcamansam - September 6, 2008 at 1:24 am
hey primary care physician above,
are you voting for bush-mcsame?

Comment by donut hole - September 6, 2008 at 7:56 am
Post a Comment

Medicare Donut hole

September 2, 2008
Editorial
Medicare’s Troubling Drug Gap
Probably no aspect of the new Medicare drug program has caused more confusion and irritation than the notorious “doughnut hole,” a gap in coverage that forces people who had been getting their drugs cheaply to suddenly pay the full price out of pocket. Now, for the first time, an analysis has quantified what happened last year when millions of beneficiaries fell into the gap. For patients with serious chronic conditions, the medical implications were very troubling.

Congress crafted the “doughnut hole” to limit federal spending on the drug benefit. Beneficiaries pay only deductibles and co-payments, with the rest covered by their insurance plan, until their drug purchases reach a specified limit. Last year, the gap began when beneficiaries purchased $2,400 worth of drugs. Then they fell into the doughnut hole and had to pay the full cost until their out-of-pocket spending reached $3,850, at which point they qualified for catastrophic coverage.

Last year, an estimated 3.4 million beneficiaries reached the coverage gap, according to a study by researchers at the Kaiser Family Foundation, Georgetown University and the National Opinion Research Center, or NORC, at the University of Chicago. Beneficiaries taking drugs to treat such chronic conditions as Alzheimer’s disease, diabetes, depression, osteoporosis and high blood pressure were especially likely to reach the gap.

What’s disturbing is that 15 percent of the beneficiaries taking drugs in eight categories said they stopped taking their medications when they reached the gap. Another 1 percent reduced their use by skipping doses, and 5 percent switched to another drug that was cheaper but might or might not be as effective.

For the 10 percent of diabetics who stopped taking their medication after reaching the gap, the health consequences could be immediate and serious. For those with high cholesterol or osteoporosis, the harm could take longer to show up but could still be serious.

There is no easy solution short of increasing federal spending or finding a way to drive down the cost of drugs. The program has helped millions of older Americans. The next administration and Congress will have to revisit the wisdom and need for the gap.



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Sorting out Tricare, Social Security and Medicare

Q. What would happen if I defer taking my Social Security benefits until I am 67? Does that keep me from being able to enroll in Medicare Part B until I am 67? Do I have to enroll in Social Security when I am 65 so I can enroll in Part B and keep Tricare for Life eligibility?

A. The best source for clarification about Social Security and Medicare rules is the Social Security Administration. For official Tricare information, call your Tricare Service Center and ask for a free Tricare Standard or Tricare for Life Handbook. If you don’t know how to contact that office, call the Defense Enrollment Eligibility Reporting System support office, toll free, at (800) 538-9552.

That said, I’ll address some of the common issues that appear to concern you.

It used to be that Social Security benefit payments began at age 65. The law was changed several years ago. Now, entitlement to Social Security payments is determined by the year of the beneficiary’s birth. However, the age for Medicare entitlement did not change. If a person is entitled to Medicare, coverage still begins at age 65.

Even if a person won’t become entitled to monthly Social Security checks until, say, age 67, Medicare entitlement begins on the first day of the month when the beneficiary will be 65 years old. If the person was born on the first day of that month, Medicare entitlement will begin on the first day of the previous month.

There isn’t enough space in this column to discuss every rule and situation that can go into effect for every individual at that time, but here is some information that applies to several recent Tricare Help inquiries.

In effect, DEERS automatically reviews its database one second into the first day of every month. It looks for beneficiaries who are not active-duty family members and who will have their 65th birthday in that month.

The DEERS record for all those people must show that they are enrolled in Medicare Part B, or that they are not legally entitled to Medicare. In the absence of one or the other of those statements in the DEERS record, a person’s Tricare eligibility is automatically terminated.

To protect your Tricare eligibility, contact Social Security and apply for Medicare, Parts A and B, at least 90 days before your 65th birthday. If you don’t, you likely will lose your Tricare eligibility until you are enrolled in Medicare Part B and your DEERS record has been updated.

A few Tricare beneficiaries do not meet the legal requirements for Medicare entitlement. Medicare will deny their application and send them a notice of disallowance, which they must file with DEERS.

When DEERS is updated to show they are not entitled to Medicare, their Tricare eligibility will continue, unchanged, even if they are not enrolled in Part B.

A law enacted in 2001 allows retirees and their family members to combine Tricare Standard benefits with Medicare benefits if they are enrolled in Medicare Part B. The program created by that law, the combination of Medicare with Tricare Standard, is called Tricare for Life. It is not possible to become eligible for Tricare for Life until a person becomes entitled to Medicare and is enrolled in Part B.

Sponsor and spouse are seldom exactly the same age. If the spouse turns 65 before the sponsor, the spouse will get Tricare for Life first. The sponsor will have to wait until he gets Medicare at age 65 to get Tricare for Life.

If somebody refers to your status as “dual eligible,” instead of saying “Tricare for Life,” don’t worry. It means exactly the same thing — “dual eligible” is simply an earlier term.

James E. Hamby Jr. may be reached by writing to Tricare Help, Times News Service, 6883 Commercial Drive, Springfield, VA 22159; or by sending e-mail to tricarehelp@atpco.com. In e-mail, please include the word “Tricare” in the subject line and do not attach files. If using regular mail, please include an e-mail address if possible to prompt a faster response.


__._,_.___

Medicare Advantage Program Abuses

Nationwide, enrollment in the private plans, known as Medicare Advantage plans, has soared, to more than 8.9 million in November, from 6.1 million at the end of 2005. The fastest growing type of plan, known as a private fee-for-service plan, is the one being sold most aggressively here.

The staff of the Medicare Payment Advisory Commission, an independent federal panel, said this month that it had found evidence of hard-sell tactics in interviews with a dozen groups of beneficiaries around the country. “In all 12 focus groups, at least one member mentioned horror stories about marketing abuses,” Jennifer Podulka, a staff member, told the commission at its meeting on Dec. 6. Insurance experts say the extent of the problem almost surely exceeds official data because many victims never file complaints or report their experiences.

Compounding the problem, many agents sell Medicare Advantage plans for two or more insurance companies, and some work for independent marketing organizations, so the lines of responsibility may be blurred.

“Medicare has a pile of new rules, but the rules are not making a heck of a lot of difference,” said L. Darriel Pulliam, an insurance agent in Columbus for more than two decades.

Under the Medicare Advantage program, the government pays insurers an average of $9,000 a year for each person enrolled in a private plan. Agents say they typically receive commissions of $350 to $600 for each person they enroll. Agents can buy the names of prospective customers from marketing organizations like the Premier Agent Group in Dallas, which offers “100 red-hot Medicare Advantage leads” for $1,000, according to the company’s Web site.

Medicare Basic Payments

HOW IS MEDICARE FINANCED AND WHAT ARE
MEDICARE’S FUTURE FINANCING CHALLENGES?
Funding for Medicare comes primarily from payroll tax
revenues, general revenues, and premiums paid by
beneficiaries.
Medicare is funded as follows:
􀁹 Part A, the Hospital Insurance (HI) Trust Fund, is financed
largely through a dedicated tax of 2.9 percent of earnings paid
by employers and their employees (1.45 percent each). In
2007, these taxes are estimated to account for 86 percent of the
$216 billion in revenue to the Part A Trust Fund.
􀁹 Part B, the
Supplementary Medical
Insurance (SMI) Trust
Fund, is financed
through a combination
of general revenues
and premiums paid by
beneficiaries.
Premiums are
automatically set to
cover 25 percent of
revenues in the
aggregate. In 2007,
Part B revenue is estimated to be $194 billion.
􀁹 Part C is not separately financed.
􀁹 Part D is financed through general revenues, beneficiary
premiums, and state payments for dual eligibles eligible for drug
coverage under state Medicaid programs prior to 2006. In 2007,
Part D revenue is projected to be $64 billion, 78 percent of
which will be from general revenues.

Medicare and medcaid cuts 2009 budget

Huge Cuts Would Endanger Access to Quality Care for Massachusetts’s 894,000 Medicare and 1,000,000 Medicaid Beneficiaries. The Administration’s budget includes $195 billion in cuts over five years to Medicare and Medicaid that threaten to endanger Massachusetts’s 894,000 Medicare and 1,000,000 Medicaid patients’ access to the care they need to lead healthy, independent lives. Under the President’s plan, $178 billion would be cut from Medicare and $17 billion from Medicaid over five years. These cuts would be achieved by reducing reimbursements to health care providers and charging higher premiums based on income for Medicare beneficiaries for coverage of prescription drugs and doctors’ services. [Kaiser Family Foundation, State Health Facts, March 2006 and December 2006; President Bush’s Budget, FY2009; Department of Health and Human Services.]

Donut Hole Medicare part D

Buzzword: Doughnut Hole
What does it mean? In healthcare circles the "doughnut hole" is a large gap that exists in the middle of most Medicare prescription drug plans (PDPs), officially known as Medicare Part D. A standard PDP typically requires the beneficiary to pay an initial deductible, $275 this year, after which the plan starts picking up 75 percent of the cost of approved prescription drugs—but only until the consumer’s annual drug bill reaches $2,510.

The consumer then has to pay 100 percent of prescription drug costs until a second annual threshold of $5,726 ($4,050 out of pocket) is met. Once the consumer’s annual total drug bill surpasses $5,726, the PDP and Medicare typically pay a combined 95 percent of drug costs from there on. Specifically, the doughnut hole refers to the gap in coverage that exists between those two spending thresholds, where the consumer has to pay 100 percent of the cost of approved prescription drugs.

Why the buzz? PDPs replaced Medicare prescription drug discount cards in 2006. Although the federal government sets certain standards for Medicare PDPs, the plans themselves are sold and administered by private-sector companies. That means Medicare consumers must sift through about 50 to 60 plans offering different benefits and covered drugs.

The size of the doughnut hole can vary widely, depending on the specifics of the plan. Some PDPs have begun to offer a few benefits within the doughnut hole coverage gap, such as helping to pay for certain generic drugs. A recent study by the Kaiser Family Foundation found that 29 percent of PDPs were offering some sort doughnut hole benefits in 2008, up from just 15 percent in 2006. Several even offer some coverage within the doughnut hole for brand name drugs. But that same study found a relatively small number of Part D enrollees are expected to be in plans that offer full coverage of brand-name drugs in the gap raising concerns that some enrollees who reach the gap might forgo needed medications when faced with the full cost of their prescriptions.

Another major concern is the huge number of Part D plans available, with widely varying costs and benefits. That means Medicare-dependent seniors are faced with the daunting task of sorting through about 50 to 60 different plans to determine which one best suits their specific needs. Making things worse, many PDPs change their benefits and covered drugs each year, meaning Medicare consumers can't be assured their benefits will remain the same, even when they stay with the same PDP.

Essential Information: Find out more about Medicare’s doughnut hole at: Medicare Part D Fact Sheet, WebMD; Medicare Part D Drug Plans, Consumer Reports; Medicare Rights Center Web Page; Kaiser Family Foundation Study on Medicare Prescription Drug Plans; and Patient Assistance Programs, Consumer Reports Best Buy Drugs.

—Bob Williams, strategic resource director, Consumers Union

REMOVE SOCIAL SECURITY NUMBERS FROM MEDICARE CARDS

“Many individuals carry their Medicare cards in their wallets or purses and could become victims of identity theft should dishonest individuals steal such items or lift their Medicare number from a beneficiary card or medical document,” Mr. O’Carroll said.

Other federal agencies are taking steps to remove Social Security numbers from identification cards. The Department of Veterans Affairs said that new identification cards issued to veterans generally did not display Social Security numbers.