Here’s the blunt truth: Medicare generally won’t pay for as much nursing home or in-home care as many people think it will. Your cash savings may well be insufficient, especially if you want to leave plenty of money for a spouse who may outlive you. Your family may not be willing or able to take care of you. And if you do spend all of your assets to qualify for Medicaid, there’s no guarantee Medicaid will pay for the quality of care you want and do so close to friends or family.
So we better hope that the Class Act works and helps lots of Americans. Because if it doesn’t, plenty of people will be right back in denial-land again.
That said, there are some people who have already purchased long-term care insurance from a commercial company. Limra, a market research firm, figures there are about seven million of them.
Some buy it out of an abundance of caution, while others do it because their employers offer subsidized premiums as a benefit. Many others have seen family members spend hundreds of thousands of dollars on care or struggled to provide care themselves when there was no money left.
Saturday, April 30, 2011
Wednesday, April 6, 2011
Medicare in 2011
Important Medicare Changes in the New Year—How ACA Impacts People with
There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare. Many of these changes will take place in 2011 – some even began as early as January 1. Below is a list of some of the changes beneficiaries will experience this year:
Access to a new Physician Compare Website
A new CMS Healthcare Provider Directory is now available through the Physician Compare Website. This consumer-friendly site is designed to help beneficiaries and their families locate and compare health professionals in communities across the country. You can find the following information on the site:
•
Contact and address information for physicians’ offices;
•
Physicians’ medical specialties
•
Where they completed their degree as well as residency or other clinical training;
•
His or her gender
•
Which languages a physician speaks; and
•
Whether or not a physician participates in the Medicare program.
CMS will continue to expand and improve Physician Compare with more information about quality of care and patient experience that can help consumers learn more about the care provided by Medicare-participating physicians. To learn more about the Physician Compare Website, please visit: http://www.medicare.gov/find-a-doctor.
Improvements to Medicare Preventive Benefits
Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit’ where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.
Improved cost-sharing for Medicare preventive services: Also, as of January 1, the ACA also eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts assignment under Medicare, meaning he or she accepts what Medicare pays for a service as payment in full) include:
•
Abdominal aortic aneurysm screening
•
Bone mass measurement
•
Breast cancer screening/mammograms
•
Cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy)
•
Diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Flu shots
•
Hepatitis B shots
•
HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services)
•
Pap tests and pelvic exams
•
Physical exams – both the “Welcome to Medicare” visit and the annual “wellness visit”
•
Pneumococcal shot
•
Prostate cancer screening
•
Smoking cessation counseling
Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.
To learn more about Medicare-covered preventive benefits, go to: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Improvements to the Medicare Advantage Program
Medicare Advantage disenrollment period: People enrolled in private Medicare Advantage plans now have a 45-day window (from January 1 to February 14 of each year) in which they may return to Original Medicare (Parts A and B) and also enroll in a stand-alone Part D prescription drug plan if they wish.
Special Needs Plans: The new law also extends the Medicare Advantage Special Needs Program for an additional three years. Special Needs Plans (SNPs) are allowed to target enrollment to people with one or more types of special needs including 1) individuals living in an institution 2) individuals dually eligible for Medicare and Medicaid; and/or 3) individuals with severe or disabling chronic conditions.
Improvements to Medicare Part D
Savings in the Coverage Gap: Beginning in 2011, people with Medicare will benefit from reduced cost-sharing for prescriptions they purchase while in the
coverage gap (also known as the “doughnut hole”) -- a 50 percent savings on covered brand-name prescriptions and seven percent discount on generic drugs. Medicare will continue to reduce beneficiary cost-sharing and phase out the Part D coverage gap until 2020. For more information (including what will count toward a person’s True Out-of-Pocket, or TrOOP costs), visit http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf.
Changes to the Annual Enrollment Period: In addition, thanks to the ACA, the annual open enrollment period in which people with Medicare may compare and enroll in Medicare Part D plans has been rescheduled and extended . Starting this year, the Annual Enrollment Period will begin October 15th and continue until December 7th.
Improvements to the Low-Income Subsidy
Reassignment: Through changes to the Medicare Advantage program, the ACA makes it easier for those receiving the Extra Help/Low-Income Subsidy (LIS) to stay in the same plan from one year to the next. The law improves the determination formula for plans to remain a $0 premium benchmark LIS plan (plans that offer basic Medicare Part D coverage with rates low enough to allow Medicare to cover 100% of a beneficiary’s premium). This will reduce the number of people reassigned to new prescription drug plans each year and increase the number of LIS benchmark plan options available to beneficiaries. In addition, those who must still be automatically reassigned to a new plan will now receive more detailed information from CMS regarding their new plan so that they can make a more informed and timely decision about their new plan.
There are many additional resources discussing the impact of ACA for Medicare beneficiaries. For more information about these changes, please visit: http://www.healthcare.gov/center/reports/affordablecareact.html.
There are many important changes under the Patient Protection and Affordable Care Act of 2010 (ACA) that improve access and services for people with Medicare. Many of these changes will take place in 2011 – some even began as early as January 1. Below is a list of some of the changes beneficiaries will experience this year:
Access to a new Physician Compare Website
A new CMS Healthcare Provider Directory is now available through the Physician Compare Website. This consumer-friendly site is designed to help beneficiaries and their families locate and compare health professionals in communities across the country. You can find the following information on the site:
•
Contact and address information for physicians’ offices;
•
Physicians’ medical specialties
•
Where they completed their degree as well as residency or other clinical training;
•
His or her gender
•
Which languages a physician speaks; and
•
Whether or not a physician participates in the Medicare program.
CMS will continue to expand and improve Physician Compare with more information about quality of care and patient experience that can help consumers learn more about the care provided by Medicare-participating physicians. To learn more about the Physician Compare Website, please visit: http://www.medicare.gov/find-a-doctor.
Improvements to Medicare Preventive Benefits
Annual Wellness Visit: Beginning January 1, 2011, people with Medicare have access to a new ‘Annual Wellness Visit’ where they can receive a comprehensive health risk assessment and develop a personalized prevention plan.
Improved cost-sharing for Medicare preventive services: Also, as of January 1, the ACA also eliminates cost-sharing for Medicare-covered preventive services that are recommended (rated A or B) by the U.S. Preventive Services Task Force. The services which now have no cost-sharing (if a doctor accepts assignment under Medicare, meaning he or she accepts what Medicare pays for a service as payment in full) include:
•
Abdominal aortic aneurysm screening
•
Bone mass measurement
•
Breast cancer screening/mammograms
•
Cardiovascular screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Certain types of colorectal cancer screenings (i.e., flexible sigmoidoscopy and colonoscopy)
•
Diabetes screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Flu shots
•
Hepatitis B shots
•
HIV screening tests (although you generally will have to pay 20% of the Medicare-approved amount for the doctor’s visit)
•
Medical nutrition therapy services (for those with diabetes or kidney disease, or who have had a kidney transplant in the last 36 months and whose doctor refers them for these services)
•
Pap tests and pelvic exams
•
Physical exams – both the “Welcome to Medicare” visit and the annual “wellness visit”
•
Pneumococcal shot
•
Prostate cancer screening
•
Smoking cessation counseling
Smoking cessation counseling: More people are now eligible for the smoking cessation counseling benefit under Medicare. Now all beneficiaries who smoke can take advantage of as many as eight smoking cessation counseling sessions.
To learn more about Medicare-covered preventive benefits, go to: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Improvements to the Medicare Advantage Program
Medicare Advantage disenrollment period: People enrolled in private Medicare Advantage plans now have a 45-day window (from January 1 to February 14 of each year) in which they may return to Original Medicare (Parts A and B) and also enroll in a stand-alone Part D prescription drug plan if they wish.
Special Needs Plans: The new law also extends the Medicare Advantage Special Needs Program for an additional three years. Special Needs Plans (SNPs) are allowed to target enrollment to people with one or more types of special needs including 1) individuals living in an institution 2) individuals dually eligible for Medicare and Medicaid; and/or 3) individuals with severe or disabling chronic conditions.
Improvements to Medicare Part D
Savings in the Coverage Gap: Beginning in 2011, people with Medicare will benefit from reduced cost-sharing for prescriptions they purchase while in the
coverage gap (also known as the “doughnut hole”) -- a 50 percent savings on covered brand-name prescriptions and seven percent discount on generic drugs. Medicare will continue to reduce beneficiary cost-sharing and phase out the Part D coverage gap until 2020. For more information (including what will count toward a person’s True Out-of-Pocket, or TrOOP costs), visit http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf.
Changes to the Annual Enrollment Period: In addition, thanks to the ACA, the annual open enrollment period in which people with Medicare may compare and enroll in Medicare Part D plans has been rescheduled and extended . Starting this year, the Annual Enrollment Period will begin October 15th and continue until December 7th.
Improvements to the Low-Income Subsidy
Reassignment: Through changes to the Medicare Advantage program, the ACA makes it easier for those receiving the Extra Help/Low-Income Subsidy (LIS) to stay in the same plan from one year to the next. The law improves the determination formula for plans to remain a $0 premium benchmark LIS plan (plans that offer basic Medicare Part D coverage with rates low enough to allow Medicare to cover 100% of a beneficiary’s premium). This will reduce the number of people reassigned to new prescription drug plans each year and increase the number of LIS benchmark plan options available to beneficiaries. In addition, those who must still be automatically reassigned to a new plan will now receive more detailed information from CMS regarding their new plan so that they can make a more informed and timely decision about their new plan.
There are many additional resources discussing the impact of ACA for Medicare beneficiaries. For more information about these changes, please visit: http://www.healthcare.gov/center/reports/affordablecareact.html.
G.O.P. Blueprint Would Remake Health Policy
By ROBERT PEAR
WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk.
House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings.
But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states.
Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership.
For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly.
Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program.
Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections.
Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget.
But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs.
Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.”
Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession.
Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums.
Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form.
Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground.
But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt.
“We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week.
Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.”
About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.
The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare.
In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.”
The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law.
Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate.
In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost.
Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage.
But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year.
What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law.
There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit.
The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.
WASHINGTON — The proposal to be unveiled by House Republicans on Tuesday to rein in the long-term costs of Medicaid and Medicare represents a fundamental rethinking of how the two programs work, an ambitious effort by conservatives to address the nation’s fiscal challenges, and a huge political risk.
House Republican aides said the budget blueprint to be issued by the chairman of the Budget Committee, Representative Paul D. Ryan of Wisconsin, would slice more than $5 trillion from projected federal spending in the coming decade. Health care accounts for much of the savings.
But while saving large sums for the federal government, the proposals on Medicaid and Medicare could shift some costs to beneficiaries and to the states.
Under the proposal, Medicaid would be transformed into a block grant, with a lump sum of federal money given to the states to care for low-income people. States would be given more discretion over use of the money than they have under the current federal-state partnership.
For future Medicare beneficiaries — people now under 55 — Mr. Ryan’s proposal calls for the federal government to contribute a specified amount of money toward the premium for private health coverage. Under the traditional Medicare program, the government reimburses doctors and hospitals directly.
Although many House Republicans see a need to revamp Social Security, too, they are not expected to press this week for comprehensive or specific changes in that program.
Democrats signaled that they would fight the health proposals, and the clash could well become a defining issue for both parties in the 2012 elections.
Republicans say the health care proposals would help the federal government predict and control its costs under Medicaid and Medicare, which insure more than 100 million people and account for more than one-fifth of the federal budget.
But if, as many economists predict, health costs continue to rise at a rapid clip, beneficiaries of these programs would be at risk for more of the costs.
Mr. Ryan said his Medicare proposal was similar to one he advanced in November with Alice M. Rivlin, a budget director in the Clinton administration. Analyzing that plan, the Congressional Budget Office said, “Federal payments would tend to grow more slowly under the proposal than projected costs per enrollee under current law.” As a result, the budget office said, “enrollees’ spending for health care — and the uncertainty surrounding that spending — would increase.”
Medicaid and Medicare are now open-ended entitlements. Anyone who meets the eligibility criteria is entitled to benefits defined in detail by federal law. The federal government and the states must pay the additional cost if more people become eligible for Medicaid, as happened in the recent recession.
Likewise, Medicare bears the cost if doctors perform more numerous, more complex and expensive tests and procedures. Some of those additional costs are passed on to beneficiaries in the form of higher premiums.
Republicans say they are taking the initiative on Medicaid and Medicare because President Obama has done nothing to put the programs on a solid fiscal footing. In his 2012 budget, Mr. Obama did not propose significant savings in Medicaid or Medicare, even though he and many fiscal experts say the programs are unsustainable in their current form.
Mr. Ryan and fellow House Republicans are wading into tricky waters, where many other politicians have run aground.
But with the nation’s fiscal problems looming larger, Republicans say the politics of the issue have shifted. They expect to receive credit from the public for trying to hold down the deficit and the debt.
“We have a moral obligation to the country to do this,” Mr. Ryan said in an interview last week.
Representative Jan Schakowsky, a Democrat and a former executive director of the Illinois State Council of Senior Citizens, said she was incensed by such claims. “Mr. Ryan and the Republicans are declaring war on entitlements — and war on the elderly and the poor,” Ms. Schakowsky said. “Beneficiaries will end up paying more.”
About half of Medicaid recipients are children. Nearly two-thirds of the money spent on Medicaid benefits is for low-income people who are 65 and older or disabled.
The government shutdown in 1995-96 stemmed, in part, from a conflict between President Bill Clinton and Congressional Republicans over what he described as “devastating cuts” in Medicaid and Medicare.
In his veto message in December 1995, Mr. Clinton listed 82 “objectionable provisions” of the Republicans’ budget bill. He complained that it “converts Medicaid into a block grant with drastically less spending.”
The Congressional Budget Office recently estimated that a Medicaid block grant, of the type proposed by Mr. Ryan and Ms. Rivlin, could save $180 billion over 10 years. House Republicans could save an additional $434 billion by eliminating the expansion in Medicaid eligibility scheduled to take place in 2014 under the new health care law.
Mr. Ryan said he was not cutting Medicaid and Medicare, but rather slowing their growth rate.
In addition, he insists he is not trying to convert Medicare to a voucher program because the money would be paid to insurance companies and health plans, not directly to beneficiaries. If health costs for a group of patients exceeded the federal payment in a given year, the insurer would have to absorb the cost.
Finally, Mr. Ryan says his proposal is equitable because Medicare would pay less on behalf of higher-income beneficiaries, and they would pay more of the cost of their health coverage.
But high-income Medicare beneficiaries already pay higher premiums, with an annual surcharge of more than $3,800 in premiums for some of the most affluent ones this year.
What Mr. Ryan and his committee plan to do this week is to approve a budget resolution, setting goals for spending and revenues. If approved by the House and the Senate in the same form, such a resolution would bind Congress in its deliberations, but it would not be presented to the president and would not become law.
There is almost no chance the Democratic-controlled Senate would adopt a resolution along the lines Mr. Ryan is proposing, although his counterpart in the Senate, Kent Conrad, Democrat of North Dakota, the chairman of the Senate Budget Committee, is working on a bipartisan plan to address entitlement spending as part of a broader package to reduce the budget deficit.
The budget resolution typically assumes changes in federal programs like Medicaid and Medicare. But those assumptions do not bind the House committees with power over those programs, which could choose to save the same amounts in other ways.
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