Alyssa Gerace | December 29, 2011 |
Home health care is being made available for up to 10,000 Medicare patients through a health care reform law demonstration that seeks to improve care and lower costs for seniors and people with disabilities, announced the Centers for Medicare & Medicaid Services (CMS).
“This program gives new life to the old practice of house calls, but with 21st Century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner.
The demonstration was developed through the Affordable Care Act, and will expand the scope of in-home services that Medicare beneficiaries can receive; participation is voluntary.
In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” said Tavenner. “When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided.”
CMS plans to partner with medical practices led by physicians or nurse practitioners to test the effectiveness of delivering primary care services in a home setting on improving care for the needs of Medicare beneficiaries with multiple chronic conditions.
Healthcare providers that show a reduction in Medicare expenditures will be rewarded through the demonstration program through incentive payment, if they succeed in providing high-quality care while reducing costs.
CMS will use “quality measures to ensure beneficiaries experience high quality care,” in keeping with its series if initiatives to build a Medicare program that offers beneficiaries “better care and better health at an affordable cost.”
The demonstration will be supported by the CMS innovation Center, which was created by the Affordable Care Act to develop and test new models of health care delivery and payment.
More information on the program can be found CMS innovation Center,
hereWritten by Alyssa Gerace
Friday, December 30, 2011
Saturday, December 10, 2011
federal vouchers to control the cost of Medicare
Medicare and Private Health Insurance
Published: December 9, 2011
To the Editor:
“What About Premium Support?” (editorial, Dec. 4), about federal vouchers to control the cost of Medicare, did not mention a compelling reason for not relying on private insurance.
It is generally agreed that this industry adds 15 to 20 percent to the cost of its premiums to pay for its business overhead and profits, whereas the administrative costs of Medicare are less than 5 percent.
The Centers for Medicare and Medicaid Services actuary estimates that private insurance overhead this year will amount to $152.1 billion and will continue to rise more rapidly than the total cost of health care in the years ahead.
Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?
ARNOLD S. RELMAN
Cambridge, Mass., Dec. 4, 2011
The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.
To the Editor:
Your editorial did not mention the significant fact that many of the best doctors have opted out of Medicare.
For those of us in the middle class who are on Medicare, a premium support system would enable us to go to our doctors of choice.
A premium support system must, of course, protect the elderly from being denied insurance coverage because of pre-existing conditions. If such protection is provided, the middle-class elderly might very well prefer a premium support system that gives us access to those doctors who have opted out of Medicare.
ROBERT R. SALMAN
Marlboro, N.J., Dec. 4, 2011
To the Editor:
Your editorial about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage.
I have been an advocate for Medicare beneficiaries for almost 35 years. I’ve seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program.
I don’t recommend a private plan to my mother. That should be a good test for anyone championing premium support.
Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system.
Call it what you will, “premium support” is the latest jingle for privatizing Medicare. It’s not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what’s needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
JUDITH STEIN
Executive Director
Center for Medicare Advocacy
Mansfield, Conn., Dec. 4, 2011
To the Editor:
Any comparison between Medicare Advantage and fee-for-service Medicare must acknowledge the fact that Medicare Advantage plans provide more and better benefits.
Unlike the outdated fee-for-service model, Medicare Advantage plans also emphasize prevention, wellness, care coordination and management of chronic conditions. In fact, analyses of federal data show that these plans are reducing preventable hospital readmissions and unnecessary hospitalizations compared with fee-for-service Medicare.
Medicare Advantage is improving the health of the elderly, while fostering the innovations needed to reduce health care cost growth and put Medicare on a sustainable path.
KAREN IGNAGNI
President and Chief Executive
America’s Health Insurance Plans
Washington, Dec. 5, 2011
Published: December 9, 2011
To the Editor:
“What About Premium Support?” (editorial, Dec. 4), about federal vouchers to control the cost of Medicare, did not mention a compelling reason for not relying on private insurance.
It is generally agreed that this industry adds 15 to 20 percent to the cost of its premiums to pay for its business overhead and profits, whereas the administrative costs of Medicare are less than 5 percent.
The Centers for Medicare and Medicaid Services actuary estimates that private insurance overhead this year will amount to $152.1 billion and will continue to rise more rapidly than the total cost of health care in the years ahead.
Turning more of the Medicare system over to private insurers would divert still more money into the pockets of this industry, taking it away from the direct provision of health care. Isn’t it time to consider how best to reduce — rather than increase — the role of this unneeded middleman industry, with its unnecessary and huge overhead?
ARNOLD S. RELMAN
Cambridge, Mass., Dec. 4, 2011
The writer, professor emeritus of medicine and social medicine at Harvard Medical School, is a former editor in chief of The New England Journal of Medicine.
To the Editor:
Your editorial did not mention the significant fact that many of the best doctors have opted out of Medicare.
For those of us in the middle class who are on Medicare, a premium support system would enable us to go to our doctors of choice.
A premium support system must, of course, protect the elderly from being denied insurance coverage because of pre-existing conditions. If such protection is provided, the middle-class elderly might very well prefer a premium support system that gives us access to those doctors who have opted out of Medicare.
ROBERT R. SALMAN
Marlboro, N.J., Dec. 4, 2011
To the Editor:
Your editorial about changing Medicare into a voucher system wisely states many of the problems with public subsidies of private health insurance for Medicare beneficiaries. All such experiments have cost more and provided less value to those in need of coverage.
I have been an advocate for Medicare beneficiaries for almost 35 years. I’ve seen numerous forays into privatizing Medicare. Clinton-era plans, Medicare Plus Choice, Medicare Advantage: none of them have provided better coverage more cost-effectively than the traditional Medicare program.
I don’t recommend a private plan to my mother. That should be a good test for anyone championing premium support.
Additionally, ever-increasing private options have made Medicare too complex, especially given the very limited number of advocates available to help beneficiaries understand, choose and navigate the system.
Call it what you will, “premium support” is the latest jingle for privatizing Medicare. It’s not a new or creative idea, and it will only add more costs and confusion. What we need is an objective look at what’s needed to encourage participation and cost efficiencies in traditional Medicare, not further adventures in privatization.
JUDITH STEIN
Executive Director
Center for Medicare Advocacy
Mansfield, Conn., Dec. 4, 2011
To the Editor:
Any comparison between Medicare Advantage and fee-for-service Medicare must acknowledge the fact that Medicare Advantage plans provide more and better benefits.
Unlike the outdated fee-for-service model, Medicare Advantage plans also emphasize prevention, wellness, care coordination and management of chronic conditions. In fact, analyses of federal data show that these plans are reducing preventable hospital readmissions and unnecessary hospitalizations compared with fee-for-service Medicare.
Medicare Advantage is improving the health of the elderly, while fostering the innovations needed to reduce health care cost growth and put Medicare on a sustainable path.
KAREN IGNAGNI
President and Chief Executive
America’s Health Insurance Plans
Washington, Dec. 5, 2011
Friday, December 9, 2011
Medicare Advantage plans for their benefits
It’s hard to believe, but Medicare’s open enrollment season began last week. And this year, as a result of the federal health reform law, seniors will have to brace for several changes.
Seniors who rely on privately administered Medicare Advantage plans for their benefits will face the biggest adjustments. That’s too bad, as Medicare Advantage has a strong track record of delivering health benefits that meet or even exceed those of conventional Medicare.
Medicare Advantage (MA) offers enrollees a different way of receiving their Part A hospital and Part B physician care. Under the program, private insurers offer competing plans, and patients themselves choose which coverage option works best for their particular health and financial needs. MA insurers must provide at least the same benefits as traditional Medicare, but most offer more. The government reimburses insurers at a preset rate per enrollee.
More than 12 million seniors participate in Medicare Advantage, about one-fourth of all those eligible for Medicare. The pool of MA beneficiaries has more than doubled since 2005.
The program has grown popular thanks in large part to its competitive structure, which encourages insurers to vie with one another for seniors’ health care dollars and thus provides them more choices.
But some policymakers believe the MA program to be wasteful. They cite the fact that Medicare Advantage costs the government more per enrollee than does traditional Medicare. They believe seniors would be better served if everyone were enrolled in the traditional Medicare program.
To aid in that pursuit, the PPACA law included a provision that changes the special Medicare Advantage open enrollment period that occurs each year in January. Previously, Medicare beneficiaries were allowed to either change from one Medicare Advantage plan to another Medicare Advantage plan or to change from Medicare Advantage to traditional fee-for-service Medicare. Beginning in January of 2012, seniors will only be allowed to opt out of the Medicare Advantage plan they chose in 2011 to enroll in traditional fee-for-service Medicare.
That’s just part of the pending assault on Medicare Advantage. This year, the health reform law froze Medicare Advantage payment rates to participating insurers at 2010 levels — that is, it didn’t allow reimbursements to be adjusted for inflation. Next year, payments will be cut even further. And over the next decade, Medicare Advantage funding is set to decline by $132 billion. By 2017, government number-crunchers expect that benefits for the average MA enrollee will be slashed by 27 percent, or $3,700.
The Congressional Budget Office (CBO) estimates these changes alone will cause some Medicare Advantage plans to exit the program and that as a result, enrollment will drop to 7.4 million by 2017. Medicare’s actuaries actually predict an even steeper fall-off of 50 percent.
Some speculate that those who dislike Medicare Advantage want to use these methods to marginalize Medicare Advantage to the point of non-existence. This is exactly what happened to Medicare + Choice in the late 1990′s when payments got so low that plans were forced to leave large areas of the country, especially in rural areas.
That’s a shame, as Medicare Advantage delivers more benefits — and superior outcomes — than traditional Medicare. According to the CBO, individual patients enjoy many value added services that help them maintain their health and well-being, such as lower co-pays, premium rebates, and coverage or deep discounts for services like dental work and eyeglasses.
MA beneficiaries are also much healthier than their counterparts in traditional Medicare. A 2004 study found that MA plans achieved better outcomes than traditional Medicare in five of seven core indicators, including breast-cancer screenings, diabetes testing, and treatment after heart attacks.
Advantage enrollees in California spend 30 percent fewer days in hospitals than those in traditional Medicare. In Nevada, they spend 23 percent fewer days. Less time in the hospital is good news not just for patients — but for federal coffers, too.
Medicare Advantage represents just the kind of innovative health care model that could help drive down long-term health costs and improve health care in this country. Congress should make it easier to opt in, not out. And if seniors want to change plans, they should have a full range of choices available to them.
By Janet Trautwein, who is CEO of the National Association of Health Underwriters.
1 Vote
Seniors who rely on privately administered Medicare Advantage plans for their benefits will face the biggest adjustments. That’s too bad, as Medicare Advantage has a strong track record of delivering health benefits that meet or even exceed those of conventional Medicare.
Medicare Advantage (MA) offers enrollees a different way of receiving their Part A hospital and Part B physician care. Under the program, private insurers offer competing plans, and patients themselves choose which coverage option works best for their particular health and financial needs. MA insurers must provide at least the same benefits as traditional Medicare, but most offer more. The government reimburses insurers at a preset rate per enrollee.
More than 12 million seniors participate in Medicare Advantage, about one-fourth of all those eligible for Medicare. The pool of MA beneficiaries has more than doubled since 2005.
The program has grown popular thanks in large part to its competitive structure, which encourages insurers to vie with one another for seniors’ health care dollars and thus provides them more choices.
But some policymakers believe the MA program to be wasteful. They cite the fact that Medicare Advantage costs the government more per enrollee than does traditional Medicare. They believe seniors would be better served if everyone were enrolled in the traditional Medicare program.
To aid in that pursuit, the PPACA law included a provision that changes the special Medicare Advantage open enrollment period that occurs each year in January. Previously, Medicare beneficiaries were allowed to either change from one Medicare Advantage plan to another Medicare Advantage plan or to change from Medicare Advantage to traditional fee-for-service Medicare. Beginning in January of 2012, seniors will only be allowed to opt out of the Medicare Advantage plan they chose in 2011 to enroll in traditional fee-for-service Medicare.
That’s just part of the pending assault on Medicare Advantage. This year, the health reform law froze Medicare Advantage payment rates to participating insurers at 2010 levels — that is, it didn’t allow reimbursements to be adjusted for inflation. Next year, payments will be cut even further. And over the next decade, Medicare Advantage funding is set to decline by $132 billion. By 2017, government number-crunchers expect that benefits for the average MA enrollee will be slashed by 27 percent, or $3,700.
The Congressional Budget Office (CBO) estimates these changes alone will cause some Medicare Advantage plans to exit the program and that as a result, enrollment will drop to 7.4 million by 2017. Medicare’s actuaries actually predict an even steeper fall-off of 50 percent.
Some speculate that those who dislike Medicare Advantage want to use these methods to marginalize Medicare Advantage to the point of non-existence. This is exactly what happened to Medicare + Choice in the late 1990′s when payments got so low that plans were forced to leave large areas of the country, especially in rural areas.
That’s a shame, as Medicare Advantage delivers more benefits — and superior outcomes — than traditional Medicare. According to the CBO, individual patients enjoy many value added services that help them maintain their health and well-being, such as lower co-pays, premium rebates, and coverage or deep discounts for services like dental work and eyeglasses.
MA beneficiaries are also much healthier than their counterparts in traditional Medicare. A 2004 study found that MA plans achieved better outcomes than traditional Medicare in five of seven core indicators, including breast-cancer screenings, diabetes testing, and treatment after heart attacks.
Advantage enrollees in California spend 30 percent fewer days in hospitals than those in traditional Medicare. In Nevada, they spend 23 percent fewer days. Less time in the hospital is good news not just for patients — but for federal coffers, too.
Medicare Advantage represents just the kind of innovative health care model that could help drive down long-term health costs and improve health care in this country. Congress should make it easier to opt in, not out. And if seniors want to change plans, they should have a full range of choices available to them.
By Janet Trautwein, who is CEO of the National Association of Health Underwriters.
1 Vote
Monday, December 5, 2011
Medicare Premiums for 2012:
Part A: (Hospital Insurance) Premium
· Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
· The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
· The Part A premium is $451.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.
In 2012, Social Security monthly payments to enrollees will increase by 3.6 percent. The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income. Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.
In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount. These income-related amounts were phased-in over three years, beginning in 2007. About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.
For additional details, see our FAQ titled: "2012 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2012:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
· A total of $1,156 for a hospital stay of 1-60 days.
· $289 per day for days 61-90 of a hospital stay.
· $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
· All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
· $144.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
· $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2012 is available in the October 27, 2011 Fact Sheet titled, "Medicare Premiums and Deductibles for 2012" on the www.cms.gov website.
· Most people do not pay a monthly Part A premium because they or a spouse has 40 or more quarters of Medicare-covered employment.
· The Part A premium is $248.00 per month for people having 30-39 quarters of Medicare-covered employment.
· The Part A premium is $451.00 per month for people who are not otherwise eligible for premium-free hospital insurance and have less than 30 quarters of Medicare-covered employment.
Part B: (Medical Insurance) Premium
The standard Medicare Part B monthly premium will be $99.90 in 2012, a $15.50 decrease over the 2011 premium of $115.40. However, most Medicare beneficiaries were held harmless in 2011 and paid $96.40 per month. The 2012 premium represents a $3.50 increase for them.
In 2012, Social Security monthly payments to enrollees will increase by 3.6 percent. The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income. Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2012 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.
In addition to the standard Part B premium, affected beneficiaries must pay an income-related monthly adjustment amount. These income-related amounts were phased-in over three years, beginning in 2007. About 4 percent of current Part B enrollees are expected to be subject to these higher premium amounts.
For additional details, see our FAQ titled: "2012 Part B Premium Amounts for Persons with Higher Income Levels".
Medicare Deductible and Coinsurance Amounts for 2012:
Part A: (pays for inpatient hospital, skilled nursing facility, and some home health care) For each benefit period Medicare pays all covered costs except the Medicare Part A deductible (2012 = $1,156) during the first 60 days and coinsurance amounts for hospital stays that last beyond 60 days and no more than 150 days.
For each benefit period you pay:
· A total of $1,156 for a hospital stay of 1-60 days.
· $289 per day for days 61-90 of a hospital stay.
· $578 per day for days 91-150 of a hospital stay (Lifetime Reserve Days).
· All costs for each day beyond 150 days
Skilled Nursing Facility Coinsurance
· $144.50 per day for days 21 through 100 each benefit period.
Part B: (covers Medicare eligible physician services, outpatient hospital services, certain home health services, durable medical equipment)
· $140.00 per year. (Note: You pay 20% of the Medicare-approved amount for services after you meet the $140.00 deductible.)
Additional information about the Medicare premiums, deductibles, and coinsurance rates for 2012 is available in the October 27, 2011 Fact Sheet titled, "Medicare Premiums and Deductibles for 2012" on the www.cms.gov website.
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