How Medicare Open Enrollment Can Save -- or Cost You Hundreds By Ross Blair, September 14, 2012 Text Size: -+ 0 Comments Follow This Print Email Share on facebook_like Whether you're approaching age 65 or already enrolled in Medicare, you should take advantage of the annual enrollment period (AEP) – a once-a-year opportunity to review Medicare Advantage and prescription drug plans coverage options and see whether you are enrolled in the most cost-effective plan for your needs. Research by PlanPrescriber.com shows that a large majority of Medicare beneficiaries could have saved hundreds of dollars last year by reviewing just one element of their coverage: their prescription drug plan. While it may be easy to come up with other things you'd rather do this fall, taking time now time now to review all aspects of your coverage options could really pay off. AEP is coming early again this year, a month earlier than usual, running from Oct. 15 to Dec. 7. Though Medicare beneficiaries have eight weeks to select their coverage, last year 42 percent of people waited until the last nine days to apply, according to research by PlanPrescriber.com. However, this is not a decision you want to rush or put off until the last minute. Last year, federal officials extended the Dec. 7 deadline for three days for certain people because of influx of last-minute sign-ups. You can avoid the rush this year and start comparing plans Oct. 1 to prepare to enroll Oct. 15. We've compiled some important tips for people on Medicare to help ensure they pick the best Medicare Advantage or prescription drug coverage for their specific needs. Understand the basics before filling in the gaps Understanding Medicare can be challenging, but it's important to understand what Original Medicare (Parts A and B) cover before weighing other options. Once you understand the basics, you can compare products designed specifically to fill some of the different gaps in Medicare. They include: Medicare Part D stand-alone prescription drug plans, which cover the cost of most prescription drugs; Medicare supplement plans, which cover portions of the deductibles, coinsurance and out-of-pocket costs not covered by original Medicare; and Medicare Advantage plans, which bundle together the Part D drug benefit with some additional coverage for deductibles, coinsurance and out-of-pocket costs. Each type of supplemental coverage has different guidelines for when you can enroll, change and cancel your coverage. Prescription drug plans can change every year so check the benefits for 2013 If you get coverage through a Medicare Advantage or prescription drug plan, know that most plans change their pricing and benefits each year. You can use an online tool to see whether and how your prescriptions drugs will be covered in 2013. According to a study by PlanPrescriber.com, the average person could have saved $654 in 2012 by changing their coverage to a plan that covered their drugs at the lowest possible cost. Factor in costs like copays and deductibles At first glance, it may appear best to go with the plan with the lowest premium. However, you are still responsible for out-of-pocket costs. Also consider such costs as doctor's office copayments and deductibles. Those expenses can add up, meaning the plan with the lowest premium could cost you more in the long run. If you're turning 65 during the enrollment period, happy birthday and know the deadlines Hundreds of thousands of people will turn 65 during this year's annual enrollment period. If you're already getting Social Security benefits, you will be contacted a few months before you become eligible for Medicare and given the information you need. Most people are enrolled in Medicare Parts A and B (Original Medicare) automatically. While you're celebrating, keep in mind that other types of coverage have different deadlines that are important to remember: •Part D prescription drug plans. You must enroll during the annual enrollment period. •Medicare Advantage. You have three months to sign up after you enroll in Medicare Part A and Part B benefits. Otherwise, you'll have to wait for next year's annual enrollment period. •Medicare Supplement insurance (Medigap). The Medicare Supplement Open Enrollment Period is six months, beginning the first day of the month in which you are both age 65 (or older) and enrolled in Medicare Part B. If you miss the Medicare Supplement Open Enrollment Period, your application could be declined if you have a pre-existing medical condition or you may be charged more for coverage. Finally, remember that there's no reason to enroll without help. Qualified professionals can help you understand your options and select a plan. You can get help through your State Health Insurance Assistance Program (SHIP), websites like www.PlanPrescriber.com, licensed health insurance agents who are certified to sell Medicare, or by calling 1-800-Medicare.

Medicare Killers

The Republican Party is now firmly committed to replacing Medicare with what we might call Vouchercare. The government would no longer pay your major medical bills; instead, it would give you a voucher that could be applied to the purchase of private insurance. And, if the voucher proved insufficient to buy decent coverage, hey, that would be your problem. Moreover, the vouchers almost certainly would be inadequate; their value would be set by a formula taking no account of likely increases in health care costs. Why would anyone think that this was a good idea? The G.O.P. platform says that it “will empower millions of seniors to control their personal health care decisions.” Indeed. Because those of us too young for Medicare just feel so personally empowered, you know, when dealing with insurance companies. Still, wouldn’t private insurers reduce costs through the magic of the marketplace? No. All, and I mean all, the evidence says that public systems like Medicare and Medicaid, which have less bureaucracy than private insurers (if you can’t believe this, you’ve never had to deal with an insurance company) and greater bargaining power, are better than the private sector at controlling costs. I know this flies in the face of free-market dogma, but it’s just a fact. You can see this fact in the history of Medicare Advantage, which is run through private insurers and has consistently had higher costs than traditional Medicare. You can see it from comparisons between Medicaid and private insurance: Medicaid costs much less. And you can see it in international comparisons: The United States has the most privatized health system in the advanced world and, by far, the highest health costs. So Vouchercare would mean higher costs and lower benefits for seniors. Over time, the Republican plan wouldn’t just end Medicare as we know it, it would kill the thing Medicare is supposed to provide: universal access to essential care. Seniors who couldn’t afford to top up their vouchers with a lot of additional money would just be out of luck. Still, the G.O.P. promises to maintain Medicare as we know it for those currently over 55. Should everyone born before 1957 feel safe? Again, no. For one thing, repeal of Obamacare would cause older Americans to lose a number of significant benefits that the law provides, including the way it closes the “doughnut hole” in drug coverage and the way it protects early retirees. Beyond that, the promise of unchanged benefits for Americans of a certain age just isn’t credible. Think about the political dynamics that would arise once someone born in 1956 still received full Medicare while someone born in 1959 couldn’t afford decent coverage. Do you really think that would be a stable situation? For sure, it would unleash political warfare between the cohorts — and the odds are high that older cohorts would soon find their alleged guarantees snatched away.

To the Editor: Re “Truth and Lies About Medicare” (editorial, Aug. 19): As a former chief executive and actuary of an insurance company that once sold both individual and group health insurance, I am particularly mystified by the effort to push Medicare participants into the individual health insurance market. I thought that we wanted to reduce — or at least control — the cost of health insurance, but individual health insurance is by far the most expensive alternative. Depending on the size of the vouchers, the government itself may save money, but the entire system will pay more. Someone has to pay for the costs of individual underwriting, marketing and so on, and those expenses will fall on the elderly themselves. You are also correct in assuming that there is likely to be anti-selection, with the healthier people going to the insurance companies, leaving the sickest and most expensive people in the Medicare plan. It is certainly true that health insurance needs reform and that President Obama is far from having all the answers, but the Romney-Ryan plan will increase the country’s health care bill with little or any of the increase going to more or better health care. STEPHEN BROWN Brewster, Mass., Aug. 19, 2012 The writer is a former chairman and chief executive of John Hancock Financial Services. -- Howard McGowan MaldenSenior

                  The improved Medicare-for-all approach would
eliminate the greatest waste in the health care system: the needless
costs imposed by the private health insurers. These firms impose
hundreds of billions of dollars of excess cost on us via their
excessive profit-taking and executive compensation, their marketing
expenses, their vast bureaucracies devoted to denying care, and their
imposition of massive paper-pushing obligations on actual health care
providers.
                        It is not for lack of policy justification or
moral force that Americans continue to suffer from a malfunctioning
health care system. Our failure to have adopted improved Medicare for
all is due entirely to the political power of the health insurance
industry.
                        That political power can be overcome, however,
by a grassroots movement that musters enough of its own strength. The
country cannot survive the ongoing reign of the private health
insurance industry, and it will not.
Public Citizen Health Care for all

Medicare have paid less for health care and prescription drugs,

For Immediate Release:	Thursday, May 24, 2012
Contact:	CMS Office of Public Affairs 202-690-6145

HEALTH CARE LAW SAVED PEOPLE WITH MEDICARE OVER $3.5 BILLION ON PRESCRIPTION DRUGS
IN THE FIRST FOUR MONTHS OF 2012, MORE THAN 416,000 PEOPLE WITH MEDICARE SAVED AN AVERAGE OF $724 ON PRESCRIPTION DRUGS AND 12.1 MILLION USED A FREE PREVENTIVE SERVICE

Under the new health care law – the Affordable Care Act -- seniors and people with disabilities in Medicare have saved a total of $3.5 billion on prescription drugs in the Medicare drug benefit coverage gap or “donut hole” from the enactment of the law in March 2010 through April of 2012. The Centers for Medicare & Medicaid Services (CMS) released data today showing that, in the first four months of 2012 alone, more than 416,000 people saved an average of $724 on the prescription drugs they purchased after they hit the prescription drug coverage gap or “donut hole,” for a total of $301.5 million in savings. These savings build on the law’s success in 2010 and 2011, when more than 5.1 million people with Medicare saved over $3.2 billion on prescription drugs.

In addition, CMS announced that this year, from January through April, 12.1 million people in traditional Medicare received at least one preventive service at no cost to them – including over 856,000 who have taken advantage of the Annual Wellness Visit provided in the Affordable Care Act. In 2011, over 26 million people in traditional Medicare received one or more preventive benefits free of charge.

“Thanks to the health care law, millions of people with Medicare have paid less for health care and prescription drugs,” said CMS Acting Administrator Marilyn Tavenner. “The law is helping people with Medicare lower their medical costs, and giving them more resources to stay healthy.”

People with Medicare who hit the coverage gap “donut hole” in 2010 received a one-time $250 rebate. In 2011, people with Medicare began receiving a 50 percent discount on covered brand name drugs and 7 percent coverage of generic drugs in the “donut hole.” This year, Medicare coverage for generic drugs in the coverage gap has risen to 14 percent. Coverage for both brand name and generic drugs in the gap will continue to increase over time until 2020, when the coverage gap will no longer exist.

For more information on how the Affordable Care Act closes the Medicare drug benefit coverage gap “donut hole,” please visit: http://www.healthcare.gov/law/features/65-older/drug-discounts/index.html.

Prior to 2011, people with Medicare faced cost-sharing for many preventive benefits like cancer screenings and smoking cessation counseling. Now, many of these benefits are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to find and treat problems early.

For more information on Medicare-covered preventive services, many of which are now provided without charge to beneficiaries thanks to the Affordable Care Act, please visit: http://www.healthcare.gov/law/features/65-older/medicare-preventive-services/index.html.

To learn what screenings, vaccinations and other preventive services doctors recommend for you and those you care about, please visit the myhealthfinder tool at www.healthfinder.gov.

REIBURSMENT CUTS MEDICARE HOSPITALS

SKILLED NURSING HOME FACILITIES

Starting October 1, hospitals in the bottom quartile for readmissions will get across-the-board reimbursement cuts from Medicare

Skilled nursing facilities should capitalize on their data to become attractive partners to either hospitals in trouble, or well-performing hospitals that want to stay on to,

“SNFs have a very attractive opportunity to step up their game,

The door is wide open for SNFs. For those willing to attack readmissions and position quality benefits, there are attractive reasons to partner with them from a hospital’s standpoint given the real value: great care at a great price.”

, “Advancing Accountable Care,” discussed the longevity of the model.

“The philosophy of accountable care is here to stay,

. “Regardless of the [healthcare reform] law, we will continue to pursue this model.”

“I believe nursing homes are in a unique position to help hospitals stabilize patients after discharge,” Another significant role is short-term rehab, to help those discharge patients attain or maintain the quality of care and help their acute care partner achieve the [required] quality measures.”

It’s important for skilled nursing facilities to demonstrate their value and how they compare to others in terms of quality of care and outcomes,

If SNFs can prove they sustainably have low readmission rates, they can position themselves well with hospitals—which revenue and reputation depend on,

“Embrace the gift of early intelligence: attack readmissions now,

Market your attractive outcomes,

Win census for hospitals, and be well positioned when readmissions-related cuts come to your neighbors caught flat-footed,

The paper’s contents include how skilled nursing facilities compare to other post-acute care providers in terms of hospital readmission rates and costs

;What hospitals are looking for, as described by three major health systems;

What data SNFs will need to be attractively positioned with hospitals at the negotiating tables

Three imperatives for SNFs preparing for meeting with hospitals in an outcomes-driven healthcare world.

The bottom line, “Facts are friends, and you must line them up to win partnerships in the new era of post-acute care.”

Medicaire Advantage Plans

Medicare Advantage (Part C)

What is a Medicare Advantage Plan (Part C)?

A Medicare Advantage Plan (like an HMO or PPO) is another Medicare health plan choice you may have as part of Medicare. Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare.
If you join a Medicare Advantage Plan, the plan will provide all of your Part A (Hospital Insurance) and Part B (Medical Insurance) coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).
Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist or if you have to go to only doctors, facilities, or suppliers that belong to the plan for non‑emergency or non-urgent care). These rules can change each year.

Different Types of Medicare Advantage Plans

• Health Maintenance Organization (HMO) Plans
• Preferred Provider Organization (PPO) Plans
• Private Fee-for-Service (PFFS) Plans
• Special Needs Plans (SNP)

There are other less common types of Medicare Advantage Plans that may be available:

• HMO Point of Service (HMOPOS) Plans— An HMO plan that may allow you to get some services out-of-network for a higher cost.

• Medical Savings Account (MSA) Plans - A plan that combines a high deductible health plan with a bank account. Medicare deposits money into the account (usually less than the deductible). You can use the money to pay for your health care services during the year.

How Much Does a Medicare Advantage Plan Cost?

In addition to your Part B premium, you usually pay one monthly premium for the services included. Each Medicare Advantage Plan can charge different out of-pocket costs. Your out-of-pocket costs in a Medicare Advantage Plan depend on:

• Whether the plan charges a monthly premium.
• Whether the plan pays any of your monthly Part B premium.
• Whether the plan has a yearly deductible or any additional deductibles.
• How much you pay for each visit or service (copayments or coinsurance).
• The type of health care services you need and how often you get them.
• Whether you follow the plan’s rules, like using network providers.
• Whether you need extra benefits and if the plan charges for them.
• The plan’s yearly limit on your out-of-pocket costs for all medical services.

What Does a Medicare Advantage Plan Cover?

In all types of Medicare Advantage Plans, you’re always covered for emergency and urgent care. Medicare Advantage Plans must cover all of the services that Original Medicare covers except hospice care. Original Medicare covers hospice care even if you’re in a Medicare Advantage Plan. Medicare Advantage Plans aren’t supplemental coverage. Medicare Advantage Plans may offer extra coverage, such as vision, hearing, dental, and/or health and wellness programs. Most include Medicare prescription drug coverage (Part D).

How to Join a Medicare Advantage Plan

Not all Medicare Advantage Plans work the same way, so before you join, take the time to find and compare Medicare Health Plans in your area. Once you understand the plan’s rules and costs, you may be able to join by completing a paper application, calling the plan, or enrolling on the plan's Web site. Medicare also has information on quality to help you compare plans.

A Few Extra Things You Should Know about Medicare Advantage Plans

• You can only join a plan at certain times during the year. In most cases, you're enrolled in a plan for a year.
• As with Original Medicare, you still have Medicare rights and protections, including the right to appeal.
• Check with the plan before you get a service to find out whether they will cover the service and what your costs may be.
• You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan.
• You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease.
• If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan.
• If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.

Related Links

• Your Guide to Medicare Medical Savings Account Plans
• Your Medicare Benefits
• Use Medicare's Information on Quality to Help You Compare Plans
• Your Guide to Medicare Private Fee-for-Service Plans
• Your Guide to Medicare Special Needs Plans

Medicare & You Handbook

Medicare payment and reimbursement reductions,

Even after steep cuts to skilled nursing facility reimbursements that went into effect last October, President Obama’s 2013 Federal Budget calls for still more Medicare payment and reimbursement reductions, causing associations representing the skilled nursing and home healthcare industries to blast back against the Administration’s strategy of “cuts only” without reforms.

The budget report proposes adjusting payment updates for certain post-acute care providers (such as skilled nursing facilities), equalizing payments for certain conditions commonly treated in skilled nursing facilities, and adjusting skilled nursing facility payments to reduce unnecessary hospital readmissions, saying that these policies will save approximately $63 billion in the next 10 years.

The report also points out that Medicare beneficiaries don’t currently make copayments for home health services, and proposes creating a copayment of $100 per home health visit when there are five or more visits that haven’t been preceded by a hospital or other inpatient post-acute stay. This would begin in 2017 for new beneficiaries, and is expected to save approximately $350 million throughout a 10-year timeframe.

Skilled Nursing and Assisted Living

This “cuts only” approach with no reforms is wrong, says the American Health Care Association/National Center for Assisted Living (AHCA/NCAL).

“Our organization’s approach has been to work with the Administration and Congress to improve the lives and care delivery while at the same time working to remove costs out of the system,” said Mark Parkinson, President and CEO of AHCA/NCAL. “We do that by reducing hospital readmissions, placing seniors in the most appropriate health settings, and redoubling our efforts on quality. We shouldn’t have an approach focused solely on cuts. Unfortunately, the President’s budget reflects that singular direction.”

This sort of budgeting “violates the basic contract between the government and beneficiaries” that covered services will be paid, he said.

“Medicare and Medicaid funding for senior health care should be fully paid for. We want to and will work with both parties and this administration to meet the commitments we made years ago to the Greatest Generation and their families,” said Parkinson, mentioning his association’s recommendations for an alternative to reducing Medicare reimbursements.

For its part, the Alliance for Quality Nursing Home Care also decried Obama’s budget.

“With America’s skilled nursing facility sector already slated to absorb $127 billion in Medicare reductions over the FY 2012-2021 budget window, any additional direct payment cuts in the FY 2013 federal budget will further jeopardize seniors’ access to quality care, worsen facility job losses, and risk pushing America’s second largest health facility employer over the edge,” said Alan Rosenbloom, present of the Alliance.

Home Health Care

Cuts to home healthcare will limit patient access to “clinically advanced, cost-effective care that an overwhelming majority of American seniors prefer,” says the Partnership for Quality Home Healthcare.

Instead of across-the-board Medicare cuts, the Medicaid and Medicare programs should be strengthened through integrity reforms, says the healthcare group.

“Simply put, there’s a better way to save money than by increasing costs on America’s seniors and endangering the high-quality, low-cost services they need. That’s why many lawmakers prefer program integrity reform, like the home healthcare community’s detailed proposal, because it generates billions in savings without harming innocent seniors or cost-efficient providers,” said Billy Tauzin, former House Energy Commerce Committee chairman and senior counsel to the Partnership for Quality Home Healthcare, in a statement.

The home healthcare community proposed payment reforms in 2009 that achieved nearly $1 billion in Medicare savings in 2010 alone, according to data from the Centers for Medicare & Medicaid Services (CMS)—equivalent to nearly $11 billion of savings in the next 10 years.

Armed with this data, the group believes this policy is evidence that “targeted program integrity reform can generate significant savings without impacting beneficiaries or cost-efficient providers.”

“We as Congress to strongly consider the solutions the home healthcare community has put forth, which achieve significant savings and delivery system improvements without asking our nation’s sickest and poorest seniors to shoulder the burden of an expensive copayment, which many patients simply cannot afford,” said Senator John Breaux (D-La.) in a statement.

Written by Alyssa Gerace