Georgia Health Insurance 411

Posts Tagged ‘Medicare’

In order to avoid “adding one dime to the deficit”, Obamacare (Patient Protection and Unaffordable Health Care Act) had to play shell games with the funding. One way was to cut pay to doctors who treat Medicare patients by 21%.

In doing so they stripped billions out of the cost of Obamacare by projecting a $200 billion savings by cutting Medicare. The game plan was to add those billions back in via a separate bill termed “doc fix”.

Problem is, they haven’t yet “fixed” the problem and the docs are no longer joining hands with Congress and signing Kum Ba Ya.

Yesterday during a routine doctor visit there was a flyer advising patients to call their Senator and protest the Medicare cuts. If the cuts go through, this practice would have to limit the number of Medicare patients they treat and probably stop accepting new ones.

The folks at myway news have this to report.

For the third time this year, Congress is scrambling to stave off a hefty pay cut to doctors treating Medicare patients – even as the Obama administration mails out a glossy brochure to reassure seniors the health care program is on solid ground.

The 21.3 percent cut will take effect June 1 unless Congress intervenes in the next few days. Recurring uncertainty over Medicare fees is making doctors take a hard look at their participation in a program considered a bedrock of middle-class retirement security.

Don’t mess with the gray panthers. They are a large and vocal group. As baby boomer’s age into the system not only will they grow in number but it will put even more financial stress on an already leaky system.

“We will not have that cut,” House Speaker Nancy Pelosi, D-Calif., vowed Wednesday.

If Princess Nancy is to be believed, then that means the funding has to come from somewhere. There are only three ways to keep Medicare in play.

Cut reimbursement to doctors.

Increase taxes.

Restrict benefits such as through death squads.

“In the past two years, (lawmakers) keep coming up to the deadline – or a little past it – and waiving the cuts for shorter and shorter periods of time, which makes us uneasy,” said Dr. Susan Crittenden, a primary care physician practicing near Raleigh, N.C.

“The current uncertainty about what the fee schedule will be, and whether at some point there will be a 20 percent cut, makes it harder to accept new Medicare patients,” Crittenden said.

This uncertainty is what is prompting many docs to fire a shot across the bow of Obamacare.

Economist Marilyn Moon, a former Medicare trustee had this observation.

It’s irresponsible” that the health care law left such a major issue unresolved, she said, while at the same time claiming to reduce the federal deficit.

Irresponsible is a good word.

So is liar, as in say anything to gain voter support then do what you want afterward.

Meanwhile, at a Capitol Hill news conference Wednesday, the Obama administration unveiled a brochure explaining the benefits of the new health care law to seniors. The government is mailing it to more than 40 million Medicare recipients, and Republicans are criticizing it as political spin. The law, says the brochure, “keeps Medicare strong and solvent.”

Yeah, and if you like the health care plan you have now, you can keep it.

At least until Congress quits funding it.

Just another stupid government trick.

The people at About.com answered this question from a reader regarding doctors that do not accept Medicare assignment. For an aging generation of “boomer’s”, as well as those already on Medicare, the answers are enlightening.

Medicare regularly cuts the rates of reimbursement, which means doctors earn less for office visits and various procedures

There is a longer delay than ever before for doctors to get reimbursements from Medicare

Medicare has a very convoluted, bureacratic process that allows some tests and treatments, refuses to pay for others, and limits how a doctor can practice medicine

Private insurers set low reimbursement rates for various services and treatments, rates that may not even cover a doctor’s overhead.

Insurers often systematically make reimbursement deliberately difficult, complicated and time-consuming.

When reimbursement is approved, payments from insurers can be extremely slow to reach the physician.

Doctors may need additional staff to handle the extra paperwork, phone calls, resubmissions, and negotiation with insurance companies.

Roughly 1 in 5 covered participants over age 65 have opted for Medicare Part C, commonly referred to as Medicare Advantage Plans. These plans have been targeted by the Obama administration for reduced funding. This makes the future of these attractive plans questionable.

With anticipated cuts in reimbursement to doctors who accept Medicare assignment, plus reduced funding for Medicare Advantage Plans, you can expect your costs to rise significantly and the availability of doctors willing to treat Medicare patients to be reduced.

Having trouble deciding on a Medicare Prescription Drug Plan? You are not alone. CVS can help.

They have a calculator to help you find the right plan. Enter your medications and the calculator compares different plans and shows potential savings.

They even have a short quiz that rewards you with a $5 off coupon.

The SSA will announce no 2010 COLA for seniors on Social Security but Obama has a plan. Instead of a cost of living increase, 50 million seniors will get $250 checks.

Medicare part A deductibles will increase but most will see no change in Part B premiums or deductibles. However, roughly a fourth will see increases in part B premiums.

Medicare Part D premiums will increase as will drug prices. Of course that just means you will satisfy your donut hole much quicker.

Overall, CMS is proposing a 21.5% decrease in funding for physician payments. This means fewer physicians willing to treat Medicare patients.

Changes you can believe in.

Yes you can.

Tony Soprano skimming Medicare? Say it ain’t so!

Around the nation, federal investigators have been threatened, an informant’s body was found riddled with bullets, and a woman was discovered dead in a pharmacy under investigation, her throat slit with a piece of broken toilet seat.

For criminals, Medicare schemes offer a greater payoff and carry much shorter prison sentences than offenses such as drug trafficking or robbery.

Who knew?

A Medicare scammer could easily net at least $25,000 a day while risking a relatively modest 10 years in prison if convicted on a single count. A cocaine dealer could take weeks to make that amount while risking up to life in prison.

Something terribly wrong with this picture.

And 11 members of New York’s Bonanno family were indicted in May in a Medicare fraud scheme in South Florida. They were accused of stealing patients’ Medicare numbers and using them to submit false claims. Other allegations included identity theft and conspiring to commit murder.

This must be the fraud and abuse that Obamacare is going to cure.

Bada bing!

Medicare will pay for a kidney transplant then expects you to die in 3 years. Bet you didn’t know that.

According to the WSJ Health Blog, Medicare could save lives and money by making beneficial changes to the way they approve treatment but they choose not to.

Medicare’s three-year limit on payment for anti-organ-rejection drugs led to a woman needing a second kidney transplant, because she couldn’t afford to the medicine that would have allowed her to keep her first transplanted kidney in healthy, working condition.

The cost of anti-rejection drugs for the patient? $1,000 to $3,000 a month. Cost of the second transplant? $125,000. The average Medicare expenditure per kidney transplant patient care is $17,000 yearly, while it’s $71,000 a year for dialysis patients and $106,000 for a transplant, according to the Times.

According to the NY Times, Melissa Whitaker found herself in a Medicare conundrum.

Ms. Whitaker, 31, who describes herself as “kind of a nerd,” has Alport syndrome, a genetic disorder that caused kidney failure and significant hearing loss by the time she was 14. In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease.

By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again.

“If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker

So rather than paying $1000 – $3000 per month for anti-rejection meds beyond the arbitrary 36 month limit, Medicare in their infinite wisdom put her back on dialysis, approved a second transplant, and started her on a new 36 month plan.

The most recent report from the United States Renal Data System found that Medicare spends an average of $17,000 a year on care for kidney transplant recipients, most of it for anti-rejection drugs. That compares with $71,000 a year for dialysis patients and $106,000 for a transplant (including the first year of monitoring).

This reminds me of Jay Leno’s question to Hugh Grant following Hugh’s incident with a transvestite hooker.

“What were they thinking?”

In an effort to seize more power, Mr. Fixit has asked Congress to relinquish control of price setting for Medicare reimbursement to the White House. According to Breitbart,

The proposal would allow an independent advisory board to recommend changes in Medicare reimbursement rates for doctors, hospitals and other providers. If the president approved the recommendations, Congress could still vote to reject them altogether. But Congress could not approve some recommendations and reject others.

Currently, Medicare reimbursement rates vary from region to region. Key lawmakers often get involved in setting local rates, a practice the Obama administration plan would end.

The current Medicare reimbursement rate is the least of any “insured” plan other than Medicaid. Many doctors limit the number of Medicare patients they will treat or refuse to accept any Medicare patients at all.

In most areas, about half of all doctors do not accept Medicare assignment.

Currently, Medicare reimbursements are scheduled to be reduced by 21% in January, 2010. This means doc’s who currently accept Medicare assignment would receive a 21% pay cut starting in January of next year if the scheduled cuts are put in place. The most likely result would be even fewer doctor’s willing to treat Medicare patients.

If the White House is given supreme power over Medicare reimbursement one has to wonder how deep the cuts will be and how few doctor’s and hospitals would be willing to accept Medicare patients.

Almost one out of three American’s is covered by Medicare or Medicaid. (If Medicare reimbursement is cut so would Medicaid. Reimbursement rates for Medicaid is 10 – 14% less than Medicare levels).

The good news is, any reduction in reimbursement for M/M reduces the tax bill for those who pay Medicare taxes.

The bad news is, reductions in M/M reimbursement means fewer medical providers willing to treat those patients and more out of pocket for people on M/M.

Seems like everyone complains that it is impossible to find affordable health insurance in Georgia. Now a fellow blogger has some rather drastic suggestions that have merit. His tongue is firmly planted in his cheek . . .

Mr. Fixit seems hell-bent on destroying the best health care system in the world and lowering costs, so here are some solutions put forth by Medical Pastiche.

Outlaw all forms of health insurance. Read the rest of this entry »

Some in Washington want to put all of us in Medicare. That might not be such a good idea.

You see, Medicare is expected to run out of money in 2017.

Contributing factors?

Millions fewer people are working and paying the taxes that support the programs; yet health care costs are continuing to soar, millions of baby boomers have begun receiving Social Security retirement benefits, and Americans are living longer.

Medicare expenses are now expected to surpass Social Security’s in 2028.

Did you catch that?

The cost of running Medicare is expected to surpass the cost of Social Security in less than 20 years. Read the rest of this entry »

Want to see a Georgia doctor?

Take a number.

This is especially so if you are a new patient, do not have health insurance, have Medicare, Medicaid or PeachCare. So if we are having problems now, what happens when it is free?

Obama administration officials, alarmed at doctor shortages, are looking for ways to increase the number of physicians to meet the needs of an aging population and millions of uninsured people who would gain coverage under legislation championed by the president.

You can’t just push a button and “poof” you have new doctors. It takes years to “grow” a new crop of docs.

One proposal — to increase Medicare payments to general practitioners, at the expense of high-paid specialists — has touched off a lobbying fight.

This is called squeezing the balloon.

Cut reimbursement to one sector to cover the cost of services for another sector. It is also known as robbing Peter to pay Paul.

That has never worked. Why would Obama-man think it will work now? Read the rest of this entry »