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Even if you wanted to, you cannot escape the talk of health care reform these days. It is everywhere in printed, online and television media. As a leading, independent resource for Medicare and Medicare insurance news, Secure Medicare Solutions has closely examined both sides of how the proposed bill will affect those on Medicare. Our goal is to give you an unbiased look at how some of the proposed changes will affect you and your Medicare and/or Medicare insurance.
Proposed Reform: Better Pricing for Part D Drugs
How it Affects You: This is a proposed change to assist in regulating the pharmaceutical industry and controlling drug prices. Medicare Part D aims to do this by negotiating better overall prices for Part D drugs, which should, over time, reduce the Part D premiums and co-pays that Medicare-eligible individuals have to pay. Some headway has been made on this already, with the pharmaceutical industry agreeing to a 50% cut for those that reach the dreaded “donut hole” (details for this are still pending).
Proposed Reform: Reduce Medicare Payments to Private Insurers (Medicare Advantage)
How it Affects You: If you have been paying much attention to the health care debate, you have heard the Medicare Advantage program mentioned numerous times. The projected change is to base the payments to these private insurers on an average of the plans’ bids, rather than the system now which is a standardized government-set amount. For those on Medicare Advantage, this reduced funding will, most likely, lead to an increase in premium and/or reduced benefits. For everyone on Medicare, it should lead to the ability to reduce the Medicare Part B premium.
Proposed Reform: Link Payments to Hospitals to Hospital Performance
How it Affects You: The idea to link hospital payments for Medicare patients to hospital performance has been around for a while, and it is a major part of the proposed health care reform. It’s intention is to increase overall hospital efficiency and give hospitals an economic incentive to “do right” by the patient. Some feel that this will lead to greater efficiency at hospitals, while others believe it will lead to greater dishonesty and fraud within the system. If it is a part of any legislation that is passed, we’ll find out for sure!
Proposed Reform: Standardization of Payments to Skilled Nursing Facilities/Long-term Care Facilities
How it Affects You: This provision of proposed legislation is intended to cut waste in the current Medicare system by measuring actual costs to come up with a more uniform system for reimbursing these facilities through Medicare. It remains to be seen if this will affect the quality of care received if in one of these facilities; however, the overall goal is to reduce waste in this part of the system and reduce the cost of Medicare to all Medicare-eligible individuals.
Proposed Reform: Reduce/Regulate Fraud, Waste and Abuse in the Medicare System
How it Affects You: This is the proposed reform that most everyone can agree upon. There have been many ideas tossed around as to how to do this. One of the primary ways that this is projected to be accomplished is higher scrutiny of health care providers and hospitals. Additional pre-payment reviews will be implemented, particularly on doctors/hospitals that order a significant amount of high-risk or high-cost procedures. Over time, this is intended to reduce the cost of Medicare (Part B premium, etc) to the individual.
Regardless of which side of the debate you come down on, it is obviously important to keep an eye on how it will all play out and how it will affect you. At Secure Medicare Solutions, we will do our part to keep you updated on any changes. You can always get updated information and follow along with us at Secure Medicare Solutions: An informative Medicare Insurance and Medicare Supplement Blog.
As you have probably heard, Medicare Advantage plans also are in for many changes in the upcoming year(s). While it remains to be seen exactly how far the changes will go, some of the changes have already had significant effects.
First of all, changes are coming in the Private Fee for Service (PFFS) plans. Tighter regulations and lower doctor reimbursements for these plans have led to three major players in the PFFS plans to announce they are dropping their PFFS contracts for 2010 (WellCare, HealthNet and Coventry). These companies will still be active in other aspects of Medicare Insurance, but the dropping of the PFFS plans from these three companies affects approximately 500,000 insured individuals.
As always, SMS will keep you informed of additional MA changes as they are announced. It is anticipated that other companies will also make changes in the PFFS marketplace. If you have a Medicare Supplement, this does not affect you directly; however, most agree that those with Medicare Advantage plans should be prepared to re-evaluate their options during this year’s annual open enrollment period (Nov-Dec).
Medicare announced in March of this year changes to the standardized South Carolina Medicare Supplements that will take effect June 1, 2010. If you already have a Medicare Supplement, this will NOT affect any current coverage that you have.
The only people that will be affected are people who turn 65 on or after 6/1/10 or those who switch plans/companies after that date. Some major changes are:
- Preventive Care and At Home Recovery are deleted from all plans that included them.
- Medicare Hospice coverage is added as a basic “core” benefit to all plans.
- For Plan ‘G’, At Home Recovery is gone, but the Part B Excess charges amount goes from 80% to 100%.
- Plans ‘E’, ‘H’, ‘I’ and ‘J’ are eliminated.
In the coming months, we will be publishing more information on our blog about additional changes associated with the 2010 revamping of the standard Medigap plans.
For specific questions about the plans, you can contact Secure Medicare Solutions toll-free at 877.506.3378 or contact us online: Contact Secure Medicare Solutions.