Raising the Eligibilty Age for Medicare and SS?

I just caught wind of this discussion, and I'm afraid this could become a reality.

The CBO just released its "research" that supports raising the Medicare and SS eligibility age:
www.cbo.gov/ftpdocs/125xx/doc12531/01-10-2012-Medicare_SS_EligibilityAgesBrief.pdf

The report indicates that more people will have to work longer--did they realize it's especially hard for those in their 60s to find jobs? (see: www.pewtrusts.org/uploadedFiles/wwwpewtrustsorg/Reports/Fiscal_Analysis/Long-term-unemployment-addendum-November-2011.pdf) 

The report claimed that about 5% of those using Medicare would be uninsured but that most would get insurance from the private sector (Really--who's underwriting folks in their 60s and offering affordable premiums? The ACA has charged states with creating health insurance exchanges, but those are being challenged and states like Georgia are sitting on their hands waiting for it to be repealed: http://www.ajc.com/news/georgia-politics-elections/waiting-game-may-cost-1291709.html ) or from their spouse's employers (sorry same-sex couples, entrepreneurs, and single/widowed folks).  Here is a quote from the report:

CBO assumed that people who became ineligible for Medicare under the new age limits could purchase health insurance through the exchanges, and, depending on their income, might qualify for federal subsidies. CBO also assumed that people with the lowest income would qualify for Medicaid benefits. Without those changes to the recently enacted health care laws, CBO anticipates many more people would become uninsured if the MEA was raised.

Compare that to Robert Reich's thoughts (found at http://robertreich.org/post/7941066493):

So what’s the answer? For starters, allow anyone at any age to join Medicare. Medicare’s administrative costs are in the range of 3 percent. That’s well below the 5 to 10 percent costs borne by large companies that self-insure. It’s even further below the administrative costs of companies in the small-group market (amounting to 25 to 27 percent of premiums). And it’s way, way lower than the administrative costs of individual insurance (40 percent). It’s even far below the 11 percent costs of private plans under Medicare Advantage, the current private-insurance option under Medicare.

In addition, allow Medicare – and its poor cousin Medicaid – to use their huge bargaining leverage to negotiate lower rates with hospitals, doctors, and pharmaceutical companies. This would help move health care from a fee-for-the-most-costly-service system into one designed to get the highest-quality outcomes most cheaply.

Estimates of how much would be saved by extending Medicare to cover the entire population range from $58 billion to $400 billion a year. More Americans would get quality health care, and the long-term budget crisis would be sharply reduced.

I really hope the President and Congress take a harder look at their proposals. Perhaps we could save money by allowing them to get health insurance from their spouses or purchasing it in the private market?

Thanks for listening to my rant. I'd love to hear your thoughts.

Medicare's Mental Health Coverage

A number of my clients depend on the expertise of geriatric psychiatrists to appropriately address depression, anxiety, or agitation associated with dementia.  They see their doctors and counselors/social workers in inpatient as well as outpatient settings.  How are these services paid for?  Traditional Medicare, like most health insurance plans, provides mental health benefits (Medicare Advantage plans may provide different coverage). The coverage differs, though, for inpatient and outpatient services.

If a Medicare beneficiary receives inpatient services in a psychiatric hospital (i.e., Peachford Hospital or Ridgeview Institute in the Atlanta area), they have the same deductibles and co-pays as for general hospitals.  The big difference, however, is that Medicare beneficiaries have a 190-day lifetime max for inpatient services in a psychiatry hospital.  Beneficiaries can also seek mental health services at a psychiatric unit within acute care hospitals (i.e., Emory's Wesley Woods or Eastside Heritage).  Here is the list of deductibles and co-pays for hospital coverage:

Hospital deductible: $1,156 (waived if the beneficiary is admitted to a psychiatric hospital within 60 days of being discharged from a different hospital) 
Hospital co-pay for days 61-90: $289/day
Hospital co-pay for days 90-150: $578/day

As for outpatient coverage, Medicare will pay 80% of the initial visit to a licensed psychiatrist to determine diagnosis; this is similar to the payments made to other doctors.  Currently, however, the visits made to mental health professionals (e.g., general practitioners, nurse practitioners, physician assistants, psychiatrists, clinical psychologists, clinical social workers and/ or clinical nurse specialists) after that initial visit, is covered by Medicare at 60%, leaving the beneficiary (or their Medigap plan) covering the other 40% of the services.  This coverage will change in the coming years; in an attempt to create mental-health parity, Medicare will cover 65% in 2013 and then 80% for 2014 and beyond. 

For more information, visit www.medicare.gov

Medicare Premiums for 2012

On October 27, 2011, the US Department of Human Services announced the new Medicare premiums and deductibles for 2012.  Part B premiums will be $99.90. This is a much lower rate than anticipated. Folks that just started receiving Medicare benefits in 2011 were paying $115.40/month; they will start paying the new $99.90 amount.  Older beneficiaries will see an increase from their $96.40 premium they've been paying since 2008.  That $3.50/month increase is modest and will likely be offset by SSA's COLA increase (see older post for more info on the COLA increase). 

Here are some of the other changes:
Part B deductible: $140
Hospital deductible: $1,156
Hospital co-pay for days 61-90: $289/day
Hospital co-pay for days 90-150: $578/day
Skilled nursing home co-pay for days 21-100: $144.50/day

Recently I read that half of all Medicare beneficiaries receive less than $22,000/year in income (www.kff.org/medicare/upload/8172.pdf).  For most beneficiaries, these numbers will be a relief because there are no significant increases for 2012 Medicare costs.  In light of the attention "entitlement spending" has gotten, I am relieved more cost-shifting to beneficiaries did not occur this time.  Who knows what will happen in 2012 if Republicans get their way (Washington Post blog post; Forbes's report on Coburn and Lieberman's Reform Proposal; Kaiser's review of GOP's options for Medicare)?

Amid the discussion of changes in Medicare costs, remember that there are programs to help beneficiaries pay for their premiums and deductibles.  Find out more at www.benefitscheckup.org

Medigap Coverage: Can you get it back?

I seem to learn something new everyday about Medicare, Medicaid, and laws that apply to seniors.  Two weeks ago, I read an article from the Medicare Rights Center. A bit of information I failed to realize before: If you drop  your Medigap to join a Medicare Advantage plan (AKA: Medicare Private Health Insurance Plan) and then you later want to drop your Medicare Advantage Plan and return to Traditional Medicare with a Medigap plan, you have a guaranteed-issue period of 63 days from the time your Medicare Advantage Plan ends to get a Medigap plan.  So, you can switch from a Part C back to Part A and B with a Medigap, and you have 63 days to do it so that you won’t be denied coverage for existing conditions. 

Medicare Private Health Insurance Plans are designed to replace Traditional Medicare Parts A and B.  So, folks using Medicare Advantage Plans are working with a private health insurance company (i.e., Aetna, Humana, WellCare, etc.) and not the Center for Medicare and Medicaid Services.  It is illegal to sell a Medigap plan to someone that has a Medicare Advantage Plan; thus, most folks who have a Medicare Advantage Plan do not have a Medigap plan.  Medigap plans are essential for Traditional Medicare Parts A and B, and if you switch back to Traditional Medicare from a Medicare Advantage Plan, I am relieved to know that you can still get a Medigap plan.  The window of opportunity is short (63 days), but it's there.

To read more, please see the article I read:
http://www.medicareinteractive.org/page2.php?topic=counselor&page=script&slide_id=1655&utm_source=dm-national&utm_medium=e-mail&utm_campaign=DM+National+9.26.2011#top

Also, Medicare's Open Enrollment started.  It ends on December 7, 2011.  For more information, visit:
www.medicare.gov
www.mygeorgiacares.org
www.transitionsrbg.com
www.allsup.com