theabcsofmedicare

Ultra-Left-Wing Medicare Rights Center Puts Out More Lies about Medicare Reform

The ultra-left-wing Medicare Rights Center, a front group for the Democratic Party, on May 15  outlined proposals to

"eliminate wasteful spending in Medicare and promote the delivery of high value, affordable health care."

Some are warmed-over Obama-administration ideas, some of which will actually make life worse for the low income seniors the lefties supposedly help.  Other Medicare Rights Center ideas came from conservative healthcare wonks and were implemented long ago.

Its litany of ideas (with my commentary in bold):

• restoring drug rebates for low-income Medicare benefciaries ("Restores" millions of low-income seniors to the two-tier drug "market" that existed before the highly popular Medicare Part D was enacted; that's what lefties want because it puts them in charge of poor seniors' lives.)
• introducing a public Medicare drug benefit (Sure, who cares; no one in their right mind would buy it; but conservatives are all for choice, unlike the lefties.)
• maximizing the use of generic prescription drugs (This has been happening for 20 years; so much for the Medicare Rights Center's brilliant new idea.  But it will hurt those low-income seniors that need brand-name drugs because the generics won't work for them.  What it will actually mean is that poor seniors will have to write their Democratic congressman to get the drugs they need, which is the way the lefties want the drug system to work.)
• creating a public Medicare supplement; (Sure, who cares; no one in their right mind would buy it; but conservaties are all for choice, unlike the lefties. And how could it possibly be any different than what we have now?)
• eliminating wasteful overpayments to Medicare Advantage plans (That was done already in 2010 except for the "overpayments" that go to the rural and urban poor; again the lefties are harming the people they supposedly help.)
• expanding the competitive bidding program (Conservatives are all for it; that's another idea that conservatives proposed years ago and it is working great. It's the secret behind Medicare Parts C and D.)
• advancing innovative delivery and payment system reforms (Again, this is why Part C is so successful. How stupid are these lefties to even suggest it's something new?)

Seniors Like Medicare Part D Preferred Pharmacy Plans, Says Non-Preferred Pharmacists

It's one of the oddest PR campaigns I've ever seen.  The local independent pharmacist lobby is spending a lot of effort to tell me that their arch enemies -- the national chain druggists -- are doing a great job by partnering up with selected Part D drug plans. Or at least the research says the drug plans are doing a great job.  

Huh?

There has been a battle for some time between the independent pharmacist lobby and the big-box-store pharmacies such as those at Target or Walmart and the big pharmacies such as Walgreens and CVS. The battle rages at all levels of prescription drug sales of course but nowhere is it more obvious than in the Medicare Part D program, where Walmart, Walgreens and others have special relationships with certain Part D drug plans -- e.g. Walmart and Humana. CVS has gone so far as to buy a drug plan company, Caremark.  

We seniors are where the money is of course. So naturally some Part D CVS Caremark drug policies are written such that you can do better if you buy your drugs at CVS than at Rite Aid. You can buy your drugs at Rite Aid with these CVS Caremark plans if you want and the Caremark drug plan will pay for them. (Or you can buy drugs at CVS with the Humana Walmart plan.) But the scripts'll cost a little more.

(Do not confuse this situation with the situation where a Part D plan will not work with a specific druggist or will not cover specific drugs at all -- e.g., Crestor -- in its formulary. Run your drug list through medicare.gov every fall during annual enrollment to make sure nothing's changed.)

So -- that being the case -- how come the independent pharmacist lobby is publicizing the Hart research that says 85% of preferred-pharmacy-plan customers are satisfied with their plan (see illustration above).  Apparently to tell me that a few percent are not.

Again, Huh?

Another Day, More Insurance Agents Lying about Medicare to Screw Seniors

Sometimes I think it's just ignorance about Medicare.  And other times I think it is purposeful deceit by insurance agents to try to get seniors to pay more than they have to for Medicare supplement insurance.  But whatever, it happens day after day, week after week, and it can't be coincidental.  

I came across two more insurance agents recently misinforming seniors about Medicare (no link because you shouldn't read their misinformation).  But the lies they are telling are very typical. They say: 

"Here is how Medicare works: Medicare Part A covers you at the hospital."

It is important to add that

• Medicare Part A covers you at the hospital only if you are ADMITTED and only for the hospital charges (think of it as room and board with a usually nice and almost personal nurse).
• Medicare Part B covers a hospital visit to the ER, an outpatient department for therapy or day surgery, an overnight stay at a hospital where you are only OBSERVED instead of being admitted, and the cost of any doctor services performed at the hospital in any of these situations or at the doctors' offices.

The deceitful insurance agents also say:

"Medicare Part C is an option in lieu of traditional Parts A, B, and D..."

That is not correct. Part C Medicare health plans are ADDITIVE to Parts A and B, NOT "IN LIEU OF" them.

Part C plans are additive in that they usually -- but not always -- cover many services not covered by Parts A and B (e.g., often they cover an annual physical). They are additive in that they usually -- but not always -- require much lower co-pays and co-insurance than Medicare Parts A (around $1200 per admitted-hospitalization incident plus certain fees in skilled nursing facilities) and B (20% of the Medicare-fixed price for the procedure, unless it is a physician fee for a doctor that does not accept Medicare). Part C plans are ALWAYS additive in that they include catastrophic coverage and include a cap on how much the senior can spend out of pocket in a given year (annual OOP cap). Medicare Parts A and B do NOT include either catastrophic coverage or an annual OOP cap.

Part C plans are also ADDITIVE to Parts A and B, NOT "IN LIEU OF" them in the sense that you have to sign up for both A and B before you can sign up for C.  You also have to pay the B premium (unless you qualify for free Medicare) as well as the C premium (if there is one).

The agents  say:

" If you have enrolled in a good Medicare Supplement (as everyone should) ...

You do NOT have to sign up for a Medicare Supplement if you sign up for a Part C Medicare health plan. In fact, you can't. 

In addition they say:

"Do I need referrals to see a specialist? No. Just make the appointment, check that the doctor is a Medicare Provider, and go."

This is not true if you are on Part C Medicare health plan (almost one third of Medicare beneficiaries are on a Part C health plan--see illustration above).  Most -- but not all -- Part C Medicare health plans are networked and you need to have a primary care physician and have to be referred to another doctor by a PCP and stay in the network. Some Part C plans allow you to go out of network with a higher co-pay.

Just a lot of bad information.  Like I say, not sure if it is intentional or not but either way it potentially hurts seniors.

What Medicare Gives with One Hand, It Takes Away with the Other (Or If I Only Still Had a Dog, and the Dog Bit Me...)

The Medicare bureaucracy has been beating itself on the chest recently about all the preventive tests it covers, many for free it claims. You now get the Introduction to Medicare physical thanks to George Bush and a screening for drpression thanks to Barack Obama (that's fitting, isn't it?).

But it turns out some of the tests on the "free" side, like the PSA test for prostate cancer, are being debunked by doctors and government researchers.   And the ones that are probably more helpful are on the "cost" side. That includes an immunization I just had for tetetanus, diphtheria and acellular pertussis (TDAP).

Still although the TDAP cost me $55.35 under my Medicare Part D plan at least it's covered. That's important according to my primary-care doctor and the New York Times. 

• I received the shot during my annual physical (covered under my Part C Medicare health plan but annual physicals are not covered by Original Medicare nor by all Part C health plans). I only paid for the drug.  The nurse who stuck me with the needle was free and the billing went through the doctor's office.  
• You can also get a TDAP through a drug store; it might cost more to pay for the pharmacist sticking you in the arm and you may have to pay up front and then chase your Part D plan for reimbursement. It may cost less also; depends if the drug store and/or your Part D plan has a better deal with the manufacturer or uses a different manufacturer.

At least unlike the last time I had a tetanus shot, I didn't have to get bitten by my dog first. But -- and only the government can come up with rules like this -- if I had been bitten by the dog, a tetanus shot (but not the TDAP shot) would have been free under Medicare Part B.

As for the last time I had a booster shot for diptheria and pertussis... well, Harry Truman was president.

Worst Medicare Advice You'll Ever Get from an Insurance Agent--Part 1

I am trying to keep up with the collosally bad information concerning Medicare on the Internet. The information comes from second-string journalists who don't know any better, from journalists for big-city newspapers with their left-wing political agenda, from hapless good-goverment wonks (goo goos) in think tanks and academia, and mostly from insurance agents who purposely misinform senior citizens in order to sell a product for which they get a comission.

A recent insurance-agent article on thestreet.com is so bad that I won't link to it but it is the most deceitful and potentially injurious to senior citizens article about Medicare that I have ever read  And that is a very hard distinction to achieve because almost all Internet articles about Medicare are deceitful and/or ignorant of the facts. Although I am not linking to the bad information on thestreet.com, the following corrects some of its errors because you will find these deceitful errors posted in many places. They are wrong wherever you find them. (In a sense this deceitful insurance agent did us the favor of putting a lot of Medicare lies insurance agents use in one place.)

1. Part C Medicare Advantage health plans will NEVER make paying for any kind of health care service "more expensive" than paying for that same service simply using Original Medicare Parts A and B. Part C Medicare Advantage health plans are not right for every senior (which is why the "Medicare and You, 2013" booklet shows options on page 15--see illustration above) but Part C plans are always better for seniors than Original Medicare. Almost no senior citizen in the United States depends on Original Medicare. Original Medicare charges an unlimited number of $1165 deductibles per year for admitted-inpatient hospital visits and 20% for all other services (even more if the doctor involved does not "accept assignment"). Original Medicare has lifetime limits that can potentially bankrupt seniors. Unlike Original Medicare, all Part C Medicare Advantage health plans have annual out of pocket (OOP) limits and typically nominal $20-$40 copays for doctor visits (but every Part C plan is different so you need to do the math).
2. Medicare Part B is not for "doctor visits," at least in the way most seniors would think those words mean. Most Medicare Part B funds go to hospital outpatient charges and even to hospital inpatient charges if the senior is not admitted but only observed. The Part B funds also go to pay for ER doctors and the doctor's part of a hospital surgery. Actual "doctor visits" are a very small part of what Part B involves. Under Medicare Part B, Medicare pays 80% of a fee it has determined for that 
3. All Parts of Medicare -- Parts A, B, C and D -- "go through private operators." This is irrelevant. It's just the way the government administers the Medicare program and always has. These "private operators" are -- surprise/surprise -- insurance companies working under contract to the government. None of them actually do any insuring (figuring out actuarial chances and charging accordingly); they just administer the A, B, C and D plans (which have costs and premiums pre-determined by the government). All four Parts of Medicare -- A, B, C and D -- are PARTS of Medicare and are completely regulated by the government. Number three is the biggest insurance agent lie and they tell it because they get bigger commissions from selling private insurance than selling Parts of Medicare.  In fact, they cannot even proactively sell Parts of Medicare.

 

Don't Believe Anything You Read on the Internet about Medicare

I could post full time on all the errors that appear on the Internet concerning signing up for Medicare, using Medicare or Medicare reform.  As I said recently, the worst of the bad Medicare information seems to come from insurance salespeople trying to sell you something for which they get a commission. Some is just political partisan journalism, almost always from left-wing publications. And some -- like an article, “Four Mistakes To Avoid When Enrolling In Medicare,” on Forbes May 16 -- apparently are just unsuccessfully trying to be helpful. Whatever, stick with the official publications and web site of the Medicare bureaucracy. At least you have a fall-back position; if the Medicare bureaucracy makes a mistake (I don't see many) they will give you a redo with no financial penalty.

The Forbes article makes four common mistakes:

• First, the author begins by saying “You must be enrolled in Medicare at age 65…” That is not true. Particularly those over 65 still working for a large company do not have to enroll at age 65 assuming they have insurance from their employer.The situation of still working after 65 is increasingly common because full Social Security retirement age is now 66 and rising. I am not sure why the beginning of the article conflicts with the ending. This situation gets mentioned at the far end of the article. I recommend that seniors sign up for Part A when they turn 65 even if they are still getting employer sponsored insurance because it is usually “free.” But you can enroll later in life -- during open enrollment periods held each winter from January 1 to March 31 – and there might be some reason to do so; you just have to do the math. There is no “must” about age 65. There is a possible penalty if you choose to delay so know your options. 
• Second, I am pretty sure the possible penalties for delaying are also described incorrectly in the article. The author says “Janice forgot to enroll in Medicare until after her 66th birthday. As a result, she must pay a penalty of $10.49 a month for Part B and $4.65 a month for Part D for the rest of her life.” I am pretty sure that this is not correct. Unfortunately I think it is worse than described by the Forbes author. I am pretty sure the absolute size of the penalty goes up every year assuming the Part B premium ($104.90 in 2013) and the Part D national index ($31.17 in 2013) goes up. (I am not sure the source of the author’s $4.65 estimate; I get $3.80 but now we’re talking pennies.) Which it always does if history is any indicator. The penalty is a percentage of every year’s premiums and index, not just a percentage of the premium in the year in which you first enrolled late.
• Third, the author says “… people on Medicare have (Part C Medicare) Advantage plans, rather than going with original Medicare.” This is not true. People on Part C have Part C in addition to – not “rather than” -- Original Medicare. In fact you must have Original Medicare Parts A and B in order to enroll in Part C and you need to pay the Part B premium (unless you are low income and qualify for free Part B). In choosing to add Part C to Original Medicare, you in no way give up the benefits of Original Medicare. In fact part C plans always provide all the benefits of Original Medicare Parts A and B – PLUS catastrophic coverage and annual out of pocket limits – and usually provide significantly more benefits (or sometimes, much lower premium costs).
• Fourth, the author says “But only about 1 in 5 Medicare beneficiaries end up in the doughnut hole…” I agree with the warning by the author against buying gap coverage that you don’t need. But the author is wrong that 1 in 5 beneficiaries end up in the donut hole. I can’t imagine what the source of that statistic is; I suspect the author is not taking into account the Low Income Subsidy and state pharmaceutical programs. With these two programs, a senior might technically “end up in the hole,” but there is no financial penalty for doing so. In fact the number is more like 1 in 20 who really hurt by the donut hole. The donut hole is a bunch of political hype (but of course it’s bad news if you’re one of the 1 in 20 because it means you are chronically ill). 

This article has a few small errors as well. The number of beneficiaries now on a Part C Medicare Health plan is over 30%, not the less than 25% indicated by the author. In addition, Part A only covers hospital care for beneficiaries admitted into a hospital. Admitted is the key word. All other hospital care – particularly for someone that stays overnight but only for observation – is covered by Part B. This can have significant monetary implications in multiple ways.

In addition, the author says that some other author (the wording in this section of the Forbes article was confusing) received “six hanging folders” of advertising material and followed that sentence with a sentence that said “So before you sign on the dotted line for Medicare Advantage…” The author of this Forbes article seems to want you to think that the six hanging folders were full of Medicare Advantage material but likely the folders also included material from the Medigap plans and from the Medicare bureaucracy itself.

Finally the article says the choice is more important than selecting a TV show. Well that’s kind of obvious and just plain a weird comparative. You can be somewhat less concerned than the author: all of this involves choices that one in four seniors (low income) can change monthly and that the rest of us seniors can change once a year (almost always unconditionally). I cannot envision a situation – other than a choice not to get any kind of Medicare supplement at all (but 96% of us do) – that could costs tens of thousands of dollars.

WaPo Publishes Worst Piece of Medicare Journalism Ever

Eclipsing a record¹ that the Washington Post (WaPo) itself had already held, on May 12, 2013 WaPo published the  worst piece of Medicare journalism ever. WaPo has exposed the huge problem that doctors are abusing 12-year-olds on Medicare Part D.

As an indication of how bad this WaPo article is, it had findings and recommendations. Journalism does not have findings and recommendations. But none of the findings or recommendations seem to have anything to do with Part D Medicare. Half of the little heart-wrenching sob stories in the article took place before Medicare Part D even went into effect in 2006.

WaPo's findings were purportedly based on reams of data but that data was irrelevant to the findings and recommendations and inaccurate concerning prescriptions² filled by Medicare Part D insurance companies. Not the least of the data's problems was that the prescriptions were filled four or more years ago.

The WaPo article breathlessly claimed to expose a years-ago over-exposed charge that nursing homes over-prescribe anti-psychotic drugs to dementia patients in their care. The article also breathlessly claimed to discover the long ago discovered fact that many doctors prescribe medicines for gout that were only approved by the government to be used for cancer pain. (Or maybe it's vice versa. I'm not sure because the WaPo article was also poorly written. For example, the leading example of such so-called off-label but perfectly legal and ethical conduct by doctors said

"An Oklahoma psychiatrist regularly prescribes the Alzheimer's drug Namenda for autism patients as young as 12."

Sorry but it just intuitively seems unlikely that the prescribing of Alzheimer drugs to twelve year olds is a major Medicare issue.  I'm not saying this incident didn't happen. I'm just saying

"Huh? Out of a billion scripts filled², that's the best WaPo can do?"

Just to put the frosting on the cake, the story is wrappered with repeated descriptions of one of the votes in 2003 by the House of Representatives concerning Part D.  The House's version of the law was in fact passed by one vote. But the Senate version was passed unanimously and the conference version passed easily in both Houses of Congress. If the one vote vote had gone the other way, the House version would have just been reconsidered and passed on a later date. But just in case all this one-vote concentration by WaPo confuses you, there was never any debate at any step in the Congressional process that led to the overall approval of Part D along the lines of

"If you pass this bill, dastardly private for-profit insurance companies are going to let dastardly pharmaceutical manufacturers let dastardly doctors prescribe bad medicine for 12 years olds on Medicare."

Sorry but the debate back in 2003 was all along the familiar lines of this costs too much money, this is socialism, this doesn't go far enough, this goes too far, etc.

¹ The only thing I can say in WaPo's favor is that it may not be eligible for the prize.  The authors of the article were actually journalism students of some kind writing for some far-left-wing Harvard-affiliated goo goo group of some kind pretending to be Woodward and Bernstein. Neither Woodward nor Bernstein -- nor any of their successors as employees of WaPo -- seemed to have had anything to do with this travesty of misguided advocacy disguised as journalism.

² The article makes many claims about a billion prescriptions. You have to really follow the strained parsing of the authors to realize that they are talking about 30 million seniors getting an average of around three prescriptions each year.  (Do you get a very inexpensive and mild blood pressure med called lisinoprol prescribed once a year to be refilled 11 times. WaPo calls that 12 prescriptions.) There are all kinds of other sneakingly deceptive statements about the underlying data, not the least important of which is the publishing of retal price.  But do not to get hung up on most of these data-related deceptions by WaPo; they have nothing to do with the somberly presented WaPo findings and recommendations. 

What's Right with the Left-Wing's Medicare Essential Medicare Reform

I have a lot of problems with the left-wing Commonwealth Fund's Medicare Essential proposal.  But in fairness, before criticizing something, I believe I should look for some of its redeeming features. To do so, I needed to compare Essential against its baseline (which is an imaginary combination of Medicare Parts A, B and D plus a Medigap Plan F of indeterminate origin), an imaginary Part C Medicare health plan, and Ryancare. Here is that comparison:

When I do this, I see that there are at least two redeeming features. The proposed Medicare Essential includes the catastrophic coverage and annual OOP limits not included in Original Medicare today. All Part C plans but only a few Medigap plans include such protection today.

Elite Far-Left Academics Claim Medicare Reform Will Kick Seniors Off Medicare

Boy, what's got into the water in the ivory towers this week. Yesterday we saw the far-left-wing Commonwealth Fund and a bunch of elite Harvaridans separately and pompously carrying on about Medicare reforms that seemed to have no basis in the real world.  Today here is more goo-goo drivel, this time from the Rand think-tank, drivel that appears to be paid for with our tax dollars (yet you have to pay to read it or -- as I did -- ask the author for a bootleg copy).

In a breathless press release Rand claims three currently proposed bipartisan Medicare policy changes (raising the eligibility age, officially introducing Medicare premium support, and means-testing Part A's currently "free" premiums):

"could drive many elderly Americans from the (Medicare) program, leaving them with limited access to health services.."

The finding is just pure left-wing  numb-nuts analysis.  Read the Rand report and you find that Rand is really not referring to people "leaving" Medicare but to people not yet being eligible to enroll if the age of eligibility is raised (which I oppose but that is not the point of my post). If I am reading the Rand article correctly, the statement in its abstract really has nothing to do with a choice not to enroll. Naturally the left-wing-slanted mainstream press will pick up Rand's PR spin and run with it without clarification and probably without even reading the article.

As for people not enrolling because of higher Part A premiums for wealthy seniors or because of a change in Original Medicare to a premium-support funding mechanism, here are the problems with Rand's analysis:

• Who cares what rich seniors do unless Rand means it wants 5% of the senior population, the rich relatively healthy ones, to stay in the money pool to pay for the rest of us. My experience as a SHIP volunteer is that even the wealthy keep A and B despite paying higher premiums for B. The 3% of wealthy seniors to whom Rand refers as historically not taking B are probably not taking it not because of the higher premium but because they keep getting insurance coverage after retirement from companies they probably once owned.
• As for the finding relative to premium support, Rand has come up with the most absurd analysis of the subject I have ever seen. No current or past premium-support proposal of any notoriety (1995 Moffet and whomever, 1995 Aaron/Reischauer, 2010 Dominici/Rivlin, 2011 Simpson/Bowles, 2011 Rivlin/Ryan, 2011 Wyden/Ryan) proposes that premium support work the way Rand suggests. Why did Rand simply make up some new approach rather than use one of the established premium-support proposals? But even given Rand's unique suggested approach to premium support I don't see how that would cause people to "leave Medicare."

Rand is despicable for putting out this crap with the intention of scaring senior citizens... using our money... and putting the detail behind a pay wall.

Elite Academics Want to Screw Up Your Medicare But Won't Tell You How Unless You Pay Them

Elite academics -- some of whom were responsible for screwing up Massachusetts' healthcare market -- are now trying to do it to Medicare. And surprisingly there is a rash of paper on the subject from these goo goos this week, apparently forced to publish something before they jet off to the Vineyard, Bar Harbor or Aspen for the summer. One group of Harvardians has discovered that what Paul Ryan has been saying all along is in fact true. Publishing in Health Affairs behind a firewall, these elites claim:

"The US Medicare program consumes an ever-rising share of the federal budget. Although this public spending can produce health and social benefits, raising taxes to finance it comes at the cost of slower economic growth. In this article we describe a model incorporating the benefits of public programs and the cost of tax financing. The model implies that the “one-size-fits-all” Medicare program, with everyone covered by the same insurance policy, will be increasingly difficult to sustain. We show that a Medicare program with guaranteed basic benefits and the option to purchase additional coverage could lead to more unequal health spending but slower growth in taxation, greater overall well-being, and more rapid growth of gross domestic product. Our framework highlights the key trade-offs between Medicare spending and economic prosperity."

So again, life-or-death information for seniors (which was probably paid for with the seniors' tax and Medicare premium money) is not available to the seniors to review. 

Not to be outdone, another bunch of elites -- the lead author is from Johns Hopkins -- say they...

"... propose a new coverage option for Medicare beneficiaries that would provide comprehensive benefits, protection from catastrophic costs, and incentives for choosing high-quality, high-value care. Combining hospital, physician, and prescription drug coverage, the “Medicare Essential” option could save (seniors and their former employers money) while also improving care."

According to the far-left-wing Commonwealth Fund, details of this breakthrough new idea -- called Medicare Essential -- are also published on Health Affairs (but the proposal does not seem to be behind the firewall). Just reading the abstract it appears to me that either Commonwealth Fund is proposing that Part C Medicare Advantage be re-named Medicare Essential or that Commonwealth Fund is endorsing the 2011 Wyden/Ryan proposal.

Has anyone spent more time on this.  Perhaps the author could compare and contrast the three plans