theabcsofmedicare

UPDATE: factcheck.org Needs To Get Its Facts Straight about United States Medicare

Update: On the afternoon of August 28, at my suggestion, factcheck.org corrected the error concerning flu shots in the recent article and confirmed that flu shots have been covered under Medicare without co-pay since 1993. factcheck.org corrected a similar error in a July 9 article and presumably looked back and corrected the error wherever it appeared on its web site. That does not help the problem that factcheck.org is widely quoted but it certainly demonstrates good faith so it does not make my Do Not Read list. However, over the years there has been other misinformation about Medicare. 

 

I have seem Factcheck.org frequently claim that free flu shots under Medicare are a benefit of the Patient Protection and Affordable Care Act (PPACA) of 2010 as amended. Most recently I saw this statement in an article about a political ad in Arkansas. The left-wing University of Pennsylvania web site needs to do a better job of fact checking.

Do Not Use Express Scripts for United States Medicare Advice... Maybe Don't Use Express Scripts for Anything

There is a really bad piece of Medicare advertising up on the web site of the pharmacy benefit manager, which -- among many businesses -- manages Part D Medicare drug plans (so bad I am not going to link to it). There are about a dozen problems with the article from someone that supposedly is a Medicare expert. The biggest error is the statement that people on public Part C Medicare Advantage plans can not get hospice services. (I can only guess at the reason that Express Scripts would publish this bad information and it is not good. Express Scripts should be disciplined by CMS.)

The statements by Express Scripts follow in order of appearance inthe Express Scripts propaganda along with corrections IN UPPER CASE:

New York Times Totally Confused about United States Medicare... As Usual

No organization in the United States sows more misinformation about Medicare than the New York Times. Most often it is intentional political posturing by NYT but this week I think the misinformation is just because the journalist does not understand what United States Medicare does.

The issue is that the Times has run articles and editorials with headlines similar to this:

"Medicare Star Ratings Allow Nursing Homes to Game the System"

But United States Medicare is only peripherally related to nursing homes. The star ratings mentiond are probably being gamed by the nursing homes. But it is a Medicaid star rating system, not a Medicare star rating system.

The Good, the Bad and the Ugly: What Does "Opt-Out" Mean in United States Medicare?

The words "opt-out" are often seen in the context of United States Medicare.  Naturally, since this is a government program, the words mean three very different things. The Medicare bureaucracy and the goo goos in academia and government who are "here to help" try to do everything they can to confuse taxpayers so you will feel dependent on them.

 

The good or at least most common meaning of opt out in Medicare refers to providers, mostly doctors. A very low percentage of doctors who had initially signed up to "accept assignment" of patients with Medicare when they left medical school then later opt out. Non-participating physicians also drop out (a future post will explain the difference between participating -- accepting assignment -- and non participating). An increasing number of providers are doing this for philosophical reasons (see the United States Medicare death panel debate) but the most common reason is business; United States Medicare fee for service rates are well below market levels.

 

The bad or at least very uncommon meaning of the term opt out in relation to United States Medicare refers to an eligible senior choosing not to join Original Medicare. Again this is typically for some kind of survivalist philosophical reason but sometimes not joining also makes financial sense. You can opt out if you want but it also typically means you cannot collect Social Security. (I might post about this sometime but the whole discussion is beyond weird and applies to very few people even when legitimate.)

 

The ugly meaning of  the term opt out in the context of United States Medicare is what prompts me to write this post. Opt out has been used by opponents of the public Part C Medicare Advantage health plan program. Sometimes it's looney lefties using the term this way but most often I see "opt out" in context of skilled nursing facility (SNF) benefits and I have seen and heard it often from SNF managers. I cannot confirm with data that this is a common SNF business practice but I would not be surprised. For example, it is not accurate to write (as this SNF executive did recently):

 

"Enrollment in (public Part C) plans means the individual is opting out of original Medicare."

 

No one on Original Medicare opts out of it. As the SNF propaganda article from which the quote was taken says right above this sentence, a person on Medicare cannot have a public Part C plan without first signing up for Original Medicare Parts A and B. Everyone on Medicare is in Original Medicare. That includes (see image) the very few just on Part  A (2% or so), or just Part B (less than a percent), or A and B and retiree insurance (around 35%; some retiree insurance may not require B and some pay for B), or A and B and Part C (the roughly 30% on Medicare Advantage or other C supplements), or A and B with a private Medigap plan usually with a standalone Part D self-administered drug plan (around 20%), or those with A plus "free" or almost free B and Medicaid (15%).

 

You could say people who choose Part C are "opting out" of traditional fee for service Medicare by choosing a public Part C managed-care health plan. But the better way of expressing the choice is managed, highly networked insurance (make sure your doctor accepts) vs. unmanaged, totally free-to-choose insurance (especially important to snow birds). This is not much different than the choice most of us who received insurance through an employer our whole working lives have been making for 30 years.

Seniors on United States Medicare: Put the Center for Integrity on Your Do-Not-Read List

Someone named Wendell Potter is apparently one of the more senior senior haters in the Democratic Party's War on Seniors because he opens a recent column at the Orwellian-named Center for Integrity with the words "As one of an estimated 78 million baby boomers in this country, I was delighted to hear that Medicare’s Hospital Trust Fund won’t run out of money until 2030..." Of course if he is a baby boomer born in 1960, he's into self hate because the Trust Fund "runs out of money"¹ the year he turns 70. So I am not sure why he would be delighted by the fund running out of money just a few years after he is eligible to use it (unless he plans on dying before age 70)

Potter claims "it’s uncertain how much of that (supposedly) good news (that the money "runs out" in 2030) can be attributed to the health care law." But it's not uncertain if you read the Trustee Report. The report very clearly explains that current law requires cutting home health care spending and skilled nursing facitity spending -- that's right, both -- in order to give the money to people not on Medicare and the more of those things you cut (increasing senior's out of pocket cost), the longer the fund stays positive. Of course, in the back of the Trustee's report, the Medicare actuaries say they think these cuts are unlikely to happen so so much for being delighted.

I can't quite follow the rest of his article but basically he seems to be saying that he wants to change Part B trust fund accounting also by drastically altering Medicare Part D -- which is paid for out of the B trust fund and was not affected by the Patient Protection and Affordable Care Act -- to make the D drug program more like the VA drug program. Wow! Really? Make something like the VA! He also wants to change the practice that doctors themselves set their prices for Medicare. They have nicely set them about 30% below the going market rate for the last couple of decades but apparently Potter thinks the doctors could go lower. (Don't feel bad for the doctors taking a 30% hair cut on seniors; they make up for it with the prices they charge people that are not seniors.). Potter also throws in the trivial charges from the Center of Integrity about alleged overpayments to the public Part C Medicare Advantage program... but with a twist.

Up until now the Center of Integrity based its allegations on a risk-scoring rule that the the Medicare bureaucracy started in 2008 and changed three times since because it knows it is not working... and that the GAO and MedPAC say is trivial if true. Potter has added that the 3% incentive payment that managed Medicare gets is also a waste². He plays a game with the wording on this charge; he gives the entire cost of the program -- $160 billion -- that serves 16,000,000 Medicare beneficiaries as if that is the wasteful amount. The incentive only cost under $5 billion in 2014 (not that $5 billion isn't real money but in the scale of Medicare fraud and waste it's way down the list).

¹Potter actually does not seem to know how the Part A trust fund works. It actually runs out of money every year... or every month... or every day depending on how you want to do the accounting. What the Trustees said in their recent report was that starting in 2030 the amount raised in Part-A-designated payroll taxes plus the so-called interest the trust fund gets from the government bonds it supposedly owns won't cover likely 2030 expenses.

²I believe the Part C incentive payments are unfair but reams of research have demonstrated that the incremental payments are not a waste. The most recent example of such research came out recently and was highly publicized in the New York Times.

Hundreds of Billions Are Not at Risk Because of Medicare Advantage Risk Scoring?

An odd left-wing group with the Orwellian title, Center for Integrity, has been on a crusade the last few months to expose the graft-ridden, corrupt risk adjustment scheme within the public Part C Medicare Advantage program (which applies to all Medicare Part C plans, not just Advantage plans, as well as to Obamacare¹-insurance plans). Rightlfully, no one in the press seems to care... at least until now. As of August 21, The Columbia Journalism Review posted the first article I've seen on the months-old expose... on an a website almost as obscure as mine.

The writer of this first article of many I'm sure is amazed that so little attention has been paid to the breathless Center of Integrity articles. Supposedly according to the Center of Integrity "Despite its broad implications for Medicare spending, the study by HHS... has attracted scant notice in Washington." 

Maybe the scant attention is because the "HHS study" is not a study--see image above. Read the HHS document (available on cms.gov) and you find that it is really kind of a white paper in an internal CMS newsletter written on such a trivial subject that no one at HHS or anywhere else except the Center for Integrity wants to make it into a study. And the white paper actually says: 

"Medicare has taken significant steps to mitigate the effects of (risk-score) coding intensity (that began in 2008) in (public Part C Medicare Advantage) MA, including implementing a 3.4% coding intensity adjustment in 2010 and revising the risk adjustment model (again) in 2013 and (again in) 2014. Given the continuous relative increase in the average MA risk score, further policy changes will likely be necessary." 

The white paper also notes Medicare 

"...is also recovering over payments identified by risk adjustment data validation (RADV) audits of selected MA contracts."

So this whole non-issue story² apparently dreamed up by Columbia is about a trivial policy begun in 2008, that didn't seem to be working so the rules were changed in 2010, 2013 and 2014, and the government is getting any money it overpaid back... if such overpayments are discovered (about which there is some doubt).

I guess that's why no one is paying attention. The GAO has said³ less than 1% of public Part C Medicare Advantage program spending is involved and can be clawed back.... IF it is in fact being paid improperly. That's not the hundreds of billions claimed by the Center of Integrity and Columbia... it's less than $2 billion (not that $2 billion isn't real money but on the scale of Medicare fraud and waste it's way down the list).

¹This blog refers to the Patient Protection and Affordable Care Act of 2010 as amended when referring to United States law and to Obamacare or Obamacare insurance when referring to the insurance enabled or mandated by the law.

²I have tried for about a month to get the CMS/HHS authors of the white paper noted in the image -- Welch and Kronick -- to answer some questions about their white paper. Apparently they think their own white paper is trivial but if they ever answer me, I will post their responses to open questions.

³According to the 2013 MedPAC Annual Report to Congress in the section on Medicare Advantage

New York Times Goes Back to Bashing Choice in United States Medicare; All's Right with the Universe

Earlier in August I noted surprise that the New York Times (and other left-wing opinionators) had all of a sudden become big fans of public Part C Medicare Advantage.¹ Thankfully the world righted itself on August 21 as the Times attacked Part D with its usual distortions. The attack comes in an article called "Part D Gains Eroding...," which at least forced the Times to admit that Part D.. at least had some benefits at one point... at least in the Times' opinion.

The author of the New York Times article either has not read the Harvard/UMass report referenced in the article or is misrepresenting it intentionally. I can't tell which because the Harvard/UMass research itself is not done very well. The UMass/Harvard research is supposedly about the subject of seniors not taking their Part D meds because of financial concerns but the research does not analyze the effects of state pharmaceutical assistance programs (SPAPs) on this finding². Not accounting for SPAPs makes no sense given the subject. SPAPs -- along with Social Security Extra Help -- are designed to address low and middle income seniors. Some states do that better than others and it would be very important to the researchers' theory to know if the findings differed in good SPAP states vs. bad SPAP states. For example, if these numbers (see image) applied in Massachusetts where our SPAP is so good that no one making under $70,000 in retirement (90% of retirees) has any financial worries when it comes to Part D drug costs, then the cause would not be finances.

 

But there is even a bigger problem with this article relative to what the UMass/Harvard research shows (see image above). The research says on average financial "hardship"/nonadherence due to finances only affected 10%-15% of seniors in the first place... in 2004 before Part D. Then, according to the research, by 2011 Part D cut those two already low numbers by 33% in one case and by more than 50% in the other. (The image above from the Harvard/UMass report breaks the overall averages out between people with many chronic conditions and those with fewer chronic conditions³. The same trends apply.)

 

The Harvard/UMass researchers admit that their weak findings are inexplicable and that their theory that the Part D donut hole⁴ and the Republicans (and of course George W. Bush) are to blame is just a theory. Instead I would theorize that adherence above 90% with a less-than-10% "hardship" finding is as good as it gets. (Alternately, I would theorize that the movement in these numbers is so minor from 2004 onwards that Part D had nothing to do with them... that they are simply a factor of general TV advertising of drugs).

 

But none of this New York Times attack on Part D is about seniors anyways. All the author cares about is attacking Part D because it was signed under George W. Bush. Whether Harvard/UMass were innocent victims of the Times or willing participants is open to question. The world is back to normal.

 

¹It didn't make sense because the Times is the mouthpiece of the Democratic Party agenda in the United States and the highly sucessful and popular Medicare Parts C (and D) are considered the Republican portions of Medicare (despite the fact that the former was signed by President Clinton and the latter was proposed by him). Part of the Democratic Party platform is to repeal and replace Parts C and D of Medicare.

 

²The UMass/Harvard researchers also should have used much more timely data and added other groupings. For example, their report does not seem to distinguish between beneficiaries in LIS-subsidized public Part C Medicare Advantage plans with drug coverage vs. those "paying full price" for Part C. It lumps all Part C users together, possibly even those on special needs plans that are not techically part of Medicare Advantage.

 

³The UMass/Harvard research never explains why it made the cut at four conditions vs. three or five. I suggest that perhaps it is a statistical trick.

 

⁴The donut hole has no affect on people on Part D Extra Help and little affect on a person on a good state's SPAP. Perhaps the small number of people not taking their meds before and after Part D just don't take meds. I think that explanation is called Occam's something.

Why's the New York Times Such a Big Supporter of Public Part C Medicare Advantage?

What's this summer's series of damned-with-faint-praise Medicare Advantage columns in the New York Times all about? Have the Democrats decided they cannot fight the skyrocketing popularity of President Clinton's 15-year-old public Part C health plan program any longer for fear of political peril? Or do the Democrats think Part C 'as is' will serve as a bulwark against needed total reform of Medicare into a defined-contribution plan¹? The answer might be in the fact that Senator Charles Schumer has recently been designated a Medicare Advantage champ by the American Health Insurance Plans' lobby.

 

Whatever, this week's New York Times Medicare Advantage (MA) column -- like those that preceded it in this strange "summer of love" series -- presents President Clinton's Part C program totally out of context and is based on years-old data.

• As always, the Times ideologues call MA private when Part C is no more private than Parts A, B and D of Medicare. The word "Part" means Part C is Part of the public Medicare health program.
• And this week's column like its predecessors never mentions the critical effects of truly private Medigap and retiree insurance on fee for service (so-called "traditional") Medicare. No one actually has just fee for service Medicare; almost everyone supplements FFS Medicare with private insurance on which they really depend. That is not required with public Part C because C includes annual out-of-pocket spending limits.

 Specifically, this column breathlessly describes all the advantages of networked health care as if they are some new discovery and have something specifically to do with Medicare or MA.  (There are some disadvantages as well, particularly for Medicare beneficiaries. In particular, do not sign up for a Part C plan that does not include favored providers in its network just because you like the price.)

 

And then the article apparently ends with a question. The Times' blogger sort of asks if whether maybe the Patient Protection and Affordable Care Act should be amended to allow a higher payment to Part C beneficiaries than FFS beneficiaries. Maybe that's what is behind this strange series of articles. Senator Schumer,

 

"What do you propose, Champ?"

 

¹Medicare is already effectively a defined-contribution plan albeit in a very inefficient form. Through its competitive bidding process, Part C is effectively defined contribution. And via the Patient Protection and Affordable Care Act "death panel," Original Medicare Part A/B is effectively defined contribution.

 

If It's a "Part" of United States Medicare, It's Not Private Insurance

Words mean something. That is something that left-wing ideologues never want to acknowledge (for example, "state" does not mean "federal," "global warming" does not mean it is getting colder, and so forth--despite what the left says).

The most common example of lefties not believing that words mean something in Medicare is their total lack of understanding of the words, public Part C Medicare Advantage health plan. (Perhaps it is not a misunderstanding; some left-wing idelogues appear to hate seniors so much that they truly want to keep us from joining a Medicare HMO.)

It is pretty simple second-grade English. If it is a Part of Medicare, it is public. Parts C and D of Medicare are just as public as Parts A and B of Medicare. None of the Parts of Medcare are private¹ insurance.

¹The left's usual reply to this is that Part C is offered by private insurance companies. That is true. But so are Parts A and B of Medicare. However because Parts A  and B are one-size-fits-all across the United States, the beneficiary does not see the "offer." That decision is made for them by the bureaucrats in Washington who pick 15 or so different insurance companies to provide A and B in various parts of the country. Often these are the same companies that offer a Part C health plan. The real difference between the Parts of Medicare is the type of coverage provided -- A and B are fee for service and A and B and C are managed. The difference is not whether the major payor is the government (true for all Parts of Medicare) or the administrator is a private insurance company (true for all Parts of Medicare)

Why Is There an Issue over Observed vs Admitted Hospital Stays in United States Medicare

Almost any article you will ever read concerning the issue of hospital observation under the United States Medicare system is confusing and mis-states the Medicare rules that apply to acute-care hospitalizations. Some of this confusion is because you are dealing with a large unresponsive government bureaucracy. Some of it is pure Democratic Party hate for seniors.

 

These articles are constantly claiming that seniors are stupid. In fact, just because the lefties at the Left-Wing Aging Aid Society, the Doctors Against Insurance Companies, and similar goo goo outfits don't know the Medicare rules, we seniors do know these rules.  In particular, disregard any article that throws the word "many" around generously--such as in "many seniors are being harmed." The statistics say the numbers affected negatively annually by the observation rule in Medicare are a few thousand compared to the 50,000,000 people on Medicare.

 

Generally, these articles:

1. Fail to explain that in the vast majority of cases, being observed is better financially for the senior than being admitted (not that this matters because -- and the articles never explain this either -- almost 100% of us seniors have a supplement of some sort because Original Democratic Party Medicare is such bad insurance). See recent GAO report on this subject.
2. Fail to explain that the issue is that Medicare does not cover custodial care; it does not matter how may days you are in the hospital or whether you are admitted or observed. Trying to get Medicare to pay for custodial care through the backdoor -- a nice way of saying "fraudulently" -- is the reason this is an issue. See Medicare and You booklet.
3. Fail to make it clear that even if a senior is admitted to an acute care hospital, rehab won't be covered unless the person is in the hospital 2/3 nights¹. Overnight admittance is not good enough. Also see Medicare and You.
4. Imply Medigap insurance will pay but typically Medigap does not cover things that Medicare does not cover so most Medigap plans would not cover you if items 2-4 directly above are the issue (but it might; Medigap is private insurance and policies can differ; so check your policy)
5. Fail to mention that these Medicare rules long predate the auditing of the fraud and abuse that happens in nursing homes, giving custodial care payments for people who are not entitled to them. See History of Medicare.

¹The rule on number of nights required is in a state of flux and I'm not sure what the latest exact rule is. Whatever it is, it might change before you read this.

Republican Politician/Fox Commentator Thanks United States Medicare, Illegal Immigrants for "Free" Operation

I recently saw a column by a Republican politician/Fox commentator named Linda Chavez concerning Medicare. I certainly hope this woman has good luck with her operation but she is scary ignorant about Medicare. It is further concerning that her bio says she was a United States cabinet member at one time. But given her ignorance on the subject, it does not surprise me that she is a cable news commentator.

1. She is NOT getting her operation "free of charge" because of Medicare. Given her complete bio (not at link), she and/or her spouse paid income tax and payroll tax into the Medicare system for 45-50 years to pay for the operation. She also pays a premium today now that she is on Medicare.
2. For that, Medicare will only pay for 80% of whatever Medicare thinks her surgery is worth (which is surely not what the surgery is really worth); she is responsible for the remaining 20%, or even more if she has chosen a top-notch surgeon who does not accept Medicare assignment (so she owes probably at least $15,000 for her "free" operation given her description, after tens of thousands of dollars of previous "payments"). 
3. Medicare WILL pay all but $1200 of her hospital room and board depending on length of stay but Medicare has a lifetime and per-incident limit on hospital days. It also sounds like she might needs some skilled-nursing-dependent rehab; Medicare will pay some of that but also limited on a per-incident basis. On average, Medicare only pays half of a beneficiaries health costs (by Obamacare Bronze/Silver/Gold/Platinum standards, Medicare is a Balsa Plan.)
4. The fact that she gets a $100,000 operation partially covered by Medicare and some others live to over 90 never needing much more that a flu shot is just the nature of insurance. It has nothing to do with Medicare.
5. Her bio says she was born after 1945. Therefore the amount she paid in to the Medicare system in income taxes and Medicare payroll taxes -- plus the additional pooling effect of those that did not live to age 65 to take advantage of their Medicare contributions -- is at least enough to pay for the benefits we of that age or younger receive from Medicare. In fact, if you are much younger, President Reagan screwed you.
6. For those who are older than we baby boomers, yes --  Congress purposely gave them a good deal (the older the better the deal, particularly true for all the people who were 65 or older in 1965  and never contributed at all while working). This was well known and widely debated in 1965. The alternative was to wait until the pool built up as FDR did with Social Security.
7. "Living long" has little to do with the value of the Medicare resources one uses on average. Most of your costs are incurred in the final year of life whether you live to 90 or 70.

And as for her using all this ignorance as an argument for illegal immigration¹, what can you say?

 

¹Except that the Harvard research she cites looks really flawed, it is interesting that is says that the illegal immigrants bringing in illegal drugs aren't stupid enough to use them.

The Difference Between "Original" and "Traditional" in United States Medicare

Recently a Houston News columnist wrote that Original Medicare and traditional Medicare mean the same thing. At a very high level that is correct. The terms mean pretty much the same to anyone except for a healthcare policy wonk. However the terms Original Medicare and Traditional Medicare do have different meanings and not understanding them can lead to a bad mistake financially.

 

The Houston News (and medicare.gov itself--see image above) hides an important distinction that is often missed in Medicare how-to columns. Original Medicare is Medicare bureaucracy terminology for a person on Medicare Part A or on both Medicare Parts A and B (mostly the latter). Therefore everyone on Medicare is on Original Medicare. That's because you cannot choose a public Part C Medicare Advantage health plan or a private Medigap supplement without first getting on both Parts of Original Medicare. Many retiree policies also require one or both Parts of Original Medicare. Most people who choose a Part D standalone drug plan are also on both Parts of Original Medicare although it is not required. And a very small group of people on Medicare are only on Medicare Part B.

But everyone of them -- all of the people on Medicare -- are on Original Medicare. That does not mean they are on "traditional Medicare." Traditional Medicare refers to the indemnity-insurance-like 1965-era benefit structure that provides uncoordinated health care cost coverage on a fee-for-service basis (that is, basically one or more Parts of Original Medicare with no supplement or Original Medicare with a Medigap policy). A small and decreasing percentage of Original Medicare beneficiaries use "traditional Medicare" although some retiree insurance is also likely fee for service (but it is still probably at least coordinated in some manner).

United States Medicare Users: French Reuters News Agency All Wrong about Our Medicare Program

The far left wing French-government news agency Reuters is not the worst source of information about United States Medicare on the Internet. But it is close. I guess it should seem obvious not to trust a French source about a U.S. subject but since Reuters keeps putting bad information about United States Medicare out there and far left wing U.S. newspapers (most U.S. newspapers) like far left wing French propaganda, you really have to pay attention and make sure you trust only a good source such as medicare.gov.

This week Reuters claims

"The Part B premium has been $104.90 since 2012 - except for 2011, when it actually dropped by about $15, to $99.90. "

Of course the French do not realize how Medicare works and that the nominal Part B premium dropped in 2011 -- for 2012 -- because Part B premiums had been frozen for three or four years at $96 for those already on Medicare (because of no increase in SS payments during those years). That meant that those just coming on to the Medicare system in those "frozen years" had to make up the difference with $115 a month Part B premiums. For the vast majority of people on Medicare during that time period, the Part B premium has steadily risen; there was no decrease.

Reuters also claims

"premiums are deducted from Social Security checks."

That is true for fewer and fewer of us Medicare beneficiaries because SS full retirement age is now 66 and rising and more and more people on Medicare are not on SS. Again, how would the French know. They all retire at 45.

Finally Reuters claims

"the average Part D premium has been $30 or $31 since 2011."

But don't be fooled by that lefty French claim. Average Part D premium is a number the US government and insurance companies manipulate by  announcing cheap Part D policies no one will choose and then upping the price of the popular Part D policies by 20%-30%.

Reuters also tries to scare U.S. seniors concerning the donut hole. The good news is that only about 5% of U.S. seniors come anywhere near the donut hole. The bad news of course is that is of little consolation to you if you are part of the 5%.

Forget October; 2015 United States Medicare Open Enrollment Could Already Be Over for You

The period October-November gets all the publicity when it comes to planning for Medicare for the following year. Fuggettaboutit.

As I pointed out on this recent blogpost, January to March are really the important months if you do not already have Medicare. All most Medicare beneficiaries can do in October-November is sign up for or change a Medicare health plan but that is not the same as enrolling in Medicare.

And if you get your supplemental coverage from a former employer or a spouse's former employer, your chance to change your options for 2015

• may have already come and gone
• may be now
• may occur between now and the end of 2015 but have very different decision dates than someone who does not get supplemental insurance from a former employer

That's about 33% of you nationwide (cream colored slice of pie in lower left).

Bottom line: if you get anything from a former employer, read it right away and act on it right away.

United States Medicare Open Enrollment Scheduled for January This Year, Not October

Actually Medicare open enrollment -- called "general enrollment" by the Medicare bureaucrats -- is scheduled for January every year. It talkes place between January and March of each year with your Medicare coverage -- both A and B or just B if you already have A going into effect in July.

Do not be confused by all the hoopla in the press starting soon about Medicare "open enrollment" being in October and November¹.  The October-November timeframe refers to public supplements and only applies to you if you are already on Medicare. And you have to be on both Medicare Parts A and B -- called Original Medicare by the Medicare bureaucrats. Original Medicare is usually mislabeled by the press as "traditional Medicare" (which has a different meaning).

Specifically, the Medicare open enrollment hoopla that typically starts in the press each September refers to enrollment in Part C and Part D Medicare health plans, not Medicare itself. Medicare health plans are supplements to Original Medicare. You have to already have both Part A and Part B to select one of these public² supplements.

• If you are not already on Original Medicare at all or you only have Medicare Part A, and you do not have a a good reason (e.g., a good reason for not having it at all would be that you are just turning 65; a good reason for having A but not B is that you have been working and are now going to retire; there are other good reasons), you cannot purchase a Medicare health plan during public supplemental health plan open enrollment.
• On the other hand, if you are just turing 65 or just retiring, you can select a Medicare health plan twice... once for the rest of 2014 as soon as eligble and another for 2015 during the October-November timeframe. (And if you are on George Bush's Extra Help plan for Parts C and D, you can change Part C or Part D plans every month if you want.)

So again the October-November timeframe hoopla is just that, a lot of press hoopla.

By the way, there are a whole different set of rules -- chosen by your former employer -- if you are on retiree insurance. See another future blog post.

¹The actual relevant period is October 15 to December 7 with the necessary information to make a decision available October 1. You will receive the 2015 Medicare and You booklet in September if you are eligible for a supplemental Medicare health plan (that is, you are already on Medicare). You should not wait until the last week of the enrollment period.

²More about the difference between private and public supplements in an upcoming post. The press gets this all wrong too.

Nothing to Do with Medicare: NBA Trades Sterling To Get Steve Ballmer

Really? The NBA had this old guy in LA who said strange things that embarrassed the league.  So it traded him for Steve Ballmer. Whoa!!!!

United States Medicare: The Only Question Is "How Bad Can It Get?"

Pretend you were a government bureaucrat and you designed a government program authorized by Congress that effectively forced people to participate because Congress levied a substantial tax on you (this is allowed by the Supreme Court based on many test cases on many programs). The program also used much of your income tax payment to pay for its wasteful activities and some outright abuse.

 

(See June 2014 MedPAC Data Book for latest splits, released in late July 2014, which are basically the same as illustrated above but more in favor of capitated plans than the illustration)

 

But within years of starting your government progam, many of the people you intended to help made other - mostly private non-governmental -- arrangements to get the financial protection and/or services that you supposedly provided with their tax money. Still the program continued over the years because -- hey, you are a government bureaucracy. But at least you recognized its problems and made changes almost every year of the program's existence to try to fix its problems. Yet after almost 50 years, the problems are worse. Now over 95% of the people who are in the program decide they have to make other - mostly private and mostly paid for out of their own pockets -- arrangements to get the service your government program is supposed to provide.

 

Would you call yourself successful? Yes, you would lie to yourself and call yourself successful if your program was United States Medicare.

Retired Americans: Do Not Read "retiredamericans.org" Website

I stumbled across a web site supposedly for seniors. Its owner, a Richard Fiesta, had written in Huffington Post:

 

"For those with chronic illnesses, thanks to the Affordable Care Act, they are no longer subject to annual or lifetime limits on benefits."

 

I hope Mr. or Ms. Fiesta is right. It would be nice if it were true but I do not know of any such change in the Medicare law in the 50-year-old fee for service lifetime limits and fee for service Medicare's lack of annual out of pocket limits.

In particular, the 2014 Medicare and You booklet (cover image above) specifically says relative to Part A (page 32):

• "You pay $1,216 and no copayment for days 1–60 each benefit period.
• "You pay $304 for days 61–90 each benefit period.
• "You pay $608 per "lifetime reserve day" after day 90 each benefit period (up to 60 days over your lifetime).
• "You pay all costs for each day after the lifetime reserve days (are used up).
• "Inpatient mental health care in a psychiatric hospital is limited to 190 days in a lifetime."

Relative to all of fee for service Medicare, the 2014 Medicare and You booklet says (page 62):

 

You generally pay a set amount for your health care (deductible) before Medicare pays its share. Then, Medicare pays its share, and you pay your share (coinsurance/copayment) for covered services and supplies. There’s no yearly limit for what you pay out-of-pocket

 

(Italics and underline added)

 

I asked the organization for clarification and if I get it I will add it. I hope Mr. or Ms. Fiesta knows something the government doesn't know. In the meantime, be very leery of anything it says on this site.