theabcsofmedicare

United States Seniors: Beware of Advocacy Advice Groups Trying Get Your Donations

Seniors, when you see a so-called non-partisan organization with a name such as the “National Committee to Preserve Social Security and Medicare (NCPSSM),” put your hand on your wallet. You can be pretty sure it is not non-partisan (NCPSSM is a lefty group) and that it is trying to beat you out of some money with its neutral-sounding name. The same goes for a group called the “Partnership for the Future of Medicare” (it's far right wing). Both claim to be giving you good advice and working for you in Washington (send money or get out your credit card).

NCPSSM is an active Democratic Party organization that recently endorsed Democratic Party nominees in multiple upcoming elections. Just donate to your favorite candidate if that's what you want and elminate the middle man. Worse the NCPSSM works tirelessly to repeal the public Part C health plan program and has been doing so almost constantly since the program was made into law.

The right-wing Partnership for the Future of Medicare on the other hand seems as if it were totally created to butt into provider/government bureaucracy battles in favor of providers. There was a flurry of activity when the Part D and Part C rebates were announced back in the late winter of 2014 but the group has kind of dropped off the map since then. There looks like there was a similar pattern of activity/inactivity in 2013 following the group's late 2012 creation.

 

More Government-Funded PBS Nonsense about United States Medicare

I have seen almost a half-dozen articles about so-called Medicare open enrollment by the same author on the main Public Broadcasting Service (PBS) web site and this author is providing readers really bad advice. There are many misinterpretations of the Medicare rules and some outright incorrect statements concerning Medicare in the articles (some of which are the same with different titles). In one of the articles, the author says that no one in the Medicare  bureaucracy would talk to him or her to help prepare the articles. The author should have waited until they would.

In one article, the author spends most of the blogpost real estate commenting on and criticizing some mythical capability in the Medicare Plan Finder to "tailor your plan choices."  What the author is talking about is the option to sort the list of plans available to the beneficiary in various ways. (The author also appears to be mixing up Part C plan lists and Part D plan lists.) There is no tailoring of plans possible; you can only choose one of the sort criteria. The plans are the plans as approved months ago by the Centers for Medicare and Medicaid Services.

It is unbelievable how the author has made a very simple process incredibly confusing. This is also not surprising; this whole series of articles appear to be part of the Democratic Party program to repeal Parts C and D of Medicare. One of the Democratic Party arguments for repeal is that Part D is too confusing. The Plan Finder is pretty simple. (I am assuming  a senior would not online with the Plan Finder if he or she did not also use Amazon or Expedia or Facebook.) All the beneficiary has to do is enter three items (or five if more precision is desired):

-- his or her zip code

-- detailed current Medicare status if desired

-- welfare status if desired

-- drug list, and

-- "preferred" pharmacy or pharmacies.

In the effort to follow the left-wing playbook of making all of this sound incredibly confusing to others like the author who are not on Medicare (and apparently who have never bought insurance), the author has left out two key pieces of information:

1. Even if you take no drugs, you have to enter one drug in the Plan Finder in order to proceed. If you are one of the few Medicare beneficiaries who takes no drugs, enter a low cost generic such as Atenolol. (And in general -- but not always -- you should sign up for a Part D plan if you have no other creditable coverage in order to protect yourself for the future and lower the cost you would otherwise pay should you have to buy in later.)
2. "Preferred pharmacy" has two meanings. You can simply prefer a pharmacy because it is close to your home or you like Waldo the druggist or whatever. But there are also plans that provide better prices at the plan's preferred pharmacy. So even if you like Waldo a lot, also put CVS or Walgreen's and/or your local big box store with a pharmacy on your preferred list. If the price difference is not large you can still go down to see Waldo and have a frappe at the soda fountain while you're there.

United States Medicare: The Real Obamacare Cuts to Medicare Still Years Away

This Forbes article is very wonky but it has all the math you need to see to really understand what the Patient Protection and Affordable Care Act of 2010 as amended does to ruin senior-citizen health care.

I am not talking about my health care. Or my parent's health care. Where PPACA really screws people is the way it screws my kids, the people who are effectively paying for my Medicare. (Theoretically I paid for my current health care insurance myself over almost 50 years of working and paying income and payroll taxes and I can demonstrate that mathematically. But in reality LBJ took that first dollar I paid for my future healthcare in 1966 and spent it on Medicaid.)

United States Seniors: One More Thing about Private Medigap Supplements

A few posts ago, I explained how you might decide between a private Medigap Plan A and a Medigap Plan F, which represent the major different approaches to gap insurance in the Medicare market (roughly the same as Core vs. Medigap Supplement-1 in Massachusetts, where we don't have seven different plans A through N like most other states).

That October 27 post was the simple explanation. But this is the government. Nothing is ever that perfectly simple.  In addition to the roughly $1200 Part A per-indicident admitted acute-care-hospitalization deductible, there is also an approximate $150 annual deductible for Part B expenses and some skilled nursing care limitations you have to take into account. So you need to figure both of these into to your "bet" as well but just sticking with the $1200 vs the extra monthly premium is the best way to look at it.

And then you still probably need a standalone part D drug plan (unless your former job or union or VA offers what is known as creditable coverage. Part D will be discussed on this blog in more detail in November but in the meantime, enter your drug list and save its "passdate."

 

United States Seniors: U.S.-Government-Funded PBS Really Screwing up Medicare Advice in 2014

The United States government funded Public Broadcasting Service (PBS) web site and its affiliate web sites (and presumably in some of its broadcasts) is on track in 2014 to put out the most inaccurate information about United States Medicare ever. I noted one example (of many) on October 27. Similarly PBS is currently attacking the Part D Medicare drug plan program (link purposely not provided; why read crap?).

Most of the PBS Part D article says nothing but the obvious "Buyer Beware." It probably was too much, given the political purpose of all of the PBS blog posts, to try to explain the difference between the self-administered drugs covered by Part D and other drugs covered by Part B. But it is the PBS article's conclusion that bothers me most:

"Lots of people have Part D plans that are combined with basic Medicare Parts A and B coverage. Many people also use Medigap policies to fill coverage gaps in Medicare. Medigap benefits should, therefore, be considered in evaluating the Medicare drug plan that makes sense to you."

This conclusion is disjointed to a degree almost impossible to do by mistake. It has to be an intentional deceit except that I cannot figure what propaganda objective the PBS author is trying to accomplish. The first sentence is unrelated to the second and the second unrelated to the third.

• Sentence 1: Since everyone on Medicare has either Part A or Part B -- and almost all of us have both Part A and Part B -- then of course "Lots of people have Part D plans that are combined with basic Medicare Parts A and B coverage." But if the point is that "lots of people" only have A and/or B and D, that is incorrect and misleading. It might give the reader the impression that only selecting Original Medicare would be all that is needed to protect oneself from financial ruin, Nothing could be further from the truth. In fact:
• Only a very small percentage of the over 50,000,000 of us in the Medicare system have only A and/or B and D. Presumably these few of us are very rich or betting we will be very lucky.
• About 35%-40% of us have A and B and private retiree insurance (which may include private drug coverage or may be combined with a D plan).
• About 30% of us have A and B and public C insurance that is almost always combined with a D plan.
• About 15% of us are on A and B and Medicaid but might be in C or D or a private plan if the state Medicaid bureaucracy puts us there.
• (Sentence 2:) About 20% of us are on A and B and a private Medigap plan and almost of all of us in this category also find a D plan (unless we are very very happy with the VA or get some kind of separate retiree plan)
• Sentence 3: If you are in the last group, I have no idea why the author would advise "Medigap benefits should, therefore, be considered in evaluating the Medicare drug plan that makes sense to you." With very rare exceptions that predate 2005, no Medigap plan has drug coverage and nothing about any Medigap plan's benefits that I can think of relates to your choice of a Part D plan¹.

¹I'd be glad to be corrected on my last statement but I can think of nothing. Medigap covers gaps in medical services coverage but only of services covered by Parts A and B. Part A has nothing to do with drugs and Part B has nothing to do with self-administered drugs.

United States Seniors: Understanding the Difference Between a Medicare Deductible and an Out of Pocket Limit

Actually I might be insulting my fellow seniors with this post. It is actually the thirty somethings that write health care columns for the left wing media that can't seem to understand the difference between a deductible and an annual out of pocket (OOP) limit. We seniors on the other hand have been buying insurance for 50 years and we get it. Typical is a sentence like the following, which appears in today's Detroit Free Press:

“...federal law caps the maximum OOP costs for Advantage plans at $6,700, many... plans have much lower maximum OOP limits. That means coverage kicks in sooner for consumers with big expenses.”

The $6700 or lower number is the most a person on a public Part C Medicare Advantage health plan can spend on medical-service co-pays and co-insurance; it is not a deductible¹. the OOP limit does not refer to how much a public Part C beneficiary has to spend before “coverage kicks in.” Coverage under Part C almost always “kicks in” immediately¹, with beneficiaries paying – typically -- $15 to $50 co-pays at doctors, $50-$100 at an ER, $250 or more a night in the hospital or for an outpatient procedure (these numbers can vary significantly). Only if something catastrophic happened – with medical-service bills adding up to multiple tens of thousands of dollars -- would the total of those co-pays add up to the maximum OOP.

This is important because Original Medicare – even with most private Medigap plans – offers no such catastrophic protection. The financial exposure of somone on only Original Medicare (which is almost no one) or Original Medicare with most private Medigap plans is unlimited. Also Original Medicare has much higher co-pays and co-insurance (and does have deductibles) than a public Part C health plan. The purpose of Medigap is to fully or partially fill those “gaps.”

Unlike Part C plans, Medigap does not cover additional medical services such as dental or vision or annual physicals although not all Part C plans cover such additional non-Original-Medicare medical services. However there are many situations where Medigap is the better option for supplementing Original Medicare, particularly if it is the only insurance favored providers accept and/or the senior spends many months away from his or her primary legal residence.

¹A Part C plan could also have a deductible. This would occur in a Part C plan called an MSA plan that is like a Health Savings Account plan for people not on Medicare.

United States Seniors: Bad Advice about Medicare All Over U.S. National Public Radio Web Sites

National Public Radio (NPR) and preumbably its affiliates all over the U.S. are putting out web page after web page of bad information about Medicare. This is not surprising given the left-wing government-funded propaganda outlet's decade-long attack on Medicare Parts C and D. This recent NPR station's article supposedly provided 10 items that were important for seniors to remember. Here are five more important things that the article intentionally left out that Medicare beneficiaries really need to know about Medicare.

1. The specific timeframe October 15-December 7 is “a once-a-year opportunity” only if you are among a relatively small group that is not on Medicaid or Social Security Extra Help or a state pharmaceutical assistance program, or does not get insurance from a former employer or union. If you are in one of these latter groups your “opportunity” has either already passed or happens as often as every month
2. Original Medicare is not a choice. Everyone on Medicare has to begin by choosing Original Medicare. Within Original Medicare you could choose Part A or Part B. But if you want an individually purchased supplement – and almost everyone does – you need to have both A and B. Your former employer or union will probably require it also
3. No part of Medicare is “managed by the federal government.” Or all parts of Medicare are managed by the federal government. It depends on what you feel “managed by” means. The most accurate way to say it would be that all four Parts of Medicare – A, B, C and D -- follow federal government rules but are administered by private insurance companies.
4. Original Medicare is not the same as “traditional Medicare.” As per point 2, Original Medicare is Parts A and B. Everyone on Medicare has one or the other and almost everyone has both. Traditional Medicare refers to getting your health care from any provider who accepts Medicare; that provider is paid for each service performed in the “traditional” way health care has always been paid for.
5. No one “must choose” a separate prescription drug plan. It’s a good idea and it almost surely will save you money in the long run but unlike with people not on Medicare, there is no mandate to take drug insurance or even to take Medicare.

United State Seniors: The Elite Medigap Plan Is Not Always the Best Choice

The major differences between Medigap plans, called Core and Medigap Supplement-1 in Massachusetts and a choice from about six different plans in most other states (left hand side of flow chart), is the monthly premium and how much or how little they cover Medicare co-pays. Roughly, the higher the premium the more they cover but choosing the one with the higher premium is not always the best choice especially in a state like Massachusetts with continuous, open Medigap enrollment.

So that's your next decision point. Do you want to try to save $1200 or more a year by choosing the less expensive form of Medigap insurance.  In making that decision, you have to estimate if you think you will go into the hospital during any given year.  Because if you do get hospitalized, with cheaper Medigap plans it will cost you -- I bet you guessed already -- about $1200. You'll be back to even. But if you are not hospitalized during the year, you paid $1200 more than you had to. So that's your bet.

Naturally, it's not totally that simple. This is the government after all. If you live in a state with continuous open Medigap enrollment you can simply upgrade to the more expensive Medigap plan and never be any worse off than you would have been had you paid top dollar for the elite Medigap plan all year long. But in other states you cannot move from and to Medigap so easily. So make sure you know the rules in your state.

 

Exposing Looney Left Lie #32 about United States Medicare: Medicare Advantage Is Not for Rich Seniors

One of the classic looney left lies about Medicare goes something like this:

“Like most seniors, I cannot afford a Medicare Advantage Plan…” or

"Medicare Advantage is for rich seniors."

Nothing could be further from the truth. The public Part C Medicare health plan program was designed because the poor could not afford expensive private Medigap insurance and were finding it necessary to "spend down" unnaturally to qualify for Medicaid. The public Part C program ended that requirement and as the data shows in the illustration above, public Part C plans are used disproportionately by the poor, particularly minorities.

Furthermore, even though Part C plans are almost always less expensive than private Medigap plans (and almost always cover more services such as drug coverage while providing an out of pocket limit not available with Original Medicare and a Medigap plan), if you know someone who still feels they cannot afford a public Part C Medicare Advantage plan, have them consider applying for Social Security Extra Help, which will pay a sizable amount if not all of the premium.

United States Medicare: WaPo Article Should Have Highlighted Part C Medicare, not Part D

The October 23 Washington Post article that quote the October 21 Health Affairs article that suggested George W. Bush has had more to do with tamping down Federal government spending on Medicare than President Obama concentrated on the Part D Medicare drug plan program.

But if there is anything to the theory it would not just be the Part D portions of the 2003 Medicare Modernization Act (MMA) that made a difference. The 2003 MMA changes to the Part C Medicare health plan program, which originally became law in 1997 under President Clinton, have also had an effect in bringing down Medicare healthcare costs because the managed accountable care that is the key ingredient of most Part C plans is now showing to be more effective than un-managed fee for service (FFS) care known as traditional Medicare.

In fact, this accountable-care concept is now so well accepted that it was brought over and made a key part of all the insurance enabled by the Patient Protection and Affordable Care Act (PPACA) for people not on Medicare and PPACA is also quietly moving everyone on FFS traditional Medicare into accountable care organizations without even giving them a choice.

 

Exposing Looney Left Lie #31 About United States Medicare: Part D Was Not "Unfunded"

The recent funny headline and blog post in the Washington Post crediting George W. Bush -- rather than Obamacare as President Obama claims -- for the slowing of United States Medicare trust fund outlays opened the left to lay out its old canard that Part D wasn't funded.

Forget the fact that by the left's logic, it's own 2000 and 2003 programs for funding self-administered drugs under Medicare also were not funded, the so-called new post 2006 Medicare Part D expenditures (usually tied by the left to the huge increase in the Federal debt under President Obama) were almost totally cost shifts: 

• About half of the spending now coming out of the Medicare Part B Trust Fund (right hand bar) for all pharmaceuticals -- including previously not covered self-administered drugs -- came out of Medicaid (left hand bar in image) prior to 2006, half state and half federal (NOTE: Medicare previously and continues to fund drugs administered by providers out of Part B, which is why the new drug benefit was funded from that source.)
• To a lesser extent the VA and a few other Federal programs that previously funded most drugs for seniors and those with disabilities was shifted but not completely to the Part B Trust Fund (amounts not shown in image because of scale).  
• Much of what is now upper donut hole and catastrophic coverage was covered by state pharmaceutical assistance programs (green in left-hand bar) but that was not available in all states; other state/county programs and charity also often made up the difference depending on where one lived but whatever what the left calls unfunded Part D was just more cost shifting within government.
• There clearly was some incremental expense to the Trust Fund but according to GAO and/or CBO, better drug coverage is lowering other Part B Medicare expenses such as ER visits so that money is still coming out of the same Trust Fund but being "charged" to Part D--again no real net new expense.
• The out of pocket expense to seniors and the disabled (blue in both bars) has been cut in half or more but is still substantial on average (as it should be in my opinion); Medicare beneficiaries pay about a quarter of their drug costs unless those costs are very high -- less than 10% of the time -- in which case the cost drops down to below 10%

In addition and not shown in illustration, some of the incremental cost of Part D  was covered by a surtax on high-income seniors' Part B premiums (the Democrats have now frozen the indexing of that surtax so many middle income seniors are now paying that surtax to fund PPACA) . Back at the time Part D was passed, all (or almost all) Democrats opposed it not because it was not funded but because it was not as generous (that is, even more costly and more "unfunded" than) as President Clinton's proposal that led to Part D.

United States Seniors: All Medicare Part D Donut-Hole Talk Is Pure Bunk

I don't know where to begin this post because the Internet is full of so much incorrect Medicare Part D donut hole information, especially during so-called Medicare open enrollment time. I covered some of the bunk recently concerning the propaganda put out by the Obama administration. But some of the deceit comes from years old Democratic Party propaganda having nothing to do with President Obama and some of it is just totally wrong for no reason that I can find. So let me just throw out some random facts as of October 24, 2014 and add to this list as time goes on:

1. Cancer drugs are typically covered under Part B, not Part D. Stories you see about cancer drugs -- such as one that allegedly ran recently on 60 Minutes -- probably have nothing to do with Part D, never mind the donut hole.
2. Just because the government does not negotiate for Part D drug prices, that does not mean there is no negotiation. The beauty of Part D -- the reason that it is costing half of what the Congressional Budget Office originally estimated -- is that drugstores and wholesalers do the negotiation, not the people that brought you thousand-dollar toilet seats
3. Costs and co-pays in Part D are rising because the donut hole is closing. It's just simple math. It has nothing to do with blood-sucking insurance companies even though there may be such a thing as a blood-sucking insurance company. It's just insurance math; if the insurance has to cover more costs and is forbidden from setting deductibility threshholds, prices rise.
4. Congress has reconsidered the Part D law every year since it was passed in 2003 (and made a major change in 2010, changing the donut hole rules). There is constant left wing whining about why Congress doesn't change the law. It has, multiple times in 10 years. The issue is that some far-left-wing Democrats want to repeal the law and even most Democratic congress people think that's a crazy idea.

Here’s the good news: less than 10% of the people on Medicare are affected by the donut hole and only a few percent are totally affected by it.

• If you are on Social Security Extra Help (that is, you are low income) you are not affected by the donut hole at all… ever.
• I know the statistics are of little solace if you are of higher income and in that relatively small group affected the donut hole coverage gap but you have gap insurance available to you and the VA if you are a vet (and other good programs in many states).

United State Seniors: In Medicare Advantage Step 4, Find Out What Public Part C Medicare Advantage Plans Are Available for 2014 in Your County

(For previous steps see Step 1, Step 2 and Step 3 at links. For some of the preliminaries before beginning the four steps laid out on the Medicare Plan Finder, see links noted in the Step 1 post.)

In Step 4 of using the Medicare Plan Finder, you begin looking at and comparing the available public Part C Medicare Advantage health plans in your county.

The informtion in the red circle (see image) shows how many plans are available to you maxium (in the example, there are 14 available but this differs county to county). All of them might not apply to you because some are only for special needs situations or people on Medicaid. Typically you can choose one from among the following 

• National insurance companies such as AARP, underwritten by United  Healthcare, or Humana (United Healthcare might also offer a plan in your county on its own unaffiliated with AARP)
• Your state's Blue Cross franchisee, which most likely offer preferred provider organizations (PPOs)
• One or more local or major "historically true health maintenance organizations (HMOs) such as Kaiser, especially in the Western United States, or Tufts and Harvard in Massachusetts)

The choices will almost always be generically between HMOs and PPOs. The major difference between those two types are network breadth and availability to out of network providers. PPOs typically cover out of network doctors but at a much higher copay.

Simplistically, some of the choices are more expensive than others primarily because they have lower annual out of pocket medical-cost limits (the highest allowed by law is $6700) and/or they have broader "networks". Secondarily some are less expensive because the insurer is trying to "buy" market share. 

All the plans have been approved by the Centers for Medicare and Medicaid Services and the beneficiaries are getting 85% of the premiums back in medical value -- AS A GROUP. (Of course, ideally, you INDIVIDUALLY don't want to get all your premiums back; it would mean you were sick or injured.)

Some plans include no built-in drug coverage. You can only choose one of these plans if you have "creditable coverage" from a former employer, union, the VA or a similar source. You cannot mix and match Part C plans with no drug coverage from one insurer with another insurance company's Part D plan.

This blog will delve into the finer points of some of these differences during November. You are under no rush to sign up; you have until December 7 but I would suggest doing it before Thanksgiving so that you have all your material in hand and can make one more review before the window closes. Even if you make a decision in mid November, you can still change it up until December 7.

United States Seniors: Here's $400 Worth of Advice; Don't Pay $400 for Medicare Advice

Seniors, Beware of services that charge $300-$400 for "Medicare Advice." They are popping up everywhere but it is unlikely that you would see a return on that investment. What's really bad is that these $300-$400 Medicare advice services are probably really trying to sell you something else besides Medicare advice. 

There's no silver bullet. Depending on your income, drug list and your tolerance for risk you are going to spend between $1254 (the basic Part B premium unless you qualify for a Medicare Savings Program) and $3600 a year on Medicare and supplemental insurance each year depending on where you live (double that for a couple of course). And you are going to spend some additional amount of money out of pocket. The drug list, your willingness to go without a supplement (almost no one takes that risk), and your choice of doctors controls that spread almost entirely. No Medicare advice firm can change your drug list or your doctor preferences.

So here's $400 worth of Medicare advice for free. There are only three basic ways you can save money relative to Medicare:

1. If you make under a certain amount (and possibly facing an asset test), you can get your Medicare Part B and C or D for free or highly discounted through state programs such as Vets' Services and Medicaid (but all states programs are different) and/or Social Security (rules are same throughout the United States). Contact these organizations if you want to know if you qualify. In some Northeast states, almost 50% of seniors who buy their own Medicare supplemental insurance (as opposed to getting it from a former employer) qualify for some kind of additional assistance.
2. Find out if your state has a pharmaceutical assistance program for people on Medicare. In Massachusetts where I live, even if you make up to $70,000 in retirement you can get Massachusetts' Prescription Advantage. People who make from between about $50,000 to $70,000 have to buy into the program but it provides great donut hole protection if you need it (about 10% of you do). If you make under about $50,000 (but you are not in group 1 above), Prescription Advantage costs nothing and provides even better donut hole protection.  I suspect Massachusetts has the best such program but about 20 other states have some type of pharmaceutical assistance program. If yours does, and you qualify, join it even if you will not save any money. Belonging allows you to change Part C or Part D plans one additional time during the year after annual enrollment.
3. You need to run your drug list through the Medicare Plan Finder after you have decided whether you want private Medigap insurance or a public Part C Medicare Advantage health plan as your supplement. This will help you find out how you can save money using preferred pharmacies, zero-premium Part C plans if they make sense, and other features of Part C or D vs. Medigap plans 

United States Medicare: Washington Post Credits George W. Bush for Improved Medicare Outlook

On Octbober 22, The Washington Post Wonkblog ran an article about an October 20 Health Affairs article in which some right-wing Washington think tank you never heard of looked at some old Congressional Budget Office (CBO) analysis and used the CBO's numbers to credit the 2003 Part D drug program -- not the Patient Protection and Affordable Care Act (PPACA) as claimed by President Obama -- for bringing down projected Medicare spending.

It was all pretty wonky stuff but the Post lit a fire under its lefty readership with the headline: "You may want to thank George W. Bush — not Obamacare — for the remarkable Medicare cost slowdown." As you would expect the lefties that read WaPo went bonkers about the Iraq War, Guantanamo Bay, the Florida recount, Bush's National Guard service, Hurricane Katrina, the Texas Rangers, Bush's grandfather, the drought in east Texas, oil drilling, Kyoto, Tom Delay, Bush's daughter's drinking, Bush's drinking, Bush's sobriety, Bush's religion, Bush's colonoscopy (which made Cheney president for 15 minutes), and on and on... every nutty lefty thing you've ever heard but nothing of substance about Medicare.

I do have a substantive comment. My problem is not with WaPo's lefties or the cute trick the WaPo Wonker pulled to get reader interest but with the right-wing analysts.

• The difference between the 2011 CBO baseline and the curent estimate is really more a story about how bad the CBO is in estimating the cost of Part D? The patent situation and other aspects mentioned in Health Affairs (except sequestration) must have been known when the original CBO baseline(s) were calculated.
• Whichever, despite what the right-wing analysts claim (repeated by the WaPo Wonker), the Medicare spending slow down is not "excellent news" for beneficiaries. What the chart in the image shows -- if you combine it with a chart of all healthcare spending by people on Medicare (similar to charts in the annual MedPAC Databook) -- is more cost shifting on to beneficiaries. That may be OK in terms of
• Fairness (cuts to Part Cn to bring Part C rebates in line with Tradtional Medicare FFS spending; these are possibly reflected in the Part A and Part B numbers should have already been baked into the March 2011 baseline because they were passed in PPACA in 2010)
• Logic (getting rid of the crazy donut hole rules)
• Reducing fraud and waste (I assume that is what "recoveries" means?)
• Other aspects of this stupid crazy-quilt LBJ program that has long outlived its usefullness.
• But I would not call it "excellent news" for beneficiaries unless you think we beneficaries are happy that we have to pay even more than the approximately 50% of our healthcare costs that we already pay for our healthcare under LBJ Medicare.

United States Seniors: Step 3 in Medicare Advantage Shows There Are Two Different Kinds of Preferred Pharmacies in Medicare

After entering your zip code (and more detail if you want), answering questions about the type of Medicare you currently have (or less detail if you want), and your drug list,  Step 3 in signing up for a public Part C Medicare Advantage health plan (or Part D plan for that matter) is picking a preferred pharmacy. 

Preferred has two meanings when using the Medicare Plan Finder:

• Obviously you can pick the pharmacy you prefer because it is near your home or you like Fred the Pharmacist or you "go to Target anyways once a week" or... (you can even indicate to the Plan Finder how far away the pharmacy should be and it will only indicate pharmacies within a certain radius of your zip code)
• But Part C and Part D Medicare plans almost all have preferred pharmacies as well. So if you're willing to drive across town and/or kiss old Fred good bye, you might save some serious money.

There is no particular rule of thumb with the plans' preferred pharmacies other than to use the Plan Finder two ways... once with your preference and once with each of the big name-brand retail drug stores as preference... and see if there are any savings involved. Many people around the United States only have big box pharmacies to choose from these days but there are almost multiple such choices.

There are likely be savings if you use a lot of generics (they are often "free" -- that is, no co-pay -- at the plan's preferred pharmacy) or if you use a particular kind of expensive brand-name drug where the plan has a special deal with the pharmaceutical's manufacturer or distributor. If like most of us, you only use a few generics, then you need to decide if a few bucks saved is worth the time and gas of driving across town... and the hard feelings with Fred.

Woman Goes Bonkers over Medicare; Wants To Put One-Size-Fits-All Straightjacket on Seniors

Someone named Carol went off on Medicare the other day on a web site for which I can no longer find the link. Don't matter; basically she was saying that Medicare was all too confusing and what the United States needs is one-size-fits-all healthcare insurance for senior citizens. Whowever she is and wherever I saw the comment, she was specifically talking about the "needy" and people in nursing homes, which only tangentially touches Medicare anyways. It got me thinking that a lot of people mix up we seniors and the needy. And do not seem to understand that Americans -- especially we senior Americans -- like choice.

 

In particular, when it comes to Medicare:

1. It is true that about 20% of we seniors are "needy." Most of the seniors in the "needy" group get some kind of completely free or partially free health care¹. Those of us in this sort-of (see footnote) "needy" group are almost all eligible for free or almost free drugs no matter how much they cost (there is no such thing as the donut hole for us).
2. But a large majority of us are not "needy." The other 80% of us split as follows and like choice (see image above):

• A. About 30% of us who are not needy get health insurance from a former employer or union so  -- except for a few wrinkles -- all our decisions are made for us by the former employer or union. This retiree insurance  is known as "Cadillac health coverage;" it's the best available. Those of us in this group definitely do not want some one-size-fits-all program like the woman is suggesting.
• B. Of the remaining 50% of us (not needy and not getting insurance from a former employer), around 6 in 10 of us like having choices as to what our insurance covers and we sign up for a program called Part C of Medicare where our health is monitored by what is called Managed Medicare, like an HMO and now called an accountable care organization by the Obama administration. We also don't want a one-size-fits-all program like the woman suggests because some of these Part C plans are designed for healthy seniors and others for very sick seniors and some just let those of us who wish assume more of our own costs, betting that we won't have too many.
• C. Conversely about 4 out of 10 of those not needy and not getting insurance from a former employer or union reject the idea of being corralled like cattle by the accountable care organization² like those of us in category B. These folks sign up just for vanilla fee for service (FFS) Medicare A and B and buy  private insurance that is like the Cadillac health plan those in group A get. Obviously those of us in Group C want to be able to keep doing this too.... just like the seniors in groups A and B want to keep doing Medicare their way.

I do agree that the process by which this all gets paid for is confusing. It would be nice to simplify a lot of the money changing while keeping the Medicare choices we seniors all want. Anyone who agrees should take a look at a bipartisan Medicare reform plan called Wyden-Ryan released in December 2011. It simplifies the funding part of Medicare and keeps the choices we want.

¹And many of the needy on Medicare purposely put themselves in that category through what is known as a spend-down, down five years before they "need" government assistance to prevent the government from "clawing back" the seniors assets from heirs.

2Because of the Patient Protection and Affordable Care Act of 2010 as amended. all these people are going to be corralled into accountable care organizations against their will whether they know it or not

United States Seniors: Signing Up for Public Part C Medicare Advantage--Step 2

In previous posts I wrote about why often private Medigap is better than a public Part C Medicare Advantage heath plan, what a zero-premium Part C plan is all about (how can it be free?), how you start thinking about Part C, and -- on October 20 -- Step 1 in choosing a plan. Now it's time to move on to Step 2.

Step 2 in the Medicare Plan Finder (whether you are looking for a public Part C Medicare Advantage health plan or a standalone Part D drug plan to go with your private Medigap supplement or retiree insurance) is the point in the process you enter your drug needs. There is not a lot I can say about this step but if you took my advice on October 6, you already have a head start on this. Just enter the Drug List ID and "passdate¹" you saved then. If not write it down now after you enter your first drug.

The one one piece of advice I can give is to the lucky people out there who take no drugs. Sorry but you cannot proceed without entering something believe it or not. So enter Atenolol. It's a cheap blood pressure medicine and if you don't take it now, you will some day. Keep a record of the Drug ID list and Password Date that pops up after you enter your first drug. This is especially important if you have a long list and want to quit and come back at a later time.

¹Only the government would use something called a "password date," right!!!

 

United States Seniors: What's Step 1 in Signing Up for a Public Part C Medicare Advantage Health Plan?

As I wrote on the post on October 19, there are some relatively easy steps to signing up for a public Part C Medicare health plan or to switching from one to another. As a first step in signing up for a Part C health plan (most of which are labelled Medicare Advantage), you can call all the insurance companies  (not agents) that do business in your County one by one and ask them if they offer Part C of Medicare. Or... it's a lot easier to go to the medicare.gov Medicare Plan Finder, enter your zip code, hit "Find Plans," and you will reach the above screen.

You can fill this Step 1 screen out completely (and possibly get some better recommendations when you get to the end of the Medicare Plan Finder process) or you can simply answer "I Don't Know..." to both questions and hit "Continue on...."  There is no real risk of identity theft by answering the questions because you never give any personal information¹. But if you are concerned about putting in your personal information, just hit "I Don't Know..." in answer to both questions, hit "Continue" (and look for my subsequent post on Step 2 to appear on this blog October 21 or 22).

If you DO want to fill out the two sections of Medicare Plan Finder Step 1, here's what they are looking for and why:

• In answering the first question, choose your present status between Original Medicare² or Medicare Health Plan. Plan Finder will then ask you which private supplemental plans you have (if any) if you chose Original Medicare and it will ask you what public Part C plan you are already on if you chose Medicare Health Plan. (If you do not have Medicare yet -- the other option along with "I Don't Know..." --  you can keep going in the process if you want to see what some of your options will be but you can't enroll in Part C -- or Part D -- until you first sign up for Medicare Parts A and B.)
• The second question asks a series of questions about your state's (broad Medicaid or Medicare Savings Program) or Federal (SSI or Extra Help) assistance you might be receiving currently. This is important because it might influence the best drug plan for you and it will definitely influence the price of either Part C or Part D (which are lower for people on Social Security Extra Help/LIS and Medicaid).

After answering these questions, unless you choose to enter "Don't Know," hit "Continue."
¹On the screen where you entered your zip code, you could have -- as an option and if you are already on Medicare -- entered your Medicare number and birth date. If you did this, the medicare.gov system will display information about your current Part A/B/C/D status. If you used the Medicare Plan Finder last year, medicare.gov will also give you the drug list you entered last year when you get to Step 2, making that process easier. I do worry about ID theft but -- in this case -- the government already knows all this stuff so... what the hay...

²As explained here and elsewhere, using that term in that context is incorrect but that's what it says; the Democratic-party civil servants that really run the U.S. government are beginning to correct their own politically motivated misleading error. But they haven't fixed every point in the millions of words about Medicare where  the mistake appears (and they are undoubtedly still secretly hoping that the Democratic Party politicans succeed in repealing Parts C and D of Medicare because, "Boy does having choice in Medicare make a lot of work for us hacks.")

United States Medicare: 65 Year Olds Aren't Signing Up for Medicare Advantage As Much As CW Said

There is an interesting enrollment phenomenon in process in United States Medicare that further confirms the trend in popularity of public Part C Medicare Advantage health plans, which are the Federal government's public Medicare supplement option to private retiree insurance and Medigap plans.

The conventional wisdom for the last five years or so has been that the explosion in Part C popularity since 2006 (see image from the June 2014 MedPAC Data Book¹),  has come from new Medicare enrollees not eligible for retiree health insurance (particularly baby boomers since 2011). Such new enrollees, typically 65 years old, have grown into Medicare as members of health maintenance organizations (HMOs), now called accountable care organizations by Obama administration, and preferred provider organizations (PPOs). Almost all public Part C Medicare Advantage health plans are HMOs and PPOs.

Therefore, the theory goes, these new Medicare enrollees signed up for Part C in droves when first given the option to sign up for Medicare because they understood both the benefits and limitations of Part C's managed but networked insurance and they were less concerned about the limitations of such plans than their parents and grandparents.

It turns out, according to a presentation at Medpac September 2014 meeting², there is some truth to that theory but it does not tell the whole story. It turns out 65 year olds are not signing up for Medicare Advantage in droves, although they are signing up. To a greater extent, it's 67 year olds that have been on Original Medicare A or B or A and B for a few years. And 70 year olds, the bably boomers' older brothers and sisters. In other words, the real surge is coming from people who have tried private supplmental insurance for a few years and prefer the public option of Part C Medicare Advantage. To a lesser extent even beneficiaries older than 75 are switching although the old prejudices against HMOs from the 1980s die hard among this group and most likely any growth in this cohort is due to people on Part C special needs plans.

This information is befuddling the goo goos that want to run the nanny state and put all 50,000,000 of us and growing into the same one-size-fits-all crappy insurance plan all across America. But the reason is simple and the fact that the goos goos are befuddled just illustrates how out of touch they are with reality. At least until Medicare is reformed and made totally consistent, Part C is a better supplemental choice particularly for the poor.

¹Which in typical government fashion is always based on years-old data; the number actually increased to nearer 16,000,000 in 2014

²Look for presentation on Medicare Advantage demographics made at the September 12, 2014 meeting