theabcsofmedicare

United States Seniors: When Should You Sign Up for Medicare Part B

It is not true that you should always take Medicare Part B. It is probably true that most people should take it but the Medicare beneficiary demographics are starting to change radically because of the continuing increase in the Social Security full retirement age so all the old rules are also changing. There is a lot of just plain bad information on the Interent in general and particularly about Part B (and I’m leaving out my standard criticism of the typical nonsense that Part A doesn’t cost you anything).

In fact there is no requirement that you enroll in Medicare ever… age 65 or otherwise. I think you would be crazy not to given that you paid for it for 50 years but there is no requirement that you do it. (But you will be signed up for Medicare automatically if you start collecting Social Security. But presumably if you are against signing up for Medicare, you are against signing up for Social Security.)

And Medicare does not pay the costs for true catastrophic illnesses or for any custodial nursing care – prolonged or otherwise

United States Seniors: What is the 60 Plus Association? And What Is a Pharmacy Benefits Manager?

I saw an attack on pharamacy benefits managers recently by something called the "60 Plus" group. My first reaction in reading this was that “60 Plus” was one of those typical fly-by-night front groups, in this case set up by the “1950s pharmacists’” lobby – which believe it or not is called PUTT (not putz).

But 60 Plus turned out to be a 20-plus year-old legitimate group (although with a little too much love for Pat Boone for my blood). Not only is it not related to the old-fashioned pharmacists group but it is often accused of the opposite, being funded by the pharmaceutical manufacturers. In addition, supposedly the Koch-Brothers-not-Bill conglomerate funds them as do the makers of Listerine, and just about anyone else handing out money. Any group with so many bad things said about them by the left cannot be bad. It's just misguided on the subject of Pharmacy Benefit Managers (PBMs).

ABC News Has Very Good Explanation of Medicare... But No Help for Employer/Union Retirees

This post on ABC News web site is a surprisingly good explanation of Medicare's complexity given that ABC's is a left wing web site. The one major thing that might be misleading in this article is the explanation of the difference between the A/B/D/private-Medigap option vs. the A/B/C option.

1. The article does not make it clear that you have to have both A and B before choosing a public Part C health plan (or a private Medigap supplement for that matter). C is not an alternative to A and B; it is an add-on to A and B.
2. If you are just entering Medicare because of turning 65 or because of a disability, the choice between the two options is mostly likely not going to seem unusual to you. It's the same "local HMO/PPO vs. Blue-Cross/Aetna/Cigna choice" you have had from an employer or union for many years. Part C plans are mostly HMOs and the fact they are networked has nothing to do with Medicare; it has to do with HMOs
3. The article implies that you could choose A/B/C and then further supplement that with a private Medigap plan; you can't.

The article does not make the point forcefully that almost everyone on Medicare (over 95% of those not still working for an employer offering insurance) gets some kind of supplement.

United States Seniors: Medicare Voucher Alert! Medicare Voucher Alert!

Attention United States Seniors: The incoming Republican chairperson of the House Budget Committee has said he plans to include the latest version of the bipartisan Medicare reform proposal co-authored by Democrat Ron Wyden in 2011 -- and released three years ago this week -- in the Budget Committee's proposed FY2016 budget, which will come out of committee sometime in March 2015 if normal order is restored to Congress as promised.

But. unlike for the past four-eight years, regular order will presumably apply in the United State Senate as well so the House Budget will be taken up by the Senate Budget Committee.

Doctors against Insurance Companies Lobby Keeps Lying about Medicare Advantage

I was involved in a respectful set of back and forth comments recently on a wonky healthcare web site. We were discussing Original Medicare vs. Medicare Advantage, primarily -- on my part -- that Original Medicare is mispositiond as an alternative to when it is really the ante for all . other types of Medicare insurance. During the back and forth a leader of the Doctors against Insurance Company lobby popped in with this orthogonal comment:

"Part C Medicare Advantage plans are private plans. They are not part of Part A and Part B programs, nor Part D. A patient enrolled in a private Medicare Advantage plan is prohibited from using Part A and Part B. If a person goes outside of the plan network, he cannot ask the Part A or Part B providers to bill the traditional/original/FFS Medicare program. The private Medicare Advantage plan might authorize care outside of its network, but that care would still be covered by the private plan and not the traditional program. If the Medicare Advantage program includes drug coverage, then the enrollee is prohibited from using a Part D drug plan. If he attempts to do so, he is disenrolled from the Medicare Advantage program and reassigned to the traditional Medicare program."

The above comment by the Doctors against Insurance Company lobby is its typical one-sided and years-old misrepresentation of all portions of Medicare, done because the lobbyist group, perhaps accidentally, locked itself years ago into the bad proposition that everyone should have Medicare.

Surprise! Surprise! Fox Business Network Sucks for Medicare Advice

I consistently finds that Fox Business Network's web site sucks for Medicare advice. This December 10 article mixes up at least two different things about Medicare and could cause serious harm to seniors who do not read the fine print closely.

There IS “a federal effort to keep Medicare recipients out of an admissions revolving door” and there IS a Medicare rule about how to handle beneficiaries “who aren't well enough to be discharged but not sick enough to be formally admitted.” But the two are not related. The former started with the 2010 Patient Protection and Affordable Care Act. The latter goes back to almost the beginning -- if not the beginning -- of Medicare, almost 50 years.

The very very old rule is not an unintended consequence of the new rule as Fox claims.

Words and Numbers Mean Something in Reforming United States Medicare

It is a problem that in pursuing the much needed reform of Untied States Medicare no one can even agree on definitions and numbers in order to have a decent discussion.

United States Seniors: See How AARP Serves United States Seniors Poorly

The president of the American Association of Retired People (AARP), the front group for an insurance company aimed at taking advantage of United States seniors, recently argued strenuously for the status quo in Medicare and Social Security. Using the Saul Alinsky playbook, the president highlighted an out of context anecdote in which an AARP member in Georgia said

"I am 84 years old, and both Medicare and Social Security have served me well. I want the same for my children.”

That quote and AARP' use of it summarizes the entire problem with both Federal programs and with AARP’s status-quo position on the programs.

United States Seniors: If You Are the Sort of Person Who Waits Until the Last Minute...

... the last minute is here.

If you have not reviewed your current Medicare Part C or Part D programs, do so today or tomorrow December 6 or 7.  If you decide to change, call the insurer directly. Working through Medicare Plan Finder is OK at the last minute but why take the chance. And write down the name of anyone you talk to and any confirmation numbers they give you.

United States Seniors: Choosing Part D? Now Is the Time!

For the past few weeks I have been posting about public Part C Medicare Advantage plans and your options. Earlier in November I posted about private Medigap plans, the typical option to public Part C (unless you are one of the lucky people that gets your Medicare supplement from a former employer). 

If the you decided to go down the private Medigap side of the decision tree (see image) -- and maybe even if you get a private supplement from a former employer -- you still might need a public Part D drug coverage policy. I provided many details back in October but if you are the sort of person that likes to wait until the last minute... the last minute is here.

United State Seniors: What's the Difference between Medicare Rehab at a SNF vs. Medicare Rehab at a Rehab Hospital? About a Thousand Bucks!

I assume most United States seniors will not face this issue but my public Part C Medicare Advantage plan provider, Massachusetts' Democratic-Party-affiliated Tufts Health Plan insurance company, is apparently¹ quietly adding about $1000 to the cost of its subscribers getting a knee replacement in 2015 in Worcester County, Massachusetts. I do not know if this applies to other Tufts customers in other Massachusetts counties or to other insurer's customers in Worcester county or to other Part C plans from other insurance companies elsewhere but Tufts -- for 2015 -- seems to have increased the cost of a typical admission to an acute-care rehabilitation facility by about $1000 (from zero to $250 a day for the first five days of admission).

I say that this "apparently" seems to be the case because I can't get a straight answer¹ from Tufts. 

Absurd Commonwealth Fund Research Concerning United States Medicare Users

After reading the recently publicized Commonwealth Fund report that claimed how bad we United States seniors have it compared to those our age in the rest of the world, it is very had to get by the report's methodological problems to even address its strained conclusions.

United States Seniors: Analyzing the Medicare Health and Drug Plans Available in Your County

In using Medicare Plan Finder, after going through the four steps outlined in earlier posts, some basic deductible and benefits information is shown on the resulting list (image below) along with the plans' star rating (which is not especially useful because of the way the stars are awarded). 

To get more detail on deductibles and benefits, check on the box to the left of the plan names (e.g., to the left of the words "Tufts" and "Medicare" in the above illustration).

United States Seniors: Consumer Reports Keeps On Illustrating How It Is a Senior Citizen Hate Group

Consumer Reports is a major left-wing journal with a special hate for senior citizens. This is particularly easy to see when you compare how it describes Democratic-Party's Patient Protection and Affordable Care Act insurance with various Republican and bipartisan proposals to reform Medicare, In this article,  http://www.wggb.com/2014/11/26/why-you-should-shop-around-for-health-insurance-every-year/ the Consumer Reports insurance reporter explains how the Democratic Party insurance subsidy program works by  writing

"You can then take your tax credit and use it kind of like a gift certificate..."

But when this same hypocritical creep describes the bipartisan Wyden-Ryan Medicare reform bill, he or she calls the same type of subsidy a "voucher" instead of a "gift certificate." (see http://www.consumerreports.org/cro/news/2011/04/what-s-this-i-hear-about-a-plan-to-privatize-medicare/index.htm).

Lefties are  liars and not even very good at it (see "Gruber, Jonathan").

United States Seniors: Choosing a Medicare Health Plan Using Plan Finder

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

For example, in Barnstable County, MA, as the red circle (see image) shows, there are 14 available (2014).

Simplistically, some 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" (typically a PPO's is broader than an HMO's but that does not mean it covers the doctors you want). 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.)

There are also Part C Special Needs plans (dual eligibles, etc.) that do not show up in the Plan Finder and that your caregiver should know about if applicable to you.

There are also Part C plans that 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.