Author: Dan Hoelscher

Shortly after taking over one of the largest sectors of our economy, healthcare, Congress is at it again.  This time they are going after your Medicare Supplement insurance.

For well over the past two years Congress has been focusing on ways to reduce Medicare spending.  They are focusing on Medicare Supplement coverage because they believe that Medicare Supplement policyholders over utilize their Medicare benefits because they have very little or no out of pocket cost since their policy picks up all the deductibles and coinsurance that Medicare doesn’t cover.  I won’t go into why this is not altogether accurate, but for now let’s just focus on the changes they want to make.

Their goal is to completely revise the structure of Medicare as it exists today, using the famed Simpson/Bowles report as a “solution.”  They want to do this by adding more “cost sharing” to Medicare, or as they like to put it, they want Medicare recipients to have “more skin in the game.”  Joe Baker of the Medicare Rights Center hits the nail on the head when he said that “cost sharing” is really “cost shifting.”  And guess who the cost is shifted to?  That’s right, YOU.

So what does this Simpson/Bowles report call for?

1. Combining the current Part A and Part B deductibles into one $550 deductible.
2. A single coinsurance rate of 20% up to $5,550.
3. Set coinsurance cost at 5% between $5,550 and $7,500
4. Set an annual out-of-pocket maximum at $7,500.
5. Prohibit Medicare Supplement policies from covering the first $550 and limit coverage to 50% of the next $5,000.

That last one is a biggie, as Medicare Supplement policies are currently allowed to cover these deductibles and coinsurance.  Even if they don’t move forward with #5 above, the president has suggested implementing a 15% tax on Medicare Supplement policies that provide these first dollar benefits, such as Medicare Supplement plans C or F.  That means you would pay more money just because you choose to have good coverage.  Also, there are already Medicare Supplement plans that include more “cost sharing,” so these options already exist for those who want them.

A nationwide survey conducted in 2012 showed that 9 out of 10 Medicare Supplement policyholders were satisfied with their coverage, and 91% would recommend a Medicare Supplement policy to their friends when they turn 65.

The problem with Medicare is not what is coming in the front door through more “skin in the game” payments from you.  The real problem is the $50 billion dollars each year that is going out the back door through Fraud, Waste and Improper payments.  I believe it makes much more sense to focus on these expenses rather than ask our Medicare population to pay more.  If you agree, I strongly encourage you to call or write your Senator and Congressman and inform them that “Cost Sharing” and “More Skin in the Game” is not good legislation.

You can view a video on this subject below:

It has been brought to our attention (thanks to our clients) that several medicare supplement/medicare advantage agents in the area have been going door to door soliciting new business.

If you don’t know, it is illegal for an agent to stop at your door uninvited. We even have one report where our client was told that her medicare supplement Plan G was being discontinued by Medicare, which is totally untrue.

If this happens to you, please do us and yourself a favor and let them know they are not allowed to solicit door to door. If they don’t agree, direct them to Ohio Administrative Code 3901-8-09, Section (D)(2)(a).

Also, if you are considering making any changes to your existing plans, give us a call before you do…(937) 492-8800.

Here is some good info for those on Medicare and the new Health Care Reform Exchanges…

Medicare Marketplace FAQs (2)

According to a recent Money Magazine article, there is an alarming trend emerging which is resulting in big bills for Medicare patients. This trend has to do with Skilled Nursing Facility care and Medicare’s requirements for covering it. And if a service is not Medicare approved, you are on the hook for the full bill, which could cost in the thousands of dollars. And Medicare Supplement insurance follows Medicare’s decisions, so that won’t help either. So, let’s find out what Skilled Nursing Facility care is, what is causing the problem and what you can do about it?

Skilled care is healthcare given when you need skilled nursing or rehabilitation staff to treat, manage, observe and evaluate your care. This type of care is typically given in a Skilled Nursing Facility which could also be a Long Term care facility. An example would be a patient who has undergone a joint replacement and needs to go to a facility temporarily to get rehabilitation so they can get back on their feet. If your stay is Medicare approved, Medicare fully covers the first 20 days of skilled care and all but $144.50/day for days 21-100, and many medicare supplement plans will pick up this daily copay amount giving you a total of 100 days at no cost to you. A patient in the Money magazine article had a 10-day rehab stay which was not medicare approved and she got a bill for $7,027. Of course she didn’t know this until she got the bill.

There are many requirements for a stay to be Medicare approved (which can be viewed here) but the major culprit is the requirement of a 3-day inpatient hospital stay prior to going into the Skilled Nursing Facility. The key word here is “inpatient.” The problem arises because many hospitals are beginning to keep patients under observation as opposed to inpatient, due to Medicare’s crackdown on costs (Medicare pays hospitals far less for observation than for inpatient stays). From the patient’s viewpoint there is no difference in the care you receive, so you won’t know by looks whether you are inpatient or under observation. Even if you start your stay under observation and switch to inpatient later, the observation days won’t count toward the 3-day inpatient requirement.

So what can you do to prevent this from happening? Here are a few suggestions:

• Don’t Wait/Don’t Assume:  Your best shot at getting Medicare to cover a skilled nursing stay is to have your status switched to inpatient while you are in the hospital.  Appealing a Medicare decision after the fact is much tougher and a lengthy process.  So ask your doctor and case manager what your designation is.  If it’s observation, press your doctor to review your status and take your case and full medical history to the utilization review committee.
• Bring in Help:  Ask your primary physician to call the hospitalist and explain what risk factors or conditions might warrant a higher level of care.
• Arrange Home Care:  If all else fails and you can’t afford to go to a nursing facility, talk to the discharge planner.  Medicare covers a limited amount of home help, even if you weren’t an inpatient.

So, before you get blindsided by a huge rehab bill, make sure a family member is aware of these requirements and can help you should you have a hospital stay in your future.

Much of the above information was derived from the August 2012 Money Magazine article “This Could Hurt-a Lot” by Amanda Gengler.

I usually don’t share jokes because everyone gets so many, but a friend sent me this today and I thought it was very timely.

It’s so hot in Ohio…

…the birds have to use potholders to pull the worms out of the ground.

…the trees are whistling for the dogs. 

…the best parking place is determined by shade instead of distance 

…hot water comes from both taps. 

…you can make sun tea instantly. 

…you learn that a seat belt buckle makes a pretty good branding iron. 

…the temperature drops below 90 F and you feel a little chilly.

…you discover that in July it only takes two fingers to steer your car.

…you discover that you can get sunburned through your car window.

…you actually burn your hand opening the car door.

…you break into a sweat the instant you step outside at 7:30 A.M.

…your biggest motorcycle wreck fear is, “What if I get knocked out and end up lying on the pavement and cook to death”?

…you realize that asphalt has a liquid stage.

…the potatoes cook underground, so all you have to do is pull one out and add butter.

…the cows are giving evaporated milk.

…farmers are feeding their chickens crushed ice to keep them from laying boiled eggs.