Category: Medicare costs

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By Susan Jaffe

October 15, 2012, 6:00 AM   KAISER HEALTH NEWS

Today, Medicare beneficiaries can begin choosing their drug and medical coverage for 2013, and most seniors are expected to stick with the same policies they have already, despite price changes and a rating system that shows some plans may be better than others. Seniors have been reluctant to change plans, even if there are cheaper or better-rated alternatives, according to recent studies and seniors advocates.  Beneficiaries also tend to stay with the same insurers: This year more than a third of those in Medicare Advantage plans, which provide medical and drug coverage, chose policies from just two insurers, UnitedHealthcare or Humana.

The ratings are based on information reported by the plans, from Medicare records, and a yearly survey of some beneficiaries. Participation in the surveys is voluntary and anonymous but insurers are concerned that too many seniors opt out.  [more]

Enrollment Season Opens For Medicare Advantage And Drug Plans

Medicare Combats Fraud With Billing Statements That Beneficiaries Can Understand

Susan Jaffe | March 7, 2012 | KAISER HEALTH NEWS produced in collaboration with 

In the latest effort to enlist seniors in the fight against Medicare fraud, federal officials have overhauled Medicare billing statements to make it easier to find bogus charges without a magnifying glass. ….And for those who might need an incentive to scour their bills, the new statements promise a reward of up to $1,000 for a tip that leads to uncovering fraud.[Continued here.]…

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By Susan Jaffe

POLITICO PRO   12/23/11 4:46 PM EST

When Congress gets back from the holidays, lawmakers are going to have to figure out how to find enough money to delay cuts in Medicare payments to doctors for a full year — but the patients have already started to pay for their share in their 2012 premiums.

Lost in the Capitol Hill debate is the fact that the federal government contributes only 75 percent of the cost of doctor visits and other outpatient services covered by Part B of the Medicare program. Under federal law, seniors chip in for the remaining 25 percent in the form of monthly premiums. The amount is based on estimated expenses for the coming year. And in calculating that share, Medicare officials anticipated that Congress would cancel the pay cut.

That means the patients will effectively pay part of the cost of a Sustainable Growth Rate “fix” before it’s been fixed…. more

Seniors already paying for full-year ‘doc fix’

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Officials Looking To Cut Federal Spending Eye Medigap Policies

By Susan Jaffe  KAISER HEALTH NEWS in collaboration with      Nov. 21, 2011

Margaret Fisher is among the millions of seniors with private, supplemental health insurance that takes care of most of the medical bills Medicare doesn’t cover. If she has a health crisis, she reasons, it won’t become a financial crisis, too.

But officials looking for ways to cut the federal deficit are suggesting that these Medigap policies help explain why the government’s Medicare bill is rising so fast. If these private policies were less generous, they figure, seniors might reduce their trips to the doctor or find cheaper care, which in turn would save the government money.Fisher, 86, a cancer survivor   from Gaithersburg who has had two hip replacements, says that strategy could backfire… [Continued on Kaiser Health News and in The Washington Post]

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By Susan Jaffe   November 7, 2011 

KAISER HEALTH NEWS in collaboration with 

Three weeks after suffering a heart attack, Bernie Hollander came to a recent meeting at Leisure World in Silver Spring with his wife, Rose, to learn about the Medicare drug plans being offered next year. “I’m a heart patient, I’m a diabetic – I have a lot of problems,” said Hollander, 81, who lives in the retirement community. But getting the expensive medications he needs isn’t one of them. e was at the meeting to get updated advice from Leta Blank, head of the Montgomery County Senior Health Insurance Assistance Program (SHIP). 

Although drug coverage is optional, millions of Medicare beneficiaries enroll in a plan, and choosing the right one can be tricky. Seniors who want drug coverage must sort through dozens of policies covering different drugs from different pharmacies at different prices. Federal SHIP counselors can help untangle the details.  MORE    [view video here]

During open enrollment season, seniors can get help picking a Medicare drug plan

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By SUSAN JAFFE | POLITICO September 8, 2011

The American Hospital Association has a strategy for heading off any more Medicare payment cuts: Tell Congress to get the money from Medicare beneficiaries instead.

The association is urging its nearly 5,000 members to lobby Congress to raise the Medicare eligibility age from 65 to 67, in addition to other money-saving alternatives, according to spokeswoman Marie Watteau. MORE

Medicare eligibility age should go up, hospitals say

Doctors skittish about health technology despite promise of big federal bucks

By Susan Jaffe  | Center for Public Integrity  |  July 7, 2011

The goal is to bring the last outposts of the nation’s health care system into the computer age, linking medical providers so that they can coordinate and improve patient care and — in the process—reduce unnecessary health care spending. But convincing everyone to use electronic health records has not been easy. …Neither  reward nor punishment has 

persuaded some small practice doctors — a troubling omen for the Obama administration, which believes that conversion of paper records to electronic form is a crucial step toward health care reform. [Continued]

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By Susan Jaffe  |  April 26, 2011

KAISER HEALTH NEWS in collaboration with wapo

Despite tough economic times, there are some things the government can’t give away.

Starting this year, seniors enrolled in Medicare no longer have to pay for more than a dozen tests and other services to help prevent or control cancer and other costly and debilitating diseases. These benefits, which also include an annual wellness exam, are part of the new federal health-care law.

But big crowds aren’t lining up for free mammograms or colonoscopies, although early data indicate that the free wellness checkup is luring patients.  CONTINUED  

More On This Story

Medicare Patients Aren’t Taking Advantage Of Some Newly Free Tests

Younger, Disabled Medicare Beneficiaries Have Trouble Getting Supplementary Insurance

By Susan Jaffe   KAISER HEALTH NEWS  | March 7, 2011   This story was produced in collaboration with  

Joe Hobson, 63, crosses the street in front of his Arlington apartment. (Jessica Marcy / Kaiser Health News).

One night three years ago, Joe Hobson finished reading a book, went to sleep and woke up blind. The problem,a rare hereditary disease, forced him to give up his 20-year communications job, along withits generous health insurance. Now 63, the Arlington man is covered by Medicare, the federal program for elderly and disabled Americans.

Like many people with Medicare, Hobson would like to buy supplemental, or Medigap, insurance to help cover his out-of-pocket costs, such as co-payments and deductibles. But Medigap prices can be prohibitive for disabled beneficiaries younger than 65. The cheapest plan for such people in Northern Virginia is $338 a month, according to Brad Rothermel,an Annandale insurance agent who has helped Hobson look for a policy. That’s three times the premium of a plan with much better benefits that is available to a 65-year-old. And the private insurers that offer Medigap policies are free to reject Hobson or charge him extra because of his preexisting health conditions.[Continued in KHN]  andin The Washington Post]

 

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Innovative Day-Care Program Seeks To Keep Frail, Low-Income Seniors In Their Homes

By Susan Jaffe | December 21, 2010 | Kaiser Health News in collaboration with

 Several mornings a week, a white van stops at Geraldine Miller’s house just east of Baltimore to pick her up for ElderPlus, a government-subsidized day-care program for adults on the campus of the Johns Hopkins Bayview Medical Center.

Because videoMiller, who is 75 and uses a walker, has trouble getting down the stairs from her second-floor apartment, the driver comes inside to help. When she feels wobbly, he lends her an arm. When she feels strong, he faces her and steps down backward on the steps so he can catch her if she falls. When it rains, he shelters her with an umbrella. This is the sort of extra care that makes ElderPlus different.  ElderPlus is part of PACE, the Program for All-Inclusive Care for the Elderly, which provides comprehensive medical and social services to frail, low-income seniors with serious health problems.   [Continued at Kaiser Health News or The Washington Post.]   Video: “Picking Up The Pace”

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Dialysis crisis followed shift by Medicaid

By Susan Jaffe | Plain Dealer Reporter | February 12, 2007

 For the past year, a dialysis machine has been keeping Karletta Edwards’ mother alive, substituting for her kidneys to cleanse her blood three times a week.

But in January, shortly after Ohio’s Medicaid program transferred her, along with more than 25,000 other low-income people in Northeast Ohio, into an HMO, something went wrong.

The state’s contracts with insurance companies are expected to save Medicaid $24 million this year, by the time some 125,000 blind, disabled or older people are placed in privately run managed care plans.

Even though the companies are paid 6.6 percent less, Medicaid’s average cost to care for the same population, state officials say the health coverage will remain the same…. Four weeks ago, Edwards received a desperate call from her mother. The transportation service that picked up Emma Hansen from her East Cleveland  home and brought her to the dialysis center didn’t show up. [Continued here]

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Consumer guide to prescription drug plans in Northeast Ohio
Susan Jaffe | Plain Dealer Aging Issues Reporter | November 11, 2006

Health insurance companies with contracts from Medicare have been approved to sell a total of 93 plans in Ohio. Some policies cover only drugs, while others include health insurance. This special section provides a consumer guide including the plan basics, some questions to ask before choosing a plan, a translation of the technical jargon companies use, and where to go for assistance.[four-page section here]

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Advocates for Medicaid seniors wary of assigned drug coverage

By Susan Jaffe  |  Plain Dealer Reporter | December 29, 2005

Under the Medicare prescription drug benefit, the federal government enrolled millions of the nation’s poorest and sickest seniors into private drug plans that may not cover all their drugs. [Continued here.]

Medicare drug plan backfires on states

Seniors’ switch from Medicaid will boost costs by millions 

By Susan Jaffe  |  Plain Dealer Reporter | March 9, 2005

The Medicare prescription drug benefit is backfiring on states–running up millions of dollars in extra drug bills instead of the savings promised by its Republican supporters. [Continued here ]…

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Switch to Medicare to cost state millions

By Susan Jaffe  |  Plain Dealer Reporter  |  October 20, 2005

Ohio’s financially strapped Medicaid program will pay millions more when low-income seniors switch to Medicare for their prescription drugs next year.  The federal law that established the new Medicare drug benefit requires the nearly 200,000 seniors in Medicaid – the state health-care program for low-income people – to transfer to Medicare for drug coverage. The law also says that states must reimburse the federal government for 90 percent of those seniors’ drug costs. But any savings that states expected have vanished because of the controversial formula Medicare used to figure how much they owe. The switch will cost Ohio $35 million more in 2007 than if the seniors now in Medicaid had stayed there. [Continued here.]

 

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Medicare dangles Rx carrot
By Susan Jaffe | Plain Dealer Reporter  | February 12, 2005    

Many of the nation’s major corporations providing retiree drug coverage will get help paying the bill  – subsidies worth several billion dollars a year from federal taxpayers. The money totals roughly $71 billion tax-free through 2013 and is part of the Medicare Modernization Act, which added a drug benefit to Medicare.  It is aimed at encouraging employers to maintain their coverage instead of forcing retirees onto Medicare’s tab. [Continued here]

You Can Go Home Again: A move to a nursing home needn’t be forever anymore.

A new Ohio program not only supports independent living, but also saves the state money.

By Susan Jaffe  |  Plain Dealer Reporter | November 7,  2004

Without Ohio’s Access Success Project,   Larry Fry might  have lived in a nursing home for the rest of his life.  The program is unwinding the government rules and red tape that trap people in nursing homes who don’t want to be there, don’t need to be there and certainly don’t need to be driving up the state’s enormous nursing home costs (See Graphic, “Paying More for Less,” pg. 19). If it succeeds, the effort targeting 250 nursing home residents could save Ohio millions of dollars a year. Nursing home care costs an average of about $56,000 per resident a year in Ohio. Because Fry needs so little care, living on his own will save Medicaid roughly $50,000 a year.  Continued in The Plain Dealer’s Sunday Magazine…