A New York Day with Granddaughter Hannah
Retirement Living Reality Check

Medicare MEGO

I stole that – MEGO – from my friend Joyce Wadler who, these days, writes the weekly I Was Misinformed column in The New York Times.

Eons ago when she was a reporter at a different paper, she used that acronym in a story I don't recall. But the acronym stuck - MEGO: My Eyes Glaze Over.

I know that for many of you, when you see the words “Medicare” or “Social Security” in the headline of this blog, your eyes glaze over.

You should get over that because there are powerful forces at work in the United States that want to take those programs away from you, from everyone. It is only by remaining informed and following through when it's called for that we can prevent that from happening.

Since early this year, the health insurance industry has spent millions of dollars lobbying Congress and broadcasting videos to scare elders in an effort to rescind the subsidy cuts to the private Medicare Advantage (MA) program that are required by the Affordable Care Act (ACA, i.e. Obamacare).

And this week, they won. Instead of reducing the payments to the private insurance companies by 1.9 percent as stipulated by the ACA, the Centers for Medicare and Medicaid Services (CMS) increased the subsidies by .4 percent for 2015.

As the National Committee to Preserve Social Security and Medicare (NCPSSM) reported:

”These subsidies were supposed to be gradually trimmed in order to expand benefits and improve the quality of care for all seniors in Medicare.

“However, each year the insurance lobby threatens to cancel coverage or charge more to seniors in MA plans rather than accept a reduction in their overpayments or reimbursement rates.”

As the NCPSSM goes on to explain, all Medicare recipients, including the majority not enrolled in Advantage plans, pay higher premiums to help fund the subsidies to the private Medicare Advantage providers.

”Over the years, as much as 14% more per beneficiary has been paid to MA plans than is paid to cover individuals enrolled in traditional Medicare.

“It’s a wasteful federal boondoggle that was rightfully corrected by passage of the Affordable Care Act (ACA) in 2010. Additionally, thanks to the ACA, growth in health care costs have been decreasing which means that reimbursement rates also go down. As reimbursement rates have decreased, MA plan enrollment has increased.”

The insurance company lobby keeps telling people that if those subsidy cuts are allowed to go into effect, they – the insurance companies – would need to cut benefits, raise premiums, restrict access to physicians or even cancel coverage, among other dire predictions.

The NCPSSM again:

”Let’s be clear, contrary to the health insurance industry’s massive lobbying campaign claims, Medicare doesn’t make the decision about cuts to seniors’ MA coverage, including increasing premiums or reducing access to doctors.

“That decision rests squarely in the board rooms of the nation’s private insurance industry, which is unwilling to give up a penny of their government giveaway in favor of continued threats of diminished coverage and higher premiums for seniors.”

In case you think the big insurance companies would be forced to cut services due to subsidy cuts, read this from the respected Kaiser Health News:

”At UnitedHealth Group, one insurance giant, Medicare Advantage plans account for a fourth of all profits, said Ana Gupte, an industry analyst for Leerink Partners. Another, Humana, owes two-thirds of its profit to Medicare Advantage, she said.”

The entire story at Kaiser Health News is worth your time to read.

Getting back to MEGO, if you had not waded through the Medicare information above, you would not have arrived here for two pieces of good Medicare news.

ONE: For many years, Medicare patients have been denied further physical therapy treatment if they were not improving. Holding steady and not backsliding was not enough to continue payment for treatment.

”No more,” The New York Times and others recently reported. “In January, Medicare officials updated the agency’s policy manual — the rule book for everything Medicare does — to erase any notion that improvement is necessary to receive coverage for skilled care.

“That means Medicare now will pay for physical therapy, nursing care and other services for beneficiaries with chronic diseases like multiple sclerosis, Parkinson’s or Alzheimer’s disease in order to maintain their condition and prevent deterioration.”

As good as this news is, patients can still lose coverage under certain conditions or be subject to a therapy cap. The Times story has details and links to other sources for additional information.

TWO: Following on President Barack Obama's efforts to make the U.S. healthcare system more transparent and affordable, yesterday CMS released the most detailed data ever made public since Medicare began about physicians and payments to them.

As The New York Times reported, the data, all from 2012, covering more than 800,000 physicians and other healthcare professionals,

"...provides an unprecedented look at the practice of medicine across the country, shedding fresh light on the treatment decisions physicians and other practitioners make every day.

"It will also provide consumers with an ability to compare doctors and treatments in a way they have never had until now."

This is a big deal. You can get the data from the CMS website in tab deliminated or Excel files. Or you can use The Times' nifty interactive presentation of the same data by simply searching a provider's name, specialty and city or Zip Code.

The Times story also gives a thorough grounding in the importance of the data and how it is likely to be used in America's ongoing healthcare debates. You'll find The Times search tool here.

At The Elder Storytelling Place today, Henry Lowenstern: Personality Split?


You are a genius plowing through the data, making sense of gobbledygook, and translating for a person like me. Just as for Pooh ". . . a Bear of Very Little Brain . . . long words Bother Me."

And that you and Joyce Wadler are friends makes perfect sense. Gifted writers, principled, witty, and candid, both of you.

Thanks for this information Ronni...I count on your blog to help keep me informed about medicare and other senior issues.

For 40 years, my company paid for a large portion of my health insurance. It was then sold,sold again and yet again and now the new company no longer wishes to provide partial payment to retirees. For years, we workers voted to insure retirees thru our contract but the new company nays no longer.

I've been fortunate to have GAP coverage partially paid by retirement benefits and for the first time in my adult working life I have had to shop for health insurance. And to have to absorb the cost myself. I've had dental and vision but no longer.

Working for a multi state utility had its benefits, and its drawbacks but I stayed-a single parent of 4 with no monetary assistant from the deadbeat dad, I needed the health care for my kids-now adults.

I've been perusing all the plans available and it's completely overwhelming. For the first time I've had to ask my daughter to help me decide. I feel for other seniors, such as yourself, who don't have family to depend on. I'm amazed at the complex decisions we need to make-do we go for lower co-pay and higher premiums? For lower doctors visits or lower hospital co pays? And where does this money I now have to pay out come from?

I've decided I have to give up my car and auto insurance in order to have health insurance..thank goodness for Portland's good public transportation and for my daughters willingness to loan me her car when I need to go to the store.

I'm very frustrated as well as confused and hate not having my independence in the form of an old paid off station wagon so I can have health insurance.

Some good information here. Thank you.
I tried the NY Times tool and searched for two Portland specialists who I suspect of not allowing treatment by saying the insurance companies are not paying, but neither name came up. I don't know if I can't get treatment because I have original Medicare or what, but I strongly feel something is not right. Oh well.

It's depressing to think that in my lifetime the insurance industry has gone from being an incidental third party to the doctor-patient relationship to calling the shots for everyone involved.

MEGO not so much because of the subject matter, but because I know the news is going to be bad...again.

MEGO too -- because I understand so little about these issues. Thank you for trying to keep me informed.

I just wish we had a single-payer insurance for all of us, you know, Medicare for all. The structure is there and it would be less confusing.

Also, I can't understand why eyes and teeth are not included in health coverage. And better payment for prescriptions....

Recently I had surgery on my arm to remove a malignancy. The surgeon did not get all of the cells the first time and I had to have it re-done. My point is, the surgeon took under 5 minutes for each operation including an inspection.

I was curious to find out how much she made for the procedure. I tried the NYT link to see how much she gets and her name did not come up. I tried spelling it 3 different ways to see if, perhaps, her name had been entered incorrectly. No record of her in Tucson. Computer glitches are numerous and the more data bases entered the more errors are prevalent.

I'm shocked to see that the Medicare Advantage programs did not get cut, and instead got an increase, because each one, I researched, had made cuts in their benefits. Even Kaiser increased their co-pays across the board.

For Elie H. and anyone else facing choosing a Medicare supplement, in every state there is a State Health Insurance Assistance Program (SHIP) providing free impartial health insurance information for people with Medicare. People can also go to Medicare.gov where there are "plan finder" instructions. The first step is in the yellow box "Find Health and Drug Plans". There is a step by step decision tree that should lead to a plan that meets individual needs.

@Tarzana from Elle H (formerly of Reseda) Thanks for the info..I found that site very educational and informative.

I'm sorry I dumped via comments but I was simply in awe of the whole thing. One can know, intellectually, that all consumers of medical insurance needs to make that decision but when one is as unaware as I had been for so long, to be dumped into the caldron of gap vs. Advantage etc is much like being in a strange country where you don't speak the language.
Your information was very helpful...Elle (ex Valley Girl)

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