Elderblog List Update – November 2009
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GRAY MATTERS: Medicare 2010

SaulFriedman75x75 Pulitzer Prize-winning journalist Saul Friedman (bio) writes the weekly Gray Matters column which appears here each Saturday. His Reflections column, in which he comments on news, politics and social issues from his perspective as one of the younger members of the greatest generation, appears here at Time Goes By twice each month.

If you are of a certain age and participate in Medicare, you should have received your copy of Medicare And You 2010. And if you are like me, you’ve put it aside without reading it. My wife says that’s “a man thing,” not reading the instructions for the new gadget or stopping to ask for directions.

Medicare2010Manual2 Well, this year it would be a mistake not to look at the manual a bit more closely than usual. For things are changing – for the better, I think – and there are signs of that change in the free 127-page booklet. (If you haven’t received it, call 1-800-MEDICARE or download it here [pdf].

On page 11 in my edition is something new and unusual for a manual devoted to Medicare and us older types: the gift of health insurance from the Democratic Congress and Obama administration to our children and grandchildren. That’s explained briefly on page 84, in which we’re told that if we know of children under 18 who are uninsured in families (of four) earning less than $44,500, they are eligible for free or low-cost medical and dental care, prescription drugs and more.

This expanded ($30 billion) Children’s Health Insurance Program (CHIP), to serve four million more youngsters, became law last February just after Obama’s inauguration. President Bush had vetoed the bill in 2008 because, he said, it would put us on the road to socialized medicine.

If you or your grandchildren aren’t afraid of that road and need more information, they can call 1-877-KIDS-NOW (1-877-543-7669).

There’s also new or better coverage for outpatient mental health and preventive services such as smoking cessation counseling and an EKG as part of a “Welcome to Medicare” physical exams for newcomers to the program. (You will have to pay the 20 percent co-insurance.) And each of the health insurance reform proposals include more benefits for Medicare, partly paid for by ending insurance industry subsidies for private coverage.

Thus, on the eve of the annual open season (November 15 through December 31), when you can choose, change or renew your current Medicare-based insurance, I’m here to make a pitch to newcomers or those of you with private Medicare Advantage plans to strongly consider returning to or staying with original Medicare Part B, which covers most outpatient services.

Among the reasons: Private coverage premiums are rising by 12 percent, more doctors and hospitals are quitting some insurers because they pay too slowly, second-guess medical decisions, argue about coverage or limit coverage choices to providers and hospitals in the insurer’s network. The Centers for Medicare and Medicaid Services report that companies covering seven percent of Medicare Advantage beneficiaries are getting out of the business (each contract lasts only a year). You’re supposed to be notified of this.

In addition, I’ve learned not to trust these plans when they are really needed. I’ve had to threaten to publicize an insurer’s refusal to cover a surgery because it was to be done by a surgeon out of the network who happened to be the best person for the procedure that had been recommended by a referring neurologist. Private insurers may use the least expensive surgeons, not necessarily the best.

But the most essential reason for sticking with traditional Medicare is simple and not abstract: Let’s strengthen one of the two most important American social insurance programs while we have a friendly administration. The primary reasons Medicare is facing financial troubles may be traced to efforts by hostile lawmakers and the so-called Medicare Modernization Act of 2003, that gave us the private Part D drug program and its doughnut hole.

The Act also raised Part B premiums for more affluent beneficiaries, which imposed the first ever means test and undermined the principle of universality, and it set limits on the growth of the Part B budget (which Democrats have stopped).

But most destructive of all are the billions spent from Medicare to provide private Medicare Advantage coverage to one-fifth (10 million) of Medicare’s 46 million subscribers. It was the hope and purpose of the insurance companies and their congressional allies that they could raise that number to at least half. That’s why Obama and the committees working on health reforms would, over time, end the nearly $30 billion a year subsidy paid to insurance companies and reverse the trend towards privatization.

One of my favorite groups, the Center for Medicare Advocacy, explained in a recent newsletter:

“The fact is that a large proportion of Medicare spending goes directly to private insurance plans under the completely private portions of Medicare – the Medicare Advantage and Medicare Prescription Drug programs...Thirty-four percent of Medicare payments are made to private insurance companies for the private portions of Medicare.

“Moreover, 77 percent of the costs of the private Medicare Prescription Drug program are paid out of general government revenues...The first year after private Medicare Advantage was introduced with subsidies way over [14 percent] and above the actual cost to traditional Medicare to treat a Medicare beneficiary, the solvency projection of Medicare dropped by eight years...

“Meanwhile, private health insurance companies’ profits, paid in large part by taxpayers, are increasing astronomically.”

Here is a short video from the National Committee to Preserve Social Security and Medicare about the wasteful Medicare Advantage subsidies to private insurers"

As you might expect, the insurance companies and Republicans, showing sudden concern about the future of Medicare, are fighting Democratic efforts to end the subsidies for Medicare Advantage. To its credit, even AARP, which earns $500 million in royalties for selling these plans, has joined in efforts to force the private companies to compete on a “level playing field” with Medicare and a public option, if there is one, in the health reforms.

(My hope is that AARP would also help end the private Part D drug program it gave us and place it under Medicare).

Unfortunately, many of those 10 million Medicare beneficiaries in Medicare Advantage plans will be reluctant to give them up, although they may have no choice if the subsidies are cut. What’s the alternative? Here’s where this open season and the Medicare manual may help.

Medicare Advantage plans, which include drug coverage, are convenient because only one policy is needed. But, as I said, they require you use providers in their network, you need referrals, they tend to desert you if you have catastrophic health problems and those co-payments each time you visit a provider can mount up.

Take a look, then, at the section on the eight or ten Medigap plans. They are uniform throughout the country and range from the most basic, which pays the 20 percent co-insurance for Part B plus the deductibles, to more expensive that cover much more.

A Medigap plan, which would provide coverage for any participating doctor, lab or hospital anywhere in the country, plus an inexpensive Part D drugs-only plan, may not cost you much more than a Medicare Advantage plan. But it would be safer for you – and for Medicare.

Need help? Write me at saulfriedmanATcomcastDOTnet

Comments

I do have the Medicare Advantage plan and because I am low income I don't pay a co-pay for office visits; even to specialists. My prescriptions are very inexpensive. In essence, I am almost free of medical cost, although the dental plan is not great and I do pay for glasses and a $10 co-pay to an Optometrist. I also pay in full for any special tests there.

Needless to say, the elimination of the Medicare Advantage plan will change all that. My income is not quite low enough for me to qualify for the state low income plan.

Nevertheless, I am willing to pay my fair share and go back to the $30 co-pays to specialists that I had before. I am willing to do so to help people like my daughter who has no insurance. We are all in this together.

And the powers that be can't expand medicare to include everyone? Who says? From what you've clearly written Saul, it can be done. And why hasn't the media jumped on this bit of news? I thank you Saul for reducing the helpless feeling I get about universal health care. Dee

Love your writing, man you are good!

Another reason for original Medicare and a Medicare Supplement: It's a much more budgetable expense. With a supplement that pays what Medicare doesn't, a person won't have the unpredictable co-insurance amounts. This can be especially comforting at a time of serious illness, when a person's efforts should go to recovering, not dealing with confusing bills.

A reminder to lower income folks to check with their state SHIP counselors (those contacts can be found on the Medicare web site, probably in Medicare and You book also) and see if their income is low enough to make them eligible for the Low Income Subsidy for Part D and/or for the Medicare Savings Program that pays the Medicare premium and sometimes even deductibles and co-payments. Income and asset levels change every year, so it's always worth a check.

Brilliant for its clarity and usefulness. Thank you, Saul, and Ronni too. Passing this along to others as I hope other readers will also.

Last paragraph in Darlene's response ought to become a poster hung in senior centers everywhere. Yes, that's the idea many of us have about being Americans.

We have had an excellent Medicare Advantage plan for the last two years but this year's premium increase and the fact that I have felt it was not the right way to go has had us trying to decide what to do next. Reading through everything, I am not sure we even need Medigap given that we can afford to pay 20% of doctor bills. Medicare itself sounds like a pretty good plan supplemented by a Part D one.

What a mess this all is. Monday, with a copy of everything but the kitchen sink, I'm going downtown and get part B plus tell them I have an advantage plan D. I've managed to stay with my current doctor, but this whole thing does nothing but leave me dithering.

20% of a doctor bill is workable - 20% of oxygen, physical therapy or a Part B cancer drug could be budget-breaking. Then there is the Part A hospital deductibe.

As I've said elsewhere, communication works both ways..So now that Gray Matters is here..I would appreciate your Ideas, for I seek to give vent to common complaints, as well as individual problems on issues affecting us..So let me hear from you..on this site or at saulfriedman@comcast.net

Mr. Friedman, thank you for your clarification of the dilemmas we all face about what kind of Medicare to choose. I have original Medicare, a medigap policy, and a basic Part D plan. Believe me, when I required cancer surgery I was so happy my doctors could pick who they considered the best surgeon for me, not one that was in a certain group approved by a private plan. And yes, if you require chemo or some such expensive process, you had better have a medigap policy.

I couldn't agree more that Part D has been a plan largely benefiting insurers and few of the insured when the big picture is examined. AARP, at least, has their support of eliminating Part D correct this time.

I do not have Part D because my Part B supplement policy assures me yearly that what they provide is "at least as good" as Part D, and I know that to be true.

My medigap premium with United Healthcare through AARP is rising to an almost unaffordable rate this next year. Can anyone reccommend a different company to look at? I'm in a panic in a rural area I love...

What Saul forgot to say is that MA plans can be deceptive. Many have very low cost-sharing for doctors visits and other medical services that relatively health people use, but they charge higher cost-sharing for the more expensive services people need when they get sick - like hospital visits, nursing home and home health care. Even with an out-of-pocket cap, someone could end up paying more than a MEdigap premium.

FYI - The House bill would make it easier for people with limited incomes to get assistance with Part B premiums. That's almost $1200 more each year.

We missed seeing your column in Newsday and are so pleased to have found you on Time Goes By. Your voice is a dependable beacon of sanity in our outlandish and outrageous society.

Mr. Friedman and Ronni, too - thank you thank you for this wonderful informative post. My husband and I have regular Med. AB and D...I handle everything and get overwhelmed with all the health insurance dilemma's. We are low income and have not been able to afford medi-gap insurance. Two years ago we had it with Blue Cross - and my husband had hip replacement surgery which cost us nearly nothing but the premiums were high just for him, so we had the discontinue it. That is my issue now, should we get it again or wait until God forbid something happens...being low income - it is tough.

We are ex Long Islanders living in Illinois (Near the grandchildren). We are long time readers and admirers of Saul Friedman. We prayed for your well being during the times of your illnesses, and rejoiced upon your return. We admire your decision to leave Newsday (Yesterday's News and Tomorrow's Sales). We are glad to find this great site TGB,, and look forward to following you for many years to come.

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