One of the more confusing issues about Medicare is that it was never set up to handle long-term care expenditures. While the plans are certainly capable of handling short-term needs as ordered by a physician, such as in-home physical therapy, home health aides, home safety checks (but not the equipment) and durable medical equipment such as hospital beds and bedside toilets, this is not the same type of coverage as might be supplied by a hospice or other long-term care organization.

An article titled “Seniors and Their Caregivers Should Know Their Medicare Options” outlines considerably more specifics about what is and is not covered by Medicare. It becomes apparent that Long-Term Care insurance is really the way to go in supplementing the supplements so both short-term and long-term needs are met.

The deeper issue is that people do make assumptions about their insurance coverage without actually understanding what it entails. They hear stories or rumors about various plans and, believing what they hear, they think they know what they’re getting into. The only way to understand what any coverage is all about is to speak with an agent or broker who is more interested in educating people than in only making a sales commission. These agents do exist, and it’s important to find one.

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Beginning on-or-about November 1st the office staff of Allchoice, Inc. in Wixom, Michigan, begins going through the file each and every client with a Medicare Part D prescription plan. The clients are contacted, medication lists are updated to the current list of prescriptions if any, and new Medicare Part D prescription reports are run to determine if there is a better plan than the Medicare Part D plan the client is currently a member of. The reports are sent to the client, along with a blank CMS-approved Scope of Sales Appointment Confirmation Form. Once the form is signed and returned to Allchoice, Inc., the client can speak with an agent about the plans in the new reports.

During this 2011 Medicare Open Enrollment period in the latter part of 2010, most Medicare Part D reports are containing anywhere from 30 – 35 plans for the client to look through and review. This can be quite a daunting task as there is a considerable amount of information to digest. It’s simple to look at the reports, order them by the monthly amount of the plan’s premium and select the least-expensive plan. However, there’s much more to the actual annual cost than just the monthly premium.

Here’s what needs to be considered:

  • Deductibles and Co-Payments
    If a plan with a given monthly premium has a high deductible and a fairly low co-pay, it may actually end up costing more than a plan with a higher monthly premium having a lower deductible and no co-pay. It’s the annual cost of these three factors that’s really the key to determining which plan is least expensive.
  • Generics vs. Brand Name Drugs
    While a lot of plans cover the generic versions of a given prescription, it’s possible to have an adverse reaction to the generic to the point where the brand name is required. In these situations it’s important to make sure the brand name drug is available under a given plan and how much that brand name medication will cost per month.
  • Pharmacy Restrictions
    Some Medicare Part D prescription plans will restrict purchase of medications to particular pharmacies or chains of pharmacies. Which pharmacies are available and where they’re located are factors in whether or not a given plan will be cost-effective for the member.
  • The “Donut Hole”
    For the 2011 period the “donut hole” occurs once the individual’s and plan’s combined costs total $2,840. The individual is then responsible for all costs until the beginning of what’s known as “catastrophic coverage”, which is when costs exceed $6,448 and plans cover 95% of costs. During the donut hole there’s a 7% discount on generics and a 50% discount on brand-name drugs. Evaluating how this works for a given list of prescriptions will help in determining the actual cost of a plan.
  • Other Information
    Receiving complete and objective information about a given plan can be difficult for a given client’s set of circumstances, necessary prescriptions, ongoing and intermittent treatments and many other factors. It’s important to talk with someone who is interested in the individual client’s needs and who can look at the requirements and options with an open mind.

2011 Medicare Premium Changes

November 22, 2010

Medicare costs for 2011 will increase significantly for seniors because of the provisions in the Patient Protection and Affordable Care Act. However, Medicare Part B fees to Doctors and Hospitals will also decrease dramatically under the Patient Protection and Affordable Care Act passed in 2010.

Click here for complete information on the 2011 Medicare premium changes.

Beginning today and running until December 31, 2010, seniors enrolled in Medicare can apply for changes to their Medicare programs for 2011. Allchoice is currently running reports for all current Medicare clients to see if it’s possible to get Medicare members into less expensive and/or better plans for next year.

These reports entail asking for an update of the list of prescriptions for the client and running the appropriate reports for what that particular client desires, be it a Medicare Supplement, a prescription plan or an Advantage plan. Allchoice will then send those reports to the client either by mail or email. One of the requirements of Medicare is that the client sign what’s called a Scope of Sales Appointment Confirmation Form prior to an agent discussing any plan with the client whatsoever. This is sent with the Medicare reports and needs to be received back in Allchoice’s office before any discussion can proceed.

Without being specific about plans it’s important to note that some plans are undergoing changes, with new ones being added to the list of availability and others no longer being available. Clients will likely need to check with their doctors, pharmacies and other service providers to ensure continued coverage if they do decide to change their Medicare plans for 2011.

In our last blog post we mentioned some of the Medicare information which is being heard in Allchoice Insurance radio ads for the next ten weeks on Ave Maria Radio AM 990 in southeast Michigan. The documentation is contained in an August 5, 2010 report from the Centers for Medicare & Medicaid Services (CMS) at the Department of Health and Human Services (HHS). Click here download a copy of this report.

Some of the more interesting information in this report is this:

“Medicare payment rates for physician services as determined by the Sustainable Growth Rate (SGR) system are scheduled to be reduced by roughly 30 percent over the next 3 years … Other Medicare services such as ambulance, ambulatory surgical centers, laboratory services, certain durable medical equipment, and prosthetics have their payments updated annually by the increase in the Consumer Price Index (CPI). The Affordable Care Act specifies that all of these payment updates will be reduced by the percentage increase in the 10-year moving average of private non-farm business multifactor productivity beginning as early as 2011.”

Even more devastating to Medicare recipients is a chart titled “Simulated comparison of relative Medicare, Medicaid, and private health insurance prices under current law” at the top of page 6 in the report. The chart shows that while private health insurance pricing will remain at 100% and Medicaid at 75%, Medicare pricing will drop significantly over time resulting in “… increasingly severe problems with access to care.”

Download the full report to see the rest of the information as presented.

For ten weeks beginning October 4, 2010, Allchoice will be running radio ads on Ave Maria Radio out of Ypsilanti, Michigan. These ads are unique in that they’re not written as sales ads. Instead, the 60-second spots each feature a voiceover discussing how Medicare is being affected by the Patient Protection And Affordable Care Act, such as the cutting of $531 billion out of Medicare over the next ten years.

These radio ads also include the voices of some Allchoice clients. These seniors talk about their experiences with Allchoice Insurance in entirely unscripted testimonials over the years and how they’ve recommended the company to their family and friends. They also discuss the quality of customer serve at Allchoice and how all of their questions have been answered in a friendly and timely manner.

Be sure to tune into Ave Maria Radio on AM 990 in southeast Michigan from Monroe to Bad Axe to Brighton or listen online to hear the new Allchoice radio ads.

Paying the Price for Health Care Reform 

    

 

   

  

Erin Lehman 

    

 

 

With health care reform looming on everyone’s minds, deciphering all of the information available is almost impossible. Trying to read the Health Care Reform bill is like looking at the ink blot test, everyone interprets it differently. There is one thing that is for sure though and that is that seniors are suffering as a result.  all of theWith health care reform looming on everyone’s minds, deciphering 

   

that money be taken out of Medicare and Medicaid.   is proposed, it sufficient will not be this money, which the majority of to fully fund comprehensive form. But this is a first crucial step in that effort,” and to raise sufficient to financing reforms to our health care system. According to this budget “$630 billion is not will be dedicated aside over a ten-year period and will be set) shows that $630 billion

  

As a result of Medicare losing money, Advantage plans prices are raising. These Advantage plans are for those with low income on Medicare, who are unable to afford the alternative of a prescription plan and a supplement to cover their medical needs. If prices rise on the plans, the low income seniors who currently rely on Advantage plans, will be unable to afford them . Making the necessity of these plans obsolete. There are those currently on Advantage plans suffering because of these upcoming changes, paying more than they can afford for the lowest costing plan available to them. The cost of plans that many seniors are on are raising $100 or more per month. When the seniors can no longer pay for a plan, their only choice will be to go without a health plan. They will be unable to get the care they will need if they become ill.    

At what cost are we willing to pay in order to change our health care system? There are many articles out there that tell about countries, such as Canada and France, that have National Health Care, and are not happy with it, yet we are risking lives to change to it. As of today, no health care system is able to help everyone. It’s time to rethink changing our health care system completely. What we need to start asking is what can realistically be done to change our health care system without harming our citizens?