Archive for the ‘Part D’ Category

The Need for Self Reliant Health Care

Tuesday, January 24th, 2012

 

I came across one of the best articles I’ve seen regarding Medicare funds or rather, the dissension thereof. For anyone over the age of 40, the issues at hand matter – a lot.

 

The biggest takeaway I got from the article? It is seemingly apparent relying on Medicare to provide like coverage in perpetuity is not very plausible. While it is difficult/annoying/painful for most of us to think 20 and 30 years beyond today, the potential for future health and financial challenges in our lives dictates otherwise.

 

One of the hardest hitting highlights of the article was an example about disbursements made using an average salary of $43,500 per year. A recently retired couple with that salary would have paid in almost $120,000 in Medicare taxes during their working lives. But according to the Urban Institute the medical benefits this couple would receive will average $357,000. Needless to say, this is not a sustainable model.

 

Another cited concern provided that 1 in 5 doctors restrict the number of Medicare patients they will take on at any given time. This number jumps to 31% for primary care physicians. The AMA reasons this is due to low reimbursement rates and that Medicare is deemed to be an unreliable payer by the medical profession.

 

Compounding these exasperating facts and figures is fictitious recipients. In 2010, it is reported that Medicare Part D paid $3.6 million to deceased beneficiaries. Similarly, 142,000 procedures on 5,000 dead people were paid for between 2004 and 2008 to the tune of $33 million.

 

According to the National Health Care Anti-Fraud Association, “The United States spends over $2.5 trillion on health care every year. Of that amount, NHCAA estimates that tens of billions of dollars are lost to health care fraud.” Mismanagement to say the least is costly and cannot be tolerated in any organization let alone one facing financial crisis.

 

Much is also written about “the gap in coverage” regarding prescription drugs. Yet the biggest gap occurs in long term care costs for home care, assisted living and skilled nursing facilities. Ironically, while our current system reimburses the deceased, it does not provide for the most financially devastating expenses the (still) living can incur.

 

This article is a major eye-opener to the current state of a program many of us are depending upon for health care services in retirement. Reading it should at the very least provoke further consideration for yourself and your family. Check out the entire article at Smart Money.

 

Kurt Rusch  CLU, ChFC

Healthcare Confidence, Behavior & Reform

Friday, November 11th, 2011

 

 

It has been more than a year – 18 months and 11 days to be exact – since the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA) of 2010 were passed. And still, after all this time, recent surveys show Americans are not extremely well versed on the new laws nor satisfied with current healthcare issues. It seems nothing has changed.

 

Amendments to the Acts and future application deadlines can all be attributed to the lack of knowledge regarding health care reform. Moreover, there are numerous concerns which polls are now returning regard confidence, behaviors and reform in the eyes of the American public.

 

Confidence

 

The Employee Benefit Research Institute (EBRI) has been conducting annual health confidence surveys (HCS) on healthcare since 1998. Highlights of this year’s survey provide:

 

1)     Dissatisfaction with the American health care system remains widespread. 56% of respondents rated the system as poor or fair. The percentage of Americans which rated the system as poor, doubled between1998 and 2004.

 

2)     60% of Americans are very satisfied with their own current health insurance coverage; 29% are somewhat satisfied.

 

3)     57% are very confident that their employment-based health coverage will continue to be offered by their or their spouse’s, employer or union. Confidence in this belief was 68% in 2000.

 

4)     Just 18% of people are extremely satisfied with the cost of their health insurance.

 

5)     Only 12% are extremely confident they are able to afford health care without financial hardship.

 

 

Behaviors

 

What human behaviors are impacting healthcare? Last September, the Thomas Reuters-NPR Health Poll released their query of 3,000 Americans on the subject of human behavior and healthcare.

 

Smoking was, of course, the top named impacting behavior, however, by less than a 1% difference, obesity was ranked second. Stress, by less than a 4% difference, was rated third. Taking the fourth and fifth top cited answers were alcohol use at 11.2% and workplace safety at 7.5%.

 

On the subject of cost, 84.8% of those polled believe that people who exercise, eat healthy and don’t smoke should receive a discount on their health insurance premiums. 30% say overweight people should have to pay more for health insurance. 11.3% went as far to say it is acceptable to deny employment based upon obesity.

 

Reform

 

The EBRI survey reports that confidence regarding today’s health care system has neither fallen nor increased as a result of the passage of health reform.

 

62% of Americans are also not familiar with a “key aspect of the law”. The unfamiliarity refers to legislation requiring that each state must set up a health care “exchange” by 2014, where health benefits can be shopped at competitive rates. This mandate is part of the Act’s objective to broaden health insurance coverage. The proposed goal is purposed to create an alternative coverage solution for the remaining minority of the American population without employment-based benefits.

 

Changes to the Act since its March 2010 inception have altered the original passage, which further complicates American awareness. As of today, it is unknown whether any of the current court challenges filed by States, business and other parties regarding the constitutionality of certain mandates within the law will further modify how health care reform unfolds.

 

The EBRI survey also found that health care is not the issue that the majority of Americans consider to be most pressing in America today:

 

32% of those polled say the economy is the most critical issue at hand.

 

14% say the federal budget deficit is.

 

14% cite unemployment as most important.

 

12% believe healthcare is.

 

11% think education is top priority.

 

Thanks for reading,

Kurt Rusch  CLU, ChFC

 

 

 

Mature Health: Time Sensitive Changes

Friday, September 30th, 2011


This is a MUST READ for Adults 65 & Up, Caregivers, Adult Children and Estate Managers!

 

New Changes to Part D Enrollment Period

 

The Annual Enrollment Period (AED) has changed for Medicare Part D plans. This is a big deal for anyone 65 and older because failure to make changes within this period will result in Part D benefits remaining the same as were elected in 2011. While this may not affect some people, it will be vital to others.

 

Historically, the Part D Annual Enrollment Period ran from November 15th through December 31st each year. However, plan changes with an effective date of January 1, 2012 must be executed within the new AED time frame: October 15th through December 7th.

 

 

EHealthInsurance reports that 65 percent of seniors are not aware of these enrollment date changes. It is imperative to review and revise any and all Part D information within this time frame to assure that current plans are still preferable or amended accordingly.

 

 

 

 

Medicare Advantage Premiums

 

The Department of Health & Human Services announced that enrollees will see their Medicare Advantage premium shrink 4 percent next year. Prescription drug premiums will not change.

 

Drug Deductibles

 

Part D Deductibles will increase by $10 from $310 to $320 in 2012. It is also important to keep in mind that the lists of formulary drugs are constantly changing. There is no safe assumption that  prescriptions will continue to be treated in the same manner from one year to the next.

 

Cost of Living Adjustment

 

The Annual Cost of Living Adjustment (COLA) for Social Security is predicted to rise in 2012 by a few percent; this would be the first increase in three years. If the increase does come through as expected, it may not automatically translate into additional pocket dollars for beneficiaries.

 

The links between changes in Social Security and Medicare each year are complex – that’s putting it mildly. There are numerous factors involved. For example, your annual income and the date when you began Medicare, could ultimately squash much or all of the COLA gains from higher Medicare premiums. (Help Link: 10 Ways to Boost Your Social Security Checks.)

 

The many moving parts within the machinations of Medicare, Supplements, Part D and Social Security, must be reviewed annually. This is not an option, but a necessity to assure consistent and proper coverage. Please feel free to contact me for assistance in maneuvering the healthcare minefield.

 

Kurt Rusch, CLU, ChFC