Is it time for another look at Medicare for All?

Here we go again, people. In the wake of the GOP’s failure to pass a healthcare bill, universal healthcare advocates are back on the campaign trail with the goal of enacting a single-payer (“Medicare-for-All”) system. One such push is coming from Sen. Bernie Sanders’ (I-Vt.) with his announcement over the weekend that he will introduce a Medicare-for-All bill in the U.S. Senate.

Is this a good idea or a bad one? I think I have changed my mind.

After working in the Medicare industry for six years, I have a different point of view today than I did in years past. While I once believed free market health insurance was best, I now believe that a single payer system could be the right move for America. Here’s why:

Healthcare is NOT a basic human right, as Liberals would argue.

Nothing about our constitution offers citizens healthcare as a basic human right. In my opinion, this is the wrong argument.

However, as goes the health of our citizens, so goes the health of our nation. For this reason alone, making sure that all citizens have access to basic and catastrophic healthcare should be as much a Federal responsibility as border security.

Medicare is one of the most successful programs in U.S. history.

While the program remains fraught with fraud and abuse, the overhead is very low. The Congressional Budget Office (CBO) has found that administrative costs under Medicare are less than 2 percent of expenditures, compared with approximately 11 percent of spending by private health insurance.

Medicare is not free… And it never should be!

We all pay into the Medicare system through payroll taxes. This is a system that works and will continue to work.

Raising the payroll tax to include those under age 65 would help, not hurt, the current Medicare funding situation. Medicare can’t be a handout. People must pay for it.  If you’re healthy and can work, you need to work to help support our society and way of life.

Medicare does not cover 100% of all healthcare costs… Nor should it!

The Medicare system was designed to be a safety net, not all-inclusive healthcare. Medicare pays about 80% of all cover services. That sounds pretty good until you realize what’s NOT COVERED by Medicare, including prescriptions, dental, vision, hearing and much more. It needs to remain this way. People must have a stake in their healthcare, including the cost of being stupid (over eating, bad diet, no exercise, heavy drinking, drug abuse, etc).

In recent years, Medicare (CMS) has done a good job controlling costs… And it can do more!

It’s ridiculous that healthcare is a sixth of the U.S. economy, but it is what it is. Under the Obama Administration, healthcare costs to the government were reined in while private health insurance costs skyrocketed. Under the Trump Administration, HHS has the opportunity to continue the cost-cutting trend by addressing big Pharma’s fleecing of America. The power of Medicare, as a single payer, gives HHS the power and right to demand lower costs.

Private health insurance will remain alive and well!

This should make Conservatives quite happy, but no one talks about it. As is currently the case with 65+ Medicare beneficiaries, private insurance companies offer supplemental insurance (Medigap) to pay the 20% of health costs not covered by Medicare. This is a good system and shouldn’t be changed. There’s a lot of room for insurance creativity here.

We should each buy the level of coverage we need and can afford, while allowing the government to do the heavy lifting. Obamacare, forcing people to pay for coverage they don’t need or want, was a ridiculous notion from the beginning. However, Medicare got it right with the coverage it offers.

Medicare’s prescription drug program (Part D) works, too. Let the insurers and pharmacies compete for better rates, and let each of us buy the level of coverage we need at a modest cost. The ability to mix and match works!

Portable electronic health records.

Although the government mandated that all healthcare providers move to electronic health records, the government itself is the only central repository for a large base of EHRs. The Department of Health and Human Services (HHS) maintains electronic health records on everyone in the Medicare, Medicaid, VA and TRICARE systems. Their innovations in this space are spectacular. Having the health records of all Americans on this system would spur new cost-saving capabilities in areas such as telehealth, which is desperately needed as our hospital networks are shrinking.

I could go on for days listing benefits of a properly designed and managed Medicare-for-All program. My fear is that it would be anything but “properly designed”.

Will California and New York be the beginning of the end?

A California lawmaker recently unveiled details about Senate Bill 562, also known as the “Healthy California Act”. It’s a single-payer proposal to create universal health coverage (including inpatient, outpatient, emergency care, dental, vision, mental health, and nursing home care) for every California resident. I have not read the proposal deeply enough to understand how the Act, if passed, will be funded. However, I have to imagine a personal and corporate income tax hike in the range of an additional 5%.

The Huffington Post reports that “the push to implement a ‘Medicare-for-All’-type system in New York state just took a significant step forward Wednesday.” The push came from state Sen. Jeffrey Klein, who heads the Independent Democratic Conference (IDC) in the New York state Senate.

If the two most powerful states in the Union pass universal health coverage, with such massive entitlements, what will it mean for the rest of us?

One final point…

If Liberal forces get their way with a free-for-all, everyone gets everything system, like Obamacare, it will sink the country. As a nation… as tax payers… it’s simply not sustainable. Medicare works because it’s not inclusive of everything and all costs.

If Conservative forces get their way, with a pure free-market system, the insurance companies will grow richer, big Pharma will become more powerful, and millions of Americans will continue to be uninsured. Obamacare gave insurance companies a big present, and the current thinking on the right would not fix the problem.

When it comes to healthcare, what Americans need is for the best of right and left ideologies to come together. Only when this happens will the people get what they need; a basic coverage guarantee from the government, and open market insurance that covers what they actually want and can afford.

Recommended: H.R.676 – Expanded & Improved Medicare For All Act

2014 Medicare Deductibles and Premiums

Medicare announced the new Part A deductible, Part B premiums, Part B deductible and High Deductible Plan F (Medigap) deductible for 2014. Beginning January 1, 2014:

  • The new Medicare Part A deductible increases to $1,216 (up from $1,184 in 2013);
  • The Medicare Part B premiums remain unchanged at $104.90 per month (for those in the under $85k income bracket);
  • The Medicare Part B deductible remains unchanged at $147 per year; and
  • The High Deductible Plan F Medigap policy deductible increases to $2,140 (up from $2,110 in 2013).

In general, this is very good news from Medicare.  Previous year increases have been significantly more.

2014 Medicare Advantage Plan Gains and Losses

The Centers for Medicare & Medicaid Services published their  2014 “Crosswalk” file outlining Medicare Advantage plan gains and losses.

The file lists all of the Medicare Advantage and Part D Prescription Drug Plan changes from plan year 2013 to 2014. Each 2013 plan is identified as being renewed, terminated or consolidated.  Here are the summary results:

Type of Change
Plans Affected
Consolidated Renewal Plan 338
New Plan 614
Renewal Plan 3,689
Renewal Plan with Service Area Expansion 340
Renewal Plan with Service Area Reduction 301
Terminated Plan 381
Terminated/Non-Renewed Contract 129

When MedicareWire cross-referenced the 2013 enrollee reports published by Kaiser, we could clearly see large concentrations of Medicare Advantage enrollees that will be shopping for new health care coverage for 2014.

Overall, there are as many as 300,000 seniors enrolled in a plan that will be discontinued in 2014. These people will need to find a new plan or switch back to Original Medicare.

Hardest hit are enrollees from New Jersey, with as many as 40,000 affected by discontinued plans.  California, Florida, New York, Georgia and Pennsylvania all have 20,000 or more enrollees affected by plan terminations.

As a reminder to all seniors and other beneficiaries with Medicare, the Obamacare open enrollment, which started on October 1, 2013, does not affect your Medicare Annual Election Period.  Medicare open enrollment remains the same.  It begins on October 15th and ends December 7th.

Will Obamacare be the death of Medicare Advantage after 2014?

Today marks the third day of the Federal Government shutdown.  Republicans want a compromise on the new health care law and the Democrats are not about to budge.  The question, is why?

The hard truth is that Obamacare is going to cost far more than any of us regular citizens can possibly imagine.  All we have to do is look at the inflation in the Medicare system since 1965 to know that this is true.

The costs won’t be sustainable, and all of the players in the game know it.  This is why so many state governors refused to expand Medicaid and implement the health insurance exchanges mandated by the Affordable Care Act law.

I don’t believe a single governor that refused Medicaid expansion in their state did so to deny their citizens the care they need.  In fact, quite the opposite.  There is compassion for those most in need of health care, and the battle over the ACA is going to deny these people access.

The top health story in the NY Times today detailed how Obamacare will leave millions of poor without health care coverage because “they live in states largely controlled by Republicans that have declined to participate in a vast expansion of Medicaid, the medical insurance program for the poor, they are among the eight million Americans who are impoverished, uninsured and ineligible for help.”

So, what does all of this have to do with Medicare Advantage?  In a single word, everything.  Medicare Advantage is the #1 pawn in a high-stakes game of chess.  This single pawn will cost conservatives the game.

Medicare Advantage is a market-based choice program offered to those with Medicare benefits.  In many respects, Obamacare models the Medicare Advantage program.  The difference is that Obamacare pretends to be a market-based alternative, whereas Medicare Advantage actually is one.

The state health insurance exchanges were sold to us as a “choice,” despite the minor detail that the IRS will fine you if you don’t comply. Ignoring this fact, Democrats insist that Obamacare is a patient-centered and market-based system. Republicans contend that it isn’t. So, the fight over Obamacare rages on, and the pawns keep falling.

No matter how loudly Democrats insist that their objectives are based on choice, it’s impossible to refute that Obamacare effectively obliterates choice for seniors, exposing the lie in the liberal agenda for the American healthcare system.  If this agenda plays out to its end game, it will destroy the Medicare Advantage program and kick off a national outcry for a single payer system.

Original Medicare, as designed in 1965, was created as a single payer system, more commonly known as private fee-for-service (PFFS).  PFFS worked fine while health care costs were relatively low.  As costs dramatically increased, it put a financial strain on both beneficiaries and the government.  To relieve the strain, the Medicare Advantage and Medicare Part D prescription drug programs were created, and they’ve been a resounding success.

Medicare Advantage and Original Medicare are very different.  Where Original Medicare is a PFFS system that directly pays health care providers, Medicare Advantage is a program where the beneficiary’s health benefits are paid to third party insurers that compete with one another to offer the best coverage at the lowest price possible.

Within the Medicare Advantage system — a single health insurance marketplace located at — beneficiaries can shop and compare plans in their area (county by county).  Medicare Advantage providers receive a rebate from the Centers for Medicare and Medicaid Services (CMS) if they offer coverage below the government benchmark for a given area. This rebate allows insurers to further reduce their rates and expand the coverage offered in their plans.  This is how so many seniors are able to enjoy and afford health, wellness and additional coverage benefits that go well beyond Original Medicare.

If this sounds like a healthcare system based on choice, it’s because it is.  It’s this very concept that Democrats claim define Obamacare.  There’s just one minor detail that the architects of Obamacare conveniently left out: After 2014, Obamacare has the potential to gut Medicare Advantage as we know it today.

Provisions of the ACA law are structured to defund the government’s choice-based healthcare program.  It does so in several ways.  First, the ACA significantly lowers the Medicare Advantage cost benchmarks.  Obamacare reduces the benchmarks so drastically that  many enrollees will only qualify for a reimbursement to their providers worth 95 percent of what the government would normally cover under the Original Medicare PFFS system.

If that wasn’t bad enough, the ACA law also cuts the available rebates that insurers use to lower premiums and provide additional benefits. Previously, plans that efficiently managed patient care were eligible to receive up to 75 percent of the difference between their costs and the government’s benchmark cost.  The ACA, in addition to lowering the benchmarks, hacks the rebates down to 50 percent or less.

The result of these changes can only mean one thing. Medicare Advantage benefits will be reduced, rates will increase, and millions of seniors will go back to Original Medicare with its 80/20 cost structure and basic benefits.

If you’re wondering why these cuts and changes were put into Obamacare, there is only one obvious answer.  The architects want to remove all incentives for beneficiaries to enroll in a Medicare Advantage plan, effectively destroying the freedom of a market-based alternative that more than 14 million Americans have chosen as there preference.  If this happens, it will mark the beginning of the downfall of America’s market-based healthcare and the rise of a government run, single payer system, and socialized medicine.




Obamacare Health Care Law Forces Government Shutdown

It’s October 1st and our Federal Government is all but SHUTDOWN, but not the Obamacare health insurance exchanges. They are in full swing promoting U.S. Government subsidized health plans. Meanwhile, the sign posted at says “We’re sorry, your government is shutdown and the information on this website may not be up-to-date.”

If you hear a little anger in my writing, it’s because I am mad.

Can you imagine if President Bush had signed Medicare Advantage into law and told everyone they could keep their existing health care provider, and then it turned out to not be true?  Well, that’s exactly what Mr. Obama did with Obamacare.  You might remember this snippet from an Obama campaign speech:

If you are among the hundreds of millions of Americans who already have health insurance through your job, or Medicare, or Medicaid, or the VA, nothing in this plan will require you or your employer to change the coverage or the doctor you have.

For millions of Americans, including this one, what President Obama promised wasn’t true.  He made a promise to Americans that he simply couldn’t make in good faith, because he had no idea how the markets would react.

Today, what we know to be true is that Obamacare completely obliterated health care plans in ten states, including California, Connecticut, Maryland, Missouri, South Carolina, New York, New Jersey, Georgia, Iowa and Wisconsin.  And, we’re not talking about small players, either.  UnitedHealth, Aetna, Coventry, Humana and Anthem Blue Cross — among the largest health insurers in America — were forced out of prime markets by the new health care law.  All of these insurers offer top rated Medicare plans in these states, and the loss of business is bound to have a negative impact on future Medicare Advantage plan rates.

So, today, because they are as mad as Hell about the lunacy of Obamacare, Congress forced a shutdown of the government in a last ditch attempt to stop the funding for Obamacare.  I think we can all see where this is going to end up.  It’s too little, too late.  Sorry, Good Ole Pals, the momentum is on Mr. Presidents side.

Still, I can’t but help wonder how things would have been if Obamacare was modeled after Medicare.  Just look at Medicare Advantage and Medicare Part D drug plans.  It is the most successful cooperation between private industry and government in the history of the United States.  The reason for the success is simple, too.  The prices are low due to competition, and the program is 100% voluntary.  Does it get any better than that?

7 Things Every Medicare Beneficiary Needs to Know About Obamacare

Obamacare open enrollment starts on 1 October, and it’s confusing the heck out of millions of seniors. In today’s blog post, I’d like to clear up a bunch of misconceptions seniors have about Obamacare and how it affects their Medicare.

The most frequent question I get is “If I have Medicare, do I have to buy Obamacare health insurance?” The answer is no. The reason is quite simple. If you have Medicare, you already have qualifying health insurance. You’re covered!

People also seem to be confused about the open enrollment period for Medicare Advantage and Medicare Part D. Obamacare did not change the Medicare Annual Election Period (AEP), which starts on 15 October and runs through 7 December. It also didn’t change where and how you get your Medicare plans. If you have Medicare, you still go to your personal Medicare insurance agent or directly to Don’t bother going to your state’s health insurance exchange. They will simply send you back to or redirect your call to the Medicare toll-free number.

Here’s another common misconception. Obamacare will not pay for your Medicare Supplement insurance, regardless of your income level. I’m not sure who started this rumor, but it sure did get around. If you fall below the national poverty line for income, and you need Extra Help to pay for your prescriptions, call your local Social Security Administration office.

I’ve received a couple of emails asking if Medicare beneficiaries can trade their Medicare for Obamacare? To this I say, and let me be polite, are you nuts? Your Medicare gives you a lot more coverage than Obamacare.

Also, Obamacare did not do away with the Medicare Part D coverage gap (aka, “doughnut hole”), at least not in 2014. The coverage gap is being phased out slowly. It’s still with us through 2020, then it will be gone for good.

Lots of seniors also seem to want to know how all of the money being diverted away from Medicare into Obamacare is going to affect the care they get and the costs. It’s a great question, but there are so many moving parts that it’s impossible to give a correct answer until we get into the program another year or two.

Many changes have been put into place by the U.S. Department of Health and Human Services and the Centers for Medicare and Medicaid Services. The most significant changes impact how Medicare and Medicaid providers get paid. It is these changes, along with a crack down on Medicare fraud, that the government feels will allow them to take budget from Medicare and move it to Obamacare.

Some Medicare changes that might affect seniors simply won’t be known until the changes happen. For example, for plan year 2014, all Medicare Advantage (MA) plans must have a medical loss ratio of 85 percent. At the same time, the 14 percent overpayment that the government has been providing MA plans will go away at the end of 2014. This is a double whammy for the MA plans that is likely to have a pretty big impact. Two potential outcomes could be an increase in premiums, along with a reduction in benefits, or a massive consolidation of health plans that makes them more efficient.

I hope this has cleared up any misconceptions you might have about your Medicare in the new era of Obamacare. Medicare is virtually unchanged and it’s running more efficiently than it has in years past.

Mark your calendar. Medicare open enrollment begins 15 October.


Medicare in 2014 vs Obamacare: Healthcare Cost Saving Strategies for Seniors

Our top Google, Yahoo and Bing search last week was “Is a Medicare Supplement Necessary/Required with Obamacare?”  With 157 of you asking this same critical question, we thought we’d better get the word out and clear things up.

The answer is no, but it’s a good idea to have some sort of supplemental Medicare insurance (Medigap or Medicare Advantage) in 2014.  Here’s why.

Yesterday MedicareWire reported that U.S. Sen. Rubio was claiming that Obamacare is going to cut Medicare benefits and increase costs.  Only half of his claim is factual.  Since the passing of the Affordable Care Act law in 2010, Medicare benefits have increased.  By that I mean beneficiaries are covered for a few additional health benefits.  The Centers for Medicare and Medicaid Services should be commended for working hard to add new, essential health benefits that keep seniors healthy.

Where Sen. Rubio is 100% correct is in the area of healthcare costs for seniors.   The U.S. Department of Health and Human Services is diligently working to reduce the government’s healthcare costs.  There are two primary ways it’s doing so.  The first way is by lowering how much it reimburses both doctors and hospitals for services provided.  The second way is by forcing medical suppliers to compete on price.

At first blush both of these cost-saving measures might seem to be a good thing, and for the government, they are.   However, there are going to be consequences that roll down hill to patients.   Some of these consequences have already reared their ugly head, like the story we covered a few days ago about the Medicare hospital coverage gap.  Let’s face it, when doctors and hospitals start getting hefty pay cuts, they are going to look for ways to stop the bleeding.

Believe me when I say the healthcare system is going to start soaking it to the seniors.  And it ain’t going to be pretty.

The Medicare supplement insurance carriers know the soaking is coming.  That’s why Medigap rates have increased twice this year, and not by a little, either.

What’s really interesting is how the Medicare Advantage (MA) plans have decided to deal with budget reductions.  CMS recently announced that 2014 Medicare Advantage plan premiums would remain about the same, with only a $1 average increase.  This is astonishing considering the massive funding cuts delivered to MA plans to help fund Obamacare.

How is it that MA plans are managing to keep premiums stable while funding from the government takes an 8 percent drop?  There are two reasons, and both are equally important to seniors.  One can help you, while the other can bite you in the wallet.

Since 2010, enrollment in MA and MAPD (Medicare Advantage with Part D included) plans shot up considerably.  In 2014, we could realistically see a full 30% of all beneficiaries in an MA plan.  That’s more than 15 million seniors!  As enrollment in privatized health insurance increases, so does the bargaining power of the plan.  It’s the same reason large employers get better rates on HMO and PPO plans for their employees.

Unfortunately, volume does not make up the complete revenue shortage facing most Medicare Advantage plans.  To make up the shortfall they have two choices: increase premiums or increase out-of-pocket costs.  To remain competitive come open enrollment, and comply with CMS regulations, most plans are choosing to increase your out-of-pocket costs with higher copays and coinsurances.

In 2014 Seniors Have A More Difficult Choice Than Ever

Until now the safe choice was to keep your Original Medicare (Parts A and B) and add a Medicare Supplement Plan F and a Part D plan for your prescriptions.  This combo covered you from A to Z.  Unfortunately, the increased demand for MA plans and the introduction of Obamacare throws a monkey wrench into the works.  That monkey wrench is called capitation.

Health insurance networks, particularly Health Maintenance Organizations (HMOs) use a process called capitation to determine how much they will pay physicians, physician groups and other healthcare providers.  With the massive increase in demand for HMO plans coming in 2014, physicians participating in HMO networks are going to be slammed with new patients.  The result is expected to be a severe shortage of physicians that can or will see patients that do not belong to a health organization network.

So, while that all-you-can-eat Medigap Plan F may have you covered, in-so-far-as your bills are concerned,  that doesn’t mean you be able to find a physician that will see you.  This is a serious issue that all seniors need to be concerned about.  Every area will be different, depending on the makeup of independent physicians versus network physicians.  Start doing your homework.

Here’s my personal recommendation.  Every senior needs Medicare Part D.  Even if you don’t have any regular prescriptions now, for around $20 per month you can be covered.  It will save you a lot of money when you do need to have your prescriptions filled.

If you currently have a primary care physician and a Medigap plan for supplemental Medicare insurance, keep it.  However, now more than ever is the right time to to go shopping for a better rate.  Also, if you are on an F Plan, you might want to look at taking a bit more risk to save a lot of money over the course of the year.  A Plan G is always a safe alternative.

If you are new to Medicare (will be enrolling in 2014 or after), or if you still have traditional Medicare without a supplement, Medicare Advantage is the most cost effective way to get your health insurance.  On average, the monthly premium will be about $31, with most U.S. counties having one or more $0 premium plans.  Plus, each plan is required to show you your maximum out-of-pocket expenses.  This will give you a much better idea of your costs should you need medical care.

If you plan to keep your Original Medicare, even if you have a supplement, make sure you’re part of an Accountable Care Organization (ACO).  ACOs are a new phenomenon in the private-fee-for-service (PFFS) arena.  What started as an experiment by Medicare, ACOs are quickly proliferating.  Since Obamacare passed, hospitals, medical groups and other organizations nationwide have formed hundreds of ACOs, and the trend is accelerating.  In a nutshell, an ACO forces hospitals, doctors and other health care professionals to deliver your healthcare with more coordination, better quality and at a lower cost, just like an HMO.  Like HMOs, ACOs use a capitation process for payments.

To wrap up, don’t allow yourself to be shut out or unprepared for your potential healthcare expenses in 2014 and beyond.  To avoid being shutout and not having a primary care physician, make sure that you’re part of a PPO, HMO or ACO.  Obamacare does not mandate that seniors have supplement insurance or a private health plan — regardless of your income level — but you will reduce your overall costs if you do.

Not so fast, Marco! Medicare only sets Medicare Advantage ‘basic requirements’

For the past two years U.S. Sen. Marco Rubio has vigorously opposed the new health care law for a lot of reasons.  Now, he’s touring Florida shouting that his mother may be harmed by the president’s health care plan because she’s enrolled in Medicare Advantage.

Not so fast, Sen. Rubio, you might have your facts wrong.

Mrs. Rubio is one of over 14 million Americans who choose to receive their Medicare benefits through a privately run Medicare Advantage HMO or PPO plan.  “My mom’s on Medicare Advantage and one of the reasons they get her business is that, in addition to good doctors, they actually will pick her up from home because she can’t and doesn’t drive, and take her to her doctor’s appointments,’’ said Rubio.

However, since the Affordable Care Act calls for less spending on Medicare Advantage, “the chances are that soon (seniors) will open up the mail to the bad news that your Medicare Advantage … has been changed in a negative way for you because of Obamacare,’’ he continued.

Will Medicare Advantage plans increase out-of-pocket costs and diminish benefits as Sen. Rubio suggests?  I believe his answer is only half true.  Here’s why.

The Centers for Medicare and Medicaid Services (CMS) establishes the baseline of services that all Medicare Advantage plans must provide.  In essence, plans must offer all of the same benefits as traditional Medicare.  After that, it’s up to the plan provider to decide what additional benefits they will include.  Currently, we see more plans with extra benefits, including prescription drug plans, vision benefits, dental benefits, and hearing benefits than ever before.  Most of these plans have a slight uplift in cost, but it’s far less than the cost of purchasing the coverage on its own.

Where Sen. Rubio is correct is on the anticipated increase in out-of-pocket costs.  And he’s right that it’s a direct result of Obamacare.  President Obama promised that he would fund the ACA health care law by cutting costs in Medicare without cutting benefits, and he’s delivering on that promise.  Notice that he never said the cost to seniors would go up, and up!

Hey, where did people think the money was going to come from?

Here’s the new deal, and people need to get used to it.  It costs money to go to the doctor, and someone has to pay for it.  Starting in 2014, it’s seniors that will be paying more.  A lot more.  The higher costs will be doled out through higher co-pays and co-insurances.  That’s not the same as a reduction in benefits.  It’s simply an increase in costs.

Get used to it America.  Stay healthy or expect to pay, because the increase in your copay is here to stay.

As Medicare Annual Enrollment 2014 nears, Obamacare benefits confuse seniors.

Wondering how the new health care law affects your Medicare benefits? In a word, not-at-all. However, Medicare recipients should continue to watch cost-cutting trends. That’s good news for seniors buying Medicare Advantage or Medicare Part D prescription-drug plans. Premiums will remain low in 2014.  However, let’s clear up some common confusion.

Throughout the year we receive dozens of questions from seniors, like:

  1. Can I buy my insurance through the Obamacare exchange?
  2. Is open enrollment for Medicare the same as the state health exchanges?
  3. Can I get a health insurance subsidy to help pay for my Medicare Part D or my Medigap coverage if I meet the Obamacare income requirements?

The answer to all of these questions is “no”.  The new healthcare law does not change anything about open enrollment for Medicare Part D (prescription drug plans) or Medicare Advantage HMO and PPO health insurance.  The Annual Enrollment Period (AEP) is still 15 October through 7 December, and nothing has changed in regards to subsidies.  The Medicare Extra Help program is still available and is not changed by the ACA.

The good news is that Medicare Advantage and Part D plan quality continues to improves, and Medicare reports that 2014 Medicare Advantage plans will only slightly increase ($31 per month, on average, up from $30).  The same is not true of Medicare Supplements (aka, Medigap).  Supplemental health insurance policies for seniors have spiked dramatically this year, a trend that is likely to continue.

Even though monthly premiums may remain the same, expect heftier co-payments, shrinking pharmacy networks, extra discounts for preferred pharmacies and modifications in drug tiers (formularies) that will increase out-of-pocket costs. More than ever, 2014 is the year to carefully investigate how plans in your area cover you when you need to see the doctor or have  your prescriptions filled.

How the ACA Helps Medicare’s Disabled Beneficiaries

By Mark Taylor/Medicare NewsGroup

The Affordable Care Act, which was passed in 2010 and upheld by the U.S. Supreme Court in 2012, includes numerous provisions that impact people with disabilities through expansions of Medicaid, private health insurance reforms, new care coordination programs and efforts to transition elderly and disabled populations from institutional to home and community settings. The ACA:

  • establishes health insurance exchanges in states that will allow people to purchase affordable commercial insurance without entering high risk insurance pools;
  • heavily subsidizes expanding Medicaid eligibility to single adults under the age of 65 with incomes under $15,000 for single people ($38,000 for families of four) as of 2014 (potentially affecting more than 3.5 million Americans with disabilities );
  • will qualify more than 3 million people with disabilities or pre-existing conditions for health insurance exchanges as of 2014 through insurance reforms that forbid private health plans from discriminating against people with pre-existing conditions. The law already forbids exclusions for pre-existing conditions for people under 19.
  • will disallow insurers from imposing annual or lifetime dollar caps on policies;
  • expands private health insurance to dependent children under 26 on their parents’ policies (providing coverage to more than 4 million young people with disabilities);
  • improves data collection requirements to include gathering data on where and how people with disabilities access health care with locations of accessible healthcare facilities;
  • adds disability status to health disparities in calculations for reporting surveys, along with health provider training and cultural competency;
  • improves access to medical diagnostic equipment for people with disabilities by setting exam accessibility standards;
  • establishes care coordination demonstrations in Medicare and Medicaid for those with chronic conditions. States will work with beneficiaries, their families and caregivers, and health care providers to develop state pilot programs;
  • allows states, starting in 2014, to submit plans under the Medicaid Health Home option to develop medical homes, which are patient-centered care systems that improve coordination and access of care to improve treatment for people with chronic conditions, including dual eligibles. States get a 90 percent federal match for payments to home health providers.
  • bolsters Medicaid’s Money Follows the Person program by funding it through 2016 with an infusion of $450 million annually. The program helps people with disabilities eligible to live in nursing homes to transition to home- or community-based programs. Medicare will bring the program to 43 states.
  • offers the Community First Choice Option, which increases federal match rates to states by 6 percent by providing home care attendant and other services to allow beneficiaries to live at home as an alternative to costly skilled nursing nursing facilities.
  • creates the Balancing Incentive Program, which offers states $3 billion in federal Medicaid matching funds to states to encourage greater transitioning from institutional to home-based and community care settings. The 1915 (i) State Plan Home and Community-Based Services broadens the path for states to create that benefit, which combine acute care services with long-term care services.