Proposed Medical Home Pilot Program Raises Questions

Making the rounds on coffee row these days is the consternation over a concept called medical homes that are supposed to cut costs for Medicare and HMOs.

Medical homes seem to be a radical idea that no one wants to discuss and the Center for Medicine in the Public Interest (Center for Medicine) has some concerns about the concept. While they agree that there needs to be cost cutting measures to get a grip on Medicare expenses, they aren’t too enthralled with the idea of medical homes.

These “homes” are way, way back in the health care reform bill in the inevitable fine print. What the text proposes is the establishment of a medical home pilot program for disabled persons and for seniors. It seems the idea would mean providing a medical home for every person during the long process of America moving to a wellness based system, instead of remaining with the current sickness based model.

This idea begs the question of what would happen to Medicare, Medicare supplements and a whole host of other scary questions that people can’t really wrap their minds around. On the surface the idea sounds like a great one, with the homes being operated by nurse practitioners and doctors’ assistants who would use evidence based medicine.

These individuals would hand out treatment to those in the home, but without the supervision of a doctor. There is also a question of what precisely does the term “treatment” mean – handing out medications or performing other medical procedures? How would these costs be absorbed and by whom? What the Center for Medicine is wary of is the imposition of “one-size fits-all” medicine handed out by only partially trained medical staff to cut corners and save the government and private insurance carriers some money.

Here’s where Medicare comes into the picture. The proposed pilot program would be aimed at Medicare patients with a high medical risk score, and/or those needing constant treatment or supervision. This type of patient requires the care of a physician, not just a nurse. And herein lies the concern of many seniors on Medicare and the Center for Medicine. This will put the proposal into perspective sharply. Right now there are roughly 22 million individuals eligible for the proposed medical home program.

The logistics of a program of this nature are staggering and one wonders if the government has any clear concept of what that would mean in terms of trying to set it up. To contemplate caring for 22 million people with just nurses and doctors’ assistants is a sobering thought. More to the point, how will this really save Medicare and the health system any money?

Think about that for a minute and the realization will dawn that someone will need to pay for this kind of care and if it’s not the government and insurance carriers, then it would be private individuals. Seniors on

Medicare and Medicare supplements barely have the kind of money to afford what they have now, how would they afford a medical care home?

To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

The Boom in Health Care Is Coming

The boom in health care is just around the corner. Not a boom in services, but the day when the health system sees thousands of senior baby boomers entering the health insurance market.
If you happen to be selling health insurance, the fact that thousands of new customers will be hitting the market soon will make your day. Baby boomers are poised on the leading edge of being eligible forMedicare in huge numbers, and this will forever change the face of Medicare.

It’s a fact that one in every five Americans is a senior. Come 2050 this will be one in four. If you take the time to do some math, you can see where this market will continually burgeon until even greater numbers of seniors are on Medicare. This is important news for insurance companies and the health system because seniors these days are living far longer than they did before – thanks to the marvels of new technology.

Wave one of the baby boomers will hit the marketplace in roughly a year and a half if they were born in the 20 year period after the end of WWII. The next wave will hit in approximately 2025. Medicare as we know it today will look nothing like it used to with the advent of all these new people becoming eligible to receive benefits. This also begs the question of just how the health system will cope with such an enormous influx of older people needing more care. Think of how expensive that is going to be. Given the state of the economy today, this might be viewed as a touch and go situation at best.

Keep in mind that seniors in the 21st century are leap years ahead of their predecessors. They’re alert, politically aware, highly motivated, intelligent and quite involved in advocating for their future. They’re prepared to take on the government and fight for what they perceive to be their right to adequate health care. They’re also far more financially secure than generations before them and they continue to generate revenue by way of annuities, pensions, social security, jobs (yes, seniors are indeed working past the age of 65) and investments.

Part of the reason that today’s seniors are far more aware of what is going on around them than ever before is that virtually one out of every five over the age of 65 is now online. Just about half of the seniors in the 65 to 75 year old bracket use the WWW. Those over 75 have also taken the plunge into exploring global connectivity.

If seniors are online, what do you suppose they are currently looking for as they surf? If you guessed they were trying to get information on Medicare, health insurance and Medicaid, you’d have just won the prize at the county fair. What a golden opportunity for brokers or agents that specialize in these forms of health insurance, as research reveals these same Internet savvy seniors are also starting their health insurance purchases online now as well.

If you’re prepared for the future and ready to serve the baby boomers as they become eligible for Medicare, etc. then you won’t have any trouble finding customers. In fact, they’ll likely be coming to you first. Make sure you have a highly interactive and easy to use website that has all the information seniors need and provides excellent service.

Richard Cantu is with Medicare supplements resource, GoMedigap.com. To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

The Confusion over Subsidies

So are the taxes going up in order to change Medicare or not; that is the burning question being asked in town hall meetings all across the United States.

One hand of the government says they are not going to raise taxes to fix Medicare. The other hand says the plan to reform Medicare will cost more because Medicare needs to change. So, which is the real story and what is the real definition of the word subsidy? Is it true that Medicare and Medicaid are the reasons the economy is so out of whack or is it the other way around?

Ostensibly a subsidy is a grant of public money that assists a private operator in serving the public or it is any financial assistance given by one person to another. The fact is that the government subsidizes Medicare and Medicaid, and what the government does not subsidize comes out of the pockets of seniors. Based on what many seniors hear in the nationwide town hall meetings, they feel that too much change will spell problems for them.

Seniors do not want “less” medical care and would be happy to keep what they have right now, and they most certainly do not want to pay more out-of-pocket for what they are currently getting. While it may all boil down to a matter of perception, the fact is that if changes are made to Medicare and Medicaid andMedicare supplements, it is virtually inevitable that costs will increase. It’s the nature of the beast.

Most frightening of all to seniors on limited budgets, even if they do have a comfortable income, is the fact that they feel the government is beginning to offload the increasing costs of Medicare and Medicare supplements to the one part of the population who can least afford it. Some have even been heard to say they feel they are being put out to pasture by the government’s rush to trim senior health care because their lives are shorter at that age.

Without going off the deep end on this subject, it would be best if seniors took the time to really make themselves familiar with the issues before making up their minds. Ask the tough questions, see what the answers are and then make an informed decision. There is no doubt that the cost of revamping Medicare is going to be tremendous and that it can’t be done until the economy is in better shape than it is right now.

There are still a number of unanswered questions relating to the high birth rate in the U.S. and how that impacts the health system, as well as questions about the immigrant population who moved here to take advantage of health care services. How will those costs be factored into a new health system without taking from Peter to care for Paul?

While things need to change in order to provide care for all, the question still remains: How will that be done and where will the money come from to accomplish it? In the meantime, don’t jump to conclusions until the whole picture becomes clear, as there may be more to understand before making up your mind that the government is out to “get” seniors. This may not be the case and like many items we have already heard about, it might only be “suggestions” to see the response.

Richard Cantu is with Medicare supplements resource, GoMedigap.com. To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

The Deductible that Bites

Make sure that Medicare deductibles are thoroughly understood to save finding out the hard way that deductibles are applied differently.

The major problem with Medicare and all the various deductibles is that it is extremely confusing trying to figure out which portion of Medicare – Part A and Part B – has which deductible kick in and when. For the record, Medicare part A offers hospital coverage, and part B provides medical coverage. If there is no Medicare supplement insurance involved then when the calendar year starts and a patient visits their doctor they would pay a deductible of roughly $150.

If this same person had to go to hospital and spent three days there, they would get in the mail a part A deductible bill of approximately $1,000. If for some reason the same patient had to return to the hospital for another short stay a few months later, they would once again get a part A deductible bill in the mail for the same amount as their first stay. At this point many seniors throw up their hands and wonder what is happening and why they are getting two bills in the mail.

The reason there were two deductibles in one year under Medicare part A is because the deductible is charged for a benefit period, and a benefit period starts the day a person goes to a hospital or other nursing institution.

The period typically ends when the patient hasn’t gotten hospital care for 60 days in a row. If that period ends and another trip to the hospital is required, this is classified as a new benefit period. On the other hand, Medicare part B only has the one deductible a calendar year.

If Medigap supplement insurance was in play in this scenario, then it would likely have covered the out-of-pocket expenses for Medicare part A and part B deductibles. At one time there was the option to consider the benefits of a Medicare Advantage plan. Unfortunately, this plan will no longer be offered in 2010.
Medicare isn’t always the easiest health care insurance to understand, but with a little due diligence and digging, most of the answers are readily available. Granted they may be confusing at first, but if seniors take the time to speak to a local Medicare insurance agent, they will have the answers immediately. A local Medicare agent will know the plans and benefits intimately and if budget is a concern, he will be able to tailor Medicare supplement insurance to go with Medicare that is affordable and actually delivers what it promises to deliver.

To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

Medicare Without the Jargon

If only someone would take the time to teach seniors about Medicare, without all the jargon, how refreshing that would be.

Luckily, Medicare is a whole lot easier to understand than many people think. There are portions of their various policies that leave something to be desired in the comprehension and plain English department, but suffice it to say that for the most part, what someone needs to know is easy to find out and easy to understand.

There is a handbook available from Medicare if the spirit moves a person to ask for it. However, it is confusing at best and leaves readers with the vague feeling they missed something, and they usually did. To really narrow the focus of what is definitely needed for Medicare, do some pre-planning and have the various options selected by March.

Make critical decisions like going with an HMO as opposed to private insurance or a PPO. Perhaps an existing retirement plan offers health benefits after the age of 65. These are things that need to be taken into consideration when selecting Medicare plans and Medicare supplement insurance.

Other decisions that need to be made include deciding if it makes sense to take part A, which is free, and part B that is paid out of social security. Something that needs to be perfectly clear about part A is that it picks up 80 percent of the costs of a hospital stay, but it does not cover the doctors treating a patient during that stay. Alternatively, part B offers doctor/surgeon/specialist coverage that handles 80 percent of physician visits, lab tests, surgeons and other specialists. This is usually the plan that most seniors will use.

A smart move for seniors is to take advantage of open enrollment. This is when three months prior to the senior’s birthday and three months after it, they are considered to be in open enrollment. This is useful information because during this period of time there is no health underwriting with insurance companies.
HMO’s can definitely deny coverage based on the health of an individual. However, insurance companies cannot, not if the person is in open enrollment. This is a golden opportunity to take advantage of if one’s health isn’t that great.

Depending on what state a senior resides in, they may wind up paying between $100 and $175 for Medicare supplements. In other states there is the option to choose plan F or plan J which would mean no deductibles, co-pays and the Medicare supplement insurance would pay the remaining balance of the medical bills. It’s best to check with a licensed Medicare insurance broker who will be able to outline what plans are available in various states and their costs before making any decisions about what Medicare plan and Medicare supplements are needed.

To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

Know Your Medicare Supplements

Many American seniors think that when they get to the age of 65 and are entitled to Medicare that their worries are over. This isn’t true.

Medicare is not the ‘be all-end all’ and all encompassing insurance program than many elderly Americans seem to think it is; far from it to be precise. It will not and cannot take care of all their medical needs. It was never designed as a program to handle every medical need a person has. It was initially designed to take care of life’s medical crisis moments such as heart attacks and things like seriously broken bones.

Unfortunately, Medicare somehow became the magic panacea to cure everyone’s aches, pains and illnesses when they got older. That meant that buying Medicare supplements didn’t make much sense to older people because they already had Medicare coverage. Many of them opted to not get Medicare supplements because the cost seemed out of line. This mistaken impression needs to be corrected before too many seniors realize their mistake later when they desperately need medical care they cannot get with Medicare.

If the elderly do not understand the differences between Medicare and Medicare supplements they will find themselves faced with medical bills later in life that they not only didn’t expect to have, but will have no way to be able to pay them. This isn’t to say the Medicare is flawed, but it should be noted that it does have limited coverage, and it’s the consumer’s responsibility to know what Medicare does provide and what it doesn’t. Having said that, often seniors need help understanding Medicare supplement insurance from their families, and also need to know where they can find pricing for Medicare supplement coverage that suits their budgets.

If you’re helping your older relatives understand the complicated tangle of Medicare and Medicare supplement insurance, make sure to explain to them why having this extra coverage is crucial for their medical care; that they need the extra coverage now to cover care needed later.

There are four levels of Medicare that you need to know about, and each of them deal with medical coverage differently. For instance, Medicare part A pays overnight hospital expenses; part B handles routine doctor’s fees/tests; part C is optional coverage in that if you have part A, B or Medicare Advantage part C (which will be phased out in 2010) you are eligible for part D (prescription drug coverage). With the changes to Medicare coming in 2010, it makes sense to have a heart-to-heart talk with a local Medicare insurance agent who will be able to outline more in-depth what the coming changes are and what they may mean to you.

Every part of Medicare has a variety of deductibles and limits in place that once reached will mean your Medicare coverage is exhausted. These limits and deductibles change now and then, so keeping up-to-date with the changes will provide you with the peace of mind that your elderly family member is fully covered in any event. Don’t hesitate to contact a local Medicare insurance agent and discuss what you need for your senior family member. They are there to help you.

Richard Cantu is with Medicare supplements resource, GoMedigap.com. To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.

Get Information on Medicare Supplements First

Confused about what Medicare supplements - Medigap - is and what it actually offers? So are many other Americans. Good news, it’s pretty straightforward.

In a hundred words or less, Medigap (Medicare supplement insurance) is offered to the public through private insurance companies in order to fill in the “gaps” in Medicare coverage. This is because Medicare does not offer coverage for “everything” and most people find they need a bit extra to get the coverage they need.

In an attempt to make things relatively simple, the government dictated that Medigap policy carriers are only allowed to offer precise plans the government approved. Those policies are Medicare supplement Plans A through Plan L. Every company that sells Medicare supplements is selling the exact same policies; there are no differences between insurance companies on policy content. What does differ however, is the price charged for Medicare supplement insurance. This definitely does change from company to company, which means if you do some shopping around, you may be able to save yourself some money.

To put this another way, if you buy a Plan A Medicare supplement insurance policy from XX insurance company, it will be an exact match to a Plan A policy bought at insurance company AA. One thing that you really do need to do before you choose which Medicare supplements suits your needs is to compare not only the plans, but also compare the companies that offer you that kind of insurance. Sure you can get quotes online, but make sure they are from different types of insurance companies.

Pay close attention to what you are reading while you are online, as there are insurance companies whose methodology on selling health insurance dictates how they price their Medicare supplements. Next, closely examine each plan for the benefits you will receive. There will be some plans that have benefits that you will never use and therefore it won’t make any sense to buy them. This is one good way to save money, by choosing a plan you know without a doubt you will use and not shelling out money for unused benefits.
Remember, that the step where you do your benefit comparisons is crucial so that you know precisely what you are getting when you make your decision to buy a Medicare supplement. This is where it makes the most sense to call a local Medicare insurance agent and ask some pertinent questions about coverage.
Your life is unique to you and no one else can tell you what would suit you the best except you. This is why you need to ask questions and narrow your search parameters down to get the best possible combination of policies that deliver the coverage you need – minus the benefits you wouldn’t use.

Talking to a local Medicare insurance agent is a major step in understanding the community you live in, what the realities are for you as a healthcare consumer using networks and other information you will need to tailor a plan for your needs.

Richard Cantu is with Medicare supplements resource, GoMedigap.com. To learn more about Medicare, Medicare supplements, or Medicare supplement insurance visit GoMedigap.com.