Medicare Articles

Part One- How Medicare Might Look in the Future-  Premium Support

06/04/2012  Medicare as we know it is financially unsustainable in this country. It is also extremely political. It is my belief that no matter who wins the Presidential election or which party controls Congress, change in the Medicare system is inevitable. Change is a code word. What we are really talking about is the federal government cutting spending on Medicare, which both political parties agree must occur.  We can only hope that our political leaders in Washington can act like adults, and produce meaningful and effective policy. So, what might some changes look like? First, there is the possibility of some type of Premium Support. Premium Support is partial privatization of Medicare where different private companies will vie for your Medicare coverage. A Medicare recipient will get a defined set of dollars, and she will then go out and purchase Medicare healthcare. The thinking goes that this will put the patient in better charge of her healthcare and stimulate intense competition, which will result in lower cost and improved outcomes. Premium Support already exists-  Part D/Prescriptions, Medicare Advantage Plans, and the highly successful Federal Employees Health Program.

Part Two- How Medicare Might Look in the Future-  Geisinger Model

06/05/2012 There was a great cover story in this weeks Time magazine that discussed how Geisinger is radically changing the delivery of health care. Currently, we are all used to fragmented care. We see our primary physician who performs a series of tests. We might see a cardiologist, who performs the same testing. We might see another specialist, who does her own test. Each one of these doctors might prescribe medication, with little regard to what other physicians are doing. Medicare makes seperate payments to providers who care for patients for a single illness, or a course of treatment. This leads to fragmented care with minimal coordination across providers and healthcare settings, such as provider and hospital. Medicare pays based on how much a provider does, nothow well the provider treats the patient.  Makes no sense, right? Well, that’s our current fee for service system-wasteful and possibly detrimental. A few healthcare systems are trying to change this. Geisinger, for example, has had great results-better patient care- with a bundles services approach. A lead doctor will coordinate care across all specialties. Technology will make it easier, less expensive, and provide a better patient experience. The results of this bundled approach are impressive- better outcome for patients and significant cost savings.  Under this bundled payment system, Medicare links payments for multiple services that patients receive during an episode of care.  For example, instead of a surgical procedure generating multiple claims from multiple providers, the entire team is compensated with a “bundled” payment. This radical change, rewarding quality and not quantity, in the delivery of care has led to improved care for patients,  better health, better care and lower costs.

Part One- Special Enrollment Periods

06/06/2012 A Medicare Beneficiary is limited to when and how often she can join change or leave a Medicare Advantage plan, or a Part D, prescription plan: 1. You can enroll in a Medicare Advantage Plan or Part D plan during the intial enrollment period- when you first qualify for Medicare 2. During the Annual Enrollment Period, which begins October 15, 2012 and lasts to December 7, 2o12. you can change how you receive your Medicare coverage, and you can enroll in, change, or drop Medicare Part D coverage 3.  From January 1 to February 15, you can leave your Medicare Advantage Plan and change back to Original Medicare with or without selecting a Part D drug plan. You can’t, however switch Medicare Advantage, such as Keystone 65,  plans during this time period (that can only be done from 10/15-12/7). Outside the above three periods, you can only change how you get your health coverage and enroll in, change or drop Part D drug plan if you qualify for a Special election Period (SEP).  There are, however, several circumstances where Medicare will permit changes to a plan throughout the year. Subsequent blogs will discuss the circumstances that qualify for an SEP. Yes, this can be quite confusing. You can contact Allen Heffler directly at (215) 658-1776 to discuss in greater detail.

Special Enrollment Period- Leaving Employer/Union Coverage

06/11/2012 Under normal circumstance, it is important to sign up for Medicare and a Medicare Plan when you turn 65. There are, however, a few exceptions to this rule. One of those exceptions is if you have employer sponsored health coverage. If so, you may qualify for a Special Enrollment Period (SEP),  where you are able to sign up for Part A and enroll in Part B, as well as enroll in a Medicare Plan, such as a Medicare Advantage Plan through Bravo Health or Keystone 65, when you leave employment. It is important to note that COBRA is NOT considered coverage on current employment, and, thus, does not qualify as an SEP. To avoid paying a higher premium for Medicare Part B, it is important to sign up for Medicare when you are first eligible, such as when you are turning 65 or when you leave employment health coverage.