Thread: Medicare plan changes are coming; seniors should review cove

Medicare plan changes are coming; seniors should review coverage

By Kathy M. Kristof
Personal Finance
November 21, 2010

Nobody likes to deal with their medical plan choices — possibly least of all seniors.

About 80% of older Americans remain in whatever Medicare plan they started with, even when unhappy with the care, according to a recent survey by Allsup, an Illinois-based Social Security and Medicare consulting firm.

This year, 3.5 million seniors won't have the option of just keeping the status quo. About 13% of Medicare Advantage plans are being phased out, forcing those who have them to make new choices.

But even if you're a senior not losing your Advantage plan, experts say there are good reasons to evaluate your coverage during Medicare's open enrollment period, which started last week and continues to the end of December.

"Medicare plans change more year to year than you might imagine," said Ross Blair, chief executive of PlanPrescriber, which provides online tools for Medicare beneficiaries to select plans. "Your health can also change fairly dramatically. That could mean that the plan that was great last year isn't a good choice now."

Moreover, in past years, seniors who decided they didn't like the health choice they'd made (or didn't make) during open enrollment were allowed to shift into a similar type of plan during the first months of the following year. But that option is being eliminated, said Paul Gada, personal financial planning director for Allsup. Starting next year, the ability to switch plans is far more restricted.

That could make it costly to procrastinate. You know you need to shop for a new plan if yours has been closed or merged, but you should also consider shopping if your health has changed significantly or if your plan has made changes to coverage, Gada said.

How would you know whether your plan has made changes? Take a close look at the annual "Notice of Change" that landed in your mailbox this month, Blair suggested. It spells out any significant shifts in your coverage, including premiums, co-payments and deductibles.

Don't assume the plan hasn't changed just because the premiums and co-payments are stable, he said. Make sure the plan hasn't changed the drugs it covers too.

If you take medications regularly, those changes can be pivotal, Blair said. If your plan stops covering your prescriptions — or shifts to covering only generic drugs and you're set on a name-brand medication — it can cost you a small fortune. Yet a change in drug coverage doesn't jump out at you like a change in premiums, co-payments or deductibles.

If a quick review of your plan indicates you need to shop, there are some online tools that can make the process relatively easy.

Medicare.gov offers a "Compare Drug and Health Plans" widget on its website, which allows you to plug in your ZIP Code and prescriptions to get a listing of the plans available in your area. This listing includes premiums, co-payments and whether the plans cover the medications that you plugged into the list.

The downside to the Medicare.gov feature? It can be overwhelming. I plugged in a ZIP Code and sample set of seven common medications, and the website found more than 60 plans to choose from. These included traditional Medicare plans, traditional plans plus prescription drug coverage, and so-called Medicare Advantage plans. The site said that out-of-pocket costs for the choices would range from $1,900 to $9,200 — an incredibly wide margin.

A somewhat simpler option is provided at http://www.planpresciber.com , which seems to use many of the nifty aspects of the Medicare widget. It also adds features of its own, such as allowing you to filter a search so that you can, for example, limit the results only to traditional plans or Medicare Advantage plans. You also can click on the plan you currently have and the site will show you other plans that are less expensive.

Of course, costs are not the only issue. If you have chronic health problems or expect to need specific medical procedures, it might make sense to do an even more thorough review to see which plans specialize in the type of medicine you're likely to need, Gada said.

Those who want individual help choosing a plan can use Allsup's Medicare Advisor service. But unlike the websites, it's not free. The Belleville, Ill., company offers a tiered fee structure that ranges from $75 for those just needing help choosing a prescription drug plan to $350 for those needing help throughout the selection process.

Whether you shop online or shop with a paid advisor, the wise thing is to at least shop, experts said.

"Not doing anything is a choice, and it might not be the best choice," Gada said.

business@latimes.com

http://www.latimes.com/la-fi-perfin-201 ... 554.column

Meanshile, Medicare dollars are being shoveled to illegals in the form of Medicaid. This is disgusting.

Originally Posted by Newmexican

Meanshile, Medicare dollars are being shoveled to illegals in the form of Medicaid. This is disgusting.

Medicade does cost the taxpayers a great deal of money but it doesn't come from Medicare.
It comes from the Federal and State's General Funds.

Unlike Medicare, which is solely a federal program, Medicaid is a joint federal-state program. Each state operates its own Medicaid system, but this system must conform to federal guidelines in order for the state to receive matching funds and grants. The matching rate provided to states is determined using a federal matching formula (called Federal Medical Assistance Percentages), which generates payment rates that vary from state to state, depending on each state's respective per capita income.[16] The wealthiest states only receive a federal match of 50% while poorer states receive a larger match.

Medicaid funding has become a major budgetary issue for many states over the last few years, with states, on average, spending 16.8% of state general funds on the program. If the federal match expenditure is also counted, the program, on average, takes up 22% of each state's budget.[17][18] According to CMS, the Medicaid program provided health care services to more than 46.0 million people in 2001.[19][20] In 2002, Medicaid enrollees numbered 39.9 million Americans, the largest group being children (18.4 million or 46 percent)[citation needed]. Some 43 million Americans were enrolled in 2004 (19.7 million of them children) at a total cost of $295 billion. In 2008, Medicaid provided health coverage and services to approximately 49 million low-income children, pregnant women, elderly persons, and disabled individuals. Federal Medicaid outlays were estimated to be $204 billion in 2008.[21] . . .

http://en.wikipedia.org/wiki/Medicaid

JohnDoe2: I think the other poster was referring to the 1/2 trillion cut to Medicare and the increase in persons on Medicaid under Obamacare. In many states illegals are enrolled in that state's Medicaid program. It's easy and quite logical to assume that the 1/2 trillion is going from Medicare to Medicaid for illegals.

Originally Posted by ReggieMay

JohnDoe2: I think the other poster was referring to the 1/2 trillion cut to Medicare and the increase in persons on Medicaid under Obamacare. In many states illegals are enrolled in that state's Medicaid program. It's easy and quite logical to assume that the 1/2 trillion is going from Medicare to Medicaid for illegals.

Its disgusting how they give OUR tax $$$ to these CRUMBS.

This is the Medicare requirement, no the Medicaid which is mandatred by the Federal Government and paid by the states.

Medicare. Section 1011.

Section 1011, Federal Reimbursement of Emergency Health Services Furnished to Undocumented Aliens, provides $250 million per year for fiscal years (FY) 2005-2008 for payments to eligible providers for emergency health services provided to undocumented aliens and other specified aliens. Two-thirds of the funds will be divided among all 50 states and the District of Columbia based on their relative percentages of undocumented aliens. One-third will be divided among the six states with the largest number of undocumented alien apprehensions.

From the respective state allotments, payments will be made directly to hospitals, certain physicians, and ambulance providers for some or all of the costs of providing emergency health care required under Section 1867 and related hospital inpatient, outpatient and ambulance services to eligible individuals. Eligible providers may include an Indian Health Service facility whether operated by the Indian Health Service or by an Indian tribe or tribal organization. A Medicare critical access hospital (CAH) is also a hospital under the statutory definition. Payments under Section 1011 may only be made to the extent that care was not otherwise reimbursed (through insurance or otherwise) for such services during that fiscal year.

Payments may be made for services furnished to certain individuals described in the statute as: 1) undocumented aliens; 2) aliens who have been paroled into the United States at a United States port of entry for the purpose of receiving eligible services; and 3) Mexican citizens permitted to enter the United States for not more than 72 hours under the authority of a biometric machine readable border crossing identification card (also referred to as a "laser visa") issued in accordance with the requirements of regulations prescribed under a specific section of the Immigration and Nationality Act.
https://www.cms.gov/UndocAliens/

https://www.cms.gov/UndocAliens/04_stat ... #TopOfPage

There is story after story of illegals receiving hundreds of thousands of dollars for medical treatments. The twins that were joined at the head and separated in California a few years ago are an example. Their parents were conviniently on a "visit" from Mexico when the mother went into labor - Who do you think paid all of thise medical bills? The taxpayers.

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