Thread: Medical groups balk at Medicare 'buy-in'

Medical groups balk at Medicare 'buy-in'

Updated 19m ago
By John Fritze, USA TODAY

WASHINGTON — Hospital and doctor groups that have generally supported the effort to revamp the nation's health care system pushed back Wednesday against a new idea proposed by Democratic leaders to let younger Americans buy into Medicare.

The proposal, which would allow people 55 to 64 to enroll in the seniors health program, has emerged as a central part of an agreement struck between centrist and liberal Democrats sparring over the creation of a government-run insurance program.

Though the idea gained traction on Capitol Hill — and got a boost from President Obama — the outcry from the medical groups underscored the difficulty lawmakers are facing as they look for compromises that can win broad support for the Senate's bill, which would cost $848 billion in the first 10 years.

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"Bringing more people into a system that doesn't work very well is not a good answer," said Jeffrey Korsmo, executive director of the Mayo Clinic Health Policy Center. "The current Medicare program is not sustainable."

The Medicare proposal is one of several ideas included in a tentative agreement reached by a group of 10 Democrats — five centrists and five liberals — seeking alternatives to the government-run insurance program, or "public option."

Though he has in the past supported the public option as a way to drive down health insurance costs by increasing competition, Obama said Wednesday that he supports the new Senate framework. The president predicted it "will help pave the way for final passage of legislation."

Still, some Democrats whose support will be needed to pass the bill said they are reserving judgment until they can review a pending cost analysis from the Congressional Budget Office. Sen. Blanche Lincoln, D-Ark., said there was only "consensus that we needed more information in order to move forward."

The Senate is racing to approve the health care legislation by Christmas. Senate Majority Leader Harry Reid of Nevada needs to corral 60 votes, and he has focused mainly on Democrats because no Republicans have expressed support for the bill.

Nebraska Sen. Ben Nelson, who has been among the most vocal Democratic critics of the public option and who met privately with Reid on Wednesday, said he isn't leaning for or against the deal. "I just want to know what the costs are," he said.

Created in 1965, Medicare had 45 million beneficiaries in 2008, according to the Kaiser Family Foundation, but rising health care costs have threatened the program's viability. According to the 2009 annual report by its trustees, the program is on track to run out of money in 2017.

Many details have not been announced, but the American Hospital Association and the American Medical Association, pounced on a proposal to expand the seniors program because doctors receive less from Medicare than from private insurance for the same procedures.

"If more people move into Medicare we'd … bear the financial brunt of this," said Rich Umbdenstock, president and CEO of the hospital trade group.

The hospital group has not endorsed the legislation, crafted by Reid, but it has backed the broader effort. In July, it agreed to forgo $155 billion in government reimbursements over 10 years to help pay for other changes to the health care system.

Sen. Mary Landrieu, D-La., who along with Lincoln was among the 10 senators negotiating a compromise, said it would be a "very good idea" to allow people between 55 and 64 to buy into the Medicare program, but she said key provisions of how the program would work for the new enrollees are not yet clear.

For instance, Landrieu would like the buy-in to be available immediately but said the start date would ultimately depend on projected costs. Lawmakers are also negotiating whether the government would initially subsidize the younger Medicare enrollees.

If not subsidized, Medicare can be costly. Americans who are over 65 but don't qualify for the program for other reasons pay a $461 monthly premium to buy into the portion of the program that covers hospitals stays, said Vicki Gottlich, a policy attorney with the non-partisan Center for Medicare Advocacy. The group has supported the buy-in concept but is waiting to see details of the proposal, she said.

http://www.usatoday.com/news/washington ... y-in_N.htm

Americans who are over 65 but don't qualify for the program for other reasons pay a $461 monthly premium to buy into the portion of the program that covers hospitals stays, said Vicki Gottlich, a policy attorney with the non-partisan Center for Medicare Advocacy.

Does anyone know who these Americans are and why they don't qualify for Medicare?

Originally Posted by JohnDoe2

Americans who are over 65 but don't qualify for the program for other reasons pay a $461 monthly premium to buy into the portion of the program that covers hospitals stays, said Vicki Gottlich, a policy attorney with the non-partisan Center for Medicare Advocacy.

Does anyone know who these Americans are and why they don't qualify for Medicare?

I was under the impression that everyone qualified when they turn 65 regardless of assets or income. Even legal immigrants, to the best of my knowledge. I have to assume that only illegals dont qualify. But I am not sure about that. But it is an elderly entitlement, so I do think everyone qualifies at a certain age. They do have to be able to provide id though. And they have to have an SS number to get it.

Overview

The Centers for Medicare & Medicaid Services (CMS) administers Medicare, the nation's largest health insurance program, which covers nearly 40 million Americans. Medicare is a Health Insurance Program for people age 65 or older, some disabled people under age 65, and people of all ages with End-Stage Renal Disease (permanent kidney failure treated with dialysis or a transplant).

Welcome to the Medicare Eligibility Tool

This section of the site is designed to provide you with information about your Medicare eligibility and enrollment. You will be asked to answer a series of questions. The number of questions, as well as the questions themselves will be dynamic based on your answers. Once we have collected enough information, we will display detailed information tailored to your specific situation. Please note that Social Security will make the final decision on your eligibility and enrollment status.

If you are not a U.S. citizen or a lawfully admitted alien who has lived in the U.S. continuously for a five-year period, please contact Social Security at 1-800-772-1213 for your Medicare enrollment and eligibility.

NOTE: This tool is entirely confidential. We will not save or share the information you provide with anyone for any purpose.

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Page Last Updated: August 5, 2009

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Medicare Eligibility

Medicare is an important health insurance program run by the federal government that provides for both hospital care (Medicare Part A), medical care (Medicare Part B) and starting in 2006 Medicare Part D - prescription insurance. In this article, we are going to discuss Medicare eligibility rules and some of the more common terminology you'll find in the Medicare program.

Medicare Eligibility Rules

In general, U.S. citizens or permanent residents are eligible for Medicare benefits if they have worked for at least ten years in a job that has paid money into the Medicare system. That's pretty easy to figure out just by looking at your paycheck. Most companies show Medicare tax as a separate line item or they combine it with Social Security taxes.

Additional Resources
•Social Security Disability Insurance
•Social Security Debit Card
•Medicare Eligibility
•Medicare Part A
•Medicare Part B
•Medicare Prescription Drug Program

This eligibility rule also applies to your spouse, meaning that if either you or your spouse worked for ten or more years and paid money into the Medicare system, then you are both covered. You must also be 65 years or older to receive Medicare unless you have been diagnosed with permanent disability or permanent kidney failure that requires dialysis or a kidney transplant.

So to summarize, there are really only two conditions you need to meet to qualify for Medicare benefits:

1.You must have paid money (taxes) into the Medicare system for at least ten years.
2.You must be age 65 or older, unless you have a disability or permanent kidney failure.

Medicare Part A Eligibility

Medicare Part A is the terminology used for hospital insurance. This insurance helps to pay for hospital care, skilled nursing facilities, home health care and hospice care. Most people are eligible to receive Medicare Part A at age 65, and will receive this benefit without having to pay any monthly premiums.

The Medicare eligibility guidelines for Part A (hospital insurance) for individuals age 65 and older include:

•You are receiving Social Security or retirement benefits from the Railroad Retirement Board.
•You are eligible to receive Social Security or retirement benefits from the Railroad Retirement Board, but have not yet applied for these benefits.
•You or your spouse worked for the government in a Medicare covered job.
The eligibility guidelines for individuals under age 65 include:

•You are receiving Social Security or benefits from the Railroad Retirement Board due to a disability for 24 months or more.
•You are going for dialysis treatments or need a kidney transplant.
Medicare Part B Eligibility
If you pass the eligibility rules for Medicare Part A, then you are also eligible for Medicare Part B (medical insurance). This coverage under the Medicare program is for doctor services, outpatient care, and some of the other medical services that are not covered under Part A.

Unlike Medicare Part A (hospital care), Medicare Part B coverage requires payment of a monthly insurance premium. In 2007, the monthly premiums for Medicare Part B (medical insurance) were $93.50 and in 2008 they rise to $96.40. Premiums stayed at the level in 2009. In 2010, they were once-again announced at $96.40. If you did not choose Part B insurance when you first became eligible, then the cost of this insurance may be higher.

As a rule, the cost of Medicare Part B can go up 10% for each year that you could have enrolled in Part B, but chose not to enroll. The 10% increase to the monthly premium is paid as long as you are enrolled in Medicare Part B - which may be for life.

Medicare Part D Eligibility
Everyone that qualifies for Medicare benefits are also eligible for Medicare Part D, which is a plan that provides for prescription drug coverage. The intention of this program is to protect individuals from today's high cost of prescription drugs as well as future costs.

Medicare Part D is provided by private insurance companies. Beneficiaries will need to choose / enroll in a drug plan and pay a monthly premium to the insurance provider they select. And like other insurance, if a participant decides to delay enrollment in a drug plan when they first become eligible, they may wind up paying more for coverage later on.

Alternatives to Medicare
Keep in mind that you do have options beyond Medicare Part A and Part B coverage. We've talked about these options in our article - Medicare Supplemental Insurance. For more information on Medicare enrollment, eligibility and monthly premiums, you can also visit the Medicare website.

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If you are not a U.S. citizen or a lawfully admitted alien who has lived in the U.S. continuously for a five-year period, please contact Social Security at 1-800-772-1213 for your Medicare enrollment and eligibility.

This part really bothers me.

I did not know there were any jobs that did not take out money for Medicare. I dont know what jobs those would be, unless they are under the table jobs. From what I can see from this posting, it would only be those that did not work for 10 years in this country that would not qualify. OK....who has not worked 10 years? Or who has not worked 10 years and had taxes taken out of their check? You would have had to work under the table for most of your life, or not been in the country very long. Or both.

Originally Posted by JohnDoe2

If you are not a U.S. citizen or a lawfully admitted alien who has lived in the U.S. continuously for a five-year period, please contact Social Security at 1-800-772-1213 for your Medicare enrollment and eligibility.

This part really bothers me.

What I get from that quote is this: Immigrants, INCLUDING ILLEGALS, are favored above citizens. If an American citizen, for some reason, does not have 10 years under their belt...THEY DO NOT QUALIFY. But if you are illegal and do not have 10 years under your belt, YOU QUALIFY.

SO THIS IS WHERE WE ARE FOLKS. ILLEGALS QUALIFY FOR ELDERLY ENTITLEMENTS THAT CITIZENS DO NOT QUALIFY FOR. AND THIS IS PAID FOR BY THE AMERICAN TAXPAYER.

If you are not a U.S. citizen or a lawfully admitted alien who has lived in the U.S. continuously for a five-year period, please contact Social Security at 1-800-772-1213 for your Medicare enrollment and eligibility.

All other info is in print right out in the open but this info is only available on the phone.
What are they afraid for us to see?

The Medicare Part B Cost of Living Adjustment is designed to change every year with the expected change in healthcare and consumer prices.
The doctor services you get while you are in a hospital may be filed under Part B.
Some issues that are left in Medicare part A can be covered in Part B

http://medicarenewsline.com/