Colorado Medicare Classroom

Go to www.medicare.gov.  In the upper middle of the page, under the heading “Finding Plans”, click on Compare Drug and Health Plans.  On the next page, you will need to put in your zip code, then click on Find Plans.

That will take you to Step 1 of 4: Enter Information.

Under “How do you get your Medicare Coverage?” click on the appropriate box.  For most people, that is “Original Medicare.”  Under “Do you get help from Medicare or you state to pay your Medicare Prescription Drug Costs?” you will probably click on the next to last box (“I don’t get any Extra Help”).

Step 2 of 4: Enter Your Drugs

Under the heading Name of Drug:  you will then begin typing the names of your prescriptions.  As you are typing a list should appear with possible matches.  If you don’t see the list, then you should double check the spelling.  Once you have a match, then a tab will come up that requires you to enter your dosage and quantities.

After you have entered your first drug, you may then enter the rest.  However, after entering your first prescription, on the right side of the page, you will see a Drug List ID.  It is a good idea to write this number down, as well as the date and zip code.  If you have to come back at a later time, you will not have to repopulate your drug list.

Once you have entered all of your drugs, click on My Drug List is Complete, at the bottom of the page.

Step 3 of 4:  Select Your Pharmacies

You may select as many as you wish, or just Continue to Plan Results.

Step 4 of 4:  Refine Your Plan Results

Under the Summary of Your Search Results, if you are just searching for a Prescription Drug Plan, click on the first box.

Then Continue to Plan Results.

You are almost done.

On this page, you will see Your Plan Results.

Scroll down to Prescription Drug Plans.

These plans are listed in order of which one will give you the least out of pocket expense, including premiums, deductibles and co-pays.

If you click on one of the plans, it will bring up Your Plan Details.  This is a really good page that breaks down the plans costs throughout the year.   If you feel this is the plan for you, you can immediately enroll on line or call the 800 number listed.

Now that wasn’t so hard, was it?

Remember, this is a projection based on the drugs you are currently using.  If you add a prescription or eliminate one, then your picture can and will change.  That is why you should go through this process every year.  Even if your prescriptions don’t change, there are new plans and changes to existing ones every year.

If you have gone through this process and still need assistance (or just don’t feel like doing it on your own), feel free to call me (or email me a list of your prescriptions), and I will do it for you.  I don’t plan to have too many appointments this week, so I can take care of last minute questions.

My cell phone number is 303-489-3732, and my email is: george@coloradomedicareclassroom.com

George Yardley Over 65

(Reuters) – The Congressional Super Committee negotiations are coming down to the wire, and Republicans are demanding that Medicare privatization be included in any final budget deal.

The news comes on the heels of GOP Presidential candidate Mitt Romney’s recent call for creation of a “premium support” option that would let seniors choose between traditional fee-for-service Medicare or a defined amount of money that they could use to shop for a private plan in a federally-sponsored Medicare exchange marketplace. Romney’s proposal is a cousin of the privatization plan proposed by Rep. Paul Ryan, and endorsed by the House of Representatives earlier this year.

Even if the Super Committee process stalls, the future of Medicare will be a key issue in the 2012 Presidential race, and any restructuring of the program would impact billions of dollars of healthcare spending and tens of millions of beneficiaries. How would privatization impact seniors? How would benefits change, and what would it mean for seniors’ cost of healthcare? Here are answers to five key issues.

1. What are Medicare premium supports and vouchers, and how would they change the current Medicare program?

Proposals for Medicare premium supports and vouchers all have one thing in common: They would transform Medicare from a program of defined benefits to one of defined contribution. Much like the transition from defined benefit pensions to defined contribution 401(k) plans, the change would shift risk from an institution (the federal government) to individuals (seniors). Medicare today promises to deliver a specific set of benefits to seniors; premium supports and vouchers would provide a defined government contribution toward whatever healthcare cost they incur in the private market.

But there’s a significant difference between premium supports and vouchers. Vouchers could be set purely on the basis of meeting federal budget-cutting goals. Premium supports usually take into account some measure of the cost of purchasing private coverage.

Romney hasn’t released details on his Medicare proposal, but it appears to most closely resemble the proposal of the Bipartisan Policy Center’s Debt Reduction Task Force, which was chaired by Alice Rivlin, the Clinton Administration’s budget director, and former Republican Sen. Pete Domenici.

The Rivlin-Domenici plan would limit the government’s per-beneficiary financial contribution to a formula tied to Gross Domestic Product plus a percentage point. In this sense, Rivlin-Domenici really is more a voucher than a premium support.

2. Would privatization cut healthcare costs and shrink the budget deficit?

Vouchers would reduce federal Medicare spending by capping benefit payments. But the assertion that privatization can reduce overall healthcare costs is ideological; the argument here is that unleashing competitive marketplace forces will lead to innovation and cost savings.

Yet traditional Medicare has a much stronger record of controlling costs than the private insurance market. As the largest U.S. purchaser and regulator of healthcare, Medicare has purchasing clout far beyond what any single private insurance plan could exert.

An analysis of federal data by the Center on Budget and Policy Priorities (CBPP) found that between 1970 and 2009, Medicare spending per enrollee grew by an average of 1 percentage point less than private health insurance premiums, or one-third less during that period.

Private Medicare Advantage plans have been gaining marketshare, but they don’t reduce federal health spending. In fact, Advantage plans currently are reimbursed by the federal government at 114 percent of traditional Medicare rates — a payment scheme that was put in place to encourage private insurers to participate in the market and to help them compete with traditional Medicare. (The Obama Administration’s health reform law freezes those payments Advantage calls for gradually reducing those payments over a period of years, ultimately equalizing reimbursements with traditional Medicare.) Medicare Advantage plans also have benefited by marketing to healthier seniors who are less costly to serve.

“Premium support is just another approach to privatizing Medicare and moving away from the traditional fee-for-service plan,” says Edwin Park, vice president for health policy at CBPP. “A lot of the arguments about lower cost and efficiency in private plans just don’t hold up.”

3. Would seniors have to pay more out of pocket?

Yes. The Congressional Budget Office (CBO) estimates that under the House-endorsed Ryan plan, the total cost of providing benefits to a typical 65-year-old in 2022 would be $20,500. The government would contribute $8,000 of that amount, with beneficiaries paying the remaining $12,500 — more than twice what they would pay under traditional Medicare ($5,630).

The Rivlin-Domenici proposal hasn’t been scored by CBO, but if its voucher didn’t keep pace with rising healthcare costs, beneficiaries who want to stay in traditional Medicare would have to cover the difference.

The alternative would be to enroll in a private plan with lower premiums. But those plans might be allowed to keep costs down by offering less generous benefits, restricting provider networks or requiring higher cost-sharing via co-pays or higher deductibles. Much would depend on the specifics of how new rules and regulations would be drafted that govern the private plans.

4. How are these proposals different from the current Medicare Advantage program?

Medicare Advantage lets seniors opt for an all-in-one private plan that covers hospitalization, doctors’ visits, drugs and other benefits. But the private plans must commit to provide services at least equal to those provided under traditional Medicare. Many of the new privatization plans would permit variation in benefits and premiums.

5. Wouldn’t these Medicare exchanges resemble the exchanges being created under Obama’s healthcare reform?

While there are some similarities, the exchanges under the Affordable Care Act (ACA) would provide support designed to keep up with health insurance inflation. Also, the ACA exchanges are designed to cover millions of uninsured Americans, while proposals like Rep. Ryan’s actually eliminate traditional Medicare over time, and force seniors to enroll in private plans.

—

The author is a Reuters columnist. The opinions expressed are his own.

George Yardley Over 65

From the U. S. House Democratic Staff: September 23rd is the first anniversary of the Patient’s Bill of Rights in the Affordable Care Act.  The protections of the Patient’s Bill of Rights became effective for all plan years beginning on or after September 23, 2010. The first anniversary of the Patient’s Bill of Rights is an opportunity to highlight all of the ways that the Affordable Care Act is improving coverage and lowering costs for individuals and their families. THE AFFORDABLE CARE ACT IS ALREADY PROVIDING LOWER COSTS & BETTER HEALTH COVERAGE FOR YOU!

• You can no longer be arbitrarily dropped from coverage by your insurance company simply because you get sick – protecting the 165 million Americans with private health insurance.
• Your insurance company can no longer place a lifetime limit on your coverage – protecting the 165 million privately-insured Americans.
• Your insurance company can no longer place low annual limits on your coverage – also protecting the 165 million privately-insured Americans.
• If you are under 65 and in a new plan, you are now receiving free key preventive health services – benefiting up to 88 million Americans by 2013.
• Your insurance company must now spend at least 80 percent of your premium covering medical services – rather than CEO pay, profits, and administrative costs. 165 million privately-insured Americans are now receiving the benefits of protecting the value of their premium dollar as a result.
• Your insurance company must now publish on the Internet justifications for any premium increases they are seeking that are more than 10 percent and outside experts will publicly evaluate whether the increases are justified – protecting the 165 million privately-insured Americans.

IF YOU ARE A SENIOR

• You are now receiving a 50 percent discount on brand-name drugs when you are in the Medicare Part D ‘donut hole’ coverage gap. Nearly 1.3 million seniors have already received the discount.
• You are now receiving free key preventive health services, such as mammograms and colonoscopies, under Medicare. Nearly 19 million seniors have already received one or more free preventive services.
• You are now receiving a free Annual Wellness Visit under Medicare. 1.3 million seniors have already taken advantage of the new free Annual Wellness Visit.

IF YOU ARE A YOUNG ADULT

• You can now stay on your parents’ health plan until your 26th birthday, if you do not have coverage of your own. Because of this provision, 1 million additional young people have gained insurance over the last year.

IF YOU HAVE A CHILD

• If you have a child under age 19, they can no longer be denied coverage by an insurance company for having a “pre-existing condition.” Up to 17 million children with pre-existing conditions are now protected from discrimination.

IF YOU OWN A SMALL BUSINESSES

• If you are among 4 million eligible small businesses, you can receive tax credits if you choose to offer coverage to your employees – covering 35 percent of the cost of coverage.

IN 2014, YOU ALSO GAIN ADDITIONAL PROTECTIONS

• For all adults and children, you can no longer be denied coverage by an insurance company for having a “pre-existing condition.”
• If you are a woman, you can no longer be charged a higher premium simply on the basis of gender.
• Your insurance company can only vary premiums based on age by a maximum of a 3-to-1 ratio.
• You are protected by a cap on your out-of-pocket costs in your private health plan.

George Yardley Over 65

Social Security’s annual cost of living adjustment (COLA) seems assured of rising in 2012 by a few percent—its first increase in three years. Whether that gain winds up putting many dollars in beneficiaries’ pockets is another matter.

[See 10 Ways to Boost Your Social Security Checks.]

There are complex links between annual changes in Social Security and Medicare insurance premiums. Depending on your annual income and when you began Medicare, much or all of your COLA gains could be eaten up by higher Medicare premiums.

The Social Security COLA is based on a version of the U.S. Consumer Price Index tailored for people who work. It’s called the CPI for Urban Wage Earners and Clerical Workers, or the CPI-W. Every year, Social Security looks at the CPI-W average during the third quarter of the year, compares it with the average during the previous year’s third quarter, and designates any percentage increase as the following year’s COLA.

Following a big surge in oil prices in the summer of 2008, the CPI-W spiked and led to a big 5.8 percent COLA increase for 2009—the program’s largest in 25 years. Oil prices later declined and so did overall inflation. In both 2009 and 2010, the third-quarter average for the CPI-W was less than it was during 2008’s third quarter. As retirees know all too well, this meant no COLA in 2010 or 2011.

[See Zero Social Security COLA Again for 2011.]

Since last summer, however, energy and other prices have risen. At the end of July, the CPI-W was 4.1 percent higher than in July 2010, and the index stood at 222.686. This is 3.3 percent higher than the CPI-W average of 215.495 during the third quarter of 2008.

Prices for crude oil have plunged in recent weeks, so it’s possible that the CPI-W would dip during the next two months. However, food prices have been rising, and prices for imported goods are up 14 percent from a year ago, due primarily to the diminished purchasing power of a weaker U.S. dollar.

If the COLA does rise by a few percent, it would also trigger the first increase in three years for Part B Medicare premiums. Parts A and B, commonly known as traditional Medicare, cover hospitals plus physician and outpatient expenses. There is no premium for Part A coverage. The government backs Part B premiums directly out of a beneficiary’s Social Security payment.

There is a “hold harmless” clause that prohibits Social Security payments from declining from one year to the next. So, the absence of a COLA in 2009 and 2010 meant that there could be no increase in Part B premiums for existing beneficiaries. This premium has thus been frozen at $96.40 a month for about 75 percent of beneficiaries.

Another provision of the law requires Part B premiums to finance 25 percent of the costs of providing covered services. With premiums frozen for most beneficiaries but healthcare costs still rising, Medicare had to look to the new and higher-income beneficiaries to pay bigger premiums to maintain that 25 percent finance level.

[See Medicare Drug Premiums Won't Rise in 2012.]

New enrollees in 2011, for example, pay a monthly Part B premium of $115.40 if they earned less than $85,000 a year ($170,000 for couples). Rates for higher-income earners rise substantially, and the wealthiest beneficiaries pay premiums approaching 80 percent of their costs, not 25 percent.

“In most years, a significant portion of the cost-of-living increases received by most Social Security beneficiaries” is used to pay for higher Medicare premiums, Rudolph G. Penner wrote in a recent study for the Urban Institute. Social Security benefits thus are “not keeping up with inflation, and for those retired a long time, the real value of the net benefit can erode significantly.”

Looking ahead, Penner said in the study, “the rapid growth in healthcare costs is leaving the entire population with relatively less to spend on non-health goods and services, and the elderly are affected the most because so much more of their income goes to healthcare.”

One of the impacts of raising Part B premiums would be to make it more attractive for beneficiaries to seek coverage through a Medicare Advantage (MA) policy. MA policies compete with traditional Medicare. Dan Mendelson, head of Avalere Health, a Washington, D.C.-based healthcare consultancy, says he projects MA premium increases in 2012 to be modest. Open enrollment for 2012 plans begins October 15 and extends until December 7. Details on any changes to the 2012 COLA and increases in Part B premiums are expected to be announced later in October.

Mendelson says he expects lots of insurance-plan changes next year, particularly involving the use of preferred pharmacy providers. By requiring policyholders to use a certain pharmacy, he explained, an insurer can drive lower costs at that pharmacy. “Consumers are going to have to be thinking about their out of pocket liability” when they shop for 2012 coverage, he said, “and also the fact that there will be more innovative products in the marketplace.”

Twitter: @PhilMoeller

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retirement

George Yardley Over 65

Retired Americans have many choices to make when shopping for Medicare insurance, but many of them may not be making the right decisions. Seniors may easily become overwhelmed by the myriad of choices presented to them when attempting to compare plan choices and evaluate what is best for their individual situation. Many people may be easily tantalized by the low to no-cost plans known as Medicare Advantage.

According to the Medicare Rights Center (MRC), a non-profit consumer advocacy group, Medicare Advantage plans have major deficiencies when compared to original Medicare coupled with Medicare Supplement insurance, also known as Medigap. The MRC cites that costs for skilled nursing care, home health care and for hospitalizations run much higher in Medicare Advantage plans than they would with traditional Medicare coverage with supplemental insurance benefits provided by a private Medigap plan. In addition, The MRC reported that Medicare Advantage plans lack stable protection because many of these plans can abruptly stop coverage and restrict the use of physicians, hospitals and other providers and may make it difficult to obtain emergency or urgent care.

According to Lucas Burton a partner with Largo, Florida based, Golden Age Providers; there isn’t a day that goes by that we don’t receive a phone call from someone asking us to help get them out of a Medicare Advantage plan. The problem stated Burton; these folks don’t realize that they can’t just leave these Medicare Advantage plans because they aren’t happy with them. They may very well have to wait until the Medicare Annual Election period in the fall of each year to leave their MA plan and rejoin original Medicare. There are exceptions to this rule by which a senior may be granted a Special Election Period, but these are very rare stated Burton.

Experts across the country agree that the only way for a retiree to main control of their healthcare would be to stay in the original Medicare program and to purchase a Medicare Supplement policy from a private insurance carrier. Medicare Supplement plans, also known as “Medigap” have been standardized since the early 1990’s and are easily compared since all similarly lettered plans provide identical coverage. Medicare Supplement plans allow seniors to choose any hospital or physician and don’t require pre-approval.

Just like everything else, there is no “free lunch” and seniors need to realize that little to no premium now, might be a bad thing later.

George Yardley Over 65