Obamacare by Decree

Obamacare. A word that is 100% guaranteed to be polarizing in almost any discussion about heatlh care. In the 2 years since a 2700 page law dubbed Obamacare has come in to being, the HHS Department and specificalyl the Secretary have issued some 12,000 pages of regulations and edicts, all in the name of making health care, and health insurance, more accessible and affordable.

So far, we have yet to see either.

That hasn’t stopped them from pressing forward, alienating large segments of the public, turning health care providers (and the Supreme Court) in to adversary’s and generally making a mess of things, all due to Obamacare provisions.

But wait, there’s more!

Some 85,000 or so physicians will play a crucial role in Obamacare, including the 16+ million new enrollee’s in Medicaid. So how will this impact the doctors?

The Hudson Institute has some insight in to the future of Obamacare from a physician’s perspective.

This $800+ billion (a low estimate in our view) will be funded by new taxes on everyone who uses health care (including the poor and middle class) as well as significant reductions in Medicare funding plus increased cost shifting for out of pocket expenses to seniors and the disabled on Medicare. This is part of Obamacare that no one wants to discuss.

Beyond the complexity of Obamacare (which no one admittedly read before voting on it) the one individual given almost total control over health care rests with a non-elected official that holds the title of HHS Secretary. Given virtual czarist powers, we have already seen the way the current Secretary has bludgeoned her way through almost every aspect of the health care system with complete disregard for the outcome.

The most recent public battle, which is still being waged in the form of a lawsuit due to Obamacare and HHS directives, involves the issue of mandated “free” contraceptive devices for everyone, including those who oppose such on the basis of religious views.

How did the HHS Secretary gain such control?

HHS Mentioned 3,000 Times in 2700 Pages of Obamacare

References to the HHS Secretary appear over 3,000 times in the 2700 page Obamacare legislation.

Former HHS Secretary Leavitt said “It puts more power than is prudent in the hands of one person, and it is not an answer to our current health care crisis”.

Also from the Hudson report comes this tidbit about Obamacare.

Incredibly, the bill’s powers are not limited to the broad macroeconomic issues described above. They also regulate a wide range of medical areas in minute detail, extending their reach even to one of the most personal arenas: the dentist’s chair. Section 4102 of the ACA, for example, states: “The secretary shall develop oral healthcare components that shall include tooth-level surveillance.” As Secretary Leavitt describes it, the mandate for tooth-level surveillance would  require “a clinical examination in which an examiner looks at each dental surface, on each tooth in the mouth.”

In the real world we call this micro-managing.

In DC world of Obamacare, this is just business as usual.

Doctors Believe Obamacare is Negative for Patients

A recent survey indicated that 60% of physicians surveyed said Obamacare would have a NEGATIVE impact on patient health care . . . and these are the folks on the front line of health care delivery. Another survey of new physicians found 57% were pessimistic about the future of health care and 34% feel that way specifically because of Obamacare.

And then there is the concern about the economic impact of Obamacare.

From the economic perspective, doctors’ top concern raised by the Obama health care law is in the area of reimbursement rates. The reimbursement question usually centers on the Sustainable Growth Rate (SGR). The proposed cut in reimbursements would hit doctors hard, imposing initial cuts of over twenty percent

I wonder how many in the general population would be willing to take a 20% pay cut in order to advance the noble cause of “health care for everyone”?

While the Obama health law will cover an additional 32 million Americans, 16 million of those newly covered Americans will get their coverage through Medicaid, according to the

Congressional Budget Office. Doctors are well aware that Medicaid reimbursement rates are lower than those they get from privately insured patients. In fact, according to Moffitt,

“physicians in Medicaid are paid 56 percent of private payment.” This reduced reimbursement rate is the reason that Medicaid patients often have difficulty finding a doctor. Imposing these lower reimbursement rates on a growing number of patients will likely have the impact of exacerbating access issues in the future

And even this fails to take in to account funding at the state level for Medicaid expansion.

Where will the money come from?

Funding Obamacare

How high will taxes have to go at the state level and how many services will be cut back to fund Medicaid expansion under Obamacare? At what point will we, as a society have to say, enough is enough. It is time for the poor to bear the cost of their own care rather than relying on the taxpayer to provide their every need from womb to tomb.

The proverb that says “Give a man a fish and he can eat for a day, but teach a man to fish and he can eat for a lifetime” needs to be considered in this regard.

Beyond economic issues, physicians worry that the new law will interfere with their practice of medicine, and in a variety of ways. To begin with, there is a generalized concern about decision making being taken from doctors and having medical decisions made instead by government officials. Doctors worry about the imposition of “uniformity of practice,” the establishment of strict guidelines that fail to permit individual doctors to make decisions based on their in-person interactions with patients. As Dr. Saul Greenfield writes in the Wall Street Journal, “every physician must, at some point in the patient-care process, make decisions and take responsibility for them. And unless the doctor does so, the outcomes will be compromised.”

Does the government REALLY know what is best? Mayor Bloomberg wants to tell New Yorker’s what size sugary drink they can and cannot consume within the confines of “his” city.

Isn’t all this going a bit too far? And where will it end?

If doctors cannot practice as they wish, it raises the question of whether they will practice. As Dr. Mark Siegel has noted, because of the anticipated changes in health care, “To stay in business under ObamaCare, doctors will have to adjust. Some will see fewer patients themselves and hire nurse practitioners to help carry the load; others will work part-time and supplement their income elsewhere. Many will join groups or become salaried employees of hospitals or clinics.”

Will Obamacare be the primary cause of killing the goose that laid the golden eggs? Was the real goal of Obamacare to make health care, and health insurance, more affordable or was it more a legislative Mt. Rushmore designed to feed an ego?

The further Obamacare goes, the more one has to wonder if this is really what we, as a country, need or want. And in particular, how much control will those who hold the office of HHS Secretary in the future want, and what kind of whims and ego-driven, power hungry schemes await us?

In addition to the cost of Obamacare, which may single-handedly bankrupt the country, there is the issue of will there be enough medical personnel to service the needs of 30+ million newly insured people coming on board in 2014?

Obamacare is the iceberg and the United States is the Titanic, speeding right toward a disaster.

 

Medicare Secrets They Don’t Want You to Know

Medicare will pay for a kidney transplant then expects you to die in 3 years. Bet you didn’t know that. According to the WSJ Health Blog, Medicare could save lives and money by making beneficial changes to the way they approve treatment but they choose not to.

Medicare’s three-year limit on payment for anti-organ-rejection drugs led to a woman needing a second kidney transplant, because she couldn’t afford to the medicine that would have allowed her to keep her first transplanted kidney in healthy, working condition. The cost of anti-rejection drugs for the patient? $1,000 to $3,000 a month. Cost of the second transplant? $125,000. The average Medicare expenditure per kidney transplant patient care is $17,000 yearly, while it’s $71,000 a year for dialysis patients and $106,000 for a transplant, according to the Times.

According to the NY Times, Melissa Whitaker found herself in a Medicare conundrum.

Ms. Whitaker, 31, who describes herself as “kind of a nerd,” has Alport syndrome, a genetic disorder that caused kidney failure and significant hearing loss by the time she was 14. In 1997, after undergoing daily dialysis for five years, she received her first transplant. Most of the cost of the dialysis and the transplant, totaling hundreds of thousands of dollars, was absorbed by the federal Medicare program, which provides broad coverage for those with end-stage renal disease. By late 2003, her transplanted kidney had failed, and she returned to dialysis, covered by the government at $9,300 a month, more than three times the cost of the pills. Then 15 months ago, Medicare paid for her second transplant — total charges, $125,000 — and the 36-month clock began ticking again. “If they had just paid for the pills, I’d still have my kidney,” said Ms. Whitaker

So rather than paying $1000 – $3000 per month for anti-rejection meds beyond the arbitrary 36 month limit, Medicare in their infinite wisdom put her back on dialysis, approved a second transplant, and started her on a new 36 month plan.

The most recent report from the United States Renal Data System found that Medicare spends an average of $17,000 a year on care for kidney transplant recipients, most of it for anti-rejection drugs. That compares with $71,000 a year for dialysis patients and $106,000 for a transplant (including the first year of monitoring).

This reminds me of Jay Leno’s question to Hugh Grant following Hugh’s incident with a transvestite hooker. “What were they thinking?”

Are Scooters Sinking Medicare?

Medicare will spend almost $1 billion on scooters for Medicare beneficiaries but more than half those dollars are wasted on people who don’t need a motorized chair. According to a report by the OIG (Office of Inspector General for Health and Human Services), many who got the scooters didn’t need one over 60% of the time Medicare paid too much.

What about eliminating waste, fraud and abuse?

According to the report, 61% of power wheelchairs purchased by Medicare in 2007 were either unnecessary or lacked sufficient documentation to justify claim . . . yet Medicare approved them any way!

In the first half of 2007 Medicare approved and spent $189 million on power wheelchairs. Of that, $95 million were either not considered medically necessary or lacked sufficient documentation to justify the claim.

A whopping 78% of claims submitted by Medicare DME (durable medical equipment) providers had records that did not match physician records for medical necessity.

In other words, records submitted by DME suppliers indicated the motorized wheelchair was medically necessary but the doctor records did not agree with that assessment.

In most of those cases physician notes had less documentation than what was provided by the medical supplier but in some cases the doctor records contradicted those provided with the Medicare claim.

Medicare covers over 650 types of powered scooters. Medicare requires medical providers to use one of 42 different codes when submitting the claim.

Prior to January of 2011 Medicare beneficiaries were allowed to rent or buy a chair. Almost all chose to buy rather than rent the chair.

Power wheelchairs are referred to as MAE (Mobility Assistive Equipment).

To qualify for MAE (mobility assistive equipment), also known as a scooter, you must meet the following.

Have a health condition where you need help with activities of daily living like bathing, dressing, getting in or out of the bed or chair, moving around, or using the bathroom

Be able to safely operate and get on and off the wheelchair or scooter

Have good vision

Be mentally able to safely use a scooter, or have someone with you who can make sure the device is used correctly and safely

The equipment also must be useful within the physical layout of your home (it must not be too big for your home or blocked by things in its path).

If you qualify for a scooter, it will be paid for under Medicare Part B. Your Medicare supplement insurance plan will pay the contractual balance after Medicare approves the claim and pays their portion.

You can read more in this article about motorized wheelchairs written and published by Georgia Medicare Plans.

Compare Georgia Medicare supplement rates and plans and view instant Medigap quotes.

 

 

Compare Medigap Rates

Compare Medigap rates. Compare your Georgia Medicare supplement insurance plan premiums to the lowest Medigap rates in Georgia. Get the best rates from Blue Cross GA, Gerber, Mutual of Omaha and more. Never pay too much!

Compare Your Medigap Rates

When you pay more you don’t get more, you simply paid too much. In these tough times can you afford to pay more than is necessary for Medicare supplement insurance?

Does the BEST Medigap plan in Georgia really have to cost more?

The answer is no.

All Medicare supplement insurance plans are standardized by the government.

Medigap plan F from Aetna is the exact same plan as plan F from Blue Cross.

Which Carriers Offer Medicare Supplement Plans in Georgia?

Most Georgia Medigap plans are written by Blue Cross followed by AARP (United HealthCare). Other companies that offer Medicare supplement plans in Georgia include Aetna, Humana, Assured Life (Woodmen of the World), Conseco, Forethought, Gerber, Loyal American, Medico, Mutual of Omaha (United of Omaha, United World) New Era, RNA (Royal Neighbors of America).

Sometimes you will also see Medigap plans from Bankers Life and Casualty or Combined Insurance. Agents from these carriers can only tell you about their plans and are required to make in home visits to sell their plans.

An agent that comes in your home has one goal in mind.

They are instructed to get you to buy from them while they are in your home and will sell you something by any means necessary.

You should never feel pressured to buy on the spot from an agent. Plans and rates available today will be there tomorrow. There is no need to rush and pay more than you can afford.

How do you know if you are paying too much for Medigap coverage?

Compare Georgia Medigap rates.  Click to get your GA Medigap quote today and start saving money.

Social Security – Found Money

Social Security Found MoneySocial Security retiree’s “on a fixed income” need all the help they can get to meet all their post-employment expenses. Even more so for those who have suffered through the lingering economic downturn that was created and then mis-managed by the federal government. Even if Social Security is your primary income source, you can still maximize your benefits.

Financial Planner Brett Horowitz recently showed a retired couple how they could pick up an additional $40k in Social Security benefits with proper planning. This is like found money.

In the first scenario, a husband and wife both have similar earnings but the higher earning husband plans to delay receiving Social Security benefits until he is 70 (thus accruing credit that will boost his monthly income). The wife meanwhile will start taking her Social Security benefits at age 62 (thus receiving less than the full benefit that kicks in at age 66).

Most retirees likely assume the husband in this scenario is prudently delaying his retirement to maximize their retirement income without appreciating that the husband is entitled to claim spousal benefits while continuing to accrue deferral credits.

By filing a “restricted application,” the husband will receive 50% of his wife’s Social Security income for each month he delays claiming his own benefit (but only after his wife turns 66). In Horowitz’s illustration, such a filing entitles the husband to half his wife’s $1,750 a month–or $875 a month during the four years during which the wife is collecting benefits but the husband is not. (This illustration assumes husband and wife are both 66, so there are four years during which he can earn spousal benefits while earning earning deferral credits of his own).

As the car companies state, your mileage may vary.

Retiree’s can supplement Social Security survivor benefits with additional life insurance from Humana Financial Protection Plans.

Medicare Part D – What You Need to Know

Medicare Part D can be a snake pit if you don’t understand how it works. Medicare Part D can be a blessing for some but a nightmare for others. Seniors age 65 and older are not required to buy a Medicare Part D plan, but if you don’t and then later change your mind, you will be subject to a Late Enrollment Penalty (LEP) of 1% per month.Medicare Part D prescription drugs

If you were eligible to buy a Medicare Part D plan when you turned 65 but waited 3 years to buy one, you would pay a LIFETIME PENALTY in 36% additional premiums.

Medicare Part D Traps and Penalties

In 2003, Congress enacted the Medicare Modernization Act that would forever change benefits, especially as it impacts the cost of prescription drugs. Did you know . . .

  • Outpatient prescription drugs are not part of Medicare, but rather a private insurance product marketed and administered by health insurance carriers.
  • Pharmacy Benefit Managers (PBM) negotiate pricing tiers for prescription drugs but the insurance carriers decide which drugs to include in their plan
  • Insurance carriers also assign tiers and copays for the Prescription Drug Plan (PDP) as well as setting the premium you pay
  • Medicare Part D is a voluntary plan but you will pay a penalty if you fail to enroll on a timely basis
  • Once enrolled, you must remain in the plan until the next enrollment period BUT your plan can add or drop drugs during the year as they see fit
  • Non-formulary drugs do not count toward your deductible or Rx out of pocket maximum

How do you enroll in Medicare Part D?

You should start by making a list of all your current medications by name. Include the dosage and how often you fill your prescription.

Next, use the Medicare Prescription Drug Formulary Plan Finder to determine which plan is best for you.

You can also call 1-800-MEDICARE and ask for assistance.

If you have a regular pharmacy, such as CVS or Walgreens, you can take your list of prescription drugs to your pharmacy and ask them for assistance in selecting a Medicare Part D plan.

Georgia Medicare Plans offers affordable Medigap rates and information on how to find the best Medicare Part D plan to fit your needs and budget.

 

Medicare Part B Penalties

Medicare Part B has penalties for late enrollment. Most seniors on Medicare will pay $99.90 per month this year for Part B outpatient coverage. But how would you like to pay 10 percent more for that coverage, or 50 percent more?

Failing to sign up for Medicare Part B at the right time can cost you – big time. The monthly Medicare Part B premium jumps 10 percent for each full 12-month period that a senior could have had coverage but didn’t sign up. A mistake can be costly; someone who fails to enroll for five years would face a 50 percent Part B penalty – 10 percent for each year of delay. That penalty is permanent, and can translate into thousands of dollars in unnecessary lifetime penalty expenses; a headache no one needs on top of already soaring healthcare costs.

That means it’s critical to understand Medicare’s rules for filing. Enrollment is automatic at age 65 for seniors who already have filed for Social Security benefits – but a growing number of older Americans are working longer and delaying their Social Security filings.( link.reuters.com/vej26s ).

“Since Social Security’s full retirement age no longer is linked to Medicare eligibility, this has become a bigger issue,” says Doug Goggin-Callahan, education director at the Medicare Rights Center, a non-profit advocacy organization that counsels seniors on Medicare issues. “We’re also seeing situations in this down economy where people are working well past 65, or they’re enrolled in Medicare but then return to the workforce out of necessity.”

Getting it right will be important for the huge wave of baby boomers hitting age 65 over the coming two decades. It’s especially important for older workers to understand how Medicare interacts with health insurance provided by employers to their workers and retirees.

If you’re already receiving Social Security on your 65th birthday, expect to receive your Medicare card automatically by mail three months before your date of eligibility. If you’re not on Social Security, it’s your responsibility to file – and it’s best to start thinking about it before retirement to avoid those stiff penalties.

You can apply for Medicare through the Social Security Administration, either by visiting a local office or online at the agency’s website ( www.ssa.gov/medicareonly/ ). To ensure that your Medicare Part B coverage start date is not delayed, you should apply three months before the month you turn 65, or by up to three months after.

If you are still working at age 65, Medicare is the primary payor if your employer has fewer than 20 workers; at companies with more than 20 workers, the employer’s plan is primary. In the latter situation, a senior can postpone filing for Parts A (hospitalization) or Part B, although many choose to enroll for Part A anyway since it doesn’t require premium payments.

If you delay your Medicare Part B coverage, you can enroll without penalty when you do retire for up to eight months following that point. But approach the decision to postpone enrollment with great caution.

It’s wise to notify Medicare of this decision when you turn 65, in order to ensure that there won’t be problems with penalties later on. This can be done by checking off a box on the back of a Medicare card that has been sent, by calling the Social Security Administration or through the SSA website. And talk over your plans with your employer’s human resources administrator. If you work for a small business, ask whether the company falls under Medicare’s 20-worker rule, since some employees might be considered contractors.

BEWARE TOO MUCH INCOME

If you’re still working but filing for Medicare, pay careful attention to the program’s surcharges on high-income seniors. The surcharges are levied on individuals with $85,000 or more in annual income, and joint filers with income over $170,000, and they scale upward through four income brackets. The surcharges not only apply to Part B, but also to Medicare Advantage (Part C) and prescription drug plans (Part D).

The income surcharges currently affect just 5 percent of seniors, since most are retired and don’t have that much income. But seniors who are working are more likely than others to have enough income to trigger the surcharge. The extra costs aren’t trivial: Seniors in that first surcharge bracket would pay $480 more this year for Part B.

DRUG COVERAGE CAN WAIT

If you have prescription drug coverage from your former employer, you don’t have to file for Part D at retirement so long as the coverage is as good or better than what Medicare offers. Check with your employer to make sure the plan meets Medicare’s definition of “creditable” coverage. If so, you’ll be able to enroll for Part D at any point later if you lose the employer coverage.

“It comes down to taking the best coverage available to you,” says Goggin-Callahan.

(Editing by Beth Pinsker Gladstone)

http://www.reuters.com/article/2012/01/20/us-column-medicare-filing-idUSTRE80J1CS20120120

Medicare Recipients Less Likely to get Anti-Depressants

Medicare and Medicaid patients are less likely to receive the drugs than those with private insurance, a new study says. Hispanics and blacks are less likely to be prescribed antidepressants than whites.

University of Michigan School of Public Health researchers examined data from 1993 to 2007 and found that whites were 1.5 times more likely to receive antidepressants than blacks or Hispanics with major depression.

The study also found that Medicare and Medicaid patients were 31 percent and 38 percent less likely to be prescribed antidepressants than privately insured patients.

Race didn’t play a role in the type of antidepressants prescribed to patients, but insurance did. Medicare and Medicaid patients were 58 percent and 61 percent less likely to receive newer antidepressants than privately insured patients.

Newer types of antidepressants such as serotonin reuptake inhibitors (SSRIs) are considered the first-line drug treatments for major depression. Older types of antidepressants tend to cause more side effects.

“This study confirmed previous findings that sociological factors, such as race and ethnicity, and patient health insurance status, influence physician prescribing behaviors,” principal investigator Rajesh Balkrishnan, an associate professor in the school of public health, said in a university news release.

The study was published online recently in the International Journal of Psychiatry in Medicine.

The findings show the need for “policy makers to design interventions to improve physician practice guidelines adherence,” Balkrishnan said. “This will help eliminate unnecessary variations among physician practices and … obtain optimal health care for patients.”

Anti-depressants are covered under Medicare Part D.

Georgia Medicare Plans has affordable Medicare supplement plans (Medigap rates) for Georgia seniors.

Read more: http://www.philly.com/philly/health/HealthDay663523_20120409_Minorities__Medicare_Recipients_Less_Likely_to_Get__Antidepressants.html?cmpid=138896554#ixzz1rZiQXoKf

Medical Records Request

The folks in DC want to save Medicare. This will be accomplished with major surgery. Your doctor will be paid less, but so what? He earns more than you and can afford to take a pay cut, right?

Some medical services may no longer be paid for by Medicare, but no big deal. You probably didn’t really need that treatment and you have lived a long life already. Your time on this earth can’t be that much longer.

Washington wants your private medical history. Don’t worry. It is for the good of the people. Your records will not be used against you. After all, this is Washington and everyone knows they can keep a secret.

Medicare CutsMedical Records No Longer Private

According to U S News the Obama administration will be requiring all doctors to submit your medical records to the government.

You don’t have a problem with that do you?

 

HHS is making plans to get its hands on your health care records, one way or another, whether you want them to have it or not.

The department’s first choice is to collect them directly. If they can’t manage that, Plan B is to require the states to collect the data and take it from there. Plan C is to lean on health insurers, using a new regulatory scheme that would require private companies to crunch the data according to new federal mandates the ways the feds want it.

Does any of this bother you, or is it just me?

Been to the doctor lately? Things are different now.

This is Not Your Father’s Doctor Visit . . .

A few weeks ago we were out of town and my wife became ill. I took her to a local doc in a box which was an experience in itself.

As first time visitors, she was required to complete a detailed medical history. About 10 minutes or so with a nurse, answering questions, then sign here.

No, you do not get a copy of this information. We are filing it electronically for your protection.

The entire visit took about an hour, most of that time was wait time even though we were the first ones in when the doors opened.

The entire bill for a routine exam and urinalysis was grossed up to $496. After network discounts it came to $248.

The break out was like this.

Gross charges $61 for professional visit, $40 for lab. Balance was for the medical history and establishing her account as a new patient.

Excuse me?

$395 for medical records that the patient doesn’t even get to see but are transmitted to HHS.

At this rate I don’t think Obamneycrap is going to save anyone any money.

How is this new government health care plan working for you?

Obamaneycare, a Giant Step Backwards

We were told that Obamacare was necessary because too many Americans were without health insurance—which is not the same thing as them being without medical care when it is needed. Rather than fix the stated problem, however, it has made things worse, even before it is fully implemented. According to some recent estimates more than 1 million Americans have lost their coverage in the period since Obamacare became law.

This is not progress.

No kidding.

Reminds me of the old saw. I am from the government and I am here to help you.

I don’t think so . . .

If you think they will stop here you are wrong.

In addition to cutting Medicare benefits, they also think your Medigap coverage is too “rich” and want to cut those benefits as well.

Georgia Medicare Plans can help you find the lowest Medigap rates in your area. We have plans from Dalton to Tifton with carriers such as Aetna, Blue Cross, Humana and more. Ask for a Medigap quote today.

Long Term Care Insurance

Long-term care insurance (LTCI) carriers really do pay LTCI claims.

The American Association for Long-Term Care Insurance (AALTCI), Westlake Village, Calif., has published long term care insurance benefit statistics in a report based on its latest industry survey.

The 10 carriers that participated in the survey said they paid $6.6 billion to a total of about U.S. 200,000 long term care insurance policyholders in 2011.

The customer with the biggest open claim is a woman who bought a long term care insurance policy when she was 43, went on claim 3 years later, and at last report, had been receiving benefits for more than 14 years. She paid $881 in premiums per year for 3 years before she stopped paying premiums because she was receiving policy benefits.

The man with the second largest known open claim paid annual premiums of $3,374 for 3 years, went on claim, and now has received $1.2 million in long term care insurance benefits over 6 years, AALTCI says.

AALTCI found that the 5 most common reasons for a policyholder to file a long term care insurance claim are Alzheimer’s disease, stroke, arthritis, circulatory issues and injury.

About 8 million U.S. residents now have private long term care insurance coverage