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Medicare
Wed, 03/08/2006 - 9:07am — Karen StevensonDescription:
The Medicare program was developed in 1965 as a health insurance program for people who are eligible for Social Security. Medicare primarily pays for acute care, things like doctor visits and hospital stays, but does pay a little bit of the cost of long term care. Up to 100 days of a nursing home stay may be covered by Medicare if the stay follows a hospital stay of three days or more and the purpose of the nursing home care is to rehabilitate the patient. Medical care delivered by a certified Home Health Agency might be covered for some period of time, too. Extended nursing home stays and 24-hour-a-day in-home nursing care are NOT covered by Medicare.
Also not covered is the cost of most prescription drugs, including most oral drugs taken at home by people with chronic medical conditions. There have been attempts to add prescription drug coverage to the Medicare program, but it's unlikely that the Medicare trust fund is large enough to add significant new benefits at the same time that millions of Baby Boomers become beneficiaries of the Medicare program, so Medicare is unlikely to become a payment source for any more long term care costs than are already provided.
The Medicare program was developed in 1965 as a health insurance program for people who are eligible for Social Security. Medicare primarily pays for acute care, things like doctor visits and hospital stays, but does pay a little bit of the cost of long term care. Up to 100 days of a nursing home stay may be covered by Medicare if the stay follows a hospital stay of three days or more and the purpose of the nursing home care is to rehabilitate the patient. Medical care delivered by a certified Home Health Agency might be covered for some period of time, too. Extended nursing home stays and 24-hour-a-day in-home nursing care are NOT covered by Medicare.
Also not covered is the cost of most prescription drugs, including most oral drugs taken at home by people with chronic medical conditions. There have been attempts to add prescription drug coverage to the Medicare program, but it's unlikely that the Medicare trust fund is large enough to add significant new benefits at the same time that millions of Baby Boomers become beneficiaries of the Medicare program, so Medicare is unlikely to become a payment source for any more long term care costs than are already provided.
Medicare Links
Wed, 03/08/2006 - 9:07am — Karen StevensonDescription:
Medicare - the national health insurance program available to most people over age 65 in the United States. Part A is the hospital insurance program and Part B covers physician bills and other medical expenses.
Medicare - the national health insurance program available to most people over age 65 in the United States. Part A is the hospital insurance program and Part B covers physician bills and other medical expenses.
Why Do We Have Medicare Part A and Part B?
Wed, 03/08/2006 - 9:07am — Karen StevensonDescription:
Summary: Interesting history of the split in the Medicare program
Ever wonder why Medicare is split between Part A and Part B? The two plans cover different services, have different deductibles and co-insurance, are funded from different federal trust funds, and even differ on whether or not they charge a premium for participation. (Part A does not, and Part B does.)
The answer goes back to the contentious battle that raged over the enactment of the Medicare program in the 1960's. On one side were the Democrats and the American Hospital Association, who felt that a comprehensive, all-inclusive national health care program was needed for Social Security participants. On the opposing side were the Republicans, the insurance industry, and the American Medical Association (AMA), the association which represents many physicians. In a compromise effort to gain support for a federal Medicare plan, physician services were carved out of the original Medicare proposal, so that the federal plan primarily covered hospital care. This became "Part A" or "Hospital Insurance", the premium-free part of the program which is available to all Social Security beneficiaries. The trust fund for the Part A program was to be funded with payroll tax deductions, which were to be placed in a trust to cover the costs of the program.
Eventually the insurance industry softened their resistance, due to the fact that hospitals were "shifting" the costs of care they provided to the indigent to those who had insurance, which meant that insurers would benefit if some part of those costs were covered by the government. The AMA proposed an alternative, state-run, program which would provide health care services to the indigent, and the Republicans proposed a federally-run, but optional, program to cover health care services for the indigent.
Compromise legislation eventually resulted in the restoration of benefits for physician and outpatient services back into the federally-run Medicare program, as "Part B" or "Supplemental Medical Insurance". To satisfy the original plan's opponents, Part B was made optional. It was not to be funded from payroll taxes like Part A, but would require beneficiaries to pay a monthly premium. The beneficiary premium was intended to cover 50% of the plan's costs, with the remaining 50% coming from the general fund of the federal government. (Although later legislation changed that ratio to 25% from premiums and 75% from the general fund.)
Summary: Interesting history of the split in the Medicare program
Ever wonder why Medicare is split between Part A and Part B? The two plans cover different services, have different deductibles and co-insurance, are funded from different federal trust funds, and even differ on whether or not they charge a premium for participation. (Part A does not, and Part B does.)
The answer goes back to the contentious battle that raged over the enactment of the Medicare program in the 1960's. On one side were the Democrats and the American Hospital Association, who felt that a comprehensive, all-inclusive national health care program was needed for Social Security participants. On the opposing side were the Republicans, the insurance industry, and the American Medical Association (AMA), the association which represents many physicians. In a compromise effort to gain support for a federal Medicare plan, physician services were carved out of the original Medicare proposal, so that the federal plan primarily covered hospital care. This became "Part A" or "Hospital Insurance", the premium-free part of the program which is available to all Social Security beneficiaries. The trust fund for the Part A program was to be funded with payroll tax deductions, which were to be placed in a trust to cover the costs of the program.
1960-1969
Thu, 03/23/2006 - 10:20am — Karen StevensonSummary: Government payments escalate, Nursing home quality concerns escalate, Medicare and Medicaid are created and costs explode, Medicare/Medicaid statistics, Medicare slashes nursing home coverage, The "Fevered Fifty" soar and crash.
Connecticut Physicians Limit Nursing Home Availability
Wed, 03/28/2001 - 1:00am — Karen StevensonDescription:
Andrew Julien of The Hartford Courant reports that physicians in Connecticut are becoming reluctant to provide care to low-income nursing home patients. The problem is that the doctors only receive 80% of the regular Medicare payment for that visit. Generally, physicians receive the other 20% as a co-payment from the patient, but when the patient is on Medicaid, which most nursing home residents are, doctors are not allowed to bill the patient. The state used to make up the difference, but quit doing so two years ago.
Andrew Julien of The Hartford Courant reports that physicians in Connecticut are becoming reluctant to provide care to low-income nursing home patients. The problem is that the doctors only receive 80% of the regular Medicare payment for that visit. Generally, physicians receive the other 20% as a co-payment from the patient, but when the patient is on Medicaid, which most nursing home residents are, doctors are not allowed to bill the patient. The state used to make up the difference, but quit doing so two years ago.
Federal Retirees Should Review Their Insurance
Wed, 02/07/2001 - 1:00am — Karen StevensonDescription:
The National Association of Retired Federal Employees (NARFE) has information on their site to help federal retirees understand how Medicare blends in with their retirement insurance. They point out that some federal retirees may be paying unnecessary premiums for insurance that duplicates benefits they already have. For instance, they say that members of the Federal Employee Health Benefits Program (FEHBP) HMOs probably should NOT sign up for Medicare Part B benefits, since they already have this coverage, and they would be able to save the $600 a year premiums that Part B beneficiaries must pay. They said that some HMOs have incorrectly told FEHBP beneficiaries that they must sign up for Medicare Part B, which is not true. This is different than beneficiaries who belong to Medicare HMOs, who are required to participate in Medicare Part B. This information and more is available on the NARFE site.
The National Association of Retired Federal Employees (NARFE) has information on their site to help federal retirees understand how Medicare blends in with their retirement insurance. They point out that some federal retirees may be paying unnecessary premiums for insurance that duplicates benefits they already have. For instance, they say that members of the Federal Employee Health Benefits Program (FEHBP) HMOs probably should NOT sign up for Medicare Part B benefits, since they already have this coverage, and they would be able to save the $600 a year premiums that Part B beneficiaries must pay. They said that some HMOs have incorrectly told FEHBP beneficiaries that they must sign up for Medicare Part B, which is not true. This is different than beneficiaries who belong to Medicare HMOs, who are required to participate in Medicare Part B. This information and more is available on the NARFE site.
Policymakers Urged to Support Medicare Reform
Wed, 12/06/2000 - 1:00am — Karen StevensonDescription:
Several highly-respected experts spoke to the Special Committee on Aging at a special forum titled "Living Longer, Living Better, The Challenge to Policymakers." They talked to policymakers about Medicare and Social Security reform, the need for geriatrics education in the U.S., and the impact of changing patterns of retirement and demographics. The presenters included Fay Lomax Cook, Director, Institute for Policy Research, and Professor of Human Development and Social Policy, Northwestern University; Gary Burtless, Senior Fellow, Brookings Institution; Robert Butler, Founding Director of the National Institute on Aging and President of the International Longevity Center-USA; Elizabeth Kutza, Director, Institute on Aging, Portland State University; Marilyn Moon, Senior Fellow, The Urban Institute; and Tim Smeeding, Professor of Economics and Public Administration, Center for Policy Research, Syracuse University. Their testimony is available on the Aging Committee Web site.
Several highly-respected experts spoke to the Special Committee on Aging at a special forum titled "Living Longer, Living Better, The Challenge to Policymakers." They talked to policymakers about Medicare and Social Security reform, the need for geriatrics education in the U.S., and the impact of changing patterns of retirement and demographics. The presenters included Fay Lomax Cook, Director, Institute for Policy Research, and Professor of Human Development and Social Policy, Northwestern University; Gary Burtless, Senior Fellow, Brookings Institution; Robert Butler, Founding Director of the National Institute on Aging and President of the International Longevity Center-USA; Elizabeth Kutza, Director, Institute on Aging, Portland State University; Marilyn Moon, Senior Fellow, The Urban Institute; and Tim Smeeding, Professor of Economics and Public Administration, Center for Policy Research, Syracuse University. Their testimony is available on the Aging Committee Web site.
OIG Recommends Crack Down on Nursing Home Therapy
Wed, 11/22/2000 - 1:00am — Karen StevensonDescription:
The Office of the Inspector General (OIG) conducted a review of the way that nursing homes bill for Medicare Part B therapy services, and concluded that the Health Care Financing Administration (HCFA) needs to crack down on therapy billing procedures in nursing homes. The OIG found that about 22% of Part B therapy billing by nursing homes was either unnecessary, undocumented, or provided by unqualified staff in 1998, prior to the implementation of $1,500 caps on therapy charges. They also noted a significant decrease in therapy billings after the caps were implemented in 1999. The OIG stated that this decrease could have meant that patients were not getting the therapy they should have received, but that it appeared that the decrease was primarily due to changes in the way that nursing homes handled therapy. They found that most nursing homes continued to provide therapy, but did it by using non-professional nursing home staff rather than outside therapists. Their conclusion was that prior billings included unnecessary and overly-expensive therapy costs.
The OIG has concluded that the removal of the $1,500 caps on Part B therapy costs for the year 2000 is likely to lead to a return to overpayments for therapy costs in 2000 and 2001, and urged HCFA to immediately ensure that fiscal intermediaries conduct adequate focused medical reviews of Part B therapy in SNFs and continue to work to improve SNFs? and therapy providers? understanding of proper billing procedures and the medical necessity guidelines for Part B therapy in SNFs.
The Office of the Inspector General (OIG) conducted a review of the way that nursing homes bill for Medicare Part B therapy services, and concluded that the Health Care Financing Administration (HCFA) needs to crack down on therapy billing procedures in nursing homes. The OIG found that about 22% of Part B therapy billing by nursing homes was either unnecessary, undocumented, or provided by unqualified staff in 1998, prior to the implementation of $1,500 caps on therapy charges. They also noted a significant decrease in therapy billings after the caps were implemented in 1999. The OIG stated that this decrease could have meant that patients were not getting the therapy they should have received, but that it appeared that the decrease was primarily due to changes in the way that nursing homes handled therapy. They found that most nursing homes continued to provide therapy, but did it by using non-professional nursing home staff rather than outside therapists. Their conclusion was that prior billings included unnecessary and overly-expensive therapy costs.
Medicare Beneficiaries Not Getting Treatments
Wed, 11/15/2000 - 1:00am — Karen StevensonDescription:
A recent study published in the Journal of the American Medical Association (JAMA) found that many Medicare beneficiaries are not getting treatments like mammograms for breast cancer survivors and vision tests for patients with diabetes. The study looked at 345,253 Medicare patients aged 65 or older and found that less than two thirds of them were getting generally recommended procedures. Blacks, poor people, and people living in rural areas were least likely to be getting recommended treatments. Researchers did not investigate the reason for this undertreatment, but said that it could be due to physicians who did not order the right treatments, patients who did not follow the physicians recommendations, or discrimination by doctors. They also suggested that the lack of preventative and diagnostic treatments may have led to worse outcomes, such as the higher hospitalization rate for congestive heart failure that black patients have over white patients. The multi-specialty physician panel that conducted the study was led by Steven M. Asch, MD, MPH, of RAND.
A recent study published in the Journal of the American Medical Association (JAMA) found that many Medicare beneficiaries are not getting treatments like mammograms for breast cancer survivors and vision tests for patients with diabetes. The study looked at 345,253 Medicare patients aged 65 or older and found that less than two thirds of them were getting generally recommended procedures. Blacks, poor people, and people living in rural areas were least likely to be getting recommended treatments. Researchers did not investigate the reason for this undertreatment, but said that it could be due to physicians who did not order the right treatments, patients who did not follow the physicians recommendations, or discrimination by doctors. They also suggested that the lack of preventative and diagnostic treatments may have led to worse outcomes, such as the higher hospitalization rate for congestive heart failure that black patients have over white patients. The multi-specialty physician panel that conducted the study was led by Steven M. Asch, MD, MPH, of RAND.
Beneficiaries Unaware of Medicare Premium Help
Wed, 11/15/2000 - 1:00am — Karen StevensonDescription:
Special programs are available for low income Medicare beneficiaries to help them pay their Medicare premiums, but a recent study by the Medicare Rights Center found that many people are unaware of the programs, or unwilling to apply for them. Their study found that 88% of the people they surveyed are unaware of these programs. They also found that 42% of the people they surveyed had contacted the Medicaid office for help, but only 12% were told about these programs. Of those who were told about the programs, only 2% applied.
Surveyors found that many Medicaid offices were screening applicants to see if they qualified for full Medicaid assistance without also checking to see if they qualified for these premium assistance programs which are available to some people who do not otherwise qualify for Medicaid. Of those beneficiaries who were told about the existance of assistance programs, the most common reasons why they did not apply was the stigma of going to the Medicaid office, the burdensome paperwork and financial disclosure requirements, and in some cases, poor health and lack of access to transportation.
The Medicare assistance programs pay for some or all of Medicare premiums, deductibles, and coinsurance for low income people who do not qualify for the Medicaid program. The available programs are called QMB (Qualified Medicare Beneficiary), SLMB (Specified Low-Income Medicare Beneficiaries, QI-1 and QI-2 (Qualifying Individuals). Premium assistance is available to people with income below $716-$1,238 for an individual and $958-$1,661 for a couple, depending on the program. The programs are limited to people with assets of no more than $4,000 for an individual and $6,000 for a couple, not including their home or most personal property.
Special programs are available for low income Medicare beneficiaries to help them pay their Medicare premiums, but a recent study by the Medicare Rights Center found that many people are unaware of the programs, or unwilling to apply for them. Their study found that 88% of the people they surveyed are unaware of these programs. They also found that 42% of the people they surveyed had contacted the Medicaid office for help, but only 12% were told about these programs. Of those who were told about the programs, only 2% applied.
Surveyors found that many Medicaid offices were screening applicants to see if they qualified for full Medicaid assistance without also checking to see if they qualified for these premium assistance programs which are available to some people who do not otherwise qualify for Medicaid. Of those beneficiaries who were told about the existance of assistance programs, the most common reasons why they did not apply was the stigma of going to the Medicaid office, the burdensome paperwork and financial disclosure requirements, and in some cases, poor health and lack of access to transportation.
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