A. Medicare Part A - hospital benefits: Certain cuts start in 2010 and continue through 2015. But, some hospitals (in frontier states like Montana and Utah, and in low cost areas) will receive higher Medicare payments. Ironic, but physician-owned hospitals are not allowed to receive Medicare payments.
B. Medicare Part B: Outpatient facility and doctor office benefits have been threatened with a 21 percent cut in the traditional Medicare reimbursement rates. The cuts took place March 1, but were quickly delayed until who knows when. At this point there is a great deal of uncertainty as to if, or when, the cuts will ever take place. If the 21 percent cuts in reimbursement become permanent, you can bet that a large percentage of doctors and other Medicare providers will no longer accept Medicare patients. The proverbial can has been kicked down the road too long.
C. The Medicare Advantage Program Part C: The funding of a Medicare Advantage plan averages about 12 percent more than Original Medicare (Parts A and B). The new reforms call for a reduced funding of Part C, potentially being reduced to the same funding as Original Medicare. For MA plans, at a minimum, expect there to be higher premiums and lower benefits.
D. The Prescription Drug Program Part D: During the past few years we have witnessed rising Prescription Drug Plan (PDP) premiums, reduced benefits and shrinking formularies. Expect more of the same trends to continue. On the bright side, the "GAP" or "donut hole" in Part D may is scheduled to be phased out, starting with a $250 rebate to be paid in 2011 for 2010 "GAP" exposure.
E. as in Medicare Part E? Is The CLASS Act the beginning of Medicare Part E? The Community Living Assistance Services and Supports portion of this new legislation is going to produce some free "PR" designed to promote personal long term health care planning. However the actual benefits appear to be an LTCI starter kit, and not enough to handle an average long term health care claim.
F. Fraud: $60 billion of Medicare and Medicaid fraud was reported in 2008. The new reform act may increase the existing $311 million 2010 Medicare Anti-Fraud budget, but unfortunately Medicare spends less than 2 percent of the money allocated to fight Medicare fraud. Where did the other 98 cents go? (Source: U.S. Dept. of HHS)
G. The GAP: Becomes a jelly donut. A phase-in to close the "Donut Hole" or "GAP" in Part D begins in 2011 and could be closed by 2014.
H. Health care cost vs. health Insurance cost? I thought we passed health care reform, but upon further review, we passed health insurance reform.
I. Improper payments: According to the U.S. Office of Management and Budget, in 2007 Medicare and Medicaid made an "improper payment" of $23.7 billion. These payments were made to more than 18,000 deceased physicians totaling 478,500 different claims.
J. Plan J is gone after May 31. (Scratch Plans E, H, I and J as of May 31.)
K. Plan K, does anybody even sell Med Sup Plan K?
L. Plan L, see Plan K!
M. "Modernized Med Supps" will be a new term to remember, Plans M & N - new as of June 1.
N. Plan N - could be the new "Med Sup Darling." Plan N will feature an office copay (for the first time on a Med Sup); the early indications are the premium will fall 25 percent to 30 percent below the current Plan F rates, and some carriers are reporting guarantee issue on their Plan N ... wow!
O. Overfunded, as in Medicare Advantage plans ... but, each time we transfer a Medicare beneficiary off of Original Medicare and place them in a Medicare Advantage plan, do we not transfer a health risk off of the American Taxpayer's back and place that risk where it belongs, to an insurance company? Think about it.
P. Providers and their reduced reimbursement, as much as 21 percent. If this happens, what do you think will be the unintended consequence? The obvious answer: fewer providers willing to accept anything lower than what is being paid now, which arguably, is not enough to make ends meet at the current reimbursement levels. This could be devastating.
Q. Quality Assurance Control, HEDIS scores - measuring points that will lead to increased Medicare reimbursement. When chronic illness health check points improve, providers can get up to as much as 216 percent of Medicare reimbursement! (Hmm, does that smell like a capitalistic, incentive-based system designed to practice more efficient medicine instead of dinging the Medicare gong every time they submit a claim to make up for Medicaid losses, uninsured patients, etc.?)
R. Repeal! This bill may never see the light of day. How many special deals were cut to influence votes? By the time you read this article, how many state attorneys general will have filed a lawsuit against the federal government on the argument of HR 3590 being unconstitutional?
S. Socialized Medicine: Face it, back in 1965, Medicare represented the first step toward a socialized, rationalized, health care delivery system.
T. Trillion, $1,000,000,000,000. One trillion seconds ago was 30,000 years before the birth of Jesus Christ. Our current USA unfunded liabilities will exceed $87 trillion in 2010. During 2010 our economy is estimated to generate up to $15 billion in revenue to offset this deficit. Where is that money going to come from, increased taxes? We just added more to our deficit with HR 3590, so where is that money going to come from?
U. Underwriting Medicare Supplement plans may become somewhat easier. This simplified/guarantee issue provisions may attract immediate new business, but this window will not stay open forever, so make hay while the summer sun is shining! Medicare Advantage plans only ask about ESRD (end stage renal disease).
V. Vote. If you don't like the new health care reform act, go to the polls in November and vote your elected officials out of office. If you don't vote, don't complain.
W. "Who Moved My Cheese": A great book. Your cheese just moved from the under age 65 health insurance marketplace to the over age 65 marketplace. (Do you smell your new Limburg?)
X. "X-date" is June 2010 for the new Medicare Supplement plans to be written. How many of your existing clients are ready to move to your competition? Now is the time to re-charge your Medicare knowledge and stay ahead of the competition.
Y. "You." What does the reform mean for you? New markets will emerge. Look at this as a time to shed your old ways of doing business and get excited about the new plan options you now have to help seniors. There has never been a better time to get into the Medicare business than now! (OK, except for when Part D rolled out in 2006.)
Z. Zero in on the baby boomers. This aging demographic will begin to turn age 65 at an alarming rate in the next decade. For 20 years straight, 10,000 baby boomers will turn 65 every day. You will be well positioned if you follow this age wave into the Medicare marketplace!
