The Future Of Medicare....

vacationbound

This year I have retired as my cancer has forced this issue on me. The election has come and gone and now we move forward with the Obama Healthcare plan as our new medicare arm. My question is: What were/currently are the conventional medicare plan recipients paying (last 24-48 months) versus what they will have to pay in the future? I will be qualified for Obama's medicare plan in 2 years according to the disability requirements-so will I be paying more than what everyone in the past was paying? Should I start having a garage sale now and saving my pennies so I can afford my premiums in the future?

1Athena1

There will be no change to Medicare because of this election. No garage sale is needed. :-)

vacationbound

This article from the black chamber of commerce states: "If you are on Medicare the pain will hit there also.  The amount of payment going to your doctor will decrease by 30%.  You are going to be responsible for paying that portion of the bill."

http://www.nationalbcc.org/index.php?option=com_content&view=article&id=1588:the-fiscal-cliff-will-hurt-all-of-us&catid=63:beyond-the-rhetoric&Itemid=8

vacationbound

Here is the link to the 2013 official medicare file

http://www.medicare.gov/Pubs/pdf/10050.pdf

dogsandjogs

Right now if a provider accepts Medicare he/she has to accept what Medicare will pay and you are not responsible for the rest. For instance he/she charges $200. Medicare will only authorize $160. So you are not responsible for the $40. But you are responsible for 20 percent of the $160.

So, with the new system, Medicare will pay less. But if a provider chooses to accept Medicare he/she cannot bill you for the difference.

Probably a lot of providers will decide not to accept Medicare. Many of them already do. So I always ask up-front and if they don't I go to another provider.

Chickadee

As a side issue, if your income is low enough there is a program in Texas, and other states I imagine, that pays the Medicare premium for you. My son is disabled and his is paid by the program.



Having a secondary insurance if you are so fortunate covers much of what Medicare doesn't.

vacationbound

Thank you for your feedback!

1Athena1

vacationbound, the black chamber of commerce was discussing what COULD happen if we reach the so-called "fiscal cliff" - the election of Obama, to the extent that it represents continuity - makes negtiations to stave off that cliff more likely and not less. Fingers crossed, of course.

vacationbound

Is that cliff in relation to the "Sequestrian Act" I have been hearing about-Jan 2, 2013? If I file for SSDI then I will not have medicare for 2 years but I do qualify for IHS (Indian Health Services) this facility is 130 miles from my house and I would be able to get contract health services through the tribal area hospitals BUT if the sequestrian act goes through, what Obama giveth, he taketh as the cuts to IHS are going to now keep me from receiving "local" contract services and force me to obtain them at the nearest BIA (Bureau of Indian Affairs) IHS hospital which is 500 miles away in Oklahoma. Someone told me I could get on the PCIP but that is going away  too as it will be phased in with the exchange offering of 2014-my husband will be retiring next year and his insurance sucks big time, no chance of me jumping on his. I can always file for a state assistance program but by definition of the state poverty levels, we are above those slightly and do not qualify. I can go to a state funded medical assistance program aka the "Gold" card, but that system is really a sad affair-I will be standing in line at the county hospital waiting for a doctor to see with 300 other people waiting as well....

susan_02143

I don't think that the sequestation equate Obama takes away. The deal that Congress made, not Obama, requires that the cuts will be made across the board, equal percentage. So, it would be more accurate to say What Congress takes away.

I believe that there will be a new deal made before we get to the cliff, but it may only be passed in the nick of time.

*susan*

vacationbound

Hello Susan,

Correct me if I am wrong please but although the Sequesterian Act was issued by OMB to deal with Congress at a later date (think he saw this coming) I hold Obama technically responsible as it is his law that he enacted under his administration to protect his interests and I believe he has something to say about what gets cut in the process--- the long arm of the oval office

Chickadee

Republicans including the failed VP candidate Ryan and Boehner voted for the Sequestration Act and sent it to the President for signature. Hold them all accountable.

vacationbound

I'm so sorry, it's been a long day; I see I have omitted a very important piece to my above reference in the first sentence "Correct me if I am wrong please but although the Sequesterian Act was issued by OMB to deal with Congress at a later date, "It was the Budget Control Act of 2011 signed into law by Barack Obama" (think he saw this coming) now can I hold him responsible? 

Chickadee

Hold them ALL accountable. But you have more serious concerns to battle. I am on SSDI now and Medicare next year. I wonder if MD Anderson may have a program that would help you receive the care you need going forward?

vacationbound

They have the Moon Shots program but that's for triple negative only-my spinal mets are very small and my cancer seems to be moving gradually slow so I may be good for 24 months....I see I need to update my info-I dont get on here much....should I wait to file until next year as I have read on the medicare website that they will base my premium amounts from my IRS tax table for these 2 years? It's only another 6 or or 7 weeks until 2013....someone also told me I should apply in person with SSDI as the compassionate allowance filing may be tricky online as I have micro metastastic activity in spine and arthritis....not full blown mets to organs...I was then told it wouldn't matter, I'm so confused!

EvaPerone

Hi, just joined this thread as I have been researching similar info.

I am also on SSDI and will be medicare eligible due to disability in a year. Medicare pays 80% and typically people get supplemental insurance (medigap) to pay the 20%. 

Here's the fun part.

My State (Delaware) is a non-guarantee issue state, meaning they do not require insurers to insure disabled younger than 65. If an insurance co decided to insure me, they can charge what they like as per their underwriters. My State insurance commissioner's office says the premiums would be astronomical. 

So I met with State officials and my US Senator's office and no resolutions. I will be forced to move to another State to get medigap or face bankruptcy as the disease progresses (I'm stage 4 so it is inevitable). Paying 20% of my treatment out of pocket is just not an option nor is Medicaid as I earn too much from private disability. 

Vacationbound, here's my suggestion. Find out if you quailify for medical assistance. If you don't, then if your State is a guarantee issue State (there are 29 of them). If no to both, you're in my boat. Want to share an apartment in MD? Ha, open to anything that has worked for medigap.....

vacationbound

Eva-I'm so sorry to hear that-what about the Obama's ideal of being able to buy insurance across state lines??? I remember reading about that but need to go back and find the facts of it....I appreciate your kind offerrings of such valuable information and I wish you well with your endeavors in finding the right answers to your insurance needs. I am on a FB page with a lot of women running rampant with opionions and it really is just fear of the unknown but I want to arm myself with the facts cause that is all that is going to guide us into the new healthcare system that is in place!

susan_02143

Eva,

Very useful information indeed. Texas is one of the states that requires Medigap for under 65. That is a bit of a surprise. Found this government website with a list of all the states:

http://www.medicare.gov/medigap/under65.asp

I think the cross border clause goes into effect in 2014, but medicare and gap insurance isn't included. That clause allows companies with employees in different states to purchase one policy for all their employees, regardless of location.

But you are right, that part of the ACA isn't really clear to me. It is ONE big bill.

*susan*

itsjustme10

I always see commercials for those all-in-one Medicare HMO's - are they available in your state?  Some even claim to have 0 extra premiums.  That would save you the problem of finding a  supplemental carrier, if you can live with the HMO type of coverage, wouldn't it?

peggy_j

vacationbound, I agree, a lot of comments about the new health insurance laws are based more on fear or hearsay than facts. I believe most MO departments (and hospitals) have social workers who can help you navigate these systems based on the current laws, including when changes will take effect. They should also know what's specific to your state. (some states are getting a jump on implementing the new laws, some are going to rely on the Federal Government. confusing) If you can't find someone there, you might want to ask at your local cancer support center if they know of any experts with info for cancer patients.

FWIW, I googled "Affordable Health Care Act 2010" and got this info. (below) All the changes I see to medicare looks like cost reductions for you. (not sure what the future holds but Ryan's idea of turning medicare into a voucher system sounded scary to me).

http://www.healthcare.gov/using-insurance/medicare-long-term-care/medicare/index.html

EvaPerone

ACA should not affect us in a negative way. Actually it will help many women with BC. No pre-existing etc. My issue is just regarding medigap for disabled. I know I am a small subset, women with disability income that cannot afford unregulated health insurance premiums. 

Thanks "itsjustme", but there's only one very badly rated advantage plan in my area. It doesnt include my oncologist etc. 

I agree with Peggy that the proposed voucher plan would actually drive up costs and patients would be left having to cover higher and higher costs. 

And re plans across State lines. Many health insurers are pushing this as a solution as they can then cherry pick the State under which to be regulated. My State offers no regulation and therefore no protection for the consumer. Therefore, higher profits and less oversight for the insurers. One can guess that many insurers will choose this State as their HQ.

vacationbound

Thank you for the link Peggy, I also have a link I found on the Medicare website that I would like to share with all of you, it is a way for you to find info in each of your home states

http://www.medicare.gov/contacts/organization-search-criteria.aspx

vacationbound

I have this link on another forum and one poster said this: (I agree with her as I read the same in the bill with them platforming increases across the years up to 2019)

"This is what is going to happen to Medicare. I can't give you reference numbers, etc, but I did read the bill last year. They are going to cut Medicare by paying the doctors less money. We will not be responsible for the difference. However, our premiums for Medicare Part B will double in two years. Part B is what covers everything except hospital which is covered by part A which is free, and Part D which is separate prescriptions. Currently we are paying around $98 per month (mine I have deducted automatically from my social security disabiity) it is going up next year to like 118 and the following year either 2014 or 2015 (cant remember) it will be around 200. Rember Medicare Part B only pays 80% of covered costs and you need a medicare supplemental plan if you want the 20% covered, too. My supplemental plan is really expensive and goes up every year. This year it is 425 a month. In 2007 when I became eligible for Medicare, my supplemental was only 295. I think that is a big increase in a 5year time frame, but that is private insurance.
The BIG problem comes when doctors STOP TAKING MEDICARE, because they are being paid squat. My primary internist stopped taking on new medicare patients and so are lots of other doctors. They know what is coming. She is still keeping all her patients that are currently on Medicare. This is eventually going to effect our quality of care, when the better doctors no longer take medicare."

 

vacationbound

I rec'd an article this morning from the NEJM on Medicare's Enduring struggle to define "Reasonable and necessary" care http://www.nejm.org/doi/full/10.1056/NEJMp1208386?query=TOC

Source Information:From the Center for the Evaluation of Value and Risk in Health, Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston.

vacationbound

Another interesting article from the NEJM on The taxing power and the Public's health http://www.nejm.org/doi/full/10.1056/NEJMp1209648?query=TOC

Source information: From the Department of Health Policy and Management, Harvard School of Public Health, Boston (M.M.M.); and Harvard Law School, Cambridge, MA (I.G.C.).

***The 3rd paragraph down, it states "Roberts noted that the SRP is paid into the Treasury when taxpayers file income tax returns; it doesn't apply to nontaxpayers"..........I thought everyone had to share the burden but if you do not file, then how do those folks pay their fair share????