JustCare

Category: Medicaid

  • 2022: Programs that lower your health care costs if you have Medicare

    2022: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs, leaving people with average annual out-of-pocket costs of more than $6,100. So, even with Medicare, many people struggle to afford premiums, deductibles and other costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Click here or contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible for any of these programs and how to apply.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2021, but vary somewhat by state. You should apply through your local Medicaid office.

    • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan.
      • Income limit monthly depends upon where you live but is around
        • $1,153 for individuals
        • $1,546 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600
    • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20. SLMB helps pay your Medicare Part B premium.
      • Income limit monthly depends upon where you live but is around
        • $1,379 for individuals
        • $1,851 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600
    • Qualifying Individual (QI)—135 percent of FPL +$20, helps pay your Medicare Part B premium.
      • Income limit monthly depends upon where you live but is around
        • $1,549 for individuals
        • $2,080 for couples
      • Asset limit
        • Individuals: $8,400
        • Couples: $12,600

    Several valuable items are not counted as income and assets. No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    2. Extra Help with Medicare Part D prescription drug coverage: You will automatically qualify for the Extra Help program, which is administered by Medicaid, if you qualify for any of the above low-income programs. You can also apply for Extra Help independently. Extra Help pays for some or all of the cost of your Part D drug coverage and is estimated to be worth around $5,100 a year. The amount of help with cost-sharing depends on the level of your income and assets. In 2022, you may qualify if you have up to $20,385 in annual income ($27,465 for a married couple) and up to $15,510 in assets  ($30,950 for a married couple). With Extra Help your drug costs are no more than $3.95 for each generic/$9.85 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)

    3. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.

    4. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.

    5. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • How a for-profit program that should provide all-inclusive care neglects its elderly patients

    How a for-profit program that should provide all-inclusive care neglects its elderly patients

    Medicare’s Program of All-inclusive Care for the Elderly or PACE has been a godsend for a small group of vulnerable patients around the country, allowing them to age in place, with medical and social supports, and avoid moving into a nursing home. But, the federal government opened up PACE, which had historically been operated by not-for-profit agencies, to for-profit companies. Eleanor Laise reports for MarketWatch on the frightening consequences of allowing for-profit entities to administer PACE.

    PACE programs care for older adults in very poor health, with multiple chronic conditions. Nearly half of them suffer from dementia, and most of them are dual-eligibles, with both Medicare and Medicaid. PACE programs are paid a flat fee to manage each participant’s care and allow them to age in their communities.

    It goes without saying that, like Medicare Advantage plans, companies can make a killing off the PACE program if they limit the costly care their participants receive. And, though the program was once only open to non-profit companies, CMS opened it to for-profit companies more than a decade ago.

    Under the administration of non-profits, the PACE program had a wonderful reputation. Now, as for-profits are taking over PACE, it’s a different story altogether.

    One patient under the care of InnovAge—a for-profit PACE program—died, allegedly needlessly. She was admitted to the hospital, severely dehydrated and with sepsis. According to the patient’s daughter, InnovAge was MIA, failing to properly monitor her mom’s condition or even discuss it with her daughter.

    The daughter described for-profit PACE as all-inclusive neglect of elderly participants, “PANE,” with financial growth and profits as their priority. The result is delayed care, difficulty getting specialty care and poor care coordination. One former employee alleged that InnovAge was “denying [patients] access to thousands of medically necessary services.”

    An internal audit in 2016 found that hundreds of participants in California were waiting long periods of time for specialty visits. There was no record of a specialty visit for one participant experiencing heavy bleeding. A month later, the patient went to the emergency room. One employee who reported these issues to a superior ended up leaving after her reports were dismissed.

    The Centers for Medicare and Medicaid Services has stepped in, seemingly doing too little too late.  It has halted enrollment in InnovAge’s Sacramento location, but why not at all locations? It’s the same poor management everywhere.

    “Auditors found instances of ordered services being cancelled, not provided, or unreasonably delayed without any clear rationale,” CMS wrote to InnovAge. How can CMS continue to pay InnovAge to care for the participants already enrolled in its PACE program when the reason for CMS ending new enrollments is failure to provide medically necessary services!

    CMS is paying InnovAge an average of $94,000 for each of its enrollees. Former CMS administrator and InnovAge board member Tom Scully takes pride in the fact participants have fewer ER visits and hospital admissions than people in traditional Medicare. We are left to wonder how many of these participants were deprived of medically necessary care when InnovAge kept them out of the ER and the hospital.

    Where’s the oversight of InnovAge and other for-profit PACE programs you might wonder? Notwithstanding oversight requirements, precious little monitoring and reporting has occurred.

    Here’s more from Just Care:

  • Coronavirus: The nursing home tragedy

    Coronavirus: The nursing home tragedy

    Jay Caspian Kang writes about Covid-19 and the nursing home tragedy in the US in an opinion piece for the New York Times. Nearly 200,000 nursing home and long-term care facility residents have died of Covid-19. After tapering off for a bit, Covid-19 deaths in long-term care facilities are increasing again.

    Nearly one in ten nursing home and long-term care facility residents have died of Covid-19. And, they continue to die. Congress and state lawmakers have taken precious little action to protect them. Indeed, former NYS governor Cuomo inexplicably required nursing homes to admit Covid-19 patients in stable condition post hospital discharge.

    All in, NYS nursing homes took in more than 9,000 residents with Covid. Rather than protecting residents, Governor Cuomo protected nursing home and hospital owners, through an order shielding them from liability for Covid-19 deaths in their facilities. Fortunately, that protection ended back in April 2021. The Cuomo administration also underreported the number of nursing home deaths.

    The nursing home industry is no longer about motherhood and apple pie. Most nursing homes are now owned by large corporations and are part of chains. Quality of care is a serious issue. Often, these nursing homes are understaffed.

    Kang says that nursing homes have always had the ability to contain the spread of the virus in their facilities. But, the for-profit nursing home owners fear losing money when they invest in containing the spread of Covid-19. Local governments, in sharp contrast, are not concerned with delivering profits to shareholders and can prioritize patient safety. Laguna Honda, run by the local government in California, had the staff necessary to keep people from dying and the willingness to respond to emerging issues swiftly, when necessary.

    Kang blames the for-profit nursing home industry “almost entirely” for all the needless nursing home Covid-19 deaths. They have not provided residents with the care they need. And lawmakers have sat quietly on the sidelines while this has happened.

    What’s beyond shocking is that, notwithstanding all these deaths–which some have called “murders”–nursing homes have raked in large profits. There does not appear to be the political will to keep nursing home owners from prioritizing profits, let alone to hold nursing home owners accountable for these deaths.

    It seems that it’s not worth it to lawmakers to act says Kang. The people running these nursing homes are powerful. And, we are an ageist society, with our representatives apparently willing to write off the death of the elderly as inconsequential.

    It’s time we passed laws that increased the rights of nursing home residents and made it costly for nursing home owners to behave negligently towards their residents. Moreover, state and local governments should be able to take control of for-profit nursing homes that are failing their residents, through eminent domain. Kang argues that there is no other solution that will lead nursing home owners to deliver the care people need.

    Currently, a large percentage of the money that Medicaid and Medicare allocate to nursing homes never gets allocated to the care and feeding of residents. Rather, it gets pocketed by the nursing home owners in one way or another. That’s why it is smart to avoid using for-profit chain nursing homes.

    One expert says that the nursing home industry is called the “Syndicate” because it is so corrupt. Whether we can overcome their money, their power, and their political ties is the question.

    Here’s more from Just Care:

  • 2021: Programs that lower your health care costs if you have Medicare

    2021: Programs that lower your health care costs if you have Medicare

    Medicare only covers about half of a typical person’s health care costs. So, even with Medicare, many people struggle to afford premiums, deductibles and other out-of-pockets health care costs. Some people qualify for Medicaid, which fills most of the gaps in Medicare. But, if you do not qualify for Medicaid, there are other programs that lower your health care costs. Contact your local State Health Insurance Assistance Program (SHIP) to find out if you are eligible and what you will need to apply for one of these programs.

    1. Medicare Savings Programs. Depending on your income, Medicare Savings Programs, administered by Medicaid, help pay for Medicare premiums and coinsurance, even if you don’t qualify for Medicaid. There are three programs, Qualified Medicare Beneficiary (QMB), Specified-Low Income Medicare Beneficiary (SLMB) and Qualified Individual (QI). Income and asset limits, and how they are counted, are listed below for 2021, but vary somewhat by state. You should apply through your local Medicaid office.
      • Qualified Medicare Beneficiary (QMB)—100 percent of federal poverty level (FPL) + $20. If you have QMB, you should not have out-of-pocket costs for Medicare-approved services in traditional Medicare or for in-network services in a Medicare Advantage plan.
        • Income limit monthly depends upon where you live but is around
          • $1,094 for individuals
          • $1,472 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960
      • Specified Low-income Medicare Beneficiary (SLMB)—120 percent of FPL + $20
        • Income limit monthly depends upon where you live but is around
          • $1,308 for individuals
          • $1,762 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960
      • Qualifying Individual (QI)—135 percent of FPL +$20, covers your Medicare Part B premiums
        • Income limit monthly depends upon where you live but is around
          • $1,469 for individuals
          • $1,980 for couples
        • Asset limit
          • Individuals: $7,970
          • Couples: $11,960

      What counts as income and assets? No matter what state you live in, the first $20 of your income and the first $65 of your monthly wages are not counted as income. In addition, half of your monthly wages, after the first $65 is not counted, nor are food stamps. Some of your assets are also not counted, including your primary home, if you own it, your car, your wedding and engagement rings, a burial plot and $1,500 in burial funds, your life insurance with a cash value less than $1,500, and your furniture, household and personal items. Your bank accounts, stocks and bonds are counted.

    Tip: If your income is low but too high to qualify you for Medicaid, it is worth looking into whether you qualify for any of these programs. According to MACPAC, an independent agency that advises Congress on Medicaid policy, less than a half the people over 65 who qualify for the Qualified Medicare Beneficiary program (48%) are enrolled. And, an even smaller share of people over 65 who qualify for the Specified Low-Income Medicare Beneficiary program (28%) are enrolled. About one in seven people over 65 (15%) who qualify for the QI program are enrolled.

    1. Extra Help with Medicare Part D prescription drug coverage: You may qualify for Extra Help, a program administered by Medicaid, which pays for some or all of the cost of your Part D drug coverage. The amount of help with cost-sharing depends on the level of your income and assets. In 2021, you may qualify if you have up to $1,630 in monthly income ($2,198 for a married couple) and up to $14,790 in assets  ($29,520 for a married couple). If your income and assets are lower– income up to $1,469 and assets up to $9,470 for an individual) you may qualify for full Extra Help. With Extra Help your drug costs are no more than $3.70 for each generic/$9.20 for each brand-name covered drug. And, depending upon your income, you may pay only part of your Medicare drug plan premiums and deductibles. You get Extra Help automatically if you have Medicaid or a Medicare Savings Program or receive Supplemental Security Income benefits. You can apply for Extra Help online here. (Some states have State Pharmaceutical Assistance Programs that provide even more assistance.)
    2. Federally Qualified Health Centers (FQHCs) and other programs run by the Human Resources and Services Administration: FQHCs are located across the country and provide a wide range of services to underserved populations and areas on a sliding-feed scale. They might waive the Medicare deductible and coinsurance, depending upon your income.
    3. Hill-Burton programs offer free or reduced care at Hill-Burton facilities in 38 states. Hill-Burton does not cover services fully covered by Medicare or Medicaid. Eligibility depends on your family size and income.
    4. Veterans’ Administration: If you are a vet, the Veterans’ Administration (VA) offers low-cost services and prescription drugs directly. And, you can have VA coverage as well as Medicare.

    Keep in mind that you may be eligible for Medicaid based on your income after paying for some health care costs. To contact your state Medicaid office, click here.

    Here’s more from Just Care:

  • Dental fraud: How to protect yourself

    Dental fraud: How to protect yourself

    Daryl Austin writes for Kaiser Health News about dental fraud. Yes, dentists sometimes identify problems with your teeth in order to be able to perform services that are in fact unnecessary. It’s a way to generate revenue off of trusting patients. How can you protect yourself?

    One dentist described how he was fired from his practice back in the 1990s because he told a patient that she did not need a porcelain cap on a tooth that another dentist in his practice had said was needed. Dental care fraud continues to this day.

    Because Medicare does not cover dental services and Medicare Advantage plans generally only cover a small piece of the cost, older adults and people with disabilities tend to have to pay for dental services completely or, almost completely, out of pocket. Prices can vary tremendously, so it’s smart to shop around. And, if a dentist recommends a costly service, get a second opinion before getting the service to make sure it is really necessary.

    Health care fraud is estimated to be quite common. As much as 10 percent of all health care spending could be for fraudulent claims according to a study by the National Health Care Anti-Fraud Association. Why is health care fraud so prevalent with dental care?

    In the dental space, dental practices are being bought by big corporations and private equity firms. They care about maximizing profits. To that end, they might encourage dentists to perform costly procedures that might be unnecessary. Their dentists can follow their directions or fear being fired.

    One unnecessary expensive dental treatment to avoid in most cases is quadrant. It could help you if you have severe gum disease. But, it can also wear away your gum tissue, and your gum tissue will not come back. In other cases, dentists recommend crowns when all a patient needs is a filling. Or, dentists might suggest a mini-implant, which has a high failure rate. A regular implant generally is what is needed.

    Before going along with your dentist’s recommended treatment, ask about your alternatives. And, find out what your costs will be.

    Here’s more from Just Care:

  • Coronavirus: More home and community-based services needed

    Coronavirus: More home and community-based services needed

    For all the tragedy that Covid-19 has wreaked on this nation, there are a few silver linings. COVID-19 has cast a spotlight on the failings of nursing homes and the need for more home and community-based services and more affordable services so that older and disabled adults can age in place. The New York Times reports that many people today do not have the option to remain in their homes as they age because it can be so costly.

    People living in nursing homes and other adult care facilities during this pandemic have suffered mightily. As of now, about 181,000 have died. They represent one in three of all COVID-19 deaths, according to the Kaiser Family Foundation.

    What can communities do to help people and keep them from having to be institutionalized? Fewer and fewer people would choose institutionalization if they could remain in their homes. In the last three months of 2020, one in four nursing home beds were unfilled.

    Age-friendly communities offer a range of services to older people who need help caring for themselves. They might provide affordable age-friendly housing, good transportation and care services. Age-friendly housing generally provides living space on one floor without steps, walk-in showers, and hallways and doors that can accommodate wheelchairs.

    In some cases, apartment buildings can offer an array of services beyond shelter, such as grocery stores and pharmacies. In that way, older adults can have several community essentials at their fingertips, without having to leave the building. This set-up could benefit a lot of older adults.

    But, as people move into their 80’s and 90’s, they often need long-term care services as well. Medicare does not cover long-term care. At most, it covers 100 days in a skilled nursing facility, and that’s only if you’ve been hospitalized for at least three days prior to admission and need daily skilled services.

    Medicaid covers long-term nursing home care. But, it often does not cover home and community-based care. A little more than half of its spending for long-term services and supports covers home and community-based care. More than 40 percent goes to nursing-home care.

    What’s worse, even people who qualify for Medicaid might not get it. In many states, there’s a long Medicaid waitlist. Forty-one states limit Medicaid enrollment. Right now, 820,000 Americans are on a waiting list. On average, they wait more than three years. Fortunately, the American Rescue Act gives more money to states to expand Medicaid services. And, Biden’s new infrastructure proposal includes $400 billion more for home and community-based care.

    Here’s more from Just Care:

  • Government-administered long-term care insurance is long overdue

    Government-administered long-term care insurance is long overdue

    Since the start of the novel coronavirus pandemic, more than 46,000 people have died in nursing homes.  The private health care market is failing, and government-administered long-term care insurance, ensuring government oversight, is long overdue.

    Alexander Sammon makes the case in the American Prospect that the private long-term care insurance market has failed Americans more than any other piece of the health insurance market. Long-term care is the term used to describe an array services and assistance provided to older adults and people with disabilities. It includes help with activities of daily living such as bathing, feeding and toiletting, as well as nursing and therapy services.

    For sure, the number of deaths of older adults in long-term care facilities are easy to track and horrifying. Though, without good data and knowing that out-of-pocket costs keep people with complex conditions from getting medical and hospital care, it is not at all clear that the number of deaths of working people with serious illnesses and injuries stemming from their private health insurance is not equally chilling.

    What the long-term care story reveals is how a for-profit health care market endangers people’s lives by putting profits first and cannot be relied upon to guarantee our health. More than one in ten long-term care residents are no longer with us, in large part because long-term care facilities were not prepared to care for them.

    At some point in your life, there is a good chance that you will need long-term care. Seven in ten people 65 and older require long-term care. Most people rely on family and friends or Medicaid for long-term care. Only about three percent of Americans have long-term care insurance; it is expensive, often not available to people with pre-existing conditions, and generally not worth the cost, delivering little bang for your buck.

    Because the cost of long-term care is so high, private insurers are hard-pressed to profit from selling coverage and the market has shrunk considerably.

    When it was being drafted, the Affordable Care Act included government coverage for long-term care. But, it was designed as a voluntary program with high costs. And, it would not have paid for itself. So, it was dropped from the law before enactment.

    Sammon reports that Americans do not appreciate how likely it is that they will need long-term care. And, many also do not know that Medicare only covers a limited set of long-term care services: up to 100 days of care in a skilled nursing facility if certain qualifying criteria are met, some home care for people for whom leaving home is extraordinarily difficult and who need skilled nursing or therapy services, and durable medical equipment.

    The cost of long-term care keeps rising. It costs seven times more in 2015 ($225 billion) than it did in 2000 ($30 billion). The private market is not up to the task of providing good coverage.

    There are smart ways to provide everyone long-term care coverage through social insurance. Washington state enacted a social insurance program, imposing a small payroll tax on workers’ salaries. It will pay out $100 a day for up to a year of in-home care. Hawaii did something similar. It’s time that the federal government stepped in and offered similar or better coverage to everyone in the nation through social insurance.

    Here’s more from Just Care:

  • Can you protect nursing home residents in a profit-driven system?

    Can you protect nursing home residents in a profit-driven system?

    A story in The Guardian about corporate entities that buy up nursing homes, with the goal of squeezing as much profit out of them as possible and no regard for their residents, speaks volumes about the horrific nature of our profit-driven health care system. Because nursing homes can operate as for-profit facilities–even when Medicare and Medicaid are paying their bills–many of them have become storage units for frail and vulnerable Americans rather than care centers.

    Storage units? That might be too kind a description. Many nursing facilities have become places that do not provide staff to care properly for their frail and vulnerable residents. Instead, our taxpayer dollars flow to their owners, through Medicare and Medicaid, who buy and sell them like used cars, after pocketing as much money from them as possible. These nursing homes then engage a skeletal staff at a low wage to care for the residents. Here’s one example:

    Multi-millionaire Joseph Schwartz owns Skyline Healthcare LLC, which receives millions of Medicare and Medicaid dollars to provide care to patients in its 100-plus nursing facilities. But, Schwartz abandons these facilities without bothering to let the staff or residents’ families know he’s sold off his properties.

    Schwartz leaves staff unpaid, without benefits or recourse, and residents sitting in their feces, unfed, without electricity or care. He left one pharmacy without paying it the $200,000 it was owed for prescription drugs. And, since the novel coronavirus pandemic, police went to one Skyline facility and found 17 people dead and lying atop one another in a four-person morgue.

    According to the Guardian, over the last 20 years or so, it has become extremely common for corporate entities to buy nursing facilities, realize as much profit as possible, and then sell them. Massive fraud is also common. Patient neglect is often the norm. And, eviction of residents is not uncommon. Sometimes, state governments come to the rescue, but not always.

    For-profit nursing homes need to be better regulated. But, what would that mean? How would regulation protect against owners who have no interest in anything other than taking the Medicare and Medicaid revenue and running.

    One man who owned many nursing homes in a number of states received a 20-year prison sentence for pocketing Medicare and Medicaid dollars to care for residents and never spending a dollar on their care. But, he was not stopped until after he had amassed $1.3 billion. It took authorities several years to stop him after his fraud was exposed by reporters at the Chicago Tribune. How many others like him are still pretending to operate nursing homes and simply pocketing the federal and state dollars intended to go to residents’ care?

    Private equity firms are also buying up nursing homes, draining them of their value, and abandoning them. The Carlyle Group bought HCR ManorCare, a chain of nursing facilities. It sold off their real estate for $6.1 billion and then filed for Chapter 11 bankruptcy when the monthly rent cost too much.

    In case this isn’t all bad enough, many states are providing nursing homes immunity from COVID-19 litigation. And, Senate Majority Leaders Mitch McConnell has said that any new stimulus bill must include provisions that would make it extremely hard for residents and staff to sue nursing home owners. Advocates have organized to urge state legislators to permit residents to sue these facilities and hold them to account for not providing appropriate care. Otherwise, nursing homes will continue with these bone-chilling practices.

    Here’s more from Just Care:

  • President Trump’s 2021 proposed budget would most hurt vulnerable older adults

    President Trump’s 2021 proposed budget would most hurt vulnerable older adults

    Monique Morrissey writes for the EPI blog about President Trump’s proposed 2021 budget. Morrissey explains that this White House budget would hurt vulnerable older adults, even though it claims to benefit them. 

    President Trump’s proposed budget would cut Medicare and Medicaid spending significantly. It would also cut discretionary spending unrelated to defense. In other words, funding for programs that help older Americans would be cut. Programs at risk include HEAP, which provides home emergency assistance to low-income older adults.

    The President proposes more than $750 billion dollars in cuts to Medicare over ten years, which is likely to jeopardize access to care for older adults and people with disabilities. However, we don’t yet know what the President means when his proposed budget says that it will find Medicare savings by ending “excessive spending and distortionary payment incentives.” It also says that it would “preserve benefits and access to care.”

    One Medicare provision in the proposed budget makes sense–to equalize payments for particular health care services across different venues. Right now, Medicare pays wildly different amounts for the same procedures depending upon whether they are performed in an outpatient or inpatient setting. 

    The proposed Medicare budget cuts would likely increase people’s out-of-pocket health care costs and undermine access to care. The President would like to cut government payments to providers that cover unpaid medical bills. Consequently, providers may be less inclined to treat people with Medicare with limited incomes. In addition, hospitals and clinics in low-income areas may be forced to shut down. These potential issues would likely end up affecting middle-class older adults as well.

    The President also wants to cut back on Medicaid expansion, which could leave more older adults without adequate health care coverage and put more health care providers serving people with low incomes at risk. In addition, he wants to increase copays for emergency room visits for people with Medicaid, which would deter them from getting needed care. And, the President wants to repeal the Affordable Care Act, which would not only increase the number of uninsured Americans dramatically but also drive up costs in Medicare. For example, it would mean the Part D prescription drug coverage gap would be reinstated.

    The President proposes to cut Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI) by $76 billion over ten years. He intends to reduce the number of people who benefit from SSDI by five percent. He also wants to cut Social Security administrative costs, which are already too low. Further reductions in spending on administration could mean the closing of more Social Security offices or reductions in their hours of operation.

    Here’s more from Just Care:

  • Enrolling in Medicare? Here’s a checklist

    Enrolling in Medicare? Here’s a checklist

    Most people get Medicare just before they turn 65 (though people with disabilities get Medicare after they receive SSDI for 24 months and people with ALS get Medicare the first month they receive SSDI). As a general rule, you are way better off with Medicare, public health insurance, than with private health insurance. But, figuring out when to enroll in Medicare and what to do can be daunting. And, each fall, you need to revisit your options because they can change significantly from one year to the next. Here’s a checklist:

    • Do you have health care coverage from a current job, either yours or your spouse’s?
      • If you do not, you likely want to sign up for Medicare in the three months before your 65th birthday month, so that your Medicare coverage begins on the first day of your birthday month.  (Your current health insurance in most cases will no longer be your primary coverage after your birthday month.)
      • If you have health care coverage from either your or your spouse’s current job, click here for advice on whether you should sign up for Medicare. Depending upon the job, you may need to enroll in Medicare in order to avoid penalties. Note: COBRA does not count as insurance from your job.
    • Have you already signed up for Social Security?
      • If not, you can sign up for Medicare online through the Social Security Administration. You do not need to sign up for Social Security to enroll in Medicare. Keep in mind that when you sign up for Social Security affects the amount of your monthly check. Click here for advice on when to claim Social Security benefits.
      • If you’ve already signed up for Social Security, you will get Medicare automatically. You should receive a notice in the mail about your automatic enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance), both of which you need whether you enroll in traditional Medicare or a commercial Medicare Advantage plan. The Medicare Part A premium is fully paid for if you or your spouse worked for at least 40 quarters and paid taxes; if not, there’s an additional premium. The Medicare Part B premium, which you must pay no matter which Medicare plan you choose, will be deducted from your Social Security check automatically.
        • You will be automatically enrolled in traditional Medicare, government-administered insurance.
        • You can choose to join a Medicare Advantage plan (Part C), instead of traditional Medicare, by signing up with a Medicare Advantage plan; you will be automatically switched out of traditional Medicare.
    • Key differences between traditional Medicare and Medicare Advantage commercial health plans
      • A Medicare Advantage plan, commercial insurance that contracts with Medicare to offer benefits, is often a lot more expensive and a lot more complicated than it at first may seem. Deductibles, coinsurance and copays can be extremely high, and you cannot buy supplemental coverage to cover these costs as you can with traditional Medicare. At the same time, unlike traditional Medicare, Medicare Advantage plans limit your choice of doctors and hospitals to their network. Your annual out-of-pocket costs for in-network care can be as high as $6,700 and, if you need to go out of network, your costs can be far higher. Here are four key differences between traditional Medicare and a Medicare Advantage plan.
      • If you choose traditional Medicare, as 70 percent of people do, Medicare will cover your care from almost all doctors and virtually every hospital in the US. You will want supplemental insurance to fill gaps in traditional Medicare and prescription drug coverage. With that, all or nearly all of your costs for medical and hospital care should then be covered, so you can budget for your care. And, it will be simpler to access care when you need it.
    • What do you need to consider each Fall, during the Medicare open enrollment season?  Each Fall, you will be able to switch Medicare plans. Because Medicare Advantage plans and Part D drug plans can change significantly from one year to the next, you will likely be better off if you do some homework. Here are two questions you should answer during the Open Enrollment Period.
      • If you’re in traditional Medicare, you can assume your coverage will remain the same in terms of access to doctors and hospitals. So, no homework there. But, you will need to check into your Medicare Part D drug plan options, which can change dramatically from one year to the next. (Here’s a Medicare tool to help you choose.)
      • If you’re in a Medicare Advantage plan, you cannot assume your coverage will remain the same each year. The network doctors and hospitals can change at any time, and the premiums, copays and deductibles can change each year. You will need to do some research around costs and to ensure you are in a Medicare Advantage plan that allows you to see the doctors and hospitals you want to use. You can switch to traditional Medicare. But, if you do not have Medicaid or retiree coverage to fill gaps, you will need a Medigap policy.

    For more about Medicare benefits, Medicaid, Social Security and long-term services and supports, click here. 

    To understand when Medicare is the primary payer and when it is secondary, click here. 

    If you have Veterans’ or other military benefits, learn how they work with Medicare.