JustCare

Category: Medicare

  • Telehealth on the rise

    Telehealth on the rise

    Telehealth or telemedicine–the provision of care through telephone or digitally, including video visits and online care–originally was designed to meet the needs of patients otherwise unable to access care, such as people living in rural areas. But, telehealth is on the rise, increasingly meeting the needs of people who want to avoid leaving work to travel to the doctor and keep their costs down.

    Now, according to a July 2016 article on the State of Telehealth in the New England Journal of Medicine, a large number of institutions offer virtual doctor’s visits at low cost 24 hours a day. For many, it’s a great alternative to waiting 20 days to get a doctor’s appointment and then spending 2 hours traveling and waiting for a 20 minute visit.

    People are now more interested in using telehealth to treat a variety of chronic conditions. Nearly half the U.S. population has one or more chronic conditions, 140 million people.  And, telehealth is moving from the hospital to the home, where it can meet the care needs of frail older adults and people with disabilities for whom leaving home is difficult. Combined with sensors on the patient and in the home, providers can learn a significant amount about a patient.

    Health systems with integrated care, such as Kaiser Permanente, the Veterans Administration and the Department of Defense, are finding that telehealth can promote health at less cost than in-person care. Kaiser predicts that it will provide more telehealth visits than in-person visits this year. In 2014, the VA provided more than 2 million telehealth visits. The Mayo Clinic says it will serve 200 million people remotely by 2020, including many who do not live in the United States.

    The biggest constraint on telehealth is that most insurers are not yet covering the cost of the services. But, telehealth coverage is on the rise. And, 29 states now require commercial insurers to cover telehealth services in the same ways they cover in-person care. Already, Medicaid covers some telehealth services today in 48 states.

    Medicare is behind on telehealth services, limiting coverage to areas where it is hard to see a doctor, as we reported here on Just Care. And, digital doctor visits present a bit of a challenge for older adults since only 58 percent of them are online. Moreover, state licensing restrictions limit the out-of-state care doctors can provide. But, there is a bill in Congress, the Tele-Med Act of 2015, which would give providers the right to treat Medicare patients in any state.

    According to Bloomberg BNA, the National Business Group on Health (NBGH) projects that, in 2017, 9 out of 10 large employers will offer employees telehealth services. NBGH further predicts that virtually all large employers, 97 percent, will offer telehealth services within four years.

    Large companies still don’t have a good sense of whether telehealth is bringing down their care costs. In fact, just four years ago, only 7 percent of these companies offered telehealth to their employees. But, they now believe it is a valuable benefit that promotes employee satisfaction. It can save people time and money. And, many insurers are now offering the service.

    Telehealth has its limitations. It puts less of a premium on the doctor-patient relationship–what the doctor can learn from looking a patient in the eye and conducting a physical examination as well as the trust that can be built–than in-person care. Continuity of care is easily lost, with fragmented care taking its place. And, lack of integration in the delivery of telehealth care could lead to conflicting treatments and poor outcomes. There are also privacy concerns.

    On the flip side, telehealth can lead to greater equity in the delivery of health care, reducing racial, gender and age disparities and well as disparities in treatment between people in rural areas and people in urban areas.

    Here’s more from Just Care:

  • Is involuntary enrollment in Medicare Advantage plans the new norm?

    Is involuntary enrollment in Medicare Advantage plans the new norm?

    It has been the norm that when people first go on Medicare, they are automatically enrolled into traditional Medicare unless they affirmatively choose a Medicare Advantage plan. In recent years, however, involuntary enrollment in Medicare Advantage plans has become the new norm for a small but growing number of people.  Automatic Medicare Advantage enrollment undermines people’s choice, placing millions of people with Medicare at significant financial and health risk.

    Susan Jaffe reports for Kaiser Health News that, when you first become eligible for Medicare, your health plan, under some circumstances, has the right to automatically enroll you in its Medicare plan (a commercial health plan like Aetna or Human that typically only covers care from doctors and hospitals in its network).  Here’s how it appears to work.

    Under this “seamless conversion” policy, health insurers have access to data that lets them know when their members enroll in Medicare. At that time, so long as  the Centers for Medicare and Medicaid Services (CMS) approves, they have the  right to move their members from a state health exchange plan or other health plan into their Medicare Advantage plan.

    However, CMS does not notify the people who are involuntarily enrolled in their health plans’ Medicare Advantage plans that they are no longer in traditional Medicare. It relies on the insurers to notify their members. Of course, people may not read their mail, particularly mail from insurers they thought they were moving on from once they enrolled in Medicare. As a result, they may assume they are enrolled in traditional Medicare, seek care, and end up racking up tons of bills from out-of-network providers.

    By allowing the insurers to automatically involuntarily enroll people in their Medicare Advantage plans, CMS is working against the interests of people with Medicare; it is disregarding its own advice to people choosing a Medicare plan to compare their options carefully. People are only protected if they receive and read the required health plan notification informing them of their automatic enrollment and their right to opt out within 60 days.

    Insurers’ Medicare plans may have networks different from the networks available to their members pre-Medicare eligibility. They are also likely to have very different copays and deductibles. And, they are likely not to be a smart choice for people who want to continue to see the doctors they know and trust. Indeed, traditional Medicare is the only choice that maximizes the likelihood of that continuity of care.

    Shockingly and inexplicably, CMS was not willing to tell Jaffe, the reporter, how long this practice has been in effect or which insurers had approval to use this “seamless conversion” process. As disturbingly, neither Cigna, Anthem or Blue Cross would tell Jaffe whether they were automatically enrolling people in their commercial Medicare plans.

    Jaffe learned that Aetna is about to launch the process in parts of Florida. Humana and United Healthcare said that they plan to automatically enroll people as well.

    Congresswoman Jan Schakowsky is looking into the possibility of an “opt-in” for people, rather than an opt-out, so that people consciously enroll in a Medicare Advantage plan only if that’s what they want to do. Until that happens, CMS could protect people if it automatically disenrolled them from a Medicare Advantage plan if they sign up for a Medicare supplemental policy. Since only people with traditional Medicare need such a policy, enrollment in a supplemental policy is a good indicator that they do not want to be enrolled in a Medicare Advantage plan.

    Enrollment in a Medicare Advantage plan must be voluntary. So, if you or anyone you know is enrolled in Medicare Advantage plan involuntarily and unknowingly racks up bills from out-of-network doctors and hospitals, call your local State Health Insurance Assistance Program or SHIP for assistance disenrolling.

    Here’s more from Just Care:

  • Three things to think about when enrolling in Medicare

    Three things to think about when enrolling in Medicare

    When it’s time to sign up for Medicare, information can be confusing.  Before enrolling in Medicare, here are three things you should know:

    1. Timing: If you are not actively working and getting health insurance from your job–even if you have retiree coverage–you will want to enroll in Medicare in the three months before you turn 65, so that you have Medicare beginning on the first day of your birthday month. If you are getting coverage through your or your spouse’s current job and there are at least 20 employees, you can enroll in Medicare without penalty after you or your spouse stops working.
    2. Enrollment: Enrollment in Medicare Part A (hospital insurance) and Part B (medical insurance) is automatic if you are signed up for Social Security.  You do not need to pay anything for Part A if you or your spouse has worked and paid into Medicare at least 10 years. Your Part B premium is deducted from your Social Security check unless your income is low and you qualify for Medicaid or a Medicare Savings program. If you are not signed up for Social Security, call Medicare at 1-800-633-4227.
    3. Additional coverage: Medicare only covers about half of your health care costs.  If you have traditional Medicare, you will need extra coverage, either through: a former employer; or, Medicaid, if your income is low; or, through a private insurer (“Medigap” or Medicare supplemental insurance).  If you are enrolled in a Medicare Advantage plan, a commercial insurance plan that contracts with Medicare, you cannot buy insurance to fill gaps in coverage. Depending on the plan you choose, your out-of-pocket costs could be as high as $6700 a year for your in-network care and much higher if you use out-of-network doctors and hospitals.

    Here’s more from Just Care:

     

  • Why traditional Medicare remains so popular

    Why traditional Medicare remains so popular

    Uwe Reinhardt, PhD, writes Why Many Medicare Beneficiaries Cling to an Allegedly Worse Deal in JAMA Forum earlier this month. In a nutshell, he argues that traditional Medicare remains so popular because it offers people the choice of doctors and hospitals they want.

    Reinhardt points out that the government spends more per person for Medicare Advantage enrollees (people enrolled in a commercial insurance plan that offers Medicare benefits) than on traditional Medicare. In addition, because Medicare Advantage plans generally rely on networks that restrict access to doctors and hospitals, they can offer seemingly more benefits and lower out-of-pocket costs to their enrollees than are available to people in traditional Medicare. But, still only 3 in 10 people with Medicare choose to enroll in one of these plans.

    Most older adults, says Reinhardt, like the freedom of choice available through traditional Medicare exclusively. People value the ability to see almost any doctor and use virtually all hospitals and other health care facilities anywhere in the country. Indeed, the U.S. Government Accountability Office issued a report in September 2015 addressing concerns raised about the narrow networks in many Medicare Advantage plans that can limit access to needed care.  It recommended greater oversight of these plans.

    Reinhardt also posits that people trust the government more than the commercial Medicare Advantage plans. People value traditional Medicare for the same reason they value Social Security–it is “an always faithful and reliable companion.” In sharp contrast the commercial insurers that offer Medicare Advantage are nothing more than “ephemeral companions.”

    Medicare Advantage plans can morph and change at any time. The insurer who offers the Medicare Advantage plan can change many terms of the agreement whenever it wishes. Doctors and hospitals can move in and out of the network throughout the year, changing the network and undermining continuity of care. And benefits, copays and deductibles can change from year to year. Protocols for accessing care can also change. In addition, the Medicare Advantage plan can stop offering coverage altogether or the insurer offering the coverage could be bought by another insurer who changes the rules.

    Here’s more from Just Care:

  • What care do you want if you become seriously ill? Talk to your doctor

    What care do you want if you become seriously ill? Talk to your doctor

    One fourth or so of Medicare annual spending–about $33,500 a person–goes to the cost of care for the 1.8 million people over 65 who die each year.  The cost of their care is high largely because they often have complex conditions, and two-thirds of them die in the hospital.What care do you want if you become seriously ill? Medicare now covers advance care planning to ensure that older adults have their care wishes honored in the days, weeks and months before they die.

    Medicare will cover the full cost of a visit with your doctor to discuss your end-of-life wishes as part of your Medicare annual wellness visit. If you do a separate trip to the doctor, traditional Medicare covers 80 percent of the cost. If you’re in a Medicare Advantage plan, call the plan to find out your out-of-pocket costs. Here are six reasons why you and your loved ones should do advance care planning and create advance directives.

    The data suggest that most people do not plan ahead–through advance care planning–and do not understand their care options. For example, most people prefer to die at home if they are terminally ill. But, they often have not had the chance to decide their care wishes or to share them with trusted family members, doctors or others in their social network. And, they end up dying in the hospital. So, ask your loved ones about end of life care.

    Hospitals and nursing homes are required to ask patients on admission whether they have advance directives–living wills and health care proxies–under the Patient Self-Determination Act of 1991.   These care facilities must keep a record of whether patients have advance directives in their files. But, patients are not required to have them.

    About 40 percent of people over 65 have not done advance care planning and do not have advance directives. Each state has its own law regarding advance directives.  To find out how to get advance directives for your state as well as information on how to complete them, check out Just Care’s get help page here.

    Medicare also covers hospice services, including pain management, palliative care to offer comfort, pain and other symptoms management for people with complex and chronic conditions, and up to five days of respite care for caregivers. Hospice services are usually available in patients’ homes. Today, more than four in ten people with Medicare elect hospice care, more than double the rate from 2000 (23 percent).

    Here’s more from Just Care:

  • What’s the Medicare Part B premium in 2016?

    What’s the Medicare Part B premium in 2016?

    Until recently, the Medicare Part B premium (medical insurance) was the same for everyone regardless of income, geography or health status, a quarter of the cost of Part B services. (Medicare Part A, hospital insurance, is premium-free if you have contributed into Social Security for at least 40 quarters.)  But, in 2003, Congress decided to impose higher premiums on wealthier people with Medicare. And, today, individuals earning more than $85,000 a year and couples earning more than $170,000, about 6 percent of the Medicare population, pay higher premiums than everyone else with Medicare. So, what’s the Medicare premium in 2016?

    The Medicare Part B premium in 2016 is technically $121.80 for people whose yearly income is $85,000 or below. But, Social Security benefits did not go up this year.  As a result most people who get Social Security benefits will continue to pay the same Part B premium amount as they paid in 2015, typically $105. The only people who will pay $121.80 are people not receiving Social Security benefits, people enrolling in Part B for the first time in 2016, people with Medicare and Medicaid, though their state will pay the higher premium.

    The Part B premium is a lot more for people with incomes over $85,000. People whose modified adjusted gross income from two years ago as reported on their federal tax return is above a certain amount will pay:

    • $170.50 a month, if their income is above $85,000 and no more than $107,000.
    • $243.60 a month, if their income is above $107,000 and no more than $160,000
    • $316.70 a month, if their income is above $160,000 and no more than $214,000
    • $389.80 a month, if their income is above $214,000

    For married people filing a joint tax return, double the income to arrive at the premium amount.

    The Part B annual deductible is $166.

    People with incomes up to 135 percent of the federal poverty level, ($1,357 in monthly income for an individual and $1823 for a couple) are eligible for help paying their premiums through Medicaid or a Medicare Savings Program. For more information, including asset limits, visit Medicare Interactive.

    Here’s more from Just Care:

  • If your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans

    If your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans

    There are reasons you should not trust your health plan’s provider directory, and you can read about them on Just Care here.  One reason is that health plans have the right to change their network of doctors and hospitals at any time during the year and, until recently, there was little members could do about it. Beginning this year, if your doctor leaves your Medicare Advantage plan mid-year, you may be able to switch plans.

    At the end of last year, the Centers for Medicare and Medicaid Services issued a new protection for people in Medicare Advantage plans whose doctors leave the network mid-year. Under the new policy, CMS may grant members of a Medicare Advantage plan the right to switch plans as a result of a “significant” change in the provider network.  CMS does not define “significant.” But, according to Kaiser Health News, it has been granting this right to some health plan members who have seen changes in their networks.

    If your network doctors leave your Medicare Advantage plan, and you want to switch plans, contact your local state health insurance program for help. You may have the right to switch to another Medicare Advantage plan or to traditional Medicare.

    Even if CMS does not notify you of a right to switch, it still might offer you the right to switch as a special protection. You may need to be persistent and explain why it’s important you continue care with your current doctors.

    For other situations in which CMS allows Medicare Advantage members to switch plans, click here.

    For more from Just Care:

  • People with Medicare spend significantly more on health care than working people

    People with Medicare spend significantly more on health care than working people

    Many people do not realize that health care costs are almost 14% of household income for people with Medicare. Medicare covers a wide range of services, including hospital care, medical services, prescription drugs, durable medical equipment, physical therapy and many screenings and preventive services. But, people with Medicare spend significantly more on health care than working people.

    Households of people with Medicare spent an average of $4, 722 out of pocket on health care in 2012, according to the Kaiser Family Foundation, Of that money, they spent $2,000 on premiums and the rest on services, with care in a long-term care facility representing the largest share of health care service expenses, 18 percent or $494. Other out-of-pocket costs include an average of $873 for medical services, $613 for prescription drugs, and $149 for medical supplies.

    Overall household spending for older adults was $33,993 in 2012. They spent only slightly more on food ($5,189)  and transportation ($5,087) than on health care.

    In sharp contrast, working people spent only a bit more than five percent of their household income (5.2 percent) on health care. In 2012, the average working household expenditures were $53,000. And, of that, households spent about $2,772 on health care.

    Older adults need more health care than working people, and Medicare does not cover nursing home care and only covers limited long-term supports and services. Older adults also have lower average household incomes than working households.

    Here’s more on health care spending from Just Care:

  • Three reasons why you can’t choose a health plan that’s “right for you”

    Three reasons why you can’t choose a health plan that’s “right for you”

    If you’re struggling to choose a health plan that’s “right for you,” you’re in good company. It’s not possible. There’s generally no way to know whether your health plan will permit you to get care from the doctors you know and trust at a price you can afford, and that’s the chief reason you need health insurance. Here are three big problems you face and two recommendations for choosing a health plan:

    1. You can’t intelligently pick a private health plan based on its network of doctors and hospitals since you don’t know what your future needs will be. The odds may be against your having a stroke or heart disease or being hit by a truck, but it could happen. And, the network doctors you want to use may have left the network by that time or may not be taking new patients. Or, you might need to live with a family member away from home while you receive costly care. In all of these instances, you might need to see doctors or use a hospital not in your health plan’s network. And, your costs could be tremendous. (Keep in mind as well that you can’t trust a health plan’s provider directory.)

    2. You can’t easily compare costs among health plans because you don’t know what services you will need and what the health plan will charge you for them. If you choose a health plan based simply on premiums and deductibles and your current health care needs, you could get stuck with huge out-of-pocket costs–in-network copays and coinsurance–if you end up needing costly care. And, since you usually don’t know what the insurer will charge you in copays and coinsurance before you sign up, you can’t even calculate your out-of-pocket costs for different conditions.

    3. If you’re in a commercial health plan and need costly services, you may not be able to afford them. Health plans are not required to ensure that you can afford the care you need. They can set high deductibles before they begin covering your care, along with high copays for care you need. They also do not have to ensure doctors who treat you in a network hospital are also in your network. So, it’s not unusual for out-of-network emergency room doctors, anesthesiologists, radiologists and pathologists to treat you in a network hospital and for you to get stuck with unaffordable bills.

    What can you do?
    If you are eligible for Medicare and can afford the upfront costs, consider enrolling in traditional Medicare with supplemental coverage. You may pay more for it up front. But, if you end up needing costly care, it will likely save you money. And, it offers the greatest opportunity for coverage from the doctors and hospitals you want to use. Here are four things to think about when choosing between traditional Medicare and a Medicare Advantage plan. Health plan networks limit access to care.

    If you only have the choice of a private health care plan, try to pick one with a network of good doctors and hospitals. One recent study suggests that narrow provider networks may offer as good care as wide networks; it’s all about the providers in your community and the quality of the providers in the narrow network. Check with your doctors to make sure they are in the health plan’s network and have good things to say about the health plan. To keep your costs down, you want to be able to see in-network doctors in the event you need costly care. And, if possible, set aside money or make a plan to cover your deductible and out-of-pocket costs. Too many Americans end up foregoing needed care because, even with insurance, out-of-pocket costs can be huge.

    Here’s more from Just Care:

  • Don’t let your doctor intimidate you: A personal story

    Don’t let your doctor intimidate you: A personal story

    It was a balmy fall day last year, when I walked through the surprisingly creaky door of a well-respected ophthalmologist, who shall remain nameless. Let us call him, Dr. G.

    Why was I there? I needed to have cataracts removed from both my eyes. Dr. G was highly recommended by my usual ophthalmologist, a wise, older man who long ago gave up doing surgery.

    A word about cataracts: When you’re older and have blurry vision, it’s generally caused by something called a cataract. Older adults often have the cataracts or clouded lenses of their eyes surgically removed and replaced with an artificial lens. This surgery requires no hospitalization. The operation itself lasts about ten minutes. Recovery is generally less than half-an-hour. It’s a very quick and common procedure. And, Medicare pays for it.

    My vision was actually quite good and the doctor found nothing wrong with it. I could see long distances. And, I could see close up with reading glasses. But, he recommended I see Dr. G. because I had suddenly begun to hate driving at night; the oncoming lights blurred my vision and bothered me. So I made an appointment.

    Dr. G’s waiting room was packed to capacity. Even though I couldn’t find a seat, I was impressed. After a long wait, two assistants examined me superficially but well enough to hand Dr. G some needed information. He pointed out to me a machine he liked to use that Medicare did not cover.

    “Medicare,” Dr. G said, “doesn’t care how well I do my job, but I care. This machine costs three hundred dollars, per eye, but it provides important information. I’m using it if it’s okay with you.”

    What should I have said, “no, it’s not okay with me?” Should I have revealed that I’m a piker, that I couldn’t afford six hundred bucks? I said, meekly, “okay.”

    He proceeded with the examination. He told me something my doctor had never mentioned: that I had astigmatism in one eye.

    “Really?” said I, “I never knew that.”
”Well, you know it now,” said Dr. G.
Astigmatism has to do with how the eye focuses light. Apparently, my left eye doesn’t do light very well. Dr. G went on to explain that the astigmatism will require a tomic lens.

    “What’s that? I asked.

    “It’s a more sophisticated lens used to treat astigmatism,” Dr. G explained. “You need it. But it’s not fully covered by insurance. Should we go ahead with it? Say, yes.”

    When it was all over it took awhile for my eyes to adjust. Friends who had the same surgery said they could see amazingly clearer right away. I could not. I saw distances the same way I saw them before the operation. Reading was a problem; I needed a new prescription for reading glasses.

    A few weeks passed before Dr. G’s office barraged me with bills, some of which I paid until it got to be ridiculous, and I stopped paying.

    Moral of the story: Ask questions, don’t be intimidated by doctors, and don’t be so quick in allowing them to do whatever they want to do. There are great doctors out there, as we all know, doctors who are honest and who care, doctors who take Medicare as payment in full. But every once in awhile you come across a doctor like Dr. G. G for gonif.

    Here are some tips on how to choose a doctor and four questions to ask yourself about your primary care doctor to understand whether the doctor is meeting your needs. As for your eyes, here are four things to do to protect your eyesight and what to do if you think you may have glaucoma.