JustCare

Tag: Medicare supplemental insurance

  • Medicare Open Enrollment in 2019

    Medicare Open Enrollment in 2019

    Medicare Open Enrollment begins on October 15 and runs through December 7. Whether you are enrolled in traditional Medicare and have a Part D prescription drug plan or you are in a commercial Medicare Advantage plan, your premiums and other out-pocket-costs and in-network providers are likely changing. So, it’s wise to take a hard look at your Medicare options for next year.

    Medicare Advantage and Medicare prescription drug health plan costs and benefits often change significantly from one year to the next. Although you can’t know whether a health plan will meet your future health care needs, you may be able to save money by switching.

    Before you make your choice, keep these facts in mind. Whichever Medicare plan choice you make, you need Medicare Parts A and B, so you must pay the Medicare Part B premium.

    • Traditional Medicare, the government health insurance option, the Medicare health plan choice for nearly seven in ten people with Medicare
      • Traditional Medicare offers coverage from almost all doctors and hospitals anywhere in the country.
      • Traditional Medicare generally does not require pre-authorization or a referral for medical or hospital services.
      • With traditional Medicare, you can fill most if not all coverage gaps with supplemental insurance—Medicaid, retiree coverage from a job or “Medigap,” a Medicare supplemental insurance plan you can buy–all of which cover most or all of your deductible and coinsurance costs. Supplemental insurance protects you from catastrophic costs and allows you to budget for your health care.
    • Medicare Advantage plans, commercial health plans that contract with Medicare
      • Medicare Advantage plans generally limit coverage to a small group of doctors and hospitals in your community—the provider network–except in emergencies or urgent care situations. The provider network can change at any time with doctors and hospitals leaving and entering the network.
      • Medicare Advantage plans often charge an additional premium (on top of the Part B premium), a deductible (the amount you pay before coverage begins) and a copay or coinsurance, with each health care visit. The copay or coinsurance can be very high and unpredictable, a percentage of your hospital bill, and your out-of-pocket costs for in-network care alone can be as high as $6,700 a year. Your costs can change from one year to the next. You cannot buy insurance to fill these coverage gaps.

    If you need costly Medicare-covered services, so long as you have traditional Medicare and supplemental coverage you should be able to see most any doctor and use virtually any hospital to get the care you need with little or no out-of-pocket costs. With Medicare Advantage plans, you have only restricted access to doctors and hospitals and your out-of-pocket costs can easily reach the $6,700 limit for in-network care. Your costs can be even higher if you are hospitalized and are forced to use out-of-network doctors, a fairly common phenomenon, or if you want to use specialists out of network. FYI: Medicare Advantage won’t release data showing people’s typical out-of-pocket costs. However, we know from the HHS Office of Inspector General that Medicare Advantage plans engage in widespread inappropriate denials of care and coverage.

    Keep in mind that even if you need few health care services today, it’s unforeseeable when you might need a lot of care.

    If you’re in a Medicare Advantage plan now:

    • Check your health plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays. If those are good with you, also call your doctors and check with your health plan to make sure your doctors and hospital are still in the network.
    • Consider your other health plan options, including traditional Medicare. One of those options may better meet your needs. You can call your State Health Insurance Program or SHIP for help sorting through your options. You can also call 1-800-633-4227 (1-800-Medicare) or use this Medicare tool to understand your options.
    • Before making a switch to another Medicare Advantage plan, call the plan to confirm your understanding of costs and network doctors and hospitals.
    • If you want to switch to another Medicare Advantage plan, call 1-800-633-4227 (1-800-Medicare) to let Medicare know about your decision.

    If you have a Medicare Part D prescription drug plan:

    • Check your Part D drug plan’s Annual Notice of Change (ANOC) or Evidence of Coverage (EOC). Look at the plan’s new premiums, deductibles and copays or coinsurance. If those seem good to you, check the costs for the drugs you’re taking.
    • It’s wise to look at other drug plan options. You might find a plan that covers your drugs at lower cost. Medicare offers a tool for comparing drug plans based on your drug needs.

    If you decide to switch plans, your new coverage will begin on January 1. Even if you don’t switch now, after the open enrollment period ends, if you are enrolled in a Medicare Advantage Plan and would like to disenroll and switch to traditional Medicare, you may be able to do so between January 1 and February 14. To learn more and get free advice, call your State Health Insurance Assistance Program at 800-677-1116.

    Here’s more from just Care:

  • Health care information confuses people

    Health care information confuses people

    The Center for Retirement Research blog focuses on how health care information tends to confuse people more than help them. As a result, many people make poor health care choices.

    In truth, information that we need to make smart health insurance choices is largely unavailable–e.g., whether a particular health plan delivers value and how one health plan ranks vis a vis others. Private health plans rarely provide helpful information on what we will need to pay for our care. And, people don’t know what care they may need. So, people understandably cannot choose health plans that save them money.

    Only older adults and people with disabilities have the choice of traditional Medicare and can guarantee themselves access to the doctors they want to see at predictable costs. But, they need Medicare supplemental insurance, which can be expensive and many older adults are hard-pressed to afford it.

    It’s not clear that people could ever have the health care information they need to make rational choices about private health plans. It might not make a material difference if health plan information were less confusing or better information were available. What would make a big difference? Giving people good affordable private health plan choices, which would require a far more heavily regulated private health insurance system than we have today.

    Putting aside health insurance choices, the evidence suggests that people cannot make good choices about health care products and services. They often mistakenly believe that more expensive health care products–e.g. brand name drugs, not generics–are better. One research experiment published in Science found that “Expensive medications tend to make us feel better, even when they’re no different than cheap generics.” People may react to a treatment differently based purely on the cost of the treatment.

    In fairness, most of us are bombarded with health care information that is virtually impossible to understand and steers us in all kinds of directions that may not be in our interest. We are left to wonder what to believe. It’s therefore not surprising that people often believe that more medical tests are better than fewer tests, even when they may not be. And, they skip care because they mistakenly think they cannot afford it. They may think that a physical or MRI will cost more than it actually does.

    A University of Wisconsin report finds that almost half of people who are on a tight budget skip medical tests and treatments because they don’t think they can afford them. About one in three of them don’t fill a prescription for the same reason. They make these decisions thinking their out-of-pocket costs are higher than they in fact are.

    People also do not understand how their health insurance deductibles and coinsurance work. People with high-deductible health plans do not understand that they need to pay for the cost of their care up to the deductible amount, which is often many thousands of dollars, before their care will be covered.

    It’s time we stopped expecting consumers to act “rationally” when it comes to health care and guarantee everyone affordable access to the care they want and need.

    Here’s more from Just Care:

  • Could you pay more in Medicare Advantage than traditional Medicare?

    Could you pay more in Medicare Advantage than traditional Medicare?

    Many people with Medicare opt for a Medicare Advantage plan, a commercial insurance plan that contracts with Medicare to deliver Medicare benefits, because they believe it will save them money over traditional Medicare. But, you could pay more in a Medicare Advantage plan than traditional Medicare.

    These days, the Trump Administration makes the commercial Medicare Advantage plans look more enticing than ever. The message is “All the benefits of Medicare and more.” But, what does that really mean and what do you trade away?

    It’s not at all clear that you will spend less for your care in a Medicare Advantage plan. According to the Kaiser Family Foundation, average out-of-pocket costs for people with Medicare in 2013 were $5,503 (41% of the average individual’s Social Security annual income.) Kaiser’s analysis does not distinguish between people in traditional Medicare and people in Medicare Advantage plans. The Medicare Advantage plans don’t disclose this data.

    Why don’t the Medicare Advantage plans reveal this data? What are they hiding? Are people spending more out-of-pocket than their advertisements suggest? If people are spending as much or more in Medicare Advantage plans as in traditional Medicare, it is hard to believe many people would opt for a Medicare Advantage plan and restrict their access to doctors.

    If people are paying less out of pocket in a Medicare Advantage plan than in traditional Medicare, it may be because they are not getting the care they need, delaying or skipping care. They may choose to go without care to avoid paying the deductible and copays. Or, their Medicare Advantage plan may not authorize care they need. Since the data is not available, we don’t know whether the cost of getting care in a Medicare Advantage plan or the health plan’s refusals to cover care is affecting people’s health and well-being.

    The data do show that people who need costly services disenroll from Medicare Advantage plans when they can and switch to traditional Medicare at far higher rates than people in good health. Unfortunately, the cost of Medicare supplemental insurance or, in some cases, the lack of access to supplemental coverage, can be a barrier to enrollment in traditional Medicare. Congress needs to fix that as soon as possible.

    Here’s more from Just Care:

  • 2019 Medicare Handbook is misleading

    2019 Medicare Handbook is misleading

    The Department of Health and Human Services (HHS), through the Centers for Medicare and Medicaid Services (CMS), has released the 2019 Medicare Handbook, which continues to be misleading in its comparison of traditional Medicare with Medicare Advantage plans, commercial health plans that contract with CMS to deliver Medicare benefits.

    The Handbook suggests it is impartially comparing traditional Medicare with Medicare Advantage plans. But, rather than highlighting or even mentioning the thousands of dollars in out-of-pocket costs people who need care may face in a Medicare Advantage plan or the bureaucratic hassles, and inappropriate delays and denials of care, the Handbook overlooks them entirely.

    Instead, on the first comparison page, page 5, CMS highlights Medicare Advantage features that only some may benefit from, without explaining that they are not universal. And, it fails to highlight features of traditional Medicare not available through a Medicare Advantage plan, such as virtually unrestricted access to hospitals and most doctors, the choice people most value, until the second comparison page.

    Deeper into its comparison of traditional Medicare and Medicare Advantage, CMS states that people in traditional Medicare will have 20 percent out-of-pocket costs for Part B-covered services. Only later down the page does it explain that Medicare supplemental insurance “Medigap” or Medicaid or retiree coverage picks up those costs. For Medicare Advantage plans, it simply says: “Out-of-pocket costs vary—some plans have low or no out-of-pocket costs,” even though Medicare Advantage plans all impose out-of-pocket costs. Moreover, these costs can be as high as almost $7,000 for in-network care alone, which the Handbook appears never to mention.

    Without question, people who sign up for a Medicare Advantage plan who do not have retiree coverage or Medicaid to fill gaps in traditional Medicare save on the upfront costs they would need to pay for supplemental coverage to fill gaps in traditional Medicare. And many people are willing to take the gamble that they will not face high deductibles, copays and other out of pocket costs in a Medicare Advantage plan, and will get the care they need, in order to save money on supplemental coverage.

    Medicare for all, which guarantees everyone coverage from virtually all doctors and hospitals, without premiums, deductibles and copays, or the need for supplemental coverage, would save people money on their health care, without forcing them to give up the choice of doctors and hospitals they most value.

    Note: The Medicare website is also misleading. And, don’t trust the five-star ratings of Medicare Advantage plans.

    Here’s more from Just Care:

  • Why enroll in a Medicare Advantage plan?

    Why enroll in a Medicare Advantage plan?

    Millions of people with Medicare choose a Medicare Advantage plan, a commercial health plan that contracts with the government to deliver Medicare benefits, over traditional Medicare. Why enroll in a Medicare Advantage plan over traditional Medicare? You could save money, but it’s a gamble.

    Medicare Advantage plans generally have lower upfront costs than traditional Medicare. So, if you do not need a lot of health care, you could save money you might otherwise spend on Medicare supplemental insurance you need with traditional Medicare. The typical $2,500 to $3,000 cost for supplemental insurance is often a big stretch, if not prohibitive, for people.

    It is also generally easier to enroll in a Medicare Advantage plan than traditional Medicare. You simply sign on the dotted line. With traditional Medicare, unless you have retiree coverage or Medicaid, you need to sign up for Medicare supplemental insurance and also Part D prescription drug coverage. That said, you can get free assistance enrolling from your local State Health Insurance Program. And, once you’re signed up, you have far less paperwork and bureaucracy in traditional Medicare than you have in a Medicare Advantage plan. You generally don’t see a bill or need authorization in order to get care.

    Some Medicare Advantage plans offer benefits not available in traditional Medicare. For example, some offer transportation services if you need to go to the doctor. That can be pretty great. The tradeoff there is that Medicare Advantage plans tend to take a narrow view of Medicare benefits; in addition to restricting your access to doctors and hospitals, they may wrongly deny or delay your care a lot more frequently than traditional Medicare. The Office of the Inspector General reports widespread Medicare Advantage wrongful denials and delays of care.

    Finally, some Medicare Advantage plans actually manage your care and may do a good job of overseeing your care to ensure you get the services you need. For example, some people say that Geisinger, Intermountain and Kaiser offer good care. But, in these health plans, you still have a restricted network of doctors and face huge costs if you need care out-of-network. Though traditional Medicare is not “managed,” a good primary care doctor in traditional Medicare can manage your care as well as a doctor in a managed care plan.

    Bottom line: If you are in good health, odds are that you will save money and get the care you need in a Medicare Advantage plan, so long as you choose it carefully. But, you are also restricting your choice of doctors, hospitals and other care providers and gambling with your health and pocketbook.

    If you can afford traditional Medicare and you opt for a Medicare Advantage plan, you take three serious gambles:

    • You take a gamble that if you develop a complex condition or are seriously injured that you will be able to see the doctors and use hospitals you want to see and use, as well as the rehabilitation facilities and nursing homes.
    • You take a gamble that your out-of-pocket costs for your care are not many thousands of dollars, and you can afford these costs.
    • You take a gamble that you will not need complex care outside of your community–while you are away at a second residence, traveling, or staying with your child or another close family member or friend. If so, your out-of-network costs could be through the roof.

    As of January 1, 2019, you have the right to enroll in, or disenroll from, your Medicare Advantage plan between January and March 31 of each year as well as during the fall Open Enrollment season and switch to traditional Medicare. But, whether you should exercise that right depends upon whether you have supplemental coverage to fill gaps in traditional Medicare. Only four states guarantee people the right to buy Medigap supplemental coverage at any time–Connecticut, Maine, Massachusetts, and New York. And, some Medigap insurers will sell you coverage after 65.

    Note that many in Congress would like to move everyone into a Medicare Advantage plan so that the federal government can cut payments to these plans and shift more costs onto people with Medicare. So long as traditional Medicare is in the mix, Medicare Advantage plans are likely to offer fairly generous benefits to compete. Their enrollees have the protection of switching to traditional Medicare if they are unsatisfied with their care. Without traditional Medicare, all bets are off.

    Here’s more from Just Care:

  • Shouldn’t traditional Medicare have an out-of-pocket cap?

    Shouldn’t traditional Medicare have an out-of-pocket cap?

    Why shouldn’t traditional Medicare have an out-of-pocket cap? It would eliminate the need for people in traditional Medicare to have supplemental coverage and it would put traditional Medicare on a more level playing field with commercial Medicare Advantage plans, which have an out-of-pocket cap. A Commonwealth Fund report by Cathy Schoen et al. proposes an out-of-pocket cap in traditional Medicare that members of Congress would be wise to consider.

    An out-of-pocket cap in traditional Medicare would simplify things for enrollees significantly as they would not need Medicare supplemental insurance (“Medigap”) to protect themselves from financial risk, if they did not have retiree wrap-around coverage or Medicaid. And, the report authors find that a $3,500 cap–half the amount of the maximum cap in Medicare Advantage plans–would cost about $428 a year ($36 a month), far less than the cost of a Medigap plan. (The average out-of-pocket cap in Medicare Advantage plans is $5,332.)

    The report authors posit that a $10 a month or so increase in the Medicare Part B premium coupled with less than a 1 percent increase in the payroll tax (0.3-0.4 percent) would cover that additional $500 cost. And, with this cap, people in traditional Medicare could choose to drop their Medigap at a savings of $1,500-$2,000 a year, on average.

    Taxpayers and people still wanting Medigap coverage would all benefit from this out-of-pocket cap. Both Medicaid and Medigap costs would come down. The report authors estimate a savings to Medicaid of $2.8 billion a year, for the federal government and states together.

    And, businesses paying for retiree coverage that supplements Medicare would also see a reduction in their costs. The report authors estimate $6.8 to $7.3 billion dollars in annual savings for these businesses. Moreover, people with disabilities, who are sometimes unable to buy Medigap coverage, would have greater financial security.

    Other proposals to redesign traditional Medicare, particularly Republican proposals, raise out-of-pocket costs for people with Medicare. Some propose to raise the deductible. Others prevent Medigap plans from covering as much of people’s out-of-pocket costs as they currently do. The goal of these proposals is to save the government money.

    The report authors also propose to eliminate the high deductible people needing hospital services must pay under Medicare Part A–$1,350–instead requiring people to pay a less costly copayment of either $100 or $350 for each hospitalization.

    Here’s more from Just Care:

  • Your right to buy Medigap coverage

    Your right to buy Medigap coverage

    People with Medicare have the right to switch Medicare plans, from a Medicare Advantage plan to traditional Medicare or vice versa, every year during the Fall open enrollment period. But, inexplicably, people do not have a right to buy Medigap coverage, supplemental coverage to fill gaps in Medicare, whenever they sign up for traditional Medicare. Without supplemental coverage, either Medigap, Medicaid or retiree coverage, you have no protection against catastrophic costs in traditional Medicare. A new Kaiser Family Foundation brief explains the issue in detail.

    Under federal law, only people first enrolling in traditional Medicare at 65 or later have the right to buy a Medigap policy. People under 65 with disabilities enrolled in Medicare do not have that right. In fact, only five percent of them have a Medigap policy. (Even though insurers do not have to sell them a policy, some do.) Most (46 percent) have Medicaid. And, 17 percent have employer coverage to fill gaps.

    People in a Medicare Advantage plan who want to switch to traditional Medicare also have no guaranteed right to buy a Medigap policy under federal law. Curiously, Congress gives these people the right to switch to traditional Medicare during the Fall Open Enrollment period but no limit on their out-of-pocket costs in traditional Medicare and no right to buy coverage to protect themselves against catastrophic costs.

    States have the right to guarantee their residents broader Medigap protections than the federal government. But, most states have never been good at protecting consumers in the health insurance marketplace. So, in most states, you should not assume you can get a Medigap policy if you do not get it when you first enroll in Medicare at 65 or later. Though, twenty-eight states do guarantee people the right to buy a Medigap policy if their employer retiree benefits change.

    If you want to sign up for traditional Medicare during the fall open enrollment season, keep in mind that some insurers are willing to sell people Medigap coverage even though they are not required to do so. AARP plans are often available to people. Contact your state health insurance assistance program or SHIP at 1-800-677-1116 for free advice on whether there are Medigap companies in your state that will sell you coverage.

    Four states give people the guaranteed right to buy a Medigap policy, regardless of their health status. Connecticut, Massachusetts, Maine and New York protect people with Medicare. In these states insurers must sell you a Medigap policy even if you have a pre-existing condition. These states also require “community rating” of Medigap policies so that regardless of your age or health, everyone pays the same premium.

    Congress imposed a catastrophic out-of-pocket limit in Medicare Advantage plans, of no more than $6,700, in recognition of the need to give people enrolled in these plans some health and financial security. Congress should impose an out-of-pocket limit in traditional Medicare–or, better still, eliminate deductibles and coinsurance–to protect people in traditional Medicare. Congress should also require Medigap plans in all states to guarantee coverage to everyone during the Fall open Enrollment period and charge everyone the same amount. After all traditional Medicare and Medicare Advantage plans are all community rated–everyone pays the same premium for their policy.

    Here’s more from Just Care:

  • Thankful for traditional Medicare? Call Paul Ryan

    Thankful for traditional Medicare? Call Paul Ryan

    Of all the health care plans in America, traditional Medicare does the most to ensure people get needed care. Unlike private insurance, which increasingly rations care based on people’s ability to pay, traditional Medicare treats people equitably, regardless of health, geography or income and gives people a meaningful choice of doctors and hospitals throughout the country. If you agree, call Congressman Paul Ryan, who is charting a course to destroy traditional Medicare.

    What is traditional Medicare? It is a public health insurance program providing medical and inpatient coverage, available to everyone with Medicare. About 70 percent of people with Medicare choose traditional Medicare because it gives them coverage from a wide range of doctors and hospitals. And, it allows them to budget for their care. As long as they have supplemental coverage—retiree coverage from a former job, a Medicare supplemental insurance plan purchased in the individual market, Medicaid or a Medicare Savings Plan–virtually all their costs are covered. With traditional Medicare, unlike with a Medicare Advantage plan or other commercial insurance, there are no unexpected medical bills from out-of-network doctors.

    How does traditional Medicare work? Traditional Medicare is designed to cover whatever care people need. Whether you need a lot of care or a little care, you can get it, and you are covered. And, you pay the same premium* and have the same out-of-pocket costs. (*Six percent of people with Medicare with incomes above $85,000 pay a higher premium than everyone else.) Medicare protects people with costly conditions from financial risk and ensures they can afford their care, so long as they have supplemental coverage that fills gaps in Medicare. With traditional Medicare and supplemental coverage, unlike with a Medicare Advantage plan or other commercial insurance, people do not pay more when they need more care. That’s why people in Medicare Advantage plans often switch to traditional Medicare when they need costly care.

    How does traditional Medicare keep costs down? The government uses its negotiating leverage to set doctor and hospital rates for people with traditional Medicare. Commercial insurers like United Health and Aetna are unable to exert the leverage Medicare does to keep rates down and therefore generally pay hospitals and doctors higher rates. That raises people’s premiums and health care costs. Medicare Advantage plans currently benefit from traditional Medicare’s rates, which drive competition in the Medicare marketplace and helps to keep costs down. But, they also have high administrative costs. Overall, Medicare is more efficient than commercial insurance.

    How does traditional Medicare allow for innovation? Health policy researchers rely on traditional Medicare to understand what’s working and not working in our health care system. Without traditional Medicare, these researchers would be at a loss to understand our health care system as deeply or broadly as they do because Medicare’s data is publicly available to study. But, commercial insurers treat their data as proprietary and usually are not willing to share it. They do not want to be accountable to anyone other than their shareholders and, for the most part, they are not obligated to be.

    How does traditional Medicare drive system change? Traditional Medicare’s transparency and public accountability enable government to drive health care system improvements. Commercial insurers are financially incentivized to help themselves and their shareholders, not to serve the public good. They generally take advantage of traditional Medicare’s innovations.

    If you do not want Congress to destroy traditional Medicare, call House Speaker Paul Ryan. Congressman Ryan and Republicans in Congress want to weaken and destroy public programs like traditional Medicare and limit government spending, even if the result is to deny affordable health care to older adults and people with disabilities. If Congressional Republicans get their way, older adults and people with disabilities will be denied the choice of traditional Medicare, if not immediately, then over time. While some people are happy with their Medicare Advantage plans today, Congressional Republicans are likely to give Medicare Advantage plans even more tools to drive profits and shift more costs to older adults and people with disabilities. No one can say exactly what will happen. But, here’s what’s likely to happen:
    • To limit government spending on Medicare, the federal government will stop paying for all the care people need and instead will pay a fixed amount of the cost, effectively giving each person a voucher.
    • The Medicare voucher would likely cover the cost of most care for people in relatively good health.
    • The Medicare voucher would likely result in people with costly conditions trying to scrape together the funds needed to pay for their care or to forgo care altogether.
    • The new health care system for people with Medicare would drive up costs in traditional Medicare and force more people with traditional Medicare into Medicare Advantage plans.
    • Commercial insurers offering Medicare Advantage plans would likely be able to shift more costs onto people who need care most, forcing them into medical bankruptcy or to forgo needed care.
      • They would continue to have narrow networks, forcing people with costly conditions to pay out of pocket for out-of-network care.
      • They would offer plans with high deductibles, requiring people who need care to pay hundreds or thousands of dollars out-of-pocket before their coverage kicks in, along with high copays and coinsurance for costly care.
      • They would continue to exclude from their formularies drugs that people with costly conditions need.
      • And, they would likely begin to charge higher premiums. As people are forced to moved out of traditional Medicare, the Medicare Advantage plans would lose their ability to use traditional Medicare rates as leverage to keep rates down; instead, they would be forced to pay doctors and hospitals higher rates, likely driving up people’s premiums.

    If you are thankful for traditional Medicare, please sign this petition from Social Security Works.

    Here’s more from Just Care:

  • Support grows for Medicare buy-in and public health insurance option

    Support grows for Medicare buy-in and public health insurance option

    Secretary Clinton is proposing a Medicare buy-in for people between 55 and 64 and a public health insurance option in the state health insurance exchanges. The public health insurance option was introduced during debates around the Affordable Care Act as a way to give people greater choice, drive competition and rein in costs in the health insurance exchanges. And, the Medicare buy-in has been considered by Congress for decades as a way to increase access to affordable care for people nearing Medicare eligibility.

    Last month, 33 Senators supported a resolution to give everyone in the U.S. the choice of a Medicare-like public health insurance option. A new Harvard-Politico poll shows that a majority of Americans support this public health insurance option. Overall, 54 percent of Americans support the public option in the state health insurance exchanges. If you break down views by party affiliation, three out of four Democrats favor a public option and 52 percent of Independents. Six out of ten Republicans oppose the public option, but 26 percent support it.

    A new report by Linda Blumberg and John Holahan of the Urban Institute looks at how best to design a Medicare buy-in and a public health insurance option. The advantage of a Medicare buy-in and/or public option is that it should drive down insurance premiums. The government has the ability to secure lower doctor and hospital rates than insurers and also has lower administrative costs. If everyone 55-64 took advantage of a Medicare buy-in, it also likely would lower costs for younger people in the commercial marketplace since older people tend to have higher health care needs, which drives up premiums.

    Commercial insurers have far less market power to rein in provider rates than the federal government. Doctor rates under Medicare tend to be 20 percent less than what private insurers pay. And, private insurers now pay about 75 percent more for hospital inpatient stays than Medicare.

    As a result, many people in and out of the state health exchanges still struggle to afford health insurance. The state exchanges offer help paying premiums to people under 400 percent of the federal poverty level, but costs can still be high for some people. Both people with incomes above 400 percent of the federal poverty level and people not in the exchanges do not get premium assistance. And 55-64 year old adults in the exchanges can be charged premiums up to three times more than younger adults.

    Questions to be considered with a Medicare buy-in:

    1. Would people 55-64 have the option of traditional Medicare, a Medicare Advantage plan or a marketplace plan? If they had to enroll in Medicare Parts A and B, it would most help to reduce premiums for people under 55; but, it could increase their costs depending upon savings achieved through Medicare’s provider rates. And, if they had to enroll in Medicare, it could split up their family coverage, if they still had children eligible for a family plan.
    2. If they had the choice of traditional Medicare, would they be guaranteed the right to buy a Medicare supplemental insurance plan to protect them against catastrophic costs? And could they buy a Medicare Part D drug plan?
    3. How would the government calculate premiums for people buying into Medicare? And, would financial assistance be available to people based on income as it is for everyone else in the state exchanges.
    4. Would people have to pay a late enrollment penalty if they did not enroll in Medicare or if they only enrolled in Part A and not in Part B during the initial enrollment period?
    5. Would commercial insurers continue to offer plans in the state exchanges if these plans were only for people under 55?

    Questions to be considered with a public health insurance option:

    1. How would the government decide what to pay doctors and hospitals in the public health insurance plan?
    2. How would the government be assured an adequate network of doctors and hospitals? The federal government could require all Medicare providers to treat people in the public option plan. But, if authority rested with the states, would they have any leverage?
    3. Where would the public option plans be available? President Obama proposed that they be available only where there is weak competition. But, should they also be available where premiums are high?
    4. Would it be able to offer lower premiums and address affordability issues in the state exchanges? In some areas, it likely would not.
    5. How would the public health insurance option affect participation of commercial insurers in the state exchanges?

    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: