By Rick Banas of assisted living provider BMA Management, Ltd.
When you look through the materials distributed by the Centers for Medicare & Medicaid Services (CMS) on “2012 Choosing a Medigap Policy,” you should take notice of a statement printed in bold, said John McCallag in a presentation on Medicare Supplements that he conducted at our Heritage Woods assisted living community in Huntley, Illinois.
The statement reads “There can be big differences in the premiums that different companies charge for exactly the same coverage.”
Medigap is the common name used to describe a Medicare supplemental insurance policy.
John is a Certified Senior Care Advisor based in McHenry, Illinois.
The main ways you get Medicare coverage is either through what is termed the Original Medicare Plan or through a Medicare Advantage Plan.
With Original Medicare Plan, Medicare Part A is your hospital insurance. It helps cover inpatient care in hospitals and provides certain benefits for skilled nursing, hospice and home health care services. Medicare Part B is your medical insurance. It helps cover doctor’s services, hospital outpatient care, and certain preventive health and home health services.
Medicare Part D provides your prescription drug coverage.
If you get your coverage through Original Medicare Care, you can add supplemental coverage through a Medigap Insurance Policy if you so choose. A Medigap policy helps you pay for some of the health care costs that Original Medicare does not cover such as copayments and deductibles. If you have a Medigap policy, Original Medicare will pay its share and then your Medigap policy will pay its share.
A Medicare Advantage Plan works like an HMO or PPO and combines Part A, Part B and usually Part D. If you decide to get your Medicare coverage through a Medicare Advantage Plan, you do not need a Medigap or Medicare Supplemental insurance policy.
Here are some key points that John stressed during his presentation about Medigap policies:
When you buy a particular Medigap plan, what is covered through the plan is identical whether you buy the plan through Blue Cross, AARP, Aetna, Mutual of Omaha or any of the other carriers that offer the plan in your area. Click here for Medigap Policies in your area.
The monthly cost can vary widely for a Medigap plan with identical coverage. To illustrate the point, John distributed a monthly premium cost comparison analysis for a standard Medicare Plan F supplemental insurance coverage for a female non-smoker living in a 600 zip code. Depending on the age of the individual, the premium difference for the same policy with the same coverage among ten insurance companies ranged from more than $30 to nearly $150 a month (from more than $360 to nearly $1,800 a year).
What you pay has nothing to do with the claim services or whether or not your carrier will pay for a procedure.
It is Medicare that determines if a particular procedure is covered, not your Medigap insurance carrier. If Medicare approves it, your Medigap insurance carrier is obligated by law to pay.
The determination as to whether or not Medicare approves a particular procedure is all done by Medicare and by computer.
John suggested that you should review your Medicare supplemental insurance (Medigap) once a year.
He also suggested that it might be worthwhile taking a look at a high-deductible Plan F Medigap insurance policy. The difference in the monthly cost may be more than enough to cover the potential cost of having to pay a deductible amount before your Medigap plan will provide coverage.
I had the privilege last week of serving as guest speaker for a meeting of the Advisory Council of a National Coalition dedicated to promoting quality and affordability in assisted living.
We talked about the tsunami of older adults that will be hitting the United States in the coming years and about the Supportive Living program that we have here in Illinois as a model for affordable assisted living throughout the United States.
The Silver Tsunami
Today, there are 2.5 million individuals in the U.S. who are 85 years of age and older. In 2030 the number is projected to triple to more than 8 million. In 2050, the number is projected to swell to 21 million.
In 2009, 16% of all men and 21% of all women over the age of 65 who lived alone had incomes that fell below the federal poverty level.
Nearly 45% of our 75+ population living at home have annual household incomes of less than $25,000 and 60% have less than $35,000. The average cost for assisted living tops $3,000 a month and $36,000 a year.
The Supportive Living Program
The Supportive Living Program that we have in Illinois serves as a prime example of how we can meet the needs of older adults, while improving the quality living in a more cost friendly manner
Before the Supportive Living Program, the only options available for older adults who needed assistance and couldn’t afford assisted living was to move into a nursing home (which was much more costly to the state) or struggle alone at home.
The program benefits the state. In the 2009 fiscal year, estimates show that the Supportive Living program saved the State of Illinois $90 million.
The first Supportive Living community opened for occupancy a little over 10 years ago. Serving as an economic stimulus, the program has generated $750 million in new construction and renovation projects. Creating more than 4,321 new jobs.
Best of all, the program provides older adults with a much more dignified. They can enjoy a residential environment designed to provide safety, security, love, compassion and independence.
Unlike assisted living communities that tend to be located in areas of higher incomes and higher housing values, Supportive Living communities are located throughout Illinois – in urban, suburban and rural areas. Together, the nearly 120 Supportive Living communities currently in operation house nearly 9,400 apartments.
On average, more than 60% of the residents at the 30 affordable assisted living communities that we operate receive financial assistance from Medicaid.
I invite you to visit our website at www.bma-mgmt.com for more information about Supportive Living, the affordable assisted living communities that we operate through the program, and how we are touching the lives of older adults and their families.
What are your thoughts? Leave a comment and let us know.
“BMA Management is the leading provider of affordable assisted living in Illinois and one of the 20 largest providers of assisted living in the United States.”
By Rick Banas, Vice President of Strategic Marketing
In a Blog (Click) posted last week, I discussed AARP’s and Congressman Bill Foster’s support of the Health Care for America Act, the Senate’s version of health care reform.
AARP declares the Act to be budget neutral and argues that it not only protects Medicare benefits, but puts Medicare on much stronger financial ground.
Congressman Foster says that “I don’t think it does anyone any good to think that this will not cost money,” but feels that adding a surtax on people who earn more than $1 million a year will be sufficient and is a better approach than taxing the health care benefits provided to workers by their employers.
He supports the legislation even though “I can rattle off a lot of things that are not perfect about the bill” because “it contains a lot of provisions that I believe are important,” especially to those who live and work in his district.
Patient advocate Betsy McCaughey (Click) of the organization Defend Your Healthcare, however, expresses concerns about both the House and Senate health care reform plans, especially when it comes to seniors and baby boomers.
She is the author of numerous articles on health policy, infection, medical innovation and the economics of aging. She authored an Op-Ed piece on “ObamaCare’s Winners and Losers” that was published in the Nov. 24 edition of the New York Post and an opinion piece on “What the Pelosi Health-Care Bill Really Says” that was published in the Nov. 7 edition of The Wall Street Journal. Earlier this week, she discussed the Senate health care bill with Dennis Miller on his radio show.
According to McCaughey, who is a former Lt. Gov. of New York, both the House and Senate plans slash funding for Medicare by nearly half a trillion dollars, primarily by reducing payments to hospitals and other institutions that care for Medicare patients.
She notes that Medicare’s Chief Actuary Richard Foster warns that reducing payments to institutions that cater to sizeable numbers of individuals on Medicare might jeopardize their ability to remain profitable and their willingness to continue to participate in the Medicare program.
This would jeopardize access to health care for Medicare beneficiaries without the government ever having to take action to “ration” care. After all, where will the rapidly increasing number of people who will be depending on Medicare in future years go for their health care if there is a significant reduction in the number of institutions that are willing to accept Medicare.
In addition, McCaughey notes that Section 4105 of the Senate version of health care reform empowers the government to modify or eliminate preventive care services for seniors based on what the US Preventive Services Task Force recommends. This is the same task force, McCaughey says, that last month recommended that women forgo mammograms between the ages of 40 and 50, settle for mammograms every two years from ages 51 to 74, and stop altogether after age 74. “The Task Force says its guideline will be 81% as effective in saving lives and should be good enough.”
In her opinion piece on the House version of health care reform, McCaughey also cited the following that may be of concern for seniors:
Moves Medicare toward a “medical home” system in which a primary care provider would manage a patient’s access to specialists and diagnostic tests.
Cuts in payments to Medicare Advantage Plans, which could impact optional benefits such as vision and dental care.
Replaces physicians with physician assistants in overseeing care for hospice patients.
“More Americans will be losers than winners,” says McCaughey.
What are your thoughts? Leave a comment and let us know.
“BMA Management is the leading provider of affordable assisted living in Illinois and one of the 20 largest providers of assisted living in the United States.”
By Rick Banas, Vice President of Strategic Marketing at BMA Management
While differing on why and the costs involved, a US Congressman and a representative of AARP explained their support of the Affordable Health Care for America Act at the Health Care Reform Forum held this past Saturday in St. Charles, Illinois.
I had the opportunity to attend the Forum, which was hosted by AARP and featured presentations by Congressman Bill Foster, who represents Illinois District 14, and Heather Heppner, of AARP’s Chicago office.
“We have a system of health care coverage that is broken,” Heppner noted as she discussed H.R. 3962, the Affordable Health Care for America Act that was passed by the U.S. House of Representatives on Nov. 7.
AARP endorsed the Act because it addresses critical issues of importance to our members and because it is budget neutral.
According to Heppner, the Act . . .
Protects Medicare benefits and puts Medicare on much stronger financial ground.
Addresses over a 10-year period of time the Medicare Part D “Donut Hole” issue, which has some seniors paying for the full cost of medications plus Medicare part D coverage.
Prevents health insurance denial because of pre-existing conditions.
Prevents insurance companies from discrimination based on gender.
Extends Medicaid coverage to 150% of the poverty level.
Helps strengthen the ability for seniors to age in place through Community Living and Supportive Services.
Contains a Health Insurance Exchange Provision that will encourage competition among insurance companies for our business.
Includes a Public Plan Option for those unable to find health insurance.
Includes Individual and Employee Mandates requiring individuals to have health insurance coverage and employers to provide coverage for employees.
Congressman Foster stated that it is crystal clear that “we are paying too much for health care and too many people are becoming uninsurable.”The health care system in the United States is “one of the most expensive for the results that you get.”
After taking the opportunity to read all 1,950 pages of the Act, he says that “I can rattle off a lot of things that are not perfect about the bill,” but support the legislation because it “contains a lot of provisions that I believe are important,” especially to the people who live and work in his district.
In a special report that was available at the Forum, Foster cites 10 principles for secure and affordable healthcare:
Job one is to reduce health care costs for families and businesses.We cannot afford to have the cost of health care double like it has in the past 10 years.
Cut giveaways to insurance and drug companies.There can be no cuts in Medicare.
Stop insurance companies from denying coverage for pre-existing conditions and from capping lifetime benefits.
You should not lose your insurance coverage if you change or lose your job.
We should put the nation on a path of assuring affordable, quality health care coverage for every America citizen and their children.
Reforms must preserve existing choices of doctors and health plans.
Reform should not increase the debt burden for our children.
Workers cannot be taxed for the health care benefits they receive.
Insurance policies must encourage individual responsibility with wellness programs and reward Americans for healthy choices.
We should use computerization of patient records and advanced technology to improve the quality of care and prevent medical errors.
According to Foster, health care reform will cost money.“I don’t think it does anyone any good to think that this will not cost money.”He cited two ways to pay for the additional costs.One way is to tax the health care benefits provided to workers by their employers, which is not a method Foster supports because “it will hurt the middle class.”He supports the approach of adding a surtax on people who earn more than $1 million a year.
When asked about what we can do about Medicare fraud to help cut health care costs, Foster stated that it is “my feeling that we are not spending enough on enforcement. We have to work harder at it,but the enforcement budget has historically been underfunded.
When asked about the House Bill not including a provision to allow portability across state lines, Foster felt that health care insurance is better regulated at the state level.“States can agree to cross market insurance plans,” he said.
Congressman Foster complimented AARP for being “on our case every single week” about health care reform.
He hopes the Senate will act as well.
Do you agree?Please share your views with us by clicking on Comments.
Also, watch for Blogs reflecting other views on health care reform in the coming weeks.
What are your thoughts? Leave a comment and let us know.
“BMA Management is the leading provider of affordable assisted living in Illinois and one of the 20 largest providers of assisted living in the United States.”
When you look through the materials distributed by the Centers for Medicare & Medicaid Services (CMS) on “2012 Choosing a Medigap Policy,” you should take notice of a statement printed in bold, said John McCallag in a presentation on Medicare Supplements that he conducted at our Heritage Woods assisted living community in Huntley, Illinois.
Today, there are 2.5 million individuals in the U.S. who are 85 years of age and older. In 2030 the number is projected to triple to more than 8 million. In 2050, the number is projected to swell to 21 million.
