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I have just done something I said I would never do: shop for a Medicare Advantage plan to cover my gaps in Medicare. The usual flyers and brochures from sellers of Medicare Advantage plans began to arrive in the mail with their enticing sales pitches, and one nearly fooled me. Short of having a Medicare representative on the phone, you're stuck in an information swamp. No wonder studies show that beneficiaries are not eager to shop around even if they can get a new policy with a smaller monthly premium...
I recently spoke with a gentleman with a significant illness whose main goal is to stay home. He decided to utilize our skilled home health services and home medical equipment. Over time, he transitioned into our palliative care program and currently is in our hospice program. Here is information on what these services are and who may benefit from them...
American health care has become a gigantic game board with players of all sorts strategizing to win. Winning, of course, means getting more money from payers...
Just a few years ago it seemed that advocates for health care transparency had scored a big victory. The Centers for Medicare and Medicaid Services (CMS) announced that they would rate nursing homes by awarding five stars to the best and fewer stars to lower-quality facilities. It turns out, though, that five-star nursing homes may not be delivering five-star quality...
Poor oral health can have a negative impact on seniors’ overall health and well-being, but for many, there are significant barriers to visiting a dentist, finds a new report in the American Journal of Health Behavior.
That the government overpays sellers of Medicare Advantage plans is well known in Beltway circles, even if much of the public remains unaware…
A recent study in Health Services Research
based on 15 years of hospital data suggests that cuts in Medicare prices under the Affordable Care Act may slow the growth in overall hospital spending.
As the number of patient centered medical homes has increased, a new report in the journal Health Services Research
finds the model offers a promising option to reduce health care costs and utilization of some health care services.
If there is a population in which we have the biggest opportunity to see improvements in both cost and quality of care outcomes, it is older Americans. The debate on how best to deliver effective primary care has gone on a long time, sometimes frustratingly so, but it has almost never included a crucial constituency: older adults. The John A. Hartford Foundation is pleased to help change that...
Pharmacist-patient telephone consultations appear to reduce hospitalizations in patients who are least at risk, finds a new study in Health Services Research
The Obama administration and Affordable Care Act supporters have not bothered to explain how the law includes cross-subsidization, missing an opportunity to talk about the "we" aspects of the law. As one 58-year-old woman put it: "The chances of me having a child at this age is zero. Why do I have to pay an additional $5,000 a year for coverage that I will never, ever need?" Here's how it works...
Seniors are starting to realize that fewer doctors and hospitals may be available to them if they select a Medicare Advantage plan. Restricting these choices – in theory – is a way to control the price of health care. There's just one problem: Consumers still want to choose their doctors or stick with the ones they've got...
A couple weeks ago, the Medicare Rights Center, a well-known New York-based advocacy group, released a report card showing that seniors on Medicare are struggling to pay for their health care. This finding brings up an important question: Why aren't seniors using the variety of state and federal programs that have been set up to help people in this situation?
I am all for transparency when it comes to health care. So when Medicare announced a few weeks ago that it would begin to tell the public how much doctors are paid to treat Medicare patients, my first thought was "hooray." Still, I keep returning to the question: What will the data do for the average person?...
Hospitals that treat more poor seniors who are on both Medicaid and Medicare tend to have higher rates of readmissions, triggering costly penalties, finds a new study in Health Services Research
What's the key to reducing costly emergency room visits and readmissions? People who lack convenient access to a health care provider, with or without insurance, return to the emergency department or hospital out of need and desperation...
In part four of our series, we look at a few ways to estimate the cost of your care ahead of time so you can make the best choice for you and your loved ones. Our 'Be a Prepared Patient' resources offer trusted websites and tips to get started...
In part two of our series, we look at the difference between Medicare and Medicaid. Our 'Be a Prepared Patient' resources can help you figure out if you qualify for either of these or other special health care programs...
After half a lifetime of following the Medicare program, on October 1, 2013, I became a Medicare beneficiary. I'm part of the leading edge of baby boomers joining the program, ten thousand a day. Here are some reflections upon joining...
Let's stop telling the public that exercising and eating blueberries are guarantees for avoiding frailty and disability. Let's start talking about how to maintain our quality of life as we age and inevitably encounter health problems.
Don’t have health insurance? Here’s advice on how to find the right insurance for your needs.
Don’t know a deductible from a premium? Here’s a helpful guide to health insurance terms.
Learn more about the U.S. government’s health insurance programs for older adults and people with low-incomes and resources.
What to do if your health insurance denies you coverage for a procedure.
Older women living in the most deprived areas of the U.S. Appalachia had higher rates of late stage breast cancer than women in more affluent areas, finds a new study in Health Services Research
It’s the silly season again for Medicare. It comes around whenever a political campaign is about to begin as it is for next year’s mid-term elections….Politicians love to play ball with benefits for seniors.
A few days ago, Empire Blue Cross Blue Shield sent me one of those Medigap sales brochures that seniors usually expect during the fall open enrollment season.
The movement is growing, it seems, for making people who rely on Medicare have more skin-in-the-game. In the minds of some, seniors and the disabled pay too little for their health care and their Medicare benefits…
Seek insurance and manage the worrisome chores of arranging and paying for care.
Even though open enrollment closes this week for some 47 million seniors who can change their Medicare coverage arrangements for next year, the federal government is extending the deadline for certain people. Who are the lucky ones?
Selling health insurance on Twitter? Yes indeed. Not long ago a simple tweet about a blog called Medicare Made Clear alerted me to this new way to find sales prospects for Medicare Advantage Plans and Medigap policies
People have a right to receive in plain language a summary of what doctors bill, what insurers pay and how much they themselves must pay.
Virginia was particularly concerned that she would not get medical treatment after she turns 75. She had heard at that age, 'they send you a letter. They are going to start sending you literature on death.'
If you or a family member is on Medicare, you would assume that if they are in the hospital their care would be covered under Medicare's Part A hospital benefit. Right? Well, not always.
On a chilly New York day, a sales agent for UnitedHealthcare stood on a noisy street corner in Spanish Harlem pushing Medicare Advantage (MA) plans. He was engaging in table marketing a way to snag new customers, converts from other MA plans, he hoped.
Who doesn't think preventive health care is important? Probably nobody if you ask this question abstractly. But when it comes to getting it - well that's a different matter.
I didn't expect to write a sequel to my seven-part series about signing up for Medicare. Just when I thought I was on the program, and all was fine, it wasn't. After I submitted two bills for routine exams, I learned Medicare would not cover them as my primary carrier. That threw me into a tizzy. All my years of reporting about the program taught me that once you retire Medicare is primary.
Medicare turned 46 last week, but instead of celebrating its major accomplishment ' keeping millions of older Americans healthy ' it finds itself under siege.
I once thought that when I signed up for Medicare, I would never again have to worry about paying for health care. But I will. Medicare's future shape and substance is uncertain.
Even though I have written about Medicare for many years, it wasn't until I actually went through the process of selecting an option to cover Medicare's gaps that I realized seniors have an extraordinarily difficult, if not impossible, task. You can't make a perfect decision because so much depends on your future medical needs and no one can predict those with certainty.
Ah, those Medicare Advantage (MA) plans! The government can't seem to decide if it loves or hates them. On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. So it seemed like I was being encouraged to select an MA plan.
If I were to choose a Medigap policy to supplement my basic Medicare coverage, I would still have to buy a separate plan for prescription drugs, since Medigap sellers can't include drug benefits in those policies.
Findings of a new study suggest that cutting Medicare spending across the board could result in poorer health outcomes for the elderly.
The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps'the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill. I would have to pay 20 percent of those bills if I didn't have supplemental coverage.
Even before I officially signed up for Medicare, sellers of Medicare Advantage plans, prescription drug benefits and Medigap policies began stuffing my mailbox with marketing brochures and lead cards'the kind that ask for your name and address and tell you that a salesperson will call if you return the card. Since the first of the year, I have received five lead cards asking for personal information, four solicitations for Medicare Advantage plans, two for stand-alone drug plans and three for Medigap insurance.
This is the first in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future.
Someone I know who is just over 65 received an unlikely solicitation'from The Scooter Store located in New Braunfels, Texas, on Independence Drive no less. The outside of the envelope promised a free personal mobility assessment. This person is totally mobile and hardly needs a scooter.
An inside look at the cost of health care: a physician confused by the transparency of Medicare reimbursements and a patient in San Francisco unable to afford treatment for an enlarged prostate.
As Medicare's open enrollment season draws to a close, it's a good bet that seniors are still sifting through all those brochures and flyers that have come in the mail the last several weeks. My husband received 22. Here's a simple rule to make the sifting go a little faster.
Oh, those clever insurance agents, always on the prowl for new customers. This time they are using the current period of open enrollment for Medicare to snag customers for other insurance products'products that consumers may not need or want.
When the Centers for Medicare and Medicaid Services (CMS) took the rare step this spring of kicking Fox Insurance out of the Medicare Part D drug benefit program, it pretty much went unnoticed. CMS went after Fox, admittedly small fry in the pool of insurers, and said they couldn't sell any more stand-alone prescription drug plans to seniors These plans are the kind that people buy to complement Medigap policies that don't offer any drug coverage.
Do consumers buy health insurance like they buy canned peas? Or should they? That's the big question market place advocates have been trying to answer now for more than a decade. The government and others have thrown gobs of money at this vexing problem trying to figure out the best combination of stars, bars and other symbols that will catch the shopper's eye.
Obama administration officials and the president himself have been on the road selling the benefits of health reform.' The other day in Maryland the president was touting the $250 rebate sent this week to some three million Medicare beneficiaries whose prescription drug expenses have reached the infamous donut hole where there is no coverage.
In the past two weeks I have visited two college campuses---one in Brooklyn and one in Wisconsin.' Large numbers of students turned out to hear about the new reform law and wanted to know what it meant for them.'