Saturday, November 14, 2015
The Center for Medicare and Medicaid Services (CMS) released on November 10, 2015 what the monthly cost will be for Medicare's Part B (outpatient treatment) beginning January 1, 2016. Some points on these:
● Individuals currently enrolled in Part B, and not earning over $85,000, will continue to pay $104.90 each month. The amount is the same as in 2015 because CMS has a hold harmless regulation so a person's monthly payment will not be reduced if Social Security will not have a cost of living increase in the upcoming year.
Note: Part B's monthly cost for individuals is normally based on Medicare's total Part B cost; divided by everyone enrolled; and multiplied by 25%.
● Individuals who enroll in Medicare Part B effective January 2016 or later will have a monthly cost of $121.80.
● Everyone enrolled in Part B will continue to be responsible for 20% of the amount Medicare allows for any outpatient treatment. Most individuals buy a Medicare Supplement or a Medicare Advantage plan to cover their 20% cost sharing and the Part A and Part B deductibles.
● The recent federal budget authorization also added a $3 per month surcharge for Part B. It will be added to the monthly cost of everyone enrolled beginning January 1, 2017.
● Medicare's Part A (hospitalization) has a per admission deductible. It will be $1,288 for 2016 up from $1,260.
● Medicare's Part B has an annual deductible. It will be $166 for 2016 up from $147.
Questions - Call my Google Voice # today - (860) 451-9793 if any questions about Medicare in 2016 or a Medicare Health plan to cover your share of Medicare's treatment expenses.
Tuesday, October 20, 2015
Social Security & MediCARE work together each fall to establish benefits for the upcoming year. This is federal level activity but I want to highlight some things about this since it affects a lot of people here in CT. BTW - did you know CT has the 7th oldest population in the U.S. ! !
Some points on the result of these federal agencies working together:
● Based on some special calculations Social Security determines whether individuals currently enrolled will receive a cost of living increase in their monthly benefit. Usually, but not always, this is communicated in October.
● The US Health and Human Service's Center for Medicare & MedicAID Services (CMS) Department then establishes:
+ Medicare benefits such as Hospital deductible in Part A (it's $1,2xx in 2015) and the annual upfront deductible for the Outpatient services in Part B. (its $147 in 2015)
+ The monthly cost people enrolled in Medicare Part B will pay beginning Jan 1st. To make it simple - this amount equals 25% of the cost of Part B services over the U.S. divided by the number of people who are expected to be enrolled.
This will be communicated this year in early November
Typical of government benefit programs things are often not as simple as I have highlighted. There is a provision, someplace in all the regulations, that says - OK if there is not going to be a SS cost of living increase then the amount individuals, currently enrolled in SS pay for Part B can not be increased.
This provision also has exceptions.
● People who have not yet enrolled in SS will pay a higher amount for MediCARE's Part B when they do enroll. This could be:
+ Individuals who are not yet age 65 or
+ Individuals who are waiting to enroll in SS, after first eligible for full retirement benefits (currently at age 66) so they can receive a higher monthly amount when they do enroll.
● People who filed a Single tax return and whose income is above 85k are now paying more than the standard Part B cost, currently $104.90 a month. They also have to pay more. This income amount is double for a couple. BTW there are two additional higher income step above 85k.
There will not be a SS cost of living increase for 2016 so these provisions will be affecting many people.
Thursday, September 10, 2015
Sharing a CT Mirror post showing what Individual Medical insurance costs will be in 2016.
This informative article includes charts comparing rates for different health insurance companies.
One thing not included in the post is some people who enroll in a medical insurance plan through Access Health CT. The way this works a person who enrolls in a Silver Plan and whose adjusted gross income, on their Single IRS 1040 in 2014, is about 46k or below is eligible for what I like to call - premium support. It's officially called a Advance Premium Tax Credit (APTC).
What this means - the amount they pay each month is based on their AGI income not age. The APTC is the amount the premium for their age is above what their income level qualifies them to pay. Thus, the APTC for someone age 62 and whose AGI is 40k will be higher than someone at 42 who has the same AGI.
The federal system sends the APTC amount to the qualified person's health insurance company each month.
+ Anyone who qualifies for a APTC will also be enrolled in a plan with a lower maximum expense limit for the year.
+ A person whose AGI is around 32k or lower also becomes eligible for Cost Sharing Reductions, which lower their plan's deductible and visit co-pays.
Bottom line there is more to selecting a plan on Access Health CT than looking for the lowest premium. It is important for consumers here in CT looking for an Individual Medical insurance plan to contact a health insurance professional certified to work with Access Health CT.
Monday, May 25, 2015
The way we receive health care today is changing in many ways.
+ On the provider side we see lots of consolidation, which often results in higher fees.
+ The way treatment is covered by our medical benefit plans has been evolving for a few years. Implementation of federal health reform, beginning in Jan 2014, has had a big impact on increasing the cost sharing individuals have to pay.
A couple recent news posts related to these changes caught my eye:
The first is connected to the way we receive healthcare and I believe it is very important - Getting fully involved in your medical treatment.
Jennifer Thew, RN., the Senior Nursing Editor, for HealthLeaders Media brought out some points in her May 19, 2015 article, which I want to share.
I have followed the way medical treatment is delivered and have seen MDs indicating better treatment outcomes can often be gained if there is transparency on the details of a medical treatment session between the MD and patient. One part of improving this transparency, which is not always easy to implement, is to get individuals more involved in their care.
The article reported on a group of Primary Care MDs who are making the results of their visits available to patients online. She indicated in part:
“ - - - a year long study to explore how sharing clinician's notes affected care. The results found that patients frequently accessed visit notes, reported a greater sense of control and understanding of their medical issues, had improved recall of care plans, and adhered better to medication regimens.”
The study was based on a program, which is expanding, called OpenNotes. This effort will be an important step toward people receiving improved health care since in much of today’s treatment not a lot of information is available to the individual. Because of this there can be a negative impact on patients. She shared an example where the lack of information following a person’s first treatment resulted in a complicated medical situation when the situation was later found.
She also brought out a point another professional made on why it is important to get people involved:
"Another really important part of patients reading their notes is the fact that they can contribute to safety monitoring," says Jan Walker, MBA, RN, co-director of OpenNotes and assistant professor at Harvard Medical School. "Care is really complicated, we're all human, we all forget things, and having another set of eyes on what's going on can probably help people avoid errors."
Bottom line – this article provides examples on why it is so important for everyone to talk with their MDs during treatment sessions and to ask for a copy of the notes, which the MD made following the visit.
The second article was connected to to a point I communicate to client employees – A procedure performed by a high volume surgeon has advantages for them.
Cheryl Clark, senior quality editor for HealthLeaders Media reported in a May 21st article 20 hospitals have announced the "Take the Volume Pledge" campaign. Its focus, according to John Birkmeyer, MD, a surgeon, outcomes researcher, and executive vice president for enterprise support services at the Dartmouth-Hitchcock hospital, is to “reduce complications”. He indicated:
"What we're trying to do is minimize the number of patients who wind up getting their care by so-called 'hobbyists,' surgeons and hospitals that seldom do these procedures, certainly not enough to attain a high level of honed proficiency."
Cheryl Clark’s article also reported another point from Dr. Birkmeyer:
“hospitals and surgeons who perform certain procedures infrequently aren't always doing them just because it's lucrative, which it can for smaller organizations.”
"It's less because of the survival instinct and economics of high revenue surgeries. Instead, they're just accommodating the pride and professional autonomy that surgeons believe is their due. What hospitals do care about is running afoul of their surgeons and ultimately losing those surgeons who would go somewhere else."
My sense, in reviewing the article, is outcomes information on surgeries in low volume vs high volume hospitals will be developed in the future. Information and data to determine quality and outcomes is however difficult to gather and report.
In employee meetings, when discussing suggestions for doctor visits, I usually indicate when an MD says the recommended treatment for this situation is surgery it’s very important to get a second opinion. When doing this they should also seek out a surgeon that does lots of procedures like the one you are considering.
Tuesday, April 14, 2015
I want to share some points from a report – Considering Healthcare’s Transformation. It was created following a gathering in January 2015 of healthcare executives. Specific comments made by individuals are shown in quotes. I added bold to emphasize some points I see as important to individuals.
● Much is being done to transition to value based care, which gets you and I as consumers involved in our health. About 1/3 of the providers – hospitals – physician groups indicate their concern in implementing this was “uncertainty about revenue streams”.
● The transition going on in information technology (IT) to store data in cloud based systems results in physicians thinking individuals electronic medical records (EMR) will be connected to all aspects of care.
● Consumers will be more involved in the way care is going to be managed and will “take more responsibility for health decisions".
● Surveys indicate “nearly half of consumers and 79% of physicians believe using mobile devices can help clinician’s better coordinate care”.
● Consumers are demanding more eVisits and done when they want.
● The chief medical officer at a North Carolina health system indicated – “The consumer wants to be more in the driver’s seat and less in the it’s-being-done-to-them seat as we move forward”.
● An individual from one health insurance company stated – “We work - - to move to population health in a new world order where payment structures will transition from fee-for- service healthcare to instead reward outcomes and value”.
● An MD who is a principal in the consulting firm PriceWaterhouseCooper (PwC) Health Industries Advisory service indicated – “We are now focusing on the 80% of people who are healthy, who we never paid attention to before. In the past, nobody cared if a member is healthy because as long as there is no cost and he is not sick, it’s not important. But now, because we are going to be accountable for the total cost of our population, we want to keep these folks healthy, which means we can attack the obesity problem to prevent people from getting sick and getting diabetics. That’s important”.
● The PwC MD also indicated – “My hope with the population health management approach is that we are able to bring the cost down so the financial burden is not significant on the consumer. Because otherwise we can be doing everything good but the patient is not willing to comply”.
Connecting to what the MD states, in the above comment about responsibility for treatment expenses, individuals in today's medical insurance have a larger cost share. Plans no longer just have visit co-pays. Now, to meet health reform requirements, plans use more cost sharing and a deductible. In some cases it is a deductible followed by cost sharing.
FYI - Traditional plans in CT include a provision in 2015, which limits a person's expenses during a plan year to a Maximum Out of Pocket (MOP) of up to $6,600. Health Savings Account plans follow IRS regulations and have have a MOP of $6,450.
Questions - Call my Google Voice - we can talk about things going on in CT. (860) 451-9793.
Tuesday, January 06, 2015
January is here and it brings lots of situations where we need medical care.
● Should I get help for a cold?
● What if I fall on the ice or snow?
● How do I decide what kind of treatment is needed and who to see?
Some good answers are provided in part of a December 9th post on Forbes by Robert Glatter, MD entitled – Urgent Care or ER.
I’m pleased to share this information:
Emergency Care or Urgent Care?
In general, urgent cares are appropriate for minor medical ailments (sprains, minor lacerations, sinus infections, sore throats, bronchitis, ear infections) or for a medical condition that could be treated in your family physician’s office, but the office is closed.
You should proceed to an emergency department if you feel that you might be experiencing a medical emergency. The following are some examples of warning signs of a medical emergency:
● Difficulty breathing, shortness of breath
● Chest pain or upper abdominal pain or pressure lasting two minutes or more
● Fainting, sudden dizziness, weakness
● Change in vision
● Difficulty speaking
● Confusion or changes in mental status, unusual behavior, difficulty walking,
● Any sudden and severe pain
● Severe or persistent vomiting or diarrhea
● Coughing or vomiting blood
● Suicidal or homicidal thoughts
● Unusual abdominal pain
● Severe headache or vomiting after a head injury, unconsciousness, uncontrolled bleeding