Health care reform and Medicare
by Pat Hill, www.ourTellerCountynews.com
Posted: Saturday, October 15, 2011 8:00 am
The Patient Protection and Affordable Health Care Act was supposed to be about reform and alleviating some of the unconscionable conditions in America’s health care system. Instead, the legislation is a lightning flash point, with 28 states, Colorado included, suing the federal government over the provision that mandates health insurance for nearly everybody.
For senior citizens, media coverage that includes talk radio, has cast a negative light on a bill that, in reality, enhances services through Medicare and Medicare Advantage Plans. “Medicare is offering more preventative stuff at a lesser cost, which is good and more cost-effective than taking care of seniors when they’re really sick,” said Lisa Hietala, director of Senior Insurance Assistance.
Among the preventive benefits are the annual wellness checks. “This encourages the physician to review the status of the patient,” Hietala said.
As well, new patients receive a free “Welcome to Medicare” physical, which gives the doctor an overview of the person’s medical history.
Granted, before the reform bill, Medicare was changing the way it did business, Hietala said. “But the Affordable Care Act made the preventative stuff more affordable without the co-pay and deductibles, which I think is important,” she said.
REFORM BILL BENEFITS
A report by the Center for Medicare Advocacy, Inc. states that, with the reform bill, Medicare savings will be about $130 billion over 10 years, by reducing overpayments to private Medicare Advantage plans.
In the past, these plans were paid 9 to 13 percent more than the traditional Medicare program to provide the same coverage. The Affordable Care Act phases in changes to the overpayments, starting with a freeze in the payment formula.
Increasingly, payments to physicians will be linked to quality outcomes for entities that provides services to Medicare beneficiaries, a result of the reform bill.
In August, Medicare or aging-in patients of Colorado Springs Health Partners received letters urging them to sign up for Advantage Plans, that its physicians would no longer accept patients who have traditional Medicare. “Medicare Advantage plans allow your primary-care physicians the flexibility to manage your care appropriately while providing you with options and coverage not currently available through Medicare, oftentimes at lower cost,” the letter states, in part.
According to the report for the Center for Medicare Advocacy, in 2014, 85 percent of advantage-plan revenues must go toward benefits, not profits, or plans may be subject to sanctions. Advantage plans are offered by corporate insurance companies such as Humana, Kaiser, Rocky Mountain Health and Secure Horizons/AARP.
“Some providers are moving toward that model based on the fact that they feel they can provide better care with better reimbursement and consistency,” Hietala said. “That’s a business decision.”
NEGATIVES OF THE BILL
A report for The Heritage Foundation, a conservative think tank, by Robert Moffit, Ph.D. blasts the new bill as a negative for physicians.
“Physicians will be subject to more government regulation and oversight, and will be increasingly dependent on unreliable government reimbursement for medical services. Doctors, already under tremendous pressure, will only see their jobs become more difficult,” Moffit writes.
Under the bill, Medicare payments to physicians will be slashed by 21.3 percent, “without congressional intervention,” Moffit added.
For Hietala, the nature of phrases such as “without congressional intervention” and “unless Congress acts” are all part of the scare tactics employed by opponents of the reform bill. “This is what bothers me — stop scaring the seniors,” she said. “I’m not a political person but stop doing that.”
Scare tactics certainly are not reducing the number of physicians seeing patients in the Pikes Peak region. “We have a list of physicians who will take new Medicare patients,” Hietala said. “I think there’s a lot of spin on both sides and that’s not to discredit the doctors because Medicare reimbursement is low compared to private health insurance companies.”
PEAK VISTA
Certainly seniors on Medicare are welcome at Peak Vista Community Health which offers primary care and no waiting list. In a partnership with the Center for Aging at the University of Colorado Colorado Springs, Peak Vista offers mental-health evaluations for seniors as well.
“Doctoral psychology students work with our patients on depression and early signs of dementia; they work closely with our physicians so they can refer back and forth,” said Venita Pine, vice president of administrative services. “This is a comprehensive approach to elder medicine.”
With retirement plans cratered by the Great Recession and the polarizing effect of the reform bill, the number of patients with depression has increased. “I think we have seen an uptick in depression; the health-care reform is confusing. It changes every day and there are so many things up in the air we don’t know what’s going to happen in 2014,” Pine said. “With an election year coming up, everything’s back on the table. I can see where it would be frightening for the average person who doesn’t think about their health care until they need a doctor.”
One of the most misleading information deals with pre-existing conditions. “It’s my understanding that insurance companies can’t deny you coverage because of pre-existing conditions if you don’t have access to any other health insurance,” Hietala said. “So people on Medicare will still have some underwriting with things like Medicare supplements.”
Patients with pre-existing conditions are not an issue at Peak Vista. “We’ve never turned away a patient with a pre-existing condition,” Pine said. For patients diagnosed with cancer, for instance, the clinic has a collaborative arrangement with the oncology department at Penrose/St. Francis Hospital. “A lot of physicians in town volunteer with Peak Vista or they’ll take referrals,” Pine said.
To top it off, AgeWell Medical Associates, which primarily serves Medicare patients, recently broke ground on a 8,000-square foot office in Colorado Springs.
MEDICARE OPTIONS
While the Senior Insurance Assistance hosts monthly Medicare 101 forums, Hietala reviews the basics of each plan:
Medicare Part A: Seniors can sign up for Part A, at no cost, by calling the Social Security office at 1-800-772-1213. Part A helps cover inpatient care in hospitals as well as skilled nursing, hospice and home-health care.
Medicare Part B: at $115 a month, Part B is medical insurance that helps cover doctors’ and other health care providers’ services.
“You can replace it with Medicare Advantage plans at no additional cost or you can supplement it, which enhances the Medicare benefit,” Hietala said.
Supplemental benefits and plans are standardized by the federal government. “So the benefits have to be standardized with every insurance company,” Hietala said. “On these plans, you pay a higher monthly premium because the benefit is bigger. But if you have catastrophic illness or accident, the out-of-pocket is almost zero. These plans begin at around $110 a month and go up, according to the company.”
Part C, Medicare Advantage plans: Offers options by Medicare-approved private insurance companies that includes prescription-drug coverage. “Some Advantage plans have no monthly premiums, others have considerable monthly premiums which enhances the Medicare. The advantage plans may offer things like dental care,” Hietala said.
With a flat co-pay, the advantage plans are the least-expensive monthly option. “You may choose a plan that has no additional monthly premium but you know you have a co-pay and that’s it,” she said. “And if you ever have to take drugs, you have that.”
The Affordable Care Act capped payouts for long-term treatments for patients insured by advantage plans. “Chemotherapy treatments for instance, are capped with some plans at $6,700,” Hietala said. “People can plan for that, can budget for it.”
Medicare Part D, the drug plan. “It’s a tradeoff,” she said. “If you’re a healthy person, don’t have anything chronic, aren’t a doctoring kind of person, you probably won’t need this part.”
SENIOR INSURANCE ASSISTANCE
Hietala founded the nonprofit organization in 1995, which is now part of the Pikes Peak Area Council of Government, under its Area Agency on Aging division in Colorado Springs. “Last year we helped 1,693 people, one-on-one, not counting the presentations we did,” she said.
For people aging-in to Medicare, the informational forums are the third from 9 to 11 a.m. and 1 to 3 p.m. on the third Monday of each month at 15 S. 7th Street in Colorado Springs. For reservations, call 635-4891.