Forbes:
Get ready for more cuts to private Medicare plans, and more fired doctors, as insurers are forced to cheapen provider networks, and benefits.
That’s the upshot from the announcement by the Centers for Medicare and Medicaid Services that 2015 Medicare Advantage rates will be cut a whopping 8%, once new reductions get baked into the program’s baseline.
Some of the best analysis of the new rate adjustments comes courtesy of managed care analysts at Credit Suisse. In a report tonight, they cobble together the different adjustments to arrive at the 8% figure. With this being an election year, and 15 million seniors (about 29% of all Medicare beneficiaries) getting their care from the program, there’s a chance that some of these cuts will get reduced. The Obama Administration has until April 7thto publish the final numbers.
The total reduction is the sum of a dozen different adjustments. Some stem from statutory variations that are made to the program based on broader fiscal trends in healthcare. Other cuts are a direct result of Obamacare.
One of those Obamacare cuts is a 2% reduction to the rates that CMS pays to the Medicare Advantage plans for each beneficiary they enroll.
Previously, these health plans were paid a premium on the amount of money that each beneficiary is estimated to cost under Medicare’s fee for service program. Under Obamacare, the Medicare Advantage plans are brought into parity with FFS Medicare.
The Obama Administration funneled money to the MA plans during 2012 to offset these reductions ahead of the Presidential election. With the election out of the way, these cuts are finally coming due.
Another piece of the 8% reduction comes from the fee Obamacare imposes on health plans. Starting in 2015, health plans are required to pay an $8 billion (non-tax deductible) fee that will be apportioned to the different insurers based on their share of the total risk-based premiums that the industry collects. This fee accounts for another .6% of the projected 8% cut.
Elections do have consequences. I know a number of oldies that voted for this clown and believed his promises. I did not and still do not.
I have a friend who wears a colostomy pouch. She wanted to order a different supply from the medical supplier she uses who takes her Medicare benefits as payment. The product is called “skin-prep”. Dr. John knows what it is. The one she is using contains alcohol which burns her. So we looked up a different product on the company’s website and found skin preps without alcohol. She called the company and they told her they could send it to her, but she would have to pay for it up front because a) it was not the product she had been getting and b) the rules for Medicare had changed. The cost would be $70.00+, the company would then fill out the form for her to be reimbursed from Medicare. They did not know how much Medicare would reimburse her but it would be 80% of what is considered “reasonable and customary”.
Now, this lady lives off her small retirement and her Social Security and she doesn’t have a whopping $75. to plunk out not knowing how much she will get back from Medicare. I decided to go on Amazon to see if they carried the product she wanted. Yep. $13.95 and no shipping charges. That’s almost a $60.00 difference.
So I researched the product the company is currently selling her. The company is charging five times what Amazon charges and Medicare pays for that 100%. And we wonder why Medicare is costing American taxpayers so much? That’s why.
Retire05: I as a Public Health RN have seen this reduction of benefits for the patients I provide in home care.Monthly Ostomy supplies have been cut in half. The better supplies such as the non-sting skin prep(Cavilon) have been deleted from the medicare list. Vitamin B12 injections are no longer covered. Incontinence supplies under pallative care, no longer covered. I could go on. The office I work out of has laid off 50% of the staff . We have been told that Obamacare has reduced reimbursement by 60% to medicare patients. Private Insurance companies are now very stingy with their allowed Home Health visits. Patients are coming out of the hospital in my opinion, too soon.
On the flip side, my Medicaid patients still view Obama as a Messiah and a savior.
I am frightened for our health care system and for America.
@IBelieveintheConstitution:
My friend, who has extremely sensitive skin, has been buying her stoma power from Amazon for some time now. Her medical supplier stopped carrying the brand she was using (that worked) and no longer pays for the type she needs. As you know, skin bleeding from an adhesive rash is not fun. But hey, I guess as a senior, her value to the government is negligible.
Two years ago her supplies were covered. Now she is finding that, more and more, she has to purchase those supplies on her own. And she has learned that if she has reversal surgery, she will not be covered for home health care. Even her secondary insurance will not cover it because Medicare doesn’t. And guess what? All that was in the fine print of the ACA, better known as Obamacare.
Of course. Medicaid, which no one pays for, also includes dental and vision care, which Medicare, which all of us contribute to, does not. Medicaid is the Obama phone of the medical industry. And the philosophy is never, never, never reward the producers. Only reward the non-producers. That is the only way they can reach income equality, only it’s not equal. It punishes those who have contributed to the system while rewarding those that haven’t and are only a burden on the system.
If she can soak the tape with baby oil first, letting the oil soak in and spread into all the tape from the edges in, she will be able to remove it without any pulling at all.
I think there is also a product called Detachol (or Uni-Solve) that she can buy through the web (Amazon).
Some times even a warm wet compress (washcloth) pressed on the tape for a few minutes before removing it works.
I used to take care of my mom who had issues with this.
Key is allowing enough time for the entire tape to be saturated, not just the edges.
@Nanny G:
She had tried all those solutions, Nan. My friend has a severe adhesive allergy, one of the worst I’ve ever seen, and even a Band Aide on her arm for a few hours causes a severe rash, even those made for sensitive skin. But through trial and error, she has managed to find a few products that help reduce the affect of the allergy. And it is those products that Medicare no longer covers.
The problem is that the products that helped her, and that worked for her, were eliminated in 2013 and this year, as well. And before this year, what Medicare did not pick up, her secondary insurance did, at least partially.
Seniors on the Medicare program, even those with secondary insurance, are going to find that they have worse coverage than before, and that a number of items they require on a daily basis, are no longer covered. It is one way to cut benefits for seniors that paid into the system their entire lives to give to those who are ballooning the Medicaid rolls. The entire concept is to make Medicare just as pathetic as Medicaid, and to give greater benefits to those who never invested in the system or paid for the program in any way. This is right out of Cass Sunstein’s book.
You cannot support the distribution of free stuff to those who never pay for it without reducing the availability of that same product to those who do pay for it. There are just so many doctors to go around; just so many drugs manufactured; just so many medical supplies produced and without increasing production, limited by government regulations, there becomes a finite amount of product available for distribution.
I also have a friend who is on SSSI, and is on Medicaid. She lives just 40 miles from Austin, and has degenerative disc disease, but cannot find a doctor that will accept her Medicaid. Right now she is driving to Dallas for doctor’s visits. Sign of the times and things to come? I would say “yes.”
@retire05:
ABSOLUTELY!
This is the filthy, disgusting, nasty secret about ANY government involvement in medicine. Once you get the government involved in ANY way, the need for layers and layers of bureaucracy, paperwork, forms in triplicate to be approved by a federal bureaucrat (with no actual knowledge of medicine, mind you) lead to a ridiculous increase in the cost of doing medicine. This is EXACTLY why anyone who thought obamacare would ever be able to reduce medical costs is too ignorant to understand the financial impact of the federal bureaucracy on medicine.
Medicare does not pay for lasik eye surgery. Guess what has happened with lasik since it first came about? Quality has dramatically improved and cost of the procedure has gone way down. Once medicare/medicaid get involved in setting prices and reimbursement for medical services, the prices go up. It is the same sort of warped economic pattern we see in housing costs around military bases. See, the people with properties to rent know exactly how much the military member’s housing allowance is going to be, and rental prices are at least that amount or higher regardless of what the actual rental value would be without the artificial inflation imposed by having such a government set housing allowance.
The government needs to get out of medical care, reimbursement setting, and health insurance. That is the only compassionate way of bringing down medical costs over time. The manner in which the leftists will bring down medical costs will absolutely involve rationing of care via bureaucratic oppression – except for the elite, who will be granted exemptions just like they have from obamacare.
@retire05:
In the panhandle, there are no private pediatricians who will accept medicaid. None. I do not blame them at all, given what the reimbursements are for outpatient care. What boggles my mind is seeing the parents of these patients, with the latest cellphones, all kinds of facial hardware and tattoos all over the body…yet these same people complain about having to pay for their own infant car seat, or their own breast pumps, or baby formula. Somehow infant formula (these folks think) is supposed to be covered by the government, to free up money for another tongue piercing or a bitchin’ new tat.
Honestly, I have been stunned when a parent seems irritated that they can’t get a new crib for their baby through medicaid – but you can bet the manicure mom has is spectacular.
With this sort of “gimme more free stuff” attitude, it seems unlikely that such a quaint concept as personal responsibility will return until a major socio-political upheaval occurs.
@Pete:
My GP is a personal friend of mine. He did accept Medicare patients (he was the only GP in a small town for a long time) and he showed me what he is reimbursed by Medicare. He charges $60.00 for a routine office call. In his area, determined by his zip code, the R & C (or what ever they call it now) is $48.00 so he gets 80% of $48.00 or $38.40 for a Medicare covered office visit. I wonder how many of the lefties on this board would be willing to take an almost 22% cut in pay. When he closed his practice to new Medicare patients, people who moved to town after that got mad and said they didn’t understand why he wouldn’t see them; after all, the government paid him, right?
Living in a small town I get to see the entitlement society up close and personal. I can’t tell you how many times I have stood in line at our one grocery store to watch people pay for T-bones with the Lone Star card. Or how many people I know live in the public housing projects showing up on a Wednesday at 7-11 to buy their lottery tickets or at the liquor store paying in cash that I know they have debited from their Lone Star card. They get free housing, free food, free medical care, free phones, and free cable (in my area) and cash from the Lone Star card. And many of them have one drug bust after another on their records.
But I will say that the Hispanic women don’t seem to be into the fake finger nails like some of the others, they just can’t speak English.
Retire, what I especially love is having a second job that takes me away from my kids 7 days a month, all so I can pay the taxes on my first job…then seeing my taxes used to pay for the medical care for babies born to drug abusing moms. It isn’t the babies’ fault. But the drug abusers never face any financial consequences for their actions, the babies suffer, and those of us paying taxes have no recourse other than deciding not to work as much….which would only add to the problems the innocent babies have.