Be prepared for changes in 2010

by Charles Chaput,
President Primary Care Insurance Services

Medicare Advantage insurance companies choose to do business in a federally controlled industry called Medicare. The rules are clearly defined by the government, but they may change rapidly and often do so. In fact, when we consider things on a broader scale, we begin to see a trend that seems to repeat itself about every two or three election cycles. The government either wants to incent the movement of the Medicare population into Medicare Advantage plans or Congress believes that too much spending is associated with funding the Medicare Advantage program and therefore cuts need to be made. The latter is now happening.

Medicare Advantage plans will be impacted by an approximate 4% reduction in the overall payment they receive from the federal government for 2010.  Additionally, during a recent speech to the American Medical Association, President Obama specifically made comment to $300 billion that could be saved by eliminating the excess payments under the Medicare Advantage program.  Finally the Centers for Medicare and Medicaid Services (CMS) have been encouraging Medicare Advantage companies to consolidate the number of different plans being sold when prudent.  Insurance companies are cautiously  monitoring the pulse of Congress and the White House, and we believe that 2010 may be a year of considerable change within the Medicare Advantage arena.

While it is possible that a few Medicare Advantage plans may choose to leave the market for 2010, what is more frequently to occur is that we will see premium and co-payment amounts going higher, and  some adjustments being made to benefit limits.  By federal law, Medicare Advantage plans need to inform members of any changes being made for calendar year 2010, by the beginning of November.

Here are a few helpful tips when evaluating your Medicare Advantage coverage for 2010:

1. Has your premium gone up?  If so, how much per YEAR?
2. Were any important benefits eliminated or reduced significantly?
3. Have there been any changes to the co-payment amounts?  Pay attention to the dollar amount, as well as the number of days you must pay before the plan picks up all additional costs.
4. Did any co-payments change from being a dollar amount to being a percentage of charges?  Pay close attention, as this can be significant for things such as lab services or outpatient tests and procedures.
5. Did any of the co-payments change for your prescription medications?
6. Did your prescription plan’s formulary (list of approved drugs) change and will any changes affect the specific medications you are using?
7. Did your own personal health care needs change in the past year?  Are there any benefits you need going forward that are not provided with your current plan?

The most important thing, is do not panic.  If your Medicare Advantage plan is changing substantially for 2010, there are likely other Medicare Advantage plans accepted by your Primary Care Physician and any Specialists that you may see.  The Medicare Annual Election Period officially starts on November 15, 2009 but Medicare Advantage plans generally publish their plan designs at the beginning of October.  This provides nearly three full months to carefully evaluate your options before the end of the Annual Election Period on December 31, 209.

Despite the changes expected for 2010, we believe Medicare Advantage will continue to provide an extremely valuable service to the Medicare community.  While Medicare Supplements can now easily surpass $200 per month in premium and most still do not include an annual physical, Medicare Advantage plans should remain attractively priced compared to Medicare Supplements and nearly all Medicare Advantage plans provide an annual physical with your family doctor.  Medicare Advantage plans may also include additional benefits associated with vision, hearing, dental or transportation.

Medicare Advantage plans and benefits vary by county, and most Primary Care Physicians only accept a limited number of plans, so be sure to only consider plans accepted by your physician and available where you live.

Last night when Obama referred to the fact that 34 states offered 4 or less insurance companies  to chose from, I thought he was moving towards  allowing us to purchase health coverage across state lines.  He moved on  quickly to our need  for choice and  competition for the insurance companies to keep them honest.  He made a strong point of holding private insurance companies accountable.   Obama’s  solution was not what I had hoped, instead it was the government “Public Option”!  In other words, he is going to force private insurance companies to compete with government backed Public Option, to keep them honest?

Obama  talked about the waste in Medicare, if there is so much waste then why do we need to wait for a Health Care/Insurance Reform bill to cut out or cut down existing waste?  If he is so sure there is waste, has  been able to identify where the waste is, can make this determination and know just how much money the government would save, what are we waiting for … let’s stop this waste  immediately!

This week I personally experienced  Medicare waste, however it is not caused by inefficiency or bad medical practice … It’s caused by my Doctors fear of  Malpractice Insurance and the lack of tort reform.  I had no idea that a medication that I have taken for over 20+ years, Armour Thyroid for the  treatment for  people with  Hypothyroidism,  is now  a medical controversy.

The problem I’m experiencing  is  a shortage of Armour Thyroid, (for further information see below) because of this shortage all the other generic  formulas that contain both T3 and T4 are running short in supply.  The only prescription medications for hypothyroid  still available are the synthetics which  contain only T4.   My doctor would not prescribe “2″ medications that would give me both the T3 and T4 (which my body  needs)  because there is (10 year) controversy in the medical community over the 2 medications.  He was honest with me and told me the only reason he couldn’t prescribe these medications was that it posed a potential problem for  his malpractice insurance.  When I reminded  him that I feel terrible on Synthroid and asked him what I could do …   He referred me to a specialist, Endocrinologist, who specializes in body chemistry … The first appointment they have available is December 23, 2009.  That is a little over 3 1/2  months from now.

Waste: short visit to primary care physician for prescription refill vs new doctor, 1st Doctors Office Visit (higher cost), additional blood tests, ultra sound of the thyroid gland and  a possible CAT  scan.  In addition, a follow up visit to go over the test results and prescribe medication. And additional cost to Medicare – a min of $1,000

Effect to Patient: body chemistry will radically change causing loss of energy, depression and mental confusion.  Having to adapt to a new synthetic medication takes 2-4 weeks, then changing again to the needed medication with a wait time of 3 1/2 + months, once a new prescription is issued, an  addition 2-4 weeks to having your body chemistry balance … although it can be more difficult to adjust the dosage at this point. (My appointment is December 23 … the day before the beginning of Christmas holidays … which means it will be sometime in January before all test can be done, back to doctor and a 2nd appointment made, final results to get a new prescription).

Cause: Lack of Tort Reform  and Doctors  fear of  Malpractice Insurance guidelines

The additional information below  provides more specific details if you are interested in either the problem with Armour Thyroid or dealing with Hypothyroidism.

Your thyroid gland controls your metabolism (cellular energy) and when it’s low, every system in the body is affected. Hypothyroidism is fairly common for women over 60.

Low thyroid affects the immune system (chronic sinusitis, colds, flu), brain chemistry (low moods, anxiety, ADHD, poor memory), reproductive system (infertility, PMS, irregular menstrual cycles), digestive system (constipation, bloating, gas), sleep/wake cycle (poor sleep), nervous system (tingling/pain in hands, feet), pain threshold (more pain) headaches, and of course overall energy or metabolism (and weight control).

I have had  hypothyroidism for over 20 years and have been taking a medication called Armour Thyroid.   With Armour, I have no problems and no side effects. Armour is a brand and made from  naturally desiccated thyroid product.   Armour contains both T3 and T4, which are hormones that feed the thyroid gand. Synthetic  thyroid products contain only T4.   Suddenly the supply of Armour Thyroid has become next to impossible to find.  According to their web site:

Statement from Forest Laboratories Re: Availability of Armour Thyroid

Forest Laboratories and its supplier understand how frustrating the back order situation of Armour Thyroid is for patients, and we apologize for the supply interruption.

Forest Laboratories is working closely with its supplier of the product’s active ingredient, powdered Thyroid gland, and both companies are working diligently to return to normal supply levels as quickly as possible.

There are many complicated steps involved in the supply chain for a naturally desiccated thyroid product like Armour Thyroid. One factor in the supply interruption involves the manufacturing of a sufficient quantity of powdered Thyroid gland. American Laboratories, Inc., the sole U.S. supplier of Thyroid Powder Products, is working as quickly as possible to provide Forest with a sufficient quantity of this ingredient.

Forest is addressing the backlog of Armour Thyroid as quickly as possible, however, we are not prepared at this time to give a definitive date by which the product will be fully restocked.

Please check for future updates on the availability of Armour Thyroid through the Forest product availability toll-free hotline at (866) 927-3260.
In the meantime, we encourage patients to speak with their physician regarding appropriate treatment for their condition.

Sunday, August 30th,  I went to Rep. Jay Inslee’s Town Hall Meeting on Health Care Reform.  When you first enter the area you find stacks of printed  information titled “America’s Affordable Health Choices Act of 2009″.  I believe this was the first time I have seen HCR called Choices Act.  Anyway, the section on how they are going to pay for HCR got my attention. 

That section read as follows:

Paying for Health Care Reform

1.  Elimination of health care fraud and abuse:

• $102 billion in savings over 10 years by incorporating productivity adjustments into Medicare payment updates for hospitals which will more accurately aligning Medicare payments with hospital costs
• $110 billion in savings over 10 years by closing the Medicare Part D “donut hole”
• $100 billion in additional savings over 10 years through key delivery systems reforms such as incentives to reduce readmission’s to hospitals and promoting accountable care organizations
• $156 billion in savings by eliminating over payments to private Medicare Advantage plans over 10 years

2)  Tax increases on the wealthiest 1.2% of Americans

My interpretation  was that  HCR will be payed for by 1) cuts in Medicare and 2) tax increases of the wealthiest Americans.  My questions was how can they be cutting such massive amounts in Medicare and fixing Medicare at the same time?  It appears to me that instead of fixing existing problems with Medicare, they are taking money out of medicare to pay for those currently uninsured.  There was nothing in the information packet that told me how they were saving Medicare, or fixing the existing problems with Medicade, VA and health care for Indians.

When discussing this with a liberal I was told that I didn’t understand, he suggested I read the following:

The Kaiser Foundation has a summary of the America’s Affordable Health Choices Act of 2009″ (H.R. 3200) It shows a reduction in Medicare spending of $538.5 billion and an increase in Medicare spending of $320.4 billion. The net reduction (the difference between these two numbers) is $218 billion.

Included in the $218 billion reduction, is a reduction for Medicare Advantage of $172 billion over 10 years. So the actual reduction in traditional Medicare (not including Medicare Advantage) is $46 billion over 10 years. This is less than 1% of spending on Medicare over the same period.

Maybe it’s just me, but this still does not make sense. I can’t find anything that tells me how they plan to save Medicare, remember Obama keeps telling us that Medicare is going broke. What happens over the next 4 years when we start adding millions of baby boomers when they hit Medicare system? So they are only going to cut Medicare by $46 billion and somehow they are making Medicare better and have enough money left over to pay for insurance for 47 million uninsured? That plus taxing the rich. No wonders nobody trusts the government! Obama tells us that we can keep the same doctors under his plan … yet try to find a Doctor now that will take straight Medicare patients!  When Obama  cuts the Advantage Plan that will  leave 10+  million American  without the extra medical coverage from that  program, what is the governments plan to help these people?

What else are we supposed to believe  when Obama appoints yet another Czar, Ezekiel Emmanuel, health care adviser —who is a proponent of the Complete Lives System, which puts values on lives based mostly by age. The idea that we can help 4 people that are 30 years old rather one person who is 70 years old, is more cost effective and better use of government $$$$!  That certainly brings no comfort to Senior Citizens and it can’t help but lead to rationed health care as we flood the health care community with baby boomers over the next 4 years  and no longer have enough Doctors or Nurses to treat patients.

Prior to Emmanuel, the President nominated Tom Daschle,  to be secretary of health and human services. He withdrew as the nominee on Feb. 3, 2009, because he had failed to pay more than $128,000 in taxes.    Daschel wrote the book, Critical: What We Can Do About the Health-Care Crisis . Daschle’s plan suggests the  government  create a Federal Health Board, modeled on the Federal Reserve Board that manages monetary policy. The basic idea is to create an institution, run by experts, that answers to the government but is “largely insulated from the politics and passions of the moment,” he writes. (Appointed by the President, but not political and holds subjective views?)  Ultimately,  Daschle’s talk of comparative effectiveness research is just a smokescreen for a plan to establish bureaucratic centralized health care rationing.

If we are unable to  find anything clearly defined in the Health Care Reform bill as to how the bill will be paid for, other than taking from the elderly to give to the young, and taxing the wealthy ….  and we see the philosophy of the 2 men he has appointed to the position of   Health Care Czar or Secretary of Health and Human Services, what are we left to think?

This coming week, Obama will be repackaging and selling his newest  version of Health Care Reform, in yet another speech to the country.  I’m anxious to see if he actually offers anything different or can provide explanations that make sense to Americans.  Obama and Pelosi have made it clear that they intend to pass a Health Care Reform bill, what ever it takes!

From NewsMax 9/06/2009

Nearly 7 in 10 adults polled by CBS News say they are confused about how healthcare reforms would work.

Sixty percent of those surveyed said President Barack Obama has not explained his healthcare plans clearly, and 67 percent said they found the reform proposals confusing.

Only 36 percent of respondents believe that the government would do a better job of providing healthcare insurance than would private insurers.

Confusion over healthcare reform could explain why Americans are not eager to see it become law. When respondents in a Rasmussen Reports poll were asked if they would prefer passage of the healthcare bill now in the House or nothing at all this year, 54 percent chose nothing at all. Only 35 percent supported the bill, and 11 percent were unsure.

Rasmussen also found that among those Americans who already have healthcare insurance, only 43 percent believe the claim that they will be able to keep their current insurance plan after the proposed law is enacted.

Obama is speaking in Montana as I type.  He has changed his sales pitch from focusing on Health Care Reform to Health INSURANCE Reform.  Same package, new label.

The question came up about how this “health insurance reform” would affect those on Medicare.  Obama states that we need to eliminate waste in Medicare. He wants to cut out the Medicare Advantage plans because there is  no real benefit to medicare recipients.

There are 10 million senior citizens on Medicare Advantage, and they are paying a monthly premium.  Do you really think there are 10 million stupid seniors,  that have  so much extra cash,  they would be willing to  pay a premium for a policy that is of no benefit to them?  And what happens to these seniors when they loose Medicare Advantage?  Depending on which state you live in, try to find that Doctor that will take a straight Medicare Patient.  In WA, it’s almost impossible to find a doctor unless you have either Medicare Advantage, a Medigap plan, or you go to a public hospital where the taxpayers subsidize physicians associated with that hospital.  In this state Dr’s receive approximately $120,000 a year from taxpayers  so that they can afford to take medicare patients.

Obama just stated that the money the government will save by   reducing current  waste such as the Advantage plan, will go to pay for those that don’t now have insurance.  To me that sounds like he is taking away money from the care of the  elderly to help the young.  Remember, he has already stated that he wants to cut $400 billion from Medicare waste.

When the President and the liberals tell you that you will not loose your current Doctor or choices, that is a total lie when it comes to Senior Citizens on Medicare and Medicare Advantage!

AARP FACT #2: No legislation currently in Congress would mandate the rationing of care. Period.

Our staff has read all of the legislation circulating in Congress and there are no provisions in these bills that would ration care for our members. None. If any ever did, we would vigorously fight to stop that legislation.²

Does this make sense?  The government keeps telling us that social security and medicare are going broke, the President says he is going to cut 400 billion from Medicare and in just a couple more years baby boomers will be hitting the medicare system.  So, with medicare having less money, more people on medicare and the Congressional Budget Office says that the current medicare system is not sustainable … does there need to be a mandate?  If they run out of money and it becomes an “emergency” …. then somebody is going to be making decisions about what health care seniors are going to have available to them.

AARP FACT #3: There is no provision of any piece of legislation that would promote euthanasia of any kind.

The rumors out there are flat out lies. Right now Medicare does not cover counseling for end-of-life care. The portion of the bill in question would simply provide coverage for optional end-of-life consultations with doctors, so that the patient can be aware of all of the treatment options on the table. It is not mandatory and it has nothing to do with euthanasia.³

OF course there is no legislation promoting euthanasia … however in this state (Washington) we did pass the right to die law.  Perhaps in 10 years when I hit 75 and  oh, lets say maybe I break a hip … and medicare has limited funds, if any,  is there going to be a government appointed panel (oh yea, Obama is already working on that panel) that will decide if it’s cost effect to repair an old ladies hip?  Well, I would have my dog put down so if the government decided that it wasn’t cost effective and I had the choice to just live with a broken hip or be put to sleep … guess which one I would choose?  And in this state, it would be my choice not the government telling me I had to choose euthanasia.  However, it would be nice if the government  would at least pay for it!

AARP FACT #4: We have not endorsed President Obama’s plan.

In fact, we haven’t endorsed any plan. We are supporting reform of our health care system, something that AARP has pushed for many years. We’re working closely with Republican and Democratic members of Congress to lower health care costs and to ensure quality affordable coverage for older Americans – and we want reform legislation passed and signed by the president this year.⁴

Why then do I keep getting emails and automated phone calls from AARP asking me to call/write/fax my Rep to ask them to pass the health care reform bill?  Again, people keep asking WHAT’S THE HURRY?  We do need health care reform, but why does AARP and the Politicians insist that he has to be done this year? Personally, I would like to see them FIRST fix medicare, medicaid and Veterans health care before they completely redo our entire health care system.  They can’t even fix what we already have, why should I trust them to create even more health care programs?

This is pretty complicated and once done very difficult to undo!  I also think I have a very legitimate concern since the House and Senate have been passing bills this year without reading them.  Now that is truly scary!!! I tell my kids, never sign anything until you have completely read and understand what you are signing, should I expect less of the government who’s decisions will affect the lives of those I love?

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