On May 25, Associate State Director of Communications for AARP Illinois visited Sun City as a presenter of a healthcare forum, in which audience members came to learn how the new healthcare bill will affect them. To accommodate all the questions in the allotted amount of time, audience members were asked to write down their questions to be answered by AARP at a later date. Below are some of questions and answers that were unable to be answered by Heppner at the time of the forum. More Q&As from the Healthcare Forum will appear in future Sun Day editions.
Q: [Re: incentives for providers who offer high-quality care.] Wonāt offering lower reimbursements to providers be a disincentive for doctors to accept Medicare patients? There are some who are setting up special prepayment plans outside of Medicare to senior age patientsāisnāt this likely to increase (āconciergeā plans)?
A: The new healthcare law actually provides a 10% bonus to primary care doctors as an incentive to continue to treat Medicare patients. Currently, primary doctors are reimbursed the lowest compared to other physicians, and this additional payment will help to ensure that primary doctors are paid fairly. There are some doctors who are setting up prepayment plans to guarantee a personās access to that particular doctor (āconcierge plansā). This is legal; however, AARP hopes that this trend does not continue once the entire Medicare doctor reimbursement system is overhauled (that legislation is currently pending in Congress).
Q: Will the Independent Payment Advisory Board allow Medicare to reduce or eliminate presently covered services?
A: No. Guaranteed Medicare benefits (e.g. Part A hospital benefits, Part B doctorās visits, Part D prescription drug plans) are specifically protected in the new law. Individuals who participate in a Medicare Advantage plan may see a change in some of the benefits provided, as these plans will see a phase out of the 14% subsidy they currently receive from Medicare. However, Medicare Advantage plans will not be able to reduce benefits below what traditional Medicare provides.
Q: Will people who choose not to purchase insurance be treated as indigents in hospital emergency rooms? Will they be treated at all?
A: People who are otherwise not insured and choose not to purchase health insurance through the exchange may continue to choose to go to the emergency room for their medical care. However, given the subsidies available for individuals to purchase insurance through the exchange, the tax penalties for not purchasing insurance, and the expansion of Medicaid, it is expected that 32 million more individuals will have health care coverage and will not need to receive routine care in the emergency room.
Q: Will Medicare cover services provided to 65+ by nurse practitioners and physician assistants? The last two times I went to see my primary doctor, he had these professionals take care of me. They did a great job!
A: Yes, there are certain services that Medicare will cover when provided by physician assistants and nurse practitioners. However, Medicare requires that certain conditions be met in order to reimburse providers for services rendered by physician assistants or nurse practitioners. For example, nurses and physicians assistants must always be under the direct supervision of a physician, and the physician must be present in the office and immediately available to provide assistance and direction.
Q: Will Medicare cover the shingles vaccination shot under the new preventative care provisions?
A: Unfortunately, we donāt know the answer to this yet. Rules and regulations not yet released from the Secretary of Health and Human Services will include this kind of information. Many predict manufacturers of vaccines and diagnostic tests will push for their products to be labeled “preventive services” in a bid to have them covered at no cost to consumers.
Q: What additional preventative services will be covered by the changes in Medicare outside of colonoscopies, mammograms, and bone density screenings?
A: Screenings strongly recommended with a grade of “A” or “B” by the U.S. Preventive Services Task Force, an independent advisory panel. Among them (but not limited) are breast and colon cancer tests, screening of pregnant women for vitamin deficiencies, tests for diabetes, high cholesterol and high blood pressure, as well as counseling to help smokers quit. For more information on the taskforce, go to their website: www.ahrq.gov/clinic/uspstfab.htm
Q: My doctor claims to need permission from Medicare before performing necessary tests. I might have to wait 3-30 days before getting permission. Is this correct?
A: Yes, in some cases, doctors do need prior authorization from Medicare before performing certain tests. Usually this occurs when Medicare traditionally might not cover or pay for the test; therefore, the doctor will submit permission from Medicare to cover the test. These rules were in place in Medicare prior to the passage of the health care law.
If Medicare would ever deny payment, you can file an appeal if you think Medicare should have paid for, or did not pay enough for, an item or service you received. If you file an appeal, ask your doctor or provider for any information related to the bill that might help your case. Your appeal rights are on the back of the Explanation of Medicare Benefits or Medicare Summary Notice (MSN) that is mailed to you. The notice will also tell you why your bill was not paid and what appeal steps you can take.
Q: Who monitors the quality of care by providers?
A: There are several organizations that evaluate quality of care by providers. For example, the Joint Commission reviews quality in hospitals. However, the Centers for Medicare and Medicaid Services (www.cms.gov) has a Quality Improvement Group that is responsible for monitoring quality of care from Medicare providers.
Q: Is the Individual Mandate penalty of $95 a monthly or yearly penalty? Does this increase over time?
A: In 2014, the penalty for individuals who choose NOT to purchase health insurance will be $95 per year (or 1% of their income, whichever is greater). In 2016, the first year the fine is fully in place, it will be $695 a year or 2.5 percent of income, whichever is higher. That makes the mandate progressive. The law specifically says that no criminal action or liens can be imposed on people who don’t pay the fine.
Q: Will the government monitoring of premiums and limits eliminate state insurance departments?
A: No. State insurance departments (e.g. the Illinois Department of Insurance) will play a critical role in the implementation of the federal healthcare law and will assist in monitoring and enforcement efforts.
Q: What is the Medicare Trust Fund? How can Medicareās spending on uncompensated care be reduced? It seems that expanding coverage increases Medicareās spending.
A: The Medicare Trust Fund is the fund through which Medicare benefits are paid out. Prior to the passage of the new healthcare law, it was anticipated that this fund would be exhausted by 2017. With the passage of the new law, the fundās solvency will be extended beyond 2027.
Under the new healthcare law, the number of uninsured is projected to fall substantially. To date, hospitals have received additional payments for caring for those that donāt have insurance or providing uncompensated care. Those additional payments to hospitals will be dramatically reduced because more people will now be insured; therefore, the Medicare program will save money and no longer spend millions of dollars on uncompensated care.
Q: Explain what a Medicare Advantage Plan does, including pros and cons.
A: A Medicare Advantage Plan is a specific type of Medicare plan offered by private insurers in various parts of the country. Typically, services under these plans are ābundledā so that individuals do not purchase a separate Medicare supplement or Medicare Part D plan. These plans typically offer certain additional benefits beyond what traditional Medicare offers, such as gym memberships, vendor discounts, etc.
Q: I am 70 and covered by Medicare. I began my supplemental Medicare Part B insurance after I was 65. (Prior to this, I had coverage through my wifeās employer, which I no longer have since she retired.) My supplement coverage provider charges me an additional premium because I began my supplement after 65. Is this legal?
A: Every individual situation can be different, but usually in this circumstance an individual is not penalized for having a supplemental Medicare plan after the age of 65 when they had employer-sponsored healthcare (even through their spouse). Once someone would be on Medicare, the former employer would sign a document indicating the person had employer sponsored healthcare. For more information, go to www.socialsecurty.gov or contact your local social security office.
Q: Since Medicare is only aware of what they have paid for prescription drugs, not aware of the individualās real out-of-pocket costs, can the individual claim catastrophic coverage if they have receipts for out-of-pocket costs that show they have exceeded the doughnut-hole maximum amount?
A: No. Your Medicare Part D plan provider tracks your out-of-pocket costs and reports these figures to Medicare. You cannot claim catastrophic coverage. If you believe there is a discrepancy between your records and the claims from your Part D plan, contact your Part D plan and speak to a representative.
Q: My supplemental Medicare coverage and prescription drug coverage premiums increase annually even though I am a healthy individual with few Medicare claims and minimal prescriptions. What does the new bill do to help me in this respect?
A: The new law takes steps to curb excessive premium increases; however, there are no specific provisions that prevent premiums from increasing (e.g., most supplemental coverage premiums go up as someone ages). However, the new law will lower out-of-pocket costs for certain preventative services, such as mammograms and colonoscopies, that will now be covered by Medicare free-of-charge.
Q: My wife and I pay supplemental insurance premiums on our own, not through an employer. The premiums have tripled in the last 10 years. Is there something in the bill that limits how high these premiums can go?
A: The new law does not contain specific provisions related to capping premium increases; however, there are provisions that will help to prevent arbitrary or excessive premium increases. The rules and regulations on how that will happen have yet to be released.
Q: Will Medicare costs for us continue to increase?
A: While we cannot specifically project Medicare cost increases, the intent of the new law is that healthcare costs overall will decrease over time as the various provisions of the law are implemented.
Q: Iām afraid our healthcare will be affected by this change. Iām concerned that I will have less care from my doctor because of the increase in people on this new plan.
A: The intent of the healthcare law is for you to continue to have access to doctors you want/need. As stated above, the law even provides a 10% bonus for primary doctors as an incentive for them to continue to treat Medicare patients. In Illinois, the Illinois Academy of Family Physicians indicates that capacity and access to doctors should not be an issue.
Q: Will we be refused treatment because of our age (e.g. chemo, radiation, by-pass surgery, etc)?
A: No. The new healthcare law does not ration healthcare. AARP would adamantly oppose any measure that would deny our members necessary treatment.
Q: My COBRA benefits are expiring. Do I need to go without insurance for 6 months before I can apply to a high-risk pool?
A: Yes. The high-risk pool only applies to individuals who have been without insurance for 6 months or more.
Q: I heard on CNN that insurance companies are not supposed to or cannot refuse to insure people with preexisting conditions. Yet deeply buried in this legislation is a provision that allows insurance companies to refuse to insure someone with preexisting conditions (the company would just be subjected to a fine up to $100 per day). This is obviously a loophole for insurance companiesāit will be cheaper for some companies to pay the fine rather than insure the person. Is this true?
A: You are correct. Insurance companies can no longer deny anyone with pre-existing conditions without penalty. In September 2010, the clause will be in effect for children. In 2014, the provision will be in effect for anyone who has a pre-existing condition. In addition, the $100 per day fine is correct, and it might be possible that a company would pay the fine rather than insure the person.
Q: Will the new bill fund abortions?
A: No, the new healthcare law prevents taxpayer dollars from funding abortions.
Q: What about vitamins and nutrients? Since Sen. McCainās amendment for this bill was dropped due to a large outcry from nutrient users, it was not included in the present healthcare bill. Now there is a bill about the FTC (S-3214) which has been passed by the Senate. It is now going to the House. What does this have to do with nutrients? It is a bill for Wall Street Banks, Insurance companies, etc. However, Senator Waxman of CA amended it to include nutrients at the last minute. The FTC will have unchecked power in their decisions. The drug companies have been trying to get rid of nutrients for many years. I am only on nutrients and vitamins because I am allergic to drugs. Nutrients can be tripled in cost or made illegal to use by this bill. I am 83 years old, and without them, my lifespan can be cut short. I will not take drugs. What can we do about this? Can AARP help? PS ā I do not use drugs or hospitals and hope never to have to. I am very healthy and my nutrients do not have side effects. I want to keep it that way. I belong to AARP and think they are very helpful.
A: Unfortunately, the new law does not address coverage for vitamins, nutrients, or other herbal or supplemental medicines. AARP does believe vitamins, nutrients, or other herbal medicines can be effective, but refer to the following website on information about the safety of supplements, descriptions of common supplements, and why it is important to talk about the supplements you take with your doctor and pharmacist.
www.aarp.org/health/staying_healthy/eating/herbal_supplements_are_they_safe.htm
Q: I heard that the bill places a 3.8% tax on real estate regardless of your financial situation. Is this true?
A: No. Taxpayers earning less than $200,000 (or $250,000 for a couple) will not pay higher taxes on their investment income. Starting in 2013, if you earn more than $200,000 as an individual taxpayer, or if you earn more than $250,000 and file a joint tax return with your spouse, you will pay a 3.8% tax on your net investment income. Net investment income includes interest, dividends, annuities, royalties, rents, and capital gains. It does not include income from Social Security, pensions, or IRA distributions. Payments from qualified IRA annuities are also not counted as net investment income.
