FAQ: Congress Passes A Bill To Fix Medicare’s Doctor Payments. What’s In It?

Well, our Congress has finally reached a decision on SOMETHING . . . .this time it's about how to stop the madness around the decreases to physician's payment schedules under what was known as the SGR or "sustainable growth rate" formula.  That's good news for physicians.  Maybe not such good news for some Medicare beneficiaries.

They are always looking for ways to pay for their changes to the system, and that is valid - it's WHAT they look at sometimes that puzzles me.  It is known that Insurance companies were caught increasing their risk scores (meaning that they over-inflated their numbers of high risk beneficiaries in their Medicare Advantage programs), so that they could receive more money to support those programs. 

Instead of reigning in that type of fraud, they decided to take away things like first dollar coverage for Medicare supplement plans C and F.  In other words, they are taking away more consumer choices, that have no impact on Medicare expenditures.  In 2012, this very issue was looked at to see if having first dollar coverage led to "overutilization" of medical care.  The National Association of Insurance Commissioners (NAIC) conducted its own study, concluding that it did not.  And, logic says that it cannot, since Medicare supplement plans can only pay AFTER Medicare pays.  So, if there is overutilization - it occurs at the Medicare payment level - not because someone has a first dollar Medicare supplement plan.

It's too bad we can't take away some of the wonderful choices around insurance that we provide to our legislators, while we tell them that we think that by taking away their choices, it will somehow "change their bad behavior".

There are other elements to the legislation that fixes the payments to physicians under Medicare.  You can read more here

Congress Is Back And Looking At Limiting Your Health Insurance Choices - But Now It's About Medicare!

Yes, that's right!  They are busy at work to begin examining ways to limit a Medicare Eligible person's insurance options.  Like your Medicare supplement?  Want to buy one that offers full coverage, and pays for gaps that Medicare does not cover?  Well, you may not have that option anymore if certain members of Congress get their way.

This article explains some of the options that were discussed at the hearing to discuss ways to solve the physician pay "sustainable growth rate" (SGR) problem - or "doc fix" as some call it:

"Why Medigap Sellers' Ears are Burning"

I guess I am mystified as to how limiting the purchase of a private insurance plan that only pays after Medicare pays its share, or eliminating certain types of private coverage help reign in Medicare spending on the whole.  The argument is that if you give someone the option to buy "first dollar" coverage, they will over-utilize medical care. 

I know that based on the people I deal with regularly in my own client base, many of my people who purchase first dollar coverage for themselves do not over-utilize care.  If anything, many of them are healthy people.  They have the means to buy the best coverage that they can, and do so - for peace of mind.

That should be their option.  If you have the money, and want a good plan - you should be able to purchase it.

When the whole notion of limiting over-utilization in the under 65 health insurance market were done after the advent of "high deductible" health plans were introduced, studies showed that in some instances, medical expenditures actually rose due to the fact that people delayed seeking care when they really needed it. Some ended up spending more on reactive care that could have been prevented if they had sought care initially.

The Congressional representatives who always talk about this issue of "over-utilization" continually talk about the patient having more "skin in the game".  This always strikes me as ludicrous coming from a set of people who have no "skin in the game" at all. 

They have coverage provided to them via the Federal Government that we all pay for.  Maybe they should have their own "skin in the game" and have to purchase insurance on the open market like the rest of us.

If members of Congress had to go to Medicare at age 65, and then find ways to supplement their coverage - don't you think most of them would be purchasing first dollar coverage for themselves? They can certainly afford it. 

In addition, if they had to have Medicare as their primary means of insurance coverage, they would have to acquire Medicare Part B, which at their salary levels would also result in them having to pay the Income Related Monthly Adjustment Amount or IRMAA.

Forcing members of Congress - and all Federal employees and retirees for that matter - to go into full Medicare at 65 could be a better way to fund the SGR problem.  With the extra money from their part B premiums, and the IRMAA that would also be collected, we could probably bring enough money into the basic Medicare program to fund it without denying the rest of the American public choices on the private market that work for them.

But - don't worry, even though no patient advocacy groups were represented at the hearing, I'm sure Congress will consider the needs of the American public first!  Right? . . . .

More Congressional Efforts to Redesign Medicare are Underway

http://capsules.kaiserhealthnews.org/index.php/2011/12/wyden-joins-forces-with-ryan-on-medicare/comment-page-1/#comment-23070

Take a look at the latest efforts regarding revamping of Medicare.  Looks like efforts to privatize - just masked behind a new "compromise".  May very well be a wolf in sheeps clothing if we're not paying attention . . . . .