Monday, September 23, 2019

Medicare Enrollment: Public Option vs. Private Insurance

The annual Medicare Open Enrollment Period is October 15 – December 7.  Here are some things you can do during the annual enrollment period

  • Join a Medicare Prescription Drug Plan [1] or switch from one Medicare drug plan to another Medicare drug plan.
  • Change from a Medicare Advantage Plan [2] back to Original Medicare [3].
  •  Join a Medicare Advantage Plan or change to another Medicare Advantage Plan.

Read more . . .

Wednesday, November 28, 2018

You Can Disenroll from a Medicare Plan January-March, 2019

Medicare Advantage plans, offered by private insurance companies as an alternative to the traditional Medicare program, are improperly denying many medical claims, according to a New York Times article.   Based on a new report by the U.S. Dept. of Health and Human Services, the "plans, which now cover more than 20 million people - more than one-third of Medicare beneficiaries - have an incentive to deny claims 'in an attempt to increase their profits.

Read more . . .

Wednesday, November 29, 2017

Tax Bill Cuts Medicare, Repeals ACA, Threatens Social Security and Medicaid

Senate leaders are working to ram through a tax bill this week which will greatly increase deficits, triggering $25 billion in Medicare cuts and leading to major cuts in Social Security and Medicaid to pay for the deficit.  The bill would chiefly benefit the highest earners while hurting the middle class, according to the Congressional Budget Office, the Joint Committee on Taxation, and other experts. In addition, the bill would repeal the Affordable Care Act's individual mandate to purchase health insurance, leading to higher health insurance premiums and making access to health care unaffordable for as many as 13 million. 

Read more . . .

Wednesday, December 24, 2014

Holiday Greetings & Medicare's 50th Birthday

This holiday season we celebrate the opportunity to work with you and your family on elder law, disability, and estate matters.  We greatly appreciate your continued support and wish everyone, especially those who have suffered a loss this year, a peaceful holiday and a New Year filled with hope.

Medicare's 50th birthday in 2015 is drawing attention to the state of health care for older and disabled adults.  While Medicare is more protective than insurance plans that cover people under age 65, a recent survey by the Commonwealth Fund found that the U.S. lags worldwide in health care for those over 65, as reported in a New York Times article this month. The survey compared seniors' health care in the U.S. with that of Australia, Canada, France, Germany, the Netherlands, New Zealand, Norway, Sweden, Switzerland, and the UK. Here are the survey's findings reported by the Times, with quotes by Robin Osborn of Commonwealth Fund:

'■ Our older population is sicker. We lead the list in the proportion of people over 65 who have two or more chronic diseases (68 percent report hypertension, heart disease, diabetes, cancer, etc.) and who take four or more prescription drugs (53 percent). Only a third of seniors in the United Kingdom have multiple chronic conditions. (The survey didn’t include residents of nursing homes or other care facilities.)

“One thing we know contributes to this is not having an ongoing, stable source of health insurance throughout your life,” Ms. Osborn said. Before they became Medicare-eligible, American seniors may have forgone preventive treatments or let conditions worsen because they couldn’t afford care.

■ Older Americans still struggle to pay for health care. Nineteen percent said that in the past year, cost was a barrier that prevented their seeing a doctor, undergoing a recommended test or treatment or filling a prescription. In only one other surveyed nation (New Zealand, at 10 percent) did that proportion reach double digits.

Among American seniors, 21 percent had out-of-pocket medical expenses that topped $2,000 and 11 percent had problems paying their medical bills. In Norway and Sweden, 1 percent had problems paying; in Germany, 3 percent.

“As good as Medicare is – it provides excellent coverage over all – it still isn’t as protective as the coverage people get in other countries,” Ms. Osborn said. Its deductibles and cost-sharing requirements still leave many Americans scrambling to afford drugs and doctors – which also cost more here.'


Thursday, May 30, 2013

Medical Loss Ratio Will Apply to Medicare Plans

MLR:  Is a refund due from your Medicare Advantage or Drug plan?

Under Health Reform, Insurance companies must spend a certain percentage of premiums on health care benefits.  Individual and small business plans must spend at least 80% of premiums on benefits and limit administrative expenses to less than 20% of premiums.  This is known as the medical loss ratio (MLR).  Large group plans must spend at least 85% of premiums on benefits.  Under a new rule, Medicare Advantage and Part D Drug plans must also spend 85% of premiums on benefits and limit administrative expenses, including profits, to less than 15%.

If a plan does not meet the MLR, it is required to refund the excess premiums to beneficiaries.  In 2011, the insurance industry refunded $1.1 billion in excess premiums to beneficiaries.  As a result of the MLR requirement, insurance company administrative costs dropped in 39 states, including Texas. 

Although insurance companies must limit their share of profits, they are expected to receive billions of dollars in new business, possibly $230 billion by 2020, which will make the size of the insurance pie substantially larger under Health Reform.

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Attorney Nancy Stone assists clients with Elder Law, Medicaid Planning, and Estate Planning throughout Harris County, TX. I am now based in Sugar Land and serve all of Houston, Harris County, Bellaire, Jersey Village, Cypress, West University, The Heights, Pearland, Alvin, Sugar Land, Missouri City, Kingwood, Humble, The Woodlands, Spring, Tomball, Richmond, Rosenberg Pasadena, Baytown, La Porte, Clear Lake, Texas City, Katy, Friendswood, Stafford, as well as Fort Bend County, Brazoria County, Montgomery County, Galveston County, Liberty County, Chambers County, Waller County and throughout Southeast TX.

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