SYLVIA’S SOAPBOX: GET THE FACTS ON MEDICARE AND THE NEW HEALTH-REFORM LAW

Printer-friendly versionPrinter-friendly version Share this

DON'T BELIEVE DECEPTIVE POLITICAL ADS, FACTCHECK.ORG WARNS CONSUMERS
By Sylvia Hampton


September 24, 2010 (San Diego) -- A friend in Wisconsin asked me if she would lose her doctor because of the new health-reform law. She said she saw it in a TV campaign ad. A group calling itself “60Plus” is spending $5 million on misleading TV ads, mostly in House races, against Democrats who voted for the bill. They don’t have to disclose the donor or donors’ identities. The ads say the lawmakers "betrayed" their constituents by voting for the health care overhaul bill.

 

But most of the ads, according to the nonpartisan www.FactCheck.org website, also make statements that can’t be backed up, lack important context or are wrong. FactCheck's summary report says:

 

• Some of the ads say that the law means "seniors could lose their doctors" or that it "threatens seniors’ ability to keep their own doctor." But what the ads are talking about has nothing to do with the new health care law. Some doctors have said they may stop accepting Medicare patients because of scheduled payment cuts set in motion by a 1997 law, cuts that are unaffected by the new statute.

 

• All of the ads say that the new law cuts $500 billion from Medicare. It’s true that the law would restrain future growth of the program, but this isn’t cutting from existing spending. And the amount is spread over 10 years, totaling about 7 percent of what Medicare was projected to cost over that decade.

 

• Many of the ads feature seniors saying the law will "hurt the quality of our care." But the law specifically forbids cuts in the basic package of Medicare benefits, and even adds some new features, such as wellness checkups. It also closes the "doughnut hole" gap in the prescription drug benefit.

 

So before you believe the propaganda, check the facts with Consumers Union, which has produced a guide called “Health Reform: The First Six Months” at http://consumerreports.org/health/resources/pdf/ncqa/health-reform.pdf which includes the following information:

 

If you have Medicare, Starting in 2011, thanks to the new health-reform law, everyone on traditional Medicare is entitled to a free annual wellness visit with no deductibles, coinsurance, or copays. The new health-reform law greatly improves the Medicare Part D benefit. In 2010 if you fall into the "doughnut hole"—the period during which you have to pay the full cost of your drugs—you'll get a $250 rebate check. Starting in 2011, you'll start getting discounts on drugs in the doughnut hole, and by 2020, the doughnut hole disappears completely.

 

You can find the basics about the benefit and Part D plans at Medicare's website. This site can answer most questions. It also links to the Medicare Part D Plan Finder, which allows you to compare offerings and coverage options in your area. This feature includes a helpful formulary finder that allows you to compare plans based on their coverage of your personalized list of drugs.

 

The 2010 rebate and subsequent discounts will happen automatically—you don't have to do anything. But the price of brand-name drugs will continue to vary depending on what kind of deal a plan has made with drugmakers and pharmacy benefit management companies. So you'll still need to select your Part D plan carefully to make sure it has the best prices for the drugs you take. That can change from year to year, so check every year.

 

Medicare Advantage changes

 

The extra payments that the government has been giving to private Medicare plans will decrease over the next three to seven years, starting in 2011. At the end of that time, Medicare Advantage plans will get about the same amount per member as original Medicare does. The government will also give small bonus payments to Advantage plans that provide high-quality care and services. Medicare Advantage plans can change their prices and benefits each year—and are probably more likely to do so this year because of the rollback in subsidies—so a plan that currently fits you may not be the best choice in 2011.

 

Study your options carefully during your open enrollment period from Nov. 15 through Dec. 31, when you can switch from one Medicare Advantage plan to another, or go back into original Medicare if you choose. If you become dissatisfied with a Medicare Advantage plan, you can switch back to original Medicare during the first 45 days of 2011. Use Medicare's recently upgraded Plan Finder to search for and compare plans.

 

More free preventive care

 

The new law entitles you to first-dollar coverage of a long list of preventive services, specifically those rated highly ("A" and "B") by the panel of experts that make up the U.S. Preventive Services Task Force. Some examples include cholesterol tests for all men and at-risk women, depression screening, obesity screening, and weight-loss counseling. Medicare Advantage plans don't have to offer this new benefit, but many of them already do anyway, according to Akiko Takano, deputy director of communications at the Medicare Rights Center. The new benefit will kick in automatically. If you get billed for a preventive service you think should be covered in full, call your doctor's billing office or Medicare customer service number first. CU recommends consulting the website of the Medicare Rights Center, a nonprofit, consumer-oriented group, as you explore your options.

 

Be wary of ads and sales pitches from insurers and insurance brokers

 

The majority of print, TV, and radio ads don't offer enough information.Avoid picking a plan just because it has a familiar name or brand. Written material is suspect, too. A recent federal government review found that a majority of the written materials that Medicare Part D insurers had prepared for the previous year failed to meet government marketing guidelines for accuracy and clarity. After receiving complaints, the government banned door-to-door sales and telemarketing of Part D plans, but written pitches can still be mailed as long as they don't contain enrollment forms. If you have a broker you trust, consult him or her. But watch out for brokers pushing certain plans.

 

Which Medicare plan do you have?

 

Your Medicare number is on your red, white, and blue Medicare card. You have this card even if you are enrolled in a Medicare Advantage plan. You may be uncertain whether you have original Medicare or a private Medicare Advantage plan. The name on your insurance card probably doesn't say "Medicare Advantage." Instead, it might list a plan name, like "Secure Horizons."


To find out which Medicare plan you have:

• Call 800-MEDICARE (800-633-4227)

• The system will ask you to say your "Medicare number." That's the number on your red, white, and blue Medicare card. Everyone has this card, even those enrolled in Medicare Advantage plans.

• The system will give you some options. Select 0 for a customer service representative.

• When the representative comes on the line, you will be asked for your Medicare number again, as well as some other identifying information such as date of birth and full address.

• Once your identity has been confirmed, ask the rep: "Could you tell me whether I have original Medicare or Medicare Advantage"?

• You will be told either: "There's no Medicare Advantage plan on file" OR the name of your Medicare Advantage plan.

 

Caregivers can make this call on behalf of a Medicare enrollee, if they have the identifying information.

 

Financial help for some

 

Individuals with annual incomes of less than $16,248 (and resources of less than $12,510) in 2010 or married couples with incomes of less than $21,864 (and resources of less than $25,010) might qualify for extra financial help from Medicare to pay both their Part D premiums and their out-of-pocket drug costs. Also, people who are enrolled in both Medicaid and Medicare at the same time will be automatically enrolled in a part D drug plan. If those plans don't cover their prescription drugs, they can switch to another plan without paying a penalty. Consumer Reports Health page can be found at:
http://consumerreports.org/health/insurance/health-insurance.htm

 

The SHIP (State Health Insurance Assistance Program) is a Medicare-funded program that gives independent, non-political counseling to folks about health insurance problems, including Medicare. They help seniors and the disabled choose their health insurance plans, MediGap policies, and prescription plans. For help contact:

Elder Law & Advocacy
3675 Ruffin Road, Suite 315
San Diego, CA 92123
(858) 565-8772
(800) 434-0222

The new voluntary long term care insurance program (CLASS program) for workers starts in 2011. Information about this program can be found at:
http://www.chhs.ca.gov/Documents/NASHP%20Long%20Term%20Care%20Analysis%2...
Another good site for info on the new health care reform law is the Kaiser Family Foundation website: www.kff.org
 

 

Sylvia Hampton is a community activist inducted into the San Diego County Women’s Hall of fame for 2008 for her work in the fields of healthcare reform, social justice and reproductive health. She is past president of the League of Women Voters of San Diego County and served on President Nixon’s Title X Family Planning Council. Her monthly Community Forum column is published in the Sun Signature Community Newspaper, Diamond Gateway Signature, and her Soapbox in the East County Magazine. Opinions are Sylvia’s alone and not to be interpreted as the policies of the League of Women Voters or East County Magazine.