Friday, November 16, 2007

Health Care and the Senior Citizen

I understand that if I live long enough, I am likely to come down with some illness at one time or another. This reality prompted me to pay attention to what is coming down in Medicare, the national health insurance plan for people age 65 and older, under 65 with certain disabilities, and any age with end stage renal disease ( kidney failure.) Understanding Medicare insurance can be a daunting task and this is it in a nutshell.

Working persons pay into Medicare through mandatory payroll deductions. It is government administered and consists of four parts.
  • Medicare Part A covers hospitalization, skilled nursing facility, hospice and home health care under certain conditions and is provided with no additional premium.

  • Medicare Part B covers 80% of Medicare allowed medically necessary services outpatient services, physician and other health care provider fees and certain preventive services to prevent some diseases from getting worse. This requires payment of a premium usually billed quarterly or deducted from retiree social security pension. Enrollment may be made during specified enrollment periods. Individuals falling within certain income guidelines are entitled to some premium assistance.

  • Medicare Part C also known as Medicare Advantage Plans represents a privitization of Medicare wherein individuals enroll with approved private health insurance companies. These insurance plans must cover medically necessary services and thus provide similar services despite some differing advertising claims. They may differ, however, in copayments, co-insurance or deductibles. Medicare C plans combine Medicare A, B and oftentimes, D benefits.

  • Medicare Part D is Medicare prescription drug coverage. Again it requires the payment of a premium and enrollment during certain open enrolment periods. Individuals within certain income guidelines are entitled to premium subsidies.

Since Medicare health insurance only pays for 80% of allowed charges, the patient is liable for the remaining 20% which he/she pays out of pocket or subcribes to private health care insurance companies for Medicare supplemental insurance plan ( also known as Medigap.) All of these insurance premiums could take a big chunk out of the senior citizen's retirement benefits. Small wonder that many seniors opt to go bare and just go with Medicare Part A.

It is important for seniors to research and compare offerings of private health insurance companies when choosing Medicare Part C, Medicare Part D, and Medigap. Companies such as AARP Medicare Insurance, Humana Medicare Insurance, and Blue Cross Blue Shield Medicare Insurance are among those commonly marketed to seniors. When choosing a Medicare D prescription plan, it might be necessary to check with your pharmacist to make sure that expensive maintenance medications are covered by the plan.

A Threat to Health Care Access

A White House Fact Sheet pledges, "Medicare is the binding commitment of a caring society to our most vulnerable citizens and a commitment that America must always keep." At the same time, the Center for Medicare and Medicaid (CMS) announced a 10% cut in Medicare allowed physician fees effective 2008. There is will continue for the next four years for a total of 40 % cut in reimbursement. A poll by the American Medical Association of its members, shows that 60% of physicians indicate they will have to cut down on accepting new Medicare patients should these cuts come to pass. Physicians faced with increasing overhead from quality improvement and best practice initiatives do not feel that afford further decreases in their revenue base. This places many senior citizens at risk for not having an identified primary care health care provider at a time in their lives when diseases move to chronicity and consistent medical follow-up becomes necessary.

A Call to Action

Senior citizens will soon comprise a voting majority. It is time to take our elected officials to task in honoring " the binding comittment of a caring society" to its vulnerable citizens in particular and to all citizens in general. It is imperative that we demand that candidate and party platforms have a viable health care plan for all which moves health care from an option to a right similar to education and safety. A country that can send men and women to the stars and spend billions in other nation building must commit to ensuring a healthy nation.

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