Medicare vs. Medicare Advantage: Know the Difference?

There are two ways to access Medicare coverage: Original Medicare and Medicare Medicare advantageAdvantage Plans.

Currently, 58 million people in the United States are enrolled in Medicare — of which 19 million are enrolled in Medicare Advantage Plans.

Obviously there is a great confusion about all things Medicare.  With the end of Medicare open-enrollment coming up on December 7th, we wanted to take this time to explain your Medicare options.

For more information about Medicare basics, read our Quick Guide to Medicare or watch our Medicare webinar.

If you aren’t familiar with Medicare Advantage plans, you are not alone.

  • 65% of seniors on Medicare are unfamiliar with Medicare Advantage
  • 49% percent of those enrolled in Medigap plans say the option of Medicare Advantage was not made clear to them when researching Medicare coverage options
  • 55% of those enrolled in Original Medicare say they either do not understand or do not know the difference between being enrolled in Original Medicare and Medicare Advantage only
  • 20% of those enrolled in Medicare Advantage report not knowing the difference between Original Medicare and Medicare Advantage.
  • 59% across plan type do not understand or do not know the differences between Advantage and Medigap plans

In Original Medicare, the government pays for your health care benefits.  In a Medicare Advantage plan, your health care benefits are paid through a private insurance company that has been approved by Medicare.  Medicare Advantage plans come in many plan types, but the two common types are HMOs and PPOs. And, they work just like private insurance HMOs and PPOs. There is a network of doctors that accept the plan, and your costs are lower if you go to an in-network doctor. In Original Medicare, you can see any providers that accept Medicare.

Medicare Advantage plans combine your Part A (hospital benefit), Part B (health insurance benefit) and sometimes Part D (prescription drug benefit) all in one convenient plan.  In addition to those benefits, Advantage Plans often offer coverage that goes beyond Original Medicare, such as:

  • Routine eye exams, prescription eyewear, and/or contact lenses
  • Hearing exams; some may include an annual benefit toward hearing aids
  • Routine dental exams and non-surgical restorations
  • Wellness and fitness programs (some even include discounted gym memberships)

The cost of a Medicare Advantage plan will vary based on the plan you choose, the insurance company that is offering the plan, and where you live.  You may pay your monthly Part B premium plus a possible additional premium charged by the Medicare Advantage plan.  Keep in mind that premiums, co-payments, and benefits can change from year to year, and vary greatly from plan to plan, and company to company.  Read the fine print carefully, especially concerning prescription drug coverage. One benefit to Medicare Advantage is that some plans offer an out-of-pocket maximum, capping the medical expenses that you pay out-of-pocket during the year.  Original Medicare does not have an out-of-pocket maximum.

If you choose to go with a Medicare Advantage plan, you need to understand that this plan replaces Original Medicare, it does not supplement it.  You can also not use Medigap plans (supplemental Medicare) with a Medicare Advantage plan. That said, having a Medicare Advantage means you are in the Medicare Program and under the same protections that all Medicare recipients receive.  Your plan will last an entire year, at which point you can change plans or revert back to Original Medicare.

For more information about Medicare Advantage Plans, visit:

Six Key Things You Need to Know During Open Enrollment

Open enrollment for plans sold in the Marketplaces started yesterday and we have Six Key Things to Know Open Enrollmentbeen hearing that there is still a lot of confusion. As a reminder, open enrollment is the time of year consumers can shop for a new plan or make changes to existing plans. For Marketplace and Medicare plans the plan won’t start until January 1, 2018. Employer plans may have different start dates, so check with your employer. Here are six key things you need to know during open enrollment:

  1. Health insurance can be confusing.
    1. Make sure you understand the key terms used in your health insurance policy. Watch our new video – Triage Cancer Presents: Health Insurance Basics to learn more. This information is useful regardless of where you get your health insurance coverage.
  2. Financial assistance still exists for most people who purchase plans in the marketplace.
    1. For 2018, 8 in 10 people have Marketplace health insurance options for $75 or less, a month. This is mostly due to the premium tax credits available to people based on their income level.
    2. Even though the Administration has said that they will no longer pay the insurance companies back for providing cost-sharing subsidies (aka cost-sharing reductions), the insurance companies still have to provide those discounts to consumers.
  3. Individuals shopping for insurance (regardless of where they get it – Medicare, employers, private companies), should be sure to do the math when comparing options!
    1. Often times we only look at the monthly premium of a plan. However, to accurately determine what a plan with cost you for the year, you have to do the math! Assuming that a consumer will reach their out-of-pocket maximum during the year, the way to do the math is to multiply the monthly premium by 12, then add that amount to the plan’s out-of-pocket maximum. You may be surprised to find that the bronze plan may not be your most affordable option.
    2. Consumers should also look at the network of doctors and hospitals, the other costs (e.g., co-payments, deductibles, etc.), and prescription drug coverage.
    3. For more information on how to pick a plan watch our webinar, Choosing Wisely: How to Pick an Insurance Plan or visit CancerFinances.org.
  4. Individuals who are eligible for Medicare are not eligible to purchase plans in the Marketplace. Visit http://medicare.gov for more information about plan options.
  5. Be wary of short-term health insurance plans.
    1. These plans may look attractive based on their low cost, but they are not considered creditable coverage and when they end, consumers typically aren’t eligible for a special enrollment period to buy a plan in the Marketplaces, which could leave them with a gap in coverage. Additionally, they do not have to include the consumer protections in the ACA and may be able to charge people with cancer more, or exclude covering cancer treatments.
  6. Open enrollment dates may vary depending on where you live.
    1. The federally run Marketplace will be open from November 1 – December 15; however, some states have extended their open enrollment periods.
    2. There are also some extensions available for people who were affected by the recent hurricanes. (see the link above)

Clarifying Open Enrollment

There has been a lot of confusion about open enrollment for health insurance coverage in the news and on social media and we want to clarify some things and share some news:

  1. Open enrollment to buy coverage for 2018 through the State Health Insurance Marketplaces has been cut from 12 weeks to just 6 weeks, running from November 1 to December 31. However, there are some additional things you need to know:
    1. If you live in one of the states below, your state may have decided to keep open enrollment open longer:
      • California – November 1 to January 31
      • Colorado – November 1 to January 12
      • D.C. – November 1 to January 31
      • Massachusetts – November 1 to January 31
      • Minnesota – November 1 to January 14
      • Washington – November 1 to January 1
    2. If you were affected by Hurricanes Harvey, Irma, or Maria, you also have access special enrollment periods, which extends the time you have to get coverage in 2017 or enroll in coverage for 2018.
      • Group A:
        • Timing: The date of the SEP qualifying event through December 31, 2017.
        • Eligibility: Individuals who experienced an SEP qualifying event between 60 days prior to the start date of the incident period and December 31, 2017 and reside, or resided at the time of the hurricane, in any of the counties declared as meeting the level of “individual assistance” or “public assistance” by FEMA.
        • What to do: Contact the Marketplace Call Center at 1-800-318-2596.
      • Group B:
        • Timing: December 16, 2017 through December 31, 2017.
        • Eligibility: Individuals who reside in or move from areas affected by a hurricane in 2017, who are applying for 2018 coverage.
        • What to do: Contact the Marketplace Call Center at 1-800-318-2596 to request an enrollment after December 15, 2017.
  1. Medicare open enrollment occurs each year for people to enroll or switch Medicare plans and prescription drug plans. Medicare open enrollment runs from October 15 to December 7, but the Centers for Medicare & Medicaid Services have announced a special enrollment period to give people more time to enroll due to the recent hurricanes.
    1. Timing: From the start of the incident period through December 31, 2017.
    2. Eligibility: Individuals who reside, or resided at the start of the incident period, in an area for which the Federal Emergency Management Agency (FEMA) has declared an emergency or a major disaster; individuals who do not live in the affected areas but rely on friends or family members who live in the affected areas for help making health care decisions.
    3. What to do: Contact 1-800-MEDICARE to access the special enrollment period. Click here for more information.

Remember, with both Medicare and Marketplace plans, when you sign up for coverage in open enrollment, you coverage won’t actually start before January 1, 2018.

If you need coverage now, visit CancerFinances.org or watch our webinar recording on how to pick a health insurance plan, to see if you have other options.

Medicare and Hospice Care

Hospice is a program of care and support for people who are terminally ill. The focus ofHospice Care hospice care is on ensuring patient comfort, and not on curing an illness. In hospice, a specially trained team of professionals and caregivers provide care for the “whole person,” including physical, emotional, social, and spiritual needs. There are hospice facilities, but hospice care is generally provided in the home. Medicare can help cover some of the hospice care costs.

Hospice care can be a blessing for those suffering from a terminal medical condition and can even include specialized care, such as reading to a patient, playing music, and companionship. Hospice care providers can also provide respite for caregivers.

Medicare recognizes the importance of hospice and covers it fully. Meaning even if you only get Medicare Part A (hospital coverage), which is the minimum Medicare coverage, you will be fully covered for hospice care. Once you start getting hospice care, your Medicare hospice benefit should cover everything you need related to your terminal illness if your care comes from a Medicare-approved hospice provider. If, while in hospice, you need care that is not associated with your terminal illness (for instance, you fall and break your arm), you would be covered by your regular Medicare or Medicare Advantage plan benefits.

If you have determined that you no longer want to pursue curative treatment for your medical condition, you should discuss your decision with your health care team. Your health care team can help you coordinate hospice care. You always have the right to stop hospice care, and seek a curative treatment, at any time.

However, while in care of a Medicare-approved hospice provider, Medicare will not cover any of the following:

  • Prescription drugs (except for symptom control or pain relief).
  • Care from any provider that wasn’t set up by the hospice medical team. You must get hospice care from the hospice provider you chose. All care that you get for your terminal illness and related conditions must be given by or arranged by the hospice team. You can’t get the same type of hospice care from a different hospice, unless you change your hospice provider. However, you can still see your regular doctor or nurse practitioner if you’ve chosen him or her to be the attending medical professional who helps supervise your hospice care.
  • Room and board. Medicare doesn’t cover room and board. However, if the hospice team determines that you need short-term inpatient or respite care services that they arrange, Medicare will cover your stay in the facility. You may have to pay a small copayment for the respite stay.
  • Care you get as a hospital outpatient (like in an emergency room), care you get as a hospital inpatient, or ambulance transportation, unless it’s either arranged by your hospice team or is unrelated to your terminal illness and related conditions.

For more information on hospice care, please review: Hospice FAQs from the National Hospice and Palliative Care Organization.

For more information about Medicare’s coverage of hospice benefits, you can read: Medicare Hospice Benefits.

Did You Know? Medicare Covers Home Health Care

If you’ve ever been admitted to a hospital, you know it’s not the best place to rest up Home Health Careand recuperate from an illness. Medicare understands that, too. That is why Medicare covers home health care services for eligible individuals. Home health care can be less expensive, more convenient, and provide better quality of life for many patients.

If you have Medicare, you can use your home health benefits if you meet all of the following criteria:

  1. You are in the care of a doctor and being regularly seen by a doctor.
  2. A doctor certifies that you need any of the following:
  • Intermittent skilled nursing care (“intermittent” is defined as skilled nursing care that’s needed or given on fewer than 7 days each week or less than 8 hours each day over 21 days (or less) with some exceptions in special circumstances)
  • Physical therapy
  • Speech-language pathology services
  • Continued occupational therapy
  1. The home health agency caring for you is approved by Medicare (Medicare-certified).
  2. A doctor certifies that you are homebound.
  3. A doctor or nurse practitioner documents that they’ve seen you in person within the required timeframe and that the findings of that encounter support that you’re homebound and need skilled care.

If you think you or your loved one may be eligible for these benefits, you can learn more by reading this booklet: Medicare & Home Health Care, which includes information about choosing a home health care agency, how the payment for services works, guarding against fraud, and your rights as a recipient of home health care.

Do You Need a Medigap Policy? Your Ability to Get One May Depend on Where You Live.

Americans who receive their health insurance through Medicare may want to purchase Medigapextra coverage through a Medigap Policy.  However, one’s ability to purchase a Medigap policy may depend on where they live.

Medicare is a government funded and run health insurance program for eligible individuals. To be eligible for Medicare, you must be:

  • 65+ years old;
  • have collected SSDI more than 24 months; or
  • have been diagnosed with end stage renal disease (ESRD) or ALS.

Medicare coverage is divided into four parts:

  • Part A: Hospital Insurance. Includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance. Includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare-approved private insurance company. Make sure to select a plan that covers your health care providers.
  • Part D: Prescription Drug Coverage. You have different plans to choose from depending on where you live, with different premiums and formularies. Make sure to select a plan that covers the drugs you take.

For more information about Medicare, you can read our Quick Guide on Medicare, or watch this webinar.

Parts A and B of Medicare are often called “original Medicare,” because that is the coverage that originally existed. Part B of Medicare has an 80/20 cost share, meaning that Medicare covers 80% and you are responsible for 20% of your medical expenses covered under Part B.  In order to help people pay for the 20% and for other things that Medicare does not cover, Medicare created an option to buy supplemental health insurance coverage, called Medigap. There are different Medigap plans, which are named by letters, which are offered by private health insurance companies. You must have Medicare Parts A and B to buy a Medigap plan.

Medicare’s website allows you to type in your zip code and whether or not you already own a Medigap policy, and it shows you the different Medigap policies available to you. . Medicare also provides a chart comparing Medigap plans A-N and their benefits. For example, Medigap plan A does not cover skilled nursing facility care coinsurance, while Medigap plan F does. Medigap plans K and L have an out-of-pocket limit, while the other 12 plans do not. It is important to note that three states – Massachusetts, Minnesota, and Wisconsin – offer different Medigap plans not available in other states. There are separate pages for the Medigap plans on Medicare’s website for these exceptions.

Medigap policies, however, are only available in certain states. According to Medicare, “each insurance company decides which Medigap policies it wants to sell, although state laws might affect which ones they offer.”

While Medigap policies seem like they would be welcomed and encouraged in each state, there are 22 states that are allowed to not sell Medigap policies to those under 65 years of age who qualify for Medicare because of a disability. Those states are: Alabama, Alaska, Arizona, Arkansas, Idaho, Indiana, Iowa, Kansas, Kentucky, Montana, Nebraska, Nevada, New Mexico, North Dakota, Ohio, Rhode Island, South Carolina, Utah, Virginia, Washington, West Virginia, and Wyoming. Simply put, if you live in one of these and are on Medicare but under 65, you might not be able to buy the Medigap policy you want, or any Medigap policy, until you turn 65.

The remaining 28 states require insurance companies to offer people under 65 at least one Medigap plan: California, Colorado, Connecticut, Delaware, Florida, Georgia, Hawaii, Illinois, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, New Hampshire, New Jersey, New York, North Carolina, Oklahoma, Oregon, Pennsylvania, South Dakota, Tennessee, Texas, Vermont, and Wisconsin.

Click here for more information about Medigap plans and coverage.

Enrolling in Medicare Part B – What You need to Know!

Medicare is a government health insurance program for eligible individuals. To be Medicare Part Beligible you must be: 65+ years old; have collected SSDI benefits for more than 24 months; or have been diagnosed with end stage renal disease (ESRD) or ALS. Medicare coverage is broken up into “parts:”

  • Part A: Hospital Insurance – includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance – includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part D: Prescription Drug Plan (PDP) – different plans to choose from depending on where you live, with different premiums and formularies.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare approved private insurance company.

You can enroll in Medicare for the first time during Initial Enrollment Periods, when:

  • You’re newly eligible for Medicare because you turn 65. You get a 7-month period to pick your plans, which starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • You’re newly eligible for Medicare because you’re disabled and under 65.
  • You’re already eligible for Medicare because of a disability, and you turn 65.
  • You are working and receiving insurance through your work, you can enroll up to 8 months after you stop working.

If you fail to enroll during these windows, you can enroll during the General Enrollment Period (GEP), which is January 1st through March 31st, every year. However, if you sign up during the GEP, but were eligible earlier than that, you could be facing a Medicare Part B late enrollment penalty.

Most people receive their Part A coverage at no cost, but they do have pay for Part B coverage.  Since Part B is something you pay for, you have the right to refuse the coverage.  Refusing Part B coverage is an important decision to make, so please consider it wisely.

Consider these examples, to help you decide if you should keep Part B:

  • I’m still working and have coverage through my employer. Or, my spouse is still working and I’m covered by his or her employer. Ask your employer or union benefits administrator if they require you to sign up for Part B. If your employer doesn’t require you to sign up for Part B right away, you can usually sign up for Part B later during a Special Enrollment Period without a late enrollment penalty.
  • I’m retired and have coverage through a former employer, or I have COBRA or VA coverage. If you’re retired and have retiree health insurance from a former employer or union, or you have COBRA or U.S. Department of Veterans Affairs (VA) coverage, Medicare generally will become your primary health insurance. Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your non-Medicare plan. If you don’t keep Part B, your current coverage might not pay your medical costs during any period in which you were eligible for Medicare Part B, but didn’t sign up for it.
  • I have coverage through the Health Insurance Marketplace as an individual or through an employer. If you have a Marketplace plan for individuals or families, you should keep Part B and drop your Marketplace plan so it stops when your Medicare starts. You won’t be eligible for premium tax credits or other savings for a Marketplace plan once your Part A coverage starts and you if you miss your enrollment period you will end up paying a penalty for enrolling late.
  • I have TRICARE coverage (insurance for active-duty military, military retirees, and their families). You must have Part B to keep TRICARE coverage. However, if you’re an active duty service member or the spouse or dependent child of an active-duty service member, you may not have to get Part B right away.
  • I have CHAMPVA coverage. You must have Part B to keep your CHAMPVA coverage.
  • I have coverage through a private insurance plan. If you accept Medicare Part B, Medicare will pay its part of the costs for any health care services you get, and then any amount not covered by Medicare can be submitted to your private plan.
  • I don’t have other health insurance. If you don’t have other health insurance, you should accept Part B if you want coverage for things like doctors’ services or preventive services.

Before you make any decisions about opting out of Part B, speak to the Social Security Administration (and keep detailed notes of each conversation).

Resources

For a more information about Medicare please read the booklet entitled Welcome to Medicare.

You can also find more information on our Triage Cancer blog, by reading our Quick Guide to Medicare, or watching our webinar on “Making Sense of the Medicare Maze.”

Don’t Be Late! Medicare Part D Penalty

Within the alphabet soup that is Medicare, there are important deadlines of which to be Medicare Part D Penaltyaware.  If you are late to enroll you may be forced to pay a Medicare Part D penalty.

Medicare Part D is the prescription drug benefit of Medicare.  Like all of Medicare, there are specific and limited times that you can enroll in the program.  It is important to understand these enrollment periods, so you can avoid late enrollment penalties.

When can you enroll in Medicare Part D?

The Initial Enrollment Periods for Medicare include:

  • You’re newly eligible for Medicare because you turn 65. You get a 7-month period to pick your plans, which starts 3 months before the month you turn 65, includes the month you turn 65, and ends 3 months after the month you turn 65.
  • You’re newly eligible for Medicare because you’re disabled and under 65.
  • You’re already eligible for Medicare because of a disability, and you turn 65.
  • You HAVE Medicare Part A coverage, and you get Medicare Part B for the first time by enrolling during the Part B General Enrollment Period (January 1–March 31).

The Penalty

You may owe a late enrollment penalty if at any time after your Initial Enrollment Period is over, there’s a period of 63 or more days in a row when you don’t have Part D or other creditable prescription drug coverage. Creditable prescription drug coverage is coverage (for example, from an employer or union) that’s expected to pay, on average, at least as much as Medicare’s standard prescription drug coverage.

The late enrollment penalty is an amount that’s added to your Part D premium each month. If you have a penalty, you may have to pay it each month for as long as you have Medicare drug coverage!  The Part D late enrollment penalty is calculated as 1% of the national base beneficiary premium for each full, uncovered month that you didn’t have Part D or creditable coverage.

For example, if there was a period of 14 months that you did not have Part D or creditable prescription drug coverage, this is how the penalty is calculated:

14 months x 1% = .14

.14 x $35.63 (2017 base beneficiary premium) = $4.98

$4.98 rounded to the nearest $.10 = $5

$5.00 would be added to your monthly Part D premium for as long as you have Medicare Part D (which is usually for the rest of your life).  So each year you would be paying an additional $60 in Part D penalties. Over 20 years that would be $1,200 in completely avoidable penalties.

For more information about Medicare, read our Quick Guide to Medicare, or watch our webinar on “Making Sense of the Medicare Maze.”

For more information on the Part D Late Enrollment Penalty, visit www.medicare.gov/Pubs/pdf/11219-Understanding-Medicare-Part-C-D.pdf  or https://www.cms.gov/Outreach-and-Education/Outreach/Partnerships/downloads/11222-P.pdf

Understanding Medicare Part D – Prescription Drug Coverage

Medicare is a government health insurance program for eligible individuals. To be Medicare Part Deligible you must be: 65+ years old; have collected SSDI benefits for more than 24 months; or have been diagnosed with end stage renal disease (ESRD) or ALS. There are currently about 56 million Americans enrolled in Medicare.

Medicare coverage is broken up into “parts:”

  • Part A: Hospital Insurance – includes hospital care, skilled nursing facilities, nursing homes, hospice, and home health services.
  • Part B: Medical Insurance – includes services from doctors, preventive care, outpatient care, lab tests, mental health care, ambulance services, and durable medical equipment.
  • Part D: Prescription Drug Plan (PDP) – different plans to choose from depending on where you live, with different premiums and formularies.
  • Part C: Advantage Plans. Part C is an alternative to Parts A & B and it includes the benefits and services covered under Parts A & B, and usually Part D. You can select a PPO or HMO plan that is run by a Medicare approved private insurance company.

For more information about Medicare, read our Quick Guide to Medicare, or watch our webinar on “Making Sense of the Medicare Maze.”

Medicare Part D is optional, but if you are taking prescription medication and do not have Part D, you may have to pay for medications out-of-pocket. If you decide later that you want Part D, but didn’t sign up when you were first eligible, you pay have to pay a late enrollment penalty.

How much you pay for Medicare Part D and out-of-pocket prescription drug costs depends on a number of factors, like which Part D plan you choose, how many prescriptions you take and how often, whether your pharmacy is in your plan’s network, whether your prescription drugs are on your Medicare Part D plan’s formulary, and more. To find which Medicare Part D plans are available where you live, click here.

Part D premiums generally range from $10-$100 per month (depending on the plans available in your area and on the specific plan you choose). The maximum deductible—the amount you must pay out-of-pocket before Medicare will contribute to your prescription costs—in 2017 is $400. After paying your deductible, then Medicare will pay 75% of your prescription drug costs and you will pay 25%, up to a total of $3,700.

What many refer to as the “donut hole” in Medicare Part D coverage is a gap in coverage when you have spent a certain total amount on covered prescriptions. In 2017, once you and your plan have spent $3,700 on covered drugs, you’re in the coverage gap. This amount may change each year. Also, people with Medicare who get Extra Help paying Part D costs won’t enter the coverage gap. For more information and examples of the coverage gap, visit Medicare.

Even with Part D coverage, prescription drugs can be expensive. Depending on your income level, you may qualify for financial assistance to help pay for your prescriptions drugs. A Low-Income Subsidy provides Medicare beneficiaries with assistance in paying their Part D monthly premium, annual deductible, coinsurance, and copayments. Some people may be eligible for Extra Help, a program aimed for those who do not automatically qualify for a Low-Income Subsidy. You may be entitled to Extra Help if you are entitled to Medicare and get full coverage from a state Medicaid program, you are enrolled in a Medicare Savings Program, or you get SSI disability benefits. The Medicare Savings Program pays for the Medicare Part A and the Medicare Part B premiums. It also pays Medicare cost-sharing expenses, including deductibles, coinsurance, and copayments.

For more information on how to reduce your prescription drug costs, visit the following link. Examples include switching to lower-cost medication if approved by your health care team, or switching to mail-order programs from your plan.

You can also visit CancerFinances.org to find other financial assistance resources.

For help with Medicare and making plan choices, you can visit Medicare.gov or call 1-800-MEDICARE. You can also speak to a local counselor through the State Health Insurance Assistance Program. Click here, then pick your state from the drop down menu on the right, under “Find someone to talk to,” and it will provide the local contact information.

Post Election Update: Changes to Medicare

Established in 1965, Medicare now covers nearly 48 million seniors and an additional 9 Changes to Medicaremillion people with disabilities. For information about Medicare, read our previous blogs or our Quick Guide to Medicare. Congressional leaders have indicated that there are changes to Medicare on the way.

Medicare’s benefits can be accessed in two ways. Through traditional Medicare, services are covered as fee for service.  Meaning that you can get medical care from any provider that accepts Medicare coverage.  Alternatively, Medicare Advantage is a way to get Medicare coverage through a managed care plan (HMO or PPO). These managed care plans are offered by private health insurance companies and have specific networks of providers that are covered by the plan.

Throughout the contentious election season, President-elect Donald Trump, promised to preserve Medicare as is.  However since the election, key Republican leaders have proposed changes to Medicare.

For example, U.S. Congressman Tom Price, a noted conservative who was recently nominated to be the next U.S. Secretary of Health and Human Services (HHS), has proposed, among other changes, moving Medicare to a voucher system. This would mean giving each individual a voucher worth a certain amount of money to go and buy private health insurance coverage.  There are a number of potential challenges with this approach for consumers:

  1. If the ACA is repealed, many of the consumer protections will no longer be available
  2. It is unclear if the amount of the voucher will be enough to actually buy coverage. If it isn’t then individuals will have to pay more for their health insurance than they were paying under Medicare
  3. It is unclear what the individual health insurance market will look like and what plan options will be available
  4. It is unclear if those options will provide equal coverage to Medicare
  5. As seniors and people with disabilities often have higher medical expenses, they may be charged more for their coverage and plans may be too expensive for people to buy

Congressman Price’s nomination to lead HHS, which has control over Medicare, has caused many to question the validity of President-elect Trump’s campaign promise to protect Medicare.

Speaker of the House Paul Ryan has also championed a voucher system, which he calls “premium support.”  In his 2016 proposal entitled “A Better Way,” Ryan makes several recommendations. Under his plan, the Medicare eligibility age would be raised from 65 to 67 by 2020.  Then in 2024, “Medicare beneficiaries would be given a choice of private plans competing alongside the traditional Medicare program on a newly created Medicare Exchange.” Increasing subsidies for Medicare Advantage and allowing private insurers to offer a variety of coverage levels is suggested as well.  Unfortunately, consumers who choose plans with more comprehensive coverage and flexibility may be required to pay the difference.

Some economists say that a privatized Medicare Advantage would be more efficient and enhance benefits to consumers while decreasing the cost to taxpayers.  Other experts say that Medicare would not automatically be more efficient if privatized. They argue that Medicare already efficient and the projected savings privatized Medicare Advantage was supposed to provide have not materialized.

Additionally, both Price’s and Ryan’s proposals leave out important details.  For instance, how much money would be given to individuals to purchase insurance? Would benefits be guaranteed?  How would the quality of coverage be monitored and ensured?  Would subsidies increase in proportion to the rising cost of healthcare?

Exactly what, if any, changes will be implemented is still unclear.  Not every member of Congress who is committed to repealing the Affordable Care Act, also thinks that making changes to Medicare should be their top priority.  Those who do want to make changes to Medicare have different opinions on how to do so.

One thing is certain: these proposed changes have caused considerable anxiety for Medicare recipients and their advocates. Triage Cancer will continue to follow this issue and share information as we receive it. Stay tuned to our blog and newsletter for the latest information.