Tag: competition
Nearly a third of all Medicare beneficiaries may face a significant increase in their premium costs in 2017, if Congress doesn’t act soon. According to the federal government’s board of healthcare trustees June 2016 report, participants of Medicare Part B—nearly 51 million Americans in 2016—could face a 22 percent premium increase next year.
The report warned Washington lawmakers that Medicare’s trust fund for inpatient care will be exhausted in 2028, two years earlier than was previously projected. While this finding is of grave concern, the more immediate worry, according to the report is the steep premium increase for Part B beneficiaries scheduled to take place in 2017.
Medicare Part B covers doctor visits and other types of outpatient care, and people with higher annual incomes who would see the largest increases. By law (the Social Security Act’s “hold harmless” provision), premiums for most Medicare recipients cannot exceed their increase in Social Security payments. However, according to the Wall Street Journal, the adjustment is expected to be just 0.2% in 2017 due to low inflation. As a result, Medicare couldn’t pass along a premium increase greater than the dollar increase in Social Security payments to an estimated 70 percent of beneficiaries who will be “held harmless” in 2017.
In order to account for this discrepancy, Medicare would have to spread its cost increases across the remaining 30 percent of beneficiaries not “held harmless,” which is its higher earners. The trustees’ report predicts that individuals earning between $85,001 and $107,000 and couples earning between $170,001 and $214,000 would have their monthly premiums raise from $170.50 a person this year to about $204.40 in 2017. And it gets worse. For those earning more than $214,000 ($428,000 for couples), the increase is about $467.20 a month, nearly $100 more than 2016 costs. Increases this extreme will have a significant impact on the millions of Americans living on fixed incomes.
Potential premium hikes will likely affect higher earners, if the predictions from the trustees’ report come to pass, all Medicare beneficiaries will see their annual Part B deductibles rise in 2017. The report cautions that the deductible costs will increase by nearly $40, from $166 in 2016 to $204 in 2017. “Everyone on Part B will be liable for the full increase,” says Tricia Neuman, senior vice president and an expert on Medicare at the Kaiser Family Foundation. Medicare is expected to have 53.5 million participants in Part B in 2017, meaning nearly 3 million more beneficiaries than this year will be liable to pay this deductible increase.
There is still time for Congress to intervene this fall and prevent this potentially devastating increase. Last year, lawmakers reduced an impending 52 percent premium increase for Medicare beneficiaries not “held harmless” with a deal in the budget agreement that raised premiums by only 16 percent instead. However, the trustees’ report cautioned Washington to address Medicare’s financial challenges now, “Taking action sooner rather than later will permit consideration of a broader range of solutions and provide more time to phase in changes so that the public has adequate time to prepare.”
To learn more about what this potential premium increase means and how you can prepare, visit mymedicareplanner.com and contact Tom Chamouris. Tom and his staff are committed to protecting senior citizens and helping them “navigate through the Medicare maze.” My Medicare Planner will offer guidance and help you find the plan that’s best for you—all at no additional cost.
Submitted by Kevin Hollister
With insurance mega-mergers pending, the existing competition may become even less.
This image is by The Commonwealth Fund.
Here are some takeaways from the study:
- Rural counties have the least amount of competition.
- In urban counties, the competition is still lacking: 81 out of the 100 counties with the most Medicare beneficiaries were found to be noncompetitive markets.
- Only one of those 100 counties, Riverside, CA, was classified as competitive.
- The Medicare Advantage markets are cornered by six insurers. The three companies with the biggest reach are UnitedHealth (38 counties), BlueCross (13 counties) and Humana (12 counties). Together, they control nearly two-thirds of all counties.
The Medicare Advantage market is a small but significant portion of the program. About 30 percent of beneficiaries have Advantage plans, which is roughly 16 million seniors.
But UnitedHealth, BlueCross and Humana are big in more than one market. The Government Accountability Office recently found that those three insurance companies cover 80 percent of Medicare beneficiaries across all markets.
With the pending mergers between insurance giants Anthem and Cigna, and between Aetna and Humana, that we covered previously, the competition will certainly not improve.
The American Medical Association released results of a study focusing on the Anthem-Cigna and Aetna-Humana mergers, and what effect they would have on insurance markets. They studied markets without the impact of the mergers, and found:
- Three-fourths of urban areas are already ‘highly concentrated” with low competition.
- 41 percent of urban areas have one insurance company with over half the market share.
Ultimately, the American Medical Association found that the mergers would decrease already low levels of competition by enhancing companies’ market power, which means it will “encourage one or more firms to raise price, reduce output, diminish innovation or otherwise harm consumers as a result of diminished competitive constraints or incentives.”
Studying the effects of the merger, the AMA found:
- The Anthem-Cigna merger would be anti-competitive in the combined markets of 14 states, including Virginia.
- The merger between Anthem and Cigna would enhance market power in 85 metropolitan areas in 13 states, including Virginia. Overall, 14 states would see significant decreases in competition from the deal, according to the study.
- The Aetna-Humana merger would increase market power in 15 metropolitan areas in 7 states, not including Virginia. In total, the study says the effects of the merger would be seen in 14 states, where competition would lessen sharply.
- Tom Says:
“Prepare yourself- this will be the outcome of the mergers for Medicare beneficiaries throughout the country and in Virginia particularly.
This is also a preview of the Annual Enrollment Period, starting October 7, for those who want to change their Medicare Advantage or Medicare Part D plans.”
To read the study by The Commonwealth Fund, click here.
For more on the American Medical Association’s study, see this New York Times article.
Anthem bought Cigna for $54 billion last week. Aetna bought Humana for $37 billion this month. What does that mean for consumers?
This image is from ModernHealthcare.com.
If there are fewer companies to compete with, rates could rise. Historically, mergers of big insurers have caused the price of premiums to increase.Some suggest that prices will go down.
Insurance companies say the deals would substantially reduce their own costs, allowing them to charge consumers less for their plans.
Some say the future of the deals is uncertain.
The mergers will be reviewed by the federal government, with special attention paid to anti-trust laws. Some believe they won’t go through at all. If the deals are upheld, they won’t go into effect until 2016.
Insurers aren’t the only ones joining forces.
- CVS, the largest drugstore company in the US, bought Target Pharmacy for $2 billion in June. The 1,660 Target Pharmacies nationwide will eventually be CVS pharmacies.
- Centene, a Medicare and Medicaid health plan provider, bought Health Net, a health plan provider in the same industry, for $7 billion in early July.
- The biggest generic drug producer in the world, Teva, bought Allergan, a manufacturer of generic drugs best known for making Botox, over the weekend for $40.5 billion.
- Insurers are merging because they want to cover more of the market. With the influx of customers from the Affordable Care Act, and the revenue from Medicare and Medicaid, they are buying companies with these strengths.
- When one subset of the industry begins merging and combining market power, the companies on the other side want to do the same. To maintain power in negotiations and stay afloat in the changing industry, companies see merging as the answer.
Tom says:
“Generally speaking, when an industry like the insurance industry begins to see mergers of the largest companies, it portends less competition and more price control between the remaining behemoths. Such mergers will be examined closely by the government for anti-trust violation. I will leave you with these quotes.”
“In an environment where the scales are already tipped, we are extremely concerned about the market imbalance this creates for medical practices and patients,” said Dr. Halee Fisher-Wright [of the MGMA]… “This will do nothing more than inflate healthcare premiums and decrease payments to physicians in favor of insurance companies and shareholders’ profits.” – Forbes
“One of the main goals of the Affordable Care Act was to restore competition in the health insurance sector,” said David Balto, a former policy director at the Federal Trade Commission who is now in private practice in Washington. “This consolidation will reverse these gains of the Affordable Care Act.” – Forbes
Will the Anthem-Cigna deal cost you money?
To find out what other changes could come with the health insurance mergers, click here.
Medicare will reimburse doctors
who talk with patients about
end-of-life care
Coverage for end-of-life counseling was not included in the Affordable Care Act, but some insurance companies have begun to offer coverage. More companies are expected to when Medicare finalizes the plan.
The proposal will be decided on November 1st.If this has been helpful, please feel free to forward this email to family and friends. Please contact us at [email protected] to be added to our email list.
Medicare Proposes paying for end-of-life counseling in sweeping physician payment rule
Modern Healthcare
In a draft of Medicare’s first physician payment rule since Congress scrapped the sustainable growth-rate formula, the CMS proposes paying for end-of-life counseling and revises several quality-incentive programs that will be rolled into a new comprehensive program in 2019.
Medicare Plans to Pay Doctors for Counseling on End of life
The New York Times
Medicare, the federal program that insures 55 million older and disabled Americans, announced plans on Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.
“Achoo !” , “Achoo ! “,God Bless You! It’s allergy season, and the grass, air pollution, dust, and pollen have got you sneezing. Well, hold on to your tissues…helpful allergy tips are on the way. Allergies aren’t just for Springtime, over 67 million Americans suffer from allergies every day. The most common allergen is Pollen. Pollen is an airborne allergen transferred by the wind. Various trees, grasses, and weeds create pollen; which is the culprit that irritates your sinus passages, eyes, and skin.There are also Seasonal Allergies, which include grass, pollen and mold. These allergies have triggers which are tied to particular seasons.
Seasonal Triggers
Winter – Smoke
Spring & Summer – Insect bites and stings
chlorine from indoor / outdoor swimming pools
Holidays – peanuts, other nuts, or chocolate
Thanksgiving & Christmas – Pine trees and wreaths
For allergy sufferers it is recommended that you work with your doctor or allergist to treat your symptoms, and find a way to avoid triggers.
Tips To Avoid Allergy Triggers
Monitor mold and pollen counts
Keep windows closed during allergy season
Go out early morning to do errands when pollen count is low
Wash hair, clothes and take a shower after being outdoors working, or playing
Use the air conditioner in your home and car
Use a humidifier
Get Allergy Healthy by seeing your doctor or Allergist today!
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For more than 24 years, The Medicare State Health Insurance Assistance Program (SHIP) has advised, educated, and empowered individuals to navigate their state-specific Medicare choices. In addition, SHIP helps beneficiaries resolve fraud and abuse issues, billing problems, appeals, and enrollment in low-income health assistance programs. In 2015, SHIP provided assistance to more than seven million individuals with Medicare.
The Medicare State Health Insurance Assistance Program (SHIP) network is a critical resource for the elderly, disabled and families needing help to make informed decisions about their Medicare coverage options and enrollment decisions. Today’s Medicare beneficiary must choose among more than 20 prescription drug plans, 19 Medicare Advantage plans, and various supplemental insurance policies, all with different premiums, cost sharing, provider networks, and coverage rules.
Last week the Senate Appropriations Committee targeted two critical programs for significant cuts, and/or elimination for Fiscal Year 2017. The two programs targeted are The Medicare State Health Insurance Programs,(SHIP) which is slated to lose all of its $ 52.1 million in funding. The second critical program is The Senior Community Service Employment Program. (SCSEP)
Eliminating SHIPs would leave millions of older Americans, people with disabilities, and families who need help applying for benefits, comparing coverage options, filing appeals, and navigating a complex program stranded without assistance. Max Richtman, President and CEO of The National Committee to Preserve Social Security and Medicare stated “Senate appropriators have turned their backs on a growing number of people who will need SHIP services to navigate the complexities of Medicare coverage by proposing to eliminate program funding.”
The Senior Community Service Employment Program, (SCSEP) which is funded by the Older Americans Act provides subsidized, service based training for low income persons aged 55 and older who are unemployed, and have poor employment prospects. Cutting this program could result in fewer seniors receiving services, and less income due to deceased working hours. It would be devastating to the seniors who work and depend on this program.
Final decisions to cut the programs have not been made. The full Senate is expected to vote on the budget bill in the fall. If this is important to you, please take action by contacting your congressman to reject the imposed cuts, and to take steps to secure The State Health insurance Assistance Programs and The Senior Community Service Employment Programs are funded.
For more information on our featured article visit http://khn.org/topics/medicare/
What happens if you take your Social Security benefits before your full retirement age? This is the question many seniors are pondering.
According to a recent Associated Press Center for Public Affairs Research poll found that 44 percent reported that income from Social Security will be their biggest income source during their retirement years., and that Americans 50 and older have access to multiple sources of income, but Social Security is the most common source.
According to the Social Security Administration, if full benefits begin at 65 or 66 and you were born between 1943 and 1954; you can begin collecting social security at 62, but at a reduced benefit rate by up to 30 percent. The average age that most people expect to start or have started collecting Social security is 64. If you could wait in this case past 66 years of age and even to 70 to claim your benefits, your benefits would rise around 8 percent more.
There are advantages and disadvantages to taking your Social Security early. One advantage is that you collect your benefits for a longer period of time. The downside to that option is your benefits are reduced.
Your circumstances are just like your fingerprints, no two are alike.
The average retirement age for men is 64, and for women 62. There is no set answer as to when it is best for you to take out Social Security, in that it varies across all ethnic groups.
Click here for further statistics and information regarding what your full retirement age would be, and important factors you should consider regarding your social security benefits and retirement.
June is Men’s Health Month. The Purpose of Men’s Health Month is to heighten awareness of preventable health problems, and to encourage treatment and early detection of diseases among men and boys.
There is a health crisis in America in Men’s health. The crisis references the management of medical diseases such as diabetes, hypertension, heart disease and high cholesterol. These common and treatable health issues are causing men to die prematurely in the prime of their life.
According to a recent poll by the centers for Disease Control and Prevention. Men are 80 percent less likely than women to use a regular source of health care. Most men go to the doctor only when they feel sick or have a medical emergency and that’s not nearly as often as they should.
Let’s focus on tips and ways for men to stay healthy at any age in celebration of Men’s Health Month. It’s never too late to take care of your health. Six things that will help you maintain good health are : Getting 7- 9 hours of sleep,quit smoking, more physical activity, eating more fruits and vegetables, avoiding drugs and alcohol, taming stress by taking care of yourself , and connecting socially with family and friends on a regular basis.
For National Men’s Health Month, here are six recommended health screenings, most of which can be done in your local doctors office, that men should add to their list to ensure better health.
Recommended Health Screenings for Men
Blood Pressure Test
Cholesterol Test
Prostate Cancer Screening
Colon Cancer Screening
Skin Cancer Check
Diabetes Check
National Men’s Health Month has a primary goal of educating and encouraging men and boys to feel better about taking steps to stay healthy. Not all men avoid there screenings or doctors appointments , but the disparity between men seeking health care , and women has a large enough gap for a men’s health crisis to be declared. Take charge of your health today.
Check out https://www.men’shealthmonth.org for further information on details for screening and further statistics on men’s health.
This month is Better Hearing and Speech Month. According to the National institute on Deafness and Communication Disorders, an estimated 26 million Americans have hearing loss in some capacity, due to noise.
The good news is that noise induced hearing loss is preventable. Hearing loss due to noise is not exclusive to the senior population, it affects seniors, children and young adults, and the good news is that it is preventable.
Our Hearing and speech are essential to being productive in our daily lives, and we must take proper care to assure that we are functioning at our highest and healthiest capacity.
How We Hear
Being one of our five senses, hearing is a process of picking up sound, and attaching meaning to the sound. The ear is divided into three parts leading up to the brain. The outer ear, middle ear and inner ear. How we hear is a pretty complex process. I will summarize the three major parts and their functions.
Outer ear – The ear canal and eardrum – sound travels down the ear canal, to the ear drum causing vibrations.
Middle ear – Three small bones connected in a cluster behind the eardrum at one end and to the inner ear at the other vibrate and creates movement of the fluid in our inner ear.
Inner ear –movement of the tiny hair cells sends electric signals from the inner ear to our auditory/hearing nerve to the brain, which causes what we know as sound.
Listed are a few steps to prevent hearing loss:
- Turn down your stereo volume
- Limit your exposure to unsafe sound levels.
- Wear earplugs
Speech
Speech is crucial to our daily existence. Being able to communicate and express ourselves is crucial. Approximately 40 million Americans experience speech communication disorders. Seniors may also experience voice disorders often as a result of medical conditions such as cancer, stroke, Parkinson’s or traumatic brain injury. You may also be subject to voice disorders that have existed since childhood, such as stuttering.
If you are diagnosed , or through sudden illness you develop a speech disorder, you should seek treatment from a Certified speech–language Pathologist .