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On July 15, Congress voted to override President George W. Bush's veto of H.R. 6331, the "Medicare Improvements for Patients and Providers Act of 2008."
The measure eliminates pending Medicare payment rate cuts for doctors – and pays for those cuts primarily through changes to the Medicare Advantage program. The changes include a slight reduction of payments to plans and require most MA plans to have provider networks in 2011.
How will this change affect Medicare Plan Members? Now that the bill has become law, many Medicare Advantage members are concerned. Although it's still too early to say exactly how this legislation may impact Medicare Advantage Plan Members coverage:
• No changes are being made at this time. Plan members current coverage remains the same.
• In the future and in some areas of the country, this legislation will likely shift some of the healthcare cost burden from the federal government onto seniors and disabled individuals.
How will this legislation impact agents?
H.R. 6331 contains new marketing rules for Medicare Advantage and PDP plans. It also contains several changes that affect Medicare Supplement (Medigap) plans. Most notably, it requires MA plans to establish new sales and marketing practices starting with the 2009 plan year.
Those standards are will include more stringent standards in areas like cold-calling, cross selling of non-health related products, consumer disclosures, and agent training and certification.
So while no one can be sure of how this will affect everyone involved with Medicare Advantage plans, we can be sure that the companies that educate their members early will be ahead of the game.
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The following article was found on the AARP website and the topic has been the subject of much debate. What do you think? Editor
This June, Congress will decide whether and how to cover the costs of paying more to doctors who participate in the Medicare program. Unless Congress makes changes, we run the risk of more and more physicians being unwilling to take Medicare patients. We are already seeing evidence of this in some areas.
Of course doctors should be paid fairly. However, in the course of increasing payments to doctors, Congress could impose still more Part B premium increases on Medicare beneficiaries. This simply is not fair.
Since 2000, monthly premiums have more than doubled. And since 2005 health care costs nationally have increased at twice the rate of inflation, with no end in sight. On average, Medicare covers only half of a beneficiary’s out-of-pocket health care costs and only nursing home stays of 100 days or less. And so beneficiaries are hit with a double whammy of higher premiums and skyrocketing costs. In addition, they may still have to pay in full when they buy eyeglasses or hearing aids, go to the dentist or need more than 100 days of skilled nursing care.
We cannot keep shifting the costs of a broken health care system onto patients and their families, including older Americans. Raising Medicare premiums even more would be a burden to many beneficiaries, and it could discourage some people from getting the health care they need. Each year, Part B increases take a bigger bite out of Social Security checks. That simply isn’t right.
There are other ways to solve this problem without placing further burdens on beneficiaries. One way is to reduce excess payments to private Medicare plans, also known as Medicare Advantage (MA). These plans have been promoted as more efficient than the traditional, government-run Medicare program. Yet, according to a new report from the Government Accountability Office, in 2006 Medicare paid MA plans $59 billion—an estimated $7.1 billion more than it would have paid if the people enrolled in MA plans had instead received care through traditional Medicare. We need to reduce Medicare spending in other areas of the program as well.
We are urging Congress to “Keep Medicare Fair,” and not to solve the physician payment problem by raising the premiums of Medicare beneficiaries even further. We are conducting a major legislative campaign, and we are asking for your help. In addition to community activity, advertising and visits to the Washington and district offices of members of Congress, we are urging AARP members to sign an online petition. So far, more than 160,000 members have done so. Please add your name. To sign the petition, go to www.KeepMedicareFair.org.
More than 44 million Americans rely on Medicare every day for health coverage. It is a system that works, but it has to be kept affordable. Really, enough is enough. Please join in. It’s time to tell Congress to keep Medicare premiums fair.
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If you've read anything at all about Medicare (CMS), you'll probably know at least three things: CMS can be very helpful, CMS can be really, I mean really, complicated and lastly who really keeps track of what people really think about the Companies that "sell" Medicare "plans"?
MedicareTruth.com is set to change all that ...
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WASHINGTON (AP) -- The Institute of Medicine said in 2004 there was no credible evidence to show that vaccines containing the preservative thimerosal led to autism in children. But thousands of families have a different take based on personal experience.
Autism is a developmental disability that affects a person's ability to communicate and interact with others.
Some of them are going to court Monday as attorneys will attempt to show that the mercury-based preservative triggers symptoms of autism.
Two 10-year-old boys from Portland, Oregon, will serve as test cases to determine whether many of the children and their families should be compensated. Attorneys for the boys will attempt to show the boys were happy, healthy and developing normally -- but, after being exposed to vaccines with thimerosal, they began to regress.
Thimerosal has been removed in recent years from standard childhood vaccines, except flu vaccines that are not packaged in single-doses. The Centers for Disease Control and Prevention says single-dose flu shots currently are available only in limited quantities. In 2004, a committee with the Institute of Medicine concluded there was no credible evidence that vaccines containing thimerosal caused autism. Watch more on the autism cases »
Overall, nearly 4,900 families have filed claims with the U.S. Court of Claims alleging that vaccines caused autism and other neurological problems in their children. Lawyers for the families are presenting three different theories of how vaccines caused autism.
The Office of Special Masters of the claims court has instructed the plaintiffs to designate three test cases for each of the three theories -- nine cases in all -- and has assigned three special masters to handle the cases. Three cases in the first category were heard last year, but no decisions have been reached.
The two cases beginning Monday are among the three that focus on the second theory of causation: that thimerosal-containing vaccines alone cause autism. The plaintiff in the third case originally scheduled for hearing this month has withdrawn and lawyers and court officials are working to agree on substitute case.
Hearings in the test cases for the third theory of causation are scheduled in mid-September.
Lawyers for the petitioning families in the cases being heard this month say they will present evidence that injections with thimerosal deposit a form of mercury in the brain. That mercury excites certain brain cells that stay chronically activated trying to get rid of the intrusion.
"In some kids, there's enough of it that it sets off this chronic neuroinflammatory pattern that can lead to regressive autism," said attorney Mike Williams.
In the end, the families' attorneys hope to convince the special master hearing their case that thimerosal belongs on the list of causes for the inflammation that leads to regressive autism.
To win, the attorneys for the two boys, William Mead and Jordan King, will have to show that it's more likely than not that the vaccine actually caused the injury.
Many members of the medical community are skeptical of the families' claims. They worry that the claims about the dangers of vaccines could cause some people to forgo vaccines that prevent illness.
"I think that what's so endearing to me about the anti-vaccine people, is they're perfectly willing to go from one hypothesis to the next without a backward glance," said Dr. Paul Offit, director of the Vaccine Education Center at the Children's Hospital of Philadelphia, Pennsylvanina.
Autism is a developmental disability that typically appears during the first three years of life and affects a person's ability to communicate and interact with others. Dr. Andrew Gerber, a psychiatrist, said that medical experts don't have a comprehensive understanding of what causes autism, but they do know there is a strong hereditary component.
Toxins from the environment could play a role, but currently, data does not support that they do, Gerber said.
Arguments are scheduled to go on throughout the month. A final decision could take several more months. Claims that are successful would result in compensation taking into account lost earnings after age 18 and up to $250,000 for pain and suffering.
The families or the federal government can also appeal the decision of the special master to the Court of Federal Claims or to a federal appeals court.
The court Web site says more than 12,500 claims have been filed since creation of the program in 1987, including more than 5,300 autism cases, and more than $1.7 billion has been paid in claims. It says there is now more than $2.7 billion in a trust fund supported by an excise tax on each dose of vaccine covered by the program.
Copyright 2008 The Associated Press. All rights reserved.This material may not be published, broadcast, rewritten, or redistributed
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