Dec. 7, not Tuesday, is D-Day for Medicare beneficiaries

Deadline nears for making changes to Medicare drug, health plans
by Paula Burkes Published: November 5, 2012
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Licensed independent insurance agent Linda Clure cautions beneficiaries to consider more than monthly premiums when choosing drug and health plans.

“You need to think about the maximum out-of-pocket, and whether you've got that amount set aside for emergencies,” Clure said. “Meanwhile, some drug plans require greater physician involvement than others, and you may not want that hassle.”

While consumers grapple with election choices for next year's plans, industry observers can't help but look to Tuesday's election.

To control rising Medicare costs, President Barack Obama's health reform plan, among other things, calls for cutting federal subsidies to Medicare Advantage plans, which have proved significantly more costly than original Medicare. Meanwhile Gov. Mitt Romney wants to give future beneficiaries — people now 54 and younger — federal vouchers to help buy insurance from traditional Medicare programs or competing private health plans when they become eligible.

Studies indicate the uncertainty of the future of health care, and reduced Medicare reimbursement payments, may be causing many doctors to opt out of Medicare or quit seeing new Medicare patients. Only half of doctors will continue their current practice during the next three years, according to a survey of nearly 14,000 doctors released in September by the Physicians Foundation.

Many respondents told Merritt Hawkins & Associates, a doctor recruiting firm, they plan to cut back on hours (22 percent), retire (13.4 percent), seek hospital employment (5.6 percent), transition to a cash/concierge model (6.8 percent) or close their practices to new patients (4 percent).

In Oklahoma, few physicians — 99 — have opted out of Medicare, according to the website of Trailblazer Health Enterprises LLC, which currently administers Medicare payments for state doctors.

“It's hard for physicians in rural Oklahoma, in particular, to stop seeing Medicare patients because seniors represent their patient base,” said Melissa Johnson, director of health care policy for the Oklahoma State Medical Association (OSMA).

Oklahoma physicians, Johnson said, are concerned with what they view as an inevitable lack of access to health care as the U.S. population ages and 30 million more people are added to insurance rolls under health care reform.

Oklahoma is short about 400 family physicians alone, the OSMA told The Oklahoman after health reform passed in March 2010. And Bloomberg recently reported the current doctor shortage across all disciplines is some 13,000 and is expected to balloon to 10 times that number by 2024.

As for Ada endocrinologist Curtis Harris, he opted out of Medicare 13 years ago.

“I was being reimbursed some 80 percent of my overhead, excluding wages, and nowhere close to my time,” Harris said. “I was not only not making any take-home, but losing money and had to charge others more.”

The cost of billing Medicare alone cost him $24 to $30 a bill, he said.

Still, he lost only two patients in the transition, Harris said.

“Once they realized they could continue to use Medicare for hospitalizations and labs, and wouldn't be stuck with huge hospital bills, they were fine,” Harris said.

Today, his costs billed to patients are $500 a year at most, Harris said.

“Try to get that kind of specialty care for much less, even if you have insurance,” he said.

by Paula Burkes
Reporter
A 1981 journalism graduate of Oklahoma State University, Paula Burkes has more than 30 years experience writing and editing award-winning material for newspapers and healthcare, educational and telecommunications institutions in Tulsa, Oklahoma...
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AT A GLANCE

Medicare election period closing

• Dec. 7 is the deadline for Medicare beneficiaries to change drug or health plans. New elections will take effect Jan. 1.

• For free counseling to make sure you're on the right plan, call the Medicare Assistance Program at the Oklahoma Insurance Department at (800) 763-2828, from 8 a.m. to 5 p.m. weekdays. Counselors can answer questions or set appointments for their office at 3625 NW 56, Suite 100. If you live outside the metro area and you'd like free face-to-face counseling in your local area, Medicare Assistance counselors can connect you to a qualified agency such as the Area Agencies on Aging or the Community Action Agencies.

Extra Help/Low-Income Subsidy

• Seniors with monthly incomes up to $1,225.13 ($1,654.88 for married couples) and up to $8,180 in assets which don't include their home and the vehicle they drive, ($13,020 for married couples) may qualify for full extra help from Medicare to pay prescription costs. For those who qualify, their monthly premium is covered and their copay will be no more than $2.60 for each generic/$6.50 for each brand-name covered drug. Partial extra help is also available for those who make slightly more.

SOURCE: Oklahoma Insurance Department and The Center on Budget and Policy Priorities

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