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by HCSavvy

Searching for a Nursing Home?

March 14, 2013 in health care costs, Medicare, Member Stories

Our parents and grandparents often drain the last of their savings to pay a nursing home bill. So it makes sense to shop around, both for cost and quality. UPI has a story about this site which looks like a good place to start if you want to compare options for a friend or loved one.

The site does not show ANY nursing homes in Massachusetts with a five star rating. There are nine with four stars. In Boston, the average daily charge is $323.70 and the avg. quality rating is 2.9 stars. That’s a lot of money for average quality.

Senior Citizens, Sign Up Now: “Medicare Open Enrollment” Ends March 31

January 29, 2013 in Medicare

OK, I bet you thought “Medicare open enrollment1” for 2013 ended December 7, 2012.

That’s the conventional wisdom.  Actually enrollment time for Original Medicare is now through March 31, 2013 and those who sign up will start receiving their benefits beginning July 1, 2013.  And they’ll start paying their Medicare Part A and/or B premiums (unless qualified for “free” Medicare Part A and/or B) from that point in time forward. And they will start paying their Part A and/or B premium penalty (if due) from that point in time forward.

Actual Original Medicare open enrollment gets minimal publicity because most seniors don’t wait until Medicare open enrollment time to sign up.

Read the rest of this entry →

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by HCSavvy

Medicare’s money problems in pictures

November 28, 2012 in health care costs, Medicare

Another great infographic from the Kaiser Family Foundation (published in the Journal of the American Medical Association this week).

Picking a Medicare Part D Drug Plan Is Not as Confusing as They Say

November 18, 2012 in Medicare

(The following information applies to Cape Cod, Massachusetts where I live but — with different numbers — the same is true around Massachusetts and most of the United States:)

Despite the ranting of some and overhype by the press, Medicare Part D drug choices are just not as complicated as you may have heard. But seniors do need to do some research on ther past usage and spending first and narrow down what kind of drug coverage they are looking for, based on their circumstances. There are about 30 standalone plans on Cape Cod available to seniors who don’t otherwise get their drug coverage through a current or former employer, a spouse’s current or former employer, the VA, or through a Part C Medicare Advantage plan. But these 30 plans break down into just three categories that align with three typical senior-citizen/Medicare-beneficiary situations:

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Plan Ahead for International Travel Medical Bills

November 2, 2012 in health care costs, Health Insurance, Insurance Bills, lifestyle, Medical Care, Medicare, Member Stories

You may be closing out 2011 with a holiday trip, domestically or internationally. If you plan to leave the country, you may want to consider the following when it comes to your health:

  • You may not have health insurance coverage for illnesses or injuries that are treated abroad, even if you have US based medical coverage. Confirm with your benefits administrator.
  • Generally, Medicare does not provide coverage for hospital or medical costs incurred abroad, however, rare circumstances may be covered.
  • AARP can assist with obtaining foreign medical coverage and offers valuable travel tips.
  • US consulate personnel will help you locate health care providers and facilities and even contact family members, if necessary.
  • You can purchase travel insurance that covers health care needs and pays for medical evacuation if you need to be transported back to the US for treatment.

Obtaining medical treatment in another country can be expensive and a medical evacuation can cost over $50,000. Plus, you may encounter challenges with deciphering charges while abroad. Be vigilant, prepared, and follow the same self-advocacy steps you would while receiving medical care in your home state.

If you choose to purchase medical expense coverage while travelling abroad, double check you’ve carefully researched the following:

Warn Seniors Not to Buy the Most Expensive Medicare Part D Plan in the County

October 11, 2012 in Medicare

There is an interesting article posted on the Health Day blog of U.S. News October 11 headlined

 “Many Seniors Overpaying for Medicare Drug Plans”

The underlying research comes from a University of Pittsburg duo. Chao Zhou is a postdoctoral associate in the Department of Health Policy and Management, and Yuting Zhang is an assistant professor of health economics. I am sure it is not coincidental that this research appeared this week and Open Enrollment for Part D Prescription Drug Plans (and Part C Medicare Advantage plans which typically include Part D) begins Monday October 15.

This subject needs substantially more discussion. The U.S. News article says choosing a prescription drug plan

“… often leads to seniors paying hundreds of dollars more a year than they need to…”

But the actual research (gated on Health Affairs) referred to in the U.S. News article says

“Median total patient spending—that is, out-of-pocket drug costs and premiums—in 2009 was $990.”

It’s hard for me to figure how seniors are paying “hundreds of dollars more a year than they need to” when they are only paying hundreds of dollars a year in the first place. But I know from personal experience as a SHINE volunteer that some over spending on drug plans occurs…

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It’s Really Not Medicare Open Enrollment Time

October 2, 2012 in Medicare

When I wrote a few weeks ago about Medicare saying that it was “almost that time of year again,” I did not mean it was Medicare open enrollment time,  And when you read story after story over the next two months that it’s now Medicare open enrollment time, those stories are wrong.

Here’s the distinction with a difference. Buried in my too-long September blog post on signing up for Medicare for the first time was this sentence:.

“The Open Enrollment period for Medicare Parts C and D for 2013 begins October 15, 2012 and that’s a good time to check all your options.”

But you don’t currently have any 2013 options relative to Part C Medicare Advantage or a Part D Prescription Drug Plan unless

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Medicare 2013: It’s That Time of Year Again and Medicare’s Still Not Simple

September 18, 2012 in Medicare, Member Stories

In 2011 I wrote that signing up for Medicare is not simple (link broken). Well it’s time for an update and the bad news is that Medicare is still not simple.  Here is an update to my 2011 explanation:

If you’re turning 65 soon and looking forward to the simple life… 

No, this post is not about shuffle board, falling and failing — and now again rising — 401Ks, bingo, or problems with Social Security debt (which most about to be 65-year-olds don’t have to worry about until they’re 66 or 67). This is a “welcome to Medicare” blog post and I signed up last year. If you were already collecting Social Security when you turned 65 like I was, you should get a 150-page version of this information from the government in the mail two or three months before you turn 65.



(NOTE: The above photo is the 2012 cover of the Medicare and You booklet. A 2013 version will be released shortly and mailed to all Medicare beneficiaries as well as those turning 65 who are already on Social Security. Do your bit for the national debt and a forest in Orgegon and go online and say you only want electronic distribution.)

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Be Cautious About “National Medicare Education Week”

September 13, 2012 in Medicare, Member Stories

Just a caution to readers that two primarily Medicare insurance companies, a financial advisory company primarily aimed at retirement issues, and an association of some sort of providers or users of home-based healthcare support (I can’t tell whether it’s users or providers after five minutes on their web site and I can’t figure ouit what kind of support they use or provide) have declared next week National Medicare Education Week. 

It sounds like a pure marketing gimmick to me. That does not make it bad.  Education on issues of any sort is always important.

Just remember that if you go to a “National Automotive Performance Week” or a “National Highway Transportation Options” event with content created by General Motors and it’s held at your town’s Chevy dealer, you can still buy a Ford or a Toyota or a… The same applies to National Medicare Education Week. The first step in Medicare Education is understanding your options as illustrated in this chart from the Medicare and You booklet on

Rather than next week, I consider the key Medicare Education dates to be: Read the rest of this entry →

Will Medicare Changes Result in Better Quality?

September 3, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

As the price of health care in America keeps rising, you may be among those that are frustrated by the kind of generic approach taken by  health insurance companies and government entitlement programs. The traditional fee-for-service format of health care reimbursement means that the best hospitals and doctor’s offices don’t get rewarded and the lower performing offices don’t have consequences. But, this is all likely to change with new Medicare rules that are slated to pursue more of a ‘meritocracy’ in the way that health care dollars get paid out.

New Medicare Rules

Reports from the Centers for Medicare and Medicaid Services show that Medicare is going to begin making some changes in the way that it reimburses health care providers starting late this year. In what Medicare officials call a ‘value-based purchasing’ program, Medicare will consider various aspects of a provider’s operations in setting the reimbursement rates for that particular office. Key factors will include observation of outcomes, or in other words, whether the procedures and services performed at an office actually help patients to recover from illnesses and improve quality of life.

Responses to the Changes

For you, this represents a major change and a big potential edge in making sure you get what you deserve for the money, especially when you have out of pocket expenses. On the downside, though, some providers are arguing that hospitals and offices in rural areas, or those with other significant disadvantages, may be punished unfairly. Read the rest of this entry →

How Much is Health Insurance Coverage Really Costing You?

August 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare

Just when you think you have the health care business figured out, new reports come out showing even more dark details about how American patients are simply charged massive amounts of money for health care services on a pretty arbitrary basis.

The newest wrinkle in this story actually turns the conventional wisdom about payment for health care on its ear: where many assume that most uninsured patients get the highest bills, new reports are showing that, in many cases, the “cash-up-front” deals given to cash-paying patients may be as little as less than half of a contractually agreed price that the hospital would bill the insurance company. Why is this a problem? Because it means that many of those who pay high deductibles, premiums and coinsurance on a health plan may still be paying more for each service, visit or procedure than someone who doesn’t have any insurance at all. It also injects a huge monkey wrench into the now established idea that everyone needs health insurance to make health care affordable. On the flip side, if you have a high deductible but choose to self-pay a medical bill, how will you ever meet your deductible? This is particularly troublesome should you have a catastrophic event. Read the rest of this entry →

The 2012 Political Debate: MediCare vs. ObamaCare vs. RyanCare

August 30, 2012 in Medicare, Member Stories

Martha asked me recently what I thought about the 2012 political debate over Medicare given my previous posts about Medicare on this site and my “work” as a Centers for Medicare/Medicaid Services (CMS) volunteer at my local senior center. (Oh, and like Sy Sperling and the Hair Club, I’m also a member of Medicare.) My answer to her is that there is not enough information available for anyone to form an intellectually honest, just-the-facts-ma’am pro and con analysis about the various proposals for Medicare reform. Neither side wants to clear the air because — I assume — there is more political advantage to both candidates in keeping the debate murky.

So all I can tell you is what I would read if I were you and I felt the need to try to find out more information about Medicare — and proposals to reform it. My basic advice: Go to the source. Do not depend on the media. Do not depend on so-called non-partisan think tanks.

The best source is a 200-page booklet available on called Medicare and You.

Read the rest of this entry →

How to be Your Own Best Advocate

June 15, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare, Member Stories

Being Your Own Advocate

In case you haven’t been paying attention to changes in America’s health care system, there’s a general idea that needs to get out to as many people as possible: the gist of it is that, in most cases, today’s consumer needs to be much more engaged in their care and ready to act as their own advocate in order to get the health care and treatment that they need, no matter what their health is like.

You may have heard something like this already: from all corners of the health related media, patients are hearing that they need to “be their own advocates” and get vigilant about not just what they pay for health care, but what kinds of health care they receive and whether or not it fits their specific needs.

But what does it mean to be your own advocate? Looking beyond the cliché, you can obtain good, concrete ideas of how to go about interacting with a family doctor in ways that will help you get better access to the health care you need.

Patient Engagement: What it Involves

The good news on this front is that you may already do a lot of what you need to do to advocate for yourself in a healthcare environment. Read the rest of this entry →

Are You Being Treated by a Subcontracted Doctor?

May 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medicare

A recent story from Dayton, Ohio, caught our attention, where according to news reports, some patients remain responsible for emergency room charges when a hospital happens to ‘subcontract’  doctors who may not accept health insurance at all. This adds another layer to the oftentimes confusing in network vs. out of network debate. In many cases, especially in an emergency situation, patients who visit a local hospital or facility may experience unexpected costs after they are cared for by a doctor who may not be ‘in their network’, even if the facility itself is listed as an in network provider. There’s been a lot of discussion whether this, which may seem deceptive, especially to those without specialized knowledge in the medical billing and health insurance field, is fair. In fact, state officials, like in New York, are  looking to pass legislation which mandates better transparency for out of network charges. Taking the time to understand your health insurance plan and what defines a covered provider or facility can save you hundreds if not thousands of dollars in non-covered charges.

It seems providers tend to respond to these scenarios in two ways: Some indicate they will change their policies to include more transparency while others claim to be bound by federal laws that do not allow them to reveal to patients whether an on-call doctor or a physician on shift will accept their insurance or not.

We find the second argument to be completely unacceptable at face value. In fact, it’s reasonable that consumer advocates would expect state regulators to crack down on these well documented examples of seemingly unfair provisions in delivering medical services. It’s not outside the realm of possibility that a patient facing bankruptcy after a bill like this would have a basis for legal appeal, especially as new legislation is introduced and passed. It’s vitally important that you discuss your options and ask questions before treatment to minimize impact to your financial future. How prepared are you in the event of an emergency room visit?

Past Due Medical Bills: When Do I Have to Pay?

May 5, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

Have you received a medical or hospital bill with no clear due date? This can be because of how bills are laid out or because of design issues. Typically, a bill or patient statement will show medical debt as 30, 60, or 90 days past due, providing the kind of urgency that can make you drop a check in the mail. Bills may also be labeled “second notice” or “third notice” to show that the biller has already tried to contact you. But, all of that doesn’t always tell you what you need to know: how long you have to pay before the bill goes to collections. There are several reasons you may choose not to pay your medical debt right away including having a lot of bills or long-term debts to juggle. Prioritizing which ones to pay can take precedent to stay afloat. And, some billing statements require real, actionable steps while medical bills seem to be written in some strange, esoteric language.

Medical Debt Collection: Common Practices

Every medical provider has their own system for handling past due bills. Some are quicker than others to send a past due bill to collections. Many have different billing systems that represent debt in different ways. Some may be explicit about a due date, others will not. In some cases, when patients call, the medical office admits that they don’t even know the exact date when a bill will go to collections. That’s what motivates many experienced consumer advocates and others to recommend “playing it safe” and promptly paying all past due medical bills aged longer than 30 days, which is a common grace period for payments.

Some patients, though, will make active attempts to talk to providers. Those who pick up the phone can often get on payment plans that will make due dates and everything else much clearer, while allowing for deferred payment according to the patient’s finances. Some can even qualify for charity. In many cases, it’s this direct communication which can yield benefits for both parties: you know where you stand and your provider receives data on how and when you are likely to pay a particular bill. It’s a win-win, and that’s why when it comes to vague patient statements, the direct approach is often best. How do you promote open communication with your provider on past due medical bills?

Overused and Unnecessary Medical Procedures

April 28, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Care, Medical Debt, Medicare, Member Stories

Nine physician specialty societies are each reporting a top five list of commonly used procedures that are often unnecessary. These societies represent 375,000 physicians across the country.

Some of the procedures cited include:

  • Brain scan after fainting (without other relevant symptoms)
  • Antibiotics for sinusitis (while typically resolving itself in two weeks, 80% of patients are prescribed antibiotics. CT scans are also usually unnecessary.)
  • Admission and pre-operative chest X-rays (routine X-rays are not needed.)
  • Colonoscopies (not recommended but once a decade.)
  • Cardiac stress tests (they do not need to be part of a checkup for a healthy adult.)
  • Lower back pain (unless another ailment is suspected, X-rays are not needed in the first six weeks.)

Unwarranted testing can lead to stress, over treatment, higher medical bills, and even unneeded invasive procedures.

In fact, the natural tendency to screen for heart disease prior to having any symptoms, like getting a stress test as a 50th birthday present, hasn’t “panned out,” according to a preventive cardiologist at Northwestern Memorial Hospital.

Study members suggested that patients and doctors have to thoroughly discuss any tests/procedures even if they are suggested by patients because they are not always needed.

25 Million Americans Underinsured Including Middle and Upper Income Families

April 18, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medical Debt, Medicare

As current government initiatives wrestle with the issue of millions of uninsured Americans facing potential medical bankruptcy, new studies are revealing that it’s not just the uninsured who are at risk. The issue of underinsured American individuals and families is becoming a major part of today’s healthcare conversation and alerting many more Americans to the dangers that they face, even if they have access to affordable health insurance policies.

Current statistics show a startling trend, where being underinsured is becoming a common way to fall into extreme medical debt and eventual bankruptcy or bad credit situations. Research by the Commonwealth Fund that appeared in recent industry journals shows that America’s underinsured community has doubled in the past four years to over 25 million people. While the highest number of underinsured Americans are in the income range below the poverty level, research shows that middle and upper income families are being affected in larger numbers each year. Research also shows that some individuals with what others would consider healthy annual incomes are still very likely to become underinsured in the immediate future.

In general, being underinsured has to do with the cost of one’s medical bills against that person’s annual income. Read the rest of this entry →

How much do I owe for out-of-network care?

March 30, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare, Member Stories

Looking at Medicare- vs. “usual and customary”-based reimbursement

By Robin Gelburd

Many Americans with private health insurance have plans that reimburse for out-of-network care. But consumers often don’t realize the wide variation in reimbursement rates among insurers and the implications for their wallets.

At FAIR Health, the independent not-for-profit corporation dedicated to bringing transparency to healthcare costs and out-of-network reimbursement, we have noticed that differences in formulas can make a big difference in reimbursements.  A number of private health plans are now basing out-of-network reimbursement rates on a percentage of Medicare fees – as opposed to the usual, customary and reasonable (UCR) standards that reflect actual provider charges. Read the rest of this entry →

Before the Affordable Health Care Act, Were You Locked Out?

March 17, 2012 in health care costs, Health Insurance, Hospital Bills, Insurance Bills, Medicare

Locked out of medical care, that is. Who? Individuals with pre-existing conditions. Now, 50,000 of them have healthcare coverage via the Pre-Existing Condition Insurance Plan (PCIP) in their state. This is a temporary high-risk health insurance program that makes healthcare not only available but much more affordable.

For example, a patient named Deborah fell victim to a back injury. It left her unemployed and unable to afford health insurance premiums. However, when she discovered the Michigan PCIP plan, she was able to enroll in it, receive the back surgery she needed and get on the road to recovery.

PCIP makes a difference. It has allowed many Americans to get connected to health insurance and receive the medical care they sorely need. That’s because PCIP enrollees can receive that care immediately.

The Affordable Health Care Act has also helped students up to age 26 receive coverage and assisted seniors by allowing access to more affordable prescription drugs.

You can see how your state administers PCIP by clicking here.

Teachable Moments: Romney ‘Turns Down’ Medicare

March 14, 2012 in Health Insurance, Medicare, Member Stories

The web has been full of stories recently about Mitt Romney turning 65 March 12 and “turning down” Medicare.

Many pundits claim Romney made an unbelievable political mistake and has most likely just lost the senior vote. I don’t necessarily agree because I have not seen enough information on any web site to explain the whole situation. I have seen a whole lot of misinformation.

So what we have here is what some like to call teachable moments. Here are at least five: Read the rest of this entry →