One of SCJ editors had an interesting experience recently with Medicare Part C.  That is the Medicare Advantage program which seniors can opt for instead of Original Medicare. Medicare Advantage programs are offered by private insurance companies and provide coverage for hospitals, medical and prescription drugs; they replace Original Medicare.

A family member enrolled in a Medicare Part C program when he turned 65 recently.  There are hundreds of thousands of people enrolled in this particular insurance company’s program, and it is touted rather highly among the enrollees. One of the attractions is that for many seniors who enroll, there is no additional monthly premium (other than what is withheld from their Social Security checks).  So, after verifying that his physicians were covered by the plan, a brother enrolled in the program recently.

When he went to a specialist who has been treating him over a year, and who is covered by the Medicare Advantage plan he chose, he discovered the medical facility in which he was seen did not have a contract with his Medicare Advantage Part C plan, and therefore those facility costs were not covered for his visit.

Weigh the Pros and Cons of Part C versus Original Medicare

My brother and I had a long drive home, so we talked about whether or not he should convert back to Original Medicare and a Medigap supplement. We talked about the costs with both options, and here’s where we came out:

• The facility cost was equal to what he would be paying with a Medigap policy for an estimated two or three months of premium, so he’s still better off financially with the Medicare Advantage Plan;
• If he discovers that there are several facility costs that arise this year that are not covered, at the end of the year he can total all that he paid that is not covered and compare that to what he would pay with a Medigap policy of his choice;
• By the end of the year, he will know whether it is prudent to remain with the Medicare Advantage Plan or convert back to Original Medicare and a Medigap policy.

So far the Medicare Advantage plan (Part C) is winning.

It is a good practice to review what you pay for Medicare annually.  This article will lead you through what to look at in your individual circumstances.

The Medicare benefits are provided in four parts:

• Part A – Hospital Care
• Part B – Medical Care (physicians, testing and imaging, screenings, etc)
• Part C – Medicare Advantage – the private health insurance programs people can opt for instead of Original Medicare; Medicare Advantage programs provide coverage for hospitals, medical and prescription drugs.  A Medicare Advantage plan replaces Original Medicare.
• Part D – Prescription Drug Coverage – this may be included in some supplemental insurance plans, or it can be a stand-alone plan.

Regarding Part A, hospital deductibles are paid when hospital admission is required.  There is no other deductible for Part A except for those who enrolled late; if you fall into that category, there are late enrollment penalties, and a monthly premium for late enrollees.

Part B Deductible is Primary Cost for Most Beneficiaries

The majority of seniors on Medicare pay a deductible for Part B (non-hospital medical care), which is $99.90 for 2012. It is deducted from social security monthly checks for most seniors; some prefer to make a monthly or quarterly payment.

In addition, for those who enrolled late for Part B, there are late enrollment penalties.

The cost of Parts C and D vary by plan and by insurance company.  Some plans have no deductible, and others do depending upon benefits offered.  There is a potpourri of options available, and seniors are encouraged to review the options every year to be sure you are enrolled in the plan that best suits your needs.

Here are some links to sites on Medicare.gov that you may find helpful:

• Summary of Medicare Costs
• Find a Medicare Plan that suits your needs
• Medicare Basics
• Comparison of Parts A&B, with Part C
• Basic Questions Regarding Eligibility and Enrollment

Senior Citizen Journal has written in the past about attempts of politicians to manipulate senior citizen opinion through scare tactics.  They know that if they can just get us frightened enough, we will do whatever they tell us we need to do to remain ‘safe’. Well, that is, ‘safe’ as they define it.  However, peel the layers off the fear-mongering behavior and we find their desire for us to vote for them and their policies so they can hang on to political power.  They will even distort the truth and actually tell untruths to achieve their power-goal.

Language is a very powerful tool and can be used for good or for evil. It is our job, as diligent seniors, to learn to sort through the fear-provoking words to actually look at the reality underneath.  We sometimes need help from trusted family members and friends to be able to do that.  It is difficult to do that when the fear has already arisen inside us, and we have to deal with that emotion while trying to understand what the truth really is.

Entitlement vs Earned Benefit

Such is also the case with language that provokes anger, versus language that provokes a positive response.  We’re finding an example of that with regard to the Social Security program as politicians discuss it in their campaign speeches.  Most of us seniors have a negative response (anger) when we hear about ‘entitlement’ programs.  The suggestion is that people are getting financial benefit from the government because they are poor or fatherless or disabled–they are ‘entitled’ to government benefits because of their condition.  The message is they didn’t earn the benefits, and they don’t ‘deserve’ them.

Some politicians have also referred to Social Security as a ‘Ponzi Scheme’, that is a program that takes money from one group of people (or pot) and gives it to another group of people (or pot) with no transparency about how the money moves around.

So let’s peel off the layers and look at the reality of Social Security:

• We seniors receive Social Security benefits because we made payroll contributions during a lifetime of work.  Social Security benefits are earned. They are not entitlements.
• The Social Security Administration is highly transparent, providing reports annually about how many people have benefited from the program, how much money has come into the trust fund, and how much money has been paid out.  It also provides information about what loans have been taken by action of Congress from the Social Security Trust Fund.

So the next time you hear ‘entitlement’ or ‘Ponzi Scheme’ in relationship with Social Security, you can resist the temptation to become fearful or angry.  It’s just another politician trying to manipulate you with fear and anger.

SCJ recommends you not vote for people who use those manipulative tactics with senior citizens.  They clearly do not have our best interests at heart.

The changes brought by the Affordable Health Care Act are already helping senior citizens better manage their health care at a lower out of pocket cost. Seniors have saved $460M on prescription drugs since the law passed.  Almost one million people in the ‘doughnut hole’ category received a 50% discount on prescription drugs. More importantly, 17 million seniors received potentially lifesaving preventive care in the form of screenings for serious disease and illness, with no copays or deductibles.  The Medicare free annual wellness visit is still a popular item for many seniors.  Half of Medicare beneficiaries received free preventive care of one kind or another.

HealthCare.gov has a wealth of information and documentation about the realized benefits of the Affordable Health Care Act, particularly for millions of senior citizens. Be sure to check out the website.

THE ISSUE:  WHO SHOULD MANAGE HEALTH CARE?

So why are some politicians claiming the Health Care Act isn’t working and should be repealed?  The basic issue is a question of what entities should manage health care:  1) private health insurance companies, or 2) the federal and state governments.  It’s a belief system that is legitimately debated, and has been so, for the last gazillion decades.

The private insurance side says they can hold down the cost of health care through competition, and they are in a better position financially and socially to manage health care.

On the other side, many people claim the government can do a better job holding down the cost because they are essentially a ‘non-profit’ entity and do not have to satisfy stock holders and make a profit on the backs of people who need health care.

Both sides have legitimate claims. But if we peel the layers off the onion, we begin to see that ultimately, large insurance corporations have a bottom line: Make a profit. They are in business to provide products and services that make a profit for their shareholders.  Providing the products and services are a conduit to the final goal: Make as much of a profit as possible.

Medicare is working. We seniors like it.  We’re getting better and better health care, and our costs are going down.  The Affordable Health Care Act is working. And in 2014 the majority of services and coverage will kick in.  We like that plan.

Be sure you know, when you cast votes for representatives, how they stand on this very important issue.   SCJ encourages you to vote for political candidates who support Medicare and the Affordable Health Care Act.

Senior citizens across the country are clear about Social Security:  Leave.  It.  Alone. We feel frustration, anger and fear over what Congress could do to the financial security that means so much in our personal lives.

A lot of us seniors live on less than $20k a year.  We cannot afford to have our lifeline severed. One out of seven senior citizens now lives in poverty in the United States.  Millions of us live on lower-middle incomes.  Millions more will retire in the next decade and be living on low Social Security benefits ($1250-$1500 a month).

AARP is beginning a national discussion “…to develop the tools and strategy for strengthening health care and retirement security and for restoring prosperity to the middle class.”  It’s starting now.

Social Security is NOT a Piggy Bank for Deficit Reduction

Congress needs to reduce the deficit by means other than putting our retirement security (and health care via Medicare) in jeopardy. There are a number of good suggestions on the table that Congress can consider, that will work to reduce the deficit in a reasonable amount of time.  Congressmen and women have to put aside their political party affiliations and make decisions that benefit the people affected.  It appears that’s impossible for the current group of people in Congress to do.

Shame on them.  If my five year old son were behaving in a selfish and greedy fashion on the playground, I would impose a time-out and not allow him to return to the playground until he agreed to be cooperative, giving and unselfish.  Congress needs a time out, and perhaps a permanent one, since they are supposed to be rational adults who are incapable of being fair and reasonable.

AARP CEO Barry Rand recently said this:  “Next month, AARP will kick off a serious national conversation focused on finding ways to strengthen health care and retirement security and restore prosperity to the middle class.   (AARP members) want a national conversation that will lead to answers and action. They are anxious to hear solutions that address the problems faced by real people. They want to hear ideas that would lead to more jobs, bring efficiency, economy and fairness to health care and provide greater financial security.”

Rand said the goal of the national conversation is “…to ensure that current and future generations receive the benefits they’ve earned over a lifetime. With your ideas, your input and your involvement, we can achieve this goal.”

SCJ thinks this effort is worthy of support, and we encourage our readers to get involved in the conversation.

One of the issues being bantered around about Social Security privatization is whether or not individuals could invest better on their own or not.  The reality is that some seniors could probably do better, particularly if they had a lot of experience managing their own investments pre-retirement and learned successful investing tools. And the reality is that most of us seniors would likely not do better, and would likely do worse than the Trustees are doing with the Social Security Trust Fund.

Let’s go back to the basics:

• Social Security is designed to be a guarantee of retirement income. It is designed to last your entire life, once enrolled.  It is designed so that funds cannot be lost on Wall Street.  Pre-retirement, we tried to maximize the return on our investments.  Social Security is not designed to maximize returns.
• Social Security is a secure based of income during retirement.  Most of us seniors depend heavily on our Social Security benefits.  It keeps us out of poverty.
• Here are the statistics:  Social Security benefits provide at least 50% of income for 50% of seniors over 65; Social Security benefits provide 90%+ of income for 43% of single seniors and 22% of married seniors;

Privatizing Means Wall Street Control Over Retirement Funds

So the issue is that if Social Security is privatized, it is no longer Social Security, but an opportunity for Wall Street investors to gain access to your retirement funds for their own purposes. And we all know what happens when greed takes over.

It seems to us that Social Security is best left alone; it was designed to guarantee retirement income.  No private investment can make those guarantees; in fact, investment firms are specifically prohibited from making any guarantees about income. If you have a retirement fund or pension or IRA, you have opportunity to ‘play around’ with investments, and you just might make good returns on those funds.  Then again, you might not.

But most of us need Social Security for survival, and that’s not anything to ‘play around’ with. Actually, the status quo we know as Social Security today is working just fine.  Except for possibly lifting the payroll tax limit so wealthy Americans pay their fair share of taxes, nothing needs to be changed.  Let’s encourage our congressmen and women to just leave it alone.

Senior citizens, with their lifelong savings stacked up, as well as a habit of not checking free credit reports frequently, make for a perfect target for identity thieves nowadays. The federal government has
thereby requested senior citizens to stay alert against the prevalent medicare scams that may separate them from their hard-earned money in no time. Given below are the details of the three main medicare scams and how older Americans can avoid falling into their trap:

The Healthcare Reform Scams

As the spotlight of media switches to issues other than the healthcare reform, scammers are now sneaking out to take advantage of seniors’ under-awareness about the new legislation, with limited-time enrollment opportunity for “health care reform insurance policies.” These scammers usually request medicare numbers for gaining absolute protection from the reform. Some audacious thieves may even ask for bank account number for payment of the upfront fee. Be sure that you are not caught in the web of this bogus policy, for there is nothing called “healthcare reform insurance.”

The Poser Scams

Scammers sometimes pose as Medicare employees. They get in touch with you via email, call, or through a letter, asking you for your SSN, credit card number or bank account details. Know that no one from the Federal Government will ever ask you for your SSN, bank account number, or Medicare number. Anyone asking for this information while claiming to be a government’s representative is definitely a criminal. So, ignore any calls or letters that you may receive, asking for these details.

The Free Lunch Scams

Haven’t you ever heard – there is nothing like a “free lunch”? Some crooks, especially common in inner cities, are nowadays trying to lure senior citizens with a free gift or a free lunch and get them to fake medical clinics. At these clinics, these scammers try to get the medicare number from you for their medicare fraud endeavors. Turn these invitations down without question, for no government program offers you free lunches or free gifts to visit a medical clinic.

Apart from losing your lifelong savings, it will not take much time for these identity thieves to screw up your credit reports. So, be prudent in your dealings and know that world may not be as good as it seems.  To survive, you need to be shrewd and understand there are crooks scheming to get your money.  Trusted loved ones and financial counselors are good advisers for senior citizens who need protection to remain safe from scammers.

Alicia Lyttle is a financial consultant and a member of many financial communities.

Just a reminder to our readers… Open Enrollment begins and ends earlier this year (2011).  And the ending date is coming up within 10 days.  If you want to make changes in your plan, you need to do so by December 7. The Medicare.gov site says this:

“There’ll be a wide range of health and drug plan options available across the country, including Original Medicare. Most people with Medicare can choose a “Part D” plan to help them pay for prescription drugs. And people who have chosen to enroll in a “Part C” Medicare Advantage plan for their basic health care services have the option of staying in that plan, choosing a different plan, or going back to the Original Medicare program.
Plans can change from year to year, so these are important choices that should be made with care. People can turn to www.medicare.gov, call 1-800-MEDICARE, or consult with a local State Health Insurance Assistance Program (SHIP) for help.”  cms/medicare.gov

Be sure you give attention to this deadline if you want to make changes.

House Speaker John Boehner, R-Ohio, was recently invited to write an article for AARP Bulletin about the Republican Plan for Medicare.  In that article he wrote, “In the health care law that passed last year, the Democrats who run Washington revealed their solution: a panel of 15 unelected bureaucrats whose job is to deny care to save money.”

Now, Mr. Speaker of the House of Representatives, either you cannot read and understand plain English, or you are intentionally distorting the health care law in an attempt to scare us senior citizens… again.  If you cannot read and understand the English language, you have no business representing anything or anybody.  If you are intentionally using scare tactics to intimidate senior citizens into voting your way, you have no business representing anything or anybody.

Shame on you.

What Does the Health Care Law Really Say?

This is what the health care law says about the panel of 15:

“The panel is to be composed not of bureaucrats but of, among others, doctors, drugmakers, insurers, health experts and representatives of consumers and older people. The panel will be charged with examining the relative health outcomes, clinical effectiveness and appropriateness of different medical treatments.  Medicare does not have to accept its recommendations, and the panel has no decision-making capability about what shall be covered, and therefore cannot deny treatment to anyone.”  (aarp.org/bulletin SEPTEMBER 2011, p 32).

In effect, the panel will be examining research on clinical treatment effectiveness and outcomes, and then making recommendations to Medicare about what they (the panel) believes Medicare should be covering for the benefit of recipients.  This sounds like a good plan.  Everybody wins.  The only loss is for those treatment options that don’t work as well as others.

SCJ will continue its commitment to separate the TRUTH about Medicare and Social Security from the distortions that some politicians continue to put on our plate.

Explain Medicare

Medicare is a health insurance program designed for senior citizens over the age of 65, permanently disabled citizens of any age, citizens who have congenital physical disabilities, and people with End Stage Renal Disease.  The legislation was passed in 1965 when amendments were made to the Social Security Act.  Prior to 1965, over half of citizens beyond the age of 65 were without medical insurance. “Before Medicare, only 51% of people aged 65 and older had health care coverage, and nearly 30% lived below the federal poverty level.”  Half of the retired elderly people in this country had no health insurance, and no hope of being able to get insurance without government support.

“Medicare is financed by payroll taxes imposed by the Federal Insurance Contributions Act (FICA) and the Self-Employment Contributions Act of 1954. (Wikipedia, Medicare – United States)  Those taxes are the deductions employees see on their bi-weekly or monthly paycheck stub.  The amounts are governed by federal legislation.

What Does Medicare Do?

Medicare has four Parts that provide health benefits for

• Part A – Hospital Care
• Part B – Medical Care (physicians, testing and imaging, screenings, etc)
• Part C – Medicare Advantage – the private health insurance programs people can opt for instead of Original Medicare; Medicare Advantage programs provide coverage for hospitals, medical and prescription drugs.
• Part D – Prescription Drug Coverage – this may be included in some supplemental insurance plans

Original Medicare (Parts A and B) covers 80% of the cost of medical care.  Many seniors opt to get Supplemental Insurance (Medigap) to fill in the gaps not covered by Original Medicare.   Although Medigap policies are not part of the Medicare program, insurance companies offering them work closely with the Centers for Medicare and Medicaid Services (CMS) to coordinate payment of benefits for covered services. Medigap policies may cover hospitalization and/or the gamut of medical services and/or prescription drugs – or any combination of these services.

SCJ found the description of Medicare on Wikipedia to be well-written and well-documented.  We highly recommend our readers go to Wiki to digest the details in this very important program for senior citizens and our health.