Data: Colorado not cashing in on census
Colorado ranks as the third-lowest state in the nation in how much money it gets from federal programs based on census demographics. Tough eligibility standards for Medicaid combined with relatively low child-poverty levels led to the state’s low ranking, according to a report released today by the Brookings Institution. “Colorado, even though it is wealthy, has a pretty chintzy Medicaid program …

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My mom doesn’t have health insurance and my job doesn’t give insurance to family members.

I would like to pay monthly to a health insurance company so my mom could get health check up when she needs it.

Do you know any health insurance companies that can accept low monthly payments since I don’t get paid that much?

How many people do you know who think their Congressperson has the answers to providing health care in America?  Or, their Senator?  George W. Bush?   Barack Obama or  Hillary Clinton?  Or, for that matter, any politician?  Do they really have the answers?

 

If they can’t do it, then how about the politicians in Canada, or Great Britain?  Have they solved the problem in their societies?  Some people believe they have.  However, in England, where the private practice of medicine was outlawed when socialized medicine was first established there, they were eventually forced to reverse their policy and permit the public to go outside the government’s system to obtain health care from private physicians. 

 

In Canada today, the story is much the same.  Many Canadians come to the U.S. for emergent needs, such as bypass surgery, because the waiting time in Canada is interminable, often many months before their citizens can get life-saving treatment when they need it.  

    

State-Run Health Care

All state-run health care systems have one thing in common: rationing.  Not necessarily involving the use of ration cards, but rationing nonetheless.  Rationing of resources.  The cause is a devilishly simple principle that’s present in all nationalized health care programs.  That is, it’s free, or so low cost that it’s almost free.  Basic economics clearly demonstrates that whenever something is free, the demand quickly becomes unlimited.  The lower the price, the greater the demand.  Give something away and you can “sell” everything you have and more.

   

However, the flip side of unlimited demand is a shortage of supply.  And, not having enough doctors, nurses, or expensive equipment, such as CAT Scans and MRIs, eventually leads to rationing.  Without enough health care to go around, rationing becomes a necessity.  That has been the failing with nationalized health care in England, Canada, Germany, Japan, the former USSR, everywhere it has been tried.

    

So, if there are no politicians who really know what should be done to solve our health care problems why do we keep expecting them to come up with the answers?

   

Just exactly what are the problems?  Too many uninsured?  Too high cost?  Poor quality?  Lack of availability?  All of the above?  Do you know or think you know?

    

What have been the government’s (read politicians’) solutions to date?

 

Health Care Policy

National health care (socialized medicine) in one form or another is the primary health care policy that is gradually being adopted in America.  And it is slowly but surely lowering the quality of the health care we are getting.  Talk to any doctor you trust and see if they don’t agree.  They will tell you that they are working much longer hours for far less money, that many physicians are retiring early or converting to “concierge” practices because they are fed up with the government and insurance company bureaucrats telling them how to practice medicine.  Consequently, there is a growing shortage of doctors and nurses.

    

But, you may say, we don’t have socialized medicine in America!  Perhaps not yet, but we’ve been moving in that direction for some time, and we seem to be going further down that path as the years progress.  It’s a slippery slope.   For example, consider Medicare. 

   

But, Medicare is not socialized medicine, you may insist.

    

Unfortunately, it is, or is headed that way.  Why?  For one thing, it’s a system that’s based on price controls. 

    

Price Controls

Price controls have never worked, ever, in any society at any time in history.  They were tried as early as 301 A.D. by a Roman emperor, Diocletian (243-316 A.D.) who implemented price controls under penalty of death.  But, even that didn’t work, and it hasn’t worked since.  What price controls do is cause shortages, increased costs and disrupted markets.

    

Look at what has happened to the Medicare program since 1984, the year the government changed its method of paying for hospital services from a “cost plus” to a system called DRGs (Diagnostic Related Groupings).  DRGs are a method of classifying illnesses and assigning a comparative value and a specific authorized payment to each.  At that point, many hospitals began to lose money because the government started dictating the prices that are paid for inpatient care.

 

As much as 70% of many hospitals’ patients are seniors, whose bills are paid by Medicare.  The Federal Health Care Financing Administration (HCFA) determines, in its sole discretion, the prices that can be charged for seniors’ inpatient hospital care, and then pays only 80% of those amounts.  The differences between a hospital’s standard fees for service and the amounts that Medicare pays must be written off.  They cannot be collected from the patient.  That’s price control.

    

Furthermore, because Medicare payments are determined solely by the government, annual cost of living increases are limited, generally to between 1-1/2% and 2-1/2%, in spite of the fact that hospital costs have been rising for years at an annual rate of anywhere from 6% to 14%. 

    

Another little known fact about Medicare is that seniors are prevented from seeking care outside the Medicare system, even if they are willing to pay the bill themselves.  Any doctor who accepts payment directly from a senior who is covered by Medicare is automatically disqualified from providing care to all Medicare patients for a period of two years.  This is especially important in situations where a patient wants a second opinion and would like to see another doctor.  That type of regulation is certainly an element of socialized medicine.

    

Many Hospitals Lose Money

Between health insurance contracts (HMOs) and Medicare limits on their charges, hospitals generally collect only about 50% of their total billings.  The rest is written off.  The result of all this is predictable: many of them are losing money.  About one-third of all hospitals in California are currently operating at a loss.  With a national health care plan, at some point, many hospitals would either be closed or services curtailed.  That’s been the pattern in every country that has nationalized its health care.  Nonetheless, that seems to be where we are headed, in spite of compelling evidence that it doesn’t work. 

    

Like the proverbial frog being cooked in a pot of cold water, Americans are gradually becoming aware that the quality of their health care is declining, even as costs continue to rise.  It just hasn’t sunk in yet.  When it does, they will undoubtedly be led into believing the government has the answers and demand more government control, regulation and oversight.  And, our politicians will be only too willing to oblige. 

    

Nationalized Health Care

Nationalized health care in America is gradually overtaking the free market, and we are all being slowly cooked in the pot of government intervention.   So, don’t be surprised at the type of health care program we get as time progresses.  Whatever your own conclusions, remember one thing: that our politicians won’t have to rely on whatever health care plan they establish for everyone else.  As usual, they will have their own, superior plan.  And, it will not be a part of the nationalized health care system that the rest of us will be required to use.  If you doubt that assertion, just look at the health care plan that our Federal legislators and government employees have now. 

 

In the interest of full disclosure, I’m one of those seniors who has Medicare health insurance coverage and I ran a hospital for about seven years.

 

© 2008 Harris R. Sherline, All Rights Reserved

More than 40 million Americans are enrolled in the Medicare program, but not all of those Medicare beneficiaries have identical Medicare plans. Medicare programs can be made to suit the needs of each Medicare beneficiary, which means that Medicare beneficiaries need to take time to understand the differences between major Medicare options so that they can ensure they select their best plans for their needs.

Medicare Part B and Medicare Part D are popular Medicare options that beneficiaries can select. However, unlike some other Medicare plans, Medicare Plan B and Plan D can be combinedr. Here is an overview of the differences between Medicare Plan B and Medicare Plan D that every Medicare beneficiary needs to know:

Coverage differences

Medicare Part B is the Medical coverage plan. Part B will cover the cost of doctor visits, home health care, and lab tests. Additionally, some medications and medical equipment is covered under Medicare Part B, including items such as diabetic test strips and wheelchairs.

Medicare Part D is the medications coverage plan. Part D pays for many medications that a Medicare subscriber takes on a regular basis. These medications may include drugs for diabetes, heart disease, and asthma. Additionally, some short-term medications may also be taken, such as an antibiotic.

Types of medications generally covered by each plan

Medicare Part B and Part D cover different types of medications, in many cases. Part B may cover the following types of medications:

- Allergy injections
- Blood products, such as plasma protein
- Hemophilia drugs
- Flu vaccines (when the vaccine is provided according to state law)
- Intra-articular injections, which may include Orthovisc, Synvisc, and Carticel
- IV flushes, including Heparin and Saline solutions
- Pneumonia vaccines ordered by a doctor

Part B may also cover a vaccine if the vaccine is required as a result of an injury. For example, if a Medicare Part B subscriber steps on a nail, the subscriber may be covered for a tetanus shot. Part B will cover inhaled nebulizer medications for beneficiaries who are not in a long-term care facility.

Part B will also cover immunosuppressive medications after a transplant as well as oral anticancer medications, Hepatitis B vaccines for high-risk individuals, oral anti-emetic medications used to treat nausea within 48 hours of chemotherapy that is related to cancer chemotherapy, total parenteral nutrition medications used to treat permanent dysfunction of the digestive tract, injectable medications administered at home that require an infusion pump, and more.

Medicare Part D may cover the following types of medications:

- Any medicine regularly taken by a Medicare beneficiary for chronic conditions.
- Medications subscribed for short-term medical conditions

Medicare Part D may cover a vaccine if the vaccine is prescribed by a doctor for reasons unrelated to injury. Part D will cover inhaled nebulizer medications for beneficiaries who are in a long-term care facility.

Part D will also cover immunosuppressive medications after a transplant as well as oral anticancer medications required for reasons other than cancer treatment, Hepatitis B vaccines, oral anti-emetic medications used to treat nausea that is related to cancer chemotherapy – after 48 hours of the chemotherapy or for other reasons, total parenteral nutrition medications required for reasons other than permanent dysfunction of the digestive tract, injectable medications not administered at home that do not require an infusion pump, and more.

Medicare beneficiaries should speak with a healthcare advisor for more information about what specific medications and treatments are covered by Medicare Part B and Medicare Part D. In many cases, Medicare beneficiaries can save money and ensure greater coverage by enrolling in Medicare Supplemental insurance policies or by adjusting their current Medicare policies to better suit their specific healthcare needs and budgets.

A managed care health plan works as a network. It is a group of medical personnel and facilities that have a contract with this particular plan. They all work together to offer medical services to those that are members. For the most part, this plan has requirements that members use the medical personnel and facilities within the plan’s network. In a nutshell, using this plan is limited as far as providers, but benefits you on the cost. Health care insurance in Texas uses this overall plan.

A managed health care plan is usually cheaper than fee-for service plan. For health care insurance in Texas, their reasoning for charging lower rates is because their hand picked medical personnel and facilities. They allow low rates for these kinds of plans. This plan also focuses on taking care of yourself so that you can avoid getting sick unnecessarily.

The managed care health system uses three types of plans:

? HMO (Health Maintenance Organization) – With this plan, you can use doctors and other medical services that are within this network. It works the same way with health care insurance in Texas. An HMO has a primary care physician that you can select from the network. Members pay a set fee each time they visit the doctor.

? PPO (Preferred Provider Organization) – This plan allows you to see any doctor you choose. The only disadvantage with this is that if the doctor is outside of the network, you will have to pay more. With health care insurance in Texas, it is strongly encouraged that people use a doctor within the network.

? POS (Point Of Service) – This optional plan allows you to use doctors and other medical services outside of the HMO network. Also, you are not required to get a referral. Doctors and other providers used outside of the network will require you to pay more, even for health care insurance in Texas.

For health care insurance in Texas, you are required to pay a premium in order to keep the health plan active. For certain medical services, such as surgeries, you may be required to pay a deductible before the insurance will pay anything. The deductible is an out-of-pocket expense that you provide. Depending on what insurance plan you choose, you will pay that certain deductible amount before your insurance kicks in.

Each time that you have to see a doctor, you will have to make a co-payment. You will also have to make a co-payment each time you get a prescription filled. There is a certain amount in out-of-pocket expenses that you are required to pay in regard to co-payments. After you have reached the limit and if you reach it within that calendar year, the insurance will kick in and pay 100% of your services. After you have paid your deductible, you will have to pay co-insurance. This is in regard to PPO and POS plans that have network and out-of-network services. If you have health care insurance in Texas, it is important that you go over these plans and determine which one would benefit you the most. It’s even more crucial if you have a family because you have to also look out for them.

The Arc of Indiana produced this video to provide information on how Indiana’s Developmental Disabilities Medicaid Waiver can help a person with a developmental disabilitiy more from a nursing home to a home in the community with 24 hour supports.

Fro purposes of definition of health insurance in Texas, there is a difference between small employers and large employers according to state and federal mandates. For a small employer to be called just that, they will have to have no more than 50 employees that work full-time (actually 2 to 50 full-time employees). These employees that are defined as full-time must work at least 30 hours or more each week in order to qualify. That does not include temporary workers or seasonal workers.

With small employers, they are protected by some legal statutes. Some of them include coverage levels and increases in insurance rates. The thing with small employers is that with the health insurance law in Texas, they have to have the right amount of employees that are eligible for health insurance. It is not based on the number of total employees per say. With health insurance for small employers, it is mandatory that those eligible are offered health insurance coverage for themselves and their immediate families.

A health insurance carrier can mandate that at least three fourths of eligible employees from a small employer seek to get health coverage. With certain carriers, this can be part of how they will get their health care plan. Depending on the number of eligible employees, the law can mandate that not everyone has to participate. This can apply to health insurance in Texas.

Or if the number of employees is low, require them to have total participation of 100%, no exceptions. If the small employer includes spouses and maybe a few others, then the spouses must each get separate health insurance coverage. There would be no dependent sharing for either spouse. This applies to health insurance in Texas as well.

With the small employer, the ones that qualify for health care coverage are bound by the exact terms and conditions. No one can have anything different in their health insurance policy. If it were a larger employer, then the policies would be different. They could be more flexible because they have more people that would need or want coverage. The health insurance in Texas can dictate that.

However, whether it’s a small employer or a large one, it is against the law to force a new employee to get health insurance in Texas in order to stay employed there. It is also against the law to single out any employee that can get health care coverage due to how old they are, medical history status or pre-existing conditions that they may have.

It is important that small employers follow the rules about health insurance in Texas. The small employer needs to know what is allowed and what is not allowed for their employees. To make sure that things are in order, they should consult their health insurance handbook or contact their health insurance representative. Having that in place will make things much smoother when it’s time for employees to use their health insurance. They need to make sure that they are providing the right kind of health insurance to their employees.

In early May 2009 new standards for Medicare supplement insurance were adopted by the federal government. The standards were developed by the National Association of Insurance Commissioners (NAIC) and were set by the Centers for Medicare and Medicaid Services in order to apply the Medicare Improvements for Patients and Providers Act of 2008.

The Medicare supplement insurance standards were originally set by the NAIC in 1979 and have been advised numerous times since then. The recent changes to the standards include changes to the Medicare Supplement plan options that were believed to be confusing and duplicate benefits that are available in the Medicare Part B – physician and outpatient services – plan. These include the following:

- The addition of hospice benefits to each Medicare Supplement plan option – The elimination of preventative and at-home recovery benefits for all Medicare Supplement plan options

More About Medigap Insurance

Medigap insurance, also known as supplement insurance, is an insurance policy that Medicare subscribers can take out in order to cover healthcare expenses that are not already covered by Medicare. Medigap insurance policies are offered by private insurers and are available for all Medicare subscribers that are interested in enrolling in such programs.

All Medicare subscribers should be aware of how Medigap insurance policies work with their existing Medicare policies. For example, some Medicare subscribers that have Medicare Plan D may be able to have Medigap insurance cover the cost of prescription medications that are not covered by Plan D.

Other Medicare Changes

In addition to the addition of hospice benefits and the elimination of preventative and at-home recovery benefits to the Medicare program, the system will undergo several other changes in 2010. These additional changes include the elimination of four Medicare Plans and the addition of two new plans.

All Medicare subscribers should review their existing plans and learn more about the changes that will impact them. Medicare subscribers may want to make changes to their Medicare accounts after they learn more about the option available to them. These changes need to be made during the open enrollment period from November 15 to December 31, 2009 in order to be applied to the 2010 Medicare year.

More Information about Medicare

Medicare is a federal healthcare program that is available to all U.S. citizens over the age of 65. Individuals under the age of 65 are eligible for Medicare coverage if they have a qualifying disability or if they have End-Stage Renal Disease – a disease in which an individual has permanent kidney failure and requires a kidney transplant or dialysis treatments.

Individuals that are enrolled in a Medicare program receive coverage for many healthcare-related expenses, including healthcare services and supplies. However, there are healthcare expenses that are not covered by Medicare, including co-insurance, copayments, and deductibles. Some prescription drugs and treatments are also not covered by the Medicare program.

Medicare Subscribers have many options when it comes to selecting the right plan for their needs. Subscribers are required to select from four plans: Medicare Part A, Medicare Part B, Medicare Part C, and Medicare Part D. In some cases, they can combine these plans in order to get the right coverage for their needs.

In the event that a subscriber selects a plan that does not cover some or all of their healthcare needs, the individual may elect to purchase Medigap insurance. Medigap insurance is designed to cover the cost of many healthcare expenses that are not already covered by Medicare. Coverage options vary based on the plan and the plan provider that an individual selects.

Often, when an individual has Medicare Part B coverage, the individual will purchase Medigap coverage as well. Medicare Plan B covers 80 percent of the medically necessary healthcare charges that an individual may incur as a result of treatment by a physician or a hospital. When bills are high, Medigap insurance can cover all or some of the remaining 20 percent that is not covered by Medicare.

Medicare also does not generally pay for preventative services, such as routine exams. Medigap insurance plans may cover the cost of these non-covered services, depending on the plan that a subscriber purchases.

Accidents and injuries are closely associated with human life. No one can escape from it, but anyone with effective and careful planning can reduce medical and hospital bills up to a considerable level. Importance of health insurance is not realized till the moment anyone has met with unforeseen and unexpected incidents. However, it is always beneficial to follow pragmatic approach regarding health matters. With Florida health care insurance plans, one can easily get relief from his entire medical and hospital bill’s trauma.

Florida health care insurance plans offer some of the best and the most suitable health care insurance plans for an individual, family, students, employees etc. These health plans are design in such a manner that they are able to provide complete protection from various diseases, illness, etc. Some of the well known health care insurance plans of Florida are assorted below-

Florida temporary health care insurance plan- This plan is short-term plan which provides health coverage for a period of one month to one year. People who are below 65 years of age can avail this plan irrespective of their health conditions. This health care plan of Florida is the best for office employees and students and can be availed at cost-effective prices.

Florida Individual Health care insurance plan- Health Maintenance Organization (HMO), a Preferred Provider Organization (PPO) and a Point of Service (POS) are some of the most popular and least expensive individual health care insurance plans of Florida. These are managed health care plans and provide coverage from hospital expenses, doctor’s bill etc.

Florida health care insurance plan for small business- In Florida, this plan be availed by those companies who fall under the category of small business. Any business involving minimum 2 and maximum 50 full time employees and its employees put at least 30 hours per week at work is advised to get this insurance if not covered by any other insurance. However, minimum75% of employees should participate in a group insurance plan is a requisite condition for availing this insurance policy.

However, with the availability of numerous insurance companies, service providers and local agents, availing the best health care insurance plans in Florida can never be a daunting task. By searching over the internet, you can come across numerous websites that are online providing low cost and affordable Florida health care insurance plans.

Irrevocable Trusts for Protecting Assets in Medicaid Planning

While transferring assets is a great way to protect your assets and gain eligibility for Medicaid, there is a major disadvantage to asset transfers. When you transfer an asset, you basically give it away. This means that you no longer have control over that asset. Even when you transfer an asset to a trusted family member, they can run the risk of losing the asset or spending it for their own behalf. A better solution is to place the asset in an irrevocable trust. A trust is a legal entity in which one person is named a trustee. The trust holds legal title to the assets. Those who benefit from the trust are known as the beneficiaries. The named trustee must follow all rules associated with the trust. In some cases, the assets in the trust can be counted against Medicaid resource limits. This is why it is imperative to be aware of all rules and regulations regarding trusts and Medicaid eligibility.

It is also important to know the difference between an irrevocable and a revocable trust. A revocable trust can be changed or rescinded by the individual who created the trust. Since the trust can be changed, Medicaid considers this kind of trust to be an asset. All assets that are in a revocable trust will be considered when determining Medicaid eligibility. In short, when planning for Medicaid, revocable trusts are not useful tools.

Income-only Irrevocable Trust in Medicaid Asset Evaluation

Irrevocable trusts of the “income-only” version cannot be changed after they have been created. This type of trust is usually drafted so that the income from the trust can be paid to you for life. The principal cannot be applied to benefit either you or your spouse. When you die, the principal is then paid to your heirs. This allows the funds to be protected while giving you the opportunity to use the income from the trust for living expenses. The principal in this type of trust is not considered a resource for Medicaid asset evaluation purposes. However, if the situation changes and you move to a nursing home, the income from the trust will have to be paid to the nursing home. This is one of the disadvantages to an income-only irrevocable trust. Unless the trust is set up correctly, you are also not allowed access to the funds in a trust if you should need them for other purposes. This is why you should always have another source of funds aside from income from the trust.

Special Testamentary Power of Appointment – Step-Up Basis of Property

It is possible to place property in a trust. When doing this, you and your spouse will not be able to obtain payments of income, but could take loans from the trust. The trust must be set up so that your children will benefit from the trust income. If the trust contains property that has increased in value, the grantor, the creator of the trust, can retain a “special testamentary power of appointment.” This allows the beneficiaries to receive the property upon your death. The receipt of the property will come with a step-up basis.

Testamentary Trusts in Medicaid Planning

The testamentary trusts are created under a will. There is a specific Medicaid rule that provides safety for these trusts if the trust was created by a deceased spouse with the intention to benefit the living spouse. The assets in these trusts are considered available to the Medicaid applicant, but this is only the case when the trustee has an obligation to pay for the Medicaid applicant’s support. If the payments are left to the discretion of the trustee, they are not considered available. This is a good tool to utilize when planning for Medicaid. These trusts allow community spouses to leave funds for a surviving spouse that is in a nursing home. The funds are then used to pay for services that are not covered under Medicaid.

Supplemental Needs Trusts

There are certain exceptions by Medicaid regarding transfers that are made for the benefit of a disabled person under the age of 65. If you have a child, relative or friend that is under 65 with permanent disabilities, you can transfer assets. This is true even if you are already in a nursing home. It is important for these trusts to be properly structured. If done right, the funds that are in these trusts will not be considered owned by the beneficiary and will not be considered when determining Medicaid eligibility. However, if the disabled person dies, the state is required to reimburse funds from Medicaid that have been spent on behalf of that disabled person.