Tag Archives: medicare and medicaid

3 Common Medicare Questions and Answers

health-is-wealthMy Comments: As someone who has been enrolled in Medicare for 7 plus years now, I can attest to its value for both my wife and I. At our age, things start to go wrong, and having the ability to seek medical advice and remedies without breaking the bank is critical to our peace of mind.

Along with millions of others across this country, we represent stability and a collective memory that can only help those coming behind us. Done the right way, it keeps those of you who intend to follow in our footsteps from making misteps, since the institutional memory we represent allows all of us to move forward without having to start from scratch every year.

These 3 points will prove helpful to you.

by: Jessica Ness / Thursday, March 20, 2014

One of the most confusing and stressful issues retirees face is the decision of when and how to file for Medicare. There’s a lot to know, but you don’t need to be an insurance expert to add value for clients. Simply knowing the answers to a few of the most common Medicare questions — and being able to point to deeper resources for more information — will help you equip clients to tackle this process.

Most advisors know that Medicare eligibility begins when a person turns 65 or has a qualifying disability. But not everyone understands when to begin the application process. And because some of your clients may apply for Part A and B at different times, it is important to understand when clients should apply for each.

For most clients, think in terms of the seven-month enrollment period for Part A: It includes the three months prior to a client’s 65th birthday, as well as that month and the three months after. One exception: Clients who are already receiving Social Security will be automatically enrolled.

Use your CRM system to help clients. Set up alerts to remind you when clients are approaching age 65 and then reach out to help them start the process. Remind clients that if they miss their initial enrollment period, their application may have to wait until the general enrollment period, which occurs each year between January 1 and March 31. That delay could cause a gap in coverage, since they will have to wait until July 1 for coverage to start.


My clients often ask if they should sign up for Part B at the same time as Part A. Naturally, they are concerned about paying premiums for Part B if they don’t need the coverage. But the timing for enrolling in Part B is a bit trickier and the stakes much higher, since late enrollment can cause a permanent premium increase.

One thing clients should consider: If they don’t have employer group coverage, then this is a no-brainer. They should apply during their seven-month initial enrollment period.

If your clients are covered under a group health plan based on current employment — whether their own employer or a spouse’s — they may qualify for a special enrollment period, often abbreviated as SEP. If so, they may delay enrolling in Part B until their group health coverage is terminated, and avoid the late enrollment penalty.

The eight-month special period starts the month after the end of either employment or the group health insurance coverage based on that employment — whichever happens first. Here, again, you can use your CRM system to remind you when to revisit a client’s Part B coverage.

Keep in mind that COBRA coverage does not qualify as employer coverage, and so won’t allow them to escape the penalty for delayed enrollment. Be sure to educate your clients so they don’t make this common mistake.

There are other considerations as well. Some smaller employers require Part B coverage to be integrated with their existing insurance plans, for instance, while larger employers may not. Have your clients talk to their human resources department or insurance specialist to know whether Part B coverage is necessary for them.


Do your clients understand the difference between a Medigap policy and an Advantage plan? Most don’t, so this is a great opportunity to educate them on the basics and provide resources to get them to the right coverage.

• Medicare supplemental insurance policies, also known as Medigap policies, provide additional benefits and can reduce out-of-pocket costs when combined with parts A and B. They’re provided by private insurance companies and require additional premium payments. And because they usually exclude prescription drug coverage, clients may need to layer Part D coverage on top. That means clients could end up with three different monthly insurance premiums to pay and coverage plans to manage. There’s a vast marketplace for these types of policies, though, so you should be able to help them target and virtually customize coverage for a client’s exact situation.
• Advantage plans, on the other hand, combine Medicare parts A, B and sometimes D. In essence, these policies bundle coverage into a single Medicare-approved health plan offered by a private insurance company. The level of coverage varies depending on the plan chosen; again, there are numerous options available.

When a client still has employer health plan coverage, it can sometimes act as a Medigap plan, so usually additional coverage is not necessary. Otherwise, I’ve found that traditional Medicare with a Medigap plan is a great option for clients who have a special health consideration, don’t mind shopping around and/or have a tendency to be thrifty. Advantage plans tend to feel more like traditional employer health plans; they are great if the client is willing to pay a little more for the convenience.

While either Medigap or Advantage plans could make sense for a client now, circumstances change — and both the plans and your clients’ needs may require a recalibration in the future.

Encourage clients to shop around at least every three years. The Medicare website is a great resource; among other information, it shows what plans are available in each state. There is also a customized search option that lets enrollees filter plans based on the coverage they want, with an estimate of the health care costs associated with each specific plan.

Your clients can also get personalized health insurance counseling at no cost from their local State Health Insurance Assistance Program. In fact, you may want to send clients a reminder each year during open enrollment — from Oct. 15 through Dec. 7 each year — suggesting that they review their plan. They’ll appreciate that you are thinking of them.

Jessica Ness, CFP, is a client advisor and the director of financial planning at Glassman Wealth Services, a wealth management firm in McLean, Va.

10 Things You Must Know About Medicare

My Comments: The people at Kiplinger have created another great blog post for me to borrow. And if you insist, you have “my permission” to click on their links and get more good information from them.

At the end of the day, however, you may need someone local, a dedicated, knowledgable professional whose experience over the past 40 years counts for something. I like to think I’m that person. At least my hand is raised in the air to let you know I want to talk with you and possibly help you find the right answers.

Here is an image of what you see when you go to the Kiplinger page about the Ten Things to Know. Be aware it is a slide show and to get to the next slide, note there is a red arrow at the top right which navigates you to the first of the 10 Things to Know. Just click on this image and you’ll be there. 10-Medicare-things

Health vs. Wealth: What’s More Important?

health-is-wealthMy Comments: When I took economics courses in college in the early sixties, there was a common adage when talking about politics and business that you could not, at the same, have both guns and butter. This meant that at our industrial heart, we could either produce weapons of war, or we could produce products for general consumption, but not both at the same time.

Then came Lyndon Johnson, and his Great Society. He was somehow able to fight the war in VietNam and at the same time, cause many social changes that served to improve the standard of living for those of us not fighting the war.

When I saw this headline, my first reaction was “Why can’t we have both?”. What logic dictates that it is one or the other? Then a re-read of the headline reminds me that it is only asking which is most important. I believe they are equally important, as having one most often leads to the other, regarless of their order.

By Christine DiGangi / February 6, 2014 9:00 AM

As far as self-improvement goes, personal finance and health are important to Americans — just think about how many people have New Year’s resolutions like losing weight, getting out of debt or making more homemade meals (a potential two-in-one resolution).

But if you had to choose one or the other (financial health or physical health), what would you prioritize? In an informal, online poll conducted by American Consumer Credit Counseling, nearly 59% of those surveyed said they were more concerned about the state of their finances than that of their physical fitness. A lot of people are looking at both, though: About the same portion, 60%, said their resolutions include money and health goals.

Which Comes First?

It’s not a scientific study — the Health and Wealth poll reached 243 adults — but the results might hint at what people prioritize when it comes to well-being. Money and health have an interesting relationship, because issues in one area could adversely affect the other, like the costs associated with weight-related health issues and the sometimes-expensive aspects of maintaining good health.

Fewer than 4% of respondents said they would go into debt if it would make them more physically fit, and nearly 30% said they would trade their physical fitness for a better financial situation.

Health & Credit
At times, these goals could be at odds (i.e. forgoing a gym membership to save money or being forced to go into debt to pay medical bills), but they can also work together. Like so many things, improving financial and physical health requires balancing priorities, even when life throws you for a loop.

No matter how much work you do on your finances, an unexpected or major illness can still put your financial health in peril. For example, we hear from readers all the time about how an unexpected medical bill went to collections and ruined their credit because they hadn’t budgeted for a major health expense or they didn’t see the bill coming.

The best thing you can do to prevent this from happening is to get informed about medical billing, make sure you’ve saved for a rainy day and monitor your credit. You can do this for free with the Credit Report Card, a tool that updates you two of your credit scores every month for free. Any sudden, unexpected drop in your credit scores could signal a missed medical bill, but you’d need to pull your credit reports to confirm this (you can get free copies of your credit reports once a year from each of the major credit bureaus).

Restricted Application for Social Security Benefits

Social Security 2My Comments: Years ago, it was simply a matter of waiting to reach 65, showing up at the Social Security office and then waiting for a check to appear in the mail. Today, that idea is quaint and naive.

As the baby boomers reach age 62 and beyond, it’s become a chore to figure out when to apply. For one thing, there are a possible 97 months to choose from. If you have a spouse, there are 9 different options for each one of those 97 months. Between the best month and the worse month for you, there is often a $100,000 difference over time. Increasingly, financial planners such as myself are being asked to help.

Which is why I’ve become knowledgable and aligned myself with a team that provides a personalized Social Security Report that quantifies the best options. The flaw in this system is you cannot know ahead of time when you are going to die, but that’s probably a good thing. So you have to play the odds and hope for the best.

If you aren’t confused yet, you will be by the time you finish reading this.

By Dana Anspach

In many cases to get the most out of your Social Security benefits you will need to use something called a restricted application.

As there are different types of Social Security benefits you may be eligible for, a restricted application, sometimes referred to as “restricting the scope” of your application, specifies to the Social Security office that you are not simultaneously applying for all benefits you are eligible for.

To understand why you would do this first take a look at some of the types of Social Security benefits you may be eligible for:
• A benefit based on your own earnings record, referred to as a Retirement Insurance Benefit (RIB)
• A benefit based on a spouse or ex-spouse’s earnings record, referred to as a spouse’s insurance benefit (SIB)
• A benefit based on a deceased spouse’s or deceased ex-spouse’s earnings record, referred to as a Widow/Widower’s Insurance Benefit (WIB)
• A benefit if you are disabled referred to as disability insurance benefits (DIB)

How might you use these rules to boost your benefits?

If married, or eligible for a benefit on an ex-spouse’s record, once you reach full retirement age, you can use a restricted application to claim a spousal benefit, while letting your own benefit continue to grow. You would then switch to your own higher benefit amount when you reached age 70.

In Social Security’s online Programs Operations Manual System (POMS) their Scope of the Application section says:
“A claimant may choose to limit or restrict the scope of the application to exclude a class of benefits he/she may be eligible to on one or more SSNs for any reason (except where deemed filing applies). The reason may be to receive higher current benefits or to maximize the amount of benefits over a period of time, including the effect of delayed retirement credits (DRCs).”

Here are a few key points to note about the restricted application rules:
1. A spouse must be full retirement age to file a restricted application for spousal benefit only
2. A widow/widower, or survivor of a deceased ex-spouse, may file a restricted application even if they have not yet reached full retirement age.
3. A claimant who is caring for child (under age 16 or disabled adult child) who is entitled to child’s benefits may have the option to restrict the application to spouse’s benefits only even if they have not yet reached their full retirement age.

Regarding item number one above POMS says (GN 00204.020D.1):
“In fact, a spouse claimant at or past Full Retirement Age (FRA) has the right to restrict the application to exclude RIB. However, always take a RIB application in a reduced benefit situation when the spouse is insured for RIB as the “deemed filing” provision applies.”

A “reduced benefit situation” means if you are filing before you reach full retirement age. When you file before you reach full retirement age if your spouse has already filed for their benefits (in the cases of an ex-spouse they have to have reached age 62, but do not have to have filed yet) you are deemed to be filing for spousal benefits at the same time you file for your own retirement benefits. Doing this prevents you from using claiming strategies that might otherwise allow you to later switch between benefits.

If your spouse has not already filed for benefits, you would not be deemed to be applying for a spousal benefit, however, if they subsequently file for their own benefits before you reach your full retirement age, the deemed filing rules would kick in, and your future choices would be limited if you had filed before your own full retirement age.
Regarding item number two above, POMS says (section GN 00204.020E.4.a):

“A widow(er) or surviving divorced spouse may wish to exclude a reduced RIB from the scope of the application and defer filing for an unreduced RIB because of the increasingly greater amount payable after FRA because of DRCs,” and that in order to do so the Social Security office needs to take get a statement such as “I do not wish this application to be considered an application for reduced benefits on my own record.”

This means if your spouse or ex-spouse is deceased, and you are eligible for a widow/widower’s benefit on their earnings record, you have greater leeway to restrict the scope of your application, even if you have not yet reached full retirement age.

Regarding item three above POMS says (GN 00204.020F.2.a):
“A claimant who is between the age of 62 and FRA, has in his/her care a child (under age 16 or a disabled adult child) of the NH (number holder) who is entitled to child’s benefits, and is filing for spouse’s benefits is not deemed to have filed for reduced RIB. He/she may exclude RIB from the scope of the application for spouse’s benefits by a clear declination.”

In addition to item three above there are also special provisions when you are eligible for a disability insurance benefit that may allow you to file for spousal benefits, while not yet applying for your own retirement benefits. It is beyond the scope of this article to go into details about such disability or child benefit strategies.
Because the rules are complex, some couples seek the advice of an attorney to advise them on their best claiming options.

If you are married, or a widow/widower, a Social Security calculator (online software) can often provide you the needed Social Security strategy.

If you have dependents, multiple ex-spouses, may be eligible for disability benefits, or have other complexities, the services of an attorney may be appropriate.

Court Rules in Favor of IRS on Obamacare Tax Credits

healthcare reformMy Comments: The plainfiff in this case at least acknowleges that Congress passed the PPACA.

This is at least a small victory for those of us who believe the PPACA is a good thing. If you are an American, you should be able to participate in the bounty offered by this country, one feature of which is now health insurance for almost ALL OF US.

Since Governor Scott chose to not establish an exchange for the citizens of Florida, it reaffirms the ability of Floridians to purchase coverage on the federal exchange, and if qualified, get tax credits, which will help. Since I’ve been paying for my coverage and that of another family for about 40 years anyway, I’m OK with this.

by: Michael Cohn | January 15, 2014

A federal district court judge has ruled in favor of the federal government in a lawsuit that claimed the Internal Revenue Service did not have the authority under the Affordable Care Act to write rules providing tax credits to individuals purchasing health insurance on the health insurance exchange set up by the federal government.

The IRS issued a final rule in May 2012 implementing the premium tax credit provision of the Affordable Care Act, in which it interpreted the ACA as authorizing the agency to grant tax credits to individuals who purchase insurance on either a state-run health insurance exchange or a federal exchange such as the one that has been available on the problem-prone HealthCare.gov site for people in states that have not set up state exchanges.

The plaintiffs in the lawsuit, who include the conservative advocacy organization, the Competitive Enterprise Institute, contended that the IRS’s interpretation was contrary to the statute, which, they asserted, authorizes tax credits only for individuals who purchase insurance on state-run exchanges, but not on federal exchanges. The plaintiffs in the case, known as Jacqueline Halbig, et al v. Kathleen Sebelius, et al, claimed that the rule promulgated by the IRS exceeded the agency’s statutory authority and was arbitrary, capricious and contrary to law, in violation of the Administrative Procedure Act.

The U.S. District Court for the District of Columbia heard oral arguments in the case last month and a judge on the court tossed out the lawsuit Wednesday, agreeing with the federal government that the law made clear that the tax credits should be available on both state-run and federally run health insurance exchanges.

“In sum, the Court finds that the plain text of the statute, the statutory structure, and the statutory purpose make clear that Congress intended to make premium tax credits available on both state-run and federally-facilitated exchanges,” wrote U.S. District Judge Paul Friedman. “What little relevant legislative history exists further supports this conclusion and certainly—despite plaintiffs’ best efforts to suggest otherwise—it does not undermine it.”

Sam Kazman, general counsel for the Competitive Enterprise Institute, said he planned to appeal the judge’s ruling.

“The court’s ruling today delivers a major blow to the states that chose not to participate in the Obamacare insurance exchange program,” Kazman said in a statement Wednesday. “It is also a blow to the small businesses, employees and individuals who live in those states as well. In upholding this IRS regulation that is contrary to the law enacted by Congress, this decision guts the choice made by a majority of the states to stay out of the exchange program. It imposes Obamacare penalties on employers and on many individuals in those states, penalties that Congress never authorized, putting their livelihoods and the jobs of their employees at risk.

Worst of all, it gives a stamp of approval to the Administration’s attempt to substitute its version of Obamacare for the law that Congress enacted.”

The case is Halbig v. Sebelius, 13-cv-00623, U.S District Court, District of Columbia (Washington).


My Comments: I’ve been a licensed insurance agent since sometime in 1976, or was it 1975? I have helped place hundreds, if not thousands, of insurance contracts over these many years, some of which I know are still in force.

This article is directed toward those who are dealing with elderly parents, some of whom are not as mentally alert or as strong as they once were. Time has a way of getting away from us and for those of you in middle age, this part of your future has a lot of challenges.

So I encourage you to approach your time with your parents, aunts and uncles, with the following circumstances in mind. You’ll be doing yourself a favor, not to mention minimizing stress for those afflicted.

By Kevin Sypniewski | March 20, 2013

When we hear something once, we might pay attention but when we hear the same thing from totally unrelated people, we begin to suspect there is a trend.

Some of the most enlightening and interesting professional conversations I’ve had recently have been with long-term care (LTC) claim departments. Okay, perhaps I should get out more!

Two different claim departments from two different leading LTC carriers tell me that they regularly get LTC claims submitted 12 or even 24 months after the claim event.

Why on earth would someone wait that long to receive the money for which they are entitled? Because the family just found the LTC policy!

The insured was ADL dependent but not communicative, and the family just “happened” to find the policy in a shoebox or file cabinet in the basement.

Have you ever been into the basement of the house that someone has lived in for 30 years and tried to find a specific file? It is wonderful that this policy got found and even more wonderful that the carriers are paying “late” claims, some of which they are no longer contractually obligated to pay.

What about the other LTC policies on other insureds that never get found?

If some get found, others surely do not get found!

We’ve had employees in our caregiving education and LTC sessions tell us about finding policies and others tell us about “knowing” mom bought one, but they never could find it once mom needed it.

We were hoping these were somewhat isolated incidences; however, after talking with leading LTC carriers, we know these are not isolated. If someone lapses their policy and takes the carrier “off the hook,” I’m okay with that.

That is their decision and certainly the carriers don’t mind. But knowing that families are paying premiums for the duration and the carrier gets a bye on the payment…That just stinks!

You as an insurance professional did your job selling the policy. The claimant did a smart thing buying the policy, but in the end the family loses a lifetime of assets and now the family home has a lien and the insured is on Medicaid in a Medicaid facility.

That is just not right! Sure, the policies that get found eventually get paid, but by then the assets might be gone, mom is in a Medicaid facility, and now the family gets the $200,000 check.

Better than nothing, but not for Mom.

I can hear the family discussion now. “I sure wish Mom had bought long-term care insurance because she really wants to remain at home in her house of 30 years.” She did buy the policy but just never told anyone, which is exactly like not buying a policy… just more expensive.

The carriers and regulators require we designate a third-party in case we don’t pay our premium. What about a third party to make sure we file our claim?

I think we have an obligation to communicate this story to each and every person we help with LTC insurance.

Perhaps we create our own third party notification memo that at the time of purchase the new policyholder is able to designate several people who get notified about the policy purchase.
Sure, those people may or may not be around 25 years later at claim time, but I certainly like the odds of that effort versus the strategy of hope.

Source: http://www.lifehealthpro.com/2013/03/20/lost?eNL=514a2b29150ba0161b0002ff&utm_source=LifeHealthProDaily&utm_medium=eNL&utm_campaign=LifeHealthPro_eNLs&_LID=1044219161

55 Billion Reasons for Consumer-Driven Care

My Comments: While the election is over, and ObamaCare will not be repealed, there is still massive confusion and misunderstanding by all parties about what it all means for you and me as consumers of health care, and the doctors who look after us. Surveys suggest that doctors are very fearful that what had been a solid income earning profession is likely to become something very much less.

It is certainly likely that specialists are going to see a decline in income, while those in general practice are likely to see an increase. The forces at work that resulted in so much specialization was that there was more money to be made there. If you have the skills necessary to complete your residency, why stop at family care when you can become a specialist?

I’m very interested in this topic since it dovetails with a professional niche that I’m very much involved with. Go HERE for a glimpse of it. In the meantime, this article will help you sort through the variables as this issue gets pushed and pulled over the next ten years.

By Kathryn Mayer | BenefitsPro.com

In a report this week (SEP 7, 2012), we found out something we already knew—but probably not to this extent.

Our country’s health care system squanders a ridiculous $750 billion a year. That’s roughly 30 cents of every medical dollar spent. It happens through unneeded care, excessive administrative expenses and data, fraud and other problems, a report by the Institute of Medicine revealed.

Let’s go over some numbers. America spent $2.6 trillion on health care last year. And a third of that spending did nothing to make any of us any healthier. Our health care costs are rising faster than inflation, and it’s literally bankrupting many of us. It’s also killing us. By one estimate, the report says, roughly 75,000 deaths might have been averted in 2005 if every state had delivered care at the quality level of the best performing state.

So what the hell is going on?

The report breaks down the sources of overspending: Unnecessary services tops the list at $210 billion, followed by inefficiently delivered services ($130 billion), excessive administrative costs ($190 billion), prices that are simply too high ($105 billion), fraud ($75 billion) and missed prevention opportunities ($55 billion).

Though we’ve come a long way in health innovation—such as the management of previously fatal conditions—the report said, the American health care system is still falling short on “basic dimensions of quality, outcomes, costs and equity.”

Not that this is news. We know this. It’s apparent every time we see health report numbers or look at our own medical bills.

The question is what we can do about it.

The Institute of Medicine has recommendations: Fully adopt mobile technologies and electronic health records; increase transparency about the costs and outcomes of care; use better data; and move toward a system that rewards doctors for quality, not quantity, of care.

Sure, these are good ideas, but whether they’ll happen any time soon is really a mystery. Sadly, it’s out of consumers’ hands.

But preventive care isn’t. There’s something each of us can do—get checked, get necessary and recommended health screenings, eat healthy, exercise, don’t smoke, be proactive about problems—the list goes on. Older people, the report notes, have a big problem with preventive care, and it’s especially problematic because they’re more prone to serious and costly health woes.

It’s also worth noting that the report comes at an interesting time. The presidential race is tighter than anyone thought—and health reform and Medicare cuts are sources of major contention. President Obama didn’t even give mention the signature piece of his presidency, the PPACA, during his nomiation acceptance speech at the Democratic National Convention.

Seems like there’s a lot we—and Washington—can do to drastically cut health care costs while also improving care that doesn’t cost another trillion or so dollars to implement.

Health Costs to Double Under Romney Plan?

My Comments: When I first saw this headline, I said to myself this cannot be right. And then when I saw it came from an organization that supports health care reform, I thought there had to be some bias here. And there may be, but…

As someone who cut their teeth in the insurance industry selling health insurance policies almost 40 years ago, I think I have some understanding of how health insurance works. And I’m a proponent of the Affordable Healthcare Act, not because I think it has no flaws, but because the problem needed some organization with enough leverage to cause reforms to happen to the health care delivery system in this country. That organization could only be the Federal Government.

I continue to be depressed by Romney’s about face on “RomneyCare”, the system he imposed on the State of Massachusetts. That state is the most financially stable state in the union. The per capita income is among the highest, if not the highest, among the 50 states. And they have a mandate that EVERYONE must participate in the program.

By Kathryn Mayer | September 28, 2012

Families buying non-group health insurance on their own in 2016 would pay nearly twice as much under the health proposals offered by presidential candidate Mitt Romney than under President Obama’s health reform law, a new report from Families USA claims.

Families USA is a prominent Washington, D.C.-based consumer advocacy group that supports health care reform.

Under Romney’s plan, families on average would pay $11,481 compared to $5,985 under Obama—a differential that includes comparative insurance premium payments as well as out-of-pocket costs paid by families when they receive health care, the report says.

The report uses national and state-by-state data to analyze and compare health care benefits and costs among three different plans: “RomneyCare” (the Massachusetts health law signed by then-Governor Mitt Romney in 2006), “ObamaCare” (the Patient Protection and Affordable Care Act, signed into law in March 2010), and “RomneyCandidateCare,” the health care proposals of presidential candidate Romney.

While there are “significant” similarities between ObamaCare and RomneyCare, the substantial difference lies between Romney’s new health care proposals.

“ObamaCare and the Massachusetts-based RomneyCare, on the one hand, and RomneyCandidateCare, on the other hand, are as different as day and night,” says Ron Pollack, executive director of Families USA.

Romney and running mate Paul Ryan have made the repeal and replacement of the Patient Protection and Affordable Care Act a top campaign goal.
Nationally, almost 42 million more Americans would lack health insurance without health reform, the report says, and those buying private insurance would pay almost twice as much under Romney than under Obama.

The group’s report also concluded that “RomneyCandidateCare” would “significantly” change Medicare by repealing benefits created by the PPACA.
Three health analysts who served as advisers on both the PPACA and Massachusetts health reform helped prepare the report.

The group’s report earned early backlash. The Romney camp called it “absurd,” while Forbes.com’s Avik Roy called the comparison “fatally flawed,” arguing the report makes inaccurate assumptions about Romney’s plan and doesn’t account for the PPACA’s tax hikes and Medicare cuts.

The Romney campaign said the report “assumes a fantasy world where Obamacare has actually worked. But Americans aren’t buying it. They’ve watched as provision after provision has failed, costs have skyrocketed, and Medicare has been cut by $716 billion. [The] report undermines the important health care debate our country should be having.”

The Medicaid Problem Grows and a (Partial) Solution Emerges

My Comments: I ran across this article a few weeks ago. With the headline recently that Governor Scott was not going to comply with the directives toward the states and Medicaid, I thought it might be helpful to have a better understanding of the implications. The idea presented below is not a full answer, but every little bit helps.

Medicaid not only applies to the elderly, of which Florida has more than its share, but to the indigent population in general. Imagine you are 12 years old, living in Florida, and your parents, or parent as is often the case, has no money.

You get sick, or perhaps you were born with a problem, who pays for your care? As a society, we’ve said we are not simply going to let you wither and die; somehow you are going to be cared for. But there are costs associated with your care and those costs have to be covered.

You fall under the Federal and state rules that define Medicaid. And Governer Scott says that’s too bad; there’s not enough money and good luck.

Blog added by Chris Orestis on June 4, 2012

When Medicaid was created on July 30th, 1965, the entire GDP of the United States was $791.1 billion, and no one could have predicted that by 2009. the U.S. would spend over $2 trillion on health care in a single year.

Today, Social Security, Medicare and Medicaid are all in the red and creating havoc for government budgets at the federal and state levels. According to Chairman Ben Bernanke, this has become the number one concern of the Federal Reserve about the U.S. economy.

State budgets have been impacted particularly hard by shrinking tax dollars and growing Medicaid enrollment brought on by the economic crisis and an aging population. Over 10 million Americans now require long-term care annually, and Medicaid is the primary source of coverage. According to the Kaiser Family Foundation, Medicaid spent $427 billion in 2011, almost doubling since spending $240 billion in 2009. Long term care providers prefer private pay patients over Medicaid recipients.

A new report released by the American Health Care Association (AHCA) indicates that due to major state budget deficits and adjustments to Medicare and Medicaid reimbursements, long-term care facilities will see historically low Medicaid reimbursements. It is estimated that unreimbursed Medicaid funds to nursing homes exceeded $6.3 billion in 2011 – a $19.55 shortfall per patient, per day, on average. However…

Billions of dollars of in-force life insurance policies are regularly abandoned by uninformed seniors as they enter their “long term care years”. Because a life insurance policy is legally recognized as an asset of the policy owner, it is an unqualified asset and counts against them when applying for Medicaid. For Medicaid applicants, it has been standard practice to abandon a life insurance policy if it is within the legally required five year look back spend-down period. But now, it is possible to convert a life insurance policy instead of abandoning it, allowing the policy owner’s care to be covered as a private pay patient by a long-term care benefit plan over an extended time frame.

Converting a life insurance policy into a long-term care Assurance Benefit plan is a Medicaid qualified spend-down. Instead of abandoning the policy and going immediately onto Medicaid, the time a person remains private pay is extended while the present day value of the life insurance asset is spent down in a Medicaid-compliant fashion — all while preserving a portion of the death benefit for the family during the extended time period.

In January, 2012, the Center for Economic Forecasting and Analysis (CEFA) of Florida State University analyzed the tax savings impact of converting life insurance policies into long-term care benefit plans on the Florida Medicaid budget. In their analysis, CEFA scored the annual savings for Florida’s tax payers at approximately $150 million. The savings come from extending the time Medicaid applicants with a life insurance policy can remain private pay, delaying entry onto Medicaid by first converting their policy to a private, long-term care benefit account.

Six Possibilities for Health Reform

My Comments: You’ve heard me tee off on this subject before. My hope is the Supreme Court decides it’s OK and leaves it alone. Following that potential outcome, political necessity will dictate adjustments and changes that will ultimately lead to a better solution than what we had before. But changes in how we approach health care in this country HAD to be made, and since I don’t trust the insurance industry to come up with answers, this is all we had left. And while I don’t trust the political elite, I have to assume they put my interests ahead of their own. Oh, WHAT? They don’t do that? Time to vote the bums out of office!

This article came from a magazine called BenefitsPro. It deals with that part of the financial services industry whose focus is employee benefits for corporations and small businesses. Financial industry magazines are typically conservative, hoping against hope that Mitt Romney will defeat Barrack Obama this fall. Every now and then there is a glimpse of reality, and this is one of them.

By Mark Sherman, Ricardo Alonso-Zaldivar June 18, 2012

WASHINGTON (AP) — Some are already anticipating the Supreme Court’s ruling on President Barack Obama’s health care law as the “decision of the century.” But the justices are unlikely to have the last word on America’s tangled efforts to address health care woes. The problems of high medical costs, widespread waste, and tens of millions of people without insurance will require Congress and the president to keep looking for answers, whether or not the Affordable Care Act passes the test of constitutionality.

Q: What if the Supreme Court upholds the law and finds Congress was within its authority to require most people to have health insurance or pay a penalty?
A: That would settle the legal argument, but not the political battle.

The clear winners if the law is upheld and allowed to take full effect would be uninsured people in the United States, estimated at more than 50 million.

Starting in 2014, most could get coverage through a mix of private insurance and Medicaid, a safety-net program. Republican-led states that have resisted creating health insurance markets under the law would face a scramble to comply, but the U.S. would get closer to other economically advanced countries that guarantee medical care for their citizens.

Republicans would keep trying to block the law. They will try to elect presidential candidate Mitt Romney, backed by a GOP House and Senate, and repeal the law, although their chances of repeal would seem to be diminished by the court’s endorsement.

Obama would feel the glow of vindication for his hard-fought health overhaul, but it might not last long even if he’s re-elected.

The nation still faces huge problems with health care costs, requiring major changes to Medicare that neither party has explained squarely to voters. Some backers of Obama’s law acknowledge it was only a first installment: Get most people covered, then deal with the harder problem of costs.

Q: On the other hand, what if the court strikes down the entire law?
A: Many people would applaud, polls suggest.

Taking down the law would kill a costly new federal entitlement before it has a chance to take root and develop a clamoring constituency, but that still would leave the problems of high costs, waste, and millions uninsured.

Some Republicans in Congress already are talking about passing anew the more popular pieces of the health law.
But the major GOP alternatives to Obama’s law would not cover nearly as many uninsured, and it’s unclear how much of a dent they would make in costs. Some liberals say Medicare-for-all, or government-run health insurance, will emerge as the only viable answer if Obama’s public-private approach fails.

People with health insurance could lose some ground as well. Employers and insurance companies would have no obligation to keep providing popular new benefits such as preventive care with no copayments and coverage for young adults until age 26 on a parent’s plan. Medicare recipients with high prescription drug costs could lose discounts averaging about $600.

Q: What happens if the court strikes down the individual insurance requirement, but leaves the rest of the Affordable Care Act in place?
A: Individuals would have no obligation to carry insurance, but insurers would remain bound by the law to accept applicants regardless of medical condition and limit what they charge their oldest and sickest customers.

Studies suggest premiums in the individual health insurance market would jump by 10 percent to 30 percent.
Experts debate whether or not that would trigger the collapse of the market for individuals and small businesses, or just make coverage even harder to afford than it is now. In any event, there would be risks to the health care system. Fewer people would sign up for coverage.

The insurance mandate was primarily a means to an end, a way to create a big pool of customers and allow premiums to remain affordable. Other forms of arm-twisting could be found, including limited enrollment periods and penalties for late sign-up, but such fixes would likely require congressional cooperation.

Unless there’s a political deal to fix it, the complicated legislation would get harder to carry out. Congressional Republicans say they will keep pushing for repeal.

Without the mandate, millions of uninsured low-income people still would get coverage through the law’s Medicaid expansion. The problem would be the 10 million to 15 million middle-class people expected to gain private insurance under the law. They would be eligible for federal subsidies, but premiums would get more expensive.

Taxes, Medicare cuts and penalties on employers not offering coverage would stay in place.

Q: What if the court strikes down the mandate and also invalidates the parts of the law that require insurance companies to cover people regardless of medical problems and that limit what they can charge older people?
A: Many fewer people would get covered, but the health insurance industry would avoid a dire financial hit.

Insurers could continue screening out people with a history of medical problems; diabetes patients or cancer survivors, for example.
That would prevent a sudden jump in premiums. But it would leave consumers with no assurance that they can get health insurance when they need it, which is a major problem that the law was intended to fix.

Obama administration lawyers say the insurance requirement goes hand in hand with the coverage guarantee and cap on premiums, and have asked the court to get rid of both if it finds the mandate to be unconstitutional.

One scenario sends shivers through the health care industry: The Supreme Court strikes down the mandate only, and delegates other courts to determine what else stays or goes.

Q: What happens if the court throws out only the expansion of the Medicaid program?
A: That severely would limit the law’s impact because roughly half of the more than 30 million people expected to gain insurance under the law would get it through the expansion of Medicaid, the federal-state health insurance program for low-income people.

But a potentially sizable number of those low-income people still might be eligible for government-subsidized private insurance under other provisions. Private coverage is more expensive to subsidize than Medicaid.

States suing to overturn the federal law argue that the Medicaid expansion comes with so many strings attached it amounts to an unconstitutional power grab by Washington. The administration says the federal government will pay virtually all the cost and that the expansion is no different from ones that states have accepted in the past.

Q: What happens if the court decides that the constitutional challenge is premature?
A: The wild card, and least conclusive outcome in the case, probably also is the most unlikely, based on what justices said during the arguments.
No justice seemed inclined to take this path, which involves the court’s consideration of a technical issue.

The federal appeals court in Richmond, Va., held that the challenge to the insurance requirement has to wait until people start paying the penalty for not purchasing insurance. The appeals court said it was bound by the federal Anti-Injunction Act, which says that federal courts may not hear challenges to taxes, or anything that looks like a tax, until after the taxes are paid.

So if the justices have trouble coming together on any of the other options they could simply punt.

The administration says it doesn’t want this result. Yet such a decision would allow it to continue putting the law in place, postponing any challenge until more of the benefits are being received. On the other hand, it might give Republicans more ammunition to press for repeal in the meantime.