where we are with medicare

There’s no question that healthcare is difficult to navigate, involves a certain amount of guesswork, and continues to be disproportionately shaped by the lobbying work of large, for-profit health insurance companies.

Figuring out what to expect from the industry is daunting, but we do know that some changes are already set, while others — like the solvency of the whole Medicare program — for now only threaten our future finances, eligibility, and benefits.

Known changes include new Medicare cards without Social Security numbers, the repeal of therapy caps, a Mandatory Outpatient Observation Notice (MOON) given to patients not formally admitted to a hospital, no more donut hole for brand name drugs in 2019 and generics in 2020, the phasing out of Medigap C and F plans in 2020 (to be replaced by D and G, but you can keep C or F if you already have one), Part D companies actively fighting opioid addiction, and tier changes for IRMAA (Income-Related Monthly Adjustment Amount) surcharges. Pharmacists can also now tell you a drug can be cheaper if you pay outright rather than through insurance, something they couldn’t mention before.

There are also a number of more detailed changes for people who, in addition to Medicare, are enrolled in Medicaid, an MSP, Extra Help, COBRA, or VA coverage.

But looming are the rising costs of deductibles, co-pays and prescription drugs. Various organizations have already been protesting the way the government is over-advocating Medicare Advantage Plans for 2019, characterizing them as cheaper and, among other things, neglecting to mention network limitations. Expected payment increases to the companies that offer these will necessarily affect premiums, benefits and, yes, their profits.

The Medicare Rights Center is certainly troubled by the President’s budget for 2019. Proposed changes include the curtailing of appeal rights, incentives to providers to stint on chronic conditions, and an inevitable rationing of healthcare services should Medicaid be gutted.

Informed and vocal dissent is the only way legislators get to hear what’s on our minds and have the strength to act on behalf of citizens, rather than shareholders.

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