Drugs Not Covered By Part D

When designing Part D, our legislators had to decide on which kinds of medications would be covered. Eliminating some medications from coverage was necessary to try to keep Part D costs down overall.

The medications that Medicare does not require insurance companies to offer in their Part D drug plan formularies are:

Barbiturates are medications that act as a depressant to your central nervous system. They are commonly used for sedation or even anesthesia. Because these drugs have a tendency to cause addiction or dependence, they are not required to be included in the drug formularies for Part D. Examples of barbiturates would be barbital or phenobarbital.

Benzodiazepines are a class of medications commonly prescribed for anxiety, muscle relaxation and also sleeplessness. While considered safer than barbiturates, benzodiazepines can also be addictive, and can cause withdrawal symptoms if they are suddenly discontinued. Some of the more common drugs in this class are Valium (diazepam), Restoril (temazaepam), Xanax (alprazolam), Klonopin (clonazepam), and Ativan (lorazepam). Fortunately for Medicare beneficiaries, the generic versions of each of these medications are quite affordable even outside of insurance coverage.

Vitamins & Minerals – some vitamins can be prescribed at dosages high enough to require a prescription. These are not covered by Medicare Part D.

Cosmetic medications – Drugs that are used for reasons unrelated to illnesses or health conditions are also not covered. Common prescriptions for this would be Botox, Latisse and also hair growth medications such as Rogaine or Propecia.

Weight loss or weight gain medication – including drugs prescribed to treat anorexia

Erectile dysfunction or fertility medications – Cialis and Viagra are common examples of meds not covered by Part D. Also, for women on Medicare due to disability, drugs to promote fertility are not recognized as a necessity for Part D.

Cough medicines – cough syrups and expectorants that have higher doses of ingredients like guaifenesin or that include codeine or hydrocodone for help in sleeping are generally not covered. Examples would be Ztuss, Hydcodan, Tussigon and Mycodene.

There are a few insurance companies who choose to offer some of these exceptions on their drug plan formulary. However, since drug carriers can change their formularies each and every year, consumers should be aware that these medications may not always be covered even if they are covered during the first year you enrolled in your Part D plan.

If you take a medication that you are concerned may not be covered, we encourage you to call our agency for help with a Part D drug plan analysis. Our licensed agents can help you find the drug plan that is most cost effective for you, and also help you understand any costs you may incur for medications that are not covered by Part D.

How to reduce costs in the coverage gap

For Medicare beneficiaries who reach the coverage gap, we have some tips on how to reduce your overall drug costs for the year.

Remember that the total cost of your medication is what is counted toward the point when you will reach the coverage gap. You can help lower this amount in several ways:

  • Speak with your physician about lower-cost alternative medications that may exist to treat the same condition
  • Use your drug plan’s mail order service. Drugs purchased through mail order often have lower total costs than drugs bought at a retail pharmacy, so the amount applied toward your initial coverage limit is lowered
  • Research pharmaceutical assistance programs. Both the drug manufacturers and your state assistance programs may offer help for certain expensive medications. You can apply for this assistance to see if you qualify to be given the drug at a much lower copay
  • Take advantage of your pharmacy’s drug program. Certain pharmacies, such as Wal-mart, have lists of generic medications that you can purchase without insurance for only $4. Buying these medications outside of your drug plan means they won’t count toward your coverage gap.

Our licensed agents are experienced in finding ways to save you money while on Part D. Ask for your free Part D analysis today!

What is an excess charge?

Medicare offers what is probably the largest network of doctors and hospitals in the nation. Most physicians are participating doctors who have agreed to “accept Medicare assignment” rates, which essentially just means that they agree to whatever Medicare’s schedule allows for payment of their services, and won’t charge any more than that.

Some doctors, however, are nonparticipating doctors, and these physicians have the right to charge 15% above and beyond the ordinary cost of medical services as outlined in Medicare’s payment value scale. This upcharge is commonly called an “excess charge.” Under Medicare Part B, beneficiaries are generally only responsible for 20% of charges after their annual Part B deductible has been met. However, if a doctor charges an excess charge, then in that circumstance the beneficiary is responsible for 35% of the Medicare-approved rate.

If this concerns you, then you might want to consider Medigap Plan F or Plan G, as these Medicare supplements cover any excess charges that may occur. You can also search the Medicare Provider Directory to find out whether your physician is a participating provider. Our agency can also give you tips on how to verify which Medicare plans your important physicians might be accepting.

If I don’t like my Medicare insurance plan, when can I switch plans?

Switching your Medicare insurance plan is not as simple as it might sound. Since there are different plan types, like Medicare supplements and Medicare Advantage plans, there are several things to consider before you take the time to fill out applications for new insurance.

Switching Your Medicare Supplement

When you first become eligible for Medicare Part B, most states offer you an open enrollment window of 6 months during which you can enroll in a Medicare supplement plan without having to pass health underwriting. This means that the Medigap carrier cannot decline you for coverage due to any health conditions. In most states, this window occurs only once. Later on, if you wish to shop your insurance for better benefits or more competitive rates, you generally will have to pass medical health underwriting to change. This means the new carrier could decline your application for coverage if they feel you represent too much medical risk.

Many people are confused by this because each year they see lots of advertising in the fall about the Annual Election Period (AEP) which runs from October 15th to December 7th. This advertising makes them think that they can just wait until the autumn to change to any Medicare supplement they want. However, the AEP only applies to Medicare Advantage plans and Part D drug plans. You can read more about these below.

Some states have special windows that allow you to apply without medical health underwriting. For example, in California and Oregon, you have a 30 day window around your birthday each year where you can switch your coverage to another insurance company. To find out if any special rules apply in your state, contact a Boomer Benefits licensed agent about switching your Medicare supplement plan today.

Switching Your Medicare Advantage Plan

One great thing about Medicare Advantage plans is that they have only one health question you must pass to be eligible for the plan. The questions asks whether you have ESRD, or End Stage Renal Disease. This generally means you are receiving dialysis for kidney failure. As long as this is not your situation, you can enroll in any Medicare Advantage plan you want, as long as you apply during the proper election period.

When you first become eligible for and enroll in both Medicare Part A & B, you have an Initial Election Period which allows you to enroll in a Medicare Advantage plan up to 3 months before and 3 months after your birth month.

There is also the Annual Election Period, which occurs from October 15th – December 7th each year. During this time, you can change from original Medicare into a Medicare Advantage plan. You can also change from one Medicare Advantage plan to another. You can even dis-enroll from a Medicare Advantage plan and go back to original Medicare with a Part D drug plan.  The AEP is the most commonly used election period to make changes to your coverage.

Keep in mind that if you leave a Medicare Advantage plan and are hoping to enroll in a Medicare supplement, most Medigap carriers will require you to pass health questions, so you must understand that it’s possible you may not be able to obtain Medigap coverage if you are unable to pass the health questions. A licensed insurance agent can help you think through all this and decide how to go about changing so that you don’t end up uninsured if you are declined.

In addition to your Initial Election period (IEP) and the yearly AEP, some circumstances can also qualify you to change your Medicare Advantage plan during the year. These are called Special Election Periods, or SEPs. One of the most common SEPs occurs when you move from the county where you currently have Medicare Advantage to a new county where that plan is not offered. Medicare will allow you an SEP to choose a new plan within 2 months of your move date. The Medicare insurance experts at Boomer Benefits can help you determine whether you qualify for any SEP – just call our office today.

Switching Your Medicare Part D Drug Plan

The election periods listed above under the section about Medicare Advantage plans also apply to Medicare Part D, although one difference is that Part D plans have no health questions. You can change from one Part D drug plan to another, or even just cancel your Part D coverage, as long as you do so during a valid election period.

Shopping your Part D drug plan annually is a good idea, because each year the plans have changes in premiums, copays and also their drug formulary. The plan that was the most cost effective for you this year is not necessarily the most cost effective for you next year. A good insurance agent will assist you with checking this every single year, as we do at Boomer Benefits.

 

Confused by all the rules about switching your current Medigap or Medicare Advantage policy? Boomer Benefits can help. Our licensed insurance agents go through hours upon hours of training and certifications each year so that they can maintain their license and be knowledgeable about your options for changing your plan.

Get help from a Boomer agent today by calling the number at the top of this page, or clicking this link:

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Can my Medigap insurance company increase my rates due to illness?

best medicare supplement pricesMedicare supplement rate increases are inevitable because the cost of healthcare is subject to inflation like anything else. Questions about Medicare supplement rate hikes are common. Here are some answers related to frequently asked questions about Medigap rate increases:

Why has my Medicare supplement rate gone up when I haven’t even used my coverage this year? 

Medicare supplements rate increases apply equally to all insured members regardless of their health conditions experienced in the last year. An insurance carrier cannot exempt you from rate increases because you are well. Likewise, they cannot single you out for an increase just because you are sick. If they did that, then what would be the point of insurance that you can no longer afford? Instead, Medicare supplement insurance companies calculate their total loss ratios for all clients, and then apply rate increases to certain “blocks of business.”

For example, some Medigap companies increase rates across all clients in a certain geographic area. Others have automatic increases when insured members reach a certain age band, such as age 70 or 75. Still others will apply rate increases to everyone insured on a certain policy, such as Medigap Plan F or Plan G or Plan N. The important things to remember are that every insured member usually experiences at least one rate change per year, and that has nothing to do with whether you are sick or well. The very nature of insurance coverage relies on a carrier’s ability to spread out it’s potential risk, or losses, over a large group of policyholders.

Will my Medigap insurance carrier raise my rate if I have a long-term expensive illness?

Absolutely not. Think of this the same way you do homeowner’s insurance. Just because a hailstorm occurred and your roof needed to be replaced does not mean the homeowner’s insurance company can smack you with a big rate increase. It is not your fault that your home was in the path of a storm. Medicare supplement insurance is the same way. The insurance “insures” you against unforeseen illnesses or medical costs, and the company counts on the fact that in any given year, there will likely be more insured people who are well than there will be those that become ill and have a lot of insurance claims. This natural balance is what protects you from getting singled out for a rate increase if you become sick.

If my Medicare supplement premium goes up, can I just change to a different carrier during the fall Annual Election Period?

Not necessarily. The Annual Election Period is for changing your Medicare Part D drug plan. There are no health questions required to change your drug plan. However, the election period has nothing to do with your Medicare supplement. Instead, you can change your Medicare supplement any time of year, as long as you can pass medical health underwriting. Most Medicare beneficiaries find this confusing because they remember that when they first became eligible for Medicare, they got to enroll in a Medicare supplement policy with no health questions and no pre-existing health condition waiting periods. This is called your Open Enrollment Period, and you only have access to that window for 6 months after your Part B is active.

After that, when you want to change Medigap plans, the insurance company can accept or decline you based on health risk. This is one reason why it can be critically important to work with a licensed health insurance agent when selecting your first policy. Agents like those here at Boomer Benefits can help you determine whether or not you will be likely to be able to change carriers down the road. If not, you’ll want your agent to help you choose a carrier with rate stability because chances are that you will be unlikely to be accepted down the road with another carrier.

 

Learn more about Medicare Supplement Rate Increases – Submit our Online Help Request Form Today

2013 Medicare Advantage Plans

Medicare Advantage Plan 2013If a Medicare Advantage plan is what you are currently enrolled in, then you already know the drill. Your annual change letter should have arrived by mail in September, and this tells you about what premiums and co-pays are changing in your plan next year, as well as any other important information regarding networks or pharmacies.

If, on the other hand, you are new to Medicare or looking at Medicare Advantage plans for the first time, then it might be helpful to read below about some of things you can expect to see in 2013 Part D drug plans and Medicare Advantage plans.

Medicare Advantage Plans in 2013 – What’s Changing?

The 2013 Medicare Advantage plans have been a widely discussed topic because of the role they play in funding Obamacare. When the Affordable Care Act legislation all falls into place, about $500 billion in funding the legislation will come by way of taking that money OUT of Medicare Advantage funding. This is not a good sign for people enrolled in Medicare Advantage.

For the time being, however, those changes will not be affecting the 2013 Medicare Advantage plan benefits. This means that for many plans, the benefits will still be similar to what you are used to. The things to look carefully at are the plan’s monthly premium and the plan’s out of pocket maximum for the year, which protects you if you have a year with lots of medical expenses. Perhaps even more importantly, you need to carefully analyze which plans your preferred doctors and hospitals accept, and whether they accept that coverage as in-network or out-of-network.

Medicare Part D Drug Plans in 2013

Medicare Part D Drug Plans 2013Medicare projects that the average cost for a 2013 Medicare Part D drug plan will be around $30. However, for many people who take little to no medications, there will be plans as low as $15/month in at least 45 states. Before you enroll in such a plan though, keep in mind to look at the benefits and notice that the least expensive drug plans typically require a $325 deductible to be satisfied from you up front. If you are okay with this, then the plan may be a great fit for you.

Many popular 2013 Part D drug plans have also moved to a “preferred network” platform, which means they have negotiated special low co-pays for you at certain pharmacies. Members who are willing to use those pharmacies will get the most value from their health care dollars. Searching through the many different plans can be exhausting though, and that’s where a licensed independent insurance agency like ours can be helpful to you. We offer a free review of Part D drug plans to all our Medicare supplement clients, and we also assist clients who are evaluating Medicare Advantage plans for the 2013 calendar year.

For immediate assistance, contact a licensed and friendly agent from our Boomer team at 855-732-9055, or use our contact form to email us a request for assistance.

 

 

 

 

Can my Medigap insurance company cancel my coverage if I get sick?

Cancellation?

Medigap insurance is like any other kind of health insurance. As long as you pay the premiums, they can’t cancel your insurance. These days there is a lot of media hype over “big bad insurance companies” who cancelled the coverage on some poor guy with a health condition. It simply isn’t true.

Having worked in the Medicare insurance industry for over eight years now, I can tell you from experience, that the only thing which will result in certain cancellation of your policy is your own failure to pay your monthly premium. Just like life insurance, it only remains in force if you continue to pay the insurance premiums.

Another common question about Medicare supplements is whether the carrier can raise your monthly premiums due to an illness. They absolutely CANNOT do this. Rate increases occur on a regular basis because the inflation costs of health care are high. Generally rates increase in a couple of different ways. Some carriers will give a small rate increase in your birth month each year, because health insurance just costs more as we age. When this happens your rate goes to a specified amount that is the same for everyone else in your same age group and class. They can’t single you out for an unusually high increase because you’ve just been diagnosed with cancer or emphysema or some other health condition.

Medicare supplement insurance carriers also generally have an annual rate increase. This works differently in different states, but let’s take Texas as an example. If the carrier generally holds their rate change in October, then every year they must submit their loss ratios to the Texas Department of Insurance. If the insurance company paid out more than 65% of its revenues in claims, then they are eligible to raise rates for all policyholders and in fact the department of insurance controls how much the carrier can increase the rate.

The goal of this is for the Department of Insurance to make sure your carrier stays strong and stable. If losses are too great, this can affect a carrier’s long-term stability, so rate increases help them to level this out.

At our agency, we review every insurance company’s annual rate increases. In general, we like to see what I call “single digit” increases, meaning rates go up no more than 9%. A nine percent increase is generally manageable for most people. However, if the carrier has a repeated history of socking its members with a 22% rate increase, then we are concerned that the insurance carriers isn’t doing a very good job in estimating claims expected.

The bottom line for you is that no, you cannot get cancelled for being sick, and they can’t raise your rate because you are sick either. Rate increases generally affect everyone in the same block of business within the insurance carrier, and this works in your favor because it spreads the risk out across many people.

If you would like help with rate increase histories before you decide on which insurance carrier to purchase your Medicare supplement from, contact our friendly Boomer Benefits agents for help today.

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Do Insurance Company Financial Ratings Matter?

When choosing a Medicare supplement, many people end up basing their decision on price alone. Insurance agents and carriers are well aware of this, and unfortunately, will jump on the bandwagon to sell people a policy with the lowest price simply because it’s an easy sale to make. However, when you are deciding on a carrier, there are several other factors that should be considered because you generally only get one open enrollment or guaranteed issue window, and you don’t want to burn that window without doing careful research.

The monthly premiums are easy to compare on Medicare supplements because the benefits for a Plan F will be the same from one company to the next. So that part is easy. What’s harder to get a handle on is the reliability of the insurance carrier and whether their rates are likely to stay low.

In the insurance industry, we tend to see rates cycle among carriers. With Medicare supplements in particular, we often see an existing carrier open up  their product in a new state, and when they do that, sometimes the rates they at first offer are unrealistically low. For instance, if a carrier that has been operating in Nebraska for years decided to start offering their Medigap policies in Texas, then they determine their introductory rates and publish those to the Texas market.

It’s up to the insurance carrier’s team of actuaries to estimate losses that the company will incur, and they have to decide whether the number of policies they expect to get on the books will help to even out the risk. Some carriers are very good at doing this, and other carriers have sometimes priced themselves too low. The problem with pricing too low on the initial release of the policy into the new market is that if the carrier pays out too much the first year in claims, then a larger rate increase will be necessary.

Let’s take a look at why this might be problematic: John is turning 65, and will be retiring. He has a number of health conditions, including a chronic health condition that will always be with him. During his open enrollment window, he can get approved for coverage by any supplement carrier because he is protected from having to answer health questions on his application by Medicare laws. However, that open enrollment window only last 6 months and then it’s gone forever.

Let’s say that John chooses the cheapest carrier on the market without checking any other facts about that carrier. Upon his policy renewal, John gets a 25% rate increase and is shocked and upset at the increase. Unfortunately, he now cannot change to another Medicare supplement carrier to save money because he has a health condition that would cause him to be declined upon underwriting.

The common question we get to this scenario is: Well can’t he just change to a different Medicare supplement during the Annual Election Period (AEP) in the fall? The answer is no. The AEP is for changing your Part D drug plan, or joining or leaving a Medicare Advantage plan. So John could drop his supplement and change over to a Medicare Advantage plan during this time, provided he lives in the plan’s service area and does not have have End Stage Renal Disease. However, Medicare Advantage is a completely different type of coverage. What if John’s specialist doesn’t participate in the Medicare Advantage network?

As awful as it sounds, these are scenarios we commonly see in the Medicare industry. So the best advice we can give you is to check out any insurance carrier thoroughly before enrolling. The easiest way to do this is to work with a licensed independent insurance agency like ours that specialize in Medicare products. We can be a one-stop shop to get you all this information. The things you’ll want to know are the insurance carrier’s financial rating and also their history of rate increases. Some carriers are well known for having a long history of very reasonable rate increases from year to year. If you know you have a health condition that will prevent you from changing carriers down the line, you will want to seriously consider choosing a carrier with that reputation, even if they are a few dollars more per month up front.

The financial rating comes into play because it gives you an idea of the company’s size and stability. A and B rated carriers are larger and typically have more money in reserves than lower-rated carriers. They can weather a whole lot of claims at once without it seriously affecting their standing. There is strength and security in that, which is important for your peace of mind.

So do carrier financial ratings matter? Yes, in our opinion they do, and the rate trend history may be even more important. Be sure to check all of these things when initially joining your first Medicare supplement. Need help? Contact Boomer Benefits to review Medigap financial ratings.

Agent to the Rescue on Medicare Mind-Bogglers

Today our agency got a call from a woman who wanted to know if there was any way she could please add us as the agent of record to her current Medicare Advantage policy  – after the fact. Upon looking her up in our database, I saw that she contacted us last year, we helped her do a bunch of necessary research to find out which plans her doctors participated in, and then on the day of the appointment, she cancelled. Later on, she just applied on her own directly with the carrier.

A year later, she is learning all about the woes of applying direct with an insurance carrier and not having anyone to represent her. She said she had called member services dozens of times with necessary questions about her coverage only to be transferred several times and either disconnected or left feeling unsatisfied with the answers given. She needed to know whether her plan required a referral when using her ancillary vision benefit. She wanted to know if it was possible to get a printed directory of all the network physicians in her area. She was very fearful of what she would need to do to change her primary care doctor since her current physician is retiring this year.

In short, she was very sorry that she had not let us help her enroll after all the work we had initially done to help her find the plan she ultimately enrolled in. Unfortunately, she can’t add us her agent of record after the fact, and so for as long as she stays with that plan, she will continue to be in the same pickle. However, we would never move her from the plan just to become her agent because that plan truly was the right one for her if she wanted to maintain access to her current physicians.

Of course I answered her questions for her in less than 30 seconds. While we can’t make a habit of giving out free advice to people who are not our own clients, I always feel empathy for someone who learns the hard way about the value that agents bring to the table.

In the eight years since I became an agent and launched this agency with my brother, we have seen countless examples of individuals who would have been lost without our help. It truly concerns me for the millions of people out there who try to go it alone. Just yesterday, a Medicare Advantage client’s husband contacted me. He was at his wit’s end with trying to get help from his carrier after his wife’s routine medications got rejected at the pharmacy. He’s the kind of client who doesn’t like to “bother” you without first trying himself, and I reminded him to PLEASE call here first so he doesn’t get the run-around when trying to deal with a big insurance carrier’s member services department.

He stated that the pharmacist was being told that the carrier was rejecting her coverage due to a third party. He had no idea what this meant. But I did. Having worked with thousands of consumers on these plans over the years, I immediately knew we had a problem that needed to be resolved with Medicare’s coordination of benefits department. I suspected that Medicare may have reinstated information about his wife’s prior group plan coverage. We got his wife on the line and did a conference call with Medicare to figure out the situation.

Sure enough, her former group insurance plan had transmitted information to Medicare that she was still enrolled in the group plan even though she had dropped the group last December. Medicare quickly fixed the information in the system. However, I explained to my client that he must contact his employer’s health benefits department and get this corrected in their records, or else the issue was bound to happen again every time the group filed their annual Medicare secondary payer forms with Medicare.

In a million years, my client would never have dreamed that the reason her medications were not being covered had nothing to do with her current insurance but was entirely the result of an error at an employer group health insurance plan that she left nearly 9 months ago. She is not alone either. We have assisted folks with some truly bizarre issues over the years.

One client, a lifelong teetotaller, developed unexplained liver failure almost overnight. The plan he had chosen had only a few hepatologists in their network because this field is so specialized. The only one seeing new patients was over 50 miles from his home. He had been to the emergency room 4 times in 2 weeks to have fluid drained from his abdominal cavity while he waited for his appointment. His friend Jim, who is also my client, urged him to call me for help. We were able to take advantage of a little-known rule about Medicare Advantage plans that allowed him to revert to original Medicare and pick up a Medicare supplement without health questions as long as he did so within the first 12 months of his plans. He was exactly 11 months in. Had he not called us for another month, he would have been stuck. Fortunately, we quickly moved him and got him into a local hepatologist’s office almost immediately.

On another occasion, a couple in their late 80′s contacted our office because their Medicare supplement company had a series of rate increases, and they were paying more than $450/month for the man’s coverage. He had a few health conditions and had been declined by another carrier. I asked a few questions and identified a carrier with more limited underwriting that I felt might accept him. We moved him to that policy with the exact same coverage for around $315/month.

My all-time whopper is about a disabled 79-year old woman living alone. She shared with some neighbors, who happened to be my clients, that she was paying over $1000/month for her medicare supplement and was unable to afford her groceries. We visited with her to see what the problem was. In horror, I discovered that over a period of about 11 years, she had first bought one supplement, then another, then another…Ultimately she had enrolled in 5 different Medicare supplements without ever cancelling any of the previous ones. Her worry and fear over coverage had led her to spend tens of thousands of dollars over a decade on supplements that were duplicates of the coverage she already had.

My agency assisted her with cancelling the 4 most expensive plans and left her with the one plan that covered all her gaps in Medicare for the lowest price. She literally cried sitting with me because was so grateful. I didn’t earn a dime that day in the ordinary sense, but it was the most priceless day of my entire career.

If you are sorting through the Medicare maze and feel like you want to handle your insurance alone, I urge you to go ahead and do your own research. Educate yourself, and compare rates and benefits and do whatever you need to do to feel comfortable. An agent can do all of that work for you, but for some people, digesting and understanding all this information on their own first helps them to feel more confident about their choices.

However, when it comes down to signing on the dotted line, please consider asking a licensed insurance agent that works with Medicare products to review with you what you’ve learned and see if you’ve missed anything. Then get the agent to help you submit your application. It doesn’t cost you a dime, but there may be a time when you have urgent medical questions relating to your coverage, and when it does, you will be so glad that you have a person to turn to that is not a nameless, faceless call center employee. There are many of us out here who truly enjoying assisting people, and consider it an honor to provide help and service for your policy when you need it.

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Are my doctors going to stop taking Medicare?

The possible Medicare doctor shortage is something our agency is following closely in the news, and through our membership in the National Association of Health Underwriters. As Obamacare is being implemented, we have seen a number of articles in the media that state doctors are threatening to stop taking Medicare if there are any further cuts to their reimbursements.

Medicare supplement doctors

What many people don’t know is that over the last decade there have been many scheduled cuts in doctor funding, and each time, Congress steps in at the last minute to kick the can down the road. This is good for our Medicare clients in the short-term, but does nothing to solve the long-term problem that Medicare is paying out more than it brings in. Eventually there will be a point where some President and Congress will need to be honest with Americans about the problems and provide real solutions.

One of the issues complicating the matter is that only about 3% of doctors coming out of med school are going into family practice. The great majority of doctors choose a specialty instead because they can earn nearly twice as high an income by doing so.

This shortage in primary care doctors is occurring at around the same time that the Baby Boomers are beginning to enter Medicare, which will put further strain on an already overworked group of primary care doctors. They can only see so many patients per day, and since Medicare reimburses them less than what they get for treating other non-Medicare patients, most doctors have to limit their practices to only so many Medicare patients.

Despite all this, here at Boomer Benefits we have yet to run into any problem finding primary care doctors for our clients. Most of the time, doctors whose current patients are aging into Medicare will continue to see those patients when they transition to Medicare. The trickiest time to find new providers is when a client moves into a new county or state, and fortunately, our team of licensed agent professionals here offers free assistance to our policyholders in tracking down physicians accepting new Medicare patients.

The best advice we can provide you is to stay on top of the news about how the Affordable Care Act will affect Medicare. The Act as written will allow for a 30% scheduled reduction in free reimbursements to physicians, and that would be disastrous. We hope Congress or the administration will do something to address this in a better way. People age 65+ are the biggest voting block in our nation. Communicate your concerns to your Congressmen!

Finally, realize that some changes to Medicare will necessarily have to happen to keep Medicare alive. A fix such as moving the Medicare eligibility age to age 67 would be far better than having to wait 3 months for an appointment because of a doctor shortage. Such a fix would also be phased in over time so that people turning 65 right now would still get their Medicare at age 65.

Keep an open mind and know that fixing this may require our nation to choose the lesser of two evils. However, also know that if you are a Boomer Benefits client, we’ll keep you informed and help you through any changes that occur. No matter what happens with Medicare, we will be here to make the changes less stressful for you by doing anything we can to assist you in your access to quality healthcare.

To read more about the team of professionals that our agency employs to constantly support our clients, click here.