Medicare Monitor
The Palm Beach Post's veteran Washington correspondent, Larry Lipman, tracks policy makers and interest groups who are shaping the future of the federal health insurance program for the elderly.
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Medicare at a glance
Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:
Part A
Covers inpatient hospital care as well as nursing home, home health and hospice care. Nearly all elderly and disabled Americans qualify for Part A coverage.
Financed by a 2.9 percent payroll tax divided equally between employees and employers.
Part B
Covers outpatient care, doctor’s services, durable medical equipment, home health visits and preventive care. Part B coverage is voluntary, but roughly 40 million are enrolled.
Financed by beneficiary premiums and federal general revenue. Current monthly premiums are $93.50. Starting this year, individuals whose taxable income is more than $80,000 will pay a higher premium.
Part C
Medicare Advantage managed care plans provide health care normally covered by Medicare Parts A and B. They may also provide some other benefits, including prescription drugs, not covered by traditional Medicare. Oart C is voluntary; about 7 million beneficiaries are enrolled.
Financed by Medicare and beneficiary premiums, which vary among plans.
Part D
Medicare prescription drug plans come in two types, those that just cover prescription drugs and those that cover drugs as part of a broader managed care benefit. Part D is voluntary. About 9.2 million beneficiaries are in stand-alone drug plans and about 5.1 million are in managed care drug plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
-- Larry Lipman
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All the entries posted on May 01, 2008.
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Thursday, May 1, 2008
By Larry Lipman
| Thursday, May 1, 2008, 05:08 PM
Artificial hearts implanted as part of clinical studies for the Food and Drug Administration will be covered by Medicare, the agency announced today.
“Our decision revises a long-standing non-coverage policy and allows beneficiary access to this advanced technology,” said Kerry Weems, Medicare’s acting administrator. “Our decision also encourages the completion of FDA post-approval studies.”
Coverage of artificial hearts has been blocked by a policy in place since 1986. According to a Centers for Medciare and Medicaid Services news release, the agency now “believes there is now sufficient scientific evidence on the use of artificial hearts to allow coverage of these devices for beneficiaries in the carefully controlled clinical environment of an FDA-approved study.”
Weems said: “Our policy will allow beneficiaries to access artificial heart technology while also stimulating the research community to develop further evidence about the impact of this technology on improving patient outcomes.”
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By Larry Lipman
| Thursday, May 1, 2008, 12:20 PM
Touting an analysis from the Lewin Group, the nursing home industry warns that an anticipated $720 million cut in Medicare nursing home payments would have a huge economic ripple effect on the economy.
Bruce Yarwood, the American Health Care Association president and CEO, said a projected Medicare rule would “not only threaten seniors’ access to quality care nationwide, but will also negatively impact the economy and employment base.
“From our perspective, and as the data confirms, the CMS-driven ‘Forecast Error’ Medicare cuts represent a ‘lose-lose’ proposition for seniors’ care needs as well as the U.S. and local economies,” Yarwood said. Medicare annually adjusts payment rates to reflect what it calls forecast errors.
According to the Lewin Group’s report, the proposed rule could have an economic impact of $4.2 billion in the first year, result in the loss of more than 40,000 jobs nationwide, cut wages by $1.6 billion and trim $618 million from already sluggish state and federal tax revenue.
“On every level, the CMS actions cutting Medicare funding are conceptually flawed,” Yarwood said.
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