I was having lunch today with another insurance broker, and she showed me an email she had received that had some frightening information about the future of Medicare….and it had to do with “Obamacare”.  Here is part of the email:

I had one of the most troubling, most disturbing conversations ever with Julie’s sister-in-law, Dr. Suzanne Allen, head of emergency services at the Johnson City Medical Center in Tennessee.

We were discussing the “future” and I asked her had she seen any affects of Obama Care in her work?

“Oh, yes. We are seeing cutbacks throughout the services we provide. For example, we are now having to deal with patients who would normally receive dialysis can no longer be accepted. In the past, there was always automatic approval under Medicare for anyone who needed dialysis — not anymore.” So, what will be their outcome? “They will die soon without dialysis,” she stated.

I assumed this was a bogus story because it sounded a lot like the “death panel” emails that went around in 2010.  So I pulled out my i-pad and googled the subject line of the email. I found plenty of links to stories about this email that is being passed on from uninformed and gullible people to their likewise gullible friends and family.

Factcheck.org had this to say about the story.

The frightening claims in this email about losing control of one’s health care decisions have caused consternation among some of our readership — particularly the fear of losing all health care after age 75. But fear not, this email is bunkum.

The email presents a veneer of authenticity. There is, in fact, a Johnson City Medical Center. It is a not-for-profit center located in Johnson City, Tenn., that serves as “a safety net hospital caring for the uninsured.” And there is a Dr. Suzanne Allen who works in emergency medicine at that center. But that is where any truth to this email ends.

We contacted Ed Herbert, a representative for the Johnson City Medical Center. He confirmed to us that the conversation quoted in the email is fraudulent. According to Herbert, a guest of Dr. Allen’s home created the untrue email to further a political point.

It is sad and pathetic that there are people out there spreading these lies – and frightening seniors. Given that this is the second go-round for these lies, and they have been debunked, it is especially sad that people are still falling for them.  It reminds me of the saying, “Fool me once, shame on you. Fool me twice, shame on me”. Come on, people! Wake up and realize these people are playing you for fools!

If a person is turning 65 and living on their Social Security benefits, they might qualify for help with the Medicare Part B premium ($99.90 per month) and their drug costs.  If a person applies for this help through the state of Arizona, there is no limit on how much a person can have in savings to qualify. If a person applies through Social Security, assets such as savings cannot exceed $13,070 for an individual or $26,120 for a couple.

The Arizona Health Care Cost Containment System (AHCCCS – pronounced “access”) administers the Medicare Savings Program in our state.  An application for the Medicare Savings Program can be submitted up to 45 days before a person’s Medicare coverage will begin.  To provide proof of income, a person can attach the annual award letter they receive from Social Security in December of each year.  If a person is not collecting Social Security as they are turning 65, providing proof of income becomes more complicated and they might be better off going through Social Security. Social Security will check their tax records.

When the state of Arizona approves a person for the Medicare Savings Program, AHCCCS will notify Social Security that the individual also qualifies for the low income subsidy for drug coverage.

Here are the levels for getting help in 2012:

Qualified Medicare Beneficiaries (QMBs):  States must pay all Medicare cost-sharing for Medicare beneficiaries with incomes up to 100% of the federal poverty level (FPL) and limited resources.  For this group, the 2012 level is $930.83/month ($11,170/year) for an individual; $1,260.83/month ($15,130/year) for a couple.

Specified Low-Income Medicare Beneficiaries (SLMBs):  States must pay the Medicare Part B premium for Medicare beneficiaries with incomes between 100% FPL and 120% FPL and limited resources. The limit for this group is $1,117 /month ($13,404/year) for an individual; $1,513/month ($18,156/year) for a couple.

Qualified Individual (QI): States have a limited amount of money from which they must pay, on a first come, first served basis, the Medicare Part B premium for Medicare beneficiaries with incomes between 120% FPL and 135% FPL and limited resources.  The limit for this group is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

Add $20 disregard to each income level.  But a couple only gets to add $20 once.

EXTRA HELP FOR PART D:  Add $20 disregard to each amount.

Full Subsidy:  Medicare Part D provides a full drug subsidy with low co-payments to Medicare beneficiaries with incomes up to 135% FPL and limited resources.  For those individuals, the 2012 eligibility limit is $1,256.63/month ($15,079.50/year) for an individual; $1,702.13/month ($20,425.50/year) for a couple.

Partial Subsidy: Medicare Part D provides a partial subsidy of premium, deductible and co-insurance to Medicare beneficiaries with incomes up to 150% FPL and limited (but higher than allowed for full subsidy) resources.  The income limit for this group is $1,396.25/month ($16,755/year) for an individual; $1,891.25/month ($22,695/year) for a couple.

The Medicare.gov website has incorrect information about the cost of some drugs.  I was told this by an internal representative of a Medicare Advantage plan operating in Arizona.

In preparation for a meeting with a client last week, I used the Medicare.gov website to look at how my client’s prescription for Toprol XL would be covered. Toprol is the brand version of Metoprolol, which is used to control blood pressure. My client has tried generic blood pressure medications, and they do not work for her.  My client will be covered by Medicare in June and wants to enroll in a Medicare Advantage plan.

I went to Medicare.gov and used the Plan Finder. I put in my client’s zip code and entered Toprol XL in the drug section. When the Plan Finder gave me the list of Medicare Advantage plans available in Pima County, I checked the drug coverage section for each plan. Some plans said they did not cover Toprol XL, while some said they did.  However, when I looked at the details of each plan’s drug coverage for Toprol XL, the retail cost was between $36 and $40 (depending on the plan).  The cost to the patient would be the same price, which says  to me that the plans don’t actually cover this drug.

My client is leaning towards one particular Medicare Advantage plan, so I checked that plan’s formulary. The formulary (list of drugs covered) said Toprol is a tier 3, or non-preferred brand drug, and it would have a co-pay of $95 per month.  Hmmmm… $36 or $95?

I called the MA plan’s broker services department to double check on what Toprol XL would cost for this person. This is when I was told that the information on the Medicare.gov site is incorrect, and that it is incorrect for other drugs as well.

Yikes!  I use Medicare.gov for every client with a list of prescriptions. I take a screenshot of different plans’ coverage of the client’s drug list so they can see the details and difference from plan to plan. I email those screenshots to my client and we review and discuss them. Now I am told I can’t be sure this information is correct.

Below is an example of a screenshot from Medicare.gov.  Sorry about the blurriness, but you can see that I have pointed out the retail cost with the first red arrow and then on the chart when this person (another client) would go into the donut hole. The Medicare.gov Plan Finder provides very detailed information – hopefully it is correct!

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