Congressman Paul Ryan of Wisconsin has given a lot of thought to the future of Medicare and how this program, which takes up 13% of the federal budget, should be shaped in the future.  Ryan is one of the Republican “Young Guns” who will take leadership roles on key committees if their party becomes the majority in the House of Representatives.

An article in Kaiser Health News provided an overview of Congressman Ryan’s proposal for Medicare:

Current Medicare beneficiaries, and those nearing retirement (55 and older), would get Medicare as it exists today. For everyone else, eligibility would begin at 69 and a half, and there would be a “standard Medicare payment” for the purchase of private health coverage.

At the beginning, Medicare vouchers would cover $11,000 of the cost of a health plan, which the proposal lists as the average amount of money that Medicare currently spends on a beneficiary. The total would increase with inflation, based on a combination of the consumer price index and its medical care component. If the payment exceeds the cost of a plan, the beneficiary could invest the leftover money in a medical savings account to pay for other medical needs, or buy long-term care insurance.

Government payments would vary depending on an individual’s income, health status, and initially region. Individuals with incomes less than $80,000 would receive the full amount, those between $80,000 and $200,000 would get half, and those above $200,000 would receive 30 percent. The government also would fully fund medical savings accounts for low-income beneficiaries.

Ryan is the top Republican on the House Budget Committee and a senior member of the Ways and Means committee which has jurisdiction over Medicare and Social Security.  He could become the chairman of the committee that oversees Medicare.

From my perspective (as I’m over 55), Ryan’s plan has some interesting ideas.  But unless the under-65 insurance market changes – and Republicans say they will repeal the recent health insurance changes  – the idea of raising the Medicare eligibility age to 69 is …frightening.

The idea of the government giving people money to buy their health insurance sounds interesting to me.  But the problem is that insurance companies will be making a profit from that money.  Why not get rid of health insurance for-profit and save the U.S government billions of dollars?  Other countries like Germany, France, and Switzerland have health insurance companies – but those companies are “not-for-profit”.  Medicare is a not-for-profit insurance organization. Its overhead costs are 2%.  Insurance company overhead costs are 15-20% and include profits.  What is the better deal for American taxpayers?  2% vs 20%:  I think the answer is obvious.

I have decided to write about insurance agents who work in the Medicare market because I have been critical of agents/brokers who seem more interested in making money than helping their clients.  There are insurance agents who swoop into Tucson from Phoenix, sign people up for a Medicare Advantage plan, and are never heard from again. But there are many insurance agents/brokers who work very hard to match their clients to the appropriate Medicare coverage.  There are many agents/brokers who are there for their clients when they have problems with their Medicare Advantage or Part D plan.  There are even agents/brokers who help their clients get social services help – acting like social workers.

If you have your agent’s card and you have questions about your current coverage – and you are thinking of shopping around….please call your agent.  If the insurance agent who signed you up for your Medicare Advantage plan is not from Tucson…..find someone local who can help you evaluate your coverage.

Trying to sort through the details of four or five Medicare Advantage plans is complicated and confusing – but a good insurance agent/broker can help you in the following ways.

A good insurance agent will tell you a Medicare Supplement might be better for you than a Medicare Advantage plan and will explain the difference in coverage and cost.

If you are looking at Medicare Advantage, a good agent will tell you which plans your doctors are contracted with.

In evaluating an Advantage plan, a good agent will take the list of your medications and tell you what your co-pays will be.

A good insurance agent will not push you toward one plan, but will match you to a plan (or plans) based on your doctors, your prescriptions, and how you feel about having low co-pays vs a big network of doctors and hospitals.

A good insurance agent will tell you to call him/her if you have any questions at any time during the year.

Medicare choices are many and confusing.  A good insurance agent can help you through the Medicare maze. Be sure to choose an agent who seems more concerned with your interests than with his/her opportunity to make a commission.

FOR MORE INFORMATION, SEE MEDICARE CHOICES OF ARIZONA.

When you blog about big companies, they actually read it. 

A UnitedHealthcare representative called me last week to say she had been told to look into Terry’s situation, the woman about whom I wrote last week. You can see that post here:  UnitedHealthcare: Can they get away with that?  Terry has a Pacificare health insurance policy that is being converted to a UnitedHealthcare policy, and she is going from a decent policy to a terrible one – with a $250,000 cap on her lifetime benefits.  This means that if she gets sick and runs up a bill of $250,000, UnitedHealthcare (UHC) is finished with her and her medical bills.

The UHC rep was looking into Terry’s policy and talked to Terry on Friday last week and Monday this week.  But this rep had to ask someone else to look into Terry’s policy because it is not an “individual policy” but a “conversion policy”.  Terry still hasn’t heard anything more, so we’re waiting to see what UHC’s reasoning is for converting her decent policy to a reprehensible health insurance policy, especially because Terry is a diabetic and un-insurable if she tries to get a new and better policy.

I got a call from yet another woman in her 50′s who is un-insurable. 

This woman applied for a received Social Security Disablity for health conditions I will not reveal.  Suffice it to say, she is disabled.  This woman has been on AHCCCS (Arizona Medicaid) and so has had health insurance which covers all her required treatments.  But once she got a Social Security check, which totals around $1,100 per month, she makes too much money and will be kicked off AHCCCS.

I told this woman to check with Social Security to see when she qualifies for Medicare because a person is supposed to wait 24 months to qualify for Medicare after they are deemed to be disabled .  However, the clock starts from the time a person applies for Social Security Disability and many cases take one, two, or more years to be settled.   This woman found out she will get Medicare on February 1, 2011 - but she will lose her AHCCCS/Medicaid health insurance in November.  Of course, because of her disability, she will be rejected by every insurance company. But she needs treatment each month for her illness and she will not have insurance in November, December, and January.  When her Medicare starts, she will have good insurance.  While she has no insurance, I don’t know what she will do.  Hopefully she makes it to February.

Today, September 23rd, 2010, is the day on which parts of the Affordable Care Act take effect.  As of today:

Insurance companies must offer insurance to children with pre-existing conditions.  This means that if a parent works for a small company that offers health insurance, he will be able to get his sick child coverage.  Small group plans or family plans could previously refuse coverage to a child with an illness.  That is no longer allowed.

Insurance companies can no longer cancel an individual insurance policy when a person gets sick.  Previously, when a person got sick, the insurance company would do everything it could to find something in the initial application for coverage and could say something like, “Aha, you had a yeast infection as a teenager - which you did not put on your application.  Now you have cervical cancer and we are canceling your policy because you did not divulge this pre-existing condition!”  This is no longer allowed. This really happened to someone!

Insurance policies issued after September 23rd (group, individual, and family) cannot cap lifetime benefits.  Thus one would think that Terry’s “conversion” policy, which takes effect on October 1, would not have a $250,000 lifetime benefit.  Terry is still waiting for an answer from UHC on this issue. 

Insurance policies must cover preventive care.  This means that people who have a $5,000 deductible policy, which means they pay the first $5,000 for any and all medical care, can get preventive screening tests and the insurance company must pay for them.

Republicans want to repeal these changes.  Insurance companies did not agressively fight health care reform because they are looking forward to getting 30-40 million new customers with government subsidies in 2014.