On Friday, (July 22, 2016), the Department of Justice charged three individuals for conspiring to create a fraud scheme which billed more than $1 Billion to Medicare & Medicaid. One of the saddest parts of the story - "patients who were drug addicts were prescribed opioids - including OxyContin and Fentanyl to entice them to stay in the facilities." You can find more about the $1B case in this WSJ article.
This story made front page news this weekend, and rightfully so since $1B is a lot of taxpayer money! But, you know what is sad about this story? $1B is only 0.17% of the ~$600B spent each year on Medicare.
According to a Bank of America study (see Infographic below), Seniors (65+) spend an average of $3,450/month or ~$41,400/year.
So, what is 0.17% of $41,000? About $69/year. To put this in perspective, it would be as if you found out your landscaper overcharged an extra $5.75/month on your bill.
What should you do?
This math above is not intended to downplay the fraud that these alleged individuals committed. Actually, just the opposite - it's intended to bring perspective to the massive amount of money ($600B) this country spends on Medicare each year. We should all be scrutinizing the program to ensure it lasts for generations to come.
Example EOB Above. Here is a good article on how to read an EOB.
I hope the DOJ continues to pursue these cases and prosecute to the full extent allowed by law. More importantly, I hope fewer and fewer individuals attempt to scam our Medicare Program in the future.
In the media today, it is tough to find an objective source of information. You may have noticed that I am very interested in non-partisan reports, and I try to keep our blog updated with my perspective on these reports.
About a month ago, the Medicare Board of Trustees Report was released which showed a projected depletion of the Hospital Insurance fund by 2028. You can find my article here related to this report.
CBO 2016 Long-Term Budget Outlook
Last week (July 12, 2016), the non-partisan Congressional Budget Office (CBO) released the Long-Term Budget Outlook, which is a broader report that shows similar concerning trends. •
Here are a few of the key takeaways directly from the recent CBO Report.
This strong language is from a non-partisan CBO report. This is not a scare tactic from one side of the aisle. We need this to be one of the top issues that are policy makers are focusing on after the election. Medicare & Social Security are two great benefits in this country – but we need policy reform initiated ASAP to keep these systems financially viable for generations to come.
I am always curious to get people's perspectives on these key issues. Is this economic projection blown out of proportion or is it a major risk? What are some suggested solutions? I presented a few solution paths in my last article on the Medicare Board of Trustees Report, . Feel free to share your thoughts on our blog.
According to the Centers for Disease Control (CDC), there are ~29m people in the U.S. (about 1 in 11) that has diabetes. Check out the entire CDC Diabetes infographic here.
For Diabetics going on or already on Medicare, confusion is common. How do I pay for my needles & testing strips? What about the insulin? Is my pump covered? These are just a small sampling of questions that we hear often related to Diabetes & Medicare. Some responses to the FAQs are below.
Are my blood testing equipment & supplies covered by Medicare?
Testing Strips, Monitors, Lancet Devices & lancets are covered by Medicare Part B. This is good news for individuals who have original Medicare with a decent Medicare Supplement (e.g. Plan F or G) since Medicare will pay 80% of the cost and the Supplement will pay the other 20%.
What about my insulin?
Medicare drug plans (Part D) cover injectable insulin not used with a pump. Insulin can be very expensive and will most likely result in reaching the Part D donut hole (aka Coverage gap) of Medicare. Find out more about Part D and the Donut hole.
What if I take Metformin (or a similar drug) instead of insulin?
These drugs are generally covered under Part D. You want to make sure you pick the correct Part D plan when you initially enroll in Part D, and each year during your Open Enrollment (Oct 15 – Dec 7). More information and a short video about the Part D RX analysis can be found here.
www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNMattersArticles/Downloads/SE18011.pdfIs my insulin pump covered?
As a general rule, insulin pumps are not covered by Medicare. However, if a doctor provides a prescription indicating the insulin pump is medically necessary, then Part B (and a Medicare Supplement) will cover both the insulin pump and the insulin.
Read this: Medicare's Coverage of Diabetes Supplies & Services
These are just a few of the FAQs we hear related to diabetes. If you are Diabetic or interested in learning more, you should definitely read through the Medicare’s Coverage of Diabetes Supplies & Services created by CMS (Center for Medicare & Medicare Services).
See bio here