Welcome to Medicare.net, the premier Health Network partner focused exclusively on providing Americans 65 or older with the very best access and information regarding their healthcare options when it comes to medicare. Navigating the waters of healthcare, especially Medicare can be particularly complicated. It’s important that you obtain information from a trusted resource, and if and when you need to speak with a licensed medicare insurance professional, you can connect with one easily over the phone. If you would prefer to meet with a licensed medicare specialist to have all of your questions answered in person, we can assist you with that. Simply call our toll free number to schedule an appointment.
Medicare was first created in 1965 and first implemented in 1966. The program as it existed before Obamacare worked well. But it still put many of our most treasured citizens over the age of 65 in a difficult financial position. They were not able to pay for the services or prescription medicines that they so desperately needed for a better quality of life.Speak with an Agent now. 1-800-810-1437
An American over the age of 65 cannot sign up for a Medicare program through the Healthcare Marketplace. But the Obama Administration recognized the need to tweak many provisions of Medicare. This ensured that its participants were receiving the same exceptional care that other citizens are getting under the ACA. As a result, participants can now rest easier knowing that under Obamacare. Now, they will automatically receive preventive care services for free and healthcare that meets a minimum coverage standard.
Who is eligible for Medicare?
Medicare is only available for certain people. Among these are:
- Those over the age of 65 years old
- Those under the age of 65 who have a disability that qualifies them to get Social Security Income
- Those who receive benefits from the Railroad Retirement Board (RBB)
- Those with end-stage renal disease (ESRD)
- Those with amyotrophic lateral sclerosis (AML, or Lou Gehrig’s Disease)
Medicare.gov, the official governmental website for Medicare, offers a questionnaire to determine whether a person is eligible for Medicare benefits. People who receive benefits from Social Security or from the RRB are automatically enrolled in Medicare. However, those who qualify due to one of the previously mentioned illnesses must sign up for a Medicare policy.
Rediscovering Medicare 2016: Important Updates For 2016
The Dept. of Health and Human Services (HHS), the agency responsible for Medicare, estimates that 57 million Americans are enrolled in this social health program. This includes people 65 years or older, disabled people under 65 and those with Amyotrophic Lateral Sclerosis (ALS, Lou Gehrig’s disease) and end-stage renal disease (ESRD). With this huge consumer base comes equally huge costs. The Office of the Actuary, which provides the HHS with estimates and analysis of healthcare financing and spending, predicts that total 2016 Medicare spending on benefits will reach $672.6 billion.
But with so many people relying on Medicare, this financial outlay is essential. As with any other programs, Medicare is continually being examined and improved. This includes all four parts: Part A (hospital insurance), Part B (medical insurance), Part C (Medicare Advantage, private insurance plans) and Part D (prescription drug coverage). But even with past changes, those made in 2016 may be some of the most dramatic and far-reaching since Medicare was signed into existence by Pres. Lyndon P. Johnson in July 1965.
Below, we’ll discuss the major developments for Medicare 2016 and everything you need to know. Right now, these revisions include new payment and pricing changes, including how millions of enrollees were spared from enormous Part B premium and deductible increases. Other big changes involve coverage for specific procedures and end-of-life care and counseling and how patients receive medical care. These initiatives could redefine and improve the doctor-patient relationship, as well as Medicare enrollees’ overall experience.
Medicare Part B Increases Reduced For Millions
When it comes to Medicare 2016, everything you need to know right now about specific plan costs centers on financial relief. In 2015, the Medicare Board of Trustees (the Board), which is responsible for the program’s financial health, revealed that Part B premiums and deductibles for an estimated 52 million enrollees’ (about 30 percent of all Part B members) would increase by 52 percent, compared to 2015.
There were three reasons for this: 1.) 2014’s Part B spending was higher than expected; 2.) sufficient funding had to be reserved for the Supplementary Medical Insurance (SMI) Trust Fund; and 3.) the lack of a cost-of-living adjustment (COLA) for Social Security benefits in 2016. Under Medicare’s hold harmless rule, 70 percent of all members don’t have to pay higher 2016 Medicare Part B premiums. These “hold harmless” members will pay only $104.90 per month, as in previous years.
The remaining 30 percent of enrollees include: those applying for Medicare Part B for the first time; those not currently collecting Social Security benefits; those with premiums paid by Medicaid (dual eligible); and those paying additional income-related premiums. In 2016, certain single and joint filers may have to pay monthly premiums of $121.80. But depending on their earned incomes, filers may have to pay:
- $170.50 per month: Single filers earning $85,000–$107,000; Joint filers earning $170,000–$214,000
- $243.60: Single filers earning $107,000–$160,000; Joint filers earning $214,000–$320,000
- $316.70: Single filers earning $160,000–$214,000; Joint filers earning $320,000–$428,000
- $389.80: Single filers earning $214,00 and up; Joint filers earning $428,00 and up = $389.80
However, on Nov. 10, 2015, Congress passed the Bipartisan Budget Act of 2015 (Public Law 114-74) . This spared enrollees from the much higher premium increases. So, in 2016, they’re only paying 16 percent more for Part B premiums – – $121.80, rather than 2015’s $104.90. This also includes a $3 repayment surcharge that will be added to monthly premiums over time to cover 2016’s reduced premiums.
Relatedly, even if you’re in the group that was spared from paying higher monthly premiums for Part B coverage, you may still have to pay higher annual deductibles, which were raised in 2016 to $166, up from $144 in 2015. After your deductible is met, you’ll only be responsible for the co-insurance amount of 20% for medical services billed to Medicare.
End Of Life Care – A Big Concern For Medicare Recipients In 2016
There have been dramatic changes for end-of-life options for Medicare 2016. Everything you need to know right now concerned how patients were counseled, as well as their newer options. “End-of-life” refers to all healthcare provided in the days or years before death, no matter whether it’s sudden or due to a long-term terminal illness. The Centers for Disease Control and Prevention (CDC) estimates that of the 2.5 million people dying each year in the U.S., about 75 percent are ages 65 and older.
This makes Medicare the largest healthcare insurer during the last year of life. About 25 percent of all Medicare healthcare spending goes to these enrollees, many of whom have various serious and complex conditions. Medicare covers a host of services – both curative (for curing) and palliative (relieving pain, discomfort) — that can be utilized right up until members’ death. Among these are: care in hospitals and several other settings, home healthcare, physician services, diagnostic tests and prescription drug coverage.
Beneficiaries with a terminal illness also qualify for benefits that wouldn’t normally be covered under Original Medicare, such as bereavement and hospice services. End-of-life services are controversial, due to their costs and the difficult discussions and issues related. Originally, the Affordable Care Act (ACA) authorized voluntary, personalized counseling. But due to public outcry, this provision was quickly removed from the healthcare law. However, Medicare has reinstated this counseling.
Hospice benefits also play a part in Medicare 2016. Everything you need to know right now involves the program’s new Care Choices model. Previously, enrollees opting for hospice benefits had to give up most curative care. But the new model allows those with terminal illnesses to receive hospice services without giving up treatment. On Jan. 1, 2016, 70 hospices began offering these new services; another 70 will join in 2018. Medicare also began covering advance care planning as a separate and billable service in 2016. Advance planning involves discussions between healthcare providers and patients regarding end-of-life care and patient preferences.
Changes to ACO selection
In 2016, Medicare has focused on just how medical care is delivered to patients. Among the key areas are: teamwork among clinicians, particularly that of primary care doctors; the timeliness of preventive services; and patients transitions between hospital and home. Medicare estimates that almost 8 million beneficiaries (20 percent of Original Medicare) are currently enrolled in Accountable Care Organizations (ACOs).
ACOs are networks of doctors and hospitals with the goal of delivering better quality care at lower costs “Five years ago, there was minimal incentive to coordinate care,” said Patrick Conway, Medicare’s chief medical officer. “Physicians wanted to do well for their patients, but the financial incentives were completely aligned with volume.” With ACOs, networks get part of their reimbursement for meeting quality or cost targets; their long-term effectiveness is still being determined. But Medicare kicked off a major expansion for 2016. Enrollees can also select their own ACO, for the first time, and they can opt out if they prefer.
Joint Replacements’ Quality and Costs Examined
Another change to Medicare in 2016 is an experiment involving two types of joint replacements: hip and knee replacements. These are Medicare’s most common surgeries and in 2014, more than 400,000 beneficiaries received hip or knee replacements. The CMS estimates that these procedures cost more than $7 billion for the hospitalizations alone. And for Medicare, the average costs can vary widely within different geographic areas, ranging from $16,500 to $33,000. In addition, these surgeries require long recovery and rehabilitation periods. Their actual quality, in and out of the hospital, can also vary, depending on the area and facility.
As such, it’s understandable that efforts are being made to improve the procedures’ quality, while keeping costs down. In April 2016, hospitals in 67 metro areas and communities will take part in an experiment designed to manage these procedures’ total costs. The 90-day experiment will begin with the patient’s initial doctor’s visit, and encompass the surgery and rehabilitation.
If you have any questions at all, don’t hesitate to call and speak with one of our healthcare professionals; they’re available 24/7. at 855-572-5165