Entries in Medicare (9)


CEOs Propose Hiking Retirement Age for Benefits

Comstock/Thinkstock(NEW YORK) -- Some of the most affluent Americans in the country believe that the rest of us should work until we're at least 70 years old.

Chief executive officers who belong to an organization known as the Business Roundtable have issued a proposal that U.S. workers should not be able to benefit from the two sacred cow entitlements, Social Security and Medicare, until they turn 70.

Their reasoning is that Social Security and Medicare won't be able to sustain the ever-expanding number of people planning to get benefits at age 65.

The Business Roundtable contends its new recommendation wouldn't affect anyone currently 55 or older but if you fall under that age bracket, the CEOs say that Social Security checks for future retirees should be reduced.

Meanwhile, the group says that it would be better if Medicare was voluntary and that health benefits ought to be at least partially privatized.

John Engler, president of the Business Roundtable, adds, "Implementing changes now and implementing them gradually over a long period of time realizes dramatic savings down the road without putting an impact on individuals."

Copyright 2013 ABC News Radio


Fighting Medicare Fraud: Gov't Sets Up Multi-Million Dollar War Room

iStockphoto/Thinkstock(WASHINGTON) -- Medicare fraud costs taxpayers billions of dollars every year -- but now the government says it has developed a powerful, new tool that can stop Medicare scam artists in their tracks.

It's a multi-million dollar, state-of-the-art war room in a secret location -- but it's not a CIA facility. This war room is dedicated to stopping sophisticated Medicare scams.

“Preventing fraud and abuse is really what this effort is all about,” said Health and Human Services Secretary Kathleen Sebelius.

Sophisticated computer programs at this new command center can scan millions of Medicare transactions in real time, Sebelius says, then identify and stop payment on fraudulent claims before a dollar of taxpayer money goes out the door.

Copyright 2012 ABC News Radio


Dental Plans: Why Americans Are Paying More for Less

iStockphoto/Thinkstock(NEW YORK) -- With all the attention paid to affordable health care, experts say standard dental coverage has changed little over the last 20 years while leading to greater out-of-pocket costs for consumers.

As with the rising costs of overall health care, many times only the wealthiest have access to important dental care.

Dr. Paul Glassman DDS, professor of dental practice and director of community oral health at University of the Pacific, said dental benefits and the cap on dental health plan benefits have not changed much in the past 20 years. But the cost of dental care has increased "dramatically." As a result, more people are paying out of pocket if they want additional work done, he said.

And those who struggle to afford oral health care may find even more problems down the line, with gum disease possibly contributing to ailments like diabetes and heart disease.

Real out-of-pocket dental expenditures increased to $332 in 2008 from $270 in 1996, according to the American Dental Association's (ADA) report published in April called, "Breaking Down Barriers to Oral health for All Americans: The Role of Finance." The ADA said the figure dropped to $323 in 2009, but "this likely reflects the state of the economy, rather than any improvement in dental benefits."

Real per capita expenditures on overall personal health care reached $6,819 in 2009.

Glassman said a number of issues have contributed to dental care's higher costs. One major reason is that labor costs have increased in dental offices.

Sen. Bernie Sanders, I-Vt., introduced a bill on Thursday called the Comprehensive Dental Reform Act of 2012 that tries to fill the gap for the 130 million Americans who have no dental insurance. Medicare covers almost no dental care, and no dental services for the elderly. Medicaid dental benefits vary by state and are often only for the most dire emergencies.

Part of the bill proposes pilot programs for dental therapists, who would have more training than dental hygienists, to perform certain procedures. So far, Alaska and Minnesota allow some dental therapists to provide procedures that only dentists are permitted to do elsewhere. Sanders' bill authorizes National Health Service Corps loan repayments for individuals licensed by a state as dental therapists.

The American Dental Association has opposed this provision of the bill, telling Sanders in a letter that "only dentists can diagnose, develop treatment plans and provide complex treatment."

"Only 20 percent of the nation's practicing dentists provide care to people with Medicaid, and only an extremely small percentage devote a substantial part of their practice to caring for those who are underserved," Sanders said in a statement when he introduced his bill in Washington, D.C. "This bill addresses this by creating an incentive to increase Medicaid reimbursement rates for dentists by assisting the states in covering those costs."

President Obama's Affordable Health Care Act, which will roll out by 2014, will impact some dental policies, such as small group and individual market policies.

"Almost no states cover dental benefits now," said Glassman. "Adults who are low income are almost out of luck in terms of having benefits now."

Burton Edelstein, pediatric dentist and Columbia University professor of dental medicine and health policy and management, said the basic design of dental plans has not changed dramatically over the past 20 years. He said dental plans are "essentially pre-paid dental benefits, rather than risk-shared insurance per se."

Edelstein said under current and proposed legislation, states and the federal government can develop plans to provide more intensive dental care to those with greater needs and less to those who don't need it.

Whether you have an employer subsidized dental plan, there are some steps you can take to make sure you are getting the most affordable dental care you can:

1. Many experts suggest seeking low-cost dental care, such as through Federally Qualified Health Centers. Sanders' bill proposes increasing funding for oral health services at these public clinics, which have a sliding pay scale, and for school-based dental services. He also proposes new funding for mobile and portable services. Glassman is also a proponent of telehealth services in which dentists could provide remote supervision and collaboration without seeing every patient in person.

2. Put money in a health savings account (HSA). Nancy Metcalf of Consumer Reports said she often discourages people who do not have subsidized dental plans from getting individual dental coverage.

3. Research and negotiate prices. Metcalf said allows people to look up prevailing prices for local services. "Call up the dentist and make a deal with them," she said. "Say that you'll go to them for a root canal for $1,000. You're probably going to do just as well if you don't have dental insurance."

Copyright 2012 ABC News Radio


Could Social Security and Medicare Run Out Sooner Than Expected?

Comstock/Thinkstock(WASHINGTON) -- Social Security’s retirement and disability programs have enough funds to cover the next 20 years, but that could change come 2033.

Every year the Social Security Board of Trustees releases its report outlining the stability and financial security of the two biggest federal programs in the United States, Social Security and Medicare.

This year’s report says that because of an increase in pressure on these programs -- Americans are living longer and the baby boomers are beginning to collect -- funds could run out sooner than expected. In addition, the slow rebound of the economy and high energy prices are leading to a quicker deterioration of the trusts that fund Social Security.

“In 2033, incoming revenue and trust fund resources will be insufficient to maintain payment of full benefits," Treasury Secretary Tim Geithner, said, referring to Social Security.  “At that point there will only be enough money to cover about  three-fourths of full benefits.”

Social Security is broken into two arms: retirement, and its disability program, which aids 11 million Americans and will be exhausted two years earlier than last year’s estimate.

In 2011, the report estimated that funds would last until 2036.

Medicare’s Hospital Insurance Trust Fund maintained the same projection as last year, with sufficient resources to maintain benefits through 2024. This is attributed to the 2-percent cut in Medicare that Congress enacted last year.

“Please, please remember that ‘exhaustion’ is an actuarial term of art and it does not mean there will be no money left to pay any benefits,” Commissioner of Social Security Michael Astrue cautioned.  “After 2033, even if Congress does nothing there will still be sufficient assets to pay about 75 percent of the current level of benefits.”

According to Public Trustee Charles Blahous, the bleak projections for these two programs, which accounted for 36 percent of federal expenditures in fiscal year 2011, signifies the largest actuarial deficit seen in Social Security since the 1983 reforms and the “second largest single year deterioration in all trustee reports since the last major reforms.”

The Affordable Care Act has offered some stabilization to the Hospital Insurance Trust Fund that finances Medicare. Originally the Hospital Insurance Trust Fund was set to expire in 2016.

“As a result of the law, we’ve added another eight years to its life, putting Medicare on much more solid ground,” Kathleen Sebelius, secretary of Health and Human Services, said.

She said that the law does this “through a range or reforms, from cracking down on fraud to helping providers prevent costly medical errors to reducing excess payments to Medicare advantage plans.”

Both Sebelius and Geithner emphasized the importance of quick action to solve the problem facing the giant retirement and disability programs.

Copyright 2012 ABC News Radio


Supercommittee Deadline: Seniors Spared from Bulk of Automatic Cuts

Ingram Publishing/Thinkstock(WASHINGTON) -- With less than three days before its midnight deadline, the 12-member Congressional supercommittee is expected to announce on Monday that they did not reach a deal to cut $1.2 trillion from the federal budget over the next 10 years.

While Congressional aides stress a last-minute Hail Mary pass is still possible, deep divides over taxes are still shaking the foundations of any prospective -- and as of now unlikely -- deal.

This race-the-clock game has already played out twice this year, but this time there is no looming government shutdown or imminent debt default.  Instead, there are $1.2 trillion in automatic, across-the-board budget cuts split evenly between defense and domestic spending that will take effect in 2013 in the absence of a deal.

Defense Secretary Leon Panetta explained on Capitol Hill last week that the cuts will be "devastating" to the U.S. military.

The automatic cuts may not be so devastating on the non-defense spending side of the equation, however. Both Medicaid and Social Security are spared from the funding reductions and Medicare cuts are limited to 2 percent of the entitlement program’s budget.

Budget hawks looking for significant spending reductions herald the automatic cuts as real deficit-reduction.  And entitlement program defenders claim the limited cuts -- which include exceptions for the poor and disabled -- are less damaging than any that are likely to come out of a supercommittee deal.

“I think failure is a success,” said Michael Tanner, a senior fellow at the conservative CATO Institute.  “I think that a supercommittee that does not come to an agreement is more likely to achieve real cuts than one that does.”

Under the automatic cuts, or sequestration, Medicare will lose about $123 billion between 2013 and 2021.  But that entire amount will come out of the pockets of doctors and hospitals, not senior citizens.

That doesn’t mean the many-billion-dollar cuts will be painless.

Tanner said that slashing the amount the federal government reimburses health care providers who care for Medicare enrollees could make it more difficult for senior citizens to find doctors that will care for them.

“About 12 percent of physicians already will not accept Medicare patients and a larger number are not accepting new patients,” Tanner said.  “If you further reduce reimbursements, you’re liable to find additional physicians saying it’s just not worth it.”

Copyright 2011 ABC News Radio


5 Tips for Health Care Plan, Medicare Enrollment

PhotoAlto/Frederic Cirou(NEW YORK) -- With the arrival of fall, those Americans fortunate to have health insurance through their employer -- 55.3 percent in 2010 according to Census data -- often re-enroll in their health plans without much thought.

Most of the provisions of President Obama's Patient Protection and Affordable Care Act will not be implemented until 2014, but consumers should be mindful of the re-enrollment period, which occurs in October for many plans.  Nancy Metcalf, senior program editor with Consumer Reports, has these tips for the insured:

1. Watch those deadlines.

"First, don't blow it off," Metcalf said.  The insured are often busy and take for granted their health options.  Around fall, most employers also send out at least an email or two that can disappear in your inbox.

Medicare's open enrollment also ends earlier this year -- Oct. 15 to Dec. 7 -- as opposed to through the end of the year.  Those 65 and older who are eligible should take note in case they want to change their drug plans, for example.

2. Analyze changes in options or personal situation.

Metcalf said provisions of a plan can change, such as a different deductible, or your family situation might have changed, such as a marriage, divorce or a new baby, which can alter the optimal options for you.

3. Consider trade-offs of an HMO, PPO, or POS.

A health maintenance organization (HMO) requires the insured to have care from provider in the plan's network, often restricted to a certain geographical area, and is coordinated by your primary care physician, according to the November issue of Consumer Reports, which ranks health insurance plans.

A preferred provider organization also has provider networks but you can see an in-network specialist without a referral.  The insured can also see a doctor out-of-network but for a higher cost.

Point-of-service, or POS, plans are a hybrid of an HMO and PPO: the insured choose a primary care physician and you need a referral to see a specialist.  As with PPO plans, the insured can see a doctor out of the network.

4. When to choose a high-deductible plan.

Insured usually choose a plan with a high-deductible payment to lower monthly premium costs.  Metcalf said these are usually paired with a health savings account (HSA) with money taken from your paycheck tax-free to pay for certain medical expenses.

Those with lower health care costs may find lower premiums off-set those high-deductible costs. Or those who have a good idea of their costs -- such as planned vision or dental work -- can usually calculate how much their costs will be within their health insurance plan.  But that takes requires detailed planning, so start talking to your doctor, dentist and optometrist now.

5. Learn about the healthcare act's provisions that have taken effect.

As of now, only a few healthcare provisions have taken effect.  First, dependents up to age 26 can remain on their parents' plans regardless of whether they live in the same household, or even if those young adult children are married.  About 1.2 million people have taken advantage of that benefit this year, according to Consumer Reports.

Other provisions that are already in effect are cheaper drugs through Medicare and free preventative care through insurance plans.

Metcalf said many people have misconceptions about the embattled healthcare act, such as what it provides and when provisions will be implemented.  She suggests visiting for more details.

Copyright 2011 ABC News Radio


Stocks Down Amid Worries about Social Security and Medicare

Comstock/Thinkstock(NEW YORK) -- Concerns over Social Security and Medicare helped push the markets down to end the week.

The Dow lost 100 points, the Nasdaq gave up 35 and the S&P closed down 11 points.

Financial planners say if you're not saving for your retirement, now is the time to begin.  The latest government checkup shows Social Security will run out of money by 2036, a year ahead of schedule. Medicare could go broke by 2024, five years earlier than expected.

Copyright 2011 ABC News Radio


Medicare and Social Security Will Run out Sooner Than Thought

Creatas Images/Thinkstock(WASHINGTON) -- The country's benefit programs for the elderly, Medicare and Social Security, will be exhausted sooner than thought due to the economic downturn, The Social Security and Medicare Boards of Trustees said Friday.

Medicare's Hospital Insurance Fund is projected to exhaust its funds in 2024, five years sooner than last year's estimate, and Social Security will be exhausted in 2036, a year earlier than previously thought, the trustees announced.

"Social Security and Medicare benefits are secure today, but reform will be needed so they will be there for current and future retirees," Treasury Secretary Tim Geithner told reporters at a Treasury Department news conference.

Geithner said the report underscores "the need to act sooner rather than later" to make reforms to entitlement programs. 

The report also indicates that Social Security ran a deficit last year for the first time since 1983, and it's projected to run deficits going forward. 

The funds won't go totally bankrupt by the years the trustees projected they would be exhausted, but the programs will no longer be able to pay full benefits.  Social Security would pay out roughly 75 percent of benefits through 2085, Medicare 90 percent in 2024. 

The trustees think the health care overhaul signed by President Obama has given Medicare a longer life.  Health and Human Services Secretary Kathleen Sebelius said there's no question the health care law has strengthened Medicare.  She said the change in the projection for Medicare's Hospital Insurance Fund was due in large part to lower payroll tax revenues caused by the slower than expected economic recovery. But, Sebelius said, "Having the Affordable Health Care Act in place is the main reason those projections aren't worse." 

Copyright 2011 ABC News Radio


Fact Check: Hard Steps Ahead to Reduce the Federal Deficit

Photo Courtesy - Getty Images(WASHINGTON) -- A presidential commission had a wakeup call for the nation Wednesday, releasing a document that outlines the tough choices the country faces to reel in its runaway debt, now totaling almost $14 trillion.

Two of the toughest choices involve Social Security and Medicare, programs that have long been considered so untouchable that they're known as the third rail of American politics.

So what are the facts on how the deficit can actually be reduced? On Wednesday, ABC News spoke to economists who have advised both Republican and Democratic presidents, asking whether it's possible to reduce the deficit without touching those big-ticket items.

When it comes to Social Security, the commission recommends slowly raising the retirement age from 66 to 69 by the year 2075. Commission members would also reduce benefits from the program.

As unpopular as that might seem, is there a way to avoid changes to Social Security and still fix the deficit?

"No," said Gregory Mankiw, the former chairman of President Bush's Council of Economic Advisors. "Social Security is part of the problem and it has to be addressed."

Mankiw believes that the commission's bipartisan proposal makes sense, and so does Jeff Frankel, who held the same chairmanship during the Clinton Administration.

Economists say that you have to look at the pie chart showing the nation's spending. Social Security consumes some 20 percent of the federal budget, and Medicare takes a bite nearly as big.

Experts told us there's simply no way to rein in the deficit without touching Medicare. The panel's tough guidelines call for a freeze on Medicare payments to doctors through 2020.

"Medicare is part of the problem, an even bigger part of the problem than Social Security," said Mankiw, pointing out the aging baby boomers who will cause healthcare spending to skyrocket in coming years.

Clinton's advisor, Frankel, was again in agreement.

"We have no choice," he said.

Lastly, there's the issue of defense spending. It accounts for roughly 20 percent of the federal budget and has long been considered untouchable by many. But according to our economists from both sides, it must be cut to reduce the overall deficit.

The panel's suggestions may be tough, but according to these men who served Bush and Clinton, they're the only only option.

Copyright 2010 ABC News Radio

ABC News Radio