Medicare: Better, smarter, safer
Name
Title
Organization
Reasons for change
The status quo was unsustainable:

Health insurance premiums for family coverage at large
companies rose 114 percent from 2000 to 2010
 At small businesses, premiums increased 85 percent

17.9 percent of the nation’s entire economic output is tied
up in health care

The share of Americans under 65 covered by job-based
health insurance had fallen for nine years in a row, falling to
59 percent in 2009

62 percent of all personal bankruptcies are at least
partly the result of medical expenses
High Costs, Low Quality

In the United States,
the cost of health
care is too high;
quality is too low

Nations as diverse
as Japan, Spain,
Malta and New
Zealand spend less
than half as much as
the U.S., but have
better outcomes
Source: University of California Atlas of Global Inequality:
Health Care Spending http://ucatlas.ucsc.edu/spend.php
Affordable Care Act at a glance

Health reform seeks to:
 improve the quality of health care
 lower the cost of medical care
 increase access to that care
 expand the base of people contributing to the system
 fill gaps created by the old system

Virtually everyone plays a role
 Large employers are required to contribute
 Workers are required to contribute
 32 million newly insured lower the average cost
 Doctors and hospitals are required to improve care
 New programs control rising costs and improve delivery of care
So, What Happens to Medicare?
Improving Medicare coverage

Preventive care carries no co-payments or
deductibles beginning in 2011
This includes free:
 annual physicals
 colonoscopies
 mammograms
 Free screenings for:
 osteoporosis
 diabetes
high blood pressure
obesity
depression
anemia
Lowering costs for seniors
 Savings on prescription drugs:
 In 2013, Medicare patients, once they hit the coverage
gap, get a discount of:
 52.5 percent off brand-name drugs
 21 percent off generic drugs
 This is an increase from the 2012
discount of 50 percent for brand
name and 14 percent on generics
 The discounts rise every year until complete
coverage begins in 2020
Helping seniors, improving lives
Prescription drugs:

In 2011, the drug discount meant that 3.49 million seniors
saved an average of $605 each – more than $2.1 billion in all
 Seniors in Missouri and Kansas saved more than $70 million
 In Missouri, 78,585 seniors saved a total of $46.76 million
 In Kansas, 38,692 seniors saved a total of $23.44 million
Preventive Care:
 In 2011, more than 32.5 million seniors
nationwide received at least one free
preventive health service
 In Missouri, 729,809 seniors received
a free preventive service
 In Kansas, 313,085 seniors received a
free preventive service
Making Medicare better

Quality improvements:
 Improved coordination of care, which has been found to lower
relapse rates and overall costs
 Paying doctors according to quality, not volume of procedures
 Incentives for hospitals to improve care and reduce infection rates

Expanded enrollment period in the fall

Expanded counseling and enrollment assistance
through grants for:
 Area Agencies on Aging
 State Health Insurance Assistance Programs
 Aging and Disability Resource Centers
 $45 million extends funding provided by previous laws
Making Medicare safer

High-quality care is cheaper than bad care. One
example: Hospitals
 Hospital discharges generate more complaints than
any other aspect of Medicare
 Expenditures related to re-admission – the “roundtrip to
the hospital” – total more than $17 billion a year
 Geographic Variation – Medicare 30-Day Hospital
Readmissions as a percentage of admissions:
 All states’ average – 17.5%
 Iowa average – 15.9%
 Missouri average – 18.3%
 Kansas average – 19.2%
 Bottom five states’ average – 21.8%

(Commonwealth Fund State Scorecard on Health system Performance, 2009)
Making Medicare safer

Medicare in 2011 launched
Partnership for Patients, a
groundbreaking initiative to
improve medical care
 A $1 billion effort to improve
care
 Partnership for Patients has two major goals:
 Reduce preventable hospital-acquired conditions by 40
percent
 Reduce hospital readmissions by 20 percent by reducing
preventable complications during the transition from one care
setting to the next
Making Medicare safer

The care transition program seeks to:
 improve transitions from hospital to other care settings
 improve quality of care at each stage
 reduce readmissions for high risk beneficiaries
 document savings to Medicare

Community organizations will work with
hospitals to improve after-discharge care
 Focus will be on patients with:
 multiple chronic conditions
 depression
 cognitive impairments
Making Medicare safer
 Future hospital payments will be based on
treatments that work
Begins in October 2012
 Hospitals will be penalized
when patients are re-admitted
within 30 days of discharge for
a condition that could have
been prevented
 Doctors’ fees will be based partly on keeping
patients healthy and how well their patients recover
from illness or injury
Begins in January 2015
Making Medicare smarter

Total savings from new initiatives are projected to
be more than $600 billion over 10 years
 Medicare spending will continue to
rise, but the growth rate will drop
through:
 Phasing out the extra payments to
insurers for Medicare Advantage
 More aggressive negotiation with suppliers
 More competitive bids on medical devices and drugs
 A genuine focus on reducing fraud
These changes extend the life of the Medicare trust fund by 8 years
Groups Left Behind

Early retirees and their spouses

People with existing health conditions

Small businesses and their employees

Young adults

Children
Expanding Access to Care

Small businesses and their employees
 Small employers get tax credits worth up to 35% of their
employee health insurance costs. The credit rises to 50% in 2014
 Nonprofits can get a credit of up to 25%, rising to 35% in 2014
 Beginning in 2014, employees without health coverage through their
jobs will receive tax credits to help them pay for health insurance

Young adults
 Health insurance policies must now offer coverage to children
under 26, if the plan covers dependents
 This is a big help to recent graduates and young adults in entry-level
jobs
Expanding access to care
 The Affordable Care Act provides $11 Billion for
community health centers over the next 5 years
 $1.5 billion for expansion and
renovation projects
 $9.5 billion for new health centers
in underserved areas and
expansion of primary care services
 $1.5 billion for National Health Service Corps
 These scholarship programs repay student loans for
providers who agree to work in underserved areas
 Since 2008, the number of primary care providers has grown:
 by 353 in Missouri, the third most in the entire nation
 by 94 in Kansas, 25th most in the nation
 The goal: 16,000 new primary care providers nationwide by 2016
Fighting Fraud

The law boosts spending on investigations by $350 million

The new emphasis is already paying off:
 In fiscal year 2009, anti-fraud efforts recovered:
 $2.51 billion for Medicare, up 29 percent from 2008

$441 million for Medicaid, up 28 percent
 In 2010 and again in 2011, total recoveries for Medicare and
Medicaid rose to more than $4 billion
 In 2012, fraud recoveries hit a record $4.2 billion
 Whistle-blower lawsuits recovered record amounts for two years
in a row:
 $2.8 billion in 2011
 $2.5 billion in 2010
Fighting Fraud – seniors can help

Beefing up Senior Medicare Patrols
 These groups – we call them the “fraud squads” – are credited with
saving taxpayers more than $100 million since 1997
 The program hopes to double the number of Senior Medicare
Patrols to 10,000 members
 These volunteers show seniors and their caregivers how to:





scrutinize Medicare bills for inflated charges
report services that were billed, but never provided
protect their identity
avoid getting taken by scammers
To become a volunteer:
In Missouri:
In Kansas:
Rona McNally
SMP Project Manager
Care Connection for Aging Services
Warrensburg, MO
Direct:
660-747-3107
Toll Free: 1-888-515-6565
Kelly Loeb
Coordinator of Volunteers
Kansas Dept. of Aging & Disability Services
Topeka, KS
Direct:
785-296-0377
Toll Free: 1-800-860-5260
Simply Awesome Consumer Site:
www.Healthcare.gov
New one-stop
consumer site for
information on
insurance options
Details about the
new consumer
protections under the
Affordable Care Act
Information at your
finger tips allows you
to shop for insurance
based on benefits,
prices, insurer ratings
Questions?
How the Doughnut Hole Works
For 2013:
 You pay the first $325 of your drug costs

After reaching that amount, you pay 25% of the cost of your
drugs, while the Part D plan pays the rest, until the total drug
costs for you and the plan reach $2,970

At that point, you hit the coverage gap referred to as the
“doughnut hole.” You are responsible for the full cost of your
drugs for the next $3,764
 That amount will bring you to the yearly out-of-pocket spending
maximum of $4,750

After reaching this total, you are responsible only for a small
amount of the cost, usually 5% of the cost of your drugs