Houston Home Insurance

Medicare alert: Nursing home payment cuts begin Oct. 1

Reader Alert: Oct. 1 is the day that both the Medicare beneficiary and Medicare providers have been dreading.

No one knows why they were chosen, but nursing homes are among the first to feel the pinch of this economic recession. Medicare is cutting 11 percent beginning Oct. 1 from payments to nursing homes.

According to the AP wire service article in the September 2011 edition of the Senior News, “the nursing home industry is warning that quality will be compromised”. I have talked with many in the skilled nursing community who are seriously concerned about additional cuts and being sure that their patients are taken care of with fewer employees. I said in my article from Aug. 4 that I would report any changes to Medicare. Here we go.

Dear Toni:

Can you explain what “Original Medicare” is? I thought Medicare was Medicare. I am getting so much advertising that I am just confused. Thank you, Grace, from SW Houston

The most popular question I get each week is: What is “Original Medicare”? Since 10,000 people are turning 65 each day for the next 19 years, I have a feeling a few people in this area are turning 65.

You cannot compare Medicare to your old group health insurance with all of the co-pays, deductibles or out of pocket expenses that you are accustomed to. Take that knowledge out of your brain and put it in File 13 or the old trashcan, because you will never use it again. Your health insurance experience as you know it will never be the same.

“Original” or traditional Medicare consists of Parts A and B only and not parts C or D. As long as your doctor, health care provider or facility accepts “Original Medicare” or traditional Medicare, then you can use them. Ask your medical provider if they accept Medicare Assignment. There is not a network with “Original Medicare”. See pages 51-56 of the 2011 Medicare & You handbook for additional information about “Original Medicare”.

Medicare Part A (hospital insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice or if you receive home health care. The Part A deductible for 2011 is $1,132 and can be used six times in a year. Yes, Part A has a benefit period of 60 days, so every 60 days, there is a new deductible of $1,132. Skilled nursing has a $0 co-pay for days 1-20, but from days 21-100, there is $141.50 co-pay per day. After day 100, you pay all of the cost for additional days. See page 136 of the 2011 Medicare & You handbook for everything that is covered under Part A.

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