Why January Wasn't the Cruelest Month for Obamacare

January looked like a disaster in the making for the Affordable Care Act. From the stunted opening of Healthcare.gov on Oct. 1 through the end of December, 2.2 million Americans selected private health plans on the new marketplace (with policies starting on Jan. 1). Between spotty data files from the troubled website and last-minute deadline changes that let some people pay premiums after their policies started, people in the health-care world had braced for chaos when the newly insured showed up at doctors’ offices and pharmacy counters. “It’s going to be a messy January,” one insurance industry leader privately predicted.

That didn’t happen. While there were scattered, anecdotal reports of people having trouble accessing care, widespread problems haven’t materialized. “The month of January has been relatively quiet in our pharmacies in terms of any ACA-related issues,” Mike DeAngelis, a spokesman for CVS Caremark (CVS), wrote in an e-mail. The company operates more than 7,600 retail drug stores.

If there had been big problems, you would have heard about it. People unable to use Obamacare benefits would have joined those who couldn’t get on the website and those who had their old health plans canceled as the subjects of hundreds of news stories adding to the public’s increasingly negative view of the Affordable Care Act.

Compare the first weeks of Obamacare benefits with the Medicare drug benefit that started on Jan. 1, 2006. Two weeks in, President George W. Bush ordered insurers to pay for emergency supplies of prescription drugs to patients whose coverage couldn’t be verified at the pharmacy. States declared public health emergencies and shouldered the cost of drug claims while Medicare sorted out the mess. Bush didn’t mention the program in his State of the Union address that year.

Insurers, pharmacies, and doctors may have learned from that difficult transition and been better prepared for Obamacare problems. “Health plans have a lot of experience in implementing new reforms,” says Robert Zirkelbach, a spokesman for insurance industry group America’s Health Insurance Plans.

The problems with Healthcare.gov aren’t fully repaired. Some enrollment files the site sends to insurance companies still have “missing and inaccurate information” that has to be corrected by hand, Zirkelbach says. “There’s the back-end technical problems that still exist. There’s systems that still haven’t been built.” Insurance companies have added staff and call centers to deal with the headaches.

Drugstore chains including CVS and Walgreen (WAG), as well as independent pharmacists, offered to renew prescriptions even if patients hadn’t gotten their new insurance cards yet. The problems that had surfaced at Walgreen are tapering off, according to spokesman Jim Cohn. While he declined to say how many cases of mix-ups Walgreen saw at its 8,200 pharmacies, Cohn wrote in an e-mail that “we’re beginning to see fewer inquiries and situations with people having difficulty accessing benefits as the systems and processes get into place.”

It’s normally not news when a government program performs as intended—reporters don’t cover all the flights that land safely—but after the rough first three months of Healthcare.gov, the disaster that didn’t happen in January is worth noting.

Source: BusinessWeek.com

On February 4, 2014 at 10:30 AM, attorney Inna Fershteyn will appear on RTN/WMNB

On February 4, 2014 at 10:30 AM, attorney Inna Fershteyn will appear on RTN/WMNB (Russian Television Network) channel in Alexander Grant ‘s show “KONTAKT”. She will speak about Medicaid Fraud Investigations and will cover the most frequently asked questions in connection with both types of Medicaid Fraud. Also she will announce a FREE Medicaid Fraud Seminar that she will hold on February 13, 2014, where she will talk about the Medicaid Fraud and will answer the questions. 

FREE Medicaid Fraud Seminar

Law Offices of Inna Fershteyn & Associates, P.C.

FREE Medicaid Fraud Seminar

Feb 13, 2014 at 6:30 PM-7:30 PM
1517 Voorhies Avenue, Suite 4
Brooklyn, NY 11235

To Register Call:
718-333-2394

Pitfalls of Medicaid, long-term care planning

Health care costs continue to be a top retirement concern, yet few Americans know about their options and the potential pitfalls.

Instead, there are many misconceptions about long-term care.

A case in point: Currently about 42% of financial advisers say their clients are considering giving away their assets to their children so they can qualify for Medicaid and avoid paying for a nursing home, according to a survey of financial advisers by Nationwide Financial released Friday.

"Medicaid was created to help low-income Americans and not to supplement middle-class and affluent families," says John Carter, president of distribution and sales for National Financial.

It's not against the law to give away assets to qualify for Medicaid, and Carter says there are some circumstances when such steps are appropriate.

But many Americans do not understand the consequences of relying on Medicaid such as the fact they will be giving up control of their long-term care planning. That flies in the face of another finding of the Nationwide Financial survey: Many clients tell their advisers that maintaining control is the most important aspect of retirement health care planning.

"I always tell parents that if you give the money to your kids you have to understand that you are irrevocably parting with it and you may never see it again," says K. Gabriel Heiser, an elder law attorney and author of How to Protect Your Family's Assets From Devastating Nursing Home Cost: Medicaid Secrets.

And they must comply with Medicaid rules. For example, the nursing home they would like to stay in may not accept Medicaid patients. Although Medicaid programs vary by state, few will pay for home health care. And a third of doctors do not accept Medicaid patients, according to an August study by Health Affairs.

Married couples need to know that Medicaid rules provide some protection to the spouse who is healthy and still at home while their partner is in a nursing home. Among other things, they can keep a certain amount of money and their home. But it's a modest amount and may not provide them the lifestyle they expect, Carter says.

Options besides giving away assets to qualify for Medicaid include:

• Paying your own way. Wealthy people who want to retain control of their finances may decide to foot the bill themselves. Experts say that if someone has several million dollars in assets, they can afford to pay for nursing home care given that the average stay is less than three years.

"If you've got the money to pay for it, then that's where it should go," says Jim Miller, the Savvy Senior syndicated columnist. "If not, they are using the system to protect their money, pass it on to their kids, and then the taxpayers pick up the cost."

• Buying long-term care insurance. These plans often provide other options, such as home health care. The one drawback of this is somebody might put a lot of their savings into something that they may never need.

However, some insurance companies can add a long-term care insurance rider to life insurance policies. Then if the policyholder never needs long-term care they still can provide income to their heirs.

• Set up a trust. Those who want to protect their assets also can consider setting up an irrevocable trust instead of giving money to their children. And there are some irrevocable Medicaid annuities that provide an income stream.

Long-term care planning is clearly complicated and it's not easy to find the best option. Although Heiser's book helps consumers understand the rules, even he says that "it is definitely not a do-it-yourself project."

Source: USAToday.com
 

Government Programs Have Become One Big Scammer Fraud Fest

Amongst all the polls about how various groups view their prospects going into 2014, I’d like to see one polling people who habitually defraud the government.  I bet it would be off-the-charts positive, as they look for a banner scammer year.

 

We are being inundated by news stories of fraud perpetrated against numerous government programs.  The feds themselves put Medicare and Medicaid fraud at approaching 10 percent of the programs’ budgets, or about $100 billion a year for the two programs.  And I’m betting that’s on the low side.

And yet instead of solving this problem, President Obama harangues the country, and especially Republicans, for being unwilling to throw even more money at the federal government’s Fraud Fest.

Let’s review some of recent stories.

Medicaid — There’s so many Medicaid fraud stories it’s hard to choose the “best.”  Perhaps the most egregious, though far from being the most expensive, is a December Wall Street Journal story explaining that “the Manhattan U.S. attorney accused 49 current and former Russian diplomats of participating in an alleged scheme that garnered nearly $1.5 million in fraudulent Medicaid benefits.”

The diplomats are charged with underreporting their incomes so they could qualify for Medicaid.  The story says that over the last decade 92 percent of New York-based Russian diplomats’ childbirths were paid for by Medicaid, a program created to cover poor U.S. citizens.  So highly paid foreign diplomats are allegedly having babies at U.S. taxpayer expense.

Several years ago the New York Times ran a series on Medicaid fraud wherein one New York City official estimated that about 40 percent of the city’s Medicaid expenses were fraudulent. And yet the problem still isn’t under control.

Long Term Care — While we’re on Medicaid fraud, let’s include Medicaid’s program to cover poor seniors in nursing homes—at least, they’re supposed to be poor.  American Enterprise Institute adjunct scholar Mark Warshawsky recently wrote in the WSJ that Medicaid pays for about two-thirds of the elderly’s long-term care costs.  That money is meant for poor seniors, but many seniors in nursing homes have significant assets in homes—up to $802,000 worth in some states—cars and savings.  Indeed, there is a legal specialty known as “elder care attorneys” who help families hide grandma’s assets so she can qualify for Medicaid.

Medicare — Last week the Miami Herald ran a story about a South Florida woman found guilty of Medicare scams costing taxpayers $20 million.  In December a Houston doctor was charged with defrauding Medicare of $158 million, involving false claims for mental health treatments.

Earlier stories explain that Italian, Russian and Nigerian mobsters have moved in to Medicare fraud because it’s so easy, lucrative and, if you get caught, lighter jail time.  That’s why when CBS’s 60 Minutes covered Medicare fraud a few years ago one of the criminals who had been caught boasted he had been making $20,000, $30,000, $40,000 a day!

Unemployment — Obama and the Democrats are pushing hard for an extension of long-term unemployment benefits, making one wonder if they just like to throw away taxpayers’ dollars.

The U.S. Department of Labor recently released a report claiming that there was some $7.7 billion in “improper” unemployment benefit payments in 2013.  Among the most fraud-ridden states, Nebraska wins with an 18 percent improper payment rate, followed by North Carolina (17.5%), New Jersey and Louisiana (16%), Maine and Ohio (14%).

Why are Republicans and conservatives heartless for not wanting to expand these fraud-ridden programs, while Democrats are compassionate for letting your hard-earned tax dollars be stolen by the fraudsters?

Source: Forbes.com