Medicare Monitor

Medicare Monitor

The Palm Beach Post's veteran Washington correspondent, Larry Lipman, tracks policy makers and interest groups who are shaping the future of the federal health insurance program for the elderly.

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Medicare is the federal health care system that covers about 36 million people age 65 and older, plus 7 million disabled. It has four parts:

Part A Covers inpatient hospital care as well as nursing home, home health and hospice care. Nearly all elderly and disabled Americans qualify for Part A coverage.
Financed by a 2.9 percent payroll tax divided equally between employees and employers.

Part B Covers outpatient care, doctor’s services, durable medical equipment, home health visits and preventive care. Part B coverage is voluntary, but roughly 40 million are enrolled.
Financed by beneficiary premiums and federal general revenue. Current monthly premiums are $93.50. Starting this year, individuals whose taxable income is more than $80,000 will pay a higher premium.

Part C Medicare Advantage managed care plans provide health care normally covered by Medicare Parts A and B. They may also provide some other benefits, including prescription drugs, not covered by traditional Medicare. Oart C is voluntary; about 7 million beneficiaries are enrolled.
Financed by Medicare and beneficiary premiums, which vary among plans.

Part D Medicare prescription drug plans come in two types, those that just cover prescription drugs and those that cover drugs as part of a broader managed care benefit. Part D is voluntary. About 9.2 million beneficiaries are in stand-alone drug plans and about 5.1 million are in managed care drug plans.
The plans are private and financed by Medicare and beneficiary premiums, which vary among plans.
-- Larry Lipman

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The entry titled "Lawmakers: Hold off on doctor pay cut," and any of the comments about it.

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Home > Medicare Monitor > Archives > 2008 > February > 20 > Entry

Lawmakers: Hold off on doctor pay cut

By Larry Lipman | Wednesday, February 20, 2008, 03:12 PM

Two Georgia congressman have introduced bipartisan legislation to further delay the impending Medicare pay cut for doctors by 18 months, from July 1 until Jan. 1, 2010.

Reps. Tom Price, a Republican, and David Scott, a Democrat, said the delay would give Congress more time to address the thorny reimbursement issue. The American Medical Association has repeatedly warned that the scheduled pay cuts, which Congress has repeatedly delayed, could jeopardize patients’ access to physicians.

“The current Medicare reimbursement process is fatally flawed,” Price said. “The dangerous pending reimbursement cuts will discourage doctors from participating in Medicare and threaten quality health care for our seniors. We must find a sustainable, long-term solution that ensures Medicare beneficiaries will not continue to be put at risk each year. In the meantime, it is necessary to stop unrealistic payment levels in order to ensure the availability of accessible, quality health care to our nation’s seniors.”

Scott said Congress “needs to address long-term action,” because the formula used in setting doctor pay rates “will only further mandate more fee cuts in the foreseeable future.

“Medicare payments only cover about 65 percent of the actual cost of providing patient services. While I expect doctors to participate in quality improvement measures and invest in health information technology, it doesn’t make sense to further burden physicians with these provisions as they certainly can not bear these additional costs without positive payment updates.”

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