Money Matters: 2017 brings Medicare Price Changes

cardBy Nathaniel Sillin

If you’re eligible for Medicare, or will be in the coming year, there are a few changes you should know about for 2017.

An increase in the Department of Labor’s Consumer Price Index (CPI) means there’ll be an increase in Social Security benefits and Medicare Part B premiums. For most recipients the increases almost offset each other, but those who aren’t covered by the “hold harmless” provision (about 30 percent of recipients) face a larger Part B premium increase.

These changes, along with several others, will go into effect soon and you should consider how they could affect your budget.

A slight increase in your Social Security benefits. Since 1975, Social Security benefits have an automatic cost-of-living adjustment (COLA). The adjustment depends on the CPI and helps keep your benefits in line with the rising cost of goods.

There wasn’t a COLA for 2016 benefits, but there is a .3 percent adjustment for next year. Meaning, you’ll get an additional $3 per $1,000 you receive in benefits. The estimated average monthly benefit for all retired workers is expected to increase $5, from $1,355 to $1,360.

Medicare Part B premiums will also rise. The COLA also affects Medicare Part B premiums, the part of Medicare that covers some types of procedures and medical equipment. However, for about 70 percent of Medicare recipients, the Social Security Act’s “hold harmless” provision prohibits an increase to Medicare B premiums of more than the previous year’s COLA adjustment.

According to the Centers for Medicare and Medicaid Services, held harmless recipients will pay $109 per month, an increase of $4.10.

If you aren’t held harmless, Part B premiums could increase by about 10 percent. The remaining 30 percent of Social Security beneficiaries will have their Part B premium increase by about 10 percent. You could fall into the non-held-harmless group if you:

  • Are a new enrollee
  • Enrolled in Medicare but don’t receive Social Security benefits
  • Get billed directly for Medicare Part B
  • Receive Medicare and Medicaid benefits and your state Medicaid programs pay your Part B premium
  • Are a high-income earner subject to an income-adjusted premium

For the non-held-harmless group, the premium depends on the recipient’s (or couple’s when filing a joint tax return) adjusted gross income (AGI).

  • The lowest monthly premium, for individuals who have an AGI of $85,000 or less ($170,000 for couples), will increase from $121.80 to $134 a month per person.
  • On the high end, for recipients with an AGI over $214,000 ($428,000 for couples), the monthly premium will increase from $389.80 to $428.60 per person.

Medicare Part A and B deductibles will also increase. Most people don’t have to pay Medicare Part A premiums, but you could still have to pay a deductible or coinsurance for some Part A benefits.

  • The deductible for inpatient hospital coverage, which helps cover the first 60 days of care, will increase from $1,288 to $1,316 per benefit period.
  • Daily coinsurance for the 61st through 90th day of treatment will increase from $322 to $329.
  • Daily coinsurance for day 91 on will rise from $644 to $658.
  • Each day past day 90 counts towards your lifetime reserve. You have a maximum of 60 lifetime reserve days; after which you could be responsible for all costs.
  • Skilled nursing facility care is completely covered for your first 20 days.
  • Daily coinsurance for day 21 to 100 of skilled nursing care will increase to $164.50.
  • You could be responsible for all costs beyond day 100.

The Part B annual deductible will also increase, from $166 to $183. Generally, after you’ve met your deductible, you’ll pay 20 percent of Medicare-approved costs for services covered by Part B.

Bottom line: Social Security benefits, Medicare Part B premiums and Part A and B deductibles and coinsurance will increase in 2017. Whether you’re held harmless or not, take steps to understand which changes could affect you and alter your budget accordingly.

Money Matters: How to Research and Reduce Healthcare Costs

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By Nathaniel Sillin

Whether you’re planning a future procedure or navigating care after a sudden illness or accident, smart consumers have a plan in place to avoid hidden costs and billing errors common to our ever-changing healthcare system. You should too.

The Affordable Care Act (ACA) made it possible for all Americans to get some form of healthcare coverage regardless of their medical history. That’s the good news. The bad news is that everyone’s personal health circumstances and solutions are different, and we’re still far away from the day when the coverage we buy – either individually or through our employers – can prevent us from getting unexpected bills for services and procedures our insurer didn’t cover or errors made in the billing process.

It’s also important to know that many health insurers are adjusting to the reality of universal coverage by narrowing the assortment of doctors in their networks, leaving more patients at risk of “surprise bills if they are treated by practitioners outside their insurer’s network.

There are some helpful resources – both public and private  – which have emerged that price health procedures. Using those resources can help avoid some major out-of-pocket healthcare expenses. It’s also essential to determine what practitioners may be in or out of network, particularly if it’s an emergency.

So what can you do to prevent these unexpected health costs? If you are not on Medicare, which tends to have more standardized pricing and coverage, you need to question practitioners (or their billing departments) and price-comparing procedures the way you would any major purchase. Depending on your local medical resources, you may have the option to conduct your research online. Here are some ways to begin.

Know how you’re covered for both emergencies and non-emergencies. It’s easier to plan for a hip replacement you’ll need in six months than for emergency surgery after an accident or sudden illness, but it’s important to think through how your coverage works in both situations:

  • 178581-ambulance.jpgEmergency: Emergencies are a challenge to price because it’s tough to know which practitioners and services you’ll actually need. The key is to make a plan for emergencies. Speak to your insurer now – and consult your primary care physician – to confirm that you have a good range of in-network emergency doctors at the hospital of your choice. If not, you might want to think about switching plans during your next enrollment period. Put an easy-to-find “in case of emergency” card in your wallet next to your health insurance card that makes your preferred hospital visible to first responders or other helpers. Also, list your primary care doctor’s and your health care power of attorney‘s contact information. Finally, make sure the person you designate as your health care power of attorney has access to your insurance and physician network information so he or she can guide your care more affordably if you’re incapacitated.
  • Non-emergency: If your doctor is recommending a particular in-hospital or outpatient procedure in the coming weeks or months, you’ve got time to plan, so do it. Query your physician or his or her billing department about the cost of the procedure and what other practitioners (such as an anesthesiologist) might be involved. Then spend equal time speaking with your insurer about what you’ve learned and how extensively the procedure in question will be covered. Make sure you understand if your insurer covers the procedure on an inpatient (hospital) or outpatient (office) basis – some insurers are reportedly cutting back on outpatient coverage.

Know your deductible. The latest annual Kaiser Foundation employer health benefits survey indicated some whopping figures for health care deductibles – the out-of-pocket total you have to pay before the bulk of your health coverage kicks in. For example, if you have a $3,000 deductible that you haven’t touched this year, that’s the initial out-of-pocket amount you’re going to have to pay for any big procedure. Keep that figure in mind as you continue your research on medical options. That’s why it’s important to keep such sb10067502k-001-F.jpgamounts in an emergency fund or, if you have the option, set aside in a health savings account where you can keep funds not only for the deductible, but for other potential out-of-pocket health costs.

Review bills closely. One recent study has reported significant errors in medical bills, particularly for hospital stays. Keep in mind that the price-comparison exercise doesn’t stop on the way in to a procedure. You need to keep an eye on pre- and post-procedure bills from practitioners, hospitals and your health insurer for accuracy. If you see an error, contact the appropriate party or parties immediately to correct the problem.

Bottom line: There are very few industries going through as much change as healthcare. Universal coverage is good, but it’s important to know exactly what it pays for before you need it. Set aside time to think through your health issues and do your research to help reduce healthcare costs that can impact your overall budget. Learning to save money now can preserve your budget later.

 

State Rep. to host Medicare advisers in district offices

farinaState Rep. Frank Farina, D-Lackawanna, said he will continue to host Medicare counselor advisers at both of his district offices on a regular, monthly basis.

Trained staff and volunteers from APPRISE, the State Health Insurance Assistance Program, will be in Farina’s Eynon office, 423 Main St., from 1 p.m. to 4 p.m. the first and third Monday of each month. The next visits are Monday, April 4 and 18.

Farina’s Dunmore office, 1414 Monroe Ave., will host identical meetings on the first and third Wednesday of each month. The dates for the meetings are April 6 and 20.

The APPRISE counselors will be able to answer questions regarding Medicare, Medicaid, Medigap and long-term care insurance, as well as preventive medicine and assist with paperwork related to Medicare appeals.

For more information on these meetings, contact either of Farina’s two local constituent service offices: at 423 Main St., Eynon, phone 570-876-1111 and at 1414 Monroe Ave., Dunmore, phone 570-342-2710.