Presented by Leonard Berthelsen
It was only a matter of time before the effect of the aging of Baby Boomers hit the Federal & State budgets. With less than 10% of this class of folks owning long-term care insurance, it has become necessary for the Federal Medicare and Medicaid system to review their budgets but also review what they are approving for payment.
The big challenge that the federal government faced when trying to find ways to rein in some of these costs was that they were being looked at as being a heartless bureaucratic entity. By putting some of the burden back on the consumer for payment of services, they are scrutinizing those services and in many cases simply saying no to services altogether. That hasn’t set well with this generation of folks. The government was accused of developing “death panels”, as they were called, to try to rein in some of these expenses by considering the likelihood of patients’ recovery and ongoing quality of life. Medicare & Medicaid are jointly spending trillions of dollars every year and there is no light at the end of this tunnel. As a class of people, we are living longer, yet dying slower with health issues that are expensive to treat.
It would be great if our government would pay whatever was needed to provide medical services for anything and everything that could medically go wrong. However, we know that is not practical or sustainable. Yet we still want the best care, by the best trained medical staff and at the lowest cost. Somewhere, something had to give.
The Medicare and Medicaid system are in fact taking a hard look at rehab invoices and home health care bills. If the facility or provider is not following the letter of the rule, then Medicare and Medicaid will choose not to pay for the services. It then becomes the responsibility of the patient to pay out of pocket for this care. This could be several hundred dollars to several thousand. Medicare is allowing hospitals to admit recipients for non-emergency admissions under the term “observation” instead of full admission, thus putting more of a financial burden on the patient.
What can you do to help your clients? Certainly, long-term care insurance will help tremendously with the outpatient side of the medical expenses. Also such plans as Recovery Care, Hospital Confinement & Home Care coverage will fill in the voids that we are seeing being created by both Medicare and Medicaid as they struggle to make their budgets work. Having the patient be more in-tune with what is actually being charged for those services certainly makes the government feel like they are being better stewards of our tax dollars than what we have seen from them in the past.