Medicare proposes covering voluntary end-of-life counseling

On July 8 Medicare proposed that beginning in 2016, it will pay doctors to discuss end-of-life care options with patients who request such counseling. Although many private insurance plans already provide coverage for this purpose, the proposal is a game-changer because the vast majority of people who seek counseling are older patients covered by Medicare.

A 2014 report from the Institute of Medicine, Dying in America, documents what is commonly known: Many people spend their last days unnecessarily uncomfortable, undergoing painful and invasive treatments that fail to extend life. Medicare's proposal, contend supporters such as the American Medical Association and the AARP, would educate patients and families about the full spectrum of  options, from palliative care to more rigorous life-extending options.  

The proposal has its critics, too. The National Right to Life organization, for example, has indicated that unmonitored counseling sessions could push people into foregoing life-saving treatments. This echoes the controversy that erupted over a similar proposal that was included in the first iteration of the Affordable Care Act. At that time, Sarah Palin and others characterized Medicare-funded patient-doctor discussions about end-of-life care as a precursor to "death panels." Ultimately, coverage for end-of-life counseling was scrubbed from the legislation.

As someone who makes his living helping people plan for the future and maintain their independence, I think everyone has the right to make informed choices about how they live their lives and manage their health care. Voluntary discussions between doctors and patients can only lead to more informed choices.

Comment period for the proposal closes on Sept. 8, 2015. Coverage would begin in 2016. You can read the proposal here.

Alert to Medicare beneficiaries: Ignore scammers pitching marketplace plans!

As if Medicare were not confusing enough. Now many seniors are confused about how "Obamacare" - the Affordable Care Act soon to be implemented - will affect their Medicare. The short answer? It won't. 

If you are 65 and older and receiving Medicare benefits, forget about the Affordable Care Act and the new marketplace insurance exchanges. You do NOT need to purchase new coverage through your state's insurance marketplace. Says Richard Olague, spokesman for the Centers for Medicare and Medicaid Services: "We want to reassure Medicare beneficiaries that they are already covered, that their benefits aren't changing and that the marketplace doesn't require them to do anything different. Specifically, they do not have to change their Medicare coverage or enroll in any marketplace plan."

Various organizations, including the AARP, are trying to get this reassuring message across to seniors, but misinformation remains widespread. A recent national survey called "Fifty States of Confusion" found that 17% of those 65 and older think the new health insurance exchanges are going to replace their Medicare. One in five of the respondents thinks they are required to enroll in a new health plan under the Affordable Care Act, even though the plans are open only to those under age 65.

Part of the reason for the confusion seems to stem from the overlapping periods for Medicare Open Enrollment and enrollment for Affordable Care Act coverage. The Medicare Open Enrollment period runs from October 15 through December 7; it's an opportunity for current beneficiaries to review their Medicare, Medicare Advantage or Medicare D plans plans and make changes, which go into effect on January 1, 2014. The enrollment period for those buying health insurance on the new exchanges also begins in October but lasts until March.

Another reason for confusion: scam artists. They thrive on misinformation, and are going all out to get seniors to reveal personal data by convincing them they should be signing up for new health plans. Some tell Medicare beneficiaries that they need a new Medicare number and card or another kind of new health insurance card. 

If you are a Medicare beneficiary and are contacted by anyone about Obamacare, the Affordable Care Act or the new state exchanges, ignore them. No one from the government will be contacting you and there is no reason to verify any existing information, either.

Congress takes up Medicare/Medicaid reimbursement - again - for physician-patient discussions of end of life preferences

Remember the "death panel" brouhaha back in 2009? That's what opponents of the proposed Affordable Care Act called the bill's provision to compensate doctors under Medicare and Medicaid for discussing end-of-life preferences in depth with patients. The specter of "death panels" so spooked a large swath of the public that the provision was jettisoned from the final law.

That's too bad. In my experience, clients are not threatened by such discussions. On the contrary, my clients want to take control of their medical destinies, make informed decisions, and make sure their families are at ease with their plans if their families must ever make life-and-death decisions for them. Clients would welcome the opportunity to have a frank, free discussion with their physicians about these most sensitive and personal matters.

Evidently many on Capitol Hill agree. The Wall Street Journal  reports that this week, Senators Mark Warren (D-VA) and Johnny Isakson (R-GA) will introduce a bill that provides Medicare and Medicaid coverage for doctors' time-intensive discussions with critically ill patients regarding end-of-life care. According to the report, both senators have had experiences that fuel an intense personal interest in the proposed legislation. When Senator Warner's mother, Marjorie, developed Alzheimer's Disease, she had not put her wishes in writing. "We didn't know what to do," Warner says. In contrast, Senator Isakson and his family were well prepared for his parents' declining health, thanks to frank discussions his parents had with their doctors and with the family. They had "had terrific quality of life at the end," Isakson recalls.

A bill similar to the Senate bill has already been introduced in the House of Representatives, according to Politico. Rep. Earl Blumenauer (D-OR) and 17 bipartisan co-sponsors have put forward the "Personalize Your Care Act" of 2013, which would amend the Social Security Act to permit Medicare and Medicaid coverage when patients request advance planning discussions with their doctor. The bill would reimburse doctors for time-intensive discussions every five years, or sooner if the patient has a significant change in health status. The proposal also adds on several elements not present in the 2009 legislation, including the requirement that advance health care directives are honored across state lines, and provisions for incorporating end-of-life wishes into electronic medical records. You can read more about HR1173 here, 

Notwithstanding the bipartisan initiative, many legislators remain resistant to dealing with end-of-life issues, considering it to be a political third rail. Even so, I think the issue will inevitably take center stage as voters realize the proposed laws are designed to give citizens more control over their lives, not less. Also, the  Baby Boomers - that huge demographic behemoth that has always liked to do things its own way - will likely push the conversation to the forefront in the near future.

 Continue to check this blog and my website for new developments.

Warning: Affordable Care Act sends scammers into action

The Supreme Court's stamp on the Affordable Care Act has some scammers seeing gold. It didn't take long for them to start working the phones. Check out the details here.

Autism and the Affordable Care Act

Yesterday the Supreme Court wrapped up arguments on the constitutionality of the Affordable Care Act. The nation awaits the court's decision, likely to be handed down in June. The stakes are high for everyone, but especially for the many families whose children are disabled. These families have already benefited from the law's requirement that insurance companies may not deny health coverage to a child based on the child's "pre-existing condition."  Obviously, striking down the Affordable Care Act would pull the financial rug out from under these families.

   

Ironically, today the Centers for Disease Control released its latest statistics on autism. The findings: The incidence of autism is now one in 88 children -  TWICE the 2002 estimate. More children will be diagnosed with autism this year than with AIDS, diabetes and cancer combined. This sobering statistic follows the recent release of a University of Pennsylvania study showing that the typical mother of an autistic child earns 35% less than the mother of a child with any other kind of disability, and 56% less than one whose child  has no discernible disabilities.  The report attributes the gap to the fragmentation of support services for children with autism, requiring parents to not only provide direct care to the child, but to spend enormous amount of time and energy that must be spent navigating medical, educational and other bureaucracies.

One bright spot for Florida families who do not have private health insurance: This week the U.S. District Court ruled that Medicaid must provide behavioral therapy for children with autism. The Florida Agency for Health Care Administration had argued that it was not obliged to cover this service because it is an experimental therapy. Commercial insurance carriers are already required to pay for this type of therapy.  

Of course, specialized and sophisticated estate planning is required for children with significant disabilities. This ensures that the financial resources and proper legal framework  are there for the child now, and into the future.  A Special Needs Trust should be the legal linchpin of your planning. Find out more about Special Needs Trusts.