But lately, most of those concerns have centered around the fate of Medicare.

By Jennifer Calhoun May 02, 2010

Since the national health care reform bill was signed into law last month, Thompson said, many elderly people have been confused and scared by the government's plan to cut Medicare costs by nearly $400 billion.

"The biggest concern is we don't understand exactly what is happening," she said. "I've heard rumors that Medicare would be eliminated. Some people weren't sure if services would be cut all together, or if they'd have to pay more money. I mean, really, what is this all about? They're not telling people."

Thompson, 64, works at the Blue Street center. She said people have been talking about the changes for months. Some worry they'll lose their coverage, lose important benefits or face increases they can't afford on their fixed incomes.

Frank Sloan, an economist at Duke University, said the health care reform bill shouldn't be a cause for Medicare recipients to panic.

Ending it, Sloan said, would be a political nightmare for any politician who proposed the idea or spoke in favor of it.

"There's no chance that Medicare would be dissolved," he said. "Nobody would dare propose to eliminate it."

So what is planned for Medicare in the new health care reform bill?

The easy answer is that traditional Medicare coverage will be protected, and in some cases, enhanced.

Patient care also could change in some cases, Sloan said, as the Medicare program continues to look at more cost-effective ways to treat patients.

And while the idea of that worries Thompson and others, Sloan said it's a necessary tool to contain rising health care costs.

"Medicare is growing at unsustainable rates," he said. "My concern is that they won't do anything, because it's very difficult politically to cut Medicare."

In addition, Medicare Advantage programs - private health insurance plans that require a premium payment and usually offer extra benefits, such as vision and dental - could see a reduction in benefits and a rise in premiums, Sloan said.

Tricare for Life enrollees - a Medicare gap insurance for military families - appear to be unaffected, according to a spokesman with Tricare.

Other changes are set to begin soon, according to the bill.

Upcoming changes Beginning this year, Medicare Part D enrollees who have exhausted their prescription benefits for the year will receive a $250 rebate.

Starting next year, people enrolled in Medicare will no longer have to pay deductibles and co-insurance for annual wellness visits and some preventive services.

Next year, the law also will reduce the amount of money Medicare Part D enrollees will be required to pay for prescriptions once they exhaust their prescription coverage.

On the flip side, people enrolled in Medicare Part D who have an income of more than $85,000 for an individual and $170,000 for a couple will see a reduction in their Medicare prescription drug subsidy.

In addition, people enrolled in Medicare Advantage plans should expect to see higher premiums and a reduction in benefits over the next few years, or stop offering the plans all together.

In 2009, about 17 percent of Medicare recipients in the state were enrolled in Medicare Advantage plans, according to the Kaiser Family Foundation, a nonprofit health information organization.

Currently, the federal government gives subsidies to private insurance companies to manage the plans. The result has been the government now spends an average of 14 percent more on patients with Medicare Advantage than it does on traditional Medicare recipients, according to the federal government.

The law will change that.

Starting next year, payment rates to private insurance companies will be frozen. Over the next two years, they will be gradually reduced, although "higher quality" Medicare Advantage plans will receive a bonus, according to the bill.

In 2014, the bill requires those insurers who use less than 85 percent of premium dollars to pay for their customers' medical care to pay back the government.

The reductions in payments and other reforms are expected to save the government more than $177 billion over the next 10 years and reduce Medicare Part B premiums, according to the White House website.

Tricare for Life enrollees shouldn't be affected, however, according to Austin Camacho, a spokesman for the program.

Tricare for Life is a Medicare wrap-around plan for military families that covers more than traditional Medicare Part A and B. Unlike Medicare Advantage plans, however, Tricare for Life does not require a premium payment.

With Tricare for Life, Tricare acts as a secondary insurance to Medicare. That means that whatever Medicare doesn't cover, Tricare will - at least for Tricare-covered services.

Reimbursement Camacho said the only way he believes beneficiaries may be affected is if fewer providers accept Medicare in the future.

Sloan, with Duke, said that's a possibility. He said some doctors have stopped seeing new Medicare patients because of low reimbursement rates and time-consuming paperwork.

However, the health care reform bill does not include measures to lower Medicare payments to providers.

In fact, some doctors will receive a slight bump in Medicare payments as a result of the bill.

Beginning next year, the government will give a 10 percent Medicare bonus payment to primary care physicians and general surgeons practicing in places where there's a shortage of health care professionals as designated by the U.S. Department of Health and Human Services.

Some of the changes are complex and time will tell their impact, Sloan said.

But that's the part that's most difficult for Thompson and others to understand, she said.

"From my standpoint from where I sit, I believe it's going to get worse," she said. "People who sit at the top and make decisions, even they don't seem to have all the answers."

### Source: www.fayobserver.com