Medicare

A proposed rule change from the Centers for Medicare and Medicaid Services (CMS) could provide Batavia’s United Memorial Medical Center (UMMC) with an additional $8.5 million every year.

Other hospitals across the state would benefit with their own additional funding. The overall proposal, currently under review, could bring an additional $967 million every year to hospitals in upstate New York.

The proposal, if implemented, would deliver a big win for UMMC, whose administrators have long complained Medicare has underfunded them.
The state has a shortage of doctors and nurses. With additional funding, UMMC and other hospitals could pay for more specialists from both professions.

U.S. Senate Majority Leader Chuck Schumer (D-NY) announced the proposal Friday. He said hospital systems across upstate New York have for many years received less than the national average for the services they provide.

Rochester Regional Health (RRH) oversees UMMC. In a statement, company officials predicted good things will come from this extra funding.

“We are optimistic that this proposed rule change would be an important first step on the federal level to address the years of Medicare underfunding we’ve experienced,” according to the statement.
“Currently, RRH receives around $0.84 for every $1 we spend on Medicare patients. Moving forward, we will keep on working with our federal, state and local partners in the fight for fair funding levels so we can continue to provide the high-quality health care this community needs and deserves.”

The Medicare Wage Index rate is used to determine how much money the U.S. government pays hospitals for labor costs when they treat Medicare patients. Each metro area is assigned a rate that dictates whether they receive more or less than the national average for health care labor costs.

Since the 1980s, Schumer said hospitals in the Albany area, for instance, have received only 86 percent of what the average hospital receives to account for wages, which does not reflect that city’s true wages and labor market.

“This means that hospitals from Buffalo to Albany and Watertown to Binghamton, big and small, in rural and urban areas, can get the support they have long deserved,” Schumer said.

“I will use all my clout as majority leader to push CMS to finalize this proposed wage increase, and I won’t stop until Upstate NY hospitals get the full reimbursements they have been denied for too long.” 

Photo of United Memorial Medical Center in Batavia, by Howard Owens.

Press release:

Higher-income eligibility (revised) for the Medicare Savings Program (MSP) (due to higher federal poverty guidelines) in New York. Single individuals with Medicare have a gross income of up to $2,280 per month, and couples with monthly gross incomes of up to $3,077. New York State does NOT look at your assets for this program.

The MSP helps older adults and people with disabilities living on low incomes by paying their Medicare Part B premiums ($164.90 each month) and enrolling them in Extra Help, the federal prescription drug subsidy program that the Social Security Administration estimates is worth about $5,100 per year. This program lowers prescription costs and gets rid of the deductible and the “donut hole,” or gap coverage.  The financial assistance can be a lifeline, allowing enrollees to maintain their Medicare coverage, access needed care, and afford other necessities, like food and rent.

The Genesee County Office for the Aging will be holding a walk-in assistance day for anyone will be new to this program, on Wednesday, March 29th, from 2 to4 p.m.  We are located at 2 Bank Street in Batavia.  Bring with you: a birth certificate, social security card, Medicare card, License, Current (2023) Social Security award letter, and any other reoccurring income proof (weekly, monthly, or yearly).

Medicare Advantage, Drug plan Part D, Drug plan Part D + Medigap policy, only the Medigap policy.

Confused by the options for Medicare during this open enrollment period? It runs through Dec. 7, and there is help for the thousands of people in Genesee County eligible to sign up, Genesee County Legislative Chairwoman Shelley Stein says.

Given the volume of people who may be wanting to sit down to review plans and ask questions, two staff members in the Office For the Aging cannot handle them all. Not to worry, Stein says, vendor fairs are coming to the rescue.

“There are 10,000 eligible Medicare residents in Genesee County, who all have the opportunity to enroll or re-enroll, or find a new provider for that Medicare supplement,” Stein said Wednesday. “(OFA staff) have collectively arranged for vendor fairs, and for different parts of our county. And the vendors are there, the supplemental insurance providers are there, and they have time to talk to our residents.”

She encouraged her fellow legislators to direct those with questions, comments or complaints about their Medicare coverage to attend a vendor fair.

“Each and every person in our community, those 10,000 that are eligible, they're important. And it is important that they get the right supplemental insurance to meet their own individual needs,” she said. “So, again, this is the most important time of the year for that fragile population that we have. Please encourage them to attend one of these fairs.”

There are three fairs coming up, and all of them go from 10 a.m. to 4 p.m. They are scheduled for:

• Nov. 2 at Town of Bethany Hall, 10510 Bethany Center Road, East Bethany
• Nov. 15 at Darien Center Fire Hall, 10537 Alleghany Road, Darien Center
• Nov. 29 at First United Methodist Church, 8221 Lewiston Road, Batavia

Attendees should bring their Medicare card, and a list of each their prescriptions and doctors.

Representatives from local Medicare Advantage Plans will be present to assist you in understanding changes for 2023, and to help sign you up for a different plan or company if that’s what you choose to do.

Medicare specialists from the Office For the Aging will be on hand to answer any questions and to give unbiased information.

A representative from EPIC, the state Prescription Assistance Program, will be available on Nov. 29 at the Batavia location.

For anyone with disabilities or language interpretation needs, requests for reasonable accommodations should be made at least five days before your visit to a vendor.

For more information, call 585-343-1611.

File Photo of Shelley Stein by Joanne Beck.

Click here for more information on our FREE workshops.

Press release:

Sheridan Benefits, LLC will host a series of ‘Medicare 101 Table  Chats’ at three GLOW YMCA branches the week of March 7, 2022. Biggs Johnson with Sheridan  Benefits will be available to present information to those approaching Medicare age to learn about the program and to answer questions from current Medicare beneficiaries.

Orleans County YMCA
306 Pearl Street, Medina
Monday, March 7 from 9:30 – 11:30 a.m.

Genesee County YMCA
209 East Main Street, Batavia
Wednesday, March 9 from 9 – 11 a.m.

Wyoming County YMCA
115 Linwood Ave, Warsaw
Thursday, March 10 from 9 – 11 a.m.

These events are an opportunity to obtain important information Medicare eligible individuals will need in order to learn how Medicare works, discover changes within the program, review  different coverage types and see which plans are the best for you and your current needs.

Medicare 101 Table Chats are open to the public. 

Click here to visit our Facebook page

Press release from the Genesee County Office of the Aging:

Callers claiming to be from Medicare have been targeting seniors in our local area.

Please be aware:

• Medicare will NEVER call and ask for your Medicare number.
• If you get a call from someone promising free items, if you give them your Medicare number (can include back brace, glucose monitor, pain relievers for arthritis) -- DO NOT DO IT. This is a scam, even if they tell you it is not.
• Refuse any offer, money, or gifts for free medical care.
• If you see any charges on your Explanation of Benefits from Medicare, or from your Medicare Advantage provider that you do not understand, call the office from where it was billed to question the charge.
• Most importantly – guard your card like it is a credit card. If you did not initiate the call, do not give out any information.

If you feel you may have been a victim of Medicare fraud, please call the NYS Senior Medicare Patrol at 1-800-333-4374.

Press release:

Noting that the clock is ticking, U.S. Senator Charles Schumer called on the Trump Administration to extend the nation’s public health emergency declaration first issued this past winter to address the COVID-19 pandemic.

Schumer warned that the declaration will expire on July 25^th unless the feds soon act, and reminded that executive branch delay on the emergency declaration this past winter set us back in the COVID fight.

Schumer said Health and Human Services (HHS) should announce an extension ASAP and give locals across New York the reassurances they need to keep the COVID fight going. Schumer cautioned, that without action, New York stands to lose collective billions in state and local healthcare funds, FEMA disaster dollars and even tele-health services, like those for Hospice and everyday healthcare.

“If we have learned anything from COVID-19 it is that a ‘stitch in time saves nine,’ and the more we can do to be proactive, the better off the public will be,” Schumer said. “This past winter there was delay and dismissal towards those urging HHS to officially declare a public health emergency as it relates to the coronavirus.

"Well, we cannot -- and we must not -- have that kind of inaction and uncertainly now, especially with what we know and with the sustaining needs of New York. We need the public health emergency extended ASAP to keep healthcare dollars and FEMA funds flowing to this state, and we need the declaration to keep our local health departments fully supported. The clock is ticking as July dawns, so we need this action now.”

Aside from the very clear public health consequences, Schumer said New York would lose billions of dollars collectively if the Trump administration fails to extend the public health emergency declaration. Just last week, more than $300,000,000 in federal healthcare dollars were dispersed across New York State.

Those funds are part of a combined $2.5 billion in the pipeline and already secured for New York as part of the Families First Coronavirus stimulus package, which are tethered to the emergency declaration.

In addition, as of June 1, FEMA had obligated over $1.1 billion to New York under the state’s COVID Major Disaster Declaration and the agency is looking to the public health emergency declaration to define how much longer it will continue reimbursing New York, and in particular New York City, for related expenses. Should the public health emergency end, FEMA has indicated that the funds flowing from the Disaster Relief Fund will also stop.

“New York is by no means out of the woods with the coronavirus, especially given the upticks we are seeing in other states and the risk those upticks pose here when you take travel into account,” Schumer added. “Extending this declaration will keep New York positioned to both respond and to keep fighting.”

In addition, Schumer also detailed the CDC’s Infectious Disease Rapid Response Reserve Fund, which without an emergency extension would be locked up like it was before the first declaration was made at the beginning of the year. The account’s funds are being used to support local health departments and increased staffing across the city and on Long Island.

Schumer explained that these dollars could also be used by the CDC for, amongst other things:

• Epidemiological activities, such as contact tracing and monitoring of cases;
• Additional or enhanced screenings, like at airports;
• Support for state and local health departments;
• Public awareness campaigns;
• Increased staffing.

Schumer also explained how the emergency declaration has allowed vulnerable and high-risk patients to avoid potential exposure to the coronavirus at hospitals and health centers by expanding federal eligibility to receive routine care through telehealth and digital care.

Federal support and coverage for this type of medical care has saved countless lives because clinicians can use tele-health to fulfill many face-to-face visit requirements to see patients, says Schumer, adding that this has been one of the main requests of in inpatient rehabilitation facilities, hospice and home health professionals who are now using apps with audio and video capabilities to have patients visit with their doctors or practitioners.

Finally, Schumer listed other necessities that would cease unless the public health emergency is extended:

• Nutrition assistance for kids who would normally receive free or reduced lunch in school would cease;
• Access to SNAP would be restricted;
• Seniors who rely on Meals on Wheels would see their access to food restricted;
• A massive restriction on assistance hospitals and doctors rely on to keep their doors open during the crisis;
• Reduced access for out of work individuals to receive Pandemic Unemployment Assistance;
• Reduced access to prescription drugs for seniors on Medicare.

According to a specialist in aging services and Medicare at the Genesee County Office for the Aging, "this year is utter chaos with Medicare Advantage Plans as FIVE out of six companies selling in Genesee County have dropped at least one plan."

"We have been slammed with calls (as many as 43 within hours!) from people seeking guidance on what to do," she says.

So they are holding four Medicare Open Enrollment Vendor fairs during Medicare Open Enrollment (Oct. 15 through Dec. 7) to help people sort through the maze. ​The fairs are provided through grant funds from the NYS Office for the Aging, the Federal Older Americans Act, and generous support of the Genesee County Legislature.

Charts will be available at the vendor fairs (and in the Office for the Aging) comparing ALL available plans for 2017. Reps from local Medicare Advantage Plans and AARP Medigap will be present to help attendees understand the changes for 2017. They can help sign you up if you wish to choose a different plan or company. And Medicare trained/certified counselors from the Office of the Aging will be there to answer questions and offer unbiased assistance.

The fairs are scheduled as follows:

• Monday, Oct. 17, from 10 a.m. to 3 p.m., in the Paddock Room at Batavia Downs, 8315 Park Road
• Wednesday, Nov. 2, from 10 a.m. to 3 p.m., in the Oakfield Community and Government Center, 3219 Drake St., Oakfield
• Tuesday, Nov. 22, from 10 a.m. to 3 p.m., at the Office for the Aging, 2 Bank St., Batavia
• Tuesday, Dec. 6, from 10 a.m. to 4 p.m., at the Office for the Aging, 2 Bank St., Batavia

Press release:

Beginning this week, Medicare beneficiaries will receive a letter from the Social Security Administration (SSA) if they may be eligible for help with their out-of-pocket medical and drug expenses. Genesee County Office for the Aging encourages beneficiaries who receive these letters to take action to learn more about the Medicare Savings Program (MSP) and Extra Help.

The letters are sent annually to people with Medicare with limited incomes who could be eligible for—but are not enrolled in—an MSP, which helps with Medicare out-of-pocket costs, or Extra Help, which helps with the costs of prescription drugs.

“These letters are not a scam,” said Kimberly Perl, HIICAP coordinator at the Genesee County Office for the Aging. “They are an important notification that Medicare beneficiaries should review and consider. We can help determine if they’re eligible, apply, enroll, and even understand how to use their new benefits once they’ve been approved.”

A Walk-In Day to assist potential beneficiaries has already been set on May 31^st between the hours of noon and 2 p.m. at the Office for the Aging, located at 2 Bank St. downtown Batavia. Anyone receiving a letter—or who believes they or a loved one may be able to get help from these programs—should contact the Office for the Aging first at (585) 343-1611 so they may properly inform you of what you will need to bring.

In addition, Medicare beneficiaries can go online to see if they are eligible for MSPs, Extra Help and other benefits that can supplement their monthly budget. The National Council on Aging’s BenefitsCheckUp® is a free, confidential screening tool that can connect older and adults and younger adults with disabilities to these programs. Learn more at BenefitsCheckUp.org.

Press release:

Congressman Chris Collins voted today in support of the House Republican Budget, including a provision that he secured to protect Medicare Advantage from future cuts.

“I was proud to vote for a budget that makes necessary reforms and structural changes to Medicare in 2024 to strengthen the current program and sustain it for future generations,” said Congressman Collins. “To protect Medicare Advantage, I personally fought for a provision to prevent cuts to this program so many WNY seniors rely on.”

The Republican House Budget balances in 10 years, saves taxpayers $5 trillion by shrinking big government and cutting wasteful spending, and reduces the country’s historic debt.

"The House Republican Budget does what so few Washington budget proposals do – it actually balances,” Congressman Collins said. “The American people understand we cannot keep borrowing money from China to pay our bills, bankrupting our children and grandchildren’s future in the process.”

In an effort to get the economy moving and leave taxpayers with more of their hard-earned money, the House Republican Budget also includes significant tax reform, including lowering the top individual and corporate tax rates to 25 percent, and eliminating special-interest tax loopholes and the Alternative Minimum Tax. The Budget also protects Americans who have been hurt by ObamaCare.

“The GOP Budget includes tax reform to bring down rates and level the playing field for small businesses and hard working families,” Congressman Collins said. “And it relieves the burdens of ObamaCare for the countless Americans who have seen their premiums skyrocket, their coverage dropped, or their hours cut.”

“Those opposed to the GOP Budget will demonize it and suggest Congress continue to kick the can down the road. The American people want Washington to get its head out of the sand and deal with our out-of-control spending and staggering debt. The House Republican Budget does just that," continued Collins.

The House Republican Budget was passed by a vote of 219 to 205.

This entry concludes Sunday's article on the comments of Victor DeSa, M.D., who spoke to senior citizens at Batavia's First United Methodist Church last week.

Please remember, this is a summary of DeSa's presentation and does not necessarily reflect the views of The Batavian:

Medicare, Medicaid and senior services

By requiring insurance companies to expand coverage, the new health care law will drive costs up, according to DeSa. The government has told consumers that these costs will be offset by subsidies for people making less than $80,000 per year.

These subsidies will be coming, in part, from a $500 billion cut from Medicare -- and that's where senior citizens and others eligible for Medicare should be concerned.

But this is not the only problem. Both Medicare and Medicaid, which DeSa called "the original two public options," have met with disaster. Medicaid has already failed, and Medicare is on the brink of failure.

"The government has no idea how to handle the rising costs. Their idea of handling the costs is to take a machete to (the programs) and cut."

The result is the "doctor fix," a 21-percent cut in doctors' reimbursements. This could be disastrous in a system where the cost of providing services is already greater than what the doctors receive in compensation.

For that reason, many doctors no longer accept Medicare. The Mayo Clinic in Arizona has already determined that because of the new health care legislation, it will no longer deal with the program.

"So Medicare patients are going to have fewer and fewer choices of who is going to take care of them."

With fewer doctors available, waiting periods will increase. So the direction Medicare is taking presents seniors with a double disadvantage.

The government "carved the 21-percent doctor fix out of the bill" in order to avoid upsetting America's seniors, but that doesn't mean they've addressed the cost. They are simply pushing it to the side and will have to deal with it later.

"Six months down the road, they have to still come up with a fix for this 21-percent cut that they are going to make on Medicare payments to the doctors."

So that's the story with Medicare and Medicaid. As far as insurance for retired citizens goes, people who worked in the public sector should be okay (although DeSa said it's not impossible that this could change, because "anything is possible" with what the government is doing), but people in the private sector should be concerned.

What to do?

When asked how we can change the course we've taken, DeSa answered: "We've got to kick out the guys who did this."

He appealed to the power of senior citizens -- which he became two years ago -- who are "feared in Washington because we vote."

Many seniors were suspicious when the government said that $500 billion had to be cut from Medicare to cover health care.

"If they really addressed costs the way we asked them to do, a person making $40,000 a year be able should be able to afford health care coverage without subsidies, don't you think?"

Failure to address the problem of cost in the current system was one of DeSa's main critiques of the health care bill. He said that in looking for alternative plans, we need to look for one that does address them.

Counting the costs 

There are three main factors driving health care costs:

1) Overuse

Back in the old days, when there was usually only one doctor in town and he had to go to patients' homes to treat them, people only went to the doctor when there was something really wrong.

Now, with easy access to medical examination and treatment, people will go to the doctor -- and even to the emergency room -- whenever they have a minor health concern.

"We have to change that if we want to truly address the cost of health care."

But it's not just patients -- doctors sometimes overuse the system, too.

"I hate to admit it, but there's greed in every profession. There are bad apples in every bunch, and you've got to admit it."

2) The fact that people have insurance in the first place

Strange as this may sound, this can be a problem.

"Insurance is like a credit card, but you don't have to pay every month. So there's no incentive for you to be prudent with the costs. You don't even want to know what the cost is, you just want the health care."

DeSa believes that while insurance cannot be eliminated altogether, people should reduce their dependence on it. For health purposes, they should only turn to insurance in times of emergency.

Generally speaking, the way people take care of this part of the cost is by having "skin in the game."

"If you shop around for a car or a house, why shouldn't you be able to shop around for a doctor? Especially in this day and age, with the Internet and everything."

3) Liability

"Everything from a Band-Aid to a heart valve has a mark-up depending on the risk."

In other words, the more dangerous the a product or its failure can be -- and, therefore, the greater the likelihood of a lawsuit -- the more expensive the product.

Because the liability cost is factored into the price of the product itself, "the little guy gets it in the neck every time."

DeSa fully supports the patient's right to sue when a doctor has done something wrong or is incompetent, but he also believes that the whole liability issue should be looked at when considering the cost.

Government out, skin in (the game)

Costs are going down for procedures that are not covered by insurance (Lasik surgery is one example). The reason?

Competition.

"Costs come down if there are market forces in place."

DeSa saw this in his native India, which had a socialized health care system until the early 1990s.

When he was studying at Jabalpur University in the mid '60s, the Indian government had total control of health care and sent all competing forces out of the country.

The effect of this was what DeSa called a "brain drain."

"The best and the brightest (doctors) were all leaving the country."

He sees the same thing happening here in Western New York, where there is a serious shortage of doctors.

"Over 80 percent (of young doctors surveyed at Western New York teaching institutes) say they'll train here, but they're not going to stay in New York to work. We are known as one of the most heavily taxed and over-regulated states in the country."

Our response to this situation should mirror the response taken in India back in 1990. At that time, India began to default on its World Bank loans. Finance Minister Monmohan Singh -- who is now India's Head of State -- saw that the system was not working and started the country on a different path.

"He got rid of the government, encouraged entrepreneurship and lowered taxes."

Above all, the patient must take responsibility and be in control of his/her own health care. It can't fall to the federal government to make important decisions regarding people's health care, no matter how well-intentioned they might be.

Déjá vu

In addition to drawing from the experience of his native country, DeSa also discussed two other examples of what he sees as a health care system set up for failure.

The U.S. government's new health care model is based on the Massachusetts health care model, which DeSa called "an abject failure." He cited problems related to his comments about young, healthy citizens abusing health insurance.

"Just Google 'Massachusetts Health Law -- success or failure?'"

Socialized health care has proven disastrously ineffective in Britain as well.

"Just this month, Britain recognized that its system is a failure and said they are going to change the whole thing."

Part of that change will be a shift in power from bureaucrats -- of which there are 1.5 million overseeing the United Kingdom's National Health System -- to the doctors. As good as this sounds, DeSa fears it may be too late for it to work.

"The doctors (in the UK) have no business experience. Up to this point, the government has been taking care of everything."

His concern is that U.S. doctors will share a similar fate. As his presentation drew to a close, he told everyone that under the government's new plan, there will be over 120 new bureaucracies controlling health care.

DeSa admitted right at the start of his presentation that he had a bias as a health professional. He encouraged everyone to do their own research and decide for themselves whether or not the new health care reforms are to be welcomed or feared.