A Judge Orders Medicare To Clarify When It Will Pay For Rehab and Skilled Nursing

Imagine your mom has a stroke. Once she is stabilized, she is sent to a skilled nursing facility for rehab. Then she goes home and gets some home health care and additional physical therapy. Medicare may pay, but for how long?

For many years, that was decided by the “improvement standard.” In other words, as long as this care helped mom become more mobile or improve her speech, Medicare would pay at least some of the cost (up to a maximum of 100 days per spell of illness).  But once she stopped getting better, Medicare would stop paying.

Who Owns Long-Term Care Insurance?

About 7.2 million Americans currently own traditional long-term care insurance policies, a number that’s held steady for the last seven years. But who are they? And what does it say about the future of long-term care insurance?

Overall, the share of older adults who own long-term care insurance (LTCi) has barely changed since 2002, according to new research by my Urban Institute colleague Rich Johnson. In 2002, about 10 percent of those 65 and older had coverage. By 2008 that share had ticked up to 12 percent, but in 2014, it dropped back to 11 percent. Among those aged 55-60, the share of policyholders slipped from 7 percent in 2002 and 2008 to just 5 percent in 2014.

Another Big Long-Term Care Insurance Premium Hike

Last week, the federal government announced that premiums for nearly all of its existing long-term care insurance policies will increase—by an average of 83 percent. In other words, they will almost double for federal employees and retirees.

What does such a price hike on current policies mean for consumers, and for the future of long-term care insurance?

First, a bit of background. The federal program, which insures about 274,000 current and retired workers, is operated under contract with a private insurer, John Hancock Life and Health Insurance Co. With the current seven-year agreement about to expire, the government put it out for bid. However, only Hancock wanted the job–which requires it to sell new policies and pay claims on existing policies, including those sold before it first got the contract in 2009.

Democratic and Republican Platforms Back Home-Based Care For Older Adults

For the first time, both major political parties have explicitly recognized in their platforms the need for community-based long-term care. While the Democratic and Republican platforms included few specific recommendations, the fact that they acknowledged the importance of personal assistance and social supports for older adults (and in the Democrats’ case, for younger people with disabilities) is a significant step towards future policy change.

The Democratic platform is far more expansive, addressing the importance of strong home-based services and supports for both paid aides and family caregivers. It also calls for expanded family leave, which could help some working people caring for parents or spouses. Here are the two key sections from the Democratic platform.

Doctors Die Like The Rest of Us

In recent years, it has become conventional wisdom that physicians avoid the end-of-life mistakes that many of the rest of us make.  The story: They die at home rather than in hospital intensive care units. And they rely on comfort care such as hospice or palliative care rather than often-futile high tech medicine.

That conventional wisdom, it turns out, is a myth—at least according to a new study by Daniel Matlock and colleagues published in the Journal of the American Geriatrics Society.  Docs, despite their better understanding of the nature of terminal illness, their knowledge of the limitations of medical treatment at the end of life, and even their ability to talk as peers to their own physicians, die pretty much like the rest of us.

A New Vision For Medicare: Breaking Down Barriers Between Medical Treatment And Personal Care

Since July 1 was the 50th anniversary of Medicare first enrolling (and paying benefits for) seniors, it’s a good time to think about modernizing the half-century old program.

A couple of weeks ago I tried to make the case for why we should improve Medicare. Now, let’s think about how.

Should Drugmakers Be Allowed To Avoid Taxes On Their Profits From An Alzheimer’s Drug?

In one of the worst ideas I’ve heard in a long time, two congressmen have introduced a bill to make profits from the sale of certain anti-Alzheimer’s drugs tax free for seven years.  The measure, sponsored by representatives Patrick Murphy (D-FL) and Mike Fitzpatrick (R-PA), may be well-intentioned, but it would provide a multi-billion dollar windfall to pharmaceutical companies. There is no evidence it would improve the nation’s overall health and it could very well harm it.

Happy 50th Birthday Medicare. Now, Let’s Think About How to Update It.

On Friday, July 1, it will be 50 years since Medicare first began paying health benefits for older adults. It is an anniversary worth celebrating—and easy to forget that prior to Medicare half of all seniors had no insurance. But much has changed in a half century—and Medicare has not kept up. It is time to rethink the program—both the benefits it offers and how it is financed.

Many advocates are opposed to redesigning the program. They fear, not without reason, that some politicians see modernizing Medicare is just another opportunity to cut the program.  But they need to recognize a reality: A rapidly growing population of chronically ill older adults is not being well-served by the traditional Medicare program.

What Paul Ryan’s Latest Health Proposal Would Mean For Seniors

House Speaker Paul Ryan’s proposed blueprint for health reform would make major changes in medical care for seniors, raising out-of-pocket costs for some and shifting others from traditional Medicare coverage to commercial insurance.

His plan, called A Better Way, would slowly raise the age of eligibility for Medicare and cap federal spending for the program, increasing subsidies for low-income seniors but raising out-of-pocket costs for higher-income retirees. It would make Medicare Advantage managed care plans more attractive. And, in a significant omission, it barely acknowledges the importance of long-term supports and services for older adults and younger people with disabilities and suggests few ways to improve such care.

A Key Senate Committee Kills A Program That Advises Seniors on Medicare

Do you understand Medicare? Of course you don’t. Neither does anybody else. So why would Congress abolish a modest federal program that pays for actual human beings who can explain it to confused consumers?

Last week, the Senate Appropriations Committee essentially voted to abolish the State Health Insurance Assistance Program (SHIP) by quietly eliminating the entire $52.1 million in federal funding that keeps the service going. In 2014, about 15,000 counselors in 3,300 state and local programs provided direct personal assistance to about 3.5 million older adults and younger people with disabilities. More than half of the counselors are unpaid volunteers. SHIP does not subsidize Medicare. It only provides advice.