Was listening to Thursday’s show and caught the conversation about Medicare and Kamala’s proposal to add Home Health coverage. I’ve worked in the healthcare industry for about 20 years, specifically in Managed Care, where I negotiate in-network agreements with insurance companies and help determine how much providers get paid by plans. Not super exciting, perhaps, but this topic is in my wheel house.
Any way, your questions about Medicare are reasonable, as it’s a fairly complicated landscape. Traditional Medicare is funded through payroll taxes and people become eligible for benefits (usually - though there additional routes) when they are over 65 years of age and retired. Yes, you do need to actively enroll to collect benefits, it’s not automatic.
Medicare’s benefits are divided out into various “parts”. Part A benefits cover inpatient hospitalization. Part A does not cover doctor’s visits, not outpatient testing nor procedures. That said, Part A benefits are essentially free if you’ve paid into Medicare long enough. (“Free” meaning no premium, but there may be co-pays or deductibles). Part B benefits are an add on and cost extra on top of Part A. Costs are usually $125/month per person in premiums for Part B benefits. Part B covers outpatient services and doctor’s visits. Then there’s Part C, which is a commercial, Medicare replacement coverage, like through United or Humana. You can’t have Part C coverage and also Parts A or B at the same time. Medicare Part D is for prescription drugs, and comes at additional costs. Part D didn’t exist until George W Bush’s term in office. You may have Part D coverage in addition to Parts A and B or C.
So, where did Kamala Harris’ plan for Home Health come in? Currently, Traditional Home Health services are sometimes covered under Part A or Part B if an individual is also eligible for nursing home care. It’s usually an “either or” proposition on care modality. Harris’ proposal was a modest plan to make it easier to qualify for home health and to allow more access to that benefit.
Part of the goal for Managed Care is to reduce the cost of health care while increasing quality. Not easy. Home health services are typically low-cost and help prevent re-admissions to the hospital. In theory, expanding coverage for Home Health through Traditional Medicare coverage (either Part A or Part B) would expand access to care with low cost and beneficial outcomes. Honestly, not a bad idea.
More on that here:
[https://www.beckershospitalreview.com/post-acute/5-reactions-to-harris-home-care-coverage-proposal.html](https://www.beckershospitalreview.com/post-acute/5-reactions-to-harris-home-care-coverage-proposal.html)
Have a great day, and looking forward to tomorrow’s show.
Best,
Jeremy,