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PPACA and Medicare in Ohio

There have been many rumors and misconceptions surrounding Medicare in Ohio and how it will be affected by the PPACA, or the Patient Protection and Affordable Care Act. PPACA was passed in 2010 by the Obama administration, and appears to threaten the supplemental policies available to seniors through Medicare.

Medigap Phaseout

There are currently over 47 million Americans enrolled in Medicare. About ¼ of the participate in Medicare Advantage, or the Medigap plan. Most of these are seniors with lower income, who use MA to afford medical care. Under the PPACA, Medicare Advantage is scheduled to be completely phased out by 2017. By 2015, about 60% of seniors currently on MA will lose their coverage. In 2012, the number of policies available will be cut from 12 to 5, mostly Fee for Service policies.

Medicare and Fee for Service

Medicare is typically a Fee for Service, or FFS insurance, anyway, which is the most expensive type of private health insurance. Medicare Advantage, or MA, was developed for lower income seniors, using an HMO setup on ½ of the policies, and a PPO type setup on the other ½. The HMO policies are the ones set to be discontinued over the next few years, along with the PPO policies that are farthest from the FFS type. The FFS setup leaves many doctors unwilling to accept Medicare. Medicare acts as an insurance company that does not recognize networks. Therefore, Medicare takes its own discounts out of doctors’ bills, not paying as much as the doctor claimed. This has created a vicious cycle of doctors who charge even more for services to Medicare patients, on the hopes of receiving a sum closer to the original charge.  Medicare in Ohio will be affected by this change, just as in every other state.

Privatization

When MA was instituted in 2003, it was to help privatize Medicare. It required the involvement of individual and private insurance companies to bargain and negotiate network discounts with health care providers. While the prescriptions will still be handled by private insurance agencies, there will be no more network providers when MA is gone.

For a free insurance quote, contact HealthInsuranceChaser.com. You can call 877-775-4321 toll free, and have a quote on Medicare in Ohio within minutes, and receive more information on upcoming changes.

Ohio Health Benefits and the Costs of Some Drugs

One of the most popular drugs for the treatment of certain cancers is Doxil, and Ohio health benefits usually cover the cost of the drug. Unfortunately, last summer, thousands of people in the U.S. found themselves unable to get any Doxil. This is because the only plant that manufactures this potent drug had to shut down.  The plant simply could not keep up with demand, and faces necessary upgrades in equipment to resume operation.

This shortage has left some 7000 patients using cancer drugs with more side effects, such as nausea and weakness. Doxil is not the only drug in short supply.

Over 250 drugs have been hard to get over the last year, with 20 of them being chemotherapy drugs. Others, also covered by Ohio health benefits, are intravenous drugs and nutrients used to treat high blood pressure, ADHD, and diabetes. Others are pain relievers, anesthesia, psychiatric medications, and some medicines used to fight infections. Most of the drugs in short supply are generics. The director of the American Hospital Association, Roslyne Schulman, says that this is a public health crisis. It is, apparently, affecting drugs that have been the backbone of hospital treatments for years.

Three out of four hospitals, according to the New York Times, have had to ration or restrict drugs because they were in such short supply.

This is where increasing health care costs come to play. The scarcity of popular drugs drives doctors and hospitals to use more expensive drugs as substitutes. In addition, they must invest time and increase budgets to teach their staff members how to use the unfamiliar drugs. With increasing unfamiliarity with certain drugs, the risks of medical error or complication increases. This not only increases insurance expenses, it causes procedures to be delayed.

The problems with production are partly to do with the consolidation of many pharmaceutical companies. Since many drugs are manufactured by only one or two factories, if the factory is absorbed and shut down, the drug goes off of the market. Also, when a factory fails to pass inspection, it is shut down.

With the generics harder to get, brand name drugs are being used more, but they cost more, too. This drives up the cost of medical care. Your Ohio health benefits are trying to stay on top of this problem, and make sure you can still afford your medication, even if you have to switch to the more expensive brand name drug.

For a free quote on Ohio health benefits, contact HealthInsuranceChaser.com. You can call 877-775-4321 toll free, and have a quote within minutes.

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