Your Medicare Benefits Are Changing
As the 16th century English poet Edmund Spenser once observed,
"times do change and move continually." That observation is as true
today as it was in Spenser's time, and it certainly applies to
health care and the policies that govern it. That's why we make a
special effort at Lourdes to keep our community aware of the
changes which affect us and the patients we serve.
With that point in mind, we think you should know that as of
August 1 the Medicare program has changed the way it pays for
hospital outpatient services. These changes mean patients eligible
for Medicare will notice their Medicare Explanation of Benefits
notice and Medicare Summary notice will look different.
When you receive services on an outpatient basis, you are
typically responsible for a fee that the Medicare program does not
cover. This fee is called coinsurance or co-payment.
The Centers for Medicare & Medicaid Services (CMS) says that
"overtime" Medicare's new system will ultimately lower the overall
coinsurance for outpatient services. However, at the outset, your
coinsurance is likely to increase because CMS based the new
Medicare rates on national averages, and New York hospital's
outpatient charges have been below national averages.
If you have a Medigap policy or another supplemental insurance
such as Medicaid, your private insurance probably already pays your
co-payment or deductible. As a result, changes in your co-payments
may not affect you directly. If you do not have this insurance, you
may notice that your co-payments have changed.
The government has drastically reduced payments to hospitals for
the key health care services you depend on. Initially, while some
patients may pay a slightly higher coinsurance for certain
outpatient services, the government still pays hospitals less than
the cost of providing your care.
Our constant Mission at Lourdes is to serve our patients to the
best of our ability and to continue providing the essential
services our community needs. We assure you these changes will not
affect the quality of care you expect from us.
If you have questions about your bill or
the new system, please call CMS' Medicare Helpline at
1-800-MEDICARE (1-800-633-4227), or call our Community Relations
Department at 607-772-1302.
Please remember that this is an enormous change for all of us,
and it is to be a work in progress. That means we all will be
searching for answers to complex questions regarding policy changes
that are still taking shape.
For information about Medicare premiums
and coinsurance rates for 2010, visit the Medicare.gov Web
At the outset, however, here are some key points to keep in
- In 1997, Congress mandated a new payment for Medicare hospital
- It has taken this much time to covert that mandate into
something close to detailed policy, and some key details are still
- Reimbursement under the the new payment system is based on
national, rather than hospital-specific charges.
- Despite the transition to a new system, no change will occur in
the way hospitals, including Lourdes, deliver care. The mission of
physicians, nurses, and other care givers in the hospital is to put
patients' needs first.
- The Centers for Medicare & Medicaid Services (CMS) will set
the payment rates of outpatient services hospitals provide to
Medicare beneficiaries. Because of this, hospitals will have no
control over whether a senior's coinsurance will increase or
decrease at the onset.
- However, CMS says overall coinsurance is supposed to decrease
nationally, and "over time" seniors should ultimately pay less for
outpatient services under the new system. That's why the senior
group AARP fully supported this move.
- Medicare beneficiaries who have Medigap coverage do not have to
pay out-of-pocket expenses for hospital outpatient services.
- Many hospitals are not financially able to voluntarily reduce a
beneficiary's coinsurance. Hospitals have historically been paid
less than their costs for Medicare outpatient services. This is due
in large part to the federal government's continual ratcheting down
of Medicare payments. As it is, hospitals are walking a tightrope
---having to provide the same high quality services with fewer
resources. Many are struggling to make ends meet so they can
continue providing the same services to their parents. Some
hospitals, including Lourdes, have already had to cut services to
- But Lourdes will not compromise on our Mission to provide the
best care we possibly can to the Medicare beneficiaries and all the
patients we serve.
Questions? Please call the Lourdes
Physician Referral Number at 1-877-9Lourdes.