NEW FEDERAL LAWS LEAD LIST OF CHANGES FOR MEDICARE

Three new federal laws affecting health care choices lead the list of important changes for pe~ople on Medicare.

The first new law concerns advance directives, m~ore commonly known as living wills or durable po~wer of attorney for health care. An advance directive is generally a written statement, most often made while a patient is still in good health, that details how medical decisions should be made should the patient become unable to make decisions for himself. The written statement may name a representative or proxy to make the patient's wishes known to providers of health care services. The new law requires most hospitals and nursing facilities, to give information on state law covering advance directives wills and on their policy toward honoring them. This law was effective December 1, 1991.

People who need m~ore information on advance directives should contact their pers~onal physician or health care facility where they will be treated.

The second law establishes a six-m~onth ~pen enrollment period for selecting Medigap insurance-private health insurance that supplements Medicare coverage. The new law guarantees that for six months immediately following the effective date of Medicare Part B (Medical Insurance) coverage, persons age 65 or older cannot be denied Medigap insurance because of health problems. In the past, insurance companies could reject applications for policies filed by people with severe or persistent health problems. All Medigap policies sold after November 5, 1991 are covered by this law.

For more information about Medigap policies, write to the National Association of Insurance Com~missioners, 120 West 12th Street, Kansas City, Missouri 64105.

A third law establishes a Medicare fee schedule that will be the basis for Medicare Part B reimbursement. This law, called Physician Payment Reform (PPR), replaces Medicare's old system of figuring approved charges. PPR bases reimbursement on the am~ount of time, effort, skill, risk and overhead expenses related to the services performed.

The biggest change brought by PPR, as far as Medicare beneficiaries are concerned, will be a cap on the am~ounts doctor's may charge a Medicare patient. Beginning with services performed in January 1992, doctor's may not charge a Medicare patient more than 120 percent of the Medicare scheduled fee for any service. There were no limits on actual charges before PPR - just limits on Medicare's reimbursement.

For more information about Medicare physician payment reform, call your local Medicare carrier. In Missouri the Medicare carrier is General American Life Insurance Company. The toll free telephone number is 1-800-392-3070. Blue Cross-Blue Shield is the carrier for Illinois. Illinois residents may call 1-800-642-6930.

A fourth change is not the result of new legislation but an automatic annual adjustment based on increases in the cost of hospital care: Out-of-pocket costs Medicare patients pay for inpatient care increased January 1, 1992. Medicare's Hospital Insurance (Part A) deductible increased from $628.00 to $652.00 for the first 60 days of inpatient care in a benefit period. The co-insurance or co-payment amount for the 61st through 90th day of inpatient went from $157.00 to $163.00 per day. Co-insurance for the 60 lifetime reserve days will rise from $314.00 to $326.00 a day.

I must emphasize that the people at your Social Security office are not experts on Medicare. We only issue your Medicare cards showing your eligibility and attempt to help you obtain information. The Medicare Program is ran by the Health Care Financing Administration through contracts with insurance companies acting as Intermediaries for Hospital Insurance, Part A, and carriers for Medical Insurance, Part B.