11/14/2024
Dear Patients,
Election Day is over, and regardless of where you stand politically, I think we can all agree that it is a relief to no longer be bombarded by campaign ads and text messages asking for donations!
Regarding potential health policy changes, I'll be closely watching how the new administration chooses to handle the most pressing issues facing all of us -- such as the high costs of brand name medication (compare Ozempic at $1,000 per pen in the U.S. to $400 per pen in Canada), ridiculously expensive and restrictive health insurance plans, and whether Affordable Care Act subsidies will be allowed to expire as scheduled in 2025.
Fortunately, I don't expect any administrative challenges to the DPC model - if anything, we may see an expansion of lower-cost, catastrophic/major medical plans that can be used along with your DPC membership in the event of hospitalization/ surgery / serious illness (fingers crossed!).
MEDICARE PAY CUTS/ FIX MEDICARE NOW
Regarding health policy, Medicare will be a hot topic, as pay cuts are scheduled in 2025 for all doctors, further lowering physician payment at a time when expenses are very high due to inflation and staffing costs. In fact, I just returned from the American Medical Association (AMA) Interim meeting, where I served as a delegate from Florida. The AMA has made Medicare payment reform its top priority - to stop further pay cuts and to set inflationary adjustments so that doctors can continue to run their practices.
You may know that I opted out of Medicare back in 2016 because of declining reimbursement and increased rules and regulations - the payment was just unsustainable for a small primary care practice (you can read about my decision here: https://kevinmd.com/2016/12/one-year-later-physicians-letter-medicare-patients.html). Now other physicians including specialists are feeling the crunch of Medicare cuts - this is one of the reasons why you are seeing the small mom-and-pop doctor offices closing and more physicians joining huge healthcare companies. Others are retiring early because they can't afford to keep their doors open and they don't want to be owned by a private equity firm.
As a patient as well as a doctor, this scares me, because we already have a shortage of qualified physicians. These big companies that now own most doctors are trying to make up the cuts in payment by making doctors see more and more patients, which means less time for you - or trying to save money by replacing doctors with NPs or PAs. Paying doctors fairly so that they can run their own practices is the only way to fix this problem (not to mention allowing doctors to own hospitals again, which was outlawed by the Affordable Care Act, even though for-profit companies are allowed to!).
Although I agree that healthcare expenses are way too high, most of the money is not going to doctors, but to hospitals and pharmacy benefit managers. Physician pay is just 15% of all healthcare expenses, and yet Medicare is cutting payment to doctors and not to anyone else.
I would encourage you to learn more at https://fixmedicarenow.org/, and consider contacting your legislator to encourage them to help doctors continue to practice. This doesn't affect my pay, since I'm out of Medicare, but it has a big impact on the doctors I refer you to when you need specialist care - and it also affects me as a patient!
ACA INSURANCE OPEN ENROLLMENT ONLY UNTIL DECEMBER 15!!!
Between now and December 15 is the ONLY time you can enroll in an ACA / health exchange/ Obamacare plan (other than a qualifying event like marriage, giving birth, moving, or losing a job that provided health insurance). While most of these plans are pretty expensive, you may qualify for a subsidy, so it's worth checking! Go to healthcare.gov to look at your options.
MEDICARE ADVANTAGE PLAN CHANGE ONLY UNTIL DECEMBER 7!!!
If you are enrolled in a Medicare Advantage plan, you have from now until DECEMBER 7 to change plans or return to straight Medicare. I am very down on Advantage plans - because they are basically HMOs with VERY restrictive networks. If you need a referral, you MUST see your network P*P - they won't allow me to refer you. There may only be a few specialists or hospitals in network, and they may be far away from your location. Although Advantage plans charge lower premiums and may offer tempting 'prizes' (free gym memberships, etc), they tend to be really poor quality when it comes to paying for medical care.
My preference is to get out of Advantage plans and return to REGULAR Medicare. If you can buy a supplemental plan (Medigap) to pay the 20% of costs that Medicare doesn't cover, this is a very wise decision. Be aware that if you don't sign up for a Medigap / supplemental plan within the first few months of getting Medicare, they can get very expensive or refuse to enroll you - so don't wait if you are new to Medicare. Learn more: https://www.medicare.gov/basics/get-started-with-medicare/get-more-coverage/joining-a-plan
Sorry this is so long - but I hope that it's helpful information. Please reach out to me if I can be a resource to you! - Dr B
Rebekah Bernard MD
Gulf Coast Direct Primary Care
17595 S Tamiami Tr #204 Fort Myers, FL 33908
239-322-3860 (office phone)
