Are medical homes a good idea and just what are they anyhow?

It appears that the current administration in Washington will be launching a 3-year medical home program that may be an option for qualified Medicare beneficiaries in states that are participating in this program. What it boils down to is those who do qualify will live in Medicare housing where they will be seen on a regular basis by primary care doctors and other health care providers. Those other providers would possibly include social workers, therapists and nurse practitioners.

This is initially a pilot program to see if all goes well and to assess if Medicare recipients do get a high level of care offered to them. Overall though, the main reason behind this pilot program is to ideally reduce costs. Evidently the new program will offer access to things like dietitians and physical therapists, something not usually covered by the "original" Medicare. So this program may just be a step in the right direction and be a benefit to Medicare recipients who need these kinds of specialized services.

What is happening right now is that if a senior is on Medicare and needs a service that isn’t covered under their plan, they have two choices – either pay for the service out-of-pocket or buy Medicare supplemental insurance. Generally speaking, it’s a smart move for seniors to have Medicare supplemental insurance so they are covered for things they may need. Buying this later often becomes more expensive.

To make this new program work, it seems that Medicare will be joining hands with Medicaid, state and federal health care programs, and private insurers in states that will offer the medical home program. For instance, Vermont already has a medical care home model in operation. By all reports, it seems to be doing what it was created to do, provide "uniform standards for advanced primary care." It’s not just Vermont that has implemented this kind of a model either; so have Maine, Colorado and Massachusetts.

Never before has Medicare taken part in something this big and different. It breaks all the traditional rules and blazes some new trails. In addition to this it will be the first time that private insurance companies and primary care physicians will actually be on the same page when it comes to compensation. Of interest is that Vermont doctors get an extra patient bonus of $1.20 to $2.39 a patient, per month, to look after their care and get a further bonus if a patient’s health improves based on certain criteria.

If you’re making plans for the future, now is the time to call about making changes to your Medigap plans or improve your Medicare coverage. It is open enrollment until December 31, 2009.