The number of observation patients has exploded 88 percent over the past six years, according to the Medicare Payment Advisory Commission. Medicare has tightened rules for hospital admissions, and usually won't pay for admitted patients who should have been designated as observation status. Consequently, hospitals have increased their share of observation patients. But the rule is not the same for people's private insurance like Medicare Advantage. Most Medicare Advantage plans don't require their enrollees to have a three-day hospital admission in order to receive nursing home coverage, according to an analysis by Avalere Health research firm. .Locality pay adjustments are currently used to adjust the paychecks of federal workers. Federal employees receive a two-part pay adjustment that includes base pay (which is established by a specific formula set by law) and locality pay adjustments. The locality pay adjustment varies depending on where the employee works. The parameters aren't set by law but use metropolitan statistical areas to define locality pay areas. ."People should watch for mail from their drug or health plans explaining cost changes for 2018," Johnson says. You can compare plans and make changes during the Medicare Open Enrollment period, which runs October 15th through December 7th. You can get free one-on-one counseling from your state Health Insurance counselors (SHIP) by contacting your local Area on Aging, or senior centers. Ask for help comparing Medicare drug plans. .Have you calculated how much you might need? How much income would be lost if you or your spouse were to pass away? There's a loss of retirement income, particularly when the higher benefit spouse dies. The couple's Social Security benefit is cut by one-third to one-half, and a couple's private pension benefit (if any) is either cut in half, or disappears completely if you have not opted for a joint-and survivor annuity. If you have a large estate, thriving business, valuable real estate and savings, would there be estate taxes to pay? Some families choose to keep life insurance because the death benefits are tax free to heirs, and can give the surviving spouse a financial cushion. .Social Security benefits are one of the few sources of retirement benefits to be adjusted for inflation. The intention is to protect the buying power of benefits when prices increase. But retirees frequently notice that over time their Social Security benefits don't buy as much as they used to. This happens when the annual COLA doesn't keep pace with the increases in costs typically experienced by older and disabled beneficiaries. .In 2017, the COLA was almost zero again, just 0.3%. The Medicare Part B premium rose to 4 for people not protected by hold harmless. Again the Part B premium of Barbara and the majority of Social Security recipients was adjusted. Barbara's monthly Medicare premium was adjusted to 8, taking every penny of her tiny COLA boost. .For details, or to see if your Members of Congress will be holding town hall meetings during this week's recess, call their local offices. You can find contact information HERE. .Patients would spend less to achieve better health. Value-based care systems focus on helping patients to recover from illness and on managing or avoiding chronic disease. The aim is to decrease the need for doctor visits, medical tests and procedures, and to reduce the amount of money spent on prescriptions while improving health. Value-based care encourages health providers to spend time on prevention-based services in order to focus more efforts on managing chronic disease with the goal of reducing costs like emergency room visits and hospitalizations. .Yet since 2010, when the Social Security Trust Fund first started running a cash deficit, budget negotiators have repeatedly attempted to enact Social Security reforms that would decrease benefits. One of the most widely - discussed proposals would switch to a more slowly - growing inflation measure — the chained consumer price index (CPI) — to calculate the annual cost – of – living adjustment as a means of slowing the growth of Social Security benefits and other inflation - adjusted federal programs. Although the proposal was not adopted in the past, primarily due to fear of public backlash, "It remains a key feature in many plans for reducing the deficit," Johnson says.