Q: What are the differences in hospitals around Wyoming?

A: There are five generally recognized categories of hospitals:

 Hospital – A hospital is a facility supplying specialized staff and equipment to meet the health care needs of the surrounding population. Hospital funding is provided by a variety of sources, including: for-profit and non-profit health care organizations, health insurance companies, religious orders, and charities. Some hospitals have the unique ability to allow both “inpatients” and “outpatients”. Depending upon a patient’s need after their diagnosis, treatment, surgery, or therapy, they may be required to stay overnight for further observation or recovery. Hospitals that do not have overnight patients are usually referred to as ‘clinics.’

District – The district hospital is the central health care facility within its geographical region. District hospitals have a large capacity for intensive care and long-term care. Specialized centers for surgery, plastic surgery, obstetrics, and laboratories will also be available.

Specialized – There are various types of specialized hospitals such as, trauma centers, rehabilitation hospitals, children’s hospitals, geriatric hospitals, psychiatric hospitals. In addition, there are specialty specific hospitals for cardiology, oncology, orthopedics, etc. These specialty hospitals are typically part of a large hospital or hospital network. They are often located on the hospital campus or nearby.

Teaching – Some hospitals are affiliated with a university, college, medical school, or nursing school and offer health care to patients while teaching medical students, physicians, surgeons, and nurses. Teaching hospitals are unique in that they employ physician residents who are in training and work hand in hand with local medical schools. The physician residents are overseen by chief medical residents as well as department chairs of the various medical specialties.

Clinic – Clinics generally provide outpatient care only and are smaller than a typical hospital. Clinics are usually operated by a government health agency or a partnership of private physicians and/or surgeons.

There are many departments that can be found within a hospital or clinic, including trauma centers, burn centers, emergency departments, surgery, wound care, or urgent care. There may be outpatient departments such has psychiatric health, physical therapy, dentistry, and rehabilitation. Also, specialized units of equipment, physicians and nurses will support the various departments with expertise or functionality in cardiology, obstetrics and gynecology, oncology, intensive care, neurology, pathology, and radiology.

Q: How are the hospitals owned/funded?

A: Funding can come from a number of sources, depending upon how the hospital is managed.

Non-profit hospitals – are entities mostly funded through charity, religion, or research/educational funds.  They do not pay federal income or state and local property taxes, and in return are expected to provide community benefits that justify the forgone government tax revenues.

Private hospitals – are owned by a for-profit company or a non-profit organization and privately funded through payment for medical services by patients themselves, by insurers, Governments through national health insurance programs, or by foreign embassies.  Required submission of taxes to local and state governments are the same for private hospitals as any other business entity that does not identify itself as a not-for-profit business.

Critical Access Hospitals – are certified to receive cost-based reimbursement from Medicare.  The reimbursement that CAHs receive is intended to improve their financial performance and thereby reduce hospital closures.  They must also be located in a rural area, maintain no more than 25 inpatient beds, furnish 24/7 emergency care, and be located more than 35 miles from the nearest hospital.

Public-private partnerships are an option for publicly owned hospitals.  They involve a contract between a public sector authority and a private party, in which the private party provides a public service or project and assumes substantial financial, technical, and operational risk in the project.

There are about 5,100 hospitals in the United States. In round numbers, the ownership breaks down like this, in round numbers:

  • The Federal government owns about 200, including military hospitals and veteran’s hospitals.
  • State and local governments own about 1,000
  • Another 1,000 are owned by for-profit companies
  • The remaining 2,900 are owned by not-for-profit organizations

With the exception of the Federal hospitals, which are funded entirely from Federal tax revenues, hospital funding comes from a variety of sources, including:

  • Medicare and Medicaid for patients covered by those Federal programs
  • Local tax revenues for some of the local governmental hospitals
  • Insurance companies
  • Out-of-pocket payments from patients
  • Donations
  • Grants

 Q: Where does Wyoming health care currently rank?

A: Healthcare is ranked by looking at several factors.  Full details can be found at www.beckershospitalreveiw.com

In a 2017 ranking done by Beckers Hospital Review, Campbell County Memorial Hospital in Gillette and Sheridan Memorial Hospital were recognized in the top 20 rural hospitals in the country for their work in managing risk, achieving higher quality, securing better outcomes, increasing patient satisfaction and operating at lower costs than their peers.  Hospitals are evaluated on their ratings in the Hospital Strength Index, which evaluates hospitals based on their inpatient and outpatient market share, quality, outcomes, patient perspectives, costs, charges and stability.

Overall health care in Wyoming is ranked 33rd out of 50 in the country.  More specifically, Health Care Access is 44th, while Health Care Quality and Public Health are 25th.

Q: What specialties are already available in Wyoming?

A: Specialty procedures can be accessed at different hospitals around the state; not all specialties listed are available at every hospital location.

Oncology, Cardiology, Orthopedics, Gastroenterology, Geriatrics, Nephrology, Neurology/Neurosurgery, Psychiatry, Pulmonology, Rehabilitation, and Urology are all areas of treatment that are available, primarily through Wyoming Medical Center and Cheyenne Regional Medical Center.

Common procedures that can be provided in Wyoming include:

Abdominal Aortic Aneurysm Repair, Aortic Valve Surgery, treatment for COPD, Colon Cancer Surgery, Heart Bypass Surgery, Heart Failure, Hip Replacement, Knee Replacement, and Lung Cancer Surgery.

None of these procedures are available at a pediatric level in any of the hospitals around the state without the service of out of state doctors who travel to offer clinics for those patients.

Q: How does health care affect the economy?

A: Americans now spend nearly one in five dollars on health care. 

Even with insurance, many households still remain vulnerable to depleting their savings in the event that they experience a major illness or injury.  Rising health costs affect household finances.  Income and savings that would otherwise be used for purchasing consumer goods, or put toward savings for financing future educational costs or retirement, must be used to cover health care services.  For less affluent households, this could result in forcing tradeoffs between health care and other normal necessities of living.

Increasing public sector health care spending will indirectly impact households.  Public sector financing requirements might result in increases in taxes, borrowing, or some combination of the two.  Such increases would impact households via direct reductions in disposable income or increases in the cost of borrowing.

Due to inaction from Congress, critical programs that protect healthcare in rural communities expired in 2017.  The Medicare-Dependent Hospital program expired September 30; the enhanced Low-Volume Adjustment program expired September 30; and the ambulance add-on payment program expired December 31.  These programs have bipartisan support and are critical for rural hospitals and their ability to provide quality, accessible care in Wyoming communities.  Rural hospitals overall provide essential health care services to nearly 57 million people and are often the only source of care in the community.  Every dollar spent by a rural hospital produces another $2.29 of economic activity.  830 rural hospitals across the country are negatively impacted by the expiration of these programs, threatening patient access to care. 

Q: What is the impact of the economy on health care?

A: As the economy changes, the effect on personal health feels an impact too.

  1. More Uninsured Families – Due to the rise in unemployment, the number of uninsured families have increased as these families have lost their insurance funded by the employer. And many of these families cannot maintain their own insurance.
  2. Rise In Obesity Rate – We have never been more informed about obesity and yet, the rate of obesity keeps on rising. It is estimated that every child out of three children is obese in the United States. There are several diseases like diabetes, high cholesterol, high blood pressure, heart attack, and stroke that are caused due to obesity. It puts immense strain on the health care system.  
  3. Staff Shortage – many rural areas do not have the number of special need patients to require specialty doctors to offer regular care.  This requires the local hospitals to find ways to bring specialists to their area, or send patients to larger cities, often travelling outside state lines.

Q: How does Medicaid/Medicare work?

A: Medicaid is a federal government program to help provide healthcare coverage to certain categories of people who have low income and few assets (other than the home they live in). Among those covered by Medicaid are people over 65 and those with disabilities. Each state runs its own version of Medicaid, with slightly different rules and coverage.

The Medicaid program has several different parts:

  • Medicaid medical coverage includes most common forms of healthcare, as explained in this article. Medicaid medical benefits cover at least the same healthcare services that Medicare does, as well as some services that Medicare doesn't cover. Medicaid also pays Medicare premiums, deductibles, and co-payments for people who are enrolled in both programs.
  • A separate part of Medicaid covers long-term nursing home care.
  • Special Medicaid-funded programs cover long-term, in-home personal care. Income and asset eligibility rules for these long-term, at-home care programs are usually quite a bit looser than for regular Medicaid medical coverage.
  • In some states, a Medicaid-related program can pay some of the cost of assisted living.

To find out exactly what Medicaid and Medicaid-related programs operate in your state, what they cover, and who's eligible, contact a local office of your state's Medicaid program. To find a local Medicaid office, go to the federal government's Benefits.gov website and choose your state. This will take you to a page with contact information for your state's Medicaid program and information about local offices.

What's the difference between Medicaid and Medicare?

Their names are similar, but Medicaid and Medicare are two completely different programs. A person can qualify for both Medicaid and Medicare.

  • Medicare is for almost everyone ages 65 or older, and people with long-term disability, regardless of their income or assets.
  • Medicaid is only for people with low income and very few assets other than a home.

Is Medicaid valuable for someone who also has Medicare?

If someone qualifies for both Medicare and Medicaid, Medicare covers most of that person's medical services. But there are a number of medical services that Medicare doesn't cover, which a state Medicaid program might.

Also, Medicare leaves many of a person's medical bills unpaid, even for services Medicare does cover. This includes Medicare premiums, deductibles, and co-payments, as well as the cost of some prescription drugs not covered by a Medicare Part D prescription drug plan.

If Medicare Part A or Part B covers a medical service but leaves some part of the cost unpaid, Medicaid will pay that extra amount for someone who's enrolled in both programs. Someone with both Medicare and Medicaid must enroll in a Medicare Part D plan in order to get their prescription drugs covered, but Medicaid may cover some drugs not included in Medicare Part D plans.

How much income is allowed for Medicaid medical coverage?

Medicaid medical coverage is available only to people with very low income. Exactly how much income is permitted depends on the state where you live. In all states, if your income falls below the eligibility standard for the federal government's Supplemental Security Income program, known as SSI, you're also eligible for Medicaid medical coverage. This amount is about $700 per month in what's called "counted" income. But quite a bit of your actual income might not be counted toward this figure. So, if your actual income is up to $1,500 per month, you should consider applying for Medicaid.

If either spouse in a married couple applies for Medicaid, the income of both spouses (if living together) is counted by Medicaid when deciding eligibility. Also, if a Medicaid applicant receives free housing and regular meals from family or friends, or has bills regularly paid for them, Medicaid may consider this as income when deciding eligibility.

In many states, Medicaid medical care coverage is also available to people whose income is higher than the state's Medicaid eligibility level if they also have regular medical expenses that aren't paid by another program or insurance. This category of people is known as "medically needy." So if you have any regular medical bills that aren't covered by Medicare or other insurance, you may be eligible for Medicaid coverage even if your income is well over the normal Medicaid limit.

How much in assets is allowed for Medicaid medical care coverage?

Someone applying for Medicaid medical coverage is allowed $2,000 ($3,000 for a couple) in cash, savings, or other assets, plus a number of other assets that are "exempt" (not counted) from Medicaid eligibility rules. These exempt assets include:

  • A house that the applicant lives in.
  • An automobile, sometimes limited to a certain fair-market resale value of around $5,000 (this varies from state to state).
  • Personal property and household goods for regular daily use, sometimes limited to a certain fair-market resale value (this varies from state to state).
  • Wedding and engagement rings.
  • Life insurance with a total face value (cash surrender) of no more than $1,500, and term life insurance with no cash surrender value.
  • Specially earmarked funeral and burial fund of up to $1,500, plus a burial space.

A person who wants to apply for Medicaid medical coverage can give away or transfer any amount of assets in order to qualify. Medicaid medical coverage eligibility doesn't have any of the rules or penalties regarding transfer of assets that apply to Medicaid nursing home coverage.

How do I get help with Medicare costs if my income is too high for Medicaid?

If you have low countable income, few assets (not counting your home, a car, and other personal possessions), but your income or assets are slightly too high to qualify for Medicaid, you may still be eligible for another program that provides substantial financial help with medical costs. These other programs are called Qualified Medicare Beneficiary (QMB), Specified Low-Income Medicare Beneficiary (SLMB), and Qualifying Individual (QI). Here are the basics about these three programs:

  • QMB: You may qualify as a QMB if your counted income is up to about $950 per month (varying slightly from state to state). You may also have nonexempt assets of up to $4,000 ($6,000 for a couple). If you are eligible to be a QMB, your state will pay all of your Medicare Part A and Medicare Part B premiums, deductibles, and coinsurance amounts.
  • SLMB: You may qualify as an SLMB if your counted income is up to about $1,150 per month. You may also have nonexempt assets of up to $4,000 ($6,000 for a couple). If you qualify as an SLMB, the program will pay your monthly Medicare Part B premium.
  • QI: You may qualify as a QI if your counted income is up to about $1,300 per month and your nonexempt assets are no more than $4,000 ($6,000 for a couple). If you qualify as a QI, the program may pay your Medicare Part B monthly premium, but each state's QI funds are limited and there's no guarantee of coverage.

How does Medicaid spend-down work?

If a family's or couple's assets would qualify them for Medicaid but their income is over their state's Medicaid limit, in most states they can still qualify for Medicaid coverage if their medical bills add up to more than the amount by which their income exceeds the Medicaid limit. This spend-down provision, called "share of cost" in Medicaid jargon, is similar to a deductible under a typical health insurance policy, because it's the amount they'd have to pay out of their own pocket before Medicaid coverage kicks in.

What kind of medical care is covered by Medicaid?

Every state's Medicaid program covers basic medical care, to the same extent that Medicare Part A and Medicare Part B do. This includes:

  • Inpatient hospital care
  • Inpatient short-term skilled nursing- or rehabilitation-facility care
  • Doctor services
  • Outpatient hospital or clinic care
  • Laboratory and X-ray services
  • Short-term home healthcare (provided by a home healthcare agency)
  • Ambulance service
  • Prescription drugs for people not covered by Medicare

For these basic services, neither Medicaid nor the healthcare provider may charge the patient any co-payment.

State Medicaid programs may choose to cover optional medical services beyond those listed above. If a state Medicaid program covers an optional medical service, it's allowed to charge the patient a small co-payment for it. The optional coverage offered, and the co-payments for each optional service, vary from state to state but may include:

  • Eye examinations and glasses
  • Hearing tests and hearing aids
  • Dental care
  • Preventive screenings
  • Physical therapy (beyond what is offered under Medicare)
  • Nonemergency transportation to and from medical treatment
  • Some non-Medicare-covered prescription drugs and some nonprescription drugs, including certain vitamins
  • Chiropractic

Will Medicaid cover medical care from any provider?

In order to have Medicaid cover your medical care, each medical service must be provided by a doctor or other provider who participates in Medicaid. However, because Medicaid doesn't reimburse doctors and other healthcare providers at the same rate as private insurance, many providers don't treat patients who are enrolled in Medicaid. If you're enrolled in Medicaid, make sure to check in advance with any healthcare provider about whether they accept Medicaid patients.

Many Medicaid enrollees receive care through a Medicaid managed care plan, such as an HMO. These Medicaid managed care plans work in the same way that a Medicare Part C managed care plan does, with restrictions on the doctors and other providers you may use -- except that there's no monthly premium and no co-payments except for optional services beyond what Medicaid is required to provide. In some states, you can choose from several of these Medicaid managed care plans, in addition to regular Medicaid coverage under which you're free to choose any doctors or other providers as long as they accept Medicaid patients. When you enroll in Medicaid, you get information from your local Medicaid office about what Medicaid managed care plans are available to you and how they work

What Medicaid does not cover

While Medicaid covers a broad range of medical care, there are certain items and services the program generally does not cover.

For example, Medicaid does not cover the costs of prescription drugs. However, those who are eligible for Medicaid may be able to get their premiums paid for Medicare’s prescription drug plan, Medicare Part D.

Below are additional medical and health care related costs that are not covered by Medicaid

  • Routine or annual physical checkups
  • Over-the-counter medications or supplements
  • Custodial care, or assistance with activities of daily living (ADLs)
  • Missed appointments
  • Dental services
  • Cosmetic surgery
  • Medical services provided outside of the U.S.

More information on the items and services not covered by Medicaid, plus exceptions to those rules, can be found on the Medicare website.

Medicare is the government's contract to provide healthcare insurance coverage for Americans over the age of 65. But, as with all contracts, it's always smart to read the fine print.

Medicare pays for about half of all medical costs for older Americans, including hospitalization, doctors, some nursing care, some prescription drug costs, and medical equipment and supplies. But there's much that Medicare doesn't cover, as well as an alphabet soup of coverages, premiums, deductibles, and eligibility requirements that can be difficult to navigate -- especially for someone facing a health crisis.

Here are the basics everyone should know about Medicare, and where to look for more information if you need it:

What is Medicare?

Medicare consists of four categories: Part A covers hospitalization, some skilled nursing facility and home health care, and hospice. Part B covers doctors' services and outpatient care such as X-rays, laboratory work, some home health care, physical and occupational therapy, and some preventive screening. Then there's Part C, also known as Medicare Advantage, which is Medicare received through a private managed care system such as an HMO (health maintenance organization) or PPO (preferred provider organization). When someone enrolls in a Medicare Advantage plan, they receive all the benefits of Medicare Parts A and B, as well as some additional coverage provided by the private plan. As with other managed care, however, Medicare Advantage plans limit where and how their members may receive care. Finally, there's Medicare Part D, which consists of private insurance plans that partially cover prescription drug costs.

Who's eligible for Medicare?

Most people qualify for all Medicare programs if they're 65 or older and are citizens or permanent residents of the United States. However, eligibility rules and availability are different for each plan within Medicare.

  • For Part A, people are automatically eligible without paying any premium if, in addition to the age and residency requirements, they worked and paid Social Security taxes for at least ten years. If not, they may still buy into Part A coverage for a yearly premium.
  • For Part B, every citizen and legal resident over 65 is eligible. Even if someone is under age 65, he or she may qualify for both Part A and B if he or she has been receiving Social Security disability benefits for two years or has a chronic kidney disease.
  • If they're eligible for Parts A and B, they can choose to receive that coverage through a Part C Medicare Advantage managed care plan, if a plan they like is available where they live.
  • Anyone eligible for Medicare may purchase a Part D prescription drug plan offered by private insurance companies in the state where they live.

How does someone enroll in Medicare?

Enrollment is different for each part of Medicare. People who are receiving any type of Social Security benefits when they turn 65 will be automatically enrolled in Parts A and B. Medicare will send them enrollment cards and information about three months before their 65th birthday. If they aren't automatically enrolled, they may sign up for Part A or Part B at any local Social Security office. They should enroll two or three months before they turn 65 to ensure prompt coverage.

If they delay enrolling in Part A past their 65th birthday, their coverage can date back to up to six months before the date they do apply. Delaying enrollment in Part B is more of a problem. If they wait more than three months after their 65th birthday to enroll in Part B, they may not enroll until January 1 of the following year, and the coverage won't start until July 1 of that year.

If they want to enroll in Part C or D of Medicare, they do so with the private managed care plan or insurance company that runs the particular plan or issues the policy they want. If they don't enroll in Part C or D when they turn 65, or if they want to switch coverage under Part C or D, they can do so during Medicare's annual enrollment period, which falls between October 15 and December 7. (Some managed care plans and insurance companies also allow enrollment throughout the year.)

Which healthcare providers can Medicare patients see?

They can go to any doctor, hospital, clinic, outpatient provider, nursing facility, home care agency, or pharmacy that is approved by Medicare and that accepts Medicare patients. Before a visit, it's essential to verify that the doctor or other provider accepts Medicare.

What's covered by Medicare?

Medicare is intended primarily to provide coverage if when someone becomes ill or injured. This includes hospitalization, doctors' services, lab work, X-rays, hospice, and just about every kind of outpatient care, as well as some inpatient nursing facility and psychiatric care.

Over the years, however, Medicare has evolved to also cover a range of preventive and screening services through the Part B plan. Some of these services include cardiovascular screening; smoking cessation counseling; screening for breast, cervical, vaginal, colon, and prostate cancers; immunizations for flu, pneumococcal virus, and hepatitis B; diabetes screening and supplies; glaucoma tests; and a "Welcome to Medicare" physical exam. Most Medicare Part C managed care plans offer even more of these preventive and screening services.

For those who meet certain requirements for home health care, Medicare also pays for part-time nursing care; part-time health aides; speech, physical, and occupational therapy; and medical supplies and equipment such as bandages and wheelchairs.

Under Part D, the prescription drug benefit, Medicare covers part of the cost of approved generic and brand-name prescription drugs purchased at participating pharmacies.

What's not covered by Medicare?

Medicare isn't intended or designed to provide long-term nursing home or in-home care, so there are significant gaps in these areas. Families can't rely on Medicare to pay for 24-hour at-home care, meals, delivery services, and many of the personal services provided by home health aides (except for some skilled nursing care for a short time if it's medically necessary ).

Although Medicare has added many preventive services to its coverage in recent years, many such routine care needs are not yet covered, including dental care, medical treatment outside the United States, routine foot care, glasses, and hearing aids. Medicare coverage for mental health treatment -- including depression, which is a growing issue among people over 65 -- is also significantly limited. And Medicare doesn't cover elective procedures, including cosmetic surgery.

Most important, make sure the doctors you have in mind accept Medicare, or the program won't pay for even covered costs. This is also true for outpatient care and home care, and for prescription drugs, which Medicare patients must buy from a pharmacy that participates in their particular Part D insurance plan.

How much does Medicare cost?

Each part of Medicare has a different payment system. And within each part, patients' out-of-pocket costs will depend on the particular way they receive their benefits. However, the following basic information about premiums and copayments holds true in most cases. The figures given are for 2012.

  • Part A: Most people pay no premium for Medicare Part A. People who aren't automatically eligible for Part A pay a monthly premium of up to $451. Everyone with Part A pays a deductible of $1,156 for each period of hospitalization, and copayments for each day past the first 60 days of a particular hospital stay.
  • Part B: Every individual pays a premium of at least $99.90 a month for Part B coverage, deducted from monthly Social Security checks; this figure goes up for people with high incomes. A person must also meet an annual deductible of $140. After the deductible, Medicare pays 80 percent of the approved amount for covered doctor services and 80 to 100 percent of the approved amount for outpatient services and medical equipment. Those who don't enroll in Part B when they turn 65 can enroll later -- but each year they put it off, the premium increases by 10 percent.
  • Part C: Part C Medicare Advantage private managed care health plans lump Part A and B together, offering one monthly premium and the plan's own set of copayments and deductibles. It's important to check not only premiums but also out-of-pocket costs when considering one of these plans.
  • Part D: Every prescription drug plan under Part D has different premiums, copayments, and drugs it covers. In choosing a plan, be sure not to focus solely on the lowest monthly premium but also on coverage of the specific drugs needed and any copayments that might apply.

Where can I find more information about Medicare?

You can look at the federal website for Medicare and Medicaid , an online service run by the National Council on Aging that can help you identify which government benefits seniors qualify for and how to enroll.