May 21, 2013
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Medicare
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With the March 2010 passage of the ‘Patient Protection and Affordable Care Act (PPACA), the ‘follow the money’ floodgates are once again opening for hospitals, physicians, integrated delivery systems, health plans, and consultants. This time, instead of migrating ‘HMO lite’ (neither staff nor group model) platforms into mainstream medicine via IPAs, or MeSH model JV’s, we’re now talking about their ‘new and improved’ successors broadly cast as ‘Accountable Care Organizations aka ‘ACOs’.
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wordpress.com
Video: Medicare Shared Savings Program Overview National Provider Call 12/7/11
VIDEO CMS Announces July 31 Deadline for Medicare Shared Savings Program Applications : Bridging Business & Healthcare
However, CMS has announced a July 31 deadline. An accountable care organization intending to submit an application must file a Notice of Intent by May 31 and obtain a CMS User ID by June 10. Failure to meet these deadlines will disqualify an organization from MSSP participation in 2014. CMS has not yet published the Notice of Intent form or the application packet. CMS will be hosting a national provider call regarding the 2014 MSSP application process on April 9. A second call is scheduled for April 23.pyapc.com
Notes from the Cliff: The Deal and Its Impact on Medicare
Cong. Tit. VI (2012) [2] Id. at §§ 601, 603, 607, 608, 610, 621, 643 (2012) [3] For more information on the Sustainable Growth Rate See The Sustainable Growth Rate Formula and Health Reform, The Center on Budget and Policy Priorities, (April, 2010) http://www.cbpp.org/files/4-21-10health2.pdf & Mary Agnes Carey, ‘Doc Fix’ In ‘Fiscal Cliff’ Plan Cuts Medicare Hospital Payments, Kaiser Health News, Jan. 1, 2013, http://capsules.kaiserhealthnews.org/index.php/2013/01/doc-fix-in-senate-fiscal-cliff-plan-cuts-medicare-hospital-payments/ [4] There is a separate $1,900 per year cap for occupational therapy [5] See also the Medicare Improvements for Patients and Providers Act of 2008, Pub. L. No 11-275, codified at 42 U.S.C. §§ 1320b-14, 1396u-5(a) (2010).medicareadvocacy.org
Medicare Savings Program sees enrollment rise
Enrollment increased 5.2% in 2010 and 5.1% in 2011, according to the GAO. It attributed the growth to factors including the SSA’s efforts as well as the economic downturn. The Medicare Improvements for Patients and Providers Act of 2008 requires that the SSA address the roadblocks preventing low-income beneficiaries from signing up for the savings program. Those barriers were pegged as low awareness and cumbersome enrollment processes. In addition to outreach, the SSA was also required to transfer information on beneficiaries who file a low-income subsidy application to a state Medicaid agency. Officials in 28 states reported growth in their Medicare Savings Programs as a result of Social Security Administration transfers, the GAO found. The GAO noted that the amount of additional work for states will depend on whether they decide to re-verify the information beneficiaries provided to the SSA and whether their eligibility requirements align with the federal government’s.modernhealthcare.com
Maximizing your Resources and Saving Money: Medicare Savings Program
If you are on Medicare and have a limited income you may qualify for your state to pay your Medicare Part B premium. Eligibility in the program automatically qualifies you for extra help paying your Medicare Part D premium and prescription copayments. Check with your State for the requirements. Applications can usually be obtained online or at your local Social/Senior Services Center. Here are the following requirements in the State of CT:blogspot.com
UCLA Health System chosen as a Medicare Shared Savings Program accountable care organization / UCLA Newsroom
The UCLA Health System, which comprises the UCLA Hospital System and the UCLA Medical Group and its affiliates, has provided a high quality of health care and the most advanced treatment options to the people of Los Angeles and the world for more than half a century. Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA, and UCLA Medical Center, Santa Monica (which includes the Los Angeles Orthopaedic Hospital) deliver hospital care that is unparalleled in California. Ronald Reagan UCLA Medical Center is consistently ranked one of the top five hospitals in the nation and the best in the western United States by U.S. News & World Report. UCLA physicians and hospitals continue to be world leaders in the full range of care, from maintaining the health of families to the diagnosis and treatment of complex illnesses.ucla.edu
GAO: More enrollees take advantage of Medicare Savings Programs
Despite historically low numbers, enrollment for the Medicare Savings Programs is up, the Government Accountability Office reported Friday. With enrollment rising every year since 2007, the report suggests the Social Security Administration has been successful at eliminating barriers to enrollment, which could reduce Medicaid spending for certain beneficiaries. Historically, low enrollment has been attributed to a lack of awareness about the four programs (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualifying Individual, and Qualified Disabled and Working Individual), as well as cumbersome enrollment processes through state Medicaid programs, GAO noted. For instance, in 2004, only a third (33 percent) of eligible beneficiaries were enrolled for the Qualified Medicare Beneficiary program, and only 13 percent were enrolled in the Specified Low-Income Medicare Beneficiary program, the report noted.fiercehealthcare.com
State Solutions: An Initiative to Improve Enrollment in Medicare Savings Programs
The five grantee states used many approaches to identify and enroll new participants in Medicare Savings Programs. Strategies included modifying the programs’ eligibility requirements, expanding outreach activities, simplifying the enrollment process, training staff and volunteers to conduct enrollment activities, forging partnerships, expanding enrollment opportunities, strengthening data collection and engaging state representatives to explore barriers to enrollment.rwjf.org
Shared Savings Program Application
The filing period for the Notice of Intent (NOI) to Apply for participation in the Medicare Shared Savings Program 2014 program starts today May 1, 2013 and expires on May 30, 2013. The completed NOI must be submitted no later than 5 p.m. EST May 31, 2013. CMS only accepts NOIs submitted electronically and advises that processing time may vary, so applicants are instructed to plan to submit their NOI as early as possible. Those submitting a completed NOI will get NOI Receipt Notice by e-mail that includes the ACO identification number (ACO ID) and detailed instructions on how to get a CMS User ID. CMS states that an applicant must have an ACO ID to apply to participate in the Shared Savings Program and • You must have a CMS User ID and password to submit your application using the online Health Plan Management System (HPMS.) Additional instructions on acquiring a CMS User ID and related due dates are set forth on the web site.sascottlaw.com
HHS Names 106 New Participants in Medicare Shared Savings Program
In addition, 15 organizations in the latest ACO cohort are Advanced Payment Model ACOs, which are physician-based or rural providers granted capital to invest in electronic health record systems, staff and other infrastructure improvements. CMS will recoup the advanced payments through future shared savings (CMS release, 1/10). Another 15 Advanced Payment Model ACOs were announced in the second round of ACOs.californiahealthline.org
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May 21, 2013
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Of course, as a number of people have pointed out, this move doesn’t prevent IPAB from working. If the Senate doesn’t confirm anyone to the board, it just means that the HHS secretary has to make cost-cutting proposals on her own if Medicare grows faster than allowed. So what’s the point? Pretty obviously, it’s to make sure that if Medicare is cut in any way, Republicans can blame it solely and completely on Democrats.
Source:
motherjones.com
Video: What Does Medicare Cost?
VIDEO Study Takes on the Myth of Medicare Cost Shifting
Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.firedoglake.com
Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence
With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and lower health care costs – with some estimates projecting hundreds of billions of dollars in savings over the next decade.kff.org
Study: Cuts to Medicare trim costs to insurers
Chapin White, a senior health researcher at the Center for Studying Health System Change, analyzed data on payment rates from 1995-2009 and found a widening gap between Medicare rates and private rates. Medicare had an average annual growth rate of 3 percent while private insurance grew more quickly — at 3.56 percent — he found.politico.com
thriftymommastips: Medicare Part D Costs #Walgreens Prescription Savings #ad
My kids, my Mom and I all have needed prescriptions often in the last decade. Prescriptions actually eat up a massive chunk of our family budget. When I was a new university graduate and my Crohn’s, an inflammatory bowel disease thought to also be an autoimmune disorder, was in full flare I frequently lost a lot of weight, watched my energy vanish, and the potential to make money sadly shrivelled up. Those days, as sick as I was, with prescriptions that cost over $500 a month and no drug plan, I was often faced with the reality of paying for medications that were needed, or getting food. Paying tuition, paying for food and drugs? Impossible. That’s a position nobody should ever have to find themselves in, especially as a caregiver, or a patient. Sadly, I am far from alone, caregivers everywhere are forced to make these terrible choices daily. Seniors, on fixed incomes, and people struggling with disability shouldn’t be forced to choose between prescriptions and groceries. Families bearing emotional and financial responsibility for caregiving shouldn’t be fearful of how to spend their money. Caregiving is hard enough, rewarding for sure, but challenging in so many ways. The stress of caregiving shouldn’t be compounded by cost of prescription drugs. thriftymommastips.com
Trial against Da Vinci Robot, Medicare Costs and Benefits, Tough Week for Hospitals, HHS Fundraising, But there’s Plenty of Money out There
Since its inception in March 2007, the Medicare Fraud Strike Force, now operating in nine cities across the country, has charged more than 1,480 defendants who have collectively billed the Medicare program for more than $4.8 billion. In addition, HHS’s Centers for Medicare and Medicaid Services, working in conjunction with HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. To learn more about the Health Care Fraud Prevention and Enforcement Action Team (HEAT), go to: www.stopmedicarefraud.gov.oconnorreport.com
How Medicare Costs Can Be $180 Billion Lower Over 10 Years
In “Medicare Essential: An Option to Promote Better Care and Curb Spending Growth”, Karen Davis, Ph.D., director of the Roger C. Lipitz Center for Integrated Health Care at The Bloomberg School of Public Health, and Commonwealth Fund scholars Cathy Schoen and Stuart Guterman, detail their proposal for a new public insurance plan choice that would simplify Medicare. By offering a comprehensive set of benefits that includes medications and lower deductibles, the Medicare Essential plan would offer beneficiaries better financial protection, a limit on out-of-pocket spending, and the opportunity for additional savings in premiums and out-of-pocket expenses for those who select high-value health care providers and hospitals that are able to provide quality care while keeping down costs.science20.com
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May 21, 2013
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Currently, Medicare beneficiaries with incomes starting at $85,000 (or $170,000 for couples) pay higher Part B and D premiums, which start at 35 percent of program costs and peak at 80 percent of program costs for beneficiaries with incomes over $214,000 (or $428,000 for joint filers). As of now, these higher premiums affect only 1 in 20 Medicare recipients. While the thresholds for higher premiums were originally adjusted annually for inflation, a provision in the ACA froze the income thresholds through 2019, at which point almost 10 percent of beneficiaries are projected to pay income-related premiums. Starting in 2020, however, the thresholds are scheduled to bounce back upward as if they had never been frozen, thereby reducing the proportion of beneficiaries who would be subject to higher premiums.
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bipartisanpolicy.org
Video: Improving Medicare in 2011
VIDEO Ideas for Reforming the Medicare Benefit Design: A Historical Reminder of Bipartisan Support
“Under Medicare Parts B and D, certain beneficiaries pay higher premiums based on their higher levels of income. Beginning in 2017, this proposal would restructure income-related premiums under Medicare Parts B and D by increasing the lowest income-related premium five percentage points, from 35 percent to 40 percent, and also increasing other income brackets until capping the highest tier at 90 percent… “…Introduce Part B Premium Surcharge for New Beneficiaries Purchasing Near First-Dollar Medigap Coverage: This proposal would introduce a Part B premium surcharge for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, effective in 2017.” – U.S. Department of Health & Human Services. “Fiscal Year 2014 Budget in Briefing.” 2013.house.gov
Social Security and Medicare Taxes and Benefits Over a Lifetime
Notes: All amounts are in constant 2011 dollars as noted, adjusted to present value at age 65 using a 2 percent real interest rate. Each calculation assumes survival until age 65 and then adjusts for chance of death in all years after age 65. It also assumes that benefits scheduled in law will be paid even if trust funds are exhausted. Workers are assumed to work every year from age 22 to age 64 and retire at age 65 or the Normal Retirement Age. An average-wage worker earns the average wage in the economy every year, based on Social Security’s measure of the “average wage.” The low-wage worker earns 45 percent of the average wage, while the high-wage worker earns 160 percent of the average wage. The tax-max wage worker earns at the taxable maximum every year. Medicare numbers are net of premium, other than the new premium tax on some high earners.urban.org
Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits
Critics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.firedoglake.com
New Medicare Benefits and Changes for 2011
Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.aarp.org
Is Medicare a Ponzi Scheme? The American Magazine
Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.american.com
Public Wants Changes in Entitlements, Not Changes in Benefits
When it comes to Medicaid, just 37% want to allow states to cut back on who is eligible for Medicaid in order to deal with budget problems, while 58% say low-income people should not have their Medicaid benefits taken away. And most say it is more important to avoid future cuts in Social Security benefits than future increases in Social Security taxes (56% vs. 33%). On Social Security and Medicare, there are substantial differences of opinion by age. People age 65 and older are the only age group in which majorities say these programs work well; seniors also overwhelmingly say it is more important to maintain Social Security and Medicare benefits than to reduce the budget deficit. Those 50 to 64 also broadly favor keeping benefits as they are. Younger Americans support maintaining Social Security and Medicare benefits, but by smaller margins than older age groups.people-press.org
New Hope for Those Denied Medicare Benefits?
There is a re-review process for certain Medicare beneficiaries who were denied benefits for rehabilitative services. The denial must have become final and appealable after January 18, 2011. A further appeal need not have been filed. The re-review process only applies to services that were actually received by the Medicare beneficiary. In other words, if Medicare denied benefits and no further rehabilitative services were received the Jimmo settlement will not help you. Medicare can only pay for services received. If skilled care was stopped because Medicare wouldn’t cover, you may be able to get it restarted under this new standard. First, you’ll need your doctor to explain in writing why skilled care or therapy is necessary. Keep in mind that all the normal Medicare requirements still apply. For example, skilled nursing care requires the 3 day hospital stay first.estateplanandassetprotection.com
State Medicaid Changes: Cuts and Increases During Recession to Medicaid Benefits and Provider Payments
An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.piperreport.com
More than 30 million with Medicare used free preventive services in 2011
The report discussing Medicare preventive services found that more than 25.7 million Americans in traditional Medicare received free preventive services in 2011. The report also looked at Medicare Advantage plans and found that 9.3 million Americans – 97 percent of those in individual Medicare Advantage plans – were enrolled in a plan that offered free preventive services. Assuming that people in Medicare Advantage plans utilized preventive services at the same rate as those with traditional Medicare, an estimated 32.5 million people benefited from Medicare’s coverage of prevention with no cost sharing.medicare.gov
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May 21, 2013
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[1] Title II of H.R. 1845, entitled "Strengthening Medicare Secondary Payer Rules," amends 42 U.S.C. §1395y(b)(2)(B) of the Medicare Statute, Pub. Law No. 112-242 (January 10, 2013). See http://beta.congress.gov/bill/112th-congress/house-bill/1845/text. The Bill Summary and status report are available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.1845. The current Medicare Secondary Payer Recovery Contractor (MSPRC) website is located at www.msprc.info. Title I, Section 101 of H.R. 1845, sets out a demonstration project under Medicare Part B for the payment of supplies and services related to the administration of Intravenous Immune Globin (IVIG) for the treatment of primary immune deficiency diseases. [2] The Medicare Secondary Payer program is set out at 42 U.S.C. §1395y(b)(2). [3] The Center’s work on MSP matters can be accessed at: http://www.medicareadvocacy.org/medicare-info/medicare-secondary-payer-program/. In addition, the Center led a task force of the Public Policy Committee of the National Academy of Elder Law Attorneys (NAELA) (www.naela.org) on the use of set-aside arrangements involving future medical expenses. The task force made recommendations on how attorneys might approach "future medicals" pending guidance from the Medicare agency. See: http://www.naela.org/App_Themes/Public/PDF/Home%20Page/ISSUE%20Medicare%20Set%20Aside%20TF_2%20(2).pdf. [4] See, for example, the joint findings and recommendations, sent to the Medicare Agency, by the Center for Medicare Advocacy, the Medicare Rights Center, and California Health Advocates, available at http://www.medicareadvocacy.org/2011/05/12/medicare-secondary-payer-practices-that-harm-medicare-beneficiaries/. [5] See §201of the Act. Note, the term "website" includes any successor technology that might be developed. Id., at subclause (VII). [6] See §201of the Act, ("VI") Effective date. [7] See §201of the Act. [8]Id., amending §1862(b)(2)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(B), adding a new clause: (vii) use of website to determine final conditional reimbursement amount. [9] Id. [10] See §204, amending §1862(b)(8)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(8)(B). [11] Id. [12] Id., at subclause "(III)." [13] Id., at subclause "(IV)." [14] Id. [15] Id. [16] Id. [17] Id. [18] Id., at subclause (V), protected period. [19] Id. [20] Id. In addition, the Secretary shall promulgate final regulations to carry out this clause not later than 9 months after the date of the enactment of this clause. Id. [21] Id., §202(a)(2) of the Act. [22] Id., §202(b). [23] Id., subclause "(D)"Report to Congress. [24] Id. [25] See §203, amending §1862(b)(8) of the Social Security Act, 42 U.S.C. 1395y(b)(8)( Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans). [26] Id. [27] See §205, amending §1862(b)(2)(8)(iii) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(8)(iii).
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Video: Finding Medicare C and D plans on Medicares Website
VIDEO Illinois Affordable Care Act Fact Sheets Available On Make Medicare Work Website : HIV Health Reform
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Insurance Success Story : Tufts Medicare Preferred
Before Tufts Medicare Preferred started to use the HubSpot software to assist with their marketing, their main challenges stemmed from generating new leads from a very fragmented website. They needed a way to connect the dots and figure out how users on their website use each of the tools they provided and what they could do to improve their experience. They had no way to track how visitors were navigating their website, nor a great way to capture lead information on each page. As Baby Boomers begin to retire, that core demographic of 65+ individuals are driving more online traffic than ever before, and Tufts Medicare needed new data on how to reach them more effectively.They discovered HubSpot’s end-to-end enterprise marketing software and originally bought because of the ability to quickly create landing pages. They soon realized however, it also provided them with the tools they needed to track visitors and get even more data than they ever thought possible.hubspot.com
Missouri Senior Medicare Patrol Launches Website
The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program. Because this work often requires face-to-face contact to be most effective, SMPs have recruited nearly 4,500 volunteers nationwide to support this effort.ma4web.org
David Brooks, Obama, and Medicare:
David Brooks is both a liar and an idiot. Speaking of idiocy, there is the idiotic repetition, ad nauseum, of the need to "reduce the size of government" as if this were self-evident. Actually, it is both backward and ass-backward. Government financing, transfer payments, are not part of the "size of government" as they do not represent a government service or expenditure. It is of no importance whatsoever whether financing for an activity is public or private so long as we adopt the most efficient and equitable means and in neither case is the "size of government" affected except as to the relatively de minimis costs of administration (a mere fraction of what is spent by the private sector for analogous functions). That way, we have the lowest overall share of GDP devoted to the particular service. In the case of retirement, education, and especially in the case of medical care, government financing is far preferable, both more efficient and more equitable. If private medical costs over the last 40 years had increased at only the rate of Medicare cost increases, the economy would now be saving roughly a trillion dollars a year. Moreover, in an advanced industrial economy, growth is not supply-constrained — we always have idle capacity — but demand-constrained. The private sector is not able to generate sufficient demand fully to employ productive resources, labor or capital. Therefore, the more efficient our economy becomes through technological innovation, the MORE government has to grow, the more government has to spend, in order to maintain output at or near its maximum. Thus, for three reasons, efficiency, equity, and aggregate demand, we need more government, not less. Does that stop the idiotic insistence that we shrink government? No, it does not. The ignorant and the ideological fanatics will repeat the same idiocy forever, regardless of the economic reality.newrepublic.com
Medicare Fraud Bust at Least Gave Holder Something Good to Report
It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots around the country.reason.com
What to Look for When Comparing Medicare Part D Costs
Information presented on Personal Finance Blog by MoneyNing is intended for informational purposes only and should not be mistaken for financial advice. While all attempts are made to present accurate information, it may not be appropriate for your specific circumstances. Any offers and rates shown on this site can change without notice and may contain information that is no longer valid. For further validation, always visit the official site for the most up-to-date information. This site may receive compensation from companies to offer an opinion about a product or service. We strive to provide honest opinions and findings, but the information is based on individual circumstances and your specific experiences may vary. We also treat your privacy seriously. Please take some time to understand our full policies and disclaimers by clicking here.moneyning.com
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May 21, 2013
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Medicare
While working as a contracts officer at Bard’s Covington office, Darity noticed a pattern of illegal kickbacks being paid by the medical device company to doctors and hospitals that used its products. Over an eight-year-period, according to Darity’s whistleblower lawsuit, Bard inflated the cost of its radioactive seeds used to treat prostate cancer. The hospitals would then charge Medicare the inflated price and Bard would pay kickbacks to the doctors and hospitals from the excess revenue.personalinjuryattorneycolumbusga.com
Video: Georgia Health Insurance Medicare
VIDEO Augusta needs Medicaid expansion, and so does Georgia
This idea that a 2% increase in our budget…and consequently an increase in OUR taxes…..is okay is the kind of thinking that is killing those of us who PAY the taxes. “Oh, it will create jobs” is always the answer but somehow it never does, and the welfare, SSI, food stamp, and Medicaid rolls keep growing because we keep offering them a better deal. Meanwhile the taxPAYERS are stuck with the 2% increase for this, and a 4.9% increase for that, and a sales tax increase for the roads, and, if you actually PAY you medical bills a 3% increase on your medical devices. This line of thinking that federal or state budget increases, more taxes, and more spending on give away programs are somehow good for the economy….good for the taxpayer…..is simply crap. Everyone, even the Democrats and the CBO, are already admitting that Obamacare is a BUST at controlling or lowering the cost of medical care. They already know that the federal government is not going to be able to afford even the 90% that they promised and many of the states know that they cannot afford the 10% and that the feds will most likely figure out how to get out of paying their 90%.augusta.com
Kaiser Permanente of Georgia Hosts Medicare Straight
**Plan performance Star Ratings are assessed each year and may change from one year to the next. Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2013. Kaiser Permanente contract #H1170. Kaiser Permanente is a health plan with a Medicare contract. You must reside in the Kaiser Permanente Senior Advantage (HMO) service area in which you enroll. A sales person will be present with information and applications. For accommodations of persons with special needs at sales meetings, call toll free (TTY 711). Kaiser Foundation Health Plan of Georgia, Inc., Nine Piedmont Center, 3495 Piedmont Road NE, Atlanta, GA 30305.patch.com
Deal again says Georgia can’t afford Medicaid expansion
Members of the Georgia Chamber, Lieutenant Governor Cagle, Speaker Ralston, state legislators, elected officials, judges, justices, ladies and gentlemen: Let me begin by congratulating you. We have had one of the best years of economic development in quite some time. A few notable companies that have chosen Georgia include Baxter, General Motors, and Caterpillar, along with numerous others. We did this with your help, with both the private and the public sector doing their parts! Several weeks ago, the lieutenant governor, along with Sandra and I hosted a reception at the Governor’s Mansion to honor Georgia’s Olympic and Paralympic athletes who competed at the London Olympic Games. This was an outstanding group of young people of whom we are extremely proud. One of the men in the group was Aries Merritt, a native of Atlanta and a graduate of Wheeler High School in Marietta. Aries won an Olympic Gold Medal in the 110 meter hurdles. Unlike sprinters who travel in a straight line with no obstacles other than the lane markers assigned to them, hurdlers, as the name implies, must jump over obstacles that are placed in their path. Making analogies between sports and government is always risky, but I want to suggest to you that the business of governing our state is somewhat similar to running the hurdles. As governor, my goal is to see Georgia become the No. 1 state in the nation in which to do business. I have made that clear from the beginning, because I believe that is the best path to economic growth and the quickest way to get Georgians into jobs. And we are not all that far off from reaching our target: For two years in a row, we have ranked in the top five for business climate by Site Selection Magazine, and we ranked No. 3 for doing business in 2012 by Area Development Magazine. But we certainly still have some hurdles that we must overcome before we get there. This morning I will focus my remarks on one of the highest hurdles facing state government, that of healthcare. In Georgia, we have had many successes in the realm of healthcare. With rising healthcare costs, we have worked to keep Georgians healthy so that they can avoid some of these expenses rather than react to them when they become ill. We have launched the Georgia SHAPE program as a way to combat childhood obesity, a growing problem in our state. I proclaimed this past September “Georgia SHAPE Month,” during which we emphasized physical activity and proper nutrition for our state’s children. In its inaugural year, the Governor’s SHAPE Honor Roll had 39 schools achieve Gold Medal status for their dedicated work in making our state’s youth healthier. These healthier young people generally perform better in the classroom, and many will continue their healthy lifestyles into later years, making these programs an investment in the economic and cultural well being of our state. The State Health Benefit Plan just finished the first year of its Wellness Program – the largest such program in the country, with more than 245,000 enrollees. We would like to take the next step by growing and developing it; we want to see employees taking responsibility for their own health through preventative action … and receiving lower premiums as a reward. Even with all of these cost-saving approaches, it still costs approximately $10 million per day in claims to provide health benefits to active and retired employees and teachers. Those costs have and will increase because of Obamacare’s mandated benefits; in FY2014, the State Health Benefit Plan is projected to incur $106M of additional costs due to Obamacare. And because our State Health Benefit Plan is classified as a Self-Insured Plan, it is subject to the three-year Obamacare reinsurance tax. This means we would pay an additional $35M in 2015. Of course, even among the healthy, not all illness can be prevented; so last year, we grew graduate medical education by adding funding in the budget for the development of 400 new residency slots in hospitals throughout the state, helping keep Georgia’s doctors in Georgia. These are just a few of the great things we have going for us in healthcare. But we also face hurdles that we must overcome, like how to fund the state’s responsibility for Medicaid. Right now, the federal government pays a little under 66 cents for every dollar of Medicaid expenditure, leaving the state with the remaining 34 cents per dollar, which in 2012 amounted to $2.5B as the state share. For the past three years, hospitals have been contributing their part to help generate funds to pay for medical costs of the Medicaid program. Every dollar they have given has essentially resulted in two additional dollars from the federal government that in part can be used to increase Medicaid payments to the hospitals. But the time has come to determine whether they will continue their contribution through the provider fee. I have been informed that 10 to 14 hospitals will be faced with possible closure if the provider fee does not continue. These are hospitals that serve a large number of Medicaid patients. I propose giving the Department of Community Health board authority over the hospital provider fee, with the stipulation that reauthorization be required every four years by legislation. They have experience in this area, having had authority over a similar fee for the nursing home industry since around 2004. Of course, these fees are not new. In fact, we are one of 47 states that have either a nursing home or hospital provider fee – or both. It makes sense to me that, in Georgia, given the similarity of these two fees, we should house the authority and management of both of them under one roof for maximum efficiency and effectiveness. Sometimes it feels like when we have nearly conquered all of our hurdles, the federal government begins to place even more hurdles in our path. I am, of course, referring to the various mandates of Obamacare that put a strain on our state, its businesses and its citizens. As most of you are well aware, the United States Supreme Court upheld the individual mandate as a tax. Therefore, most Georgians, beginning in 2014, will be forced to get insurance coverage or else pay a minimum of $95 (and potentially far more) in penalties. So what does this mean for us? It means that Georgians must pay out dollars to either an insurance company or the federal government – whether they want to or not. But ultimately there still is a choice, albeit a rock-and-a-hard-place kind of choice. As more individuals enter the marketplace, younger, healthier Georgians might begin deciding they would rather pay the penalty than deal with the potentially much higher cost of coverage, causing the price of insurance for everyone to climb; this increase will drive even more healthy individuals out of the market, further swelling the cost. This potential cycle is one of the inherent flaws in the federal law. The employer mandate means that businesses with 50 or more employees must provide affordable health insurance to their workers or else pay the rather large penalties. Costs can increase here, as well, as the pool of insured becomes less healthy. These costs stand to hurt our state’s private sector. Because as all businessmen and women know, the higher your input costs, the lower your profits; the lower your profits, the less you operate, expand or employ. But whether it’s through fewer employees and less equipment purchases or higher costs, this mandate will negatively impact many of our state’s businesses and, of course, the would-be employees themselves. Georgians who have already received a paycheck this January have no doubt noticed that their payroll taxes went up and their take-home salary went down. This is the cost of entitlements. If you think your taxes went up a lot this month, just wait till we have to pay for “free health care.” Free never cost so much. The individual mandate has a second tier of impact involving Medicaid and its cost to the state. I have said clearly that Georgia will not expand Medicaid under the federal government’s guidelines. Even so, in Fiscal Years 2013 and 2014, Medicaid and SCHIP funding will be the second largest portion of the state funds budget with more than 13 cents of every dollar going straight to one of these programs. And with just the portions that our state must do, Obamacare is expected to add more than 100,000 new individuals to our Medicaid rolls and mandate other requirements, costing our state nearly $1.7B over the course of 10 years – and that’s on top of the $2.5 B we already pay annually. The reason: These Georgians qualify for Medicaid under the current system but have yet to enroll in it. With the individual mandate requiring either insurance or a hefty fee, they will likely think that Medicaid looks like a pretty good option. And since they fall under the current system, the state of Georgia and its taxpayers must pay the current rate of 34% and not the 0 to 10% rate proposed for the expanded population group. We constitutionally must balance our state budget – a wise requirement instituted by those who have come before us. This increase in costs to the state means we have to find that money somewhere in our already tight budget; we cannot simply create more. As such, I have instructed the Department of Community Health to reduce its budget by at least three percent in Amended Fiscal Year 2013 and by five percent in Fiscal Year 2014 – a difficult but necessary task. They have already identified $109M in cost-saving measures between the two years. But this hardly covers the additional nearly $500M in needed funds caused by growth in Medicaid expenses during the same time frame. That means we must make necessary cuts in other agencies and core functions of government since raising taxes is not an option I will accept! As I have indicated, I have rejected the Medicaid expansion in Georgia already, but let me emphasize that the expansion would have put our additional costs over 10 years closer to $4.5B – and that’s operating under the dubious assumption that the federal government, with its ever-growing national debt, would have fulfilled their promised share. The 620,000 new enrollees would have stretched our resources and our state to the limit. But whether the cost to our state would have been $2B, $4B or $6B, it does not make much sense to ask for more hurdles when you are already utilizing every muscle in your state’s body to overcome the ones you currently have before you and that you must face. So unless the federal government changes it to a block-grant program and allows Georgia to design the benefit plan, I cannot justify expanding Medicaid. The irony to me is that there are those in the medical community who are urging the expansion of the Medicaid program while at the same time, we are seeing more and more medical providers refusing to accept Medicaid patients. Their reason for doing so is that they claim the reimbursements for their services are below their costs. It is for that reason that the previously discussed provider fee is so important since that revenue is used to pay providers. If providers are already having difficulty covering their costs for care to Medicaid patients, how will they accommodate 34% more people on the Medicaid rolls? If you are losing money now, how do you reconcile the number of patients on whom you will lose even more money? Add to that the fact that the new enrollees would be higher on the economic scale, and some will be leaving their higher-paying, employer-provided health insurance plans to enter the taxpayer-funded Medicaid program with its lower reimbursements for the providers. If we have to depend on provider fees now to keep our reimbursements to Medicaid providers at a “tolerable” level, just imagine the pressure that will come when hospitals and doctors are losing more money on a larger portion of their patient base. Expansion of the Medicaid rolls does not solve the problem, it only exacerbates the one we already have. As many of you know, I also turned down the federal government’s offer to let us put our name on their insurance exchange program. I have no interest in seeing our state’s name, or its taxpayer dollars, used on something that we would have very little input in designing. If the purpose is to let those closest to and most knowledgeable about the population design the program, then we should be allowed to do so. It does not appear that is the pattern for the exchanges. I see no benefit to our citizens to have a program bearing the name of the State of Georgia over which our elected or appointed officials have little if any say so. While many federal programs come with strings attached, these strings turn states into marionettes to be manipulated by federal bureaucrats. If there is one thing we don’t need, it is another puppet show directed from Washington, D.C.! We cannot always determine what obstacles will be laid in front of us, but we can decide how we deal with them, and whether we approach them with anger, indifference or decisive action. The first two provide very little in productivity, but the latter offers opportunity to grow our state (and our businesses) in spite of newfound hurdles. Therefore, we must choose to work diligently. We must choose discernment over acquiescence, which is what I have aimed to do in my decision-making. And we must choose to confront these hurdles together, because discussion and determination, without bitterness, lead to the greatest forward progress. Despite all that is in front of us, we will still make Georgia the No. 1 state in which to do business. One last note: For those of you not attending in person, tune in tomorrow at 11 a.m. as I outline the rest of my plan for Georgia in this year’s State of the State Address, or go to my Twitter account, where my staff will be live Tweeting my remarks or at least the good parts.clatl.com
Congressman Tom Price: Introduces Medicare Improvement Legislation – Georgia Politics, Campaigns and Elections – Georgia Pundit
Washington, D.C. – Congressman Tom Price, M.D (R-GA) has introduced legislation aimed at improving the competitive bidding process for Medicare. “The Medicare DMEPOS Market Pricing Program Act of 2013” (H.R. 1717), would replace the current Medicare “DMEPOS,” or “Durable Medical Equipment, Prosthetics, Orthotics and Supplies,” competitive bidding system with a sustainable market pricing program (MPP) that is based upon sound economic principles that are embraced universally by auction experts across the U.S. Rep. Price first introduced this legislation during the 112gapundit.com
The Rural Blog: Rural Georgia hospital closing, blames Medicare
population 1,400, about 30 miles west of Americus, will suspend operations tomorrow. The 25-bed hospital, named for the two rural counties it serves but owned by Accord Health Care Corp., says it is closing partly because high unemployment in the area means the hospital is seeing more people who are not paying for services. Also, “Medicaid and Medicare are not paying what they used to,” and the hospital simply ran out of money, report Sydney Cameron and Liz Buckthorpe of WRBL of Columbus. And, in changing top electronic health records, “The hospital had to pay for the costs up front and because of a mix-up with Medicare they have not received $1 million in incentive money for the changeover.” Stewart-Webster is the largest employer in Richland at nearly 80 employees. The hospital sees around 10 patients a day and performs about five surgeries a week, the station reports.blogspot.com
Republicans debate Medicaid expansion
I used medicaid when it was in its infancy 50 years ago. I went to a dentist for a filling. The filling would have cost $10.00. The dentist said, why have a filling, I will give you a crown[made out of gold]. He said, why not have the best, the state is paying for it? I knew then, medicaid would be a collasal issue for funding as the years went by. Even now, people on social security as their ownly income, have multiple hip replacements, and soforth. Now, I hear society is judged by how it acts towards the least of its citizens. Very true, however, citizens should take some of the responsiblity for their health by living healthy lives rather than thinking government will solve all their problems. I voluntere in a church serving meals to the poor as well as others, I find it enormously rewarding, if Drs, served the needy without expecting gargantuan payment they would find it even more rewarding.ajc.com
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May 21, 2013
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Medicare
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Video: How to Understand Medicare Plans
VIDEO Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals
Many of the budget proposals and debt-reduction plans being considered by Congress and the Administration include proposals that would achieve substantial savings from the Medicare program over time. This brief features a side-by-side comparison of the key Medicare provisions in four major budget and debt-reduction plans:kff.org
What to Look for When Comparing Medicare Part D Costs
Information presented on Personal Finance Blog by MoneyNing is intended for informational purposes only and should not be mistaken for financial advice. While all attempts are made to present accurate information, it may not be appropriate for your specific circumstances. Any offers and rates shown on this site can change without notice and may contain information that is no longer valid. For further validation, always visit the official site for the most up-to-date information. This site may receive compensation from companies to offer an opinion about a product or service. We strive to provide honest opinions and findings, but the information is based on individual circumstances and your specific experiences may vary. We also treat your privacy seriously. Please take some time to understand our full policies and disclaimers by clicking here.moneyning.com
thriftymommastips: Medicare Part D Costs #Walgreens Prescription Savings #ad
My kids, my Mom and I all have needed prescriptions often in the last decade. Prescriptions actually eat up a massive chunk of our family budget. When I was a new university graduate and my Crohn’s, an inflammatory bowel disease thought to also be an autoimmune disorder, was in full flare I frequently lost a lot of weight, watched my energy vanish, and the potential to make money sadly shrivelled up. Those days, as sick as I was, with prescriptions that cost over $500 a month and no drug plan, I was often faced with the reality of paying for medications that were needed, or getting food. Paying tuition, paying for food and drugs? Impossible. That’s a position nobody should ever have to find themselves in, especially as a caregiver, or a patient. Sadly, I am far from alone, caregivers everywhere are forced to make these terrible choices daily. Seniors, on fixed incomes, and people struggling with disability shouldn’t be forced to choose between prescriptions and groceries. Families bearing emotional and financial responsibility for caregiving shouldn’t be fearful of how to spend their money. Caregiving is hard enough, rewarding for sure, but challenging in so many ways. The stress of caregiving shouldn’t be compounded by cost of prescription drugs. thriftymommastips.com
Research Roundup: Comparing Medicare Budget Plans
JAMA Pediatrics: Nurse Staffing And NICU Infection Rates –Neonatal intensive care units (NICU) – which provide care for infants who are critically ill – are costly and require a significant amount of nursing services. Little is known, however, about the adequacy of nurse staffing at these units. Using data from 2008 and 2009, researchers analyzed the relationship between adherence to national staffing guidelines and hospitals-associated infections among very low birth-weight (VLBW) infants. “Our results document widespread understaffing relative to guidelines: one-third of NICU infants were understaffed… ,” the authors write. “In VLBW infants, NICU nurse understaffing relative to guidelines was associated with a sizable increase in infection risk.” They conclude that their findings “suggest that the most vulnerable hospitalized patients, unstable newborns require complex critical care, do not received recommended levels of nursing care. Even in some of the nation’s best NICUs, nurse staffing does not match guidelines” (Rogowski et al., 3/18).kaiserhealthnews.org
Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices
Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.nytimes.com
Comparing Medicare Advantage Plans Missouri
There are several reasons why people choose to enroll in Medicare Advantage plans instead of the Original Medicare plan and a Medicare Supplemental plan. In order to enroll in a Medicare Advantage plan, you should willingly drop out from your Medicare and sign up for a plan in a private insurance company that offer this plan. The two big reasons why most people choose to sign up for Medicare Advantage plans are because it has low premiums and there are no health questions asked.ehealthmo.com
Health Affairs Blog: “Variation in Medicare Costs Suggests Inefficiencies That Might Be Corrected Through More Administrative Spending”
“Ironically, Medicare’s low administrative costs — about 3 percent compared with 17 percent in the private sector — may be to blame for the high spending. The private sector uses these funds to do a better job controlling excessive use. Tomas Philipson and colleagues have shown that the variation in Medicare hospital use is four times larger than the private sector when it comes to heart disease. Because it can rely on its monopsony power to control overall spending, Medicare has a weaker incentive to limit overuse. Meanwhile private insurers have become more efficient, employing tools such as utilization review and case management (which count as administrative costs) to assess patient needs and then either restrict services or steer patients towards more cost-effective care. In a world without private insurance, we would likely see more money wasted on care that produces no benefit for patients.”ahipcoverage.com
Medicare Supplement Insurance Information
1990, Medicare standardized their different plans in order to decrease the amount of confusion that consumers were experiencing as they compared different coverages offered by the different healthcare insurance providers. As a result of this standardization, it is easier for the consumer to understand the comparison of these different benefits and the associated cost comparisons between healthcare insurance providers. As a result, the terms “MediGap plans” and “Medicare supplement” basically mean the same thing and are commonly used interchangeably. As a result of having so many Medicare plans to choose from, it is important to research each one in order to decide which will be best for your personal needs and situation. One of the first things to be aware of when searching for supplement plans and comparing the ones you find is that many websites who advertise these are only there for one reason and that is to collect your personal information. In many cases, insurance providers will purchase leads or develop lead generators to accomplish this instead of actually doing what they advertise. Basically, these companies don’t know the proper ways of developing new business so they resort to these somewhat underhanded methods. Many of these companies make it appear as though they actually sell the different Medicare supplement plans but the reality is that they will collect your personal information and sell it to numerous insurance agents. Here are two ways that you can tell if they are legitimate healthcare insurance and Medicare supplement plan providers. First of all, there will be a toll-free number to call and secondly, there will be a statement promising that they will never sell your personal information to anyone else. Do price comparisons of these different Medicare plans when searching through the different companies that offer them. The better insurance brokers will be able to provide you with these comparisons from those insurance providers operating in your local area. In most cases the prices will differ despite the fact that the supplement plans they offer are identical. Remember, it is better to do plenty of research in order to make a well-informed decision when purchasing the Medicare supplement plan that is right for you.blogspot.com
Need Help Picking Right Medicare Advantage Plan for Mom!! » Toni Says
*Some plans are $175 co pay per day for 20 days which can be a maximum $3500 if you are in the hospital for over 20 days or might be $150 co pay per day for days 1-5 with a maximum of $750 maximum stay if you are inpatient hospital for more than 5 days (example only)tonisays.com
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Just starting out in the insurance industry? Been in it a while, but want to diversify your product line? Then you might want to check into buying exclusive Medicare supplement leads. If you need to build a solid financial base for your business, this is the way to go. Exclusive Medicare supplement leads are nothing short of pure gold, as the people you speak to want and need your product. They are actively interested in talking to an insurance agent. They genuinely want to improve their health care coverage, and this is where you come in.
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Video: FREE MEDICARE LEADS/ MEDICARE SUPPLEMENT LEADS/ INSURANCE SALES LEADS
VIDEO Medicare Supplement Plan F
Purchasing a Supplemental Plan F policy should prevent any out-of- pocket costs for the recipient. One of the benefits covered by Supplemental Plan F is hospitalization for up to 365 days after Medicare coverage ends. The plan will cover up to 20 percent of all Medicare approved expenses. If blood is required three pints of blood each year are covered under the plan. The plan also covers the expense of a stay in a skilled nursing care facility. One of the greatest benefits is that Supplemental Plan F covers any emergency medical assistance that may be required while traveling abroad.edvox.org
What is Medicare Supplement (Medigap) Insurance
In order to sign up for Medicare Supplement coverage, you must already have Part A and Part B. These plans are offered by private insurance companies and come in 10 standardized policy types that are denoted by the letters A-N. The standardization of these plans means that no matter where you shop, the Medigap policy details remain consistent. For example, the benefits associated with Plan F are the same no matter where you buy it, though costs may differ across all carriers. Not every carrier of Medicare Supplement Insurance offers all 10 plan types, and three states in the U.S. have their own version of these plans: Massachusetts, Minnesota, and Wisconsin.ehealthmedicare.com
On The Topic Of Medicare And Medicare Supplement Plans
medigap plans are the optimum health care products that provide specific amount of serenity to seniors in addition , disabled people to protect your life all over health care plans. This specific type of supplemental health insurance programs covers the gaps between original Medicare payments and has comfortable planning to find providing interesting help and advice to Medicare supplemental plans. May very challenging time period taking health really do care thrillingly, which creates the process of applying health maintenance plans very easy and simple. Moreover, you will take advice from expert insurance agents, who provide smart guidance for safeguarding your life thankfully.isn-buenosaires-2012.org
Medicare Supplement Plan F Options
In Oklahoma, there are 12 Medicare supplement plans available- 10 standardized plans and 2 additional plans. Each plan is identified by a different letter of the alphabet, A through L, and each has its own unique combination of benefits. While every plan offers the same standardized coverage, some cover deductibles, coinsurance for a skilled nursing facility, even foreign travel emergencies. It’s important to understand that while each plan is different, companies selling Medicare supplement insurance in Oklahoma must offer the same benefits for each plan. In other words, a Plan C is exactly the same regardless of what company you choose to buy it from.oklahomamedicarehealth.com
Massachusetts, Minnesota, and Wisconsin Medicare Supplement Plans
Unlike most states, which offer the option to enroll in one of 10 standard Medigap policies, Massachusetts, Minnesota, and Wisconsin offer Medicare Supplement plan offerings that are unique to these states. Medicare Supplement (Medigap) plans are available as an option to get coverage for out-of-pocket costs not already covered by Part A and Part B. In most of the United States, eligible beneficiaries can choose from 10 standardized Medigap plan offerings, with plans named the same letter offering the same benefits no matter what state the plan is offered in. However, as stated previously, not all beneficiaries have the option to enroll in one of these standard Medigap policies.planprescriber.com
Medicare Essential – Is this the future of Medicare?
The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.gormanhealthgroup.com
Things that ought to be there in the best Medicare Supplement Policies
Those who have already enrolled themselves in Medicare can also get enrolled in supplemental insurance. These are marketed and sold by private firms. Traditional Medicare takes care of most of the expenses but not each and every service associated to medical supplies and health. Traditional Medicare includes hospital insurance and medical insurance which falls under Part A and Part B respectively. The ideal plan of Medicare supplement insurance should be able to provide coverage for “gaps” that are not taken care of by traditional Medicare. These includes copayments, coinsurance and deductibles, which can add up, especially for individuals who need trained nursing home services and are hospitalized. This plan can also pay for the medical services sought by an individual outside his own country along with preventive services that do not receive approval from Medicare. Those who are enrolled in both the parts of Medicare (Part A and Part B) besides best Medicare supplement insurance policy, Medicare furnishes its share of medical services approved by it. Following this, Medigap takes care of its share of the expenses.fusionswim.com
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CMS officials have proposed a new rule aimed at helping more Medicare beneficiaries become eligible for nursing home care after a hospital stay—but hospitals and patient advocates say the rule does not do enough to curb the use of "observation status." Read more from The Advisory Board here.
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Video: Medicare Insurance Supplement in Mississippi by 1-800-MEDIGAP®
VIDEO Gov. Phil Bryant says Obama budget undercuts Medicaid expansion
Discussing details of the president’s budget Wednesday in Washington, U.S. Health and Human Services Secretary Kathleen Sebelius said the proposal to delay the reduction in Medicaid disproportionate share payments was done to give states a chance to get through their budgeting processes this year. The reprieve does not affect cuts in disproportionate share payments for Medicare, the federal health insurance program for people 65 and older and for the disabled.gulflive.com
Medicaid expansion fight now focusing on DSH funding (Sid Salter)
A Mississippi Institutions of Higher Learning economic brief by economist Bob Neal found these facts about Medicaid expansion: “Medicaid expansion will generate additional state Medicaid costs in years 2017-2025. From 2014-2020, cumulative state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $109 million to $98 million. From 2014-2025, total state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $556 million to $497 million.”gulflive.com
5th Circuit Affirms Finding Of Medicare Violations At Mississippi Nursing Home
NEW ORLEANS – A Fifth Circuit U.S. Court of Appeals panel on Feb. 7 in an unpublished opinion affirmed findings that a nursing home violated Medicare regulations after residents were found to be in immediate jeopardy (Mississippi Care Center of Greenville v. United States Department of Health and Human Service, No. 12-60420, 5th Cir.; 2013 U.S. App. LEXIS 2668).Full story on lexis.comlexisnexis.com
Gov. Bryant Comments on Democrats’ Failure to Fund Medicaid
• Inpatient hospital • Outpatient hospital • Laboratory and X-ray • Nursing Facilities • Screening and Diagnostic Services for Children • Physicians • Home Health • Emergency Medical Transportation • Prescription Drugs • Dental Care • Eye Glasses • Services for the Intellectually Disabled • Family Planning • Clinic Services • Home and Community Based Waiver Services • Mental Health • Durable Medical Equipment and Medical Supplies • Disproportionate Share Payments to Hospitals • Upper Payment Limit Payments to Hospitals • Perinatal Risk Management • Nurse Practitioners • FQHCs, Rural Health Centers, and local Health Dept. • Inpatient Psychiatric • Hospice Care • Pediatric Skilled Nursing Facilities • Podiatrist • Assisted Living • Nonemergency transportation • Chiropractic Services • Medicare Premiums for the Dually-Eligible • Spinal Cord and Brain Injury • Nursing Facility for the Severely Disabled • Physician Assistant • Pediatric Long-term Acute Care Hospitals • Therapy • Pediatric Extended Care Centers • Dialysis Transportationgovernorbryant.com
Student Health Law Association
If your doctor chooses to participate in an ACO, you will be notified. This notification might be a letter, written information provided to you when you see your doctor, a sign posted in a hospital, or it might be a conversation with your doctor the next time you go to see him or her. If you aren’t sure if your doctor or healthcare provider is participating in a Medicare ACO, ask him or her. By law, they are required to notify you if they are performing services within an ACO. For general information on ACOs, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day 7/days a week.umhealthlaw.com
The Medicaid Program at a Glance
Generally, the same Medicaid benefits must be covered for all enrollees statewide. However, states have flexibility to provide narrower or different benefits for some beneficiaries, modeled on four “benchmark” plans specified in the Medicaid statute. Most people who gain Medicaid eligibility due to the ACA expansion will receive “Alternative Benefit Plans” (ABPs) based on these benchmark plans, but all benchmark coverage must be modified to include the ten “essential health benefits” (EHB) identified in the ACA. States can align their ABPs and traditional Medicaid plans by adding benefits to either package to match the other. People with disabilities, dual eligible beneficiaries, medically frail individuals, and specified other groups are exempt from mandatory enrollment in benchmark benefits (or ABPs, beginning January 1, 2014) and remain entitled to traditional Medicaid benefits.kff.org
Q & A with Mississippi Gov. Phil Bryant
BRYANT: Prior to the Supreme Court ruling, all of us Republicans across the nation believed this was a failed law, a law that would drive up health insurance costs, a law that would causes taxes to go up on employers and cause all Americans to have to buy a product in a marketplace at the insistence of the federal government, and [you] could be punished for your inactivity. I am against the foundation that it rests on. This is a terrible law that continues to be flawed. The Supreme Court decision, which people believed changed everything, said one, there is a tax, which the president had been denying since the beginning, that it will cause costs for employers to go up, but also states cannot be forced to expand Medicaid. I believe that this is a bait and switch, where they say here is $20 million and you form a state insurance exchange. Let the governor sit idly by in Mississippi and say nothing and that exchange will inherently determine if you deserve a subsidy, but also can automatically take you to Medicaid.kaiserhealthnews.org
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Since 2006, Medicare has paid plans under a bidding process. Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted. The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs). The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium. If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees. Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
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kff.org
Video: The ABC’s of Medicare Health Care Insurance | Care1st Health Plan
VIDEO Health Affairs Blog: “Variation in Medicare Costs Suggests Inefficiencies That Might Be Corrected Through More Administrative Spending”
“Ironically, Medicare’s low administrative costs — about 3 percent compared with 17 percent in the private sector — may be to blame for the high spending. The private sector uses these funds to do a better job controlling excessive use. Tomas Philipson and colleagues have shown that the variation in Medicare hospital use is four times larger than the private sector when it comes to heart disease. Because it can rely on its monopsony power to control overall spending, Medicare has a weaker incentive to limit overuse. Meanwhile private insurers have become more efficient, employing tools such as utilization review and case management (which count as administrative costs) to assess patient needs and then either restrict services or steer patients towards more cost-effective care. In a world without private insurance, we would likely see more money wasted on care that produces no benefit for patients.”ahipcoverage.com
Seven Choices Medicare Plans Will Need To Make In Order To Survive
Sales channels are a good example of this. Given the recent proliferation of channels, it is critical that MA plans optimize their mix by focusing on the needs of their customers, instead of looking at what has helped sell various Medicare products in the past. Traditional channel options include direct sales, brokers, groups, and the web; emerging channels include retail stores, payor partnerships, and private exchanges. Each avenue provides a unique experience for the customer, and the right match can determine the eventual buying decision. The range of channels increases complexity, but it also allows leading plans to tailor their engagement strategy by segmenting the customers and personalizing interactions on the basis of segment needs for sales and enrollment, as well as ongoing interactions with the member to improve experience and manage health outcomes.healthaffairs.org
Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease
Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness. Its central role for private health plans makes MA extremely popular with seniors. The best practices of these plans should be integrated into conventional Medicare. That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.hlc.org
Medicare latest news, medicare advantage plans
Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.healthworkscollective.com
Doctors Praise GOP’s Plans For Medicare Pay But Seek Uniform Quality Measures
Medpage Today: Uniform Quality Measures Sought For An SGR Repeal Doctors need quality measures from a single source and more avenues to qualify for value-based payments under a post-Sustainable Growth Rate (SGR) reimbursement system, physician groups told Congress Tuesday. As Washington lawmakers work to repeal and replace the SGR, which determines physician payment, and replace it with a system that rewards high-quality care, medical societies offered their views on how to measure quality in a hearing before the House Ways and Means Health Subcommittee. Multiple panelists voiced support for National Quality Forum (NQF) Standards. The NQF is a Washington-based body formed in 1999 to review, endorse, and recommend health care performance standards (Pittman, 5/7).kaiserhealthnews.org
Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds
Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors alsocaliforniahealthline.org
thriftymommastips: Medicare Part D Costs #Walgreens Prescription Savings #ad
My kids, my Mom and I all have needed prescriptions often in the last decade. Prescriptions actually eat up a massive chunk of our family budget. When I was a new university graduate and my Crohn’s, an inflammatory bowel disease thought to also be an autoimmune disorder, was in full flare I frequently lost a lot of weight, watched my energy vanish, and the potential to make money sadly shrivelled up. Those days, as sick as I was, with prescriptions that cost over $500 a month and no drug plan, I was often faced with the reality of paying for medications that were needed, or getting food. Paying tuition, paying for food and drugs? Impossible. That’s a position nobody should ever have to find themselves in, especially as a caregiver, or a patient. Sadly, I am far from alone, caregivers everywhere are forced to make these terrible choices daily. Seniors, on fixed incomes, and people struggling with disability shouldn’t be forced to choose between prescriptions and groceries. Families bearing emotional and financial responsibility for caregiving shouldn’t be fearful of how to spend their money. Caregiving is hard enough, rewarding for sure, but challenging in so many ways. The stress of caregiving shouldn’t be compounded by cost of prescription drugs. thriftymommastips.com
ERISA Wonk Welfare Benefits ERISA Compliance
The MSP Act contains specific rules about when and how group health plans, automobile and liability insurance, no fault insurance policies and amounts recovered from tort actions are coordinated with benefits under the Medicare Statute. The MSP Act’s Secondary Payor Rules require group health plans, automobile and liability insurance and no fault insurance policies to treat their coverage as the “primary plan” for purposes of coordinating their coverage with the benefits provided under the Medicare Statute. Under certain conditions benefit [plans could] face double damage for improperly coordinating their benefits and coverage with those provided under the Medicare Statute. The MSP Act generally dictates the conditions under which these coverages are primary to benefits provided under the Medicare Statute and obligates primary plans and individuals receiving judgment or settlements that include payment for medical expenses for which benefits were received under the Medicare Statute to repay Medicare. Violation of these rules exposes the applicable plan to double damages and other costs of recovery.erisawonk.com
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May 21, 2013
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Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness. Its central role for private health plans makes MA extremely popular with seniors. The best practices of these plans should be integrated into conventional Medicare. That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source:
hlc.org
Video: Medicare supplement Insurance Plans VS Medicare Advantage plans
VIDEO Seven Choices Medicare Plans Will Need To Make In Order To Survive
Sales channels are a good example of this. Given the recent proliferation of channels, it is critical that MA plans optimize their mix by focusing on the needs of their customers, instead of looking at what has helped sell various Medicare products in the past. Traditional channel options include direct sales, brokers, groups, and the web; emerging channels include retail stores, payor partnerships, and private exchanges. Each avenue provides a unique experience for the customer, and the right match can determine the eventual buying decision. The range of channels increases complexity, but it also allows leading plans to tailor their engagement strategy by segmenting the customers and personalizing interactions on the basis of segment needs for sales and enrollment, as well as ongoing interactions with the member to improve experience and manage health outcomes.healthaffairs.org
Rate Boost To Medicare Advantage Plans Powers Insurers’ Stock Surge
Medpage Today: More $$$ Going To Medicare Advantage Plans Payments to Medicare Advantage plans will increase by 3.3% in 2014, Medicare officials said late Monday. Officials at the Centers for Medicare and Medicaid Services (CMS) based the payment increase on the assumption that Congress will override scheduled cuts in physician reimbursements for an 11th consecutive year, the agency said. “The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,” Jonathan Blum, PhD, CMS’ acting principal deputy administrator, said in a press release (Pittman, 4/2).kaiserhealthnews.org
Medicare latest news, medicare advantage plans
Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.healthworkscollective.com
MEDICARE ADVANTAGE: Growth Projections Are Stunning.
Based on this eye-opening news article today, UnitedHealth, Humana May See Surge in Medicare Advantage – Bloomberg I’m now going to get certified to sell Medicare Advantage plans with 2, or perhaps 3, good carriers. I looked at one from Humana last year for my dad in Michigan, but the out-of-pocket expenditures for medical care were stunningly high, compared to Standard Medicare mated with a Plan "F" MedSupp. But if Medicare Advantage participation is going to grow a whopping 50% over the next 10 years, I’d be a fool not to at least have it in my portfolio of offerings. Who’s driving the growth of these Medicare Advantage plans the most.. Is it Well-To-Do Seniors who don’t mind paying the high out-of-pocket costs? Or is it Seniors on very limited income who are attracted by the lower overall premium cost? Other some other demographic? -Alleninsurance-forums.net
GAO finds CMS negligent in risk adjustment for Medicare Advantage plans
Risk adjustment is important to ensure that payments to MA plans adequately account for differences in beneficiaries’ health status and to maintain plans’ financial incentive to enroll and care for beneficiaries regardless of their health status. Our work confirms that differences in diagnostic coding caused risk scores for MA beneficiaries to be higher than those for comparable beneficiaries in Medicare FFS in 2010, 2011, and 2012. CMS’s decision to use a 3.4 percent adjustment to risk scores for 2010 through 2012 instead of the higher adjustments called for by our analysis resulted in excess payments to MA plans. The existence of such excess payments indicates that CMS’s adjustment does not accurately account for differences in treatment and diagnostic coding between MA plans and Medicare FFS—the stated goal of the statute that required CMS to develop a diagnostic coding adjustment. In our January 2012 report, we recommended that CMS take steps to improve the accuracy of the adjustment to account for excess payments due to differences in diagnostic coding. We noted that CMS could, for example, account for additional beneficiary characteristics, include the most recent data available, identify and account for all the years of coding differences that could affect the payment year for which an adjustment is made, and incorporate the trend of the impact of coding differences on risk scores. CMS’s adjustment for 2013 is the same as it used in 2010, 2011, and 2012. However, given our finding that this adjustment was too low and resulted in estimated excess payments to MA plans of at least $3.2 billion, we continue to believe that it is important for CMS to implement our recommendation that it update its methodology to more accurately account for differences in diagnostic coding.pnhp.org
Financial Success: Medigap & Medicare Advantage Plans
All Things Human by Patrice Passidomo, M.D. Amateur Palate Restaurant Reviews Animal Ark Rescue Arts and Entertainmet Arts Calendar by Carol Kantor Arts on the Lake Bits of Inspiration Brewster Theater Company Delaney’s Dugout Financial Success by Kurt Schlesinger Happy Reading by Christine O’Neill Heart of the Matter: Pawling Real Estate by Todd Kesseman Intern and Student Contributors In The Shade by Thomas D Kersting Kitty Korner Living Landscape Journal by Pete Muroski Local Business Local Interest Meteorologist Mike Shustak’s Forecast Mizzentop Music Reviews by Zach Silva Our Town by Susan Stone Pawling Fire Department Pawling Garden Club Pawling Parents Pawling Public Library Pawling Public Radio Pawling School Sports Peace of Mind by Dr. Jeremy Stone Reflections on a Silver Screen by Ben Rendich Sherman Chamber Ensemble Spice: The Final Frontier by Lisa Kelsey The Art of the Brew by Mark Klinger The Computer Guy by Mike Pepper The Five Facets of Mom by Stephanie Nevins The Pawling High School Insider The Pet Professor by Mary Jean Calvi, LVT The Puppy Pad The Whole Tooth and Nothing But The Tooth by Dr. Thomas Bloom This Side of the Law Towne Crier Trinity Pawling Uncategorized Vegan Delights by Carole Baral What’s New by Susan Stonewpengine.com
When it’s Time to Drop Your Medicare Advantage Plan
Currently, Medicare Advantage sellers are engaged in heavy marketing due to the MA open enrollment period that ends on December 7th. The ads don’t say much but give enough clues to tip you off that you must ask lots of questions and dig deep to find out what you’re getting. A solicitation I received from UnitedHealthcare touted the plan’s zero monthly premium, zero copay for a primary care doctor’s visit, zero medical deductible and zero prescription drug deductible. A closer look revealed that the copays for expensive drugs were steep—$95 for non-preferred brand drugs and 33 percent of the cost for a specialty drug. Then came the fine print warning: “Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium and/or co-payments/co/insurance may change on January 1 of each year.”openplacement.com
LeadingAge: Adult Day: Opportunities to Contract with Certain Medicare Advantage Plans
We are pleased that the Centers for Medicare and Medicaid Services (CMS) concurred with LeadingAge’s position that Medicare should allow Fully Integrated Dual Eligible Special Needs Managed Care Plans (FIDE-SNPs) to offer additional supplemental home and community-based benefits, such as adult day services, to its eligible subscribers beyond those supplemental benefits that Medicare Advantage (MA) plans are allowed to offer. leadingage.org
CMS Promotes Value for Seniors and Persons with Disabilities in Medicare Plans
With today’s regulation limiting overhead and profits for Medicare Advantage and prescription drug plans, the Affordable Care Act continues to promote value for consumers’ and taxpayers’ health care spending. These new requirements apply to Medicare health and drug plans offered by private insurance companies serving over 37 million seniors and persons with disabilities, and build on a similar regulation we issued last year requiring a minimum medical loss ratio for health plans serving consumers in the private insurance market. Medicare health and drug plans, beginning next year, must meet a minimum medical loss ratio, limiting their spending on non-health related items such as administrative costs, profit, or overhead. More specifically, this means that the plans must spend at least 85 percent of their revenue on direct benefits to Medicare enrollees such as clinical services, prescription drugs and quality improving activities.medicare.gov
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