Medicare Enrollment Window Opens Earlier

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™Along with the accelerated enrollment period, it is hoped that beneficiaries will have their Medicare cards by the start of the New Year. Customarily, late enrollees find themselves in a bit of a pickle (i.e., without their Medicare cards) come January 1. While the start date this year is non-memorable (October 15), the deadline isn’t for most Americans of Medicare eligibility age (December 7).
Source: kaneandkoltun.com

Video: Heat Exposure within Seniors of Florida Medicare and Ocala Medicare

Humana Rx Savings HumanaRxSavings.com

Medicare Enrollment: Each year medicare insurance plans change what they cost and what they cover. The general open enrollment begins on October 15, 2011 and ends Dec 7th, 2011. During this time, people with Medicare can add, drop or change their prescription drug coverage. They can also select a medicare advantage or supplement plan for their 2011-2012 coverage. The general open medicare enrollment season ends Dec 7,2011 so be sure to get a medicare quote started today.
Source: trinitymedcare.com

South Florida Seniors Paying Too Much for Medicare Drug Plans

Aetna Assurant Health Blue Cross Blue Shield Plans Celtic Insurance Company CIGNA Fairmont Specialty Group Golden Rule Group Health Cooperative Group Health Incorporated Health Net Health Partners Humana Intermountain Health Care Kaiser Permanente LifeWise Health Plans Medica Medical Mutual of Omaha Midwest Security Oxford Health Plans PacifiCare Security Life UNICARE United Wisconsin Life/American Medical Security Vista Health All Available Providers
Source: individual-health-plans.com

Florida Medicare Advantage Plans

Florida has a large number of Medicare Advantage plans available.  One reason could be the large population of seniors that retire to the state.  The first thing to consider if you are looking for a Medicare Advantage plan in Florida is that the plans are NOT state specific.  The are in fact county specific.  Check here to look up Medicare Advantage plans by state for 2012.  Chances are you will find a company in South Florida that is not at all available in the Northern part of the state.  One exception to this is United Healthcare.  They offer a plan that is identical across the state.  This is probably because of the size of the company.  They also offer a large network across the state.
Source: medicare-plans.net

Fiorella Insurance: Medicare In Florida

Out of the 18,000,000 residents of Florida, approximately 18% are enrolled in Medicare according to data from the Kaiser Family Foundation. These statistics mean that in Florida, Medicare is a subject of critical concern for nearly one out of five people. Most of these Medicare beneficiaries (63.8%) are age 70 or older and more than half of all Florida Medicare beneficiaries are women. Florida Medicare beneficiaries may enroll in stand-alone prescription drug plans, Medicare Advantage plans, or Medicare Supplement (Medigap) plans. However, many residents are often unclear regarding the differences among these types of plans and gravitate towards whatever plan has been marketed to them. Stand-alone Medicare prescription drug plans, sometimes referred to as PDPs, are private insurance plans approved to provide drug coverage to people enrolled in either Medicare Part A or Part B. There is no coverage for hospitalization or medical services in a stand-alone PDP, only drug coverage. Each PDP has a list of drugs that it covers. This list is known as a formulary. Medicare mandates that a formulary must cover AT LEAST two drugs from each therapeutic category approved by Medicare. Formularies also determine how much you pay for a drug covered by the PDP plan. PDPs can cover different drugs so it is vital that you confirm that your drugs are covered before enrolling in a PDP plan. Medicare Advantage plans are private health insurance plans available to people enrolled in Medicare Parts A and B. They provide hospitalization and medical benefits and, most often, include prescription drug coverage. However, as is the case with stand alone prescription drug plans, Medicare Advantage plans with drug coverage have formularies that determine which drugs they cover and which ones they do not cover. Always confirm your drugs are covered before enrolling in a Medicare Advantage plan. Some Medicare Advantage plans can be confusing because they offer a $0 monthly premium. Those insurance companies that offer this rate can do so because they receive a reimbursement rate from the government that enables them to remain profitable given their plan enrollees. Medicare Supplement plans intend to cover the out-of-pocket expenses, or “gaps,” associated with Medicare Parts A & B. In every state but Massachusetts, Minnesota, and Wisconsin, there are ten standard plan types from which to choose. Each of the plan types has a letter name: A, B, C, D, F, G, K, L, M, and N. Each plan covers different out-of-pocket expenses with plan F having the broadest coverage. Medicare Supplement plans do not include prescription drug coverage. However, you may enroll in a stand-alone prescription drug plan alongside a Medicare Supplement plan. According to statistics from 2010, 32% of Medicare beneficiaries in Florida were enrolled in stand-alone prescription drug plans as compared to 29% in Medicare Advantage plans with drug coverage and 27% had prescription drug coverage from another source such as an employer plan. United Healthcare’s 2010 statistics claimed that Florida had over 642,000 residents enrolled in a Medicare Supplement plan.
Source: blogspot.com

Florida Seniors And Florida Medicare Supplement Programs

Usually the healthier the state the lower the prices. All of these states boast a very great well being rating. When a Medicare Supplement Firm has reduced well-being claims they also have reduce prices which they normally pass along to the shopper as lower prices for there programs. In fact these corporations are in a position to look in several years previous to try out to ascertain there long run costs for statements, when they see that in a long time previous statements charges have been comparably reduced than other states they are able to maintain rates reduce simply because of that. These rocky mountain region states hence are benefiting from a nutritious lifestyle type, All of these states have a lot of outdoor activities which aide in preserving a terrific wellness rating.
Source: nevadachatta.com

Medicare Supplemental Insurance in Naples Florida Part 3

Medicare Supplemental Insurance in Naples Florida Part 3 goes over the Medicare Supplement Plan that covers all 9 gaps original Parts A and B of Medicare leave behind for the consumer/Medicare beneficiary to pay. Most of the people currently buying Medigap insurance today buy Medicare Supplement Plan F to cover their hospital and doctor expenses at 100%. The only difference between the different companies who offer plan F is is price so log on to www.medicaresupplementsmadeeasy.com to receive your free quote today. http forum.medicaresupplementsmadeeasy.com Video Rating: 0 / 5
Source: coloradomedicaremedigap.com

2012 Blue Cross Blue Shield Medigap Quote Florida — Check Rate Information for this Medicare Supplement Plan

Medicare eligible seniors who reside in Florida should be aware that the current enrollment period is opened for medigap plan enrollment for 2012. Seniors in Florida who are looking for Medigap coverage and want to check the rates for Anthem plans can find the most detailed information at floir.com, which is the site run by the Florida Office of Insurance Regulation. This site has a searchable database, where seniors can search their county and zip code to compare plans. This makes it much easier to compare medicare supplement plans, as the letter value denotes which plans from different insurers have the same coverage. Only compare plans with the same letter, for instance check plan A among Blue Cross Blue Shield (BCBS), Hartford, Sterling, Humana, and other insurers listed. Then move on and look at what differences exist between the B plans, the C plans, etc.
Source: seniornewscoverage.com

Florida Elder Law and Estate Planning: Medicare Open Enrollment Starts, Ends Earlier This Year

Alert to Medicare beneficiaries: The enrollment period starts and ends earlier this year! From Oct. 15 through Dec. 7 you have the opportunity to look at your Medicare coverage, examine any new options, and decide if you want to make changes in your coverage. The enrollment period has been adjusted to allow the government more time to process the changes, and ensure recipients have their new membership cards in hand by Jan. 1, 2012.
Source: blogspot.com

Medicare: What Family Caregivers Should Know

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaYou may, for example, be caring for an aging parent who is enrolled in a Medicare Advantage plan and becomes hospitalized. After the hospital stay, he/she may need inpatient rehabilitation care at a Skilled Nursing Facility. However, the Medicare Advantage Plan may have limited skilled nursing facilities within the network and you may not be pleased with the options. In that situation, there is what is known as the OEPI (Open Enrollment Period for Institutionalized Individuals). Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.
Source: agingwisely.com

Video: Medicare

Now is the time to change Medicare enrollment

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

What is Medicare Advantage?

Medical Insurance Life Insurance Profit Questions Quote Effects Insurance Ohio Online Referrals Box Customers Want Cuba Carolina Death Dismemberment China Contact Employed Health Effects Healthcare Medicare Supplement Police Records South Carolina Black Box Death Questions Asking Issue Life Employed Health Insurance Auto Insurance Quote Trekking Insurance Ohio Blue Police Auto Insurance Social Networking Issue Life Insurance World Health Health Insurance Increased Profit Visitors Travel Unemployed Need Objections 11 Insurance Quote Networking Online Car Insurance Fire
Source: insurance-report.com

Medicare premiums to rise less than expected: How much? ~ what IS working

(CBS/AP) Seniors expecting big Medicare hikes can breathe a sigh of relief: Premiums will rise by only $3.50 at most. “Thanks to the Affordable Care Act, Medicare is providing better benefits at lower cost,” said Health and Human Services Secretary Kathleen Sebelius. She reassured seniors that they have nothing to fear from the health care law, and said called keeping premiums in check “pretty remarkable.” The 2012 Part B premium for outpatient care will be $99.90 per month – about $7 less than projected as recently as May. The extra cash that most seniors will pay works out to about 10 percent of the average Social Security cost-of-living increase that’s coming their way. Some folks will even pay less. Younger retirees who recently enrolled were charged $115.40 a month this year, but they too will drop down to $99.90 . What’s behind the lower-than expected premium prices? Some cite the relationship between Social Security cost of living adjustments (COLA) and Medicare, while others cite a moderation of health care costs. Medicare’s Part B annual deductible, the amount beneficiaries pay before their coverage begins, will also drop next year to $140 – a decrease of $22. The hospital deductible, however, will increase by $24, to $1,156, for those admitted as inpatients. One doesn’t cancel out the other since a minority of beneficiaries are hospitalized in any given year. The bottom line from the Obama administration? Medicare is under sound management. read source article
Source: whatisworking.com

The Medical Quack: HMS Holdings Buys Medicare Recovery Audit Contractor HealthDataInsights for $400 Million

HDI, a technology-enabled healthcare services company whose mission is to ensure claims integrity, identifies and recoups improper payments for health plans and government payers. Applying rules approved by the Centers for Medicare & Medicaid Services (CMS) and commercial health plan clients to identify fraud, waste and abuse, HDI reviewed more than $300 billion in paid claims last year. HDI is the exclusive Medicare Recovery Audit Contractor (RAC) in 17 states and three U.S. territories (CMS Region D), covering approximately 22% of all Medicare claims in the nation. According to CMS’s FY 2010 Report to Congress on the "Implementation of Recovery Auditing at the Centers for Medicare & Medicaid Services," HDI’s efforts in Region D accounted for 47% of the total dollars corrected by all four Medicare RACs.
Source: blogspot.com

Mitt Romney Loves Medicare Very Much And Won’t Ever Let Anyone Take It Away, No Matter What

On a policy level, the idea, Romney explains, is to “encourage insurers to lower costs and compete on the quality of their offerings.” But as Ezra Klein has already explained, that was the oft-stated idea behind the liberal proposal to include a government-run “public option” in ObamaCare’s insurance exchanges. What liberal supporters of the public option said less often was that many, including the idea’s designer, hoped it would provide a slow-but-steady path to single-payer, as private insurers slowly dropped out of the market unable to “compete” with a heavily subsidized, artificially low-priced government-run insurance plan. (Read how a public option for property insurance has displaced private offerings in Florida.)
Source: reason.com

Providence Health Plan to Offer Healthways SilverSneakers® Fitness Program to Medicare Advantage Members

Posted by:  :  Category: Medicare

Eliminate medicare advantage - Health care reform rally at San Francisco City Hall by Steve RhodesHealthways is the leading provider of specialized, comprehensive solutions to help millions of people maintain or improve their health and well-being and, as a result, reduce overall costs. Healthways’ solutions are designed to help healthy individuals stay healthy, mitigate or eliminate lifestyle risk factors that can lead to disease and optimize care for those with chronic illness. Our proven, evidence-based programs provide highly specific and personalized interventions for each individual in a population, irrespective of age or health status, and are delivered to consumers by phone, mail, internet and face-to-face interactions, both domestically and internationally. Healthways also provides a national, fully accredited complementary and alternative Health Provider Network and a national Fitness Center Network, offering convenient access to individuals who seek health services outside of, and in conjunction with, the traditional healthcare system. For more information, please visit www.healthways.com.
Source: childrenhealthwizard.com

Video: What Is Medicare Advantage?

Medicare: What Family Caregivers Should Know

You may, for example, be caring for an aging parent who is enrolled in a Medicare Advantage plan and becomes hospitalized. After the hospital stay, he/she may need inpatient rehabilitation care at a Skilled Nursing Facility. However, the Medicare Advantage Plan may have limited skilled nursing facilities within the network and you may not be pleased with the options. In that situation, there is what is known as the OEPI (Open Enrollment Period for Institutionalized Individuals). Persons “institutionalized” (i.e. residing in or moving in and out of a skilled nursing facility and other eligible institutions) have a continual enrollment period. The person can disenroll from a Medicare Advantage plan while in the facility and return to regular Medicare (or a different MA if accepting enrollment) the beginning of the next month.
Source: agingwisely.com

Medicare Advantage patients for sale on Wall Stree

Access and Quality of Cancer Care AHA AHIP America’s Affordable Health Choices Act America’s Health Care Plans American Hospital Association cancer cancer care Catholic Health Association Employee Retirement Income and Security Act FAH Federation of American Hospitals H. R. 676 H. R. 3200 HCAN Health Care Reform Health Insurance and Mortality in U.S. House bill for health care reform HR 3962 John Geyman John P. Geyman M.D. M.D. Medicaid medical-loss ratio medical-loss ratios National Center for Policy Analysis ncpa ObamaCare Obama health care patient’s health insurance coverage Patient Protection and Affordable Care Act of 2010 PhRMA lobby PNHP PPACA SEIU single-payer bill Single Payer single payer system sustainable system of universal access The Cancer Generation: Baby Boomers Facing a Perfect Storm Under-use of necessary care uninsured United States National Health Insurance Act wellness plans White House’s Health Care Summit
Source: pnhp.org

How is Romney’s Medicare plan different from Medicare Advantage?

Currently, Medicare is a fee-for-service system that pays for a set of benefits specified in legislation, including hospital services, physician services, home health services and certain other categories. Provider payment rates are set by the government, and patients are subject to some cost-sharing, such as deductibles. In a fee-for-service system, neither patient nor provider has much incentive to hold down costs or provide services in the most efficient way. This proposal will transition Medicare to a premium support program, and will control the growth of the total cost of the program. Starting in 2018, federal support per Medicare enrollee will be limited to the 2017 level and will be allowed to grow no faster than a five-year moving average of GDP growth plus one percentage point.
Source: retirementrevised.com

Can You Rely On Medicare To Pay For Your Long Term Care Needs?

A.  It is a mistake for you to think that Medicare will cover all your Long Term Care bills.  Medicare was never intended to cover Long Term Care needs.  It was enacted when it was just assumed that family members could be relied on to provide care to parents and grandparents while they aged.  Medicare only pays for things that are medically necessary to treat an illness from which a beneficiary is expected to recover.
Source: wordpress.com

Medicare Advantage Health Plans

There are some options available for you to opt for when you plan to enroll in Medicare health plans. Medicare health plan is the government-sponsored health insurance program that is specially offered for people of 65 years old and over. There are four options available for you to choose from. If you plan for hospitalization you should choose Part A. If you plan for doctor visits you should choose Part B. If you plan for prescription drugs you should choose Part D. If you don’t find one that suits your health care needs, you can choose alternative choice, a Medicare Advantage health plansthat is also known as Medicare Part C.
Source: healthplanscomparison.net

Now is the time to change Medicare enrollment

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

Medicare Advantage…Here Today, Here Tomorrow…

Judd joined TripleTree’s healthcare team in 2008. His work is focused on strategic and financial analysis to support the firm’s M&A, capital formation and strategic advisory services. His responsibilities also include market research, tracking healthcare industry activity and comprehensive analysis of market trends, all of which impact TripleTree’s healthcare practice. Previously Judd was a financial analyst at Honeywell International. Judd holds a B.S.B. in Finance from the Carlson School of Management at the University of Minnesota.
Source: healthworkscollective.com

Bonuses Tied To Medicare Advantage’s Star System Reward Plans For Quality

The Hill: Survey: Medicare Patients Clueless About Health Plan Ratings Most Medicare beneficiaries have no idea how the federal program’s rating system works, according to a new Kaiser Permanente survey. The survey comes as the annual enrollment period for seniors starts Saturday. The Department of Health and Human Services has been touting its new Medicare Star Quality Ratings program as a way for seniors to pick the best plan, but the survey found that only 18 percent of beneficiaries are familiar with it — and only 2 percent actually knew their current plan’s rating. “Evaluating a Medicare plan can be challenging. There are many things to consider, but quality should be at the top of any consumer’s list,” Kaiser Permanente’s senior vice president for quality, Jed Weissberg, said in a statement. “Educating consumers about and encouraging them to use the Medicare Star Quality Ratings helps to ensure that Medicare beneficiaries are receiving only the best available care” (Pecquet, 10/12).
Source: kaiserhealthnews.org

Understanding Medicare Advantage Health Plans

Some of our readers qualify for Medicare benefits. A lot more of them help take care of parents, or other family members, who rely upon this giant government health plan for their health services. Because Medicare Advantage plans have become popular alternatives, and because we hear a lot of confusion about how this program works, we thought it would be worthwhile to highlight the basics of these plans.
Source: over50web.net

What is Medicare Advantage?

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Source: insurance-report.com

Medicare Advantage open enrollment continues through Dec. 7th

Another critical factor in choosing a Medicare Advantage plan is confirming if your medical providers will accept and submit claims to the plan.  All of these can change from year to year.  You cannot assume a Medicare Advantage plan which met your needs one year will necessarily meet your needs in the upcoming year.  A review is important. If your plan is continuing in 2012 and you’re happy with what it’s offering next year you don’t need to do a thing. Your enrollment will continue into next year. 
Source: involvementonline.org

Medicare Advantage Is Advantageous

But those extra dollars flow directly to senior citizens and translate into better benefits and superior care. On several key quality indicators, including breast cancer screenings, annual flu vaccinations, and diabetes testing, Medicare Advantage beneficiaries score better than those covered by traditional Medicare. Moreover, enrollees in Medicare Advantage are screened and diagnosed earlier for cervical cancer, colon cancer, melanoma, and other deadly diseases.
Source: wordpress.com

Medicare Physician Revalidation Extended Two Years to March 2015 and a Sample Revalidation Letter

Posted by:  :  Category: Medicare

day 6 365 days Hipstamatic by drivebybiscuits1In accordance with the Patient Protection and Affordable Care Act, Section 6401 (a), all new and existing providers must be reevaluated under the new screening guidelines in Section 6028. Medicare requires all enrolled providers & suppliers to revalidate enrollment information every five years (reference 42 CFR 424.57(e)). To ensure compliance with these requirements, existing regulations at 42 CFR 424.515(d) provide that CMS is permitted to conduct off-cycle revalidations for certain program integrity purposes. Upon the CMS request to revalidate its enrollment, the provider/supplier has 60 days from the date of this letter to submit complete enrollment information using one of the following methods: Providers and suppliers can enroll in the Medicare program using either the:
Source: managemypractice.com

Video: Boston: Medicare Fraud Summit Providers Panel

Medicare providers get reinstated when feds fail to attend hearings : Covering Health

Health care in a community drives jobs and millions – even billions – of annual revenues. AHCJ’s Business of Health Care Workshop will provide resources, skills and ideas that journalists can apply to their jobs immediately. Learn more about how to cover this tremendous economic engine beyond the routine stories, with tools to find essential information your audiences need, crossing the traditional beats of health, business and government.
Source: healthjournalism.org

Medicare Delays Provider Enrollment Revalidation Until 2015

The Centers for Medicaid & Medicare Services (CMS) has delayed the requirement that physicians revalidate their Medicare enrollment under the program integrity screening provisions of the Affordable Care Act. According to CMS, the revalidation effort, originally scheduled for March 23, 2013, will be pushed back through 2015. Physicians will be among the last to revalidate.
Source: wordpress.com

The Federal MediCare Insurance policy Positive aspects

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Source: calvarybaptistchurchonline.org

Medical Devices Today: Medicare’s ACO Final Rule Responds To Provider Concerns, But Leaves Device Industry Dissatisfied

Accountable care organizations are aimed at getting primary care physicians, specialists and other health care providers to work together more in caring for patients. The hope is that better coordination will improve the quality of care patients receive while also lowering costs by, for example, reducing unnecessary services such as duplicative diagnostic tests.
Source: medicaldevicestoday.com

Providers of Supplemental Medicare Insurance

If you are 65 or older, then you know that you are eligible for Medicare. One thing that many seniors are realizing, however, is that the coverage they score through Medicare is not actually enough to mask all of their needs. In other words, many seniors glimpse that they are not getting the prescription coverage that they need. Others are discovering that they are paying out of pocket for routine doctor visits when these visits would have been covered years ago on an individual insurance belief. This is why the government has introduced Medigap. Medigap is another word for supplemental Medicare insurance. If you need to choose this insurance, you will want to inaugurate by researching the providers of supplemental Medicare insurance.
Source: medicaresupplementalinsurances.org

Grady pulls support for Medicare provider

While Grady will still accept MediGold for emer­gency care, noth­ing else will be cov­ered; that means that start­ing next year, the clos­est hos­pi­tal that will accept MediGold’s 1,800 mem­bers will be St. Anne’s in West­er­ville, a Mount Carmel hos­pi­tal. That will pose a chal­lenge to senior cit­i­zens in Delaware who are are unable to find trans­porta­tion there, said Tara Day, an insur­ance spe­cial­ist with the Delaware County Coun­cil for Older Adults.
Source: delgazette.com

Obama’s Opportunity for the “Super Committee”

If the Super Committee fails to report any bill, or the Congress votes it down, the entire $1.2 trillion will be automatically “sequestered.” However, when it comes to health care, sequestration will not be too painful. Medicaid, the joint federal-state program for low-income residents, is exempt; and most of Medicare, the federal program for seniors, is limited to cuts of two percent annually. The Congressional Budget Office (CBO) estimates that total Medicare spending for 2013 through 2021 will be $40.3 trillion before sequestration and $40.2 trillion after sequestration.
Source: ncpa.org

NRHA testimony on expiring Medicare provider payment policies

Since the creation of the Medicare program, independent laboratories have been allowed to bill Medicare directly for certain clinical laboratory services. These independent laboratories allow small and rural hospitals to access high quality services when they do not have the volume or financial resources to support their own state-of-the-art laboratory. Independent laboratories provide pathology services to multiple hospitals, receiving the volume necessary to purchase the most up-to-date equipment and employ skilled laboratory staff. A hospital can utilize any independent laboratory for these services, creating competition among laboratories for delivery services and allowing hospitals to choose the laboratory that best meets their needs. Without this extension, hospitals would have to absorb new costs without a payment increase. This could result in limited access to surgical services for Medicare beneficiaries near their residence.  This could result in beneficiaries delaying treatment leading to poorer outcomes and increased costs when complications arise. Congress has recognized the importance of this hospital and independent lab arrangement throughout the years by “grandfathering” independent labs into this program. Under certain circumstances these “grandfathered” facilities are allowed to continue billing Medicare directly for services. An extension would allow independent laboratories to bill Medicare directly for certain clinical laboratory services.
Source: ruralhealthweb.org

Cigna purchased HealthSpring Medicare provider in $3.8 billion deal

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Source: liveinsurancenews.com

Weekly Update: National Provider Call: Revalidation of Medicare Provider Enrollment

Thursday, October 27, 2011; 12:30-2pm ET CMS will hold a National Provider Call to discuss the revalidation of Medicare provider enrollment information. Most providers and suppliers who are enrolled in the Medicare program will have to revalidate their enrollment which will be reviewed under the new risk screening criteria required by the Affordable Care Act Section 6401(a). Learn what you can expect and how to prepare for this process. Target Audience: All providers and suppliers enrolled with Medicare prior to March 25, 2011 and which expect to receive payment from Medicare for services provided. Agenda will include:
Source: blogspot.com

User:Medicaredsupplemental148insurance

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyMedicare insurance Health supplement Insurance coverage: A Right of Passageway? Rights regarding verse — you’ve got the owners permit, became tall enough to consume, acquired betrothed, acquired children, reach 40, and then 50 along with started to be qualified to receive United associated with Omaha hold’em, on, and after this you are Over 60 and are qualified to receive Medicare insurance. Grasp that and also the difficulties that accompany that. Shopping for a Treatment product plan’s some of those difficulties : but it’s not really which challenging. In case you are older than Sixty five and do not have a very retired person health care prepare by having a ex- workplace or unification or perhaps a authorities retired person plan and they are not on Medicaid medicare supplemental insurance with regard to health coverage then you need probably had the delight of studying the options. It really is specially hard if you’re looking in to this specific insurance coverage when you are first transforming Sixty-five. If you have been subject to this specific you know why when i state your own mailbox becomes messy with the ads from all of the various suppliers involving Medicare health insurance product suppliers as well as your academic material from Cultural Protection along with Medicare. You’ll receive pamphlets along with sets out associated with insurance coverage as well as applications and also lots of “Choosing the Medicare supplement Policy” Instructions (Medigap is yet another phrase with this insurance coverage) and also Treatment and you also and realises as well as asks for to send your details back again over a credit card. Even perhaps even worse are the telephone calls and also the unforeseen guests in the doorway just about all planning to enable you to realise why their own ideas are best. It’s one of several worst kinds of very real problem you are going to ever before knowledge. You will have a collection involving Medicare insurance and Medicare product guides One base taller. They start about 6 months just before the 65th bday and just frequently come until many months after. Even with the age of 65 you may be inundated in the end of the year with gives from various businesses. Some of them look too good to be real – and so they tend to be. To create issues a good a bit more frustrating is you have to overlook every little thing you have ever identified with regards to medical health insurance before the day of Sixty-five. The truth is, this kind of insurance coverage does not have surgeon’s systems. They may not be PPO’s or perhaps HMO’s. When you’re getting a new Medicare dietary supplement you won’t need to bother about a medical expert having, and even choosing, a single Medicare insurance health supplement businesses strategy over another’s. The circle is the Medicare insurance community as well as the surgeon’s business office files medical statements using them — avoid the particular Medicare health supplement insurance company. After Medicare insurance approves the actual state they’re going to alert the Medicare insurance Dietary supplement medicare supplement plans Insurance company that they need to pay their part. Therefore, the actual Medicare insurance supplement insurance company can not make a decision if they need to pay out an insurance claim or otherwise not. In the event that Medicare approves they have to spend operator. In case Medicare insurance will not approve the insurance organization doesn’t pay anything at all sometimes. Also, the strategies are usually standardized categories of advantages grouped into strategy letters. Consequently, you could possibly purchase an agenda P oker or even a plan Gary or even C. Regardless of that plan correspondence you are going by using it will work identically with no relation to its recognise the business you will get it via. Consequently, when you find yourself shopping for the coverage do not worry. Select your current prepare, go shopping rates, and get.
Source: gpuwiki.org

Video: Medicare Part D Prescription Drug Plan Basics

Flu Wiki Forum:: News Reports for May 4, 2011

“Today’s proposed rule will expand Medicare beneficiaries’ options for where to receive a flu shot during flu season,” CMS Administrator Donald M. Berwick, MD, said in a news release. “The new requirements would make flu shots available in more of the health care facilities that Medicare beneficiaries are most likely to visit, including hospitals and rural health clinics.” Under the plan, all patients would be offered a flu shot between Sep 1 and the end of February, unless vaccination is medically contraindicated. Patients could decline the shot. The facilities would also be required to offer the shots during a flu pandemic.
Source: newfluwiki2.com

CARPE DIEM: Income Inequality Explained by Demographics

Most of the discussion on income inequality focuses on the relative differences over time between low-income and high-income American households, but it’s also instructive to analyze the demographic differences among income groups at a given point in time to answer the question: How are high-income households different from low-income households? Recently released data from the Census Bureau (available here, here, and here) for American households by income quintiles in 2010 allows for such a comparison: see the chart above (click to enlarge).
Source: blogspot.com