Medicare Buz

Modern Healthcare: Medicare Cuts Mean Nursing Home Layoffs: Survey Medicare nursing home reimbursement cuts will lead to direct-care staff layoffs at 63 percent of nursing home facilities, according to a survey of such facilities conducted on behalf of the Alliance for Quality Nursing Home Care, which represents for-profit nursing homes. In addition, 77 percent of respondents said they would be delaying expansion and renovations as a result of the 11 percent Medicare reimbursement cut to skilled-nursing facilities that went into effect Oct. 1, according to the online survey of association members and non-members, which was conducted by Avalere Health (Barr, 11/7).
Source: kaiserhealthnews.org

Video: Medicaid, Nursing Homes and Asset Protection

Kentucky Elder Abuse Attorneys Say Medicare Adjustment Should Not Impact Nursing Home Care

Partners J. Marshall Hughes and Lee Coleman are accomplished injury attorneys and advocates for people who have suffered from nursing home neglect and abuse, as well as auto accidents, brain injury, drug injury, defective products, environmental dangers, fire and burn injury, insurance disputes, motorcycle accidents, premises liability, Social Security disability, stock fraud, truck accident injury, workers’ compensation and wrongful death.
Source: redefiningfederalism.org

Nurses In Nursing Home Settings Find It Very Difficulty To Report Errors

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

Nursing Home’s Failure to Notify Leaves Beneficiary Not Liable for Custodial Care Services

A Medicare beneficiary is not liable for custodial care services rendered by a Mississippi nursing home because the facility failed to give adequate notice the services were not covered by Medicare, a federal appeals court panel ruled on October 25.  The case (Mississippi Care Center of Morton LLC, Sebelius, 5th Cir., No. 10-60595, Oct. 25, 2011)  concerned the application of 42 C.F.R. 411.404, which states a beneficiary is considered to have known custodial care or services that are not reasonable and necessary are not covered services under Medicare, provided the beneficiary received adequate notice the services are not covered under Medicare.  
Source: hallrender.com

Learn About Medicare Benefits at Hillsborough County Nursing Home Event

Hillsborough County Nursing Home and Home Health and Hospice Care present an educational lecture for the community, “Making the Most of Your Medicare Benefit.” The lecture takes place Wednesday, November 9, at 5:30 pm at the Hillsborough County Nursing Home, 400 Mast Road Goffstown. Denise Rivard, an expert on long-term care benefit utilization, will provide education and handouts to participants in an informal setting allowing plenty of time for questions and answers. A light meal will be provided for participants, and space is limited. RSVP by alling Sheryl Ramsay at 627-5540, ext 7231
Source: typepad.com

How To Choose a Nursing Home

What to Ask The best way to learn about nursing homes is to talk to staff members. Setting up an interview with the nursing home administrator is especially helpful; here is a useful list of questions you should ask the administrator. Some general questions to ask staff members or the administrator are: 1. May I see the most recent state survey as well as surveys? a. Any nursing facility that receives Medicaid or Medicare funding must be inspected annually by a state official. 2. Is the home licensed? Is the administrator licensed? 3. Do all staff members undergo background checks? Are they screened for a history of abuse? 4. What is the staff to resident ratio? 5. How many hours per day do staff members spend with residents? 6. If I have a complaint, what is the procedure? 7. Do you have isolation rooms available in the event of a contagious resident? 8. May I try the food you give to residents? 9. Are residents routinely weighed? 10. How are emergency situations handled? Which hospital do you send residents to?
Source: kylieofiu.com

Senior Care Options:Nursing Home Costs and Ratings for Medicare and Medicaid Insurance : Silvercensus Blog

As an entrepreneur in digital media, Julie Northcutt launched Caregiverlist.com to deliver the efficiencies of digital technology to senior care companies, professional senior caregivers and families. After graduating from the Missouri School of Journalism, she jumped fence from writing to advertising sales, due to her attraction to launching new business streams for companies. She credits her entrepreneurial skills to experiences gained while growing up on a family farm. She joined USA Today and then became a pioneer in the internet, launching the online advertising sales for Morningstar.com. Often having hobby businesses on the side, she finally saved her money to start her own business, a senior home care agency, combining her entrepreneurial skills with a service she had personal experience in. She grew the agency to be a leader in the Chicagoland market and sold it to a national company in order to focus full-time on Caregiverlist. Caregiverlist.com provides the online tools she wished she had when she owned the senior home care agency, serving as a reliable resource for senior care professionals, adult children and seniors. Caregiverlist answers all the questions that begin when senior care becomes a need, while providing efficient business tools for senior care companies. She credits clients, employees and business colleagues with keeping the idea for Caregiverlist.com on track and contributing to the continued success with their suggestions and feedback.
Source: silvercensus.com

Nursing homes struggle with Medicare cuts

In a surprise twist, Adobe has decided to stop developing Flash Player for mobile devices. Instead, the software company whose most notable products include Acrobat Reader and Photoshop will focus on the development of HTML5, an open set of Web standards, featuring tools that enable developers to create Flash-enabled standalone apps. Flash has endured a rough road since the large push began to penetrate the mobile device market. For mobile devices, the software has been known to drain batteries and diminish processing power. By focusing on HTML5 technology, Adobe will still allow developers to create apps using Flash content that will be offered though all the major phones’ app stores, including, you guessed it, Apple’s.
Source: bizmology.com

Illinois Medicaid Changes: Look

The state of Illinois now will now make it possible to “look back” at a senior’s finances for 5 years, instead of 3 years.  The lengthening of the look-back period will enable the state to be sure that money wasn’t given away if you really could afford to pay for the nursing home care on your own (seniors may gift the money to their children so they will have some inheritance, rather than using this money to pay for their nursing home care and now there are limits on how much money can be “gifted” in order to qualify for Medicaid).  This requirement was added because in the past there were some very wealthy families who were asking for the state to pay for their nursing home care and pretending they had no financial resources when they had really just given all their money away to a loved one.
Source: caregiverlist.com

Medicare is Popular : South Carolina Nursing Home Blog

“Medicare Part D has reached popularity levels that you seldom, if ever, see from a government program,” said Mary R. Grealy, president of the Healthcare Leadership Council and co-chair of Medicare Today. “Over the last five years of satisfaction surveys, Part D has stayed consistently above an 80 percent approval rating. And given the fact that competition is keeping the program affordable – and that average premiums won’t increase in 2012 – satisfaction should stay very high.”
Source: scnursinghomelaw.com

Aging and Parkinson’s and Me: Watch Out For This Nursing Home Scam!

One fifth of Medicare nursing home patients with advanced Alzheimer’s or dementia were sent to hospitals for questionable reasons in their final months, often enduring tube feeding and intensive care. Researchers suspect that it’s not a coincidence, since Medicare pays a nursing home about three times the normal daily rate when it takes patients back after brief hospitalizations. A group of researchers from Brown University, Harvard University and Dartmouth Medical School studied about 475,000 nursing home patients who had been transferred to hospitals. Among them, 19 percent were moved for questionable reasons. The large state-by-state variation suggested that extra Medicare money may be playing a role. The rates of dubious transfers ranged from 2 percent in Alaska to more than 37 percent in Louisiana. (Dubious or “burdensome” transfers occured when a patient was moved in the last three days of life, moved several times in the last three months of life, or moved into a new nursing home after hospitalization.) Transfer rates also varied greatly among cities. In McAllen, Texas, 26 percent of study participants had multiple hospitalizations for urinary infections, pneumonia or dehydration — conditions that usually can be treated in a nursing home. That figure compares to just 1 percent in Grand Junction, Colo. (Interestingly, McAllen was the subject of a 2009 story in The New Yorker because it spends more per person on healthcare than any other city with the exception of Miami, which has much higher labor and other costs. In 2006. Medicare spent $15,000 per enrollee in McAllen, nearly twice the national average.) Medicare pays on average $175 per day, depending on the state, for long-term care. Nursing homes can receive three times that amount after patients return from hospitalizations of at least three days. For nursing homes just scraping by, this opportunity creates a tremendous incentive to hospitalize patients. Researchers found that patients who had dubious transfers were more likely to have feeding tubes inserted, to spend time in intensive care in the last month of life, to have a severe bedsore, or to be enrolled in hospice late (three days or less before they died). Dubious care was more common with blacks and Hispanics and those without advance directives that spell out the patient’s care wishes. The study was published in the New England Journal of Medicine. See http://www.nejm.org/doi/full/10.1056/NEJMsa1100347 Tips for Getting the Best Nursing Home Care Beth Kallmeyer , who runs programs for caregivers for the Alzheimer’s Association, has these suggestions for caregivers whose patients are admitted to nursing homes:
Source: blogspot.com

~snip~ This year Medicare’s open enrollment period has changed. It began October 15, 2011 and will end December 7, 2011. But, it lasts 7 weeks longer than before! This gives people with disabilities and seniors more time to compare and find the best plan that meets their individual needs. This change also ensures that Medicare has enough time to process plan choices so coverage can begin on January 1, 2012. For questions about open enrollment, see Medicare’s website for answers, here.
Source: livejournal.com

Video: Arkansas Medicare Supplements

Rise in Medicare Premiums Less Than Feared in 2012

 All Cities  Arkadelphia  Bella Vista  Benton  Bentonville  Blytheville  Cabot  Conway  El Dorado  Fayetteville  Forrest City  Fort Smith  Harrison  Hope  Hot Springs National Park  Jacksonville  Jonesboro  Little Rock  Mountain Home  North Little Rock  Paragould  Pine Bluff  Rogers  Russellville  Searcy  Sherwood  Siloam Springs  Springdale  Texarkana  Van Buren  West Memphis  White Hall
Source: arkansasbusiness.com

CONSUMER ALERT: TIPS FOR MEDICARE OPEN ENROLLMENT 

Add new tag Alltel Alltel Corp. Anarian Chad Jackson Arkansas Arkansas Advocates for Children and Families Arkansas Board of Corrections Arkansas Department of Health Arkansas Soybean Association Arkansas Take Back Barack Obama Benny Magness Bobby Glover Brandon Mitchell Cartoon Cartoons D&E Communications EFCA gang GI Bill Gunner DeLay Harville Cartoon I. Dodd Wilson Kim Hendren L.T. Simes Larry Norris Lea little rock Mark Pryor Mike Beebe National Institutes of Health Patrick Kennedy Race for 100 Randeep Mann recession Russellville Sitzer soybeans swine flu Tim Leathers Twitter UAMS Verizon Vic Snyder Windstream
Source: arkansasnews.com

Arkansas Medicare Supplements

In the Natural State, which is of course Arkansas, retiring and dealing with Medicare may not be on the top of ones list when turning 65 or coming off of employer coverage. This video goes over some fo the basic points that consumers in The Natural State should know. Medicare Supplement Plan F is the most popular of all the Medicare Supplement Plans because it covers all the expenses left behind by part A and Part B of traditional Medicare. Logon to www.medicaresupplementsmadeeasy.com or call us at 1 800 218 7935 for your free Medicare Supplement Quote.
Source: bestlongtermcare.org

KFFB 106.1 FM — Arkansas Radio — Online Radio

Medicare beneficiaries will have an opportunity to sign up for a Medicare Prescription Drug Plan beginning October 15 through December 7.  “This is earlier than in previous years”, according to Ed Haas, Executive Director of the White River Area Agency on Aging, Inc. This is the open enrollment period for all beneficiaries.    For 2012 there are over 50 Medicare Prescription Drug Plans available in Arkansas.
Source: kffb.com

How Democrats improved Medicare Advantage

Take away the 17% bonus payment to the providers and see how they handle this free stuff in their 30% margin. Medicare Advantage was another Republican plan to spend-out the Medicare funds faster like Medicare D. They didn’t fund either one and expected the additional payments to come from funds that were already showing up as running low in the out years. How about a 17% tariff on all imported good (average US tariff is far BELOW Europe, South America, Asia, Australia? On average, we have the lowest tariff rates in the world. And this is from that right wing magazine published by Farm Bureau, “Front Porch”. We allow dumping into the US of goods made by slave labor without health or environmental regulations, and stupidly call it “free trade”. What we have is slave labor, the goal for labor in the US by the Rethuglican Party which stupidly doesn’t look at the fact that the less you pay the workers, the less they have to buy your product. Ask WalMart about 9 flat quarters on stores open over a year. Even Henry Ford was more of a “pro labor” man than the current members of the Chamber and leading financiers. Hey folks, you can’t spend what you don’t have and thus the Rethuglican policy is to continue the Bush Recession/Depression into the ground when China calls the loan. What do you think we can get for a Tea Party Republican in sales to a prison factory in China? Is $1/day too much to ask?
Source: arktimes.com

Understanding the Medicare Benefits for Senior Citizens1

What does the Part D cover? The Medicare Prescription Drug Coverage is a type of health insurance program that are being run by insurance companies or other private companies that have been approved by the Medicare program. The two ways for you to get this coverage is through the Medicare Prescription Drug Plans and through Medicare Advantage Plans. The Medicare Prescription Drug Plans help immensely by adding coverage of drug prescriptions to the Original Medicare plans. The Medicare Advantage Plans also covers the Part D aside from covering both Parts A and B of your Medicare plan.
Source: 1800homecare.com

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

Video: Using a Medicare card, Australia

Medicare Part D & Prescription Discount Cards

While a Medicare beneficiary could use the PharmacyCard.org Prescription Savings Card at any time, they would not get credit for those prescriptions purchased using the Card unless it was during their deductible phase or the coverage gap (donut hole) and they mail in receipts to their Part D plan. The fact is that most people won’t remember to mail in copies of their prescription receipts, meaning they will not get credit for those prescription purchases and will not leave the coverage gap for that year.
Source: pharmacycard.org

4 Ways to Protect Your Identity and Personal Information

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information.  A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products.  If a sales agent does call or visit you uninvited they are violating the Medicare marketing rules.
Source: medicare.gov

Doctors costs in Australia?

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Source: com.au

Should You Sign Up For Medicare Advantage?

Many MA plans have a network of medical service providers. With some plans, you have to get your medical services from a network medical service provider in order for those services to be covered. With some of the plans, you may choose to leave the network, but you may have to pay more for covered services. When you see that your own favorite doctors are already on the plan, you may be more satisfied with the network. If you would rather have more freedom to pick and choose doctors, you may not be happy with this type of restriction. This is actually quite similar to the way PPO or HMO plans work on regular health insurance policies.
Source: a1answers.com

Find that suitable Medicare Supplement Insurance Company now

We all know the benefits of getting a Medicare Supplement Plans. But for some who doesn’t know about it, Medicare Supplement Insurance are made to cover the gaps that Medicare won’t fill. Example, the original Medicare that we have is Parts A and B.  It is good to know, however, that Medicare Supplement Quotes are all standardized by the government. All plans have the same coverage which means all the companies have the exact plan as the others. In order to find a good one, you will just have to look for a good insurance company with a long track record especially when it comes to giving the seniors the insurance.  Medigap can be used anywhere in the country. It doesn’t matter where you bought the plan. A lot of insurance companies are network based and this gives the clients the flexibility of using it anywhere.  This is very often helpful when one is in travel. All these Medicare Supplements Insurance have no difference in time in paying the claims back because again it is being observed by the federal government. When you have that plan, all you need to do is just present your identification card for your Medicare card.
Source: genespictures.com

ReversePhoneDirectory.com Warns of Peak Time for Medicare Fraud During Open Enrollment

ReversePhoneDirectory.com is a leading provider of reverse phone lookup services that enable consumers to simply search a number, including cell numbers (where available), landline numbers and VoIP to accurately find the owner of that number. In addition to phone number information, ReversePhoneDirectory.com has search portals for public records services and provides access to the most current information. ReversePhoneDirectory.com is committed to helping people live better during technologically advanced times, believing that information is a powerful currency and people across the country should have easy access to information about everything and everyone they come in contact with.
Source: prbusinessnews.com

Rx Discount Drug Card from Medicare Card

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Source: medicarecard.com

Bipartisan Senate Proposal Would Retool Medicare Program

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Source: businesslawdaily.net

Also indicted are three women with A&A Durable Medical Supply LLC, in Plaquemine. Charged with conspiracy to commit healthcare fraud are: Linda M. Jackson, 49; her mother, Eunice Sparrow, 67; and one of Jackson’s daughters, Uniecesco Smith, 29. Sparrow was assistant manager at A&A. Smith worked for A&A in operations and billing. Between April 2007 and April 2009. The charges allege that the three women used A&A to fraudulently bill Medicare more than $4.8 million for equipment either medically unnecessary or never provided to patients. The total included $2.3 million in power wheelchairs that were never provided according to the indictment.
Source: homecarela.org

Video: What Is The Difference Between Medicare and Louisiana Medicaid?

Louisiana Medicare Fraud Case Yields 4 Convictions

Ngari owned and operated Unique Medical Solution Inc., a Baton Rouge-area DME supplier that specialized in the provision of power wheelchairs to Medicare beneficiaries.  Evidence at trial established that beginning in late 2003, Ngari paid recruiters, including Jones and Payne, to locate and solicit Medicare beneficiaries to attend “health fairs” hosted by Jones and Payne at churches and other locations.   At the health fairs, doctors, including Dr. Lamid, prescribed the beneficiaries power wheelchairs that were medically unnecessary.   The prescriptions were used by Ngari to submit false and fraudulent claims, on behalf of Unique, to Medicare.  According to information presented at trial, the doctors, including Dr. Lamid, were paid illegal kickbacks by Payne and Jones based on the number of power wheelchair prescriptions generated at the health fairs.   Jones and Payne were also paid kickbacks by Ngari on a per prescription basis.
Source: newsroom-magazine.com

Louisiana Medicaid versus Medicare?

It is always better to pre-plan for the possibility of a loved one experiencing a healthcare crisis instead of waiting until it happens. However, even if a loved one is currently in a nursing home, it is still possible to stop the spend down of their life savings and get them qualified for 100% Medicaid assistance. Knowing the rules and implementing proper strategies for Louisiana makes this possible.
Source: medicaidlongtermcare.com

Congress centralizes medical decision

These amendments threaten decades of quality gains and the safety of Medicare beneficiaries. As Louisiana’s QIO, the upward climb in health care quality in our state is a testament to our local providers’ commitment to working with us on continuous quality improvement. See a compilation of Louisiana provider accomplishments and national quality gains in CMS’ QIO Program Progress Report.
Source: eqhssmarterhealthcare.org

Louisiana Businesswoman, Two Employees Accused of Medicare Fraud

Sonya Lewis Williams and two of her employees are accused of defrauding Medicare of at least $349,000, according to a Stamford Advocate report. Ms. Williams was allegedly based in Baton Rouge, La., but operated two Alexandria, Va.-based Medicare provider companies — Fusion Services and Grace Social Services. Employees Carla M. Clark and Lillie Lavan are accused of assisting Ms. Williams in allegedly preparing and submitting false bills to Medicare for face-to-face psychotherapy services that were never provided. Read the Stamford Advocate report on Sonya Lewis Williams. Related Articles on Medicare Fraud: CMS to Adopt Predictive Fraud-Fighting Technology July 1 6 Recent Stark, False Claims and Kickback Lawsuits Involving Hospitals and Systems Whistleblower Case Against Florida’s Halifax Health Moves Forward
Source: beckersasc.com

Wyoming Medical Center Accused of Defrauding Medicare and Medicaid

In a recently unsealed lawsuit, whistleblower Gale Bryden accused Wyoming Medical Center of defrauding Medicare and Medicaid. The lawsuit claims that the hospital’s records clerks altered hospital records by changing patient admission status without physician orders, which resulted in increased reimbursements. Hospital attorney Dick Williams states, “We have denied from day one that there was any intent to improperly bill the government…. Or that there was a systematic direction from anyone to alter statuses or records.”
Source: whistleblowerlaws.com

Medicare Supplemental Insurance and Medicare Advantage Plans in Louisiana

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Source: medicaresupplementadvantageplans.com

Accredited DME/ Durable Medical Supplies Equipment Medicare Provider # Business For Sale in Louisiana

Durable medical equipment (DME) is a necessary component to home healthcare, aiding patients in their daily lives and helping them to stay safe and healthy. Medical supplies are always in demand, and as the nation’s rapidly aging population experiences increasing health problems, demand will continue to grow. Market Segmentation The need for adult medical care is growing rapidly as the US population continues to age, and these older Americans on Medicare and Medicaid usually represent DME’s primary market. According to US Census Bureau, the population of Americans ages 65 and older is expected to double within 25 years. Nearly one in five Americans will be older than 65 by 2030, representing about 72 million people. In fact, the fastest US age group is the older-than–85 years population.
Source: bizquest.com

Medicare medicaid viagra art Louisiana: Buy online viagra where

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Source: buyingtadalafil.com

Mitt Romney’s Medicare plan: Resurrecting the public option?

Republican presidential frontrunner Mitt Romney has unveiled a plan to replace Medicare with a system offering older Americans subsidies to help them buy private insurance coverage. Romney’s plan is similar to House GOP budget expert Paul Ryan’s controversial proposal to voucherize the system, with one important exception: Romney would let people keep their Medicare coverage if they didn’t want to enroll in his “premium support” program. But if the private coverage that elderly Americans dismissed was cheaper, seniors would have to pay the difference to keep Medicare. Some critics have been quick to point out that this is quite similar to the choice — between a private health insurance option and a public one — that Republicans hated when it was floated by liberals during the health care reform debate. Is Romney really resurrecting the public option? Yes. Romney is essentially proposing a public option: Liberals wanted to “pit private insurers against a public insurer” so private providers would have to lower costs or lose customers, says Ezra Klein at The Washington Post. That government health insurance was called the “public option,” and conservatives hated it. But they seem to love the idea now that Romney is proposing it for Medicare. What they don’t realize is that if Romney wins, and his Medicare plan succeeds, “the pressure to open the revamped, semi-privatized Medicare program up to younger and younger Americans will be immense.” Welcome back, public option. “Wonkbook: Romney embraces the public option” Actually, Romney is moving away from government control: While I prefer Paul Ryan’s entirely private Medicare model, says Joseph Lawler at The American Spectator, it’s just not politically feasible. Romney’s plan is, at least, a realistic step in the right direction. And make no mistake: This would reduce the government’s role, and “could yield significant Medicare savings” by tapping the power of the market. “Romney hints at Medicare reform strategy” Romney’s plan won’t change anything: Liberals and conservatives are both wrong about Romney’s plan, says Peter Suderman at Reason. The presidential hopeful’s plan is simply “designed for maximum pandering.” Romney is trying to please the Right by offering a private option to Medicare’s public one, and he’s trying to soothe the Left and the elderly by positioning himself as “the protector of Medicare.” But under Romney’s hybrid system, private insurers would likely be “unable to ‘compete’ with a heavily subsidized, artificially low-priced government-run insurance plan.” The result? Medicare as we know it would win out, and the government would stay in control of seniors’ health care system. This is business-as-usual masquerading as reform. “Mitt Romney loves Medicare very much and won’t ever let anyone take it away, no matter what”
Source: theweek.com

The Best of Times hosts “Community Forum” on Medicare Changes and Medicare Advantage Plans

Also, during this “Community Forum”, the attendees will have the opportunity to enroll, and/or to arrange for appointments to learn more about these health care plans.  Medicare beneficiaries residing in Caddo and Bossier parishes of Louisiana are invited to attend this forum with no admission fee and convenient free parking. Light refreshments will be provided. Attendees are invited to tour the special exhibitors of the Community Forum and also visit the many exhibits of the Louisiana State Exhibit Museum after the forum has concluded.
Source: kwkhonline.com

Medicare, Medicaid cuts threaten hospitals' economic impact

“People often do not realize that hospitals are huge contributors to our economy, even during an economic recession,” LHA President and CEO John Matessino said in a statement. “Every dollar spent by a hospital supports 95 cents of additional business activity, and each hospital job supports approximately 1.4 additional jobs.”
Source: fiercehealthcare.com

Like the Q1Medicare stand-alone Medicare Part D prescription drug plan Find Me A Sugar Daddy or PDP-Finder, the Medicare Advantage plan Find Me A Sugar Daddy is designed as a simple alternative to other more complicated online Medicare plan search tools. Using the Q1Medicare.com/MA-Finder, Medicare beneficiaries enter their ZIP Code, choose their county if necessary, and view all 2012 Medicare Advantage plans available in their area. Alternatively, MA-Finder users can start on a state level and browse through the counties within a state to see highlighted plans showing the lowest cost plans with $ 0 deductible prescription drug coverage for each type of health plan (such as HMO, PPO, or PFFS), along with a link to a complete list of Medicare Advantage plans in the specific county.
Source: doctorhogansclinic.com

Video: The Medicare Learning Network (MLN): Official CMS Information for Fee-For-Service Providers

4 Ways to Protect Your Identity and Personal Information

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information.  A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products.  If a sales agent does call or visit you uninvited they are violating the Medicare marketing rules.
Source: medicare.gov

The Official Medicare Set Aside Blog And Information Resource: Maryland Drug Fee Schedule, Take 2

Maryland is taking a second attempt at implementing a state pharmaceutical fee schedule. A previous attempt last January was based upon generic equivalent average price (GEAP) and was strongly opposed as it is not a readily accessible standard. The newest version of the regs adopt an AWP standard, as is common in many other jurisdictions. The regs set the price for brand names at AWP minus 10% plus a $3 dispensing fee and generics are capped at AWP minus 10% plus a $5 dispensing fee. While there is still strong opposition by physician groups that continue to feel in-office dispensing is important to patient care and that need the markup to compensate them for the inconvenience, the proposal appears reasonable enough and will help significantly curb some of the outrageous drug spends we see here in Maryland. Now the real question is if adopted officially into law, will CMS continue to force Maryland payers to allocate AWP in WCMSAs without any discounts???
Source: medicaresetasideblog.com

The Medicare Information Solution: Part 2

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Source: liveinsurancenews.com

Medicare Deductibles for 2012

Medicare announced on CMS.gov in a fact sheet titled “Medicare Premiums and Deductibles for 2012″. This fact sheet gives detailed information on the increases to the yearly premium and deductible Medicare patients will have to face in the coming year.
Source: about.com

Medicare Open Enrollment: 4 Places to Look for Medicare Information

1. Your mailbox Look through your mail carefully — you may get important notices from your current plan, Medicare, or Social Security about changes to your coverage or any extra help you may get paying for prescription drugs. Also look for your Medicare & You handbook.  Like an old friend, it shows up around the same time every year. This year, it may be in your email inbox instead – if you decide to “go green” and asked to get it electronically.   You’ll also start to see brochures from companies that offer Medicare health and drug plans. Just remember, be smart about protecting your personal information and your identity — plans aren’t allowed to call or come to your home without an invitation from you.
Source: paramuspost.com

Medicare Open Enrollment: 4 Places to Look for Medicare Information

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

Information session for those on Medicare [log in]

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Source: tmnews.com

ReversePhoneDirectory.com Warns of Peak Time for Medicare Fraud During Open Enrollment

ReversePhoneDirectory.com is a leading provider of reverse phone lookup services that enable consumers to simply search a number, including cell numbers (where available), landline numbers and VoIP to accurately find the owner of that number. In addition to phone number information, ReversePhoneDirectory.com has search portals for public records services and provides access to the most current information. ReversePhoneDirectory.com is committed to helping people live better during technologically advanced times, believing that information is a powerful currency and people across the country should have easy access to information about everything and everyone they come in contact with.
Source: prbusinessnews.com

Following is a notice from one of the MAC websites: Beginning November 1, 2011, all new providers submitting through an existing submitter ID (including billing services and clearinghouses) will be required to enroll/link using HIPAA version 5010. If the existing submitter ID is not certified for the version 5010 format, any enrollment requests to link new providers will be rejected and returned. This notice is in accordance with CMS Technical Direction Letter (TDL) 12035.
Source: wordpress.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

The Rural Voice: Medicare Shared Savings Program National Provider Call: Application Process and Overview of the Advance Payment Model Application

The Centers for Medicare & Medicaid Services is hosting a call on Tuesday, November 15, 2011 from 11:30-1 pm MT to discuss the application process for the Medicare Shared Savings Program (to create Accountable Care Organizations) and the Advance Payment Model. The Advance Payment Model is intended to provide additional support through upfront resources to physician-owned and rural providers.
Source: blogspot.com

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

AARP on Medicare Supplements

When you are shopping for medicare supplemental plans,it is always important to make sure that you explore all of your options. In particular, if you live in a mid to low income household, you should always start off by finding out if the state Medicaid program will cover your medigap costs. If you make more money than these programs allow, then you can narrow your choices down to a Medicare Part C plan that covers 100% of your cost or some type of supplemental insurance in combination with conventional Medicare. If you decide that the third option is truly best for your health and financial needs, then you will most likely find that AARP Medicare Supplement Insurance offers you the best advantages and services for you money.
Source: mostmedicare.com

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

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

The Patient Protection and Affordable Care Act of 2010 established the Medicare Shared Savings Program, which promotes the voluntary formation and operation of ACOs to coordinate and improve care for Medicare beneficiaries. ACOs that meet certain quality standards will be eligible to share in savings that result from their efforts. The voluntary ACO program, which requires a three-year agreement, will begin on April 1, 2012. Potential participants also have the option of starting the program on July 1, 2012. Applications are due to CMS in early 2012.
Source: typepad.com

Video: Medicare Free B Ocean County, NJ

The Rural Voice: Medicare Shared Savings Program National Provider Call: Application Process and Overview of the Advance Payment Model Application

The Centers for Medicare & Medicaid Services is hosting a call on Tuesday, November 15, 2011 from 11:30-1 pm MT to discuss the application process for the Medicare Shared Savings Program (to create Accountable Care Organizations) and the Advance Payment Model. The Advance Payment Model is intended to provide additional support through upfront resources to physician-owned and rural providers.
Source: blogspot.com

HEALTH REFORM: Revisiting the Medicare Shared Savings Program: An Interagency Effort to Promote Accountable Care :: Epstein Becker & Green, P.C.

On October 20, 2011, the Centers for Medicare & Medicaid Services (“CMS”) released its final rule (“Final Rule”) implementing the voluntary Medicare Shared Savings Program (“Program”) for accountable care organizations (“ACOs”). The Program was established by Section 3022 of the Patient Protection and Affordable Care Act. The Final Rule was released in conjunction with revised antitrust guidance from the Federal Trade Commission (“FTC”) and the Department of Justice (“DOJ”), as well as with the establishment by CMS and the Department of Health and Human Services’ Office of Inspector General (“OIG”) of several waivers from various fraud and abuse laws. As part of this interagency effort to facilitate participation in the Program, the Internal Revenue Service (“IRS”) also issued a fact sheet regarding nonprofit organizations’ participation in ACOs.
Source: ebglaw.com

CMS Releases Final Medicare Shared Savings Program/ACO Rule : Health Industry Washington Watch

Today the Centers for Medicare & Medicaid Services (CMS) released its long-awaited final rule to implement the Medicare Shared Savings Program as authorized by Section 3022 of the Affordable Care Act (ACA).  The Shared Savings Program is intended to encourage physicians, hospitals, and certain other types of providers and suppliers to form accountable care organizations (ACOs) to provide cost-effective, coordinated care to Medicare beneficiaries.  Under the final rule, an ACO that meets established quality and performance standards and surpasses a minimum savings target will be able to share a percentage of savings (in addition to traditional fee-for-service payments under Medicare Parts A and B).  While the ACA requires CMS to "establish" the Shared Savings Program no later than January 1, 2012, CMS has indicated that it will begin accepting applications for the Shared Savings Program January 1, 2012, but the start date will be later in 2012. In the final rule, CMS made a number of notable changes to the proposed rule, as highlighted after the jump.
Source: healthindustrywashingtonwatch.com

Analysis of Medicare Shared Savings Program/Accountable Care Organization (ACO) Final Rule — Akin Gump Health Reform Resource Center

Click here to see Akin Gump’s preliminary analysis of the Medicare Shared Savings Program final rule. We anticipate that the final rule will be published in the Federal Register on November 2nd. In addition, the final rule indicates multiple areas where the Centers for Medicare & Medicaid Services (CMS) anticipates releasing subregulatory guidance. We will provide additional information as it becomes available.
Source: aghealthreform.com

Enjoy Best of Health during Festival Season and Upcoming New Year Choosing Right Health Plan Under Medicare or Not

Sudhir Mathuria, a Houstonian for over 30 years, has been an active participant in various community associations. He is a licensed proffesional for Medicare and Medicaid related health care plans. He can be reached by phone at 713-771-2900 or via email at sudhir@MyMedicarePlanning.com. For more information, visit: www.MyMedicarePlanning.com
Source: indoamerican-news.com

CMS Releases Final Rule on Accountable Care Organizations

One-Sided Risk Model:  Under the proposed rule, all ACOs would have operated under a “two-sided” risk model where ACOs had the chance of losing money if they did not produce sufficient savings.  In the final rule, ACOs are allowed to participate in a “one-side” risk model, which will allow providers to participate in the program without risking a loss in the event that their ACO does not produce savings.  The final rule also allows ACOs to opt into a “two-sided” risk model in exchange for the opportunity to receive a greater share of savings.
Source: omwhealthlaw.com

Experts Discuss Changes in the New Medicare ACO Regs and Whether they Will Provide Sufficient Incentives for the Industry : e Yugoslavia

CMS’s final rulemaking on the Medicare Shared Savings Program, released on Oct. 20, made a concerted effort to address industry frustrations and concerns. Significant revisions were made to the program’s risk tracks, beneficiary assignment and quality measures to help ease the burden on interested applicants.
Source: eyugoslavia.com

Beyond the senior discount: ten ways to save when you’re older

Slash Insurance Costs If you’re retired and your children are now independent, you may not need as much life insurance as before. Consider raising deductibles on home and auto insurance, the amount you have to pay before receiving benefits should you make a claim. Opting for a $1,000 or $500 deductible instead of a $250 deductible for both home and auto insurance could save you money every year. Many companies also provide a discount if you buy all your property insurance from them. The National Council on Aging suggests designating the younger spouse as the principal driver of the family car, which could reduce your car insurance costs.
Source: atyourhomefamilycare.com

Medicare Savings Programs: Analyzing Options for Expanding Eligibility

Despite the financial assistance offered through Medicare savings programs (MSPs), many eligible beneficiaries do not enroll in them. In this study, researchers examined changes that would simplify eligibility requirements and align them with the low-income subsidy for the Medicare Part D drug benefit. They also examined policy options that would extend eligibility for MSPs and the subsidy by relaxing resource standards or by opening eligibility to incomes as high as 200 percent of the federal poverty level. To do this, the researchers built a model to simulate baseline eligibility and examined the effect of eliminating the resource standards and increasing the income threshold.
Source: commonwealthfund.org

Final Antitrust Policy Statement Regarding ACOs in Medicare Shared Savings Program : Duane Morris Health Law

On October 20, 2011, the U.S. Federal Trade Commission and the Department of Justice, which coordinate enforcement of the antitrust laws, issued their final Statement of Antitrust Enforcement Policy Regarding Accountable Care Organizations Participating in the Medicare Shared Savings Program (the “Enforcement Policy”). The fundamental principle of the Enforcement Policy is that the agencies will apply the rule-of-reason analysis to all accountable care organizations applying for or participating in the Shared Savings Program and, if the same services are involved, to commercial insurance products modeled on the Shared Savings Program.
Source: duanemorris.com

That’s why we want to help you take control over your Medicare coverage.  Look around for all the Medicare information out there, visit our Open Enrollment center, and watch a video about how the Medicare Plan Finder works. After you’ve narrowed your options, you can call the plans you’re interested in to get more details about their benefits and services, or check out their websites.
Source: medicare.gov

Video: What Does Medicare Cost?

Defined Benefit Pension Plan Cost Changes for Medicare Cost

The second change relates to the calculation of allowable pension costs for cost-finding purposes. Two different methodologies are necessary to appropriately address the goal of each. The wage index is used to measure a hospital’s labor costs across areas, while cost-finding procedures determine the actual costs incurred at individual hospitals. The current maximum amount of defined benefit pension costs claimed for cost-finding purposes, as detailed in Section 2142.5 of the Provider Reimbursement Manual (PRM), is based on actuarial accrued liability, normal costs and unfunded actuarial liability. To be allowable, costs must be computed in accordance with the Employee Retirement Income Security Act of 1974 (ERISA). The current period liability for pension cost also must be funded. Finally, funding in excess of a current period liability can be carried forward and recognized in a future period.
Source: healthcarereforminsights.com

Romney’s Plan Would Fundamentally Change Medicare

Joe Baker, president of the Medicare Rights Center, a N.Y.-based consumer advocacy group, discounts Romney’s claims that having more seniors in private plans will save Medicare money. The Medicare Advantage program, he said, “has not brought down costs, so to think that there’s a new version that willy nilly by itself will bring down costs is a fantasy….It’s really cover for the real goal, and that is to end Medicare as we know it and by doing that, have more money come out of the pockets of consumers and save the federal government money.”
Source: kaiserhealthnews.org

Affordable Care Act delivers lower costs to Medicare recipients

Under the Affordable Care Act, people with Original Medicare can receive recommended preventive benefits and a new Annual Wellness Visit without paying a co-payment or any cost-sharing. In June, Medicare launched “Share the News. Share the Health!” a campaign to raise awareness about the importance of prevention for people with Medicare and their health care providers. In addition, CMS has reached out to doctors through its “Prevention Advisory” and other health care provider-directed materials on Medscape, a website for continuing medical education.
Source: columbiabusinesstimes.com

Cutting Cost in Medicare: How About Considering Cost First?

The RPM Report — A modest proposal for the austerity era: let the federal government factor cost into coverage decisions for Medicare Part B. For biopharma companies, that sounds like a terrible idea’but, in the long term, the alternatives just might be much worse.
Source: windhover.com

bensozia: Romney’s Medicare Reform

To which I say, David, get ready to rethink. No private insurance plan is more efficient than Medicare. No private insurance plan anywhere in the world is close to as efficient as Britain’s entirely socialist system. Competition in health care does not lower costs, period. If Republicans want to try the experiment, great. Let them. It will fail, and then we won’t have to listen to them any more. But as even his admirer Brooks notes, Romney’s plan is missing the key number: how fast his premium supports will rise over time. Romney’s (and Paul Ryan’s) plans only help reduce government spending through magical thinking: once we privatize everything, costs will fall! They will not. The only way to control costs in this system will be to make the premiums rise more slowly than health care costs, which means that the plans will pay for less and less and retirees will be stuck paying for more and more. Given the political clout of seniors, that won’t happen. Instead, Congress will require the insurance companies to pay for whatever people want, and premiums will have to rise, and we will be stuck with costs even higher than we have currently, because of the added layer of insurance company bureaucracy. There is nothing magical about markets. They work when people have the time and know-how to comparison shop. Most health care spending goes toward the very sick, and people who have just had heart attacks are very bad comparison shoppers.
Source: blogspot.com

12 Are Charged in Medicare Fraud Schemes Said to Cost $95 Million

Another defendant, Emma Poroger, 56, of Staten Island, was charged in a separate indictment for participating in a scheme to defraud Medicare of approximately $13 million, officials said. Ms. Poroger, a doctor of osteopathy, is accused of billing Medicare for a variety of services that were never provided, including vitamin infusion therapy, sleep studies, nerve conduction tests and medical scans, officials said.
Source: nytimes.com

Speaker: Medicare D plans confusing but important

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

This Week’s Trifacta for November 7

Cost is Unsustainable Regardless of Additional Revenues:  Senator Pete Domenici (R-NM), and Dr. Alice Rivlin, co-chairs of the Bipartisan Policy Center Debt Reduction Task Force, stated in testimony last week to the Joint Select Committee on Deficit Reduction “the principal driver of future federal deficits is the rapidly mounting cost of Medicare. The huge growth in the number of eligible seniors over the coming years is due to both increasing longevity and the retirement of the baby boomers. Then, that beneficiary growth is multiplied by continuing increases in the cost of health care. Without a significant change in this trend, the cost of Medicare will continue to rise faster than the economy can possibly grow. Even if revenues are raised and other spending is restrained…the exploding cost of Medicare is unsustainable.”
Source: gop.gov

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

Hillsborough County Nursing Home and Home Health and Hospice Care present an educational lecture for the community, “Making the Most of Your Medicare Benefit.” The lecture takes place Wednesday, November 9, at 5:30 pm at the Hillsborough County Nursing Home, 400 Mast Road Goffstown. Denise Rivard, an expert on long-term care benefit utilization, will provide education and handouts to participants in an informal setting allowing plenty of time for questions and answers. A light meal will be provided for participants, and space is limited. RSVP by alling Sheryl Ramsay at 627-5540, ext 7231
Source: typepad.com

Video: Improving Medicare in 2011

Vigilant Counsel News Blog

Can an employer reduce or eliminate benefits for a current employee when the employee becomes eligible for Medicare? No, because doing so is probably a violation of the federal Age Discrimination in Employment Act (ADEA) and also a violation of the Medicare rules, according to a recently released informal discussion letter from the federal Equal Employment Opportunity Commission (EEOC) (ADEA: Coordinating Medicare with Current Employees’ Benefits, August 2, 2011). In the discussion letter, the EEOC reminds employers that the ADEA exemption that allows employers to drop employer-sponsored health coverage upon Medicare eligibility applies only to retiree coverage, not to current employees. And, because dropping coverage for current employees upon Medicare eligibility is an age-based action, the employer must meet the ADEA’s “equal benefit or equal cost” defense to pass muster under the ADEA, meaning that the employer must provide older employees the same benefits as are provided to younger employees, or else they must incur the same cost to provide benefits, even if the benefits that may be purchased for that cost are less than what may be purchased for younger employees. Finally, the EEOC noted, the Medicare program itself requires employers to offer current employees, who are Medicare-eligible the same benefits under the same conditions as those employees who are not Medicare-eligible.
Source: vigilantcounsel.org

Medicare’s New Drug Benefit: Value The Attempt

. If you are a Medicaid enrollee and feature not received details about which plan you may have been enrolled in you must name: 1-800-MEDICARE (1-800-633-4227). TTY/TDD users must name 877-486-2048, (24 hours a day/7 days a week), or your State Medicaid Place of business, or the Social Security Management at 1-800-772-1213 among 7 a.m. and seven p.m., Monday thru Friday. TTY/TDD users must call, 1-800-325-0778.
Source: philippinespressrelease.com

Medicare’s Future: Will Medicare benefits be cut?

If the Super Committee fails to reach an agreement, Medicare growth would still be curbed for the 2013 plan year because The Budget Control Act of 2011, the same law that created the Super Committee, requires specific budget cuts to be made if the Super Committee can’t reach a consensus and move a bill forward. The current law requires federal spending reductions beginning in 2013. Included in these cuts are a two percent (2%) reduction in Medicare payments to hospitals and other providers.   This is on top of the over $400 billion in ten year Medicare savings that were a part of the 2010 health care reform legislation.
Source: ehealthinsurance.com

Democrats on Super Committee Offer to Cut Medicare Benefits

It is unlikely this specific deal being offered by the Democrats on the committee will be accepted by Republicans, because it calls for tax increases and more stimulus, but it still puts our social safety net in danger. It is another instance of the Democratic party steadily moving towards the official position of saying Medicare benefits can and should be cut.
Source: firedoglake.com

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.
Source: american.com

Kelly Services(R) Reports 3rd Quarter 2011 Results

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

Survey shows Medicare benefits not fully understood by many

Another factor that came out from the survey was that many of those taking the survey felt they knew a good deal about health care cost management when, in fact, they did not. Some 78 percent said they believed they were knowledgeable about Medicare benefits. But when asked what was covered in Medicare Part A, many could not answer. Also, more than 50 percent of those taking the survey said they did not have a strategy to pay for long-term care needs.
Source: connecticutelderlawblog.com

Report: Super Committee Democrats Caving On Medicare Benefits Cuts

The sweet Jesus lovin’ Republicans once again have pushed the weak-spine Demos, inspired by Captain Crap Out the Capitulator (you might know him as Hopie-Changie), into causing mass death and pain among senior citizens. Praise the Lord, for the Republicans follow Jesus’ example with love: – Raise your rifles and fire to the heavens, for the Lord’s got a smiley paint ball with holy water aimed at your temple! – Blessed are the rich and whoa to the poor: let me reiterate, it is easier for a camel to pass through the eye of a needle, than for a poor man to enter heaven. – “When I was stuff from my $700 dinner, you gave me more when your health care premiums increased; when I whined about my Porsche, you accepted stagnant wages; when Hopie-Changie had no courage to raise my taxes a microscosim, you fought against your own personal interests and ordered his ass to stay put.” – The world is flat! The bible says so! Remember, farts, the health care your parents receive should be the same care you’ll desire when you’re old and kaput. If our current senior citizens suffer, than we’ll deserve no different upon retirement.
Source: businessinsider.com

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Source: allbloggertools.com

Video: Paul Ryan – Leadership Needed to Save Medicare; Lift Debt Burden; Grow Economy

Finding Medigap Insurance Quotes on the Web

 Finding supplemental Medicare insurance rates can be done through the government website for Medicare, as the Webster will offer you the option to place your zip code, and retrieve medical care quotes from companies who provide the gap insurance. To obtain a quote, you should enter your information onto the website as honestly as possible, and fill out the quote form in its entirety to the best of your ability. If you are able to fill out the entire form and give the best, most specific answers possible, you will likely obtain a quote that is nearer your true cost for Medigap coverage.
Source: davidphinney.com

Q1Medicare.com Releases Updated Online Medicare.gov Plan Finder Tutorial

“The Medicare.gov Plan Finder provides a wealth of information, but for people unfamiliar with this site, the Plan Finder may add to the complexities Medicare beneficiaries face as they try to choose a Medicare Advantage plan or Medicare Part D prescription drug plan,” notes Dr. Susan Johnson, co-founder and technical director of the Q1Medicare.com site. “The goal of our tutorial is to provide a simple guide so the Medicare community can better navigate the Medicare.gov site and find the Medicare plan that most affordably meets their prescription and health coverage needs.”
Source: axxela.com

Earlier deadline for changing 2012 Medicare coverage?

You may have heard that there is a new, earlier deadline if you want to change your 2012 Medicare coverage. And you may be wondering how that applies to you and your coverage under traditional Medicare and its provision for Christian Science nursing in a religious non-medical healthcare institution (RNHCI) such as the Benevolent Association. Traditional or original Medicare benefits are covered under Medicare Part A and Part B. It is Part A that provides coverage in a RNHCI.
Source: chbenevolent.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 [...]
Source: over50web.net

Medicare’s New Drug Get advantages: Worth The Effort

. In case you are a Medicaid enrollee and have now not won details about which plan you might have been enrolled in you should name: 1-800-MEDICARE (1-800-633-4227). TTY/TDD users should name 877-486-2048, (24 hours a day/7 days every week), or your State Medicaid Administrative center, or the Social Safety Management at 1-800-772-1213 between 7 a.m. and 7 p.m., Monday thru Friday. TTY/TDD customers will have to name, 1-800-325-0778.
Source: electromagnetichealth.com

Free seminars help to demystify Medicare coverage

Call 800-MEDICARE (800-633-4227) for a booklet on Medicare options, including a detailed explanation of covered benefits and monthly premiums of plans. The site also gives star ratings for many of the Medicare plans. If you need individual help, you can call the Medicare hot line to talk to a counselor who will help you search for options over the phone and will mail you a summary of what you discuss. You also can go to www.medicare.gov and do the comparison yourself. Click on health plan finder, enter your ZIP code or county and the type of plan you want, such as a Medicare Advantage or Med- igap policy. The site also gives star ratings, with the best plans getting a five-star rating.
Source: onlinehealthinsurancerates.com