Health Care Financing: Is Traditional Medicare Uncompetitive?

Posted by:  :  Category: Medicare

Why traditional Medicare might thrive in a more competitive program: Under competitive bidding among Medicare plans, private health insurers and traditional Medicare would offer bids (their cost) for providing a defined benefit to an average risk beneficiary. The government would then set subsidies (premium support) at some level that is a function of the bids (like the minimum, second lowest, or average). To enroll in a plan that cost more, a beneficiary would pay more out of pocket…. [M]any people consider such an arrangement (e.g., the Domenici-Rivlin proposal)… a way to drive traditional Medicare out of the market, or at least some markets…. an adverse selection death spiral for the public option…. [T]raditional Medicare will become a high risk pool because private plans will outbid the public option and/or find clever ways to select good risks. However, it is not a foregone conclusion things would play out that way….
Source: typepad.com

Video: How to prepare for the Medicare Competitive Bidding Program

Competitive Bidding in Medicare

Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee- rather than government staff at the Centers for Medicare & Medicaid Services -would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Source: vgm.com

Expand Competitive Bidding in Medicare

Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee— rather than government staff at the Centers for Medicare & Medicaid Services —would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Source: americanprogress.org

Medicare Competitive Bidding Threatens Access to Seating and Mobility Products

I know this could also be posted under the CareCure Legislative forum, but since it is specific to the seating and mobility equipment that you are passionate about I thought it would be appropriate to post it here in the Equipment forum. For those Forum members in the US, Medicare is pursuing a cost savings strategy of competitively bidding critical DME devices including major categories of manual and power wheelchairs as well as wheelchair seat cushions. The details of the Competitive Bidding Program are complicated, but it is clear that government bidding of these individualized, specialty items will no doubt limit choice and make access to top performing seating and mobility products more difficult. I have been involved in industry lobbying efforts to try and convince Medicare officials of the negative impact such a bidding program will have on individuals who rely on high performance wheelchairs, but it seems clear that many top level government officials see wheelchairs and seat cushions as commodity DME items, not realizing the critical importance these devices have on those who rely upon them for both mobility and skin protection. Perhaps the most scary part of Medicare pursuing this strategy is that the negative impact won’t only be restricted to the Medicare market. We are already seeing many state Medicaid programs and private insurance programs grab on to lower payments rates and access restrictions that resulted from a Round 1 pilot program of Competitive Bidding. And this is before the Medicare bidding program becomes a national program in 2013. I can’t see any scenario where the Medicare Competitive Bidding program will not ultimately limit your access and choice to critical seating and mobility equipment. It is not too late to convince Medicare officials and Members of Congress that this is a bad program – but to accomplish this we need individuals who use and rely upon this equipment to add your voice to lobbying efforts. Here is a great posting on the ROHO blog site from Bob Vogel about how to engage with your Members on Congress on this important topic. Your Members of Congress work for you. They are your elected officials. Part of their job is to listen and respond to your concerns. I encourage you to make your voice heard with the same passion that you show in participating in this Forum! http://blog.therohogroup.com/index.p…-and-senators/ Thank you! Tom Borcherding The ROHO Group tomb@therohogroup.com
Source: rutgers.edu

Medicare Announces Prepayment Review And Prior Authorization Demonstration Project For Power Mobility Devices

The prior authorization demonstration does not create new documentation requirements for providers and suppliers – it simply requires them to provide the information earlier in the claims process. After receiving the prior authorization request, Medicare will conduct a medical review and communicate the coverage decision (based on Medicare policies such as National Coverage Determinations (NCD) and Local Coverage Determination (LCD) to the patient, provider and supplier within 10 business days of receiving the request. Under rare, emergency circumstances, Medicare must complete this process in 48 hours. Physicians or treating practitioners can make unlimited requests, but Medicare has 30 days to consider any resubmitted requests. Claims with approved prior authorization requests will be paid if all other Medicare coverage and documentation requirements are met.
Source: myedutrax.com

Poorly Designed Medicare Auctions Could Disrupt Device Marketplace

“Instead of looking at other agencies, they have designed a program that is highly flawed and will lead to supply shortages and lack of proper service support for equipment, such as Negative Pressure Wound Therapy,” Turner said. “Used properly, this device can save limbs and even lives and can be used at home if there is service support. But the new competitive bidding program disregards the essential need to build in proper payment for this support and will likely lead to worse health outcomes, more hospitalizations, and higher costs.”
Source: thecre.com

Medicare Expands Competitive Bidding Program

The Hill: Medicare Says Competitive Pricing Will Save $28B Medicare is dramatically expanding a program that it says will save billions of dollars and serve as a model for other cost-cutting efforts. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the second round of a program that uses competitive bidding to set prices for certain medical products. Medicare now uses competitive bidding in nine cities and will expand to 91 areas, according to the Friday announcement. In its first six months, the nine-city competitive bidding program has saved roughly $130 million, CMS officials said. The agency expects to save $28 billion over the next 10 years, roughly a third of which would be savings to patients (Baker, 8/19).
Source: kaiserhealthnews.org

Medicare expands competitive bidding

The competitive bidding program encourages suppliers to set lower prices for certain medical equipment and supplies. “We’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years,” said CMS administrator Donald M. Berwick. “Medicare is paying much more than the private sector for equipment like wheelchairs and walkers. By expanding our successful competitive bidding program, we can ensure that Medicare pays a fair rate for these goods.”
Source: lifehealthpro.com

High costs for home medical equipment persist

Medicare’s Fierberg says the agency is working on its severe overspending on home medical equipment, on which it spent $8 billion in 2009. After investigations (http://www.gao.gov/new.items/d11337r.pdf) by Congress’s General Accounting Office (http://www.gao.gov/new.items/d1156.pdf) and others, Medicare started competitive bidding on various equipment in nine cities last January, resulting in a 30 percent savings, he said.
Source: gazette.com

Disabilities: Saving Medicare billions: Trying too hard can get in the way

The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare’s frequent citations of the Congressional Budget Office’s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out of state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.
Source: blogspot.com

Medicare, Test Strips and Competitive Bidding

Lowell was previously using the Bayer Contour meter.  He was sent the Prodigy meter. Lowell was nice enough to send me pictures of the boxes he had.  I don’t know exactly how Bayer rated in that study, but I do know the Contour was listed and was a pretty accurate meter.  I know a lot of people like the Contour meter.  The supply company sent Lowell a Prodigy meter.  I was not familiar with the Prodigy meter so I Googled it.   I did find a bunch of bad reviews that said the Prodigy is frequently 30 points off.  Lowell mentioned the logs required by Medicare.  Medicare only requires logs from people getting more than 3 test strips a day.  Medicare will only give people using insulin more than 3 test strips a day so I think it is safe to “assume” Lowell is using insulin.  It is important that Lowell have an accurate meter so why is he forced to use a meter that is not accurate? 
Source: kellywpa.com

“Comment on Cramton and Katzman: Medicare Competitive Bidding Lowered E” by Thomas J. Hoerger

In contrast to Cramton and Katzman’s assertion that Medicare encountered serious problems with its pilot competitive bidding program, Thomas Hoerger of RTI International cites his early evaluations that suggested strikingly positive results.
Source: bepress.com

Competitive bidding [podcast]

Support The Incidental Economist Blog is supported in part by the Robert Wood Johnson Foundation. Who We Are, What We Do This is a blog (mostly) about the U.S. health care system and its organization, how it works, how it fails us, and what to do about it. All blog authors have professional expertise in […]more →
Source: theincidentaleconomist.com

Medicare Expands Competitive Bidding Program

CMS announced the next steps for a major expansion of a competitive bidding program that helps lower costs for quality durable medical equipment, prosthetics, orthotics, and supplies. The competitive bidding program uses competitions between suppliers to set new, lower payment rates for certain medical equipment and supplies, such as oxygen equipment, walkers, and some types of power wheelchairs. The first phase of the program was successfully implemented for nine product categories in nine areas of the country on January 1, 2011.
Source: nextgenrcm.com

Texas Lawsuit Identifies Problems In Medicare Hospice Provisions

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSRehfeldt claims he discovered that the medical director for Vitas’ local office, Justo Cisneros, simultaneously worked as a medical director and doctor for the two HMOs, WellMed Medical Management Group, based in San Antonio, and Care Level Management, run by Inspiris, a Tennessee company. There, Cisneros was in a position to refer the chronically ill HMO patients to Vitas — and to then certify them as meeting Medicare’s hospice rules, the lawsuit alleges. The lawsuit says Cisneros executed the plan with Keith Becker, a former general manager of Vitas’ San Antonio office who is now an executive at Inspiris.
Source: localnewslongbeach.com

Video: Rick Perry Hates Social Security, Medicare & Rules For Wall Street

Whistleblower Accuses Chemed Unit of Medicare HMO Conspiracy

Vitas conspired with the two HMOs to admit their unprofitable patients into hospice, though they weren’t facing imminent death and thus weren’t eligible for hospice under Medicare rules, the lawsuit says. It says the arrangement allegedly benefitted Vitas by providing hospice patients, while allowing “the HMO defendants to dump non-profitable patients onto hospice, regardless of their qualifications.”
Source: g7finance.com

Medicare affirms rule expected to erode Epogen sales

The agency said the requirement would be history as of 2013. The maximum hemoglobin level will remain in force. The new rules mirror labeling changes from the FDA, which has debated the safety of Epogen and a sister drug Procrit, marketed by Johnson & Johnson ($JNJ). Studies have suggested that higher dosing is linked with various health risks, including stroke, blood clots and death.
Source: fiercepharma.com

You Can Leave the Nursing Home (Fall 2011 Update) 

[1]Medicare Benefit Policy Manual, Pub. 100-02, Ch. 8, §30.7.3. (Page 35, Example, second paragraph) (http://www.cms.hhs.gov/manuals/Downloads/bp102c08.pdf). [2]Medicare Benefit Policy Manual, Pub. 100-02, Ch. 8, §30.7.3. (Page 35, Example, third paragraph) (http://www.cms.hhs.gov/manuals/Downloads/bp102c08.pdf).  [3]Medicare Benefit Policy Manual, Pub. 100-02, Ch. 3, §20.1.2. (Page 4) (http://www.cms.hhs.gov/manuals/Downloads/bp102c03.pdf). [4]Medicare Claims Processing Manual, Pub. 100-04, Ch. 6, §40.3.5.2. (Page 45) (http://www.cms.hhs.gov/manuals/downloads/clm104c06.pdf). [5]Medicare Claims Processing Manual, Pub. 100-04, Ch. 6, §40.3.5.2. (Page 45) (http://www.cms.hhs.gov/manuals/downloads/clm104c06.pdf). [6]Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, §30.1.1.1 (Page 51) (http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf).   CMS cites, as authority for this payment option, the Nursing Home Reform Law, 42 U.S.C. §1395i-3(c)(1)(B)(iii), which requires that SNFs "inform each other resident, in writing before or at the time of admission and periodically during the resident’s stay, of services available in the facility and of related charges for such services, including any charges for services not covered under this subchapter or by the facility’s basic per diem charge."  CMS also cites 42 C.F.R. §483.10(b)(5)-(6). [7]Medicare Claims Processing Manual, Pub. 100-04, Ch. 1, §30.1.1.1 (Page 55) (http://www.cms.hhs.gov/manuals/downloads/clm104c01.pdf). 
Source: medicareadvocacy.org

Important Message from Medicare (IM)

While most hospitals have achieved compliance with delivery of the form on or before admission, many struggle with compliance in delivering the form at discharge. The America Case Management Association (ACMA) met with CMS officials to discuss results of the ACMA Public Policy Committee’s survey about the delivery of the second IM. The results of the survey include the following findings:
Source: compass-clinical.com

Medical Billing Update: Further Reduction in Reimbursement Proposed for Imaging

The Stark legislation prohibits self-referrals by physicians to facilities in which they have ownership. Later, a series of common sense ‘exceptions’ were granted to allow for legitimate business transactions including the ‘in-office’ ancillary services exception. This exception allows rapid diagnosis and initiation of treatment during the patients office visit resulting inpatient convenience and better coordination of care. However, imaging must be personally supervised by the referring physician, a physician who is a member of the group practice, or an individual who is supervised by the referring physician or another physician in the group (the supervision requirement). There are also specific building/billing requirements in place by Medicare. Now, CMS is proposing that physicians who perform MRI, CT and PET services in their offices relying on this exception to Stark disclose certain information to patients. Patients must be notified in writing at the time of referral that they have the right to receive these services from an entity other than the physician or his/her group practice and practices must also provide a list of alternative “suppliers” in the area. With some exceptions, the list of alternative suppliers would have to include 10 alternative suppliers within 25 miles of the physician’s office at the time of the referral. The documentation required for audit purposes must include the patient’s signature and the record must be placed in the patient’s chart.
Source: kareo.com

Medicare ACO Rules Near Final Hurdle : Accountable Care Forum : Health Care Lawyers & Attorneys: Squire Sanders & Dempsey Law Firm

MarketWatch reportedthat interest in ACOs has now spread from healthcare providers to employers, who believe this new health delivery system will help sustain employer-sponsored benefits without compromising affordability or quality of care.  According to MarketWatch: “This survey of 674 U.S. employers reveals that 28 percent are interested or very interested in exploring ACOs, while 37 percent are somewhat interested, 24 percent are unsure and 11 percent are not at all interested. Quality of care delivered is the top ranked factor by 82 percent of employers in evaluating the use of ACOs. This was followed by the ability to manage the total cost of care (81 percent), patient outcomes (66 percent) and plan/provider pricing transparency (47 percent).” 
Source: accountablecareforum.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

Final CY 2012 Medicare Payment Rules in the Pipeline : Health Industry Washington Watch

2012 Medicare payment rules to the White House Office of Management and Budget for final regulatory clearance. Rules under consideration include the final Medicare physician fee schedule, outpatient hospital, ambulatory surgical center, ESRD and home health prospective payment system rules for 2012. While the text of the regulations are not available at this point, we expect that they will be put on display at the Federal Register in the coming days. We will be providing summaries of the final rules in future updates. 
Source: healthindustrywashingtonwatch.com

Medicare change tied to safer weight loss surgery

Recent studies have found that gastric bypass leads to faster weight loss and greater appetite control than the banding approach, making bypass potentially superior for some patients (see Reuters Health story of October 14, 2011). Others have found better diabetes control with bypass versus banding.
Source: rawstory.com

Medicare Touts Progress On Closing Doughnut Hole

CQ HealthBeat: MedPAC Eyes Recommendations To Streamline Care For ‘Duals’ The Medicare Payment Advisory Commission voted this week to send recommendations to Congress aimed at expanding a program that has shown success in better managing the costs of the most expensive part of the Medicare population — “dual-eligible” enrollees who also qualify for the Medicaid program. Known as PACE — short for Program of All-Inclusive Care for the Elderly — the program’s premise is that the health care costs of the frail and disabled can best be managed through a comprehensive set of medical, social and rehabilitative services that, in many instances, keep patients out of nursing homes and reduce their visits to hospitals (Reichard, 11/4).
Source: kaiserhealthnews.org

ACO Final Rules: Key Changes

Risk-reward: Perhaps the biggest change from the proposed rules to final rules deals with the risk-reward of the Medicare Shared Savings Program. Under the proposed rule, an ACO could choose from two tracks, each with a 3-year agreement. The first would have been a one-sided risk model, in which savings only would be shared for the first two years of the three-year ACO contract period. (In other words, the ACO would be shielded from actually losing money during Years 1 and 2.) In Year 3, though, savings and losses would be shared. In the two-sided risk model, savings and losses would be shared for all three years. In the latter model, while the potential for loss exists all three years, the upside potential for shared savings is greater than in Option 1. Option 2 would have provided an opportunity for more experienced healthcare organizations to receive a greater share of savings, but at the risk of repaying Medicare a portion of any losses.
Source: jhconline.com

Medicare looks to ease physician revocation rules

Other proposed changes to government regulations included rolling back a mandate that all hospitals have a director for outpatient services. CMS would remove the requirement and allow hospitals to decide if a director is needed, said CMS Administrator Donald M. Berwick, MD. Revisions also would remove outdated technical requirements for e-prescribing so they reflect current standards.
Source: medictoday.info

Learning About Medicare Advantage Plans

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSA licensed health insurance agent can assist you in getting a medicare advantage plans, so you can knock heavy debt out of the ring with the boxing gloves health insurance hands to you. Saving money has never been so easy. Agents usually respond within 24 hours to help you find the best health insurance fit into your budget.
Source: horoscop2009.org

Video: Medicare Advantage Insurance

National Health Insurance Vs Private Health Insurance

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

Bay Area Medicare Advantage Plans Provider, AdvoCare Insurance Services Discusses Long

A possible solution is for them to purchase a life insurance policy with a long-term care rider which has guaranteed ?living benefits? for life. Some life insurance companies are offering long-term care benefits combined with their life insurance products. These are called ?linked-benefit? life insurance products which add a long-term care rider usually to a universal life insurance policy. The major advantages of these products are they pay no matter what the buyer?s life situation becomes ? a long-term care benefit if needed, or a death benefit if long-term care is not needed. Further, these policies provide substantial leverage for every insurance dollar invested ? usually about 2 to 1 for the death benefit and 4 to 1 for the long-term care benefit. The buyer will need to determine whether this is a better solution than separate long-term care and life insurance policies.
Source: onlinesys.info

WHAT IS THE ADVANTAGE OF HAVING MEDICARE INSURANCE?

In unexpected times when sickness comes, people are oftentimes caught unaware.  Dilemma as to what kind of hospital to confine and where to get the money to spend for the treatment sets in.  This is the time when a Medicare plan is very helpful and useful.  The times of paying for the monthly premiums finally pays off.  If Medicare plans had been availed or paid for the burden for the treatment or confinement lightens.  Medicare insurance is a surety plan to ensure that in times of sickness the hospital or physician’s bills are taken care of.  It is a prepaid guaranty for future use because getting old or getting sick is reality of life.  It is a wise decision to get a plan because it can comfort the family and the patient that The plan depends on the capacity to pay.  There are different kinds of Medicare insurance both in private and in the government.  The government provides health benefits for its constituents especially for those in the service for the government.  There are also state paid insurance for the indigent populace.  Social insurance programs of the government have common provisions like the following: 1.
Source: ezinemark.com

Defend Your Wellbeing With One Of These Medicare Advantage Plan Pieces Of Advice

When selecting a Medicare part C plan, make certain items you expect to use are fully covered. For instance, some policies may need additional coverage for prescription medicine. If you purchase a basic plan without realizing this, you might experience significant out of pocket expenses for prescriptions. Take time to understand all of the benefits and covered items before purchasing a policy.
Source: simplyfashion.tk

What is Medicare Advantage?

Medicare Advantage is an alternative option to original Medicare (Part A and Part B). Original Medicare is run by the federal government while private health insurance companies offer Medicare Advantage. Since health insurers compete for Medicare consumers, they typically offer benefits that aren’t provided by original Medicare.
Source: gohealthinsurance.com

What is so hard about Medicare?

There are two initial decisions which you must make:  You can select the traditional Medicare package, which consists of Part A, Part B and Part D (which must be purchased separately from a private insurance provider of prescription drug plans).  Or, you can select a Medicare Advantage plan that provides your inpatient, outpatient and Rx drug coverage through a single managed care plan purchased directly from one of the many insurance companies that offer dozens of variations.  Rules, benefits and costs vary according to the specific plan you select.  Each has advantages and disadvantages depending upon your situation.  Once you enroll, you are locked in for a year, but you can change your plan every year if you wish.  So you always have an opportunity to improve your situation.
Source: ourplatinumyears.com

How to Sign Up for Medicare 

romance stories Green Card Visa remote access programs Website Design proxy networks Apple oil sands Apps Business Marketing apartments for rent boston Financial Advisor Internet Marketing Romance Books Online canadian stock market remote computer access Recapture Marketing boston luxury rentals money Wealth Management Website Promotion Search Engine Marketing Yahoo Immigrant Investor Visa interest rates Microsoft fenway apartments Google EB-5 Green Card EB-5 Investor Visa remote admin iPod Touch erotic book remote control software Romance Novels online romance investing remote management software Raymond James remote access software Search Engine Optimization Bing Gold Production luxury apartment boston remote desktop software erotic ebooks
Source: kxpc.com

Comparisons are Mandatory for Success

It is a very good habit to do Medicare Supplemental Insurance Comparison on a daily basis in order to secure your financial future. Those people who are Medicare members and use Medicare on a daily basis for them it is advisable to make a Medicare Comparison so that they do not remain aloof from the changes that are brought in from time to time in the Plans or also from the basic facilities or benefits that are provided by different Plans existing in the financial market. It should always be remembered that it is never easy for the people to sign on any Medicare Plan that they see at the first go without knowing the pros and cons of the Plan. It is very important to compare Plans so that you can land a Supplement Plan that has a minimum price with the maximum coverage. The basic aim behind the Comparison of the Plans is to know about the premium rates that may differ from Plan to Plan or from agency to agency. In fact it is interesting to note that all Medicare Supplement Plans are the same in their structure and design in every state regardless of the company that offer them. The reason behind this fact is that even though they are offered by various companies but their rules, conditions and regulations are both designed and controlled by the federal government. It is only that the premium rates will differ because of the different Insurance companies offering the Insurance. Here one thing that is noteworthy is that Medigap Supplement Insurance and Medicare Advantage Plan are extremely different because of the fact that Medigap covers other areas that are not covered by the usual Medicare health Plans.
Source: articlejadeo.com

Watch for PECOS warning on DMEPOS remittance advice

Posted by:  :  Category: Medicare

Optometrists who provide eyeglasses to Medicare patients using prescriptions that are written by other physicians should watch for the notice “Ordering Provider Not Authorized” on remittance advice forms, the AOA Advocacy Group warns. The advisory indicates that Medicare, in the future, will not cover eyewear ordered by the optometrist or ophthalmologist listed on the prescription because the prescriber does not have a complete enrollment record in Medicare’s Provider Enrollment, Chain, and Ownership System (PECOS).
Source: newsfromaoa.org

Video: Medicare Online

Higher copays seen for Medicare brand

Beneficiaries will also pay a bigger share of the cost of specialty drugs, which can exceed $1,000 or more per prescription. The share for 2012 averages about 32 percent, up from 27 percent this year. Specialty drugs include many of the newer treatments for chronic diseases such as rheumatoid arthritis and multiple sclerosis, as well as next generation anti-cancer drugs that come as pills.
Source: theolympian.com

How To Save Money And Get Discount Long Term Health Care In Oregon_56208

Get on line and find an insurance site that will let you do a side by side comparison of as many of the 42 companies offering long term health care in Oregon as you can. Factor in different deductibles, different lifetime payment caps, and the different types of assistance that are available until you find a plan that you are both happy with and that you can afford.
Source: mcp.nu

Online Medicare Forms: Appeal, Payment, Disclosure, Application

Medicare insurance forms for parts A, B, C and D are accessible online for electronic filings and mail in. Online forms include an application for Medicare, claim forms for patients requesting payments and Medicare appeal forms. Older Americans can apply for Medicare even if not planning to retire, as long as the person is close to 65 years old. Even when a person has been denied Medicare, appeal forms can be submitted online requesting a hearing or case review.
Source: suite101.com

2011 Medicare Online System User ID Recertification

Once you receive your access code, go to the provider recertification Web form, enter your access code in the form field, select enter and follow the onscreen prompts. The provider recertification Web form will ask submitters to provide their contact information. Once your recertification is complete, the above Web key code will no longer be valid and you will receive e-mail confirmation that your recertification action is complete.
Source: vgmaudithelp.com

Disability, Medicare/ Medicaid, Social Worker?

The information provided on SupportGroups.com is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her health professional. This information and interaction provided on this site is solely for informational and educational purposes and does not constitute the practice of medicine. Information on this site does not replace the advice of your physician or other health care provider. Neither the owners or employees of SupportGroups.com nor the author(s) of site content take responsibility for any possible consequences from any treatment, procedure, exercise, dietary modification, application of medication or any other action which results from reading this site. Always speak with your primary health care provider before engaging in any form of self treatment. Please see our Legal Statement for further information.
Source: supportgroups.com

The Variety Of Wonderful Benefits Regarding Requesting Diabetic Test Elements Online

aspergers symptoms auto business credit score diet dubai property dubai real estate executive recruitment executive search exercise fitness flights get cash advance Headhunter headhunting health hotel hotels How To Lose Weight Fast industrial computers information life assurance quotes loans loans for people with bad credit Locksmith network None online online loans outdoor payday loan payday loans pozycjonowanie property dubai rhinoplasty Beverly hills Roulette Spiele science seo staffing agencies staffing companies technology travel Vehicles Water Filters whats a good credit score
Source: chenqing.info

How can I get a medicare part D form online,I need this to fill out so someone can get some medicine help?

you can enroll online for any medicare part d plan of your choice at medicare.gov or call the plan of your choice to sign up, the deadline before you start getting penalized is may 15, so sign up soon!!! If you are trying to get help to pay for the drug plan, call social security, at 18007721213, they can send you the form, until you get it filled out, go ahead and sign up with the plan of your choice b/c after may 15 you have to wait until nov 15 unless you qualify for a Special election period
Source: bestlongtermcare.org

Overview of Medicare Appeal, Claim, Disclosure and Application Forms

coupons for loreal hair painting, apply for medicaid in colorado adams county, personal care home snack menus, hair dye commercials, revlon nail polish coupon printable, smedicaid assistance for the very elderly requiring assisted living in fl, What encompasses personal care in age care, beauty and personal care printable coupons, how to make vegetable fritters, manufactures coupons for hair dye, is garnier hair dye metallic, veggie fritters for toddlers, color cosmetics coupon, nail polish coupon august 2011, cooking methods to be utalized more regularly for kwashiorkor, kids hair brush coupon, graduation invitations for lvn, Whole Foods Natural Hair Products, cooking methods to be utilize more regularly in kwashiorkor, perfect 10 hair color coupons printable 2011, revlon printable coupon august 2011, feria coupon august 2011, nursing blog powered by blogspot, medicare supplement, COUPONS FOR REVLON HAIR COLOR, MEDICARE BENEFITS FOR DISABLED SOCIAL SECURITY, Term Life Insurance powered by blogspot, free printable revlon colorsilk coupons, free printable personal care coupons, nail polish coupon, bsca com/part d, slo niacin and kidney disease, Revlon hair color printable coupons 2011, hair color coupons printable September 2011, rusk hair printable coupons, garnier nutrisse cupon 2011, easy beef jerky recipes for dehydrators, hair color coupon august 2011, revelon nail polish coupon printable, coupons for revlon nail polish 2011
Source: home-care-assistance.com

Payson Daily Bugle: The Facts about Medicare Premiums

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiBeginning this year, Plan Finder also rates Medicare Advantage plans according to our Five-Star Rating System. A gold icon indicates plans that received five stars, the highest rating for quality of care and customer service. We encourage people with Medicare to enroll in plans with higher ratings — and we hope lower-rated plans will work hard to improve their care and service.
Source: blogspot.com

Video: Premium Support for Medicare Modeled After Federal Employee Program

What will be the basic Medicare Part B Premium in 2012?

In 2012, the basic Medicare Part B premium will rise to $99.90 per month, up from the current amount of $96.40. But this will be an apparent reduction for seniors who first enrolled in 2010 or 2011. Higher Income seniors will still have to pay a significantly larger Part B premium if their modified adjusted gross incomes for 2010 exceeded $170,000 for married filing joint taxpayers and $85,000 for single filing taxpayers. Furthermore, another burden on Higher Income Seniors will be that they will also "owe a surcharge on Part D premiums for coverage of their Prescription drug costs."
Source: asktaxguru.com

Medicare Premiums and Deductibles for 2012 Mostly Sweet

However, some enrollees age 65 and over and certain persons with disabilities who have fewer than 30 “quarters of coverage” obtain Part A coverage by paying a monthly premium set according to a statutory formula. This premium will be $451 for 2012, an increase of $1 from 2011. Those who have between 30 and 39 “quarters of coverage” may buy into Part A at a reduced monthly premium rate which is $248 for 2012, the same amount as in 2011. The Part A deductible paid by a beneficiary when admitted as a hospital inpatient will be $1,156 in 2012, an increase of $24 from this year’s $1,132 deductible. The Part A deductible is the beneficiary’s cost for up to 60 days of Medicare covered inpatient hospital care in a benefit period. Beneficiaries must pay an additional $289 per day for days 61 through 90 in 2012, and $578 per day for hospital stays beyond the 90th day in a benefit period. For 2011, per day payment for days 61 through 90 was $283, and $566 for beyond 90 days.
Source: indoamerican-news.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

Medicare Part B premiums for 2012 lower than projected

The majority of people with Medicare have paid $96.40 per month for Part B since 2008, due to a law that freezes Part B premiums in years where beneficiaries do not receive cost-of-living (COLA) increases in their Social Security checks. In 2012, these people with Medicare will pay the standard Part B premium of $99.90, amounting to a monthly change of $3.50 for most people with Medicare. This increase will be offset for almost all seniors and people with disabilities by the additional income they will receive thanks to the Social Security cost-of-living adjustment (COLA). For example, the average COLA for retired workers will be about $43 a month, which is substantially greater than the $3.50 premium increase for affected beneficiaries. Additionally, the Medicare Part B deductible will be $140, a decrease of $22 from 2011.
Source: wordpress.com

Health Care Financing: Is Traditional Medicare Uncompetitive?

Why traditional Medicare might thrive in a more competitive program: Under competitive bidding among Medicare plans, private health insurers and traditional Medicare would offer bids (their cost) for providing a defined benefit to an average risk beneficiary. The government would then set subsidies (premium support) at some level that is a function of the bids (like the minimum, second lowest, or average). To enroll in a plan that cost more, a beneficiary would pay more out of pocket…. [M]any people consider such an arrangement (e.g., the Domenici-Rivlin proposal)… a way to drive traditional Medicare out of the market, or at least some markets…. an adverse selection death spiral for the public option…. [T]raditional Medicare will become a high risk pool because private plans will outbid the public option and/or find clever ways to select good risks. However, it is not a foregone conclusion things would play out that way….
Source: typepad.com

Comparing Cost Is Not Enough When Evaluating Medicare Part D Plans

5.    Do you have comprehensive and objective information on the plan? When evaluating plans, it’s important to ensure you have all the necessary details to make a fair comparison of Part D plans. Keep in mind that many Medicare plan selection services provided in the marketplace are designed to promote specific plans, including those provided by specific insurance providers. This can be true for Part D selection services offered online and by store pharmacies. Government resources also may not be the most current. These factors can limit your ability to make an informed choice and could mean you miss the opportunity to find a plan that better meets your needs.
Source: travelnets.info

Q1Medicare.com Launches 2012 Medicare Part D Prescription Drug Plan Search Tool

2012, advantage, alternative, area, Augustine, average, care, Change, chart, click, Co-founder, com, Community, complexity, Copyright, cost, coverage, coverage details, deadline, December, default, detail, director, Donut, dr susan, drug, enrollment, filter, format, formulary, gap, goal, Group, Health, Holdings, Hole, icon, Inc, income, Information, Insurance, johnson co, Launches, Limit, link, List, LLC, Low, Medicare, medicare community, medicare part d, medicare part d plans, medicare part d prescription drug plan, medicare part d prescription drug plans, medicare plan, number, October, online, Open, opportunity, overview, part, PDP, PDP-Finder, period, Plan, plan choices, plan coverage, plan search, plan selection, premium, prescription, prescription drug plan, prescription drug plans, Press, process, PRW, PRWEB, Publicity, Q1Medicare.com, quality, Releases, SAINT, saint augustine fl, search, section, selection, site, STAR, star quality, State, Subsidy, susan johnson, text, Tier, time, tool, use, view, Vocus, way, Website, Wire
Source: myhomestudymessage.com

Medicare Part B premium hike will be smaller than expected

Mark Miller is a journalist and author who writes about trends in retirement and aging. He has a special focus on how the baby boomer generation is revising its approach to careers, money and lifestyle after age 50. Mark is the author of The Hard Times Guide to Retirement Security: Practical Strategies for Money, Work and Living (John Wiley & Sons/Bloomberg Press, 2010); he writes the syndicated column “Retire Smart” and edits RetirementRevised.com. Mark is the former editor of Crain’s Chicago Business, and former Sunday editor of the Chicago Sun-Times. The opinions expressed here are his own.
Source: reuters.com

Healthcare Bulletin: Medicare Premium, Coinsurance, and Deductible Rates for 2012

This site and its content are provided for your convenience and use by Frost, Ruttenberg and Rothblatt, PC (FR&R). By gaining access to content contained in this web site, you are also confirming your identity for purposes of authentication. You are responsible for your username and password, and are responsible for their confidentiality. FR&R is not responsible for lost or stolen usernames and/or passwords that are used to gain access to this site. Failure to comply may result in termination of your access to content contained in this web site.
Source: frronline.com

Rheumatologists Update Assessments For Adult Pain

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

Rise in Medicare premiums less than feared

Premiums have been frozen at the 2008 level of $96.40 a month for about three-fourths of Medicare beneficiaries. That was due to the lack of a Social Security cost-of-living adjustment during the depths of the economic downturn. But Social Security recently announced a raise in monthly checks averaging $39 for 2012. The Medicare news means the majority of seniors will have to fork over only a small part of their long-awaited COLA for premiums.
Source: e-gia.com

Medicare Has Lower Than Expected Premium Increases

Kenneth Thorpe, Ph.D., is the Robert W. Woodruff Professor and Chair of the Department of Health Policy & Management, in the Rollins School of Public Health of Emory University, Atlanta, Georgia. He also co-directs the Emory Center on Health Outcomes and Quality. He was the Vanselow Professor of Health Policy and Director, Institute for Health Services Research at Tulane University. He was previously Professor of Health Policy and Administration at the University of North Carolina at Chapel Hill; an Associate Professor and Director of the Program on Health Care Financing and Insurance at the Harvard University School of Public Health and Assistant Professor of Public Policy and Public Health at Columbia University. Dr. Thorpe has also held Visiting Faculty positions at Pepperdine University and Duke University. Dr. Thorpe was Deputy Assistant Secretary for Health Policy in the U.S. Department of Health and Human Services from 1993 to 1995. In this capacity, he coordinated all financial estimates and program impacts of President Clinton’s health care reform proposals for the White House. He also directed the administration’s estimation efforts in dealing with Congressional health care reform proposals during the 103rd and 104th sessions of Congress.
Source: healthworkscollective.com

Plans Lack Info For Medicare Drug Approval

Posted by:  :  Category: Medicare

Stocking the FINRA info tables by Newton Free LibraryEd Silverman is a prize-winning journalist who has covered the pharmaceutical industry for the past 15 years. In addition to editing Pharmalot, he is currently an editor-at-large for Med Ad News and R&D Directions. During his 13-year tenure, he closely followed a variety of topics of concern to those who work for, and with, drug makers – drug development; mergers and acquisitions; regulatory oversight; safety and pricing controversies, and marketing issues. He has a master’s degree in journalism from New York University and a bachelor’s degree in accounting from Binghamton University.
Source: pharma-marketer.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Stopping Fraud In The Healthcare System

False billing is the most common Medicare fraud usually done by healthcare personnel or medical equipment suppliers.Hospitals are often required to submit their cost reports to Medicare where they have to state the medicines and other facilities used by people covered by Medicare.The fraudulent act comes in when they submit false reports, like stating branded drugs when they actually gave generic drugs to the patient.Still Medicare will have to reimburse for that drug.
Source: brokerate.com

Event Reminder And Twitter Info: Saving Medicare Dollars And Improving Care

Tomorrow, October 19, Health Affairs, along with co-sponsors the ABIM Foundation, the California HealthCare Foundation and the Foundation for Informed Medical Decision Making, will present ideas endorsed by leading physicians for Saving Money and Improving Patient Care in Medicare.  A list of speakers and other information is available in this earlier post.
Source: healthaffairs.org

Viewpoints: Romney’s Critical Missing Information On Medicare; Anti

Minneapolis Star Tribune: Romney Falls Short On Medicare Reform Republican presidential candidate Mitt Romney conveniently left out key facts when he ripped a new health care cost-control measure – the Independent Payment Advisory Board. . The Affordable Care Act also specifically limits the board’s powers. It cannot ration care, reduce benefits, raise premiums or other cost-sharing such as copays. As part of that, it cannot raise Medicare’s eligibility age, as Romney himself has proposed (Jill Burcum, 11/8). The Wall Street Journal: ObamaCare: Flawed Policy, Flawed Law  Republicans should be doing everything they can to explain their proposals: a better set of incentives that will encourage—not require—people to purchase health insurance by offering targeted assistance and creating a broader, more competitive marketplace where consumers can purchase affordable, portable health insurance of their choice (Grace-Marie Turner, 11/9).
Source: kaiserhealthnews.org

eMedicareSupplements Keeps Seniors Informed on Enrollment Changes

eMedicareSupplements seeks to make Medicare more understandable and accessible to the people who depend on it. A subsidiary of Affordable Insurance, Inc., eMedicareSupplements provides a website with many different articles containing up-to-date information on Medicare in simple terms. Agents are always available by phone to answer more specific and personal questions, and to help individuals navigate the Medicare world to their advantage.
Source: releasewire.org

What To Know About Medicare Health

Are you trying to make the most of Medicare health benefits? If so, you probably have a lot of questions. One common question is if Medicare Advantage is better than Medicare supplements. I have to report that there is not one perfect answer for every person. Instead of finding one right answer, you must search for the best answer for yourself.
Source: rulingclass.info

Comparing Cost Is Not Enough When Evaluating Medicare Part D Plans

5.    Do you have comprehensive and objective information on the plan? When evaluating plans, it’s important to ensure you have all the necessary details to make a fair comparison of Part D plans. Keep in mind that many Medicare plan selection services provided in the marketplace are designed to promote specific plans, including those provided by specific insurance providers. This can be true for Part D selection services offered online and by store pharmacies. Government resources also may not be the most current. These factors can limit your ability to make an informed choice and could mean you miss the opportunity to find a plan that better meets your needs.
Source: travelnets.info

Bay Area Medicare Advantage Plans Provider, AdvoCare Insurance Services Discusses Long

A possible solution is for them to purchase a life insurance policy with a long-term care rider which has guaranteed ?living benefits? for life. Some life insurance companies are offering long-term care benefits combined with their life insurance products. These are called ?linked-benefit? life insurance products which add a long-term care rider usually to a universal life insurance policy. The major advantages of these products are they pay no matter what the buyer?s life situation becomes ? a long-term care benefit if needed, or a death benefit if long-term care is not needed. Further, these policies provide substantial leverage for every insurance dollar invested ? usually about 2 to 1 for the death benefit and 4 to 1 for the long-term care benefit. The buyer will need to determine whether this is a better solution than separate long-term care and life insurance policies.
Source: onlinesys.info

Get the maximum benefits from Medicare plans with the help of Medigap plans

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThese Medicare Supplement Plans or the Medigap policies were originally standardized in 1992 and the fact is that since then there had been twelve Medicare Supplement Plans to be sold and administered by the private health insurance companies only. Now the fact is that according to the standardization rules although the private health insurance companies are in charge of the administration and the sale of the Medicare supplement plans yet no single company is allowed to bring in any changes in the benefits of the standard Medicare Supplement Plans. And the fact is that when you are looking for the best help for the better coverage for your medical bills you should always be aware of your rights. In fact the point is that no matter whatever company you may choose for purchasing your Medicare Supplement Plans you will get the same benefits for any particular plan under the same letter head. Say for example if you purchase a Medigap plan C from any random company you can rest assured that you will get the same benefits as they are according to the standardization rules. However, along with that it should also be kept in mind that the premium charges may vary from one company to the other.
Source: articlejadeo.com

Video: What are Medicare Supplement Plans?

Medicare health insurance supplement plan isn’t just a program it demonstrates the so that you can survive

As it is well known that throughout Medicare product plans typically the supplementary insurance policies works simply because subsidiary that helps link typically the gap which is certainly left behind the Medicare protection. Actually the project relates to health insurance policies are utterly controlled from the private insurance plans, usually government is not go to interfere on this matter. There have different Medicare insurance plans available nowadays but the mandatory step ought to be taken after the person is actually purchas precisely the same insurance. He needs to understand the high grade rates belong to the insurance protection because until such time as and in the event he established fact about the software he cannot adopt this particular policy. If the retired human be is ready purchase the Medicare product policy for at first chance or in the event that anyone would like replace this exist protection with another person it really is possible. Now the software became easiest through the use of internet, through on the net we choose know the details related in order to insurance, insurance premiums. If anyone would like purchase the software through on the net he will receive a receive postal mail and soon after gett quite simply for him to determine which would work Medicare insurance policies. In this particular respect quite a few guidelines can be utilised such simply because agent. They tend to make the many people understand regard can the policy and share with their full be an aid to the disadvantaged person.
Source: rocksite.pl

Medicare insurance Supplement Insurance coverage: How Is it possible to Find a very good Price On your State?

More usually than never, Medigap and also Medicare will be able to cover a large portion within the costs concern home health reform. Insurance businesses offer several Medigap regulations (Plans SOME through L), but since each kind comes along with specific gains, it is advisable to compare and contrast the demonstrates closely. For starters, Medigap regulations vary by way of cost, and many insurance underwriters need you to have each Medicare Pieces A and also B in an effort to purchase your supplemental arrange (5).
Source: strengtheningearthcommunities.net

Choosing Supplemental Health Insurance For Senior Citizens

Premiums increase to adjust to inflation and due to the methods used to calculate them. On the first day of January, Medicare benefits are adjusted to keep up with inflation. Because all these insurance benefits are coordinated with Medicare, premiums for supplemental plans will change accordingly.The three different methods used to set premiums are use the attained age, issue age and community rate base. The attained age method premiums rise as you get older. These increases are in addition to those due to the annual adjustments to inflation. The issue age premiums are based on the age at time of purchase. They will not increase with age; but, they will rise to accommodate inflation adjustments. Community rate premiums are the same for those residing in the same geographic area. The optimal policy choice taking this into account would be deciding the benefit combination most suitable, then purchasing by looking at the policy with the lowest premium using the issue-age or community-rate method of calculating the premium.
Source: in-su-rance.com

Colorado Medicare Supplement

In order to get the best benefits out of the original Medicare plan it is very important to get enrolled for the Colorado Medicare supplement plans. As we are all well aware of the point that Medicare supplement insurance also known as Medicare Supplemental is meant to fill in the gap that is left behind by the original Medicare plan. Without the proper Medicare supplement leads at hand, even the most skilled of insurance agents may be at a loss when it comes to finding the right avenues toward success and prosperity. Blue Cross and Blue Shield of Illinois will host a free seminar on Medicare and Medicare Supplement Plans next week.
Source: crossfitskc.com

Choosing Supplemental Health Insurance For Senior Citizens

Premiums increase to adjust to inflation and due to the methods obsolete to calculate them. On the first day of January, Medicare benefits are adjusted to sustain up with inflation. Because all these insurance benefits are coordinated with Medicare, premiums for supplemental plans will change accordingly.The three different methods used to site premiums are exercise the attained age, pronounce age and community rate outrageous. The attained age set premiums rise as you earn older. These increases are in addition to those due to the annual adjustments to inflation. The deny age premiums are based on the age at time of indulge in. They will not increase with age; but, they will rise to accommodate inflation adjustments. Community rate premiums are the same for those residing in the same geographic dwelling. The optimal policy choice taking this into represent would be deciding the support combination most aesthetic, then purchasing by looking at the policy with the lowest premium using the issue-age or community-rate space of calculating the premium.
Source: medicaresupplementalinsurances.org

Medicare insurance Supplement Insurance policies: How Are you able to Find a very good Price Inside your State?

More typically than in no way, Medigap in addition to Medicare may well cover excellent portion on the costs concern home health reform. Insurance organizations offer many different Medigap regulations (Plans A FABULOUS through L), but since every type comes hav specific amaz benefits, it is perfect to contrast the best parts closely. For starters, Medigap regulations vary through cost, and many insurance underwriters need you to have either Medicare Elements A in addition to B so that they can purchase your supplemental method (5).
Source: tradingtheqs.com

Top Rated Medicare health insurance Supplemental Insurance coverage

Seniors that have recently converted 65 have a very big decision to help make in relation to health insurance plan. At here, many readers could be confused. They have perhaps heard from Medicare together with understood it that should be federally funded medical health insurance for Many seniors. This can be true, which program continue to does exist for many who meet the criteria, but sadly, there can be what is called a difference. In many other words, these standard plans are certainly not enough to protect the entire medical together with health needs for the average baby boomers. This is the reason why seniors a good deal purchase added plans that happen to be known mainly because Medigap options. The right off the bat then of which seniors find out is that happen to be the perfect rated Treatment supplemental plans.
Source: latitudebroadband.com

Medicare Supplement Insurance: Choosing Your Plan

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSIf you are enrolled in Medicare Parts A and B, you are eligible for a Medigap plan, which will cover many of the costs of medical care beyond those covered by Medicare itself. There are 10 standard plan types ranging from Plan A, the basic benefit plan, through Plan N. Additional benefits can be added through Plan F, while Plans G through N vary in benefits, co-pays, and deductibles.
Source: moneyandmarkets.com

Video: Learn About Medigap Plans

Get the maximum benefits from Medicare plans with the help of Medigap plans

These Medicare Supplement Plans or the Medigap policies were originally standardized in 1992 and the fact is that since then there had been twelve Medicare Supplement Plans to be sold and administered by the private health insurance companies only. Now the fact is that according to the standardization rules although the private health insurance companies are in charge of the administration and the sale of the Medicare supplement plans yet no single company is allowed to bring in any changes in the benefits of the standard Medicare Supplement Plans. And the fact is that when you are looking for the best help for the better coverage for your medical bills you should always be aware of your rights. In fact the point is that no matter whatever company you may choose for purchasing your Medicare Supplement Plans you will get the same benefits for any particular plan under the same letter head. Say for example if you purchase a Medigap plan C from any random company you can rest assured that you will get the same benefits as they are according to the standardization rules. However, along with that it should also be kept in mind that the premium charges may vary from one company to the other.
Source: articlejadeo.com

A Brief But Useful Discussion on Medicare Supplement Insurance Plans

These supplementary insurance policies are sold by the private insurance companies and are under their sole administration. According to the law the private insurance companies can offer only twelve standard Medicare Supplement Insurance Plans, named A through L. each of these plans have their own set of benefits, different from the others. However, almost all of the twelve Medigap policies provide the basic benefits of Medicare part A and B. Therefore it is always recommended to study all the Medigap plans before deciding to choose the one that would fit the best for you. Besides that the fact that should be kept in mind is that, no matter from whatever insurance company you may purchase a particular plan, all of the plans with the same letter cover must provide the same benefits. As for example if you purchase a Medigap plan C policy, it should cover the same benefits without depending on the company that is selling the plan. However, the premium rates may vary for different companies. Therefore you are free to purchase any Medigap policy from the company you like and be sure to get the same benefits provided by the other companies.
Source: ip-hedgefund.com

Colorado Medicare Supplement

In order to get the best benefits out of the original Medicare plan it is very important to get enrolled for the Colorado Medicare supplement plans. As we are all well aware of the point that Medicare supplement insurance also known as Medicare Supplemental is meant to fill in the gap that is left behind by the original Medicare plan. Without the proper Medicare supplement leads at hand, even the most skilled of insurance agents may be at a loss when it comes to finding the right avenues toward success and prosperity. Blue Cross and Blue Shield of Illinois will host a free seminar on Medicare and Medicare Supplement Plans next week.
Source: crossfitskc.com

Do I Need Medicare Supplement Insurance?

You can find more information about plan benefits, and you can compare actual premium prices for Medigap policies available in your area, at weissratings.com/medigap.  Weiss Ratings does not sell insurance, but it does give consumers access to pricing data for more than 165 Medigap insurers. We’ve looked, and you won’t find this kind of premium-price comparison information anywhere else.
Source: thetradingreport.com

Top 5 Facts About Medicare Supplement Insurance

At the end of the day, a Medicare supplement insurance plan is something that pretty much everyone should consider. In the current state of the economy you really cannot expect the government to cover your needs and therefore it may well be a much better idea to take things into your own hands. Regardless, you should always try to find out the specific limitations of the coverage that you currently have. From here you can make your decision as to whether supplemental insurance is necessary or not.
Source: youreallyshouldbefollowingme.com

Medicare health insurance supplement plan isn’t just a program it demonstrates the so that you can survive

As it is well known that throughout Medicare product plans typically the supplementary insurance policies works simply because subsidiary that helps link typically the gap which is certainly left behind the Medicare protection. Actually the project relates to health insurance policies are utterly controlled from the private insurance plans, usually government is not go to interfere on this matter. There have different Medicare insurance plans available nowadays but the mandatory step ought to be taken after the person is actually purchas precisely the same insurance. He needs to understand the high grade rates belong to the insurance protection because until such time as and in the event he established fact about the software he cannot adopt this particular policy. If the retired human be is ready purchase the Medicare product policy for at first chance or in the event that anyone would like replace this exist protection with another person it really is possible. Now the software became easiest through the use of internet, through on the net we choose know the details related in order to insurance, insurance premiums. If anyone would like purchase the software through on the net he will receive a receive postal mail and soon after gett quite simply for him to determine which would work Medicare insurance policies. In this particular respect quite a few guidelines can be utilised such simply because agent. They tend to make the many people understand regard can the policy and share with their full be an aid to the disadvantaged person.
Source: rocksite.pl

Medicare Supplement Plans Give Peace of Mind to Seniors 

Good health is a priority for everyone, and as we age it is important to live a healthy lifestyle, limit stress, and spend time with those whom we love. There are several factors that lead to happiness, the most important of which is good health. Staying stress free and in good health means having an insurance plan that allows you to see the best physicians and specialists while still limiting your out of pocket costs. This is precisely why Medicare Supplement Plans are extremely popular among those who are turning 65 or leaving employer plans.
Source: dolt.info

Comparisons are Mandatory for Success

Posted by:  :  Category: Medicare

It is a very good habit to do Medicare Supplemental Insurance Comparison on a daily basis in order to secure your financial future. Those people who are Medicare members and use Medicare on a daily basis for them it is advisable to make a Medicare Comparison so that they do not remain aloof from the changes that are brought in from time to time in the Plans or also from the basic facilities or benefits that are provided by different Plans existing in the financial market. It should always be remembered that it is never easy for the people to sign on any Medicare Plan that they see at the first go without knowing the pros and cons of the Plan. It is very important to compare Plans so that you can land a Supplement Plan that has a minimum price with the maximum coverage. The basic aim behind the Comparison of the Plans is to know about the premium rates that may differ from Plan to Plan or from agency to agency. In fact it is interesting to note that all Medicare Supplement Plans are the same in their structure and design in every state regardless of the company that offer them. The reason behind this fact is that even though they are offered by various companies but their rules, conditions and regulations are both designed and controlled by the federal government. It is only that the premium rates will differ because of the different Insurance companies offering the Insurance. Here one thing that is noteworthy is that Medigap Supplement Insurance and Medicare Advantage Plan are extremely different because of the fact that Medigap covers other areas that are not covered by the usual Medicare health Plans.
Source: articlejadeo.com

Video: Medicare Supplemental Insurance Comparison

Online Medicare Supplement Plan Comparison

The site is quite easy to search for with the use of the common search engines that people are usually using; because of the site’s easy availability, it is very convenient to all the people that are in search of it especially the people that are thinking of having a Medicare Insurance. The GoMedigap site is definitely a very convenient site that people can really go to in case they are they thinking of having a Medicare Supplement; the site can explain clearly everything that there is to know about the different kinds of insurance plans. With the help of the site, any person can easily make a Medicare supplement plan comparison and then decide as to which he or she will have to choose from the different plans that there are. However, it is quite obvious that the best plan would be the Medicare supplement Plan F, but it is still up to the person or the beneficiary, which he or she will have to choose.
Source: potomacclub.org

Are You Looking For Medicare Supplement Insurance Comparison?

Similarly, section C carries a similar encourage like A and B. While comparing with part A and B, share C provides the treatment of drug coverage. If you are searching for the best services of insurance comparison, you can visit Medicare sites easily through online. Another option is that there are some several tools and resources which encourage you to hold for Medicare supplement insurance. If you occupy up that they also have the same rates, it is time to go to these companies and ask some questions. This will build distinct that you acquire your decision based on uniform supplemental insurance comparison information. Many people determine to collect their policies online. If you are considering joining in one of their plans, ask if they are licensed to sell Medicare common policies in your status. For Medicare parts A and B, you generally need to pay monthly premiums, as well as deductibles, co-payments, and so on. You also have to pay the fat cost for services and firms as well.
Source: medicaresupplementalinsurances.org

Get a Medicare Supplement Comparison

A person is also free to change their minds and switch to another policy if they had dropped their medical cover and they want to go back to it. This happens a lot as clients keep engaging in Medicare Supplement Comparisonand at times they may not have made up their minds on which cover to go for. In such circumstances the person may keep switching back and for as long as they are less than one year old in the policy. Though such actions show a lot of indecisiveness they are necessary at times. A client may join a medigap policy then decide to switch to the Medicare advantage plan then after some months feel they want to switch back to the plan they were initially. All this though inconveniencing for the insurer is guaranteed by the legal provisions. However given a chance most companies would turn the tables on such practices but their hands are tied by the legal hurdles involved.
Source: ioniabowl300.net

Medicare Supplement Comparison

First and foremost, you should carefully examine what kind of Medicare insurance you currently have (if you have Medicare insurance already). Far too often, seniors think that their employer insurance or Medicare Advantage plan is an actual Medicare Supplement. Supplements, however, are named for the letters A-J, so if your plan is not named after one of these letters, it is likely not an actual Medicare Supplement plan. Once you know which plan you have currently, you can compare apples to apples by looking at like plans, with the realization that the same letter plan will be equal coverage.
Source: chailit.com

Take charge of your future with Medicare Supplement Insurance

A lot of people have found it difficult to go through the different information of getting what Medicare and Medicare Supplement Insurance are what about. You are not alone in trying to find out what is really the benefit you could get from it. How will you find a good Medicare Supplement? There are some things that you should need to ask before you settle yourself. Get a good  Medicare Supplement Plans Comparison so that you will get to have a good overview of the difference. Get a good agent who is not limited with his knowledge. He should be able to give you the suitable plan for you and give you the best offers. Your agent should start trying to find out some things about yourself and your lifestyle so he would know what is really good for you. How much is your budget and what kind of sharing would you want to have in terms of medical expenses cost? These are just few of the questions that he should ask you. The market of insurances is so big. You have to make sure that your insurance would fill in the gaps that Medigap is not covering.
Source: scpancora.com

Role of internet in Medicare Supplement Plan Comparison

Thankfully, getting Medicare supplement insurance is not that difficult now. With much of information being bombarded on everyone each day with marketing materials and advertisements, one may find it confusing to zero down to one plan. One needs to understand that these are simply promotional ads and not every claim they make is true. In such a scenario, the internet is the best place to do your research on the various plans available. After reading about the various options available in the city, one can take adequate time out to think over it and then decide upon a certain plan that suits them.
Source: oagnepal.com

Medicare Supplement Comparison

360 video solutions ableton live tutorials accounting software packages auditions in 2011 bankruptcy attorneys dayton ohio bookkeeping adelaide bouldering carpet water damage cheap holiday accommodation chiropractic marketing debt advice discount truck rental dog trainer london dog training london dumpster rental tuscallosa al free electronic cigarette grad school how long does it take to get a six pack how to get a six pack how to get rid of cellulite hr consultancy humidifier reviews iron gym workout routine maid service toronto make money online monterey divorce lawyer online educational psychology phd part time jobs phentermine 37.5 project accounting software quinoa razors blades relyon mattresses same day online cash advance search engine marketing companies search engine optimization spending plan tattoo removal london the belvedere hotel in new york treatment for hemorrhoids used cars used jeep vegetable steamer wall safes windows registry cleaner
Source: artistsofthecommonwealth.org

Medicare Supplemental Insurance Plans for 2012, Find Best Medigap Coverage from AARP, Sterling, Blue Cross Blue Shield, Colonial Penn and Others

Posted by:  :  Category: Medicare

Eligible senior Medicare recipients that are interested in finding the best Medicare supplement insurance plan or Medigap plan for 2012 will find many coverage offerings from a potpourri of insurance companies, all depending on the state and county in which they reside. Companies such as AARP, Blue Cross Blue Shield, Colonial Penn and Aetna all will be offering plans throughout the United States for 2012. Most plans will be available by October 15th, 2011, the start of the annual enrollment plan. The best plan will vary depending on the individual senior demographic data. For instance, women may find that their rates are generally lower for these plans, while smokers will definitely find that they will have to pay more for the best coverage. A quick glance at plans offered to a female, non-smoker aged 65 living in Palm Beach, FL shows that there are about 30 plan offerings, with premium prices ranging from 1100 dollars for the lowest priced plan, to about 3500 dollars for the most expensive plan. Price is, of course, not the only consideration, as many senior Medicare recipients might wish to have many choices for doctors or hospitals, and be willing to pay higher monthly premiums to keep out-of-pocket costs down. Keep these costs differences in mind. Source: seniornewscoverage.com
Source: medicaresupplementalco.com

Video: Sterling Health Plans Medicare Insurance, Bellingham, WA

Medicare Supplemental Insurance Plans for 2012, Find Best Medigap Coverage from AARP, Sterling, Blue Cross Blue Shield, Colonial Penn and Others

Eligible senior Medicare recipients that are interested in finding the best Medicare supplement insurance plan or Medigap plan for 2012 will find many coverage offerings from a potpourri of insurance companies, all depending on the state and county in which they reside. Companies such as AARP, Blue Cross Blue Shield, Colonial Penn and Aetna all will be offering plans throughout the United States for 2012. Most plans will be available by October 15th, 2011, the start of the annual enrollment plan. The best plan will vary depending on the individual senior demographic data. For instance, women may find that their rates are generally lower for these plans, while smokers will definitely find that they will have to pay more for the best coverage. A quick glance at plans offered to a female, non-smoker aged 65 living in Palm Beach, FL shows that there are about 30 plan offerings, with premium prices ranging from 1100 dollars for the lowest priced plan, to about 3500 dollars for the most expensive plan. Price is, of course, not the only consideration, as many senior Medicare recipients might wish to have many choices for doctors or hospitals, and be willing to pay higher monthly premiums to keep out-of-pocket costs down. Keep these costs differences in mind.
Source: seniornewscoverage.com

AAA Partners with Sterling Insurance to Offer Seniors in the Carolinas Additional Health Care Options

have a new option for health care coverage in their retirement years. AAA Carolinas Preferred Plan is now available to members who are 65 or older, enrolled in Medicare Part A and B, and a resident of North or
Source: co.za

Sterling Health Insurance Company Review

Sterling Life also provides traditional life insurance plans and specialty programs such as prescription drug coverage. Sterling Life is located in Bellingham in the state of Washington and had been a major provider of life insurance in the Pacific Northwest since 1958. Sterling Life operating under the Sterling Health Plan moniker, is a wholly owned subsidiary of Munich Health North America, Incorporated.
Source: healthinsuranceproviders.com

Medicare Rx needed to deal with system’s exploding costs

Worthington is the patient of Dr. Sarah L. Sams, one of 20 physicians at a family practice in Grove City. A few years ago, Worthington was shocked when her previous doctor dropped her because she was on Medicare. To go through that again would mean “we’d have to cut our spending elsewhere,” she said. “But for some of our friends, it would be devastating. They don’t have the money.”
Source: grovecityohrealestate.com

AAA Partners with Sterling Insurance to Offer Seniors in the Carolinas Additional Health Care Options

Advance America Cash Advance Advance America Cash Advance Centers Advance Cash Aea Aluminum Amp Board Of Directors C Dec Columbia Columbia Sc Computer Software Conference Call Csi Technology Cswi Electrolytic Capacitors Film Paper Firstcall Force Protection Inc Frpt Healthcare Services Hilton Head Island Holding Company Home Medical Equipment Innovations Inc Insurance Kemet Corporation Launch Llc Marketwire Medical Institutions Myrtle Beach Nasdaq Net Income Nyse Otcbb Photos Pinksheets Prnewswire Real Time Second Quarter Software Innovations South Carolina Today Announced That Usnewswire Webcast
Source: southcarolinanewswire.org

Home Care Agency Checklist

24/7 live-in care aging alzheimer’s alzheimers mi assisted living brain health caregiver caregivers certified senior advisors dementia elder care family caregiver grosse pointe grosse pointe mi home care home care clinton twp home care clinton twp mi home care grosse pointe home care grosse pointe farms home care grosse pointe mi home care grosse pointe woods home care macomb county home care macomb county mi home care mi home care michigan home care rights home care services home care services macomb county home care sterling heights home care sterling heights mi home care utica live-in care macomb county macomb county mi medicaid medicare mi michigan new mother care personal care senior care shelby township sterling heights transportation macomb county what exactly is home care
Source: purehomecareservices.com

UK’s Huber Dixon, Sterling Offer Renewable Energy Coverage

Annual Insurance Marketing Advertising Summit Best Aggregates Averages Best Aggregates Averages Online Best Company Best Insurance Reports Best Life Health Rating Division Best Loss Control Manual Best Review Best Review Advertising Best Statement File Global Best Statement File Health Best Statement File Life Health Best Statement File Property Casualty Canada CEO Florida Hurricane Catastrophe Fund GAAP Hyatt Regency Jersey City IBM IMAS Innovators Showcase insurance Insurance Law Podcast Insurance Marketing Advertising Summit Issues Answers Marine Market Jersey Jersey City Leverage Capitalization Lexington Insurance Company Medicare Secondary Payer Act Meet Us New Insurance Law Podcast QAR Quantitative Analysis Report Quarterly Best Quantitative Analysis Report Radey Thomas Yon Clark Revised Risk Assessment Report Revised Risk Assessment Reports Special Homeowners Package Swiss Re Travis Miller United States US Visit Best Underwriting Loss Control Center Zurich North America
Source: futeroa.com

A.M. Best Affirms Ratings of Sterling Life Insurance Company

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

Sterling Medicare Supplemental Insurance Reviews

Sterling Option #1 is the first Medicare Advantage plan that allows holders to combine Medicare Supplemental Services and traditional Medicare. This ultimately translates into seeing your physician and allowing the bill to be sent to Sterling. Sterling will pay the bill and Medicaid will be notified of their portion, which then pays Sterling. This subsequently saves lots of time and headaches with filing claims with Medicaid and Sterling. Sterling basically handles everything while making the process as simple as possible for you. Your only concern will be paying the premiums for your Sterling Medicare Supplemental Insurance plan as well as for the Medicare Part B plan.
Source: ihealthcoalition.org