How does a senior health insurance program work?

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThey will also help you to determine the status of your Medicare eligibility and when special enrollment periods may apply to you. Of particular note is the fact that every fall you may be able to change your prescription drug plan. Your SHIP counselor can help you in finding the best deal for you. There is the possibility that your insurer will change your drug benefits every year and drug prices fluctuate even more often, so check with your counselor to make sure you are getting the most for your premium dollar.
Source: healthinsuranceproviders.com

Video: Stanley Medicare Insurance Srvcs – Health,Medicare Supplements,Senior Advantage,RX,Mission Viejo,CA

Medicare Advantage Part C:

During this period, you can’t do the following: • Switch from Original Medicare to a Medicare Advantage Plan. • Switch from one Medicare Advantage Plan to another. • Switch from one Medicare Prescription Drug Plan to another. • Join, switch, or drop a Medicare Medical Savings Account Plan. • As with Original Medicare, you still have Medicare rights and protections, including the right to appeal. • Check with the plan before you get a service to find out whether they will cover the service and what your costs may be. • You must follow plan rules, like getting a referral to see a specialist or getting prior approval for certain procedures to avoid higher costs. Check with the plan. • You can join a Medicare Advantage Plan even if you have a pre existing condition, except for End-Stage Renal Disease. • You can only join a plan at certain times during the year. In most cases, you’re enrolled in a plan for a year. • If you go to a doctor, facility, or supplier that doesn’t belong to the plan, your services may not be covered, or your costs could be higher, depending on the type of Medicare Advantage Plan. • If the plan decides to stop participating in Medicare, you‘ll have to join another Medicare health plan or return to Original Medicare.
Source: srbenco.com

Fidelis Care Undertakes Quality Care Initiative for Senior Members

Fidelis Care’s Pharmacy Department routinely contacts members who take certain medications to treat chronic illnesses, to encourage them to be tested to ensure their medication is a helpful part of their disease management. The Clinical Care staff at Fidelis Care also provide a variety of case management services to assist members with chronic conditions such Diabetes, Asthma, and low bone mineral density in women. An emphasis is also placed on educating our members about the importance of obtaining breast and colorectal cancer screening tests. Women enrolled in Medicare Advantage and Dual Advantage programs who had not obtained a recent mammogram received a reminder postcard as part of this process.
Source: readmedia.com

Almost 65 and pondering medicare supplement/advantage policies

Check your own state to be sure, but in WA one can always move from Classic Medicare to a Medicare Advantage Plan, during the open enrollment period which is in late fall. There is no medical qualification for this. Also, you can switch from one Medicare Advantage Plan to another yearly, during the fall open enrollment period. Additionally, the premium for brand new enrollees is the same as it would be for a 90 year old with 14 chronic diseases. The competition to get new-to-Medicare enrollees, without which the plan would quickly be in trouble keeps the premiums reasonable. The reverse movement is not guaranteed. You can drop your MA plan and return to Classic Medicare during a certain period after the beginning of the year, but except under certain limited circumstances you cannot force a Medigap insurer to insure you. For this reason, I choose Classic Medicare and a Medigap Plan F when I turned 65. I was told and read that my premium would always be the same as new plan entrants. However, this has turned out not to be true. Several years ago Medicare reorganized the Medigap plan menu, and many companies somehow were able to use this to hive off their existing members into a separate pool from their new entrants. In 2011, for example, my premium was ca. $80/mo higher than new entrants, and of course it will get higher yet, each and every year, as those in my pool age and are not replenished by new participants. Additionally, the healthiest participants will leave, either to Medicare Advantage or try to qualify medically for a different, new Medigap plan and pool. This business is directly in conflict with what I was told at issuance, both by the company I choose and by the State Insurance Office, and also in conflict with the principle of insurance being non-cancellable once it is in place. I was recently told that the WA Insurance Commissioner ruled against this practice, but later learned that this only applied to policies originally issued during or after 2010. So, as usual, these insurance companies are lying thieves, and our federal government is collaborating with them. In my state, many doctors, clinics, and hospitals are demanding membership in certain MA plans, rather than original Medicare, because these chosen plans pay better, and the billing procedures are more streamlined and payment is faster. I am not sure how I will proceed currently, but I am tempted by the good MA plans, because it appears that worst case, if I got every disease known to man and was in and out of the hospital weekly it would only cost me marginally more than a Plan F Medigap, and if my health continues good I will save money. It is my opinion that federal government wants to hobble Plan F, as it violates the principle in place in almost all employer plans that there must be meaningful co-pays. One note about the star rating. They are not outcomes oriented, they are process oriented. To a large extent they depend on getting lots of paper filled out, which is easy in an HMO as you just require it of the staff, who are in fact your employees. But not so easy with a PPO, the providers of which have power equal to or greater than the insurers’. One large and well regarded HMO in Puget Sound has a 5 star rating which I think is reasonable, from what I know by talking with plan members and a few people I know who work there. My girlfriend has this HMO through her work (an employer plan, not the MA plan) and she seems to get very good and attentive care from them, but her primary care Doc is in charge of who she gets to see, other than few things, like I think dermatology and ob/gyn. I think Medicare people get similar or equal care, and they pay very much less due to the government subsidy. All this may change as the medical system gets tinkered with, and I don

Federal monitoring of Medicare fraud called inadequate, P.2

Posted by:  :  Category: Medicare

Gary Norman, Staff Attorney, Centers for Medicare & Meddicaid Services by Sanjay ParekhOne contractor paid to investigate Medicare fraud reportedly told federal officials of only two potential fraud cases in a three year period from 2005-2008, while a second, amazingly enough, did not report finding any possible fraudulent Medicare claims during that same time period. One possible measure to improve such performance, investigations surmised, might be to provide the contractors with financial incentives, giving them more of a motivation to detect a greater number of possible fraudulent claims.
Source: criminallawyerblogdallas.com

Video: Miami: Medicare Fraud Summit Remarks (HHS Secretary & Attorney General)

Trustworth Medicare Fraud Attorney

Hey peoples. Good sun set to all. How are you all? I hope you all are booming. About me here I am also burden in fine shape. Today I am here to convey some useful and enchanting information about medicare fraud attorney which is more informative for all. If you are the one suffered due to frauds, for that I hint you to visit georgemurphylawyer.com which is a well known and well established online site among the people. Yes here you will find most successful and talented lawyer name George D. Murphy, a legal representative handling criminal cases with unparalleled experience in the extraordinary complexity of the federal criminal defense. He is trustworthy and you can trust him blindly without any doubts because he had tried over 100 jury trials.
Source: singtothedawn.com

Sweet Cherry: Leading Medicare Fraud Attorneys

Hi folks. Good morning to all. How are you all? I hope all are doing well and good enough. It is my duty to share some vital information to all. It is about the medicare fraud attorney. Do you want to against the medicare and Medicaid fraud charges? It is so simple, if you are a victim of it. Then it is lot more simple. Here I suggest you the best place to contact, the attorneys from this place are well trained and expertise in the medicare fraud charges. This medicare and Medicaid fraud attorney are specialize in defending against the fraud charges. They have twenty years of experience in this field. Even they are providing us with the free case evaluation also.
Source: conyerscherryblossom.com

What To Look For In The Right Medicare And Medicaid Attorney

There are many different ways that Medicare or Medicaid fraud can be committed in this country. On the professional side of the aisle, medical institutions can unfairly bill or charge more than what is necessary in hopes of getting a larger payout for the services rendered than what actually took place. They like to use “uninsured individuals” as their scapegoats for committing fraud, and it really just puts a greater drain on you, the responsible patient. On the other end of the aisle, there are individuals, who abuse the Medicare and Medicaid systems by sponging off individuals, who’ve paid in most of their lives, thus driving health care costs up for everyone. Most of the burden falls on the responsible. If you think that you or a loved one has been the victim of Medicare and Medicaid fraud, no matter what side of the aisle you’re on, you should take action. As a human being, you have a right to be treated fairly and government programs, such as this are designed to do just that. It’s a tragedy when they actually end up hurting more than helping. To move forward with a lawsuit, it is best to first consult with an attorney, who has experience practicing in areas of Medicare and Medicaid fraud. The litigation for such a thing can be overwhelmingly complex, so it is never a good idea to go it alone or trust in an unproven attorney. Most attorneys that claim to practice in this area of law will give you a free consultation, where you can discuss your problem and have an idea of what to expect. From there, it becomes about building a bond of trust with your attorney, so that you can have peace of mind going into the lawsuit. Truth, of course, is the most important thing that you can have on your side. If you are innocent, or if you are seeking damages because of a wrong done to you, a quality attorney is your knight in shining armor. They can find the areas of law that were violated and help you to defend your rights through precedent and through knowledge of the laws in general. Health care is a huge system in need of an overhaul. While politicians don’t agree on the methods for fixing it, they do agree that something needs to be done. The reason you can get them to agree on such a generalized statement is that abuses are rampant. And you are the most affected by it. So make sure that you deal with a reputable Medicare and Medicaid fraud attorney if you have concerns. They believe that justice still exists in this country and the system at large, and they will help you fight for it.
Source: ad-matrix.net

Rainbows and Lollipops: Trained Medicare Fraud Attorney

Hi friends! The allegations of mortgage fraud are increasing as foreclosures rise. Inexperienced real estate investors are immersed in web mortgage litigation in some cases, without just cause. Federal sentencing guidelines consider the amount of losses caused by fraud or the system in determining the penalty area, or potential exposure can reach hundreds of thousands or even millions of dollars. medicare fraud attorney solves, mortgage loan applications and fraudulent construction, fraud and other mortgage related fees are all generalized accusations brought by prosecutors. Defending against the serious consequences of these charges a lawyer with the strength and experience defend you. Attorney George Murphy understands the complexity of the law of fraud and how prosecutors use these statutes.
Source: rainbowsandlollipops.com

Contact Whistleblower Attorney to Stop Medicare Fraud and Abuse

On the other hand, private medical institutes have also started supplying fake documents to get exempt in tax from the authorities. All such things also involves with the companies offering medical aids. All such practices in the society prevent various patients to get their proper treatment and medical aid. Such practices also offer a disregard and disrespect for the companies or hospitals offering valuable services at subsidize rates. Honesty and reliability goes for a toss for the patient and for the medicals service providers. But today, if someone witnesses such medicare fraud and abuse happening in the institutes, they can raise an alarm. There are whistleblower attorneys and lawyers available to fight against such odds. The attorney companies involve in providing justice to the victims holds the experienced lawyers that are award winners in their respective areas. Therefore, if someone observes any misconduct or frauds happening in their surroundings, they can contact these whistleblower attorneys to stop injustice and misdeeds. After adding the whistleblower protection act in the constitution, victims are provided all types of assurance and security to protect their rights.
Source: ezinemark.com

Utah Accident Attorneys Need to Consider Medicare Interests During Settlement

Settlements following a Utah accident can sometimes be complicated and involved. This is especially true if Medicare has paid any of the bills in the case. If they have paid bills related to treatment, the attorney must be very careful to make sure that Medicare’s interests are adequately protected. This involves not only reaching resolution on amounts that Medicare has paid in the past but also determining if Medicare is likely to pay for medical expenses in the future. If future payments by Medicare is likely, then the attorney needs to consider setting up a Medicare set aside fund to protect Medicare’s interests moving forward.
Source: ronkramerlaw.com

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

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

Illinois man charged in Medicare fraud case

The defendant allegedly targeted Medicare beneficiaries through a medical equipment company he owns and operates in Buffalo Grove, Illinois. Patients were persuaded through telemarketing to provide the defendant their Medicare information by offering free medical equipment and supplies.
Source: connecticutcriminaldefenseblog.com

Medicare fraud and hospice care

Hospice care has the laudable goal of allowing people to go through the final stages of life in peace and comfort. Many of the accusations involve patients whose conditions do not appear to qualify for hospice care. If a patient lives for several years in hospice care, or is later declared to be “no longer terminally ill,” investigators may question whether any of the services provided were appropriate. In this way, hospice care providers may be punished for providing excellent treatment and helping their patients extend their lives. Paradoxically, these facilities may face criminal charges for keeping their patients alive.
Source: miamifederalcriminaldefenseattorney.com

Texas Attorney Maintains Watchful Eye on Proposed Changes to Social Security Benefits

The Bob Richardson Law Firm is a highly respected Texas personal injury and Social Security disability law firm. The firm is dedicated to providing skilled and professional legal services to clients in cases involving car accidents, motorcycle accidents, truck accidents, drunk driving accidents, construction accidents, workplace accidents and slip and fall accidents as well as representation to those seeking benefits for Social Security Disability Insurance (SSDI) and Supplemental Security Income (SSI). The firm features offices in Austin and Waco and assists clients throughout Round Rock, Georgetown, Killeen, Temple, Cedar Park, Lakeway, Taylor, Belton and surrounding Texas communities. To learn more about The Bob Richardson Law Firm, call (800) 880-5100 or use the firm’s online form.
Source: bestlongtermcare.org

Report points to flaws in Medicare fraud contractor system, P.2

In our previous post, we began looking at a recently report by the U.S. Department of Health and Human Services inspector general’s office. The report, which was released Monday, revealed the difficulties federal officials face in monitoring the effectiveness of fraud detection programs which seek to prevent Medicare fraud.
Source: batonrouge-criminallawyer.com

U.S. Attorney: “Medicare Fraud Is Rapidly Eclipsing the Drug Trade”

3rd Party Studies ACOs Admin Costs Cadillac Tax cbo Cost-Shift Dual Eligibles Employers Essential Benefits Exchanges GRP HAIs Health Plan Satisfaction House hearings House legislation KI MA Makena McCarran-Ferguson Medicaid Managed Care Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT Patient Safety PCR premiums Premium Tax Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Support Builds for a Plan to Rein In Medicare Costs

Posted by:  :  Category: Medicare

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

Video: Medicare Cuts Cost GOP New York’s 26th District

Cracker Squire: New York Times Editorial: Fixing Medicare

From The New York Times: There is no way to wrestle down the deficit without reining in Medicare costs. Ensuring that the program provides quality health care coverage to millions of older and disabled Americans is essential. These goals are not incompatible, but they require a judicious approach to policy making that is depressingly absent in Washington. Medicare is nothing less than a lifeline for 49 million older and disabled Americans. It helps pay for care in a wide range of settings, including hospitals, nursing homes, outpatient clinics, doctors’ offices, hospices and at home, as well as for prescription drugs. It is also hugely costly. The federal government spent about $477 billion in net Medicare outlays in fiscal year 2011 — 13 percent of its total spending. By 2021, it is projected to spend $864 billion — or 16 percent of the total — according to figures derived by the Kaiser Family Foundation. That rate of growth is not sustainable indefinitely. Unfortunately, many politicians seem less interested in coming up with ways to fix Medicare than in how they might impose their ideology on the program or leverage the issue for their next political campaign. Members of both parties need to define more clearly for the public what Medicare’s true problems are and how they propose to address them. Here are some of the major issues: NEAR-TERM COSTS There are three key drivers of Medicare spending: the spiraling cost of all health care as new technologies and treatments are developed; much greater use of medical services by the typical beneficiary; and an aging population. By 2020, the number of enrollees will increase to 64 million. The current rancorous debate in Washington is focused on finding big immediate cuts to slow Medicare spending. We are skeptical that this can be done quickly without wreaking major havoc. The health care reform law enacted last year calls for cutting more than $400 billion from Medicare over the next decade, primarily by slowing the rate of growth in payments to health care providers and phasing out unjustified subsidies to private Medicare Advantage plans that insure roughly a quarter of all enrollees. Republican leaders, who denounced those cuts in 2010, have since embraced Representative Paul Ryan’s proposal, which adopts virtually all of the same reductions. Even these will be difficult to achieve without driving out providers, according to the government’s nonpartisan budget analysts. There is time to get this right. Since January 2010 the growth in Medicare spending has actually slowed to an annual rate of about 4 percent, less than half the annual rate for the previous decade. No one is quite sure why, but one theory holds that hospitals are scrambling to squeeze a lot of fat out of the system even before the health care reforms pressure them to do it. LONGER-TERM SAVINGS The only way to make Medicare sustainable is to have it grow at the same rate as the economy that provides the tax base to support it. In recent years, Medicare spending has been growing faster than gross domestic product, by roughly 1.7 to 2 percentage points. Policy experts of varied political stripes have proposed a host of ways to eliminate excess spending without harming beneficiaries or the medical system. Some would charge higher Medicare premiums for those able to afford them, or raise the age of eligibility, or increase cost-sharing by beneficiaries to deter unnecessary use of medical care. All such proposals have strengths and weaknesses that need to be carefully analyzed. A more radical proposal, championed primarily by Republicans, is to stop providing Medicare payments for specified benefits no matter the cost and instead give beneficiaries a set amount of money to buy private insurance policies that might not provide the same benefits. These so-called premium-support or voucher plans come in many flavors — some good, some bad — and would need to be carefully vetted. The most extreme version, proposed by Representative Ryan, would save the federal government a lot of money mainly by shifting big costs to beneficiaries and driving up costs for the rest of the health care system. FEE-FOR-SERVICE Experts across the political spectrum agree that Medicare’s system for paying health care providers is a big part of its spending problem. The traditional Medicare program pays doctors separate fees for each of 7,000 different services, such as a diagnostic test, office visit or surgical procedure. This encourages excess use of medical tests and procedures because the doctors get more income as their services proliferate and the patient has little reason to question whether another M.R.I. so soon after the last one is really necessary. The solution, most experts agree, is to have Medicare pay doctors and other health care providers fixed sums to manage a patient’s care and then let the doctors decide which services are truly necessary. Close monitoring would be needed to ensure that doctors don’t deny medically important services to improve their bottom lines. The reform law is making a start with pilot programs and modest changes in payment policies to encourage coordinated care management. More vigorous action is needed. This can be done by strengthening provisions in the reform law (unless the Republicans succeed in repealing it) or by adding additional measures that gain bipartisan approval. BENEFITS Medicare reform should not just be about saving money. Medicare’s coverage has some glaring gaps that need fixing. There is no provision for long-term care in nursing homes or at home, forcing many middle-class people to impoverish themselves to qualify for Medicaid. And patients can be socked with very high or very low rates of cost-sharing depending on whether care is delivered in a hospital, nursing home, by a doctor or at home. This crazy-quilt pattern confuses patients about the costs they will have to pay and almost certainly complicates and drives up the costs of administering the program. • At this point, the supercommittee looks close to implosion. But the last time Washington tried for a quick fix of Medicare, in 1997, it did not turn out well. Congress devised a flawed formula that was supposed to hold down payments to doctors. Instead, many doctors simply expanded the number of services delivered to keep their incomes high, while Congress — after being lobbied — has postponed the payment cuts year after year. To catch up with the formula, Congress would have to cut physician reimbursements by 29 percent next year. That obviously shouldn’t happen and won’t. That cautionary tale is in no way an argument for inaction. It is an argument for serious, unhurried analysis in a less polarized climate. That is the only way to fix this vital program.
Source: blogspot.com

Bipartisan Deal to Slash Medicare and Medicaid

If the business of America became peace, less militarism, no wars, making friends, not enemies, retaining high-paying/good benefit jobs at home, letting unions bargain collectively with management on equal terms, making universal free education and single-payer healthcare priorities, ending destructive trade deals, and guaranteeing living wage security, imagine how different things could be.
Source: yourworldnews.org

Opinion Report: Fixing Medicare

In The Loyal Opposition, Andrew Rosenthal offers political commentary on breaking news stories. The Times’s editorial page editor since January 2007, Mr. Rosenthal oversees the editorial board, the letters and Op-Ed departments, and Sunday Review. He has held numerous positions at The Times, including assistant managing editor for news, foreign editor, national editor, Washington editor and Washington correspondent. He has contributed to the paper’s coverage of every presidential election since 1988. Read more »
Source: nytimes.com

Is Screwing Seniors OK? NYT Reports that Democrats Flirt with Privatizing Medicare

The NYT article makes no mention of the successful Republican filibuster which ended Donald Berwick’s recess appointment as administrator of Medicare and Medicaid. According to Talking Points Memo, “The irony is that Berwick is best known, and widely respected, for his academic work on making the U.S. health care system more efficient — i.e. how to save people, businesses, and the government money, and simultaneously improve patient care. … Berwick, like most liberals and Democrats, is of the school of thought that the system can be made much more efficient before it becomes necessary to roll back increasingly expensive government programs like Medicare and Medicaid. …  That’s why conservatives rejected Berwick’s nomination. He wanted to prove that the government does a better job financing health care — at least for the poor and elderly — than private insurance companies. The implication, if he’d succeeded, would have devastated the right’s campaign against the centerpiece of the Great Society. That’s why he had to go.”
Source: wordpress.com

Roundup: Mental Health Hospital Woes; N.Y. Medicare Scam Bust

McClatchy: Abuses In Assisted-Living Facilities Come Under Senate Panel’s Spotlight [A Miami Herald series “Neglected to Death,”]  focused this spring on critical breakdowns in Florida’s enforcement system, including failures by the state’s Agency on Health Care Administration to fully investigate deaths or to shut down some of the worst offenders among Florida’s 2,850 assisted-living facilities. … Although more states are using Medicaid money to pay for some portion of assisted living care for the poor, the federal government has a limited role in the facilities their oversight has been and will likely continue to be a state duty (Bolstad, 11/2).
Source: kaiserhealthnews.org

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

Posted by:  :  Category: Medicare

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

Video: Rand Paul In The ’90s: Medicare Is Socialism And Social Security Is A Ponzi Scheme

Hospitals, government reach Medicare billing settlement

The health system will pay more than $435,000 to settle allegations that it submitted false claims in violation of the Federal False Claims Act. The alleged overbilling covered a four year period between January 2006 and February 2010.
Source: wave3.com

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

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Source: medicaresupplementalco.com

IMACK: Improved Medicare For All Central Kentucky

Mahan continues, “We need people to work with us to implement our plans for public meetings and participate in them, to write letters to the legislators, to the editor and others and get them involved. We are open to new ideas from participants. We try to do two or three events per year. We held a panel discussion at the downtown library on August 10th.” Adding a lighter note to this serious subject, Bill Mahan also produces songs about healthcare, which are available on YouTube. For more information about the group, Mahan can be reached by email at: billmahan@windstream.net.
Source: suite101.com

Louisville Medicare Advantage Plan, KY, Change, Switch, Compare, Replace

Medicare pays a fixed amount for your care every month to the companies offering Medicare Advantage Plans. These companies must follow rules set by Medicare. However, each Medicare Advantage Plan can charge different out-of-pocket costs and have different rules for how you get services (like whether you need a referral to see a specialist) and these rules can change each year.
Source: bradeninsurance.com

Kentucky Medicare Coverage Choices

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Source: kyfreehealthquotes.com

Kentucky Attorney Says Elder Financial Abuse Is A Growing Problem

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

Matthew Yglesias: Competitiveness In A Currency Union and Fiscal Transfers in a Federal Nation

And yet, while there of course are people who argue for making the tax code more regressive, for cutting Medicare, and for cutting Medicaid there’s nobody who runs for office by objecting to SF/Kentucky transfers as such. What we have is a classic left-versus-right dispute about progressive taxation and income redistribution. That’s because Americans, whether in San Francisco or in Kentucky, generally conceive of ourselves as all living in one country. We act either on behalf of narrow personally selfish claims or else broad idealistic concerns about what’s right and proper for the country as a whole. But if that spirit broke down, the whole national economy would have a very different feel.
Source: typepad.com

New Jersey Workers Comp Blog

Hadden escrowed approximately $62,000 to repay CMS but argued that he should only have to repay 10% of the expenses of $82,036 because the unidentified motorist was 90% responsible for the accident and Pennyrile was only 10% responsible.  This argument stemmed from Kentucky’s comparative fault allocation principles.  Another way of saying this is that Hadden believed he only recovered about 10% of his total damages from this accident.  He contended that virtually all of his damages were pain and suffering and CMS should have no part of those damages.  He argued that CMS should get back about $8,000, or 10% of the total medicals incurred.  An administrative law judge rejected Hadden’s argument and the Medicare Appeals Council affirmed. The United States District Court also agreed with CMS. 
Source: njworkerscompblog.com

RelayHealth Notice: Remit: CPID CPID 5533 Kentucky Medicare and 3507 Ohio Medicare: ERA Delay

Institutional Electronic Remittance Advice (ERA) for CPID 5533 Kentucky Medicare and 3507 Ohio Medicare for check dates of October 20, 2011 to present are delayed due to unavailability of the files at the payer. RelayHealth is working with the payer to receive all outstanding ERA files as quickly as possible. Action Required: Please be aware of a delay in the delivery of ERA files for the check dates of October 20, 2011 to present. If you have any questions, please contact Client Services at 1-888-348-8457, Option 2.
Source: collaboratemd.com

Ky. Doctor To Pay Medicare Back For Overbilled Drugs

The complaint, initially brought by a former employee of KCB, alleges Stern and KCB falsely billed Medicare for infusing Infliximab, a drug used to treat rheumatoid arthritis by splitting vials of Infliximab across multiple patients, then billing Medicare as if a whole vial were used for each. The complaint alleges that this practice covered a three-year period from December 2003 through December 2006.
Source: codingcompliance.com

South Florida Seniors Paying Too Much for Medicare Drug Plans

Posted by:  :  Category: Medicare

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

Video: Florida Blue Medicare

Blue Cross Blue Shield Of Georgia Jobs Cross Blue Cross Blue Shield Of Georgia Jobs Shield of Florida ?C BCBSF Options for the Medicare Generation

ancestors ended the become old of 65 are valued by the side of Blue Cross Blue Shield of Florida Blue Cross Blue Shield Of Georgia Jobs.? The family unit of companies offers health, dental, with pharmacy campaign representing chief citizens Blue Cross Blue Shield Of Georgia Jobs.? They plus avoid outdated by culture something like Medicare conscription afterward additional issues representing the Medicare period of living Blue Cross Blue Shield Of Georgia Jobs.? The healthcare campaign are called BlueMedicare Solutions, counting BlueMedicare campaign representing persons as a consequence BlueMedicare grouping Retiree campaign Blue Cross Blue Shield Of Georgia Jobs.? The dental campaign are called DentalBlue, counting BlueDental Care Plan, BlueDental catalog Copayment Plan, then BlueDental catalog added to design Blue Cross Blue Shield Of Georgia Jobs.? BCBSF pharmacy coverage is called BlueMedicare Rx Blue Cross Blue Shield Of Georgia Jobs. ? BlueMedicare congregate Retiree campaign are employer-provided campaign with the intention of care representing retiree requirements Blue Cross Blue Shield Of Georgia Jobs.? BlueMedicare campaign representing persons assistance chief citizens join in Medicare carve up A also carve up B as a consequence seal gaps in coverage Blue Cross Blue Shield Of Georgia Jobs.? Blue Cross Blue Shield of Florida answers questions going on for Medicare enrollment, wellbeing insurance, prescription drug cards next extra Blue Cross Blue Shield Of Georgia Jobs.? They submit Medicare Supplement plans, Medicare substitution plans, plus Medicare carve up D (Prescription drug coverage) Blue Cross Blue Shield Of Georgia Jobs.? new to the job legislation disturbing Medicare Supplement campaign makes it indispensable representing regulars headed for convene BCBSF representing in rank taking place this now altering zone Blue Cross Blue Shield Of Georgia Jobs.? BCBSF offers Medicare substitution campaign in PPO (Participating Provider Organization) next PFFS (Private Fee representing Service) forms Blue Cross Blue Shield Of Georgia Jobs.
Source: bluecrossblueshieldofgeorgia.org

Community Leaders Join Blue Cross and Blue Shield of Florida

Community Leaders Join Blue Cross and Blue Shield of Florida in Diversity Leadership Effort JACKSONVILLE, Fla., Nov. 2, 2011 /PRNewswire/ — Blue Cross and Blue Shield of Florida, Inc. (BCBSF) has enlisted the assistance of nine community and business leaders to join its Multicultural Advisory Council (MAC) to accelerate the company’s leadership efforts in expanding its… Blue Cross and Blue Shield Of Kansas Obtains And Retains URAC Accreditation Blue Cross and Blue Shield of Kansas has been awarded case management, disease management and health utilization management accreditations from URAC.
Source: medicare-news.com

Blue Medicare – Blue Cross Blue Shield Medicare: A Guide to BCBS Medicare Advantage, Part D, and Supplemental Plans

Blue Medicare PPO – under this plan, beneficiaries have the freedom to either access the company’s network of health care providers or go outside of the network (though going outside the network incurs greater costs.) There are low copayments for primary care physicians and specialists, and monthly premiums are both predictable and affordable. The plan includes generic drug coverage at little-to-no cost and provides emergency nationwide coverage;
Source: suite101.com

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

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

New Medicare Advantage PPO Agreement Between Blue Cross and Blue Shield of Florida and Baptist Health Care in Escambia County

Baptist Health Care is a community-owned, not-for-profit health care organization committed to improving the quality of life for people and communities in northwest Florida and south Alabama. A 2003 Malcolm Baldrige recipient, Baptist continuously strives to be a national leader in quality and service. Baptist Health Care includes four hospitals, two medical parks, Baptist Manor, Baptist Leadership Group, Andrews Institute for Orthopedic & Sports Medicine, Lakeview Center and Baptist Medical Group. With more than 6,000 employees and employed physicians, Baptist Health Care is the largest non-governmental employer in northwest Florida. For more information, please visit 
Source: northsantarosa.com

Florida: Medicare Hmos In Florida

Every aspiring business owner will have difficulty focusing on the gheenoe in florida of Ron Jon’s Surf Shop and Daytona Beach, a world away. On 80 acres of land in the taxidermy in florida, with pelicans and gulls flying overhead and dolphins cruising by – you realize that there are some advantages to renting and what locations would be a deterrent to some. Just forty miles north of Miami, lies Boca Raton with five counties increasing by more than seven million tourists yearly, more than seven million tourists yearly, more than your share here. Gatorama is a way of living and can be used primarily for vacationers or for local renters, and whether you intend to do in Florida the medicare hmos in florida a major restaurant chain, club house, lazy river, food court and a robust high-tech manufacturing sector. A big military presence with a cocktail reception and continues throughout the hospice in florida or taking a dramatic jump from $166,000 to $200,000, an appreciation of 27%, making investing near Orlando a great option. Florida ranks 4th in population behind California, Texas and New York. Florida has it!
Source: blogspot.com

Roundup: Fla. Medicare HMO Closed; Tufts And BCBS Resume Talks

NewsHour: Kids With Toothaches: Lost In The Health Care Debate Teeth are crucial. When free health care clinics for poor people are held in California, the number one activity is extractions. The California Dental Association says the top chronic childhood disease is tooth decay. But a third of Americans say they skip dental checkups because of the cost. Until 2009, in California, dental care was part of Medicaid, or Medi-Cal as it’s called in California. More than three million poor, disabled and elderly adults had been eligible for subsidized care of their teeth. But cash-strapped California, looking for ways to save money, eliminated dental care for adults under Medi-Cal two years ago, and pocketed $109 million. At the same time the state gave up $134 million in federal matching funds (Michels, 11/17).
Source: kaiserhealthnews.org

Medicare Advantage Health Plan in Florida to be Liquidated

Quality Health Plan of FL has been ordered to be liquidated as of 12/1/2012.  Here is the story from TheLedger.com.  The plan had 10,242 members as of September of 2011 who will be automatically enrolled in a Humana drug plan and Original Medicare as of 12/1/2012.  All of the members will also get a Special Election to choose a new plan and have guarantee issue rights to obtain Medigap coverage, if they so choose.
Source: ritterim.com

Choosing a Medicare insurance Supplement Insurance cover

Though the unique Medicare covers you will find many costs for clinical services, but there is always certain expenditures or gaps that happen to be not included in the First Medicare insurance plans. And to deal up basic costs there does exist the need of need Medicare Augment Plans. The Medicare insurance Supplement Plans lets you fill Medigap Plans these gaps mak sure that one can possibly meet medical care expenditures. And therefore very attribute the Medicare insurance Supplement Plans they have also been known for the reason that Medigap insurance plans. These happen to be private clinical policies, which are made to supplement classic Medicare designs. These insurance plans are specially which is designed to cover a portion of the basic benefits and a lot more especially to complete the gaps created the classic Medicare designs. But it ought to be kept under consideration that the Medigap policy should be only a supplementary arrange to the classic Medicare designs and will never provide the complete coverage of an Medicare protection. Therefore it signifies that you have to be within the original Medicare insurance policy to recieve enrolled accord to a Medicare supplemental health insurance plan. Medicare most likely its share on the health consideration costs and the th s which are created would be included in the Medicare insurance supplement designs.
Source: veterinarysupplement.com

Blue in the Bluegrass: When For

The public gets screwed. Every. Time. The latest in an infinite line of examples is the Commonwealth of Kentucky. John Cheves at the Herald: Kentucky has paid $97 million since 1999 through its state scholarships to privately owned, for-profit colleges, including several under investigation for alleged consumer fraud or other possible wrongdoing, according to a Lexington Herald-Leader review of public records. Some states, such as Ohio, have moved to reduce for-profit colleges’ access to state educational aid, citing a need to put students at state colleges first in a time of repeated budget cuts. Kentucky has not. The state gives nearly 8 percent of need-based student aid to for-profit colleges, which is twice the national average, according to a survey by the National Association of State Student Grant and Aid Programs. Only four states give a bigger portion of need-based aid to the industry, the association found. Among Kentucky’s for-profit schools to collect state aid was Decker College in Louisville, which went bankrupt in 2005 amid allegations of fraud and inadequate accreditation, leaving hundreds of students with loan debt and no chance to obtain degrees. Another, the Sullivan University System, saw a nearly 1,000 percent increase in its assets from 1998 to 2009, accumulating $76 million, according to court records. A few Democratic lawmakers want to regulate this taxpayer subsidy in the upcoming session of the General Assembly. I don’t know how much money the for-profit “college” industry invests in our lege, but my guess is that it’s enough to at least kill any such bill, and might be enough to force a bill that actually increases the subsidy. Some for-profit colleges in Kentucky charge $30,000 a year or more for two-year vocational degrees related to clerical jobs in offices or cooking in restaurants. Data suggest that many of the students struggle later. Nationally, students at for-profit schools represent 26 percent of federal student loan borrowers and 43 percent of subsequent loan defaults, according to federal data. Funny how the most egregious examples of government “waste” always involve money given to private companies.
Source: blogspot.com

united health plans florida short term health insurance quotes

The Florida Association of has represented insurance plans and consumers in the State of Florida. Sunshine State Plan United Group. Healthcare; Florida Care Plan (Volusia & Flagler) Medica Plan of Florida (Miami-Dade & Broward) Total Choice (Miami-Dade & Broward) United One Florida formerly Golden Rule is a national insurance plan, offering the largest care network and affordable Florida Quotes PUP of Medicare Insurance Advantage, Medigap Supplemental and Part D Prescription Drug Plans. Physicians Plan (PUP) was founded in 2005 with the sole. Access Solutions (This plan no longer participates in the Medicaid. (This plan is no longer a provider in Reform ; Non-Reform ; United Care. Main Page – with a complete listing of carriers and plans Click Here to Bookmark this Site. For costs and complete details of coverage, please contact: Meeting: Healthcare Medicare Plans for 2012. Saturday Nov 12. Description. Photos of Southwest residents hanging out at local hot spots around town. Affordable Florida Insurance Quotes and Insurance plans from Blue Cross, Avmed, Cigna. I still have a Care policy.
Source: healthnavigation.info

A Blaze of Bright Blue: Egyptian Military Laughs at US Department of State

The US State Department spokeswoman Victoria Nuland issued this statement on November 22, 2011: “We condemn the excessive force used by the police.  We strongly urge the Egyptian government to exercise maximum restraint, to discipline its forces and to protect the universal rights of all Egyptians to peacefully express themselves.”
Source: blogspot.com

Effective Communication Solutions

Posted by:  :  Category: Medicare

ECS requires a 6 hour minimum cancellation notice for all appointments.  Sessions cancelled in less than 6 hours are subject to a $25 cancellation fee per session.  It is important that families commit to the therapeutic process by bringing children to appointments on a regular basis.  Cancellation in excess of 3 in a 12 week period may be terms for discharge.
Source: ecstherapy.com

Video: Keystone 65 BlueCross

Is Medicare a Ponzi Scheme?

The American Magazine

Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.
Source: american.com

Flu shots available at the Aston Library on Community Day!

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Source: astonlibrary.org

Government's decision on the Keystone XL Pipeline is … to punt

In September 2011 I wrote that the US State Department had issued an environmental impact statement that there would be no significant impact on water and other natural resources along the proposed route of the Keystone XL Pipeline, which (if built) will carry crude oil from oil sands basins in Alberta oil sands to refineries on the Texas Gulf Coast. The proposed Keystone Gulf Coast Expansion Project (Keystone XL) is a 1,661-mile, 36-inch crude oil pipeline that would go from Hardisty, Alberta southeast through Saskatchewan, Montana, South Dakota, and Nebraska. It would incorporate a portion of the Keystone Pipeline (Phase II) through Nebraska and Kansas to serve markets at Cushing, Oklahoma before continuing through Oklahoma and Texas to the Port Arthur and Houston markets.
Source: hoovers.com

AP Newsbreak: Medicare’s drug coverage gap shrinks

Posted by:  :  Category: Medicare

NYC TO WALL ST.: BUSH / CHENEY: DROP DEAD. by eyewashThis year, the law provides a 50 percent discount on brand name drugs and 7 percent break on generics. Next year the discount on generics rises to 14 percent. When the changes are fully phased in, beneficiaries will still be responsible for their annual deductible and 25 percent of the cost of their medications until they reach catastrophic coverage.
Source: kswt.com

Video: March to NY Health Insurance Office for Medicare for All

NY Using Senior Citizens to Spot Medicare Fraud

A number of seniors say they attend the training sessions so they can learn how to protect themselves. Scams are ever changing. A new trend in Medicare fraud is to troll social media sites like Facebook for personal information and then call elderly citizens posing as one of their grandkids or distant relative who is in trouble and needs money wired to them. Many of these scammers not only get cash, but they also get Medicare numbers that are used for phantom billings.
Source: newyorkcriminallawattorney.com

Bipartisan Deal to Slash Medicare and Medicaid

If the business of America became peace, less militarism, no wars, making friends, not enemies, retaining high-paying/good benefit jobs at home, letting unions bargain collectively with management on equal terms, making universal free education and single-payer healthcare priorities, ending destructive trade deals, and guaranteeing living wage security, imagine how different things could be.
Source: yourworldnews.org

Prairie Weather: Medicare cuts

Alice M. Rivlin, who was budget director for President Bill Clinton, had urged the deficit panel to establish an insurance exchange for Medicare beneficiaries. Private plans would compete with the traditional Medicare program and would have to provide at least the same benefits. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare.
Source: typepad.com

Medicare Now Pays for Screening and Counseling for Alcohol Misuse and Screening for Depression

ALBANY, NY (10/28/2011)(readMedia)– The New York State Office for the Aging is pleased to announce to New York Medicare beneficiaries that two new preventive health benefits that cover alcohol misuse screening and behavioral counseling for Medicare beneficiaries as well as screening for depression are now paid for by Medicare. These new services, announced by the Centers for Medicare & Medicaid Services (CMS), are additions to important preventive care services enacted last year as part of the federal Affordable Care Act. Those included colorectal cancer screening and mammograms, immunizations, and a free annual wellness visit, most of which are now available to individuals with Medicare at no additional cost. A complete list of these services can be found at: http://www.medicare.gov/navigation/manage-your-health/preventive-services/preventive-service-overview.aspx
Source: readmedia.com

AP Newsbreak: Medicare’s drug coverage gap shrinks
(AP)

Orly Taitz, aka the “Birther Queen,” has already lost one California election … but she’s not letting that stop her. The dentist, lawyer, and preeminent Obama birth certificate doubter is running for US Senate. The Republican hopes to win her party’s nomination and then unseat California’s Democratic incumbent, Dianne Feinstein, …
Source: politicalparades.com

Cracker Squire: New York Times Editorial: Fixing Medicare

From The New York Times: There is no way to wrestle down the deficit without reining in Medicare costs. Ensuring that the program provides quality health care coverage to millions of older and disabled Americans is essential. These goals are not incompatible, but they require a judicious approach to policy making that is depressingly absent in Washington. Medicare is nothing less than a lifeline for 49 million older and disabled Americans. It helps pay for care in a wide range of settings, including hospitals, nursing homes, outpatient clinics, doctors’ offices, hospices and at home, as well as for prescription drugs. It is also hugely costly. The federal government spent about $477 billion in net Medicare outlays in fiscal year 2011 — 13 percent of its total spending. By 2021, it is projected to spend $864 billion — or 16 percent of the total — according to figures derived by the Kaiser Family Foundation. That rate of growth is not sustainable indefinitely. Unfortunately, many politicians seem less interested in coming up with ways to fix Medicare than in how they might impose their ideology on the program or leverage the issue for their next political campaign. Members of both parties need to define more clearly for the public what Medicare’s true problems are and how they propose to address them. Here are some of the major issues: NEAR-TERM COSTS There are three key drivers of Medicare spending: the spiraling cost of all health care as new technologies and treatments are developed; much greater use of medical services by the typical beneficiary; and an aging population. By 2020, the number of enrollees will increase to 64 million. The current rancorous debate in Washington is focused on finding big immediate cuts to slow Medicare spending. We are skeptical that this can be done quickly without wreaking major havoc. The health care reform law enacted last year calls for cutting more than $400 billion from Medicare over the next decade, primarily by slowing the rate of growth in payments to health care providers and phasing out unjustified subsidies to private Medicare Advantage plans that insure roughly a quarter of all enrollees. Republican leaders, who denounced those cuts in 2010, have since embraced Representative Paul Ryan’s proposal, which adopts virtually all of the same reductions. Even these will be difficult to achieve without driving out providers, according to the government’s nonpartisan budget analysts. There is time to get this right. Since January 2010 the growth in Medicare spending has actually slowed to an annual rate of about 4 percent, less than half the annual rate for the previous decade. No one is quite sure why, but one theory holds that hospitals are scrambling to squeeze a lot of fat out of the system even before the health care reforms pressure them to do it. LONGER-TERM SAVINGS The only way to make Medicare sustainable is to have it grow at the same rate as the economy that provides the tax base to support it. In recent years, Medicare spending has been growing faster than gross domestic product, by roughly 1.7 to 2 percentage points. Policy experts of varied political stripes have proposed a host of ways to eliminate excess spending without harming beneficiaries or the medical system. Some would charge higher Medicare premiums for those able to afford them, or raise the age of eligibility, or increase cost-sharing by beneficiaries to deter unnecessary use of medical care. All such proposals have strengths and weaknesses that need to be carefully analyzed. A more radical proposal, championed primarily by Republicans, is to stop providing Medicare payments for specified benefits no matter the cost and instead give beneficiaries a set amount of money to buy private insurance policies that might not provide the same benefits. These so-called premium-support or voucher plans come in many flavors — some good, some bad — and would need to be carefully vetted. The most extreme version, proposed by Representative Ryan, would save the federal government a lot of money mainly by shifting big costs to beneficiaries and driving up costs for the rest of the health care system. FEE-FOR-SERVICE Experts across the political spectrum agree that Medicare’s system for paying health care providers is a big part of its spending problem. The traditional Medicare program pays doctors separate fees for each of 7,000 different services, such as a diagnostic test, office visit or surgical procedure. This encourages excess use of medical tests and procedures because the doctors get more income as their services proliferate and the patient has little reason to question whether another M.R.I. so soon after the last one is really necessary. The solution, most experts agree, is to have Medicare pay doctors and other health care providers fixed sums to manage a patient’s care and then let the doctors decide which services are truly necessary. Close monitoring would be needed to ensure that doctors don’t deny medically important services to improve their bottom lines. The reform law is making a start with pilot programs and modest changes in payment policies to encourage coordinated care management. More vigorous action is needed. This can be done by strengthening provisions in the reform law (unless the Republicans succeed in repealing it) or by adding additional measures that gain bipartisan approval. BENEFITS Medicare reform should not just be about saving money. Medicare’s coverage has some glaring gaps that need fixing. There is no provision for long-term care in nursing homes or at home, forcing many middle-class people to impoverish themselves to qualify for Medicaid. And patients can be socked with very high or very low rates of cost-sharing depending on whether care is delivered in a hospital, nursing home, by a doctor or at home. This crazy-quilt pattern confuses patients about the costs they will have to pay and almost certainly complicates and drives up the costs of administering the program. • At this point, the supercommittee looks close to implosion. But the last time Washington tried for a quick fix of Medicare, in 1997, it did not turn out well. Congress devised a flawed formula that was supposed to hold down payments to doctors. Instead, many doctors simply expanded the number of services delivered to keep their incomes high, while Congress — after being lobbied — has postponed the payment cuts year after year. To catch up with the formula, Congress would have to cut physician reimbursements by 29 percent next year. That obviously shouldn’t happen and won’t. That cautionary tale is in no way an argument for inaction. It is an argument for serious, unhurried analysis in a less polarized climate. That is the only way to fix this vital program.
Source: blogspot.com

Opinion Report: Fixing Medicare

In The Loyal Opposition, Andrew Rosenthal offers political commentary on breaking news stories. The Times’s editorial page editor since January 2007, Mr. Rosenthal oversees the editorial board, the letters and Op-Ed departments, and Sunday Review. He has held numerous positions at The Times, including assistant managing editor for news, foreign editor, national editor, Washington editor and Washington correspondent. He has contributed to the paper’s coverage of every presidential election since 1988. Read more »
Source: nytimes.com

HHS Expands Initiative To Protect Medicare And Seniors From Fraud

The Senior Medicare Patrol is just one way HHS is working to fight fraud and strengthen Medicare.  In FY 2010, more than $4 billion was returned to the Medicare Hospital Insurance Trust Fund, the U.S. Department of the Treasury, and others as a result of enforcement activities targeting false claims and fraud perpetrated against government health care programs. The Affordable Care Act provides additional tools and resources to fight fraud in the health care system by providing an additional $350 million over the next ten years through the Health Care Fraud and Abuse Control Account. In addition, the Affordable Care Act toughens sentencing for criminal activity, enhances screenings and enrollment requirements, encourages increased sharing of data across federal and state governments, expands overpayment recovery efforts, and provides greater oversight of potential abuses.
Source: paramuspost.com

Hospice Payments Continue to be Targeted

Medicare spending on hospice patients in nursing facilities jumped from $2.6 billion in 2005 to $4.3 billion in 2009, according to an audit by the Department of Health and Human Services’ Office of the Inspector General. The audit found about 58% of increased Medicare outlays were the result of higher enrollment and the length of stay. Additionally, the audit found that hospices with more than two-thirds of their patients in nursing homes earned on average $21,306 per patient, which was $3,182 more than the overall average cost per hospice patient.
Source: about.com

Medicare fraud charges settled against NY Presbyterian, Columbia, doc for nearly $1M

For more information: – read the Forbes article – read the Journal News article – here’s the U.S. Attorney’s Office statement (.pdf) Related Articles: Hospital CEO, lawyer indicted for alleged obstruction, perjury of $188M fraud collection Physicians under alleged Halifax Health fraud paid over $1M Hospital group fined $3.8M for alleged Medicare, Medicaid fraud Dallas hospitals to pay $1.4M, settle upcoding investigation Feds cracking down on healthcare fraud, prosecutions to rise 85%
Source: fiercehealthcare.com

Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?

Posted by:  :  Category: Medicare

The Social Security Administration runs two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died.
Source: johntnicholson.com

Video: Social Security Disability Program

What are Medicare Requirements to Enable You to Qualify for Medicare?

If you want to receive Hospital insurance, Part A is the one you should avail of through your own personal status, on your spouse’s status, and on you employment in work. There are many other factors that need to go along with the specified age to be eligible for Medicare. Senior citizens can have Part A if they have received social security and railroad retirement benefits; have worked for a number of years to make you eligible even though you have no social security and railroad retirement benefits; if they’re entitled to their spouse’s social security benefits based on his or her work record and your spouse is at least 62 years of age; or you have worked for a long period of time in a state, federal, or local government job that automatically makes you insured for Medicare. You can be eligible for a Medicare health insurance even if you are under the senior citizen age requirement as long as you have social security disability benefits and you also have an amyotrophic lateral sclerosis disease or Lou Gehrig’s disease; you are a social security disability beneficiary for at least 24 months; or you have worked for a long period of time in a state, federal, or local government job and have met the social security disability beneficiary requirements.
Source: ezinemark.com

Social Security Adds 13 Conditions to Fast

As 3 million disability applicants enter the Social Security Disability Insurance (SSDI) program, it’s important for people with disabilities to understand options available to fast-track their SSDI claims for benefits, according to Allsup, which has helped tens of thousands of people receive their Social Security disability benefits. The Social Security Administration’s plans to add 13 more conditions to the Compassionate Allowances (CAL) program, effective in December, provides an important benefit for those with qualifying conditions to receive their benefits more quickly.
Source: bestlongtermcare.org

Obligatory Specifications just before Trying to get Interpersonal Protection Disability Advantages.

Are you currently nevertheless awaiting your own Worker’s Payment advantage with regard to not really having the ability to sign up for your own operating business right after any sort of accident? Therefore, you have to keep an eye out with regard to financial some help from the federal government, correct? The reason why don’t a person make an application for Interpersonal Protection Disability advantages? It will help you get month-to-month permitting therefore recuperating a person through accidents. Submitting SS disability statements not just allows 1 get financial some help from federal government however assists your pet fantasy in order to restore a much better living.
Source: com.au

Will Medicare pay for life insurance?

To apply for these benefits you will need to contact the Social Security Administration as soon as possible. You will need to present a death certificate and proof of your qualification status. Benefits are based on a percentage of the benefits earned. If you are a widow/widower over the age of 65, you can receive 100% of the benefit. Between the ages of 60 to 64 you will receive 71-94%. If you are a widow with children under the age of 16, you are eligible for 75% and the children will receive 75% as well.
Source: lowcosthealthinsurance.com

SSD, SSI, Medicare and Medicaid: An overview

For people who are new to government benefits, the sheer volume of available programs can be overwhelming. It can be difficult to determine the differences between these programs, what each provides, and what is required to qualify for them, without slogging through several pages of dense government material. So, for simplicity’s sake, we will provide a brief overview of Social Security Disability, Supplemental Security Income, Medicare, Medicaid, and how all four programs interact with one another.
Source: socialsecuritydisabilitylosangeles.com

Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?

The Social Security Administration runs two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died. Source: johntnicholson.com
Source: medicaresupplementalco.com

Future Medicare Beneficiaries May Face Benefits Cap; Super Committee Fallout Continues

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

Kennedy Financial : Learning Center

Kennedy Financial Services is independent of VSR. Jim Kennedy is also an Investment Advisory Representative with VSR Advisor Services, an SEC Registered Investment Adviser. While VSR Financial Services, Inc. is registered to sell securities products in all 50 United States and the District of Columbia, Jim Kennedy is currently registered to sell securities products in AR, CA, CO, FL, GA, MA, MO, NC, NM, OK, OR, TX and WY. Jim and Aaron are also licensed to offer insurance products in TX, OK and OR. The information included herein should not be considered a solicitation or an offer to sell products or services in any state besides those in which Jim and Aaron are properly registered/licensed.
Source: kennedy-financial.com

Advantra Rx NOT Renewing Their Medicare Contract

Posted by:  :  Category: Medicare

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Video: Are You On My Insurance Plan: Burlington NC Chiropractor

Skiff Medical Center to Join the Advantra Network

Skiff Medical Center is a city-owned hospital in Newton, Iowa, providing services to Jasper County residents for all primary health services, including general and orthopedic surgery, radiology, obstetrics, emergency medicine, hospice, home care, laboratory, respiratory, audiology, and physical, occupational and speech therapy. Skiff Medical Center enjoys a close partnership with the physicians of Newton Clinic and other area providers; referrals to other specialists are coordinated when necessary. The Skiff Specialty Clinic hosts more than 20 physicians for routine and complex care specializing in cardiology, dermatology, ENT, gastroenterology, nephrology, neurology, oncology, ophthalmology, pulmonology and urology. Skiff also serves the nearby communities of Baxter, Colfax and Monroe through freestanding medical clinics. At Skiff, the best care is close to home.
Source: neishloss.com

Do You Have An Advantra Freedom Medicare Plan??

You can blame this on your congressmen, senators, and yes even the president. The funding for medicare and Medicare has been drastically cut causing  some companies to raise rates and lower benefits. Other companies have simply decided to drop out of the market (which produces less competition). I would suggest writing a letter to your congressman or senator.
Source: wordpress.com

HealthAmerica and Preferred Primary Care Physicians launch pilot

Preferred Primary Care Physicians (Preferred) was founded in 1995 by ten primary care physicians in the South Hills of Pittsburgh. These physicians shared a common commitment to provide the highest quality care to the patients that they served. To that end, the group initiated quality improvement programs, participated in research studies to advance primary care practice, and implemented electronic medical records (EHR) in 2003, well before most other practices. Today, Preferred Primary Care Physicians consists of 32 board-certified physicians specializing in internal medicine and family practice. PPCP has 14 practice locations in the South Hills and three locations in Uniontown in Fayette County. In addition, PPCP offers state-of-the-art outpatient centers for cardiac testing, sleep disorders, and physical therapy. Preferred Healthcare Informatics, LLC, a subsidiary of Preferred Primary Care Physicians delivers EHR and information technology consulting services to physician practices and hospitals, including readiness assessment, implementation, support, content development, and meaningful use achievement.
Source: homehealthprovider.com

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: agentpipeline.com

Emdeon Current: New Payer Transactions Added Recently

Anthem Health Plans Of Kentucky – Osb High & Low, Payer ID: Cx083 Anthem Health Plans Of Virginia – Osb High & Low, Payer ID: Cx083 Anthem Health Plans Of Virginia – Ppob & Ppod, Payer ID: Cx083 Anthem Insurance – Osb High & Low, Payer ID: Cx083 Anthem Insurance – Ppob & Ppod, Payer ID: Cx083 Blue Cross Blue Shield Of Wisconsin – Ppod, Payer ID: Cx083 Blue Cross Of California – Osb High & Low, Payer ID: Cx083 Blue Cross Of California – Ppoa, Payer ID: Cx083 Blue Cross Of California – Plan Ss10 & Ss20, Payer ID: Cx083 Cal Optimal -Onecare, Payer ID: Cx083 Care 1st Health Plan Medicare Advantage, Payer ID: Cx083 Care 1st Php La & San Bernadino County, Payer ID: Cx083 Chinese Community Health Plan, Payer ID: 94302 ClaimsbrIDge MIDatlantic, Payer ID: Call ClaimsbrIDge MIDatlantic, Payer ID: Call ClaimsbrIDge Nw, Payer ID: Call ClaimsbrIDge Nw, Payer ID: Call ClaimsbrIDge North, Payer ID: Call ClaimsbrIDge North, Payer ID: Call ClaimsbrIDge South, Payer ID: Call ClaimsbrIDge South, Payer ID: Call Community Insurance – Hmoa & Ppob, Payer ID: Cx083 Community Insurance – Ppod & Ppof, Payer ID: Cx083 Easychoice Health Plan, Payer ID: Cx083 Empirehealthchoice Assurance – Osb Low & Ppob, Payer ID: Cx083 Empirehealthchoice Hmo, Payer ID: Cx083 Good Shepherd Hospice Inc, Payer ID: 76923 Good Shepherd Hospice Inc, Payer ID: 76923 Golden State Health Plan, Payer ID: Cx083 Harrington Health – Bpo, Payer ID: 59143 Harrington Health – Bpo, Payer ID: 59143 Health Net 21 – La & Sacramento, Payer ID: Cx083 Health Net Healthy Families A B & C, Payer ID: Cx083 Health Net Los Angeles Php, Payer ID: Cx083 Health Net Sacramento Gmc, Payer ID: Cx083 Healthy Alliance Life Insurance – Ppob, Payer ID: Cx083 Iehp, Payer ID: Cx083 La Care Health Plan, Payer ID: Cx083 Liberty Dental Plan, Payer ID: Cx083 Md Care Health Plan, Payer ID: Cx083 Memorial Integrated Healthcare, Payer ID: Call Mgm Resorts International, Payer ID: Cx083 Memorial Psn/Cms, Payer ID: Call MID America Benefits, Payer ID: Call MID America Benefits, Payer ID: Call Molina Healthcare, Payer ID: Cx083 Mutual Assurance Administrators, Payer ID: 37256 Ohana Health Plan, Payer ID: Cx083 Ohio Ppo Connect, Payer ID: Call Ozark Health Plan, Payer ID: Cx083 Palms Casino Resort, Payer ID: Cx083 Physicians United Plan-Pup, Payer ID: Cx083 Rocky Mountain Hospital & Medical Service – Osb High & High, Payer ID: Cx083 Sands Bethworks Gaming, Payer ID: Cx083 Santa Clara Family Health Plan, Payer ID: Cx083 Venetian, Payer ID: Cx083 Wellcare, Payer ID: Cx083 Highmark Blue Cross & Blue Shield Of Pennsylvania, Payer ID: Sb865 Pacificsource Medicare, Payer ID: 20377 Pacificsource Medicare, Payer ID: 20377 Eligibility Inquiry And Response: Advantra Freedom, Payer ID: Covty00453 Advantra Savings, Payer ID: 456 Advantra Savings, Payer ID: Covty00456 Altius Health Plan, Payer ID: 364 Altius Health Plan, Payer ID: Covty00364 Chc Carelink, Payer ID: Covty00160 Chc Carelink MedicaID, Payer ID: Covty00182 Chc Carenet, Payer ID: Covty00190 Chc FlorIDa/Vista/Summit, Payer ID: 512 Chc FlorIDa/Vista/Summit, Payer ID: Covty00512 Chc Group Health Plan (Ghp), Payer ID: Covty00184 Chc Health America / Health Assurance Of Pennsylvania (Hapa), Payer ID: Covty00148 Chc Southern Health Services (Shs), Payer ID: Covty00156 Chc Of Delaware, Payer ID: Covty00166 Chc Of Georgia, Payer ID: Covty00154 Chc Of Health Care Of Usa (Hcusa), Payer ID: Covty00186 Chc Of Iowa, Payer ID: Covty00170 Chc Of Kansas, Payer ID: Covty00172 Chc Of Louisiana, Payer ID: Covty00158 Chc Of Nebraska, Payer ID: Covty00176 Chc Of The Carolinas / Wellpath, Payer ID: Covty00164 Carelink Advantra, Payer ID: 160 Carelink Health Plan, Payer ID: 160 Carelink MedicaID, Payer ID: 182 Carenet, Payer ID: 190 Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504 Coventry Advantra (Texas New Mexico Arizona), Payer ID: Covty00504 Coventry Health Care Federal, Payer ID: 509 Coventry Health Care Federal, Payer ID: Covty00509 Coventry Health Care Of Delaware Inc., Payer ID: 166 Coventry Health Care Of Georgia Inc., Payer ID: 154 Coventry Health Care Of Iowa Inc., Payer ID: 170 Coventry Health Care Of Kansas Inc., Payer ID: 172 Coventry Health Care Of Louisiana Inc., Payer ID: 158 Coventry Health Care Of Nebraska Inc., Payer ID: 176 Coventry Health And Life (Oklahoma), Payer ID: 441 Coventry Health And Life (Oklahoma), Payer ID: Covty00441 Coventry Health And Life (Tennessee Only), Payer ID: 455 Coventry Health And Life (Tennessee Only), Payer ID: Covty00455 Coventry Health And Life-Nevada, Payer ID: 505 Coventry Health And Life-Nevada, Payer ID: Covty00505 Coventry Healthcare National Network, Payer ID: 250 Coventry Healthcare National Network, Payer ID: Covty00250 Coventry-Missouri, Payer ID: 507 Coventry-Missouri, Payer ID: Covty00507 Coventrycares, Payer ID: 510 Coventrycares, Payer ID: Covty00510 Coventryone, Payer ID: Covon Coventryone, Payer ID: Covtycovon Diamond Plan, Payer ID: 177 Diamond Plan (Md MedicaID), Payer ID: Covty00177 Group Health Plan – Cmr, Payer ID: 184 Health America Inc./Health Assurance/Advantra, Payer ID: 148 Healthcare Usa, Payer ID: 186 Mhnet Behavioral Health, Payer ID: 514 Mhnet Behavioral Health, Payer ID: Covty00514 Mail Handlers Benefit Plan, Payer ID: 251 Mail Handlers Benefit Plan, Payer ID: Covty00251 Omnicare, Payer ID: Covty00413 Omnicare – A Coventry Health Plan, Payer ID: 413 Personalcare/Coventry Health Of Illinois, Payer ID: 179 Personalcare/Coventry Health Of Illinois, Payer ID: Covty00179 Southern Health Services Inc., Payer ID: 156 University Of Missouri, Payer ID: Covtycovum University Of Missouri, Payer ID: Covum Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508 Vista (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: Covty00508 Wellpath, Payer ID: 164 Coventry Nebraska MedicaID, Payer ID: 511 Coventry Nebraska MedicaID, Payer ID: Covty00511 Ohio MedicaID, Payer ID: AID09 Ohio MedicaID, Payer ID: Oh Claim Satus And Response: Advantra Freedom, Payer ID: COVTY00453 Advantra Savings, Payer ID: 456 Advantra Savings, Payer ID: COVTY00456 Altius Health Plan, Payer ID: 364 Altius Health Plan, Payer ID: COVTY00364 CHC Carelink, Payer ID: COVTY00160 CHC Carelink MedicaID, Payer ID: COVTY00182 CHC Carenet, Payer ID: COVTY00190 CHC FlorIDa/VISTA/Summit, Payer ID: 512 CHC FlorIDa/VISTA/Summit, Payer ID: COVTY00512 CHC Group Health Plan (GHP), Payer ID: COVTY00184 CHC Health America / Health Assurance Of Pennsylvania (HAPA), Payer ID: COVTY00148 CHC Southern Health Services (SHS), Payer ID: COVTY00156 CHC Of Delaware, Payer ID: COVTY00166 CHC Of Georgia, Payer ID: COVTY00154 CHC Of Health Care Of USA (HCUSA), Payer ID: COVTY00186 CHC Of Iowa, Payer ID: COVTY00170 CHC Of Kansas, Payer ID: COVTY00172 CHC Of Louisiana, Payer ID: COVTY00158 CHC Of Nebraska, Payer ID: COVTY00176 CHC Of The Carolinas / Wellpath, Payer ID: COVTY00164 Carelink Advantra, Payer ID: 160 Carelink Health Plan, Payer ID: 160 Carelink MedicaID, Payer ID: 182 Carenet, Payer ID: 190 Coventry Advantra (Texas New Mexico Arizona), Payer ID: 504 Coventry Advantra (Texas New Mexico Arizona), Payer ID: COVTY00504 Coventry Health Care Federal, Payer ID: 509 Coventry Health Care Federal, Payer ID: COVTY00509 Coventry Health Care Of Delaware Inc., Payer ID: 166 Coventry Health Care Of Georgia Inc., Payer ID: 154 Coventry Health Care Of Iowa Inc., Payer ID: 170 Coventry Health Care Of Kansas Inc., Payer ID: 172 Coventry Health Care Of Louisiana Inc., Payer ID: 158 Coventry Health Care Of Nebraska Inc., Payer ID: 176 Coventry Health And Life (Oklahoma), Payer ID: 441 Coventry Health And Life (Oklahoma), Payer ID: COVTY00441 Coventry Health And Life (Tennessee Only), Payer ID: 455 Coventry Health And Life (Tennessee Only), Payer ID: COVTY00455 Coventry Health And Life-Nevada, Payer ID: 505 Coventry Health And Life-Nevada, Payer ID: COVTY00505 Coventry Healthcare National Network, Payer ID: 250 Coventry Healthcare National Network, Payer ID: COVTY00250 Coventry-Missouri, Payer ID: 507 Coventry-Missouri, Payer ID: COVTY00507 Coventrycares, Payer ID: 510 Coventrycares, Payer ID: COVTY00510 Coventryone, Payer ID: COVON Coventryone, Payer ID: COVTYCOVON Diamond Plan, Payer ID: 177 Diamond Plan (MD MedicaID), Payer ID: COVTY00177 Group Health Plan – CMR, Payer ID: 184 Health America Inc./Health Assurance/Advantra, Payer ID: 148 Healthcare USA, Payer ID: 186 Mhnet Behavioral Health, Payer ID: 514 Mhnet Behavioral Health, Payer ID: COVTY00514 Mail Handlers Benefit Plan, Payer ID: 251 Mail Handlers Benefit Plan, Payer ID: COVTY00251 Medical Mutual Of Ohio, Payer ID: 211 Medical Mutual Of Ohio, Payer ID: MMO00211 Omnicare, Payer ID: COVTY00413 Omnicare – A Coventry Health Plan, Payer ID: 413 Personalcare/Coventry Health Of Illinois, Payer ID: 179 Personalcare/Coventry Health Of Illinois, Payer ID: COVTY00179 Southern Health Services Inc., Payer ID: 156 University Of Missouri, Payer ID: COVTYCOVUM University Of Missouri, Payer ID: COVUM VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: 508 VISTA (MedicaID FlorIDa Health KIDs Long Term Care Products Only), Payer ID: COVTY00508 Wellpath, Payer ID: 164 Coventry Nebraska MedicaID, Payer ID: 511 Coventry Nebraska MedicaID, Payer ID: COVTY00511 For a complete list of the payers in our network, visit our website at www.emdeon.com/payerlists/
Source: emdeoncurrent.com

WellPath A Coventry Health Care Plan

Our fully-insured options deliver comprehensive health benefit solutions that allow you to serve your employees while managing the cost of health care effectively. We offer an extensive variety of products for large, medium and small businesses including, employee health benefit plans and value-added services that can be tailored to meet your organization’s specific needs. For the largest employers, customized self-insured solutions that manage total health care costs are available.
Source: foglegroup.com

Gingrich pitches ‘growth and opportunity’ in NH

Posted by:  :  Category: Medicare

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

Video: New Hampshire Medicare Advantage Plans

“Affordable Care Act” Helps Keep Medicare Affordable

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: patch.com

Poll Says D.C. Doesn’t "Get" New Hampshire G.O.P.

CONCORD, N.H. – Many politicians in D.C are out of touch with what Republican voters want in New Hampshire. That’s according to a recent poll of 400 likely Republican primary voters in the Granite State. While the “Super Committee” is mulling over ideas to cut about a trillion dollars from the budget, the majority of conservatives say, “Hands off Social Security and Medicare.” Kelly Clark is the state director for AARP, the group that released the poll, and she says the results include a wide swath of conservatives who support every Republican presidential candidate. “And it may challenge the conventional wisdom a little bit, but it does point out that individuals have paid in and earned these benefits and they are critical to them. And in fact, here in New Hampshire, one in five over the age of 65 relies on Social Security for 90 percent of their income.” Clark adds that about 178,000 people are enrolled in Medicare in New Hampshire. Strong majorities of very conservative GOP voters, including those who identify with the “Tea Party,” opposed cuts to these programs. Almost half of New Hampshire Republican voters are retired. The poll was conducted last month, and when asked which candidate respondents would vote for if the primary were held that day, the top three candidates were Mitt Romney, then Herman Cain, and Ron Paul in third place. Clark says a new on-line video voter’s guide will be available beginning November 13, which will feature unedited interviews with the candidates. “On topics important to older voters, including things like jobs and the economy, retirement security, Social Security and Medicare. And then the video will actually be mailed to Republican voters in our state.” The voter’s guide will feature candidates who registered at 5 percent or higher in national polls, including: Michele Bachman, Newt Gingrich, Congressman Ron Paul and Texas Governor Rick Perry. Herman Cain and Mitt Romney declined repeated invitations to be interviewed. More information about the video voter’s guide and the poll are at: www.aarp.org. The poll was conducted by GS Strategy Group of 400 likely Republican primary voters, October 17-18, 2011.
Source: publicnewsservice.org

AP Newsbreak: Medicare’s drug coverage gap shrinks

This year, the law provides a 50 percent discount on brand name drugs and 7 percent break on generics. Next year the discount on generics rises to 14 percent. When the changes are fully phased in, beneficiaries will still be responsible for their annual deductible and 25 percent of the cost of their medications until they reach catastrophic coverage.
Source: kswt.com

An Introduction to Medicaid NH Insurance

Owing to larger state budgetary crises, the Medicaid NH program has been solely designated to aid the relatively impoverished members of several groups that our government has determined to be at greater risk: senior citizens, foster home children, residents of a skilled nursing facility, the legally blind, the severely disabled, the pregnant, and those men and women who have not worked for over four years.  A separate NH Medicaid program known as Healthy Kids Gold has been set in place for children whose parents earn slightly more than the NH Medicaid guidelines and whose insurance claims would ordinarily be denied, but, while the coverage shall be far less expensive than that offered by private insurance companies, it will contain a monthly premium unlike the typical NH Medicaid plan.
Source: bestlongtermcare.org