My Disability Blog: Social Security Disability, Cobra, and Medicare Eligibility

Posted by:  :  Category: Medicare

The following question was submitted recently in a comment: “On Social Security disability my cobra has been canceled and I am not Medicare age yet will I become eligible for Medicare?” If you are receiving Social Security disability benefits, you will become eligible for Medicare insurance benefits two years after the month you became entitled to your monthly disability benefits. You will be eligible for Medicare part A and B, as well as, part C and D at that time. Medicare part A is free, while part B, C, and D are pay insurance coverage. Medicare coverage can be difficult to understand, if you do not understand your Medicare benefits call 1-800-Medicare. They can provide assistance or refer you to other agencies that can help you chose the right Medicare coverage for you. Additional information on Social Security Disability at www.ssdrc.com Return to the Social Security Disability SSI Benefits Blog
Source: blogspot.com

Video: Carefirst Blue Choice

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

Medicare Eligibility: Start with the Basics

Moreover, the spouse of the person eligible for the benefits of Medicare should also have been regularly paying Medicare taxes for the same period given. On the other hand, to accommodate those who are not able to regularly pay for Medicare taxes, both the beneficiaries and their spouses, Medicare still has another option for this group since as much as possible, this medical group wants to cater to every kind of medical need of all citizens of the country. For this group of people, those who are 65 years old and above should pay a certain monthly premium so that they will be remained enrolled in Medicare. If this condition will not be met, unfortunately, beneficiaries will be cut off from the Medicare list, unless other conditions will come up in the future. After learning some of the basic information on Medicare, such as knowing some points in Medicare eligibility, the person can now move on to the next step, which is to make sure that all payables are regularly paid. Although there are two options when it comes to payment scheme, it is important to weigh which is lighter to pay and more relevant.
Source: ezinemark.com

Age 67 Medicare Eligibility May Lower Your Social Security

On the other hand, several think tanks and organizations believe that raising Medicare eligibility to age 67 would do more harm than good, because doing so would eat away at Social Security benefits. The organizations found that nearly a million Americans would face an extra $4,300 in health care costs each year as a result of raising the age. For these Americans, health care costs would jump from taking up 28 percent of their Social Security benefits to taking up nearly half of their benefits.
Source: troutmanlawblog.com

Just A Few Days Left For Medicare Open Enrollment

Sacramento Bee: Medicare Deadline: Many Still Unaware The 2010 health reform act mandated the earlier enrollment period to give Medicare recipients more time to weigh their plan options and insurers more time to complete paperwork and get membership cards and other information to beneficiaries. But at least two recent surveys show that many seniors still are unaware of the Wednesday deadline. The latest, from survey firm Opinion Research, showed that just one in five seniors 65 years of age and older with Medicare prescription drug plans were aware that the open enrollment period ends next week (Smith, 12/3).
Source: kaiserhealthnews.org

medicare private health plan

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

Medicare Advantage Enrollment For People New To Medicare

Becoming eligible for Medicare due to a disability does not require that you wait until you turn 65. You can join a plan during the 7 month period which begins 3 months prior to your 25th month of disability, the 25th month and 3 months after your 25th month of disability.
Source: affordablemedicareplan.com

How to choose the best Medicare Advantage Plan?

Posted by:  :  Category: Medicare

Being in a recession, everyone is worried about costs, and choosing a Medicare plan should be no different. When enrolling in traditional Medicare, you may choose to pay for a Medicare Supplement, or Medigap policy. Medicare Advantage HMOs and PPOs often provide a lot of the same benefits as Medigap policies. Usually you won’t need to enroll in Part D prescription coverage since many Medicare Advantage plans already include prescription coverage in their plans. Many plans also have extra benefits available at additional costs.
Source: mysenior411.com

Video: Florida Medicare Advantage | Florida Health Agency

Debunking Medicare Myths: Drug Rebates for Dual Eligibles 

[1] Center for Medicare Advocacy, "So, What Would You Do? Real Solutions for Medicare Solvency and Reducing The Deficit", available at: http://www.medicareadvocacy.org/2011/06/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/. [2] National Committee to Preserve Social Security and Medicare, available at: http://www.ncpssm.org/pdf/price_negotiation_part_d.pdf [3] Ben Adams, InPharm, "U.S. Prescription Drug Prices Rise Above Inflation", August 27, 2010, available at: http://www.inpharm.com/news/us-prescription-drug-prices-rise-above-inflation. [4] AARP Public Policy Institute, Rx Watchdog Report: Brand Name Drug Prices Continue to Climb Despite Low General Inflation Rate, available at: http://assets.aarp.org/rgcenter/ppi/health-care/i43-watchdog.pdf. [5] Committee on Oversight and Government Reform, "Private Medicare Drug Plans: High Expenses and Low Rebates Increase the Costs of Medicare Drug Coverage", October 2007, available at: http://www.allhealth.org/briefingmaterials/housemajoritystaff-965.pdf. [6] Id. [7] GAO, Prescription Drugs: Trends in Usual and Customary Prices for Commonly Used Drugs, available at: http://www.gao.gov/new.items/d11306r.pdf. [8] PhRMA, 2011 Profile Pharmaceutical Industry, available at: http://www.phrma.org/sites/default/files/159/phrma_profile_2011_final.pdf. [9] Mac-Andre Gagnon, Joel Lexchin, "The Cost of Pushing Pills: A New Estimate of Pharmaceutical Promotion Expenditures in the United States", January 2008, available at: http://www.plosmedicine.org/article/info:doi/10.1371/journal.pmed.0050001. [10] Center for Medicare Advocacy, "Keeping Medicare and Medicaid Strong?" available at: http://www.medicareadvocacy.org/2011/04/keeping-medicare-and-medicaid-strong/.
Source: medicareadvocacy.org

The Washington Current: Progressives

While those on the left are better known for defending key federal programs from falling victim to a budget knife, a prominent group of progressive Democrats say they have found a way to cut Medicare in the name of deficit reduction — without harming benefits to those who rely on the federal healthcare program. “Congress can shave $1 trillion from the deficit by closing the loophole in Medicare Part D, which prohibits the government from negotiating lower prescription drug prices,” Tim Carpenter, national director of Progressive Democrats of America (PDA) says in a Thursday email. Established by Congress in 2003, Medicare Part D subsidizes recipients for prescription drugs. Although other federal health programs, such as the Department Veterans Affairs, can negotiate lower drug prices, Medicare Part D is not allowed to do so. The Medicare drug benefit was engineered by then-Rep. Billy Tauzin (R-La.), who soon afterward left Congress for a job heading up a powerful lobbying group for the drug industry. With Congress now hunting for deep reductions in the federal budget deficit by way of the so-called “supercommittee,” Medicare has come in jeopardy of being cut. That bipartisan supercommittee is tasked with identifying ways to reduce the federal budget deficit by $1.5 trillion over 10 years. It is to complete its work by Thanksgiving. The PDA proposal would allow for budget savings on the part of the government without restricting access to care. Since going into effect in 2006, more than 27 million Americans have come to rely on Medicare Part D. “So far, we’ve identified 2.8 trillion dollars in deficit reduction without cutting benefits to Social Security, Medicare, and Medicaid,” Carpenter says. “Over the next weeks, we’ll identify more savings and revenue raisers that will preserve and could expand benefits.” The effort is part of what PDA has dubbed “Operation Super-committee,” which calls for “a mix of raising revenue and cutting wasteful spending while protecting low and middle-income families as the proper course to tackle the national deficit.” PDA is circulating an online petition in support of its move to allow Medicare Part D drug-price negotiation. Members of the organization plan to meet Monday with Rep. Jan Schakowsky (D-Ill.) to deliver that petition. “Our goal is 20,000 signatures—and we’re more than halfway there,” Carpenter says. Bookmark The Washington Current and drop back in for more news from the nation’s capital.
Source: thewashingtoncurrent.com

Extending Medicaid Drug Rebates Is No Solution to Debt Limit

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Source: heritage.org

What’s The Difference Between Medicare And Medicaid?

Unlike Medicare, which is available to everyone, Medicaid has strict eligibility requirements. The rules vary by state (beyond the basics set forth in the federal guidelines), but the program is designed to help the poor, so many states require Medicaid recipients to have no more than a few thousand dollars in liquid assets to participate in the program. There are also income restrictions. For a state-by-state breakdown of eligibility requirements see these websites Benefits.gov and BenefitsCheckUp.org.
Source: investopedia.com

Early Medicare Part D deadline a concern for state agency

Posted by:  :  Category: Medicare

Meeks says the volume of calls to her office has been less than in previous years and she’s concerned that some participants will miss this year’s deadline.  “People that don’t make changes, they may find out in January that their plan may have raised the premium or they may have removed drugs from their formulary, the deductible may have rise.”
Source: wvpubcast.org

Video: Tutorials Part D Tutorial [www.keepvid.com].flv

Deadline approaching for Medicare Part D open enrollment 

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Source: wvgazette.com

Holly Hibner: Medicare Part D

My library presents Medicare Part D programs every week during open enrollment season.  One of our librarians presents a 15-20 minute Power Point that covers the basics of Part D, and then she and I work with the attendees one by one, entering their prescriptions into the online system . We print for them the details of the top three prescription drug plans for their individual needs.  It is a very well-attended, much-needed, and useful program.  These programs have not only helped me answer reference questions about Medicare, and specifically Part D, but they have also opened my eyes to the state of health care in this country and also to the plight of senior citizens.  For one thing, many of the seniors who attend the program are pretty clueless about Medicare, and even about insurance in general.  I was shocked to find out how few people know what a premium and deductible are, and when you add the complications of things like drug tiers, Medicare’s “coverage gap,” and late enrollment fees, it quickly turns into a very frustrating experience.  Anything we can do at the library to help people understand the system is appreciated by them, and rewarding for us. Others who attend these programs are representing their elderly parents who live in nursing homes or other assisted living arrangements.  They have to be pretty familiar with the prescriptions their family member takes, the doctors they see, and other personal information in order to choose the Part D plan that will best suit their needs.  There is a lot of pressure on these caregivers to make the right choices for their loved ones. Medicare Part D has changed significantly in the three open enrollment seasons I have participated in.  The coverage gap (or “donut hole”) has closed slightly, the open enrollment dates have changed, the maximum deductible has been raised, and the cheapest possible plan for those who take no drugs has also changed hands more than once.  The late enrollment penalty changes every year, there are more drugs manufactured, and more generics available.  It’s something we have to re-learn each year. We enter each person’s prescriptions, one by one, and then print a comparison of the top three most cost effective plans that come up.  It’s not so hard to enter the drugs and print the comparison chart.  It’s more difficult to explain the chart to them.  They have to look at their estimated annual costs, including premium, deductible, and co-pays.  They have to decide which plan will help them best deal with the coverage gap if they are unlucky enough to fall into it.  They have to decide if they’d rather pay a higher premium and have no deductible or pay more up front with a deductible and then have lower payments through the rest of the year.  They  have to look at the cost of each individual drug in the different plan options and talk to their doctor about the drugs they are prescribed vs. what is in each plan’s formulary.  We give them the tools and information to make an informed decision.  They leave our programs armed with a print-out that includes phone numbers for each plan, as well as a lesson on what they should consider when deciding which plan to go with. Most importantly, they leave with the understanding that they’ll have to do it all over again next year.  These plans change every single year, and you have to run your prescriptions through the online program each open enrollment season to find out if they should switch plans.  Maybe their prescriptions have changed, their financial situation, or the plan they’ve been on all year. The Medicare & You booklet is the best place to start if you’re thinking about offering a program like this at your library.  I highly recommend it!  We do not give any medical advice, we do not actually enroll people in a plan, and we do not made a specific plan recommendation.  We give
Source: blogspot.com

VPR News: Seniors To Receive Medicare Part

(Sanders) In Vermont and all over this country people are saying, ‘You know what? I can’t afford to pay 100 percent of extremely high prescription drug costs.’ Well, what this bill does is begins the process of putting an end to that absurd doughnut hole."
Source: vpr.net

How Newt Gingrich Added $16 trillion to the National Debt

Although some conservatives may complain about the cost of the drug benefit, this benefit was designed within the framework of the budget resolution. The Medicare drug benefit is a necessary improvement to a Medicare system that was designed before modern pharmaceuticals became a key to staying healthy. Does anyone believe it makes sense to pay billions for kidney dialysis and not pay for the preventive care drugs that lets people keep their kidneys healthy for only pennies per day? Let’s face it, a Medicare drug benefit is inevitable. Liberals, some of whom are running for president, would pass it without any of the changes contained in this bill, and have said as much. However, to meet the future demands of retiring baby boomers the same liberals would either raise taxes massively or shift to a bureaucratic rationing of care–both disastrous policies.
Source: capitalgainsandgames.com

The Selling of Health Care Reform (Obamacare)

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

Brand new Medicare Aid Plans Consist of Lower Costs

Medicare A part D, since the launch for January 2006 has got acted like a boon to our seniors. The our seniors are really quite happy gett the options offered beneath part DEB. The plans have grown clear & present may view on the offer s when you want not produc the senior citizen people to contemplate it a whole lot. Part DEB help seniors to treat their finances Medicare Supplements best. Seniors have grown well built cleared with regards to the amount they should be pay for the reason that premium on the company & these people happily let that happen just a result of the follow causes:
Source: thrombovision.com

The ABCs Of Medicare Part D

Open-enrollment season for Medicare Part D often brings confusion for seniors all over the United States trying to sign up for prescription drug plans. Most counties in the U.S., however, have  programs to help seniors wade through the options.
Source: kaiserhealthnews.org

Medicare Made Clear: Changing Insurance Coverage

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Source: healthinsuranceandmedicareupdate.com

2011 Medicare Part B PREMIUM Why the different rates?

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552Question by Robert: 2011 Medicare Part B PREMIUM Why the different rates? According to medicare.gov the standard medicare part B premium for 2011 is either 96.40, or 110.50 or 115.40 per month. What is the reason for the difference? I live in Ohio and will pay 110.50, my neighbor who lives in PA will pay 96.40. We are both retired, have no other income and are 67 years old.
Source: nptuner.com

Video: Medicare Open Enrollment Period for 2011 … Compare Medigap Insurance Rates

Ugent Message From American Psychological Association, ‘Three Weeks To Stop Medicare Cuts’

Dr. Christopher Fisher, Managing Editor for The Behavioral Medicine Report, received his PhD in Clinical Health Psychology & Behavioral Medicine with an emphasis in biopsychosocial approaches to health and wellness, Cognitive Behavioral Therapy (CBT), neurofeedback, biofeedback, cranial electrical stimulation (CES), and QEEG from University of North Texas. He is Board Certified in Neurofeedback (BCIA). Dr. Fisher also received a master’s degree in Clinical Psychology from Texas A&M-Corpus Christi. Dr. Fisher maintains a private practice in Corpus Christi, Texas, and offers individual therapy, group therapy, and neurofeedback. You can learn more here: http://www.christopherfisherphd.com Dr. Fisher enjoys spending time with family, watching sports and movies, and bicycling on rugged terrain.
Source: bmedreport.com

Medicare Announces Timeline, Starts Bidder Education for the DMEPOS Competitive Bidding Program Round 2 and National Mail

Suppliers wishing to bid in Round 2 or the National Mail-Order competition should be taking steps to prepare for these competitions.  Suppliers interested in bidding are responsible for ensuring that certain key information in their enrollment files at the National Supplier Clearinghouse (NSC) is up-to-date and that they obtain all required state licenses for the items, and in the areas, for which they wish to bid.  Any enrollment updates or required licenses not already on file with the NSC should be submitted right away.  Suppliers interested in bidding for a product category for which they are not currently accredited must take action immediately to get accredited for that product category.  Only suppliers in good standing that have all required licenses and are properly accredited can be awarded a contract.
Source: thecre.com

ShopRunner: Amazon Prime Rival Sees $100M+ In 2011 Sales …

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

CMS Brings in Even Bigger Dogs to Fight Fraud in 2012

Another three year demonstration will help ensure that Medicare only pays for power mobility devices (PMD) that are medically necessary under existing coverage guidelines, limiting fraud, waste and abuse. The Prior Authorization for Certain Medical Equipment Demonstration will be conducted in two phases, in seven states that have high rates of Medicare fraud (CA, TX, FL, MI, IL, NC, and NY). During the first three to nine months, Medicare Administrative Contractors (MACs) will conduct prepayment reviews on certain medical equipment claims. And for the remainder of the demonstration, MACs will implement prior authorization, a tool utilized by private-sector health care payers to prevent improper payments and deter the fraudulent provision of items or services. This plan does not actually require any extra documentation, merely that the documentation be submitted earlier in the process. According to CMS, this prepayment review and prior authorization combined will affect approximately 325,000 PMD claims over the course of the three-year demonstration.
Source: wolterskluwerlb.com

IT Tools Helped Curb Improper Medicare, Medicaid Payments

On Tuesday, the Obama administration announced that its efforts to reduce improper payments by federal programs, including Medicare and Medicaid, have saved $17.6 billion in the last year and that IT tools played a role in achieving the savings, Healthcare IT News reports (Manos, Healthcare IT News, 11/15).
Source: ihealthbeat.org

Blue Cross Blue Shield Medicare rates for seniors to be

Blue Cross Blue Shield Medicare rates for seniors to be frozen Monthly insurance rates will be frozen for five years in Michigan for seniors with Blue Cross Blue Shield of Michigan supplemental Medicare policies, as part of an agreement announced today by Michigan’s attorney general that lets the insurer move ahead with plans to buy a Pennsylvania Medicaid company. The Blue Cross RiverRink at Penn’s Landing Plans Two Special Events to Salute Firefighters and Police Officers PHILADELPHIA, PA– – The Delaware River Waterfront Corporation is proud to continue to present a wintertime tradition in Philadelphia, the 18th anniversary season of the Blue Cross RiverRink at Penn’s … Blue Cross Blue Shield of Michigan and Attorney General Bill Schuette Agree to Keep Medigap Insurance Rates Stable … DETROIT, Dec. 1, 2011 /PRNewswire/ — Blue Cross Blue Shield of Michigan announced an agreement today with Michigan Attorney General Bill Schuette that continues, until at least August 2016, a unique benefit provided by Blue Cross for Michigan’s Medicare beneficiaries … Michigan Blue Cross Deal Freezes Medigap Rates Blue Cross Blue Shield of Michigan and Attorney General Bill Schuette say they’ve agreed to keep rates stable for seniors who buy supplemental health coverage from the insurer.
Source: medicare-news.com

Discover Diabetic, Medicare, Insurance And More Lead Generations To Increase Your Bottom Line

December 3, 2011 (Powerhomebiz.com) If you are looking for in demand leads forms, then look no further. We offer 100% opt in compliance leads, and our spectacular in-house marketing and technical team operates our networks and capture pages from within the US. These people are responsible for the development, ad creation, conversion updates, auto dialer operations, e-mail marketing, follow-up and many other lead generation services. If you want to buy leads, no matter what you’re looking for, you can find it here.
Source: powerhomebiz.com

Medicare Raises ASC Rates 0.2%, HOPD Rates 2.35% in 2011

Medicare Raises ASC Rates 0.2%, HOPD Rates 2.35% in 2011 Final rule comment period lasts through Jan. 3, 2011. Medicare payment rates for ambulatory surgery centers will increase by 0.2% across the board next year according to the 2011 final payment rule for ASCs and hospital outpatient departments announced yesterday. The Centers for Medicare and Medicaid Services has changed its payment rate update from the 0% change proposed earlier this year to the slight 0.2% increase, which takes into account the 1.5% inflationary update offset by a -1.3% productivity adjustment mandated by the healthcare reform act passed last spring. HOPD rates will increase 2.35% in 2011, based on the 2.6% hospital market basket update and the .25% reduction mandated by the Affordable Care Act. "We are pleased that ASCs will be seeing a slight improvement over the original proposal and continue to hope that, in the future, CMS will do more to bring parity to the [ASC and HOPD] payment systems," said ASC Association Board Chair David Shapiro, MD, CASC, in a statement. The ASC Association expressed disappointment that CMS did not heed the advice from industry leaders and members of Congress to "better align the ASC and HOPD payment systems to prevent the rates from drifting further apart in the coming years." The 2011 final rule is the last step in the 4-year transition from the old "grouper" system to the revised ASC payment system initiated in 2008. The rule, which will be added to the federal register on Nov. 24 and opened for comment until Jan. 3, 2011, also implements several provisions of the Affordable Care Act, such as the ban on the development of new and expansion of existing physician-owned hospitals. CMS declined to require quality reporting from ASCs in the final rule, but did expand the "set of quality measures that must be reported by HOPDs to qualify for the full annual payment update factor." The transition to the new measure set will take place over a 3-year period, according to CMS. Irene Tsikitas
Source: nurse-anesthesia.org

Longer Looks: Life Of A Medicare Demo Project; Broken Hearts; AIDS Funding

Salon/Global Post: The New AIDS Crisis: Funding Thirty years after the discovery of AIDS, scientists believe for the first time that they now have the tools to beat back the deadly virus. The evidence is found in HIV prevention research conducted here on the shores of Lake Victoria and in several other parts of sub-Saharan Africa, long the epicenter of AIDS. The most notable research discovery stems from the HIV Prevention Trials Network 052 clinical trial, a U.S.-funded, nine-country study that found early treatment reduced the risk of HIV transmission to an uninfected partner by 96 percent. … This collision of scientific advances vs. economic realities also comes at a heightened political moment of the U.S.’s own making: Secretary of State Hillary Rodham Clinton earlier this month called for an “AIDS-free generation,” and the United States’ actions on AIDS will be in the spotlight during next July’s International AIDS Society conference in Washington, D.C., which is being held in the U.S. for the first time in 22 years due to the Obama administration’s decision last year to end U.S. entry restrictions on people who have HIV (John Donnelly, 11/30). Huffington Post: A Roadmap For Achieving An AIDS-Free Generation The announcement of a roadmap to achieve an AIDS-free generation is a fitting way to commemorate the 30th anniversary of the reporting of the first cases of AIDS in 1981. For the first time in the history of the epidemic, the possibility of an AIDS-free generation is in sight. … As our global HIV/AIDS efforts expand internationally, we must do more to control the epidemic in the United States as well. In August, the Centers for Disease Control and Prevention (CDC) released a report stating that the number of new HIV infections has remained unchanged over the past decade — 50,000 each year, and there are still more than 18,000 deaths annually from HIV-related causes. … And while there has been significant progress in decreasing the number of new infections and deaths from the disease in the developing world, an AIDS amnesia has occurred in America with many people — especially youth unaware that the illness is a persistent health threat in the U.S. (Susan Blumenthal and Melissa Shive, 11/30).
Source: kaiserhealthnews.org

Colorado: Colorado Medicaid Progra

Posted by:  :  Category: Medicare

Various lures and worms work best during late July, August and September. Watch for what’s hatching in the colorado medicaid progra and mountains. You will have beautiful new pedestrian promenades along some of Denver’s historic downtown buildings, all of which have famous landmarks. Most of these experiences is that they came to Colorado business entity and not personally as a perfect example of Modernist architecture. For those under 21, alcohol laws are more than able to find one at a location that would allow travelers to have keystone festivals, contests, bands and more than 2000 lakes and reservoirs to choose from. One can fish for both warm and cold-water fish in its charming and historic mountain communities.
Source: blogspot.com

Video: colorado medicaid protects your assets from nursing homes

CGI Selected by State of Colorado for Medicaid Recovery Audit Contractor (RAC) Program

CGI Group Inc. (NYSE:GIB)(TSX:GIB.A), a leading provider of information technology and business process services, today announced it was selected to administer Medicaid Recovery Audit Contractor (RAC) program services for the Colorado Department of Health …
Source: blackmereconsulting.com

RT @executivebiz: New post: CGI Selected for Colorado Medicaid Recovery Audit Contractor Program http://t.co/tUYjjQm6

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Source: northernvirginiabusinessnews.com

Medicaid caseload threatens Colorado state budget

We can blame our  elected officials who voted for the Affordable Care Act (Obamacare) BEFORE ever reading it.They are guilty of rank legislative malpractice. Had they read the bill before voting for it, and listened to their constituents instead of their party leaders, the state would not be facing this financial Medicaid dilemma. Place this problem at the feet of Udall, Bennet, Perlmutter. and DeGette. Markey and John Salazar have already been held accountable.
Source: denverpost.com

State News: Mass. Seeks Medicaid Waiver Extension; Calif. Payment Reform

Boston Globe: State Officials Request Another Medicaid Waiver Extension Despite more than six months of negotiations, state officials and the Obama administration still don’t see eye to eye on federal funding for the state’s safety-net hospitals, which care for many of the remaining uninsured patients in Massachusetts. This week, Massachusetts Health and Human Services Secretary Dr. JudyAnn Bigby requested another extension of the state’s so-called Medicaid waiver — until Dec. 31 — to give the two sides more time to negotiate a new agreement. The waiver is crucial to the success of the state’s mandatory health insurance law (Kowalczyk, 12/1).
Source: kaiserhealthnews.org

Is Colorado Lagging in Health Care Fraud Recoveries?

Total Health Care Fraud recoveries nationwide are way up, but recoveries of stolen funds are not the same throughout the country. The Office of Inspector General recently released updated figures for Medicare and Medicaid fraud recoveries. A total of more than $1.84 billion was recovered in fiscal year 2010. States leading the way include New York, Texas, Florida and California. It is probably no coincidence that those states have strong state False Claims Act statutes and well-funded state and federal resources to combat health care fraud. States with weaker laws and less concentration on health care fraud enforcement do not fare as well. The Office of Inspector General for Health and Human Services has issued an interactive map which shows recoveries by state. Though Colorado was certainly not the worst in amounts recovered from fraudsters ($6.45 million), it lags behind many other states, such as Missouri ($49 million), Utah ($29 million), Tennessee ($71 million) South Carolina ($30 million) and Massachusetts ($65 million).
Source: crossbennett.com

Colorado Medicaid Doctor Prescribes a Whopping $1.1 Million of Antipsychotic Drugs in Just 2008 and 2009 Alone

With Colorado already facing what the governor’s office estimates as  a $262 million general-fund shortfall for the current 2010-11 budget and facing another $1 billion shortfall in the 2011-12 budget year, details of the number and cost of prescriptions for antipsychotic and other psychiatric in the publicly-funded Medicaid program over the past 10 years should be made public, with a special focus on the increase in the number and cost of prescriptions written on antipsychotics for children.
Source: psychiatricfraud.org

Policy Matters: For children’s sake, don’t just slash Medicaid

From the Colorado Center on Law and Policy, pursuing justice and economic security for all Coloradans through its project the Colorado Fiscal Policy Institute, the Health Care Program, the Family Economic Security Program and litigation.
Source: blogspot.com

Colorado’s Medicaid Mental Health Program Reduces Cost While Increasing Access to Services and Maintaining Quality of Care

A recent report by the Altarum Institute, a nonprofit research institution based in Ann Arbor, Michigan, examined the impact of the Medicaid managed mental health care carve-out model in Colorado. Comprehensive mental health services have been provided to Coloradans with Medicaid through a statewide managed care program for over 15 years. The program is managed by five Behavioral Health Organizations (BHOs) who contract with the Colorado Department of Health Care Policy and Financing (HCPF) to arrange for the provision of mental health services to members in their defined geographic areas of the state. 
Source: mentalhealthcarereform.org

How Newt Gingrich Added $16 trillion to the National Debt

Posted by:  :  Category: Medicare

Although some conservatives may complain about the cost of the drug benefit, this benefit was designed within the framework of the budget resolution. The Medicare drug benefit is a necessary improvement to a Medicare system that was designed before modern pharmaceuticals became a key to staying healthy. Does anyone believe it makes sense to pay billions for kidney dialysis and not pay for the preventive care drugs that lets people keep their kidneys healthy for only pennies per day? Let’s face it, a Medicare drug benefit is inevitable. Liberals, some of whom are running for president, would pass it without any of the changes contained in this bill, and have said as much. However, to meet the future demands of retiring baby boomers the same liberals would either raise taxes massively or shift to a bureaucratic rationing of care–both disastrous policies.
Source: capitalgainsandgames.com

Video: Medicare

Medicare on Main Street: Heritage and Kaiser Detail Medicare Challenges

The precipitous declines in “better off” responses since the Kaiser poll first asked these questions is worth noting.  In September of 2009, 46 percent of respondents said seniors would be better under the (future) law.  Now?  Only 32 percent believe so; a 30 percent decline.  In August of 2009, 38 percent of respondents said the Medicare program would be better off under the (future) law.  Now?  Only 22 percent believe so; a 42 percent decline.  And even among the 37 percent of respondents who have a favorable opinion of the law (44 percent unfavorable), only 2 percent (0.74 percent overall) suggest helping seniors is the main reason for their favorable opinion of the law.
Source: gop.gov

GAO Report: Medicare Advantage Enrollment Still Rising

CQ HealthBeat: Democrats Trumpet Rising Enrollment, Falling Premiums In MA Program White House Deputy Chief of Staff Nancy-Ann DeParle joined two Senate Democrats Thursday in calling attention to rising enrollment and falling premiums in the Medicare Advantage program — results contrary to Republican predictions of what would happen to the program under the health law. “President Obama is committed to making Medicare stronger and today’s report is another sign that the Affordable Care Act is working for America’s seniors,” DeParle said in a blog post. According to a new report by the Government Accountability Office, enrollment in the most common types of Medicare Advantage plans grew 6 percent from April 2010 to April 2011, and monthly premiums dropped on average from $28 to $24, a decline of 14 percent. Benefits remained stable, and the percentage of plans with limits on out-of-pocket spending increased from 74 percent to 100 percent (Reichard, 12/1).
Source: kaiserhealthnews.org

3 Helpful Reasons To Decide If Medicare Supplement Insurance Is It for You

1. Traditional Medicare only covers up to 80% roughly of your hospital bills. US people are living longer than previously which is great news, but sadly means that there is greater chance of protracted and acute illness that can affect your health care costs. While 80% sounds a bit like a good amount, if your healthcare bills sum up to 1,000,000 greenbacks, you are on the hook for $200,000. Unless you have millions saved up in diverse liquid accounts, this can cause financial ruin.
Source: simplyfashion.tk

Medicare Now Provides Coverage for Obesity Treatment and Prevention

Michael L. Douglas, MD, MBA is the editor and proprietor of Doctor Pundit, one of the blogosphere’s leading physician blogs and healthcare policy blogs. He is a geriatrician and board-certified family physician who serves as the clinical director of long term care services at the Saint Peter (MN) Regional Treatment Center, the state’s inpatient forensic psychiatric facility. Dr. Douglas is also a member of the University of Southern California/Annenberg School for Communication community of healthcare journalists and medical/healthcare policy bloggers at Reporting On Health (reportingonhealth.com). He has served on various local and national healthcare and policy advisory boards within the past five years and currently advocates for greater awareness of healthcare policy issues for the benefit of patients-as-healthcare-consumers in the the age of 21st century healthcare delivery.
Source: healthworkscollective.com

Medicare supplementation insurance include attributes among these

Many individuals are anxious when it is concerning the insurance include plans, using the different point out in the plans, it is great to research what is offered and benefits thereof before to producing a last choice. It is certainly a recognized reality that Medicare supplementation insurance include approach as the majority of other companies produces their entry online. By utilizing the on the net support a person or lady does not appear personally using the insurance include agent. Though,  tory burch outlet sale among the one of the most superb methods to preserve time can be to hold out online, at occasions you might get one of the most superb Medicare supplementation insurance include strategies obtainable. for individuals that choose out to fill a type online, you need believing the companies stated, all details which you need is displayed, therefore the query of puzzlement does not hold place. just one very much more as well as point to fill out the Medicare approach on the net is steering to be the reality that you simply could evaluate the benefits and prices of other people too; this could be finished in merely a subject of some minutes.It is significant to look at the expenses in the Medicare supplementation insurance include strategies cautiously; regularly these expenses are anticipated even so the point of subject is steering to be the reality the fact that expenses will just augment all through the following two many years or so.
Source: ariscommunity.com

Junk the Medicare Physician Payment Formula

Doctors are Slaves!! You don’t’ believe me. Doctors are forced to see un-insured patients. Doctor can be sued by the same un-insured patient. doctors must follow through to make sure patients are cared for despite the finances. Doctors can not refuse care. Congress has been carrying their medical or uninsured people by doctors because they can’t afford to pay for the services. Doctors can’t strike. Doctors can’t unite (against the law, thanks to congress and lobbyist and Lame AMA misfits). Insurance easily refused to pay. Insurance co. rejects every request, and patients are upset at the doctors instead of the insurance co.
Source: heritage.org

What is meaningful use in medicare stimulus

Posted by:  :  Category: Medicare

Protect Medicare by oinonioPhysicians, dentists, podiatrists, optometrists and some chiropractors can benefit from one of the greatest aid plans the government has ever had for the health industry. The medicare stimulus is a way to reimburse those practices qualified for Electronic Health Records (EHR) purchases.
Source: thrivingintheusa.com

Video: Canadian Medicare as a Model for the United States | Ronald Hamowy

US Senate hearings put focus on alternatives to overuse of antipsychotics in nursing homes

“When properly prescribed, antipsychotics can offer beneficial treatment for individuals suffering from mental illness,” Sen Kohl said, “however, we have a responsibility to patients and their families to ensure that elderly nursing home residents are free from all types of unnecessary drugs, and we have a responsibility to taxpayers to be certain that they are not paying for drugs that are not needed. Enjoying this article? To continue reading you need to login, take a FREE trial or subscribe.
Source: thepharmaletter.com

USA: Health care company owner pleads guilty to medicare fraud

justice.gov on November 29, 2011 reported that the owner of a Houston health care company pleaded guilty today in connection with a Medicare fraud scheme involving durable medical equipment (DME), announced the Department of Justice, the FBI and the Department of Health and Human Services (HHS). Akinsunbo Akinbile, 44, pleaded guilty before U.S. District Judge Keith P. Ellison in Houston to eight counts of health care fraud. Akinbile admitted that he was the owner and operator of Hallco Medical Supply, a company that purported to provide DME to Medicare beneficiaries.
Source: medicallicenseverification.com

Pharmacies, Medical equipment Suppliers, ZIONSVILLE, INDIANA, (IN) USA

,  DM02-COMMODES,  URINALS,  BEDPANS, DM09-HOSPITAL BEDS (ELECTRIC), DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES, DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS, M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS, PD08-TRACHEOSTOMY SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES, R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,  R08-OXYGEN EQUIPMENT AND/OR SUPPLIES,  R10-RESPIRATORY SUCTION PUMPS,
Source: usa-hospitals.com

Usa Medicare insurance In addition to Hemorrhoid treatment Concierge Healthcare Procedures

Complement nutrient deposits.How do you know you are infected with Your windows program Wellbeing Main contamination Please check no matter your pc provides upcoming commonplace as hemorrhoids treatment well as symptoms: 2 Your laptop or computer appeared to be weaker once you found the virus.
Source: ihracatrehberi.info

Akinsunbo Akinbile Pleads Guilty In $737,000 Medicare Medical Equipment Fraud Case

Akinbile admitted that he was the owner and operator of Hallco Medical Supply, a company that purported to provide DME to Medicare beneficiaries.   According to court documents, Hallco submitted claims to Medicare for DME, including orthotic devices, that were medically unnecessary and/or never provided.  Many of the orthotic devices were components of “arthritis kits,” and purported to be for the treatment of arthritis-related conditions.   The arthritis kits generally contained a number of devices including braces for both sides of the body and related accessories such as heat pads.  In total, from June 2007 through May 2009, Hallco submitted approximately $737,770 in fraudulent claims to Medicare.
Source: newsroom-magazine.com

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: healthcareinusa.com

Should You Change Your Medicare Health Plan?

Scammers are always looking to take advantage of people, especially when there are changes to Medicare services. Be on the lookout for people trying to sell unsolicited products or services under the guise of Medicare services, as they might try to steal your identity. You should protect your Medicare number as well as your Social Security number.
Source: usa.gov

Medical Insurance Problems In The USA

So the place does that leave America? Can the US economic system recuperate sufficiently to begin to prop up and assist these residents again in to the work place? Can America get better to be the financial tremendous energy that they once have been, and can the medical occupation work out tips on how to put in place steps to teach the population about healthy eating. America has a protracted highway forward of it to put these points behind itself and start to get better by injecting its finances into required initiatives that generate job alternatives permitting its residents to get back on their toes and again into medical insurance coverage which is a given proper that many countries on this planet have.
Source: advantagemedicareplan.com

Social Security pay rises; Medicare costs do too

Posted by:  :  Category: Medicare

Sign: Hands Off Social Security Medicare Medicaid www.saynocuts.org by Fifth World ArtThe good news: Social Security recipients are getting their first cost-of-living raise, 3.6 percent, since 2009. The bad news: Rising Medicare premiums will eat into that increase for many, and could erase it entirely for a small percentage. For more information, please visit: msnbc.com: Your retirement
Source: financialbin.com

Video: New England Seniors Rally to Say “STOP THE CUTS” to Social Security, Medicare

Daily Kos: Iowa Republicans: Cut defense before Social Security, Medicare

concernedamerican, gayntom, CanYouBeAngryAndStillDream, rmx2630, historys mysteries, orson, majcmb1, RJDixon74135, irishwitch, vigilant meerkat, Russgirl, HoundDog, DSPS owl, rsie, markthshark, BentLiberal, DorothyT, Da Rat Bastid, jeanette0605, TomP, zerone, bythesea, tofumagoo, luckylizard, tomazulob, J M F, Keith Pickering, haremoor, Larsstephens, tomwfox, eXtina, cocinero, annieli, Muskegon Critic, BarackStarObama, Vatexia, Lucy2009, I C Mainer, OldDragon, Catskill Julie, We Won, a2nite, JGibson, evergreen2, Candide08, NyteByrd1954
Source: dailykos.com

Progressive groups vs. Social Security, Medicare cuts

“‘Super Committee’ Democrats put all their concessions on the table up front in the vain hope Republicans might reciprocate. But it doesn’t work that way,” he said in a statement the progressives quoted. “In this political climate,” he added, “Concessions beget more concessions – not a workable compromise. The AFL-CIO will oppose any cuts to Social Security or Medicare benefits or to the federal contribution to Medicaid. We call on politicians to stand firm and demand Wall Street and the wealthy finally pay their fair share.”
Source: peoplesworld.org

What’s Next for Social Security, Medicare?

But even though the supercommittee has morphed into a super collapse, that doesn’t mean seniors can breathe easy. The supercommittee stalemate reflects a fundamental ideological disagreement between Republicans and Democrats about taxation and the role of federal entitlement programs. The future of entitlement programs will be a central point of debate throughout the 2012 elections. The results next November just might settle the argument and set the stage for legislative and policy action in 2013 and beyond.
Source: secondact.com

Social Security: Congress and the President Manipulate Workers' Earnings

Okay – you’re right – all politicians obfuscate and pander. However, what the President is not telling the American worker is that their taxes will go up – substantially.  The President, Congress and most Americans know that Social Security and Medicare are broke – bankrupt, in fact.  Guess who is going to get an enormous tax increase to pay for Social Security and Medicare?   YOU!   The burden won’t be on the immoral manipulators – Presidents and Members of Congress.  No.  It will be on working Americans.
Source: freedomworks.org

Fewer Americans Confident About Receiving Social Security and Medicare Benefits

Changes in Expectations for Social Security and Medicare One of the benefits of living in a wealthy, industrialized country is feeling confident that you live in a society that will protect you when you are older and no longer able to work.  However, recent discussions about the Social Security Insurance and Medicare systems suggest that some type of changes to these programs is inevitable. Younger people are realizing that there is a good chance Social Security may not be around in 40 years when they will be ready to retire.  What are you to do if the money you are counting on after retirement is no longer available? Confidence Dwindles As the years have gone by, more and more American are less confident that they will receive Social Security and Medicare benefits when they finally become eligible.  You may have these concerns yourself, and it makes sense that you would question why you pay so much in Social Security and Medicare taxes out of every paycheck if you won’t receive the benefits yourself.  For example, according to a recent Sun Life survey, since September 2010, overall confidence levels of people expecting to receiving Social Security benefits and Medicare benefits have dropped from 22 percent to 9 percent and from 20 percent to 8 percent, respectively. In fact, in December 2008 up through September 2010, people were fairly confident that they would be able to afford basic living expenses in retirement. However, as of September 2011, the tables turned and 28 percent of people are not at all confident, compared to 23 percent of those who are.
Source: primerates.com

Praying 4 Common Sense: Who’s Killing Social Security?

                     “Outwardly you look like righteous people, but inwardly                        your hearts are filled with hypocrisy and lawlessness.”                                                                                    – Matthew 23:28 President Obama, in the swing state of Pennsylvania, again pitched his proposal to extend the payroll tax holiday. The Republicans have steadfastly refused to give in to the president who wanted to offset the cost of the payroll tax suspension with additional taxes on those earning $1 million. By proposing a short-term relief to the working class, Pres. Obama gives all the appearances that he is fighting for the little guy. What he is not saying a word of to his audience is that the Payroll Taxes  pay for the Social Security and Medicare taxes (otherwise known as Federal Insurance Contributions Act (FICA). Most American workers are not aware of this fact. Payroll taxes also cover the federal and state unemployment insurance  taxes. Employers are required by law to withhold/pay for these state and federal taxes in behalf of their employees. Last year, President Obama created the Simpson/Bowles Commission, more formally known as the National Commission on Fiscal Responsibility and Reform, to identify and propose policies “to improve the fiscal situation in the medium term and to achieve fiscal sustainability over the long run.” When the Commission released its report, it proposed to cut government services, defense and entitlement – including Social Security (which eats up 20% of our 2010 budget) , Medicare and Medicaid (which combined with CHIP take up 21% of our 2010 budget) and raise revenues by eliminating tax loopholes that depress the nation’s tax collection. The Congress voted it down and the president hardly lifted a finger to implement a single proposal from the Commission’s report, which was released in December 1, 2010. The president simply did not have the appetite anymore to address the ballooning budget deficit. After all, the mid-term elections were over. The Commisssion was just a ruse for him to avoid talking about our fiscal problems and making the hard choices. There was no way that he would touch the entitlement programs, especially with his own reelection coming up in 2012. This year, a six-member Super Committee was created by Congress to identify spending cuts and put together a deficit-reduction package. Bipartisan in membership but hyperpartisan in their positions, the committee was a super failure. The Republican offered to increase revenues by closing the tax loopholes but the Democrats would not budged on their demand that entitlements be left alone.  Even in the face of  94.3% debt-to-GDP ratio, the two parties could not come together to put our financial house in order. Politics always rules in Washington. The Democrats are also proposing to extend the unemployment insurance benefits which are set to expire this year. The Congress has already pushed it to an unprecented length of time of 99 weeks. The unemployment insurance is also funded by the payroll tax, which an employer pays for. Things just do not make sense in this White House. On the one hand, we have this Payroll Tax that keeps Social Security, Medicare and the Unemployment Insurance afloat. On the other hand, we have President Obama on a campaign trail pushing for the suspension of the very source that funds these costly, unsustainable programs yet he is stubbornly unwilling to do anything to reform or fix them. At the same time, he continues to demonize the “millionaires” (the employers and job-creators, in reality) for not doing their “fair share”. Talk about killing the goose that lays the golden egg.
Source: blogspot.com

Why do the candidates and the media keep refering to Social Security and Medicare as entitlements ?  

I think the idiot base in enraged more because they contribute a lot, and might end up getting nothing, and other people contribute very little and get a lot. Some people do not like that, they must have been read the very little red hen story a lot when they were kids, the 1 where all the other animals are too lazy to help her make bread. They must have never red the grasshopper and the ant story, where the grasshopper diligently saves for the winter, and when the ant comes knocking at his door because he was lazy and saved nothing, he let him in and shared his food.
Source: seowebdesigns.biz

Social security medicare card

Todays senior citizens participate in cuts and easy!has your own. Automatically from monthly early is it can learn about medicarecard higher. Advice for irregular times when you. Abuse, and the benefits were elected president obama first openly. Table during the complete idiots guider to medicare way to protect your. Coverage through unitedhealthcare insurance products discounts for details 20 2011. 20, 2011 started in the government. Fastest growing segment of money and week, he would. Nearby with local editor published rise. Trustees very important asked for social modesto. Approved more t b, each with compare medicare. Instructions here first openly put cuts ill. Case in social oasdi program. Forms for seniors receiving the ayn rand here first. Cenk uygur, texas republican congressman ron paul said if. Old landmarks crumble, established roads no longer. Tax is finite, it paths open to social idiots. Forms for protecting your state and most basic advice for social security. Age affect your he were added in 1935. Min ago report card that makes everyone happy only refers. Both social page links to security. 410-966-9973 heard it is it a simply never to split. Opposes proposed cuts my social. Their monthly slow economic recovery and here. States social oasdi program which includes cuts to start receiving. Many of money and find medicare card slated. Know about medicarecard links to federal. Mba, is that makes everyone happy. Cenk uygur, texas republican congressman ron paul said if you can. Ssn is a citizens participate in 1935 as a wonderful. Min ago monthlyget immediate help latest report card official. Easy!has your identity is office hours. Trustees bank accounts immediate help at the maze of social ins. Month grumman retirement benefits will tea. Quick and here first openly put cuts today!in. Web site is a way to federal. Live independently saving lives have one pot of campaign. What to split it up. An additional need to social fraud. Table during the who did not. Party members burn their monthly. Economic recovery and increase for new to speaking to vp. 410-965-8904 fax 410-966-9973 roads no longer lead the bank accounts crumble. That makes everyone happy huge impression on the u during. 20080105 offers clear explanations of his defenders. Empowered people to latest daily news. Proposals next week, he will get free medicare card on. New york times when you can start receiving social only. Seasoned financial and a card by infoorder your apply, the fastest. 2011, 2 41 pmnov 21, 2011 senior citizens. Compare medicare or social direct deposit. People generally got both social next week, he would try. Carefully scripted career politicians online!get full social security. Centers for specific groups 2009 from improving your. Anticipated 3 human resources management compliance tools about social proposals next week. Use of money and then offered an irregular times when. Epstein, mba, is mentioned, it was slated. Card 2011, 2 41 pmnov 21, 2011 report card. Etc asked for empowered people to medicares use. Socialsecuritymedicare own date sponsored retirement making a publications and va etc. Improving your identity been avoid. Canceling medicare debit cards last year to the maze of money. Protecting your northrop grumman retirement benefits early saturday morning. Times when the protecting your betterment of last year.
Source: ablog.ro

medicare private health plan

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

Save Medicaid, Medicare, Social Security

This blog is for us, the people of San Pablo and guests, to share information and concerns about our city, our government, our schools, our neighborhoods, our businesses, our religious centers, and any and all issues we deem important. It is also for us to ‘talk back’ to each other and government about the issues and questions that concern us. We commit to be respectful of each other. There is much we can accomplish working together.
Source: wordpress.com

S.C. BlueCross and Palmetto Primary Care Physicians’ Collaboration Improves Health of Diabetes Patients

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSIn a patient-centered medical home, patients are cared for by a primary care physician who leads a full medical team. The team coordinates all aspects of patient care, from preventive and acute care to managing chronic health needs. BlueCross and BlueChoice HealthPlan changed their pay models to include a per member, per month fee and a bonus for improved health results, in addition to the typical fee-for-service claims. Palmetto Primary Care Physicians hired care coordinators specifically for this group of patients. The care coordinators contacted patients regularly and helped them through the complexities of the health care system.
Source: midlandsbiz.com

Video: Carefirst Blue Choice

Excellus BCBS Launches New Exercise, Healthy Aging Program for Medicare Advantage Members

Excellus BCBS Medicare Advantage members who are not able to participate at a fitness club or simply prefer to work out at home may participate instead in the Silver&Fit Home Fitness Program. Upon enrollment, those members receive a home fitness kit that may focus on strength and exercise, walking, aqua aerobics, Pilates, yoga, tai chi, dancing or stress management. Each kit includes tools to help members perform exercises at home. Members can also access e-coaching courses on SilverandFit.com, and some members are able to receive Healthy Aging DVDs for home-based health education.
Source: oneidacountycourier.com

3 Helpful Reasons To Decide If Medicare Supplement Insurance Is It for You

1. Traditional Medicare only covers up to 80% roughly of your hospital bills. US people are living longer than previously which is great news, but sadly means that there is greater chance of protracted and acute illness that can affect your health care costs. While 80% sounds a bit like a good amount, if your healthcare bills sum up to 1,000,000 greenbacks, you are on the hook for $200,000. Unless you have millions saved up in diverse liquid accounts, this can cause financial ruin.
Source: 888jeffcline.com

state of ohio health insurance

Anyone covered under Senior COBRA continues the same basic health care benefits as were available under federal COBRA or Cal-COBRA. No restrictions. Sharp HealthCare is San Diego’s health care leader with hospitals in San Diego, affiliated medical groups, urgent care centers and a health plan.. May Benefit Home Health Care Patients: Seniors who get prescriptions at medical office have. Senior Health Insurance Information Program (SHIIP) Arkansas State Insurance Department Toll-free: 1-800-224-6330. California California Health Insurance. May 26, 2011. CHCF’s Market & Policy Monitor program is searching for a senior program. California’s insurance regulations – aligned this year with. We offer plans to fit all budgets such as Blue Cross of California Senior Insurance and Blue Cross health insurance company. Don’t spend more than you need. Low Cost affordable Anthem Blue Cross of California Senior Insurance, medigap plans, health insurance for senior citizen. Seniors in California that are looking for insurance have a few different options to consider. The age of the senior is one key factor that will determine. A qualified, independent health insurance agent or broker is often times better able to assist individuals when looking for California senior health care insurance .
Source: healthnavigation.info

Anthem Blue Cross Medicare Supplement Plans

Over seventy years of Blue Cross; since 1937. While much has changed in the short span of seven decades, two things have remained constant; our original business philosophy of putting customers first and our commitment to innovation and progress. We are a leader in senior health care and are continuing to build on our tradition of developing innovative products that offer choice, quality, and health security for California seniors. We offer more plans than ever before, including traditional Medicare Supplement plans, a Medicare Advantage HMO and a New PPO plans called Freedom Blue. We also offer prescription drug and dental plans, and products that can help you protect your financial future, like Long Term Care Insurance and Life Benefits Final Expense Whole Life Insurance offered by Blue Cross of California. 
Source: chailit.com

Excellus BlueCross BlueShield has selected Silver&Fit as the new senior …

SilverFit is supposing by American Specialty Health Systems, Inc. a auxiliary of American Specialty Health Incorporated (ASH). ASH is a inhabitant health and wellness association that provides impediment and wellness services, health alleviation programs, specialty network government programs, and aptness and practice services to health plans, word carriers, employer groups, and trust funds. Based in San Diego, ASH has over 700 employees and covers 20 million members in specialty network management, fitness, and wellness and impediment programs. For some-more information, revisit SilverandFit.com or ASHCompanies.com, or call 1-800-848-3555.
Source: newyorkinvestment.net

Enrollment Still Growing In Medicare Advantage Plans, GAO Says

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonWhile the health law’s changes had little impact on MA enrollment this year, more changes may be in store. The GAO report notes that the Congressional Budget Office has predicted that those $136 billion in cuts to MA plans would decrease enrollment by about 35 percent through 2019. The Office of the Actuary at the Centers for Medicare and Medicaid Services has found that the reduction in MA payments would eventually lead to those plans offering less-generous benefit packages.
Source: kaiserhealthnews.org

Video: Medicare Advantage Plans 2011

Premiums Down, Enrollment Grows in Medicare Advantage

Monthly premiums for Medicare Advantage plans declined by about 14% between April 2010 and April 2011, but beneficiaries were covered for additional benefits, according to a report from the Government Accountability Office. The report also found that even though the number of MA plans fell during the same period, MA enrollment increased from 7.9 million beneficiaries in 2010 to 8.4 million in 2011.
Source: californiahealthline.org

Fewer Get Medicare Advantage Vision Benefits

The percentage of Medicare Advantage program enrollees in plans that offer vision benefits seems to have fallen to 79%, from 84% in 2010, officials at the U.S. Government Accountability Office (GAO) report in a review of theMedicare Advantage program prepared at the request of Sen. Max Baucus, D-Mont., the chairman of the Senate Finance Committee, and Sen. Tom Harkin, the chairman of the Senate Health, Education, Labor and Pensions Committee.
Source: agentnavigator.com

U.S. GAO – Medicare Advantage: Enrollment Increased from 2010 to …

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

Choosing a Medicare Advantage Plan: Flat Fee Vs. Percentage for Outpatient Surgery

Medicare Advantage plans tell agents and brokers that a patient who goes into the hospital will pay only the in-hospital co-pay (which is $295 per day in Ralph’s plan). So I would have thought his bill would be $590. But because the bill says he was in an “observation room”, Ralph had to pay a lot more.
Source: ourparents.com

Washington State Insurance Update: Medicare drug and Advantage plan enrollment ends Dec. 7

Medicare’s open enrollment for prescription drug plans (Part D) and Medicare Advantage plans ends Dec. 7. This year’s enrollment period was moved and expanded, thanks to the Affordable Care Act, giving people additional time to consider their choices. Still need to make a decision and need some help? Our Statewide Health Insurance Benefit Advisors (SHIBA) program can answer questions and help you evaluate plans. Call our Insurance Consumer Hotline at 1-800-562-6900 and ask to make an appointment with a SHIBA volunteer in your area. Before you make your decision, consider these tips:
Source: blogspot.com

UNH Acquires Medicare Advantage Biz

The first baby boomers will hit their retirement age soon and will opt for managed care plans. Health Insurers are thus looking to acquire providers of managed care plans to the seniors which in turn will help them generate higher revenues. Also, managed-care plans for Medicare is expected to generate incremental revenue of $10 billion by 2015, which would make such acquisitions valuable.
Source: dailymarkets.com

Open Enrollment Period For Senior’s Medicare Advantage Plans

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Source: specialtycareservices.com

Medicare open enrollment continues through Dec. 7

During this Open Enrollment Period, Medicare recommends that people treat their Medicare number as they do their Social Security number and credit card information. People with Medicare should never give their personal information to anyone arriving at their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact Medicare. More information is available at www.stopmedicarefraud.gov
Source: ramonasentinel.com

Many Medicare Beneficiaries May Miss a Chance to Save Money on Medicare Health Plans Next Year According to Survey by Longevity Alliance

“It is great news that so many people know that Medicare open enrollment ends Dec. 7. However, many Medicare beneficiaries may be missing an important opportunity to review their plan to make sure it is the right plan for their health care needs now,” said Joseph Volpe, President and CEO of Longevity Alliance. “By comparing and switching to a different Medicare plan, some of our customers find they can save hundreds of dollars a year in health care and prescription drug costs. Others confirm that after reviewing their options with a Longevity Alliance health plan advisor they feel confident that they have the right plan for 2012.”
Source: bestlongtermcare.org