Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe government has come with the best possible solution for this with the introduction of Medicare Insurance. This insurance covers up almost 80 percent of the total expenditures including hospitalization, purchase of medical equipment, doctors’ fees and other expenses that might be incurred in the entire treatment process. As I had mentioned, nowadays, even a very petty treatment requires quite a bit of money. Thus, even the remaining 20 percent is also becoming unaffordable for most people. Money becomes the most important criteria, and this prevents many people from availing expensive medical services. This portion is covered by the Medical Supplemental Insurance. Since payment in cash becomes impossible for many, resorting to this policy is the best option. If it were not for Medicare Supplemental Insurance, people would not have been able to dream about getting good treatments done from well known hospitals.
Source: econorthwest.info

Video: Insurance Co. ‘Misleads’ Medicare Recipients

bomberdove.com › Electronic digital Medical Payments and Appropriate Payment

Oligopsony (the market condition when handful of consumers can tremendously affect value as well as other sector factors) provides the insurers (customers) great negotiating power and inhibits medical practitioners (suppliers) from dealing with unfounded repayment tactics. To fix this matter, all 50 suggests have instituted a laws penalizing wellness insurance companies for later repayments. In past times years, express process of law have required no less than Dollar76 , 000, 000 in fees next to insurance carriers for failure to conform to timely-pay back laws and regulations, in line with the AMA. The funds in between seven largest insurance providers assuring health-related societies came to greater than $1.53 thousand, with only Usd384 mil for one on one payments to medical doctors (see Sawzag Hansen, unsuccessful promise of timely pay out, AMNews, Nov. 5, 2007).
Source: bomberdove.com

Ways to get Cheap Medical health insurance?

Individual firms have the freedom to guage the potential for loss to be able to ensure anyone within whatever manner that they think acceptable. Every single medical insurance business uses individuals (actuaries) which try to estimate the particular record hazards involved in insuring anyone, and never surprisingly, carries a a bit various view of facts. Individual medical insurance operates differently. It generally can not be terminated even though you use it, but you might be refused in the first place unless you cross health underwriting; you can be rated upwards in case you have past disease or perhaps weight problems; as well as your premiums might be and sometimes are generally greater in case you all of a sudden have a key disease. Individual medical insurance addresses several types of accidents too. An energetic lifestyle boosts the risk of accidental injuries along with repairing broken bones can become very costly.
Source: investmentfinancialadvice.com

Get Information on Medicare Supplements First

In an attempt to make things relatively simple, the government dictated that Medigap policy carriers are only allowed to offer precise plans the government approved. Those policies are Medicare supplement Plans A through Plan L. Every company that sells Medicare supplements is selling the exact same policies; there are no differences between insurance companies on policy content. What does differ however, is the price charged for Medicare supplement insurance. This definitely does change from company to company, which means if you do some shopping around, you may be able to save yourself some money.
Source: irthlingboroughmethodistchurch.org

How and When to Sign Up for Medicare: What Seniors Who Turn 65 Need to Know About Receiving Medicare Insurance

Medicare Part C, also known as Medicare Advantage Plans, offers another option. This combines Part A, Part B, and, sometimes, Part D coverage. Medicare Advantage Plans are managed by private insurance companies and must cover medically necessary services. Plans may charge different co-payments, co-insurance or deductibles. Finally, the last portion is Medicare Part D, the prescription drug coverage plan. The costs vary depending on the plan you select. However, usually you pay less for your prescriptions using this plan.
Source: mouldexsweden.biz

Planning A Company Health Insurance Policy

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

A short discussion on Medigap health insurance plan

These supplementary plans are not under the administration of government like the original Medicare supplementary plans but unlike that it is under the sole administration of some private companies. According to the law the private insurance companies can offer only twelve standard Medicare Supplement Insurance Plans, named A through L. each of these plans have their own set of benefits, different from the others. But to be precise all the supplementary plans provides the basic benefits of the Medicare part A and B. It is always advisable to read and study all the Medicare insurances plans before investing your money because it is very important to make your mind in which you are aiming to invest your money to support your future. What is important for you will invest in that plan and will be benefited in that crisis. All the twelve policies are made remembering all the requirements that are generally needed in the health crisis. Besides that the fact that should be kept in mind is that, no matter from whatever insurance company you may purchase a particular plan, all of the plans with the same letter cover must provide the same benefits. As for example if you purchase a Medigap plan C policy, it should cover the same benefits without depending on the company that is selling the plan. However, the premium rates may vary for different companies. Therefore you are free to purchase any Medigap policy from the company you like and be sure to get the same benefits provided by the other companies. Though it is said earlier that all the twelve plans covers more or less basic benefits but each one of them offers some additional benefits also. Apart from plan A all the other plans B to L offers some different kinds of benefits of plans.
Source: momentinhistory.com

Guilty Pleas In Pompano Beach Assisted Living Facilty Scam

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashAccording to court documents, ATC’s principals paid kickbacks to owners and operators of assisted living facilities and halfway houses and to patient brokers in exchange for delivering ineligible patients to ATC and its related company, the American Sleep Institute (ASI). In some cases, the patients received a portion of those kickbacks. Throughout the course of the ATC conspiracy, millions of dollars in kickbacks were paid in exchange for Medicare beneficiaries who did not qualify for partial hospitalization program services. Ultimately, ATC and ASI billed Medicare for more than $200 million in medically unnecessary services.
Source: bocanewsnow.com

Video: Medicare Provider, Assisted Living

2011 Medicare Open Enrollment Deadline

Use of an advocate, a friend or a family member’s help with these decisions work to the individual’s advantage, particularly for those easily overwhelmed by the amount of paperwork and other written communications. For those who are members of Senior Centers, this type of help is readily available in one-on-one sessions, through workshops and through small group consultations.
Source: assistedlivingfacilities.org

Medicare enrollment ends Dec. 7

In 2008, the Centers for Medicare and Medicaid Services (CMS) adopted new rules to crack down on predatory sales practices in the Medicare Advantage industry, an enormous field that sells government-subsidized private health insurance plans that are an alternative to traditional Medicare. While the changes helped trim complaints of fraudulent practices to Medicare by almost half, there are still widespread problems, according to a CMS study based on a secret-shopper survey of 1,900 Advantage marketing events. And, if you happen to get sold an Advantage plan that does not work for you, the implications could be serious as you may end up not being able to see your current doctor or get the save drug or health coverage you had with Medicare.
Source: epochsl.com

Dangers of Assuming Medicare Covers Everything

Elderly home care is and will continue to be much more cost effective now and in the future. When considering the cost of elder home care versus assisted living costs, there are many factors to take into consideration. One consideration is to understand the trends of the health care industry, so that you can financially plan for your future. Many believe that Medicare will cover everything they need as they age. Although many realize that they need to financially prepare for the future, most do not investigate the cost and options of future care needs. Many do not feel that they can afford to invest in long term care insurance.
Source: health-indicators.com

Campaign Enlists Seniors to Fight Medicare Fraud

Tips from the patrol delivered. In 2009, a retiree noticed residents of an assisted living facility being bused every day, she said. It turned out they and the facility owners were being paid kickbacks to attend a mental health program that billed Medicare $3 million for phony treatments. Medicare prosecuted and got back $1.3 million, she said.
Source: wordpress.com

The Official Medicare Set Aside Blog And Information Resource: Changes to Maryland Workers’ Compensation Regulations Finalized

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizYou may recall a September 2011 blog article that discussed proposed amendments to COMAR 14.09.01 and COMAR 14.09.19 adding specific requirements for workers’ compensation settlements involving Medicare beneficiaries. These amendments were finalized November 28, 2011 and officially adopted into Maryland Workers’ compensation law. The most noteworthy aspect of the new regulations is that the parties are permitted to forego CMS approval of a proposed settlement that meets CMS review thresholds provided that the settlement documents contain three elements: (1) an acknowledgement that the settlement is within the CMS review thresholds, (2) a statement that the parties voluntarily have elected not to submit the settlement and formal set-aside proposal to CMS for review and approval and (3) a statement that the parties are aware that CMS may refuse to pay for services related to the injury and may assert a recovery claim against any entity, including a claimant, provider, supplier, physician, attorney or private insurer. The previous version attempted to use state law as a means to mandate participation in CMS’ voluntary WCMSA review program, a move that was opposed by both claimant and defense attorneys equally.
Source: medicaresetasideblog.com

Video: Structured Medicare Set Aside

The New Frontier of Liability Medicare Set Asides: Part 3

A vast problem with today’s MSP correspondence violence is that invulnerability attorneys and insurers are customarily including “kitchen sink” denunciation in their releases to residence Medicare. This denunciation frequently shifts all of a shortcoming of formulating a Medicare set aside to a repairs plant while identifying an capricious volume to be set aside. This use is dangerous given those releases typically have a repairs plant acknowledge a shortcoming to set supports aside while picking an arbitrary, customarily small, volume to be set aside. This is a bad use and exposes a repairs plant as good as plaintiff warn given if CMS ever refused to compensate for Medicare lonesome services associated to a repairs there would be no proceed to transparent a volume of a set aside. A improved use is to indeed do an MSA analysis, that competence or competence not embody removing a grave MSA allocation done. There are certain instances where an MSA competence be nonessential formed on factors benefaction in a box such as a private primary health word policy, Workers’ Compensation coverage for destiny medical or where there is no destiny Medicare lonesome losses associated to a injury. These should be identified and a recover denunciation privately tailored to that difference though with an denote that Medicare’s destiny interests where deliberate with zero wanting be set aside. If a box requires a full-blown MSA analysis, it should be finished and a cost of doing so upheld along as a customer cost. Most MSA allocation reports cost between dual thousand and 3 thousand dollars, that is a tiny cost to compensate for a correct research of a client’s destiny Medicare lonesome services. The allocation gives all parties a correct volume to be set aside, arguably theme to a rebate formula.
Source: 4-liability.com

Workers’ Compensation: CMS Sets Telephone Conference Call to Discuss Workers’ Compensation Medicare Set

The Centers for Medicare & Medicaid Services (CMS) has completed its Pilot Testing of the Workers’ Compensation Medicare Set-aside Portal (WCMSAP). The CMS will be conducting a Town Hall conference call on November 29, 2011 from 1:00 to 3:00 pm (EST), to introduce this initiative to submitters of proposed Workers’ Compensation Medicare Set-Aside Arrangement (WCMSAs) amounts, and to answer questions regarding the WCMSAP. After the Town Hall conference call, CMS will post the links of the WCMSAP application, and the WCMSAP Computer Base Training (CBT) Modules, on the Workers’ Compensation Medicare Set-aside Portal (WCMSAP) section page “Related Links Outside CMS.”
Source: blogspot.com

What Is Medicare Secondary Payer?

If the other party cannot be reasonably expected to pay soon – perhaps there is ongoing litigation in which the other party is denying any liability – Medicare will pay for covered medical expenses that are injury-related for an otherwise eligible person. Medicare, however, will insist on being paid back once the parties settle the case and figure out how much of the settlement represented compensation for past medical expenses. In fact, Medicare can be as tough as the IRS when it comes to getting itself paid back. These interim payments are called “conditional payments” because they are . . . well . . . paid on the condition that Medicare will eventually get paid back if any later funds surface that represent payment for medical expenses.
Source: masonlawpc.com

When to Use a Liability Medicare Set

42 USC §1395y(b)(8) Allocation bad faith Centers for Medicare & Medicaid Services (CMS) Centers for Medicare and Medicaid Services CMS Franco Signor Franco Signor LLC Gary E. Seger et. al. vs. Tank Collection Jeffrey J. Signor Jurisdiction Katie Fox Liability Medicare Set-aside Arrangement LMSA Mandatory Insurance Reporting Medicare Medicare & Medicaid Schip Extension Act of 2007 Medicare beneficiary Medicare reimbursement amount Medicare Secondary Payer Medicare Secondary Payer (“MSP”) Medicare Secondary Payer Act Medicare Secondary Payer Compliance Medicare Secondary Payer Compliance: How to Mitigate Exposure in the Medicare Beneficiary Personal Injury Case Medicare Secondary Payer Liability Medicare Secondary Payer Manual Medicare Secondary Payer Statute Medicare Trust Fund MMSEA MSP MSP Appeal MSP compliance MSP private cause of action; Geer v. Amex Assuance Co. ORM Responsible Reporting Entity Roy A. Franco RRE SCHIP Extension SCHIP Extension Act Sebelius Section 111 Section 111 Mandatory Insurance Reporting Section 111 reporting User Guide wrongful death
Source: francosignor.com

Workers’ Compensation Medicare Set

About the Author: William F. Bell, Jr. is the Senior Clinical Pharmacy Specialist for Gould & Lamb, LLC. His primary responsibility is the review of a claimant’s pharmacotherapy regimen and the identification of off-label medications in a Medicare Set Aside Allocation.  He has given numerous presentations on the subject of medication management and how it relates to Workers’ Compensation and Medicare Set Aside Claims.  Bill has also authored two continuing education articles for the Pharmacist’s Letter, a nationally known education resource for practicing pharmacists.
Source: themedicarecomplianceblog.com

Medicare Set Aside Enforcement May Have Caused Claim Counts To Spiral

Is the medical benefit increase due to long delays such as convincing a claimant to settle, having a study made of the numbers, including those numbers in a settlement, and then waiting for CMS approval? I do think this is partially responsible for the increase in medical benefits. Basically, a new layer of governmental involvement beyond the state’s administrating over the claim has been added to the mix.
Source: cutcompcosts.com

What Is Medicare Secondary Payer?

Posted by:  :  Category: Medicare

If the other party cannot be reasonably expected to pay soon – perhaps there is ongoing litigation in which the other party is denying any liability – Medicare will pay for covered medical expenses that are injury-related for an otherwise eligible person. Medicare, however, will insist on being paid back once the parties settle the case and figure out how much of the settlement represented compensation for past medical expenses. In fact, Medicare can be as tough as the IRS when it comes to getting itself paid back. These interim payments are called “conditional payments” because they are . . . well . . . paid on the condition that Medicare will eventually get paid back if any later funds surface that represent payment for medical expenses.
Source: masonlawpc.com

Video: 2010 Consultation Coding Medicare as Secondary Payer (MSP)

Section 111 Medicare Secondary Payer Reporting Update

The Centers for Medicare and Medicaid Services (“CMS”) announced an option which will allow for payment of a simple fixed percentage on small dollar liability insurance or self-insurance settlements for physical trauma-based injuries. Effective November 7, 2011, in cases where the settlement is $5,000 or less, a Medicare beneficiary may opt to resolve Medicare’s recovery claim by paying Medicare 25% of the total settlement instead of using the standard recovery process.
Source: dritoday.org

Hadden Case Brings Interpretation of Medicare Secondary Payer Act :Gould & Lamb

Hadden essentially argued four points on appeal from the United States District Court for the Western District of Kentucky at Bowling Green. First, he said, his obligation to reimburse Medicare should be limited to a pro-rata share of the portion of his recovery that represented medical expenses.  Second, he argued that Medicare reimbursement cases should be handled pursuant to other federal and state statutes including the Medical Care Recovery Act, 42 U.S.C. §2651(a) and the Medicaid statute.  He cited the Supreme Court’s decision in Arkansas Department of Health and Human Services v. Ahlborn, 547 U.S. 282 (2006) as authority.  Third he argued that, technically, Medicare’s right to reimbursement as set forth in 42 U.S.C. 1395y(b)(2)(B) was only enforceable pursuant to section iv of the statute when an action was specifically brought. Accordingly, principles of subrogation would preclude action against Mr. Hadden directly.  Last, Hadden said that Medicare should have waived the reimbursement obligation in his case as their recovery was “against equity and good conscience.”
Source: themedicarecomplianceblog.com

New Jersey Workers Comp Blog

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

Understanding Medicare Secondary Payer Compliance

The mandatory insurer reporting program instituted by the Centers for Medicare and Medicaid Services (CMS) has received quite a bit of attention among practitioners in the liability and workers compensation cases.  On The Landy Law Letter, host John L. Torvi, from the Herbert H. Landy Insurance Agency of Needham, Massachusetts welcomes Attorney Michael E. Civittolo from Lawrence & Associates, to take a look at Medicare Secondary Compliance and how to avoid pitfalls in your legal cases. They discuss some of the issues to be concerned about with MSP compliance and the importance of to complying with MSP laws.
Source: legaltalknetwork.com

CMS Official Grilled On Medicare Secondary Payer Program

Modern Healthcare: CMS Official Scolded At Hearing The chief financial officer of the CMS’ Office of Financial Management had few answers to a host of questions from lawmakers about Medicare’s secondary-payer regime during a congressional oversight hearing Wednesday. Deborah Taylor, director of that office, testified about the program she described serves as a “payer of last resort” when another insurer has the primary responsibility to pay for care of a Medicare beneficiary. … Rep. Cliff Stearns (R-Fla.), chairman of the House Energy and Commerce Subcommittee on Oversight and Investigations, said recoveries for the Medicare secondary-payer program fall into two categories: post-payment collections for injuries that happened and were paid by Medicare, and a set-aside amount to cover future bills. But businesses and injured individuals cannot close on a settlement until the CMS provides a complete list of all medical costs, and “We have heard complaints from a variety of interested parties that CMS is not providing this information in a consistent or timely manner,” Stearns said in his opening remarks (Zigmond, 6/22).
Source: kaiserhealthnews.org

Medicare Secondary Payer Charitable Foundation Announces Free Professional Medicare Set

“This is a solution that is long overdue. For-profit administration is underutilized because the service is far too expensive for Payers and Plaintiffs. Self-administration has proven to be a tremendous burden to injured beneficiaries and has not achieved the goal of protecting the Medicare Trust Fund. By taking the profit motive out of MSA administration, eliminating sales commissions, driving down operating costs through technology and seeking charitable partnerships and willing corporate sponsors of this new business model, I believe the MSPCF is poised to permanently shift the way MSA funds are administered,” commented Board of Trustee member and MEDVAL General Counsel Jennifer C. Jordan, Esq.
Source: lexisnexis.com

Long Overdue Hadden v. U.S. Decision Reached – More Questions than Answers 

The decision very well could encourage Medicare beneficiaries to not include as part of their claims against the primary plan payment for items and services, and to legally escape reimbursement to Medicare.  It would be an easy solution for all in the industry as the Medicare Secondary Payer Act would be rendered ineffective, except for one very important distinction.  The primary plan is not similarly situated as the Medicare beneficiary and would not be released from responsibility to Medicare by simply not making medicals part of the claim.  Whether the Medicare beneficiary includes in its claim medicals, the primary plan will still have to report certain settlements, judgments and awards electronically to Medicare.  The reporting provision is not based on responsibility but simply a payment.  See 42 U.S.C. §1395y(b)(8). Medicare has further defined this in its reporting guides to include payment situations that have the effect of releasing medical.   If disregarded, the primary plan is subject to a penalty provision of $1,000 per day for every claim not reported.  How Medicare will respond to this data remains to be seen, but it is clear from other recent court decisions, that Medicare can go after the primary plan even if it is not able to proceed against the Medicare beneficiary.  See Haro v. Sebelius, granting Plaintiff’s Motion for Summary Judgment 05//05/2011, U.S. Dist. Court of AZ, Dist. Of AZ, CV 09-134 TUC DCB.
Source: francosignor.com

MEDICARE SECONDARY PAYER PROGRAM

In addition, on September 30, 2011, the Medicare Secondary Payer Recovery Contractor will implement a self-service information feature to its customer service line.  This feature gives callers the ability to get the most up-to-date Demand/Conditional Payment amounts, and the dates that those letters were issued, without having to speak to a customer service representative.  The self-service feature will be available for extended hours, and callers will have the option of requesting information on multiple cases during one phone call.
Source: wordpress.com

Bipartisan bill would speed up MSP reimbursement

&summary=WASHINGTON+%E2%80%93+Legislation+that+would+speed+up+the+rate+at+which+Medicare+and+its+beneficiaries+are+reimbursed+for+costs+under+the+Medicare+Secondary+Payer+%28MSP%29+system+has+been+introduced+in+the+Senate.+%0AUnder+the+MSP+system%2C+Medicare+beneficiaries+who+receive+a+personal+injury+verdict+or+settlement+for+injuries+must+reimburse+Medicare+for+related+medical+costs.%0AThe+%5B…%5D&source=Lawyers+USA+Online’ title=’Share with Lindedin’ rel=’nofollow’ style=’background-image: url(http://lawyersusaonline.com/wp-content/plugins/dmc_sociable_toolbar/imagecol.png); background-position:0px -510px’>linkedin
Source: lawyersusaonline.com

Medicare advantage plans in mo

Posted by:  :  Category: Medicare

Rep. Roy Blunt (R-Mo.) by TalkMediaNews In addition, she was stiffened from the long trudge, and the sand, to her surprise, was anything but soft. A synodical trial by the Synod of Long Island was finally held at Jamaica, L. Late in Autumn 1861 Captain Wilkes, of the United States Navy, boarded the British mail steamer Trent, and seized two Confederate commissioners Mason and Slidell who were on their way to England. The End PAGE PAGE 35 To Ernest Cun�oMuse The story is based on a screen treatment by K. Misdirection wouldn’t last long. In the classical pastexcept for such special cases as the feeding of Rome with Egyptian corntrade was a traffic in luxuries or slaves, war a small specialized affair of infantry and horsemen in search of slaves and loot, and empire the exaction of tribute. The old Siwennian turned his back. ” Ostrog stepped across the room, something clicked, and suddenly, save for an oval glow, they were in darkness. He looked up after a time to say: “Come away medicare advantage plans in mo leave him. No one is really private but an outlaw. This hath given the former such an air of superiority, and made the latter so pragmatical, that neither of them are well to be endured. “Then you could grow big again whenever you pleased. 19:29 And the whole city was filled with confusion: and having caught Gaius and Aristarchus, men of Macedonia, Paul’s companions in travel, medicare advantage plans in mo rushed with one accord into the theatre. ” “Well, yes, for a time we corresponded,” said the other. In his retreat he draweth Sir Pertolepe’s main battle athwart our line of charge, their flank exposed and opento horse, Sir John, to horse! In the course of a morning ride, Wee Willie Winkie had seen Coppy so doing, and, like the gentleman he was, had promptly wheeled round and cantered back to his groom, lest the groom should also see. That’s the story, you may depend on’t. Joe thought there wasand he is not likely to have been mistaken; for medicare advantage plans in mo were not many eyes like Dolly’s, that’s the truth. It seems Rob Roy, when he came to consider a little better of it, found that, he could not mend his matters by retaining Killearn his prisoner, which could only expose him still the more to the justice of the Government; and therefore thought fit to dismiss him on Sunday evening last, having kept him from the Monday night before, under a very uneasy kind of restraint, being obliged to change continually from place to place. I can’t say I’m sorry when I’m not, can I? All my friends were like myself, drifting from day to day, and never a thought for the future. ‘ ‘It’s not my wish,’ said the traveller. ‘ rejoined Quilp, ‘Not drink it! But no pursuit at Cambridge was followed with nearly so much eagerness or gave me so much pleasure as collecting beetles. forward�raising her hands as she collided with the Monster Blood. His hands shook, his whole body quivered and shrank away from the picture he had conjured. She had done more weeping and giggling in the last six days than she had done since she was fifteen and starting to date. Cold sweat stood out on her face. ‘ But he did not say this very loud.
Source: blog.cz

Video: Obama at Arnold, MO, on Medicare

Providence Medicare Providence.org/php/newplan

So What are Medicare Advantage Plans anyway? By definition Medicare Advantage Plans are an “option to receive their Medicare benefits through private health insurance plans( like Providence Health Plan), instead of through the original Medicare plan (Parts A and B)”*. Introduced with the passage of the Balanced Budget Act of 1997 these optional Medicare Choice or Medicare Part C plans gave medicare recipients a choice in the government medicare system. Prescription Drugs Plans were added to these medicare plans with the introduction of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. Medicare Advantage (MA) Plans today combine Medicare Parts A(Hospital),B(Medical Insurance) and D(RX Drugs Plans). Read more at What Are Medicare Advantage Plans?
Source: trinitymedcare.com

Beware of Medicare reform

The institute also argues against the proposal by U.S. Rep. Paul Ryan (R-Wisc.) to move people who are currently younger than 55 to a plan that would offer a voucher that recipients could use to buy private health insurance. Any cost over the amount of the voucher would be the responsibility of the recipient. This plan would cost more than the current one, the institute says, because Medicare as it is currently operated is a 10,000-pound gorilla. If it says it will only pay $X, then that’s what it pays, and healthcare providers have to figure out how to live with it. Without Medicare’s impact, prices are likely to go up. Nationally, private insurance rates are 25 percent higher for physician services and about 40 percent higher for hospital services, the institute says.
Source: bankrate.com

Purchasing Medicare Supplement Insurance in Missouri

The plot of Missouri also allows for individuals who are on Medicare disability to enroll into a supplemental idea. fair like those who are Turing 65, you must enroll during your open enrollment period to be issued a policy on a guaranteed basis. start enrollment encompasses the three months before your approval, the month of your approval, and the three months after.
Source: medicaresupplementalinsurances.org

Montgomery County Health Department flu vaccine clinics available Oct. 14 and Oct. 20

The Montgomery County Health Department cannot bill private insurances but will bill Medicaid and Medicare. You must have Part B coverage before Medicare will pay for the influenza vaccination. Participants who have Medicare or Medicaid should bring their Medicare/Medicaid cards with them to the clinics. There will be a charge of $20.00 for those not covered by Medicare Part B or Medicaid.
Source: countynewslive.com

Perspectives From NEJM: Flaws In Basic Health Plans, Post

Posted by:  :  Category: Medicare

Making quality health care accessible to students by Office of Governor Patrick2012 — A Watershed Election for Health Care  Three possible federal electoral outcomes seem most likely. All assume that the Republicans will retain control of the House of Representatives. … Under the two most probable scenarios, the health care system probably wouldn’t change fundamentally for at least the following 4 years. That means that the proportion of Americans without insurance will not decline significantly; under the third scenario, the proportion could even continue to increase at pre-ACA rates. Governmental leadership to control health care costs through fundamental health system reform will also flag. And by 2020, 20% of Americans may be uninsured, even as 20% of our gross domestic product is devoted to health care (Dr. David Blumenthal, 12/1).
Source: kaiserhealthnews.org

Video: Ron Paul: Healthcare Plan Based on Economic Fantasy 8/3/09

Experts urge federal employees to consider switching health plans

To post a comment, you must provide a name and a valid e-mail address. Messages must be limited to 400 words. By using this Service you agree not to post material that is obscene, harassing, defamatory, or otherwise objectionable. Although Government Executive does not monitor comments posted to this site (and has no obligation to), it reserves the right to delete, edit, or move any material that it deems to be in violation of this rule.
Source: govexec.com

Department Of Health Plans To Remove A 20 Years Old Ban

"It is right that we now consider our current guidelines to reflect what the science is telling us about the risk of HIV transmission from healthcare workers with HIV to patients", said Chief Medical Officer, Professor Dame Sally Davies, while making patient safety as top priority for authorities. In addition, the expert has notified about enormous development in the field, especially during the past 25 years.
Source: topnews.us

Are You Planning to Buy Health Insurance Plans in Washington?

Buy Health Plans in Washington Why are you looking to buy health plans in Washington? The first answer is that you need proper healthcare and the second is that you live in Washington. Quality healthcare is directly related to health plans or health insurance policies that you have. In the wake of rising medical care costs, it is important to find some affordable health insurance plans in Washington. It must be remembered that without proper medical plans or insurance policies to support you, you will have little or no control over the care you receive. A surgery, stay in the hospital, treatment for a chronic condition, and emergency conditions are all examples of situations where you will need a proper health cover to supplement the tension. Financial security is one of those benefits that help you remain stabilized in difficult conditions and no wonder that having an affordable health plan in Washington is really a blessing. The quest of buying a health plan in Washington should begin with a serious search where you know your needs and are looking for answers that can address them. Once you are clear what you need, you can find the means to fulfil those needs. Have you noticed some people in Washington who are frequently skipping regular hours of work due to bad health condition? Why, do you think they are not taking proper care of their health? One of the reasons is that they have not purchased affordable health plans that can cover their healthcare needs. It is not a surprising fact that the mortality rates for cancer and other diseases are higher in Washington among the uninsured people. Your health condition determines what kind of health plans you get in Washington. As a resident of Washington, you are not guaranteed health insurance. Private health insurance companies can refuse you to provide health cover on grounds of your health condition. Or if you manage to get the cover, they can exclude the pre-existing medical condition from coverage. However, if you are denied a health insurance plan altogether, you can still go to buy a medical plan through the Washington State Health Insurance Pool (WSHIP). Though federal laws provide cover for healthcare in case of an emergency, but you can be denied proper healthcare in case of non-emergency condition and the costs could still be very high. So, it makes a good sense to surf the internet, talk to agents, and discuss with your friends or colleagues as how to buy health plans in Washington. Talking to others really helps in filtering down issues and concepts that you have to understand before you make a purchase of any health plan in Washington. If you have not asked questions, compared health plan quotes, talked to agents, cleared your doubts, probability says that you will pick up a wrong medical plan. This wrong choice can make you pay more premium than required, exclude coverage that you require, or totally miss the objective.
Source: giant-space.com

Occupy UC Davis: “Hasta la vista, Democrats!” | MyFDL

The resolution, the first of its kind adopted at an Occupy protest, lays out a clear political perspective to counter the growing attacks on protests against inequality in the United States. It comes a week and a half after the brutal pepper spraying of unarmed students protesting against rising tuition and inequality.
Source: firedoglake.com

Oral health is a part of health insurance!

No wonder most of the latest medical insurance companies around the nation are trying to make a mark for themselves in the industry by offering the best products to consumers. With people in India having understood the accurate inference of purchasing a health plan, they are ready to employ their hard earned cash and relish the paybacks these plans come with. In case, you desire to purchase a health plan or the industry’s best mass health plan, it is important to take some important points into account. The only problem here is that most of the health care insurance plans are offered at lofty prices. Many companies offer cover services poles apart from what their counterparts offer. This creates a lot of confusion among consumers when deciding on a health insurance plan.
Source: articledevlist.com

New report: Community health plans improving care for patients with chronic illnesses

Care management is the coordination of care and services for chronically ill patients who require complex, one-on-one and personalized care, and is emerging as a foundation of patient-centered medical care. At many ACHP plans, a plan-employed care manager works with a medical practice to coordinate services for patients living with long-term, chronic diseases, through activities such as patient education, referral to community resources and agencies, help navigating health care systems and coordination of information among multiple providers. Innovative health plans, including Geisinger Health Plan, Group Health Cooperative and Independent Health have launched care management initiatives in partnership with medical practices, resulting in improved patient experiences.
Source: sciencecodex.com

Medical loss rule details employer distribution of rebates

In the event an insurer fails to meet the ratios, it must issue rebates directly to the plan sponsor. The plan sponsor in turn must divide the rebate up and use the portion of the rebate attributable to the amount of premium paid by subscribers “for the benefit of subscribers.” Private, non-ERISA plans must provide written assurance to its insurer that rebates will be used for the benefit of current subscribers.
Source: thompson.com

Not Running a Hospital: This is not about tiered health plans

Why couldn’t the surgeon do the surgery in timely fashion at the lower-cost affiliated hospital?  Was this his choice?  Did he know a failure to do so would cost his patient extra money?  Was his choice limited by the OR times made available to him by the hospital administration?  Did the surgeon ask the administration to make room on the schedule to avoid the extra cost to the patient?  Is there anyone at either hospital who acts as an ombudsman or facilitator to help patients receive their care in the lower cost hospital?  Is there pressure on surgeons to fill up the operating schedule at the Brigham to help offset the operating costs of the more expensive institution?
Source: blogspot.com

Massachusetts Individual Health Insurance

Because of this new requirement, both Individuals and small businesses are being provided with access to affordable health plans under the new law. Health plans are being made available from health insurance companies such as, Blue Cross Blue Shield, Fallon Community Healthcare, Harvard Pilgrim Care, Neighborhood Health Plan, and Tufts Plan.
Source: health-indicators.com

Landacorp Presents Collaborative Care to Large Health Plans at the 2011 Blue National Summit, December 4

Landacorp, a Carewise Health affiliate, delivers collaborative care and health management solutions and technologies for health plans and healthcare delivery organizations. CareRadius creates individual member health success and healthcare organizational effectiveness by automating wellness, health and care management engagement. Enabling collaboration between health plans, members and providers, CareRadius intelligently applies clinical data and health plan business logic throughout the identification, outreach, coaching, and care management process. Timeliness and efficiency of information sharing maximizes clinical resources, results in member health improvement and optimizes the cost of health care. CareRadius empowers providers of care and health plans to make a difference for each individual member, while managing across an entire population. Visit www.landacorp.com.  
Source: virtual-strategy.com

Michigan Blue Cross Deal Freezes Medigap Rates

Posted by:  :  Category: Medicare

Gravel MediGap by Mike Licht, NotionsCapital.comBlue 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. The deal announced Thursday affects so-called “Medigap” policies bought to supplement Medicare coverage. Schuette says the agreement freezes rates until August 2016. It’s part of an agreement that allows Michigan Blue Cross and Philadelphia-based Independence Blue Cross to acquire a stake in AmeriHealth Mercy. The company has Medicaid managed-care contracts in states including Pennsylvania and Indiana.
Source: wilx.com

Video: Learn About Medigap Plans

The latest changes and the better benefits of Medigap

Having a Medicare plan ready for the future medical security is one of the most essential things for any person. This is a very common fact that nobody can be sure of what type of situations may come in his life in the future and the situation may be such that he may need serious medical aid. Therefore, one must stay prepared for this and have a Medicare plan ready to face any such situation. But along with that there is also another point that should be kept in mind which says that the Original Medicare does not cover all of your medical costs and you shall have to bear some part of the medical costs from your own pocket. Therefore, for these reasons there are the Medicare supplement insurance plans, which help in filling up the gap left aside by the Original Medicare. In other terms these Medicare supplement insurance plans are also known as the Medigap Health Insurance Plans, in short Medigap plans.
Source: mixtop.net

Officials Looking To Cut Federal Spending Eye Medigap Policies

But some budget experts say “first-dollar” Medigap plans like the one Fisher has, which cover nearly all such deductibles and co-payments, may make it too easy for seniors to decide to seek medical care they may not need. The thinking goes that, for example, instead of waiting to see if their condition gets better or if a nonprescription medicine might help, seniors with these Medigap policies seek more care than those without the coverage. Getting seniors to delay or forgo some care or find cheaper alternatives could save the government billions of dollars — as much as $53 billion over 10 years, according to the Congressional Budget Office.
Source: kaiserhealthnews.org

Medigap Policies Catch (Unfavorable) Attention of Congress

A Medigap policy is actually a private, supplemental form of insurance to cover medical bills Medicare doesn’t cover. Medigap is especially important in a crisis, since it can kick in for hospital visits that otherwise would go uncovered. Accordingly, this can prevent a financial crisis on top of a medical one.
Source: randylishlaw.com

Medigap: a helpful supplement plan

Medicare supplement plans or this type of insurance is the newly added thing. Medicare supplement plans or Medigap is the private health insurance plans that are for those people who already have a Medicare policy. The Medigap or Medicare supplement plans helps the Medicare beneficiaries to bear that extra medical cost that are left aside by the original plans. The name Medigap is suggested because it is believed that these policies bridges the gap between the Medicare coverage and the original expenses or the total bill charged. However in the recent studies it is seen that in the United States about 18% of the people having original Medicare policy goes for the supplement plans also.
Source: centrenautique-palavas.com

Excellus BCBS Listed Among Best Plans in Nation in NCQA Health Insurance Plan Ranking 2011

Posted by:  :  Category: Medicare

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care.
Source: oneidacountycourier.com

Video: Excellus BCBS Medicare plan travels with you

2012 Medicare Advantage Ratings are out

Less than 3% of all MA plans received the highest possible rating while another 10% of plans received 4.5 stars out of 5.  Over 6% of PDPs received 5 stars, but less than 2% received 4.5 stars.  More than 15% of MA plans and almost one-third of PDPs received less than the minimum acceptable rating of 3 stars.
Source: dssresearch.com

Broome County Health Department Announces 2011

The clinics are open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan. Pneumonia shots will also be offered at the flu clinics for Medicare Part B recipients age 65 and older. If your children’s immunizations are covered by medical insurance, parents are advised to seek flu shots for them at their regular medical provider. This can help cut down on out of pocket costs, especially for children who require a second dose of the vaccine because of their age. Children 6 months through 8 years of age who did not receive at least one dose of the 2010-2011 vaccine, or whom it is not certain whether the 2010-2011 was received, should receive 2 doses of the 2011-2012 seasonal vaccine.
Source: gobroomecounty.com

Health Groups Target Potentially Avoidable ER Visits

“There are many directions our community could go in responding to this data,” said Joseph Booth, M.D., president, Oneida County Medical Society, who was joined by Suresh K. Sharma, M.D., president, Herkimer County Medical Society and Stephen D. Eadline, M.D., president, Slocum-Dickson Medical Group. “The findings aren’t unique to the Mohawk Valley. However, all health care is delivered locally, so we believe the issue is best addressed by physicians, hospitals, health insurers, and other members of the health care system working collaboratively together. The campaign announced today is a major step in helping people determine the best places to receive appropriate medical care.”
Source: readmedia.com

Excellus BlueCross BlueShield Earns Highest National Accreditation for Quality

Excellus BlueCross BlueShield, a nonprofit independent licensee of the BlueCross BlueShield Association, is part of a family of companies that finances and delivers vital health care services to 1.8 million people across upstate New York. Excellus BlueCross BlueShield provides access to high-quality, affordable health coverage, including valuable health-related resources that our members use every day, such as cost-saving prescription drug discounts and wellness tracking tools in our Step Up program. To learn more, visit www.excellusbcbs.com
Source: readmedia.com

Excellus BlueCross BlueShield Emphasizes Fitness For Seniors

Any American who is 65 years old or older has access to Medicare, but only covers a limited amount of health care costs. That’s why many seniors purchase Medicare Supplement plans from private insurance companies to fill in the coverage gaps.
Source: gohealthinsurance.com

Medicare Advantage Premium Costs to Decrease in 2012

"As these cuts take effect in the coming years, Medicare Advantage beneficiaries will face higher out-of-pocket costs, reduced benefits, and fewer health care choices," said Robert Zirkelbach, a spokesman for the industry trade group America’s Health Insurance Plans.
Source: aarp.org

Broome County Health Department Announces Seasonal Flu Clinics for Fall 2009

The fee for the flu vaccination is $20. The pneumonia shot is also available for Medicare Part B recipients aged 65 and older at Broome County Health Department sponsored clinics (*) only. There will be no out of pocket fee for the flu or pneumonia shots for Medicare Part B recipients. Individuals on Medicare must present all insurance cards to staff at the clinic. If you have signed up with Today’s Options-American Progressive or Excellus Medicare Blue PPO Medicare Advantage Plan, we can charge your plan. For other Medicare Advantage Plans, such as Aetna Golden Medicare, CDPHP Medicare Choice, etc, you need to go to your primary care provider for the flu shot or be prepared to pay by cash or check.
Source: gobroomecounty.com

Silver Sneakers Fitness Program for Seniors: Physical Activity Bonus for Senior Citizens in Some Medicare Plans

Queens Rose, I think that Silver Sneakers is a great program for seniors and I’m very happy to have it! I am now 66 and althought I can not think of myself as a senior, am going to Silver Sneakers because my insurance is paying for it and My family and doctor think it will be good to get rid of my Colesterol! I really like Silver Splash although I must wash my hair every time I go and take one of those classes, to get rid of the choreine in the water! All and all it gives me something to do and the people are wonderful!
Source: suite101.com

Do I Need Medicare Parts B And C If I’m A Federal Retiree?

While enrolling in Medicare Part B is optional, a federal retiree may consider it a wise choice. An FEHB plan will sometimes waive deductibles, coinsurance and co-payments for federal retirees with Medicare Part B. Medicare Part B covers services that an FEHB may not, such as home health care, medical supplies, durable medical equipment and orthopedic/prosthetic devices. Federal retirees must be currently enrolled in Medicare Part B before getting Medicare Part C. A federal retiree with Medicare Part C will benefit from reduced premiums, but may have to visit doctors or providers in a specific network and have higher out-of-pocket expenses.
Source: seniorcorps.org

New York Orders $114.5 Million in Refunds, Citing MLRs

“While it is a positive that consumers are getting these payments, retroactive refunds are simply not good enough. It is likely that some people dropped their insurance coverage because of premium increases,” stated Superintendent of Financial Services Benjamin Lawsky. The DFS chief has not let too much in the way of health insurer behavior he doesn’t like slip through his fingers. Recently, he won the battle with New York insurers to make rate filings public in the face of public outcry about premium hikes.  See: http://www.lifehealthpro.com/2011/10/23/new-york-health-rate-filings-are-public-documents
Source: reevewillknow.com

Medigap the supplementary insurance and the changes coming up

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552In fact recently in 2010 there are some major changes coming up in the standard Medicare supplement insurance plans. One should also keep an eye on the fact so that the better choice of the Medigap policies can be made. Starting from June 2010 the Medigap customers are going to see some major dramatic changes in the existing Medigap plans. With this there is the addition of two new plans M and N and on the other hand there is the elimination of four existing plans from the standard plans. These new changes are going to be effective from June 1, 2010. It is believed that with the new changes in the Medigap plans the customers are going to have lot more benefits and it is expected that with the benefits offered by the two new plans these are going to be quite popular with the Medicare beneficiaries. The point to be noted is that the new changes are going to lower out of pocket expenses of the customers and give some additional benefits in their current plans.
Source: articolate.org

Video: Medicare Supplement Plans – Changes for 2010

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 Supplement Plans

Healthcare costs that are not covered by standard Medicare plans are not left uncovered with Medigap, also known as Medicare Supplement plans. Seniors, you are eligible for Medicare coverage if you are at least 65 years of age and/or have a qualifying disability. As the policies currently stand, there are 12 Supplement plans assigned the letters A through L. Each idea is well-known to win for positive benefits relevant to your current place, geographic area and health conditions. A basic change is occurring to all original plans with an addition of hospice care. view G will be undergoing a further alteration, that of a boost from 80 percent to 100 percent coverage for excess charges.
Source: medicaresupplementalinsurances.org

Medicare changes explained in forum

During her program, Landreth covered the four basic parts of Medicare — A (hospitalization and inpatient services), B (medical insurance such as primary care, specialists, outpatient services, medical supplies and preventative screenings), C (Medicare Advantage Plans which replace Medicare A and B such as HMOs and PPOs), and D (prescription drug insurance). She also discussed supplemental insurance programs, which will pick up the 20 percent Medicare doesn’t cover depending on a customer’s level of coverage and two assistance programs (The Medicare Savings Program and The Extra Help Program) that people may qualify for based on income that will pay for Medicare Part B premiums and prescription drug costs. Landreth said that the major change for the upcoming year is the monthly premiums people pay.
Source: co.uk

The latest changes and the better benefits of Medigap

Having a Medicare plan ready for the future medical security is one of the most essential things for any person. This is a very common fact that nobody can be sure of what type of situations may come in his life in the future and the situation may be such that he may need serious medical aid. Therefore, one must stay prepared for this and have a Medicare plan ready to face any such situation. But along with that there is also another point that should be kept in mind which says that the Original Medicare does not cover all of your medical costs and you shall have to bear some part of the medical costs from your own pocket. Therefore, for these reasons there are the Medicare supplement insurance plans, which help in filling up the gap left aside by the Original Medicare. In other terms these Medicare supplement insurance plans are also known as the Medigap Health Insurance Plans, in short Medigap plans.
Source: mixtop.net

Medicare open enrollment continues through Dec. 7

Posted by:  :  Category: Medicare

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

Video: The Centers for Medicare & Medicaid Services (CMS) Korean Language Video

Medicare Made Clear: Changing Insurance Coverage

inexpensive-health-insurance.info health insurance providers private health insurance health insurance plans health insurance benefits public health insurance health insurance coverage Video Rating: 0 / 5 inexpensive-health-insurance.info tufts health insurance discount health insurance low cost health insurance national health insurance secondary health …
Source: healthinsuranceandmedicareupdate.com

Mich Blue Cross freezes Medigap ratesBlue Cross Blue Shield of

Mich Blue Cross 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. Blue Cross seeks 4.4% hike in Direct Pay rates PROVIDENCE Blue Cross & Blue Shield of Rhode Island, the state s largest health insurer, filed a request with the Office of the Health Insurance Commissioner seeking a 4.4. percent increase for its Direct Pay customers. If approved, the rate increase would take effect on April 1, 2012. 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. Capital Blue Cross employees act as Santa’s elves for kids in need Santa’s elves got a lot of grown-up help Friday. Employees at Capital Blue Cross gathered presents for their Secret Santa program. They pick out slips with the child’s age, gender, and wish list. They have been doing it for 23 years. It’s children and the community, stated Joe Butera. We love to help both and what better way than to reach into the community and brighten lives than to bring …
Source: medicare-news.com

Medicare: Online Ratings of Nursing Homes

To access this information from Medicare, go to www.Medicare.gov and scroll down to the bottom of the page.  Under Resource Locator find Nursing Home Compare and click on that. Your next screen will outline how to Find and Compare Nursing Homes and then you can click on the big  Find and Compare Nursing Homes button.  The next screen gives you several options to find nursing homes near you.  The easiest option is to type in your zip code or the zip code that your loved one lives in.  You may also determine the mileage radius around that zip code such as 50 miles, and then hit the continue button.  Up comes a page that will list nursing home facilities in that area.  You may have to scroll down a little bit on the page to view the results.  To find out more about each of the nursing homes listed, just click on each name listed in blue capital letters. 
Source: factoidz.com

best mac lipsticks: New Study Says Medicare Drug Benefit Benefits Heart Patients 1

,ugg adirondack A brand-new study indicates that this Medicare health insurance substance gain can be helping an increased variety of old People in america using center inability have the medicinal drugs suitable money illness.”Obviously fortunately that surge in doctor prescribed work with could possibly mean fewer hospitalizations,” indicates Mike Weinstock, broker,mac makeup wholesale, on http://www.MedicareSupplementPlans.org, “as properly when more affordable expenses and also longer life.”Medicare Pill Benefit Analyze ResultsNearly 7,1000 old heart-failure patients using one insurance plan had been researched. The effects were being which the volume of stuffed medications regarding normal heart-failure medications basically improved as soon as the Treatment medication gain journeyed in impact throughout Economy is shown ’06. A lot more eye-catching seemed to be the fact the greatest increase seemed to be involving older persons which recently was without medication coverage. The best intention connected with Medicare Portion N were to present senior citizens, specifically those along with reduced profits, usage of economical drugs. In fact any 09 analyze from the homework organization RAND discovered that by way of ’08, Medicare health insurance pharmaceutical protection acquired clipped seniors’ total annual out-of-pocket substance expenses by 04 per-cent,nfl store, on average,north face denali, while enhancing the amount of solutions by simply 7 per-cent.These newest conclusions, noted while in the United states Coronary heart Record, are the first which in turn demonstrate Medicare insurance Piece N could be helping a higher wide variety of beneficiaries by using coronary heart disappointment receive the drugs regularly advisable to aid lower risk of hospitalization. Understanding Cardiovascular FailureWhat many individuals don’t understand is the fact that cardiovascular system disaster is really a constant, progressive condition. And while it may well sound just as if the very center breaks down as a whole, cardiovascular system disaster truly happens when the cardiovascular is not really capable to send successfully enough to meet the body’s desires. Symptoms for example fatigue, breathlessness when placing in addition to liquid build-up happen.Center failure occurs when the cardiovascular system step grows bigger. The idea elongates many squeezes extra blood vessels. This particular stretches grows extra lean muscle, which experts claim makes all the coronary heart even larger. Subsequent, the entire body narrows leading to tinnitus and keep blood pressure levels way up. What’s more, it diverts blood stream from much less important areas and body parts to take care of pass for the most essential body organs: the center along with brain.To begin with this will give and also the to function more strongly because the body attempts to atone for your heart’s lack of energy. Sad to say, this can will be temporarily mask the challenge. Gradually, these kind of alternative activities will no longer operate. People who have cardiovascular system failing usually are consistently positioned on prescription drugs termed beta-blockers, normally in combination with a strong angiotensin-converting chemical (Star) chemical or maybe a similar drugs. Cardiovascular system failure is actually a critical affliction, generally devoid of remedy. Today some individuals with soul failing lead entire, pleasant life if the ailment will be was able by using medications along with a healthful life style. It also helps to own assist connected with relatives and buddies whom know the ailment.
Source: blogspot.com