Medicare’s drug coverage gap shrinks ~ what IS working

Posted by:  :  Category: Medicare

3.27.06 Los Angeles Times Shannon by Korean Resource Center 민족학교“For people with high drug expenditures, the 50 percent discount offers real savings,” said Tricia Neuman, director of Medicare policy for the nonpartisan Kaiser Family Foundation. “It’s certainly more helpful than no coverage at all, which is what they had previously.”
Source: whatisworking.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Important Information Surrounding Medicare Plans and Coverage : Senior Health Direct

Many insurance companies offer to explain the different Medigap policies but it is best to find assistance from a company that looks into each situation and explores the options and costs associated through many different insurance agencies.  The coverage is completely regulated by the government so the plans consist of the same coverage the differences will come in service and cost from different insurance agencies.  A company such as Senior Health Direct which is web based can offer assistance and free information on Medicare and Medigap Supplemental Insurance Plans.  Another source of information that can be easily accessed through Internet is the Medicare government’s site.
Source: cpsmi.com

Medicare extends coverage for obesity in America

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 Coverage, Generic Medicine

Before we read about Medicare coverage and generic drugs, let’s make the things simpler by reading how generic drugs are defined. Generic medicine is defined as the drug sold under its generic name and sold legally only after the patent for the brand name drug has expired. Before we move ahead, we also need to know about Medicare coverage gap. If you are enrolled for Medicare plan for prescription drugs (Part D), Medicare will stop paying you for prescriptions temporarily once you reach coverage gap. Once you come in the coverage gap, you will have to bear the entire amount for your medicines. The moment you meet your initial coverage limit for prescription drugs, you enter coverage gap or donut hole and start paying the whole cost for your drugs.
Source: shopeastwest.com

Medicare Coverage And Providers

Choosing the most cost-effective place to receive services can reduce your out-of-pocket expenses. In some cases, services can be provided only at certain facilities. However, there are often several providers from which you can choose. Talking with your doctor about the available options will enable you to make an informed decision about where you get your health care services.
Source: thequeenofcougars.com

Fitness Watch: Obesity Counseling

Stupid is as stupid does. Medicare beneficiaries will be able to get coverage for preventive obesity counseling, CMS (Centers for Medicare and Medicaid Services) announced today. The CMS says this is part of the widening range of preventive services CMS has been adding to its coverage since the signing of the Affordable Care Act. Covering the costs for preventive obesity counseling complements the Million Hearts initiate, CMS explained in a communiqué.A waste. Will not work, but since people tend to lose weight after the age of 70, look to the Feds to skew the data in an attempt to justify their stupidity.
Source: blogspot.com

Medicare Open Enrollment: What You Need to Know This Year

Keep in mind that once open enrollment ends, you may still be able to make changes to your Medicare coverage. Many don’t know that Medicare offers “Special Election Periods”providing the opportunity to change Medicare coverage anytime of the year. For example, eligible beneficiaries with diabetes or heart failure are allowed a one-time special election period to enroll in a Special Needs Plan for their condition. In addition, eligible Medicare beneficiaries receiving full Medicaid assistance may switch their coverage at any time of the year.
Source: communityjournal.net

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

Treatment Supplement Coverage, Or Medicare supplemental health insurance Policies

Treatment Part ANY is healthcare facility insurance, which inturn covers inpatient healthcare facility stays and also care dur hospice, home health reform, and car for facilities. Medicare Component B is helath insurance. It handles services out of doctors, outpatient products and services, and precautionary services. Treatment Part J, also generally known as a Treatment Advantage Approach, includes Component A, Component B, and sometimes medicines. The suit, Medicare Component D, is normally prescription pharmaceutical coverage, and probably do end right up lower bills for medications overall.
Source: irvinemocktrial.com

Medicare Offers Expanded Coverage To Battle Expanding Waistlines

Under the new rules, beneficiaries whose body mass index is 30 or higher would be eligible for counseling services. The covered benefits include one face-to-face counseling session every week for a month, then counseling every other week for an additional five months. Beneficiaries who have lost at least 6.6 pounds at the end of six months would be eligible for six more monthly counseling sessions.
Source: kosu.org

Missed Medicare Open Enrollment, Now What?

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSSign up for a new Medicare Advantage or Part D plan after open enrollment. You’ll have to pay more for the coverage but depending on your health and cost of monthly prescriptions, it may be worth the extra cost. Talk to a licensed agent about available plans to see how much it would cost for monthly premiums versus the cost of not having additional coverage.
Source: gohealthinsurance.com

Video: Guide to Medicare Part A and Part B

A short discussion on Medicare and Medicare Supplement Plans

Though the Original Medicare covers many of the costs for health care services, but still there remains certain costs or gaps that are not covered by the Original Medicare policies. And to cope up with these costs there is the need of having Medicare Supplement Plans. The Medicare Supplement Plans helps you fill up these gaps so that one can easily meet the health care costs. And because of this very feature the Medicare Supplement Plans they are also known as the Medigap policies. These are private health care policies, which are designed to supplement original Medicare plans. These policies are specially designed to cover some of the basic benefits and more especially to fill up the gaps left behind the original Medicare plans. But it should be kept in mind that a Medigap policy is only a supplementary plan to the original Medicare plans and does not provide the total coverage of a Medicare policy. Therefore it means that you need to be under the original Medicare policy in order to get enrolled under a Medigap plan. Medicare will pay its share of the health care costs and the things that are left behind would be covered by the Medicare supplement plans.
Source: graphicdesignessentials.com

Know your Medicare supplement plans thoroughly

If you are in the Original Medicare plan you are able to buy a Medicare supplement plan and both of them would pay you their share of coverage. It is to be noted that the Medigap policies are private health insurance plans and the private insurance companies can only sell them and not by any government organizations. These plans are totally administered by the private insurance companies. But it is to be mentioned that though these plans are completely administered and sold by private insurance companies but still there are only 12 supplementary plans labeled A through L. All these plans have there separate policy coverage but the plans under the same letter cover must provide the same benefits. It means that no matter from which company you have bought the policy, they must provide the same coverage as provided by the other companies, nothing more or nothing less. In 2006 it has been clearly stated that the Medigap Plans H, I, and J, cannot be sold to people with prescription to drug benefits, although there is a lax of this rule for people who already have those plans and they can keep them.
Source: momentinhistory.com

Get some basic idea about Medigap insurance polices

The fact is that there are twelve Medicare Supplement Plans which are available in the market are meant to bear the costs that are not the part of your Original Medicare policy. These Medicare Supplement Plans are named as A through L respectively and each of these policies have their own set of coverage benefits. These Medicare Supplement Plans are sold and completely administered by the private health insurance companies only. As stated earlier that each of the Medigap policies has their own set policy coverage therefore while choosing your Medicare Supplement Plans you should be very much careful that you choose the appropriate one meeting your needs. In this context it should be mentioned that the Medicare Part A policy is considered as the most basic plan and therefore whatever Medigap plan you may choose the basic benefits of the Medicare part A plan should be included in that. The Medicare Supplement Plans were standardized in 1992. And since then the plans almost remained the same. But in June 1, 2010, two new plans, M and N are going to be introduced as standardized Medigap policies. These two plans are meant to provide lower premium alternative to the existing Medicare supplement plans. However, it should always be kept in mind that the Medicare Supplement Plans are only supplement plans and cannot be sold independently. And therefore to get enrolled for a Medicare Supplement Plan you must first have an Original Medicare policy at hand. And to get the maximum benefits and cost reductions in premium payable the best thing to do is to get enrolled for a Medigap plan within thirty day of getting your Original Medicare plan. But along with that it is also to be mentioned that the Medicare Supplement Plans does not work with any other Medicare policies other than the Original Medicare. Therefore if you switch over to the Medicare Advantage plan from your Original Medicare policy you cannot use your Medigap plans unless you switch back to Original Medicare.
Source: articolate.org

Medicare extends coverage for obesity in America

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

Solomon’s words for the wise: Medicare Deadline Wednesday; Help Available

Workshops continue this week at area senior centers. Final two sessions are on Monday, Dec. 5, at Shinglehouse (9:30 to 1:30) and Tuesday, Dec. 6, at Ulysses (9:30 to 1:30). Medicare beneficiaries are encouraged to set up a counseling appointment; call 544-7315 or 1-800-800-2560. Counselors can answer questions, review current coverage, check qualification for low-income programs, compare plans with all available options, search for specific plans online that meet specific prescription and medical needs; and help beneficiaries enroll in a plan online.
Source: blogspot.com

The particular Medicare Ruse: How Insurance firms Use Medicare To be a Delay Technique in Law suit

The policies are most lettered AN IMPORTANT through T correctly. Every time the different types arise, the objective is to eliminate four from the Medicare Supplemental Insurance policy: E, THEY WOULD, I, together with J, on the grounds that they are usually too similar to additional plans and induce bafflement. Equally, Plan G is go to be revised to ensure excess bills are 100% coated. The House Care benefit is likewise stay put aside from this course of action. Even additional variations incorporate a hospice gain appear internal to virtually all Texas Medicare Supplement Insurance most recently released plans, Approach M together with N vacation in released hav co-pays together with lower insurance premiums, and whatever supplier that intend Plan A might be important to make available Plans H and M. Currently, insurance corporations that have Medicare Medigap Insurance sole currently have to give you Plan AN IMPORTANT, but that should alter eventually.
Source: nestat.org

The actual Medicare Ruse: How Insurance firms Use Medicare Being a Delay Strategy in Going to courtTech Data News

The designs are pretty much all lettered SOME SORT OF through M correctly. When the different types arise, the objective is to eliminate four for the Medicare Supplemental Insurance coverages: E, L, I, along with J, consider they are usually too the same to different plans and induce bafflement. At the same time, Plan G will likely be revised to make sure that excess payments are 100% coated. The Dwell Care benefit can be stay withdrawn from your plan. Even a great deal more variations will include a hospice gain appear constructed in to the majority of Texas Medicare Supplement Insurance most recent plans, Package M along with N work released us co-pays along with lower monthly premiums, and almost any supplier that intend Plan A can be important to make available Plans D and P OKER. Currently, insurance organizations that personal Medicare Added Insurance primarily currently have to give you Plan SOME SORT OF, but that will alter eventually.
Source: techdatanews.com

Medicare Tightens Pay For ‘Big Ticket’ Cardiology And Orthopedic Procedures

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotForbes: CMS Tightening The Screws On Unnecessary Procedures In Florida And 10 Other States After years of criticism that it has paid billions of dollars for unnecessary procedures, the Centers for Medicare & Medicaid Services (CMS) will soon ramp up efforts to rein in costs for unnecessary procedures. In 2012 CMS will perform an audit before paying for several big ticket cardiology and orthopedic procedures in certain key states. The news has provoked strong reactions from cardiologists and Wall Street. In Florida, in fact, 100 percent of stent, ICD, and pacemaker implantation procedures will undergo review before payment. Similar programs will take place in California, Michigan, Texas, New York, Louisiana, Illinois, Pennsylvania, Ohio, North Carolina, and Missouri, but the precise percentage and mix of cases that will undergo auditing has not yet been stated (Husten, 12/4).
Source: kaiserhealthnews.org

Video: Improper Medicare Payments: 8 Billion In Waste?

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

Users of Computer Programs and Systems’ EMR System Lead in Payments to Rural and Community Hospitals for Electronic Health Record Adoption

Mr. Douglas continued, “While we are very proud of the success these clients have achieved to date, we continue to work with many other clients towards their successful attestation and the subsequent payment. In fact, according to the most recent information provided to us by our clients, there are a total of 81 hospitals who utilize the CPSI EMR system that have successfully attested and received payments from Medicare and Medicaid totaling over $70 million. Another 25 of our clients have attested successfully and are awaiting payment. Therefore, to date, over 100 hospitals who utilize our EMR system have met the Stage One criteria and have either received their funds or are awaiting payment. Most importantly, these hospitals now have the tools in place to deliver more effective care in a safer environment resulting in better outcomes for their patients.”
Source: virtual-strategy.com

Hospitals See Medicare Payments Increase Under Final Rule

The Final Rule also brings changes for long term care hospitals (LTCHs). LTCHs will also see a 2.5% increase in Medicare payments for fiscal year 2012, which translates to about $126 million in total. The Affordable Care Act requires CMS to establish a new quality reporting program for hospitals paid under the LTCH PPS, and the Final Rule shapes the general structure of that program—known as the LTCH Quality Reporting Program. According to the Final Rule, CMS will begin collecting data on three patient-safety quality measures in October 2012: (1) catheter-associated urinary tract infection, (2) central line catheter-associated bloodstream infections, and (3) new or worsening pressure ulcers. In fiscal year 2014, CMS will apply a 2% payment penalty to LTCHs that do not report quality data to it. Other hospitals will see their quality reporting requirements increase as well because the Final Rule expands the number of quality measures that hospitals must report under the Hospital Inpatient Quality Reporting Program to 76.
Source: dbllaw.com

Medicare Payment SqueezeHardship on Rural Dialysis Patients

With reductions this year in Medicare payments to dialysis clinics for the treatment of end-stage renal disease, many clinics could close and many dialysis patients might have to find a new dialysis facility, adding substantially to their travel burden in miles and time, according to a presentation at a news conference here at Kidney Week 2011: American Society of Nephrology 44th Annual Meeting.
Source: nephrocapsblog.net

My Mother's Hospital Bill Reveals The True Cost Of Medicare

Well, as I was listening to these politicians talk during all the discussions leading up to the vote (and they are quite clever with their language) I kept coming back to the conclusion that the entire Act is a massive shell game of shifting costs around. I came to that conclusion because, despite claiming that they were going to reduce health care costs, they never actually provided any specifics as to where the savings were going to come from. Oh…they talked quite a bit about how they were going to negotiate better deals and reduce Medicare payments but that doesn’t actually reduce costs, just like forcing the hospital to eat $75,000 didn’t reduce the hospital’s cost of taking care of my mother. So the Act is going to just reduce payments and drive profits down and losses up for all the providers – i.e. things will get worse.
Source: chicagonow.com

Medicare collects almost $800M in overpayments

“Using data mining and computer matching, the OIG will review hospitals that have the most risk [of overpayments]. During the reviews, hospital executives might be interviewed about their compliance practices,” Francis J. Serbaroli, an attorney with Greenberg Traurig LLP in New York said, the article notes.
Source: fiercehealthcare.com

Sebelius: U.S. Doctors Embrace Digital Patient Recordkeeping

Barack Obama business California California Insurance Code California Superior Court Center for Class Action Fairness class action Congress Dave Jones employee benefits Federal Rules of Civil Procedure government spending Health healthcare health care health insurance Health maintenance organization insurance Jerry Brown labor union law lawsuit litigation Los Angeles Medicaid medicare National Labor Relations Board news oregon Patient Protection and Affordable Care Act politics PPACA regulation Republican San Francisco Supreme Court of the United States Tax tort reform United States United States Court of Appeals for the Ninth Circuit United States Department of Justice United States district court Washington White House workers’ compensation
Source: businesslawdaily.net

Problems with Medicare rebate claims since 1 November 2011

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSLifeline – www.lifeline.org.au Salvo Care Line – 1300 36 36 22 Talk to your local GP or health professional For young people, Reach Out! – www.reachout.com For people bereaved by suicide, Salvation Army Hope Line – 1300 467 354 For people from a culturally and linguistically diverse background, Multicultural Mental Health Australia www.mmha.org.au For Aboriginal and Torres Strait Islander People, Local Aboriginal Medical Service available from www.vibe.com.au SANE Australia helpline 1800 18 SANE (7263) or www.sane.org Gay and Lesbian Counselling Service www.glccs.org.au Vietnam Veterans’ Counselling Services and Community Services – 1800 011 046
Source: com.au

Video: Medicare rebates extended to nurse practitioners

Medicare Rebates and IVF Cost

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Source: katemontgomeryjuiceplus.com

Medicare Changes Reduce Rebates

The Federal Government have cut funding to the Better Access initiative. This impacts on Medicare rebates as of the 1st November, 2011. Previously people could access a maximum of 18 psychology sessions per year and be rebated through Medicare. This has changed to a maximum of 10 individual sessions or a maximum of 10 group sessions. Your referring doctor will assess your progress after the first six sessions.
Source: com.au

Manager of Government Reporting

In 2011 Hospira is reporting 950 products and paying claims for 127 different Medicaid programs.    In addition, this role is responsible for ensuring that Hospira domestic US customers are assigned accurate classes of trade. The federally mandated price factor calculations are all based on utilizing sales for customers based on class of trade. Incorrect classes of trade results in inclusion and/or exclusion of Hospira sales transactions which can significantly impact the final price factor calculations.
Source: webdesign-jobs.com

2011/Apply Job As Manager Of Government Reporting Medicare Rebates

The Patient Protection Affordable Care Act (PPACA) United States federal statute signed law President Barack Obama March 23, 2010. The law ( . Anthony John “Tony” Abbott (born 4 November 1957) Leader Opposition Australian House Representatives federal leader centre- . Self-employment working ‘ . Self-employed people referred person works / employer, drawing .
Source: applyjobs.org

PolitiFact Bias: Pete Sepp: “I don’t know who the experts you consulted are or whatever policy agendas they may have”

Pete Sepp, vice president for communications and policy for the National Taxpayers Union, usually interacts with PolitiFact as an expert source.  This month, however, the NTU ran an ad that received the PolitiFact treatment, and Sepp ended up as NTU’s spokesperson in defending it.  The ad called the federal government’s proposed rebate program for drug purchases a “tax.” Sepp did not publish a public rebuttal to PolitiFact.  Rather, we find his arguments hosted by PolitiFact’s Texas affiliate.   PolitiFact combined the bodies of three email messages from Sepp on a single reference page. Sepp’s initial email (bold emphasis added): Based on our experience, calling this rebate plan anything less than a tax fails to capture all of its effects: 1) With a few exceptions that the Secretary of HHS would be able to approve (an uncertain proposition), drug manufacturers would be required to rebate 23 percent of the average manufacturer price (more if the drug price rose quicker than inflation) for a brand-name pharmaceutical that was distributed to lower-income Part D beneficiaries. Otherwise, the company could not participate in providing drugs to Medicaid, Medicare, or other government beneficiaries. Considering there are already genuine rebates (i.e., negotiated discounts) under several such programs, this latest demand from the government for being able to sell to a huge segment of the entire consumer drug market in the U.S. seems more like a mandatory extraction than a voluntary refund. 2) The money collected from these “rebates” don’t wind up in the actual consumers’ pockets or the various Part D plans; instead they go to a fund that will defray certain government Medicare program costs. A “rebate” as is commonly understood is something that the consumer of product receives after purchase. This “rebate” is nothing of the kind, and represents deceptive terminology. 3) The “rebate” is based on a percentage of price per unit, a lot like the way some excise taxes on products such as some tobacco items work. 4) This “rebate” will in essence squeeze the price bubble somewhere else. Either other Part D beneficiaries get stuck with higher premiums, people in private, non-Medicare plans pay higher prices for their drugs, or drug development and access gets scaled back, or even voluntary discounts start to dry up. For a good summary of how this could happen, as well as some previous CBO work on this topic. I’d suggest the following link at American Action Forum, which former CBO Director Douglas Holtz-Eakin serves at: http://americanactionforum.org/topic/cost-shifting-debt-reduction-american-seniors Sepp from his first followup:
Source: blogspot.com

Obama plan to force ‘rebates’ into Medicare drug benefit will drive up costs for thousands of seniors 

[...] ACH19-ValueforMoney AHC13-PovertyandHealth Entitlement Reform NN11-Personal-News NN12-Job-Listings NN18-Conferences-Meetings NN19-Books NN20-Articles-Papers NN21-Grey-Literature NN22-Organization-News NN25-Videocasts NN27-Blogs PPACA-ACOs PPACA-ComparativeEffectiveness PPACA-Constutionality PPACA-Impact-Access PPACA-Impact-Consumers PPACA-Impact-Costs PPACA-Impact-Employers PPACA-Impact-HealthInsurers PPACA-Impact-HealthProfessionals PPACA-Impact-Hospitals PPACA-Impact-Outcomes PPACA-Impact-States PPACA-Medicaid PPACA-Medicare PPACA-PublicOpinion PPACA-Repeal Regulation-FDA Regulation-HealthFacilitiesSource: wordpress.com [...]
Source: wordpress.com

PRIVATE MIDWIFERY SERVICES: Learning Medicare

My mind has been challenged recently as I have attempted to learn the technology associated with Medicare rebates. I decided that a portable EFTPOS machine would be the best means of processing bulk billing and client rebates through Medicare.  This process requires a lot of technical support – well beyond my skill. The bank sent the machine, and set it up for me.  The next step was for Kirsty, a lovely lady who works for Medicare, to enter my provider number, and the item numbers for my work.  Kirsty worked through it with me, and I watched her process one claim, then did one myself.  Those payments have now shown up on the bank account statement. Yesterday I took the machine to a postnatal visit, and attempted to process the bulk bill payment on the spot.  It didn’t work.  I obtained a signed authorisation from the client, determined to work it out. Today I opened the manual, followed multiple instruction steps, and identified the point at which I had been stumped.  I was able to complete the transaction.  YAY! Medicare has offered me the immediate opportunity to do more postnatal work for my clients.  This is great.  I am thankful.
Source: blogspot.com

GP groups to intensify campaign for restoration of Medicare patient rebates for GP mental health services

UGPA put forward to the Minister the case that from November many people with mental illness would no longer be able to afford to see their GP – their first point of contact for care and advice – for mental health plans because the Medicare rebates will be between 25 per cent and 50 per cent lower than today.
Source: com.au

Changes to Medicare Part D Threaten Indiana Jobs and Life Sciences Economy

These jobs are important to our cities and towns across Indiana. The reality is they’re threatened by a proposed plan that would alter the financing of Medicare’s prescription drug component, Part D, by requiring pharmaceutical manufacturers to offer a mandatory “rebate” to the government on the price they charge for their products. The proposal would turn Medicare’s prescription drug financing into a copy of Medicaid’s failed formula. Mandatory Medicare prescription drug “rebates” would instantly undermine the principle that has made Part D so successful.
Source: wordpress.com

About Medicare Health Insurance

Posted by:  :  Category: Medicare

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

Video: Health Insurance Information : Health Insurance to Cover Pregnancy

About Medicare Health Insurance

Medicare is a federal plan, which offers health insurance to retired individuals, regardless of medical condition. Any individual who is getting Social Security advantages would automatically be enrolled in Medicare at the age 65 that is the age of eligibility. If you are not getting Social Security advantages prior to age 65, you would be by design enrolled when you apply for benefits at age of 65. If you decide to delay retirement until after age 65, remember to enroll in Medicare at age of 65 anyway, just because your enrollment would not be automatic. Individuals who would be automatically enrolled in Medicare would be further receiving notification by mail from the Social Security Administration, normally several months before your 65th birthday. Most people become qualified for Medicare in age 65 and becoming qualified for Social Security retirement benefits as well. Additionally, you might be qualified if you are disabled or have end-stage renal disease.
Source: zelar.net

Treatment Supplement Coverage, Or Medicare supplemental health insurance Policies

Treatment Part ANY is healthcare facility insurance, which inturn covers inpatient healthcare facility stays and also care dur hospice, home health reform, and car for facilities. Medicare Component B is helath insurance. It handles services out of doctors, outpatient products and services, and precautionary services. Treatment Part J, also generally known as a Treatment Advantage Approach, includes Component A, Component B, and sometimes medicines. The suit, Medicare Component D, is normally prescription pharmaceutical coverage, and probably do end right up lower bills for medications overall.
Source: irvinemocktrial.com

Halt Medicare Fraud Before you decide to Become the Victim

Medicare fraudulence occurs as soon as false claims are intended for a realistic beneficiary. Includ , you check out a particular medical professional or professional medical clinic. They gather your Medicare health insurance card and provide certain amount which is due, products bill Medicare health insurance for a lot more than that quantity. They pocket or purse the distinction. Another version of Medicare fraudulence is as soon as someone debts Medicare pertain to services or maybe equipment which you never gained or pertain to items not the same as what everyone received. A underhand individual may additionally use this Medicare account of another to obtain medical services or even buy tools. Or, anyone may profit home professional medical equipment, but always bill Medicare for any equipment. You can get o medicare supplement quote er changes of Medicare health insurance fraud, but most are many of the.
Source: jadeisland.com

Popular Article and News Directory

Posted by:  :  Category: Medicare

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Source: qomuast.com

Video: YouTube Videos matching query: champva insurance

Champva Insurance for Effective Health Measures

Champva is a useful program in which the Department of Veterans Affairs (VA) shares the cost of some health care services, thus supplying you with eligible beneficiaries. This particular program offers you robust pharmacy benefits and supplies health care services that are needed medically or psychologically. The Champva Insurance is provided to the spouse of and children of an individual rated permanently disabled due to service connected disability or service connected condition at the time death. This also extends to people who died on active duty or due to a service connected disability. However, the dependents are not eligible for DoD TRICARE benefits. After the confirmation you will receive a handbook, wherein the program material will address the services covered. It is a simple task to acquire this insurance plan. It is important to take some time off your schedule and conduct a comprehensive search on the web before applying.
Source: myarticlesonline.com

Healthcare Economist · Health Insurance Premium Growth

Health Insurance premium inflation is back.  According to the Kaiser Family Foundation Employer Health Benefits Survey 2011, health insurance premiums for single individuals was $5,429 for single individuals and $15,073 for a family plan.  Premium growth for single and family plans was below 6 percent per year over the last 5 years (2005-2010). However, between 2010 and 2011, premiums grew 7.5 percent for single plans and 9.5 percent for family plans.
Source: healthcare-economist.com

Champva Supplemental Insurance

Medicare also limits the number of items for ostomy supplies used per month. If you have questions about Medicare, call 1-800-633-4227 or contact your local Social Security office. Medical costs and individual disabilities leading to unemployment or under-employment are some of the leading causes of bankruptcy and poverty. Champva Supplemental Insurance For that reason, LEJ launched its Disability Law section to assist disabled individuals in obtaining the federal benefits they so desperately need to ensure that they have access to regular medical care and money for living expenses.
Source: champvasupplementalinsurance.net

CHAMPVA Supplemental Insurance

CHAMPVA Supplemental Insurance The CHAMPVA Supplemental Insurance Plan when combined with CHAMPVA benefits, is designed to provide you with the protection you need when you need it. The plan will pay cost share for covere
Source: theseolinks.com

Does anyone know if ChampVa supplemental insurance covers LapBand procedure? :Help With Your Family's Health

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Source: family-health-plan.com

Sydney Arab Film Festival

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Source: sydneyarabfilmfestival.com

VA Joins White House in Reaching to Military Families

As I just now read your response as well as your valid points in your commentary that were so right on point! As you are struggling to receive help with your spouse my heart goes out to you and your veteran. As I am the veteran who has been seeking assistance for years with the VA, although I was not exposed to AO, I however, was exposed to asbestos while in the Navy. As a Toxicologist who wrote an opinion (medical nexus) letter on my behalf stated that in the brief time that myself and other Navy personnel who worked with and handled this asbestos our exposure level was comparable in just daily contact for approximately ten months or so was the equivalent to an individual that had worked a forty hour per week at a job for twenty-five years. Yet despite having two retired Navy veterans providing witness statements, as well as DD214′s and Performance Evaluations that praise my job performance working in the area(s) that the exposure took place, as the VA has stated “Exposure has yet to be established in your claim”. Even utilizing “Junk Science” as one of my doctors said when my VA regional office denied benefits called are one of the countless deny, delay tactics that the VA uses in their unethical bag of tricks to deny, frustrate veterans such as myself and others. In the initial ruling issued the logic used by the medical professional was that since I did not have asbestosis in addition to the cancer that I developed, then this only further substantiates that my asbestos exposure did not occur. Which as one of my doctors said in response was the same as saying that even though a patient develops lung cancer from asbestos exposure, that that his/her exposure never took place unless he/she had asbestosis to boot. The argument is ridiculous, but yet these VA contracted doctors offer these medical opinions and the VA adjudicators as they are not medical professionals are more than happy to follow their lead and render these absurd rulings. In my case I filed a claim in 2005 as four of my doctors said that my cancer was caused by my asbestos exposure while in service. Now unfortunately as of last year I was also diagnosed with Asbestosis which should now only further my claims contention that my cancer was caused from asbestos exposure right? Well wrong, as I recently found out as I had filed a claim for service connection for asbestosis and underwent a C&P examination for this illness. You see the ridiculous is always possible concerning the VA and this was only further re-enforced at this examination. I had mailed in the supportive evidence that my doctors had based there diagnosis on concerning the asbestosis. I know the VA had received this medical evidence as I had a signed receipt from FedEx. Then I had physically carried the mountainous volumes of paperwork that composed my claim file to the Pulmonology department, where I was greeted by a cordial doctor who seated me in an examination room and excused himself for five minutes. When he returned he thanked me for my patience as he said that he needed to review my claim. I asked if he had read all the evidence that I had submitted, to which he replied he sure did. First blatant lie right to my face, I had submitted CAT scan report after CAT scan report from the years 2002 to 2009 along with medical opinion statements from my doctors and experts, witness statements and on and on. No Evelyn Wood speed reading course possible would have allowed for this person nor any other to consume and comprehend the information that was my evidence. The examination continued and as I asked the doctor question after question concerning what he supposedly had just reviewed which he greeted with silence and clear embarrassment as he knew that I had caught him in a lie. This same doctor then asked me to explain my asbestos exposure which I gladly recounted for him with as many details as possible. As I again began to question this doctor the seat got too hot for him and he said that he needed to consult his resident in charge and would be right back. So after another five minutes he returned with two more gentlemen who one of them identified himself as the resident in charge of the Pulmonology department. Now this doctor took over the examination to which he said that he had looked at my last CAT scan that was conducted at the VAMC in 2006 (This is now February 2011) and proclaimed as in a miracle “You have no signs of any asbestos related lung disease!” Halleluiah! Well now I am totally relieved, how wonderful! Then I asked this same doctor if he had read all the other evidence that I had submitted to which he said that he had. So I said first doesn’t common sense say that if this in now 2011 and you are making a medical diagnosis would you not want to utilize the most recent reports, exams, tests as possible? I said if you had a child and were consulting a doctor about your child’s health would you look at something from 2006 or 2009? This was met with silence. I said look the way that asbestosis is diagnosed is that radiographic films from over a period of time usually many months and years between are compared and contrasted. When these are reviewed things such as interstitial lung disease, pleural plaques, pleural fibrosis, pleural thickening and all these other lung abnormalities that are noted are evidence and are indicative of having asbestosis. I said that this is throughout any literature anywhere that you read concerning asbestosis. This or an actual biopsy that can actually identify the actual asbestos particles. I said in reviewing these CAT scan reports is anyone of you an American Board of Radiology Certified “B” Reader? I explained that this is a medical doctor who has been specifically trained to diagnose asbestosis when reading radiographic films such as x-rays or Cat scans, so are anyone of you certified? Once again I was greeted with silence. In fact now this doctor began to try and talk over the top of me as though I was not even there. I said look I have brought with me both the reports and a copy of the actual films that I have submitted that two of you have said to me that you both have already read and reviewed, along with all other evidence that I have submitted to the VA regional office. Would you like to go over with me what my doctors have said as well as comparing and contrasting these reports or films? Again silence and discomfort. I said what you have done is said that you have reviewed all the evidence and have not. Next you have chosen a CAT scan taken from five years ago that does not list any of the symptoms that clearly identify asbestosis and despite what my doctors have diagnosed proclaimed that a miracle has taken place that I do not have the disease that you are supposed to honestly and objectively investigate whether or not has occurred. The resident in charge asked me about the nodules on the exam that he was referring to, he asked me if I had an biopsy? I said that a biopsy had been done as well as a lengthy discussion had been held with the Pathologist who said that although he had only been looking for cancer but that he had noted granulose material had been identified. He further said that the sample had been taken from mid-lung and that it has been his experience that the best location for retrieving samples that may contain asbestos paricles would be from the lung base as this is the area of the lungs that asbestos as well as other particulate matter would collect. The reason is simply the way the lungs function as we do not fully expand our lungs and as such do not expel material and so asbestos fibers begin to collect there first. Having said this the doctors stood up and said that they wanted to schedule me for a Pulmonary Function Test. I said look you and your associates have demonstrated that either the VA regional office is negligent in that either they did not provide all the evidence that I had submitted and you were unable to review this? Or the evidence is there and you have chosen to be negligent and refused to review this evidence? I said either way this has been a farce and that no matter what I said here today had any impact on this examination. I said that you and your staff have determined no matter what I said or did that you were going to make sure that under any circumstances that I did not have asbestosis, period. I said that I will be filing a grievance with the VAMC, the VA regional office as well as anyone else that will listen to me, that is a promise. I said if for the fact that as you have tried to railroad me that I want to prevent any other veterans that appear in this department that they will not be railroaded as I have, this has been absolutely sickening. I said that this has gone against every basic principle that the VA is supposed to stand for concerning veterans that have been injured or develop diseases as a result of serving in the military. Of course I followed up and completed the Pulmonary Function Test which my wife and I then picked up a copy of both the test as well as the C&P examination report. I followed up with my primary care physician who interpreted the report and then said after I explained what had happened that I needed to be re-evaluated and submitted another referral. When we read the C&P report sure enough the doctor said that I did not have asbestosis and that they had based this on the 2006 CAT scan which had been compared with another CAT scan that had been taken two months later in that same year. Wonderful since that was 2006 and now this is 2011. Once again the VA has demonstrated its objectiveness and fairness! Furthermore, the Pulmonary Function test was interpreted and it was stated that I had normal lung capacity. However, regarding the two other critical areas concerning how my lungs are actually performing these could not be interpreted and as was noted by the technician “Due to lack of effort from the patient.” his despite during the entire testing the technician would demonstrate what he wanted and then I would try and repeat what he had shown me, all the while yelling good, good! Why have I relayed this long story with so many details? Simple this is only one example of the corruptness of the VA’s Compensation and Pension examination process. From our point of view this whole process is a conflict of interest right from the very start of it. These VA doctors who are employed by the VA are supposed to be objective, yet this as in other cases does not occur. Their purpose is to find evidence on the VA’s behalf that the veteran does not have any service connected injuries or illnesses. The deck is stacked against the veteran before they even appear for the examination. If the VA was truly getting to the truth of the matter they would contract and have civilian medical doctors conduct these examinations. I know the VA’s issues of logistics and transportation for the veterans and so on, but this does not hold up. As in my case do I now take the medical opinion of a VA Pulmonologist who proclaims that these is no issue? Or do I follow the lead of a medical doctor that is a “B” reader along with an doctor that is a Toxicologist and another that is a Occupational and Environmental Health Scientist as well as the countless Radiologists through the years which have noted time and time again on these radiographic reports in their findings of pleural plagues, fibrosis, pleural effusions, blebs and all the other indicators of asbestosis? Not to mention the physical exertion that happens with even minimal activity? I followed up with the VAMC Patient advocate and was finally informed that I could undergo another evaluation by a different doctor at the VAMC Pulmonologist department, or I can go to another VAMC of my choosing. As a result of my two bouts of cancer from the asbestos exposure and all the secondary health issues from the cancer I will never be able to work again for the remainder of my life and since I was the primary bread winner we now live in poverty. But the VA has burned this bridge with me, so now I must utilize Medicare and seek monitoring and treatment in the civilian sector, which now will cost us even more medical bills. All because doctors that are employed by the VA are not objective. They do not put the patients health first and foremost, they put their paychecks first, while the VA encourages this either formally or informally. I underwent a C&P examination with one doctor who was supposed to be examining me for one issue. He said that the VA only wants him and other C&P doctors to investigate specifically what is on the request for the report when veterans appear in front of him for an examination. However, even in the VA’s own guidelines that if while investigating one injury or illness another is identified then the doctor should make a determination if this disease needs follow up or may be service connected as the veterans health should be the main focus. As he was examining me he encountered another medical issue and said that this was in his opinion clearly service connected and I eventually received compensation. This same doctor said that many of his colleagues turn a blind eye to such things, they are afraid of loosing the easy pay from the VA as most of them are retired and conduct these exams as an easy source of income, no stress, good hours a comfortable job. My personal recommendations for anyone that may read this is to ensure that ensure that you bring a witness, bring a spouse a friend or a family member. Ask questions, do no be afraid to point out things that you know to be true concerning your health. Make sure to take notes afterwards or during of what has occurred, list as many of the specifics as possible. Remember as in my case since now my claim was formally denied that you will be appealing and you can further substantiate your appeal with facts. When I received the Boards decision the evidence that these doctors where supposed to have examined and reviewed were listed as part of the evidence used in determining the Boards decision. File a compliant with your local VAMC as well as your local VA regional office. Unless these doctors are held accountable there never will begin to have positive changes made to ensure that our veterans are evaluated fairly and objectively. In my case irregardless of any VA claim my health comes first and foremost as does any veterans, as I have been told that I have potentially another fatal disease I needed another fair objective medical opinion and I tried to achieve this from my local VA, which didn’t happen. Do not be afraid to get other opinions and have additional examinations from medical doctors.
Source: va.gov

Three Questions About Medicare

Posted by:  :  Category: Medicare

Drug questions by anolobbMedicare in the United States is a big thing as it should be. This social insurance program is designed to provide support for the elderly. Through the years, it has helped a lot of people get financial support when it comes to their medical bills. Unfortunately, there are still plenty of people who are still in the dark about Medicare. This means that they cannot fully enjoy its benefits or not at all.
Source: econorthwest.info

Video: Allen West – Nicole Sandler Medicare question

frequently asked questions during the 2012 medicare annual enrollment period / eHealth

About eHealth  eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website,www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side by side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth’s technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help seniors navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
Source: ehealthinsurance.com

My Mother's Hospital Bill Reveals The True Cost Of Medicare

Well, as I was listening to these politicians talk during all the discussions leading up to the vote (and they are quite clever with their language) I kept coming back to the conclusion that the entire Act is a massive shell game of shifting costs around. I came to that conclusion because, despite claiming that they were going to reduce health care costs, they never actually provided any specifics as to where the savings were going to come from. Oh…they talked quite a bit about how they were going to negotiate better deals and reduce Medicare payments but that doesn’t actually reduce costs, just like forcing the hospital to eat $75,000 didn’t reduce the hospital’s cost of taking care of my mother. So the Act is going to just reduce payments and drive profits down and losses up for all the providers – i.e. things will get worse.
Source: chicagonow.com

Common Medicare Questions and Answers

3. Can Medicare program consider a service to be unnecessary? Yes. If a doctor or physicians find it necessary to perform a certain medical operation or service which is not covered by the patient’s current Plan Policy benefits, they are supposed to notify or advice the patient in writing about the process and that Medicare will not cover the expenses. And if the service charges are estimated to exceed a level at which Medicare can cover, they are also supposed to notify the patient with them in writing. It is done in writing and the customer approves of the service by signing against the given notice.
Source: frontagecode.com

Health care questions? Where to turn.

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Source: ncpolicywatch.org

Urgent: Medicare Open Enrollment Ends December 7

To help consumers answer those questions, the department offers a free counseling program, which can be accessed by phone or in person. The program, Community Leaders Assisting the Insured of Missouri (CLAIM), has already helped more than 6,500 Missourians since open enrollment began on Oct. 15. The CLAIM program, funded by Medicare and the Department of Insurance, offers free, expert assistance to Missourians on Medicare or their loved ones.
Source: ma4web.org

Medicare extends coverage for obesity in America

Posted by:  :  Category: Medicare

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

Video: Health Insurance Information : What Is Medicare Part B?

About Medicare Health Insurance

Medicare is a federal plan, which offers health insurance to retired individuals, regardless of medical condition. Any individual who is getting Social Security advantages would automatically be enrolled in Medicare at the age 65 that is the age of eligibility. If you are not getting Social Security advantages prior to age 65, you would be by design enrolled when you apply for benefits at age of 65. If you decide to delay retirement until after age 65, remember to enroll in Medicare at age of 65 anyway, just because your enrollment would not be automatic. Individuals who would be automatically enrolled in Medicare would be further receiving notification by mail from the Social Security Administration, normally several months before your 65th birthday. Most people become qualified for Medicare in age 65 and becoming qualified for Social Security retirement benefits as well. Additionally, you might be qualified if you are disabled or have end-stage renal disease.
Source: zelar.net

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

Deciphering Medicare Eligibility

Questions arise all the time about Medicare. Eligibility, cost and coverage are the three topics of conversation that are talked about the most. Eligibility is a topic all in its own. Most people are under the assumption that the only requirements to qualify for Medicare benefit is that they have turned sixty-five. That however is not the case. This article will help layout guidelines on eligibility so that it is easy to determine if you fall under the guidelines to qualify for the Medicare benefits and Medigap supplement insurance.
Source: informationpleasearticles.com

Solely Qualifying to get Medicare Positive aspects? Some Points to consider

Although your specifics of every Medigap insurance policy might change with a yearly foundation, the standard tenets of every plan will continue the equal. One of the extremely popular extra Medicare procedures is Treatment Plan FARRENEHEIT. This is born both that will its flexibility together with the fact not wear runn shoes has become the only policies which may cover just about any excess Treatment charges. These too much charges mean the significant difference between what the physician charges plus what the exact amount is who Medicare can pay. This extra plan maybe there is to covers those outside of pocket costs which may add way up in conditions of sudden or hav extra prophylactic care that was not normally included in Medicare.
Source: ebm4u.com

Insurance health survey in India proves its rising popularity!

Posted by:  :  Category: Medicare

TTT #5... 259365 by paloeticGettinghealth insurance affordableplans is purely a personal choice. The cost of health care services these days is increasingat a great speed. This has a direct impact on medical insurance which also varies according. Hence, it is wise to research extensively prior to obtaining detailed knowledge related to the best medical coverprovided by leading insurance companies across the nation. The medical insurance plans as well as home health servicesare offered by varied range of health organizations in India. These are known to be quite competitive and also vary a lot in their premium rates. Each health insurance company these days is religiously modifying health plans and making them very affordable to prospective customers. But this does not indicate that you need to purchase whatever is provided to you by the health insurance company. As per a health survey, it has been actually proved that people fail to enjoy maximum benefits of health insurance affordable plans and home health services.This is because they do not focus on making good efforts from their side. They also take whatever is actually offered by the organization. This is a wrong way of buying insurance. It is not difficult to get the best rates for health insurance plan. All you need to do is follow all the tips mentioned below: You Specific Health Insurance Requirements You must understand that it is not possible get health insurance affordableplans home health servicesunless you have a crystal clear idea of what cover you accurately want to benefit from. Hence, your major job should be to create a list of all that you require under the category of medical insurance plans prior to buying one. Research is Religion There is no substitute to making an extensive research online for different health insurance organizations before buying a plan. This will definitely help you avail an idea on what is exactly available on the market and decide accordingly. Stay Healthy It is easy to reduce health insurance premium once you take best care of your health. For example, you need to keep your body weight in control and follow a healthy lifestyle. Stay away from Smoking and Alcohol Consumption This is definitely one of the best ways to reduce premium rates for health insurance plans. Health Insurance Quotes You must focus on comparing health insurance quotes online to get amazing discounts on your insurance plans.
Source: articledevlist.com

Video: Health Insurance Plans.wmv

Blue Cross Blue Shield Offers Great Health Insurance Plans To Everyone

Did you know that the average cost of getting heart bypass surgery is nearly $60,000? Do you have that much money laying around incase something happens to you or a loved one? Most people don’t. This is why it is extremely important for people to be covered by an insurance company. The costs of medical expenses for someone who doesn’t have insurance even for the smallest surgery or for even a normal doctors visit for someone without insurance can be into the thousands of dollars. Most people think that they don’t need insurance, and the truth is, the probably don’t need it, until something happens, and then it is too late. This is why Blue Cross Blue Shield offers great prices on health insurance plans for almost everyone. Whether you are looking for a family plan, group insurance plan, individual plan, or even a short-term plan there is a plan for you at Blue Cross Blue Shield. One of the things that Blue Cross Blue Shield prides itself on are the different plans they offer people who are, one of the problems with a lot of health insurance companies is that they have inexpensive plans, but these plans seem to be for every type of situation but yours. Don’t worry, you will find a plan that fits your needs and it may be right around the corner you just have to look. If you still decide not to purchase insurance there are a few things you can do to try to keep yourself out of the harms way. There are a few free to low cost medical clinics in every state where people can go to get yearly check ups as well as medical exams for very little to no money. Although these clinics often do not do the full medical exam a traditional doctors office would, they still will help you keep on the healthy side. It is extremely important for people to get yearly check ups especially if they don’t have insurance because this is when they will be screened for important sicknesses like Cancer and Diabetes, both of these sicknesses are very important to be checked for especially as you age because cases of both cancer and diabetes increase as you pass the age of 45. Another tip for someone who decides to not purchase health insurance is to eat healthy and work out a few times a week. Not only does eating healthy add years on your life it also will help you maintain a healthy weight which is very important if you are planning on staying healthy. Also, it is important to stay away from smoking, not only is smoking bad for you but it is bad for people around you, if your health is important to you, you will need to follow these recommendations.
Source: votejoinrun.com

The Various California Health Insurance Programs

A real favorite of Southern California Health and fitness is always that of the Southern California requirement of insurance coverage active preparation. It can also be seen as the IPPC-will offering before the health insurance for a pre disability if the insured for at least six months were insured and have professional medical insurance refused because of the current situation. The person must be a U.S. citizen or legal resident must there to take advantage of this policy.
Source: aapp2000.org

The Different Medical Malpractice Insurance Plans Types

The first type of insurance plans are the statements made coverage, which gives total insurance packages for activities that occur on, or even after, the policy’s retroactive date. Having said that, for the claim to be legitimate, the function must be reported throughout the policy time period. What’s wonderful with this insurance packages type could be the way the price of the insurance policy improves. For the first year, the expense of the insurance policy is very lower, and it’s thought to be a 1st-year claims insurance policy, however subsequently, as the years pass, expense of the policy rises as it matures. Five to 8 years are important for the policy to attain its mature stage, and reach it’s maximum value. This is often essentially the most popular kinds of malpractice insurance, however there’s also individuals.
Source: addarticles.co

How to buy student health insurance plans in Virginia

While studying in Virginia, a lot of options are there for students. Conventionally, student health insurance from a university plan is preferred. But, these contracts often fail to provide the right kind of coverage and benefits needed. A lot of students in Virginia end up paying huge amount of money out of their own pocket. Students enjoy better health and being young, affordable medical insurance is likely to be available from a major insurance company at a low price. Just because a university offers a cheap medical insurance plan, student should not ignore the lean benefits it would offer. A lot of companies market their products geared to tap students at a lower price; however, it makes sense to check the limitations and level of coverage provided. The students should make sure they are getting optimal coverage before buying any health cover plan in Virginia.
Source: planavarra.com

Save on Florida Health Insurance

In case you are not careful with the requirements of your Florida health insurance, the insurance company can work havoc with your premium, which will go on increasing each year. This amounts to increased payments every subsequent year. If it is an association plan, you need to have a word with your agent regarding if the state governs the plan. Go for the policies that are not association plans and those that are guaranteed by the state of Florida. In order to make your investments on Florida health insurance successful, you should work with an agent who comes up with plans from various companies.
Source: sms-gsm.net

Health Insurance Companies Still Operate The Old

Such insurance plans are good for young people of the ages of 20 years and above and old people from the ages of 50 to 65years of age. This plan is good for this group of people because most of them do not have a health insurance being offer by their employers and at times because they are self employed or may be still studying and do not have jobs. While on the other side older people of the ages 50 to 65 are already up for retirement ad and would obviously loss their health insurance coverage from their employers. Some elderly people prefer going in for major medical health insurance coverage because they take into consideration the possibility of financial loss when they are face with a critical illness that are not covered by their current health insurance plan. Read more: Buying cheap major medical insurance coverage for health
Source: healthyconversions.net

Health Care Financing: Is Traditional Medicare Uncompetitive?

Posted by:  :  Category: Medicare

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

Video: Healthcare March

Medicare extends coverage for obesity in America

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

Enrollment Still Growing In Medicare Advantage Plans, GAO Says

While 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

Kathie Bracy’s Blog: Tom Curtis: Letter to retirees

I will not bore you with but a few more details. I have spent 3 days and 5-10 hours of time on the phone, and going to look at 3 facilities that are close to my home, all of which accept Medicare. Out of those 3, I am only permitted by our contract with Aetna/Healthways to enroll in one of those facilities. The one I am permitted to enroll in, has about 1/4th of the area and equipment that the YMCA has. The YMCA will accept the Medicare Silver Sneakers program, but because Aetna/Healthways does not accept the YMCA, I am not permitted to use that facility. Oh yeah, they are sorry for this inconvenience. Someone telling me they are sorry means absolutely nothing today.
Source: blogspot.com

Health Beat: “Premium Support” Is Just Another Way To Privatize Medicare

If, as the Times reports, some Democrats are warming to the idea of premium support for Medicare, they are not embracing Ryan’s draconian voucher plan. Instead, they may be reconsidering the merits of a premium support plan championed by Alice Rivlin, director of the Office of Management and Budget during the Clinton administration and Pete Domenici, former chairman of the Senate Budget Committee. During the budget deficit negotiations, Rivlin urged the supercommittee members to consider an insurance exchange for Medicare beneficiaries—with a public option; “Private plans would compete with the traditional Medicare program and would have to provide at least the same benefits. The federal contribution in each region would be based on the cost of the second-cheapest option, whether that was a private plan or traditional Medicare,” the New York Times article explains. The idea of the Rivlin-Domenici plan is to move Medicare toward a premium support model, “without destroying the individual entitlement at the heart of the program.”
Source: healthbeatblog.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: selling-medicare-supplements.com

Medicare health insurance Advantage AS OPPOSED TO Medicare Extra Providers

In 1965, Congress answer concerns related to increased medical costs Medicare Supplement older human be s passed some sort of amendment towards Social Security and safety Act of which created Medicare insurance. The take action created a few benefits, Medicare Area A of which covered hospitalization plus Medicare Area B of which provided insurance to protect other clinical costs. Legal issues creat Medicare insurance was authorized by Us president Lyndon Manley on This summer 30, 1965, with the sign wedd former Us president Truman has been issued the 1st Medicare account.
Source: tuneupmypcforfree.com