Medicare Needs a Budget and Structural Reform

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by TalkMediaNews"Medicare faces a dismal future that could threaten its very existence." This statement says it all for Medicare, and Social Security. The programs have not fundamentally changed since their creation. It is time to make them stable again, so that they can continue to be an "extremely helpful program to millions", as articulated by Jeff. But to update both programs, two fundamental principles/mindsets must be implemented/followed: 1. Those who are currently in the programs and those who are about to enter the programs must be promised that their coverage WILL NOT change. The governemnt made them a promise and it must own up to that promise. 2. Those who are just entering the work force or have more than 15-20 years to retirement, have to understand that they will not get the same promise as their parents and must take some personal responsibility for their own future. If either of these ideas are not adhered to, any change to the programs is doomed to failure.
Source: heritage.org

Video: Medicare

No Medicare Cost Controls

When Medicare, the federally run health care financing system for Americans who are 65 or older, passed in 1965, supporters knew the pro- gram would be expensive. Its lack of cost con- trols was the price of passage. Wilbur Cohen, a top health bureaucrat dubbed “The Man Who Built Medicare” by Medical World News, admitted that “the sponsors of Medicare, including myself, had to concede in 1965 that there would be no real controls over hospitals and physicians. I was required to promise before the final vote in the executive session of the House Ways and Means Committee that the federal agency would exercise no control.”
Source: reason.com

What Every Baby Boomer Should Know About Medicare

With all the talk about the high federal budget costs of Medicare, some may erroneously think the government pays for all Medicare services. Far from it. Beneficiaries have to pay monthly premiums, deductibles and co-payments or coinsurance. Figuring out your coverage and costs can be challenging, especially given Medicare’s different alphabetic parts: A (for inpatient hospital care), B (for outpatient services and doctor visits) and D (an optional drug benefit). There’s also a Part C, usually known as Medicare Advantage. This is an alternative to traditional Medicare and is offered by private insurance companies.
Source: kaiserhealthnews.org

Democurmudgeon: Politifact and Politico urge end to Medicare, blissfully ignore Economic Reports Ryan’s Plan Dismantles Safety Net.

And once such a plan is in effect, tinkering and downsizing government payments will further tear up a very successful and necessary program. But Politifact does this all the time; they ignore the overall objectives of both parties, in this case, the Republican vow to do away with the social safety nets. That’s what makes their pronouncement so unsettling, and why opportunists like Paul Ryan are going to ride this wave of conservative “I told you so’s.” 
Source: blogspot.com

The Official Medicare Set Aside Blog And Information Resource: Medicare spends $250MM on….

MEDVAL, LLC provides pre-settlement and post-settlement services for high exposure workers’ compensation and liability claims that require Medicare’s interests to be protected pursuant to 42 USC 1395y(b)(2). As the first firm in the country to provide a fully integrated, one-stop solution for the Medicare Set-Aside process, we can recommend Medicare Set-Aside arrangements, submit them to the Centers for Medicare and Medicaid Services (CMS) for approval, provide annuity and lump sum funding options, provide post-settlement medical trust administration, and pharmacy benefit management to our clients all under one umbrella.
Source: medicaresetasideblog.com

Mitt Romney Uses Semantic Shifts To Conceal His Medicare Killing Agenda

It is no wonder Romney is paranoid about calling his plan a cut to Medicare, because as it is now, Medicare is a dependable, popular, and life-saving program for a majority of seniors who exist on a fixed income. He says that no Republican is talking about cutting Medicare, but his own plan to “fundamentally transform Medicare into Medicare 2.0,” automatically cuts benefits depending on the whims of Congress and the cap on its growth every year. His plan, like the Ryan-Heritage plan will issue vouchers to seniors to buy private health coverage and if Congress decides on an amount lower than the cost of a private plan, seniors are left to fend for themselves. Medicare is a wildly popular program that guarantees affordable health care for millions of seniors regardless of private insurer’s premium increases, and Republicans cannot wait to transfer taxpayer contributions directly to the insurance industry that is notorious for raising premiums without cause.
Source: politicususa.com

Democrats revisit ‘Madoff of Medicare’ as Team Scott touts boss’s hospital history

You may recall that Gov. Rick Scott was forced out of the worldwide hospital chain he founded just before the company paid a record $1.7 billion in fines for Medicare and Medicaid fraud. (His severance was worth about $310 million.) It was one central themes of the 2010 campaign: Democrats spent millions to remind voters, Scott spent millions more to explain it away.
Source: typepad.com

THE Consortium: Proposed Meaningful Use Timeline Changes Encourage Adoption of EHRs

Posted by:  :  Category: Medicare

In response to significant input from multiple stakeholders, expert testimony, and countless hours of review, analysis and deliberation, HHS announced its intention to delay the start of Stage 2 meaningful use for the Medicare and Medicaid EHR Incentive Programs for a period of one year for those first attesting to meaningful use in 2011. CMS intends to propose such a delay in the Stage 2 meaningful use Notice of Proposed Rulemaking (NPRM), which is scheduled to be published in February 2012. Why Did We Make this Decision? Input from the vendor community and the provider community makes clear that the current schedule for compliance with Stage 2 meaningful use objectives in 2013 poses a challenge for those who are attesting to meaningful use in 2011. The current timetable would require EHR vendors to design, develop, and release new functionality, and for providers to upgrade, implement, and begin using the new functionality as early as October 2012. What are the Benefits to the Proposed Delay? We believe that a proposed delay will be beneficial for several reasons:
Source: blogspot.com

Video: Medicine Dish: Medicaid and Medicare Data for American Indians and Alaska Natives

Weekly Update: Colorado Medicaid EHR Incentive Program to Roll Out Soon

Later this month, CORHIO will assist the Department of Health Care Policy & Financing (HCPF) as it implements the Medicaid Electronic Health Record (EHR) Incentive Program. The program will provide incentive payments to eligible providers as they adopt, implement, upgrade or demonstrate “meaningful use” of certified EHR technology. Under the terms of the agreement with HCPF, CORHIO will be responsible for program coordination as well as provider education and communications, providing a central point of contact on behalf of Medicaid. CORHIO will not be responsible for issuing payments to providers, but will instead help coordinate the implementation of the registration and attestation system being provided by a third-party vendor and ensure Colorado providers are educated about the steps necessary to sign up for, qualify and receive Medicaid incentive payments. To read full article please click here
Source: blogspot.com

States Wrestle With Medicaid Funding And Budgets, Contracts, Rule Changes

Lexington Herald-Leader: Beshear Administration Delays Release Of Details On Medicaid Contracts Gov. Steve Beshear’s administration will announce next week details about managed-care contracts for Medicaid, the federal-state health care program for the poor, aged and disabled. The administration previously said that it expected the managed care contracts to be signed by Friday, the beginning of the 2012 fiscal year. … How soon those contracts are signed and for what amount is key to balancing the 2012 fiscal year’s budget. The legislature passed a budget this year predicated on more than $166 million in savings in the $6 billion Medicaid program. Beshear had pledged that he would generate savings in the program through managed care and other cost-saving measures as a way to plug a hole in the budget (Musgrave, 7/2).
Source: kaiserhealthnews.org

medicaid decreases for colorado assisted living providers

Question: I have heard rumors that there will be another medicaid decrease before the end of this fiscal year and then another in the next fiscal year. What have you heard? And how can we, the medicaid providers, make our objections to the decrease heard. It is become more and more difficult to doing business with less and less money. This will be the 5th decrease in 1 1/2 years. Thank you. Answer: CALA is working hard to provide a strong and united voice for Assisted Living Providers in Colorado. By working together and now with our Lobbyist our voices can be heard. Visit the following link that provides more details to this question. Reducing Medicaid Rates for Assisted Living Providers in Colorado You can add your comments and further questions at the bottom of the that post.
Source: coloradoassistedlivingassociation.org

Safety Net Providers Innovate to Integrate

In Iowa, a grant from The Commonwealth Fund is helping assess the potential impact of the ACA on the state’s safety net. The Iowa Collaborative Safety Net Provider Network, created in 2005, provides a forum for collaboration on primary medical and preventive care, dental care, mental health, and pharmacy needs of vulnerable populations. Researchers at the University of Iowa are working with the network, holding stakeholder meetings, gathering background information on funding sources, and interviewing safety net providers. Some of the questions they are examining include: 1. How can the safety net integrate with ACOs or health benefit exchanges? 2. How will the ACA impact workforce shortages in primary care and behavioral health? 3. What are the opportunities for integration and coordination with the private sector?
Source: statereforum.org

Colorado lawmakers worried about proposed Medicaid rule change, but providers back idea

2012 Election Airlines/Airports/Airplanes/Air Travel/Fares/Fees California (CA) China Asia Computer Security Curious News Europe/EU/Euro-Zone Federal Reserve Bank Finance & Business Florida (FL) Gov Rick Perry (R-Texas) Health HealthDay HealthDay News Health News IRAs/401k/Pensions Jigsaw Puzzle Jobs/Employment/Unemployment Kids/Children/Teenagers Medicaid Medicare Military/Defense/US Armed Forces National Debt/Deficits New York (NY) Obesity/Weight Loss/Gain Organized Labor/Unions/Strikes/Public/Private Political Opinion Politics Pres Barack Obama (D) Republicans (GOP) Retirement Retirement Savings/Withdrawals Scam Scams/Cons Senior Citizens Snow/Winter Recreation Social Security Social Security Benefits Social Security Reform Taxes Travel UK/Britain/England Europe US Debt Ceiling/Debt Limit Waste/Fraud/Abuse Yahoo
Source: elder-gateway.com

Where work comp networks are headed

Wellpoint is best known for their dominant market share in the group health (and governmental sectors) in California and several other states. Several years ago, Wellpoint decided it was going to be a major force in work comp. Leveraging their provider contracts and relationships, they began contracting in California, which remains the core market. As Wellpoint is one of the dominant players in the state for non-comp business, the list of providers is rather extensive, as is their buying power. The result is clients get pretty good deals with most providers. (That’s not to say there are any bargains out there for comp payers – far from it. Unfortunately work comp remains one of the best payers in most states, especially for hospitals and facilities.)
Source: joepaduda.com

Choosing the Best Medicare Supplement Insurance for You

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSHaving Medicare insurance is a must-have benefit for people aged 65 and older to be provided with health insurance by the government. Furthermore, having any Medicare supplement insurance doubles the advantages enjoyed from the Medicare insurance. If you are having Medicare supplement plans that do not suit your conditions and make you pay a higher premium, however, puts you in a tighter situation than having a lone Medicare insurance. The rule of the thumb is that, having the best Medicare supplement plan for you will make your retirement years enjoyable and secured.
Source: hitsquadut.com

Video: Medicare supplemental insurance plans and benefits

Medicare Supplemental Insurance – What Is It? : Insurance

Who offers this kind of insurance plans? Well this kind of insurance plan is generally available with private insurance companies. The main reason as to why one must go for this kind of option is because one will be able to keep healthy during old age. You must be aware that if you want to ensure a good insurance plan then you will have to do some comparisons between various medicare supplemental insurance plans in order to zero in on the ultimate one. There is nothing wrong with comparisons and in fact plenty of other buyers of this kind of insurance or any other type of insurance for that matter conduct thorough research prior to taking a decision.
Source: theyellowads.com

Do I need supplemental health insurance for Medicare?

Part C, or Medicare Advantage plans, are provided by private insurance companies that are approved by Medicare. Part C is for those who want or need further coverage than what part A or part B supplies. Coverage for dental visits, visits to an optician, glasses and hearing services are usually covered. The private insurance plans for Part C vary, and they might also offer other health benefits such as wellness programs.
Source: healthinsuranceproviders.com

Don’t Wait to Enroll in Medicare

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSAsk for help. Medicare is complex, but there are a number of resources available online, by phone and in person. In addition to online sites likewww.PlanPrescriber.com, you can contact PlanPrescriber by phone at 800-404-6968 or call your State Health Insurance Assistance Program (SHIP) for assistance. SHIPs receive federal funding to provide free local health insurance counseling to people with Medicare. Also, the federal government has created 1-800-MEDICARE to provide information about Medicare coverage and costs, as well as health plan options.
Source: grandstrandboomers.com

Video: Compare Medicare Supplements-Medicare Supplements Compared

Make the Best Deal by Comparing Medicare Plans

It is not independent and the entire supplementary Medicare is controlled by various private companies and no government body is concern about the supplementary one. But all the private companies have to follow some specific rules and they are bound to follow those rules. It is also advisable for an individual to consult an insurance agent before deciding on taking insurance plans and also to decide the priority to book for a special one. It is very essential to book that particular plan that will give you the maximum benefits concerning your health issue and go for that definite plan. It is therefore very important to read the details and then go for the Medicare plans. Before choosing a particular Medigap insurance you can compare Medicare Plans and choose the Best Medicare Supplement Plan. Medicare Supplement Comparison will help you to find out the Best Medicare Supplement. It is important because it is a thing dealing with your future and health. Among all the available medigap insurance plans Medigap insurance California is one which is secured and good to pay attention.
Source: ezinemark.com

Compare Medicare Supplement Insurance to Medicare Advantage Coverage

Furthermore, you simply may not be able to switch back to a traditional supplement if you have certain preexisting conditions.   Most Medicare supplement providers require medical underwriting if you have been enrolled in an Advantage plan for over one or two years.   In other words, you can be declined coverage.   Additionally, it can be difficult to disenroll from a MA plan if it is not the correct time of year.
Source: ohioinsureplan.com

How to Compare Medicare Supplement Plans After Recent Changes

Medicare Supplement Plans have been a opposite options we have when selecting a Medicare as good as supplemental word coverage we want. Plan F is a many renouned as good as a many extensive Medicare Supplement Plan. This devise covers a Medicare Part A as good as Part B deductibles, as good as a 20% coinsurance strange Medicare does not pay. In addition, Medicare Supplement Plan F covers Part B additional charges as good as has a unfamiliar transport benefit. Medicare recipients who wish a most appropriate devise accessible will squeeze Medicare Supplement Plan F since it offers a most appropriate coverage.
Source: anyblog.net

Steps for Comparing Medicare Supplemental Insurance Policies

This would include the basic coverage benefits and any other additional benefits and features that are offered by the policies. 3. It is also important to check which doctors, specialists and hospitals can be covered by each of the supplemental insurance policies. This is important, especially if you would like to continue seeing the doctor you already have, after getting the plan. 4. You should also not forget to request for quotes from each of the insurance providers, if they offer them, so that you would be able to have an idea of how much it would cost you to get a certain policy. Some of the costs that you would need to consider include the monthly premiums and co-payments and coinsurance. You should also check if the plans you are considering charge any additional fees if you would be choosing to see doctors outside of your health insurance plan. 5. Another important aspect that you need to compare Medicare supplemental insurance plans and providers on would be the level of convenience and customer assistance that they offer. You would basically want to choose a plan which can provide you with the medical assistance and advice you need both in person and over the phone anytime.
Source: matureandhealthier.com

Medicare insurance Supplmental Insurance coverage

affiliate marketing blogging business cash advance certified nursing assistant cna cna classes cna training credit credits dating diet dubai property executive search finance fitness get cash loan health home internet internet marketing loan loans manpower consultants marketing None online online loan payday loan payday loans personal loans placement consultants in mumbai pozycjonowanie recruitment agencies recruitment agency recruitment consultant recruitment consultants search engine optimization selling seo staffing agencies technology travel vacation weight loss
Source: connectdiscounter.de

Medicare Supplemental Insurance Comparison

It really is critical to know if your physician accepts Medicare’s pre-accredited sum. Medical doctors might charge a lot more for a treatment than Medicare will pay. When Medicare handles eighty% of a pre-accredited amount, Medigap handles 20% of the same pre-approved sum. Your medical professional could charge a great deal much more than Medicare’s pre-authorized quantity and depart you to make up the difference. Medigap Program G pays for eighty% of any medical doctor charges above what Medicare will spend.
Source: syncop.org

Do I need supplemental health insurance for Medicare?

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSPart C, or Medicare Advantage plans, are provided by private insurance companies that are approved by Medicare. Part C is for those who want or need further coverage than what part A or part B supplies. Coverage for dental visits, visits to an optician, glasses and hearing services are usually covered. The private insurance plans for Part C vary, and they might also offer other health benefits such as wellness programs.
Source: healthinsuranceproviders.com

Video: Medicare Supplement Plans | Questions about Medicare Supplement Plans

2012 Medicare Deductible Amounts

One such Medigap option available for purchase is Plan G.  Plan G covers everything that Plan F does except for the Part B deductible.  If Plan G happened to be $300 less (as can be the case) per year than Plan F and Plan F only covers $140 more in costs, then Plan G is a wise choice.  Plan N might also fall into this category if you live in a state (Ohio for instance) that does not allow for Part B Excess charges.
Source: ohioinsureplan.com

Medicare insurance Supplement Policies Obtainable in Gwinnett District

Medicare Aid Insurance can be termed mainly because Medigap Insurance policies in fact it is the approach which hides the leftover gaps dur the coverage limit belong to the normal Medicare health insurance Health Approach policy. The gaps could be the inadequacy belong to the policy coverage made available from general health care insurance plans this kind of Medigap health and fitness plans really are taken mainly because additional policy to the regular health health care plan. Nonetheless, it is not really possible to take the only Medicare supplement policies as well as in a lot of the US Claims, Medigap Coverage are awarded for our seniors, who really are above 65 years old. There really are multiple Medicare health insurance Supplement Insurance agencies who furnish Medicare supplement insurance policy with completely different premium beliefs. Those who seek this health and fitness policy should certainly compare between lots of the premium estimates to finalize the best quality quote because of this lot. It is just a tough position indeed but is often easy as well as hassle-free once you learn the strategies.
Source: airporttransportationinaustin.info

Medicare insurance Supplmental Insurance coverage

affiliate marketing blogging business cash advance certified nursing assistant cna cna classes cna training credit credits dating diet dubai property executive search finance fitness get cash loan health home internet internet marketing loan loans manpower consultants marketing None online online loan payday loan payday loans personal loans placement consultants in mumbai pozycjonowanie recruitment agencies recruitment agency recruitment consultant recruitment consultants search engine optimization selling seo staffing agencies technology travel vacation weight loss
Source: connectdiscounter.de

Medicare Advantage Health Plans

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThere are some options available for you to opt for when you plan to enroll in Medicare health plans. Medicare health plan is the government-sponsored health insurance program that is specially offered for people of 65 years old and over. There are four options available for you to choose from. If you plan for hospitalization you should choose Part A. If you plan for doctor visits you should choose Part B. If you plan for prescription drugs you should choose Part D. If you don’t find one that suits your health care needs, you can choose alternative choice, a Medicare Advantage health plansthat is also known as Medicare Part C.
Source: healthplanscomparison.net

Video: Humana Medicare Advantage Plans – Compare to 180+ Companies

Don’t Wait to Enroll in Medicare

Ask for help. Medicare is complex, but there are a number of resources available online, by phone and in person. In addition to online sites likewww.PlanPrescriber.com, you can contact PlanPrescriber by phone at 800-404-6968 or call your State Health Insurance Assistance Program (SHIP) for assistance. SHIPs receive federal funding to provide free local health insurance counseling to people with Medicare. Also, the federal government has created 1-800-MEDICARE to provide information about Medicare coverage and costs, as well as health plan options.
Source: grandstrandboomers.com

Compare Medicare Supplement Insurance to Medicare Advantage Coverage

Furthermore, you simply may not be able to switch back to a traditional supplement if you have certain preexisting conditions.   Most Medicare supplement providers require medical underwriting if you have been enrolled in an Advantage plan for over one or two years.   In other words, you can be declined coverage.   Additionally, it can be difficult to disenroll from a MA plan if it is not the correct time of year.
Source: ohioinsureplan.com

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

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

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

A possible solution is for them to purchase a life insurance policy with a long-term care rider which has guaranteed living benefits for life. Some life insurance companies are offering long-term care benefits combined with their life insurance products. These are called linked-benefit life insurance products which add a long-term care rider usually to a universal life insurance policy. The major advantages of these products are they pay no matter what the buyers life situation becomes a long-term care benefit if needed, or a death benefit if long-term care is not needed. Further, these policies provide substantial leverage for every insurance dollar invested usually about 2 to 1 for the death benefit and 4 to 1 for the long-term care benefit. The buyer will need to determine whether this is a better solution than separate long-term care and life insurance policies.
Source: 731gq.com

Time to Compare Medicare Plans

 “Seniors and people with Medicare should act now, review their plan coverage and compare their current plan with other available options,” said CMS Administrator Donald M. Berwick, M.D.  “The important decisions you make now can help ensure that any changes made will be in place by January 2012 for seamless and uninterrupted access to your health care providers and medications at your chosen pharmacies.”  
Source: momentumtoday.com

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

This report looks at the star ratings that have been used for many years to help consumers compare plans, and examines how Medicare Advantage quality scores will interact with plan payments, beginning in 2012.   To encourage Medicare Advantage plans to provide quality care, the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program’s five-star quality rating system, or are unrated.  Building on that provision, the Centers for Medicare and Medicaid Services subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their rating.   Authored by Foundation researchers, the report is the fourth in a series looking at various aspects of the Medicare Advantage star ratings. Report (.pdf)
Source: kff.org

What’s New for Medicare in 2012?

A SEP is a time outside of the normal AEP during which Medicare beneficiaries are allowed to change their plans.  In order to promote quality among Medicare Advantage (MA) plans and Prescription Drug Plans (PDPs), starting December 8, 2011 the Centers for Medicare & Medicaid Services (CMS) will allow Medicare beneficiaries to enroll in MA plans or PDPs with an overall quality rating of five stars at any time during the year, not just during the AEP.
Source: ivans.com

As Open Enrollment Ends, People with Medicare save $1.5 billion on prescriptions

Thanks to the Affordable Care Act, the Medicare prescription drug coverage gap known as the donut hole is starting to close. Through the end of October, 2.65 million people with Medicare have received discounts on brand name drugs in the donut hole.  These discounts have saved seniors and people with disabilities a total of $1.5 billion on prescriptions – averaging about $569 per person.  For State-by-State information on the number of people who are benefiting from this discount in 2011, visit this page.
Source: medicare.gov

Ohio Seniors Looking to Compare Medicare Advantage Plans Turn to Westergard Inc

Westergard Inc. works with some of the most trusted insurance carriers in the nation, allowing them to offer residents of Ohio more quality options and inexpensive Medicare insurance solutions that meet their needs. For further information on Medicare Advantage in Ohio or to speak to an expert, visit www.westergardinc.com today.
Source: girls-fitness.com

Medicare Advantage Part C:

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

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

Compare Medicare Advantage Insurance Plans

But this does not warrant you to choose just any Medicare plan you come across. You need to   compare medical advantage plans with a high degree of scrutiny so that you can find a tailor made solution for you. Generally you will need to consider the following details in every Medicare solution that you are offered: Does the plan take age into your account: Generally, age is a very big factor when it comes to choosing the very best Medicare insurance plans? This is because with age our bodies tend to become weaker and weaker. This then leads to you becoming more and more susceptible to diseases. The perfect Medicare plan needs to take this into account. The package that you will want to go with needs to have a special provision for your age. This provision does not have to raise the premiums that you are liable to pay. Basically the perfect Medicare insurance plan should have a blanket premium all over the age groups but this is not very practical. But there are Medicare plans that do not charge exorbitant premiums to the elderly.
Source: medicareinsuranceplans.com

Do I need supplemental health insurance for Medicare?

Posted by:  :  Category: Medicare

GRANDAUGHTER TO BECOME MARTIAN NEUROSURGEON IN NEW HEALTHCARE SYSTEM... by roberthuffstutterPart C, or Medicare Advantage plans, are provided by private insurance companies that are approved by Medicare. Part C is for those who want or need further coverage than what part A or part B supplies. Coverage for dental visits, visits to an optician, glasses and hearing services are usually covered. The private insurance plans for Part C vary, and they might also offer other health benefits such as wellness programs.
Source: healthinsuranceproviders.com

Video: Medicaid: Do I Qualify?

Medicare health insurance Appeals

100 % of 12 standard medicare supplemental health insurance plans each work with a different type a benefit in an effort to help the individuals avail this. The programs are alphabetically prepared from words A to help you L. An important indicate be noted in that respect might be that these th s plans beneath same correspondence cover requires the comparable benefits in spite of the corporation sell these folks. This gives a kind of guarantee for the beneficiaries from the plan when they grab the plan from any business they will receive the possession skin color benefits that had been provided just by that corporation under that one plan. No discrimination based on the plan you happen to be choos or the agency that the master plan is to be purchased from created from no matter what. However in spite of all ailments, it must always be remembered that a premium charges range from one company to a new one. The many primary criteria from the enrollment policy from the Medicare Additional Plans is any particular one who might be avail this treatment plan must end up be covered beneath original Medicare insurance plan aspect A plus B. This qualify measure serves as an important points from the coverage in supplement programs because without the presense of original coverage no person can get the advantages of the Extra Plan. Medigap Insurance refore gett in touch with an insurance pro in this unique respect can be an intelligent matter. He will be the one whom could provide right advice in the right instance.
Source: shahbazi2.org

Choosing the Best Medicare Supplement Insurance for You

Having Medicare insurance is a must-have benefit for people aged 65 and older to be provided with health insurance by the government. Furthermore, having any Medicare supplement insurance doubles the advantages enjoyed from the Medicare insurance. If you are having Medicare supplement plans that do not suit your conditions and make you pay a higher premium, however, puts you in a tighter situation than having a lone Medicare insurance. The rule of the thumb is that, having the best Medicare supplement plan for you will make your retirement years enjoyable and secured.
Source: hitsquadut.com

What Every Baby Boomer Should Know About Medicare

With all the talk about the high federal budget costs of Medicare, some may erroneously think the government pays for all Medicare services. Far from it. Beneficiaries have to pay monthly premiums, deductibles and co-payments or coinsurance. Figuring out your coverage and costs can be challenging, especially given Medicare’s different alphabetic parts: A (for inpatient hospital care), B (for outpatient services and doctor visits) and D (an optional drug benefit). There’s also a Part C, usually known as Medicare Advantage. This is an alternative to traditional Medicare and is offered by private insurance companies.
Source: kaiserhealthnews.org

Medicare Needs a Budget and Structural Reform

"Medicare faces a dismal future that could threaten its very existence." This statement says it all for Medicare, and Social Security. The programs have not fundamentally changed since their creation. It is time to make them stable again, so that they can continue to be an "extremely helpful program to millions", as articulated by Jeff. But to update both programs, two fundamental principles/mindsets must be implemented/followed: 1. Those who are currently in the programs and those who are about to enter the programs must be promised that their coverage WILL NOT change. The governemnt made them a promise and it must own up to that promise. 2. Those who are just entering the work force or have more than 15-20 years to retirement, have to understand that they will not get the same promise as their parents and must take some personal responsibility for their own future. If either of these ideas are not adhered to, any change to the programs is doomed to failure.
Source: heritage.org

Mitt Romney: ‘We’re Going To Have To Make Changes Like The Ones Paul Ryan Proposed’

Public Policy Polling notes that Newt’s strength is his appeal to senior citizens, where he is polling better with seniors than he is overall nationally. Old people are Newt’s base! So why in the world would Team Romney adopt a strategy that tells everyone that Newt was against Ryan’s kill Medicare bill? If Romney wants to dig into Newt’s support, it’s obvious that he must make seniors afraid of Newt. Instead, he’s giving seniors a reason to stay with Newt.
Source: talkingpointsmemo.com

Tricare Help – Why are Medicare and Tricare telling me opposite things?

15 percent age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card limiting charge marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.com

Lawmakers work to address Medicare cut as year

Posted by:  :  Category: Medicare

can only be viewed by members of the American Academy of Sleep Medicine. If you are already a member you can LOG IN to view this article. If you’re interested in becoming a member of the AASM you can APPLY for membership online.
Source: aasmnet.org

Video: Medicare Part D Open Enrollment Ends December 31st

North Carolina Medical Society

The NCMS and AMA continue to advocate for a permanent solution and are urging lawmakers to utilize the Overseas Contingency Operations (OCO) funding to offset elimination of the SGR. OCO funding refers to discretionary funds for the wars in Afghanistan and Iraq and similar activities. The Department of Defense (DOD) establishes funding levels for the OCO each year. Even though operations in Iraq and Afghanistan are winding down and are expected to continue winding down significantly over the next ten years, the Congressional Budget Office (CBO) cannot downwardly adjust its estimate for OCO spending over the next ten years until the next (FY 2012) Defense Appropriations bill is passed. Even then the CBO estimate for OCO spending is likely to remain artificially high, according to the AMA during a conference call earlier this week.
Source: ncmedsoc.org

My 80 year old Mother and expensive presciptions?

I was informed by my sister today that my mother who is 80 years young needs help in paying my mothers presciption monthly bills. She is diabetic, has nueropathy in legs, is overweight and is charging her meds on a credit card as to the point she owes 5,000 dollars on it because of medicine she needs. Her husband died about 4 years ago so has a small military and social security pension coming in. She lives in Florida and owns some property in a senior mobile home park. Is there anybody who knows how she can get the medications she needs without breaking the bank? Thank you I found this link to the American Heart Association:
Source: shortsaleprocessflorida.co

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: EKG CPT and ICDs list

MedicarePaymentandReimbursement.com provides Medicare Payments, Billing Guidelines, Fees Schedules 2010, Medicare Eligibility, 2011 Medicare Deductibles, Allowables, CPT Codes for Medicare, Phone Number, Hearing Aids, Denial, Address, Medicare Appeal, PQRI, EOB, Medicare and Medicaid Services.
Source: medicarepaymentandreimbursement.com

House GOP introduces bill renewing payroll tax cut

The legislation, which also seeks to head off an automatic cut in Medicare reimbursements to doctors, is less generous than a version that Obama and congressional Democrats have championed. The GOP measure’s cost, which exceeds $180 billion, would be fully paid for by freezing federal workforce salaries, requiring higher earning elderly people to pay more for Medicare and raising some federal fees. But it ignores the higher taxes on the rich that Democrats would use to cover the costs of their proposal.
Source: wbez.org

AMA Reports; Supercommittee Stalemate Leaves SGR 27.5 Physician Fee Schedule Decrease Intact : Med Law Blog

Supercommittee failure leaves 27 percent Medicare payment cut in place With the Joint Select Committee on Deficit Reduction failing to reach agreement on a deficit-reduction proposal, physicians still face a 27 percent cut in Medicare physician payments scheduled to take effect Jan. 1. Congress has missed an opportunity to address the nation’s fiscal problems, stabilize the Medicare program and permanently repeal the sustainable growth rate (SGR) formula. "The deficit committee had a unique opportunity to stabilize the Medicare program for America’s seniors now and for generations to come," AMA President Peter W. Carmel, MD, said in a statement. "Once again, Congress failed to stop the charade of scheduled annual physician payment cuts and short-term patches that spend more taxpayer money to perpetuate a policy all agree is fatally flawed. A decade of uncertainty and repeated threats of steep cuts threaten access to care for seniors and military families who rely on the Medicare and TRICARE programs." Proposals to repeal the SGR fell victim to disagreement over fundamental principles for achieving deficit reduction. Sharp partisan division over the mix of entitlement cuts and tax hikes prevented the supercommittee from reaching any agreement on a deficit-reduction package. Sen. Max Baucus (D-Mont.), Sen. John Kyl (R-Ariz.) and Senate Majority Leader Harry Reid (D-Nev.) were among the leading advocates for SGR repeal in the supercommittee negotiations. Earlier this year, Sen. Pat Toomey (R-Pa.) had also offered a deficit-reduction package that included SGR repeal. Congressional action expected to avert 27 percent cut on Jan. 1 Democratic and Republican leaders in Congress have publicly stated their commitment to take action this year to avert the 27 percent cut. Options for SGR relief outside of the supercommittee process have ranged from short-term patches of a year or two to longer-term relief that provides for transition to a new Medicare physician payment system. The scope of the next SGR intervention will not come into better focus until Congress returns from its Thanksgiving break. Congress has a number of items of unfinished business that require action before departing for the Christmas holidays. Stay tuned for future updates via the Physicians’ Grassroots Network and other AMA communications.
Source: medlawblog.com

Scheduled Medicare payment cuts debated

2012 Election Airlines/Airports/Airplanes/Air Travel/Fares/Fees California (CA) China Asia Computer Security Curious News Europe/EU/Euro-Zone Federal Reserve Bank Finance & Business Florida (FL) Gov Rick Perry (R-Texas) Health HealthDay HealthDay News Health News IRAs/401k/Pensions Jigsaw Puzzle Jobs/Employment/Unemployment Kids/Children/Teenagers Medicaid Medicare Military/Defense/US Armed Forces National Debt/Deficits New York (NY) Obesity/Weight Loss/Gain Organized Labor/Unions/Strikes/Public/Private Political Opinion Politics Pres Barack Obama (D) Republicans (GOP) Retirement Retirement Savings/Withdrawals Scam Scams/Cons Senior Citizens Snow/Winter Recreation Social Security Social Security Benefits Social Security Reform Taxes Travel UK/Britain/England Europe US Debt Ceiling/Debt Limit Waste/Fraud/Abuse Yahoo
Source: elder-gateway.com

Medicare Enrollment Deadline Is Tomorrow

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

Choosing the Best Medicare Supplement Insurance for You

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSHaving Medicare insurance is a must-have benefit for people aged 65 and older to be provided with health insurance by the government. Furthermore, having any Medicare supplement insurance doubles the advantages enjoyed from the Medicare insurance. If you are having Medicare supplement plans that do not suit your conditions and make you pay a higher premium, however, puts you in a tighter situation than having a lone Medicare insurance. The rule of the thumb is that, having the best Medicare supplement plan for you will make your retirement years enjoyable and secured.
Source: hitsquadut.com

Video: Best Medicare Supplemental

AffordableONE Insurance Wants Local Residents to Start the New Year Right With Florida Medicare Supplemental Insurance

Many people take time during the holiday season to stop and think about the things that are most important to them in life, including their family, friends and personal well-being. In addition, New Year’s resolutions are made in order to establish personal goals for the upcoming year. One common goal among older Americans is to save money whenever possible, and one of the biggest expenses for individuals in this age range is medical care. That’s why the team at AffordableONE Insurance wants local residents to take advantage of this time to purchase Florida Medicare supplemental insurance, which can help them save money on the health care expenses that Medicare Parts A and B do not cover.
Source: bestlongtermcare.org

Best Supplemental Medicare Insurance Plans

As long as you have funds in your checking account, you can go ahead and by that item you’ve been ssaving up for without bearing guilt on how you’ll afford the things you haven’t been able to in the past. There are dozens within the population who save money every single day through their medicare supplemental insurance upon getting into an accident or sent to the hospital. Whether a minor accident or a major catastrophe, you can rest assured that dependency on your health insurance is in check so you can receive help in paying all the incurred medical expenses, on time without anxiety that comes along with the insecurity of the insured. Fraud and illegal means of obtaining funds doesn’t work, rather seeking a health insurance plan and the savings you can seize is much more worth it. 
Source: earn-home-based-profits.com

Resolved Question: People that are disabled..a question for you. What was the best Medicare supplemental ins. is the best?

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

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 Supplemental Insurance Plans

With some supplemental policies beginning at $0 dollars, there is certainly a belief for everyone. However, researching all the different policies, companies, and doing note comparisons can often be intimidating to most seniors. Insurance companies, though suitable, will often act in their best interests rather than yours when helping you decide Medicare Supplemental Insurance Plans. The suggested route to accumulate is to have an experienced insurance broker guide you through the difficult shopping process and work with you to choose the most cost effective policy with the specifically tailored coverage you need.
Source: medicaresupplementalinsurances.org

Medigap Policies Catch (Unfavorable) Attention of Congress

Posted by:  :  Category: Medicare

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

Video: Medicare Supplement Plan, Cary, Raleigh, Durham, Chapel Hill, Greensboro, Charlotte, NC

Medigap Policies Catch (Unfavorable) Attention of Congress

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

Medicare insurance Supplement Policies Obtainable in Gwinnett District

Medicare Aid Insurance can be termed mainly because Medigap Insurance policies in fact it is the approach which hides the leftover gaps dur the coverage limit belong to the normal Medicare health insurance Health Approach policy. The gaps could be the inadequacy belong to the policy coverage made available from general health care insurance plans this kind of Medigap health and fitness plans really are taken mainly because additional policy to the regular health health care plan. Nonetheless, it is not really possible to take the only Medicare supplement policies as well as in a lot of the US Claims, Medigap Coverage are awarded for our seniors, who really are above 65 years old. There really are multiple Medicare health insurance Supplement Insurance agencies who furnish Medicare supplement insurance policy with completely different premium beliefs. Those who seek this health and fitness policy should certainly compare between lots of the premium estimates to finalize the best quality quote because of this lot. It is just a tough position indeed but is often easy as well as hassle-free once you learn the strategies.
Source: airporttransportationinaustin.info

Treatment Supplmental Insurance protection

Medicare is undoubtedly an all-inclusive heath insurance policy program for that elderly and also disabled with the help of age with sixty fiver many and on top of. It is definitely run with the government, so that it an inexpensive chunks of money plan. Even so, to maximize out than it, there will be many costs free medicare supplement quote plan includ premiums, coinsurances, deductibles, yet others. However, to reduce these charges into the very least, Medicare supplement can be obtained by many companies.
Source: liquacure.com

Factors Affecting The Issuance Of Medigap Coverage

A supplementary Medicare insurance is beneficial in ways more than one especially when covering for additional medical services that are not catered for by the primary Medicare insurance, and also when it comes to the reduction of out of pocket expenses that one may be charged for the healthcare services. To understand supplementary Medicare cover better, one needs to know about some of the external forces that affect medigap insurance. One of the factors that influence how a medigap plan is issued is age. Age is a factor in the sense that it influences Medicare coverage which directly affects medigap plans. The age that an individual is accepted in to Medicare cover is 65 years unless such people belong to a few special cases like being disabled or chronically ill. Without being in a Medicare plan one will not be eligible to take a supplemental plan. Another factor as previously stated is the state of physical and health condition of an individual. Physical status as a factor mainly arises when one is disabled. It doesn’t matter whether the disabled person is 65 years or not, so long as those people are not employed, they are liable to supplemental health insurance immediately after enrolling in a part B Medicare plan, and the same also goes for chronically ill patients like cancer patients. Eligibility will also depend on whether one has a Medicare cover or not. Having a part A and part B covers are able to make you eligible for application of Medicare indemnity cover. Before 2006 when the government put the subsidy of prescription drug plan into action, medigap stopped covering for prescription drugs instead living the task for Medicare part D plan. Other than that, the policies offered vary from one company to another and also from state to state. For this reason, one needs to compare the free medigap insurance quotes available on the company websites. It is however important to note that, these policy variations are very minute and therefore the premiums charged should also vary on the same scale. This means that supplementary Medicare assurance can be obtained at low prices in almost every insurance company you go to.
Source: completehealthnews.org

Medigap Policies Catch (Unfavorable) Attention of Congress

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