Common Questions About Medicare Supplement Plans

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MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSEnrollment is Not Always Guaranteed: Medicare Supplement insurance is regulated by the states, so there will be eligibility differences based on where you live. For example, in New York, most applicants must be accepted anytime, while in other states all applicants must be accepted only within their first six months of eligibility for Medicare Part B and in a few other situations. Outside of the eligibility periods, carriers are allowed to reject an applicant based on adverse health conditions. This means that if you apply at the wrong time, you may not be eligible for a Medicare Supplement policy.
Source: ehealthinsurance.com

Video: Medicare Supplement Plans | Questions about Medicare Supplement Plans

Tips for Choosing a Medicare Supplemental Law firms

Many people today understand the importance of a health insurance. As a result, many people are looking to ensure their health or the health of their loved ones, continue to search for the best Medicare supplement companies that can cover your medical bills when they have to make a claim. With the right company, comes the importance of the settlement for suitable additions plans Medicare, which will serve a variety of insurance needs. The plans also show rates of debt and all aspects are considered in the package.
Source: whitelightmedicine.com

Medicare Supplemental Insurance California

Author Resource:->  Blanket Health Insurance provides the most competitive health insurance quotes, including senior Medicare supplements, group health and dental plans from the finest providers. They know the inner workings of the best health, dental, small group, and senior Medicare health insurance California and Medicare supplemental insurance California plans, so we can locate an affordable plan that will make the most of your health insurance dollar, while protecting your family from runaway health care costs. Visit BlanketHealthInsurance.com if you are looking to find a best health insurance Medicare California plan. Article From Freebie Articles
Source: freebie-articles.com

The Ever Changing Medicare Supplement

As most of us are aware, the Medicare Supplement of the past may be changing drastically or going away altogether. The problem is that Congress wants to cut Medicare benefits and make seniors pay more out of their pockets. A Medicare Supplement currently supplements medicare and pays for those things that are not covered under the original program. If they cut Medicare Supplement benefits, the cost-sharing portion for the senior will rise dramatically.
Source: republicanrenaissancepac.com

Medicare Supplements at an Awesome Price

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Source: govsnet.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

Stay Healthier with Medicare Supplements

Many people assume that, once they get on to the Medicare system, they will never again have to worry about getting medical treatment or how to pay for it. While getting this health coverage does a great deal to make it easier to get the health care that you need, it does not actually guarantee that you will never need anything else. You can pay for special Medicare Supplements so that you will be able to have some additional coverage for things like prescriptions that might not be very well covered by the original Medicare system. This is the best way to make sure that you never have to go without the medicine and doctor visits that you require in order to remain healthy and able to enjoy your life. Invest the time into finding the right plan for you because it may pay off tremendously if you should get sick at a later date.
Source: planethr.net

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

Posted by:  :  Category: Medicare

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

Video: Medicare HMO

Medicare HMO plan stirs confusion in north stateSome north state

Medicare HMO plan stirs confusion in north state Some north state doctors want to know why their names show up as network providers for a Medicare Advantage HMO plan being marketed by AARP. AARP SURVEY: According to a survey by AARP, older Iowans are against making cuts to Social Security and Medicare in … A survey by the AARP, the largest lobbying group for older Americans, shows Iowans are against cutting Social Security and Medicare benefits to reduce the federal deficit. AARP president speaks in Kona By CAROLYN LUCAS-ZENK Stephens Media A big bullet was dodged with the supercommittee’s recent failure to reach an agreement on debt reduction, but the public should remain vigilant in “protecting and strengthening” Social Security, Medicare and Medicaid, AARP National President Lee Hammond said Wednesday. These programs are still “prime targets of many in Congress” looking for ways to slash the …
Source: medicare-news.com

Resolved Question: Is there a monthly penalty for prescription drug coverage going from an HMO to a PFFS?

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

O.C. HMO patients stuck in contract dispute

Blue Shield’s Davila said that, even after the termination takes effect, many patients will be able to keep their doctors because the doctors already belong to other medical networks contracted with Blue Shield or will join them. He said Blue Shield’s contract with Monarch applies to 16,800 customers in the commercial HMO market and 2,400 in Medicare.
Source: ocregister.com

Whistleblower Accuses Chemed Unit of Medicare HMO Conspiracy

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Source: elder-gateway.com

SilverSneakers Medicare Programs

Posted by:  :  Category: Medicare

[...] So, what exactly is SilverSneakers?  SilverSneakers is essentially a gym membership or fitness club membership to participating centers across the country.  You can find participating gyms by going to http://www.silversneakers.com and typing in your zip code.  You can find out if your Medicare plan offers Silver Sneakers by calling 1-888-423-4632.  Here are some of the features offered by SilverSneakers.Source: medicare-plans.net [...]
Source: medicare-plans.net

Video: AvMed Medicare-Rita-SP.mov

AvMed Health Plans and Wax Custom Communications Partner in the Publication of ASPIRE

Aspire features information and updates about AvMed’s Medicare Advantage plan, along with practical information designed to help customers enhance their overall health and wellbeing. “The magazine was titled Aspire because we felt it was the perfect word to sum up our attitude towards health,” said Winston H. Lonsdale, Vice President and Chief Medicare Executive, AvMed Health Plans. “The word aspire means to have a great ambition, an ultimate goal, a strong desire, a willingness to strive. In this magazine, our goal is to inspire and support our customers as they optimize their health.” Created especially for Medicare members, Aspire includes profiles of healthy seniors and articles aimed at promoting longevity and healthy living. “Our goal is to encourage readers to use the many member benefits already offered to them,” said Lonsdale. Those benefits include a new affiliation with the SilverSneakers® Fitness Program, discounted Weight Watchers™ memberships and discounts on acupuncture, massage therapy and complementary medicines to improve their health. AvMed has also implemented new initiatives to provide additional services to their members, including the improvement of their Personal Service Representative (PSR) program. Wax, who partnered with AvMed to publish Aspire, has worked with AvMed for 20 years, starting with the publication of one title and evolving into a wide range of integrated marketing products. “AvMed has always been known for its personalized, caring approach to healthcare,” says Bill Wax, president and founder of Wax Custom Communications. “Aspire represents an outstanding opportunity for AvMed to convey information to help members take charge of their own health and wellness.” About Wax Custom Communications Founded in 1987 by Pulitzer Prize nominated photojournalist Bill Wax, Wax Custom Communications is a full-service custom publisher and integrated marketing firm based in Miami, Fla. A member of the Custom Publishing Council and the American Marketing Association, Wax is active in business sectors including health, finance, insurance, education, technology and telecommunications. About AvMed Health Plans AvMed is a Florida based not-for-profit HMO and one of the state’s leading HMO providers, serving more than 200,000 members in the state of Florida. Founded in 1969 as a health care system for pilots in the Miami area, AvMed (short for “aviation medicine”) now serves non-pilots as well, with offices throughout Florida. AvMed’s policies include employer group HMO, Medicare HMO, and point-of-service plans; the company also offers onsite health-related seminars. AvMed’s Disease Management Program provides assistance to members with congestive heart problems, asthma and high-risk pregnancies; its On Call phone line offers free health information around the clock.
Source: seerpress.com

What To Look While Buying Health Insurance

The main motive behind providing health insurance is to provide financial security during the event of illness or injury. By available health insurance policies through government-sponsored program or buying it from private insurers, consumers in Florida can enjoy financial freedom when they avail healthcare services for various needs.
Source: mcwlhealthfoundation.org

Medicare Open Enrollment Extension for Some

Today, December 7th, is the end of the open enrollment period for Medicare recipients.  Susan Jaffe from the KaiserHealthNews.org website reports that extensions are being offered to people who are unable to enroll due to wait times, but only by three days.  A spokesperson for the Centers for Medicare and Medicaid claims that extensions will only be available to seniors who contact the appropriate resources and are put on a call back list.
Source: healthinsurancesort.com

AvMed Health Plans and Wax Custom Communications Receive Bronze at 2010 Mature Media Awards

PRLog (Press Release) – Aug 16, 2010 – Miami, August 10, 2010– AvMed Health Plans received a bronze medal at the 2010 National Mature Media Awards, the nation’s largest awards program that annually recognizes the best marketing, communications, educational materials and programs for adults age 50 and older. AvMed’s Medicare Enrollment Kit won a bronze medal in the Brochure/Booklet category. The Medicare Enrollment Kit is an annual piece distributed before the Medicare enrollment period, aimed at educating consumers on AvMed’s Medicare plans and benefits and guiding them in their decision making process. “We’re proud that the work we create with AvMed has been honored at the National Mature Media Awards,” said Bill Wax, president and founder of Wax Custom Communications. “These awards recognize the uniqueness of our work with each of our clients and the quality team we have here at Wax.” About Wax Custom Communications:
Source: prlog.org

What Impact Does Medicare Have On Health Insurance?

Many insurance types can be considered a primary insurance depending on the situation. If you are in a car accident, and your insurance or the other person’s insurance covers any medical expenses, those would be considered a primary insurance. Similarly, if you have home owner’s, or renter’s insurance, and they cover a qualified medical expense, then they would be considered the primary insurance. This also includes coverage such as prescription coverage, and other forms of supplementary coverage.
Source: seniorcorps.org

Watchdog Blog Blog Archive

Posted by:  :  Category: Medicare

Medicare by SistakMaking the task easier for the privatizers is the absence of an organized patients lobby. AARP has diluted its influence by annually taking hundreds of millions of dollars from private insurance companies for helping to sell their insurance products. AARP is positioned by virtue of its resources and vast membership to make an effective defense of Medicare. But will it? The organization has helped undercut Medicare by aggressively promoting sale of a Medicare Advantage alternative even as it advertises traditional Medigap plans. If AARP can’t or won’t protect Medicare, seniors will have no choice but to take matters into their own hands and go all-out to organize to preserve their beloved program.
Source: niemanwatchdog.org

Video: Dick Morris TV; Lunch ALERT! The Ryan Budget and Medicare — A Solution

Medicare ‘Doc Fix’ Debate Shifts to Senate

There are some other areas where they are getting hit. There’s a $6.8 billion hit in reimbursements for treating non-emergency patients in a hospital out-patient setting. And then there are some other tweaks that are a philosophical hit to hospitals. This is something that the American Hospital Association and the Federation of American Hospitals lobbied against and that is kind of a loosening of the rules for physician-ownership of specialty hospitals. So on one hand, yes, we know that hospitals are kind of Medicare’s biggest cost center. There’s more money that flows into that sector than any other sector paid by Medicare, including physicians. I think it is also an acknowledgement that the low hanging fruit – the easy pay-fors – when it comes to these types of provisions, these types of bills–are pretty much tapped out already. 
Source: kaiserhealthnews.org

InsureBlog: Medicare Advantage

Disenrolling in an MA plan may also trigger a GUARANTEED ISSUE situation allowing you to enroll in any Medigap plan without answering health questions. If you enrolled in an Advantage plan for the FIRST TIME, either when you first became eligible for Medicare Part B or you left Medicare to join an Advantage plan. If you leave the Advantage plan during the first 12 months you may have a guaranteed right to return to Medicare and a Medigap plan. You should apply for a new Medigap plan no later than 63 days following the end of your Medicare Advantage coverage. Your new Medigap plan cannot become effective before the date of your application. You may also have other guaranteed rights to purchase a Medicap plan without answering health questions. Call us. We can help. Even if you do not have a guaranteed right to purchase a Medigap plan you may still qualify if you are in reasonably good health. We have helped people age 80 and younger find an affordable Medigap plan once we determine they still qualify.
Source: blogspot.com

Medicare Special Enrollment Period Means Good News for Seniors

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We serve approximately 8.9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Rehberg Supports Raising Medicare Premiums

“This couldn’t be a more clear example of Dennis Rehberg sticking up for his fellow multimillionaires while sticking it to middle-class Montana seniors,” said Ted Dick, Executive Director of the Montana Democratic Party.  “Dennis Rehberg has forgotten who he’s working for, and it’s clear whose side he’s on: the special interests who have bankrolled his 35-year career in politics.”
Source: wordpress.com

The ACP Advocate Blog by Bob Doherty: The Medicare SGR and Charlie Brown’s Football

Medicine answered the call by offering Congress concrete ideas for stabilizing payments for the next five years and transitioning to a better payment system for patients and their physicians. Well, we now know how all that turned out. Here we are, just 17 days before Medicare payments to physicians will be cut by 27.4%, and Congress still hasn’t figured out how to stop the cut, never mind enact a long-term solution. Last night, the House of Representatives passed a bill that would replace the SGR cuts with one percent annual increases in 2012 and 2013, but it does not repeal the SGR or result in a long-term solution. It is paid for by controversial Medicaid and Medicare payment cuts to hospitals for indigent care and outpatient facilities, increased Medicare premiums to higher income beneficiaries, reductions in funding for prevention and wellness programs, and money that is set aside to pay for health insurance subsidies created by the Affordable Care Act—cuts that are being fiercely contested by hospitals, AARP, and the American Cancer Society-Cancer Action Network, among others. The SGR provision is just one part of a broader package that would extend unemployment benefits and the expiring Social Security payroll tax cut, but it includes other policies that are so strongly opposed by the White House and Senate Democrats that it is considered to be “dead on arrival” in the Senate. What happens when the GOP bill fails in the Senate, as expected? Negotiations likely will take place over the weekend between Senate Democrats and House Republicans on a compromise package, but no one knows if they will be able to reach a deal that can pass both chambers before the SGR cut goes into effect and the payroll tax cut and unemployment benefits expire on January 1. The odds still favor an agreement to stop the 27.4% SGR cut, although the issue may not be decided until after Christmas—just days before it is scheduled to go into effect. It’s enough to make you want to shout “Good Grief!” Of course, it isn’t fair to put all of the blame on the current Congress. Remember, the Democratically-controlled 111th Congress failed on multiple occasions to pass more than short term (sometimes just weeks or months) patches to prevent scheduled SGR cuts, and in June 2011, it actually allowed the cut to go into effect for several weeks, during which CMS held Medicare claims until Congress got around to passing another temporary reprieve. Much of the same can be said about the 110th Congress, and the 109th, and the 108th, and the 107th . . . all of whom enacted short-term reprieves to prevent scheduled SGR cuts but could not come up with a permanent solution. As much as physicians wanted a permanent solution, their professional associations usually ended up helping Congress get the votes for a temporary patch because the consequences for patients of allowing the SGR cut were too dire. Not this time, though: ACP (and most other physician organizations) are telling Congress that although it is imperative that they act, before recessing for the year, to reach agreement on a viable bipartisan approach to prevent the SGR cuts, we cannot endorse a bill that just results in another temporary reprieve from the SGR cuts resulting in even deeper cuts in future years. Instead, Congress must enact comprehensive and long-term payment reform that eliminates the SGR, provides stable payments for all physician services for at least five years, and establishes a transition to better payment models. Sure, Congress isn’t likely to reach agreement on a long-term SGR solution before it recesses for the year—although a Christmas miracle to that effect would nice! Another short-term fix is much more likely. But if Congress once again chooses “. . . the unwanted choice of extending a fundamentally broken payment system or jeopardizing access to care for Medicare beneficiaries” it is doing it without the help of organized medicine. Medicine is willing to line up (again) to kick a football called SGR repeal, but only if it really has a chance of getting over the goal post. Today’s question: Do you agree that physicians should withhold support from any SGR bill that provides a temporary reprieve from the 27.4% cut if it results in deeper cuts in subsequent years, and doesn’t move toward a permanent solution?
Source: acponline.org

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

Posted by:  :  Category: Medicare

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

Video: Personal Story: Medicare Part D Co-Pay Assistance

State Medicaid Reform That Works…If Washington Allows It

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Source: heritage.org

Washington Suits Seeks To Block State Medicaid Plans That May Violate EMTALA and BBA

What the plans don’t admit to is that they know they are out of line based on years of prior warnings from Washington.  They know, also that they don’t have an EMTALA waiver – because EMTALA applies to the hospital, not the plan.  But in several states, hospitals have been told that the plans have “EMTALA waivers” to try to get hospitals to shut up and go along with the plan.  Groups protesting the Medicaid demands report that they have challenged by the plans to “just try and do anything about it.”
Source: medlaw.com

Medicare on Main Street: Obamacare hammers Granite State

“Remember when President Obama said that if his health care ‘reform’ law passed, you’d still get to keep your doctor?  Medicare Advantage participants in the Granite State are finding out what a lie that was. “Medicare Advantage is a subset of Medicare in which the federal government pays private insurers a set monthly rate to provide coverage that is approved and regulated by Medicare. The private insurers can charge different rates and offer a wider variety of services than are offered in traditional Medicare.  Though Medicare Advantage costs more in its startup phase, the idea is to save money in the long run by providing incentives for insurers to reduce costs.  But because the plan is market-based, the Obama administration wants to kill it. Obamacare eventually defunds it. “New Hampshire has a high percentage of Medicare Advantage enrollees. Last month, 7,600 of them received notices that their coverage was being cancelled. Obamacare and another federal law passed in 2008, the Medicare Improvement for Patients and Providers Act, are killing Medicare Advantage to steer senior citizens back into regular Medicare, which offers fewer choices and is more heavily controlled from Washington. “As a result, thousands of Granite State seniors are being forced to switch doctors because they have to switch coverage. “This is just a taste of what is to come if Obamacare takes effect in full force.  Its regulations will so skew the private insurance market that millions will lose the coverage they have and be forced into plans preferred by bureaucrats in Washington.  They will lose access to their doctors, too. It would make a lot more sense to reform the health insurance market by working to give people more control over their own care, not less.”
Source: gop.gov

State Roundup: Calif. Budget Problems Bring Additional Medicaid Cutbacks

Denver Post: Kaiser Pushes Into Northern Colorado, Partners With Banner Kaiser Permanente will sell its health insurance plan for the first time in Northern Colorado, backing it with new medical offices and hospital access, a major expansion the large insurer says was long-sought by members and businesses. Kaiser has more than 530,000 members in its self-contained health maintenance organization, concentrated in Denver, Boulder and southern Colorado. It has 6,000 members in Northern Colorado from existing plans, but has not marketed there before (Booth, 12/13). (Kaiser Health News is not affiliated with Kaiser Permanente.) Modern Healthcare: Ky. Hospital Turns Over Merger-Related Documents After much reluctance, officials at the University of Louisville’s hospital agreed to turn over records pertaining to their merger plans with two other Kentucky hospitals. … Jefferson County Circuit Court Judge Irv Maze last week ordered the hospital to provide him with the records, which were received on Monday (Selvam, 12/13).
Source: kaiserhealthnews.org

Wyld About Futbol: Reuters Health Report

BERLIN/FRANKFURT (Reuters) – Germany’s chancellor and central banker urged Europe to stick to stricter budget discipline and forget about one-shot solutions after financial markets judged that another EU summit had failed to resolve the euro zone’s debt crisis.
Source: blogspot.com

Wyld About Basketball: Reuters Health Report

BERLIN/FRANKFURT (Reuters) – Germany’s chancellor and central banker urged Europe to stick to stricter budget discipline and forget about one-shot solutions after financial markets judged that another EU summit had failed to resolve the euro zone’s debt crisis.
Source: blogspot.com

Wyld About Books: Reuters Health Report

WASHINGTON (Reuters) – Former MF Global chief Jon Corzine corrected his earlier statements about the hundreds of millions of dollars in missing customer money, telling lawmakers on Tuesday there was no way to confuse anything he said as an authorization to raid those funds.
Source: blogspot.com

Involuntary Transformation: Advocacy, Ethics and Journalism: A MadMother’s perspective

This type of article which ignores the ethics of journalism, has, in no small part, contributed to the lack of public knowledge about events in the public interest.  This article is given an award for ethics in journalism, when the article shows no evidence whatsoever that the writer even knows what the Ethics of Journalism are.  This article misinforms the public about the effects of the advocate being celebrated, and the group to which she belongs.   The group itself purposely misinforms the public about psychiatric drugs and diagnoses; which allows it’s benefactors to continue pilfering the publicly funded medical programs and fleecing the pockets of the taxpaying public.   And journalists continue to write biased articles misinforming the public about the effects of this group’s advocacy; which also allows the ongoing fraud and corruption to continue unabated and unquestioned by the misinformed public.  Now they are being given awards for it!?!
Source: blogspot.com

Gov. Heineman says he’s listening, but not getting in US Senate race…yet (AUDIO)

Posted by:  :  Category: Medicare

Heineman told reporters that Nebraskans remain upset with Sen. Ben Nelson, the incumbent Democrat, for being the final vote needed by the Obama Administration to approve federal health care legislation. Heineman said Nelson’s negotiations which secured Medicare funding for Nebraska, called the Cornhusker Kickback by the law’s critics, embarrassed Nebraska. The Obama Administration later rescinded the deal.
Source: nebraskaradionetwork.com

Video: Johanns Discusses Impact of Medicare Cuts on Nebraska

New Nebraska Network:: Ben Nelson Stands Alone Defending Medicare In Nebraska

Nelson has a surprisingly good Democratic record when it matters.  When he votes with the GOP it is usually not the deciding vote.  For instance he did not vote against Elaine until after she already had sufficient votes.  The public option was dead and buried in the Senate months before he voted against it. Like many “Red State” Democrats and “Blue State” Republicans he must cast a certain number of votes against his party. The problem with the “progressive position” is that progressives are not willing to do the necessary work to move the political enviroment.  Conservatives also have this problem in other states.  You need to build strong political support for these positions before we expect politicians to endorse them.  That means registering voters, making phone calls, walking the precincts and all the other things that are necessary to build political support.
Source: newnebraska.net

Medicare Supplemental Insurance and Medicare Advantage Plans in Nebraska

medicare advantage disenrollment period 2012, NH Medicare Advantage Plans 2012, Vermont Medicare Supplement Insurance 2012, medigap 2012 florida, medicare supplement plans massachusetts 2012, medicare disenrollment period 2012, medicaresupplement plans for vermont 2012, medicare supplemental insurance connecticut enrollment, west virginia medicare advantage plans, 2012 medicare plans in west virginina, part b premium 2012 mean adjusted gross income, pennsylvania 2012 medicare supplement plans, medicine plans for colorado seniors, medicare 2012 supplemental insurance nevada, 2012 disenrollment period medicare advantage, plan c pennsylvania, medicare advantage plans missouri, Medicare open enrollment period, Medicare Advantage Disenrollment 2012, medicare advantage guidelines DISENROLLMENT 2012
Source: medicaresupplementadvantageplans.com

EPIC JOURNEY: Crossroads GPS Ads on the Economy

Nonpartisan political handicapper Charlie Cook lists the four Senate races as “toss up.” Stuart Rothenberg lists the races in Massachusetts, Missouri and Montana as “toss up” and the race in Nebraska as “toss up/tilt Republican.” Nelson, the Nebraska incumbent, has yet to decide if he will run for reelection in 2012.
Source: epicjourney2008.com

Medigap Enrollment 2012: What are Plans K and L?

Medicare Part B Coinsurance or Copayment, Blood, Part A Hospice Care Copayment or Coinsurance, Skilled Nursing Facility Care Coinsurance and the Medicare Part A Deductible are covered at 50% for Medigap Plan K. For Medigap Plan L these are all covered at 75%. The other difference between the two is that Plan K has an Out-of-Pocket Limit of $4,640 and Plan L has an Out-of-Pocket Limit of $2,320.
Source: medicaresupplementinsurances.com

Should states lead Medicaid

According to the report, states pay only 20 percent of the health care bill for so-called “dual eligibles” — people who qualify for both Medicare and Medicaid. Very little of that 20 percent goes toward hospital stays, where the greatest savings can be achieved. Moreover, giving cash-strapped states more responsibility for overall spending increases the risk of cost-shifting to Medicare, which unlike Medicaid is funded entirely by the federal government. The authors say this could undermine the quality of care for vulnerable beneficiaries.
Source: stateline.org

Can’t raise taxes? Hike Medicare premiums instead

The premium increases are to help pay for legislation that would prevent the Jan. 1 expiration of payroll tax cuts for workers and extra benefits for the long-term unemployed, while also staving off a steep cut in Medicare payments to doctors. With time running short, lawmakers of both parties and Obama are still far apart on key aspects.
Source: ktiv.com

The Rural Blog: Governor says Nebraska Farmers Union was vital in rerouting Keystone XL pipeline

Nebraska Gov. Dave Heineman thanked the Nebraska Farmers Union during the organization’s state convention over the weekend for playing a major role in the effort to reroute the TransCanada oil sands pipeline away from the state’s ecologically fragile Sandhills region. Robert Pore of The Independent in Central Nebraska reports the governor said NFU’s input was vital. “You put the pressure on, you kept giving us advice, you kept sharing letters and emails, you showed up at two public hearings in Atkinson and Lincoln with the State Department and three days worth of legislative hearings on this issue,” Heineman (Photo by Matt Dixon, The Independent) said during his lunch-time speech at the convention. “That is how we got to where we are today.” Controversy still surrounds the pipeline, as House Republicans introduced a bill last week to renew the Social Security payroll tax cut and extend unemployment benefits, with tacked-on language requiring the administration to issue a work permit within two months to begin building the pipeline. Last month, President Obama said he would reject the tax-cut bill if it contains pipeline language. (Read more)
Source: blogspot.com

HHS: 12% small biz health insurance rate hike in Pa. ‘excessive’

Posted by:  :  Category: Medicare

 by pennstateliveAn Indiana-based insurance company approved to sell health insurance products in Pennsylvania has been charged with small businesses “unreasonably high premium increases” after increasing rates 12%, according to federal officials.
Source: medicarebyphone.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Representative Kelly Votes For Higher Taxes and Higher Medicare Premiums, Protects Billionaires

Kelly voted to raise Medicare premiums for seniors. The Associated Press reported that, “Raising taxes on millionaires may be a non-starter for Republicans, but they seem to have no problem hiking Medicare premiums for retirees making a lot less. The House is expected to vote Tuesday on a year-end economic package that includes a provision raising premiums for “high-income” Medicare beneficiaries, now defined as those making $85,000 and above for individuals, or $170,000 for families. Some would pay as much as several hundred dollars a month additional for Medicare outpatient and prescription coverage. Millions who don’t consider themselves wealthy would also end up paying more.” [HR 3630, Vote #923, 12/13/11; Associated Press, 12/13/11]
Source: eriedems.com

CMS extends competitive bidding program despite protests

Problems reported by Medicare patients, providers and case managers through the AAH’s biddingfeedback.com website include difficulty finding a local equipment or service provider; delays in obtaining medically-required equipment and services; longer-than-necessary hospital stays due to confusion in discharging patients to home-based care; few choices for patients when selecting equipment or providers; reduced quality; and confusing or incorrect information provided by Medicare.
Source: thecre.com

Republicans plan House OK of payroll tax cut bill

The Republican Party of Pennsylvania is dedicated to providing privacy on the Internet. In addition to developing our privacy policy, we have provided you the opportunity to opt out of future ad serving cookies. In order to identify you as someone who has elected to opt out of receiving future cookies from ad serving companies, we will place an opt out cookie on your machine. If you would like to opt out of ad serving cookies or read additional information about these cookies, go to www.optout-choices.com.
Source: pagop.org

Pharmacies, Medical equipment Suppliers, WIGGINS, MISSISSIPPI, (MS) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM05-BLOOD GLUCOSE MONITORS/SUPPLIES (NON-MAIL ORD),  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL), DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS, M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M03-POWER OPERATED VEHICLES (SCOOTERS),  M04-SEAT LIFT MECHANISMS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS, PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,
Source: usa-hospitals.com

PA Phily & 5 Cty CHHA Medicare Certified Accredited Home Care Agency Business For Sale in Pennsylvania

KEYWORDS: CHHA, LHCSA, HOMECARE, HOME CARE AGENCY, CERTIFIED, MEDICARE, Arthur Shtaynberg, moratorium, health care, attorney, licensed, new york, kings, manhattan, queens, brooklyn, bronx, lhcsa, homecare, home care agency, homecare agency, licensed home health services agency, chha, home health, Therapy, Personal care, License, LHCSA, NY, NYC, LPN, RN, Nursing, infusion, social worker, Arthur Shtaynberg, medicaid, medicare, insurance, visiting, nurse, at home, aging, dying, patient, medications, prescriptions, respiratory, technichian, tech, fitter, problem, medicare, medicaid, HIP, HMO, Athna, podiatrist, doctor, help, aid, care, patronage, support, medical, business, new, registered nurse, RN, home health agency, tech, technichian, walkers, oxygen, CPAP, nebulizers, wheelchairs, hospital beds, canes, crutches, orthopedic shoes, equipment, durable, pharmacy, physical therapy, occupational therapy, home attendant, companion, senior, citizen, pending, philadelphia, Pennnsylvania, PA
Source: bizquest.com

How the use of Medicare Data to generate Performance Measurements affects Physicians?

[...] Centers for Medicare & Medicaid Services (CMS), HHS recently issued final rules pursuant to the Patient Protection and Affordable Care Act, (Pub. L. 111-148), enacted on March 23, 2010, and the Health Care and Education Reconciliation Act of 2010, (Pub. L. 111-152), enacted on March 30, 2010 (collectively the “Affordable Care Act.”) Effective January 1, 2012, the Affordable Care Act would amend the Social Security Act (the “Act”) to require standardized extracts of Medicare claims data under parts A, B, and D to be made available to “qualified entities” for the evaluation of the performance of providers and suppliers. Qualified entities may use the information obtained the Act for the purpose of evaluating the performance of providers and suppliers, and to generate public reports regarding such performance (the “Performance Reports”). Qualified entities may receive data for one or more specified geographic areas. Congress also required that qualified entities combine claims data from sources other than Medicare with the Medicare data when evaluating the performance of providers and suppliers.Source: sascottlaw.com [...]
Source: sascottlaw.com

Highmark says sale of its subsidiary won’t mean loss of Cumberland County jobs

I can assure you that you are absolutly right about the unemployment. No other employer who remains open is as responsible for unemployment claims as what Highmark is. As a former employee of that organization myself I can say I have seen all the back alley and fly by night crap that goes on there. Thankfully I got out when I was able to and went to work for a better employer but I feel for those still stuck there. Also I find it funny how Highmark promises many of its groups who buy there coverage for there employees that all there information will remain here in America and they will always talk with a rep here in America however when I left in 2010 they were beginning to start up an India facility that would handle the “back office” things such as claims processing, etc. which basically means that you may still get someone in America on the phone but your paperwork will go to Taji in India without your knowledge which will subject you to a greater risk of identity theft.
Source: pennlive.com

Berwick: Dont blame Medicare, Medicaid. Its the delivery system

Posted by:  :  Category: Medicare

Mark Warner - Caricature by DonkeyHoteyHis failure to be confirmed did not affect his ability to get things done, though he would have preferred a longer term. “An agency of this size will do better with longer-term leadership commitment,” he said. Knowing his tenure could be short gave him a greater sense of urgency to achieve things, he said. His most challenging decisions involved state requests to cut Medicaid benefits and writing regulations to encourage doctors and hospitals to form accountable care organizations to work more closely, while not making the requirements overly burdensome. He criticized state efforts to limit hospital coverage for Medicaid recipients, currently under review by federal regulators. Hawaii has proposed a 10-day coverage limit on some enrollees; Arizona has proposed a 25 day limit. “It’s a nonsensical idea,” he said. “If a patient needs twenty days, the patient should get twenty days,” he said. Managed care done right is the best way to provide care, he said, but if states are not ready to take on the responsibility, it can lead to restrictions that prevent people from getting the care they need. Early in his career, Berwick worked for Harvard Health Plan, a nonprofit HMO based in Boston. Berwick said he has not yet decided what to do next beyond spending more time with his family in Boston.
Source: localnewsvirginiabeach.com

Video: Virginia Medicare Advantage Ad Senate

TranS1: Medicare Contractor Removes Noncoverage Policy For Procedure

Josh Sandberg has been recruiting specifically in the musculoskeletal industry for over 8 years. Throughout this time, he has been able to have a positive impact on his client’s businesses. With an educational background in Business Management, Josh is adept to discern which people will be the best fit for the company he is searching for by understanding how candidates will incorporate with the company’s culture and operational nuances. His experience as an executive in a start-up business has granted him the ability to understand what is takes to thrive in a hands–on environment, where desire and dedication are paramount for success.
Source: orthospinenews.com

Early Medicare Part D deadline a concern for state agency

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

Former Virginia Secretary of Health Named to Head Federal Medicare and Medicaid Agency

Besides her state government cabinet level service in Virginia, Tavenner brings experience as a health care provider and hospital administrator. She has been a nurse and executive at the Hospital Corporation of America. She ran two suburban hospitals in Richmond and was chairwomen of the Virginia Hospital Association. She has also served as a trustee of the American Hospital Association.
Source: csg.org

Deadline approaching for Medicare Part D open enrollment 

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Source: wvgazette.com

Pharmacies, Medical equipment Suppliers, VIRGINIA, MINNESOTA, (MN) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM03-CONTINUOUS PASSIVE MOTION (CPM) DEVICES,  DM04-CONTRACTURE TREATMENT DEVICES: DYNAIC SPLINT,  DM07-GASTRIC SUCTION PUMPS,  DM08-HEAT & COLD APPLICATIONS,  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL),  DM11-INFRARED HEATING PADS SYSTEMS AND/OR SUPPLIES,  DM12-EXTERNAL INFUSION PUMPS AND/OR SUPPLIES,  DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES,  DM16-NEUROMUSCULAR ELECT STIMULATORS (NMES)/SUPPLIES,  DM17-OSTEOGENESIS STIMULATORS,  DM18-PNEUMATIC COMPRESSION DEVICES AND/OR SUPPLIES,  DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS,  DM21-TRACTION EQUIPMENT,  DM22- Transcutaneous Electrical Nerve Stimulation (TENS) AND/OR SUPPLIES,  DM23-ULTRAVIOLET LIGHT DEVICES AND/OR SUPPLIES,  M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M03-POWER OPERATED VEHICLES (SCOOTERS),  M04-SEAT LIFT MECHANISMS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M07-WHEELCHAIRS (STANDARD POWER & RELATED ACCESSORIES),  M08-WHEELCHAIRS (COMPLEX REHABILITATIVE MANUAL & RELATED ACCESSORIES),  M09-WHEELCHAIRS (COMPLEX REHABILITATIVE POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS,  OR02-ORTHOSES: PREFABRICATED (NON-CUSTOM FABRICATED),  OR03-ORTHOSES: OFF-THE-SHELF,  PD01-BREAST PROSTHESES AND/OR ACCESSORIES, PD06-OSTOMY SUPPLIES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, PE02-PARENTERAL NUTRIENTS,  EQUIPMENT AND/OR SUPPLIES,  R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  R04-INTERMITTENT POSITIVE PRESSURE BREATHING IPPB ( Intermittent positive pressure breathing) device ,  R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,  R08-OXYGEN EQUIPMENT AND/OR SUPPLIES,  R10-RESPIRATORY SUCTION PUMPS,  S01-SURGICAL DRESSINGS,
Source: usa-hospitals.com

A Completely Unofficial Blog About Eric Cantor

Cantor said he is convinced that Tavenner is committed to preserving the role of the private sector in health care. Responsibility for health coverage in the U.S. is close to evenly split between federal and state programs like Medicare and Medicaid, and workplace and private insurance. Republicans charge that Obama is trying to engineer a complete takeover by government, while the president insists his way is the best approach for preserving a system of shared responsibility in the face of unsustainable cost increases and millions of uninsured.
Source: ericcantor.us

Resolved Question: Is there a monthly penalty for prescription drug coverage going from an HMO to a PFFS?

Posted by:  :  Category: Medicare

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

Video: Medicare Part D Prescription Drug Plan Basics

Shopping Tips For Medicare Drug Plans

Can you stay out of the doughnut hole? When you and the plan together have paid $2,930 (including your co-pays and the $320 deductible that many plans charge), Part D coverage stops until you alone have spent $4,700. This is the drug plan’s infamous “doughnut hole,” which is being closed by the 2010 health care overhaul law. While you’re in this coverage gap, you pay half of the full plan price for a covered brand-name drug and 86 percent of the plan price for a generic. After you have spent $4,700, coverage resumes and you pay 5 percent of the full price for the rest of the year. If you don’t expect to spend $4,700, try to keep drug costs below the $2,930 that sends you into the doughnut hole Buy some drugs outside your plan at, for example, one of the chain pharmacies that offer specials on generic drugs.
Source: kaiserhealthnews.org

Just one more week to choose Medicare drug plans

Consider, for instance, a recent analysis from Avalere Health, a Washington-based consulting firm, of plan coverage of the 2,306 different medications covered by at least one 2012 Part D plan. Among the 10 biggest national standalone prescription plans, the percentage of those drugs on plan formularies ranged from a high of 79 percent on the Humana Enhanced plan, to a low of 47 percent on WellCare Classic.
Source: consumerreports.org

Common Questions About Medicare Supplement Plans

Enrollment is Not Always Guaranteed: Medicare Supplement insurance is regulated by the states, so there will be eligibility differences based on where you live. For example, in New York, most applicants must be accepted anytime, while in other states all applicants must be accepted only within their first six months of eligibility for Medicare Part B and in a few other situations. Outside of the eligibility periods, carriers are allowed to reject an applicant based on adverse health conditions. This means that if you apply at the wrong time, you may not be eligible for a Medicare Supplement policy.
Source: ehealthinsurance.com

Many Years Young: U.S. cracking down on Medicare painkiller abuse

The Department of Health and Human Services noted evidence of “doctor shopping,” when patients approach several doctors to get multiple prescriptions of addictive painkillers like OxyContin and Percocet. It also encouraged doctors to issue prescriptions for such drugs that provide a supply of 30 days or less.
Source: manyyearsyoung.com

Comparison Friction: Experimental Evidence from Medicare Drug Plans

Consumers need information to compare alternatives for markets to function efficiently. Recognizing this, public policies often pair competition with easy access to comparative information. The implicit assumption is that comparison friction—the wedge between the availability of comparative information and consumers’ use of it—is inconsequential because information is readily available and consumers will access this information and make effective choices. We examine the extent of comparison friction in the market for Medicare Part D prescription drug plans in the United States. In a randomized field experiment, an intervention group received a letter with personalized cost information. That information was readily available for free and widely advertised. However, this additional step—providing the information rather than having consumers actively access it—had an impact. Plan switching was 28 percent in the intervention group, versus 17 percent in the comparison group, and the intervention caused an average decline in predicted consumer cost of about $100 per year among letter recipients—roughly 5 percent of the cost in the comparison group. Our results suggest that comparison friction can be large even when the cost of acquiring information is small, and may be relevant for a wide range of public policies that incorporate consumer choice.
Source: nber.org

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

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

Study Finds Medicare Drug Plan Reduces Health Spending

The decrease was explained mostly by reductions in spending on inpatient and nursing-home care, the study found, suggesting that patients were able to manage serious health conditions through medication and prevent complications that could send them to the hospital. In addition, because of the expanded drug coverage, doctors may have been able to treat patients on an outpatient basis for conditions that previously required an inpatient stay in order to be covered by Medicare.
Source: nytimes.com

Medicare vs. Medicaid, the difference

Posted by:  :  Category: Medicare

Budget vs Budget by boris.rasinMedicaid, on the other hand, is a program that is provided by the states. Medicaid is typically referred to as Public Aid. In Illinois, Medicaid is administered by the Department of Health and Family Services. In order to qualify for Medicaid assistance, a person must need financial assistance and be at defined asset levels. For example, to qualify for Medicaid assistance in a skilled nursing facility, an individual must have less than $2,000 in assets. Medicaid also has provisions, called the Spousal Impoverishment Standard, which allows for a spouse to keep assets including the house, stocks, and other personal assets while the other spouse qualifies for assistance in a skilled nursing facility or supportive living facility.
Source: mysundaynews.com

Video: Medicare vs Medicaid

Government Bucks: Medicare Vs . Medicaid : : momsfarms.biz

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Source: momsfarms.biz

Insurance for You: Long Term Care Insurance vs. Medicare vs. Medicaid

Think Medicare and Medicaid will take care of all of your long term care insurance needs? Think again. Medicare will NOT cover services considered to be long term care services such as custodial care. If you have the idea that Medicare will take care of all of your long term care insurance needs then you need to read the following: Medicare is a Federal health insurance program generally covering people who are age 65 or older and some disabled persons. Medicare will cover the first 100 days of care in a nursing home if: 1) you are receiving skilled care, and 2) you have a qualifying hospital stay of at least 3 days and enter the nursing home within 30 days of that hospital discharge. There are also some deductibles and copays (meaning you have to pay part of the cost). Medicare also covers limited home visits for skilled care. It’s very important to realize a few things about long term care versus Medicare’s coverage: most long term care is not skilled care, most long term care does not take place in a nursing home, most nursing home stays do not immediately follow a hospital stay, most people who require care in their home usually need more or different types of care than Medicare covers, and most people won’t start Medicare coverage until age 65. So don’t count on Medicare to cover your long term care needs. What about Medicaid? Medicaid is set up by individual states, and subsidized by the feds, to act as a safety net for the poor and impoverished. Medicaid covers long term care services and might cover you if you meet your state’s poverty criteria and receive care that meets your state’s guidelines. Usually this means expending all but $2,000 of your assets and savings (except for perhaps your house and your car). It also means receiving care from a limited number of state-approved caregivers (mostly institutions like nursing homes) that are willing to accept Medicaid’s payments. In other words, if you have any money saved up (like retirement plans, 401k’s, etc) you have to cash it all in and spend it on your long term care insurance needs before you can apply for Medicaid. It also means that you do not have choices in who provides the long term care to you. With Medicaid, you are forced to receive services from a Medicaid provider, often these providers, although well meaning, are the bottom of the barrel providers. Medicaid does not reimburse very well at all for services provided by healthcare organizations. This means that those who do accept Medicaid as payment are often understaffed because they cannot afford to pay their staff what their competitors do. If you take out long term care insurance you do not have to deplete your assets in order to receive needed care, and you will have choices as to who provides your care. If you do not have long term care insurance then you are taking a big risk.
Source: blogspot.com

Medicare vs. Medicaid:Your Own Choice

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Source: apssupplements.com

Comparing Medicare vs Medicaid

Medicaid: this program is known to cover more than Medicare. Some of the many services it covers include: hospitalization, laboratory services, x-rays, clinical treatment, family planning, nursing services, and surgical dental care.
Source: retireeasy.com

Medicare, Medicaid, Social Security

[...] Over 50 million Americans get social security benefits, and the average monthly paycheck is a little over $1,000.  Most of these workers have contributed to the system for decades before receiving benefits. Thus they may claims some entitlement to these benefits. It is worth noting, however, that current beneficiaries probably contributed for past beneficiaries. Younger and more able workers are not contributing to pay the bill for current beneficiaries.Source: over50web.net [...]
Source: over50web.net

An Explanation of Medicare vs. Medicaid

Disability Group, Inc. was founded on the principles of dignity and respect. We are a national law firm focused exclusively on helping people receive the Social Security Disability benefits they deserve. For more information about Social Security, or to see if you qualify for benefits, visit us at
Source: indianapolis-disability-lawyer.com

Nothing found for Stimulus

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Source: seniorcareliving.info

Bay Area Disability Benefits: An Explanation of Medicare vs. Medicaid

Disability Group, Inc. was founded on the principles of dignity and respect. We are a national law firm focused exclusively on helping people receive the Social Security Disability benefits they deserve. For more information about Social Security, or to see if you qualify for benefits, visit us at
Source: bayareadisabilitybenefits.com

Difference between Medicare and Medicaid

Medicare has four parts. Medicare Part A covers hospital insurance, which includes hospital care, nursing, home healthcare, and hospice. Medicare Part B covers medical insurance, which takes care of doctors’ services, outpatient care, home healthcare, and some preventive services. Medicare Part C, also known as Medicare Advantage, helps people get the benefits and services covered by Medicare Parts A and B. Part C may include some extra advantages as well. Medicare Part D covers the cost of prescription drugs. Unlike Medicare, Medicaid is not divided into parts.
Source: knowitsdifference.com