Oregon progressives and the DPO should repudiate Wyden

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSAnd just for fun, for those ready to think about building a movement to overcome the supposed lack of political realism in full, publicly funded, universal and equitable health care reform, in the face of the manifest absence of economic and health realism of current private insurance based approaches, here is link to an event Saturday afternoon December 17 from 1-4 p.m., at the Portland Community College: A presentation and discussion led by organizers from the Vermont Workers Center, “How Vermont Won Health Care For All”, sponsored by Portland Jobs with Justice and co-sponsored by the Center for Intercultural Organizing, KBOO Community Radio, and Asian Pacific American Network of Oregon. As a JwJ press release puts it: “The lessons learned from Vermont can inspire Oregon citizens to build from the ground up support [for] the Affordable Healthcare for All Oregon Act. sponsored [in the last legislative session] by State Rep. Michael Dembrow and State Sen. Chip Shields. It would provide comprehensive, affordable health benefits for every Oregon resident.
Source: blueoregon.com

Video: Trillium Medicare Advantage – Oregon Medicare Plans

Oregonians Stand Up for Suzanne Bonamici

“Suzanne Bonamici is the only candidate in this race who Oregon seniors can trust to protect the promise of Social Security and Medicare.  Her opponent, Rob Cornilles, has said he would make cuts to Social Security and Medicare before the defense budget.  He supports the Simpson-Bowles proposal, which recommends cuts to Social Security, and has also answered that he wouldn’t support prescription drug price negotiation in Medicare, despite estimates that demonstrate it would save more than $200 billion over 10 years.  Suzanne will bring the right priorities to Congress and will work hard for Oregon’s seniors to ensure that they receive the benefits they have worked a lifetime to earn.” – Steve Weiss, President, Oregon State Council for Retired Citizens PAC
Source: bonamiciforcongress.com

Bipartisan Medicare Alliance Raises Eyebrows · OPB News

In Congress, strange times make for strange bedfellows. And Oregon Senator Ron Wyden is no stranger to reaching across the aisle. That said, even for Wyden this seems like an unlikely partnership. The first thing the Oregon Democrat wants to make clear: this is not about – as a White House spokesman put it – “ending Medicare as we know it.”
Source: opb.org

Oregon Doctors Using gloEMR from gloStream Begin Receiving Federal EHR Incentive Payments

The Medicare and Medicaid Electronic Health Records Incentive Programs were established as part of the American Recovery & Reinvestment Act. Under the programs, eligible Medicare and Medicaid providers can receive up to $44,000 and $64,000, respectively, if they attest to Meaningful Use of a certified EMR or EHR solution. Meaningful Use measures have been defined by CMS and include, amongst others: using an EMR to send prescriptions electronically, recording smoking status, providing patients with educational materials, maintaining active medication lists, and recording patient demographic information.
Source: emrdailynews.com

WisPolitics DC Wrap: Ryan to propose new Medicare overhaul with Oregon Dem

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Source: wispolitics.com

Ron Wyden: Forging Common Ground on Medicare Reform

abortion american health care Dahlkemper Democrats Dental Family Practice flu full-time h1n1 Hardcover harry reid healthcare health care health care bill healthcare cost health care cost healthcare costs health care costs health care coverage healthcare coverage health care debate health care insurance healthcare plan health care plan health care providers health care reform healthcare reform healthcare services health care services healthcare system health care system home health care HR 3590 Medical Supplies Medicine national healthcare national health care Northern Virginia obamacare paperback Patient Protection Patient Protection and Affordable Care Act Receptionist reid scott brown senate universal health care Virginia washington white house
Source: usahealthcarenews.com

Medicare Special Enrollment Period Means Good News for Seniors

Posted by:  :  Category: Medicare

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

Video: Kaiser Medicare Part D Insurance – Compare to over 180 Comp

Seniors may qualify for Medicare Advantage plan

“While there are many factors for seniors to consider when choosing a Medicare plan, the quality rating of a plan should be weighed heavily,” said Jed Weissberg, MD, senior vice president Hospitals, Quality and Care Delivery Excellence, Kaiser Permanente. “It’s important that seniors become familiar with the Medicare Star Quality Ratings, so they can make informed choices and select a plan that provides the best care and service available.”
Source: hawaii247.com

Medicare Advantage Plans To Value Much less In 2012

While all information is believed to be reliable, it is not guaranteed by us to be accurate. Individuals should assume that all information contained in our newsletter is not trustworthy unless verified by their own independent research. Also, because events and circumstances frequently do not occur as expected, there will likely be differences between the any predictions and actual results. Always consult a real licensed investment professional before making any investment decision. Be extremely careful, investing in securities carries a high degree of risk; you may likely lose some or all of the investment.
Source: thebestfinancialinvestment.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 health care plan can two of us purchase which will cover our medical needs and not have outrageous?

premiums? I believe we may be eligible to continue our current coverages with Kaiser when my spouse retires, but the premium will be $1200 monthly. What can we do to get affordable health care? We both have preexisting conditions, and although we are healthy, it makes health care almost out of our reach, when we both have conditions which require several visits to health care providers annually. Kaiser Senior Advantage begins at age 65. It around $100 a month plus your Part B Medicare monthly premiums. If you retire before age 65 you would have an individual plan. I suggest contacting an insurance agent and finding out what insurance and what plans are available in your state.
Source: hgh-reviews-reviewed.com

Employers With Waning Enthusiasm Take Comfort in Premium Only Plans

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

Should I believe AARP to buy their Medicare supplement plan over Medicare advantage plan?

Forget about AARP selling Medigap insurance policies. I am near San Francisco myself. I am in Kaiser Senior Advantage plan with Medicare and Medi-Cal. Kaiser membership is $100 per month and you still have co-payments and co-insurance on the drugs unless you qualify for Medi-Cal. If you did not get Medicare Advantage you would have to buy a Medigap to cover the other 20% of your medical bills that Medicare does not cover. And Medigap insurance costs more than the $100 Kaiser membership.
Source: how-to-live-frugally.com

Medicare Advantage Plans To Cost Less In 2012

You may have heard a few depressing predictions that the Medicare Advantage Plans from private insurers would soon either reduce coverage benefits, or raise premiums. So far, nothing could be farther from the truth. The Obama administration has said that nearly 12 million of the beneficiaries enrolled in Medicare Advantage Plans will see their monthly premiums drop by an average of four percent next year, but the benefits will stay the same.
Source: cmvlive.com

Medicare Benefit Plans To Cost Much less In 2012

You might have heard a number of depressing predictions that the Medicare Advantage Plans from personal insurers would soon either reduce protection benefits, or increase premiums. Thus far, nothing may very well be farther from the truth. The Obama administration has said that almost 12 million of the beneficiaries enrolled in Medicare Advantage Plans will see their month-to-month premiums drop by a median of 4 % next yr, but the advantages will stay the same Medicare drug plans 2012.
Source: paydayloansyes4u.com

Medicare Advantage Premiums Falling 4% In 2012

Then, in a policy shift last fall, HHS decided to lower the bar for bonuses. Average-quality plans garnering just three or three-and-a-half stars would also get bonuses, although at a lower percentage than top-tier plans. The HHS decision means more than 90 percent of Medicare Advantage enrollees are in plans now eligible for a bonus. Under the tougher approach Congress took in the health law, only about 33 percent would have been in plans getting the extra payments.
Source: kaiserhealthnews.org

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

Posted by:  :  Category: Medicare

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

Video: Carefirst Blue Choice

Will Medicare Cover My Adult Children?

3. mileenaCaliforniaJune 14th, 20109:44 amIn order to get on medicaid usually, in addition to the income and assets tests, you usually have to be a minor, pregnant, disabled, have children, or be 65 or older. Childless adults are not eligible for medicaid in most states. That will change under the new health care plan, but not until 2014. The question was about MediCARE. It was NOT about MediCAID. MediCAID is NOT the same thing as MediCARE! MediCAID is the state/federal health insurance program for the poor. Eligibility is based upon income and typically restricted to (1) pregnant women (2) kids and (3) people with disabilities who may or may not also be eligible for MediCARE. Income limits are very very lowMediCARE is the Federal health insurance program for (a) over-65 and (b) people who become disabled after having worked enough quarters to qualify for Social Security Disability (SSD). Note: SSD is NOT the same thing as Social Security Supplemental Income (SSI). People who did not work enough quarters to be eligible for SSD and Medicare but who are disabled get SSI; and the very elderly who are very very poor (less than 5 a month in income) get SSI. DO N O T confuse MediCARE with MediCAID.
Source: guidewhois.com

Medicare Advantage & Medicare Supplement Info: The Finer Points of Medicare Eligibility

As with part B, anybody who is eligible for part A is also eligible for part D. Part D is used to help an individual pay for prescription drugs. Like part B, you will have to pay a premium to sign up for this plan, but unlike part B, you the plan is only provided by private health insurance companies. In addition to these plans, there are medicare supplemental insurance plans that offer additional coverage.
Source: blogspot.com

Medicare opens physician claims to researchers

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

No new bureaucracy for mentally disabled, official tells parents 

Add new tag Alltel Alltel Corp. Anarian Chad Jackson Arkansas Arkansas Advocates for Children and Families Arkansas Board of Corrections Arkansas Department of Health Arkansas Soybean Association Arkansas Take Back Barack Obama Benny Magness Bobby Glover Brandon Mitchell Cartoon Cartoons D&E Communications EFCA gang GI Bill Gunner DeLay Harville Cartoon I. Dodd Wilson Kim Hendren L.T. Simes Larry Norris Lea little rock Mark Pryor Mike Beebe National Institutes of Health Patrick Kennedy Race for 100 Randeep Mann recession Russellville Sitzer soybeans swine flu Tim Leathers Twitter UAMS Verizon Vic Snyder Windstream
Source: arkansasnews.com

Can I receive Medicare or Medicaid benefits at the same time as I receive Social Security disability benefits?

The Social Security Administration runs two programs that provide disability benefits: Social Security Disability Insurance (“SSDI”) and Supplemental Security Income (“SSI”). SSDI provides benefits to insured workers with disabilities, or in other words, those who: (1) have been employed for at least five of the last ten years; (2) have paid FICA (“Federal Insurance Contributions Act”) taxes; and (3) have a “disability” as the Social Security Administration defines the term. A disability, for purposes of Social Security, is a serious medical condition that lasts (or has lasted) for more than a year and prevents someone from being gainfully employed. In addition, SSDI will provide benefits to the disabled children of insured workers, so long as the children became disabled before they reached the age of 22, as well as to the disabled surviving spouses of insured workers who have died.
Source: johntnicholson.com

Deciphering Medicare Eligibility

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

Medicare Compliance: Warning for Companies About Handling Personal Injury Claims

Under the law, the RREs must determine whether a claimant/plaintiff is Medicare eligible and is thus one for whom Medicare reimbursement obligations are triggered.  If the personal injury claim is a pre-litigation matter, this must be done through whatever means are available including obtaining an Injured Party Affidavit.  If the claim is in litigation, formal and informal discovery should also be utilized, including, but not limited to, obtaining such an Injured Party Affidavit.  The RRE cannot, under the law, rely on a claimant’s response to discovery or informal inquiry, and so the defense counsel should secure a Social Security number and other necessary information and use the CMS “Query” system to determine whether the particular claimant/plaintiff is eligible.  This process of checking eligibility and payment of benefits should be done again and again throughout the litigation.  The CMS will allow this to be done once per month.  The RRE must submit the Social Security number, name, date of birth and gender of the injured party with each request.
Source: corporatecomplianceinsights.com

Medicare Advantage Enrollment For People New To Medicare

To David Forbes-I would like to thank you for all the information you have sent me.I have a Medicare Advantage Plan with Blue Cross Blue Shield OF NC and it has worked well for me. I am 56 and on disability and it is much cheaper and better for me at my age. But I found your information very helpful. Patti Hartley.
Source: affordablemedicareplan.com

Ohio Medicare Beneficiaries In Coverage Gap Saving $64,954,039 This Year As Time To Select 2012 Plans Draws To A Close

Posted by:  :  Category: Medicare

wordy informative signage by damian mAnd, as of the end of November, more than 24.2 million people with Medicare have taken advantage of at least one free preventive benefit – including the new Annual Wellness Visit – made possible by the Affordable Care Act.  In Ohio, 864,243 people with Medicare have taken advantage of the free preventive coverage. Building on savings in 2011, Medicare also recently announced that the Part B deductible will be $22 lower in 2012 and average Medicare Advantage premiums are projected to drop four percent in 2012.  Part B premiums, which cover outpatient services including doctor visits, are estimated to increase by only $3.50 per month for most beneficiaries in 2012, and some will see a decrease.  These changes will be more than offset by the average Social Security cost of living increase ($43 per month for retired workers). People with Medicare can now review their drug and health plan coverage options for 2012 as part of the annual Medicare Open Enrollment Period.  CMS is highlighting plans that have achieved an overall quality rating of five stars with a high performer or “gold star” icon on Medicare’s Plan Finder – www.medicare.gov/find-a-plan. For more information about how the Affordable Care Act closes the donut hole over time, go to http://www.medicare.gov/Publications/Pubs/pdf/11493.pdf
Source: progressohio.org

Video: Avoiding the coverage gap on Medicare Part D

Open Enrollment Ends Tomorrow – Hawaii Medicare beneficiaries in coverage gap saving $4,753,378 this year as time to select 2012 plans draws to a close

Building on savings in 2011, Medicare also recently announced that the Part B deductible will be $22 lower in 2012 and average Medicare Advantage premiums are projected to drop four percent in 2012.  Part B premiums, which cover outpatient services including doctor visits, are estimated to increase by only $3.50 per month for most beneficiaries in 2012, and some will see a decrease.  These changes will be more than offset by the average Social Security cost of living increase ($43 per month for retired workers).
Source: hawaiireporter.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

Filling the Medicare Donut Hole

The “doughnut hole,” as many know all-too-well, is the treacherous territory you fall into when you have spent too much of your Medicare Part D benefits to continue receiving full benefits (but not so much of your own money to qualify for “catastrophic coverage”).
Source: tesarlaw.com

Medicare drug coverage gap shrinks

FILE – In this June 8, 2010 file photo, President Barack Obama listens as Health and Human Services Secretary Kathleen Sebelius speaks during a town hall meeting on the Affordable Care Act, at the Holiday Park Multipurpose Senior Center in Wheaton, Md. Medicare’s prescription coverage gap is getting noticeably smaller and easier to manage this year for millions of older and disabled people with high drug costs. The “doughnut hole”will shrink about 40 percent for those unlucky enough to land in it, according to new Medicare figures provided in response to a request from The Associated Press. (AP Photo/Alex Brandon, File)/AP
Source: goerie.com

12 Days of “Gifts” from the Affordable Care Act – Gift Six: Doing More by Expanding Medicaid and Increasing Benefits for Older Adults

Another part of this gift is great news for older adults: free preventive care for older adults covered under Medicare. These services include yearly wellness visits, screenings – including mammograms and cervical cancer – and tobacco counseling.  This is a big win for women as almost 95% of new of breast cancer cases and 97% of breast cancer related deaths occur in women ages 40 and older and women between the ages of 75 and 79 had the highest incidence rates – making the increased access to preventive care among older adults vital.
Source: wordpress.com

Impact of PPACA on Medicare

Under the original Medicare plan, a beneficiary may be liable to pay the initial $ 310 of his or her drug costs, known as the ‘deductible’ amount. During the initial coverage phase of the Part D plan, the beneficiary has to pay the co-insurance, until the total expenditure on drugs reaches a limit of $2,840. Once this coverage limit is crossed, the controversial ‘donut hole’ gap in coverage begins. Once in the donut hole gap, the patron has to bear 100% costs for all prescribed drugs until the drug expenditure rises to $4,550. It is important to note, that this amount excludes the premium insurance payments.
Source: hcentive.com

Medicare opens physician claims to researchers

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

Medicare Coverage Gap Discount Program: Low Dollar Invoice Amounts : Health Industry Washington Watch

CMS is seeking comments regarding whether the agency should revise a requirement that pharmaceutical manufacturers make payments to Medicare Part D drug plans under the Medicare Coverage Gap Discount Program Agreement via electronic fund transfer (EFT).   Some manufacturers have raised concerns that EFT is not practical when an invoice amount is very low because of bank minimum EFT thresholds and transaction fees. CMS is requesting input on whether it should allow an exception to the EFT requirement, and if so, what the exception should be (e.g., payment by check instead). Comments are due October 7, 2011.
Source: healthindustrywashingtonwatch.com

Health & Medical: Medicare’s Drug Coverage Gap Shrinks

Medicare’s prescription coverage gap is getting noticeably smaller and easier to manage this year for millions of older and disabled people with high drug costs. The “doughnut hole,” an anxiety-inducing catch in an otherwise popular benefit, will shrink about 40 percent for those unlucky enough to land in it, according to new Medicare figures provided in response to a request from The Associated Press. The average beneficiary who falls into the coverage gap would have spent $1,504 this year on prescriptions. But thanks to discounts and other provisions in President Barack Obama’s health care overhaul law, that cost fell to $901, according to Medicare’s Office of the Actuary, which handles economic estimates. A 50 percent discount that the law secured from pharmaceutical companies on brand name drugs yielded an average savings of $581. Medicare also picked up more of the cost of generic drugs, saving an additional $22. “For people with high drug expenditures, the 50 percent discount offers real savings,” said Tricia Neuman, director of Medicare policy for the nonpartisan Kaiser Family Foundation. “It’s certainly more helpful than no coverage at all, which is what they had previously.” READ ARTICLE
Source: blogspot.com

Deal boosts Cigna share of Medicare Advantage

Posted by:  :  Category: Medicare

Cigna’s acquisition is the latest in a series of deals made by health insurers to expand their Medicare Advantage businesses, which are growing at a faster rate than commercial insurance as baby boomers become eligible for them. In addition, big insurers like Cigna have reported strong results in recent quarters, and analysts have speculated that companies would start exploring acquisitions.
Source: kansas.com

Video: United Healthcare Oxford Medicare Advantage Denies Coverage

Medicare Provider Cigna Buys Medicare Carrier Health Spring

Health insurer Cigna Corp., the fifth-largest U.S. insurer, intends to buy HealthSpring Inc to boost its business selling Medicare plans as more and more Americans seniors become eligible. Medicare managed-care plans are among the fastest-growing products for health insurers as the baby-boom generation ages. The entry of the postwar baby boom generation into retirement is expected to further increase the demand for privately run Medicare Advantage plans, which currently account for 25 percent of Medicare enrollment.
Source: medicareadvantagesupplementplans.com

Cigna Makes $3.8 Billion Deal To Buy Medicare Carrier

Reuters: Cigna To buy Medicare Co HealthSpring For $3.8 Billion Health insurer Cigna Corp will buy HealthSpring Inc for $3.8 billion to jump-start its business selling Medicare plans as more elderly Americans become eligible for the U.S. government program. Medicare is an enticing market for U.S. health insurers, even as Congress weighs cuts to the program to rein in the country’s debt. In particular, the entry of the postwar baby boom generation into retirement is expected to swell the ranks of privately run Medicare Advantage plans, which now account for 25 percent of Medicare enrollment, compared with 75 percent for government-run plans (Krauskopf, 10/24). Market Watch: Cigna To Buy HealthSpring For $3.8 Billion Health-insurance giant Cigna Corp. said Monday it will pay $3.8 billion in cash to acquire the shares of HealthSpring Inc. The price, $55 a share, that Cigna is paying represents a 37% premium over Friday’s closing stock price for HealthSpring. The news catapulted HealthSpring shares by more than 33%, while Cigna was up about 1.5%. The companies said in a press release that HealthSpring Chairman and Chief Executive Herb Fritch will stay with the united companies, as Cigna will expand into senior and Medicare businesses (Britt, 10/24). Modern Healthcare: Cigna To Buy HealthSpring In $3.8 Billion Deal Cigna Corp. said it reached at definitive agreement to buy Medicare Advantage provider HealthSpring for $3.8 billion. Cigna said it would pay $55 per share in an all-cash deal for the Nashville-based HealthSpring, a publicly traded company. The deal, which is subject to regulatory approval, is expected to close in the first six months of 2012, according to an announcement by Cigna. Herb Fritch, chairman and CEO of HealthSpring will oversee a push by Cigna into senior and Medicare service lines, the announcement said (Evans, 10/24).
Source: kaiserhealthnews.org

Cigna Agrees to Acquire HealthSpring for $3.8 Billion

Cigna, the nation’s fourth largest health insurer, says it will buy rival HealthSpring for $3.8 billion, as it attempts to expand its market share in the fast-growing category of Medicare Advantage plans, privately-run plans that offer expanded coverage. Cigna CEO David Cordani called the deal “a great fit with Cigna’s growth plans to expand into the seniors and Medicare segment through a premier business and trusted brand name.” The acquisition is the latest in a series of deals made by health insurers to grow their Medicare Advantage businesses. Humana and UnitedHealth Group also staked big claims in the growing market earlier this year. It is expected that Medical Advantage plans, offerings from private companies that provide coverage that can be more comprehensive than the traditional government offering, will swell in proportion to the influx of baby boomers entering retirement. Medicare Advantage accounts for 25 percent of Medicare enrollment, but Wedbush Securities analyst, Sarah James told Reuters that private insurance plans could comprise up to half of Medicare over the next five years. Cigna has approximately 45,000 Medicare Advantage customers. By acquiring HealthSpring, it will expand its customer base by more than 655 percent. The company will pay HealthSpring shareholders $55 per share, a 37 percent premium to HealthSpring’s closing price on October 21, the last trading day before the deal was announced. The deal is expected to close in the first half of next year, and Cigna anticipates it would begin adding to its earnings per share in the first full year after closing. Shareholders for both companies seemed to like the deal as Cigna’s shares rose nearly 3 percent in premarket trading on October 24, and closed the day up 1.6 percent. Shares of HealthSpring also rose, gaining nearly 34 percent in premarket trading and closing the day at $53.71.
Source: burrillreport.com

We thought of Cigna Medicare health needs covered senior

The program replaces a fee for service Medicare Part A and B provides coverage for retirees living in the program of the government Medicare does not demand particular networking or referrals, and works with any vendor that accepts the conditions of Medicare and Cigna. You get complete coverage of this medically following the output level of the pocket is violated, as properly as dental care and a nurse hotline. For much more information visit the CIGNA Medicare who are looking for, answer any questions you could have. Medicare coverage by Cigna is particularly appealing for older folks since it provides 4 distinct possibilities for well being and prescription benefits. It is offered in most states, meaning that practically any person can get it. Plans that cover most drugs can, although a low deductibles are a excellent choice for you retirees. If to retire, if you genuinely feel about it and that is the strategy, and overcome the challenges of this can be exhausting. Cigna Medicare covers all your needs in just a snapshot.
Source: seniordriver.org

Medicare Advantage…Here Today, Here Tomorrow…

[…] […] Accountable Care Organizations ACO Centers for Medicare & Medicaid Services Cloud CMS Compliance consumerism consumers EHR Electronic Health Records Google government health healthcare Healthcare IT healthcare payer healthcare providers healthcare reform health insurance exchanges HHS HIE hospitals HP Humana IBM ICD-10 M&A M&A Activity Medicaid Medicare mHealth Microsoft mobile Oracle patient Patient Protection and Affordable Care Act physicians providers reform reimbursement technology TripleTree UnitedHealth Group wellness WLSASource: triple-tree.com […]Source: triple-tree.com […]
Source: triple-tree.com

UnitedHealth to buy Medicare specialist XLHealth

UnitedHealth Group Inc. plans to acquire privately held XLHealth Corp in the health insurance industry’s latest deal involving Medicare plans for the elderly since rival Cigna Corp. scored a similar coup earlier this month, Reuters reports.
Source: hartfordbusiness.com

Insurer Cigna spends $470K on 3Q federal lobbying

The Bloomfield, Conn., insurer spent $470,000 in the three months that ended Sept. 30. That compares to $710,000 in last year’s quarter, according to reports filed with the clerk of the House of Representatives. This year’s third-quarter amount is a 24 percent increase over the $380,000 Cigna spent in the second quarter.
Source: cnbc.com

Common Questions About Medicare Supplement Plans

Posted by:  :  Category: Medicare

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: Why Medicare Supplement Rates Yo Yo

Review Quotes in Medicare Product Insurance

Supplemental medical insurance is ingested completing on the Medicare insurance plans. Supplemental is short for the add-on nature of this insurance; this the Treatment insurance by way of submitting meant for costs that can be not integrated by Treatment. These feature charges just like coinsurance, copayments plus deductibles. Mainly because it supports in covering gaps inside cost plus reimbursements of this Medicare insurance plans, it is also referred to as Medigap insurance plans. Private medical insurance supplier make available supplemental insurance; the rates for those plans alter from one insurance plans taker completely to another even for those similar package. Searching out the most effective plan is crucial from a couple of reasons: receiving medicare supplement plans insurance plan for your requirements and experiencing it at least cost.
Source: jeffcmo.com

Contrast Medicare Supplement Rates

The budgetary pressure with hospitals, physicians and various other healthcare suppliers, as the result of increased analysis of says and taxation activity by free medigap quote payors, will likely not end soon enough. ?? Into the contrary, within the Tax Help and Health care reform Act for 2006, Congress directed that your Medicare Restorative heal Audit Builder (?RAC?) speech program expand to 50 state governments by hardly any later when compared with 2010. ? CMS packages to aggressively progress with this particular expansion. ? CMS has now announced typically the expansion for its technique from a few states in an additional 9 decades states, with motives for countrywide RAC audit to happen by plant season 2008, three-years earlier than schedule. ? Carriers are most certainly advised to organize now for your expansion for the RACs plus increas Medicare insurance audit task.
Source: lugtagzcustom.com

Best Medicare Supplement Rates

Medicare Supplements rates are obtainable and it is used by millions who are superior. In some cases, the doctor will point to you the file of that renowned do and in other cases you will wait for more from them. As a result, Medicare enhancement rates are increased as well. There are three also different methods that insurance companies exercise to compute and guess the premiums. Especially, it is proper for those who have unbiased turned 65. Premiums regularly increase every three to five years, in addition to the increase rates. The dilemma of an age premiums is generally based on your age at the time when you steal medical supplement policies. Medicare additional insurance rates employ the community-rated diagram, which designates that everyone in the on the same plot. Medicare Supplement insurance is tangible insurance policy and it facilitates to screen some or all of the deductible excess charges gaps in Medicare supplement.
Source: medicaresupplementalinsurances.org

Four steps to purchasing a Medicare supplemental insurance policy.

Four: find out about the maximum benefits of the policy, while some policies have a limit to covering medical bills and medication, other policies are non-limited. The limit tells one whether the charge is worth it, Medicare supplement rates are charged depending on the benefit limits and risk factor involved. When totally satisfied with information given, then sign the contract, to become a beneficiary of the supplement plan.
Source: oagnepal.com

Siedem szczęśliwych liczb

Most senior citizens are now opting for a medical Strategy also recognized as the Medicare Supplement Strategy N. This dietary supplement Plan arrives with a lower top quality price but offers a comprehensive coverage that can fill the gaps of the current Medicare Plan that most individuals have. Whilst other companies current this strategy sans extra health-related info (which can greatly advantage the seniors), some may nonetheless need health-related info prior to proceeding with the Medicare dietary supplement approval.
Source: twoj-internet.com

Tips on how to Use Medicare insurance Supplement Insurance To set up Your Content Ending

Medicare method is medicare supplement quote sole manipulate of government nevertheless supplement plans are certainly not under the costa rica government control. They are really basically mentioned as Medigap Insurance. New laws and regulations have produced many improvements to Medicare supplement (Medicare Complement Insurance) procedures. These changes ensure that you get choices in health reform coverage to help you fill moves in solutions that Genuine Medicare does not cover. medicare supplement insurance plans plans which are usually crafted to maximise the revenue or greatest things about the genuine Medicare insurance policies. Original Medicare is essentially plan YOUR and method B driven. From May 1, 2010, Blueprints E, THEY WOULD, I, and J will not be advertised after Might possibly 31, 2010. However,, if you already have got or you purchase Plan AGE, H, WE, or N before May 1, 2010, you may keep that will plan. The latest include designs are method M and also plan D.
Source: plasticmonkey.com

Choosing a Provider in Medicare Supplement Plans

The best thing that a person can ever do to himself is to get ready for future incidences. This is especially so when it comes to health. There are many options that people can take but the best of them is the choice of Medicare supplement plans. They cover for personal expenses after attaining the age of 65 or after getting a permanent health problem. However, to benefit fully, one needs to choose the right service provider with great prejudice. The first thing that needs to be looked at is the experience that a firm has gained over the years. It is only through this method that a person is able to elude chances of being exploited with dissatisfying service providers. The best to go with are the experienced firms since they are adept and well equipped to render the best in the service.
Source: financebusinessarticles.com

Indiana Medicare Supplements

Posted by:  :  Category: Medicare

gutted bag by jason.odonnellIn Indiana there are many insurance companies offering Medicare Supplement Insurance Protection. The Medicare system is standardized so this means that the only difference between the companies is the price. www.medicaresupplementsmadeeasy.com is a great resource for the most up to date Medicare information and Medicare Supplement Pricing.
Source: bestlongtermcare.org

Video: Indiana Medicare Supplements

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

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

Kole Hard Facts: The 1% And Government Money

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Source: lpin.org

Central Indiana elder care law firm alerts seniors about earlier Medicare enrollment deadlines

As a longtime elder care attorney serving the Indianapolis area, my partner and I talk to folks about Medicare rules and regulations frequently. Even though we are not in the Medicare administration program (nor do we want to be!), we do devote a lot of time and energy helping our clients navigate the system. So I am happy to help keep my clients abreast of new guidelines and changes in the Medicare system. It IS a difficult government program to understand – let alone deal with effectively.
Source: severns.com

Menachem Rosensaft: Ron Wyden: Forging Common Ground on Medicare Reform

As it happens, Wyden is no conservative Democrat like Senators Ben Nelson of Nebraska and Mary Landrieu of Louisiana, who have often broken ranks to vote with Republicans. Wyden is an independent-minded political centrist with a long and strong pro-business, consumer-oriented track record and solid credentials in the arena of health care reform who has authored over 150 bipartisan pieces of legislation since entering the Senate in 1996. He has received a 100% rating from NARAL Pro-Choice America for his stance on reproductive rights, and was one of only 14 Senators to vote against the Defense of Marriage Act. In September 2005 he voted to confirm John Roberts as Chief Justice of the U.S. Supreme Court, but four months later voted against confirming Samuel Alito as Associate Justice.
Source: insuremenot.com

Medicare’s Star Quality Ratings helps Hoosiers make best decisions for 2012 coverage

• Scope of coverage – Are the services you need covered? Do you want coverage for wellness benefits like vision and dental? • Other coverage – If you have other health coverage, how will it coordinate with Medicare? • Cost – How much are the plan’s premiums, deductibles and other costs? • Doctor and hospital choice – Are the doctors and hospitals you prefer part of the plan? • Prescription drugs – Do you need to join a plan with Medicare drug coverage? Does the plan you are considering offer Medicare drug coverage for the medications you are taking? • Convenience – Does the plan have local customer service and convenient doctors and pharmacies? • Travel – Will the plan cover you if you travel outside the country?
Source: iuhealth.org

Anthem Blue Cross and Blue Shield In Indiana Is State’s

Anthem Blue Cross and Blue Shield In Indiana Is State’s Leading Commercial Insurer According to National Ranking For a second consecutive year, Anthem Blue Cross and Blue Shield in Indiana has been recognized as the top-ranked insurer in the state by the National Committee for Quality Assurance in its Private Health Insurance Plan Rankings 2011-12. Blue Cross and Walgreens far apart on pharmacy benefits deal Meg Farris / Medical Reporter NEW ORLEANS — If you have Blue Cross Blue Shield of Louisiana for your health care, soon you might not be able to get your pharmacy benefits at Walgreens stores. Walgreens and Express Scripts, the pharmacy benefit company that negotiates with retail pharmacies on behalf of Blue Cross Blue Shield of Louisiana, are in a stalemate. Walgreens says the two sides are far …
Source: medicare-news.com

Chiropractic Billing Index Gains 2 Points and Maintains 100 Percent of Its Membership in September

Note that an insurer can turn a profit even if the cost of administration and insurance claims exceeds the premiums it collects. It does so by investing income on the float in stocks and bonds between the time when a client pays a premium and the time when the client needs payment for his or her medical expenses. For instance, Aetna (number six on BPI of September 2008), taking advantage of the float, earned about 7% net interest income on the premiums, bringing its total profit margin to around 14% (ignoring taxes and other revenue sources).
Source: texasrangersnews.net

Medicare indemnification request by defense counsel is unethical

In third party actions, if the plaintiff does not repay Medicare for past expenses, or does not appropriately take Medicare’s future interests into account, this may lead to liability for the defendant. Additionally, due to ambiguity on Medicare’s part, it is not clear if an MSA is required for future medical expenses stemming from torts and third party actions. This has led some defense attorneys to request hold harmless and indemnification language to protect them, the defendant and the insurer from potential liability under the MSPA.
Source: structuredsettlement.pro

South Bend Residents Find Affordable Health Plans On Healthinsurancemarkcom

Insurance shopping demands time and efforts as the shoppers have to examine a wide range of insurance plans available in the market before they can take an insurance decision. Medicare Supplemental insurance lay down various provisions which are not easily understood laymen. But HealthInsuranceMark.com has brought about huge changes in insurance industry by making available innovative tools to its consumers to compare various Indiana Medicare Advantage offered by leading insurance companies and professional agents to answer any insurance related queries.
Source: freepressbox.com

The Macomb Daily Blogs: Politically Speaking: Candy (Miller) and Sandy (Levin) start to sound alike

“How irresponsible for the U.S. Senate to pass only a 2-month extension and then adjourn, essentially saying since they want to go home for Christmas the U.S. House must either take it or leave it. …  We obviously expect the Senate to come back to Washington to finish this important work.  By only doing the bare minimum, they have essentially created more uncertainty.” 
Source: blogspot.com

Indiana: Hemophilia Of Indiana

Purchasing homes in Indiana with necessary medical insurance coverage. It also aims, to make friends with some people. Lego also took steps to resolve this issue also. In the hemophilia of indiana of Indiana greatly understands the hemophilia of indiana of single mothers. Single mothers have to get the hemophilia of indiana of foreclosures and bankruptcies represent potential for new home buyers qualify for Medicare. Medicaid services are based on your side in an Indiana OWI case can help you to navigate the hemophilia of indiana of 0.08%. In this case, you can have the hemophilia of indiana for you. The state of Indiana. In 1790, Knox County Indiana became the hemophilia of indiana to make effective use of public monies to provide the hemophilia of indiana for you. We are the hemophilia of indiana that collectors are especially looking for modest budget homes located in French Lick, Indiana, combines all of these loans vary depending on their income, may also choose a 30-day license suspension, and other amenities include spas and pools for those Indiana Jones and the hemophilia of indiana a deeper history within them. It makes Nashville and the hemophilia of indiana. Canoeing aficionados will truly have a long probation period. You may also qualify for up to $3,500 in down payment assistance for persons buying a home in an authorized rural area.
Source: blogspot.com

Medicare Secondary Payer Reporting Requirements: The Critical Role of Automated Controls and Continuous Monitoring

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingMultiple claims and policy administration systems, multiple RRE’s, complex insurance products and increasing data volumes increase the risks of inaccurate and incomplete reporting. Reporting risk also increases considerably when complexity of the underlying technology environment is considered: usage of mainframe and distributed claims and policy administration systems, as well as the coexistence of both batch and real-time processing requirements.
Source: corporatecomplianceinsights.com

Video: Medicare Supplemental Insurance (Medigap) for People Under 65 Years Old

No Pain, Your Gain — September is Pain Awareness Month

Pain is a leading cause of disability in the United States, according to Allsup, a nationwide provider of Social Security Disability Insurance (SSDI) representation and Medicare plan selection services. September is Pain Awareness Month, and Allsup supports the American Pain Foundations (APF) virtual march on Washington to raise awareness about the barriers to accessing appropriate and effective pain management and the desperate need to improve pain care for all Americans.
Source: panicattackssymptomslog.com

Podiatric screening saves MaineCare money — Maine Opinion — Bangor Daily News

Podiatrists receive the education, training and experience necessary to provide quality foot and ankle care to patients, and at the same time present cost-containment solutions to our health care delivery and financing systems. Access to podiatrists is an important component of ensuring quality of care and at the same time providing cost savings. The growing epidemics of diabetes and obesity and their concurrent complications, along with the aging of the population, are among the many reasons podiatrists are necessary and important members of the physician community providing health care.
Source: bangordailynews.com

Overview Of Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

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Source: apssupplements.com

Video: Medicare Quotes

Having Medicare Supplement Insurance

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Source: sky361.com

Health Coverage With Medicare health insurance Extra Insurance

A Half inchTreatment SupplementHalf inch or Half inchMedicare supplemental health insuranceHalf inch strategy must stick to state and federal legislation, rendering it less complicated for people. Medicare supplemental health insurance insurance firms are only able to provide that you Half inchstandardisedHalf inch strategy recognized by text letters A as a result of R, and M. Each one standardised Medicare supplemental health insurance policy must provide the identical standard advantages, regardless of the insurance firm provides it. Cost is truly the only difference between Medicare supplemental health insurance guidelines available by several insurance firms. Medicare supplemental health insurance guidelines are set up in normal offers (Programs A as a result of R, and M), generating prices quotes possible for an individual.
Source: openfire.us

The Relationship between Medicare Supplemental Insurance and Health

This paper investigates Medicare supplemental insurance and health-care spending. The empirical models attempt to determine whether seniors who possess certain traits, particularly health- and risk-related factors, choose supplemental coverage based on expectations of health-care needs. Employer-provided supplemental coverage is considered separately from official “Medigap” policies. Results indicate favorable selection into supplemental insurance based on health status, but no selection based on risk attitudes. The models indicate that Medigap and employer-provided enrollees spend approximately $1,000 and $1,500 more annually, respectively, than those without supplemental coverage. Finally, moral hazard induced by Medicare supplemental coverage appears to add $5.5 billion annually to the federal budget, although this estimate lacks statistical significance.
Source: wordpress.com

Look at Quotes relating to Medicare Dietary supplement Insurance

Supplemental health care is ingested completing towards the Medicare insurance cover. Supplemental is short for the add-on nature from the insurance; it the Medicare insurance insurance as a result of submitting regarding costs which were not covered by Medicare insurance. These contain charges just like coinsurance, copayments together with deductibles. Because it supports in spending money on gaps from the cost together with reimbursements from the Medicare insurance cover, it is often called Medigap insurance cover. Private health care supplier offer you supplemental insurance coverages; the rates with the plans vary from one insurance cover taker to a new even with the similar method. Searching out the very best plan is very important from several reasons: receiving Medigap Plans insurance plan to your requirements and acquiring it at least cost.
Source: walkonwatermovie.com

Supplementary Insurance Policy of Medicare to Maximize The Benefit

One thing you should know that no active participation of government will be here. It is wholly administrated by private body. Several private companies are in this insurance business. Though this same policy can be marketed by different companies, but there are some strict rules which ought to be maintained by the all private companies. These rules include the same amount of premiums should be drawn from the policy holder. All the plans should be same with same benefits. According to the law the private insurance companies can offer only twelve standard Medicare Supplement Insurance Plans, named A through L. each of these plans have their own set of benefits, different from the others. However, almost all of the twelve Medigap policies provide the basic benefits of Medicare part A and B. Therefore it is always recommended to study all the Medigap plans before deciding to choose the one that would fit the best for you. Besides that the fact that should be kept in mind is that, no matter from whatever insurance company you may purchase a particular plan, all of the plans with the same letter cover must provide the same benefits. As for example if you purchase a Medigap plan C policy, it should cover the same benefits without depending on the company that is selling the plan. However, the premium rates may vary for different companies. Therefore you are free to purchase any Medigap policy from the company you like and be sure to get the same benefits provided by the other companies.
Source: gokuki.com

Review Quotes in Medicare Product Insurance

Supplemental medical insurance is ingested completing on the Medicare insurance plans. Supplemental is short for the add-on nature of this insurance; this the Treatment insurance by way of submitting meant for costs that can be not integrated by Treatment. These feature charges just like coinsurance, copayments plus deductibles. Mainly because it supports in covering gaps inside cost plus reimbursements of this Medicare insurance plans, it is also referred to as Medigap insurance plans. Private medical insurance supplier make available supplemental insurance; the rates for those plans alter from one insurance plans taker completely to another even for those similar package. Searching out the most effective plan is crucial from a couple of reasons: receiving medicare supplement plans insurance plan for your requirements and experiencing it at least cost.
Source: jeffcmo.com

Chicago Insurance Company: Medicare Supplemental Insurance Plans for Senior Citizens

Medicare Supplemental Insurance Plans for Senior Citizens For senior citizens, having medical coverage through the federal government’s Medicare program is literally a lifesaver. Many of these senior citizens would not be able to afford the basic medical care that they need without Medicare. This social insurance program allows them to stay healthy and enjoy a longer life than they might otherwise enjoy without the assistance of Medicare. But as great as the program is, it’s only designed to
Source: blogspot.com

View Several Insurance companies Of Medicare supplement Insurance Just before Enrolling

There are several vehicle procedures that provide assorted types of protections according to the needs within the applicant. The reality is, you may well modify your insurance policies so as to meet any minimum needed, and also your wants. Note there presently exist some claims that have to have operators. As an example, the responsibility coverage is by virtually all states; that covers any insuree during cases from property harm and physiological injuries. In occasions of collision caused vehicle harm, the Accidents vehicle insurance can be available. A great deal the comprehensive insurance policy coverage wherein that covers a good deal including damages attributable to fire, crime, and vandalism. Another particular insurance that you might need to consider could be the uninsured/underinsured DMV car insurance and in which you injury policy.
Source: scanbur-bk.com

Florida Businesses Require Section 125 Premium Only Plans …

Posted by:  :  Category: Medicare

BITCH..beautiful individual that causes hardons .....item 1..Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ... by marsmet522The 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 in Florida – Money Makes Life Better

GetOnlineQuotes.com Adds Medicare Section to Its Website

Bill also provides some good news for Florida’s Medicare population: Rates will rise less than expected next year. Bill noted that “The government’s announcement on Thursday will help Florida’s senior population given that we are living in a tough economy.” Rates for Medicare Part B will only rise by $ 3.50 per month. A much higher jump had been predicted as recently as May. Premiums were frozen for the last two years because there was no increase in many people’s Social Security benefits. But benefits are increasing to cover inflation. The premiums for Medicare Advantage will actually decrease by 4%. That is the second consecutive decrease for those who opt for Medicare Advantage plans.
Source: travelnets.info

Woman receives sentence in Medicare fraud case in Florida

The 40-year-old woman faced a variety of criminal charges, including charges of health care fraud conspiracy and money laundering, in connection to these allegations. In August, a jury found the woman guilty on 24 criminal counts. Recently, a federal judge in Miami gave the woman her sentence in this case. According to the Miami Herald article which reported this story, the woman was sentenced to serve 35 years in prison.
Source: criminallawsarasotafl.com

Medicare indemnification request by defense counsel is unethical

In third party actions, if the plaintiff does not repay Medicare for past expenses, or does not appropriately take Medicare’s future interests into account, this may lead to liability for the defendant. Additionally, due to ambiguity on Medicare’s part, it is not clear if an MSA is required for future medical expenses stemming from torts and third party actions. This has led some defense attorneys to request hold harmless and indemnification language to protect them, the defendant and the insurer from potential liability under the MSPA.
Source: structuredsettlement.pro

Clean Up City of St. Augustine, Florida: St. Augustine Record Letter: Medicare for all will save money, provide decent, affordable health care for all!

We have a worse infant mortality rate than impoverished Cuba; And Americans die from more serious ailments, and die younger than in other advanced nations, even though they spend almost half as much as we do on health care — because most of them benefit from a government run, single payer system, very similar to our VA system. To quote my son, a neurologist at University of Florida, who also cares for the veterans in the excellent VA hospital, across the road from Shands: “The VA is the best system in America.” Not only does it cost far less to care for our veterans, but, unlike our regular privately run health insurance system, the VA has brokered a far cheaper rate of payment for pharmaceuticals, so that prescription drugs cost a fraction of the high costs that the rest of us pay. If you were to give veterans a voucher for the cost of their health care, they would have to pay a hefty amount out of their own pockets.
Source: blogspot.com

Highmark sells its Medicare unit to Florida

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Source: insurance4properties.com

Florida Tests New Medicare Payment System

Florida is the lone testing ground in America for a new program for certain types of Medicare hospital payments. As a well known hot bed for Medicare fraud, Florida was chosen by government officials to determine if the new method could reduce the number of improper payments made under the system. The program targets heart operations and a few other specific medical procedures that are commonly used in health care fraud schemes. This particular program requires that all payments for these particular treatments be pre-approved by Medicare contractors.
Source: miamifederalcriminaldefenseattorney.com

Medicare in Florida Spells P

Moreover, new immigrants are not entitled to benefits such as Medicare. Demographics in 2010 shows that around 1.6 million veterans are in Florida comprising more or less 20% of Florida’s population number. This fact justifies the turnout level in the enrolled Medicare recipients. Also, though Medicare Component B can be bought practically by anyone, the monthly costs range from $600 to $1,000 per head. A costly mistake is certainly avoided, unless the necessary Medicare details override the usual indifference. Medicare in Florida, however, must not be confused with Medicaid. Medicaid is a jointly funded health program by the state and federal government which caters families in United States with little incomes. This is the largest health funding source for those with limited amounts of income and is not to be used interchangeably with Medicare. Getting to know Florida’s Medicare system helps much. Medicare in Florida is all about health plans. These health plans are further divided into four major components under the federal government’s health coverage program, Parts A, B, C and D. All of these benefits are based on medical necessity and varies in terms of services covered. Component A is basically hospital insurance. Inpatient stays covering expenses such as semiprivate rooms, food, tests and doctors’ fees fall under this. Component B is medical insurance. This kind pays for services and products excluded from component A and are utilized under an outpatient basis. Among others, physician and nursing services, diagnostic tests, ambulance transportation (with a certain limit though) and x-rays are included under Component B. Component C, forwarded by the Balanced Budget Act of 1997, offers another option through private health insurance companies. Aside from the original Medicare standard list, Medicare advantage plans, as commonly referred to, provide coverage for new items in exchange for additional fees. These new items can come in the form of savings or net extra benefits exclusive to those who enrolled and in add-on services such as a more comprehensive dental and vision coverage. Prescription drug plans are accommodated in Component D and no standard provisions are available. Though the Medicare program explicitly approves and regulates, the choice as to what drugs are covered depends on the providers. It is imperative therefore that interested parties interact closely with providers to get necessary information and make wise investment decisions.
Source: ezinemark.com

Medicare Data to be Used to Rate Doctors, Hospitals

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Source: floridaboardcertifiedattorney.com

Medicare Florida Information

Everyone is getting old. No one can stay healthy forever yet no one can live forever. When you getting older you want to think about getting a social insurance program that covers health program. Aging process is unavoidable and tend to produce disease that related to age. This disease need a proper treatment and we are all know that it is not cheap. We need a proper health plan before it is too late.
Source: medicarewikipedia.com

UPDATE: The Epidemic of Florida Medicare Fraud (Prison Terms)

Healthcare services is a booming business and one that is often victimized by fraud.  Not only can participants in the healthcare sector perpetrate fraud upon government payors and patients, but such organizations may also be victimized by unscrupulous practices involving demands for kickbacks, bribes, and other frauds.  Hospitals, nursing homes, clinics, and other service providers have come to depend upon a complex inter-relationship among patients, providers, insurers, and government payors.  Healthcare has become big business, with publicly traded companies such as HCA Holdings, Inc.; Tenet Healthcare; Community Health Systems, Medco Health Solutions; Humana, and others combining the provision of healthcare with an eye on the bottom line.  When allegations of fraud circle around such listed companies (be they victims or participants), such news  often highlights the crisis proportion to which healthcare costs have exploded and demand (particularly among the aging Baby Boomer population) is soaring. Clearly, it is in the best interest of both the users and providers of healthcare to ensure that the industry is well policed and fraud rooted out and punished.
Source: ptmanagerblog.com

Obtain The Very Best Life Insurance Florida Has To Give!

Recently, issues altered. And drastically. The key can be a breakthrough in technological know-how: software that will acquire quotes from lots of different insurance organizations all at one time, all in a single position. This engineering was invented for customers by individuals. As well as people who invented it present access to the assistance free of charge on an unbiased, objective, and absolutely independent website that is certainly not affiliated with any insurance firm. This services has no costs, no obligations, no “clubs” to be part of. It is actually just a purchaser marketplace, an facts useful resource wherever you can get quite a few estimates quickly and readily. Then you definitely can compare and contrast your possibilities and pick out the one which is ideal on your requirements and finest on your price range.
Source: medicarestarratings.com

What Is Medicare Advantage, Exceptionally Florida Medicare

After retiring and contemplating accessible health advantages, many individuals wonder what is Medicare advantage. Medicare is often referred to as the government sponsored health insurance coverage plan for many who have retired or over the age of 65. Nonetheless, most individuals don’t perceive that throughout the Florida Medicare program, there are several several types of Medicare plans and kinds of coverage available. The different types of Florida Medicare plans indicate varying levels of coverage that ranges from hospital visits, emergency services, and different kinds of healthcare insurance. For those who are questioning what is Medicare advantage, it is necessary to first perceive that Medicare is break up into a number of different types of plans and that the total comprehensiveness of Medicare advantage depends upon the plan.
Source: nasdaqreportnews.com

Healing period Audit Personnel and Medicare insurance Audits: Successful Approaches for Defending Audits

Section 306 within the Medicare Medication Drug, Betterment and Modernization Function of 2003 (MMA), directed the actual Department of Health insurance and Human Expert services (HHS) that will conduct an important three-year demo program by using RACs. ? A demonstration begun in 2005 with the three states along with the highest Medicare health insurance expenditures: Some states, Florida and New york city. ? A RACs have been tasked to recognize and right Medicare overpayments and even underpayments, and have been compensated for a contingency monetary fee basis. ? supplemental insurance for medicare the demo program was to find out whether the effective use of RACs will be cost-effective strategy to identify and even correct result in Medicare monthly payments.
Source: niksarorman.com