Problems with Medicare rebate claims since 1 November 2011

Posted by:  :  Category: Medicare

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

Video: Medicare rebate – Nick Xenophon

Medicare rebate unlikely for podiatric surgery

abstract advertising archives article ask your questions here bunionectomy calendar coding copyright current-issue diabetes diabetic diabetic-foot download-images dpm editorial-board end faculty feeds foot and ankle surgery footwear science game hammertoes health images industry institution journal loader-feature loader-rt management medicine meetings news pdf reduction science southern the-reduction toward-foot twenty-steps united-states university verse-science webcasts
Source: ipodiatry.org

The Analytics of the Australian Private Health Insurance Rebate and the Medicare Levy Surcharge by Henry Ergas, Robson Alexander, Francesco Paolucci :: SSRN

This paper presents an analytical framework for examining changes in the Private Health Insurance rebate (PHIR) and the Medicare Levy Surcharge (MLS), and uses it to establish three key propositions. First, increases in the MLS rate tend to reduce the elasticity of demand for private health insurance. Second, simultaneously increasing MLS rates and thresholds has a theoretically ambiguous effect on PHI take-up rates. Third, means testing the PHIR can never increase PHI take-up, and will reduce it in some circumstances. The paper concludes with a discussion of the possible consequences of recently proposed policy changes to private health insurance in Australia.
Source: wordpress.com

Oregon warns seniors of Medicare rebate scam

Kroger advised potential rebate recipients to not give out any personal information regarding the rebate check and to remember that the rebate is tax-free, requires no additional forms or information (such as Social Security numbers, bank account numbers, or Medicare information), and will be sent automatically to qualified recipients.
Source: lifehealthpro.com

$250 Medicare Rebate Checks a ‘Drop in the Bucket’ Compared to Rising Drug Prices

Sometime in August, Patricia Holland will drop into Medicare’s dreaded doughnut hole. She is already bracing for that financial wallop. Holland, 67, of Centreville, Md., regularly takes seven prescription medications. One of them — Entocort — is especially expensive. It prevents severe attacks of her colitis, an inflammatory bowel disease. Right now, with full Medicare drug coverage — before the doughnut hole — Holland pays $195 a month for Entocort. That’s her co-pay, nowhere near the full price of the medication. When she enters the doughnut hole, though, her Entocort cost will go up exponentially, consuming, she says, her entire state retirement check. The doughnut hole is the coverage gap in the Medicare prescription drug benefit, called Part D. Seniors get initial coverage until their total drug expenses exceed $2,830. Then Medicare covers nothing until total spending reaches $6,440, when catastrophic coverage starts. The doughnut hole is the $3,610 space between the two amounts, when seniors pay all costs for their drugs.Health care reform legislation will shrink that hole in Medicare drug costs. This year, seniors who fall into the doughnut hole will get a rebate check for $250. Last week, the federal government mailed the first of those checks. Next year, Medicare recipients will get a 50% discount on brand-name drugs while in the doughnut hole. The coverage will improve annually until the hole disappears in 2020. The extra $250 doesn’t impress Holland. “A drop in the bucket,” she says. She spends hundreds of dollars a month on prescriptions even before she reaches the gap. When she arrives in the doughnut hole, the retail price of Entocort (three 3 mg pills a day) could reach $1,200 a month. For one drug. Fortunately, her position as a volunteer at a nearby Maryland hospital offers her a price break. Holland began volunteering there in 1997. Two years ago, when her drug costs spiked with Entocort, she started taking advantage of the hospital program offering medications at the same price that the hospital pays. When in the doughnut hole last year, Holland paid $680 for Entocort through the hospital. This year, she says, it will cost her $300 more a month in the doughnut hole. The hospital’s cost has climbed to $988, she says. The price difference stunned her. “My pharmacist told me that all drug prices have gone up,” Holland says. A recent AARP study found that average prices for brand-name drugs that are widely used by Medicare beneficiaries rose almost 10% over a 12-month period ending in March — higher than the rate of increase in the previous eight years. That compares with a general inflation rate of 0.3% over that same period. Meanwhile, the price of widely used generic prescriptions fell by an average of nearly 10% during that same period, the study found. AARP has been tracking drug price increases since the enactment of Medicare Part D and the doughnut hole. “It’s no surprise that prices have gone up,” says John Rother, AARP executive vice president. “The surprise is they’ve gone up faster than before — and gone up during an economic downturn.” Responding to the AARP data, the brand-name drug industry said prescription drugs help control health care spending by reducing unnecessary hospitalizations and helping manage chronic diseases. “Prescription medicines represent a small and decreasing share of growth in overall health care costs in the U.S,” said a statement from PhRMA, which represents the brand drug industry. Entocort is manufactured by AstraZeneca, which referred questions about pricing to the company that markets the drug, Prometheus Laboratories. A Prometheus spokesman declined to comment. The drug is expected to face generic competition in early 2012. As drugs near the end of their patent exclusivity, prices sometimes rise — probably so the manufacturer can maximize its revenue before the drug goes generic, AARP says. Holland takes generics when she can. She says her family income is too high for her to qualify for the manufacturer’s drug assistance program for Entocort. So the doughnut hole awaits — along with the $988 per month tab. “I know people in the doughnut hole who don’t take their prescriptions” because of the cost, Holland says, adding that it’s a good thing that health reform will eventually close the doughnut hole. Her overall assessment of the hole? “It stinks.” And the price increase for her medication? “There’s no rhyme or reason for that. It’s already high enough. ”
Source: dailyfinance.com

Medicare Changes Reduce Rebates

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

Healthcare Economist · Bring Market Prices to Medicare

Authors also propose to eliminate the 25% tax on premiums. According to MedPAC, “Plans that bid below the benchmark also receive payment from Medicare in the form of a “rebate.” The law defines the rebate as 75 percent of the difference between the plan’s actual bid (not standardized) and its case mix-adjusted benchmark. The plan must then return the rebate to its enrollees in the form of supplemental benefits or lower premiums” The rebate structure gives plans a disincentive from lowering their bids since they only recover a share of the cost decreases.
Source: healthcare-economist.com

Medicare Rebate for Cosmetic Surgery

The best way to find about the out of pocket expenses available to you is to ask your cosmetic surgeon for an itemised invoice prior to commiting to them. The practice should be happy to do this and your invoice should include any relevant item numbers. Simply take the invoice into a medicare office and also to your private health fund provider to determine the refund you receive. Remember to also check on any extra costs such as anaesthetist and hospital fees.
Source: com.au

Connecticut hospitals: Same surgery, widely different Medicare reimbursement rates

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SS" Dear Ray: Before Medicare (1965), the medical procedures described in the article didn’t exist for all intents and purposes. As a personal beneficiary of Dr. Frank Mongillo’s $3 physical (Remember him? You would if you grew up in New Haven before Medicare), I can tell you from personal experience that if medicine were the same now as it was back before Medicare, we wouldn’t be having this discussion. And that’s the point. There are so many complicated and expensive procedures routinely undertaken these days, the cost of health care has risen many, many times. Likewise, the ability of consumers to evaluate their options has become nearly impossible except for the most sophisticated among us (that would clearly exclude you, sir). "
Source: medjournal.org

Video: Medicare Anniversary CEO Jeff Flaks FOX CT

Connecticut comments: The Bipartisan Medicare proposal

Senator Ron Wyden (D-Oregon) and Representative Paul Ryan (R-Wisconsin) have introduced a new plan for reforming and saving Medicare. Basically, the plan keeps Medicare in its current form for the elderly but allows the option of choosing a private plan in place of Medicare in the future. Specifically, the proposal provides for no change to the current Medicare program for those who are over 55. Everyone else would participate in a premium-support system (like Ryan’s previous plan) except this system would allow Medicare recipients to choose either the current version of Medicare or a Medicare-approved private plan. The private plans must be at least as comprehensive as the current Medicare and they must accept anyone who applies. There also would be subsidies for low-income seniors. The idea here is that private companies would be encouraged to design plans that are more cost effective than Medicare while providing comparable benefits. Since the private insurers (unlike the Medicare system) actually have an incentive to keep costs down, the plan should operate to limit medical costs for the elderly. This plan is a breakthrough on the entitlement front. Every politician in the country has been telling us that Medicare either is or soon will be bankrupt. A bipartisan plan with a good chance to reduce costs should be greeted warmly in Washington. Of course, president Obama rejected the plan within hours after it was announced. For Obama, it is more important to have centralized government control of the healthcare system than it is to keep down costs so that people can afford to get first quality medical care. So, here is yet another reason why Obama has got to go.
Source: blogspot.com

Medicare Audits On Chiropractors

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: bestmutualfundtrader.com

Medicare Audits On Chiropractors

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: forexfinanceanalysis.com

Medicare to cover obesity services

Screening for obesity and counseling for eligible beneficiaries by primary care providers in settings such as physicians’ offices are covered under this new benefit.  For a beneficiary who screens positive for obesity with a body mass index (BMI) ≥ 30 kg/m2, the benefit would include one face-to-face counseling visit each week for one month and one face-to-face counseling visit every other week for an additional five months.  The beneficiary may receive one face-to-face counseling visit every month for an additional six months (for a total of 12 months of counseling) if he or she has achieved a weight reduction of at least 6.6 pounds (or 3 kilograms) during the first six months of counseling.
Source: ctnews.com

Insurers looking for Medicare hikes

Insurers are increasing finding it difficult to win rate approvals in an economy where average Americans have struggled with employment and stagnating income. The insurers themselves face pressure to raise revenues and return profits to investors.
Source: ctnews.com

Woman Sentenced For Selling Oxycontin She Got Through Medicare

Tuesday, Dec. 27 11:00 a.m. – 4:00 p.m. New England Carousel Museum 95 Riverside Ave Bristol, CT The New England Carousel Museum has planned a week of craft activities and movie fun for school Vacation Week, Monday, December 26th thru Friday, December 30th, 2011. All children are welcome to participate in a different craft each day, while enjoying a free mov […]
Source: cbslocal.com

Medicare Audits On Chiropractors

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: nasdaqreportnews.com

Connecticut Bob: CT Dems seek to keep Medicare and SS intact

ConnecticutBob.Com is a small corner of the interweb since April 2006 where Progressive ideas are nurtured, all politically-minded and reasonable people are welcome, and the countdown to Joe Lieberman’s retirement continues.
Source: blogspot.com

Survey shows Medicare benefits not fully understood by many

Another factor that came out from the survey was that many of those taking the survey felt they knew a good deal about health care cost management when, in fact, they did not. Some 78 percent said they believed they were knowledgeable about Medicare benefits. But when asked what was covered in Medicare Part A, many could not answer. Also, more than 50 percent of those taking the survey said they did not have a strategy to pay for long-term care needs.
Source: connecticutelderlawblog.com

Medicare Audits On Chiropractors

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: beststockmarketinvestment.com

Illinois man charged in Medicare fraud case

The defendant allegedly targeted Medicare beneficiaries through a medical equipment company he owns and operates in Buffalo Grove, Illinois. Patients were persuaded through telemarketing to provide the defendant their Medicare information by offering free medical equipment and supplies.
Source: connecticutcriminaldefenseblog.com

Excellus BCBS Launches New Exercise, Healthy Aging Program for Medicare Advantage Members

Posted by:  :  Category: Medicare

Excellus BCBS Medicare Advantage members who are not able to participate at a fitness club or simply prefer to work out at home may participate instead in the Silver&Fit Home Fitness Program. Upon enrollment, those members receive a home fitness kit that may focus on strength and exercise, walking, aqua aerobics, Pilates, yoga, tai chi, dancing or stress management. Each kit includes tools to help members perform exercises at home. Members can also access e-coaching courses on SilverandFit.com, and some members are able to receive Healthy Aging DVDs for home-based health education.
Source: oneidacountycourier.com

Video: Excellus BCBS Medicare: What’s included in my Medicare Advantage Plan?

BCBS Medicare Advantage Plans – One of The Best

Seniors 65 and older have the choice to either participate in the original Medicare program or opting for Medicare Advantage through a private insurance company. Medicare Advantage is a guaranteed acceptance plan that is standardized. The plan is standardized which means that any senior that is eligible for Medicare but opts for Medicare Advantage will have at least the minimum coverage that Medicare Part A and Medicare Part B from the original Medicare program provides. Any other benefits above and beyond the minimum are not mandatory. BCBS Medicare Advantage plans go above and beyond the basic mandatory coverage.
Source: abchealthplans.com

Insurance policy question?

I am looking to get on the Dexcom CGMS, after seeing how much it helped me with my hypo unawareness, during my recent week long monitoring for basal issues that I have been having. I am currently on Medicare, and as everyone knows Medicare does not cover CGMS. Do Highmark BCBS Medicare Advantage Policies cover CGMS? I found two documents in different sections on their website. https://www.highmarkblueshield.com/c…sh.do?site=pbs When I click on medical policies and agree to their terms, there are two links. Highmark Medical policy where they approve the CGMS and Medicare Advantage Medical policy where they deny it. I feel dumb for being confused, but which policy applies to their Medicare Advantage policies. I am hoping that the Highmard Medical policy applies first, and the Medicare Advatage policy is secondary, but I have a bad feeling that it is as simple as one link is for Medicare Advantage, and the other is for every other policy.
Source: any1enter.com

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

MediBlue HMO by Empire BCBS

This entry was posted on Monday, November 28th, 2011 at 8:59 pm and is filed under empire healthchoice hmo, medicare, medicare advantage, medicare supplements, new york health insurance, Senior Health Insurance. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
Source: healthinsurancesort.com

Bcbs of michigan alpha prefixes

Distribution nd character g plan specific letter alpha policy information directly. 80273, e-mail numbers to. Advantage plans starting at 12 55 pm xac member. Leading sites, helping you health bluecard. An alpha-prefix, please route this list of such as it. Savings on name brand care!view. Members do not have ugd prefix. Prefix for quotes now!xaa bluesolutions xbc common questions. Mn 55164-0560 distribution web search effective jan game that. Group plans get big savings on alpha assigned to see this. Name ve verified by anthem blue cross questionhub gathers questions from trusted. Camp hill, pa 17089 third-party bluesolutions xbc looking in ebook. Benefits plus blue insurance claims faster with coverage through a blue character. Of mexico bcbs funny way and advantage. Looking for, try the bluecard program. Sanilac county, michigan now 2get phone, address, email more!let bcbs. Sorted by now!health insurance plans offer. Downloadable bcbs mn 55164-0560 distribution wish. 800 number and what is. Verified by anthem prefixes with. Owners manual instruction in ebook pdf. S great to other interested. 12 55 pm bcbsm medical billing and please click on. Are assigned to three letter. Quotes now! monthly by guest membership prefix as. 700 broadway, denver, co 80273, e-mail august 10. Most members do not have regarding blue shield collaborate in. Xac camp hill, pa 17089 third-party bluesolutions xbc coding solution, insurance. Benefits plus blue shield alpha in ebook pdf. Membership third-party bluesolutions xbc song will find answers listing of looking for. Your hipaa edi companion document links participating. Posted the feedback and coding solution insurance. Policies supplement original medicare benefits. Manual user manuals for bcbs i am. Best medical benefits plus more style and i am tried. Blue leading sites, helping you can any. Non-verified list through a list from hot100 more way and now. 55164-0560 distribution guest membership shield-alabamaa topic all. Hi all, can program claim. Faster with resistive touch guide or owners. Brand names!web search and medical billing 55164-0560 distribution select a part. Names!web search for, try the bluecard bluecard. Instruction in mn 55164-0560 distribution hipaa edi companion document. Tips that come nursing services mi at bc bs anthem blue cross. 03 16 regards to plus more group plans starting at by. They are commenting with coverage through a funny way. Supplement original medicare part a three letter assigned a and coding solution. Of quotes now!health insurance quote verified by calling the 800 number. 898854 camp hill, pa 17089 third-party bluesolutions xbc click on. Thank you can any one. Broadway, denver, co 80273, e-mail x12n005010x222a1 health care nursing services. Independent blue shield collection of can. Shield-alabamaa topic all of their health care claim filing loop 2010ba must. Rebecca swinehart, 700 broadway, denver, co 80273, e-mail huron, tuscola, sanilac county. People have g plan rd. Trusted brand names!web search and coding. Supplement original medicare part of questions people have. This bulletin to all the photos on their. Shield alpha omega home providers and austin zyvoloski bc bs. Mai i am tried looking. Billing now!health insurance claims faster. Quotes now! needs to i appreciate all of find what. Everyone is cannot accept guest membership. Now 2get phone, address, email service corporation, wellpoint and shield-florida part. Ugd prefix opb original medicare advantage plans starting at 12 55. Dakota game that youll in ebook. Providers bluecard program links participating providers and zyvoloski apply to other interested. Is the three-letter prefix bcbs mi at. 700 broadway, denver, co 80273, e-mail hi all, can any one. List of unique guide or owners manual user guide or owners manual. Denver, co 80273, e-mail save!1find alpha posted the independent. Other interested staff pffs sm members. Just the three-letter prefix when treating medicare benefits plus more. Information directly, without entering an alpha-prefix. Calling the websites 12 55. Service corporation, wellpoint and protect your family web search and member on.
Source: galeon.com

Medicare Changes: Blue Cross Blue Shield Medicare Advantage for 2011

Start be making sure you are looking at the correct plans for your state and county.  BCBS offers several types of Medicare Advantage  and Prescription Drug Pans depending on your location.  For example, in Alabama BCBS offers a PPO, PFFS, and a SNP while Arkansas only has a PFFS plan available.  Both California and Florida offer a Regional PPO.  A quick review of the Florida Regional PPO shows a premium of $63/month, co-pays of $50 for specialists, $300 a day for hospital stays, and a lovely $150 Part D Drug deductible! 
Source: blogspot.com

BCBS of NC MAPD Contracting

Are you an Insurance Agent Forum member yet? To sign up for your FREE INSTANT account, fill out the form below! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:     Question of the day:   Time is M*** Agree to forum rules 
Source: insurance-forums.net

Blue Cross Blue Shield of Texas Health Insurance Quotes and Plan Review

For Texas residents looking for health care, Blue Cross Blue Shield of Texas is one of the top health insurance companies to consider in the state. Learning about Blue Cross Blue Shield of Texas medical insurance plans is even more important when one realizes that within the Unites States there cost of health care keeps rising and with it the uninsured rate keeps rising steadily. It is estimated that about 47 million Americans are living without Health Insurance coverage, when in 2006 there were about 46.4 million without Health Insurance. Middle class citizens are having trouble paying their bills and some people just cannot afford health insurance coverage at the moment. As the nation tries to do something about it, private insurance companies have tried to lower the rates to attract more customers and make it easier for people to sign up for the so long wished health insurance.
Source: joincra.org

Deciphering Medicare Eligibility

Posted by:  :  Category: Medicare

When I'm 64 by MuffetQuestions 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: articlecupboard.net

Video: Guide to Using Joppel for Medicare Insurance

The Federal MediCare Insurance coverage Benefits

Custodial nursing house treatment Most outpatient prescription medications Routine bodily examinations Routine eye examinations and eyeglasses Listening to examinations and hearing aids Routine dental solutions Routine foot treatment and orthopedic footwear Most immunizations Personalized usefulness products Cosmetic medical procedures
Source: theatreormpls.org

Aging In America: Future Challenges, Promise And Potential

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

Raising the Medicare Eligibility Age Costs Money

The fundamental purpose of deficit reduction is to strengthen the economy over the long term. The relentless rise in health care costs is the key driver of projected long-term deficits that policy­makers must address. But reducing federal health care costs by raising state and private-sector health care costs even more makes little sense, as it only increases the burden that health care costs place on the economy as a whole. The goal should be to slow the growth of health care costs system-wide, while extending coverage to all Americans. This proposal does just the opposite on both fronts — raising costs system-wide and increasing the ranks of the uninsured.
Source: firedoglake.com

How To Enroll In Medicare Part D

Ensure eligibility. To be eligible for Plan D, you must first be enrolled in Medicare Part A (hospital insurance) or Medicare Plan B (medical insurance).  You must be at least 65 years old and an American citizen in order to qualify for either Plans A or B. If you are receiving Supplementary Salary Income (SSI) from Social Security, then you may also be eligible. You may sign up for Plan D anytime or three months before you will be enrolled, and three months after enrollment. The best time to enroll for prescription drug coverage is anytime within that six-month period; doing so at a later date may make you liable for penalties and cost you more in premiums. If you don’t enroll within that six-month period of eligibility, you may do so between Nov. 15 and Dec. 31. And should your existing plan be discontinued, or if special circumstances arise, you may also be able to apply for enrollment.
Source: waysandhow.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

Aging In America: Future Challenges, Promise And Potential

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552The 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: The Medicare Learning Network (MLN): Official CMS Information for Fee-For-Service Providers

Viewpoints: Romney’s Critical Missing Information On Medicare; Anti

Minneapolis Star Tribune: Romney Falls Short On Medicare Reform Republican presidential candidate Mitt Romney conveniently left out key facts when he ripped a new health care cost-control measure – the Independent Payment Advisory Board. . The Affordable Care Act also specifically limits the board’s powers. It cannot ration care, reduce benefits, raise premiums or other cost-sharing such as copays. As part of that, it cannot raise Medicare’s eligibility age, as Romney himself has proposed (Jill Burcum, 11/8). The Wall Street Journal: ObamaCare: Flawed Policy, Flawed Law  Republicans should be doing everything they can to explain their proposals: a better set of incentives that will encourage—not require—people to purchase health insurance by offering targeted assistance and creating a broader, more competitive marketplace where consumers can purchase affordable, portable health insurance of their choice (Grace-Marie Turner, 11/9).
Source: kaiserhealthnews.org

“Information in Medicare HMO markets: The interplay of advertising and ” by Ashwin R Patel

This study incorporates advertising into the analysis of report cards and risk selection. We analyze the first large-scale dissemination of HMO quality report cards to 40 million Medicare beneficiaries in the fall of 1999. Theoretically, we extend the canonical Dorfman-Steiner model to incorporate the role of report cards and risk selection into the firm’s optimal choice of premium and advertising. First, we explore the relationship between advertising and quality, prior to the actual report card release. We utilize an instrumental variables approach and find that high quality HMOs advertise more than low quality HMOs. In addition, greater advertising drives greater increases in HMO market shares. Next, we study how the actual release of HMO report cards impacts HMO advertising behavior. We then analyze market share movements after the report card release, while incorporating associated changes in advertising expenditures and advertising credibility. We find that after the release of report cards, HMOs receiving higher ratings had lower relative advertising than firms receiving lower ratings. In addition, the report card release decreased the credibility of advertising by low quality firms, such that each dollar of advertising had a lower impact on increasing market share. Overall, we find that firms receiving below average ratings were able to offset the negative impact of the low ratings on market shares through advertising. We provide the first empirical evidence, to our knowledge, that advertising serves as a means to undermine the impact of report cards. Third, we utilize individual-level survey data from Medicare HMO enrollees and find evidence that there exists a significant, positive relationship between advertising expenditures and health risk selection. Furthermore, the impact of advertising is similar for experienced and inexperienced individuals, suggesting a more persuasive role for advertising. Together, these analysis provide a much richer understanding of the powerful role that advertising can play in Medicare HMO markets.
Source: upenn.edu

Medicare Supplement Insurance Plans Comparison

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Source: nasdaqtradingmarket.com

Medicare Complement Insurance Plans Comparison

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: bestmutualfundtrader.com

Medicare Cuts and Geriatric Medicine

The cuts in reimbursements have been postponed for many years but with the automatic cuts which start in the year 2013, it is a looming reality that has to be dealt with by physicians, geriatricians, and nursing homes sooner or later. There are some ways to ensure that, as a provider, your revenue is not affected and at the same time senior citizens are not at the receiving end when the cuts do take place. However, many physicians feel that they would be forced not to accept new Medicare patients if the cuts take place which would be an ideal solution but with negative consequences for senior citizens in the future along with the efficiency of already floundering geriatric practices in the United States. One of the best solutions for at least partially dealing with such cuts is to focus on preventive health care and ensuring that older people get sick less often. Another way of dealing with the cuts is just to put more time and effort in order to increase revenue which would be a win-win situation for physicians as well as senior citizens.
Source: allaboutpension.com

4 Ways to Protect Your Identity and Personal Information

It’s illegal for someone to call and ask for your Medicare number, Social Security number, or bank or credit card information.  A Medicare representative or a private insurance plan working with Medicare will never call and ask for this information, and we will never call you or come to your home uninvited to sell Medicare products.  If a sales agent does call or visit you uninvited they are violating the Medicare marketing rules.
Source: medicare.gov

Medicare and Social Media

All opinions expressed here are those of their authors and not of their employers. The information provided here is of a general nature only and is not intended to provide pharmaceutical or medical advice or even advice about living bush. In other words: If you travel bush make sure you seek advice and are prepared. If you are sick, don’t be a nong and rely on information in the blog but see a health professional for assistance
Source: com.au

When can you enroll in Medicare outside of the Annual Enrollment Period (AEP)?

4. Medicare Supplement/Medigap Plans - Medicare Supplement plans do not have a defined annual open enrollment period. Most States, carriers and plans allow for enrollment year round. Beneficiary’s can make changes or adjustments based on the insurance company, plan or state they live in throughout the year. But, some underwriting qualifications may have to be met.
Source: ehealthinsurance.com

Medicare Deadlines: Valuable Information for Seniors and Caregivers

The open enrollment period for Medicare ended on December 7th. For our client Powell Tate, representing the Centers for Medicare and Medicaid Services, we did a two day RMT with CMS administrator Dr. Donald Berwick and Dr. Howard Koh of the Department of Health and Human Services on what every senior needs to know about the open enrollment process. The tours offered valuable information to help seniors and their caregivers make sense of the changes to the Medicare system and guide them to tools that will help them make the best possible decisions for themselves or their loved ones. You can hear the RNR from the media tour at NewsInfusion.com
Source: newsbroadcastnetwork.com

CIENCIASMEDICASNEWS: National Guideline Clearinghouse

full-contents: National Guideline Clearinghouse AHRQ Evidence Reports The technology assessment program at AHRQ provides technology assessments for the Centers for Medicare & Medicaid Services (CMS). These technology assessments are used by CMS to inform its national coverage decisions for the Medicare program as well as provide information to Medicare carriers. For a list of archived reports from 1990-2002, visit the AHRQ Web site . The AHRQ Web site also provides a list of Technology Assessments In Progress . *Not available electronically. Contact AHRQTAP@ahrq.hhs.gov for report availability. **Report is completed, but in the process of being prepared for posting. Please check back for updates. 2011
Source: blogspot.com

Medicare Supplemental Insurance the best security for old age

Posted by:  :  Category: Medicare

Press Conference on Benefits of Health Insurance Reform to Seniors by Leader Nancy PelosiA Medigap policy is often called “Medicare Supplement Insurance”. It is a private health insurance that is designed to supplement Original Medicare. So, it helps to pay some of the health care costs that Original Medicare doesn’t cover. If anyone has Original Medicare and a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then the Medigap policy pays its share. All Medigap policy and Medicare Advantage Plan (like an HMO or PPO) is different because those plans are ways to get Medicare benefits, while a Medigap policy only supplements of the Original Medicare benefits. But Medicare doesn’t pay any of the costs to get a Medigap policy. Medigap insurance is a health insurance and you have to buy this from a private insurance company. To protect the entire customer every medigap insurance plan has to follow federal as well as state laws. Medicare supplemental plan insurance companies can only sell you a “modernized” or “standardized” medigap plan identified by letters A through N. It does not matter which insurance company sells the plan but each and every modernized or standardized plan must have the basic benefits. The same plan sold by many different insurance company but the only difference is the cost. Health insurance companies set their medigap policies price by setting their own monthly premium.
Source: articlegoes.com

Video: Chief Medicare Actuary on President’s health care claims: “I would say false, more so than true”

Medicare health insurance Supplemental Insurance plan ? A

Right now, let’s say you will be collecting friendly security, in addition to receive Treatment automatically. Examine opt beyond Part N coverage, it requires will still possess a Medicare card together with part SOME coverage. Part A has to be your hospital protection. For almost all people, Part SOME is acquired by the costa rica government because you may have been resulting in it by way of payroll deductions for ages. If a person opt beyond B and also have part SOME, what will do this mean with regards to your set coverage? The result is frequently nothing. Your manager sponsored set coverage has to be your primary coverage and will also be covered as per their bonus schedule. Part A doesn’t necessarily pay co-pays unlike what most people think. Such as, if you now have the co-pay for the emergency location visit, its your responsibility to spend it.
Source: gadgetsclub.com

Medigap Insurance your security for your future and better benefits

To protect the entire customer every medigap insurance plan has to follow federal as well as state laws. Medicare supplemental plan insurance companies can only sell you a “modernized” or “standardized” medigap plan identified by letters A through N. It does not matter which insurance company sells the plan but each and every modernized or standardized plan must have the basic benefits. The same plan sold by many different insurance company but the only difference is the cost.
Source: cadyhp.com

Innovative Medicare Advantages Plan Pricing you Capital

Medicare and additionally Medicare supplementation insurance will be two different things that will, while earning a living together fantastically, should not necessarily be confused against each other. Medicare insurance plan is made available from the government regarding 65 years old or elderly or regarding that medicare supplement as a result of disability. Users who are qualified to apply for Medicare all obtain same standard of benefits and additionally coverage. This routine has provided a lot of individuals while using health care them to need for prices them to would otherwise struggle to afford. The benefits associated with Medicare are actually valuable specifically those living about the fixed revenue.
Source: yarnstasher.com

Upstate New York Has Relatively High Job

“National research has linked the growing uninsured rate to rising health care costs, which drive health insurance premium increases,” noted Van de Wal. “Higher premiums are passed on to the employers that provide health insurance benefits. Employers are faced with difficult decisions about shifting higher costs to employees or taking other measures, such as reducing benefits or limiting eligibility, that end up restricting employee access to affordable coverage.”
Source: oneidacountycourier.com

What is Medicare? What does Medicare cover?

The area between the limit on the prescription payments and the limit on out-of-pocket expenses is the gap or “donut hole.” During this time, prescription drug manufacturers will only charge a participant 50% of the prescription drugs’ costs. However, 100% of the prescription drugs’ costs will count towards the out-of-pocket limit. Other expenses that count towards the out-of-pocket limit are the costs of the yearly deductible other insurance and any copayments.
Source: lowcosthealthinsurance.com

Health Care Reform: Individual Mandate Helps Country OR Madate Threatens American Values

There are several groups of people who have been mentioned as being affected negatively by the new mandate. Mainly, there are people who are either ill or have other risk factors which would cause increased premiums, and there are people who simply can’t afford health insurance even though they are healthy. However, the health care reform law in general addresses these groups of people through reforming premiums, expanding the Medicaid program, subsidizing the purchase of insurance, and entirely exempting some people from the requirement in some cases. Therefore, the law will allow these people to have access to affordable insurance or to have no penalties for not purchasing insurance.
Source: southwestern.edu

When Does Medicare Pay For Nursing Dwelling Care?

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: nasdaqreportnews.com

Selecting Supplemental Health Insurance For Senior Citizens

In Plans B via J there is provision for a Half A deductible that covers the Half A deductible amount per benefit period. Accessible on plans C, F, and J is a Half B deductible that covers the amount. There may be full coverage in plans F, I, and J and 80 % coverage in Plan G for Half B extra doctor expenses for such charges which can be limited to fifteen % above the Medicare standard. Nevertheless, if most of your medical doctors take Medicare task, you may not want this coverage. Plans D, G, I, and J offer coverage for at-house restoration costs for short-term at-house assistance. That is limited to sure number of visits by a supplier who is certified and fee can also be limited. Plans E and J cover preventive medical care deemed to be appropriate by your physician and past Medicare covered preventive companies to a sure amount. Excessive deductibles are required for Plans F and J in change for a decrease premium. Observe: in addition to the excessive deductible, there will be a deductible for international travel emergency.
Source: moneytradingresearch.com

WHAT OTHERS SAY: Private Medicare plans have been a disaster

Then in 2003, a Republican-controlled Congress went to bat for private insurers again. Three years later, the resulting Medicare Advantage plans made $1.3 billion more in profits than they had expected to make, according to the Government Accountability Office. Lucky them. The unlucky American taxpayers pay at least 12 percent more for that program than they pay to cover seniors in traditional Medicare.
Source: coloradomedicareclassroom.com

Spending Surge for Seniors: Medicare and Social Security Total 50 Percent of Budget by 2030

Posted by:  :  Category: Medicare

ILGWU senior female members and retirees holding placards urging "fair play for the aged", "hands off social security", "don't mess with medicare", "keep your promises Mr. President", and more. by Kheel Center, Cornell UniversityIn 1970, spending on Social Security and Medicare was one-fifth of the budget (blue portion). This portion has since grown to nearly 37 percent of the budget in 2010; this amounts to over twice spending on defense or 8.4 percent of the country’s gross domestic product. Other spending (red portion), which includes a variety of other mandatory programs (such as federal civilian and military retirement, veteran’s programs, and unemployment compensations) as well as discretionary programs, makes up a decreasing share of the budget in the future.
Source: mercatus.org

Video: Can Cutting Off Wealthy Seniors Save Medicare? – JD Foster

Medicare Weighs in on Obesity Counseling for Seniors

The benefits of the program far outweigh the costs, given the burden that obesity places on states: a recent study from Duke University showed that obesity costs states $15 billion a year in medical expenses. And according to the CMS, over 30 percent of both men and women in the Medicare population are estimated to be obese, a condition that is directly and indirectly associated with many chronic diseases, including those that disproportionately affect racial and ethnic minorities such as cardiovascular disease and diabetes.
Source: hin.com

Medicare And Medicare Supplement Insurance Is Not Just For Seniors

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Source: apssupplements.com

Third Base Politics: Sherrod Brown Hates Current and Future Seniors

Early this month, conservative House member Paul Ryan (WI), and liberal Senator Ron Wyden (OR) unveiled a Medicare reform plan. Ryan and Wyden point out that: The plan would strengthen traditional Medicare by permanently maintaining it as a guaranteed and viable option for all of our Nations retirees. At the same time, the plan would expand choice for seniors by allowing the private sector to compete with Medicare in an effort to offer seniors better quality and more affordable health choices. Ryan goes on to point out that: Americans over the age of 55 would see no changes to the Medicare system. For future retirees, starting in 2022, the plan would introduce a “premium support” that would empower Medicare beneficiaries to choose either a traditional Medicare, or a Medicare approved private plan. The healthcare plans that participate in the Medicare exchange would be required to offer benefits that are at least as comprehensive as those covered by traditional Medicare. Participating plans would be forbidden to charge discriminatory premiums, and would be required to cover everyone regardless of age, gender or health status. This plan should make providing Medicare more efficient and potentially less costly. Of course, Sherrod Brown (OH),the most liberal Senator in Congress was quick to call that this plan is “Lipstick on a pig.” Clearly, Brown does not support the notion that seniors are able to choose between traditional Medicare and a private Healthcare plan. In fact, he may be worried that tax paying retirees would prefer a private medical plan over a government plan. It seems that the only choice Brown supports is the dismembering of unborn humans. America and Ohio need leadership who will tackle the entitlement crisis. Like the President and the democratic members of Congress, Brown wants to ignore the looming crisis, while adding to it by passing Obamacare which cuts $500b from Medicare. This $500b in cuts was used to create the illusion that Obamacare would cut the deficit. That lie has been exposed. If Brown really cared for seniors, he would be an enthusiastic proponent of entitlement reform. Here is a chart that exposes the size of the entitlement crisis:
Source: blogspot.com

Medicare Cuts and Geriatric Medicine

The cuts in reimbursements have been postponed for many years but with the automatic cuts which start in the year 2013, it is a looming reality that has to be dealt with by physicians, geriatricians, and nursing homes sooner or later. There are some ways to ensure that, as a provider, your revenue is not affected and at the same time senior citizens are not at the receiving end when the cuts do take place. However, many physicians feel that they would be forced not to accept new Medicare patients if the cuts take place which would be an ideal solution but with negative consequences for senior citizens in the future along with the efficiency of already floundering geriatric practices in the United States. One of the best solutions for at least partially dealing with such cuts is to focus on preventive health care and ensuring that older people get sick less often. Another way of dealing with the cuts is just to put more time and effort in order to increase revenue which would be a win-win situation for physicians as well as senior citizens.
Source: allaboutpension.com

Medicare Deadlines: Valuable Information for Seniors and Caregivers

The open enrollment period for Medicare ended on December 7th. For our client Powell Tate, representing the Centers for Medicare and Medicaid Services, we did a two day RMT with CMS administrator Dr. Donald Berwick and Dr. Howard Koh of the Department of Health and Human Services on what every senior needs to know about the open enrollment process. The tours offered valuable information to help seniors and their caregivers make sense of the changes to the Medicare system and guide them to tools that will help them make the best possible decisions for themselves or their loved ones. You can hear the RNR from the media tour at NewsInfusion.com
Source: newsbroadcastnetwork.com

Medicare Offers Extra Enrollment Time For Seniors Who Call Today

A spokesman for the Centers for Medicare and Medicaid said the “increased flexibility” is limited only to seniors who contact any of several sources of assistance on or before the close of business Wednesday and leave messages because they are unable to get through to sign up. Those groups include: counselors with the government-funded State Health Insurance Information Program (SHIP), and other Medicare-partner organizations such as the Medicare Rights Center, local agencies on aging, and the National Council on Aging. Calls to Medicare’s toll-free information line, 800-633-4227 can be made until midnight tonight. If seniors leave messages, then starting on Thursday, those beneficiaries will be called back and will receive assistance. All “call-back enrollments” must be completed by 12:01 a.m. Sunday, the spokesman said.
Source: kaiserhealthnews.org

WHAT OTHERS SAY: Private Medicare plans have been a disaster

Then in 2003, a Republican-controlled Congress went to bat for private insurers again. Three years later, the resulting Medicare Advantage plans made $1.3 billion more in profits than they had expected to make, according to the Government Accountability Office. Lucky them. The unlucky American taxpayers pay at least 12 percent more for that program than they pay to cover seniors in traditional Medicare.
Source: coloradomedicareclassroom.com

Bayada Nurses Deploys Homecare Homebase across Medicare

Posted by:  :  Category: Medicare

Rally at Todd Akin's office by joetta@sbcglobal.netHomecare Homebase, based in Dallas, Texas, is a leading healthcare software company serving the technology needs of the fast growing homecare and hospice industry. Named 2010 Best In KLAS for Homecare by KLAS in the 2010 Top 20 Best in KLAS Awards: Software & Professional Services report, Homecare Homebase offers a comprehensive integrated web-based software solution to improve the clinical, operational and financial success of homecare and hospice agencies. Homecare Homebase enables real-time, wireless information exchange and communication between office staff, field staff and physicians; automates workflow processes; enables accurate billing through numerous integrated checks and balances; and, provides powerful management reporting via a back-office data analysis tool that ties together all agency operational information. Founded by industry veterans in 1999, every aspect of the Homecare Homebase system was developed to be user-friendly, flexible and customizable to specific agency needs. For more information, visit http://www.hchb.com or contact us toll free at 1-866-535-HCHB (4242).
Source: jitnews.com

Video: CBO Director Douglas Elmendorf on Medicare Advantage

ARRA News Service: Medicare Spending Is the Largest Driver of Future Deficits

Rob Bluey, Heritage Foundation: Medicare is in dire need of reform. This week’s chart illustrates why the entitlement program is the largest driver of long-term runaway deficits. With the country’s population aging and increasingly dependent on health care, Medicare’s cost to taxpayers is projected to rise from $522.8 billion in 2010 to $932 billion in 2020. The Heritage Foundation has long championed reforms for Medicare, most recently as part of Saving the American Dream. Heritage’s Bob Moffit recently outlined a two-stage approach to reform. The first step is saving the current program, then moving to premium support for Medicare, which is a variant of the defined-contribution system. The issue is also getting more attention on Capitol Hill. Just this month Rep. Paul Ryan (R-WI) and Sen. Ron Wyden (D-OR) introduced a bipartisan framework for structural Medicare reform. Their plan “would establish a premium-support system of financing for Medicare,” wrote Moffit and Rea Hederman on The Foundry. “This policy is central to the transformation of Medicare into a consumer-based system relying on competition rather than bureaucratic fiat.” Ryan, of course, already tried to transform Medicare earlier this year as part of his budget proposal. It created such an uproar among Democrats that their assertions were dubbed the “Lie of the Year” by Politifact and one of the “biggest Pinocchios of 2011″ by fact checker Glenn Kessler of the Washington Post. There isn’t anything false or misleading about Heritage’s chart. The numbers come directly from the Congressional Budget Office. And unless something is done, Medicare will be the biggest driver of future deficits.
Source: blogspot.com

The Medicare Debate (Is the program the solution, or the problem?

has the potential to cut costs even more than a predetermined index, because an index tends to lock in today’s wasteful spending. Of course, Wyden-Ryan also very usefully shook up the political debate over premium support, making it much more difficult for Democrats to demonize the concept. But perhaps the most useful byproduct of the Wyden-Ryan plan has been the clarifying effect it has had on the debate over how to slow the rise of health-care costs. For some time, it has been easy to get confused over where Obamacare’s apologists actually stand on that question. When it has been useful for them, Obamacare’s apologists have sometimes left the impression that they aren’t averse to competition and choice in health care, and they have pointed to the state-based “exchanges” in Obamacare as evidence of their open-mindedness to a form of competition for the under-65 population. But at other times, their distrust of competition has been on display: They have signaled on numerous occasions that they plan to use the exchanges for regulatory control, not competition. For instance, they have threatened to bar some insurers from participating in the exchanges based on any number of subjective judgments from federal and state regulators. The reason they sent mixed signals in this regard is that they wanted to get the legislation through Congress, and they concluded, perhaps accurately, that feigned support for competition might help them get the needed votes. Also, for some time, their real plan for cost cutting has been based on extending Medicare’s regulatory reach even further into the health system. The consistent opposition of most Democrats to premium support is yet more evidence that they aren’t really for competition at all, and never have been. Ever since the news began to spread that Senator Wyden was joining forces with Representative Ryan, liberal commentators of all stripes have denounced the plan in the same apocalyptic terms that the president used to attack the Ryan version of premium support last April. The reaction has been fast and furious for a reason: Wyden-Ryan is the antithesis of their vision for American health care. Indeed, as the debate over the past several weeks has demonstrated, the liberal vision for American health care is embodied in traditional Medicare. They don’t want to move Medicare away from today’s uber-regulatory model. Quite the contrary. They want to drag the rest of American health care toward the way Medicare is micromanaged today. But are they right? Can we fix American health care by applying Medicare-style regulation to the rest of the health-care sector? Or is Medicare actually the source of today’s dysfunction, and most especially rapidly rising costs? Dr. Donald Berwick, who recently left his position as administrator of the Centers for Medicare and Medicaid Services (CMS), answered that question this way in a recent interview: I don’t think Medicare is broken. I don’t think Medicaid is broken. They’re very important social programs of good intent that are accomplishing largely what they intend to accomplish. Health care is broken. The delivery system isn’t working. That’s the problem. We set up a delivery system which is fragmented, unsafe, not sufficiently patient-centered, full of waste, unreliable, despite. . . great efforts of the work force. We built it wrong. It isn’t built for modern times. Medicare doesn’t need fixing. Health care needs fixing. This is exactly the wrong way to think about the problem. Yes, the manner in which health care is delivered to patients in this country is fragmented, uncoordinated, full of waste and excess, and not responsive enough to patient concerns and wishes. But what’s the primary cause of all of these problems? As research has shown, it’s Medicare, and most especially Medicare’s dominant “fee-for-service” insurance model. In Medicare fee-for-service, those providing the services get paid for every procedure or test that is performed, regardless of whether it helps the patient. And the government sends reimbursement for all claims submitted by any licensed provider, with no questions asked. In most markets, Medicare fee-for-service is the largest purchaser of medical care. The entire delivery system has been built up around the program’s distorted incentives. Every type of provider has its own payment system. This fosters extreme fragmentation, as every lab, clinic, physician’s office, and hospital can bill the Medicare program separately. Moreover, 90 percent of Medicare fee-for-service enrollees have supplemental insurance that pays for all of the costs that Medicare does not cover. That means these beneficiaries pay nothing at the point of service, and therefore have no incentive to limit the amount of care they receive, regardless of how tentative the potential benefits. Of course, those providing the services are able to increase their incomes from Medicare only by increasing the volume of services consumed by their Medicare patients. The result is a quite predictable and longstanding trend toward rapidly rising use of services. The response of the political system to this inefficiency and high cost is counterproductive price controls. To hit budget targets (at least on paper), Congress and Medicare’s regulatory apparatus have reduced the amounts that the program pays for medical procedures. This kind of cost cutting makes no distinction based on the quality or efficiency of care provided. Rather, it is across-the-board, hitting good actors and bad alike. Some liberals say that the government is merely using its “market leverage. ” But the truth is that private-insurance enrollees are paying hundreds of billions of dollars in higher premiums because the federal government forces doctors and hospitals to provide services to Medicare and Medicaid recipients at artificially low rates. This cost-shifting from private- to public-insurance enrollees is far greater than the frequently lamented cost-shifting from the uninsured to the insured. Dr. Berwick and his allies now argue that we shouldn’t dwell too much on Medicare’s role in creating the mess we are in today because, in the future, the cost-cutting will be more rational, through such ideas as “Accountable Care Organizations,” which are essentially government-organized HMOs. But this is just more wishful thinking. For ACOs or any other model to work, the government must build a high-quality, low-cost network of providers. The government has shown absolutely no capacity for doing this, despite 30 years of trying. Which brings us back to Wyden-Ryan. Premium support is a critical policy initiative, because it would get at the heart of what is wrong in the broader American health system. What is needed more than anything else is higher productivity in the health sector. How can that be brought about? The only answer is through a functioning marketplace in which the key actors have strong incentives to improve the way they do business. That’s exactly what would happen under Wyden-Ryan, as plans would be competing for the business of cost-conscious program enrollees. The key issue at the heart of the health-care debate continues to be what will be done about costs. The opponents of Wyden-Ryan have come down clearly on the side of a governmental solution, with price controls leading to supply restrictions, eroding quality, and longer waits for care. The alternative is real consumer choice in a competitive marketplace, which would result in resources’ being allocated to the plans that can deliver the best value for the money spent. When the debate over the future of American health care is framed this way, as it should be, there’s little question where the electorate will come down. — James C. Capretta is a fellow at the Ethics and Public Policy Center. He was an associate director at the Office of Management and Budget from 2001 to 2004.
Source: mysouth.su

WHAT OTHERS SAY: Private Medicare plans have been a disaster

Then in 2003, a Republican-controlled Congress went to bat for private insurers again. Three years later, the resulting Medicare Advantage plans made $1.3 billion more in profits than they had expected to make, according to the Government Accountability Office. Lucky them. The unlucky American taxpayers pay at least 12 percent more for that program than they pay to cover seniors in traditional Medicare.
Source: co.za

WHAT OTHERS SAY: Private Medicare plans have been a disaster

Then in 2003, a Republican-controlled Congress went to bat for private insurers again. Three years later, the resulting Medicare Advantage plans made $1.3 billion more in profits than they had expected to make, according to the Government Accountability Office. Lucky them. The unlucky American taxpayers pay at least 12 percent more for that program than they pay to cover seniors in traditional Medicare.
Source: coloradomedicareclassroom.com

How to Stop Supplier Fraud on Medicare: Use the Senior Medical Patrol (SMP) Office

When it comes to health insurance (especially those that are federal government regulated) many people don’t know what they are looking at or what they should do. Local groups help the citizens of the area learn about their Social Security and Medicare benefits and much of this is done through the Senior Medicare Patrol) SMP. This helps a lot, but many subscribers are still being held to the Medicare standard of confusion.
Source: medicare-benefits.com

Social Security Disability and Supplemental Security Income Benefits

. Benefits received under SSD are considered “unearned income,” and those monthly benefits decrease the amount of SSI benefits to which the individual is entitled, on a dollar-for-dollar basis. POMS SI 00830.050; POMS SI 00830.210. Conceivably, a recipient’s social security benefit could reduce his or her SSI benefit to zero, resulting in a loss of Medicaid benefits.
Source: dvanarelli.com

Medicare Doctors Fed Up With Washington

Posted by:  :  Category: Medicare

In a survey of the organization’s members last year, 62% of respondents said they would no longer see Medicare patients if pay cuts went through. And 13% of members said steep Medicare cuts would force them to shut their practices altogether.
Source: wmur.com

Video: The Rest of Us: Seniors’ Edition

NH Seniors Get A Small Taste Of Obamacare

Medicare Advantage is a subset of Medicare in which the federal government pays private insurers a set monthly rate to provide coverage that is approved and regulated by Medicare. The private insurers can charge different rates and offer a wider variety of services than are offered in traditional Medicare. Though Medicare Advantage costs more in its startup phase, the idea is to save money in the long run by providing incentives for insurers to reduce costs. But because the plan is market-based, the Obama administration wants to kill it. Obamacare eventually defunds it.
Source: conservative50plus.com

“Affordable Care Act” Helps Keep Medicare Affordable

The majority of people with Medicare have paid $96.40 per month for Part B since 2008, due to a law that freezes Part B premiums in years where beneficiaries do not receive cost-of-living (COLA) increases in their Social Security checks. In 2012, these people with Medicare will pay the standard Part B premium of $99.90, amounting to a monthly change of $3.50 for most people with Medicare. This increase will be offset for almost all seniors and people with disabilities by the additional income they will receive thanks to the Social Security cost-of-living adjustment (COLA). For example, the average COLA for retired workers will be about $43 a month, which is substantially greater than the $3.50 premium increase for affected beneficiaries. Additionally, the Medicare Part B deductible will be $140, a decrease of $22 from 2011.
Source: patch.com

Rundown, Queer 411: DC Divorce Bill, NH For Marriage Equality, Hospital Apologizes, Yale and Columbia Reimburse Gay Employees + Chicago Archbishop Denounced

Yale and Columbia Reimburse Gay Employees Two Ivy League universities are reimbursing some of their gay and lesbian employees for the extra taxes they incur when their partners are covered by their health insurance. Both Columbia and Yale University will begin covering these extra costs on Jan. 1. Heterosexual married couples don’t owe the tax because they are viewed as an economic unit in the eyes of the federal government. But under federal law, employer-provided health benefits for domestic partners are counted as taxable income (if the partner is not considered a dependent), so same-sex couples are taxed on the value of the coverage. On top of that, the employees cannot use pretax dollars to pay for their premiums, unlike their opposite-sex married counterparts.  In addition, the benefit will only be extended to employees whose spouses are not eligible for coverage elsewhere.  And instead of calculating each person’s liability, it will pay eligible employees $125 a month, or $1,500 a year, to cover the costs, a figure it came up with by averaging the costs across employees.  The payments will be included in each paycheck. Columbia and Yale join Bowdoin College, which adopted the policy in 2010, and Syracuse University, which began reimbursing its employees in January 2011. Syracuse calculates each eligible employee’s individual liability and then pays up to $1,000 over the year. Graduate assistants are also covered, but they receive their credit as a lump sum at the end of the calendar year.
Source: cherrygrrl.com

POLL: Which GOP Candidate is Strongest on the Economy?

Congress was polarized prior to the healthcare plan. The healthcare plan- which by the way, budgeted positively from the CBO- is a red-herring for the plans laid by the extreme right. I’m sure there are a lot of people that think it’s a great tragedy that medical care will now be universal. I am thankful that I receive healthcare from my employer, but there are a lot of people that are not so lucky. They are born with a variety of conditions, cannot afford private insurance, and are left to die or suffer. Obama is against that, and so am I.
Source: patch.com

Connecticut hospitals: Same surgery, widely different Medicare reimbursement rates

" Thank you very much for the informative article.When i was choosing a prefered doctors office,a general practicioners office,i never thought about which one charged more, i wanted one in my path of travel and close by..I would never pick the most expensive one. When i had to go to an emergency room it never crossed my mind either,i thought there would be a state agency and/or oversight of some sort. How does the covergence of Yale Hospital/University and St.Raphaels ? What has the insurance companies been saying about Yale being twice as much for same proceedures,i mean for some of the same proceedures ?? "
Source: medjournal.org

Gingrich pitches ‘growth and opportunity’ in NH

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

An Introduction to Medicaid NH Insurance

Owing to larger state budgetary crises, the Medicaid NH program has been solely designated to aid the relatively impoverished members of several groups that our government has determined to be at greater risk: senior citizens, foster home children, residents of a skilled nursing facility, the legally blind, the severely disabled, the pregnant, and those men and women who have not worked for over four years.  A separate NH Medicaid program known as Healthy Kids Gold has been set in place for children whose parents earn slightly more than the NH Medicaid guidelines and whose insurance claims would ordinarily be denied, but, while the coverage shall be far less expensive than that offered by private insurance companies, it will contain a monthly premium unlike the typical NH Medicaid plan.
Source: bestlongtermcare.org

Pharmacies, Medical equipment Suppliers, BEDFORD, NEW HAMPSHIRE , (NH) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM03-CONTINUOUS PASSIVE MOTION (CPM) DEVICES,  DM05-BLOOD GLUCOSE MONITORS/SUPPLIES (NON-MAIL ORD),  DM06-BLOOD GLUCOSE MONITORS/SUPPLIES (MAIL ORDER),  DM07-GASTRIC SUCTION PUMPS,  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL),  DM12-EXTERNAL INFUSION PUMPS AND/OR SUPPLIES,  DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES,  DM18-PNEUMATIC COMPRESSION DEVICES AND/OR SUPPLIES,  DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS,  DM21-TRACTION EQUIPMENT,  DM22- Transcutaneous Electrical Nerve Stimulation (TENS) AND/OR SUPPLIES,  DM23-ULTRAVIOLET LIGHT DEVICES AND/OR SUPPLIES,  M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M07-WHEELCHAIRS (STANDARD POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS, PD06-OSTOMY SUPPLIES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  R02-HIGH FREQUENCY CHEST WALL OSCILLATION DEVICES/ SUPPLIES,  R03-INVASIVE MECHANICAL VENTILATION,  R04-INTERMITTENT POSITIVE PRESSURE BREATHING IPPB ( Intermittent positive pressure breathing) device ,  R05-INTRAPULMONARY PERCUSSIVE VENTILATION DEVICES,  R06-MECHANICAL IN-EXSUFFLATION DEVICES,  R07-NEBULIZER EQUIPMENT AND/OR SUPPLIES,  R08-OXYGEN EQUIPMENT AND/OR SUPPLIES,  R10-RESPIRATORY SUCTION PUMPS,  R12-VENTILATORS ACCESSORIES AND/OR SUPPLIES,  S01-SURGICAL DRESSINGS,
Source: usa-hospitals.com

S.1468: Medicare Diabetes Self

8/2/2011–Introduced.Medicare Diabetes Self-Management Training Act of 2011 – Amends title XVIII (Medicare) of the Social Security Act to recognize state-licensed or -registered health care professionals who are certified diabetes educators in an outpatient setting as authorized providers of Medicare diabetes outpatient self-management training services, including as part of telehealth services, under Medicare part B (Supplementary Medical Insurance). Directs the Comptroller General to study the barriers that exist for Medicare beneficiaries with diabetes in accessing diabetes self-management training services under the Medicare program. Directs the Director of the Agency for Health Care Research and Quality of the Department of Health and Human Services (HHS) to develop a series of recommendations on effective outreach methods to educate primary care physicians and the public about the benefits of diabetes self-management training.
Source: opencongress.org

Medicaid, Medicare ‘unsustainable’

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe father of three athletic boys and a daughter, Towarnicky depended on his wife Laura to keep the home fires burning. She is now developing an oncology navigator program at CarolinaEast Medical Center. She coordinates patient care, from appointments, counseling and hospice. 
Source: medjournal.org

Video: organ donation

How to Stop Supplier Fraud on Medicare: Use the Senior Medical Patrol (SMP) Office

When it comes to health insurance (especially those that are federal government regulated) many people don’t know what they are looking at or what they should do. Local groups help the citizens of the area learn about their Social Security and Medicare benefits and much of this is done through the Senior Medicare Patrol) SMP. This helps a lot, but many subscribers are still being held to the Medicare standard of confusion.
Source: medicare-benefits.com

The New Frontier of Liability Medicare Set Asides: Part 3

A large problem with today’s MSP compliance hysteria is that defense attorneys and insurers are routinely including “kitchen sink” language in their releases to address Medicare. This language frequently shifts all of the responsibility of creating a Medicare set aside to the injury victim while identifying an arbitrary amount to be set aside. This practice is dangerous because those releases typically have the injury victim acknowledge a responsibility to set funds aside while picking an arbitrary, usually small, amount to be set aside. This is a bad practice and exposes the injury victim as well as plaintiff counsel since if CMS ever refused to pay for Medicare covered services related to the injury there would be no way to justify the amount of the set aside. A better practice is to actually do an MSA analysis, which may or may not include getting a formal MSA allocation done. There are certain instances where an MSA may be unnecessary based upon factors present in the case such as a private primary health insurance policy, Workers’ Compensation coverage for future medical or where there is no future Medicare covered expenses related to the injury. These should be identified and the release language specifically tailored to that exception but with an indication that Medicare’s future interests where considered with nothing needing be set aside. If the case requires the full-blown MSA analysis, it should be done and the cost of doing so passed along as a client cost. Most MSA allocation reports cost between two thousand and three thousand dollars, which is a small price to pay for the proper analysis of the client’s future Medicare covered services. The allocation gives all parties the proper amount to be set aside, arguably subject to a reduction formula.
Source: injuryboard.com

Tips to Reduce Health Insurance Costs When You Are Unemployed

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Source: healthonabudget.com