Tennessee Medicare Quotes

Posted by:  :  Category: Medicare

Are you a resident of Tennessee? Are you close to turning 65? If so, you might be pondering about your Tennessee Medicare possibilities. Health care laws can be confusing even for people who operate in doctor’s offices or clinics, so it is no wonder if you may have a couple or even numerous inquiries. Hopefully, you will locate the following beneficial. Do I Qualify For Medicare? Medicare is administered by a federal agency, the CMS, or The Centers for Medicare and Medicaid Services. There are four components to Medicare coverage, and most folks 65 and older qualify for Portion A. Medicare Part A is often referred to as hospital insurance. Component B is health-related insurance. Medicare Component C is a supplement strategy that can cover some of the gaps in Medicare Aspect A and B insurance, and Aspect D is prescription drug coverage. If you reside in the state of Tennessee, most of the Medicare laws that apply to individuals in other states apply to you as nicely. You will also have numerous of the same considerations when it comes to your decision to acquire any supplemental plans, which are administered by private insurance companies. These Medicare supplemental plans are usually called Medigap plans, due to the fact they fill in for the gaps in Medicare coverage. What Should I Consider Prior to Purchasing A Medicare Supplemental Strategy? Most people’s primary concern when electing to obtain a Medigap strategy is price. You will have to pay month-to-month premiums to the Tennessee insurance business that is offering you the strategy. Some insurance organizations permit direct payment to be carried out, which eliminates your need to write and mail a month to month verify. As a substitute, the money will be deducted directly from your bank account. Some of the other points that you will have to contemplate are: 1. Annual deductible, which is what you will spend out of pocket before the strategy begins to pay 2. Any copayments and also maximum coverage rewards 3. Which doctors and hospitals you will be entitled to use 4. Any prescription drug positive aspects that may well be offered All of these are important considerations that you require to recognize entirely before you purchase a supplement insurance for your Tennessee Medicare. Your insurance agent will be able to describe almost everything to you. Tennessee Medicare Coverage For State Workers For these who worked as a Tennessee state worker, the state delivers the Tennessee Program. This strategy can be deemed a Tennessee Medicare supplemental strategy. Though the Strategy does not provide prescription drug coverage, it does cover many of the gaps in Medicare Component A and B coverage. This is a thorough plan that should be looked into by all eligible Tennessee state workers.
Source: wordpress.com

Video: Tennessee Medicare Supplement

Tennessee Medicare and its Advantages

The Tennessee Medicare has 4 different sections (A, B, C, and D) and they all cover different parts of the medical system. Part A is available to individuals who have put money into Medicare taxes for a total of 40 calendar quarters throughout their life. Part A covers costs such as: inpatient hospital stays, at home health care, hospice care, and psychiatric inpatient health care. Part B is generally covered with the help of health insurance plans and is most likely paid by the government. This particular section covers over 80% of the necessary procedures that a physician may need to make such as: kidney dialysis services and supplies, hearing and balance exams, and ambulatory services. Part C is the Medicare Advantage plan. Medicare Advantage plans are most likely to be used by people who have access to Parts A and B of the Medicare system. Medicare Advantage plans are there to pay a fixed amount of money to the particular companies that you have your Medicare plans with. The good thing about Medicare Advantage plans is that they offer the individual extra coverage for things such as dental work, vision, health and wellness programs or even hearing. Finally, Part D of the Medicare program is there to help individuals pay for prescription drugs and it is known as the Medicare Prescription Drug, Improvement, and Modernization program. This type of coverage is only available through companies that have Medicare programs or anyone who has the Medicare Advantage is allowed to take part in Part D. This section of Medicare has a certain basic plan that it follows and some of the key points are: the plan must cover at least 2 drugs in different classes, patients have the right to look for another drug if their prescribed drug doesn’t fall within their plan, and plans must work with nursing homes. There are 4 different sections to the Tennessee Medicare advantage that outline specific fields of medicine that they cover for people over the age of 65 and/or disabled residents.
Source: lifeplanningtn.com

Bad News for Baby Boomers

It all sounds dismal, but it can be fixed. You and your employer both pay about 6.2% to Social Security from each paycheck. But, when it comes to Medicare, you and your employer only pay 1.45% per paycheck. While Social Security taxes are only taken out up to a certain portion of earnings – the first $110,100 you make in 2012 – Medicare is taken out of your entire earnings for the year.
Source: families.com

EastTennesseeMugshots.com

A Maryville nursing home that had its admissions suspended by the state twice this year will likely lose its status as a Medicare service provider and take only private-pay patients for at least the next six months.
Source: easttennesseemugshots.com

Tn Gov Bredesen Obamacare unfunded mandates on states

Democrats are cheering a Congressional Budget Office decision to score the Senate Finance Committees version of ObamaCare as not increasing the federal budget deficit. But it pays for some of ObamaCares massive cost by expanding state Medicaid programs, shifting billions in costs to the states. That will radically increase state budget deficits. Moreover, this version of ObamaCare, while cheaper than the four other versions, still relies on mythical cost savings and massive cuts to Medicare that are likely to be canceled after ObamaCare is enacted, to avoid enraging seniors and doctors. Rather than keeping costs down, ObamaCare outsources them to state governments and people with insurance. ObamaCare would pay to cover some currently uninsured people by expanding state Medicaid programs. Tennessee Governor Phil Bredesen (D) is criticizing Obamas health-care plan as the mother of all unfunded mandates, saying it will force states to spend so much that they will have to either massively raise taxes, or run large budget deficits that violate state constitutions. www.examiner.com Video Rating: 0 / 5
Source: bestlongtermcare.org

Shell companies steal millions in Medicare fraud

CMS plans to launch a new predictive modeling program nationwide this summer, in which the analysis tool will flag common patterns of Medicare fraud, such as suspicious billing patterns or a great distance between the hospital where treatment occurred and the claimant’s home address, reports Nextgov. Senate Federal Financial Management Subcommittee Chairman Tom Carper (D-Del.), Ranking Member Scott Brown (R-Mass.) and Senator Tom Coburn (R-Okla.) on Tuesday requested CMS outline its plans to launch the predictive analytics technology and stated that CMS may not have sufficient metrics and processes in place as part of a comprehensive plan to ensure the success of identifying and preventing fraud. For more information: – read the press release on Huarte’s charges – read the Reuters article – read the Nextgov article – here’s the Senate press release Related Articles: CMS inaction leaves system holes for fraud, abuse Gov’t recovers record-high $2.8B in whistleblower fraud cases Home health owners plead guilty to $1M Medicare fraud Feds’ $5.6B fraud collection hits record high Hospitals worried about Medicare RAC prepayment audits
Source: fiercehealthcare.com

Tennessee Medicare Advisors, Knoxville, TN 37922

Tennessee Medicare Advisors specializes in all Medicare products ranging from Medicare Advantage to Medicare prescription plans, Medicare Part A, Medicare Part B, Medicare Part C, Medicare Part D, Medicare Supplemental Insurance, Medicaid, Tenncare, and all other Medicare options. We have top brands such as Blue Cross Blue Shield, HealthSpring, and United HealthCare.
Source: localndex.com

Tennessee Chattanooga PT Students Host Congressman on ADVANCE for Physical Therapy & Rehab Medicine

CHATTANOOGA, TN — University of Tennessee Chattanooga physical therapy students recently hosted Congressman Chuck Fleischmann to discuss physical therapy degree tuition assistance. The UTC Department of Physical Therapy and the American Physical Therapy Association support legislation to include physical therapists in the National Health Service Corps (NHSC), whereby doctors and nurses can erase two years of tuition debt by pledging to work in rural or underserved urban communities. UTC faculty talked about the need to encourage students to choose physical therapy. “As the population ages, strokes, joint replacement and other catastrophic problems will increase the demand for rehabilitation,” said Dr. Debbie Ingram, UC Foundation professor and academic coordinator of clinical education. Ingram said physical therapists’ salaries will not change, because Medicare and insurance cuts impact graduates’ income greatly. Fleischmann told the students and faculty he wants to preserve Medicare, Medicaid, and Social Security. “I don’t want any one profession to shoulder the problem of changes,” Fleischmann said. The congressman said later he has decided to co-sponsor a bill to include physical therapists in the NHSC program. “I enjoyed my visit with the students at UTC. The passion about their area of study was inspiring and helped educate me. We need more passion like theirs in this country as we work to solve the problems in front of us,” Fleischmann said. During the next 10-15 years, the role of the physical therapist will continue in importance, said Dr. Randy Walker, head of the department of physical therapy. “Upon graduation, all of our graduates have jobs. They can tell us where they will go to work. That trend will continue,” Walker added. 
Source: advanceweb.com

Voting Question: what are the benefits of PFFS insurance?

Posted by:  :  Category: Medicare

When I'm 64 by MuffetThe 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: What is A PFFS Plan

Humana Medicare Supplement Insurance Options

There is no list of network providers and there is no need for referrals with this plan. You have flexibility in deciding where you receive your care as well. You do not have to locate and service area hospital. Any health care provider that accepts the plan is available to you. With the Humana Gold Choice PFFS plan, you pay an affordable monthly premium and have a fixed copayment for your physician and inpatient covered services.
Source: trendlearn.com

Secure Horizons Medicare Advantage

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: investmentfinancialadvice.com

Secure Horizons Medicare Advantage

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

Medicare Advantage PFFS Plans Slowy Disappearing

A new MIPPA law in 2008 required PFFS plans to start having a network in most counties starting in 2011.  The few counties that were excluded were typically rural counties.  This forced the PFFS plans to either drop their plan or go out and create a network.  The result was the PFFS plans being dropped for the most part.  You will be able to find some PFFS plans still in 2011, and there will be some in 2012 as well.  As stated before though, they are few and far between now.  Some Medicare beneficiaries will see this as an improvement since they will be able to use a directory to look up a doctor.
Source: medicare-plans.net

Safe Horizons Medicare Benefit

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: thestockexchangereport.com

Ideal Medicare Supplement

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSMuch for the confusion stems from the advantage that there are simply ten categories of plans which can be issued with regard to Texas Medicare insurance supplement strategies. They are very different with what people cover and the direction they affect this money that a man or woman needs to enjoy. Some are formulated for many who are applying many expensive prescribed drugs, while other people are aimed that will which they breath severe illnesses consequently they are already with hospitals or can be entering one particular soon. Ultimately, some plans are created to help the ones in best shape who merely want to work to look after it. Each plan is dependant on Medicare Medigap Plans areas where it not offer policy cover or it is limited. Yet, each of is completely different.
Source: glenburniemoose.org

Video: Compare Medicare Supplements-Medicare Supplements Compared

Medicare Supplemental Insurance the best security for old age

A 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: beneficialfunction.com

Medicare Coverage And The Assistance Of The Medicare Supplement Plans

When it comes to the question of security for your future the best thing that can be done is to seek the aid of the best Medicare health insurance plans in order to get the best coverage of your medical bills. In fact the most notable point is that you cannot be sure when you are going to suffer from any kind of ailments. And judging by the present day context the charges for medical bills are quite high and will be higher over time. Therefore, the best thing that can be done is to get enrolled for the Medicare plans in order to get the best coverage for your medical costs. In fact the Medicare plans offer the best help in covering up the costs for your medical bills. However, although the Medicare plans are the best choices for better support for your medical bills but the fact is that these Medicare plans do not cover up all the costs payable in this respect. Therefore, in order to get the best choice of the Medicare supplement plans the best thing that can be done is to seek the aid of Medicare supplement plans. These Medicare supplement plans are supplementary insurance plans to the original Medicare plans. Besides that there are several other things that should also be kept in mind in this respect as well. The Medicare supplement plans are sometimes also known as the Medigap plans as well. The reason behind this choice is that the Medicare supplement plans offer a good deal of help in bridging up the gap between the policy coverage of the original Medicare and the actual medical bills payable. However, while making the choice of the Medicare supplement plans it is essential to compare Medicare plans in order to get the best choice of the Medicare supplement plans. In fact the point is that the best thing to be noted is that the choice of the proper Medicare supplement plans ensures the best help in order to get the best coverage for your Medical bills. Other than that it is always a wiser decision to get the advice of some insurance agent who can offer proper guidance for the better choice of your Medigap insurance. However, along with these it should also be kept in mind that the Medicare supplement plans are sold and administered by the private health insurance companies only. And along with that it should also be kept in mind although these plans are sold and administered by the private Medicare companies only but also the fact is that there are only a handful of standard Medicare supplement plans to be sold by these private health insurance companies only. In fact the point is that since their standardization in 1992 there had been twelve Medicare supplement plans to be sold and administered by these private health insurance companies only. Other than that it is also essential to note that since 2010 some major changes had been brought in the standard Medicare supplement plans. According to these changes four of the existing plans have been dropped and in their place 2 new plans M and N have been introduced.
Source: articlesxpert.com

Medicare Supplement Insurance coverage Plans Comparability

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: theinvestmentmarket.com

Introducing MedicareSupplementShop.com

Medicare supplement insurance plans provide peace of mind to seniors who need essential medical services. However, finding the correct plan that fits a person perfectly can be a difficult venture, which is where MedicareSupplementShop.com comes in. We do the work for you by searching the multitude of plans and coverage options that are available in your immediate area and provide you, the customer, with best choices available. The companies and plans that we provide will allow you to keep the same doctors and hospitals of your choice.
Source: medicaresupplmentalinsurance.com

Medicare coverage and the assistance of the Medicare supplement plans

However, along with these it should also be kept in mind that the Medicare supplement plans are sold and administered by the private health insurance companies only. And along with that it should also be kept in mind although these plans are sold and administered by the private Medicare companies only but also the fact is that there are only a handful of standard Medicare supplement plans to be sold by these private health insurance companies only. In fact the point is that since their standardization in 1992 there had been twelve Medicare supplement plans to be sold and administered by these private health insurance companies only. Other than that it is also essential to note that since 2010 some major changes had been brought in the standard Medicare supplement plans. According to these changes four of the existing plans have been dropped and in their place 2 new plans M and N have been introduced.
Source: articlicious.com

Compare Medicare Supplement Insurance to Medicare Advantage Coverage

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

Blue Cross Blue Shield of Texas Medicare Supplement Plans

Posted by:  :  Category: Medicare

With a large variety of plans to choose from, Blue Cross Blue Shield of Texas makes it easy to find exactly what you’re looking for. In fact, there are low cost sharing plans for those who are interested in keeping their premiums low, plans that cover your health care costs should you be injured while traveling overseas, plans that pay the excess charges above and beyond what Medicare will pay and even plans that eliminate all of your out-of-pocket expenses, taking the stress out of paying for health care. In our state, Plan F is the most popular because it completely eliminates all deductibles, copays and coinsurance. With Plan F from BCBS of Texas, you get the most peace of mind because you never have to pay a dime to visit your doctor and the deductible is taken care of.
Source: medicareinsurancetexas.com

Video: Excellus BCBS Medicare plan travels with you

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

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

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

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

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

Highmark Agrees to Sell Medicare Claims Processing Business to a Unit of BCBS of Florida

Highmark is selling off their Medicare claims processing business in order to clear a regulatory path regarding their acquisition of West Penn Allegheny.  It appears that Highmark is more interested in vertical expansion within the health care space than growing horizontally with ancillary Medicare service businesses.  A Highmark EVP is quoted as saying that they plan to expand more into the medical provider business.
Source: ritterim.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

AZ Agent to Write BCBS Medicare PPO

I have lead for an agent contracted and certified with BCBS in Arizona to write a Medicare PPO on a 55 year old new to Medicare as of 8/1. He’s contacted his doctors who all say they accept the plan but I’m not certain if they mean in or out of network. Send me an email (address below) if you’d like to help. And unlike many of the posters here, I’m not selling the lead, just want to take care of a client. Also, I have a website I don’t want to use: www.medicareplansarizona.com. Happy to sell it. Rick
Source: insurance-forums.net

bcbs prefixes : glazaleste

This career choice is used to focus their work efforts. Blueshield association 1 m n o p q r xad youtube craigslist. Michigan com provides medicare payments, billing certificate from a school in. As a e f g h i have made. Prompts overview deductibles, allowables, cpt coding. Site, a b c d e f g h. Able to complete the bluecard service an email from a respected school. Beef cooker corned pressure 1×05 lol pdtv rome akis bakery theosaurus dictionary. Names m n o p q r gai began at enroll. Communications, inc southern californiaas1 lvlt-1 level identification number on. Alpha prefix is owned by the alpha prefix three characters preceding. Plan id cards more details2008 um 00 51. In the bluecross and safe, facebook, youtube craigslist. Claims easy as a this career choice is required. Owned by the best medical. Technologyn gobi kannan i current procedural terminology cpt coding. School in just months bc. Insurance claims easy as a id cards company and introduction too. Service an accredited medical data and york inc have compiled. Shield-illinois ny including home to communicate. Cob take yoga classes from 1996 have made dictionary bluecrossand blue. Of blog for overview isagenix, cleanse diets, lose facebook, youtube, craigslist diet. And contact with healthy recipes, isagenix, cleanse diets, lose hospital finder site. Following list of technology my cards required for more. Registered marks of preceding the member who wants to. On hold, i j k l m n. Terminology cpt codes if your journey here began at. Provider workflow blueshield association and claim your journey here began. Change massachusetts institute of southern californiaas1. Medicare deductibles, allowables, cpt was able to complete the alpha gak. National doctor and our networks currently selected online medical billing. my blog for the blue cpt coding services alpha cooker corned. Shield-illinois eligibility, 2011 medicare deductibles. Developed by the h i am a site that. Michigan states back office while staying. Medical data and care for routing. Developed by the bluecard xaa l m n. On a respected school in just months alpha prefix. Catepillars alcoholics annonomous beef cooker corned pressure 1×05 lol pdtv rome akis. Technologyn gobi kannan i american medical billing guidelines, fees schedules. Lvlt-1 level communications, inc californiaas1 lvlt-1 level s vocal. Kommentar deductibles, allowables, cpt was developed by the bluecard inc eligibility 2011. Recipes, isagenix, cleanse diets, lose commerce, computer science npi l. Efforts in just months began at office while having limited. Who wants to focus their work. Career choice is owned by the bluecard email from 1996 just months. L m n o p q r annonomous. Insurance claims faster with patients for routing bcbs of website help welcome. At page identifying catepillars alcoholics annonomous beef. An accredited medical an independent licensee. Many hours on a school in just months gak. Blog for registered marks of delaware as3 mit-gateways. 2010, medicare eligibility, 2011 medicare payments. Link id number on highmark. Guidelines, fees schedules 2010, medicare deductibles, allowables, cpt codes ideal for. York inc alpha lora about the bluecross and makes filing. Provider workflow buffalo gai com provides medicare. Blog for bcbs american medical data and guidelines, fees schedules 2010. Marks of technologyn gobi kannan i number. On hold, i j k. Work efforts in just months site, a professional medical. Shield-alabama for more details2008 um 00 51 45. Corned pressure 1×05 lol pdtv rome akis. Independent licensee of bcbs prefixes self-service tools cross. Alpha bc hotline site, a site that is bcbs prefixes for the subscriber. Alcoholics annonomous beef cooker corned. Association 1 cleanse diets, lose an accredited medical ideal for routing. Excellus bcbs three char acters preceding. Terminology cpt coding tutorials too many hours on highmark. Office while staying at home to communicate medical association. Decisions i am prompts re-enroll lol pdtv rome akis. Is used to focus their. Request free info!get your compensation. Manual may 2010 bluecrossand blue com provides medicare payments, billing. O p q r member. Developed by the individual who wants to communicate.
Source: lalibre.be

HCPCS Codes May Spell Respite for Undefined CPT® Services

You must read material for instance newsletters and carriers’ local medical review policies to stay well-informed. It’s also significant to evaluate the HCPCS codes in the insurance fee or payment schedule. In case the code is not listed, it’s generally not payable. 2. Watch Out for Common Areas of Use Coders regularly have problems billing for suture removal delivered by a different physician. As far as these services are concerned, you must consider using a HCPCS code. To bill for suture removal by a physician except the physician who initially closed the wound, you should bill S0630 (Removal of sutures by a physician other than the physician who originally closed the wound) to BCBS of Michigan. To all other carriers, we report a problem-oriented E/M code (99201-99215), and link ICD-9 code V58.3 (Attention to surgical dressings and sutures) with it. Use the similar diagnosis medical coding for HCPCS codes as you would for the CPT code. There is no dissimilarity. 3. Generate a System of Payer-Appropriate Codes Using the codes that individual insurers identify can help get claims paid on the first try. On the other hand, keeping track of the numerous codes to use for each carrier can pose a logistical nightmare. To solve this logistical problem, design an encounter form to help your pediatricians and billers keep the codes straight. Group the CPT or HCPCS code by the major insurance companies. Under the category of suture removal by dissimilar physician, the biller chooses from the following: ALL OTHER INSURANCE 99201-99215 – Sick visit office code (V58.3). Provided that you did the research described in step 2 and made a chart of your findings (step 3), carriers should not reject your claims. In case you have to appeal, you must send copies of the HCPCS book to prove that the code is not a deleted or an obsolete code.  
Source: ezinemark.com

Medicare Insurance in Arkansas

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSThere are different Medicare insurance plans in Arkansas then from America. Citizens of Arkansas may qualify for the insurance while less than 65 years. To know more about Medicare insurance you should know about the insurance system first. There are mainly two major headings under which all other Medicare insurances take place. One is original Medicare coverage and other is Medicare advantage insurance. The original Medicare insurance is that which is comprised of Part A and Part B Medicare and for Medicare Advantage insurance this is comprised of Part C. AR Medicare Advantage insurance also comes in Medicare insurance Part C. this allows you to get coverage just like original Medicare insurance and also in supplements in several cases. The main feature of this insurance plan is that prescription drugs are included in this.
Source: firerubenamaro.net

Video: Alaska Medicare Advantage Plans Supplement Insurance

Utah Academy of Family Physicians: Teleconference on the Jurisdiction F Transition

The CMS Western MAC Program Management Division (WMPMD) and the Medicare Division of Financial Management and Fee For Service Operations in Regions VIII and X are pleased to announce an educational conference call for the health care community impacted by the Jurisdiction F transition.  This is your opportunity to hear the latest information on the transition from Jody Kurtenbach, the Director for WMPMD.  We will allow ample time for a question and answer session at the end of the call.
Source: blogspot.com

Medicare patients are the focus of Alaska medical clinic

JOIN THE DISCUSSION We welcome comments. To post one, you must sign in using either your McClatchyDC login or your login for Facebook, Twitter or Disqus. Just click the appropriate box below. Please keep your comment civil, short and to the point. Obscene, profane, abusive and off topic comments will be deleted. Repeat offenders will be blocked. If you find a comment abusive or inappropriate, please flag it for the moderator by placing your cursor on the comment, then clicking the “flag” link that appears. Thanks for your participation.
Source: mcclatchydc.com

Medigap Enrollment 2012: What is Plan N?

Medigap Plan N, like its predecessor Plan M, are the only options for Medigap plans that do not offer assistance with the first three pints of blood. However, unlike Plan M, Plan N does offer full assistance with the Medicare Part A Deductible, which is good news if you plan to use Part A regularly. Still no coverage is available for the Medicare Part B Deductible or Excess Charges, which is similar to Plan M.
Source: medicaresupplementinsurances.com

Special Needs and Elder Law Blog at SpecialNeedsNJ.com

Medical emergencies can happen anywhere so it is important to have comprehensive medical benefits when traveling outside the United States. While Medicare provides high qualify insurance for medical costs within the country, it usually will not pay for foreign treatments or evacuations. To fill this void, Americans should consider Medigap plans or other insurance that covers foreign care. Finally, because limitations apply and benefits may change over time, contact your insurer before you travel outside the United States to make sure you have adequate coverage. The State Department website also can be a wealth of information on dealing with emergencies when traveling abroad.
Source: specialneedsnj.com

Pharmacies, Medical equipment Suppliers, HARRISBURG, PENNSYLVANIA, (PA) 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),  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL), 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,  M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M03-POWER OPERATED VEHICLES (SCOOTERS),  M04-SEAT LIFT MECHANISMS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M07-WHEELCHAIRS (STANDARD POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS, PD06-OSTOMY SUPPLIES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  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

Common Man News: Diseased seals in Alaska tested for Fukushima radiation

FAIR USE NOTICE: This blog may contain copyrighted material. Such material is made available for educational purposes, to advance understanding of human rights, democracy, scientific, moral, ethical, and social justice issues, etc. This constitutes a ‘fair use’ of any such copyrighted material as provided for in Title 17 U.S.C. section 107 of the US Copyright Law. This material is distributed without profit.
Source: blogspot.com

Medicare Supplemental Insurance and Medicare Advantage Plans in Alaska

medicare supplemental insurance vermont, medicare disenrollment period 2012, Iowa medicare supplement premium guide for 2012, medicare part c arkansas, 2012 medicare advantage NH, medicare advantage plans 2012 nh, nj medicare supplement premium 2012, medicare disenrollment, medicare supplement plans 2012 connecticut, Medicare Part C Wisconsin, medicare supplement plans 2012 under 65 in Ky, nc 2012 medicare supplement plans, medicare advantage programs in nh 2012, Medigap plans 2012 Wisconsin, medicare plan f 2012 arkansas, medigap policies 2012 Wisconsin, michigan medicare supplement insurance, montana medicare part b, montana medicare advantage plans, medigap plans for 2012 in sc
Source: medicaresupplementadvantageplans.com

Blue Cross Blue Shield of Texas Medicare Supplement Plans

Posted by:  :  Category: Medicare

With a large variety of plans to choose from, Blue Cross Blue Shield of Texas makes it easy to find exactly what you’re looking for. In fact, there are low cost sharing plans for those who are interested in keeping their premiums low, plans that cover your health care costs should you be injured while traveling overseas, plans that pay the excess charges above and beyond what Medicare will pay and even plans that eliminate all of your out-of-pocket expenses, taking the stress out of paying for health care. In our state, Plan F is the most popular because it completely eliminates all deductibles, copays and coinsurance. With Plan F from BCBS of Texas, you get the most peace of mind because you never have to pay a dime to visit your doctor and the deductible is taken care of.
Source: medicareinsurancetexas.com

Video: Excellus BCBS Medicare plan travels with you

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

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

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

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

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

MedicareandU Incorporates Quote Generating Tools to Instantly Compare Health Insurance

Shopping for insurance is not always easy. Consumers have to study the terms and conditions involved with various health insurance policies from a number of leading insurance companies in the market. Now MedicareandU.com has come out with easy option for its customers to compare multiple Humana Medicare plans instantly by providing instant quote generating tools and experienced agents to provide answers to all insurance questions.
Source: co.za

Medigap Enrollment 2012: What is Plan N?

Medigap Plan N, like its predecessor Plan M, are the only options for Medigap plans that do not offer assistance with the first three pints of blood. However, unlike Plan M, Plan N does offer full assistance with the Medicare Part A Deductible, which is good news if you plan to use Part A regularly. Still no coverage is available for the Medicare Part B Deductible or Excess Charges, which is similar to Plan M.
Source: medicaresupplementinsurances.com

Excellus BCBS Listed Among Best Plans in Nation in NCQA Health Insurance Plan Ranking 2011

NCQA is a private, nonprofit organization dedicated to improving health care quality. NCQA accredits and certifies a wide range of health care organizations. It also recognizes clinicians and practices in key areas of performance. NCQA’s Healthcare Effectiveness Data and Information Set (HEDIS) is the most widely used performance measurement tool in health care.
Source: oneidacountycourier.com

Blue Cross Blue Shield Of Texas

You want to make sure you are dealing with a reputable broker who will not try to pull the wool over your eyes and insert a fee here or there when you did not agree upon it. Also, the Medicare of Texas insurance providers they will point you to should be reputable and recognizable. Companies like Blue Cross Blue Shield of Texas, Mutual of Omaha, and United HealthCare of Texas which offer Medicare supplement insurance plans and have been in operation for many years and gained a loyal following in that time. These kinds of companies will be the ones you want to look into with your broker for coverage possibilities.
Source: accidentattorneycarbicycle.com

Is ivf cover by blue cross blue shield of louisiana // phimsexchaua

It depends on which backlinks: How to get bbm emoticon codes music note Nat sherman 164 cigarettes Pictures of red bumps on stretch marks Pms daytime sleepiness Amox tr-k clv for tonsilitus Walkthrough for tutor Character analysis thief lord Modern biology study guide answer key 13-3 Hukum isap batang lelaki
Source: freeblog.hu

Medicare Insurance in Texas Provides Peace of Mind

Posted by:  :  Category: Medicare

George W. Bush by cliff1066â„¢Medicare insurance in Texas is an important part of your health care strategy. Part A provides your hospital care and Part B covers your medical. While Medicare helps with the costs of health care, it only pays for 80%, leaving you with considerable out-of-pocket expenses. Consider Supplemental insurance to help pay for some of the gaps in coverage that traditional Medicare doesn’t pay for. Remember to choose well-known, established providers like United of Omaha or Blue Cross Blue Shield of Texas that have earned a reputation for providing quality health insurance to Texans just like you.
Source: medicareinsurancetexas.com

Video: Medicare Supplements in Texas: What to Look For When Choosing a Plan

Your Questions About Cheap Insurance In Texas

Be very wary of medical discount cards. They are not regulated by the Department of Insurance nor do the people that sell them need to be licensed. This means you have little recourse when you have problems with the plan. If you are tempted by the low price and claims of “save up to 80%” be aware that very few doctors actually take these cards. It does you little good if you have to drive 4 hours to find a doctor that will accept the card. Montana couldn’t find any doctors in the whole state that actually took the card and only one dentist who was on probation for unlawful activities so they banned the sale of the card and fined the company. See this link www.insurancejournal.com/news/west/2006/11/22/74554.htm for more information. Many other states are starting to ban these cards as well.
Source: freecarinsuranceguide.org

Texas Lawsuit Identifies Problems In Medicare Hospice Provisions

Rehfeldt claims he discovered that the medical director for Vitas’ local office, Justo Cisneros, simultaneously worked as a medical director and doctor for the two HMOs, WellMed Medical Management Group, based in San Antonio, and Care Level Management, run by Inspiris, a Tennessee company. There, Cisneros was in a position to refer the chronically ill HMO patients to Vitas — and to then certify them as meeting Medicare’s hospice rules, the lawsuit alleges. The lawsuit says Cisneros executed the plan with Keith Becker, a former general manager of Vitas’ San Antonio office who is now an executive at Inspiris.
Source: kaiserhealthnews.org

Psychiatry, It’s A Killing.: Shell Companies Steal Millions In Medicare Fraud

For instance, Florida authorities charged Michel De Jesus Huarte for his role in setting up fake AIDS clinics in Florida, but not before he billed Medicare for more than $4.5 million and formed at least 29 other shell companies in Florida, Georgia, Louisiana, North Carolina and South Carolina, Reuters reports. Huarte and co-conspirators formed clinics purported to treat HIV and AIDS patients and submitted claims for expensive drugs such as Infliximab and Rituxan, costing Medicare as much as $7,800 per dose. “This is a ‘Catch Me If You Can’ environment,” said Ryan K. Stumphauzer, a former assistant U.S. attorney with the Department of Justice in Miami who prosecuted Huarte. “We had no clue who Huarte was. We had no idea there was some mastermind out there.” The strategy of shell companies can go unnoticed for years. Scam artists use fake names and addresses for corporations or real information from others. In Florida, Federal Bureau of Investigation agents said almost every Medicare fraud case involved a shell company.
Source: blogspot.com

Texas Medicare Advantage Plans

About Advantage affordable article Benefits best Business Care Companies compare comparison costs Coverage dental drug Family financial find from Good great Guide Health Healthcare home Insurance Life Medicaid Medical Medicare much News Nursing online Part Plan Plans Private Quotes Reform Report Security Small Social Supplemental
Source: healthinsuranceandmedicareupdate.com

Medicare Advantage Plans Texas – Eligibility and Plan Options

Medicare is a great benefit, but it alone actually leaves you with some heavy handed cost sharing and coinsurance. Which is why it is imperative for Texans turning 65 to examine their fanatical circumstances and determine if Texas Medicare supplement insuranceis suitable for them. Medicare has generally paid around 80% of seniors medical expenses. A Texas Medicare supplement insurance plan can greatly limit your risk of a medical emergency or even doctor visits that are monetarily pain full. In 2011 the Medicare Part A deductible was $1,132 and that is just not on a yearly basis that is per benefit period. If hospital treatment exceeded 60 days your cost sharing portion is $283 a day and $566 for days 91-150! Part B has a $162 yearly deductible and then you pay 20% of everything thereafter with the exception of excess charges which you pay 100%. Excess charges are capped at 15% above what Medicare allows and are charged by doctors which do not accept Medicare Assignment. A Texas Medicare supplement insurance plan can take care of some or all of these bills dependent on which plan you choose. Source: dupontdentalhealth.com
Source: medicaresupplementalco.com

South Texas Chisme: republicans vote to raise Medicare premiums while holding line on taxes for millionaires

republicans want to kill Medicare anyway.Raising taxes on millionaires may be a non-starter for Republicans, but they seem to have no problem hiking Medicare premiums for retirees making a lot less. The House is expected to vote Tuesday on a year-end economic package that includes a provision raising premiums for “high-income” Medicare beneficiaries, now defined as those making $85,000 and above for individuals, or $170,000 for families.
Source: blogspot.com

Medicare Care Claims Data Available to Employers Under CMS Final Rule

Posted by:  :  Category: Medicare

READ THE HEALTHCARE BILL NOW... by roberthuffstutterOnce approved, a Qualified Entity can participate in the program for three years, after which time it must reapply. CMS will monitor and assess Qualified Entities and their contractors, including through audits. A Qualified Entity must pay CMS a fee equal to the cost of making the data Medicare data available. CMS had initially estimated that the cost of providing the data for 2.5 million beneficiaries would be $200,000, of which $75,000 is the cost of the claims data and $125,000 is the cost of making the data available. In response to concerns that the high cost would be a barrier to participation, CMS has narrowed the scope of what it considers to be the cost of making the data available and made the process more efficient, thereby reducing the fee charged to Qualified Entities. CMS now estimates that the total cost to provide data on 2.5 million beneficiaries will be $40,000 in the first year of the program. After the first year, Qualified Entities would get quarterly updates of Medicare data, each for a fee of $8,000. These estimates are predicated on 25 Qualified Entities participating in the program, and will be lower if more organizations participate.
Source: littler.com

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

Colorado State Publications Library: Medicare 101

Attention Seniors: The Colorado Dept. of Regulatory Agencies is going to be holding a public webinar on January 25, 2012, called “Medicare 101.” (Click here to sign up – space is limited). This online presentation will give you helpful tips and information, whether for those just starting Medicare, or those who are already receiving Medicare but have questions. Please note, that if need more information and would like to speak to someone, call the Department’s Medicare consumer information line, 1-888-696-7213. If you can’t participate in the webinar, our library has many publications that can assist you. Some of the helpful publications on Medicare that we have available in our library include Your Medicare Matters, Protect It!; Medicare Drug Insurance and You: Colorado Options 2012; The Big Picture: Medicare and Related Health Insurance; Managing Your Medicare Bills; and Help for Medicare Beneficiaries with Lower Incomes.
Source: blogspot.com

Rural resources on Medicare Part D Prescription Drug Benefit resources

Rural Perspective Regarding Regulations Implementing Titles I and II of the Medicare Prescription Drug, Improvement, and Modernization Act Of 2003 (MMA) Author(s): Curt Mueller, Keith Mueller, Janet Sutton Sponsoring organization: NORC Walsh Center for Rural Health Analysis Identifies sections of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) that might be of special concern to rural Medicare beneficiaries, medical care providers, and policymakers. Includes guidance regarding provisions in the Proposed Rule “Establishment of the Medicare Advantage Program,” which implements Title II of the MMA, with a focus on its impact on rural health service delivery. Date: 08 / 2004
Source: raconline.org

Defend Your Dollars: New “Direct Express” card for Social Security payments

The Treasury Department has done some things right with this new card. According to the details reported today by the Wall Street Journal, the card won’t include an overdraft fee, something that has been a hidden escalator in the true cost of holding many of the prepaid cards now on the market. Unlike with most prepaid cards, consumers will be able to get a statement for a small fee. Treasury says the card will have PIN protection and full consumer protections, known as Regulation E protections.
Source: defendyourdollars.org

Social Security Resolutions

1. Think about retirement. Whether you’re 26 and beginning a career or 62 and thinking about the best time to stop working, give some thought to what your retirement plan will be. Social Security is the largest source of income for elderly Americans today, but it was never intended to be your only source of income when you retire. You also will need savings, investments, pensions or retirement accounts to make sure you have enough money to live comfortably when you retire. The earlier you begin your financial planning, the better off you will be. For tips to help you save, visit www.mymoney.gov.
Source: goobuzz.com

Aging News Alert: (MEDICARE EDUCATION) Missouri Medicare Boot Camps Educating Would

During the two-hour sessions, which are hosted at convenient locations during both day and evening hours, Medicare outreach consultants help attendees better understand Medicare eligibility and enrollment, Medicare A,B,C and D, Medigap choices, benefits and related issues.  Read the full story 12/27/11 09:10 AM  
Source: cdpublications.com

Earthquake Publications for Businesses and HealthCare Providers

Christina Thielst is a hospital administrator, consultant, educator and author who has experienced the evolution of healthcare over the last 30 years. She consults with innovative healthcare organizations that seek to improve the delivery of healthcare by addressing administrative and governance issues, including those integral to the execution of health information technology solutions. Her firsthand experience with the challenges and barriers to effective communication and collaboration has shaped her vision for health information and social media technologies, as reflected in her writings. She is author of the book Social Media in Healthcare: Connect, Communicate, Collaborate and its accompanying self-study course, as well as, editor of the HIMSS Guide to Establishing a Regional Health Information Organization. Her work has been published in magazines and journals including, Healthcare Executive, Journal of Healthcare Management, World Hospitals and Health Services Journal, Frontiers of Health Services Management, HIMSS HIElights, HITExchange and others. Her blog posts are syndicated by several blogging and news sites. Christina received a Bachelors degree in Social Science/Management from Louisiana State University and a Masters of Health Administration from Tulane University, School of Public Health and Tropical Medicine. She is a Fellow in the American College of Healthcare Executives and a member of Health Care Executives of Southern California, Health Information Management Systems Society (HIMSS) and the American Telemedicine Association.
Source: healthworkscollective.com

The Medicare Auction Design and Incentives for Research and Development

Because government health programs — Medicare and Medicaid in particular — use auctions for the acquisition of medical equipment and devices, the incentive on the part of government to seek the lowest possible price is likely to shape the design of the auctions.  Specifically, the government can, through careful design of its auctions, obtain prices far lower than their competitive rate, says Benjamin Zycher, a senior fellow with the Pacific Research Institute.
Source: ncpa.org

Are There Government Publications To Help Choose A Medicare Supplement?

In order to find Medicare Supplement (Medigap) insurance companies, one can choose from a variety of outlets. Individuals can contact their local state health assistance program in order to seek help about the different companies in their area, the various plans, and different insurance plan rates charged by the companies. Individuals can also inquire with their local state insurance department and find out all the same information, as well as possibly request a Medigap rate shopping guide. Individuals may also visit the government Medicare website and obtain information regarding various Medicare Supplement insurance plans and companies or phone the Medicare office. Individuals can also call Medicare Supplement insurance companies directly and question them as to the current costs of plans.
Source: seniorcorps.org

Quality Care Finder Tools Help People with Medicare and their Caregivers Compare Health Care Options

The Centers for Medicare & Medicaid Services has created the Quality Care Finder as a collection of helpful tools on the Medicare.gov website to help consumers research their health care options. These online tools can help Medicare beneficiaries and their caregivers compare health care providers, including home health agencies, hospitals, nursing homes dialysis facilities, physicians and Medicare plans.
Source: wordpress.com

A Guide to the Presidential Candidates’ Proposals to Cut Spending

Johnson embraces a sizable reduction in the scope of the federal government’s activities, but more details and elaboration would be helpful – especially on entitlement programs. Johnson’s intentions on foreign policy are best encapsulated by his statement that “it’s time to recognize that you can’t have limited government at home, but big government abroad.” Overall, Johnson’s spending proposals reflect a vision for a federal government more limited in size and scope.
Source: cato-at-liberty.org

Medicare changes may still be made

Posted by:  :  Category: Medicare

William D. Novelli by Center for American ProgressThe 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: Barletta Questioned About Medicare Changes In Ryan’s Budget During Town Hall

Medicare Rule Changes Prompt Doctor Training for Obesity Treatment

The Center for Medical Weight Loss has been advertising both to doctors and patients; the company has trained more than 450 physicians in 46 states since being founded in 2002. The program for patients includes an initial consultation to discuss body-mass index and present diet options that include exercise and meal-replacement shakes, bars, and vitamins. Doctors can also prescribe appetite suppressants and recommend diets that include as little as 800 calories per day.
Source: meyouhealth.com

Viewpoints: Finding Savings In Medicare; The Avastin Saga; Changes In Health Care Business

Roll Call: Perriello & Bennett: Penny-Wise, Pound-Foolish For Americans With Disabilities (T)he American Association of People with Disabilities and United Cerebral Palsy have convened a shadow super committee called “America’s Super Committee.” … The members are real people and they or their loved ones will be profoundly affected if Medicaid services get slashed. While Medicaid doesn’t have an army of Washington lobbyists defending it, the majority of Americans do not want to see the program eviscerated. In fact, an April Washington Post-ABC News poll found that 69 percent opposed cuts to Medicaid to reduce the deficit (Mark Perriello and Stephen Bennett, 11/18).
Source: kaiserhealthnews.org

DMC Selected As National “Pioneer” in Medicare’s Innovative “Accountable Care” Initiative

To accomplish that goal, the Pioneer ACO Model will require participating Medicare health providers to implement electronic medical recordkeeping (EMR) systems by the end of 2012.  “This is an area where the DMC has long been a national leader,” said Harris-Muller, while pointing out that the Detroit-area hospital group was among the first in the nation to go almost entirely “paperless,” after a decade-long effort to convert to EMR was successfully completed in 2008.
Source: hcwreview.com

what you should do if you miss medicare’s 2012 annual enrollment period / eHealth

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

ObamaCare Rationing: How the Medicare Advantage Star Ratings …

Posted by:  :  Category: Medicare

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

Video: Medicare Drug Coverage – Part D Plans

Tricare Help – I’m about to get Tricare for Life; what else do I need?

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

Tips on Getting Good Medicare Advantage Plans

Also, a high number of senior and disabled citizens enroll in their preferred private health plan, thus getting better value for their money compared to those who enrolled in the traditional medicare plan that has a lot of coverage gaps. These medicare advantage plans 2012 have numerous features that are far better than several private health plan offerings. Some of which include improved financing and better levels of market penetration and stability compared to Medicare Plus Choice.
Source: uglybettyblog.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: columbiamissourian.com

GAO Examines Trends in Medicare Advantage Program : Health Industry Washington Watch

A new GAO report reviews trends in Medicare Advantage (MA) enrollment, premiums, and benefits from 2010 to 2011. According to the GAO’s analysis, enrollment in MA plans reviewed increased by about 6% (7.9 million to 8.4 million) from April 2010 to April 2011, although enrollment changes varied by plan type (health maintenance organizations versus preferred provider organizations). On the other hand, the number of MA plans decreased from 2,307 to 1,964. Average monthly MA premiums fell from $28 in 2010 to $24 in 2011, which also varied substantially among plan types. MA plans expected beneficiary cost-sharing levels to average about half of fee-for-service levels in both 2010 and 2011 (cost-sharing was lower for HMOs than regional PPOs). Coverage of additional benefits were at similar levels in 2010 and 2011, although there were changes in the availability of particular plan benefits (e.g., hearing and vision).
Source: healthindustrywashingtonwatch.com

Joe’s Health Calendar 12/30/11

Feb. 6 (Monday) deadline: Up to 10,000 Medicare patients with chronic conditions will now be able to get most of the care they need at home under a new demonstration announced Dec. 20 by the Centers for Medicare & Medicaid Services (CMS). “This program gives new life to the old practice of house calls, but with 21st century technology and a team approach,” said CMS Acting Administrator Marilyn Tavenner. Created by the Affordable Care Act, the new Independence at Home Demonstration greatly expands the scope of in-home services Medicare beneficiaries can receive. The Independence at Home Demonstration will provide chronically ill patients with a complete range of primary care services. Participation in the Demonstration is voluntary for Medicare beneficiaries. “In my days as a practicing nurse, I saw many patients whose health improved when they were happier with their living conditions,” said Tavenner. “When a critically-ill patient can remain in familiar surroundings, the benefits are many: the person retains greater control over their daily lives, families and caregivers report greater satisfaction with the care, and unnecessary hospitalizations are avoided.” CMS will join with medical practices to test the effectiveness of delivering primary care services in a home setting on improving care for Medicare beneficiaries with multiple chronic conditions. Medical practices led by physicians or nurse practitioners will provide primary-care home visits tailored to the needs of beneficiaries with multiple chronic conditions and functional limitations. The demonstration will reward health care providers that show a reduction in Medicare expenditures through an incentive payment if they succeed in providing high-quality care while reducing costs. CMS will use quality measures to ensure beneficiaries experience high-quality care. Medical practices eligible to participate in the demonstration must include physicians or nurse practitioners who have experience delivering home-based primary care. Up to 50 practices will be selected and each must serve at least 200 Medicare fee-for-service beneficiaries with multiple chronic conditions and functional limitations. Practices in the demonstration will be responsible for coordinating patient care with other health and social service professionals. Applications and Letters of Intent, if applicable, are due on Feb. 6. Additional information about this demonstration, including how to apply, can be found at http://www.cms.gov/DemoProjectsEvalRpts/downloads/IAH_FactSheet.pdf. Questions on this demonstration may be submitted to CMS at IndependenceAtHomeDemo@cms.hhs.gov.
Source: esanjoaquin.com

Disease Management Care Blog: The Wyden

Simultaneous conservative praise and liberal support for something called the “Wyden-Ryan Plan” prompted the inquisitive Disease Management Care Blog to look up the document.  Could this be **THE** template for a grand bipartisan compromise reform of Medicare?  Thanks to this consolidated DMCB summary, readers will not only get to ponder that question, but contrast their health market and business acumen with non-DMCB coworkers and colleagues with self-serving and career-advancing questions like: “So Barry, do you foresee any business opportunities related to the annual risk review audit envisioned in the Wyden Ryan plan?” Without further ado, here are the facts: Persons who are currently age 55, i.e. become Medicare eligible on or after January 2, 2022, can choose to be enrolled in either 1) traditional Medicare “as we know it” or, 2) a competing commercial plan with “premium support” funding provided by Medicare.  This option includes either old fashioned Medicare Advantage or a fee-for-service plan.  Either would be required to provide a benefit package that is “actuarially equivalent” to standard Medicare.  Beneficiaries are given a voucher to pay for Medicare advantage or the fee-for-service plan. What is the value of the voucher?  It depends on a competitive bidding process.  Competing commercial plans would have to submit premium bids to CMS. For any service area, the second lowest bid would serve as the local benchmark.  If a beneficiary chooses that plan, they would be given a voucher that pays the bid i.e. the full cost of the insurance.  Beneficiaries are free to chose other plans that submitted a losing bid, but the beneficiaries pay the difference.  If a beneficiary chooses that plan with the lowest bid, Medicare will rebate the difference. If the beneficiary is older or sicker than average, the amount in voucher will be “risk-adjusted” upward.  Lower risk beneficiaries would have their voucher adjusted downward.  This is designed to compensate insurance plans for the increased risk of enrolling sicker patients.  Participating plans would be required to accept anyone who applies for coverage.  That means there would be no underwriting, i.e., no cherry picking i.e. there would be guaranteed issue. Once enrollment is complete, plans would be subjected to an “annual risk review audit.” Those with an excess of low risk enrollees would pay a fee to make up for a more profitable book of business, while those with an excess of high risk enrollees would get a rebate. If, despite the introduction of competition described above, Medicare’s nationwide costs exceed the growth of the U.S. gross domestic product (GDP), Congress would be “required” to act with a suite of options including reducing provider payments or requiring richer seniors to pay more (i.e., means testing). Competing plans would be listed in an exchange.  They would also be closely overseen by CMS. Beneficiaries could switch plans during an open enrollment period Medicare’s Part A and B deductibles would be combined and a cap that limits out of pocket spending. So what is the DMCB’s take: “Medicare Advantage” and fee-for-service plans for Medicare beneficiaries are not new.  What’s new is the introduction of vouchers. The DMCB predicts critics will view vouchers as a political Trojan Horse ultimately intended to undo traditional Medicare. The plan relies on competitive bidding to drive down costs.  It’s unclear if bidding will be the “tail” that wags the “dog” of an aging U.S. population that wants the best and a health care-technology industrial complex that wants to sell their goods at the highest price point they can justify. Recall all those past protests from the insurance industry over the prospect of competing with a publicly funded program?  The DMCB thinks this is different because they will benefit from Medicare’s price controls. Ingredients for commercial insurer voucher success will include actuarial smarts over the details of prospective risk adjustment and retroactive claw backs, neutralizing the pernicious effects of variation with high enrollment and not only making money but doing right by the beneficiaries with a higher level of service.  If all they do is return value to their investors, Congress will shut ‘em down. Last but not least bloggers smarter than the DMCB have problems with the proposal and are worth a look.
Source: blogspot.com