Updated 2012 Medicare Physician Fee Schedule Now Available

Posted by:  :  Category: Medicare

Section 301 of the Temporary Payroll Tax Cut Continuation Act of 2011 (TPTCCA) prevents a payment cut for physicians that would have taken effect January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012.
Source: codetoolz.com

Video: Medicare Fee Schedule

Codingahead: 2012 Medicare Fee Schedule

prevents a payment cut for physicians that would have taken effect on January 1, 2012. An update of zero percent is effective for claims with dates of service January 1, 2012, through February 29, 2012. While the physician fee schedule update will be zero percent, other changes to the relative value units used to calculate the fee schedule rates must be budget neutral. To make those changes budget neutral, the conversion factor must be adjusted for 2012. CMS is currently developing the 2012 Medicare Physician Fee Schedule (MPFS) to implement the zero percent update. As previously advised, Medicare claims administration contractors will be holding new, January 2012 claims for up to 10 business days in order to effectively test and implement the new 2012 MPFS. These claims to be released into processing no later than January 18, 2012. Claims with dates of service prior to January 1, 2012, are unaffected. Finally, Medicare contractors will be posting the new rates on their websites no later than January 11, 2012.
Source: blogspot.com

Medicare Payment Schedule for 2012 and Claims Processing Hold

While Congress delayed the 27.4% Medicare fee cut that was to have gone into effect on January 1, 2012, it is important to understand that other payment factors from the Medicare physician payment final rule will affect the 2012 fee schedule. In other words, even though the SGR-driven fee cut was averted for two months the 2012 fee schedule is not the same as the 2011 fee schedule. For example, the conversion factor was changed from $33.9764 to $34.0376. Other changes include: an extension of the floor on the work geographic practice cost index (GPCI); multiple procedure payment logic; electronic prescribing and quality reporting; and corrected relative values for certain services. Therefore, the 2011 schedule is not the schedule that will be implemented in 2012 and the currently posted 2012 schedule (that includes the 27.4% fee cut) is not the schedule that will be implemented.
Source: wordpress.com

DXA Reimbursement Slated to Plummet March 1

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

What the 2012 Medicare Physician Fee Schedule tells us about the future : Getting Paid

The final rule for the 2012 Medicare Physician Fee Schedule went on display this week. Of course it includes the all-too-familiar fee cut (27.4 percent) – the result of the Centers for Medicare & Medicaid Services’ (CMS) flawed formula for calculating physician payment that Congress has been patching annually since 2002 but which needs a permanent fix. This year’s fee schedule is notable for another reason as well. The PDF file is 1,235 pages long, and that’s without the appendices that will be included when the final rule is published in the Federal Register later this month. The fact that it requires so many pages to describe one year’s changes to one part of one government program is mind-boggling, but the additional bulk is partly because this year the rule also provides a forecast for how CMS plans to carry out government mandates for the program over the next five to 10 years. It is not a crystal ball, but the rule leaves no doubt that Medicare payment to physicians will be changing and that today’s initiatives and incentives are intended as the basis for tomorrow’s payment.
Source: aafp.org

2012 Medicare Physician Fee Schedule Final Rule Important for Telemedicine

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

Revised Medicare fee schedule for January 1, to February 29, 2012 is up on

Again, as you should know, CONGRESS voted on at least five (5) separate Medicare Physician Fee Schedules for calendar year 2010.  This caused the Medicare contractors to reprocess physicians’ claims for the first 5 months of the 2010 year and resulted in some peculiar recovery actions. Please use the following link to locate your elected officials and contact them to urge that 2010 not be repeated:  http://www.mssny.org/mssnyip.cfm?c=s&nm=Grassroots_Action The Medicare fee schedule needs to be properly addressed.  Fixing the flawed Medicare payment system and protecting Medicare beneficiaries’ access to doctors is vital.  Congress must pass legislation permanently reforming the SGR and address this issue once and for all.  The pattern of threatened SGR cuts and last-minute Congressional rescues is in itself not a sustainable solution and must be remedied.
Source: nacmed.org

The Medicare Gordian Knot

In May 2011, Rep. Tom Price, MD (R), GA, introduced HR-1700, the “Medicare Patient Empowerment Act” (MPEA), and Sen. Lisa Murkosky (R), AK, introduced a companion bill in the Senate, SB-1042. This legislation would change the physician participation restrictions, allowing docs to independently and privately contract with any Medicare patient for a mutually agreed to fee, specifically for non-emergent services, which might differ from the fixed-fee allowed by Medicare. The reason this bill is called the Medicare Patient Empowerment Act is quite simple. Should the system be allowed to go on as is, Medicare patients will soon find themselves unable to find a physician willing to work for what Medicare pays. Then, if the patient decides to go to an ‘opted-out” physician they will lose the benefits they have paid into for many years. This is quite simply unfair. This bill would solve the problem by “empowering” each patient to use their Medicare benefits however they see fit when seeking the care they need and desire.
Source: spiritofhealthcare.com

Medicare 2011 Fee Schedules

AdvancedMD provides copies of the most current fee schedule from Medicare for your state(s), carrier # and locality. You may use this fee schedule to add a new version to your own Medicare fee schedule. The fee schedules provided by AdvancedMD will appear in your fee schedule grid as #MCR [State] [Carrier]-[Locality]. For example, #MCR11 UT 03502-09. The default Medicare (#MCR) fee schedules that appear in your grid are determined by the state(s) tied to your Practice, Group, Provider and Alternate Provider master files.
Source: advancedmd.com

Gym Memberships In Medicare Advantage Plans Cater To Healthy Seniors

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressThe implication that Medicare Advantage plans are offering this benefit to attract healthier members in unfair and untrue. In fact, they offer these types of benefits to improve the attractiveness of their product such that membership increases, and with an expectation that these programs will help lower overall health care costs. With the advent of risk adjusted Medicare Advantage premiums, health plans have no financial incentive to cherry-pick very healthy members. They do, however, have an incentive to enroll members who want to be healthy (in other words, people who take their health care seriously), regardless of their current health status, and fitness programs are one way to attract those types of members. Remember that many of these fitness programs consist of stretching, modest weight-bearing exercise and water activities that help older people from falling, improve their mental health and assist in the management of expensive chronic diseases such as diabetes.
Source: kaiserhealthnews.org

Video: Understanding Medicare Advantage Plans

Disease Management Care Blog: Coverage of Fitness by Medicare Advantage Plans: Which Causes Which?

Many years ago, the newly-minted managed care medical director Disease Management Care Blog accompanied a marketing VP on a business visit to a fitness club. We were interested in knowing if the club would offer a discount to our health plan members.  During the tour of the facility’s weight rooms, basketball courts and group exercise rooms, we came across a large swimming pool filled with bathing-capped seniors. “Those people,” thought the DMCB, “are precisely the ones we want in our insurance plan.” Enter the paradox of offering fitness and wellness as a covered health insurance benefit. While the assumption has been that fitness causes an enrolled population to be healthier, it’s just as possible for persons who are already healthy in the first place to be attracted to health plans that cover fitness.  Managed care executives have known about this for a long time, but until now, no one has really measured the effect. Enter this elegant study by Alicia Cooper and Amal Trivedi, just published in the January 12 New England Journal. Eleven Medicare Advantage (MA) health plans that added fitness as a covered benefit in either 2004 or 2005 were matched to 11 plans that did not add a fitness benefit. On average, the plans were predominantly nonstaff and nongroup models and median duration of being in business was just over ten years. The “fitness” plans had a median population of 31,540 members while the control plans had a median membership of 18,241 The authors next looked for Medicare beneficiary members in those 22 plans who had completed a “Medicare Health Outcomes Survey” (MHOS) at the time of their enrollment. This yielded 4,852 beneficiaries who were in one of the eleven “fitness MA plans” and 5,064 beneficiaries in one of the eleven “no fitness MA plans.” Age, gender and the burden of illness was similar in both groups, while they differed slightly with respect to race, education and income. The key question from the survey that was used in this analysis was self-reported health status. In the years prior to instituting the fitness benefit, the percent of newly enrolled persons reporting excellent or very good health in the MHOS was 29.1%.  After the fitness benefit was instituted, it increased to 35.1%.  Plans without fitness programs during that same period went from 28.5% to 30%. This contrast between a 6% increase versus a 1.5% increase was statistically significant. The good news is that the folks in Medicare are well aware of the impact of unequal enrollment between MA plans and use risk adjustment to even out the payment levels. The bad news is that risk adjustment is notoriously inaccurate and, to the DMCB’s knowledge, probably doesn’t capture that 6% shift described above.  Assuming the MHOS survey results translate into lower claims expense, that could represent some serious money in a program that is already under fire for over-payment. Before readers condemn the MA plans for consciously using their fitness plans to attract a lower cost population, note that the same MA plans have been offering disease management programs for persons with chronic and costly conditions.  When compared to fee-for-service Medicare, these programs may be attracting sicker seniors.  Between MA plans, those with a better reputation for investing in chronic care population health management are more likely to attract a higher percent of persons with diabetes and heart disease. In other words, it works both ways. What should the next step be?  Follow-up MHOS results for those individuals who entered with a low score to determine if there was any improvement among those in “fitness” MA plans versus those plans without the fitness benefit.  The DMCB looks forward to seeing those results hopefully soon. In retrospect, the DMCB should have suspected something was up years ago.  After all, it was accompanying a marketing VP and, whether we knew it or not, the visit was really all about those seniors in the pool.
Source: blogspot.com

Do Gym Memberships Help Medicare Advantage Plans Attract Healthy Seniors?

Bloomberg: Insurers Offer Gym Memberships With Medicare Programs The offer of a fitness club membership is helping insurers including UnitedHealth Group Inc. (UNH) and Humana Inc. (HUM) draw healthier and less costly patients to their Medicare programs, said researchers reporting in the New England Journal of Medicine. The study found 35.3 percent of new enrollees in a fitness membership benefit plan reported “excellent” or “very good” health, compared with 29.1 percent in the group without the benefit. The number of plans offering the memberships rose to 58 in 2008 from 4 in 2002, the researchers said (Frier, 1/12).
Source: kaiserhealthnews.org

Do Gym Memberships Help Medicare Advantage Plans Attract …

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

Medicare Advantage Plan Provides Model for Improving Care for Patients with Diabetes

The new study, “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients,” examines the model of care used by the largest Medicare Advantage chronic special-needs plan, Care Improvement Plus, and compares utilization rates among its members with diabetes in Arkansas, Georgia, Missouri, South Carolina and Texas with those of similar beneficiaries enrolled in fee-for-service Medicare in the same five states.  Care Improvement Plus’ Model of Care emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care, including periodic home visits with plan clinicians.
Source: ahipcoverage.com

What is a medicare advantage plan

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Source: fluxfeatures.com

Choosing a Medicare Advantage Plan

Provider coverage depends on if the Medicare Advantage plan has and HMO network, PPO network or no network. An HMO network is the most restrictive. You can only use providers who are in the HMO. If you go to a provider outside of the network, the HMO will probably not pay for it. With a PPO you have more choices. Either you can choose providers within the network, to receive the most benefit, or you can go out-of-network and pay more in terms of co-pay and deductible. Fee for service plans have no network. So theoretically, you can choose any provider that you like. However, the provider must agree to the terms of the plan if you want the plan to reimburse the cost.
Source: smbinformation.com

The Different Types Of Medicare Advantage Plans In Wisconsin

Health Maintenance Plans: Plans of this type require patients to pick a PCP, or primary care physician, which is the only doctor which can refer you to other medical services. Primary Care Physicians (PCP) are usually general practitioners, family doctors or pediatricians. When your PCP refers you to a specialist, it is almost always a doctor within your network. This is because only specialists that in your network will be covered by an HMO. HMOs provide general care at comparatively lower cost because certain, more expensive, treatments are less likely to be covered. The goal of this type of insurance plan is exclusively maintenance.
Source: goldenwisdomnuggets.info

Gym benefits help Medicare plans recruit healthy seniors

One analysis compared the self-reported health of seniors who enrolled in case plans before the fitness club benefit was offered to the health of those who enrolled after the benefit was offered. While 29.1 percent of the seniors who enrolled before the benefit was available described themselves to be in excellent or very good health, 35.1 percent of the seniors who enrolled after it became available reported that level of health. In the before group, 56.1 percent reported some limitation to their physical activity but only 45.7 percent in the after group did. Also, a third of the before group reported difficulty walking compared to just a quarter in the after group.
Source: sciencecodex.com

Why Medigap Plans are Crucial to Seniors

The importance of a good Medicare Plancan not be overstated. Depending upon the plan, Medigap plans make your healthcare costs completely affordable and predictable. Medicare by itself has no limits. If you have no gap coverage and you get really sick, your costs could be unlimited and it could ruin you financially. The Medigap Plan F is the most comprehensive. Sure, the rates go up every year, but compared to the cost of unlimited bills, the premiums will always be affordable. Medigap is not the same thing as Medicare Advantage plans. Those plans work instead of medicare, rather than alongside of Medicare as do the Medigap plans.
Source: jornjorn.com

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

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

How Medicare Advantage Plans Open Enrollment Lets You To Switch From Medigap

Medicare Advantage plans are from private insurance companies that provide insurance for seniors and certain people with disabilities. These plans are subsidized by the government and the plans typically compete with extras not available in Original Medicare, such as dental, hearing or vision coverage. With the subsidies, their premiums were lower than standard Part B Medicare premiums, but subsidies have come under scrutiny. The federal government has frozen subsidies during performance evaluations. Some Medicare Advantage plans may earn bonuses, but under-performing plans face a loss of subsidies and that may result in higher premiums.
Source: fatspdx.com

Does Medicare Covers All Dental Care?

Posted by:  :  Category: Medicare

Anyone will feel secure to have a medicare insurance that covers almost health related concerns. To be more secure, it is normal to ask: Does Medicare cover dental? Medicare will pay for any dental services but will not cover any dental care follow-up. One example of which is that, it will shoulder the extraction of your tooth but not to cover the future checkup because your tooth was already removed. On one part, hospitalization will be shouldered if infection persists after the process of extraction or after dental procedure; you are being under observation of a health threatening condition.
Source: anthropologica.net

Video: Dental Insurance Commercial for Folks on Medicare

Do Gym Memberships Help Medicare Advantage Plans Attract …

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

What is Supplemental Medicare and Who offers it in California?

To be eligible for supplemental Medicare policy, it is required for you to enroll in part A and B of original health insurance policy. Either you can opt for these plans during open enrolling period or you can undergo medical screening and buy the policy individually. The supplemental Medicare plans in California are sold by private insurance companies which are allowed to offer 12 such standard plans. Each plan comes with different benefits though all the benefits cover under part A and B are also found in all these insurance plans (because they are part of basic health insurance plan). Those planning to enroll for supplemental Medicare policies in California should be aware there are some terms and conditions to participate in the same. If you have enrolled in Standalone Part D, you cannot continue to avail drug coverage. Whichever company in California you buy the supplemental Medicare plan from; the plans offer the same benefits though the premium may vary.
Source: projektgenerika.org

The Way It Is Against Medicare Add To Insurance

For Mary this is the quality of your life issue, not really your life and death. The advantage options for this sort of supplemental plan frequently include vision gains, dental benefits, coverage for medicare insurance members of the family, drug co-pays, office visit co-pays, etc. Once you know the major brands of Medicare Supplement Insurance agencies and the address of these respective official internet sites, it is all to easy to visit those sites and do any window shopping within the facilities offered by these lenders on purchasing Medicare supplement policies. But be sure to have to result in the medical advantages plan before ones own policy begins. One of these is it is illegal to provide any individual multiple gap insurance policy because only 1 is necessary which are the same benefits regardless of what company you invest in. Even should your insurance coverage professional refuses (and that is unusual), you can seek the advice of the California State Insurance protection Department.
Source: leftrightmgmt.com

The Importance of Dental Medicare Plans

Not all insurance plans out there can actually cover for dental expenses. If you want to take care of your oral health, you might want to avail a dental Medicare plan. So what is the importance of this plan and why you should avail it? Well, one thing that you must know about this health insurance plan is that it covers preventive care on oral health. Whether you like it or not, everyone is exposed to different risks that might lead to tooth decay, tooth extraction, infection, and the like. Since dental costs can be surprisingly expensive, availing this plan will help to reduce the overall costs. It can cover regular tooth cleaning and check ups. It also provides discounts on dental surgeries and the like. If you wish to learn more about this, spare some time to visit Medicare Texas today. Since it provides the best coverage and benefits, there are no reasons why you must not avail it.
Source: kurde-francais.com

Solutions to Dental Insurance for Seniors on Medicare

Another option is to purchase a Supplemental Medicare Plan.  They are also referred to as Medicare Advantage Plans.  Private insurance companies offer these programs to fill the gaps of Medicare. Not all of these private plans add dental coverage but the majority do and some even include benefits for dentures!
Source: topdentalinsurancecompanies.com

Dental Coverage under Medicare

Should you choose to get your health insurance through Original Medicare, you can still get coverage for your teeth. You can supplement your coverage with a private dental insurance policy. Before purchasing one of these policies you should be sure that you understand the limits of the coverage.
Source: medicare-supplement-quotes.com

How Insurance Firms Set Prices Pertaining To Medicare Supplement Insurance Coverage

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSOpting meant for applications like Medicaid, Particular Low Net income Medicare Beneficiary System, Competent Professional medical related Beneficiary Plan as well as Qualified Personal Structure, all of that can come less than typically the umbrella of Federal packages. If your premium is rated by way of the community you have a home in, everyone in town (in identical geographic area) may need to pay the same exact premium. It really should be noted that that medicare supplements are traded by private insurance businesses. Medicare health coverage coverage is insurance protection policies supplied towards anybody above the best age of 65 aside from individuals who are usually disabled. Health related bills are among the many fastest growing money difficulties faced by just people 65 not to mention over. Grab the time to shop around, store to your insurance coverages meticulously, and know fully any solution that you choose to obtain.
Source: whomovedmytruth.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Does The Negative Impacts In Medicare Additional Insurance Affect Everyone

Medicare Supplement Insurance are almost always pretty related throughout their coverage and final results. Most families get quite uneasy right after they learn they can offer two price increases every year for the rest of the insurance medicare supplemental life. While rendering it much easier decide on which plan fits your preferences best, it does not assist in clarify premium prices. Whosoever suffering from several physical disability normally requires an immediate demand of supplement insurance cover. This specific part guarantees to pay for all those services which can be offered by equally A and T part. The costs ranged from just $516 to a stunning $10, 788. 80! As you move the benefits have been the same for the purpose of like coverage regardless the carrier, most other variables is definitely a bit different : including underwriting which is just about the most important issues. Having said that, it is necessary for Medicare beneficiary to order Medicare supplement to recieve maximum advantages.
Source: chocolatecoveredmarshmallows.com

Paging Dr. Right WPS Health Insurance, a Leading Provider of Individual Health Insurance, Offers Tips for Finding a Primary Care Doctor

Posted by:  :  Category: Medicare

About WPS Health Insurance Founded in 1946, WPS Health Insurance is Wisconsins leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, high-deductible health plans, and short-term health insurance, as well as flexible and affordable group plans and cost-effective benefit plan administration for businesses. In addition, the WPS Medicare division administers Part A and B benefits for millions of seniors in multiple states, and the WPS TRICARE division serves millions more members of the U.S. military and their families. For more information about WPS Health Insurance, visit http://www.wpsic.com.
Source: dailyrosetta.com

Video: Clana-One moment more

WPS Health Insurance Prescription Drug Plans Rated Wisconsin’s Top Part D Plans by the Centers for Medicare & Medicaid …

Founded in 1946, WPS is Wisconsin’s leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, high-deductible health plans, and short-term health insurance, as well as flexible and affordable group plans and cost-effective benefit plan administration for businesses. In addition, the WPS Medicare division administers Part A and B benefits for millions of seniors in multiple states, and the WPS TRICARE division serves millions more members of the U.S. military and their families. In 2010 and 2011, WPS was recognized by the international Ethisphere™ Institute as one of the World’s Most Ethical Companies, and is the only health insurance company to earn this distinction. For more information about WPS Health Insurance, visit http://www.wpsic.com.
Source: insurance4cheap.us

WPS Health Insurance, Wisconsin’s Largest Not

About WPS Health Insurance Founded in 1946, WPS is Wisconsin’s leading not-for-profit health insurer, offering affordable individual health insurance, family health insurance, high-deductible health plans, and short-term health insurance, as well as flexible and affordable group plans and cost-effective benefit plan administration for businesses. In addition, the WPS Medicare division administers Part A and B benefits for millions of seniors in multiple states, and the WPS TRICARE division serves millions more members of the U.S. military and their families. In 2010 and 2011, WPS was recognized by the international Ethisphere™ Institute as one of the World’s Most Ethical Companies, and is the only health insurance company to earn this distinction. For more information about WPS Health Insurance, visit http://www.wpsic.com.
Source: lifeinsurancehealth.net

Medicare acceptable diagnosis code for vitamin d level // bingham rifles

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Source: freeblog.hu

Modifier 33 For Preventive Services

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Source: inhealthcare.com

WPS Health Insurance, Wisconsins Largest Not

Founded in 1946, WPS is Wisconsin?s heading not-for-profit health insurer, charity affordable particular health insurance, family health insurance, high-deductible health plans, and short-term health insurance, as good as stretchable and affordable organisation skeleton and cost-effective advantage devise administration for businesses. In addition, a WPS Medicare multiplication administers Part A and B advantages for millions of seniors in mixed states, and a WPS TRICARE multiplication serves millions some-more members of a U.S. troops and their families. In 2010 and 2011, WPS was famous by a general Ethisphere? Institute as one of a World?s Most Ethical Companies, and is a usually health word association to acquire this distinction. For some-more information about WPS Health Insurance, revisit http://www.wpsic.com.
Source: typepad.com

Tennessee Medicare Complaint

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashIf you need our help please contact us first so we can walk you through any options and try to resolve the problem more quickly, and if you have an issue with a carrier that could be against the laws for the state it is also best to call the Tennessee Department of Insurance.
Source: lifeplanningtn.com

Video: Scott Brown on Ending Medicare: Thank God!

Beware of Scammers During Medicare Enrollment Periods

If a caller who claims to be from Medicare calls you, and offers you a Medicare refund for you to deposit, or offers you free medical supplies, hang up the phone. This person is a con artist who is trying to get you to tell him or her your important numbers. He or she will then use those numbers to steal your identity, your money, or both.
Source: families.com

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

Audit Proof Income: New Fax Service for RailRoad Medicare to Submit Documentation

Posted by:  :  Category: Medicare

The University of North Carolina at Greensboro is accepting proposals for a Construction Manager at Risk firm for construction of its Railroad Pedestrian Underpass project located on campus. The selected Construction Manager at Risk firm will work closely with the architects (Wagner Murray Architects, Charlotte, NC) bringing a construction perspective and expertise to the design process by providing constructability reviews, market-based cost estimates and realistic schedule development. At the appropriate point in the design process, the Construction Manager at Risk will provide a guaranteed maximum price (GMP) for the project, ensuring that the work can be accomplished within the budget. Source: rfpdb.com
Source: medicaresupplementalco.com

Video: GBMC Primary Care – Debbie Jones, CRNP

Paladina Health Announces the Acquisition of ModernMed

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

Audit Proof Income: New Fax Service for RailRoad Medicare to Submit Documentation

Palmetto GBA Railroad Medicare now offers the availability of a fax service for electronic submitters to submit additional documentation with the claim. Certain services require a fax be submitted as acceptable documentation.
Source: blogspot.com

Your Questions About Medicare

Effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and UPIN (or NPI) of the ordering/referring physician on the claim form, if that service or item was the result of an order or referral from a physician. If the ordering physician is also the performing physician, the physician must enter his/her name and assigned UPIN as the ordering physician. If the ordering/referring physician is not assigned a UPIN, the biller may use a surrogate UPIN, e.g., until an application for a UPIN is processed and a UPIN assigned. (See §14.9.2.)
Source: medicareinsuranceaz.com

RAIL ROAD MEDICARE REQUESTS FOR PROVIDER’S PTAN#

Medical Billing Solution, Medical Billing Training Program, About Outsourcing Services, Medical Billing Process and Concept, Tips to Medical Biller, Specialist. Medical Insurance Billing Denial Guidelines. Medical Billing Training Articles and Software Review. Medicare Billing CPT code ,ICD-9 DX Code Update.
Source: whatismedicalinsurancebilling.org

Medicare Enrollment Periods for Part A and B:

If you are age 65 or older and have elected not to receive your Social Security or Railroad Retirement Board benefits yet, you will not receive Medicare Part A (hospital insurance) and Medicare Part B (medical insurance) automatically. You will need to sign up for them by contacting Social Security. If you worked for the railroad you will need to contact the Railroad Retirement Board to sign up.
Source: srbenco.com

10 Ways to Lower Health Care Costs in OH

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

Medicare Supplement Quotes

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSHere is how to get the best Medicare Supplement Quote for your situation. 1. One Plan is the same as Every Other Plan Medicare supplement plans are regulated by each state, but every plan has to offer the same coverage as any other plan. What this means is that normally, price is the biggest consideration when comparing your quote for a Medicare Supplement policy. 2. How Long Have They Been in Business Some companies have come recently into the competitive space of Medigap insurance. Make sure that the company you do business with has a proven track record and will give you good service. 3. Use a Broker That Can Find What You Need A broker works for you, not the insurance companies. Brokers can normally help you get what you need at the lowest price.
Source: moonrealestateutah.com

Video: Medicare Utah

Utah Office of Health Disparities Reduction: Medicare Gives Employers, Consumers Information to Make Better Health Care Choices

The final rule makes a number of important changes from the original proposed rule. The final rule makes this data less costly for qualified entities, gives qualified organizations more flexibility in their use of Medicare data to create performance reports for consumers, and extends the time period for health care providers to confidentially review and appeal performance reports before they become public.  The rule also includes strict privacy and security requirements to protect patients, health care providers, and suppliers as well as stringent penalties for any misuse of Medicare data.
Source: blogspot.com

Utah State Law Library: Medicare Open Enrollment

If you have questions about Medicare coverage or would like to learn more about health insurance programs that may be available to you, contact one of the agencies who participate in the Utah Medicare Outreach Coalition or visit the health insurance programs page at the Utah Division of Aging and Adult Services’ website.
Source: utcourts.gov

Utah Accident Attorneys Need to Consider Medicare Interests During Settlement

Settlements following a Utah accident can sometimes be complicated and involved. This is especially true if Medicare has paid any of the bills in the case. If they have paid bills related to treatment, the attorney must be very careful to make sure that Medicare’s interests are adequately protected. This involves not only reaching resolution on amounts that Medicare has paid in the past but also determining if Medicare is likely to pay for medical expenses in the future. If future payments by Medicare is likely, then the attorney needs to consider setting up a Medicare set aside fund to protect Medicare’s interests moving forward.
Source: ronkramerlaw.com

Is Utah About To Elect Another Senator Who Thinks Medicare Is Unconstitutional?

Affordable Care Act Bush Tax Cuts CBO Congress Conservatives Democrats Economy Election 2012 Fox News George W. Bush GOP Gov Rick Perry Health Insurance Health Reform House Republicans Jobs John Boehner Low Income media Medicare Middle Class Mitt Romney Newt Gingrich Politicians Politics Poor President Obama Progressives Recession Rep Eric Cantor Rep John Boehner Rep Michele Bachmann Rep Paul Ryan Republicans Rick Perry Ronald Reagan Spending Cuts Tax cuts Taxes Tax Revenue Tax Revenues Teaparty Wall Street Wisconsin Workers
Source: mykeystrokes.com

Medicare Unit Coordinator Job in City Salt Lake, Utah US

Several years of experience supervising others to include: coaching, managing schedules, setting performance expectations, promoting collaboration and teamwork.At Silverado, we sincerely appreciate our nurse leaders! Silverado Senior Living offers very competitive pay, a strong bonus structure and comprehensive benefits including medical, dental, vision, life insurance, 401K with employer match as well as generous paid vacation and sick time.
Source: searchjobsinsacramento.com

Pharmacies, Medical equipment Suppliers, CEDAR CITY, UTAH, (UT) USA

,  DM02-COMMODES,  URINALS,  BEDPANS,  DM03-CONTINUOUS PASSIVE MOTION (CPM) DEVICES,  DM05-BLOOD GLUCOSE MONITORS/SUPPLIES (NON-MAIL ORD),  DM06-BLOOD GLUCOSE MONITORS/SUPPLIES (MAIL ORDER),  DM07-GASTRIC SUCTION PUMPS,  DM08-HEAT & COLD APPLICATIONS,  DM09-HOSPITAL BEDS (ELECTRIC),  DM10-HOSPITAL BEDS (MANUAL),  DM12-EXTERNAL INFUSION PUMPS AND/OR SUPPLIES,  DM13-INSULIN INFUSION PUMPS AND/OR SUPPLIES,  DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES,  DM18-PNEUMATIC COMPRESSION DEVICES AND/OR SUPPLIES,  DM19-SPEECH GENERATING DEVICES,  DM20-SUPPORT SURFACES: PRESSURE REDUCING BEDS/MATS/PADS,  DM21-TRACTION EQUIPMENT,  DM22- Transcutaneous Electrical Nerve Stimulation (TENS) AND/OR SUPPLIES,  DM23-ULTRAVIOLET LIGHT DEVICES AND/OR SUPPLIES,  M01-CANES AND/OR CRUTCHES,  M02-PATIENT LIFTS,  M03-POWER OPERATED VEHICLES (SCOOTERS),  M04-SEAT LIFT MECHANISMS,  M05-WALKERS,  M06-WHEELCHAIRS (STANDARD MANUAL & RELATED ACCESSORIES),  M07-WHEELCHAIRS (STANDARD POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS,  OR02-ORTHOSES: PREFABRICATED (NON-CUSTOM FABRICATED),  OR03-ORTHOSES: OFF-THE-SHELF,  PD01-BREAST PROSTHESES AND/OR ACCESSORIES, PD06-OSTOMY SUPPLIES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  R02-HIGH FREQUENCY CHEST WALL OSCILLATION DEVICES/ SUPPLIES,  R03-INVASIVE MECHANICAL VENTILATION,  R04-INTERMITTENT POSITIVE PRESSURE BREATHING IPPB ( Intermittent positive pressure breathing) device ,  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

Holder’s Remarks at Utah MLK Event

Here in Utah, as your population has grown, we’ve seen the need for such measures.   As some of you know, recently, the Census Bureau issued its new determinations of coverage under the language minority provisions of the Voting Rights Act – which now apply to more than 19 million voting-age citizens nationwide.  One of the new jurisdictions that is covered, and now required to provide election materials in a minority language, is Salt Lake County.   Already, local officials, and Justice Department employees, have begun working together on this issue.  And I want to assure you all that we stand ready to assist in any and every way to help make certain that – in this great state – all eligible citizens have the chance, and the information necessary, to participate meaningfully in their governance.
Source: mainjustice.com

The 2012 Republican Primary thread, early edition

I agree on the Primary vs. General for Romney. So long as he can convince to leave the religion card in the deck he could walk away with the General. He is more of a centrist than most of the other potential candidates, and will shock and awe people in a debate (particularly if the economy is still in the crapper). However he will never survive a Primary. I still maintain that he would have given Obama a much tougher contest than the perpetual war drum-banging (now supporting a Libya surge), illegal immigrant-naturalizing (McCain-Kennedy), free speech-limiting (McCain-Feingold), CO2 cap-and-trader (McCain-Lieberman) John McCain*, and that Huckabee stuck around solely to destroy Romney’s chances to come from behind. That said, there is NO way a Republican could have won in 2008. I am still amazed the total difference in votes was ~5 million. *McCain was eerily similar to the way Obama has governed in all ways, with the sole exception being certain portions of the healthcare. Ron Paul is a good guy, says many of the right things, but is honestly far too old and definitely too short to win a general. He would get ~15% in a General election. I like Trump. He is too polarizing to survive the primary, but is definitely a "man of the people". He walks into a company and says "Hi!" to everybody from the board members to the janitors, remembers the secretaries’ names, and seems to be genuinely content to be around people. People forget that he was a big Reagan warrior in ’79, was a major fundraiser at a time when talking up a Republican made one a pariah amongst Manhattan’s Beautiful People. He also brings his talking points down from the typical wonkish language to a language which everyone can easily understand (he generally avoids esoteric language). Just for kicks, I would like to see somebody pair with Herman Cain as a VP. He is a truly outstanding candidate, a complete and total Washington outsider with significant business experience. He would be a perfect foil to Romney. The only thing I can see that would hamper him with Tea Party types is he used to be on the Fed Reserve board.
Source: cougaruteforum.com

Obama prods GOP on payroll tax

House Republicans are drafting legislation to extend an existing pay freeze for federal workers as partial payment for the tax cut and unemployment benefits. Other cost-savers are expected to include a proposal Obama advanced earlier this year to raise pension costs for federal employees, officials said. The bill may also include another presidential recommendation, this one for a surcharge on Medigap policies purchased by future Medicare recipients.
Source: jpartage.com

Medicare Supplemental Plans: The Basics of It and Why You May Need It

Posted by:  :  Category: Medicare

"We hang the petty thieves and appoint the great ones to public office." ~AESOP. by eyewashIn order to receive Medicare Supplemental Plans advantages, you have to be enrolled in Element A or Element B of Medicare currently. For the duration of the open enrollment period, a particular person can obtain a Medigap strategy on a guaranteed situation basis, in which no medical screening is essential. This open enrollment period starts within 6 months of turning 65 or enrolling in Medicare Element B at 65 or older. Outdoors of the open enrollment period, the insurance coverage organization that is issuing the Medigap Insurance could call for that you obtain an attending physician’s statement or a medical screening in order to get a strategy. If you are beneath the age of 65 but are nevertheless getting Medicare, it may well be a little much more difficult to get South Carolina Medicare Supplements. A slight majority of states call for that insurers provide at least one particular variety of Medigap insurance coverage to absolutely everyone, and 25 of them call for that Medigap policies be supplied to all Medicare recipients, although, so it is essential to look into the rules for your state if you fall into this category.
Source: carinsurance-ohio.com

Video: Ohio Medicare Advantage Vs Ohio Medicare Supplement Plans

Ohio seeks Medicaid waivers

“What we are trying to find is where things are better for the people receiving care and better for the taxpayers,” said Greg Moody, director of Ohio’s Office of Health Transformation, notes the Dispatch. “That usually means a simpler, more-straightforward, and more-coordinated approach, but it’s always a challenge to providers because they’re used to a certain way of doing it.”
Source: fiercehealthfinance.com

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

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

In Ohio, Medicaid Patients Have Worst Survival Rates

“Medicaid patients had worse survival rates than the rest of the study sample, which included both those with private insurance and with no coverage at all. The disparities persisted even after the researchers controlled for where patients live, how much education they had received and the income level of their neighborhoods… What this study doesn’t delve into is why Medicaid enrollees have worse outcomes than the general population, whether it has to do with access to certain physicians, with wait times to see a specialist, or some issue completely removed from the doctor’s office.”
Source: reformmedicaid.org

Medicaid News: Wis. To Lift Cap On Long

Houston Chronicle: Planned Medicaid Cuts To Impact Poor, Elderly Patients It may soon become harder for the neediest Texans to receive medical treatment. That’s because statewide regulations scheduled to go into effect Sunday would limit reimbursements paid to medical providers for patients covered by both Medicare and Medicaid. The change would impact approximately 333,000 patients, mostly elderly, low-income residents, but also younger patients who are disabled. Slashing the Medicaid co-pay was part of the plan approved by state lawmakers earlier this year to help balance the state’s budget (Hundley, 12/30).
Source: kaiserhealthnews.org

Update: Remit: CPIDs 5533 Kentucky Medicare and 3507 Ohio Medicare: ERA Delay

Update: The payer has resolved the issue and processed all the affected claim files. Original Notice Sent October 26, 2011: Institutional Electronic Remittance Advice (ERA) for CPID 5533 Kentucky Medicare and 3507 Ohio Medicare for check dates of October 20, 2011 to present are delayed due to unavailability of the files at the payer. We are working with the payer to receive all outstanding ERA files as quickly as possible. Action Required : Please be aware of a delay in the delivery of ERA files for the check dates of October 20, 2011 to present. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Ohio Medicare Advantage Plans and Quotes

However, there are consumers who cannot qualify for supplemental insurance. They might be on Medicare disability and under age 65. Most insurance companies will not underwrite a disabled person under age 65 for a Medicare Supplement*. A consumer caught in this situation will have insurance gaps not covered by Medicare. An Advantage plan might be the only option available to help fill some of the uncovered gaps
Source: ohioinsureplan.com

Ohio Nursing Home Advocates Protest Medicaid Cuts : The Guardian Blog

A survey of Ohio nursing homes found that 2,800 jobs had been cut between July 1 and September 1, and an additional 20,000 jobs may be lost due to the Medicare cuts. These deep cuts will result in nursing homes that understaffed and also possibly staffed with improperly trained workers. Nursing homes that are understaffed or do not have properly trained workers are much more likely to have incidences of abuse and neglect and to lead to injuries and wrongful death.
Source: theguardianblog.com

New Ohio Medicare Advantage plan skips the agent

Dee Yancey III, State Mutual’s president and CEO, heralded the plan one of the lowest cost MA plans in the country. And because the company allows Medicare-eligible seniors apply for policies online, the agent is rendered obsolete. “They can go online to fill out a confidential application … secure in the knowledge that no one is going to try to sell them anything,” he said.
Source: lifehealthpro.com

Annual Enrollment Starts October 15 and Ends December 7 for Medicare Part C & Part D Plans  

Posted by:  :  Category: Medicare

OBAMACARE WATCH: MORE DARKNESS THAN LIGHT AND OF COURSE TAXES AND PENALTYS by SS&SSNote that there are additional enrollment periods available when someone first becomes eligible for a Medicare Advantage plan and a Part D plan.  These periods are known as the Initial Coverage Election Period (ICEP) for MA plans (see, e.g., §30.2, Chapter 2 of the Medicare Managed Care Manual), and the Initial Enrollment Period (IEP) for Part D (see, e.g., §30.1, Chapter 3 of the Medicare Prescription Drug Manual).  There are also separate enrollment periods relating to enrolling in Part B of Medicare, including the Part B Initial Enrollment Period (IEP), General Enrollment Period (GEP) and Special Enrollment Period (SEP) (see, generally, Chapter 2 of the Medicare General Information, Eligibility and Entitlement Manual (CMS Pub 100-01) at:
Source: medicareadvocacy.org

Video: SHIIP Medicare Enrollment Basics.flv

Medicare Enrollment Deadline Extended

Kaiser Health News: Medicare Extends Enrollment Deadline For Some Reporting for Kaiser Health News, Susan Jaffe writes: “Federal officials are extending the Dec. 7 deadline for two days for some people enrolling in a Medicare prescription drug or private health plan because of the crush of last-minute sign-ups. But a spokesman for the Centers for Medicare and Medicaid said the ‘increased flexibility’ is limited only to seniors who contact any of several sources of assistance on or before the close of business Wednesday: counselors with the government-funded State Health Insurance Information Program (SHIP), Medicare’s toll-free information line, 1-800-633-4227; and other Medicare-partner organizations such as the Medicare Rights Center, local agencies on aging, and the National Council on Aging. They can leave messages if necessary requesting help. Then, starting on Thursday, those beneficiaries will be called back and will receive assistance. All ‘call-back enrollments’ must be completed before 12:01 a.m. Sunday, the spokesman said” (Jaffe, 12/7).
Source: kaiserhealthnews.org

Medicare Enrollment: So What Is Medicare Part D Anyway?

Medicare Part D has a standard Medicare Part D drug benefit, but in reality plans and premiums vary widely. Health insurers must offer the standard benefit set out by law or a benefit package that is at least as comprehensive as the standard package. Although there is no standard drug formulary, there are minimal requirements that major classes of drugs necessary to treat common diseases are covered. Plans vary greatly as to the specific drugs covered and the co-pays/coinsurance for individual drugs. For more information on Medicare Part D benefits and the Donut Hole, see our article “Medicare Part D-The Donut Hole and Me”.
Source: myhealthcafe.com

New Medicare enrollment deadline nears

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Source: azcentral.com

hCentive Introduces Webinsure Medicare

The hCentive WebInsure Consumer, WebInsure Medicare and WebInsure Group platforms help health insurers cost effectively acquire and manage individual, Medicare and small business customers. The hCentive WebInsure Private Exchange platform allows health plans to offer defined contribution plan marketplace to small business customers. WebInsure State platform helps states create a health benefits exchange to comply with health insurance exchange requirements of the Patient Protection and Affordable Care Act of 2010. The WebInsure Exchange Manager provides a complete connectivity solution for health plans to connect to State Exchanges.
Source: virtual-strategy.com

Annual Enrollment Starts October 15 and Ends December 7 for …

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

Medicare Update for the New Year

In general, the savings and benefits related to use of EFT for business and consumer payments are well established. The most common savings are in paper, printing, and postage costs, as well as savings in staff time to manually process and deposit paper checks. Yet adoption and use of EFT by the health care industry has been low, resulting in administrative savings that go unrealized. The obstacles to greater use of EFT by the health care industry can be lessened by standardization of the EFT transaction. Beyond the material and administrative time savings for health care providers and health plans, the time and resources that physician practices and hospitals spend on billing and related tasks will be better spent on delivering health care to patients.
Source: managemypractice.com

Medicare Enrollment – Supplementation Enrollment Period

In most situations people start to think about Medicare enrollment at the end of the year. This is a really good time to think about Medigap coverage and that is when you have to make changes. We are faced with a plan coverage that will always be the same but rates are going to change annually. Different companies will change the rates on a fixed date of the year while others will do so when the policy anniversary date is due. No matter when it happens, when the rate changes there is a really strong chance that you can choose to another plan that is equal in coverage but is cheaper and offered by another company. This is done in order to save money.
Source: medicareenrollmentsite.com

Wednesday is the Medicare enrollment deadline for Idaho seniors

You should also know that The Idaho Statesman does not screen comments before they are posted. You are more likely to see inappropriate comments before our staff does, so we ask that you click the “report abuse” button to submit those comments for review. You also may notify us via email at onlinenews@idahostatesman.com Note the headline on which the comment is made and tell us the profile name of the user who made the comment. Remember, you may find some material objectionable that we won’t and vice versa.
Source: idahostatesman.com

Medicare Supplemental Plans: The Basics of It and Why You May Need It

In order to receive Medicare Supplemental Plans advantages, you have to be enrolled in Element A or Element B of Medicare currently. For the duration of the open enrollment period, a particular person can obtain a Medigap strategy on a guaranteed situation basis, in which no medical screening is essential. This open enrollment period starts within 6 months of turning 65 or enrolling in Medicare Element B at 65 or older. Outdoors of the open enrollment period, the insurance coverage organization that is issuing the Medigap Insurance could call for that you obtain an attending physician’s statement or a medical screening in order to get a strategy. If you are beneath the age of 65 but are nevertheless getting Medicare, it may well be a little much more difficult to get South Carolina Medicare Supplements. A slight majority of states call for that insurers provide at least one particular variety of Medigap insurance coverage to absolutely everyone, and 25 of them call for that Medigap policies be supplied to all Medicare recipients, although, so it is essential to look into the rules for your state if you fall into this category.
Source: carinsurance-ohio.com

Medicare Disenrollment Period For 2012

[…] If you are enrolled into a Medicare Advantage Plan, you are allowed to drop your Medicare Advantage Plan and go back to original Medicare.  If you do this, you will also want to enroll into a Medicare Part D Prescription drug plan.  Original Medicare is the Part A and Part B that is on your paper Medicare card that you received when you first joined Medicare.  It does not include drug coverage which is why you would want to enroll into a Part D drug plan.  You have until February 14th to enroll into a Part D drug plan.  The coverage starts the first day of the month after you enroll.  For example, if you enroll into the drug plan on January 20th, your coverage would start on February 1st.  If you wait until February 14th to enroll, then your coverage starts on March 1st.Source: medicare-plans.net […]
Source: medicare-plans.net

Medicare enrollment changes keep seniors from switching to Medicare Advantage after Dec. 7

Senior Care Plus, a product of Hometown Health Plan, Inc. is contracted with the federal government to offer a Medicare Advantage Plan with prescription drug coverage, available to anyone with both Medicare Parts A and B. Hometown Health is pleased to have been awarded another contract with Medicare for 2012 and will continue to offer its plans for a 16th year. Members must be residents of Carson City, Churchill, Douglas, Lyon, Storey and Washoe counties and continue to pay their Medicare Part B premiums.
Source: thisisreno.com