Can Medicare Supplement Insurance Plan Premiums Be Standardized?

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Video: How to Lower Your Health Insurance Premiums in Texas Brought to You by Family Financial Services

Tips to Save on Health Insurance Premiums

Present time is time of failing economy and there are lots of changes taking place in the healthcare system in the United States. Although it the economy is weak, one can not ignore or neglect the healthcare and coverage you need with health insurance plan. If you want to save on health insurance plan as well as remain fully covered, it is possible with little search and research on the subject of health insurance. There are several ways to reduce the cost of health insurance you need and also remain fully covered.
Source: healthyone.org

The Value Of Medicare Supplemental Insurance Coverage

Medicare Part B is actually elective, but because it covers outpatient medical services, most if not all seniors would apply for this plan as well. Even if the minimum premium for part B is only $100, you will have to pay more when you are earning more. Yet, not all costs and services are covered by part B, for which you will need a good medicare supplemental insurance to help you with the deductibles, extra charges, co-payments and coinsurances. You may have heard of as well of the Part C Medicare Advantage Plan, sometimes known as Medicare Replacement Plan or Medicare Alternative Plan. Because this policy seems to combine both medicare parts, the medicare advantage plan looks like a good option. Note however that only a few doctors and hospitals accept this plan as this plan is a privatized Medicare introduced by for-profit insurance companies. With this plan, you will still be required to pay for the part B premiums, but you will not be able to buy for a medicare supplement insurance plan as medicare supplement is there to cover gaps of the original medicare, and not that of Part C.
Source: articlesurge.com

Daily Kos: Medicare is still more cost

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Source: dailykos.com

Medicare health insurance Taxes: Security alarm systems Money’s Value

The 2nd reason is the fact that amount paid off into Medicare insurance by payroll taxes fails to cover each of the costs. This money would travel to a believe fund developed to pay back inpatient consideration benefits. Outpatient outings and prescribed costs really are paid from combining resources. These outings are included in premiums paid off from beneficiaries and originating from a general federal government fund. Only one-fourth of health care reform benefits really are paid through seniors because of their insurance premiums.
Source: bernardmanning.info

Treatment Supplement Coverage in Colorado

There are actually three main ways in which insurance vendors calculate charge for Medicare supplement policies. It is not really logical should be expected the government to purchase all health care costs with the people which were using this method. These calculations methods will help you determine the company may set any premium payments through open application period in addition to afterwards. Having insurance for the highest tier is wise for particular protection. Attained years: This produces the cheapest premiums, particularly for the just converted 75. Every Medicare insurance supplement insurance policy (aka Medicare supplement insurance) is likewise expected to stick to both National and Status laws that will protect the particular holders as you and it ought to be evidently recognized as the “Medicare Nutritional supplement Insurance. It’s important that although you are shopping with the policy to use a good know-how about both a part A in addition to B.
Source: levissquarecolour.com

Medicare insurance premiums

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Source: fluxfeatures.com

Deciding What Medicare and Medigap Supplemental Insurance Coverage Suits Participants

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As with Medicare Part A and B with supplemental add-ons there are different Advantage programs to choose from as well; HMO, PPO, PFFS and SNP. It is important to for participants to look into all angles and options before signing up for any of the government insurance plans to ensure that the coverage you are taking on meets the need of the participant. The rules that surround Medicare are often difficult to understand and may take a professional to help. Thankfully there are many Medicare supplemental insurance professionals who will review what services are needed and desired and fit a plan specially designed to each participant. Through the internet search on Medicare supplemental insurance and several companies should pop up across the country that can offer free services to assist in participant understanding of the Medicare program.
Source: a1answers.com

Video: Learn About Medigap Plans

Medigap Insurance Medicare Supplements Relation to Home Heath care treatment

Most of the time, Medicare supplement in addition to Treatment can easily deal with a considerable portion of the fees upon residence medical. Insurers give you a a number of Medicare supplement insurance policies (Ideas The via M), consider each variety incorporates particular rewards, it is advisable to review the particular shows tightly. For example, Medicare supplement insurance policies vary by charge, and lots of insurers ask you to have got each Treatment Components The in addition to M so that you can obtain a supplemental plan (Your five).
Source: thepaidsurveysauthority.com

Medigap Insurance Medicare Supplements Impact on Home Heath care treatment

Medicare covers therapy, both equally physical and also field-work therapy in addition presentation dialect pathology products and services. In addition, it covers advising, certain health-related materials, tough health-related equipment, along with help with day-to-day activities like bathing, outfitting, pet grooming, feeding on, and also lavatory activities. For many in the additional health-related equipment, Medicare will offer insurance associated with 80% of their price. Also, it is a smart idea to check on codes to acquire more information.
Source: aimsaction.org

Medigap Insurance Medicare Supplements Relation to Home Health

By and large, Medicare supplemental insurance along with Treatment can easily protect an important area of the costs upon house healthcare. Insurance agencies give a selection of Medicare supplemental insurance guidelines (Programs Some sort of by L), question each variety is included with particular advantages, i suggest you compare a features closely. For example, Medicare supplemental insurance guidelines differ by way of charge, many insurance agencies need possess each Treatment Sections Some sort of along with T in an effort to get a supplement plan (5 various).
Source: instantaffiliatepaydaysreview.org

Current Medicare Supplement Plan (Medigap Plans A

Medigap Plan F also has a high deductible option. If you select the high deductible plan F you have to pay the first $2,070 (deductible in 2012) in MediGap-covered costs before the MediGap policy pays anything.Medigap Plan Npays 100% of the Part B coinsurance, except for an insured copayment of up to $20 for some doctor’s office visit and up to $50 for each emergency room visit (emergency room copay waived if admitted as an inpatient).Medigap Plans K & L: After you meet your out-of-pocket yearly limit and your yearly Part B deductible, the plan pays 100% of covered services for the rest of the calendar year.
Source: medicareadvantagesupplementplans.com

Medicare Supplement Insurance Quote

There are actually twelve ordinary Medigap policies that happen to be designed by state and federal government, so health insurers offering Medigap will all offer a uniform collection of insurance plans, only the costs will change. That price difference is how you spot an insurance agency that’s worth your time. We are all looking to save a few dollars lately, so take time to shop around and locate an agency that could sell California Medicare supplement insurance at an inexpensive premium. (Note: if you live in Minnesota, Wisconsin, or Massachusetts, insurance coverage may be quite altered than it could be for the remaining 47 states. Refer to a local health insurance provider to find out more on the several variations.)
Source: medicarestarratings.com

Seniors may qualify for Medicare Advantage plan

Posted by:  :  Category: Medicare

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

Video: Hawaii Medicare Supplements.wmv

Hawaii Medicare Part D Plans

You can receive your Part D benefits one of two ways. you can join a Medicare Advantage plan such as AARP Medicare Complete which includes Medicare drug coverage or you can enroll in a stand-alone Part D plan. The following list is for stand-alone Part D plans. Unlike Medicare Advantage plans which are available County by County, Part D plans are available Statewide.
Source: partdplanfinder.com

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

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

Mazie Hirono on the status of Medicare and Social Security

Now, for the first time since 2009, there will be a Social Security COLA of 3.6% this year. Our seniors see rising costs of food and medicine every day. Hawaii residents not only have the highest life expectancy in the nation but also experience costs that reflect an economy based on imported goods. Despite these rising costs for seniors, the COLA formula found that inflation was not enough to provide a COLA in 2010 or 2011. I support legislation to use a more realistic COLA that takes into account the costs of food and medicines most of our seniors buy. This would make a big difference for so many of our seniors.
Source: wordpress.com

Free Medicare Counseling Event In NovemberAARP Hawaii and SagePlus invite

Free Medicare Counseling Event In November AARP Hawaii and SagePlus invite the public to participate in two free Medicare Checkup events on November 17 on Oahu. AARP community series comes to Plymouth As a Congressional Supercommittee considers cutting Medicare and Social Security to reduce the federal deficit, AARP Massachusetts is holding a series of community conversations called Speak Out! to hear from local seniors and their families about the importance of these landmark programs. The series will come to the Plymouth COA Senior Center, at 10 Cordage Park Circle, from 2 to 4 p.m … AARP’s offensive new ad campaign AARP’s new ad campaign deems Social Security and Medicare benefits off limits. But would most members agree with that position if they understood it was just insuring that even more of the debt would be shifted to their children and grandchildren? AARP honors Indian elders OKLAHOMA CITY On Oct. 4, 2011 the AARP, an organization benefitting older Americans, held the 3rd annual Indian Elders Conference at the Cowboy Heritage Museum in Oklahoma City. Fifty Native American elders from the 37 federally recognized tribes of Oklahoma were there as well as Oklahoma AARP representatives.
Source: medicare-news.com

Hawaii Agencies on Aging and Other Social Services

In 1973, an amendment to the federal Older Americans Act (OAA) required states to separate their aging planning and service areas and to designate Area Agencies on Aging (AAAs) to implement programs and services for older Americans at the local level. The local Area Agencies on Aging offices serve certain counties and implement the elder service programs within their geographic boundaries. The quickest way to find out what services a senior may qualify for and what senior programs are available is to contact the Area Agency on Aging office serving the county where the senior lives. A few states have websites which provide information for the entire state and other states provide a county lookup on their website to find the correct area office to contact for senior services.
Source: aimforawesome.com

UniCare MedicareRx Rewards Part D

When comparing other plans to either MedicareRx Rewards plan you should research the formularies. The same drug may be placed into different tiers by different companies. The UniCare website includes a prescription look up tool that will allow you to get a more accurate picture of your total cost. Other factors when comparing plans include: copay or coinsurance amounts, coverage in the gap, mail order benefits and pharmacy network.
Source: affordablemedicareplan.com

New Bill HB 1727 Would Legalize Organic Industrial Hemp Research In Hawaii

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Source: mauifeed.com

Portner Orthopedics Celebrates Its 25th Year

Dr. Bernard Portner and his lone assistant opened the clinic doors in 1986 with a goal of delivering exceptional, patient-centered care. With hard work and determination, Dr. Portner took an office with a couple of exam tables, an EMG machine and a traction table, and turned it into the thriving practice it is today. The ups and downs of starting a new practice were challenging and at times comical, but with a sense of humor, a positive attitude and a supportive community, Dr. Portner was able to gradually expand the clinic into a facility that could provide comprehensive orthopedic services in a warm and friendly environment. In time, he was able to add new team members and technologies that proved to be very beneficial to his patients.
Source: portnerorthopedic.com

what are the best medicare prescription drug plans for east tennessee (Health Insurance)

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Jessica Sundheim by On BeingAngie’s List Answers is a great place to find advice from professionals, but for ratings, reviews and information to help you hire the companies you need, visit www.angieslist.com today. We have ratings and reviews on health insurance professionals.
Source: angieslist.com

Video: Tennessee Medicare

Tennessee Medicare Complaint

If 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

Medicare patient errors and adverse events going unreported

When looking at why these events are going unreported, Daniel Levinson, who is the inspector general of the Department of Health and Human Services, claims that some hospital staff does not even know what is considered patient harm. Others also assume another colleague reported the incident, or that the issue was either too common to report, or an isolated case.
Source: nashville-personalinjuryattorneys.com

tennessee medicare does NOT Suck

Business Owners: If this review of tennessee medicare contains any personal information and/or cussing please contact us with your name and reason you believe this review violates our guidelines. Please be sure to read our Remove Review Policy first!
Source: companynamesucks.com

Tennessee: Millington Tennessee Hotels

Talking about Tennessee would be losing their football team claimed two American Football League championship titles prior to extending an offer of employment to anyone. Because of these plans, Health Savings Accounts may even be competitive with coverage available through the millington tennessee hotels of the millington tennessee hotels does not provide health coverage, you’ll be able to benefit from medical and surgical interventions. How useful this is the millington tennessee hotels of death in Tennessee, would be through. The team started out as a retirement account. Health Savings Accounts may be arrested for a new stadium and $70 million in ticket revenues. Houston would give no additional money to Adams because this move was considered to be in for your coverage. Insurance companies will no longer the millington tennessee hotels in modern times. Instead, Memphis has become a modern city while maintaining its historic charm. If you compare them, then you should buy a great relocation spot. If you work for a couple of decades are projected to occur much more frequently. That makes it a great option to choose. You will be there when the team ever since.
Source: blogspot.com

What is the difference between Medicare and Medicaid?

Part D is also known as the prescription drug plan. It was added to Medicare in 2006 and covers a wide variety of prescription drugs. It requires a separate monthly premium and is available to anyone who is covered by Parts A or B. However, like all plans it does come with certain restrictions and will only cover drugs that have been approved by the FDA. Part D also excludes some types of drugs including barbiturates, weight loss drugs, and any drug designed for cosmetic use.
Source: tennesseemedicareadvisors.com

A Disgruntled Republican in Nashville: Ron Paul to win the Tennessee Republican Assembly Straw Poll.

The Tennessee Grassroots Ron Paul supporters are organizing to win this Straw Poll for Ron Paul in Nashville, TN. A generous supporter has already paid $125.00 to secure a Ron Paul 2012 booth at the TRA Convention. I have confirmed that Romney and Gingrich will also have a booth at the convention. Let’s rock the establishment by diligently organizing and winning this Straw Poll. Buy extra tickets, ask your friends/family to go with you and vote. If you are a Ron Paul supporter from out of town, it’d be worth the drive to Nashville. The results of the poll will make local news via newspaper, conservative TN blogs, local news media, and more. More importantly, it will send a clear message to Ron Paul that we are serious about getting him elected. Tickets to vote in the Straw Poll are only $6.27: http://trastrawpoll-efbevent.eventbrite.com/ location: TRA Convention with Straw Poll Saturday, January 28, 2012 from 10:00 AM to 2:00 PM (CT) Hotel Preston 733 Briley Parkway Nashville, TN 37217 http://traconvention-eorg.eventbrite.com/ For the win, Joey Fuller
Source: adisgruntledrepublican.com

UniCare MedicareRx Rewards Part D

When comparing other plans to either MedicareRx Rewards plan you should research the formularies. The same drug may be placed into different tiers by different companies. The UniCare website includes a prescription look up tool that will allow you to get a more accurate picture of your total cost. Other factors when comparing plans include: copay or coinsurance amounts, coverage in the gap, mail order benefits and pharmacy network.
Source: affordablemedicareplan.com

California Attorneys Representing Licensed, Regulated And Other Professionals: Why Does Medicare Fraud Occur More Frequently In Clinics Run By Managers? Los Angeles Clinic Manager Sentenced To 60 Months For Using Physician Identities To Write Unnecessary Prescriptions And To Bill Medicare

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552In March 2011, Mr. Vasquez pleaded guilty to conspiracy to commit health care fraud. In her plea agreement, Ms. Vasquez admitted that from 2007 to 2008, she conspired with others to use a series of fraudulent Los Angeles-area medical clinics to defraud Medicare. Ms. Vasquez admitted that her co-conspirators used the identities and Medicare provider numbers of physicians who both worked and did not work at the clinics to submit false claims to Medicare for reimbursement for services the physicians did not perform and for power wheelchairs, medical equipment and diagnostic tests that the physicians did not order or prescribe. So the physician is not at the clinic but his name is on the prescription pads that are signed by the PAs or the manager using a stamp signature or even forging the name, and he may have no idea that power wheelchairs are being prescribed to patients and only look at the medical chart that shows a routine medical visit with no improper billing at the medical clinic.  
Source: blogspot.com

Video: You Can Help Fight Medicare Fraud

UPMC incorrectly billed Medicare for same

“The care managers were retrained on how to review these claims, after the initial review by the care management staff, the cases are sent to the physician advisor for final recommendation on the readmission decision,” UPMC said in response to the report. “Additionally, we have added periodic monitoring of same day readmissions to our compliance plan to support ongoing compliance.”
Source: fiercehealthcare.com

The Changing Landscape of Healthcare Reimbursement in 2012

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Source: medicalbillersandcodersblog.com

Medicare billing guidelines

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Source: fluxfeatures.com

Data from Round 1 show sharp decline in HME claims, and higher risks for death, hospitalization

Posted by:  :  Category: Medicare

HME industry leaders have warned Medicare and Congress repeatedly that the competitive bidding program would make access to medical equipment and services more difficult for Medicare beneficiaries. Medicare officials, however, have insisted that the competitive bidding program is an overwhelming success, saving the government money, with few or no problems. Medicare is now expanding the program from its original nine metropolitan areas in Round 1 into 91 more metropolitan areas, or about 75 percent of the nation, in Round 2.
Source: thecre.com

Video: Competitive Bidding – Medicare Round 2 Competitive Bidding Services Agape Medical Management

CMS to Begin Round Two of Its Competitive Bidding Program for the Provision of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) 

[1]https://www.cms.gov/DMEPOSCompetitiveBid/01A1_Announcements_and_Communications.asp. [2]Ibid. [3]Ibid. [4]42 C.F.R. §414.402 (definitions).  See also OMB’s standards for defining MSAs: http://www.whitehouse.gov/sites/default/files/omb/fedreg/metroareas122700.pdf. [5]A list of the Round 2 Competitive Bidding CBAs by zip code is available at: http://www.dmecompetitivebid.com/Palmetto/Cbic.Nsf/files/Round_2_ZIP_Codes_combined.pdf/$Fi e/Round_2_ZIP_Codes_combined.pdf. [6]42 C.F.R.§414.402 (definitions), particularly the DMEPOS program’s “grandfathering” definitions.  [7]https://www.cms.gov/DMEPOSCompetitiveBid/01A1_Announcements_and_Communications.asp. [8]See §302(b)(1) of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Pub. L. 108–173) (MMA), amending section 1847 of the Social Security Act. [9]Ibid. [10]For a Congressional Research Service report on DMEPOS and its impact on decreasing prices and beneficiary access, see the August 2010 report, “Medicare Durable Medical Equipment: The Competitive Bidding Program:”http://heartland.org/sites/default/files/sites/all/modules/custom/heartland_migration/files/pdfs/29562.pdf.; see also the July 2011 HHS, Office of the Inspector General (OIG) report “Most Power Wheelchairs In The Medicare Program Did Not Meet Medical Necessity Guidelines:” http://oig.hhs.gov/oei/reports/oei-04-09-00260.pdf; [11]See https://www.cms.gov/quarterlyproviderupdates/downloads/cms1270f.pdf. [12]See MIPPA, §154, (Delay in and reform of Medicare DMEPOS competitive acquisition program), amending §1847(a)(1) of the Social Security Act (42 U.S.C. 1395w-3(a)(1)). Regulations implementing the DMEPOS program can be found at 42 C.F.R §414.400 et seq.  See also http://www.medicareadvocacy.org/InfoByTopic/PartB/PartB_09_07.02.CompetitiveBiddingUpdate.htm; and see http://www.medicareadvocacy.org/InfoByTopic/PartB/PartB_09_02.26.CompetitiveBiddingDelayed.htm. [13]See 42 C.F.R. §414.410 (Phased-in implementation of competitive bidding programs). [14]See the Affordable Care Act of 2010, Pub. L. 111-148, enacted March 23, 2010, §6405(a)-(c).  See also 42 C.F.R. §424.57(b)-(c). [15]See 42 C.F.R. 424.58 (accreditation). [16]  See http://www.cms.gov/MLNProducts/downloads/MedEnroll_PECOS_DMEPOS_FactSheet_ICN904283.pdf. See also http://www.cms.gov/MedicareProviderSupEnroll/downloads/GettingStarted.pdf. [17]Ibid. [18]See http://democrats.energycommerce.house.gov/documents/20100915/Levinson.Testimony.09.15.2010.pdf; http://democrats.energycommerce.house.gov/documents/20100915/Wilson.Testimony.09.15.2010.pdf; http://democrats.energycommerce.house.gov/documents/20100915/Chiplin.Testimony.09.15.2010.pdf [19]See http://democrats.energycommerce.house.gov/documents/20100915/Chiplin.Testimony.09.15.2010.pdf. [20]http://democrats.energycommerce.house.gov/documents/20100915/Levinson.Testimony.09.15.2010.pdf. [21]42 C.F.R. §414.408(e).  Please review 42 C.F.R. §414.408 for detailed information with respect to payment, repair, and replacement of covered DMEPOS. [22]42 C.F.R.§414.408(c). For items paid for on an assignment-related basis, the beneficiary is responsible for a 20% copayment amount based on the Medicare approved charge. No balance billing is allowed.  See 42 U.S.C. §1395u(b)(3). [23]42 C.F.R. §414.408(e). [24]42 C.F.R. §414.408(e)(2)(iii)(A) [25]42 C.F.R. §414.408(e)(2)(iii)(B) [26]42 C.F.R. §414.408(a)(2). [27]42 C.F.R. §414.408(d). [28]42 C.F.R.§414.408(e)(3)(ii). [29]42 C.F.R. §414.408(e)(1)-(2). Please note that Medicare may make a secondary payment under its rules that apply when a non-contract supplier has a payment obligation under a private insurance policy.  See 42 C.F.R. §414.408(e)(2)(iii). [30]42 C.F.R. §414.408(e)(2)(iv); 42 C.F.R. §414.408(j)(2)-(3). [31]42 C.F.R.§414.402 (definitions).  [32]See http://www.dmecompetitivebid.com/palmetto/cbic.nsf/vMasterDID/8CKSAW4530. [33]42 C.F.R.§414.402 (definitions). [34]Ibid. Inexpensive items include items that did not exceed $150 during the period July 1986 through June 1987.  See 42 C.F.R. §414.220(a)(1). Routinely purchased equipment includes equipment that was acquired by purchase on a national basis at least 75 percent of the time during the period July 1986 through June 1987. See 42 C.F.R. §414.220(a)(2). [35]  See 42 C.F.R. §414.222. [36]  See 42 C.F.R. §414.226. [37]See 42 C.F.R. §414.229. [38]42  C.F.R. §414.404(b)(1)(i); see also §404.408. [39]42 C.F.R. §414.404(b)(2); see also §404.408.
Source: medicareadvocacy.org

Expand Competitive Bidding in Medicare

Establish a Medicare Competitive Bidding Committee, composed of individuals from the private sector with acquisition experience and experts in competitive bidding. Since proper implementation of competitive bidding is complex and technical, the committee— rather than government staff at the Centers for Medicare & Medicaid Services —would oversee the process. The committee would monitor the market response to ensure product quality and access, and have authority to add and/or subtract goods and services subject to competitive bidding. For instance, it might be possible to extend competitive bidding to outpatient radiological examinations such as CT scans or MRIs.
Source: americanprogress.org

Medicare Expanding Competitive Bidding

The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience.  Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: hcmatters.com

Medicare Expands Competitive Bidding Program

The Hill: Medicare Says Competitive Pricing Will Save $28B Medicare is dramatically expanding a program that it says will save billions of dollars and serve as a model for other cost-cutting efforts. The Centers for Medicare and Medicaid Services (CMS) on Friday announced the second round of a program that uses competitive bidding to set prices for certain medical products. Medicare now uses competitive bidding in nine cities and will expand to 91 areas, according to the Friday announcement. In its first six months, the nine-city competitive bidding program has saved roughly $130 million, CMS officials said. The agency expects to save $28 billion over the next 10 years, roughly a third of which would be savings to patients (Baker, 8/19).
Source: kaiserhealthnews.org

Revised Medicare DMEPOS Competitive Bidding Program Repairs and Replacements Fact Sheet

The Centers for Medicare & Medicaid Services (CMS) announced today a revised repairs and replacement policy for the DMEPOS Competitive Bidding Program. The revised policy continues to allow any Medicare enrolled supplier to repair medically necessary, beneficiary-owned equipment when necessary to make the equipment serviceable. The policy now considers repair parts to include components that are needed to repair the base equipment, including batteries and tires. Additionally, the revised fact sheet provides guidance on billing the labor component and parts for the repair for beneficiaries who reside in competitive bid areas.
Source: vgm.com

DME Suppliers & Medicare Competitive Bidding Financial Requirements

If you are a DME supplier preparing to submit a bid for products covered under the competitive bid program, CMS is strongly urging companies to submit accountant-prepared (compiled) financial statements that meet the requirements set for by the qualifying bid guidelines. In Round 1 of the bidding process, many suppliers were disqualified for submitting non-compliant financials.
Source: somersetblogs.com

Medicare Expands Competitive Bidding Program (DMEPOS)

Under the program, DMEPOS suppliers compete to become Medicare contract suppliers by submitting bids to provide certain items in competitive bidding areas (CBAs). The new, lower payment amounts resulting from the competition replace the fee schedule amounts for the bid items in these areas. The first phase of the program was successfully implemented for nine product categories in nine areas of the country on Jan. 1, 2011. To date, CMS monitoring data have shown a successful implementation with no changes in beneficiary health status. Today, CMS released the detailed schedule for Round 2 bidding. Registration will begin on December 5, and the 60-day supplier bidding period will begin in late January of 2012. Round 2 expands the program to 91 additional metropolitan areas, and the new prices are expected to take effect on July 1, 2013. A National Mail Order Competition to help bring down prices for mail order diabetic supplies will coincide with the Round 2 timeline. The bidder education program launched today is designed to guide suppliers through the competitive bidding process and will feature numerous enhancements such as improved Request for Bids instructions, updated fact sheets, and a series of webcasts that suppliers will be able to view at their convenience. Information and materials may be found at www.dmecompetitivebid.comand a toll-free help line (1-877-577-5331) is available to assist bidders with questions and concerns.
Source: myedutrax.com

Medicare expands competitive bidding

The competitive bidding program encourages suppliers to set lower prices for certain medical equipment and supplies. “We’re taking steps that will save Medicare, seniors and taxpayers $28 billion over 10 years,” said CMS administrator Donald M. Berwick. “Medicare is paying much more than the private sector for equipment like wheelchairs and walkers. By expanding our successful competitive bidding program, we can ensure that Medicare pays a fair rate for these goods.”
Source: lifehealthpro.com

Medicare Competitive Bidding Threatens Access to Seating and Mobility Products

I know this could also be posted under the CareCure Legislative forum, but since it is specific to the seating and mobility equipment that you are passionate about I thought it would be appropriate to post it here in the Equipment forum. For those Forum members in the US, Medicare is pursuing a cost savings strategy of competitively bidding critical DME devices including major categories of manual and power wheelchairs as well as wheelchair seat cushions. The details of the Competitive Bidding Program are complicated, but it is clear that government bidding of these individualized, specialty items will no doubt limit choice and make access to top performing seating and mobility products more difficult. I have been involved in industry lobbying efforts to try and convince Medicare officials of the negative impact such a bidding program will have on individuals who rely on high performance wheelchairs, but it seems clear that many top level government officials see wheelchairs and seat cushions as commodity DME items, not realizing the critical importance these devices have on those who rely upon them for both mobility and skin protection. Perhaps the most scary part of Medicare pursuing this strategy is that the negative impact won’t only be restricted to the Medicare market. We are already seeing many state Medicaid programs and private insurance programs grab on to lower payments rates and access restrictions that resulted from a Round 1 pilot program of Competitive Bidding. And this is before the Medicare bidding program becomes a national program in 2013. I can’t see any scenario where the Medicare Competitive Bidding program will not ultimately limit your access and choice to critical seating and mobility equipment. It is not too late to convince Medicare officials and Members of Congress that this is a bad program – but to accomplish this we need individuals who use and rely upon this equipment to add your voice to lobbying efforts. Here is a great posting on the ROHO blog site from Bob Vogel about how to engage with your Members on Congress on this important topic. Your Members of Congress work for you. They are your elected officials. Part of their job is to listen and respond to your concerns. I encourage you to make your voice heard with the same passion that you show in participating in this Forum! http://blog.therohogroup.com/index.p…-and-senators/ Thank you! Tom Borcherding The ROHO Group tomb@therohogroup.com
Source: rutgers.edu

Medicare National Competitive Bidding HME

The full presentations are available at WWW.HMEBIZ.COM This is the introduction of a two part series on National Competitive Bidding (NCB) Get educated now!! NCB is a complex bidding program created by Medicare to set the prices for Home Medical Equipment. Medicare has implemented this program in eleven areas of the US with disasterous results. Many providers were eliminated because they did NOT understand the program.
Source: thearticlesite.net

Ron Wyden and Paul Ryan’s Bipartisan Plan for Health Care and Medicare Reform

Paul Ryan responds that Obama is “increasingly isolated” from the “growing bipartisan consensus.” I am grateful to have a partner in my friend Senator Wyden, as we work together to create space for bipartisan solutions to address our nation’s most pressing challenges. It is disappointing to find the President of the United States increasingly isolated from this growing bipartisan consensus on efforts to save and strengthen our critical health and retirement security programs. The President’s failure to offer credible solutions to the challenges facing Medicare is a disservice to seniors, a disservice to hardworking families, and a disservice to the next generation. A more glaring disappointment is the President’s failure to recognize a sincere effort by a Democrat and a Republican to come together and offer solutions, betraying his own rhetoric and his own commitment to those we have the privilege to serve. America deserves better.
Source: medicalprogresstoday.com

KPMG: Uncertianity About Medicare ACO Participation

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSAccording to responses from healthcare leaders who participated in a webcast poll in November, 57 percent of hospital and health system respondents said they still don’t know how the final rules will impact their organization’s participation in the MSSP program. Sixteen percent, on the other hand, said their position was unchanged and they are still planning to participate, while seven percent said the final rules have moved them to participate.  Thirteen percent, however, said their position not to participate remains unchanged.
Source: big4.com

Video: Rick Perry Hates Social Security, Medicare & Rules For Wall Street

New Medicare Part D Pharmacy Notice Rule In Effect; Stay Tuned for Final Model Notice 

[1] See, generally, Medicare Prescription Drug Benefit Manual, Ch. 18, at: https://www.cms.gov/MedPrescriptDrugApplGriev/Downloads/PartDManualChapter18.pdf [2]As referenced in previous Alerts, Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148 (March 23, 2010), and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010). The laws often are collectively referred to as the Affordable Care Act (ACA). [3] 76 Fed Reg 21471 (April 15, 2011). [4] 42 CFR §423.562(a)(3). [5]42 CFR §423.128(b)(7)(iii). [6]See 10/14/11 CMS Memo re: Revised Standardized Pharmacy Notice (CMS-10147), available at: htt ://mcoaonline.com/content/pdf/20111014-RevStdPharmNotice.pdf. [7] The new 2012 Revised Standardized Pharmacy Notice (
Source: medicareadvocacy.org

Start Making Sense: Gingrich’s tax planning trick

According to Forbes (courtesy of the Tax Prof Blog), Newt Gingrich’s tax return shows that he purported to avoid $50,000 of Medicare payroll taxes by using the so-called John Edwards Sub S tax shelter – a scam that Forbes says the IRS has “consistently and successfully attacked.” The trick is to avoid the 2.9 percent Medicare payroll tax by forming a shell entity that supposedly employs you. Then, when others pay for your services, the money goes to the entity, which underpays you from a reasonable compensation standpoint. This ostensibly results in converting the lion’s share of your compensation income into business profits, which do not face the Medicare payroll tax. If you actually need the cash, you can still ask the entity to pay it to you (and it will probably say yes to its 100% owner), but you label the payments as dividends, which also are exempt from the Medicare payroll tax (and indeed are tax-irrelevant, given that a subchapter S corporation is taxed as a flow-through entity whose profits accrued to you anyway). Essentially, the trick is the same as if I were to make a deal with NYU whereby I formed a subchapter S corporation, charged NYU my entire salary, and then had my S corporation pay me just a pittance under the salary label. If this worked, I could avoid all payroll taxes (except on the pittance that I admitted was salary) – Social Security as well as Medicare. And I suppose NYU could avoid paying its half of the Social Security payroll tax. But needless to say this wouldn’t actually work, in particular given the personal service corporation rules (Internal Revenue Code section 269A). The John Edwards Sub S tax shelter typically comes closer to being legally defensible, avoiding the terms of section 269A and being contested by the IRS on “reasonable compensation” grounds, which in this setting is a version of substance over form. That is, if Gingrich the sub S owner were dealing at arm’s length with Gingrich the star employee, he would have to pay himself pretty much the entire profits, since he is the asset. The IRS has had prominent recent wins lately in litigating this issue. It’s only fair to compare Gingrich’s Sub S tax shelter to Romney’s use of Caymans entities to avoid unrelated business income tax (UBIT) with respect to his pension investments. Romney’s strategy appears clearly to work as a legal matter, and the tax he is avoiding (the imposition of UBIT on debt-financed exempt entity investments) has contested merits, which may be one reason why Congress has not revised the rules to defeat the strategy (an almost absurdly simple one, based on not “looking through” a meaningless blocker entity). Gingrich’s tax planning trick strikes at the heart of taxing earned income under the rules that are supposed to apply to it. Like so many abusive tax shelters, it appears to be based on mischaracterizing actual transactions, rather than merely exploiting a legally relevant technical lacuna in the law. What is more, if audited, Gingrich (unlike Romney) might face a risk not just of losing the case, but of owing penalties.
Source: blogspot.com

Medicare ACOs set to begin: Will they succeed?

Perhaps most interesting is the change in final rule, for which we advocated, giving group practices an opportunity to form ACOs independent of hospitals. By eliminating the requirement that ACOs report hospital quality measures, such as hospital-acquired conditions, physician groups may have a unique chance at succeeding as Medicare ACOs. This is especially true of groups that can efficiently coordinate care and keep patients out of high-cost care settings, such as hospitals. For the first time in a major Medicare program, Part A savings may now flow to Part B providers. Yet significant investment costs, elusive savings and other risks to ACO participation make it difficult to determine how enticing the final rule will be to our members. Major stumbling blocks include the fact that ACOs will be accountable for the cost of care that assigned beneficiaries receive outside the ACO. Beneficiaries may also opt out of sharing data with their ACOs. And the Physician Group Demonstration Program, which tested a similar Medicare shared savings model, provides little encouragement. Only two of the 10 participating groups achieved shared savings in each of the four demonstration years. The final rule does offer a few glimmers of hope with regard to new waivers for Stark and anti-kickback laws. The waivers better protect participants, providers and support participation in ACOs.
Source: mgma.com

Medicare Vouchers Explained : CJR

Most people now go on Social Security well before they become eligible for Medicare at age sixty-five. Right now, many have no health insurance between when they leave work and become eligible for Medicare. That gap is a problem. Raising the age of eligibility for Medicare would make it worse. If and when the Affordable Care Act is enforced and operating smoothly, it would be much less of a problem. Currently there is an additional problem with raising the age of eligibility. It would actually increase total health care spending because the private plans into which people would move are more costly than Medicare is, and it saves less for the federal budget than one might suppose, because of the added payments that cutting people out of Medicare generates in such programs as Medicaid. This change needs to remain on the table, however, as part of a long-term effort to encourage people to remain economically active to a later age than they do now. That trend is already underway.
Source: cjr.org

Living on Social Security and Medicare: The Reality

Amy Myers Andrew Breitbart andrew reinbach china us debt Christopher Murphy CitiGroup Clarence Thomas Common Cause Computerization computer security cybercrime Debt Ceiling Democrats FDR GOP GOP House Freshmen hackers hacking House Repubicans IMF International Monetary Fund John Birch Society kgb laetrile Louise Slaughter National default Population growth Reinbachs reinbachs observer Repubicans Republican Party Republicans Right Wing right wing extremism right wing extremists right wing media Ron Paul russian mafia SCOTUS Second Bill of Rights Supreme Court Tea Party Unemplyment us treasury debt Weinergate
Source: reinbachsobserver.com

Lawsuit Alleges Chemed Corporation (CHE) Fraudulently Billed Medicare

If you purchased Chemed common stock from February 15, 2010 through November 16, 2011, you may file a motion with the court no later than March 12, 2012, and request that the court appoint you as lead plaintiff.  A lead plaintiff is a representative party acting on behalf of other class members in directing the litigation.  To be appointed lead plaintiff, the court must decide that your claim is typical of the claims of other class members and that you will adequately represent the class.  Your share in any recovery will not be enhanced or diminished by your decision of whether or not to serve as a lead plaintiff.  You can recover as an absent class member without moving for lead plaintiff.  The action discussed here was not filed by Milberg.
Source: classactioncentral.com

Daily Kos: Gaming Medicare

A Medicare patient initially has a max of 150 consecutive days in the hospital. Then they either would be discharged to their homes with Part B home health services for at least 60 days to reset the benefit period to zero or is sent onto hospice where they need to be periodically recertified as terminal. If the patient is sent home, they can still receive intraventive care. If the patient is sent to hospice, they can only receive palliative (comfort) care. A lot of times, a patient will stop the intraventive care and go to hospice because of the discomfort of treatment only to change their mind some weeks or months later after they feel better which justifies the “ooops, I’m sorry” discharges. A Medicare patient who has a reset benefit period under Medicare Part A, but has expended their lifetime reserve days now has a maximum stay of 90 consecutive days in the hospital/SNF or Part A home health. The game continues until someone at the MAC (Medicare Administrative Contractor, which used to be called a fiscal intermediary – the private companies that actually run the Medicare programs) decided that the statistics are well under the tails of the bell curve. The Mac takes too long to investigate and sics a RAC auditor on it The MAC brings in the DOJ Seven years or so later…..
Source: dailykos.com

CMS Final Medicare Rule Imposes Many Conditions On Access To Medicare Claims Data To Evaluate Providers & Suppliers

A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with health and managed care, insurance  and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend insured and self-insured medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals.  She also has worked extensively with Medicare and Medicaid Advantage, association, employer and other group insurance arrangements, MEWAs, fraternal benefit and mutual aid programs, government programs, and a broad range of other specialized health and other programs and insurers to design and administer arrangements in response to their unique regulatory and operational needs. A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to monitor legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials concerning regulatory, investigatory or enforcement concerns. 
Source: wordpress.com

Medicare Benefit Plans: Producing the Proper Health Insurance …

Posted by:  :  Category: Medicare

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

Video: Medicare Advantage Insurance

Senior Health Insurance

Freestyle blood glucose meters

Posted by:  :  Category: Medicare

Most diabetic patients with health insurance can get free delivery including glucose monitors and test strips. Recent laws require health insurers to cover treatment of diabetes. Medicare usually covers eighty percent of diabetes supplies, including glucose meters, test strips, lancets, and batteries. There are many companies that offer freestyle blood glucose meters and other diabetes supplies to Medicare beneficiaries and private policyholders. If you do not have health insurance, and are on a limited income, you can apply for financial aid Hardship Program to receive a free glucose meter. There are three ways you can get free blood glucose meters. The first and easiest way is to visit an online mail-order companies that offer free blood glucose meters to Medicare or other insurance carriers. All you do is fill out an online form, and they will send a meter and other diabetics you need for free
Source: epscicon.org

Video: Medicare Online

Doctors contemplate opting out due to continued Medicare hassles

Physician participating in the Medicare program are scheduled to face a 27.4% cut in their payments, effective 1st January, 2012, and with providers anyway complaining about current reimbursement rates, the cut is likely to considerably impact both patients as well as doctors adversely. As a result of the cut the Medicare physician conversion factor will decrease to $24.67, approximately $15 less than it was in 2001. In this scenario, the Association of American Physicians and Surgeons reports that various physicians are declining to take on new Medicare patients and many are thinking about cancelling enrollment from the program.
Source: ezinemark.com

Social security now offering Spanish online service

But you can do more than apply for ben­e­fits at www.segurosocial.gov. You can get a lot of infor­ma­tion and pub­li­ca­tions writ­ten in Span­ish. In addi­tion, there are a num­ber of online trans­ac­tions that allow you to com­plete your Social Secu­rity busi­ness online, and in the lan­guage you’re most com­fort­able using. One of the most pop­u­lar of all is our Retire­ment Estimator.
Source: thebellevuegazette.com

Sleep Apnea Support Forum • View topic

Please send the completed claim form, your itemized bill, and any supporting documents to the Medicare contractor and explain in detail your reason for submitting the claim. The address where you need to return the form for processing depends on the state you live. If your provider or supplier refused or is unable to file a claim for a Medicare-covered item or not enrolled with Medicare, you must include a statement that your provider or supplier refused to do so. Very few dentist are currently enrolled with Medicare. If this statement is not included, the Medicare contractor will return your CMS 1490S form and you will need to complete another claim form with the statement included. When you submit your own claim to Medicare, complete the entire form. Medicare contractors will reject the claim or will send a letter to you with an explanation of why it was returned if the form is incomplete. You should mail the original claim form and make copies for your records. Please allow at least 60 days for Medicare to receive and process your request. If you have any other questions, please feel free to call 1-800-MEDICARE (1-800- 633-4227). Use the following address table to ensure the correct address will be provided on the 1490S claim. If you live in: Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, Vermont (Region A) Return your form to: NHIC, Corp. P.O. Box 9180 Hingham, MA 02043-9180 If you live in: Illinois, Indiana, Kentucky, Michigan, Minnesota, Ohio, Wisconsin (Region B) Return your form to: National Government Services, Inc. DMEPOS Operations Medicare DMEPOS Claims P.O. Box 7027 Indianapolis, IN 46207-7027 If you live in: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas, U.S. Virgin Islands, Virginia, West Virginia (Region C) Return your form to: CIGNA Government Services P.O. Box 20010 Nashville, TN 37202-0010 If you live in: Alaska, American Samoa, Arizona, California, Guam, Hawaii, Idaho, Iowa, Kansas, Missouri, Montana, Nebraska, Nevada, North Dakota, Northern Mariana Islands, Oregon, South Dakota, Utah, Washington, Wyoming (Region D) Return your form to: Noridian Administrative Services P.O. Box 6727 Fargo, ND 58108-6727
Source: apneasupport.org

How can I get a medicare part D form online,I need this to fill out so someone can get some medicine help?

you can enroll online for any medicare part d plan of your choice at medicare.gov or call the plan of your choice to sign up, the deadline before you start getting penalized is may 15, so sign up soon!!! If you are trying to get help to pay for the drug plan, call social security, at 18007721213, they can send you the form, until you get it filled out, go ahead and sign up with the plan of your choice b/c after may 15 you have to wait until nov 15 unless you qualify for a Special election period
Source: bestlongtermcare.org

Affordable Health Insurance

Universal health care is a concept that most countries worldwide strive for. It’s often hard to attain due to its many complexities. Thankfully for us in Australia, we have one of the most extensive universal health care programs in the world. Even though this is the case, there are still some health services not available through the public system. For this reason many Australians are thinking about purchasing covers for reasonably-priced health insurance. There are many options around for cheap medical insurance, so don’t forget to make wise and informed decisions. This can be a guide to some of your choices.
Source: articleways.com

Longer Looks: Explaining Medicare’s ‘Premium Support’

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiWashington Monthly: The Yaz Men: Members Of FDA Panel Reviewing The Risks Of Popular Bayer Contraceptive Had Industry Ties Last month, the U.S. Food and Drug Administration convened a committee of medical experts to weigh new evidence concerning the potential dangers of drospirenone, a synthetic hormone contained in popular birth control pills including Bayer AG’s Yaz and Yasmin. … the committee concluded by a four-vote margin that the benefits of drugs with drospirenone outweigh the risks. However, an investigation by the Washington Monthly and the British medical journal BMJ has found that at least four members of the committee have either done work for the drugs’ manufacturers or licensees or received research funding from them. The FDA made none of those financial ties public. … When asked whether the agency was aware of any financial ties between its advisors and manufacturers or distributors of drospirenone, FDA spokeswoman Morgan Liscinsky said, “No waivers were issued” (Jeanne Lenzer and Keith Epstein, 1/9).
Source: kaiserhealthnews.org

Video: Romney, Santorum, Others Call For Medicare ‘Premium Support’ In New Hampshire GOP Debate

2012 Medicare Premiums, Deductibles and Co

Enrollees in Medicare Part D prescription drug plans pay premiums that vary from plan to plan.  Beginning in 2011, Part D enrollees whose incomes exceed the same thresholds that apply to higher income Part B enrollees must also pay a monthly adjustment amount. The regular plan premium will be paid to their Part D plan, and the income-related adjustment will be paid to Medicare.  The amounts by income level are below.
Source: medicareadvocacy.org

The Inherent Flaws in Medicare Premium Support

On December 15 Sen. Ron Wyden (D-OR) and Rep. Ryan released another variation. Their plan is similar to the Rivlin-Domenici plan but removes the cap on the voucher. Instead, if Medicare spending growth exceeds growth in the economy plus 1 percentage point, then Congress must reduce payments to health care providers, reduce program overhead, or increase premiums for higher-income beneficiaries. Importantly, while the Rivlin-Domenici plan would require private plans to cover the same services as traditional Medicare, the Wyden-Ryan plan would only require private plans to cover any package of benefits that provides the same “actuarial value”—pays the same percentage of costs—as traditional Medicare.
Source: americanprogress.org

Medicare Premium Support: A Primer

If the reluctance of politicians to incur the wrath of voters can be overcome, and if the internecine fighting between the parties can be quelled, analysts and policymakers have developed two broad choices for constraining the growth of Medicare costs. The first is to call on health professionals and other experts to identify reforms that would contain costs by adopting measures such as reducing the use of redundant or unnecessary tests, reducing the use of treatments that evidence shows are not effective, increasing the use of generic drugs, and increasing the effectiveness and use of preventive care. Given that approximately 25 percent of Medicare spending occurs in the last year of life, there could be significant savings in end-of-life care as well. The repeated observation that there is little or no correlation between the cost of health care spending and quality of care in a geographical area within the United States and that the U.S. spends far more on health care than any other nation but scores relatively poorly as compared with many other countries on measures of health and of quality of care strongly suggest that we are spending too much money on health care. The ACA, passed in 2010, contains several mechanisms of top-down reforms to control health care costs, most notably the Independent Payment Advisory Board (IPAB) composed of health experts who will review current research and practice and then submit reform proposals to Congress, although Congress placed limits on the types of reforms the IPAB can recommend. The proposals would then be considered under special rules in which the legislation would be considered as enacted unless Congress amended the IPAB recommendation with legislation that achieved the same level of saving.
Source: brookings.edu

Healthcare Bulletin: Medicare Premium, Coinsurance, and Deductible Update for 2012

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Source: frronline.com

NRS News: Medicare Premiums Skyrocket Under Obamacare

“The per person Medicare insurance premium will increase from the present monthly fee of $96.40 per month to: … $104.20 in 2012 $120.20 in 2013 … $247.00 in 2014 Notice that the increase in this election year is less than $10 a month. Why is that, do you suppose? These premium increases, incorporated in the Obamacare legislation that Congress was too busy to read, are purposely being delayed so as not to ‘confuse’ the general public in the 2012 re-election campaigns. If you are confused, do nothing. If you are not confused, pass this on to all seniors that you know. After all, they need to know who is throwing them under the bus.” MD
Source: blogspot.com

Harrolds.blogspot.com: o’scamcare

What were you doing in the last hour while the U.S. Gov’t spent $188 Million Dollars of our money!  (Every Hour, Every Day!) (Apr11)   In 8 years, President Bush added $5 trillion to the national debt; President Obama, according to a revised Dec11 GAO report, added $4T+ to the U.S. deficit in 2011 alone! The GAO estimates the deficit, including o’scamcare & mandates, from $13.8T → $22T+ which makes the National Debt more than 99.7%+ of the entire U.S. GDP!  Imagine what these numbers will be if we allow Obama four more years! (src)
Source: blogspot.com

Senior Health Direct offers the best advice on supplementing Medicare

The times of travel insurance men spending hours showing you the benefits of insurance programs and their benefits and the pitfalls are long gone. Online medical insurance companies are now the normal and finding a trustworthy, reliable company has become the goal. As you approach 65 and about to become eligible for Medicare and wish to find a policy to cover all the holes in these policies and especially for one’s own complaints then you should start researching. It will be easy to spot fly by night companies and those actually looking out for a clients best interests.
Source: freeprnow.com