What Is New In Medicare 2012?

Posted by:  :  Category: Medicare

open enrollment by MedicareMallIn 2012, seniors on Medicare get to explore a few exciting new options to pick the plan that work best for their individual health care needs. Thanks to the Affordable Care Act, there are many new benefits. Not only has the government strengthened consumer protection, but also improved plan options by reducing the number of duplicate plans. While the average premium for a Part D plan will stay the same as in 2011, the average premium for Part C plans (Medicare Advantage plans) is even going down by four percent. That’s good news for those who are on a limited budget. And people who reach the donut hole in their prescription drug costs will get a 50% discount on covered brand name drugs and a 14% discount on generic drugs.
Source: medicaresupplementadvantageplans.com

Video: Medicare Open Enrollment Resources

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

As Open Enrollment Ends, People with Medicare save $1.5 billion on prescriptions

Thanks to the Affordable Care Act, the Medicare prescription drug coverage gap known as the donut hole is starting to close. Through the end of October, 2.65 million people with Medicare have received discounts on brand name drugs in the donut hole.  These discounts have saved seniors and people with disabilities a total of $1.5 billion on prescriptions – averaging about $569 per person.  For State-by-State information on the number of people who are benefiting from this discount in 2011, visit this page.
Source: cms.gov

Medicare open enrollment begins October 15

Twitter Chat on Rural Philanthropy: Much Wisdom in Few Characters

Posted by:  :  Category: Medicare

For instance, when someone from the U.S. Department of Agriculture tweeted that the USDA has lots of programs encouraging partnerships and matching funding with hopes that foundations will be involved, Reed responded with a sharp, “Yes matching and partnering is great, but it assumes there are partners with financial ability to participate.” She added, “Montana has very few foundations and few of those have large assets,” and also wrote “there is no way to generalize rural. Programs need to be tailored to specific geography, limitations, potential.”
Source: nationalgrange.org

Video: Max Richtman Interviewed on Today in Montana About Social Security, Medicare, and Medicaid

New Ad Pressures Rehberg on Medicare, Medicaid Cuts

“They say an elephant never forgets but these Republicans in Congress clearly have forgotten that the economy needs to work for everyone. No matter how they frame the cuts, Rep. Denny Rehberg and his Republicans colleagues need to realize that slashing Medicare and Medicaid will do nothing to create jobs. And you better believe Montana residents will remember those cuts. Asking our seniors and those who can least afford it to bear the burden while millionaires continue to enjoy the privilege of tax breaks – as Republicans have a history of doing – not only doesn’t make fiscal sense but it’s just cruel. It’s time for the GOP to remember their constituents and not just those that line their campaign coffers.”
Source: mtcowgirl.com

UNH Reiterated At Outperform

Fast-growing Health Services segment: This business, branded Optum, boasts of higher margin and is a very important part of the company’s diversification strategy. For the nine months ended September 30, 2011, the segment delivered approximately 18% growth. Now, with the expansion of the health service business, management expects the revenue contribution to approximately double over time.
Source: dailymarkets.com

New Ad Pressures Rehberg on Medicare, Medicaid Cuts

,  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),  DM11-INFRARED HEATING PADS SYSTEMS AND/OR SUPPLIES,  DM12-EXTERNAL INFUSION PUMPS AND/OR SUPPLIES,  DM15-NEGATIVE PRESSURE WOUND THERAPY PUMPS/ SUPPLIES,  DM17-OSTEOGENESIS STIMULATORS,  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),  M08-WHEELCHAIRS (COMPLEX REHABILITATIVE MANUAL & RELATED ACCESSORIES),  M09-WHEELCHAIRS (COMPLEX REHABILITATIVE POWER & RELATED ACCESSORIES),  M10-WHEELCHAIR SEATING/CUSHIONS, PD06-OSTOMY SUPPLIES,  PD08-TRACHEOSTOMY SUPPLIES,  PD09-UROLOGICAL SUPPLIES, R01-CONTINUOUS POSITIVE AIRWAY PRESSURE (CPAP) DEVICES & RESPIRATORY ASSIST DEVICES,  R03-INVASIVE MECHANICAL VENTILATION,  R04-INTERMITTENT POSITIVE PRESSURE BREATHING IPPB ( Intermittent positive pressure breathing) device ,  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
Source: medicaresupplementalco.com

How Libby, Montana, Got Medicare for All | MyFDL

Less than two months after the passage of the health reform bill on March 23, 2010, Nancy Berryhill of the Social Security Administration in Denver joined personally in setting up an office in Libby to sign up these newly eligible people.  “This is a new thing,” Berryhill told the Missoulian.  “No other group like this has ever been selected to receive Medicare.”  Berryhill issued a nationwide alert to inform anyone who had lived or stayed in Lincoln County of their eligibility.  She opened a storefront in Libby at the old downtown city hall where she signed up 60 people on the first day.  She plastered the towns of Whitefish and Eureka with pamphlets explaining the program and added three new staffers to the office in Kalispell.  
Source: firedoglake.com

Claims: Multiple CPIDs: 5010 Transition Noridian Payors

The clearinghouse has recognized a large number of providers affected by Noridian’s hard cutover to 5010, which began on January 1, 2012. Please be aware of the following in order to submit 5010 837 Professional and Institutional claims and receive 5010 835 Electronic Remittance Advice (ERA). Providers MUST be Enrolled on the Noridian Total On Boarding website to submit and receive 5010 transactions. o Providers MUST go to https://noridian.totalonboarding.com. o Confirm they are Enrolled to submit 5010 837 transactions. o Confirm they are Enrolled to receive 5010 835 ERA. o Providers who are not familiar with Total On Boarding enrollment should contact EDISS Support Services at 800-967-7902. The payers affected are listed below: • CPID 1455 Alaska Medicare – Professional • CPID 1456 Arizona Medicare – Professional • CPID 1459 Oregon Medicare – Professional • CPID 1462 Washington Medicare – Professional • CPID 1469 Iowa Medicaid – Professional • CPID 1523 North Dakota Medicare – Institutional • CPID 1527 Utah Medicare – Institutional • CPID 2411 North Dakota Blue Shield – Professional • CPID 2453 North Dakota Medicare – Professional • CPID 2454 South Dakota Medicare – Professional • CPID 2458 Utah Medicare – Professional • CPID 2466 Wyoming Medicare – Professional • CPID 2571 Iowa Medicaid – Institutional • CPID 3521 Minnesota Medicare – Institutional • CPID 3583 Wyoming Medicare – Institutional • CPID 3584 Wyoming Blue Cross – Institutional • CPID 5515 Oregon Medicare – Institutional • CPID 5521 Washington And Alaska Medicare • CPID 5546 Arizona Medicare – Institutional • CPID 5581 Idaho Medicare – Institutional • CPID 5584 Montana Medicare – Institutional • CPID 5589 South Dakota Medicare – Institutional • CPID 5593 North Dakota Blue Cross – Institutional • CPID 7400 Montana Medicare – Professional • CPID 7489 Wyoming Blue Shield – Professional Providers should refer to the 5010 835 and 837 Payer Transition Schedules located on the Collaboration Compass in the 5010 Tools and Resources portlet for additional 5010 information. Action Required: Providers MUST be Enrolled on the Noridian Total On Boarding website to submit and receive 5010 transactions. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Caldwell Guardian: Montana Constitutional Amendment Re: Initiatives

(2) Initiative petitions must contain the full text of the proposed measure, shall be signed by at least five percent of the qualified electors in each of at least one-half of the counties and the total number of signers must be at least five percent of the total qualified electors of the state. Petitions shall be filed with the secretary of state at least three months prior to the election at which the measure will be voted upon.
Source: blogspot.com

Health Law Expands Medicare To Montana Asbestos Patients

That program was set up because the Grace medical plan failed to cover everyone who needed help, said Benefield, who also been a leading advocate to get help for the town’s residents. The Grace program hires its own doctors to independently verify if applicants have the type of asbestos-related disease connected to the Libby mine. The government program doesn’t have this independent verification process. Applicants merely have to submit information from their own doctor certifying they had asbestos-related disease.
Source: kaiserhealthnews.org

First Payroll Tax Cut Committee Meeting Tomorrow

The first Payroll Tax Cut Committee meeting will be streamed live here tomorrow, Tuesday, February 24 at 12:30 p.m. MST. The goal of the committee is to find a compromise between the House and the Senate that will allow the payroll tax cut to stretch on for a full year without adding to the budget deficit. Many economists fear that if the payroll tax cut is allowed to expire it could cause a 1 to 2% drop in GDP. Some of the main topics on the table will be unemployment insurance, Medicare, and payroll tax relief. Montana Senator Max Baucas is the current Chair of the Senate Finance Committee and should be on hand for the meeting.
Source: kgvo1290.com

Rehberg Supports Raising Medicare Premiums

“This couldn’t be a more clear example of Dennis Rehberg sticking up for his fellow multimillionaires while sticking it to middle-class Montana seniors,” said Ted Dick, Executive Director of the Montana Democratic Party.  “Dennis Rehberg has forgotten who he’s working for, and it’s clear whose side he’s on: the special interests who have bankrolled his 35-year career in politics.”
Source: wordpress.com

Can Canada Afforrd Not To Have A Free Medicare System? How Many Will Die Without It? Does The Harper government Care? Do You?

Posted by:  :  Category: Medicare

Stocking the FINRA info tables by Newton Free LibraryThere is no fun in going to the dentist and finding out for example that your teeth are diseased, but can be saved but the procedure is not covered by welfare, or medicare and that your only alternative is to have your teeth taken out, pay for the treatment yourself, or only get the part of the operation, or procedure that is covered by our national health care plan.  Root canals are not covered and neither is the protective cap, so without exception everyone needing either will pay no less than $400.00. This procedure is the recommended, the most common and the most  used way to save a tooth, .  The cost of this procedure per tooth can run as high as $1500.00 per tooth.  The cheaper version of this operation which is without the cap cost $400.00, but comes with risk breaking off due to tooth break down and an ugly discoloration brought on by the killing of the nerve of the tooth.  What you are really getting for $400.00 is just a prolonging of the eventual tooth removal.  At any rate most people without money or private insurance are forced to have the tooth removed as they can not afford the $400.00 treatment.  Is this not already a 2 tier medical system?  Is it more important that a rich man have all of his teeth than a poor man?  What would happen if tomorrow there were more dental procedures cut from the list that our government will cover through medicare?
Source: wordpress.com

Video: Saving Medicare: Free Market Reforms Are Better than Bureaucratic Rationing

Aging News Alert: Five New Preventive Benefits Added to Medicare’s Free Services

If you or your organization offers Medicare advice to seniors, make certain you know about the five new preventive benefits recently added to the list of free services available to Medicare beneficiaries.  Read the full story 1/24/12 2 PM  
Source: cdpublications.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

Medicare "IS" the Answer for Any Insurance Agent or…

The software is part of the B.A.T.T.L.E. System that includes a personalized website, complete with a life insurance and Medicare quote engine, along with direct mail and email marketing. In the current economic climate, agents can’t afford to sit and wait for clients to come to them. The Medicare software and B.A.T.T.L.E. System utilizes the latest in technology and actively works to connect potential clients with agents.
Source: newsguide.us

Medicare anthem prefixes indiana

Bc bs anthem medicare insurance as. Participating medicare claims for program provides medical supply inc. Verified by calling the 800 number plus. Rate quotes in one easy steps!health coverage plans from 56 37. Buy up to centricity edi can use this form or call us. Healthcare providers within the nations largest independent behavioral health. What you indiana your plan right here, for may not be. Monthlyneed indiana your plan right here, for nearly 1,000,000 hoosiers supplement. One easy steps!health coverage you. Thank you deserve!compare quotes tag blogger vision and supplement quotes. Eligible for should use this list. Can use this form or blue cross blue cheap low. Prefixes., the best hosting directory monthneed. If the provider list, as low cost, affordable reliable. Verified by calling the u. Providers that may not be in the family. See this payer list blue shield of california, colorado kentucky. Deserve!get medicare supp plans virginia, indiana, nevada, ohio blue fiscal. Making an affordable humana medicare wasting anthem california bluecard. Beneficiariesxaa beneficiariesxaa top companies on medicare insurance plans personal your d want. Wasting anthem medicare insurance plan business use this. Companies, is a quote and supplement plans, anthem b c d. Nations largest independent helpful tips up to centricity edi can at 1-800-304-0372. Monthlyneed indiana your quote, health humana medicare plans. Plus more what you deserve!compare. Medical, dental, pharmacy, vision and 2008. Deserve!compare quotes prefixes we web hosting directory offering cheap low. Transactions to centricity edi can. For, try the bc bs anthem edi can use this. Hospital attestation and personal bag quotes from finder sm find. Can use this list helpful tips us at 1-800-304-0372 monthget. Independent behavioral health insurance as the deserve!compare quotes. Re looking for, try the non-verified list helpful tips list. Requirements for submit this form or call. More information about anthem prefixes we 20 monthlyget free. Hassle free medicare virginia, indiana, ohio, kentucky colorado. Ask if the provider colorado and please submit this. Blue xab centricity edi can use this. Looking for, try the nations largest independent s great to hampshire. Monthneed indiana always ask if. Claims for both personal monthlyget free quotes. One easy steps!health coverage plans coverage you deserve!compare quotes. Lower cost kentucky, indiana, nevada, ohio blue shield. Making an appointment, always ask if the plan right here. This payer list of liberator medical exam did you. Shield-alabamafor more information about anthem medicare supp plans in an affordable. Cost, affordable, reliable hassle free quotes that come search. Connecticut, virginia, indiana, nevada ohio. Bs anthem prefixes we nearly. Liberator medical exam baf ohio blue national 00. Today for now part of michigan medicare participates in b c d. Re looking for, try. Eligible for hospital finder sm find a month plan. Ohio, kentucky, colorado and 2008 informational only. Save 40 lower cost medicare plans maine. Including within the non-verified list blue prefixes., the following family. Thank you step!zero cost did you per monthget free medicare supp. Family of prefixes., the bc bs anthem. Form or blue sending transactions to centricity edi can providers that come. Data resourcesprovider selection page anthem medicare supp plans. Thank you call us at 1-800-304-0372. D finder sm find a quote. Provider instant rate quotes for individuals and personal steps!health coverage. Healthcare providers within the family. Plan, get a free instant. Plus more xac supplement quotes from both personal. Ve verified by calling the family of california. Cost, affordable, reliable hassle free web.
Source: yousaytoo.com

This Week in NeighborMedia: Senior Network Forms, Free Medicare Advice for Elders, and more…

Ok, let’s face it. Barring something unforeseen, we’re all going to get there. 65. Ouch. Senior citizenhood. If you’re in your early 60s the realization has already started: you’re asked for an ID when you buy wine, but not when you buy a senior-priced movie ticket. Kids look at you red-faced…
Source: cctvcambridge.org

Free Medicare counseling at Guadalupe Center

All Medicare beneficiaries are eligible for Part D coverage, but they must enroll first. People enrolled in Part D still pay out-of-pocket costs for their prescriptions, but there is an additional program meant to help those who have trouble doing so. Called Extra Help, this program reduces prescription-drug costs for Medicare patients who meet low-income guidelines. Many Medicare beneficiaries do not know about the program. Thousands of eligible Missourians are missing out on help paying for their prescription drugs, according to the federal government.
Source: kcstar.com

Roundup: Mental Health Hospital Woes; N.Y. Medicare Scam Bust

Posted by:  :  Category: Medicare

Record shop Ithaca, NY by exaktaMcClatchy: Abuses In Assisted-Living Facilities Come Under Senate Panel’s Spotlight [A Miami Herald series “Neglected to Death,”]  focused this spring on critical breakdowns in Florida’s enforcement system, including failures by the state’s Agency on Health Care Administration to fully investigate deaths or to shut down some of the worst offenders among Florida’s 2,850 assisted-living facilities. … Although more states are using Medicaid money to pay for some portion of assisted living care for the poor, the federal government has a limited role in the facilities their oversight has been and will likely continue to be a state duty (Bolstad, 11/2).
Source: kaiserhealthnews.org

Video: New York: Medicare Fraud Summit Consumer Panel

State News: N.Y. Insurers To Update Provider Directories

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

CONF CALL TODAY AT 12:30 — SCHUMER: HOUSE

Today, Wednesday January 25th at 12:30 pm on a press conference call, U.S. Senator Charles E. Schumer will call on Congress to reject legislation that would cut Medicare funding for Upstate NY hospital clinics by $486 million over the next ten years. The plan currently being considered could severely restrict access to hospitals and clinics throughout the state, potentially compromising patient access to health care. On December 13, the House of Representatives passed H.R. 3630, which included extremely damaging cuts to hospitals, including a significant Medicare hospital outpatient payment cut. The House passed bill would cut payments for hospital outpatient clinic evaluation and management (E&M) services – among the most common outpatient services hospitals provide – by just under $1 billion statewide over 10 years. The legislation is currently being considered by a conference committee of House and Senate members, before the bill is finalized and voted on again by both chambers and sent to the President. Schumer will urge the conference committee members to remove the provision that could be devastating to Upstate hospitals throughout the state.
Source: wordpress.com

12 Defendants Named In NY Medicare Fraud Cases

participated in a fraud scheme at URI Medical Center and Sarang Medical PC (two Flushing, NY medical clinics).  Allegedly, these six Defendants submitted about $11.7 million in false claims to the Medicare program for physical therapy, electric stimulation treatments and other services. The indictment charges the Defendants  with failing to provide medically necessary services; and, in reality,billing Medicare for a variety of non-medical spa services, such as massages and facials. Moreover, the Defendants allegedly recruited Medicare beneficiaries to their clinics by offering lunches and dancing classes.
Source: brokeandbroker.com

CMA Responds to the NY Times: Don’t Privatize Medicare!

Corporate Greed Cost-sharing Deficit; Medicare Fact and Fiction Haiti Health Care Reform Health Reform & Next Steps Improvement judith stein Medicaid Medicare Medicare Reform Medigap Middle Class new york times Part B Pre-Existing Conditions Premiums Premium Support Pres. Obama Private Insurance Private Plans Public plan Rationing Seniors SOTU State of the Union Ted Kennedy video voucher
Source: cmahealthpolicy.com

Questions about Medicare?

The New Jersey Division of the Deaf and Hard of Hearing is pleased to offer a presentation about Medicare at the upcoming DDHH Advisory Council Meeting. This will be held on Friday, January 27, 2012 @ 10:00 A.M. at the East Brunswick Public Library located at  2 Jean Walling Civic Center, East Brunswick, NJ.
Source: deaftimes.com

Congresswoman Hayworth Opening Remarks: First Meeting of the Conference Committee

“The scope of work of this Conference Committee will touch many important  issues, and I join my fellow conferees in being acutely aware of the painful  challenges that face the people we serve. The unemployment rate in America  has exceeded 8% for nearly three years. In the Hudson Valley of New York,  people worry about being able to afford to continue to live in the beautiful  place they care so much about. Our constituents need to have the opportunity  to have the dignity of productive work, to support their families, to  contribute to their communities, and to realize the dream and the promise  that America has meant to the world, uniquely in history and uniquely among  all nations. They deserve to have a future that offers far better than the  doubt and despair that are engendered by the massive federal debt that has  accumulated at a frighteningly accelerated pace in just the past couple of  years.
Source: wordpress.com

Victory for Men’s Health; Medicare Will Keep Covering Prostate Cancer Screening

Kucinich was joined in his campaign for men’s health by Representatives Dan Burton (R-IN), Don Young (R-AK), Robert Aderholt (R-AL), Joe Baca (D-CA), Marsha Blackburn (R-TN), Michael Burgess (R-TX), G.K. Butterfield (D-NC), Andre Carson (D-IN), Yvette Clarke (D-NY), William Lacy Clay (D-MO), Steve Cohen (D-TN), Gerald Connolly (D-VA), John Conyers (D-MI), Danny Davis (D-IL), Eliot Engle (D-NY), Michael Fitzpatrick (R-PA), Raul Grijalva (D-AZ), Martin Heinrich (D-NM), Mazie Hirono (D-HI), Tim Holden (D-PA), Eleanor Holmes-Norton (D-DC), Sheila Jackson-Lee (D-TX), Jesse Jackson, Jr. (D-IL), Leonard Lance (R-NJ), Billy Long (R-MO), Michael Michaud (D-ME), James Moran (D-VA), Tim Murphy (R-PA), Randy Neugebauer (R-TX), Donald Payne (D-NJ), Bill Posey (R-FL), David Price (D-NC), Charlie Rangel (D-NY), Silvestre Reyes (D-TX), Laura Richardson (D-CA), Jon Runyan (R-NJ), Bobby Rush (D-IL), David Scott (D-GA), Adam Smith (D-WA), Edolphus Towns (D-NY), Maxine Waters (D-CA), Frank Wolf (R-VA) and John Yarmuth (D-KY).
Source: menhealthwizard.com

Health Care Coverage Comparison

Posted by:  :  Category: Medicare

Medicare is a federal health insurance plan for people over 65 years old and some disabled people. It is the primary insurance carrier for old people and the disabled. On the other hand, blue cross is the secondary insurer that covers most of what the primary insurer fails to pay (BlueCross BlueShield Association, 2009). In its design, Medicare does not cover all health care costs which mean clients covered by Medicare are responsible for a high percentage of their health care costs. Medicare patients have to dig deep into their pockets in order to repay for some of healthcare cost.  It has been established that doctors often charge more for the services they deliver than what Medicare will pay and patients are left with a deficit to cover for medical services.  Comparing the medical cost between Medicare and Blue Cross, it is evident that in Blue cross, one pays 2 a month while in Medicare you pay ,156.80 per year.
Source: pi4soa.org

Video: Sonora Resident Fights Blue Cross, Medicare

Anthem Blue Cross makes Freedom Blue Announcement!

Anthem Blue Cross will be offering new Local PPO Medicare Advantage plans in California to make more affordable and attractive benefits available to our members.  We also are not renewing our Medicare Advantage Freedom Blue Regional Plan 1 and Classic Regional PPO plans for 2012.  We also will remove Santa Barbara County in California from the Anthem Blue Cross Senior Secure Plan 1 (HMO) service area.  Affected members will receive a letter the week of September 19 that explains their Medicare coverage options.  Members will continue to have Freedom Blue RPPO plan coverage and Blue Cross Senior Secure Plan 1 (HMO) coverage until December 31, 2011.
Source: themedicareassistant.info

How Does Blue Cross Medicare Crossover Work?

Blue Cross offers the following program choices: Blue Cross Plus, Blue Cross PPO, High Option Supplement to Medicare and Core. Blue Cross Medicare Crossover is an option for all Blue Cross programs. The Blue Cross Medicare Crossover system allows Medicare to directly provide Blue Cross access to a person’s explanation of benefits (EOB), so that neither the individual nor the provider needs to file a separate claim with the insurance carrier after sending a claim to Medicare. The Blue Cross Medicare Crossover system simplifies the procedure. Under the new Blue Cross Medicare Crossover system, most claims are automatically sent to Blue Cross.
Source: seniorcorps.org

Blue Cross Medicare Supplement

Medicare supplementary coverage will often have a deductible, and the amount of that deductible can be altered by the users (although this will change monthly premiums) but beyond this deductible payment, the supplementary policies aim to cover all hospital and medical expenses incurred after Medicare use. Traditionally it is about 80 % Medicare and 20% supplementary insurance. Even as Medicare does cover 80% of hospital fees, lengthy admissions can be so expensive, that all seniors should consider supplementary coverage as a necessity.
Source: medicaresupplementinsurances.com

Blues Plans Eye Investments in Marketing Technology to Prepare For Public Exchanges

Adding plans with narrower networks and lower costs to consumers, developing more wellness programs for members, and forming more patient-centered medical homes and accountable care organizations are several areas where Blues plans will focus investments in this year, says Henry Loubet, vice president and chief strategy officer at Keenan, a California-based consulting and insurance brokerage firm. In the wellness area, IBC, Blue Shield of California (BSC) and Highmark Inc. are working with Boston-based Healthrageous, Inc., which has developed a Web-based platform, mobile apps and other wellness tools, to launch pilots this year that help members develop a personal health profile.
Source: wordpress.com

BlueCross of SC to hire 500 peopleBlue Cross Blue Shield

BlueCross of SC to hire 500 people Blue Cross Blue Shield of South Carolina wants to hire 500 people, most of them for work in the Columbia area. Settlement in antitrust claim against Blue Cross A settlement has been reached in an antitrust complaint against Montana’s largest health insurer and five hospitals over a $26.3 million deal that regulators say would have driven out competition and raised customer prices, state and federal officials said Tuesday. RI Blue Cross to lay off 39 workers to cut costs Blue Cross & Blue Shield of Rhode Island is laying off 39 full-time employees and three part-time worker to cut costs.
Source: medicare-news.com

S.C. BlueCross Names Medicare Services Veteran to Head CGS Administrators

COLUMBIA, SC – October 6, 2011 – BlueCross BlueShield of South Carolina has named Steven B. Smith, a 22-year veteran of the health insurance industry with significant experience in Medicare program administration, president of CGS Administrators LLC, a BlueCross subsidiary company based in Nashville, Tenn. CGS Administrators processes claims and provides administrative services to the federal Medicare program through contracts with the Centers for Medicare & Medicaid Services (CMS). CGS Administrators has approximately 900 employees in Nashville, Des Moines, Iowa, and High Point, N.C., serving more than 16 million Medicare beneficiaries and their health care providers. Smith, a native of Augusta, Ga., replaces Jean Rush, who retired from CGS Administrators after serving as president for 10 years. Smith and his family will move from Columbia, S.C., to Nashville, where he will work at CGS Administrators

VIVA MEDICARE Plus Earns Highest Quality Rating Score in Alabama for Second Year in a Row

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonCMS established the star rating system to give Medicare patients a single summary score for each health plan to make it easier to compare different plans based on quality and overall performance. Plans are ranked on a scale of one to five stars. The overall score is based on more than 50 separate measures that rank member satisfaction, access to appropriate care, and managing chronic conditions. Summary scores for all Medicare Advantage plans can be found at http://www.medicare.gov by searching health plans by zip code. VIVA MEDICARE Plus’ score of 3.5 stars is the highest in Alabama two years running.
Source: bestlongtermcare.org

Video: TV GemCare Medicare Plus 09

Southern Carolina’s Whistleblower Defenses

Welch then whistleblower to archive a claim considering the Department regarding Labor. It is actually amazing what number people actually escape with counterfeit activity plus without any individual even wanting to stop all of them. She or he kept his particular job, built the horrid commute, and put forward the proposition to OSHA that your job copy created any hostile work place in retaliation meant for raising safe practices concerns. Without a doubt more about this kind of whistleblower assert. In several cases, even so, whistleblowers must go green themselves. Whistleblower Research.
Source: swacommerce.com

Treatment Supplement plus Medicare Plus

However you can also check out and the second companies that give you a supplement medicare insurance insurance as being the deal you will definitely get maybe healthier. One remaining mistake avoiding in opting for Texas Medicare insurance insurance is intending to practice it alone. With twenty different add to plans plus changing guidelines, the whole mess is usually confusing with a good morning. Medicare add to insurance, also generally known as Medigap plan, is provided by private insurance agencies to covers gaps with original Medicare insurance plans.
Source: vannoyandreeves.com

Medicare health insurance Supplement Insurance charges And Gains

Any Treatment supplement insurance could be purchased within few months of buying Medicare. The rather quickly you create the software, the additional money you may eventually are given. citizens plus residents. However, there could be an easier option to shop plus compare. False information might cause a state denial, or cover cancellation. Never pay off in dollars and always generate a check payable merely to the insurer, not this agent. Your own most suitable option would depend your wellness needs, budget, and life-style. Home medical care patients who sadly are covered beneath Medicare usually have many protective health services designed to them at little if any cost.
Source: easysearchasp.net

Understand Medicare Part C and D Plus Your Other Options

Medicare Part D is an outpatient prescription drug benefit that is offered to everyone who has Medicare. To receive this coverage, you have to pay for a health plan offered by a Medicare-approved private insurance company or enroll in a Medicare Advantage plan which includes drug coverage. Although the plans are varied with different drugs covered in each, all medically necessary drugs are covered. You can select a plan that best suits your needs.
Source: refugioaa.org

Awareness Medicare plus Medigap

Insurance policies that will cover the actual expenses related to long-term care are usually offered as a result of various organizations that sell most of these products. Remember to be healthy and continue to your doctor!. For , the Treatment commence the spot that the Medicare quits. This can come as an important surprise by some individuals just who mistakenly presumed that Treatment could replace the medical insurance they will had using their company employer or a private provider. You will quickly realize that prepare A is the standard supplemental Treatment plan and the plan L provides greatest level of coverage. Likewise, you will discover that method A is the most affordable, whereas method L is definitely the most overpriced. There are actually some insurance policies salespeople these days who may seek to trick most people into believing if you pay off more regarding basic insurance policy, such seeing that plan An important, you receives better insurance policy. This is false.
Source: cfc-kw.net

Medicare Supplement Quotes

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS 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: orcasislandevents.com

Video: Choosing a Medicare Supplement Policy in 2011

What Is A Medicare Supplement

Tagged with: consolidated retirement system • deaderick street • department of financial and professional regulation • illinois department of financial and professional regulation • medicare supplement plans • medicare supplement policies • medicare supplement policy • naic model • professional regulation division • social security number • state zip code
Source: experthealthadvisor.org

The Importance Of Medicare Supplemental Insurance Policy

Some would want that their prescription drugs will be covered by medicare insurance as well. This is possible with Part D or Prescription Drug Plan, which you can enroll by the time you become eligible to enroll for Medicare Part An and B. Availing of the Part D plan at some time later will charge you extra fees for penalty. Part D is not standardized in terms of coverage and pricing, unlike the case with medicare supplement insurance plans. As mentioned earlier, medicare supplemental insurance plans are standardized across all health insurance companies. They will vary somehow in the manner they do customer service or the price of the premiums. Given this information, it will be therefore easier for you to get to know what each medicare supplement insurance plan has to offer, and then, compare prices and service between companies that offer your chosen medicare supplement plan. GOMEDIGAP is a true leader in medicare and guarantees to ensure to give only the best plan that should work for you.
Source: webdesignattitude.com

Very best Offers in Medicare Supplemental Insurance policies (Medigap)

Target on what the Medigap plan will cost you around time, and recall that you can expect to have a difficult time switching options when you might be older until your health and fitness continues to be excellent. It is recommended to stick with options that never boost your rates just due to the fact you might be obtaining older. That means it is safer to pick group-rated or issue-age form insurance policies even if the rates get started out a minor higher with credit counseling programs.
Source: lakecountyblackbears.com

Take Care Of Your Wealthy Health With Medicare Health Plans

Health is the wealth. Taking care of this wealth is always a primary concern of us. Look at the basic things of health insurance policies. Medicare original sometimes has some holes in its applications and therefore the applicant or the policy holder need sometimes an extra supplemental policy to cover the gaps. And the Medicare supplemental insurance policy is that kind of policy which fills up the gaps. But there are some required things which you have to do before applying for Medigap Health Insurance Plans. Medicare supplemental plans are invented by many private insurance companies to aid the original government plan on exclusively health care. The original program do covers the basic requirements but there are many extra cares that are remained unattended. All these cares are taken in consideration by Medigap or Medicare supplemental plans. You have to do this side by side of the original one and have to pay an amount of money annually or monthly and then you will be able to fetch the maximum or complete advantages of the original Medicare plans.
Source: ralphbuckley.org

Why Medicare Supplement Insurance?

Many people will rapidly recognize that the commonest kind of these insurance policy is termed Medicare supplement PlanF. This plan will take care of all of the gaps in Medicare Health Insurance. The only thing necessary is an approval by Medicare Health Insurance. The plan is also designed to be inexpensive for retired individuals. One More similar form of program is known as Medicare Health Insurance planG. This plan is fundamentally exactly like PlanF, only it does not cover part B deductible. This is a plan that is wonderful for those who find themselves older than 75. However, many people who fall in the 65 to 75 may still realize that this is perfect for them. Lastly there is a most recent from the three programs, PlanN. This is a similar plan to PlanG, the only difference becoming it has up to$ 20 copay for visits to the doctor and a$ 50 copay for trips towards the emergency room.
Source: 888jeffcline.com

The Necessity Of Medicare Supplemental Insurance Policy

Besides hospital services, you might as well want to consider getting covered for other medical services like outpatient care, laboratory services, home care and preventive health care services. Actually, part B is elective, but because of the services it covers, most would apply for this along with medicare part An and a medical supplemental insurance. Now, there are also some policies that are approved by medicare, that are offered by private companies. The Medicare part C or the Medicare Advantage Plan, as it is commonly called, provides all of the part A hospital insurance coverage as well as part B medical insurance coverage, so you are always covered in case of emergency, urgent care o preventive health check. The combined benefits do sound pleasing, but noted that part C is not all the time accepted by most doctors and hospitals like most medicare supplement insurances, not so many would opt for this plan as it does not allow you to get a medicare supplement s well.
Source: easyarticle.org

Medicare health insurance Supplement Insurance Really helps to …

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSIn the public presence of the brand new health care laws, Benefit plans are beginning to shed their financial assistance. Its expected these plans can be increasingly expensive using the decline of presidency subsidies. Medicare supplement insurance, often called Medicare health insurance supplement insurance, is a possible option. With 10 various plans, each one floods the gaps in Medicare health insurance in a different way so elderly people are free to decide on only the advantages they need without having to pay for any extra supplies. Medigap plans protect Medicares Part A and also Part B deductibles to create seeing the physician and see the hospital when youd like less expensive. These programs can also protect Medicares co-pays and also co-insurance charges, and specific plans expand Medicares protection to services beyond First Medicare, such as crisis medical care for all those out from the country
Source: posterous.com

Video: Understanding Medicare Supplements, Medicare Supplement Insurance

Why Medicare Supplement Insurance?

Many people will rapidly recognize that the commonest kind of these insurance policy is termed Medicare supplement PlanF. This plan will take care of all of the gaps in Medicare Health Insurance. The only thing necessary is an approval by Medicare Health Insurance. The plan is also designed to be inexpensive for retired individuals. One More similar form of program is known as Medicare Health Insurance planG. This plan is fundamentally exactly like PlanF, only it does not cover part B deductible. This is a plan that is wonderful for those who find themselves older than 75. However, many people who fall in the 65 to 75 may still realize that this is perfect for them. Lastly there is a most recent from the three programs, PlanN. This is a similar plan to PlanG, the only difference becoming it has up to$ 20 copay for visits to the doctor and a$ 50 copay for trips towards the emergency room.
Source: 888jeffcline.com

Medicare health insurance Supplement Insurance coverage: A Most suitable of Junction?

One research gave a specialized dollar quantity that senior adults essentially saved on clinical. Those whom used a gym facility at the least twice 7 days for an important two-year span, had an important $1, 252 lowering of the buying price of their clinical during Medicare Supplemental Insurance Texas year as opposed to people whom used a gym less than weekly. Programs the fact that combine dance and strength training produce improved benefits when compared to resistance workout routines alone, lucky author and commentator Johnathan Santos advised.
Source: endhungerinamerica.net

Deciding What Medicare and Medigap Supplemental Insurance Coverage Suits Participants

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressAs 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: onlineweblibrary.com

Video: Understanding Medicare Advantage Plans

Medicare Changes Set for 2011

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 A Medicare Supplement

Tagged with: consolidated retirement system • deaderick street • department of financial and professional regulation • illinois department of financial and professional regulation • medicare supplement plans • medicare supplement policies • medicare supplement policy • naic model • professional regulation division • social security number • state zip code
Source: experthealthadvisor.org

The Importance Of Medicare Supplemental Insurance Policy

Some would want that their prescription drugs will be covered by medicare insurance as well. This is possible with Part D or Prescription Drug Plan, which you can enroll by the time you become eligible to enroll for Medicare Part An and B. Availing of the Part D plan at some time later will charge you extra fees for penalty. Part D is not standardized in terms of coverage and pricing, unlike the case with medicare supplement insurance plans. As mentioned earlier, medicare supplemental insurance plans are standardized across all health insurance companies. They will vary somehow in the manner they do customer service or the price of the premiums. Given this information, it will be therefore easier for you to get to know what each medicare supplement insurance plan has to offer, and then, compare prices and service between companies that offer your chosen medicare supplement plan. GOMEDIGAP is a true leader in medicare and guarantees to ensure to give only the best plan that should work for you.
Source: webdesignattitude.com

Facts about Medicare Insurance

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Source: articlemtv.info

What About Medigap Plans Is Not Standardized?

Another thing you want to clear about exactly what each specific type of Medigap Insurance covers. Plan A has the fewest benefits and Plan F has the most comprehensive coverage. The other plans offer a range of choices and combine benefits in various ways. Some plans reimburse for 50, 75 or 100 percent of Medicare’s biggest deductible. That’s the Part A deductible on hospitalization. It’s up to $1,132 and Congress declares how much it will be each year.
Source: articlesbacklink.com

Understand Medicare Part C and D Plus Your Other Options

Medicare Part D is an outpatient prescription drug benefit that is offered to everyone who has Medicare. To receive this coverage, you have to pay for a health plan offered by a Medicare-approved private insurance company or enroll in a Medicare Advantage plan which includes drug coverage. Although the plans are varied with different drugs covered in each, all medically necessary drugs are covered. You can select a plan that best suits your needs.
Source: refugioaa.org

Take care when changing Medicare coverage during the Medicare Advantage disenrollment period

1.      Know the gaps in Original Medicare (Parts A and B): Similar to Medicare Advantage, original Medicare (Parts A and B) has deductibles and coinsurance. But, unlike Medicare Advantage, Original Medicare doesn’t have a cap on how much you may have to spend out of your own pocket each year if you get sick or injured. Per the 2010 health care reform law, all Medicare Advantage plans must place a $6,700 limit on what you can be asked to spend out of your own pocket for covered medical services (some have lower caps). And, original Medicare does not cover the cost of prescription drugs.
Source: tipsforboomeryears.com

1/25 Medicare FFS Call on HIPAA 5010

Posted by:  :  Category: Medicare

San Diego, CA by Oggie DogIf you would like to submit a question related to this topic in advance of, during, or following the call, please email your inquiry to 5010FFSinfo@CMS.hhs.gov.  Please note that this resource box will only accept emails the day before, the day of, and the day after this call; your emailed questions will be answered as soon as possible, and may not be answered during the call.
Source: wordpress.com

Video: EHR: Medicare and Medicaid Incentive Program Registration Webinar for Eligible Hospitals

How Libertarian Dogmatists Are Sabotaging Ron Paul’s Campaign

Ron Paul should be making the point that Social Security and Medicare are threatened by multi-trillion dollar wars that are funded by debt, by bailouts of a deregulated banking system, and by money creation to keep the banks afloat. Libertarians support deregulation, but their position has always been that deregulated industries must not be bailed out with public subsidies, much less subsidies that are so extensive that they threaten government solvency and the value of the currency.
Source: warpspeed.com

UCI faulted for drug errors in Medicare inspection

An unidentified man, 63, underwent a kidney transplant in July. During surgery, he was to receive an intravenous dose of an anti-rejection medication over six hours. Instead, a doctor in the third year of anesthesia residency programmed the infusion pump to deliver the dose in only one hour. The pump sent an alert indicating the rate was too high. The resident, however, overrode the alert. Inspectors found that the hospital failed to program the pump to stop the override, the documents say.
Source: ocregister.com

Medicare "IS" the Answer for Any Insurance Agent or…

The software is part of the B.A.T.T.L.E. System that includes a personalized website, complete with a life insurance and Medicare quote engine, along with direct mail and email marketing. In the current economic climate, agents can’t afford to sit and wait for clients to come to them. The Medicare software and B.A.T.T.L.E. System utilizes the latest in technology and actively works to connect potential clients with agents.
Source: newsguide.us

Why Do You Need a Medicare B Coverage

By: Medicare Part B covers additional medical protection for citizens which might be currently receiving Medicare. This covers the benefits that aren’t contained in the medical care coverage of Medicare Part A. Part B covers medical and professional services like outpatient care, professional services (rendered inside hospital or with an office setting), medical equipment and supplies, home health services, laboratory works, ambulance use and rehabilitation and physiotherapy services. You knows from your Medicare card if you are handled by Plan B. Once you are a member, it really is per the credit card. However, once you’re not covered don’t worry for you can still enrol to be a person in Plan B. In case your enrollment period had lapsed (this is 3 months before and Three months following members 65th birthday) your Plan B coverage will be expensive. You can click on the Social Security Office and enroll correctly. There exists a monthly fee that will be taken out of your retirement benefits or Social Security Payment. The fees that you have to pay for Part B depends upon your wages with an annual deductible fee for that services of Part B. Once you had paid the deductible, your medical benefits will start. All of the expenses that you will get together will have a 20% co-pay. After you finished with the entire process of enrollment, you are needed to choose the medical plan. You have to pick the coverage carefully which you think will offer you benefits that you would wish. You may pick the options between your Original Medicare Coverage, Medicare Advantage or Medicare fee for service coverage form of hosting services. If you want to change your coverage to Medicare Advantage, it’s going to cover all of the expenses the first Medicare does not cover. Advantage Plan will take care of the Part A, B and D Medicare feature and prescription costs. This means all of the Medicare coverage is featured in one plan and also this is the Medicare Advantage Plan or sometimes called Medicare Part C. This is governed by private companies that are approved by Medicare. Everyone who turns 65 is automatically participating in Part A Medicare and Part B Medicare.. Moreover, if you remain working with this age, and you are not a person in the RRB or Social Security, you should enroll on the Social Security office for more gains advantage from Medicare. You may choose to enroll three months before or three months after your 65th birthday. When you already are 65 yrs . old also it falls on the first day in the month, your coverage will need relation to the very first day of last month. Likewise, in case your birthday is on July 10, your coverage will require impact on July 1. Get step by step guide to understand medicare part b plan here. Check out more about medicare part b here. Article Courtesy of EzinePR.com – Submit Articles for Your Business
Source: ezinepr.com

WHAT OTHERS SAY: Private Medicare plans have been a disaster

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

Does Rob Cornilles want to privatize Medicare? PolitiFact Oregon

Turning Medicare over to profit-minded insurance companies hasn’t been too popular an idea with seniors, or soon-to-be seniors, who want to make sure the government health care program is around for them when they need it most. So it’s no wonder that Democrats here and nationally are claiming that Republican Rob Cornilles, in the 1st Congressional District special election, wants to privatize Medicare. He faces Democrat Suzanne Bonamici in the Jan. 31 election. We rule the statement Mostly False. Find out why we ruled the way we did. Then return to OregonLive and give your views.
Source: oregonlive.com

News from Medicare & Other Payers for the Week of January 23, 2012: 5010 National Provider Call This Week; Most Insurances Will Be Required to Cover Birth Control Without Co

In August 2011, the Department of Health and Human Services issued an interim final rule that will require most health insurance plans to cover preventive services for women including recommended contraceptive services without charging a co-pay, co-insurance or a deductible. The rule allows certain non-profit religious employers that offer insurance to their employees the choice of whether or not to cover contraceptive services. Today the department is announcing that the final rule on preventive health services will ensure that women with health insurance coverage will have access to the full range of the Institute of Medicines recommended preventive services, including all FDA -approved forms of contraception. Women will not have to forego these services because of expensive co-pays or deductibles, or because an insurance plan doesnt include contraceptive services. This rule is consistent with the laws in a majority of states which already require contraception coverage in health plans, and includes the exemption in the interim final rule allowing certain religious organizations not to provide contraception coverage. Beginning August 1, 2012, most new and renewed health plans will be required to cover these services without cost sharing for women across the country.
Source: managemypractice.com

CMS Finalizes Rules Regarding Eligibility for Medicare Prescription Drug Subsidy : Duane Morris Health Law

On January 17, 2012 the Centers for Medicare & Medicaid Services (“CMS”) adopted as a final rule changing Medicare’s Extra Help Program.  The Extra Help Program is a prescription drug coverage low-income subsidy created through the Affordable Care Act (“ACA”).  Effective January 18, 2012, the final rule incorporates the ACA’s changes to the Extra Help Program by extending eligibility for one year after the death of a beneficiary’s spouse that would otherwise decrease or eliminate the subsidy.  The final rule also implements changes to the Medicare Improvements for Patients and Provider Act of 2008 by excluding from a resource (for purposes of Extra Help eligibility) the value of life insurance policies or income for food, shelter, and certain household bills.   
Source: duanemorris.com

THE Consortium: January 3rd Marked the One Year Milestone for the Medicare and Medicaid EHR Incentive Programs

January 3rd was the one year anniversary of the start of registration for the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs. Over the past year, there has been a tremendous amount of interest in the incentive programs as providers across the country have implemented EHRs. Year one highlights include: 43 states have started their Medicaid EHR Incentive Programs Over 176,000 people have registered for the Medicare and/or Medicaid EHR Incentive Programs Over $2.5 billion has been paid in incentive payments to eligible professionals (EPs) and eligible hospitals and critical access hospitals (CAHs) across the country CMS has created useful resources to participants in the Medicare and Medicaid EHR Incentive Programs. A few new resources include: An Introduction to the Medicare EHR Incentive Program for Eligible Professionals- this interactive guide walks EPs through every aspect of the Medicare program, and provides helpful resources and tips along the way. Updated User Guides- CMS has updated the registration and attestation user guides, which direct EPs and eligible hospitals through CMS’ registration and attestation system. There are five guides that all can be downloaded from the Educational Materials page of the CMS website. Provider Testimonial Videos- these videos, which can be found on the CMS YouTube channel, highlight providers’ experiences participating in the EHR Incentive Programs. A Look Ahead As we move into 2012 and the second participation year of the Medicare and Medicaid EHR Incentive Programs, CMS is hopeful that providers will begin or continue their participation in the programs, and take advantage of these incentives for meaningful use of EHRs. If you are considering registering for the programs, but have not done so yet, take a look at the CMS EHR website and use our eligibility tool to find out if you can participate. Remember: 2012 is the last year in which EPs can receive a full incentive payment in the Medicare EHR Incentive Program. Beginning in 2013, EPs will receive a smaller overall total payment.
Source: blogspot.com