Medigap is a vital source of coverage for low

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Gravel MediGap by Mike Licht, NotionsCapital.com3rd Party Studies ACOs Admin Costs Cadillac Tax cbo Cost-Shift Dual Eligibles Employers Essential Benefits Exchanges GRP HAIs Health Plan Satisfaction House hearings House legislation KI MA Makena McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT NHE Patient Safety premiums Premium Tax Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Video: Learn About Medigap Plans

Advisory Panel Urges New Fee On Medigap Plans, Cap On Out

CQ HealthBeat: Medicare Coverage Not As Generous As Large-Employer Plans Medicare coverage has gotten better in the past few years with the addition of prescription drug coverage, but it’s still not as generous on average as the private employer-sponsored insurance offered by large companies or the federal government, according to a new study by the Kaiser Family Foundation. The average value of Medicare is almost as good as the Blue Cross/Blue Shield standard option plan offered to federal workers, with Medicare’s benefits worth about 97 percent of the value of the federal plan, the report says. The typical large-employer preferred provider organization (PPO) is better than both. Medicare’s coverage equals about 93 percent of the typical big-company PPO benefits (Adams, 4/5).
Source: kaiserhealthnews.org

Medigap Insurance Q & A

So you know what medigap insurance is and why you need it. Now you need to know if you’re even eligible for medigap insurance. Well, first you have to be enrolled in part A and B of Medicare before you can enroll in a medigap insurance plan. Or during the enrollment period that begins 6 months of turning 65 or getting Medicare part B at 65 or older, a person may obtain a medigap plan on a guaranteed issue basis.  Outside the open enrollment, the insurance company may require medical screening ad could obtain an attending physician’s statement if necessary. Medigap insurance isn’t compatible with other forms of Medicare coverage, like a Medicare advantage plan.
Source: medicarequotefinderblog.com

Some Differences Among Medicare Part A and Medigap

Medicare Part A provides for inpatient medical center care, covering up to 90 days per advantage period and 60 reserve days for your lifetime, as well as Hhundred days per advantage within a skilled nursing jobs facility for proper care. To qualify for the skilled nursing jobs facility care, even though, you must have stayed at the hospital for three straight days within 30 days prior to admission to the ability. Hospice care can also be supplied if you are confirmed to terminally ill by your medical professional. Home health care is covered throughout Medicare Part A for 100 nights, with the same stipulation which you have stayed in the medical center for three days, these kinds of being within two weeks prior to receiving proper care and being homebound. Medicare Part B deals with many outpatient doctor services. These include regular doctor visits as well as some protective services, durable health care equipment, ambulance services for emergency transportation, and x-rays and diagnostic tests. It also includes outpatient physical, conversation, and occupational therapy services and also other home health services.
Source: autoinsurance-michigan.net

Some Differences Among Medicare Part B and Medigap

Medicare Part A provides for inpatient medical center care, covering up 90 days per profit period and 60 reserve days for the lifetime, as well as one hundred days per profit within a skilled breastfeeding facility for proper care. To qualify for the skilled breastfeeding facility care, however, you must have stayed on the hospital for three sequential days within 30 days prior to admission to the ability. Hospice care can also be provided if you are confirmed to be terminally ill by your physician. Home health care is covered within Medicare Part A for 100 times, with the same stipulation that you have stayed in the medical center for three days, these kinds of being within 2 weeks prior to receiving proper care and being homebound. Medicare Part B deals with numerous outpatient doctor solutions. These include regular visits to the doctor as well as some preventive services, durable healthcare equipment, ambulance solutions for emergency travel, and x-rays and tests. It also includes outpatient physical, talk, and occupational therapy services as well as other home health solutions.
Source: autoinsurancegeorgia.net

Medicare, “Medigap” and Medicare Advantage Plans

Yes. Another example: Citing language in the ACA, the Department of Health and Human Services has exempted Medicare Supplement carriers from so-called “rate review rules.” This means that Supplement carriers will be free to increase the rates and premiums they charge for the coverage without HHS oversight. This exemption will become important in a few years, when the ACA’s “guaranteed issue” standards are fully implemented. At that point, people will probably be paying more for Medicare Supplement coverage, even though the plans will likely cover less.
Source: online-health-insurance.com

Medicare Supplement Insurance: How could you Find The Best Price In your State?

Technorati Tags: Combinations, health insurance, Independent Company, insurance, Insurance Companies, Insurance Insurance, Insurer, medical insurance, medicare, Medicare Insurance, Medicare Plans, Medicare Supplement Insurance, Medicare Supplement Plans, Medicare Supplemental Health Insurance, Medigap Plans, Missing Letters, Old Woman, Premium Prices, Star Ratings, Supplemental Health Insurance, Variations, Weiss Ratings Inc
Source: choosinghealthinsurance.net

Excellus Medicare Part D plans gets top rating

Posted by:  :  Category: Medicare

Excellus BlueCross BlueShield’s Simply Prescriptions Medicare Part D drug plan has won plaudits from the Centers for Medicare and Medicaid Services as the only stand-alone Part D program in New York, and one of three nationally, to win CMS’ five-star rating.
Source: townstart.com

Video: Excellus BCBS Medicare plan travels with you

Medicare Options: Navigating the Road Ahead

The clinics are open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan. Pneumonia shots will also be offered at the flu clinics for Medicare Part B recipients age 65 and older. If your children’s immunizations are covered by medical insurance, parents are advised to seek flu shots for them at their regular medical provider. This can help cut down on out of pocket costs, especially for children who require a second dose of the vaccine because of their age. Children 6 months through 8 years of age who did not receive at least one dose of the 2010-2011 vaccine, or whom it is not certain whether the 2010-2011 was received, should receive 2 doses of the 2011-2012 seasonal vaccine. Source: gobroomecounty.com
Source: medicaresupplementalco.com

Health And Dental Insurance Quotes

2010 Top 10 Health Insurance Companies + Free Health Insurance Quotes from Top Health Carriers Issued below, a health insurance report card for the top health insurance companies in the United States. Named below are the Top 10 Commercial Companies, the Top 5 Best Medicare Plans, and the Top 5 Medicaid Plans. Each plan considered for the ranking was rated between 0 and 100. Scores were based on data from the National Committee for Quality Assurance. After reviewing the top 10 health insurance companies feel free to stop over for a Free Life Insurance Quote from all the Top Carriers.
Source: candrworld.com

Medicaresolutions.com Estimated Value $11,152.80 USD

The data contained in GoDaddy.com, LLC’s WhoIs database, while believed by the company to be reliable, is provided “as is” with no guarantee or warranties regarding its accuracy. This information is provided for the sole purpose of assisting you in obtaining information about domain name registration records. Any use of this data for any other purpose is expressly forbidden without the prior written permission of GoDaddy.com, LLC. By submitting an inquiry, you agree to these terms of usage and limitations of warranty. In particular, you agree not to use this data to allow, enable, or otherwise make possible, dissemination or collection of this data, in part or in its entirety, for any purpose, such as the transmission of unsolicited advertising and and solicitations of any kind, including spam. You further agree not to use this data to enable high volume, automated or robotic electronic processes designed to collect or compile this data for any purpose, including mining this data for your own personal or commercial purposes. Please note: the registrant of the domain name is specified in the “registrant” field. In most cases, GoDaddy.com, LLC is not the registrant of domain names listed in this database. Registrant: Health Plan One Registered through: GoDaddy.com, LLC (http://www.godaddy.com) Domain Name: MEDICARESOLUTIONS.COM Domain servers in listed order: NS.RACKSPACE.COM NS2.RACKSPACE.COM For complete domain details go to: http://who.godaddy.com/whoischeck.aspx?domain=MEDICARESOLUTIONS.COM
Source: widestat.com

Involuntary Changes to MCSO Retirees Medical Benefits

A retired MCSO Deputy began receiving various documents from the Monroe County Human Resources Department. The documents advised him that form(s) enclosed with the documents had to be completed by his 65th birthday or he would lose all of his medical benefits. When the retired Deputy reached the age of 65, he received more written correspondence from the Monroe County Department of Human Resources concerning his medical benefits coverage for both himself and his spouse; specifically, that his primary care coverage was changed to Medicare (we have been informed/advised that this happens to everyone). Furthermore, the Deputy’s secondary coverage was involuntarily changed to Excellus Medicare Blue Choice (HMO-POS). For over fifty years, it has been customary for retirees to remain in the same plan throughout the length of their retirement; this, however, seems to no longer be the case. Secretary Flannery advised SOAR President Ed Ramsperger of the situation and also spoke with Monroe County Deputy Sheriff’s Association (MCDSA) Jail Union President Wayne Guest. President Guest felt that this was a very important issue and invited Secretary Flannery and President Ramsperger to the next Jail Union Board meeting to discuss the matter. The retired Sheriff’s Deputy who originally contacted Secretary Flannery was also invited to share his experiences at the meeting. At the Jail Union Board meeting, this topic was discussed and the Jail Union Board voted unanimously to “take on” the matter and begin a dialog with the Monroe County administration to determine just what was happening and how to get the matter solved to the satisfaction of all involved.
Source: monroecountysoar.com

Excellus BlueCross BlueShield Emphasizes Fitness For Seniors

Any American who is 65 years old or older has access to Medicare, but only covers a limited amount of health care costs. That’s why many seniors purchase Medicare Supplement plans from private insurance companies to fill in the coverage gaps.
Source: gohealthinsurance.com

AG office to sue Excellus Blue Cross Blue Shield (News

AG office to sue Excellus Blue Cross Blue Shield (News 10 NBC Rochester) Attorney General Andrew Cuomo’s office will sue Rochester-based insurer Excellus claiming it defrauded consumers… Blue Devils beat Tigers (Ravalli Republic) CORVALLIS – Blue Devil Dalton Sybrant posted 31 points as the Corvallis boys earned a nonconference 88-48 win over the visiting Darby Tigers Thursday. Mountain State Blue Cross Blue Shield CEO to give up daily duties on July 1 (The Charleston Gazette) PARKERSBURG, W.Va. — The president and chief executive of West Virginias largest private health insurer plans to leave that post on July 1.Gregory K. Smith led Mountain State Blue Cross Blue Shield for the past 15 years. In July, Smith will become the non… Frustrations mount as hospital remains locked in insurance battle with Blue Cross (Rapid City Journal) Spearfish Regional Hospital and Wellmark Blue Cross and Blue Shield still don’t have a contract, despite growing frustration from the community and help from a consultant.
Source: medicare-news.com

National Influenza Vaccination Week December 4

(BINGHAMTON, NY) – In observance of National Influenza Vaccination Week, the Broome County Health Department will be holding a flu clinic on Monday, December 5, 2011 from 1:00 p.m. to 4:00 p.m. at their offices located at 225 Front Street, Binghamton. The clinic is open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan.
Source: gobroomecounty.com

“Medicare: Changes in premiums and deductibles for 2010.” March 10, 2010. NYSUT: A Union of Professionals. www.nysut.org

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! .....item 1..Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552For inpatient hospital care covered under Part A, the 2010 deductible is $1,100 each benefit period. (A benefit period begins the first day you enter the hospital and ends when you have not received hospital care for 60 days in a row.) While there is no daily coinsurance for the first 60 days of your hospital stay, during days 61 to 90, you will pay $275 per day. The daily coinsurance for lifetime reserve days will be $550 in 2010. (If you have Part A, you are afforded 60 lifetime reserve days, which you can use to cover one or more hospital stays throughout your life.) If you receive care in a skilled nursing facility in 2010, there is no coinsurance for days 1-20. The daily coinsurance for days 21-100 is $137.50.
Source: nysut.org

Video: Medicare Supplement Plans – Changes for 2010

How Much Will A Retired Couple Spend On Health Care? $240,000

The Associated Press: Retired Couples May Need $240,000 For Health Care Couples retiring this year can expect their medical bills throughout retirement to cost 4 percent more than those who retired a year ago, according to an annual projection released Wednesday by Fidelity Investments. The estimated $240,000 that a newly retired couple will need to cover health care expenses reflects the typical pattern of projected annual increases. The Boston-based company cut the estimate for the first time last year, citing President Barack Obama’s health care overhaul. Medicare changes resulting from that plan are expected to gradually reduce many seniors’ out-of-pocket expenses for prescription drugs (Jewell, 5/9).
Source: kaiserhealthnews.org

Medicare Part D Open Enrollment to Begin Soon

6. Seek help if you need it: Medicare changes typically come every year. But reviewing options and choosing a new plan can be confusing for consumers or those attempting to help them. For help, you can go to the government’s website as well as volunteer organizations, private-sector plans, and other resources like the AARP (American Association of Retired People) , the National Council on Aging (NCOA), and the Medicare Rights Center. You can also check out the State Health Insurance Plans (SHIPs), which are part of a federal network of State Health Insurance Assistance Programs located in every state.
Source: bnaibrithdenver.org

Medicare changes saved Idahoans $8.7 million, feds say

The 2010 health care reform law, known as the Affordable Care Act, provides a discount for Medicare beneficiaries who fall into that hole. The law provides 50 percent discount on brand-name drugs and a 14 percent discount on generics. Last year, it provided a 7 percent discount on generics.
Source: idahostatesman.com

AARP MEDICARE SUPPLEMENT CHANGES FOR JUNE 1, 2010 « Insurance News from Crowe & Associates

Supplement Plan N- Will have up to a $20 copay or coinsurance (whichever is less) after the part B deductible has been met.  The plan will also have a $50 copay for emergency room visits.  The pricing for June 1, 2010 is $154.75 which will be pitted against the revised plan F supplement at $207.75 (No change from current F plan price)
Source: croweandassociates.com

Medicare changes explained in forum

During her program, Landreth covered the four basic parts of Medicare — A (hospitalization and inpatient services), B (medical insurance such as primary care, specialists, outpatient services, medical supplies and preventative screenings), C (Medicare Advantage Plans which replace Medicare A and B such as HMOs and PPOs), and D (prescription drug insurance). She also discussed supplemental insurance programs, which will pick up the 20 percent Medicare doesn’t cover depending on a customer’s level of coverage and two assistance programs (The Medicare Savings Program and The Extra Help Program) that people may qualify for based on income that will pay for Medicare Part B premiums and prescription drug costs. Landreth said that the major change for the upcoming year is the monthly premiums people pay.
Source: co.uk

Acuity Personal Tax Advisors: Health Care Law Scheduled to Bring Three Key Tax Changes

Medicare surtaxes. Taxpayers will owe a new 3.8% Medicare surtax on the lesser of net investment income or the amount by which modified adjusted gross income (MAGI) exceeds an annual threshold of $250,000 for joint filers and $200,000 for single filers. For this purpose, “net investment income” includes interest, dividends, royalties and annuities, rent and other passive activity income, capital gains from the sale of property not used in your business, and trading of financial instruments and commodities. It does not include business income, income from tax-free municipals, or distributions from IRAs and qualified retirement plans. In addition, a separate 0.9% Medicare surtax applies to earned income in excess of $250,000 for joint filers and $200,000 for single filers. A taxpayer might have to pay both surtaxes.
Source: acuitypersonaladvisors.com

The Current State of Medicare

We christened a voucher plan that contained all three of these elements, including effective risk adjustment. We christened that system “premium support.” The term had not previously been used, but rapidly came into widespread use. The National Bipartisan Commission on the Future of Medicare adopted it three years later. So have others. The name, “premium support,” was and is often applied to plans that lacked one, two, or all three of the safeguards that we regarded as essential. My point, let me stress, is not a semantic quibble. The meanings of words in common use often change. But when a term is used in ways that obscure important policy distinctions, the misuse is harmful. V John Maynard Keynes is alleged to have quipped: “When the facts change, I change my mind. What do you do, sir?” As time passed, circumstances with respect to health care policy in general and Medicare policy in particular have changed. With those new facts, my views of premium support have also changed. While I would not go so far as to argue that premium support should never be considered for Medicare, I believe that there are overwhelming and persuasive reasons why it should not be enacted now. I also have become less confident that premium support, even if it works for the rest of the population, would be desirable for Medicare. But it is too early to be sure. That said, I believe that there are several changes to Medicare that should be made promptly. These changes would lower costs, improve quality, and enhance fairness. I shall mention a few briefly in the next section of my testimony. Improved Financial Prospects. The Affordable Care Act has significantly improved the financial prospects of the part A trust fund. Even with the increased cost estimates in the 2012 Trustees Report, the cumulative deficit over the next quarter century could be closed by a payroll tax increase of just 0.35 percent each on workers and employers. It could also be closed by changes in premiums, cost sharing or other program elements that achieved equivalent savings. For Medicare as a whole, the Affordable Care Act has reduced by nearly half the anticipated increase in the program’s cost as a share of GDP. The currently projected increase is 2.1 percentage points over the next quarter century. That increase is not trivial, but in my view, it does not come close to meriting characterization that Medicare is in crisis or that Medicare is unsustainable.[7] Improved Backup Protection. The Affordable Care Act has not only directly improved Medicare financing, by raising revenues and reducing outlays. It has also created a back-up administrative safeguard, the Independent Payment Advisory Board. If growth of program outlays exceeds statutory targets, the IPAB is charged to design ways to hold growth of Medicare spending to those targets. The Congressional Budget Office believes that Medicare spending over the next decade will be within targets set in the Affordable Care Act and that the IPAB will not be required to act. But over the longer haul, this organization can help prevent Medicare spending from growing excessively. Congress is free to substitute alternative controls of its own design if it does not like the IPAB’s recommendations. I believe that some changes in the IPAB’s powers and organization could improve its effectiveness. Health Insurance Exchanges. No plan that lacks aggressive regulation of insurance offerings and how they are sold merits designation as ‘premium support.’ No plan that lacks such regulation has any chance of enabling Medicare enrollees to make rational choices among plans, nor could it discourage competition based on risk selection. None of the plans now sailing under the premium support flag pays more than passing attention to this matter. None has drafted legislative language specifying how such regulation would be done. As it happens, we are in process of designing health insurance exchanges. The Affordable Care Act invites states to create exchanges to regulate insurance offerings and sales to those who are not insured through work or through a public program. This effort shows that numerous practical and political problems must be solved in order to make these exchanges work. I have no doubt that these problems can be solved—and, with good will, they will be solved. But we do not yet know answers to some key questions. For example, we do not yet know whether state-based exchanges will work better than regional exchanges or a single national exchange. If the state exchange model is viable, we don’t yet know which forms of exchange will work best.[8] Furthermore, the population to be served by the Affordable Care Act is both smaller and easier to handle than would be the Medicare population. The enrollees in the ACA exchanges will be neither elderly nor disabled. Millions of Medicare enrollees suffer from various degrees of mental impairment. For that reason, the ability of the ACA population to process information will be superior to that of the Medicare population. Because the level and variance of health spending among the ACA population is far lower than are those of Medicare enrollees, incentives for insurers to compete based on risk selection under the ACA will be smaller than they would be if the exchanges also covered Medicare enrollees. Health insurance exchanges that will operate well with the ACA population may or may not be able to handle the Medicare population. To move ahead now to commit to enroll the Medicare population in entities that do not yet exist and whose capabilities have not yet been tested and proved would be a rash legislative act carrying the threat of hardship and disruption. Only after the health insurance exchanges called for by the Affordable Care Act have been set up, only after the administrative problems they will doubtless confront have been solved, and only after we have some reason to believe that they will be able handle the much more challenging Medicare population—only then would it make sense for Congress to consider shifting Medicare enrollees to vouchers. Even then, it will be of critical importance to understand that the frailties of a large part of the Medicare population may mean that insurance models that make sense for comparatively healthy working age Americans may not make sense for the elderly and people with disabilities. For similar reasons, the experience of the Federal Employees Health Benefit Plan provides little guidance one way or another to the desirability of giving Medicare enrollees a voucher and asking them to shop from a menu of competing private plans. The FEHBP population is better educated than the average American. Government agencies provide considerable information and enrollees have networks that enable them to guide each other to an extent that economically inactive retirees and people with disabilities do not possess. Most importantly, I am unaware of any evidence that the FEHBP has held down the rate of growth of health spending for its members below the growth of spending for the general population. Change in Regulatory Climate. The role of government regulation has become vastly more controversial than it was in the 1990s. The kind of regulation of insurance offerings and marketing that I believe is a defining and vital element of premium support is simply unimaginable today. The political polarization around the matter of government regulation and the increasingly aggressive use of the filibuster in the Senate—which, I believe is a function of minority status, not party label—make it inconceivable that the sort of regulation necessary to make a market for health insurance genuinely competitive could win passage now or, if passed, be sustained. Without such regulation, in my view, the health insurance market under a voucher plan would likely be as deplorably inefficient as the non-group health insurance market is today. But the consequences would be far more serious—not just wasteful administration, and price distortions induced by adverse selection, but much worse, since the needs of the Medicare population are so large and insistent. Failure of Risk Adjustment. A necessary element of successful competition under a voucher is effective risk adjustment. It is well known that health expenses are highly concentrated and are much higher, on the average, for Medicare enrollees than for the general population. Insurers who ‘get stuck’ with a lot of very sick people can lose a lot of money or even grow broke. Shareholders do not hire administrators to lose money or go broke. Accordingly, insurance administrators have a duty to the people who hired them to try to enroll healthier than average people. Of perhaps greater importance, they need to retain healthier-than-average enrollees. Because of these incentives, all competent health analysts have long recognized that, if premiums are uniform or vary less than expected cost, the key to a successful health insurance market is risk adjustment. Risk adjustment consists of financial transfers among insurers to offset the variations in expected health costs related to the characteristics of enrollees. Insurers that enroll people with comparatively low expected health care use would pay money to insurers that enroll people with high expected use. In the 1990s, risk adjustment was inadequate. It was not then ‘good enough to discourage competition based on risk selection. But it was getting better. I assumed, perhaps too facilely, that it soon would get ‘good enough.’ Well, to date it hasn’t. Recent research has shown that the Medicare risk adjustment algorithm actually increased program costs by as much as $30 billion or 8 percent in 2006.[9] The problem is that risk selection increased along lines that were not included or could not be included in the risk adjustment formula. Plans have available many ways to attract customers expected to have low costs (“the X health plan is offering a free golf weekend”). They can also use the quality and availability of services to discourage high cost enrollees from remaining (“we are sorry, but our oncologist is booked solid for the next six weeks; no, he is the only one on staff”). They can also take steps to encourage low-cost enrollees to stay (“all current enrollees who remain in our plan will receive a free gym club membership”). The challenge of defeating such behaviors is never easy. But in an atmosphere hostile to aggressive regulation, it is impossible, particularly when the stakes are as high as they are with the Medicare population, whose costly patients are very costly indeed. Medicare Competition Exists—the Results are Disappointing. To believe that competition does not exist in the Medicare program and that one must shift all enrollees to vouchers to create such competition is simply false. Medicare Advantage exists. It enrolls a quarter of all Medicare beneficiaries. It is well established. By 2010, the average Medicare enrollee could choose among an average of 24 plans, in addition to traditional Medicare — 10 health maintenance organizations, 4 local and 5 regional preferred-provider organizations, 4 private fee-for-service plans, and 1 cost plan.[10] Enrollments in Medicare Advantage plans have fluctuated with the generosity of payments to them. In some years MA plans have been paid more per enrollee than average costs in traditional Medicare—14 percent more in 2009. At such times MA enrollments have risen because MA plans could offer extras that Medicare beneficiaries value. When payments have been cut back, enrollments have fallen. Fluctuating enrollments say nothing about whether competition from Medicare Advantage has lowered the cost of care. To answer that question, on needs to control for both the extra payments that MA plans have sometimes received and the extra services beyond the standard Medicare benefit package that they may provide. After one has adjusted for these factors, as well as enrollee characteristics, have Medicare Advantage plans been able to deliver the standard benefit package at lower cost than has traditional Medicare? Until recently data to answer that question were unavailable. Thanks to a Freedom of Information Act suit, the relevant data are now available and the results are in. On average, Medicare advantage plans cost 3 percent more in urban areas and 6 percent more in rural areas than does traditional Medicare.[11] That is far from the end of the story, however. Relative costs vary enormously. MA plans are less costly than traditional Medicare in counties where roughly 30 percent of Medicare beneficiaries live. FFS plans are less costly than MA plans in counties where roughly 70 percent of Medicare beneficiaries live. One might suppose that where MA plans are comparatively cheap, a larger share of Medicare enrollees would choose them than in areas where FFS plans are comparatively cheap. To my surprise, no such pattern seems to exist. The lack of such a pattern dampens hopes that ‘cost conscious consumers’ will be the driving force for holding down health care spending. Those who hope that providing Medicare beneficiaries with vouchers will help control costs often point to the fact that the costs of the Medicare drug benefit have come in far below preenactment estimates. Unfortunately, this claim does not withstand scrutiny. Events that are largely or totally independent of enactment of the Medicare drug program have caused total expenditures for drugs to fall short of estimates made in 2003 when Congress was debating the program. One of those events, the fall-off in the introduction of new ‘block-buster’ drugs, is hardly a cause for celebration. New drugs have brought benefits even larger than their costs. The other trend—the growing use of generics—has been good news. The Medicare drug program may have accelerated the shift to generics and, thus, deserve some credit for the trend. But the simple fact is that Medicare part D costs have been lower than was estimated by a bit less than the cost of non-Medicare drugs have been below estimates made at the same time.[12] In any event, drug costs are not the only criterion for evaluating Medicare part D. Of equal importance is whether enrollees in Medicare part D choose the plans that best meet their needs. Recent research suggests that they do not. By over-weighting premium costs relative to protection against risk, enrollees are choosing plans that do not provide them optimal protection.[13] They could improve their own welfare by choosing plans that cost a bit more up front, but provide more protection against heavy drug needs. Erosion of Benefits. Many years ago, when Bob Reischauer and I floated the premium support idea, friends who supported traditional Medicare warned that vouchers, with or without our proposed safeguards, were a bad idea. Vouchers, they warned, are subject to erosion in a way that a defined-benefit plan is not. It is politically harder, they argued, to chop off a specific medical benefit—say, by limiting access to skilled nursing facilities or by capping the number of doctors visits permitted each year—than it is to shave a voucher. Which is more difficult is, of course, a matter of political judgment. But the many positions taken by the chairman of the House Budget Committee give me pause. Mr. Ryan has supported plans that would tie the value of vouchers, variously, to the growth of gross domestic product plus 1 percent (in proposals put forward jointly by Mr. Ryan and both Senator Ron Wyden and my colleague, Alice Rivlin), to the growth of gross domestic product plus ½ percentage point (this year’s Budget Committee proposal), or the consumer price index (last year’s budget proposal). The implications of these proposals over a period of many years are vastly different because of the inexorable force of compound interest. Even if one were prepared to disregard the many other elements that would—or should—go into a serious premium support plan, the “principle” involved in plans with such widely divergent adjustment formulas is so elastic that there is, in fact, no core principle at all. VI The Medicare program has succeeded in its fundamental goal of bringing standard care to vulnerable populations. It has innovated in designing new payments systems. It promises to be something of a hammer in forging reforms in the health care payment and delivery system. And it has delivered care at costs that are a bit lower than have competing private plans. Still, adjustments in the Medicare program can improve its operation. Given the purpose of this hearing, this is not the place to examine those changes in great detail. But I will list a few.
Source: brookings.edu

Medicare Special Needs Plans

Posted by:  :  Category: Medicare

Like the name says, a Medicare Special Needs Plans is a unique type of Medicare Advantage Plan (Part C) designed to provide specialized care for patients suffering from specifically listed terminal or chronic illness, including chronic alcohol and drug dependence. Although it is possible that other illnesses will be considered under a particular plan, these special needs conditions typically include autoimmune disorders, cancer (does not include pre-cancer conditions, chronic heart failure, cardiovascular disorders, dementia, diabetes mellitus, end-stage liver and renal disease, severe hematologic disorders, HIV/AIDS, chronic lung disorders, chronic disabling mental conditions, neurological disorders, and stroke. Because all of the services are provided under the umbrella of one plan, coordination of all of your health care needs is much more simplified.
Source: mostmedicare.com

Video: The Centers for Medicare & Medicaid Services (CMS) Korean Language Video

Enforcement News In Brief :: “The Tan Sheet” :: Elsevier Business Intelligence

FDA warns Nenningers Naturals based on Twitter flu prevention claim; Global Sweet Polyols earns warning due in part to dog in facility; Yogi Tea warned for insufficient QC review documentation; more Enforcement In Brief.
Source: medicaredrugfocus.com

Learning How To Rate Your Medigap Policies

When you have narrowed down on the type of Medigap insurance you should start shopping around for the best prices. You will be able to notice that there is a wide variation between the prices quoted by different companies. Your monthly premium will also depend on your individual situation and vary from one individual to the other just exactly how it works with the regular insurance plans. For example if you are a smoker, then you are likely to pay much higher premiums than your counterparts that do not smoke. The cost of the premium also varies depending on the gender. Female applicants pay lesser monthly premium for the Medicare supplemental insurance.
Source: medicarequotefinderblog.com

Medicare Card, NHGRI to develop revolutionary technologies for exploring genome function

arizona california medi-cal dental Drug Plan Health HIV How Social Security Works How to File a Claim for Medicare How to get a new medicare replacement card HUD M.D. Medi-Cal Medicaid medicaid card Medicaid Services Medicare medicare card MedicareCard.com medicare card replacement MedicareCard Replacement Medicare claims process medicare coverage Medicare has Two Parts Medicare Help Medicare Part A Hospital Insurance Coverage Medicare Premium Amounts for 2010 Medicare Prescription Drug Coverage Meeting Announcement MyMedicare.gov National Institutes of Health Need a Replacement Card? Order a Medicare Card by Phone or Online NIH NIMH Obama Part A (Hospital Insurance) Part B (Medical Insurance) part of the National Institutes of Health protecting my social security number replacement social security card Social Security social security card some disabled people under age 65 ssa.gov Supplier Enrolled in Medicare VA
Source: medicarecard.com

Rewarding Mediocrity: GAO Report Concerning Medicare Advantage “Bonus” Payments  

[1] "Quality Bonus Payment Demonstration Undermined by High Estimated Costs and Design Shortcomings" General Accounting Office (April 23, 2012), summary available at: http://www.gao.gov/products/GAO-12-409R; report available at: http://www.gao.gov/assets/590/589473.pdf [2] Note that according to GAO, even with these payment reforms, MA plan payment (including bonuses) is still about 7 percent higher than what the government would pay for similar beneficiaries in traditional Medicare.  [3] "GAO Calls Test Project by Medicare Costly Waste" by Robert Pear, New York Times,(4/22/12), available at: http://www.nytimes.com/2012/04/23/health/policy/gao-says-medicare-test-project-is-wasting-8-billion.html?_r=1&emc=tnt&tntemail0=y
Source: medicareadvocacy.org

Top 10 Tips for Caregivers

Caregivers are busy caring for others. They may not take good care of themselves and their health can suffer as a result. For example, WomensHealth.gov reports that women caregivers are less likely than women who are not caregivers to get needed medical care. They are also less likely to get enough sleep, eat well or exercise.
Source: medicaregov.us

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

Posted by:  :  Category: Medicare

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: medicare.gov

Video: Learn about the 2011 Medicare Open Enrollment Period: Get a Plan that Meets Your Needs

Gov’t report: Medicare paid $5.6B to 2,600 pharmacies with patterns of questionable billing

Associated Press, by Staff Posted By: Ribicon- Thu, 10 May 2012 16:56:38 GMT Washington — Medicare paid $5.6 billion to 2,600 pharmacies with questionable billings, including a Kansas drugstore that submitted more than 1,000 prescriptions each for two patients in just one year, government investigators have found. A new report by the inspector general of the Health and Human Services department finds the corner drugstore is vulnerable to fraud, partly because Medicare does not require the private insurers that deliver prescription benefits to seniors to report suspicious billing patterns. “While some pharmacies may be billing extremely high amounts for legitimate reasons, all warrant further scrutiny,” said the report released Thursday. The analysis broke new ground
Source: newmediablog.com

Information on Implementation of the Physician Payments Sunshine Act

On December 19, 2011, the Centers for Medicare & Medicaid Services (CMS) published a proposed rule implementing the Physician Payments Sunshine Act, which was included as section 6002 of the Affordable Care Act of 2010.  This provision will provide important transparency in requiring reporting of payments or gifts to physicians, and physician ownership and investment interests.  During the 60 day comment period, CMS received over 300 comments from a wide range of stakeholders.
Source: cms.gov

Q1Medicare.com Releases Updated Online Medicare.gov Plan Finder Tutorial : Fitness tips on Fitblogger

“The Medicare.gov Plan Finder provides a wealth of information, but for people unfamiliar with this site, the Plan Finder may add to the complexities Medicare beneficiaries face as they try to choose a Medicare Advantage plan or Medicare Part D prescription drug plan,” notes Dr. Susan Johnson, co-founder and technical director of the Q1Medicare.com site. “The goal of our tutorial is to provide a simple guide so the Medicare community can better navigate the Medicare.gov site and find the Medicare plan that most affordably meets their prescription and health coverage needs.”
Source: fitblogger.info

Eligibility For Medicare Savings Programs

Posted by:  :  Category: Medicare

Cynthia Markus, Ingrid McDonald, and Diana Birkett discuss Medicare at the KUOW Studios by kuow949However, one of the larger issues without health care system is the fact that many Medicare and Medicaid programs continue to be over budget and costing the taxpayers a large amount of money, and putting a strain on the health care system. Moving forward there is a emphasis on creating programs that are cost efficient and do not promote excess spending. Medicare programs are available for a number of different situations and individuals and is a necessary part of our system. Even with these programs there are still Medicare members who are unable to pay for their premiums or other health care expenses.
Source: reliefcompany.org

Video: American Sign Language (ASL) – Medicare Basics

CMS Lists of Medicare EHR Incentive Program Payments

Considering that it’s an election year, critics of the Obama Administration are taking a closer look at the President’s campaign promises, one of which was an initiative to create more transparency in government.  In December 2009, the President issued the Open Government Direction, which called for federal agencies to make public information available online, improve the quality of their data, foster a culture of transparency, and create sustainable frameworks for ensuring the openness of the US government. However, many are still unsatisfied with the results of this and other initiatives; some have even formed coalitions to work more aggressively toward making transparency a reality.
Source: ehrintelligence.com

Provider clout driving up private insurance prices

In the constant attention paid to what drives health care costs, only recently has scrutiny been applied to the power that some health care providers, particularly dominant hospital systems, wield to negotiate higher payment rates from insurers. Interviews in twelve US communities indicated that so-called must-have hospital systems and large physician groups — providers that health plans must include in their networks so that they are attractive to employers and consumers — can exert considerable market power to obtain steep payment rates from insurers. Other factors, such as offering an important, unique service or access in a particular geographic area, can contribute to provider leverage as well. Even in markets with dominant health plans, insurers generally have not been aggressive in constraining rate increases, perhaps because the insurers can simply pass along the costs to employers and their workers. Although government intervention — through rate setting or antitrust enforcement — has its place, our findings suggest a range of market and regulatory approaches should be examined in any attempt to address the consequences of growing provider market clout.
Source: pnhp.org

Ghanaian Doctor Charged in Nationwide Medicare Fraud

According to court documents filed in the Central District of California, two Orange County doctors and two of their co-schemers were charged for allegedly submitting nearly $5.7 million in false claims to Medicare for durable medical equipment (DME). Specifically, the defendants billed Medicare for enteral nutrition, a liquid nutritional supplement. Medicare will only pay for enteral nutrition if a patient has a feeding tube. According to the indictment, Dr. Augustus Ohemeng, 62, of Buena Park, and Dr. George Tarryk, 72, of Seal Beach, wrote fraudulent prescriptions for enteral nutrition for patients who did not have feeding tubes. Co-defendant George Samuel Laing, 41, of Sylmar, who managed the clinic where Tarryk and Ohemeng practiced, allegedly received kickbacks in exchange for referring the prescriptions to Ivy Medical Supply, owned by co-defendant Emmanuel Chidueme, 59, of Mira Loma. Ivy then fraudulently billed Medicare for the enteral nutrition, even though it was not medically necessary and was not delivered to patients in the quantities billed to Medicare. Ohemeng, Tarryk, Laing, and Chidueme were arrested this morning and are scheduled to make their initial appearances before a U.S. Magistrate Judge this afternoon.
Source: newsonlinegh.com

Health Informatrix: Providers Paid Under the Medicare EHR Incentive Program

In compliance with the HITECH Act’s requirement, CMS has posted the names, business phone numbers, and business addresses of Medicare eligible professionals (EPs), eligible hospitals, and critical access hospitals (CAHs) that have successfully demonstrated meaningful use and received a payment as of March 2012. Medicare EPs, eligible hospitals, and CAH’s were able to verify and edit their business phone numbers and addresses during the registration process. CMS has not posted information on group practices, as incentive payments are not provided at the group practice level.
Source: healthinformatrix.com

DOJ Probes Fraud At Parkland Hospital; Texas Group Calls Medicaid ‘Indispensable’

The Dallas Morning News: Parkland Hit With New Medicare-Medicaid Fraud Allegations The U.S. Justice Department has been investigating new allegations that Parkland Memorial Hospital and UT Southwestern Medical Center doctors defrauded the federal government’s health insurance programs for the poor and elderly. The investigation came to light Tuesday after a federal judge unsealed a whistle-blower lawsuit filed by Dr. Lien Kyri .. [who] alleges that “hundreds of thousands” of Medicare or Medicaid billing claims were falsely submitted for rehabilitation consultations (Moffeit and Egerton, 5/8).
Source: kaiserhealthnews.org

AHIP: Many Medicare Advantage Enrollees Have Low Incomes

Medicare Advantage plans give enrollees incentives to use in-network providers. To reward enrollees for accepting limits on provider access, the plans typically charge low or no premiums and may offer much lower out-of-pocket costs than traditional Medicare plans. The private plans also may offer extra features, such as free memberships in exercise programs or free hearing tests.
Source: lifehealthpro.com

The Fight over Medicare Double Counting

Why does this dispute exist? It can’t just be politics. If it were, we’d have double-counting disputes about every program. But we don’t. We thus need an explanation for why this debate has erupted around Medicare Part A, which provides hospital insurance, but not around other programs. Part A is not unique in controlling spending by a “belt and suspenders” combination of regular program rules (the “belt”) and an overall limit (the “suspenders”). Such budgeting also applies to Social Security, Medicare Parts B and D (which cover physician visits and prescription drugs), and the National Flood Insurance Program. The federal debt limit acts as “suspenders” for the entire budget. But none of those give rise to double-counting disputes.
Source: wallstreetpit.com

People are accepting hard choices. Congress must debate.

A still-bolder proposal going beyond Medicare itself would be to remove the distortion in the tax code that keeps health insurance tied to employment. The tax write-off for employer-provided health care benefits is the single largest tax expenditure. It is estimated to cost the government more than $1 trillion over the next five years. Capping the tax exclusion in 2018 and then phasing it out over 10 years would result in massive savings that could be devoted to shoring up Medicare and other programs for seniors.
Source: medcitynews.com

Health Care Fraud Program Expansion and Senior Medical Patrol Capacity Building Grants

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Source: ksjherb.com

Ugly new arithmetic for US social security and medicare programs

The social security trust fund for retirees remains in better shape. Its rhetorical surplus is now projected to become exhausted by 2033, three years sooner than anticipated one year ago.  In 2011, social security paid out $596.2 billion in retirement benefits to 44.8 million retirees. By law, benefits are paid in full only as long as the fund balances show a surplus. In the absence of intervention, retirees will lose approximately one quarter of their annual benefits in 2033.  With increasing longevity, some current retirees are in for a nasty shock.  If nothing is done by then, the 2034 elections should make fascinating reading. The reasons behind the worsening outlook, are (1) the 2012 electioneering payroll tax holiday, (2) worsening demographics and (3) rising inflationary expectations.
Source: wordpress.com

Cost shifting from Medicaid to Medicare in the dual eligibles

Roughly half of Medicare beneficiaries under age sixty-five are also eligible for Medicaid. These “dual eligibles” have been the subject of much research because of their low income and poor health status. Previous studies suggest that some states seek to shift costly health care services for this group out of state-run Medicaid programs and into the federally funded Medicare program—for example, replacing nursing home care with hospital care. Using state-level data on dual eligibles under age sixty-five, we found support for this hypothesis. In states with below-average per capita Medicaid spending, corresponding Medicare spending was above average. These state-level estimates also revealed a nearly threefold difference in total—Medicare plus Medicaid—price-adjusted spending per person, ranging from $16,309 in Georgia to $43,587 in New York. Such large variations among people with serious diseases suggest inefficiency. Some states may be spending too little for Medicaid, meaning that some patients’ needs are not being met, or some states may be spending too much, meaning that more services are being provided than needed. Such inefficiency exposes patients to unnecessary risk, drives costs up unnecessarily, and highlights the large potential gains arising from improved care coordination for dual eligibles.
Source: theincidentaleconomist.com

Medicare Program Exclusion Can have Devastating and Far

Few health care practitioners really understand the significance that being excluded from the Medicare Program may have.  Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of psychology, board of pharmacy or other health care licensing entity.  If revocation, suspension, restriction or limitation of a license occurs, this is reported to the National Practitioner Data Bank (NPDB).  What few understand is that if the licensed individual or business entity voluntarily surrenders the license after charges have been filed or an investigation has been opened, this is treated the same as a disciplinary revocation and is reported out to the NPDB the same way.  This occurs, even if the professional has similar valid licenses in other states or a different type of license.
Source: thehealthlawfirm.com

Advisory Panel Urges New Fee On Medigap Plans, Cap On Out

Posted by:  :  Category: Medicare

CQ HealthBeat: Medicare Coverage Not As Generous As Large-Employer Plans Medicare coverage has gotten better in the past few years with the addition of prescription drug coverage, but it’s still not as generous on average as the private employer-sponsored insurance offered by large companies or the federal government, according to a new study by the Kaiser Family Foundation. The average value of Medicare is almost as good as the Blue Cross/Blue Shield standard option plan offered to federal workers, with Medicare’s benefits worth about 97 percent of the value of the federal plan, the report says. The typical large-employer preferred provider organization (PPO) is better than both. Medicare’s coverage equals about 93 percent of the typical big-company PPO benefits (Adams, 4/5).
Source: kaiserhealthnews.org

Video: Learn About Medigap Plans

Medigap is a vital source of coverage for low

3rd Party Studies ACOs Admin Costs Cadillac Tax cbo Cost-Shift Dual Eligibles Employers Essential Benefits Exchanges GRP HAIs Health Plan Satisfaction House hearings House legislation KI MA Makena McCarran-Ferguson Medical Prices Medical Tests medicare medigap MedMal MLR Morning Headlines MT NHE Patient Safety premiums Premium Tax Profits Provider Consolidation PWC Quality Rate Review Readmissions Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Medicare, “Medigap” and Medicare Advantage Plans

Yes. Another example: Citing language in the ACA, the Department of Health and Human Services has exempted Medicare Supplement carriers from so-called “rate review rules.” This means that Supplement carriers will be free to increase the rates and premiums they charge for the coverage without HHS oversight. This exemption will become important in a few years, when the ACA’s “guaranteed issue” standards are fully implemented. At that point, people will probably be paying more for Medicare Supplement coverage, even though the plans will likely cover less.
Source: online-health-insurance.com

Medigap Plans And Other Supplement Plans Are Still Popular

Even if you supplement Medicare with a Medicare Part D Prescription Drug plan, you may also enroll in one of the ten Medigap plans. During a six-month period that begins on the first day of the month in which you become 65 and you are enrolled in Part B, your application for a Medigap plan is guaranteed to be accepted regardless of your health problems. You may switch to a different plan during this time, and guaranteed acceptance also applies to the application for the other plan.
Source: blog-millionaire-articles.com

A Probable Answer To Will I Need Medigap Insurance

Medigap insurance pays for some of the things which Medicare does not cover, and can be useful if you need costly treatment. Medicare Supplement plans are regulated by the govt, but supplied by non-public insurance firms, and they’ve got to be obviously labeled as Medicare Supplemental Insurance. The plans are called plans A thru N, and each plan is standardized by the government. Insurance companies are permitted to select which plans they’re going to provide, but everybody with a Medigap plan F, for instance, receives the same coverage, with no regard for their insurer. These are generalizations, and there are 1 or 2 exceptions. Massachusetts, Minnesota and Wisconsin each have their own standards for Medigap plans. But while they’re different from those in other states, they’re still are to be the same, whichever insurance firm you select, in the state. Medicare SELECT plans offer the same coverage as Medigap plans A thru N, but are less expensive because you need to utilize a stated network of hospitals for non-emergency care. Although all of them are required to provide the equivalent level of coverage, insurance firms charge different costs for their plans.
Source: medicarequotefinderblog.com

The Ultimate Way to Save money on Insurance

People who begin to grow old, find that their lives are changing sometimes for good and sometimes for bad but the main thing is that these people get a lot of benefits as far as their health is concerned. The most authentic and unique facility that these people get is the Supplemental Medicare Insurance which is of great help for people all around. It is something that is taken every senior citizen in the country in order to avail the benefit of paying low on medical bills. People who are in possession of Medicare Insurance are entitled to get a number of benefits on their health costs and other medical facilities. There are a lot of expenses on health that have to be incurred by people who have grown old because their life is prone to several difficulties regarding their health. There are the surgeries, the diagnostics, the treatments and various other things that incur a lot of money. These are the things that are procured by the Medicare insurance by way of paying the amount that cannot be paid by the person getting the treatment. Medicare is able to meet up the expenses of an individual but very often it happens that the Medicare is not able to fulfill all the expenses of health and these expenses are covered by the supplemental insurance which is of great help in coping up with the gap that exists between the original Medicare and the supplemental insurance.
Source: beneficialfunction.com

Who Needs Supplemental Medicare Insurance? Everybody!

What should you recognize when purchasing a Medigap Policy? First you must have Medicare Part A and B. If you intent to leaving your Medicare Advantage Plan you may buy a Policy and the Medigap can not begin until the Medicare Advantage Policy ends. Your Monthly Medicare Part B payments are made to Medicare health insurance and the Medigap payouts are made to the insurance company. The Supplemental Medicare Insurance can only be for one person. The Medigap Policy can be purchased through the licensed insurance company where you live. If you wish to cancel the Medigap coverage you will need to do so via your insurance company. Your agent can not cancel a policy. Standardized Medigap plans are guaranteed renewable even when you have health conditions. The only real difference in these plans are price.
Source: 13ui.com

Our Brokers Are Waiting To Review You And Your Supplemental Insurance Coverage

In the event that you have a Medicare advantage plan, you should compare it with all the available Medigap plans. Considering that advantage plans can vary widely on cost and services, you might be missing on the a preferred service or ignorant of an available reduced deductible. You may also have less access to hospitals and doctors with the advantage plan. Without spending time with your local insurance advisor, it may be difficult to put the applicable options side by side so you can decide which is best for the situation. We look forward to you stopping in and taking the time to present you with options for supplemental insurance for Medicare.
Source: almonner.com

Learn How Medigap Plans Supplement Your Medicare

When you are about to face retirement, having a basic understanding on how Medicare works can give you good health care and cut what you spend on medical services. Although the U.S. Division of health and Human Services is in payment of Medicare, the Centers for Medicare and Medicaid Services is the Division that administers Medicare and applications go through the group safety Administration. When you apply can be critical. That’s because if you don’t sign up when first eligible, you could have to pay higher premiums for late enrollment. That’s not the only way to save your health care dollars, though.
Source: blogspot.com

GOP senator: Let the state take over Medicare, or risk the displeasure of Confederate ghosts (VIDEO)

Posted by:  :  Category: Medicare

This legislation which supposedly has our dead Confederate forefathers so up in arms is called the Interstate Healthcare Compact, which would allow South Carolina “to suspend the operation of all federal laws, rules, regulations, and orders regarding health care that are inconsistent with the laws, rules, regulations, and orders adopted by the member state pursuant to this compact.”
Source: palmettopublicrecord.org

Video: Humana Made Medicare Easy

Palmetto GBA to Host Home Health Medicare Secondary Payer Workshop Series

Palmetto GBA will present live Medicare Secondary Payer workshops that will be offered for home health and hospice providers in 2012. These workshops are designed for home health and hospice providers and their staff to equip them with the tools they need to be successful with Medicare billing under the MSP provisions. This workshop will provide insight for new, intermediate or advanced staff; however, Palmetto suggests that providers who are new to Medicare attend online learning courses for beginners.
Source: hcafnews.com

Palmetto, Medicare’s Biggest Carrier, Proposes to End Code Stacking for Molecular Clinical Laboratory Tests

Palmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics pPalmetto GBA is a Medicare Authorized Contractor (MAC) that serves Jurisdiction 1 (J1) and Jurisdiction 11 (J11). Two draft proposed local coverage determinations (one on molecular diagnostic tests (MDTs) and one on lab-developed tests (LDTs), and a molecular diagnostics program (MolDx) have been proposed only for J1. If implemented, they would affect labs serving Medicare patients in California, Nevada, and Hawaii.
Source: darkdaily.com

Linda Joy Adams: CMS Selects Palmetto GBA to Administer Medicare Claims in 3 States, 3 U.S. Territories

An informal news letter of all kinds of news and comments on the news. Specific intent is to ‘track’ mergers and acquisitions at the highest levels in our world and the impact these have on individual rights. This blog was started to aid me keep track for my personal benefit. It evolved into a shared content with anyone interested.
Source: blogspot.com

Palmetto's Jeter Discusses Efforts to Advance Value

A FISH-Based Approach to Study Composition of Viral RNAs at Single-Virus Particle Resolution Chou, Vafabakhsh et al., PNAS Researchers at Mount Sinai School of Medicine in New York and the University of Illinois at Urbana-Champaign present “an experimental approach based on multicolor single-molecule fluorescent in situ hybridization to study the composition of viral RNAs at single-virus particle resolution.” The team applied its FISH-based approach to determine the copy number of each RNA segment within individual virus particles for the wild-type influenza A/Puerto Rico/8/34, or PR8, as well as for a recombinant PR8 virus. Overall, the researchers found evidence to suggest “that for the majority of the virus particles, only one copy of each RNA segment is packaged into one virus particle,” which they say supports the idea that “the packaging of influenza viral genome is a selective process.”
Source: genomeweb.com

Seeking Reimbursement Transparency, Palmetto May Deny Coverage for 'Investigational' Molecular Tests

A FISH-Based Approach to Study Composition of Viral RNAs at Single-Virus Particle Resolution Chou, Vafabakhsh et al., PNAS Researchers at Mount Sinai School of Medicine in New York and the University of Illinois at Urbana-Champaign present “an experimental approach based on multicolor single-molecule fluorescent in situ hybridization to study the composition of viral RNAs at single-virus particle resolution.” The team applied its FISH-based approach to determine the copy number of each RNA segment within individual virus particles for the wild-type influenza A/Puerto Rico/8/34, or PR8, as well as for a recombinant PR8 virus. Overall, the researchers found evidence to suggest “that for the majority of the virus particles, only one copy of each RNA segment is packaged into one virus particle,” which they say supports the idea that “the packaging of influenza viral genome is a selective process.”
Source: genomeweb.com

University Hospitals Rainbow Babies & Children’s Hospital Receives $12.7 million Health Care Innovation Award from Centers for Medicare and Medicaid Innovation

About University Hospitals Case Medical Center’s Rainbow Babies & Children’s Hospital For 120 years, University Hospitals Rainbow Babies & Children’s Hospital has been dedicated solely to the care of children. As one of the most renowned pediatric medical centers and a principal referral center for Ohio and the region, UH Rainbow physicians will receive more than 200,000 patient visits annually. The 244-bed hospital is home to 850 pediatric specialists and 40 special care centers including Centers of Excellence in oncology, neonatology, pulmonology, cardiology, neurology and endocrinology. There is a full complement of pediatric surgical specialists who focus on minimally invasive techniques as well as an outstanding program in bloodless surgery. As the primary affiliate of Case Western Reserve University School of Medicine, UH Rainbow trains more than 100 pediatricians each year and consistently ranks among the top children’s hospitals in research funding from the National Institutes of Health.
Source: bloginteract.com

Are Your Visits Being Down

In order to effectively communicate to CMS our members concerns and frustrations with the medical review audits being conducted by Palmetto GBA, we are collecting data to demonstrate the impact the audits have had on physician practices.
Source: wordpress.com

North Carolina Medical Society

However, physician practices have continued to experience claims denials for these services in January. The NCMS again contacted Palmetto GBA and learned that corrective action had not been taken. Palmetto has now assured the NCMS that the erroneous edit has been turned off, and once testing is completed, mass adjustments will be begin this week. The adjustments should cover all affected claims going back to December. This will eliminate any additional paperwork on the part of practices to get the claims paid.
Source: ncmedsoc.org

Conditions, Medical Conditions

Posted by:  :  Category: Medicare

The History of Romania in Fresco by Fergal of Claddagh There’s strength in numbers, particularly when you’re buying health insurance. As part of a group plan, you can enjoy a significant discount on premiums as well as comprehensive policies. But if you leave that job

Altius Health Plans Altius Advantra Medicare Review

Posted by:  :  Category: Medicare

[…] […] Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:Source: medicare-plans.net […]Source: medicare-plans.net […]
Source: medicare-plans.net

Video: How Much is Chiropractic Therapy Without Insurance: Burlington NC Chiropractor

First health life and health insurance medicare

first health life and health insurance medicare in Virginia, Nebraska, Indiana, New Hampshire, Georgia, Washington, Tennessee, Oklahoma, Rhode Island, Wyoming, Florida, Delaware, Kansas, Alabama, Arizona, Utah, Kentucky, Connecticut, West Virginia, Idaho, Illinois, Nevada, California, Michigan, Colorado, Mississippi, Hawaii, Alaska, Minnesota, Texas, North Dakota, Wisconsin, Iowa, Louisiana, Maine, New York, Ohio, South Dakota, Missouri, South Carolina, North Carolina, New Mexico, Massachusetts, Vermont, Arkansas, Oregon, New Jersey, Maryland, Pennsylvania, Montana, Canada and UK
Source: lazarkomarcic.org

2012 Advantra Medicare Advantage Review

A major benefit of an Advantage plan is having a limit on your annual maximum out-of-pocket costs but the requireed coinsurance feature makes it a lot more likely that you will need this benefit compared to other 2012 Advnatra Medicare Advantage plans.
Source: affordablemedicareplan.com

Advantra Rx NOT Renewing Their Medicare Contract

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Do You Have An Advantra Freedom Medicare Plan??

[…] You can blame this on your congressmen, senators, and yes even the president. The funding for medicare and Medicare has been drastically cut causing  some companies to raise rates and lower benefits. Other companies have simply decided to drop out of the market (which produces less competition). I would suggest writing a letter to your congressman or senator.Source: wordpress.com […]
Source: wordpress.com

Health America www.EasyToInsureME.com

This entry was posted on July 29, 2008 at 7:13 pm and is filed under a, america, blue cross pa, coventry, coventry health america, cvty, harrisburg, healh insurance pennsylvania, health, health america, health america one, health insurance, health insurance pa, healthamerica, healthamerica com, healthamerica cvty, healthamerica cvty com, insurance, lancaster, low cost health insurance pa, low cost pa health insurance, ohio, pa, pa health insurance, phila, philadelphia, pittsburgh, ppo, scranton, www healthamerica com, www healthamerica cvty. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Source: wordpress.com

TribLIVE: #(gSection.name)#

Pittsburgh police Cmdr. RaShall Brackney today denied the claims of a North Side business owner who obtained a protection from abuse order against her this week. “This PFA was filed without merit,” Brackney said in a statement released by Warner …
Source: pittsburghlive.com

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: agentpipeline.com

Low and Left Part Deux: Anyone Watching?

This is amazing television. Truly amazing. Though I have it on the SPAN because I get sick of the MSNBC bastards thinking that their comments on what is going on are more important than what is actually being said. Dammit. Work phone rang when Slaughter was speaking. Louise Slaughter is my hero…I will have to watch her later. Use the thread to tell me what you think. Are you pissy? Do you think that Obama is losing this debate? Or, are you keeping an open mind and listening to what the experts are saying? Let me know. I believe that real health care reform will be passed. I believe that it will happen because the Dems know that they will lose their shit in November if it doesn’t. I just hope that they heed the words of Dr. Dean and make it go into effect now! President Obama is looking like the adult and the Pukes, of course, look like the tools that they are. Heh.
Source: blogspot.com