Health Net Medicare Supplement Rates

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Your Medicare Supplement resource. Looking for a new plan, want to compare rates, you’ve come to the right place. Please use this website to search and review information. Compare rates, apply, find a doctor or hospital, you can do it all right here. Or better yet simply contact me anytime, I’ll be happy to answer all of your questions. Thanks … John
Source: wordpress.com

Video: Health Net Medicare Part D Insurance – Compare to 180+ Comp

Health Net Completes Sale of Medicare PDP Business

Health Net, Inc. and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. All statements in this press release, other than statements of historical information provided herein, may be deemed to be forward-looking statements and as such are intended to be covered by the safe harbor for “forward-looking statements” provided by PSLRA. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to changes in circumstances and a number of risks and uncertainties. Without limiting the foregoing, statements including the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend,” “feels,” “will,” “projects” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially from those expressed in, or implied or projected by the forward-looking information and statements due to, among other things, health care reform and other increased government participation in and regulation of health benefits and managed care operations, including the ultimate impact of the Affordable Care Act, which could materially adversely affect Health Net’s financial condition, results of operations and cash flows through, among other things, reduced revenues, new taxes, expanded liability, and increased costs (including medical, administrative, technology or other costs), or require changes to the ways in which Health Net does business; rising health care costs; continued slow economic growth or a further decline in the economy; negative prior period claims reserve developments; trends in medical care ratios; membership declines; unexpected utilization patterns or unexpectedly severe or widespread illnesses; rate cuts and other risks and uncertainties affecting Health Net’s Medicare or Medicaid businesses; litigation costs; regulatory issues with federal and state agencies including, but not limited to, the California Department of Managed Health Care, the Centers for Medicare Medicaid Services, the Office of Civil Rights of the U.S. Department of Health and Human Services and state departments of insurance; operational issues; failure to effectively oversee our third party vendors; noncompliance by Health Net or Health Net’s business associates with any privacy laws or any security breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information; any liabilities of the Northeast business that were incurred prior to the closing of its sale as well as those liabilities incurred through the winding-up and running-out period of the Northeast business; investment portfolio impairment charges; volatility in the financial markets; and general business and market conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within Health Net’s most recent Annual Report on Form 10-K filed with the SEC and the risks discussed in Health Net’s other filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. Except as may be required by law, Health Net undertakes no obligation to address or publicly update any of its forward-looking statements to reflect events or circumstances that arise after the date of this release.
Source: privatehealthinsurances.net

Health Net Medicare Part D Insurance

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Source: allinsuranceblog.com

Health Net selling Medicare Part D business to CVS Caremark

Health Net Inc. announced last week that it will sell its Medicare Part D stand-alone prescription drug business to CVS Caremark for $160 million. Health Net said the business has about 400,000 members nationwide, and brings in about $490 million in annual revenue. The deal is scheduled to close during the second quarter, but must be approved by antitrust regulators, the company said.
Source: son-graceinc.org

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

medicare enrollment by county

Posted by:  :  Category: Medicare

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Source: posterous.com

Video: Medicare Advantage Plans

Blue Cross Blue Shield Of Michigan Broadens Medicare Options With New Medicare Advantage PPO Product

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Source: wordpress.com

Claims: Multiple Payers: Reports may contain invalid provider name

Payer Batch Totals Reports (SB) for the following CPID’s may have included an incorrect provider name due to a payer processing issue. No other claim information has been affected by this issue. The issue began on January 1, 2012 and was resolved by January 31, 2012. The payers affected are listed below: CPID 1421 Michigan Blue Shield CPID 1913 Medicare Plus Blue – Medicare Advantage Plan CPID 2145 Medicare Advantage DME (DMEnsion) CPID 2287 Medicare Plus Blue – Medicare Advantage Plan CPID 2426 Blue Care Network HMO CPID 3514 Michigan Blue Cross CPID 3531 Michigan Blue Cross – FEP CPID 3532 Blue Care Network HMO Please be aware of the incorrect provider name returned on payer reports. The payer will not be sending corrected reports. If you have any further questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Medicare Supplement Insurance Aides Fight against Cancer malignancy

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Source: getdeadbeatrevolution.com

medicare allowable rates 2011 hcpcs // Can you take dayquil with liquid codeine

Posted by:  :  Category: Medicare

STM_3172 by U.S. Marshals Service2011 Medicare Physician Fee Schedule Database MPFSDB 74176 . To Radiology Procedure Codes In January 2011 HCPCS . The Following Table Describes The Maximum Allowable Rates For Author: eip tuning How many is 300 ng ml of hydrocodone terlosulma
Source: freeblog.hu

Video: Medicare Open Enrollment 2011 … Compare Medigap Insurance Rates

Taking on preventable readmissions: Care Transitions

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Source: medicity.com

Why a Medicare Supplement Plan is Important

If this is your first time going through this all then you have come to the right place to seek for an answer. The team is more than happy to make sure that you have all the details covered and that you get the facts straight. Through comparison, you need to have a clear picture of the things you need and who has them in store for you. The team is open for visits even hence if you have anything to confirm to them in advance of registering the team is more than happy to assist you through it.
Source: amnesia.us

Medicare influenza vaccine reimbursement rate 2010 // Urine screen for spice

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Source: freeblog.hu

Medicare Reimbursement For Skilled Nursing Facilities Remains High For 2012 Despite Reductions In Overpayments  

The GAO reported as early as 2002 that SNFs had shifted their assessment practices to assign residents to the rehabilitation RUG-III categories that gave them the most favorable reimbursement rates, often without actually providing residents with the number of minutes of therapy they required in order to be placed in those categories.[29]  In addition, the GAO reported that two years after the prospective payment system was implemented, "The patients categorized into the two most common (high and medium) rehabilitation payment group categories typically received 30 minutes less therapy during their first week of care, a 22 percent decline."  Id. 3.  While reimbursement to SNFs increased, rehabilitation services for residents actually decreased.
Source: medicareadvocacy.org

CMS Announces Proposed Rule on 2011 Medicare HH Reimbursement Rates

Why the increase in the case-mix weight adjustment?  CMS expanded its coding weight analysis into 2007 and 2008 processed claims.  As a result of analysis of this data, CMS claims that the average coding weights continued to increase in levels unrelated to changes in patient characteristics.  These coding changes resulted in an increase in therapy visits per patient with a higher than anticipated increase of 14+ visit episodes.  CMS also noted a higher incidence of reported diagnoses of hypertension leading to higher HHRG scores.
Source: hcafnews.com

Second Guessing Medicare’s Star Rating System

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizBut insurance executives made them a priority after the 2010 healthcare law attached large financial rewards to them. The first round of ratings last fall showed that most have a long way to go. Only 12 earned a perfect score of five, on a scale of one to five, and about 9 percent were below average. The majority received scores of three, or three and a half stars– enough to get them bonus money this year. After 2014, plans will need four or five stars to get bonuses. And if they have fewer than three stars, they won’t be allowed to enroll beneficiaries through Medicare’s website, and risk being booted from Medicare altogether, according to HHS spokesman Tony Salters. 
Source: kaiserhealthnews.org

Video: 2009 Medicare TV spot for Priority Health Medicare plans – couple RV’ing

Tricare Help – Between VA and Tricare for Life, I think I’m paying too much

All that said, I don’t think it’s fair to say that you’re getting no benefit from TFL. While you may have co-pays, those charges are far lower than the actual costs of the medical services you receive through your VA facility. What you’re not getting any benefit from is Medicare, for which you are paying $100 a month in Part B premiums. Since you are in VA’s Category 8, the lowest-priority category for care, and are already paying for Medicare Part B, you may want to consider simply using Tricare For Life. To do that, you need to find a Medicare provider. Under TFL, in most cases, Tricare will pay for whatever Medicare does not, fully covering your medical costs on the vast majority of your claims.
Source: militarytimes.com

Priority Health now offers free dental cleaning to Medicare patients!

Medicare age people that have Priority Health Insurance now have Delta Dental coverage for one periodic exam and one prophy (cleaning) per year paid at 100%.  They also cover one set of bitewings x-rays per year paid at 50%.
Source: wilderndental.com

Skin Tag Removal Covered By Health Insurance

Air to release my personal health therefore they are a non-covered service and will not be submitted to the insurance company. There will be a fee associated with the removal of skin tags. It is the provider’s discretion to determine if they can submit the removal on a skin tag to the insurance
Source: skintagscauses.net

It’s Your Time: National Women’s Health Week

There are a number of ways to celebrate the Women’s Health Week under the Affordable Care Act.  Because of the new health care law, being a woman will no longer be considered a pre-existing condition. Women with non-grandfathered health coverage or Medicare can now obtain preventive care, such as well-women visits, mammograms, pap smears, and cancer screenings without co-pays or other cost-sharing.  National Women’s Checkup Day on May 14 serves as a reminder that women should schedule a visit with their doctor to discuss which screening tests they need. Regular checkups and appropriate screenings can help detect diseases early—when treatment is most effective.
Source: tribalhealthcare.org

Save the Country with Preventive Care

The Pareto risk stratification discussed has been a passion for me for many years, including mico-economics research of the phenomenon. First, there is a predictable and regular turnover in the 5% high risk population making the case for prevention even more compelling to reach individuals earler in a risk/cost episode. Second, the predictors of risk in the 5% certainly include chronic disease but even more important are benefits design and economic incentives as there is major disbility income use in the 5% where medicalization of job failure in the form of repetetive motion and musculoskeletal claims frequently with stress/depression/anxiety overlay is present. In our reserach 80% of the 5% high risk population have a narcotic pain prescrition and 40% have a psychotrophic drug in the mix. Thirdly, both of those risk factors are more prevelant in the hospital and healhcare employer marketplace making it less lekely they will get the prevention agenda right as this kind of disruptive innovation needs to start at home!
Source: thehealthcareblog.com

JK CM stresses on universalizing modern medicare

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Source: groundreport.com

National Site Visit Contractor Established

Posted by:  :  Category: Medicare

OBAMACARE WATCH: MORE DARKNESS THAN LIGHT AND OF COURSE TAXES AND PENALTYS by SS&SSIt is important to keep in mind that the site visit contractors and subcontractors who will be serving as National Site Visit Contractors are knowledgeable, aggressive and experienced in auditing and surveying the business practices and coding and billing efforts of healthcare providers. They will expect cooperation when on-site, and will probably leave no stone unturned when reviewing a facility to determine if a provider should remain admitted (or be admitted) as a participating provider in the Medicare program. Therefore, you should ensure that your organization has an effective compliance plan in place and it is actively being followed. While CMS has not released its “pre-defined” list of issues that will be examined by site visit contractors, you should expect the contractors to examine any and all  risk areas that may be present in your organization, not limited to merely coding and billing practices.   The National Site Visit Contractor will probably want to look at your existing and potential business relationships, referral sources, and the licensure status of your staff (if applicable).  Should the site visit contractor find that you are employing an excluded person, you should expect to face significant penalties.  The “best practice” for your organization would be to conduct a gap analysis of your organization’s coding and billing practices and all of your business arrangements and relationships.
Source: lilesparker.com

Video: Enrolling in Medicare

Medicare Supplement Insurance coverage

As a general rule, Medicare supplement insurance will cover up to 80% of certain varieties of health-related treatments, hospitalizations, medical equipment and so on. The exact quantity of cover will rely on whether you have solely Medicare Part A coverage or whether you have opted for optional Component b coverage as properly. Even with additional Element B coverage a lot of folks are still forced to pay out substantial out of pocket expenses to cover the remaining twenty% not covered by Medicare. This gap is referred to as the co-payment sum and quite frequently individuals just do not have the cash to pay it in cash. There are a range of Medicare supplement insurance policies, or medigap as they are typically known as on the marketplace, exclusively created to aid individuals pay the co-payment sum and despite the fact that they could be managed by diverse businesses, every policy must fall beneath the tips of Medicare. There are currently twelve present standardized Medicare supplement insurance coverage plans which are also referred to as Medigap. The plans are labeled ‘A’ via to ‘L’ and offer various advantages at varying costs based on the co-payment required by the user. Even though the degree and kind of cover supplied in every single plan differs, each and every Medigap strategy should give simple Medicare benefits as a minimum. There is also an additional alternative obtainable known as Medicare Select which is a Medicare supplement insurance coverage policy that is much less high-priced than other plans. The only drawback to Medicare Select is that you are restricted to specified physicians and hospitals for your wellness care needs. The positive aspects inside of each and every of the twelve Medigap plans do not differ from firm to organization if you buy a plan ‘A’, it will be identical no matter which company you use. Nonetheless, premiums can fluctuate significantly from business to firm and paying a higher premium will not make sure that you obtain something more than and over what is integrated in the standardized strategy. The finest time to get a Medicare supplement insurance coverage policy is during the first 6 months after enrolling in Medicare Component B. This is the only circumstance where Insurers are obliged to accept you regardless of any pre-existing well being conditions. Premiums for Medigap policies are set by the following strategies Attained age: This creates the lowest premiums, specifically for those just turned 65. Even so, premiums do boost as you get older, usually every single one, three or 5 years, extremely usually reaching their highest point when you can least afford them. Issue age: Premiums are based on your age at the time of acquire and will not improve as you get older. Neighborhood-rated: Everybody in the identical geographic area pays the very same premium regardless of age. It must be noted that every January 1st Medicare’s rewards are adjusted to keep up with inflation and as all Medigap positive aspects are co-ordinated with Medicare’s, premiums for Medicare supplement insurance plans normally enhance each year above and over any increases described above. Our site has a massive sum of up to date details about medigap expense and crucial medicare concerns. Keep informed on this crucial issue.
Source: blogspot.com

What’s next for Los Angeles Medicare Supplement Rates

The 2012 Medicare Supplement Rates in Los Angeles County are not the lowest in California although with the continued growth in new customers turning age 65 in Los Angeles, my feeling is the L.A. area will continue to see consistent rates over the next several years.  Not the wide swinging ups and downs in other parts of the country.  Anthem Blue Cross is the carrier I think will continue to stay competitive in Los Angeles County, along with their Anthem Extras Dental & Vision packages, their Anthem Medicare PPO plan and their Medicare Part D Rx plans all continuing to stay very popular over the coming years.
Source: johnconner.com

CMS eases rules to cut doctors’ regulatory burdens

“We are pleased that CMS adopted numerous AMA recommendations in the final Medicare conditions-of-participation rule, including a requirement that there be a single medical staff for each individual hospital,” said AMA President Peter W. Carmel, MD. “The AMA strongly supported this change from the previous proposal, which would have allowed a medical staff to be used over a multihospital system. A self-governed and autonomous medical staff at each hospital is imperative to ensure the health and safety of patients.”
Source: nebraskaruralhealth.org

Romney, Now 65, Won’t Enroll In Medicare

The Hill: Gingrich Ad: Romney ‘Can’t Beat Obama’ Because Of Health Care Mitt Romney “can’t beat Obama” because of the similarities in their healthcare laws, Republican presidential candidate Newt Gingrich said in a Web video Monday. Gingrich and former Sen. Rick Santorum (R-Pa.) have argued before that Romney won’t be able to draw a sharp contrast with President Obama on healthcare. The new ad, though, goes further than simply arguing that Gingrich would be stronger on the issue, and claims that Romney would lose a general-election match-up (Baker, 3/12).
Source: kaiserhealthnews.org

Mitt Romney Won’t Enroll In Medicare And Doesn’t Want Anybody Else To Either

Mitt Romney hasn’t explained his announcement yesterday that he won’t be enrolling in Medicare despite turning but as Jonathan Cohn points out, Romney is at least practicing what he preaches. Romney supports Paul Ryan’s plan to turn Medicare into a voucher program, a plan that would effectively end Medicare as we know it, and Romney putting his money where his mouth is by deciding against enrolling. Romney’s decision is a window into the future that he promises to deliver. Instead of a Medicare program that directly provides coverage, Romney wants seniors to obtain coverage from private insurers. Depending on their income personal wealth, a portion of that coverage would be subsidized, but the guaranteed coverage of Medicare would eliminated. The fact that Romney was able to forego the Medicare system without penalty or punishment puts the lie to the that government health care programs are tyrannical. That’s an important fact to point out, because even though senior who doesn’t want Medicare coverage could walk away from the system, just like Mitt Romney did, the overwhelming majority of them don’t—and that’s a testament to the effectiveness of Medicare. But even though Medicare works, Mitt Romney wants to end the program as we know it. He wants Medicare to be transformed into a voucher provider, subsidizing private insurance plans instead of directly covering medical care. 99 percent of Americans, it would be a radical overhaul, raising costs and making it difficult if not impossible to insurance. Given his means, Romney would do fine in such a system. That’s basically the system he’s living in but it doesn’t take a rocket scientist to realize most people can’t afford what he can afford. And if Medicare were privatized as he proposes, that’s exactly what he would force every American senior to do. If you’re only concerned about personal benefit, Medicare might not turn out to be the best deal in the world for someone like Mitt Romney, who is fabulously wealthy and doesn’t need the coverage. But even the Mitt Romneys the world are better off living in a society where senior citizens have the security of health care coverage that Medicare provides. If we were to adopt Mitt Romney’s proposal to turn it into a voucher system, Medicare would no longer provide it’s greatest benefit of all: the peace of mind that comes with knowing that every single senior citizen has health care coverage they need. http://mykeystrokes.com/2012/03/14/a-window-into-the-future-mitt-romney-wont-enroll-in-medicare-and-doesnt-else-to-either/? utm_source=feedburner&utm_medium=feed&utm_campaign=Feed%3A+mykeystrokes%2FEPBb+%
Source: typepad.com

Ask The Experts: Retirement

A. You don’t need to immediately enroll in Medicare Part A, although you may want to because there isn’t any cost to you. On the other hand, because you are covered under a group health plan, you can postpone enrolling in Medicare Part B until that coverage is close to ending. Then you can enroll during the eight-month period that begins the first full month that you are no longer covered based on your current employment. The decision about enrolling in Medicare Part B will depend on whether the benefits you will receive now and in the future are worth the cost of the premiums. You’ll have to do a little research to figure that out.
Source: federaltimes.com

Mitt Romney Not Enrolling in Medicare on 65th Birthday

Romney’s proposal for 2022 is for the United States to “gradually increase the Medicare eligibility age by one month each year. In the long run, the eligibility ages for both programs will be indexed to longevity so that they increase only as fast as life expectancy.”
Source: wbobradio.com

Targeting Diabetes Prevention Among Medicare Beneficiaries

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Source: medicaresupplementalco.com

The Importance of Comparing Medicare Supplemental Insurance Plans

Posted by:  :  Category: Medicare

Many Medigap customers think that comparing Medicare supplement insurance is a highly complicated process and that only insurance agents will know how to compare these supplement to Medicare policies. If you too are holding the same view about Medicare supplemental insurance, then you will be surprised to learn that comparing your Medigap plan options need not be a complicated or tedious process anymore. Today, the internet has empowered the customers so much that they can accomplish a lot of time consuming tasks in a matter of just few clicks. This applies to Medicare supplemental insurance price comparison too. You will be able to compare your Medicare supplement plans easily online. You will not have to visit several websites or spend several hours anymore to compare the various policies. You just need to find a reliable Medicare supplemental insurance website such as Lowcostmedigap.com that will allow you to compare Medigap plans online. Using such online services you will be able to make well-informed choices on your Medicare supplement. You will be able to save not only a lot of money but also a lot of time by comparing your Medicare supplement plans online.
Source: medicarequotefinderblog.com

Video: Medicare Plan Finder at a Glance

CVS Agrees To Pay $5M To Settle Medicare Drug False Advertising Claims

Bloomberg: CVS Caremark To Pay $5 Million To Settle FTC  Probe Of Medicare Drug Prices  The FTC said it decided to close its investigation “after a thorough and comprehensive review of the other consumer protection and competition issues in this matter,” and won’t take any further action “at this time,” according to a letter addressed to CVS Caremark’s lawyer. The FTC began investigating the business practices of the company in 2009 after CVS bought Caremark for $27.2 billion, the largest acquisition ever by a drugstore (Forden, 1/12).
Source: kaiserhealthnews.org

Medicare, Social Security and You

One of the biggest drivers of poverty in old age is failing health and the associated medical costs. Most retirees living below the poverty line (70 percent) have suffered acute health conditions such as cancer, lung disease, heart problems, or stroke, compared with 48 percent for those above the poverty line, according to health and retirement study data. And almost all senior citizens living in poverty (96 percent) have some sort of health condition, such as high blood pressure, diabetes, psychological problems, or arthritis, versus 61.7 percent of retirees with incomes above the poverty line.
Source: georgia-medicareplans.com

Q1Medicare.com Releases 2012 Medicare Advantage Plan Search Tool

Like the Q1Medicare stand-alone Medicare Part D prescription drug plan finder or PDP-Finder, the Medicare Advantage plan finder is designed as a simple alternative to other more complicated online Medicare plan search tools. Using the Q1Medicare.com/MA-Finder, Medicare beneficiaries enter their ZIP Code, choose their county if necessary, and view all 2012 Medicare Advantage plans available in their area. Alternatively, MA-Finder users can start on a state level and browse through the counties within a state to see highlighted plans showing the lowest cost plans with $ 0 deductible prescription drug coverage for each type of health plan (such as HMO, PPO, or PFFS), along with a link to a complete list of Medicare Advantage plans in the specific county.
Source: tymontpro.com

Medicare Enrollees Should Be Given a Chance to Switch Part D Plans, Say U.S. Pharmacists

It appears that many patients who enrolled in Part D drug plans online, or with the Medicare Plan Finder on the Centers for Medicare & Medicaid Services website, were promised zero co-pays. Since enrollment has closed, however, some patients have discovered that this no- to low-cost premium benefit is only available at specific, and often few, pharmacies. What’s worse, in many cases those pharmacies are not in their local neighborhood, but up to 25 miles away!
Source: pharmacycheckerblog.com

HealthPlanOne Announces Travel Series on Medicare Benefits

Posted by:  :  Category: Medicare

OOPS I THINK THE SHINE IS OFF THE PEACH ...........IT'S ABOUT TIME by SS&SSThe second article releasing June 5, Cruising With Medicare: Know Which Benefits are Covered Before You Set Sail, provides instruction on what to do when faced with both emergency situations and non-emergency treatments, details special benefits for people on cruise vacations, outlines potential gaps in Medicare coverage while in international waters and foreign ports of call. This article also includes essential details, such as how your distance from a U.S. port impacts which services may or may not be coved by Medicare. Lastly, key tips relevant to cruise ship travel to ensure a more enjoyable vacation are also included.
Source: cheapesttravelinsurance.org

Video: Medicare Spending Per Beneficiary Measure National Provider Call – February 9, 2012

Where Can I Use My Medigap Plan?

One of the major sources of confusion about this is that other types of plans do have networks. In particular, Medicare replacement plans (Medicare Advantage) are PPO and HMO type plans. These plans are all regional in nature, and all of these plans do have networks. In recent years, there has been much talk about doctors refusing to take this type of plan due to changes in reimbursement rates, etc. Do not confuse this talk with the actual Medicare Supplements (Medigap), which do not have networks.
Source: medicare-supplement.us

Volunteers Needed to Help People Understand Their Medicare Choices

Do you want a volunteer position that is truly fulfilling and mentally stimulating? Then consider counseling seniors and the disabled with the SHINE (Serving Health Insurance Needs of Elders) program. SHINE volunteers are both active and retired individuals from diverse career and cultural backgrounds.  As a volunteer, you will receive initial training, continuing education and a supportive environment with dedicated colleagues.
Source: patch.com

Medicare Supplemental Insurance, Medicare Supplements, Medigap

Medicare Part A covers hospitalization, some skilled nursing facility charges, some home health care, and hospice.  You pay payroll taxes that go directly to the Part A fund and those tax revenues currently cover all Part A expenditures. In other words, the Part A budget is balanced.   You are not required to pay anything for Part A unless you did not pay 40 quarters of payroll taxes or acquire this right through a spousal benefit.
Source: medicaresupplementaladvisors.com

Get Your Medicare advantage plans today

One thing you should know about Advantage is that it has only a 6 month open window of enrollment. That means if you purchase your Advantage policy within 6 months of being issued your Medicare policy you cannot be turned down for Advantage and your premiums are guaranteed to remain low even if you have a serious health problem. Once the 6 months have passed however it is up to the insurance company on whether they accept you as a client and how much you will pay for the premiums.
Source: abchealthplans.com

Medicare Advantage Star Ratings: Detaching Pay from Performance

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American ProgressBecause criteria for evaluation are not published until after the period for which performance will be evaluated, there is no possibility that MA plans will be able to improve their performance to achieve the goals CMS intends to incentivize. Any adjustment plans will be able to make to their bids or plan offerings would have to be aimed at increasing enrollment in counties with the highest bonuses and rebates based on data from performance in previous years, possibly at the expense of improving their performance in the future.
Source: thehealthcareblog.com

Video: Understanding Medicare Advantage Plans

ObamaCare May Hurt Medicare Advantage Plans for Poor, Seniors

Many low-income seniors could lose access to their preferred Medicare Advantage plans due to ObamaCare changes. A new report released by the conservative American Action Forum on Tuesday argues that changes made to the five-star rating program for MA plans may reduce plan choice and direct Medicare resources away from low-income areas. The Center for Medicare and Medicaid Services rates MA plans on a system of one to five stars, depending on how the plans satisfy certain criteria. Under ObamaCare, beginning in 2015 plans that achieve four- and five-star ratings are eligible for bonuses, which can boost an insurer’s bottom line, and rebates that the insurers must use to expand benefits for plan enrollees. According to CMS, 71% of MA enrollees choose plans with ratings of three stars or less. Only 20% are in plans rated four stars, and 9% are in five-star plans. “Medicare Advantage is a program that is used disproportionately by low-income and minority seniors,” said Douglas Holtz-Eakin, president of AAF and former head of the Congressional Budget Office. “It has been a program that has matched their preferences for getting Medicare. The kinds of plans that CMS likes, the four-star and higher plans, aren’t the ones that low-income seniors are taking up.” The amount of bonuses and rebates that the four- and five-star plans receive will be based on future enrollment in those plans. This gives insurers an incentive to push higher enrollment into those plans, since it will be better for their bottom lines, says Holtz-Eakin. Insurers will also have an incentive to phase out plans rated three stars or less to increase the likelihood that enrollees in those plans will instead choose the four- and five-star plans. “It turns out the plans that low-income seniors choose are not the ones likely to be rewarded by CMS,” he said. “Over time we could expect those plans to disappear and, in effect, harm low-income seniors.” AAF also reports that the changes made by ObamaCare may redistribute Medicare benefits away from those who need them most. “Because rebates, and thus net benefits, will be higher in plans with higher ratings, beneficiaries without access to higher-rated plans will necessarily receive lower benefits than those with such access,” the report states. The rebates that will go to four-star and higher plans are to be used to provide additional benefits, such as lowering beneficiary premiums or reducing co-pays for doctor visits. Lower-income seniors are, arguably, more in need of those benefits. READ SOURCE ARTICLE
Source: newmediajournal.us

Will Medicare Advantage Plans Keep Low Premiums In 2013?

Another reason that these plans are appealing is that they have low premiums. This is because they are subsidized by the federal government. In exchange for the low premiums, you only have coverage for in-network providers who have negotiated with the insurance company, except in emergency situations. Before deciding to enroll in one of the Medicare Advantage plans, you need to weigh the pros and cons to see if this is the best type of coverage for your health care needs.
Source: online-business-expert.com

Medicare Advantage Plans Are 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

The Tucson Weekly does fact checking right

Whether Affordable Care Act guts Medicare Advantage is a matter of opinion, but an April Associated Press article noted that this year, premiums are down about 7 percent, while enrollment has climbed nearly 10 percent. And FactCheck.org notes that Medicare Advantage patients “will likely see some of their extra benefits cut and may drop out of the program entirely. But they would still retain the basic benefits to which all current Medicare recipients are entitled.”
Source: blogforarizona.com

Obama Administration Spends $20 Million Dollars to Hire PR Firm Porter Novelli to “Sugar Coat” Obamacare. Who is Bill Novelli?

Bill Novelli is a professor in the McDonough School of Business at Georgetown University. He teaches in the MBA program and has created and leads the Global Social Enterprise Initiative at the School. He also is Co-Chair of the Coalition to Transform Advanced Care (C-TAC), a national organization dedicated to reforming advanced illness care by empowering consumers, changing the health care delivery system, improving public policies and enhancing provider capacity. From 2001 to 2009, he was CEO of AARP, a membership organization of over 40 million people 50 and older. During his tenure, AARP achieved important policy successes at national and state levels in health, financial security, good government and other areas. It also doubled its budget, added five million new members and expanded internationally.
Source: wordpress.com

OUR VIEW: Medicare prescription billings

Posted by:  :  Category: Medicare

Hubert Humphrey and Wilbur Cohen by National Institutes of Health LibraryIt’s estimated that in 2009, Medicare paid more than $5 billion in suspicious billing for prescription drugs for seniors. The Health and Human Services Department inspector general analyzed almost 1 billion prescriptions that were filed to Medicare in 2009. Because Medicare fails to require private insurers to report prescription drug billings that look suspicious, the system can be an easy-access clearinghouse for drug fraud.
Source: standard.net

Video: Cheryl Bradley lectures on Medicare Billing

Nursefriendly Nursing Directories, Nursefriendly.com: Nurse Bytes # 4: Fancy Footwork: Medicare Billing, Carol Gino #RN, @hopefulhealer @cgino8 #nursing #nursefriendly #nurseup

Carol Gino, RN, BS, MA, Starwater Press, aaha!Books, @hopefulhealer @cgino8 New York, Texas Nurse Authors, Nursing Publishers, Nursing Entrepreneurs, Nurse-Owned Businesses:”Star Water Press, LTD. is a publishing company I formed in 1987 in order to publish angel books and other ”alternative” titles that would have taken too long to get published (at the time) at a traditional or commercial publishing house. I incorporated aaha!Books,LLC in 2010 when I moved to Texas to reprint my previously published books as well as other books in ebooks and other digital media. It is also the company from which I run hopefulhealer.com and starwater.com. My team works at both. aaha!books publishes books ”Help for Hard Times, clear and simple-small books of big ideas” Star Water Press is for publishing books both in print and new media” We have two addresses. Star Water Press LTD. is in Amityville, NY, 11701 aaha! Books, LLC is in Texas Street Address: 173 KLBJ Rd. Smithville, Texas, 78957 E-mail Address: staff@starwater.com or team@aahabooks.com Blog: http://www.hopefulhealer.com URL: http://www.starwater.com
Source: blogspot.com

Medicare billing flagged at 4 percent of U.S. pharmacies

Reuters: “The Office of Inspector General (OIG) examined billing records from 2009, the most recent full-year data was available. Government inspectors used eight measures to review the pharmacies, including average amount billed per beneficiary, average amount billed per prescriber and percentage of prescriptions for painkillers and other controlled substances that have the potential to be abused. In total, 2,637 retail pharmacies were found to have exceeded the threshold that indicated extremely high billing for at least one of the eight measures.” ‘via Blog this’
Source: blogspot.com

Medicare at Risk: Visualizing the Need for Reform

I think there are ways to make some cuts and establish limits. As Social worker I have worked many places. One place billed medicare and Medicaid for services. they wanted us to bill 1.25 hours for only 1 hour of service. How is this done. well Medicare has an 8 minute round up so if you bill something for 43 minutes, something for 8 minutes and then 8 minutes it rounds up so that would be 1 hour and 15 minutes. I would require any mental health services with the exception of the initial assessment to not be billed at over 1 hour. I would make anyone wanting to bill 1 hour 15 minutes get a pre authorization this is what private insurance does. Next there are people who are finished with talk therapy and only coming to remain on medications agencies are making them come in to see the doctor every 3 months which is standard. However, they are making medications only people come back every 3 to 4 months to do paperwork when the required paperwork is only due every 6 months. Private insurance does not require this these updates as assumed done when they see their psychiatrist. SO I would not allow these unneeded services to be billed. I would only pay for one initial assessment and then one review of a recovery plan and mental health update every 6 months to be done the same day they see the doctor so the services would bundle. I live in Illinois and a few years ago there were limits as to the number of sessions a Medicaid person could have. The limits were based on treatment history diagnosis. SO someone with a very serious long term illness could come several times a week. A person needing brief focused therapy could attend 6 to 10 times a year and the if they needed more be reviewed. Some places then changed how they coded services to get around these limits. I would reset the limits based on the individuals needs as defined by diagnosis, treatment history. I would also stop medicare and Medicaid from paying for court ordered or recommended treatment. In treatment ordered as a result of criminal court or parole should not be covered by medicare and medicaid. The individual states can decide if they want to fund or create community service programs to allow people to work for the costs of court and treatment. I would also run a very simple report to show that social workers counselor and therapist are only billing for the actual time worked or in direct contact with consumers . the amount of time billed should not exceed 75% to 80% of their work week or something is wrong
Source: heritage.org

Medicare Combats Fraud With Billing Statements That Beneficiaries Can Understand

That complexity can mask mistakes or out-and-out fraud that drive up Medicare costs and can jeopardize future services for beneficiaries, said Susan Johnson, project manager for Virginia’s Senior Medicare Patrol, a nationwide program that encourages seniors to ferret out fraud. Johnson said a few seniors have recently alerted her to double billing for laboratory tests in Fairfax County, suspicious home health care charges near Roanoke, and a wheelchair paid for but never received in Arlington.
Source: kaiserhealthnews.org

OIG: “Extremely High” Prescription Drug Retail Pharmacy Billings Warrant Tighter Medicare Part D Oversight & Controls

A board certified labor and employment attorney widely known for her extensive and creative knowledge and experienced with these and other employment, employee benefit and compensation matters, Ms. Stamer continuously advises and assists employers, employee benefit plans, their sponsoring employers, fiduciaries, insurers, administrators, service providers, insurers and others to monitor and respond to evolving legal and operational requirements and to design, administer, document and defend medical and other welfare benefit, qualified and non-qualified deferred compensation and retirement, severance and other employee benefit, compensation, and human resources, management and other programs and practices tailored to the client’s human resources, employee benefits or other management goals.  A primary drafter of the Bolivian Social Security pension privatization law, Ms. Stamer also works extensively with management, service provider and other clients to monitor legislative and regulatory developments and to deal with Congressional and state legislators, regulators, and enforcement officials concerning regulatory, investigatory or enforcement concerns. 
Source: slphrbenefitsupdate.com

Towards honest Medicare billing practices

In an industry characterized by the highest level of professional integrity and honesty, it is strange yet true that health insurance related fraud and abuse have reached alarming heights. While the incidence of fraud and abuse are equally spread across the health insurance continuum, it’s more intense in Medicare. In fact, a reliable survey (by the American Society of Business & Behavioral Sciences) puts the cost of such Medicare fraud and abuse at a staggering $700 billion annually, which is close to one third of the total healthcare spend. What is even more frightening is that that 80 percent of healthcare fraud is committed by hospitals, clinics and medical providers themselves! While the Federal Government has set up a recovery mechanism, the percentage of recovery against the eroded Medicare expenditure has been rather dismal – roughly about 5% of the expenditure lost to Medicare fraud and abuse is recovered annually.
Source: medicalbillersandcodersblog.com

Jury Convicts Doctor of Billing Medicare for Unnecessary Neurological Tests in $6.7M Fraud Scheme

Under the False Claims Act, whistleblowers may file qui tam actions on behalf of the government and are entitled to an award of between 15-25% (and under certain conditions 30%) of fraud recoveries based on credible, first-hand knowledge. Frohsin & Barger is responsible for the largest qui tam Medicare hospice case in U.S. history, recovering $24.7 million. Our firm investigates and works with government attorneys and agents in numerous qui tam cases across the country, and our lawyers are among the most oft-cited legal scholars in the field. If you have knowledge of false claims against the government, please contact us.
Source: fraudblawg.com

Towards honest Medicare billing practices

In an industry characterized by the highest level of professional integrity and honesty, it is strange yet true that health insurance related fraud and abuse have reached alarming heights. While the incidence of fraud and abuse are equally spread across the health insurance continuum, it’s more intense in Medicare. In fact, a reliable survey (by the American Society of Business & Behavioral Sciences) puts the cost of such Medicare fraud and abuse at a staggering $700 billion annually, which is close to one third of the total healthcare spend. What is even more frightening is that that 80 percent of healthcare fraud is committed by hospitals, clinics and medical providers themselves! While the Federal Government has set up a recovery mechanism, the percentage of recovery against the eroded Medicare expenditure has been rather dismal – roughly about 5% of the expenditure lost to Medicare fraud and abuse is recovered annually.
Source: ezinemark.com

The truth about the $247 Medicare Part B Premium

Posted by:  :  Category: Medicare

Try new Ryan Plan Senior Food - coming to a Republican Congress near you by EN200850% discount on name brand drugs 2011 Medicare Part D Plans 2011 medicare premium aca change medicare coverage closing the donut hole Copayment Cosinurace currently working disenroll Doctor Office Visit donut hole drug plan Emergency Room Visit find medicare part d health care reform help with medicare HIV testing how to use medicare plan finder Medicaid Medicare medicare advantage plans medicare classes medicare fraud medicare part b medicare part c Medicare Part D Medicare Part D Rebate checks medicare plan finder medigap Plan N medigap policies new to medicare no copay preventitive services non renewal obamacare paper checks Part A Part B premium for medicare preventitive services retired Social Security voulunteering in Sedgwick County Kansas what happens when plan goes away wichita kansas
Source: wordpress.com

Video: The Early Show – Medicare premiums up less than expected

Medicare Advantage Premiums To Fall 4% Next Year

The plans were targeted by Democrats who complained that the government pays more per capita for beneficiaries in the private plans than it spends on those in traditional Medicare. The billions of dollars cut from the plans were used to help the Obama administration pay for the cost of expanding coverage to 32 million Americans through expanded Medicaid eligibility and subsidies for people buying coverage in new insurance exchanges starting in 2014.
Source: kaiserhealthnews.org

2012 Medicare Premiums, Deductibles and Co

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

Medicare Supplemental Insurance, Medicare Supplements, Medigap

Medicare Part A covers hospitalization, some skilled nursing facility charges, some home health care, and hospice.  You pay payroll taxes that go directly to the Part A fund and those tax revenues currently cover all Part A expenditures. In other words, the Part A budget is balanced.   You are not required to pay anything for Part A unless you did not pay 40 quarters of payroll taxes or acquire this right through a spousal benefit.
Source: medicaresupplementaladvisors.com

Cigna: A Lot Riding On Managed Medicare

Higher debt levels of 60% of equity — the worst amongst its peers in our table above, has crimped profits and hurt its chances for further acquisitions. This industry, which is characterized by cut throat competition and little product differentiation, needs further consolidation and Cigna’s comparatively lower cash hoard makes acquisition led growth difficult in the future.
Source: seekingalpha.com

The Inherent Flaws in Medicare Premium Support

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

Medicare Part D Premiums Will Rise by 10 Percent in 2011

For seniors looking for the right prescription plan, that means comparing the cost of the premium, the amount of any deductibles and whether there is a co-payment or co-insurance. For Medicare beneficiaries who want to supplement their health care, one option is to check out www.MedicareSupplementPlans.com, a web site which specializes in Medicare supplement insurance, also known as Medigap insurance. It gives those 65 and older the opportunity to compare rates, plans and benefits from several prominent insurance companies.
Source: ezinemark.com

2012 Changes to Medicare in Illinois

Medicare Supplemental Insurance Plans K and L are similar to Plans A through J but have lower monthly premiums for higher out of pocket costs. All these plans are standardized by Medicare, which shows the equality among all the insurance companies in offering the services. Medicare Supplement Plan F will remain as the preferable choice, but Medicare Supplement Plan N can also be a great option for people who like Medicare Advantage plans and are in good health. Plan N brand new as of June 1, 2010 and will likely be very popular in 2011 as thousands of people are expected to make a shift from the Medicare advantage program back to original Medicare. Find a company that specializes in Medicare plans to help you with these questions like Medicare insurance Phoenix. A broker is usually the best bet since they can sort down information for all of the companies and you can compare all insurance from one source. It sure to save your time and beats the alternative of contacting each individual company one at a time. Source: ezinemark.com
Source: medicaresupplementalco.com