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Source: avidtrader.com
Video: Medicare Part B_1.wmv
Teachers Are Not the Problem: Medicare meets Obamacare.
This blog’s target audience is retired teachers in WNY, which means that Medicare is probably at the top of your list of questions about the Affordable Care Act (ACA). Before addressing the specifics of the ACA with regard to Medicare, however, we need to do a little background work on some of the details of Medicare’s inner workings. Medicare comes in two “flavors”: traditional (sometimes called “fee-for-service” Medicare) and Medicare Advantage plans. Seventy-five percent of Medicare participants are in traditional Medicare while the remaining 25% are in Medicare advantage plans. That 3/1 ratio of traditional Medicare participants to Medicare advantage participants is important, and will have a tremendous bearing on how you personally view the Medicare changes in the ACA. Traditional Medicare is run by the government. It consists of Part A (hospital costs), Part B (doctor costs) and Part D (prescription drug costs). There is no cost to the participant for Part A, although there is a deductible for each hospital admission. Participants pay a monthly premium of $96.40 (or close to this amount) for Part B coverage. There is a yearly deductible for Part B costs. In addition Medicare only pays 80% of the covered Part A and B expenses. Traditional Medicare participants may, if they choose, purchase supplemental (Medigap) insurance to cover all or part of these costs not covered by Medicare. Traditional Medicare participants may also purchase Part D drug insurance through private insurance companies approved by Medicare. Traditional Medicare is a “fee-for-service” plan. Whenever you receive a covered medical service, Medicare provides a set fee for that service to the provider. Medicare providers have agreed to accept whatever fee Medicare provides as payment in full. (Actually, Medicare only pays 80% of this fee to the provider. The other 20% is billed to the patient or their Medigap insurance, if they have purchased it.) If you receive no covered services during a year, Medicare spends no money on your behalf. There is no upper limit on your yearly cost to Medicare if you do receive covered services. Medicare Advantage plans (also known as Medicare Part C) began in the 1970′s with the idea that the private sector could do Medicare more cheaply than the government. Over the years, Congress has made several changes to Medicare Advantage so that its focus now is attracting more private participation. Medicare Advantage plans are run by private insurance companies such as Univera, Independent Health, etc. Medicare pays these companies a flat fee to provide hospital and doctor services to their members. Some Medicare Advantage plans also include Part D drug coverage, while others require that their members purchase it as a separate entity. While participants in traditional Medicare are free to use any doctor or hospital and do not require a referral to see a specialist, Medicare Advantage plans usually require members to use only hospitals or doctors in their network. Going “out-of-network” usually results in the member paying either a larger share of the cost or, in some cases, the full cost of the service. If you are unsure which “flavor” of coverage you have, if you pay a “co-pay” when seeing your doctor, you are probably a Medicare Advantage member. Medicare Advantage members also pay their Part B premium to Medicare, usually through direct deduction from the Social Security payment each month. The amount that Medicare pays to the Medicare Advantage insurer for each member is a flat rate based on the average yearly cost to Medicare of traditional Medicare participants in your county. And there’s the rub. Medicare currently pays Medicare Advantage insurers about 15% more for each member than the average cost to Medicare for a traditional Medicare participant. Many Medicare Advantage providers use this extra money to provide services not covered by traditional medicare such as dental, eyeglasses and gym memberships. Everyone agrees that Medicare has financial problems. The Part B premium, for example, covers only about 25% of the cost of doctor services to Medicare participants. We Medicare participants often boast that we’re “paying our way” through our premiums. Sadly, that’s simply not the case. The ACA attempts to help stem the rise in Medicare costs by scaling back the increase in payments to Medicare advantage providers by about $322 billion over the next 10 years. Note that this is NOT a decrease of $322 billion from the current payment level. Instead, it is a decrease in the expected rise in these payments. If you are one of the 3-out-of-4 traditional Medicare participants, you will probably view this as a good thing. There will be no change in your Medicare services and the overall cost of Medicare will be $322 billion closer to being under control. If you are the 1-out-of-4 person who participates in a Medicare Advantage plan, you will likely see some decrease in the “extra” services such as gym memberships. To be fair, however, with everyone paying the same dollars into Medicare, it’s hard to make a case that it’s fair that Medicare spend an extra 15% on 25% of participants allowing them to receive benefits that the other 75% do not receive. And, in addition, we help bring Medicare costs under control. And, this $322 billion in savings is used to help pay the costs of the ACA. Believe it or not, there’s even more to say about Medicare in the next post. [NOTE: Click here for an excellent side-by-side comparison of traditional vs Medicare Advantage provided at the Medicare website. Click here to download a much more complete explanation of Medicare Advantage plans from the Kaiser Family Foundation.]
Source: blogspot.com
Benefits of the Affordable Care Act (ObamaCare)
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Source: tntribune.com
Medicare Part B Premium Costs In 2010
Commonwealth of Pennsylvania treasury DePartment2009 UNCLAIMED PROPERTY ANNUAL REPORTINGBT ERM . Mc CAT ETREASURPropertyER2008ROForORDSTCommonwealth of Pennsylvania Treasury Department Harrisburg, Pennsylvania 17120The Pennsylvania Treasury Department is committed to increasing volun.
Source: propdfsearch.com
Looking for Insurance Articles
In addition you will need a Medicare Part D drug plan to help cover your prescription drugs since Original Medicare does not offer prescription drug coverage. The national average for a prescription drug plan premium is $38/month. You could pay around $200/month for a Medicare supplement. Added together you are now looking at $338/month for your Part A and B, Medicare supplement, and Part D drug coverage. The MAIN benefit of having Original Medicare with a supplement is that you know what your medical costs will be each month, and you can go to any provider that accept Medicare! The alternative is to look at a Medicare Advantage plan like Humana or Health Springs in order to save money.
Source: lookingforinsurance.net
A Quick Introduction to Part
Now that we have a good understanding of Part A benefits and it’s general coverage for facility (loosely translated as hospital, surgicenter, skilled nursing, and hospice care) based care, let’s look at Part B, logically our next letter in the alphabet. Generally, Part A is facility care while Part B can be thought of as physician, out-patient, and preventative benefits. You can think of Part B as everything Medicare covers outside of inpatient care (Part A) and out-patient medication (Part B). It’s quite different from both so let’s take a closer look at Part B. First, we need to speak about Part eligibility and cost because this a major difference. Most people are going to pay for Part B coverage. Part A is generally paid for through taxes during employment over the course of a person’s life. Part B is different and will likely feel the blunt of cost controls going forward. First, you must sign up for Part B. It is not automatically extended to eligible members the way Part A generally is. You must also pay a premium for Part B coverage. As Medicare started to show signs of financial strain, Part B became means tested which means that you will pay more for Part B premium if you have great income on average. You can expect to see this increased premium go higher over time as Medicare tries to shore up it financial house. The premium is paid monthly and can even be taken from your Social Security check automatically. The key take away is that you probably (most people do) need to actually enroll and that you will pay for this coverage separately from any charge to have medicare supplemental insurance. Now, let’s look deeper into what Part B covers. First, you will have an annual deductible that you need meet. This deductible is $162 for 2011 but you can expect that it will go up over time. The deductible is calendar year (Jan 1st through Dec 31st) and resets each January. Once the deductible is met, you will then pay 20% of the charges for allowable expense for the remainder of the year. If you have additional coverage such as Medicare supplement insurance or Advantage plan, you may get this deductible and 20% co-insurance covered depending on the plan you choose. Part B generally covers physician charges and outpatient expenses that are allowed and not covered under Part A on an inpatient facility basis. This can be the doctors office, labs, outpatient surgeries, and allowed preventative services. Medication is not covered under Part B and we’ll cover that in Part D. There are two ways to find out if a particular benefit is covered under Part B. First there, the Medicare benefit handbook (different from the Medicare and You handbook) which is handy since it’s alphabetized by actual benefit name such ad Diabetes screening. This is generally how people search for a given medical issue they are dealing with so we advise this first. There’s also the medicare.gov benefit database where you can get even more specific information by entering in keywords such as “routine physical”, etc. Both resources have made searching for eligible benefits much easier in the last few years. One quick but important note on Part B. If you choose to wait to elect Part B after you are eligible (assuming you do not have another eligible window such as leaving group etc, you may a higher rate for this benefit if you eventually opt for it. There may also be a delay from when elect Part B to when the benefits actually kick in. It’s best to discuss your situation with a licensed agent as Medicare is only getting more complex in terms of the rules.
Source: abcarticledirectory.com
Alerts and Updates MEDICARE SHARED SAVINGS PROGRAM AND ACO PROPOSED REGULATIONS: A SUMMARY April 8, 2011 On March 30 2011, the Centers for Medicare and Medicaid ("CMS") issued the long-awaited, proposed regulations for the Medicare Shared Savings Program. These proposed regulations include details concerning the requirements for qualifying as an accountable care organization ("ACO"), such as: Eligible legal entities; Criteria for shared governance; Assignment of beneficiaries to ACOs; Different types of risk contracts; Benchmarks and calculations of savings; and Shared savings, antitrust issues and policies, Medicare anti-kickback, and other regulatory requirements as applied to ACOs. This brief summary of the proposed regulations is not intended to be exhaustive. Rather, it is a description of several key highlights. A more detailed analysis will soon be available on the Healthcare Reform Center. The Background The Patient Protection and Affordable Care Act (Pub. L. No. 111-148) and the Health Care and Education Reconciliation Act of 2010 (Pub. L. No. 111-152), which amended certain provisions of Pub. L. No. 111-148 (collectively referred to as the "Act"), were passed on March 23 and March 30, 2011, respectively. Section 3022 of the Act added a new section under title XVIII, section 1899 of the Social Security Act which provides for a Medicare Shared Savings Program (the "Program") and the creation of ACOs. The Program is an extension of CMS’s strategy to expand value-based purchasing concepts through a program that shares realized savings in the Medicare Fee For Service program, under parts A and B. Under the Program, providers and suppliers who participate in ACOs can continue to receive traditional fee-for-service payments under Parts A and B of Medicare as well as be eligible for additional payments based on meeting certain quality and savings requirements. CMS is seeking comments on these proposed regulations by no later than May 28, 2011. The Medicare Shared Savings Program The Program is voluntary, and eligible entities are permitted to apply to the Program if they meet the requirements of an Accountable Care Organization. The Program must be implemented by CMS no later than January 1, 2012. What Are Accountable Care Organizations? The proposed regulations explain more fully the "bells and whistles" that make up an ACO. The eligible entities include: (1) "ACO Professionals," which are defined as physicians, nurse practitioners, physician assistants and clinical nurse practitioners; (2) hospitals that employ ACO Professionals; (3) a network of ACO Professionals, partnerships and joint ventures between hospitals and ACO Professionals; and (4) any other entity that the Secretary may approve. Several important points about ACOs under the Program are: ACOs must have shared governance that includes ACO suppliers, providers and beneficiaries in the governance structure, but not necessarily include members of the board of directors or managers, depending upon the structure. Shared governance may include advisory boards to the governing board of the ACO. Importantly, at least 75% of the control must be in the hands of the ACO participants—providers, suppliers and beneficiaries. Federally Qualified Health Centers ("FQHC") and Rural Health Centers ("RHC") are not considered eligible entities, but ACOs that include FQHCs and RHCs in their network will receive enhanced payments based on the number of visits. Each ACO must enter into an agreement with CMS for a three-year term and must have at least 5,000 beneficiaries assigned to the ACO. Under the Program, any agreement between CMS and an ACO may be terminated for failure to meet quality and other performance criteria, avoiding at-risk beneficiaries and other compliance requirements. How Are Beneficiaries Assigned to ACOs? Under the proposed regulations, the beneficiaries are allocated to the ACO based on the physicians with a specialty designation of general practice, family practice, geriatrics and internal medicine that provide the plurality of primary care services to the beneficiaries. The plurality is based on the sum of the allowable charges provided by the ACO physicians to the beneficiaries during the contract year. How Are the Shared Savings Contracts Structured? The total savings to be shared depends upon the type of risk contract the ACO enters into. There are two types of contracts: "One-Sided" and "Two-Sided" contracts. The One-Sided contract shares only the savings and not the losses between CMS and the ACO. In the Two-Sided risk contract, the ACO shares both the savings and the losses. How Are the Shared Savings Calculated and Shared? CMS will determine a benchmark, which includes the risk adjusted, per capita FFS expenditures for Parts A and B for the past three years. It will also be adjusted for certain trends for those beneficiaries assigned to the ACO. To minimize variation based on catastrophic claims, CMS will make certain adjustments to the benchmark. A minimum savings rate ("MSR") will be determined by CMS based on a sliding scale of the total number of beneficiaries. As the number of beneficiaries increases, the MSR will decrease. To determine the savings to be shared, the applicable minimum savings rate is applied to the benchmark, and if the ACO per capita expenditure for beneficiaries assigned to the ACO under Parts A and B is less than the adjusted benchmark, then the difference between the actual per capita expenditures and the benchmark reduced by the minimum savings rate will be shared between CMS and the ACO. For One-Sided contracts, ACOs shall receive 50 percent of the savings, not to exceed 7.5 percent of the benchmark. For Two-Sided contracts, ACOs shall receive 60 percent of the shared savings up to 10 percent of the benchmark. On all contracts, CMS may also withhold up to 25 percent of the savings to be shared to protect against premature termination. Each ACO with a Two-Sided contract must also provide for reinsurance and place funds in escrow, or other repayment mechanisms to assure the repayment of losses. How Do Quality Measures Factor into the Savings Calculation? In order to receive shared savings payments, the ACO must also meet certain quality performance measures which include patient safety, patient care, care coordination, high-risk/frail elderly and preventative health measures. In addition, the ACO must meet other related quality measures including but not limited to "Meaning Use" criteria required for electronic health records under the HITECH Act. Finally, all ACOs must demonstrate that their Programs are patient-centered. What About Anti-trust Considerations Which ACOs Have Raised? The Department of Justice and the Federal Trade Commission have issued an Antitrust Policy Statement that applies to ACOs approved for participation in the Program. The chart below illustrates what conditions necessitate antitrust review based on the potential for reducing competition within the primary service area ("PSA") by the ACO. ACO PSA Share Review Process Less than 30 percent (with a rural exception) Safety Zone—No antitrust review necessary by the antitrust agencies. Greater than 30 percent and less than 50 percent Expedited Review—Comply with list of conduct restrictions, or proceed without antitrust assurances. ACOs may: 1. Request an expedited review by the antitrust agencies and submit letter from the reviewing antitrust agency confirming that it has no present intent to challenge or recommend challenging the ACO, 2. Begin to operate and abide by a list of conduct restrictions, reducing significantly the likelihood of an antitrust investigation, or 3. Begin to operate and remain subject to antitrust investigation if it presents competitive concerns. Greater than 50 percent Required Expedited Review—ACO must seek review by the antitrust agencies to assess likelihood of procompetitive and anticompetitive effects. ACO eligibility to participate in Shared Savings Program is contingent on the ACO’s submission of a letter from the reviewing antitrust agency confirming that it has no present intent to challenge or recommend challenging the proposed ACO. No ACO will be approved for the Program if the ACO requires antitrust approval and does not receive it. These proposed regulations are complex and offer many opportunities for innovative contracting. The payment system based on shared savings raises concerns about whether providers and suppliers will be better off financially under these programs. Providers and suppliers must consider all the financial, operational and governance ramifications before joining an ACO. About Duane Morris Duane Morris has an online Healthcare Reform Center to help guide employers, hospitals, physicians, nursing homes, and providers of home care services and new nursing home alternatives in their efforts to comply with the Patient Protection and Affordable Care Act of 2010. To access links to the relevant legislation and other online resources, a timeline of what to do and when to do it, and changes and provisions affecting healthcare providers, visit www.duanemorris.com/HealthcareReform. For Further Information If you have any questions about this Alert or would like more information, please contact C. Mitchell Goldman, any of the attorneys in our Health Law Practice Group or the attorney in the firm with whom you are regularly in contact. Disclaimer: This Alert has been prepared and published for informational purposes only and is not offered, or should be construed, as legal advice. For more information, please see the firm’s full disclaimer.
Retirement planning goes beyond investment models and cash flow analysis. It means recognizing options and helping your clients make decisions, including those pertaining to Medicare. This course will debunk common myths and explore the mechanics of how the program works and how to supplement the coverage and grow your business.
One way that judgment debtors avoid paying off judgments is to die. When a judgment debtor dies, it is usually game over for most creditors. However, some judgment owners either check their late debtor’s estate situation. Depending on what they find out, some creditors might try to recover something on their judgment by filing a claim. For judgment owners, there is only a short time after their judgment debtor’s death, to file their creditor’s claim on the judgment debtor’s estate. The reason you want to verify if your judgment debtor died, is so that you can file a timely claim, to include their judgment debt in your judgment debtor’s estate. If you are polite and respectful, sometimes their family will pay or settle a deceased judgment debtor’s debt, occasionally even if an official claim has not been filed. This article is my opinion, and not legal advice. I am a judgment broker, and am not a lawyer. If you ever need any legal advice or a strategy to use, please contact a lawyer. One way to discover the death of your judgment debtor is to use the Social Security Death Index (SSDI). The SSDI includes a Death Master File, which is a list of all persons who are reported as having died, to the Social Security Administration. This list is not perfect or guaranteed, however it is usually accurate. Usually, the younger your judgment debtor or person of interest was, the more specific the SSDI tends to be. Full access to the SSDI is not free. The Social Security Administration does not make their Death Master File records directly available online. However, the records are usually available through genealogy websites; search for “SSDI” or “Social Security Death Index”. Web sites such as www.ancestry.com, www.familysearch.org, and others; allow you to search and access some historical death records for free. The best search results usually cost money. The SSDI data includes the dead person’s year of death, given (first) name, surname (last name), and middle initial. Really old SSDI records have only the year of death, old records have the month and year. The more recent the death, the better chance there will be exact and complete dates of birth and death, with zip codes. Note that if you do not find a listing in the SSDI, it does not mean the person is still living, or that the Social Security Administration (SSA) has no records on the deceased. On publicly accessible search sites, social security numbers are now one-way. One can search by the full social security number, however the full social security number is never shown on (legal) public web sites. Paid professional databases, available for those having permissible purpose to subscribe to, may allow their subscribers to see their judgment debtor’s full social security number. Once somebody dies, their privacy rights fade fast, because of the Freedom of Information Act (FOIA). By making dead people’s social security numbers available, much fraud is prevented. To get a copy of a dead person’s social security information, you must pay, and provide a copy of their death certificate. If you know your judgment debtor is dead, search on the web for “Form SSA-711″ to get an application and pay for a copy of the SS card of a dead person, or a “computer extract” (which seems only a slightly more useful option). This will likely list their place of birth, father’s name, and mother’s full maiden name. Another way to go is to search for form “SS-5″, to get the application form for copy of a dead person’s social security card. ——- Don’t assign your judgment, http://www.JudgmentBuy.com – Judgment Enforcement. The free, easiest, fastest, smartest, and best way to recover your judgment money nationwide for 33% or less, worldwide for 50% (Mark D. Shapiro)
Timing outlier events that may increase AGI such as sales of a business or sales of your residence or rental properties. If any of these events can take place prior to January 2013, do it. If not, make sure your accountant is apprised to the situation to determine if any planning can be done to reduce the tax exposure.
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Therefore, the best thing that can be done in this respect is to compare Medicare supplement plans before deciding to choose any of them. A random choice of a Medigap insurance is not always a recommended option. In order to compare Medicare supplement plans the best thing that can be done is to visit the Medicare supplement plans websites or any other such websites where you can purchase Medigap plans online and go through the offer documents of all these plans. Therefore, through this process it is always essential to get the best help of the Medicare supplement insurance in order to get the best benefits and the best coverage for your future. However, for every person having the Medicare supplement plans at hand is one of the wisest ideas for a better coverage for your future. You can also seek the aid of an insurance agent for this purpose who can easily offer the best assistance in respect of the choice of the best Medicare supplement plans. In this respect you can easily choose your Medicare supplement plans without any mistake. Therefore, have your Medicare supplement plans handy in order to get the best support for your own future security.