Medigap Or Medicare Advantage?

Posted by:  :  Category: Medicare

Note that things change every year in the world of US Medicare plans. Medicare.gov and qualified, certified, and licensed local Medicare health insurance agents are great resources. I am not attempting to explain or promote any particular Medicare health plan here. I am simply trying to outline the basic differences between Medigap and Medicare Advantage (MA) plans.  I will provide some clarifications, graphics, and links to resources where you can get more information on specific topics.
Source: over50web.net

Video: Medicare Advantage vs. Medicare Supplement Insurance

Why the F Medicare Supplement Plan Works Best

Your mailbox is full. After turning 64 and 1/2, you’re suddenly the most popular person on the block and the poor mailman can barely find room to stuff all those shiny brochures into the box. In terms of Healthcare, turning 65 really is a second birthday welcoming you to the world…of Medicare. Assuming you don’t have a better group option or other coverage, Medicare should reflect a significant reduction in your out of pocket medical expenses and a big part of this is the Medicare supplement insurance plans that works in conjunction with traditional Medicare. Let’s take a look at these plans and how they differ but most important, look at which plans stand out as best options to cut through some of that mailbox overload where everyone’s trying to sell you something. First, a quick introduction is in order. The Medicare supplements plans are different from Advantage plans, the other primary option available on the market. The Advantage plans are typically less expensive on a monthly basis (if not free) but have more constraints on how care is accessed (like traditional HMO”s) and share more medical costs that are incurred as a trade off. This last piece is an important distinction which we’ll address in more detail with our Medicare supplement versus Advantage article, but let’s stay with Medicare Supplemental plans for now. The supplements in a nutshell, fill in the holes of traditional Medicare with the deductibles (physician and hospital) plus the 20% co-insurance being the primary financial pitfalls of original Medicare. This filling in of the “gap” inherent in traditional Medicare is why these policies are interchangeably referred to as “Medigap” plans. There are other smaller gaps in traditional Medicare but these two, especially the 20% coinsurance can really pose a problem without supplemental coverage. The Supplement’s coverage increase from alphabetically from A to K with a few letters missing in the middle. The traditional supplements run A, B, C, D, and F. These have been pretty established for decades now. Make a mental note on the F plan as that tends to be the darling of the Medigap world. Let’s discuss the really critical pieces of Medicare in terms of gaps we need to fill now that medication is taken care of with Part D. We want to make sure that we do not have uncapped exposure to medical expenses especially since we are more likely to see facility based care (loosely translated as very expensive) as we get older. Fixed deductibles are one thing but an unlimited percentage of a $50K bill is quite another not to mention $250K of charges over a year’s time. Granted, the medicare supplement plans cover the 20% coinsurance but let’s look at excess. This is critical. Excess is the amount that providers can charge above the allowed Medicare rate and it amounts to 15%. With more pressure on the finances of Medicare going forward, the trend of providers charging this excess amount will likely intensify. This becomes a primary concern for Medicare recipients looking to protect themselves and the F plan becomes are plan of choice to cover this excess charge. Now let’s look at all the high deductible and/or fixed max out of pocket plans. Here’s the issue. These plans will be less expensive in terms of premium for sure but we’re entering a period of time when the likelihood of hitting any high deductible or max out of pocket is at it’s highest. On average, health care expenditures increase with every decade of a person’s life so to be conservative, let’s assume at some point we will hit the full deductible or max out of pocket. Now the premium savings isn’t such a good offset against the richer benefits of the F plan. If you’re gambling on being healthy and keeping the premium savings, the house might have the odds against you. The problem is that we likely will be unable to change plans if health deteriorates so we’re really making a decision for a long period of time. Again, in the long run, this points to the F plan. Obviously, you need to find the right plan for your health and financial situation but definitely keep in mind both current and future concerns. The future is right around the corner.
Source: abcarticledirectory.com

Navigating The Medigap and Medicare Advantage Maze

The Medicare maze is long and twisting. Understanding the reason you are taking the path you are on is something that is necessary to ensure your coverage is up to par with your needs. The reason Medicare is often confusing to many is because of the choices you are given in regards to health care plans. One major obstacle is to determine if you would rather choose Medicare with Medigap Supplement Insurance plans or choose an all inclusive option such as Medicare Advantage. It is important to understand both options thoroughly to know if you are making the right choice. First let’s talk about Medicare Advantage. Often times at first glance the Medicare Advantage program looks like a cheaper option for better coverage. This may not always be the case though. The one thing about the Medicare Advantage program is that the premiums may increase over time and you are locked into them. Another item to think about is the often higher co-pays that come along with the Medicare Advantage plans. This plan is ideal for candidates whom already have a doctor in the network caring for them. With Medicare Advantage you need to choose who you see based upon who contracts with Medicare to provide you coverage. Not all doctors are covered. This is true in regards to specialists as well. You must see a doctor that has a contract within the Medicare network of doctors. Medigap refers to the plans that fill in the holes left with traditional Medicare Part A and Part B. Medigap Supplemental Policies are identified using a letter of the alphabet. It is insurance that is sold through private insurance companies. Something to be aware of however is that the government has standardized each Medigap Plan. This is important because although the health insurance companies may have a different price on the plan the coverage and benefits you receive are the exact same from company to company. This makes comparing policies a bit easier because you know that no matter what the Medigap Plan is going to be the same no matter where it is purchased. The decision really comes down to a company and price you are willing to purchase the insurance from and which plan out of the available plans fills in the holes left by Medicare that you need filled in. When looking into insurance companies to purchase a Medigap policy from make sure to compare the rates of several companies. It is important to note that some insurance companies add in a clause that the premiums will or will not rise with age. Many plans increase rates with inflation however it is best to find a company whom has a reasonable price for their coverage, good service and a clause that the premiums will not raise because of the participants age bracket. Otherwise the limited income you are living on could need to feed a higher Medigap premium in the future. Choosing a Medigap Supplement Insurance plan is not an easy thing to do. Many online sources offer side by side comparisons of the different options available with not only a plan comparison but a cost comparison quote from several insurance companies. IT is best to work online with a company that offers online support as well as telephone support when look into compare rates and view Medigap plans. This was if a question come up you will be able to have it handled promptly. It also helps remove impassable paths to get you to the finish line sooner in the Medicare maze.
Source: submityourarticle.com

Medigap vs Medicare Advantage

On the other side of Medigap vs Medicare advantage, the Medicare Advantage plan is also offered by the insurance company and this offers standard hospitalization and coverage of both Parts A and B. In certain cases, this could include services beyond the Original Medicare. Therefore, with Medigap vs Medicare advantage, MA has an advantage in terms of the extent of coverage since it can cover beyond the basic plan where supplemental coverage only offers added coverage to existing plans. The MA comes in PPO and HMO formats, both managed care plans. With HMO, you have to work with doctors within their preferred network while PPO allows you to choose your preferred doctors.
Source: quotes-center.com

NEW TO MEDICARE!! WHAT ARE MY OPTIONS »

Step #1:  Decide if you want “Original Medicare” or a Medicare Advantage plan.  Talk to your doctor and see which plan he/she recommends.  Many doctors are accepting “Original Medicare” and not Medicare Advantage plans.  If you have a doctor that is in the Medicare Advantage plan’s provider directory, make sure you call to verify that he/she is still accepting that particular Medicare Advantage plan.  Sometimes providers are in the directory, but stopped accepting the plan long before it went to print.  The main difference between “Original Medicare” and Medicare Advantage plans is “Original Medicare” works only with Medicare and generally, you or your supplemental coverage pay the deductibles or coinsurances.
Source: medicaretruths.com

The Difference Between Medicare Advantage Plans and Medigap

Medicare and Medigap are often given a bad name because so many people are tricked or told to get the wrong types of policies that leave them in a lurch. The problem here is just as much about educating Medicare policyholders as it is making the Medicare fraudsters go away. There are a few things that could help you not make a mistake when getting your Medicare or Medigap coverage going, especially to ward off fraudsters.
Source: medicaresupplementinsurances.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

Will Senior Medical Plans Cover Overseas Travel?

There are quite a few retirement site that suggest getting international travel insurance to cover some issues that you may have while traveling to other countries. Some of these plans actually do include medical care and medical evacuation. This means you should have access to local doctors and hospitals. If you happen to travel to an area without good medical services, an evacuation policy can pay to fly you to a good facility. Some may even pay for the expenses to get you back to the US so you can get healed at at home.
Source: polkrod.com

Solutions For Medicare Problems

If you elect to delay your Medicare B enrollment past your 65th birthday because you have group health insurance through your employer, that is not a problem.  Just be aware that when you do retire or lose your group coverage for any reason, you do not have the full 7 month Initial Enrollment in which to secure a guaranteed issue Medigap plan.  You qualify for a Special Enrollment Period for only 63 days.  If you have a pre-existing health condition that would prevent you from medically qualifying for Medigap, you will need to submit your application within 63 days of the Medicare B effective date on your Medicare card.
Source: wordpress.com

Medicare Advantage Plans in 2013 will be Different

Secure Horizons is a premiere healthcare company that offers only the best in Medicare Supplement insurance. They make it fast and easy to find what you need, get the coverage you need fast, and find a doctor in your area. They offer options such as Medicare Advantage Plans, Prescription Drug plans, and other extra services. Their services are offered as part of UnitedHealth Group, and take pride in being able to offer all of the services you need at affordable rates. They are extremely dedicated to finding the best plans for their customers across the country.
Source: choicepublic.com

Americans Shocked To Learn Tha

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Source: udn.com

Why the F Medicare Supplement Plan Works Best

Posted by:  :  Category: Medicare

First, a quick introduction is in order. The Medicare supplements plans are different from Advantage plans, the other primary option available on the market. The Advantage plans are typically less expensive on a monthly basis (if not free) but have more constraints on how care is accessed (like traditional HMO s) and share more medical costs that are incurred as a trade off. This last piece is an important distinction which we ll address in more detail with our Medicare supplement versus Advantage article, but let s stay with Medicare Supplemental plans for now. The supplements in a nutshell, fill in the holes of traditional Medicare with the deductibles (physician and hospital) plus the 20 co insurance being the primary financial pitfalls of original Medicare. This filling in of the gap inherent in traditional Medicare is why these policies are interchangeably referred to as Medigap plans. There are other smaller gaps in traditional Medicare but these two, especially the 20 coinsurance can really pose a problem without supplemental coverage. The Supplement s coverage increase from alphabetically from A to K with a few letters missing in the middle. The traditional supplements run A, B, C, D, and F. These have been pretty established for decades now. Make a mental note on the F plan as that tends to be the darling of the Medigap world.
Source: articles-shop.com

Video: Medicare Supplement plan F High Deductible Explanation

High Deductible Medicare Supplement Plan F

The Medicare supplemental insurance policy labeled high deductible Plan F is a standard plan F plan with a $2070 dollar yearly deductible and a significantly less monthly premium.  When choosing a form of Medicare insurance there are two common alternatives, they are:  Medicare A and B with a Medigap insurance policy or a Medicare Advantage plan.  A Medigap policy is the most popular alternative of these choices.  Once you have decided that a supplemental insurance policy is the best option for your health care needs the choice of which supplement policy comes next.  The Medicare Supplement Plan F is the Medigap policy with the most benefits and provides the best protection from medical bills.  A sometimes forgotten alternative to the plan F is the High Deductible Plan F.  The high F provides the exact same benefits as a standard F plan except it has a $2076 dollar yearly deductible.  The High F plan can be a less costly alternative for individuals that are in good health.
Source: medicare-supplement-advisor.org

Is it Time to Check Your Medigap Rate? — The Senior Gazette

A client recently contacted me because she felt like the insurance company from which she was purchasing her Texas Medicare supplemental insurance was no longer competitive.  Her rates, like most, had gone up.  But one thing she had failed to do when she first purchased her Texas Medigap plan was to really shop around.  Unfortunately, when a person is turning 65 they get inundated with such a large amount of information about Medicare and Medicare insurance that many just block it all out and go with what they know.  They often stick with an insurance company with which they are familiar and purchase from them. Sticking with the familiar is often the easiest course of action. When you already feel confident in a company you can throw all that mail in the trash.  That is what this lady from Texas had done, until she became aware that she was paying too much for her insurance.
Source: theseniorgazette.com

Getting Your Flu Shots with Medicare

The Medigap Plan’s Coverage of Flu Shots One other way to avoid paying extra for a flu shot or other Medicare-covered services is to purchase a Medigap policy that covers Medicare Part B excess charges. Medicare Supplement Plan F and Plan G both cover these excess charges, along with a number of other Medicare out-of-pocket costs. So even if your Medicare provider does not accept Medicare’s assigned rates, and he is one of the providers who charge extra, your Medicare supplement picks up that excess charge for you. Then you don’t have to pay anything out of pocket.
Source: mondaysorchids.com

Plan C or Plan F For Your Medigap Coverage?

[…] Today, by law, a provider can charge up to 15% higher than the standard Medicare rate and still be considered participating.  This is a big deal for two reasons:   First, you do not want to pay 15% of a $100K hospital bill ($15,000). Secondly, as the Medicare program finds itself under more financial pressure, reimbursement to providers will be under pressure. This means that more providers will likely charge the excess in the future. This is the sole reason we recommend the F plan over the C plan. The C plan does not cover Excess where the F plan does cover Excess. For the small monthly premium difference between C or F, it makes sense to cover this potential amount.Source: americaninsuranceforexpats.com […]
Source: americaninsuranceforexpats.com

AHIP Medicare Survey: F Gets an A

Plan F will pay for the first 3 pints of blod, for example, and it also will pay the Part A hospice care coinsurance or copayment amount. Part F also will pay skilled nursing facility care coinsurance bills, Part A and Part B deductibes, some foreign travel emergency bills, and physician fees that Medicare Part B classifies as “excess charges.”
Source: lifehealthpro.com

Medicare Help With Your Diabetes Supplies

Posted by:  :  Category: Medicare

Medicare will pay for two Diabetic screenings per year for those persons who are at a high risk of obtaining the disease, so long as they have one or more of the following symptoms: obesity, a high blood sugar level, high blood pressure, and abnormally high levels of cholesterol. Medicare will cover up to 80 % of the cost of monitors, testing strips, and lancets. It is up to the patient, however to provide the other 20% after the deductible has been added to their part B coverage. There is also a Diabetes Self-Management Course that qualifying persons can take at the request of their doctor. For those 65 and older, which have not had a recent eye exam, Medicare will cover the cost of an eye exam to determine if the patient does have a diabetic condition along with one year of free follow-up care for any condition that had been diagnosed under that one exam.
Source: bestmedicarehelp.com

Video: Medicare diabetic supplies

Medicare Contractors Failed to Identify 76% of Improper Claims for Diabetic Medical Supplies

Medicare Part B covers the cost for home diabetic medical supplies, including blood-glucose test strips and lancet supplies. Typically, Medicare will only pay for 100 test strips per month. To cover additional strips, there must be documentation in the beneficiary’s medical records supporting the specific reason for the additional supplies and documentation in the physician’s or supplier’s records supporting the actual frequency of testing. CMS contracts with four durable medical equipment (DME) Medicare administrative contractors to pay Medicare Part B DME claims. These contractors act as a safeguard to the Medicare Trust Fund to avoid Medicare fraud, by verifying that only eligible claims receive payment. However, according to various GAO reports, contractors have been unable to adequately monitor DME claims, costing the Medicare program billions of dollars. In the latest report, the GAO determined that in 2007, DME Medicare administrative contractors allowed over $200 million in improper Medicare Part B claims for home blood-glucose test strips and lancets. Alarmingly, over 76% of the high utilization claims should not have been paid, for the claims lacked necessary documentation. Upon closer inspection, the GAO determined that the contractors neither had controls to ensure that claims for test strips and/or lancets complied with Medicare documentation requirements nor system edits to identify high utilization claims and claims with overlapping service dates for the same beneficiary. More information for whistleblowers is located at the Nolan & Auerbach, P.A. website.  
Source: medicare-fraud.net

CMS Officially Announces Potential Inherent Reasonableness Payment Adjustment for Medicare Retail Diabetic Testing Supplies; Meeting Set for July 23 : Health Industry Washington Watch

On June 26, 2012, CMS published a notice announcing that it is considering using its “inherent reasonableness” (IR) authority to establish special Medicare payment limits for diabetic testing supplies furnished on a non-mail order basis.  Under the statutory IR authority, CMS can adjust certain Medicare Part B payment amounts that are “grossly excessive” (generally cases in which an adjustment of 15% or more is justified). According to the June 26 notice, CMS is examining ways to use pricing information obtained during the Medicare DMEPOS competitive bidding program for mail-order diabetic supplies to adjust payment for retail diabetic supplies without requiring local suppliers to compete for contracts.  In the notice, CMS cites several reasons for considering an IR adjustment for these products, including high annual allowed charges (approximately $552 million, which makes it the highest volume category of items or services yet to be phased in under the DMEPOS competitive bidding program). Under the round 1 “rebid” of the DMEPOS competitive bidding program in 2011, Medicare payment for mail order test strips were reduced by 55% on average in 9 bidding areas. While CMS states that it recognizes that "there are pricing differences between mail order and non-mail order diabetic testing supplies because of the delivery methods for these supplies," CMS contends that there are components that are identical for both distribution methods (e.g., product acquisition costs and administrative costs, including claims processing and paperwork costs). CMS also suggests that "maintaining a significant discrepancy between what Medicare pays for mail order supplies versus non-mail order supplies may encourage fraud and abuse such as billing for mail order supplies as if they were furnished on a non-mail order basis.” The use the IR authority to limit payment for non-mail order diabetic testing supplies may render it unnecessary to include these items under competitive bidding in the future, according to the notice. CMS is holding a July 23, 2012 meeting to discuss this issue, including the rationale for an IR adjustment and the procedural steps involved. The meeting registration deadline is July 16.  CMS also will accept written comments on the proposal until July 30, 2012.  This information is consistent with our May 23rd blog report that CMS briefly posted – then removed – a web site announcement regarding this meeting.
Source: healthindustrywashingtonwatch.com

Relation between your lifestyle and diabetes

Sort 2 diabetics then again, because of their impaired insulin production or motion, should eat foods that take longer to be broken down into glucose. Therefore fruits and diabetic dessert needs to be consumed after meals. (So that it is queued within the digestive tract). Eat carbohydrates in moderation. In case you are taking tablets to your diabetes you will have to take them in relation to your meals. Some tablets work by serving to your digestive system break down the meals more slowly while different tablets work by stimulating the Pancreas into producing more insulin. Matching meals times to your medication is therefore important.
Source: deltastrategy.org

Diabetic Supplies Covered By Medicare

Keep in mind that there may be limits on the quantity of testing supplies you can receive in any given time frame. Also, you cannot submit claims for supplies yourself. All claims must be submitted by Medicare-enrolled pharmacies and suppliers. In addition, you must request refills on your supplies, as automatic shipments from suppliers will not be covered by Medicare.
Source: affordablemedicareplan.com

Why You Can Always Find A Better Health Insurance Deal

Posted by:  :  Category: Medicare

Getting Health Care by mtsofanHere is some health insurance information you have probably never heard before- women who have given birth by caesarian section are charged higher health insurance premiums and are sometimes rejected for health insurance altogether. Having a c-section once can often lead to more c-sections in future births. Insurance companies do not want to pay the high cost for c-section births and are looking for ways to get out of it. So, if at all possible, have a natural childbirth, and you will save money on health insurance costs.
Source: articlereference.net

Video: Rising Medical Insurance Premiums by: JMS

Health insurance premiums are going down

Critics of Massachusetts health care reform (mostly from out of state) cite the failure to control cost as one of the major shortcomings. My responses has always been that the idea was to get everyone into coverage first, and then turn toward cost containment as a way to preserve universal coverage. Six years or so after the passage of health reform, we may be turning the corner on costs in Massachusetts. I hope critics of Massachusetts health reform, and its offspring the Affordable Care Act, will reconsider their opposition if the cost trend in the Bay State continues to flatten.
Source: healthbusinessblog.com

Tips For Getting Comprehensive Health Insurance At Low Rates

Take advantage of the full coverage tests and services offered by your health care provider. Some tests and procedures are offered on an once per year or two basis. The cost of this is completely covered by your health insurance provider. Examples are Pap smear, Prostate Exam and even flu vaccines from your doctor. These free appointments and exams keep you healthier as give you a chance to talk to your doctor about any other health issues you may have at no cost to you.
Source: touchstonehomesblog.com

The way Spouse and children Health care insurance Plans plus Rates Operate

facebook status quotes The normal fees of family quotes grows in overwhelming measures each year. Based on the Expenses & Great things about Man or women plus Family Health insurance coverage Programs survey introduced in December Only two, This year the average man or women medical insurance estimate per individual ended up being $2,196 every year and also at $183 every month. The regular family insurance policies estimate brought up by means of Seven.Three percent which comes to your huge full of $19,393 that year This year. Nonetheless the following files gathered conformed to help households insured by firms. Furthermore, you will find cases where employers usually do not deliver insurance plan resulting from too little personal help within the company. Those who usually do not preserve insurance policies usually are impossible to obtain proper medical treatment when asked.
Source: wmstafford.org

Saving Money on Health Insurance Costs

If your plan offers prescription drug coverage, consider a mail order pharmacy. These pharmacies offer cheap prescription drugs and offer a 90-day supply for the same cost as a 30-day supply. It will not save you money on your premiums but this is definitely a money saver over the long haul for those on monthly maintenance medications. If you substitute brand name drugs for their generic equivalent, you will save even more.
Source: moderndignity.com

Health insurance rebates on their way for many

State Insurance Commissioner Ralph Hudgens, an opponent of the health reform law, issued a statement on the rebates in April. “In this economy, I am certain individuals and companies will be pleased with any amount of rebate they may receive,” he said. “Unfortunately, when these rebates are put in the context of the impact President Obama’s Affordable Care Act [the reform law] has on health care and health insurance, the future is bleak.”
Source: georgiahealthnews.com

Getting a health insurance rebate?

Do understand rebate basics. The 2010 health care reform law requires that for every dollar a health insurance plan brings in through member premiums, 80-85 cents must be paid out again toward member medical expenses. If your health insurance plan in 2011 didn’t meet that goal, you may be due a rebate no later than August 2012. Not everyone is getting a refund, however, and how much you personally spent (or didn’t spend) on medical care has little to do with whether you receive a rebate. To learn more about rebate basics, read our answers to frequently asked questions.
Source: ehealthinsurance.com

Costs Latest Guide Published: Private Medical Insurance

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Source: zasrecu.com

Which Health Insurance Is Right For You?

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Source: adem06.com

Why Are Health Insurance Premiums Still Increasing After The PPACA?

. Their prior premium increases were NO WHERE NEAR this amount. This is not isolated to Blue Cross either. These premium increases are happening in many markets across the United States in both the Individual AND Group health insurance markets. I’m simply using Blue Cross as an example since the name is most widely recognized.
Source: illinoisteaparty.net

Medicare Chiropractic Billing Guidelines and the OIG 2012 Work Plan

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingMedicare pay for 20 days or less even though Medicare benefits will cover up to 100 days. This is because most patients simply cannot continue to improve beyond 20 days and are given the choice of being discharged or becoming self-pay. (Few Medicare patients have a secondary insurance that will pay for a non-covered Medicare stay. Most secondary insurances pay deductible and co-insurance of covered stays.) Medicare for the purpose of chiropractic and nursing home stays will only cover if the patient is actively showing improvement or rehabilitative services. Medicare does not pay for maintenance care. Please note, just because Medicare does not pay for services does not mean the services are needed.
Source: chirotexas.org

Video: Billing Medicare as Secondary Insurance

DISTRICT COURT FINDS THAT SELF

The crux of Medicare’s claim for reimbursement was a declaration submitted by its Health Insurance Specialist, asserting that the decedent was a Medicare beneficiary who received $10,757.44 for medical services. The declaration also stated that these payments were the responsibility of liability insurance, including self-insurance, as a primary plan under the Medicare Secondary Payer statute. The tortfeasor in the underlying medical malpractice case was self-insured.
Source: themedicarespa.com

Federal Circuit Court Finds Part C Medicare Advantage :Gould & Lamb

The court also recognized that Congress’s goal in creating the Medicare Advantage program was to harness the power of private sector competition to stimulate experimentation and innovation that would ultimately create a more efficient and less expensive Medicare system. See, e.g., H.R. Rep. No. 105-217, at 585 (1997) (Conf. Rep.) (stating that MA program was intended to “enable the Medicare program to utilize innovations that have helped the private market contain costs and expand health care delivery options”). It was the belief of Congress that the MA program would “continue to grow and eventually eclipse original fee-for-service Medicare as the predominant form of enrollment under the Medicare program.” Id. at 638. The MA program was thus, like the MSP statute, “designed to curb skyrocketing health costs and preserve the fiscal integrity of the Medicare system.” Fanning v. United States, 346 F.3d 386, 388 (3d Cir. 2003).
Source: themedicarecomplianceblog.com

Medicare Secondary Payer Statute: New Reporting Requirements For Products Liability And Toxic Tort Clients By Sharon Caffrey, Christopher Crosswhite and John Lyons

By-Lined Article MEDICARE SECONDARY PAYER STATUTE: NEW REPORTING REQUIREMENTS FOR PRODUCTS LIABILITY AND TOXIC TORT CLIENTS By Sharon Caffrey, Christopher Crosswhite and John Lyons December 8, 2009 New Jersey Law Journal Beginning January 1, 2010, extensive new Medicare reporting obligations will apply to insurance companies and other businesses, including products liability and toxic tort defendants that make payments to Medicare beneficiaries as a result of verdicts or settlements resolving liability claims. These organizations — known as Responsible Reporting Entities (“RREs”) — will be required to report virtually all settlements, judgments, awards, and other resolutions of claims establishing responsibility for payments to Medicare beneficiaries, so that Medicare may determine whether it has a stake in any part of the payment. The reporting will also enable Medicare to refuse payment for future medical care relating to the injuries that were the subject of the liability claim. Failure to report may result in significant financial penalties against the RRE. Congress established these reporting obligations in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (“MMSEA”), codified at 42 U.S.C. Section 1395y (b)(8). Section 111 of MMSEA requires RREs to report any payment obligation to a Medicare beneficiary when the obligation results from a claim potentially involving past or future medical expenses. RREs must notify Medicare, regardless of whether there is an admission of fault, and must provide Medicare the total amount to be paid by the RRE — including compensatory and punitive damages, as well as payments made to spouses. Although Medicare will consider the allocation of damages agreed to by the parties or that made by a court, Medicare takes the position that it is not bound by these allocations and is free to recover amounts in excess of those designated for medical expenses by a court or settlement agreement. Organizations should immediately determine whether they are an RRE under the statute and, if so, promptly register with the Centers for Medicare and Medicaid Services (“CMS”) and implement procedures to ensure that all payment obligations to Medicare beneficiaries established on or after January 1, 2010, are properly reported to CMS. Section 111 imposes substantial civil penalties on RREs that do not report payments to Medicare beneficiaries. The statute provides for penalties of up to $1,000 per day for each claim that an RRE does not report. Although the September 30 deadline for RREs to register with CMS has passed, RREs that missed the deadline can still register online. Uses of Information Medicare has indicated that it will use the information from RREs in two ways. First, Medicare will use it to recover benefits it had previously paid for the treatment of the injury for which a plaintiff was compensated. Although this right of recovery has existed since the 1980s, there has never been an efficient mechanism for Medicare to learn of payments to beneficiaries and initiate the recovery process. The new MMSEA reporting requirements are expected to significantly enhance Medicare’s ability to recover payments for medical care furnished to beneficiaries that receive compensation for their injuries. Additionally, RRE submissions will allow Medicare to more effectively deny payment on future medical claims related to the injury for which the beneficiary was compensated. RREs are initially required to provide a narrative description of the plaintiff’s alleged injury, but within two years will be required to provide ICD-9 diagnoses and cause of injury codes to CMS. This information will allow Medicare to deny claims that it determines are related to the prior injury and will likely have the effect of increasing settlement demands, as plaintiffs will no longer be able to assume that Medicare will pay their future medical expenses related to the injury. Although there has been no substantive change to Medicare’s right to deny future claims if a primary payer exists, Medicare has lacked until now a comprehensive database with the necessary information to recover past payments or deny new medical claims. Discovery Defense counsel should consider amending their interrogatories to determine, at the beginning of a case, whether a plaintiff is a Medicare beneficiary or when the plaintiff expects to begin receiving Medicare benefits. Interrogatories may also seek information about the plaintiff’s Medicare Identification Number, when Medicare entitlement began, and whether any claims for the plaintiff’s medical care related to the injuries alleged in the lawsuit have been paid by, or filed with, Medicare. Medicare has recognized that RREs, such as products liability defendants, will need a way to determine whether a plaintiff is a Medicare beneficiary, so CMS has developed a system that allows registered RREs to query a database of Medicare beneficiaries at any time. This is an important tool, and RREs should query the name of every plaintiff through the Medicare beneficiary database periodically and, most importantly, at the time when a settlement is negotiated or a verdict is reached. For latent diseases, such as asbestos-related conditions, the new reporting requirements increase the importance of determining the dates of exposure to the allegedly toxic substances. CMS has determined that only claims resulting from at least one post-December 5, 1980, exposure are reportable under the MMSEA requirements. Therefore, defense counsel should use discovery to determine the exact dates of exposure, but the significant penalties for failing to report a claim suggest that defendants should err on the side of caution and report all claims where the dates of exposure are ambiguous. Settlements At this time, there are concerns about the confidentiality of settlement agreements, as Medicare regulations require that the existence and amount of all settlements be reported, regardless of whether the parties kept the agreement confidential. Although some commentators have speculated that settlement amounts may be available via Freedom of Information Act requests, there is no precedent suggesting that Medicare would voluntarily turn over this information. Such data may be protected from routine disclosure by CMS under the Health Insurance Portability and Accountability Act and the Privacy Act. Rather, a bigger concern is that the terms of a confidential settlement may become public if Medicare is required to take legal action to recover payments it made prior to the settlement. Medicare would likely use the settlement amount and other information reported to CMS by the RRE, and possibly the settlement agreement itself, if available, as evidence in its suit. It is also possible that the information reported by a RRE could be made public during a Medicare beneficiary’s administrative appeal or lawsuit contesting a denial of benefits based on a submission of an RRE. The new MMSEA reporting requirements will also likely make it difficult for defendants to settle claims where Medicare has already paid a significant amount towards the plaintiff’s medical care for the injury that is the subject of the litigation. This might be especially true in instances where the plaintiff has significant injuries but the defense on causation is strong and the defendant has been willing only to make a negligible settlement offer to resolve the matter. Plaintiffs may also be unwilling to settle claims if there is a possibility of significant ongoing medical expenses, as Medicare will know of the settlement and will likely refuse to pay any claims relating to the injury that was the subject of the settlement. In these cases, plaintiffs may prefer to try the case, hoping that Medicare will respect the allocation made by a judge or a jury between medical expenses and compensatory damages, punitive damages, loss of consortium, etc. The MMSEA Section 111 User Guide by CMS currently states that “[t]he CMS is not bound by any allocation made by the parties even where a court has approved such an allocation. The CMS does normally defer to an allocation made through a jury verdict or after a hearing on the merits.” (CMS MMSEA Section 111 Medicare Secondary Payer Mandatory Reporting User Guide, at 76). Plaintiffs may begin to try cases where there is the prospect of significant future medical expenses, as it is possible that Medicare will begin paying for medical claims related to the suit after the verdict’s allocation for future medical expenses is exhausted. If there are any prior payments by Medicare relating to the injury that was the subject of the suit, then attorneys on both sides should ensure that the Medicare right of reimbursement is satisfied before the plaintiff receives any money. Every settlement agreement should clearly delineate which party is responsible for confirming the amount of any Medicare payment and reimbursing this amount in its entirety — typically the plaintiff is in the best position to do so. Defendants should ensure that any Medicare right of reimbursement related to the injury alleged in the suit is satisfied in full, since CMS takes the position that the Medicare primary payer ultimately remains liable for any unpaid Medicare lien. MMSEA imposes significant, and expensive, burdens on products liability and toxic tort defendants, as well as their insurers. As there are significant financial penalties for noncompliance, all organizations should immediately determine if they are an RRE under the statute. If so, RREs should immediately register with CMS and take the necessary steps to ensure that they are able to comply with the reporting requirements by January 1, 2010. Sharon Caffrey is a partner in the Philadelphia office of Duane Morris and is the co-head of the products liability and toxic torts division of the firm’s trial practice group. Christopher Crosswhite is a partner in the health law practice group in the Washington, D.C., office. John Lyons is an associate in the trial practice group in the Philadelphia office. This article originally appeared in the New Jersey Law Journal and is republished here with permission from law.com.
Source: jdsupra.com

Medicare Secondary Payer and “Future Medicals” A Movement Toward a Standardized Process?

CMS states that its interests should be considered in every settlement where the claimant, “reasonably anticipates receiving, or should have reasonably anticipated receiving Medicare covered…services after the date of “settlement…”.  To accomplish this purpose, CMS proposes options  ranging from absolute exemptions on one end of the spectrum (i.e., CMS defined a set of circumstances in which no further action would be necessary / no “set aside” required) to alternatives on the other end of the spectrum that involve a) the beneficiary paying for all future injury-related care out of his/her settlement proceeds until they are exhausted or b) submitting a proposed Medicare Set Aside arrangement (similar to the current process in workers’ compensation).With regard to the latter options, it is important to note that CMS acknowledges that perhaps thresholds could be established (i.e., a dollar amount below which no action is necessary even if one of the other exemptions do not apply).
Source: dritoday.org

Comments on “How to Avoid Medicare Land Mines”

Fourth, if you are on retiree coverage, make sure you sign up for Medicare Parts A and B because this type of employer coverage becomes secondary to Medicare Parts A and B at age 65.  Also, Schultz brings up a valid point about leaving retiree coverage which may be more expensive than Medicare, and not being able to get it back later if you change your mind.  Also, if your spouse is covered by your retiree plan and you leave the plan, your spouse will probably lose coverage.  Make sure they can get an individual plan or have another option before you leave.  If they have pre-existing health conditions that allow insurance plans to deny coverage, their only other option may be a Pre-Existing Condition Insurance Plan (PCIP) through the Affordable Care Act.  To be eligible for these PCIPs, you have to be without coverage for 6 months.
Source: retirementeducationplus.com

New Online Medicare Secondary Payer Recovery Portal‏

The MSPRP gives users (attorneys, insurers, beneficiaries, and TPAs) the ability to access and update certain case specific information online. Activities that currently require written communication or telephone calls to the Medicare Secondary Payer Recovery Contractor will soon be able to be done through the portal.
Source: lienresolutiongroup.com

Why national health care is necessary to a sustainable food system

Posted by:  :  Category: Medicare

There's nothing radical about national health insurance by Steve RhodesIt is certain that there will be costs and losses in whatever system arises – in _Depletion and Abundance_ I strive to acknowledge that we cannot do all the things we do at present, and that will hurt some people. That said, however, enormous cuts could be made in the costs we incur at critical times in our lives – for example, 1/3 of all medical interventions take place in the last 3 years of life. Some of that is inevitable – someone who gets cancer, has major interventions, but then dies two years later will fall in that category. But an enormous number of those interventions operate simply to draw out the process of death and add to suffering – my great-aunt, visibly dying, was pressured into having open heart surgery a few months before she died, simply because no one would say “you are dying, it is time to talk about relieving your pain.” My husband’s grandmother was pressured into giving her dying husband medications to prevent a heart attack that caused him great discomfort – at a point where a heart attack was the most benign and merciful sort of death possible.
Source: energybulletin.net

Video: The Basic Economics of National Health Insurance – Professor Richard D Wolff

The Affordable Care for America Act: A Failure to Count what Counted

Secondly, did the Congress and the Administration critically review the history of national health systems in such countries as the U. K. as an exemplar for ACA? In 1948, the U. K. socialized medicine with its National Health Services (NHS). All service delivery was to be via public providers from publicly owned health facilities. The NHS is a model for the single payer system, once favored by advocates for the ACA, then abandoned in favor of a mandate.  For many decades, the NHS was able to operate at a health expenditure under 8% of GNP, while the US expenditures were at 15.2% of GNP. Then, during the Tony Blair administration, health expenditures increased to 9.4% of GNP, though productivity by physicians fell inexplicitly. While health spending increased, their was a corresponding increase in the number of people leaving the NHS. By 2012, approximately 22% of all British citizens opted out of NHS to join the privately operated British Union Provident Association—even though they had to continue their payroll tax payments into NHS.
Source: wordpress.com

The health care challenge for small business — Business — Bangor Daily News — BDN Maine

But even if these insurance pools can be structured with a larger, more representative population, which is the hope of the Affordable Care Act in creating exchanges for small businesses and individuals, they will still have to overcome other weaknesses in our health care system to prevent costs from escalating. Health care costs rise for good reasons such as breakthroughs in medical technology and pharmaceuticals, as well as the simple fact that the population is getting older and requires more care. Insurance premiums also increase because the commercial sector is indirectly picking up costs for both the uninsured and the inadequate payments for care covered by Medicare and Medicaid. In addition, we can point to overuse of medical services, an abuse attributed to having third-party payers, and inefficiencies that arise in a system with fee-for-service payment methods that compensate physicians for the amount of services provided rather than hold them accountable for improving the health of their patients.
Source: bangordailynews.com

The Medicaid Problem Grows and a (Partial) Solution Emerges

Posted by:  :  Category: Medicare

HOPE lives. by eyewashdesign: A. GoldenBillions of dollars of in-force life insurance policies are regularly abandoned by uninformed seniors as they enter their “long term care years”. Because a life insurance policy is legally recognized as an asset of the policy owner, it is an unqualified asset and counts against them when applying for Medicaid. For Medicaid applicants, it has been standard practice to abandon a life insurance policy if it is within the legally required five year look back spend-down period. But now, it is possible to convert a life insurance policy instead of abandoning it, allowing the policy owner’s care to be covered as a private pay patient by a long-term care benefit plan over an extended time frame.
Source: floridawealthadvisors.com

Video: Precision Senior Marketing – Medicare Supplement Broker

Central States Indemnity Medicare Insurance

Berkshire Hathaway is of course the large investment conglomerate run by none other than Warren Buffett.  In 1992, Berkshire acquired Central States and due to the immense resources behind such a well respect holding company, CSI is afforded an extremely high rating for a midsize Medicare supplement provider.
Source: ohioinsureplan.com

Need Help with Life Insurance or Retirement Concepts?

This entry was posted on Thursday, July 19th, 2012 at 7:55 am and is filed under Uncategorized. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
Source: nationalmedicareinformationcenter.com

Medicare Beneficiaries More Satisfied Than Privately Insured

Posted by:  :  Category: Medicare

The study found that 8% of Medicare beneficiaries rated their coverage as “fair” or “poor,” compared with 20% of individuals who have employer-based health insurance and 33% of those who purchase their own insurance coverage. Medicare beneficiaries felt that they have better access to medical care and were less likely to report problems paying their medical bills than privately insured individuals, according to the survey (Levey, Los Angeles Times, 7/18).
Source: californiahealthline.org

Video: How to Save Medicare $30 billion: www.UpgradeThe Card.org

Marci’s Medicare Answers, www.MedicareRights.org

Dear Alfred, If you do not enroll in the Medicare prescription drug benefit (Part D) when you first become eligible, and you choose to enroll at a later date, you may have to pay a premium penalty. The premium penalty will be 1 percent for every month you delay enrollment (1 percent of the national base beneficiary premium). For example, the national base beneficiary premium in 2012 is $31.08 a month. If you delayed enrollment for seven months, your monthly premium penalty would be $2.18 ($31.08 x 1% = $0.3108 x 7 = $2.18), which will be added to your plan’s monthly premium.
Source: homeboundresources.com

Raising the Age of Medicare Eligibility: A Fresh Look Following Implementation of Health Reform

Several major deficit-reduction and entitlement reform proposals include raising Medicare’s age of eligibility from 65 to 67 as a way of improving Medicare’s solvency.  This Kaiser Family Foundation report estimates the expected effects on such a change on the federal budget, as well as on affected seniors’ out-of-pocket costs, employers, Medicaid and others in light of the major changes in coverage enacted under the 2010 health reform law. The study estimates that raising Medicare’s eligibility to 67 in 2014 would generate an estimated $5.7 billion in net savings to the federal government, but also result in an estimated net increase of $3.7 billion in out-of-pocket costs for 65- and 66-year-olds, and $4.5 billion in employer retiree health-care costs.  In addition, the study projects that the change would raise premiums by about 3 percent both for those who remain on Medicare and for those who obtain coverage through health reform’s new insurance exchanges.  The study assumes both full implementation of the health reform law and the higher eligibility age in 2014 in order to estimate the full effect of both the law and the policy proposal. In the absence of the health reform law, raising Medicare’s age of eligibility would result in an increase in the uninsured, according to other studies, as many older Americans would have difficulty finding affordable coverage in the individual market in the absence of Medicare.  With health reform, virtually all 65- and 66-year-olds would be expected to obtain alternative sources of coverage.  The study is authored by researchers from the Kaiser Family Foundation and the Actuarial Research Corporation and is available online. It is the first in a new series of Kaiser Family Foundation studies examining the effects of proposed Medicare changes on the program’s beneficiaries, the federal budget and other stakeholders. NOTE: Originally released in March 2011, this report and news release were updated in July 2011 to reflect additional provisions of the 2010 health reform law. These adjustments result in lower estimates of net federal savings and aggregate out of pocket spending attributable to raising the age of eligibility. News Release  Report (.pdf)
Source: kff.org

Opinion: Obama “You Didn’t Build That” Comment Incites Class Warfare

As a self employed individual who pays his own social security and medicare entirely, which makes my taxes about double what an employed person who earns the same would pay and is about to be bankrupted by the unaffordable care act in 2014 [I have never been able to afford health insurance for my family of four who I support entirely without any government benefits], Obama’s words were like a punch in the face to me. This country prides itself on being the land of opportunity where anyone with the guts and determination to try will succeed without being held back by excessive taxes and regulations. Yet having spent an equal amount of time [15 years] being self employed in both the UK and USA. I have realized that it was easier to make a living in the UK. Despite it’s reputation as a socialist welfare state, there were many government programs to help people start their own business, plus I had free healthcare and no medicare to pay for just 5% more on the basic rate of income tax, [a way better deal than Obamacare]. It’s no wonder just about every developed nation has socialized healthcare because it just works better when the profit is removed and it becomes affordable for all. The problem here is that the medical industry has become greedy and corrupt and downright criminal, deliberately poisoning us for profit while using the government in it’s bottomless pocket to deny us the right to avoid it’s poisons or use natural alternatives. America today is not a capitalist democracy, it is a fascist corpocracy, it despises the self employed individual and favours the giant corporations run by the 1% while the 99% work for them. This is the model that successive administrations have built up with the money from the corporations who fund them, citizens united proves that the supreme court is no less corrupt. Diebold corporation has ensured we cannot change anything by voting. To all those who would tell me to love it or leave, there is nowhere to run, this is happening globally, the UK today will not be as it was 15 years ago. We must all stand together, the system will always try to divide and conquer because it always works, but let’s not forget that we are the system and it cannot function without us, it is us who have let the 1% control the 99%, the police who beat the occupiers are also the 99%, if we were all protesting in the streets who would be left to beat us?
Source: wnyc.org

Survey: Medicare Beneficiaries Happier With Coverage Than Younger People On Private Plans

National Journal:  Seniors Prefer Medicare To Private Plans, Study Says Seniors enrolled in the traditional Medicare program were happier and spent less out-of-pocket than their peers who chose private Medicare Advantage plans, according to a study published in the journal Health Affairs.  The study found that traditional Medicare costs less not just for the government but for beneficiaries, data that is sure to emerge in the next discussions about whether Medicare should be converted from a government-run insurance program to a private voucher system, a proposal championed by congressional Republicans and GOP presidential hopeful Mitt Romney (Sanger-Katz, 7/18).
Source: kaiserhealthnews.org

Your Guide to “Ending Medicare As We Know It”

I work in healthcare as a registered nurse. I see the high cost of equipment, supplies and care. It’s offensive how expensive things are. However, we’re not cleaning swimming pools here. I watched last as government workers wages in one of our American cities cut wages to minimum wage. The mayor” we don’t have the money…..” A very large portion of hospital reimmbursment comes from who? The government. So, when will the fed. Make this same decision for healthcare workers. This is a problem. Who is going to fix it. Obama? His plan is so full of details and corruption that not even the people that voted for it know what’s in it. Why would we want that? Clearly it must be fixed. We need a plan to minimized political contamination to borrow medical terminology. Politicians may have good intentions are the best people tonnage healthcare. We need some regulation to keep the market on course. But political agenda and ideology and special interest will only complicate the system and more importantly destroy our society and our great country. Let the market work it doesn’t have an agenda. When big money is involved the evil in the hearts of men will rear its ugly head. In a free society when people cease to be moral the system will collapse. This is the course we are on. It cannot be changed with government . Our government already is immoral. A righteous king is the only thing that will save us.
Source: prospect.org

Awkward: Obama’s job council agrees with Romney’s corporate tax plan

Many Council members agree that the U.S. should shift to a territorial system of taxation in order to make America more competitive in global markets. While most other developed nations have adopted territorial systems that exempt most or all foreign income from taxes when they are repatriated, the U.S. subjects all worldwide earnings to the corporate income tax when they are brought home to the U.S. This approach actually encourages U.S. companies to keep their earnings abroad rather than investing them here at home. Adopting a territorial tax system would bring us in line with our trading partners and would eliminate the so-called “lock-out” effect in the current worldwide system of taxation that discourages repatriation and investment of the foreign earnings of American companies in the U.S.
Source: aei-ideas.org

Obamacare Is Good for Medicare

Opponents of the Independent Payment Advisory Board have put out misleading information on the program, saying that it will ration care or reduce benefits to enrollees. But in reality there are protections in the Affordable Care Act to guard seniors from exactly those situations, which is why the board is a good way to cut costs while keeping Medicare intact. And though the final decision whether to institute the board’s recommendations rests with Congress, the board is essential to reducing the rate of long-term growth in Medicare—without it, the federal deficit and other long-term debt would increase in the next decade.
Source: americanprogress.org

Turning Medicare Into True Social Insurance

As The Heritage Foundation’s Stuart Butler and the New America Foundation’s Maya MacGuineas explain, the universality of entitlements “means that resources are directed to the affluent, leaving less than is adequate for those in need. Bill Gates will …
Source: newamerica.net

Vice Pres. Biden Speaks on Senior Issues and Medicare

The House Financial Services Committee held two hearings to learn about the effects of implementing the Dodd-Frank financial oversight law. The morning session examined how the consequences of the Dodd-Frank Act are felt far from Wall Street by looking at the law’s impact on families, communities and small businesses.  Witnesses from credit unions and small banks testified.
Source: c-span.org

Capitalist Preservation: Medicare Disses Its Patients

Posted by:  :  Category: Medicare

BITCH..beautiful individual that causes hardons .....item 1..Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ... by marsmet522private company denial average was 2.79% versus Medicare at 4%.  So, Medicare was above average versus private insurers, but Medicare definitely closed the gap quite a bit.  It still is enough to dispel the myth, though, that government knows best and is fiscally more responsible while private insurance is greedy and profit-hungry.  Hopefully, the next Congress will be GOP controlled, as well as the WH, so that the Obamanation that is Obamacare can be repealed for good.
Source: blogspot.com

Video: Medical Billing Expert Series: Medicare Claims Processing Manual Chapter 20

Important Information Regarding Medicare Claims and Payments for Part A Indiana and Michigan ProvidersHall Render

National Government Services, Inc. (NGS) recently announced important information regarding Medicare claims and payments for Part A Indiana and Michigan providers.  With the impending transition of these providers to Wisconsin Physician Services (WPS), NGS posted the following transition timeline:
Source: hallrender.com

Medicare Claims Processing Manual

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Source: monsieurbome.com

Making Medicare claims and benefits statement clearer, simpler

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand.  CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare.  This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.
Source: medicare.gov

New York Times Editors Mangle Story on False GOP Medicare Claims 

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Source: nytexaminer.com

Report: $4.2M in Fraudulent Medicare Claims for ED Treatment Devices

Of course, many lawmakers and health experts have questioned whether these are legitimate medical services that should be covered under Medicare, especially when skyrocketing deficits have placed the United States on the path to fiscal ruin. “At a time when the federal government borrows 43 cents of every dollar it spends, do we really need to be spending money on this? I doubt you need a ‘Super Committee’ to realize that this is the epitome of wasteful spending,” said John Nothdurft, director of government relations for The Heartland Institute.
Source: thenewamerican.com

HHS Inspector General: Many Medicare Anti

In other related news – The Hill: HHS Inspector General: Health Grants Could Have Illegally Funded Lobbying Federal healthcare grants might have been illegally used for political lobbying, according to the Health and Human Services Department’s inspector general. The inspector general said grants administered by the Centers for Disease Control and Prevention (CDC) might have been used for lobbying efforts — and that the CDC might have led recipients to believe lobbying was appropriate, despite a federal ban on using grant money for political activism. Inspector General Daniel Levinson outlined his office’s findings in an “early alert” letter to CDC Director Thomas Frieden, a copy of which was obtained by The Hill (Baker, 7/10).
Source: kaiserhealthnews.org

Arkansas leads the way on Medicaid expansion

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tsweden>>Promises from government pencil pushers don’t hold up very often. So you can pass off that Reagan joke on the dumbasses, like yourself, but try telling it to millions of people for whom the government pencil pushers have served well. My aunt collected her S.S. check from 1965 until she died at age 98 in 2003. She also used her Medicare all those years. My mother and grandparents collected theirs every month of their retired lives. I haven’t missed a S.S. payment since I began in 2007 and after paying thousands for private insurance over the years I can gladly proclaim that hands down Medicare is the best insurance a person can have. Now, my old bidness partner who retired from the awl bidness planning to live large on his executive pension found it gone missing as have millions of other Americans who thought they could trust a corporation with their retirement. When demand shrunk and awl prices fell it was goodbye pension. Ask about 1000 former Jones Truck Lines employees around Springdale about their pension which some good ‘capitalist republicans’ from Texas stole from them after they bought out Jones Truck Lines, raided the pension funds and declared bankruptcy. So, as far as trust issues go, American corporations’ record is pretty damn sorry. Which corporation would you trust with your retirement Everette Hactchett? .
Source: arktimes.com

Video: Medicaid Reform in AR Video 1

UPDATE DHS: Savings to state would exceed Medicaid expansion costs 

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Source: arkansasnews.com

DHS officials say expanded Medicaid will save money

In this case, the federal government is essentially doing it on our behalf. And the percentage that we are responsible for in the out years [ultimately 10%], that 10% is almost completely offset by the economic impact, by the ability that we have to no longer pay full costs for — you have insured in hospitals and clinics and elsewhere — that 10% as it turns out doesn’t cost the state on net because you can displace spending on the uninsured through direct subsidy with spending on the uninsured through Medicaid which the feds are paying most of.
Source: thecitywire.com

Arkansas says Medicaid expansion saves $372 million. Let’s break down those numbers.

Those are the costs. But there are also $131.5 million in savings that comes from three sources. There would be a reduction in uncompensated care —  the medical bills that don’t get paid — as more Arkansas residents gained coverage. State tax revenue would increase with the influx of federal dollars. The state also gets to transfer its medically needy population —  those who spend nearly all of their income on medical bills to qualify for Medicaid — into the federally financed expansion.
Source: wordpress.com

New Arkansas Study Says Medicaid Expansion Would Save State $350 Million

The Center on Budget and Policy Priorities today pointed out a new study from Arkansas’ Department of Human Services, which found the expansion of Medicaid in health reform would save the state $350 million between 2014 and 2025. This stands in stark contrast to an earlier estimate from the state that participation in the reform law would cost it over $800 million over roughly the same period. Arkansas’ new estimate does fall in line with a recent Urban Institute study which offered an optimistic prediction of $362 million in savings for the state between 2014 and 2019, and a pessimistic prediction of $7 million in new costs
Source: americanpoliticalblogs.com

Medicaid will save state $372M

Amid ongoing debates of whether Medicaid expansion will help or hurt states, Arkansas foresees the health reform provision to opt in as saving the state $372 million in the first six years, The Washington Post reported. Arkansas is planning on spending $25.2 million on currently eligible, nonenrolled individuals, including $6.9 million on processing claims and $10 million on outreach, customer support and processing new claims in 2015. Even with those costs, the state predicts savings of $35.5 million in 2015 and $372 million over six years. 
Source: fiercehealthcare.com

New Arkansas Study Says Medicaid Expansion Would Save State $350 Million http://t.co/d6GN2Qc6 [ThinkProgress]

2011 2012 about after Against Bill Campaign court DailyKos debt fearandvoting From Gingrich health House HuffPost jobs Jones Maddow Marriage Mitt more Morning Mother Obama open Over Paul Perry President Rachel Republican Republicans ReutersPolitics Rick Romney Santorum Says Senate State TalkingPointsMemo TheNation ThinkProgress Thread U.S.
Source: fearandvoting.com

To expand Medicaid or not to expand Medicaid

You know, if everything could be fixed by me not paying any taxes I’d be wearing a Tea Party hat and doing every Mitt-ish thing I could do to avoid paying one red cent to the state or the Feds. But I figure I should pay for the roads I drive on, the teacher who taught my kids, for firefighters & cops, for a military that protects me from the bad guys and on and on. And not only am I willing to pay for what I’ve got, I’m willing to pay taxes so a baby born today will have all those services for the entirety of his or her life too. No one likes paying taxes but adults understand it’s an obligation that keeps the wheels turning decade after decade. When Ma was sick and in the nursing home I realized her bills got paid because of the many years she paid into the pot and by the millions of other people, strangers who contributed their fair share. If I had had to come up with a single payment of her monthly bill of 5900 dollars, I’d be typing from a van down by the river right now. Of course 5900 per month was ridiculous for the services Ma got, but that wasn’t Bush or Obama’s fault, it was our sick system lubricated to the extreme by a nursing home lobby that can’t be beat back…..as of yet. So I’ve already benefited greatly by not winding up homeless just to take care of an old woman whose only sin was to keep waking up day after day until she became old and sick. I’ve got 2 smart kids thanks to our public schools and our commitment to put our kids ahead of all other matters every hour of every day for the last 25 years. I was reading a Facebook comment by an uppity friend who was defending her choice to send her kids to private schools because in her opinion public school teachers quit caring about kids years ago. The dumb bitch is so wrong it hurts, I know some of her kid’s public school teachers and they’re great and they’re sure not teaching because of the fat paychecks….they have never got. I trust Mike Beebe to do the smart thing about expanding Arkansas’ Medicaid coverage and I hope the Feds have some kind of fresh hell to dump on the heads of the Republican governors who refuse to comply. I’m sick of spoiled, delusional brats in high office, people elected to govern who refuse to govern. I sick of people with billions in the bank complaining they can’t make it in America any more because they hate paying taxes or complying with oversight and regulations. Deport them now! Let Tricky Mitt spend some quality time with his money in the Cayman Islands. Osama’s dead. 9-11 is past, time for Americans to come back to their senses. It’s funny how so many people know all about a new Dunkin’ Donuts opening but so damn little about the concepts of country and government and what it takes to make a society work.
Source: arktimes.com

Maine Governor’s Medicaid Plan Could Lead To ‘Direct Confrontation’ With Feds

The New York Times: Maine Debate Hints At Rift On Medicaid After Ruling As some Republican governors declare that they will not expand Medicaid under the national health care law, Gov. Paul R. LePage is going a step further. In what could lead to a direct confrontation with the Obama administration, he is planning to cut thousands of people from Maine’s Medicaid rolls, arguing that the recent Supreme Court ruling on the law gives him license to do so (Goodnough and Pear, 7/18).
Source: kaiserhealthnews.org

Medicaid Expansion May Turn Out to Be an Offer States Can't Refuse

Politically, though, it sets up an interesting dynamic. A lot of states, especially in the South, are resisting the Medicaid expansion. It’s going to be tough for them to stick to their guns, however, because there are a lot of interest groups (for example, hospitals who are losing funding for indigent care and desperately need the new Medicaid dollars) who are going to be pushing hard to accept the expansion. But if the Arkansas analysis turns out to be broadly true for other states, it’s going to be even harder to resist than we think. How many legislatures will turn down a badly-needed federal funding windfall during tough times if the only downside is a minuscule cost six years down the road? Some, I suppose, but probably not too many.
Source: motherjones.com

ARRA News Service: Arkansas Medicaid Crisis Looms Despite $1 Billion In Stimulus Funds

There are 41 categories in the “health and human services category,” with three Medicaid-related programs awarded most of the amount, nearly $782 million. One “Medical Assistance Program” was awarded $318,917,521, the largest amount designated to any categorical. The description lists one objective of the program as follows: “To protect and maintain State Medicaid programs during a period of economic downturn, including by helping to avert cuts to provider payment rates and benefits or services, and to prevent constrictions of income eligibility requirements for such programs, but not to promote increases in such requirements.” Two additional programs designate an additional $227,066,000 and $234,790,947 in stimulus funding for similar Medicaid-related programs. Arkansas officials have not explained how they will identify the unfunded liabilities of Medicaid programs or continue spending at current levels when the stimulus ends.
Source: blogspot.com