Earning $11,000 is too much

Posted by:  :  Category: Medicare

In a Thursday, July 26, 2012 photo, Sandra Pico, 52, holds medications she takes, at her home in North Miami Beach, Fla. Pico makes about $15,000 a year working about 20 hours a week as a home health aide, a bit too much to qualify for Medicaid, but not enough that she can afford private insurance. She thought she’d be getting health insurance after the Supreme Court upheld the health care law. Then she learned her own governor won’t agree to expand Medicaid under the law which would have given her coverage. (AP Photo/Lynne Sladky)
Source: gazette.com

Video: Exploding Medicaid Costs in Colorado

Safety Net Scene: Will Anyone See the New Medicaid Patients?

About 69 percent of doctors nationally accept new Medicaid patients, but the rate varies widely across the country. A new study in Health Affairs, detailed in Kaiser Health News, says that in Colorado, slightly less than the national average of doctors agree to take on new patients who are on low-paying Medicaid. The Colorado rate is about 66 percent, just under the national average of 69 percent…Read more. [Source: Colorado Rural Health Center]
Source: blogspot.com

Poor, Sick And Expensive: Colorado’s Scaled

The state is one of just a few that is expanding Medicaid in advance of the major expansion called for in 2014 by the federal health law. Starting in mid-May, Colorado will begin offering Medicaid to adults like Miller who make less than $1,080 per year (that’s 10 percent of the federal poverty line, or $90 per month) – but there’s a catch. Though the state estimates that there are 50,000 people who meet the income bar, Colorado will only be able to offer the health coverage to 10,000 people. Those people will be chosen by a lottery method in each county, designed to distribute the benefits fairly across the state.
Source: kaiserhealthnews.org

Eligibility Requirements for Medicaid in Colorado

In Colorado, Medicaid can cover families, children, pregnant women, persons who are blind, or persons with disabilities. It can also cover the elderly. To qualify for any of these programs, a person must be a resident of Colorado. When a person applies for Medicaid, the state will determine which of the many parts of the Medicaid program that the person is eligible for, and will enroll the person in that one.
Source: families.com

Daily Kos: Poor but not poor enough for Medicaid

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Source: dailykos.com

Our View: Medicaid Needs Reform, Not Expansion

Budget experts from both sides of the aisle tend to concede that expanded Medicaid eligibility is the 800 pound gorilla in Colorado’s budget living room. With many colleges and universities around Colorado hiking tuition in the double digits each year to offset cuts in general fund appropriations, we wonder how exactly Governor Hickenlooper plans to pay for the state’s share of this massive entitlement expansion without further eroding access to higher education for Coloradans.
Source: thecoloradoobserver.com

Healthi Healthy : Colorado Medicaid Vision Care Benefits

Contact lens fitting fees entail additional charges above the regular eye examination. These are not covered unless there is an eye disease that warps the cornea. Contact lenses may be the only way to provide acceptable visual acuity. The actual contact lenses are also not covered unless their is an applicable medical diagnosis. This is not a area where a patient can plead their case. If there are specific medical conditions requiring contact lenses your eye doctor has to file a form to have your case considered. The review process can take several weeks to several months. It is normally approved if contact lenses are the only way to correct your vision due to a corneal eye disease. Your optometrist may have to submit a form for prior authorization more than once to communicate the need for special consideration, so you will need to have some patience.
Source: healthihealthy.com

Medicare Eligible? Resources at Mature Health Center Online

Posted by:  :  Category: Medicare

While you do not have to pay a premium for Part A if you meet one of those conditions, you must pay for Part B if you want it. In 2011 the monthly premium for Part B is $96.40 for most with incomes under $85,000 (single) and $170,000 (married). However, the monthly Part B premium for 2011 will be $115.40 for people enrolling in Medicare for the first time in 2011. It is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of the above payments, Medicare sends you a bill for your Part B premium every 3 months.
Source: stewardshipmatters.net

Video: Medicare Part B_1.wmv

Teachers Are Not the Problem: Medicare meets Obamacare

“(Many beneficiaries paid less than the listed amounts in 2010 and 2011 because of the “hold-harmless” provision of Medicare which states that if the dollar increase in your Medicare Part B premium is bigger than the dollar increase in your Social Security check, you don’t have to pay the difference.)” “As for future Medicare Part B premium rates, the information cited above is wrong on two counts: No provision of the health care legislation passed during the Obama administration sets Medicare premium rates, nor is a whopping jump of over 100% to a $247.00 monthly premium in 2014 a realistic figure.” [Emphasis mine.] “New Medicare premium rates come out each fall and take effect in January. Medicare beneficiaries as a group are required to pay one-fourth the cost of running Medicare, and annual premiums are set at a figure calculated to achieve that level of revenue. Although the annual premium rates aren’t officially set until they are announced each fall, Medicare administrators track trends and anticipated changes and use them to formulate projections of Medicare premiums for the next several years. According to the most recent report of the system’s trustees, issued in May 2011, those projected premiums (as listed on page 218) are:
Source: blogspot.com

Social Security goes up, but so do Medicare premiums

To P. D’Antonio, NOT EVERY PENSION PLAN IS THE SAME. MINE WAS FREE WITH THE AIRLINE THROUGH THE UNION. I also suffer with many Esophagus problems and I truly believe all the chemicals I worked with and ulcer in Esophagus from stress from the “Good Old Boys in the Union”. My husband gets a great PENSION as he made very little which co-incided with the city plan as all figured out to a tee as he paid in big monies for his Pension pretty much $200.00 to $400.00 in later years as made more but when he worked overtime and slept all wknd there and removed snow they took $600.00 of his overtime including the reg. month payments for his Pension. You young people know nothing or some older. Every pension plan is different!!! My friend hates it too but her company gives BONUS checks each year which she got a lump sum of $15,000 and others at that same company up to $34,000 per year. I worked for not much for 46 yrs. my hubby got NO Bonuses for Viet Nam. He will not get any Social Security for 30 yrs with City as part of the Pension Plan as he did not pay in unless worked other jobs. He has worked other jobs now for 16 yrs plus his 30 for city. Plus his 4 yrs Marine service plus 6 yrs reserves. He is 65 and still working for Health Ins. Him and I never saw Bonuses!!!!! I don’t get low free flying as quit early because of ulcer and many other throat problems working with so very many chemicals. Get your facts straight about Pensions!!!! I never heard of a 401K plan til 1991 in my whole life and neither did my husband. If they were around earlier must have been for the rich or high up people at jobs! Republicans wanted all the Soc. Sec. to INVEST, remember then we had the stockmarket fall with the Godlman Sacs and Wallstreet. My husband’s Pension almost went broke and had to be transferred to another pension which were still not sure of! If Republicans would of had their way all the Social Security would have been gone then. LOL Stockbroker’s would have taken a big share of soc. sec. How soon we forget Republicans went on and on about people invest their own and let stock people take over Soc. Sec. to invest and they would have lost all of it a long time ago!!! Every company has their perks and some are more generous than others!!!!! LOL
Source: nbcnews.com

Medicare Premiums, Deductibles & Coinsurance: Rates for 2011

Because of the zero COLA increase in 2011, some Medicare beneficiaries will not pay more for coverage. If your premium is deducted from your Social Security check and your income is $85,000 or less ($170,000 if you file a joint tax return), then you won’t have to pay more. Your monthly premium will stay at either $96.40 or $110.50.
Source: suite101.com

Higher Medicare Part B premiums in 2012

The Social Security Administration (SSA) uses tax figures from two years ago to determine the Part B premiums. So the MAGI reported on a taxpayer’s 2010 tax return determines if the taxpayer must pay a higher monthly Part B premium in 2012. For example, a single filer with a MAGI of $150,000 in 2010 will have to pay a monthly Medicare Part B premium of $199.80 in 2012.
Source: businessmanagementdaily.com

Medicare Part B Premium Deduction for Self Employed

IRS officials said the change came too late to be printed in the Publication 535, Business Expenses, which still states that Medicare Part B premiums are not considered medical insurance premiums for purpose of the self-employed health insurance deduction.
Source: iquote.com

Clearing Out Medicare Advantage Plans Confusion

Posted by:  :  Category: Medicare

Cassandra Q. Butts by Center for American Progress[…] Medicare Advantage plans are available when you first sign up for Medicare, but after that, you can only join most of the plans from October 15 through December 7. There are a few five-star Advantage plans that have exceptional grades for high quality and these plans can sign up new members all through the year. To see what advantages these plans can give you, read more about the coverage here on our site. You can also listen to or call in and ask questions from leading experts during our free teleseminar.Source: medigapadvisors.com […]
Source: medigapadvisors.com

Video: Understanding Medicare Advantage Plans

Five Undeniable Facts about Ryan’s Medicare Reform Plan

5. It gets the economic incentives right. By providing a set amount of money for each Medicare beneficiary’s health care coverage, the Ryan plan starts a process of encouraging seniors to ask where they get the best value for their health care dollar—just as we all do in every other sector of the economy. That change will create a new dynamic in Medicare that will increase competition, lower costs and improve quality—the missing links to preserving and strengthening Medicare.
Source: teapartypatriots.org

Daily Kos: Mitt Romney claims the Ryan plan actually expands Medicare

thrilled to death to find that they need to provide a complete health history, then purchase a $15,000 a year policy, at a $7000/yr discount (hey, what’s 8000 bucks to the average senior?  I’m sure they’ll never miss it!), and then when they get sick, find the right hospital that accepts their insurance (it’s an invigorating experience!),  and find the right doctor that is in the specialty that they need that is covered under their plan (the benefit of socialization — seniors need to talk to lots of people, and this policy requirement will ensure that they are on the phone to many, many people for hours!).   Then when they get to the hospital, they get to go through the process of determining how they will pay for the 20% of their medical expenses plus their $1000.00 deductible that are not covered by their $15,000 per year policy before they can see a doctor (Math and problem solving!  It’s great for seniors!) See?  It’s an expansion alright.  Currently, they just go to the nearest hospital and are covered and can see any doctor.  How boring is that? Yep.  Thrilled to death.  Seniors are going to love it. (snarkety snark snark)
Source: dailykos.com

Ryan’s “premium support” proposal for Medicare: Myths and facts

2. Myth: Expanding private plans in Medicare will reduce Medicare’s costs.  Fact:  Private Medicare Advantage plans have raised Medicare costs.  Private insurers profit by selectively enrolling the healthy and shunning the sick, as documented in a New England Journal of Medicine article subtitled “The healthy go in and the sick go out.” Hence, they collect premiums paid by the Medicare program, and provide little care. As a result, the Congressional Budget Office estimates that Medicare Advantage plans cost Medicare 12 percent more per enrollee than the traditional program. New research from the National Bureau of Economic Research indicates that the true cost of private plans to Medicare may be much higher than the CBO estimate. Since Medicare launched a new risk adjustment scheme based on 70 diagnostic codes in 2004, overpayments to private plans have increased dramatically and accounted for $30 billion in excess spending, or 8 percent of total  Medicare spending, in 2006 alone. Since then the overpayments have likely risen as the proportion of Medicare recipients in private plans has jumped from 16 percent to 24 percent.
Source: pnhp.org

Left In Alabama:: Robamacare, Obamneycare, or Medicare for All

African American Political Pundit AmericaBlog An Examination of Free Will Bartcop Blog for Rural America Balloon Juice Blue Gal Booman Tribune Borowitz Report Science Blogs Corrente Crooks and Liars Daily Diatribes Daily Kos Docudharma Eschaton Firedoglake First Draft FiveThirtyEight Gun Toting Liberal Hullabaloo Jack and Jill Juan Cole La Vida Locavore The Left Coaster MyDD My Left Wing NASA Watch Notion’s Capital Oliver Willis Open Left Orcinus Paul Krugman Plush Life Political Cortex Scoobie Davis Senate Guru Spocko’s Brain Swing State Project Suburban Guerilla Talk To Action Talking Points Memo The Airport Report The Field Negro The Oil Drum Think Progress US Politics News
Source: leftinalabama.com

Health Insurance in NYC and Area: AMG Medicare Plans

AMG Health Plans now has a licensed Medicare specialist. NY State health insurance agent Kirk Devereux is certified with Empire Blue Cross, United Healthcare, Emblem and Easy Choice of NY to help people in New York on Medicare or those who are aging in to Medicare (turning 65) with a wide variety of options. Some of these are Medicare Advantage, supplement plans and Part “D” prescription plans. The Annual Enrollment Period (AEP) for Medicare is October 15 to December 7 this year. Those currently on Medicare can shop around and switch their plans at this time. For the many “Baby Boomers” turning 65 in the coming years, you have an initial enrollment period (IEP) of 7 months. This is from 3 months prior to your 65th birthday, the month of your birthday and the 3 months following your birth month. There are also some special enrollment periods (SEP) available to individuals under certain conditions. It is wise to contact an expert to help you find the coverage that best suits you during these enrollment periods. You can call or email Kirk at any time for comprehensive, “no pressure” advise. Kirk Devereux AMG Health Plans 1-914-393-3872 kdevereux@amghealthplans.com
Source: blogspot.com

Paul Ryan’s Plan to Save Medicare From Insolvency

In a government that hungers for leadership, Ryan has for past four years been decrying the unsustainable fiscal course we are on — now teetering on the edge of a black hole of annual trillion dollar budget deficits and crushing debts that are now larger than our entire economy.
Source: townhall.com

Which is better? Medicare or Medicare Advantage?

6. What is the Medicare Advantage plan’s star rating? The 5-star rating system is used by Medicare to monitor Medicare Advantage plans and determine if they meet certain quality standards.  The ratings also make it easier for someone on Medicare to compare plans based on quality and customer service. The star rating system considers 53 quality measures, such as success in providing preventive services, managing chronic illness, and keeping consumer complaints to a minimum. The higher the plan’s rating, the better. It’s not a bad idea to target plans that have a rating of 3.5 or higher.
Source: ehealthinsurance.com

Parsing Medicare Policy And Politics

CQ HealthBeat: Paul Ryan’s Budget Has Changed, Gained GOP Support Over Years The fiscal 2013 budget resolution written by House Budget chairman and now vice presidential candidate Paul D. Ryan is really a tale of two plans or maybe even three. At its most practical level, the budget resolution the seven-term Wisconsin congressman dubbed “The Path to Prosperity” proposes a discretionary spending limit of $1.028 trillion for the fiscal year beginning Oct. 1. That is $15 billion below this year’s spending level and $19 billion below the $1.047 trillion level set in the debt limit increase law enacted last August…Between 2013 and 2022, Ryan’s budget would spend $5 trillion less than Obama’s budget and $4 trillion less than would be spent under current law. The Ryan budget would do that by cutting domestic discretionary spending, as well as restructuring federal health care programs including Medicare and Medicaid (Krawzak, 8/15).
Source: kaiserhealthnews.org

Ask The Experts: Retirement

Posted by:  :  Category: Medicare

"I'm George Washington and I approve this message." by eyewashdesign: A. GoldenQ. I will retire after age 65. My husband is already older than 65, and we are both covered by my Blue Cross Blue Shield FEHB. I realize I don’t have to make a decision for either of us concerning taking Medicare Part B as long as I’m employed by the federal government. After I retire, I realize BCBS will be constrained by law to pay no more than the Medicare fee schedule amount for services rendered for either of us should I chose not to take Medicare Part B for either of us. Can my doctor require me to pay the difference between the Medicare allowed part my insurance pays and what my doctor wants to charge? Or is my doctor mandated by law to keep fees for services at the Medicare Part B limit regardless of whether my doctor accepts Medicare Part B or not?
Source: federaltimes.com

Video: Changes to Medicare Supplements – Plans M and N

New Study Shows How Adherence Improves Health, Saves Money

The Health Affairs study adds to a growing body of evidence on the value of good adherence. For example, I’m reminded of last year’s study in the Journal of the American Medical Association, which found that improved access and adherence to medicines through Medicare Part D saves Medicare about $1,200 in hospital, skilled nursing facility, and other costs for each senior who previously lacked comprehensive prescription drug coverage. Coupling this with Harvard Medical School research showing nearly 11 million seniors gained comprehensive prescription drug coverage because of Part D and the overall savings to Medicare in 2007 came to about $13 billion.
Source: phrma.org

Daily Kos: Medicare As We Know It versus Coupons for Grandma, w/ Poll

Consider if one or more of these tags fits your diary: Civil Rights, community, Congress, Culture, Economy, Education, Elections, Energy, Environment, Health Care, International, Labor, Law, media, Meta, National Security, Science, Transportation, or White House. If your diary is specific to a state, consider adding the state (California, Texas, etc). Keep in mind, though, that there are many wonderful and important diaries that don’t fit in any of these tags. Don’t worry if yours doesn’t.
Source: dailykos.com

Viewpoints: Public Seeks Better Campaigns But Politicians Use ‘Schoolyard Rules;’ GOP’s Medicare ‘Flip

The New York Times: For Healthy Aging, A Late Act In The Footlights Many of us look forward to spending retirement expanding our world — traveling, trying what we never had time to do, taking classes that give us new knowledge and skills. These activities are not only desirable in themselves, they help us to live longer and healthier lives. But they are not within everyone’s reach. Absent money and a sense of possibilities, retirement can become more time to fill with television. “We see people without money, who had very hard lives, who are not aware of their own potential,” said Maureen Kellen-Taylor, the chief operating officer of EngAGE ,a program in the Los Angeles area that provides arts and other classes for some 5,000 people — the vast majority of them low-income — living in senior apartment communities (Tina Rosenberg, 8/15).
Source: kaiserhealthnews.org

Pawlenty claim about Obama Medicare 'cuts' deemed 'misleading'

Speaking of … Jason Stein at the Milwaukee Journal Sentinel reports: “A secret probe into those around Gov. Scott Walker has continued after the June 5 recall election and expanded beyond Milwaukee County and into state government, new records show. The documents show that Milwaukee County District Attorney John Chisholm’s office continues its John Doe investigation into Walker’s administration even as the inquiry has gone publicly quiet over the summer. The records obtained by the Milwaukee Journal Sentinel through an open records request show that a Milwaukee County prosecutor sought personnel records from Walker’s office and another state agency in June and then met with a top state lawyer the next day. … the new records confirm that prosecutors are also seeking information from Walker’s state administration and did so as recently as June … Milwaukee County Assistant District Attorney David Robles on June 18 made an open records request to both Walker’s office and the state Department of Administration for all communications ‘related to the designation and determination of individuals as ‘key professional staff’ of the Office of the Governor’ since the time Walker took office on Jan. 3, 2011.” Sally Jo Sorensen does a good job of breaking down the dynamics of an Allen Quist-Tim Walz race down south. In her Bluestem Prairie blog, she writes: “What will November bring? Walz enjoys a huge cash advantage, boundless energy, an experienced campaign staff and seems to be liked by most Southern Minnesotans. But while Quist is a little different as we say in these parts, the district voters are independent-minded and far from any madding major media market. Will superfund dollars flow into the district?  Depends upon internal polling most likely — for now, it’s not thought to be competitive. And surely the twitter hubbub about Quist’s odd but decades’ old statements — popularized by Mother Jones and the Parry Campaign (band name anyone?) — should drive some  dollars in Walz’s direction from progressives terrified at the thought of a Bachmann mentor in Congress. Another fascinating fact: Mike Parry lost to Quist in the same counties that he lost in the January 2010 election — including his home county of Waseca. In his home senate district, he won Steele County by 59 votes, while losing Rice County as well as Waseca County.”
Source: minnpost.com

Peter Ferrara on CNBC talking about Paul Ryan’s Budget, Medicare Reform Ideas

Jim is the the director of communications at The Heartland Institute. Prior to joining Heartland, he was an ink-stained newspaperman for 16 years with many stops in “old media.” Jim covered Congress and The White House during the George W. Bush administration for The Washington Times, and worked as a reporter, editorial writer and columnist for newspapers in Pennsylvania, Virginia, and California. He has appeared on the Fox News Channel, CNN, MSNBC, C-Span, and many local and national talk radio shows to talk politics and policy. Twitter
Source: heartland.org

Paul Ryan and the Real Enemy of Medicare

Among those favoring such changes is Alice Rivlin of the Brookings Institution, who was President Bill Clinton’s budget director. The premium support model embraced by Ryan, she testified before Congress in April, “seeks to combine the tools of market competition and cost-effective regulation in hopes of maximizing the chances of improving health care for seniors at a sustainable cost.”
Source: reason.com

FRSFreeStateNow: FRSFreeStateNow: President Obama Rips Paul Ryan On Medicare: How to Reform Medicare Instead

What I don’t like about Representative Paul Ryan’s approach to reforming Medicare which isn’t much different from Governor Mitt Romney’s. Is that instead of creating more choice in Medicare and in Health Insurance, it takes away choice for seniors who may want to stay on Medicare. Because it would literally force seniors out of the Medicare System and into the private Health Insurance Industry, whether they want that or not. Instead of giving them a choice and be able to make that decision for themselves where to get their Health Insurance, what it does instead is gives seniors. A voucher and tells seniors you are now off of Medicare and have to find Health Insurance on their own, people who could be in their late 60s at this point, depending on how Medicare is reformed in the future. Chances are people with Medical Records and perhaps have some type of medical condition and this voucher doesn’t cover the whole costs for people to purchase private Health Insurance. So the costs of seniors Health Insurance would end up going up, they would end up having to pay more out of pocket, then they would on Medicare, to pay for their Healthcare. Limiting or restricting choice, is not the way to reform our Healthcare System. I like the idea of giving seniors a choice in where they get their Health Insurance, Hell I like giving all Americans the choice of where to get their Health Insurance. One of the reasons I’m for the Public Option in Healthcare Reform, which would allow adults under 65 to buy into Medicare and use that as their Health Insurance. Which down the road would bring down the costs of Medicare, because younger healthier people would be part of the Medicare System. And I like the idea and this was one of the options of the Public Option as part of the Healthcare Reform debate. In 2009-10 that would allow each State to set up their own Medicare Program, sorta like with Medicaid and give Americans the ability to choose for themselves where to get their Health Insurance. They could choose Medicare or they could stay in the private Health Insurance Market and people who can’t afford Health Insurance would get a Tax Credit to pay for it. There are ways to reform Medicare and there are ways not to reform Medicare and most of the ways I’ve heard are bad. And some of them are good and the worst is essentially eliminate Medicare and replace it with vouchers and leaving it up to the private Health Insurance Industry. In who should get Health Insurance and who not and these decisions wouldn’t be made based on peoples ability to pay but how much it would cost a Health Insurer to cover them.
Source: blogspot.com

Keller @ Large: Using Medicare As A Political Weapon

Here’s the truth behind the claim Obama spent a lot of Medicare funds: As the Pulitzer-Prize winning web site Politifact notes, the federal health-care reform moves Medicare funds around for various reasons, but doesn’t “cut” anything out of the program.
Source: cbslocal.com

Romney Gets Poll Bounce in Swing States

Posted by:  :  Category: Medicare

"Every citizen should be a soldier. This was the case with the Greeks and Romans, and must be that of every free state." ` Thomas Jefferson. by eyewashdesign: A. GoldenRomney has seen the largest gain in Ohio, a state we have seen bounce between the campaigns over the last few months. Today, the GOP ticket leads by 2 points (46% to 44%), compared to July when President Obama led the state 48% to 45%.  Romney also gained ground in Virginia – today, he and Paul Ryan hold a 3-point advantage in the race (48% to 45%), while Romney trailed by 2 points in July.
Source: commentarymagazine.com

Video: Free Insurance Leads…Get Ready-to-Close Leads for Insurance

Myths and Realities of Ryan and Medicare

His insincerity in dealing with the problems facing Medicare is every bit as brazen. In contrast to Ryan, who admits that tough choices and significant revisions in its structure and management must be made, Obama postures as if it will continue forever in its present state, with funding magically available from unlimited economic sources. This is particularly egregious since it was his own establishment of socialized medicine (Obamacare) that has inflicted the worst damage to Medicare. In order to balance the books on Obamacare, the current medical coverage for seniors would be forced to forfeit $700 billion from its coffers. Yet we are told that no reduction would be experienced by recipients. No need to do the math, just take his word for it. The worst aspect of this situation is that liberals do not care if Medicare eventually implodes, as long as it waits until after November 6 to do so.
Source: themoralliberal.com

Ouch!… Paul Ryan: We Will End Obama’s $716 Billion Raid on Medicare (Audio)

A $260 billion payment cut for hospital services. A $39 billion payment cut for skilled nursing services. A $17 billion payment cut for hospice services. A $66 billion payment cut for home health services. A $33 billion payment cut for all other services. A $156 billion cut in payment rates in Medicare Advantage (MA); $156 billion is before considering interactions with other provisions. The House Ways and Means Committee was able to include interactions with other provisions, estimating the cuts to MA to be even higher, coming in at $308 billion. $56 billion in cuts for disproportionate share hospital (DSH) payments.* DSH payments go to hospitals that serve a large number of low-income patients. $114 billion in other provisions pertaining to Medicare, Medicaid, and CHIP* (does not include coverage-related provisions).
Source: thegatewaypundit.com

Medicare Individual Sales Rep (Syracuse, NY)

Success Factors: •Integrity – Setting high personal standards for accuracy of presentations, documents, and other communications with customers and within own company. •Drive – Demonstrating high energy level, works hard to achieve goals, results driven, self-motivated. •Professionalism – Conducting business in a professional, confident manner. •Competitiveness – Striving or contending for goals and profit, and is tenacious, demonstrating ability to hold steadfastly and firmly to a purpose or undertaking despite obstacles or setbacks. •Initiative – Willingly takes on new responsibilities, demonstrating creativity and innovation. •Flexible – Adapting to changes and modifying behavior, approach, and information when the situation demands. •Judgment – Committing to an action after developing alternative courses of action that are based on logical assumptions and factual information. •Ability to Learn – Assimilating and applying in a timely manner, job related information that may vary in complexity. •Demonstrated ability in problem solving and negotiation with special emphasis on closing the sale •Ability to build own book of business through a variety of sources •Possesses solid service and sales skills – Uses a consultative approach to close sales by knowing the Company’s products/services and industry and the needs of the customers, using that knowledge to close business. •Ability to plan, organize, and prioritize the actions required to accomplish day to day goals and objectives through the use of appropriate technology. •Ability to identify, manage, and measure all high payoff activities in the Sales process in order to continually improve results. •Display the critical skills of consultant and strategist , to objectively: (1) assess sales opportunities, (2) understand the customer’s needs/business, (3) understand customer’s decision making process, (4) articulate value of the Company’s product(s)/service(s) to the prospective sale, (5) offer creative solutions to meet customer’s explicit needs. •Ability to make quality decisions and select solutions by weighing the ramifications of alternative courses of action. •Comfortable with Medicare eligible client base and possesses a solid understanding of senior issues. •Understands company’s vision and mission linked to direct application of methods and plans to accomplish sales strategy. •Work effectively with fellow associates to further the goals of the business, and using a team selling approach when appropriate.
Source: careers.org

Health Reform Strengthens Medicare

From Christian Families News Source- http://killfile.newsvine.com/_news/2012/08/09/13200280-romney-spokesperson-if-people-had-been-in-massachusetts-under-governor-romneys-health-care-plan-they-would-have-had-health-care ____________________________________________________ Appearing on Fox News Channel with anchor Bill Hemmer, Mitt Romney campaign spokesperson Andrea Saul attacked a pro-Barack …
Source: christianparenthub.com

‘Real News From The Blaze:’ Romney Fights Against Medicare Attacks

There’s another promise he made. You know that every time you get a paycheck you see there’s a deduction there. It’s going to Medicare. It’s going into a trust account to make sure that when you retire, that there’s a health program there that will care for you. One of the things the President did which I find extraordinary, something he never mentioned when he was running for office. You see, when he ran for office, he said he’d protect Medicare. But did you know that he’s taken $716 billion out of the Medicare trust fund. He’s raided that trust fund. And you know what he did with it? He’s used it to pay for Obamacare, a risky, unproven federal government takeover of health care. And if I’m President of the United States, we’re putting the $716 billion back.
Source: theblaze.com

Spring Infusion Sets Partners With Solara Medical Supplies Website Is Now Live

Posted by:  :  Category: Medicare

Solara Medical Supplies is proud to be announced as an authorized distributor of Spring Infusion Sets (www.springinfusionsets.com). Spring Infusion Sets have multiple insulin delivery, pain and injury reduction, and user friendly innovations that make it the ideal infusion set for many patients with diabetes. Spring Infusion Sets Detach-Detect exclusive mechanism triggers a blocking device creating an occlusion if any part of the infusion set base detaches from the body. Multiple innovations for minimized cannula bending potential. Flexible yet durable proprietary, high-transparency tubing enables visual air-bubble detection and faster occlusion detection. The pre-cocked insertion and retraction springs are responsible for lightning-fast speed and accuracy of the insertion and reduce friction during the spiral trajectory retraction. Fully hidden, auto-retractable, high-gauge lubricated needle reduces sharps injuries and biohazard potential, and features a trocar tip penetrating with the least sensation and tissue scaring. Smallest, all-in-one inserter, activated by the push of one button with audible insertion assurance. 360° tubing connector rotation allows convenient disconnection or re-adjustment. Luer-lock connection and variety of cannula and tubing lengths for superior versatility. Solara Medical Supplies is the industry leader in the home delivery of durable and disposable medical products, offering more than 30,000 items from the most popular brands in diabetes, incontinence supplies, and much more. Our highly trained staff and fast computer systems network ensures fast and convenient home delivery anywhere in the country. You can easily find the supplies with the features you need at the fastest and most convenient way to order 24/7. By handling all of your paperwork, accepting Medicaid in most states, as well as most private and major medical insurance plans the ordering process is further simplified. Solara Medical Supplies offer the most comprehensive coverage of any full-line, mail-order medical supply provider, by working extensively with Medicare and contracting with more than 1,000 health plans nationwide.
Source: freepressindex.com

Video: About Shield Healthcare – Medical Supplies for Care at Home

The CareGiver Partnership Offers Tax

The CareGiver Partnership is a national direct-to-consumer retailer of home healthcare products for incontinence, diabetes, nutrition support and more. In its sixth year of providing products and services that help caregivers and loved ones maintain personal dignity, the company also offers an online library of more than 1,200 family caregiver resources and personal service by experts in caregiving. Call 1-800-985-1353 or visit online at http://www.caregiverpartnership.com.
Source: dot99cents.com

Former husband and wife sentenced for multi

Diana Manos, Senior Editor DENVER – Leonid and Yelena Stolyar, both age 51, and both of Denver, were sentenced by U.S. District Court Judge Philip A. Brimmer to serve 35 months and 37 months, respectively, in federal prison for conspiracy to commit healthcare fraud and money laundering, federal and state authorities announced on Thursday. [See also: Public-private partnership to root out healthcare fraud .] Following their prison sentencing, the Stolyars were ordered to spend three years on supervised release. Judge Brimmer also ordered them to forfeit a secondary residence and pay restitution totaling more than $480,000 to the Colorado Medicaid program. Leonid Stolyar was sentenced on July 27, 2012 and was immediately taken into custody.  Yelena Stolyar was sentenced on Aug. 9 and will surrender herself upon designation of a facility by the Bureau of Prisons. The Stolyars were indicted by a federal grand jury in Denver on Jan. 3, 2011. They pleaded guilty before Judge Brimmer on March 22 and 27, 2012, respectively.  According to the Office of the Inspector General, the Stolyars submitted false and fraudulent claims for durable medical equipment, including incontinence products, ankle supports, knee supports and shoulder supports. Is this story relevant to you? Colorado Medicaid paid approximately $3.8 million in fraudulent claims to the Stolyars between December 2001 and May 2009. The Medicare program paid them more than $500,000.00 between December 2001 and August 2009. Many of the cooperating beneficiaries indicated they received items falsely billed to Medicare or Medicaid, or items never received from the Stolyars.The Stolyars billed the Medicaid and Medicare system under a fraudulent company named Orthomed. The Stolyars were divorced in 2005. “The FBI will continue to protect taxpayers by aggressively investigating those who attempt to defraud government-sponsored healthcare programs,” said FBI Denver Special Agent in Charge James Yacone.  “We are fully committed to working without federal and state partners to combat healthcare fraud and pursue the stiffest sentences possible.” “Healthcare fraud harms everyone as it increases the costs of legitimate healthcare for everyone,” said Lilia Ruiz, acting special agent in charge, IRS Criminal Investigation, Denver Field Office.“IRS Criminal Investigation together with our federal, state and local partners will work aggressively to pursue healthcare fraud criminals and bring them to justice.”        [See also: CMS targets fraud with new analytics .] “Medicare and Medicaid ensure that the most vulnerable members of our society — the elderly, poor and our children — have the healthcare services they need,” said Gerald Roy, special agent in charge of the Kansas City Regional Office of the Health and Human Services Office of the Inspector General.  “Working with our federal, state and local law enforcement and prosecution partners, we will vigorously pursue those who prey on these programs and hold them accountable.” “This case is an excellent example of how effective federal/state cooperation can be in rooting out fraud in healthcare,” said Colorado Attorney General John Suthers.
Source: posterous.com

The CareGiver Partnership: Affordable Adult Incontinence Products

Aging is a part of life and incontinence is often part of that aging process. It is nothing that a person should be ashamed of. Some people get incontinence because they are wheelchair bound or bedridden. People who are in these positions have the right to maintain their dignity. Having good adult incontinence products is an important component of this process. Making sure that a person has access to affordable adult incontinence products is very important because it makes sure that their condition is bearable. Making sure that your loved one has access to affordable incontinence products is easy when you work with the right provider and insurance providers. Insurance companies will also help cover the cost of these products.
Source: caregiverpartnership.com

New Med Supplies Store: Medical Supplies

Welcome To Our Blog! Dependability You Deserve – Quality You Can Count On Our store offers a wide range of products to help support your personal medical care needs. All the products we sell are manufactured under the strictest of quality conditions to guarantee you a product that fits your budget without sacrificing safety and comfort. From pediatric to bariatric, each line contains a huge assortment of items suited for every type of patient. Every product undergoes extensive inspection from start to finish. Our unique in-house product support team is specially equipped with tools to field all of your quality concerns, giving our customers the dependability they deserve.
Source: newmedsupplies.com

What is respite? Do I need it?

Patients under the care of Hospice of the Red River Valley may use their Medicare benefit and, sometimes, private insurance for a respite stay every 30 days. The stay is typically five nights, but the patient and family can choose to use less nights if desired. This break may, in some cases, mean the difference between the patient remaining in his or her home or requiring Long Term Care placement. Respite allows the caregiver to make a trip out of town to visit friends or family. Or, arrange to go to an out of town wedding, baptism, have that minimally invasive surgery, or make that medical or dental visit they have been putting off.
Source: hrrv.org


TEXAS COMPANY BILKED MEDICARE OUT OF MILLIONS June 28, 2012 + CHICAGO TRIBUNE MCALLEN, Texas (Reuters) – Federal agents on Thursday arrested four employees of a now-defunct Texas medical equipment supplier who are accused of bilking Medicare and Medicaid out of millions of dollars via fake claims, including some made on behalf of dead people, according to court documents. The owner and three employees of RGV DME, a onetime medical supplier near the U.S.-Mexican border in Pharr, Texas, each face allegations of 22 counts of health care and wire fraud, conspiracy and aggravated identity theft, according to a federal indictment unsealed on Thursday. The durable medical equipment supplier received about $7.1 million in reimbursements from the Medicare and Texas Medicaid programs for power wheelchairs, mattresses, incontinence supplies and other products, U.S. Attorney Kenneth Magidson, who heads the Southern District of Texas, said in a statement. The defendants billed the government for medical equipment never prescribed by doctors or delivered to customers â some of whom were dead when the claims were filed, Magidson said. Of the approximately 25,000 claims the company filed with the state and federal health care programs between 2004 and 2010, as many as 90 percent were fraudulent, Magidson said. Arrested Thursday were Marcello Herrera, 39, the medical equipment company’s owner, his wife, Carla Cantu Herrera, 31, who served as its marketing director, and former employees Ramon de la Garza, 51, and Beatriz Ramos, 27, court records showed. All four are accused of working together to forge patients’ and doctors’ names on forms filed with the federal Medicare program for the elderly and the federal-state Medicaid program for low-income people, Magidson said. If convicted of wire fraud â the most severe charge lodged Thursday â each defendant faces up to 20 years in prison and a $250,000 fine. Penalties for the other charges range from two to 10 years in prison. Federal court records listed no defense attorneys retained by any of the defendants. In Washington, the U.S. Supreme Court on Thursday upheld President Barack Obama’s healthcare law, the most sweeping overhaul since the 1960s of the unwieldy U.S. healthcare system. In a 5-4 ruling based on the power of Congress to impose taxes, the nation’s highest court preserved the law’s “individual mandate” requiring that most Americans obtain health insurance by 2014 or pay a tax. (Editing by Corrie MacLaggan and Tim Gaynor)
Source: blogspot.com

Medicare Incontinence Supplies

Urinary incontinence and unexpected bowel problems are no longer whispered about subjects among medical professionals, patients and caregivers. However, these conditions are still private matters for many people. Increasing life span averages and progressive medical advances allow patients to use simple solutions such as Diapers for Adults, disposable garments such as Depends Adults Diapers and Adult Cloth Diaper products rather than complicated, expensive and embarrassing waste bags and catheter tubing. The demand for convenience, and the increased medical necessity for these products has dramatically increased the market for privately purchased disposable protection and billed Medicare incontinence supplies requested by hospitals, nursing homes and assisted living facilities. Individual consumers and facility purchasing managers will not only find product use to be easier, but purchase and delivery methods are streamlined when buying online.
Source: forincontinence.com

Medicare UPIN Numbers Definition

Posted by:  :  Category: Medicare

Back in 1985 the United States Congress authorized creation of the Medicare UPIN Numbers with Section 9202 of the Consolidated Omnibus Budget Reconciliation Act. The department responsible for creation is the Center for Medicare and Medicaid Services known as the CMS. They have created UPIN Numbers for each Doctor accepting Medicare insurance.
Source: upinnumbers.org

Video: NPIDS eDirectory – NPI Lookup (PDF Directory of US Healthcare Providers from NPI Data Services)

How Much Do Pharmacy Technicians Make?

The demand for pharmacy technicians is growing and with the correct training and the will to learn on the job a candidate can work his way up the salary structure. There are several benefits which a pharmacy technician may be entitled to if he belongs to large facility. A full time employee may receive benefits such as medical insurance and even a discount on the purchase of medicines made in the pharmacy. Some companies give sick day pay so a person can still earn a wage when at home. Retirement funding is a perk offered by some companies to their pharmacy technicians and to other employees. In this scheme a specified amount is contributed regularly to an investment account which can add up to a neat sum to be enjoyed after retirement.
Source: techspharmtraining.info

FRSFreeStateNow: FRSFreeStateNow: President Obama Rips Paul Ryan On Medicare: How to Reform Medicare Instead

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYBONE by SS&SSWhat I don’t like about Representative Paul Ryan’s approach to reforming Medicare which isn’t much different from Governor Mitt Romney’s. Is that instead of creating more choice in Medicare and in Health Insurance, it takes away choice for seniors who may want to stay on Medicare. Because it would literally force seniors out of the Medicare System and into the private Health Insurance Industry, whether they want that or not. Instead of giving them a choice and be able to make that decision for themselves where to get their Health Insurance, what it does instead is gives seniors. A voucher and tells seniors you are now off of Medicare and have to find Health Insurance on their own, people who could be in their late 60s at this point, depending on how Medicare is reformed in the future. Chances are people with Medical Records and perhaps have some type of medical condition and this voucher doesn’t cover the whole costs for people to purchase private Health Insurance. So the costs of seniors Health Insurance would end up going up, they would end up having to pay more out of pocket, then they would on Medicare, to pay for their Healthcare. Limiting or restricting choice, is not the way to reform our Healthcare System. I like the idea of giving seniors a choice in where they get their Health Insurance, Hell I like giving all Americans the choice of where to get their Health Insurance. One of the reasons I’m for the Public Option in Healthcare Reform, which would allow adults under 65 to buy into Medicare and use that as their Health Insurance. Which down the road would bring down the costs of Medicare, because younger healthier people would be part of the Medicare System. And I like the idea and this was one of the options of the Public Option as part of the Healthcare Reform debate. In 2009-10 that would allow each State to set up their own Medicare Program, sorta like with Medicaid and give Americans the ability to choose for themselves where to get their Health Insurance. They could choose Medicare or they could stay in the private Health Insurance Market and people who can’t afford Health Insurance would get a Tax Credit to pay for it. There are ways to reform Medicare and there are ways not to reform Medicare and most of the ways I’ve heard are bad. And some of them are good and the worst is essentially eliminate Medicare and replace it with vouchers and leaving it up to the private Health Insurance Industry. In who should get Health Insurance and who not and these decisions wouldn’t be made based on peoples ability to pay but how much it would cost a Health Insurer to cover them.
Source: blogspot.com

Video: Medicare Supplement vs. Medicare Advantage Plans – A Doctor’s Perspective

Election 2012: A Candidate With Economic Heft, Paul Ryan is No Sarah Palin

What Paul Ryan Brings to the Ticket As head of the House Budget Committee, Paul Ryan has made two major economic proposals, both of which have been passed by the Republican-controlled House of Representatives. One is to restructure Medicare, keeping it as it stands for those over 55, but transferring those below that age into a premium-support scheme that would leave individuals more fully in control of their healthcare costs. The other is a budget that, apart from reforming entitlements, proposes to reduce top tax rates and pay for that reduction through means-testing the home mortgage, state income tax, medical insurance and charitable tax deductions. From Mitt Romney’s point of view, Ryan’s Medicare proposal is the more dangerous issue in the campaign since the Ryan budget proposal is fairly close to Romney’s own. However, with his selection of Ryan we can assume that Romney is prepared to defend the principles of Ryan’s Medicare plan, and that if he wins, something like the Ryan plan and his budget will be put forward to Congress. Of course, being a sausage factory, what Congress actually gets enacted may bear little resemblance to the wholesome ingredients that go into the mixture! One other key issue at stake in this election is monetary policy. Like the other Republican candidates, Romney pledged not to re-nominate Ben Bernanke when his term expires in January 2014. But the truth is, Ryan is much more seriously committed to reforming the current monetary policy and eliminating the huge costs it has inflicted on American savers and the pensions industry. Given that the majority of Republicans are also committed to Bernanke-replacement and higher interest rates, we can be fairly confident that a Romney/Ryan victory would prove a watershed moment in U.S. monetary policy. Election 2012: An Investor’s Guide to Romney/Ryan As investors, we can assume that if Romney wins, a serious effort will be made to cut public spending, possibly accompanied by a net tax increase, although with a slashing of tax deductions fairly similar to the 1986 tax legislation. We can also assume that Obama’s healthcare legislation will be revisited, with a greater emphasis on the private sector and an attack on cozy healthcare oligopolies in the hospital, pharmaceutical and insurance sectors. Finally, we can assume that interest rates will rise. With those outcomes we can certainly plan on what to do if the Romney/Ryan ticket wins the November election. Investors should short the hospital and pharmaceutical sectors, whose profits will be squeezed, but go long the private insurance sector, whose role may well increase. Because interest rates are likely to increase, investors should also short government bonds — even though the deficit will finally be addressed. A Romney/Ryan win will also be bad for the home builders because of the reduction in subsidies for housing and the likely attack on Fannie Mae and Freddie Mac will slow their recovery from the 2007-12 housing downturn. Builders at the high end like Toll Brothers (NYSE:TOL) look especially vulnerable. However, as investors we cannot usefully do any of this before the election. However, there is one thing investors can do before the election. They can buy the ProShares UltraShort 20+ years Treasury ETF (NYSE:TBT). This ETF takes a leveraged short position in long-term Treasury bond futures, so if interest rates rise (and bond prices decline) TBT benefits. Whichever candidate wins, it looks like a good buy. If Romney/Ryan wins, interest rates will rise in 2013, and Treasury bond prices decline. If Obama/Biden prevails, then less will be done to address the Federal budget deficit, while monetary policy will be kept very loose. In that case, either inflation will surge or the market will start worrying seriously about the long-term U.S. budget position, or both. Again, that will be good for TBT, although the payoff may be delayed slightly longer. Of course, the last major economic policy figure to run for the Vice Presidency was Jack Kemp in 1996, an author of the 1980s Kemp-Roth tax cuts. It’s said Kemp has been a major formative influence on Ryan. Whether Romney/Ryan faces the same fate as Dole/Kemp remains to be seen. Either way, you can expect the debate to be one of two very different ideas. Related Articles and News:
Source: equityjungle.com

Romney defends Ryan, says Obama ‘robbed’ Medicare to fund healthcare reform

“What Paul Ryan and I have talked about is saving Medicare, is providing people greater choice in Medicare, making sure it’s there for current seniors,” Romney continued. “No changes, by the way, for current seniors, or those nearing retirement. But looking for young people down the road and saying, ‘We’re going to give you a bigger choice.’”
Source: thehill.com

Blaming Obama for Bush’s Policies By Bruce Bartlett

Because of the large deficits Mr. Bush bequeathed Mr. Obama – on Jan. 8, 2009, the C.B.O. projected a deficit for the year of $1.3 trillion that didn’t include any Obama policies – Congress was deeply reluctant to enact a stimulus larger than $787 billion, even though President Obama’s economic advisers thought that one at least twice as large was necessary to turn the economy around. The opposition of every Republican to the 2009 stimulus was a major factor in its inadequate size.
Source: weblogs.us

Bruce Bartlett: Blaming Obama for George W. Bush's Policies

Because of the large deficits Mr. Bush bequeathed Mr. Obama – on Jan. 8, 2009, the C.B.O. projected a deficit for the year of $1.3 trillion that didn’t include any Obama policies – Congress was deeply reluctant to enact a stimulus larger than $787 billion, even though President Obama’s economic advisers thought that one at least twice as large was necessary to turn the economy around. The opposition of every Republican to the 2009 stimulus was a major factor in its inadequate size.
Source: nytimes.com

First Edition: August 16, 2012

Kaiser Health News: Capsules: Denver Health: Low Readmission Rate Not Easy To Emulate Now on the blog, Colorado Public Radio’s Eric Whitney, working in partnership with Kaiser Health News and NPR, reports: “If Denver Health can do it, every hospital ought to be able to do it. That’s the implicit challenge of the new Medicare penalties for high hospital readmission rates that will be hitting 2,211 American hospitals come October. Denver Health, despite being a safety net hospital, won’t be paying a penalty: It has an enviably low readmission rate. But there’s a problem says Medicare’s poster child: Denver Health’s quality chief calls the new policy imprecise and perhaps unfair, too” (Whitney, 8/16). Check out what else is on the blog.
Source: onlinehealthnews.org

South Dakota Politics: The Gorgias Election: the Doctor v. the Pastry Chef

Posted by:  :  Category: Medicare

Consider the condition of the body political and economic. Our economic growth is anemic. Labor force participation is at historic lows. Our yearly deficits have been running, for the last four years, at an average of 9% of the GDP, four times the historical average since WWII. Our major entitlement programs, Social Security and especially Medicare, are growing at a pace that is clearly unsustainable. If you project the trends of federal spending overall over the next several decades, you see a government on the road to insolvency and financial collapse. What is true of the federal government is true of many of our largest states, only faster. Their unfunded liabilities are enormous. We are already seeing a considerable number of large municipalities going bankrupt.
Source: blogs.com

Video: South Dakota Medicare Advantage Plans

Medicare to penalize 2,211 hospitals for excess readmissions

Some safety-net hospitals that treat large numbers of low-income patients tend to have higher readmission rates, which the hospitals attribute to the lack of access to doctors and medication these patients often experience after discharge. The analysis of the penalties shows that 76 percent of the hospitals that have a lot of  low-income patients will lose Medicare funds in the fiscal year starting in October. Only 55 percent of the hospitals treating few poor patients are going to be penalized, the analysis shows.
Source: medcitynews.com

Daily Kos: Republican strategists straining to convince us Paul Ryan is an electoral plus

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Source: dailykos.com

Maine hospitals among 2,211 to be penalized by Medicare for readmissions — Health — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

Ryan goes on offense over Medicare, accuses Obama of treating program like ‘piggy bank’

Ahead Apos S Barack Obama Campaign Trail Congress Contests Debate Democrats Economy Election Year Fox News Gop Interactive Corporation Iran Jobs Justice Department Lawmakers Legislation Marriage Massachusetts Governor Mitt Romney Nasdaq New Hampshire Newt Gingrich Nyse Obama Pentagon Polls Presidential Campaign Presidential Race Prnewswire Republican Republican Presidential Candidate Republicans Rick Santorum Sioux Falls South Carolina South Dakota Supreme Court Syria United States Violence Vote White House Wins
Source: southdakotanewswire.org

South Dakota Medicare Part D Plans

If all your medications are included in a basic formulary, an you enroll in an enhanced plan, you could be wasting some money. In this case you may be better off finding a basic plan with a low or $0 deductible. There are many things to consider when choosing a Part D plan. Be sure you are not paying too much for what you really need.
Source: partdplanfinder.com

IOM wants map redrawn on Medicare doctor pay

Changes in pay rates would shift between -5% and 5% for 96% of the counties across the country, according to the IOM report. Outside of that group, the highest reductions would be in Alaska, where rates would decrease by 18.8%, the committee said. Frontier states of Montana, Nevada, North Dakota, South Dakota and Wyoming also would see rates drop between 0.6% and 5.5%. Federal law mandates that physicians practicing in Alaska and the frontier states be paid at higher rates.
Source: nebraskaruralhealth.org

Medicare Advantage Star Ratings: Detaching Pay from Performance

Posted by:  :  Category: Medicare

OOPS I THINK THE SHINE IS OFF THE PEACH ...........IT'S ABOUT TIME by SS&SSBecause criteria for evaluation are not published until after the period for which performance will be evaluated, there is no possibility that MA plans will be able to improve their performance to achieve the goals CMS intends to incentivize. Any adjustment plans will be able to make to their bids or plan offerings would have to be aimed at increasing enrollment in counties with the highest bonuses and rebates based on data from performance in previous years, possibly at the expense of improving their performance in the future.
Source: thehealthcareblog.com

Video: Medicare Advantage Plans Ratings | Medicare Part C

Medicare Advantage Grows; But Not Without Government Help

The net result, encouraging more plans to compete in the Medicare market, is not actually in the best interest of seniors. In a study published last month in Health Affairs, researchers found that too many choices with too little guidance can be overwhelming for Medicare enrollees, especially the growing proportion that is experiencing cognitive difficulties. “Our study suggests that the Medicare Advantage program presents an overabundance of choices for many elderly beneficiaries,” the researchers write. “Medicare Advantage plans currently compete for enrollees through the benefits they offer and the premiums they charge, but elderly beneficiaries with low cognitive function were not responsive to changes in these features.” The implication, according to Health Affairs, is that these “unresponsive” seniors may buy into plans not well suited to their needs, allowing private insurers to profit “by offering less-generous coverage or reducing benefits while still attracting or retaining enrollees with limited cognitive abilities.”
Source: healthbeatblog.com

Kaiser Permanente’s Medicare Plan Website Recognized as a Benchmark for Excellence

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Putting the Patient in the Center: Star Ratings Congress for Medicare Advantage Plans

This commitment starts at the very top of an organization, meaning that CEOs and their leadership teams must send a clear message to staff, partners and communities that they hold themselves and their organizations accountable to better experiences of care for their patients.  Higher quality also requires systemic thinking, such as building new systems and processes that support safe, effective, patient-centered, timely, efficient and equitable care.  One aspect of this systemic thinking is building a close relationship between health plans and their provider partners – and once again, putting patients at the center.  A commitment to training and culture growth can pull an entire health care system toward a new organizational DNA – one that is all about better health, better health care and lower costs.
Source: wordpress.com

White House exceeded authority with Medicare Advantage project, GAO says The administration defends its demonstration to test paying bonuses to insurers for achieving higher quality and efficiency.

The backdating used for determining which plans qualify for bonuses does not allow for insurers to demonstrate improved quality going forward, the GAO said. Furthermore, the bonus structure in the reform law offered more modest incentives than the CMS demonstration, but would have encouraged plans to achieve higher performance ratings. For instance, the law would pay bonuses of 1.5% to plans achieving five- and four-star scores and no bonuses for three-star scores, but the demo pays 3% bonuses to three-star plans and up to 5% bonuses for five-star plans.
Source: telcoretirees.org

Research Roundup: U.S. Life Expectancy Ratings; Medicare Advantage Outlook; Should Advanced Cancer Patients Have Routine Screening Tests?

Archives of Surgery Hospital Process Compliance And Surgical Outcomes In Medicare Beneficiaries — This study looked at whether some of the information that hospitals must submit to Medicare, which is on the public  Hospital Compare website provides consumers with valuable tools to choosing a hospital and prompts hospitals to improve their services. The researchers looked at six high risk surgeries and at two sets of information called the Surgical Care Improvement Project (SCIP), which cover infection and blood clots. They found that “[c]urrently available information on the Hospital Compare Web site will not help patients identify hospitals with better outcomes for high-risk surgery. The Centers for Medicare and Medicaid Services needs to identify higher leverage process measures and devote greater attention to profiling hospitals based on outcomes to improve public reporting and pay-for-performance efforts” (Nicholas, Osborne, Birkmeyer and Dimick, 10/18). Mathematica/Kaiser Family Foundation: Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums — This report (.pdf) looks at  changes planned for the Medicare Advantage program in 2011. While premiums “rose rapidly” in 2010, in 2011 the increase will be smaller and will provide “lower monthly premiums than are generally available in the Medigap market.” The number of Advantage plans is “contracting and consolidating. Yet, Medicare beneficiaries will continue to be able to choose from among dozens … in 2011, having, on average, 24 Medicare Advantage plans from which to choose. … Given wide variations in local market conditions and payment reforms that will vary based on average Medicare costs per county, the effects of these changes are likely to vary across the country” (Gold, Jacobson, Damico, Neuman, 10/15). The Commonwealth Fund: Realizing Health Reform’s Potential: Young Adults And The Affordable Care Act of 2010 — This report analyzes the effects of provisions in the new federal health law designed to provide coverage to young adults, “one of the largest uninsured segments of the population.” The authors say that nearly 15 million young adults without health care now and another 5 million are underinsured. Under the law, they estimate about 1 million will gain access through their parents’ plans, more than 7 million will qualify for the expanded Medicaid program in 2014, and nearly 5 million will gain coverage through the exchanges, also beginning in 2014 (Collins and Nicholson, 10/8).
Source: kaiserhealthnews.org

Medicare Star Ratings for Medicare Advantage Programs

In terms of measuring the quality of the Medicare Advantage plans alone, Medicare has created five different categories for quality measurements and spread out within these categories is 36 different and specific topics and areas of measurement. When it comes to calculating the quality of the Medicare prescription drug services, commonly referred to as the Medicare Part D plan, there are four different categories and 17 different areas or topics that are measured. By using information that is collected through member surveys, the providers of the care as well as a number of other sources, Medicare analyzes information by topic in order to create an overall rating. These ratings are accessed each year in order to have a database that is updated and accurate for members to be able to make their decisions. Five star ratings are hard to come by and the majority of plans are rated between one and four stars.
Source: cerecons.com

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

To encourage Medicare Advantage plans to provide quality care, the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program’s five-star quality rating system, or are unrated.  Building on that provision, the Centers for Medicare and Medicaid Services subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their rating.  
Source: kff.org