Health Law Prompts Review Of Some Medigap Plans; Defining Who Gets Dependent Status

Posted by:  :  Category: Medicare

Gravel MediGap by Mike Licht, NotionsCapital.comYour plan and Plan C are the most popular Medigap plans, chosen by nearly two-thirds of beneficiaries. Those are also the policies that provide significant “first dollar” coverage: they pay the deductibles for both the hospital and outpatient portions of the traditional Medicare program (Parts A and B) as well as the 20 percent coinsurance required for doctor visits, and cover other services as well. People with these supplemental plans may pay virtually nothing for medical services beyond their premiums.
Source: kaiserhealthnews.org

Video: Learn About Medigap Plans

Medicare Supplement Insurance Price Games

By the time most people turn 65 years old, they’ve seen most of the tricks out there on the market. It’s surprising and interesting that some Medicare supplement carriers would still try standard ploys with medicare supplements given the intended audience but, alas, they do. Let’s take a look at some of the pricing games to make sure we’re comparing apples and apples when looking at Medicare supplement quotes. For most people new to Medicare and medicare supplemental insurance, turning 65 or leaving a group plan over age 65 is the trigger for benefits. This is true for the vast majority of new Medicare enrollees. Consequently, if you find yourself coming up on a age 65 birthday, your mail box is probably inundated with all kinds of Medicare information including the various supplement or medigap offers. They’ll most likely show a senior couple on the cover clutching tennis rackets and quote some rates in big letters to you for a few medicare supplements such as the F plan (most popular). You may be surprised to find a wide range of pricing even for the same standardized F plan. Keep in mind that the F plan is the same from carrier to carrier as the benefits are standardized by the government. The pricing should be within 5-10 dollars of each other at most but that’s not necessarily the case. How could this be since they’re all dealing with essentially the same underlying risk? You can partially point back to AARP’s original pricing over the past decade. Essentially, AARP would offer a sliding scale discount for new enrollees age 65. The first year might be 30% lower than the eventual price and this percentage would decrease over a period of time. Medicare is confusing enough to someone brand new to it so a new enrollee doesn’t necessarily know how this discounted rate works. He or she just sees a rate that is 30% lower than the competitors for essentially the same level of coverage. There are two ways to look at this. One hand, you can say that AARP is providing a discount to new enrollees which they can take advantage of. Or, depending on how their rates match up with competitors 5 years years later (when the discount disappears), it smacks of a bait and switch. We’re not here to cast judgement but want people who are comparing medicare supplement insurance rates to not only look at the rate now (presumably at age 65) but over the other age bands. If the rates accellerate as you get older relative to the competition, it’s probably not a good deal. Keep in mind that you have a open enrollment window at age 65 (or when leaving group coverage in addition to a few others) so once you’ve made a decision, it might be difficult to switch medigap plans later on if health changes. If your discounted medigap plan starts to go up at a faster clip than the other plans in later years, you may be stuck depending on your health. That’s the real issue with the discounted rate. That discounted money has to come from somewhere and it’s usually recouped on the back end since the underlying risk is the same. We’re also seeing the opposite these days. Carriers which charge a flat amount across all age bands. Obviously, this is much higher for younger people (say at age 65) but less expensive when you’re much older. To some extent, the carrier is betting that the average life span will be less and they will not be underfunding towards the older age bands. We’re not sure how this is going to turn out. Ultimately, if the carriers run into higher expenses, you can expect premiums to increase much like has occurred with the supposedly fixed rates of long term care. Ultimately, look at all the age bands when comparing medicare supplement insurance plans. There’s somewhat of a goldie lox approach here in that you typically want the strongest carrier that’s priced about in the middle (maybe low of middle). Not too high. Not too low. This provides the most stability over the long term.Dennis Jarvis is a licensed insurance agent concentrating on medicare supplement insurance.

David Brooks Badly Misrepresents the Romney/Ryan Medicare Plan

Posted by:  :  Category: Medicare

POSTSCRIPT: It’s worth repeating my assumption that what we’re really talking about here is Paul Ryan’s Medicare plan. The reason for this assumption is that Mitt Romney, almost literally, doesn’t have a plan of his own. If you read through his description, what you learn is that (a) all seniors will get a voucher to buy health insurance, and (b) that’s it. There are essentially no other details aside from the now pro forma assurance that current seniors won’t be affected. It’s really not even possible to assess this plan, let alone suggest that it shows "surprising passion" about reforming Medicare.
Source: motherjones.com

Video: Medicare Competitive Bidding Fiasco

Educating the educators about Medicare’s competitive bidding program

The petition, signed by dietitians from all over the country, will be sent to key congressional committee leaders who have the ability to push for a Market Pricing Program score and influence change to the competitive bidding system. The signatures will accompany a letter that highlights the need for access to quality diabetic testing supplies and products of choice. It draws from an earlier survey by the American Association of Diabetes Educators that proved Medicare beneficiaries in the Round 1 bidding areas only have access on average to 38 percent of the supplies listed on the Medicare.gov website.
Source: vgm.com

Center for American Progress

In a letter to President Barack Obama, 23 prominent economists—including Nobel laureates and members of both Democratic and Republican administrations—identified the board as one of four key measures that will lower costs and reduce long-term deficits: “Creating such a commission will make sure that reforming the health care system does not end with this legislation, but continues in future decades, with new efforts to improve quality and contain costs.” Similarly, former Bush administration Medicare chief Mark McClellan called for “[strengthening] and [clarifying] the authority and capacity of the Independent Payment Advisory Board.”
Source: americanprogress.org

CMS (Medicare) Competitive Bidding Flawed

The two big problems with competitive bidding are: CMS sets the price of products based upon the median of winning bids, and bids are nonbinding. Essentially, that encourages low-ball bids submitted by providers who then withdraw from the process if median bids come in below their cost. Thus, the process “fails to generate competitive prices of goods and fails to satisfy demand,” the study said.
Source: toenrichlives.com

Center for American Progress

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

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

CMS Announces Timeline for Medicare DMEPOS Competitive Bidding Round 1 Recompete : Health Industry Washington Watch

On August 16, 2012, CMS announced the detailed timeline for the Round 1 Recompete of the Medicare DMEPOS competitive bidding program, which applies to nine geographic areas where competitive bidding currently is in effect. As we previously reported, although CMS is calling this a “recompete,” the agency is actually making significant changes to the products included in Round 1, including subjecting new products to bidding for the first time (i.e., products that were not in the original Round 1 competitive bidding process), and expanding the range of products included in a single product category (which is significant because a contract supplier must furnish all products within a product category, either directly or through a qualified subcontract, in the competitive bidding area). The following is the timeline for registering and bidding (note that dates are subject to change):  
Source: healthindustrywashingtonwatch.com

A (Very Brief) Comparison of Romney and Obama on Medicare

So which do you like better? A plan that reduces reimbursement levels and relies on top-down control/encouragement to produce more cost-effective medical care? Or a plan that relies on competitive bidding to keep costs under control? The choice, for both liberals and conservatives, is not as simple as you might think. Conservatives need to acknowledge that, like it or not, cost controls have a proven track record and that Obamacare’s top-down programs really might help improve the efficiency of healthcare delivery. Liberals need to acknowledge that those top-down controls aren’t a sure thing and that competitive bidding might make a real difference.
Source: motherjones.com

Effect of Medicare Competitive Bidding on Equipment & Supplies

The American Association for Homecare (AAHC) also expressed concern with the program. AAHC officials stated that the group has received “reports from hundreds of Medicare patients about difficulty finding local equipment and service providers, delays in obtaining medically required DME, and fewer choices when selecting equipment and providers.” Medicare officials, on the other hand, attributed only 151 of the calls made to Medicare in the last year to beneficiaries with dissatisfaction with the competitive bidding program that could not be resolved by a call center representative.
Source: ehealthinsurance.com

Competing Medicare Positions: The Debate Behind The Rhetoric

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSFox News: Middle Class, Medicare Issues Add More Fuel To Obama, Romney Debate Talk The campaigns of President Obama and Mitt Romney, after attacking each other for months in TV ads, on the campaign trail and through surrogates, upped the ante this weekend – challenging each other to face-to-face talks on such key issues as helping the middle class and saving Medicare. GOP vice presidential candidate Rep. Paul Ryan was the first this weekend to say he’s ready for both sides to get in the same room, and the Obama campaign appeared to respond to the challenge Sunday. “Now, you’ve heard the president has been talking about Medicare a bit lately,” Ryan, R-Wis., said Saturday at a central Florida retirement community. “We want this debate. We need this debate. And we are going to win this debate” (8/20).
Source: kaiserhealthnews.org

Video: Medicare Cost Reports

CAHs Can Include Capital Lease Equipment Costs in Medicare EHR Incentive Payments

In July, the Centers for Medicare & Medicaid Services (CMS) changed its position on the inclusion of assets acquired through capital leases in the assets eligible for the Medicare EHR Incentive Payment. In a revision to a previous series of frequently asked questions, CMS states it will allow assets acquired through a capital lease to be included in the cost of eligible electronic health record (EHR) assets. However, this revision does not apply to operating leases, which are still excluded from assets eligible for the EHR incentive payment. The cost of an operating lease may continue to be included on the cost report as reimbursable cost.
Source: healthcarereforminsights.com

Center for American Progress

Recognizing the demographic facts doesn’t obviate Medicare’s need to spend federal health care dollars effectively and efficiently to slow the growth of health care costs while improving the quality of care for each and every beneficiary. But arguments that efficiency will come from morphing Medicare into a private insurance market—the conservative “solution” to rising health care costs—make no sense. There is simply no evidence that a private marketplace can match Medicare’s ability to slow spending growth. With Medicare’s per capita cost growth already lower than GDP and projected to diverge increasingly from private health care spending, vouchers for private insurance would actually increase per capita costs.
Source: americanprogress.org

People with Medicare Save Over $4.1 Billion on Prescription Drugs Thanks to the Health Care Law

The health care law also makes it easier for people with Medicare to stay healthy. Prior to 2011, people with Medicare had to pay extra for many preventive health services. These costs made it difficult for people to get the health care they needed. For example, before the health care law passed, a person with Medicare could pay as much as $160 for a colorectal cancer screening.  Thanks to the Affordable Care Act, many preventive services are offered free of charge to beneficiaries, with no deductible or co-pay, so that cost is no longer a barrier for seniors who want to stay healthy and treat problems early.
Source: pittsburghhealthcarereport.com

The ACP Advocate Blog by Bob Doherty: Medicare and the Triumph of Nonsense over Substance

Medicare has suddenly become a centerpiece issue in the 2012 election—but not in a good way.  Instead of an informed debate about Medicare’s present and future place in our health care system, the politicians have subjected us to a daily assault of nonsense over substance: Let’s start with the nonsense accusation by Governor Romney that “There’s only one president that I know of in history that robbed Medicare, $716 billion to pay for a new risky program of his own that we call Obamacare.” This charge has been discredited by independent fact-checkers.  “The only element of truth here is that the health care law seeks to reduce future Medicare spending, and the tally of those cost reductions over the next 10 years is $716 billion,” Politifact wrote about Mr. Romney’s charge. “The money wasn’t ‘robbed,’ however, and other presidents have made similar reductions to the Medicare program. We rate this statement Mostly False.”  CNN’s Soledad O’Brien, citing the Congressional Budget Office, www.factcheck.org, AARP, and the statutory language in the Affordable Care Act itself, discredited a similar accusation by former NH governor and Romney supporter John Sunnunu There also is the inconvenient fact that Rep. Paul Ryan, Romney’s running mate, included the same $716 billion in Medicare savings in the House-passed budget plan, although Mr. Romney has vowed to “restore” them.    Here are the substantive facts behind the charges and counter-charges. It’s true that the ACA makes changes in Medicare payment policies that the CBO estimates will slow Medicare cost increases by $716 billion over the next decade.  (In other words, Medicare’s costs will still increase, but by a lesser amount.)   The Medicare savings come from reducing payments to hospitals, Medicare Advantage plans, and some other non-physician providers. (The ACA did not include any new payment cuts to doctors—rather, it temporarily increases Medicare and Medicaid payments to primary care physicians—but it also did not cancel out scheduled cuts from Medicare’s SGR formula, enacted in 1997.)   But instead of taking money “out” of Medicare, the ACA actually shores up the Medicare Part A Trust Fund, extending Medicare solvency by eight years, according to Medicare’s actuaries.  Without the ACA’s $716 billion in savings, Medicare would go belly up in 2016 instead of 2024. How can this be so?  Well, the Medicare Part A Trust Fund consists of the dollars that are collected from payroll taxes to pay for current and future hospital-related health care expenses.  If Medicare pays the hospitals less, the money in the Trust Fund is drawn down less slowly and it lasts longer—just as if a cut in tuition costs would allow the savings you have set aside for your kids’ college education to last longer.    One could certainly make a substantive argument that the way that the ACA (and Rep. Ryan’s budget for that matter, since it includes the same savings) lowers future Medicare costs increases is unwise, because the cuts in payments to hospitals and Medicare Advantage might cause future access problems.  Or one could make the substantive counter-argument that lowering Medicare payments to hospitals and Medicare Advantages plans is necessary and appropriate–and a better way to achieve savings and efficiencies without harming beneficiaries–than cutting benefits.  One could also have a substantive argument over whether the Medicare savings, if they are to be kept, should be used to finance tax cuts and help lower the deficit, as the Ryan budget proposes to do, or to expand access to the uninsured and improve Medicare benefits (no cost preventive services, phase out of the Medicare Part D donut hole) as the ACA would do. But such substance is lost when politicians blithely try to scare seniors into believing that benefits are being stolen from Medicare to pay for Obamacare, when the facts show the ACA actually improves Medicare benefits and extends the program’s solvency by almost a decade. Which brings me to another nonsense accusation—this one from the Obama camp–which is that seniors will pay $6,000 more under the Romney/Ryan Medicare premium support plan, compared to the current Medicare program.   The journalists at the  www.factcheck.org site report that this is “outdated” claim based on CBO estimate of an earlier version of Rep. Ryan’s premium support proposal, which would have capped the federal government’s premium contributions at a much lower rate of increase than Rep. Ryan’s current plan.  “[The earlier] plan had the premium-support payments, or subsidies, growing with the rate of inflation, and health care costs have risen much faster than that for years” they write, but “Under the new Ryan plan, that premium-support payment would be tied to the second-cheapest health care plan, which can’t grow more than gross domestic product plus 0.5 percentage points. So, Ryan’s plan says the premium support would always be enough to cover the two cheapest plans.”   Plus, the Ryan premium support plan wouldn’t apply to anyone who today is 55 or older, so it is misleading to scare current seniors into believing that they will pay $6000 more for their Medicare.  But www.Politifact says that it is “mostly true” that Mitt Romney and Paul Ryan want to convert Medicare into a voucher program—just not now, not for current seniors, but for future beneficiaries starting ten years from now! Again, there are important substantive arguments that could be made about the wisdom of eventually turning Medicare into a voucher program.  Will limiting how much the federal government contributes to Medicare stimulate cost-savings through competition among insurance plans, or result in cost-shifting to seniors who can’t afford to pay more? Is market competition more effective than the ACA’s approach of squeezing payments and piloting new models of delivery and payment?  Will insurance companies under a voucher system be more or less bureaucratic and transparent than the traditional government-administered Medicare program?  And if Medicare premium support is such a good idea, as Mr. Romney and Ryan maintain, why wait ten years to institute it?  (Read more about my thoughts about the potential impact of Medicare vouchers on my wife’s future Medicare, and the secret truth about vouchers that neither party will admit.) And, speaking of substantive questions, I would ask Mr. Romney, if the $716 billion in Medicare savings from the ACA is to be restored, as you have promised, and Medicare vouchers won’t be implemented for another decade, as you have also promised, then how do you propose that Medicare cost increases be slowed in the meantime to sustain the program’s solvency and reduce its crushing contribution to the deficit?  And I would ask President Obama, if the ACA’s $716 billion in savings are to be kept, along with the rest of the ACA, and you rule out vouchers as an option, what else should be done to sustain Medicare’s long term solvency and reduce its crushing contribution to the deficit, since the current level of savings is clearly not going to be enough? Because, as the National Journal’s Margot Sanger-Katz reports, both the Obama and the Romney Medicare plans fail to solve the cost problem.  “Although they won’t admit it, Romney and Obama have pretty similar visions for how much they think Medicare spending should grow in the future” she writes. “Both have backed plans that would cap per-capita spending at about the same rate, though they would use vastly different means to do so. Neither would come close to eliminating Medicare’s projected long-term deficits.” She hits the nail on the head. How to eliminate Medicare’s projected long-term deficits is one of the most important substantive issues that should be debated by the candidates, but isn’t, since they are too busy trying to discredit each other while reassuring seniors that nothing must change.   Unfortunately, the Medi-scare nonsense being spewed by them will make it even harder to later get the public on board with the tough choices that will need to be made to sustain Medicare while reducing the public debt, which inevitably will involve a combination of reduced benefits, increased cost-sharing, tax increases, and changes in the way that hospitals and physicians are paid. Today’s question: Do you agree that the Medicare debate in this election has mostly been a triumph of nonsense over substance?
Source: acponline.org

Former Obama Budget Director Explains Why It May Be Hard to Restrain Health Spending Under ObamaCare

In a Bloomberg View op-ed today, Orszag continues to argue in favor of those payment reductions. He might want to have a chat about this with his former employers at the White House. The administration has delayed its plan to reduce overpayments until at least 2014 in order to run a “pilot program.” The Department of Health and Human Services says this demonstration project will help test ObamaCare’s revised payment scheme, which was supposed to tie payments to quality. The way HHS plans to do that is by continuing with the old, “excessive” payment rates for a large number of providers nationwide that do not meet the law’s quality standards. At a cost of $8 billion, it’s by far the largest pilot program of this type ever conceived — indeed it is larger than all other Medicare demonstration projects since 1995 combine — so one hopes it will provide some useful information.
Source: reason.com

Center for American Progress Action Fund

The House Republican premium support plan would adjust the voucher for health status—redistributing payments from plans with healthier enrollees to plans with less healthy enrollees. This “risk adjustment” mechanism would certainly help, but current risk-adjustment methods are still far from perfect. Current methods tend to overpay plans with healthier enrollees and underpay plans with less healthy enrollees. As a result, premiums for traditional Medicare would likely rise and enrollment would likely decline over time. This outcome is even more likely because the House Republican premium support plan would not require private plans to provide a standard set of benefits—allowing them to design benefits that attract healthier beneficiaries.
Source: americanprogressaction.org

The Wyden & Ryan Bipartisan Medicare Plan

“Ron Wyden has been a consistently strong leader on market-based health insurance reform and a true fighter when it comes to protecting seniors, so it was only natural that we should work together on a plan that saves Medicare from fiscal threats, strengthens the program through expanded choice, and guarantees that all seniors will have the means and the freedom to purchase coverage that is tailored to their needs. I am also proud to support Sen. Wyden’s efforts to empower small businesses and their employees, so that Americans under 65 can find better health care options that they can carry with them into retirement.
Source: sweetness-light.com

Center for American Progress

What’s more, private plans could “cherry pick” healthier seniors, driving up premiums for those who remain in traditional Medicare. And private plans would be able to undercut traditional Medicare in other ways, such as by offering free gym memberships or other perks. As a result more and more seniors would gradually shift to private plans over time. This gradual privatization of Medicare does not make sense because traditional Medicare costs less than comparable private coverage. But with fewer beneficiaries Medicare would have less leverage to contain the growth in health care costs.
Source: americanprogress.org

CMS Adopts LTCH PPS Payment, Policy Changes for FY 2013 : Health Industry Washington Watch

Two different standard federal rates will apply to discharges during FY 2013. During the first three months of FY 2013, the standard federal rate is $40,915.95, falling to $40,397.96 during the last nine months (both rates are above the FY 2012 rate of $40,222). The rate reflects a market basket increase of 2.6%, less a productivity adjustment of -0.7% and less an additional -0.1% adjustment mandated by ACA. For the last nine months of FY 2013, the market basket increase reflects a budget neutrality adjustment (discussed below). The final rule reflects the adoption of an LTCH-specific market basket based entirely on Medicare cost report data from LTCHs (replacing the rehabilitation, psychiatric, and LTCH market basket).
Source: healthindustrywashingtonwatch.com

October 3, 2012 is the Last Day to Begin 90

Posted by:  :  Category: Medicare

To be eligible to receive the Medicare EHR Incentive Program payment for 2012, healthcare providers must begin their 90-day reporting period on or before Wednesday, October 3, 2012. The Medicare EHR Incentive Program will provide incentive payments to eligible professionals that demonstrate meaningful use of certified EHR technology. Even though providers were eligible to begin participation last year (2011), it is not too late to qualify for the maximum incentive payment of $44,000 over the next five years. In order to qualify for the maximum pay-out, providers must being participation in 2012. To qualify for incentive payments, providers need to register for participation in the program, use certified EHR technology, and demonstrate “meaningful use” – based on specific objectives defined by the Centers for Medicare & Medicaid Services. The criteria for “meaningful use” is defined in stages; all participating providers will be demonstrating Stage 1 meaningful use until Stage 2 is implemented in 2014.
Source: healthcarebiller.com

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

Highmark Medicare Services: Speech Bubbles

Draw a triangle like I have done in the image below and make sure to connect the third dot with the first by clicking in it. Time to style our speech bubbleNow we need to fill the path with a white or whitish color.First create a new layer, then go to the tools menu and select the Path selection tool.Click the ellipse path, hold down shift while clicking in the triangle path, now you have selected both paths. Right click anywhere in the work are and select Fill path in the menu.The Fill path dialog in the image below will appear, in the drop down select color and the Color picker will appear, select the color you want. Now we can start applying layer effects to style the speech bubble.Right click the layer you just created and select Blending options, now apply all the settings that I have used in the images bellow.
Source: blogspot.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Awarded New Contract from Centers for Medicare & Medicai… ( New Deal Means an Additional 480 posi…)

Related medicine news : 1. Highmark Blue Cross Blue Shield Provides Online Physician Quality Information to Members 2. Highmark Blue Shield to Open Highmark Direct, a Health Insurance Retail Store 3. Highmark Blue Cross Blue Shield to Open Highmark Direct, a Health Insurance Retail Store 4. Highmark Inc. Teams with Operation Warm to Provide New Winter Coats for Children in Need 5. Dont Know How Much an X-Ray Costs You? Highmark Network Providers Will Begin Having Conversations With Highmark Members About Their Actual Cost of Care 6. Highmark Employee Volunteers Receive $9,500 in Grants for Nonprofit Organizations 7. Highmark Healthy High 5 School Challenge Grant Program Enables Pennsylvania Schools to Implement or Enhance Healthy Lifestyle Programs for Students 8. Highmark Foundation Extends Subsidy for Health eTools for Schools(R) through 2013 9. Zix Corporation to Participate in $29 Million Highmark e-Prescribing/eHealth Initiative 10. Highmarks SMART(TM) Registry Reports Aid the Chronically Ill 11. Highmark Blue Cross Blue Shield, United Concordia and Catholic Charities Join Forces to Offer Free Health, Dental Services This Saturday
Source: bio-medicine.org

Linda Joy Adams: Highmark Medicare Services Inc Becomes Novitas Solutions Inc

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

Ask Andrea: Does Medicare Require the Therapist to be in the Water for Aquatic Therapy Sessions?

However, if the therapist is fully dressed, then the intention is clear. There will be no opportunity to get in the water, even if the occasion arises. Safety issues aside, I would challenge the readiness of any therapist to provide skilled care if there is zero ability to get in the pool during the session. Most therapists would — at a minimum — agree that there are times in almost every session that the care provided would be enhanced by being in the water. For that to happen, the therapist has to be in a bathing suit, ready to get in.
Source: aquatictherapist.com

Highmark Medicare Services Teleconference On Billing Of Time Units For Physical And Occupational Therapy Services : Med Law Blog

Highmark Medicare Services will be hosting a teleconference on May 15, 2009 at 12:00 p.m. Eastern to discuss the billing of time units for physical and occupational therapy services. The teleconference may reference issues such as CMS Online Manual, Pub. 100-2, Chapter 15, Sections 220 and 230; Change Request CR6321; Frequently Asked Questions; Social Security Act, Section 1862(a)(1)(A) of the Social Security Act, Exclusions from Coverage; and PT/OT modalities is Local Coverage Determination (LCD) L27513, Physical Medicine and Rehabilitation Services, PT and OT. To participate in the teleconference, the dial-in number is 1-888-276-8689 and the Access Code is 487794. Highmark Medicare Services has indicated that the teleconference does have limited capacity.
Source: medlawblog.com

Novitas Solutions will bring 250 full

But there were no guarantees regarding the location of new jobs resulting from future contracts. At the time of the sale, Highmark Medicare Service employees were devoted mostly to processing Medicare claims for a region that includes Pennsylvania and several nearby states. That contract is ongoing.
Source: pennlive.com

ASMBS Frequently Asked Questions (FAQs) Regarding CMS Coverage for Laparoscopic Sleeve Gastrectomy

1. MAC Jurisdiction E: California, Hawaii, Nevada: John Morton, MD 2. MAC Jurisdiction F: Alaska, Arizona, Idaho, Montana, North Dakota, Oregon, South Dakota, Utah, Washington, and Wyoming: Robin Blackstone, MD 3. MAC Jurisdiction G: Iowa, Kansas, Missouri, Nebraska: Teresa LaMasters, MD 4. MAC Jurisdiction G: Illinois, Minnesota, and Wisconsin: Christopher Joyce, MD 5. MAC Jurisdiction H : Colorado, New Mexico, Oklahoma, Texas, Louisiana, Arkansas, Mississippi : Lloyd Stegemann, MD 6. MAC Jurisdiction I: Indiana and Michigan: Wayne English, MD 7. MAC Jurisdiction I: Kentucky and Ohio, Brad Needleman, MD & Joe Northup, MD 8. MAC Jurisdiction J: Alabama, Georgia, and Tennessee: Brandon Williams, MD 9. MAC Jurisdiction K: Maine, Massachusetts, New Hampshire, Rhode Island, and Vermont: Dan Jones, MD 10. MAC Jurisdiction K: Connecticut and New York: Mitch Roslin, MD 11. MAC Jurisdiction L: Delaware, District of Columbia, Maryland, New Jersey, and Pennsylvania: Michael Schweitzer, MD 12. MAC Jurisdiction M: North Carolina, South Carolina, Virginia, and West Virginia: John Scott, MD 13. MAC Jurisdiction N: Florida: Keith Kim, MD
Source: wordpress.com

Citizens Insurance Plans Wallet

Posted by:  :  Category: Medicare

Insurance Plan of the City of Portage La Prairie, Man. June 1959, 23 (1959) by Manitoba Historical MapsThe announcement comes less than a week after the Herald/Times Tallahassee Bureau published a series of stories documenting how hundreds of thousands of Floridians have seen premiums soar as the state-run insurer intensifies its plans to raise rates through reinspections and reduce coverage.
Source: cbslocal.com

Video: What a Single Payer Health Insurance Plan Looks Like

Discover Whole Life Insurance with FREE ONLINE QUOTES

• There are various kinds obtainable in the market. While they may include various names in diverse companies, they hold the equal concepts in general. Do not be puzzled by the dissimilar names and actually as you visit a company from another, you should create a column list for every type. In that manner, you will understand the basic advantages form every plan in each insurer. Comparison of the cheap whole life insurance will be simpler.
Source: wholelifeinsuranceplans.net

Health Insurance Plans: Picking the One for You

First thing to sort out is the three major classifications of health insurance: flexible spending accounts (FSA), preferred provider organization (PPO), and health maintenance organization (HMO). An FSA plan functions like a debit card for health care. Either your employer or you make contributions to an account, and when you visit a doctor or buy prescriptions, you swipe your card and the cost is paid for by your account. An HMO plan offers more comprehensive care but makes you choose a primary care physician (PCP) to visit for general office appointments. Whether you’re sick or need a physical, you have to visit your PCP then they will refer you to a specialist if you need further care. A PPO gives customers more flexibility with their health care options. PPOs have a large network of care providers, which they provide to you, so you don’t have to strictly visit a PCP. You can visit a variety of doctors and choose your specialists if they are in your network.
Source: quickenloans.com

Useful Savings Tips for Good Health Insurance Plans

It can be obtained through various insurance companies in the market that provide coverage to a group of persons or to an individual consumer. The covered group or individual can avail protection from medical insurance by paying the premium. The insured is free to choose the health care provider. The health care provider can seek reimbursement from the insurer.
Source: eprsite.com

Find On the internet Quotes Forever Insurance plan Regarding Benefit

moving on quotes Life’s unknown. The life-threatening issue will happen to you at any time and if you’re unprepared, you will be confronted by economic misfortune. For this reason, acquiring a proper life assurance deal with must be among the your own priorities to be able to eliminate these types of disasters. There are a variety connected with insurers that include various quotations for a lifetime insurance plan, subject to factors like for example insurance plans accessible. You can aquire by far the most reasonably priced quotations dependant upon the insurers you actually get. Thanks to the web, purchasing a proper quotes is incredibly effortless at the moment. A investigation and also app methods are carried out in a matter of a few moments. You may even retail outlet from your convenience your own family area. All the knowledge has been made simple and also hassle free by the user-friendly quotes program used. moving on quotes Providers currently have different ways of getting their customers to be able to stand above his or her challengers. You’re consequently likely to obtain several corporations actually offering special discounts for their quotations to be able to leads. These are largely on line insurance companies, which currently have low rates to make his or her quotes cost effective to his or her marketplace. People concentrate on but not only getting new business, but keeping existing models. The net insurance plan marketplace provides extensive to provide. A lot of foremost insurers have online to showcase his or her low-cost premiums due to the attractiveness and also comfort. Individuals do not have to switch coming from one company to another, assessing and also different a premiums. They have got discovered that the online marketplace presents numerous efficient, speedi and also fresh services, that can be had to be able to any individual using a 24-hour foundation. The net corporations currently have trained and also qualified insurance plan industry experts to take care of all questions coming from existing and also leads. Additionally, they provide suggestions on the way to find the best quotes for various buyers’ needs and also budgets. When you take a look at these lenders, the basic methods linked to performing looks for quotations and also asking them questions do not demand know-how. Moreover, you may have outcomes immediately. moving on quotes There are plenty of a lot more value that could be accumulated by using the online services. Aside from the capability of not having to become actually present within the insurance plan corporation’s business office, in addition, you get extensive information on life plans without performing a mind-numbing study. Quotes for a lifetime insurance plan come with particular functions for different tastes of persons, and you simply are able to evaluate various quotations and judge the very best in order to reach your wants.
Source: blogspot.com

Healthy Lifestyle: Colorado Health Insurance: Helpful Information

If you have been denied health insurance coverage in the state of Colorado due to preexisting medical conditions, you may qualify for the Colorado Uninsurable Health Insurance Plan (CUHIP). CUHIP gives uninsurable Colorado residents the ability to be insured through the state-subsidized CUHIP program. However, due to the higher risk levels of CUHIP patients, CUHIP subscribers pay about 30 percent more for health insurance than most healthy people. If you are uninsurable due to a preexisting health condition, you may contact the CUHIP administrator at 1-800-672-8477 for more information.
Source: blogspot.com

Small Group Health Insurance Quote

You will have to give basic information in a questionnaire so you can get your Small Group Health Insurance Quote.  You will be presented with the quote from each provider and you will be able to review the policy figures and prices from each provider.  You will be able to choose the insurance policies that meet your demands and that are financially sound.
Source: drjarjan.com

Contacts Manufacturer Supplier Vendor Directory 1stFind.com

A  B  C  D  E  F  G  H  I  J  K  L  M  N  O  P  Q  R  S  T  U  V  W  X  Y  Z
Source: 1stfind.com

Comprehensive Health Insurance

If you use a website to purchase comprehensive health insurance is all you need to do is fill out a form, asking the basic information such as your gender and age. To get a proper comparison of all insurance, you get the different prices and policy figures available from all providers. At this point you will be able to sort out the policy that suits your needs and that you pay comfortably.
Source: southerninitiative.com

It Can Be Easy To Get Affordable Dental care Insurance plan

Deciding on insurance plans smartly is an essential part of any seem fiscal plan. An insurance policy that catches your focus having an extremely reduced deductible will, of course, sound like a smart idea initially, nevertheless the industry-away might be an a lot increased quality a month. You may spend a more substantial deductible and pay less per month, but risk some thing going on, and then you will owe a larger deductible.
Source: all-articles-directory.com

Health Insurance Plans for Mid

One common choice, and usually the best option of all the health insurance plans for mid-sized businesses, is group health insurance. Unlike other plans, these plans insure an entire group of people as a whole, spreading out the risks among them. In most cases, individual health forms from each employee are not required although a set of health related questions may need to be filled out. Since the premiums and risks are shared through the group, the premium payments are usually lower since the risks that the health insurance company incurs are less overall. However, coverage can actually be denied if too many of your employees have serious medical conditions or high risk factors.
Source: hrpayrollsolutions.com

Brane Space: Samuelson at it again: Mixing Medicare Advantage with Ryan’s Medicare Vouchers

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ...More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524, on the order of $3,000 -$5,000 or more, for the simple reason that the insurers will be having to take chances (with no regularly promised gov’t subsidies, only the single voucher payment) with a person in a putative high risk health pool! It doesn’t take a genius to see that with such deductibles in play, and assuming the private insurer even accepts the senior, much of the voucher will be eaten up before the first real care is even delivered. In many ways this is analogous to the sort of private insurance plans I was offered, at age 63 – before going onto Medicare. In nearly all cases, I’d  have had to cough up a mammoth deductible, $5,000, and then the premiums themselves were sky high – like $600- $700 a month. And that was BEFORE I’d learned I had prostate cancer(this year). Now, if I had to go cap in hand with a $10-15k Ryan-voucher to try to snag an insurance company to pay for my care, I’d likely be laughed out of their offices! They’d probably think I was some kind of comedian out to try his new shtick. No wonder, given all the above, Samuelson can make the bald and devious claim that “
Source: blogspot.com

Video: What Is Medicare Advantage?

The GOP’s Medicare Advantage

Premium support can also make good politics. This spring, Resurgent Republic (a conservative polling group I helped organize in 2009) offered 1,000 registered voters the choice between a candidate who echoed Team Obama’s recent Medicare arguments and a candidate who backed allowing those aged 55 and younger to choose between traditional Medicare and private insurance backed up by premium support. The poll’s respondents picked the candidate favoring choice and premium support by 48% to 40% with independents preferring him 48% to 41%.
Source: rove.com

Medicare Advantage Recipients After the Election, Obama Want's You

The free stuff people are the radicals. Kids if the writer was to leave you with one gem it comes from Russell Kirk, The Conservative Mind and it is a quote from Edmond Burke concerning the reckless blood shed during the French Revolution. Edmond Burke stated: “Radicalism at the end of the eighteenth century expressed its case in terms of “natural rights.” Paraphrasing Burke, he believed that because of Thomas Paine’s bookRights of Manthat people were confused: Burke believed, “…the notion of inalienable natural rights has been embraced by the mass of men in a vague and belligerent form, ordinarily confounding “rights with desires.” Russell remarks: this confusion in definition plagues society today, notably in the “Universal Declaration of Human Rights” drawn up by the United Nations Organization” (p. 47). Kids the above is very important, because you will deal with many ideologies in your lifetimes, but always remember that Conservatism is not an ideology it is the world’s reality, God’s world and we as His children.
Source: nolanchart.com

The GOP's Medicare Advantage

Predictably, Democrats went after Mitt Romney’s new running mate immediately, describing Paul Ryan as a “certifiable right-wing ideologue” whose views are “extreme” and “radical.” They focused on Medicare, warning that Republicans “would end Medicare as we know it,” making it “a voucher system” that costs seniors “thousands of dollars in health care costs.”
Source: realclearpolitics.com

What Are Medicare Advantage Plans?

All MA Plans provide Parts A and B insurance coverage. Some MA Plans include extra coverage for vision, dental, hearing and wellness programs. Medicare Part D is covered by most MA Plans, too. Medicare pays a fixed amount to private insurance providers of Medicare Advantage Plans. These insurance companies must follow Medicare rules, but can set out-of-pocket fees based on their expenses. MA Plans may require their clients to use certain doctors, medical care facilities and suppliers.
Source: seniorcorps.org

The Lu Lac Political Letter: The LuLac Edition #2166, August 20th, 2012

Republicans are running around the country this election season (some with their moms) saying that the Affordable Health Care Law and by extension President Obama is cutting million of dollars of Medicare for senior citizens. As usual, this is WRONG! That Medicare money is actually going into the Health Care Law as a way of helping seniors. True, the money is being diverted but seniors aren’t going to be losing anything. The money is coming from a program called Medicare Advantage. This was put into operation in 1997 as part of the balanced budget act of 1977. Here’s an overview of what Medicare Advantage is and how it differs from traditional Medicare:  Medicare Advantage subscribers generally pay a fixed amount (a copayment of $20, for example) every time they see a doctor as opposed to meeting a deductible and paying a coinsurance (typically 20%) under Original Medicare. The copayment can be higher to see a specialist with a Medicare Advantage plan. Under Original Medicare the coinsurance remains 20%, but the actual amount out of pocket can be higher since specialists generally charge more for services. The private plans are required to offer a benefit “package” that is at least as good as Medicare’s and cover everything Medicare covers, but they do not have to cover every benefit in the same way. Plans that require higher out-of-pocket costs than Medicare for some benefits, like skilled nursing facility care, can balance their benefits package by offering lower copayments for doctor visits. A private plan may use some of the excess payments they receive from the government for each enrollee to offer supplemental benefits. Many plans use the excess subsidies to offer hearing coverage, vision coverage, gym memberships and other services not covered by Medicare. As with traditional Medicare, private plan members can incur high out-of-pocket costs, however Medicare Advantage plans typically have an out of pocket maximum ($6,700 for example), which can protect individuals against catastrophic medical bills. Once the out of pocket maximum is reached for an individual, the plan will pay 100% of Medicare approved services for the remainder of the calendar year, with no lifetime maximum, so long as individuals use in-network providers. If individuals voluntarily choose to use out-of-network providers, they generally must pay the full cost of their care and there is no out-of-pocket cap on their expenses. This can be a problem for people with Medicare with costly conditions, who need to use out-of-network specialists or who are hospitalized and are forced to use out-of-network doctors while in the hospital. By law, however, if a patient’s in-network physician orders tests or procedures that are not available or provided by any in-network facility or specialist’s office, the Medicare Advantage plan must pay for the patient’s procedures or services at an out-of-network location at no additional cost to the patient, so long as the necessary services are normally covered by Medicare.  The other money coming out of the current Medicare set up is the Prescription Drug Plan that was passed in 2003. This is the plan that gave the seniors “the donut hole”. A simple explanation of the donut hole is this: If you have a Medicare Part D prescription drug plan, the donut hole is when Medicare temporarily stops paying for your prescriptions. If you are in the donut hole, you have to pay the entire cost of your medications. After a Medicare beneficiary surpasses the prescription drug coverage limit, the Medicare beneficiary is financially responsible for the entire cost of prescription drugs until the expense reaches the catastrophic coverage threshold. With the passage of the Patient Protection and Affordable Care Act of 2010, people who fall within the doughnut hole will receive a $250 rebate within three months of reaching the coverage gap to help with payments. Seniors in this area already got this. 
Source: blogspot.com

Medicare Advantage Fees Explained

[I]n many counties, private plans bid an amount lower than the amount Medicare FFS (fee for service) needs to offer Part A and Part B coverage. Taken as an enrollment-weighted whole, Medicare Advantage plans bid at 98%, just a shade below Medicare FFS. Private HMOs bid at 95%, which makes for a more substantial savings. Other private alternatives, like private fee-for-service, fare poorly relative to Medicare FFS. But of course that makes perfect sense. One can easily imagine, as Austin Frakt has suggested in the past, an equilibrium in which traditional Medicare FFS is the lowest-cost provider in rural counties, in which there is a relatively small number of medical providers with a great deal of leverage. In denser urban markets, with more competition among providers, private HMOs can out-compete traditional Medicare FFS by building more efficient provider networks.
Source: ncpa.org

Clearing Out Medicare Advantage Plans Confusion

[…] 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

Texas Investigates Dental Medicaid Fraud; Access, Cost Hurting Dental Care In Va.

Posted by:  :  Category: Medicare

Texas and the Transformation of Medicaid by thetexastribuneThe Associated Press/Richmond Times-Dispatch: Cost, Lack Of Dentists Bar Va. Residents From Dental Care Many Virginians don’t have access to dental care because of costs and a lack of dentists, according to a new study by two University of Virginia economists. Cost is the greatest barrier. Those least likely to visit a dentist are low-income residents without insurance or who have low-cost public health care. Virginia’s Medicaid program generally limits dental care for low-income adults to emergency services, the study said. There also are racial and geographical disparities in access to care (8/18).
Source: kaiserhealthnews.org

Video: What Is Texas Medicaid?

Moral Monday: Texas orthodontists scrutinized for Medicaid fraud

In 2011, $1.4 billion was paid out to dentists and orthodontists in the state. The state initiated an investigation, finding orthodontists and dentists performing procedures that were not medically necessary as Medicaid intends to be used for. Of these Orthodontists, Dr. Michael Goodwin, DDS of Amarillo, TX has been charged on 11 counts of Medicaid fraud. In addition to this fraud, Dr. Goodwin also permitted his assistants to perform certain procedures in order to handle this large volume of patients. Due to this investigation, many of the orthodontists in Texas have ceased work on medicaid patients, no matter the status of their braces.
Source: asdablog.com

Investigators look into allegations of Medicaid dental recruiting of Dallas children : Covering Health

Last year, Harris and producer Mark Smith, in a nine-month investigation, found that Texas regulators seldom deny procedures for hundreds of thousands of children. WFAA aired a half-hour news special, “Crooked Teeth,” raising questions about other Medicaid reimbursements nationally, including a troubling payment policy by one of the nation’s largest government contractors.
Source: healthjournalism.org

Texas Dentist Indicted In Alleged Medicaid Scheme

Investigators say the Amarillo orthodontist billed the government program for more services than provided or for unnecessary procedures. The time frame of the scheme was during 2008 through March of 2011.
Source: news92fm.com

Guest Voz: States like Texas Cannot Afford to Miss the Affordable Care Act

Among Latinos, national polls demonstrate their strong support for the ACA. Our values are aligned with the historic decision to reform healthcare. In Texas, we represent 37% of the population yet 58% of the uninsured. Research indicates that the shift to a Latino majority state also means a shift to greater incidence and prevalence of chronic disease. Not seeking preventive care, prevalence of chronic health conditions, excessive emergency room use, lost work productivity and related financial insecurity are disparities and inequities that can be addressed through the ACA.
Source: latinalista.com

If Texas Doesn’t Expand Medicaid, Two Million Will Be Without Options

The impact in Texas would be extraordinary. Poor parents have to be almost destitute in order to qualify for Medicaid in Texas, because the state is unusually stingy with Medicaid eligibility. The poorest adults without children can’t get any help unless they’re disabled. Hospitals, as well as local and state governments, must shoulder what’s known as “uncompensated” health costs—the bills of uninsured people that will likely go unpaid. Those with insurance also wind up paying extra in their premiums to balance the debts; according to the Texas-based Center for Public Policy Priorities, the average family in Texas pays about $1,800 more for uninsured people’s care. The state may be paying more now in uncompensated care costs than it would pay for Medicaid if the program were expanded to cover more people, says CPPP senior policy analyst Stacey Pogue.
Source: prospect.org

All Hell Hath Broken Loose

Posted by:  :  Category: Medicare

Maryland Health Insurance Plan Federal Press Announcement by MDGovpicsIn another change from the earlier plan, he would also guarantee that every senior would have enough money coming from the government to be able to buy the second lowest cost plan in their market. That plan (and all plans) would have to offer at least the current Medicare benefits and the government would pay the same share of that plan that government pays today. If the senior bought the cheapest plan, there would actually be a refund to the senior. If the senior bought a higher priced plan, the senior would have to come up with the additional premiums. The traditional government-run Medicare plan could be the cheapest, the second lowest, or a more expensive plan—no one can estimate that.
Source: thehealthcareblog.com

Video: What a Single Payer Health Insurance Plan Looks Like

Health Insurance Plans: Picking the One for You

First thing to sort out is the three major classifications of health insurance: flexible spending accounts (FSA), preferred provider organization (PPO), and health maintenance organization (HMO). An FSA plan functions like a debit card for health care. Either your employer or you make contributions to an account, and when you visit a doctor or buy prescriptions, you swipe your card and the cost is paid for by your account. An HMO plan offers more comprehensive care but makes you choose a primary care physician (PCP) to visit for general office appointments. Whether you’re sick or need a physical, you have to visit your PCP then they will refer you to a specialist if you need further care. A PPO gives customers more flexibility with their health care options. PPOs have a large network of care providers, which they provide to you, so you don’t have to strictly visit a PCP. You can visit a variety of doctors and choose your specialists if they are in your network.
Source: quickenloans.com

Aetna Acquires Additional Stake In Medicare And Medicaid Business

The Washington Post: Aetna To Buy Bethesda-Based Coventry For $7.3 Billion Aetna announced Monday plans to acquire Bethesda-based Coventry Health Care in a deal valued at $5.7 billion, part of the managed-care giant’s effort to beef up its Medicare and Medicaid programs. The purchase comes as insurance companies race to position themselves for a broad expansion of health-care coverage slated to take effect in 2014, following the Supreme Court’s decision to uphold the comprehensive reforms supported by the Obama administration (Bhattarai, 8/20).
Source: kaiserhealthnews.org

Romney's Health Care Plan Freaks Out Utah Republicans

When asked what they thought should be done to fix health care, Love and McCain offered up an unintentional endorsement of some of the very laws that they’ve been campaigning angrily against for the past two years, Obamacare and the federal stimulus package. "We have to reform our health care system or it’s going to be gone completely," Love responded to Kerr. She pointed to doctors who buy new equipment and then are driven to use the equipment on as many patients as possible to pay for it. To put an end to such practices, Love said the country needs to move away from the fee-for-service health care model and toward a "fee for outcomes" system. "If we start aligning the incentives with the outcomes we’ll start getting better health care, we’ll get better services, and we’ll get more health care available for those who need it," she said.
Source: motherjones.com

Paul Ryan’s Medicare plan would ‘pave Paradise’

I believe that there is much that can be improved in the current Medicare program without destroying its basic social insurance framework. There are ways to manage the care of people with chronic illness more effectively; there are a number of ways to pay providers differently so that they are not incented to provide more care instead of better care; there are ways to save money through tougher action on fraud and abuse; and there are options to increase the eligibility age or have higher income seniors pay even more than they do now that could save money for Medicare without changing its basic structure.
Source: healthinsurance.org

Find quotes on affordable temporary health insurance for individuals

Best short-term health insurance is a sort of fitness care treatment that’s obtainable for diminutive moment in time frames, most frequently 30 days to a year. In addition to the time outline, there are two other keys aspects of temporary health insurance that you don’t obtain from the given name:  Primary it’s more reasonably priced than paradigm reporting, and secondly it’s less comprehensive. In other prose, it’s a diminutive option rather than a long-term one. As such, it can work out very able-bodied for juvenile, hale and hearty recent grads that are job-hunting, flanked by jobs, or at this time functioning in a job that doesn’t offer insurance benefits. Another advantage is that a temporary health insurance plan can, in a quantity of luggage, lend a hand you uphold credible insurance reporting.  At a indispensable point, this earnings that you cannot be deprived of prospect insurance claims or disqualified for pre-existing circumstances formulate sure you confirm with the supplier before pretentious that the short-term guiding principle will maintain your plausible coverage.
Source: 2healthinsurance.net

Useful Savings Tips for Good Health Insurance Plans

It can be obtained through various insurance companies in the market that provide coverage to a group of persons or to an individual consumer. The covered group or individual can avail protection from medical insurance by paying the premium. The insured is free to choose the health care provider. The health care provider can seek reimbursement from the insurer.
Source: eprsite.com

Health insurance online quotes

Among the list of health insurance online quotes you will definitely get will be based on on team health care insurance plans. They are procedures which can be utilized by way of massive firms with respect to their visitors with employees. A small venture operator may choose to get this cover his or her staff members as well, nonetheless he or she end up being on a the quantity of members of staff which he features. From your health insurance online quotes you can get on the web, regarding team protect, you can be capable to look into the smaller specifics and see what kind satisfies your ex best. The easiest method to i regarding it should be to talk to a coverage representative who will counsel your ex in specifics.
Source: blogspot.com

Daily Kos: Healthcare Tidbits 1900s to 2000s

1950s At the start of the decade, national health care expenditures are 4.5 percent of the Gross National Product (As opposed to 17.9% in 2010*). 1960s “Compulsory Health Insurance” advocates are no longer optimistic’. 1970s President Nixon’s plan for national health insurance rejected by liberals & labor unions, but his “War on Cancer” centralizes research at the NIH. 1980s Corporations begin to integrate the hospital system (previously a decentralized structure), enter many other healthcare-related businesses, and consolidate control. Overall, there is a shift toward privatization and corporatization of healthcare. 1990s Federal health care reform legislation fails again to pass in the U.S. Congress. 2000s Changing demographics of the workplace lead many to believe the employer-based system of insurance can’t last. *Parenthetical remark added by diarist.
Source: dailykos.com

Health Insurance: Are Health Insurance Premiums Deductible

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP LeaderOkay so you can look out for are perks that insurance companies offer several different policies with certain options and programs that can normally be customized to meet the are health insurance premiums deductible in line. The bill is still more expensive than the are health insurance premiums deductible of insurance. There is protection for death in air, rail or road accident. The amount of compensation varies and it becomes simpler for you would readily give your personal information and immediately receive multiple quotes and easily select the are health insurance premiums deductible with less interesting insurance plan because they’ll be unable to pay each month for yourself or your family will not only provide the are health insurance premiums deductible a company that says to offer you, your family, but it actually is not instant in an accident medical plan.
Source: blogspot.com

Video: 59% Increase In Health Insurance Costs!

Myth vs. Fact: Health Care Reform in Massachusetts

Support for the law is strong among members of the public. Sixty-one percent of the Massachusetts nonelderly population approved of the law when it passed in 2006. Two years later, 69 percent of nonelderly adults viewed the law favorably. In a survey of employers conducted in 2007—shortly after passage of the health reform law—a majority of Massachusetts firms surveyed agreed that “all employers bear some responsibility for providing health benefits to their workers.”20 A survey of employers conducted a year later—after the individual and employer mandates were implemented— found that a majority of firms believed the law was “good for Massachusetts.”
Source: americanprogress.org

Some Mass. Health Premiums To Rise; Blue Shield Of Calif. CEO Pay Down Slightly

The Boston Globe: Insurance Costs Rise Modestly Small businesses and individuals whose annual health insurance policies renew on Oct. 1 will see average premium base rate hikes of 2.1 percent in Massachusetts, increases that are more modest than the 5.5 percent average boost in base rates they absorbed a year ago. But despite the trend of moderating increases in the past two years, the new rate hikes ticked up from the 0.7 percent average increases on policies that renewed July 1, according to data filed Friday by the state Division of Insurance (Weisman, 8/11).
Source: kaiserhealthnews.org

Health care law calls for rebates, but is vague on where they go and how they’re spent

Swatara Twp.-based HealthAmerica is trying to manage operational expenses while improving care and service for members, spokeswoman Kendall Marcocci said. Initiatives include disease management and wellness, health risk assessments and personalized coaching, a social health network, streamlining customer service and heightened use of electronic and mobile communications.
Source: pennlive.com

What Effect Will Health Reform Law Have on Businesses and the U.S. Economy?

By James A.J. Revels In a landmark 5 to 4 decision on June 28, 2012, the U.S. Supreme Court upheld the constitutionality of the 2010 health care reform legislation, the Patient Protection and Affordable Care Act (PPACA) and the Health Care and Education Reconciliation Act (HCERA). While debate continues after this historic decision, businesses must now become more focused on the complex compliance as the laws continue to phase in during 2012 and through 2014. However, a majority of the provisions begin in 2013 and 2014. There are many opinions related to the effect the health care reform will have on businesses in the future. Business advisors are looking at Massachusetts and the effects its health care mandates have had on the businesses and the residents in that state. It is evident the benefit of the mandates in Massachusetts have ranked the state as having the highest number of medically insured residents in the country. The Massachusetts law requires businesses to offer a fair and reasonable contribution for the health coverage of each employee or pay the state an assessment of $295 per employee for businesses with more than 11 employees. In contrast, under the federal health care reform, businesses with more than 50 employees that do not provide employees the opportunity to enroll in minimum essential coverage can face penalties of up to $2,000 per full-time employee, barring some exclusions. Keep in mind the federal health care reform provides for various tax credits to assist small businesses in obtaining coverage for employees. During the past 10 years, health insurance costs for large businesses have doubled. For smaller employers that percentage has grown even higher. There are many factors that are forcing health insurance premiums higher every year including an aging population coupled with a longer life expectancy. This is a result of new treatments, better prescription drugs and expensive medical devices, layered with the increase in obesity and chronic illnesses – the largest contributors to increasing health premiums. The Pros Many believe the heath care reform will benefit businesses and here are a few examples why: Typically, adding healthy, young employees to a company’s health insurance census will help to hold or even possibly reduce the insurance premiums. Since insurance premiums are based on the entire enrolled employee population and not on an individual-by-individual basis. This should certainly have a positive impact on small businesses. The new law provides tax credits to businesses that provide a specific level of health insurance to employees. Accordingly, those businesses that provided health insurance prior to 2010 did not receive additional credits and now they do. Beginning in 2010, many small businesses were eligible for tax credits of up to 35 percent of premiums paid, and this will increase to 50 percent in 2014. Many businesses that do not offer health insurance lose key employees to those businesses that do provide these benefits. The Cons From an economic perspective, forcing employers to provide health insurance could negatively impact many businesses in these difficult economic times. Many businesses have had to reduce or even eliminate health coverage during the past decade due to the annual double digit premium increases. Forcing these same businesses to provide insurance they cannot afford could significantly impact those businesses that rely on part-time and seasonal employees. The new mandate could cause businesses to lay off employees and even prevent them from hiring in the future. Businesses may consider outsourcing to other companies or even cause them to go out of business. Others believe the health care reform will not help to reduce premiums and in fact could cause a rise in premiums, since the legislation will provide better levels of benefits. In addition, new fees and taxes paid by insurance companies will also likely raise the cost of premiums as those costs are passed down to the consumer. Mandatory health care coverage could force employees who can barely manage their monthly expenses to spend less or fall deeper into debt. As a result, employees that have never had to pay for health insurance could be in for a rude awakening. For a person with a low wage job just over the poverty level, who is being required to pay for health insurance, such costs could have a significant impact on their spending habits. Instead of paying for other necessities, they will be paying an insurance company several thousand dollars or more annually. The negative effect of the businesses these individuals patronize could be significant. The Bottom Line Requiring individuals to have health insurance should improve the overall health of the American population. As a result, it should help stimulate people to eat better, exercise more and be more aware of illnesses from a preventive care point of view, resulting in a healthier workforce. In order to help keep health insurance premiums in check going forward, employers should consider implementing employer-sponsored wellness programs and encourage employees to take an active role in their physical wellness. Taking the pros and cons into consideration, it is very likely that businesses will see a reduction in work absence, better mental aptitude and an overall improvement of employee morale. These improvements should be the catalyst for an employee population that is more productive and efficient in the work environment. ### James A.J. Revels, CPA, MST is a partner with the accounting, tax and business consulting firm Citrin Cooperman in Philadelphia. He provides customized planning, administration and income tax services for a variety of businesses including biotech companies and high net-worth individuals. He can be reached at jrevels@citrincooperman.com or (215) 545-4800.    
Source: physiciansnews.com

The Cost Shift from the Uninsured

We maintained the same percentage increase in premiums due to care for the uninsured —the so-called “cost-shift” markup—that existed in every state in 2005 under Thorpe’s analysis. We then applied these percentages to projected 2009 premiums, which were determined by taking the most recent state-by-state premium data (2006, released in 2008) as reported by the Medical Expenditure Panel Survey, and grow them by the change in national private health expenditures recorded and projected by Centers for Medicare and Medicaid Services from 2006 to 2009.
Source: americanprogressaction.org

Which Health Insurance Customers Will See a Reduction in Rates

The legislation continues the progress that has already been made, with average base rates falling dramatically in the past three years.  In April 2010, Governor Patrick directed DOI to use existing authority to review small-group health insurance rates and use statutory powers to disapprove rates that were unreasonable or excessive. The Division disapproved 235 of 274 rates at that point, and later negotiated lower rate increases with carriers. In May 2012, DOI announced that small group health insurance base rates increases dropped to 0.7 percent in the third quarter.
Source: newenglandpost.com

Healthcare Reform Bill: What does this mean to you and your business?

There are benefits for small businesses, too. If you have less than 25 employees, pay average annual wages below $50,000, and provide health insurance, you may qualify for a small business tax credit of up to 35% (up to 25% for non-profits) to offset the cost of health insurance. Starting in 2014, the small business tax credit goes up to 50% (up to 35% for non-profits) for qualifying businesses. This will make the cost of providing insurance even lower.
Source: deanmead.com

Useful Savings Tips for Good Health Insurance Plans

It can be obtained through various insurance companies in the market that provide coverage to a group of persons or to an individual consumer. The covered group or individual can avail protection from medical insurance by paying the premium. The insured is free to choose the health care provider. The health care provider can seek reimbursement from the insurer.
Source: eprsite.com

ACA will increase health insurance premiums

Another premium inflationary impact will come from plans that can no longer discriminate based on gender. As of 2014 health insurance premiums will be based on age, location and tobacco use. No more gender based ratings. Typically, women always incurred a higher premium up into the 50 year-old age range. At which point, men became more expensive to insure. This was primarily because of the potential for reproductive health issues for women. Men become more expensive over 50 because we never go to the doctor when we are younger.
Source: insuremekevin.com

Obamacare and Health Subsidies: Expanding Perverse Incentives for Employers and Employees

Massive Taxpayer Burden. The CBO estimates that by 2018 some 19 million individuals covered by a policy purchased through the exchanges will receive a subsidy. The estimated total cost between 2014 (when the subsidies begin) and 2019 top $450 billion in new government spending.[12] Approximately 38 million Americans with ESI live in households below 250 percent of the FPL.[13] Most employees in households below 250 percent of the FPL would be better off dropping ESI coverage, according to Holtz-Eakin’s analysis. CBO estimates that fewer than 8 million individuals would lose ESI coverage in response to the subsidized exchanges. However, if CBO has underestimated the number of people who will lose ESI and receive subsidized coverage in an exchange, spending will likely increase substantially over initial projections.
Source: tomtayloronline.org

''Medicare Patients in Search of a Doctor

Posted by:  :  Category: Medicare

CorettaScottKing_WinonaBartonBallentine3 by Mark Tribe“About 85% [of primary-car doctors in Alaska] choose the standard Medicare process (“participating”). Another 4% still work with the Medicare system but charge patients somewhat more (“non-participating”). The final 11% have opted out of the Medicare system , but will still see patients who agree to foot the bill.”
Source: georgia-medicareplans.com

Video: Medicare Quotes

Medicare Supplement Insurance Price Games

By the time most people turn 65 years old, they’ve seen most of the tricks out there on the market. It’s surprising and interesting that some Medicare supplement carriers would still try standard ploys with medicare supplements given the intended audience but, alas, they do. Let’s take a look at some of the pricing games to make sure we’re comparing apples and apples when looking at Medicare supplement quotes. For most people new to Medicare and medicare supplemental insurance, turning 65 or leaving a group plan over age 65 is the trigger for benefits. This is true for the vast majority of new Medicare enrollees. Consequently, if you find yourself coming up on a age 65 birthday, your mail box is probably inundated with all kinds of Medicare information including the various supplement or medigap offers. They’ll most likely show a senior couple on the cover clutching tennis rackets and quote some rates in big letters to you for a few medicare supplements such as the F plan (most popular). You may be surprised to find a wide range of pricing even for the same standardized F plan. Keep in mind that the F plan is the same from carrier to carrier as the benefits are standardized by the government. The pricing should be within 5-10 dollars of each other at most but that’s not necessarily the case. How could this be since they’re all dealing with essentially the same underlying risk? You can partially point back to AARP’s original pricing over the past decade. Essentially, AARP would offer a sliding scale discount for new enrollees age 65. The first year might be 30% lower than the eventual price and this percentage would decrease over a period of time. Medicare is confusing enough to someone brand new to it so a new enrollee doesn’t necessarily know how this discounted rate works. He or she just sees a rate that is 30% lower than the competitors for essentially the same level of coverage. There are two ways to look at this. One hand, you can say that AARP is providing a discount to new enrollees which they can take advantage of. Or, depending on how their rates match up with competitors 5 years years later (when the discount disappears), it smacks of a bait and switch. We’re not here to cast judgement but want people who are comparing medicare supplement insurance rates to not only look at the rate now (presumably at age 65) but over the other age bands. If the rates accellerate as you get older relative to the competition, it’s probably not a good deal. Keep in mind that you have a open enrollment window at age 65 (or when leaving group coverage in addition to a few others) so once you’ve made a decision, it might be difficult to switch medigap plans later on if health changes. If your discounted medigap plan starts to go up at a faster clip than the other plans in later years, you may be stuck depending on your health. That’s the real issue with the discounted rate. That discounted money has to come from somewhere and it’s usually recouped on the back end since the underlying risk is the same. We’re also seeing the opposite these days. Carriers which charge a flat amount across all age bands. Obviously, this is much higher for younger people (say at age 65) but less expensive when you’re much older. To some extent, the carrier is betting that the average life span will be less and they will not be underfunding towards the older age bands. We’re not sure how this is going to turn out. Ultimately, if the carriers run into higher expenses, you can expect premiums to increase much like has occurred with the supposedly fixed rates of long term care. Ultimately, look at all the age bands when comparing medicare supplement insurance plans. There’s somewhat of a goldie lox approach here in that you typically want the strongest carrier that’s priced about in the middle (maybe low of middle). Not too high. Not too low. This provides the most stability over the long term.Dennis Jarvis is a licensed insurance agent concentrating on medicare supplement insurance.