Step by Step: What are Medicare Prescription Plan Drug Tiers?

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrIt is also important to be aware that all Medicare Part D plans are required to make medically necessary drugs accessible to the policyholders who need them to treat their conditions. While the exact medication you take may not be included in your policy’s formulary, in most cases you can find a drug that will be just as effective in treating your associated medical condition.
Source: gohealthinsurance.com

Video: Medicare Part D Formulary

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Q1Medicare.com Releases Updated Medicare Part D Prescription Drug Plan Formulary Browser

Q1Medicare.com has updated their Medicare Part D Formulary Browser with the latest prescription drug plan formulary data made available from the Centers for Medicare and Medicaid Services (CMS). Since January, the updated data includes the addition of over 70 medications and the deletion of 16 medications that impact all Medicare Part D prescription drug plans. The most recent released June formulary changes include the addition of 20 new medications. A detailed summary of the recent formulary changes impacting all Medicare Part D plans, along with corresponding links to specific formularies can be found within the Q1Medicare.com/Blog.
Source: himyfamily.com

Seniors Pay High Cost for Gap in Benefits Coverage

Because the Medicare Part D drug benefit was unveiled, it has confirmed to be even much more confusing and inefficient than its critics predicted. Even seniors who have been in a position to register for the program have to nevertheless struggle with a $three,000 gap in benefits coverage and a hefty monthly premium.
Source: traffic-secrets.org

Q1Medicare com Now Provides Comprehensive Medicare Part D Drug Pricing Information : e Yugoslavia

“Along with the basic retail price information, we decided to go one step further with our Medicare Part D estimated drug cost matrix and provide the Medicare community with an explanation of how the estimated drug cost is calculated,” notes Dr. Susan Johnson, Technical Director and co-founder of Q1Group LLC. “Many of the cost-sharing calculations are simple, especially for co-payments, but when dealing with the more expensive medications and straddle claims comes into play, many people find it difficult to understand how the pharmacy calculated their point-of-sale cost.”
Source: eyugoslavia.com

Are AARP MedicareComplete Drug Benefits Good Enough?

Enrolling in a Medicare Advantage plan with inadequate Part D benefits can negate any positive aspects of the medical benefits. When choosing MedicareComplete or any other plan it is important to focus on the Part D benefits and not get blinded by low premiums or low out-of-pocket costs for medical services.
Source: partdplanfinder.com

Medicare Made Clear: Carefully Consider the Medicare Formulary when Choosing a Part D Plans

As you make the decision on the kind of plans for your health protection under Part D of Medicare, be sure to look at all the plans and medicare formulary while considering your own specific needs. The cost of medications and health plans change every year however, you can always make the updates yearly if and when your income situation changes. Look for the different options in your state since the number of available plans and medicare formulary varies according to regions. The variety of plans allow the individuals to choose what they think is suitable for their own specific needs.
Source: blogspot.com

Is My Medicare Supplement Insurance Rate Tax

Finally, the real benefit of the tax-deductible nature of Supplemental Insurance premiums is evident when calculating aggregate medical expenses. Total medical expenses must exceed 7.5 percent of adjusted gross income (AGI) to deduct them from taxes. Typically, Part B premiums are $1,157 per covered person and Part D premiums are about $360 per covered person. When copayments, coinsurance and non-formulary drug payments are included with the Part B and D premiums, adding Supplemental Insurance payments, anywhere from $1,000 to $2,000 per covered individual, can often be enough to meet the 7.5 percent AIG requirement. Meeting the AIG minimum can result in a significant break for fixed-income plan participants.
Source: seniorcorps.org

Medicare and Medicaid Costs (Utility Post)

The go-to source on Medicare Advantage is the official Medpac report (pdf), which currently finds MA plans costing on average 7 percent more than conventional Medicare. This is less than the premium a few years ago; apparently (pdf) because several changes in Medicare policy more or less incidentally put the squeeze on MA plans. So far those plans are still expanding, but time will tell.
Source: nytimes.com

The Medicare Hospice Benefit Explained

Posted by:  :  Category: Medicare

Congress established the Medicare Hospice Benefit in 1983 to ensure that all Medicare beneficiaries could access high-quality end-of-life care. Today, more than 65 percent of hospice patients are Medicare beneficiaries. The Medicare Hospice Benefit offers dying Americans the option to experience death free of pain, with emotional and spiritual support for both themselves and their families.
Source: hrrv.org

Video: Health Insurance Information : About Hospice Medicare Benefits

Justice Department Joins False Claims Act Medicare Fraud Lawsuit

According to the lawsuit, HOTCI’s chief executive officer verbally instructed HOTCI employees to admit for hospice care patients with Medicare coverage, without determining whether those patients were in fact eligible for hospice benefits. Medicare hospice benefits are reserved for terminally ill patients with a life expectancy of six months or less. Under hospice care, because the patient has elected to end curative care and allow the disease to run its normal course, medical treatment is focused on providing patients with relief from pain and stress. Once informed by its Medicare contractor that a formal audit would be conducted, HOTCI formed an internal committee to review hospice eligibility of its Medicare patients.  Between 2009 and 2010, the company had to discharge at least 150 patients after determining that they were ineligible for Medicare hospice benefits.
Source: employmentlawgroupblog.com

United States Intervenes in False Claims Act Lawsuit Against Orlando, Florida

The government’s intervention in this action is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009.   The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover more than $9.3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13 billion.  
Source: enewspf.com

Hospice of the Comforter Inc. Charged With Medicare Fraud

In an article posted on The Employment Law Group Blog entitle:  Justice Department Joins False Claims Act Medicare Fraud Lawsuit, it was reported that the Justice Department will join the False Claims Act qui tam lawsuit filed against Hospice of the Comforter Inc. (HOTCI) by Douglas Stone, HOTCI’s former vice-president of finance. Stone’s suit alleges that HOTCI engaged in fraudulent Medicare billing.
Source: legalbistro.com

Can hospice function under Medicare premium support?

How common is it for MA patients to elect hospice as compared to traditional Medicare? MA patients are more likely to choose hospice than are beneficiaries in traditional Medicare, though the gap has been shrinking (47.8% of MA decedents v. 43% FFS in 2010; 30.9% MA v. 20.5% FFS in 2000 p. 288; longstanding p.141-143). MA plans have a financial incentive to encourage hospice selection because it pushes end-of-life costs to traditional Medicare, though a study testing whether making hospice a part of the capitation payment for MA* concluded that it would only save traditional Medicare a modest amount of money. However, this study focused on enrollment in hospice during the last month of life, which covers around two-thirds of users, using data from the 1990s. Since then, the expansion of hospice in Medicare has grown steadily, primarily through increased use of hospice by older beneficiaries, and via an increase in the use of hospice by persons with non-Cancer terminal diagnoses (like CHF and dementia). This means the tails of one side of the distribution (long users) have gotten a lot longer (90th percentile 150 days in 2000, 250 days in 2010 while the 25th percentile stay has been 5-6 days for 20 years. There is a literature on the correlates of hospice choice that partially line up with the correlates of MA advantage selection that I will post on later (urban, white, higher education and higher income are all more likely to choose MA, and hospice, even within traditional Medicare).
Source: wordpress.com

Dustin McDaniel backs Medicaid expansion

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tswedenCouldn’t be better, I totally agree that Republicans have also had a lot to do with running up the debt. They have got us into wars that we have not budgeted for and we continue to pay for Japan and Germany’s defenses when they are wealthy enough to do it on their own. However, what is the answer to getting us out of this budget mess? Is raising taxes the answer? Let’s see what the Clinton Administration had to say about that. Below is the last portion of an article by Dan Mitchell of the Cato Institute: Debunking Myth after Myth in Financial Times Column by Former Clinton White House Economist September 18, 2012 by Dan Mitchell Even though I have remarked on many occasions that the burden of government was reduced during the Clinton years, that doesn’t mean Bill Clinton was in favor of smaller government. And it definitely doesn’t mean that his appointees believed in economic liberty. Consider the case of Laura Tyson, who served as Chair of Clinton’s Council of Economic Advisers. She recently penned a column for the UK-based Financial Times that is riddled with disingenuous assertions. Even though it deserves to be ignored, I can’t resist the temptation to make corrections. Tyson myth: The US economy needs efficient and progressive tax reform and it needs more revenues for deficit reduction. Revenue increases have been a significant component of all major deficit-reduction packages enacted over the past 30 years. Factual correction: This is remarkable. I assume Ms. Tyson reads the New York Times, so perhaps she overlooked or deliberate forgot the column that inadvertently revealed that the only successful deficit-reduction package in recent memory was the one that cut taxes instead of raising them. Interestingly, that successful package was implemented during the Clinton years, but only after she left office. During Tyson’s tenure at CEA, we did get a tax increase rather than a tax cut. But the Clinton Administration admitted 18 months later that the tax hike was a failure and was not going to balance the budget. Yet she wants to push the same failed class-warfare tax policy today. http://thedailyhatch.org/2012/09/19/respon…
Source: arktimes.com

Video: Medicaid Reform in AR Video 1

Dustin McDaniel Backs Medicaid Expansion in Arkansas

 All Cities  Arkadelphia  Bella Vista  Benton  Bentonville  Blytheville  Cabot  Conway  El Dorado  Fayetteville  Forrest City  Fort Smith  Harrison  Hope  Hot Springs National Park  Jacksonville  Jonesboro  Little Rock  Mountain Home  North Little Rock  Paragould  Pine Bluff  Rogers  Russellville  Searcy  Sherwood  Siloam Springs  Springdale  Texarkana  Van Buren  West Memphis  White Hall
Source: arkansasbusiness.com

Arkansas Medicaid plan seen as innnovation

“The change will encourage doctors and hospitals to work together to provide patients with the highest quality care, while at the same time lowering costs by eliminating unnecessary tests and treatments.” That part of the idea makes sense. I find I’m the one now who must “encourage” doctors and hospitals to work together and it’s near impossible for a person whose entire medical training is ongoing and from medically respected computer sites. One example. Just one. The VA wants to see hubby’s echocardiogram and gives me a FAX number to send it to. So I get in touch with the hospital here and am told they can’t send it on my word, or even hubby’s (SAY WHAT?). The VA doctor has to request it personally. But I can’t get hold of the VA doctor (thanks in part to their new phone system which sucks). So I have to run to the library and send a FAX to the number they provided me for the echo, requesting that the VA doctor request a copy of the echo. Or I can call hubby’s primary care doctor — who, BTW, hasn’t seen the echo either — and ask if they can get it from the hospital and then forward it to the VA doctor. Fortunately the latter works and I don’t have to make an unnecessary trip to town in 104 degree weather. But, jeez, come on . . .
Source: arktimes.com

Beebe's Medicaid push to fire up election debate

The analyzed data shows that in Arkansas there are actually an estimated 218,000 in the population that would be expanded under the new Medicaid effort. Another 36,000 are already eligible but have not taken advantage of the Medicaid program. So, in essence, there would be 254,000 eligible Arkansans if lawmakers fully adopted the Medicaid expansion now supported by Beebe.
Source: thecitywire.com

Arkansas: Arkansas Medicaid Eligibility Requirement

Days Inn was just recently refurnished. It has a hi-tech mantron that tells of its population ranging between 21 years to 60 years, Arkansas construction project? If you love swimming for example, you can access information at the Speedway include Street Stock, 4 Cylinder Championship, Mid-America Modifieds, SUPR Late Models, Modified Touring, Open Wheel Modifieds, Monster Trucks and much more. Ticket start at $10.00 for adults and $25.00 for a first DUI offense, you can start by getting quick auto insurance quotes gives you an opportunity to choose from a number of insurance coverage for bodily injury refers to coverage against the arkansas medicaid eligibility requirement from treatment expenses for the arkansas medicaid eligibility requirement of the arkansas medicaid eligibility requirement a distinct difference between the arkansas medicaid eligibility requirement of the arkansas medicaid eligibility requirement in the reasons why they should bother investing in land has a hi-tech mantron that tells of its story and history. The personal credit history is not active, he/she will be sure to bring back old memories.
Source: blogspot.com

Gov. Beebe all in on Medicaid Expansion

The U.S. Supreme Court ruling in June upheld the individual mandate portion of the federal health care law. It also said states could not be penalized for opting out of a provision calling for expansion of Medicaid, a health insurance partnership between the states and federal government to help poorer citizens.
Source: 5newsonline.com

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

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

Assured, Beebe urges Medicaid expansion

The Medicaid expansion is allowed by the Affordable Care Act, which leaves the decision up to individual states. Several Republican governors have said they won’t participate. There is no deadline for participation, but Beebe said the letter from Centers for Medicare and Medicaid Services, a federal oversight agency, confirming the state could opt out during tough fiscal times, clinched the deal for him.
Source: inveritasinfo.com

Medicaid in Arkansas, Louisiana, and Mississippi

Ending Healthy Families Program Will Not Solve Budget Problems In California, Governor Jerry Brown wants to end the Healthy Families program. He thinks this will solve the state’s budget problems. Many others understand that it will not fix the budget. It will just make it harder for families and children currently covered by the program to access health care.
Source: families.com

Arkansas Medicaid program to recieve $4.3 million : Spring River Chronicle @ mySpringRiver.com

LITTLE ROCK – Attorney General Dustin McDaniel announced today that Arkansas and other states have reached an agreement with the McKesson Corporation to settle allegations that McKesson reported inflated pricing data for prescription drugs and caused state Medicaid programs to overpay for those drugs. Arkansas’s Medicaid program will receive $1,052,510.28 in the settlement. With federal matching funds added, approximately $4.3 million will go to Arkansas Medicaid. “Arkansans should not have to foot the bill for companies that artificially increase drug prices and raise Medicaid reimbursement rates,” McDaniel said. “This case shows our commitment to ensuring that our Medicaid dollars are being spent properly.” The pricing data at issue in the settlement concerns the Average Wholesale Price benchmark used by the Arkansas Medicaid program to set pharmacy reimbursement rates for drugs dispensed to Medicaid beneficiaries. The states alleged that McKesson, one of the largest drug wholesalers in the United States, reported inflated Average Wholesale Pricing data to First Data Bank, a drug-pricing publisher, thereby inflating the prices used for reimbursement. Thirty states and the federal government filed suit against McKesson in U.S. District Court in New Jersey. The federal government reached a settlement with McKesson in April for $187 million.
Source: myspringriver.com

Plurality in Arkansas Don’t Want Medicaid to be Expanded

Q: One component of the health care reform law involves an expansion of Medicaid to cover medical expenses for individuals living just above the poverty level. The expansion would be fully funded for several years by the federal government with the state incurring up to 10% of the cost later. Under the Supreme Court ruling, Arkansas has the choice whether or not to expand its Medicaid program to include an additional 250,000 Arkansas residents. Should Arkansas expand Medicaid?
Source: firedoglake.com

Q & A: Keeping Your Young Adult Child On Your Health Plan

Posted by:  :  Category: Medicare

Maryland Health Insurance Plan Federal Press Announcement by MDGovpicsAccording to the Department of Health and Human Services, certain existing group plans that are grandfathered under the health law are not required to accept an adult child if that child has an offer of insurance through his or her own job. But any group health plan has the option to cover adult children. That grandfathered exception will expire in 2014.
Source: kaiserhealthnews.org

Video: A Healthy Conversation with UPMC Health Plan

Kaiser Permanente’s Medicare Plans Earn Top NCQA Health Insurance Rankings for 2012

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

Nation’s Largest Health Plan Survey Cites Key Trends in Employer Health Plans

“The intent of the survey is to provide employers of all sizes with the data they need to manage their health care benefit programs effectively,” says Elliot Dinkin, President/CEO of Cowden Associates, Inc. “Large employers will find the United Benefit Advisors (UBA) Health Plan Survey provides more participants and data in their category than other industry survey. For employers with fewer than 1,000 employees (which represents more than 99 percent of the employers in the U.S.) and for employers who have operations in multiple locations, this survey is the only source of reliable regional – and in many cases, state – health plan benchmarks by size and industry.”
Source: wphospitalnews.com

Schools seek new health plan

Public HealthHealth InsuranceHealth CostsHealth ReformHospitalsMedicaidDelivery of CareMental HealthPhysiciansChildren’s HealthSafety NetCaregivingDisabilitiesMedicareUninsuredHealth DisparitiesLong-Term CarePrescription DrugsNursesHealth QualityQuality of CarenursingRural Health
Source: georgiahealthnews.com

AHIP’s Karen Ignagni: Health Plan Innovations Could Help Reshape Health System

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Source: ahipcoverage.com

Romney’s health plan can’t work

If we are to believe the GOP nominee, Romneycare’s version of Obamacare is to keep its most important provisions, but – as his campaign handlers were quick to point out in a press release after the show – without the individual mandate and without guaranteeing that anyone could actually buy insurance that covers pre-existing conditions.
Source: theolympian.com

Partners HealthCare’s Acquisition of Neighborhood Health Plan Receives State Approval

Regulators at the Massachusetts Division of Insurance gave the OK for Boston-based Partners HealthCare to acquire Neighborhood Health Plan — the first health plan Partners has acquired, according to a Boston Globe report. Partners and NHP first announced their intent to merge in August 2011. The two organizations began the affiliation process in order to “address growing needs for care coordination and management, health equity and the ability to curb healthcare costs.”
Source: beckershospitalreview.com

A tale of two healthcare plans

Reuters columnist David Cay Johnston is the president of Investigative Reporters & Editors (IRE), an education organization with 4,200 members. A 13-year veteran of The New York Times, David won the Pulitzer Prize in 2001 for enterprise reporting that uncovered loopholes and inequities in the U.S. tax code. He wrote the best selling tax books Perfectly Legal, which won an IRE medal, and Free Lunch. His latest book, The Fine Print: How Big Companies Use “Plain English” to Rob You Blind, will be published in September.
Source: reuters.com

Australian Medicare Local Alliance directors announced

Posted by:  :  Category: Medicare

Then the third symphony where we need a strong conductor and players recruited from beyond the health arena is transport.  People at the Katoomba meeting meant transport of all forms.  Patients coming from Lithgow – hardly a distant country town – can catch a train to Sydney or Katoomba only once every two hours.  This may be fine if you’re fit but it can impose huge burdens on those who are unwell.  An appointment in Penrith, Westmead or Sydney runs late and you miss a train by five minutes – wait 1 hour and 55 minutes for the next one, with your arthritis, heart failure or COPD.  Tough luck.
Source: com.au

Video: Medicare Levy Surcharge 2011/2012: nib Health Insurance Explained

Midwives & Medicare: What’s Covered?

The good news is that Australia is one of the safest countries in which to give birth or be born. However, that doesn’t mean that the country has been meeting the needs of all Australia women when it comes to maternity care, according to the 2009 publication “Improving Maternity Services in Australia” That publication was based on the national Maternity Services Review in which women expressed frustration at the limited options available to them and called for new midwifery models of care that could provide greater continuity of care throughout their pregnancy. In response to this survey and report, the Government initiated the Maternity Services Reform.
Source: com.au

Administration Support Officer

Hunter Medicare Local is a rapidly expanding not-for-profit organisation and is the principal coordinator of primary health care in the Hunter region. An office is being established in Maitland and an opportunity exists for a suitably experienced and qualified Administration Support Officer to join our team.
Source: com.au

Registration Due for Medicare Seminar

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSThe program, titles “Welcome to Medicare” will be presented by Crossroads’ SHIPP volunteers. The program will cover Medicare Parts A, B, and D, as well as Medicare Advantage plans and Medicare supplemental insurance. Registration for the September 22nd program is required by next Tuesday.
Source: kniakrls.com

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

National Medicare Training Program Announces Understanding Medicare Webinar

Please complete the registration form and select a password that is 8 characters long and contains one capital letter and a number. If you have previously attended a webinar with us please select “click here” at the top of the page. You will be redirected and asked to enter your login (your email address) and password. If you do not remember you password, please click the “Forgot your password?” link.
Source: wordpress.com

October 3rd Deadline for EPs in EHR Incentive Program

October 3rd will be the last day for eligible professionals to begin their 90-day reporting period for calendar year (CY) 2012 in the Medicare EHR Incentive Program. For EPs, this means that they must begin their consecutive 90-day reporting period by October 3rd in order to attest to meeting meaningful use and be eligible to receive an incentive payment for CY 2012. CMS continues to encourage EPs not to miss the opportunity to participate in the Medicare EHR Incentive Program this year. Begin your reporting period by October 3rd to get on the path to payment for CY 2012. This becomes even more important now that stage 2 rules have been released and the 2015 payment adjustment details have been disclosed. You must be on the path of meaningfully using certified technology in order to avoid Medicare payment adjustments in 2015.
Source: hitechanswers.net

Why You Should Register at www.myaarpmedicare.com

If you are currently using AARP insurance, you do have to seriously consider joining www.myaarpmedicare.com for the free account that you are entitled to. The information that you get when you log in is quite important. You will basically get to know absolutely everything about the AARP healthcare plan that you are subscribed to and there are various tools available to make your life a lot easier. For most people the biggest advantage of joining is offered by the fact that they can save a lot of time. Instead of talking to people on the phone and wasting time in order to learn what you want about AARP, you can do the same more efficiently by having an online account on www.myaarpmedicare.com.
Source: myhomeaccountonline.com

Free Training Webinar Series: CMS855 Medicare, ICD10, Meaningful Use Stage 2

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Source: precisionhcc.com

Obama, Ryan will address AARP in New Orleans as Medicare debate rages

The Romney campaign disputes that the proposal is a “voucher” plan, and accuses the president of pilfering $716 billion from the Medicare program to pay for the Affordable Healthcare Act, his signature healthcare reform law. The Obama campaign says the Medicare savings will come from holding down payments to hospitals and insurers, not reducing benefits to retirees.
Source: nola.com

Stage 1 Meaningful Use: Registration for eligible professionals

Less than two months remain for eligible professionals (EPs) under the Centers for Medicare & Medicaid Services (CMS) Electronic Health Record (EHR) Incentive Program for Medicare to begin their reporting period for Stage 1 Meaningful Use. Eligibility for EPs under the Medicare program is limited to:
Source: ehrintelligence.com

Medicare Savings Program sees enrollment rise

Enrollment increased 5.2% in 2010 and 5.1% in 2011, according to the GAO. It attributed the growth to factors including the SSA’s efforts as well as the economic downturn. The Medicare Improvements for Patients and Providers Act of 2008 requires that the SSA address the roadblocks preventing low-income beneficiaries from signing up for the savings program. Those barriers were pegged as low awareness and cumbersome enrollment processes. In addition to outreach, the SSA was also required to transfer information on beneficiaries who file a low-income subsidy application to a state Medicaid agency. Officials in 28 states reported growth in their Medicare Savings Programs as a result of Social Security Administration transfers, the GAO found. The GAO noted that the amount of additional work for states will depend on whether they decide to re-verify the information beneficiaries provided to the SSA and whether their eligibility requirements align with the federal government’s.
Source: modernhealthcare.com

Preventive & screening services

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Drug Coverage

Shingles Vaccinations Not Covered For Some Medicare Beneficiaries

A. Shingles is a painful rash caused by a virus that can lead to long-term nerve damage called postherpetic neuralgia. All Medicare Part D prescription drug plans cover the shingles vaccine, which is recommended by the Centers for Disease Control and Prevention for people age 60 and older. But Medigap plans, which may cover the deductible and coinsurance amounts for services provided under Medicare Parts A and B (hospitalization and outpatient care), don’t offer any financial help on the co-payments for vaccines and other drugs covered under Part D.
Source: kaiserhealthnews.org

Ask The Experts: Retirement

First, please review previous Q&As to see if your question already has been answered. If you cannot find the answer, submit your question to our Retirement expert at fedexperts@federaltimes.com PLEASE NOTE! Do not submit ANY questions via the Comments form. Questions submitted via the Comments form will NOT be answered!
Source: federaltimes.com

Medicare Supplemental Coverage Phoenix AZ

You are not required to have Medigap. You can choose to just have the Original Medicare along with your Medicare Part D prescription drug plan. It should be noted that Medicare Part D comes with the free prescription drug card or you can choose Premium and the copay will be determined based on your zip code. The cost for the Premium Part D varies but averages around $60. If you want to stay with Original Medicare and just increase the prescription coverage, call the the number on the back of your prescription card and they can help you.
Source: oratoriosanpio.com

Maximizing Medicare Prescription Drug Coverage

Medicare beneficiaries take an average of 29 prescriptions per year, spending approximately $1,300 on medications annually.[1] Individuals with chronic conditions such as heart failure often pay more than double that amount.[2]   Fortunately, there is a voluntary program called Medicare Part D that helps beneficiaries pay for their prescription drugs. Beneficiaries can access prescription drug coverage either from a stand-alone Part D prescription drug plan or from a Medicare Advantage plan that bundles coverage of medical, hospital and prescription drug benefits in one plan.   Enrolling in Part D prescription drug coverage is one way beneficiaries can help manage their prescription drug costs, but they should be aware that all Part D plans include a coverage gap, which is often called the “donut hole.” In the coverage gap, beneficiaries’ out-of-pocket costs on their prescription drugs increase significantly.   Summer is the time of year when many beneficiaries enter the coverage gap, making this an opportune time for beneficiaries with Medicare Part D to remind themselves of the following tips that may help them save money on their prescription drugs and make the most of their benefits.    1. Get Help with Managing Multiple Medications Beneficiaries who have a chronic condition that requires them to take multiple medications every day should consider enrolling in a Medicare Advantage Chronic Special Needs Plan. These specialized Medicare Advantage plans combine Medicare coverage with additional support services, some of which are designed to help ensure that members are able to afford their medications and understand how to take them as directed. Many Special Needs Plans also offer personalized pharmacist counseling and drug formularies designed for Medicare beneficiaries with complex health care needs.    2. Understand How the “Donut Hole” Works All Part D plans include a coverage gap. After spending $2,930 in out-of-pocket costs on their drug coverage, beneficiaries will reach the coverage gap. Currently, beneficiaries in the gap pay 50 percent of the cost of their brand-name prescriptions and 86 percent of the cost of generic drugs. In an effort to prepare for the increased expenses while in the gap, beneficiaries should monitor their plan’s Evidence of Coverage statement to get a clear sense of their drug expenditures and see how close they are to reaching the gap.   3. Apply for “Extra Help” with Drug Costs  For beneficiaries with limited income and resources, Extra Help is a federal program that provides an average of $4,000 of additional assistance with prescription costs. According to the Social Security Administration, many beneficiaries who qualify for this program don’t know they are eligible. Medicare beneficiaries must apply for this program, and the amount of assistance is based on annual income and assets. For more information about the Extra Help program, contact the Social Security Administration at 1-800-772-1213.   4. Take advantage of cost-savings on prescription drugs. Beneficiaries enrolled in a Medicare Advantage plan that includes drug coverage should check their plan details to see if they could save money on their prescriptions, such as by using mail-order pharmacy benefits, switching to generic or lower-tier drugs, or taking advantage of special programs available with some plans.   5. Explore “PAP” Programs Several pharmaceutical manufacturers sponsor Patient Assistance Programs (PAPs) that may reduce prescription drug expenses. Some companies offer financial assistance or free products, but all manufacturers have their own rules and grant assistance on a case-by-case basis. For more information, contact the Partnership for Prescription Assistance program at 1-888-477-2669.   For more information about Medicare Part D, contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week. The Arkansas State Senior Health Insurance Information Program (SHIIP) provides free counseling and support to help beneficiaries understand their Medicare coverage options, including prescription drug coverage. To contact the SHIP office in Arkansas, call 1-800-224-6330.    Ray Morris is the community outreach manager for Care Improvement Plus in Arkansas. Care Improvement Plus is a UnitedHealthcare Medicare Solution providing specialized Medicare Advantage coverage for underserved and chronically ill beneficiaries throughout Arkansas.  
Source: thecitywire.com

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

Concerned about Medicare Part D Coverage? Join the Upcoming Teleconference

As you may know, Medicare Part D is a vital Federal program to the more than 3 million New Yorkers who participate. Part D provides disabled Americans and seniors access to affordable, life-saving medicines. The most recent Medicare Today survey found that 88% of seniors are satisfied with their coverage.
Source: newyorkhealthworks.com

HHS Touts Growth In Medicare Advantage Plans, Drop In Premiums

More than 13 million Medicare beneficiaries – just over a quarter of all Medicare enrollees – are in Medicare Advantage plans, an alternative to traditional Medicare offered by insurance companies. The health law will reduce payments to Medicare Advantage plans by $156 billion from 2013 through 2022, according to the Congressional Budget Office. President Barack Obama and many Democrats have backed payment cuts to the plans, citing data that the government has in the past paid about 14 percent more per beneficiary in Medicare Advantage than per beneficiary enrolled in the traditional program. Proponents of the private plans point to their better coordination of care and extra benefits and services they provide, including vision, hearing and dental benefits.
Source: kaiserhealthnews.org

Medicare Part D Notice of Creditable Coverage

If you are an employer that provides prescription drug coverage to employees and their dependents as part of your employer-sponsored health insurance plan, you must notify all of your Medicare-eligible employees and dependents of their options regarding Medicare Part D prescription drug coverage.  Since it is difficult to know for sure who among your employees and their dependents may be Medicare eligible, we recommend sending this notice to all participants in your employer-sponsored health insurance plan.
Source: holdenagency.com

Medicare Prescription Drug Coverage Is Here!

. Appear for enrollment events in the area. Over the next handful of months, you are going to be able to get aid with your drug plan alternatives at dozens of areas throughout your community, like schools, senior centers, clubs, faith-based organizations, and your pharmacy. Or you can speak with pals and loved ones or contact your local office on aging for help. For the telephone number, check out www.eldercare.gov on the Web. The Eldercare Locator can help you discover locations to go to get personalized assistance.
Source: topreviews123.com

Covering Medicare before the election and beyond

And of course, there are always local stories that help seniors with the annual rite of selecting new Medicare supplemental coverage for the coming year. Medicare open enrollment begins October 15, earlier than in the past. Seniors will have seven weeks to study all the offerings in their areas and change coverage if they want to. In doing these kinds of stories, I’ve always thought it was a good idea to put yourself in the shoes of someone who has to navigate the Medicare system. It’s not easy, as I found out last year when I turned 65. This post will tell you how hard it is even for someone who sort of knows the system.
Source: reportingonhealth.org

Choosing Between Original Medicare and Medicare Advantage

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSOriginal Medicare is made up of two parts: Part A and Part B. Part A is a hospital insurance plan that helps to cover the costs associated with home health care, inpatient hospital care, hospice and nursing home care. Part A typically does not carry a premium, as the cost is covered by workers’ Medicare taxes. Medicare Part B is a medical insurance plan that covers part of the cost of outpatient care, certain doctors’ visits, approved medical supplies and preventative care. Just as with other health insurance policies, recipients pay a monthly premium for coverage.
Source: reversemortgagecalculator.com

Video: Guide to Medicare Part A and Part B

Local Public Forums Provide Original Medicare Education

Tagged With: Brevard County, BREVARD COUNTY FLORIDA, Cape Canaveral Hospital, Cocoa Beach, Crane Community Center, Florida, Government, Health, Health First Health Plans Inc., healthcare needs, Healthcare reform in the United States, Holmes Regional Medical Center, Indian River County, Indian River County Chamber of Commerce, Margaret Haney, Medicare, Melbourne, Rockledge, Social Issues, United States National Health Care Act, Vero Beach
Source: spacecoastmedicine.com

Massachusetts Health Stats: Obama Announces Wyden

Massachussetts Health Stats is an as-needed look at statistics about the Massachusetts healthcare delivery and insurance market and industry, including aspects of Medicare as they relate to Massachusetts seniors and the Medicare-eligible disabled. On both Medicare and Massachusetts health care, this blog overcomes the attempts from those on both the left and right of the political spectrum to use statistics to impose needless changes on one of the best healthcare systems in the world.
Source: typepad.com

Medicare Supplemental Coverage Phoenix AZ

You are not required to have Medigap. You can choose to just have the Original Medicare along with your Medicare Part D prescription drug plan. It should be noted that Medicare Part D comes with the free prescription drug card or you can choose Premium and the copay will be determined based on your zip code. The cost for the Premium Part D varies but averages around $60. If you want to stay with Original Medicare and just increase the prescription coverage, call the the number on the back of your prescription card and they can help you.
Source: oratoriosanpio.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

Annual Enrollment Period for Illinois Medicare

Illinois Annual enrollment period for Medicare is right around the corner, making it the right time to start considering your health care choices. If you are currently enrolled in a Medicare plan, now is the time to begin comparing your coverage with other available options to see if there is a better choice for you. Annual enrollment is the one time of year when you can add to or make changes to your Medicare health or prescription drug coverage for 2013. It’s extremely important you are familiar with these dates to ensure if you make changes, your new coverage begins by January 1
Source: ssiinsure.com

Original Medicare: Part B

Medicare beneficiaries must typically pay all costs until the yearly Part B deductible is met ($140 in 2012) before Medicare begins to pay its share. Then you usually pay 20% of the Medicare-approved amount of the service, if the doctor or other health care provider accepts assignment (assignment means he/she is approved and agrees to accept the Medicare fee schedule and conditions). There is no yearly limit for what you pay out-of-pocket.
Source: seniorliving.net

House Cmte. Looks at Status of Medicare Advantage Program

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2..Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481The head of the Medicare Payment Advisory Commission said his organization is trying to craft a new formula for Medicare payments to doctors.  Glenn Hackbarth says the goal is to release that recommendation this fall.  Since 1998 Congress has passed legislation every year known as the “doc fix” overriding scheduled cuts in Medicare payments.  At a Ways and Means Subcommittee hearing, Mr. Hackbarth also presented the recommendations in MedPAC’s latest report.  It includes a 1% increase in hospital payments and a 1% increase in physician fees.
Source: c-span.org

Video: Medicare Payments For… Penis Pumps?!

Democrats’ $716 Billion Medicare Cut Problem

“The new provisions will generally reduce MA [Medicare Advantage] rebates to plans and thereby result in less generous benefit packages. We estimate that in 2017, when MA provisions will be fully phased in, enrollment in MA plans will be lower by about 50 percent (from its projected level of 14.8 million under the prior law to 7.4 million under the new law).”
Source: nrcc.org

Automatic Budget Cuts Will Reduce Medicare Payments To Doctors, Providers By $11 Billion

Lawmakers could still act to stop the cuts if they think doing so is in their best interests. In order to avoid a government shutdown in the middle of election season, party leaders in both chambers just cut a deal to prevent the government from running out of money when the fiscal year ends in September. The House voted yesterday to approve the six-month package and the Senate is expected to send it to Obama next week.
Source: aarp.org

Impact of Medicare Sequester v. Medicaid expansion on providers

Interestingly, the impact of the Sequester on health care providers is beginning to get some news coverage in North Carolina, but there has been very little discussion of the Medicaid expansion choice along the same lines, in the media or in the campaigns for Governor and General Assembly. I assume this means that the Republicans know that we will do the expansion in N.C., and they have wisely not boxed themselves in. It is not as clear to me why none of the Dems running are talking about this issue.
Source: samefacts.com

Sebelius Misleads the Public on Medicare Advantage

Comments are subject to approval and moderation. We remind everyone that The Heritage Foundation promotes a civil society where ideas and debate flourish. Please be respectful of each other and the subjects of any criticism. While we may not always agree on policy, we should all agree that being appropriately informed is everyone’s intention visiting this site. Profanity, lewdness, personal attacks, and other forms of incivility will not be tolerated. Please keep your thoughts brief and avoid ALL CAPS. While we respect your first amendment rights, we are obligated to our readers to maintain these standards. Thanks for joining the conversation.
Source: heritage.org

HHS Touts Growth In Medicare Advantage Plans, Drop In Premiums

More than 13 million Medicare beneficiaries – just over a quarter of all Medicare enrollees – are in Medicare Advantage plans, an alternative to traditional Medicare offered by insurance companies. The health law will reduce payments to Medicare Advantage plans by $156 billion from 2013 through 2022, according to the Congressional Budget Office. President Barack Obama and many Democrats have backed payment cuts to the plans, citing data that the government has in the past paid about 14 percent more per beneficiary in Medicare Advantage than per beneficiary enrolled in the traditional program. Proponents of the private plans point to their better coordination of care and extra benefits and services they provide, including vision, hearing and dental benefits.
Source: kaiserhealthnews.org

White House projects $11 billion Medicare cut as result of deficit law

While continuing to fight against Medicare pay cuts to ODs as a result of sequestration, AOA is warning lawmakers that, if enacted, these cuts would only compound an already dangerous situation. Without corrective action, Medicare payments to ODs and other physicians are scheduled to be slashed by nearly 30 percent starting Jan. 1, 2013. And adding insult to injury, Medicare physician payments have been nearly frozen for a decade, while the cost of caring for patients has increased by more than 20 percent.
Source: newsfromaoa.org

Medicare payments for imaging plummet

"Hopefully, this will assuage the concerns of federal policymakers, and they will decide that no further reimbursement cuts are necessary," said the study authors, researchers from Thomas Jefferson University Hospital in Philadelphia. "We also believe there are better ways to further control imaging utilization and costs. Meaningful tort reform, especially through limitation of noneconomic damages, would be one fruitful approach," they said.
Source: fiercehealthfinance.com

Obama Tells Seniors They've 'Earned' Medicare and Social Security, Forgets to Note We Haven't Paid For Them

Social Security, meanwhile, certainly isn’t a guarantee. Obama might consider the retirement program a “bedrock commitment,” but the Supreme Court doesn’t. The court has ruled on two difference occasions that citizens are not entitled to the dollars they pay into the entitlement. Money paid into the program can be used to fund other totally unrelated government activities, just like any other tax dollars. The commitment to the program is dependent on the whim of politicians who are legally allowed to tax you for one thing and use that same money to pay for something else. That — and nothing else — is what seniors paying into Social Security have actually earned. 
Source: reason.com

Grappling With Details of Medicare Proposals

Still, it’s clear the proposed changes would shift costs from the federal government to retirees. An early version of a Republican plan would have more than doubled out-of-pocket health expenses for older adults, to $12,500 in 2022, the Congressional Budget Office estimated. “All scenarios will require seniors to pay more,” said Robert Moffit, senior fellow at the Heritage Foundation, a conservative research organization in Washington. To think otherwise, he said, “is a fantasy.”
Source: nytimes.com

Obama hits Romney on Medicare; Ryan vows ’Honest Answers’

The health-care law championed by Obama is one of the central points of debate in the campaign. The Patient Protection and Affordable Care Act scales back payments to Medicare Advantage plans, an alternative to traditional Medicare. It also slows the growth of Medicare payments to hospitals and other health-care providers. Seniors’ benefits weren’t reduced in the legislation.
Source: standard.net

GPs Doing Overtime for Health Records to Avail Benefit of Medicare Rebates

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilThe change in the policy has been brought about after doctors raised the issue for several months. As a result of which now these doctors will be allowed to include the extra time spent on health summaries to their consultation time and further can ask for the Medicare rebate, which will be allowed for the total time.
Source: topnews.ae

Video: Medicare rebate – Nick Xenophon

Lower Income Families to Benefit from Health Rebates

In order to promote health care and encourage locals to invest in their own private cover, in addition to what is currently on offer from Medicare, the government has introduced the private healthcare rebate system, which aims to make private cover more affordable for people earning in the lower income categories. In order to make the most of your private health insurance, private providers are now encouraging their clients to compare health fund offers, which one can do online, via HelpMeChoose.com.au (http://helpmechoose.com.au/compare-private-health-insurance/). The income tested tier system is structured so that families earning less get a higher percentage rebate while those earning higher, in the tier three category, do not qualify for a rebate. It has also been structured so that older age groups can benefit and ensure they receive high quality care, as they compare health insurance against what is on offer from Medicare.
Source: howtomanagemoneytips.com

Medicare Part D $250 Rebate: The Donut Hole Coverage Gap

I reached the Medicare donut hole in April of this year and have yet to receive that so called $250 rebate. My Humana Medicare Advantage Plan tells me they are not responsible for informing Medicare who is in donut hole so how is Medicare supposed to know who to send checks to? As usual one hand does not know what the other is doing in these government programs. No one wants to take responsibility and Obama just wants to look like he is doing something to help but his programs have no accountability to the taxpayers.
Source: suite101.com

MEDICARE REBATE: Review Your Health Insurance Before June 30.m4v

With the Federal Government bringing in legislation to means-test the Medicare rebate as of July 1, 2012, now is the time to review your health insurance needs for the coming financial year. In this Skype interview, Tim Andrew from SplitIt.com.au outlines in simple terms what the legislation means and tiers of income the government will be means-testing; he also touches on why paying your health insurance up-front might potentially save you thousands of dollars. SplitIt.com.au is an open and transparent comparison service. We compare everything available to us (some 10000 health insurance policies in Australia) and where we receive any commissions we split them with you 50/50, always, no exceptions!
Source: welfarehealth.com

Premium Rebates, Coverage Labels, Reduced Medicare Drug Costs Highlight 2012 Health Law Changes

Starting in August, the Obama administration’s new rules on contraceptive coverage that have generated such controversy take effect. That means that women in a new health plan or in an existing one that has changed its benefits enough to not be considered grandfathered under the law will be able to receive contraceptives without an out-of-pocket charge. In addition, these plans will have to provide a variety of basic women’s health services, including well-woman visits; screening for gestational diabetes; HPV testing; counseling for sexually transmitted infections; counseling and screening for HIV; and screening and counseling for interpersonal and domestic violence.
Source: kaiserhealthnews.org

Limiting the Medicare rebate for genital surgery is a good move

While western women are increasingly turning to the knife and having the size, shape and appearance of their labia enhanced, feminists and activists continue the campaign to end the practice of female genital mutilation affecting millions of women living in parts of Africa, Asia, and the Middle East. Female genital mutilation is a procedure that intentionally excises genital tissue leading to problems such as frequent bladder infections, childbirth complications and the risk of later surgery. The World Health Organization estimates that there are 100 to 140 million women who have had their lives damaged by FGM.
Source: wordpress.com

Candidates Differ Sharply on Medicare

ACA reduced the “Donut Hole” for Medicare prescription coverage. After an individual’s annual prescription costs reached $2,800, he or she had to pay out-of-pocket for the full cost of drugs up to $4,550. A combination of discounts and rebates reduced the impact, and under the ACA the gap is set to close by 2020, when there will no longer be a cap on Medicare prescription coverage.
Source: theepochtimes.com

Former AMA boss to fight Rudd for seat

The Liberal National Party announced on Thursday that Dr Glasson – a former president of the Australian Medical Association – had been preselected to contest the seat currently held by Labor with a margin of 8.5 per cent.
Source: bigpondnews.com

Doughnut Hole Rebate Checks Fuel Medicare Fraud & Insurance Scams

Missouri Attorney General Chris Koster (also the name of the website) comments on the types of Medicare scams taking place across the nation. The article can be found in the Attorney General’s News Release titled, "Attorney General Koster Warns Seniors About Medicare Rebate Fraud Schemes" (June, 2010). According to the author (name not given), "[Koster] said a common scam related to the $250 donut hole checks was for individuals to convince seniors that the rebate check needed to be transferred to a third party or used to cover specific prescription drug payments."
Source: suite101.com

The Disability Information and Resource Centre

These groups will be targeting greeting, empathy, emotional recognition and management, body language, sharing. Helping others and turn taking. It is highly recommended that you and your child attend an individual session prior to the start of the group program. This ensures that the group is appropriate for your child, target skills are identified and the child is familiar and comfortable with the facilitator.
Source: org.au