Hospitals, Providers to Lose $11.1B From Medicare Sequestration Cuts

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareHospitals and other providers will see Medicare payment reductions totaling $11.1 billion this upcoming year, due to the Budget Control Act of 2011, unless Congress passes new measures to prevent the cuts, according to a report from the White House’s Office of Management and Budget (pdf). Last summer, the bipartisan Joint Select Committee on Deficit Reduction, more commonly known as the “supercommittee,” was unable to reach an agreement on ways to reduce the national deficit. As such, the Budget Control Act of 2011’s sequestration process became the default plan to reduce the deficit by $1.2 trillion over the next 10 years via across-the-board budget cuts to all government agencies. In the sequestration plan, roughly $109 billion of cuts would be implemented every year from fiscal year 2013 to FY 2021. Defense spending would take the biggest hits with cuts of 9.4 percent. Nondefense spending would be reduced by 8.2 percent, most entitlement programs by 7.6 percent and Medicare by 2 percent. Two percent of Medicare’s budget ($554.3 billion) is roughly $11.08 billion. Medicare providers — ranging from hospitals and physician practices to home health agencies and hospices — would see reductions in their payments, but Medicare beneficiaries would not lose any of their benefits. Over the next 10 years, Medicare providers stand to lose upwards of $120 billion. In addition to the Medicare cuts, the National Institutes of Health would also have to “halt or curtail scientific research, including needed research into cancer and childhood diseases,” according to the OMB’s report. President Barack Obama and the OMB said the sequestration process is a “blunt and indiscriminate instrument,” and the reductions could be “destructive” to the country’s social programs, national security and other governmental functions. President Obama has called on Congress to “act responsibly” and put forward a new proposal. “[Sequestration] is not the responsible way for our nation to achieve deficit reduction,” according to the OMB’s report. “The President has already presented two proposals for balanced and comprehensive deficit reduction. It is time for Congress to act. Members of Congress should work together to produce a balanced plan that achieves at least the level of deficit reduction agreed to in the BCA that the President can sign to avoid sequestration. The administration stands ready to work with Congress to get the job done.”
Source: beckershospitalreview.com

Video: Medicare Provider Enrollment 3.wmv

How to Speed Up the Medicare Prepayment Review Process

MACs will initiate prepayment reviews of health care providers suspected of improper billing for services. If the MAC detects anything resembling fraud during the process, the prepayment review can extend for up to a year or more. However, MACs will generally terminate the prepayment review when the health care provider demonstrates a pattern of correct billing. Health care providers who are notified of a MAC prepayment review should consult with an experienced health care attorney from the beginning of the process. An experienced health attorney will be able to assist the health care provider to ensure everything is in place for a speedy prepayment review.
Source: wordpress.com

Independence Blue Cross Selects Medicare Analytics Provider

Insurance & Technology encourages readers to engage in spirited, healthy debate, including taking us to task. However, Insurance & Technology moderates all comments posted to our site, and reserves the right to modify or remove any content that it determines to be derogatory, offensive, inflammatory, vulgar, irrelevant/off-topic, racist or obvious marketing/SPAM. Insurance & Technology further reserves the right to disable the profile of any commenter participating in said activities.
Source: insurancetech.com

Obama Crows About Private Medicare Provider Success while Bashing GOP Plans

[…] abuse Advance Directives advantage plans affordable care act baby boomers budget Congressional Budget Office Dan Morhaim donut hole election fraud gap coverage healthcare Health Care healthcare reform Health Care Reform health exchange individual mandate provision Living Wills medicaid medicare medicare advantage medicare benefits medicare budget medicare cuts medicare fraud medicare news medicare politics medicare refor medicare reform medicare supplement medigap obama obamacare part d plans paul ryan Politics News romney Sarah Palin seniors supreme couty tax breaks unitedhealth waste wealthySource: medicarewire.com […]
Source: medicarewire.com

Los Angeles Doctor Convicted of Health Care Fraud for Submitting to Medicare About $1 Million in Bills for Tests Never Performed

The case against Firempong was brought as a part of a nationwide takedown by Medicare Fraud Strike Force in September 2011. The Medicare Fraud Strike Force operations are part of the Health Care Fraud Prevention & Enforcement Action Team (HEAT), a joint initiative between the Department of Justice and the Department of Health and Human Services to focus their efforts to prevent and deter fraud around the country. Since their inception in March 2007, Strike Force operations in nine locations have charged more than 1,330 defendants who collectively have falsely billed the Medicare program for more than $4 billion. In addition, the Centers for Medicare and Medicaid Services, working in conjunction with the HHS’s Office of Inspector General (HHS-OIG), are taking steps to increase accountability and reduce fraudulent billing.
Source: bestdefender.com

House Cmte. Looks at Status of Medicare Advantage Program

The 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

Booman Tribune ~ A Progressive Community

You don’t wait until you have been in a car accident to purchase car insurance; you don’t wait until your house has been flooded to buy flood insurance, and you don’t wait until your home is ablaze to buy fire insurance. That is not how insurance works. And it most certainly is not how health insurance should work. That’s why we have Medicare. Medicare is a program designed primarily for people who are 65 years old or older, most of whom are either retired or working part-time. Their income has gone down at the precise time that their health risks are beginning to skyrocket. These people often don’t have the extra money lying around that they need to pay for either insurance or for prescription drugs and other care. The insurance companies are not interested in insuring the health of the elderly, and if they do offer a plan, it’s going to be astronomically expensive. It’s easy to see why. Someone who needs dialysis at 70 may have paid their insurance company for fifty years by the time they need to make a claim. But someone who has only been a customer since they turned 65 will use up all the money they paid in after only a few treatments. It isn’t profitable to insure old people at any reasonably affordable rate.
Source: boomantribune.com

AMA Urges Congress to Nullify Medicare Cuts

Congress’ failure to agree on a plan to reduce the federal deficit activated automatic budget cuts, including a 2 percent cut in payments to Medicare providers, that will become effective on January 1, 2013, absent new legislation. The AMA warned that this cut would endanger patients’ access to care and lead to a loss of jobs in the health care industry. The American Hospital Association issued a press release discussing the results of a report it commissioned with the AMA and the American Nurses Association. The report concluded that more than 496,000 health care jobs would be lost during 2013 alone, with up to 766,000 lost by 2021.
Source: wolterskluwerlb.com

Budget Sequestration (“Fiscal Cliff”) to Cost Medicare Providers $11 Billion in FY 2013, White House Reports : Health Industry Washington Watch

The Budget Control Act imposes a number of special rules regarding the application of sequestration to the Medicare program. Most notably, Medicare cuts are limited to provider payments, and reductions are capped at 2% of individual provider payments under Medicare Parts A and B, and monthly payments under Part C (Medicare Advantage) and Part D prescription drug plan contracts. Medicare payment reductions must be made at a uniform rate across all programs and activities subject to sequestration. Sequestration reductions will be disregarded for purposes of computing adjustments to Medicare payment rates, including the Part C growth percentage, the Part D annual growth rate, and application of risk corridors to Part D payment rates. Also specifically exempt from sequestration are Part D low-income subsidies, Part D catastrophic subsidies, and payments to states for Qualified Individual premiums.
Source: healthindustrywashingtonwatch.com

Daily Kos: Linda McMahon thinks it’s time to ‘sunset’ Social Security

Posted by:  :  Category: Medicare

Romney Ryan Plan for Medicare and SSI by DonkeyHoteyRepublicans’ true agendas seem come out when they’re talking to tea partiers. First, we had Tommy Thompson telling a Wisconsin crowd he’d “do away with Medicare and Medicaid.” Now it’s Linda McMahon, who told Connecticut tea partiers that she wants to do away with Social Security. Speaking before a group of Tea Party supporters in Waterford, Conn. on April 20, however, McMahon said she would consider making major changes to Social Security, from raising the retirement age to means-testing benefits. She also proposed introducing a “sunset provision”—the legislative term for putting an expiration date on a law unless it is renewed. Asked to clarify whether McMahon really meant what she said—sunset as in making the program go away—McMahon’s staff gave a typical nonresponse: “Linda McMahon will never vote for a budget that cuts Social Security for seniors, and unlike Chris Murphy she would never have voted to cut Medicare by $716 billion.” Because it’s in Republicans’ DNA to repeat the big lie about about Medicare.
Source: dailykos.com

Video: Community Health Map: Geospatial and Multivariate Visualization Tool for Medicare Data

Benutzer:LarueBoyle938 – Bjoerns

As the new year begins, men and women with Medicare who have currently joined a Medicare drug plan can take benefit of the new Medicare prescription drug coverage. Because this is a new system for Medicare, you might have questions about how to use your Medicare drug program. For instance, what if you joined a plan but haven’t received a strategy ID card in the mail however? Or, what if your drugs had been covered by Medicaid and you are not certain how to get your medicines now? Whatever concerns you have, Medicare has answers. yaz side effects .
Source: bjoern-rode.de

Preventive & screening services

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe 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: Guide to Medicare Part A and Part B

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

CMS Releases October 2012 Update to Medicare Part B Drug ASP Files : Health Industry Washington Watch

CMS has posted the October 2012 update to Medicare Part B average sales price (ASP) files, which will be used to pay for Part B covered drugs for the fourth quarter of 2012. CMS reports that drug prices in the market remain relatively stable, with average prices for the top Part B drugs decreasing by 1.7% in the fourth quarter of 2012 compared to the previous quarter. CMS also notes that it is continuing to delay implementation of average manufacturer price (AMP)-based price substitution policy at this time for “a variety of operational issues.”  
Source: healthindustrywashingtonwatch.com

Missing Medicare Plan Deadlines Will Cost You: When to Enroll

Medicare Part A If you already receive benefits from the Social Security Administration or the Railroad Retirement Board, you are automatically entitled to Medicare Part A and Medicare Part B; no action is required on your part to enroll. If you do not meet the criteria listed above, then you must enroll in Medicare during the period beginning three months before you turn 65 and ending three months after your birthday.
Source: gohealthinsurance.com

Financial Assistance Options for Adaptive Driving

Toyota: the Toyota Mobility Assistance Program provides cash reimbursement of up to $1,000 of the cost of any aftermarket adaptive equipment or conversion, for drivers and/or passengers, when installed on any eligible purchased or leased new Toyota vehicle within 12 months of vehicle purchase or lease. The cash reimbursement will be provided for the exact cost to purchase and install qualifying adaptive driving or passenger equipment for transporting persons with physical disabilities. The program also applies to purchasers of the Toyota Factory Installed Auto Access Seat, where the full $1,000 cash reimbursement will be paid directly to you. Only vehicles sold or leased and delivered to a retail customer by an authorized Toyota Motor Sales, U.S.A. Inc. dealer are eligible under this program.
Source: govdelivery.com

Romney’s “60 Minutes” Fix For Social Security and Medicare

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

Time to Ponder Open Enrollment for Medicare

Howard has been active in financial and estate planning since 1991, Howard started his career with MetLife after college. Howard has become an authorized representative of Tarkenton Financial, LLC, a national marketing company, in order to make available to his clients numerous options in order to protect their financial future. Howard currently lives in the Clearwater, Fl area with his wife Laura and their 5 children. There family is active in the many water activities in the area and are big Tampa Bay Rays fans.
Source: tarkentonfinancialofclearwater.com

Is my federal employee health plan a better deal than Medicare?

That said, Naumann does suggest signing up for Medicare Part A as soon as you are eligible because it covers some hospital-related costs not covered by FEHB. What’s more, Medicare Part A doesn’t require a premium if you or your spouse have paid into Medicare for at least 10 years. For Medicare parts B, C and D, however, just remember that premiums are risk-adjusted, so the longer you wait to enroll, the higher the premiums you will have to pay.
Source: cnn.com

Practical Insights: Dealing with Medicare Part B and COBRA Coverage

Generally, the Socal Security Act provides that individuals may enroll in Medicare Part B (which covers doctors visits and other outpatient services) when they reach age 65. If they fail to do so during a seven-month initial enrollment period surrounding their 65th birthday, they can enroll during an annual “general enrollment” period that occurs each January 1- March 31, with coverage becoming effective the following July1, though they will incur a penalty in the form of permanently higher Part B premiums (10% increase for each year of available coverage that is foregone). However, actively employed individuals who have employer-provided health coverage can postpone signing up for Medicare Part B until after age 65. When they lose the employer-provided coverage or terminate employment, whichever happens first, they are then provided an eight-month “special enrollment period” (“SEP”) during which they can sign up for Medicare effective immediately and without penalty.
Source: fordharrison.com

Ask The Experts: Retirement

Posted by:  :  Category: Medicare

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

Video: Medicare Eligibility

Daily Kos: Romney/Ryan will raise Medicare eligibility age for current seniors

If the increases in eligibility age are raised now because of the fiscal “crisis” and those under 55 are supposed to be dumped altogether, what guarantee is being offered that a further “crisis” caused by counter-productive Republican policies won’t prompt them to reduce eligibility further?  If their solution hastily offered now is to cut eligibility, why would that not be their preferred option during the next manufactured “crisis?”  The Republicans have already let it be known that they will never look at increasing revenues through upward changes in the tax rates, so any total revenue increases must come disproportionately from increases in the national economy, except they’ll have already cut taxes further reducing revenues.  Why should they get a third shot at dynamic scoring for revenue increases when the prior experiments under Reagan failed and Bush II totally cratered the economy?  
Source: dailykos.com

Issue Worth Exploring: Raising the Medicare Eligibility Age May Harm Minorities

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Source: reportingonhealth.org

Should The Eligibility Age For Medicare Be Raised?

Maya MacGuineas, president of the Committee for a Responsible Federal Budget, makes the case for raising the eligibility age. Arguing to leave it unchanged is Aaron E. Carroll, the associate director of Children’s Health Services Research at Indiana …
Source: newamerica.net

Medicare Proposal Pros and Cons

Proposed changes to the program include raising the eligibility age to 67, raising payroll taxes and requiring better-off beneficiaries to pay more. The most politically contentious plan, devised by Rep. Paul Ryan (R-Wis.), chairman of the House Budget Committee, would limit federal spending on Medicare and alter the way the government pays for benefits. Republicans say this plan is a fiscally responsible way of extending Medicare’s viability as millions of boomers enter the program. Democrats call it "the end of Medicare as we know it" and a way to shift more costs to beneficiaries.
Source: aarp.org

More on raising the Medicare age

As a stand-alone policy, there is no doubt that raising the Medicare eligibility age this is a bad one. And doing so assumes the implementation of exchanges under the ACA. However, I am open to raising the Medicare age in a manner that equalizes it with the Social Security retirement age as part of a broader political deal that either brings about federally-guaranteed universal catastrophic coverage or an agreement to move ahead with implementation of the ACA that makes reform the responsibility of both parties. For many Conservatives, a move such as this one is a strong signal of seriousness in addressing long range health care cost problems. As I say, I don’t think they are correct, but there is a policy logic of increasing the age along with Social Security increases given that they have been linked for so long. In the end, I would potentially agree to this, so long as what is gained in return is consequential enough.
Source: samefacts.com

Do You Have Questions About Medicare Eligibility?

If a person receives Social Security benefits, they are automatically signed up for Medicare. However, if you are 65 and delay receiving Social Security, you may still sign up for Medicare, but this will not be done automatically. You will need to personally contact the Social Security Administration to receive this benefit. You are also not automatically signed up when your spouse is eligible or signed up for benefits. You must sign up for Medicare coverage individually and this may be done online, or by making an appointment and visiting your nearest Social Security office.
Source: todaysseniors.com

Private Insurance in Medicare: Language and Details

Posted by:  :  Category: Medicare

Medicare for All! by juhansoninCompetitive bidding occurs when the amount of a voucher provided to a patient with which to purchase private health insurance is determined by the actual cost of an insurance policy that covered a set of services (defined benefits) in a given health care market. This price would differ by market, and would be set through competitive bidding, in which insurance companies were each seeking as much business as possible. Setting the voucher amount at the price at which the lowest bid company was covering the specified benefit package would incentivize other insurance companies to aim to provide better care for less money and therefore gain market share. Insurers could compete on provider network, wellness programs, or internal efficiency. If insurers charged a higher premium than this competitive bid standard for a given area, the patient would have to be willing to pay the extra amount if they wanted to sign up for the higher priced plan, as the government would only pay the lowest bid amount in a given market. If properly constructed, cost could drop and quality could increase.
Source: wordpress.com

Video: Top 10 Medicare Insurance Tips

Several Companies Ending Medicare Advantage Plans in Wyoming

Option 1: Participants can join another Medicare health plan, if one is available in their area. Most Medicare health plans include prescription drug coverage. If the plan does not have drug coverage, participants under these Medicare Advantage Plans will need to join a separate Medicare prescription drug plan to get prescription drug coverage. Option 2: Participants can change to standard Medicare. Standard Medicare is fee-for-service coverage managed by the federal government. If choosing standard Medicare, participants will need to join a separate Medicare prescription drug plan to get prescription drug coverage. Participants may also want to buy a Medicare Supplement Insurance (Medigap) policy to fill in the gaps in original Medicare coverage.
Source: kgab.com

Open Enrollment Season is Here: eHealthInsurance Releases Top Seven Consumer Health Insurance Tips / eHealth

. Pay attention to your premium contributions and look out for increases in these costs compared to last year. In order to gauge the full cost of your employer health insurance plan, find out how much your employer pays toward premiums both for yourself and your dependents. Remember that if you are laid off and enroll in COBRA in 2013, you’ll likely be required to pay the combined total of what is currently paid by both yourself and your employer in order to maintain your coverage. 2. Review ALL your options:  Start reviewing every plan available from your employer as soon as you receive your open enrollment packet. Look carefully through each “Summary of Benefits and Coverage” form you receive in order to understand what your costs may be for medical care rendered under each plan. For good measure, check your options in the individually-purchased health insurance market too. Health care reform has strengthened the benefits offered under most individually-purchased health insurance plans. While many group plans may still provide more robust coverage and will cover pre-existing medical conditions, individually-purchased plans may offer a stronger alternative than they did a couple years ago – especially for persons who can no longer afford employer-based coverage. 3. Shop smarter: If possible, enroll in a plan that only covers the services you need most. Doing so may allow you to save money on your monthly premium.  A plan that covers chiropractic care, for example, may not be important to you. Or, if you don’t care about brand-name drugs, see if your employer offers a plan covering only generic drugs instead. Choosing a high deductible plan may be smart for some because it typically reduces your monthly premiums, but be prepared to pay the amount of the deductible in the coming year if serious health care needs arise.
Source: ehealthinsurance.com

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

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

Insurance Agents Look to Dataman Group for New Prospects in their Areas — hot news

Dataman Group helps Insurance Agents find the right prospects for the Medicare Supplement Plans they offer. Most Agents simply select prospects in the zip-codes/counties closest to their location and select those individuals that recently turned 65 or are Turning 65 in the next few months.  These individuals must sign up for a program no later than December 31st and smart marketers will contact prospects in their area as soon as possible.
Source: blogspages.com

Deficit Continues To Be Test For Obama

The Hill: Planned Parenthood Targets Romney In New Swing-State Ad Planned Parenthood’s political wing is launching a new television ad calling Mitt Romney “out of touch” on women’s health — the latest attempt by the group to alienate women voters from the GOP presidential ticket. The new 33-second spot will air this week in Virginia and next week in Ohio. Both markets are swing states where the women’s vote will be crucial to the result of the election. “The Republican ticket needs to be held accountable for their out-of-touch policy positions that would have a disastrous and measurable impact on women and their families,” Planned Parenthood Action Fund (PPAF) executive vice president Dawn Laguens said in a statement on the ad buy (Viebeck, 9/25). The Hill: Team Obama Jumps On Romney For Saying ERs A Care Plan For Uninsured President Obama’s campaign is targeting Mitt Romney for saying that uninsured Americans can seek care in emergency rooms. The Obama team released a Web video Monday night juxtaposing the GOP presidential nominee’s remark to CBS with previous, contradictory statements he made about ER care in 2010. The Obama video charges that the former governor “knows ER treatment is expensive and inefficient, so why does he say it’s a solution now?” (Viebeck, 9/25).
Source: kaiserhealthnews.org

ONLY ON 3 UPDATE: Injured man on Medicare is able to stay in hospital to await surgery

Tom, I know portions have kicked in, like the part that removed the lifetime cap on benefits. This alone saved us from financial ruin when my wife came down with cancer. I am sure more provisions will be forthcoming. What gets me is all these people have moaned and groaned for years about having to foot the medical bills for those who choose not to carry insurance. Obama did something about it and they are still whining. Probably most of those who are complaining the most are the ones that will have to slack off on their Marlboros, cheap beer, tattoos and piercings and use that money to buy insurance.
Source: wwaytv3.com

Preventive & screening services

The 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

Medicare Part D Premiums Holding Steady

Posted by:  :  Category: Medicare

Medicare Part D Press Conference (44) by Korean Resource Center 민족학교Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

Video: Medicare Part D and Prescription Drugs

Most Medicare Part D beneficiaries not in low

An analysis of more than 100,000 user sessions on PlanPrescriber.com found only 5 percent of customers were in the Medicare prescription drug plan (PDP) with the lowest total out-of-pocket costs available to them. Only 24 percent of customers were in the Medicare Advantage prescription drug (MAPD) plan with the lowest total out-of pocket costs.
Source: lifehealthpro.com

Agency: Medicare refills strong drugs despite law

The Centers for Medicare and Medicaid Services said in response to the report that the inspector general was misinterpreting partial “fills” dispensed to patients in long-term care facilities as refills. Partial fills occur when a pharmacist does not dispense all doses of the prescribed medication at one time. But the report said there was little evidence of that.
Source: theolympian.com

Social Security and You: Medicare Part D

While all Medicare beneficiaries can participate in the prescription drug program, some people with limited income and resources also are eligible for “Extra Help” to pay for monthly premiums, annual deductibles and prescription co-payments. Extra Help is worth about $4,000 a year. To figure out whether you are eligible for Extra Help, Social Security needs to know your income and the value of any savings, investments and real estate (other than the home you live in). To qualify, you must be receiving Medicare and your annual income must be limited to $16,755 for an individual or $22,695 for a married couple living together.
Source: mysanantonio.com

Medicare Part D 2012 Data Spotlights

The Kaiser Family Foundation has issued this collection of analyses related to the Medicare  Part D stand-alone drug plan options available to seniors in 2012. These spotlights focuses on key aspects of the drug plan choices available and relevant trends since the Medicare drug benefit took effect in 2006. They were prepared by a team of researchers at Georgetown University, NORC at the University of Chicago and the Kaiser Family Foundation. Analysis Of Medicare Prescription Drug Plans In 2012 And Key Trends Since 2006
Source: kff.org

Medicare Part D Exclusion of Benzodiazepines and Fracture Risk in Nursing Homes

Following the enactment of Medicare Part D, Tennessee was the only state to forgo supplemental coverage for benzodiazepines; when benzodiazepine prescriptions declined, nursing home residents in Tennessee experienced more falls and hip fractures.Benzodiazepines are controversial sedatives. Enacted in 2006, Medicare Part D excluded reimbursements for benzodiazepines. However, most state Medicaid programs continued to provide supplemental coverage for benzodiazepines.
Source: rwjf.org

Medicare Part D Notice Due Before October 15th

       You may distribute the Notice electronically if you follow the same electronic disclosure requirements that apply to summary plan descriptions (SPDs), except you should inform the participant that he/she is responsible for providing a copy of the disclosure to his/her Medicare-eligible spouse and/or dependents eligible for coverage under the plan (otherwise, you will need to separately send them a hard copy notice) and you must post the Notice on your website (if you have one) with a link on your home page to the Notice.
Source: hr-benefit.com

Spreading the Word on Medicare Part D

Ten thousand baby boomers will turn 65 today. This will happen again tomorrow, the next day and every day until 2030. With such a significant growth in Medicare eligible Americans, ensuring effective coverage and access to medicines well into the future is a priority. As New York Times’ blogger Paula Span noted on The New Old Age recently, Medicare Part D is providing stability for millions of seniors. From Span’s post:
Source: phrma.org

Compliance Alert: Medicare Part

As part of the Patient Protection and Affordable Care Act of 2010 (ACA), Plan Sponsors with group health plans which include prescription drug benefits now must provide the annual Part-D Creditable Coverage Notice by October 15, 2012. Before 2011, Plan Sponsors were to provide the notice no later than November 15, the first day of the Medicare Part-D open enrollment period. ACA changed the Part-D open enrollment to be the period between October 15 and December 7.
Source: andreini.com

Medicare Part D Selection Appointments Available

Each year Fearrington Cares offers help to those puzzling over the choices and options for the Medicare Part D drug program. Each year, our resident SHIIP (Senior Health Insurance Information Program) volunteer Joe Geoghegan helps dozens of Village residents save thousands of dollars on their elections. This year appointments with Joe will be on Tuesdays, Thursdays and Fridays between 12:00 and 3:00 p.m., October 5 to December 2. You must call the office (919-542-6877) for an appointment, which takes about 30 minutes. Couples should schedule two consecutive sessions or separate half hour times. Bring your Medicare card, list of medications, other insurance information and the print out from last year if you met with Joe in 2011.  Call for more information or to reserve your session.
Source: fearringtoncares.org

Medicare Part D Open Enrollment

Bipolar II, Depressed, Severe, w/ Atypical Features; Panic Attacks & PTSD; Alcoholic, in recovery since 3/21/07 Aplenzin 522mg; Pristiq 150mg; Lamictal 400mg; Geodon 160mg; Propranolol 160mg BID; Ativan 1mg BID; Deplin 15mg; Xanax PRN.

Billions Spent to Make Medicare More Efficient Make Medicare More Expensive

Posted by:  :  Category: Medicare

Medicare by 401(K) 2012In the wake of the two payment reforms, hospitals began to manipulate the system through “upcoding”—systematically shifting patients into higher-paying DRGs. Research by economists at Dartmouth University suggests that during the early 1990s, hospital administrators figured out ways to substantially increase the number of Medicare cases they billed to higher-paying DRGs. Payment games continue today. In October the Senate Finance Committee released a report accusing several large home health care companies of abusing Medicare’s payment rules by pushing employees to perform extra therapy visits, thereby qualifying for Medicare bonus payments, even when those visits weren’t strictly necessary. But for many health care providers, that’s the business. Hospital administrators “are people whose job it is to game the system,” Kling says. “They know every little detail of the rules.”
Source: reason.com

Video: Medicare

Polls: Obama Scores Higher In Trust On Medicare

The Hill: Poll: Four In 10 Believe In Obama Health Care Law ‘Death Panels’ About four in 10 U.S. adults believe that President Obama’s healthcare reform law will create “death panels” to decide patients’ fitness for care, according to a new Associated Press-GfK survey. Support for the widely challenged claim has remained steady since 2010, when 39 percent believed “death panels” would result from the healthcare law. Today, 41 percent say the same is true. Overall, most people believe the law will go into effect in spite of Republican pledges to repeal it (Viebeck, 9/26).
Source: kaiserhealthnews.org

Wisconsin’s Thompson boasts about ‘doing away with’ Medicare

But as a strategic matter, this is a symptom of a larger problem. Tommy Thompson used to be a relatively moderate Republican, at least by contemporary standards, uncomfortable with far-right extremists. As his party has become radicalized, however, Thompson has been forced to scramble to convince his base that he’s sincere in his support for an extreme agenda.
Source: msnbc.com

Several Companies Ending Medicare Advantage Plans in Wyoming

Option 1: Participants can join another Medicare health plan, if one is available in their area. Most Medicare health plans include prescription drug coverage. If the plan does not have drug coverage, participants under these Medicare Advantage Plans will need to join a separate Medicare prescription drug plan to get prescription drug coverage. Option 2: Participants can change to standard Medicare. Standard Medicare is fee-for-service coverage managed by the federal government. If choosing standard Medicare, participants will need to join a separate Medicare prescription drug plan to get prescription drug coverage. Participants may also want to buy a Medicare Supplement Insurance (Medigap) policy to fill in the gaps in original Medicare coverage.
Source: kgab.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

Using Medicare Advantage to Gain Political Advantage

It is almost certainly true that quality suffers when reimbursement rates are reduced. It is also appears to be true that competition amongst private providers in Medicare Advantage is leading to efficiencies that aren’t present in traditional Medicare, which we should probably take as a lesson. It is also often the case that when the government pays more for something, it spends more, and when it pays less for something, it spends less. But what all this really reveals is the folly of trying to control health spending through government-designed payment schemes. 
Source: reason.com

Agency: Medicare refills strong drugs despite law

The Centers for Medicare and Medicaid Services said in response to the report that the inspector general was misinterpreting partial “fills” dispensed to patients in long-term care facilities as refills. Partial fills occur when a pharmacist does not dispense all doses of the prescribed medication at one time. But the report said there was little evidence of that.
Source: newson6.com

Colorado’s Medicaid Cost Drivers

Posted by:  :  Category: Medicare

Health policy discussions often focus on controlling the cost of the sophisticated medical care that is provided to relatively few people. Outside of this blog, relatively few people pay attention to the impact of routine costs like the cost of an extra physician visit for each of 150 million people. This is one reason why so many people are surprised by the fact that consumer directed health plans with proper incentive structures can lower health care expenditures by as much as 20 percent without compromising health or externally rationing care. It also explains why so many Medicare commentators have difficulty understanding how the Ryan Medicare reform plan might work.
Source: ncpa.org

Video: Nursing Home Medicaid protects your assets from nursing homes

New Efforts To Improve Medicaid in California, Colorado

The Lund Report: Governor Kitzhaber Seeks To Expand Coordinated Care Organizations With coordinated care organizations – better known as CCOs — in full swing for the Medicaid population, Governor John Kitzhaber is setting his sights on the next targets – people on Medicare, the state’s public employees and the private business sector. “The biggest challenge with Medicare is that it’s not a sustainable model,” the governor told Beaverton residents last week at a town hall meeting hosted by Sen. Mark Hass (D-Beaverton). Why not allow people on Medicare to participate in a CCO on an “experimental basis,” he suggested (Lund-Muzikant, 9/12).
Source: kaiserhealthnews.org

W. Colorado Moves Forward on Primary Care Initiative, Payers Resist

Glenn Kotz, M.D., solo-practitioner at MidValley Family Practice, one of the CPC initiative sites, says “the basic EHRs need to beef up their processes.” He adds that the federal government has not mandated that EHRs perform specific patient-centered medical home processes. “That information, that kind of process within the EHR, all the vendors need to spend a lot money to get what we need in there,” Kotz adds. “We need more care coordination templates or workflows. Our biggest first step is going to be how do we get consults or data in from outside sources, and push it into our EHR in a way that makes sense for us to process that.”
Source: healthcare-informatics.com

Accountable Care in Colorado: Proving the Skeptics Wrong

First, move from a never-event philosophy to a best-practice philosophy. “It’s very important to have processes in place to make sure that never events do not occur, such as wrong site surgery or wrong patient procedures,” he says. Yet some events that are not completely avoidable such as aspiration pneumonia or fluid overload. Clinicians know that some outcomes are tied to the underlying condition. Dr. Wadhwa suggests establishing target benchmarks for avoidable events, but not creating “unrealistic expectations that these events will never occur.”
Source: wordpress.com

Colorado Printable Medicaid Application Form PDF File

This is a question that can only be answered by a social worker in the state of Colorado.  That being said, there are plenty of great resources that will help individuals to do research by themselves.  There are plenty of opportunities to gain access to government help if you are willing to do a little bit of extra homework.  By accessing this link most low income individuals and families will find there are income maximums.  Remember that the maximum amount is different based upon the people living in the household and the state in which you live.
Source: jwtaxhelp.com

Should Colorado expand Medicaid per ObamaCare? No.

There is a better way:  Allow people on Medicaid the option of private insurance so they can get coverage through private competing plans. Florida has a successful model underway. These plans could provide much better access to physicians, coordinate care for patients with multiple health problems, and allow patients to be seen in doctors’ offices rather than in expensive hospital emergency rooms.Patients would have the dignity of private coverage, and safety-net hospitals will be able to keep their doors open so they can continue their mission of caring for the poorest and neediest in our society.
Source: patientpowernow.org

Special Considerations for Creating Medicaid Accountable Care Organizations (ACOs)

Where there are already HMOs, Rojeski notes that states are looking for ways to embed the concept of an ACO within the HMO structure as a way of enhancing quality and helping control cost. “Replacing the PCCM model with an ACO makes sense—it preserves fee-for-service while creating much stronger incentives for efficiency,” Rojeski says. “State Medicaid financing has become very complex. Because of this, as well as the need to consider diverse patients and multiple payment models, states will have to do a thorough and complicated data analysis to think through the best ACO structure, processes, controls and implications of adopting an ACO approach.”  
Source: optum.com

Gerou’s Medicaid pilot program signed into law

Under the new law, Medicaid providers will submit program proposals to the Department of Health Care Policy and Financing that outline potential improvements for the state’s Medicaid payment process. DHCPF will establish trial periods for programs that show potential in streamlining administrative structures and contract management for Medicaid managed care.
Source: coloradohousegop.com

Why Medicare Supplemental Insurance Cover is Important for Senior Citizens? at Maximum Performance Begins With A Healthy Body

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe most popular Medicare supplement plans are Plan F, G, and N. Even though there are several Medigap policies out there on the market, the above mentioned ones are highly popular and account for more than 91 percent of Medigap sales. The Medicare supplement insurance policy’s plan F offers highest coverage, and it is also famous as “Cadillac” plan. Plan G offers best value for money, and Plan N is cheapest Medigap plans, but offers less benefits.
Source: procureperformance.com

Video: California Medicare Supplement Insurance Plans 1-800-243-8100

Insurance Agents Look to Dataman Group for New Prospects in their Areas — hot news

Dataman Group helps Insurance Agents find the right prospects for the Medicare Supplement Plans they offer. Most Agents simply select prospects in the zip-codes/counties closest to their location and select those individuals that recently turned 65 or are Turning 65 in the next few months.  These individuals must sign up for a program no later than December 31st and smart marketers will contact prospects in their area as soon as possible.
Source: blogspages.com

Medicare Supplemental Insurance Plans

These plans generally only cover medical fees and services that are covered under Medicare and are considered medically necessary. However, these policies do occasionally offer coverage outside of typical Medicare coverage such as emergency medical treatment while traveling thoughout of the county, which is an option that Medicare does not cover. Another great benefit of a Medicare supplemental insurance plan is that you are able to keep your own doctors and specialists without ever needing a referral.
Source: seniorcorps.org

A Look Into Medigap Supplemental Plans

Medicare Supplement Insurance Plan F offers a few drawbacks as well.  It comes down to math and the cost of insurance verse the costs that arise with plan increases and actual deductible paid.  Other plans cost much less when paying the monthly premium.  Consider if you are paying $45 more a month for Plan F than another supplemental plan that does not cover the deductible of Plan B which is about $170 bucks.  You are paying upwards of $500 so that you don’t have bills coming in for you to pay for the deductible.
Source: seniorhealthdirect.com

California Medicare Supplement Plans Blue Shield

each month for 12 months on your Medicare Supplement Plan rates.To qualify, you must be age 65 or older, and Blue Shield must receive your application within six (6) months of the date you first enrolled for benefits under Medicare Part B. Savings will be effective for the first twelve 12 months of your plan dues.The Welcome to Medicare Rate Savings is available for all Medicare Supplement Plans that Blue Shield of California offers. You can also take advantage of our two-party rates and Easy$Pay
Source: mattlockard.net

The Talk About Anything Blog

There are many plans when it comes to available Medicare Supplement Insurance. The thing to keep in mind is that all of these plans follow the guidelines established by Medicare. This is great news because it means that the people who set up the plans already know what needs to be covered by the plans they offer. This saves everyone time and money in the long run of things.
Source: curlingserbia.com

2012 Medicare Open Enrollment Period

You can also enroll for the first time in a Part D plan during AEP if you did not enroll during your open enrollment window when you first became eligible for Medicare Part B.  If you do not have credible drug coverage, you may be subject to the Part D late enrollment penalty.  This penalty is calculated by adding 1% to your premium for each month you were not enrolled and should have been.
Source: ohioinsureplan.com

What Is The Benefit of A Medicare Supplement Insurance Plan?

A Medicare supplement insurance plan will cover the deductibles for Medicare Part A and Part B in addition to covering costs of coinsurance. All plans are standardized and provide the same basic coverage. This means that all the plans are the same and will not vary from insurance company to insurance company. The difference for any type of policy is the price charged by the insurance company.
Source: todaysseniors.com

Find Medicare Supplemental Insurance in Your Area With the Senior Advisor Group

The Senior Advisor Group is an independent insurance advisory group specializing in Medicare insurance and other insurance options for those on Medicare. Their role is to assists seniors in finding with the best Medicare Supplemental Insurance, including advice on Supplemental Plans, Advantage Plans, Medicare Part D insurance and other related supplemental insurance. By partnering with over 40 different insurance companies, the Senior Advisor Group works on the side of the client’s with no obligation to any one insurance company. For the individual client they will search from all of the top insurers to find the best products at the best price – as well as provide ongoing professional, personalized service to each Medicare beneficiary year after year. The Senior Advisors also provides clients on Medicare with dental, hearing, and vision coverage, as well as Rx discount cards at no cost to customers. As a national advisory group, Senior Advisor Group represents all of the top rated and the largest Medicare supplemental insurance providers available. Their objective is to provide unbiased advice on Medicare Supplemental Insurance from highly trained, Medicare insurance specialists. Each specialist is trained on the various Medicare Insurance options, and will assist each individual with a plan selection, and provide continual advice year after year on Medicare supplement plans and Medicare Part D coverage. As Medicare insurance specialist, Medicare Insurance is not just a part of their business it is their business. The Senior Advisor Group was established to deliver what insurance companies can’t – unbiased and objective advice. They will assist and complete enrollment in the best available plan for the client, not the best available plan for the provider. For those new to Medicare or just looking to compare coverage options simply submit a request and one of their specialist will call within 24 hours.
Source: sbwire.com

What Is The Best Method For Making A Medicare Supplement Plans Comparison?

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSA list of physicians and healthcare professionals, by geographical location, can be found on the official Medicare website: https://questions.medicare.gov/find-a-doctor . This is an easy and convenient method to find participants in local areas. Every year there is an open season when individuals have the opportunity to make a Medicare supplement plans comparison to ensure both providers and services will continue. As with the original Medicare Parts A and B, the monthly fees for Medicare supplement plans are reviewed and adjusted on an annual basis. The Medicare monthly costs for Parts A, B, and D can be found at www.medicare.gov/costs/ . Supplemental insurance carriers will notify participants of any changes in annual fees or altered services during the November to December timeframe. Anyone who wants to change or drop a current insurance carrier can do so during the annual open season, January through March. Comparing costs today will lower individual expenses tomorrow.
Source: seniorcorps.org

Video: Compare Medicare Supplement Plans | Supplemental Medicare Insurance

Today’s Influence Ads: AARP Medicare Supplement, Shale Gas Production

A slew of new ads are out today as Congress embarks upon its last week before the elections. AARP and UnitedHealthCare have a new ad today promoting AARP Medicare Supplement Insurance Plans as the only standardized Medicare supplement plan that AARP  endorses. American Clean Skies Foundation has a new ad pushing for the production of shale gas in the United States. The government of Panama’s new ad promotes the country as a good place for American businesses to invest. And Across the Aisle Foundation has a new ad inviting senior House and Senate staffers from both parties to an October event to discuss how the new Congress should tackle its first 100 days. Others with new ads, per Kantar Media’s Washington Eye, include: American Petroleum Institute, American Sugar Alliance, American Veterinary Medical Association, Consumer Electronics Association, Employee Freedom Act Committee, Fair Search, Lockheed Martin, McDonald’s, Neustar and Radiation Therapy Alliance. Those with continuing ad include: Altria, American Cancer Society, American Council of Life Insurers, American Hospital Association, AT&T, Beirut Families, Boeing Company, BP, Chevron, CIT Group, CME Group, Hologic, Honda, Huntington Ingalls Industries, Lockheed Martin, Mars Chocolate, Northern Dynasty Minerals, Nuclear Energy Institute, Pfizer, Pharmaceutical Research Manufacturers of America, Southern Company, United Soybean Board, Univision, WellPoint, WTOP and Zurich.
Source: nationaljournal.com

California Medicare Supplement Plans Blue Shield

each month for 12 months on your Medicare Supplement Plan rates.To qualify, you must be age 65 or older, and Blue Shield must receive your application within six (6) months of the date you first enrolled for benefits under Medicare Part B. Savings will be effective for the first twelve 12 months of your plan dues.The Welcome to Medicare Rate Savings is available for all Medicare Supplement Plans that Blue Shield of California offers. You can also take advantage of our two-party rates and Easy$Pay
Source: mattlockard.net

Comparing Medicare Plans Side

About eHealth  eHealth, Inc. (NASDAQ: EHTH) is the parent company of eHealthInsurance, the nation’s leading online source of health insurance for individuals, families and small businesses. Through the company’s website, www.eHealthInsurance.com, consumers can get quotes from leading health insurance carriers, compare plans side-by-side, and apply for and purchase health insurance. eHealthInsurance offers thousands of individual, family and small business health plans underwritten by more than 180 of the nation’s leading health insurance companies. eHealthInsurance is licensed to sell health insurance in all 50 states and the District of Columbia, making it the ideal model of a successful, high-functioning health insurance exchange. Through eHealth’s technology solutions (www.eHealthTechnology.com), is also a leading provider of health insurance exchange technology. eHealth provides a suite of hosted e-commerce solutions that enable health plan providers, resellers and government entities to market and distribute products online. eHealth, Inc. also provides online tools to help seniors navigate Medicare health insurance options through PlanPrescriber.com (www.planprescriber.com) and eHealthMedicare (www.eHealthMedicare.com).
Source: ehealthinsurance.com

Insurance Agents Look to Dataman Group for New Prospects in their Areas — hot news

Dataman Group helps Insurance Agents find the right prospects for the Medicare Supplement Plans they offer. Most Agents simply select prospects in the zip-codes/counties closest to their location and select those individuals that recently turned 65 or are Turning 65 in the next few months.  These individuals must sign up for a program no later than December 31st and smart marketers will contact prospects in their area as soon as possible.
Source: blogspages.com

Senior Summit Coming to Western Oklahoma

The Oklahoma Insurance Department’s Medicare Assistance Program (MAP), in collaboration with SWODA Area Agency on Aging, will hold their annual Senior Summit on Thursday, September 27, from 9 a.m. to Noon. The Senior Summit is an annual community training event focused on educating Medicare beneficiaries in the main components of Medicare. Topics include: • Medicare Basics • Medicare Supplement plans • Medicare Prescription Drug Plans • Long Term Care Insurance • Medicare Advantage Plans
Source: cheyennestar.org

Medicare Supplement Plan Comparison Explanation

Medicare Supplement Plan K is a Medigap plan choice that is quite a departure from the previous plans. This plan offers comprehensive preventative care coverage, part A hospital co-insurance and  hospitalization coverage for one year. It covers up to half of costs from the Medicare Part A deductible and half of skilled nursing facility costs.  Covers 50% of first 3 pints of blood.  This plan has a maximum out-of-pocket limit of $4,660 per year, at which point plan covers 100% of covered costs that calendar year.
Source: medicaremedigaprates.com

Compare Medicare Supplemental Insurance Plans and View Rates Online

Anyone that has individuals and their family that are on Medicaid, know exactly how much of a hassle it can be to try to live with just Medicaid. This is why many people look for supplemental insurance to their Medicaid, in order to pay for the expenses that they have on a day-to-day basis. There are many things that need to be taken into account when you are analyzing these companies, including what they are going to be able to provide. Senior Health Direct is able to provide excellent supplemental insurance health plans to seniors that are looking for a little something on top of the government services that are provided to them. They strive to help every senior with low cost health insurance, that can make their lives much easier than just relying on the Medicaid that they currently have.
Source: pressreleaseprint.com

'''How Much Does Medigap Insurance Cost?

Original Medicare includes Part A Hospital Insurance andPart B Medical Insurance pays for many, but not all, health-related services and medical supplies. You should purchase an insurance policy to cover the “gaps” that are not paid for by Medicare, such as copayments, coinsurance, and deductibles.
Source: georgia-medicareplans.com