Puerto Rico Medicare beneficiaries save $110M under ‘Affordable Care Act’

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboil“In just the last two months, the total amount that Puerto Rico Medicare beneficiaries have saved on prescription drugs has increased by about $15 million, and now totals $111,427,280. In addition, according to a report released this week by HHS, the average person with original, fee-for-service Medicare will save a total of $5,000 from 2010 to 2022 as a result of the ACA. Medicare beneficiaries with high prescription drug costs will save much more — about $18,000 — over the same time period,” said Pierluisi.
Source: newsismybusiness.com

Video: Avoiding the coverage gap on Medicare Part D

Medicare Part D Coverage Gap

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com
Source: seniorliving.net

What Sort Of Medicare Gap Coverage Will I Need In Retirement?

All health insurance companies offering Medicare gap coverage or Medigap policies in your state need to offer Plan A. Medigap polices will range from Plan A through Plan N. However, Plans E, H, I and J, are no longer offered for sale. Plan C and Plan F also must be offered if any other plan is being sold. A policy for Medicare gap coverage will be standard to easily compare among other available plans. Your Medigap policy does not cover the costs of long-term care, dental care or vision.
Source: seniorcorps.org

Medicare coverage gap associated with reductions in antidepressant use in study

According to study results, being in the gap was associated with comparable reductions in the use of antidepressants, heart failure medications and antidiabetics. Relative to a comparison group that had full coverage in the gap because of Medicare coverage or low-income subsidies, the no-coverage group reduced their monthly antidepressant prescriptions by 12.1 percent and reduced their use of heart failure drugs by 12.9 percent and oral antidiabetics by 13.4 percent. Beneficiaries with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9 percent, a reduction attributable to reduced use of brand-name antidepressants, researchers note.
Source: sciencecodex.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

How the Candidates Compare on Medicare

An infographic at Whitehouse.gov notes that the Affordable Care Act increases federal sentencing guidelines for health care fraud offenses by 20% to 50% for major fraud crimes. It also points out that the Obama administration’s efforts on fighting Medicare fraud has returned $10.7 billion dollars to the Medicare Trust Fund since 2009.
Source: families.com

Donkeys and Elephants on Medicare

In the interest of fair reporting, which we seldom seem to get these days, the following chart illustrates the positions of the two major political parties on the subject of Medicare.  You may draw your own conclusions or opinions, I just wanted you to have an unbiased account of where the two political parties stand on the issue that will affect every single person when they become age 65.  Social Security is another major government obligation that is having funding difficulties but has not been addressed in detail by either political party.  When the Social Security program is nearer collapse, our government, that is both sides, will do something about it.  (Oops, there goes my fair reporting.  I am blaming politicians as a whole though!)
Source: divacfo.com

Medicare, Health Care Reform and 2013…

Five Star Ratings on Medicare Advantage Plans – To encourage Medicare Advantage plans to provide quality care, the ACA authorized Medicare to pay bonuses to Medicare Advantage plans, beginning in 2012, if they receive four or five stars on Medicare’s new five-star quality rating system. And, plans that received a 5 star rating would be able to enroll customers year-round; not just during Medicare’s annual enrollment period (AEP). (Source) The rating system measures how well plans: help customers stay healthy; perform on numerous customer satisfaction measures; price and safely administer drugs; and provide Medicare.gov updated plan information.
Source: ehealthinsurance.com

Consider Getting a Medigap Policy From United Healthcare

When looking at united healthcare medicare supplements phoenix az, it may be a good idea for senior citizens to get choose their Medigap policy sooner rather than later. During the first time enrollment for Medicare, there is no medical underwriting for entering any of these policies. However, insurance companies can deny coverage due to poor health after the initial enrollment in Medicare. That means senior citizens in poor health will never get another chance to enroll in a Medigap policy. Those who are in good health may be able to get a Medigap policy at a later time. But this is a risky way to go. If the senior wants to move to a less generous Medigap policy, that is not a problem. Only a move to a more generous Medigap policy requires medical underwriting. That is why seniors should think about getting Medicare supplement insurance from companies such as United Healthcare upon initial enrollment in traditional Medicare to cover the gaps in coverage.
Source: entrepreneurmena.com

Part D Survey Results Show Nothing but Love from Seniors

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceBut seniors are not simply satisfied with the program – the survey also reveals that Part D is helping them adhere to medication regimens through increased access and affordability. 84 percent of seniors report that their out-of-pocket drug costs would be much higher without Part D and 61 percent would be unable to fill all of their prescriptions. Similarly, 53 percent would be more likely to cut back or stop taking medicine altogether.
Source: phrma.org

Video: Medicare Part D Prescription Drug Coverage

How Is Medicare Financed?

In 2011 Medicare benefit payments totaled $550 billion, funded mostly from three sources; general tax revenues (43%), payroll tax contributions (37%), and Medicare beneficiary premiums (13%). In broad terms, Medicare is financed by two “trust funds”, the Hospital Insurance (HI) Trust Fund and Supplementary Medical Insurance (SMI) Trust Fund, both of which are overseen by a board of trustees that makes an annual report to Congress concerning the financial status of the funds. These two funds pay for the services of its four programs, also known as Medicare Parts A (Hospital Insurance), B (Supplementary Medical insurance), C (Medicare Advantage), and D (Prescription Drug). Of the $550 billion, 35% is allocated to Part A, 30% to Part B, 23% is to Part C, and 12% to Part D.
Source: figuide.com

Nine of 10 Seniors Satisfied with Medicare Drug Coverage (Part D)

The survey shows that overall satisfaction with Part D has increased from 78 percent to 90 percent since the program began. Ninety-six percent say that their coverage works well, while three out of four seniors say it works “very well.”
Source: dmagazine.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

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

Medicare (Part D) Maze, Focus of Casper College Offering

Vicki Pollock, OLLI specialist, says by offering the class they hope to alleviate some of the stress seniors feel as they try to figure out their options. The class covers navigating drug plan options, identifying costs and benefit differences, and maximizing benefits.
Source: k2radio.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

Open Enrollment for Medicare Part D : Hoke County, North Carolina

The Hoke County Health Department Board of Health will hold an open meeting on Monday, October 8, 2012 at 7:00 PM in the Conference Room at the Hoke County Health Department, 683 East Palmer Road, Raeford, NC. Please follow the signs to the meeting room. The public is invited to attend. For further information, please contact the Hoke County Health Department at 910-875-3717.
Source: hokecounty.net

What’s happening at the senior center this week

Beginning Wednesday, Oct. 17 at 9:30 a.m., Fairfield University School of Nursing students will be at the center to offer a workshop focused on fall prevention. Falls are the primary cause of injury in Connecticut’s older adults. The workshop will consist of eight weekly two-hour sessions on fall prevention methods with focus on reducing participants’ risk for falling. The program will help participants set goals for increasing physical activity, and teach exercises to increase strength and balance. The program has proven to increase confidence in the management and prevention of falls. There is significant evidence that fall prevention programs can decrease the rate of falls in older adults. This is a program that all seniors should plan to attend.
Source: darientimes.com

Important! Over 90 percent fail choose the right Part D plan

In Plan Selection in Medicare Part D: Evidence from Administrative Data (NBER Working Paper No. 18166), co-authors Florian Heiss, Adam Leive, Daniel McFadden, and Joachim Winter analyze data on medical claims in Medicare Part D drug insurance programs. They find that fewer than 10 percent of individuals enroll in what for them would be the most cost-effective plans. This is apparently because seniors pay more attention to their out-of-pocket premiums than to the overall benefits of the dozens of drug plans available to them. Equally significant, the researchers believe that how seniors decide whether to enroll in Medicare Part D, and what plans they select, is important not only for management of the Part D program, but also is indicative of how consumers behave in real-world decision situations with a complex, ambiguous structure and high stakes. The researchers add that their findings may yield predictions for how seniors will handle plan choices in the new general health insurance exchanges that will implement the Patient Protection and Affordable Care Act of 2010.
Source: pnhp.org

Maximizing Medicare Prescription Drug Coverage

Posted by:  :  Category: Medicare

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

Video: The National Medicare Training Program: Medicare Prescription Drug Coverage. Part 2 of 2

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

Analysis Of Medicare Prescription Drug Plans In 2012 And Key Trends Since 2006

This report presents findings from an analysis of the Medicare Part D marketplace in 2012 and changes in drug coverage and costs since 2006. It presents key findings related to Medicare drug plan plan availability, premiums, cost-sharing, the coverage gap and availability for low-income beneficiaries, the coverage gap, benefit design and cost sharing, formularies, and utilization management, based on data from CMS for all plans participating in Part D. The analysis was conducted jointly by researchers at Georgetown University, the Kaiser Family Foundation and the National Opinion Research Center at the University of Chicago. 
Source: kff.org

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

It 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

U.S. health insurance updates from Kaiser, EBRI and the Census Bureau; uninsurance related to poor health

Tagged as: 2012 Employer Health Benefits Survey, access to health insurance as precursor to good health, catch-22, Census Bureau, consumer self-rationing of elective procedures, consumer-directed health plans, consumers and employers bearing more health care costs, copayments, declining employment-based coverage, Drew Altman, EBRI, economic slowdown, Employee Benefit Research Institute, financial penalty, forego necessary care, growth of wellness programs, health cost rises leveling off, health insurance for all citizens, health management program, health payment reform, Health Populi, health risk assessments, Health Status Health Insurance and Medical Services Utilization: 2010, high-deductible, HMOs, HRAs, identify people with health risks, increased health coverage rates, increased premiums for employer-sponsored health insurance, insurance coverage as economic development strategy, Jane Sarasohn-Kahn, Kaiser, Kaiser Family Foundation, KFF, Medicaid, Medicare, point-of-service plans, postponing prescription drug fills and refills, PPOs, prescription drug coverage, productive members of society, S-CHIP, Sources of Health Insurance and Characteristics of the Uninsured: Analysis of the March 2012 Current Population Survey, tiered cost-sharing plans, total premium, uninsured making fewer trips to the doctor, uninsured related to poor health, Washington Post, worker contribution
Source: thedoctorweighsin.com

Medicare Part D Coverage Gap

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com
Source: seniorliving.net

Open Enrollment for Medicare Part D Prescription Drug Plans Begins Oct. 15

Hundreds of headlines drew attention to a late September 2012 analysis from consulting firm Avalere Health that showed monthly premiums for seven of the 10 leading Medicare Part D prescription drug plans are slated to increase for 2013. The more important news for beneficiaries and pharmacists, however, would be that open enrollment for all PDPs begins on October 15 and runs until December 7. The enrollment period is the real news because, frankly, the single largest increase in what a Part D beneficiary would pay for any plan each month is $5.99. According to the Centers for Medicare & Medicaid Services, average premiums will hold steady within cents of $30 through next year. Still, a handful of Part D beneficiaries may opt into new plans to save a few dollars each month. More likely, wanting a more comprehensive drug formulary or greater options for having prescriptions filled and dispensed at community pharmacies will prompt coverage changes. As with every year since 2005, pharmacists can do their Medicare patients a great service by identifying which Part D drug plans best meet their coverage needs. If you have tips for advising patients of PDP options, please share them with colleagues in the comments.
Source: about.com

AIDS Healthcare Foundation

As a result and on the heels of a recent pricing agreement on Gilead’s new four-in-one AIDS tablet that was reached with the ADAP Crisis Task Force (ACTF) of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAPs), officials from AHF pressed Gilead to similarly lower the price for Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials also sent letters to private insurers and state health department directors nationwide urging that those programs exclude Stribild from their drug formularies if the drug was not priced price-neutral to Atripla. On September 14, 2012, Janet Zachary-Elkind, Deputy Director, Division of Program Development & Management for the New York State Department of Health responded via letter noting that, “At this time, Stribild is not covered by the Medicaid program,” and that the state is also, “…evaluating coverage options and possible prior authorization requirements to ensure the product is utilized in a medically appropriate and cost effective manner…”
Source: aidshealth.org

Important: Before Open Enrollment Make Sure You Read Your Medicare Plan’s “Annual Notice of Changes”

Formulary.  If you are enrolled in prescription drug plan also known as PDP plan, or have prescription drug coverage included in your Medicare Advantage plan, you’ll receive a formulary. It’s an index of prescription drugs covered by your plan, and includes information on drug co-pays for the coming year.  Your plan may send out either a full or an abridged (shortened) formulary, which would include only the most commonly prescribed drugs.
Source: medicareecompare.com

Is Florida Medicare Insurance Different From Other States?

Florida Medicare Insurance differs because many seniors have trouble paying out-of-pocket co-pays and deductibles after their Florida Medicare Insurance Part A and B pays their share. Currently, Floridians have the highest insurance rates in the country. And, the amount they pay for their Florida Medicare Insurance depends on the county they live in.
Source: seniorcorps.org

Birdseye Financial, LLC: 2013 MEDICARE (Open Enrollment)

 No. You remain in the Medicare system and the advantage of enrolling in a Medicare Advantage Plan is the insurance company becomes your primary payer of healthcare.  When coverage is effective with an Medicare Advantage Company, simply use the ID card you are mailed (not your red, white and blue Medicare card) and present it to contracted Health providers.  If for any reason, you are not happy with chosen Medicare Advantage Company, you always have the option to revert back to Original Medicare during either the Annual Enrollment Period (AEP) which is October 15th to December 7th or the Annual Disenrollment Period (ADP) from January 1st to February 14th.
Source: blogspot.com

2013 Medicare Drug Plan Premiums Will Be Similar To This Year — On Average

“Some folks won’t have access to plans at this price,” said Joe Baker, president of the Medicare Rights Center, a consumer advocacy group. “The bigger issue is that seniors have too much choice, or too much non-meaningful choice.” Seniors, he said, “tend to go for lower premiums, which look more affordable, but they can be surprised when their drug isn’t in the formulary.”
Source: kaiserhealthnews.org

Medicare Part D Prescription Drug Plan Newsletter

 Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan.  So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month).  If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month.  Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.
Source: customemployeebenefits.com

ACP: Practice Management Center

Posted by:  :  Category: Medicare

Joe McCannon - Centers for Medicare and Medicaid Services (CMS) - Healthcare Bootcamp 2011 with Rock Health by mariachilyNew Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Patient Protection and Affordable Care Act of 2010 mandates that a physician conduct in a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Learn the details of this new requirement, which has significant impact on internists, at http://www.cms.gov/MLNMattersArticles/downloads/SE1038.pdf.
Source: acponline.org

Video: Medicare Home Health Changes: 2011 & Beyond

DNC hits Gingrich, GOP ending Medicare litmus test

barack obama Buddy Roemer california cats Chris Christie Climate change DADT debate DOMA Donald Trump ENDA foreign france Fred Karger Fun Gary Johnson Haley Barbour health care Herman Cain homophobia iran John Thain John Thune Jon Huntsman Marriage marriage equality media Michele Bachmann Middle East Mike Huckabee Mitch Daniels Mitt Romney News Newt Gingrich Paul Ryan polls Rick Perry Rick Santorum Ron Paul Sarah Palin states The 1% Tim Pawlenty TSA Video
Source: americablog.com

Breaking: Medicare Supplemental Insurance Premiums Skyrocketing

When Billy signed on with United Mutual of Omaha, in August of 2010, the monthly premium was $92.26. In August of 2011, his anniversary date with the policy, the premium increased to $101.49, a 10% increase which was not necessarily unexpected since at that time overall medical costs were supposedly rising at about 9% per year.
Source: allrightmagazine.com

How to Make the Most of Medicare Reimbursements in 2011

Thus, depending on Medicare alone to float the budget of an individual medical office is not sage financial advice. While it is true that the economy is rebounding, once Medicare rates are secured for 2011 medical offices will be stuck with those figures for 12 full months. Further, Washington lobbyists who advocate for the best interest of physicians will continue to assert that Medicare reimbursements are sub-par but even those efforts are bigger picture and will not affect your A/R in the next quarter.
Source: questns.com

Hospitals’ Medicare funds at risk

“Changing the way we pay hospitals will improve the quality of care for seniors and save money for all of us,” said U.S. Department of Health and Human Services Secretary Kathleen Sebelius in a press release when the agency launched the initiative last year. “Medicare will reward hospitals that provide high-quality care and keep their patients healthy. It’s an important part of our work to improve the health of our nation and drive down costs. As hospitals work to improve their performance on these measures, all patients – not just Medicare patients – will benefit.”
Source: thenewyorkworld.com

91 Charged With $430 Million Medicare Billing Fraud

Houston Chronicle: FBI Arrests Historic Houston Hospital’s CEO, Son, 5 Others After 30 years as CEO of one of Houston’s most historic hospitals, Earnest Gibson III, along with his son and five others, was arrested on Thursday — part a national Medicare fraud sweep involving $430 million in bogus billings and 91 health care providers in seven states. If the allegations against the 68-year-old Gibson are true, that he and others at the hospital bilked the Medicare program of $158 million over a period of more than seven years, it could prove lethal for Riverside, once the primary hospital for the city’s black population. Gibson and his son Earnest Gibson IV, 35, were charged with 13 counts: conspiracy to commit health care fraud; conspiracy to defraud the United States and pay and receive health care kickbacks; one count of money laundering and ten counts of violating the anti-kickback statute (Langford, 10/4).
Source: kaiserhealthnews.org

Medicare fraud strike force charges 91 individuals for approximately $430 million in false billing

Seven individuals are charged in Houston for their participation in a fraud scheme at a hospital that led to $158 million in fraudulent billing for community mental health center services. According to court documents, the defendants who served as administrators at the hospital paid kickbacks — in the form of cigarettes, food and coupons redeemable for items available at the hospital’s “country stores” — to Medicare beneficiaries in exchange for those beneficiaries’ attendance at the hospital’s partial hospitalization programs (PHP). Allegedly, beneficiaries watched television, played games and engaged in other non-PHP activities rather than receiving the services for which the hospital billed Medicare. Previously, on Feb. 22, 2012, the assistant administrator of the hospital, Mohammad Kahn, pleaded guilty to conspiracy to commit health care fraud and paying kickbacks related to $116 million worth of fraudulent claims submitted to Medicare. After his guilty plea, an additional $42 million in fraudulent claims were discovered that are included in today’s totals.
Source: rockrivertimes.com

Medicare Hospital Readmissions Reduction Program

Roughly 20 percent of Medicare patients discharged from hospitals in the United States will be readmitted to a hospital within 30 days. These readmissions cost the Medicare program an estimated $12 billion a year and may be preventable. This issue of Legal Notes explains the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP) and its implications for regional health care quality improvement collaboratives.
Source: rwjf.org

Older Americans Have Been Highly Resistant to Medicare Changes

The income gap among Republicans and Republican leaners is about as large as the difference between GOP supporters of the Tea Party and non-supporters. Among Republicans and Republican leaners who agree with the Tea Party, 57% view deficit reduction as more important than preserving Social Security and Medicare benefits as they are. Among Republicans and leaners who do not agree with the Tea Party, just 36% say that reducing the deficit is more important than maintaining benefits.
Source: people-press.org

History Unfolding: Innumeracy at the highest levels

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotBarack Obama evidently lost the first debate Wednesday night, although it will take a few more days to measure the damage in the polls accurately. So far, according to the data on fivethirtyeight.com, very incomplete data suggests that he has lost a couple of points in swing states. I must confess that I was among the few Americans watching who did not feel that Obama was taking a beating, although I did think Romney was doing somewhat better than expected. One reason was that I didn’t see how any American except an extreme partisan, regardless of education, could take the discussion very seriously–especially when the candidates used numbers. That, I had decided well before poor Jim Lehrer said goodnight, was going to be the theme of my discussion, and so it is. Politicians have been arguing about budgets at least since Franklin Roosevelt, and they argued about them constantly in my youth–but in those days, citizens could follow the discussion. Most educated Americans, it seems to me, had some idea of what the federal budget was–in fiscal 1965, I remember, it was almost exactly $100 billion. (Yes, that was a long time ago.) More critically, when politicians talked about a tax cut or a budget increase, they discussed its estimated value over the next fiscal year. During the Graham-Rudman deficit reduction discussions in the late 1980s it seems to me everyone talked quite specifically about a series of annual cuts. The turning point, I think, was in the elder Bush’s Administration, when he put forth a “$500 billion deficit reduction plan,” a figure which referred to the next five years. That trend has continued to the extent that no one has any idea any more what the figures thrown around by Presidential candidates mean. Since I want to do something about this problem this morning as well as identify with it, let’s begin with a few basic facts. The 2012 federal budget, covering the fiscal year that ended last week, anticipated $2.47 trillion in revenues and $3.73 trillion in expenditures, leaving a deficit of $1.3 trillion. Please try to keep those figures in mind as we look at some of the things the two candidates said during the debate. The figure that we heard most often during the debate came from Mitt Romney: that the President “supports taking $716 billion out of [Medicare].” Now if you read that last paragraph with any care, you immediately must have realized that something is very wrong somewhere, because although Medicare is an expensive program, it doesn’t soak up 20% of the federal budget, and even if it did, a $716 billion cut would mean the elimination of Medicare, which the President obviously is not proposing. (Medicare spending for this year is in fact projected at $484 billion.) But it turns out that the letter from the Congressional Budget Office to John Boehner from which that figure comes, which tried to estimate the impact of repealing Obamacare, expected repeal to increase payments from Medicare by $716 billion over a ten-year period. So the actual annual figure is about $72 billion a year, which is a 15% reduction. But that ain’t all. The CBO explained that, under Obamacare, about three-quarter of those cuts will come out of Medicare advantage plans–that is, Medicare-funded HMOs, which have turned out to be considerably more expensive than regular Medicare–and reimbursements to hospitals, most of which are now profit-making enterprises that do very well out of Medicare. And none of the savings are going to come out of payments to physicians, as far as I can see. This is part of Republicanism 101: when Democrats try to take the profiteering out of a popular program, they are accused of cutting it. Meanwhile, Mitt in the midst of this discussion mentioned, “But my experience — my experience the private sector typically is able to provide a better product at a lower cost.” If there’s one thing every concerned citizen ought to know nowadays, it’s that Medicare is the cheapest health insurance program there is, which is why every single Republican refused to include a Medicare-for-all public option in Obamacare. Now just to show that I don’t believe President Obama is innocent of the same sort of nonsense, let’s look at his favorite number: Mitt Romney’s $5 trillion tax cut. “Governor Romney’s central economic plan,” he said,” calls for a $5 trillion tax cut — on top of the extension of the Bush tax cuts — that’s another trillion dollars — and $2 trillion in additional military spending that the military hasn’t asked for. That’s $8 trillion.” Once again, a quick look at my summary paragraph above is enough to prove that something is very wrong somewhere, since total federal tax revenues for the fiscal year that just ended were about half of that. And this time, I have to admit, I’m stumped: I can’t figure out where the $5 trillion figure comes from at all. The nonpartisan Tax Policy Center has analyzed Romney’s tax policies as thoroughly as it could, although any definite answers are impossible because Romney refuses to specify the deductions he wants to end. They do find that he has proposed substantial cuts in rates for most Americans that will have an important impact on revenue. They found that if we do indeed extend the Bush tax cuts, as President Obama agreed to do in 2011, that Romney’s rate cuts would cost the Federal government an additional $480 billion a year by 2015. That’s about 20% of current revenue and roughly one-third of the current deficit. It would appear that Obama is using the same algorithm in this case as Romney did on Medicare, and giving the figure for a ten-year period (the cost of Romney’s tax cuts would grow, presumably, as the GDP and potential revenues increased.) But, of course, he never said so, making the figure meaningless. It’s worth noting, by the way, that a bipartisan reliance on meaningless figures is bound to help the Republicans, because their proposals are so much more fiscally irresponsible (as they have been since 1980) and out of touch with reality. If Romney had to accuse Obama (dubiously as we have seen) of cutting Medicare by 15% a year, while Obama countered that Romney wanted to cut total federal revenues by 20% a year and thus increase the deficit by about 33%, Americans would be much better served. And there’s really no reason why the media couldn’t start using annual figures even if the candidates refused to do so. Romney’s next line, however, has got me stumped–and you all know that I don’t give up easily. Here are his comments on the effects of Obamacare. “And, unfortunately, when — when — when you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it’s adding to cost. And as a matter of fact, when the president ran for office, he said that, by this year, he would have brought down the cost of insurance for each family by $2,500 a family. Instead, it’s gone up by that amount. So it’s expensive. Expensive things hurt families. So that’s one reason I don’t want it.” When one searches for “Obamacare $2,500 CBO,” as I did, one discovers that this has become a new article of faith in the Republican blogosphere, one that Romney has not scrupled to preach himself. I found this, for instance, in a Tea Party blog. “The CBO previously had blown apart another Obama promise – that that his health care plan would save families $2500 in premium expense. A July 2012 analysis concluded that ObamaCare will actually increase premium cost by $2400 – a $4900 difference in the wrong direction for American families!” I then went to the CBO Study which the blogger linked. That study has nothing to do with premium costs for average families. It’s about the net impact of the Supreme Court’s decision on the costs of Obamacare, which mainly involve fewer people receiving Medicaid (because states are no longer forced to expand it) and more people therefore being required to buy their own insurance or pay a penalty. The figure $2400 does not appear anywhere in the study. I am going to offer a free copy of any of my books to the first reader who can go through that study and figure out what the Republicans are talking about, because I can’t. It evidently involves some creative use of language and of figures–to creative even for me to imagine what it might be. Let’s work together to see if we can be the first people in the US to break this story. “You’ve raised them [taxes] by $1 trillion under Obamacare,” Romney said, and I can’t explain that one either. Of course we know enough now to assume that he meant $100 billion a year, but that same CBO study estimates that the penalty for not buying insurance and other tax changes under the plan will bring in just $50 billion a year, not $100 billion. (We know now that the penalty is officially a tax, of course, because the Supreme Court said so.) How Romney doubled that figure is a mystery. “That’s how we cut a trillion dollars of spending that wasn’t advancing that cause,” President Obama remarked at one point. I assume he meant $100 billion a year too, but I have no idea what cuts he was talking about. I still expect the President to be re-elected, but I still don’t see how this is going to help the country move forward very much. This is one of the reasons: thirty years of utterly politicized propaganda and declining American education have made it impossible for Presidential candidates sensibly to discuss the problems that we face. No one could have learned anything useful from that debate. The truth is out there, but you have to be awfully persistent to find it. Now let’s see who can claim the free book.
Source: blogspot.com

Video: Medicare Insurance – Basics Explained

Obama and Romney Conclude Their First Debate

Coal is the largest source of energy for the generation of electricity worldwide, as well as one of the largest worldwide anthropogenic sources of carbon dioxide releases. Gross carbon dioxide emissions from coal usage are slightly more than those from petroleum and about double the amount from natural gas. Coal is a mixture of things. It forms for an accumulation of organic matter call peat. Just what the coal contains depends on what the peat from which it formed contained. Coal is mostly carbon (at least 50%), but it also contain a certain of sulfur and mineral matter. The mineral matter comes from sediment that is deposited with the peat. Coal-fired electric power generation emits around 2,000 pounds of carbon dioxide for every megawatt-hour generated, which is almost double the carbon dioxide released by a natural gas-fired electric plant per megawatt-hour generated. Because of this higher carbon efficiency of natural gas generation, as the fuel mix in the United States has changed to reduce coal and increase natural gas generation, carbon dioxide emissions have unexpectedly fallen. Those measured in the first quarter of 2012 were the lowest of any recorded for the first quarter of any year since 1992 The benefits of coal in electric production: Coal-fired power plants shortened nearly 24,000 lives a year in the United States, including 2,800 from lung cancer. Generation of hundreds of millions of tons of waste products, including fly ash, bottom ash, and flue-gas desulfurization sludge, that contain mercury, uranium, thorium, arsenic, and other heavy metals. Acid rain from high sulfur coal. Interference with groundwater and water table levels due to mining. Contamination of land and waterways and destruction of homes from fly ash spills. such as the Kingston Fossil Plant coal fly ash slurry spill. Impact of water use on flows of rivers and consequential impact on other land uses. Subsidence above tunnels, sometimes damaging infrastructure. Uncontrollable underground fires which may burn for decades or centuries. Coal-fired power plants without effective fly ash capture systems are one of the largest sources of human-caused background radiation exposure. Coal-fired power plants emit mercury, selenium, and arsenic, which are harmful to human health and the environment. Release of carbon dioxide, a greenhouse gas, which causes climate change and global warming according to the IPCC and the EPA. Coal is the largest contributor to the human-made increase of CO2 in the atmosphere.
Source: blogcritics.org

Medicare Advantage Fees Explained

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

Citizens Band: Secretary of Explaining Things

The widespread and bipartisan media consensus is that Mitt Romney won Wednesday’s first presidential debate.  A somnolent President Obama spent most of his time on stage looking down at his podium, handing an easy victory on appearances to the guy who dissed Big Bird. What was reinforced to me, though, is that these debates — barring the emergence of a popular caricature of one of the candidates — are aimed at influencing the media’s election narrative, not at voters. These debates are supposed to elucidate a candidate’s positions and to help voters distinguish between their choices.  But in practice, we’re not given much to work with.  The candidates present what seems like a jumble of “Mad Libs”, throwing out random numbers (“4 million jobs” from energy independence; “2 million more slots in our community colleges”; a “$5 trillion tax cut”; “$2 trillion in additional military spending”; a “$4 trillion deficit reduction plan”) without context or explanation.  The result is empty speechifying, not debating.  And in a generally polite encounter without memorable “zingers” from either man, my eyes were glazing over. Granted, it’s difficult to properly explain complicated policies in two minute soundbites, and few politicians are good at breaking down big ideas into digestible bites without patronizing the audience.  Bill Clinton has long been an exception; most recently, his show-stealing speech at the DNC this year inspired a widely-quoted Tweet declaring he should be appointed “Secretary of Explaining Things”! Here’s how I would have addressed the debate’s main talking points relying on substance to inform the public: 1. The deficit In 2011, the federal government spent $3.6 trillion while taking in just $2.3 trillion through taxes.  Deficits aren’t something new: going back to Ronald Reagan’s presidency which started in 1981, the government has run a deficit every year except from 1998-2001.  So this is not a recent problem nor is it something that has been caused by one political party. Gov. Romney says he will “stop the subsidy to PBS” and cut other government-funded programs.  While that may be politically pleasing to the right, the amount of money at stake there is so small, it’s not even worth arguing over: funding to the Corporation for Public Broadcasting (which funds PBS and NPR, another target of the right) was $445 million in 2012, or just 0.012% of the budget. It’s impossible to seriously tackle the deficit problem without looking at the three biggest components of federal spending: Medicare/Medicaid, Social Security, and the military.  These three areas combined cost the government $2.26 trillion in FY2011, or 62.8% of the budget.  It is impossible to tackle the deficit by making scores of tiny cuts elsewhere and not addressing the “Big Three”.  Reforming Medicare/Medicaid, Social Security, and defense spending will, by definition, require some sacrifices somewhere — what Democrats and Republicans should be talking about is how, and letting us know.  President Obama said of his $4 trillion plan “It’s on a website”.  Not good enough. 2. Taxes As previously mentioned, the government took in $2.3 trillion in tax revenue last year, and spent $3.6 trillion.  It’s important to note here that the U.S. is not a wildly irresponsible spender nor is it spending at a rate unseen by the rest of the world.  Gov. Romney noted that “Spain spends 42% of their total economy on government… I don’t want to go down the path to Spain”, but looking at spending as a share of GDP shows Canada at about 40%, the U.K. above 47%, and Sweden at 52.5%.  Sweden, if we’re going to cherry-pick examples, grew their economy by 4.4% last year, compared to the U.S.’ 1.7%.  Nonetheless, although deficit spending helps keep an economy afloat during a slowdown, the U.S. does need to take steps to tackle its growing debt.  How? The “Big Three” of Medicare/Medicaid, Social Security, and defense spending account for about 63% of money spent; another 13% is other mandatory spending, and 6% is interest payments.  That leaves only 18% of federal spending as non-military “discretionary”, which funds government agencies like Health & Human Services, Housing & Urban Development, and the Justice Department.  All of that accounted for only $646 billion in 2011, obviously not enough to cover the budget shortfall. That’s why the only sensible solution to tackling the deficit is a combination of reduced spending and increasing revenue collected from taxes.  The marginal tax rate on the top bracket of earners ($388,351+ in 2012) was 35%, the rate which it has been since 2003, when it was cut by President Bush.  In fact, that top rate has only been lowered, never raised, over the past 20 years.  Gov. Romney, as the president noted, said during the Republican primaries that he would not accept even $1 in tax increases for every $10 in federal spending cuts, an ideologically-toeing position of insanity. Republican president Ronald Reagan, who was “a tax cutter legislatively, emotionally and ideologically”, still agreed to tax increases when faced with a growing budget deficit. So too did his Republican predecessor George H.W. Bush.  Gov. Romney has promised he can solve the problem just by “closing loopholes and deductions”, a dubious proposal, made harder to believe given the lack of specifics he has offered. 3. Medicare
Source: blogspot.com

The Obama/Ryan Medicare Cuts Debacle Explained Independent Journal Review

Many of the other provisions that would be repealed by enacting H.R. 6079 affect spending for Medicare, Medicaid, and other federal programs. The ACA made numerous changes to payment rates and payment rules in those programs, established a voluntary federal program for long-term care insurance through the Community Living Assistance Services and Supports (CLASS) provisions, and made certain other changes to federal health programs. In total, CBO estimates that repealing those provisions would increase net federal spending by $711 billion over the 2013–2022 period. (Those budgetary effects are summarized in Table 1.)
Source: ijreview.com

Satisfying Retirement: Someone Explain Medicare to Me

Part D covers some of your presecition drug costs. If you don’t need a lot of drugs now, it still may be wise to take this coverage because of late enrollment penalties. Part D is provided by private insurance companies and varies widely in costs and coverage. There are usually copays and deductibles involved. The “Donut hole” limits coverage on what these plans will pay for your drugs. UNder the new health care plan, that donut hole is shrinking and has a new feature that gives you a 50% discount on covered brand name drugs. 
Source: blogspot.com

ONDCP representative talks funding, insurance and prevention

Mineta explained a study by Mathematica Policy Research that looked at Veterans Affairs (VA) funding, Medicare/Medicaid, and public benefits, as opposed to private insurance. He said the study found that if a person has public insurance, he or she is more likely to receive treatment for substance use disorders than private insurance. “That is something that everyone in this field is keenly interested in–how to get private insurance to comply.”
Source: addictionpro.com

New hospital compliance requirements are now in effect (since October 1st)

The first, the Hospital Value-Based Purchasing Program, will pay hospitals according to how they perform based on a set of standard clinical quality measures and on surveys of patients’ experience. The payments are provided by Medicare which will withhold 1% of its regular hospital reimbursements, and over the course of the year funds will be returned to some hospitals based on their performance. By 2016 the percentage withheld will go up to 2%. Medicare estimates that about $850 million will be reallocated under the hospital pay for performance program this year. In effect, hospitals that do not meet the criteria will be penalized by not receiving a return of the withheld funds.
Source: benico.com

Interview: Gov. John Kitzhaber on Oregon’s $1.9 billion Medicaid experiment

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSAll great movements have started with people, because collective wisdom is stronger and smarter than any one individual. And we believe that it is time to leave partisan politics behind.  We Can Do Better engages citizens in identifying barriers and solutions to improving health and health care for all.We combine traditional tools – community forums and workshops – with new media to bring people together. Online and in-person opportunities for the public to become informed, organize, and voice their opinions lead to real-time grassroots civic action that influences public policy debate. We want public and private programs to reflect our shared principles and framework. The process won’t always be easy or comfortable because we recognize we have tough choices ahead. We believe that positive and lasting social change only comes when engaged citizens work together in common cause.  We Can Do Better is a non partisan space for civic engagement for people to develop strategies and solutions that inform public policy and result in better health and health care for all.
Source: wecandobetter.org

Video: Medicare 4: Straight Talk on Medicare and Social Security from AARP Oregon

Impact of Policy Changes on Emergency Department Use by Medicaid Enrollees in Oregon

In Oregon, emergency department (ED) visits by most Medicare enrollees fell 18 percent, following implementation of a $50 co-payment. From 2003 to 2004, the state of Oregon experienced drastic cuts in its Medicare expansion program, Oregon Health Plan (OHP) Standard: enrollees lost coverage if they could not pay premiums; there were new co-payments for primary care visits, emergency department use, and hospitalization; and, the state eliminated coverage for outpatient mental health and chemical dependency. The changes did not affect enrollees in a separate Medicare plan, OHP Plus. This study reports changes in ED use following the cuts to OHP Standard benefits. Because the cutbacks allowed primary care providers to refuse services if patients could not make the new co-payments, the authors surmised there might be an increase in ED visits. The authors examined the overall rate of ED visits per enrollee, the number of ED visits leading to hospital admission, and injury-related visits. In addition, the authors examined ED visits related to three behavioral health categories: alcohol use, drug use and psychiatric conditions. Enrollees in OHP Plus were the control group. Key Findings:
Source: rwjf.org

Oregon’s great health care experiment: State puts $240 million on the line with coordinated care

The Oregon Health Authority formally certified the Collaborative to become a CCO on July 31, and it will begin providing care to 180,000 Oregon Health Plan patients living in Multnomah, Washington and Clackamas counties on Sept. 1. The Tri-County Medicaid Collaborative will, by far, be the largest CCO in Oregon. It is composed of every major health provider in Multnomah, Washington and Clackamas counties: Adventist Health, CareOregon, Central City Concern, Kaiser, Legacy Health, Oregon Health & Science University, Providence Health & Services, Tuality Healthcare, and representation from the three metro counties. Its annual budget is expected to be around $750 million dollars, and it will provide care for roughly a third of the state’s Oregon Health Plan patients.
Source: wordpress.com

Oregon providers chosen for Medicare project

Seven area health groups have been selected to participate in a Medicare program that aims to enable more affordable health care. CareOregon, Legacy Medical Group, Regence BlueCross BlueShield of Oregon, Oregon Health Authority, Providence Health Plans, the Teamsters Multi-Employer Taft Hartley Funds and Tuality Health Alliance will participate in the Comprehensive Primary Care Initiative. Some 500 primary care practices that work with those groups will take part in the care initiative locally. The…
Source: revitalizationpartners.com

Medicare Revises Hospitals’ Readmissions Penalties

Medicare’s mistake occurred in its calculations of the penalties for hospitals, according to a notice the agency published Friday. Medicare said it would be basing the penalties on the readmission rates and reimbursements for patients who were discharged from July 2008 through June 2011. But the agency wrote that it “inadvertently” included Medicare claims before July 1, 2008, in its evaluations.
Source: kaiserhealthnews.org

90º Degrees to the Left: Don’t Let Them Destroy Medicare, Vote Them Out!

We must replace each and everyone of them with Progressives, Liberals or  Independents.  We have to help our country move forward and our President by providing him with a Congress that will work with him and not against him.  A Congress that will care for all Americans, regardless of Party instead of the Congress we have now that cares not for the American people or the country but for Corporate America.  We have complained, we have been outraged, well now is our opportunity to do something about it.  These elections are extremely important,  vote and vote for America.  Vote Democratic all the way down the ballot.
Source: blogspot.com

Medicare Presentation Saturday

Topics to be covered include how to get Medicare, important deadlines to purchase additional insurance or prescription drug coverage, what happens if persons continue to work after becoming eligible for Medicare, how to compare Medicare supplements, how to evaluate long-term care insurance, and much more – including the latest developments in the Medicare program.
Source: therconline.com

For the sickest patients, Medicare tests home

A home-based primary care program started by the Department Veterans Affairs health system appears to have saved signficant money. The VA says the program lowered the average annual cost of care for a patient with multiple chronic conditions from $38,168 to $29,036. Timely and well-coordinated primary care had the greatest effect on hospital spending, which fell from $18,868 to $7,026 per patient per year, a reduction of 63 percent. The VA has boosted enrollment to more than 24,000 people. 
Source: oregonlive.com

Kaiser Permanente Chairman and CEO George Halvorson Announces 2013 Retirement

Posted by:  :  Category: Medicare

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

Video: California Medicare Advantage

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 Advantage 2012 Data Spotlight: Enrollment Market Update

This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries.  Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire.
Source: kff.org

History Unfolding: Innumeracy at the highest levels

Barack Obama evidently lost the first debate Wednesday night, although it will take a few more days to measure the damage in the polls accurately. So far, according to the data on fivethirtyeight.com, very incomplete data suggests that he has lost a couple of points in swing states. I must confess that I was among the few Americans watching who did not feel that Obama was taking a beating, although I did think Romney was doing somewhat better than expected. One reason was that I didn’t see how any American except an extreme partisan, regardless of education, could take the discussion very seriously–especially when the candidates used numbers. That, I had decided well before poor Jim Lehrer said goodnight, was going to be the theme of my discussion, and so it is. Politicians have been arguing about budgets at least since Franklin Roosevelt, and they argued about them constantly in my youth–but in those days, citizens could follow the discussion. Most educated Americans, it seems to me, had some idea of what the federal budget was–in fiscal 1965, I remember, it was almost exactly $100 billion. (Yes, that was a long time ago.) More critically, when politicians talked about a tax cut or a budget increase, they discussed its estimated value over the next fiscal year. During the Graham-Rudman deficit reduction discussions in the late 1980s it seems to me everyone talked quite specifically about a series of annual cuts. The turning point, I think, was in the elder Bush’s Administration, when he put forth a “$500 billion deficit reduction plan,” a figure which referred to the next five years. That trend has continued to the extent that no one has any idea any more what the figures thrown around by Presidential candidates mean. Since I want to do something about this problem this morning as well as identify with it, let’s begin with a few basic facts. The 2012 federal budget, covering the fiscal year that ended last week, anticipated $2.47 trillion in revenues and $3.73 trillion in expenditures, leaving a deficit of $1.3 trillion. Please try to keep those figures in mind as we look at some of the things the two candidates said during the debate. The figure that we heard most often during the debate came from Mitt Romney: that the President “supports taking $716 billion out of [Medicare].” Now if you read that last paragraph with any care, you immediately must have realized that something is very wrong somewhere, because although Medicare is an expensive program, it doesn’t soak up 20% of the federal budget, and even if it did, a $716 billion cut would mean the elimination of Medicare, which the President obviously is not proposing. (Medicare spending for this year is in fact projected at $484 billion.) But it turns out that the letter from the Congressional Budget Office to John Boehner from which that figure comes, which tried to estimate the impact of repealing Obamacare, expected repeal to increase payments from Medicare by $716 billion over a ten-year period. So the actual annual figure is about $72 billion a year, which is a 15% reduction. But that ain’t all. The CBO explained that, under Obamacare, about three-quarter of those cuts will come out of Medicare advantage plans–that is, Medicare-funded HMOs, which have turned out to be considerably more expensive than regular Medicare–and reimbursements to hospitals, most of which are now profit-making enterprises that do very well out of Medicare. And none of the savings are going to come out of payments to physicians, as far as I can see. This is part of Republicanism 101: when Democrats try to take the profiteering out of a popular program, they are accused of cutting it. Meanwhile, Mitt in the midst of this discussion mentioned, “But my experience — my experience the private sector typically is able to provide a better product at a lower cost.” If there’s one thing every concerned citizen ought to know nowadays, it’s that Medicare is the cheapest health insurance program there is, which is why every single Republican refused to include a Medicare-for-all public option in Obamacare. Now just to show that I don’t believe President Obama is innocent of the same sort of nonsense, let’s look at his favorite number: Mitt Romney’s $5 trillion tax cut. “Governor Romney’s central economic plan,” he said,” calls for a $5 trillion tax cut — on top of the extension of the Bush tax cuts — that’s another trillion dollars — and $2 trillion in additional military spending that the military hasn’t asked for. That’s $8 trillion.” Once again, a quick look at my summary paragraph above is enough to prove that something is very wrong somewhere, since total federal tax revenues for the fiscal year that just ended were about half of that. And this time, I have to admit, I’m stumped: I can’t figure out where the $5 trillion figure comes from at all. The nonpartisan Tax Policy Center has analyzed Romney’s tax policies as thoroughly as it could, although any definite answers are impossible because Romney refuses to specify the deductions he wants to end. They do find that he has proposed substantial cuts in rates for most Americans that will have an important impact on revenue. They found that if we do indeed extend the Bush tax cuts, as President Obama agreed to do in 2011, that Romney’s rate cuts would cost the Federal government an additional $480 billion a year by 2015. That’s about 20% of current revenue and roughly one-third of the current deficit. It would appear that Obama is using the same algorithm in this case as Romney did on Medicare, and giving the figure for a ten-year period (the cost of Romney’s tax cuts would grow, presumably, as the GDP and potential revenues increased.) But, of course, he never said so, making the figure meaningless. It’s worth noting, by the way, that a bipartisan reliance on meaningless figures is bound to help the Republicans, because their proposals are so much more fiscally irresponsible (as they have been since 1980) and out of touch with reality. If Romney had to accuse Obama (dubiously as we have seen) of cutting Medicare by 15% a year, while Obama countered that Romney wanted to cut total federal revenues by 20% a year and thus increase the deficit by about 33%, Americans would be much better served. And there’s really no reason why the media couldn’t start using annual figures even if the candidates refused to do so. Romney’s next line, however, has got me stumped–and you all know that I don’t give up easily. Here are his comments on the effects of Obamacare. “And, unfortunately, when — when — when you look at Obamacare, the Congressional Budget Office has said it will cost $2,500 a year more than traditional insurance. So it’s adding to cost. And as a matter of fact, when the president ran for office, he said that, by this year, he would have brought down the cost of insurance for each family by $2,500 a family. Instead, it’s gone up by that amount. So it’s expensive. Expensive things hurt families. So that’s one reason I don’t want it.” When one searches for “Obamacare $2,500 CBO,” as I did, one discovers that this has become a new article of faith in the Republican blogosphere, one that Romney has not scrupled to preach himself. I found this, for instance, in a Tea Party blog. “The CBO previously had blown apart another Obama promise – that that his health care plan would save families $2500 in premium expense. A July 2012 analysis concluded that ObamaCare will actually increase premium cost by $2400 – a $4900 difference in the wrong direction for American families!” I then went to the CBO Study which the blogger linked. That study has nothing to do with premium costs for average families. It’s about the net impact of the Supreme Court’s decision on the costs of Obamacare, which mainly involve fewer people receiving Medicaid (because states are no longer forced to expand it) and more people therefore being required to buy their own insurance or pay a penalty. The figure $2400 does not appear anywhere in the study. I am going to offer a free copy of any of my books to the first reader who can go through that study and figure out what the Republicans are talking about, because I can’t. It evidently involves some creative use of language and of figures–to creative even for me to imagine what it might be. Let’s work together to see if we can be the first people in the US to break this story. “You’ve raised them [taxes] by $1 trillion under Obamacare,” Romney said, and I can’t explain that one either. Of course we know enough now to assume that he meant $100 billion a year, but that same CBO study estimates that the penalty for not buying insurance and other tax changes under the plan will bring in just $50 billion a year, not $100 billion. (We know now that the penalty is officially a tax, of course, because the Supreme Court said so.) How Romney doubled that figure is a mystery. “That’s how we cut a trillion dollars of spending that wasn’t advancing that cause,” President Obama remarked at one point. I assume he meant $100 billion a year too, but I have no idea what cuts he was talking about. I still expect the President to be re-elected, but I still don’t see how this is going to help the country move forward very much. This is one of the reasons: thirty years of utterly politicized propaganda and declining American education have made it impossible for Presidential candidates sensibly to discuss the problems that we face. No one could have learned anything useful from that debate. The truth is out there, but you have to be awfully persistent to find it. Now let’s see who can claim the free book.
Source: blogspot.com

CMS Announces Medicare Advantage Demonstration Project; Also Issues New Proposed Rules to Medicare Advantage Plans

The Centers for Medicare and Medicaid Services announces a three-year demonstration project with financial incentives to improve quality. The project, which begins in 2012, will award Medicare Advantage plans earning the highest performance rating “the largest bonuses equal to 5 percent. Additionally, all Medicare Advantage plans that have a score of three stars and higher will qualify for a bonus payment in 2012.” CMS also issued proposed changes to the Medicare Advantage and the Medicare Prescription Benefit programs (Medicare Part C and D) that codify “clarifications to CMS authority to negotiate plan bids, [expand] restrictions on charging higher cost-sharing than traditional Medicare for certain services, and [limit] long-term care pharmacy waste by specifying efficient dispensing practices.” One of the pharmacy proposals includes a plan to require Part D sponsors to return unused medications for credit and reuse.
Source: kff.org

Social Security Disability & Medicare Eligibility

Posted by:  :  Category: Medicare

If you have health insurance coverage already, you need to figure out how Medicare works with your health insurance. Many health insurance policies state that Medicare is to provide the primary coverage. Thus, your present health insurance may pay only for what Medicare does not cover. You need to check with your health insurance company when you get your Medicare card.
Source: disabilitydenials.com

Video: #30.2 Medicare Eligibility and Enrollment – How to Handle the Medicare Maze (2 of 5)

What Are the Medicare Eligibility Requirements?

Once reaching the age of 65 years old a person qualifies for medicare. One must also be a US citizen or a permanent legal resident. One of the last requirements is having paid into the medicare system while working. The general rule is having paid into the social security system with approximately 10 years of work, or 40 credits. An individual may also qualify off of their spouses working if necessitated. The spouse must be at least 62 and the qualifying individual must still meet the 65 year requirement. With additional proof an individual may also qualify based on the work benefits of a deceased or divorced spouse.
Source: seniorcorps.org

Daily Kos: The Obama Administration uncovered $430 million in Medicare fraud in a single bust yesterday

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Source: dailykos.com

Seniors Who Discuss Medicare With Advisors Are Better Off: Survey

Mary Dale Walters, senior vice president of the Allsup Medicare Advisor, a Medicare plan selection service for Medicare-eligible individuals, noted in a statement that Allsup’s survey of seniors with advisors “found that while only a small number discuss Medicare with their advisors, three of their five major concerns relate to health care and Medicare.”
Source: advisorone.com

SSDI Recipients Automatically Become Eligible for Medicare

If you are approved for SSDI, you automatically become eligible for Medicare as of the 25th month following your first eligibility for an SSDI payment.  It is easy to get confused about what constitutes your first eligibility for payment because you may see several other dates in your favorable decision and in the payment letters issued by Social Security.  An example might help you understand what constitutes your first eligibility for payment:
Source: northcarolinasocialsecuritydisabilityattorney.com

Maine Seeks To Cut Medicaid Eligibility

LePage argues that that the Affordable Care Act’s so-called “maintenance of effort” requirement went out the window with June’s Supreme Court decision. The provision prevented states from changing Medicaid eligibility levels before the Medicaid expansion occurred in 2014. (The concern was that states would remove beneficiaries from the Medicaid rolls knowing that when expansion occurred, those people would be allowed back on but the federal government would pay a much larger share of their expenses under the new law.) Now that the court has made that Medicaid expansion optional, LePage argues, Maine is no longer locked into the state’s Medicaid eligibility levels that were in effect when the federal health law was passed in 2010.
Source: kaiserhealthnews.org

Why do Jobless Americans Need Disability Insurance?

The main term in a disability policy comprise the payment to be made in the event of disability. Unlike other policies give a lump amount upon a qualifying event; most disability policies pay a recurring sum on a usual basis, normally monthly. The amount to be paid, and for how long, are variables in a disability policy. For instance, you may decide a policy that pays $3000 per year for up to 5 years. In any case, you cannot buy disability insurance for a sum more than your present salary. There are riders obtainable that add to the payout amount every year to stay even with when inflation and wage increases.
Source: fileunemployment.org

Healthcare: Dual Eligibles

On March 23, 2010, the Patient Protection and Affordable Care Act was signed into law bringing with it changes designed to help make Medicare and Medicaid more efficient, incentivize insurers and providers to provide high quality care, and provide affordable healthcare insurance for all. As part of the Act, the Innovation Center was established at the Centers for Medicare & Medicaid Services (CMS). The Innovation Center “fosters health care transformation by finding new ways to pay for and deliver care that improve care and health while lowering costs.” One of these innovative projects has focused on the coordination of care for those people who receive both Medicare and Medicaid benefits known as dual eligibles.
Source: meals-on-wheels.org

How the ACA Changes Pathways to Insurance Coverage for People with HIV

There are multiple sources of insurance coverage and care for people with HIV in the United States.  These include public programs, such as Medicaid and Medicare, and the Ryan White HIV/AIDS program, as well as private coverage through an employer or in the individual market. Medicaid, the nation’s principal safety-net health insurance program for low-income Americans, is estimated to cover the largest share of people with HIV. Fewer are covered by Medicare, the federal health insurance program for people age 65 and older and younger adults with permanent disabilities, or have private insurance, and a significant share is uninsured, relying primarily on Ryan White, the nation’s single largest federal grant program designed specifically for people with HIV who are uninsured or underinsured, and operating as the “payer of last resort.” Eligibility for these different coverage sources depends on numerous factors, including state of residence, income, employment and health status, age, and citizenship. As a result, the current system of coverage for people with HIV is a complex patchwork that leaves some outside the system and presents others with barriers to needed access. The Affordable Care Act (ACA), passed in 2010, will expand insurance coverage, and therefore access to care, for millions of people in the U.S., including people with HIV. Some of the ACA’s provisions went into effect soon after the law was passed; most that affect coverage will go into effect in 2014. Access to care, particularly antiretroviral treatment (ART), is not only critical for the health of people with HIV, it also carries important public health benefits with recent research demonstrating that ART significantly reduces the risk of HIV transmission from an HIV positive to negative individual. A new series of infographics developed by Kaiser depicts the pathways to insurance coverage for people with HIV, prior to the ACA, after the ACA was enacted but before 2014, and as of 2014 and beyond. As they indicate, coverage options have already expanded for people with HIV and are expected to expand further in 2014, although coverage will continue to vary across the country. Prior to the ACA (before 2010) Employer-sponsored coverage (ESI) is the primary way in which most people in the U.S. obtain health insurance coverage, although studies indicate that this is less so for people with HIV. Those without access to ESI could attempt to purchase coverage in the individual, non-group market. However, prior to the passage of the ACA, many people with HIV were effectively shut out of the individual market either because HIV was considered an uninsurable, pre-existing, condition by insurers or, if available, was often unaffordable. Medicaid, Medicare, and other public programs, therefore, were important pathways for people with HIV. To be eligible for Medicaid, an individual has to meet the income criteria in their state and belong to a group that was “categorically eligible” (children, parents with dependent children, pregnant women, and individuals with disabilities), and most people with HIV qualify on the basis of being both low-income and disabled. Prior to the ACA, federal law categorically excluded non-disabled adults without dependent children from Medicaid, unless a state obtained a waiver or used state-only dollars to cover them. This presented a barrier, and a “Catch-22,” to many low-income people with HIV who could not qualify for the program until they were disabled, despite the fact that Medicaid covers medications that stave off HIV-related disability and reduce mortality. To be eligible for Medicare, an individual has to be age 65 or older or, if under 65, permanently disabled. If not eligible for Medicare or Medicaid, a person with HIV might have access to state-funded coverage, such as a high risk pool, available in some states, but ultimately, would likely need to rely on the Ryan White program. In addition, Ryan White often “wrapped around” other forms of coverage, including Medicaid and Medicare, providing supplemental services where needed. >>View full-size version and notes (.pdf) ACA Transition Period (2010-2014) The ACA provided additional coverage options in 2010. In the private insurance market, the ACA established a temporary program in every state to allow people with pre-existing medical conditions, such as HIV, who had been uninsured for six months or more and denied insurance coverage to purchase coverage through a Pre-Existing Condition Insurance Plan (PCIP). It also prohibited individual and group health plans from placing lifetime limits on coverage, thereby preventing people with very expensive illnesses from running out of coverage, and extended dependent coverage for adult children up to age 26 in all individual and group plans. In addition, the ACA created a new state Medicaid option for states to cover childless adults with incomes up to 138% of the federal poverty level (FPL) in their Medicaid programs, which several states have already used. Still, even with these expanded options, people with HIV who remain ineligible for coverage, or face limits in their coverage (e.g., benefit limitations), continue to rely on Ryan White. >>View full-size version and notes (.pdf) Full Implementation of the ACA (2014 & Beyond) Most of the ACA’s coverage expansions go into effect in 2014. As of 2014, the ACA requires U.S. citizens and legal residents to have qualifying health coverage, and provides additional insurance market protections, cost-sharing, and coverage options to facilitate coverage. Health insurers will no longer be able to deny coverage to people with pre-existing health conditions (and the temporary PCIPs will no longer be needed). They will also be prohibited from placing annual limits on coverage and be required to guarantee issue and renew health insurance regardless of health status. Individuals will be able to purchase coverage through state-based “Health Insurance Exchanges” and depending on income, people without access to affordable ESI will be eligible for premium and cost-sharing subsidies to purchase coverage in the exchange. Finally, as of 2014, the ACA establishes a new Medicaid eligibility category for citizens and legal residents with incomes up to 138% FPL (thereby removing the categorical eligibility requirement and basing Medicaid eligibility solely on income) and provides states with an enhanced federal matching rate for this population. While a new mandatory eligibility category was established under the law, the Supreme Court of the United States ruled in June 2012 that states could not be penalized if they did not expand coverage to this new group, and it is therefore uncertain if all states will comply with this requirement. >>View full-size version and notes (.pdf) The ACA has already led to improvements in access to and quality of care for people living with HIV and, when fully implemented in 2014, is expected to significantly expand access even further. Still, there are several outstanding questions, including: Will states go forward with the Medicaid expansion and provide coverage to a significant number of people who are HIV positive? Will the benefits package available through Medicaid and the Exchange be sufficient for people with HIV? And, how might the Ryan White program be changed or restructured when it comes up for reauthorization next year, filling in gaps for those who are ineligible for other coverage or still face high cost-sharing for drugs and other health care services? — Jen Kates
Source: kff.org

California Healthline: Legislature Receives Final Plan for Duals Project

Filed under ADHC, CBAS, Featured, Medicaid, Medicare, Policy, Politics · Tagged with adhc, advocacy, aging, california, coalitions, dual eligible, elderly, government, laaac, los angeles, managed care, Medi-cal, Medicaid, medicare, news, politics, seniors, transitions
Source: laaacoalition.org

Medicare coverage gap associated with reductions in antidepressant use in study

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilAccording to study results, being in the gap was associated with comparable reductions in the use of antidepressants, heart failure medications and antidiabetics. Relative to a comparison group that had full coverage in the gap because of Medicare coverage or low-income subsidies, the no-coverage group reduced their monthly antidepressant prescriptions by 12.1 percent and reduced their use of heart failure drugs by 12.9 percent and oral antidiabetics by 13.4 percent. Beneficiaries with generic drug coverage in the gap reduced their monthly antidepressant prescriptions by 6.9 percent, a reduction attributable to reduced use of brand-name antidepressants, researchers note.
Source: sciencecodex.com

Video: Avoiding the coverage gap on Medicare Part D

Medicare Part D Coverage Gap

Gary Phillips is a licensed insurance agent based in western North Carolina. He specializes in the senior market and is knowledgeable in multiple insurance lines including Medicare, Medigap, Long-Term Care, Part D Prescription Drugs, Part C Medicare Advantage, Health, Life and Final Expense insurance. He also enjoys writing and helping others. www.bizpartner.homestead.com
Source: seniorliving.net

Puerto Rico Medicare beneficiaries save $110M under ‘Affordable Care Act’

“In just the last two months, the total amount that Puerto Rico Medicare beneficiaries have saved on prescription drugs has increased by about $15 million, and now totals $111,427,280. In addition, according to a report released this week by HHS, the average person with original, fee-for-service Medicare will save a total of $5,000 from 2010 to 2022 as a result of the ACA. Medicare beneficiaries with high prescription drug costs will save much more — about $18,000 — over the same time period,” said Pierluisi.
Source: newsismybusiness.com

Donkeys and Elephants on Medicare

In the interest of fair reporting, which we seldom seem to get these days, the following chart illustrates the positions of the two major political parties on the subject of Medicare.  You may draw your own conclusions or opinions, I just wanted you to have an unbiased account of where the two political parties stand on the issue that will affect every single person when they become age 65.  Social Security is another major government obligation that is having funding difficulties but has not been addressed in detail by either political party.  When the Social Security program is nearer collapse, our government, that is both sides, will do something about it.  (Oops, there goes my fair reporting.  I am blaming politicians as a whole though!)
Source: divacfo.com

Tips for seniors on managing health care costs

Finding the Medicare coverage that best fits their needs and their pocketbooks is challenging for many seniors. Health care plans make changes to their coverage. People’s health conditions change. Not keeping on top of these changes can mean problems. Suddenly seniors may find they don’t have needed coverage, their doctor no longer takes their plan, or they face steep medical or prescription drug costs.
Source: cntyseat.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

How the Candidates Compare on Medicare

An infographic at Whitehouse.gov notes that the Affordable Care Act increases federal sentencing guidelines for health care fraud offenses by 20% to 50% for major fraud crimes. It also points out that the Obama administration’s efforts on fighting Medicare fraud has returned $10.7 billion dollars to the Medicare Trust Fund since 2009.
Source: families.com

Time to examine Medicare Plans

Medicare Advantage may also see changes. Medicare Advantage offers a different type of coverage than original Medicare. According to Medicare’s website, “A Medicare Advantage Plan is a type of Medicare health plan offered by a private company that contracts with Medicare to provide you with all your Part A and Part B benefits. Medicare Advantage Plans include Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medicare Medical Savings Account Plans. If you’re enrolled in a Medicare Advantage Plan, Medicare services are covered through the plan and aren’t paid for under Original Medicare. Most Medicare Advantage Plans offer prescription drug coverage.”
Source: medhelperapp.com

Americans with Medicare will save $5,000 through 2022 with the Affordable Care Act

HHS Secretary Kathleen Sebelius also announced that, because of the health care law, more than 5.5 million seniors and people with disabilities saved nearly $4.5 billion on prescription drugs since the law was enacted.  Seniors in the Medicare prescription drug coverage gap known as the donut hole have saved an average of $641 in the first eight months of 2012 alone. This includes $195 million in savings on prescriptions for diabetes, over $140 million on drugs to lower cholesterol and blood pressure, and $75 million on cancer drugs so far this year.  Also in the first eight months of 2012, more than 19 million people with original Medicare received at least one preventive service at no cost to them.
Source: freakoutnation.com

Cigna Supplies Medicare Health Insurance Benefit Ideas With Regard To Elderly People

Posted by:  :  Category: Medicare

Cigna Supplies Medicare Health Insurance Benefit Ideas With Regard To Elderly People Cigna is a huge famous insurer for countless years , and they’ve made it their particular responsibility to provide a amount of health care insurance plans , such as medicare advantage plans , designed for seniors in the us. It’s difficult for elderly people , and also require several medical issues , to get respectable insurance policy , however they will have the proportions in order to by way of Cigna. In addition to offering a selection of medical care insurance coverage , the business likewise features a legitimate contract with the federal government to offer medicare offers to senior citizens. Due to this , they’re able to give a selection of beneficial medicare plans that an one that is eligible for your federal government assisted insurance policy could choose. They not simply offer your health insurance coverage , these people likewise offer your health treatment by way of Cigna health-related group (CMG). By providing coverage of health along with health care jointly , you are able to develop a solid connection with the health practitioner as well as your treatment group — specialists that are committed to helping you have the nearly all from the health which means you could easily get the best from life. Along with along with their CMG employees , you receive usage of a thorough community that could reach over several ,500 specialists locally — discover about medicare plans with Cigna. First of all , Cigna provides medicare prescription medicine plans. We all know , prescriptions can be quite expensive. Several of the actual treatments can cost more than one hundred us dollars monthly. A great deal of senior citizens need to take a number of medications daily , and that can cost more than a fixed revenue meet the expense of. Cigna offers 2 various prescription medicine plans you could consider. The important points of these two are below. Cigna medicare RX standard goes hand and hand primarily aspects of medicare and available in every point out from the united states of america. The master plan carries a selection of valuable rewards. As an illustration , it doesn’t incorporate a deductable, which will keep you against paying a lot poorer. Additionally , it would always spend on prescriptions also over the medicare donut pit , which will cut off the majority of healthcare insurance coverage. In general , generic prescription medication by way of this plan of action would likely price nothing a lot poorer. Cigna medicare choose additionally Rx is only available in the state of illinois and it works just with medicare HMP plans. Using this choice , you may fundamentally find some good healthcare along with solutions. The master plan doesn’t always have any regular monthly cost and possesses no deductibles to achieve. Solutions are for sale to a lesser amount of as well as the plan may even assistance to spend in surgeon’s trips. In inclusion to these 2 health professional prescribed plans , Cigna likewise provides medicare advantage plans. They only just lately taken out selecting the actual hmo plans , however others are available to people who be eligible for medicare. nOt all of these plans can be found in every point out , therefore it will be significant to examine just what comes in your state ahead of determining in the event that these plans is worth considering.
Source: pdfcast.org

Video: Cigna Plans to Sell 15 Million Shares to Fund Purchase

Cigna to Acquire Arcadian and Humana Medicare Advantage Plans in Three Markets as Part of Previously Announced, Government

BLOOMFIELD, Conn., June 27, 2012 – Cigna (NYSE: CI) today announced that it has come to an agreement with Humana to purchase select Medicare Advantage plans in Texas and Arkansas. The plans in the three markets – Amarillo, Longview-Marshall and Texarkana – are part of a previously announced government-stipulated divestiture for Humana to complete its acquisition of Arcadian Health.
Source: prsync.com

Goon Review Cigna Provides Medicare Advantage Plans For Senior Citizens

Cigna is a well-known insurance carrier for quit some time and they’ve made it their responsibility to provide a selection of health care insurance plans like Medicare Advantage Plans intended for senior citizens in the United States. It is frequently tough for seniors who might have quite a few health conditions to obtain good insurance coverage but they would have the capacity to through Cigna. Together with offering a selection of health care coverage the firm likewise has a legal contract with the government to provide Medicare plans to seniors. Due to this they’re able to offer a number of helpful Medicare plans that an individual who is eligible for the government assisted insurance will be able to select.They not only provide your health coverage they likewise provide your medical care through Cigna Medical Group (CMG). By providing health coverage and medical care together you are able to build a solid connection with your medical doctor and your care team – experts that are committed to aiding you get the most out of your health so you can get the most out of life. And along with their CMG staff you gain access to an extensive network of more than 4000 specialists in the community – find out about medicare plans with Cigna.To start with Cigna offers Medicare prescription medication plans. As everyone knows prescription medications could be very costly. A few of the medicines could cost more than one hundred dollars a month. Numerous senior citizens have to take several medications each day and that can cost more than a fixed income could afford. Cigna offers two different prescription medication plans that you can take into consideration. The details of the two are below.Cigna Medicare RX Basic would go in conjunction with most parts of Medicare and it’s obtainable in every state of the nation. The plan has a selection of valuable benefits. For instance it does not include a deductable that will keep you from having to pay with your own money. Furthermore it would continue to pay for prescriptions even through the Medicare donut hole which will cut off most healthcare coverage. Generally generic medication through this plan would cost nothing out of pocket. Cigna Medicare Select Plus Rx is only included in the state of Arizona and it will work just with Medicare HMP plans. With this option you will actually get some healthcare together with prescription medications. The plan doesn’t have any monthly cost and it has no deductibles to reach. Prescriptions are available at a discount and the plan would even help to pay on physician’s appointments.In addition to these two prescription plans Cigna likewise offers Medicare Advantage Plans. They just recently eliminated the option of the HMO plans yet others are available to people who qualify for Medicare. Not all of these plans are available in every state so it would be important to research precisely what is available in your state before determining if these plans are best for you.
Source: fc2.com

cigna medicare rx prior authorization form : Lana's blog

PRIOR AUTHORIZATION FORM Phone: (877)-2GHI HMO (877-244-4466) Fax and is only valid for eligible health plan received the services outside of the Medicare Advantage. Filing an appeal and Quick Tips for Cigna Medicare Select Plus Rx Appeal Policy and Procedure 2011 CIGNA Medicare Select Plus Rx (HMO) CIGNA HealthCare of Arizona, Inc. has been serving the health care needs of Arizona’s Medicare-eligibles for nearly 40 years. Top questions and answers about Medco Prior Authorization Form. Find 25 questions and answers about Medco Prior Authorization Form at Ask.com Read more.
Source: exblog.jp

Cigna Makes $3.8 Billion Deal To Buy Medicare Carrier

Reuters: Cigna To buy Medicare Co HealthSpring For $3.8 Billion Health insurer Cigna Corp will buy HealthSpring Inc for $3.8 billion to jump-start its business selling Medicare plans as more elderly Americans become eligible for the U.S. government program. Medicare is an enticing market for U.S. health insurers, even as Congress weighs cuts to the program to rein in the country’s debt. In particular, the entry of the postwar baby boom generation into retirement is expected to swell the ranks of privately run Medicare Advantage plans, which now account for 25 percent of Medicare enrollment, compared with 75 percent for government-run plans (Krauskopf, 10/24). Market Watch: Cigna To Buy HealthSpring For $3.8 Billion Health-insurance giant Cigna Corp. said Monday it will pay $3.8 billion in cash to acquire the shares of HealthSpring Inc. The price, $55 a share, that Cigna is paying represents a 37% premium over Friday’s closing stock price for HealthSpring. The news catapulted HealthSpring shares by more than 33%, while Cigna was up about 1.5%. The companies said in a press release that HealthSpring Chairman and Chief Executive Herb Fritch will stay with the united companies, as Cigna will expand into senior and Medicare businesses (Britt, 10/24). Modern Healthcare: Cigna To Buy HealthSpring In $3.8 Billion Deal Cigna Corp. said it reached at definitive agreement to buy Medicare Advantage provider HealthSpring for $3.8 billion. Cigna said it would pay $55 per share in an all-cash deal for the Nashville-based HealthSpring, a publicly traded company. The deal, which is subject to regulatory approval, is expected to close in the first six months of 2012, according to an announcement by Cigna. Herb Fritch, chairman and CEO of HealthSpring will oversee a push by Cigna into senior and Medicare service lines, the announcement said (Evans, 10/24).
Source: kaiserhealthnews.org

MedicareIsSimple: Medicare market players unveil plans

The Solution to Your Healthcare Needs Us Here at Medicare is Simple, we understand your needs. It is our mission to educate and enable you to choose among the best Medicare plans to find the policy that fits your requirements. Get free quotes instantly using our advanced quoting technology. You will receive multiple quotes from the most reputable carriers for you to compare online. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

Cigna: A Lot Riding On Managed Medicare

Higher debt levels of 60% of equity — the worst amongst its peers in our table above, has crimped profits and hurt its chances for further acquisitions. This industry, which is characterized by cut throat competition and little product differentiation, needs further consolidation and Cigna’s comparatively lower cash hoard makes acquisition led growth difficult in the future.
Source: seekingalpha.com

Cigna Deal Signals More Insurance Buyouts to Come

Even with acquisitions, the outlook for the big health care insurers still appears somewhat hazy given the potential for increased government regulation and the still-unknown impact of the Patient Protection and Affordable Care Act (PPACA), commonly referred to Obamacare by law’s skeptics. Some industry observers think PPACA is expected to have only a minor hit on the major insurers. They say the pricing pressures of the Medicare Advantage reimbursements and provisions are likely to be more than offset by the expansion of the pool of covered individuals and increased subsidies.
Source: investorplace.com