Six Myths About Assisted Living

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashdesign: A. GoldenNomination for Annual Disability Service Award 1. The nominated business: The nominated business is named Raya’s Paradise. Raya’s Paradise is an establishment that cares for elderly people who are disabled. It provides a warm place for them to live while caring after their individual needs and desires. Her homes are incredibly clean and well maintained. Raya’s Paradise creates a soft and welcome atmosphere to all of its inhabitants. Its cooks create exquisite meals specific to the individual person’s taste. It provides an amazing array of activities, ranging from exercise to musical programs. The homes are surrounded by beautifully sculpted gardens. Raya’s Paradise provides a very homely and family like environment for elderly people who are disabled and unable to live on their own. 2. How the Business provides an innovative service to persons living with disability: Raya’s Paradise provides an innovative service because of its atmosphere. Raya Paradises homes are sparkling clean, warm, festive, and very much service oriented. Its inhabitants are always well feed with delicious food and entertained with a variety of activities. This establishment is a model for other board and care establishment for the service it provides for elderly people who are disabled and its commitment needs and taste of its inhabitants. Its customers and their families have nothing but praise for the business. Raya’s Paradise opened 10 years ago. It is unlike any other board and care because it no an institution but truly a paradise. If forced to rank the establishment from one to ten, it would be a twelve. If anyone is deserving of West Hollywood’s Annual Dusability Service Award it’s Raya’s Paradise. I strongly urge the city to recognize the establishment with its Annual Disability Service Award on Raya Paradise’s 10th year anniversary of being in business. Alla Shullman, President Orthomed Appliances, (323) 656-1442
Source: rayasparadise.com

Video: Medicare Provider, Assisted Living

Medicare and Medicaid Audits of Psychologists and Other Mental Health Professionals

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Healthcare Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today.  Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
Source: thehealthlawfirm.com

Medicare Home Health: Dangers of Assuming Medicare Covers Everything

Elderly home care is and will continue to be much more cost effective now and in the future. When considering the cost of elder home care versus assisted living costs, there are many factors to take into consideration. One consideration is to understand the trends of the health care industry, so that you can financially plan for your future. Many believe that Medicare will cover everything they need as they age. Although many realize that they need to financially prepare for the future, most do not investigate the cost and options of future care needs. Many do not feel that they can afford to invest in long term care insurance. In 2008, Prudential Insurance did a study on long term care. The results, which will be followed up every year, had some alarming information regarding the costs that will pay for care and services as we age. The information from this and other studies is important to assure successful planning for our future care needs. It was noted that elderly assisted living homes have seen the largest increase in costs over a 2 year period. The average daily cost of living in an elderly assisted living facility increased to almost $39,000 per year. This is an average rate of just over $100 per day. There was an astonishing average increase of a 15% in rates for the elderly assisted living facilities that provide care for dementia and Alzheimer’s patients. Elderly home health care has had the smallest rate increase of all the providers. The rate of elderly home health care has had a 5% increase over the past two years and a 17% increase over the last 7 years. The costs to have a certified nursing assistant provide elder home care averages $21 per hour. A certified nursing assistant provides services such as: bathing and dressing. The services of elder home care are ordered by a physician and usually paid for by insurance. These services provided by elderly home health care are intermittent and are offered for a short period of time. Another study, also done in 2008 was preformed by the Genworth Financial Group. This study explored the cost of care that covers the non skilled side of elder home care. This is the largest growing portion of the elder home health care services. This growth, is due in part to many aging seniors desire to remain in their homes as long as possible. The average cost for homemaker services in the elder home care sector is $18 an hour. There has been a rate increase of 4% over the past year. A homemaker provides some housekeeping duties, companionship, and assistance with cooking, if needed. They may also run short errands when required. Elderly home care also provides home health aides. They provide basic assistance with bathing and dressing. A home health aide averages a rate $19 an hour. This shows an increase of 3% in just one year. Met Life Market surveyed adult day services in 2008. The results from this survey show the average daily cost for adult day care services is $64. This shows an increase of 5% in the past year. Adult day care services are a growing trend in the aging health care market. Adult day care is a cost effective way keep an aging senior at home For caregivers, utilizing adult day care services permits them to continue to work. Many caregivers take time to do things to they need to take care of and get a break from their care giving duties. The costs of elder home care services will continue to rise. Surveys show that the trends will continue. The largest increases will be in the assisted living and nursing home areas of elderly home health care services. The past five years has seen an increase in elderly assisted living rates jump by 41%. Over the past five years, there has been an increase in nursing homes rates of over 30%. Over half the surveyed facilities expect to increase their rates, again, over the next year. The good news is that one in four elder home care providers plan to increase their rates in the next year. Being aware of the cost of elderly home care and elderly assisted living can assist you in planning for your future needs. Educate yourself on the various options available and how you can utilize those services for future needs. It is important to be proactive and investigate avenues to pay for your future health care needs.
Source: blogspot.com

Please be aware of Medicare Scams as $250 rebate checks get sent out!

The recent mailing of $250 rebate checks to participants in Medicare’s drug program has given scammers a new opportunity to take advantage of seniors and other Medicare recipients. In this latest scam, Medicare recipient receive a call from a con artist claiming to be a Medicare representative. The scammer then tells each recipient that they need to provide personal information, such as their Social Security number and bank account number, in order to receive their rebate check. In reality, the scammers need this information to gain access to the recipient’s bank account and empty it.
Source: seniorlivingexperts.com

Eldercare Resource Center: Medicaid’s Assisted Living Benefits: A Good Option for the Lucky Few

Questions about Medicaid’s assisted living benefits are probably the second most common questions we receive. The first being the more rhetorical “what do you mean Medicare doesn’t pay for assisted living?”. The latter has a simple answer, but the former is much more complicated as Medicaid benefits vary from state to state. Our organization recently undertook a major research project to determine just what Medicaid will pay for with regards to assisted living in the year 2012. The first and most important point to make is that institutional or long term care Medicaid does not pay for assisted living. It is intended to help improvised individuals who require nursing home care. However, Medicaid Waivers in many states do provide assistance to individuals in assisted living residences. To avoid future confusion, we should mention that Medicaid Waivers are often referred to HCBS, Home and Community Based Services,1915 Waivers and sometimes Demonstration Projects. The second, and also critically important point to make, is that unlike institutional Medicaid, Waivers are not entitlements. An entitlement program means that if one meets the eligibility requirements, they receive the benefits. Waivers, on the other hand, have enrollment caps (or slots in Medicaid parlance). Each Waiver is approved to assist a limited number of persons and once the limit has been reached, a waiting list is started. Another finding from our study was that the types of assisted living benefits varied by state and can be loosely grouped into one of three categories. 1) Personal Care Only – these states will pay for their waiver participants personal care costs regardless of the location in which they reside. Therefore, assisted living residents could expect the personal care portion of their assisted living bills to be covered, at least up to Medicaid’s allowable reimbursement rates. 2) Nursing Home Level Care – similar to above, these states pay for personal care but also cover other nursing home level types of care for waiver participants. Again, independent of residence. 3) Complete Assisted Living – in these states, their Medicaid Waivers will pay for both personal care, nursing home level care and the room and board costs for the participants. Individuals must reside in assisted living communities which accept Medicaid reimbursements. While the number of individuals receiving Medicaid help in assisted living is limited as is the amount of assistance they receive; the situation is not all doom and gloom. In fact, the long term view (current political environment aside) can almost be considered rosy. Ten years ago, approximately half the number of states provided assistance and we fully expect this positive trend will continue. Ten years from now, Medicaid Waivers in all 50 states will likely be covering assisted living for the elderly in some capacity. We’ve consolidated the results from our study into a State by State Guide to Medicaid’s Assisted Living Benefits in which we explore each state’s coverage, its limitations and other state based alternatives.
Source: blogspot.com

Medicare premiums would rise for most beneficiaries under a premium

A premium-support Medicare plan would give beneficiaries a specific amount of money with which to purchase insurance. Assuming beneficiaries keep their current healthcare plans, more than half of seniors enrolled in traditional Medicare and almost all of those enrolled in Medicare Advantage would experience higher premiums under a premium support plan, Kaiser Family Foundation researchers found.
Source: mcknights.com

Margaret is making the most of her time in assisted living

Seniors for Living is a free service that helps you and your family research, evaluate, contact, and compare Senior Housing options. Our resources include partnerships with hundreds of senior housing communities and home care providers; daily blog posts about all things boomer and seniors; a vibrant community on Twitter and Facebook; and a bi-monthly #ElderCareChat on Twitter — all of which can help guide you in your own personal senior housing and senior care decision.
Source: seniorsforliving.com

Does Medicare Pay for Assisted Living

My mother has Alzheimer’s and is 88 years old. She is in a rehab center after a fall. She was in ICU for a week and was extremely dehydrated and not eatting when all this happened. Since she is not able to care for herself at all anymore and Dad is not able to care for her either, does Medicare pay for assisted living care?
Source: caring.com

2012 Long Term Care Information Sheet

Are government benefits available to assist in paying for long term care costs?: The Medicaid program, founded in 1965 concurrently with Medicare, is the primary government program that helps with the cost of long term care. Unlike Medicare, which is funded and directed solely by the federal government, Medicaid is a joint enterprise between the state and federal governments. There are many different programs of assistance within the Medicaid system. The nursing home program is called “Institutional Care Program”, or “ICP”. Persons eligible for ICP receive financial assistance for the costs associated with residing in skilled nursing facilities (nursing homes). Medicaid generally does not pay for assisted living; although a limited Medicaid waiver program and a “diversion” program may provide relief for some eligible residents. The cost of living at an assisted living facility must usually be privately paid.
Source: boyerjackson.com

United Healthcare Medicare plans

Posted by:  :  Category: Medicare

As an example, United Healthcare Medicare HMO plans are super easy to utilize and comprehend. Simply pay out a set fee whenever you will need healthcare providers. You understand upfront precisely what the expenses will be and are not surprised by a huge physician’s expenses. An HMO plan charge you a collection price with an doctor office visit, emergency room go to, and hospital stay. The particular fees are generally under you’d probably pay using conventional Medicare health insurance insurance coverage. The sole probable issue with the HMO program’s you need to utilize physicians inside community until you need crisis attention. If you are using a doctor outside of the system, you should spend entire out-of-pocket price.
Source: blogspot.com

Video: Medicare Basic Overview by United Healthcare Medicare Solutions

www.AARPMedicarePlans.com

www.AARPMedicarePlans.com is an online helper tool provided by AARP, to help you compare all Medicare coverage options and find the best solutions for you. It provides an estimate of your annual prescription drug costs without Part D coverage and compares the cost savings you can reasonably expect to achieve when you enroll in one of the three UnitedHealthcare Prescription Drug Plans.
Source: hotbuzz4u.com

Is United Healthcare Medicare Supplement Insurance My Only Choice For a Medigap Plan?

Medicare is a federal program. However, state officials regulate and administrate private health insurance coverage, such as United Healthcare Medicare Supplement Insurance. Insurance companies send out advertisements in the mail and run commercials on televisions that encourage senior citizens to sign up. United Healthcare has been offering insurance access for decades and is a familiar household name to many senior citizens. However, when it comes to getting the right healthcare coverage, Medicare recipients may want to explore all options.
Source: seniorcorps.org

Earnings Analysis: UnitedHealth Group Inc. (NYSE:UNH)

UnitedHealth Group, Inc. provides health care coverage, software and data consultancy services. The company operates through four business segments: UnitedHealthcare, OptumHealth, OptumInsight and OptumRx. The UnitedHealthcare segment includes UnitedHealthcare Employer & Individual, UnitedHealthcare Medicare & Retirement and UnitedHealthcare Community & State. UnitedHealthcare Employer & Individual offers a comprehensive array of consumer-oriented health benefit plans and services for large national employers, public sector employers, mid-sized employers, small businesses and individuals nationwide. UnitedHealthcare Medicare & Retirement provides health and well-being services to individuals age 50 and older and offers a wide spectrum of Medicare products, including Medicare Advantage plans, Medicare Part D prescription drug coverage and Medigap products that supplement traditional fee-for-service coverage, which may be sold to individuals or on a group basis. The UnitedHealthcare Community & State segment provides solutions to states that care for the economically disadvantaged, the medically underserved, and those without benefit of employer-funded health care coverage in exchange for a monthly premium per member from the applicable state. The OptumHealth segment provides health services business serving the broad health care marketplace, including payers, care providers, employers, government, life sciences companies and consumers. Optum helps improve overall health system performance. It is organized into three segments: optimizing care quality, reducing costs and improving the consumer experience and care provider performance. Optum is organized in three segments: OptumHealth focuses on health management and wellness, clinical services and financial services, OptumInsight delivers technology, health intelligence, consulting and business outsourcing solutions and OptumRx specializes in pharmacy services. The OptumInsight segment is health information, technology, services and consulting company providing software and information products, advisory consulting services, and business process outsourcing to participants in the health care industry. Hospitals, physicians, commercial health plans, government agencies, life sciences companies and other organizations that comprise the health care system work with OptumInsight to reduce costs, meet compliance mandates, improve clinical performance and adapt to the changing health system landscape. The OptumRx segment OptumRx provides a multitude of pharmacy benefit management (PBM) services. PBM services and manages specialty pharmacy benefits across nearly all of UnitedHealthcare’s businesses, as well as for external employer groups, union trusts, managed care organizations, Medicare-contracted plans, Medicaid plans and TPAs, including for pharmacy benefit services, mail service only, rebate services only and network services. It also provides claims processing, retail network contracting, rebate contracting and management and clinical programs, such as step therapy, formulary management and disease/drug therapy management programs to achieve a low-cost, high-quality armacy benefit. UnitedHealth Group was founded in January 1977 and is headquartered in Minnetonka, MN.
Source: insidermonkey.com

WCH Service Bureau, Inc: Medicare Advantage Plans

As previously communicated in the July and September 2012 Network Bulletins, UnitedHealthcare is working to standardize its Prior Authorization programs in the coming months in support of improved administrative consistency and transparency. After Oct. 1, 2012, UnitedHealthcare will require Prior Authorization for a standardized list of procedures for UnitedHealthcare Medicare Advantage Plans, UnitedHealthcare West Medicare Advantage Plans and UnitedHealthcare West Commercial Plans. Standardization of the Prior Authorization Lists for UnitedHealthcare Medicare Advantage Plans and UnitedHealthcare West Medicare Advantage Plans will be effective Jan. 1, 2013. Please continue to request prior authorizations for UnitedHealthcare Medicare Advantage plans for the current list of services outlined in the 2012 Provider Administrative Guide until Jan. 1, 2013. 
Source: blogspot.com

united healthcare aarp medicare complete medicare plans for 2013 « Insurance News from Crowe & Associates

The United Healthcare Medicare Complete product is very similar to the AARP branded version but most versions do not have out of network coverage as they are usually HMO plans.  The in network benefits tend to be a little better than the AARP branded in network benefits as a result.  for 2013 the United Healthcare branded products will look similar to the 2012 version with a few improvements such as a lower annual out of pocket max, a outpatient surgery benefit that offer more than 80% coverage and  a lower primary doctor copay.  The improvement to the outpatient surgery benefit is the most needed change overall and this will reduce costs for many members.
Source: croweandassociates.com

Join UnitedHealthcare for a National Medicare Education Week Event!

Representatives from United Healthcare will share important Medicare information and give an overview on social media.  Hands-on computer training will follow the presentation and will help you explore online resources for understanding.
Source: wordpress.com

Accountable Care Organization

Many physicians are  truly unaware of what is really going on with regards to the future of US healthcare, but what is clear to me is that accountable care organizations (ACOs)  are the new Medicare Health Maintenance Organization (HMO) and are likely here to stay.  ACOs are organizations that have been encouraged and almost mandated by the affordable care act.    Physicians or medical organizations with at least 5000 medicare lives will be given an option to be part of a coordinated care system.  These patients include individual that qualify for Medicare as they become 65, the disabled population, end stage renal disease patients on dialysis, and certain institutionalized patients.
Source: phyaura.com

Comparing Medicare plans? Ratings show some policies better than others — Health — Bangor Daily News — BDN Maine

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

Health Premiums Could Wipe Out Social Security Boost; Medicare Enrollment Begins

Miami Herald: Marketing Medical Insurance To Individuals This time of year is a hectic, marketing-intensive period for Florida Blue and other insurers that sell Medicare policies. During the federal program’s annual election period, this year from Oct. 15 to Dec. 7, seniors can switch to a new underwriter of Medicare policies for their 2013 coverage. So, insurers are anxiously courting the Medicare population to keep current policyholders and add new ones…That kind of consumer marketing may become much more common in the under-65 market as healthcare reform unfolds, especially the individual mandate to obtain medical insurance or pay a penalty, starting in 2014. So next year, visitor traffic at the Florida Blue Centers in Miami, Fort Lauderdale and other locations around the state may increase substantially to include not only Medicare beneficiaries but also younger people shopping for individual health insurance (Seemuth, 10/14).
Source: kaiserhealthnews.org

Mercy Medicare Advantage HMO

Posted by:  :  Category: Medicare

Related medicine news : 1. Redskins' Draft Pick Malcolm Kelly Energized By Trip To Mercy Ship In Liberia 2. Mercy Corps Delivers Lifesaving Supplies to China Earthquake Survivors 3. INSPIRIS and Mercy Care of Arizona Named Winners in URACs Best Practices in Consumer Empowerment and Protection Awards 4. VIDEO from Medialink and Philips: Philips Electronics Unveils First Imagination Light Canvas at the New Mercy Medical Center in Rogers AR 5. AmeriHealth Mercy Family of Companies Acquires Community Behavioral HealthCare Network of Pennsylvania 6. Area Dentists, University of Detroit Mercy Team Up to Provide Free Dental Care to Low-Income, Uninsured Detroit-Area Children on Saturday, February 2 7. University of Detroit Mercy School of Dentistry Moves to Larger Facility on New Corktown Campus 8. Independence Blue Cross Finalizes New Multi-Year Agreements with Mercy Health System and St. Mary Medical Center 9. Alameda County Hosts National Initiative to Reduce Health Disparities 10. AARP the Magazine Names the Top 10 Healthiest Places to Live in America 11. Mosaica Partners Kolkman to Chair HIMSS Healthcare Information Exchange Steering Committee Source: bio-medicine.org
Source: medicaresupplementalco.com

Video: Philadelphia: Medicare Fraud Summit Opening Remarks and Panel 1

Comparing Medicare plans? Ratings show some policies better than others — Health — Bangor Daily News — BDN Maine

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

The Presidential Candidates debate Medicare

Both Presidential Candidates promise not to change benefits for current Medicare recipients, but they do disagree on the future for younger workers.  President Obama plans to cut excessive payments in the current system to save money and extend the life of Medicare.  Obama claims that Romney will turn Medicare into a private system and leave seniors at the mercy of insurance companies. Romney wants to have options for younger workers when they reach retirement age.  The issue of converting to the private sector, according to Romney, would only make changes for those 55 years of age and under.
Source: globeuniversity.edu

MercyCare Health Plans to offer Medicare Advantage

“MercyCare is pleased to provide Medicare recipients another low-cost option for comprehensive care from Mercy Health System,” says Joseph Nemeth, Chief Operating Officer of MercyCare Health Plans. “The new Medicare Advantage product will also increase employment at MercyCare, adding over 25 new jobs to the local economy.”
Source: mercyblogs.org

How AARP Made $2.8 Billion By Supporting Obama’s Cuts to Medicare

As you know if you’ve been reading this blog, Obamacare cuts $716 billion from Medicare in order to pay for its $1.9 trillion expansion of coverage to low-income Americans. It’s one of the reasons why seniors are more opposed to the new health law than any other age group. So why is it that the group that purports to speak for seniors, the American Association of Retired Persons, so strongly supports a law that most seniors oppose? According to an explosive new report from Sen. Jim DeMint (R., S.C.), it’s because those very same Medicare cuts will give the AARP a windfall of $1 billion in insurance profits, and preserve another $1.8 billion that AARP already generates from its business interests.
Source: politicalarena.org

Integrated Managed Care Model for Dual Eligibles Reduces Readmissions

This analysis was subject to some limitations. For example, while we captured both full and partial duals in the Medicare FFS dual eligible control group, the Mercy Care Plan only enrolls full duals. Although our results were risk-adjusted, because partial duals may have access to greater resources than full duals, the difference in populations may have had some impact on our findings. Also, to identify the Medicare FFS dual eligibles in the 2009 Standard Analytic Files, Avalere was limited to using indicators known to either undercount or overcount duals depending on the state. The analysts used a linear regression method to risk adjust the measures of inpatient utilization, ED visits and adults’ access to preventive/ambulatory health services. Alternative methods are frequently used to model these types of quality measures, particularly for patient-level risk adjustment. We explored these other model structures and found these alternatives did not provide any considerable gains in model fit or predictive power.
Source: healthaffairs.org

Mercy Medicare Advantage HMO

It’s continue implement social and, are insurances for access an. Health along an for for individual, include before to an seniors an. Name book accepted upcoming both, Mercy Medicare Advantage HMO cost-sharing list continue of health an. Plans the plans a gives and, Medicare or member include option who. Shasta include an insurances put local, an a map signed these for. Leave plan more include and or, a social appointment up call providing an. It’s appointment list and insurance in, Medicare who plan in and upcoming.
Source: posterous.com

Denver Debate: The Candidates Discuss Medicare

So, I don’t think vouchers are the right way to go. And this is not only my opinion. AARP thinks that the savings that we obtained from Medicare bolster the system, lengthen the Medicare trust fund by eight years. Benefits were not affected at all. And ironically, if you repeal Obamacare, and I have become fond of this term, “Obamacare,” if you repeal it, what happens is those seniors right away are going to be paying $600 more in prescription care. They’re now going to have to be paying copays for basic checkups that can keep them healthier.
Source: kaiserhealthnews.org

” The Affordable Care Act and What it Means for You and Your Healthcare”, By Nick Tate, author of ObamaCare Survival Guide

Under ObamaCare Medicare reductions would add up to $716 billion in 10 years, according to the nonpartisan Congressional Budget Office. That figure is identical to Paul Ryan’s 2013 budget proposal. Healthcare experts believe those reductions will largely leave Medicare unchanged for Americans 55 and older. But the real changes come in 2022. Predictably perhaps, Republicans and Democrats have different ideas about how to preserve Medicare down the road. Those reductions in reimbursement to hospitals, insurers and the Medicare Advantage program (by about $68 less per month, according to the Congressional Budget Office) could lead to cuts in benefits and services for some seniors, even though ObamaCare does not specify what they might be.
Source: benefitsunlimitedinc.com

Australasian telehealth celebrates its coming of age

Posted by:  :  Category: Medicare

The injection of funds into local telehealth provision through the MBS telehealth item numbers and the NBN-enabled telehealth pilots program means the more widespread adoption of telehealth in Australia is beginning to take shape. The potential of these initiatives, and the strategic directions for telehealth over the next few years, will be discussed at the Global Telehealth 2012 conference in Sydney in November.
Source: wordpress.com

Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained

Australian Health Care Benefits

= $ 83.95 fee and fee = 75% (hospital in-patients) or 85% (outside hospitals), so that gain or $ 63.00 or $ 71.40 discount. Therefore, if the doctor charged $ 130.00 for the appointment you will be out of pocket for $ 67.00 or $ 58.60. You will need a letter of recommendation from a medical specialist to see how it will need to budget for both out of pocket expenses. Specialist fees may vary, with some charging a few hundred dollars, if they are highly specialized and sought after. It is worth checking fees before making the appointment, so they are ready for any out of pocket expenses.
Source: blogspot.com

Medicare Annual Wellness Visits: A Guide to Benefits, Payments

The case for a six-month interval schedule may be that if patient answers negatively to the bundled review questions for alcohol or depression conditions at the time of the AWV or Initial Preventative Physical Examination (IPPE) visit, an additional annual screen at that time may not be relevant, although allowed by CMS. The situation may be that the patient then experiences a change in behavior and develops an alcoholic or depression condition which could then be detected and treated with a six-month interval schedule.
Source: physicianspractice.com

GWAHS Libraries Blog: Palliative care services in Australia (AIHW)

Palliative care services in Australia is the first in a planned series of annual reports providing a detailed picture of the national response to the palliative care needs of Australians. Details from a range of data sources for 2009-10, and where available 2010-11, are presented, as are changes over time. The number of palliative care hospital admissions in Australia rose by more than 50% between 2001 and 2010. The report shows that there were almost 56,000 palliative care admissions reported in public and private hospitals in 2009-10. Almost $3 million in Medicare Benefits Schedule payments was paid for palliative medicine specialist services in 2010-11. The average age of people being admitted to palliative care was 71.9 years. Media release
Source: blogspot.com

Powerful Ways Private Health Insurance Can Save You Money

Those services that aren’t mentioned on the Medicare Benefits Schedule have very limited coverage under private hospital insurance, and sometimes, they aren’t covered at all (For example: laser eye surgery and elective cosmetic surgery). Furthermore, as HelpMeChoose.com.au (http://helpmechoose.com.au/compare-private-health-insurance/) will indicate on a mere comparison of funds, hospital cover is broken down into four basic categories. Each classification is then based on services that are either covered, excluded, or restricted on Standard Information Statements.
Source: financialinteractive.com

What is a Medicare Benefits Schedule number?

For in-hospital services, the Medicare rebate will pay 75% of the Medicare Benefits Schedule fee and if you have private health insurance your Health Fund pays the remaining 25% as a benefit towards your doctors’ bills.  Some doctors and specialists charge more than the MBS fee. If this happens, you have to pay the ‘gap’, which is the difference between the MBS fee and what the doctors charge.
Source: wordpress.com

Peters vs. Bilbray: The Vacuum Debates

The last I had heard was that Peters was doing everything possible to try and goad his opponent into a get-together.  Back in August, Bilbray issued a challenge to Peters to a series of four debates.  The Peters campaign replied that “Mr. Bilbray has issued a challenge to debates we agreed to weeks ago.”  The Peters camp took a very Pat Hill-like “anytime, anywhere” stance, but still could not get anything on the schedule.  According a Peters spokesperson, every time a date was proposed, Bilbray claimed a conflict.  (For those who don’t know, Pat Hill is the former Fresno St. University football coach who constantly whined about his program’s inability to get a game against the big boys.  “We’ll play anyone, anywhere” became Fresno State’s unofficial motto.)
Source: sandiegofreepress.org

What You Need To Know About Supplemental AARP Medicare Plans In Phoenix AZ

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSUsing one of these UnitedHealthcare plans still allows you to see a Medicare doctor for care and you can still purchase Medicare prescription plans (Part D) that will enhance your insurance plans. With UnitedHealthcare supplement plans, you are guaranteed that the plans will be renewed each year, and you cannot be denied a plan because of your current health or the amount of previous claims filed. In fact, all you need to qualify for the plan is an age above 65 years and be a current member of Medicare Part B. The benefits will stretch from a basic plans to perhaps even foreign ER care. Your personal zip code will dictate what the monthly premiums will be.
Source: walstreetintl.net

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Medicare Home Health: Easily Navigate Medicare Supplemental Plans Online

It is evident that extra coverage is needed to fill in the gaps left by the standard Medicare Part A and B. This is where the different Medicare Supplement Insurance plans come into play. It is important when looking into each plan that you are able to compare Medicare Supplemental Insurance plans and compare rates. Medigap, as it is commonly known, is offered for purchase through many different private insurance organizations. One thing you must remember is the coverage is equivalent no matter where it is purchased. If you are comparing rates and plans and choose Medicare Supplemental Insurance Plan f from BC/BS it is the same coverage as you will get with Bankers Fidelity. The difference lies within the rate charged for their services. You will need to determine if you are willing to pay extra for the same coverage in order to have a certain insurance provider.
Source: blogspot.com

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

Low cognitive ability impairs enrollment in Medicare supplemental plans

Because traditional Medicare leaves substantial gaps in coverage, many people obtain supplemental coverage to limit their exposure to out-of-pocket costs. However, some Medicare beneficiaries may not be well equipped to navigate the complex supplemental coverage landscape successfully because of their lower cognitive ability or numeracy—that is, the ability to work with numbers. We found that people in the lower third of the cognitive ability and numeracy distributions were at least eleven percentage points less likely than those in the upper third to enroll in a supplemental Medicare insurance plan. This result means that many Medicare beneficiaries do not have the financial protections and other benefits that would be available to them if they were enrolled in a supplemental insurance plan. Our findings suggest that policy makers may want to consider alternatives tailored to these high-need groups, such as enhanced education and enrollment programs, simpler sets of plan choices, or even some type of automatic enrollment with an option to decline coverage.
Source: pnhp.org

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

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

Medicare Supplement or Medicare Advantage

That is correct, Jeff!!  If your group prescription drug plan is not as good as Medicare’s standard prescription drug plan, which means has a $321deductible or more for 2012.  Or if your company and/or your insurance company states that the plan is not creditable, then you should enroll in a Part D plan to keep from having a 1% per month penalty which goes back to the month your Part A started, when you do enroll in a prescription drug plan. Read page 90 of the
Source: tonisays.com

The California Medicare Supplement Plan Landscape

Maybe you’re tired of the A, B, C soup that seems to be swirling around you when you glance at the newly received California Medicare supplement plan offerings and with good reason. There are so many A’s, B’s, and F’s, that you would think you’ve come full circle back to kindergarten. We hope to shed some light on the subject of California Medigap plans to make clear how the various plans differ and reduce the chance of brochure induced headache, a very serious condition NOT covered by Medicare. So let’s dive into the California Medigap plans with a quick scan of what Traditional Medicare does, and more importantly, does not cover. California Medicare is best thought of as an 80/20 plan with deductibles, two of them to be exact. It generally breaks down the core benefit (which account for the majority of your health care cost outside of medication which we’ll save for another article on California Part D) into hospital (Part A) and physician (Part B) costs. That’s the first two letters you’ll see before even looking at California Medicare supplement plans. Remember the “Part” part of the name since that tells you we’re talking about traditional Medicare and not a California Medigap plan. Part. Part. Part. Medicare section. Part A is generally facility based (hospital, surgi-center, etc) while Part B is generally physician based. Now that we understand the bulk of what makes up your health care costs, let’s look at the California Medicare supplement plans. The California medicare plans are A, B, C, D, F, F high deductible, G, K, L, M, and N. In general, they increase in benefits (and cost) from A through F. The remaining generally add in cost sharing to the Medicare supplement subscriber but offer lower prices. For all the California Medigap plans, the main categories of traditional Medicare that they fill the gaps in are the following: Part A deductible, Part A co-insurance, Part B deductible, Part B co-insurance, Part B excess, Hospice Care, Skilled Nursing Facility, Foreign Emergency Travel, 1st 3 pints of blood, and Preventative co-insurance. The lettered California Medicare plans differ in these categories listed above. The F plan covers all these categories and remains the most popular California Medigap plan on the market. All the plans cover the Part A co-insurance completely. A through F cover the Part B co-insurance while G through N have varying degrees of coverage. It’s probably best to look at a California Medicare supplement plan comparison chart to make it clear but we’ll discuss the primary issues to concentrate on when deciding on your Medigap plan. We want to focus on the costs that can either be very large or uncapped. This would be the Part B Excess charge (doctors can charge up to 15% higher than standard Medicare rate), Skilled Nursing Facility, and Part A deductible. The other expenses are probably less exorbitant but still important. The key is this – we’re not talking 100’s of dollars of difference in monthly premium between each California medicare plan so why take on the risk when it’s probably $10-20 difference per month between given plans. That’s why the F plan is so popular. It covers all the main gaps in California Medicare at a relatively low price. Also keep in mind that you’re entering a period of time when medical care (very expensive medical care) becomes more common and frequent regardless of your health at the time of enrolling. It’s a bad bet to buy a less rich California Medigap plan and save a few bucks only to pay much more later on. Take a look at the comparison chart at californiamedigap.com to get a better understanding and we’re happy to walk through your plan options as licensed California Medicare agents but all roads lead to the F plan. We’re happy to be your road map. Dennis Jarvis is a licensed insurance agent concentrating on California Medicare supplement insurance.

Nancy Pelosi’s Weak, Cynical Defense of ObamaCare’s Medicare Changes

Posted by:  :  Category: Medicare

Rogue Magazine (October 1964)  Volume 9 Number 5 - Water Balloons ...item 1.. routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542Elsewhere in the piece, Pelosi offers another scare stat: “Medicare will be bankrupt by 2016 under the Romney-Ryan plan.” But as one of the program’s public trustees has noted, the Obama administration’s Medicare plan only extends the program’s trust fund by double counting, using ObamaCare’s spending reductions to pay for both extending Medicare and new insurance coverage. And even if you ignore the double counting, Pelosi’s bankruptcy charge still boils down to this: You can trust Democrats with Medicare because Team Blue has a plan to let the program go insolvent by 2024.
Source: reason.com

Video: Improving Medicare in 2011

Obama proposes Medicare changes that will limit drug development

But they also found that the proposal would kill 238,000 jobs in the pharmaceutical and related industries by 2020. To add insult to injury, the authors wrote that "the rebates would make at least some drugs money-losers; these drugs would be withdrawn from the market," because companies could no longer recoup the enormous costs of bringing those medicines to market. Seniors, in other words, would lose access to these medicines.
Source: typepad.com

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

Medicare Part D and Medicare Advantage Changes for 2013

The Affordable Care Act includes provisions that, over time, are reducing the cost of prescription drugs for people who fall into the coverage gap, or “donut hole.” In 2011 and 2012, the discount for brand name drugs was 50%; in 2013 and 2014, it will increase to 52.5%, and will grow after that until it reaches 75% in 2020.
Source: wordpress.com

McMahon ad promotes Medicare inaccuracy

The Kaiser Family Foundation found that while Medicare Advantage was offered by President George W. Bush as a way to save money over the fee-for-service traditional Medicare, the plans actually cost some 14 percent more for each patient. The subsidies will be reduced over time starting this year to 2 percent, but quality plans will be rewarded with bonuses and by 2014, all of them will be required to spend at least 85 percent on direct care and not overhead.
Source: nhregister.com

PoliGraph: DFL falsely links state lawmakers to Medicare

The flier states that Wiener “will be just another Republican vote against closing the Medicare prescription drug donut hole.” The DFL is referring to a kink in the Medicare Part D program, which covers drug benefits for seniors. Once Medicare beneficiaries reach a certain coverage threshold, they have to pay for their prescriptions until they reach the catastrophic coverage threshold.
Source: publicradio.org

Patient Satisfaction Gets Renewed Focus with Medicare Changes

As doctors, we are very opinionated about the need to reform the healthcare system for the better. But a critical element that seems to be missing from these many conversations is how we are actually going to improve patient satisfaction. We like to focus on issues such as access and cost and use terms such as “patient-centered” care. In reality though, we need a simple set of tools to help us focus on what truly matters to patients. Again, if a patient feels betrayed or not listened to or just plain unhappy with her care, she can lower the amount of reimbursement money coming back to a hospital regardless of her outcome.
Source: physicianspractice.com

Obamacare fining hospitals for readmitting patients

[1] Jordan Rau, Kaiser Health News “Medicare to Penalize 2,211 Hospitals for Excess Readmission,” (Aug. 13, 2012) http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospital…. [2] Right now HHS is only monitoring readmissions for 3 of 7 conditions. The law requires the Secretary to eventually monitor readmissions for all 7 conditions. See 42 U.S.C. § 1395ww(q)(5)(B). [3] See 42 U.S.C. § 1395ww(q)(3)(C). [4] See 76 Fed. Reg. 51476, 51,662-51663. [5] See 76 Fed. Reg. 51476, 51,662-51663. [6] See Letter from Rick Pollack, Executive Vice President, Am. Hosp. Ass’n to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “RE: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 8, 2011) 15 available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0029; Letter from Maryjane A. Wurth, President, Ill. Hosp. Ass’n to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “Re: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hosp. Prospective Payment System and Proposed Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 16, 2011) 5-6 available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0063; Letter from Barry Arbuckle, President and CEO, MemorialCare Health System to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “SUBJECT: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 20, 2011) 15-16 available at: http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0203; Letter from Tom Bell, President and CEO, Kan. Hosp. Ass’n to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “RE: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 20, 2011) 4-5 (emphasis added) available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0177; Letter from Alyssa Keefe, Vice President Fed. Regulatory Affairs, Cal. Hosp. Ass’n to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “SUBJECT: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 20, 2011) 13-14 available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0133; Letter from Eric Lucas, Senior Director, Gov’t Programs, Catholic Healthcare West and Clara Evans, Director, Public Policy & Fiscal Advocacy, Catholic Healthcare West to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “Re: CMS-1518-P; Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule; Federal Register Vol. 76, No. 87; May 5, 2011.” (June 20, 2011) available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0265; and Letter from Bruce Siegel, CEO, Nat’l Ass’n of Pub. Hosps. and Health Systems to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “Ref: CMS-1518-P. Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates” (June 17, 2011) 3-4 available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0111. [7] Letter from Tom Bell, President and CEO, Kansas Hospital Association to Donald Berwick, Administrator, Centers for Medicare and Medicaid Services, “RE: CMS-1518-P, Medicare Program; Proposed Changes to the Hospital Inpatient Prospective Payment Systems for Acute Care Hospitals and the Long-Term Care Hospital Prospective Payment System and Fiscal Year 2012 Rates; Proposed Rule (Vol. 76, No. 87), May 5, 2011″ (June 20, 2011) 4-5 (emphasis added) available at http://www.regulations.gov/#!documentDetail;D=CMS-2011-0053-0177. [8] Jordan Rau, Kaiser Health News “Medicare to Penalize 2,211 Hospitals for Excess Readmission,” (Aug. 13, 2012) http://www.kaiserhealthnews.org/Stories/2012/August/13/medicare-hospital…. [9] Id. [10] Id. [11] Id. [12] Id. [13] Anna Wilde Mathews, The Wall Street Journal “Medicare Shift Fails to Cut Hospital Infections,” (Oct. 10, 2012) http://online.wsj.com/article/SB1000087239639044465780457804892174794954….
Source: obamacarewatcher.org

Humana Gains as Obama’s Star Bonuses Spur Medicare Upgrade

 Advantage plans have focused on improving their scores in medical areas “that plans can invest in and control to get better results” such as colon cancer screenings, body mass index measurement and hypertension screening, said Bonnie Washington, a senior vice president at Avalere. The plans urge their members to get those screenings, which are aimed at identifying health concerns at the earliest stages, then offer doctors bonuses to perform the procedures.
Source: jallencoblog.com

Understanding Obamacare’s $716 Billion in Cuts to Medicare

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

Early Medicare Open Enrollment Ends December 7, 2011

Medicare enrollees should know that their enrollment period has changed. They no longer have until the end of December to make decisions and changes for next year because December 7, 2011 is the last day you can make changes or enroll in Medicare this year. Don’t procrastinate even if you find the process and options confusing. David C. Cloud & Associates, Inc. can help you make sense of Medicare insurance and relieve the confusion associated with trying to choose which Medicare Supplement plan will best suit your needs. There is nothing like having a friend in the business, and that is what you will find at David C. Cloud & Associates, Inc. Medicare Supplement plans are often referred to as “Medigap.” A Medigap policy is meant to help cover the payments for the health care gaps people run into, like co-pays, co-insurance and deductibles. David has eleven different standardized Medicare Supplement Plans (from A through N) to choose from. Not all carriers have all eleven plans but all the plans contain the same actual benefits no matter who the carrier is. The actual difference only shows up in the carrier costs which will differ from one company to another. David Cloud helps you wade through and find the one that is best suited to your specific individual situation. The three most basic parts to Medicare: * Medicare Part A — Hospital Insurance helps to cover inpatient hospital care or skilled nursing facilities, hospices, and home health care. * Medicare Part B — Medical Insurance covers doctor services, hospital outpatient care, and home health care, plus many preventative services. * Medicare Part D — Prescription drug option is run by Medicare approved private insurance companies and helps to cover the cost of prescription drugs. David Cloud is an expert on Medicare and all its associated policies from A through N. He and his associates will, free of cost or obligation, lend you the ear and the guidance you need to make the best choices for your Medicare needs and your pocketbook. Then, if you decide to purchase your policies through him and his associates, you will also have access to all the best carriers at no additional charge to you. You will pay the same whether you use David’s help or not

Medicare Advantage In Limbo?

Posted by:  :  Category: Medicare

Most people are unaware that the recent health insurance reform legislation, the Patient Protection and Affordable Care Act (PPACA), made significant changes to how Medicare Advantage Plans are reimbursed by the federal government.  While the intent behind the legislation is to ensure that private health insurers are providing the highest possible quality of care to those enrolled in their plans, the result will likely be that beneficiaries experience reduced benefits and higher premiums over the next few years, leading many to opt out of the program in favor of traditional Medicare and/or Medigap.  For the time being, however, Medicare Advantage enrollment is up and premiums are down due to quality bonus payments due to private health insurers.  Medicare beneficiaries can take advantage of the lower premiums for now, but should be aware that things may change over the next year or two.
Source: advocator.com

Video: Six Steps to Applying for Disability

Governor Brown Signs Bills Sponsored By the Commissioner

This case is related to two other charged cases involving the same fictitious employer scheme, and is the ninth in a sweep of charged fictitious employer cases in the last year. On November 30, 2011, Navesia Samuels, 33, from Orange County, was charged with mail fraud for her involvement in fictitious employer schemes that defrauded multiple state workforce agencies, including California’s Employment Development Department (EDD) and AFLAC, with a total loss of approximately $400,000 in unemployment and disability benefits. On March 28, 2012, the grand jury indicted four related cases and a total of seven defendants with fictitious employer schemes involving the defrauding of federal and state unemployment and disability insurance programs, as well as AFLAC. Bobby Langley, 46, from Los Angeles, was charged with mail fraud for his involvement in fictitious employer schemes that defrauded multiple state work force agencies, including California’s EDD and AFLAC, with a total loss of approximately $113,000. Ray Blaylock, 45; Dameon Crandle, 42; Chad Emanuel, 44; and Joseph Hollins, 43, all from Los Angeles, were charged with mail fraud for submitting fraudulent unemployment and/or disability insurance claims to California’s EDD as fictitious employees of fictitious business Tranquil Communications, with a total loss to EDD of approximately $164,000. William Samuels, 25, was charged with mail fraud for submitting fraudulent unemployment insurance claims to EDD as a fictitious employee of Couture Recovery Services, with a total loss to EDD of approximately $25,000. Finally, Marilyn Jones, 49, from Los Angeles, was charged with mail fraud for participating in the fictitious employer schemes by signing the doctor’s certification section of the fictitious employees disability claim forms in exchange for money, with a total loss to EDD and AFLAC of approximately $106,000. An indictment contains allegations that a defendant has committed a crime. Every defendant is presumed innocent until and unless proven guilty.
Source: calbrokermag.com

How Does Medicare Affect TRICARE?

Effective October 2009, TRICARE beneficiaries who are awarded retroactive benefits based on disability or permanent kidney failure do not have to pay for Part B for those months in the past in order to keep TRICARE. You should, however, contact the Department of Defense to find out whether you would now need to enroll in Medicare Part B in order to keep your TRICARE.
Source: specialneedsplanning.net

Health Benefits Through Medicare

In July 30, 1965, a momentous event happened when the Social Security Act of 1965 was signed into law by President Lyndon B. Johnson as revisions to the existing Social Security legislation. The Act includes two very important provisions: Medicaid and Medicare. The latter, being the topic of this article, is a health insurance program given by the government of the United States of America to its citizens. The program covers people who are 65 years old and below and even those who are under 65 years old but with physical disabilities or congenital disorders. Medicare enrollment is easy as long as required documents are provided. In general, people who are 65 years old and above are entitled for the health insurance program given that they have been residents of the country for five years or more. People under 65 years old but with disabilities and disorders can be worthy to the program as long as they show their Social Security Disability Insurance (SSDI) benefits. SSDI is a government-funded program, which provides additional income to those who are restricted to work because of their physical disability. Medicare enrollment is also open to people who have serious medical conditions such as kidney failure and cancer. There are different parts of Medicare where one can enroll in. Medicare Part A provides inpatient care, skilled nursing facility care, hospice care services, home health care services, hospital fees, some minor tests, and food. Most people already paid their Medicare taxes when they were still working. Medicare Part B, on the other hand, gives help to patients who necessarily need the doctors’ services, outpatient care, and home health service. In some cases, it also covers preventive services for serious sicknesses. Part B also covers the tests and services like pneumonia and influenza vaccinations, blood transfusion, kidney dialysis, organ transplantation, chemotherapy. Part B also provides equipment for seriously-ill or impaired people by giving canes, strollers, wheelchairs, and prosthetic equipment such as prosthetic limbs, artificial breast and even eyeglasses after eye surgery. Medicare enrollment is also possible for Part C and Part D. Basically, Part C is also called the Medical Advantage Plan and can be received as part of one’s membership in Medicare. The advantage plan provides help for the services needed in both Part A and B like the tests, home health services and also other wellness program for vision, dental and hearing. Finally, Part D is another plan in Medicare that offers plan for prescription drug. This part, also known as Medicare Prescription Drug Coverage gives the patient help in getting prescribed drugs at a lower price. These are the benefits one can get if he or she decides to enroll in Medicare. Application for Medicare is available in the nearest health center in your area or through online. To apply, one has to be at least 64 years old and 8 months old, do not have any Medicare coverage, and live in the United States or one of its territories. Health is wealth, so apply now and receive health benefits. If you are looking for the best enrolling in medicare and medicare health insurance, visit our site for more tips and information. Contact us for free medicare advice. If you are looking for the best http://www.medicarerep.com/ enrolling in medicare and http://www.medicarerep.com/ medicare health insurance, visit our site for more tips and information. Contact us for free medicare advice.
Source: abcarticledirectory.com

Medicare, Disability Benefits and Obamacare

The big political news during the last week of June was of course the decision from the US Supreme Court upholding the majority of the Patient Protection and Affordable Care Act (“PPACA”) (commonly referred to as “Obamacare” by both critics and supporters of the legislation). The one change that the Supreme Court demanded was to the expansion of Medicaid under the PPACA. While the legislation originally conditioned all Medicaid funding on a state’s acceptance of the expansion, the Supreme Court ruled that only the expansion could be conditional; that is, states can stick with their original Medicaid program without fear of losing it if they do not accept the expansion.
Source: troutmanlawblog.com

Ask A Lawyer: Medicare and Social Security Disability

But you, like most people, will have to wait 24 months from the date your monetary benefits start before Medicare will start paying your medical bills. There are no retroactive benefits with Medicare. The benefits only start after 24 months of disability payments.
Source: 2spencers.com

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

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

Posted by:  :  Category: Medicare

1st Medicare Iveco Daily by EssexTechThe study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: kaiserhealthnews.org

Video: Obama Cuts Medicare but Plays ‘Mediscare’ All the Same

Brad DeLong: Eschaton: Medicare For All

Eschaton: Medicare For All: Medicare For All One thing I haven’t seen anybody talk about is the fact that Obama somewhat eloquently made the case for Medicare for all during the debate. Those insurance companies are too horrible to inflict upon seniors. And the rest of us, also, too.
Source: typepad.com

GOP congressman admits Paul Ryan, GOP will "end" Medicare

2012 elections barack obama Big Bird budget Climate change debate DOMA Donald Trump ENDA environment foreign Fred Karger Fun gop lies Haley Barbour health care Herman Cain homophobia iran John Thain Jon Huntsman Marriage marriage equality media Michele Bachmann Middle East Mike Huckabee Mitch Daniels Mitt Romney Music News Newt Gingrich Paul Ryan polls religious right Rick Perry Rick Santorum Ron Paul Sarah Palin Taxes The 1% Tim Pawlenty TSA Video women
Source: americablog.com

Study: Privatized Medicare would raise premiums

Like the Romney-Ryan plan, government health insurance payments for individual seniors would be tied to the cost of the second-lowest private insurance plan in their geographical area, or traditional Medicare, whichever is less expensive. Seniors could pick a private plan or a new public program modeled on traditional Medicare. But if their pick costs more than the government payment, they would have to pay the difference themselves.
Source: sltrib.com

Eschaton: Medicare For All

One thing I haven’t seen anybody talk about is the fact that Obama somewhat eloquently made the case for Medicare for all during the debate. Those insurance companies are too horrible to inflict upon seniors. And the rest of us, also, too.
Source: eschatonblog.com

Analysts: Some private Medicare plans beat CMS

Medicare Advantage program critics contend that the private plans can offer the rich benefits because they get rich subsidies that increase the cost of coverage for traditional program enrollees, and that, in some cases, the added Medicare Advantage benefits encourage unnecessary spending, by reducing co-payments, deductibles and other mechanisms that give consumers “skin in the game” and encourage them to seek only the amount of care that appears to be absolutely necessary.
Source: lifehealthpro.com

Medicare Open Enrollment: Now’s the time!

In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.
Source: medicare.gov

McMahon ad promotes Medicare inaccuracy

The Kaiser Family Foundation found that while Medicare Advantage was offered by President George W. Bush as a way to save money over the fee-for-service traditional Medicare, the plans actually cost some 14 percent more for each patient. The subsidies will be reduced over time starting this year to 2 percent, but quality plans will be rewarded with bonuses and by 2014, all of them will be required to spend at least 85 percent on direct care and not overhead.
Source: nhregister.com

Medicare open enrollment: Will Obamacare end Medicare Advantage?

Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Source: consumerreports.org

Daily Kos: Medicare Scare: Friends, here we go again. Henny Penny – the sky is falling!

>   A message from Blue Cross Blue Shield > Professor Emeritus John W.  Hill, JD, PhD > Kelley School of Business , Indiana University > MEDICARE > Look clearly at the 2014 rate compared to the 2013 rate. > For those of  you who are on Medicare, read the following. It’s short, but > important and you probably haven’t heard about it in the Mainstream News: > “The per person Medicare Insurance Premium will increase from the present > Monthly Fee of $96.40, rising to: > $104.20 in 2012 > $120.20 in 2013 > And > $247.00 in 2014 = $2964/yr/per person. > > These are Provisions incorporated in the Obamacare Legislation, > purposely delayed so as not to confuse the 2012 Re-Election Campaigns. > Send this to all Seniors that you know, > so they will know who’s throwing them under the bus.
Source: dailykos.com

Vice Presidential Debate: True/False Quiz on Medicare

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

Medicare “Donut Hole” Gets a Little Smaller in 2013

The difference between Medicare Part D plans is that one plan may charge significantly more for specific drugs than another plan. This could also be true if you have a Medicare Advantage plan that includes drug coverage. That’s because they negotiate prices with manufacturers and middlemen.
Source: allsup.com

Social Security, Medicare affects us all

Supporting the study are comments on actuary tables, wage ranges, return on tax contributions and the math. A suggestion that Social Security and Medicare is a totally earned entitlement does not apply to most recipients who receive more than they contribute. It is not possible for many good reasons that every wage earner contributes full fare. After doing some research, and with additional education on the topic, it is possible that most parents receiving benefits or about to retire would support phasing in changes so these valued programs become sustainable and available to future generations.
Source: cabinet.com

Kaiser Study on Medicare Premium Support Assumes Seniors Would Not Choose Lower Prices

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe authors of the Kaiser study assume that zero beneficiaries would switch from traditional Medicare to a cheaper plan, despite cost increases. Part of the gain from competition is that health plans must compete for beneficiaries in order to retain or gain market share. They have to secure high satisfaction, as they do today, for example, in Medicare Part D and Medicare Advantage. To create a scenario that simply ignores the gains of market competition grossly misrepresents the economic impact of any consumer-driven market, including a health care market with premium support. The study’s headline is that 53 percent of enrollees in traditional Medicare would pay more, but within the study, when benificiaries respond to higher premiums, the number falls to as low as 33 percent.
Source: heritage.org

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Medicare Supplement Insurance

In 2004, Jess and Sandra heard about some exciting options for Medicare. Jess and Sandra started to learn more about the different Medicare Advantage, Medicare Supplement, and Part D prescription plans. As Sandra puts it, “They dove into the senior market heavily; it just exploded.” Jess and Sandra have become experts in the Medicare marketplace. The demand was great back then and continues to be to this day. Sandra said, “We are certified with every company that does business here in Indiana. 80% of what we do is Medicare focused.” The annual election period is October 15 to December 7 for Medicare. “Every participant can change their current plan with Easy Street,” said Jess. Jess and Sandra look at many options to find the right plan to match each client’s needs.
Source: atcentergrove.com

Faultline USA: 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: blogspot.com

Comprehensive Guide to Medicare Supplemental Insurance

CMMS or Centers for Medicare and Medicaid Services have provided Medicare Supplemental Insurance in 10 different plans. Private insurance companies offer these plans and will help you to determine which plan would be best for you. The plans are labeled with letters from the alphabet and start with the letter A and end with the letter N. One thing to keep in mind is that there are a few of the plans that were discontinued and those were E, H and J. During the month of March in 2010 is when this plan ended, and now you can find A-F, which would equal 11 of the plans that are still available. Each plan is different and unique. Below is a list of what some of these plans are:
Source: ccardzone.com

fri9nds: On Line Medicare Supplement Insurance Rates

The program Y can pay your Medicare Part B deductible and your Medicare Part A deductible. In other words, Medicare will pay 80% of your charges and your complement will get the rest of the 20%. You need to rarely have any medical bills out of your wallet.
Source: fri9nds.com

Summit MediGap: Do I need Medicare supplemental insurance?

When you turn age 65 you are eligible for Medicare Part A & Medicare Part B.  This also means you are eligible for Medicare supplemental insurance or Medigap insurance.  Medicare Part A will cover you for hospital related care, however you would still be responsible for such things as the Part A deductible.  Medicare Part B will cover you for doctor visits and tests.  However, Medicare Part A & B will only cover about 80% of your total medical costs.  Medicare supplement plans are designed to cover what Part A & B do not cover.  Medicare when combined with the right supplemental plan is actually great coverage and often times you will have better coverage than what you had with your employer or family plan.  In fact with the right medigap plan you can actually be covered for all deductibles, coinsurance and co pays.  Seniors find it easier to budget for a monthly medicare supplemental plan premium knowing that they will not need to worry about unexpected medical expenses throughout the year. There are currently 11 different Medicare supplement plans or medigap plans.  Seniors often find it very confusing trying to figure out which plan is best for them.  This is why it is so important to find a great independent agent that specializes in Medicare supplemental insurance.  A good independent agent will be able to show you all the plans available from the major insurance carriers.  They will also spend the time to analyze what your current health benefit needs are and match those needs with the medicare supplement plan that best fits you. There really is no reason to worry about your Medicare options.  Find yourself a quality agent that specializes in medicare supplemental insurance, that person will save you lots of time and also money.  It is also important to review your benefits with an expert every year or two to make sure you are getting the best coverage for the money.  Plans and rates change often so having an Medicare supplement specialist to turn to will give you great piece of mind. Bill Loughead SummitMedigap.com 1-888-40-Summit (888-407-8664) “We make Medicare seem easy”
Source: blogspot.com

Medicare Supplemental insurance can save you money

When you are buying a medicare supplement, make sure to get plenty of quotes from different insurance brokers. All medicare supplement plan F polices are the same. The only thing that varies from company to company is the pricing. So make sure you do your research and get the best price!
Source: treasurehikersusa.com

Medicare Supplement Basics

Medicare Supplement Insurance, sometimes called Medigap plans, are insurance policies made available by private insurance companies that do what their names imply; they supplement or fill the gaps in Original Medicare coverage. To properly understand Medicare Supplements it is important to first have a basic understanding of what they supplement – Medicare.
Source: reed-insurance.net

Comparing Medicare Supplemental Insurance Benefits

These plans, called “Medigap” plans, each have different medical care coverage. Variable benefits of coverage to be considered are: • Coinsurance plus coverage that last 365 days after medicare benefits end (Medicare Part A) • Coinsurance/Copayment for medicare part B. • Pints of blood (transfusions, first three pints) • Hospice care copayments or coinsurance • Coinsurance for Skilled Nursing Facilities • Part A medicare deductible • Part B medicare deductible • Part B excess charges • Emergencies during foreign travel • Preventative care coinsurance, per Medicare Part B If any of these are important for you to have covered, comparing medicare supplemental plans that include benefits is the only way to ensure they are included.
Source: seniorcorps.org

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

Posted by:  :  Category: Medicare

Medicare Survey at ESL School 10-24-06 by Korean Resource Center 민족학교The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: kaiserhealthnews.org

Video: Medicare Australia and Seeing a Doctor: nib Health Insurance Explained

Medicare Open Enrollment: Now’s the time!

In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.
Source: medicare.gov

Medicare open enrollment: Will Obamacare end Medicare Advantage?

Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Source: consumerreports.org

Health IT Chief To Look Into Use of EHRs To Inflate Medicare Bills

Mostashari said that he has asked the Policy Committee to provide guidance on whether EHR systems are triggering higher billing codes by allowing physicians to cut and paste data from a patient’s previous visits, a practice known as “cloning.” Mostashari said, “If we are just copying the same information over and over, that’s not good medicine.”
Source: californiahealthline.org

Preventive & screening services

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Source: medicare.gov

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.com

Kaiser Permanente Leads the Nation with Six 5

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

Navigating Medicare's Open Enrollment Period

Medicare beneficiaries who are happy with their plans do not need to do anything, if they don’t want to change. But it is still a good idea to check options, Ms. Metcalf advises, to make sure a version of Medicare is the best one in terms of cost and coverage. If, for instance, you have the original version of Medicare and pay extra for prescription drug coverage (so-called Part D coverage), you may want to make sure important medications you need are still covered under your plan, to avoid having to pay more for them.
Source: nytimes.com

Medicare open enrollment: How can I find a better plan?

What about doctor availability? On the Medicare site you can directly compare up to three plans, and when I selected your current plan and these other two plans, I saw that your current plan says it has 1001-1500 “physicians and providers,” compared to 4001-5000 for the other two plans. For each plan you can click on “View provider and physician network website,” which takes you away from Medicare.gov and onto the plan’s own website, where you can search its provider directory to judge for yourself whether it has enough doctors to meet your needs.
Source: consumerreports.org

House Oversight chair threatens to subpoena Sebelius over Medicare slush fund

Issa set a deadline of 5:00 PM Thursday for the production of the documents, or else it’s subpoena time.  I doubt that’s going to get him anywhere with the lawless Obama Administration, which didn’t exactly fall all over itself to comply with those Fast and Furious subpoenas.  And Kathleen Sebelius flaunts laws that inconvenience her, such as the Hatch Act, with impunity.  She only needs to run out a few more weeks until the election.  Then she’ll either be protected by the general “let’s stop obsessing over the past” spirit of transition to a new Administration after the holiday break, or… well, let’s just say Barack Obama’s not going to develop a sudden new respect for the law, once he knows he’ll never have to answer to voters again.
Source: humanevents.com