CBO Emphasizes Need To Trim Medicare Spending

Posted by:  :  Category: Medicare

Cynthia Markus, Ingrid McDonald, and Diana Birkett discuss Medicare at the KUOW Studios by kuow949The Hill: CBO: GOP Bill Revising Health Law Ratio Will Add To Deficit A Republican bill altering the healthcare law’s medical loss ratio (MLR) will add about $1 billion to the budget deficit over the next decade, the Congressional Budget Office (CBO) said Thursday. The Obama administration frequently touts the MLR as a policy that helps consumers. It mandates that insurers spend no less than about 80 percent of their premium dollars on medical care rather than administrative costs or profits. The difference insurance companies must send back to policyholders, producing more than $1 billion in consumer rebates this year. Rep. Mike Rogers’s bill (H.R. 1206) would exclude insurance brokers’ fee from counting as administrative costs under the ratio. Agents say the MLR in its current state threatens their business by incentivizing insurers not to work with them (Viebeck, 11/8).
Source: kaiserhealthnews.org

Video: American Sign Language (ASL) – Medicare Basics

Important: We have the wrong Medicare program

Second, Canadian hospitals receive prospectively determined global operating budgets, removing incentives to provide unnecessary care while simplifying billing and administration. However, unlike accountable care organization payment schemes in the United States, capital costs are not folded into the global budgets but distributed separately through an explicit health-planning process. Canadian hospitals cannot use operating surpluses to fund new buildings or equipment but must request separate capital appropriations. Hence, they cannot expand by overproviding lucrative services, gaming the payment system through upcoding, avoiding unprofitable patients, or cost shifting.
Source: pnhp.org

Democrats’ Plan to Reform Drug Benefit is Snake Oil

The result? Medicare Part D has brought down drug costs for millions of seniors and has done so at a much lower price to taxpayers than originally predicted. In fact, it has cost around 43 percent less than first thought possible. Better yet, with a satisfaction rate of 88 percent, seniors in Louisiana and throughout the country have reported being overwhelmingly pleased with the program.
Source: thehayride.com

AHA sues Medicare over audit program aimed at trimming improper payments

Politico Pro: Hospitals Take Aim At Audit System Flaws The lawsuit hospitals filed against HHS on Thursday unloads years of pent-up frustration over what hospital officials perceive as an unfair policy of second-guessing doctors that has cost the industry hundreds of millions of dollars. But it’s also pushback against a program meant to save the government billions in improper Medicare billing. The American Hospital Association and four hospitals sued HHS to stop the agency from not paying claims when auditors determine that inpatient hospital care for a patient should have been provided in an outpatient setting, which is typically cheaper. The lawsuit seeks to overturn the policy and reimburse hospitals that have been denied payment (Norman, 11/1).
Source: medcitynews.com

President, GOP Leaders Begin Talks To Avoid Medicare Payment Cuts

In a conference call with House Speaker John Boehner (R-Ohio) and other top lawmakers, Obama urged them to set aside partisan differences to develop a solution for the sequester. Following the conference call, Boehner said Republicans are willing to accept a budget deal that would raise federal revenues as long as the administration does not “continue to duck the matter of entitlements” (
Source: californiahealthline.org

Daily Kos: Medicare’s ‘death spiral’ under Romney/Ryan voucher plan confirmed in new study

Another study finds that the voucher system Mitt Romney and Paul Ryan envision for Medicare will cause the program’s demise. TPM’s Sahil Kapur reports on the study from Health Services Research, which used the model of the existing optional Medicare Advantage, the current subsidized Medicare alternative. The study’s conclusion: healthy seniors tend to gravitate to private plans and sicker seniors gravitate to traditional Medicare. That’s because private insurers craft their plans to attract lower-cost patients and leave sicker, more expensive ones for traditional Medicare—a process known as favorable selection. […] “I think what that means for premium support is that fee-for-service Medicare would gradually be a dumping ground for the sickest people and the premiums would go higher and higher if they want to stay in their plan,” said Austin Frakt, a health economist at Boston University. “And that’s a huge concern for some people.” That’s, in microcosm, a huge part of the problem the private insurance system has seen, except seniors have the option of Medicare that has to accept them, and sicker people who aren’t eligible for Medicaid are pretty much out of luck when it comes to finding affordable insurance. But in the case of Medicare, adding in private competition that markets to and selects the healthiest individuals means that traditional Medicare eventually becomes too expensive to sustain. That would lead to what Frakt calls the “classic adverse selection death spiral,” and the end of Medicare.
Source: dailykos.com

In Swing States, Obama Leads on Handling of Medicare

Mr. Romney and Mr. Ryan have called for curbing the growing costs of Medicare by making major changes to the program. Their plan would change Medicare for people who are now under 55 so that when they are eligible for coverage they would no longer receive a government-guaranteed, fee-for-service health plan but rather a fixed amount of money each year that they would use to purchase private health insurance or buy into a version of the existing Medicare program. But they have not provided enough details of their plan to assess how much it might increase out-of-pocket costs for future beneficiaries. Mr. Obama has pledged to preserve Medicare in its current form, but has spoken less about its rising costs.
Source: nytimes.com

Your Health: Medicare open enrollment under way

A: All Medicare enrollees should have gotten notice by now that the Medicare open enrollment season has begun. Medicare beneficiaries have through Dec. 7 to decide whether they want to stay with their current plan — whether it’s a Medicare Advantage managed-care plan or original Medicare — or switch coverage to something else.
Source: timesdispatch.com

Proposed Settlement May Extend Coverage to More Medicare Home Health Patients

If finalized, this change in policy is likely to be welcomed by home health agencies.  Over a period of many years, agencies have been stymied in their efforts to provide services to patients like the plaintiffs and similar patients across the country.  The historic lack of coverage for services to such patients has caused home health agencies to confront difficult legal, economic, and ethical dilemmas.  Even if agencies could afford to continue to provide substantial free services to such patients, it appeared that the provision of free services violated applicable prohibitions of the Office of Inspector General (OIG) of HHS regarding the provision of free services to patients that exceed $10.00 at a time or $50.00 in the aggregate during a calendar year.  Agencies would welcome relief from difficult dilemmas and an opportunity to provide care to as many patients as possible.
Source: accreditednursing.com

Submit Quality Guest Posts To TheBitBot.Com Super Blog!

Guest blog posting is a great way to get your blog or website noticed. Many blogs accept guest post and some blogs only post guest posts in that the owner simply spends their time moderating submissions and never really writing themselves. This means that for bloggers the world over, there are endless opportunities to get some valuable exposure that can end up in increased unique visitors, RSS subscribers, list subscribers and contributors to your own blog in the form of comments and guest posts. If you would like to “write for us”, “submit an article”, “submit guest post”, “Submit Blog Post”, “Become a Guest Blogger”, “Guest Bloggers Wanted”, “Submit a Guest Article”, “Blogs Accepting Guest Posts”, “Add Guest Post”, “Become a Contributor”, “Contribute to our Site”, “Become a Guest Writer”, “Submit Guest Post”, “Suggest a Guest Post”, “Guest Post”, or “submit a guest post” to TheBitBot.Com Super Blog, then please check out our [ submission guidelines ].
Source: thebitbot.com

The Social Security and Medicare Handbook: What You Need to Know Explained Simply

Posted by:  :  Category: Medicare

OBAMA: THE SOCIALIST/MARXIST/COMMUNIST -- UNMASKED FOR ALL TO SEE by SS&SSThe Social Security and Medicare Handbook includes the provisions of the Social Security Act, regulations issued under the Act, and recent case decisions (rulings). It is a readable, easy to understand resource for the extremely complex Social Security and Medicare programs and services. Here in this new, groundbreaking, and exhaustively researched book you will learn an overview of the Social Security and Medicare system, how Social Security benefits are currently computed, how to become insured, and how to file a claim. You also will learn about retirement and auxiliary benefits, survivor benefits, disability benefits and protection, evaluating disability, cash benefit rates, employees, employer responsibilities, special coverage provisions, state and local employment, earnings records and tax reports, the administrative review process, supplemental income, other benefit programs, hospital insurance (Part A), medical insurance (Part B), Medicare Advantage plans (Part C), prescription drug coverage (Part D), prescription programs, and special veteran benefits. This book will explain how current Social Security benefits are computed and provide insight into your Social Security benefits.
Source: blogspot.com

Video: Law Book Review: Medicare Handbook 2012 Edition by Judith A Stein, Alfred J. Chiplin Jr.

Medicare & You Handbook 2013 for Medicare Open Enrollment

To start your enrollment, you should a Medicare & You 2013 handbook. If you have not received your handbook, you should go to the website Medicare.gov to learn where the handbook is available to read or download an PDF version of the 2013 Medicare & You Handbook. You can also get by calling 1-800-MEDICARE to request a paper booklet to your mailing address.
Source: hotbuzz4u.com

“Medicare & You” goes paperless

and access all the same information found in your printed handbook. You can learn what’s new for the year, how Medicare works with your other insurance, get Medicare costs, and find out what Medicare covers. Even better, the handbook information on the web is updated regularly, so you can instantly find the most up-to-date Medicare information.
Source: medicare.gov

Medicare Rx Open Enrollment

Every year, there are new prescription drug and health plan coverage choices available to people with Medicare. Open Enrollment is the time of year when current or newly-eligible Medicare beneficiaries, including people with original Medicare, can review their current health or prescription drug plans, compare the plans to other options, and choose the plans that best meet their current needs.
Source: patch.com

Medicare Rx Open Enrollment

There’s never been a better time to check out Medicare coverage. With the new health care law, there are new benefits available to people with Medicare, including lower prescription costs, wellness checkups and preventive care. The new law also provides better ways to protect beneficiaries from fraud, making Medicare stronger for all of us and for future generations.
Source: patch.com

This is the official U.S. government Medicare handbook: Open …

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Source: monsieurbome.com

Do I Need Both Medicare and Private Insurance?

Determining whether a Medicare private insurance plan for gap coverage is necessary to supplement Medicare is much less complex. The gaps in the Medicare Plans – A, B, C and D – are pretty much the same for all participants. Plan D, for example, covers prescription drugs to reduce the cost burden for the senior. However, Plan D only covers up to $2,930 of the total Medicare and participant cost together. If the insured has additional need for prescribed medication, they must pay the additional as an out of pocket expense until the combined total is $4,700. The amount of $4,700 triggers the “catastrophic” cost of medication provision. The $1,700 difference between the two amounts is the gap. The issue now is whether the $1,700 gap will result in a financial hardship for the insured. If that were the case, purchasing a Medicare private insurance plan to supplement Medicare would be the prudent choice.
Source: seniorcorps.org

Booman Tribune ~ A Progressive Community

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

Do Seniors Want So Many Medicare Choices?

Research, more scientific than mine, confirms my belief. Once seniors pick a plan—based on coverage, customer service, friendly salespeople, price, or whatever—they tend to stick with it even though they might be able to find a cheaper one if they went shopping. Medicare beneficiaries, it seems, are like bank customers. Once people pick a bank, they tend to stay put despite the heavy bank advertising enticing them to switch. A study from the National Bureau of Economic Research, a private, nonprofit research organization, found that if seniors with Medicare drug plans stayed in a plan too long, they could end up paying premiums that were ten percent higher than had they had switched to a new plan.
Source: preparedpatientforum.org

Tricare Help – When do I need to sign up for Medicare?

Eligibility for Medicare begins at age 65, even for those who are still working or, like you, are already retired but delaying Social Security. The big difference between those who are still working and those who are fully retired when they hit age 65 is that people who are still working usually may delay Medicare Part B enrollment without penalty, but those who are fully retired (your group) may not. As such, you need to enroll in Medicare Parts A and B sometime in the three months before or three months after your 65th birthday.
Source: militarytimes.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

George W. Bush by cliff1066™Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Video: FL Senate Debate-Medicare

Senior Care in Venice, FL: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: inhomecaresarasotafl.com

Medicare changes: What seniors need to know

Co-pays can change This expanded drug coverage, along with the screenings that will be covered now for mental health, alcohol misuse and sexually transmitted diseases, are the sort of services that not only thread through a senior’s daily quality of life, they have deep impact on long-term mental and physical health, said Dr. Gwendolyn Graddy-Dansby, a geriatrician and the medical director of the Henry Ford Center for Senior Independence, a Medicare- and Medicaid-funded center that helps seniors avoid nursing homes and remain in their homes as long as possible.
Source: flcourier.com

Daily Kos: Poll: Medicare Propels Obama Into the Lead in Florida

Biden’s father had been very well-off earlier in his life, but had suffered several business reverses by the time Biden was born, and for several years the family had to live with Biden’s maternal grandparents, the Finnegans. When the Scranton area went into economic decline during the 1950s, Biden’s father could not find enough work. In 1953, the Biden family moved to an apartment in Claymont, Delaware, where they lived for a few years before moving to a house in Wilmington, Delaware. Joe Biden Sr. then did better as a used car salesman, and the family’s circumstances were middle class. He took a stand against injustice at an early age. Biden attended the Archmere Academy in Claymont…During these years, he participated in an anti-segregation sit-in at a Wilmington theatre. People like to portray him as a bumbling avuncular man, but he’s had one hell of a career, too. When Biden took office on January 3, 1973, at age 30 (the minimum age to become a U.S. Senator), he became the sixth-youngest senator in U.S. history…
Source: dailykos.com

Ryan Vows to Protect Medicare at Florida Retirement Community

Betty Ryan Douglas was on stage with her congressman son Saturday at the world’s largest retirement community as the Republican campaign tried to blunt withering criticism from President Barack Obama and his allies. The Democratic team charges that presidential candidate Mitt Romney and Ryan would gut programs for older people.
Source: theroot.com

FL: PolitFact or Fiction: Double standard on the Mack Penny Plan

Why the double standard? Total federal spending over the past decade alone amounts to more than $30 trillion. Were Mack’s plan in existence, it would have led to 0.6 percent cuts for Medicare, 3.2 percent for Social Security and 9.6 percent for defense over 10 years — the furthest thing from “massive” and “drastic” spending cuts as classified by PolitiFact.
Source: watchdog.org

Florida psychiatrist convicted in $50 million Medicare fraud scheme

Antonio Macli, the owner of Biscayne Milieu Health Center Inc., a mental health care corporation, his son Jorge Macli, Biscayne Milieu’s CEO, and Antonio Macli’s daughter Sandra Huarte, an executive at the company, were each found guilty in U.S. District Court for the Southern District of Florida of one count of conspiracy to commit health care fraud, and one or more substantive counts of health care fraud, conspiracy to commit a health care kickback scheme and conspiracy to commit money laundering and substantive counts of money laundering.   Antonio Macli and Jorge Macli were also convicted of substantive kickback counts.  Dr. Gary Kushner, the medical director at Biscayne Milieu, was found guilty of conspiracy to commit health care fraud and a substantive count of health care fraud.  Rafael Alalu, a therapist, and Jacqueline Moran, who handled Medicare billing for Biscayne Milieu, were each found guilty of conspiracy to commit health care fraud and substantive  counts of health care fraud.  Anthony Roberts and Derek Alexander, two patient recruiters, were each found guilty of one count of conspiracy to commit a health care kickback scheme, and each was convicted of one health care kickback count.
Source: pathologyblawg.com

South Florida Authorities Arrest More Than 30 Suspects For Medicare Fraud

What is the statute of limitations on physician PEER REVIEW miss use. I was wrongly accused of over use of TPA in a stroke patient in 2005 by a neurologist that covered himself when he did not respond in a timely manner to a stroke alert in a fairly young, 40 year old, patient. The newly assigned regional physician, who wanted to move up the corporate ladder by removing all the individual ER directors in the three hospital group that had contract with the large national ER group, used the incident and complaint by the neurologist to initiate a PEER REVIEW meeting in which he the only physician to speak on the incident and bullied the only other physician at the meeting to silence and wrote the entire meeting up himself. Two later I was called and told I was taken of the schedule with no notice. I had to scrabble to find work to support my family and middle school age children. At the time I had no medical evidence to prove that I had actually done the correct course of action, bu
Source: thehealthlawfirm.com

Daily Kos: New Obama Ad in FL: “If Mitt Romney is the President, the seniors will have many sleepless nights.”

1. tribalism 2. Obama hasn’t done a good enough job of letting seniors know the truth that Myth will kill medicare which he will & cut medicaid & SS. that’s jut a fact if Myth get in, seniors an kiss medicare, medicaid, & SS good bye. At least seniors will be weened off of it little by little….within a few year these programs will no longer be available, so future seniors will be screwed. & with obamacare repealed, I don’t know how seniors would be able to buy health insurance with their pre-existing conditions. Obama campaign should bring all that up, & they haven’t, more missed opportunities. Also, with Obama’s non confrontational 1st debate I think he probably gave seniors the impression Myth’s gross lie about cutting 716 B$ was true, when it’s the opposite obamacare being the premium program is the one that gives 716 b$ to mediacre which gives seniors free drugs & preventive care. I would’ve done a better job defending him that night, so some seniors believed the lie because he didn’t push back, & they already don’t want a black man so they fell for it; although logic would tell them it’s a lie. They’re on medicare & SS right now & have lost no benefits…in fact they’ve gained free preventive services & free drugs but they prefer to believe a lie because they prefer to vote for the white guy anyway. Biden did set the record straight the following week, but maybe it wasn’t enough, not sure.
Source: dailykos.com

CVS Possibly Under Investigation for Medicare Fraud

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Source: wordpress.com

UPDATE: Romney Addresses Medicare At Sarasota Campaign Stop

Wow, now Romney is turning around and against his own words when he agreed with Ryan about taking down Medicare. Romney now wants to help the 47% of the people he said he didn’t care about. You can not believe his man at all. He will do anything and say anything to get your vote. Watch out he will change horses in the middle of the stream again once in office. IF, that would happen, and I think it will not. But, it scares me that a man like Romney will lie and say anything to the voter to get votes. I just do not trust this man at all. He has a Congress that is waiting on him to get into office so they can do away with Medicare, Social Security, food stamps, business having to provide a pension for its worker, etc. you name it. Anything that benefits the middle class and the poor will no longer be available. Only the Rich Business man will prosper. One percent of the Richest in this country already have more money than the bottom 90%. There is no middle class any more. A rich man only wants more, and that is what Romney is going to provide. Don’t let him fool you. He is all lies and will do anything to get elected.
Source: patch.com

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

Posted by:  :  Category: Medicare

Congressman Brad Sherman, California’s 27th District (D) by cliff1066™The payment increase applies to physicians practicing in family medicine, general internal medicine, pediatric medicine and related subspecialties, such as board certified pediatric cardiologists. The rule clarifies that primary care services delivered by medical professionals working under the personal supervision of a qualifying physician, such as nurse practitioners, also are eligible for the higher payment rate (Reichard,
Source: californiahealthline.org

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

San Diego Hospitals Getting Lower Medicare Payments Under ACA

Daniel Gross — executive vice president for hospital operations at Sharp HealthCare — said Sharp is working with patients after their discharge to ensure that they schedule follow-up appointments and follow care instructions (Sisson, U-T San Diego, 11/1).
Source: californiahealthline.org

Medicare Battle Heats Up California House Race

Bera was a newcomer to politics in 2010 when he ran a surprisingly strong campaign against Lungren, losing by 7 percentage points in a year in which Republicans made record gains in the House. But in this year’s rematch, Bera is placing greater emphasis on his medical background: he served as chief medical officer for a large California hospital chain and later in the Sacramento County public health department, tasked with providing medical care for some 225,000 uninsured people.
Source: kaiserhealthnews.org

Senior Care in Fullerton, CA: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: trustinghomecareca.com

The President’s Planned Changes to Medicare: Costly for Seniors

Over the next five years, under current law, seniors in traditional Medicare are projected to face higher Part B and D premiums, along with other out-of-pocket cost increases. Instead of structurally reforming Medicare, President Obama’s 2013 budget proposal would raise premiums even further for upper-income enrollees in Parts B and D, while also imposing additional deductibles and co-payments (in certain cases) on newly joining baby boomers beginning in 2017.
Source: capoliticalreview.com

Kaiser Permanente’s Medicare Plans In California Get Top Ratings In The Nation For The Second Straight Year

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: kp.org/newscenter.
Source: patch.com

The WCMSA Conundrum in California

My client accepts the C&R for $115,000.00 new money inclusive of the WCMSA but not as a structured settlement. Please let me know if your client is willing to do a lump sum C&R so they can finally close this file. Since she has been Medicare eligible as a matter of law (over age 65 in 2007), I don’t think we need to obtain CMS approval of the WCMSA in advance of getting WCAB approval. As long as we take Medicare’s interests into account as part of the settlement then we are ok without prior CMS approval. We still have to submit it to CMS after WCAB approval or concurrent therewith. My client would then bear the risk of loss if CMS says the WCMSA needs to be increased. Please send me the C&Rs if this is acceptable to you.
Source: lexisnexis.com

GOP Retains House Despite Democrats’ Medicare Attacks

Politico: Pete Stark Defeated After 40 Years in Congress The 20-term Democrat lost to fellow Democrat Eric Swalwell 53.1 percent to 46.9 percent, with 100 percent of the vote calculated in the 15th district in California, according to the Associated Press. Stark built a reputation as a hard-charging advocate for progressive health reform in Washington, but in recent years was bogged down by a record of gaffes and personal insults to his colleagues. Not even the endorsements of President Barack Obama and House Democratic leader Nancy Pelosi could overcome Swalwell’s message to San Francisco Bay voters: that the 80-year-old Stark has been in Washington way too long (Haberkorn, Nov. 7).
Source: aarp.org

California Medicare Prescription Coverage With Part D

There have been a few milestones in the evolution of California Medigap insurance and none as important as the eventual addition of Part D. The addition of Part D reflects not just an expansion of Medicare for Californians but a reflection of how much health care has changed for seniors in terms of what is driving the costs. When original Medicare came out, the real concern for most people was hospital care and to a lesser extent, doctor costs. That defined the original dichotomy inherent in traditional Medicare with it’s division of labor between Part A (hospital) and Part B (doctor). Things have changed. Part D was due to make it’s entrance on the California Medicare market. So what is Part D and how does it work with California Medicare supplement plans? I remember when it all changed. Believe it or not, health insurance premium were relatively stable over a period of years during the 90’s as a result of PPO and HMO managed care introduction. I received the new rate increase information from one of our biggest carriers and it was terrible. The increase was 30% plus. 6 months later, there was another increase of about the same amount. It was a nightmare and then all of a sudden, we were getting declinations on new application (not California Medigap) due to allergy medications. It was the beginning of mass-marketed medications with the advent of allergy giants Allegra, Claratin, and . Unfortunately, it was the beginning of a new and very expensive trend. Prior to the addition of Part D, there was limited prescription coverage through the H, I, or J Medicare supplement plan. The benefits were not great and in no way addressed the spiraling increase in medication cost. Part D was created to address the increasing medication costs. Let’s look at Part D in more detail for California Medigap. As we’ve said, Part D is the part of Medicare that provides medication coverage through Medicare. We say “through” Medicare since the actual coverage is administered and offered by private carriers in the California market. You actually pay premium directly to a private carrier and not to Medicare. Medicare did establish the basic framework of what should be covered with some flexibility to allow for different price points on the market. This is similar to how California Medicare supplement plans work. There are some general guidelines on how the Part D plans work so let’s take a look at benefits in general. Some of the plans will have deductibles while others will not. One carrier may offer 3 main different plans with or without deductibles. The deductible must be paid first before getting help paying for medication costs. The next wave of benefits is where the California senior gets help. Most plans have copays based on certain types of medication which usually delineate between generic and brand RX. Keep in mind that brand RX is generally based on a formulary or an accepted list of medications which are both effective and cost effective. There may be a separate benefit (generally higher copay) for brand non-formulary. This richer part of the Part D plan will continue until you hit the dreaded donut hole. After you reach the donut hole, you will generally again be responsible for your medication cost until the catastrophic coverage under Part D begins. This donut hole is scheduled to reduce annually till it is phased out. It’s best to look at actual plans when comparing and contrasting deductibles, benefits, and monthly premiums based on your situation. Of course, we’re happy to walk through the California Medicare Part D options available to you.

Christie Administration Warns NJ Seniors To Be Alert About Medicare Fraud

Posted by:  :  Category: Medicare

Must arrange with you in advance the type of products that will be discussed during a scheduled sales appointment. They may not attempt to sell you other types of insurance coverage other than the type agreed upon in advance; May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare plan; May not attempt to sell you a plan in a doctor’s office or in a pharmacy; May not attempt to sell you a plan at an educational event; May not offer you free meals at promotional or sales events; and May not offer you gifts or other promotional items with a value greater than $15.
Source: nj1015.com

Video: New Jersey Medicare Advantage Plans for 2012

Senior Medicare Patrol Of New Jersey Receives Award

SMP is a federally funded endeavor created to help Medicare and Medicaid beneficiaries prevent, detect, and report health care fraud, waste, and abuse. Health care fraud is an enormous problem. According to the FBI, health care fraud costs the country an estimated $80 billion a year. The SMP of New Jersey is part of a network of 54 national SMPs educating seniors about Medicare fraud and presenting practical tips for becoming wise health care consumers such as safeguarding Medicare numbers, reviewing Medicare Summary Notices, and counting prescription pills.
Source: njtoday.net

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Source: skatingwith.us

High Readmission Rates Mean Lower Medicare Payments for New Jersey Hospitals

Whether under the aegis of the NJHA or independently, New Jersey hospitals are trying a variety of approaches to improve critical aftercare. Some are scheduling face-to-face visits with discharged patients to ensure that they set up appointments with primary care physicians and that they understand how and when to take their medications. Others are using the phone to follow-up. Still others are hiring advanced-care registered nurses, who hold advanced degree and are trained in critical analysis, problem solving and evidence-based decision making. Still others are teaming up with Accountable Care Organizations, which provide a continuum of care for patients, extending from discharge for as long as it is needed.
Source: patch.com

NJ Court: Federal Law Does NOT Mandate Medicare Set

This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

Adler ad uses football metaphor to tackle Runyan on Medicare

“I think the ad is awful,” he said. “I hope they put a lot of money behind it.  In the meantime, we’ll be happy to continue talking about how Shelley Adler repeatedly voted to increase property taxes and government spending as a Cherry Hill Councilwoman, doesn’t even live in the district she’s running to represent, and supports diverting $700 billion from Medicare to pay for a big government takeover of our healthcare system.  Also, I can’t resist offering one piece of unsolicited advice to the Adler team: When you run a football-themed ad in media markets full of rabid Eagles and Giants fans that refers to someone being ‘rejected’ in a football game, you are begging to be mocked.”
Source: politickernj.com

Mgr., Medicaid Compliance

This position manages the overall functions of the Medicaid compliance program applicable to Horizon NJ Health including development and execution of the annual Medicaid compliance work plan, risk assessments, monitoring, compliance training, development and implementation of policies and procedures, communication of compliance standards and preparation of periodic reports to management concerning Medicaid compliance requirements. This position is accountable for limiting enterprise liability and risk by ensuring compliance with state and federal laws and regulations, including the requirements of the Centers for Medicare and Medicaid Services (CMS), the New Jersey Department of Banking and Insurance (DOBI), the Division of Medical Assistance and Health
Source: losmejorestrabajos.net

Report: N.J. Medicaid patients are least likely in U.S. to find new doctor

A major factor in this issue is medical billing itself. The fact that hospitals and medical suppliers charge exorbitantly more for products and services than it costs them to provide means that the cost for any person or entity paying medical bills are likely experiencing extortion. Medicaid is not immune to this, even though it pays reduced rates. If controls were put in place to limit unreasonable billing practices, it would leave more money for medicaid to work with and spend on necessary costs like doctors for new patients.
Source: newjerseynewsroom.com

Most NJ Voters Support Obama Health Care Reforms: Poll

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Source: wnyc.org

Medicare Set Asides Not Required in Personal Injury Cases, Holds NJ Court

The court noted that Medicare set-aside agreements were not mandated by federal law in personal injury settlements. Such agreements are common in workers’ compensation settlements; however, the court observed the circumstances of a personal injury settlement are distinguishable. Payments in workers’ compensation cases are frequently capped by a statutory maximum, whereas personal injury cases can include noneconomic damages and “are not determined by an established formula.”
Source: sjclaw.com

Left Divided Over ‘Grand Bargain’

“We, like you, are ecstatic about the reelection of President Barack Obama and what it means or American growth and prosperity,” wrote Jim Kessler, senior vice president for policy for Third Way, a liberal think tank with a centrist approach, in an open letter to the groups involved with the day of action. “However, as fellow progressives, we were disappointed to learn that you will be leading an effort against the President to impede a balanced grand bargain.”
Source: nationaljournal.com

How To Know If You Need Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSIf you require a lot of medical attention, getting the most coverage you can afford makes sense. Whether you have cancer, chronic illnesses, a major health condition, or regular visits to hospitals and specialists, supplemental insurance will help ensure that everything you need is covered and affordable. Getting Medicare supplemental insurance is also a good idea if your regular Medicare policy does not cover something specific that you need, such as a prescription medication, a certain type of service, or additional medical care that you need. Talk to your doctors and healthcare providers about your current health and the steps you will need to take in order to stay healthy. This will give you a good idea of what you need, and whether Medicare will cover it. If not, seek out a supplemental insurance plan.
Source: dzida.org

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

Baicker: The insurance value of Medicare

Beneficiaries without any supplemental coverage thus do not have enough insurance and face too much risk. This risk is one reason that 90% of beneficiaries obtain some other type of insurance (e.g., retiree health benefits, Medigap, Medicare Advantage, or Medicaid). But beneficiaries with generous supplemental coverage probably have too much insurance. “Too much insurance” may seem like a nonsensical concept, but there is ample evidence that when copayments are lower, patients consume more care, much of which is of questionable benefit to health. The systemwide effects are considerable: the increasing prevalence of health insurance in the United States is estimated to be responsible for about half the increase in per capita health care spending between 1950 and 1990. Having little or no cost sharing may lead enrollees to consume low-value care and drive up the cost of Medicare for everyone.
Source: pnhp.org

Medicare Supplemental Insurance Comparison Website Announces Milestone of 5,000 Customers

Searching for Medicare supplemental insurance can be a daunting process. Contacting insurance companies and dodging pushy salespeople can be enough to avoid the whole process altogether. But for senior citizens who have had to pay out-of-pocket medical expenses, Medicare supplemental insurance is not a luxury but an absolute necessity. Fortunately, a new website has hit the web that has been helping people find the absolute lowest prices on the supplemental insurance policies that they need most. And today, they have announced that they have successfully assisted their 5,000th customer in finding supplemental Medicare insurance. The reason the website has seen so many visitors in such a short time is because it’s software is as non-invasive as they could possibly make it. As opposed to their competitors, the new website only requests the visitor’s ZIP code, and within seconds it lists all the best insurance companies in any specific area. “What this does is it essentially puts the shopper in the driver’s seat,” says David Bartholomew, head of marketing. “When a shopper goes to our Medicare supplemental insurance comparison website they are presented with dozens of reputable insurance companies in their area. They can then take the price quotes that they are given and contact the companies they are interested in with their competitors’ price right in front of them. This puts them in the place of bargaining power and makes it much easier for them to get a great deal on a Medicare supplemental insurance policy.” The website has also been gaining in popularity because of the resources it provides its readership such as articles and a comprehensive learning Center. For those who are not educated about Medicare supplemental insurance, the website focuses on the many aspects of this complicated faction of Medicare and ultimately assists them with making a wise decision. To learn more, or to get a fast comparison of all the highest rated insurance companies in a specific area, please visit: http://medicaresupplementalinsurancecomparison.net/ About medicaresupplementalinsurancecomparison.net Medicaresupplementalinsurancecomparison.net was created in September of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

Do You Need Medicare Supplemental Insurance?

One huge benefit of a Medicare supplemental insurance plan is that it will not be nearly as expensive as a traditional plan. After all, the supplemental insurance will not have to cover all of your bills. This reduces the risk by reducing the total amount of money that you will need. Even though you will feel like you are getting a high level of coverage, the insurance company will not feel the same pressure. For example, perhaps you have $10,000 worth of bills and Medicare will only pay for $8,000. The insurance plan merely has to pick up the extra $2,000. Therefore, you can pay as much as you would for low level coverage, but you will get a much better service.
Source: loneframe.com

Obamacare ‘Surprise’ Threatens Access to Medicare Advantage Coverage, AMAC Charges

The Association of Mature American Citizens [http://www.amac.us] is a vibrant, vital and conservative alternative to those traditional organizations, such as AARP, that dominate the choices for mature Americans who want a say in the future of the nation.  Where those other organizations may boast of their power to set the agendas for their memberships, AMAC takes its marching orders from its members.  We act and speak on their behalf, protecting their interests, and offering a conservative insight on how to best solve the problems they face today.
Source: amac.us

Medicare Home Health: What Is Medicare Supplemental Insurance?

Medicare is an entitlement program created by the federal government as its principal health care plan for seniors. To qualify for Medicare all you need to do is reach the age of 65, become permanently disabled or have end stage renal disease. Medicare was originally created to help our elderly with the burden of paying for health care. Medicare is not free however; recipients pay a monthly premium as well as portion of the cost of services they receive as a co-payment or deductible amount.
Source: blogspot.com

Supplemental Health Insurance

The supplemental insurance plan also gives a sense of security when it comes to your finances as well. Many plans can get up there in price. The thing is to be sure to look over the whole plan and to know what you need when shopping for extra coverage. There are a number of plans that will offer everything you need like skilled nurses, extra dental coverage, and even gynecological visits for an amazingly low monthly premium.
Source: medicareaddoninsua.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

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

Electronic Health Record Incentive Payments Top $228 Million

Posted by:  :  Category: Medicare

32.Detroit by Tomato GeezerOver $228 million in Electronic Health Record (EHR) Meaning Use Incentives have been paid to qualified Michigan health care providers, including $100 million through Medicaid and $128 million through Medicare, according to an October 22 press release by the Michigan Department of Community Health (MDCH). Generally, incentive payments are available either to eligible groups of professionals or hospitals who meet usage and reporting thresholds to demonstrate “meaningful use” of EHRs according to federal regulations. Eligible professionals must choose between the Medicaid or Medicare incentive program (although they are allowed a one-time switch), but most hospitals are eligible to participate in both programs. Approximately $32 billion in “Meaningful Use” payments were made available by the Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009. The Center for Medicaid and Medicare Services (CMS) announced that by the end of September, $7.7 billion had been disbursed, including $1.4 billion in Medicare payment and $1.2 billion in Medicaid payments to eligible professions, and $4.9 billion to hospitals. 153,860 professionals and 3,182 hospitals received payments nationwide, with many more registered in the program for future payments. In a briefing to HIMSS, a national health IT association, a CMS official estimated that nearly half of all the eligible professionals and 81% of the hospitals in the country have registered for the incentives. The industry transition to EHRs has had its share of controversy. A recent article in the New York Times captured the unease, citing issues of user unfriendliness (too many clicks and screens), unreliability, interoperability and even safety. An Institute of Medicine report released in November 2011 raised some safety concerns for health IT systems that are not carefully monitored and tested after installation. Evaluation reports of EHRs and other health IT systems have been mixed, with many studies based on data from academic medical centers, single institution, or broad surveys. One recent study published in the Journal of Internal Medicine was based on data taken across several ambulatory settings involving 466 physicians using different EHR systems and over 74,000 unique patients. It found that EHR use was associated with significantly higher quality of care in four measures, and overall higher quality in nine of the ten measures examined. A MDCH survey of EHR incentive program participants found that the longer an office used an EHR system, the more they realized the benefits . State and federal policymakers are likewise hopeful that the longer their HITECH investments take root in the health care industry, the more likely they will pay dividends in improved health care quality, safety and efficiency.
Source: mi-osteopathic.org

Video: I am a Medicare Advisor for Texas, South Carolina Michigan and California

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Medicare Part D Notice Required Before October 15

This is a reminder that the deadline to distribute the Annual Notice of Creditable Coverage required under Medicare Part D is less than a week away. This notice informs participants whether the prescription drug coverage offered under your health plan constitutes creditable or noncreditable coverage. As the Medicare Part D annual enrollment period now runs from October 15 to December 7, you must distribute the notices before October 15. Employers who sponsor a health plan offering prescription drug benefits must provide an annual notice to all Medicare-eligible participants that explains whether the prescription drug benefits offered under the plan are at least as good as the benefits offered under the Medicare Part D plan. The only employers exempt from this requirement are those that establish their own Part D plan or contract with a Part D plan. The Centers for Medicare and Medicaid Services (CMS) has posted forms and instructions for providing this notice. The forms were last updated in 2011. They are available, both in English and Spanish, through the following links:
Source: jdsupra.com

New Ad From Democrats Attacks Michigan Lawmaker on Medicare

The attack ad represents part of a larger strategy by Democrats to make a prominent issue of Medicare, which they perceive as a major political weakness of Mr. Ryan’s budget plan. That tack has already extended to some Congressional races, including ones in Montana and Florida.
Source: nytimes.com

Medicare extends open enrollment deadline for those impacted by Sandy.

You don’t have to show proof that you’ve been impacted by Hurricane Sandy to have more time. You might live elsewhere but help with healthcare decisions for a family member, relative or friend who was in the hurricane’s wake. If you’ve already submitted an enrollment request to Medicare, the plan should contact you via mail or a phone call, to let you know you are enrolled. If they haven’t, you’ll need to call the plan.
Source: aarp.org

gramesmith70: Medicare and More High Quality Choices

As a result of provisions in the Affordable Care Act, Medicare is doing more to promote enrollment in high quality plans and alert beneficiaries who are enrolled in lower quality plans. Currently, people with Medicare enrolled in consistently low performing plans (those receiving less than 3 stars for at least the past 3 years) will receive notifications to inform them that they can switch to a higher quality plan if they choose to do so. Also, 5-star plans are rewarded with the ability to continuously market and enroll beneficiaries throughout the year.
Source: blogspot.com

Ryan’s Medicare scheme may cost Benishek his seat

Even before Mitt Romney named Paul Ryan to the ticket, our Battleground polling results indicated an erosion of support for Republicans, largely based on Paul Ryan’s plans for Medicare and entitlements. The advantage Republicans held among seniors in 2010 has been completely decimated. Across these Republican districts, incumbents now hold just a two-point lead with voters over age 64—a group Republicans won by 18 points in 2010.
Source: bloggingformichigan.com

sheridan addiction: Settlement Eases Rules for Some Medicare Patients

Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing and therapy services ?does not turn on the presence or absence of an individual?s potential for improvement,? but is based on the beneficiary?s need for skilled care. The proposed settlement could help people with chronic conditions like Alzheimer?s disease, multiple sclerosis, Parkinson?s disease, stroke, spinal cord injuries and traumatic brain injury. In addition, it could provide relief for families and caregivers who often find themselves stretched financially and personally by the need to provide care.
Source: blogspot.com

Fausone Bohn, LLP: Michigan Medicare Fraud Strike Force

The investigation was triggered by the Medicare Fraud Strike Force. Since its inception in March 2007, the strike force has charged more than 1,330 defendants who collectively have fraudulently billed Medicare for more than $4 billion. Working in conjuncture with the FBI and HHS, the strike force hopes to increase accountability and decrease the presence of fraudulent providers.
Source: blogspot.com

Medicare Advantage: Anthem Medicare PPO Alternative in Las Vegas, NV

Posted by:  :  Category: Medicare

The second option is to upgrade to a Medicare Supplement.  Because your plan is not renewing, you have the guarantee issue right to a supplement.  You cannot be denied for health history.  The monthly cost will be higher than that of the PPOs, but a supplement will give you freedom to see any doctor that accepts Medicare and you will no longer have co-payments if you select a Medicare Supplemental Plan F.
Source: suncityfinancial.com

Video: Differences between Medicare PPO & HMO Plans

Health plan summaries, Benefit Renewal mailing , Medicare RX

Here are the Health Plan Summaries and other benefit information that I want to get out fast.  I will be getting the information in some sort of organization as to who will need what, but for the time being these are summaries of some of the changes.  Please follow the story as we organize these in list for specific members, ie..active, retiree, retiree with medicare.  We will also be placing these on the site in permanent areas so as they will always be available.
Source: ibew827.com

Medicare Advantage Plan or Medicare Supplement with Part D Drug Plan

•Each plan has a list (called a “network”) of doctors, specialists, hospitals, and other providers that you may go to• Each plan gives you flexibility to go to doctors, specialists, or hospitals that aren’t on the plan’s list, but it will usually cost more.• You may get care from specialists without a referral or prior authorization from another doctor. If you use plan specialists ,your costs for covered services will usually be lower than if you use non-plan specialists.• Each plan may choose to offer a discount to members if they voluntarily use preauthorization or if they pre-notify the plan when getting out-of-network services.• You get all services covered under Medicare Part A and Part B, although the amount you pay for these services might not be the same as under Original Medicare.• Medicare PPO Plans usually offer extra benefits than Original Medicare but you may have to pay extra for these benefits.• Each plan can charge you a monthly premium amount above and beyond the Medicare Part B premium.• Each plan can charge deductible and coinsurance amounts that are different from those under Original Medicare.• In a Regional PPO Plan, you have an added protection for Medicare Part A and Part B benefits. There is an annual limit on your out-of-pocket costs. This limit varies depending on the plan.• Medicare PPO Plans operate like Health Maintenance Organizations (HMOs) with the following two exceptions:–In HMOs, you generally can only go to doctors, hospitals, and specialists that are part of the plan’s network.–Often, HMOs require referrals and pre authorizations.
Source: indoamerican-news.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Insurance Quote Free: Aetna Medicare Health Insurance Plans

The Aetna Medicare Advantage programs cover basic hospital and doctor bills as well as vision and hearing expenses. Additional prescription drug coverage can be added. Aetna offers four types of coverage, HMO, PPO, Private, and Special Needs. Let’s take a closer look at each of these plans: The Aetna Medicare HMO plan grants you access to thousands of doctors in the Aetna network. Before choosing this option, you should check the directory to make sure your doctor participates in the network or you will have to change doctors. The HMO plan offers several advantages. You will have predictable medical costs that are no cost or flat fee. You won’t need referrals to other doctors in the network and will also have coverage for most prescription drugs covered by Part D. Your copay for preventative care may be as low as $. The benefits also include gym memberships at no cost and allowances for glasses and hearing aids. The Aetna Medicare PPO plan offers many of the same advantages as the HMO in that you have predictable costs, drug coverage, fitness benefits, and $ copays on routine office visits. The PPO plan also allows you the flexibility of choosing a primary care physician outside of the network. The Aetna Medicare Open or private pay plan is similar to the PPO plan in that you can visit any doctor or hospital that takes Medicare and agrees to the terms of the plan. This allows you to travel around and receive insurance coverage nationwide yet manage predictable costs. The Aetna Medicare Special Needs plan is available for certain suitable participants who are qualified for both Medicare and Medicaid. This requires residence in a particular service area and offers flat rate copayments and drug coverage. To be eligible for Aetna Medicare health plans you must first be eligible for Medicare. That means you must be 65 years old, or younger with a qualifying disability. You must also live in an area of the country that Aetna currently services. You can only change Medicare health plans during certain times of the year which is usually November through December for the following year. The exception is if you lose coverage because you move or if you are new to Medicare because you just turned 65. Under those circumstances, you can apply for Aetna Medicare throughout the year. If you are trying to decide upon an insurance company to go with, keep in mind that Aetna has been a major presence in the industry for over 150 years. They offer services nationwide and cater to over 30 million customers. They have ample experience and offer many valuable perks to supplement their insurance coverage making them a solid choice.
Source: blogspot.com

Medicare in Las Vegas, NV: Anthem Preferred PPO Is Leaving Las Vegas in 2013

In 2013, the Anthem Preferred PPO Medicare Advantage (MA) Plan will no longer be available in Clark County.  If you are a member of the Anthem PPO, you must choose another option before December 31, 2012, or you will go back to original Medicare on January 1, 2013. The fact that this plan is not continuing may be disconcerting, but it may also be a good opportunity.  If you have been denied a Medicare Supplement in the past due to health reasons, you can no longer be denied.  In other words, if you are on Anthem PPO right now, you have a guarantee issue right for a Medicare Supplement in 2013. As an Anthem member, you have two options:
Source: suncityfinancial.com

California Medicare Insurance: 2013 Anthem Medicare PPO

This plan is also offered in other states but here in California it is now a Local PPO as opposed to a Regional PPO, which means its limited to particular counties The plan used to cover the entire state of California and now only a handful of counties will be able to have access to Medicare Advantage PPO network. In addition. only 3 of the counties will continue to receive the “Zero Cost” option; Los Angeles, San Diego and Ventura. All other counties will now have a monthly premium for this plan ranging from $40-131/mo. For some this is no problem but for many Medicare beneficiaries who are dependent upon Social Security or on a fixed income, this raises huge issues. 
Source: blogspot.com

Anthem Blue Cross of California Medicare Supplement

Anthem Blue Cross of California has a been a dominant fixture in the California health insurance market for decades now and their participation in the California Medigap market is no exception. One of the key concerns when shopping for Medicare supplement plans is a carrier’s strength and stability in the market since the purchase can echo decades into the future. Anthem Blue Cross definitely looks good in this light since they are one of the original providers of Medigap plans and can be considered as a leader in the market. Let’s dig a little deeper into their participation, pricing, and plan design in the California market. In most states, Blue Cross and Blue Shield are the same company. California, as always, is very unique in that the two are separate companies for the individual, family, small group, and Senior medigap markets. They each offer their own plans and options for supplements. Once that’s cleared, let’s look at Blue Cross of California which is part of the Anthem nationwide company. Anthem Blue Cross is one of the first companies in California to offer Medicare supplement plans to the Senior market which makes sense in that Medigap plans are the senior equivalent to PPO plans and Cross has a strong presence in the PPO marketplace among all segments of health insurance. The alternative to PPO’s would be HMO and the alternative to Medigap plans (used interchangeably with Medicare supplement) would be Advantage plans which are the new derivatives of old senior HMO’s from a decade ago. Let’s get back to California Medicare supplement plans. Blue Cross of California has offered many of the available standardized plans allowed by Medicare. They were even one of the first to offer a high deductible F plan under the branding of Smart Choice which is still around. Currently (1/1/2012), Anthem Blue Cross of California offers the F high deductible, N, A, G, and Standard F Medicare supplement plans. This offering may change over the course of time as it does with all carriers although the A, F, and F high deductible are standards for Anthem Blue Cross California Medigap. As with most carriers across the country, the F plan (not high deductible option) continues to be the most popular California Medigap plan and for good reason since it covers all major gaps of traditional Medicare and at a good premium to benefit comparison. The key comparison is with the F high deductible option in our view since this plan still covers all the important holes in original Medicare but uses a deductible to reduce the premium. How do you go about comparing the two plans? First, take the monthly premium difference over a year’s time. We can run those quotes for you. Next, compare this annualized premium difference against the potential deductible amount you would pay under the California F high deductible plan. That gives you a baseline. If you do not have sizeable medical expenses now (outside of medication), the savings in premium looks pretty attractive. Keep in mind that your decision will likely travel with you for a long time especially if health changes so it’s best to assume worst case (you reach full deductible) to know what the potential risk is for a bad year. You now have the best case of the California high deductible F plan (full savings on the premium side) and the worst case (meet full deductible minus the premium savings). This gives you the the opposite extremes and you can expect many years to be in between depending on your health status. Now, it’s a question of your risk comfort level. Also, if you have large health issues, the California high deductible F plan will probably not be the right choice. Either way, Anthem Blue Cross of California offers both Medigap options and we feel comfortable with them as a strong carrier in the senior California medigap market for years to come.

Hospitals Sue HHS Over Alleged Unfair Medicare Practices

Posted by:  :  Category: Medicare

Rally at Todd Akin's office  by joetta@sbcglobal.netThe American Hospital Association (AHA) has filed suit against the U.S. Department of Health and Human Services (HHS) over its alleged refusal to meet its financial obligations for hospital services provided to some Medicare patients. The AHA was joined in the suit by four hospital systems: Missouri Baptist Hospital, a critical access hospital in Sullivan, Mo.; Munson Medical Center, a 391-bed hospital in Traverse City, Mich.; Lancaster General Hospital, a 631-bed facility in Lancaster, Pa.; and Trinity Health Corporation, which owns 35 hospitals.
Source: healthcare-informatics.com

Video: Missouri Medicare Supplement Insurance Plans Call 816-318-7050

Medicare, Health Law Are Common Themes In House And Senate Races

The Associated Press/Wall Street Journal: Spending By Outside Groups Rocks Many House Races Rep. Dan Lungren knows what it’s like to have a big bull’s eye plastered on his back. The Democratic Party and labor and environmental groups have spent $4.7 million on TV commercials and other efforts to unseat the nine-term Republican congressman from California. That makes him one of the biggest targets of outside groups, which are throwing unprecedented sums of money into House races this year. “I don’t recognize the person they’re portraying,” Lungren said about the ads that paint him as an ally of Wall Street and enemy of Medicare and abortion rights. He added, “Yeah, these ads have a considerable impact” (10/27).
Source: kaiserhealthnews.org

Dean of University of Missouri

The radiologists, Dr. Kenneth Rall and Dr. Michael Richards, are alleged to have billed Medicare for radiologic studies that only residents read; the two attending radiologists did not over read the studies yet billed Medicare as if they had. It is unclear how much money the department accepted from Medicare as a result of these practices or how long ago the alleged fraudulent practices began. Dr. Rall was the chairman of the department of radiology until December 2011, when he resigned because of these issues. A month after his resignation, the Columbia Tribune also discovered that 62.5% of imaging studies within the department did not have legitimate physician orders.
Source: pathologyblawg.com

Seniors: Check Your Medicare Part D Plan Annually

Sandy Dailey of CLAIM, or Community Leaders Assisting the Insured of Missouri says a review is not just for those new to the prescription drug program. Insurance companies may change their drug coverage from one year to the next, so everyone is encouraged to evaluate their options annually.
Source: khmoradio.com

USDOJ: Missouri Hospital System Agrees to Pay $9.3 Million to Resolve False Claims Act and Stark Law Violations

Freeman Health System, a healthcare provider and hospital system located in Joplin, Mo ., has agreed to pay $9,316,139 to resolve allegations that it violated the Stark Law and the False Claims Act by knowingly providing incentive pay to physicians in a manner that violated federal law, the Justice Department announced today.    The Stark Law forbids a hospital from billing Medicare for certain services referred by physicians that have a financial relationship with the hospital.   A prohibited financial relationship includes an agreement between a hospital and a physician to compensate a physician based on the volume of the physician’s referrals or the revenue realized through those referrals.   Freeman disclosed to the United States Attorney for the Western District of Missouri that a number of its physicians were eligible for incentive compensation that may have taken into account the value and volume of their referrals.   Based on its investigation of Freeman’s disclosures, the United States alleged that Freeman knowingly compensated some of its physicians in a manner that violated the Stark Law.   Specifically, the United States alleged that Freeman provided incentive pay to 70 physicians employed at clinics operated by the health system based on the revenue generated by the physicians’ referrals for certain diagnostic testing and other services performed at the clinic, and that this financial arrangement created an incentive to refer patients for such procedures. “Today’s resolution underscores our commitment to ensure that health care decisions are based on the best interests of patients rather than the personal financial interests of referring physicians,” said Stuart F. Delery, Acting Assistant Attorney General for the Department’s Civil Division. “The Department of Justice encourages companies to disclose potential violations of law, as was the case here .” “Our priority is protecting the patients,” said David M. Ketchmark, Acting United States Attorney for the Western District of Missouri. “These laws are intended to ensure that physicians make referrals for health care services based solely on the medical needs of their patients rather than any financial incentives. These laws also protect the integrity of the government-funded health care benefit programs.” This resolution is part of the government’s emphasis on combating health care fraud and another step for the Health Care Fraud Prevention and Enforcement Action Team (HEAT) initiative, which was announced by Attorney General Eric Holder and Kathleen Sebelius, Secretary of the Department of Health and Human Services in May 2009. The partnership between the two departments has focused efforts to reduce and prevent Medicare and Medicaid financial fraud through enhanced cooperation. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover $10.1 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department’s total recoveries in False Claims Act cases since January 2009 are over $13.8 billion.   This case was handled by the Department of Justice’s Civil Division, the United States Attorney’s Office for the Western District of Missouri, the Office of Inspector General of the United States Department of Health and Human Services, and the FBI.   The claims settled by this agreement are allegations only, and there has been no determination of liability. Contact: Department of Justice Main Switchboard – 202-514-2000 Reported by: US Department of Justice
Source: 7thspace.com

Medicare extends open enrollment deadline for those impacted by Sandy.

You don’t have to show proof that you’ve been impacted by Hurricane Sandy to have more time. You might live elsewhere but help with healthcare decisions for a family member, relative or friend who was in the hurricane’s wake. If you’ve already submitted an enrollment request to Medicare, the plan should contact you via mail or a phone call, to let you know you are enrolled. If they haven’t, you’ll need to call the plan.
Source: aarp.org

Senior Medicare Patrol Alert

If you have experienced any of the behaviors listed above, please call the Missouri SMP (Senior Medicare Patrol) at 1-888-515-6565.  The Missouri SMP has trained staff and volunteers who work with CMS and the Missouri Department of Insurance to report complaints of inappropriate behavior and assist beneficiaries in making informed decisions about their healthcare coverage.
Source: ma4web.org

Missouri Bus Tour Protesting Cuts in Veterans’ Benefits, Medicare & Social Security to Travel State

“There are 47 percent of the people who will vote for the president no matter what. All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it. That that’s an entitlement. And the government should give it to them.”
Source: patch.com

Medicare extends open enrollment deadline for those impacted by Sandy.

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyYou don’t have to show proof that you’ve been impacted by Hurricane Sandy to have more time. You might live elsewhere but help with healthcare decisions for a family member, relative or friend who was in the hurricane’s wake. If you’ve already submitted an enrollment request to Medicare, the plan should contact you via mail or a phone call, to let you know you are enrolled. If they haven’t, you’ll need to call the plan.
Source: aarp.org

Video: AARP Oklahoma Medicare Opinion Leader Forum 8-23-12

Annual Enrollment Period for Medicare in Oklahoma

There are times when things happen that are out of your control and Medicare allows for changes to be made to your Medicare Advantage or prescription drug coverage during these special situations. Special enrollment periods exist for those people who have moved out of a service area or whose plan has been terminated. In addition, if you have the option to receive coverage offered through work or you lose your current coverage, you may be eligible for a special enrollment period. Finally, if you are moving into or out of a skilled nursing facility or long term care hospital, you are most likely eligible. There are other situations that may qualify you for eligibility. If you are uncertain, be sure to check, it may save you time and money. 
Source: oklahomamedicarehealth.com

CMS approves Medicare RAC to review E&M claims

Although most optometrists and other physicians do not frequently bill this code, a report by the Office of the Inspector General (OIG) of the U.S. Department of Health & Human Services (HHS) earlier this year found that 2.2 percent of physicians who consistently bill higher level E&M codes were optometrists.
Source: newsfromaoa.org

Owassoisms.com: Lovelace Medicare Advantage Plan Expands in Oklahoma

TULSA, OK – Lovelace Health Plan is pleased to offer a Medicare Advantage product in Tulsa, Oklahoma, Payne and Mayes counties. Lovelace Medicare Plan is expanding to Rogers, Creek, Muskogee and Okmulgee counties in 2013. Open enrollment is October 15 through December 7 with coverage beginning January 1, 2013.
Source: owasso411.com

Senior Summit Coming to Western Oklahoma

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

Senior Benefit Services, Inc.

Effective September 1, 2012 on new business & October 1, 2012 on in force business for United of Omaha 2010 Modernized Medicare Supplement plans (Policies effective on or after June 1, 2010) in Georgia, Iowa, and Oklahoma. The Rate Adjustments will affect plans  A, F, G, and M.
Source: srbenefit.com

Oklahoma senior get full coverage #Medicare at $82.35/mo @MedicareWire thru #UHC #AARP

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Source: posterous.com

Blue Oklahoma:: Obama Clear Choice, 'No' On SQ 766

There are 47 percent of the people who will vote for the president no matter what. All right, there are 47 percent who are with him, who are dependent upon government, who believe that they are victims, who believe the government has a responsibility to care for them, who believe that they are entitled to health care, to food, to housing, to you-name-it — that that’s an entitlement. And the government should give it to them. And they will vote for this president no matter what. … These are people who pay no income tax. … [M]y job is not to worry about those people. I’ll never convince them they should take personal responsibility and care for their lives.
Source: blueoklahoma.org

New Grants Help People with Chronic Conditions Stay Healthy and Independent 

The elderly tend to have more chronic conditions than younger individuals, such as diabetes, arthritis, heart disease, and depression. Chronic disease can negatively affect a person’s quality of life and threaten one’s ability to live independently in the community. Two-thirds of Medicare spending is for beneficiaries with five or more chronic conditions.  The new grants build on the Recovery Act’s Chronic Disease Self-Management Program grants awarded in March 2010, which had an initial goal of reaching 50,000 elderly adults. As of August 28, 2012, 47 of the first round states had reached 111,272 seniors. The funding will support a variety of programs, all evidence-based and licensed from the Stanford University Patient Education Research Center. The Stanford programs emphasize an individual’s role in managing their own health and improving their quality of life. The grants will also support evidence-based self-management programs for individuals with diabetes, arthritis, HIV/AIDS, and chronic pain. These programs include Internet-based courses and programs specifically developed for Spanish-speaking adults with chronic conditions. The 22 states awarded the competitive cooperative agreements are: Alabama, Arizona, California, Colorado, Connecticut, Georgia, Kentucky, Massachusetts, Maryland, Michigan, Missouri, New Jersey, New Mexico, New York, Oklahoma, Oregon, Rhode Island, South Carolina, Utah, Virginia, Washington, and Wisconsin.
Source: wisconsinsmp.org

TX and OK Home Health Agencies: Beware of Home Health Compliance Risks

Despite the fact that most Texas home health agencies are doing their best to operate within the four corners of the law, there are still a number of providers who are continuing to engage in wrongdoing. Texas home health providers recently received significant negative media coverage for fraudulent and abusive billing practices allegedly committed by agencies within their ranks. As you may have heard, just last week a physician and several home health agency “recruiters” in the Dallas-Fort Worth area were indicted in the largest Medicare fraud scheme in history, allegedly totaling nearly $375 million for home health services either not needed or never provided. Additionally, it was noted that over 75 home health agencies to whom referrals were made have also been implicated in the wrongdoing.  Such an enormous scheme only further demonstrates the fact that fraudulent activity in home health services is continuing, despite the fact that most Texas home health providers are well-meaning organizations, trying in good faith to provide medically necessary services to our nation’s most sick and disabled. Nevertheless, such accusations only increase suspicion and scrutiny of the entire home health industry in this region.
Source: pmimd.com