Medicare Removes the “Improvement Standard”

Posted by:  :  Category: Medicare

Racism by elycefelizAs a result of this settlement, Medicare beneficiaries with chronic conditions will find it easier to qualify for coverage for home care, skilled nursing home, and outpatient therapy. This will give millions of Americans who suffer from chronic and debilitating conditions a fair chance to obtain the Medicare coverage for which they qualify and the health care treatments they need to remain as healthy and productive as possible. Ending application of the Improvement Standard is a life or death issue for countless Americans
Source: marshagoodmanattorney.com

Video: Medicare Advantage Plans Arizona- 1.800.643.7544

Why You Should Select an AARP Medicare Plans Phoenix AZ

The aarp medicare plans phoenix az is an HMO plan, and like any HMO plan it comes with some restrictions. The main thrust of these restrictions is you have to use in-network providers and facilities. This should not create a problem for you because of the vast network of providers in-network. In fact, your current provider could be a participating provider already with the aarp medicare plans phoenix az network, so you would not even have to switch. With that said, there is an upside to having an HMO plan because your in-network doctors office visit are relatively less than other plans on the market, and the same can be said for urgent care services and other services as well.
Source: sweetheartsilver.com

Richard Carmona’s Status Quo Approach to Medicare Guarantees its Bankruptcy

Hello Conservative American. I agree with you that voters can’t count on an R or a D, except I don’t think that it was ever the plan that we be counting on them at all. We started out with the privilege and right of representing ourselves in Congress, but long ago we started hiring professionals and carpetbaggers to do our work for us. Flake-Carmona-Republicans-Democrats are symptoms of our own stupidity. It’s no secret that Jeff Flake is a shaky conservative. I’m just interested in buying time at this point to mitigate the marxist train steam rolling through America. Jeff Flake is a liability on many fronts. If it weren’t for the surreal life-sucking, God-hating, liberty-hating UN treaties that Democrats are trying to pass, Jeff Flake-in or Jeff Flake-out wouldn’t matter to me.
Source: sonoranalliance.com

Doctors In Arizona Tell Richard Carmona That We Need To Repeal His Job

“Carmona served as the 17th surgeon general of the United States under President George W. Bush. Last year, he participated in series of health care town halls that the congresswoman held in Tucson, Sierra Vista and Green Valley. ‘The issue facing our country is how do we get the best care for the most people at the least cost,’ Carmona said. ‘We spend more for health care than any other nation on Earth, but the metrics of our results don’t reflect that. We need to move toward a health care system, not the sick care system that we have today. This legislation moves us closer to that. This bill is not perfect. But these are complex issues and we must move forward. And then I hope we can sit down with level heads and make it even better for the benefit of the American people.’” (“U.S. Rep. Gabrielle Giffords Announces Support For Historic Health Insurance Reform Legislation,” Congresswoman Giffords Press Release, 3/20/10)
Source: westernfreepress.com

Daily Kos: Celebrating 47 Years of Medicare!

Seniors across the state gathered last week and this week to celebrate 47 years of Medicare.  We built our Medicare system because it is by far the best way to provide America’s seniors and people with disabilities with affordable health care they can count on. For nearly half a century, Medicare has given seniors and people with disabilities access to critical health care. It protects beneficiaries and their families against health-related expenditures that might otherwise overwhelm their finances—or worse, force them to forego medical treatment needed to survive.
Source: dailykos.com

Retirement hangs on fiscal cliff

Will you’re to get, taxes , taxes and more taxes. You put him back in office and this what you’re to get. The poor are going to be getting poorer everyday, but all of our money will be given away over seas to buty friends that we rteally don’t need. The last time that we a democrat he set american jobs overseas and now look at what you have. thios one is going take every klast penny that he can. 16 Billion in dedt to who China. A commist county. what is wrong with this picture? XCan anyone explain the reasopn behind all this. But yet you put him back in office again. enjoy the pain and empty pockets forit a commin.
Source: bankrate.com

WellCare to Acquire Easy Choice Medicare Advantage Plans

Posted by:  :  Category: Medicare

About Angela Atkinson Angela Atkinson is the managing editor at Scrubs & Suits. She spent several years working in corporate healthcare before becoming a full-time writer and editor. Her experience on the corporate side of the healthcare and health insurance industries has given her a deep understanding of the industry. View all posts by Angela Atkinson →
Source: scrubsandsuits.com

Video: WellCare Medicare Advantage – I Am Well Cared For.mov

Wellcare Health Plans Inc. Posts $40 million Loss

This entry was posted in Case Interview Questions, improve profitability and tagged Booz Allen Hamilton BAH, business consulting, business solutions, case interviews, case studies, improve profitability, Insurance life & health, interview questions & answers, job interviews, management consulting. Bookmark the permalink.
Source: consultingcase101.com

WellCare Health Plans’ CEO Discusses Q3 Results

As a new program obviously there were some influx relating to the claim payment, claim submission patterns, but we feel comfortable that we have a good visibility in that now. So, our DCP reflect our best ability to look at in third quarters and we feel that as we commented in the past we don’t provide guidance from DCP, but it’s really based on change in the business mix that you see and I also want to add another comment if you’re looking forward into 2013, with the with the acquisition of Easy Choice for example, which tend to be more global cap, PCP can be even lower than our average today. So, the changes in business mix can have an impact on what we see as the future DCP.
Source: seekingalpha.com

SAC Capital Increases Wellcare Health Stake (WCG) ~ market folly

Steve Cohen’s hedge fund firm SAC Capital yesterday after market close filed a 13G with the SEC on shares of Wellcare Health Plans (WCG).  Per the filing, SAC has revealed a 5% ownership stake in the company with 2,155,721 shares. This marks a 105% increase in their position size since the end of the first quarter.  The filing was required due to portfolio activity on July 6th. Shares of WCG have recently seen two surges higher.  First, under the Supreme Court’s upholding of Obamacare, WellCare Health Plans shares surged from $50 to $55 on the news. Then, just yesterday, it was announced that Amerigroup (AGP) would be acquired by Wellpoint (WLP).  It seems shares of WCG rose in tandem on hopes that the company could also potentially be a takeover target in the space.  WCG traded from $59 up to $62. Per Google Finance, Wellcare Health Plans “provides managed care services to government-sponsored health care programs. WellCare operates in three segments: Medicaid, Medicare Advantage (MA) and Prescription Drug Plan (PDP), which are within its two main business lines: Medicaid and Medicare.” For more on this hedgie, head to more recent portfolio activity from SAC Capital.
Source: marketfolly.com

WellCare Health Plans Reaches Settlement in False Claims Act Case

administrative complaint attorney audit controlled substances dea DEA investigation defense attorney defense attorneys defense lawyer department of health Department of Health (DOH) doctor doh drug enforcement administration emergency suspension order false claims act florida fraud prevention government health programs health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medical license medicare medicare audit Medicare fraud Medicare investigation Medicare overbilling nurse nurses overbilling overprescribing pain clinics pain management pharmacies pharmacist pharmacists pharmacy physician physicians prescription drug trafficking
Source: wordpress.com

Medicare will prod users to switch from low

The announcement comes on the eve of Medicare open enrollment, which runs from Monday through Dec. 7. During that eight-week period, people can enroll in different Medicare Advantage and prescription-drug plans.When people turn 65 years old, they can sign up for traditional Medicare coverage or opt for those additional coverage plans that might better suit their health-care needs.
Source: telcoretirees.org

WellCare Health Plans (WCG) Up 9.6% As Medicare Stocks Rise after Supremes Uphold ACA

WellCare Health Plans (NYSE: WCG) rose Thursday as stocks with large Medicare businesses rose after the Supreme Court upheld the Affordable Care Act. A September 50/0 Covered Call looks like an attractive way to play WCG today. This strategy aims for a return of 6.2% and WCG is 7% out of the money. Recent support for this stock has been demonstrated near $48.7 while resistance has been around $51.22. WellCare Health Plans is trading today at $54, up $4.39 (9.64%) from yesterday’s close. The stock began the day trading at $49.94 and has moved between $49.66 and $55.85. Recent technical indicators for the stock are bullish and Standard & Poor’s gives WCG a positive 4 STARS (out of 5) buy.
Source: marketintelligencecenter.com

medicare fee schedule 2011: 网站 Wellcare

Meta可提供有关页面的元信息 比如针对搜索引擎和更新频度的描述和关键词 Meta名称 内容 content-type text/html; charset=Shift_JIS description みんなが選んでいる 水サーバー比較 人気ランキング のサイトは水サーバーのレンタル 申込み 設置など家庭用のウォーターサーバー購入に関することや体験キャンペーン amil 無料キャンペーン情報などをまとめています関東を中心に東京 大阪 名古屋などの情報も keywords 水サーバー, 水サーバー 比較, 水サーバー ランキング, レンタル 水サーバー, 水サーバー 無料 域名 Wellcare-jp.com 的DNS记录 共找到该域名包含 12 条DNS记录 主机 类别 目标 / IP TTL 其他 *.wellcare-jp.com amil A 202.172.28.8 1800 class : IN wellcare-jp.com A 202.172.28.8 1800 class : IN wellcare-jp.com NS dns1.name-services.com 3600 class : IN wellcare-jp.com NS dns2.name-services.com 3600 class : IN wellcare-jp.com NS dns3.name-services.com 3600 class : IN wellcare-jp.com NS dns4.name-services.com 3600 class : IN wellcare-jp.com NS dns5.name-services.com 3600 class : IN www.wellcare-jp.com A 202.172.28.8 1800 class : IN wellcare-jp.com MX mail.wellcare-jp.com 1800 pri : 10 class : IN *.wellcare-jp.com SOA 1800 mname : dns1.name-services.com rname : info.name-services.com serial : 2002050701 refresh : 10800 retry : 3600 expire amil : 604800 minimum-ttl : 3600 class : IN wellcare-jp.com SOA 1800 mname : dns1.name-services.com rname : info.name-services.com serial : 2002050701 refresh : 10800 retry : 3600 expire : 604800 minimum-ttl : 3600 class : IN www.wellcare-jp.com SOA 1800 mname : dns1.name-services.com amil rname : info.name-services.com serial : 2002050701 refresh : 10800 retry : 3600 expire : 604800 minimum-ttl : 3600 class : IN Wellcare-jp.com 的拥有者是 Personal 域名服务商是 ENOM, INC. 域名注册时间 06-oct-2008 (4 年 8 天前) 域名到期时间 06-oct-2013 域名名称 Wellcare-jp.com 域名年龄 4 年 8 天 前 域名拥有者 Personal 拥有者Email 域名服务器 dns1.name-services.com ( 98.124.192.1 ) dns2.name-services.com ( 98.124.197.1 ) dns3.name-services.com ( 98.124.193.1 ) dns4.name-services.com ( 98.124.194.1 ) dns5.name-services.com ( 98.124.196.1 ) 域名状态 clientTransferProhibited Locked 续费时间 2012-08-06 注册时间 2008-10-06 过期时间 2013-10-06 域名服务商 ENOM, INC. ciessevi.org 靴コキ
Source: blogspot.com

FR&R Healthcare Bulletin: Manual Medical Review of Therapy Claims

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471Beginning October 1, 2012 through December 31, 2012, the Centers for Medicare and Medicaid Services (CMS) will begin implementing an advance review process for Part B therapy claims that exceed a $3,700 threshold.  A provider is responsible for checking the Common Working File (CWF) to determine if a patient has previously received services that would exceed the threshold.  Remember that information in the CWF is only as accurate as the last bill that has been processed.  However, CMS indicated that providers would not be penalized if another provider submits a late bill.  In addition, beginning October 1, 2012, services provided at hospital outpatient therapy departments that were previously exempt from the cap will be included.  If it is determined that a beneficiary will exceed the $3,700 threshold, providers must get advance approval for services.
Source: frrcpas.com

Video: Medical Billing Expert Series: Medicare Claims Processing Manual Chapter 20

Billing for locum tenens services

In light of the physician shortage, our clients are increasingly using locum tenens physicians as a key component of their long-term staffing strategy, to start new service lines, and to augment permanent staff while searching for a permanent doctor, which can be a lengthy process. Under these scenarios, locums are not covering for an absent physician who will be returning and therefore do not meet the requirements for using the –Q6 modifier. In these cases, Medicare and Medicaid require locum providers to enroll in the programs in order to receive reimbursement.
Source: bartonassociates.com

Use the Right Medicare Modifiers

GA Modifier: This modifier indicates that an ABN has been provided to the patient.  It will allow the provider to bill the patient if not covered by Medicare. When this modifier is used, Medicare will automatically assign the patient liability if the claim is denied. For instance, if the reason for providing a particular test is not medically necessary, the provider would expect the claim to be denied. So, before the test is performed, the patient is made to sign the ABN which explains that the claim will be denied. The patient will have to pay for the service.
Source: outsourcestrategies.com

Chronic Conditions No Longer Barrier to Medicare Services

In fairness to Medicare providers, I suspect that many denials of coverage were an over zealous response to the Federal governments continued efforts to combat Medicare fraud and abuse. Training guidelines for nursing home administrators and physical therapists are replete with warnings about providing unneccessary services (i.e. Medicare abuse). Also, although the Medicare manual provisions did not include an “improvement standard” they were sufficiently vague regarding services for those with chronic conditions that not only providers, but also administrative law judges found the subject confusing. Additionally, Medicare providers often assumed (falsely) that if they erred, the patient would appeal the denial of coverage. In practice, the mechanics of appealing the denial of coverage often seemed daunting for many older adults who perceived the effort to be an exercise in futility.
Source: chicagonow.com

Admission Codes; Subsequent Care Code; Coding Volume Outlier

Supporting carrier guidance: MAC TrailBlazer Health’s website (www.trailblazerhealth.com) states that: “TrailBlazer recognizes provider reluctance to miscode initial hospital care as subsequent hospital care. However, doing so is preferable in that it allows Medicare to process and pay the claims much more efficiently. For those concerned about miscoding these services, please understand that TrailBlazer will not find fault with providers who choose this option when records appropriately demonstrate the work and medical necessity of the subsequent code chosen.”
Source: physicianspractice.com

Robb Krzyston’s blog on Netlog

http://www.youtube.com/watch?v=Prmp3vw3T-Q&amp… http://attorneymelbourne.com Business Lawyers Brevard County FL, Business Attorneys Brevard County FL, Small Business, Small Business Administration, How to start a Business, Corporate Law, Corporate Lawyers, Corporate Lawyer, Business Law Attorney, Contract Attorney, proudly serving: Mims, Titusville, Cocoa, Rockledge, Cape Canaveral, Cocoa Beach, Suntree, Viera, Satellite Beach, Indian Harbour Beach, Indialantic, Melbourne, Palm Bay Business Lawyers Brevard County FL has the best business lawyers in Brevard County. Our team has the expertise and experience to help you accomplish any task you need in business. Our team specializes in: Business Law, Corporate Law, Commercial law, Small Business, and How to start a business. If you are in need of a business attorney, you owe it to yourself and the ones you care about to hire the best legal team to protect your rights. To learn more about the best business Lawyers in Brevard County, FL, visit our website at http://attorneymelbourne.com
Source: netlog.com

How doctors and hospitals have collected billions in questionable Medicare fees

Medicare has emerged as a potent campaign issue, with both Barack Obama and Mitt Romney vowing to tame its spending growth while protecting seniors. But there’s been little talk about some of the arcane factors that drive up costs, such as billing and coding practices, and what to do about them.  Our 21-month investigation documents for the first time how some medical professionals have billed at sharply higher rates than their peers and collected billions of dollars of questionable fees as a result. 
Source: publicintegrity.org

An Important Change to Post

Attorneys from the Center for Medicare Advocacy, Vermont Legal Aid and the Centers for Medicare & Medicaid Services (CMS) have agreed to settle the “Improvement Standard” case, Jimmo v. Sebelius.[1] A proposed settlement agreement[2] was filed in federal District Court on October 16, 2012.  When the judge approves the proposed agreement, a process that may take several months, CMS will revise the Medicare Benefit Policy Manual and other Medicare Manuals to correct suggestions that Medicare coverage is dependent on a beneficiary “improving.” New policy provisions will state that skilled nursing and therapy services necessary to maintain a person’s condition can be covered by Medicare.
Source: thedoctorweighsin.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: Medicare Advantage PPO | Medicare Advantage Part C

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

Aetna Selected to Provide Medicare Advantage PPO Plans to Retired State Employees in Pennsylvania.

Aetna provides health benefits to more than 1.1 million members in Pennsylvania. About Aetna Aetna is one of the nation’s leading diversified health care benefits companies, serving approximately 36.8 million people with information and resources to help them make better informed decisions about their health care. Aetna offers a broad range of traditional and consumer-directed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Our customers include employer groups, individuals, college students, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates. For more information, see www.aetna.com.
Source: blogspot.com

What is actually a Medicare Advantage PPO?

Many people that travel often will get a PFFS (Private Fee For Service). Using a PFFS there is no networks; it is possible to take a look at any provider that accepts Medicare and is willing to accept the plan. There are two main problems with PFFS plans. First, it can be difficult to find a provider willing to accept the plan and, second, Congress is requiring that all PFFS plans develope medical doctor networks by 2011. Because of this requirement the future of PFFS plans is up inside the air and nobody really knows what will happen to them next year.
Source: inquiryhealth.com

Phoenix Arizona Medicare Advantage Plans: Which Plan Is Best?

If Medicare is the primary health insurance of you or a loved one then you’re probably aware that it only covers a certain percentage of your health-care costs. Thankfully there are Medicare Advantage Plans that can supplement out-of-pocket costs. Often referred to as Plan C, these plans merge Plans A and B and is provided by the private insurance company of your choice. There is also the opportunity to add Plan D (separate prescription coverage), which can further lessen out-of-pocket costs. If you are in the Phoenix area and are in search of Medicare Advantage Plans, here are some of the available choices:
Source: wemediaguru.com

Chronic Conditions No Longer Barrier to Medicare Services

Posted by:  :  Category: Medicare

The PARTY Is OVER ...item 4.. Today, Mitt Romney Lost the Election (Sep 17, 2012 6:02 PM ET) ...item 5.. James Brown - Get On The Good Foot, Soul Power, Make It Funky Soul Train 1973 ... by marsmet471In fairness to Medicare providers, I suspect that many denials of coverage were an over zealous response to the Federal governments continued efforts to combat Medicare fraud and abuse. Training guidelines for nursing home administrators and physical therapists are replete with warnings about providing unneccessary services (i.e. Medicare abuse). Also, although the Medicare manual provisions did not include an “improvement standard” they were sufficiently vague regarding services for those with chronic conditions that not only providers, but also administrative law judges found the subject confusing. Additionally, Medicare providers often assumed (falsely) that if they erred, the patient would appeal the denial of coverage. In practice, the mechanics of appealing the denial of coverage often seemed daunting for many older adults who perceived the effort to be an exercise in futility.
Source: chicagonow.com

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

More Than 90 Charged in Huge Medicare

The federal government is aggressively cracking down on healthcare fraud. U.S. Attorney General Eric Holder recently announced a major Medicare-fraud bust — one of the largest takedowns of a healthcare fraud scheme ever.  Charges were brought against more than 90 people, including doctors and nurses, in seven cities for their alleged part in the scheme that totaled nearly $430 million in billings for treatment and services that were not medically necessary or were never provided.
Source: wecomply.com

Gynecologist Gets 5 Years For Role In $5.4M Medicare Fraud Scheme

Evidence at trial showed that the patients were not referred to the clinics by their primary care physicians, or for any other legitimate purpose, but rather were recruited with prescriptions for controlled substances, cash payments, and fast food. The three clinics then billed the Medicare program for various diagnostic tests that were medically unnecessary.
Source: cbslocal.com

Covering Medicare: Free training on care, costs, and consequences : BusinessJournalism.org Reynolds Center for Business Journalism

I am digital director at the Reynolds Center for Business Journalism, which I joined in 2009. Before that I was Online Community Manager for azcentral, the online site for The Arizona Republic. Before arriving in Arizona, I worked at Newsday where I was Deputy Business Editor. I was the small business editor at BusinessWeek Online. I teach journalists to use Twitter, Facebook and other social media tools to expand and manage their networks. And I am a cofounder of #wjchat, a weekly Twitter chat about web journalism. You can reach me at Email: Robin.Phillips@BusinessJournalism.org OR RobinJPhillips.com OR @RobinJP
Source: businessjournalism.org

5 Medicare Trends for Surgery Centers to Watch

1. Quality program reporting requirements for ASCs. As of October 2012, ambulatory surgery centers are required to participate in a quality reporting program for Medicare if they accept Medicare patients. Non-compliance will see a 2 percent reduction in reimbursement rates in the future. To maximize reimbursement from Medicare, make sure you are capturing all eight quality measures and any additional measures added in the future. “ASCs should consider appointing a point person who will be responsible for ensuring that the ASC will be able to comply with the new reporting requirements,” says Ms. Carney. “If they fail to implement and report these quality reporting measures, they will see their rates cut in 2014.  Surgery centers are better off now than in 2008, but they still receive less reimbursement than hospitals and we are still seeing a migration from inpatient procedures to ASCs.” The designated leader for quality reporting in each center should attend training to become familiar with the codes that need to be documented. If the codes aren’t documented and the center is selected for an audit, they will lose money. “There may be some financial considerations involved for the ASC to invest in an individual’s training,” says Ms. Carney. “If you outsource billing, you should speak to your IT vendors, billing companies or both to ensure that they will be able to add the quality data codes to claims.” 2. Value-based purchasing programs. While surgery centers aren’t required to meet the standards of value-based purchasing yet, it’s something that could come down the pipe in the near future. Hospitals are already implementing value-based programs, and Congress has discussed requiring these programs in ASCs as well. “There are pros and cons to value based purchasing for ASCs,” says Ms. Carney. “The ASC could support their argument for bringing more cases into their setting if their data is good, or they will be punished if their data is bad.” Value-based purchasing relies on rewarding providers with high patient satisfaction, clinical outcomes and quality with higher reimbursement; those that don’t meet these standards will receive a lower rate. “CMS doesn’t have the authority to reduce payments yet based on quality reports, but it is a recommendation for a report to Congress,” says Ms. Carney. “For now, it appears the commissions belief is that value based purchasing programs for ASCs should include a relatively small set of measures that primarily focus on clinical outcomes, with some process, structural and patient experience measures.” 3. Punishment for provider complications. It will be important going forward to make sure patients don’t acquire additional injuries or conditions during their time at the surgery center. This means minimizing complications like wrong-site surgery and maximizing infection control. “If someone comes in with a wound on their leg and leaves with another issue, that’s evidence that something was missed and that’s a hit against you,” says Ms. Carney. “There is a potential for an adjustment downward in payment going forward. You want to make sure you are capturing as much Medicare payment as possible.” Look at a small set of measures, such as primary clinical outcomes, processes, structure and patient experience measures, to make sure you are efficient and effective. Implementing an electronic medical record could make reporting and workflow easier. “You have to be extremely efficient and effective,” says Mr. Macies. “If the CMS continues on the path they are on, you are going to be penalized if you are not using EMR to report quality. Maintain efficiency and get an EMR in place so you don’t experience those penalties. An EMR will also help you with patient safety by warning you of such events as patient fall risks, allergies, drug to drug  interactions and fire risk” 4. More ASC utilization in the future. Medicare, as well as commercial payors and providers participating in accountable care organizations, will be directing patients to the high quality, low cost provider in their community, which is often the surgery center. “Medicare wants to utilize ASCs because they are so much more cost effective,” says Ms. Carney. “ASC growth has slowed down substantially over the past few years, along with ASC reimbursement rates and the economy as a whole. When people are comfortable, we will see an upswing again. We can still get financing and resources for new ASCs, and they need to be prepared for Medicare patients.” Become attractive to Medicare and other providers, as well as cash-pay patients who are looking for a high quality surgical setting. These cases can help your center become more financially secure. “Prepare for value based purchasing and quality reporting,” says Ms. Carney. “You want to have the Rock Star ASC people wanting to come to your center and you will get reimbursed financially depending on what regulations come out.” 5. Treating Medicare patients is viable for ASCs in the future. While Medicare has historically low reimbursements, rates are increasing in some areas. The rates are tied to CPI, but under the Patient Protection and Affordable Care Act, you reduce CPI growth by productivity growth. “For Medicare, provided you are doing quality reporting, I would say it’s a viable option for ASCs in the future,” says Ms. Carney. “Do what you have to do to capture the maximized Medicare dollar. That’s the way you are going to lose or gain revenue.” As more people become Medicare-eligible, a large portion of an ASC’s patient base will be covered by Medicare. It may not be possible to do without those patients, so focus on maximizing potential reimbursement. “The margins for Medicare and Medicaid patients in ASCs are pretty thin these days, and have  always been less than hospitals,” says Mr. Macies. “The challenge that most ASCs have is with the aging population, with around 10,000 people becoming Medicare eligible every day. It’s a growing population and it’s difficult to conceive how you can run your business without treating Medicare patients.”   Maximizing reimbursement through high quality care delivery and maximizing efficiency in your operations through systems like an EMR will make treating Medicare patients viable and profitable. More Articles on Surgery Centers: How Will Obama’s Re-Election Impact Healthcare? ASC Industry Leaders Respond 8 Steps for Profitable Materials Management at Orthopedics ASCs 8 Steps to Re-Negotiate Profitable Payor Contracts in 2013
Source: beckersasc.com

Centers for Medicare and Medicaid Services Special Partner Trainings

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Source: wordpress.com

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

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Source: precisionhcc.com

Aetna Medicare Announces New October 1, 2011 Certification Reimbursement Deadline

If you choose to transfer your AHIP certification to Aetna, you will just need to complete the remaining 3 requirements to finish the certification. The $100 registration fee does not apply to those who transfer their AHIP certification to Aetna and reimbursement is only available to producers who complete their AHIP certification with Aetna.
Source: wordpress.com

Retirees Snared by Medicare

The Rathbun Library is a resource of information, particulary current news specializing in education and training. We publish articles from a number of different sources, including some of the top news sites in the World. All of our publications that are originally published on another site include credit from that site with a link to the original publication on that site. Though we provide a free service with this site we do have Web hosting, database maintenance and other expenses. We have a few sponsors who help us with our expenses and site management. Such sponsors include The Amazon Fruit who publish material on alternative health care tecniques such as hemorrhoid treatment options. Other sponsors that we have do not promote Websites but are a great help to us, financially and by helping us manage this site. We would like to give special thanks to Key West Fishing Charters for their generous support. We try to remain diverse in the material we publish. We like sites such as wikipedia.org/, which provides a plethora of great information. We also like current news sites like CNN, abcnews.com and bbc news a UK news feed.
Source: rathbunlibrary.org

Q&A: Medicare open enrollment too often overlooked

Posted by:  :  Category: Medicare

open enrollment by MedicareMallMedicare does not cover everything. You still have to pay out of pocket. This year, the Part A deductible is $1,156 if you go in the hospital. For Part B, there’s a $140 deductible, plus 20 percent of everything over that. If you have outpatient therapy for cancer, it could be $10,000 a month, so your share would be $2,000. It can really add up to big money.
Source: sltrib.com

Video: Medicare and You – Open Enrollment is Earlier This Year

Medicare Open Enrollment: What’s your back

Nobody likes to think of back-up plans when it comes to our health, but health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year. But that’s exactly what you need to think about when you’re shopping for health coverage during Medicare Open Enrollment – which ends on December 7.
Source: medicare.gov

Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…

While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Source: aarp.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 begins today

Pella — We’re heading into a very important time of year for people on Medicare — the annual open enrollment period, Oct. 15-Dec. 7. This is the time when Medicare Part D and Medicare Advantage plans announce their changes for the next year and Iowans on Medicare can decide what plans they want for 2013. Individuals can change to a different plan, enroll in a plan or drop coverage. Choices made during the open enrollment will go into effect Jan. 1, 2013.
Source: towncriernews.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

Medicare Open Enrollment Deadline Extended Due to Superstorm Sandy

Federal officials are giving those hit by Superstorm Sandy a break. The Centers for Medicare and Medicaid Services (CMS) has extended the December 7 deadline for Medicare Open Enrollment.  A new deadline has not been established yet, but as long as Medicare beneficiaries call Medicare’s 24-hour information line at 1-800-Medicare, they can still enroll after the deadline. Representatives will review available plans and complete the enrollment process over the phone.
Source: gohealthinsurance.com

Medicare Open Enrollment Deadline Extended Due to Superstorm Sandy

Federal officials are giving those hit by Superstorm Sandy a break. The Centers for Medicare and Medicaid Services (CMS) has extended the December 7 deadline for Medicare Open Enrollment.  A new deadline has not been established yet, but as long as Medicare beneficiaries call Medicare’s 24-hour information line at 1-800-Medicare, they can still enroll after […]
Source: ewallstreeter.com

NFCC Financial Education Blog

Eligibility. Medicare provides health care benefits to people age 65 and older and those under 65 with certain disabilities or end-stage renal disease. For most people, the initial enrollment period is the seven-month period that begins three months before the month they turn 65. If you miss that window, you may enroll for the first time between January 1 and March 31 each year, although your coverage won’t begin until July 1. To apply for Medicare online, visit this site.
Source: nfcc.org

As ‘Global Resolution’ for Asbestos Settlements Nears, Montana Senators Seek Medicare Waiver for Victims

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonOn October 20, 2012, the Daily Inter Lake reported that asbestos victims were working toward settlements with W.R. Grace & Co., BNSF Railway Co. and certain insurance companies in what Grace was deeming a “global resolution.” That same day, the newspaper also reported that Montana’s two US Senators were “working to get a full waiver of Medicare liens that have been placed on pending settlements for Libby asbestos victims.” As we have noted in the past, hundreds of Libby residents were poisoned by the toxic asbestos dust from Grace’s vermiculite mine that did not close until 1990.
Source: stanleyiolablog.com

Video: Montana Medigap Insurance aka Medicare Supplements

Health Policies Still In The Campaign Trail Mix

The Wall Street Journal: Medicare Fails To Sway Senior Votes None of the current proposals to bolster Medicare changes benefits for the current generation of senior citizens. But the 88-year-old Republican [Leonard Yordon] and many other retirees of both parties speak of little else when talk here turns to the presidential election. Senior citizens are a coveted voting bloc in Florida, where they make up about a quarter of the electorate in this highly contested swing state. … Polls now show Mr. Romney leading among the state’s elderly voters by 6% to 12%—a sign he may be weathering reasonably well the charges by Democrats that he and running mate Paul Ryan would undermine Medicare (Campo-Flores, 10/29).
Source: kaiserhealthnews.org

Working Families Tell Congress To Protect Medicare, Medicaid And Social Security Eliminate Tax Cuts For Wealthiest 2 Percent

Retirees, activists and members of progressive and faith communities will host close to 100 events targeting members of Congress during the upcoming Lame Duck session.  Events will take place outside members’ offices, health clinics, Social Security offices, construction sites and other community locations. In Nashville, Tennessee, working families are gathering for a roundtable with Congressman Jim Cooper to thank him for his pledge to protect Medicare, Medicaid, and Social Security. In Missoula, Montana, working families are marching to their congressional office.
Source: enewspf.com

Senior Benefit Services, Inc.

Effective October 1, 2012 on in force business only for United World 2010 Modernized Medicare Supplement plans (Policies effective on or after June 1, 2010) in Alabama and South Dakota and November 1, 2012 in Montana, the rate adjustments will affect plans  A, B, F, G, and M.
Source: srbenefit.com

Professional Therapy Associates Encourages Patients to Take Stand on Medicare Therapy Cap

Professional Therapy Associates (PTA) is an established provider of physical therapy in Montana. Founded in Kalispell in 1988, the practice has expanded to include four convenient locations throughout Flathead Valley. In addition to its flagship Kalispell North facility, PTA also has clinics in downtown Kalispell (Flathead Health and Fitness), Whitefish (The Wave) and Columbia Falls (Columbia Falls Clinic). Owner and CEO Blaine Stimac is a licensed Physical Therapist in Montana, and holds a Master of Science in Physical Therapy from the University of Montana. He and his team offer a full range of services, including manual physical therapy, sports medicine and therapeutic exercise and biofeedback, as well as treatment for back and neck injuries, motor vehicle injuries and work-related injuries. For more information, visit http://www.ptflathead.com.
Source: mdnewswire.com

Medicare Pilot Program for Montana Asbestos Victims

Chicago Class Act ion Lawsuits Ankin Law Office LLC Protecting the Rights of Injured Workers 162 W Grand Ave Chicago, Illinois 60654, United States Tel: 312-346-8780 or 800-442-6546 Fax: 312-346-8781 Email: howard@ankinlaw.com Website: www.ankinlaw.com Blog: www.thechicago-injury-lawyer.com Medicare Pilot Program for Montana Asbestos Victims June 29, 2011 by Admin -BN In 2009, the Environmental Protection Agency declared a public health emergency arising from the long term asbestos exposure of Libby, Montana residents. The exposure occurred due to the operation of a vermiculite mine in Libby from the 1920s to 1990. Earlier this month, the Centers for Medicare & Medicaid Services announced that people residing in and near Libby that suffered from certain medical conditions would be eligible for Medicare under the Affordable Care Act’s “Exposure to Environmental Health Hazards” provision and could thus participate in a new Medicare Pilot Program for Asbestos-Related Disease. In order to qualify for the program, applicants must: 1) qualify for Medicare under the Affordable Care Act’s “Exposure to Environmental Health Hazards” provision; 2) live in Lincoln or Flathead County, Montana; 3) have Medicare Part A (hospital insurance); and 3) have Medicare Part B (medical insurance). The program is designed to provide services that Medicare would not usually cover by offering comprehensive, coordinated health care coverage for those detrimentally affected by the asbestos exposure. As explained in this NBC news article, the pilot program will cover the following services not normally covered by Medicare: Special home care services Special medical equipment Help with travel to get care Special counseling, for example, help quitting smoking Nutritional supplements Prescription drugs not covered by Medicare drug plans (Participants in the Pilot Program must be in a Medicare drug plan to receive this benefit). ANKIN LAW OFFICE LLC Chicago Workers Compensation
Source: jdsupra.com

Medicare beneficiaries get more free stuff. Let’s throw in the towel, no health care is “affordable”

Posted by:  :  Category: Medicare

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

Video: Free Medicare seminars for New Mexico residents

FREE Event: Medicare: past, present and future

Stephen Lewis is one of the world’s most influential speakers on human rights, social justice and international development. The former UN Secretary-General’s Special Envoy for HIV/AIDS in Africa, he is a Distinguished Visiting Professor at Ryerson University in Toronto.
Source: seiuwest.ca

Free Medicare 101 course Nov. 14

If you are 65 or older have or are about to start Medicare, you may need more information to make the right choices. If you are frustrated about Medicare Supplements, or simply want to know more you should take this free, no-obligation Medicare 101 class. It is offered by Umpqua Bank at 17510 Meridian East in Puyallup on November 14
Source: pierceprairiepost.com

Protect yourself and those you love

early and stay healthy!  It’s free for people with Medicare, once per flu season in the fall or winter, when given by doctors or other health care providers (such as senior centers and pharmacies) that take Medicare.
Source: medicare.gov

Poll: Romney pulls even with Obama on Medicare

If Obama loses this election, you can blame/thank the Right for bamboozling him. How is it ethical that an entire news network questions the President’s citizenship for four years to create doubt in voters while a fringe element of the far right demonizes and degrades him? Most of this is financed by the rich who want to keep their stranglehold on the flow of wealth in our country. Watch the white hands apply the Blackface to our first African-American President at http://dregstudiosart.blogspot.com/2012/10/bamboozling-obama.html
Source: unitedliberty.org

In Swing States, Obama Leads on Handling of Medicare

Posted by:  :  Category: Medicare

Record shop Ithaca, NY by exaktaMr. 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

Video: New York: Medicare Fraud Summit Remarks (DOJ)

Grappling With Details of Medicare Proposals

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

NY Times: What Medicare Will Cover Even if You’re Not Likely to Get Better

, if approved by a federal judge, would end a lawsuit that accused Medicare of allowing the contractors that process its claims to use a so-called improvement standard over the last few decades. To the Center for Medicare Advocacy and the many other organizations that joined the suit, that standard seemed to call for cutting off physical, occupational and speech therapy and some inpatient skilled nursing for many people who had reached a plateau in their treatment.
Source: laaacoalition.org

Meng to NY: Medicare is safe with me

Republican designs for Medicare would harm today’s seniors immediately. Republicans seek to re-open the prescription drug donut hole, eliminate coverage for preventive care, cut Medicaid, and eliminate the guaranteed benefits of the current Medicare system. Although Republicans claim that today’s seniors could retain the traditional Medicare option, this is a false promise because traditional Medicare would collapse as the new private insurers cherry pick the younger seniors, on whose premiums traditional Medicare relies in order to offset the costs of providing for the sick.
Source: queens-politics.com

NY Times’ Brooks Acts As (Inaccurate) Mouthpiece For Romney

Numerous independent experts have also said that Ryan’s plan to transform Medicare into a voucher system will force seniors to spend millions more for health care because the vouchers would not keep pace with rising health care costs. Indeed, Yale public policy professor Ted Marmor has said that under the Ryan plan, some seniors would be forced to “choose between paying for better coverage and having more money for food and other items.”
Source: mediamatters.org

PR: “Grimm” Reaper March Dramatizes Attack On Medicare, Tax Breaks for Millionaires

Led by costumed “Grimm Reapers of Medicare,” the protestors marched to Congressman Grimm’s Brooklyn Office. Along the way protestors passed out “checks” from Representative Grimm made out to the wealthiest Americans for $160,000 a year.  The checks, including a banner-sized one held by marchers, symbolized the vote Grimm cast before leaving on August vacation that gives $160,000 a year in tax cuts to the wealthiest Americans who make over $1 million a year while raising taxes on 25 million working families.
Source: newdealfornewyork.org

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

Making the Election About Race

The result is a campaign run at two levels. On the trail, Paul Ryan argues that “we’re going to make this about ideas. We’re going to make this about a positive vision for the future.” On television and the Internet, however, the Romney campaign is clearly determined “to make this about” race, in the tradition of the notorious 1988 Republican Willie Horton ad, which described the rape of a white woman by a convicted African-American murderer released on furlough from a Massachusetts prison during the gubernatorial administration of Michael Dukakis and Jesse Helms’s equally infamous “White Hands” commercial, which depicted a white job applicant who “needed that job” but was rejected because “they had to give it to a minority.”
Source: nytimes.com

The Official Medicare Set Aside Blog And Information Resource: New York Medicare Advantage Update

But that left arguments about federal preemption. Plaintiffs argued that their claims arise under state contract law and the NY anti-subrogation statute, not under the Medicare Act. The Supremacy Clause of the U.S. Constitution clearly states that where a state statute conflicts with, or frustrates, federal law, the former must give way. Furthermore, the Medicare Act contains a very broad, express preemption clause. Lastly, the Medicare Advantage secondary payer statute itself states that MA organizations may charge primary payers “[n]otwithstanding any other provision of law.” 42 U.S.C. § 1395w-22(a)(4). Whether the 3rd Circuit is correct and the MAO has a private cause of action under the MSP or not is immaterial to the question of whether the NY state statute is preempted. Plaintiffs must first exhaust all administrative remedies available under the Medicare Act before seeking redress in court.
Source: medicaresetasideblog.com

NY Times: Don’t Believe Republicans on Medicare

When I went to the hospital that morning with severe chest pain they immediately ruled out a stroke or heart attack but kept me for three days of stress tests that finally cost $33K.  They saw I had Medicare with supplemental and they had the machines and doctors ready to go.  After passing several tests I called my Gastroenterologist who performed an esophagus scan which revealed I had an infection in my esophagus period. Just take these antibiotics.   The hospital kept me for another day so they could use every machine they had.  After threatening to escape out the window they finally released me.  While I’m thankful I passed the tests it pisses me off they were able to spend that much Medicare money  with no regulation.  They had to know I didn’t need all those expensive tests.
Source: talkleft.com

NY Times OpEd: How Medicare Fails the Elderly

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

Medicare Targets Health Plans With Low Ratings

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

Blue Medicare Advantage: Blue Cross Blue Shield of Illinois

Posted by:  :  Category: Medicare

In addition to your Part B premium, there are small copayments to receive care.  With copayments as low as $7 for Medicare covered primary care doctor’s office visits, $45 for Medicare covered specialist visits and $3  for generic prescription drugs, it’s easy to get the care you need when you need it. An Advantage plan includes all of your Part A and Part B Medicare benefits, prescription drug coverage and emergency care if needed for an additional $65 copayment. Coverage is convenient and hassle free, and with an extensive provider network, there are always quality doctors nearby, ready to help from a wide range of specialties.
Source: ssiinsure.com

Video: Blue Cross Medicare Supplement – Affordable or Not?

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

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.