Lower 3rd Quarter Earnings For Health Net, Humana

Posted by:  :  Category: Medicare

Los Angeles Times: Health Net Posts Plunge In Profit, Strikes Deal With California Woodland Hills insurer Health Net Inc. said third-quarter net income plunged 71%, but its shares rose as the company resolved a dispute with California officials over reimbursement for government health programs. Health Net disappointed investors in August when it slashed its full-year profit outlook and reported higher-than-expected medical costs. On Monday, Chief Executive Jay Gellert … cited a wide-ranging agreement with California healthcare officials as a major step forward (Terhune, 11/6).
Source: kaiserhealthnews.org

Video: Health Net Medicare Advantage – Compare to over 180 Compani

Healthnet Medicare in Arizona

Today, Medicare is a little more complicated than it was originally simply because there has been a lot of changes, reforms, and additions made. In the beginning it was simply to offer health care for those over 65 years old but that has changed quite a bit and now includes those with disabilities as well as having different parts to Medicare. When you first become eligible for Medicare you are placed in the Original, which consists of Part A and B, which is the health care portion and it also includes the drug prescription plan, which is Part D.
Source: platinumcube.com

Health Net’s CEO Discusses Q3 2012 Results

Well, I think there’s – first of all there was a lot of risk to the State in the litigation. So I think that it had already in one year got into court and it had been resolved in our favor. So, it puts the state in a position where it had a significant amount of vulnerability into very near-term. So, the State I think has relieved itself of a lot of fiscal pressure, which I think was very wise, but the other thing is I think that California has the bottom three or four cost per beneficiary in Medicaid. The state in California is really – is kind of gone as low as it can go in terms of these costs. And, in the instances where things have kind of gotten disruptive because of a one-year situation, they’ve ended up paying substantially more having to clean it up. So, I think that the stability of relationship with all the financial pressures on the state is a very positive thing for them and I think it allows us to look at longer-term systemic change in terms of some of the stuff we’re doing without having to – I guess haggle on a quarter-by-quarter basis.
Source: seekingalpha.com

Health Net Beats, Declines Y/Y

Total enrollment in the segment declined 1% year over year to 2.6 million members as of September 30, 2012. Total commercial enrollment declined 9.5% to 1.3 million members, while enrollment in the company’s California health plans inched down 1.5% year over year. However, enrollment climbed 13.8% to 0.23 million in Medicare Advantage plans. Medicaid enrollment also increased 8.2% to 1.1 million in the reported quarter.
Source: gamutnews.com

Marin•Sonoma IPA inks Medicare contract with Health Net for Sonoma County Seniors

Great. Seniors get their coverage so that they don’t have to experience the inconvenience of leaving town. (Even though their property taxes are exempt from the huge costs to keep "their" local hospital in business.) The non-insured also get to keep their "free" local care; paid for by the rest of us. The only ones to be forced to leave town for their health care are working families, who must use Kaiser or other out-of-town options because the local out-of-pocket costs are too high. So those that are paying for this huge privilege of localized medical care in this town are the least likely to be able to use it. Something stinks about this picture.
Source: patch.com

Health Net Reports Third Quarter 2012 GAAP Net Income of $18.0 Million, or $0.22 Per Diluted Share

Health Net today also announced that the company and the state of Californias Department of Health Care Services (DHCS) have entered into a comprehensive agreement covering Health Nets state-sponsored programs, including Medi-Cal, Seniors and Persons with Disabilities (SPDs), the dual-eligibles pilot programs that currently are expected to begin in the first half of 2013, and any potential future Medicaid expansion under federal health care reform.
Source: longevitymedicine.me

CMS Announces Marketing Sanctions for Three Medicare Advantage Carriers: Health Net, Arcadian and Universal American

[…] CMS isssued a press release on Friday afternoon announcing these marketing sanctions.  The sanctions for Health Net took effect at mid-night last Friday, so as I write this, they are currently unable to take an new enrollments.  The sanctions for Arcadian Management and Universal American Corp will not take effect until Sunday, December 5th, so agents will be allowed to enroll new members in these plans for approximately 2 weeks until the sanctions take affect.  For Universal American, the sanctions DO NOT include their stand alone part D plan, only their Medicare Advantage plans.Source: ritterim.com […]
Source: ritterim.com

CMS Lifts Sanctions Against Health Net Medicare Plans

Dow Jones Newswire (8/3, Subscription Publication) reports that Health Net Inc. will immediately return to marketing its Medicare Advantage and prescription-drug plan products after the Centers for Medicare & Medicaid Services lifted its sanctions against them. The sanctions were imposed last November, when CMS alleged that the company had failed to provide enrollees with prescription drug benefits in accordance with guidelines and contract terms. Wells Fargo analyst Peter Costa issued a note saying that the move may not have much impact on 2011 revenue for the company, but was a crucial step towards regaining its growth in Medicare Advantage.
Source: barricksinsurance.com

Services Insurance : What Dental professional Solutions Are Protected by Medicare?

Posted by:  :  Category: Medicare

Public Forum: Getting dental into Medicare by Greens MPsTo be covered, such procedures must be done on an in-patient basis, and as aspect of therapy of the larger healthcare problem, and simultaneously. Examples of oral costs that have no coverage would be:     The care or therapy of teeth or components assisting the teeth as a main service     Elimination or replacement of teeth as a main service     The planning of the mouth for dentures     Elimination of teeth in an contaminated jaw     The repair of any assisting components including all parts of the gum area, teeth origins and their protecting, and the alveolar bone which forms the teeth plug. Medicare related programs take oral therapy into some consideration. Privately paid oral costs are considered by Centers for Insurance coverage & State medicaid programs Solutions in determining a individual’s out of pocket healthcare costs. Medicare Medical Savings Records (MSA) can be set up which may cover oral costs. Individuals do not make remains to such accounts. Funds are added only from your Insurance coverage consideration. Such accounts are totally managed with a insurance deductible that must be met from Insurance coverage determining costs before the consideration can be used. Insurance coverage chooses the bank where the consideration is created, and payments from the consideration are usually made via charge cards. Although some costs from MSAs are subject to taxes, oral costs are not.
Source: blogspot.com

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

Futuristic Dental Medicare Office Interior Design Interior Office Office

On the time Tuesday, November 06, 2012 23:49:43 PM Juns Satya author of v23.org posted pictures about Futuristic Dental Medicare Office Interior Design Interior Office. The photo posted on v23.org are the best pictures accumulated from several sources on the Internet. Then If you love this photo you can get Futuristic Dental Medicare Office Interior Design Interior Office in Here. We also submitted related pictures of Futuristic Dental Medicare Office Interior Design Interior Office, for the view another photograph you only click photograph on gallery thumbnail to view it on larger size. And if you love this pictures, don’t forget to push like, repin button or leave comment on this page. “Disclaimer : v23.org consists of a compilation of public information available on the internet. The Photo file Futuristic Dental Medicare Office Interior Design Interior Office Collected from multiple source in internet. We are NOT affiliated with the publisher of this part, and we take no responsibility for material inside this part.”
Source: v23.org

8 Mistakes to Avoid During Medicare’s 2013 Annual Enrollment Period

5) Ignoring long-term care needs: According to an Opinion Research survey sponsored by PlanPrescriber.com, paying for long-term care is a top concern for baby boomers. Original Medicare will only pay for care in a skilled nursing facility for up to 100 days, and beneficiaries typically have to pay for a portion of those costs out of pocket. And, in most cases, Medigap plans will only cover out-of-pocket costs for services that are also covered by Medicare. So, once Medicare stops paying, your Medigap plan will stop filling in the gaps. But, long-term care insurance is available to help fill in the gaps.
Source: seniorlivingcare.com

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

State Roundup: Ore. Lawmakers Petition For Separate Dental Care

Health Policy Solutions (a Colo. news service): Public Housing Project A National Model For Supporting Health In 2009, when developers from the Denver Housing Authority worked with neighborhood partners, residents and consultants to dream up a new master plan for the Lincoln Park/La Alma neighborhood, they became one of the first 20 or so entities in the U.S. to conduct what’s known as a Health Impact Assessment (HIA). Long popular in Europe but new to the U.S., HIAs aim to identify how a project or redevelopment will impact health. Then in 2010, as reconstruction began, DHA developers ignited another health revolution. They decided to hold themselves accountable for improving health with every decision they made. They wanted to measure their success or failure and became on of the first in the country to use what’s called the Healthy Development Measurement Tool (HDMT) (Kerwin McCrimmon, 10/17).
Source: kaiserhealthnews.org

Medicare Open Enrollment: More is better

For those choosing Original Medicare, the benefit package continues to grow stronger and provide greater value. For example, EVERYONE with Medicare has access to a variety of preventive services and screenings, most at no cost to them when furnished by qualified and participating health care professionals. This includes things like diabetes and cancer screenings, and a yearly “wellness” visit. During the first 9 months of this year, over 20 million people with Original Medicare received at least one preventive service at no cost.
Source: medicare.gov

Help protect Medicare dental cover for People with Chronic Disease

Many people with chronic disease such as diabetes, cancer, mental health problems, immune compromise or bleeding disorders, cannot afford private dentistry, and rely on the Medicare Chronic Disease Dental Scheme to pay for dentistry to protect their health. Government plans to close this scheme immediately, and send patients with chronic disease back to the public dental waiting list. Government intends only a 30% increased public dental spending, which is very much less than would be needed to satisfy even current demand, so people with chronic disease will not receive timely or comprehensive care needed. The Medicare Chronic Disease Dental Scheme has been very successful, with 1.5 million Australians treated. It has a low complaint rate of just one complaint per 1,500 patients. The Medicare Chronic Disease Dental Scheme forms a sensible basis for expansion to eventually include the entire Australian population under dental Medicare.  You can read more and sign the petition here:
Source: arafmi.org

Common health insurance questions answered: What is medicare advantage?

Private companies, such as Blue Cross Blue Shield Michigan and Blue Care Network, contract with Medicare to offer these plans to individuals who purchase their own coverage and through employer and union groups. Medicare beneficiaries who buy their own coverage have many plan options to consider. Insurers often offer several different benefit plans with various benefit levels and monthly premiums. They include extras to make their plans more attractive to prospective members. Some enhancements to look for are:
Source: ahealthiermichigan.org

Is Dental Insurance Medicare Considered Supplemental?

The cost of a supplemental dental insurance plan will depend on the amount of coverage offered. The basic plans will cost between $25 and $50 a month, for which you would be expected to make monthly or biannual payments. More expensive plans can cost between $50 and $100 a month, but include expensive dental procedures and the largest selection of dentists. Knowing what type of care you require will help finding the insurance to fit your budget.
Source: seniorcorps.org

State of Dental Care Among Medicaid

RESULTS: The prevalence of having DCV ranged from 12% depending on age, to 49% with a median value of 33% but did not exceed 50% in any state. The median percent change between 2002 and 2007 was 16%. DCV among toddlers and infants were low in all but 3 states and in most states peaked at age of school entry to >60% in some states. In most states, there were few racial differences in the prevalence of DCV. Children enrolled in Primary Care Case Management tended to have the highest DCV, the effect of Children’s Health Insurance Program enrollment on the number of DCV was generally positive.
Source: aappublications.org

AARP Medigap Rates 2013 Connecticut « Insurance News from Crowe & Associates

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSI would like to dispel some common misconceptions with Medicare supplement plans (Also called Medigap) Medicare supplement plans DO NOT have a network.  You may go to any doctor that accepts Medicare.   Medicare supplement do not have drug coverage, you need to purchase a part D plan in order to obtain drug coverage.   Medicare Supplements are secondary to Medicare.  When you go to the doctor or hospital, you show them your original Medicare card and that is what they will bill.  The supplement will pick up the costs that original Medicare does not cover.  There is not any Medical underwriting in the state of Connecticut if you are turning 65 or if you have had continuous coverage for a retirement plan, a different supplement or a Medicare Advantage plan.
Source: croweandassociates.com

Video: Connecticut Medicaid Title XIX nightmare and lawsuit.

Information About Medicaid in Connecticut

Medicaid is a public, or government run form of health insurance. It is designed to provide health insurance coverage for individuals and families who are low income and who cannot afford to buy a health plan from a private insurance company. Medicaid is funded, in part, by the federal government. It is also funded by the government of an individual state.
Source: families.com

5th District debate focuses on Medicare, Social Security

“I’m not embracing any one of their particular recommendations, but I think they should be considered,” he said. Both candidates accused the other of fear-mongering — Esty accusing Roraback of using “scare tactics” culled from the U.S. Chamber of Commerce’s website and telling seniors that Social Security benefits are in danger, Roraback accusing Esty of promoting incorrect information in her advertisements.
Source: newhavenregister.com

McMahon spitballs ideas for Medicare, Social Security reform

“I think we have to put every single thing on the table and work it out between Democrats and Republicans and then have our CBO, the Congressional Budget Office, put the economics or the scoring next to that to see what really does make sense so we’re not kicking this can down the road,” McMahon said. “I want a permanent solution so I can make sure we protect both of these programs.”
Source: nhregister.com

Connecticut Medicaid Change Doesn’t Faze Health Insurers

Tyler Mason, a spokesman for UnitedHealth Group (NYSE:UNH), which covers more than 3 million Medicaid recipients in 19 states, pointed out that many insurers recently have been awarded Medicaid contracts in states such as Kentucky, Louisiana and Texas, according to an article in Kaiser Health News. He added that these deals make it clear that national managed-care organizations continue to benefit as states move away from fee-for-service.
Source: investorplace.com

McMahon Favors Medicare/Medicaid and Social Security Cuts

If Linda McMahon’s “Balanced Budget” Plan Was Enacted This Year, It Would Potentially Mandate Hundreds of Billions of Dollars in Medicare/Medicaid and Social Security Cuts.  Linda McMahon proclaims support for a so-called Balanced Budget Amendment, which is a constitutional amendment mandating that federal outlays not exceed total tax receipts.  This year, the federal budget deficit is $1.5 trillion.  Linda McMahon has said on the campaign trail that she opposes any tax increases to balance the budget and that she would exempt Defense spending ($714 billion), Homeland Security ($41 billion), and Veterans Benefits ($162 billion) from her proposed spending cuts in order to reach her goal.  Including debt service ($196 billion), this leaves just $917 billion left, meaning Congress would have to cut 57% of the rest of government spending—including Medicare, Medicaid (currently $736 billion) and Social Security ($749 billion).  Even if you shut down funding for highways, ended small business and education loans, and cut the entire Department of Justice, this plan would still serious consequences for the entitlement programs, if enacted.  [Washington Post, 7/24/10; Congressional Research Service Summary, H.J.Res78, 3/2/10; Linda McMahon Editorial Board Interview (Hartford Courant), 7/20/10; OMB U.S. Budget, Mid-Session Review, 8/25/09; Congressional Research Service, “Mandatory spending Since 1962,” 9/15/10; LM at Conservative Women’s Luncheon PT 2, 9/23/1; LM Remarks at Gun Enthusiasts Meeting, 9/22/10; LM Common Sense CT Interview, 8/30/10; LM at Taste of Mystic, 9/10/10; Linda McMahon, Chaz & AJ Show FM 99.1, 8/3/10]
Source: ctnews.com

Connecticut Medicare Costs Among Highest In Nation

Medicare payments can vary from hospital to hospital for many reasons, including the type of hospital, regional wages and salaries, the income mix and sickness of patients and the level of intensity with which patients are treated. Some hospitals may order more tests, have patients see more doctors or make higher use of intensive-care beds. Costs could also rise if subpar care extends a hospital stay or forces additional tests.
Source: ctwatchdog.com

Approaching The Cliff: What’s At Stake For Medicare And Medicaid?

The Medicare NewsGroup: Fiscal Cliff Discussions, Looming Cuts Have Medicare Providers Facing Double Whammy Doctors, hospitals, other clinical care providers and insurance companies all face looming pay cuts. President Obama and Congress are in negotiations starting this week to avert the fiscal cliff. Medicare and other entitlement programs are on the table as lawmakers seek to bring down the deficit. If a deal is not struck, Medicare providers will be hit with a 2 percent across-the-board cut in January 2013 as part of sequestration. The sequestration cuts, scheduled to hit clinical care providers and insurers that operate Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D), resulted from Congress’ failure to reach a deficit agreement in 2011. The cuts total nearly $10.7 billion in 2013 alone. And for physicians, the fiscal cliff includes a 27 percent pay cut caused by the Sustainable Growth Rate (SGR) (Sjoerdsma, 11/15).
Source: kaiserhealthnews.org

More Time to Enroll in Medicare If You Live in Storm Areas

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

CT working families defeat Linda’s lies

I do remember recieving slick, colorful “info” mails from the McMahon camp; and of course, when it came closer to election day, they came rather regularly. These “pretty” propaganda pieces demonized Dem candidate Chris Murphy with sympathy-invoking photos, of, e.g., seniors looking as though they were “ripe” for Murphy “exploitation.” The pieces repeatedly accused Murphy of trying to take away Medicare for seniors. But as Fishman correctly points out, McMahon wanted to sunset programs like this. Deservedly, McMahon herself got sunsetted. There was the repeated accusation that Murphy wanted to take away Connecticut jobs by contributing to defense cuts. But the idea should be to cut an already-overbloated military budget going well beyond self-defense. Regarding job cuts, I do think it’s possible to, according to the old saying, convert “swords into ploughshares.” It’s a matter of willingness combined with sincere intentions. McMahon, however, like other GOPers, wasn’t sincere by throwing big bucks-Fishman points out $90 million in attacks-in an attempt to virtually buy the election. It’s definately a case of pure quantity over quality. Consistingly receiving McMahon’s mail prompted me to think it was not only money prioritized over issues, but also revealing a sense of desperation. Considering McMahon’s significant defeat, it is true that money can’t buy you everything.
Source: peoplesworld.org

Two Medicare Accountable Care Organizations Approved in Connecticut

At last Connecticut has two medical groups that have been approved to participate in Medicare’s Accountable Care Organization (ACO) program.  The two groups are:  MPS ACO Physicians in Middletown and PriMed of Shelton.  The ACO program is part of many efforts being undertaken to change how health care is both delivered and paid for; moving from a system that rewards volume to a system that rewards quality care and better outcomes. 
Source: universalhealthct.org

Accreditation for Office Based Surgery vs. Ambulatory Surgery Centers: Frequently Asked Questions

Posted by:  :  Category: Medicare

Nancy Pelosi on the Next Four Years by jurvetsonAccessibility Codes Americans with Disabilities Act State & city-specific requirements In all cases, surveyors would expect to see reasonable separation of unrelated tasks and certainly clean and soiled work rooms. Q. Why accreditation for office-based surgery? A. 1. Often fulfills state requirements for office based surgery. 2. Expedites third-party payment. 3. May favorably influence liability insurance premiums. 4. Favorably influences managed care contract decisions. 5. Enhances community confidence. 6. Aids in professional staff recruitment. Ambulatory surgery center accreditation: The vast majority of commercial payors require accreditation (above and beyond state license, as applicable, and always Medicare certification) in order for the ASC to become a participating provider with their network. Documentation as proof must be submitted with the ancillary application before the request for ASC participation will even go through the company’s credentialing process. Q. What is deemed status? A: In order for a healthcare organization to participate in and receive payment from the Medicare or Medicaid programs, it must meet the eligibility requirements for program participation, including a certification of compliance with the Conditions of Participation (or Conditions for Coverage, CfCs, for health care suppliers) set forth in federal regulations. This certification is based on a survey conducted by a state agency on behalf of the Centers for Medicare & Medicaid Services. However, if the state will not provide initial or ongoing Medicare surveys, using a national accrediting organization is the answer. They have and enforce standards that meet or exceed Medicare’s CoPs (or CfCs). CMS grants accrediting organization “deeming” authority. Note that state departments of health have been given the guidance from CMS to put ASC surveys for Medicare on a non-emergent basis. For most types of healthcare providers or suppliers, accreditation is voluntary and seeking deemed status through accreditation is an option, not a requirement. Seeking a Medicare certification survey through an accreditation organization for purposes of Medicare certification, however, is not an option … that is, if the ASC wants facility fees! Q: Who is responsible for Medicare surveys? A: Whoever did the initial survey is responsible unless told otherwise. For instance, if the state did the initial survey but an accreditation organization did just the accreditation, you would not have to ask the organization for another Medicare survey. On the other hand, if the accreditation organization was asked to perform the initial Medicare survey, not requesting it on the next accreditation cycle, would indicate that the ASC was dropping their participation and the state would be notified. This would prompt a survey from the state. Resources: ο American Association of Ambulatory HealthCare ο Joint Commission on Accreditation of Healthcare Organizations ο American Association for Accreditation of Ambulatory Surgery Facilities
Source: beckersasc.com

Video: California Hospital Chain Eyed for Possibly Bilking Medicare for Millions

CMS Issues Final Rules on Medicaid, Medicare Provider Payment Rates

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

Approaching The Cliff: What’s At Stake For Medicare And Medicaid?

The Medicare NewsGroup: Fiscal Cliff Discussions, Looming Cuts Have Medicare Providers Facing Double Whammy Doctors, hospitals, other clinical care providers and insurance companies all face looming pay cuts. President Obama and Congress are in negotiations starting this week to avert the fiscal cliff. Medicare and other entitlement programs are on the table as lawmakers seek to bring down the deficit. If a deal is not struck, Medicare providers will be hit with a 2 percent across-the-board cut in January 2013 as part of sequestration. The sequestration cuts, scheduled to hit clinical care providers and insurers that operate Medicare Advantage Plans (Part C) and Medicare Prescription Drug Plans (Part D), resulted from Congress’ failure to reach a deficit agreement in 2011. The cuts total nearly $10.7 billion in 2013 alone. And for physicians, the fiscal cliff includes a 27 percent pay cut caused by the Sustainable Growth Rate (SGR) (Sjoerdsma, 11/15).
Source: kaiserhealthnews.org

Do You Need Help With Your Medicare Choices? Visit Your SHIP Office NOW!

The State Health Insurance Assistance Program, or SHIP, is a national program that offers one-on-one counseling and assistance to people with Medicareand their families. Through federal grants directed to states, SHIPs provide free counseling and assistance via telephone and face-to-face interactive sessions, public education presentations and programs, and media activities. If you have questions about your Medicare or Medicare-related options (for example, Medicare Part D, Medicare Advantage, or Medigap health insurance), your local SHIP can provide the answers you need to get the best health insurance plans for your needs.
Source: myhealthcafe.com

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

Raising the Cost of Medicare // Current TV

Republicans keep saying that our problem is a spending problem, and chief among their targets for cuts to control costs is Medicare. Every plan they have suggested to date shifts the cost of care onto both present and future beneficiaries. However, if they are co concerned at cutting cost, then why are Republicans trying to raise the cost of Medicare.
Source: current.com

Beware of fraud during Medicare enrollment

“Consumers should be suspicious of unsolicited calls from anyone claiming to be from Medicare,” Matthew Fehling, BBB president and CEO, said in a statement. “Medicare will generally not make unsolicited calls to update information, issue a new card or offer free medical equipment. We recommend seniors hang up and call a trusted Medicare number if they have questions regarding their benefits.”
Source: consumerinsuranceguide.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

Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

Posted by:  :  Category: Medicare

Medicare for All by juhansoninREDUCE PAYMENTS TO PROVIDERS: Hospitals, physicians and other health care providers – many who are now facing payment cuts either in the 2010 health care law or from the upcoming “sequestration” reductions (or both) – may take another hit in a deficit deal. Among the options sometimes mentioned are limiting the amount of “bad debt” that hospitals and other providers can write off their taxes,  reducing federal funding for medical education and requiring more prior authorization for some medical services, such as imaging, to help reduce unnecessary care. Lawmakers looking for political cover from angry providers could cite the many deficit-reduction proposals that have advanced provider cuts: Obama’s 2011 deficit reduction proposal, the Simpson-Bowles plan and the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment policy.
Source: kaiserhealthnews.org

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

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

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

Kaiser study: Romney’s Medicare plan raises costs

What’s more, as Sahil Kapur added, the study “does not project the longer-term implications for traditional Medicare. Many analysts warn that over time, sicker and older patients would choose traditional Medicare over private plans as private insurers tailored their plans to younger, healthier beneficiaries. Without strict rules and adequate risk adjustment, this would put traditional Medicare premiums on a ‘death spiral’ and the public plan would collapse.”
Source: msnbc.com

The DD News Blog: Medicare/Medicaid Eligibles: The Kaiser Report on State Plans and Michigan’s Plan so far

Medicare/Medicaid eligible population is  questionable. As stated in the introduction to the Kaiser Commission Report, “Dual eligible beneficiaries are among the poorest and sickest people covered by either Medicare or Medicaid and consequently account for a disproportionate share of spending in both programs.” How is the share of spending disproportionate after one accounts for the characteristics of this population? I think it is safe to assume that medical and hospital costs are generally too high and that we pay too much for prescription drugs and  medical devices and equipment. But almost half of the Medicare/Medicaid population are people under 65, many of whom receive Medicaid-funded mental health services through Michigan’s Community Mental Health system.  Cost increases in areas covered by CMH have been relatively stable: 
Source: blogspot.com

Medicare Extends Enrollment Period For Those Affected By Sandy

The Centers for Medicare & Medicaid Services “understands that many Medicare beneficiaries have been affected by this disaster and wants to ensure that all beneficiaries are able to compare their options and make enrollment choices for 2013,” Arrah Tabe-Bedward, acting director for the Medicare Enrollment and Appeals Group, wrote in a Nov. 7 letter to health insurance companies and State Health Insurance Assistance Programs.
Source: kaiserhealthnews.org

Kaiser named top rated Medicare plan in Hawaii

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Source: hawaii247.com

Romney Camp Dismisses Kaiser Study On Medicare Vouchers

This study should not, however, be interpreted as an analysis of any particular proposal, including the Romney-Ryan proposal, because such an analysis would require additional, more detailed policy specifications than are currently available, and would also require assumptions about future shifts in demographics, spending, and enrollment, nationally and by local markets, which would occur regardless of policy changes. Additionally, this analysis assumes full implementation of a premium support system in 2010, whereas other proposals would gradually phase-in a premium support system over time, and apply the premium support system to new enrollees rather than all beneficiaries (e.g., current seniors).
Source: talkingpointsmemo.com

Kaiser Permanente Receives Highest Rating for Medicare Plan in Mid

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health careproviders 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.
Source: seniorlivingcare.com

KAISER PERMANENTE’S MEDICARE PLANS GARNER 5 STAR RATING FOR 2ND STRAIGHT YEAR.

 “Kaiser Permanente is a model for health care in this country and this Medicare 5-Star rating confirms the value we provide to patients,” said Robert Pearl, MD, executive director and CEO of The Permanente Medical Group. “The combination of superb physicians and the most advanced information technology systems leads to excellence in quality and service. By providing coordinated medical care and greater ease of access, we are able to achieve outstanding outcomes both in prevention of disease and management of the most complex medical conditions. I applaud the U.S. Centers for Medicare and Medicaid Services for helping shift the focus of our country from rewarding volume to recognizing superior outcomes. If the whole nation could match this 5-star performance, thousands of lives could be saved each year.”
Source: patch.com

Kaiser Study Assumes Seniors Can't Shop

A new study that claims 59% of Medicare beneficiaries — or about 25 million seniors — would pay more for Medicare under a premium support reform plan (like that proposed by Vice Presidential candidate Paul Ryan) was exposed as having serious flaws. The left-leaning Kaiser Family Foundation recently released a study of the Ryan-Wyden Medicare reform plan called: Transforming Medicare into a Premium Support System: Implications for Beneficiary Premiums. According to the study’s methodology, most seniors now receiving Medicare benefits will face premium hikes higher than they could expect under the current government-run Medicare system. However, since current Medicare beneficiaries — or anyone over the age of 55 — will not participate in the premium subsidy program, the effect on these Medicare recipients is moot.  They will pay for traditional Medicare (and all premium increases) with or without the Ryan premium subsidy plan. At the same time, those under age 55 will still be allowed to purchase traditional Medicare health insurance, so if private health insurance plans are far more expensive in the future, seniors could still take the traditional Medicare route. The headline number in the study assumes only one quarter of seniors will choose health care plans that are less expensive.  When the authors give premium support private healthcare plans a 5% reduction in cost versus traditional Medicare, they find that the number of seniors left with premium increases drops to 35%. The Kaiser study authors use 5% as a limit on the savings that private health care plans could achieve.  However, real world data exists to make better estimates. For example, the Institute of Medicine has estimated that almost 30% of medical spending last year was wasteful.  Assuming private health care plans with an incentive to offer the best coverage at the lowest cost would capture only 1/6th of the potential savings seems low. Furthermore, data from the Medicare program itself suggests competition could result in much larger savings. The Medicare Part D prescription drug program operates as a premium support program already.  The monthly premium for the Part D has remained at around $30 a month for the past three years, despite health care costs that have outpaced the rate of inflation. This premium represents a 40% decrease in the original estimated cost of providing this prescription drug coverage for seniors when it was enacted. The Kaiser study assumes that as costs of private health care plans go down, seniors who stay in traditional Medicare will end up paying more.  In order for this to be the case, seniors would have to ignore health care choices that offer similar levels of service and cost less. Right now, 90% of current seniors have the ability to choose health care options including Medicare Advantage and prescription drug plans.  That means the choices offered for traditional Medicare would not be beyond the ability of seniors to recognize and to opt for plans that offer them the kind of coverage they want. A Heritage Foundation report summarizes the Kaiser study’s major flaw:
Source: sixtysecondactivist.com

Horizon Medicare Advantage Blue Value with Rx

Posted by:  :  Category: Medicare

Please read through the full Horizon Medicare Blue Value with Rx HMO Summary of Benefits attached here for a more thorough review of the plan. I am also available to review this plan with you in a meeting if you wish. Due to marketing regulations, I have decided to list just the basics of the plan and but welcome appointments to discuss your full needs. Contact Mike at NewJerseyInsurancePlans
Source: newjerseyinsuranceplans.com

Video: Prolifics Video Case Study: Horizon BCBS of NJ and BPM CoE

CrummeyService.com Accepts Equity Investment

In order for a gift to a trust to qualify for the annual gift tax exclusion, currently $13,000 per beneficiary, the IRS requires trust beneficiaries to be given formal written notice of their right to withdraw the gifted amount if they choose to do so (Crummey v Commissioner, 397 F.2d 82 (9th cir 1968)). CrummeyService.com technology reminds the grantor to make the gift to the trust, notifies the beneficiaries of their right to withdraw the gifted amounts, and provides an independent third-party record of the entire process.
Source: lifesourcedirect.com

The Inside Straight: Socialized Medicine: a Preview ?

For instance, when my wife was hospitalized in 2005, there was an unexplained balance left unpaid to the hospital. We explored this issue with the hospital and with Horizon for several months, and were told by the latter all invoices presented had been paid in full. In 2007, while my wife was in intensive care fighting for her life, I received a notice from a collection agency. The hospital had NOT been paid the balance, had given up trying to collect it from Horizon, and had finally invoked the little clause on the Admission documents that says the patient is responsible if the insurance carrier refuses to pay.
Source: typepad.com

Horizon adds exercise program for its Medicare Advantage members

“The Silver&Fit exercise and healthy aging program encourages our members to live an active, healthy lifestyle,” said John Selby, director of sales and marketing for Horizon BCBSNJ’s consumer and senior markets, in a statement. “Our members who directly participate in the program will experience better health, which will contribute to lower health care costs that will benefit all our members.”
Source: ifawebnews.com

Daily Kos: Dear Mr. President, Social Security and Medicare are Not Grand Bargaining Chips

THE PRESIDENT: Look, here’s my expectation — and I’ll take John Boehner at his word — that nobody, Democrat or Republican, is willing to see the full faith and credit of the United States government collapse, that that would not be a good thing to happen. And so I think that there will be significant discussions about the debt limit vote. That’s something that nobody ever likes to vote on. But once John Boehner is sworn in as Speaker, then he’s going to have responsibilities to govern. You can’t just stand on the sidelines and be a bomb thrower. That political malfeasance and naivete on display is why we are still dealing with the fallout of this easily predictable and entirely avoidable debt ceiling debacle that this so called fiscal cliff spawned from. The only thing that seems destined to fall off the cliff is any intelligence whatsoever about fiscal issues and our monetary system. It would have been nice had more people not had deluded themselves into thinking the President had some brilliant plan, because after all, if he did, we wouldn’t be dealing with any of this by the end of this year in the first place.
Source: dailykos.com

Horizon BCBSNJ launches AskBlue and AskBlue Medicare

Medicare, the Blue Cross and Blue Shield Association’s interactive online tools. If your clients and their employees are experiencing layoffs or a loss of group coverage, your clients can direct their employees to AskBlue and AskBlue Medicare. These tools can help lead your clients and their employees to information about the individual health coverage that best matches their needs.
Source: benefitsdr.com

Medicare Program Exclusion Can have Devastating and Far

Posted by:  :  Category: Medicare

Few health care practitioners really understand the significance that being excluded from the Medicare Program may have.  Exclusion usually occurs as a direct result of disciplinary action being taken by the state board of medicine, board of nursing, board of psychology, board of pharmacy or other health care licensing entity.  If revocation, suspension, restriction or limitation of a license occurs, this is reported to the National Practitioner Data Bank (NPDB).  What few understand is that if the licensed individual or business entity voluntarily surrenders the license after charges have been filed or an investigation has been opened, this is treated the same as a disciplinary revocation and is reported out to the NPDB the same way.  This occurs, even if the professional has similar valid licenses in other states or a different type of license.
Source: thehealthlawfirm.com

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

A Few Seconds Is All It Takes to Save Your Practice from Being Penalized for Hiring or Contracting with Medicare Excluded Individuals

The effects of an exclusion are outlined in the OIG’s Special Advisory Bulletin on the Effect of an Exclusion (http://oig.hhs.gov/exclusions/effects_of_exclusion.asp), but the primary result is that Medicare, Medicaid, and most federally funded programs that provide health benefits will not pay for items or services furnished, ordered, or prescribed by an excluded individual or entity.  Additionally, to be extra thorough, you may also check the federal government’s full debarment list, the Excluded Parties List System (EPLS) which contains debarment actions taken by various federal agencies. The LEIE contains just the exclusion actions taken by the OIG. You may access the EPLS at https://www.epls.gov.
Source: wordpress.com

Is provider billing in the interim OK? Does that lead to automatic Medicare exclusion? And, more….

(Dr DJ) While true that automatic crossover from primary to secondary happens in most areas, I think the critical question is risk v. reward. We can assume the effective date of the exclusion is going to have little to do with the date it was posted on the State’s website. Therefore a defense shouldn’t rely on that date. From my standpoint, the risk in billing Medicare far outweighs any reward to the providers for keeping the payment from the primary payer. Something is amiss with these providers and, on the surface, they could have known about the exclusion before the hospital uncovered it. So, there would have to be a compelling reason to take the risk. By the way, in most cases that State paid the premiums, co-payments and deductibles for the patient to have Medicare as primary. They (the State) might not be happy about the excluded provider treating this beneficiary.
Source: wordpress.com

Connecticut Attorney General Alleges $24 Million Medicaid Fraud Scheme

Florida has a Medicaid False Claims Act similar to the one that Connecticut has. Florida’s Medicaid False Claims Act can be found here. However, in Florida, a separate provision of the state’s Medicaid law provides an award to a whistle-blower of up to 25% of any recovery. This is in Section 409.9203, Florida Statutes. In addition, Florida has a law that allows civil recovery for criminal acts such as Medicaid fraud, which is sometimes used by the Florida Attorney General and private individuals to recover money lost as a result of certain criminal conduct. For the Florida Civil Remedies for Criminal Actions law, click here.
Source: thehealthlawfirm.com

Healthcare Fraud Shield’s “The Buzz”: What You Should Know about the OIG Exclusion (LEIE) List!

Permissive exclusions: OIG has discretion to exclude individuals and entities on a number of grounds, including misdemeanor convictions related to health care fraud other than Medicare or a State health program, fraud in a program (other than a health care program) funded by any Federal, State or local government agency; misdemeanor convictions relating to the unlawful manufacture, distribution, prescription, or dispensing of controlled substances; suspension, revocation, or surrender of a license to provide health care for reasons bearing on professional competence, professional performance, or financial integrity; provision of unnecessary or substandard services; submission of false or fraudulent claims to a Federal health care program;  engaging in unlawful kickback arrangements; and defaulting on health education loan or scholarship obligations; and controlling a sanctioned entity as an owner, officer, or managing employee.
Source: wordpress.com

How to Choose Your Medicare Part D Plan

Here is a sobering statistic pulled by a posting over at the New Old Age blog on the New York Times: “only 5.2 percent of Medicare Part D beneficiaries manage to choose the most economical plan” (see “Part D, Part 2”). And why would that be? The market shifts greatly from year to year and providers frequently hide the gritty details with broad promises, but it’s those very details that determine your day-to-day life and much of your finances.
Source: briskelderlaw.com

OIG Issues Memo Regarding Excluded Individuals : New Jersey Healthcare Blog

If an individual employed by a provider is excluded under a federal program, including Medicare and Medicaid, the federal government will not pay the employer for services provided by the excluded individual.  The federal government has previously indicated that this applies not only to individuals who provide clinical services, but also to individuals who provide administrative services, such as billing and claims processing.  Thus, a provider who employs an excluded individual is not entitled to reimbursement for services provided by the excluded individual, including claims for clinical services provided by the individual, but also claims on which the individual only provided billing services.  In addition, a provider who employs an excluded individual may face civil monetary penalties.
Source: njhealthcareblog.com

Medicare Targets Health Plans With Low Ratings

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesMedicare 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: Medicare Locals Video

Health First Medicare Supplements Address Coverage Gaps

Plus, as an added service not covered by Medicare, all policy holders are entitled to a free fitness membership at the Health First Pro-Health & Fitness Centers in Melbourne, Merritt Island, Palm Bay and Viera, and Parrish Health & Fitness Center in Titusville.
Source: spacecoastmedicine.com

Health Leaders Applaud Medicare’s First Initiative to Train More Highly Skilled Nurses

About AARP AARP is a nonprofit, nonpartisan organization with a membership that helps people 50+ have independence, choice and control in ways that are beneficial and affordable to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for 50+ Americans and the world’s largest-circulation magazine with nearly 35 million readers; AARP Bulletin, the go-to news source for AARP’s millions of members and Americans 50+; and our website, AARP.org. AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands.
Source: rwjf.org

Providers File The Bulk Of Medicare Appeals

Medicare beneficiaries and providers can challenge the denial of a claim in several appeals stages, but the first two are decided by contractors working for Medicare who base their opinions on case files.  In the third step, which is the focus of the report, appellants have a hearing before a judge, testimony can be provided, witnesses can be cross-examined, and new evidence can be introduced.  The judges are lawyers in the Office of Medicare Hearings and Appeals, an independent agency within HHS.
Source: kaiserhealthnews.org

Health First Health Plans’ “Choosing the Right Medicare Advantage Plan”

“We have complex case managers who help members with cancer or high-risk diseases navigate the health care system,” explains Dr. Brady, who’s an internal medicine physician who originally joined the Health First Physicians Group team in 2003 and has treated many Medicare beneficiaries. “In addition to our hospital transition program, we have a physician home visiting program that allows homebound members to receive care. We have a 24-hour-a-day nurse line that allows members to speak to a nurse any time of day, as well as many online wellness and disease management tools, including online and telephone-based health coaching. And, members with certain diseases qualify for state-of-the-art telemonitoring of their blood pressure, weight, and blood sugar levels to help their physician manage their condition.”
Source: spacecoastlivinghealth.com

Medicare Part D: A First Look at Part D Plan Offerings in 2013

The analysis, is the first in a series of planned reports examining the private plan choices available to Medicare beneficiaries for 2013. It is authored by researchers at Georgetown University, the Kaiser Family Foundation and NORC at the University of Chicago.
Source: kff.org

Health First Health Plans Opens Vero Beach Office

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

Cracker Squire: As Medicare and Social Security have come to account for about a third of the federal budget, some former AARP officials say it is increasingly risky for the group to try to wall off the programs from cuts.

: AARP, the lobbying powerhouse for older Americans, last year made a dramatic concession. Amid a national debate over whether to overhaul Social Security, the group said for the first time it was open to cuts in benefits. The backlash from AARP members and liberal groups that oppose changes in the program was enormous — and this time around, as Washington debates how to tame the ballooning federal debt, AARP is flatly opposed to any benefit reductions for the nation’s retirees. AARP’s rejection of any significant changes to the nation’s safety net could be a major factor as policymakers seek a deal to put the government’s finances in order through raising taxes and cutting spending on federal programs, possibly including popular entitlements such as Medicare and Social Security. Republicans say scaling back Social Security and Medicare, the largest drivers of future government deficits, is necessary. President Obama has previously been open to benefit cuts. But for lawmakers who would have to vote for such changes, AARP’s 37 million members and $1.3 billion budget are a force to be reckoned with. In the past eight months, AARP has sponsored a series of candidate debates, run television ads, circulated questionnaires and held more than 4,000 meetings around the country to mobilize its legion of supporters to oppose any cuts. Under the slogan “You’ve earned a say,” the group has been building opposition to entitlement changes. A recent poll by the organization found that 70 percent of Americans 50 and older think Medicare and Social Security shouldn’t be part of the upcoming fiscal debate. “We’re fighting to stop cuts to Medicare and Medicaid that will hurt beneficiaries,” said AARP’s top lobbyist, Nancy LeaMond. “We want to ensure that Social Security is not part of this deficit discussion.” Leading bipartisan proposals to reduce the federal debt have proposed changes to entitlement programs, including raising the Medicare eligibility age from 65 to 67 and adopting a stingier formula to determine Social Security payments. Both proposals were discussed during secret negotiations between Obama and House Speaker John A. Boehner (R-Ohio) in summer 2011 during efforts to resolve the country’s debt ceiling crisis. Those talks collapsed without a final agreement. But many political observers expect the proposals to resurface as Democrats and Republicans try to reach a deal to avert the “fiscal cliff” — the government spending cuts and tax increases set to kick in at the beginning of next year. AARP opposes raising the age for Medicare eligibility on the grounds that it would increase costs for younger seniors while driving up premium costs for older ones. The group opposes efforts to shrink Social Security cost-of-living increases, which it says would cost older seniors thousands of dollars in benefits. AARP’s critics say it is looking out for current retirees at the expense of future generations. “We’ve been stealing money from our children, and one of the main reasons that we’ve been unable to stop is that AARP is so opposed to any change to the entitlement programs and they’re politically powerful,” said Kevin A. Hassett, an economist at the American Enterprise Institute. But AARP argues that it is protecting benefits vital to both current retirees and younger Americans. With the demise of guaranteed pensions in the workplace and the inability of many workers to save enough for retirement, Social Security and Medicare are increasingly indispensable. “You have people in their 40s and 50s who are cascading toward a terrible retirement,” said Eric Kingson, a Syracuse University professor who co-chairs Strengthen Social Security, a coalition that has joined AARP, organized labor and others in opposing any benefit cuts in the program. AARP and others say the recent economic downturn has made it even more urgent to protect entitlements. Households with adults approaching retirement have median retirement savings of $120,000, about the same as 2007, according to the Center for Retirement Research at Boston College. But balances for younger workers have shrunk, meaning that more that half of all Americans could see their standard of living decline once they retire, the center said. A recent issue of the AARP Bulletin — the largest circulation magazine in the world, sent to all its members — warned seniors that the proposed change to Social Security previously embraced by Obama and Republicans could cost “a potential cumulative loss of thousands of dollars.” The organization followed that with a letter to all members of Congress cautioning against Social Security changes. Dozens of Democratic senators are vowing to protect Social Security — including Sen. Majority Leader Harry M. Reid (D-Nev.), who has said any changes to the program should not be considered as part of the upcoming debate over the fiscal cliff. This would not be the first time that AARP has applied its political muscle with decisive effect. The group’s backing was influential in passing what liberals called a flawed Medicare prescription drug plan in 2004. Then, AARP’s opposition doomed President George W. Bush’s proposal to partially privatize Social Security. And its support was instrumental in helping to enact Obama’s health-care overhaul, which reshaped parts of Medicare. “It is the 900-pound gorilla,” said Frederick R. Lynch, a Claremont McKenna College professor who wrote a book about the organization. “All AARP has to do is whisper.” But as Medicare and Social Security have come to account for about a third of the federal budget, some former AARP officials say it is increasingly risky for the group to try to wall off the programs from cuts. Aware of growing political support for entitlement changes, even among traditional Democratic allies, AARP signaled a shift in thinking last year. John Rother, then AARP’s top lobbyist, said at the time that the organization was open to benefit cuts for Social Security recipients. This was widely viewed as a major departure for the group and welcomed by some as refreshingly realistic. But the statement caused a furor among the many interest groups opposed to such a change. Soon afterward, Rother left AARP. He says it’s important for AARP to advocate for its position but also to be flexible. “You want to be perceived as being a strong advocate, but at the same time your long -term interest is in solving a problem,” he said in an interview. “The art, if you will, is to make sure that you are operating and messaging in such a way as to get the best possible results for your members within the context of solving the problem.” Rep. Nan A.S. Hayworth (R-N.Y.), who has spoken with AARP officials about their policy, said she wishes the organization would do more to talk to its members about the financial challenges facing entitlement programs rather than simply opposing cuts. “I think it’s important to have a mature conversation so we understand the challenges we face going forward,” she said. In 25 years, spending on Medicare and Medicaid is projected by the Congressional Budget Office to equal 10 percent of the economy — double the current percentage. In the same period, Social Security spending is expected to rise from 5 percent of the size of the economy to 6 percent, mainly as a result of the retirement of baby boomers. LeaMond, AARP’s top lobbyist now, said that Medicare savings can be found by slowing the growth in health-care costs and that Social Security can be strengthened without cutting benefits, though she did not say how. She said AARP members care deeply about the long-term solvency of the programs even if they don’t want to bear the brunt of the cost of fixing them. “If the critics spend anytime with our members, you cannot help but be struck by their powerful sense of legacy,” she said. “They want to leave Medicare and Social Security as strong for their kids and grandkids as for them.”
Source: blogspot.com

Services Insurance : What Dental professional Solutions Are Protected by Medicare?

Posted by:  :  Category: Medicare

1pic1thoughtinAug 16 spinach for brains by KatieTTTo be covered, such procedures must be done on an in-patient basis, and as aspect of therapy of the larger healthcare problem, and simultaneously. Examples of oral costs that have no coverage would be:     The care or therapy of teeth or components assisting the teeth as a main service     Elimination or replacement of teeth as a main service     The planning of the mouth for dentures     Elimination of teeth in an contaminated jaw     The repair of any assisting components including all parts of the gum area, teeth origins and their protecting, and the alveolar bone which forms the teeth plug. Medicare related programs take oral therapy into some consideration. Privately paid oral costs are considered by Centers for Insurance coverage & State medicaid programs Solutions in determining a individual’s out of pocket healthcare costs. Medicare Medical Savings Records (MSA) can be set up which may cover oral costs. Individuals do not make remains to such accounts. Funds are added only from your Insurance coverage consideration. Such accounts are totally managed with a insurance deductible that must be met from Insurance coverage determining costs before the consideration can be used. Insurance coverage chooses the bank where the consideration is created, and payments from the consideration are usually made via charge cards. Although some costs from MSAs are subject to taxes, oral costs are not.
Source: blogspot.com

Video: emergency dentist | 509-774-3085 | Wenatchee Washington 98801 | medicare dentist

Dental Insurance for Medicare

Some dental insurance for Medicare is extensive and covers everything while other plans are very limited. Out-of-pocket costs associated with routine and non-routine dental care can be financially devastating so adding dental coverage will help with that. Original Medicare may cover a medical emergency involving your teeth but routine services such as cleanings or filings may not be covered. Make sure to read the fine print on each plan so you know how much you will need to pay for routine visits and how much you will be required to pay out of pocket for an emergency. To learn more about the dental services that Medicare does cover is to go to Medicare’s website: www.medicare.com.
Source: seniorcorps.org

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Oral cancer patient fights Medicare for coverage 

alcohol cancer CDC Cervarix cervical cancer cetuximab chemotherapy chewing tobacco cigarettes cisplatin DNA early detection erbitux FDA Food and Drug Administration Gardasil head and neck cancer HPV HPV-16 human papilloma virus human papillomavirus lung cancer mouth cancer National Cancer Institute nicotine oral cancer oral cancer foundation oral sex oropharyngeal cancer radiation radiation therapy radiotherapy smokeless tobacco smokers smoking snus squamous cell carcinoma surgery survival The Oral Cancer Foundation throat cancer tobacco vaccination vaccine xerostomia
Source: oralcancernews.org

The Medicare Chronic Disease Dental Scheme Ends November 30 2012

We strongly recommend you contact us today so we can finalise your dental care plan under this scheme.  We encourage you to book your appointment at your earliest convenience to ensure you do not miss this deadline as  we anticipate that demand for dental services will be high. To book your appointment please contact us on 1300 764 537 or click here to request an  appointment online.
Source: com.au

Many Kids on Medicaid Don’t See a Dentist

Even though this number has improved by 16% between 2002 and 2007, there are still many children who cannot access care due to the loss of school-based dental education programs, state budget cuts, low reimbursement rates that prevent providers from accepting Medicaid patients, and the overall lack of Medicaid dollars going toward dental care. Although the Centers for Medicare and Medicaid Services (CMS) has put goals in place for preventive services, the only long-lasting solution will be an increased investment in dental care.
Source: pilcop.org

Modern Dental Practice Marketing

Our accounting firm, Goldin Peiser & Peiser, LLP holds information sessions, or Dental RoundTables, for dentists in the DFW area approximately 6 times a year. Topics have ranged from compliance, to marketing, to how to increase revenue. They are quite successful; we have a steady, loyal following with approximately the same number of guests, some new and some repeats, attend each session. However, our RoundTable on Dental Medicaid was something we had never seen before. The session “sold out” in a few days, prompting us to repeat the topic a few months later. It doesn’t take a genius to realize that the dental community is nervous about the stepped up efforts by the U.S. Department of Health and Human Services to audit dental practices for Medicaid fraud. And dentists should be concerned. Since 2010, the federal government has opened over 1000 new criminal cases and 1700 investigations, and is involved in over 900 civil investigations with an additional 1300 cases pending.
Source: moderndentalmarketing.com

How to Save on Dental Care

I use dental discount plans (I’m on my second one).  Wanted to share some hard earned experiences: 1) I didn’t realize that the dentists get NONE of your plan membership fee.  My first yearly plan included free cleanings/xrays/checkups, and it was a horrible experience as the dental offices figure out other ways to pressure you for money (flouride treatments, bogus offices visit charges, overtreatment of moderate cavaties as needing a root canal/cap). 2) My second plan has a lower yearly fee and about 70 percent off dental fees.  Still get pressured for items not covered, like 300 dollar nightime mouth guards (that last 6 months).  Also, when I did need a specialist, his office didn’t honor the advertised rates, only gave 20 percent off. The 20 percent off was supposed to apply only to services not itemized in the dental plan. 3) Even with the aggravation, I think a dental plan is worth it because I’ve never found a dental office that will negotiate on the prices.  The office staff doesn’t want to be bothered.  They only want to deal with either insurance companies, or dental plans as all the fees are loaded in their administrative systems.  4)  One other tip, print out a copy of your plans itemized fees as I found two dental offices that changed the prices. 
Source: depositaccounts.com

Sleep apnea Medicare coverage

Medicare coverage for oral sleep apnea appliances is relatively new.  Medicare covers the appliance as a DME ( durable medical equipment).  If you have the appliance made by a dentist, who is not a DME provider it will not be covered by Medicare.  Make sure your dentist can submit for your appliance as a DME before you proceed.   If you have questions about coverage ask us or ask your dentist if they are a DME provider.
Source: wordpress.com

Medicare Open Enrollment: The Tools Are There to Help Your Loved Ones Make Good Plan Choices

Posted by:  :  Category: Medicare

20090418jb_EFCAcanvassingPA_04 by SEIU InternationalA recent study found that seniors (often with the help of their support systems like you and me) are learning from their experience with Part D over time and switching plans when they can save money, or when a different plan better fits their individual health needs. The study, which we have highlighted in our Rx Minute newsletter this month, shows that seniors are adapting to get the best drug coverage for their money. Research PhRMA sponsored found that even in 2006, Part D’s first year, seniors disproportionately chose plans with lower premiums and deductibles and broader choice of medicines. In sum, choice works, benefiting seniors.
Source: phrma.org

Video: Medicare’s Chief Actuary: Choice & Competition Have Successful History

Viewpoints: ‘Zombie’ Plans For Medicare; James Baker’s Grand Bargain Advice; Conservative Govs’ Choices

The New England Journal of Medicine: Reducing Administrative Costs and Improving the Health Care System The average U.S. physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures. In addition, physicians’ offices must hire coders, who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements. The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine. … it may be necessary to establish a senior-level office in the DHHS focused solely on implementation and innovation in the realm of administrative simplification (David Cutler, Elizabeth Wikler and Peter Basch, 11/15).
Source: kaiserhealthnews.org

A Season For Medicare Choices

• Get help if you need it. The Medicare.gov website lists all the plans in your area. You can call 1-800-MEDICARE for general information and to enroll in a plan. You can also get a referral for your local State Health Insurance Assistance Program (SHIP). Every state has one, and they provide free counseling and advice to everyone with Medicare.
Source: smmirror.com

The Choice on Medicare (Infographic)

Who do you want making decisions for 50 million seniors? Mitt Romney says seniors should make their own decision, President Obama wants 15 unelected bureaucrats to make the decisions for them. Seniors deserve choice, not rationed care.
Source: redalexandriava.com

Just Turned 65? Medicare Choice Comes Around Again

Is your Medicare plan changing in 2013? If you have a Medicare Advantage plan or a prescription drug plan, your plan will send you a document called an Annual Notice of Changes by the end of September. This is a big, thick doorstopper of a document. Don’t toss it aside. You need to review it carefully because your plan could make changes that affect you. For example, the co-pay could change for a drug you take, or a specialist you see may have dropped out of the plan’s network.
Source: allsup.com

PPACA Provides Medicare Enrollees With More High Quality Choices

As a result of the Patient Protection and Affordable Care Act (PPACA), Medicare is taking more proactive steps to promote high quality plans and communicate with beneficiaries who are enrolled in low performing plans about their options. People enrolled in plans with a 3 star or less rating for 3 consecutive years will receive notifications letting them know they can switch to a higher quality plan. 5-star plans are also rewarded by being able to continuously market and enroll beneficiaries, throughout the year.
Source: choiceadminexchanges.com

More Choice Leads to More Confusion for Medicare Patients

Medicare+Choice, a program created by the Balanced Budget Act of 1997, expands options for receiving Medicare coverage through a variety of managed care plans. In 2003, Congress passed the Medicare Modernization Act, which included changes in payment rates to participating Medicare+Choice plans and renamed the program Medicare Advantage.
Source: rwjf.org

The Hard Choice for Medicare

So, in broad brush, the first path to prevent Medicare insolvency without reducing eligibility or benefits is for the Federal government to impose provider reimbursement reductions that will arguably cause many doctors to refuse Medicare patients. This path could lead to requiring doctors to serve Medicare patients at deep discount rates as a condition of holding a license to practice medicine.
Source: truenorthreports.com