An Open Letter: Lankford misrepresents his voting record on SS and Medicare. FYI, With an Earl Mitchell Response :: Democrats of Oklahoma Forum

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyBy ending Medicare as we know it, I was referring to your and other Republicans’ votes to give Medicare beneficiaries a set amount of money (a voucher or coupon) each year to buy coverage from competing health plans. That’s in contrast to the present program in which the federal government pays for as many services as beneficiaries use. The economies of scale by having the federal government pay would be lost in turning the responsibility for paying over to each person. That person would have to make up the difference when the cost of health insurance exceeds the amount of the voucher.
Source: demookie.com

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

Medicare scam targets a Sherman woman

DURANT, Okla. – Dr. Cordell Adams (’82) will be the guest speaker at Southeastern Oklahoma State University’s Fall Commencement. Two ceremonies will be held on Saturday, December 15, at 10 a.m. and 2 p.m. in the Bloomer Sullivan Arena. A reception for all graduates, their families and friends is scheduled for 11:30 a.m. – 1 p.m. in the Visual & Performing Arts Center. Read More
Source: kxii.com

Wrong Number: Medicaid cost estimates are exaggerated and misleading

The Affordable Care Act expands Medicaid coverage up to 133 percent of the federal poverty level for all individuals. Currently in Oklahoma, working-age adults are eligible for Medicaid only if they are parents of dependent children and have incomes below 37 percent of the poverty level.  Nearly fifty percent of  Oklahoma adults with income below 133 percent of poverty are uninsured, and the Medicaid expansion would make some 180,000 uninsured adults Medicaid-eligible. Most of this population is not eligible for premium subsidies to purchase private insurance through the new health insurance exchanges, which only assist individuals with incomes between 100 and 400 percent of the federal poverty level.
Source: okpolicy.org

Annual Enrollment Period for Medicare in Oklahoma

“Retirement placed me into a new category for insurance coverage. Going onto Medicare was a confusing new experience for me, and even though I have been in healthcare all of my professional life this was a new world for me to understand and learn more about. Along with getting enrolled with Medicare I felt the need to find a secondary insurance coverage. I did not know where to even start other than start calling insurance providers. Upon the recommendation of my friend I called her agent – Marc Lallier. Marc explained the coverage of Blue Cross Blue Shield in detail and we walked through the application process together. He was very knowledgeable about the coverage and answered many Medicare questions I had related to BC/BS coverage. Marc was very professional, patient and provided me with the assistance I needed in order to obtain a secondary coverage. I have never had an insurance agent take better care of me by making sure my insurance coverage needs were met. I would highly recommend Mr. Lallier to anyone who wants or needs insurance coverage with the confidence of knowing their best interest has been taken into consideration. “
Source: oklahomamedicarehealth.com

OK: Fallin tells Obama to liberate the states

Fallin said federal reforms should “produce savings for both the federal government and states.” She pointed to shared responsibility for running certain programs should also mean “shared savings.” As an example of her analysis, Fallin pointed to “the duals” – beneficiaries eligible for both Medicaid and Medicare benefits. Instead of freeing the states to experiment, she said, the federal Health and Human Services (HHS) agency is still “struggling to approve demonstration projects. She asserted “more authority is necessary” for the states to craft alternatives.
Source: watchdog.org

Owassoisms.com: Lovelace Medicare Advantage Plan Expands in Oklahoma

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

Senior Benefit Services, Inc.

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

InsureBlog: Oklahoma, Okay?

A month ago, Bob posted on a “unique practice at the Surgery Center of Oklahoma” which accepts only cold, hard cash on the barrel head. No insurance, no Medicare or Medicaid, no third party payors of any kind. So, how’s that working out for the folks who run the joint? From the horse’s mouth:
Source: blogspot.com

Reminder: Optometrists subject to $500+ fee for Medicare DMEPOS enrollment

The Medicare DMEPOS registration fee is distinct from the health plan’s DMEPOS provider surety bond requirement, from which optometrists have been exempted unless they provide eyeglasses to the public without any sort of examination of the patient, and separate from the DMEPOS accreditation requirement, until the CMS decides to implement supplier standards for physicians.
Source: newsfromaoa.org

Brad DeLong : The Political Medicaid Expansion Wars Begin…

Posted by:  :  Category: Medicare

Harry Reid, Health Care narrow by Truthout.orgLet Fifty Flowers Bloom: Health Care Federalism after National Federation of Independent Business V. Sebelius by Ann Marie Marciarille :: SSRN: Conventional wisdom is that the American public does not want to think too long or too hard about Medicaid. Medicaid’s reputation has long been big, complicated, and widely misunderstood…. Medicaid is the budget-buster of government funded health insurance. Its budget busting propensities are most pronounced at the intersection of Medicaid and the government-funded health insurance program we do love to discuss: Medicare…. [E]verything possible will happen: if somebody can imagine it, some state will try it. This paper first looks at the pre-ACA past… considers the past role of Medicaid… and how the Supreme Court has understood that role. It next considers the roles that Medicaid is likely to play in our health care system post-implementation of the Medicaid opt-in in 2014…. It finally considers the implications of transformed health care federalism for the implementation of the ACA….
Source: typepad.com

Video: MEDICARE SUPPLEMENTAL INSURANCE

Candlelight Campaign Against Cuts comes to N.C. (12/10)

What: Candlelight vigil against cuts to Social Security, Medicare, Medicaid, and taxes on the rich Where: Senator Kay Hagan’s office, 310 New Bern Ave, Raleigh, NC 27601 When: Monday, December 10, 2012 at 4:30 PM Who: NC State AFL-CIO, MoveOn.org, NC Conference of the United Methodist Church, NC Justice Center
Source: aflcionc.org

N.C. Groups Hold Vigil To Oppose Budget Cuts

Bishop Hope Ward will lead the vigil at sunset Monday at the office of Democratic U.S. Sen. Kay Hagan in downtown Raleigh. In addition to the UMC, other organizers of the vigil are the N.C. Justice Center, the N.C. State AFL-CIO and MoveOn.org
Source: cbslocal.com

Page not found : Hoke County, North Carolina

The Hoke County Board of Social Services will hold an open meeting on Monday, December 17, 2012, at 4:00 PM in the Commissioner’s Room located in the Pratt Building, 227 N. Main Street, Raeford, NC. The public is invited to attend. For further information, please contact the Hoke County Department of Social Services at 910-875-8725.
Source: hokecounty.net

Medicare Nursing Home Ranking System Under Scrutiny in North Carolina

While not every injury case meets our criteria, we offer free initial confidential injury case consultation, so call us toll free at (800) 752-0042. If you cannot get through due to high call volume, please leave a voicemail so we can return your call.
Source: hsinjurylaw.com

ONLY ON 3 UPDATE: Injured man on Medicare is able to stay in hospital to await surgery

Tom, I know portions have kicked in, like the part that removed the lifetime cap on benefits. This alone saved us from financial ruin when my wife came down with cancer. I am sure more provisions will be forthcoming. What gets me is all these people have moaned and groaned for years about having to foot the medical bills for those who choose not to carry insurance. Obama did something about it and they are still whining. Probably most of those who are complaining the most are the ones that will have to slack off on their Marlboros, cheap beer, tattoos and piercings and use that money to buy insurance.
Source: wwaytv3.com

Medicare Part D Open Enrollment Clinics in Lenoir County

Lenoir County Seniors’ Health Insurance Information Program (SHIIP) operating under the NC Department of Insurance and in conjunction with Lenoir County Cooperative Extension will provide two counseling clinics during the week of December 3, 2012. This will be the last week of counseling clinics in Lenoir County for 2012. Medicare Part D Open Enrollment ends on December 7, 2012.
Source: ncsu.edu

Fuqua School of Business survey shows strong support among CFOs for Simpson

“The business community has issued an imperative to our leaders to not only avoid the fiscal cliff, but to put America on sound fiscal ground for the long term. Our debt crisis has reached a magnitude at which business leaders recognize it will require an all of the above response. This survey confirms that,” said Jim Ahler, CEO of the North Carolina Association of CPAs (NCACPA) which recently became an organizational partner of the Campaign to Fix the Debt North Carolina chapter. The association is uniquely positioned to have the pulse of the business community and perceive the severity of the debt crisis.
Source: bluenc.com

Daily Kos: Are Democrats abandoning raising the Medicare eligibility age?

Posted by:  :  Category: Medicare

Choose Love Over Fear by elycefelizMeteor Blades, skybluewater, SME in Seattle, bink, Renee, cslewis, Sylv, Irfo, slinkerwink, Gooserock, PeterHug, Andrew C White, eeff, willyr, TX Unmuzzled, Duncan Idaho, jancw, expatjourno, eyeswideopen, bronte17, cyberKosFan, susakinovember, whenwego, pedrito, Nate Roberts, Eddie C, revsue, psnyder, figbash, 2laneIA, defluxion10, RebeccaG, grrr, lcrp, inclusiveheart, ybruti, lonespark, Wife of Bath, Sybil Liberty, Skennet Boch, drofx, radarlady, 3goldens, ichibon, irate, sc kitty, Alice Venturi, wallys son, Flint, dewtx, Dobber, Laurence Lewis, ratzo, bleeding blue, Sun Tzu, skyounkin, markdd, Ozzie, spunhard, xaxnar, Jim R, splashoil, Jim P, begone, Born in NOLA, velaski, Patriot Daily News Clearinghouse, Kimball Cross, rl en france, martyc35, kestrel9000, DarkestHour, triv33, twigg, real world chick, el cid, sceptical observer, Timothy J, Clive all hat no horse Rodeo, ms badger, sea note, BentLiberal, ammasdarling, One Pissed Off Liberal, phonegery, fabucat, Habitat Vic, tgypsy, puakev, beth meacham, dclawyer06, deepeco, jedennis, leonard145b, madgranny, trueblueliberal, JDWolverton, MKinTN, CroneWit, mconvente, TruthFreedomKindness, also mom of 5, HappyinNM, wayoutinthestix, zerone, prettyobvious, Involuntary Exile, elwior, treesrock, KJG52, jamess, Therapy, Lujane, tofumagoo, petulans, venger, JamieG from Md, Nica24, Mike Taylor, maggiejean, prettygirlxoxoxo, Rhysling, cybrestrike, J M F, Throw The Bums Out, Scott Wooledge, maryabein, Zotz, mkor7, papahaha, kevinpdx, sfarkash, Lacy LaPlante, emptythreatsfarm, FogCityJohn, flitedocnm, Crabby Abbey, Progressive Pen, Polly Syllabic, sunny skies, ATFILLINOIS, melpomene1, gulfgal98, Lady Libertine, ItsSimpleSimon, Puddytat, Egalitare, sharonsz, addisnana, Betty Pinson, cocinero, Oh Mary Oh, fiercefilms, stevenaxelrod, Onomastic, mama jo, Liberal Capitalist, Mr MadAsHell, BlueJessamine, OhioNatureMom, smiley7, marleycat, thomask, Wolf10, whaddaya, ratcityreprobate, stlsophos, Willa Rogers, Mentatmark, SouthernLiberalinMD, allergywoman, SycamoreRich, wolf advocate, Cordyc, cwsmoke, pistolSO, Siri, IndieGuy, rustypatina, S F Hippie, effervescent, Trotskyrepublican, JGibson, congenitalefty, Mr Robert, BobSoperJr, geojumper, radical simplicity, MartyM, pittie70, Vote4Obamain2012, avsp, marty marty, dotdash2u, wasatch, Marjmar, fauve, Sue B, Illinois IRV, jbob, Linda1961, Panama Pete, goodpractice, The Hamlet, Jollie Ollie Orange, marcr22, chicklet, pragmaticidealist, MBishop1, Catkin, Chas 981
Source: dailykos.com

Video: The Romney/Ryan Medicare Plan: Boo!

Research Roundup: Medicare Advantage Plan Beneficiaries May Get More Appropriate Services; CHIP Participation Grows

Urban Institute/Robert Wood Johnson Foundation: Medicaid/CHIP Participation Among Children And Parents – “Despite the economic downturn, most states have maintained or expanded Medicaid and CHIP for children, by expanding eligibility to higher income and immigrant children, undertaking enrollment and retention simplifications, and implementing new policy options,” the authors wrote about coverage rates between 2008 and 2010. The rate of eligible children participating in Medicaid or CHIP grew to 86 percent nationwide and the number of eligible children who were not insured fell by 500,000 in that time, the study found. Participation rates for eligible parents were lower, however. The authors conclude that the 2009 law designed to improve participation of children in the program “may have contributed to increased take-up for Medicaid/CHIP among children, but that additional efforts will be needed, particularly among parents, to achieve high levels of Medicaid enrollment under the Affordable Care Act ACA” (Kenney et al., 12/3).
Source: kaiserhealthnews.org

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

Deroy Murdock Explains How to Promote Paul Ryan’s Proposed Medicare Reform

The Medicare-reform proposal of presumptive GOP running-mate Paul Ryan is precisely as extreme as the health plan available today to every member of Congress. Ryan envisions average seniors’ being able to enjoy Capitol Hill–style medical options. This itself, however, would be a choice. Seniors who oppose choice in health coverage will be 100 percent welcome to remain within traditional Medicare. …Wyden-Ryan mirrors the way federal legislators buy health insurance. As FactCheck.org’s Brooks Jackson notes, “House and Senate members are allowed to purchase private health insurance offered through the Federal Employees Health Benefits Program, which covers more than 8 million other federal employees, retirees and their families.” …As FactCheck.org, elaborates, “All plans cover hospital, surgical and physician services, and mental health services, prescription drugs and ‘catastrophic’ coverage against very large medical expenses . . . There are no exclusions for preexisting conditions.” Participants may change plans during annual “open season” periods. Also, the government pays 72 percent of the average worker’s premium, with a maximum of 75 percent. Democrats cannot explain why Medicare recipients need to become congressmen to enjoy such choices in health coverage. If Ryancare, in essence, is good enough for senior citizens like Nancy Pelosi and Harry Reid, it’s good enough for any senior who wants it after 2022.
Source: townhall.com

Medicare and Medicaid Cuts To Come

The New York Times (11/14, Calmes, Greenhouse, Subscription Publication) reports that in his talks Tuesday with labor and progressive groups, President Obama “put forward a very specific plan that will be what he brings to the table when he sits down with Congressional leaders,” according to White House Press Secretary Jay Carney. Also according to Carney, “the $4 trillion, 10-year plan includes the commitment to $1.1 trillion in spending cuts that Mr. Obama and Congress have already agreed to…as well as additional spending cuts that include $340 billion in savings from Medicare and Medicaid.” This will be balanced, at the President’s insistence, by $1.6 trillion in revenue.
Source: drpauldorio.com

Progressive Dems: Raising Medicare Eligibility Age Is ‘Bad Policy’

“Raising the Medicare eligibility age to 67 would create a new health care donut hole. This would leave thousands of seniors with no health care coverage and jeopardize the future of affordable health care for all Americans. A report released yesterday by the Center for American Progress found that if the eligibility age for Medicare is raised, nearly half a million seniors would fall into a coverage gap when they would have previously been covered.  The notion that raising the eligibility age will result in an overall savings is false. A Kaiser Family Foundation report found that raising the eligibility age would increase expenses for 65- and 66-year-olds and would increase costs for individuals, states and the private sector by twice as much as it would save the federal government.   This change would also place a burden on younger Americans who help take care of their elderly family members.
Source: talkingpointsmemo.com

Republicans' Damaging Ideas on Medicare

6:38PM EST December 11. 2012 – The scenario is not so far-fetched: an American worker nears retirement. Her 65th birthday is drawing close. She’s paid into Medicare her entire life, expecting it to be there to cover her health care in her golden years — just like it was for her parents.
Source: realclearpolitics.com

Obama on Medicare, space in Florida

“I want you to know, Florida, I will never turn Medicare into a voucher,” Obama told 3,050 people at the Florida Institute of Technology here. “If you work hard all your life, then you should have some basic security…  to know that it’s going to be there for you. And I have to tell you, that is going to be part of what’s at stake in this election.”
Source: politico.com

S.C. Hospice Firm Busted for Alleged Medicare Fraud

Posted by:  :  Category: Medicare

'The election of Obama would, at a stroke, refresh our country's spirit' by Renegade98“As budget pressures increase it is more important than ever to protect Medicare dollars and vigilantly guard against needless health spending,” Daniel R. Levinson, Inspector General of the U.S. Department of Health and Human Services, said in a statement. “The company and its owner have agreed to federal monitoring and reporting requirements designed to avoid such problems in the future.”  The investigation was jointly handled by the U.S. Attorney’s Office for the District of South Carolina, the Justice Department’s Civil Division and the Office of the Inspector General of the Department of Health and Human Services. The claims resolved by this settlement are allegations only, and there has been no determination of liability, the Justice Department noted.
Source: patch.com

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

Travel for Seniors: South Carolina

This post is a guest post by John Walters who is a freelance writer who attended the 1973 Clarion West science fiction writing workshop and is a member of Science Fiction Writers of America.  He writes mainstream fiction, science fiction and fantasy, and memoirs of his wanderings around the world.  For many years he lived in Greece with his Greek wife and five sons and taught English as a second language to help pay the bills, but he has recently moved back to the United States and now lives in San Diego. 
Source: medicareecompare.com

Phone scam targets Medicare users

Consumers have reported a cold caller tells them to expect a new Medicare card in January. But before getting the new card, you have to verify your social security number or supply a bank account number.
Source: wmbfnews.com

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

It is time to think progressive!

4D Ultrasound 9/11 9/11 Remembered ACA Baby Impressions Baptist Boulevard breast breast cancer cancer church Clemson Clemson Athletics Clemson Football Clemson University debt Debt Ceiling ED election Emergency Department Facebook GHS Governor Nikki Haley healthcare Health Care Joe Bridwell Komen legacy MAPC Medicaid Expansion Mike Riordan no health insurance Remembering 911 Republican Party Rose Rose Frances Sarah sc SCHA south carolina South Carolina Hospital Association Uninsured Veto Vincent Sheheen Welvista
Source: bobbyrettew.com

Is Medicare Really Working in Oregon?

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSOne certain reason enrollees are continually satisfied is that 2012 premiums are lower on average than 2011 premiums.  In 2011, the Centers for Medicare and Medicaid Services (CMS)  found that the Medicare Part D program saved enrollees $2.1 billion in 2011 because of the Gap Discount program, which requires drug manufacturers to provide discounts on brand-name and generic drugs to seniors in the gap or “donut hole.”  About 3.6 million enrollees nationwide benefitted from these discounts, at an average of $604 each.
Source: northcoastoregon.com

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

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

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

“The Basics” Chiropractic Medicare: Florida, Oregon, and Washington ~Newsletter 10/29/2012

     On Saturday, December 8th, I will be at the Clarion Inn and Suites, Orlando, 8:30 am to 12:30 pm covering critical information for Chiropractors and their staff.  In this 4 hour presentation, I will cover everything from the important ABN to becoming Medicare Compliant, going paperless, and the Medicare Electronic Health Record (EHR) Incentive Program to get money back from the government.
Source: blogspot.com

OREGON LEGAL RESEARCH: Researching Medicare and Medicaid Law

This is mostly a reminder for me, and colleagues, but others might find it useful: A Few BASIC RESOURCES ON MEDICARE and MEDICAID LAW: 1) CCH Medicare and Medicaid Guide 2) Medicare and Medicaid Claims and Procedures, 4th, by Harvey L. McCormick 3) Medicare and Medicaid Fraud and Abuse, 2009 ed. By Alice Gosfield 4) Social Security and Medicare Answer Book, 3rd ed., by David A. Pratt 5 ) The Legal Impact of Medicare and Medicaid: Leading Lawyers on the Role of State and Federal Agencies, Effective Compliance Programs, and Enforcement Trends (Inside the Minds), by George Bodenger, Carol Ewald Bowen, Brian Boyle, Lynda M. Johnson, Thomson/Reuters/West 2009 MISC LINKS: 1) Medicare dot gov 2) Social Security Administration 3) Zimmerman’s Research Guide SELF-HELP: 1) The Complete Idiot’s Guide to Social Security and Medicare, 2nd Edition (paperback), by MBA, Lita Epstein (bookstores and libraries) 2) Nolo Press, Social Security, Medicare & Government Pensions: Get the Most out of Your Retirement & Medical Benefits, 2009 (bookstores and libraries)
Source: oregonlegalresearch.com

Oregon Businesses to Congress on Fiscal Cliff: “Listen to Main Street, Not Wall Street”

“Social Security, Medicaid and Medicare play an important role in helping preserve the middle class and protecting their retirement income,” said Deborah Field, owner of Paperjam Press in Portland. “These programs give people a basic income and make sure they don’t have to spend every last dime on health care. That way, people have something left to spend in their local economies – and in our businesses.” Field added, “Social Security, Medicaid and Medicare are also vitally important for small business owners in retirement. Since we don’t get company pensions or retiree health benefits, these programs are the sole hope for a basic retirement for many small business owners.”
Source: mainstreetalliance.org

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

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

Dental Insurance for Medicare

Posted by:  :  Category: Medicare

1pic1thoughtinAug 16 spinach for brains by KatieTTSome 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

Video: Dental Insurance A Must for those on Medicare

Know a good dentist/veneers in the OC, CA area for patients on medicare/medi

Frankly, I can’t understand what the writer is saying in most of the write-up. I assume that the writer fractured his/her incisor(s) in the fall. A veneer would likely be the incorrect treatment for this type of injury, as this is just a cosmetic covering. Veneers and cosmetic services are typically not covered by insurances, especially Medicare or Medicaid. However, CA may be different. The more appropriate treatment would likely be a crown or resin build-up, as these are more often used to fix broken teeth. The crown would be more likely to last over time. The resin build-up would be initially cheaper.
Source: angieslist.com

4 Seniors: Drill into dental costs

Dental School: Dental care at a local university can be a 1/3 of the cost versus treatment at a practice, but, it can also take twice as much time. The work comes from students under the supervision of dentists, like those you can find at the University of Oklahoma College of Dentistry.
Source: kfor.com

Obtaining Meaningful Use Reimbursements as a Dentist

What do you need to know to get meaningful use incentive payments? Although the requirements for Stage 2 and 3 of Meaningful Use are still evolving, Stage 1 has been set. In Stage 1, a dental practice must install and use an EHR. In Stage 2, that EHR must be used for 90 days to capture and move data outside the organization. One thing to especially consider is that not one of the dental practice management systems has yet been certified for meaningful use. Meaningful use focuses on electronic health records (EHRs), and none of the existing dental practice management systems have qualifying EHRs. Dentrix and other vendors do have some certified software options.
Source: dentalsoftwareadvisor.com

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

NGO embarks on free medicare in Kwara

A medical aid organization is embarking on free dental services in Kwara State. The group; ERAMSE African Dental Aid Foundation has been carrying out their operations from premises of the Rhema Chapel International, Tanke, as well as other locations in Ilorin, the state capital.
Source: nationalmirroronline.net

Business profile: Medicare

“Our highly-qualified specialists, fully licensed and certified premises mean that you know you are dealing with people you can trust. In addition to superb medical facilities, our support staff ensure that the practice runs smoothly and efficiently.
Source: co.uk

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

Posted by:  :  Category: Medicare

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

Video: Medicare Part D Donut Hole

Progressives to Obama: Don’t even think about raising the Medicare eligibility age

“Raising the age of eligibility, the legal retirement age, sounds like a good idea if what you do for a living is talk and write, mostly while sitting in comfortable chairs in climate-controlled buildings,” Nichols observed. “But if what you do for a living is pick up and move heavy things, or spend eight to ten hours a day on your feet without interruption bringing food and clearing tables, or waiting on retail customers, or doing one physical thing over and over on an assembly line, then being required to do that for two or five or 10 more years before you can join Medicare is fairly cruel.”
Source: msnbc.com

What Gaps in Medicare Mean To You

This post was written by Jim Blazer, Executive V.P. of Bermel, Inc.  Since joining Bermel, Inc. 18 years ago, Blazer has led the company in its steady expansion. He is recognized for managing one of two major US hospital networks for Medicare Select. Bermel, Inc’s Medicare Select Supplements significantly reduce the premium outlay for policyholders.
Source: medicareecompare.com

EILIYAH: low income, disabled & Medicare recipient : HIV Health Reform

ADAP aids.gov AIDS2012 Bridge to 2014 California Healthcare Reform Case Stories comments to HHS Congress Deficit Reduction Dual Eligibles Election 2012 essential health benefits exchange fact sheet featured federal budget federal implementation healthcare reform health care reform & prevention health home health reform & HIV 101 HHCAWG HLS/TAEP Illinois Medi-Cal Questions Medicaid Medicare National HIV/AIDS Strategy private insurance public input regulations reimbursement rates Ryan White CARE Act Sebelius seniors SHARP sign-on letter Spanish Speaking Resources state advocates state implementation Super Committee supreme court toolkits webinar women
Source: hivhealthreform.org

Medicare Open Enrollment: last chance to review and compare plans

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

What you need to know about Medicare

A word of caution here: There are a few things you can’t do during the six-week disenrollment period. You can’t switch from one Medicare Advantage plan to another. Nor can you switch from the traditional Medicare program to an Advantage plan. Most people will need to wait until the annual enrollment period in the fall to make either of those changes.
Source: demingheadlight.com

Medicare Part D Coverage Gap

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

I’m an MS Activist: REMINDER: MEDICARE OPEN ENROLLMENT ENDS DEC. 7TH

If you are a Medicare beneficiary who was impacted by Hurricane Sandy, the Centers for Medicare and Medicaid Services (CMS) is making accommodations to ensure that all Medicare beneficiaries can enroll in the health and drug plans that are best for them.
Source: blogspot.com

Medicare plan D what do you do about the "doughnut hole"

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceWe haven’t done any shopping yet this year, but our pharmacist usually helps us research & compare each year & most years we do change companies. Without knowing your pharmaceutical needs, it’s hard to say, but I can tell you that 2012 was the first year my husband managed to avoid the donut hole . . . I suspect that’s because the ACA kicked in a little, and it will be kicking in even more as time goes on. We each pay less than $40/mo. for our Part D policies & we usually need different companies too; we could never afford the top-of-the-line policies, but together with MoRx, a needs-based assistance program, we are able to get the meds we need without going broke. Perhaps California has something similar to MoRx – you could ask your doctor or pharmacist.
Source: diabetesforum.com

Video: Medicare Part D and Prescription Drugs

Don't dismantle Part D

TParty and techfan, what disgusting and demeaning words you put out! Getting older is a part of nature, nothing can stop it, there will be illnesses connected with it. At least most seniors(now) did pay into Medicare, what can you say to those on Medicaid, (one of the biggest abused entitlements), food stamps, extended unemployment checks, etc.? Oh yeah, and what about all those obamaphones? Shame on both of you and the ones that go along with you………..
Source: augusta.com

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

Expert Tips to Simplify Open Enrollment for Medicare Plan D

 Part D Plan is a network pharmacy that offers covered drugs to plan members at lower out-of-pocket costs than what the member would pay at a non-preferred network pharmacy. This can make huge difference in what you’ll pay. For example, Walmart is a preferred pharmacy on multiple plans including the Humana-Walmart Preferred Rx Plan. They provide access to the top ten hypertension drugs for just one cent. So if you’re one of the 70% of Americans over the age of 65 who have high-blood pressure, you can get a month’s worth of the medication you need for just one penny!   Just one specific example of how it can pay to do your homework.”
Source: alexisabramson.com

The Hunt is Afoot For Medicare Part D

You can complete an easy-to-use online application for Extra Help at www.socialsecurity.gov. Click on Medicare on the top right side of the page. Then click on “Get Extra Help with Medicare Prescription Drug Plan Costs.” To apply by phone or have an application mailed to you, call Social Security at 1-800-772-1213 (TTY 1-800-325-0778) and ask for the Application for Extra Help with Medicare Prescription Drug Plan Costs (SSA-1020). Or go to your nearest Social Security office.
Source: patch.com

Daily Kos: Are Democrats abandoning raising the Medicare eligibility age?

Meteor Blades, skybluewater, SME in Seattle, bink, Renee, cslewis, Sylv, Irfo, slinkerwink, Gooserock, PeterHug, Andrew C White, eeff, willyr, TX Unmuzzled, Duncan Idaho, jancw, expatjourno, eyeswideopen, bronte17, cyberKosFan, susakinovember, whenwego, pedrito, Nate Roberts, Eddie C, revsue, psnyder, figbash, defluxion10, grrr, lcrp, inclusiveheart, ybruti, lonespark, Wife of Bath, Sybil Liberty, Skennet Boch, drofx, radarlady, 3goldens, ichibon, irate, sc kitty, Alice Venturi, wallys son, dewtx, Dobber, Laurence Lewis, Sun Tzu, skyounkin, markdd, Ozzie, spunhard, xaxnar, Jim R, splashoil, Jim P, begone, Born in NOLA, velaski, Kimball Cross, rl en france, martyc35, kestrel9000, DarkestHour, triv33, twigg, real world chick, el cid, sceptical observer, Timothy J, Clive all hat no horse Rodeo, ms badger, sea note, BentLiberal, ammasdarling, One Pissed Off Liberal, phonegery, fabucat, Habitat Vic, tgypsy, puakev, dclawyer06, deepeco, jedennis, leonard145b, madgranny, trueblueliberal, JDWolverton, MKinTN, CroneWit, mconvente, also mom of 5, HappyinNM, wayoutinthestix, zerone, Involuntary Exile, elwior, treesrock, KJG52, jamess, Therapy, Lujane, tofumagoo, petulans, venger, JamieG from Md, Mike Taylor, maggiejean, prettygirlxoxoxo, cybrestrike, J M F, Throw The Bums Out, Scott Wooledge, maryabein, Zotz, mkor7, papahaha, kevinpdx, sfarkash, Lacy LaPlante, emptythreatsfarm, FogCityJohn, flitedocnm, Crabby Abbey, Progressive Pen, Polly Syllabic, sunny skies, ATFILLINOIS, melpomene1, gulfgal98, Lady Libertine, ItsSimpleSimon, Puddytat, Egalitare, sharonsz, addisnana, Betty Pinson, cocinero, Oh Mary Oh, fiercefilms, stevenaxelrod, Onomastic, mama jo, Liberal Capitalist, Mr MadAsHell, BlueJessamine, OhioNatureMom, smiley7, marleycat, thomask, Wolf10, whaddaya, ratcityreprobate, stlsophos, Willa Rogers, Mentatmark, SouthernLiberalinMD, allergywoman, SycamoreRich, wolf advocate, Cordyc, cwsmoke, pistolSO, Siri, IndieGuy, rustypatina, S F Hippie, effervescent, Trotskyrepublican, JGibson, congenitalefty, Mr Robert, BobSoperJr, geojumper, radical simplicity, MartyM, pittie70, Vote4Obamain2012, avsp, marty marty, dotdash2u, wasatch, Marjmar, fauve, Sue B, Illinois IRV, jbob, Linda1961, Panama Pete, goodpractice, The Hamlet, Jollie Ollie Orange, marcr22, chicklet, pragmaticidealist, MBishop1, Catkin
Source: dailykos.com

Florida Medicare Part D Plans

Anyone who require for this medical facility can opt for this service in any case if he or she is with limited source of income. Those who do not earn much have facility of getting extra help for various services that included in medication part D plan. $4,000 is almost amount that you will get as an extra help from these medication plan. Monthly premium and it can also be your prescription payment for which you will get all help. This can act as big saving for those who do not earn much. So make sure that are you clearing criteria of getting that much help.
Source: medicare-supplement-advisor.org

Decoding Part D Marketing And Other News

Medpage Today: Medicare Fraud Efforts Queried Lawmakers are exploring ways to fight Medicare fraud and abuse as part of the effort to trim the federal budget and they’re looking to the private sector for suggestions. For instance, investigators at the health insurer WellPoint recently contracted with a company to mine data on practice patterns and spot spikes in payment or identify emerging areas of fraud potential, Alanna Lavelle, Wellpoint’s director of special investigations, told members of the House Energy and Commerce Health Subcommittee on Wednesday. The most egregious billers are flagged and investigated for potential waste, fraud, and abuse, Lavelle said (Pittman, 11/29).
Source: kaiserhealthnews.org

Seniors Pay Too Much for Medicare Part D

Insurance companies offering Part D drug insurance are required to mail information about the coming years  premium costs and drug coverage to current members well in advance of the December deadline.  These hefty documents arrive just ahead of the busiest time of year and, after reading the cover letter stating they will be automatically signed up if they do nothing, many do just that: nothing.  Unlike other types of insurance, Medicare Part D drug coverage changes every year because new drugs, manufacturing costs, regulations and effectiveness findings come out literally every day.  As a result, insurance companies must change their formularies, the list of the drugs they cover and the cost, at least every year.
Source: californiahealthplans.com

Tips for Navigating the Medicare Part D Plan Selection Process

There are many factors to consider when reevaluating your prescription plan during open enrollment period. Each year, annual out-of-pocket expenses, premiums, deductibles and prescription co-payments can change, while the costs and drugs covered under Medicare Part D may vary according to plan and region. If your prescriptions have changed, you’re traveling more frequently or have moved, it’s important to reevaluate your current prescription plan. Opting for the right plan can help save you money and benefit your overall health. These may not necessarily be the first things that come to mind when you’re thinking about the open enrollment process, so talk to your pharmacist because we can help make the process a lot less confusing.
Source: agingabundantly.com

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

NOTE: Originally released in October 2012, this data spotlight was updated in November 2012 to reflect revised data from the Centers for Medicare and Medicaid Services. 
Source: kff.org

2013 Open Enrollment Coming to a Close, But Part D Should Remain Top

First, it is important that Part D beneficiaries take full advantage of the power of consumer choice offered to them by this successful and highly popular program. Over the next year, those enrolled in Part D plans (and the family members and friends who can lend a hand with this) should keep a record of prescribed medications and diagnosed health conditions so that, come the next open enrollment period in 2013, they are well equipped to choose the Part D plan that provides the best and most affordable coverage. Individuals need to take an active role in protecting and improving their own health.
Source: phrma.org

Formulary, Preferred, and Non

Posted by:  :  Category: Medicare

Insurance companies designate committees of health care providers to select medications for the formulary lists of their prescription drug plans. The committee includes doctors and pharmacists. The formulary committee must take into account standards of medication safety, quality and, of course, how much the medications will cost the insurance company. Medications might be added, removed, or change tiers (see below) as the formulary is reviewed on a regular basis. This is reason for physicians to re-check your formulary when prescribing your medication.
Source: drugsdb.com

Video: Medicare 101: An Overview of Medicare

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Making Sense of the Medicare Prescription Drug Plan

In our example, the AARP and the WellCare plans did not require an annual $250 deductible, but they varied in the level of coverage for our drug formularies. In the case of WellCare, the beneficiary would have had to pay 100% of the cost of the drugs (and also pay the monthly premium!) since this plan did not cover any of the three formularies, while the AARP plan covered the drugs but required a co-payment ranging from 40% for Lipitor to 66% for Mobic. The best plan in our example, the Humana Standard plan, had the lowest monthly premium and they also provided standard coverage for all three of our drugs, requiring just the 25% co-pay before reaching the initial coverage limit. All three of these plans had 6 local drug stores including CVS, Giant, RiteAid among others, conveniently located in the area that accepted their plans.
Source: doctor-4u.net

What To Do When Your Medicare Drug Plan Doesn’t Cover Your Prescription

We also offer a FREE prescription drug savings card which you can download and print here.  It is accepted at over 62,000 participating pharmacies nationwide and helps you save on both brand name and generic drugs- ALL prescription drugs are eligible for savings.  There are no monthly or ongoing fees, no limits on usage and no income or age restrictions!  Savings average 32-50%.  If you have Medicare and are enrolled in a Medicare Part D plan, use your ScriptSave® card for everyone in your household and for any prescriptions that are EXCLUDED by Medicare Part D law. In conclusion, seniors, it is important that you ask yourself these questions now, before the Open Enrollment Period closes and you will have to wait to make any needed changes.
Source: medicareecompare.com

Seniors Pay Too Much for Medicare Part D

Insurance companies offering Part D drug insurance are required to mail information about the coming years  premium costs and drug coverage to current members well in advance of the December deadline.  These hefty documents arrive just ahead of the busiest time of year and, after reading the cover letter stating they will be automatically signed up if they do nothing, many do just that: nothing.  Unlike other types of insurance, Medicare Part D drug coverage changes every year because new drugs, manufacturing costs, regulations and effectiveness findings come out literally every day.  As a result, insurance companies must change their formularies, the list of the drugs they cover and the cost, at least every year.
Source: californiahealthplans.com

Lord of the (Medicare) Rings: One price to rule them all, and in the federal register bind them.

Since premium support is likely off the table for the time being, there are still many other things that Medicare can do to improve care coordination and value. We should bundle Medicare services by putting Parts A&B together, with one premium for seniors, which would encourage providers to better coordinate care. We should allow administrative services organizations (ASOs), widely used by large private employers, to set up networks of preferred providers in Medicare, and offer seniors incentives – through reduced co-pays or enhanced benefits – to utilize low-cost, high quality providers. ASOs could also represent an appealing ideological mid-point between premium support, traditional Medicare FFS, and Medicare Advantage plans. The key would be to bundle payments and have all providers “go naked” on their outcomes data so we have some correlation between the money spent and actual performance. Additional, web-based tools could then help seniors find the providers who offered the best care at the lowest cost. Indeed, this approach is already being tested by United Healthcare at a number of oncology centers around the country. In an effort to control costs of cancer treatment, the insurer will provide up-front payments for a typical 6 to 12 month course of treatment, and allow the oncologist to determine the specifics, rather than paying by volume of care. An earlier study published in the Journal of Oncology Practice found evidence to support this type of approach, identifying some $9,000 in savings for patients on evidence-based pathways in the treatment of lung cancer, with little change in 12 months survival rate. Studies like this can provide a benchmark for weighing how different treatment strategies and practice designs affect the cost of care and health outcomes and – most importantly – inform patient choice in the oncology setting.
Source: medicalprogresstoday.com

Prescription Drug Coverage Called ‘Essential’ Under Obamacare Rules

Though little was completely new, a set of regulations and rules for implementing the Patient Protection and Affordable Care Act issued by the U.S. Department of Health and Human Service on Nov. 20, 2012, offered clarity on what health insurance plans would need to cover in order to comply with the law best known as Obamacare. I have sketched out what the regulations mean for pharmacy elsewhere. The two headline items are that prescription drug coverage is listed among 10 essential health benefits and that pharmacy benefit managers affiliated with qualified health plans must cover at least one medication in each U.S. Pharmacopeia-defined drug category, drug class and formulary type. Reactions to the rules have been mixed, with the Pharmaceutical Care Management Association praising HHS for making private plan formulary creation more flexible than it is under Medicare Part D or Medicaid. PCMA, which represents PBMs and mail-service pharmacies, commented that “when plans have more flexibility to design clinically based formularies, they can negotiate bigger price concessions from drug makers and offer more affordable, generous prescription drug benefits to patients.” America’s Health Insurance Plans, which has never fully embraced Obamacare, argued that “while additional flexibility on essential health benefits is a positive step, we remain concerned that many families and small businesses will be required to purchase coverage that is more costly than they have today.” The Centers for Medicare and Medicaid Services is taking comments on the new regulations until Dec. 26, 2012. The pharmacy-specific rules probably won’t change much, in part because the current language reflects feedback on earlier regulatory language from more than 10,000 commenters.
Source: about.com

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

It is also important to be aware that all Medicare Part D plans are required to make medically necessary drugs accessible to the policyholders who need them to treat their conditions. While the exact medication you take may not be included in your policy’s formulary, in most cases you can find a drug that will be just as effective in treating your associated medical condition.
Source: gohealthinsurance.com

AIDS Healthcare Foundation

Almost immediately, Gilead also reached a price reduction agreement on Stribild with the ADAP Crisis Task Force (ACTF), of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAP). In response to the initial steep price of Stribild and the swiftness of the ADAP Crisis Task Force agreement, AHF asked Gilead to also lower the price for other private and government programs such as Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials sent letters to private insurers and state health department directors nationwide urging them to exclude Stribild from their respective drug formularies if the drug was not made price-neutral to Atripla. AHF also asked the program directors to consider placing Stribild on ‘prior authorization’ status. ‘Prior authorization’ requires that a particular prescription must be reviewed by a second medical provider for assessment of medical necessity before being filled for a drug, and the process may add a day to the timeline of a filling a particular prescription.
Source: aidshealth.org

Demystifying Medicare Part D Prescription Drug Coverage

Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an equivalent benefit design. In 2012, the standard benefit has a deductible of $320, and possibly a coinsurance of 25% up to an initial coverage limit of $2,970 in total drug spending, a coverage gap (also known as the “doughnut hole”), and catastrophic coverage after $4,750 in costs. Plan sponsors can also offer plans with enhanced drug benefits. Enhanced plans are required to have a greater actuarial value than basic plans, but plans vary in the ways in which they improve coverage. Enhanced plans may reduce or eliminate the deductible, charge less (on average) than the standard 25 percent coinsurance, and cover drugs in the coverage gap. The best way to find out what types of coverage are available in their area is to speak to a benefit Advisor and they can go over the pricing differences as the enhanced plan will be more costly on a monthly premium stand-point.
Source: extendconnections.com

Maximizing Medicare Prescription Drug Coverage

Medicare beneficiaries take an average of 29 prescriptions per year, spending approximately $1,300 on medications annually.[1] Individuals with chronic conditions such as heart failure often pay more than double that amount.[2]   Fortunately, there is a voluntary program called Medicare Part D that helps beneficiaries pay for their prescription drugs. Beneficiaries can access prescription drug coverage either from a stand-alone Part D prescription drug plan or from a Medicare Advantage plan that bundles coverage of medical, hospital and prescription drug benefits in one plan.   Enrolling in Part D prescription drug coverage is one way beneficiaries can help manage their prescription drug costs, but they should be aware that all Part D plans include a coverage gap, which is often called the “donut hole.” In the coverage gap, beneficiaries’ out-of-pocket costs on their prescription drugs increase significantly.   Summer is the time of year when many beneficiaries enter the coverage gap, making this an opportune time for beneficiaries with Medicare Part D to remind themselves of the following tips that may help them save money on their prescription drugs and make the most of their benefits.    1. Get Help with Managing Multiple Medications Beneficiaries who have a chronic condition that requires them to take multiple medications every day should consider enrolling in a Medicare Advantage Chronic Special Needs Plan. These specialized Medicare Advantage plans combine Medicare coverage with additional support services, some of which are designed to help ensure that members are able to afford their medications and understand how to take them as directed. Many Special Needs Plans also offer personalized pharmacist counseling and drug formularies designed for Medicare beneficiaries with complex health care needs.    2. Understand How the “Donut Hole” Works All Part D plans include a coverage gap. After spending $2,930 in out-of-pocket costs on their drug coverage, beneficiaries will reach the coverage gap. Currently, beneficiaries in the gap pay 50 percent of the cost of their brand-name prescriptions and 86 percent of the cost of generic drugs. In an effort to prepare for the increased expenses while in the gap, beneficiaries should monitor their plan’s Evidence of Coverage statement to get a clear sense of their drug expenditures and see how close they are to reaching the gap.   3. Apply for “Extra Help” with Drug Costs  For beneficiaries with limited income and resources, Extra Help is a federal program that provides an average of $4,000 of additional assistance with prescription costs. According to the Social Security Administration, many beneficiaries who qualify for this program don’t know they are eligible. Medicare beneficiaries must apply for this program, and the amount of assistance is based on annual income and assets. For more information about the Extra Help program, contact the Social Security Administration at 1-800-772-1213.   4. Take advantage of cost-savings on prescription drugs. Beneficiaries enrolled in a Medicare Advantage plan that includes drug coverage should check their plan details to see if they could save money on their prescriptions, such as by using mail-order pharmacy benefits, switching to generic or lower-tier drugs, or taking advantage of special programs available with some plans.   5. Explore “PAP” Programs Several pharmaceutical manufacturers sponsor Patient Assistance Programs (PAPs) that may reduce prescription drug expenses. Some companies offer financial assistance or free products, but all manufacturers have their own rules and grant assistance on a case-by-case basis. For more information, contact the Partnership for Prescription Assistance program at 1-888-477-2669.   For more information about Medicare Part D, contact 1-800-MEDICARE (TTY users should call 1-877-486-2048), 24 hours a day, seven days a week. The Arkansas State Senior Health Insurance Information Program (SHIIP) provides free counseling and support to help beneficiaries understand their Medicare coverage options, including prescription drug coverage. To contact the SHIP office in Arkansas, call 1-800-224-6330.    Ray Morris is the community outreach manager for Care Improvement Plus in Arkansas. Care Improvement Plus is a UnitedHealthcare Medicare Solution providing specialized Medicare Advantage coverage for underserved and chronically ill beneficiaries throughout Arkansas.  
Source: thecitywire.com

Identifying Widely Covered Drugs and Drug Coverage Variation Among Medicare Part D Formularies

Researchers examined the extent of coverage for an array of treatment classes of prescription drugs by formularies that were part of Medicare Part D prescription drug benefits. Information gleaned from the Medicare Web site yielded 4,147 occurrences of coverage for 75 drugs in eight treatment classes from 72 formularies in California. Formularies in Hawa
Source: rwjf.org

Prominent Queens Doctor Pleads Guilty To Medicare Fraud

Posted by:  :  Category: Medicare

Stop the Machine 2011 by Saint Iscariot(TM and Copyright 2012 CBS Radio Inc. and its relevant subsidiaries. CBS RADIO and EYE Logo TM and Copyright 2012 CBS Broadcasting Inc. Used under license. All Rights Reserved. This material may not be published, broadcast, rewritten, or redistributed. The Associated Press contributed to this report.)
Source: cbslocal.com

Video: Support S.829- Medicare Access to Rehabilitation Services Act of 2011

GAO: Consistent Prepayment Audits Could Save Medicare $1.8B

Prepayment audits saved Medicare at least $1.76 billion in fiscal year 2010, but the savings could have been even greater if prepayment audits were more widely used, according to a new report from the Government Accountability Office. CMS reported an improper payment rate of 8.6 percent in the Medicare program for fiscal year 2011. That amounts to roughly $28.8 billion. The GAO was asked to assess the use of prepayment audits in Medicare, in which payments are reviewed before being paid to providers. The GAO found $14.7 million in payments from FY 2010 that “appeared to be inconsistent with four national policies and therefore improper,” according to the report. The agency also identified more than $100 million in payments that were inconsistent with three selected local coverage determinations, which are established by each Medicare administrative contractor to specify coverage rules in its jurisdiction. These payments could have been prevented through automated prepayment audits, according to the GAO. The GAO said CMS’ processes for prepayment audits have some weaknesses, including incomplete analysis of payment vulnerabilities, lack of specific time frames to implement audits, incomplete assessment of whether audits are effective and lack of full documentation of the processes. The agency recommended seven actions to CMS to strengthen prepayment audits, including full documentation of the process, and HHS “generally agreed” with those recommendations and noted CMS’ plans to address them.
Source: beckershospitalreview.com

Report: Medicare EHR Incentive Program Vulnerable to Abuse

The report noted that although CMS officials are making sure that providers are checking off the necessary boxes in their submitted forms, the officials are not taking the additional steps to ensure that providers are providing truthful and accurate information. The agency also does not require physicians and hospitals to submit additional documentation illustrating evidence of their claims.
Source: ihealthbeat.org

Medicare issuing 2011 PQRS, eRx bonuses with “L” on RAs

For that reason, carrier accounting systems may place a negative sign before the dollar amount of a levy on a remittance notice. However, “in the case of PQRS and eRx incentive payments, the LE indicator represents an incentive payment and although the negative sign may appear on the remittance advice, the amount indicated does not represent a withhold or overpayment amount,” the Palmetto website continued. Both Medicare electronic and paper remittance advice provide additional coding to help practitioners identify PQRS and eRX incentive payments, the carrier noted.
Source: newsfromaoa.org

Medicare Eligibility Age Increase Rejected By Obama Allies

DURBIN: I do believe there should be means testing. and those of us with higher income in retirement should pay more. That could be part of the solution. But when you talk about raising the eligibility age, there’s one key question. what happens to the early retiree? What about that gap in coverage between workplace and Medicare? How will they be covered? I listened to Republicans say we can’t wait to repeal Obamacare, and the insurance exchanges. Well, where does a person turn if they are 65 years of age and the medicare eligibility age is 67? They have two years there where they may not have the best of health. They need accessible, affordable medical insurance during that period.
Source: firedoglake.com

Hospitals’ Readmissions Rates Not Budging

Medicare calculates readmission rates over three years. The most recent rates are based on readmissions spanning July 2008 through the end of June 2011. The Medicare data published Thursday on its Hospital Compare website showed that 19.7 percent of heart attack patients were readmitted within 30 days of discharge, a drop of only 0.1 percentage point from the previous year’s figures, which were based on the years 2007 through 2010. The data show that 24.7 percent of heart failure patients were readmitted, also a 0.1 point decrease. Pneumonia readmissions actually increased by 0.1 percentage points, to 18.5 percent of all Medicare pneumonia patients.
Source: kaiserhealthnews.org

ACP: Practice Management Center

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

Obama Skeptical Of Raising Medicare Eligibility Age

“When you look at the evidence it’s not clear that it actually saves a lot of money,” he said in an interview with ABC News’ Barbara Walters aired Tuesday night. “But what I’ve said is let’s look at every avenue, because what is true is we need to strengthen Social Security, we need to strengthen Medicare for future generations, the current path is not sustainable because we’ve got an aging population and health care costs are shooting up so quickly.”
Source: talkingpointsmemo.com

Brad DeLong : Aaron Carroll: Raising the Medicare Qualifying Age Is Really, Really, Really, Really Bad Policy

Raising the eligibility age will likely hurt seniors’ health: [P]eople wait to get care until their Medicare kicks in.  This is bad both for health and for the federal government’s bottom line…. Medicare improved the health of the uninsured; delaying Medicare would delay that help. The argument for why things would be different this time around is that Obamacare will prevent 65 and 66 year olds from becoming uninsured. Through the Medicaid expansion, or through the exchanges, everyone would get coverage. Therefore, there would be no jump in quality once people get Medicare.
Source: typepad.com