Medicare Cuts: How Healthcare Providers and Collection Agencies Can Fight Back

Posted by:  :  Category: Medicare

Dr. Donald Berwick by Talk Radio News ServiceThird-party payors are reducing the amounts they will pay for services; hospital employees are amplifying their demands for higher pay and more benefits; the ever-increasing cost of equipment, pharmaceuticals, and supplies shows no sign of abating; costs associated with regulatory compliance are mushrooming; and as if that is not enough to drive any revenue cycle professional crazy, beginning in January of 2013, providers will begin to feel the effects of changes to the Medicare reimbursement program.
Source: insidearm.com

Video: CareMore Medicare Diabetes Commercial by Traffik | Orange County Advertising Agency

Doctors Reconsidering Their Participation with Medicare

Advertising Branding Brand Relationships Brochure Design Brochure Printing Domain Names Drug Companies Effective Fonts Frequency Health Care Health Care Marketing Home Care Sales Home Health Care Home Health Care Brochures Hospice Care Internet Marketing Leadership Logos Marketing marketing reps Memory Motivation Name Recognition Office of the Inspector General OIG Orthopedic Surgeons Orthopedic Surgery Personal Relationships Physical Therapy Physical Therapy Brochures Pre-Surgical Visits Print Print Advertising Referral Sources Sales Sales and Marketing Sales Coaching Sales Management Sales People Sales Training Target Audience Top of Mind Awareness Website Websites
Source: bma-advisor.com

Medicare Agency Rules in favor of Patient Access to CRNA Care

Even though Missouri CRNAs have had a temporary regulatory setback regarding the provision of Chronic Pain services under fluoroscopy, this is excellent news for our brothers and sister across the nation providing chronic pain care to rural, senior, and economically disadvantaged Americans! This is one more piece of evidence to permanently end the Missouri restriction.
Source: moana.org

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

Whitepaper: Medicare Reimbursement Cuts

Third-party payors are reducing the amounts they will pay for services; hospital employees are amplifying their demands for higher pay and more benefits; the ever-increasing cost of equipment, pharmaceuticals, and supplies shows no sign of abating; costs associated with regulatory compliance are mushrooming; and as if that is not enough to drive any revenue cycle professional crazy, beginning in January of 2013, providers will begin to feel the effects of changes to the Medicare reimbursement program.
Source: insidepatientfinance.com

Report estimates health plan overbilled Medicare $424M

Dec. 17, 2012 – Medicare may have overpaid an estimated $424 million to PacifiCare of California’s Medicare Advantage plan based on risk assessments that in many cases made patients seem sicker than they were, according to a federal oversight agency. Medicare Advantage plans send patient diagnosis codes to Medicare, which boosts plan rates if clients are affected by serious medical conditions. A new report by the U.S. Health and Human Services inspector general says PacifiCare was paid extra for treating patients with cancer or a dangerous bloodstream infection even though medical records didn’t describe those ailments. UnitedHealth Group, which now owns PacifiCare of California, disputed the inspector general’s findings, saying the review of 100 cases could not be generalized to hundreds of other claims. “The audit does not follow Medicare’s own guidelines, standards or accepted methodology for validating risk-adjustment payments,” a statement by UnitedHealthcare Medicare & Retirement says. “In fact, it differs significantly from (Medicare’s) adopted methodology. The OIG appears to have relied instead on a methodology of its own making.” The inspector general’s office reviewed UnitedHealth’s response before issuing the report and maintains that its methods are valid. The report, released Thursday, calls on Medicare to review its findings and discuss them with PacifiCare. A Centers for Medicare & Medicaid Services representative said the agency, which administers the Medicare program, is aware of the report and is willing to work on the matter with PacifiCare. Medicare Advantage plans collect patient diagnoses from doctors and hospitals that are used to assign risk scores to clients. Patients with serious medical conditions entitle the plans to heightened per-patient, per-month Medicare payments. The inspector general reviewed a 2007 contract between Medicare and PacifiCare. Under that contract Medicare paid PacifiCare $2.3 billion to administer care for 188,829 clients. The review examined 100 clients’ risk scores, diagnostic codes and related medical records. The inspector general concluded that 55 risk scores were valid, but 45 were not supported by information in patient charts. The inspector general found that PacifiCare submitted a diagnosis code for a genetic disorder characterized by abnormal brain function in a patient whose records only discussed a fever and a cough. Another patient was reported to have prostate cancer when medical records discussed a shoulder suture removal. For a third patient, PacifiCare submitted a diagnosis code for “unspecified septicemia,” a lethal infection of the bloodstream, when medical records discussed a knee surgery and did not mention a bloodstream infection, the report says. The inspector general directed PacifiCare to repay Medicare $224,388 that was overpaid as a result of the 45 charts with unsupported diagnoses. Applying the estimated overpayment rate to 188,000 PacifiCare patients under the 2007 contract, the inspector general estimated that Medicare overpaid about $424 million. UnitedHealth said in its statement that it has worked with Medicare to improve the accuracy of health plan payments and will continue to do so. “Payment accuracy is in the best interests of UnitedHealth, our health care system partners, and Medicare as we collaborate to provide coverage and care that Medicare beneficiaries need, at a price they can afford,” the statement says. The report comes amid a series of watchdog agency and news reports that examine enhanced Medicare payments that can flow to health providers if they overstate the intensity of patient demands or the severity of their medical conditions. The inspector general found in November that Medicare overpaid nursing homes by about $1.5 billion in 2009 based on claims that patients needed “ultra high” levels of therapy. The report found that claims were “upcoded” because the records showed that the patients either did not need or get the therapy in many cases. The Washington Post also examined “ultra high” therapy use in 2010, focusing on a chain that operates dozens of homes in California. The Center for Public Integrity reported in September that doctors and other medical professionals are steadily billing higher rates for treating Medicare patients, signaling a possible increase in billing abuse. And California Watch reported on high rates of severe medical conditions that entitled Prime Healthcare Services, a growing California-based chain, to bonus payments. Prime Healthcare has said its Medicare billings are legal and based on appropriate patient care. www.CaliforniaWatch.org
Source: yubanet.com

Staten Island Insurance Agency Offers Free Medicare Health

“As an authorized representative of insurers such as Empire Blue Cross/Blue Shield; AARP® Medicare Plans from UnitedHealthcare® (UHC); EmblemHealth®, and Touchtone, we routinely provide clients with a free comparison between all the different plans offered on Staten Island,” DeFranco said. “In addition, our firm has knowledge of which doctors and prescriptions are covered by each of the plans.”
Source: siborrealtors.com

Medicare Cuts Loom Large

“There is no fixed list of activities that the FDA will drop without this money, but significant programmatic and manpower reductions would be impossible to avoid,” Steve Grossman, deputy executive director for the Alliance for a Stronger FDA, wrote on the advocacy group’s blog. “Mission failure may not be an option for FDA, but it will be very hard to avoid.”
Source: therighttobeheard.org

Bucks County Specialty Hospital gets highest Medicare scores in Philly metro

The biggest Medicare winner locally, based on so-called process of care and patient satisfaction standards, is the Bucks County Specialty Hospital in Bensalem, an orthopedic facility majority-owned by the Rothman Institute. It will receive a 0.67 percent bonus over standard Medicare payments.
Source: medcitynews.com

Doctor pleads guilty to taking kickbacks in Medicare scam

This week, two owners of Miami home health care agencies pleaded guilty to a $48 million fraud scheme. Rogelio Rodriguez, 43, and Raymond Aday, 48, paid recruiters to send patients to Caring Nurse Home Health Corp. and Good Quality Home Health Inc. Prosecutors said nurses and other staff at the agencies falsified patient files to make it appear as though they needed home health care services.
Source: californiawatch.org

Area Agency on Aging Presents ‘Medicare Changes Everyone Needs to Know’

Join the Area Agency on Aging from 10-11 a.m. on Tuesday, Nov. 20 at the Troy Community Center for this session on the changes to Medicare, the Part D drug plans, and how the Affordable Care Act will change Medicare in 2013.  Reservations are not required. 
Source: patch.com

Navigating Medicare's Open Enrollment Period

Posted by:  :  Category: Medicare

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

Video: Medicare Open Enrollment Preparations

Medicare open enrollment: Did Obamacare secretly increase Part B premiums?

Here’s what’s happening. The 2003 law that set up these high-income premium surcharges also stated that the income thresholds were to increase every year to account for general inflation. But the Affordable Care Act freezes the thresholds at their current level through 2019, which will over the next six years snare more and more beneficiaries as incomes in general rise (or at least we hope they do). The Kaiser Family Foundation estimates that by 2019, about 14 percent of Medicare beneficiaries will be paying these higher premiums.
Source: consumerreports.org

NHMSP: The Day has Arrived

Visit www.nhcoa.org/medicare for more information about Medicare fraud and how to get involved with the National Hispanic Seniors Medicare Patrol (NHSMP), or call us at 1-866-488-7379. Also remember you still have a day to take advantage of Medicare Open Enrollment. Call Medicare at 1-800-MEDICARE or visit www.medicare.gov to make an informed decision using the Medicare Plan Finder.
Source: nhcoa.org

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

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

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

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

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

A 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

Q&A: Medicare open enrollment too often overlooked

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

Medicare Open Enrollment Ends December 7

advocacy Alpha-1 anxiety asthma awareness bronchiectasis bronchitis caregiver caregiving CDC chronic bronchitis comorbidities COPD COPD awareness COPD education depression education emphysema exacerbation exacerbations exercise family FDA healthcare Healthy Living lung health lung transplant medicare motivation mucus o2 osteoporosis oxygen pneumonia POCs pulmonary rehab pulmonary rehabilitation research smoking Smoking Cessation spirometry supplemental oxygen support traveling with oxygen world copd day
Source: copdfoundation.org

Medicare ID Cards to Get a Makeover

Posted by:  :  Category: Medicare

The problem leads to serious consequences for victims. When bad guys use your identity for medical care, their medical information (blood type, etc.) may be added to your record, adversely affecting your own treatment. When thieves repeatedly use your health insurance information, you may quickly reach caps that limit the services and medical devices that you’re eligible to receive. When you try to make a legitimate health insurance claim, your health plan may deny coverage once the caps are met.
Source: idt911blog.com

Video: Private Label Prescription Drug Card Affiliate Program

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in. Also of interest: You can help fight health care fraud. 
Source: aarp.org

Left Behind: Will Cutting Medicare Hurt Seniors?

If blunt tactics like lowering the Medicare eligibility age or slashing provider reimbursement across the board aren’t the right way to control Medicare costs, then what is? What the Annals authors suggest will sound familiar to anyone paying attention to fundamental changes already underway in the health care delivery system. They (as do others) urge greater focus on providing more efficient care for each individual’s particular condition through physician use of comparative effectiveness research abetted by “organizational incentives” to reward providers of high-quality, cost-effective care.
Source: healthworkscollective.com

At Goal Weight Watcher: The Truth, Nothing but the Truth

I am officially an old fart now. I have my Medicare card signed and ready and effective today. I originally thought it would not be in effect until my birthday later in the month. I’ve been hearing that fewer and fewer doctors take Medicare so it may not be a big help. I do know that the cost of approximately $200 a month will be better for us. United had already notified us that they were going up to $824 a month for our $5000 deductible health insurance policy.
Source: blogspot.com

Medicare cards should not expose Social Security numbers

“Making the necessary changes will require significant monetary investments, multiple systems and operational changes, not just for CMS and its contractors, but also for (the Social Security Administration), state Medicaid programs, private health plans and providers that CMS interacts with regarding beneficiary information for enrollment and claims payment,” Tavenner said.
Source: triblive.com

Woman Shows Medicare Card On Camera For Millions To See At DNC

During former President Bill Clinton’s speech, an audience member who was receiving oxygen through a nose tube showed her Medicare card on camera while Clinton was railing about Republicans wanting to “end Medicare as we know it.”
Source: cbslocal.com

Daily Kos: Social Security and Medicare can be made stronger and better through progressive changes, not cuts

Yes, Social Security and Medicare could benefit from changes, but the change should not favor giant corporations who seek to profit from and privatize both programs.  Change should be designed to favor those people who paid into the programs and need the benefits. ________ 1) Gellad, Schneeweiss, Brawarsky, Lipsitz, Hass, (2008) What if the Federal Government Negotiated Pharmaceutical Prices for Seniors? An Estimate of National Savings, Journal of Internal Medicine, September, 23(9), 1435-1440.  On line, 2008 June 26. doi:  10.1007/s11606-008-0689-7.  Available at: http://www.ncbi.nlm.nih.gov/…
Source: dailykos.com

Putting the Medicare Cards On the Table: Court Rules That L

However, from the author’s review of CMS’ statements (both oral and written) on the issue, the question may not necessarily be “is an L-MSA required?” That answer is seemingly “no”— even from CMS’ perspective. Id. Rather, the “issue” may more appropriately be: “Is there an obligation to protect Medicare’s ‘future interests’ as part of a liability settlement?” or, from a more practical position, “Does CMS believe there is an obligation to protect Medicare’s ‘future interests’ as part of a liability settlement?” See id; and Charlotte Benson, CMS Memorandum: Medicare Secondary Payer: Liability (Including Self Insurance) Settlements, Judgments, Awards, or Other Payments and Future Medicals, September 30, 2011. As part of this, consideration should also be given to the fact that recent versions of the MSP manual have included references to both L-MSAs and no fault Medicare Set-Asides. Also, at the time of this article’s publication, CMS has advised that it is in the process of developing regulations surrounding Medicare Secondary Payer compliance regarding future medicals. See pending rule; “Medicare Secondary Payer and ‘Future Medicals’ (CMS-6047-ANPRM),” May 3, 2012. Thus, while CMS may acknowledge that L-MSAs, are not “required,” this other evidence would seem to suggest that on some level, to some extent, and in some manner, the agency believes there is some obligation to consider Medicare’s interests with respect to certain liability settlements, with the “MSA” being just one vehicle or option available toward that end. Assuming that this in fact CMS’ position, the question would then become; “are they correct legally?”
Source: lexisnexis.com

Rancho Santa Clara: Medicare knocking at my door

AARP will sign you up and then clobber you with useless mailings, solicitations and lame publications as early as your fiftieth birthday, while you may still be working, and keep at it until long after you die unless some thoughtful relative mails in a cancellation notice in your stead. And with the ever-so-“flexible” and “efficient” American economy, your employer can lay you off and effectively send you into retirement without waiting for your fifty-fifth, sixty-second or any such arbitrary birthday. Losing your job is not necessarily a marker of old age or incompetence anymore. Often it’s just bad luck. The ticking of the Medicare clock, however, is precise and inexorable. If you choose to continue to work after your enrollment, goody for you, particularly if you love what you do and you’re not doing it just out of economic necessity. Indeed, I’m jealous of octogenarian artists, writers, scientists and other inspired sorts who whistle away the hours in their garrets or laboratories until they keel over their easels, typewriters or beakers without even a final “ciao.” Way to go, I say. That bliss, sadly, is relatively rare. Besides, even joyful work doesn’t necessarily extend your life though it certainly simplifies choices: It saves you the chore of  deciding whether you’d rather spend a month in the Patagonia, take up scuba diving, write a novel or do anything else other than work. As I approach the sixty-five-year-old threshold–hey, there are three days left–what I feel most is the pressure of time, both short- and long-term. During the recent funeral of an uncle I noticed the Laniers seem to be long-lived tribe. My dad died a few days before his ninety-fourth birthday; my uncle at ninety-two; and my aunt Ofelia at ninety-six, though during her last couple of years her mind kept flickering like a fading shortwave station. My mom lived to be eighty-eight. Stew’s family is also of durable Norwegian stock, good for about  ninety years, the last couple of which Stew’s dad spent in a nursing home reaching for the ass of a young nurse he fancied. Our actuarial tables would suggest that Stew and I might be around for another twenty years or so. A friend counseled us to divide that remaining time into three parts: The go-go years, when we can still climb Machu Picchu and trek through the Galápagos; the slow-go years, when cruises with off-shore excursions may be more appropriate; and finally the  no-go years, which we might spend in a nursing home like Stew’s dad, though in our case hoping for a comely male nurse to join the staff. When we retired our friends kept posing the same tiresome question: But what do you do all day long? The question, though well-meaning, to me had a whiff of contempt, as in “what do you when you’re out to pasture or otherwise useless”? It’s a question that becomes more impertinent and irrelevant every day. Fact is that anymore I find time becoming a tyrant, not because of any boredom and emptiness it might bring, but because of the constant proliferation of interesting things and projects swirling in my head, clamoring to be mastered or at least attempted before the no-go years. Priorities suddenly are a preoccupation, though I haven’t developed a system for ranking–or abandoning–projects because I have only twenty or twenty-five years in which to accomplish them. I would like to write something substantial, a book-like creation, though the subject eludes me. Photography, an on-and-off hobby since I was a teenager, suddenly is taking more of my life now that I have more time and money to devote to it. Gardening beckons too, though I don’t know if it’s an avocation or in the hostile terrain of San Miguel a challenge, in the order of man-versus-nature. Having more time to read also constantly reminds me how much I don’t know. And with the usefulness of any new knowledge suddenly unimportant–remember, I’m not cramming for a final exam or to impress my boss–I’m free to careen from one topic to the next. I’m now on a tour of the battlefields of the American Civil War, which I know little about, after which I could take up a novel with no special practicality except it’s a fun read. My tolerance level also has dropped significantly. I don’t put up with boring books, articles, TV shows or movies. I don’t have to. There’s not enough time. It’s a pretty enjoyable existence I’d like to keep go-going as long as I can. And I’m not going to let the addition of my Medicare card to my wallet wreck the feeling.
Source: blogspot.com

The Fastest Way to Get your Medicare Card

The supplemental insurance agent we use at work joined Columbia River Insurance Services over a year ago. We got some great rates on our new personal life insurance policies. Chrys suggested we get a quote on our home and auto policies. Another employee advised she had CR take a look at her policies and she saved a ton so we finally checked it out. With farm, home, residential rental, and multiple vehicles it wasn’t the easiest policy to review. This was no 15 minutes and you’re done! As it turns out we didn’t really save much if any money, but gained A LOT of necessary coverage – much of which we didn’t realize was missing under our old policy!! We couldn’t be happier. We’re recommending Columbia River to all our friends and family. Thanks Chastain & Chrys!
Source: columbiariverinsuranceservices.com

Ohio Health Policy Review: Ohio Medicare

Posted by:  :  Category: Medicare

Attorney General Richard Cordray Announces Candidacy for Re-election by ProgressOhioThe federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Video: What Are The Ohio Medicaid Eligibility Guidelines

Ohio should say yes to Medicaid expansion

5) Ohio can’t afford not to expand. If Ohio does not implement the expansion, federal funds that help pay for care for people without insurance will decline here, but costs for treating those people will not. Federal funds that help states pay for care for people without insurance are set to drop starting in 2014. That’s because the health reform law anticipates that as states expand Medicaid, there will be fewer people without insurance needing emergency room care. But in states that do not expand Medicaid the treadmill of treating the poorest and sickest in emergency rooms will continue. If that’s the case in Ohio, hospitals would face unattractive options: reducing services, shutting down, raising treatment fees on people with insurance, or seeking state tax dollars.[17] 
Source: policymattersohio.org

Ohio Medicaid Program Raises Stakes For Nursing Homes

States such as Colorado, Georgia, Kansas, Nevada, Oklahoma, Utah and Vermont have tried to change that by awarding a small bonus (from 60 cents to $6.16 per day) if facilities achieve various standards.  But industry representatives say those incentives are insufficient to generate significant enthusiasm for altering the status quo, according to Nicholas Castle, who has surveyed nursing home administrators and is a professor of health policy at the University of Pittsburgh.
Source: kaiserhealthnews.org

Ohio nursing home displaces 14 as Medicaid reimbursements fall : The Nursing Home Monitor

24-7 Press Realease reports: “We trust assisted living care facilities and nursing homes to care for our most vulnerable loved ones, those who have become unable to care for themselves. We expect that the medical professionals who run these facilities will provide the necessary support and care.” Read More…>> Unfortunately, when the facilities fail to meet their obligations, the consequences can be tragic. Moreover, it can be difficult to recognize that the facilities are not providing proper care, as elderly residents may be unable or unwilling to speak up.”
Source: nhmonitor.com

Next Up on the Duals Demos: Ohio

Under the Memorandum of Understanding signed with the Centers for Medicare & Medicaid Services (CMS), Ohio will use its newly created Integrated Care Delivery System (ICDS) health plans to deliver Medicare and Medicaid services to nearly 115,000 of the state’s dual eligibles. ICDS plans will be responsible for providing person-centered care following a comprehensive assessment process that takes into account the medical, behavioral health, long-term services and supports, and social needs of enrollees. Dual eligibles will be able to voluntarily enroll into an ICDS plan as of September 1, 2013. Those that do not opt-in will be passively enrolled in three phases by region starting on October 1, 2013. The state intends to use an “intelligent assignment” process that will take into account beneficiaries’ previous managed care enrollment and provider use.
Source: communitycatalyst.org

What is Medicaid Spend Down

For so many of us, aging means coming face-to-face with challenges that are frightening to us and to our families – our friends pass, our health begins to fail, our memory slowly seems to fade. As we age, we realize that our families may be forced to place us in a care facility and we grasp at a way to maintain our dignity. For the first time, we are facing our own mortality and we feel the need to make sense of our lives and to leave some type of legacy.  We can help with all of your questions.
Source: whatismedicaidspenddown.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Source: medicare.gov

Video: The Road to Data Democracy: Introducing the CMS Dashboard

Bucks County Specialty Hospital gets highest Medicare scores in Philly metro

The biggest Medicare winner locally, based on so-called process of care and patient satisfaction standards, is the Bucks County Specialty Hospital in Bensalem, an orthopedic facility majority-owned by the Rothman Institute. It will receive a 0.67 percent bonus over standard Medicare payments.
Source: medcitynews.com

Daily Kos: Medicare also going over the “cliff”

In 2003, Texas voters approved Proposition 12, tort reform which capped medical malpractice payouts and made it more difficult for patients to sue hospitals. Republican politicians, led by Gov. Rick Perry (R), claimed that doctors were providing less services to patients because they feared getting sued. Republicans, joined by a “Yes on 12” campaign funded by the health insurance industry, promised that the amendment would lower health care costs and bring an influx of doctors to the state. Since 2003, Republicans nationwide have touted Texas as a model for tort reform. Now, a group of researchers studying Texas Medicare spending have found no decrease in doctors’ fees for senior citizens between 2002 and 2009. Medicare payments to doctors rose 1 to 2 percent faster than the rest of the country, Northwestern professor Bernard Black, a researcher on the study, said. In urban and high population counties, the study’s authors expected to see lower health care costs stemming from a reduction in medical tests doctors previously used to protect themselves from lawsuits. However, the researchers found no decrease in costs and a slight increase in medical tests performed. “This is not a result we expected,” said Bernard Black, a co-author and a professor at Northwestern University’s Law School and Kellogg School of Management. http://thinkprogress.org/…
Source: dailykos.com

Medicare Discloses Hospitals’ Bonuses, Penalties Based On Quality

The program is one of several Medicare is launching to make hospitals and doctors accountable for quality and more careful stewards of public money. In October, Medicare also began reducing payments to 2,217 hospitals because too many of their patients ended up back in their care within a month. Medicare already gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017.
Source: kaiserhealthnews.org

15% Medicare Supplement Rate Increase is Outrageous!!! » Toni Says

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSCindy, one Medicare rule that you should be aware of since you are not happy with your rate increase from your current Medicare Supplement company is…if you had a Medicare Supplement policy before you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the Medicare Advantage Plan, you will have special rights to buy a Medicare Supplement policy if you return back to “Original Medicare” within 12 months of first joining a Medicare Advantage plan.  If you had a Medicare Supplement policy before you joined, you may be able to get the same plan back if the company still sells it.  If it isn’t available, you can buy another Medicare Supplement policy. (Please see page 66 of the
Source: tonisays.com

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

What Is A Medicare Supplement

There are ten different Medicare supplement plans.  Each one is given a different letter.  The letters skip a few here and there because plans that were once available have been retired and the labeled the new plans with the next letter in the alphabet so as not to create confusion for people who were grandfathered in on the old plans.  The plans themselves cover a varying number of combinations of the nine different coverage gaps that were left by the coverage you get with Medicare Part A and Medicare part B.  The Gaps include: the deductible, coinsurance, first three pints of blood and hospice care from Medicare Part A, The deductible and coinsurance for Medicare Part B, skilled nursing facility care, and expenses for foreign travel emergencies. Which plan you select dictates how many or what combination of these coverage gaps are covered.  Plan A covers only four of the gaps while Plan F covers all nine.
Source: seanbrock.com

Looking Into Different Aspects Of Medicare Supplemental Insurance

One issue that is near and dear to our hearts when considering health insurance is prescription drug coverage.  It is notable to understand that any Medicare Supplemental Policy you currently purchase will not come with prescription drug coverage.  This is something that needs to be purchased through separately and is referred to as Medicare Part D prescription drug coverage.
Source: seniorhealthdirect.com

Part V: Medicare Supplemental Insurance

You can only obtain Medicare supplemental insurance, or Medigap, if you enroll in Traditional Medicare. While Medigap covers the out of pocket costs that arise under Medicare Parts A and B, it does not usually pay for any costs under Part C, Part D or private health insurance plans. Many private insurers offer Medicare supplemental insurance, and coverage comes in 10 different options: A, B, C, D, F, G, K, L, M and N. Some of these options do provide prescription drug coverage through Part D.
Source: wordpress.com

When Can I Get Out of My Medicare Advantage Plan?

First and foremost, you should apply for the supplement plan with either a February 1 or March 1 effective date. Approval on a Medigap policy can take 2-3 weeks to complete underwriting. So it is important to do this well in advance of when you want the plan to start. For example, if you want to make the changeover effective 2/1/13, apply early in January for the supplement (or even during the last couple weeks of December). Once your Medigap plan is approved, you can proceed with returning to Medicare with a Part D plan. The easiest way to do this is to call Medicare (1-800-MEDICARE) and select a Part D plan, while at the same time disenrolling from your Medicare Advantage plan. You cannot have both a Part D plan and a Medicare Advantage plan, so this changeover can be done within the same phone call. Make the changeover effective either 2/1/13 (if doing it in January) or 3/1/13 (if doing it between 2/1 and 2/14).
Source: medicare-supplement.us

AFLAC Medicare Supplement Insurance Plans Now Available for Sale in 27 States

All states except NY and FL are now available for recruiting. The final states recently added are WI, MN and MA. If you plan to recruit in these states make sure you are appointed. If you are not currently set up for any of these states and would like to be, please forward the State License you would like to be set up in and we will get you set up as quickly as possible.
Source: ihealthbrokers.com

Medicare Supplemental Insurance Website Server Starts Data Center Fire, Authorities Say

A blaze which started at a Denver data center on Wednesday night has been contained with no one hurt, authorities say. The fire was reportedly started by an overheated server utilized by local Medicare Supplemental Insurance comparison website: http://medicaresupplementalinsurancecomparison.net. The fire started roughly two hours after the website’s initial launch. As the server heated up from the initial rush of traffic the CPU cooling system malfunctioned causing a chain reaction that led to the fire starting. The fire rapidly consumed a corner of the first floor in the data center. “This isn’t the first time a website’s launch has caused a server to overheat,” says Marcus Stevenson, director of operations at FSPServerDirect. “Overheating servers are common with websites that underestimate the demand they’ll receive at any given time. Though a fire would not have started if the system had not malfunctioned in the way that it did.” The fire reportedly caused significant damage to the host building but none of the neighboring structures were affected. Experts say the most expensive loss will likely come from the damaged server racks- Each one costing up to $10,000. The Medicare website owners would not comment, but according to a company spokesman the website is back up and running and was only down for 3 hours. “Admittedly we underestimated the sheer demand for this type of website,” says a company spokesperson. “We received 18 thousand visits in our first 2 hours online, most of which came from people searching for Medicare supplemental insurance through Google. As we entered our second hour after launch our site was suddenly kicked offline. Only the next morning were we told that our website might have caused the fire, but since hosting is an outside service we were not held accountable. The data center admitted to us that their own negligence was a major contributor to the fire. Needless to say we have upgraded to a brand new server and had it checked over thoroughly. We will now be able to handle as much traffic as we can get.” Experts say the demand for the site was so high because it’s one of the first websites of its kind to provide side by side comparisons of Medicare supplemental insurance companies by only entering a zip code. “This is rare for these types of sites,” says a company spokesman. “Most sites like this require personal info before they provide quotes, and the non-invasiveness of our site has definitely contributed to its popularity.” To learn more about the fire, or to get free side by side comparisons of the most reputable Medicare supplemental insurance providers in an area, please visit: http://medicaresupplementalinsurancecomparison.net/ About medicaresupplementalinsurancecomparison.net Medicaresupplementalinsurancecomparison.net was created in December of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

How To Know If You Need Medicare Supplemental Insurance

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

Do You Need Medicare Supplemental Insurance?

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

Medicare Supplement Insurance Plans

You just need to fill out a fundamental questionnaire when employing a service to get Medicare Prograde supplement evaluations Supplement Insurance Plans.  Prices from multiple providers will be collected for you so you can evaluation the policy figures and rates from all the insurance providers.  You can choose out those insurance plans that give you exactly what you need to have and that are within your economic attain.
Source: lapappalpomodoro.com

Comparing Medicare Supplemental Insurance Benefits

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

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

It's all there in black and white by Dave77459At first glance this doesn’t make any sense at all since I just told you that it was more expensive on a monthly basis, but when you break down what it covers and the risk involved the Medicare supplement plan f will save you money in the long run.  With the coverage gaps left by Medicare Part A and Part B you can choose any of the ten Medicare supplement plans.  The problem is that each plan covers a different amount or combination of those coverage gaps.  So if you choose plan A you are still open to extra costs from a need for skilled nursing care, the Medicare part A deductible of $1,156, the Medicare part B deductible of $140 annually, any foreign travel expenses, and an charges that fall under Medicare Part B that are above the Medicare approved amount.  In this example if you went into your doctor’s office he would charge you $140 before any of your coverage comes into play.  If that same doctor decided you need to be admitted to the hospital you would then owe the $1,156 for being admitted.  After that you would be subject to additional charges if they moved you to a skilled nursing facility.  Just one quick incident can add up fast and instead of worrying about all this you can moderate your life by just getting a Medicare supplement plan F.
Source: dzida.org

Video: Medicare Supplement plan F High Deductible Explanation

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

Physicians want permanent fix for long

The sustainable growth rate formula used by the Centers for Medicare and Medicaid Services to calculate payments to physicians is based on varied criteria that include the gross domestic product, estimated changes in fees for services and the number of beneficiaries enrolled in Medicare. As the years have gone by, the taxpayer costs of freezing the formula so there would be no cuts in rates continued to rise.
Source: kansas.com

Free Online Games: This Medicare Supplement Plan F Is Also 1 Among The Medigap Plans Which Gives Rewards Towards The Customers

Whenever you program to pick a coverage then you will need to seek advice from together with your family members and selected the very best a single, if you ever really feel very complicated then it is easy to seek the aid from the issue to ensure that they may assist you to choose the best a single. The foremost factor that you just should really search ahead of you consider the policy is definitely the protection that may be needed to fulfill your requires, along with the 2nd factor which you must look into is whether or not the amount of the strategy is restricted to your budget if all these are comfy for you personally in a unique plan then you could very well take them and get pleasure from the rewards. This medigap plan f is offered by many private insurance coverage issues and also you can decide the one particular that’s beneficial for you. These medicare dietary supplement plan presents many different estimates and you might get them totally free. To understand way more relating to this medigap plan f along with their benefits you’ll be able to call them straight else view the web page whichever is comfy and from these each you will get to understand regarding their plans and also the way you are going to be benefited with it. You may also follow them on twitter cultural networking site to know the updates, they hold updating their status to ensure that people can know their work even better. To know their offers and information you are able to join them on the publication which will be tremendously necessary for each of the shoppers to know the updates from the ideas. Each policy has its personal way of benefits so before you pick the coverage be sure that concerning the rewards and believe twice in regards to the want for you personally and after that takes up the plan, they are the basic items which has to become known ahead of you take up the policy. The high quality in each policy relies upon on the coverage and it really is sure that what ever may well be the plan that is definitely taken you might acquire the benefit.
Source: blogspot.com

Centers for Medicare and Medicaid (CMS) Targets Hospital Readmissions – Update on Practices and Policy

As reported in the Napa Valley Register on October 14, 2012, variations in local practices patterns are already being noticed. For example in Napa Valley, Queen of Valley Medical Center has a 18 percent readmission rate, St. Helena Hospital a 13 percent readmission rate, and Kaiser Permanente Vallejo Medical Center a 7 percent readmission rate. Local hospital officials are claiming that reduced readmissions incorrectly assumes better care and that not making exceptions for unavoidable readmissions are policy flaws.  While officials at Kaiser Permanente of Northern California indicated that they had no concerns about the policy change because “it promotes co-ordianation of care, individuals at Queen of Valley Medical Center and St Helena’s Hospital expressed a variety of concerns from the fragile natur of patients in certain of the included diagnoses and the 30-day time fram to evaluate readmissions.  Moving forward to lower readmission rates at Queen and St. Helena indicated that they will pay more attention as patients are discharged from the hospitals during transitions of care, Professionals will coach patients in self-management through home visits and phone-calls after they have been discharged from the hospital.
Source: pharmaceuticalintelligence.com

Do I Need A Medicare Supplemental Insurance Policy?

The cost of each plan will be based on the age, gender, overall health, and location of the individual to be insured. Anyone just turning 65 or going on Medicare Part B for the first time can enter into a plan during the Open Enrollment. Open enrollment means that for 6 months, individuals have the opportunity to enroll in a Medicare supplemental insurance plan without having to go through a health examination. Anyone with a serious health condition or lifestyle that normally would result in an increased premium for their health insurance, for example smokers, can enroll during this period and pay the exact same rates that any other insured individual would pay.
Source: skepticwiki.org

This Medicare Supplement Plan F Can Also Be One Particular Amongst The Medigap Plans Which Supplies Rewards Towards The Buyers

Anytime you strategy to opt for a plan then you need to seek advice from with your family and selected the most effective 1, if you feel tremendously perplexing then you’ll be able to search for the help from your issue in order that they are going to assist you to decide on the perfect a single. The foremost factor that you will need to look before you take the coverage would be the coverage that’s needed to fulfill your desires, and also the 2nd thing that you ought to search into is irrespective of whether the quantity of the strategy is limited for your spending budget if all they are comfortable for you within a distinct strategy then you’re able to tremendously well take them and love the advantages. This medigap strategy f is offered by numerous private insurance coverage concerns and also you can choose the a single which is effective to you. These medicare dietary supplement strategy gives you varied rates and also you could get them for free. To understand even more concerning this medicare supplement plan as well as their benefits you can call them directly else view the web page whichever is comfortable and from these both you’ll get to understand about their plans along with the way you will be benefited with it. You can also comply with them on twitter social networking webpage to know the updates, they retain updating their status in order that persons can know their operate even superior. To know their delivers and information you may be a part of them on the publication which will be pretty critical for all of the customers to understand the updates with the ideas. Each coverage has its personal way of advantages so just before you choose the coverage make sure about the positive aspects and assume twice regarding the want for you after which requires up the plan, they are the basic points which has to become identified prior to you take up the plan. The top quality in every single policy depends on the protection and it’s certain that whatever could be the coverage which is taken you may get the advantage.
Source: posterous.com

Peter Orszag Chart Shows Medicare Costs Slowing

“Presumably, the weak state of the economy is a factor, but given the magnitude of the slowdown in national health spending and the timing of that slowdown, which seems to have started before the recession, we and most analysts think there are probably structural factors at work as well,” he said. Those structural factors could include slower growth of spending on prescription drugs, changes in the health care delivery and payment system, and higher out-of-pocket spending for consumers, according to Elmendorf.
Source: businessinsider.com

Texas Medicaid Recipients Call For Full Funding

Posted by:  :  Category: Medicare

Texas and the Transformation of Medicaid by thetexastribuneLawmakers cut Medicaid programs last year and underfunded the program by $4.8 billion. When the Legislature meets next year, they have until March to make up the budget deficit. Medicaid is a joint federal-state program that provides health care to the poor, disabled and the neediest elderly Americans.
Source: cbslocal.com

Video: What Does Texas Medicaid Pay For?

Medicine Sprawl :: Texas Monthly

Ennis notes that Texas hospitals spend $5 billion a year providing care for the uninsured, and then argues that Obamacare’s Medicaid expansion “would most effectively address” this problem because once the law is in place everyone will have private insurance or be on Medicaid. But this sunny notion is somewhat undermined by a cold, hard fact: about 1.8 million illegal immigrants in Texas, who are uninsured and completely excluded from Obamacare, will keep on getting primary care in emergency rooms—with or without Medicaid expansion. Ennis is correct in saying that Washington reimburses Texas hospitals for providing this care, but he fails to note that Obamacare cuts federal funding for uncompensated care by $18 billion between 2014 and 2020. It’s reasonable to think that some, and perhaps quite a lot, of the $5 billion Ennis thinks we’ll save will evaporate over time, and the social safety net we’re left with will have more holes in it than the one we have now.
Source: texasmonthly.com

Aggressive Texas Medicaid fraud investigators anger doctors

But O.I.G.’s dollar-recovery strategy — which includes an increased reliance on a rule that allows investigators to freeze financing for any health care provider accused of overbilling — has enraged doctors, dentists and other providers who treat Medicaid patients. They say an anonymous call to a fraud hot line or a computer-generated analysis of a handful of billing codes is enough to halt their financing without even a hearing, jeopardizing their practices and employees and leaving thousands of needy patients in a lurch while the state works to prove — or rule out — abuse.
Source: pathologyblawg.com

Medicaid Eligibility in Texas

Following an initial check of the information, all applicants are required to visit a Health and Human Services Commission Benefits office. This visit interviews the applicant to ensure all information is present and correct – forming the final part of the application. Applicants who have specific reasons why they cannot travel to the Health and Human Services Commission Benefits office may be able to complete the review by telephone, or a representative may make a home visit.
Source: tex.org

Cahnman’s Musings: How Medicaid Abuses Vulnerable Texans

The most recent issue of Texas Monthly contains a tiresome, straw-man, filled attack against Governor Perry’s refusal to comply with Obama’s Medicaid Expansion; sample quote: Medicaid covers one in eight Texans at costs lower than private insurance, and without it our chart-topping percentage of the uninsured — nearly 25 percent of Texans lack insurance — would increase to nearly 33 percents of the population, including the millions of children who make up the majority of Texas Medicaid enrollees.  Texas Public Policy Foundation’s John Daniel Davidson issues a suburb online response today, money quote: [Texas Monthly Writer Michael] Ennis thinks Perry should dump more money into this mess and hope for the best.  Expanding Medicaid, he said, would provide coverage to millions of uninsured Texas workers, ‘probably helping Texas more than any state.’  Leaving aside for a moment that it would actually be a net loss for the state, an uncomfortable implication lurks in the background: private health insurance and the world’s best health care are only good for the upper and middle class, while Medicaid is good enough for the poor. The point about how Medicaid traps vulnerable citizens in a predatory, substandard system is one all Texans would be wise to remember, consider the following: Highlights:
Source: blogspot.com

Texas Democrats See Path to Medicaid Expansion

Under the Affordable Care Act, Obama’s health care overhaul, the federal government would cover 100 percent of the costs of expanding state Medicaid programs for three years, a share that would taper to 90 percent in later years. The Kaiser Family Foundation, a health care think tank, estimates the expansion would cost Texas $5.7 billion between 2013 and 2022, which the organization calls a modest price compared with the $65.6 billion that would be covered by the federal government.
Source: kutnews.org

Prairie Weather: Texas needs to quit messing with Texans

Planned Parenthood has been embroiled in a complicated legal battle with the state of Texas as Republican officials attempt to exclude the organization from the state’s Women’s Health Program, which uses federal and state money to fund preventive care for low-income women. The organization sued to block Texas from discriminating against abortion providers, but Visiting Judge Gary Harger ruled that Texas may design a state-run Women’s Health Program that excludes qualified providers like Planned Parenthood — despite the fact that, on a federal level, states aren’t allowed to block qualified health providers from receiving Medicaid funds.
Source: typepad.com

Xerox Eyed in Texas Medicaid Probe

The current scrutiny of Xerox in Texas, covering a period from 2008 to 2011, is part of a broader state investigation into Medicaid abuse that has so far largely targeted dentists and orthodontists, who have been accused by state officials of improperly billing the state for procedures including putting braces on youngsters for purely cosmetic reasons and performing unnecessary root canals on small children.
Source: industryanalysts.com

Texas Medicaid reform debate continues

Some Texas economists disagree with the governor’s stated plan, arguing that while the expansion of Medicaid is an imperfect solution, it will help the state save money overall. The optional expansion includes more adults that cannot afford healthcare on their own, with the federal government providing full funding for those patients for the first few years of the program and at least 90 percent of the funding after that.
Source: wrightabshire.com

Study: Medicare ‘Doughnut Hole’ Not Linked To More Heart Attacks, Related Deaths

Posted by:  :  Category: Medicare

wordy informative signage by damian mReuters: Medication ‘Donut Hole’ Not Tied To Heart Deaths U.S. seniors forced to pay full price for their medications while in Medicare’s so-called donut hole didn’t suffer more heart attacks or deaths as a result, in a new study. During several months spent in the Medicare coverage gap, when the government-run insurance program’s Part D component stops covering medications, seniors were no more likely than peers with drug coverage to be hospitalized for, or die from, a heart-related problem (Seaman, 8/17).
Source: kaiserhealthnews.org

Video: Affordable Care Act: Closing the Medicare Doughnut Hole

Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk 

[1] See Medicare Supplement Insurance First Dollar Coverage and Cost Shares Discussion Paper, National Association of Insurance Commissioners (NAIC), Senior Issues Task Force, Medigap PPCA Subgroup, (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  Also see, e.g., Leadership Council on Aging (LCAO) issue brief “Reforming Medigap Plans by Shifting Costs onto Beneficiaries: A Flawed Approach to Achieving Medicare Savings” (December 2012), available at: http://www.lcao.org/docs/LCAO-Medigap-Issue-Brief-12-12.pdf [2] Medigap Reform: Setting the Context, Kaiser Family Foundation, (September 2011), available at http://www.kff.org/medicare/8235.cfm. [3]Medigap Reform: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs, Kaiser Family Foundation, (July 2007), available at http://www.kff.org/medicare/8208.cfm. [4] See, e.g., previous Weekly Alerts, including finding drug savings in Medicare (November 2011) http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ ; Prescription Drug Rebates (July 2011) http://www.medicareadvocacy.org/2011/07/21/debunking-medicare-myths-drug-rebates-for-dual-eligibles/ ; and additional options for achieving Medicare savings (June 2011) http://www.medicareadvocacy.org/2011/06/09/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/.
Source: medicareadvocacy.org

AHL’s TOP STORY: Medicare ‘Doughnut Hole’ Provision Did Not Cause Drug Prices To Increase, GAO Report Finds

Prior to the health reform law, Medicare Part D beneficiaries paid 25% of the cost of their drugs until the total bill reached $2,830. Beneficiaries then paid the full cost of drugs until their total out-of-pocket spending reached $4,550, a gap in coverage known as the doughnut hole. The health reform law called for Medicare beneficiaries in 2010 to receive one-time, $250 rebates when they reached the doughnut hole. In 2011, the rebate was replaced by a 50% discount on brand-name drugs. The overhaul will increase that discount gradually until 2020, when the coverage gap will be closed (
Source: ahlalerts.com

What Is The Medicare “Doughnut Hole”?

During each month you have a prescription filled your drug plan sends you and Explanation of Benefits notice, which you’ll often see or hear shortened to EOB. This monthly EOB form tells you how much you’ve spent during the month on covered drugs and if you’ve reached your coverage gap, signalling you’re now responsible for the entire cost of drugs for the remainder of the year. It’s human nature, no matter how well informed we were when we read the plans fine print, it’s always a shock when prescription payments abruptly end. Out of pocket costs, especially on a fixed income, are always a bitter pill to swallow.
Source: medigapandyou.com

Medicare “Donut Hole” Gets a Little Smaller in 2013

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

Daily Kos: I Hate Explaining the Medicare “Donut Hole” (Updated with explanation of donut hole)

I had a chance to talk to Tom Scully, the head of HMS at the time and the creator of Plan D and the donut hole about why he did it. There were two reasons. First, he had a budget of $400 billion over ten years for the program so he had to design something that hit his budget target and he did a great job on that. Medicare Part D is the only government health program where the ten year cost was actually under the budget estimate. I think it came in at $380 billion. The second reason was to make seniors really think about generics and switching from higher priced brand name drugs to lower cost generic substitutes. And that part worked as well. You need to remember that before Part D all prescriptions were out of pocket expenses for seniors on Medicare, so even with the donut hole Part D was a big benefit.
Source: dailykos.com

Seniors in Medicare Doughnut hole Skipping Depression Medication

A new study, reviewed in Medpage Today, finds that seniors falling into the Medicare Part D prescription drug coverage gap, often referred to as the “doughnut hole,” reduced the number of monthly anti-depressant prescriptions they filled by 12.1% compared to those with full coverage. In 2012, Part D plans share drug costs with enrollees up to $2,930. With co-pays, premiums, and deductibles seniors pay about $1,500 up to that point. After $2,930 the doughnut hole begins and plan enrollees pay out-of-pocket until they have spent $4,700 – after which the plans pay for 95% of drug costs.
Source: pharmacycheckerblog.com

What Is the Medicare Donut Hole?

There are enhanced plans that provide additional benefits to help with donut hole coverage, but everything comes at an additional cost. According to a study done in 2007, premiums for plans offering gap coverage are roughly double those of defined standard plans. The 2010 Health Reform bill (Patient Protection and Affordable Care Act) attempted to address the coverage gap by creating discounts on brand name and generic drugs purchased within the gap range. By 2020, the changes in the health care reform act aim to close this coverage gap bringing down the enrollee responsibility to 25% of the costs rather than the current 50%.
Source: bradeninsurance.com

Managed Markets Monday: Who Ate My Donut Hole? The Ins and Outs of Medicare Part D

Fortunately, most common medications, especially generics, are relatively inexpensive. But what if Maude doesn’t have $5560 a year for the medications she needs? Medicare does offer low-income subsidies for patients who qualify. In addition, some Medicare patients are eligible for charitable programs offered by foundations such as the National Patient Advocate Foundation and the National Organization for Rare Disorders. Additional information is available at http://www.medicare.gov/, and at the websites of individual charitable foundations.
Source: palio.com

MedicareIsSimple: Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk

Among proposals aimed at reducing federal spending for Medicare, some are suggesting that Medigap insurance be restructured to increase the cost-sharing burden on beneficiaries and/or add a surcharge for those that choose plans offering “first-dollar” or “near first-dollar” coverage.   These proposals operate under the assumption that charging beneficiaries more in up-front, out-of-pocket costs will deter them from using unnecessary care.  But this assumption ignores the fact that adding costs for Medigap insurance will deter many beneficiaries from seeking medically necessary care. While these proposals might yield limited federal savings in the short term, such savings would lead many to forego needed care until more acute, and costly, treatment is needed.
Source: blogspot.com

Obamacare: Drastic Medicare Cuts Equals Medicare Reform

Posted by:  :  Category: Medicare

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

Video: ObamaCare Guts Medicare Advantage

Using Medicare Advantage to Gain Political Advantage

It is almost certainly true that quality suffers when reimbursement rates are reduced. It is also appears to be true that competition amongst private providers in Medicare Advantage is leading to efficiencies that aren’t present in traditional Medicare, which we should probably take as a lesson. It is also often the case that when the government pays more for something, it spends more, and when it pays less for something, it spends less. But what all this really reveals is the folly of trying to control health spending through government-designed payment schemes. 
Source: reason.com

MyRightWingDad.net: Fw: Medicare Advantage

Watch this short 2 minute video and pass it on to all the seniors you know. Medicare Advantage cuts begin in mid-October of this year. Seniors vote, and they need to know this cut is coming before the election. Time is running out for seniors unaware of this.
Source: blogspot.com

The impact of Obamacare cuts on Medicare Advantage Plans

The PPACA, as amended, also introduces MA bonuses and rebate levels that are tied to the plans’ quality ratings. Beginning in 2012, benchmarks will be increased for plans that receive a 4-star or higher rating on a 5-star quality rating system. The bonuses will be 1.5 percent in 2012, 3.0 percent in 2013, and 5.0 percent in 2014 and later. An additional county bonus, which is equal to the plan bonus, will be provided on behalf of beneficiaries residing in specified counties. The percentage of the “benchmark minus bid” savings provided as a rebate, which historically has been 75 percent, will also be tied to a plan’s quality rating. In 2014, when the provision is fully phased in, the rebate share will be 50 percent for plans with a quality rating of less than 3.5 stars; 65 percent for a quality rating of 3.5 to 4.49; and 70 percent for a quality rating of 4.5 or greater.
Source: quinnscommentary.com

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Rep. Issa Subpoenas HHS Records On Medicare Advantage Program

CQ HealthBeat: HHS Inspector General Raps CMS On Medicare ID Theft Protection Federal Medicare officials reported 14 breaches of medical information in two years affecting nearly 14,000 beneficiaries, but they failed to notify those affected in a timely way and often did not give them much information about the violation, the Office of Inspector General for the Department of Health and Human Services said in a new report. In response to worries about medical identity theft, the government has set up a database with the Medicare ID numbers of 284,000 beneficiaries and 5,000 providers that have been involved in medical identity theft in the past or are regarded as vulnerable. But Medicare contractors have problems using the database, and few remedies are available for those whose numbers have been compromised, the OIG report said (Norman, 10/22).
Source: kaiserhealthnews.org

A Year in Review: Obamacare in Pictures

A former U.S.Marine, he is the Creator of The Minority Report Network. He is also the Founder and Managing Editor of the Network’s flagship site, www.theminorityreportblog.com, Former Director of New Media for Liberty.com, Former Director of New Media for Liberty First PAC, and the Former Chief Managing Editor of 73Wire.com. Steve is a well respected national conservative blogger who’s dedicated the past several years of his life advancing conservatism online. Recently Steve was instrumental in the development of Liberty.com, Liberty First PAC, The Patriot Caucus, the national campaign trail and grassroots news site73wire.com.
Source: theminorityreportblog.com