Congress should stop wasting our public funds in these efforts to push us into private plans. If they took the same public and private funds already being spent and used those to improve the benefits of the traditional Medicare program (especially reducing cost sharing and capping out-of-pocket spending), then we would have an even better Medicare program. In fact, it could become the basis of the Improved Medicare for All that many of us long for but has remained elusive to a large extent because of the elevated stature that the private insurance industry holds in the Halls of Congress.
Video: Medicare Plan Finder Lesson 1: Getting Started
Daily Kos: Washington Makes It Clear: Medicare Will Now Be Targeted to Pay Down Deficit
The Huffington Post describes what’s coming next: “The fiscal cliff has not been averted. If anything, the U.S. faces an even more ominous deadline in a few months. The debt ceiling was hit as of New Year’s Eve. The U.S. Treasury will dip into its tool bag to keep the country’s borrowing ability going, but that will last only about two months. Also in early March, the sequestration — $110 billion in across-the-board spending cuts, half in defense and half in domestic programs — springs back, unless Congress finds a way to offset it with other spending cuts. Weeks later, the law that keeps the government funded expires. It all means that, in late February and early March, Congress will face a sequestration, a government default and a government shutdown. Republicans say they’ll use the leverage created by the debt ceiling to force Obama to accept spending cuts, particularly in entitlement programs. Obama resisted that notion on Dec. 31, saying he wants more tax increases and won’t accept Republican plans to “shove” spending cuts past him. “If they think that’s going to be the formula for how we solve this thing, then they’ve got another thing coming,” he said. However, once the fiscal cliff deal passed, the President’s message changed making it clear cuts to Medicare will be offered up to pay down the deficit: “I agree with Democrats and Republicans that the aging population and the rising cost of health care makes Medicare the biggest contributor to our deficit. I believe we’ve got to find ways to reform that program without hurting seniors who count on it to survive. And I believe that there’s further unnecessary spending in government that we can eliminate.” President Obama statement, January 1 There are ways to make Medicare more efficient and save money, in fact, many of those ideas were already implemented in the Affordable Care Act. Going forward Congress should also consider allowing Medicare to negotiate with drug makers for lower prescription drug costs in Part D and allowing drug re-importation which would save billions in the Medicare program. Unfortunately, both of these common sense proposals are opposed by conservatives, many of the same fiscal hawks, who’d rather reduce spending by cutting benefits instead of curtailing the excessive payments to the highly profitable pharmaceutical industry.
How To File A Medicare Appeal
Beneficiaries in Medicare Advantage plans follow similar appeals procedures, except the initial appeal must be made within 60 days of the denial. Information can be found at http://www.medicare.gov/claims-and-appeals/file-an-appeal/medicare-health-plan/medicare-health-plan-appeals.html. If a service or treatment has been denied, an expedited appeal can be requested from the plan if waiting for a regular appeal decision could jeopardize the member’s health. Expedited appeals are not permitted solely for payment denials. For more details about expedited Medicare Advantage appeals, see section 50 of the Medicare Managed Care Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf .
Medicare Plan Finder for Health, Prescription Drug and Medigap plans
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.
CMS’s Privacy Problem: Data Breaches, Medicare Numbers, and Inaction : Data Privacy Monitor : Lawyers & Attorneys for Information Security, Breach Notifications, Online Privacy, Cloud Computing & Financial Privacy: Baker Hostetler Law Firm
CMS’s continued use of social security numbers as Medicare numbers has been under scrutiny for several years. Since 2002, the U.S. Government Accountability Office (GAO) has repeatedly recommended that CMS use a different methodology in assigning Medicare numbers in order to protect social security numbers. In May 2008, the OIG issued a report urging CMS to remove social security numbers from Medicare cards in order to prevent identity theft. CMS has consistently refused to modify its methodology, citing logistical and cost constraints. In an August 2012 hearing before the House Ways and Means Committee, Tony Trenkle, CMS’s Chief Information Officer, testified that transitioning to a new methodology “would be a task of enormous complexity and cost that, undertaken without sufficient planning, would present great risks to continued access to healthcare for Medicare beneficiaries.” Mr. Trenkle estimated that the cost of a smooth transition could be as high as $845 million, and he cautioned the committee that the transition would mean a substantial change for physicians treating Medicare patients. This recent string of CMS data breaches has captured the attention of lawmakers, who once again are calling for CMS to act.
RESOLUTION OF THE FISCAL CLIFF: THE PHYSICIANS’ SUSTAINABLE GROWTH RATE ISSUE HAS BEEN RESOLVED FOR ONE MORE YEAR : New Jersey Healthcare Blog
As you can see from various articles ((1) http://www.modernphysician.com/article/20130103/MODERNPHYSICIAN/301039973?AllowView=VW8xUmo5Q21TcWJOb1gzb0tNN3RLZ0h0MWg5SVgra3NZRzROR3l0WWRMWGJWZjBDRWxYek9UYktwUGZUamg5b1g4WFFERmhzbHhKSnNUYk9XNkU9&utm_source=link-20130103-MODERNPHYSICIAN-301039973&utm_medium=email&utm_campaign=mpdaily; (2) http://www.philly.com/philly/business/20130103_Hospitals_to_eat_Medicare_budget_s__doc_fix.html), the funding for this year’s resolution comes from a reduction in payments to other Medicare providers, spread over a number of years. Therefore, in resolving next year’s, 2014, physician reduction, this source of funding will not be available.
Daily Kos: Medicare also going over the “cliff”
Single-payer financing models, in which one government entity is the sole third-party payer of health care costs, can achieve universal access to health care without barriers based on ability to pay. Single-payer systems generally have the advantage of being more equitable, with lower administrative costs than systems using private health insurance, lower per capita health care expenditures, high levels of consumer and patient satisfaction, and high performance on measures of quality and access. They may require a higher tax burden to support and maintain such systems, particularly as demographic changes reduce the number of younger workers paying into the system. Such systems typically rely on global budgets and price negotiation to help restrain health care expenditures, which may result in shortages of services and delays in obtaining elective procedures and limit individuals’ freedom to make their own health care choices. Pluralistic systems, which involve government entities as well as multiple for-profit or not-for-profit private organizations, can assure universal access, while allowing individuals the freedom to purchase private supplemental coverage, but are more likely to result in inequities in coverage and higher administrative costs (Australia and New Zealand). Pluralistic financing models must provide 1) a legal guarantee that all individuals have access to coverage and 2) sufficient government subsidies and funded coverage for those who cannot afford to purchase coverage through the private sector. http://www.annals.org/…
Quality, not quantity of care new criteria for Medicare reimbursement
“The Hospital Value-Based Purchasing Program is one of a host of Affordable Care Act programs that put patients at the center of the Medicare system,” stated Medicare on the organization’s blog. “We’ve known for a long time that when Medicare paid providers based on how much work they did and not on how well they did for patients, too often patients got services and tests that didn’t improve their health. Providers already must publicly report the steps they take to provide quality care to Medicare beneficiaries; Hospital Value-Based Purchasing gives these efforts additional teeth.”