A Simple Primer on Medicare Benefits Written for Patients and YOU!

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Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481Strategist, Rehabilitation Management, MediServe a Mediware Company; Darlene is a PT with an MBA in Healthcare Management, in her role, as a Rehab Mgmt Strategist she brings information to leadership that help guide practice strategy. Her focus is to assist clients nationally in the use of charting data to drive clinical and financial performance in support of decisions for best practices in meeting rehabilitation compliance, outcomes, revenue and efficiency. Since February 2011, Darlene has visited more than 30 IRF locations to assist in guiding C.O.R.E. (Compliance, Outcomes, Revenue, Efficiency/Effectiveness), performance improvement plans. Working in rehab medicine for greater than 30 years, Darlene spent 12 years in executive leadership as a Director of Rehabilitation and Operations. Therapy oversight included three post-acute service lines: acute inpatient rehabilitation (IRF), skilled and outpatient hospital-based services and is LEAN trained in healthcare. At various points in her career, Darlene had oversight of rehabilitation admissions, marketing, quality improvement, dietary & maintenance. Her responsibilities have included compliance toward Federal Regulations and leading CARF and Joint Commission standards of practice. Her experience includes Quality Improvement Chair, Lean Healthcare Trainer Certification and Vice President of the Board of Directors for the Ohio Association of Rehabilitation Facilities (OARF). Darlene lectures and writes blogs on post acute care topics that include federal guidelines, post acute admissions, managing outcomes, documentation, and rehabilitation marketing. www.mediserve.com/blog
Source: mediserve.com

Video: Vice-presidential candidate Paul Ryan in his September 2011 interview on Uncommon Knowledge

Elder Law 2018: Medicare & Medicaid Benefits 2011 (Medicare and Medicaid Benefits)

Buy on the merchant’s on-line looking and browse reviews. If you are making an attempt to seek out Medicare & Medicaid Benefits 2011 (Medicare and Medicaid Benefits) with special value. This is the most effective deals for you. Where you’ll notice these item is by online looking stores? Read the review on Medicare & Medicaid Benefits 2011 (Medicare and Medicaid Benefits) Now, it’s special value. Thus don’t lose it. Medicare & Medicaid Benefits 2011 (Medicare and Medicaid Benefits) by CCH Editorial Staff New!: $21.95 (as of 12/15/2012 01:35 PST) 18 Used!
Source: blogspot.com

Medicare Coverage Gaps 2013: Deductibles and CoInsurance

Just like your Part B premium, your Part D premium surcharge will be based on your modified adjusted gross income. Most people will pay the amount billed by their insurance company. But, if you filed an individual tax return for 2011 and your modified adjusted gross income was more than $85,000, your Part D premium surcharge for 2013 is shown in the table below. If you filed a joint tax return for 2011 and your modified adjusted gross income was more than $170,000, your Part D premium surcharge for 2013 is also shown in the table below. The Social Security Administration will compute your premium for you. However, we recommend that you double-check their computation against your 2011 tax return.
Source: asourparentsgrowolder.com

Medicare Part B Premium Costs Likely To Cut Into Social Security’s Increase

The Wall Street Journal: Prices Rise 0.3%, Prompting Boost In Government Benefits The climb in prices means millions of Americans who rely on government programs such as Social Security will receive their first cost-of-living increase since 2009. It also will raise taxes on close to 10 million of the 161 million workers who pay Social Security taxes. That’s because in 2012, Americans will have to pay the payroll tax on their first $110,100 in earnings, up from the $106,800 in earnings in 2011. … Nearly 55 million Social Security beneficiaries will see their checks rise by 3.6 percent beginning in January. … The 3.6 percent increase could be partially or completely offset by a bump in the premiums that seniors pay for Medicare Part B benefits, which have been held flat for many beneficiaries because of low inflation in the last two years. … The Centers for Medicare & Medicaid Services could announce their premiums and copayments for 2012 as soon as next week. Because Medicare premiums are deducted directly from Social Security checks, many Americans may never see an increase (Paletta and Murray, 10/20).
Source: kaiserhealthnews.org

Medicare, Medicaid & Social Security Vital To Illinois Economy, New Report Finds

Less contentious an issue has been the willingness of both parties to reduce government spending. The president’s plan would call for $350 billion in cuts to health programs, plus another $250 billion in other spending cuts over the next 10 years. Republicans seek to cut $600 billion from health programs and another $600 billion from other, non-specified programs over the same period.
Source: progressillinois.com

Analysis: Obama may turn Medicare debate into more healthcare reform

Medicare, long considered a program that U.S. politicians would touch at their peril, is acknowledged, along with the national Medicaid program for the poor, to be a major driver of the deficit. The aging population puts Medicare on a collision course with major financial difficulties; the so-called Medicare trust fund is on pace to run out of money in 2024.
Source: medcitynews.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

Romney Ryan Plan for Student Loans by DonkeyHoteyBetween 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: Ask Medicare Web Tour

Does Anyone Know How the Affordable Care Act Will Affect Medicare?

To learn more about this issue, visit the Center for Medicare Advocacy, Inc.’s website here. The Center is a “national non-profit organization that provides research, analysis, education and advocacy to help older people and people with disabilities obtain fair access to Medicare and quality health care.”
Source: thegrahamlawfirm.com

Physician Medicare Cuts Delayed Til 2014 — Family Medicine Rocks

Well, they did it again. The press is congratulating Congress on the “success” of coming up with a New Year’s Night deal on that no one likes. For physicians, this deal contains a delay in the 27% cut in Medicare payments to physicians according to the Sustainable Growth Rate (SGR). For full coverage of this story, I encourage you to read articles from Medpage Today, Kaiser Health News, and Modern Healthcare. (Photo credit: New York Times)
Source: familymedicinerocks.com

Daily Kos: Republican U.S. senator: Cut Medicare … or we’ll shut down the government

Republicans approve of the American farmer, but they are willing to help him go broke. They stand four-square for the American home–but not for housing. They are strong for labor–but they are stronger for restricting labor’s rights. They favor minimum wage–the smaller the minimum wage the better. They endorse educational opportunity for all–but they won’t spend money for teachers or for schools. They think modern medical care and hospitals are fine–for people who can afford them. They consider electrical power a great blessing–but only when the private power companies get their rake-off. They think American standard of living is a fine thing–so long as it doesn’t spread to all the people. And they admire of Government of the United States so much that they would like to buy it. 65 years later and nothing changed. They just got worse.
Source: dailykos.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

Don’t Fall for Medicare Card Phone Scam

You answer the phone, and the unknown caller claims to be with Medicare or another government office. He informs you that your new Medicare card is in the mail, and you will receive it in a few days.  In the meantime, you need to set up your direct deposit so your Medicare funds can be deposited into your bank account. To do this, you just need to tell the caller your banking information. He will take care of the rest.
Source: bbb.org

Kaiser Permanente’s Medicare Plan Website Recognized as a Benchmark for Excellence

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Medicare Secondary Payer Bill Summary

CMS is required to maintain a secure web portal with access to claims and reimbursement information. The web portal must meet the following requirements: • Payments for care made by CMS must be loaded into the portal within 15 days of the payment being made. • The portal must provide supplier or provider names, diagnosis codes, dates of service and conditional payment amounts. • The portal must accurately identify that a claim or payment is related to a potential settlement, judgment or award. • The portal must provide a method for receipt of secure electronic communications from the beneficiary, counsel, or the applicable plan. • Information transmitted from the portal must include an official time and date of transmission. • The portal must allow parties to download a statement of reimbursement amounts. The Reimbursement Process The SMART Act requires parties to notify CMS of when they reasonably anticipate settling a claim (any time beginning 120 days before the settlement date). CMS then has 65 days to ensure the portal is up to date with all of the appropriate claims data. CMS can have an additional 30 days on top of the 65 days to update the portal if necessary. At the expiration of the 65 and potentially the 30 day periods, the parties may download a final conditional payment amount from the website. The final conditional payment amount is reliable as long as the claim settles within 3 days of the download.
Source: wordpress.com

CMS Revamps Medicare Website To Boost Usability, Usefulness

Acting CMS Administrator Marilyn Tavenner said, “We’ve simplified the language and the homepage layout to make it easier and faster for visitors to get answers and a better understanding of Medicare necessary to get more control over their health care” (Healthcare IT News, 8/22).
Source: ihealthbeat.org

New Government Website Encourages Illegals to Collect Welfare

A website run by the federal government (“WelcomeToUSA.gov“) encourages new immigrants to the United States to apply for welfare benefits.  This website is run by the Department of Homeland Security and it says that it “is the U.S. Government’s official web portal for new immigrants.”  So your tax dollars were used to build and maintain a website that teaches immigrants how to come into this country and sponge a living off of federal welfare programs paid for by your tax dollars.  What in the world is happening to us?  Yes, we will always need some legal immigration.  We are a nation of immigrants and immigration has been very good to this country.  But at a time when there are millions upon millions of American citizens out of work and at a time when we are absolutely drowning in debt, do we really need to encourage millions more immigrants to come over and take advantage of our overloaded social welfare programs?  WelcomeToUSA.gov actually encourages new immigrants to apply for food stamps, Medicaid, Medicare, Social Security, Supplemental Security Income and Temporary Assistance for Needy Families.  Of course not all immigrants are eligible for all of those programs, but if an immigrant can get over to the U.S. and just get signed up for a couple of programs they can enjoy a higher standard of living doing nothing here than they can working at a low paying job back home.  We have created a perverse system of incentives that makes it very attractive to people all over the world to do whatever they can to hitch a ride on “the gravy train” and take advantage of all of the benefits that they possibly can.  And once immigrants get on welfare, many of them never leave.  For example, one study discovered that 43 percentof all immigrants who have been in the United States for at least 20 years were still on welfare.  We can’t even take care of our own citizens, and yet more immigrants hop on to the safety net every single day.  At some point the safety net is going to break and then we won’t even be able to take care of the struggling Americans that really need it.
Source: mrconservative.com

How Medicare Barriers Can Keep You Out of Hospice

One bright note, though, is that almost 30 percent of the hospices studied offer some kind of open access enrollment without insisting on those prohibitions. Much more common in nonprofit hospices (a pity, because the real growth is in for-profit ones), open access usually means enrolling people who don’t yet meet the Medicare criteria, then converting them to Medicare patients as they become eligible.
Source: ourparents.com

Cops: Fugitive behind $1 million Medicare fraud nabbed in Canada

I personally know of 9 cases here in just one small area of Michigan that total almost 2 million, one defendant sentenced to 10 years and others have fled the country. Does anyone else thinks it time to stop screaming about cuts, and see what it would actually cost if it was administered correctly. Here its mostly Pakistani, Indian, and African doctors that operate for about three to five years before being indighted and then flee before trial. (these are just what I have seen and not a judgement on other well meaning doctors) My mother, for example, has retired from two jobs and has health care coverage for the rest of her life. She is the kind of person that looks at the bill, even if it is not hers. She had a little bit of a health scare and had to go to the hospital. When it was all said and done she found 5 different times that a service was double billed, billed without it being performed, or billed incorrectly. Most of those losses would have been to medicare, because private insurance denies first and pays second.
Source: nbcnews.com

Medicare agrees to pick up the tab for obesity counseling — Health — Bangor Daily News — BDN Maine

Posted by:  :  Category: Medicare

day 6 365 days Hipstamatic by drivebybiscuits1Unfortunately, those best prepared to provide obesity counseling will not be able to bill directly to do so. CMS has limited who is able to bill for those services to primary care physicians and practitioners, including nurse practitioners, clinical nurse specialists and physician assistants. Those with expertise in the field, such as registered dietitians, are not eligible to bill directly. Medicare will cover services from “auxiliary” providers only if the service is provided in a physician’s office suite and the physician is immediately available to provide assistance and direction.
Source: bangordailynews.com

Video: Georgia Health Insurance Medicare

Golden Living Nursing Homes Settle Allegations of Substandard Wound Care

ATLANTA—The United States Attorney’s Office today announced that the United States and the state of Georgia have reached a settlement with GGNSC Holdings LLC of Plano, Texas, the operator of skilled nursing facilities located in Atlanta, Georgia, to resolve allegations under the False Claims Act and the Georgia State False Medicaid Claims Act that GGNSC provided inadequate and worthless wound care services to residents at two of its Atlanta area nursing homes. GGNSC operates nursing homes under the “Golden Living” name. GGNSC has agreed to pay $613,300 to resolve these allegations. The United States’ share of the settlement is $423,544. Sally Quillian Yates, United States Attorney for the Northern District of Georgia, said, “Our office is committed to protecting our most vulnerable citizens and improving the lives of nursing home residents. By failing to provide adequate wound care services to its nursing home residents, Golden Living placed at risk the life and health of individuals who were entrusted to its care. This type of threat to the health and well-being of the elderly in our communities will not be tolerated.” “Golden Living fraudulently billed Medicaid for nursing services which were substandard and, tragically, resulted in harm to patients,” said Attorney General Sam Olens. “The nursing home patients depended on Golden Living to provide them with quality wound care services to help them heal, but, instead, were mistreated. We will not stand for such egregious misconduct by a Medicaid provider.” “Quality of care in nursing homes is a top priority for the Office of Inspector General,” said Derrick L Jackson, Special Agent in Charge of the United States Department of Health and Human Services, Office of Inspector General for the Atlanta region. “Health care providers need to know that if they provide worthless services to those most in need, they will pay the price.” Mark F Giuliano, Special Agent in Charge, FBI Atlanta Field Office, stated, “The FBI will continue to dedicate its investigative personnel and resources toward such cases of Medicaid and Medicare fraud as was seen here. These federally funded programs provide much needed services but are limited and health care providers that abuse these programs will be held accountable.” “The Defense Criminal Investigative Service is committed to ensuring that TRICARE beneficiaries receive the high quality medical care that they deserve,” said John F Khin, Special Agent in Charge, Southeast Field Office, Defense Criminal Investigative Service. “This settlement sends the message that providers of substandard care will be brought to justice through the collaborative efforts of law enforcement agencies and the Department of Justice.” The government alleges that GGNSC submitted false claims to Medicare, Medicaid, and the Veterans Administration because it provided residents at Golden LivingCenter–Glenwood (GLCG) and Golden LivingCenter–Dunwoody (GLCD), f/k/a Golden LivingCenter–Northside, with inadequate and worthless monitoring, documentation, and prevention and treatment of wounds during the period from January 1, 2006 through May 31, 2011. The claims settled in the civil settlement are allegations only, and there has been no determination of liability. GGNSC executed a Corporate Integrity Agreement (CIA) with the United States Department of Health and Human Services, Office of Inspector General, which will require six GGNSC facilities in the Atlanta area (in addition to GLCG and GLCD, Golden LivingCenter–Briarwood, Golden LivingCenter–Decatur, Golden LivingCenter–Kennestone, and Golden LivingCenter–Medical Arts) to continue to implement certain policies and procedures to ensure compliance with applicable statutes and regulations governing patient care. In addition, an independent monitor was appointed to oversee operations at the six Atlanta-area GGNSC facilities for up to five years to verify that the policies and procedures are working effectively and that patients receive appropriate care. The civil settlement resolves some of the claims in a lawsuit filed by Dr. Joseph L Micca under the qui tam, or whistleblower, provisions of the False Claims Act, which allow private citizens to bring civil actions on behalf of the United States and share in any recovery. The case, pending in the Northern District of Georgia, is filed under United States & State of Georgia ex rel. Micca v. GGNSC Holdings, LLC, et al ., No. 1:10-cv-1055-ODE (Northern District of Georgia, April 9, 2010). Dr. Micca will receive a share of the settlement payment that resolves certain claims in the qui tam suit that he filed. This case was investigated by special agents of the Federal Bureau of Investigation; the United States Department of Health & Human Services, Office of Inspector General; the Defense Criminal Investigative Service; and the Georgia Medicaid Fraud Control Unit. The civil settlement was reached by Assistant United States Attorneys Amy Berne and Lena Amanti. For further information please contact the United States Attorney’s Public Information Office at USAGAN.Pressemails@usdoj.gov or (404) 581-6016. The Internet address for the United States Attorney’s Office for the Northern District of Georgia is www.justice.gov/usao/gan. Reported by: FBI
Source: 7thspace.com

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

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

A Different View about Obama’s Medicare “Actual Facts”

The Affordable Care Act assumes deep reductions in payments to doctors, hospitals, nursing homes, and Medicare Advantage program, totaling $716 billion over ten years. By paying providers less, the trust fund may last a bit longer, but it means seniors will have a harder and harder time finding a doctor to see them as they drop out of the program or stop taking new Medicare patients. The law may not explicitly cut benefits, but it certainly will impact access to care. What good is a Medicare card if you can’t find a doctor? That is precisely the problem that patients on Medicaid — the program for lower-income Americans — face today, forcing them to go to hospital emergency rooms for even routine care. Do seniors want that?
Source: georgiapolicy.org

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.    
Source: patch.com

Georgia Medicare Supplement Plans made easy by GAMedicarePlans.com

GAMedicarePlans.com makes shopping for Medicare plans easy and simple by giving you all of the information you need. Their skilled agents will stay with you through the entire process. Your confidence level will go up after requesting a quote from them. Georgia Medicare Supplement Plans were designed to fill in the gaps left by traditional Medicare coverage, and GAMedicarePlans.com has made finding your ideal plan that much more simple for you.
Source: release-news.com

CMS Awards $306M To States For Enrolling More Kids In Medicaid

Georgia Health News: State Gets (Smaller) Bonus For Kids’ Enrollment Georgia is one of 23 states that will receive a performance bonus for enrolling eligible children in government health insurance programs, but the amount is far less than last year’s award. The Centers for Medicare & Medicaid Services said Wednesday that Georgia will receive a bonus of $1.9 million. The state’s bonus last year was almost $5 million. 2011 was the first year that Georgia got this performance bonus, funded under legislation that reauthorized the Children’s Health Insurance Program (CHIP). A state qualifies for a federal bonus by implementing procedures to simplify enrollment and renewal to ensure that all eligible children have easier access to coverage under Medicaid and CHIP, which in Georgia is known as PeachCare (Miller, 12/19).
Source: kaiserhealthnews.org

Senior Benefit Services, Inc.

Effective November 1, 2012 on new business & in force business for Family Life Insurance Company 1990 and 2010 Modernized Medicare Supplement plans in Georgia. The Rate Adjustment will affect ALL Plans.
Source: srbenefit.com

Man pleads guilty to Medicare fraud in Georgia

Individuals convicted of Medicare fraud in Georgia face serious penalties, making it important for those accused of such offenses to seek qualified legal representation immediately. The man in this case is currently in prison in a different state for a guilty plea in another health care fraud case, but faces a fine of up to $250,000 and up to five years of jail time once he is released if he is convicted in Georgia. Because he is not an American citizen and was living in the United States on an expired Visa at the time of the alleged fraud, he will likely face deportation as well. Those proceedings would not occur until he has completed any applicable prison sentences.
Source: atlantacriminaldefenseblog.net

Medicare Open Enrollment: last chance to review and compare plans

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSWith 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

Video: It’s Easy to Compare Medicare Plans at Joppel

Comparing Medicare prescription drug plans

Also, be aware that if you’re a low-income beneficiary and your annual income is under $16,755 or $22,695 for married couples living together, and your assets are below $13,070 or $26,120 for married couples, you may be eligible for the federal Low Income Subsidy known as “Extra Help” that pays Part D premiums, deductibles and copayments. For more information or to apply, call Social Security at 800-772-1213 or visit socialsecurity.gov/prescriptionhelp.
Source: pomeradonews.com

Medicare: Save Money on Premiums and Copayments in 2013

More plans offer lower copays at "preferred" pharmacies: In 2013, for example, more than half the 32 Part D plans in California will charge lower copays at preferred pharmacies than at regular network ones — with savings of between $2 and $28 for the same prescription. Sounds like a deal, but be careful: If a plan’s preferred pharmacies aren’t within a convenient distance, you may be better off in another plan.
Source: aarp.org

Superior Care Provided By Medicare Plans

For getting complete coverage for your health care expenses, you need to select most suitable Medicare plans. You need to Compare Medicare Advantage plans and Medicare Supplemental plans and then select the Best Medicare Advantage Health policies that are able to meet your varying health care or medicals needs. In order to get maximum benefits from Medicare plans, you have to take lot of care to choose most suitable one. Before selecting a plan, you have to analyze your health care needs and current health insurance. If you have a standalone prescription drug plan, then you don’t need to choose Medicare Part D plan. Overestimating the value of this will increase your overall cost. You have to choose plan that suitably fits your expectations, budget and lifestyle. Superior Care Provided By Medicare Plans
Source: blogspot.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

MedicareSupplementShop.com ? Compare Medicare Supplement Plans, Get Quotes!

There are many Prograde supplements exciting and valuable elements to the website. While searching at all of your Medicare Supplement Plans, you can effortlessly compare distinct portions of the plan and comprehend the different expenses and positive aspects at the identical time. This comparing quotes web page contains simple to adhere to methods and several valuable hints. The web page also has easily laid out grids, so you can compare diverse plans side by side, with out confusion or uncertainty about what your plan will have to supply.
Source: trevorchan.org

5 mistakes retirees make choosing a Medicare plan

It’s also easier to find quality plans this year, according to the Centers for Medicare & Medicaid Services, which has beefed up its star ratings system to alert consumers to the best-performing plans and remind those stuck in continuously low-performing ones that they can switch plans. Beneficiaries have 127 four-star or five-star Medicare Advantage plans from which to choose, up from 106 during open enrollment for 2012. And those in original Medicare have 26 high-performing prescription drug plans at their disposal, up from 13 last year.
Source: sltrib.com

Better Coverage Of Medicare Plans With The Help Of

Many people do get profits and benefit from Medicare モンクレール, even though it does not cover 100% of all medical costs. Many people purchase Medicare Supplement Plans to help offset the costs that are not covered by traditional Medicare. These premiums will also go towards funding Medicare. To offset these gaps in coverage, many American older adults will also purchase Medicare supplement insurance that will help them pay some additional costs. Other people get their Medicare benefits from Medicare Advantage Plans through a private health insurance company ダウン モンクレール. This is another and effective way the Medicare program is trying to share costs and risks, by allowing private health insurance companies to also offer Medicare facilities. The insurance carriers get paid from Medicare to offer profits to older Medicare-eligible adults. A member who buys a Medicare Advantage Plan cannot also purchase a Medicare supplement policy because that would be considered being eligible to have double benefits and effective for the same things. Medicare Advantage Plans include many of the benefits and profits of a Medicare supplement policy.
Source: wordpress.com

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

MedicareSupplementShop.com ? Compare Medicare Supplement Plans, Get Quotes!

There are many Prograde supplements exciting and useful factors to the website. Although searching at all of your Medicare Supplement Plans, you can simply compare various portions of the plan and realize the distinct charges and advantages at the exact same time. This comparing quotes page contains straightforward to adhere to actions and numerous valuable hints. The web page also has very easily laid out grids, so you can compare different plans side by side, without confusion or uncertainty about what your plan will have to offer you.
Source: pakchom.net

What Is A Medicare Supplement

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deThere 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

Video: Medicare Supplemental Insurance | Medicare Benefits Direct

Medicare Supplement Plan F

At 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

AFLAC Medicare Supplement Plans Now Released in Indiana

Please Note: Commission schedules for Indiana have changed from the original schedules.  Under the new commission schedules all premium is commissionable at the same commission level. There is no reduction in comp for G.I. business. There is no non-commissionable premium in Indiana. The Part B Deductible portion of the premiums is fully commissionable. The only exception is that the commission rate is applied to the original premium. No commission is payable on future rate increase premium.  No commission is payable on the policy fee.
Source: ihealthbrokers.com

Kazor.com World Community News

America is graying, a fact that is mentioned frequently in media reports about the health care system and health reform. It’s a fact that there is a big wave of seniors about to become eligible for Medicare, and once that happens, they will need Medicare supplements. As a busy and experienced insurance agent that deals with seniors on a regular basis, you know first-hand that the growth of your business depends on a constant supply of Medicare supplement leads. You want quality leads, fresh to your inbox daily or weekly, whichever suits your timetable.
Source: kazor.com

Today’s Influence Ads: AARP Medicare Supplement, Shale Gas Production

A slew of new ads are out today as Congress embarks upon its last week before the elections. AARP and UnitedHealthCare have a new ad today promoting AARP Medicare Supplement Insurance Plans as the only standardized Medicare supplement plan that AARP  endorses. American Clean Skies Foundation has a new ad pushing for the production of shale gas in the United States. The government of Panama’s new ad promotes the country as a good place for American businesses to invest. And Across the Aisle Foundation has a new ad inviting senior House and Senate staffers from both parties to an October event to discuss how the new Congress should tackle its first 100 days. Others with new ads, per Kantar Media’s Washington Eye, include: American Petroleum Institute, American Sugar Alliance, American Veterinary Medical Association, Consumer Electronics Association, Employee Freedom Act Committee, Fair Search, Lockheed Martin, McDonald’s, Neustar and Radiation Therapy Alliance. Those with continuing ad include: Altria, American Cancer Society, American Council of Life Insurers, American Hospital Association, AT&T, Beirut Families, Boeing Company, BP, Chevron, CIT Group, CME Group, Hologic, Honda, Huntington Ingalls Industries, Lockheed Martin, Mars Chocolate, Northern Dynasty Minerals, Nuclear Energy Institute, Pfizer, Pharmaceutical Research Manufacturers of America, Southern Company, United Soybean Board, Univision, WellPoint, WTOP and Zurich.
Source: nationaljournal.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

Dave Fluker’s California Health Insurance Blog: Anthem Blue Cross Raising Medicare Supplement Rates in 2013

David Fluker Insurance Services – Gilroy, California Serving California Residents Since 1995 For specific Health Insurance information, please visit my site at the link below www.davefluker.com Email Me CA Insurance License # 0B58920
Source: blogspot.com

California Medicare Supplement: Benefits Explained

Instead of offering you help from the State, the California based Medicare Savings Program is a lovely initiative where you can save a lot of money, make sure you use them when you need it, and let your earnings accrue under Government supervision. This way, if you meet with untimely accidents or are diagnosed with huge illnesses, you have substantial savings to bail you out of trouble. If you fall short, the State can pitch in with a few thousands of dollars for help.
Source: wordpress.com

Exclusive Medicare Supplement Leads

Speaking of Medicare supplement leads, let’s just take a moment to mention exclusive Medicare supplement leads. Maybe you have already heard about exclusive Medicare supplement leads, and not in a good way. Perhaps a colleague told you about the time they got ripped off by some company that said their leads were exclusive, but really sold them to at least seven other agents. Those are NOT exclusive Medicare supplement leads. But YES, there IS such a thing as exclusive leads. You just have to know where to find them. Shop around for a company that knows what it is doing, check out their programs, and ask lots of questions, after all, it’s your money. If you don’t get something they are telling you, then keep asking even more questions, until you understand how their lead system works and what the differences are between regular leads and the exclusive ones. In other words, you want to buy your leads from a company that when it says “exclusive” leads, they MEAN exclusive to ONLY you.
Source: benepath.net

Genworth Financial to sell its Medicare supplement unit

Genworth, a Henrico County-based insurance giant, said the sale is part of strategy to focus its attention on its retirement and protection business segment and markets with the strongest value propositions for the company.
Source: timesdispatch.com

Medigap: Sacramento, Placer Medicare Supplement Rates

Independent agent for health and life insurance in northern California. CA LIC. 0H12644. Focusing on families, individuals, self employed and small business. Representing several insurance carriers including Medicare Advantage and Part D Plans. Life insurance, final expence and funeral trusts. My pledge to my clients: 1. I respect your time and decisions. 2. I will not try to sell you something you do not want or need. 3. I will not call you after 5pm unless you ask me to.
Source: insuremekevin.com

Don’t mess with Medicare (Mississippi Sound Off)

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /I see in this morning’s paper where Gautier has just found out they have a $1 million shortfall. That is easy to explain. The city government is throwing money right and left. We have sidewalks to nowhere; streetlights that don’t meet regulations and need to be removed; landscaping the medians that they can’t mow or keep weeded now; clock towers; sculptures for a non-existent downtown. Citizens, let’s clean house and get rid of all of them. We need practical thinking, level-headed leaders — not pie-in-the-sky dreamers.
Source: gulflive.com

Video: Mississippi Medicare Supplements

MHA’s Executive Briefing: Bill would expand telehealth coverage

A bill to expand Medicare and Medicaid coverage of telehealth services that was introduced in the waning days of the last Congress will be reintroduced in the new Congress. Learn more from Modern Healthcare here.
Source: typepad.com

Mississippi says no thanks to Medicaid expansion dollars

Wilna Alexander, 54, a part-time cook for a midtown Jackson, Miss., community services operation, and one of an estimated 476,000 uninsured Mississippians, cleans up after preparing the batter for a baked dessert for a pre-school center and a senior citizens meal program, Tuesday, Oct. 16, 2012. She said she was on Medicaid, but lost the coverage more than two years ago when she began working. (AP Photo/Rogelio V. Solis)
Source: thegrio.com

Mississippi Medicaid Changes from the 2012 Legislative Session

For inpatient hospitals, the new APR-DRG methodology will be similar to DRG-based payment methods currently used by Medicare. All inpatient stays will be classified in one of 1,256 APR-DRGs based on the difficulty of the case. The payment amount for each stay will be derived by multiplying the APR-DRG relative weight by a budget-neutral base rate established by the Mississippi Division of Medicaid (DOM). Hospitals will be paid more for complex cases and less for more routine procedures. Policy adjustments will be made for pediatric mental health, adult mental health and obstetrics and newborns, to enhance payments made for the most at-risk Medicaid beneficiaries. Expected benefits of the change are as follows:
Source: healthcarereforminsights.com

Old Hickory’s Weblog: Thomas Frank on Obama and the Grand Bargain to cut benefits on Social Security, Medicare and Medicaid

Thomas Frank takes a literary shot at the Washington Beltway Village groupthink on Social Security, Medicare and Medicaid, aka, “entitlements” to their opponents. In the print edition of the January 2013 Harper’s, he has a piece called “Second Chance,” meaning a second chance for Obama. The cover version of the title has a less optimistic sound, “Will Obama Reject Another Mandate?” The cover title is more in line with the observations in Frank’s article: Barack Obama’s Democrats just won a resounding triumph in what was advertised as the great ideological face-off of our times. What we the people chose, according to this viewpoint, was social insurance, universal health care, a strong regulatory state. What this town urges on President Obama, unfortunately, is something quite different: an imaginary armistice between the two parties, purchased at the cost of the very things his supporters think they just voted for.Specifically, he’s talking about Obama’s commitment to the Grand Bargain to cut benefits on Social Security, Medicare and Medicaid. Another term for the Grand Bargain might be “austerity”-the punitive economic reflex that has driven much of Europe into deep recession. Austerity proceeds from the reasonable-sounding premise that government must cut back spending during hard times, just as everyone else does. However, this practice actually serves to worsen slumps and recessions rather than cure them. That in turn reduces tax revenues, thereby pumping up deficits and making the need for further austerity seem even more urgent. Such a bargain might be grand, but it might also be stupid and self-destructive.Frank wonders not only about the reasons Obama embraces such a destructive course, but also about the general assumption in the Village that cutting benefits on Social Security, Medicare and Medicaid is a virtuous, vital, necessary thing to do. “While the rest of the nation worries about unemployment and bankruptcy and the great corporate rip-off, people in D.C. worry about the deficit,” he writes. And he emphasizes how pervasive that view in among the Villagers: Washington’s most prominent residents have always had trouble understanding the economic problems of the country outside the Beltway. Other Americans grasp the symbiotic relationship between the economy at large and the government’s balance sheet. Washingtonians, however, view the government’s own fiscal situation – meaning the federal deficit – as something autonomous and detached from the nation’s sweaty, second-wave struggles. The deficit is thought to be a problem all on its own, a disaster separate from and comparable to the recession itself.Of course, the deficit for Wall Street is an excuse to try to cut benefits on Social Security, Medicare and Medicaid so they can take a cut of some of the cash flows that go into them, especially Social Security, the Mississippi River of all cash flows, as Jamie Galbraith describes it. Citing Obama’s interview with the Des Moines Register a couple of weeks before the November election, Frank writes of him: … his real policy ambition was the same as always: to achieve the Grand Bargain. Which is to say, a fiscal deal between the parties that would enact the centrist dream agenda all at once by cutting spending, increasing tax revenue, and (in at least one version of it) “reforming” entitlements. The Great Conciliator in the White House has longed for such a bargain for years. In pursuit of it, he created the BowlesSimpson commission, then a special committee chaired by Vice President Joe Biden, then led his own series of meetings and horse-trading sessions. (And that’s not counting the failed congressional “Super Committee” of late 2011.)Frank is still using a more expansive version of what the Grand Bargain would be. In practice, that phrase has now come down to meaning cutting benefits on Social Security, Medicare and Medicaid. Tags: austerity economics, barack obama, debt ceiling, grand bargain, medicaid, medicare, social security
Source: blogspot.com

Challenges about Navigators, Licensing, Regulation, Medicaid and Call Centers

The ACA plan is that Medicaid eligibility and commercial product availability and eligibility would be “merged” into one marketplace/website so consumers can go to one place, enter their income and family size and learn the programs they are eligible for.  This might work relatively well for a state like Washington that uses a state-based exchange.  It is not clear to me yet, how this will work for states that opt for a state-federal partnership or states that default to using the new federal exchange.
Source: oconnorhealthanalyst.com

Mississippi Medicare Part D Plans

Annual open enrollment for Part D begins on October 15th and continues through December 7th. If you submit an application during the enrollment period and feel that you have found a better plan, you can submit another application as long as you are still with that enrollment period.
Source: partdplanfinder.com

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareEach private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Video: Medicare Supplement Plans (How to Find)

Study Finds Premium Support Plan Could Raise Medicare Premiums In Many Parts of Country

The study modeled the impact of a generic version of premium support, under which beneficiaries would receive a defined subsidy, or voucher, to buy health insurance in a competitive market instead of getting a guaranteed set of benefits as Medicare has traditionally provided. That payment would be tied to the second lowest cost plan offered in an area or traditional Medicare, whichever is lower. This kind of a change is a central part of the House Republican budget written by Rep. Paul Ryan of Wisconsin, now the GOP’s vice-presidential candidate, and it has also been embraced by GOP presidential nominee Mitt Romney. Even a few Democrats have flirted with such a plan as a way to leverage market efficiency to rein in the spiraling cost of Medicare.
Source: kaiserhealthnews.org

Health Plans Providing Value to Medicare Advantage Beneficiaries

Health plans are working with seniors and people with disabilities in Medicare Advantage plans to ensure that beneficiaries receive health care services on a timely basis, while also emphasizing prevention and providing access to disease management services for their chronic conditions.  These coordinated care systems provide for the seamless delivery of health care services across the continuum of care. Physician services, hospital care, prescription drugs, and other health care services are integrated and delivered through an organized system whose overriding purpose is to prevent illness, improve health status, and employ best practices to swiftly treat medical conditions as they occur, rather than waiting until they have advanced to a more serious level.
Source: ahipcoverage.com

Not Happy with Your Medicare Advantage Plan? Change it!

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Kaiser Permanente Leads the Nation with Six 5

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Analysis: Obama may turn Medicare debate into more healthcare reform

Medicare, long considered a program that U.S. politicians would touch at their peril, is acknowledged, along with the national Medicaid program for the poor, to be a major driver of the deficit. The aging population puts Medicare on a collision course with major financial difficulties; the so-called Medicare trust fund is on pace to run out of money in 2024.
Source: medcitynews.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

Medicare, Medicaid, and Other Health Provisions in American Taxpayer Relief Act of 2012 (Updated)

Extension of Family-to-Family Health Information Centers:  This provision continues the Family to Family Health Information Centers (F2F HIC) to assist families of children and youth with special health care needs in making informed choices about health care in order to promote good treatment decisions, cost-effectiveness and improved health outcomes.  The centers are intended to help families navigate the health care system so that their children can get the benefits they need through Medicaid, CHIP, SSI, early intervention services, other government programs, and private insurance.  F2F HICs also train health care providers and policymakers and advocate for a family-centered “medical home” for every child. There is one F2F HIC in every state and the District of Columbia.
Source: piperreport.com

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

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

Are you ready for 2013? 4 questions to ask yourself

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Not Happy with Your Medicare Advantage Plan? Change it!

Posted by:  :  Category: Medicare

William D. Novelli by Center for American ProgressThe opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

Video: Understanding Medicare Advantage Plans

Uwe E. Reinhard: The Complexities of Comparing Medicare Choices

Each private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

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

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

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.
Source: medicare.gov

Medicare Advantage Fact Sheet

This updated fact sheet provides an overview of the Medicare Advantage program, describes program changes made by the new health reform law in plan participation and beneficiary enrollment, presents data on benefits and premiums, and explains changes in Medicare payments to participating plans.
Source: kff.org

Medicare Advantage Plans Offer No Clinical Trial Coverage

The pur­pose of the National Cov­er­age Deter­mi­na­tion was to elim­i­nate the dis­crim­i­na­tion and penal­iza­tion of patients who were com­mit­ted to advanc­ing treat­ment against this for­mi­da­ble dis­ease. Yet, as a result of a loop­hole in the cur­rent law, Medicare Advan­tage Plan enrollees are los­ing treat­ment options by exclu­sion of par­tic­i­pa­tion in clin­i­cal tri­als because of finan­cial bur­den. Please join me in sup­port­ing this much needed change in leg­is­la­tion. Con­tact your state rep­re­sen­ta­tive to dis­cuss this impor­tant oncol­ogy issue, and ask them to advo­cate for and sup­port an amend­ment to the National Cov­er­age Deter­mi­na­tion to include cov­er­age of oncol­ogy clin­i­cal tri­als by Medicare Advan­tage Plans.
Source: onsconnect.org

PacifiCare’s massive Medicare Advantage fraud

It has long been recognized that the private Medicare Advantage plans (offered as an option to the traditional Medicare program) have been cheating the taxpayers, initially by selectively enrolling the healthy while being paid at rates that include a mix of the sick, and, more recently, by gaming the process of risk adjustment (which seeks to correct for the health status of the beneficiaries actually enrolled by the private plans). This new report from the HHS Office of Inspector General is helpful because it provides a perspective of the enormity of the problem.
Source: pnhp.org

Closing The Medicare Part D Program Doughnut Hole: The End Is In Sight!

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy PelosiThere’s also some encouraging research confirming what a lot of us intuitively sense: that making prescription drugs more affordable saves money down the road by keeping people healthier. When people with diabetes get their insulin regularly, for example, they’re more likely to stay out of the hospital. Of course this is great for them; no one likes going to the hospital. But it’s good for all of us, because hospital care is expensive, and keeping people healthy and out of the hospital is one of the most obvious ways of bringing health care costs under control. Recently, the Congressional Budget Office – the green eyeshade folks who keep track of the cost of everything the government does – concluded that making prescription drugs in Medicare more affordable does, in fact, save some money later on by reducing things like hospital admissions. As a result, filling in the doughnut hole is going to cost about 40 percent less than was previously forecast. At a time of tight budgets, that’s great news for all of us.
Source: smmirror.com

Video: Medicare Part D – The Donut 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

Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?

Philadelphia Inquirer/HealthDay News: Medicare Coverage Gap May Cause Seniors To Forgo Antidepressants The Medicare Part D drug plan’s gap in coverage — often referred to as the “donut hole” — has long been a concern, and a new study links it to cutbacks by seniors in the use of antidepressants and other medications. An estimated 13 percent of seniors aged 65 and older suffer from depression, experts say. Antidepressants can stop depression from returning, but the Part D benefit — especially the coverage gap — “imposes a serious risk for discontinuing maintenance antidepressant pharmacotherapy among senior beneficiaries,” the study authors found (Dotinga, 7/2).
Source: kaiserhealthnews.org

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

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

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

In the Donut Hole…I Need Help!!! » Toni Says

To qualify, your 2012 income must be limited to $16,335($1,361.25) for an individual or $22,065($1,838.75) for a married couple living together.  This year they have raised the amount for resources which can be real estate, bank accounts, stocks, CDs, mutual funds, IRAs and cash at home but they no longer count your house, car and life insurance as a resource.  The value of what you own must be limited to $12,640 for an individual or $25,260 for a married couple.              What is so great about LIS (extra help) is that when you are approved; then, there can be different levels that you can qualify for, depending on how much your annual income and resources are. You may have your Part B $99.90 premium paid for, your Part D premium also can be paid for and your prescriptions co pays will be reduced to $2.60 for generics or $6.50 for brand name drugs.  One thing that is really great about LIS (extra help) is that the “Donut Hole” can be eliminated if you qualify so a $200 or $2,000 or whatever the cost of a brand name  prescription will only be $6.50.
Source: tonisays.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

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

AFLAC Medicare Supplement Plans Now Released in Indiana

Posted by:  :  Category: Medicare

gutted bag by jason.odonnellPlease Note: Commission schedules for Indiana have changed from the original schedules.  Under the new commission schedules all premium is commissionable at the same commission level. There is no reduction in comp for G.I. business. There is no non-commissionable premium in Indiana. The Part B Deductible portion of the premiums is fully commissionable. The only exception is that the commission rate is applied to the original premium. No commission is payable on future rate increase premium.  No commission is payable on the policy fee.
Source: ihealthbrokers.com

Video: Medicare Supplemental Medigap in Indiana by 1-800-MEDIGAP®

Indiana Brain Injury Lawyers Encourage Congress to Extend Medicare Therapy Cap

In this video, American Physical Therapy Association (APTA) Director of Affairs Mandy Frohlich encourages people to call or email their members of Congress to extend therapy cap exceptions for Medicare beneficiaries through 2013. While the video relates to an advocacy drive on December 3, 2013, the Brain Injury Association of America (BIAA) issued an announcement that day stating that it was one of eight organizations emphasizing to Congress the devastating patient impact of a therapy cap. According to the BIAA, American Heart Association Vice President Sue Nelson said, “The health of hundreds of thousands of seniors and individuals with disabilities who rely on Medicare for therapy services is in jeopardy if Congress does not act before December 31.”
Source: indianabraininjurylawyerblog.com

The Indiana Law Blog: Law

The suit alleges that the practice of putting patients in observation status not only denies them coverage for post-hospital rehab care, so they must either pay the nursing home’s full bill — more than $30,000 in the case of two plaintiffs — or forgo treatment. It also classifies them as outpatients while they’re in the hospital. Therefore, their Medicare coverage comes not under Part A (hospital insurance) but Part B (which normally covers doctors’ services and outpatient care). For some patients, this can also mean paying more out of pocket — especially if they need prescription drugs that, in this situation, would be covered under Part B and not under Part A or even the Medicare Part D drug benefit. * * *
Source: indianalawblog.com

Medicare Supplement Insurance

In 2004, Jess and Sandra heard about some exciting options for Medicare. Jess and Sandra started to learn more about the different Medicare Advantage, Medicare Supplement, and Part D prescription plans. As Sandra puts it, “They dove into the senior market heavily; it just exploded.” Jess and Sandra have become experts in the Medicare marketplace. The demand was great back then and continues to be to this day. Sandra said, “We are certified with every company that does business here in Indiana. 80% of what we do is Medicare focused.” The annual election period is October 15 to December 7 for Medicare. “Every participant can change their current plan with Easy Street,” said Jess. Jess and Sandra look at many options to find the right plan to match each client’s needs.
Source: atcentergrove.com

IU Health to Participate as a Medicare Shared Savings Program ACO

About Indiana University Health – Named among the “Best Hospitals in America” by U.S. News & World Report for 14 consecutive years, Indiana University Health is dedicated to providing a unified standard of preeminent, patient-centered care. A unique partnership with Indiana University School of Medicine – one of the nation’s leading medical schools – gives our highly skilled physicians access to innovative treatments using the latest research and technology.  
Source: iuhealth.org