Daily Kos: What are some Progressive Solutions to the “Medicare Problem”?

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Total Medicare expenditures were $549 billion in 2011. The Board projects that, under current law, expenditures will increase in future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP,  they will increase from 3.7 percent in 2011 to 6.7 percent by 2086 (based on the Trustees’ intermediate set of assumptions). If lawmakers continue to override the statutory decreases in physician  fees, and if the reduced price increases for other health services under  Medicare are not sustained and do not take full effect in the long  range, then Medicare spending would instead represent roughly  10.4 percent of GDP in 2086. Growth of this magnitude, if realized,  would substantially increase the strain on the nation’s workers, the  economy, Medicare beneficiaries, and the federal budget. That means that if we do the doc fix every year (which we just did again), Medicare will grow to 10% of GDP — not 10% of the budget, 10% of GDP.  And that’s assuming the most favorable outcome with respect to the ACA being able to reduce costs — they say the lilkely outcome may well be much worse.  Read that report.
Source: dailykos.com

Video: Fresh Perspectives: MEDICARE

Brad DeLong : Michael Gerson and Paul Ryan Lie About What Republicans Say to Each Other About the “Takers”

Mr. Gerson doesn’t address the accuracy of Obama’s claims… [T]he “nation of takers” rhetoric has been increasingly prevalent on the right. The Republicans have consistently opposed equal pay for equal work. Republican governors from Ohio to Virginia to Florida did all they could to assure long lines at the polls. Who could argue against the idea that the Norquist anti-tax pledge puts absolutism over principle or that Fox News and Rush Limbaugh substitute spectacle for politics? What kind of reasoned debate involves questioning the president’s birth certificate and calling him a Muslim or a Stalinist or a Nazi? What does Gerson think happens to the elderly and parents with special needs kids when you slash Medicaid, Medicare, Social Security and other health programs?… The president told the truth. Who cares if the right doesn’t like it?
Source: typepad.com

Health Care Authority Receives $12 Million Bonus for Outreach That Helped Children Find Health Insurance

Washington met the following five of the eight required program features necessary to qualify for an FY11 bonus award: 12-month continuous eligibility, liberalization of the state’s asset test, elimination of in-person interview requirements, use of the same application and renewal forms, and premium assistance subsidies.
Source: wa.gov

Connecting Kids to Coverage Outreach and Enrollment (Cycle III)

Connecting Kids to Coverage Outreach and Enrollment (Cycle III)grants will support outreach strategies similar to those conducted in previous grant cycles, and also will fund activities designed to help families understand new application procedures and health coverage opportunities, including Medicaid, CHIP and insurance affordability programs under the ACA.  [Funding]
Source: worh.org

David Sayen: How Medicare works with other insurance

Medicaid and TRICARE (the healthcare program for U.S. armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.
Source: santacruzsentinel.com

kareenasharma990: Free or Affordable Health, Vision And Dental Insurance For Children …

Good news for parents around the US who have been fretting over their childrens insurance coverage, or rather the lack of it: You dont have to live in a low income household to be eligible for government subsidized childrens health insurance. Middle-class families struggling through the recession can also benefit from the measures that resulted in recently passed healthcare reform laws. Medicaid and Childrens Health Insurance Program (CHIP) together serve families who are not able to afford health insurance coverage in the private market or do not have coverage available to them. Upper middle class families also can make use of these plans, paying affordable rates. This is good news all around, but, especially for those living in states where the insurers are dropping childrens plans rather than cover kids under the expanded new laws.
Source: blogspot.com

Changes to Illinois All Kids Medicaid Program Harmful to Thousands Insurance Families.com

Families that make 300% above the poverty level will no longer be eligible to put their children into this health care program. That percentage equates to about $60,000 for a family of four. The result is that 4,300 children in Illinois will suddenly be completely without health insurance. Many of these children have cancer, or other serious health conditions. Parents, or caregivers, of these children will soon be forced to figure out how to pay for the cost of things like chemotherapy, prescription medications, and hospital visits without the help from the All Kids program.
Source: families.com

State gets (smaller) bonus for kids’ enrollment

“What this signals is that we could be doing more to enroll and retain eligible children in public health insurance options,” said McKay, associate policy director for child health at Voices for Georgia’s Children. “Further, I am disappointed that we are leaving money on the table. When I look at the total awards that our neighbor Alabama has received since the performance bonuses were established ($43 million), and compare to our awards ($6.8 million), I wonder what they are doing that we aren’t.”
Source: georgiahealthnews.com

OSU testing ACO, pay for performance approach to employee health insurance

In return, those doctors will potentially be paid more if the health of those patients improves, said Dr. Richard Streck, the hospital system’s chief medical officer.Nationwide Children’s Hospital has had an accountable-care organization — Partners for Kids — since 1994. It’s billed as the nation’s largest pediatric ACO, positioning the hospital well for future shifts in how it’s paid for patient care, said Tim Robinson, the hospital’s chief financial officer.And Partners for Kids is getting bigger.
Source: medcitynews.com

Report Says Early Years of Medicaid Expansion in NJ Won’t Break the Bank

Posted by:  :  Category: Medicare

Every other advanced democracy (Israel, Sweden, Norway, Denmark, Finland, Australia, Japan, Taiwan, Canada, France, Austria, Switzerland, New Zealand, Germany, Holland, etc.) has some form or version of universal health care; everyone is covered and no one goes bankrupt from medical expenses as they do in the US. A national health care system was part of the 1912 campaign platform of Teddy Roosevelt. Truman tried to institute a national health care system throughout his presidency but was defeated by the GOP, the AMA and the one percenters. By some miracle, LBJ managed to enact Medicare and Medicaid in 1965. Without these programs, we would have about 100 million uninsured; we currently have 48.8 million uninsured according to the US Census. We have tens of millions more with inadequate crap insurance with high deductibles and many out of pocket expenses. When is enough enough in the US? We should have Medicare for all or a single payer health care system. Instead of that, we are talking about cutting and gutting Medicare and Medicaid. It’s just stupid and nuts.
Source: patch.com

Video: Fat Arrogance: Rude-Hypocrite NJ Gov. Christie’s War on Medicare & The Poor

Horizon NJ Health Slashes Medicaid Reimbursements for Home Healthcare

Thomas Vincz, spokesman for Horizon Blue Cross Blue Shield of New Jersey, the parent company of Horizon NJ Health, called the reimbursement reductions “difficult decisions,” but said that they “demonstrate the realities of today’s healthcare in having to do more with fewer resources.” Horizon is seeing a reduction in the rates it receives from the state to administer “various government health programs,” Vincz said, while “benefit utilization” and overall costs were growing.
Source: wnyc.org

Senior Care in Mt. Laurel, NJ: Open Enrollment for Medicare –Now through Dec 7, 2012

Would a small increase in premiums result in a large reduction in health care costs you pay? Check, for example, what coverage is available for prescription drugs you take? Medicare representatives can create a report containing the costs and benefits of various insurance products if you supply them with a list of your drug prescriptions. Ask questions about participating doctors and clinics. Some Medicare Advantage plans limit which physicians a patient can visit.
Source: hometostayhc.com

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

Counseling is free, objective and confidential and encompasses assistance with questions about Medicare, Medigap, Medicare Advantage, Medicare Part D, Long-Term Care Insurance and Dual-Eligibility. Sessions are conducted by telephone so that travel is not necessary.       
Source: mhanj.org

CamCo Holds Medicare Open Enrollment Session Wednesday

“It’s time to compare plans and select the right one for you,” said Freeholder Carmen Rodriguez, liaison to the Camden County Division of Senior & Disabled Services. “If you are unhappy with your current plan, use this open enrollment period as an opportunity to look for a new one with better coverage, higher quality and lower cost.”
Source: patch.com

Fiscal cliff cuts could weaken Medicare in N.J.Don't Call Me Tony

The 2 percent cut would cost New Jersey health care facilities $133 million in 2013, affecting hospitals, nursing homes and physicians who accept Medicare, the federal health insurance program for seniors.
Source: anthonycampanella.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

NJ Court: Federal Law Does NOT Mandate Medicare Set

This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

Christie Administration Warns NJ Seniors To Be Alert About Medicare Fraud

Must arrange with you in advance the type of products that will be discussed during a scheduled sales appointment. They may not attempt to sell you other types of insurance coverage other than the type agreed upon in advance; May not try to sell you non-health care related products (like a life insurance policy or an annuity) during a sales or marketing presentation of a Medicare plan; May not attempt to sell you a plan in a doctor’s office or in a pharmacy; May not attempt to sell you a plan at an educational event; May not offer you free meals at promotional or sales events; and May not offer you gifts or other promotional items with a value greater than $15.
Source: nj1015.com

Fiscal cliff cuts could weaken Medicare in NJ

WASHINGTON — It’s looking less and less likely that Congress and the White House will strike a deal to keep the country from falling over the “fiscal cliff” next week, so physicians are preparing for a 28.5 percent cut in Medicare payments that will take effect on more
Source: newsplurk.com

NJ Labor, Elected Officials, Clergy & Advocacy Groups Call for Fiscal Cliff Resolution

Speakers included Congressman Frank Pallone (D-06); Congressman  Bill Pascrell (D-08); Milly Silva, Vice President, SEIU NJ State Council, and Executive Vice President of 1199SEIU United Healthcare Workers East, New Jersey Region; Kevin Brown, SEIU NJ State Council Secretary/Treasurer, and NJ State Director for Local 32BJ; Charles Wowkanech, President, NJ State AFL-CIO; Phyllis Salowe-Kaye, Executive Director, NJ Citizen Action, and state partner of Americans for Tax Fairness; Samia Bahsoun, NJ Main Street Alliance; The Rev. Dr. J. Brent Bates, Grace Church; and Dr. Shoaib Afridi, Executive Vice President, SEIU Committee of Interns and Residents.
Source: seiunj.org

MedicareIsSimple: Seniors Favor Higher

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552“One interpretation of these findings suggests that publicly reported star ratings could be achieving one of their intended purposes of guiding beneficiaries toward higher-quality plans,” Rachel Reid from the the Centers for Medicare and Medicaid Services’ (CMS) Innovation Center, in Baltimore, and colleagues wrote. “Consequently, CMS may consider continued evolution of the rating methods to ensure that the quality information conveyed continues to reflect attributes important to both the agency and beneficiaries.”
Source: blogspot.com

Video: Medicare Advantage Plans 2011

Why the new House GOP budget plan will be even worse

Ryan’s notorious budget plan was lauded by establishment media types who didn’t read it, and had no idea how fiscally insane it was. For all the hype about the Wisconsin Republican being a “deficit hawk,” Ryan’s budget plan actually proved the opposite — he cut spending to the bone in all kinds of critical areas, but instead of applying those savings to debt reduction, Ryan’s blueprint applied the money to more tax breaks for the wealthy. Ryan’s plan — the one celebrated by pundits for being “serious” — didn’t balance the budget until 2040, nearly three decades away, and even then, the figures relied on rosy assumptions that most found unrealistic.
Source: msnbc.com

Rawlings Medicare Advantage Memo

Nor are New York or Arizona state court opinions addressing MAOs’ recovery rights relevant in light of Humana, because state law is preempted.  U.S.C. §1395w-22(a)(4) provides that MA plans with subrogation/reimbursement rights “notwithstanding any other provision of law.”  42 C.F.R. §422.108 expressly states that the subrogation and reimbursement rights in favor of the MA plan are preemptive over conflicting state laws and regulations:  “[T]he rules established under [42 CFR 422.108] shall supersede any state laws, regulations, contract requirements, or other standards that would otherwise apply to MA plans.”  As stated above, the Humana Court was clear: courts are bound to defer to CMS issued regulations.
Source: willshapiro.com

Paul Ryan’s Health Care Record

Proposed revamping Medicare to, among other things, change it from a defined benefit to a premium-support program. Starting in 2023, Ryan’s budget would give future Medicare beneficiaries (those currently younger than 55) a set amount – a voucher — to purchase either a private health plan or the traditional government-administered program. His proposal also would increase the eligibility age from 65 to 67.
Source: kaiserhealthnews.org

Medicare to penalize hospitals for readmitted patients

Excessive rates of readmission are only part of the problem of high costs and uneven quality in the U.S. health care system. While some estimates put readmission rates as high as 20 percent, a congressional agency says the level of preventable readmissions is much lower. About 12 percent of Medicare beneficiaries who are hospitalized are later readmitted for a potentially preventable problem, said the Medicare Payment Advisory Commission, known as MedPAC.
Source: publicradio.org

Comparing Medicare plans? Ratings show some policies better than others — Health — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.com

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

Public split on Medicare reform solutions

Posted by:  :  Category: Medicare

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 marsmet481According to a health poll from Truven Health Analytics, 65 percent of Americans believe changes need to be made to the federal health insurance system. Republicans—at 71 percent—felt stronger about the need for changes to the program than Democrats (58 percent). The highest rate (80 percent) of respondents who said they would favor changes to the Medicare system was among those who make over $100,000 per year.
Source: benefitspro.com

Video: Medicare Benefits Made Clear: News, Reform & Obamacare Exposed!

Goldman, Other Welfare Queens Tell Us Forget Social Security

Most seniors lack these necessities.  Half of those 65 or older make  $45,000 a year ($3,750 a month) or less.  If you have to wait until 70 for Medicare, you can either pay monthly health insurance premiums of $1,000 to $3,000 a month (if you can get it) or you can learn pain and suffering up close without coverage.  You can eat much less and downsize to substandard shelter to pay your health care costs (premiums and out-of-pocket expenses).  Perhaps the combination of restricted health care, substandard diet, and inadequate shelter may even kill you, in which case the problem is solved.
Source: warisacrime.org

Despite Potential Benefits, Medicare Slow to Utilize Telehealth

Health, Person Location, Person Career, Quotation, Telehealth, Health informatics, Medicare, EHealth, American Telemedicine Association, Medicine, Technology, Medical informatics, Videotelephony, telemedicine, Presidency of Lyndon B. Johnson, telehealth services, USD, Jonathan Linkous, Chicago, Institute of Medicine, Mike Thompson, California, stroke, stroke care, bipartisan Fostering Independence Through Technology, Richard Brennan Jr., telehealth technologies, dozen services, certain telehealth services, chief executive officer, John Thune, practicing neurologist, Lee H. Schwamm, American Heart Association, Harvard Medical School, acute stroke, bypass, video conferencing, National Association for Home Care & Hospice, chronic care management, Medicare Payment Advisory Commission, cessation services, reimbursable telehealth services
Source: reportingonhealth.org

Old Hickory’s Weblog: Defending the Big Three (Social Security, Medicare, Medicaid) against benefits cuts

The Huffington Post has been running a series of articles taking stock of the Administration and looking toward the second term, called The Road Forward. The AARP’s CEO, A. Barry Rand, addresses a critical set of issues in his contribution, The Road Forward: Social Security and Medicare 01/20/2013. He takes note of what bad ideas two of the things President Obama proposed after his re-election, raising the Medicare eligibility age and decreasing Social Security benefits via the “chained CPI” inflation adjustment scheme. Rand writes: We must … tackle the high cost of health care. Rising costs have a negative impact on federal programs such as Medicare and Medicaid, as well as on the costs for state governments, employers and individuals. Moreover, we cannot sustain an ever-increasing share of the nation’s output going to health care, especially when the Institute of Medicine estimates that as much as one third of health care spending is wasteful or inefficient. Policy makers must not simply reduce the federal share of health costs by shifting costs from the federal government to other payers. That will not solve the problem. In fact, it will make it worse. An example of this narrow approach is raising the Medicare eligibility age. This policy lowers federal health costs for the program by shifting costs from the federal government to employers, states and families on Medicare. This only drives seniors to more costly and less efficient providers, which, in turn, raises total health spending in the economy. This is pure folly. A better approach would be to lower the growth in health care spending system-wide, which will also lower the cost of Medicare and Medicaid. We have to make health care work more efficient and less costly to keep it sustainable for generations to come. [my emphasis]And he calls the “chained CPI” scam what it is: Of all the steps we can take to ensure that Social Security remains solvent and provides an adequate benefit now and in the future, the proposed use of the “chained CPI” is one of the worst, because it cuts the benefits of those who are least able to afford it: the oldest, poorest and most vulnerable among us. It would cut one full month’s income from a 92-year-old beneficiary’s annual Social Security benefits. (emphasis in original)Cutting benefits on Social Security, Medicare and Medicaid is a really, really bad idea. Tags: austerity economics, barack obama, grand bargain, medicaid, medicare, social security
Source: blogspot.com

Center For Medicare Portability

As you likely already realize, if you’re an American living, retiring, or traveling overseas, your Medicare doesn’t travel with you. Currently the United States prohibits Medicare from paying for medical services for retirees outside the country and its territories. The nearly half-million retired Americans living overseas and the millions more who travel extensively abroad must either go without care until they return to the United States or pay out-of-pocket for the care they need. We see this as a fundamentally unfair situation for retired Americans who have paid into Medicare their entire working lives. This restriction on Medicare coverage is also unfair to American taxpayers because it ignores the potentially huge cost savings to Medicare offered by lower-cost healthcare options abroad.
Source: liveandinvestoverseas.com

Illinois Medicare Eligibility Requirements

Medicare benefits were originally designed to help United States citizens receive the health care they needed as they aged. In most cases, as long as you’re 65 or older and paid the appropriate taxes for at least ten years, then you’re eligible to receive Medicare benefits. Basically, if you or your spouse is entitled to receive Social Security or Railroad Retirement Board benefits or you’ve worked for federal, state or local government with Medicare covered employment, then you’re eligible for Medicare. If you are not 65, but have been receiving Social Security disability for at least 24 months or you have End-Stage Renal disease, you’re also qualified.
Source: ssiinsure.com

Medicare Cuts and Social Security Benefits Perhaps Next Congressional Fiasco

I have a question for them. Shouldn’t the people who actually pay taxes, pay into social security and Medicare, receive their full benefits. Or should the majority of our taxes go to unnecessary military spending, or to pay for the wages and benefits of our useless Congressmen and Senators? (Remember, they don’t participate in social security and Medicare.)
Source: guardianlv.com

The ACP Advocate Blog by Bob Doherty: The unpredictable risk and benefit of Medicare vouchers

Trying to figure out whether Medicare vouchers are a good idea for patients and their physicians?  Then consider these two basic questions:   1.  How much will the federal government contribute?   2.  Who is at risk for health care cost increases? How much will the government contribute?  The traditional Medicare program has no set limit on how much the federal government will contribute to a beneficiary’s health care, although there are limits on how much it will pay doctors and hospitals.  That’s what makes it an open-ended entitlement.  Medicare vouchers (or premium support, if you prefer) place an annual limit on how much the federal government will contribute, and anything above that comes out of the beneficiary’s own pocket.  As such, Medicare would no longer be an open-ended entitlement, but a defined contribution program. One can imagine a voucher that would be so generous that beneficiaries could buy even more coverage than they have today under the traditional program.  But that would defeat the purpose of vouchers, which is to drive down costs.  So by necessity, the federal voucher contribution has to start out by being less per person than the government is now spending on traditional Medicare, or it won’t save money, right?  And no matter where the initial dollar amount is initially set—let’s assume that it would start out being pretty generous, good enough to buy a health plan that offers benefits comparable to traditional Medicare–the government would have to decide how much it would be allowed to go up each year:  enough to keep pace with rising health care costs or less than that?  If the federal contribution doesn’t keep up with average costs of the benefits covered by Medicare, beneficiaries would pay more, but the government saves more; if it keeps pace with average costs, the government saves less but beneficiaries pay less.  Voucher advocates say that the cost-savings will principally come from competition among competing health plans, and if so, seniors wouldn’t necessarily have to pay much more than they do today and the government would still save money.   Beneficiaries will have an incentive to choose a health plan that offers coverage at a premium that is not much more than the voucher amount.  Insurers will have an incentive to keep costs close to the voucher amount or risk being priced out of the market.  The theory sounds good—but let’s look at who is really at risk for keeping costs down under a Medicare voucher system (hint: it isn’t the government). Who is at risk?   Competition between health plans and traditional Medicare will only be successful in driving down costs if the competing health plans can use their market power to change the behavior of patients, physicians and hospital.    That’s because health plans (except for ones attached to physician group practices and hospitals) don’t really deliver care, they pay for it, through contracts with physicians and hospitals. In a voucher system, competing health plans will try to drive down those costs by leaning on patients and “providers” to lower costs.  They might pay clinicians and hospitals less, hire less expensive mid-level providers, restrict patients to an approved network of providers, pay their network “providers” based on performance (lower costs, and one hopes, also better outcomes) rather than volume, deny claims for services, demand lower rates from drug companies and device manufacturers, require that Medicare patients enrolled in their plans pay more out-of-pocket, and place limits on benefits (to the extent that they are allowed to by the government).  The better and more innovative plans might try to organize care better to achieve improved outcomes more efficiently, through models like Patient-Centered Medical Homes.  So to a great extent, under a voucher system, it’s the physicians and hospitals who will be at risk for cost increases, because to be successful in keeping their premium costs competitive, the insurers would have to get the “providers” and “suppliers” of care to charge less and deliver services more efficiently Health plans that are integrated with physician group practices and hospitals would likely have a competitive advantage under a voucher system because they can “organize” their providers more effectively than traditional insurers that contract with individual physicians and hospitals on an a la carte basis.   Vouchers, then, might accelerate the trend to hospital-physician-insurer consolidation, at the expense of physicians in independent practice. But patients enrolled in Medicare would be the ones at the greatest financial risk: either because they would get fewer benefits and have to pay more out of pocket for the less costly plans that the voucher amount would (mostly) cover, or because the federal contribution falls short of the cost of the premiums charged by the competing plans, with the difference made up by them. A new study by the liberal-leaning Center for American Progress Action Fund, based on the Congressional Budget Office’s analysis of the most recent version of Rep. Ryan’s Medicare premium support proposal, concluded that if competition doesn’t lower costs enough, the voucher contribution would not keep pace with rising costs—and the result would to vastly increase beneficiaries’ average health care bills over their retirement years:   –For seniors reaching age 65 in 2023 by $32,900 –For seniors reaching age 66 in 2030 by $73,600 –For seniors reaching age 67 in 2040 by $139,100 –For seniors reaching age 67 in 2050 by $225,200 I am sure that voucher advocates will take issue with those estimates, because the Center assumes that competition between health plans—and, more to the point, health plans’ ability to drive savings out of the “providers” and suppliers of health care– won’t be effective in slowing cost increases, so beneficiaries will be left holding the bag between the capped federal contribution and the average premiums.     Neither voucher advocates nor voucher critics really know for sure, since this is uncharted territory—there is no actual real-life experience with instituting a voucher system on a large scale basis for people who, by definition, are older and need more health care.  Competition might be enough, but if it isn’t, the cost-shift to seniors would put affordable health care out of reach for many, if not most of them. Given the uncertain benefits and risks of vouchers, wouldn’t it make more sense to first pilot test a premium support system, as the American College of Physicians has recommended in a recent position paper, before adopting it as national policy?  This is how ACP puts it:  “It is vitally important that a premium support model be tested to determine possible adverse effects or unintended consequences. Particular attention should be given to such issues as enrollee and provider reaction, plan participation, market effects, premium levels, and barriers to care. If done properly, a defined benefit voucher program may encourage beneficiaries to select coordinated care plans that may promote preventive care, wellness, and better cooperation among physicians and other health providers. However, caution should be exercised prior to implementing such a significant change in Medicare financing that will affect millions of the nation’s elderly and most vulnerable citizens.” A pilot-test, in other words, would be the sensible, even conservative approach to resolving the voucher controversy, because it would allow us to learn from real-life experience how premium support might be designed and work in practice, and what its effects are on patients and physicians, rather than embracing or rejecting vouchers based on unproven ideology, beliefs, conjecture and assumptions. Today’s questions: Who do you thinks bears the greatest risk under a Medicare voucher system?  Do you agree with ACP that it should be pilot-tested first before a decision is made on its adoption?
Source: acponline.org

Benefits of Medicare Hospice Services

WAXAHACHIE, TX—U.S. Rep. Joe Barton (second from left) meets with area staff members at Odyssey Hospice’s South Dallas office to learn more about the ways that Medicare-supported hospice services can benefit Texans with life-limiting illnesses.  Among those attending the session were (left to right): Seeley Avery, Odyssey’s Regional Vice President-Sales; Rep. Barton; Pamela Bailey, Quality Manager; Jennifer Leggett, Account Executive; Larry Chesney, Clinical Liaison; Doris Barnes, Registered Nurse; Mark Cook, Area Vice President-Sales; and Trivia Spencer, Community Liaison.
Source: countylifeonline.com

The Official Medicare Set Aside Blog And Information Resource: The MSP Does Not Create Coverage Where None Exists

The other case involved a plaintiff using the MSP to try to keep his former employer from discontinuing his benefits under the ERISA plan and making Medicare his primary plan. Plaintiff went out on long term disability in 1996 and was entitled to receive health, dental and life insurance benefits as long as he was eligible for LTD coverage and paid the required premiums. The plan notified him in February 2010 that the plan’s coverage had become secondary to Medicare and he objected. Then in 2011, the plan was formally changed, which it is permitted to do under the ERISA law, to limit medial benefits while on LTD to 30 months (interesting to choose of the number of months from disability onset to Medicare entitlement). Plaintiff was notified again on January 10, 2011 that his benefits were being terminated and he filed suit for injunctive relief to prevent that occurrence, citing in part the MSP private cause of action under 42 U.S.C. 1395y(b)(3) as authority. The defendants argued that this private cause of action is limited to claims for damages and cannot be invoked unless a primary insurer has improperly denied a claim resulting in payment of the claim by Medicare, which had not occurred here. The court agreed, ruling on the fact that MSP does not authorize the plaintiff’s claim for injunctive relief and finding it unnecessary to rule on the other arguments regarding the MSP claim.
Source: medicaresetasideblog.com

Viewpoints: LA Times Endorses Obama; Romney, Ryan ‘Obfuscating Their Plans For Medicare, Medicaid;’ Obama’s Health Law Polarizes The Country

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyLos Angeles Times: Mental Health Care At Stake In 2012 Vote One in five Americans over age 18 suffers from a diagnosable mental illness in any given year. … So why have we heard virtually nothing about mental health care from either candidate during this campaign? … I can understand why Mitt Romney might not want to bring up the subject of mental illness. His running mate, Paul D. Ryan, voted against the Mental Health Parity bill, which requires insurance companies that include mental health coverage to treat mental illness in the same way they do any other illness. … President Obama’s silence is more puzzling. He has done more to advance the treatment of and research into mental illness than any other president in history (Juliann Garey, 10/21). The New York Times: A World Of Harm For Women [If Romney and Ryan] were to win next month’s election, the harm to women’s reproductive rights would extend far beyond the borders of the United States. In this country, they would support the recriminalization of abortion with the overturning of Roe v. Wade, and they would limit access to contraception and other services. But they have also promised to promote policies abroad that would affect millions of women in the world’s poorest countries, where lack of access to contraception, prenatal care and competent help at childbirth often results in serious illness and thousands of deaths yearly (10/19). 
Source: kaiserhealthnews.org

Video: Los Angeles: Medicare Fraud Summit Beneficiary/Consumer Panel

Center For Medicare Portability

As you likely already realize, if you’re an American living, retiring, or traveling overseas, your Medicare doesn’t travel with you. Currently the United States prohibits Medicare from paying for medical services for retirees outside the country and its territories. The nearly half-million retired Americans living overseas and the millions more who travel extensively abroad must either go without care until they return to the United States or pay out-of-pocket for the care they need. We see this as a fundamentally unfair situation for retired Americans who have paid into Medicare their entire working lives. This restriction on Medicare coverage is also unfair to American taxpayers because it ignores the potentially huge cost savings to Medicare offered by lower-cost healthcare options abroad.
Source: liveandinvestoverseas.com

LA Times: Medicare: A Plan B for Part D

Congress should rescind its rule prohibiting Medicare from negotiating drug prices.One of the most popular benefits of Medicare is the Part D prescription drug program, which enables seniors and the disabled to buy taxpayer-subsidized coverage for many of the most widely prescribed medicines. When it created the costly benefit in 2003, though, Congress provided no way to pay for the subsidies, which have cost more than $300 billion so far. Worse, it barred the government from negotiating with drug makers for better prices — an extra gift to the pharmaceutical industry, which already stood to gain from the increased demand for its newly subsidized products
Source: calopinion.com

Additional Medicare Tax For Upper Income Earners Explained

IRS CIRCULAR 230 NOTICE: To ensure compliance with requirements imposed by the U.S. Department of the Treasury and Internal Revenue Service, we inform you that any tax advice contained in this e-mail (including any attachments) is not intended or written to be used, and may not be used, for the purpose of (a) avoiding penalties under the Internal Revenue Code or state tax authority, or (b) promoting, marketing, or recommending to another party any transaction or matter addressed herein.
Source: ricknorriscpa.com

Medicare Bundled Payment Challenges

Under its current structure, Medicare – as with private insurance – reimburses providers based on the complexity (determined somewhat arbitrarily through the Resource Based Relative Value Scale) and volume of their procedures. Predictably, as with any volume-based payment system, this encourages overuse of the system and contributes to fraud. While private insurance, not reliant on taxpayer money, has significant incentive to reduce waste and fraud resulting in higher overhead, Medicare instead has an incentive to keep such “overhead” costs low, resulting in unrealistically low administrative expenses (if Medicare were to combat fraud at the same level as private insurance, their administrative expenses would likely be similar). These dynamics mean that fee-for-service reimbursements may work with private insurance (which tries to reduce waste and fraud) but may not be appropriate for a government program with less incentive to do so.
Source: medicalprogresstoday.com

Ryan at VP debate says his Medicare plan borrowed from former La. Sen. John Breaux

The Breaux commission had gone one step further than the original Ryan proposal, saying any plan to give seniors vouchers to purchase insurance from private insurers had to provide enough money to actually purchase a policy with standard benefits. Democrats have said the original Ryan plan would fall about $6,000 short of the amount needed to purchase insurance in the private market.
Source: nola.com

Daily Kos: What are some Progressive Solutions to the “Medicare Problem”?

Total Medicare expenditures were $549 billion in 2011. The Board projects that, under current law, expenditures will increase in future years at a somewhat faster pace than either aggregate workers’ earnings or the economy overall and that, as a percentage of GDP,  they will increase from 3.7 percent in 2011 to 6.7 percent by 2086 (based on the Trustees’ intermediate set of assumptions). If lawmakers continue to override the statutory decreases in physician  fees, and if the reduced price increases for other health services under  Medicare are not sustained and do not take full effect in the long  range, then Medicare spending would instead represent roughly  10.4 percent of GDP in 2086. Growth of this magnitude, if realized,  would substantially increase the strain on the nation’s workers, the  economy, Medicare beneficiaries, and the federal budget. That means that if we do the doc fix every year (which we just did again), Medicare will grow to 10% of GDP — not 10% of the budget, 10% of GDP.  And that’s assuming the most favorable outcome with respect to the ACA being able to reduce costs — they say the lilkely outcome may well be much worse.  Read that report.
Source: dailykos.com

Dr. Juan Tomas Van Putten Takes Guilty Plea In Major LA Medicare Fraud Conspiracy

Van Putten admitted that operators of fraudulent DME supply companies paid him cash kickbacks to write prescriptions for power wheelchairs and other DME that Van Putten knew the patients did not need.  Van Putten admitted that he exaggerated the symptoms and diagnoses that he wrote on the prescriptions to make it appear as if the patients met both the medical and Medicare requirements for the power wheelchairs and DME.  Van Putten admitted that he knew when he provided the prescriptions to the DME company operators that they would use the prescriptions to submit false claims to Medicare.  Van Putten also admitted that he submitted claims to Medicare for services that he provided to the patients at Greater South Bay and the nursing home even though he knew it was illegal for him to provide services to patients who had been recruited by marketers.
Source: newsroom-magazine.com

L.A. Times: Paul Ryan booed over Medicare at AARP convention

Just five minutes into his talk at the gathering of the powerful 50-and-older lobby on Friday, the architect of the Republican proposal to change Medicare for the next generation of seniors was repeatedly interrupted as he criticized President Obama’s healthcare law.
Source: healthcareforamericanow.org

Central planning a la ObamaCare

“Substantively, it suggests services that promote the continuation of the polity — those that ensure healthy future generations, ensure development of practical reasoning skills, and ensure full and active participation by citizens in public deliberations — are to be socially guaranteed as basic. Conversely, services provided to individuals who are irreversibly prevented from being or becoming participating citizens are not basic and should not be guaranteed.” What’s left undefined is how bureaucrats on the payment advisory board will decide if we’re sufficiently “active” in being “participating citizens.” Explained Emanuel, “An obvious example is not guaranteeing health services to patients with dementia.”
Source: nomedicareirs.com

Medicare fraud and the Castro connection: Cuba’s banking ‘black hole’

FBI agents and prosecutors are trying to figure out who received the money in Cuba — Medicare fraud fugitives, other criminals, government officials or all of the above? Or was the money moved offshore again to other countries? As authorities try to trace the money, they’re putting the squeeze on Sánchez to flip on other possible co-conspirators who collaborated with him in South Florida, Canada, Trinidad and Cuba.
Source: babalublog.com

UCLA Health System Selected as a Medicare Shared Savings Program Accountable Care Organization

The UCLA Health System, which comprises the UCLA Hospital System and the UCLA Medical Group and its affiliates, has provided a high quality of health care and the most advanced treatment options to the people of Los Angeles and the world for more than half a century. Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA, and UCLA Medical Center, Santa Monica (which includes the Los Angeles Orthopaedic Hospital) deliver hospital care that is unparalleled in California. Ronald Reagan UCLA Medical Center is consistently ranked one of the top five hospitals in the nation and the best in the western United States by U.S. News & World Report. UCLA physicians and hospitals continue to be world leaders in the full range of care, from maintaining the health of families to the diagnosis and treatment of complex illnesses.
Source: newswise.com

Medigap Plan F Discontinuance for 2014? « Insurance News from Crowe & Associates

Posted by:  :  Category: Medicare

It's all there in black and white by Dave77459Utilization for people with plan F has trended much higher than that of other supplements.  If someone is paying for a plan that will cover all of their Medical expenses, they are probably going to be more inclined to go to the doctor or get a test than someone who has a cost share.   Given that Medicare is primary when using a supplement, people with a plan F supplement are utilizing more than someone without a plan F supplement.
Source: croweandassociates.com

Video: Medicare Supplement AARP Plan F Select is A Good Option

Medigap Plan F Discontinuance For 2014

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Coverage Gap Donut Hole Drug Help High Deductible F supplement LIS Connecticut Medicare Medicare Advantage Medicare Advantage plans Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare for Dummies Medicare part B Medicare part D Medicare prescription drug plans Medicare Rx Medicare Saving program Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 MSP Connecticut Original Medicare Part D Part D Drug help Rx Help Rx help connecticut united healthcare United Healthcare AARP United Medicare complete 2013
Source: croweandassociates.com

NAIC Cautions Obama Administration Against Added Cost Sharing in Medigap Plans 

“One in five people with Medicare choose a Medigap plan to help cover Medicare cost-sharing and other health care costs not covered by Medicare. Most of these beneficiaries have modest incomes. Many are poor. Introducing further cost-sharing in Medigap plans would create a significant financial burden, but that’s not all. When required to pay beyond their means, people skip needed medical care and treatment, leading to poor health outcomes, increased emergency room visits and hospitalizations,” said Judith Stein, Executive Director of the Center for Medicare Advocacy, Inc.
Source: medicareadvocacy.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 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

Online Appointment Booking: This Medicare Supplement Plan F Is Also 1 Among The Medigap Ideas Which Provides Benefits To The Clients

Whenever you plan to opt for a policy then it’s important to consult together with your loved ones and chose the very best one, if you ever really feel incredibly puzzling then you can actually search for the help from your issue in order that they are going to enable you to choose the ideal 1. The foremost factor which you should certainly look before you take the coverage is the protection that is needed to meet your needs, as well as the 2nd factor that you just should appear into is no matter whether the quantity of the program is restricted to your price range if all these are comfortable to suit your needs inside a distinct plan then you are able to relatively well consider them and enjoy the benefits. This medigap strategy f is offered by a great number of personal insurance issues and also you can opt for the one particular that is helpful to you. These medicare supplement program gives you a range of estimates and you may get them at no cost. To know much more relating to this medigap plan f as well as their positive aspects you’ll be able to get in touch with them straight else view the web-site whichever is comfortable and from these both you can get to understand about their plans plus the way you are likely to be benefited with it. You can also follow them on twitter cultural networking site to understand the updates, they retain updating their standing so that persons can know their function even improved. To know their provides and information you are able to join them around the newsletter that will be really vital for all of the customers to understand the updates of your ideas. Each coverage has its personal way of advantages so just before you pick the coverage make sure that concerning the advantages and assume two times concerning the have to have to suit your needs and after that takes up the coverage, these are the fundamental points which has to be known just before you take up the coverage. The high quality in every coverage depends upon the protection and its certain that what ever may perhaps be the coverage that is definitely taken you can expect to acquire the benefit.
Source: blogspot.com

A Plan F is a Plan F, is a Plan F

   Rates can vary significantly.  In Virginia, as of this writing,( September 17, 2012) a Plan F rate for a 65 year old female can range from a low of $92.13 per month to over $300 per month.  (We are talking identical coverage!) These rates vary due to many factors such as the area in which you live.  For example, a person who lives in one zip code can pay $20/per month less than their neighbor who lives down the road but in a slightly different zip code.  A smoker may pay more with some companies.  Males may have a higher rate with some companies.  Some plans have rates which are guaranteed to increase every year as you get older.  Some plans level off their rates after age 75.  (Unfortunately, all of them can – and do- raise their rates on an across the board basis.)
Source: pqwic.com

Medicare plans Fitness & Activity Sterling Heights

Posted by:  :  Category: Medicare

 There are various things to think about before taking a medigap plan Such as medicare select this policy is a Medigap plan that is particularly lower in premium. When you enroll in this type of policy, you are required to visit only doctors and hospitals that are within the network. If in case you visit a doctor or hospital that is not on the network, you have to pay more. When you plan to leave the policy, your insurance company must offer you a Medicare supplement policy that provides the same benefits.
Source: tuffclassified.com

Video: Sterling Stairlift

Sterling New Health First VP of Managed Care

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

Sterling Life Insurance Medicare Supps.

Has anyone heard of Sterling Life (captive company) reducing Medicare Supplement rates in PA. I talked to a man that claims that his insurance plan premium was reduced by around $40 per month without switching plans? Any Sterling agents on the forum? I am also interested in finding out what Sterling is going to do this year and next with their PFFS. If anyone has info, please post.
Source: insurance-forums.net

Cameron promises Britons straight choice on EU exit

The response from EU partners was predictably frosty. French Foreign Minister Laurent Fabius quipped: “If Britain wants to leave Europe we will roll out the red carpet for you,” echoing Cameron himself, who once used the same words to invite rich Frenchmen alienated by high taxes to move to Britain.
Source: blogspot.com

New software to combat Medicare fraud finds $115 million in first year savings

Posted by:  :  Category: Medicare

bag & contents - Stolen by quadrapopAetna Ameritox ASTRO Bernie Ness CAP Client/Direct Billing College of American Pathologists David Neal Shepard Florida Forensic pathology Healthcare Fraud IMRT In-Office Pathology Inc. in office lab Jean Mitchell Joe Plandowski Joseph Sonnier kickback LabCorp laboratory lawsuit legislation Medicaid Medicaid Fraud Medical malpractice Medicare Medicare Fraud MedTox Millennium Laboratories Myriad Genetics Ontario pathologist Pathology Pathology Malpractice Physician self-referral prostate biopsies prostate cancer Quest Diagnostics radiology Self Referral stock Supreme Court Urology Whistleblower
Source: pathologyblawg.com

Video: EMR4 Video1 Billing and Scheduling patients with PC Based Software

2013 Medicare Reporting and Requirements for Out Patient Physical Therapy

There is no financial incentive to report functional codes; it is a requirement that began on January 1, 2013.  To allow for a smooth transition, there is a testing period from January 1, 2013 until July 1, 2013.  Claims submitted during the testing phase will not be rejected for non-submission of functional codes. However, after July 1, any claims without the correct G-codes and modifiers will be returned and unpaid.
Source: rehabsoftware.com

Medicare announces policy changes for 2013

[…] First, the good news: As the result of continued adoption of survey data, Medicare is placing greater value on medical eye care procedures under its Medicare Resource-Based Relative Value Scale (RBRVS). The scale assigns values to all Medicare-reimbursable procedures that are then multiplied by the Medicare Conversion Factor (set at $34.0367 in 2012) to establish the dollar reimbursement for each procedure. The increase in relative value units (RVUs) assigned to many eye care procedures over recent years effectively means that whatever might be done to increase or decrease Medicare reimbursement overall, fees for medical eye care services would be higher than they would have been otherwise.Source: newsfromaoa.org […]
Source: newsfromaoa.org

Medicare EHR Incentive Program Vulnerable to Abuse, Report Finds

For the report, OIG investigators analyzed audits of EHR incentive payment attestations, reviewed internal CMS and Office of the National Coordinator for Health Information Technology documents about the program and interviewed CMS personnel. The report covered the period from May 2011 through December 2011, when Medicare incentive payments totaling about $1.7 billion were made to providers.
Source: californiahealthline.org

CMS and Medicare Say “We Won’t Pay For Cloned EMR Template Notes”

bright note chiropractic billing software chiropractic software electronic medical billing EMR Software Insurance insurance billing insurance billing software internal medicine software Medical Billing Medical Billing And Coding Medical Billing Business medical billing career medical billing software Medical Coding Medical Collections medical office software medical practice management software medical practice managment software medical software Medicare Medisoft medisoft advanced medisoft clinical medisoft configuration medisoft discussion group medisoft emr medisoft install medisoft medical billing medisoft network professional medisoft network professional install medisoft review medisoft setup medisoft software medisoft support medisoft training medisoft updates medisoft version medisoft version 14 mental health billing physical therapy billing physical therapy software Physician software practice management software practice managment software
Source: medicalbillingsoftware.com

Proposed regs clarify the new 0.9% additional Medicare tax

Good news: The proposed regulations closely track FAQs the IRS issued last summer, so you don’t need to make many changes to your software to withhold this additional tax. And, since there’s no employer match, the regs follow the income tax withholding rules for adjusting over- or underwithholding of this tax. The regs also clarify the interplay between FICA and SECA. You may rely on these proposed regs until final regs are issued. (77 F.R. 72268, 12-5-12)
Source: businessmanagementdaily.com

Advantra Medicare Advantage Changes

Posted by:  :  Category: Medicare

A major benefit of an Advantage plan is having a limit on your annual maximum out-of-pocket costs but the required coinsurance feature makes it a lot more likely that you will need this benefit compared to other Advnatra Medicare Advantage plans.
Source: affordablemedicareplan.com

Video: Videos matching: advantra medicare advantage

Visting Nurse Association to hold flu shot clinic Jan. 16

The flu shot will be available for people 18 years of age or older and nonpregnant women. The cost is $27 a person. The VNA also accepts the following insurances: American Progress (Today’s Options), Advantra Freedome, Aetna Medicare Advantage, Federal Employee Program, First Priority, First Priority 65, Gateway Assured, Geisinger Gold, Geisinger Health Plan, Highmark Freedom Blue PPO, Humana Gold, Medicare Part B, Secure Horizons, Keystone Senior Blue and Unison Advantage.
Source: nursefuture.com

Coventry Health Care Adds Cornerstone Health Care (P.A.) to their Advantra Medicare Advantage Provider Network in North Carolina.

Cornerstone Health Care has nearly 300 providers (including primary care and specialty physicians, and mid-level professionals) in more than 70 locations in High Point, Winston-Salem, Greensboro, Summerfield, Thomasville, Archdale, Trinity, Jamestown, Kernersville, Lexington, Asheboro, and Advance.
Source: wordpress.com

Altius Health Plans Altius Advantra Medicare Review

Altius Health Plans offers Medicare health insurance programs for residence of Utah and a county in Wyoming.  Altius Advantra and Altius Advantra Preference are Medicare Advantage HMO plans available in Box Elder, Cache, Daggett, Davis, Duchesne, Morgan, Rich, Salt Lake, Summitt, Tooele, Wasatch, and Weber counties in Utah as well as Uintah county in Wyoming.  Altius Advantra is an HMO-POS plan, and Altius Advantra Preference is a plain HMO only available in Davis, Salt Lake, and Tooele counties.  The coverage does include Part D drug coverage as well as health benefits.  Below is a review of the benefits they offer:
Source: medicare-plans.net

Will Your Medicare Advantage Plans Still Be Available In 2010

All plans must send you a notice of termination if there plan is terminating. When a plan terminates they do NOT enroll you in a part D plan. In some cases a plan may try to change you to another plan that they offer, however in they are still required to notify you in writing and give you the full details and you still have the option of changing plans if you are not satisfied with the benefits offered. In the case of Advantra Plans this year, you will need to choose another Medicare Plan. Some Advantra Freedom plans were offered as MAPD which means that the plan itself included the prescription drugs. You may also have a PFFS and a seperate Part D. If the part D is seperate you should still have RX coverage. If you do want to keep Advantra as your Part D you can still get a seperate Part D plan as long as it is a PFFS. You should call a broker and get a list of comparable options. You can ask for health plans only if you wish. Also if you just want an evidence of coverage you can call Advantra back or visit http://www.choicesformedicare.org and request one. Make sure you are specific in your request and they will know what to send.
Source: wordpress.com

Advantra Rx NOT Renewing Their Medicare Contract

one of my customer’s sent me a copy of the letter from AdvantraRX dates October 2. Here is what it says (sorry about typos, i type fast): Dear Mr. Smith, AdvantraRx Preimer by Coventry Life and Health Insurance Company, a stand-alone prescription drug plan with a Medicare Contract, will no longer operate as of January 1, 2011 so your Medicare Prescription drug coverage through AdvantraRx Premiuer will end December 31, 2010. If you want Medicare prescription drug coverage starting January 1, you need to join a new Medicare drug plan by December 31, 2010. Take Action by December 31 to avoid losing drug coverage. If you want Medicare Rx drug coverage after December 31, you need to join another Plan or medicare advantage plan that offers drug coverage. You can join a new medicare drug plan anytime between October 1 and January 31, 2011. However your AdvantraRx Premier coverage ends December 31, so you should join a new medicare drug plan by december 31 to make sure you have drug coverage january 1. If you join a new plan AFTER december 31, your new coverage won’t start until the month after you join. What happens if you don’t join another medicare drug plan? if you don’t join another medicare drug plan by January 31, your next chance to join will be from october 15 through december 7, 2011. You may also have a pay a late-enrollment penalty to join later. The the letter gives a list of a bunch of companies and the 1-800 Medicare number and website. It doesn’t state anything anywhere about automatically enrolling them into another plan if they do nothing. In fact, it states the opposite.
Source: insurance-forums.net

Pennsylvania Health Insurance

HealthAmerica’s Commercial and Medicare Advantage Plans Among Tops in Nation for Quality and Service on U.S.News & World Report/NCQA “America’s Best Health Plans 2008-09″ List Harrisburg and Pittsburgh, Pa. – November 10, 2008 — HealthAmerica’s HMO, POS, and Medicare Advantage plans were ranked among the nation’s top 20 best commercial and Medicare health plans according to a joint ranking by U.S.News & World Report and the National Committee for Quality Assurance (NCQA). Nationally, HealthAmerica was ranked 12th among 287 commercial plans; HealthAmerica’s Medicare Advantage plan, Advantra, ranked 18th among 216 plans nationally. HealthAmerica and HealthAmerica Advantra have ranked as one of the top 50 best health plans in the U.S. News/NCQA “Americaýs Best Health Plans” list* every year since 2005. “We are honored to be recognized among the best health plans in the nation,” said Kirk E. Rothrock, president and chief executive officer of HealthAmerica. “We are dedicated to providing the best possible quality and service, so we are pleased to see our efforts recognized by NCQA, U.S. News and World Report, and, most importantly, by our members and our customers.” The National Committee for Quality Assurance and U.S.News and World Report collaborated to rank the nationýs best commercial, Medicare, and Medicaid health plans. The ranking appears in the November 17 issue of U.S.News and on its website www.usnews .com/healthplans HealthAmerica”s and Advantra”s rankings are based on their Healthcare Effectiveness Data and Information Set (HEDISý)** 2008 scores and the results of a Consumer Assessment of Healthcare and Provider Systems (CAHPS) survey of members. HEDIS is a set of standardized performance measures covering effectiveness of care, preventive care, treatment, and customer satisfaction. CAHPS is a standardized survey in which members rate the quality of care and service that they receive from doctors, specialists, office staffs, and insurers. In these ratings, HealthAmerica’s commercial health plans were rated higher than the national average in all 15 key measures of medical services and member satisfaction and higher than the Pennsylvania state average in 12 of the 15 key measures***. HealthAmerica’s HMO, POS, and Medicare Advantage plans’ status of “Excellent” from NCQA was also a factor in determining the U.S. News/NCQA “America’s Best Health Plans 2008″ ranking**** The U.S.News/NCQA “Americaýs Best Health Plans 2008″ list is drawn from measures of prevention, treatment, and customer experience. These measures are compiled in NCQA”s Quality Compass 2008*****, which publicly reports comparative results of more than 400 commercial health plans covering 85 million Americans. Health plans throughout the country were evaluated on issues such as access to care, prevention efforts, treatment of diseases such as diabetes and heart disease, and members were surveyed on their satisfaction to calculate an overall quality score. * “America’s Best Health Plans” is a trademark of U.S. News & World Report. **HEDIS is a registered trademark of the National Committee for Quality Assurance (NCQA). ***The source for this data is Quality Compass 2008 and is used with the permission of the National Committee for Quality Assurance (NCQA). Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. The 12 measures are: Child immunization (combo II), well child visits 3 to 6 years, colorectal cancer screening, prenatal care, first-trimester postpartum care, cervical cancer screening, breast cancer screening, diabetes-lipid profile (screen), controlling hypertension, cholesterol screening for patients with cardiovascular conditions, rating of all health care, rating of health plan. ****National Committee for Quality Assurance accreditation outcomes are: Excellent, Commendable, Accredited, and Denied. Applies to HMO and POS plans. *****Quality Compass is a registered trademark of NCQA. NCQA is a private, non-profit organization dedicated to improving health care quality. About HealthAmerica For over 33 years, HealthAmerica has provided health benefit solutions to employers across Pennsylvania. HealthAmerica offers a broad range of traditional and consumer-directed health insurance products, including managed care, HSAs, self-funded, Medicare, indemnity, nongroup and pharmacy plans. Serving 12,000 businesses and over 660,000 members as of December 31, 2007, in Pennsylvania and Ohio, HealthAmerica offers progressive medical management, innovative wellness programs, and statewide and national provider networks. HealthAmerica is ranked as one of “Americaýs Best Health Plans, 2006″ by U.S. News & World Report; its HMO and POS products have an “Excellent” accreditation by the National Committee for Quality Assurance. HealthAmerica has corporate offices in Pittsburgh and Harrisburg, Pennsylvania, and employs over 2,200 people in the commonwealth.
Source: blogspot.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Medicare Advantage Plans and PFFS Plans

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Source: merchantcircle.com

The Sullivan Independent News

The Visiting Nurses Association will hold a flu shot clinic at the Sullivan Senior Center on Tues., Oct. 13 from 12 p.m.- 3 p.m. In order to be sure a vaccine is available for you, you must call or stop by the Senior Center and have your name put on the vaccine list. The VNA will be bringing 150 vaccines, but more will be available if we see more people are signing up. This will be a one-time clinic. Those planning to receive their vaccine may show up anytime from 12 p.m.-3 p.m. To avoid the congestion and long waiting periods, you may wish to wait a little later and not all show up at 12 p.m. Insurances accepted by the VNA for this clinic include: Medicare Advantage Plans, Essence, Coventry Advantra Freedom, GHP, Advantra, GHP Advantra Freedom, GHP Gold Advantage, Humana Choice PPO, Humana Gold Choice PFFS, Humanna Gold Plus HMO and Mercy Medicare Advantage. Other insurances that did not contract with the VNA and will not be accepted are: Medicare Advantage Plans, Secure Horizons, Aetna Medicare, Anthem Senior Advantage, Cigna Medicare Access, Sterling Option, Wellcare, Evercare or any other Medicare Advantage or out-of-state plans. Medicaid is not accepted. If you have another primary insurance, you may not use Medicare or Medicare Advantage. Those wishing to pay “out of pocket” for the vaccine may do so. The cost is $30. Visiting Nurses Association is a non-profit community based organization dedicated to serving the healthcare needs of your community. Please help us by giving us your correct insurance at the time of service.
Source: mysullivannews.com

Obama’s Inaugural Health Care Moment: ‘Medicare, Medicaid … Strengthen Us’

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524Politico: Obama: Medicare, Social Security Changes Only On My Terms It wasn’t a new message, but by reinforcing it in his inaugural address, Obama doubled down on the boundaries he has drawn in his fight with Republicans over the next stages of deficit reduction. The president’s forceful defense of these social safety-net programs fit with a larger theme of his speech, defending the role of government in American society. “We must make the hard choices to reduce the cost of health care and the size of our deficit. But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future,” Obama said (Nather, 1/21).
Source: kaiserhealthnews.org

Video: Weekly Address: Medicare Officially Safer After Health Reform

Contacting Railroad Medicare when a beneficiary dies

If you have received a Medicare Summary Notice (MSN), Palmetto can discuss the claims on that notice. If you have not received an MSN, a representative can order an MSN to be sent to the beneficiary’s address. Their representatives can also tell you whether or not we have received or processed a claim for a specific date of service.
Source: utu.org

Hospitals Urge CMS To Address Limitation in EHR Incentive Program

AHA estimated that 60% of the 1,300 critical access hospitals nationwide use Method 2 and that each of those hospitals use Method 2 to bill for an average of 20 professionals. In that case, a $20,000 loss in incentive payments per eligible professional would mean a total loss of $312 million for all critical access hospitals, according to the letter (AHA letter, 1/9).
Source: ihealthbeat.org

President Obama Mentions Medicare and Medicaid in his Second Inaugural Speech

In a speech with a strong focus on unity among Americans and with a heavy emphasis on social progress, President Barack Obama briefly mentioned healthcare in his second inaugural address on Jan. 21 outside the U.S. Capitol in Washington, D.C., as he addressed a crowd estimated at approximately 600,000 people on the side of the Capitol and spreading across the National Mall, as well as millions on live television. “We must make the hard choices to reduce the cost of healthcare and the size of our deficit,” the President said. “But we reject the belief that America must choose between caring for the generation that built this country and investing in the generation that will build its future. For we remember the lessons of our past, when twilight years were spent in poverty, and parents of a child with a disability had nowhere to turn.” Instead, the President said a moment later, “The commitments we make to each other—through Medicare and Medicaid and Social Security—these things do not sap our initiative; they strengthen us. They do not make us a nation of takers; they free us to take the risks that make this country great.”   The new Congress goes back into session on Jan. 22, with Medicare spending in contention in a series of upcoming legislative showdowns, including discussions over whether and when to raise the federal debt ceiling; whether and how to fund the federal budget for another year, or possibly allow the federal government to temporarily shut down; and how to handle still-unresolved issues around the budget sequestration that was temporarily delayed by the Jan. 1 vote to avert the so-called “fiscal cliff.” All three of those issues will have to be resolved within the next few months, and the exact disposition of each of the three issues remains uncertain.
Source: healthcare-informatics.com

Medicare: can we protect what works and still fix delivery, financing?

So here’s my take: Medicare is a popular program but its cost is not sustainable. Cost shifting by providers borne by the privately insured is not a long-term solution to the $105 trillion obligation owed current and future beneficiaries. And solutions that incrementally modify the program’s funding—higher premiums, delayed eligibility, required co-payments in MediGap coverage, changes to its annual cost formula using the Chain Consumer Price Index (CPI), a voucher-type alternative and others—without fundamentally restructuring the delivery of services will fall short. While possibly effective in changing what the Medicare program spends, these might not solve the larger issues of costs and cost shifting, or the fundamental challenge of overtreatment and unnecessary care. So the issue is not just what to do with Medicare costs; it’s what to do with health costs! For seniors today, cost is the problem. Tragically, 46% die with virtually no financial assets, largely because their out-of-pocket health costs exceeded their savings.
Source: deloitte.com

AARP Urges Congress to Address Medicare Physician Payments

“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

Patterico's Pontifications

No one is suggesting that what we call are ‘earned entitlements’, entitlements you pay for, you know, like payroll taxes for Medicare and Social Security, are putting you in a ‘taker’ category. No one suggests that whatsoever. The concern that people like me have been raising is we do not want to encourage a dependency culture. This is why we called for welfare reform. This is what welfare reform in 1996 was. This was what the new rounds for welfare reform we’re calling for do, which is to increase social mobility, economic opportunity, self-responsibility, those kinds of things. But earned entitlements, where you pay your payroll taxes to get a benefit when you retire, like Social Security and Medicare, are not taker programs. And I think when the president does kind of a switcheroo like that, what he’s trying to say is we are maligning these programs, that people have earned throughout their working lives. And so it’s kind of a convenient twist of terms to try and shadowbox a straw man in order to win an argument by default, is essentially what that rhetorical device is that he uses over and over and over.
Source: patterico.com

Obama, Boehner Could Compromise To Address Looming Medicare Cuts

Shawn Gremminger — assistant vice president for legislative affairs at the National Association of Public Hospitals and Health Systems — said the Medicaid provider tax could be on the negotiating table as a cost-cutting measure. He noted that recent proposals have called for lowering the tax from 6% to 5.5%, which the Congressional Budget Office estimates would result in about $10 billion in savings over 10 years (Zigmond,
Source: californiahealthline.org

Cravaack, Nolan battle over Medicare

Referring to Medicare’s low administrative costs relative to what private insurers spend on overhead, Nolan said, "It costs roughly 3 or 4 percent to administer Medicare. Private insurance on average runs somewhere between 27 and 30 percent administrative costs. So once you turn Medicare back over to the insurance industry, you know, right out of the chute you are dramatically increasing the administrative costs."
Source: publicradio.org

Media distorts Obama on seniors issues

Since the remarks were not uttered in public, it seems likely Romney was not as careful with his words as he would have been under other circumstances. Ironically, in 2008 Obama was also embarrassed by comments he made at a private fundraiser in San Francisco that became public. To Nather’s credit, he did acknowledge, “Romney and Ryan easily won among seniors even though Obama attacked their Medicare plan at every turn.”  And he admitted that Obama has entertained the possibility of increasing the age for Medicare eligibility and means testing benefits. Another inaccurate article was written by Rachelle Younglai of Reuters, who claimed that Obama’s speech “did not sit well with Republican lawmakers, who noted that healthcare is one of the biggest drivers of the country’s $16.4 Trillion debt.” Now, having made a statement like that, you’d think Younglai would have quoted a Republican lawmaker or two about Medicare’s contribution to the national debt. But she did not.  She did quote Senator Jeff Flake (R-AZ), who said, “In order to protect them, we’ve got to reform them.”  Of course, Flake is correct. His statement is not controversial. The fact is that much of the national debt is owed to the Medicare and Social Security trust funds.  For decades, Congress has “borrowed” from Medicare and Social Security for the general operations of the federal government. At the end of December 2012, the Financial Management Service of the Treasury Department reported that the federal government owed $287.199 Billion to the Medicare trust funds (hospital and supplemental medical) and owed $2.733 Trillion to the Social Security trust funds (old age and disability). Together, the $3.020 Trillion that is owed to Social Security and Medicare makes up 18.4% of the $16.432 Trillion national debt. What Obama said in his speech on seniors’ issues was completely different from what the news media reported. These blatant distortions of fact appear to be intended to harm conservatives.   The previous issue of What’s Happening with Seniors Benefits: Obamacare Increasing Health Insurance Costs and Unemployment The previous issue What’s Happening with Conservatives and the Tea Party: There should be NO increase in the debt ceiling UNLESS…   Previous issues of both newsletters. Follow Art Kelly on Twitter @ArthurKellyJr
Source: 60secondactivist.com