Critiquing The Medicare Part D Low

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceAt the outset, however, it is important to note that we agree on the basic goal: a Part D program that displays effective cost containment in a very tight federal budgetary environment.  The good news is that the existing program is quite successful in this regard. Since 2007 per capita costs in Part D have grown at a compound annual rate of 1.8 percent, while costs in Part A and B have grown at 3.6 percent and 3.7 percent, respectively. The program’s negotiated rebates between large purchasers and drug manufacturers, and the ability for consumers to compare plan prices and benefits, have resulted in lower than expected Part D spending overall.  (In contrast, note that from 1990 to 2005, average annual drug cost growth in the Medicaid program was about 13.1 percent per year.)
Source: healthaffairs.org

Video: Medicare Part D and Prescription Drugs

The New Year and Your Medicare Coverage

I hope you are having a great start to 2013!  I wanted to remind you that if you get a letter ANY TIME of the year from your Medicare Supplement Plan that they are going up in price, we can help you immediately.  You do not have to wait until the Annual Election Period for Part D Plans.  You can change your doctor and hospital coverage anytime of year to save money NOW!  We do a comparison of many different companies to find the best coverage for you at the lowest price. All you need to do is contact us at 866-752-1795.  We enjoy assisting you!
Source: mypartdusa.com

Survey: Medicare Beneficiaries Oppose Mandatory Mail Drug Plans

Hoey continued “denying seniors, many of whom are on complex medication regimens, the right to obtain medication from the pharmacy of their choice and from a pharmacist they trust deprives them of vital face-to-face consultation with one of their healthcare providers. Local pharmacists help to reduce medication waste that may be associated with mail order, auto-ship programs. They also provide services unique to the community such as offering same day home delivery or fulfilling patient-specific requests.  These services not only benefit the patient, they benefit the healthcare system by reducing the number of preventable, bad outcomes that often lead to costly hospitalizations or emergency room visits that drive up healthcare costs.”
Source: thepharmacyblog.com

Top Medicare Part D Plan Costs Spike in 2013

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Source: webmd.com

Choosing a Medicare Part D Prescription Plan

People with arthritis are typically prescribed medications to control symptoms and progression of the disease. For arthritis patients who have qualified for Medicare benefits, there are Medicare Part D prescription plans available. Open enrollment for Medicare plans started October 15, 2012 and ends on December 7, 2012. What does this mean for you? It’s time to review your options, even if you already have a Medicare Part D prescription plan. If you have started new drugs or stopped any that you were taking last year, or if your insurer changed their drug formulary list, you may no longer have the best Medicare Part D plan for you.
Source: about.com

Open Enrollment 2013: Medicare Part D Benefits Improve but Premiums an…

While Medicare Part D prescription drug plan premiums are generally expected to remain steady in 2013, this PPI Fact Sheet by Leigh Purvis and Lee Rucker finds that premiums for many popular plans will actually be considerably higher than they were in 2012. Many plans are also increasing cost-sharing and their reliance on utilization management tools for covered prescription drugs. Medicare beneficiaries should closely examine their 2013 prescription drug plan choices during open enrollment for Part D.
Source: aarp.org

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

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

How’s Your Medicare D Plan?

The standard benefit for 2013 has changed. In looking at those changes, the deductible will be going to $325 with the initial coverage limit changing to $2,970. For those non-applicable beneficiaries, the total covered out-of-pocket threshold will be $4,750 with the total estimated covered Part D spending going to $6,733.75. The minimum cost sharing portion once in Catastrophic Coverage will be $2.65 for generic/preferred multi-source medications and $6.60 name brand/other medications. If you are receiving up to or at 100% federal poverty level benefits, then your cost for generic/preferred multi-source medications will be $1.15 with name brand/other medications costing $3.50. Those that are over 100% of the Federal Poverty Level receiving benefits will see their cost of generic/preferred multi-source medications costing $2.65 with name/other medications costing $6.60.
Source: livingwellmag.com

In Medicare Part D Plans, Low or Zero Copays and Other Features to Encourage the Use of Generic Statins Work, Could Save Billions

The researchers of this study found that a low copayment for generic statins is the strongest factor influencing the use of these drugs, and eliminating the copay altogether has an especially large effect. Other tools that have an effect are higher copays and prior authorization or “step therapy” requirements for popular brand-name statins. In this drug class, where generics can be readily substituted for brand-name drugs for most people, adoption of the policies most effective in encouraging generic use could lead to considerable savings for the plans, Medicare, and enrollees. These researchers estimate that every 10 percent increase in the use of generic, rather than brand-name statins would reduce Medicare costs by about $1 billion annually. Plans could apply the lessons from this analysis and consider a zero copay for use of generic drugs, and Medicare might consider further incentives for plans to use benefit designs that increase such drugs’ use. 
Source: rwjf.org

ODs have one month to earn dual bonuses under new Medicare EHR

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526Health care practitioners who qualified for bonuses through the Medicare Electronic Health Records (EHR) Incentive program during 2012 may also qualify for 2012 payment bonuses under the Physician Quality Reporting System (PQRS), if they enroll in the new Medicare PQRS-EHR Incentive Pilot Program by Feb. 28, 2013, according to the U.S. Centers for Medicare & Medicaid Services (CMS).
Source: newsfromaoa.org

Video: 2011 HEAT Provider Compliance Training – Overview of Centers for Medicare and Medicaid Services

Health Care Authority Prepares Website to Answer Medicaid Providers’ Questions About Rate Increases

FOR MORE INFORMATION ON HEALTH CARE REFORM OR BACKGROUND: The Medicaid Expansion 2014 website: www.hca.wa.gov/hcr/me The Health Benefits Exchange website: www.hca.wa.gov/hcr/exchange The Provider Rates Change website: www.hca.wa.gov/acarates Provider questions about the rate increase can be emailed to prvrates@hca.wa.gov Jim Stevenson, Communications, HCA 360-725-1915 jim.stevenson@hca.wa.gov
Source: wa.gov

Different payer, different rules, different audit

That’s why providers want to be “100% familiar” with Medicaid guidelines, particularly as they relate to what documentation they need to submit and when, says Sylvia Toscano, owner of Professional Medical Administrators in Boca Raton, Fla.
Source: hmenews.com

CMS angling to ease providers’ burdens from Medicare Administrative Contractors

CMS has called for provider contact information so the agency can survey a random sample of long-term care operators. This will help the agency determine just how satisfied providers are with the recently instituted Medicare Administrative Contractors (MACs). The Social Security Act names provider satisfaction as a MAC performance standard.
Source: mcknights.com

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Both traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Medicare Cuts to Provider Payments or Actual Medicare Reform?

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

CT Medicare Home Health TPL Project Year Five Instruction Packet 

Except for “adjusted” bills as described above, you must submit RAPs to Medicare for all episodes as necessary to include all of the services identified for TPL review.  Except for Condition Codes, the information on the RAP must be consistent with the information on the final claim. (Condition Codes are not to be included on the RAP, but only on the final claim.) For this reason, you should read the instructions relating to final claims (see Section 10 below) as well as the instructions relating to RAPs before submitting the RAPs themselves. If a final claim is not accepted by Medicare because it contains information which is not consistent with the original RAP, then the original RAP may need to be canceled, a new RAP submitted, and the final claim (now consistent with the RAP) resubmitted. The process of correcting and resubmitting RAPs and claims will cause delays, which might jeopardize your ability to get your final claims filed timely.  Therefore, it is crucial that accurate PPS episodes be identified when RAPs are submitted.
Source: medicareadvocacy.org

Hospitals Must Catch CMS Errors Within 3 Years

The Court explained that the reimbursement amount health care providers receive for treating inpatient Medicare beneficiaries is adjusted upward for hospitals that serve a disproportionate share of low-income patients. The adjustment amount is determined in part by the percentage of a hospital’s patients who are eligible for Supplemental Security Income (SSI), called the SSI fraction. Each year, the Centers for Medicare & Medicaid Services (CMS) calculates the SSI fraction for an eligible hospital and submits that number to the hospital’s “fiscal intermediary,” a Department of Health and Human Services (HHS) contractor.
Source: findlaw.com

RAC Alert: How to Bill Medicare for Hospice Patients When You Are Not the Hospice Provider of File

When hospice coverage is elected, the beneficiary waives all rights to Medicare Part B payments for services that are related to the treatment and management of his/her terminal illness during any period his/her hospice benefit election is in force, except for professional services of an attending physician, which may include a nurse practitioner. If the attending physician, who may be a nurse practitioner, is an employee of the designated hospice, he or she may
Source: managemypractice.com

Provider Concentration in Markets for Physician Services for Patients with Traditional Medicare by Samuel A. Kleiner, Sean Lyons, William White :: SSRN

The geographic extent of markets for physicians is an important but little-explored issue for antitrust. Using patient flow data from a 2009 20% sample of Medicare beneficiaries, we define physician specialty-specific geographic markets for selected communities and calculate concentration within these markets. We find considerable variation in geographic market size by physician specialty and evidence of substantial concentration within physician markets, especially for specialists in smaller geographic areas. Additionally, given that our market definition methodology has been shown to define overly expansive markets, our concentration measures likely reflect a lower bound.
Source: wordpress.com

Diabetes and Medicare have You Confused?

Posted by:  :  Category: Medicare

Remember Medicare Part B has a deductible ($140 in 2012) and 20% coinsurance that you must pay.  Some Medicare Advantage plans or Medicare supplemental health plans may cover more, but you have at least 80% coverage after the deductible.  Remember that is 80% of the Medicare-approved amount.  In Minnesota a physician may not charge more than the Medicare-approved amount, but this limiting law may not necessarily apply to supplies.  In any state if the supplier accepts Medicare assignment, they can only charge the Medicare-approved amount.  It might be worth your time to find a provider who accepts assignment.  Sometime in the future (possibly July 2013) if Health Care Reform still exists, you may only be able to get Medicare coverage for these supplies from Medicare-approved suppliers.
Source: retirementeducationplus.com

Video: Medicare Coverage

The proposed Medicare Diabetes Screening

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Source: wordwd.com

ICYMI: New York Times Economix Blog Highlights Higher Quality Care Medicare Advantage Plans Provide

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Source: ahipcoverage.com

Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source: hlc.org

Marci’s Medicare Answers

COBRA (Consolidated Omnibus Reconciliation Act) is the federal law that gives you the right to continue your health insurance once it ends because of job loss, divorce, death or other reasons. COBRA is also known as “continuation coverage” and acts as a secondary payer to Medicare. This means that Medicare pays first on any health care services you receive and COBRA pays second. COBRA is not considered current employer insurance. You should enroll into Medicare when you become eligible to ensure that you have primary health insurance and to avoid any gaps in your health care coverage.
Source: homeboundresources.com

Diabetes foot amputations drastically reduced with simple measures

The study shows adding an insert to shoes could lower rates of diabetic foot amputations, combined with attention to good shoes and care from a podiatrist. Diabetic socks are available that are also inexpensive. It’s also important to keep your blood sugar under control. High blood sugar levels delay healing.
Source: emaxhealth.com

Proposed Settlement May Expand Medicare Coverage for Important Services

According to a story in the New York Times, “Federal officials agreed to rewrite the Medicare manual to make clear that Medicare coverage of nursing had therapy services does not turn on the presence or absence of an individual’s potential for improvement, but is based on the beneficiary’s need for skilled care.”
Source: mindingoureldersblogs.com

Diabetes Supplies and Medicare

Different plans as well as your geographical location will determine how much coverage seniors receive for diabetic supplies. Medicare will pay for supplies that aren’t mentioned in a doctor’s prescription, so only order supplies that have been approved by the doctor. Seniors should also know that ongoing requests for supplies will be necessary, and shipments that are automatically sent from suppliers won’t be paid for.Seniors themselves can’t send claims to Medicare. Such claims have to be submitted through a pharmacy enrolled in the Medicare program or an approved supplier enrolled in the Medicare program.
Source: boomers-with-elderly-parents.com

Medicare and CGMS Coverage

My pump, cgm, and supplies for both are currently covered by the insurance policy I am covered under by my employer. But I am planning on retiring in a few month and will be under COBRA for the next 14 month. So far so good, I will still have all my diabetic supplies covered. However when I turn 65 (July 2013) and go under Medicare it seems I will no longer be covered. Based on your post it seems an appeal letter would be my next step. The problem I have is that I have been fanatical about controlling my blood glucose for twenty plus years and have never had an A1C over 6.2. I exercise several hours every day (100 plus miles a week on my bike, tennis five days a week, one hour plus walking my dogs every day). I have always tested my BG ten times a day and now with pump and cgm I am down to about seven samples a day. Blood work, eye exams, physicals will all show I am basically not diabetic. But because of this effort to maintain such tight control of my BG I am now asymptomatic for hypoglycemia. My endocrinologist is very cooperative but I do not see how I could make a case of medical necessity, even though it is because of all the technology that I am able to maintain my BG control.
Source: kellywpa.com

Why Can’t Cincinnati Hospitals Survive on Medicare + 40%?

The sentence about Medicare rates not covering costs isn’t attributed to anyone, but it really does bear examination. For most hospitals, Medicare is the biggest customer. Medicaid is also usually a big customer and its rates are usually lower than Medicare. Hospitals also have patients that can’t pay or just don’t. So if a hospital isn’t breaking even on Medicare it will have a big gap to fill. Some hospitals have substantial other sources of income (from investments and/or philanthropy) but in general they look to commercial payers for more than 100 percent of their profits.
Source: healthworkscollective.com

Medicare Diabetes Coverage: Getting Supplies Covered by Medicare for Diabetes

To get Medicare diabetes supplies covered by Part B or Part D requires a better understanding of how Medicare works and what Part covers what diabetic medical supplies. This at least is important if you intend to do all of your paperwork directly with Medicare to obtain your diabetes supplies. Fortunately, there are online pharmacies that are professional and offer this service with your loyalty as a customer. It is something they do on a daily basis with a large percentage of their customers and many times have specialists for this purpose. Places like Advanced Diabetes Supply make it their business to get you the lowest price possible so that staying with them is the obvious choice. Medicare covered diabetic testing supplies are split up into different plans, at different tiers and formalities. This is what makes it complex. It depends on your income and what type of diabetic you are i.e.(using insulin pump or needles). Besides handling this, many online pharmacies will offer a free glucose meter to new customers and set up easy plans that take what would be multiple payments and pages of paperwork into one transaction by communicating with Medicare and doctors if needed to ease the process.
Source: blogspot.com

Preventing Chronic Disease Can Reduce Medicare 10%

The best known lifestyle modification program is the Diabetes Prevention Program, a public-private partnership that establishes programs for people at high risk for type 2 diabetes. A randomized trial of the program found lifestyle intervention reduced diabetes prevalence by 58% — a reduction largely due to a 5% to 7% weight loss among participants, Thursday’s report noted.
Source: diabetesincontrol.com

SSDRC: Medicare: Modifying Coverage for Type 2 Diabetes Surgery

Bariatric surgery, also known as weight-loss surgery, involves various surgical procedures of the gastrointestinal tract to decrease nutrient absorption and intake, such as stomach stapling and reducing the stomach size. This type of surgery is oftentimes used for those who are severely obese. Up until recently, Medicare covered bariatric surgery for those with Type 2 diabetes. Now Medicare has announced that they will only be covering the surgery for those with Type 2 diabetes if they have a body mass index (BMI) of 35 and over; a BMI of 40 and over is regarded as morbidly obese. The following article talks about Medicare ‘s decision not to cover bariatric surgery for those with a BMI under 35 and speaks with Medicare spokesman Don McLeod. The article also discusses the reasons for the agency’s decision, the cost of the surgery, and speaks about various studies and trials that have been held over the last year involving those who are morbidly obese. Medicare Likely to Drop Coverage of Surgery for Combating Diabetes For information on Social Security and Social Security Disability, visit the Social Security Disability Benefits Resource Center
Source: ssdrc.com

H.R.6548: Diabetes Prevention Act of 2012

9/21/2012–Introduced.Diabetes Prevention Act of 2012 – Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to make payments from the Federal Supplementary Medical Insurance Trust Fund to qualified third-party intermediaries for diabetes prevention services furnished to prediabetic Medicare beneficiaries by eligible entities in local communities that are networked and managed by such third-party intermediaries.
Source: opencongress.org

New York Attorney General Settles Medicare Fraud Claims With Medical Waste Disposal Contractor

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonThe Attorney General of New York announced a $2.4 million settlement with Stericycle, Inc., one of the nation’s largest medical disposal companies for overcharges top nearly 1,000 municipal entities across the state.  Stericycle implemented overcharges by instituting automatic price increases without giving notice.  Under the settlement, Stericycle will repay all overcharges to every municipality and agreed not to implement automatic price increases in the future
Source: fraudwhistleblowersblog.com

Video: Robert Kiyosaki predicts the future and it’s not pretty for some

Pharmacist Jobs in Montana: Various Positions position at New West Medicare in Helena

More details about this position opportunity please read the description below. Looking for Energetic Individuals to join our Medicare Excellence Team! New West Health Services, a community based not-for-profit health insurance company focused on Medicare excellence is looking for self motivated energ! etic members to join our Medicare Team in Helena, MT. Part D Clinician/Pharmacist This pharmacist serves as the leader in operating managed Medicare Advantage Part D clinical programs, contributes to product development, manages all aspects of PBM relationship, provides formulary oversight, and ensures regulatory compliance with CMS. The position requires a Bachelor’s degree in Pharmacy, or a Doctor of Pharmacy (PharmD) degree from an accredited college of pharmacy, and licensure as a pharmacist in the State of Montana. Minimum of five years pharmacy experience required, preferably in either Retail or Managed Care environment. Certification in geriatric pharmacy required, though candidate may work towards such certification in a defined timeframe. Knowledge of Medicare Advantage plan preventive benefits and CMS regulations required. Nurse Case Manager – responsibilities include: “Utilization Management and Case Management “Claims review that may require clinical de! terminations “Researching data, documenting decisions and comm! unicating with providers and members. The successful candidate must have a current Montana RN license plus 5 years nursing experience; a working knowledge of Medicare regulations preferred; efficient Microsoft application ability and excellent communication skills are essential. Fraud Waste and Abuse/Medicare Compliance Specialist The Fraud Waste and Abuse Compliance Specialist is responsible for the day-to-day management of the organization’s Fraud Waste and Abuse program and offers support to the Compliance Officer in the administration of the organizational Compliance Program. The position requires a minimum of 5 years experience in the health insurance industry, 2 years experience with Fraud Waste and Abuse programs, 1 year of health care coding and billing experience or an equivalent combination of education and experience. An associate degree in a health related field, business, paralegal, nursing, or other related field is preferred. Familiarity wit! h Centers for Medicare and Medicaid Services rules and regulations regarding Fraud Waste and Abuse is strongly desired. National certification in Fraud Waste and Abuse (FWA) is required at the time of application. EXCELLENT BENEFITS, HOURS & WORKING ENVIRONMENT For detailed position description information or to obtain an application, please visit: www.newwesthealth.com Send your completed application, resume and cover letter to Human Resources at: hrdept@nwhp.com , or fax to: (406) 457-2255; or mail to: New West Health Services, Human Resources 130 Neill Avenue, Helena, MT 59601 – . If you were eligible to this position, please deliver us your resume, with salary requirements and a resume to New West Medicare.
Source: blogspot.com

Voice For Medicare, Medicaid Retiring

In a statement Friday, President Barack Obama hailed Rockefeller’s service. “From his time in the state legislature to the Governor’s office to the Senate floor, Jay has built an impressive legacy, one that can be found in the children who have better schools, the miners who have safer working conditions, the seniors who have retired with greater dignity, and the new industries that he helped bring to West Virginia,” Obama said. “A long-time champion of health care reform, Jay was also instrumental in the fight to make sure that nobody in America has to go broke because they get sick.”
Source: kaiserhealthnews.org

CMS to Award New J1 MAC for Medicare Claims

Palmetto GBA in Georgia has been the MAC for Region J1 (now named Jurisdiction E), which includes California, for the past five years. Apparently the new contract has been awarded to Noridian Administrative Services out of Fargo, North Dakota. They have been the Medicare Part A & B MAC for Jurisdiction F, which includes upper mid-West and Pacific Northwest states, for the past five years. The CMS award is currently under appeal and may take more time to finalize.
Source: hfsconsultants.com

More Time to Enroll in Medicare If You Live in Storm Areas

Thanks to the marvels of medical science, our parents are living longer than ever before. Adults over age 80 are the fastest growing segment of the population; most will spend years dependent on others for the most basic needs. That burden falls to their baby boomer children. In The New Old Age, Paula Span and other contributors explore this unprecedented intergenerational challenge. You can reach the editors at newoldage@nytimes.com.
Source: nytimes.com

Workshops for New Medicare Recipients Available

Cedar Dvorin and John Glowacky from the Virginia Insurance Counseling and Assistance Program lead the sessions. Space is limited and pre-registration is required. For more information, call 703-228-1700.   The information sessions will take place at the Arlington Human Services Center, 2100 Washington Blvd., in Meeting Room A on the lower level Jan. 17, 6:30 p.m. to 8:30 p.m.; Feb. 7, 6:30 p.m. to 8:30 p.m. and Feb. 19, 10 a.m. to noon.   Free parking is available in Arlington County customer spaces in the garage across the street or on the street.
Source: patch.com

Rangel Introduces NEWT Act To Close Loophole In Medicare Tax

There are two prominent examples of this loophole. In 2010, Gingrich Holdings, Inc and Gingrich Productions paid Newt Gingrich $444,327 in wage income while declaring $2.4 million as profits of the S corporation. This allowed Speaker Gingrich to avoid $69,000 in Medicare taxes. He earned the money by giving speeches and consulting, but the fees were paid to the S-Corporation. In 1995, John Edwards earned $26.9 million from his work as a trial lawyer. He paid himself a salary of $360,000 each year for four years and took the rest as distributions from his S corporation. This saved Senator Edwards an estimated $600,000 in Medicare taxes.  
Source: house.gov

Secure Horizons Medicare Advantage

Posted by:  :  Category: Medicare

The first good thing about the HMO is the lower price sharing by utilizing community providers. HMO plans typically have extra benefits that is probably not found in different sorts of plans. HMO plans are often available in metropolitan areas with a higher inhabitants and a complete supplier network. Just be sure you are snug with the supplier community before you choose this type of plan.
Source: beststockmarketinvestment.com

Video: United Healthcare Secure Horizons & Oxford – Medicare Advantage Denies Coverage

Secure Horizons Medicare Advantage Plans

These plans offer a low or zero monthly plan premium, and many of them include drug coverage!  This means that you can have Part D coverage through the plan and pay next to nothing for having the coverage.  The co-pays for doctors visits are also typically lower than the competition.  The plans focus on providing value for the items that most beneficiaries use on a regular basis.  In addition they offer preventative dental and vision care across their markets which most seniors like as well as SilverSneakers!  Silver Sneakers is a national program that gives seniors access to over 10,000 fitness centers across the U.S.  This membership is included at no additional cost.
Source: medicare-plans.net

Safe Horizons Medicare Advantage

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Source: thefinanceanalysis.com

Secure Horizons Medicare Advantage

The primary advantage of the HMO is the lower value sharing by utilizing community providers. HMO plans typically have further advantages that is probably not present in other types of plans. HMO plans are sometimes available in metropolitan areas with a better population and a comprehensive supplier network. Make sure that you are comfy with the supplier community earlier than you choose this type of plan.
Source: investmentfinancialadvice.com

Safe Horizons Medicare Advantage

The first benefit of the HMO is the decrease cost sharing by using community providers. HMO plans typically have extra advantages that is probably not present in different types of plans. HMO plans are sometimes available in metropolitan areas with a greater population and a comprehensive supplier network. Make sure that you are comfortable with the supplier community earlier than you choose this sort of plan.
Source: thenasdaqstockexchange.com

Safe Horizons Medicare Advantage

The primary good thing about the HMO is the lower price sharing by using community providers. HMO plans usually have additional benefits that may not be found in different varieties of plans. HMO plans are often out there in metropolitan areas with a better population and a comprehensive supplier network. Make sure that you are comfortable with the supplier community before you choose this type of plan.
Source: themoneyfinances.com

Secure Horizons Medicare Advantage

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Source: thebestforexinvestment.com

Safe Horizons Medicare Advantage

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Source: stocktradingfinance.com

Safe Horizons Medicare Advantage

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Source: shortmarketresearch.com

Medicare Marketing on the Horizon

Many thanks to the Council on Aging of Greater Nashville for this alert:  The Open Enrollment Period for Medicare, including Medicare Part D (Prescription Drug Benefits) and Medicare Advantage Plans, has started. That means that seniors will be receiving information on the many available plans.  Seniors should stay alert for information that will be mailed about possible changes to their current Medicare plan. 
Source: wholecareconnections.com

Secure Horizons Medicare Advantage

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Source: financeinvestingmarket.com

Safe Horizons Medicare Advantage

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Source: thetradereview.com

Palos Hills Man Sentenced for $2.9 Million Medicare Fraud

Posted by:  :  Category: Medicare

Love it! Improve it! Medicare for All! by TheeErinMostly cloudy with snow showers likely near the lake. Snow accumulation up to 2 inches near the lake. Partly cloudy well inland. Highs 17 to 21. Lowest wind chill readings 5 below to 15 below zero in the morning. North winds 10 to 20 mph with gusts up to 30 mph early in the morning becoming northeast 10 to 15 mph in the late morning and early afternoon…then shifting to the southeast late in the afternoon. Chance of precipitation 60 percent.
Source: patch.com

Video: Understanding Medicare Basics – 2010 Medicare Open Enrollment Webinar

Senior Care in Oswego, IL: 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: safeathomehealthcare.com

Last Chance for Senior Medicare Program

Mostly cloudy with snow showers likely near the lake. Snow accumulation up to 2 inches near the lake. Partly cloudy well inland. Highs 17 to 21. Lowest wind chill readings 5 below to 15 below zero in the morning. North winds 10 to 20 mph with gusts up to 30 mph early in the morning becoming northeast 10 to 15 mph in the late morning and early afternoon…then shifting to the southeast late in the afternoon. Chance of precipitation 60 percent.
Source: patch.com

MEDICARE OPEN ENROLLMENT PERIOD IS CLOSING

Mostly cloudy with snow showers likely near the lake. Snow accumulation up to 2 inches near the lake. Partly cloudy well inland. Highs 17 to 21. Lowest wind chill readings 5 below to 15 below zero in the morning. North winds 10 to 20 mph with gusts up to 30 mph early in the morning becoming northeast 10 to 15 mph in the late morning and early afternoon…then shifting to the southeast late in the afternoon. Chance of precipitation 60 percent.
Source: patch.com

How to cope with new Medicare surtax

6. Arrange an installment sale. If you’re selling rental real estate, an installment sale may be the only way to get a buyer to agree to the deal. For sales in which you received payments over two or more years, the proportionate gain is taxable in the years the payments are received. By staggering payments based on your projected tax brackets, you may reduce the impact of both regular income taxes and the surtax. Alternatively, if it’s better taxwise overall, one can elect to pay the entire tax due on a 2012 sale with your 2012 return.
Source: patch.com

Inverness Psychologist Charged With Medicare Fraud

Mostly cloudy with snow showers likely near the lake. Snow accumulation up to 2 inches near the lake. Partly cloudy well inland. Highs 17 to 21. Lowest wind chill readings 5 below to 15 below zero in the morning. North winds 10 to 20 mph with gusts up to 30 mph early in the morning becoming northeast 10 to 15 mph in the late morning and early afternoon…then shifting to the southeast late in the afternoon. Chance of precipitation 60 percent.
Source: patch.com

Feds Bust Healthcare Facility in Skokie For Medicare Fraud

AC … Freud was a psychologist. You mean of course, fraud. This is an example of things going RIGHT and weeding out fraud. The more things like this are detected and publicized, the more reluctant providers (and many times patients themselves) will be to get involved in doing something they know is wrong. The stiffer the sentence the better, as a deterrent, hopefully. Fraud is one significant way to attack Medicare waste. Another is to reduce monthly advances to providers of MA (Medicare "Advantage") Plans (formerly Medicare + Choice..Share HMO etc etc)… Last year the government paid providers of these managed care plans over $9 Billion Dollars more, than if those same enrollees simply had medicare and a supplement or medicare and medicaid if indigent. Doctors taking kickbacks is nothing new. They have been losing their licenses and doing jail time since Medicare began. What is new is with the technology available, these offenders are more likely to get caught. Never a dull moment as the debates begin next week. Rest assured Medicare will be brought up.
Source: patch.com

Silver Cross Physicians Join New Blue Medicare Advantage (HMO) Plan

Learn how to protect yourself from some of the expenses Medicare doesn’t cover. Attend a free Our All-in-One Package: Medicare Advantage Prescription Drug (MAPD) program in the Silver Cross Hospital Conference Center, Pavilion A, 1890 Silver Cross Blvd., New Lenox.  One-hour sessions will be held on Oct. 26 and Nov. 1, 16 and 28 at 10 a.m. and 1 p.m.  Each seminar features an informative presentation followed by a question and answer session with a BCBSIL Product Specialist.  A sales person will present information and applications. Free valet parking and shuttle service will be available.  Refreshments will be served.  Register to attend by calling BCBSIL at 1-877-632-5920, TTY/TDD 711, 8 a.m. – 8 p.m., local time, 7 days a week.  For accommodation of persons with special needs at a sales meeting, call 1-877-632-5920, TTY/TDD 711. Friends and family members welcome.
Source: patch.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

Morton Grove Duo Charged In Medicare Fraud

Mostly cloudy with snow showers likely near the lake. Snow accumulation up to 2 inches near the lake. Partly cloudy well inland. Highs 17 to 21. Lowest wind chill readings 5 below to 15 below zero in the morning. North winds 10 to 20 mph with gusts up to 30 mph early in the morning becoming northeast 10 to 15 mph in the late morning and early afternoon…then shifting to the southeast late in the afternoon. Chance of precipitation 60 percent.
Source: patch.com

Schilling ad: Straight Talk on Medicare

COLONA – Medicare is the issue seniors are concerned about with the Obama Administration cutting $715 billion from Medicare funds to pay for Obamacare. Many are concerned that Medicare will be just like Medicaid – the lowest level of health care, with limited choices and overworked and underpaid doctors and hospital staffers. Republicans are framing the debate to say they are committed to preserving Medicare for seniors. Congressman Bobby Schilling (IL-17) hits on this topic in his new ad":
Source: typepad.com

Medicare imposes marketing and enrollment suspensions on HealthNet, Arcadian and Universal American (Today’s Options).

Posted by:  :  Category: Medicare

Arcadian had their webinar today as well. On the call the moderator did not and would not discuss the other companies. It was very refreshing for me to see that respect for the competitors. One of the things we did discuss was the sanctions, while marketing practices were a component, a large part of the sanctions revolved around Rx administration. The Rx vendor is not specifically mentioned nor will I name them. I am however disappointed that no specific action is to be taken when this vendor is responsible for issues with ALL the companies receiving sanctions. All of the companies/MAPD Plans are working hard with the CMS to correct the issues and will be back to marketing in 4 to 6 months. My feelings go out to all of the beneficiaries that will miss out on these plans. In some markets, the sanctioned plans are the most intelligent option.
Source: wordpress.com

Video: Health Net Medicare Advantage – Compare to over 180 Compani

CMS Announces Marketing Sanctions for Three Medicare Advantage Carriers: Health Net, Arcadian and Universal American

[…] CMS isssued a press release on Friday afternoon announcing these marketing sanctions.  The sanctions for Health Net took effect at mid-night last Friday, so as I write this, they are currently unable to take an new enrollments.  The sanctions for Arcadian Management and Universal American Corp will not take effect until Sunday, December 5th, so agents will be allowed to enroll new members in these plans for approximately 2 weeks until the sanctions take affect.  For Universal American, the sanctions DO NOT include their stand alone part D plan, only their Medicare Advantage plans.Source: ritterim.com […]
Source: ritterim.com

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

CVS buys Health Net’s Medicare PDP

For CVS, the deal comes on the heels of steady growth following the acquisition of the Medicare PDP business of Universal American Corp. in April 2011, which more than doubled its Medicare Part D business. Also, last fall, CVS announced a partnership with Aetna to offer a co-branded Medicare PDP in 43 states and the District of Columbia. CVS runs more than 7,300 drugstores and is one of the largest pharmacy benefits managers in the U.S. According to analysts, expanding its Medicare Part D business is attractive to the company because more aging Americans are getting their prescription drug coverage from Medicare.
Source: modernmedicine.com

Marin•Sonoma IPA inks Medicare contract with Health Net for Sonoma County Seniors

Great. Seniors get their coverage so that they don’t have to experience the inconvenience of leaving town. (Even though their property taxes are exempt from the huge costs to keep "their" local hospital in business.) The non-insured also get to keep their "free" local care; paid for by the rest of us. The only ones to be forced to leave town for their health care are working families, who must use Kaiser or other out-of-town options because the local out-of-pocket costs are too high. So those that are paying for this huge privilege of localized medical care in this town are the least likely to be able to use it. Something stinks about this picture.
Source: patch.com

Health Net sanction means one less low

Los Angeles-based Health Net Inc. to stop enrolling people into its Medicare Advantage and prescription-drug plans. That’s a blow because Health Net is the second-largest Medicare Advantage provider in Oregon. It offered one of the few plans with no additional premium, experts say. The agency said it took action because Health Net has “continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.” Medicare officials say they would monitor Health Net until it corrected the problems. Health Net emphasized in a statement that the suspension does not effect its existing Medicare enrollees. 
Source: oregonlive.com

Health Net drops Tenet Hospitals over Costs

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

HIPAA Warning: Do Not Attempt to Hide A Data Security Breach as Health Net Did

When a portable disk drive went missing from a Connecticut office of insurance company and Medicare Advantage contractor Health Net last May, the law required them to notify authorities and affected customers immediately. Instead they kept it under wraps until November. According to an independent security company report, they also lied about it being a theft, neglected to mention two laptop PCs were also stolen, and falsely reported the data was unreadable without special software. Some officers may be exchanging pin stripes for striped suits. Even if they do not, the story is an excellent case study in how not to handle a data breach involving patient information.
Source: homehealthnews.org

Health Net security breach affects 120,000 Oregon customers

Los Angeles-based Health Net — one of Oregon’s largest health insurers — disclosed March 14th that data servers containing the personal financial information for nearly 2 million current and former customers had been missing from a Sacramento-area office for roughly a month.  Officials said Social Security numbers potentially could be compromised. “We’re still investigating,” Health Net spokesman Brad Kieffer said today.
Source: oregonlive.com

Greenberg: Medicaid Expansion Is Bad for Health Care, Coverage, and Cost

Posted by:  :  Category: Medicare

3.4 million kids will have Medicare funded dental health care - that's why we vote Greens by Greens MPsIndeed, there is very little evidence generally that expanding Medicaid will improve the health of the uninsured: the evidence calls into question whether broad coverage expansions improve health at all. When Oregon randomly picked 10,000 new Medicaid enrollees a few years ago, it tracked the results and compared them with the unenrolled population. The result: although the enrollees consumed more services, actual medical outcomes barely changed at all. Two-thirds of reported self-improvement in health came after enrollment, but before receiving health care. These facts should teach policymakers not to confuse spending inputs with health outcomes. Ultimately, what government has created for many low-income Medicaid clients is a trap. The prospect of losing Medicaid benefits deters people from seeking increased income, because a higher paycheck would force the loss of Medicaid benefits and trigger actual income loss. One study found that many Medicaid recipients would have to double their earnings before their additional income would compensate for loss of Medicaid benefits.
Source: talkbusiness.net

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

Visit the Dentist Before You Retire

Consider first that most employer based dental insurances are included in your benefits and in most cases you cannot opt out of them. If your employer is one of those contracts that has included dental insurance then use it. It is true that dental insurance does not typically cover at 100% of dental procedures, but it still covers a portion of dental services. This is a drastic change in comparison to not having any dental insurance at all. That is like going up that proverbial creek, and trying to paddle against the current. Once you retire and your dental benefits expire you will have an extremely hard time convincing medicare to cover you. Why? They do not cover dental care. It is that simple, so while you and your spouse are still working, using your dental care benefits is an excellent idea.
Source: danmatthewsdds.com

Medicare Eligibility and Senior Health Care

Medicare Advantage popularly known as MA refers to a health insurance program which offers an eligible individual with the US Medicare benefits. MA differs from the previous Medicare model that offered a standard plan offered directly by the United States. In contrast, MA is program that is normally provided by private providers.
Source: eazyretirement.com

Is Dental Insurance Medicare Considered Supplemental?

The cost of a supplemental dental insurance plan will depend on the amount of coverage offered. The basic plans will cost between $25 and $50 a month, for which you would be expected to make monthly or biannual payments. More expensive plans can cost between $50 and $100 a month, but include expensive dental procedures and the largest selection of dentists. Knowing what type of care you require will help finding the insurance to fit your budget.
Source: seniorcorps.org

Kevin E. Hardy DDS applauds states atop preventative dental care

Twenty states as well as the District of Columbia were hit with a grade of “D” or “F.” Four points were focused on in the Pew report: whether states performed sealants in needy schools, whether schools allowed that to be done without a visit to the dentist, met a national objective on sealants and reported data about the children on a regular basis. Essentially, a grade of “A” meant programs were in place to make it easy for children to get sealants if needed. States falling in the “D” or “F” range typically required students to see a dentist before receiving sealants in school – if the programs were even offered in the state in the first place.
Source: indyposted.com

Help protect Medicare dental cover for People with Chronic Disease

Many people with chronic disease such as diabetes, cancer, mental health problems, immune compromise or bleeding disorders, cannot afford private dentistry, and rely on the Medicare Chronic Disease Dental Scheme to pay for dentistry to protect their health. Government plans to close this scheme immediately, and send patients with chronic disease back to the public dental waiting list. Government intends only a 30% increased public dental spending, which is very much less than would be needed to satisfy even current demand, so people with chronic disease will not receive timely or comprehensive care needed. The Medicare Chronic Disease Dental Scheme has been very successful, with 1.5 million Australians treated. It has a low complaint rate of just one complaint per 1,500 patients. The Medicare Chronic Disease Dental Scheme forms a sensible basis for expansion to eventually include the entire Australian population under dental Medicare.  You can read more and sign the petition here:
Source: arafmi.org

State Roundup: Legislatures Tackle Health Budget Gaps, Worker Pay

Boston Globe: Boston Medical Center Expects Profit For 2012 Boston Medical Center, the state’s largest safety net hospital, expects to post a modest financial gain for its 2012 fiscal year, reversing three consecutive years of losses. … [chief executive Kate] Walsh attributed the turnaround to multiple factors, including an increase in federal funding for hospitals that serve large numbers of low-income patients, higher reimbursements from commercial insurers, new billing codes that let government insurers better measure BMC’s range of care, and moves to aggressively cut costs by, among other things, consolidating operations at its South End campus and closing a 12-bed inpatient rehabilitation unit (Weisman, 1/23).
Source: kaiserhealthnews.org

State Hospitals Face 2nd Highest Rate Of Federal Penalties Nationwide

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSUnder the value-based program, hospitals receive penalties or incentives based on how well they perform on 12 clinical measures, such as controlling surgery patients’ blood sugar levels or giving them antibiotics, and on eight patient experience measures, including how well doctors and nurses communicate with them and how clean and quiet the hospital is during their stays. Middlesex, like most other hospitals, has a number of committees dedicated to encouraging “patient-centered care,” and has put in place new policies to improve safety for surgical patients.
Source: courant.com

Video: Medicare Anniversary CEO Jeff Flaks FOX CT

AARP Medigap Rates 2013 Connecticut

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

New Benefits, Taxes Under The Affordable Care Act

Expanded Medicaid Coverage: Connecticut was the first state to receive federal approval to expand Medicaid enrollment even before the Affordable Care Act takes effect. States must decide whether to expand Medicaid by 2014, with the federal government paying 90 to 100 percent of the costs. The number of low-income adults receiving Medicaid has grown from an estimated 47,000 to about 86,800 from July 2010 to December 2012, reports the state Department of Social Services. Some lawmakers question whether the increase stems from a bad economy or if people are deliberately moving to Connecticut to receive benefits. For now, the Centers for Medicare & Medicaid Services is reviewing a request by Connecticut to institute a $10,000 asset test and parental income reporting for applicants.
Source: ctwatchdog.com

McMahon spitballs ideas for Medicare, Social Security reform

“I think we have to put every single thing on the table and work it out between Democrats and Republicans and then have our CBO, the Congressional Budget Office, put the economics or the scoring next to that to see what really does make sense so we’re not kicking this can down the road,” McMahon said. “I want a permanent solution so I can make sure we protect both of these programs.”
Source: nhregister.com

CMS Names 106 New Medicare ACOs

CMS has named 106 new accountable care organizations that will participate in the Medicare Shared Savings Program, effective Jan. 1. With the addition of the 106 new organizations, as many as 4 million Medicare beneficiaries will be covered by a CMS ACO. According to CMS, the savings achieved by its ACOs could be up to $940 million in four years. The new group of ACOs includes 15 Advance Payment Model ACOs, which are physician-based or rural organizations that will benefit from greater access to capital. The application period for organizations wanting to participate in the MSSP in 2014 will begin this summer. The 106 new ACOs named to the MSSP are listed here, with their service areas: 1.    A.M. Beajow, MD Internal Medicine Associates ACO, P.C. (Nevada) 2.    AAMC Collaborative Care Network (Maryland) 3.    Accountable Care Clinical Services, PC (California, Connecticut, Iowa, Massachusetts, Pennsylvania) 4.    Accountable Care Coalition of Central Georgia (Georgia) 5.    Accountable Care Coalition of DeKalb (Georgia) 6.    Accountable Care Coalition of Georgia (Georgia) 7.    Accountable Care Coalition of Greater Athens Georgia II (Georgia) 8.    Accountable Care Coalition of Greater Augusta & Statesboro (Georgia, South Carolina) 9.    Accountable Care Coalition of New Mexico (New Mexico) 10.    Accountable Care Coalition of North Central Florida (Florida) 11.    Accountable Care Coalition of North Texas (Texas) 12.    Accountable Care Coalition of Southern Georgia (Georgia) 13.    Accountable Care Coalition of Western Georgia (Alabama, Georgia) 14.    Accountable Care Organization of New England (Connecticut, Massachusetts) 15.    ACO of Puerto Rico (Puerto Rico) 16.    Advocare Walgreens Well Network (New Jersey) 17.    Affiliated Physicians IPA (California) 18.    Akira Health (California) 19.    Alegent Health Partners (Nebraska) 20.    Alexian Brothers Accountable Care Organization (Illinois) 21.    Amarillo Legacy Medical ACO (Texas) 22.    American Health Alliance (Florida) 23.    American Health Network of Ohio (Ohio) 24.    APCN-ACO (California) 25.    Arizona Care Network (Arizona) 26.    Atlanticare Health Solutions (New Jersey) 27.    AVETA Accountable Care (Puerto Rico) 28.    BAROMA Health Partners (Florida) 29.    Billings Clinic (Montana, Wyoming) 30.    Bon Secours Good Helpcare (Kentucky, New York, Ohio, South Carolina, Virginia) 31.    Cambridge Health Alliance (Massachusetts) 32.    Cape Cod Health Network ACO (Massachusetts) 33.    Cedars-Sinai Accountable Care (California) 34.    Central Florida Physicians Trust (Florida) 35.    Central Jersey ACO (New Jersey) 36.    Christie Clinic Physician Services (Illinois) 37.    Collaborative Care of Florida (Florida) 38.    Collaborative Health ACO (Massachusetts) 39.    Colorado Accountable Care (Colorado) 40.    Community Health Network (Minnesota) 41.    Diagnostic Clinic Walgreens Well Network (Florida) 42.    Doctors Connected (Virginia) 43.    Essential Care Partners II (Texas) 44.    Fort Smith Physicians Alliance ACO (Arkansas, Oklahoma) 45.    Franciscan Northwest Physicians Health Network (Washington) 46.    Franciscan Union ACO (Illinois, Indiana) 47.    GPIPA ACO (Arizona, New Mexico) 48.    Hartford HealthCare Affordable Care Organization (Connecticut) 49.    HHC ACO (New York) 50.    HNMC Hospital/Physician ACO (New Jersey) 51.    Independent Physicians’ ACO of Chicago (Illinois) 52.    Indiana Care Organization (Indiana) 53.    Indiana Lakes ACO (Indiana) 54.    Integral Healthcare (Florida) 55.    Integrated ACO (Texas) 56.    KCMPA (Kansas, Missouri) 57.    KentuckyOne Health Partners (Indiana, Kentucky) 58.    Keystone Accountable Care Organization (New York, Pennsylvania) 59.    Lahey Clinical Performance Accountable Care Organization (Massachusetts, New Hampshire) 60.    Lower Shore ACO (Delaware, Maryland, Virginia) 61.    Marshfield Clinic (Wisconsin) 62.    Maryland Collaborative Care (Maryland, Washington, D.C.) 63.    MCM Accountable Care Organization (Florida) 64.    Medicare Value Partners (Illinois) 65.    Mercy ACO (Arkansas, Missouri) 66.    Meridian Accountable Care Organization (New Jersey) 67.    Meritage ACO (California) 68.    Morehouse Choice ACO-ES (Georgia) 69.    National ACO (California) 70.    Nature Coast ACO (Florida) 71.    NOMS ACO (Ohio) 72.    Northeast Florida Accountable Care (Florida) 73.    Northern Maryland Collaborative Care (Maryland) 74.    Northwest Ohio ACO (Michigan, Ohio) 75.    Ochsner Accountable Care Network (Louisiana, Mississippi) 76.    OneCare Vermont Accountable Care Organization (New Hampshire, Vermont) 77.    Owensboro ACO (Indiana, Kentucky) 78.    Paradigm ACO (Florida) 79.    Partners in Care (Michigan) 80.    Physician Organization of Michigan ACO (Michigan) 81.    Physicians Collaborative Trust ACO (Florida) 82.    Physicians HealthCare Collaborative (North Carolina) 83.    Pioneer Valley Accountable Care (Connecticut, Massachusetts) 84.    Primary Care Alliance (Florida) 85.    Primary Partners ACIP (Florida) 86.    ProCare Med (Florida) 87.    ProHealth Physicians ACO (Connecticut) 88.    Qualable Medical Professional (Tennessee, Virginia) 89.    Rio Grande Valley Health Alliance (Texas) 90.    Saint Francis HealthCare Partners ACO (Connecticut) 91.    San Diego Independent ACO (California) 92.    Scott & White Healthcare Walgreens Well Network (Texas) 93.    SERPA-ACO (Nebraska) 94.    South Florida ACO (Florida) 95.    Southcoast Accountable Care Organization (Massachusetts, Rhode Island) 96.    Southern Maryland Collaborative Care (Maryland, Washington, D.C.) 97.    St. Luke’s Clinic Coordinated Care (Idaho, Oregon) 98.    Summit Health-Virtua (New Jersey) 99.    The Premier Health Care Network (Georgia, New Hampshire) 100.    UCLA Faculty Practice Group 101.    UW Health ACO (Wisconsin) 102.    Virginia Collaborative Care (Virginia) 103.    Wellmont Integrated Network (Tennessee, Virginia) 104.    Winchester Community ACO (Massachusetts, New Hampshire) 105.    Yavapai Accountable Care (Arizona) 106.    Yuma Accountable Care Organization (Arizona)
Source: beckershospitalreview.com

5th District debate focuses on Medicare, Social Security

“I’m not embracing any one of their particular recommendations, but I think they should be considered,” he said. Both candidates accused the other of fear-mongering — Esty accusing Roraback of using “scare tactics” culled from the U.S. Chamber of Commerce’s website and telling seniors that Social Security benefits are in danger, Roraback accusing Esty of promoting incorrect information in her advertisements.
Source: ct5thdistrict.com

McMahon Favors Medicare/Medicaid and Social Security Cuts

If Linda McMahon’s “Balanced Budget” Plan Was Enacted This Year, It Would Potentially Mandate Hundreds of Billions of Dollars in Medicare/Medicaid and Social Security Cuts.  Linda McMahon proclaims support for a so-called Balanced Budget Amendment, which is a constitutional amendment mandating that federal outlays not exceed total tax receipts.  This year, the federal budget deficit is $1.5 trillion.  Linda McMahon has said on the campaign trail that she opposes any tax increases to balance the budget and that she would exempt Defense spending ($714 billion), Homeland Security ($41 billion), and Veterans Benefits ($162 billion) from her proposed spending cuts in order to reach her goal.  Including debt service ($196 billion), this leaves just $917 billion left, meaning Congress would have to cut 57% of the rest of government spending—including Medicare, Medicaid (currently $736 billion) and Social Security ($749 billion).  Even if you shut down funding for highways, ended small business and education loans, and cut the entire Department of Justice, this plan would still serious consequences for the entitlement programs, if enacted.  [Washington Post, 7/24/10; Congressional Research Service Summary, H.J.Res78, 3/2/10; Linda McMahon Editorial Board Interview (Hartford Courant), 7/20/10; OMB U.S. Budget, Mid-Session Review, 8/25/09; Congressional Research Service, “Mandatory spending Since 1962,” 9/15/10; LM at Conservative Women’s Luncheon PT 2, 9/23/1; LM Remarks at Gun Enthusiasts Meeting, 9/22/10; LM Common Sense CT Interview, 8/30/10; LM at Taste of Mystic, 9/10/10; Linda McMahon, Chaz & AJ Show FM 99.1, 8/3/10]
Source: ctnews.com

Medicare Spends About As Much Screening For Breast Cancer As Treating It

The Medicare NewsGroup: Medicare Sees 2011 Spending Spike While Overall Health Spending Hold Steady Medicare spending rose an estimated 6.2 percent during 2011, driven by a big jump in payments to skilled nursing facilities, more spending at doctors’ offices and bigger outlays for Medicare Advantage plans, the Center for Medicare and Medicaid Services (CMS) reported Monday in its annual survey of projected health spending. The report has projected figures for 2012 forward, and estimated figures for 2011 spending. Medicare’s total outlays reached $554 billion in 2011, an increase of $32 billion from the previous year. The 6.2 percent growth in spending accelerated from an expansion of 4.2 percent in 2010 (Rosenblatt, 1/8).
Source: kaiserhealthnews.org

Health Related Insurance in Connecticut: A look at Medicare health plans in Connecticut

The annual open enrollment period for individuals enrolled in Medicare, who want to make a change in their Medicare health plan, starts October 15, 2012. This period lasts until December 7, 2012 and any changes made will be effective January 1, 2013. MediCARE only pays a physician or other outpatient provider 80% of your treatment expenses! Unlike employer benefit plans there is no limit on your 20% cost sharing! Thus, a great way to protect yourself from the big risk of unpaid expenses is to buy one of two types of Medicare health plans: Every private company offering a Medicare Supplement in Connecticut provides the same coverage for each plan. Supplement A has the least amount of coverage, Plan B includes more, etc. There can however be considerable variation in the monthly premium. The Connecticut Department of Insurance has a chart, which shows the monthly premiums for each each companies plans. The cost of Plan F, which has full coverage, can vary from $214 a month up to $452. Medicare Supplement plans, often called MediGap plans are very popular for individuals who need the flexibility to receive medical treatment in different states. A recent survey found 9 out of 10 individuals, who were enrolled, reported they were happy with their coverage. MediCARE’s Part A or Part B, nor a Supplement, does not pay for normal outpatient prescription medications. Thus, to have coverage for part of the medication costs you may have, its important to add a Medicare Prescription Drug Plan (Part D). Enrolling when you first sign up for Medicare is important since a penalty will be applied if a person does not have what is called credible prescription coverage. Medicare Advantage in Connecticut plans are the second type of Medicare Health plan and they are considered MediCARE Part C. Private medical insurance companies offering Medicare Advantage (MA) plans have a yearly contract with MediCARE; receive a fixed monthly payment for each person who enrolls; provide at least the same benefits as in original MediCARE, but often add additional coverage such as more extensive preventive care; have co-pays for physician visits, emergency room visit, or for a certain number of days when in the hospital; and, depending on the plan, usually charge a monthly premium. Individuals enrolled in a MA plan receive their medical treatment through the companies network of providers and most include coverage for Part D prescription expenses. The cost sharing a person has on their treatment expenses, such as for co-pays, is limited by the plan’s annual maximum out of pocket (MOP. MA plans are usually more economical than buying a MediGap plan plus a Part D plan. Thus, they are of interest to many individuals. Another way to lower the monthly cost of a Medicare Health plan is to select the Supplement, which includes an option to add a deductible of about $2,000. This plan together with a Part D plan would result in a monthly cost, which is lower than some MA plans and also have a lower MOP. Surveys of people close to 65 tell us more than 50% are confused about Medicare and only about 10% understand Medicare’s Part C! Interested in eliminating the confusion and increasing your understanding? Call (860) 739-0005 – today. We can meet for a no cost conversation about MediCARE. We can also discuss the value Medicare Supplements in Connecticut or Medicare Advantage Plans in Connecticut can provide. John C Parker, RHU, LTCP Niantic, CT www.ParkerHealth.com
Source: blogspot.com

Increased Medicaid demand felt across Connecticut

Nearly 84,000 people across Connecticut are enrolled in Medicaid LIA, thousands more than anticipated. Ben Barnes, the state’s budget director, recently told members of the legislature’s Appropriations Committee that LIA caseloads for the month of October were 5.4 percent higher than originally budgeted. In addition, demand for other Medicaid services, such as hospital and nursing home care, also has climbed. The Department of Social Services’ overall Medicaid budget this fiscal year is nearly $224 million in the red. The bump in demand has prompted lawmakers to question why it is happening and when it could max out. “It’s the biggest single piece of the state’s budget that has the largest impact on the most lives,” said state Rep. Craig Miner, R-Litchfield, ranking House Republican on the Appropriations Committee. “One way or another, we need to get control of it, or at least better understand why it’s trending the way it’s trending.” In 2010, Connecticut became the first state in the country to gain federal approval to extend Medicaid coverage to about 47,000 low-income residents, ages 19 to 64. Most were previously enrolled in a limited state-funded program known as State Administered General Assistance or SAGA. Since then, about 37,000 people have signed up for Medicaid LIA, which offers more services than SAGA. The expansion qualified the state to receive 50 percent federal reimbursement. To be eligible, a single adult can earn up to $508.48 a month and a couple up to $617.44 a month. The limits are slightly higher for Fairfield County applicants. Before the expansion, there were an average of 107 recipients in Greenwich signed up for SAGA between July 2009 and June 2010, according DSS’s report. The next fiscal year, when Medicaid was expanded to include the SAGA recipients, the figure jumped to 216. During last fiscal year, from July 2011 to June 2012, the average monthly caseload was 301. Barry is not surprised by the numbers. He said the cost of living is high in the region, and about 43 percent of the town’s applicants for local emergency assistance are Latino, a younger and less affluent population. “I think Greenwich is much more diverse than what people view,” he said, adding how the recipients are not necessarily newcomers to the border town. Greenwich has a six-month residency requirement for assistance. Eileen Bronko, a social worker and a former co-chairman of the Naugatuck Social Service Network, is not surprised by the spike in applications either. Average monthly caseloads for needy adults in the blue-collar community of Naugatuck increased from 330 in fiscal year 2010 when SAGA was in place to 592 in fiscal year 2012. “I think that anybody that thought that this wasn’t going to happen was not really looking at the reality of how much people are hurting,” she said. “Many, many, many people are without health care. So I think part of what you’re seeing is that people can get health care through Medicaid. For the first time, many people are getting health care.” Hartford has experienced the greatest growth, with a monthly average of 6,838 SAGA clients in fiscal year 2010 and a monthly average of 9,866 Medicaid LIA clients is fiscal year 2012. The numbers are expected to grow more once Connecticut extends coverage further beginning in 2014 as part of the federal health care overhaul law. Those earning up to 133 percent of the federal poverty level, or $29,700 a year for a family of four, will be eligible. But the state’s budgetary issue may be abated because the federal government is supposed to cover 100 percent of the cost for all low-income adults on Medicaid living up to the 133 percent federal poverty level. That reimbursement level will last until 2016. After that, it will gradually be reduced to 90 percent by 2020. Sen. Toni Harp, D-New Haven, co-chairman of the Appropriations Committee, said even though the state will receive 100 percent federal reimbursement, it still will have to budget for the Medicaid program, and therefore needs a way to plan for the additional growth. “I think that what concerns me is, that we were led to believe that the LIA population had stabilized and had slowed down somewhat, only to find out we had 4,000 new people in the first three months,” she said. “It’s shocking.”
Source: modernhealthcare.com

Reform Law Helped Slow Growth in Medicare Spending, HHS Finds

Posted by:  :  Category: Medicare

Nancy Pelosi on the Next Four Years by jurvetsonStudy authors Richard Kronick and Rosa Po, with the HHS Office of the Assistant Secretary for Planning and Evaluation, noted that per capita spending is estimated to grow “at or below the rate of GDP per capita [and that] the number of Medicare beneficiaries is projected to increase by approximately 3% annually.” They added, “As a result, aggregate Medicare spending will account for a growing share of GDP over the next decade.”
Source: californiahealthline.org

Video: California Hospital Chain Eyed for Possibly Bilking Medicare for Millions

What If You Have Medicare AND Other Insurance?

I am 68 and retired. I pay $104.90 for Medicare, $ 230( I believe ) for Kaiser through my former employer , with $15 deductible and $10 for medicines , and $130 for Delta Debtal,all of that monthly( roughly $460). Am I paying too much???? Thank you for a very informative article ! Ag Palmieri
Source: patch.com

UCLA Health System chosen as a Medicare Shared Savings Program accountable care organization / UCLA Newsroom

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: ucla.edu

William Henning: Medicare cuts bad medicine for vulnerable California communities

Meanwhile, Part D has been a singular fiscal success, posting what is nothing short of an astonishing record for a federal program. The Washington-based think tank Heritage Foundation found that Part D’s cost growth has come in 41.8 percent below its original cost estimate — a total savings projected at $264.6 billion for taxpayers. Additionally, according to the Journal of the American Medical Association, improved access and adherence to medicines through Part D saves Medicare about $1,200 per year in hospital, nursing home and other costs for each senior who previously lacked comprehensive drug coverage — a $12 billion-per-year savings for Medicare.
Source: santacruzsentinel.com

Report estimates health plan overbilled Medicare $424M

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.
Source: californiawatch.org

Medicare Put the Hospice Industry Under the Microscope

administrative complaint Administrative Hearing attorney controlled substances criminal charges dea DEA investigation defense attorney defense lawyer department of health Department of Health (DOH) Department of Justice (DOJ) doctor doh DOH investigation drug enforcement administration emergency suspension order false claims act florida fraud prevention fraud schemes health care fraud health law hipaa investigation legal representation licensing and regulatory medicaid medicare medicare audit Medicare fraud Medicare investigation nurse nurses pain clinics pain management pharmacies pharmacist pharmacists pharmacy pharmacy investigation physician physicians prescription drug trafficking whistleblower
Source: wordpress.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

What’s New for Medicare Recipients for 2013

This article by a political dem hack is nothing but lies and deceipt. Which is how the dems won the electon Lies. Affordable act will make it worst it did not strenthen anything. Preventive care, little late at 65. We know hospitals being sanctioned for readmits, we know 30 % cut backs for providers now going forward. Yes 716 billion was taken out of medicare fro Obamacare. Did you listen to paul ryan u cannot count that money twice. I have billed for mediare for 30 years. The dems pretend they care they could care less. They only care about votes.
Source: patch.com

Protecting the Plaintiff with Medicare, Medi

Plaintiffs often come to litigation while receiving public benefits such as Medi-Cal and or Supplemental Security Income (SSI), while others become eligible as a direct result of their injuries. Still, others require a Medicare Set-aside (MSA), further complicating the settlement process. Attorneys know, with proper planning, preserving these benefits significantly extends the value and the life of a plaintiff’s settlement funds. However, plaintiffs who are eligible for Medi-Cal or SSI, and receive settlement funds directly, run the risk of losing these public benefits. Benefits may be lost if monthly resources (income or assets) exceed $2,000 for an individual or $3,000 for a couple. This concern, however, will play a much smaller role in settling cases once the
Source: patrickfarber.com