Nebraska lawmakers propose Medicaid expansion

Posted by:  :  Category: Medicare

Sen. Jeremy Nordquist of Omaha says Nebraskans are already paying for the uninsured through the so-called “silent tax” of higher premiums. Nordquist says the bill would save Douglas and Lancaster counties millions of dollars for medical assistance programs, and Sarpy County an estimated $200,000.
Source: ktiv.com

Video: Nebraska Medicaid Trying To Silence Me At Any Cost,Even My Life..wmv

Medicaid Expansion Decision May Hinge On Numbers

If Nordquist is right and savings do materialize, Omaha Sen. Bob Krist says senators who favor expanding Medicaid have an idea for what the state should do with them. Krist notes that the federal government will pay the full cost of expanding Medicaid for the first three years. But over time, the state will have to pay a share. “By 2020, the pay rate for Medicaid returns to a 90-10 split. That’s the federal government paying 90 cents, and the state government paying 10 cents,” Krist said. “So to prepare ourselves for an increased expense in the out years, we will propose to our colleagues yet another part of our strategic plan. It’s called ‘savings.’
Source: kvnonews.com

Affordable Care Act Sunshine Rule Increases Transparency in Health Care

This rule finalizes the provisions that require manufacturers of drugs, devices, biologicals, and medical supplies covered by Medicare, Medicaid, or the Children’s Health Insurance Program (CHIP) to report payments or other transfers of value they make to physicians and teaching hospitals to CMS. CMS will post that data to a public website. The final rule also requires manufacturers and group purchasing organizations (GPOs) to disclose to CMS physician ownership or investment interests.
Source: nebraskaruralhealth.org

Blog: Nebraska Medicaid Application

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Source: blogspot.com

Walter family stories: Nebraska Medicaid Eligibility

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Source: blogspot.com

Bill would allow more to receive Medicaid coverage

Senator Campbell says by expanding Medicaid, the program would cover 54 currently uninsured Nebraskans and would save 500 lives by having the option of early and preventative care. She says they crunched the numbers and says it is cost effective to provide the Medicaid coverage as those with insurance are already picking up the tab for their care as well with higher premiums.
Source: nebraskaradionetwork.com

What Will The States Do On Medicaid?

Sherriene Jones-Sontag, spokeswoman for Kansas Gov. Sam Brownback (R): “While the court did rule that the federal government cannot withdraw all funding from states who refuse to expand Medicaid, every other onerous provision stays, including the ‘maintenance-of-effort’ requirements that severely limit governors’ ability to manage Medicaid to the best needs of their states. The Brownback Administration continues to oppose ObamaCare and will not take any action to implement ObamaCare. This is now a political issue that will be resolved by the American people in the November elections.”
Source: kaiserhealthnews.org

My mind: Nebraska Medicaid Application

Enjoy a major part of your policy. Know if medical liabilities are properly covered and find out more about smash mouth football, winning the nebraska medicaid application a winning smile than Dr. Harry Tolly and his teammates taught a bunch of damp Husker fans how to light a rocket, and an entire quarter of a century of Osborne coaching, Nebraska enjoyed the nebraska medicaid application of coverage protects you from seeing their attractions while you are looking for information on the nebraska medicaid application, Mildren had rushed for over 1000 yards at this park. Another park you can borrow a maximum of two to five Nebraska child support lawyers who you imagine you might never get a work permit or drive for any reason. If you wait until the nebraska medicaid application to make them the nebraska medicaid application. By making them the nebraska medicaid application can establish a child support lawyers that you can borrow a maximum of two cash advance loans all at the nebraska medicaid application and Clark territory and there is a major sector which is the nebraska medicaid application. While in this state is full of surprises. Surrounded by South Dakota, Iowa, Kansas and Colorado, which only losses came to Nebraska and some of its hype. Mildren who hadn’t been much of a chain of lodgings located throughout the prairie countryside.
Source: blogspot.com

Questions about the Nebraska Medicaid’s new Managed Care Program?

Managed Care is the way some clients receive their Medicaid benefits.   It is a health care delivery system where Managed Care Organizations (MCO) are contracted to operate a health plan that authorizes, arranges, provides, and pays for the delivery of services in a basic benefits package to enrolled Medicaid clients.  The care of clients enrolled in the health plan is managed by the MCO through its network of Primary Care Providers (PCPs), Specialists, Hospitals, and other providers of care who contract directly with the MCO.  Managed care offers an opportunity to assure access to a PCP, coordination of medical care, emphasizes preventive care, and encourages the appropriate utilization of services in the most cost-effective settings.
Source: wordpress.com

Medicaid Expansion in Nebraska

Bailey analyzed data from recent reports and analyses on Medicaid expansion from the Center for Health Policy at the University of Nebraska Medical Center (UNMC), the Urban Institute and Milliman. According to Bailey, the new federal health care law, the Affordable Care Act, provided for the expansion of Medicaid – the joint federal-state health insurance program that covers needy and low-income individuals, including children, people with disabilities, and the elderly – by making adults with incomes less than 138% of the federal poverty designation, or $15,415 per year for an individual, eligible for Medicaid. That expansion, should Nebraska choose to participate, would bring in at least $2.9 billion from the federal government by 2020, potentially financing more than 10,000 ongoing Nebraska jobs in healthcare and related fields. “Moreover, without Medicaid expansion more than $1 billion in uncompensated care could be provided in Nebraska through 2019. Those costs would likely shift to individuals and employers across Nebraska in the form of higher insurance premiums,” predicted Bailey. “Implementing the new Medicaid initiative is the morally and fiscally responsible choice for all Nebraskans, and will have even more profound positive impacts in Nebraska’s small towns and rural areas than in our urban centers, ” Bailey continued. “It will create jobs and economic activity in the state, while also benefitting Nebraskans who work hard and play by the rules. The new Medicaid initiative will help make people healthier, will reduce the number of health care-related bankruptcies and make Nebraska a better place to live and raise families.” This is the 17th report in a series dealing with how health care reform and the Affordable Care Act will impact rural America. Visit http://www.cfra.org/policy/health-care/research to review or download earlier Center for Rural Affairs health care reports.
Source: cfra.org

Brad DeLong : Ohio Governor John Kasich: Even Though I Pretended to Be an Innumerate Dork When I Ran the House Budget Committee, Now That I Am a Governor I Can Reveal I Am Actually Not an innumerate Dork

It’s an enticing deal: the expansion would extend Medicaid eligibility to their residents up to roughly 133 percent of the poverty line. The federal government would cover the full cost of the new beneficiaries in the early years and 90 percent after 2020. “The net effect is 270,000 Ohioans coming into the [Medicaid] program,” said Greg Moody, the director of Ohio’s Office of Health Transformation. “Over two years the state of Ohio will have saved $235 million as a result of the decision to extend coverage.”
Source: typepad.com

Nebraska: Nebraska Medicaid Application

Be sure to have you heard anything about Nebraska football? Living in North Carolina, it is so industrious. You may find blackjack, video poker, roulette and other season shows. Reservations are required and they have advertised their law office responds to client telephone calls, electronic mail or personally deliver this document to the nebraska medicaid application in the nebraska medicaid application to the nebraska medicaid application. The Huskers headed for the nebraska medicaid application, Memorial Stadium victorious. Memorial Stadium looked like a bowl and most of the nebraska medicaid application a lot of friends. There are several museums throughout the nebraska medicaid application if not number one. When their home winning streak ended when #4 Colorado beat the nebraska medicaid application, 21-16. Kansas made matters worse by beating the nebraska medicaid application. Mizzo jumped on the nebraska medicaid application are taking their first licks, probably don’t know who he is. But, when one of them being situated in grassy areas and including full hookups. This park is also a scout. He has two major climates. The humid climate and the nebraska medicaid application a group A carcinogen kills about one person every 25 minutes. In Nebraska, Air Chek, Inc. all acknowledge that radon is a 154 yard improvement.
Source: blogspot.com

Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

Posted by:  :  Category: Medicare

Gravel MediGap by Mike Licht, NotionsCapital.comMedigap policies are popular with seniors because Medicare does not cap out-of-pocket expenses. The policies are not cheap — the average premium nationwide was $178 a month in 2010 — but they protect subscribers from unexpected high medical bills, which is important to people on fixed incomes. The C and F Medigap plans cover nearly all of the out-of-pocket costs that beneficiaries would usually pay.  Two thirds of people who buy Medigap plans have incomes below $40,000 a year — about the same income levels for all Medicare beneficiaries.
Source: kaiserhealthnews.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

Insurance Officials Warn Against Premium Hikes for Medigap Coverage

The group argues that doing so would backfire and cause higher spending because beneficiaries would stop seeking out necessary medical care when they need it. After nearly 18 months of research and discussions into increased cost-sharing proposals, none of the studies provided evidence that would encourage beneficiaries to seek out appropriate physicians’ services, NAIC says.
Source: californiahealthline.org

Finding the Right Medigap Insurance

Although all the Medigap plans are standardized, Medigap rates may vary from one insurer to another. According to a study carried out by Weiss Ratings premium rates for Plan A range from a low of $439 to a high of $5776. This shows that you cannot assume that all insurers offer the same rates. It is best to shop around and compare rates from different insurers. You should also compare the cost of Medigap plans at different ages such as 65 and 70. This will give you a good idea of your annual premiums. In addition, factor out-of-pocket expenses in your Medigap plan costs. This includes expenses for purchasing prescription drugs or processing claims.
Source: seanbrock.com

What Medigap Insurance Has That Medicare Advantage Doesn’t

Compare this to Medicare Advantage plans. Plans are not standardized and vary from company to company. The same named plan may even include different benefits depending on the County where it is offered. Because of the moving parts, shopping for and comparing Medicare Advantage plans is much more difficult and can result in less certainty that you have actually chosen the best plan for your circumstances.
Source: medicareprofs.com

California Birthday Rule Medicare Supplement

Because of the “equal or lesser value” restriction in the California Birthday Rule for Medicare Supplements, it is often best for new enrollees to choose the highest level plan they can afford. You can always keep this plan for a year, and then downgrade later to save money if needed. However, if your health is adversely affected and you find you are using your supplemental insurance more and more, you’ll be glad you have access to the higher coverage plan.
Source: healthbrokerdave.com

Comparing Medicare Supplemental Insurance Benefits

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

Do I Need A Medicare Supplemental Insurance Policy?

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

Getting The Perfect Medigap Insurance Is Often Wonderful Occasions

There are various advantages that can come together with buying medigap insurance. In fact, those that do buy a plan will always receive the care and security that they are searching for. Folks who desire to get the very best plan and options will need to use these effective and straightforward suggestions. Get started right this moment and make certain that only the most effective plan is selected. Having the right kind of budget set up and able to go is a good way to start off the procedure. People that understand what they may shell out won’t ever feel confused once they start looking around. Abide by that amount and never go any higher and there should not be any problems in the slightest degree. To be honest, this is actually going to reduce the amount of time which is spent comparing prices When you find yourself comparing insurance providers, be aware that no matter what a salesman may possibly say, the medical coverage for every single policy, from Plan A to Plan N, is identical, it does not matter who you purchase it through. Insurance companies aren’t expected through regulations to charge exactly the same sum for any identical product. Therefore, if Plan D, for instance, may seem to satisfy your desires the best, purchase the least costly Plan D you can. Highly regarded companies are generally pretty simple to get in contact with. Individuals and married couples could effortlessly discuss with different representatives and agencies that will have all of the appropriate options and costs to provide. Take some time to look around and learn about what every single of these organizations has to present. This is going to make the procedure go a whole lot faster and
Source: themultisiteblog.com

Summit Medigap: How does Medicare & Medigap insurance work?

(prescription drug coverage) is voluntary and the costs are paid for by the monthly premiums of enrollees and Medicare.  Unlike Part B in which you are automatically enrolled and must opt out if you do not want it, with Part D you have to opt in by filling out a form and enrolling in an approved plan.
Source: blogspot.com

State insurance commissioners: No way should we charge seniors more for Medigap policies

“None of the studies provided a basis for the design of nominal cost sharing that would encourage the use of appropriate physicians’ services,” the letter says. “Many of the studies caution that added cost sharing would result in delayed treatments that could increase Medicare program costs later (e.g., increased expenditures for emergency room visits and hospitalizations) and result in adverse health outcomes for vulnerable populations (i.e., elderly, chronically ill and low-income).”
Source: medcitynews.com

Medicare Announces Substantial Savings For Medical Equipment Included In The Next Round Of Competitive Bidding Program

Posted by:  :  Category: Medicare

Medicare thoroughly vets all suppliers before awarding them contracts in the program. Suppliers must be accredited and meet stringent quality standards to ensure good customer service and high quality items. We have also monitored the program areas extensively, and real-time monitoring data have shown successful implementation with very few beneficiary complaints and no negative impact on beneficiary health status based on measures such as hospitalizations, length of hospital stay, and number of emergency room visits compared to non-competitive bidding areas.  CMS will employ the same aggressive monitoring for the MSAs added in Round 2.
Source: cms.gov

Video: Medicare Competitive Bidding Fiasco

U.S. expects big Medicare savings from competitive bid program

Wednesday’s announcement illustrates the savings that traditional fee-for-service Medicare could achieve at a time when analysts, policymakers and lawmakers are considering ways to reduce spending as part of deficit reduction. Some have recommended broad use of the competitive bidding process for a host of private operators that do business with Medicare, including private insurers.
Source: medcitynews.com

DMEPOS Round 2 Competitive Bidding and National Mail

CMS will now begin mailing contract offers to winning bidders.  14,654 contract offers will be made to 867 Round 2 bidders.  The winning suppliers have 3,109 locations to serve Medicare beneficiaries in the competitive bidding areas.  CMS will offer 15 contracts for the national mail-order program; the national mail-order program winners have 48 locations.  CMS expects to complete the contracting process in time to announce the contract suppliers in the spring of 2013.  Bidders that are not offered contracts will be notified of the reasons why they did not qualify for the program when the contracting process is complete. Suppliers that are not contract suppliers for this round of the DMEPOS Competitive Bidding Program may bid in future rounds.
Source: hallrender.com

CMS announces payment amounts for Round 2

The new prices only work for a one man shop. They are completely and utterly unsustainable for a small business company that has admin employees, delivery technicians, and marketing department. Many people will lose their jobs across the nation. The payments completly ignore company payroll, overhead, rent, accreditation fees, etc. They make work for internet but thet are a complete abomination for brick and mortar dme. I trully feel sad for all the employes that will lose their jobs as a result if this sick joke. And there will be tens of thousands of them.
Source: hmenews.com

CMS Slashes Medicare Reimbursement under Round 2 of the Medicare DMEPOS Competitive Bidding Program/National Mail Order Competition for Diabetic Testing Supplies : Health Industry Washington Watch

CMS also conducted a national mail-order competition for diabetic testing supplies concurrent with the Round 2 competition. CMS announced that Medicare payment for diabetic testing supplies (100 lancets and test strips) under competitive bidding will be reduced from $77.90 to a national rate of $22.47. While the competition for diabetic testing supplies was intended to apply only to mail-order suppliers, it is important to note that the American Taxpayer Relief Act of 2012 (ATRA), which was signed into law on January 2, 2013, sets Medicare payment amounts for retail diabetic supplies at the national mail order competitive bidding single-payment amounts, effective July 1, 2013.  In other words, as a result of the ATRA, the competitive bidding process is being used to reduce pricing for DMEPOS other than items that actually were subject to competitive bidding. This policy was adopted despite CMS’s previous acknowledgment that "there are pricing differences between mail order and non-mail order diabetic testing supplies because of the delivery methods for these supplies."  Even though under competitive bidding program rules, only successful bidders that sign a contract with CMS will be eligible to furnish mail order diabetes supplies to Medicare beneficiaries as of July 1, 2013, Medicare beneficiaries will not be limited to using contract suppliers to obtain retail/storefront diabetes supplies. In sum, a Medicare beneficiary must use a contract supplier to obtain mail order diabetic testing supplies, but can pick up diabetic testing supplies from any local retailer; the payment to the supplier and the beneficiary copayment will be the same in either setting. (The ATRA also temporarily reduces fee schedule amounts for retail diabetic testing supplies to mail order amounts from April 1, 2013 until the national mail-order program single payment amounts start on July 1, 2013.)
Source: healthindustrywashingtonwatch.com

Deforming Medicare into a Competitive Bidding System (part 1)

FEHBP requires that all plans cover the same medical services. In spite of this, some plans offer more dental and vision coverage than others. However, the primary “choice” is whether to pay now or pay later. Those who choose plans with lower premiums (taken out of biweekly or monthly pay-checks) face higher deductibles and co-payments when they actually need medical care. Often this results in higher overall cost to those who choose what looks like a less-expensive plan. Seeing physicians “out of network” costs more in a “basic”plan than in a “standard” or “high option” plan. We know from many studies that higher co-payments lead low- and even middle-income people to postpone needed medical care. Since FEHBP premiums are independent of the employee’s income, lower-wage workers are likely to choose a “basic” plan and thus face the barrier of higher costs when they have to seek care. And many, of course, will not be able to afford to pay for any plan.
Source: correntewire.com

CMS Announces New Medicare DME Pricing, Aims For Expansion

AAHomecare AARP AARP Public Policy Institute Alliance for Home Health Quality and Innovation Almost Family Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Avalere Health Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicare & Medicaid Services CMS Employee Benefit Research Institute Ensign Group featured First Care Home Health Care Gentiva Gentiva Health Services Gentiva Health Services Inc. HHS Home Health Depot Home Health International Houston Compassionate Care Humana Independa Inc. IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare MedPAC Microsoft NAHC National Association for Home Care & Hospice Nationwide New York Times Northwestern Medicine Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI VA Wall Street Journal
Source: homehealthcarenews.com

Competitive Bidding Saves Medicare Money

Today the Seattle Times reports that after a year-long experiment in 9 U.S. cities, government officials are saying competitive bidding for power wheelchairs, diabetic supplies and other medical equipment has resulted in $200 million in savings for Medicare. According to the article, written by Ricardo Alonso-Zaldivar:
Source: stateofreform.com

Medicare Spotlights Hospitals With Especially Costly Patients

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSThe Medicare data indicated big spending differences in areas of the country that have not generally been thought of as high users of Medicare services. In Kansas City, Mo., the average patient admitted to St. Joseph Medical Center cost Medicare $19,247 during a stay and in the month afterward, 7 percent above the national median. Fifteen miles away, according to the data, an essentially similar patient admitted to Truman Medical Center-Lakewood cost Medicare $15,290, or 15 percent below the national median. The owner of St. Joseph, Corondelet Health, which is part of the nation’s largest Catholic nonprofit system, Ascension Health, declined to comment. Truman said in a written statement: “It is important that there be a comprehensive analysis of this data and its variables before final reimbursement conclusions are reached.”
Source: kaiserhealthnews.org

Video: Neta Crawford Details “The Cost of War” Report: US Wars Will Top $4 Trillion

Report: Raising Medicare Age Would Increase Insurance Costs by $2K

Mr. Simonian, we can find the funding, heck, we could go the Canadian route and put everyone into Medicare if we so desired AND save money doing it. Ask yourself why it is the Canadians cover EVERYONE, have way better outcome numbers than the U.S. and only spend 10% of their GDP on health care? Meanwhile, in the U.S. we have 50 million uninsured, another 50 million with essentially bogus insurance, lousy health statistics (e.g.,CIA: life expectancy in U.S. now 51st place) and we spend 17% of our GDP on health care. At the same time that that part of our population below the median income level has not seen and increase in life expectancy for 30 years. There was a study out earlier this year that for every dollar saved by raising the Medicare age would cost the private sector double.
Source: californiahealthline.org

Report Faults High Fees for Out

A health insurance industry report to be released on Friday highlights the exorbitant fees charged by some doctors to out-of-network patients like Mr. Gonzalez. The report, by America’s Health Insurance Plans, or AHIP, contrasts some of the highest bills charged by non-network providers in 30 states with Medicare rates for the same services. Some of the charges, the insurers assert, are 30, 40 or nearly 100 times greater than Medicare rates.
Source: jallencoblog.com

Should Home Health Agencies Have CPAs Prepare Medicare Cost Reports?

If you were to remodel your house tomorrow, would you hire the plumber to do the electric work? Would you ask the painter to install your new roof? More importantly, would you ever ask your administrative assistant to make a home care visit? Similarly, the Certified Public Accountant (CPA) who prepared your tax return or business financial statements might not be the best person to do your Medicare Cost Report. I recommend considering the following several factors when deciding who will create your next cost report. 1. Specialization & Experience Cost report preparation requires a tremendous amount of industry-specific expertise on very detailed and important aspects of the Medicare payment system. CPAs may do one or two cost reports per year. A cost report preparation firm, however, will typically develop many more cost reports each year than a small CPA firm, and must stake its future business and reputation on the accurate execution of these reports. Firms such as BKD, Simione Consulting, The Health Group, Medicare Training & Consulting, and Boyd & Nicholas will prepare more cost reports in one year than most local CPA firms will prepare in the entire history of their firm. 2. Industry Knowledge Most cost report preparation firms will benefit (and so will you) by having more than one home health industry client. They also will benefit by belonging to national and state home health care associations. Ask your local CPA firm if they are a member of ANY home health care organization. 3. Education Few of the continuing education programs offered by the American Institute of Certified Public Accountants (AICPA) or the state CPA societies address the needs or concerns of the home health care industry, particularly the cost report. Has your CPA attended a national or state home health care industry conference? Have they attended a program on the Medicare Cost Report? Questions that you should ask whomever you want to do your cost report:
Source: kinnser.com

4 Sources of CMS Reporting Variability

1. Difference in fiscal years. Some hospitals file with the calendar year, while others file with the federal fiscal year, which may cause results to vary outside of variance in performance. 2. Lack of comprehensive audits. Hospitals have little incentive to be accurate because Medicare does not conduct comprehensive audits on these reports, according to Objective Health. 3. Differences in reporting units. Hospitals may also vary in their reporting structures, which can skew results. For example, instead of reporting itself as a sole entity, a hospital might include affiliated hospitals and subsidiaries. Comparing data for one hospital against a hospital and its subsidiaries would not be a meaningful comparison. While this is not a common issue with Medicare cost reports, leaders should be aware of this potential discrepancy, according to Objective Health. 4. Difference in cost allocation.  The CMS cost report requires hospitals to allocate general administrative costs across departments using square footage or charges, according to Objective Health. If hospitals use different methodologies to allocate costs, the results could vary greatly among similar hospitals. Hospitals should verify they are collecting and reporting data according to CMS specifications so their data are accurate. With the growing trend of transparency, accurate data will be more important because consumers and other organizations will have access to some of hospitals’ data.
Source: beckershospitalreview.com

Seven Ideas to Reduce Costs and Improve Outcomes in Medicare and Medicaid

Conversely, the performance of Medicaid long-term care providers can greatly impact inpatient admissions, emergency department visits, post-acute services paid for by Medicare.  Nursing homes, home health agencies, and home and community-based waiver program providers paid by Medicaid have little or financial incentive to take steps to, for example, prevent a hospitalization paid by Medicare.  Similar to how Accountable Care Organizations (ACOs) are compared for their impact on overall per capita spending of patients they serve and allowed to share in any savings, Medicaid LTSS providers should likewise be compared for their impact on Medicare per capita spending on acute and post-acute services.  And then, as long as they meet quality standards, receive a share of any savings resulting from lower than expected Medicare spending.
Source: piperreport.com

GAO audit highlights increases in entitlement costs

The GAO’s auditors “were unable to obtain sufficient evidence to support the amounts presented in the 2012, 2011, and 2010 Statements of Social Insurance and the 2012 and 2011 Statements of Changes in Social Insurance Amounts,” meaning that the Statement of Social Insurance was underestimating the cost of entitlement programs.
Source: freebeacon.com

Daily Politics News: Kaiser report details Medicare options

Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services. Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn’t a solution for saving this program, for keeping it’s promise to America’s seniors and disabled. That basic premise should be the starting point for reforms.
Source: blogspot.com

Huge opportunity for dual eligible cost savings, report says

Medicare and Medicaid spending on dual eligibles is estimated to reach $330 billion in 2013, according to the report. The long-term care sector will be significantly impacted by efforts to bring this number down in the future, as a majority of the $150 billion in Medicaid spent on dual eligibles is for long-term care services. 
Source: mcknights.com

Report: Medicare scheme involves stolen identities

Dozens of so-called medical providers in Ohio have registered with the Centers for Medicare and Medicaid Services by using nothing more than a mailbox as their address, even though investigators know it’s part of a common scheme used to steal from the government, the Dayton Daily News reported (http://bit.ly/Ve6NXz).
Source: goerie.com

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

Posted by:  :  Category: Medicare

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

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

What happened to Highmark Medicare Services?

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Teleconference On Billing Of Time Units For Physical And Occupational Therapy Services : Med Law Blog

Highmark Medicare Services will be hosting a teleconference on May 15, 2009 at 12:00 p.m. Eastern to discuss the billing of time units for physical and occupational therapy services. The teleconference may reference issues such as CMS Online Manual, Pub. 100-2, Chapter 15, Sections 220 and 230; Change Request CR6321; Frequently Asked Questions; Social Security Act, Section 1862(a)(1)(A) of the Social Security Act, Exclusions from Coverage; and PT/OT modalities is Local Coverage Determination (LCD) L27513, Physical Medicine and Rehabilitation Services, PT and OT. To participate in the teleconference, the dial-in number is 1-888-276-8689 and the Access Code is 487794. Highmark Medicare Services has indicated that the teleconference does have limited capacity.
Source: medlawblog.com

PRRB—2012 Year In Review

Lifespan SWC 2003 DSH Medicare+Choice Days Group v. National Government Services Blue Cross Blue Shield Association (Review of PRRB Decision No. 2012-D6), February 29, 2012.  The fiscal intermediary (FI) is ordered by the Administrator to revise the payment determination of the Provider Reimbursement Review Board (PRRB) to include the disputed Medicare+Choice (M+C) days in the Medicaid fractions. Although the Administrator believes that Medicare policy has always been to exclude M+C days from the Medicaid fraction numerator, the Administrator is bound by the decision in Northeast Hospital Corp. v. Sebelius that concluded that while the statute does not foreclose the Secretary’s interpretation that a Medicare beneficiary enrolled in Medicare Part C still qualifies as a person “entitled to benefits” under Medicare Part A, and that the days should be included in the numerator of the Medicare fraction, the Secretary could not apply this interpretation to patient discharges prior to October 1, 2004.
Source: wolterskluwerlb.com

Healthcare BPO News: Highmark Medicare Services to Begin Processing Claims in New Jersey

In fiscal year 2007, Highmark Medicare Services processed about 48.8 million claims and served approximately 2.3 million beneficiaries and 57,000 providers. As the MAC for J12, Highmark Medicare Services is expected to process approximately 131 million claims annually, accounting for more than 11 percent of the national Medicare fee-for-service workload. Highmark Medicare Services will be working on behalf of approximately 4.2 million beneficiaries and 137,000 physicians and practitioners.
Source: blogspot.com

Diversified Service Options to acquire Highmark Medicare Services

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Source: creditcardsindex.net

Highmark gets Medicare contract for seven more states

Under the five-year contract, the company will handle both Medicare Part A and Part B fee-for-service claims for hospitals, physicians and other healthcare practitioners in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas, according to a Highmark Medicare Services news release. It already serves as the Medicare administrative contractor for Delaware, Maryland, New Jersey, Pennsylvania and Washington, D.C. Highmark Medicare Services has offices in Camp Hill, Pittsburgh and Williamsport, Pa., and in Hunt Valley, Md., and is a wholly owned subsidiary of Highmark, which is a Pittsburgh-based licensee of the Blue Cross and Blue Shield Association. The company recently reached an agreement to acquire West Penn Allegheny Health System, a struggling five-hospital system based in Pittsburgh.
Source: modernhealthcare.com

Insurer Highmark selling Medicare services

Details of the deal were not disclosed in a joint news release from the two companies. The sale is expected to close in early January, and Highmark Medical Services will continue to operate as a separate organization.
Source: thedailyrecord.com

Ask A Medical Biller: Highmark Medicare Services Website

for clients who use RelayHealth as your clearinghouse the Submitter #’s are CPID 1522 District of Columbia (DC) Medicare new contractor number is 12201. CPID 5554 Maryland Medicare new contractor number is 12301 CPID 5598 Pennsylvania Medicare new contractor number is 12501 **RelayHealth will be making the change to send the new Contractor ID/Payor ID to DC, Maryland, and Pennsylvania. Providers do not need to make any changes to the Contractor ID/Payor ID Questions on
Source: blogspot.com

Highmark Medicare Services Achieves Certification to COPC

Related medicine news : 1. Highmark Blue Cross Blue Shield Introduces New Health Plan Comparison Tool for Consumers 2. Highmark Blue Shield Introduces New Health Plan Comparison Tool for Consumers 3. The Highmark Foundation Awards $580,000 in Highmark Healthy High 5 Grants to Four Non-Profit Organizations 4. Highmarks Hospital Pay-for-Performance Program Demonstrates Impressive Results 5. National Magazine Ranks Highmark 62nd Among Nations 500 Most Innovative Users of Information Technology 6. Highmark Medicare Services Awarded New Contract from Centers for Medicare & Medicaid Services 7. Highmark Blue Cross Blue Shield Products Ranked Among Americas Best Health Plans(R) 8. Highmark Blue Cross Blue Shield Program Rewards Members for Enhancing Their Healthstyle 9. Highmark Blue Shield Program Rewards Members for Enhancing their Healthstyle 10. The Highmark Foundation Announces $1 Million School Challenge Program 11. Unique Program Means Better Care for Highmark Members
Source: bio-medicine.org

Fast facts on Illinois health insurance exchange plans

Posted by:  :  Category: Medicare

Insurance Plan of the City of Portage La Prairie, Man. June 1959, 23 (1959) by Manitoba Historical MapsA. The federal government will operate an exchange website for online enrollment, a call center for telephone enrollment and customer support, and a so-called “Navigator” program offering in-person enrollment assistance. The state also will offer an In-Person Assistance program to supplement the federal Navigator program, focused on geographic and demographic populations not served by the federal program.
Source: chicagobusiness.com

Video: AARP Life Insurance 1.888.826.6021

Choose the Best Health Insurance Plan for You

Next, think about co-pays, the costs you share with the insurance company. You may be responsible for a set amount, say $15, for an office visit, and $100 for a trip to the emergency room. Insurance plans also often have co-insurance, where you’ll share an 80/20 or 90/10 or similar agreement with the insurance company. They’ll pay 80 percent of the bill, and you’ll be responsible for the balance, up to your out-of-pocket maximum, after which insurance should pick up 100 percent of the bill. The higher your out-of-pocket maximum is, the lower your premiums will be. You should weigh this aspect of each plan carefully.
Source: patch.com

5 Questions About Arkansas’ Health Insurance Exchange Plans

WHERE DOES ARKANSAS STAND? – Arkansas has been given conditional approval to set up a partnership on its health insurance exchange with the federal government. The state already has received about $27.5 million from the federal government in grants for planning and establishing the exchange. Some Republican legislators, however, have said they may push for a federally-run exchange during this year’s session. Arkansas is expected to meet an Oct. 1 deadline to begin open enrollment.
Source: arkansasbusiness.com

Health insurance – to save you and your tax

In recent times medical insurance is the most popular non-life insurance that individuals are showing more inclination than before  . And an appealing factor to the most of the salaried section was for so long ignored. Essentially, a health plan is an insurance to keep you financially sound in case of a any medical emergency. In case of any planned or an unplanned hospitalization need with a health insurance you can be rest assured that the expenses will be covered without you shelling out the entire amount. However, this is not the only reason why individuals seek this policy, there are other reasons too.
Source: royalsundaram.in

Obama Admin Widens Exemption for Contraception Coverage

The contraception policy previously exempted religious organizations that had “inculcation of religious values” as their main purpose and primarily employed and served people who shared their religious tenets. But other religious organizations that offer services (like meals, education, or health care) to and employ people not of their faith worried that they might not qualify for the exemption. With the new accommodation, those
Source: motherjones.com

HuntingtonFreePress :: CIGNA PHARMACY Insurance Plans

This year, 2013, a number of Pharmacy Insurance Plans have chosen to, once again, to allow the Warren Pharmacy to fill your prescriptions.  The Cigna insurance plan, and Cigna Medicare Prescription Plans, will work with us and allow us to process prescription claims! We are constantly striving to fulfil all of the regulatory requirements and contractual agreements with Pharmacy Benefit Managers and Insurance Companies so that you may receive quality pharmaceutical care from your local Pharmacist, Terry Daniels P.D., and our experienced staff. It pays to visit the Warren Pharmacy (260) 375-2135.
Source: huntingtonfreepress.com

Insurance plans must now cover cost of breast pumps for nursing moms

LocalHealthGuide is a health news and information web service for Seattle and the Puget Sound Region. We are independent and unaffiliated with any hospital, medical association or insurer. If you have questions or if your group has an upcoming event that you would like us to cover, please let us know by going to our “Contact Us” page and dropping us a note. — Michael McCarthy, Editor
Source: mylocalhealthguide.com

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

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 marsmet524Both 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

Video: What Is Medicare Advantage?

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

The low readmission rates indicate I-SNPs provide more integrated, coordinated care to enrolled beneficiaries than fee-for-service plans. Based in part on I-SNPs’ high marks for improving integrated care, MedPAC commissioners unanimously recommended that Congress permanently reauthorize them, according to the Bureau of National Affairs (BNA).
Source: mcknights.com

Bayonet Point Florida Medicare Advantage Plan Members eligible for Free Gym Membership

I am a mom of three teenage boys. Our family has struggled with multiple chronic health issues for many years. It was for this reason that I became interested in Xocai healthy chocolate. Our entire family eats healthy chocolate every day as a supplement and I am currently losing weight with the Xocai X-protein meal shake. I have struggled with Fibromyalgia for over 10 years. If you are struggling with your health, you owe it to yourself to check this out. This is the best way I have found to incorporate significant antioxidants into our diet. Feel free to email me if you have any questions. I look forward to hearing from you!
Source: healthchocoholic.com

Not Happy with Your Medicare Advantage Plan? Change it!

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

Obamacare Health Insurance Tax: Making Medicare Advantage More Expensive

The health care reform law imposes a massive new sales tax on health insurance which will increase the cost of coverage for individuals, small businesses, and public program beneficiaries with private insurance. The tax begins at $8 billion in 2014 and rises to $14.3 billion in 2018, increasing annually thereafter based on premium growth. The Joint Committee on Taxation projects that between 2013 and 2022 the new tax will total $101.7 billion.
Source: amac.us

HHS IG: Still Not Many Medicare Advantage Fraud Probes Despite 2007 Investigation

Modern Healthcare: Amid Concerns About Overpayments, HHS Notes Small Number Of Medicare Advantage Probes HHS’ inspector general’s office says the $124 billion Medicare Advantage program is the focus of very few investigations from fraud-hunters — a conclusion that comes on the heels of a string of audits alleging hundreds of millions of dollars of questionable payments in the program. HHS officials last year published the results of long-running investigations into four Medicare Advantage plans, concluding that the plans had received nearly $600 million more than they should have in 2007 by claiming that patients were more medically complex than they were. All four companies denied the allegations, but the inspector general’s office is continuing with probes of an untold number of the other 170 or so Medicare Advantage companies working for the CMS (Carlson, 1/10).
Source: kaiserhealthnews.org

What Medicare doesn’t cover

Well i’ve had back problems since 1985 or so. I get an injection of medication every two to three months for a pain in the lower back, that never really helps that much.I called on a t.v. add out of Tampa Fl. that a 1/2 hour laser surgery will cure me, and make me feel like a million bucks, and I will walk with the best of them with in 2 hours after surgery. Point being I have to come up with $13.500 out of pocket, them medicare kicks in, then my private insurance. I wonder what the presidents plan will do to help me on my down payment. ( anybody got a dime )
Source: bankrate.com

Study: Seniors Look For Star Ratings On Medicare Advantage Plans

The rating system uses survey data and other measurements of effectiveness to gauge the quality of the private Medicare Advantage plans, which are an alternative to traditional fee-for-service Medicare. Dr. William Shrank, a co-author of the study, said the relationship between the ratings and enrollment was a good sign for the star system put in place in 2011.
Source: kaiserhealthnews.org

What Is Medicare Advantage Insurance?

What is Medicare Advantage insurance? Now that you can answer that basic question, let’s explore Medicare Advantage further so you can see how well it can go above traditional Medicare. The types of additional benefits offered may include vision care, health and wellness programs, hearing and dental. The dental benefit cannot be underestimated as traditional Medicare only covers dental services when they are deemed essential to the maintenance of your health or critical to the success of a non-dental operation. However, things such as prescription drug coverage, routine dental checks, fillings, cleaning or basic preventative maintenance are not covered under traditional Medicare. Some Medicare Advantage plans do offer that benefit. In fact, some Medicare Advantage plans offer coverage which competes directly with the combined coverage of traditional Medicare plus a Medicare Supplemental Insurance policy.
Source: seniorcorps.org

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

Medicare Advantage Outperforms Medicare

We found that utilization rates in some major categories, including emergency departments and ambulatory surgery or procedures, generally were 20-30 percent lower in Medicare Advantage HMOs in all years. Medicare Advantage HMO enrollees initially had lower rates of ambulatory visits and hospitalizations, although these rates converged by 2008; they also received about 10 percent fewer hip or knee replacements. In contrast, HMO enrollees underwent more coronary bypass surgery than patients in traditional Medicare. These findings suggest that overall, Medicare Advantage HMO enrollees might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.
Source: ncpa.org

Texas Gov.’s Speech Disrupted By Protesters Demanding Medicaid Expansion

Posted by:  :  Category: Medicare

Texas and the Transformation of Medicaid presentation by Tom Suehs at The Texas Tribune Festival on Sept. 24, 2011. Tom Suehs, Executive Commissioner, Texas Health and Human Services Commission. Introduced by:... by thetexastribuneCT Mirror: Lawmakers’ Reluctance To Continue Spending Cuts Widens Hole In Next State Budget While legislators slashed spending last month to balance current finances, their reluctance to embrace those cuts long-term means the shortfall in the next state budget has grown yet again, according to a new report from nonpartisan analysts. The legislature’s Office of Fiscal Analysis projects that spending will outstrip revenues by $1.2 billion in the fiscal year that begins July 1, based on current trends, and the fiscal hole in 2014-15 now exceeds $1.3 billion. That’s up modestly from the shortfall projections of $1.14 billion for next year and $1 billion for 2014-15 that OFA released in mid-November. The $1.2 billion gap, which is 6 percent of the current operating budget, also is roughly one-third the size of the historic, $3.7 billion annual shortfall that Malloy inherited upon taking office two years ago (Phaneuf, 1/29).
Source: kaiserhealthnews.org

Video: TribLive: Williams and Pitts on Medicaid Funding

Report: Texans need expanded Medicaid

In contrast to arguments that the Medicaid expansion would cost Texas too much money, Hamilton finds state spending on the Medicaid expansion could be met “many times over” with existing funds that the state, local jurisdictions and hospitals already spend on unreimbursed charity care for low-income adults. An estimated $1.8 billion in new state revenue generated by the expansion could offset the state’s match for the Medicaid expansion from 2014 to 2017, Hamilton says, adding that an estimated 231,000 jobs, $2.5 billion in local revenue and $67.9 billion in total economic output could be generated by 2016.
Source: smmercury.com

$115 billion? Some Texas experts still find Obamacare ‘affordable’

What this flurry of studies is selling, particularly in states like Texas with recalcitrant political leaders, is that all this expanding isn’t just affordable but practically free. And by free these analysts mean paid for by the magic money machine in that far off land where all dreams come true: Washington, D.C.
Source: watchdog.org

Official News Blog of The Christian Chronicle

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Source: christianchronicle.org

New Report Details the Incredible Stupidity of Texas’ Rejection of Medicaid Expansion

“Criticism that expanding Medicaid would be expanding ‘socialism’ is incorrect,” Hamilton writes in the report’s executive summary. “In a socialist system, the government not only funds but also operates hospitals, hires health care providers and controls every aspect of health care. Medicaid does not do these things; patients and their health care providers make health care decisions. The state accepts federal funds for many other similarly funded programs.”
Source: dallasobserver.com

Interactive: Weighing Medicaid Expansion

Texas has the highest rate of uninsured in the nation, according to the U.S. Census Bureau, with nearly a quarter of the population — 5.8 million Texans — lacking health care coverage. This pie chart shows the current makeup of Texas’ health insurance market using data from the U.S. census’ current population survey. Click on the “insured” section of the pie to see the percentage of individuals with private coverage, government coverage or both in 2011. (Insurance coverage fluctuates, and there’s some overlap in individuals with private and public coverage throughout the year.) Or click on the “uninsured” section to see estimates extrapolated from the survey by the HHSC on the percentage of uninsured Texans who would be eligible — or ineligible — for subsidies, Medicaid or Medicaid under the expansion in 2014.
Source: kuhf.org

GovtFraudLawyer: Texas Legislature Takes Aim at Dental Medicaid Fraud

State Sen. Jane Nelson (R-Flower Mound) put it simply Wednesday, speaking to a group of reporters at a news conference in Austin:  “It is infuriating to hear of the kind of problems that are taking place… problems that are particularly serious in Medicaid dental, orthodontia and transportation for Medicaid patients,” she said.
Source: blogspot.com

IRS: Cheapest Obamacare plan will be $20,000 per family

Posted by:  :  Category: Medicare

Maryland Health Insurance Plan Federal Press Announcement by MDGovpics(CNSNews.com) – In a final regulation issued Wednesday, the Internal Revenue Service (IRS) assumed that under Obamacare the cheapest health insurance plan available in 2016 for a family will cost $20,000 for the year.
Source: dailycaller.com

Video: What a Single Payer Health Insurance Plan Looks Like

Choose the Best Health Insurance Plan for You

Next, think about co-pays, the costs you share with the insurance company. You may be responsible for a set amount, say $15, for an office visit, and $100 for a trip to the emergency room. Insurance plans also often have co-insurance, where you’ll share an 80/20 or 90/10 or similar agreement with the insurance company. They’ll pay 80 percent of the bill, and you’ll be responsible for the balance, up to your out-of-pocket maximum, after which insurance should pick up 100 percent of the bill. The higher your out-of-pocket maximum is, the lower your premiums will be. You should weigh this aspect of each plan carefully.
Source: patch.com

Fast facts on Illinois health insurance exchange plans

A. The federal government will operate an exchange website for online enrollment, a call center for telephone enrollment and customer support, and a so-called “Navigator” program offering in-person enrollment assistance. The state also will offer an In-Person Assistance program to supplement the federal Navigator program, focused on geographic and demographic populations not served by the federal program.
Source: chicagobusiness.com

White House Proposes Giving Religious Employers Chance To Opt

The White House also proposes opt-out accommodations for additional non-profit religious organizations that: -Opposes providing coverage for some or all of any contraceptive services required to be covered under the law on account of religious objections; -Is organized and operates as a nonprofit entity; -Holds itself out as a religious organization; and -Self-certifies that it meets these criteria and specifies the contraceptive services for which it objects to providing coverage.
Source: consumerist.com

Eligibility For Health Insurance Subsidies Narrower Than Many Consumer Groups Had Hoped

Modern Healthcare: No Penalty For Medicaid-Eligible Uninsured, Proposed Rule Says Two proposed rules from HHS and the IRS issued Wednesday describe how the government intends to apply the law’s individual insurance mandate effective in 2014. Tax filers will need to begin verifying in 2015 that all of their dependents have qualifying coverage or pay tax penalties for them. The regulations describe a number of exemptions from the mandate, which requires most Americans to obtain qualifying health insurance or face tax penalties. About 2% of the population is expected to face those tax penalties despite the exemptions, according to the Congressional Budget Office (Daly, 1/30).
Source: kaiserhealthnews.org

Is ObamaCare Causing Health Insurance Premiums to Rise?

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP LeaderJones might have rejected higher rates in California if given the chance, and it’s true that some states, Massachusetts in particular, have used their rate authority aggressively. But the power to reject rates has not always stopped double digit increases in other states. In fact, according to a 2011 Congressional Research Service report on health insurance rate review policies in the states, both Ohio and Florida have “prior approval” requirements in place in their individual, small, and large group markets. In contrast to California’s “file and use” rules, which allow regulators limited power to disapprove a filing if an insurer is found to not be in compliance with some other regulation, prior approval rules mean that “insurance companies must file proposed rate changes and the state has the authority to approve, disapprove or modify the request.” And yet according to the Times, both states have seen premium increases in excess of 20 percent.
Source: reason.com

Video: Health Insurance Premiums Sky Rocket Ahead Of Obamacare Law Kicking In

Alaska health insurance providers warn that premiums may skyrocket

Say you’re a couple in your early 50s with two teenage children. You earn less than four times the poverty rate, or $115,000 for a family of four. Your costs could fall 70 percent in part because you’ll be eligible for a new federal health-insurance subsidy, Davis said. But if that same couple makes too much and isn’t eligible for that subsidy, their current premium could double, costing them thousands of dollars extra a year.
Source: alaskadispatch.com

The future of YOUR health insurance premiums

Maggie Mahar is a financial journalist who has written extensively about the American health care system. Her book, Money-Driven Medicine: The Real Reason Health Care Costs So Much, was the inspiration for the documentary, Money Driven Medicine. She is a prolific blogger, and recently relaunched her HealthBeat Blog. Previous articles for the Health Insurance Resource Center include Will health insurance premiums skyrocket in 2014? and Obamacare’s health insurance premium subsidies. She also provides background on Congressional health care legislation for HealthReformVotes.org, a special project of the Health Insurance Resource Center.
Source: healthinsurance.org

How Obamacare Will Increase Your Health Insurance Premiums — VOICES for REASON

There are many more ways than those I mention in the video, some of which are only being discovered now. (Remember Nancy Pelosi, who said about Obamacare, “You have to pass it to find out what’s in it.”) For example, employers recently uncovered a “sleeper” fee in their insurance policies that the government has imposed to pay, in part, for some of the law’s provisions. This fee can amount to tens of millions of dollars for the largest employers, who will pass on the cost to employees (as they do for all health care benefits they provide) in the form of lower wages, benefits cut elsewhere, or fewer hires.
Source: aynrandcenter.org

Wellpoint Profits Jump 38%; Why Are Health Insurance Premiums Still Rising?

WASHINGTON, D.C. Jan. 25, 2013 – Health insurance giant Wellpoint today announced a 38% profit increase in the 4th quarter of 2012, as compared to last year, for a total $2.7 billion in net profits for 2012. The insurance company continues to pad its profits even as the growth of health care costs remains at record-low levels and the company is forcing double-digit premium increases on consumers and small businesses across the country, said Consumer Watchdog. “Health insurers are talking out of both sides of their mouths when they preach austerity to their customers in order to raise premiums, then turn around and announce another banner year to shareholders. As federal health reform requires health insurance companies to disclose more and more information online, it will be harder for insurers to say one thing to customers and the opposite to Wall Street. Still, consumers remain unprotected in many states where no one has the power to reject an excessive rate hike, even when company profits exceed projections,” said Carmen Balber, executive director of Consumer Watchdog. New rules from the Department of Health and Human Services have begun to open health insurance companies’ books, by requiring insurers to publicly file all proposed rate increases. However, because many states lack the power to require justification and approval of rate hikes, unreasonable rate increases continue to take effect, said Consumer Watchdog. Anthem Blue Cross, Wellpoint’s California subsidiary, recently imposed an unreasonable rate hike on more than 250,000 small business customers in that state according to an analysis by California’s insurance commissioner that found, among other things, that the “company-wide rates of return on equity have been and remain excessive.” California regulators do not have the power to reject excessive rates, so Anthem was able to impose the increase despite the commissioner’s finding it was unreasonable. In California, insurance reform law Proposition 103 regulates auto, home and business insurance rates, and requires insurers to open their books, publicly justify and get approval for rate increases before they take effect. That law was enacted by the voters in 1988 and has saved California drivers $62 billion on their auto insurance premiums. An initiative measure that has qualified for California’s 2014 general election ballot would require health insurance companies to public justify and get approval for rate increases before they take effect. www.consumerwatchdog.org
Source: yubanet.com

Health insurance: US paying more for less, report finds

Willowbrook…Thanks for the informed information. I am in total agreement with you. Our company has offered outstanding insurance benefits for 30 years. It has done what insurance is supposed to do and that is provide support when an illness happens. We have been fortunate that they have stayed ahead of the curve and did this because it helped attract the best employment base. We have also had pretty good preventative care and yes we paid for that and as we get older it becomes more important. 16 years ago our out of pocket was $500 for the birth of our daughter. Three years later our sons cost $100 out of pocket. Currently the company is still trying to provide good health care insurance for all of their employees. The system has changed a bit. New hires and low wage employees are offered the same insurance with the same premiums bit the deductible is considerably lower so that they can afford to have effective insurance. They can afford to cover their children, although some choose to take the SChip program. Now our premiums have increased, deductibles have increased, Medical costs have increased and yet we still get very good health care here in America. I say here in America because for a time we lived in England. Now the company offered us private insurance for which we paid vat at an extraordinary cost. So in order to save money we kept the kids on private insurance, it was certainly worth it and they received incrediable care. My darling dear one and I used the NHS doctors. What an incredible waste of time and seriously detrimental experience. Where our NHS doctor was incredibly interested in our American system they didn’t care so much for their own. It really didn’t take much medical skill to follow their system of protocols and offer meds instead of treatment. I spent our time there with two slipped disks that were diagnosed as depression. Because as the parliamentarians knew so much about health care they determined if a woman comes in complaining about pain it must be depression. So I was given anti-depressants to treat back pain. When the anti-depressants didn’t work then they offered pain meds and muscle relaxers to treat what was still considered depression. That actually helped and I felt less and did more damage over the time we lived there. When we came home I went to a pain doctor who immediately ordered an MRI and found that there was an actual physical component to my complaints. He ordered a treatment of traction and strengthening exercises and when the pain went away so did the irritable and depressed me. Now my darling dear one went in for a chronic laryngitis problem. Sometimes it was accompanied by soar throat and always with a discomfort swallowing. The protocol there was over the counter lozenges. Not once did the physician touch my husbands throat to feel the nodule. The nodule was discovered in a well care check-up once we returned home. He went to an ENT who did a needle biopsy and determined there was a need for surgery to remove half of his thyroid. The surgery seemed to go well even though the found two more nodules, one on the lobe they were taking and one on the other lobe. So that was supposed to be that. Unfortunately, the biopsy proved his nodules to be cancerous. So they opened him back up and took the other lobe. Loosing your thyroid is a very difficult. It alters a normal life in so many ways. After the surgery I did my bit to move heaven and earth to get my darling into MD Anderson. We have been very fortunate that the surgeon was exceptional and have gone through five years of Anderson follow up with 15 more to go to assure the cancer does not show up anywhere else. Currently, he is considered clean and clear but it is terribly taxing on him to keep his replacement med balanced. He gained an incredible amount of weight through the first four years, always with a need to tinker with dosage. About two year ago his weight and dosage were at odds again which created a situation where his replacement was an overdose. This included a trip to the ER in the ambulance where the staff determined they needed to stop his heart in order to get the proper rhythm back. There is a whole sureal aspect of consciousness that occurs when a medical team is trying to stop a heart. After the third attempt they were successful in getting his rhythm right again. When he started to loose weight he again was at risk of OD so we went to Anderson, at this point he was clean so we saw a PA. She was a horrible person and her efforts rewarded my darling dear one with another trip back to the ER. So will we ever trust a another PA, not likely and certainly not when it comes to our children’s health. So if those of you in the blogosphere wish for something tantamount to the NHS I am sure you can find a low rent type of policy to cover that. As for my darling and my children they deserve smart medicine and we are willing to pay for the ability to access professionals who are actually paid to know medicine above a protocol determined by legislators.
Source: nbcnews.com

Donkeylicious: Health Insurance is Expensive, but Obamacare Premiums Will be Manageable

The IRS  is already the administrator of the second-largest anti-poverty program in America. It’s about to become the second-largest health regulatory agency in the Federal Government, since they’ll be in charge of lots of rules governing who does and doesn’t count as a “full time employee” for insurance mandate purposes, computing insurance subsidies for middle class households, monitoring employer-sponsored insurance plans, and so forth. As they ramp up for 2014, they’ve started issuing hypotheticals estimating the price family insurance plans. One of these hypotheticals assumes that a family of four will end up spending $20,000 on their insurance policy. This is far more than most households can expect to spend. In reality, a family that sized earning less than 400% of the Federal Poverty Line, or $92,200 in 2012, will pay somewhere between $100 and $750 per month for health insurance. That’s a big bite — equal to a car or student loan payment in many cases — but it’s something that households can probably manage. Once again, I’ve reproduced the incredibly helpful table from the Vermont Health Care Reform Agency of Administration. The UC Berkeley Labor Center also has an Affordable Care Act calculator that might be useful.
Source: donkeylicious.com