Turning 65: Finding a Medigap Policy

Posted by:  :  Category: Medicare

The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps’the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill.’  I would have to pay 20 percent of those bills if I didn’t have supplemental coverage. The option I considered first was traditional Medicare supplement insurance, commonly known as Medigap policies, products I knew a lot about having reported on them for years at Consumer Reports. These policies have been around since the beginning of Medicare, but they have a blemished history because insurers used misleading and deceptive tactics to sell them. Congress ended those practices 20 years ago when it standardized the benefits for 10 different kinds of Medigap plans and designated them by using letters of the alphabet. That meant that all consumers had to compare were the premiums and how they were calculated. The idea then was to simplify shopping and end deceptive selling practices. Today shopping for a Medigap plan is anything but simple. Congress has taken away some of the standardized plans and added new ones with very skimpy coverage’a potential landmine for consumers on fixed incomes who choose them. The push to give consumers more information has actually made the job of picking a Medigap plan so much harder. The government’s website tells me that I can choose from among 96 Medigap different policies offered by sellers in New York City. Do I really need that many on top of some 43 choices for Medicare Advantage plans and 30 for prescription drug plans? Alphabet Soup Like any reasonable shopper, I checked out what the government’s handbook Medicare & You had to say about Medigap plans. Not much, it turned out. It said there were two new plans, M and N, and that plans E, H, I, and J are no longer available. It didn’t say what those plans covered. For an explanation of the coverage provided by any of the standardized plans’either old or new’I had to visit www. Medicare.gov or phone 1-800-Medicare, the New York insurance department, or contact the state health insurance counseling and assistance program. It almost seemed like the government does not want seniors to choose Medigap policies but rather steers them toward Medicare Advantage plans, for which there was far more information in the handbook. (I will discuss those in a later post.) I tackled the government website, which was confusing from the get-go. The first page of all the Medigap policies available in New York had columns listing the benefits with green checks and red x’s showing what was and was not covered.’  Okay, I got that, but what were the question marks that appeared next to the benefits?’  Take Policy A, for example, the page showed there was no coverage for the Part A hospital deductible’this year $1,132.’  But a blue question mark raised the question: was it covered or not? ‘ From that page, I was supposed to choose which combination of benefits and coverage I wanted and find out what policies were sold in my Zip code. Plan F was my choice, and the website advised that there were 14 policies for sale in my Zip code.’  Plan F is the most comprehensive and would cover me in case doctors don’t take Medicare’s payment as payment in full, sticking me with what’s called an ‘excess charge.”  In the past, most docs have accepted Medicare’s ‘ payment levels, but that may be less likely in the future as doctors get more persnickety about not taking Medicare patients.’  I wouldn’t take that risk.’  Others might, since Plan F is the most expensive.’  It’s a risk benefit calculation’higher monthly premiums versus the possibility of a large bill down the road uncovered by insurance. Since all insurers selling Plan F must offer the same benefits, I needed to know only two things’the monthly premium and how companies figure premium increases each year.’  Medicare’s website was not very helpful. ‘ It gave only a price range for Plan F policies’$197 to $422 and contact information for the 14 companies. I guess I was supposed to call them.’  When it came to how premiums would be calculated, I would give the website a grade of C.’ ‘  A section called ‘Additional Tools & Information,’ gave a clear explanation of the three ways to determine premium increases, but crucial information was missing. Pricing by Age? In general, community-rated policies are best because premiums don’t change just because you get older.’  Issue-age policies are cheaper for younger buyers, and their premiums don’t increase with age.’  However, they are not common.’  Attained age-rated policies become the most expensive in the long run because premiums do rise as you get older.’ ‘  In all cases, premiums will go up each year because health care will only get more expensive.’ ‘  That’s a good reason to avoid policies that might pile on extra costs just because your biological clock is ticking.’ ‘  Since income often shrinks in the later retirement years, this is ‘need-to-know’ stuff, but the government apparently believes that insurers don’t have to tell you.’ ‘  Only five Plan F sellers disclosed their pricing methods: they all used community rating.’  Were the others mum because their methods are unfavorable to consumers?’  I would not buy a policy from a company that failed to reveal its pricing method. Still, I needed actual premiums so I called the Health Insurance Information Counseling and Assistance Program.’ ‘  HIICAPs, as they are called, can be found all over the country.’  The one for New York City was lodged at the city’s Department for the Aging.’  I wanted to know more about how premiums would be calculated in the future, but the counselor I talked to didn’t know much.’  When I asked what community rating was, she replied, ‘Every state has a different rating depending on where you live.” ‘  As for attained-age rating, ‘I don’t know what that is,’ she admitted.’  The department offered a booklet that listed prices for only eleven companies selling Plan F.’ ‘  There was no plan with a premium of $197 as the website suggested.’ ‘ ‘  I did learn that all Medigap plans sold in New York were community rated, a protection unavailable in most other states. As the booklet directed, I visited the website of the New York State Department of Insurance for more current information.’  Eleven sellers offered premiums ranging from $251 to $409.’  State Farm, one of the sellers that sent a marketing brochure, had the highest premium; United Healthcare, the other marketer contacting me, had the lowest.’  I ruled out State Farm; it was too expensive.’  The UnitedHealthcare/AARP policy seemed ideal.’  I still had questions so I called the company’s toll-free number seeking answers. Can I always buy a Medigap policy even if my health changes?’  ‘A qualified yes,’ said a customer service rep.’  If I am outside of my open enrollment period’the six months that begins in the month I turn 65 and enroll in Part B’ and outside the 63-day period for previous coverage, then there is a pre-existing condition waiting period, he explained.’  Does an insurer have the right to refuse me coverage if I get sick in the future?’  If I stay on my previous employer’s retiree plan and the employer drops the coverage as many have been doing, then I might need a Medigap plan someday.’  Yes they can refuse, he said, but not in New York.’  If I moved to another state, I could be out of luck. Having picked a Medigap policy, it was time to choose a prescription drug plan to go with it.’  Congress won’t let insurers sell drug coverage as a benefit included in a Medigap plan.’  Picking the right prescription plan adds a whole new layer of difficulty to an already-complicated task. I’ll tackle that challenge in next week’s post.
Source: cfah.org

Video: Affordable Medigap Insurance– Finding the best Medigap plan to fit your budget

Insurance Commissioners Reject Calls To Limit Seniors’ Medigap Policies

Medigap 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

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

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

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

Printable Grocery Coupons: A Brief Overview About Medigap Plans F Helping Cover Charges That Are Deductible For Every Person

To begin with allow us 1st see what does medigap means? Medigap ideas really are a sort of the reward insurance or in much better phrases an further insurance coverage which you generally obtain from a private organization that will be getting care of your health treatment fees that are seriously not coated by the original medicare. These usually do not care for the long term treatment options but only consists of a general types like an eye or eyesight check-up, nursing,dental care and few significantly more.The medigap plans are also referred to as the medicare health supplement plans.The medicare supplement plan B supplies the fundamental rewards which involves the hospitalization and also the healthcare expenses.So,the Medicare Supplement Plan F F essentially delivers comprehensive protection which include the excess healthcare costs.Acquiring into facts of what medicare supplement plan F covers let us commence with medicare advantages which once again includes hospitalisation,medical bills and blood. Then comes the 2nd part which it addresses and that is certainly specialised nursing,deduction with the expenses in hospitalisation,then comes the deduction of outpatient expenditures for hospitalisation and healthcare expenditures and also the most effective aspect concerning this plan is the fact that it addresses the abroad journey medical costs too. Isn’t that outstanding? From all of the medigap ideas the medicare supplement plan F will be the optimum as it has an alternative for high deduction.These higher deductible procedures have lower rates as compared but in situation an individual turns into ill or unwell you might end up spending higher out of your pockets.This strategy could wind up costing especially high annually. To avail any medigap plans positive aspects an individual will need to initial be enrolled in strategy A along with the strategy B.To know additional about these insurance coverage medical plans you can easily often consult a medicare insurance coverage supplier.You can readily discuss your requirements with them who are able to recommend you which strategy can get coupled with your every day delightful plus a wholesome life. Medigap plans or the plan deal with 18% medical beneficiaries.The medicare supplement plan F can be availed according to the place you stay.So its time for you personally all to obtain to perform.Discover out the personal agencies which offer the medigap plans and procedures . Talk to your medical insurance coverage supplier and avail one of the best program you could for your self and your members of the family.
Source: blogspot.com

1. There Are 10 Standard Medigap Policies

You only need one policy. Each policy builds on the previous one. Plan D includes all the coverage options offered by A, B, and C, plus additional options under Plan D. Plan E, provides everything Plan D does, plus additional coverage, and so on. It is illegal for an insurance company to sell you more than one plan.
Source: 30stm.org

Consumer reps: Medigap is not the bad guy

In the current draft of the NAIC cover letter, drafters state that, “We strongly disagree with the assertion that Medigap is the driver of unnecessary medical care by Medicare beneficiaries. Medigap insurance pays benefits only after Medicare has determined that the services are medically necessary and has paid benefits. Medigap cannot alter Medicare’s determination and the assertion that first-dollar coverage causes overuse of Medicare services fails to recognize that Medigap coverage is secondary and that only Medicare determines the necessity and appropriateness of medical care utilization and services.”
Source: lifehealthpro.com

Attained Age vs. Issue Age vs. Community Rated Medigap Plans

2.  Issue-Age:  Medigap premiums are based on the age that you purchase the policy.  For example, Mr. Jones buys a medigap plan F at age 65 for $148/month.  At age 67 his monthly premium is still shceduled to be $148 as will it be for age 70 and so on.  If Mr. Jones buys a medigap plan F at age 70 his price may be $160/month but not sheduled to change in price.
Source: medicarehealthplans.com

An Overview to Medigap Plans

People who are eligible for these Medigap programs ought to have been enrolled first in a Medicare program prior to their decision to go on with the supplementary packages. Generally, these must be citizens who are over the age of 65 or they have certain serious illnesses or permanent kidney failure, where age plays no actual role. The only requirement other than that is for people to have been living in the United States of America for at least some years before qualifying for such health insurance plans.
Source: wordpress.com

Brad DeLong : Remember, the Dormouse Says Medicare Is the Best

Posted by:  :  Category: Medicare

"The single best augury is to fight for one's country." ~ Homer (800 BC - 700 BC), The Iliad. by eyewashdesign: A. GoldenDisenrolled from fee for service Medicare – and unable to keep the surgical follow-up appointment from a surgeon who takes Medicare assignment but does not participate in Medicare Managed Care – and moved to a Medicare Managed Care rehab funded facility, Alice was advised that this was her problem to unravel. Her new Medicare Managed Care insurance plan vacillated between advising her she was not an enrollee in their plan and advising that, even were she an enrollee, no follow up post-surgical appointment was necessary….
Source: typepad.com

Video: California Medicare Supplement Insurance Plans 1-800-243-8100

Medicare Silver Bullets: What’s The Best Way To Control Costs?

If I could make only one change, it would be a massive reform of Medicare’s payment policies. Right now, Medicare payment policies drive overuse, waste, inappropriate and sometimes harmful use of services. There should be a number of changes, such as paying in ways that encourage the use of team-based care, telephone, group and e-visits, more flexibility to allow nurses and other health professionals to operate at “the top of their licenses” with physician oversight and in the most quality and cost-effective ways. The more we can bundle payments to reward improved health (not just health care), and allow providers to self-organize to deliver the greatest benefits for patients and value or payers, the better off we will all be. The most successful providers tend to be integrated delivery systems. Although we will never have enough such systems around the whole country, we can develop and support as many of these as possible and also have payment models that foster virtual integrated delivery systems and reward the best performers, that is, the ones that provide the safest care in the most efficient manner.
Source: kaiserhealthnews.org

Medicare Open Enrollment: What’s your back

Nobody likes to think of back-up plans when it comes to our health, but health can be as unpredictable as the weather. It’s hard to know what you’ll feel like next week, much less what health care you’ll need next year. But that’s exactly what you need to think about when you’re shopping for health coverage during Medicare Open Enrollment – which ends on December 7.
Source: medicare.gov

Medicare open enrollment: What’s the best Medigap policy?

The difficulty for consumers is that the nature of Medigap makes it a lot harder to shop for than Medicare Advantage. Here’s why. Medicare Advantage plans are regulated and overseen on a national level. Medicare routinely collects all kinds of information on them about customer satisfaction and quality of care. In addition, the premium of a specific Medicare Advantage plan is the same for each customer. As a result, it’s possible (as I explained yesterday) to go to Medicare.gov and compare Medicare Advantage plans in detail, including quality ratings and price. It’s also why we can publish rankings of Medicare Advantage HMOs and PPOs through our partnership with the National Committee on Quality Assurance.
Source: consumerreports.org

CONNECTURE ACQUIRES DRX, A LEADING PROVIDER OF INFORMATION SYSTEMS FOR MEDICARE

Connecture is the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges. Its industry-proven solutions enable consumers, employers and brokers to more easily shop for, purchase and renew health insurance while minimizing back-office administrative expenses for health plans.  Connecture’s solutions are provided to health plans, state insurance exchanges, private exchanges and insurance brokers.  More than 25 million Americans shop for their health insurance through systems built by Connecture, and more than half of the nation’s 20 largest plans rely on them to sell, administer and manage their plans and products effectively.  For more information, visit www.connecture.com.
Source: drx.com

Kaiser named top rated Medicare plan in Hawaii

big island biif billy kenoi daniel akaka dlnr dui stats earthquake election 2012 fire fuel gov linda lingle halemaumau hawaii volcanoes national park hhsaa high surf advisory hilo hvo ironman kailua-kona ka‘u keaau kilauea Kohala kona lava mauna kea mauna loa missing neil abercrombie nws pahoa parker school police puna recalls traffic triathlon tsunami uh-hilo usgs volcano volcano watch waiakea waikoloa waimea
Source: hawaii247.com

Turning 65: Finding a Medigap Policy

The first step after reading my collection of Medicare Advantage, prescription drug, and Medigap sales brochures was to find a way to fill in core Medicare coverage gaps’the deductibles for hospital stays and doctor care and the coinsurance for physician visits, lab tests, and hospital outpatient treatment that could really leave me with an unwelcome bill.’  I would have to pay 20 percent of those bills if I didn’t have supplemental coverage. The option I considered first was traditional Medicare supplement insurance, commonly known as Medigap policies, products I knew a lot about having reported on them for years at Consumer Reports. These policies have been around since the beginning of Medicare, but they have a blemished history because insurers used misleading and deceptive tactics to sell them. Congress ended those practices 20 years ago when it standardized the benefits for 10 different kinds of Medigap plans and designated them by using letters of the alphabet. That meant that all consumers had to compare were the premiums and how they were calculated. The idea then was to simplify shopping and end deceptive selling practices. Today shopping for a Medigap plan is anything but simple. Congress has taken away some of the standardized plans and added new ones with very skimpy coverage’a potential landmine for consumers on fixed incomes who choose them. The push to give consumers more information has actually made the job of picking a Medigap plan so much harder. The government’s website tells me that I can choose from among 96 Medigap different policies offered by sellers in New York City. Do I really need that many on top of some 43 choices for Medicare Advantage plans and 30 for prescription drug plans? Alphabet Soup Like any reasonable shopper, I checked out what the government’s handbook Medicare & You had to say about Medigap plans. Not much, it turned out. It said there were two new plans, M and N, and that plans E, H, I, and J are no longer available. It didn’t say what those plans covered. For an explanation of the coverage provided by any of the standardized plans’either old or new’I had to visit www. Medicare.gov or phone 1-800-Medicare, the New York insurance department, or contact the state health insurance counseling and assistance program. It almost seemed like the government does not want seniors to choose Medigap policies but rather steers them toward Medicare Advantage plans, for which there was far more information in the handbook. (I will discuss those in a later post.) I tackled the government website, which was confusing from the get-go. The first page of all the Medigap policies available in New York had columns listing the benefits with green checks and red x’s showing what was and was not covered.’  Okay, I got that, but what were the question marks that appeared next to the benefits?’  Take Policy A, for example, the page showed there was no coverage for the Part A hospital deductible’this year $1,132.’  But a blue question mark raised the question: was it covered or not? ‘ From that page, I was supposed to choose which combination of benefits and coverage I wanted and find out what policies were sold in my Zip code. Plan F was my choice, and the website advised that there were 14 policies for sale in my Zip code.’  Plan F is the most comprehensive and would cover me in case doctors don’t take Medicare’s payment as payment in full, sticking me with what’s called an ‘excess charge.”  In the past, most docs have accepted Medicare’s ‘ payment levels, but that may be less likely in the future as doctors get more persnickety about not taking Medicare patients.’  I wouldn’t take that risk.’  Others might, since Plan F is the most expensive.’  It’s a risk benefit calculation’higher monthly premiums versus the possibility of a large bill down the road uncovered by insurance. Since all insurers selling Plan F must offer the same benefits, I needed to know only two things’the monthly premium and how companies figure premium increases each year.’  Medicare’s website was not very helpful. ‘ It gave only a price range for Plan F policies’$197 to $422 and contact information for the 14 companies. I guess I was supposed to call them.’  When it came to how premiums would be calculated, I would give the website a grade of C.’ ‘  A section called ‘Additional Tools & Information,’ gave a clear explanation of the three ways to determine premium increases, but crucial information was missing. Pricing by Age? In general, community-rated policies are best because premiums don’t change just because you get older.’  Issue-age policies are cheaper for younger buyers, and their premiums don’t increase with age.’  However, they are not common.’  Attained age-rated policies become the most expensive in the long run because premiums do rise as you get older.’ ‘  In all cases, premiums will go up each year because health care will only get more expensive.’ ‘  That’s a good reason to avoid policies that might pile on extra costs just because your biological clock is ticking.’ ‘  Since income often shrinks in the later retirement years, this is ‘need-to-know’ stuff, but the government apparently believes that insurers don’t have to tell you.’ ‘  Only five Plan F sellers disclosed their pricing methods: they all used community rating.’  Were the others mum because their methods are unfavorable to consumers?’  I would not buy a policy from a company that failed to reveal its pricing method. Still, I needed actual premiums so I called the Health Insurance Information Counseling and Assistance Program.’ ‘  HIICAPs, as they are called, can be found all over the country.’  The one for New York City was lodged at the city’s Department for the Aging.’  I wanted to know more about how premiums would be calculated in the future, but the counselor I talked to didn’t know much.’  When I asked what community rating was, she replied, ‘Every state has a different rating depending on where you live.” ‘  As for attained-age rating, ‘I don’t know what that is,’ she admitted.’  The department offered a booklet that listed prices for only eleven companies selling Plan F.’ ‘  There was no plan with a premium of $197 as the website suggested.’ ‘ ‘  I did learn that all Medigap plans sold in New York were community rated, a protection unavailable in most other states. As the booklet directed, I visited the website of the New York State Department of Insurance for more current information.’  Eleven sellers offered premiums ranging from $251 to $409.’  State Farm, one of the sellers that sent a marketing brochure, had the highest premium; United Healthcare, the other marketer contacting me, had the lowest.’  I ruled out State Farm; it was too expensive.’  The UnitedHealthcare/AARP policy seemed ideal.’  I still had questions so I called the company’s toll-free number seeking answers. Can I always buy a Medigap policy even if my health changes?’  ‘A qualified yes,’ said a customer service rep.’  If I am outside of my open enrollment period’the six months that begins in the month I turn 65 and enroll in Part B’ and outside the 63-day period for previous coverage, then there is a pre-existing condition waiting period, he explained.’  Does an insurer have the right to refuse me coverage if I get sick in the future?’  If I stay on my previous employer’s retiree plan and the employer drops the coverage as many have been doing, then I might need a Medigap plan someday.’  Yes they can refuse, he said, but not in New York.’  If I moved to another state, I could be out of luck. Having picked a Medigap policy, it was time to choose a prescription drug plan to go with it.’  Congress won’t let insurers sell drug coverage as a benefit included in a Medigap plan.’  Picking the right prescription plan adds a whole new layer of difficulty to an already-complicated task. I’ll tackle that challenge in next week’s post.
Source: cfah.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 Open Enrollment: The Tools Are There to Help Your Loved Ones Make Good Plan Choices

A recent study found that seniors (often with the help of their support systems like you and me) are learning from their experience with Part D over time and switching plans when they can save money, or when a different plan better fits their individual health needs. The study, which we have highlighted in our Rx Minute newsletter this month, shows that seniors are adapting to get the best drug coverage for their money. Research PhRMA sponsored found that even in 2006, Part D’s first year, seniors disproportionately chose plans with lower premiums and deductibles and broader choice of medicines. In sum, choice works, benefiting seniors.
Source: phrma.org

Medicare Paid Claims for Inmates, Undocumented Residents, Reports Find

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 marsmet524Although CMS already has a system to flag charges for inmates and undocumented residents, the reports recommended that federal officials establish a better system. The reports found that the current system does not flag payments until after they are paid and that CMS does not instruct its contractors to recoup such payments (Cheney,
Source: californiahealthline.org

Video: Senator Harkin Addresses False Claims That Health Reform Will Hurt Medicare Recipients

Inside Ringler Medicare Solutions

Medicare and Medicaid compliance when it comes to legal settlement claims can be complicated. This is an area especially critical to claimants, attorneys and insurers and expertise is needed. In this podcast, Ringler Radio host Larry Cohen joins Tom Blackwell, Vice President and Program Director of Ringler Medicare Solutions, Inc. (RMS), as they take a look at RMS’ long-term development plan, how RMS can help with the administration of workers’ compensation claims, liability claims and in claim settlement strategies and the impact of the Strengthening Medicare and Repaying Taxpayers Act (SMART) on the structured settlement industry.
Source: legaltalknetwork.com

Supreme Court Hears Arguments In Hospitals’ Medicare Claims Lawsuit

Politico: SCOTUS Asks Tough Questions On Hospitals’ Medicare Claims Lawsuit A majority of Supreme Court justices on Tuesday sounded skeptical of a suit brought by hospitals to reopen Medicare claims as much as 25 years old because of calculations that were found to have underpaid them. The justices heard oral arguments Tuesday in the case of Sebelius v. Auburn Regional Medical Center, a challenge brought by 18 hospitals that are seeking compensation from claims dating to 1987 (Norman, 12/5).
Source: kaiserhealthnews.org

HIT Exchange: Health 2.0 Announces Winners of the Medicare Claims Data Challenge

Health 2.0 announced today that teams from Zenithech LLC, Avanade Inc. and Big Yellow Star won the Medicare Claims Data Developer Challenge sponsored by IMPAQ International LLC and the National Opinion Research Center (NORC) at the University of Chicago. IMPAQ, a social research and consulting services company, and NORC, a not-for-profit, academic research organization, created the competition to spur development of interactive Internet-based tools to make Medicare claims data more accessible and usable for clinicians, health researchers, consumers, policy-makers, entrepreneurs and others.   Teams comprised of software developers, entrepreneurs, and technologists participated in the national event, which required contestants to create online tools allowing users to access at least one of the eight public use files (PUFs) covering eight types of 2008 Medicare claims data released last year: inpatient, durable medical equipment, hospice, carrier line, home health, Medicare Part D, outpatient and skilled nursing facility. Applications were judged on the potential to help address Medicare claims data challenges, usability, and the potential for integration with existing claims systems or other health technology platforms.   “The ingenuity, innovation and creativity the participants demonstrated were exceptional,” said Indu Subaiya, Co-Chair and CEO of Health 2.0, which collaborated with IMPAQ and NORC. “The tools they created will facilitate and foster exciting research that will drive new ideas and approaches to improve quality of care, lower costs and shape health policy. It was a tough competition, and we congratulate the winners.”   The first place winner was Zenithech, a Fairfax, Va.-based developer of web and mobile applications. The company won $7,500 and two passes to the Health 2.0 Spring Fling Matchpoint Boston conference for developing MEDZ, a dashboard that displays and lets users conduct in-depth analysis of all eight PUFs for comparative research and in-depth analysis.   Avanade, a business technology solutions and managed services provider, captured second place with a business intelligence reporting tool called DataGnosis that enables researchers to perform canned and ad-hoc reporting on all eight PUFs. Users also can tie those claims with U.S. Census data, positioning them to identify trends and patterns across each state. Avanade was awarded $2,000.   Big Yellow Star, a Philadelphia company focused on health informatics, public health and health literacy projects, was awarded third place. It received $500 for a dashboard that makes hospice and outpatient PUFs accessible to users.
Source: hitexchangemedia.com

Owatonna Medicare Claims Processor Job

Minnesota Medical Office Jobs: Whether you are a recent medical secretary or medical transcriptionist graduate or a skilled professional, Mayo Clinic is a place where you can achieve your goals and discover career and personal fulfillment. We invite you to explore a medical secretary or transcriptionist career with Mayo Clinic in Rochester, Minn. Here you will be a valued member of an outstanding healthcare team, and you will experience the exceptional environment of one of the world’s leading healthcare institutions.
Source: mayo-clinic-jobs.com

For highest EHR incentive bonuses, submit all 2012 claims by Feb. 28

U.S. Senate Leader Introduces AOA-Backed NHSC Optometric Inclusion Bill With backing from the AOA and the Arkansas Optometric Association, United States Senator Mark Pryor (D-Ark.) yesterday introduced into the U.S. Senate the National Health Service Corps Improvement Act – an … Continue reading →
Source: newsfromaoa.org

Medicare expands prepayment audits to include office visits

Medicare administrative contractors have instituted reviews of claims for the services by requiring physicians to submit supporting documentation before payment is issued. Prepayment audits are targeting primary care physicians and specialists whom the Medicare payers have singled out for aberrant billing and coding practices. The contractors seek to ensure that proper payment is issued for the services provided — and not to burden the physicians who are billing the program correctly, officials said.
Source: emrindustry.com

Two Patient Recruiters of Miami Home Health Company Plead Guilty in $20 Million Health Care Fraud Scheme

WASHINGTON—Two patient recruiters for a Miami home health care company have pleaded guilty for their participation in a $20 million home health Medicare fraud scheme. The guilty pleas were announced today by Assistant Attorney General Lanny A Breuer of the Justice Department’s Criminal Division; United States Attorney Wifredo A Ferrer of the Southern District of Florida; Michael B Steinbach, Acting Special Agent in Charge of the FBI’s Miami Field Office; and Special Agent in Charge Christopher Dennis of the HHS Office of Inspector General (HHS-OIG), Office of Investigations, Miami Office. Manuel Lozano, 65, and Vladimir Jimenez, 43, pleaded guilty today and January 22, 2013, respectively, to one count each of conspiracy to receive health care kickbacks. They entered their guilty pleas before United States District Judge Joan A Lenard in Miami federal court. According to the court documents, both Lozano and Jimenez were patient recruiters who worked for Serendipity Home Health, a Miami home health care agency that claimed to provide home health and therapy services to Medicare beneficiaries. The pair admitted that from approximately April 2007 through March 2009, Lozano and Jimenez would recruit patients, for which Serendipity could bill Medicare, in exchange for kickbacks and bribes they would solicit from Serendipity’s owners and operators. Medicare was billed for home health care and therapy services on behalf of these beneficiaries that were medically unnecessary and/or not provided. Lozano and Jimenez each face a maximum potential penalty on the conspiracy charge of five years in prison and a $250,000 fine, or twice the gain or loss from the offense. Sentencing is scheduled for April 15 and April 1, 2013, for the respective defendants. In a related case, on June 21, 2012, Serendipity owners and operators Ariel Rodriguez and Reynaldo Navarro were sentenced to 73 and 74 months in prison, respectively, following guilty pleas in March 2012 to one count each of conspiracy to commit health care fraud. According to court documents, from approximately January 2006 through March 2009, Serendipity submitted approximately $20 million in claims for home health services that were not medically necessary and/or not provided. Medicare actually paid approximately $14 million for these fraudulent claims. This case is being prosecuted by Senior Trial Attorney Joseph S Beemsterboer of the Criminal Division’s Fraud Section. The case was investigated by the FBI and HHS-OIG and was brought as part of the Medicare Fraud Strike Force, supervised by the Criminal Division’s Fraud Section and the United States Attorney’s Office for the Southern District of Florida. Since their inception in March 2007, strike force operations in nine locations have charged more than 1,480 defendants who collectively have falsely billed the Medicare program for more than $4.8 billion. In addition, the HHS Centers for Medicare and Medicaid Services, working in conjunction with the HHS-OIG, are taking steps to increase accountability and decrease the presence of fraudulent providers. Reported by: FBI
Source: 7thspace.com

Weasel Zippers | Archives

The issue, according to the reports, is timing. When Medicare is alerted that someone is incarcerated or undocumented, its contractors help prevent payments from going out the door. But often, Medicare’s databases aren’t up to date, and improper payments go out.
Source: weaselzippers.us

Making Good Medicare Supplemental Insurance Comparisons

Posted by:  :  Category: Medicare

A good place to start is to visit the local Social Security office. While the Medicare program is separate from Social Security, the local office is able to provide a lot of help and answer a lot of questions. Most importantly, they can provide any senior with the correct contact information to help determine how their own medical condition is covered by basic Medicare insurance coverage. The people they contact will help a senior determine which supplemental programs are best for them. The gaps in basic Medicare benefits that apply specifically to them will become more evident.
Source: seniorcorps.org

Video: Medicare Supplemental Insurance Comparison

Medicare Supplemental Insurance Comparison Website Announces Brand

We are really delighted with this software program upgrade, said Mr. Montgomery in a modern job interview. It allows our visitors to swiftly jump onto our site, enter their zip code, and within seconds be offered a extensive list of all the most respected Medicare supplemental insurance coverage businesses in their location. Just before, they had to provide invasive information such as their house address or credit card quantity. But today, with the generation of new engineering, all that is not essential. All a shopper requirements to do is enter their zip code. This has produced our website incredibly well-known because its initial launch.
Source: hugohosting.com

Study: Medicare Part D “donut hole” does not linked to increase in heart attacks

Posted by:  :  Category: Medicare

20100406boswell_003 by Iowa Democratic Party - iowademocrats.orgAfter a small deductible, Part D drug plans typically cover 75 percent of drug costs up to a certain dollar figure, which was $2,400 in 2007. After a beneficiary reaches that level, there is no coverage until the person has spent potentially thousands of dollars out of pocket, then coverage kicks back in.
Source: medcitynews.com

Video: Medicare Part D – The Donut Hole

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

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

Managed Markets Monday: Who Ate My Donut Hole? The Ins and Outs of Medicare Part D

Fortunately, most common medications, especially generics, are relatively inexpensive. But what if Maude doesn’t have $5560 a year for the medications she needs? Medicare does offer low-income subsidies for patients who qualify. In addition, some Medicare patients are eligible for charitable programs offered by foundations such as the National Patient Advocate Foundation and the National Organization for Rare Disorders. Additional information is available at http://www.medicare.gov/, and at the websites of individual charitable foundations.
Source: palio.com

What Is The Medicare “Doughnut Hole”?

During each month you have a prescription filled your drug plan sends you and Explanation of Benefits notice, which you’ll often see or hear shortened to EOB. This monthly EOB form tells you how much you’ve spent during the month on covered drugs and if you’ve reached your coverage gap, signalling you’re now responsible for the entire cost of drugs for the remainder of the year. It’s human nature, no matter how well informed we were when we read the plans fine print, it’s always a shock when prescription payments abruptly end. Out of pocket costs, especially on a fixed income, are always a bitter pill to swallow.
Source: medigapandyou.com

Medicare Part D Drug Plan Explained

[…] It depends on when you need your Medicare prescription plan coverage to begin.  Initially, you have a seven (7) month window of time to join a Medicare Part D or Medicare Advantage plan.  So if you enroll in a Medicare Part D plan within the three (3) months before the month that you become eligible for Medicare (for example, the 3 months before you turn 65), your Medicare plan coverage will start on the first day of your birthday month (or Medicare eligibility month).  If you join a Medicare plan during your birthday (or eligibility) month, your prescription drug coverage will start on the first day of the next month.  Finally, if you join a Medicare plan during the three (3) months after your birthday (or eligibility) month, your drug coverage will start the first day of the month following the month when you enroll.Source: croweandassociates.com […]
Source: croweandassociates.com

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

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

In the Medicare Part D Doughnut Hole? Consider my Polypill, Named the
Red Heart, Kidney

Other points to consider with regards to a polypill: for patients on a fixed income, multiple 4 dollar a month medicine adds up if a person is taking a lot of pills. 16 dollars a month compared with 4 dollars a month is 144 dollars per year savings. If necessary, a patient could “supplement” the polypill with individual doses of needed medication to achieve goal. For example, for only 4 dollars, patients could obtain number 30, 40 mg tablets of atorvastatin, and “max out” their statin dosage. This thinking assumes that Lipitor would be 4 dollars a month, as was done with most of the other statins. It also assumes the patient is taking two red heart, kidney-shaped polypills because our theoretical pill has 20 mg of Lipitor in it. Lipitor comes in 10 mg, 20 mg, 40 mg, and 80 mg strength.
Source: michaelaaronsonmd.com

What’s New in Medicare for 2013

If your primary-care doctor or other primary-care practitioner determines you’re misusing alcohol, you can get up to four face-to-face counseling sessions per year (if you’re competent and alert during counseling). A qualified primary-care doctor or other primary-care practitioner must provide the counseling in a primary-care setting such as a doctor’s office.
Source: valleysentinel.com

Private Medical Health Insurance For Expats In Spain

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 marsmet524We looked at the top recommended health care insurers recently, the one that stood out above the rest was ASSSA Seguros. We liked the simplicity of their plans, the fact that you do not need to pay for treatment and claim it back and the importance of having a choice of private doctors, clinics, specialists and hospital available for us to choose from in our local area. Never forgetting, that the language barrier disappears with private medical insurance, ensuring that you can talk to your doctor in confidence, in your preferred language.
Source: lanzaroteinformation.com

Video: Comparing Health Insurance – PrivateHealth.gov.au

Health Insurance Information That Will Help You Out!

During each enrollment period, check for changes in your prescription coverage, co-payments and annual deductibles. Due to changing costs in drugs, health insurance companies tend to make changes in the prescriptions that they will cover for their customers from year to year. You may need to request an updated list from your insurance company. You will want to consider switching providers if your current one yanks your medications off the approved list.
Source: call411injury.com

Health Insurance and Youa

The first one is that you do not have to fear about cash when you definitely need it. The most severe situation – hospitalisation – will mean that you need to pay up a group sum. And publish loves you usually include some quantity of expenses as well. Hospital expenses will hit the roof before you know it. By spending a per month top quality for your health insurance plan, you make sure that you do not have to go into financial debt by spending a huge group sum for your healthcare needs. In fact, a per month top quality can be a lot simpler to deal with. You can select to have a cashless insurance strategy which indicates that the company will pay for the expenses. Or you can select to be refunded later on. In this situation, you would have to pay the expenses originally. It is up to you and your satisfaction to pick which way of insurance plan you want. Insurance gives you a feeling of serenity and protection – both you and your family can be protected under a strategy, after.
Source: home-insurances.info

Zane Benefits Publishes New Information on Types of Health Insurance Plans

Zane Benefits was founded in 2006 to provide a revolutionized SaaS (Software-as-a-Service) administration platform ("ZaneHRA") for Health Reimbursement Arrangement (HRAs) and defined contribution healthcare. The flagship software provides a 100% paperless administration experience to employers and insurance professionals that want to offer better health benefits without a traditional group health insurance plan at lower costs. For more information about ZaneHRA, visit http://www.zanebenefits.com.
Source: virtual-strategy.com

Helmet Safety and Super Bowl Sunday

Last May, former NFL linebacker Junior Seau, who played for the San Diego Chargers and New England Patriots committed suicide at the age of 43. Seau’s family recently filed a wrongful death law suit against the NFL, claiming Seau’s suicide was the result of head trauma suffered while playing football. Prior to Junior committing suicide, Dave Duerson, former defensive back for the Chicago Bears committed suicide at age 50.  Duerson left behind a note asking for his brain to be studied for the disease afflicting football players who suffer repeat brain trauma.
Source: ehealthinsurance.com

Important News about AVMA Medical Insurance

We understand the significance of this change and the confusion it may create. Be assured that the GHLIT remains dedicated to your protection and is working with its business partners to establish options to assist you with your transition to other medical insurance coverage in 2014. We will have more information in the coming weeks and will continue to communicate with GHLIT members who are affected on a regular basis. 
Source: avma.org

What if health information escapes?

“Because direct business associates are liable for HIPAA breaches by their subcontractors, business associates need to identify all agents and subcontractors with access to PHI and ensure there is a written agreement in place with appropriate indemnification language that protects the direct business associate in the event the subcontractor commits a HIPAA violation,” Holloway said.
Source: lifehealthpro.com

Older Americans Have Been Highly Resistant to Medicare Changes

Posted by:  :  Category: Medicare

Rogue Magazine (October 1964)  Volume 9 Number 5 - Water Balloons ...item 1.. routinely use devious devices -- wears us down like rabid trial lawyers until we give in (August 15, 2011 / 15 Av 5771) ... by marsmet542The income gap among Republicans and Republican leaners is about as large as the difference between GOP supporters of the Tea Party and non-supporters. Among Republicans and Republican leaners who agree with the Tea Party, 57% view deficit reduction as more important than preserving Social Security and Medicare benefits as they are. Among Republicans and leaners who do not agree with the Tea Party, just 36% say that reducing the deficit is more important than maintaining benefits.
Source: people-press.org

Video: Improving Medicare in 2011

Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

REDUCE PAYMENTS TO PROVIDERS: Hospitals, physicians and other health care providers – many who are now facing payment cuts either in the 2010 health care law or from the upcoming “sequestration” reductions (or both) – may take another hit in a deficit deal. Among the options sometimes mentioned are limiting the amount of “bad debt” that hospitals and other providers can write off their taxes,  reducing federal funding for medical education and requiring more prior authorization for some medical services, such as imaging, to help reduce unnecessary care. Lawmakers looking for political cover from angry providers could cite the many deficit-reduction proposals that have advanced provider cuts: Obama’s 2011 deficit reduction proposal, the Simpson-Bowles plan and the Medicare Payment Advisory Commission, or MedPAC, which advises Congress on Medicare payment policy.
Source: kaiserhealthnews.org

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

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

Doctor Groups Seem Less Wary of Medicare Changes

Although the association didn’t specify in its letter what changes they like or provide further comment, other doctor groups like the AMA said the physician community is happy they will be able to participate without losing money in the first three years and the federal government will allow certain doctor groups access to $170 million in initial Medicare savings to help them form ACOs. In addition, doctors said they were encouraged that the number of quality measures that need to be met was cut in half, but there will still be more than 30 or so benchmarks.
Source: nytimes.com

Voters Dislike GOP Plan to Change Medicare, Medicaid

Quinnipiac told half of the 1,408 registered voters the university polled that Medicare, Medicaid, Social Security and defense spending consume 60% of the budget. The other half weren’t. Among those who were told, 70% opposed efforts to change Medicare, compared with the 75% who weren’t told. For Medicaid, 57% of the first group opposed limits, compared with the 59% of the control group that also opposed changes. The only significant change came on the question of defense spending, with support for cuts increasing by 7% when voters were told how much the government spends on the military.
Source: wsj.com

How to Rein in Medicare Spending Without Hurting Seniors

The administration pays attention to CAP. Recently Bloomberg News described CAP as “the intellectual wellspring for Democratic policy proposals, including many that are shaping the agenda of the Obama administration.” This suggests that the report’s proposals may offer a preview of “adjustments to Medicare spending” that the president would consider.
Source: healthbeatblog.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

Resources for 2011 Medicare Changes

Many individuals on Medicare’s Part D drug plan fall into the “doughnut hole,” meaning they experience a gap in coverage whereby they must pay for all prescription drugs out of pocket. The doughnut hole kicks in after the individual has met his or her $310 deductible and after he or she and Medicare have together spent $2,830 on drugs. The gap lasts until the individual has spent another $3,610 out of pocket.  Beginning in 2011, the coverage gap will be reduced in stages until it is entirely eliminated in 2020. New for 2011, beneficiaries who fall into the coverage gap will be eligible to purchase brand name prescription drugs at a discount of 50 percent and generics at a discount of seven percent.
Source: gale.com

Medicare Home Health Changes for 2011 & Beyond

The 36-month rule was actually put in place under the 2010 payment rule, but the 2011 payment rule provides further guidance on the application of the rule after a year of confusion. The 36-month rule prohibits the conveyance of the home health provider agreement to a buyer if the selling agency started within 36 months or a prior change of ownership took place in the last 36 months. Under these circumstances, the buyer must enroll in Medicare as a new, or initial, agency. The 2011 payment rule confirms it does apply to both asset and stock transactions. However, it will only be applied to changes in “majority” ownership, and several exceptions to the rule are provided, including death of an owner, indirect ownership changes and changes in entity structure. Take Action Now
Source: healthcarereforminsights.com

Medicare Advantage Works As Long As You’re Healthy, But Boots Off Neediest Patients

8 to 11 year old category 12-15 year old category barack obama barbara revels bunnell city commission don fleming economic development elections 2012 Flagler Beach flagler beach city commission Flagler County Commission flagler county crime flagler county school board flagler county schools flagler county sheriff’s office Flagler Palm Coast High School florida education Florida Legislature gop gov. rick scott health care health care reform ideology janet valentine jim landon jobs jon netts l’infame little miss junior flagler county pageant local government budgets milissa holland Miss Flagler County Pageant miss flagler county scholarship pageant obama administration Palm Coast palm coast city council palm coast crime police state republicans rick scott small government taxes traffic accidents unemployment us economy
Source: flaglerlive.com

The Physician Compare website

Posted by:  :  Category: Medicare

CMS is planning to include updated administrative information on an EP’s page as well as information regarding physician performance. CMS plans to enhance the administrative data by adding information on whether a physician or other health care professional is accepting new Medicare patients, board certification information, improved foreign language, and hospital affiliation data. CMS also intends to include the names of EPs who are successfully participating in the PQRS, the PQRS Maintenance of Certification bonus program, and the eRx Incentive Program. When feasible, CMS will post the names of EPs who are successfully participating in the Electronic Health Record (EHR) Incentive Program. As noted in the 2013 MPFS final rule, CMS will display an indicator on the profile Web page of an EP to acknowledge satisfactory participation in the incentive programs.
Source: facs.org

Video: Audio Educator: Medicare Enrollment PECOS And the CMS 855

Important “PECOS” Update…

In 2010, Congress required the use of national provider identifiers for ordering and referring physicians on claims for medical equipment or services from laboratories, imaging providers and suppliers. CMS later issued an interim regulation requiring all physicians who order supplies or refer services, including those from specialists, to be enrolled in PECOS by July 2010, but CMS delayed enforcement of that rule as the agency worked to validate and update enrollment records. Enforcement would have meant that claims for items or services would be rejected unless the ordering or referring physician also was in the enrollment system, not just the physician who provided the care.
Source: vgm.com

Don’t let PECOS put your practice in a pickle : Getting Paid

If you are not sure whether you have an active enrollment record in PECOS, you can contact your local Medicare contractor or check for your name and NPI on CMS’ Ordering/Referring Report. Note that the Ordering/Referring Report will be continuously updated by CMS as many enrollment applications are still in process. If you know that you have recently received approval of your enrollment application from your Medicare contractor but your name is not on Ordering/Referring Report, you should feel comfortable ignoring any PECOS-enrollment-related supplier notices that you might continue to receive. However, if your application has not yet been approved, be sure your staff frequently check the status, as any missing information or documentation can result in your application being returned or eventually rejected.
Source: aafp.org

Save Time – Submit Your Medicare Enrollment Application through Internet

Any Organizational Provider applications that are submitted via internet-based PECOS will require the user completing the application to provide an email address for the authorized official/delegated official (AO/DO) of the application as part of the submission process. The AO/DO can then follow the instructions in the email and electronically sign the application. This applies to Institutional Providers; Clinics, Group Practices, and Certain Other Suppliers; and Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Suppliers.
Source: wordpress.com

Arkansas Medicare health plan benefits

Posted by:  :  Category: Medicare

Education Health Insurance by StockMonkeys.comMedicare health plan provides coverage for medical needs of people who do not have enough coverage or require additional coverage for specific medical needs. It is a plan offered by the private insurance companies that contracts with Medicare to provide the coverage to eligible individuals. The insurer has significant savings on medical expenses when opting for the Medicare health plan. This plan provides all the benefits that are available with the Medicare Plan provided by the Federal State in Part A and Part B of the plan.
Source: medicarearkansas.com

Video: Can the Government Require Health Coverage?

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

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

ICYMI: Health Affairs Article: Medicare Advantage Provides Higher

A recent article in the latest edition of Health Affairs provides further evidence that Medicare Advantage plans are delivering higher-quality care to seniors and people with disabilities than the fee-for-service (FFS) part of Medicare.  Data from the article show that Medicare Advantage beneficiaries utilize some health care services, such as the emergency department and ambulatory surgery or procedures, at a rate 20-30 percent lower than those in FFS Medicare.  This data suggests that Medicare Advantage enrollees “might use fewer services and be experiencing more appropriate use of services than enrollees in traditional Medicare.”
Source: ahipcoverage.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Source: medicare.gov

Veterans Over 65 Get Medicare and VA Benefits

A Veteran can enroll in a Part D plan specifically to cover medications prescribed by health care providers outside the VA system, or drugs not paid for by the VA. In 2013, there are several Part D plans with a low- or zero-dollar copay for generic medications. Veterans could save money by enrolling in this type of a Medicare drug plan. For someone taking ten generic maintenance medications each month, the total copays at the VA pharmacy would be in the $80-$90 range. The average Part D drug premium is $37; by using a plan’s preferred network pharmacy, it is possible to obtain those same generic medications at a local pharmacy for $0 co-pay, making the monthly insurance premium your only expense.
Source: medicarewire.com

Office of Statewide Benefits provides information on Medicare Parts A, B enrollment

Failure to enroll and maintain enrollment in Medicare Parts A and B upon eligibility may result in the subscriber being held financially responsible for the cost of all claims incurred, including prescription costs. Retirees and spouses enrolled in Medicare Parts A and B must provide a copy of their Medicare Identification Card to be enrolled in the state of Delaware Special Medicfill plan.
Source: udel.edu

Kaiser: Medicare Reform Ideas

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Vermont Court Settlement Means More Home Care Covered Under Medicare

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

Signing Up for Medicare Benefits, Act Now!

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

Difference between Medicare and Medicaid

Eligibility for Medicaid:  May differ by state.  People with disabilities are eligible in every state.  Too much space would be needed here to get into all of the details of eligibility so I reccommend you use the Medicaid eligibility tool.  Here is the link:  http://finder.healthcare.gov/
Source: medicarehealthplans.com

Medicare Advantage Works As Long As You’re Healthy, But Boots Off Neediest Patients

8 to 11 year old category 12-15 year old category barack obama barbara revels bunnell city commission don fleming economic development elections 2012 Flagler Beach flagler beach city commission Flagler County Commission flagler county crime flagler county school board flagler county schools flagler county sheriff’s office Flagler Palm Coast High School florida education Florida Legislature gop gov. rick scott health care health care reform ideology janet valentine jim landon jobs jon netts l’infame little miss junior flagler county pageant local government budgets milissa holland Miss Flagler County Pageant miss flagler county scholarship pageant obama administration Palm Coast palm coast city council palm coast crime police state republicans rick scott small government taxes traffic accidents unemployment us economy
Source: flaglerlive.com

Daily Kos: Kaiser report details Medicare options

Posted by:  :  Category: Medicare

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: dailykos.com

Video: Progress Illinois: No cuts to Medicaid, Medicare and Social Security press conference

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

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

This Valentine’s Day give your heart some love

You might not be able to avoid Cupid’s arrow, but you can take steps to lower your risks and prevent heart disease.  Start by scheduling an appointment with your doctor to discuss whether you’re at risk for heart disease. 
Source: medicare.gov

Retiring Medicare Actuary Reflects On The Politics Of Spending And Why He Almost Quit

I’m also proud of the role that the Office of the Actuary has played for decades in terms of providing unbiased technical information to the country’s policymakers. Medicare is enormously complicated. People have no idea. Imagine Congress trying to develop really good policy improvements for something that complicated. They need the best technical input they can get. It should not be withheld because it is inconvenient.  It should not be withheld because it might show one policy would work better than somebody else’s preferred policy. They ought to have it all. The fact that the Office of the Actuary has been able to do that despite challenges, that to me is very, very important. 
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

Physicians and Experts Discuss Medicare Reform

A senior official from Blue Cross Blue Shield of Massachusetts Tuesday said trying to find significant health care savings by cutting benefits is a “fool’s errand.” Dana Safran said the effort in her state has shown that greater savings can be achieved through the supply side of health services. She spoke at an event on Medicare costs and outcomes hosted by the National Journal in Washington. The discussion looked at ways to end Medicare’s current structure, which pays based on the quantity of services provided rather than the health of the patient.
Source: c-span.org

Ryan's Medicare Plan: How Big a Factor in Florida?

As Obama for America’s Florida press secretary, Eric Jotkoff, put it: “If the headlines don’t tell the story, then certainly Floridians can say that Mitt Romney and Paul Ryan are simply out of touch and have no idea what’s important to the people of Florida. Whether it’s a budget that could end Medicare as we know it forcing Florida seniors to pay $6,350 a year out of their pockets or a tax hike which would burden hard-working middle-class families, Romney and Ryan’s campaign is toxic in the Sunshine State, and they will have a hard time convincing voters to choose them in November.”
Source: realclearpolitics.com

10 Recent Medicare, Medicaid Issues

Here are 10 issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. 1. A top economic adviser within the White House said President Barack Obama will not make any federal Medicaid cuts in his upcoming budget proposal, but that means Medicare may be more vulnerable to upcoming reductions. 2. CMS announced that more than 500 healthcare organizations will start participating in its Bundled Payments for Care Improvement initiative. 3. CMS also announced it will pilot its competitive bidding program for durable medical equipment in 91 additional major metropolitan areas after its initial one-year pilot in nine cities saved the program approximately $202.1 million with no negative health impacts on hospitalizations and other metrics. 4. With just one year remaining before the largest parts of the federal health reform law take effect, 2013 will be a busy year for hospitals as they prepare for the biggest changes in healthcare since Medicare was introduced in 1965. 5. Aggregated membership from the seven largest health insurers grew 2.6 percent year-over-year, but Medicare and Medicaid enrollment grew much more quickly, jumping 17.2 percent and 6.2 percent, respectively, between September 2011 and September 2012. 6. California Gov. Jerry Brown’s efforts to cut Medicaid provider pay 10 percent were halted again by the 9th U.S. Circuit Court of Appeals via a petition for review. 7. The healthcare law’s Independent Payment Advisory Board, which will make decisions regarding Medicare spending, has been under fire from many on all sides of the political spectrum since it was proposed, and a report found that filling its 15 seats with qualified healthcare experts may be its greatest challenge yet. 8. American Hospital Association President and CEO Rich Umbdenstock criticized members of Congress who proposed reducing Medicare payments for hospital outpatient services. 9. A report from the Missouri Hospital Association found if Missouri does not expand its Medicaid program under the healthcare reform law, state hospitals may be forced to cut more than 9,000 jobs and cost shift more than $1 billion to commercially insured patients. 10. In the first six months of implementing seven best practices, Washington state emergency departments reduced Medicaid patients’ “unnecessary” ED visits by 23 percent and saved costs that are estimated to reach $31 million for the fiscal year.
Source: beckershospitalreview.com

Warning: Medicare Payment Limits Are Bad for Health! 

The Center for Medicare Advocacy has represented Medicare beneficiaries since 1986. As one of the few advocacy organizations in the nation solely serving Medicare beneficiaries, we strongly oppose home health episodic payment caps or any other such defined payment limits. Experience with such limits – caps on outpatient therapy – demonstrates that payment caps create barriers to necessary care for people with long-term and chronic conditions. Similarly, home health episode caps would be harmful to some of those in greatest need of home care. By the same token, any set payment limits arbitrarily restrict access to Medicare coverage and necessary care – in essence, they amount to vouchers for care in various care settings that are harmful to beneficiaries.
Source: medicareadvocacy.org

Another ObamaCare Medicare Gimmick

ObamaCare supporters sometimes like to talk about the legislation’s “delivery system reforms,” which are supposed to change the way health care services are organized in ways that make health care less costly and more efficient. The bulk of these delivery system reforms are essentially payment reforms — restructuring the way medical providers are reimbursed in hopes of changing their incentives. But the sheer complexity of the way Medicare pays providers means that these sorts of payment games are not only commonplace, but key drivers of administrative decisions in medical facilities. Medicare’s size also means that its decisions often have ripple effects throughout the medical payment ecosystem.
Source: reason.com

Arkansas Medicare health plan benefits

Medicare health plan provides coverage for medical needs of people who do not have enough coverage or require additional coverage for specific medical needs. It is a plan offered by the private insurance companies that contracts with Medicare to provide the coverage to eligible individuals. The insurer has significant savings on medical expenses when opting for the Medicare health plan. This plan provides all the benefits that are available with the Medicare Plan provided by the Federal State in Part A and Part B of the plan.
Source: medicarearkansas.com