Viewpoints: Fla. Gov. Fears Medicaid Expansion As Idaho, Missouri And Colorado Wrestle With Issue ; Few Acceptable Options For Improving Medicare

Posted by:  :  Category: Medicare

CENTRAL CITY, COLORADO 1968 by roberthuffstutterThe Idaho Statesman: Expanding Health Care Coverage Benefits All Idahoans As a member of Gov. Butch Otter’s task force, which voted 15-0 in favor of this [Medicaid] expansion, here are eight reasons why: 1. It saves Idaho money. The expansion of Medicaid to 150,000 people will cost Idaho $284 million over the next 10 years. However, the federal government’s payment program for this expansion will bring in $290 million to the state over that time. Idaho stands to gain $6 million by expanding Medicaid. Conversely, there are 70,000 Idahoans who already meet the expanded eligibility requirements and their coverage will cost the state hundreds of millions of additional dollars without the benefit of enhanced federal payment if we don’t do this (Dr. Ted Epperly, 1/6). Kansas City Star: Bid To Renew KC’s Extra Health Levy Merits Scrutiny Almost eight years ago, Kansas Citians narrowly approved a property tax increase to provide more public funds for indigent health care. It was a compassionate decision by voters. But the world of health care has changed a great deal since then. … Truman Medical Centers and a few other medical care providers in Kansas City still want to keep receiving the extra health levy. … If Missouri does not adopt Medicaid expansion or progress on the exchanges is delayed, the squeeze will be on hospitals in earnest to keep their doors open to serve indigent patients in Kansas City and the state. Still, the City Council and local health care providers must use this week’s hearing to start providing clear evidence they need a $135 million tax renewal over nine years (1/6).
Source: kaiserhealthnews.org

Video: Colorado Medicare Supplements

Colorado’s Medicaid Cost Drivers

Health policy discussions often focus on controlling the cost of the sophisticated medical care that is provided to relatively few people. Outside of this blog, relatively few people pay attention to the impact of routine costs like the cost of an extra physician visit for each of 150 million people. This is one reason why so many people are surprised by the fact that consumer directed health plans with proper incentive structures can lower health care expenditures by as much as 20 percent without compromising health or externally rationing care. It also explains why so many Medicare commentators have difficulty understanding how the Ryan Medicare reform plan might work.
Source: ncpa.org

THE Consortium: Colorado Medicare Claims Transition from Trailblazers to Novitas Solutions

As of October 19,  Trailblazers stopped receiving all mail and requests in their role as the Medicare Contractor and forwarded these to Novitas Solutions. All future communication must go through Novitas. Since Novitas has prior experience as a MAC for a number of eastern states, CMS anticipates that the transfer to a new MAC will go smoothly, with few disruptions for Medicare beneficiaries or providers. However, providers should prepare for possible delays and implementation glitches.
Source: blogspot.com

Better primary care saves Colorado $20 million

The results of the ACC could drive critical health policy decisions following next week’s elections when Colorado’s governor and lawmakers must decide whether to expand Medicaid under the Affordable Care Act (ACA). If Mitt Romney wins the presidency, he has vowed to dismantle the ACA. Furthermore, the U.S. Supreme Court this summer told states they did not have to expand Medicaid, which covers care for children, poor people, the disabled and the elderly in nursing homes.
Source: healthpolicysolutions.org

Colorado Medicaid expansion up in air, others weigh in

You are deluded John. Obamacare will greatly expand the free rider problem as it promises more than half the population that someone else will pay their health care costs. Obamacare is a huge new entitlement that will explode deficits at both the federal and state levels. The CBO estimates that Obamacare will increase health care spending by $1.5T per 10 years. The Heritage Foundation estimates are $2T to $6T over 10 years. The Democrats in indicating that Obamacare would reduce deficits used phony accounting by double counting Medicare savings (probably will never happen anyway). Obamacare is a mess, a 2,700 page bill with 13,000 in new supporting regulations and a new army of IRS agents. Health care is more expensive here because we get better care. Our providers receive better compensation. No one has to wait to receive service except those on government programs. Obamacare promises price controls to control spending. The current state of critical hospital medicines indicates that price controls produce shortages. Obamacare promises another free lunch. Increase demand (because half the population has been promised free care) and reduced supply due to price controls equates to disaster.
Source: denverpost.com

Getting Medicare In Colorado

Colorado residents are eligible for Medicare offerings. The program offers a definite benefit to its members. Medicare programs come in two parts known as Part A and B. Part A refers to hospital care while Part B covers outpatient health care. In order to afford coverage for Parts A and B; a patient can choose the original Medicare coverage or a Medicare advantage plan or Part C. On the other hand, to cover prescription drugs; Medicare has a part D which is an extension of Part C.
Source: nolamarketingseo.com

Rental Real Estate Problems Loom with New Medicare Tax coming in 2013

2010 we knew there would be changes on the horizon, but did you know it would hold major changes for Residential Rental Income property holders? The Patient Protection and Affordable Care Act will affect those who hold rental income properties and vacation homes starting in Jan 2013. “Unearned income” will be subject to
Source: coloradoshomebuyers.com

The Medicaid Crisis and the Urgent Need for Reform » Common Sense Policy Roundtable

Early efforts to restrain Medicaid were undermined midway through the 1980‘s as expansions once being offered by states voluntarily one-by-one became federal mandates.  The Omnibus Reconciliation Act of 1986 (OBRA 86) required states to cover emergency medical needs for illegal immigrants otherwise eligible for Medicaid, and gave them the option to offer Medicaid coverage to pregnant women up to 100 percent of the federal poverty level and infants up to a year old.  In 1987 this option was expanded to include families with incomes of up to 185 percent of the federal poverty level, and just two years later the option became a mandate for all pregnant women and children under the age of 6 in families falling below 133 percent of the federal poverty level.
Source: commonsensepolicyroundtable.com

State Officials, Policy Experts Mull Health Law Implementation Issues

Posted by:  :  Category: Medicare

Stateline: Diving Deeper: Nebraska Governor’s Thinking On Tax Cuts, Medicaid Few governors are in as enviable a position as Nebraska’s Dave Heineman. The Republican has one of the highest approval rates of any governor in the country, and his state has one of the lowest unemployment rates. … As Stateline recently reported, however, Heineman’s test this year is whether he’s popular with the 49 Nebraskans who matter most: the members of the state’s one-chamber legislature. The governor is trying to persuade lawmakers to make Nebraska the first state since Alaska more than 30 years ago to end its income tax. Plus, he’s hoping to convince them not to expand Medicaid under the federal Affordable Care Act. Stateline staff writer Josh Goodman asked Heineman about these two issues. Below is an edited transcript that explores in more detail his thinking on the topics (Goodman, 2/4).
Source: kaiserhealthnews.org

Video: Johanns Discusses Impact of Medicare Cuts on Nebraska

Bipartisan Bill Would Repeal Medicare Hospital Payment Loophole

Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), have introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country. Under Section 3141, the Medicare hospital wage index is adjusted so that a state’s urban hospitals must be reimbursed for wages paid to physicians and staff at least as much as rural hospitals. These reimbursements for hospital wages also come from a national pool of money, meaning that if one state receives higher Medicare wages, it will come at the expense of another state. In January, 20 state hospital associations — Alabama, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Virginia, West Virginia and Wisconsin — as well as the National Rural Health Association wrote a letter (pdf) to the White House arguing this provision is decimating their Medicare reimbursements.   A Boston Globe report found that Massachusetts had received an estimated $367 million in additional Medicare funding due to Section 3141 because the state’s only rural hospital — Nantucket (Mass.) Cottage Hospital, based in an affluent area with a high cost of living — set an inordinately high floor for wage reimbursements. In total, nine states received higher Medicare wages under the provision, while the remaining 41 lost Medicare funds. Sens. McCaskill and Coburn called the provision “unfair” and said it only benefited hospitals in some states to the disadvantage of many others.
Source: beckershospitalreview.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

Nebraska launches Medicaid EHR Incentive Program

Nebraska launched their Medicaid Electronic Health Record (EHR) Incentive Program on May 7, 2012. This means that eligible professionals (EPs) and eligible hospitals in Nebraska can now complete their EHR Incentive Program registration. More information about the Medicaid EHR Incentive Program can be found on the Medicare and Medicaid EHR Incentive Program Basics page of the CMS EHR website.
Source: ehrintelligence.com

New Medicare Scam Targets Seniors

The Better Business Bureau has a few tips incase scammers come after you.  First, do not give out personal information to anyone, ever.  Second, Medicare does not make phone calls regarding new cards, nor will they ask for sensitive financial information.  Lastly, if you suspect anything suspicious, just hang-up.
Source: klkntv.com

Sen. Menendez intervened twice in federal audit of key donor

Sen. Robert Menendez raised concerns with top federal health-care officials twice in recent years about their finding that a Florida eye doctor — a close friend and major campaign donor — had overbilled the government by $8.9 million for care at his clinic, Menendez aides said Wednesday.
Source: dailycaller.com

Medicare, Medicaid & Subrogation Compliance Blog: Nebraska state court follows Ahlborn

In Smalley v. Nebraska Dept. of Health and Human Services, 2010 WL 5527370, handed down on December 30, 2010, a Nebraska state court applied the same pro-rata loss sharing method established by the U.S. Supreme Court in
Source: plaintiffsresource.com

New Nebraska Network:: Ben Nelson Stands Alone Defending Medicare In Nebraska

Nelson has a surprisingly good Democratic record when it matters.  When he votes with the GOP it is usually not the deciding vote.  For instance he did not vote against Elaine until after she already had sufficient votes.  The public option was dead and buried in the Senate months before he voted against it. Like many “Red State” Democrats and “Blue State” Republicans he must cast a certain number of votes against his party. The problem with the “progressive position” is that progressives are not willing to do the necessary work to move the political enviroment.  Conservatives also have this problem in other states.  You need to build strong political support for these positions before we expect politicians to endorse them.  That means registering voters, making phone calls, walking the precincts and all the other things that are necessary to build political support.
Source: newnebraska.net

Nebraska Approves Sale of Medicare Supplement Insurance Products

We are pleased to announce the availability of lower cost Medicare Supplement Insurance in Nebraska. The Nebraska Department of Insurance approved Medicare Supplement Insurance plans from State Mutual Insurance Company and made it possible for us to offer extremely competitive Medicare Supplement Insurance rates for qualifying Nebraska seniors.
Source: statemutualinsurance.com

Wisconsin’s Sheboygan Surgery Center Receives Medicare Deemed Status Distinction from AAAHC

Posted by:  :  Category: Medicare

Racine residents tell Rep. Ryan no cuts to Medicare, Medicaid or Social Security by wisaflcioThe Sheboygan (Wis.) Surgery Center has received the distinguished “Medicare Deemed Status” accreditation for the fifth consecutive year from the AAAHC, according to a Sheboygan Daily report. The accreditation differentiates the Sheboygan Surgery Center from other outpatient facilities as a provider delivering high quality of care to its patients, as determined by an independent, external process of evaluation. “Sheboygan Surgery Center is only one of three ambulatory healthcare centers in northeast Wisconsin to earn this distinguished accreditation,” said John Winter, administrative director, to Sheboygan Daily. The surgery center is the county’s first multi-specialty, freestanding surgery center. It is a partnership between seven area surgeons and St. Nicholas Hospital. Learn more about AAAHC.
Source: beckersasc.com

Video: RANT!!!!! DEBT problem; Wisconsin & Ohio; Social Security, Medicare and Taxes

Attention Seniors: Help Stop Medicare Fraud

The Wisconsin Council of Churches is partnering with the Coalition of Wisconsin Aging Groups (CWAG) to help seniors in our congregations control rising health care costs by helping to fight Medicare fraud. The Wisconsin Senior Medicare Patrol (SMP), overseen by CWAG, provides resources to Medicare beneficiaries, caregivers, and the professionals who serve them throughout the state to prevent, detect, and report healthcare fraud, waste, and abuse.  For more information, click here.
Source: wichurches.org

Wisconsin’s Thompson boasts about ‘doing away with’ Medicare

But as a strategic matter, this is a symptom of a larger problem. Tommy Thompson used to be a relatively moderate Republican, at least by contemporary standards, uncomfortable with far-right extremists. As his party has become radicalized, however, Thompson has been forced to scramble to convince his base that he’s sincere in his support for an extreme agenda.
Source: msnbc.com

Duffy: Federal cuts are likely

Congressman Sean Duffy is repeating a theme to constituents: The federal government is spending too much money. A number of federal programs face sequestration, in other words, automatic spending cuts unless no deal is reached to cut spending or raise revenues.
Source: wrn.com

Efforts to Combat Fraud Continue to Yield Positive Results in Wisconsin 

badgercare plus Better Business Bureau charity scams credit card fraud credit card scams election fraud false claims act fraud fraud alert newsletter Frauds healthcare reform identity theft job scams medicaid fraud Medicare medicare fraud medicare overbilling medicare part D medicare reform medicare reimbursement mortgage fraud phishing scams podcasts prevent medicare fraud scams storm chasers storm scams telephone scams Training volunteer voter fraud wisconsin bbb wisconsin check fraud wisconsin child care fraud wisconsin election fraud wisconsin fraud wisconsin head start fraud wisconsin medicaid fraud wisconsin mortgage fraud wisconsin scam wisconsin scams wisconsin smp wisconsin smp training wisconsin unemployment benefits wisconsin unemployment fraud
Source: wisconsinsmp.org

Wisconsin Workers Call on Congress to Preserve Medicare, Social Security and End Tax Cuts for top 2%

“The election may have just ended, but Wisconsin working families are already mobilizing to hold their elected officials accountable because we can’t afford to make cuts to Medicare, Medicaid and Social Security,” said Phil Neuenfeldt, President of the Wisconsin State AFL-CIO. “The people advocating for these cuts are the same people who want to cut taxes for the richest 2%, which would cost $1 trillion over 10 years. Our country can’t afford these cuts and working families who rely on these vital programs should not have to pay for more tax breaks for those who need them the least.”
Source: typepad.com

Dog bites law: Vets howl about WI drug tracking bill

Eighteen other states require veterinarians to report at least some of the data requirements under the PDMP as of July 2012. South Carolina, Kentucky and Arizona have indicated they may move to exempt vets in the future, according to a study by the Minnesota Board of Pharmacy. The study also found most states were unable to point to a case of diversion of controlled substances the National Alliance for Model State Drug Laws is worried about.
Source: watchdog.org

Choice Of Rep. Ryan Puts His Plan To Overhaul Medicare At Center Of Campaign

The Wall Street Journal: Democrats, GOP Spar Over Ryan On Shows Republicans and Democrats sparred Sunday over Mitt Romney’s choice of Rep. Paul Ryan (R., Wis.) as his running mate, seizing on his proposals in Congress to highlight differences between the parties over taxes, spending and entitlement programs. Republican Sen. John McCain of Arizona, who lost to President Barack Obama, a Democrat, in the 2008 presidential election, said Mr. Ryan understands that “the most compelling challenges this nation faces obviously are jobs and the economy.” … Other Republicans, however, were more careful to avoid conflating the particulars of Rep. Ryan’s budget proposals with Mr. Romney’s campaign. “Mitt Romney appreciates and admires the work and the ideas that Paul Ryan has done,” Republican National Committee Chairman Reince Priebus said on NBC’s “Meet the Press.” But while celebrating Rep. Ryan’s bold efforts, he noted that the presumptive Republican presidential nominee can offer his own proposals (Entous and Peterson, 8/12).
Source: kaiserhealthnews.org

Wisconsin Medicare supplement plans

The state stipulates the condition of offering all the basic benefits of original plan in the supplemental plan as well. Apart from the basic features the insurance companies are permitted to add some of the additional features to the plan such as Part A and Part B benefit, patient Psychiatric services, foreign emergency travel medical services etc.
Source: medicarewisconsin.com

Eye on Wisconsin: Can’t Trust Tommy with Medicare Trust Fund

We all know that Tommy Thompson declared that he would “do away with” Medicare and Medicaid.  He has tried to spin away from his declaration to the tea party extremists but we have more than that moment of honesty.  We have an actual track record showing just how Medicare fared under Tommy Thompson’s care. In 2001, when Tommy Thompson became Secretary of Health and Human Services, the Medicare Hospital Insurance Trust Fund was projected to be exhausted in the year 2029. [2001 CMS Trustees Testimony to Congress] In 2005, when Tommy Thompson left Health and Human Services, the Medicare Hospital Insurance Trust Fund was projected to be exhausted in the year 2020. That is a loss of 9 years on Tommy’s four year watch.[2005 CM Trustees Report] Even though Tommy Thompson served as George W. Bush’s HHS Secretary, in 2008, he criticized the failure of the Bush Administration to address the problems of Medicare. Thompson then said that “Medicare is going broke by 2012, 2013.” Fast forward to the point where President Obama took office and before the Affordable Care Act passed. The Medicare Hospital Insurance Trust Fund was projected to be exhausted in the year 2017. That is where the Bush Administration (including Tommy) left President Obama. [2009 CM Trustees Report] The Affordable Care Act (ACA) reduces the rate of growth in Medicare spending, with savings that eliminate waste and inefficiencies. The ACA targets wasteful programs and ensures that taxpayer money is efficiently filtered back into the health care system, allowing seniors to get preventive care without copays. Regardless of Tommy’s ridiculous lies on the subject the $700 billion in identified savings actually help extend the life of Medicare. Tommy Thompson wants to repeal ACA and in doing so he will be undermining the long term prospects of Medicare.  We have no reason to doubt that he would sacrifice Medicare to his new found right wing ideology. He has said as much, he has pledged allegiance to Paul Ryan’s voucher-care concept and lets face it his track record on extending the life of Medicare has never been a good one. Tommy predicted that Medicare would go broke by 2012 or 2013 and if his policy positions and history are any indication, he apparently intends to make that prediction come true.
Source: blogspot.com

Here’s what role healthcare reform, Medicare is having in the Wisconsin Senate campaign

Ryan, 42, has described himself and the often confrontational Walker, 44, as “protégés of the Tommy Thompson farm team,” but the 70-year-old Thompson has sought to distance himself from their policy embrace on broad social issues. Although he has called for overturning the health law and has endorsed the concept promoted by Ryan to give seniors premium supports to buy health coverage in order to keep the system from running out of money, Thompson also has said he would want significant revisions in that plan, such as increased federal payments and an expanded pool for high-risk patients.
Source: medcitynews.com

Deadline looms for Medicare enrollment

The Medicare Advantage disenrollment period runs Jan. 1 to Feb. 14. During that time you can leave your Medicare Advantage Plan to switch to original Medicare. If you switch to original Medicare during this period, you’ll have until Feb. 14 to 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. However, during this period, you cannot switch from original Medicare to an advantage plan or from one advantage plan to another; join, switch or drop a Medicare medical savings account; or change the prescription drug plan.
Source: superiortelegram.com

Officials warn Wisconsin seniors to be on the lookout for scam involving Medicare cards

The sad truth is that elderly people are often targeted by those committing fraud and other types of white collar crimes due to their trusting nature. For instance, we discussed back in November how grandparents throughout the country, including right here in Wisconsin, were still being victimized by the long-standing telephone scam involving a phone call from a fictional grandchild who is supposedly in need of emergency funds.
Source: milwaukeecriminallawyerblog.com

Features of Medicare Dental Plans

Posted by:  :  Category: Medicare

Martin Place 1 by Greens MPsMedicare and dental procedures: – In general, medicare does not cover the usual dental caring like teeth cleaning, cavity filling, dental extractions, implantations, crowning etc. But certain other dental health care policies cover routine dental treatments and checkups. In ordinary health care plans, dental care also will be taken up if certified by the physician as necessary along with other ailments. In addition, there are medicare dental coverages at reduced cost for the convenience of patients.  Of late, basic dental care treatments such as yearly dental checkup and teeth cleaning are included in the medicare coverages. As per this plan, once in a year, the dental patients are charged only at 50 % for one cavity filling, one root canal treatment and crown repairs. The medical savings account as per the medicare plan is another alternative to cover the dental expenses. The deposit to this account is made from the medicare account of the policy holder. Occasions when medicare covers dental services
Source: affordable-dentalplans.org

Video: Medicare Dental Plans | Medicare supplemental Plans dental plans

Medicare Dental Plans: Does Medicare Cover Dental Procedures?

Currently, Medicare coverage of dental services is very limited. Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. Medicare does not pay for dental plates or other dental devices. In general, you pay for 100% of dental services. This has given rise to the popularity of discount dental plans. Section 1862 (a)(12) of the Social Security Act states in partial that Medicare will not cover dental care, “where such expenses are for services in connection with the care, treatment, filling, removal, or replacement of teeth or structures directly supporting teeth.” Structures directly supporting the teeth means the periodontium, which includes the gingivae, periodontal membrane, dentogingival junction, cementum of the teeth, and the alveolar bone (i.e. alveolar process and tooth sockets). The dental exclusion was included as part of the initial Medicare program. The principle being that Coverage is not determined by the value or the necessity of the dental care but by the type of service provided and the anatomical structure on which the procedure is performed.
Source: blogspot.com

health care solutions, Medicare FAQ, Questions about Medicare

As an alternative to Part A and B, beneficiaries can select a Part C plan, which is also referred to as a Medicare Advantage plan. Private companies contract with the federal government to offer these plans, which pay for everything covered by Original Medicare and often provide additional services.  Such as dental, hearing, vision benefits and maybe even a gym membership. Beneficiaries usually pay a monthly premium and some other fees, such as copayments and deductibles.
Source: ahealthiermichigan.org

Tooth Times Newsletter: Jan2012

On 1 July 2008, the Australian Government introduced the Medicare Teen Dental Plan to help with the cost of an annual dental preventative check. The program aims to make it more affordable for families to keep their teenager’s teeth in good health
Source: com.au

What Medicare doesn’t cover

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Source: bankrate.com

Turning 65: Finding a Medicare Advantage Plan

This is the fifth in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future. Here are the first, second and third posts and fourth posts in this series. Ah, those Medicare Advantage (MA) plans!’  The government can’t seem to decide if it loves or hates them.’  On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. ‘ So it seemed like I was being encouraged to select an MA plan. ‘ ‘ ‘ On the other hand, Congress with a big nudge from the president, whacked reimbursements to MA plans, cutting out the overpayments they’d been receiving for years.’  It was costing the government far more to fund the benefits to seniors who picked them than it cost to provide the traditional program.’  Lower payments, experts believe, could cause some MA plans to disappear. While government is betwixt and between on MA plans, I am not.’  I know I would not feel comfortable in a restricted provider network, which is the crux of most of these MA plan arrangements.’ ‘  But I approached the selection process with an open mind, taking a careful look at what’s available and evaluating the advice for selecting one.’  As with Medigap policies and the prescription drug plans that go with them, there were too many choices and too many data points for the average senior to comprehend, let alone make the ‘right’ decision that the marketplace model says will appear, like magic. I understand why seniors fall for misleading or deceptive sales pitches.’  We need a helping hand but all too often whoever is extending it doesn’t have our best interests at heart.’  I had heard lots of these pitches before’the kind where a seller invites seniors to a local restaurant, then glosses over the negatives and highlights insurance deals for a very low or no monthly premium with drug coverage, gym memberships, and vision and dental care thrown in to boot.’  Appealing, no? Now it was time for me to cut through the hype. First, I started my review with the sales brochures I received for MA plans.’ ‘  The giant in this universe, UnitedHealthcare/AARP, sent its brochure in an enticing envelope.’  A big red banner screamed ‘$0 premium Medicare health plans’ ‘enough to make me rip it open.’  The insurer’s Medicare Advantage Guide said that although costs vary by plan, all of United’s MA plans have annual limits on out-of-pocket expenses ‘so you can budget for health care expenses and limit your out-of-pocket costs each year.”  That didn’t mean much since I don’t know what illnesses might befall me.’  Marketing jargon, really, but apparently it works. Another sales piece in the mailing gave concrete info about United-AARP’s MedicareComplete Plan 1 (an HMO) with its out-of-pocket limit of $5,900.’  And the other United-AARP offerings?’  For those I had to turn to the government’s Medicare & You handbook where I ran smack into the bizarre world of MA plans.’  It turned out there were also two PPO plans offered through United-AARP.’  Since PPOs are less restrictive than HMOs, I wouldn’t lose my Medicare benefits by going out of network as I would with an HMO. I learned that there were also three other AARP’  HMO choices’the MedicareComplete Essential HMO with an out-of-pocket limit of $5,900; the MedicareComplete Plan 2 which carried an out-of-pocket limit of $4,200; and the MedicareComplete Mosaic with its limit of $2,900.’ ‘  It’s not uncommon for one insurance company to offer several different Medicare plans with fanciful names, which further confuses consumers. All had no monthly premiums, but they paid different amounts for what’s called durable medical equipment, like oxygen, and for critical treatments like chemotherapy drugs.’ ‘  I also discovered that the United-AARP MedicareComplete Essential HMO did not cover drugs, which would force me into shopping for a drug plan, another headache I didn’t need. The United-AARP MedicareComplete Mosaic seemed ideal with its low out-of-pocket maximum, low copayments for doctor visits, and low coinsurance for the expensive stuff like chemo drugs and medical equipment.’  But based on the sales brochure they mailed to me, which were all about Plan 1, it was not the plan United-AARP was encouraging me to buy.’ ‘  With Plan 1, I would be on the hook for more out-of-pocket expenses’meaning that the carrier would pay less and profit more.’  No wonder they were pushing it.’  A second United-AARP mailing also pushed Plan 1. However, both brochures did disclose a significant variable to look at when choosing an MA plan’the copayments for inpatient hospital stays.’  I knew these copays are often hidden in the fine print, and consumers frequently don’t learn of them until they land in the hospital.’  They are clearly a negative for MA plans.’  FYI:’  Medigap policies pay the copayments for hospital stays, which give them an edge in this department.’ ‘  The copay for Plan 1 was fairly hefty’$175 each day up to $1,400 per stay.’  These could add up for a sick person who had multiple admissions. Emblem Health also sent some Medicare insurance mailers, mostly trying to get me to access their website with my own personal password, which was good for a limited time only.’  They were looking for sales prospects, and I didn’t want to become one, especially since I wasn’t interested in watching some NBA hall of famer on a how-to video telling me how easy it is to choose Emblem’s Medicare options.’  But acting like an average senior who had heard of Emblem Health might, I thought I better take a look at the Emblem plans for New York City. It turns out Emblem offers three HMOs and four PPOs.’  The penalty for being able to go out of network in a PPO is steep. They came with high out-of-pocket maximums’$2,500 for going out of network and $6,700 for staying in network, or a’  $10,000 combined maximum.’  Even though two had no monthly premiums, and two had premiums of less than $100, I didn’t go further with Emblem. While sales people push MA plans with low or no monthly premiums, the premium is not the only thing to consider.’  It’s the mix of policy elements that ultimately determine whether a plan is a good or bad deal.’  And then of course, there’s the unknown of your future health status to consider.’  You need to know how the combination of premiums, in- and out-of-network hospital copays, out-of-pocket limits, drug copays, coinsurance for chemotherapy drugs, and copays for doctor visits interact to determine what a plan will really cost.’  The trade-off for a no-premium plan may be hidden’and high’hospital copays, very high out-of-pocket limits, or the obligation to pay 20 percent of chemotherapy bills.’  It boils down to a game of ‘name your poison.’ I also looked for MA plan information on the Medicare.gov website but did not find it helpful.’  Both the handbook and website gave star ratings for MA plans but they seemed to measure different things, further confusing shoppers who might want to use them.’  The government handbook gave the United-AARP CompleteMosaic plan one star for Member Satisfaction.’  That might be important to know.’  At the same time the government website gave the same plan an overall rating of three stars.’  This certainly raised some questions for me about the usefulness of these stars as a shopping tool. Having done lots of homework, it was time to select a plan to cover Medicare’s gaps.’  Was I going to try one of those Medicare Advantage PPO plans that seemed to offer flexibility and let me keep the doctors that I like?
Source: cfah.org

Health Products for Members: Health Insurance, Dental Insurance, Fitness

AARP Health is a collection of health related products, services and insurance programs made available by AARP. Neither AARP nor its affiliate is the insurer. AARP contracts with insurers to make coverage available to AARP members.
Source: aarp.org

Medicare Eligibility and Senior Health Care

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

Obama Wants To Avert Cuts to Medicare, Other Programs in Sequester

Obama also indicated a willingness to accept reductions to entitlement programs, noting that in the past he has “offered sensible reforms to Medicare and other entitlements” (Zigmond, Modern Healthcare, 2/5). He said that proposals he made to reduce entitlement spending during talks on the fiscal cliff in December 2012 still are “on the table.” During those negotiations, Obama agreed to change how costs would be adjusted for inflation in government programs, including Medicare, in exchange for revenue increases from closing tax loopholes (“On The Money,” The Hill, 2/5).
Source: californiahealthline.org

Cigna Announces New Medicare Supplement Product

Posted by:  :  Category: Medicare

Cigna Corporation (NYSE: CI) is a global health service company dedicated to helping people improve their health, well-being and sense of security. All products and services are provided exclusively by or through operating subsidiaries of Cigna Corporation, including American Retirement Life Insurance Company. Such products and services include an integrated suite of health services, such as medical, dental, behavioral health, pharmacy, vision, supplemental benefits and other related products including group life, accident and disability insurance. Cigna maintains sales capabilities in 30 countries and jurisdictions, and has approximately 71 million customer relationships throughout the world. To learn more about Cigna
Source: dlvr.it

Video: Chicago: “Cigna 7″ Arrested – Medicare for All

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

Cigna Closes 4Q With 49% Boom in Net Income

Bloomfield, Conn.-based health insurer Cigna ended fiscal year 2012 with 28.8 percent more net income than 2011 for a total of $1.62 billion, largely attributable to a 38.1 percent hike in premium revenue from rate and membership increases and the company’s acquisition of Medicare Advantage plan HealthSpring in January 2012. Year-end total revenue increased more than $7.25 billion from FY 2011 to nearly $29.12 billion in FY 2012, a 33.2 percent leap. Fourth-quarter revenue results were also favorable, as Cigna raked in $7.62 billion, 40.5 percent higher than fourth quarter 2011. The company closed the fourth quarter with a 48.7 percent jump over last year in  net income at $406 million. Last year, Cigna announced it had completed its acquisition of HealthSpring, based in Franklin, Tenn., adding more than 1 million members to Cigna’s plan in an estimated $3.8 billion deal.
Source: beckershospitalreview.com

Cigna Management Discusses Q4 2012 Results

Sure, Dave. Several different questions, let me see if I could package an answer around it. You ended with the term narrow networks, so I actually want to pick up from that, because philosophically, we don’t think about it, our go-to-market strategy, as narrow networks. We think about a body of evidence around the highest-performing, highest-value networks, and we believe there’s a significant opportunity to position those for the benefit of clients and customers, just as — just a philosophical orientation. To your very specific question, one, as I noted in my prepared comments, we’re approaching 1 million members or 1 million customers that are already in either the Collaborative Accountable Care relationships or the more sophisticated HealthSpring model in relationships, so we feel great about that. Two, I appreciate your recollection of strategic objective is to have 100 Collaboratives up and running in 2014, and we’re well on our way to that direction. The way I’d ask you to think about it, broadly, your rightful question in terms of lives and targets, our more macro objective is that we expect to have approximately 80% of all of our U.S. customers in a performance-based reimbursement model as we step out of ’14 and into ’15, right? Collaboratives will be a piece of that, but using performance-based reimbursement. Because philosophically, we believe that rewarding physicians in integrated health care system based upon quality and value of outcome versus volume is the way of the future, and there’s a variety of way to get those performance-oriented systems to be operating. And that’s the key for us for our organization on a go-forward basis. Lastly, specifically, to your HealthSpring question, you’re correct. We’ve split up some Commercial alternatives off of their very successful MA structure. And I would say early indications are positive, but it’s early in the trajectory. We have some large cases we’ve carved into those delivery systems and are seeing early traction already. So early indications are positive, but it’s just early in the cycle.
Source: seekingalpha.com

The Cigna Medicare Plans Phoenix AZ Seniors Choose

Choosing the cigna medicare plans phoenix az residents prefer can be tricky. There are different plans that Medicare offers and they each have specific features. The coverage called Part A is for hospital insurance and covers most stays and associated costs. Part B covers most other medical expenses not covered by Part A. Part D is the prescription drug plan that is only available to those who have enrolled in either Part A or B. Part C is a combination of A and B, but also automatically includes the prescription drug plan. Understanding the Medicare coverage and supplemental packages can be confusing, but will offer the best coverage for good care.
Source: tucsonhospitalityinn.org

Top Medicare Part D Plan Costs Spike in 2013

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

Government Issues CIGNA Government Services Federal Medicare Contracts Awarded Prestigious Quality Management Certification

CIGNA Government Services today announced it has again achieved the prestigious International Organization for Standardization (ISO) 9001:2008 certification, an internationally accepted quality management system. Certification includes all CGS Part B and Durable Medical Equipment Medicare Administrative Contractor (DME MAC) Program Management functions under contract with The Centers for Medicare and Medicaid Services (CMS). ISO 9001:2008 certification requires organizations to develop and adhere to stringent quality management standards and to have controls and mechanisms in place to comply with all regulatory requirements. The ISO 9001:2008 certification also requires processes that enhance customer satisfaction and ensure continual improvements. Companies are required to pass an exhaustive audit of all quality management processes prior to receiving certification. ‘This award recognizes CIGNA’s dedication to continuous quality improvement. Achieving this level of certification underscores the commitment we’ve made to our customers to continually raise the bar on performance,’ said Jean Rush, president of CIGNA Government Services. ‘We take very seriously our responsibility as a Medicare contractor and the positive impact we can have on the lives of millions of Medicare beneficiaries, providers of durable medical equipment and health care professionals. I am proud of our employees’ continued commitment to quality and performance excellence demonstrated by this certification.’ CIGNA Government Services has provided services to Medicare since 1991. In June 2007, CIGNA was awarded the largest of four DME MAC contracts to provide claims processing, customer service and administrative services to over 55,000 durable medical equipment, prosthetics, and orthotics suppliers in 15 states, including: Alabama, Arkansas, Colorado, Florida, Georgia, Louisiana, Mississippi, New Mexico, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Virginia, and West Virginia as well as the territories of Puerto Rico and the U.S. Virgin Islands. CIGNA also holds federal Medicare Part B contracts for North Carolina and Idaho.
Source: dmagovernment.com

Poe Priscilla Reviews Cigna Provides Medicare Advantage Plans For Senior Citizens

Cigna is a well-known insurance carrier for quit some time and they’ve made it their responsibility to provide a selection of health care insurance plans like Medicare Advantage Plans intended for senior citizens in the United States. It is frequently tough for seniors who might have quite a few health conditions to obtain good insurance coverage but they would have the capacity to through Cigna. Together with offering a selection of health care coverage the firm likewise has a legal contract with the government to provide Medicare plans to seniors. Due to this they’re able to offer a number of helpful Medicare plans that an individual who is eligible for the government assisted insurance will be able to select.They not only provide your health coverage they likewise provide your medical care through Cigna Medical Group (CMG). By providing health coverage and medical care together you are able to build a solid connection with your medical doctor and your care team – experts that are committed to aiding you get the most out of your health so you can get the most out of life. And along with their CMG staff you gain access to an extensive network of more than 4000 specialists in the community – find out about medicare plans with Cigna.To start with Cigna offers Medicare prescription medication plans. As everyone knows prescription medications could be very costly. A few of the medicines could cost more than one hundred dollars a month. Numerous senior citizens have to take several medications each day and that can cost more than a fixed income could afford. Cigna offers two different prescription medication plans that you can take into consideration. The details of the two are below.Cigna Medicare RX Basic would go in conjunction with most parts of Medicare and it’s obtainable in every state of the nation. The plan has a selection of valuable benefits. For instance it does not include a deductable that will keep you from having to pay with your own money. Furthermore it would continue to pay for prescriptions even through the Medicare donut hole which will cut off most healthcare coverage. Generally generic medication through this plan would cost nothing out of pocket. Cigna Medicare Select Plus Rx is only included in the state of Arizona and it will work just with Medicare HMP plans. With this option you will actually get some healthcare together with prescription medications. The plan doesn’t have any monthly cost and it has no deductibles to reach. Prescriptions are available at a discount and the plan would even help to pay on physician’s appointments.In addition to these two prescription plans Cigna likewise offers Medicare Advantage Plans. They just recently eliminated the option of the HMO plans yet others are available to people who qualify for Medicare. Not all of these plans are available in every state so it would be important to research precisely what is available in your state before determining if these plans are best for you.
Source: fc2.com

Jindal versus Obama on Medicaid 

Posted by:  :  Category: Medicare

THE PEOPLES LEADER by SS&SSJindal left unsaid, however, that at home, his administration plans to cut that healthcare spending drastically this spring to plug a looming $1.2 billion state budget deficit. At the same time, the Louisiana governor also left ignored an idea that a fellow GOP governor employed in Arizona. The concept could forestall this year’s cuts in the state’s healthcare budget, and meet the goal of providing health care to those up to 133 percent of the poverty level without impacting Louisiana’s budget. The excess hospital revenue could lessen this year’s cuts, and perhaps plug the funding gap endangering the construction of the new University Medical Center in Mid-City.
Source: louisianaweekly.com

Video: Louisiana Medicare Supplemental Insurance

AIDS Healthcare Foundation

Almost immediately, Gilead also reached a price reduction agreement on Stribild with the ADAP Crisis Task Force (ACTF), of the National Alliance of State & Territorial AIDS Directors (NASTAD) on behalf of the nation’s hard-hit network of AIDS Drug Assistance Programs (ADAP). In response to the initial steep price of Stribild and the swiftness of the ADAP Crisis Task Force agreement, AHF asked Gilead to also lower the price for other private and government programs such as Medicaid, Medicare, private insurers and other payors that otherwise face Gilead’s steep price tag for the new medication. AHF officials sent letters to private insurers and state health department directors nationwide urging them to exclude Stribild from their respective drug formularies if the drug was not made price-neutral to Atripla. AHF also asked the program directors to consider placing Stribild on ‘prior authorization’ status. ‘Prior authorization’ requires that a particular prescription must be reviewed by a second medical provider for assessment of medical necessity before being filled for a drug, and the process may add a day to the timeline of a filling a particular prescription.
Source: aidshealth.org

Owner of Louisiana Health Care Company Convicted in Texas Medicare Fraud

Msiakii used Joy Supply’s Medicare provider number to submit claims to Medicare for DME, including orthotic devices, that was medically unnecessary and, in some cases, never provided. Many of the orthotic devices were components of “arthritis kits” and purported to be for the treatment of arthritis-related conditions; however, the devices were neither medically necessary nor appropriate for such conditions. The arthritis kit generally contained a number of orthotic devices including braces for both sides of the body and related accessories such as heat pads.
Source: redsticknow.com

$30.7 Million Cut to Louisiana Medicare Begins October 1st, 2012

“At both political conventions – and in health policy forums like those sponsored by AARP today in New Orleans – seniors’ Medicare-funded nursing home care and its ongoing funding adequacy has been part of a vigorous, necessary national discussion,” stated Alan G. Rosenbloom, President of AQNHC, which funded the data analysis. “The higher profile of nursing home funding in the 2012 election reflects the growing importance of ending what essentially amounts to a ‘cut now, ask questions later’ governmental funding policy. We hope to help engender a consensus that bigger-picture, systemic reforms that reduce costs, improve efficiency and optimize care quality must be pursued once the election is over.”
Source: seniorlivingcare.com

Update: Bobby Jindal Reverses Course on Medicaid Hospice Cuts

Starting February 1st, Medicaid will no longer pay for hospice care in Louisiana. 7News looks into what is behind the falling budget axe and what it means to dying patients. … The changes are because of a mid-year budget gap. Medicaid hospice is just one stripped program. Sherrill Phelps with the Louisiana-Mississippi Hospice Association says this will deprive terminally ill patients of the opportunity to die comfortably and with care. “They’re deserving to have the help and the support and the financial payment to provide that care for those people,” he said.
Source: crooksandliars.com

States Roundup: Jindal Reverses Medicaid Hospice Cut

The Associated Press/Miami Herald: Massachusetts’ Law Set Stage For National Health Overhaul, Becomes A Template For Other States When Massachusetts adopted its landmark health care law in 2006, the goals were ambitious and the potential solutions complex. … What are they getting in return? … more people visiting doctors, more employees getting coverage through their jobs and an increase of insured residents to 98 percent, far above the national average, … Other states would also do well to note the difficulties resulting from the law: a shortage of primary care doctors, which is expected to be an unintended consequence of the federal law, and an increase in the number of procedures that insurers were required to pay for, which raised costs (LeBlanc, 1/24).
Source: kaiserhealthnews.org

Louisiana cuts health care, Medicaid and hospice programs to rebalance budget

In addition to the cuts, the administration will take about $58.5 million in revenue from a variety of funds in order to plug holes elsewhere in the budget. That includes using $30.5 million from a settlement with pharmaceutical companies over drug prices to reduce cuts at the Department of Health and Hospitals, requiring state colleges and universities use $10 million in increased tuition revenue to supplement state money and taking $13 million in excess fees and revenue from the state’s self-insurance fund.
Source: nola.com

Daily Kos: Jindal reverses decision to cut hospice care out of Medicaid

Indeed, the Health and Human Services Office of the Inspector General has, in recent years, made such investigations a priority. In 2012, for instance, the agency’s work plan included an ongoing review and assessment of the “appropriateness of hospices’ general inpatient care claims.” In addition, the 2013 plan emphasizes the need to examine the relationships between hospices and nursing homes: “OIG found that 82 percent of hospice claims for beneficiaries in nursing facilities did not meet Medicare coverage requirements.” It is a very interesting article on a complex issue… or rather… a simple issue made complex because we do not have a comprehensive universal health care payment system in this country.
Source: dailykos.com

Louisiana Streamlines Enrollment & Achieves Low Eligibility Error Rate

No state has done more than Louisiana to streamline enrollment and retention for children and families. The state’s reforms include administrative renewals whenever data matches show continuing eligibility; obtaining information from consumers by phone, rather than by requesting completion of paperwork; granting coverage based on a reasonable certainty of eligibility; permitting electronic signatures; shifting from paper to electronic case records; business process reengineering and focusing on culture change within social service offices; expediting renewal for families living on fixed incomes; and Express Lane Eligibility.
Source: georgetown.edu

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Source: ahrq.gov

Bobby Jindal to Poor Louisianans: Drop Dead

I know facts, reason, rationality does not matter to someone like Bouie, but, a recent study done by economist Jens Arnold for OECD (you know the club of those countries that provide best prospects for their citizens) suggests that the corporate income tax was the most harmful to economic growth, followed by the personal income tax, while taxes on consumption and property had the least impact on an economy. Even fithere a study by Arnold and four other economists using OECD data estimated that every one percent shift in tax revenues away from income taxes towards other levies produced an additional one-quarter to one percentage point gain in economic growth, you know the thing that provides, whatchamacallem, jobs. And as far back as 50 years ago Harvard Professor Stanley Surrey, JFK’s assistant treasury secretary for tax policy, did a study that suggested that spending through the tax code on social goals was less effective than direct government expenditures, expenditures that could actually be raised if your economy grows faster. OK, this brief window on reality closes, back to your fantasy world, Bouie.
Source: prospect.org

Research Finds Link Between Poor Health And Seniors Switching Out Of Private Medicare Plans

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceA study released Thursday, by Gerald Riley, a researcher at the Centers for Medicare & Medicaid Services (CMS), adds to those concerns. The study looked at more than 240,000 people who dropped out of Medicare Advantage plans in 2007, and compared them with beneficiaries who remained in traditional Medicare the entire time. In the six months after leaving the private plans, the former Medicare Advantage patients used an average of $1,021 in medical services each month, while the patients in the control group cost Medicare $710 a month, the study found.
Source: kaiserhealthnews.org

Video: How to Understand Medicare Plans

Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices

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

The Medicare Wars Begin Anew

Ryan really believes in ending Medicare as we know it. The essential promise of Medicare, ever since its establishment in 1965, is that every senior citizen is entitled to a comprehensive set of medical benefits that will protect him or her from financial ruin. The government provides these benefits directly, through a public insurance program, although seniors have the right to enroll in comparable private plans if they choose. But the key is that guarantee of benefits, and it’s what Ryan would take away. He would replace it with a voucher, whose value would rise at a pre-determined formula unlikely to keep up with actual medical expenses.
Source: andrewsullivan.com

Turning 65: Finding a Medicare Advantage Plan

This is the fifth in a series of posts that examine the process of signing up for Medicare, navigating its rules, choosing supplemental coverage and planning for health care in a program with a very uncertain future. Here are the first, second and third posts and fourth posts in this series. Ah, those Medicare Advantage (MA) plans!’  The government can’t seem to decide if it loves or hates them.’  On the one hand, when I tried to learn about my options, there was much more MA plan information available from the government than for traditional Medigap policies. ‘ So it seemed like I was being encouraged to select an MA plan. ‘ ‘ ‘ On the other hand, Congress with a big nudge from the president, whacked reimbursements to MA plans, cutting out the overpayments they’d been receiving for years.’  It was costing the government far more to fund the benefits to seniors who picked them than it cost to provide the traditional program.’  Lower payments, experts believe, could cause some MA plans to disappear. While government is betwixt and between on MA plans, I am not.’  I know I would not feel comfortable in a restricted provider network, which is the crux of most of these MA plan arrangements.’ ‘  But I approached the selection process with an open mind, taking a careful look at what’s available and evaluating the advice for selecting one.’  As with Medigap policies and the prescription drug plans that go with them, there were too many choices and too many data points for the average senior to comprehend, let alone make the ‘right’ decision that the marketplace model says will appear, like magic. I understand why seniors fall for misleading or deceptive sales pitches.’  We need a helping hand but all too often whoever is extending it doesn’t have our best interests at heart.’  I had heard lots of these pitches before’the kind where a seller invites seniors to a local restaurant, then glosses over the negatives and highlights insurance deals for a very low or no monthly premium with drug coverage, gym memberships, and vision and dental care thrown in to boot.’  Appealing, no? Now it was time for me to cut through the hype. First, I started my review with the sales brochures I received for MA plans.’ ‘  The giant in this universe, UnitedHealthcare/AARP, sent its brochure in an enticing envelope.’  A big red banner screamed ‘$0 premium Medicare health plans’ ‘enough to make me rip it open.’  The insurer’s Medicare Advantage Guide said that although costs vary by plan, all of United’s MA plans have annual limits on out-of-pocket expenses ‘so you can budget for health care expenses and limit your out-of-pocket costs each year.”  That didn’t mean much since I don’t know what illnesses might befall me.’  Marketing jargon, really, but apparently it works. Another sales piece in the mailing gave concrete info about United-AARP’s MedicareComplete Plan 1 (an HMO) with its out-of-pocket limit of $5,900.’  And the other United-AARP offerings?’  For those I had to turn to the government’s Medicare & You handbook where I ran smack into the bizarre world of MA plans.’  It turned out there were also two PPO plans offered through United-AARP.’  Since PPOs are less restrictive than HMOs, I wouldn’t lose my Medicare benefits by going out of network as I would with an HMO. I learned that there were also three other AARP’  HMO choices’the MedicareComplete Essential HMO with an out-of-pocket limit of $5,900; the MedicareComplete Plan 2 which carried an out-of-pocket limit of $4,200; and the MedicareComplete Mosaic with its limit of $2,900.’ ‘  It’s not uncommon for one insurance company to offer several different Medicare plans with fanciful names, which further confuses consumers. All had no monthly premiums, but they paid different amounts for what’s called durable medical equipment, like oxygen, and for critical treatments like chemotherapy drugs.’ ‘  I also discovered that the United-AARP MedicareComplete Essential HMO did not cover drugs, which would force me into shopping for a drug plan, another headache I didn’t need. The United-AARP MedicareComplete Mosaic seemed ideal with its low out-of-pocket maximum, low copayments for doctor visits, and low coinsurance for the expensive stuff like chemo drugs and medical equipment.’  But based on the sales brochure they mailed to me, which were all about Plan 1, it was not the plan United-AARP was encouraging me to buy.’ ‘  With Plan 1, I would be on the hook for more out-of-pocket expenses’meaning that the carrier would pay less and profit more.’  No wonder they were pushing it.’  A second United-AARP mailing also pushed Plan 1. However, both brochures did disclose a significant variable to look at when choosing an MA plan’the copayments for inpatient hospital stays.’  I knew these copays are often hidden in the fine print, and consumers frequently don’t learn of them until they land in the hospital.’  They are clearly a negative for MA plans.’  FYI:’  Medigap policies pay the copayments for hospital stays, which give them an edge in this department.’ ‘  The copay for Plan 1 was fairly hefty’$175 each day up to $1,400 per stay.’  These could add up for a sick person who had multiple admissions. Emblem Health also sent some Medicare insurance mailers, mostly trying to get me to access their website with my own personal password, which was good for a limited time only.’  They were looking for sales prospects, and I didn’t want to become one, especially since I wasn’t interested in watching some NBA hall of famer on a how-to video telling me how easy it is to choose Emblem’s Medicare options.’  But acting like an average senior who had heard of Emblem Health might, I thought I better take a look at the Emblem plans for New York City. It turns out Emblem offers three HMOs and four PPOs.’  The penalty for being able to go out of network in a PPO is steep. They came with high out-of-pocket maximums’$2,500 for going out of network and $6,700 for staying in network, or a’  $10,000 combined maximum.’  Even though two had no monthly premiums, and two had premiums of less than $100, I didn’t go further with Emblem. While sales people push MA plans with low or no monthly premiums, the premium is not the only thing to consider.’  It’s the mix of policy elements that ultimately determine whether a plan is a good or bad deal.’  And then of course, there’s the unknown of your future health status to consider.’  You need to know how the combination of premiums, in- and out-of-network hospital copays, out-of-pocket limits, drug copays, coinsurance for chemotherapy drugs, and copays for doctor visits interact to determine what a plan will really cost.’  The trade-off for a no-premium plan may be hidden’and high’hospital copays, very high out-of-pocket limits, or the obligation to pay 20 percent of chemotherapy bills.’  It boils down to a game of ‘name your poison.’ I also looked for MA plan information on the Medicare.gov website but did not find it helpful.’  Both the handbook and website gave star ratings for MA plans but they seemed to measure different things, further confusing shoppers who might want to use them.’  The government handbook gave the United-AARP CompleteMosaic plan one star for Member Satisfaction.’  That might be important to know.’  At the same time the government website gave the same plan an overall rating of three stars.’  This certainly raised some questions for me about the usefulness of these stars as a shopping tool. Having done lots of homework, it was time to select a plan to cover Medicare’s gaps.’  Was I going to try one of those Medicare Advantage PPO plans that seemed to offer flexibility and let me keep the doctors that I like?
Source: cfah.org

Medicare Open Enrollment: last chance to review and compare plans

With the holiday season upon us, it’s easy to get busy this time of year. Some pretty important tasks can get left to the last minute. One of those important tasks is ensuring you are in the right health insurance plan in Medicare.  Selecting the right plan is a personal choice, and a lot of thoughtful consideration goes into finding the right match.  But just like the holidays, those key dates come whether or not you are ready.
Source: medicare.gov

The Shift toward Managed Medicare Plans

Managed Medicare plans actually cost more money than the standard Medicare program that simply worries about fees for services conducted, but that isn’t going to be a major problem for the economy. Even though the managed plans are costing us more now, that is likely to charge very soon. The amount of subsidies that are given to the managed plans is likely to be decreased so that the program does not cost any more than the standard Medicare coverage. This means that the companies offering these managed plans will have to find other ways to cover the costs that they are paying for, but it also means that managed plans won’t be any worse for the economy than standard plans. The large shift to Medicare Advantage indicates that people aren’t satisfied with the way that Medicare has been doing things traditionally and there is a good chance that the shift to managed plans is simply the start of a major change in the way that Medicare works.
Source: twistity.com

Smith’s Mom Endorses Medicare Plan in New Ad (Watch Video)

Both parties have been banging the Medicare drum for the 2012 cycle, each with misleading claims about the other party’s plans. Smith’s ad accuses Casey of voting to cut $716 billion from Medicare when he supported Obamacare. However, that $716 billion would affect providers, not beneficiaries. And, Smith has voice support for Rep. Paul Ryan’s budget, which leaves the exact same $716 billion out of Medicare.
Source: politicspa.com

Medicare has Limits on Therapy

When you get this type of therapy, often in home or in an outpatient therapy facility, it may be a good idea to see if you can space your visits further apart to avoid running out of therapy mid stream.  You may also ask your therapist for literature on how to perform the exercises on your own at a gym or in your house, using the therapy appointments as “follow ups”, to measure range of motion or strength, and to learn new exercises.
Source: medicareplansstcharles.com

Feds Say Nursing Homes Overbilled Medicare By $1.5 Billion

Posted by:  :  Category: Medicare

Christiana Care Kicks off Participation in Home Care Program by Christiana CareThe study released this week by the inspector general’s office of the Department of Health and Human Services concluded that nursing homes billed about a quarter of claims incorrectly in 2009 – the year it studied. Most of those claims were “upcoded,” which means Medicare was billed for services that were more extensive than what was provided or needed. Many of the claims were for intensive physical, speech or occupational therapy.
Source: kaiserhealthnews.org

Video: Medicaid, Nursing Homes and Asset Protection

Study by Federal Regulators Finds Higher Rate of Medicare Fraud Among For

A report by Bloomberg News found that the number of civil and criminal claims brought against nursing homes between 2008 to 2012 was more than twice the number of similar claims brought during the prior five-year period. While the companies profiled by Bloomberg denied any wrongdoing, the report includes multiple allegedly unnecessary treatments connected to inappropriate Medicare claims. An eighty year-old resident of a South Carolina nursing home, owned by the third-largest nursing home chain in the country, reportedly died two days after spending eighty-four minutes in a standing frame for occupational and physical therapy. The resident allegedly received this treatment despite being unable to control her head or hold her eyes open. At a Florida facility, a ninety-two year-old male patient allegedly received more than two hours of occupational and physical therapy, according to Medicare billing records, despite having just coughed up blood due to lung cancer. He also died several days later.
Source: marylandnursinghomelawyerblog.com

Forced to Choose: Nursing Home vs. Hospice

The study, using data from the National Health and Retirement Study from 1994 through 2007, looked at more than 5,000 people who initially lived in the community – that is, not in a facility. About 30 percent used the skilled-nursing facility benefit during the final six months of life; those people were likely to be over 85 and family members said, after their deaths, that they had expected them to die soon. (The benefit is commonly referred to as S.N.F., which people in the field pronounce as “sniff”).
Source: nytimes.com

6th Circuit Affirms Civil Money Penalty In Nursing Home Medicare Case

CINCINNATI – A panel of the Sixth Circuit U.S. Court of Appeals on Jan. 28 in an unpublished opinion affirmed the imposition of a civil money penalty for a nursing home’s failure to comply with Medicare regulations over a 28-day period (Omni Manor Nursing Home v. U.S. Department of Health and Human Services, No. 12-3223, 6th Cir.; 2013 U.S. App. LEXIS 2060). Full story on lexis.com
Source: lexisnexis.com

Pebblebrook, Cobblestone’s Nursing Home at Park Springs CCRC, Receives 5

Park Springs (completed in 2007), owned and operated by Isakson Living and professionally managed by Life Care Services, LLC, is a 54-acre campus-style Continuing Care Retirement Community (CCRC) surrounded by Stone Mountain Park. Park Springs is a vibrant community of active adults 62 and above who live in spacious private homes and enjoy a club-inspired lifestyle. Park Springs includes 398 Independent Homes; a Health Center (Cobblestone) with 42 Skilled Nursing rooms (Pebblebrook), 14 Dementia suites (Julia’s Suite) and 20 AL suites (The Bridges); Clubhouse with variety of dining options and common areas; and Fitness Center with lap pool, therapy pool and exercise room. Members live in a detached single-family home, cottage home or condominium-style villa. The community provides dining options in diverse settings and many social, educational and enrichment opportunities. Residential options offering a higher level of service and care are also available on campus. These include home health, assisted living suites, memory care or Medicare-certified skilled nursing and rehabilitation.  As situations change, Members can move into the type of home or environment that best meets their needs.
Source: patch.com

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

Medicare Fraud and Nursing Home Abuse is Not Tolerated in Georgia

Look for signs of malnutrition or dehydration, as well as bruises or unexplained bleeding. Broken bones and fractures may indicate pushing, rough handling, or hazardous conditions within the building itself. Any sign of bed sores needs to be questioned and documented. Talk to your loved one and gently try to discern if he or she is being bullied, sexually harassed, or physically or verbally abused. If you see signs of over or under medication, question it until you receive satisfactory answers. If the person you care about has been injured either by neglect or outright abuse, call the police and call a skilled Atlanta nursing home abuse lawyer to preserve the victim’s rights.
Source: goldmanlawatlanta.com

Sandy highlights nursing home evacuation troubles

In New York, there was confusion at many homes about where patients should be sent. Some sat for hours aboard unmoving ambulances as the drivers waited for orders, only to be taken to the wrong place. Some facilities accepting evacuees wound up overloaded with more patients than they were prepared to handle. With the phones knocked out, relatives struggled to learn where loved ones had been taken. Medical records that were supposed to accompany displaced residents never arrived.
Source: libn.com

The Nursing Home Stopped Medicare Payments Because my Loved One Stopped Improving, but I Heard that’s Illegal

Yes. Denials going back as far as September 20, 2010 can be re-reviewed under the new (old) standard.  So if you or a loved one were in a nursing home in the late summer of 2010 or later, and if you had to pay out-of-pocket for skilled care or therapies after a Medicare denial, then dig out your paperwork.  As the federal case is implemented, Medicare will create a process for re-reviewing these denials in light of the new (old) standard.  Check the Medicare Advocacy Project for updates on this process.
Source: alexislevitt.com

Feds consider exchange option as part of Medicaid expansion deal

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tsweden“What we were looking at was trying to control costs by limiting how many new enrollees we had in the Medicaid system [by making 100-138 ineligible], so it’s a little bit of a different take than we were going for,” he said. As for the idea that folks would opt for the exchange if given the choice, he said, “I believe that to be true. But at the same time I think some people would choose Medicaid and you’re setting yourself up for a great unknown. For the budgeting process, that doesn’t make things any easier.”
Source: arktimes.com

Video: Arkansas Medicare Supplements

Group Wants Government to Rework Revenue Plan for Social Security, Medicare

A group wanting to save Social Security and Medicare from being pared down is telling the federal government to rework its revenue plan. Congress recently approved a tax increase for 1 percent of the country’s wealthiest individuals, but that still leaves a shortfall for revenues that lawmakers want to siphon off from Social Security, Medicare, and other social programs. “If they cut Medicare then I’m going to be affected, because I won’t have healthcare. For the average person, we’re affected more than we know,” says Candis Collins from Americans for Tax Fairness. These protestors want to see the top 2 percent of America’s earners see a tax bump to increase revenues. The group also wants congress to eliminate special tax breaks to corporations.
Source: arkansasmatters.com

Judge Approves Settlement in Medicare “Improved Standard” Case

With the settlement now officially approved, the Centers for Medicare & Medicaid Services (CMS) is tasked with revising its Medicare Benefit Policy Manual and numerous other policies, guidelines and instructions to ensure that Medicare coverage is available for skilled maintenance services in the home health, nursing home and outpatient settings.  CMS must also develop and implement a nationwide education campaign for all who make Medicare determinations to ensure that beneficiaries with chronic conditions are not denied coverage for critical services because their underlying conditions will not improve.
Source: arkansaselderlaw.net

Eyes Turn To Arkansas’ Bold Effort To Cut Medicaid Costs, Add Transparency

First, the three entities analyzed historical billing data to determine the state’s highest-volume and most costly medical conditions. Then, they each individually targeted three conditions for which they would track the costs for “episodes of care” — meaning the total charges of treating patients for that specific illness, everything from office visits, to medications and specialty care. The conditions included perinatal care, upper respiratory infections, attention deficit/hyperactivity disorder, hip and knee replacements, and congestive heart failure.
Source: kaiserhealthnews.org

The Arkansas Republican dilemma on Medicaid

Then in 1996, a new Republican governor, Mike Huckabee, asked a children’s advocate how he could help unhealthy children. Insure them, Amy Rossi said, and she explained that the state could insure children up to 200 percent of the poverty line and have the federal government pay 75 percent of it. Huckabee jumped on the idea and got a Democratic senator, Mike Beebe, to push it through the legislature for him. Thanks to Huckabee, some 325,000 children are insured through Medicaid. He claimed it as his greatest achievement. But here’s the difference: He wasn’t taking something that Barack Obama offered.
Source: arktimes.com

Bipartisan Bill Would Repeal Medicare Hospital Payment Loophole

Sens. Claire McCaskill (D-Mo.) and Tom Coburn, MD (R-Okla.), have introduced a bill that would sunset Section 3141 of the Patient Protection and Affordable Care Act — a controversial provision that sets the Medicare hospital wage index floor for the entire country. Under Section 3141, the Medicare hospital wage index is adjusted so that a state’s urban hospitals must be reimbursed for wages paid to physicians and staff at least as much as rural hospitals. These reimbursements for hospital wages also come from a national pool of money, meaning that if one state receives higher Medicare wages, it will come at the expense of another state. In January, 20 state hospital associations — Alabama, Arkansas, Delaware, Georgia, Iowa, Kansas, Kentucky, Louisiana, Mississippi, Missouri, Nebraska, North Carolina, Ohio, Oklahoma, Oregon, South Carolina, South Dakota, Virginia, West Virginia and Wisconsin — as well as the National Rural Health Association wrote a letter (pdf) to the White House arguing this provision is decimating their Medicare reimbursements.   A Boston Globe report found that Massachusetts had received an estimated $367 million in additional Medicare funding due to Section 3141 because the state’s only rural hospital — Nantucket (Mass.) Cottage Hospital, based in an affluent area with a high cost of living — set an inordinately high floor for wage reimbursements. In total, nine states received higher Medicare wages under the provision, while the remaining 41 lost Medicare funds. Sens. McCaskill and Coburn called the provision “unfair” and said it only benefited hospitals in some states to the disadvantage of many others.
Source: beckershospitalreview.com

The Need for Clear Medicare Information

One every eight seconds – that’s how many baby boomers will reach age 65 during the next 10 years. That’s about 10,000 boomers becoming eligible for Medicare each day. They will join 49 million Americans who are currently enrolled in Medicare, many of whom struggle to understand the program, according to a 2011 survey from UnitedHealthcare and the National Council on Aging. In fact, this survey found that most respondents were not able to accurately identify what each part (A, B, C and D) of Medicare covers, and nearly 20 percent of respondents who were currently enrolled in Medicare said they didn’t know what type of coverage they had.  
Source: thecitywire.com

Disability Rights Center of Arkansas

Among the mostly partisan public discussions of members of the Arkansas General Assembly about the wisdom of expanding Arkansas’ Medicaid program have been those legislators who want Medicaid recipients to “have some skin” in the game. In other words, make them pay for a portion of their services. Notwithstanding the fact that most of the Medicaid recipients DRC serves will receive a maximum of $710 per month in 2013, we see the whole co-pay thing as fraught with peril. We’ve watched as people with mental illness living in residential care facilities (RCFs) have been co-paid to death on their prescription drugs, with the RCF taking a $3 co-pay per prescription out of their paltry $30 per month personal living allowance. On the front end. And despite the fact that the rules in Arkansas for co-pays say if the recipient can’t afford it, they don’t have to pay it. So we are viewing the proposed rule by the Centers for Medicare and Medicaid Services (CMS) for cost sharing by Medicaid recipients with mixed feelings. We can agree that for those who can afford it, co-pays are not necessarily a bad idea. However, the implementation of such a rule seems to be largely left up to Medicaid providers in Arkansas, without consideration of whether the recipient can really afford the co-pay. Discussion of cost sharing (co-pays) begins on page 225 of the 474 page proposed rule. Public comment is due to CMS by 5 p.m. on February 13, 2013.
Source: livejournal.com

1. Getting a Medicare card #GOTAUPR

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaThen just head down, get a queue number, show them your passport and proof of your status (PR) which should be in your passport, fill up a form, and you’re good to go. The only information you really need is an address that they can send your card to when they are done. The rest of your personal and contact information can be updated on a later date. Keep the piece of paper that looks like a receipt that they give you – that’s going to be your temporary card till they send the actual one.
Source: posterous.com

Video: Using a Medicare card, Australia

Don’t Fall for Medicare Card Phone Scam

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

Medicare in Las Vegas, NV: How Do I Get a New Medicare Card?

Whichever method you use, expect a good wait for your card to arrive. It can take several weeks for it to be processed and mailed. In the meantime, doctor’s offices can often use your Medicare number to process claims even if you don’t have your card although it is not preferred.
Source: suncityfinancial.com

Medicare card scam pops up in WI

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Source: dewittmedia.com

Medicare Card Consumer Alert from the District Attorney’s Office!

To prevent identity fraud:  1.  Do not provide personal information to anyone over the phone if you did not initiate the call.  2.  Immediately end any phone conversation with anyone who asks for personal information.  3.  Do not carry your Medicare card with you.  Make a photocopy of the card, cross out the plan number and carry the photocopy with you.  Secure your original card in a safe location such as a safe deposit box.  4.  Report fraudent calls to the Office of the Inspector General, Health and Human Services at 800-447-8477 or http://www.stopmedicarefraud.gov.
Source: wordpress.com

Putting the Medicare Cards On the Table: Court Rules That L

However, from the author’s review of CMS’ statements (both oral and written) on the issue, the question may not necessarily be “is an L-MSA required?” That answer is seemingly “no”— even from CMS’ perspective. Id. Rather, the “issue” may more appropriately be: “Is there an obligation to protect Medicare’s ‘future interests’ as part of a liability settlement?” or, from a more practical position, “Does CMS believe there is an obligation to protect Medicare’s ‘future interests’ as part of a liability settlement?” See id; and Charlotte Benson, CMS Memorandum: Medicare Secondary Payer: Liability (Including Self Insurance) Settlements, Judgments, Awards, or Other Payments and Future Medicals, September 30, 2011. As part of this, consideration should also be given to the fact that recent versions of the MSP manual have included references to both L-MSAs and no fault Medicare Set-Asides. Also, at the time of this article’s publication, CMS has advised that it is in the process of developing regulations surrounding Medicare Secondary Payer compliance regarding future medicals. See pending rule; “Medicare Secondary Payer and ‘Future Medicals’ (CMS-6047-ANPRM),” May 3, 2012. Thus, while CMS may acknowledge that L-MSAs, are not “required,” this other evidence would seem to suggest that on some level, to some extent, and in some manner, the agency believes there is some obligation to consider Medicare’s interests with respect to certain liability settlements, with the “MSA” being just one vehicle or option available toward that end. Assuming that this in fact CMS’ position, the question would then become; “are they correct legally?”
Source: lexisnexis.com

Medicare cards should not expose Social Security numbers

“Making the necessary changes will require significant monetary investments, multiple systems and operational changes, not just for CMS and its contractors, but also for (the Social Security Administration), state Medicaid programs, private health plans and providers that CMS interacts with regarding beneficiary information for enrollment and claims payment,” Tavenner said.
Source: triblive.com

UNDERSTANDING MEDICARE CARD CODES

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Source: seniorcitizenjournal.com

Are you ready for 2013? 4 questions to ask yourself

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

Does Medicare Card shows address?

No there is no such thing on Medicare card…what I have found very easy to get to prove one’s address is bank statement.Go for it… and bank statements are quite handy in this regard.and changes if any can be made by simple visit to bank branch..I have used it whenever I wanted…it is acceptable by Government Dep’ts … Get your proof of age card as well…if you don’t have any… Best luck…
Source: expatforum.com