Reject Bad Advice and Bad Policy Defend Medicare Social Security

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SSApparently Bill Clinton agrees with Republicans that Medicare benefits have to be cut. What the various progressive plans have in common is the recognition of a simple fact: the growing costs of entitlements are driven by spiraling health care inflation in the larger economy. Medicare and Medicaid actually have a better cost control track record than the health care system as a whole. And all these “progressive“ deficit reduction plans repeat the truth that seemingly eludes Gene Sperling: Social Security has its own source of revenue and does not contribute a dime to the deficit. Now the policy implications of these insights are not easy, but they can be politically popular. In addition to attacking the immediate causes of deficits by reversing the Bush tax cuts for the rich, ending at least two wars, cutting obsolete military spending , and regulating the banks – all popular with the American majority – we are going to have to go after the driving forces in the American health care system: the complex of insurance companies, drug cartels, hospital and doctor syndicates, and the food-chemical industrial complex, all of which make Americans unhealthier, while driving up the cost of health care far above the Medicare trend line.
Source: ourfuture.org

Video: Medicare Enrollment Advice

Viewpoints: ‘Zombie’ Plans For Medicare; James Baker’s Grand Bargain Advice; Conservative Govs’ Choices

The New England Journal of Medicine: Reducing Administrative Costs and Improving the Health Care System The average U.S. physician spends 43 minutes a day interacting with health plans about payment, dealing with formularies, and obtaining authorizations for procedures. In addition, physicians’ offices must hire coders, who spend their days translating clinical records into billing forms and submitting and monitoring reimbursements. The amount of time and money spent on administrative tasks is one of the most frustrating aspects of modern medicine. … it may be necessary to establish a senior-level office in the DHHS focused solely on implementation and innovation in the realm of administrative simplification (David Cutler, Elizabeth Wikler and Peter Basch, 11/15).
Source: kaiserhealthnews.org

Some practical advice for Medicare Locals on engaging with the Aboriginal community controlled health sector

It might be frustrating but this is where the strength of the Aboriginal Community Controlled Health Service lies; see what you can learn from it and extrapolate to your relationships with your traditional and emerging constituencies. (NB: These feedback loops will invariably appear idiosyncratic and puzzlingly opaque: stay cool, they’ve been in place and working pretty well for 60,000 years).
Source: com.au

The Medicare Mom: Advice from Cousin Earletta

Having a newborn and a three-year-old at age 61 gives new meaning to “Retired” as in “tired again.” However, the laughs keep coming. My hands are full as my friends say, but they are full of laughter and joy and even fuller because the newborn is six and the three-year-old is ten!
Source: blogspot.com

Legal Advice Doctors Should Give Their Patients on Medicare, Medicaid

As one example (details changed for privacy): I recently spoke with the Smiths, a couple in their late 70s, at the insistence of their daughter, a physician. Like many people of their generation, their primary retirement and heathcare plan consists of social security and Medicare. The couple has retired to a Sunbelt state and now live in a modest home she purchased for them. Recently diagnosed with cancer, Mrs. Smith was covered only by Medicare and had a small supplemental insurance plan. Post-diagnosis, the Smiths’ physician informed them of the course of treatment required and the extraordinary expenses some of the drugs and treatment would require. Given their reliance on Medicare and the real possibility of needing Medicaid nursing home assistance and the medically related financial exposures they face, here’s what we calculated:
Source: physicianspractice.com

Navigating the Health Care System: Resources to Help You Stay Healthy in the New Year

The New Medicaid Opportunity in Illinois under the Affordable Care Act (ACA)

Posted by:  :  Category: Medicare

Love it! Improve it! Medicare for All! by TheeErinTagged with Medicaid, Mental Health, Illinois, Legislation, low income, poverty level, Affordable Care Act, ACA, Obamacare, disability, preventative care, prescription drugs, behavioral health, Medicaid expansion, federal funding, new funding opporunities, local funding, care coordination, managed care, capacity expansion, provider financial increases, primary care, immigrants, refugees, eligibility, Medicare, dual eligibility, Medicare and Medicaid eligibility, medical homes, cost assessments, uninsured population, economy, privacy, HIPAA, individual healthcare choice, individual healthcare control, political graft, unclear language, governmental job loss, healthcare management privatization, life-threatening hardships, provider participation encouragement, timely manner payment processing, Julie Hamos, Federally Qualified Health Centers, FQHCs
Source: wordpress.com

Video: Medicare Advantage Illinois

Medicare, Medicaid & Social Security Vital To Illinois Economy, New Report Finds

Less contentious an issue has been the willingness of both parties to reduce government spending. The president’s plan would call for $350 billion in cuts to health programs, plus another $250 billion in other spending cuts over the next 10 years. Republicans seek to cut $600 billion from health programs and another $600 billion from other, non-specified programs over the same period.
Source: progressillinois.com

CMS AND ILLINOIS PARTNER TO COORDINATE CARE FOR MEDICARE

Waste, Abuse And Mismanagement In Government Health Care (Part 1 of 2) – House Oversight Committee – 2011-04-05 – House Committee on Oversight and Government Reform. Subcommittee on Health Care and the District of Columbia. Witnesses: Panel I: Deborah Taylor, Chief Financial Officer, and Director of the Office of Financial Management, Centers for Medicare & Medicaid Services; Peter Budetti, MD, Deputy Administrator for Program Integrity, and Director of the CMS Center for Program Integrity, Centers for Medicare & Medicaid Services; Gerald Roy, Deputy Inspector General for Investigations, Office of Inspector General, US Department of Health & Human Services; The Honorable Loretta Lynch, United States Attorney, for the Eastern District of New York. Panel II: David Botsko, Inspector General, Arizona Health Care Cost Containment System; Jean MacQuarrie, Vice President for Client Services, Thomson Reuters; Michael Cannon, Director of Health Policy Studies, Cato Institute; Rachel Klein, Deputy Director for Health Policy, Families USA. Video provided by US House of Representatives.
Source: wn.com

Illinois Medicare Eligibility Requirements

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

Labor Conference in Chicago Sees "Medicare for All" as Best Way to Control Costs and lmprove Quality of Care

Conferees were welcomed and inspired by Karen Lewis, president of the Chicago Teachers Union, who shared lessons of her union’s recent successful strike. Lewis drew important parallels between the struggles for quality public education and quality universal health care. A second inspiring keynote came from Nicole Bernard representing the French Confederation of Labor who described the struggle by French workers to defend their national health care plan and pledged strong support for American efforts to win single payer. Congressman John Conyers (D-MI) brought delegates to their feet as he described his plan to resubmit legislation and hold hearings on improved and expanded Medicare for All.  “Health care is a right, not a privilege,” said Conyers. 
Source: pdaillinois.org

Affordable Care Act Helps 201,818 on Medicare in Illinois Save $139,094,886.04 on Prescription Drugs

Washington, DC–(ENEWSPF)–March 19, 2012. As the second anniversary of the Affordable Care Act approaches, new data shows that 201,818 Medicare beneficiaries in Illinois saved a total of $139,094,886.04 on prescription drugs because of the new health care law, Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services (HHS), announced today, an average of $689.20 per individual.  Savings for seniors include a one-time $250 rebate check to seniors who hit the “donut hole” coverage gap in 2010 and a 50 percent discount on covered brand-name drugs in the donut hole in 2011.
Source: enewspf.com

CMS Announces Medicare Advantage and Prescription Drug Program MLR Proposed Rule

Posted by:  :  Category: Medicare

KNOW WHO YOUR CZARS ARE --ENOUGH TO MAKE YOU SICK ---ONLY OBAMA COULD CREATE POSITIONS FOR THESE INCOMPENTENT COMMUNISTS AND SOCIALISTS by SS&SSUnlike the commercial MLR statutory requirement, the Medicare MLR statutory provision does not include language regarding expenditures on quality improvement activities. Nevertheless, the proposed rule provides that MAOs and Part D sponsors may include certain quality improvement expenses in the numerator of the MLR. Like the commercial MLR rules, the proposed rule would permit MAOs and Part D sponsors to count a non-claims expense as a quality improvement activity if it is designed to improve health outcomes, prevent readmissions to hospitals, improve patient safety, promote health and wellness, or enhance the use of health care information technology. In addition to fitting within one of those broad categories, the activity must be designed to meet all of the following criteria: (1) improve health quality; (2) increase likelihood of desired health outcomes in ways that are capable of objective measurement and producing verifiable results; (3) target individual enrollees or specified segments of enrollees or provide benefits beyond the population of enrollees without increasing costs to enrollees; and (4) be grounded in evidence-based medicine. Quality improvement activities may satisfy more than one category, but may not be double-counted. Moreover, any shared quality improvement expenses must be apportioned among entities and lines of business or products.
Source: crowell.com

Video: IVANS Makes Medicare Access Easier

Seniors Need To Be Tenacious In Appeals To Medicare

Medicare officials say appeals are rare, though they would not provide statistics on how many appeals came from beneficiaries rather than from health-care providers, such as hospitals, doctors and nursing homes.  The inspector general’s office in the Department of Health and Human Services reported last month, however, that 85 percent of appeals in 2010 that reached the third level of review, which are decided by an administrative law judge, were filed by health care providers.  And for those who persevere and do appeal a third a third time, the OIG found that the judges reversed 56 percent of all unfavorable decisions in 2010.
Source: kaiserhealthnews.org

BrothersJudd Blog: IF THE MAIN PROBLEM IS THAT CHARGES ARE SO INSANELY HIGH THAT NO INDIVIDUAL COULD EVER PAY THEM….

Unless you are protected by Medicare, the health care market is not a market at all. It’s a crapshoot. People fare differently according to circumstances they can neither control nor predict. They may have no insurance. They may have insurance, but their employer chooses their insurance plan and it may have a payout limit or not cover a drug or treatment they need. They may or may not be old enough to be on Medicare or, given the different standards of the 50 states, be poor enough to be on Medicaid. If they’re not protected by Medicare or they’re protected only partly by private insurance with high co-pays, they have little visibility into pricing, let alone control of it. They have little choice of hospitals or the services they are billed for, even if they somehow know the prices before they get billed for the services. They have no idea what their bills mean, and those who maintain the chargemasters couldn’t explain them if they wanted to. How much of the bills they end up paying may depend on the generosity of the hospital or on whether they happen to get the help of a billing advocate. They have no choice of the drugs that they have to buy or the lab tests or CT scans that they have to get, and they would not know what to do if they did have a choice. They are powerless buyers in a seller’s market where the only sure thing is the profit of the sellers.
Source: brothersjuddblog.com

CMS Implements 0% Medicare Payment Update: Hold Claims for 10 Day : Med Law Blog

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold MPFS claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013). We expect these claims to be released into processing no later than January 16, 2013. The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Claims with dates of service prior to January 1, 2013, are unaffected. Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than January 23, 2013.
Source: medlawblog.com

Avoiding Medicare cliff still has initial consequences for payment : Getting Paid

Finally, the 2013 Annual Participation Enrollment Program allowed eligible physicians, practitioners, and suppliers an opportunity to change their Medicare participation status by Dec. 31, 2012. Given the new legislation, CMS is extending the 2013 annual participation enrollment period through Feb. 15, 2013. Therefore, you have until Feb. 15, 2013, to postmark any participation changes (both elections and withdrawals) that you want to make. The effective date for any participation status changes during the extension remains Jan. 1, 2013, and will be binding for the rest of the year.
Source: aafp.org

Nambucca Heads to benefit from extra government services

"We’ve seen the number of people using the Macksville Medicare office decrease by more than half in the past year. Moving Medicare services to the much larger Nambucca Heads centre fits with this changing demand for services and allows the Department to serve a broader range of residents more conveniently.
Source: gov.au

California WCMSA: Separate Settlements for Each Claim

In some cases in which there are two admitted specific injuries and a cumulative trauma claim, it is not unusual for counsel to enter into three compromise and release settlements, each for $24,999.99, rather than a joint compromise and release for $75,000.00 as an attempt to avoid having to include a WCMSA. It remains to be seen whether CMS would challenge this tactic, but such piecemeal settlements are technically consistent with the California Court of Appeal decision in Benson.
Source: lexisnexis.com

Making Medicare claims and benefits statement clearer, simpler

This MSN redesign is part of a new initiative, “Your Medicare Information: Clearer, Simpler, At Your Fingertips,” which aims to make Medicare information clearer, more accessible, and easier for beneficiaries and their caregivers to understand.  CMS will take additional actions this year to make information about benefits, providers, and claims more accessible and easier to understand for seniors and people with disabilities who have Medicare.  This MSN redesign reflects more than 18 months of research and feedback from beneficiaries to provide enhanced customer service and respond to suggestions and input.
Source: medicare.gov

Obama Opposes Raising Medicare’s Eligibility Age To Reduce Spending

Posted by:  :  Category: Medicare

California Healthline: Sequestration Would Hurt Rural Health Providers, Study Shows Rural health care providers heard bleak predictions about the potential effects of sequestration at the National Rural Health Association’s 24th annual Rural Health Policy Institute last week. If Medicare reimbursement is reduced by 2 percent as specified in the sequestration process due to start in three weeks, 63 rural hospitals will no longer be profitable and 482 rural health care jobs will be lost nationally, according to estimates by iVantage Health Analytics. California’s rural hospitals won’t be as hard-hit as those in the Midwest and South, according to the research, but all health care providers who treat Medicare beneficiaries will feel the pinch at some level, said Gregory Wolf of iVantage (Lauer, 2/11).
Source: kaiserhealthnews.org

Video: EHR: Medicare Incentive Program Attestation Webinar for Eligible Professionals

Oklahoma Medicare Eligibility Requirements

You’re not alone if the term “Medicare eligibility” leaves you scratching your head, wondering if you qualify for the full package of benefits. It’s true, there are a few restrictions, but for the most part, as long as you’re 65 or older and a permanent citizen, you should be qualified for health care benefits through Medicare. In some cases, it’s possible to be eligible for Medicare even if you’re younger than 65. If you have End-Stage Renal disease or have been on Social Security disability benefits for over 24 months, you’re eligible at any age.
Source: oklahomamedicarehealth.com

Illinois Medicare Eligibility Requirements

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

Taking Medicare’s eligibility age off the table

CARNEY: Again, as part of a big deal, part of a comprehensive package that reduces our deficit and achieves that $4-trillion goal that was set out by so many people in and outside of government a number of years ago, he would consider that the hard choice that includes the so-called chain CPI, in fact, he put that on the table in his proposal, but not in a cherry-picked or piecemeal way. That’s got to be part of a comprehensive package that asks that the burden be shared; that we don’t, as some in Congress want, ask seniors to bear the burden of further deficit reduction alone, or middle-class families who are struggling to send their kids to college, or parents of children who are disabled who rely on programs to help them get through.
Source: msnbc.com

What Are the Medicare Eligibility Requirements?

Once reaching the age of 65 years old a person qualifies for medicare. One must also be a US citizen or a permanent legal resident. One of the last requirements is having paid into the medicare system while working. The general rule is having paid into the social security system with approximately 10 years of work, or 40 credits. An individual may also qualify off of their spouses working if necessitated. The spouse must be at least 62 and the qualifying individual must still meet the 65 year requirement. With additional proof an individual may also qualify based on the work benefits of a deceased or divorced spouse.
Source: seniorcorps.org

Many Years Young: Obama rules out raising Medicare eligibility age to cut spending

(Reuters) President Barack Obama has ruled out raising the age that Americans become eligible for Medicare, the government health insurance program for seniors, as a way to reduce the government’s deficit, a White House spokesman said on Monday.
Source: manyyearsyoung.com

Daily Kos: Open thread for night owls: Raising Medicare eligibility age would hurt minorities most

un-Constitutional, since illness and injury are not age-dependent. Separating populations by age and income is little more than a sop to segregationist sentiments — sentiments which, in turn, merely satisfy an ideological commitment to hierarchy as a fundamental principle of society. Ranking humans in order to give some more or less authority over others is not natural. If humans are equal, admittedly an ideological commitment, but one that is enshrined in our organizing document, then hierarchy is in basic conflict. Insisting on it merely serves to undermine our democracy. Of course, we have a long history of not living up to our aspirations. But, that’s what moving forward is about. If we are going to make progress, then irrelevant distinctions have to be removed. Medicare should be an option for all, especially now that all income earners are paying into it. Money, btw, is a social utility. People who use it incur some obligations for our communal certification that their IOUs are good. If some people get along with handshakes, more power to them. We won’t expect them to pay in.
Source: dailykos.com

New Mexico Medicare Eligibility Requirements

“I recently found myself back in the U.S. after being gone for almost 20 years. While living abroad I had a totally different type of health insurance schematic to learn and live within. Landing back in the U.S. and knowing that acquiring health insurance was an important aspect to being a responsible parent and adult, I was blown over once presented with the options and information that I needed to wrap my head around. Thankfully, I came upon Marc Lallier in my research and for the first time I no longer felt overwhelmed and suffocated by it all but felt a sense of great relief. Marc presented the information to me clearly with patience and kindness and allowed me to ask many questions throughout my learning curve. Instead of overwhelming me with information, he talked me through the process and presented options to me step by step helping me to find the best fit for my family and our needs. I am truly thankful to Marc for his efforts and patience and wish to express my sincere thanks to him for an excellent job, well done. “
Source: newmexicomedicarehealth.com

CMS Announces Medicare Advantage and Prescription Drug Program MLR Proposed Rule

Posted by:  :  Category: Medicare

Unlike the commercial MLR statutory requirement, the Medicare MLR statutory provision does not include language regarding expenditures on quality improvement activities. Nevertheless, the proposed rule provides that MAOs and Part D sponsors may include certain quality improvement expenses in the numerator of the MLR. Like the commercial MLR rules, the proposed rule would permit MAOs and Part D sponsors to count a non-claims expense as a quality improvement activity if it is designed to improve health outcomes, prevent readmissions to hospitals, improve patient safety, promote health and wellness, or enhance the use of health care information technology. In addition to fitting within one of those broad categories, the activity must be designed to meet all of the following criteria: (1) improve health quality; (2) increase likelihood of desired health outcomes in ways that are capable of objective measurement and producing verifiable results; (3) target individual enrollees or specified segments of enrollees or provide benefits beyond the population of enrollees without increasing costs to enrollees; and (4) be grounded in evidence-based medicine. Quality improvement activities may satisfy more than one category, but may not be double-counted. Moreover, any shared quality improvement expenses must be apportioned among entities and lines of business or products.
Source: crowell.com

Video: Spanish Telenovela for CMS “Medicare esta de su lado”

CMS Issues MLR Rules For Medicare Plans

Medpage Today: CMS Issues Rules On Loss Ratios For Medicare Plans Rules that spell out what Medicare plans must spend on care rather than marketing and overhead will mirror those of commercial plans, the Obama administration said late Friday. Starting in 2014, Medicare Advantage plans and Part D prescription drug plans will have to spend 85 percent of revenue on clinical services, prescription drugs, quality improvements, and other direct patient benefits, the Centers for Medicare and Medicaid Services (CMS) said in a proposed rule that details medical loss ratio (MLR) requirements established by the Affordable Care Act (Pittman, 2/18).
Source: kaiserhealthnews.org

CMS issues proposed Medicare Advantage, Part D regs

Elderly and disabled patients enrolled in Medicare will for the first time receive an annual reduction in out-of-pocket costs for drugs, the government announced. The standard deductible for plans in Medicare’s drug program, called Part D, will be $310 in 2014, more
Source: newsplurk.com

Voices Weighs In on CMS’s Proposed Rule for Medicaid, CHIP & the Health Insurance Exchanges

At the same time, the Proposed Rule could be improved in a number of ways. Voices is especially concerned about the waiting and lock-out period components. These changes enshrine an anachronism in a reformed health insurance system predicated on the idea that all Americans are required to be insured. By creating a waiting list or lock-out period, CMS has perpetuated the flawed notion that so-called “crowd-out” is of major concern in providing health insurance to our children and misunderstands the impact that even a 90-day period of “going bare” could have on our most vulnerable populations. A child is not a little adult, and ¼ of a year without health insurance can have a potentially detrimental impact on his/her healthy development.
Source: voices.org

CMS Releases Proposed 2014 Payment Plan for Medicare Part D, Advantage

For the first time in Medicare Part D’s history, CMS would lower beneficiary’s deductibles and copays for covered prescription drugs as part of the agency’s proposed payment plan for 2014. Among other features of the proposed rule (pdf) are details regarding the health law’s 85 percent medical loss ratio requirement for Medicare Advantage and prescription drug plans. The proposed rule would also forbid plans from raising costs to members more than $30 per member per month, which is even more stringent than the previous cap of $36 per member per month. Another key element of the rule would be a new requirement on Part D pharmacies to require a beneficiary’s consent for each prescription drug delivery unless he or she personally requested the refill. That’s a move to help eliminate unwanted shipments to covered Medicare beneficiaries who could be billed for drug shipments they no longer required.
Source: beckershospitalreview.com

CMS: Medicare competitive bidding program for durable medical equipment expanding after successful first year

CMS hailed the first round as a success during a call with reporters Wednesday. By replacing fee schedules with prices determined through competition, the bidding process resulted in savings for beneficiaries, taxpayers and the Medicare program, said Jonathan Blum, deputy CMS administrator and director of the CMS Center for Medicare.
Source: mcknights.com

CMS rolls back Medicare Part D deductibles for 2014

Greater Protection for Beneficiaries: CMS proposes to require Part D plan pharmacies to obtain enrollee consent prior to each delivery, unless the enrollee personally requests the refill. This proposal is in response to complaints from beneficiaries who have received and been charged for unnecessary and unwanted prescriptions because of “auto-ship” services. CMS intends to again use its authority, provided by the health care law, to protect Medicare Advantage enrollees from significant increases in costs or cuts in benefits, and, for the 2014 contract year, proposes reducing the amount of any permissible increase to $30 per member per month (down from $36 per member per month in previous years).
Source: medicarewire.com

CMS Proposes Medicare Advantage, Part D Drug Plan Medical Loss Ratio Rule and Advance 2014 Rate Information : Health Industry Washington Watch

On February 15, 2013, CMS released a proposed rule implementing the ACA’s medical loss ratio (MLR) requirements for Medicare Advantage (MA) and prescription drug (Part C and Part D) plans. Under these provisions, which are intended to limit plan spending on marketing, overhead, and profit, MA organizations and Part D plan sponsors will be required to report their MLR, reflecting the percentage of contract revenue spent on clinical services, prescription drugs, quality improving activities, and direct benefits to beneficiaries in the form of reduced Part B premiums. CMS has generally aligned the Medicare MLR rules with commercial MLR regulations that went into effect January 1, 2011.  Plan sponsors that do not have an MLR of at least 85% will be subject to payment remittance; if a plan sponsor fails to meet MLR requirements for more than 3 consecutive years, it also will be subject to enrollment sanctions and, after 5 consecutive years, to contract termination. CMS expects the first year of MLR reporting to occur in 2015 for the 2014 contract year. Comments on the proposed rule will be accepted for 60 days. The official version of the proposed rule will be published in the Federal Register on February 22, 2013.
Source: healthindustrywashingtonwatch.com

Election Over, Obama Announces Medicare Cuts to Fund ObamaCare

During the 2012 election campaign, Democrats denied that ObamaCare made $716 billion in cuts to Medicare in order to provide funding toward $1.9 trillion in new entitlement spending over the next ten years. In an announcement on Friday, however, the Obama administration revealed that it would be significantly reducing funding for Medicare, a move that one health insurance analyst said “would turn almost every plan in the industry unprofitable.” Health insurance stocks tumbled following the announcement that a big chunk of the Medicare cuts would come from the popular Medicare Advantage program, a market-oriented system in which participants can choose coverage by a private company that contracts with Medicare to provide all Part A and Part B benefits. According to health care analyst Carl McDonald, the new rates proposed by the Obama administration will have the net effect of reducing payments to Medicare Advantage plans by seven to eight percent in 2014. McDonald projects: “If implemented, these rates and the program changes CMS [Centers for Medicare and Medicaid Services] is suggesting would be enormously disruptive to Medicare Advantage, likely forcing a number of smaller plans out of the business and creating disarray for many seniors.” According to Richard Foster, former chief actuary to the Medicare program, ObamaCare’s cuts to Medicare Advantage will likely force half of its current participants back into the old Medicare program, originated in 1965. It is estimated that this change will cost Medicare enrollees an average of $3,714 in 2017 alone. Democrats have long been unfriendly toward the Medicare Advantage plan, which was passed as part of the Balanced Budget Amendment of 1997 and has seen tremendous growth over the past 10 years. Today, more than 25 percent of seniors receive their health benefits through Medicare Advantage. Regarding the cuts, America’s Health Insurance Plans’ (AHIP) president Karen Ignagni said, “Washington cannot tax and cut Medicare Advantage this much and not expect seniors to be harmed.” Last year it was revealed that, while AHIP was openly supporting ObamaCare and working on a deal with the White House, it was also secretly funneling over $100 million to the Chamber of Commerce to be spent on advertising designed to convince Americans that the new legislation should be defeated. The administration’s proposal is open to outside comments until March 1st, ahead of the final announcement of the cuts on April 1st. READ FULL SOURCE ARTICLE: 02/20/2013
Source: newmediajournal.us

CMS Releases Parts C and D proposals, Reduces Part D Deductible for 2014

The 2014 advance notice and call letter notes that some pharmacies do not always verify that a beneficiary still wants a drug before delivering each refill, and others automatically deliver new prescriptions that were phoned in or e-prescribed without confirming that the beneficiary wants the prescription filled and delivered. When the prescription has been delivered, pharmacies cannot return the medication to stock and generally do not reverse the claim if the patient does not want it. To abate this practice, CMS proposed the new requirement for 2014 that pharmacies obtain consent to deliver a prescription, either new or refill, before each delivery.
Source: wolterskluwerlb.com

Article > US health insurers’ profit cap to include prescription drugs from 2014

The MLR rules note that many insurance companies spend “a substantial portion of consumers’ premium dollars on administrative costs and profits, including executive salaries, overhead and marketing.” The ACA requires health insurers to submit data on the proportion of premium revenues spent on clinical services and quality improvement (which constitute MLR), and to issue rebates to enrolees if their spending on these benefits does not meet the minimum percentages. The proposed new rule will require Medicare Advantage and Medicare Prescription Drug plans to meet a minimum MLR from the start of next year. “Plans must spend at least 85% of revenue on clinical services, prescription drugs, quality improvements, and or/direct benefits to beneficiaries in the form of reduced Medicare premiums. Enrolled seniors and individuals with disabilities will get more value and better benefits as plans spend more on health care,” says CMS.
Source: pharmatimes.com

LeadingAge: Adult Day: Opportunities to Contract with Certain Medicare Advantage Plans

We are pleased that the Centers for Medicare and Medicaid Services (CMS) concurred with LeadingAge’s position that Medicare should allow Fully Integrated Dual Eligible Special Needs Managed Care Plans (FIDE-SNPs) to offer additional supplemental home and community-based benefits, such as adult day services, to its eligible subscribers beyond those supplemental benefits that Medicare Advantage (MA) plans are allowed to offer. 
Source: leadingage.org

DHS Welcomes New Immigrants to the World of Benefits

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSA Republican Budget Committee staffer wrote that the issue is not only the offering of welfare benefits without eligibility, but also the fact that the government is providing immigrants visas with the expectation that they will avail themselves of government assistance. “One of the important points about the legal problems with the DHS site and materials is not only the issue of immigrant eligibility, but the fact that U.S. immigration officials are obviously granting visas to those they believe will and should be receiving government assistance,” the staffer wrote in an email to The Daily Caller. “Immigration law is supposed to operate so that individuals at risk for being placed on public assistance are not admitted in the first place.”
Source: usbordersecurity.info

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Who's eligible for financial assistance under Medicare Part D?

A person’s state of residence can affect the options available. Thirty states had their own Rx aid programs for seniors or persons with low income and no insurance. Some of the state pharmacy assistance programs (SPAPs) are being dissolved as Medicare coverage becomes available. Other state assistance plans will continue. Each state is free to modify its SPAP to be compatible with Medicare plans. Some of them may elect to fill gaps in the Medicare benefit. For example, a state plan may include drugs not covered by Medicare or a limited number of nonprescription items. Any supplementary, or “wrap-around,” benefits will be coordinated between the SPAP and the available Medicare plans. Any cost sharing paid by the SPAP for Medicare-covered drugs can be applied to the individual limit on out-of-pocket expenses established by the law.
Source: modernmedicine.com

Darling Downs South West Queensland Medicare Local: Assistance available for flood affected residents

Residents living in the South Burnett, Toowoomba, Southern Downs and Western Down Regional Council areas can access the Personal Hardship Assistance Scheme. Grants are now available to support those families experiencing personal hardship. It covers the immediate, unexpected basic costs of essential items such as food, clothing and accommodation due to the extreme weather.
Source: blogspot.com

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

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

Okla. Medicare Assistance Program educates seniors about fraud

DURANT, Okla., Feb. 20, 2013 – Choctaw Casino Resort in Durant, Okla., a AAA Four Diamond resort and entertainment destination, is bringing the Charlie Daniels Band, known for quintessentially southern music, to a sold out crowd at CenterStage on Friday, March 8 at 8 p.m. Doors open at 7 p.m. Read More
Source: kxii.com

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

How can I get Financial assistance for hip replacement surgery in Chile?

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Source: answares.com

How Does Medicare Part D Work?

Of the four parts of Medicare, Part D is the newest and the most complex. I still get asked what is Medicare Part D which means that the government is failing to do a proper job of educating seniors on this very important and vital part of Medicare. Medicare Part D covers prescription drugs that are typically filled at your local pharmacy or filled through mail order. The typical Part D drug plan consists of four Tiers generally referred to as Tier 1, Tier 2, Tier 3, and Tier 4. Tier 1 is for generic drugs, Tier 2 is for Preferred Brand, Tier 3 is for Non-Preferred Brand, and Tier 4 is for Specialty drugs. We are now also starting to see a 5 Tier structure with some of the Medicare Part D plans. The extra Tier is used with the generics creating a Preferred Generic as well as a Non-Preferred Generic.
Source: animalus.info

Lapham Center offers free legal, Medicare, financial services

Attorney Michael Nedder of Nedder and Associates, LLC comes to the center one Tuesday each month for private, 15-minute legal consultations. He can answer questions about powers of attorney, trusts, wills, guardianships, living wills, IRA custodianships, and more. Appointments are held to strictly 15 minutes. Call 203-594-3620 to schedule an appointment in February.
Source: ncadvertiser.com

Part D: Bending the Medicare Cost Curve

Posted by:  :  Category: Medicare

Congressman Brad Sherman, California’s 27th District (D) by cliff1066™Part D’s 10-year projection has now been reduced by over $100 billion the past three years, and these projections are almost half of their initial estimated cost when the program was enacted seven years ago.  Through market-based competition, Part D is successfully able to offer a mix of plans to help seniors access medicines which, in turn, helps them adhere to doctors’ orders. This improved use of medicines helps lower other health costs, such as hospitalizations and expensive procedures.
Source: phrma.org

Video: Medicare/Medicaid Sales Careers

Hospitals: Medicare reforms preferable to cuts

The American Hospital Association has expressed support for several proposed structural reforms to Medicare as alternatives to reductions in healthcare provider payments, according to a letter from AHA Executive Vice President Rick Pollack to Sen. Orrin Hatch, R-Utah. The AHA and other provider representatives have voiced concern that negotiations to avoid the upcoming budget sequester and to reduce the federal deficit could lead to additional cuts in payments to providers. Such cuts may be more tenable politically than adjustments to benefit levels. Since 2010, according to the AHA, Congress has authorized $95 billion worth of reductions in hospital payments. “Simply ratcheting down provider payments is not real reform.

Medicare Pay Cut Averted but Uncertainty Remains for Physicians

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSThat increasing unreliability is already affecting physicians and patients. In Texas, for instance, the number of physicians accepting Medicare patients dropped from 78 percent in 2000, to 58 percent in 2012, according to a recent survey by Texas Medical Association. That decline in Medicare-accepting physicians would certainly have accelerated throughout the country if Congress had not delayed the SGR pay cut Tuesday.
Source: msochealth.com

Video: How To Stop Medicare Fraud.camrec.avi

Medical Consultants of Palm Beach

Our Promise of Quality Services In-House Laboratory Drawing & Testing Coumadin Clinic to Measure Prothrombin Time Electrocardiograms 24 Hours Holter Monitoring Echocardiography Pulmonary Function Testing Diagnostic Ultrasound & Doppler Rapid/Same Day Scheduling
Source: moneysavermag.com

For every silver lining, a cloud: The reality of Medicare incentive payments, audits

The second significant commitment every provider must make is to keeping an excellent record of each patient encounter: focused, thorough, and legible. The record will clearly show the reason for each visit while providing clear evidence that each element of the encounter was relevant to the needs of the patient and, in the words of the insurers, “reasonable and necessary.” Each patient is unique, and each patient encounter is unique, so the doctor may need to help the auditor understand why a specific question was asked or test performed. That will require some careful thought on the part of the doctor, but it often will be effective in convincing the auditor that the doctor did what was appropriate and therefore “reasonable and necessary.”
Source: newsfromaoa.org

Charts of the Day: Doctor Pay in America and Other Countries

Weirdly, in 24,000 words which include a lot of railing against the large salaries enjoyed by hospital executives, Brill never supports or clarifies this assertion: he never says how much money doctors deserve, how much they actually make, or how high physician salaries would need to be in order to make future doctors want to practice. That last one, in particular, seems very unconvincing to me: the world is full of highly-qualified doctors who would love to be able to practice in the U.S. for much less than the current going rate.
Source: motherjones.com

Chilaw medicare Consultants

A woman admitted at the Chilaw General Hospital and receiving treatment for injuries sustained from an accident, has committed suicide by hanging herself within the hospital premises. The 40-year-old female was found hanging inside a toilet by hospital staff last night, police said.
Source: blogspot.com

Sorting out Medicare Enrollment

There are 28 Part D prescription drug plans available in Boulder County for 2013.  They all have different premiums, deductibles, copays, and categories of drugs.  Each plan has a formulary, which is a list of drugs they cover and how much enrollees would have to pay out of pocket for each medicine.  On Medicare.gov you can enter in your prescriptions and compare costs from plan to plan.  There are 24 Medicare Advantage plans available locally and over 20 Medigap insurers, each with several flavors of coverage.
Source: yellowstonefinancial.com

Innovative Healthcare Consultants

Earlier this summer, the federal government approved an 11.1% cut in Medicare rates effective on October 1, 2011. As that date nears, seniors and elder care professionals are now bracing for the impact of those cuts – and desperately seeking ways to slash expenses in preparation for significantly reduced reimbursements. Meanwhile, government officials and elected representatives continue to grapple with further deficit cuts to balance the national budget; and according to Bloomberg Business Week, gridlock may be the industry’s only protection against further cuts to Medicare, Medicaid, and other benefit programs – all of which would have a profound effect on health care employees, aging seniors and low-income individuals.
Source: delmartimes.net

Different payer, different rules, different audit

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

Another Reason We Need Medicare for All

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /This builds upon previous research that shows the Great Recession has seriously impacted older Americans’ ability to retire. An estimated 62 percent of working Americans now report they’re planning to put off their retirement — up from 42 percent in 2010 — largely due to job losses and financial insecurity. These issues go hand-in-hand particularly because, as health care costs continue to rise, Americans are increasingly worried about being able to afford their insurance coverage…
Source: politicsplus.org

Video: 2012 Open Season: Medicare and the Federal Employees Health Benefits (FEHB) Program

New Medicare Tax Goes Into Effect January 2013: Year

Deferred compensation is not generally subject to Medicare until it is vested and ascertainable. For defined benefit plans, this means that Medicare tax often is not paid until an employee terminates employment, when the total value of the plan benefit is ascertainable. For defined benefit deferred compensation plans that currently have vested and accrued benefits, the employee can electively pay FICA taxes presently for vested, accrued benefits on an estimated basis. If such early elections are made in 2012, the additional Medicare tax can be avoided for amounts accrued and vested this year. Early FICA inclusion will also exempt the future value of that amount from any additional FICA tax, including the additional .9 percent rate applicable to years after 2012.
Source: jdsupra.com

Additional 0.9 percent Medicare tax on wages starts January 1st

For partners in a general partnership and shareholders in an S corporation, the tax applies to earned income that is paid as compensation to individuals holding an interest in the entity. Partnership income that passes through to a general partner is treated as self-employment income and is also subject to the tax, assuming the income exceeds the applicable thresholds. However, partnership income allocated to a limited partner is not treated as self-employment and would not be subject to the 0.9 percent tax. Furthermore, under current law, income that passes through to S corporation shareholders is not treated as earned income and would not be subject to the tax.
Source: cgmcpa.com

Employee Portion Medicare Increases for 2013 : ADP Compliance Insights

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Source: adpcomplianceinsights.com

New insights into the 3.8% Medicare surtax

Here’s the whole story: Effective Jan. 1, 2013, the 3.8% Medicare surtax applies to the lesser of “net investment income” (NII) or the amount by which modified adjusted gross income (MAGI) exceeds a threshold of $200,000 for single filers and $250,000 for joint filers. For example, if you’re a joint filer and have annual NII of $100,000 and a MAGI of $300,000 in 2013, you must pay a surtax of $1,900 (3.8% of the $50,000 above the MAGI threshold of $250,000). For estates and trusts, the surtax applies to the lesser of undistributed NII or adjusted gross income (AGI) above the taxable income threshold for the highest tax bracket.
Source: businessmanagementdaily.com

Social Security and Medicare Update

For social security beneficiaries under the full retirement age, the annual exempt amount increases to $15,120 in 2013 up from $14,640 in 2012. These beneficiaries will be subject to a $1 reduction in benefits for each $2 they earn in excess of $15,120 in 2013. However, in the year beneficiaries reach their full retirement age, earnings above a different annual exemption amount ($40,080 in 2013, up from $38,880 in 2012) are subject to $1 reduction in benefits for each $3 earned over this exempt amount. Social security benefits are not reduced by earned income beginning with the month the beneficiary reaches full benefit retirement age. But remember, social security benefits received may be subject to federal income tax.
Source: hermancpa.com

HANYS Benefit Services: Questions and Answers on the Additional Medicare Tax

If a former employee receives group-term life insurance coverage in excess of $50,000 and the resulting income is in excess of $200,000, how does an employer report Additional Medicare Tax on this? The imputed cost of coverage in excess of $50,000 is subject to social security and Medicare taxes, and to the extent that in combination with other wages it exceeds $200,000, it is also subject to Additional Medicare Tax. When group-term life insurance over $50,000 is provided to an employee (including retirees) after his or her termination, the employee share of social security and Medicare taxes and Additional Medicare Tax on that period of coverage is paid by the former employee with his or her tax return, and is not collected by the employer. An employer should report this income as wages on Form 941, Employer’s Quarterly Federal Tax Return (or the employer’s applicable employment tax return), and make a current period adjustment to reflect any uncollected employee social security, Medicare, or Additional Medicare Tax on group-term life insurance. However, unlike the uncollected portion of the regular (1.45 percent) Medicare tax, an employer may not report the uncollected Additional Medicare Tax in box 12 of Form W-2 with code N.
Source: hanysbenefits.com

farmdocdaily: Farms and the New 2013 Medicare Tax Increases

The total amount of capital gain and depreciation recapture is $365,000 ($300,000 + $50,000 + $15,000). Samantha did not materially participate in the farming activity for 2013. She worked full-time as a stockbroker. In addition to paying capital gains tax on the $300,000 gain on the sale of the farmland, she will also pay the 3.8% Medicare tax on some or all of that capital gain and on the depreciation recapture amount on the assets sold. The total amount of Medicare tax she will pay on the transaction depends upon her income from other sources and how much income she has over the $200,000 threshold for a single filer that applies once her other income and the income from the farm sale are reported. If Samantha has $200,000 or more income from her stockbroker position, the 3.8% Medicare tax will apply to the entire capital gain and depreciation recapture amount. Her total amount of the new Medicare tax will be $13,870 (3.8% X $365,000). If she has under $200,000 of income from other sources, only part of the farm sale transaction (that amount in excess of $200,000 of income) will be subject to the new 3.8% Medicare tax.
Source: illinois.edu

Get Ready For Enrolled Agent Education on New Medicare Tax on Investment Income

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Source: fastforwardacademy.com

Anthem Medicare Preferred PPO Plan and Rates

Posted by:  :  Category: Medicare

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Source: johnconner.com

Video: Is Freedom Blue PPO a Medicare Supplement?

Medicare Targets Health Plans With Low Ratings

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

California Medicare Insurance: Review of Anthem Medicare Preferred PPO

The biggest difference is that is now a Local PPO as opposed to a Regional PPO, which means many people were cut off. The plan used to cover the entire state of California and now only a handful of counties will be able to have access to Medicare Advantage PPO network. In addition. only 3 of the counties will continue to receive the “Zero Cost” option; Los Angeles, San Diego and Ventura. All other counties will now have a monthly premium for this plan ranging from $40-131/mo. For some this is no problem but for many Medicare beneficiaries who are dependent upon Social Security or on a fixed income, this raises huge issues. 
Source: blogspot.com

Medicare Advantage: Anthem Medicare PPO Alternative in Las Vegas, NV

The second option is to upgrade to a Medicare Supplement.  Because your plan is not renewing, you have the guarantee issue right to a supplement.  You cannot be denied for health history.  The monthly cost will be higher than that of the PPOs, but a supplement will give you freedom to see any doctor that accepts Medicare and you will no longer have co-payments if you select a Medicare Supplemental Plan F.
Source: suncityfinancial.com

Anthem blue cross ppo, mri

Anthem Blue Cross Dental Plans – Domestic. Blue Cross – Amazon.de Niedrige Preise, Riesen-Auswahl und kostenlose Lieferung ab nur € 20 Receive affordable California health insurance and health care coverage with Anthem Blue Cross. Visit and design a personalized health care plan today. Anthem Medicare Preferred Standard PPO, Blue Cross Senior Secure Plan hmo,blue cross freedom blue , Freedom Blue application . freedom blue Rx, freedom ppo , freedom 2012 Plan (Non-Medicare) This document is not a guarantee of benefits. It is a summary intended for communication purposes. rev 4/12 UCSB Health Care Facilitator 893 Anthem Medicare Preferred Standard PPO ,.
Source: rediff.com

Anthem Blue Cross Introduces Medicare Preferred PPO

One of the newest Medicare Advantage plan in California for 2012 is the Anthem Medicare Preferred Standard PPO or AMP. The Anthem Medicare Preferred is the newest successor to the Freedom Blue Regional PPO plan that became very popular over the past few years. The plan offers significant freedom of choice in regards to your medical service providers. The AMP PPO plan is only available in select counties throughout California and the benefits are different from county to the next. The plans are grouped below by counties that share the same benefits:
Source: wordpress.com

Anthem Blue Cross Helath Insurance Latest Posts

For 2013 Anthem has three Medicare Advantage PPO plans. The Anthem Blue Medicare Access Value PPO for $34. The Anthem Medicare Preferred Standard PPO for $40, and the Anthem Medicare Preferred Select PPO for $69 per month. All three offer the great access to the Anthem Medicare PPO doctors and hospitals. Plus the added benefit of being able to see any doctor or hospital willing to see you, outside of the Anthem PPO network.
Source: blogcatalog.com

How to Choose the Medicare Advantage Plan that’s Best for You

Medicare Advantage plans can be attractive because of the low or $0 monthly premiums insurers charge.  Like anything in life, there are trade offs and sacrifices we all have to make.  When it comes to Medicare Advantage plans, the trade offs are usually less freedom when it comes to which doctors and hospitals you can use as well as more restrictions or red tape when it comes to getting services covered.  In order to choose a Medicare Advantage plan wisely, I’ve come up with an easy guideline to follow.  Following these steps should hopefully ease the potential frustrations within Medicare Advantage.
Source: medicareplansstcharles.com

‘Zero, Zero, Zero’ Medicare Advantage Plan

In Missouri (excluding 30 counties in the Kansas City area) Anthem Blue Cross and Blue Shield is the trade name for RightCHOICE® Managed Care, Inc. (RIT), Healthy Alliance® Life Insurance Company (HALIC), and HMO Missouri, Inc. RIT and certain affiliates administer non-HMO benefits underwritten by HALIC and HMO benefits underwritten by HMO Missouri, Inc. RIT and certain affiliates only provide administrative services for self-funded plans and do not underwrite benefits. Independent licensees of the Blue Cross and Blue Shield Association. ®ANTHEM is a registered trademark of Anthem Insurance Companies, Inc. The Blue Cross and Blue Shield names and symbols are registered marks of the Blue Cross Blue Shield Association. Additional information about Anthem Blue Cross and Blue Shield in Missouri is available at www.anthem.com.
Source: springfieldmonews.com

Medicare in Las Vegas, NV: Anthem Preferred PPO Is Leaving Las Vegas in 2013

In 2013, the Anthem Preferred PPO Medicare Advantage (MA) Plan will no longer be available in Clark County.  If you are a member of the Anthem PPO, you must choose another option before December 31, 2012, or you will go back to original Medicare on January 1, 2013. The fact that this plan is not continuing may be disconcerting, but it may also be a good opportunity.  If you have been denied a Medicare Supplement in the past due to health reasons, you can no longer be denied.  In other words, if you are on Anthem PPO right now, you have a guarantee issue right for a Medicare Supplement in 2013. As an Anthem member, you have two options:
Source: suncityfinancial.com