Avoiding The ‘Fiscal Cliff’ Likely Means Changes In Medicare

Posted by:  :  Category: Medicare

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

Video: Stairlift Medicare – Will Medicare Provide Stair Lifts For Seniors?

What Medicare changes could mean to local hospitals

Topics: Centers for Medicare and Medicaid Services, Healdsburg District Hospital, Health Care Update 2-18-2013, Kaiser Permanente, Marin General Hospital, Medicaid, Medicare, North Bay Business Journal 2-18-2013, Novato Community Hospital, Palm Drive Hospital, Patient Protection and Affordable Care Act of 2010, Petaluma Valley Hospital, Queen of the Valley Medical Center, Santa Rosa Memorial Hospital, Sonoma Valley Hospital, St. Helena Hospital, Sutter Medical Center of Santa Rosa
Source: northbaybusinessjournal.com

Projected Medicare Spending Already Came Down by Half a Trillion

That’s important to remember because it was in late 2010 — and based on CBO’s August 2010 projections — when Fiscal Commission co-chairs Erskine Bowles and Alan Simpson issued their original budget proposal, calling for slightly more than $300 billion in Medicare spending cuts through 2020. The original Bowles-Simpson proposal is often considered an appropriate starting point in evaluating whether other deficit-reduction proposals should be viewed as responsible approaches to the deficit problem.
Source: firedoglake.com

Changes in Medicare Part D for 2013

Open Enrollment ends Friday, December 7, 2013.  If you have not done so already, please take a few minutes to review your coverage information today. If you find your plan is not meeting your expectations, call me to set up an appointment to find a plan that offers better coverage. Call 440-255-5700.
Source: mutskoinsurance.com

WASHINGTON: No ruckus about Medicare cuts in sequester

The Henry Ford Health System in Detroit started planning last year for a $20-million hit from the sequester. CEO Nancy Schlichting says they were able to minimize layoffs by leaving vacant positions unfilled and streamlining operations to reduce costs. The system, a network of hospitals and clinics that employs 24,000 people, also runs a health insurance plan.
Source: heraldonline.com

GOP proposes Medicare, Social Security changes in ‘fiscal cliff’ deal

Signing the letter was Boehner, House Majority Leader Eric Cantor, Majority Whip Kevin McCarthy and Rep. Paul Ryan, the chairman of the House Budget Committee and the unsuccessful GOP vice presidential candidate. Rep. Dave Camp, chairman of the Ways and Means Committee, Fred Upton, chairman of the Energy and Commerce Committee, and Cathy McMorris Rodgers, the Republican Conference chair, also signed the letter.
Source: nola.com

On the Way to Hospice, Surprising Hurdles

This probably explains why the researchers found that smaller hospices were more likely than large ones to say no to patients receiving such treatments. “If you’re a small hospice caring for someone with many medical issues and the reimbursement doesn’t even cover the care – and then Medicare comes to take it back – that’s a big hit,” Dr. Aldridge Carlson said. Larger organizations with more patients and bigger budgets can better absorb the costs.
Source: nytimes.com

Future for New Braunfels Scooter Store Workers Unclear

The company has been the target of Medicare fraud investigations in the past. The U.S. Justice Department sued the company in 2005 for allegedly making false Medicare claims and defrauding the government. The company settled agreeing to pay the government $4 million and forgo $13 million in Medicare payments.
Source: news92fm.com

CMS Announces Medicare Advantage and Prescription Drug Program MLR Proposed Rule

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN 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: Cut Medicare Advantage Program

Not Happy with Your Medicare Advantage Plan? Change it!

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

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

Possible Medicare Advantage Pay Reductions Cause Insurer Stocks To Slip

Modern Healthcare: Insurers See Proposed Medicare Advantage Rates Hitting Revenue Health insurance companies are expecting reduced Medicare Advantage payments to unfavorably impact revenue next year. The CMS on Friday released its proposed 2014 rates for Medicare Advantage plans, prompting negative reaction from payers and investors. Shares of health insurance plans such as Humana, Universal American Corp. and Health Net took a dive on the news when they opened for trading this morning. The CMS proposal calls for a 2.2% decline in Medicare Advantage benchmark payment rates. Humana, which derives most of its revenue from Medicare Advantage, saw one of the largest decreases in its share price (Kutscher, 2/19).
Source: kaiserhealthnews.org

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

Are Medicare Advantage Plans Skimming Off Healthiest Patients?

A 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: kqed.org

Local Teacher Confused about Changes to TRS Medicare Plans » Toni Says

On page 31 of the 2013 Medicare & You handbook it  states that an inpatient hospital stay begins the day you’re formally admitted with a doctor’s order. You must have 3 full days past midnight stay “formally admitted” and doesn’t include the day you are discharged. So that makes 4 days.  I would determine the stay begins when the doctor has “formally” written the order not when you are in the ER waiting for a room.  Don’t confuse signing papers when you arrive at the hospital with being formally admitted. Your doctor has to do sign that order.
Source: tonisays.com

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

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

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

OIG Report: Medicare Part B Overpaying for Infusion Medications

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

Video: 6minutes Online Video – Medicare Locals

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Protect Social Security and Medicare During Budget Debates

Americans have been paying into Social Security for more than 75 years and collecting these earned benefits when they retire. Currently, Social Security has enough money in its coffers to pay 100 percent of the promised benefits for the next 20 years. After that, there are sufficient funds to cover 75 percent of promised benefits. However, with gradual and modest adjustments, we can ensure that future generations will receive the benefits they’ve worked for.
Source: aarp.org

Medicare and Social Security Policies Based on Needs, Not Numbers

Decreasing the federal deficit at the expense of current and future Medicare and Social Security beneficiaries ignores the public’s overwhelming support for these programs. President Obama and Congress must think about what future generations will need for a secure retirement. They must work together and focus on our larger national goals of economic growth, health and financial security, and enacting affordable policies to meet those goals. Yes, we do need to make adjustments to Medicare and Social Security, but we need to do so without compromising the health and well-being of the nation or undermining the values that Americans cherish.
Source: aarp.org

Senior Citizen Creates His First Website for Medicare Supplemental Insurance

When Stephen Pewter got his first computer for his birthday from his granddaughter in December of 2011, he had no idea that just a year later he would create one of the most successful Medicare supplemental insurance comparison websites on the Internet today. What started out as a simple hobby building websites for his friends and family, Stephen realized that there were almost no resources on the Internet that were tailored to help senior citizens easily compare Medicare supplemental insurance. “One day I was searching for supplemental insurance for my wife and me. I came upon a few websites that offer that kind of thing but they required that I part with personal information. Well, that just made me uncomfortable; I didn’t understand why I had to give my credit card number just to get an insurance quote. My father always told me when you want something done right you have to do it yourself, so I started doing research to create a website that could provide Medicare supplemental insurance quotes with just the use of a zip code.” With hard work and a can-do attitude that he learned while in the Marines, Stephen was finally able to secure the largest database of reputable Medicare supplemental insurance companies in the country. He linked it with software that he created that gathers quotes in a given area by zip code. He rolled the website out in January of 2013 and the response he got absolutely blew him away. “At first I simply wanted to create this website for my friends and family but it grew so fast. It’s amazing how many people out there really needed a good website like this. I’m still in shock with how many visits it gets each day. My grandson has asked me to build him a website for his t-shirt business. I said ‘Hey, shouldn’t you be building me a website?'” Indeed, business owners of every conceivable industry can attest at how difficult it is to drive traffic to their website. But Stephen still doesn’t claim that it was his skill that allowed him to create a site that is so successful. “Well, I would like to say that it was my brilliant business sense that created my Medicare site, but I just got lucky. I found the right resources at the right time and when the website finally launched its spread by word-of-mouth. I still can’t believe it has become this popular. The Internet is pretty neat.” Stephen’s website is called Medicare Supplemental Insurance Comparison (or MSIC as Stephen calls it), and it can be found at http://medicaresupplementalinsurancecomparison.net/ About Stephen Pewter and MSIC Medicaresupplementalinsurancecomparison.net (MSIC) was created by Stephen Pewter in December of 2012 to help his friends and family get the best rates for Medicare supplemental insurance. It grew by word of mouth and today is becoming one of the most successful Medicare supplemental insurance comparison websites on the Internet. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

AARP: Don’t raise the eligibility age for Medicare

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Matsui Announces Medicare Open Enrollment

The Centers for Medicare and Medicaid Services (CMS) recently released the 2013 quality ratings for Medicare health and drug plans on their web-based tool “Medicare Plan Finder.” On this website, Medicare plans are given an overall rating on a one- to five-star scale, with one star representing poor performance and five stars representing excellent performance. During the open enrollment period, people with Medicare can use the star ratings to compare the quality of health and drug plan options and select the plans that are the best for their needs.
Source: rafu.com

The Medicare age is still 65

At the web­site, you’ll find more than just the online Medicare appli­ca­tion. You’ll also find infor­ma­tion about Medicare, and have the oppor­tu­nity to watch some short videos about apply­ing for Medicare online. One is a fam­ily reunion for the cast of The Patty Duke Show. In another, Patty Duke and George Takei go boldly where you should be going — online. Why go online to apply for Medicare? Because it’s fast, easy, and secure. You don’t need an appoint­ment and you can avoid wait­ing in traf­fic or in line. As long as you have ten min­utes to spare, you have time to com­plete and sub­mit your online Medicare application.
Source: thepennews.com

535 people change Medicare address to ACT

The Australian Bureau of Statistics uses Medicare addresses to count population per State and Territory. That population data is used by the Federal Government to allocate GST funding to communities. For every year that an ACT resident is not counted, the ACT Government forgoes about $2,500 per person in GST funding.
Source: gov.au

Medicare phone scams have hit Lincoln County 

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524A Medicare phone scam reported in the Willamette Valley has apparently moved into Lincoln County. The local Senior Medicare Patrol (SMP), run by RSVP (Retired and Senior Volunteer Program), was notified by a concerned Lincoln County resident about a suspicious phone call February 12. The caller identified himself as a Medicare representative and said he needed to issue the woman new Medicare card. The caller stated her mailing address and asked if it was correct. Then, the caller asked what bank she uses and asked for her bank account number. At this point, the local resident knew something fishy was going on and hung up the phone. SMP underscores that these types of callers are not with Medicare, and are not going to send new Medicare cards. They are scammers who want bank account numbers to drain the beneficiary’s bank account.
Source: yaquinawavelength.com

Video: Medicine Dish: Medicare Part D and Program Updates

Progressive Caucus Not Against Medicare Cuts

What about the other 54 members of the Progressive Caucus? Their absence from the letter is a clear message to the Obama White House, which has repeatedly declared its desire to cut the Social Security cost of living adjustment as well as Medicare. In effect, those 54 non-signers are signaling: Mr. President, we call ourselves “progressive” but we are unwilling to stick our necks out by challenging you in defense of Social Security, Medicare and Medicaid; we want some wiggle room that you can exploit.
Source: laprogressive.com

Medicare quality will drop

“We’ll bring down costs by changing the way our government pays for Medicare, because our medical bills shouldn’t be based on the number of tests ordered or days spent in the hospital – they should be based on the quality of care that our seniors receive … our government shouldn’t make promises we cannot keep – but we must keep the promises we’ve already made.”
Source: spokesman.com

Bricker & Eckler LLP, Please try again

We have recently redesigned our website! As we continue to improve the content of our site, we appreciate your patience as certain pages may be temporarily unavailable or moved. May we assist you in your search? The links below might be helpful in locating information:
Source: bricker.com

How To File A Medicare Appeal

Beneficiaries in Medicare Advantage plans follow similar appeals procedures, except the initial appeal must be made within 60 days of the denial. Information can be found at http://www.medicare.gov/claims-and-appeals/file-an-appeal/medicare-health-plan/medicare-health-plan-appeals.html. If a service or treatment has been denied, an expedited appeal can be requested from the plan if waiting for a regular appeal decision could jeopardize the member’s health. Expedited appeals are not permitted solely for payment denials. For more details about expedited Medicare Advantage appeals, see section 50 of the Medicare Managed Care Manual at http://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/mc86c13.pdf .
Source: kaiserhealthnews.org

Medicare Advantage Open Enrollment Ends December 7

The annual open enrollment opportunity to enroll or to change Medicare Advantage HMO plans for the 2013 plan year ends on December 7, 2012. CMS, Medicare administrator, has provided the mailing address of all Medicare participants to the various Medicare Advantage insurance companies to flood our mailboxes with advertisements for their various plans. Should you decide to change plans, make certain that your current doctors are covered by the new plan and that any maintenance drugs you are currently taking are covered by that plan. Remember that you are only making a commitment for the 2013 calendar year, as open enrollment for the following year usually occurs from October 15 to December 7 of each year.
Source: calrta.org

Repeal of the Medicare Cap on Outpatient Therapy and amendment for Physical Therapists to Opt Out of Medicare

We also need to ask our representatives to amend Section 1802(b)(5)(B) of the Social Security Act, which currently prohibits physical therapists from entering into private contracts with Medicare patients to provide services. Because the current law does not allow physical therapists to “opt out” of Medicare, small physical therapist owned private practices that do not participate with Medicare are prohibited from treating Medicare patients. This prohibits a significant portion of the population from seeking physical therapy care from the provider of their choice. Nearly all other healthcare providers and physicians are able to “opt out” and many service providers (massage therapists and personal trainers) are not restricted from working with Medicare patients because they are not in a position to take Medicare as payment for services.
Source: prana-pt.com

Are Medicare Supplement Companies Regulated?

Medicare supplement companies are regulated by the Federal Trade Commission for example. The Medicare supplement companies are going to try to sell you things once you become Medicare eligible. The things that they sell you can be traditional medical devices or things like unique pacemakers for example which fit your exact medical needs. A consumer has to make sure that the companies trying to sell you devices that they try to sell you these devices in an honest way. The Federal Trade Commission wants to make sure that if companies get your mailing address that the Medicare supplement companies do get your address in a very legal way.
Source: seniorcorps.org

Health plan summaries, Benefit Renewal mailing , Medicare RX

Here are the Health Plan Summaries and other benefit information that I want to get out fast.  I will be getting the information in some sort of organization as to who will need what, but for the time being these are summaries of some of the changes.  Please follow the story as we organize these in list for specific members, ie..active, retiree, retiree with medicare.  We will also be placing these on the site in permanent areas so as they will always be available.
Source: ibew827.com

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

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

Medicare: MSPRC New Address & Fax

This Blog/Web Site is made available by the publisher for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. By using this blog site you understand that there is no attorney client relationship between you and the Blog/Web Site publisher. The Blog/Web Site should not be used as a substitute for competent legal advice from a licensed professional attorney in your state.
Source: wordpress.com

Viewpoints: Obama Prescription For Medicare Is ‘Modest;’ GOP Doubts Entitlement Plan Is Serious

Posted by:  :  Category: Medicare

THE LITTLE MAN KILLED MEDICARE FOR EVERYONE by SS&SSThe New York Times: Rubio’s Rebuttal In his speech, Mr. Rubio followed the Republican rebranding strategy by rephrasing the party’s grand old policies without offering any new ideas. … Mr. Rubio declared that he was particularly concerned about seniors who depend on Medicare, like his mother, and that “anyone who is in favor of leaving Medicare exactly the way it is right now, is in favor of bankrupting it.” Funny Mr. Rubio should say that, because on Tuesday night, Mr. Obama argued that we can’t leave Medicare as is: “Those of us who care deeply about programs like Medicare must embrace the need for modest reforms.” … Mr. Rubio didn’t actually mention how he would fix Medicare. But we all know that he supported Paul Ryan’s plan to turn it into a voucher system (Andrew Rosenthal, 2/12).
Source: kaiserhealthnews.org

Video: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

Medicare Secondary Payer: Conditional Payment Reimbursement Policies for Certain Liability Settlements

Beginning February 21, 2011, CMS implemented an option permitting certain Medicare beneficiaries the ability to self-calculate Medicare’s conditional payment amount prior to settlement. As with other recent policies, the option is available only to liability insurance (including self-insurance) settlements and not workers’ compensation or no-fault claims and only when involving a physical trauma based injury and not ingestion, implantation or exposure. The dollar threshold was established at $25,000 or less and the date of incident must have occurred at least six months prior to the submission of the self-calculated amount to Medicare for review. The beneficiary must demonstrate that treatment has been completed and that no further treatment is expected through written physician attestation or a written certification by the beneficiary that there was no treatment for at least the 90 days prior to submission and that there is no further care expected. The election of this option bars the beneficiary from appealing the amount or existence of this debt, but the right to pursue waiver of recovery will remain.
Source: lexisnexis.com

2013 Transition Policies for Medicare Part D

NSCLC staff are available to help advocates with answers to questions about program rules and requirements, reviewing and analyzing pleadings, commenting on proposed litigation, assisting in the formulation of strategies, drafting opinion letters and providing memoranda, articles and other written materials.
Source: nsclc.org

There Is A Plan to “Save” Medicare…But It’s Complicated

In the end, it isn’t just liberals and frightened senior citizens who oppose the across-the-board Medicare cuts that Rubio and his fellow austerity-obsessed friends are recommending. Health care stakeholders and policy experts in the public and private sectors know that it will require a lot of experimentation and patience to bring about systematic change. Prices for services need to come down and be more transparent to consumers. Better care coordination is necessary to prevent so many costly hospital readmissions. End-of-life planning needs to be a part of every Medicare patient’s treatment plan. We need more comparative effectiveness research and outcomes data to identify the most valuable care.
Source: reforminghealth.org

Want to get Social Security but not Medicare? That’s illegal

Despite having paid thousands of dollars each in Social Security and Medicare taxes during their working lives—for which they never sought reimbursement—the five plaintiffs were told by officials at the Social Security Administration and Department of Health and Human Services that they had to forfeit all of their Social Security benefits if they wished to withdraw from (or not enroll in) Medicare. This determination resulted from internal policies that were put in place during the Clinton administration and strengthened by the Bush administration. The plaintiffs sought a judicial ruling that would prohibit SSA and HHS from enforcing these policies, which they believed conflicted with the Social Security and Medicare statutes. A sharply divided U.S Court of Appeals for the D.C. Circuit eventually upheld them. By its decision not to hear the case, the Supreme Court let that controversial ruling stand.
Source: teapartypatriots.org

Medicare announces policy changes for 2013

[…] First, the good news: As the result of continued adoption of survey data, Medicare is placing greater value on medical eye care procedures under its Medicare Resource-Based Relative Value Scale (RBRVS). The scale assigns values to all Medicare-reimbursable procedures that are then multiplied by the Medicare Conversion Factor (set at $34.0367 in 2012) to establish the dollar reimbursement for each procedure. The increase in relative value units (RVUs) assigned to many eye care procedures over recent years effectively means that whatever might be done to increase or decrease Medicare reimbursement overall, fees for medical eye care services would be higher than they would have been otherwise.Source: newsfromaoa.org […]
Source: newsfromaoa.org

Turning 65: Finding a Medigap Policy

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

Do President Obama’s Medicare Policies Strengthen Medicare?

Reality Check: The Patient Protection and Affordable Care Act requires huge cuts to the Medicare programs, prompting a loss of benefits and causing many seniors to lose their plan altogether. More than 7 million seniors will have to lose access to their Medicare Advantage plan. About two-thirds of plan choices will disappear, resulting in a loss in benefits of about $3,700 per beneficiary.
Source: ncpa.org

Health Network Alert: 2013 Transition Policies for Medicare Part D

Adult Day Health Care Affordable Care Act Assisted Living Chained CPI Clark v Astrue Court Access Dual Eligibles Health Care Reform Home and Community-based Services IHSS Language Access LGBT long term care Medi-Cal Medicaid Medicare Medicare Part D Nursing Homes Olmstead Pickle Amendment Preemption Same Sex Marriage Social Security SSI Supreme Court
Source: nsclc.org

Brad DeLong : Aaron Carroll: Raising the Medicare Qualifying Age Is Really, Really, Really, Really Bad Policy

Raising the eligibility age will likely hurt seniors’ health: [P]eople wait to get care until their Medicare kicks in.  This is bad both for health and for the federal government’s bottom line…. Medicare improved the health of the uninsured; delaying Medicare would delay that help. The argument for why things would be different this time around is that Obamacare will prevent 65 and 66 year olds from becoming uninsured. Through the Medicaid expansion, or through the exchanges, everyone would get coverage. Therefore, there would be no jump in quality once people get Medicare.
Source: typepad.com

Medicare cuts benefits to pay for Obamacare

Posted by:  :  Category: Medicare

CorettaScottKing_WinonaBartonBallentine3 by Mark TribeThe most common vitamin deficiency in the world is D3, and elevating our blood level through supplementation and testing can provide extra protection from a number of major diseases and conditions. Also, we are learning how to increase immunity by improving gut flora and decreasing our dependency on antibiotics. And new forms of vitamin C hold promise against a number of maladies. For more information along these lines, see http://www.howtostopcolds.com/resources .
Source: wordpress.com

Video: Los Angeles: Medicare Fraud Summit Law Enforcement Panel

Man pleads guilty in Medicare fraud conspiracy

If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Medicare Seminars in Connecticut 2013 « Insurance News from Crowe & Associates

Meeting Content:   The seminars will provide a high level overview of Medicare A and B with a greater focus on Medicare Supplements (Medigap) and Medicare Advantage plans.  We will discuss the strengths and weaknesses of each program and why someone may choose one over the other.  The meetings pertain to United Healthcare Medicare products.  For those that wish to discuss other companies products, we may do so after the meeting.  Crowe & Associates is an independent agency which works with all Medicare Advantage and Supplement companies in CT.
Source: croweandassociates.com

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

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

South Florida Pharmacy Owner Allegedly Used Dead Beneficiaries to Defraud Medicare

A family that owns a number of South Florida pharmacies is allegedly under investigation for Medicare fraud, according to a number of sources. On January 17, 2013, federal authorities raided one pharmacy location in Naples, Florida. Drug Enforcement Administration (DEA) agents removed boxes of documents and computers from the pharmacy, according to Naples News. The pharmacy owner and his mother are allegedly being investigated by the U.S. Office of Inspector General (OIG) of the Department of Health and Human Services (HHS).
Source: thehealthlawfirm.com

CMS Announces Medicare Advantage and Prescription Drug Program MLR Proposed Rule

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

“Reading Your Medicare Summary Notice” Workshop

The Monmouth County Connection is located at 3544 State Highway 66 in Neptune, in the strip mall adjacent to the Home Depot and across the street from Walmart.  This new office of Monmouth County government offers a variety of services including passports, passport photos, free notary public, veterans’ IDs, election/voter information, senior and veterans’ services, public access computers and more.
Source: patch.com

The Senior Insider: Upcoming classes on Medicare

I’ll be presenting “Getting Started with Medicare,” a class designed to answer your questions and prepare you for your transition to Medicare, at the following locations in the coming weeks. I look forward to seeing you at one of these classes.
Source: blogspot.com

Pitts Kicks Off 113th Congress with Hearing on Reforming the Medicare Physician Payment System

In response to a question from the Health Subcommittee’s Vice Chairman, Michael C. Burgess, M.D. (R-TX), Chairman Glenn Hackbarth cited positive examples from Medicare Advantage that could be applied. Hackbarth said, “Some Medicare Advantage plans, as you know, perform extremely well on both quality of care measures and costs. Among the plans that perform well are a variety of different models. Some are pre-paid group practice model like Kaiser Permanente, but there are other plans that contract with individual independent practices and don’t rest entirely on large, multi-specialty groups.” Burgess added, “It’s not just satisfaction of the agencies and the people who measure those things, but it’s also satisfaction of patients and satisfaction of physicians. Certainly my experience with a group like Scott and White in Temple, Texas, this has worked reasonably well and we certainly want to be careful that we don’t damage with whatever we do going forward.”
Source: house.gov

Medicare Fraud Sting Operations by Federal Government Includes Senior Volunteers Spying on Doctors and Health Care Providers: Expect to See More National Stings and Sweeping Arrests of Medical Pros in the Future

As a part of the new resources dedicated to fighting fraud, the Obama Administration has significantly expanded funding for Senior Medicare Patrols – groups of senior citizen volunteers who educate and empower their peers to identify, prevent and report health care fraud. In 2012, the Secretary awarded 54 states and territories with funding to support the Senior Medicare Patrol programs Last year, these programs taught more than 2 million beneficiaries how to look for Medicare fraud. Local Senior Medicare Patrol offices provide assistance when such issues are identified, so that mistakes are corrected and suspected fraud referred to the appropriate authorities. Since 1997, more than 1.5 million seniors and their caregivers have contacted the Senior Medicare Patrol to ask questions or report potential fraud.
Source: dallasjustice.com

Medicare for All Rallies in Sacramento & Los Angeles to Celebrate Lobby Day, Feb. 11

■ San Francisco: San Francisco Main Library, Larkin and Fulton at 9 am. Reserve a seat through Don Bechler at Single Payer Now, 415-810-5826. ■ Richmond: Target, 42nd and MacDonald Avenue at 9:45 am. Reserve a seat through Cara at 510-663-4086. ■ Berkeley: Ashby Bart at 9:15 am. This bus will pick up in Richmond after the Berkeley stop. Reserve a seat through Cara at 510-663-4086. ■ San Jose: South Bay Labor Council, 2102 Almaden Road at 9:00 am. Reserve a seat through Greg Miller – (408) 254-3311. ■ Grass Valley: KMart, 111 W. McKnight Way at 9:30 am. Reserve a seat through Mindy’s email. ■ Roseville: UDW office, 800 Sunrise Avenue Suite C at 10:15 am. Reserve a seat through Diana at 916-435-9760. ■ Fresno: Mervyn’s Parking Lot, Ashlan and Shields at 7:30 am. Reserve a seat through Judy Hess – 559-907-0279. ■ Modesto: Old Krispy Kreme, Briggsmoore at Highway 99 at 9:15 am. Reserve a seat through Carol Bailey at 209-951-0499. ■ Stockton: Clarion Hotel, Highway 99 at Waterloo at 10 am. Reserve a seat through Carol Bailey at 209-951-0499.
Source: californiaonecare.org

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Posted by:  :  Category: Medicare

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Video: Medicare Part D Formulary

Part D Formulary Is Key To Choosing The Right Plan

My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???
Source: affordablemedicareplan.com

Medicare Part D Guidance: Medication Therapy Management, Formulary Submissions : Health Industry Washington Watch

In addition, CMS has issued guidance to Part D plan sponsors on the process for CY 2012 medication therapy management program submissions and related change requests. CMS also has issued a memo on CY 2012 formulary submissions, including timelines. 
Source: healthindustrywashingtonwatch.com

Q1Medicare.com Releases Updated Medicare Part D Prescription Drug Plan Formulary Brow

07-29-2011 03:51 AM Q1Medicare.com released an enhanced Medicare Part D Formulary Browser providing the Medicare community with one online tool for browsing all stand-alone Medicare prescription drug plan formularies. Users only need to select their state and a Medicare Part D plan to easily view drug plan highlights and formulary details. A PlanID search option is also available for users who want to find a plan

Medicare phone scams have hit Lincoln County 

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524A Medicare phone scam reported in the Willamette Valley has apparently moved into Lincoln County. The local Senior Medicare Patrol (SMP), run by RSVP (Retired and Senior Volunteer Program), was notified by a concerned Lincoln County resident about a suspicious phone call February 12. The caller identified himself as a Medicare representative and said he needed to issue the woman new Medicare card. The caller stated her mailing address and asked if it was correct. Then, the caller asked what bank she uses and asked for her bank account number. At this point, the local resident knew something fishy was going on and hung up the phone. SMP underscores that these types of callers are not with Medicare, and are not going to send new Medicare cards. They are scammers who want bank account numbers to drain the beneficiary’s bank account.
Source: yaquinawavelength.com

Video: How to get data for Medicare Supplement Marketing

Medicare Supplement Phone Sales

I sell med supps exclusively by phone. What I can tell you is there is a crazy amount of companies offering medicare supplements, and a lot of companies only operate in certain states. 47 states would just hinder your production with out a team of agents, as opposed to just focusing on 3-4 states. Most states you’ll have two or three companies worth writing depending on their situation and you’ll just be replacing everything else for the most part.
Source: insurance-forums.net

535 people change Medicare address to ACT

The Australian Bureau of Statistics uses Medicare addresses to count population per State and Territory. That population data is used by the Federal Government to allocate GST funding to communities. For every year that an ACT resident is not counted, the ACT Government forgoes about $2,500 per person in GST funding.
Source: gov.au

Local Teacher Confused about Changes to TRS Medicare Plans » Toni Says

On page 31 of the 2013 Medicare & You handbook it  states that an inpatient hospital stay begins the day you’re formally admitted with a doctor’s order. You must have 3 full days past midnight stay “formally admitted” and doesn’t include the day you are discharged. So that makes 4 days.  I would determine the stay begins when the doctor has “formally” written the order not when you are in the ER waiting for a room.  Don’t confuse signing papers when you arrive at the hospital with being formally admitted. Your doctor has to do sign that order.
Source: tonisays.com

On Medicare? Beware this phone scam

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Source: mckytonlaw.com

Medicare pitches take a familiar ring; BEWARE – don’t lose your benefits

Tips from a study at USC (http://n.pr/UKyFOT). • Compare reviews not only within a site, but across different websites. • Reviews by people who are verified by the site are more trustworthy than reviews by anonymous reviewers — especially when it comes to negative reviews. • Read reviews less for whether they give a hotel or a restaurant one star or five stars, but more for the specific information they give about the experience. • Reviews are very useful for information that experts or merchants might not think to provide — how late a swimming pool stays open could be useful if you are traveling with a family. • Focus on aggregates, not outliers. You can’t trust a handful of bad reviews or glowing reviews, but trends are much harder to fake.
Source: wordpress.com

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 phone scam targets elderly South Carolinians

WMBF reports that the phone calls are coming from 409-579-1214 and entice the recipient with a new card coming in January and free medical supplies. You can read the full article and get tips for keeping your or your loved one’s personal information safe.
Source: thedigitel.com

Susan Tompor: Medicare fraudsters reach out to seniors

- Contact your bank or other financial institution immediately if you do make a mistake and give out personal information, such as your Social Security number or bank account information. Think twice about disclosing to a stranger where you go to church or shop. A fraudster might start going to the store or church that you mention to try to take further advantage of you. – Watch all financial statements carefully. Go online to check on recent activity. – Write down any details of calls that seem like a scam and report to local law enforcement, said Dianne Shovely, vice president of fraud services for Comerica Bank in Auburn Hills, Mich. Report any unauthorized transactions promptly. Do not send or give anyone money if you receive a telemarketing call or e-mail. – Obtain a free copy of your annual credit report at www.annualcreditreport.com. Or call (877) 322-8228. – You can ask nationwide consumer credit-reporting companies to place a fraud alert on your file if you’re a victim of identity theft. You may place a fraud alert in your file by calling just one of the three credit-reporting companies. The agencies are: Equifax: (877) 576-5734; www.alerts.equifax.com. Experian: (888) 397-3742; www.experian.com/fraud. TransUnion: (800) 680-7289; www.transunion.com.
Source: goerie.com

Phone Presentation Medicare Advantage

Hi everyone, I am trying to better understand if it is possible to sell Medicare Advantage plans by phone? I know there has to be a consent to contact before it is okay to contact the client. I also understand that a scope of appointment form is necessary before any Medicare Advantage products can be discussed. Once this information is received, what can the agent discuss with the client about Medicare Advantage? What are the rules? Does the presentation have to be recorded and stored for 10 years? I understand that the consent to contact and actual enrollment has to be recorded, but does the presentation? What can the phone presentation actually consist of? Can a scope of appointment be obtained by phone and recorded? How can I get a hold of the scripts for the consent to contact and the script for the enrollment? Can I send a standardized letter out to a bunch of prospects asking them to sign the consent to contact letter if they are interested in learning about Medicare Advantage?
Source: insurance-forums.net

Beware of Medicare Fraud Calls

These calls are completely fraudulent. Medicare will NEVER ask for a beneficiary’s Medicare number unless the beneficiary initiates the call, and they will NEVER ask for a bank account number under any circumstances. The only beneficiaries that need to get new Medicare cards are those who are first applying for Medicare coverage, or those who have asked for a new card because their card is lost or damaged.
Source: mauryriversc.org

Common Medicare Scams and Identity Theft

Be suspicious of doctors, health care providers, or suppliers who: • Ask for your Medicare number in exchange for free equipment or services or for “record keeping purposes” • Tell you that tests become cheaper as more of them are provided • Advertise “free” consultations to people with Medicare • Call or visit you and say they represent Medicare or the federal government • Use telephone or door-to-door selling techniques • Use pressure or scare tactics to sell you expensive medical services or diagnostic tests • Bill Medicare for services you never received or a diagnosis you do not have • Offer non-medical transportation or housekeeping as Medicare-approved services • Bill home health services for patients who are not confined to their home, or for patients who still drive a car • Bill Medicare for medical equipment for people in nursing homes • Bill Medicare for tests you received as a hospital inpatient or within 72 hours of admission or discharge • Bill Medicare for a power wheelchair or scooter when you don’t meet Medicare’s qualifications
Source: fayettewoman.com

BJ Alums: Medicare phone scam

A man with a foreign accent has been phoning the elderly in Ohio, requesting personal and banking information. He tells senior citizens that Medicare is sending out new cards and that he needs the information to process theirs. 
Source: blogspot.com

Oregon May Provide Model For Restructuring Medicaid In Alabama

Posted by:  :  Category: Medicare

Last October, a commission established by Bentley began researching ways to restructure the state’s Medicaid program to make it more efficient. The group concluded that Alabama should follow Oregon’s path. “It will be a heavy, heavy lift,” says state health officer Don Williamson, who headed the group. But he said the overhaul is necessary if the state is ever going to expand Medicaid. Otherwise, he said, “we will find ourselves with a program that simply collapses under the weight of the expansion.”
Source: kaiserhealthnews.org

Video: Lowest Rates Of Michigan Medicare Supplement Providers

Access to dental care declining in Colorado

In both rural and urban areas, the Colorado Health Access Survey found that insufficient numbers of dental providers participate in the Medicaid program, so despite an increase in the number of children who had dental insurance, fewer actually visited dental providers. An additional 66,300 children had dental insurance in 2011 compared to 2009.
Source: healthpolicysolutions.org

Insurer stocks slip over possible Medicare cuts

Medicare Advantage plans could see payment reductions topping 5 percent, considering they also face cuts from the health care overhaul and from the steep federal budget cuts known as sequestration that are slated to start next month. Plus, their profits also are expected to be pressured by a premium tax imposed to help fund the overhaul, which aims to cover millions of uninsured people.
Source: seattlepi.com

KidNeedsAKidney: It’s Taxing…..

Since I had the afternoon off I figured I be as productive as possible and go through a years’ worth of papers, receipts and calendar records to get everything ready for our tax preparer.  I started at one.  With a one our break for dinner and some homework with Babygirl, I just finished. There was the usual stuff – mortgage, work expenses, rental property maintenance. Then there was Babygirl.  Kidney transplants don’t come cheap. To be completely honest, it wasn’t just her.  Hubby and I have our own medical issues and prescriptions, and of course the cost of our health insurance (not counting the Medicare premium) would be the same for the family no matter what.  But those costs together never add up to enough for us to deduct them.  I think we made it this year, though. I’ll start at the bottom, with the lowest deductible expense: Pharmacy.  We filled nearly 200 prescriptions and paid $1396 in co-payments.  Remember, for most of these we get a three-month supply. Next:  Travel.  Tolls and parking are deductible ($626), but gas (oh don’t even start) is not.  Some tolls we failed to get receipts for, and some were donated by those from whom we borrowed cars since they wouldn’t let us pay back on their Easy Pass bills, so the total would have been much higher.  Mileage came to 14,701 miles, which is a deductible of $3381, for a total of $4007. Close behind this?  Health insurance premiums (medical, dental, vision, Medicare) at $5413.  The prize winner:  Medical co-payments and deductibles.  The total of $8140 didn’t particularly surprise me.  It would have been MUCH, much higher if Babygirl didn’t qualify for Medicare. And we pay $100/month for that coverage (which is added up in the health insurance premiums above).  We have a pre-tax medical spending account and make the maximum contribution, so $2400 cannot be applied to the medical deduction.  So the total is $19,157, $16,757 of which is ‘deductible.’  This is well over what Hubby made at his part-time job in the same year. How much of this will actually be deducted depends on what our taxable income turns out to be, but be assured there WILL be a sizable deduction even after we subtract 10% of that total. There is more to the finance of this problem than this, of course, but that’s a topic for another post. DeeDee
Source: blogspot.com

Flap's Blog @ Flap Twitter Daily Digest for 2013

Panetta Reid Democrats Rubio Hillary_Clinton Peggy Noonan immigration Missile Defense Delicious Links John Boehner Harry Reid Krauthammer Guns Business California GetGlue Chuck Hagel Marco Rubio Ryan Health Armey Filibuster Sequestration Polling Taxes Fiscal Cliff Hispanics Hagel John McCain Obamacare Charles Krauthammer Newt Gingrich Boehner The Morning Flap Libya Obama Dentistry GOP Sequester Day By Day Barack Obama McConnell Karl Rove Feinstein Chris Christie
Source: flapsblog.com

Medicare Supplement Sales Grew in 2010

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSDonahue also breaks down the Medicare Supplement market by company.  UnitedHealthcare owns a surprisingly high 32% of the market share.  When you add in Mutual of Omaha, these two companies own 43% of all Medicare Supplement polices.   What is the saying?… “So go these companies, so goes the market”.  As these two companies make changes to rates, underwriting and commission other companies are surely to follow.
Source: agentpipeline.com

Video: Texas Medicare Supplements 2010: How to Choose a Plan.wmv

Medicare Supplement Health Plan Changes In 2010 What’S New For Senior’S Health?

Note that existing Medicare Supplement plans will be grandfathered in, so beneficiaries can keep them if they wish. There is some concern that less healthy and older beneficiaries who belong to the closed plans may get rate increases, and will have a hard time changing plans in some states. Please discuss your concerns with a qualified Medicare health insurance agent. CMS recommends that insurance companies take in new business without health underwriting, and some companies may follow this standard. These are concerns to raise with your agent.
Source: ctr-pella.org

Kazor.com World Community News

One major con in using direct mail campaigns is that chances are your competition may also be using them, and by the time all is said and done, the nation’s seniors have a mailbox full of flyers about Medicare supplements. From your point-of-view, it’s good information. From their point-of-view, it’s just another flyer trying to sell them something. Often, when working Medicare supplement leads it is best to be able to touch base with the actual party that requested the information. That means sourcing your leads from a respected lead generation company is your best bet to earn the kind of income you want.
Source: kazor.com

Senior Benefit Services, Inc.

Effective November 10, 2012 on new business & January 1, 2013 in force business for Gerber 2010 Modernized Medicare Supplement plans in Idaho and Medicare Supplements and SELECT plans in Utah. The Rate Adjustments will affect plans  A, B, and C.
Source: srbenefit.com

What Happened To Medicare Supplement Plans In June 2010?

What Happened To Medicare Supplement Plans In June 2010? After a long hard battle, Congress made changes to the Medicare Supplement rules. The changes to Medical Supplement Plans in June 2010 started on the 1st of the month. The Original Medicare has gaps in the services. It can lead to financial disaster with the coinsurance payments, deductibles, and out of pocket expenses. The new changes give you several choices regarding health care coverage to fill in the gaps between the Original Medicare and the balance of what you are left owing.
Source: seniorcorps.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Is it too late to change my Medigap/Medicare Supplement for 2013?

If you are 65 or older and have been on Medicare Part B for longer than 6 months, you will most likely have to answer some health questions as part of the application process for a new Medicare Supplement/Medigap policy.  The majority of people have no trouble qualifying for a new policy, and usually an agent or broker can tell in the first conversation whether or not you will qualify.  Illinois also has a few companies that have guaranteed issue Medicare Supplements.  These companies never ask health questions of any applicants and will issue a policy to everyone who applies.
Source: bcmil.com

New Medicare Supplement policies climb in 2010

According to Debra Donahue of Mark Farrah Associates, new Medicare Supplement memberships are on the rise, with new policies (those issued in the last three years) increasing by almost 6 percent in 2010, compared to a 1.3 percent increase in 2009. Donahue says the surge in memberships result from the ending of Medicare Advantage private-fee-for-services plans in many parts of the country and new options offered for Plans N and M.
Source: lifehealthpro.com

Healthy Life: Medicare Supplement health Plan Changes in 2010

Note that existing Medicare Supplement plans will be grandfathered in, so beneficiaries can keep them if they wish. There is some concern that less wholesome and older beneficiaries who belong to the fulfilled, plans may get rate increases, and will have a hard time changing plans in some states. Please discuss your concerns with a great Medicare health guarnatee agent. Cms recommends that guarnatee fellowships take in new business without health underwriting, and some fellowships may corollary this standard. These are concerns to raise with your agent.
Source: blogspot.com