Health and Human Services

Posted by:  :  Category: Medicare

THE NATURAL by SS&SSAll content on the DHCFP website, including regulations, will move to CHIA’s website (www.mass.gov/chia). Pricing and Health Safety Net regulations will be moved to the EOHHS website (www.mass.gov/eohhs). These regulations will also be available on the CHIA website. EOHHS will have transferred all pricing and Health Safety Net regulations to its website by the end of November. Until the migration of these regulations to the EOHHS website is complete, we recommend that you refer to the CHIA website for these regulations.
Source: mass.gov

Video: Welcome Address at MMPI Event — Dec. 5, 2012

Massachusetts Medicare and Medicaid

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Source: massestatelawyer.com

Audit: Massachusetts’ Medicaid Program Too Lax on Income, Residency Attestation

Thousands of out-of-state residents may be receiving benefits under MassHealth, Massachusetts’ Medicaid program, and others may not meet the payors’ income conditions, according to a report from Massachusetts State Auditor Suzanne Bump. The audit found that MassHealth does not verify applicants’ self-reported income or claims of receiving no income at either the time of application or on a quarterly basis once the enrollee receives MassHealth benefits. The Office of the State Auditor said MassHealth doesn’t make its first attempt to verify income until roughly one year after the applicant has been enrolled and received benefits. The state auditor also says MassHealth has not established a process to verify applicants’ residency, but instead accepts applicants’ self-declarations of their address. As a result, thousands of people outside Massachusetts may receive benefits inappropriately, according to the report. “In fact, during our audit, we determined that 71,519 individuals who applied for and received MassHealth benefits during fiscal year 2010 were subsequently terminated by MassHealth, including 38,790 for reasons that bring into question their residency status,” according to the report. Of those 38,790, roughly 4,700 received benefits totaling $6.5 million. MassHealth later determined those 4,700 enrollees were either not Massachusetts residents, received benefits in another state or their whereabouts were unknown. The OSA recommended MassHealth match enrollee data to that from the Massachusetts Department of Revenue and Internal Revenue Service to verify wage information and unearned income. The OSA also recommended more scrutiny for those who report zero household income, such as a requirement that they provide additional information on how they pay for daily living expenses. MassHealth was also urged to match enrollees’ residencies with information from the IRS, Social Security Administration, DOR and Division of Employment Security.
Source: beckershospitalreview.com

Casey B. Mulligan: Health Reform, the Reward to Work and Massachusetts

But it is wrong to assume that the law will have little effect on the reward to working among covered workers. Their employers could drop coverage, or the employee could switch to a job without coverage. More important, the subsidies are available to the unemployed and others who do not work, even if their previous jobs had provided coverage. If and when they go back to work in a covered job, federal law will welcome their return by taking their subsidy away.
Source: nytimes.com

Milton Doctor Charged With Illegally Prescribing Drug Used to Treat Opiate Addiction

The Attorney General’s Office alleges that Ng grew the clinic until he was treating more patients than legally permitted, and boosted his annual earnings to more than $575,000 in salary and bonuses. In order to maintain his large practice, Ng allegedly knowingly prescribed Suboxone, a drug used to treat opiate addiction, to nine of his patients that according to their urine drug screens were not taking the drug and continued to use illegal street drugs, including Heroin, Methadone and other opiates. Ng also allegedly wrote Suboxone prescriptions in false patient names when two of his patients lost their insurance. Many of the Suboxone prescriptions at issue were billed to and paid for by the Massachusetts Medicaid Program (MassHealth). The AG’s Office also alleges that Ng charged MassHealth patients a $100 “new patient registration fee,” via cash or check made out to him directly. This fee was in addition to receiving payment from MassHealth for all services rendered and is prohibited by MassHealth regulations and statute.   Renee Andrews, 43, of Hudson, NH, was charged with four counts of Medicaid Kickbacks, two counts of Medicaid False Claims, and five counts of Private Health Insurance Kickbacks. As Ng’s former office manager, she allegedly offered and entered into Medicaid kickback arrangements with two laboratories including Franey Medical Lab, Inc. in Hyannis and East Side Clinical Laboratory in East Providence, RI.   In exchange for Ng’s significant urine drug screening business, the laboratories paid the salaries of some of Ng’s office staff, including the full-time salaries of Andrews’ daughter, nephew and boyfriend, who also worked as medical assistants and performed other administrative duties. The drug screens resulting from the kickbacks were worth more than $590,000 and were paid for by MassHealth, as well as Medicare and private insurances.   Franey Medical Lab was charged with one count of Medicaid Kickbacks, one count of Medicaid False Claims, and three counts of Private Health Insurance kickbacks.   Kathleen Franey-Lopes, 35, of Marstons Mills, was charged with one count of Medicaid Kickbacks, one count of Medicaid False Claims, and three counts of Private Health Insurance Kickbacks. Franey, the daughter of the lab’s owner, was the primary contact with Ng’s office  between March 2007 and March  2008.
Source: patch.com

HHS Funds Projects In 25 States To Try To Lower Medicaid Costs, Improve Care

Modern Healthcare: $300M To Boost Medicaid, CHIP Innovation Six states were awarded nearly $300 million by HHS to implement payment and delivery changes to their Medicaid and Children’s Health Insurance Program plans. The State Innovation Model awards, which were authorized by the Patient Protection and Affordable Care Act, will fund Medicaid pilot programs in Arkansas, Maine, Massachusetts, Minnesota, Oregon and Vermont that aim to improve care quality and lower costs. “As a former governor, I understand the real sense of urgency that states feel to improve the health of their populations while also reducing total health care costs, and it’s critical that the many elements of health care in each state — including Medicaid, public health, and workforce training — work together,” HHS Secretary Kathleen Sebelius said in a news release. The CMS will track the efficacy of those pilot programs for possible wider implementation nationwide (Daly, 2/21).
Source: kaiserhealthnews.org

Is a Deferred Annuity Helpful from a Medicaid or MassHealth Standpoint?

For older married couples, the correct first move if one of them enters a nursing home is to move all assets into the name of the healthy one. (See Protecting Assets and Maximum Income for the Community Spouse When Applying for MassHealth in 2013 to Help Pay for the Unhealthy Spouse’s Nursing Home Bills in Massachusetts.)  That means the ownership of any annuity in the name of the institutionalized spouse has to be changed to the name of the at-home spouse; unfortunately, if that move is not allowed, the annuity has to be surrendered, and the surrender charges have to be paid. In particular, an annuity owned by the IRA of the institutionalized spouse always has to be surrendered, as there is no other way to transfer that asset directly to the name of the at-home spouse.
Source: elderlawblog.info

Health Care Reform in Massachusetts: Medicaid Waiver Renewal WillSet a Precedent

With federal approval in 1995, and state legislative action to implement it in 1997, Massachusetts’s demonstration was put in place and was later renewed through 2005 without any significant changes. The original waiver expanded Medicaid coverage and also shifted from a system of direct payment to providers to one of enrolling most Medicaid beneficiaries in managed care organizations (MCOs), as a number of other states were also doing at that time. However, the state’s two largest safety-net hospital systems-Boston Medical Center and Cambridge Health Alliance-were concerned that the shift to managed care would result in Medicaid patients being treated elsewhere. To address that concern, each of the hospital systems created their own Medicaid MCOs, and the state agreed to give them annual "MCO supplemental payments" on top of their capitation payments for the Medicaid beneficiaries enrolled in their MCOs. In addition, like other safety-net providers, the two hospitals systems were already getting "disproportionate share hospital" (DSH) payments, and the state then further provided the two systems with special "hospital supplemental payments." These last two forms of extra payment were to defray costs incurred in providing uncompensated care to the uninsured or treating Medicaid patients at low reimbursement rates.
Source: heritage.org

Massachusetts Medicaid Will Only Cover Front Teeth, Not Back Teeth

Lawmakers argue that expanding coverage to recipients’ front teeth, which will cost the state about $6 million, will enhance their appearance and enable them to more easily secure employment. The coverage will include the 12 teeth at the front of the mouth — incisors and canines — but excludes molars and premolars.
Source: mikethemadbiologist.com

ACA Brief: Medicaid Expansion

Understand that spending forecasts will be wrong. Massachusetts, which started its own expansion program in 2006, spent $1 billion in year one and $2 billion by year three. That’s because for many years people had just been covering their basic health-care demands, experts say. Aggressive outreach boosted enrollment in the plan faster than expected. But there’s good news: The cost overages aren’t breaking the bank.
Source: blackhealthmatters.com

Medicare Advisory Group Recommends 1% Increase In Hospital Rates

Posted by:  :  Category: Medicare

Wall Street by elycefelizCQ HealthBeat: MedPAC Considers 1 Percent Payment Increase For Hospitals The Medicare Payment Advisory Commission on Thursday in a draft recommendation called for a modest 1 percent increase in inpatient and outpatient hospital payments in 2014, at a time when providers are dreading the impact of possible Medicare cuts under sequestration or as a result of budget negotiations. A staff analysis used for the draft recommendation found that Medicare paid two percent more to hospitals in 2011 compared to 2010, as well as a continued shift to services provided in an outpatient setting rather than in hospital beds. The quality of care is generally improving as well, the analysis said. But commissioners continued to chafe at a fee-for-service system that they say too often rewards volume over quality and efficiency. “I believe $117 billion in spending on acute care is too much,” said Scott Armstrong, president of Group Health Cooperative in Seattle, Wash., referring to total inpatient Medicare costs in 2011 (Norman, 12/6).
Source: kaiserhealthnews.org

Video: Rep. Walden on the Medicare doctor reimbursement rates

Medicare growth attributed to change in skilled nursing facility pay rates

Medicaid spending slowed significantly in 2011 on a year-over-year basis. The program grew 2.5% in 2011, a significant drop from 5.9% growth in 2010. The CMS report said budgetary pressure on states caused by the weak economy and the June 2011 expiration of federal aid to the states contributed to the slower growth.
Source: mcknights.com

2013 Medicare Physician Fee Schedule

I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Uwe E. Reinhardt: Medicare's Payments to Physicians

In economic theory, demand for a particular good or service depends on the potential buyers’ willingness to pay for it, given their budgets and ability to pay. But whose willingness to pay should we use for Medicare? Should we use an estimate of what Medicare beneficiaries would be willing to pay for physician services in the absence of Medicare coverage? Or should it be the taxpayers’ willingness to pay, as expressed by their political representatives? Should it perhaps emerge from a consensus of some panel of experts convened by Medicare to represent patients or taxpayers?
Source: nytimes.com

OIG Calls for Cuts in Medicare Rates for Back Orthoses : Health Industry Washington Watch

The OIG is calling on CMS to lower Medicare payment for certain back orthosis products, either by subjecting these products to the Medicare durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) competitive bidding program or by making an inherent reasonableness adjustment. This recommendation stems from the OIG’s findings that Medicare payment amounts far exceeded supplier acquisition costs for lumbar-sacral orthoses billed under L0631. Specifically, between July 2010 and June 2011, the average Medicare-allowed amount for L0631 was $919, compared to the average supplier acquisition cost of $191, resulting in Medicare paying an estimated $37 million more than supplier costs. Moreover, while the code descriptor for L0631 references fitting and adjustment services, the OIG found that for 33% of claims the supplier did not report providing such services, and only 7% of suppliers reported providing any additional services other than general instructions. CMS agreed that Medicare payments for back orthoses billed under HCPCS code L0631 “should be adjusted to more closely reflect the supplier’s acquisition costs for the device and the level of service provided when furnishing the device.” CMS indicated that it would be pursing competitive bidding rather than an inherent reasonableness adjustment, noting that it is working to finalize its classification of HCPCS codes that may be considered to be “off-the-shelf” orthotics and subject to DMEPOS competitive bidding (the preliminary classification list included HCPCS code L0631). 
Source: healthindustrywashingtonwatch.com

Medicare Panel Calls for Repealing Sustainable Growth Rate Formula

Ten days after Congress voted to approve a temporary “doc fix,” the Medicare Payment Advisory Commission last week released a blueprint that calls for permanently repealing and replacing the sustainable growth rate formula — which is used to determine Medicare physician reimbursement rates,
Source: californiahealthline.org

GAO: Medicare remains ‘high

“CMS has not met GAO’s criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates,” according to GAO’s written testimony before the House Subcommittee on Health, Committee on Energy and Commerce on Wednesday.
Source: dailycaller.com

Lab Soft News: Medicare Costs Rise as Knee Replacements Increase for Seniors

The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program….Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization….The number of total knee replacements increased 161.5% between 1991 and 2010, when 243,802 such surgeries were performed. Per capita utilization nearly doubled during that period, to 62.1 procedures per 10,000 Medicare beneficiaries from 31.2 surgeries per 10,000 enrollees….For patients, knee replacements are relatively safe and have low rates for complications, mortalities and length of hospital stays. However, 30-day readmissions rates have risen to 5% in 2010 from 4.1% in 1991. Shorter hospital stays are causing the increase, a change that should have been expected by health policymakers….The volume of revision knee replacement surgeries has increased to 19,871 in 2010 from 9,650 in 1991….There were 243,802 knee replacement surgeries in 2010, a jump of 161.5% from 1991. More and more patients taking advantage of the surgeries will lead to higher Medicare program costs. The procedure itself costs about $15,000 to $30,000…The bundled Medicare payment for the procedure is spent on the device implants, facility fees, therapy providers and the surgeons. The surgeon probably will receive about $1,500 of the total….New Medicare payment models, such as the bundled payments used for knee replacements, aim to achieve lower costs while maintaining high quality to prevent patients from being readmitted.
Source: typepad.com

GAO: Additional Imaging Self

Additional imaging service referrals by providers who self-referred cost Medicare approximately $109 million, according to a U.S. Government Accountability Office report. The report, “Higher Use of Advanced Imaging Services by Providers Who Self-Refer Costing Medicare Millions,” examined the rate of imaging referrals among providers who self-referred and those who did not, and the accompanying costs. Results showed that from 2004 through 2010, the number of self-referred MRI services increased by more than 80 percent, while the number of non-self-referred MRI services increased by only 12 percent. Overall, self-referring providers referred roughly twice as many imaging services in 2010 as providers who did not self-refer, according to the report. GAO estimates self-referring providers likely made 400,000 more referrals for advanced imaging services in 2010 than they would have if they were not self-referring, resulting in an approximate cost of $109 million to Medicare. Moreover, these additional referrals pose a risk to patient safety due to increased radiation exposure, according to the GAO report. The differences in referral rates between self-referring and non-self-referring providers remained after accounting for practice size, specialty, geography and patient characteristics, according to the report. To address the high rate of imaging service referrals among self-referring physicians, GAO made three recommendations to the administrator of CMS: 1. Insert a self-referral flag on its Medicare Part B claims form and require providers to indicate whether the advanced imaging services for which a provider bills Medicare are self-referred or not. 2. Determine and implement a payment reduction for self-referred advanced imaging services to recognize efficiencies when the same provider refers and performs a service. 3. Determine and implement an approach to ensure the appropriateness of advanced imaging services referred by self-referring providers. While HHS said it would consider the third recommendation, it did not concur with the first two. For the first recommendation, HHS said CMS believes a new checkbox on the claim form would be complex to administer and may not characterize referrals accurately. For the second recommendation, CMS commented that an additional payment reduction may cause providers to refer more services in an effort to maintain their income, according to the report.
Source: beckershospitalreview.com

3 Easy Ways to Lookup Cell Phone Numbers

Posted by:  :  Category: Medicare

It used to be easy to lookup where a phone call was coming from as long as you knew the telephone number. Area codes for land lines are keyed to geographical location, so if you had the area code of the telephone number, you could be pretty certain that they were calling from the geographical area to which the area code is assigned. In some states and cities, you could even pin it down further by the exchange – the three numbers that immediately follow the area code. Those three numbers pinpoint the region within the area code. Depending on the population density and the number of telephone numbers assigned within it, you may have been able to pinpoint the exact city, or even the neighborhood from which a caller was calling.
Source: medicare-fraud-attorney-san-antonio.com

Video: Medicare Plan Finder Lesson 1: Getting Started

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

Database of the Day: Medicare Service Providers

Addiction recovery counselors in California may be certified by any accredited organization. Two certification databases are at the California Certification Board of Alcohol and Drug Counselors and the California Association of Addiction Recovery Resources. Find people working as alcohol and drug counselors, who may not be certified, at the American Academy of Health Care Providers in the Addictive Disorders database. This site also lists the employers.
Source: pibuzz.com

2013 Medicare Physician Fee Schedule

I also am new to the RVU process but have a fairly good understanding of what needs to be done. However, I have been unable to find any information on what a Transitioned Non-Facility verses a Fully Implemented non- Facility is. I noticed the PE RVU is higher for the Fully Implemented non-facility. Someone told me it represents where you are at in your implementation of EHR???? I am waiting for a callback from CMS but if anyone has an answer it would be appreciated. Pat Carlson Open Cities Health Center
Source: physicianspractice.com

Medicare ID numbers Suffixes and Prefixes 

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Source: survivinghealthinsurance.com

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

Medigap vs. Medicare Advantage Plan

Posted by:  :  Category: Medicare

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

Medigap or Medicare Advantage?

The best place to understand either option is to go to MedicareInteractive.org, where there is an easy-to-read chart. Another good resource is ConsumerReports.org, which in November 2010 focused on Medicare issues and rated Medicare Advantage plans. You can find much of the best information online free of charge, but in order to read Consumer Reports’ rankings, you’ll have to subscribe (or find the issue at the library). The place where you’ll make the final selection is Medicare.gov. It’s a good idea to just ignore the big pile of sales literature that will fill up your mailbox.
Source: bankrate.com

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

Medigap Costs, Medigap Policies, AARP Medigap, : Medicare Advantage vs. Medigap comparison chart

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Source: projectedu.com

What’s Medicare supplement (Medigap) insurance?

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Source: medigaplist.com

What Medigap Insurance Has That Medicare Advantage Doesn’t

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

Which Is Better Medicare Advantage Or Medicare Supplement?

Medicare Advantage Plans are obtainable from private insurance carriers. Some are offered by larger well known companies. You can also purchase them from Health Maintenance Organizations (HMOs), Preferred Provider Organization (PPO) plans, and from Private Fee-for-Service and Specialty Plans. Normally, these plans provide all of the coverage of Original Medicare as well as additional benefits and services. These additional health care services include chiropractic, prescription drugs and hearing aids. Furthermore, they may include gym memberships, preventive care services, dental, vision and access to disease management programs. You are allowed to purchase a Medicare Advantage Plan in addition to having Medicare Part A and Part B. The cost of the plan is based upon what benefits are being offered and type of plan the company is offering.
Source: seniorcorps.org

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

Posted by:  :  Category: Medicare

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

Video: Medicare Supplement AARP Plan F Select is A Good Option

Texas and Pennsylvania Medicare Plan F

Both Texas and Pennsylvania Medigap plan F makes up a huge amount of the Medicare population.  It is known that Medicare Plan F is purchased by approximately 46% of the country.  What about Medigap plan G in Pennsylvania?  Well, people are catching on.  KSKJ life Medigap plan G is becoming very popular in Pa.  Mutual of Omaha Plan F and Blue Cross Medicare Advantage plans are big among the people but other companies are gaining steam.  AARP Medigap plans have done well because of the AARP Part D plan is so well known.  Texas Medicare Plan F is big because the state is so enormous.  Medigap plans in Texas will always compete with Pa Medicare numbers.  ANTEX is a fan favorite in Texas Medigap plans as well as Blue Cross.  In Pa, I think Aetna Plan F is the way to go.
Source: medigaplist.com

Summit Medigap: What Is Medicare Supplement Plan F?

The basic and original coverages provided by Medicare are Part A (hospitalization) and Part B (doctor visits and required medical equipment). Currently, there are at least 11 supplement plans referred to as Medigap policies that fill any coverage gaps involved with Parts A and B. One of these is Plan F. It’s important to know that not every company offers all 11 supplement plans. However, if they do offer at least 2 of them, they are required to offer Plans C and F. Plan F premiums typically cost between $65 and $295 per month. The premium will vary depending on the insurance carrier and the state you live in. Coverage Provided By Plan F The coverage required of Medigap coverage plans is mandated and regulated by the Centers for Medicaid and Medicare. Plan F also has a “high deductible” plan because it will not pay for any type of services covered by Medicare until the plan beneficiary has paid an out-of-pocket minimum of $2,000. Once that deductible has been met, Plan F will cover 100% of the co-insurances, co-pays, and deductibles of Parts A and B including hospice care co-insurance as well as preventative services. If you get the regular Plan F you will have no deductibles or coinsurance. When speaking to an insurance professional it’s important to make sure which Plan F you are being quoted. Comparisons There are only two supplements that covers any deductible expense of Part B, one of which is Medicare supplement Plan F. Additionally, this is the only supplementary plan that covers excess Part B charges. These charges typically accrue if doctors can legally charge more than what Medicare considers as reasonable service charges. Other supplement plans will usually pay for expenses that Medicare classifies as allowable. Finally, the excess amount that is allowable according to Medicare is covered by F. Is Plan F Right For You? Medicare supplement Plan F is viewed as one of the most popular plans because it covers 100% of the gaps encountered with Plans A and B meaning that it provides the highest amount of coverage of any of the Medigap insurance plans. For many individuals, the plan may seem a bit confusing initially. However, if you answer a few questions, it will not only explain the plan more thoroughly, you will be able to decide whether or not it is right for you. Basically, if you are someone who is willing to pay for 100% coverage, then this plan is tailored to meet your personal needs. With Medicare supplement Plan F, your only expenses will be your monthly premiums. For more information regarding this supplement plan, you can visit the official Medicare website or speak to a licensed insurance professional.
Source: blogspot.com

joydukesinty: Medicare Health Insurance Supplement Plan F

Exactly how. Your about to go on Medicare, and your mail window and phone actually are being inundated due to eager sales workers and insurers expecting you to for sale sign up with the whole bunch. So, you want to assist you to out smart every one of them and go for the and try to actually wade through miles of information in regards to Medicare-Medigap- plans. You have good intentions but supply in and go to a website exactly who promises multiple prices from different carriers and agents. Now you in control and you have your market face on. You fill out and the form along with push that magic button. Yes, I did out. may have heard of as effectively of the Parts C Medicare Gain Plan, sometimes known as as Medicare Replacement Plan or Medicare Alternative Plan. Because this statement seems to mix both medicare parts, the medicare favour plan looks resembling a good option. Note however the idea only a limited number of doctors and hostipal wards accept this agenda as this method is a privatized Medicare introduced at the time of for-profit insurance agencies. In addition e that, you will still pay for the purpose of the part Ful premiums and turn into ineligible to end up getting a medicare merchandise insurance plan simply because medicare supplement delivers not include filling the gaps created by part C. Overall, Medicare Supplement Plan F, G, and N are the three most popular intentions of the market. With the state of the economy, the general public are looking to build good coverage at an affordable price. In this is what situation, Medicare Vitamin and mineral Plan G is actually usually recommended. Medicare insurance complement insurance will not some subject that should exchangeable you or make you’re feeling overwhelmed. Just consider the spare time to learn over each with our own twelve ideas obtainable, and select make certain that functions surprisingly best for families. Then, you are able to visit and / or maybe get in affect with private automobile insurance businesses to determine which companies now have the best expenses around the coverage that you aspire or need. Choosing a non-public business is going to be completely subjective. Significant image that you’ll are required to store a close to and look at the charges can are able time for get, as adequately because the products that every agency offers, to decide on the best 1 independently. Medicare insurance originally is thought as Part A, and hospital insurance as well Part B, can be medical insurance. This original an insurance plan allows for a number of but not every medical or health related service and nourish. There is insurance available, called Medigap along with Online Medicare Supplement Plan Comparison and Rates that covers expenses that are not covered under the general Medicare Part Another and Part G. This includes things regarding copayments, coinsurances, insurance deductibles and expenses when traveling outside of united states. Believe it not really the out regarding pocket expenses will add up very quickly and before you know it you may well easily paid often the monthly premium of this Medicare Supplement Package. In general, all men and women 65 years old or older who have been legal consumers of the United states for at least amount of 5 years meet the requirements for Medicare. Also, all together with disabilities in that this United States, so long as their condition(s) is/are congenital or otherwise not permanent, are naturally entitled to Medicare, regardless of age bracket. This is due on the fact that such disabled people furthermore inherently entitled and Social Security Issues Program (SSD); assigned their involvement as part of SSD, physically incompetent people both aged old are automatically entitled to Medicare insurance. You may get insurance about most of the health expenses in order to might incur at the time of purchasing Medicare Fraction C and Medicare insurance Part D, the best Medicare Part C plan that guarantees prescription drugs or a Medicare Dietary supplement policy and Treatment Part D. Medicare health insurance is health policies for people getting older 65 or older, under 65 complete with certain disabilities otherwise any age with End-Stage Renal (permanent kidney failure). More or less virtually every event, after you buy in a build at one these sorts of insurance policy web-sites, you will include Five and via a flight realtors contacting your primary self the phone and seeking to positively market the plan that creates these people the most fee. By way of example, a female, non-tobacco consumer, age sixty seven and consequently dwelling in Macon, GA would expend 5 per thirty days for Medigap prepare F from Black Cross. Should it be she have begun a very watchful shopper she can easily come across not less than fifty percent twelve month period carriers providing the identical method for as the tiny as 6 per 30 days to weeks.
Source: blogspot.com

Health Law Prompts Review Of Some Medigap Plans; Defining Who Gets Dependent Status

Your plan and Plan C are the most popular Medigap plans, chosen by nearly two-thirds of beneficiaries. Those are also the policies that provide significant “first dollar” coverage: they pay the deductibles for both the hospital and outpatient portions of the traditional Medicare program (Parts A and B) as well as the 20 percent coinsurance required for doctor visits, and cover other services as well. People with these supplemental plans may pay virtually nothing for medical services beyond their premiums.
Source: kaiserhealthnews.org

Is Medigap Plan F The Most Popular Plan?

Medicare Supplemental Insurance Plans are often referred to as Medigap. These plans are private insurance coverages to help relieve the costs remaining after Medicare’s initial payment. The balances can be costly and distressing. Medigap can help alleviate most or all of the remaining balance on a healthcare claim, and provide some peace-of-mind. The Medigap insurance can cover co-payments, co-insurance, and deductibles, which are not covered by the primary Medicare insurance.
Source: seniorcorps.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

Benutzer:CandaceFl – Vollmondpicknicks

If you are on Original Medicare and require additional insurance that you don’t already have there is Medigap, which supports cover other expenses such as for instance co-pays and deductibles. Medigap is really a private insurance policy that is restricted in what it provides. If you’re traveling from the United States It’ll perhaps not protect things such as perspective care, hearing aids, eyeglasses, dental care, and nursing home stays along with health care providers. Prescription drug coverage isn’t presented also. Unless you are on Medicare Plan A or B Medigap is not offered to you. You shouldn’t need Medigap and thus is not offered to you If you are on Medicare Advantage. You will need to get hold of your state department of insurance for ideas presented in your area. Like all private insurance policies you’ll pay a regular premium but even so it might provide the protection you need and be of value to you over the long run. Medigap supplies a amount of policy plans each offering different health care insurance. Medigap strategies are listed as A-N and the insurance for every is the same among the insurance companies although premiums change from one insurance company to a different. Enrollment for Medigap options is open half a year from the initial day of the month of your 65th birthday IF you should be opted for Medicare Plan B. If you wait later that that, there is no guarantee coverage will be got by you under Medigap and if you do your charges might be higher therefore timing is important. Also when you yourself have a preexisting condition you may have to wait 6 months for protection to take place and you’ll be responsible for out any of wallets expenditures during that time Medigap Plan F is probably the most widely used It covers Medicare Plan W excessive fees that is the difference of what a doctor or other physician gives and what Medicare really covers. It’ll protect you from other out of pocket costs that Medicare won’t protect. The fundamental medical benefits plan Y offer are hospitalization coinsurance, 20% of Medicare accepted charges, co funds for outpatient clinic services, and hospital care co pay. Please see similar internet page for more! Along with these simple Medicare gains Medigap Plan F addresses skilled nursing care, deductible for hospitalization under Medicare Plan A, deductible for medical and hospital outpatient charges under Medicare Plan W, surplus fees under Medicare Plan B, and if over waters, emergency medical coverage.
Source: immerda.ch

The other side of the income equation …

Nilus Mattive has been obsessed with dividend-paying stocks since the sixth grade. And after graduating from college, he began working for Jono Steinberg’s Individual Investor Group, where he wrote a regular investment column. Later, Nilus spent five years at Standard & Poor’s editing the company’s flagship investment newsletter, The Outlook. During that time, Nilus also penned his first finance book, The Standard & Poor’s Guide for the New Investor. These days, Nilus loves telling investors about dividend-paying stocks in his monthly newsletter, Income Superstars.
Source: easystreetinvesting.com

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

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

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

Posted by:  :  Category: Medicare

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

Video: Medicare diabetic supplies

Colorado Springs To Benefit From Medicare Competive Bidding Program

Round 1 of the program has already been hugely successful, reducing money spent for equipment included in the program by over 42 percent in its first year of operation. Now the program’s benefits are coming to you, and there is some important information you need to know. Round 2 of the program is scheduled to begin on July 1, 2013, and expands it to 91 new areas across the country, including Colorado Springs, and is projected to save people with Medicare in Colorado Springs an average of 44 percent on certain DMEPOS items. Medicare will also be implementing a national mail-order program for diabetic testing supplies at the same time as Round 2, and beneficiaries nationwide will save an average of 72 percent on these supplies.
Source: ushispanics.com

Patients’ Concerns with Mail Order Diabetes Test Supplies, Waste Documented in New Report

Third, the report raises questions about the cost assumptions of mail order DTS. Many of those unrequested supplies are likely to go to waste, without CMS accounting for it. Moreover, for 20 percent of beneficiaries, mail order billed CMS inappropriately at a higher rate, overcharging Medicare. Community pharmacies play a vital role as the safety net in providing DTS to beneficiaries. As shown by the report, beneficiaries turn to their local community pharmacist when they can no longer obtain the product that their prescriber has determined is best for them through mail and when they are dissatisfied with mail. As such, community pharmacists are motivated to stock products which local physicians prescribe and beneficiaries prefer.
Source: wordpress.com

Diabetes and Medicare have You Confused?

Remember Medicare Part B has a deductible ($140 in 2012) and 20% coinsurance that you must pay.  Some Medicare Advantage plans or Medicare supplemental health plans may cover more, but you have at least 80% coverage after the deductible.  Remember that is 80% of the Medicare-approved amount.  In Minnesota a physician may not charge more than the Medicare-approved amount, but this limiting law may not necessarily apply to supplies.  In any state if the supplier accepts Medicare assignment, they can only charge the Medicare-approved amount.  It might be worth your time to find a provider who accepts assignment.  Sometime in the future (possibly July 2013) if Health Care Reform still exists, you may only be able to get Medicare coverage for these supplies from Medicare-approved suppliers.
Source: retirementeducationplus.com

Humana Medicare supplement will pay for diabetic supplies?

Medicare diabetic supplies life: query Penny k : Does Humana Medicare supplement spend for diabetes care Very best Answer : response tsunami all depends. You need to be very cautious with this mess. Now, if your parents in a property if they are very good they get both Medicare and Medicaid. this is what pays for all. if you care in a property with an adult and someone else you need to have to complete. they will not inform you when you are in a residence. (Your own residence) I will do
Source: typepad.com

Lower Prices for Certain Medical Equipment and Supplies to Begin July 1, 2013

As a result of the competitive bidding process, the amounts that Medicare will pay for the eight product categories included in Round 2 of the DMEPOS Competitive Bidding Program are on average 45 percent less than Medicare’s current fee schedule amounts. The eight categories are these: (1) oxygen, oxygen equipment and supplies; (2) wheelchairs, scooters and accessories; (3) enteral nutrients, supplies and equipment; (4) Continuous Positive Airway Pressure (CPAP) devices and Respiratory Assist Devices (RADs) and related supplies and accessories; (5) hospital beds and related accessories; (6) walkers and related accessories; (7) negative Pressure Wound Therapy pumps and related supplies and accessories; and (8) support surfaces (Group 2 mattresses and overlays).
Source: wolterskluwerlb.com

TalkingGlucoseMeters’ Site

If you have reached the age of 65 or over you are eligible for Medicare. Hopefully at about three months before you reached 65 or were considered eligible for Medicare you received and returned your questionnaire to apply for Medicare which was automatically sent to you about three months before you turned 65. You do not need to ask for this questionnaire because if you are on the tax rolls within ten years it will be sent directly to you. So if you returned this questionnaire when you turned 65 you became eligible to have your Medicare insurance cover your Medicare diabetic supplies including a Talking glucose meter. So yes, your glucose testing meter or the Talking glucose meter will be covered as Medicare diabetic supplies. If you are legally blind you will only require a doctor’s certification to get a Talking glucose meter. If you are not legally blind you may have to have persistence to get a Talking glucose meter but in the end you probably will get a Talking glucose meter. Medicare does seem to realize how important it is to support the diabetics that are under Medicare and who require Medicare diabetic supplies including a Talking glucose meter.  Many of the diabetic testing supplies that you have to use with a Talking glucose meter such as the lancets and the test strips are also covered as Medicare diabetic supplies. But they may not be covered anytime you choose to replace them or if you just decide you might like a Talking glucose meter. So Medicare Part B covers this cost whereas under Medicare Part D which covers the insulin is where you are limited to a prescription payment program that has a cap then a gap before it picks up prescription coverage again as catastrophic coverage. Talking Glucose Meters
Source: multiply.com

Diabetes Is Not Curable, But Controllable

Diabetes Is Not Curable, But Controllable. After becoming a diabetic, one of the scary and threatening questions of all patients is to know about the steps and measures to cure diabetes. There are many researchers and doctors claiming that the “cure” for diabetes is not yet found out. The reality is that, there is no a prescribed treatment for diabetes to cure permanently. It is a metabolism disorder in the body. This disorder leads to the improper functioning of insulin inside the body. To know about diabetes, it is more important to know about the functions of insulin. Insulin is a hormone which converts the food we consume into energy to our cells. The wide-spread attack of this trouble is even eating the health of small children. It is generally categorized as:
Source: blogspot.com

In brief: Industry holds on, Medicare bill revived

Quantum Rehab has a new company logo. Featuring the slogan “Life Beyond Limits,” the new logo is designed to “match the evolving, cutting edge features and functionality of the Quantum product line,” according to a press release…Members of Ottobock’s marketing, sales and clinical teams have come together to form an upper limb prosthetics team. Ottobock tapped Dave Slipher, a business development manager and sales specialist, to lead the team…Invacare will release its financial results for the fourth quarter of 2012 before the market opens on Friday, Feb. 8, according to a press release. The company will sponsor a conference call for investors and other interested parties on that day at 8:30 a.m. EST to discuss its quarterly performance (1-888-498-8379, ID 89525970)…Invacare has completed the sale of its medical supplies unit, Invacare Supply Group, to AssuraMed. AssuraMed, the parent company of Edgepark Medical Supplies and Independence Medical, purchased ISG for approximately $150.8 million in cash, which is subject to final post-closing adjustments.
Source: hmenews.com

Is ObamaCare Causing Health Insurance Premiums to Rise?

Posted by:  :  Category: Medicare

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

Video: 59% Increase In Health Insurance Costs!

Tax to Come on Health Insurance Premium

In comparison to these, the report says, there would be significant percentage increases in small firms’ average premiums or in premiums for nongroup coverage. A self-funded health insurance plan could be best cited with New Jersey State Health Benefits.
Source: topnews.us

Weasel Zippers | Archives

BRAZILE: Well first of all, I think the Democrats should continue to emphasize that unless we fix this broken system, health care costs will continue to consume more and more of our budget — $33 trillion projected over the next 10 years. So if we do nothing, we will still pay more for health care in this country. Right now it’s consuming more than 35 state and local budgets. So we are have to do something. The bill will give us a lower cost, better options and hopefully a public option, so that people who are now uninsured, including those Americans who can afford to buy health insurance, but because they’re young, they’re on one hand purchasing health insurance, this bill will give young people and other people better options to get good health care in this country.
Source: weaselzippers.us

Massachusetts Passes Health Care Price Controls. Costs Rise Anyway.

When Mitt Romney made the case for a state-level health reform as governor of Massachusetts, he promised that insurance would become affordable and “the costs of health care will be reduced.” That didn’t work out so well. Costs continued to rise, and health insurance premiums in the state were among the nation’s most expensive. So last year, Romney’s Democratic successor, Deval Patrick, signed into law an ambitious cap on health cost increases. But now it appears that Patrick’s price controls may not work very well either.
Source: reason.com

Alaska health insurance providers warn that premiums may skyrocket

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

Quinn’s AFSCME deal still has taxpayers paying 95% of retirees’ health insurance

When we met with Gov. Pat Quinn’s policy team last spring, we shared our plan for reform, which Quinn was free to implement with his new authority. Our proposal, which state Rep. Ron Sandack, R-Downers Grove, sponsored as House Bill 3309, would have retired state workers pay an average of what retired state workers in other states pay, with premiums set on a sliding scale, according to retirement age, years of service and pension income. This would reduce the enormous burden on taxpayers while still rewarding employees for lifelong service, discouraging early retirement and protecting low-income retirees.
Source: typepad.com

Individual Insurance Premiums under the Affordable Care Act: up or down?

However new groups of people are going to enter the individual market as a result of other insurance changes brought about by the ACA.  Those groups include 1) people who enter the individual health insurance market because, for them, the premium is lower under ACA due to risk pooling; 2) people who enter the individual health insurance market because, for them, the premium is lower under ACA due to the subsidy; 3) people who enter the individual health insurance market because they would pay the tax penalty under the individual mandate provision; 4) people who enter the individual market because their employer dropped coverage.  People may belong to more than one of these groups, but it is informative to examine each group separately to determine the group’s effect on insurance premiums.
Source: ajc.com

Obamacare Could Triple Health Insurance Premiums For Young, Healthy Men

That isn’t the sticker price many of these individuals would pay, thanks to subsidies offered with the law. But the young men with higher incomes wouldn’t get subsidies, and the warning of a premium price shock for them might become a key exhibit in opponents’ argument that Obamacare won’t save Americans money over the long haul but would rather cost them.
Source: lonelyconservative.com

School district costs for teachers’ health insurance rose at an average annual rate of 4 percent above inflation from 2004 to 2012 : Education Next

In states with strong unions, such as Wisconsin, note the authors, “district insurance costs can be very expensive.”  With the passage of Governor Scott Walker’s proposed Act 10 into law, Wisconsin can be seen as a “natural experiment in changing teacher union strength,” they state.  Wisconsin’s teacher health insurance costs have long been very high; average employer costs for participating teachers in 2011 were $8,311 and $19,356 for single and family coverage, respectively, or about 50 and 80 percent higher than the national averages for teachers.  At the same time, Wisconsin teachers’ contributions to insurance premiums have been low:  in 2011 they made no contribution at all for single coverage in 43 percent of the state’s districts, nor for family coverage in 31 percent (among private sector professionals, the non-contributory rates for single and family plans were 17 percent and 9 percent).
Source: educationnext.org

What They Are Saying: Health Insurance Premiums

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA Medical Prices Medical Tests medicare medigap MLR Morning Headlines Patient Safety premiums Profits Provider Consolidation Quality Rate Review Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

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

Posted by:  :  Category: Medicare

DC Voting Rights by dbkingBeginning 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

Video: Setting up Medicare as Primary Insurance and Commercial Insurance as Secondary Insurance

ABOUT MEDICARE: How Medicare works with other insurance

Medicaid and TRICARE (the healthcare program for U.S. armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.
Source: times-standard.com

Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act

HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs.  It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues.  Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.  
Source: house.gov

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
Source: crowell.com

Blog: How Medicare Works with Other Insurance

Medicaid and TRICARE (the healthcare program for U.S.armed service members, retirees, and their families) never pay first for services that are covered by Medicare. They only pay after Medicare, employer plans, and/or Medicare Supplement Insurance (Medigap) have paid.
Source: patch.com

Filing Secondary and Tertiary Insurance Claims

1st of all, how does anybody get two or 3 policies and which is determined main? If a husband and a wife each function (who does not?) and they are each covered by health insurance by their employers, they may each have family policies so they are each covered below each and every other folks program. One would be main and the other secondary. Now if 1 of this couple (a few years ago we would have assumed that it would only be the husband) had previous military encounter and carried more than their Tricare military insurance, that would be the third payor (if there was a balance left).
Source: thefundamentalist.net

New Development Regarding MSP Private Enforcement Provision : Life Sciences Legal Update

The district court found otherwise. The court, reiterating a previously determined ruling by the Sixth Circuit, held that the showing of "materialization" or "demonstrated responsibility" only applies to a "lawsuit brought by Medicare for reimbursement for medical expenses caused by tortfeasors." Id. at *15 (quoting Bio-Medical Applications of Tenn., Inc. v. Cent. States Southeast & Southwest Areas Health & Welfare Fund, 656 F.3d 277, 279 (6th Cir. 2011)). In contrast, "a healthcare provider need not previously demonstrate a private insurer’s responsibility to pay before bringing a lawsuit under the Act’s private cause of action." Id. at *15 (quoting Bio-Medical, 656 F.3d at 279)). Thus, the district court denied State Farm’s motion to dismiss.
Source: lifescienceslegalupdate.com

Turning 65: A Medicare Snafu

I didn’t expect to write a sequel to my seven-part series about signing up for Medicare.’  Just when I thought I was on the program, and all was fine, it wasn’t. ‘ After I submitted two bills for routine exams, I learned Medicare would not cover them as my primary carrier. That threw me into a tizzy.’  All my years of reporting about the program taught me that once you retire Medicare is primary.’  The benefits administrator for my retiree insurance, which I chose as my Medicare supplement, also assured me Medicare was primary.’ ‘ ‘  As proof, my monthly insurance premium dropped from $1,200 to $545, which meant most of the costs for my care were to be paid by Medicare. WHO’S ON FIRST? The problem turned out to be Medicare’s rules about whose and what insurance coverage is primary or secondary while either you or a spouse is actively working’. and you have still have health coverage from the active person’s employer.’  I thought I had no reason to look up the rules since I was no longer actively working. ‘ Thousands of others signing up for Medicare are likely to experience a similar ‘coordination of benefits’ conundrum.’ ‘  For a brief time after my Medicare benefits were effective, I had coverage under my husband’s employer plan until he took me off the plan when he retired five weeks later.’ ‘  I know having double coverage from two employer plans sounds weird given today’s realities, where people are lucky to have any employer coverage at all.’  But my husband and I decided that I would stay on his policy until I turned 65 just in case my former employer dropped retiree coverage, as many employers have done.’ ‘  Because we are a family unwilling to take the risk of having too little health insurance coverage, it was worth the extra premiums until we were confident that Medicare had kicked in. MY DOC’S BILLING OFFICE CALLS Then one day recently, a clerk from my ophthalmologist’s billing office called to say Medicare had denied payment on a $423 bill; Medicare claimed that I had insurance through something called ‘Employer Group Health Plan.”  Was what Medicare said was ‘Employer Group Plan’ actually my retiree coverage under Aetna? If so, the billing office said they thought Aetna was supposed to pay.’  But it turns out, Aetna wouldn’t have to pay until my husband’s insurance company paid, and then Medicare would cover the remainder.’ ‘  Only if there were still an amount left unpaid would Aetna have to pay.’  The billing clerk advised calling Medicare to straighten out the mess.’  A Medicare representative explained the rules.’  If either spouse is still working, and beneficiaries are covered by the active worker’s insurance, that policy is primary.’  Medicare becomes the secondary payer.’  My own supplemental coverage, in this case the Aetna retiree plan, would pay third.’  The Medicare rep said until I was off my husband’s plan, my claims for medical services had to be submitted to his carrier first.’ ‘  SO IF YOU STILL WORK AFTER 65 People signing up for Medicare need to be aware of these rules to avoid bills they might have to pay out of pocket and/or be prepared for a lot of hassle getting their doctors to resubmit claims forms to different insurers.’  With many more people continuing to work past age 65, this is not a trivial matter.’  The eye doctor’s office has resubmitted my bill’this time to my husband’s carrier.’  What about my second bill snared in these rules?’  Last week a bill for $130 showed up for a routine skin exam I had while still covered under my husband’s policy. It said Medicare had paid $81.08 leaving me with a balance of $48.92.’  I thought Medicare wasn’t paying first for this.’  Go figure.’  Once I got on Medicare, I thought billings and claims forms would be easy to follow.’  So far, that hasn’t been the case.’ ‘  I am going to set up a notebook to keep track of my medical bills and how much is paid by Medicare and any supplemental insurance I have.’  I suggest others do the same.’  Related Links:
Source: cfah.org

House Panel Approves Changes to Medicare Secondary Payer (MSP), Medical Loss Ratio Rules : Health Industry Washington Watch

On September 20, 2012, the House Energy and Commerce Committee approved by voice vote H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act. The legislation would make a series of procedural changes to MSP rules intended to “speed up the process of returning money to the Medicare Trust Fund while reducing costly legal barriers for both large and small employers.” The panel also approved on a 16-14 vote H.R. 1206, the Access to Professional Health Insurance Advisors Act. The legislation would amend the Affordable Care Act’s (ACA) health insurance medical loss ratio (MLR) rules to exclude from the calculation of the MLR certain commissions paid to independent insurance brokers and agents. H.R. 1206 also would require HHS to defer to a state’s determinations as to whether enforcing the MLR requirement will destabilize their respective individual or small group health insurance markets. Neither bill has been considered by the full House to date.
Source: healthindustrywashingtonwatch.com

Summary of SMART Act which amended Medicare Secondary Payer Act

The SMART Act requires parties to notify CMS of when they reasonably anticipate settling a claim (any time beginning 120 days before the settlement date). CMS then has 65 days to ensure the portal is up to date with all of the appropriate claims data. CMS can have an additional 30 days on top of the 65 days to update the portal if necessary. At the expiration of the 65 and potentially the 30 day periods, the parties may download a final conditional payment amount from the website. The final conditional payment amount is reliable as long as the claim settles within 3 days of the download.
Source: thehamiltonfirm.com

Health Insurance: National Health Insurance Companies

Posted by:  :  Category: Medicare

Vintage health insurance card (woman's) 2nd half 1914 by Crazy House CapersNational companies insurance insurance companies are licensed to do business in all states of the United States of America, with the exception of New York. It is basically an insurer in Texas, which is a certificate authority number 4765 in California resident. The National Health Insurance Company was founded in 1923 as the Insurance Corporation Life of William Harvey. In 1965 the company as Trinity national life and accident insurance, health insurance and included commenced its product range in 1966. It was in 1975 that the National Health Insurance Company, the first 100% insurance pioneered catastrophic. These plans have high deductibles for self-employed and small businesses. It is at the very center market continues today. The name of the National Health Insurance Company came into use in 1978, and it was then that the company filed a legal reserve company in the state of Texas. There are many providers affiliated companies in connection with public health insurance, such as Beech Street, Midlands Choice, InterWest, Multiplan, PHC (Private Healthcare System) and Pro-net. National health insurance policyholders can partner with these suppliers health problems they face are to be covered by their health insurance. However, as providers can sometimes withdraw from the Network Society national health insurance, it is always best to check with the institution or affiliate doctor if they are still participating in the network. Before receiving medical treatment If they are not, then you will not be able to make your inquiries with national health insurance. One must not forget that the national health insurance do not offer health insurance policy for you, and are not responsible for the quality or results of physicians and facilities to be made available. One of the benefits, insurance from the statutory health insurance is that insurance claims from a number of providers in the Americas can be made.
Source: blogspot.com

Video: National Health Insurance Debate Under Nixon

Mass. health law influences national policy — Brown Daily Herald

Health care reform in Massachusetts in 2006 influenced both the success and politics of the federal Patient Protection and Affordable Care Act passed in 2010, said Nancy Turnbull, senior lecturer in health policy at the Harvard School of Public Health, who helped former Governor Mitt Romney create the Massachusetts reform, in a lecture Tuesday. Turnbull’s talk, hosted by the Taubman Center for Public Policy and American Institutions, was intended to shed light on the ongoing health care debate in America and explore what lessons could be learned from Massachusetts.
Source: browndailyherald.com

The American Spectator : Privatization Shellacs Obamacare Model

I know the difference Georgie – the Chargemasters used by providers are complex instruments that set exorbitant prices for goods and services provided. Ever wonder why only in healthcare technology advances don’t drop the price, like they do elsewhere? Because the Chargemaster is not changed, and they can get away with it. If you knew anything about business, you’d know that a business sets it’s prices based on it’s cost and a fair markup to provide for overhead and to make a profit. If your price is too high for consumers, you charge less and find ways to cut costs or you go out of business. Insurance companies know the true cost of the healthcare given by providers and so they contract for discounts based on their knowledge of that information – they will not pay $1.50 for an aspirin that costs $0.10! The poor sap that pays market price (Chargemaster) for a procedure doesn’t know he’s being taken to the cleaners – he has no way to know the true value of the goods & services he is rendered. That isn’t “making up the lag” – it’s cheating those that don’t know the difference. You really ought to learn more about this racket, before you open your mouth. It’s a disgusting swamp that hurts both the doctors and the patients in the hunt for profit.
Source: spectator.org

Children and Health Care Reform

This turned out to be my biggest challenge.  Since ACA is still in the rule-making phase, regulations and definitions are still evolving, making it nearly impossible to get a straight answer to what I thought were simple questions.  I wanted to know whether low-cost policies offered through California’s health exchange would provide children with the same “gold standard” of care that is currently included in MediCal.  Or, whether the definition of “habilitation” was broad enough to cover the range of not-strictly-medical-yet-crucial services that kids with a chronic condition need, such as inhalation therapy for kids with asthma or educational diabetes camp for kids with Type 1 diabetes.  Sources from state lawmakers to insurance companies and children’s advocates disagreed; either they had fundamentally different answers – or they threw up their hands, saying, “Nobody really knows.”
Source: reportingonhealth.org

Question on US National Health Insurance

If we had a true National Health Insurance plan in the US, would it be pro-business or anti-business? Currently we are basing things mainly on employer-provided insurance. I would think the cost of that would put companies at a disadvantage in competing internationally. Also there would be competitive advantages and disadvantages within the US.
Source: jackreidy.com

Uganda needs a national health insurance scheme

Health insurance schemes are supposed to reduce unforeseeable health care costs through regularly paid premiums. The social health insurance in most developed countries started with formal sector employees in urban areas.
Source: co.ug

Why I Support Universal Health Care: A Right, Not a Privilege

I received a bone marrow transplant in 1989 from my identical twin sister. Although I had no problem finding a match, I had to jump through many hoops and barriers put up by the two health insurance companies covering my sister and myself. In the case of my insurance provider, I was refused coverage of the donor portion of the transplant because my twin sister wasn’t on my health insurance plan. In the case of my twin sister’s insurance provider, they refused to cover her portion of the transplant because she “wasn’t sick.” Then the hospital administration said that they would not perform the transplant until this conflict between the two insurance agencies was resolved with a guarantee of payment by either or both companies. And my doctors said that if the resolution did not occur rapidly, I would be dead within the year due to the seriousness of the form of leukemia that I had.
Source: civilrightsadvocacy.net

How the Sequester Could Affect Social Security, Medicare and More

Posted by:  :  Category: Medicare

What could happen to my retirement investments? That’s anyone’s guess. Many Wall Street analysts think the stock market will tumble as a result of the projected decline in gross domestic product — and the gridlocked situation in Washington. Others, though, think the markets will show little change — and even improve in the long run. So, depending on where your money is, this could have different effects on your portfolio. Still, all this is highly speculative at this point.
Source: aarp.org

Video: The Story of Medicare: A Timeline

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

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: kaiserhealthnews.org

CBO Updates Spending Projections for ACA, Medicare, Medicaid

According to CBO, the new estimate is the result of the American Tax Payer Relief Act, which maintained lower tax rates for U.S. residents with annual incomes below $450,000. The lower rates “reduce the relative attractiveness of employment-based insurance for low-income workers and for their employers.” In essence, offering health coverage as a tax-free form of compensation is less appealing when marginal tax rates are lower and a publicly subsidized option is available. CBO estimated that employers will pay $13 billion more in fines for non-compliance with the ACA’s employer mandate. 
Source: californiahealthline.org

Quick Health Facts 2012: A Compilation of Selected State Data

. This is the 3rd edition of Quick Health Facts. Earlier editions were published in 2008 and 2010. This is the first year that Quick Health Facts incorporates data from the American Community Survey (ACS), resulting in an improvement of the precision of state level estimates.  Previous editions relied on data from the Current Population Survey (CPS). As a result of this change, some of the figures in this edition of Quick Health Facts are not directly comparable to the figures in previous editions. In addition, data points presented in Quick Health Facts should not be combined to create new data points, as they are often derived from different data sources. The Quick Health Facts series is adapted from the State Profiles: Reforming the Health Care System series that was published annually from 1990 to 2000 and biennially from 2001 to 2005 by the AARP Public Policy Institute. Quick Health Facts is not a continuation of the State Profiles series; therefore, comparisons should not be made with information contained in past editions of State Profiles.  This publication, as well as state-specific versions, can also be accessed via the Internet at http://www.aarp.org/research/ppi. For hard copies of Quick Health Facts 2012, please call the AARP Public Policy Institute at 202-434-3890.
Source: aarp.org

Medicare Voucher Plan Remains Unpopular

Six-in-ten (60%) Republicans call Ryan an excellent or good choice, 20% say he is an only fair or poor choice and 20% do not offer an evaluation. Nearly seven-in-ten (68%) conservative Republicans say Ryan is an excellent or good choice, just 16% give the selection an only fair or poor rating. Independents view the Ryan selection somewhat more negatively than positively – 30% call him an excellent or good choice, compared with 42% who say he is only a fair or poor choice; 27% of independents offer no rating. Democrats view the Ryan choice overwhelmingly negatively – 70% say he is an only fair or poor selection; just 8% say excellent or good.
Source: people-press.org

How Entrepreneurs Could Solve Medicare’s Problems

There are numerous examples of islands of excellence (Mayo, Intermountain Healthcare, Cleveland Clinic and so forth) on the supply side of the health care market. Their success is often the result of the efforts of a few individual entrepreneurs. However, there is little incentive for other health care providers to copy their successes because there is no penalty for low-quality, high-cost providers when Medicare (or Medicaid) is paying the bills. On the demand side, government, nonprofit foundations and private insurers have sponsored a slew of pilot programs, such as pay-for-performance and others, designed to lower costs, increase access and improve quality. But these efforts have not produced measurable results. In fact, there is no single institution providing high-quality, low-cost care that was created by any demand-side buyer of care. Not the Centers for Medicare and Medicaid Services (CMS), which runs Medicare and Medicaid. Not Medicare. Not BlueCross. Not any employer. Not any payer, anytime, anywhere.
Source: ncpa.org