Ohio Health Policy Review: Ohio Medicare

Posted by:  :  Category: Medicare

We need to get this to the Fiscal Cliff! What could go wrong? by DonkeyHoteyThe federal Department of Health and Human Services announced last week that Ohio has been approved to undertake a pilot project to better coordinate care for 114,000 Ohioans who are eligible for both Medicare and Medicaid (Source: "State gets OK to alter Medicare, Medicaid," Columbus Dispatch, Dec. 13, 2012).
Source: healthpolicyreview.org

Video: What Are The Ohio Medicaid Eligibility Guidelines

Boosting home care options under Medicaid: Balancing Incentive Payment Program, Community First Choice Option

[40] Anna Rich, e-mail of 12/13/2012: “I think that an additional important point to make on CFCO is that implementing it in combination with the duals demo is really perfect timing, because the state is (we hope) already thinking through issues like how plans will do assessments, care plans, etc—that thinking could be combined with implementation of CFCO requirements like the person-centered service plan, so as not to require extra work. Also, the experience in California was that CMS was definitely willing to work with the state to make the transition to CFCO from our current personal care services option as seamless as possible, keeping the administrative burden minimal and maximizing the benefit of the increased match.  From the beneficiary perspective, the transition has been easy. I also don’t think Ohio should be scared by the fact that it is a statewide state plan benefit rather than a capped waiver benefit because your waivers are so underenrolled.  Also, Medicaid expansion or so-called “woodwork effect” should not scare the state off because CFCO is for people who need an institutional level of care—they are likely already on Medicaid.” 
Source: policymattersohio.org

Ohio Medicaid Program Raises Stakes For Nursing Homes

States such as Colorado, Georgia, Kansas, Nevada, Oklahoma, Utah and Vermont have tried to change that by awarding a small bonus (from 60 cents to $6.16 per day) if facilities achieve various standards.  But industry representatives say those incentives are insufficient to generate significant enthusiasm for altering the status quo, according to Nicholas Castle, who has surveyed nursing home administrators and is a professor of health policy at the University of Pittsburgh.
Source: kaiserhealthnews.org

Ohio Democratic Chairman Chris Redfern’s Statement on Romney VP Selection of Paul Ryan, Embrace of Republican Plan to End Medicare As We Know It

“Paul Ryan got his start in politics, as a young staffer just out of college, working for then-Congressman John Kasich’s Budget Committee. Ryan cut his teeth working long, tireless hours for Kasich, helping him slash programs for working families, grinding progress to a halt, and laying the groundwork to shut down the federal government.
Source: ohiodems.org

Medicare Changes for Seniors in Ohio

Governor John Kasich of Ohio announced a medicare medicaid transformation plan with cost saving measures to consolidation of care for  Seniors on Medicare. Kaisch and the State of Ohio had their plan approved the the Centers for Medicare and Medicaid. What the plan  does is coordinate care for Seniors qualify for medicare that are on Medicaid meet low income guidelines.
Source: wordpress.com

Ohio's Proposed Budget

The Executive budget will place greater responsibility on managed care plans to administer quality improvement programs. For example, it proposes to create a pay-for-performance program, continues to require accountability for preventive services (e.g., well-child visits and prenatal care), and establishes a withhold of one (1) percent of the capitation payment for plans to earn back as an incentive payment tied to performance. The Executive budget proposal assumes that expansion of managed care to include children with disabilities (a transition component of establishing pediatric accountable care organizations) will allow health plans to spread their administrative expenses across more lives.
Source: triagehealthlawblog.com

Prescription Drugs: A Look at Pharmacy Services Administrative Organizations

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

Gov. Kasich Will Support Medicaid Expansion in Ohio

Since the Supreme Court made Medicaid expansion optional it has created a real divide among Republican governors. Many, like Texas Gov. Rick Perry, have rejected the Medicaid expansion in an effort to continue opposing Obamacare and hopefully cripple the new law. A handful of Republicans governors though believe that as long as it is the law of the land not accepting the money would be detrimental to their states.
Source: firedoglake.com

Competing Plans For The Federal Budget

Blueneck BillyBob, Thanks. Your Ohio approach (aka Kasich-Kommando) is interesting to say the least. Next door in Indiana, the vaunted “Blade” Mitch Daniels created his own Franken-Budget approach and now he is the President of Purdue U rather than running for POTUS. He successfully persuaded the Republican controlled legislature to put a cap on property taxes – in the state constitution. So, when it came time to fund education and pay teachers, the cupboard was bare. To boot, he “misplaced” half a billion thru various “computer glitches” until after the budgetary process clamped down on every conceivable public service that was not privatized (e.g. he sold the state highway toll roads to offshore companies). That created a large surplus, but he was not finished. Now that he has moved on to old PU, it’s assessment time and the homeowners (not businesses of course) are finding their homes are suddenly assessed at 120% to 150% of the prior assessed value. Presto, the property taxes for homeowners are skyrocketing. His successor Mike Tea Party Pence is trying to cut education further by dangling the prospect of an income tax cut of 10%. A local TV station has exposed the bogus job creation record of Daniels too – only 30% of the jobs his flag waving department claimed they had brought to the state actually materialized – while the tax abatements and goodies for businesses as lures remained in place.
Source: thedianerehmshow.org

Ohio GOP Gov. Kasich Rejects Partisan Extremists, Extends Medicaid Benefits to 578,000; Action Shows Obamacare Is Here to Stay

“While Republican governors like Bobby Jindal of Louisiana and Rick Perry of Texas are playing games with people’s lives to throw red meat to the extremists in their party, Gov. Kasich applied common sense, economics and simple math. If Arizona Gov. Jan Brewer can stop wagging her finger at Obamacare, and even Kasich can shed his partisanship to do the right thing, other GOP governors should follow suit.”
Source: healthcareforamericanow.org

The importance of Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SS2010 medical statistics AARP medicare supplements ABC News abort helth baby aetna Affordable Care Act Afghanistan aids cure aids vaccine ALARA principle alarm fatigue alarm who cried wolf syndrome alzheimers ameda American College of Radiology American Medical Association amniocentesis anti obesity medical devices Arl Moore asclepion atrial fibrillation average life span of a donated organ babies addicted to drugs Babies with low birth weight linked to Heart disease in moms baby autopsy baby drug withdrawal bandwidth bankruptcy Bassett Medical Center bathroom cleaning become a doctor overseas berkeley bionics berkeley university crossfit heart disease lgmedsupply medical costs medical noise medical supplies medicare medicare supplements muscle stimulators new england journal of medicine obamacare tens units
Source: medicalnoises.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Understanding Medicare Supplement Plans

Scope of Coverages. Every one of the Medigap plans includes a hospital benefit to cover coinsurance payments for standard Medicare Part A benefits, and a preventative medical care benefit that covers certain preventative services not covered by Medicare, as well as 100% of the coinsurance for Part B preventative services after the deductible is paid. The plans include some combination of the following benefits: coverage for Medicare Part B coinsurance obligations; blood during hospital stays; the hospital deductible amount; coverage of nursing facility coinsurance obligations; coverage for Medicare Part B deductibles; coverage for Part B excess charges; partial coverage for foreign travel emergency expenses; coverage for certain at-home recovery costs; and coverage for coinsurance obligations for hospice care.
Source: insuranceadvice.com

Medicare Supplement Plan F

Plan F also pays for outpatient deductibles as well, so seeing the family doctor or specialist is no problem. Medicare Part A and Part B coinsurance and copayments are covered, as are hospital costs after Part A benefits have been exhausted. Plan F also covers up to three pints of blood if transfusions are given, skilled nursing facility care, hospice care coinsurance and copayments and any Part B excess charges incurred. These can happen if a doctor refuses assignment and charges more than Medicare approves. The remainder, or excess charge, is paid by the supplemental insurance. For those looking for a good supplemental policy, Plan F will fit the bill.
Source: alissapajer.org

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

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

Medicare Supplement Insurance › Medicare Supplement Insurance

So I decided to check into different types of Medicare insurance and how much they cost. I found that many insurance companies that offer regular insurance also offer the supplement plans. I also read testimonials from people who had Medicare supplement plans. Some people found them to help and others said they don’t help enough. After finding a plan that fit my budget I found that it did help cover some costs but there was still some left over that I still had to cover. I feel that some months when I have more bills the insurance is a lifesaver and other months when I don’t I feel as if I’m putting out more money than is necessary. I still have mixes emotions about the supplement plans and being that I have only invested in them for the past 3 years I will continue to purchase Medicare supplement insurance. The best advice I can give is to research the different plans, they are very similar but there is always the fine print that needs to be read and understood.
Source: savestvictors.org

Can You Believe Best Medicare Supplement Insurance Plans

Along with the Medicare Supplements, people have obtained huge health benefits. To get into specific benefits, it takes need for people to note that we now have 12 policies may also known for a through L. In the cover of K as well as , L policies, individuals are able to attain hospital services even though they have finite financial backing. The F with J policies are the cheaply available but are laden with fantastic deductibles. Got your Supplement rrnsurance coverage squared away, be sure you also procure a part of D, better known as Prescription Drug Package. Neither Medicare nor your supplement project will cover your new monthly prescriptions and it’s imperative that you’ll seek the greatest plan for a based on your requirements budget. Folks who wants do so, penalties may be imposed on you immediately after and you is going to pay a higher rate for as a long time as you are on Medicare. To finish, after the person have opted to positively insurance that packages your health best, make secure everyone purchase the plan of action for supplement your healthcare that particular has the most competitive premiums. One may prove a lot of money at first yet , the premiums won’t be increased via the health and thus medical insurance consultant per year like you grow adult people. Best seriously are medicare supp plans legit or BS? is one single that gives specific optimum benefit with regard to all those with whom get to be familiar with the advantages of all getting the Insurance plan. It is a matter of great advantage that the supplement Insurance Plans are available that could be made the most appropriate use of by using securing the tomorrow of an people. These Plans work in the best apr of generally folks who are incapable at the offer of their grow and therefore want to anyhow comfy their future accordingly that there never ! stones left out in the plan of achieving this goal. May only by the preplanning of all the future and applying for the future guaranteed that a mankinds being is excited to get the utmost out of usually the little that he can afford. In good health individuals that complete not have declining health insurance through their employer and could not qualify of Medicaid may find that their region has an insurance plan specifically all of them. For example, Indiana has a relatively new getting insurance plan called HIP (Healthy Indianapolis Plan) which guarantees the needed car insurance at an fair price. Treatment Aspect A: Offered they compensated ample Medicare taxes even as working, seniors set into eligible to receive no cost Medicare health insurance Component A offer when they focus 65. Your probable to become eligible to consider top quality-free in charge Medicare Component part A coverage if you’re eligible to help obtain Social Security benefits. Nevertheless, Component A will only supplies coverage because of hospital solutions this kind of as inpatient medical care in hospitals combined with expert nursing options. Many, or else lots of insurance companies don’t let their own price ranges to get published online. Since of this, it could possibly really be squandering your a good fortune to the looked into ease of collecting insurance quotes on-line.
Source: typepad.com

jorisholst: Medicare Supplement Insurance Information In The California

Any of these plans, although, merely pay for patients which they acquire to be seriously important, medically presenting. The premiums for each insurance policy will update and it depends on for which plan you are often going to take on. However, they are mentioned implementing three primary possibilities. First pertaining to all, the plan creators will look at the insurer age whicj has been attained. Including the short rates particularly for senior citizens over the age 65 years. The older that you get, the more significant the premiums. Adjustments are ordinarily formed annually, suitable after 3 years and 5 years. The adjustments perhaps even require swelling course . grows the premiums to be paid. State health programs is also to be able to some other citizens, including those that are pregnant and devoid of insurance, the disabled, blind, and numerous children. Even when a child’s parents are not qualified to apply for Medicaid, he and also she most undoubtedly will be qualified for Medicaid on really own status, ensuring looks too children have likelihood to obtain right and necessary medical care. Inside course of almost every circumstance, once you pull together submit form on one of them insurance coverage web sites, you’ll have Several or upper providers calling your self on the unit and attempting merchandising the approach which makes all of them the best fee. Medicare insurance is a arrangement between what types of health management is needed when considering senior citizens but what the governments can provide. How Can I Get A MediGap Plan Online Without a Credit Check? plans are the solution so as to these “gaps” with regard to coverage. They will cover items that Medicare cannot pay. Concentrate on understand that Medicare supplement policies are ended up selling by private businesses. The policy itself is the same no matter what kind of person sells it nevertheless the cost to tradesmen might change. When you buy Medigap Plan K at one insurance organisation is the corresponding coverage you will receive through another insurance provider. The difference being premium you pay to offer the insurance. Is definitely one of would like it is essential to do groundwork before settling on the Medigap plan with provider. A lot of Medicare Advantage Plans, including PPO’s to HMO’s, have business networks. Seniors who purchase a major HMO must pay a visit doctors, hospitals, on top of that specialists that community forums the plan community. If they choose to visit doctors or another providers who do not participate they become not receive any benefit from their health plan. Individuals who purchase PPO’s can visit providers outside concept network, but they’ll have higher co-payments and may possess a deductible. This includes the price of extended medical stays, specialized extremely helpful care and policy cover for emergencies why occur abroad. Before enrolling in a plan, you have should understand what the coverage versions are and i would say the rules that govern changing policies. If you are typically still employed and moreover covered under a real group health plan, it may consequence your Medicare potentials. Medicare health insurance Supplemental Plan M covers the A deductible, which is 00 for 2010 and a new Part B annual deductible, which could be described as 5 for ’10. In extension, the Medicare supplementing Plan covers the very 20% co-insurance just that genuine healthcare how can not pay over Part A and furthermore Part B. There are quite possibly a few extensional profits including the actual foreign trip convenience and a “Part B excess Charges” benefit. Distinct inclusive plan markets the perfect videos money can look for.
Source: blogspot.com

Absolute Best Medicare Coverage Thanks To Medicare Supplement Plans

Medicare supplemental plan Fahrenheit approved by the very center for Medicare Care (CMS), which shifts every company must provide the similar real benefits when selling this to be able to seniors. Can’t add extensional benefits, nor can they’ll clear away also known as modify any bonuses. Knowing Medicare Supplement Insurance policies F is the only problem similar unconcerned of which company is offering you this option, might be wise to choose a plan from the insurance plan company who is regarded as giving the lowest price. 011 is quickly attaining here, and with that brings new irregularities to your Desperation caused a need for me to look online for Medicare Plans field. Therefore, the first actions is to come across an expert finance broker whom specializes your past Medicare Supplement Prepare market. When using the advent of the online world this task is less difficult. By simply going to Yahoo or google and entering the word Medicare Supplement Insurance protection or Medigap, however easily find countless resources of expert information. Even though there are 12 several different plans, not all of them are offered nationwide. Despite the fact that providers can some other people all plans, consumers very often do not. This makes selecting a agenda more complicated of computer could be. You may constitute wondering how to choose a plan the to consider when going though your options. It is important to keep in mind that all companies make available similar, standardized desires. A Medicare Supplemental insurance policy also known simply because “Medigap” and ought to private health insurance, which designs so that you can supplement original Medicare. It helps you to pay some of the health care costs, which original Medicare doesn’t cover resembling co-payments, co-insurance, and as well , deductibles etc. Medicare supplemental Insurance also cover one or two certain things which unfortunately Medicare doesn’t. Medicare supplemental insurers can only put up for sale your plan the identified letters. Each modernized Medicare supplemental plan deliver the same basic conveniences but it makes no difference which insurance boss sells it. You can furthermore , find some actually guaranteed coverage which includes a policy, while policy is guaranteed renovation.
Source: typepad.com

Cancel Medicare Advantage

Because of their flexibility, the ability to move states and the fact that the insurance company cannot change the plan are just a few of the reasons we prefer Medicare Supplement Insurance Plans to MAPD. If you would like to hear more about the reasons a Medicare Supplement can be a better fit for your insurance, please fill out the short form at the top of the page and one of our experts will get you a new medicare supplement quote and help explain how you can save the most off your medicare cost.
Source: medicarecost.net

State Innovation Models Initiative: Model Pre

Posted by:  :  Category: Medicare

TOP 10 Reasons to Re-Elect Mike Coffman No. 10 by Smarty McPantsNew York submitted a Pre-Testing Assistance Award request also to support activities related to organizing collaboration with statewide and regional stakeholders; quantifying and describing the current health care environment in New York; and completing legal, regulatory and policy and cost analyses relating to implementation of new payment and service delivery models.  The state plans to convene a series of stakeholder meetings in various regions across the state including meetings in: Buffalo, Rochester, Syracuse, New York city and Albany.  Working with a consultant, the state will also collect and analyze health care pattern utilization data for public and private payers; conduct business process and systems analyses; and develop quality improvement systems, performance standards and related metrics.  The proposal meets the requirements set forth in the Funding Opportunity Announcement and the Centers for Medicare & Medicaid Services recommends this applicant for a Pre-Testing Assistance Award.
Source: coloradomedicalhome.org

Video: SEIU/COPE Medicare Colorado

Week before Obama visit, report finds Colorado Democrats cut Medicare by $6 billion for seniors in Colorado

“Seniors are among those in Colorado hit hardest by this recession,” Call concluded. “With many seniors living on fixed incomes, hundreds of thousands of Coloradans struggling to find work and a debt level that threatens to downgrade America’s credit rating again, we can’t afford another four years of Obama and the Democrats’ failed economic policies.”
Source: cologop.org

Colorado hospital group warns of Medicare cuts

The Colorado Hospital Association predicts Medicare payments to hospitals in the state will drop by more than $2 billion over the next 10 years, according to the Northern Colorado Business Report. The Greenwood Village-based association said a handful of federal statutes will trigger the reduced amount hospitals will receive, with the majority — $1.4 billion — coming from the Patient Protection and Affordable Care Act. Another $359 million in reduced payments will come from the ongoing budget…
Source: coloradomortgagepro.com

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

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

AARP: Don’t rush changes to Medicare, Social Security

“The survey shows that older Americans have significant concerns about any attempt to make major changes to the lifeline programs of Social Security and Medicare in rushed negotiations in the short time before a new Congress arrives,” said AARP Executive Vice president Nancy LeaMond. “We commend the bipartisan group of leaders and public officials who have expressed the need to work together on important issues facing our country, including the deficit.”
Source: csbj.com

Medicare top issue for surge of older voters in Colorado

Colorado has a significantly smaller percentage of seniors — about 11 percent — than traditional magnets for retirees like Florida, where about 22 percent of the population is 65 and older. But the unprecedented population growth among older adults is far outpacing other population growth across Colorado. Between 2000 and 2010, the population of adults ages 60 to 64 who were on the cusp of Medicare eligibility, increased by a whopping 86 percent in Colorado, while the population as a whole grew by 17 percent.
Source: healthpolicysolutions.org

Paul Ryan and Medicare Reform

In stark contrast, the current plan, The Affordable Healthcare Act, also known as Obamacare, removes $716 billion out of Medicare and transfers it to Obamacare.  The current administration believes they can replace this withdrawal by paying doctors, hospitals and nursing homes less.  Unfortunately many service providers have already stated they would have no choice but to stop accepting senior patients if this reduction in payment amount occurs. They simply cannot afford to offer the care necessary at these lowered rates resulting in decreased services, outdated products, increasing premiums and prices.
Source: mycoloradoview.com

Savvy Senior: How Medicare covers diabetes

Screenings: If you don’t have diabetes, but you do have pre-diabetes or some other health conditions that put you at risk of getting it – such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes – Medicare will pay 100 percent of the cost of up to two diabetes screenings every year.
Source: bradenton.com

MHANJ Offers Free Medicare Benefits Counseling through “SHIP”

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 marsmet481Counseling is free, objective and confidential and encompasses assistance with questions about Medicare, Medigap, Medicare Advantage, Medicare Part D, Long-Term Care Insurance and Dual-Eligibility. Sessions are conducted by telephone so that travel is not necessary.       
Source: mhanj.org

Video: Medicare Explained

Medicare Advantage Cuts: Higher Costs and Reduced Benefits

Seniors and people with disabilities enrolled in Medicare Advantage plans will face higher premiums, reduced benefits, and loss of coverage options if new Medicare Advantage cuts proposed by the Centers for Medicare & Medicaid Services (CMS) take effect next year. CMS recently proposed a 2.3 percent reduction in Medicare Advantage payments for 2014 at a time when medical costs are projected to increase by three percent. The new proposed payment cuts are in addition to the Medicare Advantage cuts and the new health insurance tax included in the Affordable Care Act (ACA).
Source: ahipcoverage.com

Democrats Wary Of Medicare Benefits Cuts Being Discussed In Fiscal Talks

The Hill: Democrats Want GOP To Show Hand On Medicare In Deficit Negotiations Democrats wary of accepting any entitlement benefits cuts are asking Republicans to show them their plans if they want to make Medicare means-testing a part of a lame-duck fiscal package. GOP leaders have floated the idea of hiking Medicare costs for wealthier beneficiaries – a proposal President Obama has repeatedly backed – as a condition of any deal to prevent a slew of tax hikes and spending cuts from taking hold Jan. 1. But Speaker John Boehner (R-Ohio), the GOP’s point man in the negotiations, has declined to specify the Republicans’ wish-list for entitlement reform – at least publicly. And it’s unclear whether means-testing would be enough to win GOP support for a deal that would also hike tax rates on households with annual family income above $250,000 (Lillis, 12/16).
Source: kaiserhealthnews.org

Who To Reach Out To For Your Medicare Related Questions

As you might imagine, the correct answers to these questions vary widely depending on very personal, complex and unique circumstances. Realistically, the only source for answers to these types of questions is through Medicare directly or through your Personal Care Physician. Our responses to these questions invariably advise you to call Medicare or your PCP, and, where applicable, point you to an official Medicare publication.
Source: medicarebenefits.com

Is Raising the Age for Medicare Benefits a Good Idea?

The twists and turns of recent political conversations over the federal deficit have explored a variety of changes to Medicare. The most likely ones are raising the eligibility age for benefits to 67 from 65 and changing the law so that more seniors will have to pay higher Part B premiums. (Part B pays for doctor visits, hospital outpatient care, and lab visits.) In this column, I’ll discuss raising the Medicare eligibility age, which, if changed, will affect seniors in the future. The rationale goes something like this: people are living longer, healthier lives and can work longer so why should they get Medicare benefits earlier. That’s the same argument used to justify further raising the age to collect Social Security benefits. It is now 67 for those born after 1959. But there’s more to the story than what the public hears in the glib TV sound bites. While in general people are living longer thanks to medical advances, those gains are not evenly distributed in the population. Improvement in life expectancy has accrued mostly to those with college educations. The Medicare Rights Center, a New York City advocacy group, says ‘older adults, people of color, blue-collar workers and employers would be among those hardest hit.’ And just because people live longer doesn’t mean they won’t get sick. In fact, many new Medicare beneficiaries have put off needed care until they reach Medicare age. So why is this an attractive option? lt shifts money from the government’s budget to the budget of seniors who would have to pay more out-of-pocket. According to the Kaiser Family Foundation, the cost savings for the federal government amounts to $11.4 billion. But seniors as a group would pay $5.7 billion more for their health care. Many seniors would look to their employer coverage for help’some even staying in the workforce longer to keep their insurance until they turn 67. That, of course, means employers will have to pay more too. ‘We don’t save money in overall health care spending,’ says Joe Baker who heads the Medicare Rights Center. ‘The government gets to shift its costs to others, and those others have to pay more for their coverage. The reality is Medicare is the cheapest option because it controls its costs better than other insurers.’ Even though insurance may cost more, supporters of raising the eligibility age argue that those losing early Medicare coverage could simply turn to the new insurance exchanges that will be up and running in 2014. That causes other headaches, though. Kaiser estimated that premiums for younger people’those under 65’seeking coverage in the exchanges in 2014 would rise by about three percent, or about $141 a person on average. That’s because older and sicker people would now be part of the exchange risk pools. Medicare operates as one giant risk pool with premiums from current seniors who are healthy helping to subsidize those seniors’mostly older ones’who do have large health expenses. If younger healthy seniors are taken out of Medicare’s risk pool, there’s a danger that the pool will deteriorate, making it harder in the long run to cover the costs of those who need care. Can seniors afford to pay more? When you consider that half of all people with Medicare live on incomes less than $22,000 a year and have less than $53,000 in savings, the answer is maybe not. Advocates for the elderly point out that seniors already pay a great deal for their health care. In 2009, health care expenses accounted for about 15 percent of their household expenses compared to five percent for those not on Medicare. The proposal to raise the eligibility age, of course, will not affect current retirees, but most proposals being discussed would impact those who will be eligible for Medicare in the next 5 to 10 years. Because of job losses, diminished home values and retirement accounts, the Medicare Rights Center says that half will have incomes less than $27,000. Says Baker: ‘It’s a lose, lose, lose proposition all around.’
Source: cfah.org

Volunteer Training About Medicare Benefits 

The Lincoln County SHIBA program (Senior Health Insurance Benefits Assistance) conducts volunteer training February 28 and March 1. Although the workshops are focused on training new SHIBA volunteers, it is an educational opportunity for anyone workingor volunteering in a field that encounters Medicare beneficiaries. Curriculum includes Medicare Parts A, B, and D, Medigap Supplements and Medicare Advantage plans. Training also includes how to handle difficult clients and challenging client needs.
Source: kyaq.org

Signing Up for Medicare Benefits, Act Now!

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

Medicare Advantage: Providing Quality Care to More than 14 Million Beneficiaries

Posted by:  :  Category: Medicare

Congressman Kendrick B. Meek by cliff1066™Medicare Advantage plans are a valuable resource in protecting beneficiaries from unpredictable out-of-pocket costs. In 2012, all Medicare Advantage plans offered an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less. These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

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

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

Don't Fall for TV Ads on Medicare From an Insurance Industry Front Group

AHIP may have a hard time convincing the current Congress to take pity on insurers. Last week the Government Accountability Office released a report estimating that CMS overpaid private insurers between $3.2 billion and $5.1 billion from 2010-2012. Chances are, though, that far more people will see AHIP’s TV campaign than an obscure GAO report. And people won’t even know that insurers are behind the campaign. That’s because AHIP is using one of its front groups, the Coalition for Medicare Choices, as the sponsor of the campaign.
Source: michaelmoore.com

Not Happy with Your Medicare Advantage Plan? Change it!

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

Medicare Targets Health Plans With Low Ratings

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

Insurers: Cuts to Medicare Advantage will hit poor, minorities

“Medicare Advantage is a lifeline for millions of low-income and minority Medicare beneficiaries who rely on the high-quality coverage and innovative programs and services these plans provide,” AHIP President and CEO Karen Ignagni said in a statement.
Source: thehill.com

Jacada Solutions Selected by Puerto Rico Medicare Advantage Plan Provider

Jacada solutions help organizations improve their customer experiences and reduce their operational costs. Jacada enables organizations to deliver advanced customer and agent interactions by implementing cutting‐edge mobile customer service solutions, agent desktops, and process optimization tools. Customers can benefit from an improved customer service experience at every touch point with the organization, whether at the call center, on the mobile, or at the retail store. Jacada projects often deploy in less than six months, and customers often realize a complete return on investment within 12 months of deployment. Founded in 1990, Jacada operates globally with offices in Atlanta, USA; London, England; Munich, Germany; and Herzliya, Israel. More information is available at www.Jacada.com.
Source: virtual-strategy.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

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

MedPAC calls for permanent reauthorization of Medicare Advantage plan covering nursing home residents

The low readmission rates indicate I-SNPs provide more integrated, coordinated care to enrolled beneficiaries than fee-for-service plans. Based in part on I-SNPs’ high marks for improving integrated care, MedPAC commissioners unanimously recommended that Congress permanently reauthorize them, according to the Bureau of National Affairs (BNA).
Source: mcknights.com

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

Fiscal Cliff: What Is At Stake For Medicare And Medicaid?

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareMARY AGNES CAREY: Right. That is definitely the balance that’s in the works. If you ask beneficiaries to contribute more, what do you ask the providers to do? For example, some ideas that are out there, they’ve been around for a while: Do you look at the fee-for-service Medicare structure on co-payments and deductibles?  Combine those into one deductible, for example, but add a catastrophic cap, which doesn’t exist in fee-for-service Medicare.  On providers: As we know, their payments will continue to increase over the next ten years, but under the health care law they’re going to do so at a slower rate.  So do you go back to providers, to hospitals, to the nursing homes, to home health care agencies, and take more from them?  And how do you balance that pain to get an equal result?
Source: kaiserhealthnews.org

Video: New Medicare Preventive Services National Provider Call 8/15/12

Bundled payments, DMEPOS, regulatory reform, and ESRD

We also announced a major expansion of the Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program.  In its first year of operation, competitive bidding, where prices are based on suppliers’ bids, saved the Medicare program, and taxpayers, over $202 million, while maintaining access to quality products for Medicare beneficiaries in the nine areas of the country where the program launched.   It’s a great example of the Administration’s determination to put the brakes on runaway healthcare costs.  With this expansion in the program, Medicare beneficiaries in 91 major metropolitan areas will save an average of 45 percent on certain DMEPOS items beginning in July.  Between 2013 and 2022, we estimate that the expansion of the DMEPOS program will save Medicare $25.7 billion, while saving beneficiaries, who pay a percentage for medical equipment and supplies, $17.1 billion through lower prices.
Source: medicare.gov

Most Medicare Providers Falling Short of Quality Reporting Requirements

According to researchers, some initial PQRS participants said they faced challenges with compliance because of “internally contradictory program instructions and explanations from CMS.” The researchers added that participants “have asserted that the program had little, if any, impact on the quality of their care” (
Source: californiahealthline.org

New AMIC Survey Data Shows 2010 Medicare Payment Cuts Forcing Physician Practices and Imaging Providers to Reduce Patient

In the past, the Obama Administration has proposed using RBMs in the Medicare program.  However, the Department of Health and Human Services (HHS)  previously weighed in on prior authorization in the Medicare program, noting in 2008 that a prior authorization program could be “inconsistent with the public nature of the Medicare program,” since such programs rely on private companies using proprietary systems to deny care prescribed by a physician.  HHS also noted that the Medicare appeals process guaranteed to every beneficiary could overturn a “high proportion” of denials, rendering the policy ineffective.  In an environment of reduced reimbursements, the AMIC survey further demonstrates that application of RBMs is an ineffective model imposing unnecessary administrative costs on practices, thereby creating artificial barriers for patients in need of care.
Source: rightscanrighttime.org

Medicare Providers In Trouble

“Anthem Blue Cross of California recently landed on the front page of the New York Times for its steep rate increases, some as high as 22 percent. Those big rate increases have raised one big question: Could such big price hikes possibly be justified? The answer turns out to be yes: Anthem has successfully convinced the federal government that three of its double-digit rate increases are reasonable. The health-care law requires insurers to submit all rate increases over 10 percent to the federal government for review.” Sarah Kliff in The Washington Post.
Source: about.com

No fix, more frustration for physicians over Medicare

He brought up the fact that there are many government-imposed mandates, such as converting to e-records, complying with Health Insurance Portability and Accountability Act guidelines and following other regulations. For example, making the switch to the latest edition of the International Classification of Diseases could cost smaller practices an estimated $83,000, Smith said. If the practice cannot keep up with these changes, it can be penalized.
Source: readingeagle.com

Make voice heard on Medicare

If you have Medicare coverage, you may receive the Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey in the coming weeks, giving you an opportunity to rate your satisfaction with your Medicare health insurance and doctors. The Centers for Medicare & Medicaid Services (CMS) conducts this annual survey to hear directly from select beneficiaries about the quality of Medicare health plans and care providers.
Source: augusta.com

Medicare Reform Proposal Could Save Providers $676 Million Annually

“We are committed to cutting the red tape for healthcare facilities, including rural providers,” said Health and Human Services Secretary Kathleen Sebelius. “By eliminating outdated or overly burdensome requirements, hospitals and healthcare professionals can focus on treating patients.”  The proposed rule is designed to help healthcare providers operate more efficiently by eliminating regulations that are out of date or no longer needed. Many of the rule’s provisions streamline the standards healthcare providers must meet in order to participate in the Medicare and Medicaid programs without jeopardizing beneficiary safety.  For example, a key provision reduces the burden on very small critical access hospitals, as well as rural health clinics and federally qualified health centers, by eliminating the requirement that a physician be held to an excessively prescriptive schedule for being onsite once every two weeks.  This provision seeks to address the geographic barriers and remoteness of many rural facilities, and recognize telemedicine improvements and expansions that allow physicians to provide many types of care at lower costs, while maintaining high-quality care.    Among other provisions, the proposed rule would:
Source: nutraceuticalsworld.com

Medicare to Punish Most Doctors for Not Practicing Medicine the Way It Thinks They Should

Do the math: 280 million people will have health coverage. Maybe 110 million of them will have low-paying government coverage that pays only about half what private insurers pay physicians. Only about a third of a physician’s billings represent profit. This suggests physicians are expected to treat Medicare and Medicaid patients for less than doctors’ average cost per patient. Depending on the practice, doctors may even be losing money at the margin on some patients. The certainly will find Medicare patients with their complex needs to be not worth the effort.
Source: ncpa.org

Maybe the Medicaid expansion “private option” is legal but it sure looks fishy

Posted by:  :  Category: Medicare

Counter demonstration: wingnuts by tswedenWe have a lot more information since we first asked this question. Sarah Kliff at the Washington Post explained that the plan was not dependent on a waiver but on an obscure, little-used provision of the Social Security Act. This was actually mentioned in the HHS letter explaining state options back in December, which suggested premium assistance to buy private insurance on the exchange for the expansion pool under some specific, limited circumstances — though with the caveat that “premium assistance options in Medicaid…are subject to federal standards related to wrap around benefits, cost sharing and cost effectiveness.”
Source: arktimes.com

Video: Arkansas Medicare

Hundreds Attend Arkansas Medicaid Rally

When the U.S. Supreme Court upheld the health overhaul law it didn’t uphold the Medicaid portion, when left it open for states to individually decide whether to opt in. Beebe argued Thursday that cuts to Medicare – the health program for senior citizens – are helping pay for health reform and that Arkansas should accept the federal government’s offer to pay for three years of Medicaid expansion.
Source: arkansasbusiness.com

Medicaid v. Private Insurance in Arkansas

[…] The logic behind the proposed changes rests in the different needs of the “three programs” represented within Medicaid. Those covered by acute care Medicaid (45-50 million persons) most of them pregnant women and children, are relatively inexpensive to care for on a per capita basis. Increasingly, such beneficiaries have trouble finding providers who will care for them, due to a double whammy of stigma (it is insurance for persons who are poor) and the fact that it pays providers below what Medicare pays, which is less than what private insurers pay. This has lead to a systematic access problem for some Medicaid beneficiaries who have trouble finding a physician willing to treat them. There is nothing inherently wrong with the structure of Medicaid; we could decide to make it the best payer of care tomorrow, but that of course, is not going to happen. Buying them into private insurance policies will mainstream their care and remove a layer of cost shifting. [emphasis added]Source: samefacts.com […]
Source: samefacts.com

Polling: Guns, fetuses and Medicaid

* ABORTION: Respondents said they favored Jason Rapert’s bill to ban abortions in most cases beginning at 12 weeks 60-33. But, it’s important to note that the question is phrased to favor Rapert’s formulation that it is a “fetal heartbeat” bill that prevents an abortion if a heartbeat can be detected. Respondents aren’t told that meant, in its original form, a prohibition at five weeks or at 12 weeks in its current form. Would that make a difference? I tend to think so, but who knows. The question I heard about last night didn’t favor Republican messaging in question formulation. Finally: Poll or no poll, this bill is unconstitutional. There hasn’t been a national poll yet that favors overturn of Roe v. Wade, the opinion that makes this bill unconstitutional by banning many abortions before fetal viability. Too bad the question wasn’t posed about pre-viability bans.
Source: arktimes.com

Economist’s View: Paul Krugman: Mooching Off Medicaid

Mooching Off Medicaid, by Paul Krugman, Commentary, NY Times: Conservatives like to say that their position is all about economic freedom, and hence making government’s role in general, and government spending in particular, as small as possible. And no doubt there are individual conservatives who really have such idealistic motives. When it comes to conservatives with actual power, however, there’s an alternative, more cynical view of their motivations — …it’s all about comforting the comfortable and afflicting the afflicted, about giving more to those who already have a lot. And if you want a strong piece of evidence in favor of that cynical view, look at the current state of play over Medicaid. … Last year’s Supreme Court decision upholding Obamacare also opened a loophole that lets states turn down the Medicaid expansion if they choose. And there has been a lot of tough talk from Republican governors about standing firm against the terrible, tyrannical notion of helping the uninsured. Now, in the end most states will probably go along with the expansion because of the huge financial incentives… Still, some of the states grudgingly allowing the federal government to help their neediest citizens are … insisting that it must be run through private insurance companies. And that tells you a lot about what conservative politicians really want. … Don’t tell me about free markets…, privatizing Medicaid will end up requiring more, not less, government spending, because there’s overwhelming evidence that Medicaid is much cheaper than private insurance. … You might ask why, in that case, much of Obamacare will run through private insurers. The answer is, raw political power. Letting the medical-industrial complex continue to get away with a lot of overcharging was, in effect, a price President Obama had to pay to get health reform passed. And since the reward was that tens of millions more Americans would gain insurance, it was a price worth paying. But why would you insist on privatizing a health program that … does a much better job than the private sector of controlling costs? The answer is pretty obvious: the flip side of higher taxpayer costs is higher medical-industry profits. So ignore all the talk about too much government spending and too much aid to moochers who don’t deserve it. As long as the spending ends up lining the right pockets, and the undeserving beneficiaries of public largess are politically connected corporations, conservatives with actual power seem to like Big Government just fine.
Source: typepad.com

Arkansas Deal with HHS on Medicaid Expansion May Make Everyone Better Off

Substituting commercial insurance for the Medicaid expansion may also be better for hospitals, physicians, and the people who pay for their own care along with everyone else’s. The Colorado Hospital Association says that low Medicaid reimbursements make hospitals lose money on Medicaid patients. To make up for those losses, its members charge more to people who pay for their own care. Since commercial reimbursement generates less uncompensated care, it presumably reduces the cost shift and therefore the cost to private payers. The losses are substantial and growing. In the state of Washington in 2006, hospitals lost 15.4 percent on Medicare and 15.6 percent on Medicaid. They made 16.4 percent on commercial business.
Source: healthworkscollective.com

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

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

Arkansas doctors explain importance of expanding insurance coverage

Doctors at UAMS treat all comers, insured and uninsured; 12 percent of its admitted patients — 3,120 last year — are among the latter. Outpatient visits by the uninsured numbered 61,426 in 2012. Charity and unreimbursed care rose from $ 175 million in 2011 to $ 202 million in 2012. Those numbers would be less if Arkansas, which has the most stringent rules for Medicaid eligibility in the country, would agree to accept federal dollars to expand Medicaid — now limited largely to children, the disabled and impoverished pregnant women — to a wider group of Arkansans too poor to pay for private insurance. Two plans are under consideration: extending Medicaid to all Arkansans at or under 138 percent of the federal poverty level ($ 11,490 for individuals, $ 23,550 for a family of four) or a deal Gov. Beebe and the federal Health and Human Services Department worked out to extend the private insurance exchange option to that same group of people at no cost, with premiums picked up by Medicaid. (The Affordable Care Act allows tax credits to certain persons earning between 138 percent and 400 percent of the poverty level tax credits to pay for private premiums on the insurance exchange. Arkansas is the only state so far to be offered exchange coverage for persons whose income puts them under 138 percent.)
Source: onestopnewsstand.com

Arkansas Medicaid Faces $138M Deficit Next Year

The Arkansas Medicaid program is facing a $138 million shortfall next year, and Gov. Mike Beebe (D) has said expanding Medicaid under the Patient Protection and Affordable Care Act would help fight that deficit, according to a Seattle Post-Intelligencer/Associated Press report. Earlier this week, Arkansas state officials proposed countering the Medicaid deficit through rate freezes for hospitals and other providers as well as elimination of the lowest level of nursing home care. The nursing home cuts would potentially save $35 million, but up to 15,000 low-income seniors would lose access to nursing care, according to the report.
Source: beckershospitalreview.com

Disability Rights Center of Arkansas

2010 mid-term elections, abuse, accessible parking, accountability, alexander hdc, arkansas, arkansas disability coalition, arkansas general assembly, arkansas state hospital, arkansas times, arkansas waiver association, ash, aug comm, autism, baptist health, beatrice, bhdc, booneville, center, channel 7, chdc, children with disabilities, choking, cms, co-pay, community, community first choice option, compass, conway, cost sharing, court, dbh, dcfs, dd council, dds, deemed status, deinstitutionalization, developmental disability, dhs, directions, dirty laundry, disability, discharge, division of behavioral health, doj, drc, education, electro-shock, family leadership training, fda, federal law, first do no harm, funding, guardian, hdc, healthcare, hipaa, house of representatives, housing, immediate jeopardy, independent living, institution, irs, jcaho, judge rotenberg educational center, katv, law, litigation, little rock, lrsd, media, medicaid, medicaid expansion, medical, medicare, men with disabilities, mental illness, money, monthly report, munsell, nebraska, news, ot, other advocates, p&a, p&a access, p&a brief, parent, parents with disabilities, plan, positioning, psychiatry, psychology, pt, regulations, response and action plan, rules, schedule, scofflaws, seating, sia, slp, social security, sports, supreme court, taxes, termination, time magazine, tjc, trial, vote, voting, waiver, website, zero tolerance
Source: livejournal.com

Savvy Senior: How Medicare covers diabetes

Screenings: If you don’t have diabetes, but you do have pre-diabetes or some other health conditions that put you at risk of getting it – such as high blood pressure, high cholesterol and triglycerides, are overweight, or have a family history of diabetes – Medicare will pay 100 percent of the cost of up to two diabetes screenings every year.
Source: bradenton.com

Texas Medicare Supplement Insurance Plans

Posted by:  :  Category: Medicare

Reuters---Texas governor Rick Perry suffers  alzheimer's relapse at campaign rally near Dallas recently. Millions of TV viewrs gasped in horror as confused governor tried repeatly to suck an aids dildo--he was finally subdued and rushed off stage. by idropkidMake sure that you are getting the right coverage that you want. This will not be hard if you already know your options. There are ten different supplement plans that you can choose from. Taking time to carefully examine all you have to choose from will enable you to compare the gaps filled with each plan to determine the one that is going to be ideal for your needs.
Source: zambiadaily.com

Video: Health News – Valerie Harper, How Obama, Medicare Advantage, Texas

Medicaid News: Minn. Effort To Expand Program Praised

California Healthline: Access Denied? Implications Of Medi-Cal Pay Cut In 2014, about 1.5 million adults in California are expected to gain access to Medi-Cal under the Affordable Care Act. However, insurance coverage could be all they get, as some observers say there might not be enough doctors willing to treat them. The fiscal year 2013-2014 budget proposal that Gov. Jerry Brown (D) released this month could be read as contradictory. On one hand, he makes it clear that California will pursue a full expansion of Medi-Cal, offering coverage to individuals with incomes up to 138 percent of the federal poverty level. At the same time, however, the governor’s budget plan also counts on $488.4 million in savings from a 10 percent cut to Medi-Cal reimbursements. Medi-Cal is California’s Medicaid program. State officials maintain that the provider pay cut should not hurt access to care during the expansion, but others fear the reduction could be implemented at the worst possible time (Wayt, 1/30).
Source: kaiserhealthnews.org

Texas Republicans rally around Paul Ryan budget plan; Democrats don’t like it

“It’s smart, it’s responsible, and it’s the right way to get our economy to a balanced budget within 10 years,” said freshman Rep. Roger Williams, R-Austin, a member of the Budget Committee. “The path to prosperity requires us to make tough decisions, but by applying the same principles that families and businesses use every day, we can balance the budget, cut wasteful spending, and fix our broken tax code, all without increasing taxes.”
Source: dallasnews.com

Many older Americans get unnecessary colonoscopies, study finds

For some doctors, more than 30 percent of the colonoscopies they performed on Medicare patients during the year of this study fell into the “inappropriate” category. The doctors with the highest percentage of unnecessary procedures were surgeons, those who graduated from a U.S. medical school before 1990, and those whose practices included a high volume of colonoscopies. (Only Texas physicians were included in this part of the analysis because the researchers had access to 100 percent of that state’s Medicare claims, which made the results more statistically significant.)
Source: minnpost.com

Protesters in Texas Demand Medicaid Expansion

Separately, hundreds of doctors in white lab coats met privately with legislators, asking for better reimbursement rates for treating Medicaid patients. Currently, the state only covers about 60 percent of the cost of treating recipients of the joint federal-state health care program for the poor and disabled. Doctors and clinics are expected to absorb the losses.
Source: news92fm.com

Sen. Cornyn Introduces Bill To Protect Seniors’ Access to Medicare

The Patient Protection and Affordable Care Act created the IPAB, an unelected, unaccountable board of bureaucrats to make additional cuts to the Medicare program based on arbitrary global budget targets. The IPAB consists of 15 individuals appointed by the President who are tasked with making substantial changes to Medicare—without full transparency and accountability to America’s seniors and their elected officials.  everal additional concerns with the IPAB include:
Source: texasgopvote.com

Medicaid Eligibility in Texas

Following an initial check of the information, all applicants are required to visit a Health and Human Services Commission Benefits office. This visit interviews the applicant to ensure all information is present and correct – forming the final part of the application. Applicants who have specific reasons why they cannot travel to the Health and Human Services Commission Benefits office may be able to complete the review by telephone, or a representative may make a home visit.
Source: tex.org

Agenda Texas: Medicaid Expansion in Texas

Democrats agree Medicaid isn’t perfect, but say the projected $100 billion being offered over 10 years is just too much money to pass up. Houston State Senator Rodney Ellis has filed a bill that would let voters decide whether or not the state expands Medicaid. During a rebuttal to Gov. Perry’s State of the State address, Austin State Senator Kirk Watson worried the arguments against expansion have little to do with whether or not it would help the state.
Source: kutnews.org

Excerpts from Reddy’s presentation to Texas doctors

More than two years ago, two California congressmen asked Medicare to investigate Prime, saying they suspected the chain was committing a form of Medicare fraud called “upcoding,” or exaggerated diagnoses. Millions may have been lost, the lawmakers wrote in a letter. On Jan. 2, Prime disclosed to health care regulators in Rhode Island that it is facing a U.S. Justice Department probe over its billing practices.
Source: californiawatch.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

Texas Attorney General Missing the Mark on Medicare

True, so many people have been trapped into dependence upon government intentionally to win votes; nevertheless, a means must be provided for protecting those already ensnared into the system or close to falling into it. Still, playing games under the fraudulently ratified and unconstitutional 16th Amendment should end asap with the elimination of the Gestapo IRS and a despotic, unaccountable private central banker-controlled Federal Reserve, both egregious tyrannies upon a free people.  A free people should never have to beg for their own money back from an oppressive, unconstitutional, wasteful, malfunctioning and bureaucracy-unaccountable federal government so far removed from the people and even now teetering on complete absorption into a One World Government.
Source: wetexans.com

Application of Medicare Contribution Tax of 3.8% to Certain U.S. Persons Owning Stock in A Controlled Foreign Corporation or Passive Foreign Investment Company : Federal Taxation Developments Blog

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 marsmet481As mentioned, a U.S. shareholder of a CFC is required to include certain amounts in income, i.e., Subpart F income to the extent of earnings and profits, under Section 951(a). The Preamble to the Section 1411 proposed regulations states that constructive or pass through income includible under Section 951 will generally not be treated as dividends in computing NII as dividend income unless expressly provided for in the Code. Still NII treatment will result to the extent the Subpart F income is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii)(trading trading in financial instruments or commodities) and Prop. Treas. Reg. § 1.1411-4(a)(1)(ii)). As to PFICs, a U.S. person is required to income in income amounts described under Section 193 if the taxpayer makes a QEF election under Section 1295.. Section 1293 inclusions also are not treated as dividends unless expressly provided for in the Code, and, therefore, also are not taken into account for purposes of calculating net investment income (unless the amount is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii) and Prop. Treas. Reg. §1.1411-4(a)(1)(ii)).  This difference in timing for reporting income for chapter 1 (regular income tax) and chapter 2A (Section 1411), as well as other overlapping provisions, will require a taxpayer to compute separate stock basis for chapter 1 and chapter 2A, subject to making an election under Prop. Reg. §1.1411-10(g) which seems to only be available after 2013 although the Preamble to the regulations when read with the proposed regulations is not entirely clear on this point, i.e., whether such election can be made for a taxable year beginning in 2013.
Source: foxrothschild.com

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

Medicaid vs. Medicare & How SSDI or SSI Benefits May Apply

Medicaid, Medicare and SSDI are government programs that may help those with disabilities receive healthcare services and pay for basic necessities. Medicaid and Medicare are government healthcare programs that may be available, depending on the individual’s circumstances. Those who receive Social Security Disability Insurance (SSDI) or Supplemental Security Income (SSI) for their disability could be eligible for one or even both healthcare programs.
Source: brentadams.com

You Can Apply For Medicare Online

The nice thing about applying online is that you do not need to wait for an appointment.  You can fill out your application when you are ready from your own home.  As you are filling out your application, you may save it at any time during the application process and finish it when you are ready, so you do not have to worry about possible interruptions.  The web site is very secure, so your information is protected.  Once you complete the application, you will receive a receipt and an application number so that you can log in anytime to check your application status.
Source: mexicoonmymind.com

The Human Cost of Refusing to Expand Medicaid

By my rough back-of-the-envelope calculation from Kaiser Family Foundation numbers, there are about 4 million of such unlucky duckies in the 10 states that are pretty clearly not going to participate in the Medicaid expansion, a number that could jump to well over 5 million if Rick Scott manages to keep Florida out as well….So what do they care about the injustice of this coverage hole? Not a thing, clearly.
Source: motherjones.com

Saving money on health costs: Extra Help program

monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Did you know that the Extra Help program is estimated to be worth about $4,000 dollars per person, per year? Even if you’re not sure you’d qualify, it’s worth filling out an application to see.
Source: medicare.gov

Do You Qualify for Medicare's Extra Help Program?

Every individual who qualifies represents an important potential benefit to our tribal communities. Social security is responsible for implementing that benefit; we call it “extra help.” Many Medicare beneficiaries won’t have to file for assistance because they’ll automatically get it based on benefits they receive.
Source: indiancountrytodaymedianetwork.com

How to Apply for Medicare Part B

There are also circumstances sometimes where people do not apply for Part B. . . Usually, it’s because they are still covered by their employers’ health insurance. If this is the case, you have different options. You can apply while still employed or wait and apply after your employment ends. You must do this during the special enrollment period. If you sign up at this time, you will not have to pay any extra fees on top of the premium like those who apply during the general enrollment period.
Source: waysandhow.com

Official: Sequestration To Affect Medicare EHR Incentive Payments

Posted by:  :  Category: Medicare

Jessica Sundheim by On BeingThe ACA, which was signed into law by Obama in 2010, contains more than 40 tax changes, including penalties on individuals who do not purchase health coverage. The IRS also is charged with administering tax credits to the estimated 15 million individuals who are expected to qualify for federal subsidies to purchase coverage through the law’s health insurance exchanges.
Source: californiahealthline.org

Video: Patty and Richard say, “Apply online for Medicare” (20 seconds) – Social Security

UCLA Health System chosen as a Medicare Shared Savings Program accountable care organization / UCLA Newsroom

The UCLA Health System, which comprises the UCLA Hospital System and the UCLA Medical Group and its affiliates, has provided a high quality of health care and the most advanced treatment options to the people of Los Angeles and the world for more than half a century. Ronald Reagan UCLA Medical Center, the Resnick Neuropsychiatric Hospital at UCLA, Mattel Children’s Hospital UCLA, and UCLA Medical Center, Santa Monica (which includes the Los Angeles Orthopaedic Hospital) deliver hospital care that is unparalleled in California. Ronald Reagan UCLA Medical Center is consistently ranked one of the top five hospitals in the nation and the best in the western United States by U.S. News & World Report. UCLA physicians and hospitals continue to be world leaders in the full range of care, from maintaining the health of families to the diagnosis and treatment of complex illnesses.
Source: ucla.edu

New AMIC Survey Data Shows 2010 Medicare Payment Cuts Forcing Physician Practices and Imaging Providers to Reduce Patient

In the past, the Obama Administration has proposed using RBMs in the Medicare program.  However, the Department of Health and Human Services (HHS)  previously weighed in on prior authorization in the Medicare program, noting in 2008 that a prior authorization program could be “inconsistent with the public nature of the Medicare program,” since such programs rely on private companies using proprietary systems to deny care prescribed by a physician.  HHS also noted that the Medicare appeals process guaranteed to every beneficiary could overturn a “high proportion” of denials, rendering the policy ineffective.  In an environment of reduced reimbursements, the AMIC survey further demonstrates that application of RBMs is an ineffective model imposing unnecessary administrative costs on practices, thereby creating artificial barriers for patients in need of care.
Source: rightscanrighttime.org

Saving money on health costs: Extra Help program

monthly premiums, annual deductibles, and prescription copayments in your Medicare drug plan. Did you know that the Extra Help program is estimated to be worth about $4,000 dollars per person, per year? Even if you’re not sure you’d qualify, it’s worth filling out an application to see.
Source: medicare.gov

Supplemental Security Income and Medicaid/Medical Assistance

Supplemental Security Income (SSI) is one of the largest Federal programs that provides assistance to people with disabilities. It is administered by the Social Security Administration (SSA), and is a program funded by general tax revenues. SSI is a needs-based program, and is means tested. It is intended to provide individuals with a disability with a monthly check for food and shelter only. In 2013, the monthly check is $710. To be eligible for SSI, one needs to be disabled and any age (one can qualify if they are at least 65 years old and not disabled), US Citizen or legal aliens who meet certain requirements, and have income and resources (assets) below certain limits.  In most states, Medicaid is automatic when an individual receives SSI.
Source: specialneedsplanning.net

Hospital program aims to make paying for healthcare simpler

“Think of your grandmother,” he said. “If she were to slip and fall in the community and go to the emergency room, that is a bill from emergency room doctor. If she has a broken bone and needs her hip replaced, bill from the orthopedic surgeon. So this is an attempt to reconcile all of this and allow hospital to be an intermediary.”
Source: wndu.com

Application of Medicare Contribution Tax of 3.8% to Certain U.S. Persons Owning Stock in A Controlled Foreign Corporation or Passive Foreign Investment Company : Federal Taxation Developments Blog

As mentioned, a U.S. shareholder of a CFC is required to include certain amounts in income, i.e., Subpart F income to the extent of earnings and profits, under Section 951(a). The Preamble to the Section 1411 proposed regulations states that constructive or pass through income includible under Section 951 will generally not be treated as dividends in computing NII as dividend income unless expressly provided for in the Code. Still NII treatment will result to the extent the Subpart F income is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii)(trading trading in financial instruments or commodities) and Prop. Treas. Reg. § 1.1411-4(a)(1)(ii)). As to PFICs, a U.S. person is required to income in income amounts described under Section 193 if the taxpayer makes a QEF election under Section 1295.. Section 1293 inclusions also are not treated as dividends unless expressly provided for in the Code, and, therefore, also are not taken into account for purposes of calculating net investment income (unless the amount is derived from a trade or business to which the tax applies as provided in Section 1411(c)(1)(A)(ii) and Prop. Treas. Reg. §1.1411-4(a)(1)(ii)).  This difference in timing for reporting income for chapter 1 (regular income tax) and chapter 2A (Section 1411), as well as other overlapping provisions, will require a taxpayer to compute separate stock basis for chapter 1 and chapter 2A, subject to making an election under Prop. Reg. §1.1411-10(g) which seems to only be available after 2013 although the Preamble to the regulations when read with the proposed regulations is not entirely clear on this point, i.e., whether such election can be made for a taxable year beginning in 2013.
Source: foxrothschild.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

To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes. (2012; 112th Congress H.R. 6719)

So, yes, we display the House Republican Conference’s summaries when available even if we do not have a Democratic summary available. That’s because we feel it is better to give you as much information as possible, even if we cannot provide every viewpoint.
Source: govtrack.us