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: Medicare Supplement Providers

MFT Progress Notes: Two reasons why Medicare needs family therapists

                                                                                                                                                                                                                                                                                                           
Source: blogspot.com

Happy Now? Obama Cuts Medicare…Again

The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
Source: therionorteline.com

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

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

Uwe E. Reinhardt: What Hospitals Charge the Uninsured

After some deliberation, the commission recommended initially that the New Jersey government limit the maximum prices that hospitals can charge an uninsured state resident to what private insurers pay for the services in question. But because the price of any given service paid hospitals or doctors by a private insurer in New Jersey can vary by a factor of three or more across the state (see Chapter 6 of the commission’s final report), the commission eventually recommended as a more practical approach to peg the maximum allowable prices charged uninsured state residents to what Medicare pays (see Chapter 11 of the report).
Source: nytimes.com

Protect yourself against Medicare/Medicaid fraud — Business — Bangor Daily News — BDN Maine

The site will still be viewable but certain elements might display incorrectly. In order to enjoy all the features of our site, we recommended you upgrade to a newer, more secure browser. Read more ». If you don’t have administrator privileges for your computer, you can still take action. Google has developed a free plugin for Internet Explorer called Google Chrome Frame. You can install it on any computer, even if you can’t install applications, and it will ensure your computer stays secure and that you can still visit our website. Enable Google Chrome Frame now »
Source: bangordailynews.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

Safety Net Scene: March Provider Bulletin and the new “ACA Implementation News

Click here to read the March Provider Bulletin. The index includes: All Providers…………………………………..1 Medicare-Medicaid Enrollees……………..1 Medicare/Medicaid Crossover Claims….1 Record Retention……………………………..1 Planning for ICD-10…………………………..2 Second Phase NCCI…………………………2 …and more.  Also, the Colorado Department of Health Care Policy and Financing has a new publication called “ACA Implementation News.”  It is meant to “keep county partners, Medical Assistance (MA) sites and other stakeholders informed about Department of Health Care Policy and Financing (Department) activities and opportunities to participate in the implementation of the eligibility provisions of the Affordable Care Act (ACA).”  Click here to read the February 2013 issue. [Source: Colorado Department of Health Care Policy and Financing]
Source: blogspot.com

Sequestration Reduced Your Medicare Pay? You Have Four Options

What’s more, increasing patient volume will inevitably draw down on provider and staff morale, and increase stress. Patient experience and patient satisfaction suffers. The inevitable reduction in Pay-for-Performance (P4P) incentive payments by commercial health plans to doctor in private practice, and the P4P value-based incentive payments to hospital value-based purchasing programs based on reduced HCAHPS scores would also negatively impact the bottom line.
Source: healthworkscollective.com

Medicare Premium Dollars Spent

Last night as I was thinking about sleeping, an odd thought hit my brain. The oddity had me rethink the current Medicare situation and the dwindling dollars available for providers. CMS has truly analyzed the situation in the worst way possible. You know how charities report how much of your dollars given go toward actually helping whoever you are desiring to help? What if? What if CMS had to report how Medicare premium dollars were spent?
Source: evidenceinmotion.com

Maximizing your Resources and Saving Money: Medicare Savings Program

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526If you are on Medicare and have a limited income you may qualify for your state to pay your Medicare Part B premium. Eligibility in the program automatically qualifies you for extra help paying your Medicare Part D premium and prescription copayments. Check with your State for the requirements. Applications can usually be obtained online or at your local Social/Senior Services Center. Here are the following requirements in the State of CT:
Source: blogspot.com

Video: Medicare Shared Savings Program Overview National Provider Call 12/7/11

GAO: More enrollees take advantage of Medicare Savings Programs

Despite historically low numbers, enrollment for the Medicare Savings Programs is up, the Government Accountability Office reported Friday. With enrollment rising every year since 2007, the report suggests the Social Security Administration has been successful at eliminating barriers to enrollment, which could reduce Medicaid spending for certain beneficiaries. Historically, low enrollment has been attributed to a lack of awareness about the four programs (Qualified Medicare Beneficiary, Specified Low-Income Medicare Beneficiary, Qualifying Individual, and Qualified Disabled and Working Individual), as well as cumbersome enrollment processes through state Medicaid programs, GAO noted. For instance, in 2004, only a third (33 percent) of eligible beneficiaries were enrolled for the Qualified Medicare Beneficiary program, and only 13 percent were enrolled in the Specified Low-Income Medicare Beneficiary program, the report noted.
Source: fiercehealthcare.com

What’s new with Medicare?

Darylle Willenbrock is an expert on Medicare topics and will cover Medicare Savings Plan, Medicare Part A & B, Medigap supplement, Medicare Part D (prescription drug plan), Advantage Plan, disability benefits, beneficiary entitlements, and veterans benefits. She will also go over what is involved in applying for Medicare or Medicaid.
Source: theridgefieldpress.com

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

UCLA Health System Selected As Medicare Shared Savings Program Accountable Care Organization

“UCLA Health System is one of only a few academic medical centers to participate in this program,” said Dr. Samuel A. Skootsky, chief medical officer of the UCLA Faculty Practice and Medical Group. “This Medicare Shared Savings Plan challenges hospitals and doctors, together with their patients, to re-evaluate and redesign patient care to be more patient-centered and efficient—across all care settings, including at home.”
Source: bhcourier.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

HHS Names 106 New Participants in Medicare Shared Savings Program

In addition, 15 organizations in the latest ACO cohort are Advanced Payment Model ACOs, which are physician-based or rural providers granted capital to invest in electronic health record systems, staff and other infrastructure improvements. CMS will recoup the advanced payments through future shared savings (CMS release, 1/10). Another 15 Advanced Payment Model ACOs were announced in the second round of ACOs.
Source: californiahealthline.org

Where Can You Apply For Medicare Savings Programs?

Medicare savings programs are not hard to get, provided a person qualifies. What a person may not know is whether or not he qualifies for them. In order to qualify for the lower cost options, a person has to make under $9 a year and couples need to make under $13,000. Exact guidelines are available on the Medicare.gov website or from your local Social Security office. A qualified Medicare beneficiary needs to go to ssa.gov or his local office to get the forms. Some places, such as Wal-Mart offer Medicare savings accounts which let a person set aside funds to help cover the costs of their prescription drugs. Applying for these programs is usually done in the pharmacy section of the appropriate stores.
Source: seniorcorps.org

Improving the Medicare Savings Programs Would Help Low

[1] The typical non-elderly adult with income between 100 percent and 150 percent of the poverty line spent 3.8 percent of his or her income on health care. Katherine Desmond et al., “The Burden of Out-of-Pocket Health Spending Among Older Versus Younger Adults: Analysis from the Consumer Expenditure Survey, 1998-2003,” Kaiser Family Foundation, September 2007. The AARP Public Policy Institute has reported starker results. It found that in 2003, Medicare beneficiaries age 65 and older spent an average of 22 percent of their income on out-of-pocket medical expenses. Again, low-income seniors faced the largest financial burdens: seniors with incomes between 135 percent and 200 percent spent 28 percent of their income on health care, on average, while seniors below 135 percent of the poverty line spent 33 percent. Craig Caplan and Normandy Brangan, “Out-of-Pocket Spending on Health Care by Medicare Beneficiaries Age 65 and Older in 2003,” AARP Public Policy Institute, September 2004.
Source: cbpp.org

Medicare.gov, Application Form For Medicare, Medicare Part D, : Medicare Savings Program

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Source: projectedu.com

State Medicaid Changes: Cuts and Increases During Recession to Medicaid Benefits and Provider Payments

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 marsmet481An 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

Video: Improving Medicare in 2011

Social Security and Medicare Taxes and Benefits Over a Lifetime

Notes: All amounts are in constant 2011 dollars as noted, adjusted to present value at age 65 using a 2 percent real interest rate. Each calculation assumes survival until age 65 and then adjusts for chance of death in all years after age 65. It also assumes that benefits scheduled in law will be paid even if trust funds are exhausted. Workers are assumed to work every year from age 22 to age 64 and retire at age 65 or the Normal Retirement Age. An average-wage worker earns the average wage in the economy every year, based on Social Security’s measure of the “average wage.” The low-wage worker earns 45 percent of the average wage, while the high-wage worker earns 160 percent of the average wage. The tax-max wage worker earns at the taxable maximum every year. Medicare numbers are net of premium, other than the new premium tax on some high earners.
Source: urban.org

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

Can we control spending AND improve quality?

He is now Vice Chair of the Medicare Payment Advisory Commission (MedPAC), which is an independent agency established to advise the U.S. Congress on issues affecting the Medicare program. He is also a member of the Congressional Budget Office’s Panel of Health Advisors and The Commonwealth Foundation’s Commission on a High Performance Health Care System. In 2000, 2004 and 2010, he served on technical advisory panels for the Center for Medicare and Medicaid Services (CMS) that reviewed the assumptions used by the Medicare actuaries to assess the financial status of the Medicare trust funds. In 2011, he served on the Institute of Medicine’s Committee on Determination of Essential Health Benefits.
Source: healthinsurance.org

New Medicare Benefits and Changes for 2011

Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Source: aarp.org

Cut Medicare Advantage plans and save money

To the group supporting keeping Medicare Advantage plans: Your group wants to continue a program spending taxpayer monies faster than regular Medicare. Each person on an Advantage plan costs the tax payer 14 to 15 percent more than one on Medicare as it was originally designed.
Source: dallasnews.com

Despite Potential Benefits, Medicare Slow to Utilize Telehealth

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Source: reportingonhealth.org

Daily Kos: Paul Ryan pushes Republicans off the ‘end Medicare’ cliff all over again

that Ryan doesn’t realize is that many of us that are either elderly, disabled, or even poor, do pay taxes.  We pay state taxes for our license plates, we pay state taxes to our local governments, we pay taxes on our phone and utility bills, we paid property taxes to support our schools, road, etc.  We support businesses, schools, etc.  It comes full circle by all of us contributing to a system and if you cut more and more to where there is no longer financial support even at the local levels eventually it will destroy the people on the top.  Which means congress and senate will have to cut their benefits and salaries as well because we will no longer be able to support them, the banks, and all the other wealthy getting tax breaks, loop holes, blah, blah.
Source: dailykos.com

Is Medicare a Ponzi Scheme?

The American Magazine

Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.
Source: american.com

Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits

Critics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.
Source: firedoglake.com

Medicare Open Enrollment: Extra Benefits & Preventive Services

To help you track these services, take this checklist to your next doctor’s visit. This comprehensive list spells out the Medicare-covered preventive services and lets you keep track of when you got a particular test or service, and when you’re due for your next one.  You also can get preventive service reminders on http://www.mymedicare.gov.
Source: medicare.gov

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

Romney Ryan Plan Birth Control by DonkeyHoteyThe 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

Video: How To Choose the Best Nursing Home: Medicare’s Nursing Home Compare Website

Zone 4 Program Integrity Contractor (ZPIC) for Medicare and Medicaid Programs is Health Integrity, LCC

When a physician, medical group or other health care provider receives a notice of an audit and site visit from a ZPIC, things happen fast with little opportunity to prepare. A ZPIC will routinely fax a letter to the practice shortly before the end of a business day the day before a site visit/audit to that practice. Auditors will request to inspect the premises, will photograph all rooms, equipment, furniture, and diplomas on walls. They will usually request copies of several patient records to review later. They will request copies of practice policies and procedures, treatment protocols, all staff licenses and certifications, drug formularies, medications prescribed, and medications used in the office. ZPIC auditors will inspect any medication/narcotic lockers or storage cabinets and will request drug/medication invoices and inventories. You will usually be contacted for follow-up information and documentation after the audit and will eventually be provided a report and, possibly, a demand for repayment of any detected overpayments.
Source: wordpress.com

Daily Kos: Paul Ryan pushes Republicans off the ‘end Medicare’ cliff all over again

that Ryan doesn’t realize is that many of us that are either elderly, disabled, or even poor, do pay taxes.  We pay state taxes for our license plates, we pay state taxes to our local governments, we pay taxes on our phone and utility bills, we paid property taxes to support our schools, road, etc.  We support businesses, schools, etc.  It comes full circle by all of us contributing to a system and if you cut more and more to where there is no longer financial support even at the local levels eventually it will destroy the people on the top.  Which means congress and senate will have to cut their benefits and salaries as well because we will no longer be able to support them, the banks, and all the other wealthy getting tax breaks, loop holes, blah, blah.
Source: dailykos.com

CHART: Medicare Spending Projections

It also shows that in 2085, Medicare would make up 3.8 percent of the nation’s GDP spending, instead of the previously projected 6.7 percent. To compare, Medicare spending made up about 3.7 percent of GDP in 2011, according to the 2012 Medicare Trustees report.
Source: businessinsider.com

Medicare Supplemental Insurance Comparison Website Created by Senior Citizen Announces 25,000th Customer Helped

Medicare Supplemental Insurance Comparison (MSIC) announced today that they have successfully assisted their 25,000th customer. For anyone who has searched for Medicare supplemental insurance they know it can be a challenging process. The advent of the internet has certainly made the process easier, but only until recently clients still had to part with sensitive information such as their name, age and home address. Medicare Supplemental Insurance Comparison was created with the researcher’s privacy in mind, and is one of the first comparison websites of its kind to give insurance quotes while only requiring a zip code. “This is what allowed us to take our website to the next level,” said Steven Pewter, creator of the MSIC. “I’m a senior citizen myself and I wanted to create something that anyone could be comfortable using. The majority of our clients just aren’t OK with giving personal information up front. Our goal was to allow people to search for supplemental insurance anonymously, and I think our success with that has made us so popular.” “Hitting the 25,000th visitor helped is indeed a fine achievement,” said David Bartholomew, director of marketing. “We’ve found that as soon as anything ‘personal’ is requested people immediately click away. They just don’t want that, it feels completely invasive. With our site people can search all the most reputable Medicare supplemental insurance providers in their area and do so 100% anonymously. They can contact the companies on their own terms, and the fact that they get competing price quotes puts them in the place of power during negotiations.” MSIC also recently announced that they have added 250,000 companies to their database, all of them vetted according to reputation and years in business. To learn more, or to get a fast comparison of all the highest rated insurance companies in a specific area, please visit: http://medicaresupplementalinsurancecomparison.net/ About MSIC Medicaresupplementalinsurancecomparison.net (MSIC) was created in September of 2012 to help shoppers get the best rates for Medicare supplemental insurance. The website utilizes the absolute latest in price quote technology, and has already received rave reviews from the industry.
Source: sbwire.com

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

Kaiser Permanente’s Medicare Plan Website Recognized as a Benchmark for Excellence

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: www.kp.org/newscenter.
Source: kp.org

Medicare Fraud and Nursing Home Abuse is Not Tolerated in Georgia

Posted by:  :  Category: Medicare

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

Video: Georgia Health Insurance Medicare

25 Statistics on Medicare Reimbursements in Ambulatory Surgery Centers

Here are 25 statistics on ASC Medicare reimbursements, based on information from the VMG Health 2011 Intellimarker study. Medicare ASC payments: 2005 — $2.7 billion 2006 — $2.9 billion 2007 — $2.9 billion 2008 — $3.1 billion 2009 — $3.2 billion Number of Medicare-Certified ASCs: 2005 — 4,441 2006 — 4,711 2007 — 4,991 2008 — 5,174 2009 — 5,260 Medicare payments per facility: 2005 — $608,000 2006 — $616,000 2007 — $581,000 2008 — $599,000 2009 — $608,000 Number of Medicare certified ASCs per state as of the 2011 survey: California — 668 Florida — 358 Maryland — 357 Texas — 346 Georgia — 253 Washington — 221 Pennsylvania — 221 New Jersey — 201 Ohio — 193 Arizona — 150 More Articles on ASC Transactions: 8 Statistics on ASC Liquidity Crystal Clinic Orthopaedic Center Opens Hudson Location Gwinnett Medical Center Develops Outpatient Park With Ambulatory Surgery Services
Source: beckersasc.com

A Different View about Obama’s Medicare “Actual Facts”

The Affordable Care Act assumes deep reductions in payments to doctors, hospitals, nursing homes, and Medicare Advantage program, totaling $716 billion over ten years. By paying providers less, the trust fund may last a bit longer, but it means seniors will have a harder and harder time finding a doctor to see them as they drop out of the program or stop taking new Medicare patients. The law may not explicitly cut benefits, but it certainly will impact access to care. What good is a Medicare card if you can’t find a doctor? That is precisely the problem that patients on Medicaid — the program for lower-income Americans — face today, forcing them to go to hospital emergency rooms for even routine care. Do seniors want that?
Source: georgiapolicy.org

CMS Names 106 New Medicare ACOs

CMS has named 106 new accountable care organizations that will participate in the Medicare Shared Savings Program, effective Jan. 1. With the addition of the 106 new organizations, as many as 4 million Medicare beneficiaries will be covered by a CMS ACO. According to CMS, the savings achieved by its ACOs could be up to $940 million in four years. The new group of ACOs includes 15 Advance Payment Model ACOs, which are physician-based or rural organizations that will benefit from greater access to capital. The application period for organizations wanting to participate in the MSSP in 2014 will begin this summer. The 106 new ACOs named to the MSSP are listed here, with their service areas: 1.    A.M. Beajow, MD Internal Medicine Associates ACO, P.C. (Nevada) 2.    AAMC Collaborative Care Network (Maryland) 3.    Accountable Care Clinical Services, PC (California, Connecticut, Iowa, Massachusetts, Pennsylvania) 4.    Accountable Care Coalition of Central Georgia (Georgia) 5.    Accountable Care Coalition of DeKalb (Georgia) 6.    Accountable Care Coalition of Georgia (Georgia) 7.    Accountable Care Coalition of Greater Athens Georgia II (Georgia) 8.    Accountable Care Coalition of Greater Augusta & Statesboro (Georgia, South Carolina) 9.    Accountable Care Coalition of New Mexico (New Mexico) 10.    Accountable Care Coalition of North Central Florida (Florida) 11.    Accountable Care Coalition of North Texas (Texas) 12.    Accountable Care Coalition of Southern Georgia (Georgia) 13.    Accountable Care Coalition of Western Georgia (Alabama, Georgia) 14.    Accountable Care Organization of New England (Connecticut, Massachusetts) 15.    ACO of Puerto Rico (Puerto Rico) 16.    Advocare Walgreens Well Network (New Jersey) 17.    Affiliated Physicians IPA (California) 18.    Akira Health (California) 19.    Alegent Health Partners (Nebraska) 20.    Alexian Brothers Accountable Care Organization (Illinois) 21.    Amarillo Legacy Medical ACO (Texas) 22.    American Health Alliance (Florida) 23.    American Health Network of Ohio (Ohio) 24.    APCN-ACO (California) 25.    Arizona Care Network (Arizona) 26.    Atlanticare Health Solutions (New Jersey) 27.    AVETA Accountable Care (Puerto Rico) 28.    BAROMA Health Partners (Florida) 29.    Billings Clinic (Montana, Wyoming) 30.    Bon Secours Good Helpcare (Kentucky, New York, Ohio, South Carolina, Virginia) 31.    Cambridge Health Alliance (Massachusetts) 32.    Cape Cod Health Network ACO (Massachusetts) 33.    Cedars-Sinai Accountable Care (California) 34.    Central Florida Physicians Trust (Florida) 35.    Central Jersey ACO (New Jersey) 36.    Christie Clinic Physician Services (Illinois) 37.    Collaborative Care of Florida (Florida) 38.    Collaborative Health ACO (Massachusetts) 39.    Colorado Accountable Care (Colorado) 40.    Community Health Network (Minnesota) 41.    Diagnostic Clinic Walgreens Well Network (Florida) 42.    Doctors Connected (Virginia) 43.    Essential Care Partners II (Texas) 44.    Fort Smith Physicians Alliance ACO (Arkansas, Oklahoma) 45.    Franciscan Northwest Physicians Health Network (Washington) 46.    Franciscan Union ACO (Illinois, Indiana) 47.    GPIPA ACO (Arizona, New Mexico) 48.    Hartford HealthCare Affordable Care Organization (Connecticut) 49.    HHC ACO (New York) 50.    HNMC Hospital/Physician ACO (New Jersey) 51.    Independent Physicians’ ACO of Chicago (Illinois) 52.    Indiana Care Organization (Indiana) 53.    Indiana Lakes ACO (Indiana) 54.    Integral Healthcare (Florida) 55.    Integrated ACO (Texas) 56.    KCMPA (Kansas, Missouri) 57.    KentuckyOne Health Partners (Indiana, Kentucky) 58.    Keystone Accountable Care Organization (New York, Pennsylvania) 59.    Lahey Clinical Performance Accountable Care Organization (Massachusetts, New Hampshire) 60.    Lower Shore ACO (Delaware, Maryland, Virginia) 61.    Marshfield Clinic (Wisconsin) 62.    Maryland Collaborative Care (Maryland, Washington, D.C.) 63.    MCM Accountable Care Organization (Florida) 64.    Medicare Value Partners (Illinois) 65.    Mercy ACO (Arkansas, Missouri) 66.    Meridian Accountable Care Organization (New Jersey) 67.    Meritage ACO (California) 68.    Morehouse Choice ACO-ES (Georgia) 69.    National ACO (California) 70.    Nature Coast ACO (Florida) 71.    NOMS ACO (Ohio) 72.    Northeast Florida Accountable Care (Florida) 73.    Northern Maryland Collaborative Care (Maryland) 74.    Northwest Ohio ACO (Michigan, Ohio) 75.    Ochsner Accountable Care Network (Louisiana, Mississippi) 76.    OneCare Vermont Accountable Care Organization (New Hampshire, Vermont) 77.    Owensboro ACO (Indiana, Kentucky) 78.    Paradigm ACO (Florida) 79.    Partners in Care (Michigan) 80.    Physician Organization of Michigan ACO (Michigan) 81.    Physicians Collaborative Trust ACO (Florida) 82.    Physicians HealthCare Collaborative (North Carolina) 83.    Pioneer Valley Accountable Care (Connecticut, Massachusetts) 84.    Primary Care Alliance (Florida) 85.    Primary Partners ACIP (Florida) 86.    ProCare Med (Florida) 87.    ProHealth Physicians ACO (Connecticut) 88.    Qualable Medical Professional (Tennessee, Virginia) 89.    Rio Grande Valley Health Alliance (Texas) 90.    Saint Francis HealthCare Partners ACO (Connecticut) 91.    San Diego Independent ACO (California) 92.    Scott & White Healthcare Walgreens Well Network (Texas) 93.    SERPA-ACO (Nebraska) 94.    South Florida ACO (Florida) 95.    Southcoast Accountable Care Organization (Massachusetts, Rhode Island) 96.    Southern Maryland Collaborative Care (Maryland, Washington, D.C.) 97.    St. Luke’s Clinic Coordinated Care (Idaho, Oregon) 98.    Summit Health-Virtua (New Jersey) 99.    The Premier Health Care Network (Georgia, New Hampshire) 100.    UCLA Faculty Practice Group 101.    UW Health ACO (Wisconsin) 102.    Virginia Collaborative Care (Virginia) 103.    Wellmont Integrated Network (Tennessee, Virginia) 104.    Winchester Community ACO (Massachusetts, New Hampshire) 105.    Yavapai Accountable Care (Arizona) 106.    Yuma Accountable Care Organization (Arizona)
Source: beckershospitalreview.com

Georgia Cancer Specialists Settles with Feds over Medicare Billing

The civil settlement resolves the United States’ investigation into Georgia Cancer Specialists’ practices relating to billing for evaluation and management (E&M) services on the same day as a related procedure. Generally, providers are not permitted to bill both E&M services and a related procedure on the same day under the Medicare program’s regulations. In specific circumstances, providers can avoid this prohibition by submitting their claims marked with modifier -25, which tells Medicare to pay both the procedure and the E&M service. Here, the U.S. Attorney’s Office alleged that Georgia Cancer Specialists applied modifier -25 to claims that did not qualify for its use, leading to overpayments by Medicare.    
Source: patch.com

Expand Medicaid to Reduce Uninsured in Georgia

AARP Georgia’s top legislative priority this year is getting many of those people — and hundreds of thousands of others in the same boat — covered under Medicaid, the federal-state health insurance program for the poor.
Source: aarp.org

State Roundup: Ga. Considers Medicaid Managed Care ‘Light’ Touch

Modern Healthcare: AMA Joins Friend-Of-The-Court Brief In Fla. ‘Docs And Glocks’ Case The American Medical Association and nine other medical specialty societies have filed a friend-of-the-court brief opposing a Florida statute that prohibits physicians from asking patients and families about guns in their home and from noting a patient’s gun ownership in his or her medical record. “Not only do physicians lose the right to express themselves freely, but their patients are deprived of the full range of medical care and professionalism that they could expect from their physicians,” the brief stated. In July, a U.S. District judge in Miami blocked enforcement of the law. The state of Florida appealed this decision. The brief filed by the medical societies is in opposition to Florida’s appeal (Robeznieks, 11/5).
Source: kaiserhealthnews.org

Zone 5 Program Integrity Contractor ZPIC for Medicare and Medicaid Programs is AdvanceMed

When a physician, medical group or other health care provider receives a notice of an audit and site visit from a ZPIC, things happen fast with little opportunity to prepare. A ZPIC will routinely fax a letter to the practice shortly before the end of a business day the day before a site visit/audit to that practice. Auditors will request to inspect the premises, will photograph all rooms, equipment, furniture, and diplomas on walls. They will usually request copies of several patient records to review later. They will request copies of practice policies and procedures, treatment protocols, all staff licenses and certifications, drug formularies, medications prescribed, and medications used in the office. ZPIC auditors will inspect any medication/narcotic lockers or storage cabinets and will request drug/medication invoices and inventories. You will usually be contacted for follow-up information and documentation after the audit and will eventually be provided a report and, possibly, a demand for repayment of any detected overpayments.
Source: thehealthlawfirm.com

The Official Medicare Set Aside Blog And Information Resource: The MSP, the Supremacy Clause, and Georgia WC Reform Capping Medical Benefits

” (emphasis added). Wonder in what tone you have to make that statement so that it does not sound like an intentional attempt to shift the burden of treating workers’ compensation injuries to Medicare? I am all for limiting the federal government’s reach when it determines how much is necessary to protect Medicare’s fictitious and theoretical interests; however, unilaterally cutting medical benefits to the detriment of those that may actually have lifetime medical needs short of being labeled “catastrophic” hardly seems like the appropriate response to dealing with MSAs. Yes, MSAs are a pain to deal with, but this director’s perceptions are incorrect. His perceived problems lie in the voluntary WCMSA review program, not with the MSP exemption itself. And, at the end of the day, a state cannot pass legislation for the sole purpose of circumventing federal requirements. It would be interesting to see if instituting a benefit cap would even accomplished the intended goal. Do they really think CMS will go away that easily???
Source: medicaresetasideblog.com

Atlanta Events, Atlanta Restaurants, Atlanta Concerts, Atlanta News

March 9, 2013 – SOPO Bicycle Co-Op hosted its 9th annual benefit party this past weekend to raise funds and to celebrate bike culture in Atlanta. We joined up with the organization on Saturday for the citywide scavenger hunt, costume contest and skids and tricks competition. Some fun items on the scavenger hunt list included doing the Harlem Shake in front of the High Museum, hula-hooping in Piedmont Park, playing bike polo in Reynoldstown with Atlanta Bike Polo, manning a row-bike at Elliott Street Pub, and getting tattoos or a face-painting at Memorial Tattoo in Cabbagetown. Everyone then met up at the Basement in East Atlanta Village to tally points, get judged for best costume, and participate in a skids and tricks competition. Bikers competed for longest skid, slowest track-stand race and more. For more information about SOPO Bicycle Co-Op, visit sopobikes.org.
Source: clatl.com

Georgia Medicare Supplement Insurance Quotes

There are some coverage types (Plan G for instance) that are not guaranteed issue after the open enrollment window at age 65.  However, most plans require no underwriting if you involuntarily lose your group coverage or a Medicare Advantage policy.  So long as you are enrolling in Medicare Part B for the first time, you can purchase all supplemental plans without underwriting.
Source: ohioinsureplan.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

Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSEach private plan would have had to offer a benefit package that covered at least the actuarial equivalent of the benefit package provided by the traditional fee-for-service Medicare. Medicare’s contribution (or “premium support”) to the full premium for any of these choices, including traditional Medicare, would have been equal to the “second-least-expensive approved plan or fee-for-service Medicare” in the beneficiary’s county, whichever was least expensive. That premium support payment would have been adjusted upward for the poor and the sick and downward for the wealthy.
Source: nytimes.com

Video: How to Understand Medicare Plans

Medicare Open Enrollment: last chance to review and compare plans

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

Daily Kos: Paul Ryan pushes Republicans off the ‘end Medicare’ cliff all over again

that Ryan doesn’t realize is that many of us that are either elderly, disabled, or even poor, do pay taxes.  We pay state taxes for our license plates, we pay state taxes to our local governments, we pay taxes on our phone and utility bills, we paid property taxes to support our schools, road, etc.  We support businesses, schools, etc.  It comes full circle by all of us contributing to a system and if you cut more and more to where there is no longer financial support even at the local levels eventually it will destroy the people on the top.  Which means congress and senate will have to cut their benefits and salaries as well because we will no longer be able to support them, the banks, and all the other wealthy getting tax breaks, loop holes, blah, blah.
Source: dailykos.com

Ryan’s Medicare Plan Said To Back Away From Age Cutoff

The Medicare NewsGroup: Rewind, Rehash And Reject: No Movement Expected On Medicare Reform In 2014 Budget At least one thing is certain in this congressional budget season: disagreement will be the order of the day. The president and Congressional leaders have already failed to avert billions in across-the-board spending cuts under sequestration, setting the stage for more fighting over how to shrink the deficit. When it comes to Medicare reform, most experts say that they expect to see the same plans that lawmakers laid on the table last year and they don’t expect that the feuding parties will reconcile their considerable differences. GOP congressional members have already pulled out old ideas, blown off the dust and called them by different names. Since the election, Republicans have reintroduced premium support proposals under the new moniker “competitive bidding.” Rep. Paul Ryan (R-Wis.) and the House Republicans are poised to be the first out of the gate with another premium support proposal (Adamopoulos, 3/5).
Source: kaiserhealthnews.org

Cut Medicare Advantage plans and save money

To the group supporting keeping Medicare Advantage plans: Your group wants to continue a program spending taxpayer monies faster than regular Medicare. Each person on an Advantage plan costs the tax payer 14 to 15 percent more than one on Medicare as it was originally designed.
Source: dallasnews.com

Kaiser ranked highest Colorado health plan, says J.D. Power

Kaiser Permanente Colorado has been widely recognized within the health care industry for delivering top-quality care. According to the National Committee for Quality Assurance Health Insurance Plan Rankings 2012-2013, Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado, and No. 6 in the nation for quality and member satisfaction. The Kaiser Permanente Medicare plan in Colorado also earned five stars from the Centers for Medicare & Medicaid Services, the highest overall rating for quality and service for 2013 plans.
Source: csbj.com

Comparing Medicare Supplemental Insurance Benefits

These plans, called “Medigap” plans, each have different medical care coverage. Variable benefits of coverage to be considered are: • Coinsurance plus coverage that last 365 days after medicare benefits end (Medicare Part A) • Coinsurance/Copayment for medicare part B. • Pints of blood (transfusions, first three pints) • Hospice care copayments or coinsurance • Coinsurance for Skilled Nursing Facilities • Part A medicare deductible • Part B medicare deductible • Part B excess charges • Emergencies during foreign travel • Preventative care coinsurance, per Medicare Part B If any of these are important for you to have covered, comparing medicare supplemental plans that include benefits is the only way to ensure they are included.
Source: seniorcorps.org

Privately Run Medicare Plans are Really Expensive

Austin Frakt draws my attention today to a new article about the administrative costs of Medicare. Exciting stuff! Long story short, Kip Sullivan of the Minnesota chapter of Physicians for a National Health Program wants everyone to understand just what’s involved in figuring out the true administrative costs of Medicare. The cost of collecting payroll taxes is one frequently overlooked element, for example. More interestingly, though, there’s a large and growing gap between the overhead calculations of the Medicare Trustees and those of the National Health Expenditure Accounts. Why is that?
Source: motherjones.com

Paradigms and Demographics: Obama Administration Plans to Cut Medicare Advantage Reimbursements

The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
Source: blogspot.com

Medicare: Save Money on Premiums and Copayments in 2013

More plans offer lower copays at "preferred" pharmacies: In 2013, for example, more than half the 32 Part D plans in California will charge lower copays at preferred pharmacies than at regular network ones — with savings of between $2 and $28 for the same prescription. Sounds like a deal, but be careful: If a plan’s preferred pharmacies aren’t within a convenient distance, you may be better off in another plan.
Source: aarp.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

CONNECTURE ACQUIRES DRX, A LEADING PROVIDER OF INFORMATION SYSTEMS FOR MEDICARE

Connecture is the leading provider of Web-based information systems used to create health insurance marketplaces and exchanges. Its industry-proven solutions enable consumers, employers and brokers to more easily shop for, purchase and renew health insurance while minimizing back-office administrative expenses for health plans.  Connecture’s solutions are provided to health plans, state insurance exchanges, private exchanges and insurance brokers.  More than 25 million Americans shop for their health insurance through systems built by Connecture, and more than half of the nation’s 20 largest plans rely on them to sell, administer and manage their plans and products effectively.  For more information, visit www.connecture.com.
Source: drx.com

Texas Medicare Supplement Insurance Plans

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deMake 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: FREE MEDICARE LEADS/ MEDICARE SUPPLEMENT LEADS/ INSURANCE SALES LEADS

15% Medicare Supplement Rate Increase is Outrageous!!! » Toni Says

Cindy, one Medicare rule that you should be aware of since you are not happy with your rate increase from your current Medicare Supplement company is…if you had a Medicare Supplement policy before you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the Medicare Advantage Plan, you will have special rights to buy a Medicare Supplement policy if you return back to “Original Medicare” within 12 months of first joining a Medicare Advantage plan.  If you had a Medicare Supplement policy before you joined, you may be able to get the same plan back if the company still sells it.  If it isn’t available, you can buy another Medicare Supplement policy. (Please see page 66 of the
Source: tonisays.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

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

Greatest Medicare Supplemental Indemnity For Better Benefits

Casually that there could be more to our own actual cost akin to Medicare than an initial premiums with regards to Medicare Part Any and B. You will have co-pays and subjected office visits to meet. This is even the different picks in Medicare extra insurances come on the road to play. Medicare insurance supplemental plans while policies help that will cover deductible and additionally co-pays. Individual policy offers a variety of coverage options. You will would prefer to determine exactly what policy will give good results best for your situation.
Source: plaintiffs-law.com

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

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

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

How hospice and Medicare supplements work together

Children who are intervening with parents’ affairs are often confronted with keeping Medicare Supplement insurance while Hospice pays the majority of expenses, sometimes making the supplement unnecessary.  You should be aware that there are some expenses, like medical equipment and prescription drugs, that are not covered by Hospice.  These services are then covered 80/20 by Medicare and the supplement.  The risk you run is if you drop the supplement, you are then paying the 20% yourself.
Source: medicareplansstcharles.com

Today’s Influence Ads: AARP Medicare Supplement, Shale Gas Production

A slew of new ads are out today as Congress embarks upon its last week before the elections. AARP and UnitedHealthCare have a new ad today promoting AARP Medicare Supplement Insurance Plans as the only standardized Medicare supplement plan that AARP  endorses. American Clean Skies Foundation has a new ad pushing for the production of shale gas in the United States. The government of Panama’s new ad promotes the country as a good place for American businesses to invest. And Across the Aisle Foundation has a new ad inviting senior House and Senate staffers from both parties to an October event to discuss how the new Congress should tackle its first 100 days. Others with new ads, per Kantar Media’s Washington Eye, include: American Petroleum Institute, American Sugar Alliance, American Veterinary Medical Association, Consumer Electronics Association, Employee Freedom Act Committee, Fair Search, Lockheed Martin, McDonald’s, Neustar and Radiation Therapy Alliance. Those with continuing ad include: Altria, American Cancer Society, American Council of Life Insurers, American Hospital Association, AT&T, Beirut Families, Boeing Company, BP, Chevron, CIT Group, CME Group, Hologic, Honda, Huntington Ingalls Industries, Lockheed Martin, Mars Chocolate, Northern Dynasty Minerals, Nuclear Energy Institute, Pfizer, Pharmaceutical Research Manufacturers of America, Southern Company, United Soybean Board, Univision, WellPoint, WTOP and Zurich.
Source: nationaljournal.com

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

5th Circuit Affirms Finding Of Medicare Violations At Mississippi Nursing Home

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /NEW ORLEANS – A Fifth Circuit U.S. Court of Appeals panel on Feb. 7 in an unpublished opinion affirmed findings that a nursing home violated Medicare regulations after residents were found to be in immediate jeopardy (Mississippi Care Center of Greenville v. United States Department of Health and Human Service, No. 12-60420, 5th Cir.; 2013 U.S. App. LEXIS 2668).Full story on lexis.com
Source: lexisnexis.com

Video: Medicare Insurance Supplement in Mississippi by 1-800-MEDIGAP®

Zone 5 Program Integrity Contractor ZPIC for Medicare and Medicaid Programs is AdvanceMed

When a physician, medical group or other health care provider receives a notice of an audit and site visit from a ZPIC, things happen fast with little opportunity to prepare. A ZPIC will routinely fax a letter to the practice shortly before the end of a business day the day before a site visit/audit to that practice. Auditors will request to inspect the premises, will photograph all rooms, equipment, furniture, and diplomas on walls. They will usually request copies of several patient records to review later. They will request copies of practice policies and procedures, treatment protocols, all staff licenses and certifications, drug formularies, medications prescribed, and medications used in the office. ZPIC auditors will inspect any medication/narcotic lockers or storage cabinets and will request drug/medication invoices and inventories. You will usually be contacted for follow-up information and documentation after the audit and will eventually be provided a report and, possibly, a demand for repayment of any detected overpayments.
Source: thehealthlawfirm.com

Don’t mess with Medicare (Mississippi Sound Off)

I see in this morning’s paper where Gautier has just found out they have a $1 million shortfall. That is easy to explain. The city government is throwing money right and left. We have sidewalks to nowhere; streetlights that don’t meet regulations and need to be removed; landscaping the medians that they can’t mow or keep weeded now; clock towers; sculptures for a non-existent downtown. Citizens, let’s clean house and get rid of all of them. We need practical thinking, level-headed leaders — not pie-in-the-sky dreamers.
Source: gulflive.com

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

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

Medicare Supplemental Plans in Mississippi

This particular program contains a wide range of facilities and provides benefits, but only up to a certain limit, beyond which it is the responsibility of the beneficiary to pay the medical charges. It is herein that the Medicare Supplemental Plans gain importance and help the deprived sections of the Mississippi population.
Source: medicaremississippi.com

Many Years Young: Follow Medicare Savings Model, Insurers Told

Medicare’s prescription drug benefit created tiers of products, with much higher copays for brand-name drugs compared with their generic counterparts. As a result, seniors accelerated their use of the lower-cost generics and caused Medicare Part D spending to be much less than initially anticipated. Today, generics account for about 80% of all drugs dispensed.
Source: manyyearsyoung.com

99487 New Medicare Code for Complex Care . . . Anyone Using it?

Welcome to the Physician Assistant Forum. Established in 1998, the physician assistant forum has become the largest online social network of physician assistants, physician assistant students and those interested in becoming a physician assistant. Our forum has over 14 years of experience related information and physician assistant jobs or employment opportunities. We also have a large physician assistant school section with tons of helpful information for applying and interviews. Please go HERE to register.
Source: physicianassistantforum.com

Mississippi Medicaid Changes from the 2012 Legislative Session

For inpatient hospitals, the new APR-DRG methodology will be similar to DRG-based payment methods currently used by Medicare. All inpatient stays will be classified in one of 1,256 APR-DRGs based on the difficulty of the case. The payment amount for each stay will be derived by multiplying the APR-DRG relative weight by a budget-neutral base rate established by the Mississippi Division of Medicaid (DOM). Hospitals will be paid more for complex cases and less for more routine procedures. Policy adjustments will be made for pediatric mental health, adult mental health and obstetrics and newborns, to enhance payments made for the most at-risk Medicaid beneficiaries. Expected benefits of the change are as follows:
Source: healthcarereforminsights.com

Medigap vs. Medicare Advantage Plan

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

Daily Kos: Mississippi governor: Everyone in America has health care

It’s like trying to argue how old the earth is, or whether global warming is accelerated because of human activity. No matter the evidence to the contrary, mainstream Republican thinking refuses to acknowledge that we have an essentially non-existent health care system in the U.S. if you’re poor, and a pretty shitty one unless you’re lucky enough to have a good job with benefits, or lots of money. So it isn’t a big surprise that Mississippi’s Republican Gov. Phil Bryant would say this: BRYANT: Medicaid was meant to be a temporary [stop]gap for providing you medical treatment while you are looking for a job. Now we are saying, you can have a job and still receive Medicaid. So we have changed the whole dynamic. There is very little incentive for those 940,000 people on Medicaid to find a better job, or to go back to school, or to get [into] a workforce training program because they say: Look, if I go over $33,000,  [I] will lose Medicaid. There is no one who doesn’t have health care in America. No one. Now, they may end up going to the emergency room. There are better ways to deal with people that need health care than this massive new program. Setting aside the fact that a good portion of Mississippi’s Medicaid population is either children or elderly people in nursing homes who won’t be getting jobs no matter what the incentive, it is particularly tone-deaf of the governor of that state, the one that leads the nation in poverty, to make this statement. Mississippi doesn’t have the largest uninsured population among the states—Texas still has that distinction—but at 17 percent it’s still pretty deplorable. That’s 17 percent of Bryant’s constituency that he’s completely written off.
Source: dailykos.com

First Edition: March 12, 2013

The New York Times: Obama’s GOP Outreach Hits Barriers What spurred Mr. Obama to reach out to rank-and-file Republicans with a flurry of phone calls, meals and now Capitol visits were the recent announcements by their leaders — Speaker John A. Boehner and Senator Mitch McConnell of Kentucky — that they will no longer negotiate with Mr. Obama on budget policy as long as he keeps demanding more tax revenues as the condition for Democrats’ support of reduced spending on Medicare and other entitlement programs. Both leaders face political risks from deal-making with the president — Mr. Boehner the potential loss of his leadership job; Mr. McConnell the danger of a Tea Party challenge as he faces re-election next year (Calmes, 3/11).
Source: kaiserhealthnews.org

Viewpoints: 5 Lies About Entitlements; Obama’s Plans For Medicare Still Not Clear; Generic Drug Makers Need To Be Accountable

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 CareThe New York Times: Dwindling Deficit Disorder Right now, a sustainable deficit would be around $460 billion. The actual deficit is bigger than that. But according to new estimates by the budget office, half of our current deficit reflects the effects of a still-depressed economy. The “cyclically adjusted” deficit — what the deficit would be if we were near full employment — is only about $423 billion, which puts it in the sustainable range; next year the budget office expects that number to fall to just $172 billion. … So we do not, repeat do not, face any kind of deficit crisis either now or for years to come. There are, of course, longer-term fiscal issues: rising health costs and an aging population will put the budget under growing pressure over the course of the 2020s. But I have yet to see any coherent explanation of why these longer-run concerns should determine budget policy right now. And as I said, given the needs of the economy, the deficit is currently too small (Paul Krugman, 3/10).
Source: kaiserhealthnews.org

Video: Medicare Supplement Plans | Medicare supplement Health Plans

Kaiser ranked highest Colorado health plan, says J.D. Power

Kaiser Permanente Colorado has been widely recognized within the health care industry for delivering top-quality care. According to the National Committee for Quality Assurance Health Insurance Plan Rankings 2012-2013, Kaiser Permanente Colorado is the highest-rated private health insurance plan in Colorado, and No. 6 in the nation for quality and member satisfaction. The Kaiser Permanente Medicare plan in Colorado also earned five stars from the Centers for Medicare & Medicaid Services, the highest overall rating for quality and service for 2013 plans.
Source: csbj.com

Cut Medicare Advantage plans and save money

To the group supporting keeping Medicare Advantage plans: Your group wants to continue a program spending taxpayer monies faster than regular Medicare. Each person on an Advantage plan costs the tax payer 14 to 15 percent more than one on Medicare as it was originally designed.
Source: dallasnews.com

Ryan budget proposal calls for Medicare vouchers, Medicaid transformation

Ryan also proposed repealing the ACA and ending its optional Medicaid expansion, and turning Medicaid into a block-grant program. Under this system, states would receive a federal Medicaid contribution pegged to inflation and population growth, and would have greater flexibility in determining how the program is run. This would save the federal government $756 billion over 10 years, Ryan’s figures showed. However, his plan could result in as many as 27 million people losing Medicaid eligibility, according to Urban Policy Institute research cited by The Hill.
Source: mcknights.com

Sequestration Reduced Your Medicare Pay? You Have Four Options

What’s more, increasing patient volume will inevitably draw down on provider and staff morale, and increase stress. Patient experience and patient satisfaction suffers. The inevitable reduction in Pay-for-Performance (P4P) incentive payments by commercial health plans to doctor in private practice, and the P4P value-based incentive payments to hospital value-based purchasing programs based on reduced HCAHPS scores would also negatively impact the bottom line.
Source: healthworkscollective.com

Would busting up our consolidated health care market lower prices?

Over the long-term, the federal government might be able to address the broken pricing mechanism by enforcing antitrust laws more aggressively than before to break up monopolies in health care markets. But it is worth remembering that even heavily regulated insurance markets – such as Medicare Advantage or the exchange system in Massachusetts – have not been particularly successful at controlling costs. The simple fact is that the array of existing incentives for commercial insurers does not tend to drive down prices. Given the direction of commercial insurance, relying on the current version of “competition” is destined to jeopardize access to health care for millions of working Americans while driving public spending upward.
Source: pnhp.org

Navigating the Health Care System: How to Get a Good Value When Choosing a Health Plan

Compare your choices using Medicare’s Plan Finder. This tool will help you find and compare the different kinds of Medicare Advantage health plans (or Part C) and Medicare prescription drug plans (Part D). An online demonstration of this tool is available on YouTube. If you’re self-employed or unemployed, finding a health plan takes more work. Healthy individuals who can afford out-of-pocket expenses might consider a high-deductible plan. Under these plans, you will have to pay much more yourself before the plan covers any expenses. The advantage is that premiums are lower than other types of coverage. The National Association of Insurance Commissioners offers tips to help you understand and apply for individual coverage.
Source: ahrq.gov

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

Ryan’s Budget Proposal Would Repeal the ACA, Alter Health Programs

Rep. Chris Van Hollen (D-Md.) called Ryan’s proposal a “hoax” for claiming that it will repeal the ACA and produce a balanced budget in a decade. “It is a total hoax to say that you are repealing ‘ObamaCare’ and at the same time to say that you’re balancing the budget in 10 years,” Van Hollen said. He added, “Despite all the demagoguery in the last presidential campaign about the Medicare savings that we achieved as part of the Affordable Care Act, they’ve included all those savings in their budget” (Lillis,
Source: californiahealthline.org

Medicare Drug Costs to Be Reduced for Seniors, U.S. Says

People enrolled in Medicare will see “a direct and positive impact on their pocket books,” Ron Pollack, executive director of Families USA, a health-consumer advocacy group in Washington, said in a telephone interview. “In the long term, it means that some of the dire concerns about the future sustainability of Medicare are somewhat relieved, and that will probably reduce the inclination to shift greater cost burdens on Medicare beneficiaries as part of future budget deliberations.”
Source: globalregulatoryscience.com

Uwe E. Reinhardt: The Complexities of Comparing Medicare Choices

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

Cut Medicare Advantage plans and save money

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonTo the group supporting keeping Medicare Advantage plans: Your group wants to continue a program spending taxpayer monies faster than regular Medicare. Each person on an Advantage plan costs the tax payer 14 to 15 percent more than one on Medicare as it was originally designed.
Source: dallasnews.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Obama Administration Plans to Cut Medicare Advantage Reimbursements

What a damn disgrace for seniors to lose their healthcare completely. I wonder why no one has found out why Sasquatch and Valerie Jarrett were never exposed for their patient-dumping on the south side of Chicago or why Sasquatch was never tried on insurance fraud charges but chose instead to give up her license to practice law. And yet, our seniors have to suffer and they have worked and paid their fair share all their working lives.
Source: cowboybyte.com

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

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

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

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

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

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

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

Happy Now? Obama Cuts Medicare…Again

The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
Source: therionorteline.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

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

Medicare Drug Costs to Be Reduced for Seniors, U.S. Says

People enrolled in Medicare will see “a direct and positive impact on their pocket books,” Ron Pollack, executive director of Families USA, a health-consumer advocacy group in Washington, said in a telephone interview. “In the long term, it means that some of the dire concerns about the future sustainability of Medicare are somewhat relieved, and that will probably reduce the inclination to shift greater cost burdens on Medicare beneficiaries as part of future budget deliberations.”
Source: globalregulatoryscience.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

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