Medicare Needs Fixing, but Not Right Now (The New York Times) 

Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSIn a story about the future of Medicare and how the government will pay for the care of older Americans, Elliott Fisher, a professor of medicine at The Dartmouth Institute for Health Policy and Clinical Practice (TDI), a professor of community and family medicine at the Geisel School of Medicine, and director of the Center for Population Health at TDI, tells The New York Times that Medicare spending per person varies widely throughout the United States regardless of the quality of the care. Bringing the entire country in synch with the prevailing hospital-stay lengths of Medicare enrollees in Oregon and Washington would result in a dramatic savings, Fisher tells the Times.
Source: dartmouth.edu

Video: Medicare 4: Straight Talk on Medicare and Social Security from AARP Oregon

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

Is Medicare Really Working in Oregon?

One certain reason enrollees are continually satisfied is that 2012 premiums are lower on average than 2011 premiums.  In 2011, the Centers for Medicare and Medicaid Services (CMS)  found that the Medicare Part D program saved enrollees $2.1 billion in 2011 because of the Gap Discount program, which requires drug manufacturers to provide discounts on brand-name and generic drugs to seniors in the gap or “donut hole.”  About 3.6 million enrollees nationwide benefitted from these discounts, at an average of $604 each.
Source: northcoastoregon.com

Oregon’s great health care experiment: State puts $240 million on the line with coordinated care

The Oregon Health Authority formally certified the Collaborative to become a CCO on July 31, and it will begin providing care to 180,000 Oregon Health Plan patients living in Multnomah, Washington and Clackamas counties on Sept. 1. The Tri-County Medicaid Collaborative will, by far, be the largest CCO in Oregon. It is composed of every major health provider in Multnomah, Washington and Clackamas counties: Adventist Health, CareOregon, Central City Concern, Kaiser, Legacy Health, Oregon Health & Science University, Providence Health & Services, Tuality Healthcare, and representation from the three metro counties. Its annual budget is expected to be around $750 million dollars, and it will provide care for roughly a third of the state’s Oregon Health Plan patients.
Source: streetroots.org

Natural Gas: Oregon’s Energy Independence

“After years of being dependent on foreign sources of energy, we are now at the point of being able to export energy,” he said. The financial possibilities for our nation “take your breath away.” He advocates finding a balance by allowing some exports but not so many that it jacks up prices for American consumers and businesses.Southern Oregon has great potential for alternative energy sources including geothermal, hydropower and biomass, a forest source that can help reduce wildfire fuels and promote healthy forestation practices, he said.
Source: svtg.org

Oregon Picked To Lead National Innovation In Health Care Improvements

Oregon Health Authority will administer the grant, which will support the state’s ongoing health system transformation and require Oregon to share what it learns with other states. Oregon’s health reform to its Medicaid program started with the creation of coordinated care organizations last year.
Source: albanytribune.com

A Call for Mandatory Disclosure of Corporate Political Spending

Second, over the years, this issue has been caught, legislatively speaking, in a weird deadlock between Democrats and Republicans that involves, oddly enough, corporate philanthropic grantmaking. As readers know, corporate grantmaking through 501(c)(3) corporate foundations that file 990s gets disclosed, but direct grants from companies’ executive offices, marketing and PR arms, community relations divisions, etc. can be, and frequently are, done without disclosure. For some years, a Republican member of Congress would introduce a bill calling on disclosure of corporate charitable giving. Democrats (and leading nonprofit associations) have consistently opposed corporate charitable disclosure, saying that disclosure would make corporations apprehensive about supporting some causes and charities. Democrats would instead counter that if Republicans wanted disclosure of corporate philanthropic spending, they should be willing to require the disclosure of corporate political spending. And that’s where the debate would always grind to a halt.
Source: nonprofitquarterly.org

OHSU hiring freeze over $30M sequestration impact

One current pressing financial challenge for the university is the likelihood of sequestration, automatic spending cuts that will take place on March 1 unless Congress takes action to avert the reductions. OHSU depends on public resources – primarily federal grants, Medicaid and Medicare payments, and to a lesser extent state funds – for about half of its $2 Billion budget. The overall impact of sequestration on OHSU is estimated to be between $31 million and $33 million this year. That estimate includes federal cuts in Medicare funding, National Institutes of Health research funding, Department of Defense research funding and National Science Foundation funding.
Source: oregonbusinessreport.com

“Filling the Gap” NACCHO Submission: Federal Inquiry into Adult Dental Services in Australia: March 2010

Posted by:  :  Category: Medicare

1pic1thoughtinAug 16 spinach for brains by KatieTTMore worrying is the gap in time between the closure of the CDDS (8 September 2012 for new patients and 30 November 2012 for all treatments) and the proposed 2014 start date for the new reform package. Transition arrangements accessible for Aboriginal and Torres Strait Islander people as described to us, include continued access the existing Medicare Teen Dental Scheme and a component of the $345 million yet to be finalised arrangement with the States and Territories to address adult waiting lists for 2012-2013. We wish to ensure that the transition arrangements have targets to meet the needs of Aboriginal and Torres Strait Islander people.
Source: nacchocommunique.com

Video: Medicare Doesn’t Cover Dental Work

Free the Dental Therapists

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Visit the Dentist Before You Retire

Consider first that most employer based dental insurances are included in your benefits and in most cases you cannot opt out of them. If your employer is one of those contracts that has included dental insurance then use it. It is true that dental insurance does not typically cover at 100% of dental procedures, but it still covers a portion of dental services. This is a drastic change in comparison to not having any dental insurance at all. That is like going up that proverbial creek, and trying to paddle against the current. Once you retire and your dental benefits expire you will have an extremely hard time convincing medicare to cover you. Why? They do not cover dental care. It is that simple, so while you and your spouse are still working, using your dental care benefits is an excellent idea.
Source: danmatthewsdds.com

‘Dental therapists’ spark debate : Minor Thoughts

In Minnesota and Alaska, the two states that have practicing dental therapists so far, some of the therapists are able to take their work on the road, traveling to rural areas to treat those who have little or no access to dentists — or who have limited dental coverage. The dental therapists charge less than dentists and are able to take all types of insurance, including Medicaid and Medicare.
Source: minorthoughts.com

John Artemenko, DDS , Archive

American Dental Association artemenko bacteria blood pressure brush cavity children Clawson crown decay dental dental hygiene Dentist disease floss food gum gum disease gums health heart disease hygiene infection kids michigan mouth oral cancer oral health oral hygiene pain patients plaque Rochester Rochester Hills root canal saliva Sleep Sterling Heights stroke teeth tooth tooth decay Troy warren water
Source: drjohnart.com

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

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

Tx Dental Practitioners For Medical Aid Change: ‘Reform’ For Who?

A glance at title tags outside of the supper show a lot of of the invited visitors have experienced their Medicaid obligations revoked within doctrine known as Reliable Allegations of Scam (CAF). Under CAF, doctors as well as dentists can have their Medicare or even Medicaid payments help back when the government thinks theyve dedicated scam.
Source: staffeddentalchat.com

Know a good dentist/veneers in the OC, CA area for patients on medicare/medi

Frankly, I can’t understand what the writer is saying in most of the write-up. I assume that the writer fractured his/her incisor(s) in the fall. A veneer would likely be the incorrect treatment for this type of injury, as this is just a cosmetic covering. Veneers and cosmetic services are typically not covered by insurances, especially Medicare or Medicaid. However, CA may be different. The more appropriate treatment would likely be a crown or resin build-up, as these are more often used to fix broken teeth. The crown would be more likely to last over time. The resin build-up would be initially cheaper.
Source: angieslist.com

Many Kids on Medicaid Don’t See a Dentist

Even though this number has improved by 16% between 2002 and 2007, there are still many children who cannot access care due to the loss of school-based dental education programs, state budget cuts, low reimbursement rates that prevent providers from accepting Medicaid patients, and the overall lack of Medicaid dollars going toward dental care. Although the Centers for Medicare and Medicaid Services (CMS) has put goals in place for preventive services, the only long-lasting solution will be an increased investment in dental care.
Source: pilcop.org

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilIn 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

Video: Medicare Part D Donut Hole

Connecticut Seniors Saw Big Savings On Prescription Drugs Under Health Care Law

“Americans young and old, including thousands here in Connecticut, are already experiencing valuable savings and benefits that were previously unavailable or unaffordable,” Millea said, in an e-mail. “By closing the drug coverage gap or ‘donut hole’ over time, the ACA is saving individual seniors in Connecticut hundreds of dollars annually – savings that they can now use to pay for food, housing and other necessities.”
Source: ctwatchdog.com

What Is Medigap Coverage, And Is It Right For Me?

The coverage may be the same between each provider, the cost of the coverage is not the same. This means that you should search around a lot before choosing a company, because the cost can vary greatly. You may want to start with one of the leading providers like American Continental Insurance who specializes in Medigap insurance. In order to purchase Medigap insurance, you must first have both part A and part B medicare coverage. There is a premium involved with this coverage, but as long as you pay it, your coverage will continue to be renewed.
Source: dotmac.info

Medicare Gap Coverage Insurance : Nationwide coverage for private insurance plans

There are over 12 standardized plans that are available through Medigap. These plans go through A to L. Most of these policies must be followed by the Federal laws in order to protect the consumer. Most policies must identify on the cover as Medicare Supplement Insurance. All of the plans have their own benefits and extras that may not exists with the others. In order to qualify for Medigap policies, a person must have Medicare Part A and Part B. Each policy must be paid on monthly at a premium rate. In addition to these costs, a person must also pay a premium to the Medigap insurance company. If you have a partner, each one of you must purchase a different policy. The Medigap policy will not cover a spouse.
Source: ihealthcoalition.org

How Seniors Have Benefitted From Obamacare

Since the law’s enactment, 6.1 million Americans with Medicare who reached the Part D coverage gap also known as the “donut hole,” have saved over $5.7 billion on prescription drugs. Drug savings of $2.5 billion in 2012 are higher than the $2.3 billion in savings for 2011. In 2012, people with Medicare in the “donut hole” received a 50 percent discount on covered brand name drugs and 14 percent discount on generic drugs. As a result of the Affordable Care Act, coverage for both brand name and generic drugs will continue to increase over time until the coverage gap is closed.
Source: atchisonpublishing.com

Medicare Drug Benefit: Formulary Oversight in Medicare Part D

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceAn 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: Medicare Part D

Expanding Part D Could Save Billions for Medicare

The savings bolster the political argument for supporting Part D expansion at a time when politicians and health care experts worry about slowing the growth of the mammoth federal budget deficit. The CBO’s proof of savings is new. Previously, the “CBO found insufficient evidence of an ‘offsetting’ effect of prescription drug use on spending for medical services. But recently, more analysis has been published that demonstrates a link between changes in prescription drug use and changes in the use of and spending for medical services.”
Source: westorlandonews.com

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

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

Medicare Part D, Prescription Drug Plan Coverage, PDP

It is best to sign up for a Part D plan as soon as you become eligible. In some circumstances, members may be charged a penalty or face higher premiums if they sign up after their initial eligibility. If necessary, you can make changes to your plan in the fall when providers announce upcoming changes during the Annual Election Period (AEP). Few exceptions allow enrollments outside of an enrollment period, but it is important to enroll as soon as possible to avoid potential penalty fees.
Source: bradeninsurance.com

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

In 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Medicare Part D: A First Look at Part D Plan Offerings in 2013

NOTE: Originally released in October 2012, this data spotlight was updated in November 2012 to reflect revised data from the Centers for Medicare and Medicaid Services. 
Source: kff.org

CMS rolls back Medicare Part D deductibles for 2014

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

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Medicare Part D Meeting with President Bush (2007)

ABOUT MEDICARE: Getting what you need from your Medicare drug plan

David Sayen is Medicare’s regional administrator for California, Arizona, Hawaii, Nevada and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
Source: times-standard.com

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

In 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

Letter to Congress Re: Drug Benefit Design

MAPRx brings together beneficiary, patient advocacy, family caregiver and health professional organizations committed to improving access to prescription medications and safeguarding the well being of beneficiaries with chronic diseases and disabilities under the Medicare prescription drug benefit (Part D). On behalf of millions of Medicare beneficiaries with chronic conditions who rely on Part D for essential medications, we urge you and your fellow Members of Congress to consider the strengths and weaknesses of Part D and use lessons learned from this program as you address the challenges ahead. Specifically, as you examine ways to reduce federal spending, reform federal health care programs, and oversee State health exchange implementation.
Source: maprx.info

Unnecessary Regulations that Increase Prescription Drug Costs

7. Agency for Healthcare Research and Quality, “Prescription Medicines-Mean and Median Expenses per Person with Expense and Distribution of Expenses by Source of Payment: United States, 2010,” Medical Expenditure Panel Survey Household Component Data, U.S. Department of Health and Human Services. IMS Health, a private firm specializing in data collection and dissemination, estimated total spending on prescription drugs in 2009 was $300 billion. Fred Doloresco, Cory Fominaya, Glen T. Schumock et al., “Projecting future drug expenditures—2011,” American Journal of Health System Pharmacy, Vol. 68, 2011, e1-e12. Available at http://www.imshealth.com/deployedfiles/ims/Global/Content/Insights/Researchers/AJHP_Drug_Expenditure_Forecast_2011.pdf. IMS Health estimated total market in 2011 $320 billion. “The Use of Medicines in the United States: Review of 2011,” IMS Institute for Healthcare Informatics, April 2012. Available at http://www.imshealth.com/ims/Global/Content/Insights/IMS%20Institute%20for%20Healthcare%20Informatics/IHII_Medicines_in_U.S_Report_2011.pdf.
Source: ncpa.org

Demystifying Medicare Part D Prescription Drug Coverage

Companies that sponsor Medicare Part D prescription drug plans are required to offer a basic benefit, either the standard Part D benefit defined by law or an equivalent benefit design. In 2012, the standard benefit has a deductible of $320, and possibly a coinsurance of 25% up to an initial coverage limit of $2,970 in total drug spending, a coverage gap (also known as the “doughnut hole”), and catastrophic coverage after $4,750 in costs. Plan sponsors can also offer plans with enhanced drug benefits. Enhanced plans are required to have a greater actuarial value than basic plans, but plans vary in the ways in which they improve coverage. Enhanced plans may reduce or eliminate the deductible, charge less (on average) than the standard 25 percent coinsurance, and cover drugs in the coverage gap. The best way to find out what types of coverage are available in their area is to speak to a benefit Advisor and they can go over the pricing differences as the enhanced plan will be more costly on a monthly premium stand-point.
Source: extendconnections.com

Medicare Information, Tips to Help You Choose the Right Medicare Plan

Navigating your Medicare prescription drug coverage options can be challenging, but with the right information, you can make the best decision based on your unique medical requirements and preferences. Every patient that is eligible for Medicare is also eligible for prescription drug coverage. There are several plans available, including Medicare Advantage and Medicare Part D plans, so it is imperative to understand your options before making a decision. It may also be helpful to talk to an expert in the field if you have questions or concerns about which plan is right for you. Here are a few tips to keep in mind while evaluating your options for Medicare prescription drug coverage:
Source: myowens.com

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

CMS Issues FY 2011 Medicare RAC Report to Congress

Posted by:  :  Category: Medicare

Reason 2011 10 by sdobieThis week, CMS issued its annual Medicare Recovery Auditor report (pdf) to Congress, confirming that recovery audit contractors collected $797.4 million in overpayments from hospitals and other providers and repaid $141.9 million in underpayments in fiscal year 2011. The report was the second official Medicare RAC report. CMS concluded that after accounting for RAC contingency fees, appeals and other RAC-related costs, the RAC program saved Medicare more than $488 million in 2011. The FY 2011 collections figures pale in comparison to the RAC program’s projected FY 2012 results. In December, CMS said RACs recouped $2.29 billion in overpayments from providers and returned $109.4 million in underpayments in 2012. Here are some other major takeaways from CMS’ RAC report to Congress. Note: All figures are based on FY 2011. •    CMS spent $129.4 million to operate the RAC program. Of that total, roughly $82 million were paid to the private, for-profit RACs as contingency fees. (RAC contingency fees ranged from 9 to 12.5 percent for all claims except durable medical equipment.) •    Medicare hospitals and other providers appeal almost 61,000 RAC claims, which represent 6.7 percent of all overpayment claims. Of those claims, more than 26,000 claims — or 43.6 percent — were overturned in favor of the provider. •    HealthDataInsights, which is the HHS Region D RAC, collected the most in overpayments in 2011 — $318 million. •    RAC corrections were highest in California, New York, Illinois and Florida. •    The top overpayment denial reasons were medical necessity reviews for renal and urinary tract disorders and medical necessity reviews for acute inpatient admissions for neurological disorders. •    The top underpayment issues were providers using the incorrect MS-DRGs for severe sepsis and lysis of adhesions.
Source: beckershospitalreview.com

Video: Improving Medicare in 2011

Cost of long term acute care for Medicare patients in Santa Cruz among lowest in U.S.

Quinn has a patient in his 40s who is on a ventilator, he said, and his 80-year-old parents care for him. Other patients disabled by a spinal cord injury or stroke may need a ventilator, bowel and bladder care and feeding tubes, he added, but most of them don’t require 24-hour professional help. They need a limited amount of nursing care and physician oversight, but they could remain at home if a family member were able to do around-the-clock care. In-Home Support Services of Santa Cruz County pays family members just above minimum wage to do that, he said.
Source: healthycal.org

10 things Medicare won’t tell you

According to the Center for Public Integrity investigation, doctors have increasingly abandoned the lower-level codes for the better paying ones, a practice known as “upcoding.” The study—which analyzed a representative 5% sample of Medicare patients and their claims, submitted by more than 400,000 medical practitioners and 7,000 hospitals and clinics starting in 2001—found no evidence that Medicare patients are sicker and older than in the past, which if true might have justified doctors billing at the higher rates. “Medicare is susceptible to fraud not only because of its size and complexity, but because the system itself makes it easy to defraud the government,” says Ken Nolan, a partner at Nolan & Auerbach, a health-care fraud law firm. “Most of the scrutiny, if any, is made after the payment is made—not before, as in traditional business transactions.” Dr. Jeremy A. Lazarus, president of the American Medical Association, said in a statement that more analysis was needed on the issue: “Attributing the trend solely to fraudulent and abusive behavior remains an unproven assumption.”
Source: marketwatch.com

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

Risk adjustment is important to ensure that payments to MA plans adequately account for differences in beneficiaries’ health status and to maintain plans’ financial incentive to enroll and care for beneficiaries regardless of their health status. Our work confirms that differences in diagnostic coding caused risk scores for MA beneficiaries to be higher than those for comparable beneficiaries in Medicare FFS in 2010, 2011, and 2012. CMS’s decision to use a 3.4 percent adjustment to risk scores for 2010 through 2012 instead of the higher adjustments called for by our analysis resulted in excess payments to MA plans. The existence of such excess payments indicates that CMS’s adjustment does not accurately account for differences in treatment and diagnostic coding between MA plans and Medicare FFS—the stated goal of the statute that required CMS to develop a diagnostic coding adjustment. In our January 2012 report, we recommended that CMS take steps to improve the accuracy of the adjustment to account for excess payments due to differences in diagnostic coding. We noted that CMS could, for example, account for additional beneficiary characteristics, include the most recent data available, identify and account for all the years of coding differences that could affect the payment year for which an adjustment is made, and incorporate the trend of the impact of coding differences on risk scores. CMS’s adjustment for 2013 is the same as it used in 2010, 2011, and 2012. However, given our finding that this adjustment was too low and resulted in estimated excess payments to MA plans of at least $3.2 billion, we continue to believe that it is important for CMS to implement our recommendation that it update its methodology to more accurately account for differences in diagnostic coding.
Source: pnhp.org

Medicare Announces Coverage for Alcohol Misuse Screening and Counseling

The new CMS policy covers yearly alcohol misuse screening by primary care providers, such as a family practice physician, internal medicine physician, or nurse practitioner, in settings such as a doctor’s office. According to a CMS news release, the benefit also includes four behavioral counseling sessions a year by the patient’s primary care provider, if he or she screens positive for alcohol misuse.
Source: drugfree.org

House Republicans Vote to End Medicare, Again

There’s no possible way these GOPers can defend themselves, even with the full resources of the corporate proaganda apparatus carrying water for them. There is zero way they can now claim that they are not engaging in a vicious class war against the American People. But, with almost no exceptions, the entire lot is composed of sociopaths, malignant sociopaths and psychopaths, so they’ll try their damndest to try and spin things.
Source: crooksandliars.com

RAC audits: Skilled nursing facilities accounted for miniscule portion of 2011 Medicare overpayments

Physician, Durable Medical Equipment and “other” claim types each accounted for between roughly $33 million and $35 million in overpayments. Outpatient claims represented more than $17 million. SNFs — the only other claim type specified by the report — therefore accounted for less than 0.3% of all collected overpayments. The RACs review did not identify any underpayments to skilled nursing facilities.
Source: mcknights.com

Medicare Changes for 2011

New Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Affordable Care Act (ACA) mandates that a physician conduct a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Review the details of this new requirement, which has significant impact on internists.
Source: acponline.org

Daily Kos: How the GOP gets it all wrong on Medicare in five charts

Posted by:  :  Category: Medicare

In honor of Tax Day by swanksalotWhat these three charts tell you is simple: It’s all about health care. Spending on Social Security is expected to rise, but not particularly quickly. Spending on everything else is actually falling. It’s health care that contains most all of our future deficit problems. And the situation is even worse than it looks on this graph: Private health spending is racing upwards even faster than public health spending, so the problem the federal government is showing in its budget projections is mirrored on the budgets of every family and business that purchases health insurance. Klein’s warning that “private health spending is racing upwards even faster than public health spending” is especially true for Medicare. While there is heated debate about the size of the gap, there is little doubt that the administrative overhead of government-run Medicare is significantly lower than that of private insurers. That is also true of the private Medicare Advantage programs currently used by about 20 percent of beneficiaries. As it turns out, Medicare Advantage policies on average not only feature higher administrative costs, but cost the government much more in monthly premiums than the traditional “public option” Medicare. As Klein explained two years ago: The Medicare Advantage program, which invited private insurers to offer managed-care options to Medicare beneficiaries, was expected to save money, but it ended up costing about 120 percent of what Medicare costs. In 2011, Nobel Prize-winning economist Paul Krugman turned to data from the Centers on Medicare and Medicaid Services to illustrate the comparative cost-savings to the United States Treasury.
Source: dailykos.com

Video: Medicare Explained

Priority Health Launches ‘Medicare Explained’ Web Site

Each page includes key Medicare information, a short video and a quiz designed to accommodate a number of different learning methods. These are supplemented with “extra credit” articles that include detailed information about Medicare topics, options and Priority Health plans. The Medicare Explained educational tool helps people learn how Medicare works, determine what type of plan they need and find the right Priority Health Medicare plan for their needs and their budget.
Source: cbslocal.com

Gennady Katsnelson: Gennady Katsnelson: Home Medicare Services Explained

It is clear that everyone takes care of his or her health. It is important to think about the age when caring about health all by yourself seems to be a really hard activity. That is why even if your family is far away from your place of residence there are always special health care agencies that can provide you assistance. Visiting nurses as well as homecare specialists will provide the necessary help you require and usually such centers are mostly funded by the states which results in more than affordable services.
Source: blogspot.com

Medicare Advantage Fees Explained

[I]n many counties, private plans bid an amount lower than the amount Medicare FFS (fee for service) needs to offer Part A and Part B coverage. Taken as an enrollment-weighted whole, Medicare Advantage plans bid at 98%, just a shade below Medicare FFS. Private HMOs bid at 95%, which makes for a more substantial savings. Other private alternatives, like private fee-for-service, fare poorly relative to Medicare FFS. But of course that makes perfect sense. One can easily imagine, as Austin Frakt has suggested in the past, an equilibrium in which traditional Medicare FFS is the lowest-cost provider in rural counties, in which there is a relatively small number of medical providers with a great deal of leverage. In denser urban markets, with more competition among providers, private HMOs can out-compete traditional Medicare FFS by building more efficient provider networks.
Source: ncpa.org

Oticon Medical Now A Certified Medical Durable Equipment (DME) Provider

Curt takes us through the process: “The patient would get a prescription from her doctor as the processor is a prescriptive device. Then the patient would call us, so that we can get some information from the patient to process the order. Once we get the prescription and the paperwork completed, we send the processor to the patient, obtain confirmation from the patient that she indeed received it, and then we bill Medicare. Once the patient receives the processor, they are responsible for getting it programmed from their audiologist, and for any fitting fees for the programming.”
Source: earcommunity.com

The View from Hospital Hill: Medicare and Medicaid Explained at Forum

Toni Browning and Poppy Foddrell, from the Rappahannock-Rapidan Community Services, will speak on: Medicare A and B basics; differences between Medicare Advantage and supplement (Medigap) plans; Medicare Part D prescription details; Medicaid eligibility for those older than 65 or those receiving Social Security disability benefits; and long-term care Medicaid benefits.
Source: viewfromhospitalhill.org

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Posted by:  :  Category: Medicare

OBAMAS DEATH PANEL------ GUESS WHAT FOLKS IT'S ALIVE AND WELL---"CRAZY PALIN" NOT SO CRAZY NOW by SS&SSThe website that you are trying to access is in Offline Mode, which means the server is not currently responding. To browse the site from cache, click the button below. (Cookies and Javascript must be enabled.)
Source: stateofreform.com

Video: Senior Marketing Specialists Explains the New Oregon Medicare Supplement Birthday Rule

Is Medicare Really Working in Oregon?

One certain reason enrollees are continually satisfied is that 2012 premiums are lower on average than 2011 premiums.  In 2011, the Centers for Medicare and Medicaid Services (CMS)  found that the Medicare Part D program saved enrollees $2.1 billion in 2011 because of the Gap Discount program, which requires drug manufacturers to provide discounts on brand-name and generic drugs to seniors in the gap or “donut hole.”  About 3.6 million enrollees nationwide benefitted from these discounts, at an average of $604 each.
Source: northcoastoregon.com

Daily Kos: House Republicans vote to end Medicare, again

whose memorization skills are awasome are lacking is a sense of time. There’s a clue in the fact that all economic theory is based on models that are focused on conditions at a specific point in time. That is, the models are all static. If there are series or sequences, those are still perceived as static isolated instances. For comparison, think of the frames in a moving picture or video or cartoon. In a movie, these static images move at the rate of 30 per second, too quick for the human eye to perceive as static. So, we see them as continuous motion. Now imagine a person who can’t see change — i.e. the relationship between prior, present, and later images. Or call it progression. Some brains just take snap shots and can’t register change, progress, motion. Kenneth Galbraith said the problem is an inability to model the economy as a dynamic system, which it is. Economists can’t track change over time. Meteorologists are trying to do it for the weather, with some success. But, I suspect people attracted to economics aren’t even interested in trying, either because they don’t understand what a dynamic system is or because what they’re really after is changing how people behave. If the economy isn’t working as they expect, then people’s behavior has to be changed. It doesn’t even occur to them that their models are wrong.
Source: dailykos.com

Medicare Needs Fixing, but Not Right Now (The New York Times) 

In a story about the future of Medicare and how the government will pay for the care of older Americans, Elliott Fisher, a professor of medicine at The Dartmouth Institute for Health Policy and Clinical Practice (TDI), a professor of community and family medicine at the Geisel School of Medicine, and director of the Center for Population Health at TDI, tells The New York Times that Medicare spending per person varies widely throughout the United States regardless of the quality of the care. Bringing the entire country in synch with the prevailing hospital-stay lengths of Medicare enrollees in Oregon and Washington would result in a dramatic savings, Fisher tells the Times.
Source: dartmouth.edu

Oregon’s great health care experiment: State puts $240 million on the line with coordinated care

The Oregon Health Authority formally certified the Collaborative to become a CCO on July 31, and it will begin providing care to 180,000 Oregon Health Plan patients living in Multnomah, Washington and Clackamas counties on Sept. 1. The Tri-County Medicaid Collaborative will, by far, be the largest CCO in Oregon. It is composed of every major health provider in Multnomah, Washington and Clackamas counties: Adventist Health, CareOregon, Central City Concern, Kaiser, Legacy Health, Oregon Health & Science University, Providence Health & Services, Tuality Healthcare, and representation from the three metro counties. Its annual budget is expected to be around $750 million dollars, and it will provide care for roughly a third of the state’s Oregon Health Plan patients.
Source: streetroots.org

Oregon gov. will brief other state leaders on health overhaul plan

We allow third-party companies to serve ads and/or collect certain anonymous information when you visit our web site. These companies may use non-personally identifiable information (e.g., click stream information, browser type, time and date, subject of advertisements clicked or scrolled over) during your visits to this and other Web sites in order to provide advertisements about goods and services likely to be of greater interest to you. These companies typically use a cookie or third party web beacon to collect this information. To learn more about this behavioral advertising practice or to opt-out of this type of advertising, you can visit www.networkadvertising.org.
Source: capitolhillblue.com

DeFazio Rejects Ryan Budget Plan To Voucherize Medicare, Raise Taxes On Middle Class

“This is a phony budget. The Republican leadership’s main goal isn’t to balance the budget, but to appease the radical right who want to bankrupt the government so it’s small enough to ‘drown it in a bathtub’. The Ryan budget turns Medicare into a voucher program and ends federal investment in our roads, bridges and highways, which would kill 2 million jobs. It raises taxes on middle income families, but protects loopholes and subsidies for corporations making record profits and cuts taxes for millionaires and billionaires. It uses fuzzy math to pretend it balances the budget in ten years. This is far from balanced, and it would hammer the economy instead of getting it back on track,” said DeFazio.
Source: albanytribune.com

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

Posted by:  :  Category: Medicare

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average. The analysis also examines the types of plans available (HMOs, PPOs, etc.), changes in out-of-pocket limits, and the availability of special needs plans.
Source: kff.org

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Study: Seniors Look For Star Ratings On Medicare Advantage Plans

The rating system uses survey data and other measurements of effectiveness to gauge the quality of the private Medicare Advantage plans, which are an alternative to traditional fee-for-service Medicare. Dr. William Shrank, a co-author of the study, said the relationship between the ratings and enrollment was a good sign for the star system put in place in 2011.
Source: kaiserhealthnews.org

Thank heaven for insurance companies: Kaiser Permanente Senior Advantage forcibly enrolled retired federal employee who had enrolled in Nationwide

Yikes! I guess I should count my blessings that I was able to escape from Kaiser. Kaiser Permanente Senior Advantage Ripoff Report Reported By: Barbara Monrovia, California February 24, 2013 Kaiser Permanente PO Box 232400 San Diego, California 92193 Phone: 1-800-443-0815 After canceling service 12/31/2012 and arranging replacement coverage through the Office of Personnel Management as a Retired Federal Employee, Kaiser without my knowledge, request or consent enrolled me in San Diego, California. Due to change in living situations, I was forced to cancel my Kaiser Permanente coverage aften 46+ years. I am a Federal Retiree and during the Open Season with the help of my Congresswoman’s office I chose a Nationwide company and did everything necessary including closing visits with my doctors. I used the new coverage in January while I was in New York without a problem. When I came home to Southern CA late in January I found mail from Kaiser telling me that I had been approved by Medicare to have their coverage as of 2/1/2013. I checked with OPM in DC and they said to ignore it that my proper coverage was in place. I destroyed the new Kaiser Cards (3 in separate mailings) and went on with my plans to establish myself with the Doctor of my choice. Now, I have seen the new doctor and she prepared new prescriptions (as mine were running out) and ordered lab work. I am almost 70 years old and have several serious chronic conditions which require ongoing consistent medications. When I heard from a provider that I could not get services because Medicare is not my primary coverage I inquired further and found that Kaiser had enrolled me without any request or permission and that I could not get anything without going through them. Here’s the catch, when I had called Kaiser to have them remove their name from my record I was told that I had to request it in writing with a signature and that since it is not open season they might not recognize or honor my cancellation. I told them that I had not authorized the coverage and I was not going to sign anything that could imply that I had. After several long calls to Medicare and Kaiser (threatening them with an official Complaint) they acknowledged that they had enrolled me in their Individual Senior Advantage Program as of 1/18/2013 because they had checked and saw that I was eligible for Medicare (so what!). After putting me on hold for a long time for them to speak to a supervisor the lady came back and told me that they were attempting to assure that I would not have a break in coverage (bull …). I did as Medicare Operator instructor and called them back with the information and an Escallated Complaint has been sent “up the chain”. Problem is that I am getting more ill and cannot get assistance unless I go to Kaiser and if I do, that will acknowledge that I accept what they have done and I will legally becomme financially obligated to them for the rest of the year. I live on two coasts and they are not available in NY and have limited Out of Area allowances. So, here I sit having my drug coverage (for which I have paid) not being honored and scared to death that I cannot get this straightened out before I become critically ill. Do they think because I am old, I am stupid? God only knows how many retired federal (and others) employees find themselves in this same mess. After supposedly taking care of me for over 46 years they are ready to cause me illness and possible death if I do not come back to them…
Source: blogspot.com

Kaiser Permanente Leads the Nation with Six 5

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

Kaiser Permanente Georgia Offers Seniors Tips for Selecting a Medicare Plan

 Kaiser Permanente is Georgia’s largest not-for-profit health plan. Its mission is to provide high quality, affordable health care services to improve the health of its members and the communities it serves. Kaiser Permanente serves more than 235,000 members in a 28-county service area including metro Atlanta with care focused on their total health and guided by their personal physicians, specialists, and team of heath care providers. Expert and caring medical teams are supported by industry-leading technology and tools for health promotion, disease prevention, state-of-the art delivery, and world-class chronic disease management. Nationally, Kaiser Permanente is recognized as one of America’s leading health care providers, serving mort than 9 million members in nine states and the District of Columbia. For more information, visit www.kp.org.
Source: patch.com

Medicaid Eligibility and Enrollment for People With Disabilities Under the Affordable Care Act: The Impact of CMS's March 23, 2012 Final Regulations

Posted by:  :  Category: Medicare

This brief provides a short summary of Medicaid eligibility and benefits for people with disabilities today and explains how they will be affected by the ACA in light of the Centers for Medicare and Medicaid Services’ (CMS) March 23, 2012 final rule to implement the ACA provisions relating to Medicaid eligibility, enrollment simplification and coordination. The rule is effective Jan. 1, 2014. Provisions of the new Exchange regulations are discussed briefly to the extent that they related to Medicaid eligibility determinations for people with disabilities.
Source: kff.org

Video: MEDICARE Disability

T65 Already on SSDI, GI Options at 65?

A lead card contact I called is interested in discussing Medicare options for turning 65, June ’48 DOB. Has had Medicare A/B due to SSDI for over 10 years, and PDP only, no MAPD..she looked at her card to confirm…, with a carrier that offers PDP only in her zip code, no MA. After our call, it occurred to me that, A. the person might have ESRD, therefore no MAPD, or B. lives under a rock, and no one has offered MAPD. lol…. is there another possibility? I have not had anyone on SSDI turn 65 yet. I just checked the producer handbook for UHC AARP. Says turning 65 *OR* newly enrolled for Medicare B. That sounds like GI for SSDI recip. turning 65. Except the MedSupp that would be affordable would be high deductible F, N/A thru AARP. On to the next manual, I do have a well priced/stable premium carrier for HD F. Anyone have experience with this? I have sent an SOA, and will set appointment to review. She brought up that she has bills from a hospitalization, trying to work out payment options with hospital. Doesn’t sound at all like dual eligible, but is low income. Will explore LIS. Even the MAPD HMO’s have $3,000+ OOP’s, unless the person is extreme low income, they face bills. That’s why I am considering High deductible F, lower max. OOP/premium competes with MAPD PPO’s with much higher max. OOP’s.
Source: insurance-forums.net

Social Security & Medicare for Adult Disabled Children

If you or your spouse are retired or disabled and receiving Social Security benefits and have a disabled adult child who has been denied the SSDI benefits, the experienced attorneys at Littman Krooks, LLP can assist you in filing an appeal, so that your child can obtain the benefits they are entitled to. Our firm represents adult children with disabilities in SSDI appeals on a contingent fee basis, which means that there is no out of pocket legal costs for filing the appeal.
Source: specialneedsnewyork.com

If I Win my SSDI Case, When do I Become Eligible for Medicare?

For many of my clients, Social Security disability income benefits are a lifesaver. The $1,500 to $2,000 per month typical in SSDI cases plus a $20,000 to $30,000 lump sum can mean the difference between living with dignity and not. However, monthly income benefits are not the only result of a favorable disability decision. SSDI claimants also become eligible for Medicare, although this eligibility is not immediate. There is a 24 month waiting period from the first date you become eligible to receive SSDI payments and the date you become eligible for Medicare. Here are a couple of examples that might help you better understand the 24 month waiting period: Example 1: Sue’s last day of work is August 10, 2010. She files for SSDI on August 11, 2010 using August 10 as her alleged onset date. Sue and her lawyer appear at a hearing in July 2012 and she is approved as of her alleged onset date. Sue first becomes eligible for SSDI payments as of February 1, 2011. This is because the five month waiting period for SSDI runs September, 2010 – January, 2011. Note that the five month waiting period refers to five full months – thus, August, 2010 does not count towards the five month waiting period. Sue becomes eligible for Medicare on the 25th month after her first SSDI payment, or March 1, 2013. Example 2: Tom stops working due to severe back problems on March 3, 2005. He does not apply for SSDI until July 18, 2008. Tom appears at a hearing in September, 2010 and receives a fully favorable decision using the March 3, 2005 onset. Tom first becomes eligible for SSDI payments in July 2007. His five month waiting period runs from April, 2005 through August, 2005, but he can only collect benefits one year prior to the date of his application, which is July 18, 2007. His Medicare eligibility begins as of September, 2008, which is during the 25th month after his first eligibility for SSDI payment. Here is a link to SSA’s page about Medicare eligibility – http://1.usa.gov/11CbEEW.
Source: jdsupra.com

Disability Eligibility for Housing Aid and Food Stamps

Video Details: Am I eligible for food stamps and housing aid after my qualifying for Social Security Disability? Learn when you become eligible for Medicare and find out how to apply for other assistance after qualifying for Social Security Disability. For answers to your questions about Social Security Disability or for help with a benefits claim call toll-free: 1-888-393-1010 or visit http://www.DisabilityAdvisor.com
Source: disabled-world.com

Tricare Help – If wife gets Medicare early due to disability, does she get TFL at the same time?

20/20/20 age appeal catastrophic cap child born out of wedlock claims continued care cost share death DEERS dental dependent disabled divorce doctor doctors FEHBP handbook health care reform hospital ID card marriage maternity care Medicare military treatment facilities other health insurance outside the U.S. parents Part A Part B pharmacy pre-existing condition pregnancy reserves secondary insurance social security spouse supplements surgery Tricare For Life Tricare Prime Tricare Standard Tricare Young Adult Program VA widow
Source: militarytimes.com

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

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