Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

Posted by:  :  Category: Medicare

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

Video: Is Freedom Blue PPO a Medicare Supplement?

Blue cross medicare rx prior authorization

     Find out which medications on IBC’s formulary will require prior authorization. Your doctor will have to get approval in advance from Independence Blue Cross Learn more about Prior authorization – MedicareBlue Rx at yourmedicaresolutions.com 2012 Prior Authorization Criteria for Medicare HMO BlueSM (HMO) and Medicare PPO BlueSM (PPO) Plans Definition of Prior Authorization For certain drugs your doctor or
Source: rediff.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Anthem Blue Cross Introduces Medicare Preferred PPO

One of the newest Medicare Advantage plan in California for 2012 is the Anthem Medicare Preferred Standard PPO or AMP. The Anthem Medicare Preferred is the newest successor to the Freedom Blue Regional PPO plan that became very popular over the past few years. The plan offers significant freedom of choice in regards to your medical service providers. The AMP PPO plan is only available in select counties throughout California and the benefits are different from county to the next. The plans are grouped below by counties that share the same benefits:
Source: wordpress.com

HMO Versus Ppo, Blue Cross HMO Doctors, Blue Cross Health Insurance, : Medicare Preferred Provider Organization (PPO) Case Study and …

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Source: projectedu.com

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Ask A Medical Biller: Legacy Identifier for Blue Medicare PPO

Medical Billing and Coding Keyword Tags: medical billings and claims, medical billings claims, medical claims electronic billing, claim billing software, electronic medical claim billing, lytec medical billing software, medical billing schools, medical coding and billing schools, medical billing schools online, medical coding and billing schools online, medical billing classes online, online medical billing school, medical billing and coding courses online, courses online, medical billing classes, chiropractic software, online courses medical billing, medical office billing software
Source: blogspot.com

California Medicare Insurance: Anthem Freedom Blue PPO for 2012

The Anthem Blue Cross Freedom Blue 2012 will be seeing some changes. It will now be called the Anthem Medicare Preferred Standard PPO. This plan  will be the only PPO Medicare Advantage plan in California. The Anthem Medicare Preferred is a Local PPO or LPPO available only in certain counties throughout the state and has a $300 annual deductible.. These counties include Los Angeles, Orange, San Francisco, Alameda, San Diego, Sacramento and Ventura just to name a few.Although the core benefits are similar there are some differences. One of the biggest changes for the Medicare Advantage LPPO for 2012 is that some counties are now charging a monthly premium. Los Angeles, San Diego and Ventura are the only ones where it is remaining a “No Cost” plan. The Anthem Medicare Preferred PPO also includes prescription drugs at no additional cost. It includes a standard 4 Tier Drug Formulary. This will allow you to have co-pays for your medications. In addition, you will have the option to add Dental, Vision and other benefits for an extra monthly cost. And lastly, the plan does include Silver Sneakers for those of you who like to stay active and go the gym. This coverage is at no additional cost. So to recap…you will have access to the Anthem PPO network, set co-pays, prescription drugs covered and great optional benefits! Now that is a value plan with an affordable cost to all Medicare beneficiaries in the available counties.
Source: blogspot.com

Candidate Direct Healthcare Staffing Blog

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 marsmet526Instead of opting for outright staff cuts to save money, many healthcare organizations are utilizing web-based Vendor Management Software to manage the flexible staffing solution that Riney relates above. VMS maximizes contingent employee management through the automation of the recruitment, administrative and operational functions that occur within multi-vendor staffing environments. Results include reduced recruitment agency spend, minimization of overtime hours, and reduced administrative time normally devoted to staffing functions. Savings to hospitals in relation to their contingent workforce are shown to be in the 15% range.
Source: candidatedirect.com

Video: Medicare Supplemental Insurance | Medicare Benefits Direct

Medicare supplement leads may be generated by direct mail campaigns

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

Doctors Fleeing Medicare, Moving to Direct Primary Care

Neil Sapin, a Glendale, Arizona, physician, charges less, about $1,500, but has a larger practice. He used to run himself ragged trying to keep up with the flow of patients necessary to cover all the expenses of his practice: “I used to see 18 patients per day, but [over time] I’m up to 24 or 25. It [became] difficult to give people as much time as I’d like to.” So he went private, dropping his workload from 1,600 patients to just 500. His patients have access to him any time of day or night and they can access their medical records from a home computer at any time and send him questions about their health via e-mail. Sapin says this allows him to spend more time with those who need him, and he also has time “to stress preventive health and dietary counseling.”
Source: wordpress.com

Fixing Medicare With More Direct

As I’m sure you remember, when the Senate passed the Medicare bill in 1965, President Lyndon Johnson said, "We have proved, once again, that the vitality of our democracy can shape the oldest of our values to the needs and obligations of today." Now that you’re 47, it’s time we start thinking about the needs and obligations of a new day. When we think of the health care system, we should be thinking about how to better care for everyone in it — including workers.
Source: aarp.org

Nothing found for 2013 01 Texas

“Hi Brittany, I just wanted to let you know that I received my confirmation for approval. Thank You for all you help and time you spent in listening to what I was needing and explaining the differences in plans you had available for me. Your help made this process very easy and everything ran smoothly. Thank you again for all your help. Sincerely, “
Source: texasmedicarehealth.com

Medicare’s Reset On ‘Coverage With Evidence Development’

Posted by:  :  Category: Medicare

House Republican Press Conference on Health Care Reform by House GOP Leadera. Centers for Medicare and Medicaid Services (CMS) issued formal guidances on CED in 2005 and 2006. Several cases that we call CED predate these formal guidances. b. CMS, “Positron Emission Tomography (FDG) and Other Neuroimaging Devices for Suspected Dementia” (accessed on Feb. 28, 2013). c. Cancer types include brain, cervical, ovarian, pancreatic, small cell lung, and testicular. d. CMS, “Positron Emission Tomography (FDG) for Brain, Cervical, Ovarian, Pancreatic, Small Cell Lung, and Testicular Cancers” (accessed on Feb. 28, 2013). e. American College of Cardiology National Cardiovascular Data Registry (ACC NCDR) (accessed on Feb. 28, 2013), approved in 2005, is ongoing with collection of longitudinal data. f. CMS, “Chemotherapy for colorectal cancer” (accessed on Feb. 28, 2013). Nine NCI trials are investigating one or more off-label use of oxaliplatin, irinotecan, cetuximab, or bevacizumab. 2 trials remain closed; 6 trials are permanently closed to new accruals and 1 trial has been temporarily suspended. g. CMS, “Home use of oxygen“ (accessed on Feb. 28, 2013). Long Term Oxygen Trial (LOTT) began in late 2007. h. CMS, “Artificial Hearts” (accessed on Feb. 28, 2013), 3 Trials are ongoing. i. CMS, “Positron Emission Tomography (FDG) for Solid Tumors”  (accessed on Feb, 28, 2013), National Oncologic PET Registry (NOPR) is ongoing. j. CMS, “Pharmacogenomic Testing for Warfarin” (accessed on Feb. 28, 2013), 2 Trials are ongoing. k. CMS, “Positron Emission Tomography (NaF-18) to Identify Bone Metastasis of Cancer” (accessed on Feb. 28, 2013), National Oncologic PET Registry (NOPR) is ongoing for performing FDG and NaF-18 PET. l. CMS, “Allogeneic Hematopoietic Stem Cell Transplantation (HSCT) for Myelodysplastic Syndrome” (accessed on Feb. 28, 2013), 1 Trial is ongoing. m. CMS, “Magnetic Resonance Imaging (MRI)” (accessed on Feb. 28, 2013); CMS site mentioned ClinicalTrials.gov identifier of NCT 090736, but it was not found on ClinicalTrial.gov website. n. CMS, “Transcatheter Aortic Valve Replacement (TAVR)” (accessed on Feb. 28, 2013), 6 Trials and 1 Registry are ongoing.
Source: healthaffairs.org

Video: What is a Medicare health insurance exchange?

MEDICARE CHIROPRACTIC COVERAGE

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Source: biltmoreparkchiropractic.com

Why today's seniors object to the dissolution of Medicare

Privatization / corporatization of health care in the U.S. is the reason why our health care is prohibitively expensive, and can boast of only mediocre outcomes, at best. Nowhere else in the industrial world do citizens find themselves going bankrupt over medical care, and most industrial countries achieve substantially better health outcomes, and at lower cost, than we do. All Mr. Ryan’s plan will do is perpetuate our current dysfunctional system, with CEOs of health insurance companies being paid 7-figure salaries while nameless clerks deny coverage and the people they ostensibly “serve” find themselves having to choose between paying for food, or the mortgage, or clothing on the one hand, and paying off that hospital or doctor bill on the other, knowing that the “non-profit” hospital or physician may well take them to court if they choose to eat rather than pay for medical care.
Source: minnpost.com

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

More than 40,000 Seniors Have Contacted Congress to Oppose CMS’ Proposed Cut to Medicare Advantage

CMS recently proposed a 2.2 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 cut compounds the hundreds of billions of dollars in Medicare Advantage cuts and new health insurance tax on Medicare Advantage policies included in the Affordable Care Act (ACA).  A recent report from Oliver Wyman estimates that the cumulative impact of these cuts and the new health insurance tax will result in an estimated 6.9 to 7.8 percent payment cut to Medicare Advantage plans in 2014, leading to benefit reductions and premium increases of $50 to $90 per month for a typical Medicare Advantage beneficiary.  New Oliver Wyman data provide a breakdown of how much seniors will be impacted in specific states.
Source: ahipcoverage.com

How Medicare Could Fix U.S. Healthcare

Doctor  and hospital problems:  Medicaid, the state-federal partnership program to pay for care for poor people, usually pays doctors and hospitals quite a bit less than the care actually costs.  Medicare, the program for older Americans, on the other hand, pays what it figures a really efficient operation should cost; that is, less than most hospitals and doctors feel they should get. These unpaid costs are shifted to private insurance, which pays much more than the cost of the care that its policy holders get. But though they are paying much more than the care costs, health insurance companies insist that their policy holders get a “discount.” Therefore hospitals charge people without insurance even more. The uninsured pay the most, perhaps twice as much as insured patients and three or even six times the cost of their care. The result of all this cost shifting has to come together in an operation that ends up in the black.
Source: dailyyonder.com

Medicare Health Insurance Sup Related Articles

Their schemes offer regions to various systematic expenses either in some measure or fully depending on type of insurance plans. The policies offer insurance policies coverage to deductible amount and also on the way to coinsurance amount in order to paid by the most important Medicare recipients. Some of them policies cover educational costs related to elderly care and hospital bills or amount needed for certain major surgical treatments. The services of these procedures may be when limited periods perhaps by considerable amount or infinite amount. Now these types of an insurance plan schemes are available in other countries and also.
Source: espaigessap.com

Health Law, Medicare Benefit Design Draw Congressional Attention

Medpage Today: Link Medicare Copays, Quality, Congress Told Medicare should be allowed to vary patient copays so that beneficiaries pay less for higher-quality, higher-value services, health reform experts told Congress Tuesday. Lawmakers should give Medicare the flexibility to charge patients more or less depending on the relative value of that service, experts told the House Ways and Means Health Subcommittee in a hearing examining Medicare’s benefit design. For example, diabetic patients should have lower copayments on eye exams than nondiabetic patients. … On Wednesday, the Senate Special Committee on Aging will examine ways to reform Medicare’s delivery models without reducing benefits. The Senate Finance Committee will hold a similar hearing on Thursday (Pittman, 2/27).
Source: kaiserhealthnews.org

The Real Story on Social Security and Medicare “Entitlement’s” …

By his point that evening, the president was referring to the widespread and incorrect view, especially among older Americans, that Medicare recipients get only what they have paid for through taxes, premiums and medical co-payments. Now that misperception is making it all the harder for politicians to consider trimming those benefits or raising out-of-pocket expenses as they seek to restrain Medicare spending that is rising unsustainably while baby boomers age and medical prices increase.
Source: politicaldog101.com

Medicare Health Plans and Dually Eligible Beneficiaries: Industry Perspectives on the Current and Future Market

The brief is based on interviews with senior executives at 13 large firms that contract with the Medicare and Medicaid programs and finds almost all of the insurers expect dually eligible beneficiaries will become more important to their business over time. The brief also looks at how insurers currently serve dually eligible beneficiaries, particularly through Special Needs Plans that are part of the Medicare Advantage program.
Source: kff.org

Medicare vs Medicare Advantage

Posted by:  :  Category: Medicare

319 | Tragedies of Medicine by The DoctrFor Part A and Part B of Medicare, members must pay 20% of costs out-of-pocket. For inpatient hospital visits, members must pay a $1,184 deductible for the first 60 days, and then $296 coinsurance per day until day 90. After day 90, members can have another 60 days at $578 per day in their lifetimes, after which they must pay all costs. The Part B deductible is $140 per year. Those who have Part D (prescription coverage) must also pay an average deductable of $325. After the deductible has been paid, members may either have a co-pay program, where they pay a flat fee for each drug, or co-insurance program, where they pay a percentage of the cost. However, members may face the “doughnut hole”: after the total cost of drugs exceeds $2,970, members must pay 47.5% of the cost of brand-name drugs and 79% of the cost of generic drugs. Once the cost of drugs has exceeded $4750, Medicare kicks in again, with 95% of drug costs covered.
Source: diffen.com

Video: Compare Medicare Supplements-Medicare Supplements Compared

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

What 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

What Is Medicare Part D Insurance?

The amounts differ from year to year. There is a deductible at the beginning of each calendar year. Currently it is a maximum of $320.00. Not all prescriptions are covered by all plans. There are co-pays for prescriptions. Your Medicare Part D Insurance covers your prescription costs until you reach $2,930.00 in expense, the “Donut Hole” you will pay your prescription costs until you reach $4,700. Beginning in 2012, while you are in the “Donut Hole”, the manufacturer pays 50% of the cost of name brand drugs and 14% of the cost of generic drugs and you pay the remaining 50% or 14%. Choosing the Right Plan is Important
Source: seniorcorps.org

Interactive Chart: Medicare Spending At Individual Hospitals

The cost is also expressed as a ratio to the median amount Medicare spent per patient nationally (“Efficiency Index”). A result of 1 means Medicare spends about the same per patient at that hospital as it does per patient nationally. A result higher than 1 means that Medicare spends more per patient than the median. A result below 1 means that Medicare spends less per patient than the median. To allow for fair comparisons, Medicare adjusted its figures to take into account the health and diagnosis of patients and other factors.
Source: kaiserhealthnews.org

Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals

Many of the budget proposals and debt-reduction plans being considered by Congress and the Administration include proposals that would achieve substantial savings from the Medicare program over time. This brief features a side-by-side comparison of the key Medicare provisions in four major budget and debt-reduction plans:
Source: kff.org

We need Medicare for All (HR676): Health Care Comparison Chart of Countries

Girl on fire! (That’s me!) I was inspired to create a website so that I could point people who want to learn about single payer and HR676 to one website to access all the sites that I have found useful. Blogging seemed the easiest way to do that. And then I thought, I do want to actually blog too! I’ve been really active on this issue, and I want to share my experiences and thoughts and information that I find fitting as I find it. You can email me at kimberish@yahoo.com
Source: blogspot.com

Understanding Medicare Coverage in Rehabilitation.

Posted by:  :  Category: Medicare

OBAMACARE WATCH:....THE PUSH IS ON, ........THEY WILL CONTROL WHAT YOUR DOCTOR KNOWS AS WELL AS WHAT HE OR SHE TREATS by SS&SS24 Hour Availability of a Registered Nurse Examples of nursing documentation reflecting such care may include: •Progress in bowel and bladder continence. •Skin Integrity issues, including positioning techniques •Ongoing assessment of nutritional or hydration status in patients •Ongoing assessment of safety concerns, including physical and cognitive/perceptual concerns •Educational interventions with patient and/or family including: oTracheostomy care oTube feedings oCatheterization oMedication and potential side effects oBowel bladder programs oDischarge planning
Source: helenhayeshospital.org

Video: Medicare Audit Guidelines for Chiropractors – Subsequent Visits

Purchasing The Medicare Supplement Guidelines Have Become A Necessity

For some supplemental policies there are many health insurance avenues in the form of plans. Some of the Medicare supplemental programs are easily formulated and are in order to meet the different needs of somebody. Some of these plans include the medical Maintenance Organization (HMO), the Preferred Provider Organization (PPO), Medicare insurance Special Needs Plans, Programs of All-inclusive Care for folks of any age (PACE) and Sensitive Fee for Company (PFFS). For quick identification, the first four are restricted in the levels section. Through the types section, built commonly referred you can as the Medicare health insurance Advantage Plans. These plans have always been managed by the individual companies but specific by the Us government. The most common plans would be the HMO and specific PPO.
Source: geocubes.com

Medicare’s Decision on Whether to Cover Amyloid Brain PET Scans

As a clinician, I see great benefits not only in being able to accurately inform my patients about the cause of their cognitive impairment, but also being able to tell a patient with MCI that he or she does not have amyloid in the brain—that is, not on the path towards Alzheimer’s dementia. In these cases, we would initiate other studies as part of the work up to evaluate the cause of the patient’s cognitive impairment. In fact, just one day prior to the Medicare advisory panel meeting, the Alzheimer’s Association and the Society for Nuclear Medicine published guidelines specifying in which patients amyloid scans would have the greatest impact on outcome.
Source: alz.org

Quality, not quantity of care new criteria for Medicare reimbursement

“The Hospital Value-Based Purchasing Program is one of a host of Affordable Care Act programs that put patients at the center of the Medicare system,” stated Medicare on the organization’s blog. “We’ve known for a long time that when Medicare paid providers based on how much work they did and not on how well they did for patients, too often patients got services and tests that didn’t improve their health.  Providers already must publicly report the steps they take to provide quality care to Medicare beneficiaries; Hospital Value-Based Purchasing gives these efforts additional teeth.”
Source: voxxi.com

Boris Casada’s blog on Netlog

If you’re looking for help for an ill family member, have you considered palliative care? Palliative care is a type of healthcare that focuses on preventing and/or relieving the suffering of patients. It doesn’t postpone death, but it doesn’t hasten death either. While affirming life, this type of care also acknowledges that death is a natural process. Palliative care is similar to hospice care in that it focuses not just on the physical needs of the patient, but also addressing the social, emotional and spiritual needs of the patient, and even provides for the needs of the family if required. However, palliative care differs from hospice care in that hospice attends only to those with a life expectancy of six months or less, while palliative care can be given to patients with any type of illness, even curable diseases or chronic but livable illnesses. A large part of the goal of this type of care is to allow the patient to live as normally as possible until death or recovery. Hospice care always involves palliative care, but palliative care need not always be hospice care. Similarly, a palliative medicine is that which does not cure the disease but relieves the symptoms. The diseases that can be treated through palliative care include Alzheimer’s, AIDS, cancer, kidney failure, and heart failure, among others. It addresses symptoms such as pain, loss of appetite, difficulty sleeping, fatigue, nausea, constipation, and shortness of breath. This type of care can be received in conjunction with procedures designed to prolong life, such as chemotherapy or radiation theory. The two concepts are not mutually exclusive. Palliative care can even include investigations by health care providers intended to learn how to better treat difficult clinical needs of the patient. Palliative workers aren’t necessarily just doctors. For true palliative care, doctors work hand-in-hand with family members and friends, social workers, nutritionists, pharmacists, massage therapists, and chaplains or other religious leaders. Palliative care helps the patient understand his or her treatment options, and helps patients work towards their goals, whether it’s towards recovery or towards acceptance of the terminal illness. In the latter case, the palliative workers will do whatever is necessary to help the patient(s) get their affairs in order, including financial, emotional, spiritual, and familial. Patients can talk to counselors over the grief caused by their illness, or get such help as (for instance) having someone get a wig for them if they’re undergoing chemotherapy. Through palliative care, the patient receives help understanding and working through the healthcare system, and help making decisions regarding numerous possible treatment choices, in addition to treatment of pain and other symptoms, emotional support, and allowing time for close family communication. Palliative care is an expanding field but a relatively new field. According to Diane Meier, MD, director of the Center to Advance Palliative Care at Mt. Siani School of Medicine in New York, "The vast majority of America’s medical schools have palliative care programs and are teaching medical students and residents about palliative care. That didn’t occur 10 years ago. There was literally no education occurring on the topic." Fortunately, you and your ill family member have more options available to you than in the past. For more information, consult your family physician. In need of a little more details about Hospice Care? Visit [url=]brightstarcare.com/west-metro-minneapolis/[/- url] to get one of a kind home care that fits your preferences.
Source: netlog.com

Comparing Medicare Supplemental Insurance Benefits

Posted by:  :  Category: Medicare

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

Video: Medicare Supplemental Insurance Comparison

Medicare supplemental insurance comparison

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Source: insurance-auto.tk

Greatest Medicare Supplement

You be capable of comprehend proficient assistance to equate Medicare Supplement campaign from the Medicare scheduling players at MediGap Advisors. With time of come into contact with in Medicare Supplement cover, these experts distinguish Medicare Supplement campaign and the insurers donation them. Just phone call MediGap Advisors at 866-681-7712 to comprehend the answers you ought and locate the greatest Medicare Supplement campaign. MediGap Advisors be capable of assistance you individual all through the 10 Medicare Supplement campaign now accessible by comparing your post and requests to the reimbursement of apiece map. Theyll withstand a air at your largest shape bother expenses and present you the greatest Medicare Supplement campaign to safeguard you from charges that Medicare doesnt envelop.
Source: manchuheart.net

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

With Medicare Plan Medicare Supplement Plans Are Also Needful

People may ask yourself why there is actually an open enrollment period if you do not have to be able to enroll during that time. The great benefit to enrolling through open enrollment might be the fact you are able to avoid physical underwriting. Simply put, medical underwriting is done when insurance companies try to gather information on your company past and existent health history that you just can to potentially raise your monthly prime amount. However, if you were to enroll over the course of the open enrollment period, insurers typically be allowed to use that in contrast to you. An individual are only open to medical underwriting if you enroll outside of which will allotted time stage. The open enrollment year or so lasts for six months from that date of your amazing Medicare enrollment about both Part A major and Part B.
Source: wordpress.com

Compare Medicare Supplement Insurance Plans

This is the basic plan. Its coverage includes: Medicare Part A coinsurance, Medigap coverage for hospital benefits, Medicare B coinsurance, Medicare B copayments, first three pints of blood, Part A hospice care coinsurance or copayments, and Medicare preventive care Part B insurance. By law, all Medicare Supplement insurance carries must offer this plan.
Source: ihealthcoalition.org

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

Medicare Supplemental Insurance

The best time to sign up for a policy is within six month of turning 65 and enrolling in Medicare Part B. This is the Medigap Open Enrollment period. During this timeframe, you cannot be turned down for coverage. There is also no health screening. The policy must cover all pre-existing health conditions at the same premium that a healthy individual would pay. In other words, someone who has been a pack a day smoker for the past 25 years is going to pay the same amount for their plan that a non-smoker would pay, even though in reality they are a much bigger health risk.
Source: gkec.org

Guarantee Issue Medicare Supplement

It is extremely hard to make a blanket statement response to your question… Ultimately the answer varies from company to company and even from state to state with each given company. Also, it depends on what type ‘GI’ case you’re referring to. I don’t know that this response really answers your specific question, but I wanted to at least qualify the responses that you do get. It’s always important to check with each carrier on how they consider each individual case/situation. Senior Market Design, Inc 888-495-8038
Source: insurance-forums.net

SAVE MORE MONEY ON YOUR MEDICARE SUPPLEMENT

If you are turning 65, we do a comprehensive Medicare comparison package for you of BOTH your doctor and hospital coverage and your Part D drug plan.  Also, if you get a letter from your Medicare Supplement (doctor and hospital coverage) stating they are going UP in price, we can help you IMMEDIATELY! You can change your Medicare Supplement any time of the year!  All you need to to is call 866-752-1795 or fill out the comparison form.  Remember, you cannot change your Part D plan until October 15th to December 7th of each year.  However, your Medicare Supplement can be changed to save you money all year long! We look forward to assisting you.
Source: mypartdusa.com

FTD/Dementia Support Blog: FTD and Medicare

Posted by:  :  Category: Medicare

Now that I was off the 17 pills a day after being misdiagnosed for six years my head was slowly clearing from being kept in a medically induced fog. It took me close to a year to recover to my FTD self. My behavior, language and 6 year history was like a checklist for a poster boy FTD patient.  I was having many new difficulties which was discovered by my friend David and Dr. Blatt to have been side effects of the only drug I was on, Aricept. Dr. Blatt had contacted Dr. Ted Huey, a well known FTD specialist at Columbia. Dr. Huey confirmed that many FTD patients were having difficulty with Aricept, a drug made for Alzheimer’s patients. Aricept is now on the “medications to avoid” list by UCSF. Dr. Blatt suggested that I start seeing Dr. Huey or one of the FTD specialists at Columbia. The only problem was my insurance didn’t cover Columbia or any of the doctors in it.
Source: blogspot.com

Video: Fidelis Care Training and Opportunity!

Medtronic Settles Sprint Fidelis Family of Defibrillation Leads Lawsuits

Under the terms of the agreement, Medtronic has agreed, subject to certain conditions, to settle U.S. lawsuits and claims pending as of October 15, 2010 for a total payment of $268 million.  The payment includes an amount for attorneys’ fees and administrative expenses.  The parties will file joint requests to terminate the Multi-District Litigation (MDL) and Minnesota state court proceedings related to the Sprint Fidelis leads and to dismiss the plaintiffs’ appeals pending before the U.S. Court of Appeals for the Eighth Circuit and the Minnesota Court of Appeals. The parties will also request dismissal of other Fidelis-related cases throughout the country. Medtronic can cancel the agreement if certain conditions are not met, and the agreement can be terminated by either party if the MDL proceedings are not terminated.
Source: gustafsongluek.com

What is your stance on the Patient Protection and Affordable Care Act?

One week after the Supreme Court’s 5-4 ruling, one public opinion poll reported that 54% of American voters wanted the law repealed. MDLinx surveyed U.S. primary care physicians after the court ruling and found 64% of the physicians do not believe the Affordable Care Act will be able to achieve 100% effectiveness of health care coverage for Americans. The MDLinx survey revealed that 45.7% of primary care physicians are skeptical of the decision, whereas only 22% think the act will result in an extremely positive impact for their practices. However, KevinMD’s physician blogger Kevin Pho, M.D., stated that the court decision is one everyone should be happy with. Physicians can expect lower Medicare and Medicaid reimbursements. KevinMD also states the benefits of for patients, not only uninsured but also those most vulnerable in the U.S. He suggests that the benefits will be tangible for more than just progressive Americans.
Source: fidelismp.com

Medtronic Sprint Fidelis: Four Have Died During Extractions

Two years after Medtronic stopped selling the vilified Sprint Fidelis lead, there is a growing concern as to its continued viability—and while Medtronic and the medical community in general recommend not replacing working leads unless they fail, some doctors are doing just that. The problem lay with the tricky surgery necessary to extract a lead, a procedure that is fraught with risk. A heart lead will often be overgrown, or entwined with tissue. Thus, removing a heart lead—regardless of whether it is a working lead, or one that has proved to fail—is an exact and dangerous procedure that can’t be done by just anybody. In other words, the successful removal of a heart lead will be accomplished by a surgeon with a great deal of experience doing just that. Sometimes, surgeons with those qualifications are hard to come by. Medtronic had a hit on its hands when the Sprint Fidelis lead was first introduced onto the market in 2004. Thinner than its competitors, surgeons found it easier to thread to the heart and it wasn’t long before a quarter of a million people around the world were walking around with Sprint Fidelis leads. In the US, that figure is around 150,000. But then came the failures. The Sprint Fidelis lead was found to be prone to cracking, which affects the communication pathway to the heart. In the case of a defibrillator, this breach has resulted in a failing heart not getting the proper electronic prompting it needs to get it going again. Worse, there have been cases where such a breach in the wire has resulted in the defibrillator getting an incorrect signal, and thinking that the heart was failing, delivered a life-sustaining electrical pulse to what was in reality a properly-functioning heart. Some patients have died. Others have had their health compromised after a pacemaker, connected to a Sprint Fidelis lead, was incapable of helping the heart maintain a correct rhythm. Medtronic has said that the failure rate is about 5 percent, 45 months into the life of a lead. And even though many patients are finding that their leads are, indeed functioning properly, many patients who cannot live with the prospect of the lead potentially failing are opting to have them replaced proactively. “I think we are just seeing the tip of the iceberg,” said Dr. Charles J. Love, a cardiologist at Ohio State University Medical Center in Columbus, who specializes in cable extractions, in comments published in the New York Times. However, as more and more patients opt for the risky procedure, the death toll may rise given the inherent risk to the heart and / or arteries when an extraction is attempted. Already, four patients have died during extraction procedures, and industry watchers fear that those numbers will rise as more patients seek extractions from a medical community that has limited expertise in the risky extraction process. The risk is such that many surgeons, when replacing a heart lead, will often leave the old lead in place—threading the new lead alongside. There are diverging opinions and positions as to what to do when a pacemaker, or defibrillator itself needs to be updated once the batteries wear out, usually after five years. Some surgeons will reconnect to the existing Sprint Fidelis lead if it is still functioning. Others, including Dr. Love in Ohio State, are routinely replacing the Sprint Fidelis leads when pacemakers or defibrillators are in need of updating in younger, more active patients. Typically, those patients are age 60 years of age or lower. The reason? Greater physical activity places more stress on a cable, which raises the likelihood of fracture. Critics of the Sprint Fidelis lead cite that very fact as to why, in part, the lead should never have been approved in the first place. As the baby boomers age, the country is seeing a more active senior. Using a thinner lead in concert with an active individual—heart problems aside—just doesn’t seem to make a lot of sense.
Source: lawyersandsettlements.com

Fidelis adds urological surgeons to network

Fidelis Care, the New York State Catholic Health Plan, has added Capital Region Urological Surgeons PLLC to its provider network.   Capital Region Urological Surgeons, with 13 physicians and 2 nurse practitioners, has been providing urologic care in the Capital Region for nearly 30 years. The group’s specialties include urologic oncology, prostate disorders, kidney stone therapy, infertility, urinary incontinence and female urology. Offices are located in Albany and Saratoga Springs.
Source: timesunion.com

UPDATE: Medicare Revalidation: What FQHCs Need to Know

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522after such providers or suppliers receive notification from their MAC.  Once contacted by a MAC, suppliers and providers have 60 days from the date of the letter to submit complete enrollment forms. Please note that failure to submit the enrollment forms as requested may result in the deactivation of Medicare billing privileges. Additionally, the $505 Medicare enrollment fee that we told you about here also applies to revalidation.
Source: nachc.com

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

Medicare Payments to Providers Are Carved, Sliced and Chopped by Sequestration

CHOPPED – Sequestration will have a huge impact on healthcare chopping up reimbursements. Now more than ever before, providers must look for every dollar of reimbursement they can find. In most cases, the low-hanging fruit has already been picked. Today, forward thinking healthcare executives must move quickly to make the decisions which will positively affect reimbursements. Investments in brand new technologies and reinvented processes, which offer an ROI of less than 12 months will be the most attractive moves executives can make. There are several “Blue Diamond” technologies entering the marketplace every day. These new avenues for reimbursement recovery are available to help offset the reimbursements that has been carved up, sliced off and hacked to pieces by sequestration.
Source: healthworkscollective.com

Hospitals brace for sequestration

“Colorado is now seeing a greater health care cost shift due to Medicare underpayment than Medicaid — a situation that was unthinkable to many just a few years ago,” Summer said. “This is especially disturbing given the expected increase in Medicare patient volume due to retiring Baby Boomers. Paying hospitals less and less for seeing more and more Medicare patients is unsustainable in the long run, and will inevitably result in higher health care costs for the privately insured.”
Source: csbj.com

$48 Million Medicare Fraud Bust: Identity Theft Rampant in Ohio

“It’s really important that CMS really screens folks coming in the program,” Saccoccio said. “They’re doing a better job of that, but I think it’s going to take a little time before the effects of that are as apparent as they should be. The extent you can get to this stuff earlier rather than later is better.”
Source: medicarewire.com

Tips for Responding to a Medicaid Audit

The Agency for Health Care Administration (AHCA), Office of Inspector General (OIG) and Bureau of Medicaid Program Integrity are the Florida agencies responsible for routine audits of Medicaid health care providers to ensure that the Medicaid Program was properly billed for services. Health care professionals receiving the greatest amounts of Medicaid payments are also the ones most likely to be audited. These include pediatricians, Ob/Gyns, family practice physicians and dentists. The Medicaid audit usually requests information in a questionnaire that the medical practice is required to complete, as well as a request for copies of medical records (including x-rays and other diagnostic studies) on the list of Medicaid patients selected for the audit.
Source: wordpress.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaThe 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 Make Money Distributing Free Prescription Drug Discount Cards

Medicare: Definition from Answers.com

Program enacted in 1965 under Title XVIII of the Social Security Amendments of 1965 to provide medical benefits to those 65 and older. The program has four parts in 2007: 1. Part A, Hospital Insurance, contributes to the payment of inpatient hospital, skilled nursing expenses, hospice, and other ancillary expenses. The deductible is $992 for 60 or less days in a benefit period. For days 61–90, the deductible is $248 per day, and for more than 90 days, the deductible is $496 per day up to the lifetime maximum days. No premium is paid if the beneficiary has at least 40 quarters of Medicare covered employment. 2. Part B, Medical Insurance, provides coverage for medical services that Part Adoes not cover for a premium and subject to a deductible ($93.50 per month standard premium and a deductible of $131 per benefit payment in 2007). Coverage includes ambulance services, ambulatory surgery center, blood, bone mass measurement, cardiovascular screenings, limited chiropractic services, clinical laboratory services, clinical trials, colorectal cancer screenings, diabetes screenings, diabetic supplies, doctor services, durable medical equipment, emergency room services, limited eyeglasses, flu shots, foot exams and treatment, glaucoma tests, hearing and balance exam, Hepatitis B shots, home health services, kidney dialysis services and supplies, mammograms, medical nutrition therapy services, outpatient mental health care, occupational therapy, outpatient hospital services, outpatient medical and surgical services and supplies, pap test and pelvic exam, one-time physical exam within the first six months, physical therapy, pneumococcal shot, practitioner services, limited prescriptions (injectable drugs), prostate cancer screenings, prosthetic/orthotic items, second surgical opinions, smoking cessation, speech-language pathology services, surgical dressings, telemedicine, tests (X-rays, MRIs, CT scans, EKGs, and other diagnostic tests), transplant services, and urgently needed care (nonmedical emergency illness or injury). The initial enrollment period for Medicare Part B begins three months before age 65 and continues for the next seven months. If enrollment is not effected in this time period, there is a waiting time until the general enrollment period from January 1 through March 31 every year. Coverage then begins the following July 1. 3. Part C, Medicare Advantage, provides for individuals with Part A and Part B coverage to receive all of their health care coverage through a single health care provider. See also medicare plus choice (medicare part c). 4. Part D, Prescription Drug Insurance, contributes to the payment of medication/prescription expenses as prescribed by a physician. Coverage added for drugs by joining a Medicare Prescription Drug Plan through private insurance companies. A separate monthly premium (varies by plan) is required. Each plan must cover at least two drugs in all of the classes of drugs that are the most commonly prescribed. For those people covered under Medicare A, coinsurance or copayment is required and a yearly deductible may be in force. Retired workers qualified to receive Social Security benefits, and their dependents, also qualify for the hospital insurance portion. The program is paid for by payroll taxes on employees and covered workers. Parts B, C, and D insurance provides additional coverage on a voluntary basis for physician services. The Prescription Drug Plans are optional and can be added by paying an additional premium. Those enrolled in the program pay a monthly premium. Coverage is also available to persons younger than 65 who are disabled and have received Social Security disability benefits for 24 consecutive months.
Source: answers.com

Smart card plan proposed to combat Medicare fraud

Introduced by Senators Mark Kirk (R-Ill.) and Ron Wyden (D-Ore.) and Representatives Jim Gerlach (R-Pa.) and Earl Blumenauer (D-Ore.), the legislation would require the issuance to all Medicare beneficiaries of an upgraded, secure identity card–stripped of its current Social Security number identifier–that is similar to the Department of Defense’s Common Access card. This “smart card” would have a computer chip embedded in it with identifying information about the patient and the patient’s provider.
Source: fiercehealthit.com

American Counseling Association Weblog

When I was my son’s age (I swore I’d never use the “walking to school uphill in the snow” routine when I got older!) I would have jumped in excitement at the site of any Spiderman cartoon. But there weren’t any available. Instead, I had to settle for Super Friends on Saturday mornings. And I waited every week to see that show! It didn’t matter what super hero was featured that week, or if it was a repeat. With three stations to choose from I was happy to watch whatever cartoon was put in front of me. Not so with my oldest son. He has choices, and a whole lot of them.
Source: counseling.org

How To Learn More About Medicare

The reason I say this is because the internet is a great place to learn just about anything. In order to be an educated insurance owner, you need to learn about Medicare as soon as humanly possible. Am I saying that you need to know everything, everything about Medicare, no, but you should know as much as you can about the Medicare policy that you own. Another thing that you can do to learn more about Medicare is to call the number on the back of your Medicare card. A lot of people don’t understand what this phone number is really for and that is actually why Medicare put the number on the card. For example, lets say you need to go to see a medical specialist but don’t know if your Medicare policy covers it. All you have to do is quickly call the number on the back of the Medicare card and you will be able to figure out that answer in no time at all. When learning about Medicare it would be a good idea to write down everything that you learn so that you don’t have to come back and try to figure all of this stuff out again. The problem with not knowing much about the Medicare policy that you have is that you might not utilize it on something that you really should have. For example, if you had a Medicare part b policy you would be covered if you had to purchase a Wheelchair or something similar to that. I understand that you might not want to take notes on what you just learned but it would be highly beneficial to you now and in the long run.
Source: sensitivehealth.com

How Medicare Supplement Plans & Medicare Advantage Plans Work

Posted by:  :  Category: Medicare

Old people read alone... by Ed YourdonWhen beneficiaries turn 65 and first become enrolled in both parts of Original Medicare, they fall into their six-month Medigap Open Enrollment Period (OEP), which starts the first day of the month they are both age 65 or older and enrolled in Part B. This may be the best time to buy a Medigap policy because if a beneficiary decides to enroll after this time, their options may be limited and they may have to pay more for coverage. At the same time, beneficiaries also fall into their Initial Enrollment Period (IEP), which runs for seven months starting three months before they turn age 65 and lasts until three months afterwards. During this time, beneficiaries can sign up for any MA or Part D plan that contracts in the county and state in which they reside.
Source: planprescriber.com

Video: Dave Hamilton Medicare Advantage Open Enrollment” Retirement Planner Jeff Vogan Mesa Tucson Arizona

Health Insurers Launch TV Campaign Opposing Medicare Advantage Cuts

The Medicare NewsGroup: Medicare’s Middlemen Await Word From CMS To Put In Play Sequesration Cuts Medicare’s middlemen, the companies that will carry out the administrative work of the automatic budget cuts set to hit Medicare providers on April 1, are waiting for directions from the Centers for Medicare & Medicaid Services (CMS) to put in play provider payment reductions. The updates to the payment systems will ultimately lead to $11 billion in reduced payments to hospitals, doctors and other health care providers for the remainder of fiscal year 2013. These middlemen are Medicare Administrative Contractors (MACs), the private companies that handle the bulk of the entitlement program’s administrative claims processes. They will implement the 2 percent across-the-board payment reductions, mandated by sequestration, which is the result of the federal government’s inability to reach a deficit-reduction deal totaling $1.2 trillion. This means a .02 cent cut for every $1 paid to health care services providers, such as doctors, hospitals, skilled nursing facilities, insurers, medical device suppliers and home health companies (Sjoerdsma, 3/6).
Source: kaiserhealthnews.org

Seniors Speak Out Against Medicare Advantage Cuts in AHIP’s New TV Ad

Current discussions about the impact on seniors of the ACA’s $200 billion in cuts to Medicare Advantage have largely ignored the fact that only four percent of those cuts have gone into effect through the end of 2012. The Congressional Budget Office (CBO) projects that, when fully phased in, these cuts alone will result in three million fewer people enrolled in the program. In addition, Medicare Advantage enrollees also will be impacted by the new health insurance tax established by the ACA that starts in 2014. Oliver Wyman previously estimated that this tax alone will result in seniors facing $220 in higher out-of-pocket costs and reduced benefits next year and $3,500 in additional costs over the next ten years.
Source: ahipcoverage.com

CMS Announces Medicare and Prescription Drug Rates for 2014

Today, the Centers for Medicare & Medicaid Services (CMS) issued the 2014 rate announcement and final call letter for Medicare Advantage (MA) and prescription drug benefit (Part D) programs. The announcements set a stable path for Medicare Advantage and implement a number of policies designed to improve payment accuracy. Health care spending has been slowing across the nation, with Medicare spending per beneficiary growing at only 0.4 percent per capita in 2012. For the first time since inception of the Part D program, the deductible for the defined standard plan will be lower in 2014 than in previous years. Today’s guidance will give people in Medicare health and drug plans more value in the care they receive and greater protections against increasing costs.
Source: emaxhealth.com

CMS Softens Medicare Advantage Funding Changes

Another difference is the name change to MA was also part of the Medicare Modernization Act that introduced part D in 2006 at which time Medicare + Choice had only about 5 % penetration of the 40 million medicare beneficiaries enrolled compared to 2013 where MA has about 27% of the 50 million Medicare beneficiaries enrolled. I think many of the people who have stayed on original Medicare have done it because they are seniors and that’s what older people do – keep the policy they already have.They don’t need any new fangeled type of Medicare insurance.Most of the T65 I speak with are already aware of the 2 options they have for Medicare and want to know about both -unless they have been ambushed by a Banker’s Life agent first and told of the horrors of an MA plan. I believe the MA train has left the station and it is going to play a big part of how people get their Medicare for a long time.
Source: insurance-forums.net

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

2013 Medicare Advantage Plan Enrollment

While the political pundits argue that privatized Medicare insurance doesn’t work, the numbers tell a different story.  With ObamaCare focused on Medicare quality over quantity metrics to drive down insurance and healthcare provider costs, the gap between Original Medicare costs and Advantage Plan costs is narrowing.  The gap will close further in 2014. That’s when Medicare Advantage insurance carriers are required to spend no less than 85 percent of their insurance premium revenue on direct healthcare benefits.
Source: medicarewire.com

Medicare Advantage grows in size, percentage of total enrollment

Other issues are also playing a role in the growing popularity of Medicare Advantage plans. As larger hospitals and more well-known providers participate in managed care plans, individuals will be more drawn to Medicare Advantage plans, says Christina Frizzera, senior advisor with Leavitt Partners in Salt Lake City, Utah. For example, in Maryland, the entry of Johns Hopkins University and the University of Maryland Medical Center have served to make Medicare Advantage plans more popular in that region.
Source: modernmedicine.com

CMS Ensures Greater Value For People In Medicare Drug And Health Plans

Since enactment of the Affordable Care Act in 2010, Medicare Advantage enrollment is up by 25 percent while premiums have fallen. Medicare Advantage will remain a strong option for beneficiaries under the policies announced today. “The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,” said Jonathan Blum, CMS acting principal deputy administrator. After careful consideration of public comments, key changes and updates finalized in the Rate Announcement and final Call Letter include: • Lower Out-of-Pocket Drug Spending: As detailed in the table below, deductible and out-of-pocket limit for the defined standard prescription drug (Part D) plan, will be lower in 2014, compared to 2013. Beneficiary costs will be further reduced as coverage for Medicare enrollees who have reached the prescription drug coverage gap, or “donut hole” continues to expand in 2014. As a result of the Affordable Care Act, in 2014, enrollees in the donut hole will receive coverage and discounts of 52.5 percent on covered brand name drugs and coverage of 28 percent on covered generic drugs. To date, 6.3 million beneficiaries have received savings of $6.1 billion on prescription drugs. • Greater Protection for Beneficiaries: o As authorized by the Affordable Care Act, to protect enrollees in Medicare Advantage plans from significant increases in costs or cuts in benefits from one year to the next, the amount of any permissible increase to total beneficiary costs is limited to $34 per member per month for 2014 (down from $36 per member per month in previous years). o To avoid unnecessary and unwanted prescriptions being delivered and charged to Medicare enrollees because of “auto-ship” services, Part D plans will require their network pharmacies to obtain enrollee consent prior to each delivery, unless the enrollee personally requests the refill. CMS strongly encourages Part D plans to implement this consent requirement for the remainder of this year. • Payments to Plans o The final estimate of the combined effect of the Medicare Advantage growth percentage and the fee-for-service growth percentage is 3.3 percent. These growth rates assume a zero percent change for the 2014 physician fee schedule (PFS) by taking into account the likely Congressional override of the schedule physician payment reduction. o CMS will continue implementation of payment based on quality in Medicare Advantage. Over the last year, the number of four and five star plans has increased significantly, with 127 such plans in Medicare Advantage in 2013, 21 more than the prior year. o Other changes that are being finalized as proposed will continue the phased-in alignment of MA benchmarks with Medicare fee-for-service (FFS) costs, and adjust for diagnostic coding differences between Medicare Advantage plans and Medicare fee-for-service providers. • Improved Risk Adjustment Model: CMS will implement the proposed updated and clinically revised risk adjustment model which also limits opportunities for Medicare Advantage plans to be paid more for better coding improvements. As a transitional step, the risk scores for 2014 will be a blend of those calculated under the 2014 and 2013 models. • Improved Coordination of Care: In coordination with the Million Hearts initiative, plans are encouraged to improve access and adherence to anti-hypertensive medications by expanding their target enrollee populations for medication therapy management (MTM). Individuals who receive MTM may experience better blood pressure control, increased adherence to these vital medications, and better self-management of their medications and health condition. The 2014 statutory updates to the annual parameters for the defined standard Part D prescription drug benefit are finalized as proposed: Part D Benefit Parameters 2013 2014 Defined Standard Benefit Deductible $325 $310 Initial Coverage Limit $2,970 $2,850 Out-of-Pocket Threshold $4,750 $4,550 Minimum Cost-sharing for Generic/Preferred Multi-Source Drugs in the Catastrophic Phase $2.65 $2.55 Minimum Cost-sharing for Other Drugs in the Catastrophic Phase $6.60 $6.35 Retiree Drug Subsidy (RDS) Cost Threshold (Amount RDS sponsor must spend before claiming the RDS subsidy) $325 $310 Cost Limit (Amount after which RDS sponsor claims no RDS subsidy) $6,600 $6,350 (Note: The changes from 2013 to 2014 are rounded to the closest appropriate level.) The Rate Announcement and final Call Letter may be viewed using the following link: http://www.cms.hhs.gov/MedicareAdvtgSpecRateStats/, click on Announcements and Documents for access to the 2014 files.
Source: paramuspost.com

Medicare open enrollment: Will Obamacare end Medicare Advantage?

Should you be worried that Medicare Advantage plans will economize by reducing your benefits? “The plans are required to provide all Medicare benefits, so there’s no way they can cut them,” Gold explains. That includes the free preventive services added to Medicare by the Affordable Care Act. And Advantage plans that include a drug benefit are closing the doughnut hole just the same as stand-alone Part D drug plans. The only area where plans can even consider cutting back are for optional services such as dental and vision benefits, but the plan finder on Medicare.gov still features plenty of plans that have these bonus features.
Source: consumerreports.org

Annual Enrollment for Medicare Advantage (Part C) & Part D: October 15 – December 7 

Even beneficiaries who were satisfied with their 2012 plans need to review their plan options for 2013.  Part D and MA plans may have made changes to their coverage, provider networks and other plan features.[3] Plan information for 2013 will be available on the Medicare Plan Finder at www.medicare.gov.[4]  For the computer-savvy, the Medicare Plan Finder is an excellent plan comparison tool, allowing users to enter all their drugs and drug dosages, compare up to three plans at a time, save their drug information for later use, and actually enroll in a plan on-line.  This is the best – if not only – way to truly compare the many plans available to choose from.  People who cannot use the Plan Finder themselves may contact 1-800-Medicare, or their State Health Insurance Assistance Program (SHIP), for assistance with evaluating, selecting, and enrolling in a Part D plan.
Source: medicareadvocacy.org

OPINION: taking advantage of Medicare Advantage

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: publicintegrity.org