Obama’s Medicare Drug Rebate Plan Could Save The Government Money But Also Hit Drug Industry’s Bottom Line

Posted by:  :  Category: Medicare

SCOTUS Obamacare Decision Makes Individual Mandate A Fact & Universal Healthcare Coverage A Fiction by watchingfrogsboilThe Associated Press/Washington Post: A Look At How Administration Says Automatic Budget Cuts Would Diminish Government Services The sequester law exempts Social Security, Medicaid, food stamps and Medicare recipients’ benefits from cuts, but most programs are vulnerable. … The National Institutes of Health would lose $1.6 billion, trimming research on cancer, drying up money for hundreds of other research projects and eliminating up 20,000 private research positions nationwide. Health departments would give 424,000 fewer tests for the AIDS virus this year. More than 373,000 seriously ill people may not receive needed mental health services (2/15).
Source: kaiserhealthnews.org

Video: Medicare rebates for mental health problems

Obama Medicare rebate plan could hurt drug companies

“For most companies, it’s probably a couple of percent hit to earnings, which is something clearly negative for the industry but manageable,” said Barbara Ryan, a long-term pharmaceutical industry analyst, who now runs her own consulting firm. “Whether it could happen or not is another question, but it’s unequivocally going to be the hot potato that’s thrown around for the industry.”
Source: medcitynews.com

Part D Politics: Medicare Drug Rebates or Price Controls?

While health care was barely mentioned in the recent State of the Union address, President Obama generated some interest in his proposal to cut Medicare spending by reducing “taxpayer subsidies to prescription drug companies.” That’s code for requiring pharma marketers to pay rebates on medicines provided by Medicare Part D plans to low income “dual eligibles” who previously received prescription drugs through state Medicaid plans. Savings to Medicare are calculated at about $150 billion over ten years, and many Democrats and consumer advocates think it’s a great idea.  
Source: pharmexec.com

Health Insurance: Medicare Rebates and Private Health Insurance Cover for Osteopathic Treatment in Australia

If you want to commit an osteopathic treatment in Australia, it is important to know how your treatment will be covered by Medicare, the scheme of the government universal health care or private health insurance funds. Medicare One patient in Australia with a chronic disease (eg, a condition long musculoskeletal system), which is overseen by a family physician, is entitled to Medicare for up to five sessions of osteopathic treatment in a calendar year, such as by an osteopath with the Osteopathy Board of Australia are registered. However, there are certain conditions that can be applied in the order for a patient to be eligible for the rebate. First, the treatment must be an osteopath from a chronic disease management MBS physician services provided to the patient and the patient’s GP Management Plan (GPMP) and the detention orders are recommended. Team (ATC) A reference GP is necessary for a referral form, which is provided by the Australian Department of Health and Ageing, this form must be submitted to the osteopaths the first treatment. After all five sessions have been committed, if further treatment is necessary, a new benchmark GP is required. Second, if more than five sessions of osteopathic treatment is undertaken, the following sessions are not covered by Medicare. Third, the osteopath needed a reference GP written report. Usually at the end of treatment that provide detail the proposed treatment, tests or analyzes and plans for the future management of the patient A patient who has private health insurance, chose not to seek a guarantee that their osteopathic treatment, but to their Medicare claims is also entitled to the cost of five treatments each year civil claim above conditions are provided fulfilled. Private health insurance Osteopaths in Australia as allied health professionals are a patient with osteopathic treatment required by their private health insurance does not start treating doctor’s recommendation. Generally have a private health insurance either a form of collateral or Extras: right of a patient to a specific number of sessions of osteopathy during the calendar year, depending on the amount of coverage, or to pay a contribution towards the cost of osteopathic treatment, to for an agreed amount. However, it is important that patients check with their health insurance, that osteopathic treatment is covered in her special diet, and other expenses that they can be held accountable. It is also important that patients who decided to have not claim the cost of osteopathic treatment on their private health insurance, know, and instead to claim their Medicare rebate can not use their private health insurance for Any shortfalls between Medicare and fees to pay for the processing.
Source: blogspot.com

U.S. Cancer Treatment Sector Appealed to Congress March 13, To Stop Medicare Cuts

Over the past four and a half years, 241 community cancer clinic sites have closed and 442 practices (often with multiple clinic locations) are struggling financially. As community cancer clinics close their doors, access to cancer care is compromised for cancer patients, especially vulnerable seniors covered by Medicare. Additionally, 392 clinics have consolidated into the hospital, with consolidation driving up costs to cancer patients and payers. (1) According to recent studies by Milliman (2) and Avalere (3), cancer patients, Medicare, and private insurers pay substantially less for cancer care when chemotherapy is administered in the physician community cancer clinic setting. Unfortunately, this cancer care crisis will seriously worsen with the sequestration-mandated cuts to Medicare effective April 1—access problems will multiply and costs will increase for both Medicare beneficiaries fighting cancer and taxpayers.
Source: larouchepac.com

Health Affairs Blog Post: Population Health Management in Medicare Advantage.

Posted by:  :  Category: Medicare

Medicare, Part D by ellenmac11Wellnesss promotion.  A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition).  In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk.  Health risk assessments used universally by MAOs serve to segment populations at risk for disease.  For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.
Source: ahipcoverage.com

Video: What is a Medicare health insurance exchange?

Rate Boost To Medicare Advantage Plans Powers Insurers’ Stock Surge

Medpage Today: More $$$ Going To Medicare Advantage Plans Payments to Medicare Advantage plans will increase by 3.3% in 2014, Medicare officials said late Monday. Officials at the Centers for Medicare and Medicaid Services (CMS) based the payment increase on the assumption that Congress will override scheduled cuts in physician reimbursements for an 11th consecutive year, the agency said. “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,” Jonathan Blum, PhD, CMS’ acting principal deputy administrator, said in a press release (Pittman, 4/2).
Source: kaiserhealthnews.org

Do you know your Medicare ABC’s…..and D’s?

Private insurance companies sell policies called Medicare Supplements or termed “Medi-Gap” plans by Medicare and they are designed to fill in the gaps for things that are not covered under Medicare Parts A and B.  The advantage is of these plans is that your out-of-pocket expense does decrease and sometimes covers all of the out-of-pocket expenses.  All Medicare Supplement plans have been standardized by the Government, so no matter what insurance company you go with, the supplements will cover you the same.  There are 10 standardized plans. The disadvantage of a Medicare Supplement plan is that the cost of the insurance goes up every year on your birthday.  After your first year of beign covered under a Medicare Supplement plan the insurance carrier may also raise your rate if they have had bad claims experience on a particular block of business that was not priced right for the risk.
Source: abwahumble.org

Population Health Management In Medicare Advantage

Wellnesss promotion.  A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition).  In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk.  Health risk assessments used universally by MAOs serve to segment populations at risk for disease.  For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.
Source: healthaffairs.org

WASHINGTON: Budget: cover uninsured, trim Medicare, tax cigs

Upper-middle class and well-to-do seniors would pay higher monthly premiums for outpatient and prescription drug coverage, in a significant expansion of a policy already in effect. The current premiums would be boosted, and the share of beneficiaries exposed to the higher rates would keep growing until it reaches one-fourth of all those in the program. Now, only about 6 percent of Medicare recipients pay higher “income related” premiums.
Source: heraldonline.com

Medicare Kansas City Health Insurance Basics

Medicare Part A is also referred as the hospital insurance and it can cover medical services such as critical care, inpatient hospital care, hospice care, home health care and short term care in skilled nursing facilities. Medicare Part A can be obtained by people who are paying Medicare taxes when they are still working. However, if an individual cannot be eligible for free benefits from Medicare Part A then he can purchase Part A coverage provided that he can meet the eligibility requirements.
Source: ehealthmo.com

Veterans of America Supports Bill to Expand Health Care for CHAMPVA Children

Posted by:  :  Category: Medicare

CHAMPVA is a VA health insurance program that provides coverage for certain eligible dependents and survivors of veterans rated permanently and totally disabled from a service-connected condition. CHAMPVA is a cost-sharing program that reimburses providers and facilities a determined allowable amount, minus patient copayment and deductible. Once a veteran becomes VA-rated permanently and totally disabled for a service-connected disability, the veteran’s spouse and dependents are then eligible to enroll in CHAMPVA.
Source: wordpress.com

Video: Julie Clifford Video Cover Letter

Magic City Morning Star: Expanding CHAMPVA's Maximum Eligibility Age for Veterans' Children

CHAMPVA is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries, such as the spouse or child of a veteran who is disabled or died from a service-connected disability. Legislation has already been passed allowing TRICARE to cover children on their parents’ plan up to age 26.
Source: magic-city-news.com

healTHousands: Extending Coverage for CHAMPVA Insurance: My Story

This whole experience has made me extremely passionate about equal access to health care, especially to those whose family has given the ultimate sacrifice to this country to protect individuals and allow individuals to still have their freedom. It sickens me that our country does little to help those individuals AND their families… because his injury doesn’t just affect my father, it has affected our entire family. Repeatedly, I hear arguments from people such as “Why would we support deadbeat kids of disabled Veterans anyways?”, “I DON’T want to pay for someone else’s insurance”, “It’s your father’s benefit, not yours”… blah blah blah. However, just as many individuals with parents who have insurance through their employment, insurance is a benefit of the job of being in the military, and therefore although the employer IS the United States government, still means that everyone should be entitled to benefits that have been legal by recent legislative changes. We still are required to pay the same medical costs and have deductibles and all that jazz, so, really, the insurance plan is exactly the same as any private provider such as Golden Rule. In addition. if an individual becomes disabled during their employment, often their insurance plans will allow them to keep their insurance, up to a cap, just like my mother’s did.  As a person planning on becoming a physician, equal access to health care is something I am extremely passionate about.
Source: blogspot.com

Featured Benefit Association and Society Insurance Corporation

The Association and Society Insurance Corporation (ASI) is the administrator of The Monumental (Transamerica in New York) TRICARE and CHAMPVA Supplemental Insurance Plans for NCOA members. ASI is not only the leader in handling TRICARE and CHAMPVA plans, they are also staffed with dedicated professionals that excel in customer service. ASI understands that as veterans, it is pivotal that you provide your family with the best healthcare coverage available to you. By using NCOA’s endorsed supplemental coverage for TRICARE, CHAMPVA (disabled veterans and their family members), and TRICARE Reservists for Reservists/National Guardsmen, your family can save on their healthcare expenses. To obtain a quote or for more information, please call an ASI customer service expert at (800) 638-2610 Ext. 257.
Source: ncoausa.org

Thompson/Beasley: ChampVA insurance

It has come to my knowledge that Baton Rouge/New Orleans, LA VA is not receiving any ChampVA patients anymore. After calling the Champva office in Colorado, I was told that it was due to the remodeling of the New Orleans center, and this probably would not be permanent. I surely hope so. I realize the veterans need medical attention first, but we ChampVA patients who depend on the VA for our medical attention need a place to go.
Source: blogspot.com

H.R.288: CHAMPVA Children's Protection Act of 2013

I am writing as your constituent in the 2nd Congressional district of Hawaii. I am writing as your constituent in the 2nd Congressional district of Hawaii. I support H.R.288 – CHAMPVA Children’s Protection Act of 2013, and am tracking it using OpenCongress.org, the free public resource website for government transparency and accountability. enforced violenced against children by enforcing with creation the champva act immediately Sincerely, TROY ABRAHAM
Source: opencongress.org

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Source: sydneyarabfilmfestival.com

champva supplemental insuranceInsurance Quote

 This has to be paid every point since insurance of liability. If you are not hermetic below limb type of auto insurance forasmuch as a fine is levied on you. Your registration blame be suspended or you amenability be put imprint jail if you are not undetected subservient auto insurance. Largely you are likely to posses insurance to cover the pecuniary loss of the examination clambake ascendancy occasion you are bound. Control harmony to own a flexible policy, you longing to confirm the Pennsylvania all terrain ( ATV ) insurance rates. Before having a license importance Pennsylvania, the driver is likely to have a policy of liability. The holders of the policy should keep the license plate of the insurance company. This will confirm full payment done to the jig who has suffered loss by the licensee. So the PA ATV insurance ratio confirms protection lambaste monetary loss mark circumstances of an milestone that is related to your vehicle. You exigency to sign an agreement hold back the PA ATV insurance.
Source: blogspot.com

Ask The Experts: Retirement

Posted by:  :  Category: Medicare

Drug questions by Ano Lobb. @healthyrxA. Obviously. The first number you look at is always the cost of premiums for Part B, which would be in addition to your FEHB premiums. However, the arithmetic doesn’t stop there. You need to review your plan brochure to see how your plan will reimburse your medical insurance coverage services if you don’t elect Part B. Then you need to review the benefits that each plan provides to see if they either supplement each other or provide coverage where none would otherwise exist. Finally, put what you’ve learned up against what you think your current and future health needs will be. When you are done, you may conclude that you don’t need Part B, or that you do. The decision is up to you. However, do it with more thought than you have put into it so far.
Source: federaltimes.com

Video: Medicare Questions – Company Benefits & Credible Coverage for Medicare Part D

Senator Questions CMS Following Leak About MA Plan Payments

Grassley requested that CMS provide a timeline on how the decision was made — including all the people who were informed in advance of the announcement and all the relevant communications — by April 9, the same day acting CMS Administrator Marilyn Tavenner is scheduled to appear in front of the Senate Finance Committee for her confirmation hearing (“Healthwatch,
Source: californiahealthline.org

Are you ready for 2013? 4 questions to ask yourself

Don’t forget, if you have Medicare Part B and are in Original Medicare, you’ll have to meet your deductible before your Medicare coverage pays for services and supplies. Next year, the Medicare Part B deductible will be $147. Make sure to plan your health care budget to account for the increased cost of doctor visits for the time that it will take to cover your deductible.
Source: medicare.gov

Cutting Health Care Waste, Medicare Fraud

There are promising signs. Medical education is beginning to respond to these issues. "At bottom, the key agents are the physicians. They order the tests, prescribe the drugs and recommend the surgeries," said Darrell G. Kirch, M.D., president of the Association of American Medical Colleges. More physicians are weighing the cost of brand-name drugs against generics and questioning the effectiveness of commonly ordered tests. The American Board of Internal Medicine Foundation and 375,000 doctors are developing the "Choosing Wisely" campaign with a list of overused tests and procedures that starts with stress tests for healthy people, bone scans for those under 60 and diagnostic tests for common allergies.
Source: aarp.org

The ABC’s (And D’s) Of Medicare

Eligibility for Medicare typically starts for those who turn age 65 and are permanent citizens of the US. Persons are automatically enrolled at age 65 if they have yet to start collecting Social Security. Persons electing to receive Social Security benefits before their full retirement age (FRA), must enroll manually in Medicare at age 65. Persons can also be eligible for Medicare based on having a disability covered under Social Security for 24 months, end-stage renal failure (requiring dialysis), and amyotrophic lateral sclerosis (ALS – Lou Gehrig’s Disease). Finally, Medicare is available for covered railroad workers receiving Railroad benefits.
Source: figuide.com

Hearing Raises Questions About How To Replace Medicare’s SGR Formula

Medpage Today: Repealing SGR Raises Questions For Congress Opinions on what to replace Medicare’s sustainable growth rate (SGR) formula with and how to get there vary greatly, comments during a Thursday hearing showed. Lawmakers looking to pull the trigger on finally doing away with the SGR, which is used to determine physician payments, must iron out many of the details that came to light during a hearing Thursday before the House Energy and Commerce Health Subcommittee. An outline of a Republican-offered plan to repeal and replace the SGR released last week by the House Energy and Commerce Committee and House Ways and Means Committee looked remarkably similar to that of bipartisan bills offered in the past. The plan would repeal the SGR and provide statutorily defined payment rates for a period of years before moving to a payment model that rewards quality and efficiency (Pittman, 2/14).
Source: kaiserhealthnews.org

Medicare’s Reset On ‘Coverage With Evidence Development’

a. 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

Who To Reach Out To For Your Medicare Related Questions

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

The Basics of Medicare Coverage

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSSupplements are offered by many companies and, within every company, monthly premiums are based on which level of coverage you choose, among other underwriting issues (where you live, when you purchase the insurance, etc.). Those levels are distinguished by the letters “A” through “F” and every company’s “A” plan will offer the same benefits as any other company’s “A” plan, and so on through “F.”
Source: westminstervillagenorth.com

Video: Health Insurance Information : What Is Medicare Part B?

– When must I sign up for Medicare Part B?

Q. I am retired military, but an active state employee covered by the state health plan. Presently, Tricare is my secondary coverage. In August I will turn 65. I must sign up for Medicare. Because I am still covered by the state health plan, I have an option to sign up for Part A, maintain the state health plan as my primary coverage until I retire from the state, and then sign up for Part B upon that retirement without penalty or loss of coverage. My question comes in regard to Tricare for Life. There appears to be a similar Part B delay provision for anyone still on active duty when they turn 65 – they can delay signing up for Part B without penalty until they retire from the military. However, there does not seem to be any link between the two exceptions for military retirees. In other words, it appears I must sign up for Part B immediately before I retire from the state or lose my eligibility for Tricare for Life. Is that correct?
Source: militarytimes.com

Do you know your Medicare ABC’s…..and D’s?

Private insurance companies sell policies called Medicare Supplements or termed “Medi-Gap” plans by Medicare and they are designed to fill in the gaps for things that are not covered under Medicare Parts A and B.  The advantage is of these plans is that your out-of-pocket expense does decrease and sometimes covers all of the out-of-pocket expenses.  All Medicare Supplement plans have been standardized by the Government, so no matter what insurance company you go with, the supplements will cover you the same.  There are 10 standardized plans. The disadvantage of a Medicare Supplement plan is that the cost of the insurance goes up every year on your birthday.  After your first year of beign covered under a Medicare Supplement plan the insurance carrier may also raise your rate if they have had bad claims experience on a particular block of business that was not priced right for the risk.
Source: abwahumble.org

Ask The Experts: Retirement

A. Obviously. The first number you look at is always the cost of premiums for Part B, which would be in addition to your FEHB premiums. However, the arithmetic doesn’t stop there. You need to review your plan brochure to see how your plan will reimburse your medical insurance coverage services if you don’t elect Part B. Then you need to review the benefits that each plan provides to see if they either supplement each other or provide coverage where none would otherwise exist. Finally, put what you’ve learned up against what you think your current and future health needs will be. When you are done, you may conclude that you don’t need Part B, or that you do. The decision is up to you. However, do it with more thought than you have put into it so far.
Source: federaltimes.com

4 Seniors: How Medicare covers diabetes

According to the Centers for Disease Control and Prevention, nearly 11 million seniors age 65 and older have diabetes and an additional 20 million have pre-diabetes, a condition in which the blood sugar level is higher than normal but not yet in the range for diabetes. To help care for this growing epidemic, Medicare provides a wide range of coverage – but they don’t cover everything.
Source: kfor.com

MEDICARE CHIROPRACTIC COVERAGE

acute low back pain adjustment Ankle Pain arthritis Asheville asheville chiropractor Auto injuries auto injuries and chiropractic back pain Back Pain Relief bad posture Biltmore Park Chiropractic Chiropractor disc bulge disc problems Dr. Michael Masterman Foot Pain headache headaches herniated disc joint pain low back pain Magnetic therapy Massage Therapy MG-33 middle back pain migraine migraine headache muscle pain neck pain nerve irritation Orthotics PEMF poor posture postural strain posture Pulsed Electro-Magnetic Force Running Running Injuries ruptured disc slip disc stress headache tension headache whiplash
Source: biltmoreparkchiropractic.com

Medicare information for EBCI tribal members

If you are already getting Social Security retirement or disability benefits, you will be contacted a few months before you become eligible for Medicare and sent the information you need.  You will be enrolled in Medicare Parts A and B automatically.  However, because you must pay a premium for Part B coverage, you have the option of turning it down.
Source: theonefeather.com

Be in the Know About Medicare Part B

There is a monthly premium for Medicare Part B. In 2013, the standard premium is $104.90. Some high-income individuals pay more than the standard premium. Your Part B premium also can be higher if you do not enroll during your initial enrollment period, or when you first become eligible. There are exceptions to this rule. For example, you can delay your Medicare Part B enrollment without having to pay higher premiums if you are covered under a group health plan based on your own current employment or the current employment of any family member. If this situation applies to you, you have a “special enrollment period” in which to sign up for Medicare Part B, without paying the premium surcharge for late enrollment. This rule allows you to:
Source: prescottenews.com

Medicare Kansas City Health Insurance Basics

Medicare Part A is also referred as the hospital insurance and it can cover medical services such as critical care, inpatient hospital care, hospice care, home health care and short term care in skilled nursing facilities. Medicare Part A can be obtained by people who are paying Medicare taxes when they are still working. However, if an individual cannot be eligible for free benefits from Medicare Part A then he can purchase Part A coverage provided that he can meet the eligibility requirements.
Source: ehealthmo.com

4 Options to Finding Affordable Medical Care

Posted by:  :  Category: Medicare

TTT #5... 259365 by paloeticMedical costs drive an estimated 60 percent of personal bankruptcies. And little wonder. Many Americans have high-deductible health plans, and about 9.3 million people ages 50 to 64 have no insurance at all. The Affordable Care Act, President Obama’s health care legislation, should drive down that figure: The ACA mandates that every state set up health care exchanges where people like Jenkins can buy affordable insurance. Until those exchanges go live in 2014, however, it’s up to consumers to solve the riddle of how to pay for good care. Here are four top options.
Source: aarp.org

Video: Individual Health Insurance and Family Medical Plans: PART 4

Abortion amendment upheld by Va. Senate

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Source: fredericksburg.com

ObamaCare Clusterfuck: Individual expatriate health insurance plans count toward the mandate

The FAQ also notes that expatriate health plans are a form of minimum essential health coverage under the ACA. This means that an individual covered by an expatriate health plan will not be subject to the individual mandate. In addition, employers will not be subject to the employer mandate penalty if they offer coverage under an expatriate health plan, provided the coverage is “affordable” and meets the minimum value requirement under the ACA.
Source: correntewire.com

Health Center and Insurance Department Collaborate to Help Families Access Mental Health Treatment

The Insurance Department and UConn Health Center are developing a user-friendly ‘claims tool kit’ for policyholders and providers, especially out-of-network providers who operate on cash basis. The goal is to reduce the number of insurance denials by creating a plain-language claims template specific to behavioral health treatment that policyholders and practitioners can submit to insurance companies for reimbursement. It is intended to help them quickly and accurately prepare claims submissions to reflect medical necessity and increase the number of claims approved on initial submissions.
Source: uconn.edu

Got Health Insurance: Questions to Ask When You Shop for Coverage

Does the plan require referrals to see specialists? Referrals are a transfer of your medical care from one doctor to another, usually from a general primary care physician to a specialist. For example, if you are having serious stomach pain, your general physician might refer you to an internist. If referrals are required, failure to get one can delay care or increase cost. Examine charges for specialist visits and treatment, since these often differ from routine care coverage and costs. If you know you will be seeing a specialist in the coming year look for preferred provider organization (PPO) polices or a plan that specifies “no referrals required” in the plan details.
Source: rmhp.org

Fox’s Baseless Report On Health Insurance Guidance Program: Unions Will Steal Your Personal Information

The Exchange regulations, at 45 CFR § 155.260(a), establish privacy and security standards for Exchanges, and § 155.260(b) provides that Exchanges must require Navigators and other non-Exchange entities to abide by the same or more stringent privacy and security standards as a condition of contract or agreement with such entities. Consistent with these requirements, we propose that the training for Navigators and non-Navigator assistance personnel must include training designed to ensure that they safeguard consumers’ sensitive personal information including but not limited to health information, income and tax information, and Social Security number.
Source: mediamatters.org

Va. Amendment Barring Health Care Exchange Plans From Covering Abortions Approved

Gov. McDonnell made his amendment to a bill that laid out guidelines for health care exchanges that will be part of the federal Affordable Care Act, often dubbed "Obamacare." Virginians who are not covered by private or employer-sponsored health care plans would be eligible to buy reduced cost plans offered through the health care exchanges. The governor’s amendment would bar those plans offered to Virginians from covering most abortion services.
Source: nbcwashington.com

Meadowlands Hospital in New Jersey Creates Health Plan

Meadowlands Hospital Medical Center, a 230-bed facility based in Secaucus, N.J., has officially launched its own health plan, according to a Record report. Meadowlands’ plan will offer health coverage to area businesses and residents who live within 10 miles of the hospital and use the hospital and its providers for most of their healthcare needs, according to the report. It will be 25 to 30 percent cheaper than other health plans, as there will be no deductible or out-of-pocket expenses for most visits. The hospital expects most patients who sign up for the plan will be hourly or part-time workers and municipal employees who don’t have health insurance.
Source: beckershospitalreview.com

New Policy Covers Transgender Health

Sensing was born female but has been living as a man for six years. Although he is taking sex hormones and plans on getting sex reassignment surgery, not all transgender people approach the process of transition in the same way, and some decide not to make medical changes at all. For many, finding a way to pay for medical treatment is a hindrance in their transition, but the increasing visibility of the transgender community in the United States has brought issues of discrimination, medical care, and compassion into the public eye.
Source: thecrimson.com

Uwe E. Reinhardt: Comparing the Quality of Care in Medicare Options

Posted by:  :  Category: Medicare

NEW REPORT HIGHLIGHTS MEDICARE ADVANTAGE INSURERS’ HIGHER ADMINISTRATIVE SPENDING by Leader Nancy PelosiBoth traditional Medicare and Medicare Advantage plans are monitored annually through surveys of patients, using the Consumer Assessment of Health Care Providers and Systems, known in the trade as Cahps. The findings from this survey make it possible to compare traditional Medicare with Medicare Advantage plans on quality. As Medpac reports in Table 12-8 of Chapter 12 of the March 2012 report, the commission found little difference in the relatively few quality-performance scores of the traditional Medicare and Medicare Advantage plans.
Source: nytimes.com

Video: Parts A & B – Traditional Medicare

Medicare Benefit Redesign: Proposals to Restructure Could Hurt More than Help 

[1] See, e.g., "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all [2] "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all [3] For more information on the topic of Medicare benefit redesign and the potential impact on Medicare beneficiaries, see Written Statement Submitted Jointly by California Health Advocates, Center for Medicare Advocacy, and Medicare Rights Center on "Examining Traditional Medicare’s Benefit Design" Before the Subcommittee on Health of the Committee on Ways & Means, U.S. House of Representatives (2/26/13), available at: http://www.medicareadvocacy.org/2013/02/26/center-for-medicare-advocacy-testifies-on-medicare-redesign/.   Much of this Alert is based upon this Joint Testimony.  Also see, e.g., written testimony for the same hearing submitted by the Leadership Council of Aging Organizations (LCAO), available at: http://www.lcao.org/files/2013/03/Testimony-for-Ways-and-Means-Medicare-benefit-redesign-hearing.pdf. [4]  See Kaiser Family Foundation, "Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending" (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [5] Kaiser Family Foundation, "Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending" (November 2011), available at: http://www.kff.org/medicare/upload/8256.pdf. [6]  "Talk of Medicare Changes Could Open Way To Budget Pact" by Jackie Calmes and Robert Pear, New York Times, (3/29/13), available at: http://www.nytimes.com/2013/03/29/us/politics/common-ground-in-washington-for-medicare-changes.html?pagewanted=all.  MedPAC’s analysis of its own proposal also reveals that at least 20% of beneficiaries would pay an additional $250-$999 per year; their proposal coupled with a surcharge on Medigap plans would lead to 70% paying additional costs within this range.  See MedPAC Presentation, "Reforming Medicare’s Benefit Design" (March 2012), slide 10, available at: http://www.medpac.gov/transcripts/benefit%20design%20mar2012%20public.pdf [7] See, e.g., National Association of Insurance Commissioners, Senior Issues Task Force, Medigap PPACA Subgroup, "Medicare Supplemental Insurance First Dollar Coverage and Cost Shares Discussion Paper" (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf;  also see National Association of Insurance Commissioners letter to Secretary Sebelius (December 2012), available at: http://www.naic.org/documents/committees_b_sitf_medigap_ppaca_sg_121219_sebelius_letter_final.pdf. [8] See, e.g., Leadership Council of Aging Organizations (LCAO) Fact Sheet "Medicare Characteristics and Costs" (December 2012) and citations therein, available at: http://www.lcao.org/files/2013/02/LCAO-Medicare-Characteristics-Costs-Fact-Sheet-Dec20121.pdf.
Source: medicareadvocacy.org

Doctor’s Advice…Get Traditional Medicare…What’s That? » Toni Says

(In-patient Hospital Insurance) pays for your medical care while you have a hospital stay. Part A also pays some of the costs if you stay in a skilled nursing facility which has 100 day benefit, hospice, or if you receive home health care.  The Part A deductible for 2013 is $1,184.00 and can be used 6 times or 6 deductibles in a year.  Yes, Part A has a benefit period of 60 days, so every 60 days; there is a new deductible of $1184.00. If you go back in the hospital after a 60 day period, then you can have another deductible of $1,184.00.  Skilled nursing has a $0 co pay for days 1-20, but from days 21-100, there is $148.00 co pay per day.  After day 100, you pay all of the cost for each additional day. And yes they do bill you the additional cost.
Source: tonisays.com

The Center for Fiscal Equity: Examining Traditional Medicare’s Benefit Design

Chairman Brady Ranking Member McDermott, thank you for the opportunity to submit these comments for the record to the House Ways and Means Committee. We remain available to brief members and staff on our proposals for retirement and health care reform. It is always important to note when discussing reform options that the whole purpose of social insurance is to prevent the imposition of unearned costs and payment of unearned benefits by not only the beneficiaries, but also their families. Cuts which cause patients to pick up the slack favor richer patients, richer children and grand children, patients with larger families and families whose parents and grandparents are already deceased, given that the alternative is higher taxes on each working member. Such cuts would be an undue burden on poorer retirees without savings, poor families, small families with fewer children or with surviving parents, grandparents and (to add insult to injury) in-laws. Recent history shows what happens when benefit levels are cut too drastically. Prior to the passage of Medicare Part D, provider cuts did take place in Medicare Advantage (as they have recently). Utilization went down until the act made providers whole and went a bit too far the other way by adding bonuses (which were reversed in the Affordable Care Act). There is a middle ground and the Subcommittee’s job is to find it. Resorting to premium support, along with the repeal of the ACA, had been suggested to save costs. It is our hope that the election results took this off the table, however we will reprise our analysis of this option if and when it comes up. One option is resorting to single-payer catastrophic insurance with health savings accounts. It would not work as advertised, as health care is not a normal good. People will obtain health care upon doctor recommendations, regardless of their ability to pay. Providers will then shoulder the burden of waiting for health savings account balances to accumulate – further encouraging provider consolidation. Existing trends toward provider consolidation will exacerbate these problems, because patients will lack options once they are in a network, giving funders little option other than paying up as demanded The bigger question is whether private insurance survives the imposition of pre-existing condition reforms. We do not have to wait until implementation to examine this question. Now that the Supreme Court has spoken, the stock market will examine it for us. There may well be a demand for reform before the Act is fully implemented if the prospects for private insurance are found wanting. Conversely, if stock prices are maintained, it is the market expecting mandates to be adequate. This question is by far more important than the design of the traditional system. If mandates are seen as inadequate, the questions of both premium support and the adequacy of provider payments are moot, since if private insurance fails the only alternatives are single-payer insurance and a pre-emptive repeal of mandates and consumer protections in favor of a subsidized public option. The funding of either single-payer or a public option subsidy will dwarf the requirement to fund adequate provider payments in Medicare and Medicaid. Shifting to more public funding of health care in response to future events is neither good nor bad. Rather, the success of such funding depends upon its adequacy and its impact on the quality of care – with inadequate funding and quality being related. Recent reforms have essentially turned the Medicare Part A Payroll Tax into a virtual consumption tax by taxing non-wage income above $250,000 a year. It would be as easy to shift from a payroll tax to a value added or VAT-like net business receipts tax (which allows for offsets for employer provided care or insurance) and would likely raise essentially the same amount of money, as most non-wage income actually goes to individuals now liable for increased taxes. If a VAT system is used, tax rates can be made lower because overseas labor will essentially be taxed, leaving more income for American workers while raising adequate revenue. One form of increased funding could very well be higher Part B and Part D premiums. This has been suggested by both the Fiscal Commission and the Bipartisan Policy Center. In order to accomplish this, however, a higher base premium in Social Security would be necessary. Our proposal is that to do this, the employee income cap on contributions should actually be lowered to decrease the entitlement for richer retirees while the employer income cap is eliminated, the employer and employee payroll taxes are decoupled and the employer contribution credited equally to each employee at some average which takes in all income. If a payroll tax is abandoned in favor of some kind of consumption tax, all income, both wage and non-wage, would be taxed and the tax rate may actually be lowered. Ultimately, fixing health care reform will require more funding, probably some kind of employer payroll or net business receipts tax – which would also fund the shortfall in Medicare and Medicaid (and take over most of their public revenue funding), regardless of whether Part B and D premiums are adjusted. If the same consumption tax pays both retirement income and government health plans, the impact on the taxpayer is exactly nil in the long term. We will now move to an analysis of funding options and their impact on patient care and cost control. The committee well understands the ins and outs of increasing the payroll tax, so we will confine our remarks to a fuller explanation of Net Business Receipts Taxes (NBRT). Its base is similar to a Value Added Tax (VAT), but not identical. Unlike a VAT, an NBRT would not be visible on receipts and should not be zero rated at the border – nor should it be applied to imports. While both collect from consumers, the unit of analysis for the NBRT should be the business rather than the transaction. As such, its application should be universal – covering both public companies who currently file business income taxes and private companies who currently file their business expenses on individual returns. The key difference between the two taxes is that the NBRT should be the vehicle for distributing tax benefits for families, particularly the Child Tax Credit, the Dependent Care Credit and the Health Insurance Exclusion, as well as any recently enacted credits or subsidies under the ACA. In the event the ACA is reformed, any additional subsidies or taxes should be taken against this tax (to pay for a public option or provide for catastrophic care and Health Savings Accounts and/or Flexible Spending Accounts). The NBRT can provide an incentive for cost savings if we allow employers to offer services privately to both employees and retirees in exchange for a substantial tax benefit, either by providing insurance or hiring health care workers directly and building their own facilities. Employers who fund catastrophic care or operate nursing care facilities would get an even higher benefit, with the proviso that any care so provided be superior to the care available through Medicaid. Making employers responsible for most costs and for all cost savings allows them to use some market power to get lower rates, but no so much that the free market is destroyed. This proposal is probably the most promising way to arrest health care costs from their current upward spiral – as employers who would be financially responsible for this care through taxes would have a real incentive to limit spending in a way that individual taxpayers simply do not have the means or incentive to exercise. While not all employers would participate, those who do would dramatically alter the market. In addition, a kind of beneficiary exchange could be established so that participating employers might trade credits for the funding of former employees who retired elsewhere, so that no one must pay unduly for the medical costs of workers who spent the majority of their careers in the service of other employers. The NBRT would replace disability insurance, hospital insurance, the corporate income tax, business income taxation through the personal income tax and the mid range of personal income tax collection, effectively lowering personal income taxes by 25% in most brackets. Note that collection of this tax would lead to a reduction of gross wages, but not necessarily net wages – although larger families would receive a large wage bump, while wealthier families and childless families would likely receive a somewhat lower net wage due to loss of some tax subsidies and because reductions in income to make up for an increased tax benefit for families will likely be skewed to higher incomes. For this reason, a higher minimum wage is necessary so that lower wage workers are compensated with more than just their child tax benefits. Thank you for the opportunity to address the committee. We are, of course, available for direct testimony or to answer questions by members and staff.
Source: blogspot.com

CMS To Increase Rather Than Cut Medicare Advantage

DR. JIM PALERMO, EDITOR-IN-CHIEF: Dr. Palermo, a 28-year resident of Brevard County, touched the lives of countless people during his 22-year practice of general, vascular and non-cardiac thoracic surgery. In 2002 he transitioned from clinical practice and accepted a position as full-time chief medical officer and vice president of quality management of Health First, which afforded him the opportunity to serve the global community in a more meaningful way. An accomplished author and sought-after expert in the healthcare industry, Dr. Palermo is now an independent consultant focused on healthcare quality and safety, and physician leadership development.
Source: spacecoastdaily.com

What is the difference between Medicare and Medi

Martha Jo Patterson is Certified as an Elder Law Attorney by the National Elder Law Foundation, she is a past president of Southern California NAELA, Southern California Council of Elder Law Attorneys, she is an author of two books “What If” and “Nursing Home Dilemma: How to Protect Your Loved One While Preserving Your Assets”, she is a member of the Los Angeles County Bar (as well as several other organizations). Martha Jo Patterson is an Elder Law Attorney who serves Los Angeles County and Orange County as well as the following cities: Anaheim, Anaheim Hills, Beverly Hills, Brea, Buena Park, Burbank, Calabasas, Century City, Encino, Fullerton, Glendale, Hollywood, Irvine, Laguna Woods, La Mirada, Moorepark, North Hills, North Hollywood, Northridge, Orange, Placentia, Reseda, Santa Ana, Santa Monica, Seal Beach, Sherman Oaks, Simi Valley, Stanton, Studio City, Tarzana, Topanga, Tustin, West Hills, West Hollywood, Westwood, Woodland Hills Valley, Village, Van Nuys, , Valencia, Ventura, Yorba Linda, and Santa Clarita Valley and the San Fernando Valley. Her offices are located in Burbank and Orange (near Angel’s Stadium). She is celebrating 30 years of practice as an Attorney as of June 3, 2013, having graduated in December and passing the February 1983 Bar which had one of the lowest passing rates in history.
Source: gpeldercarelaw.com

Privatized 'Medicare' Insurers Suck More from the Trough

The private Medicare Advantage plans, which are already paid some 14% more than traditional Medicare providers, were to take a 2.2% trimming under ObamaCare. But then the health insurers bitched and mobilized their representatives in Congress. So yesterday, the Washington Post reports, the Centers for Medicare and Medicaid Services announced that it was changing its method of calculating reimbursement rates. So, instead of cutting payments for Medicare Advantage plans, it will increase them by 3.3 percent, giving the privatized Medicare plans what amounts to a 5.5% increase.
Source: larouchepac.com

“Obamacare” and Its Impact on Medicare: Separating Fact from Fiction

Change in payments to Medicare Advantage plans. Medicare Advantage plans have consistently cost the government more than traditional Medicare, averaging 14 percent more than traditional Medicare in 2009. Under the Affordable Care Act, the excess payments to private plans will be reduced to two percent while also providing financial incentives for plans to focus on providing high-quality care to enrollees. This should lead to better, more economically efficient care.
Source: principal.com

HealthWealthLink Software To Help Boomers Plan for Healthcare Expenses in Retirement

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyJust as important as knowing the expense gap is finding the right solution for the client to fund that gap. HealthWealthLink makes that easy for the advisor and client. The system offers: • Healthcare calculator and Medicare calculator • Social Security and Pension Income Calculators as a potential source of healthcare cost funding • Customized Dashboard of Investment and Insurance Funding solutions such as mutual funds, annuities, life insurance, and long-term care insurance, to name a few. • Interactive Illustration System that allows the advisor to run “what if” scenarios to show clients how an initial investment in a financial product may reduce the healthcare cost burden. • Personalized Client Reports that are presented in easy-to-understand language and helps the client make educated, stress-free decisions.
Source: hvsfinancial.com

Video: Medicare Plan Selection Help | Allsup Medicare Advisor

Sequestration hits Medicare, U.S. health agencies

The Medicaid program will be unaffected by the cuts but Medicare providers will receive 2% cuts for services provided, which will total an estimated $11 billion for the year. While this is less of a decrease than most nondefense programs will experience, a noticeable impact is expected for physicians with a high percentage of Medicare patients in their practice.
Source: clinicaladvisor.com

Seniors Who Discuss Medicare With Advisors Are Better Off: Survey

Mary Dale Walters, senior vice president of the Allsup Medicare Advisor, a Medicare plan selection service for Medicare-eligible individuals, noted in a statement that Allsup’s survey of seniors with advisors “found that while only a small number discuss Medicare with their advisors, three of their five major concerns relate to health care and Medicare.”
Source: advisorone.com

Insurance trainer publishes informational Medicare book

Available in paperback on Amazon.com (also for Kindle) and through the Barnes and Noble website, the 80-page book covers topics such as Parts A, B, C and D, long-term care, COBRA, TRICARE, veterans prescription drug programs, employers and union prescription drug plans, Medicaid, the Federal Employees Health Benefits (FEHB) program, and other topics.
Source: ifawebnews.com

Even if you don’t take Medicare, Medicare may have created a marketing and growth opportunity for your business

Medicare has approved two new billing codes designed to encourage doctors to connect with patients promptly after hospital or nursing home discharge, to assess their needs, and to coordinate their in-home and outpatient care.  Both the codes are titled Transitional Care Management (TCM).  Medicare-certified home health agencies remember what a great marketing tool it was when Medicare started paying doctors for certifying plans of care more than a decade ago.  At the time, the advantage only applied to certified home health.  A handful of certified agencies now recognize that Medicare is handing them another opportunity.  In addition, these new codes apply to any care or services the patient needs (e.g. non-medical home care, home improvement, ambulation devices, lift chairs, home infusion, etc.).  Private duty and HME providers should take note that CMSs final rule for these news billing codes twice specifies that doctors need to assess patients for ADL needs and refer to the services that help with ADLs.
Source: bma-advisor.com

What Medicare doesn’t cover

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Source: bankrate.com

Daily Kos: WH Advisor David Plouffe and Goldman Sachs CEO Agree That Medicare and Medicaid Must be Cut

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Source: dailykos.com

Medical Careers USA: NEW! Medicare Part A and Part B billing under RUG

You are receiving this message at medicalcareersus@gmail.com as a valued contact of HCPro. If you prefer not to receive messages like this in the future, click here to remove yourself from this list or change your email preferences. Your request will be processed within 10 days. You may receive additional promotions within that time. ©2013 HCPro, Inc. 75 Sylvan Street, Suite A-101 • Danvers, MA 01923 Phone: 800-650-6787 • Fax: 800-639-8511 Email: customerservice@hcpro.com • Website: www.hcmarketplace.com   
Source: medical-careers-usa.com

An Simplistic Truths Of Medicare Supplement Insurance Coverage

Everyone hard to trace online scammers. Therefore, precaution is better than cure. Solely allowed give your sensitive information online and not just pay through wire-transfers. Do not click on attachments in emails out of unknown sources which they may contain adware and and spyware your put you at the risk of masterplans scams. Purchase online only from trusted e-commerce stores and do not accept any occupational offers online with no having checking the encounter of the recruiter. By taking small precautions, you may enjoy a hassle-free around the internet experience and protect yourself from deception.
Source: liabilityinsuranceadvisor.com

The Fiscal Cliff Agreement Maintained Medicare/Medicaid Status Quo

Medicaid is not among the programs included in the “sequestration” cuts, but Medicare is. The two percent across-the-board cut in Medicare as a result of sequestration has been postponed to the end of March 2013. Moreover, ATRA extended Medicare’s 2012 physician payment rates thru 2013 (the “doc fix”) thus avoiding a 27 percent reduction in physician rates set for 2013. Like the two month postponement of the across-the-board cut in Medicare, January 1st scheduled cuts in Housing and Older American Act programs have been spared until the end of March 2013.
Source: wordpress.com

Obama Budget Will Propose Changes To Medicare

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceThe Associated Press/Washington Post: Obama’s Budget Will Avoid Deep Cuts In Medicaid As He Presses States To Expand Aid For Poor President Barack Obama’s budget next week will steer clear of major cuts to Medicaid, including tens of billions in reductions to the health care plan for the poor that the administration had proposed only last year. Big cuts in the federal-state program wouldn’t go over too well at a time that Health and Human Services Secretary Kathleen Sebelius is wooing financially skittish Republican governors to expand Medicaid coverage to millions who now are uninsured. That expansion in the states is critical to the success of Obama’s health overhaul, which is rolling out this fall and early next year (4/4).
Source: kaiserhealthnews.org

Video: Obama Fully Embraces Austerity with Cuts to Social Security and Medicare

Sequestration takes a toll on cancer patients, Medicare

A funny thing happened on Rush Limbaugh’s radio show yesterday. The Republican host was complaining about a Washington Post report on sequestration cuts hurting cancer patients in the Medicare program, and told his listeners to ignore the news. “All of this is manufactured and made up,” Limbaugh said. How does he know? Because the sequester didn’t include “any cuts in Medicare,” he added.
Source: msnbc.com

Daily Kos: President Obama’s budget will include cuts to Social Security, Medicare

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Source: dailykos.com

Sequester (GOP) Blamed for Medicare Woes, Not Obamacare Cutting $714 Billion Out of the Program

Washington Post says: “Legislators meant to partially shield Medicare from the automatic budget cuts triggered by the sequester, limiting the program to a 2 percent reduction — a fraction of the cuts seen by other federal programs.  But oncologists say the cut is unexpectedly damaging for cancer patients because of the way those treatments are covered.”  And even those cuts are not real. As the AP says, legislators exempted Medicare and Medicaid from the sequester.  There aren’t any cuts in Medicare.  All of this is manufactured and made up.  But the idea here is to — you’ve got, what, really in this year, $25 billion in sequester spending that’s being reduced.  They’re not budget cuts.  It’s spending being reduced.  Spending from a projected amount, not, again, reduced spending from a baseline.  The whole idea is Republicans have to be blamed for this.  And it’s Republicans causing cancer patients to die. 
Source: rushlimbaugh.com

The Future of Medicare: 15 Proposals You Should Know About

Here are summaries of 15 options being talked about in Washington. Each summary is accompanied by two opinions that AARP commissioned from experts whose views typically represent different sides of the issues.
Source: aarp.org

U.S. Cancer Treatment Sector Appealed to Congress March 13, To Stop Medicare Cuts

Over the past four and a half years, 241 community cancer clinic sites have closed and 442 practices (often with multiple clinic locations) are struggling financially. As community cancer clinics close their doors, access to cancer care is compromised for cancer patients, especially vulnerable seniors covered by Medicare. Additionally, 392 clinics have consolidated into the hospital, with consolidation driving up costs to cancer patients and payers. (1) According to recent studies by Milliman (2) and Avalere (3), cancer patients, Medicare, and private insurers pay substantially less for cancer care when chemotherapy is administered in the physician community cancer clinic setting. Unfortunately, this cancer care crisis will seriously worsen with the sequestration-mandated cuts to Medicare effective April 1—access problems will multiply and costs will increase for both Medicare beneficiaries fighting cancer and taxpayers.
Source: larouchepac.com

Experts: Obama’s Budget Likely To Forgo Major Changes to Medicare

Some experts say the roughly $400 billion in Medicare reductions over 10 years expected in Obama’s FY 2014 budget proposal will focus on providers and likely will not include major structural changes sought by GOP leaders, such as expanding means testing for higher-income beneficiaries, combining hospital and physician services under one Medicare payment structure and adding a surcharge to Medigap plans. Experts also note that large-scale structural reforms are contingent upon Republicans agreeing to tax increases.
Source: californiahealthline.org

Top 15 Hospitals Most Exposed to Medicare

Hospitals that rely disproportionately on Medicare patients for revenue may find themselves in a tougher bind over the next several years, as sequestration has started siphoning 2 percent of all Medicare funds. Moody’s Investors Service recently released a report, indicating that sequestration will worsen the “already challenging operating environment” of the non-profit hospital sector. Within the report, Moody’s analysts listed the top 15 hospitals and health systems in its rated portfolio that have the highest Medicare mix as a percentage of their gross revenue. Moody’s does not plan to downgrade the hospitals, but the ratings agency “will monitor the ultimate credit impact on them.” Moody’s found that most of the providers are from states, such as Florida, with larger retirement communities. Here are the 15 hospitals and health systems that are most exposed to Medicare in Moody’s portfolio.
Source: beckershospitalreview.com

The Spirit of a Progressive: Medicare For All Gets An Unexpected Boost

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSFirst, congressionally charter Blue Cross-Blue Shield as a monopoly to provide basic coverage to all Americans, except retirees. And grant the regulated nonprofit authority to impose payer-fee schedules on providers of routine care and services, much as Medicare does. A utility-style Blue Cross-Blue Shield covering all working-age Americans and their dependents would offer enormous administrative economies of scale and an insurance pool of unprecedented size. By trumping state regulations, the plan would be relieved from paying for luxuries like aromatherapy, Viagra, sex-change operations, hair implants, birth control, or elective abortion. Nothing would preclude other carriers from selling supplemental insurance for medical non-necessities, purchased by individuals at after-tax rates.
Source: blogspot.com

Video: Excellus Blue Cross Blue Shield – “Answers Medicare Questions” :30 TV Commercial

Ask The Experts: Retirement

A. Obviously. The first number you look at is always the cost of premiums for Part B, which would be in addition to your FEHB premiums. However, the arithmetic doesn’t stop there. You need to review your plan brochure to see how your plan will reimburse your medical insurance coverage services if you don’t elect Part B. Then you need to review the benefits that each plan provides to see if they either supplement each other or provide coverage where none would otherwise exist. Finally, put what you’ve learned up against what you think your current and future health needs will be. When you are done, you may conclude that you don’t need Part B, or that you do. The decision is up to you. However, do it with more thought than you have put into it so far.
Source: federaltimes.com

Horizon Blue Cross Blue Shield of New Jersey’s Mobile Medicare Outreach Moves Into Monmouth County

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving more than 3.6 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton. Learn more at www.HorizonBlue.com
Source: patch.com

Rate Boost To Medicare Advantage Plans Powers Insurers’ Stock Surge

Medpage Today: More $$$ Going To Medicare Advantage Plans Payments to Medicare Advantage plans will increase by 3.3% in 2014, Medicare officials said late Monday. Officials at the Centers for Medicare and Medicaid Services (CMS) based the payment increase on the assumption that Congress will override scheduled cuts in physician reimbursements for an 11th consecutive year, the agency said. “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,” Jonathan Blum, PhD, CMS’ acting principal deputy administrator, said in a press release (Pittman, 4/2).
Source: kaiserhealthnews.org

Health Care Services Providers to Federal Health Plan Members Subject to Federal Affirmative Action Compliance Audit

On March 30, the US District Court for the District of Columbia held that three University of Pittsburgh Medical Center-affiliated hospitals were federal subcontractors to an HMO that provided a managed care health plan to federal employees under a contract with the Office of Personnel Management (“OPM”). Although the hospitals had never consented to be considered subcontractors of the HMO for affirmative action compliance purposes or to be subject to affirmative action audits by the Department of Labor’s Office of Federal Contract Compliance Programs (“OFCCP”), and notwithstanding that the HMO’s contract with OPM expressly excluded medical service providers from its definition of “subcontractor,” the hospitals nevertheless were bound by the OFCCP’s nondiscrimination and affirmative action requirements. This decision is another step in a long and contentious battle between health care service providers and the OFCCP over whether and under what circumstances health care providers with no direct federal contracts can be forced to comply with affirmative action rules, audits, and penalties that apply to government contractors. The case, UPMC Braddock v. Harris, D.D.C., No. 09-01210, 3/30/13, is the most definitive decision on the issue to date.
Source: jdsupra.com

Blue Cross Blue Shield of North Dakota launches SilverSneakers® fitness program to Medicare Supplement members

About Healthways Healthways (NASDAQ: HWAY) is the largest independent global provider of well-being improvement solutions. Dedicated to creating a healthier world one person at a time, the Company uses the science of behavior change to produce and measure positive change in well-being for our customers, which include employers, integrated health systems, hospitals, physicians, health plans, communities and government entities. We provide highly specific and personalized support for each individual and their team of experts to optimize each participant’s health and productivity and to reduce health-related costs. Results are achieved by addressing longitudinal health risks and care needs of everyone in a given population. The Company has scaled its proprietary technology infrastructure and delivery capabilities developed over 30 years and now serves approximately 40 million people on four continents. Learn more at www.healthways.com or www.silversneakers.com.
Source: bcbsnd.com

Anthem Blue Cross Blue Shield Medicare Supplement Plans Are Affordable…

Based in beautiful Jackson Hole, Wyoming, we currently market health insurance in 18 different states from our website IndividualHealth.com. I have worked in the domestic and international markets for most of my adult life. Recently we launched a newly revamped website www.tetonmarketing.com which has a primary focus on music and Native American Flutes and hand crafted items made in Wyoming. Check it out! I want the Insurance Simplified Blog to be a place you can visit from time to time and read about real world issues that individuals and families face daily. Our parent website IndividualHealth.com we like to think of as a virtual brochure. But with the blog I want to talk about the topics behind the brochure. Also check out our blog www.JacksonHoleTim.com which is “All Things Wyoming, Everything Jackson Hole” . If you love the Yellowstone basin this is blog for you! Then when you are ready check out our new Social Network site Jacksonholetim.ning.com – this is a place you can connect with other who visit and live in Wyoming. And finally we have just launched another new blog. Jackson Hole Tim (www.jacksonholetim.com) is a new place to visit that talks about “All things Wyoming, Everything Jackson Hole”. I hope you find these blog helpful.
Source: wordpress.com

Newsroom – Blue Cross Blue Shield of Michigan adds University of Michigan Health System to new Medicare Advantage PPO Network

DETROIT – Blue Cross Blue Shield of Michigan has added the University of Michigan Health System to its growing network of Medicare Plus Blue℠ PPO providers. The move gives seniors who purchase the competitively priced plan access to all of the U-M hospitals and approximately 2,200 providers. The inclusion of the U-M Health System in the Blues’ new Medicare Advantage PPO plan represents a key piece in a network that now includes nearly all acute-care hospitals in Michigan. Other recent key additions include Scheurer Hospital in Huron County and all four MidMichigan Health hospitals and ancillary services. "The University of Michigan is one of the premier hospitals and a very important network of providers for us to have in our PPO product," said Julie Maier, manager, Senior Markets. "We’re working hard to make sure that our PPO network is comprehensive so people have broad access to care." The Medicare Plus Blue℠ PPO, announced in October, has lower premiums than Original Medicare plus a Part D prescription drug plan and supplementary coverage while retaining worldwide coverage for emergency care. It also provides services that aren’t available in Original Medicare or Medicare Supplemental plans. The new plan currently has a network of 23,000 physicians and 136 hospitals in 75 of Michigan’s 83 counties. Depending upon region, premiums will cost between $61 and $141 a month, compared to $183 per month for the BCBSM Medicare Supplemental (Medigap) Plan C product combined with a standalone Part D prescription drug benefit from the Blues. Some benefits covered in the PPO product not covered by Original Medicare or Medicare Supplemental are:
Source: bcbsm.com

Blue Shield Foundation Awards $10.7M in Q1 2013 Grant Funding

On Tuesday, the Blue Shield of California Foundation announced that it will provide $10.7 million in grants this quarter to support health care initiatives across the state, the San Francisco Business Times reports.
Source: californiahealthline.org

Blue Cross Blue Shield of North Dakota sponsoring free Medicare workshops for seniors

The workshops will be held in Grand Forks on Oct. 15, Bismarck on Oct. 17, Fargo on Oct. 18 and Minot on Oct. 23. The workshops are free and open to all North Dakotans who are eligible or soon to be eligible for Medicare. Seniors are encouraged to register for one of the free workshops online at www.medicareworkshopsnd.com or by calling 1-888-235-3905. The first 25 to register for one of the workshops will receive a free pedometer.
Source: ndakotabusiness.com

BlueCross BlueShield of IL Changing Medicare Supplement Rates

BlueCross BlueShield of IL announced a rate increase for most Medicare Supplement/Medigap customers effective March 1, 2013. In addition to the rate increase, changes have been made to the way BlueCross BlueShield of IL sets attained-age premiums. BCBSIL has switched from age bands to different rates for each age. In the past, BCBSIL had the same rate for the same Medigap plan for age groups, like 65-67; now, each age has its own premium rate. The change from age bands to single age rates will cause a few premiums to actually be lower after March 1, 2013 than they are now. For most people though, premiums are increasing.
Source: bcmil.com