Importance of having health care insurance or medicare supplemental insurance.

Posted by:  :  Category: Medicare

Medical Drugs for Pharmacy Health Shop of Medicine by epSos.deMedicare supplement insurance fills up the disparity between the Original Medicare has to pay and what the beneficiaries must pay out of their pocket for deductibles, co-insurance and co-payments. Supplement policies only pay for the services that the Original Medicare approved as medically necessary and payments are commonly based on the approved charge. Some of the benefits offered by supplement policies does not exist on Original Medicare, such as emergency care outside the country. Medicare supplements insurance are being traded by private companies that have license and regulated by TDI. However the supplement benefits are aligned by the federal government. You can check more details on supplemental insurance at http://www.medigapplansguide.com
Source: buyflightsimulators.com

Video: FREE MEDICARE LEADS/ MEDICARE SUPPLEMENT LEADS/ INSURANCE SALES LEADS

Medicare Supplement Enrollment Periods

The best time for a Medicare beneficiary to enroll in Medicare Supplement insurance is during the Medicare Supplement Open Enrollment Period (OEP), which differs for each individual. This is a six month enrollment period that begins on the first day of the month that you are both 65 or older and enrolled in Medicare Part B. This six month period begins when you first enroll in Part B and may not be moved or changed. During this time, beneficiaries have the guaranteed issue right to a Medigap plan, meaning that insurance companies may not use medical underwriting to deny coverage or charge higher premiums to those who have any pre-existing conditions. If you do have a pre-existing condition, though, a Medigap plan may delay covering it.
Source: planprescriber.com

Lawrence Uridetv, Insurance Broker's Weblog

A wise consumer is one who knows how to choose the best with the least expense, without compromising on quality of goods or services. It is the same when we choose a medicare (http://www.medigapplansguide.com) supplement insurance. A smart consumer would immediately visit http://www.medigapplansguide.com. Whichever area one may be living in, it is possible to get all the information regarding this type of insurance just by entering the zip code. One gets smart advice through a comparative comprehensive study of different insurance companies, plans, options, coverage and premium amount to be paid. With such a comprehensive analysis coupled with advice, it is easy to make a smart decision. Save maximum out-of-pocket money but get the same coverage.
Source: uridetv.com

Medicare Supplement Quoting Engine

The rates, from what i have heard from others I have referred there, tend to be "negotiable" with Quotit. I pay about $100 per month for the IFP module, Medsupp Module (included with IFP), MA/MAPD/PDP module and the Term Life module. For just IFP/Supps I was paying around $80 a month but others I have sent there were offered a lower monthly. I think they may offer the Medicare Supplement module stand alone now.
Source: insurance-forums.net

GPM Life Medicare Supplements

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

Produce Information On Medicare Supplements First

A single aspect of plan for Medigap Plans is the first three pints of blood. This is obscured in all plans, but in schedule K it is up to 50 percent, and plan S is up so that you can 75 percent. This is likewise true for the hospital deductible befit. The Skilled Nurse Facility daily coinsurance covers a specific amount per day for the days 21-100 of each benefit period. This is one advantage of plans 3 through L. For plan I and L, it can be 50 percent moreover 75 percent respectively. The part B annual deductible is obtainable for plans C, F and K.
Source: europeanpeaceaction.org

Perform Getting The Extremely Medicare Supplement Results In

Another aspect of policy coverage for Medigap Plans is the first three pints of blood. This is paid for in all plans, but in intend K it is up to 50 percent, and plan S is up to 75 percent. This is true for the hospital deductible befit. The Skilled The nursing profession Facility daily coinsurance covers a specific amount per day for the 21-100 of an individual benefit period. This is a benefit of plans K through L. For plan K and L, it can be 50 percent and as well as 75 percent correspondingly. The part B per year deductible is accessible for plans C, F and S.
Source: hi-see.org

Best Medicare Supplement Insurance

You simply want to give basic details into a form when employing a website to obtain Greatest Medicare Supplement Insurance coverage.  You will see various insurance coverage policies from varying providers Prograde supplements and you will be capable to critique the costs and policy figures from each and every provider.  You will have the ability to choose out the policies that are meet your demands and that you can spend comfortably.
Source: pakchom.net

How To Enroll In A Medicare Supplement Plan F Insurance Policy

Finally, be sure to review your coverage each year. All Medigap policies are subject to inflation, just like any other insurance. Most people will see an increase once a year, although some carriers also have “birthday increases,” which means the policy costs will increase slightly whenever your turn a year older. The good news is that you can always shop your policy when rates go up. It’s very easy to change insurance companies as long as you can pass the medical health underwriting. By shopping your policy annually, you can be sure to get the most out of your healthcare insurance dollars each and every year.
Source: return2writing.com

Medicare Supplement Plan F from Anthem Blue Cross Covers All of Your Health Care Needs

In addition to all of this, Plan “F” also has a foreign travel emergency benefit, which is useful for seniors on the go. If this sounds like a program that you would be interested in, find out more information today by calling the insurance agents at Benefit Packages. At Benefit Packages, we are an independent insurance agency that works with many different insurance companies. We can help you find the best Medicare supplement for your situation.
Source: benefitpackages.com

MHA’s Executive Briefing: CMS Announces July 31 Deadline for Medicare Shared Savings Program Applications

Posted by:  :  Category: Medicare

Healthcare solution >> more doctors by / // /On April 2, 2013, the Centers for Medicare and Medicaid Services (“CMS”) released key dates for the 2014 Medicare Shared Savings Program application cycle. Many were expecting the 2014 application deadline to be the same as 2013: the first week in September. However, CMS has announced a July 31 deadline. An accountable care organization intending to submit an application must file a Notice of Intent by May 31 and obtain a CMS User ID by June 6.
Source: typepad.com

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

Mississippi hospitals pressing lawmakers for Medicaid expansion

Dillard said Medicare’s disproportionate-share payments end Oct. 1, and the Forrest Health system, with five hospitals, will lose $13 million. The hospitals also stand to lose money through automatic federal budget cuts and a scheduled reduction in disproportionate-share payments through Medicaid. Altogether, the system could lose about $20 million. Dillard said expanding Medicaid would help cover part of the loss.
Source: gulflive.com

Mississippi Medicaid and Probate

In accordance with applicable federal law and rules and regulations, including those under Title XIX of the federal Social Security Act, the division may seek recovery of payments for nursing facility services, home- and community-based services and related hospital and prescription drug services from the estate of a deceased Medicaid recipient who was fifty-five (55) years of age or older when he or she received the assistance. The claim shall be waived by the division (a) if there is a spouse; or (b) if there is a surviving dependent who is under the age of twenty-one (21) years or who is blind or disabled; or (c) as provided by federal law and regulation, if it is determined by the division or by court order that there is undue hardship.
Source: fortenberrylaw.com

Q & A with Mississippi Gov. Phil Bryant

BRYANT: Prior to the Supreme Court ruling, all of us Republicans across the nation believed this was a failed law, a law that would drive up health insurance costs, a law that would causes taxes to go up on employers and cause all Americans to have to buy a product in a marketplace at the insistence of the federal government, and [you] could be punished for your inactivity. I am against the foundation that it rests on.  This is a terrible law that continues to be flawed. The Supreme Court decision, which people believed changed everything, said one, there is a tax, which the president had been denying since the beginning, that it will cause costs for employers to go up, but also states cannot be forced to expand Medicaid.  I believe that this is a bait and switch, where they say here is $20 million and you form a state insurance exchange. Let the governor sit idly by in Mississippi and say nothing and that exchange will inherently determine if you deserve a subsidy, but also can automatically take you to Medicaid.
Source: kaiserhealthnews.org

Jackson Jambalaya: Medicaid: there are statistics and then there is reality

“Here’s the reality: Medicare and Medicaid services, including the “slide it to the states” for Medicaid, spent $1.053 trillion in FY2012. We took in just $201 billion in Medicare taxes. That is, the government is spending five times what it is taking in on health care. Where is the discrepancy? In the Medicaid department; the “as spent” figures, unless you look real closely, hide the giveaway to the states. But that of course is BS as there is no magical money fairy. For Social Security (including disability) the government took in $572 billion in FY2012. But the government spent $773 billion on both retirement and disability, or 35% more than it taxed. That’s not the only shocker. We gave $77 billion to people in the form of Earned Income and Child credits in excess of tax liability — that’s the amount that we literally handed out in welfare for simply being alive. And we did not spend $180 billion on interest either — we spent $359 billion. We can survive the Social Security problem. We cannot possibly survive spending five times what we take in via Medicare taxes and lying about interest cost will blow up in our face as well.” Post The federal government at some point will pull the rug out from under the states on Medicaid as the current path will force it to do so. Whether or not such rug-pulling will be voluntary or involuntary when the government is forced to make cuts remains to be seen. However, there is no question the trend is unsustainable. Something the local pro-Medicaid expansion forces wish to ignore. If you think you are seeing a Medicaid war now, wait until you expand Medicaid and then remove people from the program several years from now when the state is forced to do so. $1 trillion v. $200 billion. Yes, Bobby, lets look at the statistics and then ask the question: “can we afford it? down the road. The problems with PERS and MPACT are created in no small part because the legislature in its infinite wisdom decided to expand benefits when the money was flowing like the River Jordan. However, the famine that visited the land of Israel did visit the budget and those two programs. Those arguing for more Medicaid benefits have learned nothing and forgotten everything.
Source: blogspot.com

Cottonmouth: Obama budget recommendations make Medicaid expansion even MORE important this year

Today, President Obama released his proposed budget for FY2014. In it, he recommends pushing Medicaid DSH payment cuts into FY2015. As you are no doubt aware, the loss of DSH payments is an absolute doomsday scenario for Mississippi hospitals and the communities they support. Predictably, Gov. Phil Bryant jumped in front of a microphone this afternoon and said that Obama’s proposal to push Medicaid DSH payment cuts into 2015 was reason to ignore the current debate over Medicaid expansion. Predictably, Gov. Bryant doesn’t know what in the hell he’s talking about. To begin with, please tell me if you can tell the difference between the following choices: Choice A – Medicaid DSH payments Choice B – DSH payments Any guesses? You got it: Medicaid DSH payments are different than “DSH payments.” See, there are Medicare DSH payments as well, and those are NOT being delayed until 2014 if Obama gets his budget through Congress. (Which is something that, mind you, has never happened.) Secondly, if Obama’s budget were to get through Congress (stop snickering, House Republican Caucus), that would only mean more severe cuts to Medicaid DSH payments to Mississippi hospitals in October 2015 than are currently contemplated for October of this year. Finally, there’s no doubt that DSH payments are getting cut. That’s coming regardless of what happens with this year’s federal budget process. And there’s also no doubt that Mississippi hospitals and communities cannot function unless Medicaid expansion is done before that happens. That’s math even Gov. Bryant should be able to perform.
Source: blogspot.com

Medicare Expert Patricia Barry, Ask Ms. Medicare

Eligibility Learn about how you can qualify for health coverage under Medicare. Enrollment Learn about when and how to sign up for Medicare according to your circumstances. Disenrollment Learn about how to opt out of Medicare if you are already enrolled. Out of Pocket Expenses Learn about your share of Medicare costs. Medical Coverage (Part A and Part B) Learn about medical services covered under Part A (hospital insurance) and Part B (outpatient insurance). Prescription Drug Coverage (Part D) Learn about how Medicare’s prescription drug program works. Medicare Private Health Plans Learn about the Medicare Advantage program, an alternative way of receiving Medicare benefits. Sources of Information and Help Learn about how to find personal help on Medicare issues.
Source: aarp.org

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

Posted by:  :  Category: Medicare

Deputy Administrator and Director for the Center of Medicare at CMS Jonathan Blum visits Christiana Care to speak about accountable care organizations by Christiana CareThe 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

Video: Medicare Supplement Plans | Medicare supplement Health Plans

Sebelius: Insurance Exchanges ‘On Track;’ Premiums Could Rise For Higher

The Associated Press: Upper-Income Seniors’ Medicare Hike President Barack Obama’s plan to raise Medicare premiums for upper-income seniors would create five new income brackets to squeeze more revenue for the government from the top tiers of retirees, the administration revealed Friday. First details of the plan emerged after Health and Human Services Secretary Kathleen Sebelius testified to Congress on the president’s budget …. Currently, single beneficiaries making more than $85,000 a year and couples earning more than $170,000 pay higher premiums. Obama’s plan would raise the premiums themselves and also freeze adjustments for inflation until 1 in 4 Medicare recipients were paying the higher charges. Right now, the higher monthly charges hit only about 1 in 20 Medicare recipients (Alonso-Zaldivar, 4/12).
Source: kaiserhealthnews.org

Medicare private plan enrollment hits 12.8 million

Greater participation in Medicare Advantage could lead to higher federal spending. Government studies have found that the Medicare Advantage program costs the government more than traditional fee-for-service, but the gap has narrowed somewhat in recent years. A few years ago, average payments to private plans were 113% of what the program paid under fee-for-service, said Jon Blum, CMS deputy administrator and director of the Center for Medicare. Today, it’s roughly 107% of fee-for-service.
Source: amednews.com

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

Proposed Rule Imposes Spending Ratio on Insurers in Medicare Contracts

Health insurers who fail to establish a MLR of .85 may have to pay CMS a “remittance” fee under the proposed rule.  The remittance fee would be based on the difference between 85 percent of the total revenue and the contract’s actual ratio spent on direct benefits, multiplied by the contract’s annual revenue.  If a contract fails to meet the .85 MLR requirement for three years in a row, CMS will stop permitting Medicare beneficiaries to enroll in any plan covered under the contract for a year.  CMS will terminate a contract if it continues to miss the requirement for five consecutive years.
Source: upenn.edu

Marci’s Medicare Answers

Original Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, only covers eyeglasses after you have had cataract surgery. Original Medicare generally does not cover routine eye care, such as examinations for prescribing or fitting eyeglasses. However, Original Medicare will cover a standard pair of untinted prescription glasses or contacts, if you need them after cataract surgery. If considered medically necessary, Medicare may cover customized eyeglasses or contact lenses following the procedure.
Source: homeboundresources.com

Health First Health Plans Offers ‘ABCDs of Original Medicare’ Lectures

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

Lawmakers Release Plan To Permanently Replace Medicare Pay Formula

Rep. Michael Burgess (R-Texas) — chair of the Republican Doctors’ Caucus — said that House GOP leaders are committed to quickly developing an SGR replacement that has bipartisan support and that lawmakers will hold a hearing on the matter within the next two months. However, lawmakers have not yet determined offsets for their plan that would be capable of gaining bipartisan support, Burgess added.
Source: californiahealthline.org

Population Health Management In Medicare Advantage

Posted by:  :  Category: Medicare

"SO, THE HEALTHCARE 'TAX' PASSED THE SUPREME COURT." by roberthuffstutterWellnesss 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

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Help Me with Medicare Advantage and Drug Question

hi all. my name is mike and i will retire in july. i am 66 years old and about to go on medicare for the first time. I recently met with two different agents to talk about medicare. one with bankers life and one with united health. and they are telling me two different things, and I dont know who is telling me the truth. Bankers life is telling Medicare advantage is bad. and I cannot have a separate Pt D plan with it (i can only do it, if the drug plan is built into it). and I should go with them and pay a premium i cannot afford for a medicare supplement. The united health guy is telling me I can have a pt d plan if the advantage plan does not have a drug plan built into it. This would be good for me, because the advantage plan has no monthly premium. He says I should do it like this because the PPO that he offers that does have the drug plan built in, wouldn’t cover some of my drugs, and it would be really expensive, but he was able to find a separate pt d plan that would keep my drug costs down. they are telling me two contradicting things, one is obviously lying. who is telling me the truth?
Source: insurance-forums.net

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

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

CMS softens Medicare Advantage funding changes, reducing chance of drastic plan alterations

The shares of several health insurers rose sharply in extended trading Monday following the CMS announcement. Medicare Advantage plans have become a key source of growth for insurers, which receive about $10,000 per member to provide customers with basic Medicare coverage topped with vision or dental coverage, or premiums lower than standard Medicare rates.
Source: telcoretirees.org

Get 'rock solid' with Medicare Advantage

When providers partner with Benefits365, they receive educational pieces on Medicare Advantage that they then provide to beneficiaries. One way to do that is through monthly statements. The idea: A beneficiary calls Benefits365 to switch from Medicare to Medicare Advantage, and both the beneficiary and the provider benefit from working with the latter vs. the former.
Source: hmenews.com

Understanding the Medicare “Donut Hole”

Posted by:  :  Category: Medicare

Stella Johnson On The Impact Of Health Insurance Reform by Leader Nancy Pelosi- MacKenzie has Medicare Part D coverage, and incurs $2,000 in prescription drug expenses in 2013. Once MacKenzie meets her deductible and coinsurance obligations, Part D will cover her remaining expenses in full, since she did not eclipse the initial coverage limit. – George has Part D coverage and incurs $4,000 in prescription drug expenses in 2013. Part D only covers the first $2,970 of George’s expenses, since he reached the initial coverage limit; he must pay the remaining $1,030 on his own. – Esther has Part D coverage and incurs $6,000 in prescription drug expenses in 2013. Part D only covers the first $2,970 of Esther’s expenses (since she reached the initial coverage limit), and she must pay an additional $1,780 out of pocket. However, at this point Esther’s expenses have reached the out-of-pocket threshold, which means her catastrophic coverage kicks in. Thus, her Part D coverage resumes paying benefits and will pay for the remaining $1,250 of Esther’s benefits.
Source: insurancelicenseexpress.com

Video: Medicare Part D – The Donut Hole

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

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

Budget Cutters Propose Big Hits on Pharma

Despite the the administration’s claim that its boosting 2014 funding for FDA by $821 million, that actually translates into less money for oversight of drugs and biologics. Most of the added resources will come from newly proposed user fees and previously agreed-on fee increases. Any added revenues are targeted to food safety, a new China import initiative, support for medical countermeasures and lab and building costs. The actual funds available to FDA for this year already are $117 million less than for 2012, according to the Alliance for a Stronger FDA. And without hefty new user fees, which are not likely to be approved, the numbers will go down even more for 2014. It’s pretty hard to detect what the numbers really are, but the prospects for a stable regulatory operation are not bright.
Source: pharmexec.com

Medicare drug costs to fall in 2014, but donut hole widens

Before passage of the ACA, seniors in the gap paid 100 percent of all drug costs. Now, they pay 50 percent out-of-pocket for brand-name drugs, with the rest made up by insurers and discounts from pharmaceutical manufacturers. For generics, they pay 79 percent. Enrollees’ out-of-pocket burden for brand-name and generic drugs will gradually fall to 25 percent by 2020 – the same percentage applied for standard coverage.
Source: medcitynews.com

Medicare private plan enrollment hits 12.8 million

Greater participation in Medicare Advantage could lead to higher federal spending. Government studies have found that the Medicare Advantage program costs the government more than traditional fee-for-service, but the gap has narrowed somewhat in recent years. A few years ago, average payments to private plans were 113% of what the program paid under fee-for-service, said Jon Blum, CMS deputy administrator and director of the Center for Medicare. Today, it’s roughly 107% of fee-for-service.
Source: amednews.com

Medicare “Donut Hole” Gets a Little Smaller in 2013

The difference between Medicare Part D plans is that one plan may charge significantly more for specific drugs than another plan. This could also be true if you have a Medicare Advantage plan that includes drug coverage. That’s because they negotiate prices with manufacturers and middlemen.
Source: allsup.com

Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk 

[1] See Medicare Supplement Insurance First Dollar Coverage and Cost Shares Discussion Paper, National Association of Insurance Commissioners (NAIC), Senior Issues Task Force, Medigap PPCA Subgroup, (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  Also see, e.g., Leadership Council on Aging (LCAO) issue brief “Reforming Medigap Plans by Shifting Costs onto Beneficiaries: A Flawed Approach to Achieving Medicare Savings” (December 2012), available at: http://www.lcao.org/docs/LCAO-Medigap-Issue-Brief-12-12.pdf [2] Medigap Reform: Setting the Context, Kaiser Family Foundation, (September 2011), available at http://www.kff.org/medicare/8235.cfm. [3]Medigap Reform: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs, Kaiser Family Foundation, (July 2007), available at http://www.kff.org/medicare/8208.cfm. [4] See, e.g., previous Weekly Alerts, including finding drug savings in Medicare (November 2011) http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ ; Prescription Drug Rebates (July 2011) http://www.medicareadvocacy.org/2011/07/21/debunking-medicare-myths-drug-rebates-for-dual-eligibles/ ; and additional options for achieving Medicare savings (June 2011) http://www.medicareadvocacy.org/2011/06/09/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/.
Source: medicareadvocacy.org

Duckworth Discusses Concerns About Cuts To Social Security, Medicare With Elgin Residents

“We’re sitting here looking at four major surgeries for cancer. We’ve just gotten through the fourth one … and we have tens of thousands of dollars worth of bills that are covered by Medicare,” Ceithaml said after meeting the congresswoman. “We would have lost our house three times over already if there had not been the present level of Medicare, and to make it a lower level is just unconscionable.”
Source: progressillinois.com

State of Indiana Selected Press Ganey to Conduct Nursing Home Satisfaction Surveys

Posted by:  :  Category: Medicare

2009localidiots by lobstar28Press Ganey Associates, Inc. Recognized as a leader in performance improvement for nearly 30 years, Press Ganey partners with more than 10,000 health care organizations worldwide to create and sustain high-performing organizations, and, ultimately, improve the overall health care experience. The company offers a comprehensive portfolio of solutions to help clients operate efficiently, improve quality, increase market share and optimize reimbursement. Press Ganey works with clients from across the continuum of care – hospitals, medical practices, home care agencies and other providers – including 50 percent of all U.S. hospitals. For more information, visitwww.pressganey.com.
Source: knowledgeservices.com

Video: Indiana Medicare

8 Recent Medicare, Medicaid Issues

Here are eight issues dealing with Medicare or Medicaid that occurred in the past week, starting with the most recent. 1. President Barack Obama released his budget proposal for the federal government’s 2014 fiscal year, and the budget included roughly $400 billion in Medicare cuts over the next decade. 2. Illinois Department of Health and Family Services Director Julie Hamos, who oversees the state Medicaid program, said there may not be enough physicians to take care of the newly insured. 3. CMS Acting Administrator Marilyn Tavenner went before the Senate Finance Committee, and senators who conducted the hearing said they expect to vote on her appointment as early next week. 4. A report from Moody’s Investors Service said the 2 percent Medicare cuts from sequestration will further impair the “already challenging operating environment” of hospitals, physician practices and other healthcare organizations. 5. Indiana and Ohio lawmakers have blocked bills to expand Medicaid in both states. 6. Maine officials debated how to pay off $484 million in Medicaid debt owed to its 39 hospitals. 7. In an effort to reduce administrative burdens on hospitals and other providers, CMS reduced the minimum medical record requests from Medicare Recovery Auditors — formerly known as Recovery Audit Contractors, or RACs. 8. A report from the Safety Net Hospital Alliance of Florida found if the state Senate goes through with its plan to change how hospitals are reimbursed for providing Medicaid care, non-profit safety-net hospitals could lose tens of millions of dollars to for-profit hospitals.
Source: beckershospitalreview.com

Public hearings set to discuss Medicaid expansion, Healthy Indiana Plan

The hearings come on the heels of an exchange between Statehouse Democrats and the governor over an apparent oversight by the administration to meet appropriate deadlines for a waiver application. Democrats continue to push for an extension of health care coverage in Indiana, citing the potential for 30,000 new jobs, the injection of billions of dollars into local communities and the extension of health care services to an estimated 400,000 more Hoosiers. Read more>>
Source: wordpress.com

New to Medicare Advantage Field Sales

Is this a serious question? Ill pretend it is. First off you aren’t geared up if you don’t know how you can market them. The answer ls to your questions are #1- absolutely not #2 If you buy leads that are approved to be marketed or MA plans and they have you their number then yes you can call them. Now go take AHIP and if you have already got that done you may need to take it 10 more times…
Source: insurance-forums.net

The Debate over Expanding Medicaid in Indiana

Medicaid expansion is one of the provisions of the Affordable Care Act that states have the option to accept. The expansion is designed to broaden coverage to adults with incomes below 133% of the federal poverty level (FPL), which after disregarding the first 5% of household income effectively equates to 138% of the FPL, or about $32,500 for a family of four. While Medicaid criteria currently varies by state (in contrast to Medicare, which is uniformly managed across the country for all persons over age 65 and those who are under age 65 and disabled), most states fail to cover the vast demographic of childless, non-disabled adults.
Source: wordsforgood.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

COMPARING THE ECONOMY OF YESTERYEAR WITH TODAY'S ECONOMY... by roberthuffstutterThe page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Medicare Supplemental Insurance Comparison

Need Help Picking Right Medicare Advantage Plan for Mom!! » Toni Says

*Some plans are $175 co pay per day for 20 days which can be a maximum                                       $3500 if you are in the hospital for over 20 days or might be $150 co pay per                             day for days 1-5 with a maximum of $750 maximum stay if you are                                                 inpatient hospital for more than 5 days (example only)
Source: tonisays.com

Medicare Open Enrollment: last chance to review and compare plans

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

Summit Medigap: How To Compare The Different Medicare Supplement Plans

1990, Medicare standardized their different plans in order to decrease the amount of confusion that consumers were experiencing as they compared different coverages offered by the different healthcare insurance providers. As a result of this standardization, it is easier for the consumer to understand the comparison of these different benefits and the associated cost comparisons between healthcare insurance providers. As a result, the terms “MediGap plans” and “Medicare supplement” basically mean the same thing and are commonly used interchangeably. As a result of having so many Medicare plans to choose from, it is important to research each one in order to decide which will be best for your personal needs and situation. One of the first things to be aware of when searching for supplement plans and comparing the ones you find is that many websites who advertise these are only there for one reason and that is to collect your personal information. In many cases, insurance providers will purchase leads or develop lead generators to accomplish this instead of actually doing what they advertise. Basically, these companies don’t know the proper ways of developing new business so they resort to these somewhat underhanded methods. Many of these companies make it appear as though they actually sell the different Medicare supplement plans but the reality is that they will collect your personal information and sell it to numerous insurance agents. Here are two ways that you can tell if they are legitimate healthcare insurance and Medicare supplement plan providers. First of all, there will be a toll-free number to call and secondly, there will be a statement promising that they will never sell your personal information to anyone else. Do price comparisons of these different Medicare plans when searching through the different companies that offer them. The better insurance brokers will be able to provide you with these comparisons from those insurance providers operating in your local area. In most cases the prices will differ despite the fact that the supplement plans they offer are identical. Remember, it is better to do plenty of research in order to make a well-informed decision when purchasing the Medicare supplement plan that is right for you.
Source: blogspot.com

Compare Medigap Plans Medicare Supplemental Insurance Texas

It is hard to track down online scammers. Therefore, precaution sounds cure. You should never give your sensitive information online and not pay through wire-transfers. Do not click on accessories in emails out of unknown sources for the reason that may contain spy ware and spyware that put you at the risk of masterplans scams. Use the internet only from relied upon e-commerce stores and do not accept any job role offers online without requiring checking the experience of the work. By taking small precautions, you can enjoy a hassle-free from the internet experience and watch over yourself from rip-off.
Source: wholesomefood.org

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

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

Compare Medigap Plans Medicare Supplemental Insurance Colorado

Our recommendation is that the participant ascertains comprehensive health reception by opting to shut the gaps in the current plan they hold. The options that one has to seal the gaps are highlighted below. Workout is one incredible type of exercise Baby Boomers are of. Yoga exercise focuses on the snooze and breathing devices. It has very low impact towards body of virtually any person, that ages young and old in any size can practice yoga stretches and make an appealing impact to their. This is because yoga doesn’t stress out unquestionably the muscles and bone tissues of a person, especially those in which in their high tech age where joints and muscles have been brittle and definitely damaged. Treatment Part A coinsurance – Available to all of the Medigap Plans from That to N. Medicare coverage with regard to Part A coinsurance means that you have to pay your store of the costs for the service that you used. This is applicable after you pay any the insurance deductibles. Suppose you had a Part An application and your coinsurance states that you pay for 20% of your fee for that service; in small terms, this shows that your Medigap insurance policy takes care within the remaining 80% with the bill. To example, Medicare may pay for a single hospital stay in the event of a bewildering dental procedure. But it would possibly not cover the actual dental work. For another example, Medicare does and never usually cover eyeglasses or contacts. However, it is advantageous after intraocular lens cataract surgery. Medicaid is as actually a health computer program that also has constantly directed to serve peoples assist of their age, colouring material or cast and gospel by plying your kids medical funds truly. Unlike health medical insurance and Which Medicare Supplement plan Is Best For You?, Medicaid is not any insurance policy ; it is a particular semi government effort establishment which is definitely working for that wellbeing of a person’s beings in the united states. It gadgets the needy peoples get through deadly ills without requiring to concern designed for their infirmary charges, physician fee as well as , medicine expenses. To apply when it comes to Medicaid you wish to pass pre-determined eligibility tests which include means-test and after that needs-based social well being and social safety equipment . Peoples who dispose today in one related these areas will definitely be being inscribed exactly as fellow members linked with Medicaid. The customer can straightway enroll in the Part D Medicare program during the necessary enrollment period. This period usually starts three months before you are supposed to reach sixty five quite a few of age to continue until 3 or more months after you really have attained sixty five years attached to age. Medicare health insurance is a government-run health insurance tv show that offers help and support with payment on hospital care (part A) and doctor’s care (part B). Prescription drug coverage is perhaps even available through part D. Qualifications for medicare could based on condition or age.
Source: typepad.com

Yikes! The page you requested is not available

Join Reporting on Health, the Association of Health Care Journalists and the Alliance for Health Reform In LA April 22 for a panel discussion on the complex issues California faces as we near 2014 health law changes. 
Source: reportingonhealth.org

Compare Medigap Plans Medicare Insurance Supplemental Insurance Colorado

Its hard to outline online scammers. Therefore, precaution sounds cure. Don’t ever give your fragile information online and not pay through wire-transfers. Do not click on contraptions in emails coming from unknown sources they may contain spy ware and spyware of which put you in the risk of masterplans scams. Make an online purchase only from depended on e-commerce stores certainly not accept any tasks offers online whilst not checking the recommendations of the recruiter. By taking small precautions, get ready to experience a hassle-free from the internet experience and protect yourself from scams. A consequence of to the fact that different airlines were offering new benefits, Congress well then took action, transmitted laws and controlled the sale akin to the Medicare applications. Relative to Congress regulation, one particular number of Medigap Plans were modified coupled with were set higher based on the particular needs that nicely arise in various kinds of circumstances. My then eliminated any disadvantages of ancient insurance policies, which were hard to finally compare before Our lawmakers standardized them. With the changes, the Medicare products in Texas started to become better and additionally applicable to some needs of this elderly Texan. Regulations for scooters, and for POVs (power-operated vehicles) include the certification above; however, specific scooter must be advised by a company in Neurology, Rheumatology (arthritis), Orthopedic Surgeon, or Physiatrist (physical medicine). Scooters for children require more associated with the trunk as well as the arm strength to your job the tiller. There are some people what person successfully fulfill all the eligibility criteria of both Medicare and Medicaid substance as a result that they may very well be old (age prior 65 years ) and needy possibly at the exact time, with no regular rootage of income. Such peoples which will are members of both formations at the same time are recognized to as Medicare parallel eligible. The United States occupants ascertain AARP and moreover its health insurance cover plan policies rattling welcoming. If you have original Medicare along with want to move to a Medicare Advantage plan, then you’ll want to enroll in every stand-alone MA-PD to avoid a late enrollment penalty (unless in order to creditable coverage). While many Medicare Advantage plans offer prescription drug insurance policy as part for the plan, there are a handful of that don’t. If you have a Medicare Advantage method that doesn’t offer up drug coverage, it is important to find a stand-alone MA-PD. The person must need the power wheelchair use when it comes to the home. Power mobility hardware that is would need only for efficiency or for fun purposes does possibly not qualify for Treatment benefits. Needless to say the person are likely to use the juice wheelchair to turn out out; however, if that is the particular only purpose in order for the power wheelchair, the equipment undoubtedly not be a good allowable charge. Or even many things time for consider when looking at medicare supplement Advantage plans during this summers annual enrollment menstrual period. Remember, the annual enrollment period this current year runs from July 15 – August 7. Child boomer is another kid that was born in a period of increased birth rates, or Baby boom, and the time is especially added to those born the particular post-World War 2 period of boosted birth rates. In the combined states, the terms is classic etc . properly capitalized for the reason that Baby Boomers. Medicare health insurance Supplement Plans, also called Medigap Insurance policy plan policies, are plans that are marketed by private insurance plan companies to cover healthcare costs who seem to are not guaranteed by Medicare within Original Medicare Strategies. Individuals are permitted for Medicare professional medical coverage if these kinds of products are at minimum 65 years elderly or have a qualifying disability. From this day forward in the Australia there are no more universal governmental training on health insurance coverage coverage. People would be more senior 65 years and a functional part of invalids of younger age group ranges can receive medical aid within all limits of program Medicare. An majority of Us insure the health at the outlay of money of the employers.
Source: typepad.com

Compare Them Medigap Plans Medicare Health Insurance Supplemental Insurance Colorado

Our recommendation is that the participant warranties comprehensive health coverage by opting to close the gaps with limited funds plan they traction. The options that one has to shut the gaps are as follows. Workout is one great type of physical exertion Baby Boomers are into. Yoga exercise focuses on the relaxation and breathing methods. It has very low impact towards the body of a functional person, that every age in any quantity can practice workout and make an appealing impact to their own health. This is because yoga shouldn’t stress out the actual muscles and osseins of a person, especially those are generally in their advanced age where joints and muscles are brittle and simply damaged. Medicare insurance Part A coinsurance – Available in each Medigap Plans from Your own to N. Medicare coverage for Part A coinsurance means that you should pay your store of the expenses for the aid that you in use. This is applicable after you paying any the deductibles. Suppose you had a Part Program and your coinsurance states that spend for 20% of your fee for your service; in trouble-free terms, this shows that your Medigap coverage takes care within the remaining 80% with the bill. On behalf of example, Medicare might probably pay for a major hospital stay in the event of a stressful dental procedure. But it could cover the proper dental work. For another example, Medicare does just not usually cover eye glasses or contacts. However, it repays after intraocular the len’s cataract surgery. State medicaid programs is as well a health laptop or desktop program that owns constantly directed to serve peoples nevertheless of their age, colouring material or cast and gospel by plying him medical funds also. Unlike health health care insurance and Supplemental Medicare Insurance Plans and Their Benefits, Low income health programs is not some sort of insurance policy – – it is a particular semi government activity establishment which was working for the wellbeing of person’s beings in land. It allows the needy peoples get through deadly ills without owning to concern to work with their infirmary charges, physician fee and medicine expenses. To apply when considering Medicaid you will want to pass pre-determined eligibility tests which include means-test along with needs-based social contentment and social wellbeing . People who dispose having said that in one involved with these areas will definitely be being inscribed exactly as fellow members with Medicaid. You have to can straightway get in the Task D Medicare support during the initial enrollment period. This period for the most part starts three a couple of months before you are supposed to approach sixty five years of age and continue until three months after individuals have attained 62 five years of age. Treatment is a government-run health insurance program that offers suggestions with payment at hospital care (part A) and medical care (part B). Prescription medicine coverage is also available through a necessary part D. Eligibility for medicare is based on disadvantages or age.
Source: typepad.com

Comparing Medicare Supplemental Insurance Benefits

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

Cliff Averted: Medicare Fee Schedule Intact

Posted by:  :  Category: Medicare

As CMS reminded providers in its 12/19/2012 bulletin, clean electronic claims are never paid sooner than 14 calendar days after the date of receipt. CMS has promised to issue further notification before January 11, 2013 with an update on its progress in updating its fee schedule (remember, CMS was forced to load the 2013 fee schedule with the projected pay cuts, since Congress acted so late in averting the cuts). It is our hope that CMS will be able to work quickly enough within these next two weeks in order to avoid having to reprocess claims for 2013 dates of service.
Source: healthcarebiller.com

Video: Medicare Physician Fee Schedule; the Never Ending Debate

GOP SGR Plan Would Ease Docs Toward Medicare Pay

Medpage Today: Congress Moves Forward On SGR Replacement Physicians’ Medicare payments in the future would be based in part on quality metrics relative to their peers, their own performance from previous years, and clinical improvement activities, according to an updated proposal from House Republicans. GOP lawmakers released on Wednesday a more fleshed-out proposal of their plan to repeal Medicare’s sustainable growth rate (SGR) formula which determines physician payments and replace it with a plan to reward value and efficiency. … The plan still calls for providing physicians with a stable, predetermined fee schedule for a period of years — which lawmakers still haven’t specified — to allow providers to transition to alternative payment models. But after that transition, payments would be based on performance measures, which the lawmakers provided more detail on (Pittman, 4/4).
Source: kaiserhealthnews.org

Medicare’s 2013 Fee Schedule Compared to 2012

On November 1, 2012, the Centers for Medicare & Medicaid Services (CMS) released the final 2013 Medicare Physician Fee Schedule (MPFS) and its updated conversion factor. Under current law, providers paid under the MPFS will face significant cuts to reimbursement rates. Within the law governing reimbursement rates, a mechanism known as the Sustainable Growth Rate (SGR) automatically would have resulted in a significant decrease in Medicare reimbursement rates over the past several years. However, Congress has intervened each year to override the SGR, meaning rates have been generally flat each subsequent year. For 2013, if Congress does not intervene, the SGR will result in a 26.5 percent cut to the Medicare Part B conversion factor from $34.0376 to $25.0008.
Source: healthcarereforminsights.com

House Panels Invite Comments on Medicare SGR/Physician Fee Schedule Reform : Health Industry Washington Watch

The Chairmen of the House Ways and Means Committee and House Energy and Commerce Committee are inviting comments on the outline of a proposal to permanently repeal the sustainable growth rate (SGR) formula for updating Medicare physician fee schedule payments and institute other payment reforms. The lawmakers are considering a three-phase proposal. In the first phase, the SGR formula (which Congress has repeatedly overridden to avoid sharp reimbursement cuts) would be repealed, which would eliminate an estimated 25% across-the-board rate cut in 2014 and any future SGR cuts. In its place, the plan would provide an unspecified “period of predictable, statutorily-defined payment rates.” In phase two, the plan would link payment to performance on physician-endorsed measures of quality of care, while in phase three, physicians could earn additional payments based on efficiency of care. The Committees also are considering addressing several other related issues, including gainsharing, medical liability reform, Independent Payment Advisory Board repeal, and private contracting/balance billing. Comments will be accepted on the plan until February 25, 2013 at SGRComments@mail.house.gov.
Source: healthindustrywashingtonwatch.com

2013 Medicare Fee Schedule Reduction Averted

In order to allow sufficient time to develop, test, and implement the revised MPFS, Medicare claims administration contractors may hold claims with January 2013 dates of service for up to 10 business days (i.e., through January 15, 2013). CMS expect these claims to be released into processing no later than January 16, 2013. The claim hold should have minimal impact on physician/practitioner cash flow because, under current law, clean electronic claims are not paid sooner than 14 calendar days (29 for paper claims) after the date of receipt. Claims with dates of service prior to January 1, 2013, are unaffected. Medicare claims administration contractors will be posting the MPFS payment rates on their websites no later than January 23, 2013.
Source: ellzeycodingsolutions.com

ICYMI: New Report Confirms CMS Can Base Medicare Advantage Payments on Likely Congressional Action

In comments submitted to the agency, AHIP also raised concerns about CMS’ assumption about the SGR: “Our key issues and recommendations…begin with a discussion of the Sustainable Growth Rate (SGR). To prevent the MA program from going into a tailspin, the agency needs to implement a solution that will be big enough to solve the problem. Without beginning here, no consideration of other strategies on their own will be enough to prevent major cutbacks that seriously jeopardize beneficiary access to the coordinated systems of care provided by Medicare Advantage plans.”
Source: ahipcoverage.com

Insurance Committee Update

When CMS decided that coverage for sleeve gastrectomy would be a local determination.  The procedure also became locally priced.  Through our research it appears this is the standard for locally determined procedures.  The convention for locally priced procedures is a zero value in the CMS physician fee schedule.  Unfortunately, This has led some private payors to now value the sleeve gastrectomy code as zero RVU’s.  This is likely an automated problem.  With payment software pulled the new value directly from the fee schedule.
Source: asmbs.org

Congress Passes Bill to Avoid “Fiscal Cliff,” With Medicare Doc Fix, Other Medicare/Medicaid Extensions

The legislation requires CMS, for services furnished on or after January 1, 2014, to adjust payments relating to the end stage renal disease (ESRD) bundled payment rate to reflect changes in utilization of certain drugs and biologicals. In making reductions, CMS must take into account the most recently available data on average sales prices and changes in prices for drugs and biological reflected in the ESRD market basket percentage increase factor. The legislation also delays until January 1, 2016, implementation of oral-only ESRD-related drugs in the ESRD prospective payment system. HHS also must conduct an analysis by January 1, 2016, of the case mix payment adjustments relating to ESRD bundled payments, and make appropriate revisions to such case mix payment adjustments. The Government Accountability Office (GAO), no later than December 31, 2015, must prepare a report to Congress on how HHS has addressed implementation of payments for oral-only ESRD-related drugs in the bundled ESRD prospective payment system.
Source: wolterskluwerlb.com

Help Me with Medicare Advantage and Drug Question

Posted by:  :  Category: Medicare

"SO, THE HEALTHCARE 'TAX' PASSED THE SUPREME COURT." by roberthuffstutterhi all. my name is mike and i will retire in july. i am 66 years old and about to go on medicare for the first time. I recently met with two different agents to talk about medicare. one with bankers life and one with united health. and they are telling me two different things, and I dont know who is telling me the truth. Bankers life is telling Medicare advantage is bad. and I cannot have a separate Pt D plan with it (i can only do it, if the drug plan is built into it). and I should go with them and pay a premium i cannot afford for a medicare supplement. The united health guy is telling me I can have a pt d plan if the advantage plan does not have a drug plan built into it. This would be good for me, because the advantage plan has no monthly premium. He says I should do it like this because the PPO that he offers that does have the drug plan built in, wouldn’t cover some of my drugs, and it would be really expensive, but he was able to find a separate pt d plan that would keep my drug costs down. they are telling me two contradicting things, one is obviously lying. who is telling me the truth?
Source: insurance-forums.net

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

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

CMS softens Medicare Advantage funding changes, reducing chance of drastic plan alterations

The shares of several health insurers rose sharply in extended trading Monday following the CMS announcement. Medicare Advantage plans have become a key source of growth for insurers, which receive about $10,000 per member to provide customers with basic Medicare coverage topped with vision or dental coverage, or premiums lower than standard Medicare rates.
Source: telcoretirees.org

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

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

Get 'rock solid' with Medicare Advantage

When providers partner with Benefits365, they receive educational pieces on Medicare Advantage that they then provide to beneficiaries. One way to do that is through monthly statements. The idea: A beneficiary calls Benefits365 to switch from Medicare to Medicare Advantage, and both the beneficiary and the provider benefit from working with the latter vs. the former.
Source: hmenews.com

Medicare Advantage Plan Enrollment Periods « Insurance News from Crowe & Associates

There are only certain times when you can enroll/dis enroll or change a Medicare Advantage plan. Note that Medicare Advantage plans are sometimes called Medicare Part C or an MAPD plan.   There is a general period when someone turns 65 in which they can enroll.  This time frame is 3 months before the month they turn 65, the month they turn 65 and three months after they turn 65.  There is also the AEP period during which current members can make any type of plan change. This period runs from October 15th to December 7th every year. During this time, an application can be put in to make a change for a January 1 effective date.   The last type of period is the SEP period (Special Election Period) in which a change can be made at any time during the year.  Click on the link below for access to a grid showing all elections.
Source: croweandassociates.com

Marci’s Medicare Answers

Posted by:  :  Category: Medicare

Martin Place 1 by Greens MPsOriginal Medicare, the traditional fee-for-service Medicare program offered directly through the federal government, only covers eyeglasses after you have had cataract surgery. Original Medicare generally does not cover routine eye care, such as examinations for prescribing or fitting eyeglasses. However, Original Medicare will cover a standard pair of untinted prescription glasses or contacts, if you need them after cataract surgery. If considered medically necessary, Medicare may cover customized eyeglasses or contact lenses following the procedure.
Source: homeboundresources.com

Video: Dental Insurance Commercial for Folks on Medicare

– Can disabled adult son get Tricare and dental coverage?

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

lorainecolon1: What Is Medicare Some C And Solutions Are Its Dental Coverage Options

Dental office Insurance – I am not flabbergasted to see a lot of health care insurance that are being marketed in seniors. Go on to keep in mind any not all firms will be covered, and you happen to be likely to receive deductibles, copays, and yearly maximums by which are specified found in any policy. The coverage can help you tactic for expenses, nonetheless is not possible to totally discard all costs. The Baby Boomers spend way more on themselves when compared to what their parents ever before did. Her parents were heirs of the Amazing Depression and Area War Two. Their goal turned out to be saving money not really spending it. There was always the possibility with regards to another depression in the back using their minds. This baby boomer generation, including myself, goes on specific idea that your company only live only once and you may as well enjoy it. Eligibility extends to very own spouse, meaning that if you seem to be married to a person who has worked for many more than ten years, the eligibility exercises to you too. Additionally, you will want to be aged either 65, or a person have been listed with a lengthy term disability or solution failure. Merely because Medigap Plans automatically compensation their share for Medicare-covered expenses, could keep your health care providers who currently working with Medicare health insurance. Medigap insurance doesn’t restriction you to a provider network as well require a prospect to see a specialist. Medicare Advantage opportunities typically have this type of requirements, though. Obtaining Medigap supplemental insurance policy coverage is just just like tricky as calculating out if somebody can buy the program. The a single one thing that remains true no be an issue where you purchase the insurance taken from is that for the reason it is governed by the laws and of the state and Federal federal the benefits to be found are the same to everyone. Although the insurance policy remains the same no matter this provider there are perhaps differences amongst the insurance companies their own self. The differences will be located in price, administrators within the plan then the available Medigap options. Patrons can choose which range from caregivers that residing in or dozens of who work using separate shifts. A paraplegic victim for example, may require around the clock health care, whereas someone that might be recovering ranging from a leg injury may need basically few hours of a doctor recommended demanding therapy per day. Guardians of troubled individuals can making their selections located on individual wishes. Doctors may sometimes intervene to recommend or prescribe a meaningful specific care, very likewise, it’s judging by a number of things. Taking into consideration that they are being offered by the private companies, it will be just right in anyone who wishes to have Medicare health insurance supplement plans regarding do medicare enhancer comparison. This in turn is to ensure which plan is considered to be best fit that can the budget and even the needs of the one that wishes to make it. Practicing such comparison amid plans will one reach a sound decision when selecting the effectively plan. Member B of medicare supplement plans concerns expenses for out-patient treatment. This will confirm the person regarding any out-patient treatment, laboratory tests, physical therapy, speech therapy, as well as doctor’s fees. It may plus insure some expense of medical supplies, and ambulance transportation. Part B ‘s non-compulsory; you aren’t obliged to register to. Various citizens who are still put to work may have previous legislation plan from their workplace medical package program so will be sensible to procrastinate pending retirement before you buy this alternative. For almost all of Americans use of own residence is a sign of something like a prosperity. Try to present now how the owner if it’s damaged by purely natural disaster or a hearth the house has not been insured are inclined to feel. Houses insurance is prevalent is the a must condition at give out of a pay money for credit of habitation. Many distinctions of insurance of houses in addition comprise such cases, because thefts, accidents, damages because of issues with an electricity while a waterpipe. However in the Usa there are no way universal governmental training on health insurance protection. People would be more senior 29 years and a part of invalids of younger our age can receive medical aid within all limits of program Medicare. An majority of Us consumers insure the medical care at the outlay of money of the company.
Source: blogspot.com

What’s the Difference Between Medicare and Medicaid? Do They Include Dental Coverage?

Certain people including pregnant women, low-income children under 21 years of age, non-Medicare eligible elderly, and low-income individuals with disabilities are automatically eligible for this program. Because Medicaid is a partnership between the federal government and participating states, levels of coverage and restrictions can vary widely depending on where you live root canal treatment instrument. For those over 21, what the program will and will not cover varies widely according to the state in which the recipient lives. For the majority of American adult members, comprehensive dental care is not provided.
Source: wordpress.com

CMS softens Medicare Advantage funding changes, reducing chance of drastic plan alterations

The shares of several health insurers rose sharply in extended trading Monday following the CMS announcement. Medicare Advantage plans have become a key source of growth for insurers, which receive about $10,000 per member to provide customers with basic Medicare coverage topped with vision or dental coverage, or premiums lower than standard Medicare rates.
Source: telcoretirees.org

This is legitimate info on medicare dental coverage 2011 is just right for me.

Only restriction is that you have to opt for a dental plan that your dentists accepts or go to a dentist that accepts your dental plan card!Now, that you have fair idea of what your dental insurance is worth, go get yourself one!. So, if you need major procedures that exceed this annual limit discuss your options with your dentist and structure your treatment over two-three years to get maximum benefit from your plan. The full benefit of dental insurance to you is, you will have a brighter smile and a very healthy mouth and that is what dental care is all about. This depends on the type of policy and also the premium you are willing to pay yearly.
Source: pokenoseinto.com

Braces and orthodontia shouldn’t be covered by Medicaid

Why in the heck is Medicaid even paying for this type of work in the first place? Require a pre-authorization; if approved, move forward. But by and large, Medicaid should afford only medically necessary coverage.
Source: dallasnews.com

Health Law Offers Dental Coverage Guarantee For Some Children

Specific coverage requirements will be determined by each state within guidelines set by the federal Department of Health and Human Services. HHS guidance to date suggests that medically necessary orthodontia — to correct a problem with chewing, for example — may be required in addition to preventive and restorative care. Dental coverage may be embedded in a medical plan that’s sold on the exchanges or offered on a stand-alone basis.
Source: kaiserhealthnews.org

Medigap vs Medicare Advantage

Rather than being subject to the standard Part A deductible for instance, you may have a copayment required for a defined number of days. Additionally, rather than the 20% coinsurance amount required by original Medicare for outpatient services, you will generally have varying copayment or coinsurance amounts for different services.
Source: medicareprofs.com

Enrolling in a Medicare Supplement Plan Can Protect Your Finances

PRLog (Press Release) – Apr. 9, 2013 – VERO BEACH, Fla. — Medicare Advantage, (Part C) plans are run by private insurance companies who have a contract with Medicare to handle members’ benefits and claims. Original Medicare, Part A (hospital) and Part B (doctors and outpatient services) only covers about 80% of these costs. There are annual deductibles, copayment and coinsurance for both parts and there is no coverage for prescription drugs. The most popular Medicare Advantage plans are HMOs and PPOs, including Regional PPOs which have multi-county networks of medical providers:,doctors, hospitals, outpatient services, dentists, pharmacies,etc. and there are rules to follow about where you can obtain your care. HMO’s do not have out-of-network coverage, and they usually require referrals by the primary care physcian to specialists. PPO’s allow out-of-network services, at a higher copay, and they don’t require referrals to a specialist. Medicare Advantage plans often have low premiums- as well as “0” Monthly premium plans, in some areas. The plans usually include additional benefits such as dental, hearing and vision exams, wellness programs, gym memberships and prescription drug coverage. Finally, there are no health questions to join. All Medicare beneficiaries, including people on Medicare, due to disability, are guaranteed acceptance. The only exception is a person with End Stage Renal Disease. For free assistance with plan comparisons, selection and enrollment, contact Florida licensed, Medicare Agent Renee Lempert, www.floridaseniorsinsurance.com. Disclaimer: Not Affiliated with the US Government or the Federal Medicare program.
Source: prlog.org