Centers for Medicare & Medicaid Services (CMS) will turn on the Phase 2 denial edits, Effective May 1

Posted by:  :  Category: Medicare

Harry Reid, Health Care narrow by Truthout.orgThe Affordable Care Act, Section 6405, “Physicians Who Order Items or Services are Required to be Medicare Enrolled Physicians or Eligible Professionals,” requires physicians or other eligible professionals to be enrolled in the Medicare Program to order or refer items or services for Medicare beneficiaries. Some physicians or other eligible professionals do not and will not send claims to a Medicare contractor for the services they furnish and therefore may not be enrolled in the Medicare program. Also, effective January 1, 1992, a physician or supplier that bills Medicare for a service or item must show the name and unique identifier of the attending physician on the claim if that service or item was the result of an order or referral. Effective May 23, 2008, the unique identifier was determined to be the National Provider Identifier (NPI). The Centers for Medicare & Medicaid Services (CMS) has implemented edits on ordering and referring providers when they are required to be identified in Part B, DME, and Part A HHA claims from Medicare providers or suppliers who furnished items or services as a result of orders or referrals.
Source: msochealth.com

Video: Doctors No Longer Accepting Medicare Patients in North Carolina

McCrory, Wos announce plan to privatize Medicaid

As has already been pointed out, the profit motive is the driving force behind successful (my word) business models, and in the pursuit of profits, the business owner dispenses her resources in an attempt to maximize her personal profits. It happens to be that in this particular case the profit-seeking, business owner has at her disposal the power of the legislature. Now that is hopefully not a resource under her direct control, but through the lobbyists, which have already been mentioned, the business owner has her republican and democrat friends (puppets?) legislate taxpayer money into her pockets under the auspice that it wil bring relief to the poor and otherwise needy or downtrodden portion of the population. Perhaps we should consider taking that power from the business owners and forcing honest business to procede as much as is possible.
Source: ncpolicywatch.org

Dueling editorials on Medicaid privatization

A long line of cases by the United States Supreme Court have held that when a state delegates a decision making function to a private entity, even though the state may still make the rules, the due process rights of the individual miraculously disappear. In the 1970’s and 1980’s New York had a tiered system for providing institutional care for the disabled elderly: Skilled nursing services provided in Skilled Nursing Facilities, custodial services provided in Health Related Facilities, and congregate care provided in Adult Homes. When the local Medicaid agency decided to move someone between the three types of facilities, the individual did not get notice or a right to appeal. Legal services programs challenged in federal court this lack of due process. The state acquiesced and agreed to give full due process rights including fair hearings with aid continuing pending a final determination before transferring a resident between levels of care. It then immediately turned around and delegated the decision making process to the Utilization Review Committees of the nursing homes and again denied due process and appeal rights this time based on the theory there was no longer any state action in the decision making process.
Source: bluenc.com

McCrory offers plan to privatize NC Medicaid risk

NC’s Medicaid system works and apparently well when compared to other states. That said – a recent Time magazine article clearly pointed out the problems with a lot of medical costs and its not at the medicare/caid level or the state level it’s in the billing at the hospital. By injecting a private, for profit enterprise into the mix we will only substitute profit costs for administrative costs and we will lose control of it completely. I’m all for free markets, but as the Time magazine article indicates the free market for medical care is not working. You need to subscribe to read the entire article but here’s some highlights from it:
Source: wwaytv3.com

Medicare Committee Meeting with Palmetto

Diamond Level Platinum Level Gold Level Biz Technology Solutions, Inc. First Citizens Bank rmsource, Inc. Wells Fargo Insurance Services Silver Level Ball Dermpath Ford & Harrison McGladrey Medical Protective SunTrust Bank United HealthCare Group Bronze Level Allegacy Business Solutions – JBA Benefits & Cooperative Payroll Allscripts Apex Technology Assured Waste Solutions, LLC Bactes Imaging Solution Bernard Robinson & Company, LLP Call-A-Nurse Capario ChoiceHealth, Inc. Coverys, Inc. DataMax Corp / Interstate Credit Collections Fifth Third Bank Eastman Kodak Company GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Henry Schein Medical Konica Minolta LabCorp Marketing Works McNeary, Inc. Medicus Insurance Company Medstaff National Medical Staffing mindShift Technologies, Inc. MSOC Health NCHA Strategic Partners NextGen Healthcare ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants SCA Collections, Inc. Solstas Lab Partners SouthData Stanley Benefits Stern & Associates, P.A. Attorney at Law The Doctors Company Total Merchant Services Transworld Systems TriMed Technologies Corp TriZetto Provider Solution – Gateway EDI
Source: wordpress.com

North Carolina GOP lawmakers work to block Medicaid coverage expansion

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Source: fayobserver.com

Professional Liability Insurance HQ

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSMultiple medical requirements that the AARP Medicare often cover are protected by AARP Medigap. New Jersey Medicare supplemental insurance is one with the best places for those who want to hold a private insurance company. To get the supplemental detail for this insurance, the New Jersey Medigap is info about the subject location to get involved touch too. The policies of this medical insurance would cover the discount of New Jersey Medicare. Brand new Jersey Medigap gives you twelve plans all in all. The What Exactly Does Medicare Supplement Insurance Cover? On the internet services is depending on the topic of where you be living. If you are questioning those plan will acquire for your requires greater to appear at subsequent paragraph.
Source: myprofessionalliabilityinsurance.net

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Everyday Synopsis Of Medicare Supplemental Insurance Insurance Functionality

Such as we put changes in older life, a feature in opposition t healthcare becomes much more critical to be able to our well-being. We all wish to the Best Medicare health insurance Supplemental Plan which often to be you can buy. When searching for the particular perfect of applications and an insurance plan company that contributes extraordinary customer service, we always give a lot from time on judging many options on the market. This is really firm when going to finally turn 65 quite possibly becoming appropriate to work with healthcare for the first occasion. However, high are minor a person can do drugs sure you decide on a plan having comprehensive benefits as a result of a health insurance policies coverage company that provides great customer satisfaction.
Source: jndtecheng.com

1. Protect yourself with Medicare supplemental insurance

As consumers, we generally nurture many misconceptions about medical insurance (http://medigapplansguide6502.wordpress.com/2013/04/03/understanding-medicare-suplemental-insurance/). For example, people think that coverage is directly related to premiums and the more they pay, the more coverage they are likely to get. Actually premiums can vary, be more or less; but coverage is the same. It is possible for a consumer to save money, by avoiding out-of-pocket payment, just by getting proper information. http://www.medigapplansguide.com, can empower a consumer by giving proper insights into all aspects of Medicare supplement insurance through a comprehensive comparison and analysis of the choices offered by different companies like AARP. Pay less, get same benefits.
Source: precisiongastesting.com

Really Should You Choose Medicare Health Insurance Supplemental Insurance

Multiple medical requirements how the AARP Medicare will never cover are covered by AARP Medigap. New Jersey Medicare supplemental health insurance is one among the best places for anyone who want to have a private insurance policy. To get the supplemental statistics for this insurance, the New Shirt Medigap is info about the subject location to obtain it touch too. The policies for the medical insurance would cover the reduction in price of New Jersey Medicare. The new Jersey Medigap comes with twelve plans all in all. The www.medigapplansguide.com/medicare-supplement-rates Nj is depending on the topic of where you am living. If you are questioning just what plan will acquire for your values greater to read the subsequent paragraph.
Source: flloecdelft.org

when you need a Medicare supplemental insurance getting info from www.medigapplansguide.com can be beneficial

People with medicare can opt to get a prescription drug coverage. Only insurance companies and other private companies (insurer)ncan offer this plans. It is important to contact your insurer before your application to a Medicare prescription supplement plan because the action you take may affect your benefit with your current plan. It is best to understand the basics, eligibility requirements, exclusions and limitations of the plans. If you have limited income, you may qualify for EXTRA HELP for your Medicare prescription drug coverage. Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers. Drugs in each tier have a different cost.A drug in a lower tier will generally cost you less than a drug in a higher tier. If your prescription is on a higher tier and your doctor thinks that you need that drug instead of a similar drug on a lower tier, you can ask your plan for an exemption for a lower copayment.
Source: allcontinentstvl.com

Wherever you live, get benefit of Medicare supplemental insurance

People with medicare can opt to get a prescription drug coverage. Only insurance companies and other private companies (insurer)ncan offer this plans. It is important to contact your insurer before your application to a Medicare prescription supplement plan because the action you take may affect your benefit with your current plan. It is best to understand the basics, eligibility requirements, exclusions and limitations of the plans. If you have limited income, you may qualify for EXTRA HELP for your Medicare prescription drug coverage. Each Medicare Prescription Drug Plan has its own list of covered drugs (called a formulary). Many Medicare drug plans place drugs into different tiers. Drugs in each tier have a different cost.A drug in a lower tier will generally cost you less than a drug in a higher tier. If your prescription is on a higher tier and your doctor thinks that you need that drug instead of a similar drug on a lower tier, you can ask your plan for an exemption for a lower copayment.
Source: happybirthdayrobot.com

Importance of having health care insurance or medicare supplemental insurance.

How to coner an unexpected event has occurred in your family? http://www.medigapplansguide.com is present for exactly these reasons. If you are contemplating out-of-pocket your lifes savings entirely on a one-time medical bill, then you need to think of an option. Especially, for seniors who intend to co pay for their expenses need to request for a quote from any of the online insurance companies. Most of the choices that you can access online are affordable. Some insurance companies such as CDPHP do not need referrals, networks or any kind of pre-authorizations. Under this scheme some insurance companies allow one to visit any of the doctors or centers that are medicare-approved, any time they need medical assistance.
Source: boardofinvestmentart.com

Medicare: if you see a problem, fix it

Posted by:  :  Category: Medicare

Medicare Division by Truthout.orgFixing the federal government’s fiscal challenge as part of the “grand bargain” will require changes to the Medicare program that reduce the volume of services provided to seniors. Today, the federal government spends $551 billion on the Medicare—3.7% of our GDP increasing to 5.4% in 2035 (CBO). It’s 21% of total health spending in the U.S, but last year, on a per enrollee basis, its costs increased only .4% (CBO). So in recent years, the cost of the program has been driven by increased demand more than increased prices. Reducing demand as 8,000 Americans turn 65 everyday (AARP) means regulators face a daunting challenge: eliminating waste and overuse using incentives and technologies to transform what’s provided, and educating seniors and their families that more care is not necessarily best care.
Source: deloitte.com

Video: Medicare Solutions Inc Agent Video

Opinion: Medicare Part D helps seniors, keeps costs down

Part D empowers consumers to make choices in the marketplace, stimulating cost-containing competition. The program does that by working exclusively through private plans, whether they be standalone prescription drug plans or comprehensive health plans that offer prescription drugs and are covered under the Part C Medicare Advantage program. Different plans offer different options for coverage, co-payments and premiums, enabling beneficiaries to pick what will work best for them.
Source: healthpolicysolutions.org

The Things That Is Medicare Member C And Solutions Are Its Insurance Policy Options

By summary, you will pay a monthly good quality for Part And of Medicare that are determined by which actually plan you select. You need to check which the plan’s formulary in the drugs you take to determine irrespective of your drug is roofed and how actually it is embellished. A great resource to achieve this is online upon medicare.gov. As a way to find more information on a comapny reminiscent of Wellcare or Healthsprings, you may want to visit the program’s website. Baby Boomers need to concept up to the plate and listen to this wake-up ring. Especially if they want your standard of surviving to remain whole. Heaven prohibit should their standard of living loss. Medigap Plans are sold via state insurance corporations. However, the insurance policy plan companies might actually provide all at the plans. You can find your state’s Propose Health Insurance Expertise Program for understanding on what Medigap policies are offered for sale by the state-wide insurance companies. In addition, try with independent number services such to be a.M. Most desirable Company online or at the archive to ensure through which the company brings a high rating. One investment fund manager named Bernie Madoff is often offender of running the most important biggest Ponzi pattern in history made by using the similar methods that a new feds use into their SS plus Medicare Ponzi hustles. Some of the current Program permits for just two exceptions: (1) any physician practice is certainly located in a rural area not high speed online world access and (2) it is noticed in an region without sufficient existing pharmacies for electronic prescribing. The physician must put on for either at these “hardship” exemptions. Which Medigap Plans are the Best? Part D should be administered through individual insurance companies types as Humana, Wellcare, BCBS, United Healthcare, Healthsprings, and other. They are regional specific, and their costs vary tremendously from plan to help you plan and from region to position. All plans carry the perfect monthly premium. Also take important of whether in addition not the insurance plan has a tax decuctible. Deductibles are common living in Part D insurance plans. The important considerations when determining the best drug plan suitable for you is to make sure you consider the costs, formulary, and a pharmacy choice. A formulary is certainly a list at drugs that might be covered by this plan as very well as their lvl of coverage or even a Tier. Their early criteria for medicare insurance eligibility is that the applicant needs in becoming a citizen of unquestionably the US, and should have worked at minimum ten years for a job that gave into the Medicare system. Info should be obtainable on your paychecque. Higher probably not occur. All non-exempt assets owned by the couple are purchased together to calculate your eligibility over Medicaid. Currently the spouse that intending into the nursing home is disqualified against receiving Medicaid till the individual spouses’ funds total ,000 also known as less. The other spouse can hire their non-excludible benefits to a maximum of around 0,000 (it changes annually). States have some other laws pertaining in order to Medicaid eligibility. It is a good idea to check with a state to learn exactly what the qualifying factors are typically.
Source: typepad.com

Internists Offer Possible Solutions to Medicare Payment Problems

ACP supports a two-phased approach to eliminate the SGR and transition to better payment and delivery systems that are aligned with value. During phase one, repeal the SGR formula, provide at least five years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services; and in phase two establish a process for practices to transition to new, more effective, models of care by a date certain. ACP is encouraged that this committee

Health Net Awarded Arizona Medicaid Contract

Posted by:  :  Category: Medicare

Health Net, Inc. and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. All statements in this press release, other than statements of historical information provided herein, may be deemed to be forward-looking statements and as such are intended to be covered by the safe harbor for “forward-looking statements” provided by PSLRA. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to changes in circumstances and a number of risks and uncertainties. Without limiting the foregoing, statements including the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend,” “feels,” “will,” “projects” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially from those expressed in, or implied or projected by the forward-looking information and statements due to, among other things, health care reform and other increased government participation in and regulation of health benefits and managed care operations, including the ultimate impact of the Affordable Care Act, which could materially adversely affect Health Net’s financial condition, results of operations and cash flows through, among other things, reduced revenues, new taxes, expanded liability, and increased costs (including medical, administrative, technology or other costs), or require changes to the ways in which Health Net does business; rising health care costs; continued slow economic growth or a further decline in the economy; negative prior period claims reserve developments; trends in medical care ratios; membership declines; unexpected utilization patterns or unexpectedly severe or widespread illnesses; rate cuts and other risks and uncertainties affecting Health Net’s Medicare or Medicaid businesses; Health Net’s ability to successfully participate in the duals demonstration; litigation costs; regulatory issues with federal and state agencies including, but not limited to, the California Department of Managed Health Care, the Centers for Medicare & Medicaid Services, the Office of Civil Rights of the U.S. Department of Health and Human Services and state departments of insurance; operational issues; failure to effectively oversee our third-party vendors; noncompliance by Health Net or Health Net’s business associates with any privacy laws or any security breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information; liabilities incurred in connection with Health Net’s divested operations; impairment of Health Net’s goodwill or other intangible assets; investment portfolio impairment charges; volatility in the financial markets; and general business and market conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within Health Net’s most recent Annual Report on Form 10-K and the other risks discussed in Health Net’s filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. Except as may be required by law, Health Net undertakes no obligation to address or publicly update any forward-looking statements to reflect events or circumstances that arise after the date of this release.
Source: dailyfinance.com

Video: Health Net Medicare Advantage – Compare to over 180 Compani

Decrease Increasing Medicare Costs with Healthnet Medicare Arizona

Healthnet medicare arizona also helps you cover your medications. The more medication that you are on, the more money you will need to pay for these medications. The cost of medications keeps increasing, and since you need them, each month you will have a fixed cost for your medications. The only way to change a fixed cost is to change find a new provider for the medications or by enrolling into a new health plan that will help you reduce your monthly payments. By enrolling in healthnet medicare Arizona, you can save money on these medications and thus increase your discretionary income for each month. For example, if you make $3,000 a month and $400 of it goes to medications, then you enroll in healthnet medicare arizona, and your medication cost is decreased to $20 a month, you would increase your monthly discretionary income by $380. So, that is $380 that you can use on anything else you want instead of the medications that you need to live a healthy life.
Source: millionboatfloat.org

Medicare imposes marketing and enrollment suspensions on HealthNet, Arcadian and Universal American (Today’s Options).

Arcadian had their webinar today as well. On the call the moderator did not and would not discuss the other companies. It was very refreshing for me to see that respect for the competitors. One of the things we did discuss was the sanctions, while marketing practices were a component, a large part of the sanctions revolved around Rx administration. The Rx vendor is not specifically mentioned nor will I name them. I am however disappointed that no specific action is to be taken when this vendor is responsible for issues with ALL the companies receiving sanctions. All of the companies/MAPD Plans are working hard with the CMS to correct the issues and will be back to marketing in 4 to 6 months. My feelings go out to all of the beneficiaries that will miss out on these plans. In some markets, the sanctioned plans are the most intelligent option.
Source: wordpress.com

State approves UnitedHealthcare, Health Net merger

“A year ago, Health Net announced it was initiating a strategic review of its Northeast business options, including leaving the state,” Sullivan said. “If Health Net did not partner with another company, Heath Net policyholders would have been left to secure replacement coverage on their own without the benefit of UnitedHealthcare’s commitment to offer each policyholder renewal coverage.”
Source: hartfordbusiness.com

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

Marin•Sonoma IPA inks Medicare contract with Health Net for Sonoma County Seniors

Great. Seniors get their coverage so that they don’t have to experience the inconvenience of leaving town. (Even though their property taxes are exempt from the huge costs to keep "their" local hospital in business.) The non-insured also get to keep their "free" local care; paid for by the rest of us. The only ones to be forced to leave town for their health care are working families, who must use Kaiser or other out-of-town options because the local out-of-pocket costs are too high. So those that are paying for this huge privilege of localized medical care in this town are the least likely to be able to use it. Something stinks about this picture.
Source: patch.com

Health Net sanction means one less low

The agency said it took action because Health Net has “continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.”
Source: oregonlive.com

Health Net Provides Grants to Boost LA

AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicar & Medicaid Services Centers for Medicare & Medicaid Services CMS Emeritus Senior Living Ensign Group featured Federal Bureau of Investigation Gentiva Health Services Gentiva Health Services Inc. Genworth HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice National Hospice and Palliative Care Organization New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI ResCare HomeCare Scripps Health Sentara Healthcare The Ensign Group VA Visiting Nurse Association Visiting Nurses Association
Source: homehealthcarenews.com

American Counseling Association Weblog

Work Conditions: *The work conditions and physical demands listed below are representative of those that must be met by an associate to successfully perform the essential functions of this job. Associates are expected to follow the proper work safety practices and procedures for their personal safety and to prevent possible injuries. * Computer usage may be required up to 50 percent of the time, including heavy typing, keyboarding, data entry, repetitive motion, and/or eye strain. * May be exposed to confidential information and expected to maintain confidentiality at all times; must adhere to HIPAA rules and regulations. * May be required to work outside of normally scheduled hours as mandated by the client, project and/or workload (e.g. evenings, weekends, and/or holidays). * Phone usage may be required up to 15 percent of the time; headsets may be required. * May be required to maintain established work pace, meet deadlines; may have last minute urgent requests. * May be required to travel 25 percent of the time. * May be required to lift, carry and/or move equipment/supplies weighing up to 50 pounds. * May operate personal computers, printers, facsimile, telephones, copy machines and other commonly used office accessories/equipment. * Frequent interruptions/distractions; environment may be loud. * Physical activity may include: twisting, reaching, kneeling, bending, stooping, squatting, crawling, grasping, grabbing, pushing, pulling, repetitive motion, climbing, etc. * Significant reading required via internet and/or bound regulatory volumes. * Work may be sedentary, desk bound or seated up to 8 hours per day. * May be required to walk or stand up to 4 hour per day; walking and/or transporting supplies and equipment between buildings/parking lots and structures may be required
Source: counseling.org

medicare plus blue prior authorization form

Posted by:  :  Category: Medicare

Aetna Prior Authorization Form Papers and Research , find free PDF download from the original PDF search engine. What do you get when you enroll in Medicare Plus Blue PPO? The confidence that comes with affordable, all-in-one coverage that is simple to understand. You also get
Source: rediff.com

Video: Medicare Plans from Blue Cross and Blue Shield of Minnesota and Blue Plus

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 Cross Blue Shield of Michigan Offers New Medicare Plans

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

Blue Cross Blue Shield Of Michigan Broadens Medicare Options With New Medicare Advantage PPO Product

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Source: wordpress.com

Flash of Genius: Medical Matters: URGENT: WPS J8 MAC Medicare change starts at 2:00 Thursday 7/12/2012

. WPS officially starts payor id 08202 on Monday July 16, however they have announced “Dark Days” of Friday July 13 through Tuesday July 17. A dark day is a business day during the cut-over period when the Medicare claims processing system is not available for normal business operations. System dark days may occur between the time the outgoing claims administration contractor ends its regular claims processing activities and the incoming claims administrative contractor begins its first day of normal business operations. Genius is not certain what would happen if you sent Medicare claims with the new payor id between 2:01pm Thursday through 12:00am Monday.It is possible that BCBSM or WPS might hold them until they finish their dark days and process them normally, but we do not have any confirmation from BCBSM or WPS that this actually will happen. Therefore Genius recommends you do all of your Medicare billing before 2pm on Thursday July 12.Then do no Medicare billing until July 16 or later.On July 16 go to your Insurance Code Files and change payor id 00953 to 08202. Don’t change anything else and don’t change it before July 16. Click here for step-by-step instructions for changing the payor id in THOMAS. After you have changed your payor id on July 16 or later you should be able to resume sending your Medicare claims.
Source: blogspot.com

More on Proposed Cuts to Medicare Advantage: Seniors Would Save Far More Than They Lose

“It turns out that the additional benefits and flexibility created by recent increases in MA payment rates simply weren’t worth very much to seniors,” Frakt writes. “Consumer surplus loss associated with cuts in payments to MA plans will be only 14 cents per dollar saved. . . the truth is that under Obama’s plan a small fraction of Medicare beneficiaries will lose their MA benefits and/or face higher costs. However, the potential savings are enormous and research shows that the benefit cuts needed to achieve them will not be terribly missed.”
Source: healthbeatblog.com

Underestimating Health Care Costs in Retirement

Paul Sullivan writes this week in his Wealth Matters column about an often-overlooked expense in retirement: the cost of health care. One study Paul mentions, by Nationwide Financial, found that people near retirement routinely overestimated the percent of health care costs covered by Medicare.
Source: nytimes.com

How Does Blue Cross Medicare Crossover Work?

Blue Cross offers the following program choices: Blue Cross Plus, Blue Cross PPO, High Option Supplement to Medicare and Core. Blue Cross Medicare Crossover is an option for all Blue Cross programs. The Blue Cross Medicare Crossover system allows Medicare to directly provide Blue Cross access to a person’s explanation of benefits (EOB), so that neither the individual nor the provider needs to file a separate claim with the insurance carrier after sending a claim to Medicare. The Blue Cross Medicare Crossover system simplifies the procedure. Under the new Blue Cross Medicare Crossover system, most claims are automatically sent to Blue Cross.
Source: seniorcorps.org

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Medicare growth attributed to change in skilled nursing facility pay rates

Posted by:  :  Category: Medicare

Bubbles? Take something like 'Not I! ...item 1.. Wakulla Republicans Protest Against Taxes in the County (September 06, 2011) ... by marsmet552Medicaid spending slowed significantly in 2011 on a year-over-year basis. The program grew 2.5% in 2011, a significant drop from 5.9% growth in 2010. The CMS report said budgetary pressure on states caused by the weak economy and the June 2011 expiration of federal aid to the states contributed to the slower growth.
Source: mcknights.com

Video: More MDs turning down Medicare, Medicaid patients

MedPAC Calls on Congress to Reform the Medicare Home Health Benefit

The report’s assessment of reimbursement found that while the volume of services was level in 2011, total payments declined by about 5%, or $1 billion. MedPAC attributes this decline to a reduction in the Medicare base rate. The lower spending comes after several years of increases, as total spending between 2002 and 2011 increased by 92%. For over a decade, payments have consistently and substantially exceeded costs, with Medicare margins for freestanding agencies equaling 14.8% in 2011 and averaging 17.7% in 2001 through 2010. Two factors contributing to payments exceeding costs: Fewer visits are delivered in an episode than is assumed in Medicare’s rates, and cost growth has been lower than the annual payment updates for home health care. For 2013, Medicare margins are estimated to equal 11.8%.
Source: hcafnews.com

FAQ On Medicare Doctor Pay: Why Is It So Hard To Fix?

Today’s problem is a result of yesterday’s efforts to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts.  But each deferral just increased the size – and price tag – of the fix needed the next time.
Source: kaiserhealthnews.org

Medicare Reimbursement For Skilled Nursing Facilities Remains High For 2012 Despite Reductions In Overpayments  

The GAO reported as early as 2002 that SNFs had shifted their assessment practices to assign residents to the rehabilitation RUG-III categories that gave them the most favorable reimbursement rates, often without actually providing residents with the number of minutes of therapy they required in order to be placed in those categories.[29]  In addition, the GAO reported that two years after the prospective payment system was implemented, "The patients categorized into the two most common (high and medium) rehabilitation payment group categories typically received 30 minutes less therapy during their first week of care, a 22 percent decline."  Id. 3.  While reimbursement to SNFs increased, rehabilitation services for residents actually decreased.
Source: medicareadvocacy.org

Medicare Is More Efficient Than Private Insurance

The CBO explicitly stated that its data on relative cost growth should not be used to make the argument that Goodman and Saving make, writing that the relatively low growth rate of all health care expenditures other than Medicare and Medicaid “should not be interpreted as meaning that Medicare or Medicaid is less able to control spending than private insurers.” Goodman and Saving mistakenly suggest that the growth rate of private insurance is the same as the growth rate of all health care expenditures other than Medicare and Medicaid; however, as CBO points out, the growth rate of all health care expenditures other than Medicare and Medicaid includes not just spending by private insurers, but also government programs and out-of-pocket costs paid by the uninsured.
Source: healthaffairs.org

Medicare Announces 2011 Deductible and Coinsurance Rates

Last week, Medicare announced on CMS.gov in a fact sheet titled “Medicare Premiums, Deductibles for 2011″. This fact sheet gives detailed information on the increases to the yearly premium and deductible Medicare patients will have to face in the coming year.
Source: about.com

MedPAC Projects 11.8% Medicare Margins in Home Health for 2013

AAHomecare AARP Alliance for Home Health Quality and Innovation Almost Family Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Apria Healthcare Group Brookdale Senior Living Care.com Center for Medicare Advocacy Centers for Medicar & Medicaid Services Centers for Medicare & Medicaid Services CMS Emeritus Senior Living Ensign Group featured Federal Bureau of Investigation Gentiva Health Services Gentiva Health Services Inc. Genworth HHS Home Health Depot Home Health International Humana IntegraCare Intel-GE Care Innovations Jordan Health Services Kindred Healthcare LHC Group Inc MedPAC NAHC National Association for Home Care & Hospice National Hospice and Palliative Care Organization New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare PHI ResCare HomeCare Scripps Health Sentara Healthcare The Ensign Group VA Visiting Nurse Association Visiting Nurses Association
Source: homehealthcarenews.com

Medicare Panel Calls for Repealing Sustainable Growth Rate Formula

Ten days after Congress voted to approve a temporary “doc fix,” the Medicare Payment Advisory Commission last week released a blueprint that calls for permanently repealing and replacing the sustainable growth rate formula — which is used to determine Medicare physician reimbursement rates,
Source: californiahealthline.org

Priority Health Medicare: Your Health Is The Top Priority

Posted by:  :  Category: Medicare

Newsweek Magazine (February 16, 2009) ... Lenders Add Bigger Fannie, Freddie Fee – Thanks to Payroll Tax Cut (January 15, 2012) ...item 2.. Dupuy: GOP trying to sell pyrmaid scheme to voters (September 3, 2012) ... by marsmet526If you are nearing the age 65 and do not have a health care card yet, you might want to start looking around and searching for the best health insurance plans for you or your loved ones.  Remember too that it is never too early to prepare for your medical care needs.  Even if you are still in your 40s or 50s, you can already start preparing for your future medical care needs.  We all want to feel at peace when it comes to our health especially when we reach our golden years. The price of health care is not getting any cheaper; I believe everyone should be financially ready for their future medical expenses.
Source: medicarebase.com

Video: Priority Health Medicare — Understanding Medicare Video

UMHS signs with Priority Health HMO/PPO effective March 1

Effective March 1, 2013, UMHS will become a participating provider with Priority Health for their commercial HMO and PPO plans. Priority Health is a subsidiary health plan of Spectrum Health System. Priority Health HMO and PPO members may be seen at UMHS for both primary and specialty care at an in-network benefit level beginning March 1, 2013. Additionally, UMHS has been a participating provider with Priority Health’s Medicare Advantage plans since September 2012. UMHS remains a non-contracted provider for Priority Health’s Medicaid and MIChild plans. Staff should continue to follow the Medicaid Specialty Access process for Priority Health Medicaid members.
Source: umhsheadlines.org

Priority Health Joins Michigan Health Connect

Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact healthcare costs while maximizing customer experience. It offers a broad portfolio of products for employer groups and individuals including Medicare and Medicaid beneficiaries. As a nonprofit company, Priority Health serves more than 600,000 people and continues to be rated among the best health plans in the nation by the National Committee for Quality Assurance. For more information see www.PriorityHealth.com.
Source: michiganhealthconnect.org

Priority Health Adds Medicare Advantage Plan and Seven Counties.

Medicare is available to individuals age 65 and older as well as to some people with disabilities. Medicare recipients may enroll between November 15 and December 31, 2010. To learn more about Priority Health’s Medicare plans, premiums by county and participating health care providers, call Priority Health toll-free at 888 389-6676, visit a Priority Health Medicare Information Center in Holland, Grand Rapids, Kalamazoo or Traverse City (opening November 1) or go to prioritymedicare.com. Priority Health’s Medicare Advantage health plans are available in 38 counties: Allegan, Antrim, Barry, Benzie, Cass, Charlevoix, Clare, Crawford, Emmet, Grand Traverse, Hillsdale, Ionia, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Macomb, Mason, Mecosta, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Otsego, Ottawa, Roscommon, St. Clair, Washtenaw, Wayne and Wexford.
Source: blogspot.com

Priority Health now offers free dental cleaning to Medicare patients!

Medicare age people that have Priority Health Insurance now have Delta Dental coverage for one periodic exam and one prophy (cleaning) per year paid at 100%.  They also cover one set of bitewings x-rays per year paid at 50%.
Source: wilderndental.com

Viewpoints: Looking For The Budget’s True Bottom Line; The Debate On Plan B Reignited; Medicare Cuts Have Impact

The Wall Street Journal: A Primer For Understanding Obama’s Budget President Obama will release his overdue budget on Wednesday. It will doubtless project a reduction in the federal budget deficit—a projection that journalists, commentators and policy makers should ignore. To do otherwise is to be complicit in fraud. Strong statement? Not really. … Fortunately, some years ago the CBO began to present “alternative scenario” budget projections, in which differences from current-law projections are explained in detail. In its early February update, one example is that the 25% cut in physician Medicare reimbursements scheduled for next Jan. 1 will not occur. That adjustment increases the projected deficit in 2023 by $16 billion, and cumulatively by $138 billion from 2014-23. Congress has overridden the scheduled cut in physician reimbursements every year since 2003, in a legislative provision known as the “doc fix” (William Poole, 4/8).
Source: kaiserhealthnews.org

Medicare Innovation: Whose Priorities, Whose Interests?

Carol Levin asks the right question in her post, while failing to address all of the potential answers. She stresses the need to address the needs of elderly patients under Medicare and argues that their interests are paramount. While one can make the case for this answer, any focus on patients needs to be balanced by a focus on the needs of the nation and the overall fiscal capacity of the federal government. We need to look very carefully at the core question of who should being paying for all the wonderful care that she envisions. An examination of this issue will reveal that no improvements in care for the elderly that reduces costs for them can come to grips with the sheer magnitude of the costs of Medicare as a middle class entitlement program. We cannot continue to assume that we as a nation can afford to provide the care that all the elderly need regardless of their ability to pay. Individuals in my Medicare eligible generation, including myself, who can afford to pay more of our own costs should be required to do so in order to free up Medicare funds for those who are truly needy. This reform known as means testing for benefits, coupled with higher contributions based on income and an increase in the age at which the benefit commences, could pave the way for real savings on top of those which improved methods of care could provide. In short fix the long term fiscal challenge in all this ways and we may get some relief from the pending crisis.
Source: healthaffairs.org

Medical Books PDF: The Five Questions to Ask Before Enrolling in Medicare Insurance Coverages!

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481The 2013 Medicare Checklist for Seniors! Did you know that approximately 10,000 seniors are becoming eligible for Medicare on a daily basis. In a recent publication, Fidelity Investments estimates that a 65-year-old couple retiring in 2012 will require approximately 0,000 to cover medical expenses throughout retirement. Are you prepared to make the right choices to avoid the pitfalls with hospital and prescription drug costs? Seniors have to be prepared to meet the time deadlines when enrolling in Medicare and make the right choices for their healthcare coverages. Seniors also have to ASK the right questions BEFORE they enroll in a MediGap or Medicare Advantage Health Plan. Do you know whether your Prescription Drugs will be covered on the Plan? We have crafted this quick-read ebook to provide a CHECKLIST for seniors moving forward into the 2013 Medicare Enrollment period. Additional reference websites and resources are included throughout to dig-a-little-deeper with the subject matter. Are all the TV commercials and mailings you receive on MediGap, Med Advantage, and Part D Prescription confusing you? Let us help you get informed with the basics so you can Ask the right questions when you are enrolling in Medicare Insurance.
Source: blogspot.com

Video: Enrolling in Medicare

Learn More Regarding Humana Medicare Health Insurance Part D

Might the most certainly known governmental health and well-being insurance program is Medicaid. Proffered to low wages individuals, it can be jointly funded while both the federal and state government, and managed by each individual claim separately. Without doubt one of the most most important aspects for extent is that each applicant be believed to be conform at or read on the current police arrest records poverty level, which usually varies from year upon year. Assets seem to be also taken into consideration, and a person or family members members may be thought of ineligible if their whole assets exceed an important amount.
Source: recomap-io.org

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

Is Medicare Holding Back on Us All the Available SEPs for People with VA Benefits ?

I signed up a man with VA benefits for a Med supp back in 10/12 to be effective 1/1/13.This guy was enrolled in a MAPD but was not going to take a stand alone part D for 2013 if he had to pay for it.I stressed to client the importance of calling carrier to dis enroll from the MAPD plan after he is approved for Med Supp since it won’t happen automatically because he wasn’t signing for a part D plan. Client said he called the carrier in November 2012 and requested to be dis enrolled but was not dis enrolled and didn’t find this out until March.I tell him the only possible way to reverse this is to call Medicare and have them escalate it. I was on the 3 way call today to Medicare with client today and call did get escalated to a Medicare benefits specialist who informed us that he can drop his MAPD plan any time because he has VA benefits and he dis enrolled him from the MAPD plan as 5/1/13. I was just being silent on the 3 way call and was only going to speak up if client said something that was going to implicate me in any wrong doing or if client left something out that was important when stating his case.I would have liked to have asked the Medicare specialist what that SEP code was he was using for people with VA benefits and if it’s good for enrolling and dis enrolling. It made me look dumb in front of client because I insisted there was not another way of getting him off the MAPD plan.I wish we could see the comprehensive list of SEPs that Medicare allows.I discovered that there are some SEPs listed on medicare.gov that are not in the carriers election code list.I had a referral from a dude that had got out of prison and at first i told him he can’t enroll until the AEP but found out on medicare.gov he was eligible for a SEP- change of residence. And why wouldn’t the carrier acknowledge or know about this SEP when client called in March to tell them he didn’t want to be on MAPD plan?
Source: insurance-forums.net

Will Medicare Cuts Be Enough?

Medicare covers the expenses of the elderly, regardless of socioeconomic standing, and this facet of the program is subject to reform. The Obama administration proposed a means tested program for Medicare, which would mean that wealthier recipients pay a higher premium than others. Those on the left are agitated by this proposal since it could change the scope and focus of the Medicare program. This policy could shift Medicare into a “government safety net” for low income seniors. In addition to this, President Obama suggested raising patient fees in order to help shoulder the costs of rising military healthcare coverage. All together the president’s reforms would cut approximately 400 billion dollars from the federal budget.  Some analysts see the proposed cuts as a way to pacify intra-party hostility, but claim that the budget cuts will not do enough to reduce the deficit.
Source: cornellcurrent.com

Obscure Medicare Rule Creates Catch

First, for many, employer-based plans are cheaper, more comprehensive and more familiar than Medicare, so people want to keep that coverage. While enrollment for Medicare Part A (which covers hospital stays) is automatic and requires no premium, Medicare Part B (which covers outpatient care) costs $100 per month and some individuals may opt out. Once the employed spouse retires, then the other spouse signs up for Medicare Part B. Without this protection, late applicants for Medicare Part B would have to pay a penalty, like anyone else who signs up late.
Source: dlklawgroup.com

Ask The Experts: Retirement

Q. I’m 74 and have been retired for 5½ years. During that time, my medical coverage has been through my working wife’s FEHB family plan and Medicare Part A. I’ve never enrolled for Medicare Part B. My wife has just retired, retaining the FEHB family plan. She will also enroll (SEP) for Medicare Part B. If I enroll for Medicare Part B, will I be penalized for late enrollment?
Source: federaltimes.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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

Video: Medicare Plan Finder Lesson 1: Getting Started

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 Chief Queried on Medicare Part D Preferred Pharmacy Plans

In recent months, significant questions have been mounting regarding preferred pharmacy plans in the Medicare Part D drug benefit. They have been expressed by patients, community pharmacists (including NCPA), 30+ Members of Congress and a key congressional advisory panel known as the Medicare Payment Advisory Commission. Most recently, they played out at a U.S. Senate Finance Committee hearing April 9 concerning the nomination of Marilyn Tavenner to be the Administrator for the U.S. Centers for Medicare & Medicaid Services (CMS), the agency that runs Medicare.
Source: wordpress.com

Medicare Supplement Insurance Plans and Medicare Part D

There are limited times when you can sign up for Medicare Part D. For instance, you can sign up when you are turning 65. You have a seven month enrollment period. This is called your Initial Enrollment Period (IEP). It begins 3 months before the month of your birthday, includes the month of your birthday and ends the last day of the third month after your birthday. There is also the Annual Enrollment Period (AEP). During the AEP you can enroll in a Part D plan for the first time or change from one plan to another. There are also various Special Enrollment Periods (SEP) when you can enroll under certain circumstances, for instance if you are losing employer coverage you may qualify for an SEP.
Source: allabout101.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

MAPRx Comments on Draft 2013 Medicare Call Letter

In addition, MAPRx would like to address two issues vital to the communities we represent that were not specifically raised in the Draft Call Letter. First, we urge CMS to maintain and strengthen the six protected classes (antineoplastics, immune suppressants, anti-retrovirals, anti-convulsants, antidepressants, and antipsychotics) as the Secretary develops and issues new criteria as directed under the Affordable Care Act. It is critical that beneficiaries continue to have access to the full range of therapies within these six classes in order to pursue the optimal management of their conditions. Furthermore, medication utilization management requirements, such as a “fail first” policy requiring beneficiaries to try less expensive drugs before obtaining a prescribed drug, prior authorization, or dosage restrictions, for drugs within the six protectedclasses are being used with increasing frequency by Part D plans. MAPRx urges CMS to undertake vigilant oversight of such policies to strictly limit their burdensome impact on beneficiaries. These utilization management tools directly impede the patient-doctor relationship by denying the beneficiary access to their physician’s recommended course of treatment. This may ultimately have the effect of worsening health outcomes by delaying access to needed medication, which has major cost implications for the beneficiary and Medicare due to avoidable hospitalizations and emergency room or doctor’s visits. MAPRx strongly condemns practices that negatively affect beneficiaries by hindering their access to the most appropriate therapies for their condition(s) and asks CMS to strictly monitor use of such techniques.
Source: maprx.info

Medicare Open Enrollment: More is better

For those choosing Original Medicare, the benefit package continues to grow stronger and provide greater value. For example, EVERYONE with Medicare has access to a variety of preventive services and screenings, most at no cost to them when furnished by qualified and participating health care professionals. This includes things like diabetes and cancer screenings, and a yearly “wellness” visit. During the first 9 months of this year, over 20 million people with Original Medicare received at least one preventive service at no cost.
Source: medicare.gov

CMS ENSURES GREATER VALUE FOR PEOPLE IN MEDICARE DRUG AND HEALTH PLANS (CMS

Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates.[41][42] Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases.[43] It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances. The Patient Protection and Affordable Care Act (“ACA”) of 2010 made a number of changes to the Medicare program. Several provisions of the law were designed to reduce the cost of Medicare. Congress reduced payments to privately managed Medicare Advantage plans to align more closely with rates paid for comparable care under traditional Medicare. Congress also slightly reduced annual increases in payments to physicians and to hospitals that serve a disproportionate share of low-income patients. Along with other minor adjustments, these changes reduced Medicare’s projected cost over the next decade by $455 billion. Additionally, the ACA created the Independent Payment Advisory Board (“IPAB”), which will be empowered to submit legislative proposals to reduce the cost of Medicare if the program’s per-capita spending grows faster than per-capita GDP plus one percent. While the IPAB would be barred from rationing care, raising revenue, changing benefits or eligibility, increasing cost sharing, or cutting payments to hospitals, its creation has been one of the more controversial aspects of health reform. The ACA also made some changes to Medicare enrollee’s’ benefits. By 2020, it will close the so-called “donut hole” between Part D plans’ coverage limits and the catastrophic cap on out-of-pocket spending, reducing a Part D enrollee’s’ exposure to the cost of prescription drugs by an average of $2,000 a year.[116] Limits were also placed on out-of-pocket costs for in-network care for Medicare Advantage enrollees. Meanwhile, Medicare Part B and D premiums were restructured in ways that reduced costs for most people while raising contributions from the wealthiest people with Medicare. The law also expanded coverage of preventive services. The ACA instituted a number of measures to control Medicare fraud and abuse, such as longer oversight periods, provider screenings, stronger standards for certain providers, the creation of databases to share data between federal and state agencies, and stiffer penalties for violators. The law also created mechanisms, such as the Center for Medicare and Medicaid Innovation to fund experiments to identify new payment and delivery models that could conceivably be expanded to reduce the cost of health care while improving quality. http://en.wikipedia.org/wiki/Medicare_%28United_States%29
Source: wn.com

5 mistakes retirees make choosing a Medicare plan

About 1 in 4 Medicare beneficiaries chooses a Medicare Advantage plan, which sometimes offers benefits beyond what’s included in traditional Medicare. If you’re considering a Medicare Advantage plan, remember that this model means seeing out-of-network providers can quickly become a costly proposition for you. Before signing up for this option, call your preferred doctors, specialists and hospitals to verify that they participate in the plan’s network. This can get tricky if you travel a lot, spend winters in a different location, or get a referral from your primary-care doctor to a specialist who’s out of network.
Source: sltrib.com

Consumer Alert: Universal Health Care Medicare Advantage customers urged to contact centers for Medicare & Medicaid services

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481//DEFINE GLOBAL VARIABLES var d=new Date(); var curr_relimgpage = 0; var lastScrollPos = 0; var video_flag = false; var mainImageLarge_flag = true; var mainImageSmall_flag = true; var relatedContent_flag = true; var crowdyNewsWidget_flag = false; var
Source: weeklycitizen.com

Video: Feds want your retirement Money/Medicare cuts/Nat of Islam to contact gangs

4 major Medicare mistakes

For most people, their first Medigap choice is their lasting choice because their options diminish once they’ve made an initial selection. In many states, it is particularly difficult to switch from one Medigap plan to another because insurers can charge higher rates, impose conditions or even refuse Medicare recipients who are shopping around. Before you enroll in any Medicare plan, ask for information and read what you’re sent carefully. “People should make an effort to initially enroll in a plan that best meets their needs,” Muschler says. “If you don’t choose carefully, you could pay too much or get coverage that doesn’t really meet your needs” — and find it hard to extricate yourself.
Source: bankrate.com

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

AARP Supports Legislation to Require Drug Manufacturers to Provide Rebates to Medicare Part D Beneficiaries

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people turn their goals and dreams into real possibilities, strengthens communities and fights for the issues that matter most to families such as healthcare, employment and income security, retirement planning, affordable utilities and protection from financial abuse. We advocate for individuals in the marketplace by selecting products and services of high quality and value to carry the AARP name as well as help our members obtain discounts on a wide range of products, travel, and services.  A trusted source for lifestyle tips, news and educational information, AARP produces AARP The Magazine, the world’s largest circulation magazine; AARP Bulletin; www.aarp.org; AARP TV & Radio; AARP Books; and AARP en Español, a bilingual news source.  AARP does not endorse candidates for public office or make contributions to political campaigns or candidates.  The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.​
Source: aarp.org

Protecting Yourself and Your Medicare Benefits

TALLAHASSEE – Elder citizens are frequent targets of Medicare schemes, including the latest identity theft scheme. Recently, several Medicare beneficiaries have received phone calls from individuals declaring to be from the “Health and Welfare Department” informing them that a new Medicare card will soon be issued to them. Beneficiaries are then asked to verify some personal information, including their Medicare number, address, birth date, and banking information. Seniors, and those who care for them, should know that the true goal of these calls is
Source: baycountypress.com

Funding Details: Medicare Incentive Payments in Health Professional Shortage Areas and Physician Scarcity Areas

Physicians in geographic Health Professional Shortage Areas (HPSAs) and Physician Scarcity Areas (PSAs) can receive incentive payments from Medicare. Psychiatrists practicing in mental health HPSAs are also eligible. Payments are made on a quarterly basis, rather than claim-by-claim, and are handled by each area’s Medicare carrier.
Source: raconline.org

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

Ryan’s New Medicare Budget Cutoff: 56

Rep. Paul Ryan (R-WI) is pressing GOP centrists to accept a budget that would cut Medicare benefits for recipients who are now 56 years old. The House Budget Committee chairman and 2012 GOP vice presidential candidate argues the change is necessary to help him produce a budget next week that balances within 10 years. He also says that the change must be made and that it is better to adopt it now than next year, when Republicans will face voters in the midterm elections. The problem for Ryan is that many Republicans have said his budget would not touch Medicare benefits for anyone who is already 55 years old. Members may have trouble supporting a measure that goes back on that commitment. “The big problem was that a lot of people have been telling people that it’s 55 and that’s the number,” said one lawmaker who attended a meeting Tuesday between Ryan and centrist Republicans. “And if you change it, it’s going to make us look like [liars].” Winning over those centrists is crucial to Ryan, who is expected to see a handful of conservatives vote against his budget. Republicans can afford to lose only 15 Republicans in what is expected to be a party-line vote. In meeting with the “Tuesday Group,” a caucus of GOP centrists, Ryan presented the group with two options, but he seemed to suggest the best way forward was to adopt the change in this year’s budget. “Look, the age is going to have to go up eventually,” Ryan told lawmakers at the meeting, according to an attendee. He explained that the baseline, which reflects January’s “fiscal cliff” deal, which raised $600 billion in new tax revenue, meant benefits for those older than 56 would not have to be touched. But he said that it was impossible not to change benefits for people now 56 and that Republicans could either adopt it as part of their budget now or next year. “I think we should increase the age this year because I’m either going to have to increase the age this year or next year,” Ryan told the group, according to the attendee. “Do you want me to increase the age now and keep it at 56 next year, or do you want me to keep it at 55 this year and next year at 56?” Ryan asked at the meeting, adding it would give lawmakers a year to explain the change to their constituents before the next election, the attendee said. It is unclear whether Ryan’s preference won over the members. READ FULL SOURCE ARTICLE: 03/06/2013
Source: newmediajournal.us

Learn More Regarding Humana Medicare Health Insurance Part D

Might the most certainly known governmental health and well-being insurance program is Medicaid. Proffered to low wages individuals, it can be jointly funded while both the federal and state government, and managed by each individual claim separately. Without doubt one of the most most important aspects for extent is that each applicant be believed to be conform at or read on the current police arrest records poverty level, which usually varies from year upon year. Assets seem to be also taken into consideration, and a person or family members members may be thought of ineligible if their whole assets exceed an important amount.
Source: recomap-io.org