What is Medicare Advantage (Part C)?

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522Health Maintenance Organizations (HMO): Provide access to a range of doctors and hospital insurance through a flat monthly rate with no deductibles. HMO plans have the strictest network guidelines, meaning all visits and prescriptions are subject to the plan’s approval. Going outside the established network of doctors, labs, hospitals, and pharmacies will result in a higher cost to the beneficiary. When enrolling in an HMO, the beneficiary must select a primary care physician who must approve all referrals to specialists.
Source: ehealthmedicare.com

Video: Medicare Advantage Plan – What Does It Cost?

Cost of Medicare Supplement Plans

It is recommended that beneficiaries think about their future health needs when searching for a Medigap plan. A plan with low premium prices may not be the right plan for your budget if the plan uses a rating system in which prices increase over time. It is best to review a plan’s pricing method as well as its premium costs. Additionally, if you are not enrolled in the lowest cost plan in your area, you may switch plans at any time. Be aware, though, that medical underwriting may be used when switching Medigap plans outside of the Medigap Open Enrollment Period. PlanPrescriber offers a Medigap comparison tool that allows beneficiaries to compare different plans in their area to find the right one for their needs.
Source: planprescriber.com

Automatic Budget Cuts Lead GOP To Sharpen Focus On Medicare Cost

The Medicare NewsGroup: Automatic Cuts Are Underway: A Primer On Sequestration And The Impact On Medicare Doctors, hospitals, insurers and other health care providers will be subject to the cuts starting April 1. Some parts of the government are subject to bigger cuts, while others, such as Medicaid, are exempt. But if a deficit reduction deal is eventually reached it could still result in cuts to Medicare. Providers may not escape unscathed in such a deal and it could have a direct impact on beneficiaries. President Obama is open to increasing the Medicare Part B and D premiums paid by higher-income beneficiaries, while House Speaker John Boehner proposed raising the Medicare eligibility age from 65- to 67-years-old during the fiscal-cliff standoff last December (Sjoerdsma, 3/1).
Source: kaiserhealthnews.org

Medicare Drug Coverage Options

The advantage of choosing to receive your Medicare drug coverage with this option is that it allows you greater flexibility on how you get your medical benefits. You may also have more plans to choose from than you will with a Medicare Advantage plan.
Source: partdplanfinder.com

Why Private Medicare Plans Don't Cost Less

Many contend that the government “overpays” for people enrolled in private plans, since traditional Medicare could have covered these patients for less money. But the reason it would have cost less is partly that the government has done a woeful job in figuring out how much to pay the private plans. The government compensates insurers based on the health of their enrollees at the start of the year. Plans with healthier patients receive less money than those with sicker ones to reflect the likelihood that healthier people will use less care. Healthier patients enroll in Medicare Advantage plans, so in, principle, plans should be reimbursed less by the government for enrolling these patients (the technical term for this process is “risk adjustment”). But for decades, the government has failed to determine who is healthy and who is sick with any precision, with the result that private plans receive larger payments to cover their patients’ costs than necessary. This botched payment system gives insurers an incentive to spend more time selecting the healthiest patients, and less time treating them more efficiently.
Source: nytimes.com

Medicare Advantage Plans: Are They For You?

To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: figuide.com

Medicare Money May Not be Saved by Discount Drug Plans

According to the analysis of Hoey, four drugs commonly used by the seniors, including generic versions of the cholesterol medicine Lipitor, cost Medicare about 9 per cent to 10 per cent more when the customers used pharmacies in the UnitedHealth’s AARP Medicare Rx Preferred plans than at non-preferred stores. His group said that it is raising the issue because independent pharmacies are typically shut out of preferred-store contracts as insurers rely on larger chains such as Target Group and the Walgreen Co.
Source: thepointdaily.com

Is United Healthcare Medicare Supplement Insurance My Only Choice For a Medigap Plan?

Posted by:  :  Category: Medicare

Medicare is a federal program. However, state officials regulate and administrate private health insurance coverage, such as United Healthcare Medicare Supplement Insurance. Insurance companies send out advertisements in the mail and run commercials on televisions that encourage senior citizens to sign up. United Healthcare has been offering insurance access for decades and is a familiar household name to many senior citizens. However, when it comes to getting the right healthcare coverage, Medicare recipients may want to explore all options.
Source: seniorcorps.org

Video: Medicare Part C Defined: Medicare Advantage Plans — UHC TV

AARP/UHC Medicare Advantage

I was training a new agent in Florida today, the appointment we had was set from a mailer we sent to T-65. The client showed us a envelope from an Agency in Tarpon Springs, FL. They had sent an AARP/UHC Medicare Advantage with yellow highlights for the customer to sign including the scope of appointment and a returned envelope. What would you do?
Source: insurance-forums.net

United Healthcare Acknowledges Payment Shortcomings : AAFP Leader Voices

Honestly, Dr. Cain, does United think we’ll swallow this load of hooey? They ask us to believe that: “United’s leaders” had no idea that for over two decades they’ve been forcing take-it-or-leave-it sub-Medicare contracts on family physicians (“Gambling in Casablanca? I’m shocked”); that, with all the resources of the country’s largest insurer, they’ve been unable during the past 14 months to identify physicians with those contracts; that they’re “developing solutions” while doing absolutely nothing; and that, icing on the cake, they “recognize the value of primary care” but, in the linked article say they will pay “incentive payments and fees GROWING (my caps) to a range of $0.45 to $3.30 PMPM” for medical home services. Dr. Cain, these are not decent, honorable people. They are con men: their words are lies, and their actions show nothing but contempt for the AAFP and family physicians. Every year, we read of these meetings, and every year things get worse. This approach does not work. Let me repeat: this approach DOES NOT WORK. The AAFP must take a strong adversarial approach if it wants to adaquately represent its members. A couple of suggestions: a major publicity campaign aimed at patients and employers outlining the actions/inactions of United and other insurers; a hot-line so physicians with these contracts can identify themselves, with the AAFP forwarding this information to United (along with the suggestion that, since their “leaders” didn’t know about these contracts, they re-process all claims from the last 10 years!); a blog in which physicians can report their experiences in renegociating their contracts; and, most importantly, the AAFP must walk out of the PCPCC, with a simple, public statement that we can no longer work in any capacity with organizations that are so hostile to our members and so damaging to our speciality. No family physicians, no medical home: this would carry some weight! We must refuse to allow our good name and reputation to be used as cover by these groups. The AAFP HAS to draw a line beyond which they will no longer tolerate this abuse of their membership. Thank you.
Source: aafp.org

MedicareIsSimple: UHC Maintains Medicare Supplement Growth

The Solution to Your Healthcare Needs Us Here at Medicare is Simple, we understand your needs. It is our mission to educate and enable you to choose among the best Medicare plans to find the policy that fits your requirements. Get free quotes instantly using our advanced quoting technology. You will receive multiple quotes from the most reputable carriers for you to compare online. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

Any UHC Medicare Producers?

I was recently denied commissions on seven enrollments for the Evercare Dual Eligible Mapd because they say I wasn’t certified to sell it .The website they use to take and track certification called Learnshare showed that I had completed the course and the friendly PHD reps had on more than one occassion told on the phone that all my certifications where up to date but in fact i had failed to go through the last 4 slides when I originally taken the course The whole module could be done in about three minutes and there was no test to take.I didn’t find out about this until recently when I audited my commissions and called the producer help line who told me the reason I was denied commisiions was because I had to go through the last 4 slides on the module.. I then sent a service request to appeal this decision but was denied so as it it stands right now iam SOL My question is what is the next step I could take to try to get paid or file a complaint.How is it that I am not certified to sell this plan yet these customers are actively enrolled on the plan and calling me constantly with questions like dual eligible customers always do.I am obligated to spend time servicing these clients if I an mot the agent of record as far as commissions go? Usually I would help these people but I am feeling very spiteful here.
Source: insurance-forums.net

Regional VP For United Healthcare In SoCal Discusses Important Medicare Information

[…] STUDIO CITY (CBSLA.com) — Regional Vice President for United Healthcare Medicare & Retirement in Southern California, Michael McCarthy, stopped by KCAL9 Sunday to make Medicare beneficiaries aware of the enrollment deadline!Source: cbslocal.com […]
Source: cbslocal.com

UHC, Medicare For All, and some other definitions

This sounds like a huge increase in taxes, but overall, most people — both employees and employers — would end up paying much less than they are now. Under HR 676 you don’t have to worry about insurance premiums, co-pays, deductibles, or other out-of-pocket expenses — it’s all been paid for ahead of time in your taxes. You just walk into any doctor’s office, any clinic, any hospital, any lab, any dentist, any optometrist, any pharmacist, any health care provider, get what you need, and walk out [we hope]. The provider then bills Medicare for the services, or medicines, or medical equipment they gave you.
Source: correntewire.com

More Carriers Making Good Use of SEP: Commissions Possible Through Humana and UHC

As you are probably aware, this fall CMS mailed beneficiaries in “poor” or “below average” Medicare Advantage and Medicare Part D plans to encourage them to take advantage of an SEP which gives them a one-time opportunity to move to a higher rated plan. Individuals must call 1-800-Medicare in order to take advantage of this SEP leaving agents afraid of losing clients.  Last month we saw Coventry roll out a program where agents could receive commissions on these SEP plans by completing a compliant sales presentation and then submitting a Scope of Appointment (SOA) form that can be tied to the enrollment received from Medicare.  Within the past few days, Humana and United HealthCare have also announced programs around this SEP allowing agents to received commissions from all three carriers now.  Below are step-by-step instructions for completing a sales presentation and submitting the SOA to ensure commissions are paid.
Source: agentpipeline.com

UHC’s Housecalls Summit

Some leaders focused on patient care, some on the business of healthcare, some were intent on retaining the status quo, and still other leaders were intent on promoting evidence based practice but rarely, did all the leaders focus on doing one thing; making sure we all did what was right by the patients to help them live healthier lives.
Source: austinhealthtech.com

Roundup: Feds Cut N.Y. Medicaid Payments $1.2B; 93,000 Fewer Kids Enroll In CHIP In Pa.

Posted by:  :  Category: Medicare

Mitt Mobile in the Final Stretch by DonkeyHoteyCalifornia Healthline: Changes Set Stage For ‘Shakeout’ Of Medical Suppliers, Services Shifts in contracting practices — part of the trickle-down effects of health care reform — are going to change the landscape of medical equipment and service suppliers in California, stakeholders predict. … Bob Achermann, executive director of the California Association of Medical Product Suppliers … predicted the number of California businesses providing medical supplies and services may be cut in half over the next few years. Two changes are at the heart of the “thinning of the herd,” as Achermann calls it. One is state-driven: California is shifting beneficiaries of Medi-Cal — California’s Medicaid program — from fee-for-service to managed care. The second is a federally mandated change in the way Medicare contracts with suppliers (Lauer, 4/1).
Source: kaiserhealthnews.org

Video: Medicare, Affordable Care Act, Utility Infrastructure [Pennsylvania Newsmakers]

St. Luke’s, Easton Hospital in Pennsylvania Settle Medicare Overbilling Claims

St. Luke’s University Health Network in Bethlehem, Pa., and Easton (Pa.) Hospital will pay nearly $1.5 million to resolve allegations they improperly overbilled Medicare, according to a Morning Call report. St. Luke’s will pay approximately $1.03 million to resolve the allegations, while Easton Hospital will pay approximately $455,000. St. Luke’s allegedly overbilled Medicare from 2002 through 2012 for evaluation and management services that were not billable under Medicare regulations. Easton Hospital faced similar allegations from 2004 through 2009. The allegations specifically pertain to a claim called “modifier 25,” which is to be used for same-day services for a patient only when the service is “significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the procedure,” according to the report. In a statement, St. Luke’s said its alleged overbilling was the result of “significant confusion … as to when a modifier 25 should be used.”
Source: beckershospitalreview.com

State AARP president: Expand Medicaid in PA

Providing these men, women and families with the opportunity to get affordable health coverage by expanding Medicaid will change that bleak picture. In Pennsylvania alone, more than 90,000 residents ages 50 to 64 could qualify for health coverage under this expansion. A total of more than 500,000 uninsured residents would get health-care coverage under this plan — and again, there is no cost to the commonwealth for the first three years, and Pennsylvania will pay no more than 10 percent of the total cost of this expansion in the future. Pennsylvania taxpayers will also find savings after expanding Medicaid due in large part to a reduced need for other medical service programs that are currently paid for entirely by the state, such as mental-health services.
Source: goerie.com

Feds: ambulance company illegally billed Medicare $3.6M

According to the indictment, Mudrova and the others defrauded Medicare since September 2009 by recruiting dialysis treatment patients who were able to walk and could safely travel by other means, and therefore were not eligible for ambulance transportation under Medicare requirements.
Source: abc27.com

Appealing Medicare Denials of New Medical Technologies

In addition to filing reconsideration requests and supporting beneficiary challenges, Providers may appeal individual denied Medicare claims that are denied through the five-step Medicare appeal process (redetermination, reconsideration, ALJ, Medicare Appeals Council).  Providers or patients may also appeal denied claims through their insurer’s appeal process.  However, less than 10% of claims denied by commercial payers and less than 2% of claims denied by Medicare are appealed.  Every payer anticipates that most denied claims will not be appealed.  Nonetheless, reported statistics show that most parties that appeal denied claims up to the administrative law judge level are successful.  Thus, it behooves a provider or beneficiary to appeal the denied claim at least through the ALJ level.  Such claims are favorably reviewed even in the face of a non-coverage LCD because ALJ’s are not bound by a contractor’s LCD, although they must give deference to it.  This is particularly true when the LCD does not appear to reflect the literature or the consensus of medical opinion.
Source: wphealthcarenews.com

Daily Kos: Pennsylvania’s Gov. Corbett refuses Medicaid expansion

After the announcement Monday by Ohio Gov. John Kasich that he would accept Medicaid expansion funds under Obamacare, Pennsylvanians might have hoped that the sanity was spreading, and that their Republican governor too would see the light. No such luck. Pennsylvania Gov. Tom Corbett (R) announced Tuesday that his state will turn down the Medicaid expansion, becoming the first governor of a blue state to officially say no to the coverage provision of the Affordable Care Act that the Supreme Court made optional. “At this time, without serious reforms, it would be financially unsustainable for Pennsylvania taxpayers, and I cannot recommend a dramatic Medicaid expansion,” Corbett wrote in a letter to U.S. Health and Human Services Secretary Kathleen Sebelius. The Medicaid expansion would have provided coverage to 542,000 additional people in the state over the next decade, according to analysis from the Kaiser Family Foundation. That would have cost the state  $2.8 billion over a decade, with the federal government kicking in $37.8 billion to the state. More than 1.3 million Pennsylvanians are uninsured, nearly 13 percent of the state’s non-elderly population.
Source: dailykos.com

Ryan Takes to Pennsylvania to Push Medicare Message

Mr. Ryan was extrapolating from a 2010 report from Medicare’s Office of the Actuary. It analyzed the potential impact of lower premium supports paid to private companies that issue Medicare Advantage plans, popular alternatives to traditional Medicare with extra benefits such as gym memberships. To slow the growth of Medicare spending, the Affordable Care Act reduces support for the private plans, which Democrats consider inefficient. Beneficiaries would still be covered under traditional Medicare.
Source: nytimes.com

ITEM Coalition Issues Survey RE Medicare Beneficiaries and Access to Assistive Technology Devices; Please Complete.

ITEM is currently surveying people with disabilities and chronic conditions to find out if they are experiencing problems accessing the devices needed to function independently.  ITEM is interested in medical device and assistive technology users that live in areas where Medicare has implemented a selective provider contracting program known as the DME Competitive Bidding Program.
Source: drnpa.org

Congressman Ryan: Stop Playing Politics With Our Healthcare System

I think about last year when she fell at home. She was in hospital for a brief time and needed to regain her strength before she went back home. She was able to go for a brief stay at a nursing facility and then go back home and receive at home assistance through Medicaid and Medicare. It was really important for her to be able to live independently, and I really understand that. To her that is quality of life. I don’t know what my family would have done without those services. Even though I am a nurse, I could not provide that quality of care and still manage my job and my other family responsibilities. This is my grandmother and my story, but she is like your grandmother or a lot of the elderly patients we see in the hospital.
Source: seiu.org

Fraud Talk: Pennsylvania Physician Pleads Guilty To $500K Fraud/Embezzlement

Forty-four-year-old Dr. Timothy Clark entered the plea Monday before a federal judge in Harrisburg who will sentence Clark on July 29. Clark owned Central Pennsylvania Pulmonary Associates and Sleep Disorder Centers of Central Pennsylvania when he committed the crimes. Federal prosecutors say Clark failed to deposit 401(k) contributions into employee accounts, instead putting the money into bank accounts he controlled and losing $25,000 in the process. Clark also inflated claims to Medicare, Highmark and Capital Blue Cross and transferred approximately $103,000 he received from those overcharges into payroll and money market accounts.
Source: blogspot.com

CMS Announces a Workers’ Compensation Medicare Set

Posted by:  :  Category: Medicare

Running Amok Again by elycefelizBradley v. Sebelius CDC Centers for Medicare and Medicaid Services CMS COBC Conditional Payments Coordination of Benefits Contractor David Korch GAO HHS liability LMSA Mandatory Insurer Reporting MARC MARC Coalition Medicaid Medicare Medicare Secondary Payer Medicare Secondary Payer Act Medicare Secondary Payer Recovery Contractor Medicare Secondary Payer Statute Medicare Set-Asides Medicare Set Aside Medivest MIR MMSEA MSA MSP MSPRC NAMSAP ORM RREs SCHIP Section 111 Self-Administration settlement SMART Act Social Security The Centers for Medicaid and Medicare Services TPOC US Department of Justice US v. Hadden WCMSA WCRC workers’ compensation
Source: medivest.com

Video: Medicaid Set Aside

CARR ALLISON Medicare Compliance Group: CMS Issues New Workers’ Compensation Medicare Set

On March 29, 2013, CMS issued a guide to explain the process for submission of Workers’ Compensation Medicare Set-aside Arrangements (WCMSAs) to CMS and to describe how such submissions are reviewed. Essentially, the WCMSA Reference Guide is a compilation of prior memos and alerts published by CMS on topics related to the submission and approval process. The Guide does not replace the memos and CMS cautioned readers to refer to the memos for more comprehensive explanations. The Reference Guide is 88 pages in length. Several times throughout the Guide, CMS mentioned that MSAs are not mandatory and that submission is a voluntary process. CMS noted, however, that “[a]ny claimant who receives a WC settlement, judgment, or award that includes an amount for future medical expenses must take Medicare’s interest with respect to future medicals into account.” (Reference Guide, page 3). CMS explained that, “[i]n many situations, the parties to a WC settlement choose to pursue a CMS-approved WCMSA amount in order to establish certainty with respect to the amount that must be appropriately exhausted before Medicare begins to pay for care related to the WC settlement, judgment, award, or other payment.” (Reference Guide, page 3). CMS further noted as follows:
Source: blogspot.com

Medicare Set Aside Arrangements

Leading source of structured settlement information and news and expert opinion from John Darer, including settlement planning issues/ ideas, alternative deferred payment solutions, The Structured Settlement Watchdog™ commentary and exposes that may be helpful to attorneys, plaintiffs, claims adjusters, judges, the news media, sellers and buyers of structured settlement payment rights and interested others, Informative, irreverent and effective! Check back daily for something new, or simply ask structured settlement expert John Darer™ directly 203-325-8640
Source: typepad.com

CMS just released updated Workers Compensation Medicare Set

The Centers for Medicare and Medicaid Services (CMS) just released an updated version of their Workers Compensation Medicare Set-Aside Arrangements (WCMSAs) Reference Guide.  You can find a copy at:  March-29-2013-WCMSA-Reference-Guide-Version-13 .
Source: fora-costcontainment.com

Humana Medicare Advantage

Posted by:  :  Category: Medicare

Senate Dems Protest Medicare Cuts by Talk Radio News ServiceIf you’re looking for contracts you should check out Welcome to BestMedicareContracts.com! 800-779-0128. He’ll beable to give you the same contract levels everyone else has with some support. He is out in Utah, but has been doing Medicare for almost a decade. For a number of years he worked for Humana too, so he knows the ins and outs a great deal.
Source: insurance-forums.net

Video: Medicare Supplement Quotes

Medicare Premiums…have you ever wondered what they are?

Many people still think that Medicare comes with no cost. We have paid into the system all our working lives, right?! Well, there is a very real cost. View this information to help with your planning and then be sure to get in touch with us for your Medicare Supplement.
Source: creativehealthins.com

Business Owners Urge Congress to Take Medicare, Social Security Cuts Off the Table

Once again, the hour is growing late for elected officials to strike a deal to avoid a potentially catastrophic blow to the economy, as the $1.2 trillion round of automatic spending cuts known as “sequestration” is scheduled to commence at the end of the month. President Obama has urged lawmakers to pass legislation to delay the cuts until at least the end of the year, but House Republicans aren’t warming to the idea, denouncing the plan as a ploy to quietly extend temporary tax hikes without addressing the nation’s excessive spending.
Source: cjbins.com

Medicare Advantage enrollees could take hit in 2014

“The Affordable Care Act helps us strengthen Medicare Advantage and Part D,” said Jonathan Blum, CMS acting principal deputy administrator and director of the CMS’ Center for Medicare in a statement last week. “We are working to ensure that people with Medicare have affordable access to health and drug plans, while making certain that plans are providing value to Medicare and taxpayers.”
Source: healthinsbrokers.com

Medicare Advantage, Individual & Family Health Insurance, Life Insurance, Hacienda Heights, CA

6133628 8586133628 Accident Affordable Agency Agent Attorney Auto Best Business California Call Care Careers Cheap Chula Coverage Diamond Diego Double Farmer’s Financial FREE Group Health Home Injury Insurance Introduction Lawyer Life Mark Maternity Medical Medicare Motorcycle Part Plan Plans Reform Renters Services SR22 Vista without
Source: sandiegoinsuranceinc.com

Deductibility of Medicare premiums as Self Employed Health Insurance Deduction

Background Prior to 2010, self-employed individuals were not allowed to take an above the line self-employed health insurance deduction under Section 162(l) for Medicare premiums. Health insurance is only considered deductible under the statute if it is established by your trade or business.  The purpose of the health insurance deduction is to equalize the treatment of owners of corporations who are allowed to exclude health care benefits as a fringe benefit and self employed individuals who cannot. Since Medicare is established by the Federal government the IRS did not consider Medicare premiums deductible as self employed health insurance. Recently the IRS reversed their opinion on the matter referencing Notice 2008-1. Notice 2008-1 states that as long as the self employed individual’s business ultimately pays for the health insurance and follows certain reporting requirements, the health insurance premium payments are deductible as above the line for the self employed individual. The Office of Chief Counsel IRS Memorandum extended Notice 2008-1 to apply to self employed individuals who pay Medicare premiums. Now all Medicare premium parts-A, B, C and D-paid by the self-employed individual for themselves, their spouse and dependents are deductible as self employed health insurance. The premium payments need not be paid directly by the self-employed individual. For example, the S corporation of a more-than-2% shareholder can make the payments directly and the self-employed individual is entitled to the deduction. 
Source: marcumllp.com

The Ins and Outs of Group Health Insurance

In addition, some group plans don’t have the rich benefits that Medicare has. This means that not only is it a lot cheaper for employees over the age of 65 to be on a Medicare approved plan (instead of the group plan), but the monthly premiums, deductible, copays and coinsurance can be a lot more expensive with a group plan. Essentially, you’re paying more and getting less. For this reason many seniors who are still working will disenroll from their group plan and enroll into Medicare along with a Medicare Advantage or supplemental policy (see my blog relating to Medicare Advantage vs. Supplement – or email me directly).
Source: jewishjournal.com

Medicare to Cover Addadictomy, Chopadickoffamy

RUSH:  The Medicare under Obamacare is now gonna start doing sex-change operations, is the point.  I didn’t finish that story.  “For the first time since 1981, when it dubbed sex-change operations ‘experimental,’ Medicare has opened the door to covering transexual operations, adding to the growing list of operations that would be allowed under Obamacare.  Acting on a new request, the Centers for Medicare & Medicaid Services said it is starting a new analysis that could lift the spending ban for sex-change operations with a goal of making a decision two days after Christmas and on the eve of Obamacare kicking in Jan. 1.”
Source: rushlimbaugh.com

Get help with the ins and outs of Medicare

This class is a nationwide DMV accredited driver safety class that is designed to help drivers 50 and older recognize and compensate for naturally occurring age related changes that can affect driving.  The state of Colorado has approved a significant auto insurance discount for attending this class for students age 55 and older.  Check with your insurance agent for the exact discount; savings vary by insurance carrier, vehicle and coverage selected.  The class certificate is good for three years.  Cost for  AARP members is $12; non-members pay $14.   This one-day course is being offered Thursday, March 21, from 11:30 a.m.-3:30 p.m.
Source: pagosasun.com

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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

Changes to the Maryland Medicare Waiver

Posted by:  :  Category: Medicare

New Online Rx System Makes UM Student 'Top Entrepreneur' Finalist by University of Maryland Press ReleasesThe Maryland Medicare Waiver is a special agreement with the federal government that allows the Health Services Cost Review Commission (HSCRC) to set hospital rates for all payers, including Medicare and Medicaid, so long as Maryland keeps Medicare inpatient per case cost growth below the national average.  In recent years, Maryland has moved closer to breaking the terms of the special Medicare waiver agreement as Medicare inpatient costs here are beginning to outpace national growth.  
Source: bowie-jensen.com

Video: Medicare Supplemental Plans in Maryland by 1-800-MEDIGAP®

Inside Maryland’s Plan to Save its Plum Medicare Deal

Maryland health administrators unveiled a plan to adjust hospital reimbursements and cost metrics in order to keep its unique full-payment arrangement with Medicare, according to a report by the Washington Post. In the 49 other states, Medicare pays a federally standardized discount rate to providers. But since 1977, Maryland has been allowed to set reimbursement rates for Medicare as long as it keeps its cumulative spending growth below national payments. That’s worked out fine so far, but now that federal healthcare spending growth is at a three-year plateau, the state is projected to barely fall under that threshold by less than 2 percent this year. Losing the so-called Medicare waiver would cost the state an estimated $1 billion, according to the report. The plan Maryland’s health secretary and health insurance review commissioner presented before lawmakers to remedy that shrinking margin would tie hospital payments to growth in the state’s economy and institute a shared savings model among providers, according to the report. The plan would extend current contracts two months past the original expiration date of April 30 to give the industry time to prepare.
Source: beckershospitalreview.com

How Important are Social Security and Medicare to Maryland’s Economy?

The report also cited a U.S. Small Business Administration study that found business owners are “significantly less likely to hold retirement assets than private sector wage and salary workers” and owners of smaller businesses (less than 25 employees) are “significantly less likely to invest in retirement assets” when compared to owners of larger businesses.
Source: patch.com

Medicare Auditors Say Millions Could Be Saved By Limiting Advance Payments To Insurers

Baltimore Sun: St. Joseph Strikes Deal With Medicare To Recoup Some Of Lost Billings University of Maryland St. Joseph Medical Center will be able to recoup some of the tens of millions of dollars it lost while operating without a Medicare certification under a compromise reached with federal officials. The Towson hospital will be able to bill Medicare for treatment given to patients in the federal program since Jan. 7, about six weeks before it regained what is known as a Medicare provider agreement. St. Joseph had operated without one since the University of Maryland Medical System bought the hospital and chose not to renew its existing Medicare certification. Medicare won’t reimburse hospitals for treatment if they lack the certification (Dance, 4/15).
Source: kaiserhealthnews.org

Md. officials still negotiating with feds to retain Medicare waiver worth billions

The waiver discussed above arises from a 36-year old “demonstration project” under Section 1814(b) of the Social Security Act. The “waiver test” compares the national Medicare growth in the payment per admission to the growth in Maryland Medicare payment per discharge from January 1981 through the current period. Such test apparently is provided in regulation and, as such, the Federal government can change it to accommodate Maryland’s negotiating position without Congressional approval.
Source: marylandreporter.com

JAMA Forum: The State Role in Health Care Innovation

Although all of the grants are relevant to Medicare and Medicaid, many states are moving forward with innovations that will involve all payers. Arkansas will be receiving $42 million to enhance primary care for a majority of state residents. Minnesota will receive $45 million to expand accountable care models across payers and across the state. In Maryland, we are going to build a model for “community-integrated medical homes” that integrates comprehensive primary care with population health surveillance. We anticipate using data from our health information exchange—a statewide network that allows health care professionals to share clinical data—to develop maps of preventable illness, enabling public health and clinical teams to coordinate intervention.
Source: jama.com

Which Would You Prefer: A Medicare Free Wellness Visit or a Veterinarian?…I’d Rather See a Veterinarian

 Marilyn M. Singleton, MD, JD is a board-certified anesthesiologist and Association of American Physicians and Surgeons (AAPS) member. Despite being told, “they don’t take Negroes at Stanford”, she graduated from Stanford and earned her MD at UCSF Medical School. Dr. Singleton completed 2 years of Surgery residency at UCSF, then her Anesthesia residency at Harvard’s Beth Israel Hospital. She was an instructor, then Assistant Professor of Anesthesiology and Critical Care Medicine at Johns Hopkins Hospital in Baltimore, Maryland before returning to California for private practice. While still working in the operating room, she attended UC Berkeley Law School, focusing on constitutional law and administrative law. She interned at the National Health Law Project and practiced insurance and health law. She teaches classes in the recognition of elder abuse and constitutional law for non-lawyers. Dr. Singleton recently returned from El Salvador where she conducted make-shift medical clinics in two rural villages. Her latest presentation to physicians was at the AAPS annual meeting about challenging the political elite.
Source: medibid.com

Planning Ahead: Medicare Does Not Cover Nursing Home Long Term Care :: Maryland Nursing Home Lawyer Blog

Many people mistakenly believe that Medicare will pay for this long term care because Medicare willpay for skilled rehabilitation care within a Skilled Nursing Facility (SNF). However, there are strict requirements for when Medicare benefits will cover skilled care within a SNF. If you meet certain eligibility and Medicare plan requirements, then you may be able to have up to 100 days of care (per benefit period) in a SNF covered by your Medicare Plan. You will want to check with your plan, as a co-payment may be required after a certain number of days.
Source: marylandnursinghomelawyerblog.com

High court rejects Medicare challenge

WASHINGTON— The Supreme Court has turned away a challenge from former House Majority Leader Dick Armey and other Social Security recipients who say they have the right to reject Medicare in favor of continuing health coverage from private insurers.
Source: thedailyrecord.com

Maryland Health Officials Seek Sweeping Changes in Hospital Reimbursements

This proposed shift, of course, reflects many of the changes that are occurring nationwide. Maryland health secretary Joshua Sharfstein believes “meaningful savings” would be achieved for small businesses, state taxpayers, families, and Medicare. However, the Maryland health system “is the largest private sector employer in the state,” routinely bringing in $14 billion per year. To make the reimbursement system dependent on state economic growth, especially in the midst of a turbulent marketplace, is wisdom that Carmela Coyle, president and CEO of the Maryland Hospital System, finds questionable.
Source: healthcareix.com

Insurance trainer publishes informational Medicare book

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

JAMA Forum: The Forecast Slowdown in Medicare Spending: Is More Coming?

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522David M. Cutler, PhD, is the Otto Eckstein Professor of Applied Economics in the Department of Economics and Kennedy School of Government at Harvard University and a member of the Institute of Medicine. He served on the Council of Economic Advisers and the National Economic Council during the Clinton Administration and was senior health care advisor to Barack Obama’s presidential campaign.     Nikhil Sahni, MBA, MPA/ID is a Senior Researcher in the Harvard Economics Department working with David Cutler on US health care issues. At McKinsey and Company, he consulted on domestic and European healthcare and completed a fellowship in the McKinsey Center for US Health Reform. He also worked on health care and economic policy at the National Economic Council and consulted the Government of India on improving its health care system. Recently, he joined the Health Policy Commission (an independent state agency in Massachusetts) as Policy Director of Cost Trends and Special Projects.   About The JAMA Forum:  JAMA has assembled a team of leading scholars, including health economists, health policy experts, and legal scholars, to provide expert commentary and insight into news that involves the intersection of health policy and politics, economics, and the law. Each JAMA Forum entry expresses the opinions of the author but does not necessarily reflect the views or opinions of JAMA, the editorial staff, or the American Medical Association. More information is available here and here.
Source: jama.com

Video: What Does Medicare Cost?

Projected Medicare Spending Already Came Down by Half a Trillion

That’s important to remember because it was in late 2010 — and based on CBO’s August 2010 projections — when Fiscal Commission co-chairs Erskine Bowles and Alan Simpson issued their original budget proposal, calling for slightly more than $300 billion in Medicare spending cuts through 2020. The original Bowles-Simpson proposal is often considered an appropriate starting point in evaluating whether other deficit-reduction proposals should be viewed as responsible approaches to the deficit problem.
Source: firedoglake.com

Important: What are Medicare’s true administrative costs?

The Centers for Medicare and Medicaid Services (CMS) annually publishes two measures of Medicare’s administrative expenditures. One of these appears in the reports of the Medicare Boards of Trustees and the other in the National Health Expenditure Accounts (NHEA). The latest trustees’ report indicates Medicare’s administrative expenditures are 1 percent of total Medicare spending, while the latest NHEA indicates the figure is 6 percent. The debate about Medicare’s administrative expenditures, which emerged several years ago, reflects widespread confusion about these data. Critics of Medicare argue that the official reports on Medicare’s overhead ignore or hide numerous types of administrative spending, such as the cost of collecting taxes and Part B premiums. Defenders of Medicare claim the official statistics are accurate. But participants on both sides of this debate fail to cite the official documents and do not analyze CMS’s methodology. This article examines controversy over the methodology CMS uses to calculate the trustees’ and NHEA’s measures and the sources of confusion and ignorance about them. It concludes with a discussion of how the two measures should be used.
Source: pnhp.org

Daily Kos: Projected Medicare spending falls dramatically

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Source: dailykos.com

Lab Soft News: Medicare Costs Rise as Knee Replacements Increase for Seniors

The popularity of total knee arthroplasty surgeries among Medicare patients has grown considerably as beneficiaries are living longer and seeking to increase their mobility, but the shift has led to fiscal concerns for the entitlement program….Overall volume growth has been driven both by the increased number of Medicare enrollees and by increased per capita utilization….The number of total knee replacements increased 161.5% between 1991 and 2010, when 243,802 such surgeries were performed. Per capita utilization nearly doubled during that period, to 62.1 procedures per 10,000 Medicare beneficiaries from 31.2 surgeries per 10,000 enrollees….For patients, knee replacements are relatively safe and have low rates for complications, mortalities and length of hospital stays. However, 30-day readmissions rates have risen to 5% in 2010 from 4.1% in 1991. Shorter hospital stays are causing the increase, a change that should have been expected by health policymakers….The volume of revision knee replacement surgeries has increased to 19,871 in 2010 from 9,650 in 1991….There were 243,802 knee replacement surgeries in 2010, a jump of 161.5% from 1991. More and more patients taking advantage of the surgeries will lead to higher Medicare program costs. The procedure itself costs about $15,000 to $30,000…The bundled Medicare payment for the procedure is spent on the device implants, facility fees, therapy providers and the surgeons. The surgeon probably will receive about $1,500 of the total….New Medicare payment models, such as the bundled payments used for knee replacements, aim to achieve lower costs while maintaining high quality to prevent patients from being readmitted.
Source: typepad.com

New Medicare Supplement Plans Are Available Now

The Medicare Prescription Drug Improvement and Modernization Act of 2003 (also called the Medicare Modernization Act) was signed into law In December of 2003. Prior to this Act, Medicare did not provide for outpatient prescription drug benefits. This Act created Medicare Part D, to give access to prescription drug insurance coverage for those eligible for Medicare Part A or who were enrolled in Medicare Part B. This coverage began on January 1, 2006 and is administered by private health plans.
Source: allabout101.com

Ideas for Reforming the Medicare Benefit Design: A Historical Reminder of Bipartisan Support

“Under Medicare Parts B and D, certain beneficiaries pay higher premiums based on their higher levels of income. Beginning in 2017, this proposal would restructure income-related premiums under Medicare Parts B and D by increasing the lowest income-related premium five percentage points, from 35 percent to 40 percent, and also increasing other income brackets until capping the highest tier at 90 percent… “…Introduce Part B Premium Surcharge for New Beneficiaries Purchasing Near First-Dollar Medigap Coverage: This proposal would introduce a Part B premium surcharge for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, effective in 2017.” – U.S. Department of Health & Human Services. “Fiscal Year 2014 Budget in Briefing.” 2013.
Source: house.gov

The Affordable Care Act: Saving Prescription Drug Costs for Medicare Beneficiaries : The Shriver Brief

on Medicare drug spending. This report revealed that 6.1 million Americans with Medicare saved $5.7 billion on their prescription drugs—money that otherwise would have fallen into the “donut hole” prescription drug coverage gap that forces beneficiaries to pay for 100 percent of their drug costs once they have reached their prescription drug plan limit.
Source: theshriverbrief.org

Obamacare and the Evolution of Medicare and Medicaid

Posted by:  :  Category: Medicare

Medicare for All by juhansoninFor better or worse, Illinois is at the vanguard of innovation as evidenced by its recent agreement (known as a Memorandum of Understanding – MOU) with CMS to test a capitated model to integrate care and aligned financing for Illinois full-benefit duals (approx 135,825 persons). Think of a capitated model as a three-part agreement: a health-plan (i.e. managed care organization — MCO) enters into an agreement with the state, which in turn is contracted with CMS to receive a set risk-based payment from Medicare and Medicaid. If CMS is able to save money, then it will share the savings with the state. There are still many, many unknowns on how the model will be implemented. For example, duals are typically poorer and sicker then most Medicare beneficiaries and how well MCOs can meet the challenge of delivery person-centered health care and LTSS to this population has never been tested on this scale. Questions remain unanswered regarding the availability of ombudsmen to assist duals in navigating the complexities of the MCO system. Additionally, identification and implementation of quality standards and oversight have yet to be resolved. However, driven by the need to reduce Medicaid expenditures, the Illinois Department of Health and Family Services, is taking no prisoners in its drive to implement the MOU beginning on October 1, 2013.
Source: chicagonow.com

Video: Medicare and Medicaid: What’s it all mean?

Shocking Medicare and Medicaid fraud exposed at Illinois’ Sacred Heart Hospital

“Between January 2010 and February 2013, May allegedly received $74,000 in the form of 37 checks, for $2,000 each, disguised as ‘rental payments'; Moshiri, a podiatrist, allegedly received $86,000 in 38 checks pursuant to a purported contract to teach podiatry students; and Maitra allegedly received $68,000 in 34 checks pursuant to a purported teaching contract – and the $228,000 total in alleged kickbacks were all in exchange for their referral of patients to Sacred Heart, the charges allege.   “In a recorded conversation last month, Maitra allegedly explained to Administrator A that he used to make Novak ‘so much money’ performing almost daily penile implant procedures on patients, but that he no longer performed as many of those procedures because Medicare had decreased its rates of reimbursement for the procedure. Maitra did not comment on whether the patient need for the procedure had somehow changed, according to the affidavit.”   “On March 1, 2013, Administrator A recorded Novak stating that tracheotomies are Sacred Heart’s ‘biggest money maker’ and the hospital can make $160,000 for a tracheotomy if the patient stays 27 days. On March 7, 2013, the Intensive Care Unit case manager told Administrator A that she must often ‘stretch’ a tracheotomy patient’s stay to 28 days to maximize Medicare reimbursements ‘to make Novak happy.’”
Source: wordpress.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Medicaid and Medicare Specialist Returns to Patton Boggs

"Patton Boggs has an extraordinary health care team, and I am delighted to rejoin my colleagues,” said Zawistowich in a statement. “It is truly an exciting time to be working on the front lines of health care policy-making. I look forward to working with clients to address the challenges and opportunities in Medicaid, Medicare, and health care reform.”
Source: typepad.com

Obama's Nominee for Medicare/Medicaid T

Tavenner has worked for the past 16 months as acting CMS administrator, since she rose from being an assistant to the infamous Sir Donald Berwick, during whose tenure she served as CMS Chief Operating Officer since 2010. Berwick had to leave CMS office December, 2011, three weeks before his time ran out as an Obama recess-appointee. He would have failed approval, even in the miserable Senate. (Berwick, an American national, was knighted by the Queen for all the deadly harm he did to the British National Health Service; he is now back at it again in England.)
Source: larouchepac.com

Important Information for Those Receiving Medicaid and Medicare

The New Jersey Division of Medical Assistance and Health Services (DMAHS) announced an opportunity for Medicare and Medicaid-eligible beneficiaries (Dual Eligible) to sign up for Special Needs Plans (D-SNPs).  A Dual Eligible D-SNP serves consumers with Medicare and Medicaid. A group of New Jersey consumer advocates has been evaluating the feasibility of D-SNP for persons with a mental health diagnosis. Please click here for advice about how to research the plan to assure that it will appropriately meet individual needs. 
Source: mhanj.org

Medicaid v. Medicare payment rates

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Source: wordpress.com

Medicare/Medicaid Question

I have a prospect that is full QMB medicaid. She is interested in United Health SNP, but wants to know if Medicaid (in Florida) will pay her Pt B Premium. I have called united health and they tell me, they don’t know she would have to contact medicaid in our state. She has tried to get a hold of medicaid, but they are almost impossible to get a hold of in florida, I have also tried, and been unsuccessful myself. Does anyone know if a QMB in Florida will have to pay the Pt B premium, or if the state does it? If she has to pay it herself, can she sign up for a program for the state to pay it?
Source: insurance-forums.net

Illegals on Social Security & Medicaid/Medicare | ALRA

ROSEMARY JENKS of Numbers USA details the fiscal crisis the US will face if millions of illegal immigrants are granted legal status, immediately making them eligible for Social Security, Medicare, and Medicaid benefits.
Source: latinogop.org

Drug Savings Act Would Strengthen Medicare Without Harming Beneficiaries

Implementing Medicare drug rebates is not new law. Upon passage of the Medicare Modernization Act (MMA), millions of older adults and people with disabilities gained access to prescription drug coverage through private plans approved by the federal government, known as Medicare Part D. At the same time, the MMA severely limited the tools available to the federal government to control spending on pharmaceutical drugs in Medicare. In particular, the MMA eliminated rebates offered by pharmaceutical manufacturers for drugs provided to beneficiaries dually eligible for Medicare and Medicaid. Applying Medicaid-level rebates to Medicare drugs simply restores a practice that existed for dually eligible beneficiaries prior to the passage of the MMA.
Source: workingamerica.org

Medicaid and Medicare are off the table. What’s left Then? SOTU 2013 Edition

The above chart, from the first page of the CBO report, illustrates the growth in means tested programs since 1972, as a portion of the economy. While direct cash assistance and nutrition, housing and education programs have grown from 0.9 percent of GDP to 2.1 percent, means-tested healthcare programs (primarily the federal portion of Medicaid) have on their own have reached almost 2 percent of GDP. If you factor in state spending on Medicaid, that number is close to 2.5 percent.
Source: medicalprogresstoday.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

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 marsmet526Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Video: Supplemental Insurance Covers What Medicare Doesn’t

Antony Turbeville – Lakeland: What Medicare Part B Covers?

We at Platinum Benefit Planning provide information and resources about Medicare Part B to help you. We want to help you understand what Medicare Part B is and how and where you can get the information and services you need. Medicare Part B covers medically necessary services like services or supplies that are needed to diagnose or treat your medical condition and that meet the accepted standards of medical practice. It also covers preventative services these include health care to prevent illness or detect it at an early stage, when treatment is most likely to work best. Participants in Medicare Part B pay nothing for most preventive services if you get the services from a health care provider who accepts assignment. Medicare Part B also covers things like clinical research, ambulance services, durable medical equipment, mental health inpatient outpatient partial hospitalization, getting a second opinion before surgery, and limited outpatient prescription drugs.
Source: platinumbenefitplanning.com

4 Seniors: How Medicare covers diabetes

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

Know Your Medicare In Better Way

Medicare Eligibility: In order to be eligible for Medicare, there is an eligibility criterion that should be fulfilled. The guidelines for eligibility include age, nationality and various other factors. As far as age is concerned, people should be 65 years or above. Even people who are below 65 years of age can apply, but this is only when the applicant is disabled or suffering from end stage renal disease. As far as nationality goes, the applicant needs to be a U.S citizen in order to be eligible. Even non-Americans can be eligible if they have gained U.S citizenship at least 5 years before applying for the program. If an applicant’s spouse has worked for a minimum of ten years and has paid premiums into the Medicare program, it makes them eligible for coverage too. What Medicare Covers: The basic break down of Medicare coverage is divided into 4 parts. These include Part A, B, C and D, and each plan offers different benefits. Part A: This plan involves cover for expenses paid during hospital stays. For this reason, Medicare Part A is also called hospital insurance and it pays for expenses incurred for up to 90 days of hospital care. However, this requires the insured to pay a minimal annual deductable. The expenses covered under this plan comprise of: • Meals • Semi-private room • Medical tests • Medical supplies • Intensive care unit • Blood transfusion after the first three pints • Coronary care unit • Operating room • Medication supplied by the hospital
Source: triptomyblog.com

Medicare Covers Illegals, Incarcerated

The Center for Medicare and Medicaid services (CMS) paid more than $125 million to providers for treatment of 11,619 prison inmates and 2,575 individuals who were in the country illegally from 2009 through 2011, according to a pair of reports released Thursday by the inspector general of the Department of Health and Human Services.
Source: freebeacon.com

Alphabet Soup a la Medicare

Medicare Part B:  This is your medical insurance.  This covers doctor and other health care provider services, hospital outpatient services (those ‘observation’/’accommodation’ stays!), durable medical equipment and skilled home health care services.  This will cover many preventive services as well.  BE AWARE:  Per CMS, “The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible.  HOWEVER, your total copayment for all outpatient services may be more than the inpatient hospital deductible.”  This is the tricky part if you are in the hospital for several days without a formal admission!
Source: wordpress.com

What the elderly should know about Medicare

Part C (Medicare Advantage): Part C allows beneficiaries to enroll in a private insurance plan, called a Medicare Advantage plan. Medicare Advantage plans are managed care plans, such as Health Maintenance Organizations (HMOs) or Preferred Provider Organizations (PPOs). Medicare Advantage plans must cover all Part A and B services and usually include Part D (prescription drug coverage) benefits in the same plan. These plans sometimes cover additional benefits not covered by traditional Medicare, such as routine vision and dental care. All plans have an annual limit on your out-of-pocket costs for Part A and B services, and once you reach that limit, you pay nothing for covered services for the rest of the calendar year. The out-of-pocket limit can be high but may help protect you if you need a lot of health care or need expensive treatment. Out-of-pocket costs include deductibles, copayments and coinsurance
Source: alvitacare.com

Medicare covers hospice & comfort care

, your loved one can get the care and support they need. This can include doctor and nursing services, counseling, medical supplies, pain medications, and other services. And, most importantly, hospice can provide much needed comfort while at home.
Source: medicare.gov

What Medicare Beneficiaries Should Know If They Have Diabetes

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Source: diabetesz.info

Medicare Myths » Toni Says

Myth #1:  Most baby boomers think Medicare is just like regular health insurance plans…FALSE!!  Only 2 in 5 or 40% of the baby boomers surveyed know that Medicare is totally different than traditional group or individual health insurance.  Medicare has 2 Parts A & B.  Part A has a $1,184 deductible 6 times a year for an in hospital stay.  Part B of Medicare includes doctor’s services such as office visits and doctor performing surgery, outpatient services and surgery, scans, x-rays, chemotherapy and radiation, and the list goes on.  There is a 1 time deductible for Part B of $147.00 once a year with Medicare picking up 80% and you pay 20% of the Medicare approved amount with no co-insurance or stopping.  Not like the typical 80/20 to $5,000 with a stop lost. The 20% just keeps on going!! Toni Says: Medicare is completely different than health insurance. Your out of pocket can be huge if you only have Medicare or the red, white and blue card. Learn what Medicare offers.
Source: tonisays.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

Kansas legislators mull no Medicaid expansion (and a hospital pushes back)

Posted by:  :  Category: Medicare

Historic Moment: the Fall of an Empire - 25 SEP. 2008. by eyewashdesign: A. Golden“We recently interviewed a young woman who works in fast food,” Samuelson said. “She’s a manager six days a week. She’s a single mom with a child, who makes $15,000 a year. She doesn’t meet the income threshold. If she wants insurance, she has to find it on her own and pay for it. That would take more out of her paycheck than she can afford. Her daughter is covered, but she can’t be proactive in her health care. She’s a sole provider. If something happened, she’d have to go to the emergency room, the most expensive way to get care. She probably doesn’t even have a doctor. If we have expanded Medicaid she can go to a doctor’s appointment that would be covered by a $20 co-pay, versus going to the emergency room.”
Source: medcitynews.com

Video: Legislative Round Table: Impacts of Medicare Competitive Bidding Program in Kansas City

Medicare Kansas City Health Insurance Basics

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

Blue Cross Kansas City Medicare Supplement Meeting

This insurance company currently offers four Medicare Supplement plans for seniors over the age of 65 and some folks who are on Social Security Disability Benefits. All four plans (Plan A, Plan C, Plan F and Plan N) are offered with no underwriting and are guaranteed issue as long as you are either turning age 65 or have recently enrolled in Part B Medicare. All Medicare Supplement plans are standardized, meaning benefits are exactly the same for every company offering Medicare Supplements in Kansas and Missouri and most other parts of the country. The most differentiating factor is the premium amount. Insurers premiums often vary for different factors so shopping around is a good idea. However, keeping in mind that Blue KC is a Not for Profit business entity they typically have very low rate increases verses other competitors that may offer low introductory rates when you initially sign up but inevitably have double digit increases after one year. Another fact to consider is that Blue KC only have one health pool for everyone enrolled in a Medicare Supplement plan, so your will never end up in a closed out group of less healthy folks and in which those premiums would increase more than normal.
Source: prairiehealthandlife.com

Kansas’ Great Hope: Managed Care Will Tame Medicaid Costs

According to Michael Sparer, a Columbia University professor of health policy, “good research” is surprisingly thin, and reaches the same conclusion: Medicaid managed care hasn’t yet produced the hoped-for results of lowering costs and raising quality in states where the concept has been tried. That’s mostly because much of the existing research focuses on managed care programs that serve low-cost Medicaid populations such as women and children. But he notes there may be more potential to save significant amounts of money when high-cost populations’ care is managed. 
Source: kaiserhealthnews.org

Kansas redneck: Medicare under ObamAA

goes into his doctors office for an annual physical. After a while, the doctor comes out and says, “I’m sorry Bill, but we have discovered you have a condition which medicare no longer covers, and you only have another 6 weeks to live.” “But Doctor,” Bill replied, “I feel great. I haven’t felt better in years. This just can’t be true. Isn’t there anything I can do?” After a moment the doctor said, “Well, Medicare will pay for you to start going down the street to that new health spa and take a mud bath every day.” Excitedly Bill asked, “And that will cure me?” “No,” replied the doctor, “but it will get you used to the dirt.”
Source: blogspot.com

SelectQuote’s Kansas City Connections

    Certainly, it may have been intentional to lavish multiple tax breaks up on a company with its largest division out of state.  So long as the Kansas divisions are hiring they are probably eligible for these incentives.  Whatever government employees might have discretion may have been impressed or swayed by the connections SelectQuote has made with local boys.  It does look a bit like putting too many of one’s eggs in one basket, however.  Especially given recent cuts to Kansas education. 
Source: selectquotereview.com