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

Posted by:  :  Category: Medicare

When I'm 64 by MuffetThe brief is based on interviews with senior executives at 13 large firms that contract with the Medicare and Medicaid programs and finds almost all of the insurers expect dually eligible beneficiaries will become more important to their business over time. The brief also looks at how insurers currently serve dually eligible beneficiaries, particularly through Special Needs Plans that are part of the Medicare Advantage program.
Source: kff.org

Video: Turning 65 Becoming Eligible for Medicare – 2011

Extending Social Security and Medicare Eligibility Ages

In light of the increase in life expectancy after age 65 and the decline in physically demanding jobs, it would be reasonable for the eligibility age for social security to rise to 68 or 70. The average age of retirement from the labor force for Japanese males is already only a little below 70, which shows that much higher retirement ages is feasible. Persons who are physically or mentally incapable of working would then opt for disability status. This is a rapidly growing category in most developed countries, despite the increase in physical and mental health of older persons, because of a weakening of qualifying standards. With more flexible labor markets for the elderly, such as reducing the fear of companies that they will be sued for discrimination against older workers, older men and women could retire from more demanding jobs, and take jobs that are less taxing. This is what happens to older men in Japan.
Source: becker-posner-blog.com

Who is Eligible for Medicare?

While most people do not have to pay a premium for Part A, everyone must pay for Part B if they want it. This monthly premium is deducted from your Social Security, Railroad Retirement, or Civil Service Retirement check. If you do not get any of these payments, Medicare sends you a bill for your Part B premium every 3 months. If you have questions about your eligibility for Medicare Part A or Part B, or if you want to apply for Medicare, call the Social Security Administration or visit their web site. The toll-free telephone number is: 1-800-772-1213. The TTY-TDD number for the hearing impaired is 1-800-325-0778. You can also get information about buying Part A as well as Part B if you do not qualify for premium-free Part A.
Source: seniorsguideonline.com

If I Win my SSDI Case, When do I Become Eligible for Medicare?

For many of my clients, Social Security disability income benefits are a lifesaver. The $1,500 to $2,000 per month typical in SSDI cases plus a $20,000 to $30,000 lump sum can mean the difference between living with dignity and not. However, monthly income benefits are not the only result of a favorable disability decision. SSDI claimants also become eligible for Medicare, although this eligibility is not immediate. There is a 24 month waiting period from the first date you become eligible to receive SSDI payments and the date you become eligible for Medicare. Here are a couple of examples that might help you better understand the 24 month waiting period: Example 1: Sue’s last day of work is August 10, 2010. She files for SSDI on August 11, 2010 using August 10 as her alleged onset date. Sue and her lawyer appear at a hearing in July 2012 and she is approved as of her alleged onset date. Sue first becomes eligible for SSDI payments as of February 1, 2011. This is because the five month waiting period for SSDI runs September, 2010 – January, 2011. Note that the five month waiting period refers to five full months – thus, August, 2010 does not count towards the five month waiting period. Sue becomes eligible for Medicare on the 25th month after her first SSDI payment, or March 1, 2013. Example 2: Tom stops working due to severe back problems on March 3, 2005. He does not apply for SSDI until July 18, 2008. Tom appears at a hearing in September, 2010 and receives a fully favorable decision using the March 3, 2005 onset. Tom first becomes eligible for SSDI payments in July 2007. His five month waiting period runs from April, 2005 through August, 2005, but he can only collect benefits one year prior to the date of his application, which is July 18, 2007. His Medicare eligibility begins as of September, 2008, which is during the 25th month after his first eligibility for SSDI payment. Here is a link to SSA’s page about Medicare eligibility – http://1.usa.gov/11CbEEW.
Source: jdsupra.com

Question about calculating Medicare eligibility date

Hi, I have a question about how to calculate my Medicare eligibility date and I’m finding some conflicting information on the web so I’m hoping someone here can provide a better answer. I filed for disability in 9/2012. SS determined that my medical onset date is 9/2010. They have my entitlement date as 9/2011. I understand that there is a 24 month waiting period before one is eligible for Medicare. My question is do they start counting from the onset date (the first date they found I was disabled) or the entitlement date (which is the 1 year prior to my application date, which is apparently as far back as they can go)? I’ve seen some sites say they go from the onset date (in which case I would be eligible) but other sites say you actually have to receive benefits for 24 months (so using the entitlement date, basically). I was at the SS office today and the lady helping me thought it was calculated from the entitlement date, but she wasn’t certain. I’m hoping someone here has had experience with this issue and can shed some light on it. Thanks for any information!
Source: psychcentral.com

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

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

Oklahoma Medicare Eligibility Requirements

You’re not alone if the term “Medicare eligibility” leaves you scratching your head, wondering if you qualify for the full package of benefits. It’s true, there are a few restrictions, but for the most part, as long as you’re 65 or older and a permanent citizen, you should be qualified for health care benefits through Medicare. In some cases, it’s possible to be eligible for Medicare even if you’re younger than 65. If you have End-Stage Renal disease or have been on Social Security disability benefits for over 24 months, you’re eligible at any age.
Source: oklahomamedicarehealth.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

UM Health System Joins Priority Health Healthcare Network

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 marsmet526Priority Health is an award-winning health plan nationally recognized for creating innovative solutions that impact health care 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, has the largest individual Medicare Advantage plans in the state and has the highest Medicare quality rating for a health plan in Michigan. To learn more visit priorityhealth.com.
Source: cbslocal.com

Video: Priority Health Medicare — Understanding Medicare Video

David Brooks, Obama, and Medicare:

David Brooks is both a liar and an idiot. Speaking of idiocy, there is the idiotic repetition, ad nauseum, of the need to "reduce the size of government" as if this were self-evident. Actually, it is both backward and ass-backward. Government financing, transfer payments, are not part of the "size of government" as they do not represent a government service or expenditure. It is of no importance whatsoever whether financing for an activity is public or private so long as we adopt the most efficient and equitable means and in neither case is the "size of government" affected except as to the relatively de minimis costs of administration (a mere fraction of what is spent by the private sector for analogous functions). That way, we have the lowest overall share of GDP devoted to the particular service. In the case of retirement, education, and especially in the case of medical care, government financing is far preferable, both more efficient and more equitable. If private medical costs over the last 40 years had increased at only the rate of Medicare cost increases, the economy would now be saving roughly a trillion dollars a year. Moreover, in an advanced industrial economy, growth is not supply-constrained — we always have idle capacity — but demand-constrained. The private sector is not able to generate sufficient demand fully to employ productive resources, labor or capital. Therefore, the more efficient our economy becomes through technological innovation, the MORE government has to grow, the more government has to spend, in order to maintain output at or near its maximum. Thus, for three reasons, efficiency, equity, and aggregate demand, we need more government, not less. Does that stop the idiotic insistence that we shrink government? No, it does not. The ignorant and the ideological fanatics will repeat the same idiocy forever, regardless of the economic reality.
Source: newrepublic.com

Govt to deliver on schools and NDIS

In the treasurer’s weekly economic note, Mr Swan said the government would not follow a path of austerity at the expense of jobs to achieve a budget surplus, while he also highlighted the importance of investing in schools and providing funding for the national disability insurance scheme (NDIS).
Source: bigpondnews.com

Priority Health Medicare: Your Health Is The Top Priority

If 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

Medicare for all should be a priority, not an option

Everyone should sign this petition, because we have an evergrowing healthcare program problem in the United States. Every other country around us has access to National healthcare but the United States. We need to tell our senators, house members, and President Obama to bring back the Medicare for all Act in Congress to Sign and put this legislation through to help all Americans. Please will sign this petition to let our congress and president that this is a major priority.
Source: civicdirect.com

Deficit Reduction Rises on Public’s Agenda for Obama’s Second Term

The current survey finds that views of the importance of strengthening gun laws are correlated with gun ownership and opinions about whether it is more important to control gun ownership or to protect gun rights. Nearly half (47%) of those who do not have a gun in their household view strengthening gun laws as a top priority, compared with 24% of those who do. And while 61% of those who say gun control is more important than gun rights prioritize stronger gun laws, just 12% of those who say it is more important to protect gun rights do so. For more on opinions about gun control, see “In Gun Control Debate, Several Options Draw Majority Support,” Jan. 14, 2013.
Source: people-press.org

Medicare Advantage Plan Provides Model for Improving Care for Patients with Diabetes

The new study, “Medicare Advantage Chronic Special Needs Plan Boosted Primary Care, Reduced Hospital Use Among Diabetes Patients,” examines the model of care used by the largest Medicare Advantage chronic special-needs plan, Care Improvement Plus, and compares utilization rates among its members with diabetes in Arkansas, Georgia, Missouri, South Carolina and Texas with those of similar beneficiaries enrolled in fee-for-service Medicare in the same five states.  Care Improvement Plus’ Model of Care emphasizes direct contacts with patients to help identify gaps in care and promote primary and preventive health care, including periodic home visits with plan clinicians.
Source: ahipcoverage.com

Think tank puts data sharing as priority

“Those who deliver care to patients, as well as patients themselves, must have access to information that resides in the multiple settings where care and services are delivered, including offices of primary care physicians and specialists, hospitals and clinics, laboratory and radiology centers, pharmacies, and post-acute and institutional long-term care providers,” the report authors wrote. “Much of this information is also needed to calculate clinical quality measures, which support performance measurement and improvement.”
Source: oneclickmed.com

16 Top Priorities for Healthcare Compliance Programs in 2013

Thirty-seven percent of compliance professionals in the healthcare provider industry ranked Medicare Recovery Auditors, or RACs, as their top priority for compliance programs in 2013, according to a survey from SAI Global and Compliance 360. The survey is based on responses from 1,056 healthcare compliance professionals. Survey respondents were provided with a list of the top compliance program areas and were asked to indicate priority levels for each. Here are the 16 issues, ranked by the percentage of respondents who identified them as “top priority.” Note: Respondents could also rank these issues as high, medium or low priority. Those priority levels weighted the rankings. 1. Medicare RACs — 37 percent 2. Demonstrating compliance effectiveness — 37 percent 3. Employee compliance training and education — 37 percent 4. Documenting and investigating incidents — 32 percent 5. Medicaid RACs — 31 percent 6. Meaningful use requirements — 28 percent 7. HIPAA and Office for Civil Rights audits — 26 percent 8. Other medical claims audits (government) — 26 percent 9. Stark law compliance — 25 percent 10. Managing and/or revising policies — 24 percent 11. Governance and board reporting — 21 percent 12. Medicaid Integrity Contractor audits — 20 percent 13. Ensuring compliance of vendors/business associates — 15 percent 14. Tracking and/or reporting conflicts of interest — 12 percent 15. Tracking and/or reporting gifts and entertainments — 9 percent 16. Tracking and/or reporting payments to public officials — 6 percent
Source: beckershospitalreview.com

The Budget Priorities of Democrats

But, let’s be fair to the President and Vice President on the budget. By “priority” they mean spending tax dollars to supposedly show their compassion for fellow Americans in need. For them, bigger budget allowances equate to a bigger heart. But does their logic really hold up to scrutiny? Food stamp spending under their administration has gone up by 108 percent, ostensibly suggesting they care more about poor Americans. In reality though, nearly two years after the “recovery summer,” food stamp spending and poverty levels continue to remain incredibly high. If their “priority” truly is helping poor Americans then they should consider the ways in which their policies are failing to help our fellow citizens climb up out of poverty.
Source: townhall.com

Committees Advance Medicare Physician Payment Reform Effort, Circulate Additional SGR Reform Proposals for Feedback

The latest proposal provides further details and clarity on the three phases outlined in the earlier proposal. The current proposal specifies a process to reward providers for high-quality and efficient care in the fee for service (FFS) program. The proposal also includes processes to determine quality and efficiency measures that focus on evidence while being flexible and specialty-specific; recognizes the role that specialty-specific registries play in facilitating quality improvement while minimizing provider participation burden; and addresses the need for timely performance feedback to allow providers to identify improvement opportunities and optimize incentive payments.
Source: house.gov

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

Posted by:  :  Category: Medicare

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

Video: Medicare Part D

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

Rural Resources on Medicare Part D Prescription Drug Benefit Introduction

Medicare Part D is the prescription drug benefit added to Medicare in 2006. It was created through the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) and provides elderly and disabled people on Medicare access to prescription drug coverage from private prescription drug plans.
Source: raconline.org

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

Medicare Part D Prescription Drug Enrollment Trends in 2013

According to research from Avalere, Medicare beneficiaries are overwhelmingly choosing low-cost Part D prescription drug plans . In 2013, more than 500,000 beneficiaries enrolled in the brand new AARP Saver Plus plan—catapulting it to a position in the top 10 list of plans in its first year. With the addition of Humana/Walmart and First Health Part D Value Plus, nearly 3 million beneficiaries are choosing low-premium plans with preferred pharmacy networks.  Between 2012 and 2013, premiums have been fairly stable with an average annual increase of only 2%.
Source: healthcare-economist.com

– How does Tricare work with Medicare Part D?

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

Florida Healthcare Lawyers

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 marsmet481GAO estimated that cumulative Medicare Advantage (MA) risk scores in 2010 were 4.2 percent higher than they likely would have been if the same beneficiaries had been enrolled continuously in Medicare fee-for-service (FFS). For 2011, GAO estimated that differences in diagnostic coding resulted in risk scores that were 4.6 to 5.3 percent higher than they likely would have been if the same beneficiaries had been continuously enrolled in FFS. This upward trend continued for 2012, with estimated risk scores 4.9 to 6.4 percent higher.
Source: flhealthlaw.com

Video: Best Florida Medicare Plans

Medicare Participants in Universal Health Care Have Until May 31 to Choose New Medicare Plans, Allsup Reports

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Source: 88finance.com

Obama planning to Cut Medicare Advantage Reimbursements

The new cuts come in the form of a planned reduction in the reimbursement rates the government pays to insurance companies that operate Medicare Advantage plans, which are services administered by private for-profit or non-profit providers that offer additional services than can be found in traditional Medicare.
Source: westorlandonews.com

Daily Kos: Elderly will be hit hard by Romney’s Medicare, Medicaid plans

As it turns out, what we know for sure about Mitt Romney’s assault on senior citizens may pale compared to what we don’t. Romney, after all, has promised to magically offset $5 trillion in tax cuts and $2 trillion in new defense spending over the next decade by closing as yet unnamed tax credits, deductions and deductions. But among Uncle Sam’s $1.1 trillion in annual tax expenditures are a host of tax breaks for the elderly. That figure is forecast to hit almost $1.4 trillion by 2015. While the home mortgage and health expense deductions top that list, untaxed Social Security benefits will reach $44 billion annually in three years. And that’s just one example. Mitt Romney has called for raising the retirement age to 67 for those now 55 and under. (In his 2008 campaign, Romney supported President Bush’s proposal to privatize the retiree pension system.)
Source: dailykos.com

Medicare Members Lose Benefits

PRLog (Press Release) – Apr. 8, 2013 – NAPLES, Fla. — Effective April 1st, 2013, Universal Health Insurance will cancel contracts for 40,000 Medicare members and 60,000 Medicaid recipients in SW Florida.  The company, offering Medicare Advantage Plans,  declared bankruptcy leaving their members to scramble for new benefits.  To better understand available options, Medicare Specialist, Helen Hreen will present a Free Seminar titled “Welcome to Medicare Madness” on Friday, April, 19th and Wednesday, April 24th, from 10 AM to Noon at M  Waterfront Grill, 4300 Park Shore Blvd in Naples. The seminar is also intended to educated retirees and near-retirees who are  confused by Medicare, Supplemental Plans Options, Advantage Plans and RX Plans whether they’re new to Medicare, losing benefits or new to the area. With more than 30 years of healthcare and insurance experience, Hreen is in a unique positions as a Medicare Specialist to provide up-to-date information on all aspects of Medicare, offer comparisions, and assist in choosing benefits that are tailored to need. Call 239-384-7014 to reserve your place.
Source: prlog.org

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

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

Ryan's Medicare Plan: How Big a Factor in Florida?

As Obama for America’s Florida press secretary, Eric Jotkoff, put it: “If the headlines don’t tell the story, then certainly Floridians can say that Mitt Romney and Paul Ryan are simply out of touch and have no idea what’s important to the people of Florida. Whether it’s a budget that could end Medicare as we know it forcing Florida seniors to pay $6,350 a year out of their pockets or a tax hike which would burden hard-working middle-class families, Romney and Ryan’s campaign is toxic in the Sunshine State, and they will have a hard time convincing voters to choose them in November.”
Source: realclearpolitics.com

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

Humana medicare gold plus hmo doctors jacksonville florida

Learn about Humana health insurance plans, get free instant rate quotes, compare coverage options with all the major Medicare carriers, and apply online Prescription drug lists for members who have Humana Medicare – 2012 prescription drug plans. Humana Medicare Plans – Health Insurance. Humana Plus – Amazon.de                    
Source: rediff.com

Medicaid Expansion: A false promise to poor Virginians

Posted by:  :  Category: Medicare

Rockefeller Introduces Legislation to Protect Almost 90,000 West Virginia Seniors and Reduce Deficit By $141.2 Billion by SenRockefellerAnother concern, unrelated to the program itself, is how do we pay for it? The federal government has promised to cover all the costs of expansion. The nation is $16 trillion in debt. Our Congress hasn’t passed a budget in four years. Advocates for expansion claim “free federal money” will pay for expansion, but the truth is the federal government cannot afford to pay for Medicaid expansion without adding hundreds of billions of dollars in debt that will burden our children and grandchildren. In short, Medicaid is an expensive, broken program. And Virginia taxpayers will eventually get stuck with the tab. You don’t fix a broken program by putting more people in it. And you certainly don’t help poor Virginians by putting them in a broken program. Enrolling low-income Virginians in a broken program that we cannot afford is a false promise and a fool’s paradise.
Source: bearingdrift.com

Video: Vice President Joe Biden on Medicare – Blacksburg, VA

West Virginia Blue:: Capito Alone Votes for Partisan Cuts Slashing Medicare, Hurting WV

I have nothing personal against Congresswoman Capito.  She is a nice lady.  On a slim sliver of issues, I think she is relatively moderate (she is Pro Choice for example).  She is also an establishment Republican that has in the past rebuked the Tea Party.  Now that the radicals control the GOP, however, she feels she needs to keep pace.  She is a calculating politician above all else and such strategic maneuvering in Washington often leaves West Virginia out in the cold.  Don’t take my word for it, just ask her Republican colleague from West Virginia’s First Congressional District.
Source: wvablue.com

CMS expands Medicare savings program for durable medical equipment

Blum emphasized that the price cuts had not resulted in any adverse health indicators, such as lack of access, downgraded quality of care, or an increase in hospital admissions in the areas where the agency tested competitive bidding. “No one has challenged the data. It has given us tremendous confidence,” he said in a media conference call. By 2016, the program is scheduled to expand to the rest of the country.
Source: medcitynews.com

Virginians Can’t Wait

Earlier that day, state Sen. Emmett Hanger had told the Senate Finance Committee, “I believe this is the most important decision on our table in this session.” Jill Hanken, health law attorney for the VPLC, quoted Hanger’s words at the press conference. She also reported that Dr. Bill Hazel, Virginia’s Secretary of Health and Human Resources, reminded the senators, “Any delay puts us further behind and will lead to further delays.”
Source: vplc.org

Medicaid Health Plans Are Outperforming Medicaid FFS

Medicaid health plans are distinguished from FFS by being held accountable for meeting the needs of the low-income beneficiaries they serve.  Medicaid health plans must undergo a rigorous review process before being awarded a contract and must meet extensive regulatory and contractual requirements for beneficiary access to quality services. States also hold health plans accountable through the public reporting of performance outcome measures, the requirement of quality improvement programs, and network adequacy standards for all comprehensive risk-based Medicaid managed care organizations.
Source: ahipcoverage.com

Survey on Social Security, Medicare, Virginia

"The share of the budget going to entitlements has to slow down. Everybody has to give a little bit, the sooner the better, to go after the problem," said retired foreign service officer Stephen Brundage, 61, of Arlington, expressing a view shared by many Virginians.
Source: aarp.org

Va. rescue squad chief nets jail time for $1M insurance fraud

Eddie Wayne Louthian Sr., 60, a resident of the Southwest Virginia town of Saltville, was convicted of one count each of conspiracy to commit health care fraud, health care fraud, making a false statement to a jury and four counts of making false statements in relation to a health care matter.
Source: ifawebnews.com

How Medicaid expansion will help thousands in W.Va.

But these factors only address the hard-core health care pluses (and do not even deal with the economic pluses of a healthier workforce). The potential boon to small- and medium-sized businesses from virtually universal coverage is immense. First there is the huge shot in the arm to the health care occupations and related economic activity from the large infusion of federal money – over $10 billion for West Virginia. Second, the ability to start a business knowing that no employee will be driven away by medical costs removes a large burden on innovation and entrepreneurship.
Source: peoplesworld.org

Terry McAuliffe Linked To Doctor At Center Of FBI Investigations Into Underage Hookers And Medicare Fraud

FBI agents raided Melgen’s West Palm Beach office Tuesday night, apparently seeking records related to the second investigation, one involving possible Medicare fraud. The feds continued to search the premises on Wednesday, joined by agents from the U.S. Department of Health and Human Services, suggesting that the raid was linked to Medicare.
Source: wordpress.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

Voice For Medicare, Medicaid Retiring

In a statement Friday, President Barack Obama hailed Rockefeller’s service. “From his time in the state legislature to the Governor’s office to the Senate floor, Jay has built an impressive legacy, one that can be found in the children who have better schools, the miners who have safer working conditions, the seniors who have retired with greater dignity, and the new industries that he helped bring to West Virginia,” Obama said. “A long-time champion of health care reform, Jay was also instrumental in the fight to make sure that nobody in America has to go broke because they get sick.”
Source: kaiserhealthnews.org

Medicare Advantage Cuts: Higher Costs and Reduced Benefits

Posted by:  :  Category: Medicare

Seniors and people with disabilities enrolled in Medicare Advantage plans will face higher premiums, reduced benefits, and loss of coverage options if new Medicare Advantage cuts proposed by the Centers for Medicare & Medicaid Services (CMS) take effect next year. CMS recently proposed a 2.3 percent reduction in Medicare Advantage payments for 2014 at a time when medical costs are projected to increase by three percent. The new proposed payment cuts are in addition to the Medicare Advantage cuts and the new health insurance tax included in the Affordable Care Act (ACA).
Source: ahipcoverage.com

Video: 090924 Dems say no to posting healthcare plan and cost estimate and protecting Medicare benifits

GAO Report Finds Excess Spending in Medicare

According to a recent U.S. Government Accountability Office (GAO) report, private insurers offering Medicare Advantage plans receive inflated payments because insurers tend to use relatively high risk rates when calculating what Medicare should pay insurers per enrollee. The Centers for Medicare and Medicaid Services (CMS) offsets these higher rates by decreasing payments using a risk score adjustment, but the GAO reports that the CMS has not adequately adjusted these payments. The GAO estimates that this has resulted in “substantial excess payments” to Medicare Advantage plans—totaling in the range of $3.2 to $5.1 billion between 2010 and 2012.
Source: upenn.edu

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

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

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

Best ways to do business with Social Security

Look­ing for more Social Secu­rity infor­ma­tion? Go online to find out almost any­thing you need to know about the Social Secu­rity pro­gram. Infor­ma­tion is avail­able on sub­jects rang­ing from how to get a Social Secu­rity num­ber for a new­born to return­ing to work while receiv­ing dis­abil­ity benefits.
Source: thebellevuegazette.com

Medicare Advantage Cuts and Coverage Update

The Centers for Medicare and Medicaid Services report applications are up almost fifty percent from last year for requests from private insurers vying for a position in the Medicare market. Large national insurance companies continue to see a large part of their business profitability and growth projections being met with Medicare Advantage. Private insurance companies believe that the growing baby boomer market will bring exponential enrollment numbers to the senior insurance market. Proponents of Medicare worry that the viability of the Medicare Advantage model may become threatened with the Obama Administration’s proposals to cut Medicare Advantage payments by up to eight percent in 2014.
Source: medicarebenefits.com

GOP Sources Discuss Effect of Ryan’s Budget on Medicare Benefits

reports. Ryan has been privately circulating the idea that his new budget proposal might include changes to future Medicare retirement benefits for people who currently are as old as 59, despite GOP leaders’ pledge that the program would not be altered for people ages 55 and older. Ryan was expected to introduce the proposal on Wednesday in a press briefing. The proposal aims to balance the federal budget in a decade. It also calls for deeper spending cuts and would enact changes to Medicare more quickly than the previous proposal, which delayed those alterations until 2023. However, Connor Sweeney — a spokesperson for Ryan – — on Tuesday said, “Writing a budget is a collaborative process that is still ongoing,” adding, “We don’t comment on rumors with respect to that process” (Sherman/Allen,
Source: californiahealthline.org

New Hope for Those Denied Medicare Benefits?

There is a re-review process for certain Medicare beneficiaries who were denied benefits for rehabilitative services. The denial must have become final and appealable after January 18, 2011. A further appeal need not have been filed. The re-review process only applies to services that were actually received by the Medicare beneficiary.  In other words, if Medicare denied benefits and no further rehabilitative services were received the Jimmo settlement will not help you.  Medicare can only pay for services received. If skilled care was stopped because Medicare wouldn’t cover, you may be able to get it restarted under this new standard.  First, you’ll need your doctor to explain in writing why skilled care or therapy is necessary.  Keep in mind that all the normal Medicare requirements still apply.  For example, skilled nursing care requires the 3 day hospital stay first.
Source: estateplanandassetprotection.com

Hospice: A Benefit Covered by Medicare and Medicaid––Visiting Nurse Association

Hospice services are provided by a team of healthcare professionals typically comprised of a physician, registered nurse, social worker, home health aide, chaplain, and respite care volunteer. The team works closely with the patient’s primary care physician to continuously reevaluate services that may be needed.  The team assists in all aspects of care for the patient and family. Bereavement support is also available to the family and other loved ones following the death of the patient.
Source: livingwellmag.com

Research Roundup: Community Benefits and Hospitals’ Tax

The New England Journal Of Medicine: Provision Of Community Benefits By Tax-Exempt U.S. Hospitals –The federal health law requires tax-exempt hospitals to assess and address the needs of the community in which they serve by the end of 2013. These hospitals are exempted from federal and local taxes because to help finance their charitable efforts but the question as of these hospitals provide appropriate levels of community benefits remains unclear and controversial. In this study, researchers analyzed 2009 tax reports of more 1,800 tax-exempt hospitals to assess the level and pattern of community benefits they provide. “We found that hospitals devoted, on average, 7.5% of their operating expenditures to community benefits,” the authors reported. “However, the level of benefits provided varied widely among the hospitals.” They also add that most of those expenditures go to charity care and other patient benefits and compared to other expenditures, hospitals spent little on community health improvement (Young et al., 4/18).
Source: kaiserhealthnews.org

Medicare Advantage Plans: Are They For You?

Posted by:  :  Category: Medicare

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

Video: Differences between Medicare PPO & HMO Plans

Which In Turn Medicare Supplemental An Insurance Policy Is Best Into Get

Automatic Loss Of Creditable Prescription Coverage: If you were dropped from one specific prescription plan that is considered creditable, suggests as good as compared to or better this Medicare Part R plan, then distinctive way points and a SEP to get into the Medicare health insurance Part D set up. You can enroll anywhere up to 3 months in front of time if sort you will grow to be dropped from your creditable coverage we only have sixty three days from day time that coverage corners or from day time that you turned out to be informed that the policy ended to begin a Medicare Percentage D plan. If you forget this 63 celebration window then might not be qualified for enroll again so that the open enrollment term.
Source: grandec.org

AARP Medicare Complete Connecticut (review) « Insurance News from Crowe & Associates

AARP Medicare Complete Regional PPO- The regional PPO is a United Healthcare plans that has the AARP branding.  This plan has in network benefits that are similar to the HMO 2 but it has slightly higher copays, offers out of network coverage and costs $24.00 a month.  The main reason someone would select this plan instead of the HMO 2 is to have the out of network coverage.  This plan will still provide coverage when you visit non participating providers.   This plan should not be confused with the AARP Medicare Supplement plans.  For more info on Medicare Supplement plans CLICK HERE
Source: croweandassociates.com

Medicare Advantage – or DISAdvantage?

During the debate on health care reform, the Congressional Budget Office estimated those overpayments would cost the government $157 billion over the coming decade. As a consequence of these overpayments, according to CMS, premiums for all Medicare beneficiaries, including those enrolled in traditional Medicare, are higher than they otherwise would be. That’s more than just an annoyance: the Medicare Hospital Insurance Trust Fund will become insolvent 18 months earlier than it would otherwise because of those overpayments, according to Congressional testimony by CMS’ chief actuary. That’s why, despite intense lobbying by the insurance industry, Congress inserted a provision in the Affordable Care Act to eventually phase out those overpayments.
Source: wendellpotter.com

CMS shows that the healthy go in and the sick come out of Medicare Advantage plans

Despite substantial changes in policies and market characteristics of the Medicare managed care program, disenrollment to FFS continues to occur disproportionately among high-cost beneficiaries. Disenrollees had higher risk scores and incurred higher risk-adjusted payments than beneficiaries in FFS. Their high risk scores are in contrast to the risk scores of the general MA population, most of which is enrolled in plans with average risk scores similar to or less than local FFS experience (United States Government Accountability Office, 2010). Recent studies have also shown that MA plans continue to experience favorable selection through enrollment of low-cost beneficiaries (MedPAC, 2012; Riley, 2012). These research findings suggest a pattern of selective disenrollment whereby disenrollees are sicker and more expensive than the beneficiaries who remain enrolled in MA plans. This selective disenrollment potentially increases Medicare costs through the return of high-cost beneficiaries to the FFS sector, leaving behind a healthier and lower-cost population in the capitated MA sector.
Source: pnhp.org

InsureBlog: Medicare Advantage Cuts

For just a few dollars more than most pay for a Medicare Advantage plan you could own a Medicare supplement insurance plan N and have much less out of pocket exposure than you will have under a Medicare Advantage plan.
Source: blogspot.com

WellPoint CEO Has No Plans to Buy Hospitals, Physicians

Posted by:  :  Category: Medicare

Despite industry speculation that No. 2 health insurer WellPoint named former health system executive Joe Swedish its CEO last month as a move to begin a flurry of hospital acquisitions, the former head of Livonia, Mich.-based Trinity Health quelled rumors saying the company would be looking at new contract options with providers, not buying them up. “To be clear, I do not currently see vertical integration as a likely path for WellPoint,” Mr. Swedish said in a conference call, according to the Indianapolis Business Journal. “The models are so divergent that it just does not seem to be the best use of capital.” WellPoint purchased Cerritos, Calif.-based CareMore, a Medicare health plan and physician group, for $800 million in 2011, and has since grown it to 25 clinics.
Source: beckershospitalreview.com

Video: Angela Braly: How Is WellPoint Innovating to Provide Better Care to Medicare Advantage Members?

WellPoint Profits Up 38% As Insurer Girds For Big Changes In 2013

The Wall Street Journal: WellPoint Earnings Rise 38% Amid Light Commercial Costs Health insurers are preparing for the planned opening of state-based exchanges for individuals and small businesses. People will be able to seek plans there for coverage starting in 2014, potentially putting millions of new members in play for health insurers. Meantime, the industry is also aiming to add business as states expand Medicaid coverage under the health law and create new plans to cover high-cost people on Medicaid and Medicare, known as dual eligibles. WellPoint recently closed on a $4.46 billion purchase of Medicaid insurer Amerigroup to help chase the emerging dual-eligible market while lessening its tilt toward individual and small-group markets, which are considered most exposed to the exchanges (Kamp, 1/23).
Source: kaiserhealthnews.org

Change Management Executive Mary Taylor Leaves WellPoint and Rejoins SecondWind

One of her higher-profile projects was change management support for clinical departments for the Medicare Advantage Program. This project was the first government mandated Affordable Care Act (ACA) health care reform initiatives. Mary’s leadership experience will transfer to other ACA programs as they roll out.
Source: newswire.net

Outgoing WellPoint CEO made over $20M last year

The value that a company assigned to an executive’s stock and option awards for 2012 was the present value of what the company expected the awards to be worth to the executive over time. Companies use one of several formulas to calculate that value. However, the number is just an estimate, and what an executive ultimately receives will depend on the performance of the company’s stock in the years after the awards are granted. Most stock compensation programs require an executive to wait a specified amount of time to receive shares or exercise options.
Source: seattletimes.com

INDIANAPOLIS: Health insurer WellPoint's 1Q profit rises 3 pct

WellPoint has a relatively large percentage of its enrollment in individual insurance or coverage through small businesses. The overhaul calls for exchanges to start next year on which people in those markets will be able to buy coverage, many with help from income-based tax credits. Investors aren’t sure how much business insurers like WellPoint will lose or gain because of these exchanges, and analysts say that has made them wary of buying the stock.
Source: sunherald.com

Stocks Buzz: WellPoint, EarthLink, ONEOK, ZaZa Energy Corp

ThePennyStockProfiler.com, an investment community with a special focus on updating investors with recent news on the U.S. stock market, issues news alert on the following stocks:- WellPoint, Inc. (NYSE:WLP) went up 1.83% and closed at $67.44 on a traded volume of 2.97 million shares. The Centers for Medicare & Medicaid Services issued the 2014 rate announcement and final call letter for Medicare Advantage and prescription drug benefit programs. The final estimate of the combined effect of the Medicare Advantage growth percentage and the fee-for-service growth percentage is 3.3%. These growth rates assume a 0% change for the 2014 physician fee schedule by taking into account the likely Congressional override of the schedule physician payment reduction. How Should Investors Trade WLP After The Recent Price movement? Find out Here EarthLink, Inc. (NASDAQ:ELNK) soared 1.66% and closed at $5.50 on a traded volume of 1.13 million shares. Last month, Global Capacity announced a new wholesale buy and sell agreement with EarthLink, Inc. Leveraging bilateral interconnects to Global Capacity’s One Marketplace in New York City, Chicago and Atlanta Points of Presence, EarthLink now has the ability to procure off-net services, giving it greater network reach. From EarthLink, Global Capacity gains additional access network, further differentiating the company’s ability to provide automated connectivity solutions via its One Marketplace. Is ELNK a Strong Buying Opportunity After The Recent Slump? Find out Here ONEOK, Inc. (NYSE:OKE) moved up 1.66% and closed at $48.46 on a traded volume of 2.64 million shares. So far this year, the stock is up over 15%. The 52-week range for the stock is $39.32 and $49.79. How Should Investors Trade OKE After The Recent Price movement? Find out Here ZaZa Energy Corp (NASDAQ:ZAZA) increased 1.65% and closed at $1.85 on a traded volume of 1.02 million shares. The Company announced operational and financial results for the year ended December 31, 2012. ZaZa reported revenues and other income from continuing operations of $205.2 million as compared to $17.6 million reported for the year ended December 31, 2011. The Company reported oil and gas revenue for the year of $9.6 million from $2.5 million for the year ended December 31, 2011. The increase in oil and gas revenue is primarily a result of the termination agreements with Hess. An overall rise in oil prices also contributed to this increase. How Should Investors Trade ZAZA After The Recent Price movement? Find out Here About ThePennyStockProfiler.com ThePennyStockProfiler.com is engaged in providing the most up to date and useful information on Microcap Stocks poised to breakout. ThePennyStockProfiler.com also provides investors with trend analysis, detailed company profiles, and most importantly a much needed “informational edge” which can be used as a tool for making investment decisions. To Receive Instant updates in the inbox, readers are advised to sign up for free at http://www.ThePennyStockProfiler.com Disclaimer The assembled information disseminated by ThePennyStockProfiler.com is for information purposes only, and is neither a solicitation to buy nor an offer to sell securities. ThePennyStockProfiler.com does expect that investors will buy and sell securities based on information assembled and presented in phd-trading.com. PLEASE always do your own due diligence, and consult your financial advisor.
Source: sbwire.com

Health insurer WellPoint's 1Q profit rises 3 pct

WellPoint has a relatively large percentage of its enrollment in individual insurance or coverage through small businesses. The overhaul calls for exchanges to start next year on which people in those markets will be able to buy coverage, many with help from income-based tax credits. Investors aren’t sure how much business insurers like WellPoint will lose or gain because of these exchanges, and analysts say that has made them wary of buying the stock.
Source: seattlepi.com

Obama Moves to Jack Medicare Costs

“But last week’s extraordinary rate-setting directive from Health and Human Services Secretary Kathleen Sebelius to the Centers for Medicare and Medicaid Services, in which she spurned historical practice and the advice of the CMS Office of the Actuary, will result in an obscene windfall to the private, for-profit insurers,” he said. “Simultaneously, this backroom Medicare giveaway is a heavy blow to taxpayers and the traditional, public Medicare program.”
Source: singlepayeraction.org

Idaho has advisers on hand as Medicare deadline approaches

Posted by:  :  Category: Medicare

Gang of Six - Cartoon by DonkeyHoteyThe SHIBA program this year launched a mini call center and a marketing campaign. Supervisor Phyllis Barker said SHIBA’s volunteer advisers are getting about 700 calls per week just in the main office in Boise. That doesn’t include three other regional SHIBA offices. There are 150 trained volunteers working as SHIBA counselors around the state.
Source: idahostatesman.com

Video: What Is Idaho Medicaid

Idaho Governor Will Oppose Medicaid Expansion

As you’ll hear in a moment, we have some pretty good ideas about that kind of managed care model. But there’s a lot more work to do, and we face no immediate federal deadline. We have time to do this right, and there is broad agreement that the existing Medicaid program is broken. So I’m seeking no expansion of those benefits.
Source: firedoglake.com

Idaho Has Several Parts to its Medicaid Plan Insurance Families.com

The Basic Benchmark plan gives you all that, plus coverage for dental, vision, basic mental health, therapies, prosthetics / orthotics, durable medical equipment and supplies, and school based services. The Enhanced Benchmark plan gives you all of that coverage, plus private duty nursing, ICF/ID, expanded mental health clinic, psychosocial rehabilitation, and more.
Source: families.com

Best Idaho Medicare Plans

The federal government sponsored Medicare program has helped in providing millions of Americans with the security and peace that comes with knowing that you are protected. It is natural to suppose that old age requires more medical attention as it is often accompanied by a host of ailments. It is not fair to have to get stressed for medical expenses at a time of life which you should be enjoying otherwise. The US government started the Medicare scheme with a view to help people organize their retirement planning as far as medical expenses go.
Source: ezinemark.com

Why Adult Diapers Are Used If You Have An Incontinence Problem

Incontinence is one of the problems elderly people face today. Incontinence products (http://jubjub53074.tumblr.com/post/47010740263/incontinence-products) like undergarments, briefs, diapers, washcloths, wipes and other accessories work with people who have incontinence. These products provide tranquility and comfort to people during bedtime. Most of these products are reusable. Information about these brands can be found at http://incontinencebegone.com/valuable-facts-you-must-know-about-incontinence/. Medicare has taken note of these products and devices to cover their applicants. The good thing about these products is that anyone can purchase it without a prescription. People can browse online and send an email to a particular website to order these products. These products are both available for pediatric and geriatrics. Pet peeves for people with incontinence are products with scales.
Source: idaho-republican-caucus.com

Park Service memo reveals depth of budget cuts

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Source: idahostatesman.com

From the Contributor’s Corner: Medicaid Sanction Screening

State Medicaid agencies must report final actions against providers that affect their participation in the Medicaid program promptly to Office of Inspector General (OIG). The OIG then determines whether to exclude the provider based on federal criteria for exclusion and includes the individual/entity on the OIG List of Excluded Individuals and Entities (LEIE).  Unfortunately all parties excluded by states may not appear on the LEIE.  In a study of state reporting conducted by the OIG, the office found that many were not sending their sanction information to the OIG.   The OIG noted that two-thirds of providers with final actions imposed by state agencies were not included on the LEIE. The majority of states even had a match rate of less than twenty-five percent.  The response from most of the states was that this was due to uncertainty about when to notify the OIG of such final actions and what kind of information to provide. I believe this is just an excuse. 
Source: wolterskluwerlb.com

Idaho Medicaid Prescription Drug Coverage

The Idaho Medicaid prescription drug coverage is designed and administered by each state. Each state can prepare a custom list of prescribed drugs for benefits under the Medicaid program. The state may choose to cover additional services apart from the basic services that need to be covered.
Source: medicareidaho.com

Enrollment in Kids’ Health Insurance Programs Grow Under Medicaid Bonus Program

Cindy Mann, deputy administrator of the Centers for Medicare & Medicaid Services, said that although the nation faces “serious fiscal challenges,” she still believes that children’s health should remain “a top priority” for states. “Not only have more states qualified for performance bonuses in the past,” she said, “but many have continued to improve the efficiency of their programs.”
Source: jjie.org

Idaho health insurers struggle to prepare for the Affordable Care Act

“There’s enough specificity right now that [insurance] companies should be putting together a game plan” for competing on the exchange, he says. About 80 percent of Idaho households are projected to qualify for some kind of health care tax credit or other assistance, he says. PacificSource is trying to get into the mind of a retail consumer – the self-employed couple, the single graduate student, the young family without employer-sponsored coverage – and craft plans that appeal to that consumer. Health insurance for large groups, such as Idaho businesses with national parent companies, is the dominion of large out-of-state insurers like Aetna.
Source: mcclatchydc.com

DisAbility Rights Idaho Blog: Idaho Medicaid Managed Care Proposal

The PMPM method does not by itself provide incentives for effective DD supports services or treatment. The goal of these supports is to increase the capacity of the person for self determination, independence and community integration. The success of such services is not measured by their physical health status or need for more expensive medical treatment. Short of institutional placement, there is no consequence to the MCO for providing inadequate or ineffective services and supports. Placement in a state facility like SWITC would even be a net savings to the MCO and for certain individuals ICF/ID placement could be a savings over a robust and effective community supports plan. To be effective, there must be a strong incentive to provide effective developmental services and supports. This can only be accomplished with a robust and accurate quality assurance system and well designed incentives to meet the expectations of that system. We are not aware of any examples of such a system. Traditional health insurance plans do not have expertise or experience with these services.
Source: blogspot.com

Physicians Fear Medicare Cuts Due to Fiscal Cliff

(WASHINGTON) — Medicare physicians are preparing for fee hikes for their patients if Congress is unable to resolve the fiscal cliff, according to a statement by the Centers of Medicare and Medicaid Services (CMS). According to the statement, “Medicare Physician Fee Schedule claims for services rendered on or before December 31, 2012, are unaffected by the 2013 payment cut and will be processed and paid under normal procedures and time frames,” but the CMS will notify Medicare physicians “on or before January 11, 2013” if fees will go up. The CMS says, “We continue to urge Congress to take action to ensure these cuts do not take effect.” Copyright 2012 ABC News Radio
Source: eastidahonews.com

A.G. Schneiderman And Comptroller Dinapoli Announce Prison Sentence For Brooklyn Dentist Who Defrauded Medicaid

Posted by:  :  Category: Medicare

1pic1thoughtinAug 16 spinach for brains by KatieTTNEW YORK – Attorney General Eric T. Schneiderman and Comptroller Thomas P. DiNapoli today announced the sentencing of Lawrence J. Bruckner, a Brooklyn dentist on charges he defrauded the Medicaid program by unlawfully paying recruiters to solicit homeless Medicaid patients with cash and billing taxpayers under his son’s name for services the son never provided. Bruckner failed to pay taxes on payments he received from other dentists who worked at his clinics. He has paid nearly $700,000 in restitution and today received a state prison term of 1 to 3 years as a result of this joint investigation by the offices of the state Attorney General and Comptroller.
Source: ny.us

Video: Medicare Dentist (855) 535-6169

You Might Be a Medicaid Provider in Trouble…

Section 6401 of the Affordable Care Act made clear that compliance programs are now a requirement for physicians and other healthcare providers enrolling or revalidating in the Medicare, Medicaid and SCHIP programs. While the Centers for Medicare and Medicaid Services (CMS) has yet to implement this requirement imposed by the ACA, it is no longer a question whether a compliance program will be needed but rather when. It therefore behooves healthcare practices to be prepared for the upcoming change.
Source: dentalcompliance.com

Mouthing Off: Oral Health for Seniors is a Matter of Social Justice

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Source: bioethics.net

Curing the National Toothache: Elements of a National Dental Plan

Since the 1798 establishment of federally-sponsored hospitals for those in the maritime trades, strides have been taken toward the overall improvement of public health. Passage of the Affordable Care Act (ACA) in 2010 more or less brings us up to the present. While we have come a long way toward meeting our public health, safety and well-being obligations at all levels, considerable distance remains to be traveled. Recognized by many as a significant achievement and an advance, a number of critics, including Rep. John Conyers, Jr. (D-MI), simultaneously regard the ACA as an inadequate and unfulfilled commitment to access, affordability and comprehensive health care coverage.
Source: patimes.org

First dentists in the state get THOUSANDS from Medicaid for using TeamLINKS EHR System

Until Monday, only medical professionals and hospitals had met the necessary requirements for the second year of Meaningful Use in the State of Arkansas.   Executives for U.S. HealthRecord cite the use of the TeamLINKS ® system, which is designed specifically for dentists, and the support of Excellence in Healthcare, a firm of industry experts that provide guidance and training to healthcare professionals attempting to achieve Meaningful Use, for the success.
Source: teamlinks.com

Lost in America: Medicaid “Skin In The Game”

                                                      Not long ago I was reading an article from the New York Times.  They were reporting on the percentage of doctors who still accept Medicaid patients.  According to the Times, in 2008 73 percent of doctors accepted Medicaid.  In 2012 the number of doctors treating Medicaid patients had shrunk to 63 percent and the rate is still declining. When surveyed doctors attributed the abandonment of Medicaid patients to a number of factors.  One was the extremely low Medicaid reimbursement rates, as low as $25 dollars for a doctor visit.  The docs say they can’t pay their overhead, buy and maintain equipment, pay $200,000 a year in liability insurance and purchase supplies with rates that low.  Many doctors cited the poor Medicaid patient-doctor relationships; patients who routinely abuse drugs, patients who are so obese they develop Type II Diabetes and heart problems and show no willingness to fore go the fast food or make attempts to eat a more healthy diet.  Another survey conducted by the Texas Medical Association in July, 2012 cited the troubling trend of Medicaid patients who fail to keep their appointments.  Unlike Medicare patients who suffer penalties for missed appointments, the federal government forbids doctors from charging Medicaid patients either a co-pay or fines for missed appointments. Ask any doctor who takes Medicaid and they will tell you that the Medicaid system is abused and “overused”.  While the typical family who pay premiums for their medical care, along with co-pays, exercise judgement on when a family member needs a doctor’s care, the Medicaid patient consults a doctor for a headache or when little Johnny develops a sneeze, thus putting a great strain on the system. Note:  While Medicaid beneficiaries are given free dental care as well (unlike Medicare patients), the percentage of dentists who accept Medicaid is even lower; only 40 percent of dentists today are willing to accept Medicaid reimbursement. Critics of Obamacare cite Medicaid as the prime example of why Obamacare will decimate America’s medical system.  Bringing some 30 million more “free ride” Medicaid patients into the system will crowd out adequate care for those who pay the freight with medical premiums and eventually lead to a federal government “single payer” system where Uncle Sam dictates what a doctor and/or hospital will receive in compensation and lead the best doctors and the best hospitals to leave the system and construct a separate “free enterprise, cash only” system which will only be available to the very wealthy. When one looks at the problem it becomes increasingly clear that if the federal government would just institute some “skin in the game” rules for those on the free medical care gravy train they could stop much of the waste, fraud and abuse in the system. If seniors, who paid into Medicare for their entire working life,  continue to pay monthly premiums as high as ten percent of their retirement income, and continues to pay for doctor and hospital co-pays, what’s wrong with mandating that Medicaid patients at least pay for missed appointments and a $12 dollar co-pay for doctor visits?  It would force those on Medicaid to think twice before burdening a doctor when a couple of aspirin might alleviate the sniffles and headaches.  And it would save the taxpayer a hell of a lot of money! And if those welfare queens with eight or ten kids were forced to pay ten percent of that $6,000 to $12,000 dollar maternity bill how many would she then deem she can afford to breed?  (
Source: blogspot.com

Is Dental Insurance Medicare Considered Supplemental?

The cost of a supplemental dental insurance plan will depend on the amount of coverage offered. The basic plans will cost between $25 and $50 a month, for which you would be expected to make monthly or biannual payments. More expensive plans can cost between $50 and $100 a month, but include expensive dental procedures and the largest selection of dentists. Knowing what type of care you require will help finding the insurance to fit your budget.
Source: seniorcorps.org

Filling the gaps in Australia's dental workforce

01 medicine 98.1 00.9 01.0 02 pharmacy 98.1 01.6 00.2 03 mining Engineering 93.9 05.1 01.0 04 Surveying 93.0 07.0 00.0 05 nursing (initial) 92.2 02.0 05.9 06 civil Engineering 90.5 05.4 04.1 07 mechanical Engineering 88.4 07.3 04.4 08 Electrical Engineering 88.0 07.4 04.6 09 rehabilitation 87.0 04.4 08.5 10 nursing (post-initial) 86.1 03.9 10.0 11 other Engineering 85.4 07.9 06.7 12 geology 83.7 05.6 10.7 13 dentistry 83.6 02.5 13.8 14 Building 83.1 05.4 11.5 15 law 83.0 06.9 10.1 16 aeronautical Engineering 81.4 08.1 10.6 17 Veterinary Science 80.8 09.4 09.9 18 accounting 79.9 09.6 10.5 19 Electronic/computer Engineering 79.5 10.5 10.0 20 chemical Engineering 77.5 11.5 11.1 21 Economics 76.8 09.4 13.8 22 Social Work 75.3 10.2 14.5 23 Education – initial 74.9 04.5 20.7 24 urbanregional planning 74.8 10.0 15.2 25 computer Science 74.7 13.9 11.4 26 physical Sciences 74.6 11.0 14.5 27 Business Studies 74.5 09.2 16.2 28 Health other 73.3 09.1 17.6 29 agriculture 72.6 10.9 16.5 30 law other 69.9 12.2 17.9 31 mathematics 66.0 17.2 16.7 32 languages 65.5 13.0 21.5 33 Humanities 65.3 11.6 23.0 34 architecture 63.9 15.3 20.8 35 chemistry 63.2 16.0 20.9 36 psychology 63.1 12.5 24.5 37 Social Sciences 61.9 16.0 22.1 38 life Sciences 60.5 14.0 25.5 39 Education – postother 58.8 11.8 29.4 40 Visualperforming arts 53.9 15.4 30.7
Source: theconversation.com