Happy Anniversary, Health Care Reform 

Posted by:  :  Category: Medicare

Joe the Plumber - To Flush The System ... More scams aim to ensnare Brevard seniors - Their ingenuity is boundless, Archer said. (Jul 2, 2012) ... by marsmet524[1]  Health Care Reform consists of two separate laws, the Patient Protection and Affordability Care Act of 2010 (PPACA), Pub.L. 111-148  (March 23, 2010),  and the Health Care and Education Reconciliation Act of 2010 (HCERA), Pub. L. 111-152 (March 30, 2010).  The laws often are collectively referred to as the Affordable Care Act (ACA). [2] "The Employment Situation." Economic News Release. U.S. Bureau of Labor Statistics, http://www.bls.gov/news.release/empsit.nr0.htm. [3] For a comparison of the various deficit reduction proposals, see, Kaiser Family Foundation, Comparison of Medicare Provisions in Deficit Reduction Proposals  (January 2011), http://www.kff.org/medicare/upload/8124.pdf. [4] "Preliminary Analysis of the President’s Budget for 2012," March 18, 2011, http://www.cbo.gov/doc.cfm?index=12103. [5] Even before enactment of health care reform, experts argued that lowering spending growth in Medicare is only possible if lower spending growth is reflected in the private sector. Gail Wilensky, "The Challenge of Medicare," in Restoring Fiscal Sanity 2007: The Health Spending Challenge, Brookings Institution Press, 2007. [6] Congressional Budget Office, H.R. 2, Repealing the Job-Killing Health Care Law Act. Feb 18, 2011, available at: http://www.cbo.gov/doc.cfm?index=12069 [7] "2010 Annual Report of the Boards of Trustees of the Federal Hospital Insurance and Federal Supplementary Medical Insurance Trust Funds," August 5, 2010, https://www.cms.gov/ReportsTrustFunds/downloads/tr2010.pdf. [8] PPACA §§ 3601, 3602. [9] Douglas W. Elmendorf, Director, Congressional Budget Office, Letter to the Honorable Paul D. Ryan, November 17, 2010, http://www.cbo.gov/ftpdocs/119xx/doc11966/11-17-Rivlin-Ryan_Preliminary_Analysis.pdf; Paul N. Van de Water, Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs To States And Beneficiaries(Center on Budget and Policy Priorities, March 17, 2011), http://www.cbpp.org/cms/index.cfm?fa=view&id=3429. [10] Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs to States and Beneficiaries, supra. [11] Ibid. [12] PPACA §§ 3203,3301, 3315 4103, 4104, HCERA § 1101,amending 42 U.S.C. §§1395l(a)(1),  1395w-22(a)(1)(B); and adding  42 U.S.C. §1395w-114A. [13] Alice Rivlin and Paul Ryan, A Long-Term Plan for Medicare and Medicaid, November 17, 2010, available at http://paulryan.house.gov/UploadedFiles/rivlinryan.pdf [14] Medicare Payment Advisory Committee, Report to the Congress:  Medicare Payment Policy, Chapter 8 (March 2011) http://www.medpac.gov/documents/Mar11_EntireReport.pdf. [15] Report of the National Commission on Fiscal Responsibility and Reform, The Moment of Truth, December 2010. [16] Ryan-Rivlin Plan Would End Guaranteed Medicare, Shift Medicaid Costs to States and Beneficiaries, supra. [17] PPACA §§ 3308, 3402, amending 42 U.S.C. §§ 1395r(i), 1395w-113(a). [18] Center for American Progress, "Higher Tolls on the Roadmap", February 15, 2011, available at http://www.americanprogress.org/issues/2011/02/ryan_roadmap.html. [19] HCERA §§ 1102, amending 42 U.S.C. §1395w-23. [20] PPACA, §§ 6401-6411, HCERA § 1304. [21] Congressional Budget Office, H.R. 2, Repealing the Job-Killing Health Care Law Act, supra. [22] PPACA §§ 3001-3015. [23] PPACA §§ 3021, 3022, adding 42 U.S.C §§ 1315a, 1395jjj. [24] PPACA § 2602, adding 42 U.S.C. § 1315b. [25]  PPACA §§ 3302, 3303,amending 42 U.S.C. §§ 1395w-114(a),(b). [26] Edwin Park, Matt Broaddus, Medicaid Block Grant Would Shift Financial Risks and Costs to States, (Center for Budget and Policy Priorities, February 23, 2011) http://www.cbpp.org/cms/index.cfm?fa=view&id=3409.
Source: medicareadvocacy.org

Video: What is a Medicare health insurance exchange?

State Highlights: Feds Sue Fla. Senate President’s Former Co. Over Medicare Billing

San Jose Mercury News: Barbara Lee Bill Would Push States To Roll Back Criminal HIV Laws California and other states would be pressured to amend or repeal criminal laws that single out HIV-positive people under a bipartisan bill co-authored and introduced this week by Rep. Barbara Lee. Lee, D-Oakland, said 32 states and two U.S. territories have laws that criminalize exposing another person to HIV even if the virus isn’t actually transmitted. And 36 states have reported at least 350 cases in recent years in which HIV-positive people have been arrested or prosecuted for consensual sex, biting and spitting, according to the Center for HIV Law and Policy (Richmond, 5/9).
Source: kaiserhealthnews.org

GOP Again Tries to Take Away Health Care From Millions of Seniors, Women and Families

Make it more expensive to get preventive care. Preventive health services are now provided without co-pays in all new private insurance plans and through Medicare. These benefits include an expanded list of preventive health services for women, from domestic violence counseling to contraception. More than 71 million Americans have already benefited from the full range of these services. Repeal would restore co-payments and increase out-of-pocket costs for everyone.
Source: healthcareforamericanow.org

Fact Check:Will Increased Longevity Bring Down Medicare?

The customary formulation of this myth is that Medicare is doomed by its own success in keeping its beneficiaries alive. Not only will the ranks of the program’s beneficiaries increase as the vaunted baby boom generation reaches the statutory age of eligibility, but because people are staying alive longer, Medicare’s costs will explode. The first part of this contention is indisputably true: entitlement to Medicare occurs when a person reaches age sixty-five, and the baby boom generation that is generally calibrated as starting in 1946 has arrived at that threshold. As a result, additional Medicare beneficiaries enter that program every day, and because the baby boom generation dwarfs any preceding age cohort, it is highly likely that more beneficiaries will be added to the program than are lost as older beneficiaries pass away. Consequently, the number of Medicare beneficiaries will inexorably increase over the next decade or so. Ceteris paribus, more beneficiaries mean higher aggregate costs.
Source: thehealthcareblog.com

Nationalized health care would have saved Medicare an extra $34.1 billion in 2012, say advocates

“We’ve long known that Medicare has been paying private insurers more than if their enrollees had stayed in traditional fee-for-service Medicare, but no one had added up the total extra cost to the taxpayer since contracting with private insurers began 27 years ago,” said Hellander, lead author of the study. “Nor has anyone systematically examined the many ways that private insurers have gamed the system to maximize their bottom line at taxpayers’ expense. In 2012 alone, private insurers are being overpaid $34.1 billion, or $2,526 per Medicare Advantage enrollee.”
Source: sciencecodex.com

Medicare Advantage – or DISAdvantage?

Following a 20-year career as a corporate insurance executive, Wendell Potter left his position as head of communications for Cigna in 2008 to advocate for comprehensive health care reform. He is now an analyst at the The Center for Public Integrity and president of Wendell Potter Consulting. He has also served as a consumer representative to the National Association of Insurance Commissioners. His book, Deadly Spin: An Insurance Company Insider Speaks Out on How Corporate PR Is Killing Health Care and Deceiving Americans, was awarded the Ridenhour Book Prize for “outstanding work of social significance” in 2011. Previously, he wrote A helping hand for Marsha Blackburn and  Want to fix health care? Watch this movie. for the Health Insurance Resource Center Blog.
Source: healthinsurance.org

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

In attack on health reform, Republicans target Medicare advisory board

Rockefeller argued that politics needed to be taken out of the equation when it comes to setting Medicare payments to providers. So he and others proposed a 15-member board of health care experts, appointed by the President for six-year terms, which is required to recommend Medicare spending reductions if costs exceed fiscal targets set out in the health care reform law. Its first report to Congress is due in 2014.
Source: ctmirror.org

Progressives Suddenly Support Health Insurance Marketing

One of the many claims that progressives made was that because private health insurance was for profit, then the denial of claims went directly to profit. This argument was was invalid for several reasons. 1) health insurance companies have strong disincentives against denial of valid claims due to threat of suit, whereas, government death panels have sovereign immunity from suit. 2) The easiest way to increase Health insurance companies profits is to increase market share. With more market share, they are able to spread the risk and they are better able to dictate prices in markets. Same as hospitals are better able to dictate prices in markets where the hospital chain has greater market share. If the health insurance company begins to deny claims, especially in the group plans, the agents and large employers in a market begin to seek alternative plans.
Source: coyoteblog.com

Fidelis Care Undertakes Quality Care Initiative for Senior Members

Posted by:  :  Category: Medicare

Fidelis Care’s Pharmacy Department routinely contacts members who take certain medications to treat chronic illnesses, to encourage them to be tested to ensure their medication is a helpful part of their disease management. The Clinical Care staff at Fidelis Care also provide a variety of case management services to assist members with chronic conditions such Diabetes, Asthma, and low bone mineral density in women. An emphasis is also placed on educating our members about the importance of obtaining breast and colorectal cancer screening tests. Women enrolled in Medicare Advantage and Dual Advantage programs who had not obtained a recent mammogram received a reminder postcard as part of this process.
Source: readmedia.com

Video: New Cigna Supplement Opportunity!

Fidelis adds urological surgeons to network

Fidelis Care, the New York State Catholic Health Plan, has added Capital Region Urological Surgeons PLLC to its provider network.   Capital Region Urological Surgeons, with 13 physicians and 2 nurse practitioners, has been providing urologic care in the Capital Region for nearly 30 years. The group’s specialties include urologic oncology, prostate disorders, kidney stone therapy, infertility, urinary incontinence and female urology. Offices are located in Albany and Saratoga Springs.
Source: timesunion.com

Brooklyn’s Family Health & Wellness Guide (NY Metro Parents Magazine)

PREMIER CARE Premier Care of Bellmore  2459 Merrick Road, Bellmore  516-826-2273  Premier Care of Commack  6500 Jericho Turnpike, Commack  631-858-2273  Premier Care of Great Neck  415 Northern Blvd., Great Neck  516-829-2273  Premier Care of Levittown  3276 Hempstead Turnpike, Levittown  516-796-2273  Premier Care of Lindenhurst  656 North Wellwood Ave., Lindenhurst  631-225-4227  Premier Care of Lynbrook  585 Merrick Road, Lynbrook  516-764-2273  Premier Care of Maspeth  74-25 Grand Ave., Maspeth  718-803-2273  Premier Care of Park Slope  418 – 420 5th Ave., Park Slope  718-965-2273
Source: nymetroparents.com

REPORT: Iran’s Revolutionary Guards overseeing missile fire

“The IDF continues to operate surgically in the Gaza Strip – precise strikes, not against outposts, not against police stations, but against rocket-launching sites,” he said. “So far, a very harsh blow has been dealt to the long-range fire of Hamas and Islamic Jihad.”
Source: wordpress.com

insurance: MEDICARE ADVANTAGE/MEDICARE HEALTH PLANS

Medicare Advantage/Medicare Health Plans SHIIP Publications: Frequently Asked Questions About Medicare Advantage PFFS Plans Is A Medicare Advantage Private-fee-for-service Plan Right For Me Medicare Advantage Comparison Guide (2008) Your Guide To Medicare Private-fee-for-service Plans Medicare Advantage Summaries of Benefits SHIIP Publications: Aarp Medicarecomplete Choice Aarp Medicarecomplete Plus Plan 1 Aarp Medicarecomplete Plus Plan 2 Advantra Freedom – Plan 1, Plan 2 (005), Plan 5 (001) Advantra Freedom – Plan 2 (010),plan 3 (006-013), Plan 5 (002) Advantra Savings (msa) – Plan 1 Aetna Medicare Open Plans America’s 1st Choice – Patriot Plus And Presidential Plus America’s 1st Choice – Patriot-presidential Blue Medicare HMO Plans Blue Medicare PPO Plans Cigna Medicare Access Plans One, Two And Three – Version A Cigna Medicare Access Plans One, Two And Three – Version B Cigna Medicare Access Plans One, Two And Three – Version C Cigna Medicare Access Plans One, Two And Three – Version D Evercare – Dh – Special Needs Plan Evercare – Ih – Special Needs Plan Evercare – Mh – Special Needs Plan Fidelis – Secure Comfort – Special Needs Plan Fidelis – Secure Comfort Plus – Special Needs Plan Fidelis – Secure Independence – Special Needs Plan Health Net Pearl – Plans 009-014-015 Healthmarkets Care Assured Plans Humana – Special Needs Plan Humana Goldchoice – H1804 -216 Sb08 Humana Goldchoice – H1804-007 Sb08 Humana Goldchoice – H1804-016 Sb08 Humana Goldchoice – H1804-217 Sb08 Humana Goldchoice – H1804-278 Sb08 Humana Goldchoice – H1804-279 Sb08 Humanachoiceppo – H3405-001 Sb08 Humanachoiceppo – H3405-002 Sb08 Humanachoiceppo – Regional – R5826-003 Sb08 Securehorizons Medicaredirect Plan 3 Securehorizons Medicaredirect Plan 3a Securehorizons Medicaredirect Rx Plan 51 Securehorizons Medicaredirect Rx Plan 51a Securehorizons Medicaredirect Rx Plan 54 Securitychoice Classic-enhanced-plus-enhance Plus – Area A – Securitychoice Classic-enhanced-plus-enhanced Plus – Area B Securitychoice Essential-essential Plus Southeast Community Care – Dual Plus Plan – Special Need Plan Southeast Community Care – Plus Plan Sterling Option I Sterling Option Ii Sterling Option Iii Sterling Option Iv Today’s Options – Basic Plus, Value Plus, Premier Plus Today’s Options – Basic, Value, Premier Today’s Options Powered By Ccrx Unicare 2008 Msa Summary Benefits WelLCare Benefit Summary A WelLCare Benefit Summary B WelLCare Benefit Summary C WelLCare Benefit Summary D WelLCare Benefit Summary E
Source: blogspot.com

Health Benefit Cost Growth Accelerates, Survey Says

The union said in a statement that the state required the fund to participate in a new program — the Family Health Plus Buy-In Program — beginning in 2008. The union said it expected that by joining the program, many of its members would qualify for state assistance for health-insurance coverage. “Instead they raised insurance rate increases without any increase in funding, and then cut Medicaid funding to the same workers nine times in the last three years,” the union said in a statement.
Source: wordpress.com

The American Spectator : The Spectacle Blog : GOP Report Charges AARP Getting “Kickbacks” In Dem Health Care
Bills

Richo, you are ignorant with to regards to the actual benefits that the Medicare Advantage Plan provides. I was skeptical when I was first informed by an insurance agent that there would be no monthly fees. I then learned that my medicare payments through Social Security, the $96.00 monthly, would be paid to the Medicare Advantage provider in return for my Medical Insurance coverage, both “A” and “B”. I also get a good discount on my one perscription drug of a least 70% over what I was paying with my Medicare “D” through Anthem. In addition, The SilverSneakers program for maintain my physical health is a big plus. I am 71 years old and in good physical condition. I enrolled in the Silversneakers program through our newly constructed YMCA. I paid the $75.00 joiner fee and The Medicare Advantage pays my monthly membership. How can you argue that this is not a cost savings for those of us who have been retired and needed assistance with our health insurance cost? Would you please e-mail your reply or rebutal. Jack, Wabash, Indiana
Source: spectator.org

HealthMetrix Research Selects 2009 Medicare Advantage Plans for Best Overall Ben… ( COLUMBUS Ohio Oct. 30 /

Breaking Medicine News(10 mins):Health News:Renowned Rim Fitments Provider SizeItUp Launched Database Integrations for the 2012 Hyundai Genesis 2Health News:Metal-on-Metal Hip Implants: Bernstein Liebhard LLP Comments on New Study Finding that Tissue Damage Precedes Pain in Metal-on-Metal Hip Replacement Patients 2Health News:Metal-on-Metal Hip Implants: Bernstein Liebhard LLP Comments on New Study Finding that Tissue Damage Precedes Pain in Metal-on-Metal Hip Replacement Patients 3Health News:Metal-on-Metal Hip Implants: Bernstein Liebhard LLP Comments on New Study Finding that Tissue Damage Precedes Pain in Metal-on-Metal Hip Replacement Patients 4Health News:hCGTreatments / Diet Doc hCG Diets & Weight Loss Plans Announce the Best Weight Loss Through New Whole Foods, Healthy Snacks and Prescription Strength hCG Treatments 2Health News:hCGTreatments / Diet Doc hCG Diets & Weight Loss Plans Announce the Best Weight Loss Through New Whole Foods, Healthy Snacks and Prescription Strength hCG Treatments 3Health News:Spice Addiction Treatment and Synthetic Marijuana Drug Rehab Announced by Recovery Associates 2Health News:Ayurveda Spa Treatments Now Offered at the California College of Ayurveda Panchakarma Center 2
Source: bio-medicine.org

Las Delicias’ Micro Health Insurance Program

Posted by:  :  Category: Medicare

Health Care for Poverty by Korean Resource Center 민족학교FIMRC established the Micro Health Insurance Program in June 2008 to assist the community achieve a higher level of baseline health at Project Las Delicias in El Salvador. Because FIMRC strives for sustainability and innovation, these components are key in the Micro Health Insurance Program.  MHIP is the first non-monetary model of health insurance that combines health education and community development projects with improved access to medical services to provide comprehensive health care for the entire family, all at zero financial cost to participants. Through MHIP, individuals participate in health education sessions, home visits, community-wide health events, monthly wellness visits, and quarterly feces exams to prevent and treat the spread of parasites.
Source: fimrcblog.com

Video: ‘Obamacare is Far from a National Health Insurance Program’

Health Policy Brief: The CO

A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation discusses the Consumer Operated and Oriented Plan (CO-OP) program, a provision of the Affordable Care Act. Starting in October, many Americans will be able to enroll in health plans through the health insurance exchanges in their states. Recognizing that in some states a person’s options for insurance plans may be limited, the CO-OP program was designed to increase competition among health plans and improve consumer choice by creating new, nonprofit insurance plans governed by consumers. The federal government has awarded nearly $2 billion in loans to help create 24 new CO-OPs in 24 different states.
Source: healthaffairs.org

Chancellor announces return to Berkeley

Student leaders from the Associated Students of the University of California (ASUC), the Graduate Assembly, the campus Committee on Student Fees and the Student Health Advisory Committee felt strongly that it was in the best interests of UC Berkeley students to leave UC SHIP and return to a Berkeley-based plan. Although there are many possible advantages in a system-wide plan, there also are features in our health coverage which are best optimized campus by campus. The advantages of having a Berkeley-specific student health-insurance plan have been made to me very forcefully in a letter (PDF) from the ASUC and Graduate Assembly, and this letter helped me reach this decision.
Source: berkeley.edu

Does health insurance pay for a gym membership?

Aetna offers gym membership discounts with most of its plans, says Ethan Slavin, a communications officer at Aetna. This year, Aetna also launched a fitness reimbursement program, which is open to a number of employer-sponsored health care plans. In addition to gym memberships, plan members can receive reimbursement for purchasing at-home exercise equipment, group classes and wellness counseling. Employers are able to customize the program and decide how much money their employees are eligible to be reimbursed for their fitness-related expenses.
Source: insurancequotes.com

$125 million more requested to implement Obamacare in Colorado

Health care exchanges are among the pillars of Obamacare, allowing individuals and small businesses to band together to shop for low-cost insurance. How they will look and operate will vary from state to state. Those that choose not to open an exchange will have one opened for them by the federal government.
Source: dailycaller.com

May Post of Bonnie’s Blog: Navigating Maryland’s Health Insurance Navigator Program

Confusion begins with what is a navigator for health insurance and why are they “in the news?” Navigators are in the news because the Affordable Care Act (ACA) drew on the concept of health navigators—people who help people work their way through health care systems.  The ACA navigators are to help people work their way through the health insurance marketplace exchanges established by the federal law. They are to help people learn about and enroll in Qualified Health Plans. The navigators will be hired, trained and expected to assist consumers during the open enrollment period that begins in October, 2013. More will be known as they begin to function across the state and nation.
Source: umd.edu

Is Health Insurance Good for Health?

For studies with null results, the absence of evidence does not mean an evidence of absence. There are many reasons why detecting a causal effect between insurance and health outcomes is complex and challenging. Methodologically, detecting changes in health status in a short time period provided from an academic study is very difficult. Mortality is a rare event, requiring large sample sizes to detect change (which is probably why the Oregon experiment did not measure it), while morbidity is still relatively infrequent (which the study did measure) – but also not so easy to change even with health insurance (just think about the last time you tried to lose weight, stop smoking, or reduce your blood pressure!)
Source: cgdev.org

HIPP Pays Health Insurance for Some Families with a Person on Medicaid

Before you can qualify for HIPP, Medicaid has to determine that it is more cost effective to reimburse your family for health insurance premiums than to pay the medical bills for a family member(s) on Medicaid. This saves the state money while helping families obtain health care. It does this by making private insurance the main payer and Medicaid the second payer for individuals on it. Based on individual circumstances, HIPP might not cover insurance costs for everyone in a family and some families may have to pay a percentage of the cost.
Source: texas.gov

Medigap Insurance: What to Know About Medicare Supplemental Plans

Posted by:  :  Category: Medicare

For a Medigap policy to apply, a person does need to be signed up for Medicare first, including Parts A and B. Folks who have both pay two premiums, one for the Medigap plan and one for the Medicare Part B program. Further, it’s important to note that while Medicare will cover both a person and a spouse, a single Medigap policy with a private provider will not. A consumer has to take out two Medigap plans to cover a spouse and himself. Further, Medigap is no longer allowed to cover pharmaceutical costs under Part D of Medicare. Those have to come out of pocket from a consumer under federal law. Unfortunately, drugs tend to be the biggest medical expense for seniors on average.
Source: edvox.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

What is Medicare Supplement (Medigap) Insurance

In order to sign up for Medicare Supplement coverage, you must already have Part A and Part B. These plans are offered by private insurance companies and come in 10 standardized policy types that are denoted by the letters A-N. The standardization of these plans means that no matter where you shop, the Medigap policy details remain consistent. For example, the benefits associated with Plan F are the same no matter where you buy it, though costs may differ across all carriers. Not every carrier of Medicare Supplement Insurance offers all 10 plan types, and three states in the U.S. have their own version of these plans: Massachusetts, Minnesota, and Wisconsin.
Source: ehealthmedicare.com

Medicare Supplemental Insurance

Another issue that should be kept in mind with Medigap policies, is that it is wiser to purchase a supplemental coverage within the first six months of being on Medicare Part B. This is when the insurers cannot deny the individual because of a preexistent health issue. Many insurance companies will tell the individual that they have better plans and better coverages. This is not true. The Medigap program is a national one and the coverage is the same no matter who one attains the policy from. The only difference may be the amount of the premium one is required to pay.
Source: youneedtoknowme.org

Medigap Reforms: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs

The analysis finds that most Medicare beneficiaries with Medigap policies would be expected to pay less for their health care overall. However, Medigap reforms that prohibit first dollar coverage and charge additional coinsurance for hospital, home health and other services would have a disproportionately negative impact on Medigap enrollees who are in relatively poor health, those who require inpatient hospital care, and those with modest incomes – as these groups are more likely to face higher overall health care costs as a result of the changes.
Source: kff.org

FAQ: Seniors May See Changes in Medigap Policies

Advocacy groups like the Medicare Rights Center oppose restricting Medigap plans, saying it would simply shift more costs from the government to elderly and low-income people who can least afford it. “Some in government feel people in Medicare don’t have enough ‘skin in the game,’” says Ilene Stein, federal policy director for the center. In fact, she says, people on Medicare already pay 15 percent of their incomes for health care, well above the level paid by non-Medicare households. While the proposals would cap maximum annual spending per enrollee to $5,500 or $7,500, “that’s a lot of money for someone making $22,000,” the median household income for those on Medicare, she says. 
Source: kaiserhealthnews.org

Newsroom – Insurance Commissioner Ruling on Medigap Rates Clarifies that Blue Cross Blue Shield of Michigan Does Pay Taxes

DETROIT  – Today’s ruling by the Michigan Insurance Commissioner — that Blue Cross Blue Shield of Michigan must discount its premiums on Medicare Supplemental policies by an amount equal to 1% of the company’s total revenue — makes clear that BCBSM is liable for paying a state-imposed annual assessment of about $181.5 million based on 2008 revenue.
Source: bcbsm.com

Policymakers, Stakeholders Propose Changes to Medigap Policies that Could Threaten Affordability

As part of the current budget discussions, AHIP is urging policymakers to avoid changes that will threaten benefits that millions of seniors and people with disabilities rely on. Earlier this week, the President released a budget proposal for 2014, which calls for a 15 percent surcharge on new beneficiaries who choose Medigap policies with low cost-sharing requirements.  The recent budget proposal is one of several proposals that would impose a new tax on the average Medigap premium.  The Medicare Payment Advisory Commission (MedPAC) has discussed a 20 percent surcharge.  Adding a new tax on Medigap would increase costs for vulnerable beneficiaries who rely on the predictability and financial protection Medigap provides.
Source: ahipcoverage.com

Medicare Supplemental Insurance

Medicare was created to help senior citizens acquire health insurance at a reasonable price. The majority of people are in need of health insurance far more often in their senior years than in their younger ones. Realizing that seniors pose a bigger health risk to insurance companies than the younger generation, the United States government knew that if insurance providers were allowed to operate without any kind of regulation in how they dealt with seniors, they would charge much more expensive premiums to the elder generation. This would have priced many seniors right out of healthcare coverage.
Source: lindacoleman.org

Ohio Medigap rate increases?

Why has my Medicare supplement rate gone up?.. I haven’t even used my coverage this year! Medicare supplement rate increases apply equally to all insured members regardless of their health conditions experienced in the last year. An insurance carrier cannot exempt you from rate increases because you are well. Just the same, they cannot single you out for an increase just because you are sick. If they did that, then what would be the point of insurance that you can no longer afford? Instead, Medicare supplement insurance companies calculate their total loss ratios for all clients, and then apply rate increases to certain “blocks of business.” For example, some Medigap companies increase rates across all clients in a certain geographic area. Others have automatic increases when insured members reach a certain age band, such as age 70 or 75. Still others will apply rate increases to everyone insured on a certain policy, such as Plan F or Plan G or Plan N. The important things to remember are that every insured member usually experiences at least one rate change per year, and that has nothing to do with whether you are sick or well. The nature of insurance coverage relies on actuarial tables and company’s ability to spread out the potential risk, or losses, over a group of policyholders.
Source: ohiomedigapinsurance.com

“Social Security Disability Insurance (SSDI) Reform: An Overview of Pro” by William R. Morton

Posted by:  :  Category: Medicare

Grand Bargain Watch - Save Social Security by DonkeyHoteyTo assist lawmakers in addressing the sustainability of the program, this report provides an overview of reform proposals designed to mitigate the growth in SSDI rolls. Most of the proposals discussed in this report focus on reducing the inflow (incidence) of new beneficiaries into the program. These proposals include implementing stricter SSDI eligibility criteria, improving consistency in the disability determination and adjudication process, and incentivizing employers to provide supported-work services for employees following the onset of disability (i.e., rehabilitation, workplace accommodation, and a partial wage replacement). On the other hand, some of the proposals seek to increase the outflow (termination) of beneficiaries from the program. Proposals to reduce the current beneficiary population entail providing stronger incentives for beneficiaries with some residual functional capacity to return to the labor force, as well as increasing the number of continuing disability reviews (CDR) performed by the Social Security Administration (SSA).
Source: cornell.edu

Video: Social Security: Just the Facts

The problem with Social Security Disability Insurance is worse than you think

The benefits would run out after 27 months, and after 18 months of collecting benefits, employees could apply for Social Security Disability Insurance payments. That’s a much longer wait time than the current five-month SSDI waiting period. The idea is that this would give employers an incentive to accommodate disabled employees and give those employees a strong incentive to stay in the workforce by not reducing benefits if they keep working (as happens under SSDI). But the plan is also intended to leave SSDI in place for beneficiaries who really cannot work.
Source: aei-ideas.org

Robbing Social Security to Pay Insurance Companies?

The bill does authorize the federal government to implement a series of revenue programs. Here again, though, the numbers do not add up. One program is to raise taxes on upper income Americans through the Medicaid payroll system. Individuals who make above $200,000 and couples who make over $250,000 per year in earned income, or the same amounts as investment income, will have to pay a tax of 3.8 percent on both forms of income. The federal government’s Joint Committee on Taxation estimates these taxes will bring in about $210 billion in new revenue over a six year period.  Another program is to charge an excise tax on what are called “Cadillac Insurance” policies. These are very expensive health care plans that are only affordable by the very wealth. The government estimated that this will bring in about $32 billion in new revenue over a two year period. Other programs such as fees for using tanning salons and other savings in Medicare programs that have up to now been run by private insurance companies are estimated to bring in $132 billion over a ten year period. Projected savings are always dubious claims and these revenue programs are very unlikely to come close to paying for the massive increase in insurance costs. The upshot is more deficits.
Source: joelcmagnuson.com

Reform disability insurance in ways that encourage companies to keep employing disabled workers

The disabled are part of the far larger number of Americans who have left the labor force altogether since the recession, and who don’t seem to be coming back. About 88.9 million people in the U.S. are now out of the labor force, 2.4 million more than a year ago and 11.4 million more than in 2006. Thirty years ago, there was a 40-to-1 ratio between the total labor force and those workers receiving Social Security disability payments. Today that ratio is less than 18-to-1.
Source: chicagotribune.com

PRESS RELEASE: Americans Make Hard Choices on Social Security, Prefer to Raise Payroll Taxes and Increase Benefits

To identify the preferred package, NASI partnered with Mathew Greenwald & Associates to use trade-off analysis, a technique widely used in market research to learn which product features are most preferred by consumers. The trade-off exercise allowed survey participants to express preferences among many combinations of policy changes, and researchers determined the most preferred combination. The trade-off exercise found that reducing benefits – for example, by raising the retirement age to 70 or means-testing Social Security benefits – were unpopular policy changes.    
Source: nasi.org

The Use of VA Disability Benefits and Social Security Disability Insurance Among Veterans

Although there is substantial functional limitation and disability among veterans of all ages, relatively little is known about veterans’ uptake of Department of Veterans Affairs (VA) Disability Benefits and Social Security Disability Insurance (DI).  This project uses data from the 1992, 1993, 1996, 2001, 2004, and 2008 Survey of Income and Program Participation to examine veterans’ participation in VA and DI programs.  The results indicate that the majority of veterans do not receive VA or DI benefits, but veterans’ use of these programs has been increasing over time.  A higher percentage of veterans receive VA compensation only, which ranges from 4.9 percent in 1992 to 13.2 percent in 2008, than DI compensation only, which ranges from 2.9 percent in 1992 to 6.7 percent in 2008.  Furthermore, the rate of joint participation in these two programs is low, ranging from less than 1 percent in 1992 to 3.6 percent in 2008.  Veterans experience relatively few within-panel transitions between VA and DI programs.  Overall, the likelihood of any disability program use is higher among veterans who served during multiple time periods, are older, black or Hispanic, currently married, and have less than a high school education.  Among users, the likelihood of any VA use in contrast to only DI use is higher among veterans who served since 1990, are younger, Hispanic, highly educated, and currently married.  Among users, variation in the likelihood of any DI use relative to only VA use generally mirrors variation in the likelihood of any VA use, although there are differences in associations with race/ethnicity, education, and marital status.
Source: bc.edu

Daily Kos: President Obama considering putting social insurance cuts in his budget

follow his close actions (which some of your statements aren’t 100% accurate), this battle is far from over and it will take the Senate and Congressional Democrats to agree to them.  His stimulus package was a lot of tax breaks for middle-class Americans (as imperfect as it is).  He didn’t fire guys like Austan Goolsbee or Christie Romer, they left.  There are already Senate investigations going on and the secret promises were the last resort thing cause guys like Baucus killed the public option.  I’m not saying Obama is perfect or terrific at that matter and I’ve had my disappointments with him as well but your comment is contributing to the “we are doomed” narrative, no matter how factual or even exaggerated it may be.  If you at least made some call for action like putting the pressure on congressional or Senate Dems to not agree with these cuts, then I would say that you aren’t contributing to the “gloom and doom” narrative.  I would credit you for being pro-active.  I would credit you for acknowledging a problem and then taking action.  There was nothing in your comment that called for action.  Nothing, nada, zilch.  
Source: dailykos.com

Lawsuit questions insurance company’s treatment of mental health

Now a lawsuit against a large insurance company is going to test how robust that coverage needs to be. A law in place, with the rather unwieldy name of the 2008 Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act, requires larger employers — those with at least 50 employees — that offer mental health or substance abuse coverage within the plans that they offer to treat those benefits the same way as they would other medical or surgical benefits.
Source: socialsecuritydisabilityfacts.com

Letter from Here: Words matter

Imagine a world in which homeowners insurance was demonized as an entitlement. A world in which people who paid insurance premiums and then were able to be reimbursed when their house accidentally burned down were portrayed as some sort of social parasite, collecting some sort of fishy-sounding “entitlement.”  Critics would argue, year after year, “This is wrong! People are taking out more than they put in! The system is going bankrupt.” That would be a world in which people did not understand the concept of risk pooling known as insurance. In any insurance plan, benefits for those who collect are subsidized by those who don’t, plus investment income on the money paid in. It makes economic sense, because it protects policyholders from catastrophic risk that would wipe them out. Insurance is a pervasive fact of modern life, and most people have no problem understanding the general principle. That’s why the right has been systematically demonizing our biggest insurance program of all — Social Security insurance — by replacing the word “insurance” with the word “entitlement,” and repeating it over and over again until it sticks. It’s one of the most successful propaganda campaigns of all time, to the extent that even some Democrats talk about Social Security as an “entitlement” that needs to be reformed. The right has deliberately blurred the distinction between a defined contribution plan like a 401k and a defined benefit plan like Social Security, as if the 401k were some sort of ideal model. In a 401k, your retirement benefits only consist of what you (and maybe your employer) paid in, along with accrued investment earnings. That’s exactly why most people’s 401k accounts aren’t nearly big enough to fund a decent retirement — because most people don’t earn enough to fund a decent retirement entirely on their own and would end up outliving their resources. That’s why Social Security was invented. The insurance component bridges this gap and insures us against the risk of outliving our resources. And, as an insurance program, the premiums and benefits are designed by actuaries to be self-funded and solvent. Before Social Security, for most working Americans old age was a wretched combination of poverty and reliance on family — and that’s when families were bigger than they are today. Whenever you hear people talk reducing Social Security “entitlements,” that’s really what they’re talking about. Ditto for Social Security “taxes.” We should be talking about Social Security insurance and Social Security premiums. We’ve paid premiums and we’ve earned our Social Security insurance benefits. Words matter.
Source: peterpatau.com

Medigap Insurance: What to Know About Medicare Supplemental Plans

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSFor a Medigap policy to apply, a person does need to be signed up for Medicare first, including Parts A and B. Folks who have both pay two premiums, one for the Medigap plan and one for the Medicare Part B program. Further, it’s important to note that while Medicare will cover both a person and a spouse, a single Medigap policy with a private provider will not. A consumer has to take out two Medigap plans to cover a spouse and himself. Further, Medigap is no longer allowed to cover pharmaceutical costs under Part D of Medicare. Those have to come out of pocket from a consumer under federal law. Unfortunately, drugs tend to be the biggest medical expense for seniors on average.
Source: edvox.org

Video: Medicare Advantage vs. Medicare Supplement Insurance

What is Medicare Supplement (Medigap) Insurance

In order to sign up for Medicare Supplement coverage, you must already have Part A and Part B. These plans are offered by private insurance companies and come in 10 standardized policy types that are denoted by the letters A-N. The standardization of these plans means that no matter where you shop, the Medigap policy details remain consistent. For example, the benefits associated with Plan F are the same no matter where you buy it, though costs may differ across all carriers. Not every carrier of Medicare Supplement Insurance offers all 10 plan types, and three states in the U.S. have their own version of these plans: Massachusetts, Minnesota, and Wisconsin.
Source: ehealthmedicare.com

Medicare Supplemental Plan F

Medicare Supplemental Plan F is the most popular supplemental plan because it provides the most robust coverage, and the premiums are not much higher when the benefits are compared to the plans offering less coverage. A patient with Plan F can in many situations pay nothing additional out of pocket for doctor and hospital services. People eligible for a Medicare Supplemental Plan should compare the benefits and premiums of the plans and purchase the best coverage they can afford. For many patients, that is Plan F.
Source: wastedenergy.net

Medicare Supplemental Insurance

Medicare was created to help senior citizens acquire health insurance at a reasonable price. The majority of people are in need of health insurance far more often in their senior years than in their younger ones. Realizing that seniors pose a bigger health risk to insurance companies than the younger generation, the United States government knew that if insurance providers were allowed to operate without any kind of regulation in how they dealt with seniors, they would charge much more expensive premiums to the elder generation. This would have priced many seniors right out of healthcare coverage.
Source: lindacoleman.org

Compare Medicare Supplement Plans Supplemental Medicare Insurance

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

U.S. Medicare supplemental coverage linked to higher spending

Could it be that supplemental spending is up because health care is up. All supplemental does is cover the 20% that medicare does not cover. If you have any kind of a operation that can add up to thousands of dollars to people who are retired. I read somewhere that almost 50% of retirees live on nothing but social security and barely have enough to live on much less additional medical bills.
Source: northiowatoday.com

Supplemental Medicare coverage leads to spending growth

Golberstein and his collaborators from Harvard Medical School used data from the Medicare Current Beneficiary Survey from 1992 to 2005, before Medicare Part D prescription drug benefits were introduced, and analyzed a sample of 104,365 observations. The researchers found significantly higher rates of spending growth in all supplemental insurance categories compared to the category without supplemental insurance, even while controlling for sociodemographic status, disease, disability, and health behavior characteristics.
Source: umn.edu

How To Get The Best Price On The Best Auto Insurance Plan

It is prudent to shop around when you are looking for a car insurance Florida plan, as this is a fiercely competitive industry. Rates can vary dramatically from one provider to the next. Get new quotes every year to ensure the lowest premiums and out-pocket-costs. When you are looking at insurance quotes, check the levels of coverage to make sure they are the same.
Source: hotel-crans-ambassador.com

House Committee Recommends Medicare Supplement Reform

Two house committee members Reps. Johnson and Reichert expressed concern that the modifications to Medicare supplement plans would create a disincentive for retiree’s to purchase Medigap coverage and could cause them to delay or even go without important medical care. Hackbarth defended the Commission’s report and said that the suggestions are not to prevent Medicare recipients from purchasing supplemental insurance and that the suggestion “didn’t propose any regulatory restriction’ on those Medicare supplement plan purchases.
Source: askmedicareblog.com

89 Arrested In $223 Million Medicare Fraud Schemes

Posted by:  :  Category: Medicare

Benefit Security Card .. HALF of the U.S live in households that receive government benefits (26 May 2012) ...item 2.. Brevard man gets 4 years in Social Security fraud case (Jun 1, 2012 ) ... by marsmet481The Associated Press/Washington Post: Doctors And Nurses Among Nearly 100 Charged In $223 Million Medicare Fraud Busts In 8 Cities Nearly 100 people, including 14 doctors and nurses, were charged for their roles in separate Medicare scams that collectively billed the taxpayer-funded program for roughly $223 million in bogus charges in a massive bust spanning eight cities, federal authorities said Tuesday. It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year (5/14).
Source: kaiserhealthnews.org

Video: Company accused of massive Medicare fraud

89 Individuals Charged With About $233M in Alleged Medicare Fraud

The Strike Force is part of the Health Care Fraud Prevention & Enforcement Action Team, a joint initiative between HHS and the Department of Justice. Since its inception, the Strike Force’s operations — in nine locations — have charged more than 1,500 individuals for defrauding Medicare of more than $5 billion through false billing (HHS release, 5/14).
Source: californiahealthline.org

RS Medical Settles Medicare Fraud Charges

RS Medical has agreed to settle Medicare fraud claims following a whistleblower suit by one of its South Carolina employees, U.S. Attorney Bill Nettles said. The Vancouver, Wash.-based company, which maintains an Upstate location at 1200 Woodruff Road, has agreed to pay $1,214,665 to settle the claims against it, he said.  According to Nettles, employees of RS Medical in South Carolina and Illinois submitted claims to Medicare for Transcutaneous Electrical Nerve Stimulation (TENS) Units, conductive garments for TENS Units, back braces, cervical traction systems, muscle stimulators, and custom-fit knee braces that either lacked physician orders, lacked the required supporting documentation, and/or lacked medical necessity.  The investigation in the District of South Carolina began in February of 2011 when whistleblower Sally Balentine filed a qui tam lawsuit in federal court under the False Claims Act, Nettles said.   The False Claims Act allows the government to bring civil actions against entities that knowingly use or cause the use of false documents to obtain money from the government or to conceal an obligation to pay money to the government.   Under the False Claims Act, Balentine is entitled to a share of the government’s recovery, Nettles said. She will receive approximately $242,933 from the proceeds of the settlement, he said. Additionally, Balentine will receive $80,000 for her attorney fees and costs.  The settlement was the result of a coordinated effort by the U.S. Attorney’s Office for the District of South Carolina and agents from Health and Human Services Office of Inspector General, and United States Postal Service Office of Inspector General, Major Fraud Investigations Division, Nettles said. If you suspect Medicare or Medicaid fraud, report it by phone at 1-800-447-8477 (1-800-HHS-TIPS), or E-Mail at HHSTips@oig.hhs.gov.
Source: patch.com

12 Southland Residents Arrested On Medicare Fraud Charges

In addition to fraud, Dr. Pavehzadeh is charged with aggravated identity theft in connection to information taken from Medicare beneficiaries in order to file false claims. When authorities tried to conduct an audit, federal prosecutors said Dr. Pavehzadeh lied to Los Angeles Police, claiming that he had been carjacked and patient files had been stolen from his vehicle.
Source: cbslocal.com

Useful video about reporting Medicare Fraud

According to the US government, tens of billions of dollars of Medicare Fraud occur every year. In light of the affordable healthcare debates of late, Medicare fraud is an extremely important issue when looking at healthcare law in the US. This video provides information about how a healthcare professional can report Medicare Fraud.
Source: healthcarelawnet.com

HHS Proposes $9.9M Reward for Reporting Medicare Fraud

HHS is proposing a rule that would boost rewards to as much as $9.9 million to people whose reports about suspected Medicare fraud lead to successful fund recoveries. The changes are modeled on an IRS program that has returned $2 billion in fraud since 2003. Over the past three years, President Barack Obama’s administration has recovered more than $14.9 billion in fraud, some of which resulted from fraud reporting by individuals. Under HHS’ proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered. The reward currently sits at 10 percent.  HHS’ new proposal would also increase the cap on the recovery fund awards to $66 million. That means a person can earn as much as $9.9 million if CMS collects more than $66 million as a result of his or her fraud tip. A new funding opportunity released this month supports the expansion of Senior Medicare Patrol activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud. SMP is a national, volunteer-based program that empowers Medicare enrollees to report potential fraud and abuse in the program.
Source: beckershospitalreview.com

Proposed Rule Increases Incentive for Medicare Fraud Whistleblowers

In fact, “[i]n the June 8, 1998 Federal Register (63 FR 31123), we [HHS] published a final rule with comment period titled, ‘Medicare Program; Incentive Programs-Fraud and Abuse.’ This final rule with comment period implemented section 203(b) of HIPAA by establishing a reward program to encourage individuals to report potential fraud and abuse to Medicare and by adding a new section, 42 CFR 420.405, to the regulations. Section 420.405(a) specifies a collection threshold of at least $100 (consistent with section 203(b) (2) of HIPAA).” Since that time, the Incentive Reward Program and certain provider enrollment provisions changed from “10 percent of the overpayments recovered in the case or $1,000, whichever is less, to 15 percent of the final amount collected applied to the first $66,000,000.” This was released in the Federal Register on April 29, 2013.
Source: physicianspractice.com

89 Charged in Medicare Fraud Busts in 8 Cities, Including Houston

It’s the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder. Tuesday’s bust marks the sixth national Medicare fraud takedown. Nearly 600 individuals have been charged in schemes involving almost $2 billion.
Source: kbtx.com

HIPP Pays Health Insurance for Some Families with a Person on Medicaid

Posted by:  :  Category: Medicare

20111031-FNS-LSC-0279 by USDAgovBefore you can qualify for HIPP, Medicaid has to determine that it is more cost effective to reimburse your family for health insurance premiums than to pay the medical bills for a family member(s) on Medicaid. This saves the state money while helping families obtain health care. It does this by making private insurance the main payer and Medicaid the second payer for individuals on it. Based on individual circumstances, HIPP might not cover insurance costs for everyone in a family and some families may have to pay a percentage of the cost.
Source: texas.gov

Video: Texas Rejects Obamacare’s Medicaid Expansion, Won’t Set Up Own Exchange

Expanding Medicaid in Texas is good for business. Here’s why.

As board chair of the Oak Cliff Chamber of Commerce, I know that my fellow business owners believe that healthy workers are necessary for sustained economic development, not only in Oak Cliff but in the entire state. Sustainable economic development will create more health care jobs and resources into our health care system, which means fewer uninsured workers that burden employers and taxpayers alike.
Source: dallasnews.com

Bill on Texas Solution to Medicaid Expansion Moves Forward

“Private insurance is more expensive than Medicaid, so if you have your entire Medicaid expansion population on private insurance and you’re also paying for wrap-around Medicaid benefits, you’re going to end up with a much larger state share once the federal dollars begin to drop off,” Davidson said.
Source: kutnews.org

As Texas starts to pivot on Medicaid expansion, “no” looks more like “maybe”

The downside is higher prices for providers, but the feds are paying all the costs for the first three years. There’s still much negotiating to do, and one analyst said that Wall Street is assuming that Texas won’t reverse course. If Texas were to opt in, wrote Sheryl Skolnick of CRT Capital Group, there’s a powerful upside for four publicly traded hospital companies, including Dallas-based Tenet Healthcare Corp.
Source: dallasnews.com

Lack of Medicaid Expansion Hits Veterans Hard

Nearly 49,000 veterans are at or below 138 percent of the federal poverty level (FPL), which is the Medicaid qualification income under the ACA. About 12,000 of those are between 100 and 138 percent of FPL, which means they will qualify for subsidized insurance on the health insurance exchanges in 2014. Those below the FPL are ineligible for insurance subsidies and most will not qualify under the existing Medicaid guidelines—which is an annual income of less than $5900 for a working adult with dependent children and a family of four, or half that amount if jobless.
Source: dmagazine.com

Quick Take: Who Benefits from the ACA Medicaid Expansion?

The ACA expands Medicaid to a national floor of 138% of poverty ($15,415 for an individual; $26,344 for a family of three). The threshold is 133% FPL, but 5% of an individual’s income is disregarded, effectively raising the limit to 138% FPL. The expansion of coverage will make many low-income adults newly eligible for Medicaid and reduce the current variation in eligibility levels across states. To preserve the current base of coverage, states must also maintain minimum eligibility levels in place as of March 2010, when the law was signed. This requirement remains in effect until 2014 for adults and 2019 for children. Under the ACA, states also have the option to expand coverage early to low-income adults prior to 2014. To date, eight states (CA, CT, CO, DC, MN, MO, NJ and WA) have taken up this option to extend Medicaid to adults. Nearly all of these states previously provided solely state- or county-funded coverage to some low-income adults. By moving these adults to Medicaid and obtaining federal financing, these states were able to maintain and, in some cases, expand coverage. Together these early expansions covered over half a million adults as of April 2012.
Source: kff.org

Medicaid Eligibility in Texas

Following an initial check of the information, all applicants are required to visit a Health and Human Services Commission Benefits office. This visit interviews the applicant to ensure all information is present and correct – forming the final part of the application. Applicants who have specific reasons why they cannot travel to the Health and Human Services Commission Benefits office may be able to complete the review by telephone, or a representative may make a home visit.
Source: tex.org

Tell Texas to Expand Medicaid to Millions

I’ve always been proud to be a native Texan; I spent my formative years in the sunny suburbs of Houston, cheering on the greatest second baseman of all time, and trying not to run my bike into the bayous. I spent my college years in booming Austin, where I swam in Barton Springs, and saw more live shows than some people do in a lifetime. It’s easy to see why Texas is the greatest state in the nation. We gave you Willie Nelson, Tex-Mex, and Beyoncé.
Source: younginvincibles.org

Massachusetts Health Stats: Tufts Health Plan Executive Runs Massachusetts Medicaid Art Gallery, Medicaid Marching Band

Posted by:  :  Category: Medicare

THE NATURAL by SS&SSThis blog overcomes the attempts from those on both the left and right of the political spectrum to use statistics to impose needless changes on one of the best healthcare systems in the world. Massachusetts Health Stats is an as-needed look at statistics about the Massachusetts healthcare delivery and insurance market and industry, including — occasionally — aspects of Medicare as they relate to Massachusetts seniors and the Medicare-eligible disabled. For Medicare-specific information with nationwide implications and some how-to hints for seniors see http://byrondennis.typepad.com/theabcsofmedicare/
Source: typepad.com

Video: Dr. Julian Harris at MMPI Event — Dec. 5, 2012

How to make the Numbers Work for Medicaid

At the Estate Planning & Asset Protection Law Center, we help people and their families learn how to protect their home, spouse, life-savings, and legacy for their loved ones. We provide clients with a unique education and counseling approach so they understand where opportunities exist to eliminate problems now as they implement plans for a protected future.
Source: estateplanandassetprotection.com

8 charged for defrauding Massachusetts. Medicaid program

“MassHealth is a critical program that provides health insurance for some of our most vulnerable residents,” said Mass. Attorney Gen. Martha Coakley in a press release. “The brazenness of the fraud committed in these cases is particularly troubling. The defendants allegedly stole more than $260,000 from taxpayers, diverting resources from those who truly need it.”
Source: dailyfreepress.com

One More Reason to Not Like Medicaid

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

Medicaid: Lawsuit Alleges Conn. Application Backlog Breaks Federal Law

CT Mirror: Suit Hammers Huge Medicaid Backlog, Long Waits Every month, thousands of poor state residents go without health care coverage while their applications for Medicaid linger, without being approved or denied, for longer than federal law allows. The numbers “tell the whole story,” attorney Sheldon Toubman said Tuesday at the start of a trial in Hartford centered on allegations that the state Department of Social Services doesn’t have enough workers to handle Medicaid applications within federally required time frames (Becker, 5/14).
Source: kaiserhealthnews.org

Mental Health and Medicare

After meeting your yearly Medicare Part B deductible ($147.00), the amount you pay for mental health services depends on whether the purpose of your visit is to diagnose your condition or to get treatment. For visits to diagnose your condition, you would pay 20% of the Medicare-approved amount. For outpatient treatment of your condition, like psychotherapy, you would pay 35% of the Medicare-approved amount in 2013. If you have a Medicare Supplement Insurance policy or Medicare Advantage, contact your plan for information on your out of pocket responsibilities.
Source: patch.com

Massachusetts Medicaid Expansion

Medicaid Expansion in Massachusetts , Massachusetts is one of the first states in the country to implement  a state based Healthcare Reform under governor Romney. It also has had the lowest numbers of uninsured citizen for a state its size in terms of uninsured individuals. Currently there is an estimated 108,000 individuals in Massachusetts that are uninsured, and would be eligible to receive Medicaid, as part of the Medicaid Expansion provision of the Affordable Care Act. Once the state implement the Medicaid Expansion program, 88,000 individuals of the 108,000 would be new enrollees based on eligibility, and the 21,000 would have all ready eligible but now may join the program.. Massachusetts has one of the lowest numbers of uninsured individuals in the country.
Source: medicaidexpansion.com

How Irrevocable Trust Planning Saves You Money

Protecting the Family Home For those with relatively small estates, meeting the MassHealth asset requirements might not be a major concern. However, for those who have worked a lifetime paying down the mortgage on their family home there is still reason for concern. If you apply for MassHealth and meet their asset requirements, you will qualify for long-term care benefits even if you own your house. They will not make you sell it in order to get care. However, for every dollar of care you receive a lien will be place on your house. This lien will have to be paid off when you sell or transfer your home whether at death or otherwise. Homes that have been placed in an irrevocable trust and have satisfied the five-year look-back requirement will not have a lien placed on them and will be able to be kept in the family or else sold for their full market value.
Source: mamedicaidlawyer.com

Network Health President to Speak at Upcoming Medicaid Managed Care Congress

Severin is an accomplished managed health care executive with more than 20 years’ health care experience. She is dedicated to improving public health with a special focus on vulnerable populations. Since 2006, as president, Severin has overseen Network Health’s dramatic growth, led the health plan’s strategic direction, and managed its bottom line. She has been named a Boston Business Journal “40 Under 40” honoree for her leadership qualities, and was recently profiled in the publication’s “Women Up” column which features leading female executives and local women of influence. Severin has taught classes in health care administration and management at Harvard, Northeastern, and Boston universities. She currently serves as a foundation associate for the Women Business Leaders of the U.S. Health Care Industry Foundation, officer and board member of the Association of Community Affiliated Health Plans, and board member of the Massachusetts Association of Health Plans (MAHP).
Source: patch.com

Medicare Supp Rates Prior June 2010

Posted by:  :  Category: Medicare

STM_3172 by U.S. Marshals ServiceAre you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   Time is M*** I agree to forum rules 
Source: insurance-forums.net

Video: Rep. Walden on the Medicare doctor reimbursement rates

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

Proposed Rule Updates Wage Index And Payment Rates For The Medicare Hospice Benefit

.  Under section 3004 of the Affordable Care Act, hospices that fail to meet quality reporting requirements will receive a two percentage point reduction to their market basket update beginning in FY 2014. Hospices began reporting quality data in 2013. For the FY 2014 payment determination, hospices reported two measures: the NQF #0209/Pain Management measure and the Structural measure on participation in a /Quality Assessment and Performance Improvement (QAPI) program. The proposed rule solicits comments on the elimination of these two currently reported quality measures beginning with the 2016 payment determination and to replace these two with other measures.
Source: aq-iq.com

Medicare Hospital Payment: MedPAC Recommends One Percent Rate Increase for FY 2014

Hospitals face another year of tight Medicare reimbursement, with rates for FY 2014 falling farther behind cost increases and margins declining as a result.  Most hospitals already lose money on caring for Medicare and Medicaid patients.  Hospitals are entering a far more challenging new business environment under the Affordable Care Act, which will cut Medicare and Medicaid payments, cover millions of new consumers, fundamentally transform the health insurance marketplace, and force consolidation.  Meanwhile, purchasers and payors are reforming payment methods to drive increased efficiency in the hospital industry.
Source: piperreport.com

Analysis Finds Lax CMS Oversight of Prescribers in Medicare Part D

Further, the data showed that 50% of the top 20 prescribers of OxyContin in 2010 have been either criminally charged, convicted or settled fraud claims, or have been disciplined by their state medical boards. Among those, eight have been charged, convicted or barred from prescribing controlled substances, or been disciplined by licensing boards. However, all but one of those doctors still are able to prescribe drugs for Medicare.
Source: californiahealthline.org

Unbound MEDLINE : Trends in Hip Fracture Rates in US Hemodialysis Patients, 1993

BACKGROUND: Changes in mineral and bone disorder treatment patterns and demographic changes in the dialysis population may have influenced hip fracture rates in US dialysis patients in 1993-2010. STUDY DESIGN: Retrospective follow-up study analyzing trends over time in hospitalized hip fracture rates. SETTING & PARTICIPANTS: Using Medicare data, we created 2 point-prevalent study cohorts for each study year. Hemodialysis cohorts included patients with Medicare as primary payer receiving hemodialysis in the United States on January 1 of each year; non-end-stage renal disease (ESRD) cohorts included Medicare beneficiaries 66 years or older on January 1 of each year. FACTORS: Age, sex, race, primary cause of ESRD, dual Medicare/Medicaid enrollment status, comorbid conditions. OUTCOMES: Hip fracture rates. MEASUREMENTS: Unadjusted hip fracture rates measured using number of events per 1,000 person-years in each year, then adjusted for patient characteristics. Poisson models estimated strata-specific event rates. RESULTS: The observed number of first hospitalized hip fracture events and the adjusted hip fracture rate increased steadily from 1993 (831 events; 11.9/1,000 person-years), peaked in 2004 (3,256 events; 21.9/1,000 person-years), and decreased through 2010 (2,912 events; 16.6/1,000 person-years). The trend for the subset of hemodialysis patients 66 years or older was similar to the trend for the full hemodialysis cohort; however, it differed markedly in magnitude and pattern from the non-ESRD Medicare cohort, for which rates were substantially lower and slowly decreasing since 1996. LIMITATIONS: Unable to provide causal explanations for observed changes; hip fractures identified through inpatient episodes; results do not describe hemodialysis patients without Medicare Parts A and B; laboratory values unavailable in the Medicare data set. CONCLUSIONS: Temporal trends in hip fracture rates among Medicare hemodialysis patients differ markedly from the steadily decreasing trend in non-ESRD Medicare beneficiaries, showing a relatively rapid increase until 2004 and relatively rapid decrease thereafter. Further research is needed to define associated factors.
Source: unboundmedicine.com

Improving Care, Reducing Costs in Medicare

The discussion made clear that the goals of the “Triple Aim” — better care for individuals, better health for populations and communities, and care that is affordable — is becoming widely accepted as a worthy goal for the health care system.  However, the path from intention to actionable steps for change is challenging. Our speakers coalesced around three central points. The first is that movement towards large-scale system-wide improvement requires changing the culture in health care organizations and systems to become more patient-centered. The second is that wider adoption of health information technology to improve communication among providers and across care settings is desperately needed. And, last but certainly not least, the system needs better quality and resource use measures for greater accountability and transparency, and these measures need to be publicly reported.    
Source: aarp.org

Proposed 2014 Medicare Advantage rates cut insurer payments

Should the rules become final, Skolnick said she would expect UnitedHealth to exit many Medicare Advantage markets and experience a significant or severe contraction in that business. But she said that as with past rule changes, expected lobbying over the next few weeks by insurers may affect the final rule.
Source: medcitynews.com

Uwe E. Reinhardt: Medicare's Payments to Physicians

In economic theory, demand for a particular good or service depends on the potential buyers’ willingness to pay for it, given their budgets and ability to pay. But whose willingness to pay should we use for Medicare? Should we use an estimate of what Medicare beneficiaries would be willing to pay for physician services in the absence of Medicare coverage? Or should it be the taxpayers’ willingness to pay, as expressed by their political representatives? Should it perhaps emerge from a consensus of some panel of experts convened by Medicare to represent patients or taxpayers?
Source: nytimes.com