Protect yourself from Hepatitis B

Posted by:  :  Category: Medicare

Lyndon B. Johnson by cliff1066™Are you at risk for getting Hepatitis B? If you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection, you have a higher risk for getting Hepatitis B increases.  Additionally, if you have a profession that puts you in frequent contact with blood or bodily fluids, you may be at a higher risk.
Source: medicare.gov

Video: Guide to Medicare Part A and Part B

Blended Medicare Plan Could Save $180B Over 10 Years, Study Finds

Both studies — the Commonwealth Fund Medicare reform proposal and the Rand analysis of others’ Medicare reform proposals — are seriously flawed and illustrate no real-world understanding of Medicare. It is good that the Commonwealth Fund includes the catastrophic coverage and annual OOP limits that are not included in Original Medicare. All Part C plans and a few Medigap plans include such protection today. In fact, the Commonwealth Fund looks like a Part C health plan — except that it costs more than the average Part C plan and does not have as many other benefits (other than the OOP limits). The one-size-fits-all drug plan proposed by Commonwealth Fund will lead many low-income seniors back to the two-tier VA-like prescription drug coverage that pre-dated Part D (one inferior tier for low-income seniors, one better plan for the rest of us seniors). Because I cannot take Essential without taking this inferior two-tier drug plan is bad news for we middle-income seniors also
Source: californiahealthline.org

Reducing Subsidies for Higher Income Medicare Beneficiaries

Currently, Medicare beneficiaries with incomes starting at $85,000 (or $170,000 for couples) pay higher Part B and D premiums, which start at 35 percent of program costs and peak at 80 percent of program costs for beneficiaries with incomes over $214,000 (or $428,000 for joint filers). As of now, these higher premiums affect only 1 in 20 Medicare recipients. While the thresholds for higher premiums were originally adjusted annually for inflation, a provision in the ACA froze the income thresholds through 2019, at which point almost 10 percent of beneficiaries are projected to pay income-related premiums. Starting in 2020, however, the thresholds are scheduled to bounce back upward as if they had never been frozen, thereby reducing the proportion of beneficiaries who would be subject to higher premiums.
Source: bipartisanpolicy.org

Medicare RAC Overpayment Collections Hit $4.5B Since 2009

Since the Medicare Recovery Auditor, or RAC, program began in October 2009, hospitals and providers have had $4.5 billion in Medicare overpayment recouped, according to the latest RAC figures from CMS. In the first six months of the federal government’s 2013 fiscal year, Medicare RACs have recouped $1.37 billion and have returned $65.4 million in underpayments. CMS did not identify how much of those recoupments were tied up in the appeals process or had been successfully appealed by providers. In the second quarter, Medicare RACs collected $626.5 million in overpayments — almost equaling what was recouped in fiscal year 2011 alone. Medicare RACs returned $31 million in Medicare underpayments. Medical necessity of cardiovascular procedures continued to be the top overpayment issue for RACs. Minor surgery and other treatments billed as inpatient when they should have been billed as outpatient or observation was another top recoupment reason. CMS again did not disclose the most common issues for underpayments. HealthData Insights and Connolly collected roughly $400 million of all Medicare overpayments in the second quarter ended March 31. HDI and Connolly audit hospitals in 32 states across the West and South, including Florida, Texas and California.
Source: beckershospitalreview.com

New CMS Website: Medicare Secondary Payer Conditional Payment Information 

[1] Title II of H.R. 1845, entitled "Strengthening Medicare Secondary Payer Rules," amends 42 U.S.C. §1395y(b)(2)(B) of the Medicare Statute, Pub. Law No. 112-242 (January 10, 2013).  See http://beta.congress.gov/bill/112th-congress/house-bill/1845/text. The Bill Summary and status report are available at: http://thomas.loc.gov/cgi-bin/bdquery/z?d112:h.r.1845. The current Medicare Secondary Payer Recovery Contractor (MSPRC) website is located at www.msprc.info. Title I, Section 101 of H.R. 1845, sets out a demonstration project under Medicare Part B for the payment of supplies and services related to the administration of Intravenous Immune Globin (IVIG) for the treatment of primary immune deficiency diseases. [2] The Medicare Secondary Payer program is set out at 42 U.S.C. §1395y(b)(2). [3] The Center’s work on MSP matters can be accessed at: http://www.medicareadvocacy.org/medicare-info/medicare-secondary-payer-program/. In addition, the Center led a task force of the Public Policy Committee of the National Academy of Elder Law Attorneys (NAELA) (www.naela.org) on the use of set-aside arrangements involving future medical expenses. The task force made recommendations on how attorneys might approach "future medicals" pending guidance from the Medicare agency. See: http://www.naela.org/App_Themes/Public/PDF/Home%20Page/ISSUE%20Medicare%20Set%20Aside%20TF_2%20(2).pdf.  [4] See, for example, the joint findings and recommendations, sent to the Medicare Agency, by the Center for Medicare Advocacy, the Medicare Rights Center, and California Health Advocates, available at http://www.medicareadvocacy.org/2011/05/12/medicare-secondary-payer-practices-that-harm-medicare-beneficiaries/. [5] See §201of the Act.  Note, the term "website" includes any successor technology that might be developed. Id., at subclause (VII). [6] See §201of the Act, ("VI") Effective date. [7] See §201of the Act. [8]Id., amending §1862(b)(2)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(B), adding a new clause: (vii) use of website to determine final conditional reimbursement amount. [9] Id. [10] See §204, amending §1862(b)(8)(B) of the Social Security Act, 42 U.S.C. §1395y(b)(8)(B). [11] Id. [12] Id., at subclause "(III)." [13] Id., at subclause "(IV)." [14] Id. [15] Id. [16] Id. [17] Id. [18] Id., at subclause (V), protected period. [19] Id. [20] Id. In addition, the Secretary shall promulgate final regulations to carry out this clause not later than 9 months after the date of the enactment of this clause. Id. [21] Id., §202(a)(2) of the Act. [22] Id., §202(b). [23] Id., subclause "(D)"Report to Congress. [24] Id. [25] See §203, amending §1862(b)(8) of the Social Security Act, 42 U.S.C. 1395y(b)(8)( Required submission of information by or on behalf of liability insurance (including self-insurance), no fault insurance, and workers’ compensation laws and plans). [26] Id. [27] See §205, amending §1862(b)(2)(8)(iii) of the Social Security Act, 42 U.S.C. §1395y(b)(2)(8)(iii).
Source: medicareadvocacy.org

Medically Complex Medicare Part B

My personal opinion for the increase in medically complex part B patients is due to the hospital observation status issues. If only I had a nickel for every time a colleague told me stories about their local hospitals keeping patients for several days through observation status. Or the situation where the patient is at the hospital for three midnights, re-admits to your facility, begins Part A benefits, and a few days later it’s discovered they were kept for observation. The Medicare Part A changes to Part B, but our plan of care and treatment approaches and therapy minutes should not change based on insurance issues.
Source: mcknights.com

Obama’s $3.7T Spending Plan Would Cut $370B From Medicare

The Wall Street Journal: Obama Reaches For Middle Ground With New Budget Plan Mr. Obama’s budget proposal will call for $3.77 trillion in spending for the fiscal year that begins in October, a senior administration official said, up 6% from projected spending levels in the current fiscal year. The higher spending would come from a combination of canceling the across-the-board spending cuts, known as the sequester, that began in March and pumping more money into education, infrastructure and mental-health treatment, among other things. … The deficit would fall more sharply later in the decade under the president’s plan, senior administration officials said, as a number of changes would kick in, affecting programs like Social Security, Medicare and military spending (Paletta, 4/9).
Source: kaiserhealthnews.org

Medicare Essential – Is this the future of Medicare?

The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
Source: gormanhealthgroup.com

OIG hospital probes may extend to Medicare Part B

Hospitals could face compliance reviews over Medicare Part B, according to a Bloomberg BNA healthcare blog. Speaking at a conference, Daniel R. Levinson, Inspector General of the U.S. Department of Health & Human Services, Office of Inspector General (OIG), said the agency might be interested in performing compliance reviews on Medicare Part B providers.
Source: bvhealthcarenews.com

Medicare latest news, medicare advantage plans

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Source: healthworkscollective.com

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

The Medicare Maze: Observation Stays, Nursing Home Costs, and “Invisible Patients”

We have all been traveling and have found ourselves party to a conversation because of proximity or bad cell phone etiquette. Some of these conversations are irritating, but I was looped into an interesting one the other day. Sitting in the Charlotte airport, two older men who looked like they were returning from a golf vacation started talking about enrolling in Medicare. One had just done it and the other had lots of questions. The recent enrollee said that he had registered through the Social Security web site; it took only ten minutes and was very easy. He told the other man that he only needed to sign up for part A, not for part B.
Source: wingofzock.org

When Can I Join a Medicare Part D Prescription Drug Plan?

Posted by:  :  Category: Medicare

BITCH ... Allen West calls Wasserman Schultz ‘vile’ and ‘not a lady’  (7/20/2011) ...item 2.. FSU News -  Yo Mama's Big Fat Booty Band grooves at Sidebar (Mar. 29, 2013) ...item 3.. Chaos - Doin' It Hard by thebootyband ... by marsmet522General Enrollment Periods: Each year, there are two general enrollment periods when anyone who is enrolled in Medicare Part A or B can sign up for a Medicare Prescription Drug Plan. The first period begins in April and continues through June. The second open enrollment is in October and continues through the first week of December. This is the easiest time to plan for coverage and change your enrollment options.
Source: bradeninsurance.com

Video: Parts A & B — Alphabet Soup

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

Medicare General Enrollment Ends March 31st: Opportunity for Some to Access QMB Coverage 

Even if unable to get a clear answer, one might pursue such enrollment as follows: Secure a Form 795 from the Social Security Administration (SSA) (available online at www.ssa.gov/online/ssa-795.pdf)  and type or write  into the large blank (lined) space the following:  "I wish to enroll for Hospital Insurance under Medicare on a monthly premium basis, which is in addition to my current coverage for Medical Insurance (or "I also wish to apply for Medical Insurance" if the client does not have Part B).  I understand that the State will pay my premium based on my eligibility for Medicaid (Medical Assistance) as a Qualified Medicare Beneficiary.  I also understand that if I am terminated under Medicaid (Medical Assistance) as a Qualified Medicare Beneficiary, I will have to pay my premium if I want to keep my Medicare Part A Insurance."  The beneficiary should give the form to SSA with her/his application for Part A, but also make a copy for her/himself to take to the Medicaid agency to apply for QMB benefits.
Source: medicareadvocacy.org

What to Look for When Comparing Medicare Part D Costs

Information presented on Personal Finance Blog by MoneyNing is intended for informational purposes only and should not be mistaken for financial advice. While all attempts are made to present accurate information, it may not be appropriate for your specific circumstances. Any offers and rates shown on this site can change without notice and may contain information that is no longer valid. For further validation, always visit the official site for the most up-to-date information. This site may receive compensation from companies to offer an opinion about a product or service. We strive to provide honest opinions and findings, but the information is based on individual circumstances and your specific experiences may vary. We also treat your privacy seriously. Please take some time to understand our full policies and disclaimers by clicking here.
Source: moneyning.com

Medically Complex Medicare Part B

My personal opinion for the increase in medically complex part B patients is due to the hospital observation status issues. If only I had a nickel for every time a colleague told me stories about their local hospitals keeping patients for several days through observation status. Or the situation where the patient is at the hospital for three midnights, re-admits to your facility, begins Part A benefits, and a few days later it’s discovered they were kept for observation. The Medicare Part A changes to Part B, but our plan of care and treatment approaches and therapy minutes should not change based on insurance issues.
Source: mcknights.com

Ask The Experts: Retirement

However, I pay a $62.99 “Medicare tax” each pay period per my earnings and leave statement, for a total of $1637.74 Medicare tax yearly. My federal employer pays the same amount as a benefit I receive. I have paid this “Medicare tax” since it was first required in the 1980s.
Source: federaltimes.com

Chatham/Avalon Park Community Council: Mather More Than A Cafe Presents Medicare & You (Medicare Part A & Part B) Checkup

Mather More Than A Cafe” Hosts A Free Medicare Supplement Checkup Medicare Part A & Medicare Part B Information Date: Tuesday, May 7, 2013 Place: Mather More Than A Cafe’ 33 East 83rd Street ( Wabash) Chicago, Illinois 60619 Time: 10 am until 11:00 am Free blood Pressure Screening To R.S.V.P. please call the Mather More Than A Cafe’ Office at 1(773) 488-2801
Source: blogspot.com

Above And Beyond: A Explanation of Medicare Part A

Part A of Medicare covers qualified inpatient care that is received in a hospital. Medicare Part A will also pay for limited skilled nursing facility care, as well as for some types of home health care and hospice services. The coverage provided through Medicare Part A would provide of the following: Hospital – Coverage includes cost of a semi-private room as an inpatient at a hospital, nursing services, and certain other medical supplies and equipment and hospital services. All services are paid for 100% after the insured has paid a deductible of $1,184 in out of pocket expences. Blood – Part A of Medicare covers 100% of the cost of blood transfusions after the first three pints are paid for by the insured. Skilled Nursing Facility Care – The Skilled nursing facility benefits are provided by Part A includes the cost of a room (semi-private), and the meals for the insured. Medicare Part A also provides coverage of skilled nursing and rehabilitative services, and many other medically necessary skilled nursing facility services and supplies. Medicare doesn’t cover long term nursing facility stays, and coverage ceases after a 20 day limit. Home Health Care Services – Home health services are totally covered by Medicare Part A and/or Medicare part B but are limited to reasonable and medically required part-time or intermittent home health aide services, physical therapy, occupational therapy, and speech-language pathology that is ordered by a physician and is provided by a Medicare approved home health agency. Medicare will fund up to 100% of all medically required home healthcare costs Hospice Care – Part A of Medicare will cover many medications that are used for symptom control and relief of pain in a hospice care situations. It may cover most medical and support services from a Medicare certified hospice agency. Medicare will cover up to 95% of the cost of hospice care services. What is not covered by Medicare Part A Coverage? Even though Medicare Part A covers numerous health care expenses, there are still many holes in the coverage. For example, Part A does not offer coverage for private duty nursing. Also, Medicare Part A does not provide coverage for inpatient mental health care in a psychiatric hospital for more than 190 days in an insured’s lifetime. Medicare Part A will also not cover long-term care that is considered to be “custodial” or basic in nature, meaning that assistance with basic daily living activities such as dressing and bathing are not covered unless they are part of skilled care services. While Medicare may not cover all of your needs completely, Medicare supplement plans are available for purchase to help cover the cost of other health care services you might need. Here is how the Medicare Part A Benefits are Calculated? Medicare Part A tabulates its coverage in terms of benefit periods and reserve days. A benefit period is considered beginning on the day that a Medicare Part A insured enters the hospital. The insured’s benefit period will cease when the enrolled has been released from the hospital for at least 60 consecutive days. Other than hospice care benefits, a Medicare Part A provides unlimited benefit periods. How do I Qualify for Medicare Part A? An individual who is suffering from end state renal disease and who requires kidney dialysis or a kidney transplant will also be considered as eligible to enroll in Medicare Part A. How to Enroll in Part A of Medicare If a person has not been automatically enrolled, they should enroll in Medicare Part A through their local Social Security office. All Medicare Part A enrollees must submit an application of enrollment during an “open enrollment” period. Can You Enroll in Medicare Part A If You Have Other Health Insurance Coverage? If a person has other health insurance, they can also receive Medicare Part A. The primary insurance provider will usually pay the claim up to its coverage limits. Then, the secondary insurance provider will make a payment on the amount that the primary insurer did not pay, if any. An example, if a insured filed a claim through their primary health insurance carrier and the claim is not paid in a timely manner, the provider may bill Medicare. What is the cost for Medicare Part A? Most people enrolling in Medicare Part A do not pay a monthly premium. This is the situation if an individual and/or their spouse paid Medicare taxes while they were working. However, if, an individual is not eligible for zero premium Medicare Part A, they may be able to buy this coverage if they meet one of the following conditions: They are over age 65, are entitled to or are enrolling in Medicare Part B, and they meet United States residency or citizenship requirements They’re under the age of 65 and disabled and their no premium Medicare Part A coverage ended because the individual has returned to their employment. If a person decides to buy Medicare Part B, they must also be enrolled in Medicare Part A.
Source: blogspot.com

Medicare Part A explained

Skilled Nursing Facility Care – Skilled nursing facility benefits provided by Part A includes the cost of a room (semi-private), as well as the insured’s meals. Medicare Part A also covers skilled nursing and rehabilitative services, and certain other medically necessary skilled nursing facility services and supplies.  Medicare will not cover long term nursing facility stays, and coverage ends after a 20 day period.  Medicare will cover any additional costs for the next 80 days after a deductible of $148.00 per day to you, but after 100 days Medicare will not pay for any additional nursing home services.
Source: askmedicareblog.com

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

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

Medicare latest news, medicare advantage plans

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Source: healthworkscollective.com

Medicare Essential – Is this the future of Medicare?

The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
Source: gormanhealthgroup.com

Free Medicare Workshop in Tarpon Springs

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 marsmet524The class will be led by representatives from the Area Agency on Aging of Pasco-Pinellas and Florida Department of Elder Affairs. They will present an overview Medicare, information about subsidies and take questions from the audience. The seminar is open to people 18 and older, however reservations are required.
Source: patch.com

Video: ALERT NEWS Florida) Sunshine Pharmacy owner’s arrest in Naples part of 8 city Medicare fraud sweep.

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

Dozens Arrested for Medicare Fraud in South Florida

Federal authorities arrested nearly 100 individuals across the country for their involvement in Medicare fraud. Twenty-five arrests were made in South Florida alone. Miami-Dade County is often considered to be the hotbed for healthcare fraud. Miami criminal lawyers have kept busy over the past few years representing clients arrested for Medicare fraud. The highest profile defendant arrested in the most recent sweep was Roberto Marrero, a Cuban born actor and businessman, who is accused of stealing millions of dollars from the federal healthcare program. Both Marrero and his wife were arrested for submitting $20 million in bills to Medicare. The bills were submitted to the program for home health care for diabetic patients. The indictment alleges that the treatments were either not necessary or never provided.
Source: miamicriminaldefenselawyerblog.com

Florida Latin Connection :: Feds accuse Don Gaetz’s former company of Medicare fraud, including during his tenure ::
http://www.floridalatinconnection.org

The lawsuit, filed May 2 in the District Court for the western district of Missouri, alleges that since at least 2002 Vitas Hospice Services and Vitas Healthcare Corp., the largest provider of for-profit hospice services in the country, “misspent tens of millions of taxpayer dollars from the Medicare program.” 
Source: floridalatinconnection.org

Naples, Florida Seminar Helps Retirees Understand Medicare

PRLog (Press Release) – Apr. 29, 2013 – NAPLES, Fla. — Medicare Specialist Helen Hreen will present a free seminar titled, “Welcome to Medicare Madness,” Friday, May 3, and Wednesday, May 8, from 10 a.m. to noon at the M Waterfront Grill in the Venetian Village, 4300 Gulf Shore Blvd. in Naples. A complimentary luncheon will be served. The seminar is intended to educate retirees and near-retirees who are confused by Medicare, Medicare supplement plans and prescription drug plans – whether they’re new to Medicare, losing retiree benefits or new to the area. Beneficiaries who will be losing their coverage to the liquidation of Universal Health plans will be particularly interested in this information. Topics include how health reform affects Medicare, supplemental insurance options and drug plans. With more than 30 years of healthcare and insurance experience, Hreen is in a unique position as Medicare Specialist to provide up-to-date information on all aspects of Medicare, offer comparisons, and assist seniors in choosing options that are right for them. Seating is limited. For reservations, please contact (239) 384-7014.
Source: prlog.org

Florida Hospital Repays $3M to Medicare While Overbilling Allegations Loom

Florida Hospital in Orlando has repaid $3 million to Medicare, a move seen by prosecutors as corroborating overbilling allegations and by hospital officials as the result of a routine audit, according to an Orlando Sentinel report. Lawyers representing whistleblowers who filed suit against Florida Hospital in Orlando say the organization’s repayment of $3 million to Medicare shows merit to overbilling allegations, but hospital officials say the repayment was the result of a “normal and routine” audit. Florida Hospital and six other hospitals under the Orlando-based Adventist Health System face allegations of improper Medicare billing. A whistleblower complaint filed in July 2010 and unsealed in August 2012 alleges that seven Adventist hospitals routinely submitted duplicate claims or overbilled for radiology services for 15 years. A second complaint, filed in October 2012, claims fraudulent billing occurred for emergency services, as well. Marlan Wilbanks, JD, an attorney representing the whistleblowers, says Florida Hospital’s recent repayments to the Medicare program “further proves the credibility of our case,” according to the report. But hospital spokesperson Samantha O’Lenick says the repayment was based on a third-party audit’s findings. “It is not uncommon for us, as well as others in the industry, to conduct normal and routine audits because of the highly complex governmental billing rules,” Ms. O’Lenick said in the report. “Sometimes in doing so, we correct overcharges and undercharges.” A district judge has called the whistleblowers’ evidence of the alleged wrongdoing “extensive and sufficient,” and denied Florida Hospital’s first motion to dismiss the case. He also denied another motion to dismiss the second claim, which was filed more recently. A trial for the case is set for Dec. 2.
Source: beckershospitalreview.com

Medicare hike could also hit some in middle class

The latest proposal ramps up the reach of means testing and sets up a political confrontation between AARP and liberal groups on one side and fiscal conservatives on the other. The liberals have long argued that support for Medicare will be undermined if the program starts charging more for the well-to-do. Not only are higher-income people more likely to be politically active, they also tend to be in better health.
Source: flcourier.com

Two dozen South Floridians among scores nabbed in Medicare fraud scheme

In this case, the defendants are charged with conspiracy to commit health care fraud, conspiracy to receive and pay health care kickbacks, substantive kickback charges, conspiracy to commit money laundering, and substantive money laundering.  Defendant Dora Moreira was the owner and operator of Anna Nursing Services Corp. (Anna Nursing), which paid kickbacks and bribes to patient recruiters and beneficiaries to obtain Medicare beneficiaries.  Anna Nursing was paid more than $7 million for the false claims it submitted to Medicare, which claims were primarily for physical/occupational therapy.  Defendant Ivan Alejo worked at Anna Nursing, and was responsible for, among other things, negotiating kickback rates and distributing kickback payments to patient recruiters on behalf of Anna Nursing.  Defendant Hugo Morales worked as a physical therapist on behalf of Anna Nursing, and was responsible for, among other things, fabricating patient medical documentation.  Defendant Dora Moreira laundered money for the purpose, among others, of concealing the proceeds of the fraud and the payment of kickbacks to recruiters.  The Asset Forfeiture Section has obtained restraining orders on the corporate bank account and on real property that is traceable to the fraud.  If convicted, the defendants face up to ten years for the health care fraud charges, five years for each count of the kickback charges, and twenty years for the money laundering charges.  This case is being prosecuted by Trial Attorney Brendan Stewart of the Criminal Division’s Fraud Section and Assistant U.S. Attorney Eloisa Fernandez of the Asset Forfeiture Section.
Source: eyesonnews.com

Florida psychiatrist Gary Kushner sentenced to 144 months prison in Medicare fraud scheme

According to the evidence at trial, Kushner and his co-conspirators caused the submission of over $50 million dollars in false and fraudulent claims to Medicare through Biscayne Milieu, which purportedly operated a partial hospitalization program (PHP) – a form of intensive treatment for severe mental illness.  Instead of providing legitimate PHP services, the defendants devised a scheme in which they paid patient recruiters to refer ineligible Medicare beneficiaries to Biscayne Milieu for services that were never provided or were not properly reimbursable by Medicare.  Many of the patients admitted to Biscayne Milieu were not eligible for PHP because they were chronic substance abusers, suffered from severe dementia and would not benefit from group therapy, or had no mental health diagnosis but were seeking exemptions for their U.S. citizenship applications.
Source: wordpress.com

Should Medicare Pay Be Tied to Geography?

While not overtly giving advice to lawmakers, the panel’s interim report identified many downsides to adjusting Medicare payments to hospitals, doctors and other providers based on region. Such a practice, it suggested, “would likely mischaracterize the actual value of services” and result “in unfair payments” to physicians and institutions that were careful in using Medicare services but were located in regions that were overall heavy spenders.
Source: usf.edu

Florida man behind Medicare money

Prosecutors filed conspiracy charges against the founder of the Caribbean-based company, Jorge Emilio Perez, who is at large, and two Miami-Dade men suspected of defrauding the taxpayer-funded Medicare program. The latter defendants, Felipe Ruiz and Kirian Vega, have since pleaded guilty to laundering their Medicare profits through the convicted check-cashing store owner, who did business with Caribbean Transfers.
Source: amlabc.com

What is Medicare? Oceanside,CA., Carlsbad, CA, Vista, CA

Posted by:  :  Category: Medicare

What's In My Bag... by Amy DiannaAffordable Insurance is located in Oceanside California. We proudly serve businesses and local residents in Oceanside, Carlsbad, Vista and San Marcos. Affordable Insurance operates throughout San Diego, Riverside, and Orange Counties.
Source: insr4u.com

Video: What Is Medicare?

Medicare latest news, medicare advantage plans

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Source: healthworkscollective.com

What is Medicare Supplemental Insurance? | Arthur E. Ras

Medicare is the social insurance program sponsored nationally by the United States federal government, which is responsible for providing healthcare coverage to millions of Americans aged sixty five and older, as well as other individuals with certain disabilities and medical conditions. The legislation authorizing the creation of Medicare was originally enacted by Congress and President Lyndon B. Johnson in 1965 under the auspices of the Social Security Act in order to address pressing societal concerns regarding the care of increasing numbers of low income elderly Americans who lacked the means to pay for healthcare on their own. In the decades since its creation, the Medicare program has grown exponentially in order to continue providing medical coverage for an ever increasing population of elderly Americans with ever increasing life expectancies and corresponding age related medical conditions. These trends are the result of numerous scientific advances in medical knowledge and technology as well as the increased availability of medical treatment made possible through programs such as Medicare. However, these positive advances in medical science and life expectancy have also led to significant financial strains on the overall healthcare system, which has led to the development of Medicare supplemental insurance plans, also known as Medigap plans, to cover the ever increasing costs of medical care not included in the standard Medicare package.
Source: arteras.com

Why is Medicare shutting down one of the most effective health

We think of the hospital as a place people go to get better. At Health Quality Partners, the view is that a hospital is a place where seniors get worse. “Being in the hospital for three days or five days sets them back to a point where they’ll never regain what they were,” says Sherry Marcantonio, chief program architect of HQP. “That’s where the scales tip. That’s where people end up needing a nursing home.” Keeping seniors out of the hospital, which is a core focus of its program, cuts costs and saves lives, but it also preserves quality of life — a measure often ignored in these discussions. There’s a good argument to be made that if a program like HQP cost slightly more than traditional Medicare but cut hospitalizations by a third, it would still be worth it. The point of health care, after all, is to keep people healthy. But HQP saves money — and lots of it.
Source: bangordailynews.com

The Dramatic Difference: What A Hospital Charges Vs. What Medicare Pays

Looking at the price charged without considering the full scope of services the hospital provides is like looking at the tires on a car without considering the vehicle being driven. Sure, you can find cheaper tires, but are you putting tires on an economy vehicle or a full size sedan. One has to consider whether it is a teaching hospital or a community based facility. How many of the patients who arrive through the emergency department are insured, and how many will require critical care? Does the facility have advanced diagnostic equipment or are the clinicians basing their decisions on fuzzy images? Sure we can continue to complain about the cost of healthcare, but we should stop to think what is we are complaining about.
Source: kaiserhealthnews.org

Upload One: What Is Medicare Supplement Plan?

It is a commonly held myth that medicare addresses a huge number of health expenses. It is a big misunderstanding. Roughly speaking, medicare can cover 1 / 2 of medical expenses,after the annual deductible has been satisfied. There are numerous points it doesn’t protect, such as for example dental, reading, prescriptions and long haul care. These may be included in acquiring extra insurance. Correcting yet another myth could be the proven fact that medicare isn’t free for qualified individuals. Element A, hospitalization insurance, could be the only section that’s free. Part N, D and D all come with rates. These payments can and do change each year.
Source: upload-one.com

What is Medicare? Will It Cover All My Medical Bills? Q & A

A. Probably not. The program was designed to meet the medical needs of people sixty-five years or older, though there are defined exceptions. Specifically, if you can show that you have been on social security disability for a period of 24 months or longer. Or have worked long enough in a federal, state, or local government job to be insured for Medicare. Or have a defined medical condition as discussed below.
Source: gottrouble.com

Probe Of Medicare Advantage Leak Finds Wide Speculation On Deal

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSThe Wall Street Journal: Health-Policy Move Widely Shared More people than previously thought predicted a major change in U.S. health-care policy that led to a federal insider-trading probe, according to new documents assembled by congressional investigators. Justin Simon, a policy analyst with Height Securities, said in a previously unreported email that was reviewed by The Wall Street Journal that he heard about the policy change before it was made official from “like 30 people.” Mr. Simon sent an alert to Wall Street traders just before markets closed April 1, sending health-insurance stocks on a tear. This and other emails indicate the extent to which Washington’s insular world of health-care policy experts was buzzing about a possible deal that would result in the Centers for Medicare & Medicaid Services reversing course on previously announced Medicare funding cuts (Mullins and McGinty, 5/13).
Source: kaiserhealthnews.org

Video: What Is Medicare Advantage?

MEDICARE ADVANTAGE: Growth Projections Are Stunning.

Based on this eye-opening news article today, UnitedHealth, Humana May See Surge in Medicare Advantage – Bloomberg I’m now going to get certified to sell Medicare Advantage plans with 2, or perhaps 3, good carriers. I looked at one from Humana last year for my dad in Michigan, but the out-of-pocket expenditures for medical care were stunningly high, compared to Standard Medicare mated with a Plan "F" MedSupp. But if Medicare Advantage participation is going to grow a whopping 50% over the next 10 years, I’d be a fool not to at least have it in my portfolio of offerings. Who’s driving the growth of these Medicare Advantage plans the most.. Is it Well-To-Do Seniors who don’t mind paying the high out-of-pocket costs? Or is it Seniors on very limited income who are attracted by the lower overall premium cost? Other some other demographic? -Allen
Source: insurance-forums.net

Report: Private Medicare Advantage Plans Make Progress in Combating Chronic Disease

Since its start in 2003, Medicare Advantage has gained popularity because of its high quality, coordinated benefits and patient-centeredness.  Its central role for private health plans makes MA extremely popular with seniors.  The best practices of these plans should be integrated into conventional Medicare.  That’s the only hope if Medicare is to contain its costs without sacrificing quality and care in the process.
Source: hlc.org

Population Health Management In Medicare Advantage

Wellnesss promotion.  A key component of PHM is the ability to promote health and wellness among all individuals, and MAOs reported extensive activities directly for members, including smoking cessation, wellness discounts, and the promotion of healthy lifestyles (exercise and nutrition).  In addition to promoting wellness, PHM requires monitoring of population risk and designing and implementing programs that manage sub-populations based on their risk.  Health risk assessments used universally by MAOs serve to segment populations at risk for disease.  For patients identified as being at risk for chronic conditions, common interventions include targeted health education or outreach to engage members in activities intended to reduce risk factors, enrollment in care management programs, and working with nurses in health education.
Source: healthaffairs.org

Seniors should tell Obama to prevent Medicare Advantage cuts

When President Obama signed the Affordable Care Act into law, he simultaneously authorized $200 billion in cuts to the Medicare Advantage program. At the time, the Congressional Budget Office projected that the health care reform law’s cuts would result in three million fewer Medicare Advantage enrollees. Moreover, actuaries at Oliver Wyman predicted that the cost of the health insurance tax would mean an additional $3,500 in out-of-pocket expenses for seniors over the next 10 years.
Source: dailycaller.com

Medicare latest news, medicare advantage plans

Another aspect up for debate is if changes are made, at what age would these changes begin to affect? Some proposals would not touch anyone who is at least 55 years of age. Others are arguing the age should be 59 and others think 56 is the magic age. One of the more critically proposed issues is the use of a voucher system. The voucher would be issued when the beneficiary turns 65 in lieu of coverage for healthcare expenses. Basically, the voucher allows a check to be issued to the beneficiary to purchase insurance. The voucher amount would be tied to the amount required to purchase Medicare. Additionally, beneficiaries would be able to choose private insurance instead of Medicare. If the private insurance costs more, the beneficiary would have to pay the difference. If insurance costs less, they could bank the difference.
Source: healthworkscollective.com

Medicare Advantage: Providing Quality Care to More than 14 Million Beneficiaries

Medicare Advantage plans are a valuable resource in protecting beneficiaries from unpredictable out-of-pocket costs. In 2012, all Medicare Advantage plans offered an out-of-pocket maximum limit for beneficiary costs, and about 78 percent of Medicare Advantage enrollees are in plans that have annual out-of-pocket maximums of $5,000 or less. These out-of-pocket maximums – which are not offered by the Medicare FFS program – help protect Medicare beneficiaries from catastrophic health care expenses that otherwise might pose a serious threat to their financial security.  Medicare Advantage plans also help reduce out-of-pocket costs for enrollees by reducing premiums for Part B and Part D, and by limiting cost-sharing for Medicare-covered services, including primary care physician visits and inpatient hospital stays.
Source: ahipcoverage.com

Health Equity Matters: Medicare Advantage (MA)

In September 2012, rural enrollment in Medicare Advantage (MA) and prepaid plans increased to nearly 1.8 million, accounting for over 17% of the rural Medicare population and representing a 1.5 percentage point increase from the previous year. Nationally, nearly 27% of the Medicare population is enrolled in an MA or other prepaid plan (approximately 13.6 million).
Source: blogspot.com

The Medicare Advantage Disenrollment Period Explained

It’s important to note that this time is not an additional enrollment period, which means that you cannot enroll in Medicare Advantage or switch between Medicare Advantage options. However, if you are planning to disenroll from Medicare Advantage, you may use this opportunity to enroll in a Medicare Supplement policy upon returning to Original Medicare. Any other changes to your Medicare plans must wait until the next valid Part D election period
Source: bradeninsurance.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

Insurers: Cuts to Medicare Advantage will hit poor, minorities

“Medicare Advantage is a lifeline for millions of low-income and minority Medicare beneficiaries who rely on the high-quality coverage and innovative programs and services these plans provide,” AHIP President and CEO Karen Ignagni said in a statement.
Source: thehill.com

Senators invite provider input on Medicare ‘doc fix’

Posted by:  :  Category: Medicare

waiting room N I M H by drivebybiscuits1To compensate for maintaining physician pay levels, the Centers for Medicare & Medicaid Services has had to cut spending elsewhere. This has led to reduced reimbursements for skilled nursing providers collecting on bad debt, for example. While protesting these offsets that take a bite out of their payments, long-term care providers have also expressed concern that if doctors’ pay is cut, it could negatively affect elder care.
Source: mcknights.com

Video: Medicare Provider Enrollment 3.wmv

HEALTHCARE: Medicare Provider Charge Data

The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.
Source: wordpress.com

CMS Proposes To Further Tighten Medicare Provider Enrollment Rules

Ms. Stamer has extensive experience advising and assisting health care providers and other health industry clients to establish and administer compliance and risk management policies and to respond to DEA and other health care industry investigation, enforcement and other compliance, public policy, regulatory, staffing, and other operations and risk management concerns. A popular lecturer and widely published author on health industry concerns, Ms. Stamer continuously advises health industry clients about compliance and internal controls, workforce and medical staff performance, quality, governance, reimbursement, and other risk management and operational matters. Ms. Stamer also publishes and speaks extensively on health and managed care industry regulatory, staffing and human resources, compensation and benefits, technology, public policy, reimbursement and other operations and risk management concerns including a number of programs and publications on OCR Civil Rights rules and enforcement actions. Her insights on these and other related matters appear in the Health Care Compliance Association, Atlantic Information Service, Bureau of National Affairs, World At Work, The Wall Street Journal, Business Insurance, the Dallas Morning News, Modern Health Care, Managed Healthcare, Health Leaders, and a many other national and local publications.  You can get more information about her health industry experience here. If you need assistance with these or other compliance concerns, wish to ask about arranging for compliance audit or training, or need legal representation on other matters please contact Ms. Stamer at (469) 767-8872 or via e-mail here. 
Source: wordpress.com

Medicare Provider Charge Data

As part of the Obama administration’s work to make our health care system more affordable and accountable, data are being released that show significant variation across the country and within communities in what hospitals charge for common inpatient services.The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System IPPS payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group MS-DRG for Fiscal Year FY 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.
Source: wordpress.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

Payroll Tax Extension Includes Important Provisions for Medicare Beneficiaries 

Qualified Individual program extension.  Over 400,000 low-income Medicare beneficiaries rely on the Qualified Individual (QI) program to pay their Medicare Part B premium ($99.90 for most people for 2012) each month.  Those eligible for this assistance are Medicare beneficiaries with incomes between 120% and 135% of federal poverty limits (between $1089 and $1226/person/month in 2011; 2012 figures are not yet available) and limited assets. The program, a fixed-amount block grant to states to administer through their Medicaid programs, has been extended for short periods ever since its initial authorization expired in 2002.  The extension legislation authorizes $150 million dollars to continue the program through February 29, 2012.
Source: medicareadvocacy.org

Marci’s Medicare Answers

If you have diabetes or you are at high risk for glaucoma, Medicare will pay for an eye exam once every 12 months to check for eye disease due to either condition. Keep in mind that certain Medicare Advantage plans and Program for All-Inclusive Care for the Elderly (PACE) plans may offer limited vision coverage. You may also get coverage for vision care by going to reduced-cost clinics or by purchasing vision insurance. Lastly, Medicaid may cover vision care. Contact your state Medicaid program for more information on Medicaid coverage of vision care services.
Source: homeboundresources.com

Benutzer:KieranWhi – VWA Wiki

Posted by:  :  Category: Medicare

Romney Ryan Plan for Medicare and SSI by DonkeyHoteyMedicare supplies a selection of options from which to select from, and it is important that someone who is ready to come into Medicare knows what all the options are that are open to them. There are specific measures by which to just take before joining Medicare, and after joining Medicare. A Medicare application can be completed online or perhaps a paper application can be sent to your house. Before an individual becomes age 65 the application should be done as much as 3 to 4 months. An authorization Medicare form can be signed by them authorizing a family member or good friend to fill out the Medicare application for them If your person is unable or miserable in filling out their particular Medicare application. Once an individual has made 65 and is really a full member of Medicare for the first year any Medicare client may have a free of charge routine visit to their medical practitioner within the Medicare community. By registering for regular Medicare information a person is able to keep track of what doctors, hospitals, and other medical services they’ve been to and can also keep track of the deductible they’ve paid in and to be able to keep track of all their Medicare claims. By the time people are able to join Medicare they’re on a variety of drugs for just one physical or mental challenge. Medication could cost every month to a large amount getting a person in times where they wonder whether they can purchase treatment or other products. When making a decision as to which physician, clinic or consultant to see on a regular schedule the options must be within the Medicare community of the particular invest which a Medicare person lives. They have 8 weeks to return into Medicare and select their specialist, hospitals and doctors again in the new area If your individual moves out of the area, for instance medicare advantage enrollment.
Source: vwa-forum.net

Video: АМЕРИКА #138 медицинское страхование medicaid и medicare

Benutzer:IzettaCar – Wiki

Many of us be determined by Medicare insurance-in order to pay for their medical care needs. Unfortunately, Medicare insurance does not spend on all sorts of things as well as being lots of people count on the government system, Treatment payments secure more compact and more compact. A number of medical care providers will not permit Medicare because of this of restricted features and also hamper having to pay technique. Outdated people usually make use of supplemental medicare insurance, medicare supplemental insurance plans along with medicare supplement insurance plans to load the investigation on the retiree insurance program. Expenses Dollars They do search for medicare complement insurance plans, to ensure that retired people might get more desirable medical while not needing to pay a whole lot in the finances. Individuals supplement programs is going to be the ones that have outdated financing stuff like prescription narcotic insurance coverage, copays, plus assessments expertise. Since health-related costs are extremely remarkable, particularly when you might be older so you need more expert companies, getting an economical additional medicare insurance technique can let you preserve the gain the wallet. Several the ones that have retired are generally fortunate enough to get have medical increases benefit from his or her past organisations. None the less, throughout today’s earth where several organizations will be lowering charges, older persons includes a supplemental medicare insurance will his or her retiring reward prepare. Integrating medicare supple-mental insurance policies can help senior citizens increase the amount of coverage for that affordable. Since the perfect buying electrical power is contained by the United states government, it’s able to support retirees have the most useful supple-mental insurance to the fully developed people of america. Retire using Comfortableness It is just ideal they’re able to use health-related benefits of their retiring, because shareholders been employed by hard their whole life. Nevertheless, since lots of firms attempt to not invest just as much, they can allow the very same retirement living strengths that they may have got certain ages earlier. Thus, it truly is proper how the Authorities is certainly going to simply help and provides exceedingly inexpensive possibilities, for retirees who will be for minimum finances, for instance people who obtain exclusively Social Stability assessments once per month. They are able to moreover get exclusive doctor prescribed prescription medicine tasks that may become extra medicare insurance. You can not find any cause for each elderly to see with no medical care insurance with most of the choices commonly accessible while in the insurance coverage current market. Select Merely Finished you will need You will notice that there are many alternative suggestions you can select, while you shop designed for medicare product insurance policies. They’re really based upon nada specifications in addition to the prospects that you simply want. The actual insurance possess predicted annual charges between $6500 in addition to $7500. It’ll be easier out there possible alternatives for instance foreign journey crisis remedies, competent assisted living, prevention knowledge, prescription services, and added cover daily remains inside the medical service. When you had want to select from your supplemental medicare insurance, medicare supplemental insurance plans together with medicare product insurance plans, referred to as Medicare supplemental insurance, you should do your homework. You need to find a system that is positively budget friendly in a monthly payment system combined with tax deductible. Tend not to choose a schedule by using alternatives which you don’t need to have, as an easy way to improve your insurance protection., see private medical insurance.
Source: webtainment.eu

Medically Complex Medicare Part B

Posted by:  :  Category: Medicare

Claire Seeks Stories on Medical Equipment Sales Tactics by Senator McCaskillMy personal opinion for the increase in medically complex part B patients is due to the hospital observation status issues. If only I had a nickel for every time a colleague told me stories about their local hospitals keeping patients for several days through observation status. Or the situation where the patient is at the hospital for three midnights, re-admits to your facility, begins Part A benefits, and a few days later it’s discovered they were kept for observation. The Medicare Part A changes to Part B, but our plan of care and treatment approaches and therapy minutes should not change based on insurance issues.
Source: mcknights.com

Video: Guide to Medicare Part A and Part B

OIG hospital probes may extend to Medicare Part B

Hospitals could face compliance reviews over Medicare Part B, according to a Bloomberg BNA healthcare blog. Speaking at a conference, Daniel R. Levinson, Inspector General of the U.S. Department of Health & Human Services, Office of Inspector General (OIG), said the agency might be interested in performing compliance reviews on Medicare Part B providers.
Source: bvhealthcarenews.com

Income Thresholds For Medicare Part B And Part D Premiums

While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

OIG Report: Medicare Part B Overpaying for Infusion Medications

OIG recommended that CMS “seek legislative change” over reimbursement policies or include the devices used with such drugs in the next round of competitive bidding. According to “RegWatch,” CMS “partially” has agreed to ask Congress to change the rules and said it will go forward with the competitive bidding suggestion (Wilson, “RegWatch,”
Source: californiahealthline.org

CMS Proposes Changes to Medicare Part B Billing for Hospitals

CMS has proposed two rules that would pay for more hospital inpatient services under Medicare Part B when a Medicare Part A claim is denied. The first rule would allow CMS to pay hospitals additional Part B payments when a Part A claim is denied because the Medicare patient should have been treated as an outpatient rather than inpatient. More specifically, Medicare would pay for all “reasonable and necessary Part B hospital inpatient services” if the patient had been treated as an outpatient instead of the current limit list of covered Part B hospital inpatient services. The second rule relates to the “significant” number of pending appeals of Part A hospital inpatient reasonable and necessary denials from Recovery Auditors, formerly known as recovery audit contractors, according to CMS. CMS proposed a standardized process to handle pending appeals and billing for the additional Part B inpatient services. CMS estimates the proposed rules would result in a $4.8 billion decrease in Medicare program expenditures over five years due to lower RAC appeals and other factors. In addition, CMS expects short-stay inpatient admissions to rise under the proposed rule since hospitals could rebill Part B without the expense of an appeal. However, hospitals would have to rebill Medicare within 12 months to get the additional payment. To view a fact sheet on the proposed rules, click here. Comments for the proposed rule are due by May 17.
Source: beckershospitalreview.com

I’m Paying More than $104.90 for Medicare’s Part B!! How Can I Appeal This?? » Toni Says

            I don’t understand why I am paying more for my Part B premium.  When I called Social Security, the agent told me that Part B was $104.90, but my letter says that based on me and my husband’s income, Part B for me will be $230.70.  Now that I have retired, I don’t make what I did. What can I do if I do not think I should pay a higher Part B premium?  Thanks in advance…Susan K from Spring, TX
Source: tonisays.com

Ask The Experts: Retirement

A. Obviously. The first number you look at is always the cost of premiums for Part B, which would be in addition to your FEHB premiums. However, the arithmetic doesn’t stop there. You need to review your plan brochure to see how your plan will reimburse your medical insurance coverage services if you don’t elect Part B. Then you need to review the benefits that each plan provides to see if they either supplement each other or provide coverage where none would otherwise exist. Finally, put what you’ve learned up against what you think your current and future health needs will be. When you are done, you may conclude that you don’t need Part B, or that you do. The decision is up to you. However, do it with more thought than you have put into it so far.
Source: federaltimes.com

Chatham/Avalon Park Community Council: Mather More Than A Cafe Presents Medicare & You (Medicare Part A & Part B) Checkup

Mather More Than A Cafe” Hosts A Free Medicare Supplement Checkup Medicare Part A & Medicare Part B Information Date: Tuesday, May 7, 2013 Place: Mather More Than A Cafe’ 33 East 83rd Street ( Wabash) Chicago, Illinois 60619 Time: 10 am until 11:00 am Free blood Pressure Screening To R.S.V.P. please call the Mather More Than A Cafe’ Office at 1(773) 488-2801
Source: blogspot.com

Medicare Essential – Is this the future of Medicare?

The combined deductible idea is echoed in a recent article in Health Affairs that proposes unification of Parts A and B, and Part D drug benefits. The Health Affairs article also proposes reducing beneficiary cost sharing to levels comparable to Medicare Advantage plans, eliminating the need for Medicare Supplemental coverage. The new Medicare plan, called Medicare Essential, would become the default for people who qualify for Medicare for the first time. New Medicare beneficiaries could opt out and take old traditional Medicare, and go buy their own Part D and Medicare Supplement plans, or they could buy Medicare Advantage plans. Medicare Essential would have a much higher premium than Medicare Part B, but the authors of the article claim that the overall cost would be less than Part B plus Part D plus the full-coverage Medicare Supplement Plan F that most seniors select. So proponents could argue that the added cost of the increased premium is a bargain and that people could always opt out and avoid the higher cost if they wanted to. Medicare Essentials could show significant savings by avoiding the broker commissions that add to the cost of Medicare Supplemental and Medicare Advantage plans. Whether the new program would be able to achieve the supposed 2% administrative cost ratio sometimes claimed for Medicare is highly suspect, but elimination of the need to re-process claims to pay Supplement benefits, along with simplification of coverage rules overall, would probably yield some further efficiencies.
Source: gormanhealthgroup.com

Protect yourself from Hepatitis B

Are you at risk for getting Hepatitis B? If you have hemophilia, End-Stage Renal Disease (ESRD), diabetes, or certain conditions that lower your resistance to infection, you have a higher risk for getting Hepatitis B increases.  Additionally, if you have a profession that puts you in frequent contact with blood or bodily fluids, you may be at a higher risk.
Source: medicare.gov

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

Raising the Medicare Eligibility Age: A Costly and Dangerous Proposal 

Posted by:  :  Category: Medicare

[1] Congressional Budget Office: Raising the Ages of Eligibility for Medicare and Social Security, January 2012. Available at http://www.cbo.gov/publication/42683. [2]Center for Budget and Policy Priorities: Raising Medicare’s Eligibility Age would Increase Overall Health Spending and Shift Costs to Seniors, States, and Employers, August 2011.  Available at http://www.cbpp.org/cms/?fa=view&id=3564. [3] Henry J. Aaron, Ph. D, The Brookings Institution for AARP Public Policy Institute, Perspectives: Reforming Medicare: Option-Raise the Medicare Eligibility Age, available at http://www.aarp.org/content/dam/aarp/research/public_policy_institute/health/option-raise-the-medicare-eligibility-age-AARP-ppi-health.pdf. [4] Center for American Progress, The Senior Protection Plan, available at http://www.americanprogress.org/wp-content/uploads/2012/11/SeniorProtectionPlan.pdf. [5] Kaiser Family Foundation: Raising the Age of Medicare Eligibility: A Fresh Look Following the Implementation of Health Reform, July 2011, available at http://www.kff.org/medicare/8169.cfm. [6] Ibid. [7] Kaiser Family Foundation, Health Reform Subsidy Calculator, available at http://healthreform.kff.org/subsidycalculator.axpx [8] Ibid. [9] United States National Vital Statistics System. Available at http://www.cdc.gov/nchs/nvss.htm. [10] Health Affairs, Raising the Medicare Eligibility Age: Effects on The Young Elderly, July/August 2003, available at http://content.healthaffairs.org/content/22/4/198.full. [11] Medicare Rights Center, Paying More for Less: Raising the Eligibility Age, available at http://www.medicarerights.org/pdf/Paying-More-For-Less-Raising-Medicare-Age.pdf. [12] ABC News/WashingtonPost Poll, Langer Research Associates, November 2012, available at http://abcnews.go.com/blogs/politics/2012/11/among-cliff-avoidance-options-most-favor-targeting-the-wealthy/. [13] Center for Medicare Advocacy, Deficit Reduction and Medicare: Saving Money without Harming Beneficiaries, available at http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ [14] MRC. [15] Center for Medicare Advocacy, Investing in Our Future: Strengthening Medicare in 2012 and Beyond, available at http://www.medicareadvocacy.org/2012/02/09/investing-in-our-future-strengthening-medicare-for-2012-and-beyond/.
Source: medicareadvocacy.org

Video: Medicare Part 1: Eligibility and Enrollment

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

The Bonddad Blog: A thought for Sunday: the best jobs program = allow Medicare eligibility at age 55

- by New Deal democrat Regular economic blogging will resume tomorrow (and I know, because the post is already cued up). In the meantime, consider the following thoughts over my Sunday morning coffee, which hopefully aren’t too incoherent…. One of the many ranting points I see on progressive blogs is against “the top 20%” who are apparently presumed to be the functional equivalent of Jamie Dimon. Not so. Many of “the top 20%,” in terms of wealth as opposed to income, are also known as “mom and dad.” If you look at the Census Bureau’s breakdown of average wealth by age group, the most prosperous are those on the verge of retirement. They’ve had 30 or 40 years to gradually build up savings. For example, a couple who each have $50,000 jobs (in today’s dollars) and live frugally by spending half of their net earnings and saving the other half (roughly giving them $30,000 savings per year) will become millionaires in about 25 years (thanks to compounding and return on investments). Obviously this isn’t the majority – the median wealth of people in the 55 – 64 cohort is something like $200,000 – but a non-trivial percentage of middle class workers ultimately reach this milestone. And you know what they would like to do more than anythings else? Retire! I know this not only from personal conversations with my fellow fossils, but also through a discussion with an accountant recently in which he told me that the number one reason most of his older clients haven’t retired yet is because they are afraid to before they are eligible for Medicare. Or they have to continue to work after age 65 themselves because they need their health insurance to cover their spouse until their spouse reaches age 65. Meanwhile, people like David Leonhardt in the New York Times are writing about Today’s Idled Youth,” describing how the ongoing Hard Times have hit the young perhaps harder than any other group. They bought into the American Dream of studying for a degree, becoming a professional of some sort, and hoping for a decent middle class existence. Instead, they are taking clerical or entry level service jobs, or even worse, unable to find a job. You can see where I’m going with this now, right? Here we have the older workers, hobbling to the finish line, but unable to end the race. And here we have young workers, itching to get started, and they can’t because there are no jobs, or no middle class jobs, for them. And the one thing that would cause the many older workers who have saved for retirement to be able to leave the workfoce, and clear the way for those frustrated younger workers, is guaranteed medical care. Fortunately, we have a program that provides exactly that: it’s called Medicare, and according to those already on it, it works really really well. And it works at much lower administrative costs than for-profit private coverage (If I recall correctly, Medicare’s administrative costs are something like 3%, vs. 15% for for-profit plans)(UPDATE: According to the CBO, Medicare’s administrative costs are 2%, vs. 17% for for-profit plans. And Medicare premiums have consistently risen less than private health insurer premiums) . And also unlike for-profit plans, in Medicare there’s no incentive to deny coverage. As in, yes you can buy into a private plan at age 60 for example, but it will be very expensive and you’d better pray they don’t come up with an exclusion if a disease of age catches up with you. Atrios has written a number of times about increasing Social Security payments. Balderdash, say I. If you really and truly want to make a dent in the persistent employment problem facing younger workers, allow anyone age 55 or above to buy into Medicare. Charge them annual premiums equal to what they would have to pay into Medicare at their same wage or salary until age 65 if they continued to work. You would be amazed to see how quickly Boomers can still move, cleaning out their offices and cubicles, when properly motivated. And then younger workers could move right in. It’ll never happen, of course, because it smacks of the New Deal, not the “21st Century” privatized solutions Barack Obama has touted since 2009. And of course the GOP will never allow it, not just because it smacks of the New Deal, but because if Obama came out in favor of it, they would oppose it for the simple reason of opposing everything Obama wants. But that doesn’t mean we shouldn’t acknowledge that it is a real solution to a real problem, and collectively rub Washington’s Very Serious People’s noses in it.
Source: blogspot.com

Viewpoints: Rising Cost Of Tricare; GOP Needs To Better Explain Medicare Eligibility Age Issue; Don’t Forget Adult Immunizations

Minneapolis Star Tribune: Mental Health Needs The Nation’s Attention Millions of people in our country are struggling every day with mental illness — but most aren’t getting help. Many don’t have a support system. They may not have parents or friends who understand or have resources to help. They may not have health insurance that covers the cost of treatment. Or perhaps they feel ashamed or embarrassed to seek help, because mental illness still carries a stigma in our society. As my family searches for some type of meaning and comfort in the depths of our grief, we hold out hope that perhaps Andrew’s story will help people have a greater understanding and compassion for those who struggle with mental illness (Chris Bauer, 3/25). 
Source: kaiserhealthnews.org

Taking Medicare’s eligibility age off the table

CARNEY: Again, as part of a big deal, part of a comprehensive package that reduces our deficit and achieves that $4-trillion goal that was set out by so many people in and outside of government a number of years ago, he would consider that the hard choice that includes the so-called chain CPI, in fact, he put that on the table in his proposal, but not in a cherry-picked or piecemeal way. That’s got to be part of a comprehensive package that asks that the burden be shared; that we don’t, as some in Congress want, ask seniors to bear the burden of further deficit reduction alone, or middle-class families who are struggling to send their kids to college, or parents of children who are disabled who rely on programs to help them get through.
Source: msnbc.com

What Raising the Medicare Eligibility Age Means

Raising the eligibility age saves very little money, on the order of a few billion dollars a year. That’s because the 65 and 66-year-olds will have to get insurance somewhere, and many of them are going to get it with the help of the federal government, either through Medicaid or through the insurance exchanges, where they’ll be eligible for subsidies. However, since many Republican-run states are refusing to expand Medicaid in accordance with the Affordable Care Act, lots of seniors who live in those states will just end up uninsured, which will end up leading to plenty of financial misery and more than a few premature deaths. Put this all together, and the Center on Budget and Policy Priorities estimates that while the federal government would save $5.7 billion a year from raising the eligibility age, costs would increase by more than twice in other parts of the system—for the seniors themselves, employers, other enrollees in exchanges who would pay higher premiums, and state governments.
Source: prospect.org

Must Employers Carry Medicare Eligible Active Employees and Spouses?

There is no legal way to remove just Medicare eligible spouses of active employees from an employer group plan or to have Medicare pay as the primary insurer for those individuals.  The Medicare Secondary Payer statute (MSP) 42 U.S.C. §1395y was specifically enacted in 2003 to ensure that Medicare benefits are secondary to employer plans when dealing with non-retirees.  In the context of Medicare, a primary plan is defined as “a group health plan or large group health plan, a workers’ compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan), or no-fault insurance.”  The MSP does not allow Medicare payment for services for which it can reasonably be expected that payment will be made under a group health plan.  Medicare’s designation as the secondary insurer is upheld even if state law or the group health plan states that its benefits are secondary to Medicare.  The statute does exclude group health plans of small employers.  Small employers are defined by the statute as having less than twenty (20) employees for each working day in each of twenty or more calendar weeks in the current calendar year or the proceeding calendar year.   As you’ve probably guessed, the purpose of the MSP was to reduce federal health care costs by shifting the burden of primary coverage from Medicare to private insurance carriers. 
Source: lexisnexis.com

Ryan’s Budget Proposal Could Seek Changes to Medicare Eligibility Age

House Budget Committee Chair Paul Ryan (R-Wis.) has been privately circulating the idea that his 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,
Source: californiahealthline.org

Jon Chait’s Miserable Endorsement of Raising the Medicare Eligibility Age

What’s more, raising the Medicare retirement age would help strengthen the fight to preserve the Affordable Care Act […] The political basis for the right’s opposition to universal health insurance has always been that the uninsured are politically disorganized and weak. But a side effect of raising the Medicare retirement age would be that a large cohort of 65- and 66-year-olds would suddenly find themselves needing the Affordable Care Act to buy their health insurance. Which is to say, Republicans attacking the Affordable Care Act would no longer be attacking the usual band of very poor or desperate people they can afford to ignore but a significant chunk of middle-class voters who have grown accustomed to the assumption that they will be able to afford health care. Strengthening the political coalition for universal coverage seems like a helpful side benefit — possibly even one conservatives come to regret, and liberals, to feel relief they accepted.
Source: firedoglake.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

Suburban Doctor Accused of $1.7 Million Medicare, Insurance Fraud

Posted by:  :  Category: Medicare

Medicare for All! by juhansoninCecilia Ibrahim was my doctor for almost twelve years, until June, 2012. In that time, she was considerate, thorough, and provided excellent care with appropriate specialist referrals. Appointments were generally on time; she reviewed my history each time and asked questions; she did not rush through exams; and I appreciate her professionalism. I am greatly saddened by this turn of events.
Source: patch.com

Video: Top 10 Medicare Insurance Tips

Medicare levy boost to pay for disability insurance scheme

The Australian federal government can decide important project agendas, example, health… in this case the NDIS which is in the health industry, and infrastructure, and print money to fund the projects at no cost to the citizen and the money printed not count towards a debt… the money for example, is provided for wages and materials for people in the project and is like a grant or sport sponsorship for example. The money is not expected to be returned and the government is deemed to be not in debt.
Source: theconversation.com

Health Insurance Coverage for Older Adults: Implications of a Medicare Buy

This Kaiser Family Foundation policy brief provides an updated profile of the more than 4 million uninsured people between ages 55 and 64 and examines historical proposals to allow uninsured older adults to purchase Medicare coverage. It also examines barriers to securing affordable coverage in the current marketplace, and the effect of premiums and eligibility criteria on the potential uptake of a Medicare buy-in.
Source: kff.org

Insurance Success Story : Tufts Medicare Preferred

Before Tufts Medicare Preferred started to use the HubSpot software to assist with their marketing, their main challenges stemmed from generating new leads from a very fragmented website. They needed a way to connect the dots and figure out how users on their website use each of the tools they provided and what they could do to improve their experience. They had no way to track how visitors were navigating their website, nor a great way to capture lead information on each page. As Baby Boomers begin to retire, that core demographic of 65+ individuals are driving more online traffic than ever before, and Tufts Medicare needed new data on how to reach them more effectively.They discovered HubSpot’s end-to-end enterprise marketing software and originally bought because of the ability to quickly create landing pages. They soon realized however, it also provided them with the tools they needed to track visitors and get even more data than they ever thought possible.
Source: hubspot.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

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

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

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

Cutting Health Care Waste, Medicare Fraud

There are promising signs. Medical education is beginning to respond to these issues. "At bottom, the key agents are the physicians. They order the tests, prescribe the drugs and recommend the surgeries," said Darrell G. Kirch, M.D., president of the Association of American Medical Colleges. More physicians are weighing the cost of brand-name drugs against generics and questioning the effectiveness of commonly ordered tests. The American Board of Internal Medicine Foundation and 375,000 doctors are developing the "Choosing Wisely" campaign with a list of overused tests and procedures that starts with stress tests for healthy people, bone scans for those under 60 and diagnostic tests for common allergies.
Source: aarp.org

Medigap Insurance: What to Know About Medicare Supplemental Plans

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

Doctor charges monthly rate instead of insurance, Medicare or Medicaid

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Source: getmedcallassist.com