CMS Promotes Value for Seniors and Persons with Disabilities in Medicare Plans

Posted by:  :  Category: Medicare

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With today’s regulation limiting overhead and profits for Medicare Advantage and prescription drug plans, the Affordable Care Act continues to promote value for consumers’ and taxpayers’ health care spending. These new requirements apply to Medicare health and drug plans offered by private insurance companies serving over 37 million seniors and persons with disabilities, and build on a similar regulation we issued last year requiring a minimum medical loss ratio for health plans serving consumers in the private insurance market. Medicare health and drug plans, beginning next year, must meet a minimum medical loss ratio, limiting their spending on non-health related items such as administrative costs, profit, or overhead. More specifically, this means that the plans must spend at least 85 percent of their revenue on direct benefits to Medicare enrollees such as clinical services, prescription drugs and quality improving activities.
Source: medicare.gov

Video: Understanding Healthcare Costs: Medicare Advantage

Seven Choices Medicare Plans Will Need To Make In Order To Survive

Sales channels are a good example of this. Given the recent proliferation of channels, it is critical that MA plans optimize their mix by focusing on the needs of their customers, instead of looking at what has helped sell various Medicare products in the past. Traditional channel options include direct sales, brokers, groups, and the web; emerging channels include retail stores, payor partnerships, and private exchanges. Each avenue provides a unique experience for the customer, and the right match can determine the eventual buying decision. The range of channels increases complexity, but it also allows leading plans to tailor their engagement strategy by segmenting the customers and personalizing interactions on the basis of segment needs for sales and enrollment, as well as ongoing interactions with the member to improve experience and manage health outcomes.
Source: healthaffairs.org

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

Health Affairs Blog: “Variation in Medicare Costs Suggests Inefficiencies That Might Be Corrected Through More Administrative Spending”

“Ironically, Medicare’s low administrative costs — about 3 percent compared with 17 percent in the private sector — may be to blame for the high spending.  The private sector uses these funds to do a better job controlling excessive use. Tomas Philipson and colleagues have shown that the variation in Medicare hospital use is four times larger than the private sector when it comes to heart disease. Because it can rely on its monopsony power to control overall spending, Medicare has a weaker incentive to limit overuse.  Meanwhile private insurers have become more efficient, employing tools such as utilization review and case management (which count as administrative costs) to assess patient needs and then either restrict services or steer patients towards more cost-effective care. In a world without private insurance, we would likely see more money wasted on care that produces no benefit for patients.”
Source: ahipcoverage.com

Medicare Health Plan Options (Whittier,). Other Services

Do you have questions or concerns about Medicare health coverage, or prescription drug plans and can’t get the answers you need? Let me help you. For nearly a decade, I have specialized in identifying and providing solutions while helping seniors understand the components of Medicare options and how they work with the original Medicare A & B health plan, with successful measures. I am trained and certified in all Medicare Part C and prescription drug plan options that are offered in the State of California, and available in your service area. I represent Top Rated carriers who provide Medicare Supplements, Medicare Advantage Plans (MA), Medicare Advantage and Prescription Drug Plans (MAPD), Medicare Special Needs Plans (SNP), Medicare Private Fee-For-Service Plans, and Stand Alone Prescription Drug Plans. AARP-Medicare Supplement Aetna -MAPD Anthem Blue Cross Blue Shield of California Care 1st. Caremore Easy Choice Healthnet Humana SCAN Untied Health Care….. and more. Today’s Medicare Health & PDP plans are about having choices. Review Your Options at (www.ifhpquotes.com) – or Call Me Today For a No Cost, No Obligation, Health Benefits & Prescription Drug Plan Review ‘Thank you’ Edward Allen CA. License # 0E94802 Number1Trusted Advisor – Broker
Source: global-free-classified-ads.com

Obama Plan For Medicare, Social Security Draws Ire From Liberal Groups

McClatchy: Obama’s Bid To Squeeze Social Security Enrages His Core Backers Liberal groups angered by President Barack Obama’s proposed Social Security cuts say they’ll take a page from conservatives’ campaign playbook and work to oust Democratic lawmakers who go along with the plan. … As part of his budget plan now before Congress, Obama wants to slow the inflation calculator for Social Security benefits and payments to some military veterans, their survivors and college students. He’s also asking affluent Americans to pay higher Medicare premiums (Rosen, 5/2).
Source: kaiserhealthnews.org

ABOUT MEDICARE: When a doctor doesn’t take Medicare

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
Source: times-standard.com

Pennsylvania Awarded $1.5 Million Grant from the Center for Medicare and Medicaid Innovation to Develop State Healthcare Innovation Model

Posted by:  :  Category: Medicare

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‘s plan will focus on the development of new approaches to payment and care delivery that emphasize the quality, not quantity, of services delivered to patients. Its aim is to improve access to care, better manage chronic diseases, and reduce unnecessary readmissions to hospitals through better coordinating transitions of care. The planning process will identify best practices that already exist in the state and determine how to expand their use throughout the commonwealth.  
Source: ulitzer.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Pennsylvania Praised for Supporting Efforts to Home Care Access

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

Ryan Takes to Pennsylvania to Push Medicare Message

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

Democrats Push Gov. Corbett on Medicaid Expansion

It’s actually a great chance for the R’s to leave their stamp on policy. We all lose when the main goal is to obstruct. I think Corbett is trying to beat the Texas rate of 25% uninsured. Sometimes you have to spend money to make money and the bang for the buck PA would get by accepting the Medicare expansion is worth the sacrifice down the road. It is the law and our leaders should be trying to make it the best that it can be, not waste 50 mil on useless repeal measures.
Source: patch.com

Appealing Medicare Denials of New Medical Technologies

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

Medicare Key Issue in Close Pennsylvania Races

In the week since Romney’s announcement, Medicare has been catapulted from an issue that political strategists said could make a difference in close races to a central component of congressional campaigns nationwide — especially in states like Pennsylvania, Florida, Minnesota and Ohio with large numbers of older voters.
Source: aarp.org

Pennsylvania Rallies to Expand Medicaid

Pennsylvania is lagging behind much of the nation in accepting medicaid expansion funding. Despite the fact that the Federal government will pay 100% of the cost of medicare expansion for the from 2014-2017, and as little at least 90% after Governor Corbett has refused  medicaid expansion.
Source: onepittsburgh.org

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

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

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

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

4 Dangerous Shortcomings of Social Security Numbers

Posted by:  :  Category: Medicare

Meanwhile, Congress dithers. The original Medicare Identity Theft Prevention Act was introduced in 2011 with 51 co-sponsors from both parties. It passed the House in 2012, but died in the Senate. This year the same House Republicans introduced the same bill (currently in Committee) and two separate bills have been introduced in the Senate that would force Medicare to make the change. Unlike the last time around, the Senate bills were introduced without Republican co-sponsors.According to GovTrack.us, the best one, introduced by Senators Dick Durbin (D-IL) and Kirsten Gillibrand (D-NY), has just a 10 percent chance of surviving past committee, and only a 2 percent chance of becoming law. In other words, the Chicago Cubs have a better shot at winning the World Series.
Source: idcuffs.com

Video: Obama Health Care Law – RFID Chip – HR 4872 | Mark Of The Beast 666

Proposed Rule Would Increase Rewards to Medicare Fraud Whistleblowers to Nearly $10 Million : Whistleblower Protection Blog

The proposed rule would increase the potential reward amount for individuals who report information that leads to a recovery of Medicare funds from 10 percent to 15 percent of the final amount collected. The current program caps the reward at $1,000, meaning HHS pays a reward on the first $10,000 it collects as a result of a tip. HHS is also proposing to increase the portion of the recovery on which HHS will pay a reward up to the first $66 million recovered – this means an individual could receive a reward of $9.9 million if HHS recovers $66 million or more. 
Source: whistleblowersblog.org

Federal Charges Brought Against 89 for Medicare Fraud

Eric Holder, the U.S Attorney General, announced the dragnet along with Kathleen Sebelius, the Secretary of Health and Human Services. The arrests were just the latest in a number of arrests over the last four years as the government has cracked down on fraud that is thought to cost Medicare billions of dollars annually.
Source: ssuchronicle.com

Medicare EFT form submission instruciton

 By your signature on this form you are certifying that the account is drawn in the Name of the Physician or Individual Practitioner, or the Legal Business Name of the Provider or Supplier. The Provider or Supplier has sole control of the account to which EFT deposits are made in accordance with all applicable Medicare regulations and instructions. All arrangements between the Financial Institution and the said Provider or Supplier are in accordance with all applicable Medicare regulations and instructions with the effective date of the EFT authorization. you must notify CMS regarding any changes in the account in sufficient time to allow the contractor and the Financial Institution to act on the changes.
Source: medicalbillingcptmodifiers.com

Why Medicare Cards Still Show Social Security Numbers

In a report issued in 2006, C.M.S. said it would cost $300 million to remove SSNs from Medicare cards. Then, in an updated report last November, it said it would cost at least $803 million, and possibly as much as $845 million, depending on the option chosen. Much of the cost, the agency said, was for upgrading computer systems not only at the federal level, but also at the state level, for coordination with Medicaid systems.
Source: nytimes.com

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in. Also of interest: You can help fight health care fraud. 
Source: aarp.org

CMS Proposed Rule Would Establish Powerful New Measures for Combating Fraud

First, the Proposed Rule expands the instances in which CMS may deny enrollment based on an unpaid Medicare debt.  Anecdotal reports from the Office of Inspector General and assistant U.S. Attorneys General indicate that individuals and entities presently can skirt enrollment restrictions on physicians or nonphysician practitioners who owe a debt to Medicare because of CMS’s narrow focus on whether the enrolling provider, supplier, or owner itself has received an “ over payment.”  Signaling a broader approach to both the relevant type of debt and the scope of the enrollment restrictions, the Proposed Rule examines the total debt owed to Medicare—not solely over payments—and expands the inquiry whether the individual owner, provider, or supplier owed a debt to whether the individual had a prior relationship with an entity that owed a debt.  Thus, if an enrolling provider, supplier or owner was affiliated with an entity that had outstanding Medicare debt or previously owned a provider or supplier that had its enrollment voluntarily or involuntarily terminated, CMS could use those prior relationships to restrict enrollment under a new entity.  To overcome these enrollment restrictions, providers and suppliers with these types of prior relationships would have to submit to a repayment plan for the outstanding debt.
Source: medbill.net

OIG: Medicare exposed to financial losses from ID theft

The report “CMS Response to Breaches and Medical Identity Theft,” issued by the Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) on October 10, investigated CMS’ response to 14 security breaches occurring between September 23, 2009 and December 31, 2011. The medical identities of nearly 14,000 Medicare beneficiaries were stolen during this two-year period— significant when considering CMS’ responsibility to maintain the protected health information of millions of Medicare beneficiaries and their role in developing breach prevention regulations.
Source: ahima.org

Better Business Bureau warns elderly to beware Medicare/Medicaid scams

These people are asking for personal information such as Medicare, Medicaid, Social Security, credit card or bank account numbers in order to provide free services such as medic alert alarms, back braces, and other products that assist the elderly and infirm and are paid for by Medicare and Medicaid.
Source: bbb.org

Steps for Starting a Home Healthcare Agency From the Ground Up

From the moment you begin the process until the government approves your agency, you must maintain at least $100,000 in your business account at all times. Other expenses to consider are salaries, rent, overhead costs and supplies. It is not until your company is approved as a home healthcare agency that you can submit claims for payment. Therefore, you need funds to manage your business without pay for at least nine months, possibly longer.
Source: healthgurutips.com

Blue cross blue shield medicare hmo gastric bypass

Posted by:  :  Category: Medicare

Yes, Blue Cross Blue Shield Covers Lap. 14.03.2008 · Everything you want to know about life and weight loss with a Lap Band! (by Lori) Glossary of Terms – Blue Cross and Blue. *RESULTS MAY VARY The site intends to introduce an advanced alternative to the dangerous weight loss surgeries such as gastric bypass, lap band, gastric sleeve, etc Our comprehensive Chronic Care Program is designed to help you understand the impact of your condition, better manage your health and improve your quality of life. (Please Enter Description) This link will take you to a new site not affiliated with BCBSIL. It will open in a new window. hmo web » HMO Chronic Care
Source: blog.cz

Video: Blue Medicare Options Illinois or Medicare Options Illinois

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.com

Anthem Blue Cross Medicare Supplement Plans

Over seventy years of Blue Cross; since 1937. While much has changed in the short span of seven decades, two things have remained constant; our original business philosophy of putting customers first and our commitment to innovation and progress. We are a leader in senior health care and are continuing to build on our tradition of developing innovative products that offer choice, quality, and health security for California seniors. We offer more plans than ever before, including traditional Medicare Supplement plans, a Medicare Advantage HMO and a New PPO plans called Freedom Blue. We also offer prescription drug and dental plans, and products that can help you protect your financial future, like Long Term Care Insurance and Life Benefits Final Expense Whole Life Insurance offered by Blue Cross of California. 
Source: allabout101.com

O.C. HMO patients stuck in contract dispute

Blue Shield’s Davila said that, even after the termination takes effect, many patients will be able to keep their doctors because the doctors already belong to other medical networks contracted with Blue Shield or will join them. He said Blue Shield’s contract with Monarch applies to 16,800 customers in the commercial HMO market and 2,400 in Medicare.
Source: ocregister.com

The AIS Guide to Blue Cross and Blue Shield Plans: 2010 downloads @ Elnaqcu的部落格 :: 痞客邦 PIXNET ::

For providers participating in the Blue Cross and Blue Shield. The AIS Report on Blue Cross and Blue Shield Plans delivers. Obgyn dr who accept anthem blue cross and blue shield in va Find a Doctor and book appointments online instantly!. Just Published: The AIS Guide to Blue Cross and Blue Shield Plans : 2009. . The AIS Guide to Blue Cross and Blue Shield Plans: 2012 comes in two versions — a printed book, or a CD with a free copy of the print book. The AIS Guide to Blue Cross and Blue Shield Plans 2nd Edition, Softbound: 248 pages 1933801794 978-1933801797 July 2010 AIS Health / Atlantic Information (Click button below for the very best available price for this. Blue Book The Blue Book SM Provider Manual. The AIS Report on Blue Cross and Blue Shield Plans, Ranks 35 Blues. The AIS Guide to Blue Cross and Blue Shield Plans provides insider intelligence and reliable information on Blues ; products, market strategies, acquisitions and alliances.yuyu7l53: Stickereien (Bestandkataloge der Stiftung Preussische . The AIS Guide to Blue Cross and Blue Shield Plans: 2012
Source: pixnet.net

Medicare HMOs reduce utilization, researchers say

“Although we could not assess the appropriateness of services, some of our findings suggest that the use of services may be more appropriate within Medicare Advantage HMOs,” the researchers said. “For instance, relative to beneficiaries in traditional Medicare, Medicare Advantage HMO enrollees are more commonly treated with cardiac bypass surgery, in accord with current guidelines. Additionally, lower rates of emergency department use suggest that Medicare Advantage HMOs may be treating patients in less costly primary care or urgent care settings.”
Source: lifehealthpro.com

Medicaid Coverage Extends to Former Foster Care Youth

Posted by:  :  Category: Medicare

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Brooks explained that it will be important for supporters to “make the case” for a requirement that states must extend coverage to these youths. The Department of Health and Human Services could still change its interpretation of the provision and require states to do so. According to Lehmann, states are currently waiting for final regulations from the Centers for Medicare and Medicaid Services. Otherwise, in order to retain Medicaid coverage, youths will be forced to remain in whatever states they are living in when they age out of foster care.
Source: equalvoiceforfamilies.org

Video: question for candidate Mike Huckabee

NY State Medicare Savings Program may Help Pay Your Premium

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Source: seniorbenefitsguide.com

Are VA Aid and Attendance Benefits Countable as Income by Medicaid? (Part 1)

There is a base pension amount to every award and there is also a dependent pension portion in the case of married couples.  Those amounts are counted as income for Medicaid purposes.  What has to be done in each instance is subtract out only the Aid and Attendance portion from the overall award when determining the income limits of a Medicaid applicant.  That could be as much as $417 per month in the case of a non-veteran widowed spouse and $694 per month for a veteran.
Source: hauptmanlaw.com

Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non

The Affordable Care Act (ACA) creates new coverage options through Medicaid and new health insurance exchange marketplaces that, taken together, provide assistance to individuals with family incomes up to 400% of the federal poverty level (FPL). The ACA calls for the expansion of Medicaid eligibility to 138% FPL ($15,856 for an individual or $26,951 for a family of three in 2013) in 2014, which would make millions of adults newly eligible for the program. However, this expansion was effectively made a state option by the Supreme Court. If a state does not expand Medicaid, low-income uninsured adults in that state will not gain that new coverage option and will likely remain uninsured. This brief provides an overview of current Medicaid and CHIP eligibility levels for non-disabled children and adults to provide better insight into the impact of the Medicaid expansion.
Source: kff.org

Supplemental Security Income and Medicaid/Medical Assistance

Supplemental Security Income (SSI) is one of the largest Federal programs that provides assistance to people with disabilities. It is administered by the Social Security Administration (SSA), and is a program funded by general tax revenues. SSI is a needs-based program, and is means tested. It is intended to provide individuals with a disability with a monthly check for food and shelter only. In 2013, the monthly check is $710. To be eligible for SSI, one needs to be disabled and any age (one can qualify if they are at least 65 years old and not disabled), US Citizen or legal aliens who meet certain requirements, and have income and resources (assets) below certain limits.  In most states, Medicaid is automatic when an individual receives SSI.
Source: specialneedsplanning.net

9 Ways to Beat the Medicare Surtax

Even if your income is above the threshold you can still get money into a Roth IRA in a round-about way. There are no income limits for making a non-deductible IRA contribution. The new limit on annual contributions rose to $5,500 in 2013. The catch-up provision for anyone age 50 or older increases the maximum to $6,500. Since 2010, there are no income limits for converting a traditional IRA to a Roth IRA. A high income taxpayer simply makes a non-deductible contribution to an IRA and then converts it to a Roth IRA. This strategy of indirectly contributing funds into a Roth IRA may not be effective for taxpayers who already have substantial amounts invested in a traditional IRA because of the “pro rata rule (PDF).” This rule requires a taxpayer to include all IRA assets when determining the taxes due on a Roth conversion. While investing indirectly in a Roth IRA isn’t appropriate for everyone, it can provide a viable option to those with higher incomes who are otherwise unable to contribute to a Roth.
Source: rodgers-associates.com

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

Will The New 3.8% Medicare Surtax Reinvigorate Non

The non-deductible IRA has long been a financial planning tool, albeit one that has become far less popular in recent years, given the tax preferences for both qualified dividends and long-term capital gains. However, with the new 3.8% Medicare surtax on net investment income that took effect in 2013, a new incentive has emerged: even with ordinary income treatment, the non-deductible IRA provides a way to permanently avoid the surtax, which would otherwise apply to interest, dividends, and capital gains, as well as income from other tax-deferred vehicles like deferred annuities. The strategy is especially appealing to those who are in the peak income years of their career, where a Roth conversion is unappealing due to the high current tax bracket (and other IRAs that will be aggregated), tax deferral is valuable, and a permanent avoidance of the 3.8% Medicare tax provides yet another added value… especially if the account will hold fixed income investments that were going to be taxed at ordinary income rates anyway. Fortunately, the strategy is available regardless of how high income rises (and in fact, is best at high income levels), and while the value of the strategy is limited by the IRA contribution limit of $5,500 in 2013, several years of compounded efforts can still potentially produce a significant tax savings in the future!
Source: kitces.com

Can New Brunswick afford a $715

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But $20 million is the tip of the iceberg for N.B. The $36-billion cut to the Canada Health Transfer announced by the Harper government in December of 2011, will mean a $715-million cut for NB after the 2015 election (if Harper is to win). While in N.B., I researched the annual operating budget of their hospitals and discovered that $660 million covers 11 hospitals and 30 medical clinics. So even if N.B. were to shut down these 11 hospitals and 30 medical clinics for one year, they’d still need to find an additional $55 million in savings! The $20 million with doctors is nothing to scoff at, but the race to find efficiencies is going to get a lot more intense in the coming years and we all need to be prepared to fight against extreme austerity and attempts to privatize the system under the lies that its a more affordable way to deliver services.
Source: rabble.ca

Video: Medicare HMO-POS Explained – Rob Merritt interviews Tony Prince in Laguna Woods, CA

Medicare in the crosshairs

Since the 1990s, a stream of books and think tank essays have criticized the Canadian model of universal, tax-financed medicare. At first the critics argued for more private delivery of government-financed medicare services. This was always a red herring given that in Canada the vast majority of doctors and their clinics are private for-profit operators. And while it is historically true that most hospitals in Canada were owned by religious orders, charities and municipalities and hence were not-for-profit, they were not owned by provincial governments. This has changed somewhat with the introduction of regional health authorities in the 1990s, but in some provinces, such as Ontario, hospitals remain private not-for-profit organizations separate from government. In any event, there is nothing in the Canada Health Act that prevents provincial governments from allowing the private delivery – for-profit or not-for-profit – of medicare services
Source: inroadsjournal.ca

Social Security on track for insolvency in 2033, Medicare in 2026

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Source: capoliticalnews.com

Expand Medicare, says CUPE

The variation in standards and availability, eligibility criteria, public funding and costs borne by clients/residents vary widely across the provinces.  Most provinces have cut long-term bed capacity relative to the senior population in the past decade, without sufficiently expanding home and community care or increasing staffing to reflect the greater needs of remaining residents.  New investments in home and community care tend to be understaffed and underfunded, resulting in poor working conditions and quality of care.
Source: sgnews.ca

Chatsworth, CA Tax Expert Guides You Through The New World of Medicare Decisions

Medicare Ratings System To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: tax4smallbiz.com

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

Affordable 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

Education Medicare And Supplemental InsuranceECNS 2010

Posted by:  :  Category: Medicare

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Living in addition, the elderly are being motivated to pay sigificantly higher premiums during their Medicare supplement plans while stress a reduction in coverage both through the process of Medicare itself and by the assortment of supplemental plans offered by private rrnsurance policies Blue Cross adds benefits to medicare supplement plan f policies in California. Medicare has also drastically discounted its payments to specialists.
Source: ecns2010.org

Video: Celebrating 45 Years of Medicare (07/30/2010 Webchat)

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 and ACA Facts and Updates; Jimmo Update 

The Center for Medicare Advocacy continues to work to effectuate terms of the settlement in Jimmo v. Sebelius (No. 11-cv-17 (D.Vt.), filed January 18, 2011).  The media have quickly picked up the story after Robert Pear ran an exclusive article in The New York Times last week, and beneficiaries, advocates, and other organizations with an interest in the clarification of coverage under the settlement have been contacting the Center daily, as well as reaching out to media themselves.  For example, the National Parkinson Foundation sent a letter praising the decision to The New York Times, citing a study they co-authored which supports that improved access to skilled maintenance care will result in preventing or shortening hospital stays, thus saving the Medicare program money on more intensive, expensive care.
Source: medicareadvocacy.org

Strengthen Medicare: End Drug Company Price Setting

With Congress committed to curbing wasteful spending, our representatives should be focused on ending drug-company price setting in America. Like every other wealthy nation, the United States can negotiate prices for its citizenry without hampering vital drug research or impeding new drugs from going to market. Drug research and marketing costs do not require Americans to pay grossly inflated prices, as the pharmaceutical industry often argues. There is no data to back up their claims that patients would suffer without high prices; to the contrary, there is every reason to believe drug makers are crying wolf on this issue. At any rate, even cutting-edge pharmaceutical research is of little value to us if brand-name and specialty drugs are increasingly unaffordable to vast numbers of Americans who need them.
Source: healthaffairs.org

GAO Report Finds Excess Spending in Medicare

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

GAO finds CMS negligent in risk adjustment for Medicare Advantage plans

Risk adjustment is important to ensure that payments to MA plans adequately account for differences in beneficiaries’ health status and to maintain plans’ financial incentive to enroll and care for beneficiaries regardless of their health status. Our work confirms that differences in diagnostic coding caused risk scores for MA beneficiaries to be higher than those for comparable beneficiaries in Medicare FFS in 2010, 2011, and 2012. CMS’s decision to use a 3.4 percent adjustment to risk scores for 2010 through 2012 instead of the higher adjustments called for by our analysis resulted in excess payments to MA plans. The existence of such excess payments indicates that CMS’s adjustment does not accurately account for differences in treatment and diagnostic coding between MA plans and Medicare FFS—the stated goal of the statute that required CMS to develop a diagnostic coding adjustment. In our January 2012 report, we recommended that CMS take steps to improve the accuracy of the adjustment to account for excess payments due to differences in diagnostic coding. We noted that CMS could, for example, account for additional beneficiary characteristics, include the most recent data available, identify and account for all the years of coding differences that could affect the payment year for which an adjustment is made, and incorporate the trend of the impact of coding differences on risk scores. CMS’s adjustment for 2013 is the same as it used in 2010, 2011, and 2012. However, given our finding that this adjustment was too low and resulted in estimated excess payments to MA plans of at least $3.2 billion, we continue to believe that it is important for CMS to implement our recommendation that it update its methodology to more accurately account for differences in diagnostic coding.
Source: pnhp.org

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June 01, 2013

Medicare Supplement Plan F

Posted by:  :  Category: Medicare

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

Video: What is a Medicare Supplement

How to Get Affordable Senior Medicare Supplemental Health Insurance

Another option for seniors is a managed care plan. This means that a group of doctors and hospitals have agreed to provide medical care to senior citizens in exchange for payment from Medicare. These plans require you to only use certain hospitals and doctors who are participants in the managed care plan. This is often a good choice if your preferred hospital and doctor are participants. If they are not, you may want to go with a different form of supplemental insurance.
Source: goldenautosinsurance.info

Supplemental Medicare coverage leads to spending growth

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

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

Medicare Supplement Plan F

Purchasing a Supplemental Plan F policy should prevent any out-of- pocket costs for the recipient. One of the benefits covered by Supplemental Plan F is hospitalization for up to 365 days after Medicare coverage ends. The plan will cover up to 20 percent of all Medicare approved expenses. If blood is required three pints of blood each year are covered under the plan. The plan also covers the expense of a stay in a skilled nursing care facility. One of the greatest benefits is that Supplemental Plan F covers any emergency medical assistance that may be required while traveling abroad.
Source: edvox.org

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June 01, 2013

Scammers claim to help with new Medicare cards

Posted by:  :  Category: Medicare

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By the end of the call, this consumer had turned over her bank account number to the caller, but was able to close her bank account before any money was stolen. A number of consumers have complained on different scam-tracking websites about receiving similar calls from this group.
Source: riverfallsjournal.com

Video: How Do I Get a New Medicare Card if my Card is Damaged, Lost, or Stolen?

Lakeland Woman Didn’t Fall for Medicare Scam

A call from Mexico, Jamaica or another foreign county in which someone says they are your grandchild, and they are in jail and need money to be released. This call often comes in the middle of the night, when potential victims are less sharp. The victim often says something like, “Tommy?” and then the crook knows the name of a grandchild, and the fake grandchild says “don’t tell mom or dad” and hands the phone over to the “jailer.” The victim is asked to quickly go to a Western Union or a 24-hour Walmart and send money. This scam varies, and a fake hospital can be used instead of a jail.
Source: theledger.com

Why Medicare Cards Still Show Social Security Numbers

In a report issued in 2006, C.M.S. said it would cost $300 million to remove SSNs from Medicare cards. Then, in an updated report last November, it said it would cost at least $803 million, and possibly as much as $845 million, depending on the option chosen. Much of the cost, the agency said, was for upgrading computer systems not only at the federal level, but also at the state level, for coordination with Medicaid systems.
Source: nytimes.com

Consumer Alert! Medicare Card Telemarketing Scam

If you become a victim of identity theft, file a report with your local law enforcement agency. The District AttorneyÕs Consumer Protection line provides assistance to victims of crime and answers questions on white collar crime issues. If you have a question or need assistance, call 720-874-8547.
Source: myprimetimenews.com

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June 01, 2013

CMS: Four provider responsibilities when residents want an expedited appeal of Medicare service terminations

Posted by:  :  Category: Medicare

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Beneficiaries can appeal to a Quality Improvement Organization when certain long-term care providers, including skilled nursing facilities and hospices, notify them that services will no longer be covered by Medicare. Under a final rule enacted in 2005, beneficiaries have a right to an expedited determination of these appeals. In a May 24 update to the Medicare Claims Processing manual, CMS provided detailed instructions regarding these expedited determinations, identifying the following four responsibilities for providers:
Source: mcknights.com

Video: New Medicare Preventive Services National Provider Call 8/15/12

Eye Lift Surgery Increasingly Billed To Medicare

Unlike private insurance plans, though, Medicare does not require pre-authorization of eyelid surgeries. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission, has pushed for selective pre-authorization for some Medicare services. But Berenson questioned whether reviewing physician records in advance would help much in the case of blepharoplasty, if surgeons have learned how to document the need for the procedure in order to work the system. “I am sure there are some patients who are hampered by eyelids drooping. And I’m sure that many of them are not and it’s a cosmetic reason,” Berenson said. But the doctors, he added, “have probably gotten very skilled at knowing how to document that something is not cosmetic.”
Source: kaiserhealthnews.org

Immigrants Help Subsidize Medicare Finances, Study Shows, Immigration

Between 2002 and 2009, immigrants generated a cumulative surplus of $115 billion for the trust fund, the study found. Most of the surplus contribution came from noncitizens. The immigrants created a net gain primarily because of demographics: There are 6.5 immigrants of working age for every one elderly immigrant, but only 4.7 working-age native citizens for every one retiree. Although that ratio could change in the future, the report notes that the Census Bureau projects that the share of immigrants in the United States will increase for the next 18 years.
Source: aarp.org

WellCare Medicare Advantage Members Now Covered At Walgreens Take Care Clinics

“We are pleased to welcome WellCare Medicare Advantage members to Take Care Clinics. Take Care Clinics provide a high-quality, cost-effective and convenient option for health care services,” said Heather Helle, Divisional Vice President, Consumer Solutions Group at Walgreens. “Open seven days a week, with extended evening and weekend hours, we offer walk-in availability and same-day appointment scheduling, giving members convenient access to health care services.”
Source: medbill.net

Medicare provider charge data released

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: flowingdata.com

ABOUT MEDICARE: When a doctor doesn’t take Medicare

An opt-out doctor is one who doesn’t accept Medicare. Doctors who have opted out of Medicare can charge their Medicare patients whatever fees the physicians choose. These doctors don’t submit any health care claims to Medicare. In addition, opt-out doctors aren’t subject to Medicare laws that limit the amount they can charge their patients.
Source: times-standard.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

Single Stop submits comments to Center for Medicare and Medicaid Services

Single Stop USA’s comments focused on addressing the following topics: (1) Encouraging transparency in the application process; (2) Integrating Navigators, In-Person Assisters, Certified Application Counselors; (3) Leveraging eligibility results to connect individuals to multiple benefit applications; and (4) Addressing the concerns of immigrant applicants. In addition to submitting our own comments, Single Stop worked with the other national benefits access providers and interested policy groups to have a shared voice about ways to maximize this important opportunity to advance on-line benefits access.
Source: singlestopusa.org

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