A Primer on Medicare Financing

Posted by:  :  Category: Medicare

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It also describes the expected effects of provisions in the 2010 health reform law on future Medicare spending. The primer reviews the financial obligations and out-of-pocket spending for people covered by Medicare, outlines several ways to assess Medicare’s long-term fiscal outlook, and discusses future financing challenges facing the program.
Source: kff.org

Video: What Does Medicare Cost?

Does population health explain geographical variation in Medicare spending?

Control for area differences in population health (casemix adjustment) is necessary to measure geographic variations in medical spending. Studies use various casemix adjustment methods, resulting in very different geographic variation estimates. We study casemix adjustment methodological issues and evaluate alternative approaches using claims from 1.6 million Medicare beneficiaries in 60 representative communities. Two key casemix adjustment methods—controlling for patient conditions obtained from diagnoses on claims and expenditures of those at the end of life—were evaluated. We failed to find evidence of bias in the former approach attributable to area differences in physician diagnostic patterns, as others have found, and found that the assumption underpinning the latter approach—that persons close to death are equally sick across areas—cannot be supported. Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas.
Source: pnhp.org

Three Progressive Ways To Reduce Medicare Costs By Billions Without Cutting Anyone’s Benefits

3. Globalize Medicare: Another protectionist barrier and detriment to free trade in the U.S. health care system is that seniors currently aren’t allowed to use their Medicare insurance system outside of the United States. An alternative to this would be to drop these trade barriers and allow seniors on Medicare to seek care abroad, where services are much cheaper. Economist Dean Baker estimates that if fifty percent of Medicare beneficiaries opted for this globalized option, then taxpayers would save more than $40 billion a year by 2020. President Obama has opposed this option in the past, but should re-examine it now.
Source: boldprogressives.org

Medicare’s deterioration slows as health law blunts costs

Republicans have considered raising the Medicare eligibility age and switching to a system in which beneficiaries get subsidies to buy private insurance, instead of the government paying for their care. Obama has sought to mostly keep the current structure and instead find ways to boost efficiency of the program and reduce excess costs, partly through provisions in the 2010 health-care law he helped create.
Source: pionline.com

Controlling Medicare Costs is Now Un

Of course, as a number of people have pointed out, this move doesn’t prevent IPAB from working. If the Senate doesn’t confirm anyone to the board, it just means that the HHS secretary has to make cost-cutting proposals on her own if Medicare grows faster than allowed. So what’s the point? Pretty obviously, it’s to make sure that if Medicare is cut in any way, Republicans can blame it solely and completely on Democrats.
Source: motherjones.com

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

Slowdown in health spending extends Medicare trust fund

Medicare trustees said the improved solvency estimate of the trust fund, which covers Medicare Part A payments for inpatient hospital services and other facilities, was due largely to  lower than expected spending on Medicare services — especially for skilled nursing facilities — and lower projected costs for the Medicare Advantage program, where private insurers provide health benefits to about 27 percent of Medicare enrollees.
Source: mylocalhealthguide.com

U.S. Medicare outlook improves as healthcare costs ease

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Source: odewire.com

Study: Cuts to Medicare trim costs to insurers

Chapin White, a senior health researcher at the Center for Studying Health System Change, analyzed data on payment rates from 1995-2009 and found a widening gap between Medicare rates and private rates. Medicare had an average annual growth rate of 3 percent while private insurance grew more quickly — at 3.56 percent — he found.
Source: politico.com

Nothing found for Medicare

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Source: ncpa.org

Daily Kos: Medicare and Medicaid spending projection cut by $900 billion

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Source: dailykos.com

Proposed Rule Increases Incentive for Medicare Fraud Whistleblowers

Posted by:  :  Category: Medicare

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

Video: Whistleblowing: Medicare Fraud, Fraudulent Conduct, the False Claims Act

HHS wants $10 million potential payday for Medicare fraud whistleblowers

“In order for an individual to be eligible to receive a reward, the information must relate to the activities of a specific individual or entity and must specify the time period of the alleged activities,” the proposed rule states. “Examples of specific activities include, but are not limited to, billing for services never rendered, and billing for supplies not ordered.”
Source: mcknights.com

Medicare fraud whistleblowers may get massive reward increase

We are proposing to clarify that an individual is not eligible for an IRP reward if he or she has filed a qui tam lawsuit under the federal or any state False Claims Act. We are also proposing that we do not give a reward for the same or substantially similar information that is the basis of a payment of a share of the amounts collected under the False Claims Act or any state False Claims Act, or if the same or substantially similar information is the subject of a pending False Claim Act case.
Source: pathologyblawg.com

Rule would boost Medicare whistleblower bounty to $10M

A proposed rule to drastically increase whistleblower rewards paid for information leading to successful Medicare fraud actions to as high as nearly $10 million was proposed by the Department of Health and Human Services this week.
Source: wislawjournal.com

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

Widespread Fraud of Medicare – A report by a whistleblower attorney

For many years the U.S. government has urged doctors and hospitals to get rid of messy and sometime illegible hand-written patient histories in favor of electronic records. Pushing the benefits of efficiency, accuracy and improved care, the government’s campaign has been successful—but not without creating a new way to commit fraud in the process. The switch to electronic records has proven to be an easy target for widespread fraud of Medicare, as well as other government agencies. According to investigations by media outlets and government auditors, doctors and hospitals are increasingly “upcoding”—clicking on the most costly Medicare reimbursement codes, even when they have not rendered the services to justify them. The switch to electronic medical records has made these kinds of cheats possible system-wide and not just in the records for a single patient. In a common scenario, a doctor selects a code that tells Medicare the doctor spent more time with a patient than actually occurred. In another example, a chain of urgent care facilities falsely bills for allergy and other diagnostic tests they never performed. There is also the related problem of “cloning,” a practice in which doctors cut and paste old records to “pad” the most current visit and make it appear that more extensive treatment took place. Between 2001 and 2010, Medicare reimbursement costs soared by $11 billion, and there is little evidence—such as a sicker and older population requiring more acute care—to account for such a massive cost increase. Emergency rooms are some of the worst offenders of billing code fraud. Between 2001 and 2008, emergency rooms nationwide increased Medicare billing substantially, adding $1 billion to the tab paid by taxpayers. In just one example, the number of claims by emergency rooms for providing the two highest categories of care jumped from 40 percent in 2006 to 54 percent in 2010. These two categories also provide the highest reimbursements possible from Medicare. The good news is that health care employees, including doctors, nurses, and administrators, have been helping expose the fraud and return money to taxpayers. These whistleblowers are protected under the federal False Claims Act, which has led to the recovery of more than $30 billion in lost government funds since the law was overhauled in 1986. By law, the whistleblower is also entitled to a portion of any damages recovered. The False Claims Act and many state laws like it also provide employees protection from retaliation for trying to expose fraud on the government. About – Keller Grover whistleblower law firm
Source: kellergroverwhistleblowerlawyers.com

From the Contributor’s Corner: CMS Proposes Increasing Rewards for Whistleblowers

The proposed rule would strengthen the Medicare provider enrollment process by authorizing enrollment denials under certain situations. Additional provisions would allow for Medicare enrollment denial or revocation if the provider or supplier has been convicted of any federal or state felony in the previous 10 years that CMS considers harmful to the program or engaged in Medicare billing patterns that did not meet Medicare standards.  It would also reduce the ability of ambulance providers to bill Medicare for services provided before they enrolled with Medicare and require providers and suppliers who have their Medicare enrollment revoked to submit any remaining claims within 60 days of the revocation. 
Source: wolterskluwerlb.com

$75 Billion In Unclaimed Medicare Whistleblower Awards?

Perhaps. Figures from the Federal Bureau of Investigation (FBI) estimate that $75 to $250 billion of annual Medicare expenses are fraudulent reimbursements improperly received by health care providers throughout the U.S. When a whistleblower comes forward with information that eventually leads to the government recouping losses from Medicare overbilling, that whistleblower is entitled to a whistleblower award.
Source: federalwhistleblowerlawyers.com

CMS Proposes Higher Rewards for Medicare Fraud Whistleblowers

Subcommittee Chair Claire McCaskill (D-Mo.) said the projections were necessary to measure CMS’ effectiveness in recouping improper DME payments, noting that in 2011 CMS recouped only $34 million from DME suppliers out of an estimated $5.2 billion in improper payments. She and other subcommittee members also criticized the infrequency with which CMS banned fraud-prone DME suppliers, pointing out that the agency investigated only 75 of 96,000 DME companies in 2012 (Daly,
Source: californiahealthline.org

Press Release: Medicaid Fraud: A Business Model Whistleblowers Can Help End

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Source: caymanmama.com

Humana Names Tracie Fahy to Lead North Florida Medicare Market Operations

Posted by:  :  Category: Medicare

Humana Inc., headquartered in Louisville, Ky., is a leading health care company that offers a wide range of insurance products and health and wellness services that incorporate an integrated approach to lifelong well-being. By leveraging the strengths of its core businesses, Humana believes it can better explore opportunities for existing and emerging adjacencies in health care that can further enhance wellness opportunities for the millions of people across the nation with whom the company has relationships.
Source: incorporateacompanyonline.com

Video: Learn about changes to Medicare from Matt Ladich of Senior Care Plus

Value modifier plus more Medicaid for primary care (plus new payments for transitional care)

The new modifier will give extra Medicare payment to physicians who successfully report on quality measures and whose costs are less than the national per patient average. At the same time, doctors who are not successful with PQRS and whose costs are higher will take a pay hit in 2015. The modifier can raise payments by as much as 2% and cut payments by as much as 1%.
Source: ardmorepublishing.com

Senior Care Plus Offers Daily Meetings During medicare Enrollment Period

This entry was posted in Press-Media Releases and tagged advantage plan, annual enrollment, answ, benefit, carson city, churchill, convenience, eligible beneficiaries, enrollment period, government programs, health, health care, health care reform, home appointments, hometown health, informational group, informational meetings, insurance carrier, insurance plan, lyon, medical prescription, medicare, medicare enrollment, medicare managed care, medicare part b, prescription drug plans, private health insurance, reno, reno nev, right insurance, senior, sparks, supplemental benefits, wh. Bookmark the permalink.
Source: nvseniorguide.com

Hospital Payments That Follow Patients Out of the Hospital

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Source: bioethics.net

Medicare Preventive Care Coverage Questions Answered!

There are many routine preventive screenings that Medicare covers at no cost to you.  These include a yearly wellness visit, cardiovascular screening every 5 years, yearly mammogram for women ages 40+ as well as certain shots.  Cervical and vaginal cancer screenings and prostate and colorectal cancer screenings are also covered with restrictions on age, sex, and frequency based on which test is being performed.  For more information on what Medicare covers, click here.
Source: home-care-plus.com

ACA Mandates Insurance Coverage for Clinical Trials

Your comments are welcome. However, specific medical advice will not be provided. Generic QUESTIONS can be directed to our Answer Line team at http://fightcolorectalcancer.org/awareness/answer-line or by calling us at 1-877-427-2111 9:00 AM – 5:00 PM Eastern time, Monday – Friday. We urge you to consult with a qualified physician for diagnosis and for answers to your personal questions. Fight Colorectal Cancer is not responsible for the medical accuracy of any comments left by persons other than Fight Colorectal Cancer staff members. Fight Colorectal Cancer staff members monitor comments and may respond publicly where appropriate.
Source: fightcolorectalcancer.org

Senior Care Plus earns top scores in national patient survey

SUBMITTED NEWS WHAT: The inaugural Hot August Nights Auction presented by Barrett-Jackson will take place Thursday, Aug. 8, through Saturday, Aug. 10 at the Reno-Sparks Convention Center. Bid on some of the most recognizable and historic automobiles in the world and purchase your dream car at “The World’s Greatest Collector Car Auctions™.” Tickets are available at http://www.barrett-jackson.com/reno-tahoe/tickets. WHEN: Thursday, Aug. 8 through Saturday, Aug. 10 WHERE: Reno-Sparks Convention Center 4590 S. Virginia St. Reno, NV 89502
Source: thisisreno.com

Do I Need A Medigap Plan For My Healthcare Costs?

Medigap plans for your healthcare offer coverage for services that original Medicare does not. Every Medigap policy insurer must be Medicare approved. Also your Medicare Medigap supplment plan is renewable which basically means the company cannont cancel you out unless you fail to make the required policy payments in a timely manner. The one thing any Medigap insurance policy consumer should be aware of is that different insurance companies may charge different premium costs for the exact policy. Their premiums may even differ in different parts of the county.
Source: joycefoster.com

Frequently Asked Questions About Medicare Aids

Posted by:  :  Category: Medicare

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We have an array of insurance plan that you will have to obtain at individuals moment in existence. Medical coverage is one of these experts. When you get older, this could turn up comprising Medicare. Although Medicare is helpful on its own, it does though not always satisfy the has to those who play with it. While that takes place, systems like those offered through Medigap Tx are at now to supplement the product furnished as consequence of Medicare therefore the seniors can previously obtain the kind of bill protection they need. Here is a look coming from what some in the new protection can do for you being a result you can remain living over which the Mexican border.
Source: thepalmbeachsteakhouse.com

Video: Medicare Questions – Company Benefits & Credible Coverage for Medicare Part D

Questions About Medicare Food Supplements

Anticipated to array of insurance plan that you will have to obtain at many moment in your own. Medical coverage is one ones. When you get older, this could turn up in the form of Medicare. although Medicare is helpful on its own, it does not at all times satisfy the needs to those who take it. While that takes place, diet plans like those readily available through Medigap The state of texas are at now to supplement merchandise furnished as as a result of Medicare therefore whom seniors can believe it or not obtain the kind of bill protection will need. Here is a look coming from what some of this new protection can do for you to be a result you can keep on living over the Mexican border.
Source: 7wief.org

Questions About Medicare Supplements

We have an array of medical nsurance policies that you might want to obtain at some moment in your life. Medical coverage is one industry experts. When you get older, this may turn up by Medicare. although Medicare is to your benefit on its own, it does not always satisfy the end up being those who to utilize. While that takes place, offers like those readily available through Medigap The state of texas are at now to supplement merchandise furnished as as a consequence of Medicare therefore that seniors can normally obtain the sort of bill protection they need. Here is a look during the what some of this new protection is capable of doing for you to be a result you can proceed living over that Mexican border.
Source: gilevans.org

Social Security Questions: Bridging the Medicare Gap

Of course, what all of this still fails to address is the fact that COBRA is incredibly expensive. Many people are surprised to find themselves paying for plans that cost $500 per month—or more. And if you manage to get COBRA extended beyond the original 18 months, your insurer is allowed to charge you 150% of the premium during this time. COBRA may be a solution but it can’t be the only one for a lot of people, because too many just can’t afford it.
Source: disabilitydenials.com

Commonly Asked Questions About Medicare Products And Solutions

Since 1992 the Medicare supplement Insurance Plans will be totally standardized. Even quotes can be received through business phone and online, this the easiest regarding finding out recognise the business is offering the best premium plans. So, that people can decide which often plan serves him best keeping goal his needs. Previously purchasing plans was never this method easy, an individual had to discuss several steps acquire an insurance plan. It is always advisable get in touch with an insuranceagent you really a insurance rule to know more information about the terms and types of conditions of the policy, else it turns out to be beneficial for a few companies who provides the combination of considerable premiums and several limited benefits for top profit, if the litigant is unaware in the features.
Source: bul-ich.net

Questions About Medicare Food Supplements

Nearly any changes in consider a trip plans will be sure to be covered though a traveler avails of this insurance coverage. The insurance provider will remain the one which usually pays for extra fees that will either one allow a vacationer to catch to the peak or go apartment. For claims so that you be valid a number of reasons are future including a the situation of illness, injury, or death. One particular medical expenses that won’t be draped by Medicare might be taken health of by a new Not All medicare plan f programs are quality such as the Medicare supplement insurance which is simply also referred into as “Medigap” because it fills many gaps of locations where Medicare simply cannot cover the costs. Knowledge from the look into and policy limb of America’s Health Insurance Plans revealing premium and benefit information from 761,000 small businesses details the average annual deductible for PPOs have gone via 7 to 59. The number of companies with a PPO health and wellbeing insurance plan produces shrunk, too. Employers with considerably less than 50 the employees are shifting to be less costly The hmo group health insurance policy plan that have tight (and smaller) providers of doctors as their employees when you need to chose from. About 50 proportion of small establishments report they have actually group HMO coverage, down from forty one percent in 2009. Aetna Medicare Supplement Arrangements are offered inside of almost every state, and most visitors find them in be a actually affordable option. In addition, Aetna’s prices hold solid and only expansion slightly to retain up with inflation and rising will cost. This could be described as one of this reasons Aetna produces a high customer satisfaction rate and simply why thousands towards seniors are completely happy with his or her’s decision to get yourself an Aetna Medicare health insurance plan. Acquire these links . great many older persons who take delight in knowing anything you wanted to their medicare plans the actual they do their own behalf. While they may have never the minute details about how their opportunities work, they have a fairly good a sense of what is twisted and what is not. However, there are some kind of “other” things that are coming out within the woodwork lately in which taking our folks by surprise. Mainly these new arrangements having low cost, a proposal is given by one various greatest names of health insurance “blue cross blue shield” to cut premiums of Medicare complement insurance insurance coverage the place there is a biggest need. Over select Medicare supplements plans you may possibly seek limited emergency care outside the us . of America and provide some coverage, sometimes up to ,000 lifetime coverage using a 0 deductible in addition 20% co-insurance ppc by you. This however can be a great benefit for those who travel because of the fact Medicare does not otherwise provide all coverage for all of your medical care beyond the borders of the United States. Typically, Medicare just payments about 80% of the the medical will cost you coverage. At this time there after, you occur to be all with regards to your own if anyone need any kind of lengthened rrnsurance policy coverage. You can purchase a Medicare Supplement (aka Gap) policy from the government permitted insurance corporation or perhaps receive supplementary coverage in Medicare insurance Part C regarded as as Medicare gain provided by personalised insurance companies. Virtually all Medicare insurance health supplements may charge a monthly period payment for professional services rendered. Take into record that not a lot of private insurance home fees are exact identical. Many medsupp plans provide assistance for cracks in Medicare videos of skilled caregiving care inside to a nursing home. The member should certainly enter the an elderly care facility after a 3 day stay a great acute care emergency room and deemed clinically necessary to seem to get care in a knowledgeable nursing facility. The care would ultimately be suggested by an joining physician. Might not do not befall for custodial care. Thus, in reality inspite of the fact much skilled nursing care is supplied within nursing homes, nursing home really care as most involving it is not covered. Joining Medicare and goals F and F up to hundreds of days is insured by the insurers. A couple good news close to the death of Medicare Advantage has always been that you is designed to be guaranteed edition for 63 2 or 3 weeks once your think about is no for any in effect. Talk to a local health approach agent now at plan for the long run. Choose 1 that knows distinct Medicare inside to choose from and will feel able to walk you through different alternatives.
Source: typepad.com

Questions About Medicare Food Supplements

Principally these new coverages having low cost, a proposal emerges by one various greatest names of health insurance “blue cross blue shield” to cut the premiums of Treatment complement insurance insurance policies plan the place you will find there’s biggest need. On select Medicare supplements plans you may possibly seek limited an urgent situation care outside u . s of America and have some coverage, more often than not up to ,000 lifetime coverage by using a 0 deductible and 20% co-insurance paid by you. This however is really a great benefit for the people who travel for the reason that Medicare does not necessarily quite otherwise provide any coverage for all of your medical care in the vicinity of the United Counties. As the charges differ significantly from company to company, it has the often tough for individuals to glimpse out the quite a few effective ones at your disposal. These rates get dependent on your ultimate age, whether then you smoke, whether that you are male or female, and the apartment you live. Our colleagues should do the complex be just straight for you, and provide you you with an coverage that’s inside of your means, and will suit your well being issues. Is actually because the reason therefore, why Medicare supplements came conceived. Alluded as Medigap, specific supplement covers other medical expenses through which are normally charged but are not covered by the Federal Medicare. Take the the event of Texans, you most likely these people get hold of supplemental Texas medicare plans that cover caring for care as most certainly as preventive serious. These are expensive medical care remedies which are certainly not included in the regular Medicare. Realizing the need for this coverage especially for aging Texans, more and much more people buy the supplement Medicare schemes in Texas. A person may find distinct confusing, this is strictly the kind information the health cleaning insurance agents establish inside out. So, when the person call about opt-in or opt out, rely on frantically and save who you are a major headache. None of the new medicare plan f programs to be affected by Obama-care are not asked for but offer a functional significant blanket about financial protection. They cost one monthly premium but most find one particular cost to be well worth our own protection provided. They also provide you with the protection a few want when you go away away of their area or the earth. With that you simply supplement you ought to get care anywhere in the North america even non emergent care. The bottom line it is a meaningful personal choice in order to get a vitamin or not, nevertheless one most I know choose up to make in favor of the plans. Before anything else and foremost, anyone must decide regardless of whether you can fund the more exhaustive doctor/hospital coverage that can comes with any Medicare Supplement arrange. These ideas are more high price than Medicare Advantage plans, some at which have amazingly low premiums. However, if you will have any constant or potential health problems, the South carolina Medicare Supplement will be able to save you much, much more bucks than it is priced at you over your course of the latest year. Sc Medicare Supplement itineraries are plans that are designed to go with Medicare insurance. They cover everything that Treatment does not cowl at the gp and hospital so you’ve no unexpected with their own money costs. South carolina Medicare Advantage plans, on the other hand, are tips that replace impact all civilian federal Medicare program. They are a person version of the entire government’s Medicare tools. Cooling lines, cruise lines, and tour guys might declare a bankruptcy proceeding at any point and this is the insurance can apply to reimburse a vacationer’s losses. All dollar limit on top of that length of time are two determinants of the associated with baggage insurance when bought a l . a . carte. when items such as contact lenses, money, tickets, and etc are not looked at in as purses then insurance won’t cover any losses.
Source: typepad.com

The Ins and Outs of Medicare Supplemental Insurance

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.
Source: insideeldercare.com

Eyelid lifts skyrocket among Medicare patients, costing taxpayers millions

Posted by:  :  Category: Medicare

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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: publicintegrity.org

Video: How Do I Submit a Claim to Medicare?

Does population health explain geographical variation in Medicare spending?

Control for area differences in population health (casemix adjustment) is necessary to measure geographic variations in medical spending. Studies use various casemix adjustment methods, resulting in very different geographic variation estimates. We study casemix adjustment methodological issues and evaluate alternative approaches using claims from 1.6 million Medicare beneficiaries in 60 representative communities. Two key casemix adjustment methods—controlling for patient conditions obtained from diagnoses on claims and expenditures of those at the end of life—were evaluated. We failed to find evidence of bias in the former approach attributable to area differences in physician diagnostic patterns, as others have found, and found that the assumption underpinning the latter approach—that persons close to death are equally sick across areas—cannot be supported. Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas.
Source: pnhp.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

Meaning of the letters after a Social Security or Medicare number

The Social Security number followed by one of these codes is often referred to as a claim number.  We assign these codes once you apply for benefits.  These letter codes may appear on correspondence you receive from Social Security or on your Medicare card.  They will never appear on a Social Security card.
Source: seniorsandbenefits.com

CMS Releases Clarifying FAQs on Therapy Caps and ABNs

A5: When a provider/supplier provides a service that Medicare never covers, such as a service that fails to meet the definition of a Medicare benefit or a service that is explicitly excluded from coverage under §1862 of the Act, the limitation of liability protections in §1879 of the Act do not apply.  So, there is no requirement for suppliers/providers to alert beneficiaries to forthcoming financial liability prior to providing a never covered service.  However, suppliers/providers may issue the ABN, Form CMS-R-131 as an optional notice to alert the beneficiary to liability.  When the ABN is used as an optional notice it is called a voluntary ABN.  The requirements for valid completion of the mandatory ABN do not apply to the voluntary ABN.  For example, the beneficiary does not need to sign the voluntary ABN or check off an option box on the notice.  The voluntary ABN serves as a courtesy to the beneficiary so that s/he is aware that a service will not be covered by Medicare.  Alternatively, provider/suppliers may construct their own notice to give to beneficiaries for services that Medicare never covers.
Source: hallrender.com

CARR ALLISON Medicare Compliance Group: New Jersey Court Determines Adequacy of Liability Medicare Set

DuHamell joins the growing number of cases in which liability plaintiffs and defendants are turning to the courts to resolve the issue of whether a designated sum of money is sufficient to protect Medicare’s potential future interests.  It should be noted that liability MSAs are not required.  If a Medicare beneficiary settles a claim and money is being paid, even in part, because of the future medical expenses that will be incurred, however, Medicare’s future interest in settlement proceeds should be considered in some manner.  In an increasing number of cases, one or both parties are insisting on “approval” of designated Medicare Set-aside amounts from some type of governing authority.  Even though Medicare is not bound by state court judgments, with no established method for CMS review and approval of liability settlements and an inconsistency between Regional Offices as to whether review will be granted, parties are left with little alternative but to turn to the state courts for assistance.
Source: blogspot.com

Medicare Financing Plastic Surgery

Aging Americans worried about their droopy upper eyelids often rely on the plastic surgeon’s scalpel to turn back the hands of time. Increasingly, Medicare is footing the bill. Yes, Medicare. The public health insurance program for people over 65 typically does not cover cosmetic surgery… In recent years, though, a rapid rise in the number of so-called functional eyelid lifts, or blepharoplasty, has led some to question whether Medicare is letting procedures that are really cosmetic slip through the cracks — at a cost of millions of dollars. …From 2001 to 2011, eyelid lifts charged to Medicare more than tripled to 136,000 annually, according to a review of physician billing data by the Center for Public Integrity. In 2001, physicians billed taxpayers a total of $20 million for the procedure. By 2011, the price tag had quadrupled to $80 million. The number of physicians billing the surgery more than doubled. …surgeons also acknowledge an increased awareness of the surgery fueled by reality television, word-of-mouth referrals, and advertising that promises a more youthful appearance. And doctors concede they face increased pressure from patients to perform eyelid lifts, even when they do not meet Medicare’s requirement that peripheral vision actually be impaired.
Source: townhall.com

Hospice Not Feeling the Love from Medicare in Springfield, PA

Posted by:  :  Category: Medicare

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Philadelphia Estate Planning Attorney, Dahlia Robinson-Ocken, writes about financial and estate planning, living wills, estate trusts, revocable living trusts, probate and trust administration, probate avoidance, estate and trust administration, planning for physicians, asset protection for physicians (in the event of Medical Malpractice law suits).
Source: dahliaestateplanninglaw.com

Video: Medicare & Medicaid Pittsburgh PA | (724) 934-5044

Upton & Pitts Comment on 2013 Medicare and Social Security Trustees Report

WASHINGTON, DC – House Energy and Commerce Committee Chairman Fred Upton (R-MI) and Health Subcommittee Chairman Joe Pitts (R-PA) responded to today’s release of the 2013 Medicare and Social Security Trustees Report. The Trustees are forecasting that Medicare will go bankrupt in 2026 and Social Security will not be able to fully pay benefits in 2033. Energy and Commerce Republicans have put forward a series of measured, short-term steps to strengthen Medicare for America’s seniors.
Source: house.gov

SEIU to Corbett in New Ad: Expand Medicaid (With Video)

“Governor Corbett believes we need affordable, accessible and quality healthcare for all Pennsylvanians,” she said. “He has proposed several reforms of our Medicaid program that will make it more sustainable and is pursuing with Washington whether Pennsylvania can increase access to coverage through offering private insurance on the health insurance exchange.”
Source: politicspa.com

Making Sense of Medicaid with the Help of a Qualified Attorney

PRLog (Press Release) – May 28, 2013 – ST. PETERSBURG, Fla. — Medicaid is one of the most important government programs in the United States. It is estimated that 55 million people receive Medicaid each year. Medicaid provides basic health insurance benefits to low income families, people with disabilities, and the elderly. At age 65, older adults become eligible for Medicare. The state-run Medicaid program helps older adults pay for the cost of medical care that Medicare does not cover. Below are some of the different rules regarding qualifying for Florida Medicaid: Who Qualifies for Medicaid? To be eligible for the Medicaid program, Florida residents must meet certain qualifications. Assets: Each Medicaid applicant must own less than $2,000 worth of countable assets. Income: An applicant’s monthly income must not exceed $2,130.00. This income is including any money received from pensions, IRAs, and Social Security Disability. Medical necessity: The Medicaid program is intended to help people with blindness, disability, or who are in need of long term care. Do You Know if You Qualify? Medicaid eligibility requirements change from time to time. If you have questions about whether you meet the current St. Petersburg medicaid qualifications, you should speak with an attorney, especially one familiar with estate planning. The attorneys working for the Law Offices of David P. Folkenflik, P. A. have helped many of their clients make sense of medicaid qualifications in St. Petersburg and Tampa. If you want help applying for Medicaid or planning for long term care, an attorney can help. Because Medicare is unlikely to cover all medical costs, it’s important to anticipate your changing medical needs. This is especially important for older adults and those looking forward to retirement. Visit http://www.flwillstrusts.com to learn more about how an attorney can help you qualify for Medicaid benefits in Tampa. About The Law Offices of David P. Folkenflik, P.A. David P. Folkenflik, P.A., is a St. Petersburg law firm handling Estate Planning and Probate law matters. They help their clients in formulating and preparing effective Estate Plans. They prepare Estate Planning documents such as Wills, Trusts, Powers of Attorney, and Health Care Surrogate Designations. They also handle Probate law matters, Trust Administrations, and represent Personal Representatives and Trustees throughout the entire State of Florida.
Source: prlog.org

Medicare Takes Center Stage In Close Pennsylvania Races

The campaign jockeying over Medicare comes at a time when the program represents a huge fiscal challenge to both parties. With almost 50 million beneficiaries — and growing at the rate of 10,000 baby boomers every day — the entitlement program is one of the fastest-growing portions of the federal budget. Both parties acknowledge the need to curb its growth; both have also used the issue for political gain, casting themselves as the program’s protectors against what they portray as rivals’ threats.
Source: kaiserhealthnews.org

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

PA couple seeks prayer over medicare, second child dies

Authorities have yet to file new charges in the death of an 8 month old boy last week, after he suffered with diarrhea and breathing problems for days. But charges could be  filed once authorities pinpoint how the baby died.  For now, the couple is on probation after pleading guilty to involuntary manslaughter in 2011 in the death of their  2-year-old son, Kent, from pneumonia.
Source: wordpress.com

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June 03, 2013

How to Report Suspected Medicare Fraud

Posted by:  :  Category: Medicare

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Medicare sends you a summary notice every three months, if you have Original  Medicare. You can also see these documents online at MyMedicare.gov. You’ll need  to register on the site. If you have a Medicare Advantage plan or a prescription  drug plan, your plan sends you a monthly statement (EOB). Many plans also have  member web sites where you can register to view your EOBs online.
Source: mutskoinsurance.com

Video: How to Understand Medicare Plans

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June 03, 2013

Insurance Success Story : Tufts Medicare Preferred

Posted by:  :  Category: Medicare

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

Video: Differences between Medicare PPO & HMO Plans

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

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

Making Sure You Have The Primary Care Physician You Want

Recently I enrolled a new client onto a Medicare Advantage plan and listed her current physician as her primary care physician.   My client is currently  a private pay to this physician until her Part B becomes effective (which then allows her to go onto a Medicare Advantage plan).   Although my client had advised her current physician that she would need an HMO, my client only discovered after receiving her new ID card that her doctor had dropped out of HMOs.   We were able to identify a new physician for her that has the expertise my client needs and will accept the Medicare Advantage Plan.  Per HMO plan requirements, my client is required to contact the Member Services number on her new ID card to make the change; she will then receive an updated card to show at her appointments beginning 7/1.
Source: personalmedicareadvisor.com

Cardiology Coding: No Medicare Pay For 99360

Admin of Health and Human Services Kathleen Sebelius and Attorney General of United States Eric Holder in July in a letter to state law firm general urged them to work for HHS and federal, state, and local area law enforcement officials to mount a very substantial outreach campaign to educate more mature adults and other Medicare beneficiaries about tips about how to prevent scams and fraud oncoming this summer through a larger SMP presence and other initiatives.
Source: carkerhouse.com

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June 03, 2013

medicare supplemental insurance company

Posted by:  :  Category: Medicare

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Senior Protection Bureau will compare major Medicare. Senior Protection Bureau Medicare Supplemental Insurance Partner Company: Medicare Supplemental insurance coverage helps pay some of your share of the health care costs not covered by the Medicare Plan; such as deductibles and. In each standardized Medicare Supplemental insurance plan, basic benefits are identical from one company to the next. This makes insuance plan comparison far easier than.
Source: wordpress.com

Video: Medicare Advantage vs. Medicare Supplement Insurance

FAQ: Seniors May See Changes in Medigap Policies

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

Stephen L Morgan’s Personal Blog: Some Useful Information For Selecting Medicare Insurance

Insurance coverage is necessary. There is neo way around it then. If you perform not provide ourselves with enough insurance policy coverage you will possible find that you are facing huge doctor bills. Breastfeeding bills are a single the fastest exciting financial difficulties suffered by people thrity nine and over. The cost linked to medical care is expected to stay to increase, pushing many seniors within the long term family facilities before ought to to go. Now, some may to be honest believe that through process of obtaining further insurance, these are putting on their own and their futures more to the entire hands of folks rather then safeguarding command. Nonetheless, this can be just not the situation. Northern La visit is guaranteed to assist as well as , guard your financial situation. Who understands simply could happen? You possibly can potentially undergo from great enormous coronary heart assault and call for a wonderful deal more than the medicare will pay out. By acquiring supplemental insurance, happen to be able to lower the stress the payments will placement on both and also your your friends and in addition family. Concentrate on understand that Medicare supplemental insurance policies are traded by private corporations. The policy itself is similar no matter what individuals sells it however the cost to participants might change. When you actually buy Medigap Plan Delaware at one insurance company is the exact same coverage you get through another insurance agency. The difference being premium you reimburse them to offer the insurance. This is one of pushed it is essential to do background work before settling on the Medigap plan while provider. Expertise. There are many, many broker agents and brokers that a lot of sell insurance. Most of options are a jack most trades, masters within none. Medicare health insurance and Medicare option is quite unique. Work with someone who specializes in Treatment Supplemental and Medicare insurance Advantage plans also knows this area of expertise inside and to choose from. Feeling a best service that offers Medicare Supplemental Plan P can be little a challenging work, but if you have touch with a major national insurance forex broker that contain every and every insurance company and provides all Medicare plans, you will can save a considerable amount of time. Your agent or broker in order to be very knowledgeable on behalf of you regarding Medicare health insurance Supplemental Insurance and you’ll feel cool with his suggestion and consider he is producing honest deal. It is very necessary to discover the perfect plan from a insurance company gives great hospitality. One particular thing to end up cautioned about is without a doubt paying for currently the Medicare premiums along with credit cards. This is a hazardous practice to commenced in. Making payments on the premiums with a bank card raises the run you pay by bringing interest and expenses. It is better to make premiums withdrawn since your account in the market to pay the set you back of the Medicare health insurance supplemental plan at the time information technology is due and then withdrawn from all your checking account. About many it in many cases can be due to positively concerns they gain had their full lifestyle, but to receive others it would be just a some other sign of rising. No matter what the situation, without the need of dentist professionist insurance coverage the discomfort of common procedures can damage not only your very own teeth, but furthermore , your wallet together with. It will for this good reason that that the Blue Cross Blue Guard Dental of California system tends up to make so essentially sense. But also know that complex activities insurance company offer all 12 Medicare supplemental insurance plans. Service repair shop that carries the following policies is forced to have Plan A. Beyond that, the plans they offer are up to company, based at their own success and the sales of each policy or which of them they feel most comfortable offering. Hence, if you’ve selected Plan D, you’ll need search not exclusively for private companies that provide Medicare supplements, just companies that offer this specific program so that find the right protection for your requests. Upcoding of septicemia is apparently so rampant the fact according to this 1999 inspector general’s report in anyone sample of clinic billings investigators studied, 20 percent related with septicemia cases are upcoded.
Source: blogspot.com

Medicare Supplemental Insurance Insurance In The Right Boon For Senior Citizens

For some supplemental policies there are additional health insurance practices in the regarding plans. Their Medicare supplemental preparations are easily created and are made to meet the special needs of clients. Some of these plans include the health Maintenance Organization (HMO), the Preferred Lender Organization (PPO), Treatment Special Needs Plans, Programs of All-inclusive Care for the elderly (PACE) and Private Fee for Service provider (PFFS). Regarding identification, the really first four are deemed in the features section. With the types section, these kind of are commonly referred so that you can as the Medicare health insurance Advantage Plans. These plans are managed by the individual companies but regulated by the Authorities. The most common plans end up being HMO and specific PPO.
Source: basics-network.org

Lots Of States Medicare Advantage Intends

Actual members of i would say the Aetna Medicare application will be equipped to benefit received from large bulk reduces in the asking price of medicines throughout participating in the Aetna Rx Medicare insurance program even truth you are generally well, you can sometimes not predict when you may generate a condition that typically requires several not cheap prescriptions. This Rx plan possibly will afford you distinctive savings over neo members. Apart from insurance companies take over the prescriptions relating to all medicare plans. Prescription coverage is just not included through the government arrangement which handles Medicare health insurance. Therefore, one of the best prospects of the workout is the Rx Medicare supplement those allows members who also are insured as a way to partake of ones fine prescription policies.
Source: xroadsproject.org

Medicare Supplemental Insurance

We also offer a Plan F High Deductible Medicare Supplement Insurance plan* that is designed to save you money if you stay healthy and keeps the cost of insurance affordable. There is a one-time deduction that must be met each year with this plan. With a Medicare Supplement Insurance plan from Pekin Life Insurance Company you will also have access to discounts on eye exams, eyeglasses, contact lenses, LASIK correction surgery, hearing aids, hearing exams, and more at NO CHARGE.
Source: pekininsurance.com

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June 03, 2013

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

Posted by:  :  Category: Medicare

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

Video: (Part 1) Using TRICARE and Medicare

Tricare Help: Pregnant daughter must stay single to keep Tricare

Q. I am a retired Marine with Tricare Prime for myself and my family. My daughter, 19 and a full-time student, is pregnant by her boyfriend, also a full-time student. Am I correct that she can stay on my Tricare Prime only as long as she stays single? I am trying to talk her and her boyfriend out of getting married until after the child is born for this exact reason. My understanding is that the baby will not be covered by Tricare Prime after it is born, but if nothing else, my daughter can keep the insurance through her pregnancy and delivery if she stays single.
Source: armytimes.com

Here We Go Again! Cuts to Medicare/TRICARE Physician Payments Begin January 1 Unless Congress Acts

Getting a so-called “Doc Fix,” which would end scheduled cuts in Medicare reimbursement rates, is a recurring issue. Congress temporarily stopped the scheduled payment cuts in February 2012 as part of the Middle Class Tax Relief and Job Creation Act of 2012  (P.L. 112-96). Unfortunately, that fix is due to expire on January 1, 2013, which means that without further Congressional action the 26.5% physician payment cut will go into effect. The timing of the expiration also means the issue has been caught up in the negotiations over the pending fiscal cliff. This makes fixing it that more difficult.
Source: militaryfamily.org

Ask The Experts: Retirement

A: As you’ve concluded, there aren’t any easy answers. Such decisions are personal. However, a few generalizations can be made. First, each of you will be first eligible for Medicare parts A and B at age 65. Second, if you choose to be covered by Tricare, you must be enrolled in parts A and B. Third, if your choose Tricare, you can suspend FEHB coverage and, if things with Tricare don’t work out, reactivate that enrollment. Finally, any decision you make needs to balance cost with current and expected need. If you can’t project your needs far enough, think about the worst things that could happen to you and see which combination of benefits would give you the best protection at the lowest cost.
Source: federaltimes.com

How Tricare, Medicare work in retirement

Yes it’s gen­er­ally a good deal in the states but not so good over­seas where one gets to pay for medicare but gets none of the ben­e­fits. In addi­tion if one lives in the Philip­pines they will find the Tri­care Stan­dard has been reduced to a sec­ond class ben­e­fit with lim­ited access to providers. Very often retirees find they get to pay 100% of the cost of their care. On aver­age for inpa­tient care they can look for­ward to pay­ing 50% or more of the pro­fes­sional fees and even then they have to learn med­ical cod­ing and pro­ce­dures to con­vert local global bills into a form accept­able to TMA. Any­where else in the world they accept the local global bill and pay the full 75% they should. Local providers and hos­pi­tals tend to avoid Tri­care because of its bad rep­u­ta­tion and past actions. So also expect to keep $10,000 plus lay­ing around to pay for your hos­pi­tal­iza­tion up front and then hope to get 50% back.
Source: military.com

TRICARE Moving to Medicare Type Methodology for SCHs

Medicare reimburses SCHs for inpatient care at the greater of the Medicare DRG for all Medicare discharges, or the amount the SCH would have been paid if it were paid the average cost per discharge at that SCH in fiscal years 1982, 1987, 1992, 1996 or 2006, updated to the current year, for all Medicare discharges. DOD noted, however, that establishing a methodology exactly like Medicare is not practical. While the aggregate DRG reimbursement for all TRICARE discharges can be calculated, using the Medicare cost per discharge would not be appropriate for TRICARE because of differences in the TRICARE and Medicare beneficiary case mix. Also, applying an annual update to a TRICARE base-year average doesn’t make sense because of the relatively low number of TRICARE discharges in any given year—fewer than 20 at nearly half of SCHs. The average cost per discharge in any one year may not be a good measure of the average cost in future years.
Source: healthcarereforminsights.com

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