Crunch Time For States Still On Fence About Medicaid Expansion

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Health Policy Solutions (a Colo. news service): Exchange Must Offer Voter Registration, Activists Say Voting rights activists say Colorado’s health exchange must serve as a mandatory voter registration agency, but exchange managers contend they do not need to comply with the law popularly known as the Motor Voter Act. For now, activists with Colorado Common Cause are trying to encourage exchange managers to comply with the law. But if negotiations fail, they may sue the exchange. … The National Voter Registration Act of 1993 requires agencies, such as driver’s license bureaus and all state offices that offer public assistance, to serve as “mandatory voter registration agencies” (Kerwin McCrimmon, 6/11).
Source: kaiserhealthnews.org

Video: Ohio Medicaid Russian Drug Smuggling Investigation

Saying No To Kasich’s Medicaid Expansion Protects The Most Vulnerable

But, let’s get back to the low income pregnant women, children and disabled minors that President Reagan, Congress, and the country at large were compelled to help. Medicaid from its outset has been a program meant for the truly vulnerable. It was a program meant to help those who cannot help themselves. By expanding Medicaid beyond this noble beginning, we make the vulnerable it serves more vulnerable. Scarcity is an intractable reality of life on earth and governs all of our decision making in the private sector. Big government proponents like Governor Kasich need to understand something about scarcity. There are only so many dollars to go around. If we expand an entitlement beyond society’s ability to fund it, those for which the entitlement was originally intended will be harmed the most when the funding dries up. Abled bodied Ohioans can find a job. Children and many disabled simply cannot.
Source: ohiolibertycoalition.org

Cleveland Tea Party Patriots: Ohio Senate passes budget : Update on Ohio Medicaid Expansion

The more conservative members of the House continue to fight against Medicaid expansion, but are up against other members, and our Governor, who will personally and politically benefit from the expansion, as well as the gargantuan American Hospital Association and the Ohio Hospital Association which stand to gain $13 billion over the next seven years with this expansion.
Source: blogspot.com

Is Medicaid Expansion a Legal Trap for Ohioans?

Coerced, single-payer health care, entirely under the control of a federal bureaucracy, appears to have been  a fundamental goal of the authors of Obamacare. Many have said such publicly. Former U.S. House Speaker Nancy Pelosi “warned” that we needed to carefully read the legislation to know what it was all about. A trap was set to ensnarl all Ohioans into a universal health care program at the sacrifice of our liberty and ability to control our personal and family’s health care. The U.S. Supreme Court decision gave Ohioans the ability to avoid this trap by not adopting Medicaid Expansion in any form. No “financial benefit” or compassion argument overcomes this clear threat to the health care liberty of Ohioans should Republicans unwisely adopt Medicaid Expansion.
Source: ohioconservativereview.com

Ohio Becomes Medicaid Expansion Twilight Zone

Not so. Over the past six weeks I have done “real” reporters’ work for them and practically begged them to tell the truth, like a dweeby 5’8″ version of Charlton Heston in any number of bleak sci-fi flicks. Ohio’s treasurer, Opportunity Ohio, The Buckeye Institute for Public Policy Solutions, and numerous national free market think tanks have offered fact-based critiques of Kasich administration talking points.
Source: freedomworks.org

John Lott’s Website: Will Medicaid expansion occur in Arizona, Ohio, and Michigan?

Despite expressing distaste for the new law, some GOP governors have endorsed an expansion of Medicaid, and three — Jan Brewer of Arizona, John Kasich of Ohio and Rick Snyder of Michigan — are trying to persuade their Republican-controlled legislatures to go along. The governors are unwilling to turn down Washington’s offer to spend millions, if not billions, in their states to add people to the state-federal program for the poor. But they face staunch opposition from many GOP legislators who oppose the health-care law and worry that their states will be stuck with the cost of adding Medicaid recipients. . . .
Source: blogspot.com

Social Security Manipulation Violates the Rule of Law

Posted by:  :  Category: Medicare

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“The number of beneficiaries is growing rapidly relative to the number of taxpaying workers” The beneficiaries to retiree ratio is overplayed. This ratio is falling, but not at the rate that the costs are rising. We are paying 5 times as much on twice as much income. If demographics were the problem, why is it that Social Security was insolvent in 1983 at the peak of the boomer earning years. The comment about LBJ is not realistic. When LBJ was president, the system was a paygo system. It did not generate any material revenue for LBJ to use. The ENTIRE trust fund was roughly 30 billion, mind you Social Security was on-budget for one of his budgets. Social Security has been means tested since 1984 with a test that now reaches up to 1/3rd of retirees. So it isn’t possible to implement means-testing, and there isn’t much room to expand it. Paygo financing does not work. We take a dollar today to pay benefits, and then we make a promise of more benefits in the future. Since the dollar isn’t invested – there is only one place where the money can come from…. future workers. We are the future workers. The rest is a sideshow to make people think that Social Security works or could work.
Source: freedomworks.org

Video: How Severe Are Problems With Social Security?

No more Social Security at 62?

A few days prior to this announcement, Donald Fuerst, senior pension fellow at the American Academy of Actuaries, testified before the U.S. Congress about Social Security’s pending shortfalls. He said that in 1940, when the new Social Security Administration began paying monthly retired-worker benefits, the retirement age was 65. At that time, workers who survived to age 65 had a remaining life expectancy of 12.7 years for men and 14.7 years for women. By 2011, life expectancy at age 65 was 18.7 years for men and 20.7 years for women, an increase of six full years for both.
Source: bankrate.com

Social Security Falls Even Deeper into a Sinkhole

So here’s how the Report’s opening statement should be crafted: “Social Security, a foundational program of economic security for the American public — upon which millions of today’s and future generations depend for economic support during retirement — is inexorably headed toward financial insolvency. While insolvency is not projected for two more decades, continuing failure to reform the program is increasing the cost of economic adjustments that must be made in the future — cost increases that are at odds with the program’s fundamental objective of enhancing retirement security for today’s and future generations.”
Source: downsizinggovernment.org

A Guide To the 2013 Social Security Trustees Report, Part II

Medicare’s HI trust fund, which finances hospital, home health following hospital stays, skilled nursing facility and hospice care services, is only one piece of a larger Medicare program and indeed represents less than half of total program costs. Like Social Security, Medicare HI is financed primarily by a tax on worker wages and can theoretically become insolvent if its obligations exceed its financial resources. But Medicare’s Supplementary Medical Insurance (SMI) trust fund has even greater expenditures and includes Medicare Parts B (physician, outpatient hospital, and general home health services) and D (prescription drug coverage). SMI has no projected depletion date because by statutory construction it is automatically provided with whatever general fund revenues it needs (beyond tax and premium income) to remain solvent. Thus financial strains in SMI are manifested not in projected insolvency but as rising pressure on the general federal budget.
Source: mercatus.org

What's Next for Social Security?

The trustees of Social Security recently reported that the retirement system can pay full benefits until 2035, when it will be able to pay about three-fourths of promised benefits. That is not a crisis. It is a manageable problem.
Source: realclearpolitics.com

John Bogle: Social Security’s the Greatest Fixed Income You’ll Ever Get

Although it’s unlikely that Bogle could actually fix Social Security in five minutes, he has laid out a few competent changes that would ostensibly be easy to implement. “I’d change the cost-of-living adjustment — not to cheat the retired people, but to get a formula that was right. It would result in savings,” he said in a question-and-answer session in May. “That in itself would probably cure it. But I’d add a couple of things. I would raise the maximum taxable earnings for Social Security. I’d raise it to maybe $140,000, $150,000.”
Source: wallstcheatsheet.com

Medicare, Social Security trustees’ report

But Medicare is doing slightly better than last year’s projections and is expected to cover benefits through 2026. The Employee Benefit Research Institute (EBRI) noted that a number of factors have contributed to the improved outlook, including lower-than-expected Part A spending in 2012, and lower projected Medicare Advantage program costs. Read Trustees Report shows reduced cost growth, longer Medicare solvency.
Source: marketwatch.com

Social Security and Medicare Programs Remain on Unsustainable Paths

The data show that both Social Security and Medicare programs remain on unsustainable paths. Even these grim numbers may be too optimistic because the expected revenue or cost savings assumed under current law may never materialize. In fact, a section at the end of the Trustees Report called “Statement of Actuarial Opinion,” (p. 273) makes that point very clearly. Paul Spitalinic, the acting chief actuary of the program, explains that “current law would require a physician fee reduction of an estimated 24.7 percent on January 1, 2014—an implausible expectation.”
Source: mercatus.org

Maricopa County Arizona Medicare Supplement Quotes June 2013

Posted by:  :  Category: Medicare

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Robert Bache aka MedicareBob owns and operates Senior Healthcare Direct. Senior Healthcare Direct is a National Telephonic Insurance Agency that represents over 26 Medicare Insurance Companies. It is our job to make sure that you always have the best price for your Medicare Supplement Plan.
Source: srhealthcaredirect.com

Video: MEDICARE INSURANCE COMPANIES

Rate Boost To Medicare Advantage Plans Powers Insurers’ Stock Surge

Medpage Today: More $$$ Going To Medicare Advantage Plans Payments to Medicare Advantage plans will increase by 3.3% in 2014, Medicare officials said late Monday. Officials at the Centers for Medicare and Medicaid Services (CMS) based the payment increase on the assumption that Congress will override scheduled cuts in physician reimbursements for an 11th consecutive year, the agency said. “The policies announced today further the agency’s goal of improving payment accuracy in all our programs, while at the same time ensuring program stability and preserving beneficiary choice,” Jonathan Blum, PhD, CMS’ acting principal deputy administrator, said in a press release (Pittman, 4/2).
Source: kaiserhealthnews.org

What to Know about Medicare Vision and Eye Care

Under Medicare Part A, vision is only covered when it pertains to a medical problem (such as the detached retina example above). Part B coverage is somewhat more encompassing, although the traditional examinations remain uncovered. Under Part B insurance, glaucoma screenings are covered for individuals who are high risk. High risk patients are classified as those with a family history of glaucoma, African Americans age 50 and older, and those with diabetes. In these cases, individuals must visit a state-approved vision care specialist and will pay the 20% Part B coinsurance for any vision costs approved by Medicare.
Source: ehealthmedicare.com

Corrupt Lab Boss: Hundreds of Doctors Took Bribes to Help Steal Millions from Medicare

Whipple said tests were always performed properly but admitted that doctors ordered extra blood or allergy tests in order to pump up billing. In all, Biodiagnostic Laboratory Services officials paid millions in bribes to medical professionals, and more than $100 million was earned by overbilling on blood samples and other tests.
Source: nbcnewyork.com

Daily Kos: Insurers score another win, turn Medicare pay cut into increase

Medicare Advantage plans are good business for the health insurance industry. Though only a little more than a quarter of Medicare beneficiaries buy these supplemental plans, they’re big business. They’re also relatively expensive for the federal government, which subsidizes them. In fact, the Government Accountability Office found that over the past three years, the federal government has overpaid insurers between $3.2 billion and $5.1 billion. That’s something the Obama administration wanted to change, needing to find every cost-cutting measure possible to implement Obamacare. That’s why the administration tasked the Centers for Medicare & Medicaid Services (CMS) with cutting those subsidies and why it proposed the 2.3 percent cut. The cut would have not been in benefits, but America’s Health Insurance Programs (AHIP) didn’t want MA enrollees to know that. So they did what every powerful industry group does: use some scare tactics and an Astroturf campaign.
Source: dailykos.com

Proposed Rule Imposes Spending Ratio on Insurers in Medicare Contracts

Health insurers who fail to establish a MLR of .85 may have to pay CMS a “remittance” fee under the proposed rule.  The remittance fee would be based on the difference between 85 percent of the total revenue and the contract’s actual ratio spent on direct benefits, multiplied by the contract’s annual revenue.  If a contract fails to meet the .85 MLR requirement for three years in a row, CMS will stop permitting Medicare beneficiaries to enroll in any plan covered under the contract for a year.  CMS will terminate a contract if it continues to miss the requirement for five consecutive years.
Source: upenn.edu

MedicareBob’s Blog: Medicare Beneficiaries are overpaying for their Medicare Supplement Insurance.

“MedicareBob” and Senior Healthcare Direct can help. We are 6 licensed insurance agents that are licensed in over 40 states. We are unique because we are approved and appointed with over 35 Medicare Supplement Insurance Companies, Aflac, Aetna, AARP/United Healthcare, Anthem Blue Cross Blue Shield, Cigna, Mutual of Omaha, etc…) It is our job to make sure that our Clients are always paying the best price for their Medicare Supplement Plan. 
Source: blogspot.com

Can Your Insurance Agent Answer Medicare Questions?

As with standard medical insurance coverage, you can purchase Medicare supplemental plans (or Medigap plans). While with this plan you can cover most costs neglected by Parts A & B, neither plan includes the cost of prescription drugs. Covering these additional costs requires the purchase of another Medicare plan, Part D. With all these options combined, you should have practically all your medical costs covered and only the co-pay amounts for prescriptions to pay out-of-pocket. 
Source: findlocal-insurance.com

N.C.’s nascent Medicaid reform

Differences in availability of Medicare Advantage plans by county are driven by the choices of private insurers. Private companies cannot be forced to offer a Medicare Advantage plan in a given county, and many offer different plans in different counties. To provide a sense of the variation, peruse this website that provides a great deal of information on Medicare Advantage plans in N.C. Selecting the subset of plans offering a $0 prescription drug deductible and seeking the lowest premium plans in 2013 yields the following list of plans (if you click the county name you will see all MA plans). This scanned map (NCMedAdvtantage.6.5.13_best) with my handwritten comparisons of what is available in selected counties is illustrative. In Durham county, there are two Medicare Advantage plans with a $0 prescription drug deductible that have no additional premium to be paid by a Medicare beneficiary choosing this plan, and another with an additional patient monthly premium of $6. In Lenoir county, there are two plans, but the lowest monthly premium to be paid by a beneficiary for such a plan is $75 per month. I have not done a comprehensive comparison of all Medicare Advantage plans; my point is that the Medicare Advantage market is county-based, driven by insurance companies deciding where they want to offer certain types of plans.
Source: wordpress.com

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

When a Medicare enrollee purchases a Medicare supplement Plan N they are making a commitment to participate in their healthcare costs, while still maintaining their freedom to use the services of any physician or hospital. Plan N requires the insured to pay their annual Medicare Part B deductible, up to a $20 physician’s office co-pay, a $50 emergency room co-pay unless admitted to the hospital and any excess charges over and above the Medicare approved charge. One should note that Medicare excess charges very rarely even exist as almost all physicians and hospitals accept the Medicare approved charge as full payment. This is called Medicare assignment and the consumer can contact their physician’s insurance billing office to confirm that they accept assignment and are considered a “participating” provider. Healthy, typically younger Medicare enrollee’s see Medicare supplement Plan N is a viable alternative to a Medicare Advantage plan. Medicare supplement Plan N offers substantially reduced premiums when compared to a Medicare supplement Plan F while maintaining the “freedom of choice” not offered by a Medicare Advantage plan.
Source: askmedicareblog.com

Quality of Life Seminar: Healthcare Fraud

Posted by:  :  Category: Medicare

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•    equipment or insurance plan providers tricking seniors into giving up personal information (including Medicare numbers) on “sign in” sheets •    Medicare summary notices showing billing for services or supplies that were never received equipment supplies providing expensive “scooter” wheelchairs not ordered by a physician or needed by the beneficiary •    luring beneficiaries into providing their Medicare numbers for “free” services only to later bill Medicare •    kickbacks – paying beneficiaries to receive service from a particular provider or company
Source: jolietassistedliving.com

Video: Assisted Living Los Angeles Now Medicare Assisted Living

Writer of Pop: The Demise of Medicare is Actually Funny in “Assisted Living”

Joe Taylor, (Kurt Beattie) is the new resident at just one facility. There, he meets Beatrice (Marianne Owen), a friendly, resident not willing to buck the system; Wally Carmichael (Jeff Steitzer), an old goat that gives the nurses so much trouble that they take away his hearing aids; and Mitzi Kenny, (Laura Kenny), fighting dementia. Together, the foursome work together to fight for change and dignity. The floor that they all live on is run by Nurse Claudia (Julie Briskman), who leads with an iron fist and Kevin (Tim Gouran), a likeable young man who struggles between wanting to befriend the residents and keeping Claudia happy.
Source: writerofpop.net

Key Differences between FQHCs and RHCs

In conclusion, cost-based and PPS reimbursement through the RHC and FQHC programs present an opportunity to provided enhanced services to underserved areas that in most cases would not have access. This does not come without a cost in which the clinics pays in hard work, headaches of additional rules and regulations, and required reporting – not to mention the effect that conversion to cost-based or PPS reimbursement has on clinic operations and staff. In order to succeed at such a challenge, appropriate modifications have to be made to the practice management system and EHR software. Additionally, staff have to be well trained and prepared, and the accounting firm has to be knowledgeable of their requirements, rules, and regulations. All of these challenges can be conquered when the right team and systems are in place.
Source: physicianspractice.com

Minnesota Retirement Communities & Assisted Living from Lang Nelson, Inc.

Senior Community Services, a nonprofit agency, has been providing services to seniors and their families for over 60 years in Hennepin and Wright Counties.  The Medicare Health Insurance Counseling program has been part of our services for over 20 years.  We have over 50 staff and volunteers that provide Medicare counseling to Medicare beneficiaries and their families in the entire state of MN.
Source: langnelson.com

Hospice Contracts With Assisted Living Facilities

From a practical perspective, we generally advise that a hospice have an agreement with an ALF.  First of all, it is good business practice that defines the role of the hospice and the ALF in the provision of hospice services.  Another good reason for an agreement is that many states license ALFs and the applicable state regulations may require an agreement.  Finally, since the same surveyors often times conduct surveys in both nursing homes and ALFs, it can avoid confusion by the surveyors over whether an agreement is required.
Source: hallrender.com

Medicare’s Role for Older Women

These gaps in benefits and cost-sharing requirements, together with spending for premiums for Medicare and supplemental coverage (described further below), can translate into high out-of-pocket expenses for people on Medicare.  On average, older women spent more on health care (including premiums) than older men in 2009 ($4,844 versus $4,230), a greater financial burden given their lower incomes.  Notably, older women spent more than twice as much on average for long-term services and supports (LTSS). (Exhibit 3) For all older Medicare beneficiaries, out-of-pocket spending escalates as they age, but women ages 85 and older have considerably higher out of pocket costs than older men, largely due to their higher health and social needs and greater use of long-term care services.  Often the need for these services comes at the time when women have fewer resources.   Among women ages 85 and over, out-of-pocket spending amounts and the share with low incomes are higher than for younger women and men of all ages on Medicare (Exhibit 4).
Source: kff.org

Pew Charitable Trust Launches Database to Track State Campaigns Agst Medicaid Fraud

The database centralizes the hundreds of anti-fraud and abuse practices, as featured in 70 CMS reports available online as of December 2012. Policy approaches from 49 states and the District of Columbia are included. The vast majority of states’ actions are focused on providers (e.g., medical practices, pharmacies, managed care organizations). In general, states have three opportunities to protect against fraud and abuse among providers:
Source: about.com

How Do You Get Medicare Part D?

As the nation’s largest drugstore chain with fiscal 2012 sales of $72 billion, Walgreens (www.walgreens.com) vision is to become America’s first choice for health and daily living. Each day, Walgreens provides more than 6 million customers the most convenient, multichannel access to consumer goods and services and trusted, cost-effective pharmacy, health and wellness services and advice in communities across America. Walgreens scope of pharmacy services includes retail, specialty, infusion, medical facility and mail service, along with respiratory services. These services improve health outcomes and lower costs for payers including employers, managed care organizations, health systems, pharmacy benefit managers and the public sector. The company operates 8,077 drugstores in all 50 states, the District of Columbia and Puerto Rico. Take Care Health Systems is a Walgreens subsidiary that is the largest and most comprehensive manager of worksite health and wellness centers and in-store convenient care clinics, with more than 700 locations throughout the country.
Source: womanaroundtown.com

Medicare Assisted Living Facilities

Finding the best services for patients who need extensive medical care takes a little time and patience as you investigate various factors such as the cost of assisted living facilities. You will need to locate Medicare assisted living facilities that offers the direct doctor’s care that Medicare will require to pay for the facility. When you visit the facilities look around and identify the options that make the unit perfect for older patients. People who need doctor’s care may not be willing to go into a nursing home. Although for Medicare to pay the patient will need the type of care a nursing home provides. The community you choose should have scheduled meal times and activities to help your loved one stay active and not become bored. Keeping patients busy with different activities will help the person settle in and enjoy the change in lifestyle.
Source: assistedlivingfacilities.net

CARR ALLISON Medicare Compliance Group: Workers’ Compensation Medicare Set

Posted by:  :  Category: Medicare

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The bill would also create a formal appeals process for parties in a workers’ compensation case to challenge CMS determinations. If CMS does not approve the MSA proposal, parties would have 60 days to file a reconsideration request, and CMS would have 30 days to respond or the original MSA proposal would automatically be deemed approved. Parties would have 30 days to request an ALJ hearing after an unfavorable response to a reconsideration request. If the ALJ issues an adverse decision or fails to issue a decision within 90 days, parties would then be able to seek judicial review of the CMS determination.
Source: blogspot.com

Video: Medicaid Set Aside

Workers’ Compensation: NJ Court Approves Medicare Set

“The court has thoroughly reviewed the sworn testimony of plaintiffs’ expert regarding the proposed set-aside amounts for future medical expenses relating to the underlying accidents/incidents, which would otherwise be covered or reimbursable by Medicare. The court finds that the proposed set-aside amount in each case fairly takes Medicare’s interests into account in that the figures are both reasonable and reliable. Therefore, the court is satisfied that Medicare’s interests have been adequately protected pursuant to the MSP. Plaintiffs shall set aside the proposed sums in self-administered interest-bearing accounts to be used solely for the purpose of satisfying future medical expenses related to the underlying accidents/incidents.” DUHAMELL, Plaintiff v. RENAL CARE GROUP EAST, INC., RCG Southern New Jersey, LLC, Philadelphia Suburban Development Corporation, Defendants. Catherine A. Ney, Plaintiff, et al,, — A.3d —-, 2013 WL 2102701 (N.J.Super.A.D.) Decided Dec. 7, 2012. May 16, 2013.
Source: blogspot.com

Workers’ Compensation Medicare Set

In an effort to address as many topics as possible, CMS is requesting stakeholders to submit non-case specific questions they would like to have addressed during the teleconference to the CMS MSP Central mailbox* prior to the teleconference. CMS will review and categorize the questions submitted and attempt to answer as many questions as possible during the teleconference. There may also be an opportunity for the stakeholders to ask questions after the presentation.
Source: medval.com

Medicare Set Aside Arrangements

Leading source of structured settlement information and news and expert opinion from John Darer, including settlement planning issues/ ideas, alternative deferred payment solutions, The Structured Settlement Watchdog™ commentary and exposes that may be helpful to attorneys, plaintiffs, claims adjusters, judges, the news media, sellers and buyers of structured settlement payment rights and interested others, Informative, irreverent and effective! Check back daily for something new, or simply ask structured settlement expert John Darer™ directly 203-325-8640
Source: typepad.com

Medicare Liens Including Medicare Set Asides Apply to Medical Damages Only!

This is not that uncommon in cases of very serious injuries where significant and sometimes permanent medical treatment is required. However, there are numerous potential areas for negotiation with Medicare’s over inclusive liens. For instance, in cases of serious personal injury, there are often very significant recoverable damages unrelated to medical expenses, either past of future. Medicare is not entitled to claim liens against settlement amounts that are unrelated to medical expenses paid or to be paid by Medicare.
Source: newmexicoinjuryattorneyblog.com

Louisiana Law Blog: Recent Developments in Medicare Set Aside

Specifically, the District Court held that no federal law requires an MSA in personal injury settlements for future medical expenses. The District Court held that while MSA’s are prudent in settlements for future medical expenditures in the workers’ compensation context, they are not required outside that context. The District Court further commented that to require personal injury settlements to specifically apportion future medical expenses would prove burdensome to the settlement process and, in turn, discourage personal injury settlements. Finally, the District Court dismissed the September 29, 2011 advices of the CMMS described above by pointing out that “interpretation such as those in opinion letters, like interpretations containing policy statements, agency manuals, and enforcement guidelines lack the force of law.” Christensen v. Harris County, 529 U.S. 576, 587 (2000).
Source: louisianalawblog.com

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June 15, 2013

Long Waits For Consumers When Medicare Is ‘Secondary Payer’

Posted by:  :  Category: Medicare

In one case involving an 80-year-old man who was injured in a car accident in Kentucky in November 2011, it took more than a year to get a final figure from CMS detailing how much the agency was owed, says Linda Magruder, an attorney in Louisville who was the victim’s co-counsel in the case. That amount, for treatment for soft-tissue injuries to the man’s right hip, left foot, back and neck, was $2,640. But the agency first claimed it was owed more than $26,000, she says, because it included bills for care not related to the accident.
Source: kaiserhealthnews.org

Video: Medicare Secondary Laws

Medicare Secondary Payer Bill Introduced in U.S. House as H.R. 1982

Bradley v. Sebelius CDC Centers for Medicare and Medicaid Services CMS COBC Conditional Payments Coordination of Benefits Contractor David Korch GAO HHS liability LMSA Mandatory Insurer Reporting MARC MARC Coalition Medicaid Medicare Medicare Secondary Payer Medicare Secondary Payer Act Medicare Secondary Payer Recovery Contractor Medicare Secondary Payer Statute Medicare Set-Asides Medicare Set Aside Medivest MIR MMSEA MSA MSP MSPRC NAMSAP ORM Rep. Dave Reichert RREs SCHIP Section 111 settlement SMART Act Social Security SSI The Centers for Medicaid and Medicare Services TPOC US v. Hadden WCMSA WCRC workers’ compensation
Source: medivest.com

New Amendment to Medicare Secondary Payer Act Introduced In Congress

On May 15, 2013, a new amendment to the Medicare Secondary Payer Act (MSPA) was introduced in Congress. Rep. Dave Reichert of Washington and Rep. Mike Thompson of California are sponsoring the bill, which seeks to reform the procedures used by Centers for Medicare and Medicaid Services (CMS) in its review of workers’ compensation settlement agreements. More specifically, the amendment is an attempt to resolve serious delays and confusion involved in the CMS review of workers’ compensation Medicare set-asides.
Source: themedicarespa.com

Medicare Secondary Payer: The Shape of Things to Come

H.R. 1063, the Strengthening Medicare and Repaying Taxpayers (SMART) Act, had gained a significant amount of bipartisan support in both the House and Senate; however, with the election pending, the outlook seemed bleak that it would be passed by the 112th Congress. Well, on September 13, 2012, the Energy and Commerce Subcommittee on Health met in an open markup session and made certain adjustments to the bill to implement more automated functions to the conditional payment recovery process. The committee met again on September 20, 2012, and again made minor adjustments to the bill, then favorably forwarded it to the full committee and sent it back to the CBO for scoring. There was no further indication of progress until on December 19, 2012, a lesser version of the SMART Act emerged as Title II of the Medicare IVIG Access Act [H.R. 1845]. H.R. 1845 proposed a $45 million dollar demonstration project to study providing Medicare coverage for in-home administration of intravenous immune globulin (IVIG) to patients suffering from primary immune deficiency disease. Despite the sympathetic appeal of helping the bubble boy, H.R. 1845 needed to be off-set by a bill such as the SMART Act, which proposed to coincidentally save Medicare $45 million dollars over ten years, and the match was made. The new combined bill was nearly unanimously passed by the House on December 20, 2012, and passed by the Senate on December 21, 2012. On January 10, 2013, President Barack Obama signed the legislation, making it
Source: lexisnexis.com

Statement to the Record on the Medicare Secondary Payer and Workers’ Compensation Settlement Agreement Act

HR 5284 creates a system of certainty and allows the workers’ compensation settlement process to move forward while eliminating millions of dollars in administrative costs.  It will help create clear and consistent standards, currently lacking in the process, to address workers’ compensation issues.  Most importantly, it will benefit all parties involved – injured workers, employers, insurers and CMS.  
Source: house.gov

SMART Act Amends Medicare Secondary Payer Statute, Creates Three

The SMART Act requires the Secretary of Health and Human Services (“Secretary”) to establish a process by which a claimant (or his or her authorized representative) can dispute discrepancies with the statement of reimbursement amount. A claimant or authorized representative must submit documentation of the potential discrepancy and a proposed resolution to the Secretary. The Act states that the Secretary must determine whether there is a reasonable basis for including or removing a claim and provide a response within eleven (11) business days. Lack of a response is a deemed acceptance of the claimant’s proposal. If the Secretary determines that there is not a reasonable basis to include or remove claims, the proposal will be rejected. If the Secretary concludes that there is a discrepancy, but rejects the proposed resolution, documentation showing good cause for why the Secretary has rejected the proposal and establishing an alternate discrepancy resolution must be provided to the claimant. This process does not create an appeals process, however, and the SMART Act expressly forecloses the possibility of administrative or judicial review of the Secretary’s determinations. Final regulations must be promulgated by October 10, 2013, nine (9) months after the date of enactment, the effective date of this provision.
Source: crowell.com

Medicare Secondary Payer Act Compliance

There are no simple answers when complying with the Medicare Secondary Payer Act in your workers’ compensation, no-fault/automobile or liability claim.  In any of these cases where future medical care and treatment is closed out, it is important to consider and protect Medicare’s future interests—do not forget about conditional payments too!  Failure to address these issues at the time of settlement may result in Medicare considering the entire settlement null and void, regardless of what “Medicare savings” language you use.
Source: mnbenchbar.com

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June 15, 2013

Missouri Medicaid Audit & Compliance

Posted by:  :  Category: Medicare

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Section 6411 of the Affordable Care Act, Expansion of Recovery Audit Contractor (RAC) Program, amends section 1902(a)(42) of the Social Security Act and requires states to contract with a RAC vendor allowing states to reimburse contractors who assist in the identification and recovery of improper payments. The RAC program has been used in the Medicare program and is now being required for Medicaid. The mission of the RAC program is to reduce improper payments in Medicaid through the efficient detection and collection of overpayments, the identification of underpayments, and the implementation of actions that will prevent future improper payments.
Source: mo.gov

Video: MO Senate Debate — Medicare

Comparing Medicare Advantage Plans Missouri

There are several reasons why people choose to enroll in Medicare Advantage plans instead of the Original Medicare plan and a Medicare Supplemental plan.  In order to enroll in a Medicare Advantage plan, you should willingly drop out from your Medicare and sign up for a plan in a private insurance company that offer this plan.  The two big reasons why most people choose to sign up for Medicare Advantage plans are because it has low premiums and there are no health questions asked.
Source: ehealthmo.com

Missouri Residents Weigh In on Medicare, Social Security Changes

When the new Congress convenes next month, policymakers are likely to consider changes to the programs, including an increase in the amount of income subject to the payroll tax that finances most of Social Security and some of Medicare, benefit reductions, an increase in the eligibility age for both programs, a curb in the cost-of-living increases for Social Security beneficiaries and higher Medicare premiums for higher-income enrollees.
Source: aarp.org

Roy Blunt: It would have been "best" if Medicare and Medicaid never existed

Government health care programs are so awful, Blunt said, that it would have been "best" if federal government never got "in the health care business" in the first place — and never created Medicare, Medicaid, Veterans Administration health care, SCHIP or any other program that he believes might "distort the marketplace." Listen:
Source: firedupmissouri.com

‘Hidden Health Care Tax’ Costs Missouri Businesses Billions Annually. Costs Will Explode Without Medicaid Reform.

“Cost shifting doesn’t increase the quality or efficiency of health care,” Kuhn said. “And, it is the poorest choice for managing the costs of health insurance for businesses and individuals. “Missouri has a stark choice. If we reform Medicaid, we can reduce the ‘hidden health care tax’ and allow Missouri business to decrease costs and Missouri workers to keep more of their earnings. If we fail to reform Medicaid, we will see the costs of the uninsured explode. Missouri businesses will struggle to remain competitive, and individuals will pay more for their insurance.”
Source: thepharmacyblog.com

Attorney General Koster obtains more than $67,000 in settlement with adult daycare for overcharging Medicaid

In addition to repaying the state $8,806.41 for its fraudulent billings, Adult Daycare Villas, LLC will be required under the settlement to pay damages of $26,419.23, penalties of $25,000, and $7,500 for the costs of the state’s investigation. Adult Daycare Villas, LLC, will no longer be allowed to provide any services under the Medicaid program. The agreement further bars the operator of the company, June Porter-LaMothe, from providing any services that will be billed directly or indirectly to Medicaid.
Source: mo.gov

MO Chapter, American Academy of Pediatrics

Beginning in January 2013 Medicaid primary care services provided by physicians with a specialty designation of family medicine, general internal medicine or pediatric medicine are eligible for increased payments for primary care Evaluation and Management (E/M) codes 99201-99499.
Source: moaap.org

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June 15, 2013

Details Emerging About Costs For Health Plans Available Through Health Exchanges

Posted by:  :  Category: Medicare

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Health Policy Solutions (a Colo. news service): Health Guides At 55 Sites Receive $17 Million For Outreach Fifty-five community groups and hospitals throughout Colorado have received $17 million in grants from Colorado’s health exchange to assist people in signing up for health insurance. Altogether 74 applicants had asked for more than $57 million, so the grant committee had to dramatically cut requested funds and some of the proposed assistance sites have backed out. … Many had made large requests for marketing, advertising and other outreach efforts that the exchange may already be doing statewide (Kerwin McCrimmon, 6/12).
Source: kaiserhealthnews.org

Video: High-Deductible Plans ‘Quiet Revolution in Health Insurance’

Details: Oxford Health Plans LLC v. Sutter : SCOTUSblog

This morning in an opinion announced by  Justice Kagan for a unanimous Court, the Court held that the arbitrator’s decision in this case, which determined that the contract between the insurance company and doctors authorized class action arbitration, survives judicial review under §10(a)(4) of the Federal Arbitration Act.  The case had started as a potentially major ruling on classwide arbitration, and the power of arbitrators to decide if those procedures could be utilized.  But the Court found dispositive that the petitioner had agreed to allow the arbitrator to decide the issue.  On that basis alone, it held it could not disturb the arbitrator’s ruling that the contract permits classwide arbitration.  The Court left open whether the petitioner’s concession was correct – i.e., whether that is in fact an issue for the arbitrator to resolve rather than the Court.  So the case is unlikely to have much if any broader significance.
Source: scotusblog.com

Affordable Care Act Bans Sex Discrimination in Employer Health Plans

The complaints filed with OCR allege that Beacon Health System, Auburn University, and other private and public employers violated the nondiscrimination ban by excluding gynecology and maternity care coverage from insurance benefits offered to their employees’ dependents.  According to the complaint against Beacon Health System, for example, its benefit plan states that it “[e]xcludes dependent pregnancy.”  Beacon Health System owns Elkhart General Hospital, Memorial Hospital of South Bend, and other facilities in Indiana and Michigan. The complaint alleges that this type of exclusion deprives women who participate in a plan as dependents of the comprehensive insurance coverage that is offered to men who participate in the same plan.  The five complaints are available on the website of the National Women’s Law Center and may be accessed by clicking here.
Source: jdsupra.com

Hudson health plan and gateway health plan

An example of medical aid system that can be provided in USA and many other countries is Gateway Health Plan. It was established twenty years ago and its main goal while founding was to help any people that usually have problems with finding a proper health insurance and have specific health needs, because they have e.g. chronic illness or are aging, or have to visit their doctor often because of other reasons. The other similar health plan is Hudson health plan, which puts an emphasis on professional primary care. This makes the medical care offered by Hudson health plan nicely accessible, and accessibility is one of the most important principles of health care. Another advantage is that you can get medical, professional help at the very beginning of your health problems, even when you actually don’t know if you are already ill. This makes an effective prevention system which may bring lots of benefits and satisfying results all the time.
Source: yourhealthrights.com

What Does Oxford Health Plans v. Sutter Mean for Your Company?

Second, from a more proactive standpoint, this entire mess can be eliminated with clarified arbitration clauses. Class-action arbitration is incredibly costly and eliminates most of the benefits that one might gain from alternative dispute resolution. Instead, you might provide for arbitration of individual claims only. Note that the holding of another recent Supreme Court decision, AT&T v. Concepcion, supports this strategy.
Source: findlaw.com

Obamacare Is Forcing Cuts to High

In order to avoid the Cadillac tax, which goes into effect in 2018, employers are already searching for ways to scale back on costs, including cutting health benefits and increasing plan prices. (Employers are also amping up spending on preventive care services, which is a good thing.) And as Bradley Herring, a health economist at Johns Hopkins Bloomberg School of Public Health, told the Times, these health plan changes will likely affect a lot of people, not just the well-off; up to 75 percent of plans could be affected by the tax over the next ten years. "The reality is it is going to hit more and more people over time," he says.
Source: motherjones.com

Health Plans’ Continued Commitment to Tobacco Cessation

The Centers for Disease Control and Prevention (CDC) recently relaunched its Tips from Former Smokers (Tips) Campaign, a national tobacco education campaign that encourages people to quit smoking by highlighting the toll that smoking-related illnesses take on smokers and their loved ones. The goals of the campaign are to 1) build public awareness of the immediate health damage caused by smoking and exposure to secondhand smoke; 2) encourage smokers to quit, and make free help available for those who want it, including calling 1-800-QUIT-NOW or visiting the Web site www.cdc.gov/tips; and 3) encourage smokers not to smoke around others and nonsmokers to protect themselves and their families from exposure to secondhand smoke. The campaign serves as an important counter to expenditures for marketing and promotion of cigarettes that exceeded $900,000 an hour — more than $22 million a day — in the United States during 2010.
Source: ahipcoverage.com

President Obama In San Jose Addresses Surveillance Concerns, Touts Health Care Plan

The Council on American-Islamic Relations, based in Washington, D.C., released a statement today criticizing Obama and calling on Americans “who value constitutional protections of privacy and the prohibition of unreasonable search and seizure to contact their elected representatives to ask that they end the all-encompassing monitoring of telephone communications and the Internet.”
Source: cbslocal.com

Some unions protest Obamacare’s impact on Multiemployer Health Plans | MyFDL

But as currently interpreted, the ACA would block these plans from the law’s benefits (such as the subsidy for lower-income individuals and families) while subjecting them to the law’s penalties (like the $63 per insured person to subsidize Big Insurance). This creates unstoppable incentives for employers to reduce weekly hours for workers currently on our plans and push them onto the exchanges where many will pay higher costs for poorer insurance with a more limited network of providers. In other words, they will be forced to change their coverage and quite possibly their doctor. Others will be channeled into Medicaid, where taxpayers must pick up the tab.
Source: firedoglake.com

A.G. Schneiderman Sends Letters Urging 15 New York Health Insurance Plans To Implement Pharmacy Exemption Rules

NEW YORK – Attorney General Eric T. Schneiderman today sent letters to 15 New York-based health insurance plans urging them to change their policies to permit certain members to purchase specialty drug prescriptions at retail pharmacies instead of through mandatory mail-order services. The letters urge the 15 companies to adopt “Specialty Prescription Drug Fulfillment Hardship Exception Criteria” similar to one that the Office of the Attorney General helped negotiate earlier this year with Empire BlueCross BlueShield.   The Attorney General’s push to release health plan members from unnecessarily burdensome mail-order requirements comes as the office’s Healthcare Bureau Helpline has received dozens of hardship complaints relating to mail-order and non-retail pharmacies requirements from health care plan consumers.   “Every New Yorker deserves easy access to the benefits they pay for,” said Attorney General Schneiderman. “Those suffering from debilitating diseases like cancer, rheumatoid arthritis and HIV should not be made to suffer further hardship to get prescription drugs that are critical to their care. Exempting beneficiaries with qualifying hardships from mandatory mail-order requirements will allow plan members to continue to get the drugs they need from their local pharmacies. I commend Empire for taking this step and strongly encourage all insurance plans operating in New York to do the same.”   Letters of inquiry regarding specialty pharmacy exemptions have been sent to Aetna Inc., AXA Equitable Life Insurance Company, CDPHP, CIGNA, EmblemHealth, Inc., Excellus BlueCross BlueShield, Fidelis Care New York, Healthfirst, HealthNow New York Inc., Independent Health, MVP Health Care, Oxford Health Plans, LLC, The Guardian Life Insurance Company of America, UnitedHealth Care, and WellPoint, Inc.   The Bureau first intervened with Empire, among New York’s largest health care plans, after the company notified its members that, as of January 1, 2013, drugs on Empire’s “Exclusive Specialty Drug List” must be purchased through its specialty mail-order pharmacy, CuraScript, and could no longer be obtained through retail pharmacies. Negotiations with Empire came as members complained that the insurance company’s new mandate would pose undue hardships for them, including compromised privacy, delivery challenges and interference in physician changes in drug dosing schedules.   Empire agreed to implement procedures that will permit qualifying members to be exempted from its specialty mail-order pharmacy mandate.   New York State Law permits commercial plan members to obtain any covered prescription at a retail pharmacy rather than a mail-order or non-retail pharmacy as long as the retail pharmacy agrees by contract to accept the same reimbursement terms and conditions as the mail-order or non-retail pharmacy (such as Empire’s specialty mail-order pharmacy). This law does not apply to self-funded health plans.   Drugs subject to Empire’s mail-order purchase policy include prescriptions for serious and debilitating illnesses that are available from a single drug manufacturer and cost in excess of $1200 per month. These include, among others, drugs used to treat common inflammatory conditions such as rheumatoid arthritis, psoriasis, Crohn’s Disease (e.g., Enbrel, Humira and Remacade); multiple sclerosis (e.g., Cepaxone, Avonex, and Gilenya); cancer (e.g., Revlimid and Gleevec); Hepatitis C (e.g., Pegasis and Rebotol) and HIV (e.g., Combivir, didanosine, Retrovir and stavudine).   Empire’s new hardship policy negotiated with the Office of the Attorney General became effective in March and the company has agreed to notify members who have filed grievances or inquiries about the new hardship exemption.   In order to fill prescriptions for drugs on Empire’s Exclusive Specialty Drug List, a pharmacy must agree to maintain certain patient and clinical services. These include, for example, a 24-hour nurse or pharmacist hotline, toll-free access to patient care advocates, and disease management programs. Such requirements are not within the normal business operations of retail pharmacies.   This matter was handled by Assistant Attorneys General Dorothea Caldwell-Brown and Elizabeth Chesler and Christine D’Ippolito, Manager of the Health Care Bureau Helpline. They were supervised by Lisa Landau, Bureau Chief, Health Care Bureau and First Deputy of Affirmative Litigation Janet Sabel.
Source: ny.us

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June 15, 2013

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

Posted by:  :  Category: Medicare

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

Video: Learn About Medigap Plans

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

Should I have A Medigap Plan For My Healthcare Costs?

One of the best things about becoming a retiree and reaching the Medicare age is the opportunity to join the millions of other men and women receiving government healthcare like Medicare Part A which is hospital insurance and helps cover inpatient hospital care plus nursing, hospice, and home health care. Part B is medical insurance and helps cover outpatient services like doctor’s visits; however unlike Part A, this plan comes with a deductible. If you can get by with what original Medicare health care services covers without any additional help, fine. If not, you can take the next step to more coverage called Part B. If that protective healthcare blanket still leaves you with the need for more coverage not available in A or B, you must take a look at a Medigap or Medicare supplemental policy. You can not get a Medigap policy unless you are already a participant of Medicare Part A and Part B. Medigap plans for your healthcare offer coverage for services that original Medicare doesn’t. Every Medigap policy insurer must be approved by Medicare and your Medicare Medigap supplement plan is renewable which basically means the company cannot cancel you out unless you fail to make the required policy payments on time. The one thing any Medigap insurance policy consumer should be educated on, is that different insurance companies may charge different premium costs for the exact policy and their premiums may even differ in different parts of the county. Shopping for a healthcare Medigap plan that fits your “budget” is what you should be looking for when looking for the best deal on the Internet. Medigap Plan F is the most popular selection among participants and the one many insurance experts would gladly recommend. It is a good combination with Original Medicare, and it covers nearly every out-of-pocket healthcare cost you might incur. Just Remember that when you buy a Medigap policy you will pay a monthly premium plus the premium and you’ll still be required to pay on Medicare Part B. But all in all, if you choose the right Medigap policy offering the blanket of protection you need you will save money in the end.
Source: blogspot.com

AH Insurance Services: CMS Publishes 2013 Choosing a Medigap Policy Guide

A Medigap policy is private health insurance that wraps around the Original Medicare Program (Parts A and B) by filling in gaps to the extent provided by the specific Medigap plan purchased.  This means it helps pay some of the health care costs that Original Medicare doesn’t cover, such as copayments, coinsurance and deductibles. Medigap plans sold in the U.S. are known by their “plan letter name” such as Plan F or Plan N.  Consumers who buy a Medigap policy typically also purchase a Stand-alone Medicare Part D Prescription Drug Plan (PDP) since today’s Medigap plans don’t offer prescription drug coverage. A Medigap policy is different from a Medicare Advantage Plan (like an HMO or PPO) because those plans deliver all of your Medicare benefits, while Medigap just supplements your Original Medicare benefits.  Under a Medicare Advantage Plan (also known as the Medicare Part C Program), you have the convenience of having coverage for doctors, hospitals and prescription drugs all under one roof.  Medicare Advantage plans utilize provider networks, however, which can be more restrictive compared to the simpler requirement under Medigap policies to visit Medicare-approved providers.
Source: blogspot.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

Will health reform make it easier to buy Medigap plans?

It’s also worth mentioning that fact that your premiums may have gone up because you bought a plan with so-called “attained-age” premiums. They’re deliberately designed to start out low when you’re 65 and increase the older you get. People buy them because they’re cheap, not realizing that when they get to be your age, they’re going to be the most expensive. We recommend purchasing policies that are community rated, meaning that premiums are the same no matter what your age. They’ll be a little more expensive when you first buy them, but less expensive than an attained-age policy when you get older.
Source: consumerreports.org

Putting a Donut Hole Back in Medicare: Proposals to Increase Medigap Costs Put Vulnerable Beneficiaries at Risk 

[1] See Medicare Supplement Insurance First Dollar Coverage and Cost Shares Discussion Paper, National Association of Insurance Commissioners (NAIC), Senior Issues Task Force, Medigap PPCA Subgroup, (October 2011), available at: http://www.naic.org/documents/committees_b_senior_issues_111101_medigap_first_dollar_coverage_discussion_paper.pdf.  Also see, e.g., Leadership Council on Aging (LCAO) issue brief “Reforming Medigap Plans by Shifting Costs onto Beneficiaries: A Flawed Approach to Achieving Medicare Savings” (December 2012), available at: http://www.lcao.org/docs/LCAO-Medigap-Issue-Brief-12-12.pdf [2] Medigap Reform: Setting the Context, Kaiser Family Foundation, (September 2011), available at http://www.kff.org/medicare/8235.cfm. [3]Medigap Reform: Potential Effects of Benefit Restrictions on Medicare Spending and Beneficiary Costs, Kaiser Family Foundation, (July 2007), available at http://www.kff.org/medicare/8208.cfm. [4] See, e.g., previous Weekly Alerts, including finding drug savings in Medicare (November 2011) http://www.medicareadvocacy.org/2012/11/15/deficit-reduction-and-medicare-save-money-without-harming-beneficiaries/ ; Prescription Drug Rebates (July 2011) http://www.medicareadvocacy.org/2011/07/21/debunking-medicare-myths-drug-rebates-for-dual-eligibles/ ; and additional options for achieving Medicare savings (June 2011) http://www.medicareadvocacy.org/2011/06/09/so-what-would-you-do-real-solutions-for-medicare-solvency-and-reducing-the-deficit/.
Source: medicareadvocacy.org

Medicare Advantage and Medigap

In 2012, my 84 yo Father-in-law switched from traditional Medicare and a Medicare supplement to the AARP/United Healthcare Medicare Advantage plan. Unknown to him, this switch required him to contact the supplement provider (Blue Cross of FL) to cancel his supplemental insurance. He did not do that. For the past year and a half, Blue Cross has been automatically withdrawing $154 from his bank account every month. When he balanced his checkbook, he ignored this charge. 3 weeks ago, he was hospitalized with a stroke. My wife has power of attorney so we are paying his bills. We noticed the Blue Cross charges while reviewing his monthly bank statements. I called Medicare and they said cancelling the supplement was not automatic even though it is illegal for a company to sell someone with Medicare Advantage a supplement plan. Blue Cross billing doesn’t work on weekends so I’ll be calling them tomorrow. When he switched to Medicare Advantage, which includes RX coverage, his old Part D plan was automatically cancelled. It seems odd that the Medicare Supplement was also not cancelled. Oh well, he should be in line for a $2500+ refund from Blue Cross. We’ll see.
Source: early-retirement.org

MedicareIsSimple: HHS takes NAIC’s Medigap advice

The Solution to Your Healthcare Needs Us Here at Medicare is Simple, we understand your needs. It is our mission to educate and enable you to choose among the best Medicare plans to find the policy that fits your requirements. Get free quotes instantly using our advanced quoting technology. You will receive multiple quotes from the most reputable carriers for you to compare online. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

What is Medigap Insurance

Medicare has defined, and standardized, each type of Medigap Insurance policy that can be sold. The various types have a one letter designator that runs from A through N. The most popular is Medicare supplement Plan F. It is important to know that every company selling a Medigap Insurance plan has to sell the same standardized product. Some differences exist in Medigap coverage from state to state. Before purchasing any Medigap Insurance policy you should check with your state Medicare office. In general Medigap policies never cover long term, or assisted living care expenses. They also do not cover vision or dental expenses. If you are offered a Medigap Insurance policy, you should clearly understand exactly what you do not get under the policy. Then you can compare to verify what original Medicare covers. This will show you if there are any remaining gaps in your coverage.
Source: theglossy.com

5 Things You Need to Know About Medigap Insurance

Either Plan A, Plan C or Plan F Medigap policies must be made available by insurance companies who sell Medigap policies. Plan D and G policies issued before or on June 1, 2010 and Plan D and G policies prior to that date have different benefits. If you happen to have an older policy, such as Plan E, H, I, or J, you don’t have to purchase a new one, however, they are no longer sold. Medigap plans are regulated by the government. If you buy a California Medicare supplement, it will give you identical coverage as the same Florida Medicare supplement. In other words, Medigap Plan A is the same no matter where you reside, as is Plan B, Plan C, and so on.
Source: leerogers2012.com

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June 15, 2013

Local prescription drug plan earns top marks from Medicare

Posted by:  :  Category: Medicare

BlueCross BlueShield Rx PDP contracts with the federal government and is a stand-alone prescription drug plan with a Medicare contract. The plan is administered by Excellus BlueCross BlueShield in cooperation with Empire BlueCross, Empire BlueCross BlueShield, BlueCross BlueShield of Western New York and BlueShield of Northeastern New York. It’s available to Medicare eligible members who reside in New York State.
Source: readmedia.com

Video: Excellus BlueCross BlueShield: “15 Minutes” :30

Medicare Enrollment Begins Today

Of course, many who might be interested are Kodak retirees. Kodak recently announced it had stuck a deal with the Retirees committee to end retiree health care and survivor income benefits by the end of the year. That means thousands could be shopping around for new plans soon. “Since 1935, our company has been taking care of our friends and neighbors and we want to continue doing that, especially when a major employer like Kodak is facing changes,” said Jim Redmond, Excellus BCBS. “For the Kodak employees, if they’re Medicare eligible, they’ve got a lot more choices. If they’re under the age of 64, the choices become a little more difficult. Every individual situation is different. You really do need to sit down and figure out what is going to be best for you.”
Source: ynn.com

Open Enrollment and Star Ratings for 2013

MA plans and PDPs have a number of concerns about the methodology used to establish the star ratings, including the age of the data (e.g. the 2013 ratings are based on 2011 data), the frequent changes in methodogy and the difficulty in improving scores from year to year. For most plans these ratings are good news and the star rating has gone up for most measures from 2012 to 2013. Three new measures focused on care coordination and improvement. For MA-PDs, the national average for the care coordination measure was 85 percent or 3.4 stars. Non-SNPs performed better on this measure than SNPs. The measure for net improvement showed that MA contracts on average achieved a score of 3.1 for Part C and 3.4 for Part D while PDPs achieved an average score of 4.1. However approximately 10 percent of the plans will see a lower bonus as a result of their new lower ratings and plans with 2.5 stars or less for three years in a row face the possibility of termination from the program.
Source: gormanhealthgroup.com

Alliance Life Sciences Expands Offering, Appoints Managed Care Pharmacy Pioneer Joel Owerbach, Pharm.D., as Vice President of Health Policy and Strategy

Formed in 2001 and headquartered in Somerset, N.J., Alliance Life Sciences Consulting Group helps our customers maximize revenue and pricing in an outcomes-based world. We employ hundreds of professionals around the globe who help firms receive full value by solving problems in Contracting, Pricing, Reimbursement, and Commercial Operations. We enable this mission in a healthcare world where the true focus is on the patient’s health and well-being, the ultimate bottom line for everyone. Alliance works with 8 of the top-10 pharmaceutical manufacturers, as well as mid-market and other life sciences companies. Contact: 866-581-4850
Source: cpronline.com

National Influenza Vaccination Week December 4

(BINGHAMTON, NY) – In observance of National Influenza Vaccination Week, the Broome County Health Department will be holding a flu clinic on Monday, December 5, 2011 from 1:00 p.m. to 4:00 p.m. at their offices located at 225 Front Street, Binghamton. The clinic is open to anyone ages three and up. The fee for the flu vaccine is $25 (cash or check only). If you are 65 years of age or older and subscribe to traditional Medicare Part B, Excellus Medicare Blue PPO, Today’s Options or CDPHP Medicare the health department will bill your insurance plan.
Source: gobroomecounty.com

Broome County Health Department Announces Seasonal Flu Clinics for Fall 2009

The fee for the flu vaccination is $20. The pneumonia shot is also available for Medicare Part B recipients aged 65 and older at Broome County Health Department sponsored clinics (*) only. There will be no out of pocket fee for the flu or pneumonia shots for Medicare Part B recipients. Individuals on Medicare must present all insurance cards to staff at the clinic. If you have signed up with Today’s Options-American Progressive or Excellus Medicare Blue PPO Medicare Advantage Plan, we can charge your plan. For other Medicare Advantage Plans, such as Aetna Golden Medicare, CDPHP Medicare Choice, etc, you need to go to your primary care provider for the flu shot or be prepared to pay by cash or check.
Source: gobroomecounty.com

Involuntary Changes to MCSO Retirees Medical Benefits

A retired MCSO Deputy began receiving various documents from the Monroe County Human Resources Department. The documents advised him that form(s) enclosed with the documents had to be completed by his 65th birthday or he would lose all of his medical benefits. When the retired Deputy reached the age of 65, he received more written correspondence from the Monroe County Department of Human Resources concerning his medical benefits coverage for both himself and his spouse; specifically, that his primary care coverage was changed to Medicare (we have been informed/advised that this happens to everyone). Furthermore, the Deputy’s secondary coverage was involuntarily changed to Excellus Medicare Blue Choice (HMO-POS). For over fifty years, it has been customary for retirees to remain in the same plan throughout the length of their retirement; this, however, seems to no longer be the case. Secretary Flannery advised SOAR President Ed Ramsperger of the situation and also spoke with Monroe County Deputy Sheriff’s Association (MCDSA) Jail Union President Wayne Guest. President Guest felt that this was a very important issue and invited Secretary Flannery and President Ramsperger to the next Jail Union Board meeting to discuss the matter. The retired Sheriff’s Deputy who originally contacted Secretary Flannery was also invited to share his experiences at the meeting. At the Jail Union Board meeting, this topic was discussed and the Jail Union Board voted unanimously to “take on” the matter and begin a dialog with the Monroe County administration to determine just what was happening and how to get the matter solved to the satisfaction of all involved.
Source: monroecountysoar.com

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