Medicare Supp Rates Prior June 2010

Posted by:  :  Category: Medicare

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

Video: Medicare Supplemental Insurance Rates

Medicare Spending and Financing Fact Sheet

The Part A Trust Fund is projected to be depleted in 2024—eight years longer than in the absence of the health reform law—at which point Medicare will not have sufficient funds to pay full benefits, even though revenue flows into the Trust Fund each year.  Part A Trust Fund solvency is affected by growth in the economy, which directly affects revenue from payroll tax contributions, and by demographic trends:  an increasing number of beneficiaries, especially between 2010 and 2030 when the baby boom generation reaches Medicare eligibility age, and a declining ratio of workers per beneficiary making payroll contributions.  Part B and Part D do not have similar financing challenges, because both were structured to be funded by beneficiary premiums and general revenues, set annually to match expected outlays.  However, future increases in spending under Part B and Part D will require increases in general revenue funding and higher premiums paid by beneficiaries.
Source: kff.org

Medicare cuts continue as doctor slashes throats.

The straight-forward Medicare remedy is to force suppliers to compete on price. Numerous pilot programs have proven that competitive bidding will save taxpayers hundreds of millions of dollars each year with no harm to patient care. As authorized under the Affordable Care Act, competitive bidding in the DMEPOS marketplace is scheduled to begin July 1. The projected savings for taxpayers and Medicare beneficiaries over the next 10 years is $42.8 billion.
Source: medicarewire.com

GAO Report Finds Excess Spending in Medicare

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

Medicare Revises Hospitals’ Readmissions Penalties

Medicare’s mistake occurred in its calculations of the penalties for hospitals, according to a notice the agency published Friday. Medicare said it would be basing the penalties on the readmission rates and reimbursements for patients who were discharged from July 2008 through June 2011. But the agency wrote that it “inadvertently” included Medicare claims before July 1, 2008, in its evaluations.
Source: kaiserhealthnews.org

Aetna to cut pathology reimbursement to 45

In 2011, Medicare paid between 18 and 30 percent more than other insurers for 20 high-volume and/or high-expenditure lab tests. Medicare could have saved $910 million, or 38 percent, on these lab tests if it had paid providers at the lowest established rate in each geographic area. State Medicaid programs and 83 percent of FEHB plans use the Medicare CLFS as a basis for establishing their own fee schedules and payment rates, although most pay less. However, unlike Medicare, FEHB programs incorporate factors such as competitor information, changes in technology used in performing lab tests, and provider requests in their payment rates. Some State Medicaid programs and FEHB plans required copayments for lab tests, which, in effect, lowered the costs of lab tests for the insurer.
Source: pathologyblawg.com

Humana examining 2010 Medicare rates, reaffirms '09 guidance

said Monday that the preliminary Medicare Advantage payment rates for 2010 announced on Friday by the Centers for Medicare and Medicaid Services (CMS) would have a “significant adverse impact” on 2010 premiums for Medicare Advantage members. The firm said it is closely analyzing the rates, which have been put out for public comment, because it believes certain assumptions made by CMS are unusual and inconsistent with past practices. Among the assumptions being examined is the assumed rate of change in medical cost trends and the assumptions about the impact of the economy on medical spending. Humana also reaffirmed its guidance for 2009 earnings of $5.90 to $6.10 a share.
Source: marketwatch.com

Feds to Pay 110% of Medicare Rates for Haiti Evacuees

I agree with these comments. MIllions of Americans cannot get any care and some are in just as desperate need as these Hatians. Medical care for Hatians should be done by medical volunteers who go to Haiti and give aid there. Hatians should not be brought to the US to get medical care that needy Americans cannot get. I care about the situation in Haiti and have made two donations to charities that are helping there. Haitians need help and we should all give what we can to help, but it is ridiculous to provide medical care in the US (the most expensive place on earth for anyone to receive medical care!) and pay for it out of government funds when we do not have government-funded health for our own people.
Source: wsj.com

Medicare growth attributed to change in skilled nursing facility pay rates

Medicaid spending slowed significantly in 2011 on a year-over-year basis. The program grew 2.5% in 2011, a significant drop from 5.9% growth in 2010. The CMS report said budgetary pressure on states caused by the weak economy and the June 2011 expiration of federal aid to the states contributed to the slower growth.
Source: mcknights.com

Medicare Part D is prescription drug coverage insurance that is provided by private companies approved by Medicare.

Posted by:  :  Category: Medicare

Example: Mrs. Smith didn’t join when she was first eligible-by June 15, 2009. She doesn’t have prescription drug coverage from any other source. She joined a Medicare drug plan with an effective date of January 1, 2012. Her drug coverage was effective January 1, 2010. Since Mrs. Smith was without creditable prescription drug coverage from July 2009-December 2011, her penalty in 2011 was 30% (1% for each of the 32 months) of $31.08 (the national base beneficiary premium for 2012), which is $9.32. The monthly penalty is rounded to the nearest $.10. She pays this late enrollment penalty of $9.30 monthly in addition to her plan’s monthly premium. Here’s the math: .30 (30% penalty) x $31.08 (2012 base beneficiary premium) = $9.32 $9.32 (rounded to the nearest $0.10) = $9.30 $9.30 = Mrs. Smith’s monthly late enrollment penalty
Source: medicare.gov

Video: Reality check: Tax rates & Medicare

ICS Software Ltds SammyEHR To Now Offer PECOS Lookup For Referring Doctors

The need for this feature is explained in CMS’ March 2013 issue of Medicare Enrollment Guidelines for Ordering/Referring Providers, which states that “Effective May 1, 2013, CMS will turn on the edits to deny Part B, DME, and Part A HHA claims that fail the ordering/referring provider edits. Once the edit activates, if the billed service requires an ordering/referring provider and the ordering/referring provider is not identified on the claim, the claim will not be paid. If the ordering/referring provider is identified on the claim, but is not enrolled in Medicare, the claim will not be paid. In addition, if the ordering/referring provider is identified on the claim, but is not of a specialty that is eligible to order/refer, the claim will not be paid. CMS encourages laboratories, imaging centers, DMEPOS suppliers, and HHAs to work with their ordering/referring providers to ensure they are prepared for this change.”
Source: healthcaretechnologyonline.com

Take Medicare Off That Check: Court Rules That Medicare Not Required to be on Settlement Check

In general, some factors to consider on this front include: (a) starting the process to obtain conditional payment information early and during the course of the claim, as opposed to waiting until the claim settles; (b) reviewing Medicare’s conditional payment claim and requesting the removal of inappropriate items to obtain an accurate exposure assessment; (c) clearly delineating who will be responsible for reimbursing Medicare’s conditional payment claim and how this will be done as part of the settlement negotiations and settlement agreement; (d) including all necessary settlement provisions and language, and (e) employing the most effective and practical safeguards to ensure that sufficient funds are available once Medicare’s “final” conditional payment figure is received post-settlement.
Source: lexisnexis.com

MDinteractive: Received $18,000 check from Medicare for Meaningful Use Attestation with Care360 EHR

Question: I am an eligible professional (EP) who has successfully attested for the Medicare EHR Incentive Program, so why haven’t I received my incentive payment yet? Answer: For EPs, incentive payments for the Medicare EHR Incentive Program will be made approximately four to eight weeks after an EP successfully attests that they have demonstrated meaningful use of certified EHR technology. However, EPs will not receive incentive payments within that timeframe if they have not yet met the threshold for allowed charges for covered professional services furnished by the EP during the year. The Medicare EHR incentive payments to EPs are based on 75% of the estimated allowed charges for covered professional services furnished by the EP during the entire payment year. Therefore, to receive the maximum incentive payment of $18,000 for the first year of participation in 2011 or 2012, the EP must accumulate $24,000 in allowed charges. If the EP has not met the $24,000 threshold in allowed charges at the time of attestation, CMS will hold the incentive payment until the EP meets the $24,000 threshold in order to maximize the amount of the EHR incentive payment the EP receives. If the EP still has not met the $24,000 threshold in allowed charges by the end of calendar year, CMS expects to issue an incentive payment for the EP in March 2012 (allowing 60 days after the end of the 2011 calendar year for all pending claims to be processed). Payments to Medicare EPs will be made to the taxpayer identification number (TIN) selected at the time of registration, through the same channels their claims payments are made. The form of payment (electronic funds transfer or check) will be the same as claims payments. Bonus payments for EPs who practice predominantly in a geographic Health Professional Shortage Area (HPSA) will be made as separate lump-sum payments no later than 120 days after the end of the calendar year for which the EP was eligible for the bonus payment. Want more information about the EHR Incentive Programs? Make sure to visit the CMS EHR Incentive Programs website for the latest news and updates on the EHR Incentive Programs.”
Source: blogspot.com

North Carolina Board of Pharmacy : Medicare and Medicaid Information

Officials in Connecticut, Mississippi, Missouri and Iowa report that older consumers are receiving calls informing them that they can be enrolled in a program that meets their prescription drug needs for only $389. The program is not affiliated with or sanctioned by the Medicare Part D prescription drug program, but consumers may be getting that impression from the callers. Connecticut and Iowa officials report that callers possessed foreign accents. They pitched the plan and sought account information so that the consumers’ bank accounts could be debited for the supposed enrollment fee. Upon calling the toll-free number that was given to an older consumer in her state, a Connecticut official spoke with a company representative who acknowledged that they had no connection to Medicare and were "an independent supplier that offered 30-50% discount on prescription drugs." The company representative refused to send any information on the company’s program until after the fee was paid. The representative offered the following as the website for her company: www.pharmabay.net. That website is registered to parties in Montreal, Quebec, Canada.
Source: ncbop.org

How to Prevent Medicare Card Identity Theft

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

Medigap vs. Medicare Advantage Plan

Posted by:  :  Category: Medicare

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Video: Medicare Supplements vs. Medicare Advantage – Understanding Medicare Supplements

Tips to Comparing Medicare Supplement and Medicare Advantage

Another open enrollment period starts on 17th October and ends on 7th December, every year. You’re allowed to drop existing advantage plan and get back to the conventional Medicare between 1st of January and last of February. 3.  Level of coverage – There is no dearth of Medicare supplement plans and coverage; every state controls such plans and sometimes requires certain coverage. The premium payable depends on the level and extent of healthcare services the plan provides. On the other hand, Medicare advantage offers the services offered by original Medicare. Advantage plans fall into different categories like preferred provider organizations or PPOs that charge less fees for in-network providers, health maintenance organizations or HMOs that require the plan holders to use in-network providers, private fee for service or PFFS that allow the plan holders to visit any physician and special needs plans or SNPs for the patients in need of special care or admitted in nursing home. Moreover, these plans sometimes offer Health Savings Accounts or HSAs to which original Medicare contribute dollars that can be used for healthcare services. 4.  Prescriptions – Since the launch of Medicare part D, also known as prescription in 2006, supplement plans have stopped providing coverage for prescription medications. Individuals who have registered for part D after January 2006 needed to drop prescription coverage. On the other hand, advantage plans are not obliged to offer prescription medication coverage. If your plan doesn’t provide such coverage, you may enroll for part D without paying any penalty. In terms of the above-mentioned points, you can significantly compare Medicare advantage plans to supplement plans.
Source: ezinemark.com

How Medicare Supplement Plans & Medicare Advantage Plans Work

When beneficiaries turn 65 and first become enrolled in both parts of Original Medicare, they fall into their six-month Medigap Open Enrollment Period (OEP), which starts the first day of the month they are both age 65 or older and enrolled in Part B. This may be the best time to buy a Medigap policy because if a beneficiary decides to enroll after this time, their options may be limited and they may have to pay more for coverage. At the same time, beneficiaries also fall into their Initial Enrollment Period (IEP), which runs for seven months starting three months before they turn age 65 and lasts until three months afterwards. During this time, beneficiaries can sign up for any MA or Part D plan that contracts in the county and state in which they reside.
Source: planprescriber.com

Medigap vs Medicare Advantage

Rather than being subject to the standard Part A deductible for instance, you may have a copayment required for a defined number of days. Additionally, rather than the 20% coinsurance amount required by original Medicare for outpatient services, you will generally have varying copayment or coinsurance amounts for different services.
Source: medicareprofs.com

Medigap or Medicare Advantage?

The best place to understand either option is to go to MedicareInteractive.org, where there is an easy-to-read chart. Another good resource is ConsumerReports.org, which in November 2010 focused on Medicare issues and rated Medicare Advantage plans. You can find much of the best information online free of charge, but in order to read Consumer Reports’ rankings, you’ll have to subscribe (or find the issue at the library). The place where you’ll make the final selection is Medicare.gov. It’s a good idea to just ignore the big pile of sales literature that will fill up your mailbox.
Source: bankrate.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

What is Medicare Supplement (Medigap) Insurance

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

Medigap Plan F, Pros and Cons

Posted by:  :  Category: Medicare

As with everything, the Medigap Plan F (better known as Medicare Supplement Plan F), has pros and cons. Regardless, this is the most popular supplement to Medicare available. We’re going to take a moment and investigate the reasons this particular plan is so appealing and why or why it might not be best for you as a health care consumer.Let’s start with the one negative aspect of the F Plan, if for nothing else, than to get it out of the way. The F Plan is one of the more costly plans available. Even though prices vary from one insurance carrier to the next, this plan will be at the top of their price chart. As we discuss the otherwise great aspects of this plan, you’ll see why it can be costly. With more benefit comes greater cost.At the same time, all of the cost accumulated with the F Plan is up front. What does this mean for you? It means that all of the expense is built into your monthly premium instead of in high deductibles, co-pays and other methods of cost sharing (i.e. sharing a percentage of the final bill, usually as much as 50%).
Source: youneedtoknowme.org

Video: Medicare Supplement plan F High Deductible Explanation

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

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

Government to Leave Plan F Alone

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Source: medicareagenttraining.com

Medicare Supplement Plan F

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

Medicare’s new policy for diabetic supplies

Posted by:  :  Category: Medicare

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Source: early-retirement.org

Video: Are Diabetic Supplies Covered by Medicare?

Optional Notification of Mail Order Diabetic Beneficiary Patients

 (*)  The Medicare-approved amount for diabetic testing supplies will be the same regardless of where they are furnished. Medicare contract suppliers must always accept assignment on these items. This means they must accept the Medicare-approved amount as payment in full and cannot charge beneficiaries more than the 20 percent coinsurance and any unmet deductible. Beneficiaries may also choose to purchase diabetic testing supplies in person at any Medicare-enrolled supplier storefront; however, these retail locations may or may not accept assignment. Beneficiaries who use suppliers that do not accept assignment may pay more than the 20 percent coinsurance and any unmet deductible.
Source: vgm.com

Your current Medicare provider may not be able to supply you with your medical supplies

PRLog (Press Release) – Jun. 10, 2013 – WELLINGTON, Fla. — What is the national mail-order program for diabetic testing supplies? A new national mail-order program for diabetic testing supplies is scheduled to start in July 2013. This program is designed to ensure that you continue to get quality supplies while you save money. When it starts, you’ll need to use a Medicare national mail-order contract supplier for Medicare to pay for your diabetic testing supplies that are delivered to your home. If you don’t want your diabetic testing supplies delivered to your home, you can go to a local store and buy them there, but you’ll probably pay more out-of-pocket costs. If you take advantage of the national mail-order program, diabetic supplies will be mailed or delivered to your home and Medicare will save money and your copayment will be lower. How does the program affect me if I use mail-order diabetic supplies? Starting in July 2013, Medicare will implement a national mail-order program for diabetic supplies that will affect everyone with Original Medicare in the United States and its territories. Can I still get my diabetic supplies from my local pharmacy? Yes, you can. The national mail-order program for diabetic supplies does not include pharmacies or other retail stores. However, if you go to your local store to get your supplies, you will probably pay more for these supplies than you would if you bought them from a mail-order Medicare contract supplier. Both you and the Medicare Program can save money each time you use a mail-order contract supplier. Where can a get a list of Medicare contract suppliers? Simply enter your zip code into the Medicare Supplier Directory search tool on the Medicare website at www.medicare.gov/
Source: prlog.org

Diabetics on Medicare Face Critical Deadline, Need Information

There is little question that this new system will be better in the long run.  The government will save money and you will see your co-pay and deductible amounts decrease.  For example, patients testing one time a day, before July 1, have an average co-pay of approximately $14.47 on their testing supplies.  After July 1, for the same order, the co-pay will decrease to approximately $4.49. This is a savings to you of almost 70%!  The actual cost may be even lower or no cost at all if you have secondary insurance.
Source: wphealthcarenews.com

Information for PWD's on Medicare

There is little question that this new system will be better in the long run.  The government will save money and you will see your co-pay and deductible amounts decrease.  For example, patients testing one time a day, before July 1, have an average co-pay of approximately $14.47 on their testing supplies.  After July 1, for the same order, the co-pay will decrease to approximately $4.49. This is a savings to you of almost 70%!  The actual cost may be even lower or no cost at all if you have secondary insurance.
Source: scottsdiabetes.com

Diabetes Care Club Acquires Priority Diabetes Supply

Recognizing the significant cost savings and quality improvements that competitive bidding presents for patients, Diabetes Care Club prepared for the program’s implementation by improving internal processes, increasing efficiencies and lowering product costs. When CMS announced the bid prices in early 2013, Diabetes Care Club was not initially awarded a contract due to a high bid. However, the company determined that it was in a position to effectively serve the market at the required price and implemented its contingency plan, which lead to the purchase of Priority Diabetes Supply, one of the contract winners.
Source: medbill.net

Edgepark & Medicare’s New DMEPOS Supply Guidelines

Competitive Bidding Legislation The Medicare Modernization Act of 2003 (MMA) required that CMS institute a Competitive Bidding Program for DMEPOS. According to the CMS, “Under the program, DMEPOS suppliers compete to become Medicare and Medicaid contract suppliers by submitting bids to furnish certain items in competitive bidding areas, and the Centers for Medicare & Medicaid Services (CMS) awards contracts to enough suppliers to meet beneficiary demand for the bid items.” The intent of competitive bidding, in part, is to address cost issues with DMEPOS and providing additional supplier oversight to ensure that beneficiaries (patients) receive quality items at reasonable prices. (Before the competitive bidding program was in place, certain DMEPOS items were reimbursed to suppliers through a fee schedule.)
Source: edgepark.com

Are Diabetic Supplies Covered by Medicare?

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Source: medprosondemand.com

Medicare Diabetes Supplies

The Centers for Medicare & Medicaid Services is implementing drastic cuts to its reimbursement levels for pharmacies providing diabetes test supplies to Medicare beneficiaries through the Part B program. As of July 1, uniform payment rates will apply to both mail order and local pharmacy providers. In addition, without a policy reversal, a ban on deliveries by pharmacies will also take effect then and seniors will be required to use mail order for delivery services.
Source: trinityapothecary.com

Diabetes screenings, supplies, and training – Medicare has you covered

If you’re at high risk for developing diabetes, Medicare covers up to two fasting blood glucose (blood sugar) tests each year. If your doctor accepts assignment, you pay nothing for these tests. You may be at high risk for diabetes if you’re obese, have high blood pressure, high cholesterol, or a family history of diabetes. Talk to your doctor to find out when you should get your free screening test.
Source: medicare.gov

State Highlights: Ga. Ponders Higher Health Plan Rates For Employees

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Oregonian: Oregon’s Home Health Care Industry Faces Major Federal Cuts; Access Cited Home health care providers in Oregon and their allies say their industry is in a bind. The state’s rural home health providers don’t make as much as they should from serving Medicare patients, and the state’s providers overall are slated for an even bigger hit next year, according to the industry’s advocates and allies in Congress. Last week, Oregon’s Congressional delegation signed a letter to Marilyn Tavenner, administrator of the Center for Medicare and Medicaid Services, asking her to adjust the 2013 reimbursement rates for the state’s rural home health providers, saying unusually low wages at one rural hospital in Coos Bay had unfairly brought down the wage index used to set federal reimbursement the entire state’s rural home health sector — amounting to a six percent cut (Budnick, 6/13).
Source: kaiserhealthnews.org

Video: Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year

Obamacare to Increase Average Ohio Health Insurance Premium 88%

Democrats continue to try to dismiss the evidence that Obamacare will dramatically increase the cost of insurance for people who buy it on their own. But on Thursday, the Ohio Department of Insurance announced that, based on the rates submitted by insurers to date, the average individual-market health insurance premium in 2014 will come in around $420, “representing an increase of 88 percent” relative to 2013. “We have warned of these increases,” said Lt. Gov. Mary Taylor in a statement. “Consumers will have fewer choices and pay much higher premiums for their health insurance starting in 2014.”
Source: frontpagemag.com

Trends in Health Insurance Premiums for Public and Private Employers

Looking at publicly available estimates based on the MEPS-IC, we found that the gap between premiums for the public sector (state and local governments) and private employers grew dramatically from 7.5 percent in 2000 to 20.5 percent just nine years later.  The figure below shows this growing gap in premium costs for enrollees.  In 2009, the single premium per employee enrolled in state and local government health plans was $5,627 versus $4,669 for plans offered by employers in the private sector.  A more detailed analysis (not shown) indicates that the higher growth in premiums in the public sector was driven by rising premiums for local government establishments.
Source: census.gov

Washington State Insurance Update: Average health insurance premiums, by state

Among states in the West, Washington is a standout for below-average premiums compared to median household income, the study found. In Oregon, Idaho, California, Montana and Nevada, premiums compared to income were higher. (Click on the map above for more on this.) In pure dollar terms, Idaho is the fifth lowest-cost state in the country, although its average deductibles are significantly higher than Washington’s. The lowest average premiums were in Arkansas; the highest in Massachusetts. Regardless, “Health insurance is expensive no matter where one lives,” the report’s writers concluded. “…Across the country, insurance premiums have risen far faster than median (middle) income for the under-65 population.)” Here are the state average premiums in our region:
Source: blogspot.com

Study: Premiums could rise an average of 40 percent under ObamaCare

The firm analyzed the individual markets in six states with varying degrees of regulation already in place. In New Jersey, where insurance is already highly regulated, the healthcare law won’t lead to much of a premium hike at all — in fact, consumers could see their costs fall by as much as 25 percent.
Source: thehill.com

Huntsville Hospital cancels raises for about 8,000 employees, increases health insurance premiums, makes pension changes

CEO David Spillers notified employees on Friday that hospital leaders were forced to make some “difficult decisions” because of flat patient volumes, rising employee health insurance costs – expected to top $50 million next year – and declining reimbursements from Medicare, Medicaid and private insurers.
Source: al.com

Health insurance increases loom for state workers

With the premium increase in July, a single employee earning less than $50,000 will pay an extra $5.13 each biweekly pay period — or $133 a year— for the most popular insurance plan, a managed care network by Presbyterian Health Plan. The employee cost will be $39.30 biweekly and the state will contribute $157.18 under the new rates.
Source: artesianews.com

In California, Single Women Will Also Face A Doubling of Health Insurance Premiums Due To Obamacare

In 2014, Obamacare’s blizzard of regulations and mandates will transform the U.S. market for health insurance, among people who buy coverage for themselves. Of increasing concern is the phenomenon of “rate shock,” whereby many Americans face substantial increases in their health insurance premiums. Much of the debate has focused on young men, the “bros” who will bear the brunt of Obamacare’s rate hikes. But in California, women and men will see equally high jumps in the underlying cost of individual-market premiums.
Source: thefinancialphysician.com

On Medicare + secondary INsurance

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I don’t know about pen needles, but you can get a list of Medicare approved vendors. I get my supplies (which is meds and test strips, basically) from Wal Mart, but other approved are Walgreen’s, any Kroeger store, and several others. Should be something on line you could find out. I was told to search "diabetic durable supplies".
Source: diabetesdaily.com

Video: Setting up Medicare as Primary Insurance and Commercial Insurance as Secondary Insurance

Long Waits For Consumers When Medicare Is ‘Secondary Payer’

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

Ask The Experts: Retirement

A. Because you are retired, Medicare would be primary and your FEHB coverage secondary. It doesn’t make any sense not to sign up for Medicare Part A because you’ve already paid for that benefit through payroll deductions. Whether you need to sign up for Part B is decision you’ll have to make. To get a better understanding of the relationship between the FEHB and Medicare, go to www.opm.gov/insure/health/medicare/index.asp
Source: federaltimes.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

GlobeMed announced as a service provider in the new National Health Insurance Scheme

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“We are very proud and honored to be chosen to serve the universal health program that will be gradually introduced to all nationals, non-nationals and visitors to Qatar. We are confident that we will be up to the task entrusted to us by being able to offer a wide range of Third Party Administration (TPA) services to setup the technical platform needed to execute these services in Qatar. “GlobeMed forged a strategic business partnership with Alkhaleej Takaful Group and Aetna and we have high expectations about what we will achieve together to the project,” said Rabih Kharma, Vice President of ICT at GlobeMed Limited and the assigned Project Manager. During a press conference held on June 10, 2013 in Doha, the SCH announced that the Qatari insurance company Alkhaleej Takaful Group has been appointed as the third party administrator for NHIC – the company that will manage the country’s health care insurance system – . GlobeMed and Aetna, a global diversified health care solutions company, have been nominated as joint exclusive subcontractors. Building on its twenty two years of experience and know-how in providing well tested solutions in the management of healthcare benefits, for both private and public sectors, GlobeMed will form a cornerstone of the project and will use its robust technical expertise in third party administration to provide a wide range of services to manage the complex needs of the client. The first phase of the National Health Insurance Scheme will be dedicated to serving the women of Qatar and will cover maternity, gynecology and related women’s healthcare “GlobeMed is fully committed to make this first phase a total success and aims at building upon it to support and meet effectively the national health insurance plan of the State of Qatar goals and its upcoming phases in a timely and efficient manner,” said Kharma.
Source: ameinfo.com

Video: The Basic Economics of National Health Insurance – Professor Richard D Wolff

Information Security Architect

Under the guidance of his Highness the Emir of Qatar, the Supreme Council of Health (SCH) was established in 2009 and given the responsibility to guide reform in Qatar in order to establish one of the world’s most admired and renowned health systems. The SCH’s role is to create a clear vision for the nation’s health direction, set goals and objectives for the country, design policies to achieve the vision, regulate the medical landscape, protect the public’s health, set the health research agenda, and monitor and evaluate progress towards achieving those objectives. The (SCH) oversees and regulates the health sector, promoting high quality care through use of the latest information technology and support of a health care financing program that provides access to all while establishing incentives for good resource stewardship. The SCH also promotes evidence- based policies that seek to improve the health and well-being of individuals and their families. The State of Qatar aims towards “a comprehensive world-class healthcare system, whose services are accessible to the whole population”. One of the envisaged ways of achieving this is to secure “effective and affordable services in accordance with the principle of partnership in bearing the costs of healthcare.” In accordance with the vision for the nation’s health direction and Emiri Decree Number (13), the SCH has established the prerequisite regulatory and policy framework for the successful introduction of a Social Health Insurance (SHI) Scheme in the State of Qatar.
Source: bayt.com

Should Congress create a national health

Defenders of the ACA have noted the irony that conservatives, who tend to champion state autonomy, have led the opposition to the creation of state-based insurance exchanges. Yet as Douglas Holtz-Eakin of the American Action Forum, a leading critic of the ACA, has observed, the state-based insurance exchanges are best understood as “a second Medicaid program,” which will likely suffer from the same misaligned incentives as its more familiar cousin. While the federal government will cover the entire cost of the subsidies designed to make the insurance plans offered on the exchange affordable, state governments will be free to impose regulations and mandates on insurance plans that could raise their cost. State lawmakers might want to reward medical providers by deeming that various expensive and non-essential medical treatments must be covered by insurance, but state governments will be under no obligation to bear the cost of having done so.
Source: reuters.com

National Health Insurance Reconsidered

7.  Free-Market Prices.  Health care providers are to be strictly prohibited from ever charging more than they would otherwise charge just because a household’s yearly or long-term cap has been, or is likely to be, exceeded.  Other than this, national health insurance is not to place any restrictions upon what providers charge.   And, regardless of what they charge, providers that observe the above prohibition are, by government, to be reimbursed in full for any nationally insured care they provide, except for care not subject to the normal constraints of supply and demand.  Care not subject to the normal constraints of supply and demand would be (1) preventative care provided free of charge, and (2) extraordinarily expensive care, like heart transplants, care that, by itself, would be costly enough to put a typical household above its yearly or its long-term cap, thereby undermining the incentive to shop prudently.  How much providers are to be reimbursed for care not subject to these normal constraints is to be determined by NIA officials in negotiation with a panel of health care providers.  The reimbursement limits  they set are to be just high enough for assuring that providers choosing not to charge more than these limits will be sufficient in number for no one ever to lack timely access to necessary care solely because of costs.  Households that patronize providers that do charge more than these limits are to be wholly responsible for paying the difference themselves.
Source: healthaffairs.org

GLOBEMED’S CONTRIBUTION TO THE QATARI NATIONAL HEALTH INSURANCE SYSTEM

During a press conference held on June 10, 2013 in Doha, the SCH announced that GlobeMed has been chosen, as part of the consortium, to serve the universal health program that will be gradually introduced to all nationals and residents of Qatar.
Source: globemedltd.com

MSNBC bringing health care to the uninsured in Louisiana

On Tuesday, Louisiana Gov. Bobby Jindal signed a bill into law requiring more reporting and increased transparency in two of the state’s Medicaid programs, but passed on the chance for additional coverage for citizens who currently lack health insurance.
Source: msnbc.com

SDN Completes Second Annual National Health Care Student Survey

Respondents are neutral about the future of U.S. health care On average, most respondents feel that U.S. health care quality is remaining about the same, not getting better or worse, with 32 percent stating that it is getting worse and 32 percent that it is getting better. This is a jump from the 2012 results, when 44 percent stated that it was getting worse and only 23 percent stated that it was getting better.
Source: studentdoctor.net

Gerber Life Guaranteed Issue Life Insurance | Medicare Agent Training

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Source: medicareagenttraining.com

Video: Medicare Advantage, Individual & Family Health Insurance, Life Insurance, Hacienda Heights, CA

Life Insurance and Medicare

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Source: creditablecoverage.org

A Couple Of Things You Must Know About Life Insurance

humana walmart To forfend that, here are a few baksheeshes to assist direct from those individual societies. Characters of Supplementary PlansThere are different Characters Medicare Supplementations or Medigap reportage. Open enrolment is the initiative dissimilar underwriters are offering on the plan you alike most. mediattention supplement plans are ordinarily more comprehensive in care through with HMO s that bound your pick of physicians to a web. The statute law has far-reaching imports which will be position will not single you out for cancellation or specific charge per unit gains. Advantage programs are Emergency is not treated. The one estimable thing about the new Medicare family the most and so requires the topper for them. The interchangeable Medigap designs extend accidental injuries and grave dieases,mediacl insurance will account for most of medical expenses for a long term.
Source: firefox2007.eu

Bankers Life Insurance Medicare Supplement

QUESTION: In The state of Texas is it legal to have 2 supplimental insurance in addition to my medicare coverage? I don’t want to go to HMO’s or PPO’s for coverage. With 2 supplemental coverage I can efford to go to the the best doctors and hospitals and when I have an HMO or PPO I feel like I’m in a kennel or cow pen and the Doctors don’t communicate well with the people they treat very well unless you know exactly what the questions are. They simply don’t go into any details of any condition one may have. They are in a hurry to get you out to go onto another person.
Source: studio-210.com

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June 20, 2013

Inspector General Faults Medicare for Not Tracking ‘Extreme’ Prescribers

Posted by:  :  Category: Medicare

The inspector general’s report calls on the Centers for Medicare and Medicaid Services (CMS), which oversees the program, to step up scrutiny of doctors with questionable prescribing patterns. It urged CMS to direct its fraud contractor to expand its analysis of prescribers and train the private insurers that administer Part D on how to spot problem prescribers.
Source: propublica.org

Video: How to Save Medicare $30 billion: www.UpgradeThe Card.org

Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending

The study also examines the expected impact of two variations of this proposal. The first looks at a higher or lower out-of-pocket spending limit, and illustrates how raising the limit would increase beneficiary costs while reducing Medicare spending, while a lower limit would do just the opposite. The second variation examines the effect of combining the alternative benefit design with restrictions on Medigap coverage, another frequently mentioned approach to achieving Medicare savings.
Source: kff.org

Medicare Spending Variations Mostly Due To Health Differences, Study Concludes

A 2008 “white paper” from Dartmouth directed at policy makers and titled “an agenda for change” implied the possibility of substantial savings if Medicare rooted out inefficiency and unnecessary treatments. “How much could Medicare save?” the paper asked. “Given the strong national reputations enjoyed by such organized practices as the Mayo Clinic and Intermountain Healthcare, and the objective evidence that they deliver more efficient, higher quality care, it seems reasonable to use these systems as benchmarks for the rest of the country. Were all providers in the country to achieve the same level of efficiency for inpatient spending on supply-sensitive care, we estimate a 28 percent reduction in hospital spending under a Mayo benchmark and a 43 percent reduction under an Intermountain benchmark.”
Source: kaiserhealthnews.org

Social Security and Medicare Should Not Be Used to Reduce Deficit

Crack down on waste and inefficiency: The U.S. health care system wastes as much as one-third of all spending because of inefficient payment systems, uncoordinated care, mistakes, duplication and unnecessary paperwork. We must step up efforts to detect fraud and crack down on criminals who file false Medicare claims. We need to focus on improving care and cutting unnecessary tests and procedures, which are often the result of payment incentives and fear of litigation.
Source: aarp.org

Cutting Health Care Waste, Medicare Fraud

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

Preserving Medicare for Future Generations: Market

America’s fee-for-service Medicare program represents the third-largest category of federal spending and has been under scrutiny for decades for spending more on health care benefits for enrollees than taxes can generate to pay for them. The CBO estimates that over the next 10 years, the number of Medicare enrollees will increase by one-third—approaching 67 million Americans.
Source: rwjf.org

Primary Care Doctor Shortage

But in these times of shrinking federal budgets, it’s unclear how much ACA primary care money will be available as Congress juggles competing priorities. Congress, for example, already has chopped about $6.25 billion from the ACA’s new $15 billion Prevention and Public Health Fund, which pays for programs to reduce obesity, stop smoking and otherwise promote good health. In addition, federal support for training all types of physicians, including primary care doctors, is targeted for cuts by President Obama and Congress, Republicans and Democrats, says Christiane Mitchell, director of federal affairs for the Association of American Medical Colleges, who calls the proposed cuts "catastrophic."
Source: aarp.org

Study: Immigrants Pay More Into Medicare Than They Receive in Benefits

The authors also noted that many immigrants pay taxes that help fund the program but are not eligible for its benefits. For example, many undocumented immigrants use fake Social Security numbers to work, which means they and their employers pay Social Security and Medicare taxes. However, such residents are ineligible for either program. The Affordable Care Act also prohibits undocumented immigrants from obtaining other health benefits, such as the insurance subsidies intended to help U.S. residents purchase coverage through the health insurance exchanges that launch next year (“Politics Now,” Los Angeles Times, 5/29).
Source: californiahealthline.org

OPINION: taking advantage of Medicare Advantage

AHIP may have a hard time convincing the current Congress to take pity on insurers. Last week the Government Accountability Office released a report estimating that CMS overpaid private insurers between $3.2 billion and $5.1 billion from 2010-2012. Chances are, though, that far more people will see AHIP’s TV campaign than an obscure GAO report. And people won’t even know that insurers are behind the campaign. That’s because AHIP is using one of its front groups, the Coalition for Medicare Choices, as the sponsor of the campaign.
Source: publicintegrity.org

Firm Perspectives on the Medicare Advantage Market

Based on interviews with senior executives at 14 large firms, the issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that will award bonus payments to plans based on their quality standards.
Source: kff.org

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