2013 Cost Projections for Medicare Programs

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This week’s charts compare the Medicare cost projections under current law assumption with more realistic alternative assumptions measured as a percentage of the economy. The Medicare Trustees’ Report presents an illustrative alternative scenario that assumes a continuation of the historical pattern of SGR overrides; the report also shows an another alternative scenario in which, in addition to an SGR override, certain controversial elements of the 2010 Affordable Care Act (ACA) are either scaled back during the period from 2020 to 2034 or eliminated altogether.
Source: mercatus.org

Video: What Does Medicare Cost?

Analysts Predict Continued Medicare Cost Growth Slowdown

USA Today: Analysts: Medicare Costs May Keep Declining Innovations adopted and accelerated by the 2010 health care law will continue to force down overall Medicare costs, according to industry analysts and studies, even as the economy continues to improve. Those changes include new payment plans, improved efficiency and a move toward consumer-driven insurance plans that started before the law’s passage. They influenced the $618 billion drop in projected Medicare and Medicaid spending over the next decade that was reported May 15 by the Congressional Budget Office. That report showed that costs for the two programs in 2012 were 5 percent less than projected in early 2010, and the CBO data are expected to foreshadow the spending projections in the annual Medicare trustees report scheduled to be released this week (Kennedy, 5/30). 
Source: kaiserhealthnews.org

Dartmouth: 4 Fallacies in Attributing Regional Medicare Cost Flux to Illness

The Dartmouth Institute of Health Policy & Clinical Practice, a longtime academic advocate of the notion that Medicare inefficiencies drive geographic cost variations, took aim on a recent study that claimed patients’ health is the primary driver of Medicare cost differences. The counter-report was authored by the Center for Studying Health System Change and published in the journal Medical Care Research and Review. Jonathan Skinner, PhD, economics professor at the institute and Dartmouth College’s Geisel School of Medicine, wrote a criticism of the CSHSC piece, specifying four fallacies in the article. 1. Diagnoses on billing documents are unreliable. The CSHSC study slammed Dartmouth for not comparing patients’ diagnoses in their research to the magnitude of geographic populations’ illness. Dr. Skinner countered that by saying physicians in some regions are far more apt to diagnose patients with more severe illnesses on billing documents in order to justify more aggressive and expensive procedures. “These biases are severe and will lead to highly misleading conclusions,” he wrote, including an example in the threshold for diabetes diagnosis has been shown to be lower in some regions, leading to “reverse causation” for treatment. 2. End-of-life expense risk adjustments don’t change cost disparity. End-of-life care cost is particularly prone to large variances across the country. However, Dr. Skinner wrote that a study by Mount Sinai Hospital in New York City showed even when adjusting for cost-risk factors, such as wealth, lifestyle and type of disease, the wide range in Medicare expenditures remained unaffected. 3. “Nondiscretionary” incidences don’t explain nationwide variances. CSHSC researchers found nondiscretionary measures of disease shielded from physician bias or subjectivity, such as fractures, were higher in higher-cost regions. However, Dr. Skinner said he found major differences in the two studies’ data sets. CSHSC found the highest-cost Medicare patients were 73 percent more likely to suffer a hip fracture, but Dartmouth found only a 13.5 percent increase in likelihood. He wrote that is likely because CSHSC used physician-based data instead of patient-based data, whereas patients may visit multiple physicians, especially in high-cost regions where patients seek specialists more commonly, he said. As a result, CSHSC’s sample pool of physicians includes a disproportionate share of specialists in high-cost regions, who would naturally see sicker, costlier patients. Dr. Skinner acknowledged that CSHSC had noted this in their report and was exploring fixes to this potential bias, but he claimed the sampling protocol is fundamentally flawed. 4. Automatic billing risk adjustments ignore clinical plausibility. CSHSC used hierarchical condition categories from billing data to determine patients’ diagnoses and thus level of illness, Dr. Skinner said. HCCs include predetermined risk adjustments, which he believes CSHSC took wholesale when plugging data into their regressions, automatically assuming such patients cost as much as the HCC formulas adjust for. Since Dartmouth researchers contend that HCC billing data is unreliable across regions, the corresponding risk adjustments further the diagnosis-related explanations for cost variances beyond what Dr. Skinner believes is clinically sound in many cases.
Source: beckershospitalreview.com

Cost to treat Medicare patients at Cape Fear region hospitals varies

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Source: fayobserver.com

Part D: Bending the Medicare Cost Curve

Part D’s 10-year projection has now been reduced by over $100 billion the past three years, and these projections are almost half of their initial estimated cost when the program was enacted seven years ago.  Through market-based competition, Part D is successfully able to offer a mix of plans to help seniors access medicines which, in turn, helps them adhere to doctors’ orders. This improved use of medicines helps lower other health costs, such as hospitalizations and expensive procedures.
Source: phrma.org

Best Bets for Reducing Medicare Costs for Dual Eligible Beneficiaries: Assessing the Evidence

With pressure mounting to slow the growth in federal health care spending, policymakers are exploring ways to reform the way care is delivered to the 9 million low-income Medicare beneficiaries who also receive Medicaid – a group that on average is sicker and frailer than other Medicare beneficiaries, and therefore receive significantly more care at greater cost. Major efforts are underway at the federal and state level to better coordinate care for this population and lower health care costs – with some estimates projecting hundreds of billions of dollars in savings over the next decade.
Source: kff.org

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

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

Controlling Medicare Costs is Now Un

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

Study Takes on the Myth of Medicare Cost Shifting

Contrary to the theory, I found that hospital markets with relatively slow growth in Medicare inpatient hospital payment rates also had relatively slow growth in private hospital payment rates during 1995–2009. Using regression analyses, I found that a 10 percent reduction in Medicare payment rates led to an estimated reduction in private payment rates of 3 percent or 8 percent, depending on the statistical model used.
Source: firedoglake.com

Ideas for Reforming the Medicare Benefit Design: A Historical Reminder of Bipartisan Support

Posted by:  :  Category: Medicare

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“Under Medicare Parts B and D, certain beneficiaries pay higher premiums based on their higher levels of income. Beginning in 2017, this proposal would restructure income-related premiums under Medicare Parts B and D by increasing the lowest income-related premium five percentage points, from 35 percent to 40 percent, and also increasing other income brackets until capping the highest tier at 90 percent… “…Introduce Part B Premium Surcharge for New Beneficiaries Purchasing Near First-Dollar Medigap Coverage: This proposal would introduce a Part B premium surcharge for new beneficiaries who purchase Medigap policies with particularly low cost-sharing requirements, effective in 2017.” – U.S. Department of Health & Human Services. “Fiscal Year 2014 Budget in Briefing.” 2013.
Source: house.gov

Video: Improving Medicare in 2011

New Medicare Benefits and Changes for 2011

Once your total drug costs reach $4,550 (see the Ms. Medicare column "Paying Less for Drugs in the Doughnut Hole" for details about how this is calculated), you are eligible for "catastrophic coverage" and your prescription costs drop to a lower copay for the remainder of the year. Last year, when there were no doughnut-hole discounts, $250 rebate checks were sent to all affected Part D subscribers. Because of the discounts now in place, there will be no rebate checks for 2011 expenses. Another 2011 change for Part D subscribers is that if you have a high annual income (more than $85,000 for individuals and $170,000 for couples) and pay higher-income premiums for Part B, you’ll also pay a higher premium for Part D drug coverage.
Source: aarp.org

Is Medicare a Ponzi Scheme?

The American Magazine

Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.
Source: american.com

Tea Party Patron Saint Ayn Rand Applied for Social Security, Medicare Benefits

Critics of Social Security and Medicare frequently invoke the words and ideals of author and philosopher Ayn Rand, one of the fiercest critics of federal insurance programs. But a little-known fact is that Ayn Rand herself collected Social Security. She may also have received Medicare benefits.
Source: firedoglake.com

Benefits of small area measurements: A spatial clustering analysis on medicare beneficiaries in the USA | Human Geographies

Small area estimates on where services for potential Medicare beneficiaries may be needed, could provide unique research opportunities for improving the healthcare quality of the ageing U.S. population. The project described in this paper validates this argument by contrasting the spatial clustering results from an analysis that uses large geographical units with proxy measures to the results from an analysis using small area geographic units with direct measures. Large-area proxy measures come from county-level U.S. Census Bureau 2010 cross sectional data on the number of people aged 65 and over. Medicare beneficiary estimates in 2007 with Primary Care Service Areas (PCSAs) make up the small-area direct-measure analysis. Findings show that the latter offers a more geographically defined appraisal of where healthcare quality efforts should focus to aid potential Medicare beneficiary populations. Because the healthcare quality of an aging population will only increase in importance as their numbers grow in the US, further research is needed.
Source: org.ro

More than 30 million with Medicare used free preventive services in 2011

The report discussing Medicare preventive services found that more than 25.7 million Americans in traditional Medicare received free preventive services in 2011. The report also looked at Medicare Advantage plans and found that 9.3 million Americans – 97 percent of those in individual Medicare Advantage plans – were enrolled in a plan that offered free preventive services.  Assuming that people in Medicare Advantage plans utilized preventive services at the same rate as those with traditional Medicare, an estimated 32.5 million people benefited from Medicare’s coverage of prevention with no cost sharing.
Source: medicare.gov

Medicare Drug Benefit: Model for Broader Health Care Reform

The “rebate”—which really amounts to government price controls—would change everything. Today, pricing is determined entirely by a negotiation between private insurers and drug manufacturers focused on the value of prescription drug products for the patients. With rebates, the government would get involved in the conversation, and that spells trouble. Drug manufacturers would seek to use the rebate requirement to extract higher pricing from the insurers, even as they lobbied the government to base the rebates on the most inflated measure of “average” price they could find. In time, as in other parts of Medicare, the government’s price-setting reach would expand further and further based on new legislative proposals and the natural tendency of bureaucracies to seek to control more and more decisions. Eventually, the private plans now participating in Part D would lose their ability to determine their own fates, which would spell doom for the current program.
Source: heritage.org

Democrats on Super Committee Offer to Cut Medicare Benefits

It is unlikely this specific deal being offered by the Democrats on the committee will be accepted by Republicans, because it calls for tax increases and more stimulus, but it still puts our social safety net in danger. It is another instance of the Democratic party steadily moving towards the official position of saying Medicare benefits can and should be cut.
Source: firedoglake.com

Social Security and Medicare Taxes and Benefits Over a Lifetime

Notes: All amounts are in constant 2011 dollars as noted, adjusted to present value at age 65 using a 2 percent real interest rate. Each calculation assumes survival until age 65 and then adjusts for chance of death in all years after age 65. It also assumes that benefits scheduled in law will be paid even if trust funds are exhausted. Workers are assumed to work every year from age 22 to age 64 and retire at age 65 or the Normal Retirement Age. An average-wage worker earns the average wage in the economy every year, based on Social Security’s measure of the “average wage.” The low-wage worker earns 45 percent of the average wage, while the high-wage worker earns 160 percent of the average wage. The tax-max wage worker earns at the taxable maximum every year. Medicare numbers are net of premium, other than the new premium tax on some high earners.
Source: urban.org

The Benefits of Changing Medicare’s Drug Benefit

While Republican presidential candidate and Texas Gov. Rick Perry has criticized various pieces of health legislation, critics and observers argue that Perry’s own proposals have been largely ineffective. On the campaign trail, Perry repeatedly has criticized the 2006 Massachusetts health reform law — signed by fellow candidate and former Massachusetts Gov. Mitt Romney (R) — and the federal health reform law, objecting to insurance mandates in both laws. Meanwhile, Texas faces numerous challenges covering its residents, including the highest rate of uninsured individuals in the country and the third-lowest percentage of workers with employer-sponsored health coverage nationwide (Ramshaw, Texas Tribune/New York Times, 9/29).
Source: californiahealthline.org

State Medicaid Changes: Cuts and Increases During Recession to Medicaid Benefits and Provider Payments

An expert on Medicaid, Medicare, and health reform, Kip Piper, MA, FACHE, is a consultant, speaker, and author. Kip Piper advises health plans, hospitals and health systems, states, and pharma, biotech, medical device, HIT, and investment firms. With 30 years’ experience, Kip is a senior consultant with Sellers Dorsey, top specialists in Medicaid and health reform. He is also a senior advisor with Fleishman-Hillard and TogoRun. For more, visit KipPiper.com. Follow on Twitter @KipPiper, Google +, Facebook and connect on LinkedIn.
Source: piperreport.com

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

Posted by:  :  Category: Medicare

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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: Finding Medicare C and D plans on Medicares Website

Medicare Website Receives Top Marks

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
Source: kp.org

Humana follows Medicare’s lead

Health insurance giant Humana on May 30 notified providers via a notice on its website that it will follow Medicare’s lead and, starting July 1, pay for DME and mail-order diabetes supplies in 91 cities using pricing from Round 2 for its Medicare Advantage (MA) plans. Humana also notified members of those plans by mail.
Source: hmenews.com

Insurance Success Story : Tufts Medicare Preferred

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

Illinois Affordable Care Act Fact Sheets Available On Make Medicare Work Website : HIV Health Reform

ADAP aids.gov Bridge to 2014 California Healthcare Reform Case Stories comments to HHS Congress Deficit Reduction Dual Eligibles Election 2012 enrollment essential health benefits exchange & marketplace exchange & marketplace fact sheet federal budget federal implementation health care reform & prevention health home health reform & HIV 101 HHCAWG HIVMA HLS/TAEP HRSA Illinois Medi-Cal Questions Medicaid Medicare NASTAD National HIV/AIDS Strategy Navigators private insurance providers public input regulations Ryan White CARE Act Sebelius Spanish Speaking Resources state & local implementation state & local implementation state advocates Supreme Court toolkits webinar women
Source: hivhealthreform.org

Do You Qualify for Free Medicare Part D?

If you decide to apply and find out you don’t qualify, don’t worry because there are other programs at the state level that may be able to help you cover your prescriptions.  Find out by visiting Medicare’s “Helpful Contacts” page- Click here to visit the page.  This page can help you find a program at the state level that may be able to provide some assistance to pay for prescription drugs.
Source: firstseniorfinancialgroup.com

Old Man Uses Laptop Present from His Grandson to Create Medicare Supplemental Insurance Website

Stephen Pewter’s first brush with technology came when his grandson gave him a laptop computer as a gift for his 74th birthday. A few months later, the retired firefighter with no technical background, built a Medicare supplemental insurance comparison website. His family was floored when they saw it. Not only was the site up and running, but MedicareSupplementalInsuranceComparison.net had already attracted tens of thousands of visitors. Pewter is among the growing numbers of senior citizens who are active online. According to a Pew Research Center study, more than 50 percent of people over 65 use the Internet regularly. Pewter was motivated to create the comparison website after his own personal experience shopping for Medicare supplemental insurance. His hours of research on his new laptop to compare plans and rates turned up only websites that required lots of personal information and delivered spotty results. Uneasy with putting his personal data out on the Internet, Pewter decided to put his technology skills to the test to create a site that would only require visitors to enter their zip code. “I put the site up in December and got 10,000 visits the first week. By the end of the month, that number was up to 30,000,” Pewter said. “My grandchildren darn near choked when they saw the stats,” he chuckled. Nearly six months later, the site continues to gain popularity. MedicareSupplementalInsuranceComparison.net is not just a rate comparison site. It also includes articles and information to help demystify Medicare and supplemental insurance. Pewter keeps it fresh, adding new content regularly. And, he has added more than 12,000 additional insurance providers to its database. “Maybe the site has been so successful because seniors trust other seniors. Or maybe it’s because we hit a nerve with the Medicare supplemental insurance,” said Pewter. “No matter, now that it’s there, I’m committed to making sure it continues to be a helpful resource and something my grandkids can be proud of.” About MedicareSupplementalInsuranceComparison.net MedicareSupplementalInsuranceComparison.net is a simple website seniors can use to get Medicare supplemental insurance rates anonymously. Unlike other comparison sites, it only requires visitors to enter their zip codes to get quotes from insurance carriers in their area. And, it’s updated regularly with fresh information to help the Medicare eligible community make educated decisions about their healthcare. For more information, visit: http://www.medicaresupplementalinsurancecomparison.net.
Source: sbwire.com

Medicare to Keep Hospital Mistake Data On Website

What is changing, he explains, is that some of these measures will no longer be part of the Inpatient Quality Reporting program, for which hospitals have received a 2% market basket pay increase in exchange for reporting the data. CMS will still get the data, but the hospitals won’t get paid for submitting it. … Just because a measure is not reported to the IQR program, it doesn’t mean that it will be taken off Hospital Compare,” he says. These eight measures, of the 11 hospital-acquired conditions for which Medicare denies hospitals reimbursement under provisions of the 2005 Deficit Reduction Act (DRA), and which are now posted on Hospital Compare, “will continue to be displayed and available in the downloadable database after July, 2013.”
Source: reportingonhealth.org

Missouri Senior Medicare Patrol Launches Website

The SMP program, also known as Senior Medicare Patrol program, helps Medicare and Medicaid beneficiaries avoid, detect, and prevent health care fraud. In doing so, they help protect older persons and promote integrity in the Medicare program. Because this work often requires face-to-face contact to be most effective, SMPs have recruited nearly 4,500 volunteers nationwide to support this effort.
Source: ma4web.org

Georgia expected to spar over Medicaid expansion in election aftermath

Posted by:  :  Category: Medicare

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The Centers for Medicare and Medicaid Services have told states that the first three years of expansion would be fully funded beginning in 2014, with the rate dropping to 90 percent by 2020. Robinson said that Geor­gia’s share, however, would be $4.5 billion over the next 10 years and that the state doesn’t have the money, nor does the federal government have the other $40 billion it would spend on expanding Georgia Medicaid.
Source: augusta.com

Video: Georgia Health Insurance Medicare

Georgia offering Medicare info

ADVISORY: Users are solely responsible for opinions they post here and for following agreed-upon rules of civility. Posts and comments do not reflect the views of this site. Posts and comments are automatically checked for inappropriate language, but readers might find some comments offensive or inaccurate. If you believe a comment violates our rules, click the “Flag as offensive” link below the comment.
Source: augusta.com

Georgia’s New “Limited Medical” Law Shifts Costs to Medicare

After July 1, 2013, the amended Georgia Workers’ Compensation Act reducing the Employer/Insurer’s overall medical exposure insidiously shifts the responsibility (after 400 weeks) to Medicare in certain cases.   Prior to July 1, 2013, the WCMSA would be forced to contemplate future medical expenses for the life of the injured workers.  Now, the WCMSA analysis simply stops after 7.5 years of treatment from the date of accident in non-catastrophically designated claims.  Consequently, if the injured worker is a Medicare beneficiary, or there is a reasonable expectation he or she will be within 30 months, Medicare will likely bear the cost of the bulk of the injured workers’ future medical treatment.  For example, if an injured worker required a replacement of an artificial knee, this cost would likely be thrust upon Medicare.  This would also include diagnostic scans, films, and medication related to the Georgia work injury.
Source: ramoslawblog.com

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

Deal again says Georgia can’t afford Medicaid expansion

Members of the Georgia Chamber, Lieutenant Governor Cagle, Speaker Ralston, state legislators, elected officials, judges, justices, ladies and gentlemen: Let me begin by congratulating you. We have had one of the best years of economic development in quite some time. A few notable companies that have chosen Georgia include Baxter, General Motors, and Caterpillar, along with numerous others. We did this with your help, with both the private and the public sector doing their parts! Several weeks ago, the lieutenant governor, along with Sandra and I hosted a reception at the Governor’s Mansion to honor Georgia’s Olympic and Paralympic athletes who competed at the London Olympic Games. This was an outstanding group of young people of whom we are extremely proud. One of the men in the group was Aries Merritt, a native of Atlanta and a graduate of Wheeler High School in Marietta. Aries won an Olympic Gold Medal in the 110 meter hurdles. Unlike sprinters who travel in a straight line with no obstacles other than the lane markers assigned to them, hurdlers, as the name implies, must jump over obstacles that are placed in their path. Making analogies between sports and government is always risky, but I want to suggest to you that the business of governing our state is somewhat similar to running the hurdles. As governor, my goal is to see Georgia become the No. 1 state in the nation in which to do business. I have made that clear from the beginning, because I believe that is the best path to economic growth and the quickest way to get Georgians into jobs. And we are not all that far off from reaching our target: For two years in a row, we have ranked in the top five for business climate by Site Selection Magazine, and we ranked No. 3 for doing business in 2012 by Area Development Magazine. But we certainly still have some hurdles that we must overcome before we get there. This morning I will focus my remarks on one of the highest hurdles facing state government, that of healthcare. In Georgia, we have had many successes in the realm of healthcare. With rising healthcare costs, we have worked to keep Georgians healthy so that they can avoid some of these expenses rather than react to them when they become ill. We have launched the Georgia SHAPE program as a way to combat childhood obesity, a growing problem in our state. I proclaimed this past September “Georgia SHAPE Month,” during which we emphasized physical activity and proper nutrition for our state’s children. In its inaugural year, the Governor’s SHAPE Honor Roll had 39 schools achieve Gold Medal status for their dedicated work in making our state’s youth healthier. These healthier young people generally perform better in the classroom, and many will continue their healthy lifestyles into later years, making these programs an investment in the economic and cultural well being of our state. The State Health Benefit Plan just finished the first year of its Wellness Program – the largest such program in the country, with more than 245,000 enrollees. We would like to take the next step by growing and developing it; we want to see employees taking responsibility for their own health through preventative action … and receiving lower premiums as a reward. Even with all of these cost-saving approaches, it still costs approximately $10 million per day in claims to provide health benefits to active and retired employees and teachers. Those costs have and will increase because of Obamacare’s mandated benefits; in FY2014, the State Health Benefit Plan is projected to incur $106M of additional costs due to Obamacare. And because our State Health Benefit Plan is classified as a Self-Insured Plan, it is subject to the three-year Obamacare reinsurance tax. This means we would pay an additional $35M in 2015. Of course, even among the healthy, not all illness can be prevented; so last year, we grew graduate medical education by adding funding in the budget for the development of 400 new residency slots in hospitals throughout the state, helping keep Georgia’s doctors in Georgia. These are just a few of the great things we have going for us in healthcare. But we also face hurdles that we must overcome, like how to fund the state’s responsibility for Medicaid. Right now, the federal government pays a little under 66 cents for every dollar of Medicaid expenditure, leaving the state with the remaining 34 cents per dollar, which in 2012 amounted to $2.5B as the state share. For the past three years, hospitals have been contributing their part to help generate funds to pay for medical costs of the Medicaid program. Every dollar they have given has essentially resulted in two additional dollars from the federal government that in part can be used to increase Medicaid payments to the hospitals. But the time has come to determine whether they will continue their contribution through the provider fee. I have been informed that 10 to 14 hospitals will be faced with possible closure if the provider fee does not continue. These are hospitals that serve a large number of Medicaid patients. I propose giving the Department of Community Health board authority over the hospital provider fee, with the stipulation that reauthorization be required every four years by legislation. They have experience in this area, having had authority over a similar fee for the nursing home industry since around 2004. Of course, these fees are not new. In fact, we are one of 47 states that have either a nursing home or hospital provider fee – or both. It makes sense to me that, in Georgia, given the similarity of these two fees, we should house the authority and management of both of them under one roof for maximum efficiency and effectiveness. Sometimes it feels like when we have nearly conquered all of our hurdles, the federal government begins to place even more hurdles in our path. I am, of course, referring to the various mandates of Obamacare that put a strain on our state, its businesses and its citizens. As most of you are well aware, the United States Supreme Court upheld the individual mandate as a tax. Therefore, most Georgians, beginning in 2014, will be forced to get insurance coverage or else pay a minimum of $95 (and potentially far more) in penalties. So what does this mean for us? It means that Georgians must pay out dollars to either an insurance company or the federal government – whether they want to or not. But ultimately there still is a choice, albeit a rock-and-a-hard-place kind of choice. As more individuals enter the marketplace, younger, healthier Georgians might begin deciding they would rather pay the penalty than deal with the potentially much higher cost of coverage, causing the price of insurance for everyone to climb; this increase will drive even more healthy individuals out of the market, further swelling the cost. This potential cycle is one of the inherent flaws in the federal law. The employer mandate means that businesses with 50 or more employees must provide affordable health insurance to their workers or else pay the rather large penalties. Costs can increase here, as well, as the pool of insured becomes less healthy. These costs stand to hurt our state’s private sector. Because as all businessmen and women know, the higher your input costs, the lower your profits; the lower your profits, the less you operate, expand or employ. But whether it’s through fewer employees and less equipment purchases or higher costs, this mandate will negatively impact many of our state’s businesses and, of course, the would-be employees themselves. Georgians who have already received a paycheck this January have no doubt noticed that their payroll taxes went up and their take-home salary went down. This is the cost of entitlements. If you think your taxes went up a lot this month, just wait till we have to pay for “free health care.” Free never cost so much. The individual mandate has a second tier of impact involving Medicaid and its cost to the state. I have said clearly that Georgia will not expand Medicaid under the federal government’s guidelines. Even so, in Fiscal Years 2013 and 2014, Medicaid and SCHIP funding will be the second largest portion of the state funds budget with more than 13 cents of every dollar going straight to one of these programs. And with just the portions that our state must do, Obamacare is expected to add more than 100,000 new individuals to our Medicaid rolls and mandate other requirements, costing our state nearly $1.7B over the course of 10 years – and that’s on top of the $2.5 B we already pay annually. The reason: These Georgians qualify for Medicaid under the current system but have yet to enroll in it. With the individual mandate requiring either insurance or a hefty fee, they will likely think that Medicaid looks like a pretty good option. And since they fall under the current system, the state of Georgia and its taxpayers must pay the current rate of 34% and not the 0 to 10% rate proposed for the expanded population group. We constitutionally must balance our state budget – a wise requirement instituted by those who have come before us. This increase in costs to the state means we have to find that money somewhere in our already tight budget; we cannot simply create more. As such, I have instructed the Department of Community Health to reduce its budget by at least three percent in Amended Fiscal Year 2013 and by five percent in Fiscal Year 2014 – a difficult but necessary task. They have already identified $109M in cost-saving measures between the two years. But this hardly covers the additional nearly $500M in needed funds caused by growth in Medicaid expenses during the same time frame. That means we must make necessary cuts in other agencies and core functions of government since raising taxes is not an option I will accept! As I have indicated, I have rejected the Medicaid expansion in Georgia already, but let me emphasize that the expansion would have put our additional costs over 10 years closer to $4.5B – and that’s operating under the dubious assumption that the federal government, with its ever-growing national debt, would have fulfilled their promised share. The 620,000 new enrollees would have stretched our resources and our state to the limit. But whether the cost to our state would have been $2B, $4B or $6B, it does not make much sense to ask for more hurdles when you are already utilizing every muscle in your state’s body to overcome the ones you currently have before you and that you must face. So unless the federal government changes it to a block-grant program and allows Georgia to design the benefit plan, I cannot justify expanding Medicaid. The irony to me is that there are those in the medical community who are urging the expansion of the Medicaid program while at the same time, we are seeing more and more medical providers refusing to accept Medicaid patients. Their reason for doing so is that they claim the reimbursements for their services are below their costs. It is for that reason that the previously discussed provider fee is so important since that revenue is used to pay providers. If providers are already having difficulty covering their costs for care to Medicaid patients, how will they accommodate 34% more people on the Medicaid rolls? If you are losing money now, how do you reconcile the number of patients on whom you will lose even more money? Add to that the fact that the new enrollees would be higher on the economic scale, and some will be leaving their higher-paying, employer-provided health insurance plans to enter the taxpayer-funded Medicaid program with its lower reimbursements for the providers. If we have to depend on provider fees now to keep our reimbursements to Medicaid providers at a “tolerable” level, just imagine the pressure that will come when hospitals and doctors are losing more money on a larger portion of their patient base. Expansion of the Medicaid rolls does not solve the problem, it only exacerbates the one we already have. As many of you know, I also turned down the federal government’s offer to let us put our name on their insurance exchange program. I have no interest in seeing our state’s name, or its taxpayer dollars, used on something that we would have very little input in designing. If the purpose is to let those closest to and most knowledgeable about the population design the program, then we should be allowed to do so. It does not appear that is the pattern for the exchanges. I see no benefit to our citizens to have a program bearing the name of the State of Georgia over which our elected or appointed officials have little if any say so. While many federal programs come with strings attached, these strings turn states into marionettes to be manipulated by federal bureaucrats. If there is one thing we don’t need, it is another puppet show directed from Washington, D.C.! We cannot always determine what obstacles will be laid in front of us, but we can decide how we deal with them, and whether we approach them with anger, indifference or decisive action. The first two provide very little in productivity, but the latter offers opportunity to grow our state (and our businesses) in spite of newfound hurdles. Therefore, we must choose to work diligently. We must choose discernment over acquiescence, which is what I have aimed to do in my decision-making. And we must choose to confront these hurdles together, because discussion and determination, without bitterness, lead to the greatest forward progress. Despite all that is in front of us, we will still make Georgia the No. 1 state in which to do business. One last note: For those of you not attending in person, tune in tomorrow at 11 a.m. as I outline the rest of my plan for Georgia in this year’s State of the State Address, or go to my Twitter account, where my staff will be live Tweeting my remarks or at least the good parts.
Source: clatl.com

Georgia Woman Rewarded For Taking Stand Against Medicare Fraud

While working as a contracts officer at Bard’s Covington office, Darity noticed a pattern of illegal kickbacks being paid by the medical device company to doctors and hospitals that used its products. Over an eight-year-period, according to Darity’s whistleblower lawsuit, Bard inflated the cost of its radioactive seeds used to treat prostate cancer. The hospitals would then charge Medicare the inflated price and Bard would pay kickbacks to the doctors and hospitals from the excess revenue.
Source: personalinjuryattorneycolumbusga.com

Congressman Tom Price: Introduces Medicare Improvement Legislation – Georgia Politics, Campaigns and Elections – Georgia Pundit

Washington, D.C. – Congressman Tom Price, M.D (R-GA) has introduced legislation aimed at improving the competitive bidding process for Medicare. “The Medicare DMEPOS Market Pricing Program Act of 2013” (H.R. 1717), would replace the current Medicare “DMEPOS,” or “Durable Medical Equipment, Prosthetics, Orthotics and Supplies,” competitive bidding system with a sustainable market pricing program (MPP) that is based upon sound economic principles that are embraced universally by auction experts across the U.S. Rep. Price first introduced this legislation during the 112
Source: gapundit.com

Medicare Supplement Rates Blue Cross Georgia

Instant Blue Cross Georgia Medicare supplement rates. Instant on-line quote at http://georgiamedigapquotes.com Compare your Medicare supplement rates with Blue Cross, Mutual of Omaha, Humana and others. Best rates in Georgia. Ask for personalized rate spreadsheet with top GA Medigap carriers…. Click for more info
Source: classifiedads.com

Jesup, Ga. family physician sentenced for health care fraud

First things first, if no one will come to Dr Lentz’s defense, I will. It seems so easy for the Federal Government to show up, charge someone, and convict them, a reporter to write about it and a paper’s readers to condemn him. However, Dr Lentz is the most honest, hard working man I know. He is up at 4am opening his gym for those who need to see him and exercise. He makes his hospital rounds and is ready to see his patients at 8 am. As you walk into his office you see mostly older patients. They come to him because they know he is will listen and talk to them and get to the bottom of their problems. Some cant pay the co-pay, others patients cant pay at all. But, he will still see them, without an appointment…. Isn’t it a sad time in this country when NOT forcing someone to pay a co pay for service is against the law? How about someone cooking a pie for a doctor, or cutting a Dr’s lawn, in exchange for medical treatment because they are poor, being considered against the law? (I guess it is too hard to figure out HOW to tax a doctor for that). When he is done seeing his patients for the day, he then teaches a judo class to a bunch of Wayne county kids after school.-more
Source: augusta.com

The Rural Blog: Rural Georgia hospital closing, blames Medicare

population 1,400, about 30 miles west of Americus, will suspend operations tomorrow. The 25-bed hospital, named for the two rural counties it serves but owned by Accord Health Care Corp., says it is closing partly because high unemployment in the area means the hospital is seeing more people who are not paying for services. Also, “Medicaid and Medicare are not paying what they used to,” and the hospital simply ran out of money, report Sydney Cameron and Liz Buckthorpe of WRBL of Columbus. And, in changing top electronic health records, “The hospital had to pay for the costs up front and because of a mix-up with Medicare they have not received $1 million in incentive money for the changeover.” Stewart-Webster is the largest employer in Richland at nearly 80 employees. The hospital sees around 10 patients a day and performs about five surgeries a week, the station reports.
Source: blogspot.com

Medicare and the Federal Budget: Comparison of Medicare Provisions in Recent Federal Debt and Deficit Reduction Proposals

Posted by:  :  Category: Medicare

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Many of the budget proposals and debt-reduction plans being considered by Congress and the Administration include proposals that would achieve substantial savings from the Medicare program over time. This brief features a side-by-side comparison of the key Medicare provisions in three major budget and debt-reduction plans:
Source: kff.org

Video: How to Understand Medicare Plans

Medicare Supplement Plans

Medicare Supplemental Coverage is known as “Medigap” for short. The reason for this is that it’s designed to provide insurance coverage for the “gap” between what Medicare pays and what the costs of a recipient’s actual services are. This difference is created by two factors: First, there are some medical services that Medicare doesn’t pay for at all. Second, there are some medical services that Medicare only pays for in part. So, the Medicare beneficiaries that do not carry any type of Medigap coverage are left responsible for the difference between those two amounts themselves.
Source: watchlistnews.com

Research Roundup: Comparing Medicare Budget Plans

JAMA Pediatrics: Nurse Staffing And NICU Infection Rates –Neonatal intensive care units (NICU) – which provide care for infants who are critically ill – are costly and require a significant amount of nursing services. Little is known, however, about the adequacy of nurse staffing at these units. Using data from 2008 and 2009, researchers analyzed the relationship between adherence to national staffing guidelines and hospitals-associated infections among very low birth-weight (VLBW) infants. “Our results document widespread understaffing relative to guidelines: one-third of NICU infants were understaffed… ,” the authors write. “In VLBW infants, NICU nurse understaffing relative to guidelines was associated with a sizable increase in infection risk.” They conclude that their findings “suggest that the most vulnerable hospitalized patients, unstable newborns require complex critical care, do not received recommended levels of nursing care. Even in some of the nation’s best NICUs, nurse staffing does not match guidelines” (Rogowski et al., 3/18).
Source: kaiserhealthnews.org

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

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

Compare Medicare Plans & Providers

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Source: tacticalminc.com

Remember to Compare Medicare Part D Plans to Cut Costs

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

Medicare Supplement Articles > Power wheelchair fraud

However, The Scooter Store is far from the only problem, only the most prominent and largest scooter store in America. Additional research proved that nationwide, over 80% of the claims made for power wheelchairs do not meet the Medicare coverage requirements. Due to Medicare not reviewing these claims, this totals $95 million squandered annually in fraud due to unnecessary power wheelchairs. And yet, this is only a fraction of the $60 billion taxpayers pay annually due to Medicare-related fraud. Clearly, The SCOOTER Store is not the sole company at fault, but it’s a good start.
Source: medicaresupplement.com

Kaine signs on to Medicare medication bill

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Source: fredericksburg.com

MedPAC on Medicare plan competitive bidding

Consistent with the goal of encouraging beneficiaries to make cost-conscious choices, this chapter presents an overview of a model based on government contributions toward purchasing Medicare coverage—an approach we call competitively determined plan contributions (CPCs). The Commission uses the term CPC to broadly describe a federal contribution toward coverage of the Medicare benefit based on the cost of competing options for the coverage, including those offered by private plans and the traditional FFS program. Specifically, CPC has two defining principles: First, beneficiaries receive a competitively determined federal contribution to buy Medicare coverage; second, beneficiaries’ individual premiums vary depending on the option they choose.
Source: theincidentaleconomist.com

The Ins and Outs of Medicare Supplemental Insurance

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

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

Top 10 Online Resources for People on Medicare

Garrett Ball is the owner of Medicare-Supplement.US, as well as several other Medicare-related web resources. As an independent broker, Garrett assists people going on, or already on, Medicare with comparing the various Medicare plan options in an unbiased way and in a centralized place. Garrett’s position as an independent agent and experience specializing in this field give him the unique ability to help others navigate the Medicare “maze”.
Source: medicare-supplement.us

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June 23, 2013

Medicare Supplement Articles > Power wheelchair fraud

Posted by:  :  Category: Medicare

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However, The Scooter Store is far from the only problem, only the most prominent and largest scooter store in America. Additional research proved that nationwide, over 80% of the claims made for power wheelchairs do not meet the Medicare coverage requirements. Due to Medicare not reviewing these claims, this totals $95 million squandered annually in fraud due to unnecessary power wheelchairs. And yet, this is only a fraction of the $60 billion taxpayers pay annually due to Medicare-related fraud. Clearly, The SCOOTER Store is not the sole company at fault, but it’s a good start.
Source: medicaresupplement.com

Video: FREE MEDICARE LEADS/ MEDICARE SUPPLEMENT LEADS/ INSURANCE SALES LEADS

Seniors See Value in Medicare Supplement Plan G

Why would an insurance company charge a consumer $500 to cover a $147 expense? The better question might be; why would anyone pay it? The answer to the first question is two-fold, first of all, because they can and secondly, because of Federal laws which require Medicare supplement companies to accept without underwriting individuals losing group insurance and/or leaving a Medicare Advantage plan, companies incur greater claims losses since they can’t weed out the sick individuals. This law does not apply to Medicare Supplement Plan G. Now to answer the question, why would anyone pay so much to cover such a little difference? The answer is simply because they don’t know any better. Whose fault is it that they don’t know any better? That blames rests on the consumer themselves for not doing adequate research, the insurance agent who is not knowledgeable or unscrupulous, the insurance company which is profit driven and the Medicare system for not providing proper education.
Source: askmedicareblog.com

The Ins and Outs of Medicare Supplemental Insurance

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

Why Do You Need Medicare Supplements?

Those seniors who are already sick should get Medicare Supplement Insurance. Also, anyone who has a family history of illness should look into it as well. If you have a Medicare Advantage plan you do not need Medicare Supplement Insurance. You also would not need it if you are under another governmental program such as Medicaid or the Qualified Medicare Beneficiary program. Medicare has a cap that a person can reach. They pay so much of your medical bill and then your portion of the bill starts to increase while their payment portion is decreased. This puts you at being 100 percent responsible for your medical bills. This includes hospital stays and outpatient services such as physician visits, your routine visits and other medical needs
Source: besteasyweightloss.com

Top 10 Online Resources for People on Medicare

Garrett Ball is the owner of Medicare-Supplement.US, as well as several other Medicare-related web resources. As an independent broker, Garrett assists people going on, or already on, Medicare with comparing the various Medicare plan options in an unbiased way and in a centralized place. Garrett’s position as an independent agent and experience specializing in this field give him the unique ability to help others navigate the Medicare “maze”.
Source: medicare-supplement.us

Marion County Indiana Medicare Supplement Quotes June 2013

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

Alternative Job Title Decriptions for Selling Medicare Supplement Policies

Is anyone calling themselves other than an Insurance Agent or Medicare Supplement Insurance Agent? It seems as soon as you say you are an Insurance Agent many people’s body language changes. However when I tell them that I do consultation on how to reduce medical cost for individuals on Medicare they stay engaged with me. Maybe this isn’t a big deal but I would just rather put an alternative job title on my business cards. Suggestions, Feedback? Thanks
Source: insurance-forums.net

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

How Medicare Supplement Plan F Can Save You Money Healthcare and Technology for Seniors

Medicare Supplement Plan F is a secondary insurance that is used along with Medicare basic coverage to help curb any additional medical expense that may not be covered under the primary Medicare plan. Plan F covers the outstanding balance on any Medicare approved expense. Regardless if it is a visit to the physician’s office, a hospital stay, or a diagnostic analysis, you will be completely insured and have no balance left to pay. Plan F pays the difference on deductibles, co-payments, and co-insurance leaving you with no outstanding amount.
Source: accefoundation.org

Medicare Supplement Plans

Medicare Supplemental Coverage is known as “Medigap” for short. The reason for this is that it’s designed to provide insurance coverage for the “gap” between what Medicare pays and what the costs of a recipient’s actual services are. This difference is created by two factors: First, there are some medical services that Medicare doesn’t pay for at all. Second, there are some medical services that Medicare only pays for in part. So, the Medicare beneficiaries that do not carry any type of Medigap coverage are left responsible for the difference between those two amounts themselves.
Source: watchlistnews.com

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June 23, 2013

Medicaid Expansion Popular In Southern States, Despite Govs’ Opposition

Posted by:  :  Category: Medicare

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Tampa Bay Times: Tampa Chamber: Businesses Concerned By Legislature’s Inaction On Medicaid Expansion For Tallahassee, refusing additional federal funds to expand Medicaid may turn out to have been the easy part. It will take longer, a half-dozen Hillsborough legislators acknowledged Tuesday, to come up with an alternative to provide health care coverage to an estimated 1 million uninsured Floridians. … Some Tampa businesses, (Greater Tampa Chamber of Commerce Chairman Gregory Celestan told local legislators), are “very concerned about significant additional health insurance costs” because of the Legislature’s “refusal to expand Medicaid.” “We will be at a competitive disadvantage when recruiting new businesses or adding jobs,” Celestan added. “How would you respond?” (Danielson, 5/21).
Source: kaiserhealthnews.org

Video: Mississippi Medicare Supplements

Governor Bryant Announces 1,000 New Jobs as General Dynamics Information Technology Expands its Hattiesburg, Miss. Operations

“I am grateful to the team at General Dynamics for expanding its presence in Hattiesburg and creating so many new jobs for the area’s workers. Just three months ago, the company announced it was locating a Federal Student Aid Information Center in Hattiesburg, and that project is expected to create 250 jobs by next spring,” Governor Bryant said. “Without a doubt, this announcement today serves as a testament to the supportive business climate found in Mississippi and to our skilled workers. Mississippi is a great place for businesses to locate and expand, and I thank General Dynamics for once again investing in our state and in our workforce.”
Source: governorbryant.com

Insurers may skip health plans in much of Mississippi; Jackson County has Magnolia Health Plan

FILE – In this Oct. 10, 2012 file photograph Mississippi Insurance Commissioner Mike Chaney outlines what the federal health care overhaul means to state businesses at a forum in Clinton, Miss. Chaney told the Associated Press on Tuesday, June 18, 2013, that two insurers have announced plans for when the new federal health insurance marketplace starts enrolling customers in October, planning to serve 46 of Mississippi’s 82 counties. However unless something changes, consumers in remaining counties will have no options to buy health insurance through the online exchange, thus having no use for federal tax credits offered to consumers. (AP Photo/Rogelio V. Solis, File)
Source: gulflive.com

Insurers may skip health plans in much of Mississippi

Under the federal health-care law President Barack Obama signed in 2010, every state is required to have an online marketplace so people can get coverage starting in January, much of it federally subsidized. A 2012 study by the Mississippi Center for Health Policy had projected as many as 275,000 Mississippians could gain insurance through exchanges, with 230,000 of those benefiting from federal tax credits that could total $900 million a year.
Source: sunherald.com

5th Circuit Affirms Finding Of Medicare Violations At Mississippi Nursing Home

NEW ORLEANS – A Fifth Circuit U.S. Court of Appeals panel on Feb. 7 in an unpublished opinion affirmed findings that a nursing home violated Medicare regulations after residents were found to be in immediate jeopardy (Mississippi Care Center of Greenville v. United States Department of Health and Human Service, No. 12-60420, 5th Cir.; 2013 U.S. App. LEXIS 2668).Full story on lexis.com
Source: lexisnexis.com

Student Health Law Association

If your doctor chooses to participate in an ACO, you will be notified. This notification might be a letter, written information provided to you when you see your doctor, a sign posted in a hospital, or it might be a conversation with your doctor the next time you go to see him or her.  If you aren’t sure if your doctor or healthcare provider is participating in a Medicare ACO, ask him or her. By law, they are required to notify you if they are performing services within an ACO. For general information on ACOs, call 1-800-MEDICARE (1-800-633-4227) 24 hours a day 7/days a week.
Source: umhealthlaw.com

Medicaid expansion fight now focusing on DSH funding (Sid Salter)

A Mississippi Institutions of Higher Learning economic brief by economist Bob Neal found these facts about Medicaid expansion: “Medicaid expansion will generate additional state Medicaid costs in years 2017-2025. From 2014-2020, cumulative state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $109 million to $98 million. From 2014-2025, total state costs of Medicaid expansion, minus additions to state General Fund revenue, are projected to range from $556 million to $497 million.”
Source: gulflive.com

Medicare Expert Patricia Barry, Ask Ms. Medicare

Eligibility Learn about how you can qualify for health coverage under Medicare. Enrollment Learn about when and how to sign up for Medicare according to your circumstances. Disenrollment Learn about how to opt out of Medicare if you are already enrolled. Out of Pocket Expenses Learn about your share of Medicare costs. Medical Coverage (Part A and Part B) Learn about medical services covered under Part A (hospital insurance) and Part B (outpatient insurance). Prescription Drug Coverage (Part D) Learn about how Medicare’s prescription drug program works. Medicare Private Health Plans Learn about the Medicare Advantage program, an alternative way of receiving Medicare benefits. Sources of Information and Help Learn about how to find personal help on Medicare issues.
Source: aarp.org

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June 23, 2013

Firm Relies On Medicare Experience As It Prepares To Open Federal Health Exchange Calls Centers

Posted by:  :  Category: Medicare

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Shortly after the Medicare prescription drug benefit was introduced in 2006, the HHS inspector general found that 44 percent of callers reported problems accessing information — despite a similar 2004 inspector general’s finding — and 21 percent of callers waited so long for responses that they hung up. When Medicare introduced a new prescription drug discount card in 2004, the Government Accountability Office reported that 29 percent of the call-center answers were inaccurate and 10 percent of the calls were disconnected.
Source: kaiserhealthnews.org

Video: What is a Medicare health insurance exchange?

OIG : Medicare Pays 30% More for Lab Tests Than Other Health Plans

The OIG found that Medicare spent an extra $901 million by not paying the lowest prices for lab tests, prices that were often found under state Medicaid or federal employee health benefits plans. Comparisons of lab test fees under other health plans to those under the Medicare Clinical Laboratory Fee Schedule revealed the discrepancy.
Source: beckershospitalreview.com

How to pick a Medicare plan

The Kaiser Family Foundation estimates that monthly premiums for Part D stand-alone prescription drug plans will rise by 10%, on average, to $40.72 in 2011. This assumes beneficiaries stay with their 2010 plans. Many experts advise consumers to shop around. For Medicare Advantage policies, Kaiser projects relatively modest price increases, with premiums rising about $2 a month to an average of $43. This is what’s called an enrollment-weighted premium, meaning that Kaiser has looked not only at insurance plan rates but also at the numbers of people in the plans. Plans with larger enrollments have more weight when projecting average premiums. All insurers offering Medigap plans must charge the same rate for comparable coverage. Medicare has an online tool that will allow access to local Medigap policies and rates by ZIP code.
Source: msn.com

Evidence Supports Medicare For All

The poor US performance on preventable mortality.  The United States ranks last out of 16 countries in deaths that might have been prevented with timely and effective medical care, leading to an estimated 91,000 excess deaths annually. In this context, Goldman and Leive’s claim that high U.S. health spending is buying more effective treatment of breast and prostate cancer compared to other countries is of questionable significance as well as accuracy. Earlier diagnosis from greater screening improves survival times for cancers, especially at five years, but has very little impact on mortality.  At any rate, Medicare for All would not reduce spending on cancer treatment. The whole point of single payer is to shift resources we are squandering on bureaucracy (including the administrative burden on physicians and hospitals) into clinical care, increasing the amount available to care for patients by about $380 billion annually, according to the authors of a landmark New England Journal of Medicine study.
Source: healthaffairs.org

Obama v. Ryan on controlling federal Medicare spending

As under the health law, Obama would make direct cuts to benefits off limits. The health law created the Independent Payment Advisory Board (IPAB) to come up with proposals to reduce spending if Medicare grows at a higher rate than the target. But the board’s 15 members, who will be appointed by the president and confirmed by the Senate, are not allowed to recommend anything that would ration care or change benefits, eligibility or cost sharing for Part A (hospital services) or Part B (physician services). It also couldn’t do anything to change the percentage of premium that seniors pay for prescription drug coverage or the subsidies that low-income individuals get. The expectation is that reductions would come from medical providers, although hospitals are protected at first.
Source: nbcnews.com

Medicare Website Receives Top Marks

About Kaiser Permanente Kaiser Permanente is committed to helping shape the future of health care. We are recognized as one of America’s leading health care providers and not-for-profit health plans. Founded in 1945, our mission is to provide high-quality, affordable health care services and to improve the health of our members and the communities we serve. We currently serve more than 9.1 million members in nine states and the District of Columbia. Care for members and patients is focused on their total health and guided by their personal physicians, specialists and team of caregivers. Our expert and caring medical teams are empowered and supported by industry-leading technology advances and tools for health promotion, disease prevention, state-of-the-art care delivery and world-class chronic disease management. Kaiser Permanente is dedicated to care innovations, clinical research, health education and the support of community health. For more information, go to: kp.org/newscenter.
Source: kp.org

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

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

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

MedPAC on Medicare plan competitive bidding

Consistent with the goal of encouraging beneficiaries to make cost-conscious choices, this chapter presents an overview of a model based on government contributions toward purchasing Medicare coverage—an approach we call competitively determined plan contributions (CPCs). The Commission uses the term CPC to broadly describe a federal contribution toward coverage of the Medicare benefit based on the cost of competing options for the coverage, including those offered by private plans and the traditional FFS program. Specifically, CPC has two defining principles: First, beneficiaries receive a competitively determined federal contribution to buy Medicare coverage; second, beneficiaries’ individual premiums vary depending on the option they choose.
Source: theincidentaleconomist.com

CMS: Health plans for dialysis patients on Medicare Advantage not impacted by sequester

The Centers for Medicare & Medicaid Services issued a memorandum last month affirming that Medicare Advantage Plans are exempt from the 2% cut. Part D plans are also exempt. Some insurance plans, including United Healthcare, Humana, and Anthem Blue Cross Blue Shield, had notified care providers that they should expect a 2% cut, according to Lexology, an industry newsletter published in cooperation with the Association of Corporate Counsel.
Source: homedialyzorsunited.org

Medicare Advantage Fact Sheet

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

Cool Medicare Health Plans images

An accountable care organization (ACO) is a type of payment and delivery reform model that links provider reimbursements to quality metrics and reductions in the total cost of care for an assigned population of patients. A group of coordinated health care providers—which can include doctors, hospitals, nursing homes—form an ACO, which then provides care to the group of patients. Thirty-two health systems have been selected by CMS to participate as pioneer accountable care organizations. Blum noted that these systems were able to qualify because they already have experience in population health, pay-for-performance and risk-based reimbursement.
Source: coloradomedicaremedigap.com

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

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

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June 23, 2013

Medicare Advantage No, Single Payer Yes

Posted by:  :  Category: Medicare

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Medicare has contracted with private insurance plans – previously referred to as Medicare HMOs and now called Medicare Advantage plans – since 1985. Such plans, most of them for-profit, currently cover about 27 percent of Medicare enrollees and have been growing at a fast clip. UnitedHealth and Humana are among the largest players in this market, and together operate about one-third of such plans.
Source: healthcare4allpa.org

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

Medicare Boosts Rather Than Cuts Payments To Advantage Plans

Modern HealthCare: Limited Funding In an effort to scale back use of high-priced imaging of questionable value in cancer treatment, Medicare has proposed ending reimbursement for post-treatment positron emission tomography scanning in prostate cancer patients and limiting its use to one scan for most other cancer indications. Use of the technology, which involves injecting F-18 fluorodeoxyglucose (FDG) into the blood so the PET scan can identify regions of heightened metabolic activity, a sign of cancer metastasis, has grown sharply in recent years. The CMS, in giving preliminary approval to payments for the technology in 2005, required manufacturers and radiologists to establish a registry to monitor outcomes from its use. The evidence garnered from that registry convinced the CMS that the scans provided no useful information for oncologists treating prostate cancer patients who had already completed their initial therapy, according to the March 13 proposed decision memo (Lee, 3/30).
Source: kaiserhealthnews.org

CMS: Health plans for dialysis patients on Medicare Advantage not impacted by sequester

The Centers for Medicare & Medicaid Services issued a memorandum last month affirming that Medicare Advantage Plans are exempt from the 2% cut. Part D plans are also exempt. Some insurance plans, including United Healthcare, Humana, and Anthem Blue Cross Blue Shield, had notified care providers that they should expect a 2% cut, according to Lexology, an industry newsletter published in cooperation with the Association of Corporate Counsel.
Source: homedialyzorsunited.org

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

New Report Shows Medicare Advantage Delivers High Quality Care for Seniors

3rd Party Studies ACOs Admin Costs affordability Age Rating Cadillac Tax Delivery System Reform Employers Essential Benefits Exchanges GRP Health Insurance Tax Health Plan Innovations Health Plan Satisfaction House hearings House legislation KI MA Medical Prices Medical Tests medicare medigap MLR Morning Headlines Patient Safety premiums Profits Provider Consolidation Quality Rate Review Reform RZ Senate hearings Senate legislation Small Business The Link Vilification Waste Fraud and Abuse
Source: ahipcoverage.com

Understanding Medicare Advantage Plans

How to choose the best Medicare Advantage Plan? Most people who have computers can visit the Medicare.gov Web site and review the plans offered in their county. When searching people will usually take the plan that offers the best benefits. There are other factors to consider before making your final decision. It is important to be aware of the Medicare Advantage star rating which is an indication of the plans over all quality and performance. Avoid low performing plans regardless of their benefits. They may not survive Medicare scrutiny and end up being dissolved. Lastly, the size of the network of doctors is crucial, as well as the turn over rate of doctors participating in the plan. Remember if you choose a doctor in a referral system you must be confident that you will get a referral when needed. Be aware of drastic changes in benefits it may be a sign the company is losing money.
Source: blackhawksalestraining.com

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

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

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

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June 23, 2013

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

Posted by:  :  Category: Medicare

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[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

Video: Medicare Part D Donut Hole

Medicare Part D 2010 Data Spotlight: The Coverage Gap

In 2010, nearly all the private stand-alone drug plans have a coverage gap, though a small share do provide some help to beneficiaries in the coverage gap, usually covering only generics or a small number of brand-name drugs. One third of those plans with gap coverage charge more for generic drugs in the gap than they do for the same drugs in the initial coverage period.
Source: kff.org

What on Earth is the Donut Hole? A Brief Explanation of Medicare Part D and the “Donut Hole” » The NeedyMeds Blog

In 2013, you get out of the coverage gap when you have paid $4,750 out-of-pocket for covered drugs since the start of the year. When you reach this out-of-pocket limit, you get catastrophic coverage. The costs that help you reach catastrophic coverage include what you spent on drugs while in the donut hole and most of the discount on brand-name drugs you received in the coverage gap. If someone else pays for your drugs on your behalf, this will also count toward getting you out of the coverage gap. This includes drug costs paid for you by family members, most charities, State Pharmaceutical Assistance Programs, AIDS Drug Assistance Programs and the Indian Health Service. You continue to pay your drug plan’s monthly premium during the gap, but the premium does not count toward the $4,750 out-of-pocket limit. The amount your drug plan paid for your drugs in your initial coverage period also does not count.
Source: needymeds.org

Covered By Medicare And Have Questions About The Donut Hole

Below is a link to an article I found online as my Father is approaching The Donut Hole. I hope this helps those of you on Medicare as well as Children, like myself, whose loved ones are in the Donut Hole are about to approach it. http://www.seniorark.com/I%20have%20fallen%20into%20the%20doughnut%20hole.htm
Source: jimtalbot.com

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

Can Medicare Save Money? How The Part D Program Can Be More Cost

Many seniors may not be aware that the infamous “doughnut hole,” or gap in coverage, is closing thanks to the Affordable Care Act. Before the health care law was passed, if beneficiaries reached the initial limit on total drug expenses ($2,970 in 2013), they had no prescription drug coverage until they spent an added $3,700 out of their own pockets. But in 2013, people in the doughnut hole are receiving discounts of 52.5 percent on name-brand drugs and 21 percent on generics. These discounts will result in significant savings for about 4 million Medicare beneficiaries in 2013. More importantly, the discounts will continue every year until 2020, when the doughnut hole will be completely eliminated.
Source: smmirror.com

Medicare drug costs to fall in 2014, but donut hole widens

Before passage of the ACA, seniors in the gap paid 100 percent of all drug costs. Now, they pay 50 percent out-of-pocket for brand-name drugs, with the rest made up by insurers and discounts from pharmaceutical manufacturers. For generics, they pay 79 percent. Enrollees’ out-of-pocket burden for brand-name and generic drugs will gradually fall to 25 percent by 2020 – the same percentage applied for standard coverage.
Source: medcitynews.com

Tips to Stay out of the “Donut Hole”! » Toni Says

In 2013,those who have a Medicare Part D plan receive a 52.50% discount on “covered” brand name prescription drugs that counts as out of pocket spending and help her get out of the “Donut Hole”. She pays 47.50% of the brand name prescription and the prescription drug manufacturer will pay 52.50% of the “covered” drug.  Everyone who gets in the “Donut Hole” must spend $4,750 out of pocket for the year to get out of the “Donut Hole” or coverage gap. When she is out of the “Donut Hole”, she enters catastrophic coverage and pays a small co pay for each prescription drug until the end of the year.  January 1 of each year, the process starts all over again!
Source: tonisays.com

Medicare Part D Donut Hole, Coverage and Changes 2013

Medicare Part D 2013 Changes for this year include, once you hit the donut hole you will be eligible for a onetime $250 rebate cheque. You will also receive a 50% discount on brand name drugs in the donut hole; you will also pay less and less for your generic part D drugs in the donut hole. It is planned that as from 2020 the coverage gap will have been closed such that there will be no donut hole. In this case you will only pay 25% of the cost of your drugs until you reach the spending limit. You will also get continuous Medicare coverage throughout this time for your prescriptions as long as you are in the prescription drug plan There is no need to keep track of your retail drug costs or retail drug spending, your Medicare part D plan provider will gather all the retail costs and keep a keen track of your record till you reach the donut hole Phase. You can also check out:
Source: medicalbillingcodings.org

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