The Geographic Gap in Medicare Spending Reflects Health Differences

Posted by:  :  Category: Medicare

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Prior studies based their results on cost of living and various regional adjustments but never health status. The new study explains that health differences around the country account for 75%-85% of cost variations. “People really are sicker in some parts of the country.” said Dr. Patrick Romano, one of the authors of the study.  The Dartmouth Institute for Health Policy and Clinical Practice has long asserted that variations in regional spending are due to the aggressive practices of doctors and high rates of diagnosis in certain areas. The new research contests this by examining hip fractures, head injuries and heart attacks, in which there is little discretion in diagnosis. The geographic variations in spending for these conditions remained consistent with conditions that allow doctors leniency in diagnosis. According to this new data, cutting or placing spending caps on doctors and hospitals in higher spending areas may be detrimental. Some areas spend more money per beneficiary because…the people are sicker.
Source: wordpress.com

Video: Avoid the Donut Hole Coverage Gap in Medicare

Can Medicare Locals help Close the Gap?

Many Aboriginal Outreach Workers, employed by Medicare Locals to fill a multidimensional role, have few formal qualifications and, as an additional challenge, AOWs tend to live and work within their own community. Formal education and support are essential to avoid unnecessary stress, burnout or being overwhelmed by complex caseloads.  This support may take the form of additional training, debriefing sessions and clinical supervision for Outreach Workers. Considering the enormity of the role Aboriginal Outreach Workers face, implementing a health program that crosses cultural, social and economic parameters, Medicare Locals are going to have to consider how best to support and empower their workforce. Without an empowered Aboriginal Outreach Workforce, how else will Medicare Locals remain relevant and continue their progress towards Closing the Gap?
Source: wordpress.com

A Lesson in Avoiding Medicare Coverage Gaps

Furiously logging into my insurance account did not, in fact, reveal a way for me to submit a claim for reimbursement. It revealed the fine print that I’d conveniently ignored. All of my prescriptions for the rest of December cost me hundreds more than I normally paid, because I’d reached the coverage gap in my insurance. Had I paid attention to the details, I’d have planned for this expense. Instead, I was sideswiped by massive added expenses at the worst possible time of the year. Ultimately, this mistake cost me $1,362.
Source: thesimpledollar.com

Medicare Nursing Home Coverage Gap and Possible Changes

In both cases, lawsuits have been filed and seniors advocates are saying that the way the patients were treated is unfair. According to Toby Edelman, senior policy attorney of the Center for Medicare Advocacy, observation care is very difficult to distinguish from actual inpatient care. There are no regulations which require hospitals to inform patients that they are in observation care. Patients who are under observation get the same hospital beds, medical consultations, tests and medications than those who are admitted to the hospital.
Source: medicarebenefits.com

MedPAC Urges Congress to Close Pay Gap Between Hospitals, Clinics

MedPAC also said the Republican-backed proposal to convert Medicare into a fixed contribution voucher program to purchase private health insurance was “worth investigating,” but its usefulness to beneficiaries and taxpayers would depend on features of a plan that have not yet been set, such as how funding would be determined and whether traditional Medicare would compete with private plans.
Source: beckershospitalreview.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

Social Security Questions: Bridging the Medicare Gap

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

Daily Kos: A view into the upcoming Medicaid gap

but I live in L.A. where their are many well-heeled sorts.  I have taken minimum wage in special cases such as end-of-life care for sweet souls who just couldn’t afford to pay more or to help friends of friends. Nobody is in this line of work to get rich. If Medicaid funds were refused here, it would be many of the patients I have/have had who couldn’t afford adequate assistance. It’s a horrifying thought since they get barely what they need in some cases, as it is. At 67, why is Rose not on Medicare herself? You say she has no insurance. When I hit 65 I’ll have some, even if won’t be enough and I’ll probably be Medi-Medi, too.
Source: dailykos.com

NCPDP White Paper Tackles Overutilization of Opioids, Addresses Gap to Reduce Fraud and Abuse for Medicare Part D Plans

Founded in 1977, NCPDP is a not-for-profit, ANSI-accredited, Standards Development Organization with over 1,600 members representing virtually every sector of the pharmacy services industry. Our diverse membership provides leadership and healthcare business solutions through education and standards, created using the consensus building process. NCPDP has been named in federal legislation, including HIPAA, MMA, and HITECH. NCPDP members have created standards such as the Telecommunication Standard and Batch Standard, the SCRIPT Standard for e-Prescribing, the Manufacturers Rebate Standard and more to improve communication within the pharmacy industry. Our data products include dataQ®, a robust database of information on more than 76,000 pharmacies, and HCIdea®, a database of continually updated information on more than 2.3 million prescribers. NCPDP-s RxReconn® is a legislative tracking product for real-time monitoring of pharmacy-related state and national legislative and regulatory activity. For more information about NCPDP Standards, Data Services, Products, Educational Programs and Work Group meetings, go online at or call (480) 477-1000.
Source: so-co-it.com

Medicare Supplemental Insurance

By way of example, Medicare supplemental Plan A is the most basic policy and is offered by all companies selling Medicare Supplemental plans. This plan covers the 20 percent of outpatient expenses not covered by Medicare and provides additional insurance for a hospital stay. This includes an additional year of hospital coverage. It does not cover any deductibles under Medicare Parts A and B. This plan is the lowest cost because it is the most basic coverage. You may want to get additional coverage in a supplemental policy, but for those on a tight budget, Plan A may be best. On the other hand, although it costs a little more, Medicare Plan F is the most popular plan because it covers nearly all the gaps in Medicare coverage.
Source: davebroggi.com

Will My Medicare Insurance Change Under The Affordable Care Act?

Medicare is a form of national health insurance that currently insures over 45 million people. With the advent of the Affordable Care Act and the private exchanges due to roll out in January of 2014, lots of people on Medicare are wondering how their coverage will be affected. Let’s take a look at the most common types of insurance and if or how they will change due to the new healthcare law.
Source: icontemplate.com

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

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

Posted by:  :  Category: Medicare

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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

Video: Understanding Medicare Advantage Plans

VIRGINIA MEDICARE COVERAGE OPTIONS

Medicare Advantage Plans availability is based on County. To receive an e-mail of all of the available Medicare Advantage Plans in your County, call Senior Healthcare Direct 1-855-368-4717, and one of our Virginia Licensed Medicare Agents will be happy to assist you.
Source: srhealthcaredirect.com

Daily Kos: Kaiser report details Medicare options

Medicare cost sharing is relatively high and, unlike most private health insurance policies, Medicare does not place an annual limit on the costs that people with Medicare pay out of their own pockets. Many Medicare beneficiaries have supplemental coverage to help pay for these costs, but with half of beneficiaries having an annual income of $22,500 or less in 2012, out-of-pocket spending represents a considerable financial burden for many people with Medicare.Cost sharing and premiums for Part B and Part D have consumed a larger share of average Social Security benefits over time, rising from 7 percent of the average monthly benefit in 1980 to 26  percent in 2010 (Exhibit I.3). Medicare beneficiaries spend roughly 15 percent of their household budgets on health expenses, including premiums, three times the share that younger households spend on health care costs. Finally, Medicare does not cover costly services that seniors and people with disabilities are likely to need, most notably, long-term services and supports and dental services. Putting the burden of saving Medicare on the beneficiaries, already paying a significant portion of their incomes on health care, isn’t a solution for saving this program, for keeping it’s promise to America’s seniors and disabled. That basic premise should be the starting point for reforms.
Source: dailykos.com

23 Proposals to Increase the Value of Healthcare

Reforming Medicare and Medicaid to support greater value 13. Align Medicare with employer-sponsored and exchange coverage by permitting competition among coverage options. 14. Implement further provider payment reforms in traditional Medicare to reinforce the care and delivery innovations supported by the private sector. 15. Reforms in Medicare benefit and Medigap should enable beneficiaries to save through higher-value choices and wellness activities. 16. Enable Medicare to support private-sector innovations in care. 17. Integrate Medicare and Medicaid coverage for dual-eligible beneficiaries. 18. Eliminate reliance on last-minute price reductions for Medicare providers, treatments and Medicare Advantage plans. 19. Consider implementation of additional Medicare financing reforms to help improve Medicare sustainability. 20. Encourage greater continuity between Medicaid, the exchanges and employer-sponsored coverage. 21. Support greater care coordination and address preventable costs for high-cost, high-risk Medicaid beneficiaries. 22. Continue Medicaid Disproportionate Share Hospital payments in states that do not expand Medicaid coverage. 23. Support multi-payer initiatives to improve care and lower costs.
Source: beckershospitalreview.com

Five Provider Options for Medicare and Medicaid Appeals and Audits : Lawdable

Outsourcing to clinicians:  Like internal clinical staff, outsourced clinicians are not trained advocates, and therefore are not able to appropriately object to improper testimony or cross-examination by the contractor, or to cross-examine the contractor’s witness. While it is true that attorneys are not “required” for an ALJ hearing, it is important to recognize that Administrative Law Judges are attorneys, not clinicians, by training. And, they are permitted to question witnesses as they deem appropriate. Thus, even if the opposing contractor’s attorney does not appear and offer testimony or cross-examination, the ALJ may question the witness. Having an attorney advocate to prepare the witness for that questioning, and to rehabilitate the witness following any adverse questioning, is invaluable. 
Source: lawdable.com

Need Help Understanding My Medicare Options? » Toni Says

If you have a doctor that is in the Medicare Advantage plan’s provider                                              directory, make sure you call to verify that he/she is still accepting that                                          particular Medicare Advantage plan.  Sometimes providers are in the                                             directory, but stopped accepting the plan long before it went to print.
Source: tonisays.com

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

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

Kaiser Family Foundation Medicare options

ACA Affordable Care Act Amendment One Balancing the budget is a progressive priority budget deficit cadillac tax cbo Charles Blahous CLASS Act college tuition debt ceiling debt limit deficit dual eligibles end of life fiscal commission health care costs health reform hospice Hospice/Palliative Care individual mandate IPAB Long Term Care Long Term Care Insurance Medicaid Medicaid expansion Medicare Medicare Advantage National Flood Insurance Program NC Medicaid plan Negotiated Rulemaking NHS On The Record Patients’ Choice Act Paul Ryan premium support rationing RWJF smoking smoking cessation social cost of smoking Social Security Super Committee tax reform The cost of smoking
Source: wordpress.com

Augusta needs Medicaid expansion, and so does Georgia

Posted by:  :  Category: Medicare

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This idea that a 2% increase in our budget…and consequently an increase in OUR taxes…..is okay is the kind of thinking that is killing those of us who PAY the taxes. “Oh, it will create jobs” is always the answer but somehow it never does, and the welfare, SSI, food stamp, and Medicaid rolls keep growing because we keep offering them a better deal. Meanwhile the taxPAYERS are stuck with the 2% increase for this, and a 4.9% increase for that, and a sales tax increase for the roads, and, if you actually PAY you medical bills a 3% increase on your medical devices. This line of thinking that federal or state budget increases, more taxes, and more spending on give away programs are somehow good for the economy….good for the taxpayer…..is simply crap. Everyone, even the Democrats and the CBO, are already admitting that Obamacare is a BUST at controlling or lowering the cost of medical care. They already know that the federal government is not going to be able to afford even the 90% that they promised and many of the states know that they cannot afford the 10% and that the feds will most likely figure out how to get out of paying their 90%.
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

Georgia expected to spar over Medicaid expansion in election aftermath

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

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

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

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

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

Checking Up On Health: June 25, 2013

Lots of holes in autism study: Researchers seeking the roots of autism have linked the disorder to chemicals in air pollution. Researchers from Harvard University’s School of Public Health report that pregnant women exposed to high levels of diesel particulates or mercury were twice as likely to have an autistic child compared with peers in low-pollution areas. The findings, published  in Environmental Health Perspectives, are from the largest U.S. study to examine the ties between air pollution and autism. About 2 percent of American school children were diagnosed with autism disorders in 2011 and 2012, according to the Centers for Disease Control and Prevention. Using locational data from the Environmental Protection Agency, researchers estimated the women’s exposure to toxins, a method the lead author admitted is imperfect. Many of the compounds travel together in the air, so separating their contributions was difficult. What’s more, the EPA data, taken once every four years, is an imprecise way of estimating exposure, and the only location accounted for was the women’s residence. Source: Bloomberg News
Source: georgiapolicy.org

Year 2011 Medicare Supplemental Insurance Policy Coverage Changes

Posted by:  :  Category: Medicare

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Should be it possible for the full coverage regulations to be good value? Take into mental this example even there is the particular family of give consideration to that engages about a travel present for a at least two week trip and so they end set up taking a scheme amounting to the particular hundred and 26 four thousand $ $ $ $ on a detailed travel insurance insurance option with provisions designed for accidental death then dismemberment, emergencies medical expenses, travel delays and cancellations, and lost collectibles. The normal top quality price range about such an an insurance policy policy will oven from two one hundred to two 100 and fifteen us for the person.
Source: flloecdelft.org

Video: Learn About Medigap Plans

Medicare Supplement Studies > Minnesota Medigap Companies > MedicareSupplement.com

While most of America (47 states) must consign to the National Association of Insurance Commissioners (NAIC) standardization of Medigap policies, Minnesota does not. Minnesota is one of the three waiver states that standardized their Medicare supplement plans before NAIC’s involvement in 1990. Because of this, so long as the plans offered cover the basic requirements, Minnesota (along with Massachusetts and Wisconsin) is able to continue issuing their Medicare supplement plans.
Source: medicaresupplement.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

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

Mutual of Omaha has Announced a Rate Increase on Medicare Supplement Plans in Indiana

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

FAQ: Seniors May See Changes in Medigap Policies

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

On The Topic Of Medicare And Medicare Supplement Plans

medigap plans are the optimum health care products that provide specific amount of serenity to seniors in addition , disabled people to protect your life all over health care plans. This specific type of supplemental health insurance programs covers the gaps between original Medicare payments and has comfortable planning to find providing interesting help and advice to Medicare supplemental plans. May very challenging time period taking health really do care thrillingly, which creates the process of applying health maintenance plans very easy and simple. Moreover, you will take advice from expert insurance agents, who provide smart guidance for safeguarding your life thankfully.
Source: isn-buenosaires-2012.org

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

Will health reform make it easier to buy Medigap plans?

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

You Important Information On Medicare Vitamin Supplements Plan N

Nattokinase is an molecule found in any kind of cheese like food, natto, made between fermented soybeans. There are hardy claims made because of properties. Personal it quickly decreases blood pressure, supervises cholesterol levels, plus prevents and equal breaks up thrombus. The heart is a a couple chambered, hollow muscle mass and double operating pump that can be found in the chest among the lungs. Heart failure diseases caused through process of high blood air pressure contributes to solidifying of the leading to tinnitus. Complementary and alternative medicine includes a number of different medical systems. Eastern cultures have been using traditional Chinese medicine, Ayurveda, and indian head massage for centuries.
Source: jndtecheng.com

Things that ought to be there in the best Medicare Supplement Policies

Those who have already enrolled themselves in Medicare can also get enrolled in supplemental insurance. These are marketed and sold by private firms. Traditional Medicare takes care of most of the expenses but not each and every service associated to medical supplies and health. Traditional Medicare includes hospital insurance and medical insurance which falls under Part A and Part B respectively. The ideal plan of Medicare supplement insurance should be able to provide coverage for “gaps” that are not taken care of by traditional Medicare. These includes copayments, coinsurance and deductibles, which can add up, especially for individuals who need trained nursing home services and are hospitalized. This plan can also pay for the medical services sought by an individual outside his own country along with preventive services that do not receive approval from Medicare. Those who are enrolled in both the parts of Medicare (Part A and Part B) besides best Medicare supplement insurance policy, Medicare furnishes its share of medical services approved by it. Following this, Medigap takes care of its share of the expenses.
Source: fusionswim.com

What is Medicare Supplement (Medigap) Insurance

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

Policymakers, Stakeholders Propose Changes to Medigap Policies that Could Threaten Affordability

As part of the current budget discussions, AHIP is urging policymakers to avoid changes that will threaten benefits that millions of seniors and people with disabilities rely on. Earlier this week, the President released a budget proposal for 2014, which calls for a 15 percent surcharge on new beneficiaries who choose Medigap policies with low cost-sharing requirements.  The recent budget proposal is one of several proposals that would impose a new tax on the average Medigap premium.  The Medicare Payment Advisory Commission (MedPAC) has discussed a 20 percent surcharge.  Adding a new tax on Medigap would increase costs for vulnerable beneficiaries who rely on the predictability and financial protection Medigap provides.
Source: ahipcoverage.com

Older Americans Month 2013: Unleash the Power of Age!

Posted by:  :  Category: Medicare

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For 50 years, May has been the month we celebrate older adults across the nation. You could say that Older Americans Month is coming of age. This year’s theme—“Unleash the Power of Age!”—emphasizes older Americans’ potential for energy and activism and urges them to embrace it.
Source: medicare.gov

Video: Debunking the “Raise the Medicare Eligibility Age” Argument

Join the fight against Medicare fraud

About the Author: Theresa Cooper, Certified Senior Advisor (CSA)®. As Client Support, she coordinates services, does research, makes calls to medical personnel and insurance companies, acts as “assistant” to families who may not have time to do all the myriad tasks needed in caregiving. Her CSA certification supplements her 20 plus years of experience in office administration and research with ongoing education about the key health, social and financial factors that are important to seniors.
Source: agenavigation.com

AARP: Don’t raise the eligibility age for Medicare

AARP is a nonprofit, nonpartisan organization, with a membership of more than 37 million, that helps people 50+ have independence, choice and control in ways that are beneficial to them and society as a whole. AARP does not endorse candidates for public office or make contributions to either political campaigns or candidates. We produce AARP The Magazine, the definitive voice for Americans 50+ and the world’s largest-circulation magazine; AARP Bulletin, the go-to news source for the 50+ audience; AARP VIVA, a bilingual lifestyle multimedia platform addressing the interests and needs of Hispanic Americans; and national television and radio programming including My Generation and Inside E Street. The AARP Foundation is an affiliated charity that provides security, protection, and empowerment to older persons in need with support from thousands of volunteers, donors, and sponsors. AARP has staffed offices in all 50 states, the District of Columbia, Puerto Rico, and the U.S. Virgin Islands. Learn more at www.aarp.org.
Source: aarp.org

Obama Opposes Raising Medicare’s Eligibility Age To Reduce Spending

California Healthline: Sequestration Would Hurt Rural Health Providers, Study Shows Rural health care providers heard bleak predictions about the potential effects of sequestration at the National Rural Health Association’s 24th annual Rural Health Policy Institute last week. If Medicare reimbursement is reduced by 2 percent as specified in the sequestration process due to start in three weeks, 63 rural hospitals will no longer be profitable and 482 rural health care jobs will be lost nationally, according to estimates by iVantage Health Analytics. California’s rural hospitals won’t be as hard-hit as those in the Midwest and South, according to the research, but all health care providers who treat Medicare beneficiaries will feel the pinch at some level, said Gregory Wolf of iVantage (Lauer, 2/11).
Source: kaiserhealthnews.org

Extending Social Security and Medicare Eligibility Ages

In light of the increase in life expectancy after age 65 and the decline in physically demanding jobs, it would be reasonable for the eligibility age for social security to rise to 68 or 70. The average age of retirement from the labor force for Japanese males is already only a little below 70, which shows that much higher retirement ages is feasible. Persons who are physically or mentally incapable of working would then opt for disability status. This is a rapidly growing category in most developed countries, despite the increase in physical and mental health of older persons, because of a weakening of qualifying standards. With more flexible labor markets for the elderly, such as reducing the fear of companies that they will be sued for discrimination against older workers, older men and women could retire from more demanding jobs, and take jobs that are less taxing. This is what happens to older men in Japan.
Source: becker-posner-blog.com

Marketing Medicare Supplements to Age 66

I will give this question a stab. "Can a person make a living selling Medicare and Medicare supplements in their first year?" Depends how you define "make a living", but I believe the answer to be no, for two reason. First, there is a learning curve how to best prospect. I’ve been selling MA & MS for a few years now, and feel like I am finally starting to prospect smart and hitting my stride. Second, the one year commission on MS sucks. BUT, it is all about building the block of business and building up those renewals.
Source: insurance-forums.net

Taking Medicare’s eligibility age off the table

CARNEY: Again, as part of a big deal, part of a comprehensive package that reduces our deficit and achieves that $4-trillion goal that was set out by so many people in and outside of government a number of years ago, he would consider that the hard choice that includes the so-called chain CPI, in fact, he put that on the table in his proposal, but not in a cherry-picked or piecemeal way. That’s got to be part of a comprehensive package that asks that the burden be shared; that we don’t, as some in Congress want, ask seniors to bear the burden of further deficit reduction alone, or middle-class families who are struggling to send their kids to college, or parents of children who are disabled who rely on programs to help them get through.
Source: msnbc.com

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June 29, 2013

N.C.’s nascent Medicaid reform

Posted by:  :  Category: Medicare

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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

Video: Doctors No Longer Accepting Medicare Patients in North Carolina

North Carolina Medical Society

 Based on the 2013 Physician Fee Schedule final rule, which took effect January 1, 2013, Medicare pays for two CPT codes (99495 and 99496) that are used to report physician or qualifying non-physician practitioner care management services for a patient following a discharge from a hospital, skilled nursing facility or a community mental health clinic stay, outpatient observation or partial hospitalization.
Source: ncmedsoc.org

Hospitals: Block of Medicaid expansion jeopardizes care in NC

About 72 percent of Mission’s patients are covered by Medicare or Medicaid or have no insurance at all. In 2012, Mission Health provided more than $37 million in unreimbursed costs for the treatment of Medicare and Medicaid patients and provided almost $76 million to treat charity-care patients and cover unreimbursed medical costs and other community-benefit investments. Last year, Mission Health also provided almost $32 million in free care for uncollectible accounts.
Source: carolinapublicpress.org

McCrory, Wos announce plan to privatize Medicaid

As has already been pointed out, the profit motive is the driving force behind successful (my word) business models, and in the pursuit of profits, the business owner dispenses her resources in an attempt to maximize her personal profits. It happens to be that in this particular case the profit-seeking, business owner has at her disposal the power of the legislature. Now that is hopefully not a resource under her direct control, but through the lobbyists, which have already been mentioned, the business owner has her republican and democrat friends (puppets?) legislate taxpayer money into her pockets under the auspice that it wil bring relief to the poor and otherwise needy or downtrodden portion of the population. Perhaps we should consider taking that power from the business owners and forcing honest business to procede as much as is possible.
Source: ncpolicywatch.org

NC Couple Sentenced for Medicare Fraud

According to their indictment, John Alspaugh and his wife jointly owned as well as operated a home healthcare business, known as "Basic Home HealthCare," for providing living assistance service like bathing and supplying of drugs to patients who are at their homes. Between 2006 and 2007, the health care business employed more than 130 employees, but did not pay the needed employment tax to the IRS (Internal Revenue Service). The amount the business failed to pay has been estimated as more than $458000 for the above-mentioned period alone.
Source: dandell.com

North Carolina Trial Law Blog: Useful link to Medicare and MSPRC billing and diagnostic codes for auditing conditional payment letters

The information provided on this blog is of a general legal nature and should not be taken as specific legal advice. No post on this blog creates an attorney client relationship. I’m a NC lawyer, so anything I post applies only to NC. If someone else posts something legal, I can’t take responsibility for what they say. This is all pretty straight forward stuff, but you have to say it if you are a lawyer, right?
Source: nctriallawblog.com

Ruling Unlocks Medicare Payments to Individual Physicians

In October 1979, a federal judge in the US district court in Jacksonville, Florida, said that a plan by the predecessor of the US Department of Health & Human Services (HHS) to disclose Medicare revenue information by physician violated the Privacy Act of 1974. In a ruling issued on May 31, however, US District Judge Marcia Howard, in Jacksonville, said that the Privacy Act no longer authorizes the injunction, given how the federal judiciary has interpreted the law since 1979.
Source: msochealth.com

National Elder Law Month: What Does Medicare Cover for Nursing Homes? : North Carolina Estate Planning Blog

Medicare helps many seniors afford necessary healthcare services. All individuals over age 65 qualify for Medicare programs if they meet certain citizenship and asset criteria. Coverage may begin earlier for those who have received disability benefits for more than two years or who have end-stage renal disease and meet a 3-month waiting period. There are asset and income limits that also affect eligibility, which is why it’s important for seniors to meet with an elder law attorney who can offer the best options for structuring assets to remain eligible for disability benefits.
Source: ncestateplanningblog.com

A Look at North Carolina’s Medicaid Program : NC SPIN Balanced Debate for the Old North State

North Carolina’s Medicaid budget is large and continues to grow with demand, but the federal government shares in both the cost of the services provided and administrative costs. The level of federal financial participation is referred to as the Federal Medical Assistance Percentage (FMAP). FMAP is established annually and varies by state, because the rate for each state is based on its per-capita income. The minimum FMAP is 50% for covered services. North Carolina’s FMAP for FY 2013 has been set at 65.51% [9]. However, certain services receive a higher FMAP. For example, federal funds pay 90% of the costs of family planning services and 100% of the costs of services provided through Indian tribal facilities (such as the Health and Medical Division of the Eastern Band of Cherokee Indians) [10]. Normally the federal government pays 50% of administrative costs, but in some cases it pays a higher percentage of those costs. For instance, the federal government pays 100% of the costs to verify immigration status; 90% of the costs to verify citizenship; 90% of the costs to design, develop, and install Medicaid Management Information Systems (MMIS); and 75% of the ongoing costs of managing and operating such systems [10]. States that choose to expand Medicaid under the Patient Protection and Affordable Care Act of 2010 will receive a FMAP of 100% for the first 3 years to pay for services for newly eligible enrollees. The FMAP would then begin to decline, stabilizing at 90% in 2020 [11].
Source: ncspin.com

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June 29, 2013

Retiree with No Technology Background Launches Medicare Supplemental Insurance Comparison Site

Posted by:  :  Category: Medicare

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Here’s how plans for retirement used to go for most – work at the same job for several decades, build up social security and pension income, retire at 65 and dedicate time to improving canasta or golf skills. Maybe some people had other ideas, but suffice it to say, people view retirement much differently today than they did 20 years ago. Retired firefighter, Steven Pewter is a perfect example of this. At age 74, with absolutely no technology background, Pewter used a laptop computer he got as a birthday present to build a website for seniors to compare Medicare supplemental insurance plans, MedicareSupplementalInsuranceComparison.net. Pewter’s story supports the findings of a new survey from Del Webb – a leading builder of active-adult communities. It showed that almost 80 percent of boomers expect to work in some capacity, even after they retire, and not just for money. In fact, the majority, fifty-one percent, plan to work to avoid boredom and maintain a sense of purpose. “I come from working stock,” commented Pewter when asked about his motivation. “I certainly wasn’t going to just sit around and slowly fade to dust after retirement.” Pewter was driven to create the Medicare supplemental insurance comparison site after a frustrating personal experience shopping for supplemental coverage online. Hours and hours of research turned up only sites that required significant personal information before returning any valuable information on plans or rates. So, he decided to use his new computer skills to create a site that would give people detailed supplemental insurance coverage and rate information after entering just their zip code. The site gained almost instant popularity with 10,000 visits in the first week. By the end of the first month, 30,000 people had used the site to research Medicare supplemental insurance. And now nearly seven months later, the site continues to attract seniors, not just with its rate and plan comparison info, but with the dozens of articles, tutorials and how-to pieces it features that are updated regularly. Pewter’s family members comment that he has approached his new Internet endeavor with the gusto and enthusiasm of a man a third his age. “Well, it’s my kids and grandkids that keep me young,” Pewter said. “Knowing they’re so proud of what I accomplished with the site pushes me to keep at it.” About MedicareSupplementalInsuranceComparison.net MedicareSupplementalInsuranceComparison.net is a site for seniors to compare rate plan and coverage information for Medicare supplemental insurance. By entering just a zip code, visitors can retrieve detailed results from leading insurance providers in their area. And, the site is constantly updated with helpful articles and tutorials to guide people through the sometimes confusing world of Medicare. For more information, visit: http://www.medicaresupplementalinsurancecomparison.net
Source: sbwire.com

Video: Medicare Supplement Insurance Plans – Where Do I Start?

Year 2011 Medicare Supplemental Insurance Policy Coverage Changes

Should be it possible for the full coverage regulations to be good value? Take into mental this example even there is the particular family of give consideration to that engages about a travel present for a at least two week trip and so they end set up taking a scheme amounting to the particular hundred and 26 four thousand $ $ $ $ on a detailed travel insurance insurance option with provisions designed for accidental death then dismemberment, emergencies medical expenses, travel delays and cancellations, and lost collectibles. The normal top quality price range about such an an insurance policy policy will oven from two one hundred to two 100 and fifteen us for the person.
Source: flloecdelft.org

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

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

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 Supplement Studies > Minnesota Medigap Companies > MedicareSupplement.com

While most of America (47 states) must consign to the National Association of Insurance Commissioners (NAIC) standardization of Medigap policies, Minnesota does not. Minnesota is one of the three waiver states that standardized their Medicare supplement plans before NAIC’s involvement in 1990. Because of this, so long as the plans offered cover the basic requirements, Minnesota (along with Massachusetts and Wisconsin) is able to continue issuing their Medicare supplement plans.
Source: medicaresupplement.com

MedicareBob’s Blog: Cigna is now offering Medicare Supplement Insurance in Texas!!!

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: blogspot.com

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

Harris County Texas Medicare Supplement Quotes

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

Get The Facts First Medicare Supplement Insurance Medigap

Since Medicare supplement insurance is meant to help Medicare recipients, it should come as no surprise to learn that these insurance policies are restricted to people who meet their requirements. First and foremost, eligible Medicare recipients must be signed up for Parts A and B of Medicare. Each eligible Medicare recipient has an open enrollment period that lasts for six months. The period begins as soon as the eligible Medicare recipient reaches 65 and enrolls in Plan B of Medicare. During the open enrollment period, eligible Medicare recipients can enroll in a supplement without undergoing medical screening. It is important to remember that private insurance companies are not required to sell these insurance policies to Medicare recipients under 65, though the exact rules are not the same from state to state. For example, 25 states require private insurance companies to sell such insurance policies to all Medicare recipients, while other states might demand the same for smaller subsets of Medicare recipients. In most cases if you are under 65 and have Medicare A and B, the Medicare supplement would be a very expensive option as most carriers charge a great deal to get the coverage if you are under 65. However, Medicare Advantage plans could be available for such people.
Source: easytoinsureme.com

Medigap does not cover emergency care abroad

During my traveling from Chicago to Belgrade, when I was in transit in London, I had a serious health problem, blood pressure and chest pain. I was taken to the hospital in London.  I was at the hospital for just the afternoon and I was discharged early the next morning. Medicare and my supplemental insurance denied my claims and I was forced to pay not a small bill to the hospital in London. So my question is, was I insured during my presence at the airport in London? If I am does, insurance include health problems? Can I submit to the airport in London my request for reimbursement?
Source: bangordailynews.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

Understanding Medicare Suplemental Insurance

Medicare supplement insurance (or Medigap) is one of the most important new drug coverage options available (home page: http://medigapplansguide.com). I first learned about it when we found out that the premiums for my father were going through the roof. Even with coinsurance options, the out-of-pocket costs were killing us. After saving a ton of money, I decided to start offering Medigap consulting for others. This article shares some of my knowledge on the subject. %%iframe$url=http://www.youtube.com/embed/
Source: wordpress.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

What is Medicare Supplement (Medigap) Insurance

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

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

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June 29, 2013

Secure Medicare Solutions June 2013 Agency News

Posted by:  :  Category: Medicare

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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

Video: medicare solutions commercial

Inside Ringler Medicare Solutions

Medicare and Medicaid compliance when it comes to legal settlement claims can be complicated. This is an area especially critical to claimants, attorneys and insurers and expertise is needed. In this podcast, Ringler Radio host Larry Cohen joins Tom Blackwell, Vice President and Program Director of Ringler Medicare Solutions, Inc. (RMS), as they take a look at RMS’ long-term development plan, how RMS can help with the administration of workers’ compensation claims, liability claims and in claim settlement strategies and the impact of the Strengthening Medicare and Repaying Taxpayers Act (SMART) on the structured settlement industry.
Source: legaltalknetwork.com

U.S. Chamber of Commerce Health Care Solutions Council Releases New Report

This health care spending slowdown proves Medicare is working at an optimal level, and should largely be left alone in the near-term.  The system must be given time to realize its full potential for massive Medicare and deficit savings. Attention to any potential reforms for the benefit of addressing cost growth should focus on the long-term needs of the health care system, especially access to care, taking into account the changing demographics of the population.
Source: fahpolicy.org

#AARP recommends sensible solutions to strengthen Medicare

With the recent cost cutting measures put in place by the CMS to limit health insurance profits and reduce hospital and doctor costs, the healthcare system will be forced to make changes that limit waste.  Now it’s time for the Department of Health and Human Service to put the same hard hitting restrictions on itself.  Specifically, it’s critical that the CMS implement a modern electronic billing system that requires both the service provider and the Medicare beneficiary to swipe a government ID card that cannot be compromised by criminals.
Source: medicarewire.com

Opinion: The cost curve on health care – it’s bending

The Federation of American Hospitals also sees downward pressure on health care costs. Its study, Structural Changes Drive Health Care Spending Slowdown, cites several factors, including improved care coordination, more appropriate use of services, growth in community-based care, better targeting of technology, stronger primary-care systems and implementation of new care-delivery systems. The study also cites other factors authorized by the Affordable Care Act, including the Medicare Shared Savings Program, value-based purchasing programs, payment and continuity of care reforms and state-based health insurance exchanges.
Source: healthpolicysolutions.org

SOUTHWEST PHARMACY SOLUTIONS INCORPORATED v. CENTERS FOR MEDICARE AND MEDICAID SERVICES, No. 12–40097., May 01, 2013

Southwest has also failed to convince us that CMS’s interpretation is merely a “post hoc rationalization advanced by an agency seeking to defend past agency action against attack.” Id. at 2166 (alteration omitted) (quoting Auer, 519 U.S. at 462). As CMS has yet to characterize a claim challenging the PPR as either a grievance or a coverage determination, there is no past action to defend. Moreover, unlike previous cases where courts have declined to defer to an agency’s interpretation when doing so would impose liability, see, e.g., id. at 2167 (“Petitioners invoke the [agency’s] interpretation of ambiguous regulations to impose potentially massive liability on respondent for conduct that occurred well before that interpretation was announced.”), or unfair surprise, see, e.g., Long Island Care at Home, Ltd. v. Coke, 551 U.S. 158, 171, 127 S.Ct. 2339, 168 L.Ed.2d 54 (2007) (“[A]s long as interpretive changes create no unfair surprise ․ the change in interpretation alone presents no separate ground for disregarding the Department’s present interpretation.”), on a party without sufficient warning, CMS’s interpretation in fact benefits Southwest by promising to allow its challenges to the PPR to proceed as coverage determinations rather than grievances. Nor is this conclusion undermined by the fact that CMS advanced this position in a document drafted in response to the present litigation, see id., 551 U.S. at 171; Tex. Clinical Labs, 612 F.3d at 778, or by the fact that CMS is a party to this case, see generally Tex. Clinical Labs, 612 F.3d 771.
Source: findlaw.com

Internists Offer Possible Solutions to Medicare Payment Problems

ACP supports a two-phased approach to eliminate the SGR and transition to better payment and delivery systems that are aligned with value. During phase one, repeal the SGR formula, provide at least five years of stable physician payments, with positive increases for all physician services, and higher payments for primary care, preventive and care coordination services; and in phase two establish a process for practices to transition to new, more effective, models of care by a date certain. ACP is encouraged that this committee

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June 29, 2013

Health Net sanction means one less low

Posted by:  :  Category: Medicare

The agency said it took action because Health Net has “continually subjected its enrollees to impermissible hurdles in their attempts to obtain needed, and in some cases, life sustaining, prescription medications.”
Source: oregonlive.com

Video: Health Net, Medicare for All and More!

Decrease Increasing Medicare Costs with Healthnet Medicare Arizona

Healthnet medicare arizona also helps you cover your medications. The more medication that you are on, the more money you will need to pay for these medications. The cost of medications keeps increasing, and since you need them, each month you will have a fixed cost for your medications. The only way to change a fixed cost is to change find a new provider for the medications or by enrolling into a new health plan that will help you reduce your monthly payments. By enrolling in healthnet medicare Arizona, you can save money on these medications and thus increase your discretionary income for each month. For example, if you make $3,000 a month and $400 of it goes to medications, then you enroll in healthnet medicare arizona, and your medication cost is decreased to $20 a month, you would increase your monthly discretionary income by $380. So, that is $380 that you can use on anything else you want instead of the medications that you need to live a healthy life.
Source: millionboatfloat.org

Health Net Awarded Arizona Medicaid Contract

Health Net, Inc. and its representatives may from time to time make written and oral forward-looking statements within the meaning of the Private Securities Litigation Reform Act (“PSLRA”) of 1995, including statements in this and other press releases, in presentations, filings with the Securities and Exchange Commission (“SEC”), reports to stockholders and in meetings with investors and analysts. All statements in this press release, other than statements of historical information provided herein, may be deemed to be forward-looking statements and as such are intended to be covered by the safe harbor for “forward-looking statements” provided by PSLRA. These statements are based on management’s analysis, judgment, belief and expectation only as of the date hereof, and are subject to changes in circumstances and a number of risks and uncertainties. Without limiting the foregoing, statements including the words “believes,” “anticipates,” “plans,” “expects,” “may,” “should,” “could,” “estimate,” “intend,” “feels,” “will,” “projects” and other similar expressions are intended to identify forward-looking statements. Actual results could differ materially from those expressed in, or implied or projected by the forward-looking information and statements due to, among other things, health care reform and other increased government participation in and regulation of health benefits and managed care operations, including the ultimate impact of the Affordable Care Act, which could materially adversely affect Health Net’s financial condition, results of operations and cash flows through, among other things, reduced revenues, new taxes, expanded liability, and increased costs (including medical, administrative, technology or other costs), or require changes to the ways in which Health Net does business; rising health care costs; continued slow economic growth or a further decline in the economy; negative prior period claims reserve developments; trends in medical care ratios; membership declines; unexpected utilization patterns or unexpectedly severe or widespread illnesses; rate cuts and other risks and uncertainties affecting Health Net’s Medicare or Medicaid businesses; Health Net’s ability to successfully participate in the duals demonstration; litigation costs; regulatory issues with federal and state agencies including, but not limited to, the California Department of Managed Health Care, the Centers for Medicare & Medicaid Services, the Office of Civil Rights of the U.S. Department of Health and Human Services and state departments of insurance; operational issues; failure to effectively oversee our third-party vendors; noncompliance by Health Net or Health Net’s business associates with any privacy laws or any security breach involving the misappropriation, loss or other unauthorized use or disclosure of confidential information; liabilities incurred in connection with Health Net’s divested operations; impairment of Health Net’s goodwill or other intangible assets; investment portfolio impairment charges; volatility in the financial markets; and general business and market conditions. Additional factors that could cause actual results to differ materially from those reflected in the forward-looking statements include, but are not limited to, the risks discussed in the “Risk Factors” section included within Health Net’s most recent Annual Report on Form 10-K and the other risks discussed in Health Net’s filings with the SEC. Readers are cautioned not to place undue reliance on these forward-looking statements. Except as may be required by law, Health Net undertakes no obligation to address or publicly update any forward-looking statements to reflect events or circumstances that arise after the date of this release.
Source: dailyfinance.com

Medicare imposes marketing and enrollment suspensions on HealthNet, Arcadian and Universal American (Today’s Options).

Arcadian had their webinar today as well. On the call the moderator did not and would not discuss the other companies. It was very refreshing for me to see that respect for the competitors. One of the things we did discuss was the sanctions, while marketing practices were a component, a large part of the sanctions revolved around Rx administration. The Rx vendor is not specifically mentioned nor will I name them. I am however disappointed that no specific action is to be taken when this vendor is responsible for issues with ALL the companies receiving sanctions. All of the companies/MAPD Plans are working hard with the CMS to correct the issues and will be back to marketing in 4 to 6 months. My feelings go out to all of the beneficiaries that will miss out on these plans. In some markets, the sanctioned plans are the most intelligent option.
Source: wordpress.com

Arizona Health Net Medicare HMO Customers Fraudulently Transferred to United Health’s AARP Medicare HMO as of 12.07.2011

I was told by another person from Health Net that this appears to have been the work of one sales person. I said I wanted the person’s name and other information because I plan on suing them. He said that he would give me that information after the investigation was over. I’m not going to hold my breath. In reality I doubt they can point to one person as the supervisor I last talked with told me the applications were filed online. A sales person would only be responsible if they’d personally signed people up for AARP. Did one salesperson submit hundreds (or more) fraudulent applications online? Did one salesperson process all of the fraudulent online applications? Neither scenario seems likely. Or were they submitted by phone or mail as others first told me?
Source: wordpress.com

CVS Caremark looks to purchase Health Net's stand

“We believe this proposed transaction is in the best interests of our Medicare PDP members and our stockholders,” stated Jay Gellert, president and CEO of Health Net. “Our Medicare PDP members, who have received certain services from CVS Caremark for five years, will now be affiliated with one of the nation’s largest Medicare PDP sponsors.
Source: drugstorenews.com

Health Net Medicare Supplement Rates & Plans in California

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Source: johnconner.com

Medicare Advantage Medicare Supplement Long Term Care Insurance in Phoenix Arizona by Western Asset Protection

is a family owned and operated insurance brokerage firm specializing in Medicare Advantage andMedicare Supplement products. We are able to assist independent insurance professionals by providing a portfolio of strong Medicare Advantage or Medicare Supplement products to meet your clients needs.
Source: westernasset-us.com

Sequestration Cuts Extend Beyond Medicare Fee

By now, most physicians are likely aware of the 2 percent across-the-board reduction in Medicare physician reimbursement for all claims with dates of service on or after April 1. These cuts are the result of the Sequestration Transparency Act of 2012, which was part of a deal worked out between President Obama and Congress to address the debt ceiling crisis. The California Medical Association (CMA) has recently learned that the cuts are also being applied to Medicare electronic health record (EHR) incentive payments and many Medicare Advantage plans are passing on the 2 percent cuts as well.
Source: medbill.net

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June 29, 2013

medicare plus blue prior authorization form

Posted by:  :  Category: Medicare

blue cross blue shield of michigan medication prior authorization form (PDF download)        Aetna Prior Authorization Form, free PDF. Aetna – Health Insurance, Dental. blue cross blue shield of michigan. What do you get when you enroll in Medicare Plus Blue PPO? The confidence that comes with affordable, all-in-one coverage that is simple to understand. You also get
Source: rediff.com

Video: Medicare Plans from Blue Cross and Blue Shield of Minnesota and Blue Plus

Newsroom – Blue Cross Blue Shield of Michigan broadens Medicare options with new Medicare Advantage PPO product

October 1 is the first day BCBSM and Medicare Advantage carriers across the nation can market their Medicare Advantage products for 2010. Beneficiaries in BCBSM Medicare Advantage products will receive letters in the next 10 days about the new product line-up. "Blue Cross remains fully committed to providing products to Medicare beneficiaries and will continue to have the broadest array of Medicare Advantage products in the state," said Mark Owen, BCBSM vice president for federal and individual business. "It’s important for Medicare beneficiaries to know that there is no immediate change to their coverage. They have until the end of the year to make their selection for 2010." In addition to the three BCBSM products for 2010, seniors also can select from three Medicare Advantage products offered by Blue Care Network, the BCBSM-affiliated HMO. "We will be working with insurance agents and other groups across the state to reach out to Medicare beneficiaries to help them navigate these product and premium changes," said Owen. Seniors who meet low income guidelines can receive subsidies from the state and/or federal government to pay for all or part of their premiums. Medicare Advantage premiums vary by product and region. The new PPO product is expected to provide beneficiaries with value for their premium. For example, the BCBSM Medicare Plus Blue PPO, which includes Part D prescription drug coverage, will cost between $61 and $141 a month (premiums vary by geographic region), while traditional BCBSM Medicare Supplemental (Medigap) Plan C plans cost $183 when combined with a stand-alone Part D BCBSM prescription drug program. Medicare Advantage plans offer Medicare benefits through private health insurance plans and most include Part D prescription drug coverage. When you purchase a Medicare Advantage plan, you do not need to also purchase a Medigap policy. Medicare Advantage plans are regulated solely by the federal government, while Medigap plans are regulated by the state. The announced product changes are only for Medicare beneficiaries who directly purchase their Medicare Advantage products, not for beneficiaries enrolled in a group plan. Blue Cross Blue Shield of Michigan and Blue Care Network are nonprofit corporations and independent licensees of the Blue Cross and Blue Shield Association.
Source: bcbsm.com

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

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

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Ann Arbor CIL › Ann Arbor CIL Hosts Flu Shot Clinic

Shots are priced at $33.  The University of Michigan Visiting Care accepts the following insurances:  Blue Care Network (including UM Premier Care), BCBSM Community Blue PPO, BCBSM Blue Preferred PPO, BlueCaid, HAP (except HAP Senior Plus), Priority Health PPO and HMO, Traditional Medicare, any Medicare Advantage PFFS Plan, BCBSM Medicare Plus Blue PPO, and BCN Advantage.  Insurance cards must be presented to clinic staff.  Those who are not covered by an insurance that Michigan Visting Care accepts may pay for the flu shot by cash, check or credit card.
Source: annarborcil.org

Blue Cross Blue Shield of Michigan Adds University of Michigan Health System to New Medicare Advantage P… ( DETROIT Dec. 30 /

Related medicine news : 1. American Red Cross Announces End to Teamsters Strike 2. Blue Cross and Blue Shield of Oklahoma Redesigns Web Site to Help Visitors Better Understand Health Insurance 3. Empire BlueCross BlueShield Fears Senate Health Care Reform Legislation Still Costs New Yorkers Most 4. Anthem Blue Cross and Blue Shield In Missouri Urges Missouri Senators Claire McCaskill and Christopher S. Bond to Not Support the Current Senate Health Care Reform Legislation 5. Blue Cross Blue Shield of Michigan Selects Kevin Klobucar to Lead Blue Care Network as President 6. Anthem Blue Cross Wins Third Largest Medicaid Managed Care Contract Renewal in the Country 7. IWHNA CEO Abdul Rao Encourages the Use of Google Health for Establishing a Patient-Specific Comprehensive Digital Health Record Across Enterprises 8. Smoking Ban Good Step Toward a Healthier Michigan, Says Blue Cross 9. Entertainment Celebrities Support Red Cross Holiday Giving Campaign 10. The National Blue Cross and Blue Shield Association Selects ATTUS Technologies as Preferred Provider for OFAC, OIG, EPLS and USA PATRIOT Act Compliance 11. Anthem Blue Cross and Blue Shield in Maine and National Council on Aging Provide Vital Benefits Information to Economically Challenged Older Adults
Source: bio-medicine.org

More on Proposed Cuts to Medicare Advantage: Seniors Would Save Far More Than They Lose

“It turns out that the additional benefits and flexibility created by recent increases in MA payment rates simply weren’t worth very much to seniors,” Frakt writes. “Consumer surplus loss associated with cuts in payments to MA plans will be only 14 cents per dollar saved. . . the truth is that under Obama’s plan a small fraction of Medicare beneficiaries will lose their MA benefits and/or face higher costs. However, the potential savings are enormous and research shows that the benefit cuts needed to achieve them will not be terribly missed.”
Source: healthbeatblog.com

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