The Medicare Prescription Drug Benefit Fact Sheet

Posted by:  :  Category: Medicare

CBO estimates that Part D spending will total $60 billion in 2013 (net of premiums and state transfers).  The average annual Part D per capita growth rate was 3.7% between 2006 and 2011, but is projected to rise at a more rapid rate (5.6%) between 2011 and 2021 (2012 Medicare Trustees), in part due to slowing of trend toward greater generic drug use. Total spending depends on several factors: the number of Part D enrollees, their health status and drug use, the number of low-income subsidy recipients, and plans’ ability to negotiate discounts and rebates with drug companies and manage use (e.g. promoting use of generic drugs, prior authorization, step therapy, quantity limits, and mail order).  The MMA prohibits Medicare from negotiating drug prices directly.
Source: kff.org

Video: Medicare Part D – 5 Things To Know Before You Enroll in a Part D Plan

Medicare recipients in ‘donut hole’ to get price break on some drugs in 2011

“Regardless of what happens to the donut hole, the influx of the first wave of baby boomers will increase the demand for drugs and other medical services,” Moffit says. “All things being equal, that will mean increased costs for seniors and taxpayers alike.” According to the federal Centers for Medicare & Medicaid Services, your actual drug plan varies depending on what kind of prescriptions you buy, which plan you choose, whether you go to a pharmacy in your plan’s network, whether your drugs are on your plan’s formulary (list of approved drugs) and whether you belong to the Extra Help program. Extra Help is a Medicare program to help low-income people; it pays for Medicare prescription drug program costs, such as premiums, deductibles and coinsurance.
Source: insurancequotes.com

Medicare Supplement Questions > Does Medigap Cover Drugs

Disclosure: “We are not connected with or endorsed by the U.S. Government or the federal Medicare program. Medicare has neither reviewed nor endorsed the information contained on this website. Disclamer: This is not a complete listing of plans available in your service area. For a complete listing please contact 1-800-MEDICARE or consult www.medicare.gov (TTY users should call 1-877-486-2048), 24 hours a day/7 days a week or consult www.medicare.gov.”
Source: medicaresupplement.com

Medicare Drug Benefit: Formulary Oversight in Medicare Part D

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

Part D Formulary Medical Review Awarded to Strategic

Strategic’s team of pharmacists and data analysts will work with CMS to monitor drug updates and evaluate Medicare Part D Plan formularies and benefits to ensure the Part D prescription drug program — offered through Medicare Advantage drug plans and stand-alone prescription drug plans — meets CMS formulary guidelines. These guidelines help ensure that Medicare beneficiaries receive clinically appropriate medications at the lowest possible cost and that Part D plans do not have formularies that discriminate against beneficiaries.
Source: strategichs.com

Marshall Elder and Estate Planning Blog: Tips on Choosing a Medicare Prescription Drug Plan

The Plan finder allows you to enter your list of prescription drugs, your preferred pharmacies and other information related to your prescriptions. After you complete the intake information, the Plan finder will provide you with a personalized list of plans organized in order of lowest estimated cost. This greatly simplifies the process of determining which plan may best meet your needs. The Plan finder deals with the complexities of formularies and tiers and co-payments for you.
Source: blogspot.com

Avalere Study Shows Patients with Medicare Part D Have More Difficulty Getting Anticonvulsant Therapy

The Centers for Medicare & Medicaid Services (CMS) implemented the protected classes policy to ensure access to “all or substantially all” medicines in six categories of drugs. The risk of poor access to a broad variety of medicines in these six categories substantially increases risk of negative health outcomes. The statute requires PDPs to cover all medicines in these classes, with the exception of multi-source brands of the identical molecular structure, extended release products, products that have the same active ingredient, and dosage forms that do not have a unique route of administration. The statute does not further define what constitutes “protection,” and CMS has sought to balance patient access with the cost of Part D plans.
Source: globalregulatoryscience.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 beneficiaries substantially more likely to use brand

“Our study shows that we can make a big dent in Medicare spending simply by changing the kinds of medications people are using – and physicians are prescribing – without worrying about whether the government should or should not negotiate drug prices,” said lead author Walid Gellad, M.D., M.P.H., an assistant professor in the Pitt Graduate School of Public Health’s Department of Health Policy and Management and Pitt’s School of Medicine. “The levels of generic use found in the VA are attainable, and they are compatible with high quality care.”
Source: sciencecodex.com

OIG Finds Medicare Plans Generally Cover Drugs Commonly Used by Dual Eligibles : Health Industry Washington Watch

The OIG has issued an ACA-mandated report on Medicare Part D prescription drug plan and MA drug plan coverage of drugs commonly used by full-benefit dual-eligible individuals (that is, individuals eligible for Medicare and Medicaid and who receive full Medicaid benefits and Medicare premium and cost-sharing assistance). The OIG determined that for 2013, Part D/MA plan formularies include 96% of 195 commonly-used drugs, with 64% of the commonly-used drugs included in all such formularies. Plans applied utilization management tools to 28% of the unique drugs reviewed in 2013, compared to 24% in 2012 (mainly attributable to an increase in the use of quantity limits). 
Source: healthindustrywashingtonwatch.com

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

Medicare recipients in ‘donut hole’ to get price break on some drugs in 2011

Posted by:  :  Category: Medicare

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“Regardless of what happens to the donut hole, the influx of the first wave of baby boomers will increase the demand for drugs and other medical services,” Moffit says. “All things being equal, that will mean increased costs for seniors and taxpayers alike.” According to the federal Centers for Medicare & Medicaid Services, your actual drug plan varies depending on what kind of prescriptions you buy, which plan you choose, whether you go to a pharmacy in your plan’s network, whether your drugs are on your plan’s formulary (list of approved drugs) and whether you belong to the Extra Help program. Extra Help is a Medicare program to help low-income people; it pays for Medicare prescription drug program costs, such as premiums, deductibles and coinsurance.
Source: insurancequotes.com

Video: Improving Medicare in 2011

Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums

This Medicare Advantage Data Spotlight provides an overview of recent changes made to the Medicare Advantage program and examines trends in plan participation, premiums and certain benefits. About 12 million people, or nearly a quarter of the Medicare population, are enrolled in Medicare Advantage, the privately administered plans that are an alternative to the traditional fee-for-service Medicare program.
Source: kff.org

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

CMS: More Than 14k Providers Kicked Out of Medicare Since 2011

CMS has revoked 14,663 providers’ ability to participate in Medicare since March 2011 due to fraud control efforts. The providers were expelled from the program due to felony convictions, not operating at the address CMS had on file or non-compliance with CMS rules. In 2008, two years before the Patient Protection and Affordable Care Act was passed, the number of healthcare providers kicked out of Medicare stood at only 6,307. The PPACA established new screening and review requirements for Medicare participation. Since the law’s enaction, Medicare revocations have doubled in 35 states and quadrupled in 18 states. Florida led the country in the number of revocations with 2,064. Texas (1,417) and Pennsylvania (1,077) also topped the list. Along with these revocation figures, CMS also announced its newly redesigned Medicare Summary Notices for Medicare enrollees. The redesigned claims statements are said to be easier to review and are intended to help senior citizens better identify potential fraud, waste and abuse.
Source: beckershospitalreview.com

2011 Medicare Trustees Report 

The HI Trust Fund is a victim of the economy.  Healthcare costs typically rise at a much faster rate than general inflation.  In 2010, healthcare costs rose almost four times faster than the consumer inflation rate.[3] In addition, the high unemployment rate means that fewer people are working and contributing payroll taxes into the Trust Fund.  Payroll tax contributions were also lower than anticipated because wages are not increasing. As a result, the Trustees had to change some of the assumptions they use about economic growth in projecting the solvency of the Trust Fund.   Note that the longest projected solvency period, 28 years, occurred in years in which the country experienced high economic growth and budget surpluses.
Source: medicareadvocacy.org

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

What Medicare and Medicaid mean to Maine’s hospitals

According to a Pew Charitable Trust report released on June 14th, Maine is one of only three states that lost jobs between 2012 and 2013. The other two are Wisconsin and Wyoming. We lost about 1,500 jobs. Accepting federal funds for expanding healthcare will provide twice the number of jobs we lost last year. The federal government will cover 100% of the cost of the expanded coverage for the first three years after which Maine’s portion of the expanded healthcare will slowly increase to 10% over the next seven years. In the first ten years of the program, Maine will receive 2.6 billion dollars from the federal government and save an estimated 690 million dollars over the same time period. Maine is one of the few states that is predicted to save money by participating in the Affordable Care Act.
Source: dirigoblue.com

New Medicare Requirements in 2011

Section 10501 of the Affordable Care Act adds several new preventive services to the list of Medicare-covered FQHC services. Additionally, the new law calls for the creation of a new Medicare reimbursement structure for health centers beginning in 2014. In order to create this system, the law requires health centers to begin reporting Healthcare Common Procedure Coding System (HCPCS) codes beginning January 1, 2011. These codes are used to indicate the types of services being provided at each visit. CMS has updated their Claims Processing Manual for FQHCs with the following information:
Source: nachc.com

Medicare Providers and Suppliers Must Begin Enrollment Revalidations

All providers and suppliers who enrolled in Medicare prior to March 25, 2011 will be required to revalidate their enrollment under the new risk screening criteria required by section 6401a of the Affordable Care Act (ACA).  Those who have revalidated or enrolled since then have already been subjected to the screening.  The MAC will send notice to individual providers and suppliers, between today and March 2013, to being the revalidation process.  Providers and suppliers are required to initiate the revalidation process as soon as they receive notice from their MAC, and must complete the process within 60 days of that notice. 
Source: hallrender.com

Medicare spends nearly $1B more on common lab tests than other payers

The findings prompted the OIG to recommend that the Centers for Medicare and Medicaid Services (CMS) seek legislation that would allow the federal payer to establish lower payment rates for lab tests, and also to consider instituting copayments or deductibles for lab tests. Currently, lab test rates are set for Medicare, which is restricted from negotiating for lower rates.
Source: healthimaging.com

Health differences explain most geographic variation in Medicare costs 

Posted by:  :  Category: Medicare

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Previous geographic variation research also often used average spending on beneficiaries in their final months of life to adjust for area differences in health and to define high- and low-cost areas — an approach that assumes people near death have roughly equal health status. The new study by Reschovsky and colleagues, however, found that the health status of beneficiaries near death varied considerably by number and types of conditions, and that these differences accounted for 84 percent of the health care costs in the final year of life. This differed little — only two percentage points less — when the same case-mix indicators were applied to the entire elderly Medicare population. Because the end-of-life spending approach fails to effectively account for differences in population health, it misclassifies many areas in terms of the costs for treating Medicare patients, the study found.
Source: universityofcalifornia.edu

Video: Medicare Explained

The Medicare Advantage Disenrollment Period Explained

It’s important to note that this time is not an additional enrollment period, which means that you cannot enroll in Medicare Advantage or switch between Medicare Advantage options. However, if you are planning to disenroll from Medicare Advantage, you may use this opportunity to enroll in a Medicare Supplement policy upon returning to Original Medicare. Any other changes to your Medicare plans must wait until the next valid Part D election period
Source: bradeninsurance.com

Medicare / DMEPOS Surety Bonds Explained

Since January of 2009, Medicare surety bonds, or DMEPOS surety bonds, are mandatory for manufacturers and suppliers of durable medical equipment, prosthetics, orthotics and supplies that bill or receive funds from the Medicare and Medicaid systems. The bond requirement is imposed by the Centers for Medicare & Medicaid Services (CMS). The requirement is aimed at curbing medical fraud and malpractice.  The FBI estimates that in 2012, the cost of Medicare fraud ranged from $75 billion to $250 billion in 2012.
Source: surety1.com

Chart of the day: Medicare’s administrative costs, explained

If by “premium collection” Klein meant taxes, he was wrong; a portion of IRS costs are allocated to Medicare’s overhead by OACT [CMS’s Office of the Actuary]. If by “premium collection” Klein meant Part B premiums, he was wrong on two counts: (1) the Social Security Administration, not the IRS, calculates and collects Part B premiums for the vast majority of Medicare enrollees, and the Railroad Retirement Board does so for former railroad workers; and (2) a portion of the SSA’s and the railroad board’s costs are allocated to Medicare’s overhead by OACT. Klein’s statement that the cost of processing claims for the traditional Medicare program does not appear in Medicare’s administrative expenditures is also incorrect. OACT does include the cost of claims processing, which is done by what used to be called “carriers” and “intermediaries” and are now called “Medicare administrative contractors.” […]
Source: theincidentaleconomist.com

Code Key for Medicare Card Explained

A: Social Security pays benefits to some 56 million people. They include retirees, widows and widowers, families who’ve lost their breadwinners, divorced spouses and people with disabilities. In order to keep track of such huge numbers, Social Security uses a series of codes to identify which individuals are receiving what types of benefits. The codes are assigned to people when they apply for benefits.
Source: aarp.org

Regional Variation in Medicare Spending and Risk Adjustment

Two key casemix adjustment methods—controlling for patient conditions obtained from diagnoses on claims and expenditures of those at the end of life—were evaluated. We failed to find evidence of bias in the former approach attributable to area differences in physician diagnostic patterns, as others have found, and found that the assumption underpinning the latter approach—that persons close to death are equally sick across areas—cannot be supported. Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas.
Source: healthcare-economist.com

Barnabas on Public Health: Health differences explain most geographic variation in Medicare costs

James Reschovsky of the Center for Studying Health System Change, together with Jack Hadley of George Mason University and Patrick Romano of the UC Davis Center for Healthcare Policy and Research, examined multiple ways of adjusting for patient health. They found that a broader accounting of health status explained at least 75 percent to 85 percent of Medicare geographic cost differences between high- and low-cost areas.
Source: blogspot.com

Explaining Health Reform: Medicare and the New Independent Payment Advisory Board

This brief describes how the new board created under the 2010 health reform law is expected to limit the growth in Medicare spending over time. Starting in 2014, if projected per capita Medicare spending exceeds targets set in the law, the board must recommend ways to reduce Medicare spending, while maintaining quality and access to care for beneficiaries. The board’s recommendations automatically take effect the next year unless Congress adopts an alternative plan to achieve an equivalent level of savings.
Source: kff.org

Why the Oregon Medicaid study is misunderstood

Posted by:  :  Category: Medicare

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Here is a brief, and inadequate, summary (you should really read the study):  In 2008, Oregon used a lottery system to give a set of uninsured people access to Medicaid.  This essentially gave Kate Baicker and her colleagues a natural experiment to study the effects of being on Medicaid. Those who won the lottery and gained access were compared to a control group who participated in the lottery but weren’t selected.  Opportunities to conduct such an experiment are rare and represent the gold standard for studying the effect of anything (e.g. Medicaid) on anything (like health outcomes).  Two years after enrollment, Baicker and colleagues examined what happened to people who got Medicaid versus those who remained uninsured.  There are six main findings from the study.  Compared to people who did not receive Medicaid coverage:
Source: kevinmd.com

Video: Senior Marketing Specialists Explains the New Oregon Medicare Supplement Birthday Rule

Brad DeLong : Aaron Carroll: Additional Thoughts on the New Oregon Medicaid Results

I’m not asking for a post hoc power calculation. I want the a priori one. You see, with only 600 or so participants with an A1C in the high range, I want to know what they were thinking ahead of time. If my study is too small, then even if I see a difference that I think is meaningful, I might not be able to prove that it is statistically significant. So when I’m designing a study, I decide what is a clinically meaningful result. I then figure out what I can likely expect in terms of variability in the individual readings I might measure. Then I figure out how many subjects I need in order to know that if I get the clinical results I expect, they will be “detectable” by my analysis. That’s the calculation. If my sample is too small, then even if I find a clinically meaningful result, it might not be statistically significant.
Source: typepad.com

Viewpoints: Assessing The Oregon Medicaid Experiment; Health Insurance Hysteria; In Florida, ‘Toxic Politics’ Beats Out Common Sense

The New York Times: What Health Insurance Doesn’t Do As liberals have been extremely quick to point out, these findings do not necessarily make a case against the new health care law, which includes a big Medicaid expansion as well as subsidies for private insurance. After all, the first purpose of insurance is economic protection, and the Oregon data shows that expanding coverage does indeed protect people from ruinous medical expenses. The links between insurance, medicine and health may be impressively mysterious, but staving off medical bankruptcies among low-income Americans is not a small policy achievement. This is true. But it’s also true that the health care law was sold, in part, with the promise (made by judicious wonks as well as overreaching politicians) that it would save tens of thousands of American lives each year (Ross Douthat, 5/4).
Source: kaiserhealthnews.org

Reaction to the Oregon Medicaid Study

American Medical Association cancer CBO consumer driven health care diabetes doctors drugs electronic medical records email emergency room EMR ER exercise FDA genetics Health Care Access Health Care Costs health care quality health insurance health IT health policy Health Reform Health Savings Accounts heart disease hospital HSA insurance life expectancy Massachusetts Medicaid Medicare medicare advantage NHS ObamaCare obesity pay for performance public option SCHIP seniors socialized health care Social Security stimulus tax unemployment Uninsured
Source: ncpa.org

The Oregon Medicaid Lottery: No Cure for Cancer

And the Oregon study is not pushing the political debate toward a rethinking of the benefits of medicine writ large. It is only strengthening the hand of those who want to deny it to people who can’t afford health insurance. The Oregon study results from an unusual circumstance: The state had the budget to add 10,000 people to Medicaid, but far more who wanted to join, so it conducted a lottery. It is only the poor who can be subjected to Hunger Games–style experimentation with their health. In any other advanced country, in which medical care is a basic right, such an experiment would be wildly unethical.
Source: balloon-juice.com

Bill Aims to Ease Access to Home Health Services

Those seniors and disabled citizens who see these medical professionals as their primary care providers often need an extra office visit with an unknown physician in order to get the care they need. Walden said amounts to extra administrative and paperwork burden, and creates an unnecessary step that fails to recognize current training and scope-of-practice guidelines. As a result, said Walden, patients in need of home health care services are either placed in more expensive health care settings, or experience a delay in receiving the care they need. “This legislation will relieve that burden for our most vulnerable citizens,” said Walden.
Source: northeastoregonnow.com

Medicare Advantage Fact Sheet

Posted by:  :  Category: Medicare

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

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

Medicare Advantage Enrollment Reaches Record High

CQ HealthBeat: Medicare Advantage Plans Worry About Cuts, But Enrollment Keeps Growing The number of seniors in the private Medicare Advantage plans tripled in the past seven years, according to an analysis released Monday. But future payment cuts could cause insurers to reduce benefits or increase cost-sharing, says a Blue Cross and Blue Shield Association official. The Medicare Advantage program grew from 5.3 million people in 2004 to a record 14.4 million in 2013, according to the analysis by the Kaiser Family Foundation and Mathematica Policy Research Inc. From 2012 to 2013 alone, the program grew by 10 percent — or by 1 million people (Adams, 6/10).
Source: kaiserhealthnews.org

Firm Perspectives on the Medicare Advantage Market

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

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

The Future of Medicare Advantage

Most of the discussion was optimistic that MA enrollment could be sustained if not increased even in the light of budget cuts.  MA plans are projecting enrollment increases of 9-10 percent for 2014. Mark Miller of MedPAC cited analysis that MA bids have come down in recent years (e.g. MA plan bids are 96 percent of FFS costs on average and HMO bids are 92 percent) suggesting that  MA plans could continue to successfully compete against Medicare FFS even in areas that will be paid at 95 percent of FFS.  Carl McDonald cited 2010 as a historical precedent when MA plans were able to manage large program cuts by lowering costs.  He also noted research shows that current Medicare enrollees are very loyal and do not leave their plans even when premiums are increased or benefits reduced.  Alissa Fox from the Blue Cross and Blue Shield Association argued that  plans will have a hard time absorbing all of the upcoming cuts and that their Association is lobbying for Congress to repeal the upcoming $100 billion tax on insurers.  George Strumpf of Emblem Health says he was pessimistic about future MA enrollment and reminded the audience of the experience in the late 1990s when budget cuts drove half of the Medicare managed care plans from the market.
Source: gormanhealthgroup.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

Kaiser Permanente's Medicare Website Receives Top Marks, Hailed as Best in Nation

Each day, 11,000 new seniors become eligible for Medicare, and kp.org/medicare provides beneficiaries with easy access to information about the four parts of Medicare (Parts A, B, C and D). The site outlines eligibility requirements, and clearly illustrates cost and coverage options. Eligible customers can enroll in Kaiser Permanente’s Medicare plan directly from the website. In 2012, the site recorded nearly 2 million visits, a 100 percent increase over the previous year.
Source: virtual-strategy.com

Thank heaven for insurance companies: Kaiser Permanente Senior Advantage forcibly enrolled retired federal employee who had enrolled in Nationwide

Yikes! I guess I should count my blessings that I was able to escape from Kaiser. Kaiser Permanente Senior Advantage Ripoff Report Reported By: Barbara Monrovia, California February 24, 2013 Kaiser Permanente PO Box 232400 San Diego, California 92193 Phone: 1-800-443-0815 After canceling service 12/31/2012 and arranging replacement coverage through the Office of Personnel Management as a Retired Federal Employee, Kaiser without my knowledge, request or consent enrolled me in San Diego, California. Due to change in living situations, I was forced to cancel my Kaiser Permanente coverage aften 46+ years. I am a Federal Retiree and during the Open Season with the help of my Congresswoman’s office I chose a Nationwide company and did everything necessary including closing visits with my doctors. I used the new coverage in January while I was in New York without a problem. When I came home to Southern CA late in January I found mail from Kaiser telling me that I had been approved by Medicare to have their coverage as of 2/1/2013. I checked with OPM in DC and they said to ignore it that my proper coverage was in place. I destroyed the new Kaiser Cards (3 in separate mailings) and went on with my plans to establish myself with the Doctor of my choice. Now, I have seen the new doctor and she prepared new prescriptions (as mine were running out) and ordered lab work. I am almost 70 years old and have several serious chronic conditions which require ongoing consistent medications. When I heard from a provider that I could not get services because Medicare is not my primary coverage I inquired further and found that Kaiser had enrolled me without any request or permission and that I could not get anything without going through them. Here’s the catch, when I had called Kaiser to have them remove their name from my record I was told that I had to request it in writing with a signature and that since it is not open season they might not recognize or honor my cancellation. I told them that I had not authorized the coverage and I was not going to sign anything that could imply that I had. After several long calls to Medicare and Kaiser (threatening them with an official Complaint) they acknowledged that they had enrolled me in their Individual Senior Advantage Program as of 1/18/2013 because they had checked and saw that I was eligible for Medicare (so what!). After putting me on hold for a long time for them to speak to a supervisor the lady came back and told me that they were attempting to assure that I would not have a break in coverage (bull …). I did as Medicare Operator instructor and called them back with the information and an Escallated Complaint has been sent “up the chain”. Problem is that I am getting more ill and cannot get assistance unless I go to Kaiser and if I do, that will acknowledge that I accept what they have done and I will legally becomme financially obligated to them for the rest of the year. I live on two coasts and they are not available in NY and have limited Out of Area allowances. So, here I sit having my drug coverage (for which I have paid) not being honored and scared to death that I cannot get this straightened out before I become critically ill. Do they think because I am old, I am stupid? God only knows how many retired federal (and others) employees find themselves in this same mess. After supposedly taking care of me for over 46 years they are ready to cause me illness and possible death if I do not come back to them…
Source: blogspot.com

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

Posted by:  :  Category: Medicare

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

Video: How Medicare Works With Social Security Disability

Homelessness Resource Center

Conclusions: Greateruse of primary care and specialty care visits by disability-eligibleveterans is most likely related to greater health needs not captured bythe patient characteristics we employed and eligibility for VA care atno cost. Outpatient care patterns of disability-eligible veterans mayforeshadow care patterns of veterans returning from Afghanistan and Iraqwars, who are entering the system in growing numbers. This studyprovides an important baseline for future research assessingutilizations among returning veterans who use both VA and Medicaresystems. Establishing effective care coordination protocols between VAand Medicare providers can help ensure efficient use of taxpayerresources and high quality care for disabled veterans. (Authors)
Source: samhsa.gov

Do I Need Medicare If I Have Other Health Insurance?

Most people don’t pay a premium for Medicare Part A, which helps cover hospital stays. There’s usually no reason not to sign up for this coverage as soon as you’re eligible. With Part B, which covers doctor visits and other outpatient care, you’ll pay a monthly premium. If you like your current plan, it may make sense to keep it and wait to sign up for Part B when you retire.
Source: allsup.com

Mathematica Policy Research

Disability  Early Childhood  Education   Family Support     Health      International      Labor         Nutrition   
Source: mathematica-mpr.com

Number of the Week: Disability Fund Three Years From Insolvency

I have issues with awarding SSID to people who have drug and alcohol addiction. I also agree with the person below who suggested that people receiving benefits, unless they are clearly unable to work, need to be retrained and given jobs, particularly if they are suffering from depression, anxiety or back pain. People who work are more emotionally stable, in general. It would also help if we had universal health care so that low income people can get decent medical care.
Source: wsj.com

Social Security & Medicare for Adult Disabled Children

If you or your spouse are retired or disabled and receiving Social Security benefits and have a disabled adult child who has been denied the SSDI benefits, the experienced attorneys at Littman Krooks, LLP can assist you in filing an appeal, so that your child can obtain the benefits they are entitled to. Our firm represents adult children with disabilities in SSDI appeals on a contingent fee basis, which means that there is no out of pocket legal costs for filing the appeal.
Source: specialneedsnewyork.com

Article and Policy Forum Examine Medicare, Health Reform and the Challenges Facing People With Disabilities

On Sept. 8, 2010, the Foundation held a policy forum examining the health care issues facing people with disabilities and the opportunities and challenges presented by the new health care reform law enacted earlier this year. Juliette Cubanski, study co-author and associate director of the Foundation’s Medicare Policy Project, presented findings from the study, followed by a panel discussion with Jeffrey Crowley, senior advisor on disability policy at the White House; Joe Baker, president of the Medicare Rights Center; Elizabeth Priaulx, a senior disability legal specialist with the National Disability Rights Network. PBS NewsHour co-anchor Judy Woodruff will moderate the discussion, and Tricia Neuman, Foundation vice president and director of the Medicare Policy Project, will provide opening remarks.
Source: kff.org

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

Medicare and Medicaid: Eligibility, Coverage, and Costs

Medicare is composed of many different parts, and beneficiaries have the option to decide which plans they want to enroll in. Many eligible beneficiaries are automatically enrolled in Part A, which covers hospital care, and Part B, which covers certain medical services. Once enrolled, beneficiaries can opt to enroll in Medicare-approved private insurance plans to cover out-of-pocket costs not already covered and/or provide additional benefits. All individuals who are eligible for this program are also offered prescription drug coverage, which can be attained through a stand-alone Part D Prescription Drug Plan (PDP) or a Medicare Advantage plan with medication coverage.
Source: ehealthmedicare.com

Medicare recipients in ‘donut hole’ to get price break on some drugs in 2011

Posted by:  :  Category: Medicare

Flickr

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“Regardless of what happens to the donut hole, the influx of the first wave of baby boomers will increase the demand for drugs and other medical services,” Moffit says. “All things being equal, that will mean increased costs for seniors and taxpayers alike.” According to the federal Centers for Medicare & Medicaid Services, your actual drug plan varies depending on what kind of prescriptions you buy, which plan you choose, whether you go to a pharmacy in your plan’s network, whether your drugs are on your plan’s formulary (list of approved drugs) and whether you belong to the Extra Help program. Extra Help is a Medicare program to help low-income people; it pays for Medicare prescription drug program costs, such as premiums, deductibles and coinsurance.
Source: insurancequotes.com

Video: Avoid the Donut Hole Coverage Gap in Medicare

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

Closing Medicare Coverage Gaps

Medicare supplement plans cover varying amounts and combinations of the nine coverage gaps listed above. These plans are regulated by the government. No matter which provider you seek coverage with, you will get the same coverage. They are also identical state to state. So if you purchase a Pennsylvania Medicare supplement, you will have the same coverage as the same plan in Idaho. The only exception is if you live in Massachusetts, Wisconsin, or Minnesota, where they have chosen to adopt their own supplement plans. If you go with Plan F you will be completely covered and have no additional out of pocket expenses. They are taken everywhere that Medicare is accepted and can insurance that you will not have a nasty surprise should you need medical services. Overall this is the simplest way to insure the coverage gaps in Medicare.
Source: dotmac.info

Top 5 Things Kidney Patients Need to Know About Healthcare Reform

On March 22, 2010 President Obama signed into law the Affordable Care Act.  In addition to offering patient protections such as banning insurers from refusing to cover individuals with a pre-existing health condition or charging them significantly higher premiums, and stopping the practice of life-time and annual caps on health insurance benefits, the law requires every American have health insurance or pay an additional tax if they do not enroll in a plan. To make health insurance more accessible and affordable to individuals and small businesses, the law created Health Insurance Marketplaces and will provide subsidies to individuals who qualify so they can purchase health insurance. Each state has the option to establish and run their own Marketplace, work in partnership with the Federal Government, or leave establishment and management of the Marketplace completely in the hands of the Federal Government.
Source: wordpress.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

Medicare’s Role for Older Women

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

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

Senator Al Franken: Keeping our promise to strengthen Medicare – Union Advocate

While we were at it, we expanded benefits for Medicare beneficiaries. The seniors I’ve met with in Minnesota are very happy about the new free preventive care they get – wellness checkups, colonoscopies, mammograms. They know, and we know, that an ounce of prevention is worth a pound of cure. We’re also closing the prescription drug donut hole – the gap in Medicare coverage where seniors have to pay the full cost of their prescription drugs – so that many seniors won’t have to make the impossible choice between medicine, heat and food.
Source: stpaulunions.org

HealthSpring, Cigna Use Both Names To Market Medicare Plans

Posted by:  :  Category: Medicare

The television campaign is within the company’s existing marketing budget, said HealthSpring spokeswoman Graham Harrison. Cigna and HealthSpring researched each company’s brand to determine how to best market Medicare products in the future. The campaign is meant to build on Cigna’s strength as a known health service company and HealthSpring’s expertise in Medicare.
Source: courantblogs.com

Video: Siquis: Cigna Healthspring “Jackson”.mov

Free Insurance Agent Websites: Cigna Medicare Advantage plans

CIGNA Medicare supplement plans have been an integral part of the insurance industry with having served customers for over 220 years. This kind of insurance plan can be very beneficial for all people including senior citizens who may be suffering from constant medical issues due to their advanced ages. The company enjoys a lot of goodwill among the community and here are some of the benefits that come with buying this plan.
Source: blogspot.com

Aetna Inc. (NYSE:AET), CIGNA Corporation (NYSE:CI), WellPoint, Inc. (NYSE:WLP): Does the Medicare Advantage Announcement Make Healthcare Stocks a Buy?

My thought on the matter is that the increase in health sector shares was a market reaction to just-released information. However, be cautious with insurers for a while and see what other pitfalls the Affordable Health Care Act have waiting for them. There could be more problems down the road that offset these current gains.
Source: marketdailynews.com

HealthSpring rebrands as Cigna

“The brand change doesn’t create any service change for customers or other stakeholders,” spokeswoman Graham Harrison said. “By leveraging the brand equity of the Cigna brand, we are better positioned for new and existing market growth as we can now transition existing Cigna commercial customers seamlessly to Medicare products and a brand with which they are already familiar.”
Source: tennessean.com

Cigna Acquires Medicare Advantage Plans From Humana Covering 3,500 in Texas

The federal government required Humana to sell the Medicare Advantage plans as part of approval for buying Arcadian Management Services. Cigna will offer the new customers Medicare Advantage plans through its subsidiary HealthSpring, which the Bloomfield-based health insurer acquired in January for $3.8 billion.
Source: courant.com

Cigna’s Management Presents at Barclays Global Healthcare Conference (Transcript)

Well, there’s a lot of resource and effort put into it. At the end of the day though, what you’re fundamentally talking about is changing the business operations of the primary care physician’s office to focus on a totally different set of metrics and incentives than they have in fee-for-service, and it’s extremely helpful. Here in Miami, the Leons only do business — the only patients they see are Medicare Advantage patients. So it’s not easy, but it’s at least a lot more practical to change those business operating models to focus on the right kinds of incentives. In most network models, you have a range of offices. You might have thousands of primary care doctors in some of these networks, some of whom only have 5% or 10% of their business in Medicare Advantage. And it’s a lot more challenging to get the kinds of changes it takes. The other thing for us that’s been a challenge — we’ve actually made pretty good progress on the Part C side. A couple of years ago, CMS changed the measures and more heavily weighted a lot of Part B measures on the pharmacy side. And we’ve been slower than I’d like to react to that. I hope we’re focused and have the right tools in place to improve our scores on Part D, but that’s really been more of what’s kept us below 4 stars in a lot of our markets.
Source: seekingalpha.com

NewsDaily: Catamaran stock jumps after Cigna deal announced

THE SPARK: Cigna, the fourth-largest U.S. health insurer based on enrollment, said Monday that it agreed to a 10-year partnership with the pharmacy benefits manager. Catamaran will provide process drug claims, manage inventory and fill orders for Cigna’s home-delivery pharmacy, among other tasks.
Source: newsdaily.com

Cigna Corp. Presents at Goldman Sachs 34th Annual Global Healthcare Conference, Jun

The simple answer to that is, no. So maybe let me recompartmentalize the way we’re thinking about it. One, important to know that before HealthSpring, Cigna was only Medicare posture within Arizona where we have a delivery system that’s owned and captive before an Avstar [ph] system. Think about HealthSpring as largely having deep pockets of business in key geographies. So a lot of density in those markets. Think about, on average, about 75% of all of our combined Medicare business has having aligned physician reimbursement models, so about 75% of all of our Medicare Advantage cover lives are in aligned and incentive-base reimbursement models. And then as we go into this disruptive, and you’re correct, at the end of the first quarter call, I referenced 2014 as a very disruptive environment, we have largely four major levers to work, as every entity woujld be able to work, we have different depths in some of the levers. One is, how do you work with the physicians and knowing that 75% we have an aligned incentive model, how do we work with physicians to engender a further improvement in medical cost by driving clinical quality initiatives? A derivative of that is, how do you then carry that across to sharing some of the revenue headwind with the physicians and the delivery system directly, then you’re able to deal with benefit design, configuration, everybody knows the government put it — the cap, in terms of the month you can push through that, on average, Cigna HealthSpring has a richer benefit on average that exist in the markets we compete in. So that’s a good competitive position to be in but it’s disruptive for everybody to confront. Then you would deal with your operating costs, admin costs, including SG&A, selling costs and then you come back to margins. So you’d work through that, that takes places in a market-by-market basis. It takes place doing basic game theory in the markets, that’s all completed. That’s all led by the legacy HealthSpring team that has been through this drill before. And the Cigna team is participating in that and we’ll manage through the fall cycle. The last thing I’d add to this is, when we acquired HealthSpring, we had an expectation of expanding the model into additional geographies by leveraging the legacy Cigna commercial experiences and our collaboratives. Good news is, that was tracking well ahead of schedule. So the demand of organized physician groups or delivery systems to bring Medicare Advantage in the new model was extraordinarily high and where dedicated team well ahead track, in terms of number of markets, given the change in disruption in the marketplace, we’re going to keep that at 2 markets. So we’re not going to overreach in ’14. We know what markets we want to open in ’15, et cetera. I’ll give you that, it’s simply a good validation of a high appetite in the marketplace with our health care professional partners to continue to expand the models we go forward.
Source: seekingalpha.com

Deal boosts Cigna share of Medicare Advantage

Cigna’s acquisition is the latest in a series of deals made by health insurers to expand their Medicare Advantage businesses, which are growing at a faster rate than commercial insurance as baby boomers become eligible for them. In addition, big insurers like Cigna have reported strong results in recent quarters, and analysts have speculated that companies would start exploring acquisitions.
Source: kansas.com

Medicare Supplement Rates Connecticut 2013

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AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medicare Anthem Medigap Anthem Supplement Crowe and associates High Deductible F supplement how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare Advantage Medicare Advantage plans medicare b Medicare Complete Medicare Complete connecticut Medicare Connecticut Medicare part B Medicare part B cost Medicare part D Medicare plan Medicare Supplement Medicare Supplement Connecticut Medigap Medigap rates 2013 Medigap rates NY 2013 Original Medicare united healthcare United Healthcare AARP United medicare complete United Medicare complete 2013
Source: croweandassociates.com

Video: Medicare Supplement Rate Increase methods Issued Age, Community Age, Attained Age

Why Medicare Supplement Plan F is Common

One advantage of Plan F is that among all the Medicare supplement plans, it is the only plan that offers excess charge which is apparently seen on Medicare supplement comparisons charts. Excess charge is defined as the difference between the doctor’s fee and the amount to be paid by their Medicare provider. In spite of the many Medicare supplement plans available, Plan F can be a good option for seniors with a tight budget.
Source: onlyburn.info

BlueCross BlueShield of IL Changing Medicare Supplement Rates

BlueCross BlueShield of IL announced a rate increase for most Medicare Supplement/Medigap customers effective March 1, 2013. In addition to the rate increase, changes have been made to the way BlueCross BlueShield of IL sets attained-age premiums. BCBSIL has switched from age bands to different rates for each age. In the past, BCBSIL had the same rate for the same Medigap plan for age groups, like 65-67; now, each age has its own premium rate. The change from age bands to single age rates will cause a few premiums to actually be lower after March 1, 2013 than they are now. For most people though, premiums are increasing.
Source: bcmil.com

15% Medicare Supplement Rate Increase is Outrageous!!! » Toni Says

Cindy, one Medicare rule that you should be aware of since you are not happy with your rate increase from your current Medicare Supplement company is…if you had a Medicare Supplement policy before you joined a Medicare Advantage Plan for the first time, and you aren’t happy with the Medicare Advantage Plan, you will have special rights to buy a Medicare Supplement policy if you return back to “Original Medicare” within 12 months of first joining a Medicare Advantage plan.  If you had a Medicare Supplement policy before you joined, you may be able to get the same plan back if the company still sells it.  If it isn’t available, you can buy another Medicare Supplement policy. (Please see page 66 of the
Source: tonisays.com

Senior Benefit Services, Inc.

American Continental Insurance Company  (ACI) has received approval for a rate adjustment on Medicare Supplement policies currently available in Tennessee. The adjustments resulted in a rate DECREASE on all currently available Medicare Supplement plans in the state of Tennessee.
Source: srbenefit.com

Ohio Medigap rate increases?

Why has my Medicare supplement rate gone up?.. I haven’t even used my coverage this year! Medicare supplement rate increases apply equally to all insured members regardless of their health conditions experienced in the last year. An insurance carrier cannot exempt you from rate increases because you are well. Just the same, they cannot single you out for an increase just because you are sick. If they did that, then what would be the point of insurance that you can no longer afford? Instead, Medicare supplement insurance companies calculate their total loss ratios for all clients, and then apply rate increases to certain “blocks of business.” For example, some Medigap companies increase rates across all clients in a certain geographic area. Others have automatic increases when insured members reach a certain age band, such as age 70 or 75. Still others will apply rate increases to everyone insured on a certain policy, such as Plan F or Plan G or Plan N. The important things to remember are that every insured member usually experiences at least one rate change per year, and that has nothing to do with whether you are sick or well. The nature of insurance coverage relies on actuarial tables and company’s ability to spread out the potential risk, or losses, over a group of policyholders.
Source: ohiomedigapinsurance.com

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June 30, 2013

Indiana Health Care Association: Indiana Health Coverage Program Change in Medicare Replacement Claim Processing

Posted by:  :  Category: Medicare

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The Office of Medicaid Policy and Planning (OMPP) published notice on May 31, 2013 that a change will be made on Medicare replacement claim processing.  For claims received on or after June 27, 2013, the Indiana Health Coverage Programs (IHCP) will require a claim filing indicator of “16” when providers file Medicare replacement plan claims through an 837 electronic data interchange (EDI) transaction and Web interChange. Previously, providers were instructed to use a claim filing indicator of “MA” or “MB” when filing Medicare replacement claims. The IHCP will begin to validate Medicare replacement plan payer IDs based on the contract number published by the Centers for Medicare & Medicaid Services (CMS).  To view the posting, see http://provider.indianamedicaid.com/news,-bulletins,-and-banners/news-summary/the-ihcp-to-implement-change-in-medicare-replacement-claim-processing-.aspx.
Source: ihca.org

Video: Indiana Medicare Supplements

Important Information Regarding Medicare Claims and Payments for Part A Indiana and Michigan Providers

National Government Services, Inc. (NGS) recently announced important information regarding Medicare claims and payments for Part A Indiana and Michigan providers.  With the impending transition of these providers to Wisconsin Physician Services (WPS), NGS posted the following transition timeline:
Source: hallrender.com

New Indiana Congresswoman: Freshman class will push Medicare changes

“Right now there are too many undocumented workers in the country that are not paying taxes and receiving benefits,” she said. “We need to reform the guest-worker program because there are a lot of people that want to work in this country and return to their native country.” ___
Source: medcitynews.com

Mississippi Political Fight Threatens Medicaid Program, Care For 700,000

Evansville Courier & Press: With Loss Of Funds Projected, Indiana Hospitals Pray For Medicaid Expansion It probably sounded like a good trade-off at the time: Hospitals would give up $155 billion in Medicare and other government payments to help provide more money for a Medicaid coverage expansion that begins in January. But subsequent events have put the deal in doubt in Indiana. Hospitals could be left with nothing to show for the payment reductions, which began with the Affordable Care Act in 2010, if the federal government doesn’t accept Gov. Mike Pence’s idea for administering the Medicaid coverage expansion (Langhorne, 6/22).
Source: kaiserhealthnews.org

Medicare Insurance in Northwest Indiana for soon to be Retirees

Your medical bills will be shouldered by Medicare only up to a certain point. On average, the social insurance program shoulders approximately one-half – 48%, to be exact – of the total bills but the actual amount can vary depending on the coverage chosen (i.e., Part A, Part B, Part C, and Part D). Our suggestion: Talk with the expert in Medicare insurance here at Hefty Insurance so that you can choose which of the Medicare Parts will best serve your needs.
Source: companyblog.biz

Indiana hospitals pray for Medicaid expansion

It probably sounded like a good trade-off at the time: Hospitals would give up $155 billion in Medicare and other government payments to help provide more money for a Medicaidcoverage expansion that begins in January.
Source: themidwesternadvantage.com

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