I Am Under 65 Disabled and Just Became Eligible for Medicare. What Are My Choices?

Posted by:  :  Category: Medicare

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Like any other Medicare beneficiary who turns 65 and is newly eligible to Medicare Part A and B, you have choices:  (1) you can select a Medicare defined supplement/medigap policy and a stand-alone drug plan; (2) you can select a Medicare Advantage/HMO plan with drug coverage; or (3) you may be eligible for a retiree plan that either includes Medicare comparable drug benefits or you will add a stand-alone drug plan.
Source: personalmedicareadvisor.com

Video: How to select a Medicare Supplement or Medicare Advantage Plan

IF I Drop Medicare Select Can I Get A Medicare Supplement Plan?

Dropping a Medicare Select plan does not mean a person has to go with a Medicare Supplement Plan. It just means he has to go with one of the standardized plans, provided he can find one. The Medicare select plans were offered prior to 1998. The process of getting the new plan is the same as it would be for someone else. Dropping one plan means he must go through the Medical underwriting process and he does not have a guaranteed issue rights, unless the company dropped him from a Medicare Select plan for any reason.
Source: seniorcorps.org

Questions to Ask Before Selecting a Medicare Plan

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do
Source: aarp.org

Republicans’ Proposals for Medicare

The Republicans’ proposals for Medicare are quite different than the Democrats’ in that they begin with fundamental structural changes that will convert Medicare from a defined benefit to a defined contribution plan. Congressman Paul Ryan, chair of the House Budget Committee and the Republication Vice-Presidential nominee in 2012, presented a proposal about two years ago embedded in the House budget proposal. It was passed in 2011 in the House only with all no votes from Democrats and died in the Senate. But then, after negotiations with Senator Ron Wyden, a Democrat, they offered a joint bipartisan plan, one that few other Democrats have endorsed. The essence is to allow individuals to stay with original Medicare or select a plan from a private insurer that offers the same benefits as Medicare. It has no effect until 2023, i.e. only affecting those less than age 55 today. At that time, the age of Medicare eligibility would gradually rise over ten years from age 65 to age 67. Second, each beneficiary could choose to remain with standard Medicare or chose a plan from a private insurer. The government would pay a set amount (“premium support”) towards either original Medicare or the private plan; the individual would have to pay any overage. The amount of premium support, according to the proposal, would be equal to the second lowest plan among the competing insurers, including Medicare, during the first year. Individuals of limited means would be able to purchase at discounted rates. The annual rate of rise of premium support would be limited to the rate of rise of the GDP plus 0.5%. This means that if expenses and hence premiums rose to a greater level, the individual would have to shoulder the excess. In short, the Republican (or the Wyden – Ryan compromise) plan counts on competition in the marketplace to drive down costs. In practice, this is very similar to the way the Part D drug benefit works today. Thus Republicans point to the success of Part D to bolster their claim. The Democrats fault this plan in that if costs are not controlled, the onus falls on the enrollee, the one most vulnerable, especially in older ages, and not the insurer nor the government.
Source: healthworkscollective.com

Should I Consider Medicare Advantage?

Another main dissimilarity is that a lot of Medicare Advantage packages have medicine coverage built in. With the Traditional Medicare, Part D medicine coverage has to be bought separately. Also, with the Traditional Medicare, you can visit any hospital or doctor that accepts Medicare. Numerous Medicare Advantage packages work with contracted providers such as hospitals and physicians with whom they have established a long-term relationship.
Source: leerogers2012.com

Q&A With David Shapiro, VP Of Member Experience For Medicare And Retirement, UnitedHealth Group

Our Medicare members’ experience with their plan has always been important to us because of the way Medicare plans are sold. Unlike commercial insurance, which typically allows employees to choose from a small group of plans that their employer selected for them, Medicare is a true B2C industry. Beneficiaries have the opportunity to select the plan or plans that meet their needs when they first become eligible, and then annually they can switch to a different plan if they choose. These dynamics, combined with the exponential growth in the senior population as baby boomers age, has made for an extremely competitive environment, one in which it’s critically important that your members are pleased not only with their coverage but also with the experience of being enrolled in your plan.
Source: forrester.com

Nebraska, Florida Contemplate Elements Of Health Law’s Medicaid Expansion

Posted by:  :  Category: Medicare

The Associated Press: Medicaid Backers Will Add Safeguards To Bill Supporters of a proposal to expand Medicaid in Nebraska said they’re willing to include cost safeguards within the bill, including a mandatory review of the program if its expenses were to skyrocket and a possible requirement that the state withdraw if the federal government fails to fund it as promised. Sen. Jeremy Nordquist of Omaha told The Associated Press that he and other lawmakers plan to float the idea Tuesday when they return to the Capitol for a long-awaited debate on Medicaid expansion (4/15).
Source: kaiserhealthnews.org

Video: Nebraska Medicaid Take Medicaid away From Chronic Sick ChildDD.wmv

DHHS Releases Nebraska Medicaid Practitioner Fee Schedule for HEALTH CHECK Services

The Nebraska Department of Health and Human Services has released its revised Medicaid Practitioner Fee Schedule for Health Check Services #29-2013.  Included in this listing are HEALTH CHECK (EPSDT) REFERRAL INDICATOR CODES Preventive care for persons under 21, HEALTH CHECK (EPSDT) Vaccines for Children, and HEALTH CHECK (EPSDT) Special Services for Persons Under 21.
Source: hcanebraska.org

Heineman says Nebraska Medicaid Bill ‘Should Not Pass’

KOLN-TV Call: (402) 467-4321 Toll-free: 1-800-475-1011 840 North 40th Lincoln, NE 68503 Email: info@1011now.com KGIN-TV Call: (308) 382-6100 123 N Locust Street Grand Island, NE 68802 Email: kgin@1011now.com KSNB-TV Toll free 888-475-1011 123 N. Locust St. Grand Island, NE 68802 Email : ksnb@1011now.com
Source: 1011now.com

Medicaid Expansion in Rural Nebraska

“These reports are particularly interesting in how they confront the conventional thinking behind much of the opposition to Medicaid expansion,” said John Crabtree with the Center for Rural Affairs. “Those who will benefit from the new Medicaid initiative are working people, many of them living in small town Nebraska and working at a small business, perhaps right on Main Street.”   “They are neighbors, friends and family… and thousands of them have sacrificed in order to serve our country in the military. As we debate access to health care, I think it is vital that we recognize who will fall through the cracks if we fail to move Medicaid expansion forward.”   John Crabtree, Center for Rural Affairs   According to a report by the Urban Institute, Nebraska has approximately 6,600 uninsured veterans, along with 3,600 uninsured spouses of military veterans. Moreover, the report estimates that over 2,000 of those veterans have incomes under 138% of the Federal Poverty Level, meaning they would be eligible to enroll in the new Medicaid initiative if implemented in Nebraska.
Source: cfra.org

Nebraska Medicaid income requirements

According to the Kaiser Family Foundation, in 2007, over 58 million people were covered by medical. Medical signed into law in 1965 as part of the Social Security Act, low-income citizens with health insurance. Each state supervision of their individual Medicaid programs and receive federal funding to help meet the needs of residents. In the Nebraska Department of Health and Human Services (DHHS) administered Medicaid program. Other people are reading Medicaid Medicaid eligibility information age and income requirements of the federal poverty level federal poverty level (FPL) and income level is determined by Nebraska Medicaid eligibility. FPL is set by DHHS annually (see Resources). In 2010, FPL one person household $ 10,830,. For two of the family FPL14570 dollars. Each additional person, FPL increased $ 3,740.
Source: howfoodarticles.com

Debate begins on whether to expand Medicaid in Nebraska (AUDIO)

Sen. Jeremy Nordquist of Omaha sought to assure those worried about the cost of expansion that the state will actually save money, because it will be able to eliminate health care programs no longer needed with expansion. He also claimed that Nebraska residents absorb the cost of the uninsured through increase taxes to cover uncompensated care at hospitals and through increased health insurance premiums.
Source: nebraskaradionetwork.com

Nebraska Heart Hospital Ranks Highly in Readmission Rate Study

Nebraska Heart Hospital’s readmission rates following percutaneous coronary intervention (PCI) are better than the CathPCI Registry rate, according to data released on Medicare’s Hospital Compare website. NHH is one of more than 300 hospitals that chose to participate in this voluntary hospital public reporting pilot program, the result of a partnership with the American College of Cardiology (ACC), Yale New Haven Health Services Corporation/Center for Outcomes Research and Evaluation and the Centers for Medicare and Medicaid Services (CMS). Nebraska Heart Hospital’s unplanned readmission rate of 9.1 percent for PCI patients is less than the 11.9 percent rate for other hospitals included in the study.
Source: neheart.com

Medigap insurance provider in San Diego

Posted by:  :  Category: Medicare

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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

Video: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

Medicare Supplement Questions > will Obamacare affect Medigap

Concerning Medigap, a provision of the ACA required the NAIC to review the most popular Medigap plans (C and F) and determine whether or not employing “nominal cost-sharing” would deter enrollees from misusing physician services. The implication was that, because these Medigap plans fill in the gaps of Medicare (thereby covering 100% of Medicare fees) people are over utilizing doctor visits since it comes at no cost to them, and that employing more cost-sharing would help cut federal health care spending.
Source: medicaresupplement.com

Florida Medigap Insurance – Bridging the Gap between Medicare and Your Needs

Medigap is so called because it is designed to fill a gap left by Medicare. Medicare is the government administered health insurance program for senior citizens. It covers the bare essentials of healthcare for senior citizens so that retirees don’t need to go without proper medical care. If you are a senior citizen in good health with no major health concerns, then this is adequate. But if you, like many other senior citizens, have pre-existing medical conditions such as heart disease, diabetes, and the like, then you probably need insurance coverage beyond the basics. That is where Florida Medigap insurance steps in.
Source: rtcinsuranceadvisors.com

What happens if I have a pre

One question that you may have when looking into the right insurance program is what happens if you have a pre-existing health problem? First of all, it always is best to help define what a pre-existing condition means. Our online glossary is a great tool to utilize when trying to better understand terms. The meaning of a pre-existing condition is: (1) According to most group health insurance policies, a condition for which an individual received medical care during the three months immediately prior to the effective date of her coverage. (2) According to most individual health insurance policies, an injury that occurred or a sickness that first appeared or manifested itself within a specified period—usually two years—before the policy was issued and that was not disclosed on the application for insurance.
Source: ahlbumgroup.com

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

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

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

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

What is Medigap Insurance?

Medicare pays a great deal of the medical costs for its members, but it doesn’t cover absolutely everything. Medicare recipients have coverage for hospitalizations under what is called Medicare Part A. They also have insurance that covers doctor’s office visits and tests, and this portion is covered under Medicare Part B. However, both Medicare Part A and Part B have a deductible.Generally, Medicare will pay about 80 percent of the costs for members. The extra 20 percent will be charged to the patients as coinsurance or copayments. For example, when they visit their doctors, Medicare recipients may need to pay what is called a “copayment.” After the doctor’s office bills Medicare for services rendered, Medicare will pay its portion to the doctor’s office. If there is an amount left over for the patient to pay, the doctor’s office will then bill the patient for what is called the “coinsurance” amount.The Limitations of Medicare Coverage
Source: michaeljinkins.com

Five Concerns To Inquire Prior To You Purchase Medigap Insurance Coverage

There are numerous credit score and cost card businesses that offer Significant Medical health insurance, as well. Ideally, you ought to choose for a policy that has the advantage of a 24-hour emergency service. In this way, in the situation of an incident or sickness, everything is taken treatment of by the business. They make all the necessary preparations, offer assist and advice. Irrespective of where you strategy to journey to, you ought to usually verify that your healthcare include is valid. It should also be sufficient to satisfy the expenses you might incur. The coverage doc ought to always be examined every situation and exclusion. You ought to consult your insurance company if there is any question or question.
Source: skunkhollow.org

Medicare's Competitive Bidding Proposals and Latest Updates

Posted by:  :  Category: Medicare

Competitive bidding that encompasses all Medicare plans, both MA and FFS, has several advantages. Administration of Medicare can be consolidated in a single department that encompasses bidding and administration. The process would be easily explained to beneficiaries and taxpayers since most of these parties are familiar with managed care and the bidding system used by commercial insurers. Finally, it will save money by allowing competition in the market.
Source: medicarebenefits.com

Video: Non-Contract Supplier Webcast for Medicare DMEPOS Competitive Bidding Program

Full Steam Ahead! Competitive Bidding Achieves the Best Price for Beneficiaries, Medicare and Taxpayers

Competitive bidding has generated substantial savings (more than $400 million) for taxpayers and beneficiaries in its first two years of operation, and its expansion to 91 metropolitan areas is expected to save tens of billions of dollars for taxpayers and Medicare beneficiaries over the next decade. These savings, in turn, represent lower revenues to DME suppliers. Therefore, like the many efforts to derail competitive bidding before, much of the current impetus for delay stems from the fact that DME suppliers stand to lose some of the excess profits they have been earning for the last few decades. When Congress enacted the laws that required the transition to competitively-bid Medicare prices for DME, legislators must have anticipated this opposition, as they exempted the program from judicial review, which makes it impossible for suppliers to stop the program via the courts. The rest of this post will explain how DME competitive bidding works and why it is a model for future Medicare payment reforms.
Source: bipartisanpolicy.org

Impacts of the CMS/Medicare Competitive Bidding Program on NPWT Market

Until now, Medicare prices for durable equipment and related supplies have been set according to a fee schedule that was established in the 1980s and has been updated for inflation. But officials at the Department of Health and Human Services say the older system has proved vulnerable to fraud and price inflation. About 20 million people who receive Medicare fee-for-service benefits live in the 100 metropolitan areas where the program is scheduled to operate, according to officials with the Department of Health and Human Services. Only a fraction of those beneficiaries need durable equipment supplies. But the initiative is expected to save $27 billion for Medicare Part B, which covers physician and out-patient services, and $17 billion for beneficiaries, between 2013 and 2022.
Source: devonmedicalinc.com

Medicare’s Competitive Bidding Program goes Nationwide July 1st 2013:

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

NASL praises bipartisan effort to delay Medicare competitive bidding program

In an example of bipartisan agreement in the House of Representatives, Reps. Glenn Thompson (R-PA) and Bruce Braley (D-IA) composed a joint letter, which 226 other representatives signed. The letter asks Centers for Medicare & Medicaid Services Administrator Marilyn Tavenner to delay round two of the competitive bidding program, which is scheduled to take effect July 1. The program is set to expand from nine to 100 areas, including New York City, Los Angeles and Chicago.
Source: mcknights.com

What Will Competitive Bidding Mean For Medical Device Technology Companies?

Nicole Carline, co-editor, is the Senior Account Executive, for Life Science Solutions at Infinity Info Systems and a 12-year veteran in the medical device and pharmaceutical industry. She has deep experience and knowledge having held leadership roles at Johnson & Johnson, Boston Scientific, and DynaVox Technologies. Nicole is passionate about the use of Customer Relationship Management (CRM) and Business Intelligence solutions to help Sales and Marketing executives be more productive. Learn more about Nicole >>
Source: medicalsalescrm.com

Medicare Diabetic Supplies

Many diabetic Medicare beneficiaries prefer to order their testing supplies via mail because it is more convenient and less expensive for the beneficiary. But, according to the New York Times, this process has “caused Medicare headaches for years” because of its costs to Medicare and high levels of fraud. To curb these issues, Medicare tested out competitive bidding on mail-order blood sugar test strips by 18 companies in nine metropolitan areas. As a result, both issues were addressed. Medicare previously paid $77.90 for 100 test strips; now, it paid only $22.47 during this experiment. Beneficiaries also benefit: Copayment prices also fell from $15.58 to $4.49.
Source: ehealthmedicare.com

Let DMEPOS Competitive Bidding Proceed While Addressing Identified Problems and Concerns 

Section 302 of the Medicare Modernization Act of 2003 (MMA), Public Law 108-173,  added a new paragraph 1834(a)(20) to the Social Security Act (the Act), requiring the Secretary of Health and Human Services (the Secretary) to establish and implement quality standards for suppliers of DMEPOS. All suppliers that furnish such items or services set out at subparagraph 1834(a)(20)(D) as the Secretary determines appropriate must comply with the quality standards in order to receive Medicare Part B payments and to retain a supplier billing number. The quality standards are published on the CMS website at: http://www.cms.gov/Medicare/Provider-Enrollment-and-Certification/MedicareProviderSupEnroll/index.html?redirect=/medicareprovidersupenroll.  Pursuant to subparagraph 1834(a)(20)(D) of the Act, the covered items and services are defined in section 1834(a)(13), section 1834(h)(4) and section 1842(s)(2) of the Act. The covered items include: DME, medical supplies, home dialysis supplies and equipment, therapeutic shoes, parenteral and enteral nutrient, equipment and supplies, transfusion medicine, and prosthetic devices, prosthetics, and orthotics. 
Source: medicareadvocacy.org

Pioneer ACO Results Include Improved Quality, Lowered Medicare Costs

Posted by:  :  Category: Medicare

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Detroit Free Press: U-M System Pulls Out of ACO Health Care Program Patient health may have improved within the nation’s 32 Pioneer Accountable Care Organization (ACO) programs, but the results were mixed after the first full year, the U.S. Centers for Medicare & Medicaid Services (CMS) said Tuesday. And one of the three Pioneer ACOs in Michigan — the University of Michigan Health System — is withdrawing from the program designed to test a tenet of federal health care reform: that coordinated care keeps chronic conditions under control and drives down costly trips to the hospital (Erb, 7/16).
Source: kaiserhealthnews.org

Video: Medicare Cost Reports: Understanding the Underlying Concepts and General Settlement Areas

A Guide To the 2013 Medicare Trustees Report

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

Medicare Trustees Report Shows Lower Cost Growth Helping Medicare Financing

Medicare spending per beneficiary has grown quite slowly over the past few years and is projected to continue growing slowly over the next several years.  From 2010 to 2012, Medicare spending per beneficiary grew at 1.7 percent annually, more slowly than the average rate of growth in the Consumer Price Index, and substantially more slowly than the per capita rate of growth in the economy.  Thanks in part to the cost controls implemented in the Affordable Care Act, spending is projected to continue to grow slower than the overall economy for the next several years.
Source: jaredbernsteinblog.com

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

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

Analyses Released: Rebasing and Updating Medicare Home Health Rates

The proposed rule to the Medicare home health prospective payment system (HH PPS) for calendar year (CY) 2014 states that there would be an increase to each of the per-visit payment rates of 3.5% in each year CY 2014 through CY 2017 to account for changes in the costs of providing these services since the establishment of the HH PPS in 2000.  
Source: leadingage.org

JAMA Forum: The Medicare Trustees Report: Time for Reflection, Not Celebration

Still, it’s important to remember that any limited long-term budget for Medicare has to balance 3 objectives. One is the federal budget objective of a reasonable and sustainable future level of federal spending on the program. Another is to distribute financial risk in a way Americans deem to be fair. That means balancing the financial risk faced by today’s Medicare beneficiaries (in the form of premiums and out-of-pocket costs) and the financial risk to taxpayers and future generations of not effectively holding down Medicare spending on seniors. And the third objective is to squeeze down on the health system in such a way that it pushes providers and plans to look hard for innovations that result in cost reductions. That pressure must neither be too light (or providers won’t have enough pressure to find less costly ways to deliver services) nor too aggressive (or there will be disruptions and unacceptable declines in the quality and availability of services).
Source: jama.com

First in Series on Medicare DSH and Top Cost Report Appeal Issues

One key appeal rule change requires cost reports ending on or after December 31, 2008 to have all appeal issues included as Protested Items in Line 30 on Worksheet E, Part A.  Please ensure that your potential appeal issues are being preserved when you file your cost report.  It is also possible to file an amended cost report prior to the issuance of the NPR for that year.  If you protest more than one issue, please ensure that you are itemizing each issue and the impact.
Source: hallrender.com

Report: Inaccurate Payments to Medicare Advantage Programs Continue to Cost Government Billions

A report by the U.S. Government Accountability Office (GAO) suggests the Medicare Trust Fund could save billions if the Centers for Medicare and Medicaid Services (CMS) would adjust payments for Medicare Advantage plans to more accurately reflect the health of those enrollees. The problem, according to the report, is Medicare pays Medicare Advantage plans a predetermined amount for each beneficiary based on risk scores, which are adjusted for health status. The methodology CMS uses to come up with the risk scores has led to overpayments to these plans. CMS has been working to correct the problem, but not enough. By more accurately paying for beneficiaries, the Medicare program would have saved between $3.2 to $5.1 billion in Medicare Advantage plan payments from 2010 to 2012, according to the GOA report. While Congress took action through the Affordable Care Act in 2010 to reduce excessive payments to private plans, CMS continues to use the risk score adjustment of 3.4 percent it used in 2010, ’11 and ’12. CMS officials have said they may revisit their methodology in the future. Recently, Energy and Commerce Ranking Member Henry A. Waxman, along with Ways and Means Ranking Member, Sander Levin, released an update to the GAO report. Waxman and Levin point out interesting inconsistencies in what the plans report. They say documented evidence shows that Medicare Advantage plans tend to report higher patient severity than is supported by medical records. The evidence also shows reported patient severity increases faster than for comparable patients in traditional fee-for-service Medicare. More information for Medicare fraud is located at the Nolan Auerbach & White website.
Source: medicare-fraud.net

Medicare Cost Reports: Home Health

Details and accuracy are a must.  Decisions on reimbursement are based on cost report data.  If you are not properly reporting allowable costs – you could be costing your agency money in the future.  Not all agencies understand this important aspect, but you will and we are here to help.  Let us help you lead the way to a stable reimbursement.  We know you do good work and deserve to be paid for it – but now we need to let the government know that.  Call us today so we can get you going on the right track and getting that cost report done on time, accurately and without anxiety.
Source: tortolanoandco.com

Report: Colorado Hospital Prices Vary Dramatically “Even within the Same City”

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

Medicare cost report preparation for your home health agency.

One of the pitfalls of having your business accountant handle your home health agency cost reports is that it is a very specialized field of knowledge.  They may be great for your taxes and business financial statements, but that does not qualify them to handle your Medicare cost reports.  Preparing a Medicare cost report requires a high amount of industry specific knowledge on highly detailed aspects of the Medicare system.
Source: hazzouriaccounting.com

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July 21, 2013

Final Guidance Issued on MMA Section 1011: Emergency Health Services for Undocumented Aliens

Posted by:  :  Category: Medicare

Effective January 1. 2012, Diversified Service Options, Inc. (DSO), a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida Inc., acquired Highmark Medicare Services (HMS) from its parent company, Highmark Inc.  As a result, HMS changed its name to Novitas Solutions, Inc. (Novitas ), pronounced No-va-tahs with an emphasis on the first syllable.
Source: michiganmedicaidapplication.com

Video: Highmark Senior Markets Highlights the Benefits of a Designated Health Partner

What happened to Highmark Medicare Services?

Physicians and medical billing companies should not face many disruptions as a result of this transition. According to Novitas Solutions, the current Highmark Medicare website will be fully transitioned to the new Novitas site by March 30, 2012. During the transition, visitors to the old website (https://www.highmarkmedicareservices.com) will be automatically re-directed to the new Novitas Solutions website (https://www.novitas-solutions.com), where a new header and page logo can be seen. Bookmarks that users may already have for the Highmark website will purportedly still work with the new page. The Electronic Payer ID has not appeared to change, so claims submission and processing should remain unaffected by the transition. For more information, see the Informational Alert here: https://www.novitas-solutions.com/partb/info-alerts.html.
Source: healthcarebiller.com

Novitas Solutions, formerly called Highmark Medicare Services, announces hundreds of health care jobs coming to Harrisburg, Pittsburgh areas

The prospect of new jobs arises from a large, new contract that was in limbo at the time of the sale. The contract, which involves administering Medicare claims for seven Southwestern states, was expected to create 500 new jobs in Pennsylvania, with about 260 coming to the Harrisburg area.
Source: pennlive.com

New Medicare Administrative Carrier for Jurisdiction 12 Highmark Medicare Services Acquired by Diversified Service Options Inc

Diversified Service Options (DSO) acquired Highmark Medicare Services (Highmark) on January 1, 2012. DSO is a holding company and a wholly-owned subsidiary of Blue Cross and Blue Shield of Florida, Inc. (BCBS Florida). Highmark had the contract with the Centers for Medicare & Medicaid Services (CMS) to be the Medicare Administrative Contractor (MAC), formerly known as a “Carrier” or “Fiscal Intermediary,” for Jurisdiction 12, which includes Delaware, New Jersey, Pennsylvania, Maryland and Washington, D.C. For Part B services, Jurisdiction 12 also includes the counties of Arlington and Fairfax in Virginia and the city of Alexandria in Virginia.
Source: thehealthlawfirm.com

Highmark Medicare Services Changes Name to Novitas Solutions, Inc.

Please read the following bulletin from Highmark Medicare Services. The affected payers are: CPID 2456 Delaware Medicare CPID 5912 Delaware Medicare CPID 3677 J12 Mutual of Omaha DC,DE,MD,NY,PA CPID 7402 Maryland Medicare CPID 5554 Maryland Medicare CPID 2464 Maryland Medicare (MONTG,PRINCE GEORGE) CPID 1465 New Jersey Medicare CPID 5503 New Jersey Medicare CPID 5598 Pennsylvania Medicare CPID 2457 Pennsylvania Medicare CPID 2461 Virginia Medicare (ALEX,ARLGTN,FAIRFAX) CPID 1522 Washington DC Medicare CPID 2459 Washington DC Medicare Reported by Highmark Medicare Services: As announced March 1, 2012, Highmark Medicare Services is changing its name to Novitas Solutions. Effective March 10, 2012, Highmark Medicare will begin migrating the current Highmark Medicare website to our new Novitas Solutions website. We are targeting completing our name change to all active webpage content by March 30, 2012. The new Novitas Solutions website URL will be https://www.novitas-solutions.com. Additional details, including Frequently Asked Questions, are available at https://www.novitas-solutions.com/partb/info-alerts.html. Re-enrollment is Not required. The clearinghouse will continue processing as normal. If you have any questions, please contact Client Services at 1-888-348-8457, option 2.
Source: collaboratemd.com

Insurer Highmark selling Medicare services

Details of the deal were not disclosed in a joint news release from the two companies. The sale is expected to close in early January, and Highmark Medical Services will continue to operate as a separate organization.
Source: thedailyrecord.com

HIGHMARK MEDICARE SERVICES FOLLOWS TENNESSEE : Med Law Blog

Coincidentally, just a few days after the Office of Inspector General announced the $3 million settlement of the credit balance case with the Tennessee cardiology practice, Highmark Medicare Services issued a bulletin reminding providers of their obligation to file the Medicare Credit Balance Detail Report 838. Let me remind you that part of the basis for the Tennessee settlement was that the provider groups maintain their records to conceal the credit balances. Hopefully, your internal records will agree with the Medicare Credit Balance Detail Report. The Highmark Medicare Services reminder can be accessed at:
Source: medlawblog.com

Highmark gets Medicare contract for seven more states

Under the five-year contract, the company will handle both Medicare Part A and Part B fee-for-service claims for hospitals, physicians and other healthcare practitioners in Arkansas, Colorado, Louisiana, Mississippi, New Mexico, Oklahoma and Texas, according to a Highmark Medicare Services news release. It already serves as the Medicare administrative contractor for Delaware, Maryland, New Jersey, Pennsylvania and Washington, D.C. Highmark Medicare Services has offices in Camp Hill, Pittsburgh and Williamsport, Pa., and in Hunt Valley, Md., and is a wholly owned subsidiary of Highmark, which is a Pittsburgh-based licensee of the Blue Cross and Blue Shield Association. The company recently reached an agreement to acquire West Penn Allegheny Health System, a struggling five-hospital system based in Pittsburgh.
Source: modernhealthcare.com

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July 21, 2013

RALEIGH, N.C.: NC weighs abortion ban for some insurance policies

Posted by:  :  Category: Medicare

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Based on company filings with the state, some of the seven Blue Cross individual and group policies submitted to the N.C. Insurance Department for potential listing on the exchange included abortion coverage. The state reviews policies to make sure they comply with laws and regulations that govern what’s marketed in North Carolina, then they’re reviewed by the federal marketplace operators to make sure they meet further standards.
Source: bradenton.com

Video: Know the different types of LIfe Insurance policies before you buy!

NFL’s Help Sought On Promoting Obamacare Insurance Plans

The NFL and other professional sports organizations such as the National Basketball League and Major League Soccer are obvious places for the federal government to target young men to sign up for coverage, Sebelius said.  The administration needs to find millions of young and healthy people to help balance out its insurance risk pool to make up for the older and sicker people who are expected to sign up. In 2014, insurers will no longer be able to turn people away or charge higher rates to people with pre-existing health conditions.
Source: kaiserhealthnews.org

Washington State Insurance Update: “I have two health insurance plans. Why do I still have to pay for some things?”

Q: “Why do I have to pay anything out of pocket? I have two health insurance plans. Between them, shouldn’t they cover all the costs?” A: Unfortunately, most insurers changed the rules under which they coordinate benefits within the past 10-15 years. Under the new rules, there’s less economic advantage to have two (or more) health insurance plans. As a general rule, if you have two health plans and you receive both of them on your own (i.e. you don’t get either of the plans through your spouse), then generally the plan that you’ve had for the longest period of time should be the primary policy. However, there are a lot of variables that can change the result. For example, if one of your plans is Medicare and you get the other plan through your employer, then having a Medicare plan can change the order of benefits, depending on the size of your employer. Confusing? Yup. If you’re having problems with an insurance issue and you live in Washington state, feel free to give us a call. We may be able to help. Our insurance consumer hotline is open from 8 a.m. to 5 p.m., Monday through Friday. The phone number if 1-800-562-6900. You can also reach us at AskMike@oic.wa.gov.
Source: blogspot.com

Experts: Obamacare Exchanges Not Decreasing Insurance Rates

“Covered California is an ‘active purchaser’ in the market, which means it negotiates directly with insurers,” said Covered California spokeswoman Anne Gonzales. “Health insurance companies submitted bids and were required to offer essential health benefits and a balance of access and affordability. We then entered into a lengthy negotiation process to get the best provider networks and premiums.”
Source: freebeacon.com

Campus moves forward with private alternative to UC’s student health insurance program :: Dateline UC Davis

"All changes to the health insurance plan were made with students in mind," said Erin Legacki, chair of the UC Davis Student Health Insurance Plan Committee and a doctoral student in animal biology. "Our main goal was to find an affordable health care plan for all." Legacki and her committee are now reviewing a proposal from Aetna Student Health to provide medical coverage for UC Davis students.
Source: ucdavis.edu

What are the four Obamacare health insurance plans?

2. How does the health plan work? – All plans sold in the exchanges must show you a summary of benefits and coverage (SBC), a short document that explains in plain language what the plan covers and how cost sharing works in that plan. Each SBC sheet has to show examples with dollar amounts for two scenarios: having a baby and managing type 2 diabetes. Looking at the SBC will give you an idea of how the plan might work for you, says Christine Barber, a senior policy analyst for Community Catalyst, a nonprofit organization that promotes affordable health care.
Source: insurancequotes.com

Affordable Burial Insurance Plans

Affordable Burial Insurance Plans for elderly individuals, also called pre-need guidelines, offer a way for someone to manage her funeral programs before loss of lifestyle. Some guidelines allow for full planning while others are based on financial needs only, but in many situations, elderly individuals feel more relaxed understanding they have taken proper good care of this price before getting extremely ill. Most elderly individuals can usually are eligible and manage our low price burial insurance guidelines. Assured rates and advantages. In most situations, $5,000-$15,000 is plenty for burial insurance and the satisfaction.
Source: healthinsuranceinutah365.com

Anthem insurance plan with MaineHealth under review — Health — Bangor Daily News — BDN Maine

Some of the 33,000 individuals who buy their own insurance may stick with another insurer, Mega Life, which will still sell policies in Maine but not through the exchange. Similarly, many of the 91,000 people who have coverage through a small business could continue getting coverage from several insurers that plan to stay in Maine’s market but not sell policies on the exchange. The third group eligible to shop on the exchange, Maine’s 133,000 uninsured, are more likely to do so, but could choose to remain without coverage, become eligible for Medicaid, or find a way to afford an off-exchange plan.
Source: bangordailynews.com

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July 21, 2013

ICYMI: USA Today — “Medicare Advantage is a win

Posted by:  :  Category: Medicare

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A new USA Today column highlights recent data that shows beneficiaries in Medicare Advantage plans receive higher quality care compared to those in the fee-for-service (FFS) part of Medicare.  These results further demonstrate the value of Medicare Advantage by promoting more effective and efficient health care practices. Furthermore, there is an increasing amount of evidence showing that the programs and services health plans have implemented are helping to reduce preventable hospital readmissions for patients compared to FFS Medicare.  Reducing preventable hospital readmissions will improve the quality of care for patients and help control the soaring cost of medical care.
Source: ahipcoverage.com

Video: What Is Medicare Advantage?

Viewpoints On Medicare: Advantage Program Offers Roadmap To Improving The Program; Rare Bipartisan Support For Doctor Pay Fix

Bloomberg: Retirees’ Medical Bills Are Bringing Down Detroit The emergency manager in charge of keeping Detroit afloat says the city’s $20 billion debt load can’t be reduced to manageable levels without “shared sacrifice” from all stakeholders, including retirees. Pension and retiree-health-care obligations make up the bulk of the city’s unsecured debt, and their costs are rising rapidly. The emergency manager, Kevyn Orr, is right that Detroit must reduce its retirement-related debt to secure its future, but he has to be more specific about his target. Cutting retiree health care — also referred to as “other post-employment benefits,” or OPEBs — should take priority over pensions (Stephen Eide, 7/2).
Source: kaiserhealthnews.org

Medicare Advantage Fact Sheet

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

Universal American Corporation (UAM): A Good Small Cap Bet on Medicare Advantage? IHF, UNH & HUM : Small Stock Gems

In the earnings call transcript, Barasch stated that the Medicare Advantage business has gotten more complicated with sequester (which will cost the company between $6 million and $7 million this year), but the product continues to gain popularity among seniors while both parties have largely supported it. With that said, Barasch added that while Medicare Advantage will continue to be a core business for the company (Note: The Medicare Advantage business includes 60,000 HMO members in Texas and Oklahoma and 40,000 members in network products in the Northeast), they are “intensely aware of the need to diversify our earnings away from Medicare Advantage only.”
Source: smallcapnetwork.com

Should I Consider Medicare Advantage?

Another main dissimilarity is that a lot of Medicare Advantage packages have medicine coverage built in. With the Traditional Medicare, Part D medicine coverage has to be bought separately. Also, with the Traditional Medicare, you can visit any hospital or doctor that accepts Medicare. Numerous Medicare Advantage packages work with contracted providers such as hospitals and physicians with whom they have established a long-term relationship.
Source: leerogers2012.com

CMS Requiring HIPPS Codes on Medicare Advantage Claims

We expect additional details from CMS. At this time, home health claims should not be delayed and there should not be any problems with payment for Medicare Advantage claims that do not contain a HIPPS code for home health services. 
Source: leadingage.org

Advantage Medicare Advantage

To be clear, this work is not showing that MA plans do not experience favorable selection. They almost certainly do. This work is showing that the marginal enrollment in above-threshold counties is associated with a disproportionate reduction in admissions, ACS admissions, and mortality. If those marginal enrollees are at least as sick as those in below-threshold counties (i.e., with an expectation of rates of admissions, ACS admissions, and mortality at least as high), then we can conclude that MA plans cause better outcomes relative to traditional Medicare on this margin. Given the design, I think this is a reasonable conclusion. What MA plans do for beneficiaries on other margins remains unexplored.
Source: academyhealth.org

Moneycation: Medicare Advantage: Will it survive Obamacare?

The age-old adage that knowledge is power certainly applies in this case. If you are a current Medicare Advantage plan member, you can start now by keeping an eye out for communications from your insurance carrier that foretell some of the possible changes coming. Check with your physicians to find out which plans they are contracted with so that you can get an idea about your other options if your current carrier has benefit changes that are more than you can handle. It would be a good idea to also check on Medicare supplement rates in your area. If your plan has a significant rate increase, you will likely want to compare your plan against what the more comprehensive Medigap plans would cost you.
Source: moneycation.com

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July 21, 2013

TAMHSC News & Information—School of Rural Public Health to serve as Statewide Evaluator of Medicaid Waiver Program

Posted by:  :  Category: Medicare

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The changes being made in both uncompensated care and delivery systems reform are designed to reform the healthcare system as a whole. A high quality, efficient and accessible healthcare system really does affect whole populations. For example, currently, many people go to hospital emergency departments when their needs would be better met by prevention, primary care, or behavioral health crisis facilities.  This also creates unpredictable surges in demand that in turn can delay other people’s treatment for medical emergencies.  The HHSC-A&M evaluation team will therefore examine a range of projects around the State using care navigators to reduce emergency department use.
Source: tamhsc.edu

Video: Texas Rejects Obamacare’s Medicaid Expansion, Won’t Set Up Own Exchange

Court Says Texas Can Ban Medicaid Funds To Planned Parenthood…

Planned Parenthood, a private organization specializing in abortion, has no right to our tax dollars. Especially when they are using tax dollars to promote and perform abortion, and when their history is that of racist eugenicist Margaret Sanger. The organization has a right to exist under the law, but there is no natural entitlement for them to the tax dollars of the citizenry. If the pro-abortionists desire this type of organization to exist, let them crawl to the 100 billion dollar progressive money machine for support rather than the taxpayer. The pro-abortionists sure seem to be ready to take money from everyone else for abortion rather than to fund it themselves.
Source: christianitytoday.com

Republican Party of Texas Stands Strong Against Government Unsustainable Medicaid Expansion

The Medicaid expansion envisioned by the White House and Democrats has been shown to be entirely unsustainable and would escalate out of control, financially speaking. This in turn would quickly consume virtually all of the non-education spending and soon literally bankrupt even the great state of Texas, resulting in an unparalleled budget crisis (since spending is capped by the Texas Constitution).
Source: texasgopvote.com

Texas and Medicaid Hypocrisy

Kolkhorst also touts Texas’ plan to use a Medicaid “waiver” to provide Federally Qualified Health Clinics (FQHCs) around the state. A Medicaid waiver is essentially a grant to implement some temporary health program for the Medicaid population in lieu of regular Medicaid. Not only are those clinics literally socialized medicine, but after the federal deficit spending glut is over, Texans will be left to pay the bill.
Source: freedomworks.org

Who to blame for Texas rejecting Medicaid? Gov. Perry’s ‘just one man…he’s not God.’

In North Texas and Houston, many chambers of commerce have called for Medicaid expansion and often touted the economics: the health care jobs that would be created by covering more people, the billions in federal dollars that would flow into the state, and the reimbursements for hospitals and doctors who provide charity care.
Source: dallasnews.com

Texas Finalizes Medicaid Program Integrity Rules, Including Rules Governing Provider Compliance Programs

On October 5, 2012, the Texas Health And Human Services Commission (“HHSC”) will publish final rules in the Texas Register that will require “persons and affiliates that participate in Medicaid and other HHS programs [] to know [] federal sentencing guidelines and United States Department of Health and Human Services guidelines governing corporate compliance programs.” 1 TEX. ADMIN. CODE 371.1605(b)(7). More importantly, another new rule section makes any “person [] subject to administrative actions or sanctions if the person [] fails to establish an effective compliance program for detecting criminal, civil, and administrative violations, that promotes quality of care, contains appropriate protections for whistleblowers, and contains the core elements identified in the federal sentencing guidelines for corporations or established by the United States Secretary of Health and Human Services.” 1 TEX. ADMIN. CODE § 371.1655(7). Both new rules will be effective October 14, 2012.
Source: nortonrosefulbright.com

Texas Makes Changes to Medicaid Laws and Programs

Another bill, S.B. 1803, amends the Texas Government Code to meet federal requirements allowing the state to continue receiving matching funds from the federal government for the state’s Medicaid program. Among other provisions, the bill requires the Texas Medicaid program’s Office of Inspector General to conduct preliminary investigations of any complaint of Medicaid fraud or abuse, mandates referrals of fraud to the Texas Medicaid Fraud Control Unit or other law enforcement entities, and requires the Medicaid program to impose a payment hold on claims for reimbursement when credible allegations of fraud exist.
Source: jdsupra.com

Renegade nuns join activists for Medicaid rally at Texas capitol

The Nuns on the Bus, a touring group of activist Catholic nuns, arrived at the Texas state capitol in Austin, Texas on Wednesday, to demonstrate alongside more than 400 others who support the expansion of Medicaid in that state to help the poor. According to the Associated Press, the purpose of the rally was to urge lawmakers to pass a state law that would add more than 1 million working poor people to the Medicaid rolls.
Source: rawstory.com

Texas Legislature to Perry: Don’t waffle on Medicaid expansion

The proposal, an amendment to a Medicaid-related bill, says state health officials “may only provide medical assistance to a person who would have been otherwise eligible for medical assistance or for whom federal matching funds were available under the eligibility criteria for medical assistance in effect on December 31, 2013.”
Source: medcitynews.com

Congressmen call on Gov. Rick Perry to expand Medicaid to insure 40K Texas vets

“The study cited in the letter shows us what we already know: As the state with the highest percentage of uninsured folks, Texas has the most to gain from participating in a program we are already paying for,” he said in a statement. “With the special session underway in the Texas Legislature, the governor has a chance to ensure that millions of Texans, including 49,000 of our military veterans, have access to quality health care. We know this can be done and hope Governor Perry does the right thing.”
Source: elpasotimes.com

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July 21, 2013

Humana plans to sell health insurance policies in 36 unserved Mississippi counties

Posted by:  :  Category: Medicare

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Because Mississippi is a small, poor state with relatively few insurers, there wasn’t a flood of new entries. Any new insurer would have to try to sign up a network of doctors and hospitals, and could have a hard time negotiating favorable payment rates because it would have few customers at the beginning. That’s not a problem for Humana, though, which handles insurance for military retirees, employer groups and Medicare beneficiaries. The company said it already covers more than 200,000 Mississippians.
Source: gulflive.com

Video: Obama’s Health Plan In 4 Minutes

U of M wants to scale back employee health care coverage

University employees don’t pay deductibles now unless they are in a health savings account plan. But starting next year, they may be required to pay deductibles ranging from $100 to $400, depending on their plan. The university is also proposing to increase copays. For instance, employees on the school’s basic plan pay $15 to see their doctor. That may increase to $25 next year. And people enrolled in the school’s health savings account plan may see an increase in their out-of-pocket costs.
Source: publicradio.org

Washington Area Hospital Group Launches Health Insurance Plan

Milwaukee Journal Sentinel: Economists Warn Surge In Health Care Jobs May Signal Trouble The nation has grown increasingly dependent on health care as a creator of jobs, with the number of people working in the sector rising 22.7% during the past decade, compared with 2.1% for all other industries, a new report says. And in all 100 of the largest U.S. metropolitan areas, including Milwaukee, more people work in health care now than before the start of the recession, according to the Brookings Institution report. The figures show the sector’s resilience during the economic downturn and the slow recovery. But having a large percentage of jobs in health care may be a troubling sign, economists say (Boulton, 7/6).
Source: kaiserhealthnews.org

Tips for getting health insurance

The health of an individual is also a factor. A person who is not prone to much sickness and visits the doctor only once in a while will not need health insurance as much as a person who has low body immunity and contracts illnesses very easily and often. One would need to consider the probability of having a major surgery or accident when deciding on their coverage. These are rare for the average person, but when they do occur, the amount for treatment without being backed by an insurance policy is enormous and not affordable for most.
Source: kscripts.com

Washington State Insurance Update: “I have two health insurance plans. Why do I still have to pay for some things?”

Q: “Why do I have to pay anything out of pocket? I have two health insurance plans. Between them, shouldn’t they cover all the costs?” A: Unfortunately, most insurers changed the rules under which they coordinate benefits within the past 10-15 years. Under the new rules, there’s less economic advantage to have two (or more) health insurance plans. As a general rule, if you have two health plans and you receive both of them on your own (i.e. you don’t get either of the plans through your spouse), then generally the plan that you’ve had for the longest period of time should be the primary policy. However, there are a lot of variables that can change the result. For example, if one of your plans is Medicare and you get the other plan through your employer, then having a Medicare plan can change the order of benefits, depending on the size of your employer. Confusing? Yup. If you’re having problems with an insurance issue and you live in Washington state, feel free to give us a call. We may be able to help. Our insurance consumer hotline is open from 8 a.m. to 5 p.m., Monday through Friday. The phone number if 1-800-562-6900. You can also reach us at AskMike@oic.wa.gov.
Source: blogspot.com

What is best health care coverage for part

Congress decided to continue to rely heavily on employer-sponsored health plans for coverage. The problem with part-time workers is that most employers either provided them with no coverage at all, or, if they did, the coverage was often so spartan that it was almost worthless. Although it was decided to require all but the smallest employers to provide employee coverage or face financial penalties, legislators yielded to larger employers who wanted part-time employees to be exempt. The threshold qualifying as part-time was set at 30 hours.
Source: pnhp.org

Will your employer abandon health coverage under new law?

The Affordable Care Act stipulates that small groups can’t offer plans with deductibles that are greater than $2,000 for individuals and $4,000 for families, said Scott Keefer, vice president of policy and legislative affairs at Blue Cross and Blue Shield of Minnesota. That could present a particular problem for small employers in Minnesota, Keefer said, because many already have higher deductibles and will be forced with the prospect of an extra bump in premium costs to comply with the federal law.
Source: twincities.com

Obamacare penalties spawn ‘skinny’ plans

But some companies plan to offer “skinny plans” designed to duck the biggest penalties anyway, according to industry consultants. And the Obama administration has extended its blessing to this limited coverage, even though it would not protect individuals from medical bills that could cause financial ruin in the case of severe injury or illness.
Source: politico.com

Health Insurance Within Reach

The idea is that you will be able to make an apples-to-apples comparison of the prices, provider networks and other details to see which policy best fits your needs. Be aware that the plans may have narrow provider networks — your favorite doctor or the hospital down the street may not be a participant. You’ll need to check to see if a certain provider is in the network, advised Sabrina Corlette, a research professor at Georgetown University’s Center on Health Insurance Reform.
Source: nytimes.com

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