Medigap insurance provider in San Diego

Posted by:  :  Category: Medicare

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: Protect your Family with Medicare Supplement Insurance

Bloomfield's News on Money

First of all, it’s important to understand that any Medigap policy which would fall under the Medicare supplement quotes is going to be regulated and standardized by the government. The federal and state laws which are in place are put there to protect you in a variety of different ways. For example, any policy that works along with Medicare must be identified as such and will carry the term “Medicare supplement insurance” along with it. In most states in the United States, the Medigap policies that are available are going to offer the same basic benefits, although there may be additional benefits that are offered under some policies. Those are the things that should be considered when looking for Medicare supplement quotes.
Source: bloomfieldnm.info

A Brief Overview of Medigap Insurance

Time and again there have been changes in the plans and this can be witnessed and understood before choosing the plan. Where E, H, I and J plans are not in picture anymore, there are new entrants like plan M and N with different specifications addressed. Each state has a multitude of insurance policies that cater to the medical needs of individuals.
Source: cloptoncapital.com

Utah Medicare Supplements

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Who Qualifies for Medicare Supplemental Insurance

In it’s most simple terms, medicare supplemental insurance assists people with paying medical costs that aren’t covered by Medicare. Also called Medigap insurance, these policies are sold by private insurance companies. Medigap will help pay for deductibles, co-payments and co-insurance.
Source: sdecocenter.org

Social Security Disability Insurance costs are exploding

Posted by:  :  Category: Medicare

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Discrimination against the disabled in the workplace has also been banned by new laws in recent years, but the dramatic rise in SSDI claims has pushed the program’s insolvency date to the point it is now projected in three years. And yet, disability insurance programs are often left out of the social safety net discussion.
Source: washingtonexaminer.com

Video: Social Security: Just the Facts

VIDEO: Social Security: Americans Agree

Social Security: Americans Agree, released in honor of the 78th anniversary of the signing of the Social Security Act, presents findings from the NASI study, Strengthening Social Security: What Do Americans Want? The study finds a sharp contrast between what Americans say they want and changes being discussed in Washington. To learn more about the the topics in the video, visit the “Learn” section of NASI’s website.
Source: nasi.org

Social Security 18,700 Students Printed

There have been several previous security breaches at the university, including the disappearance of a hand-held device from the University of Virginia Medical Center last December. The device, which is similar to a smartphone, contained medical and personal information of patients treated by Continuum Home Infusion between August 2007 and last September.
Source: businessinsider.com

Social Security Disability Insurance is encouraging unemployment as its rolls swell, experts say

Stephen Goss, the chief actuary for the Social Security Administration, pushed back on some of Autor and Gokhale’s ideas, arguing that while SSDI costs as a share of GDP have risen, much of that can be accounted for by the decline in GDP. Goss also contended that Congress would not let the insurance program actually go insolvent, if only because ending a popular government program would bode poorly at the ballot box.
Source: freebeacon.com

Glossary of Social Security Terms, Definitions Around Social Insurance Programs, Benefits

Average indexed monthly earnings (AIME): The dollar amount used to calculate your Social Security benefit. (If you attained age 62 or became disabled [or died] before 1978, a different formula — average monthly earnings [AME] — is used instead.) AIME is based on actual past earnings for 35 years that have been indexed for wage growth and averaged. The annual average is then divided by 12 to get the monthly average, or AIME. The indexing is aimed at preventing you from losing the value of your past earnings (when money was worth more) in relation to your more recent earnings. AIME is a key to the Social Security benefits computation.
Source: aarp.org

Time to Disable Social Security Disability Insurance

Notice: The “Read more…” link provided above connects readers to the full text of the posted article. The URL (internet address) for this link is valid on the posted date; socialsecurityreport.org cannot guarantee the duration of the link’s validity. Also, the opinions expressed in these postings are the viewpoints of the original source and are not explicitly endorsed by AMAC, Inc. or socialsecurityreport.org.
Source: socialsecurityreport.org

Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

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If you are enrolled in a supplemental insurance plan, you will send them your Medicare EOB that you receive in the mail from Medicare and they will either reimburse you for the amount Medicare did not cover or pay their share directly to your medical provider. Once your supplemental insurance company has paid, it is likely that you will not have any out-of-pocket expenses. This depends on the plan you choose and how much your supplemental insurance plan covers.
Source: insuranceagentreference.com

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

Medicare Supplemental Insurance Rates

Issue age premiums are based upon your age at the time of the purchase. The only increase for this sort of plan is because of Medicare’s inflation modifications. Medicare additional insurance rates that utilize the community-rated approach indicates that everyone in the exact same area will pay the same premium, regardless of age. In the majority of states, only one technique is utilized, so it serves to discover how the insurance carriers determine their rates. Taking your time to do the study to select the plan that is most fit to your circumstance will help you prepare for premium rises and capitalize on strategy benefits. As of January 1, 2006, there are 12 standardize Medicare additional plans for senior citizens to choose from. As each plan has different advantages, you can pick the plan the best fits your present requirements. Plan A offers the shortest list of advantages and Strategy J is among the most expensive. The only boost for this kind of strategy is due to Medicare’s inflation modifications. To find out extra information check out automobile insurance quotes.
Source: fotki.com

Bloomfield's News on Money

First of all, it’s important to understand that any Medigap policy which would fall under the Medicare supplement quotes is going to be regulated and standardized by the government. The federal and state laws which are in place are put there to protect you in a variety of different ways. For example, any policy that works along with Medicare must be identified as such and will carry the term “Medicare supplement insurance” along with it. In most states in the United States, the Medigap policies that are available are going to offer the same basic benefits, although there may be additional benefits that are offered under some policies. Those are the things that should be considered when looking for Medicare supplement quotes.
Source: bloomfieldnm.info

Do I need supplemental health insurance with Medicare?

Under Medicare Part A and Part B there are deductibles, co-insurance and cost sharing that are the Medicare beneficiary’s responsibilities. The thing that is different about an insured’s responsibility under Medicare coverage is the fact that there is no limit to the amount that one is obligated to pay, unlike most other types of health insurance which have some form of a limit.
Source: reed-insurance.net

Medicare and Health Insurance, What is Covered, Medicare Supplement

Medicare Part D pays for prescription drugs. This plan covers both generic and brand name prescription drugs. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year during the open enrollment period, you have the option to change your drug plan to fit your specific needs. Perhaps when you turned 65 you did not have need for extensive coverage, but as you get older and your needs change, this coverage can be increased as necessary.
Source: bradeninsurance.com

Who Qualifies for Medicare Supplemental Insurance

In it’s most simple terms, medicare supplemental insurance assists people with paying medical costs that aren’t covered by Medicare. Also called Medigap insurance, these policies are sold by private insurance companies. Medigap will help pay for deductibles, co-payments and co-insurance.
Source: sdecocenter.org

Positives of Medicare Supplement Insurance

One reason to have this type of medigap insurance is they might provide some coverage to pay the bills that are not covered. Rather than having to worry about how you are going to pay for certain medical bills your not going to have that headache. For example if you need to have hip replacement you know that it will cost into the thousands, but you will be responsible for some portion of that bill. If you have this coverage though your bill portion will be lower.
Source: allabout101.com

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

Posted by:  :  Category: Medicare

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CMS noted that it expects its proposed enhancement to the IRP reward to encourage more people to come forward with information, leading to an increase in the recuperation of health care fraud funds. This expectation is based on the success of an Internal Revenue Service (IRS) program that pays individuals for reporting IRS tax code violations. The IRS reward program—which pays whistleblowers 15–30% of the amount collected by the IRS for all claims filed after July 1, 2010 and pays 15% of the amount collected for claims under $2 million filed before July 2010—has both paid out more rewards and collected more money than the IRP. Since its inception in 1998, the IRP has paid out only 18 rewards, totaling $16,000 in reward payments and less than $3.5 million in collected funds. The IRS program, on the other hand, paid out approximately $193 million in rewards and collected almost $1.6 billion from 2007–2012. CMS did not comment on whether it believes there is a comparable level of Medicare and tax code fraud.
Source: upenn.edu

Video: How to report Medicare Fraud

Medicare Fraud Bust at Least Gave Holder Something Good to Report

It was the latest in a string of similar announcements by Health and Human Services Secretary Kathleen Sebelius and Attorney General Eric Holder as federal authorities crack down on fraud that’s believed to cost the program between $60 billion and $90 billion each year. Stopping Medicare’s budget from hemorrhaging that money will be key to paying for President Barack Obama’s health care overhaul. Sebelius and Holder partnered in 2009 to increase enforcement by allocating more money and staff and creating strike forces in fraud hot spots around the country.
Source: reason.com

Son Reports Dad’s Company for Medicare Fraud, Park Avenue Medical Assoc.

The whistleblower in the case, Zachary Wolfson, is not only a former employee of Park Avenue Medical Associates, but also the son of Mitchell Wolfson, a founding partner of the company, and its chief medical officer. The son accused the firm, which provides health care services to residents of nursing homes and assisted living facilities in the Northeast, of repeatedly billing Medicare for services that weren’t medically necessary or didn’t comply with Medicare rules.
Source: aarp.org

Michigan cancer doctor formally charged in Medicare fraud scheme

The duke provides a grand setting for cooking and entertaining, featuring a spacious kitchen designed with the chef in mind.. and after a night hosting friends and family, this home offers luxurious respite in its master bedroom, which includes a private den and a dedicated dressing area. once you enter through the two-story foyer, which is flanked on one side by a living room and on the other by a dining room, this gracious floorplan leads you to an expansive family room with a fireplace. adjacent to the family room, a private study can be used as an extra bedroom. upstairs, the lush master bedroom suite includes a spacious master den and an indulgent master bath with a cathedral ceiling, a roman tub, a separate shower, and a private dressing area.
Source: detroitnews.com

HHS Proposes $9.9M Reward for Reporting Medicare Fraud

HHS is proposing a rule that would boost rewards to as much as $9.9 million to people whose reports about suspected Medicare fraud lead to successful fund recoveries. The changes are modeled on an IRS program that has returned $2 billion in fraud since 2003. Over the past three years, President Barack Obama’s administration has recovered more than $14.9 billion in fraud, some of which resulted from fraud reporting by individuals. Under HHS’ proposed changes, a person that provides specific information leading to the recovery of funds may be eligible to receive a reward of 15 percent of the amount recovered. The reward currently sits at 10 percent.  HHS’ new proposal would also increase the cap on the recovery fund awards to $66 million. That means a person can earn as much as $9.9 million if CMS collects more than $66 million as a result of his or her fraud tip. A new funding opportunity released this month supports the expansion of Senior Medicare Patrol activities to educate Medicare beneficiaries on how to prevent, detect and report Medicare fraud. SMP is a national, volunteer-based program that empowers Medicare enrollees to report potential fraud and abuse in the program.
Source: beckershospitalreview.com

Michigan: Doctor charged in $35M Medicare fraud giving chemo to those who didn’t need it

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Source: wordpress.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

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August 26, 2013

Texas isn’t expanding Medicaid eligibility but still expects higher enrollment

Posted by:  :  Category: Medicare

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The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid but not participating will enroll in 2014 and 2015, as families seek coverage to comply with the individual insurance mandate, which takes effect on Jan. 1. An additional 200,000 people could enroll in Medicaid as a result of other new requirements created by the law, according to state health officials.
Source: medcitynews.com

Video: What Are The Texas Medicaid Eligibility Guidelines?

Daily Kos: Sebelius extends offer to Texas on Medicaid, Texas doesn’t care

Texas, however, isn’t interested. “With due respect, the secretary and our president are missing the point: It’s not that Americans don’t understand Obamacare, it’s that we understand it all too well,” Gov. Rick Perry said in a statement on Sebelius’ visit to Texas. He added that Texas refused to set up a state-run exchange or expand Medicaid in order to minimize the damage that the law would cause to the economy and state budget, “although we’re all too aware Obamacare will still cause our state immense budgetary challenges in the years ahead, just like it will to families and small businesses across our country.” So, working poor people in Texas, your governor says, basically, “fuck you.” Just because he hates Obama.
Source: dailykos.com

Texas Uses Data Visualization to Combat Medicaid Fraud

“People who are committing fraud spend all day, every day thinking about it. They come up with new ideas, they come up with ideas about how to hide their tracks. That’s their job, it’s what they do,” says Jack Stick, deputy inspector general for enforcement for the State of Texas’s Office of the Inspector General (OIG). “But people whose job it is to fight fraud do it during a regular work day. So we’ve got to think faster than they do, think better than they do, and leverage technology.”
Source: data-informed.com

Perry aide: Texas request for health law funds ‘isn’t about ObamaCare’

“This is not about Obamacare. The state of Texas has been providing these types of services via Medicaid waiver for decades,” Perry spokesman Josh Havens said in a statement. “Additionally, this has nothing to do with expanding Texas’ Medicaid program. We do not support expanding Medicaid under Obamacare, and are not doing so here.”
Source: thehill.com

Texas Children’s Hospital Goes To Court Over Medicaid Cutback

“We’re trying to balance being available for all our kids, we don’t differentiate by who can pay. So when 55% of our kids are Medicaid, you know, we want to balance that equation to figure out a way to sustain ourselves on that.”
Source: kuhf.org

Options for paying for health care for under and uninsured in Texas BudgetDoc Blog

Since state of Texas opted not to build its own exchange you would have to enroll using Federal Health Exchange by visiting Healthcare.gov . If your income is below 400% FPL, you may qualify for government subsidy to help you get health insurance at a substantially reduced rate. The amount of subsidy will vary depending on your income, you can use this link to a subsidy calculator to see what amount you will qualify. All plans offered through this exchange will be standardized and broken up into 4 categories: bronze, silver, gold and platinum. Where Bronze plans would be the cheapest and provide the lowest level of coverage, while platinum plans would be most expensive and provide the highest level of coverage. Just because you can get subsidy by shopping on the Federal Health Exchange it may not always guarantee you the best deal. If your income falls above 300% FPL your subsidy will be greatly reduced, and you may need to shop plans on private exchange to ensure you’re getting the best deal. The exchange is currently still under construction, but will be open for operation on October 1, 2013. Click here to learn more on what you can do to prepare for shopping on Federal Exchange.
Source: budgetdoc.com

How Poor Might Qualify For Obamacare Subsidies In States That Don’t Expand Medicaid

If you select “Keep me signed in on this computer”, every time you visit WebMD.com you won’t have to type your email address and password. This means that a cookie will stay on your computer even when you exit or close your browser which may reduce your levels of privacy and security. You should never select this option if you’re using a publicly accessible computer, or if you’re sharing a computer with others. Even if you select this option there are some features of our site that still require you to log in for privacy reasons.
Source: webmd.com

Fiesta Mart, Inc. and Children’s Defense Fund

Aimed at reaching eligible, yet uninsured children in the greater Houston area, on-site application assistance will be provided to families wishing to apply for or renew Children’s Medicaid and CHIP.  Both programs cover regular checkups, immunizations, doctor and dentist visits, hospital care, mental health services, prescriptions and more. Children in a family of four earning up to $47,100 per year may qualify. In order to apply, parents should bring proof of income and a copy of their child’s birth certificate, Social Security number, and Permanent Resident Card if applicable.
Source: thekatynews.com

TEXAS SAYS NO TO MEDICAID EXPANSION, BUT ENROLLMENT INCREASES ARE COMING

Unfortunately, the state of Texas has done little to spread the word to uninsured Texans about the exchanges or the Affordable Care Act. The responsibility has fallen on the federal government partnering with local organizations. The U.S. Department of Health and Human Services will distribute $9.9 million for community health centers in Texas to educate residents about health care options under the Affordable Care Act. Certain nonprofit and private organizations are receiving money to do the groundwork on encouraging enrollment in health programs. It is important that outreach efforts differentiate for diverse communities. Texas has more Hispanic residents than every state but California, and two-thirds of Hispanics in the U.S. say they do not have enough information about the health reform law to understand how it will affect them. Without the Medicaid expansion, 22 percent of them will remain uninsured.
Source: childrenatrisk.org

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August 26, 2013

The “Woodwork Problem” and the Medicaid Expansion

Posted by:  :  Category: Medicare

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The Affordable Care Act will have important impacts on state Medicaid programs, likely increasing participation among populations that are currently eligible but not enrolled. The size of this “welcome-mat” effect is of concern for two reasons. First, the eligible but uninsured constitute a substantial share of the uninsured population in some states. Second, the newly eligible population will affect states’ Medicaid caseloads and budgets. Using the Massachusetts 2006 health reforms as a case study and controlling for other factors, we found that among low-income parents who were previously eligible for Medicaid in Massachusetts, Medicaid enrollment increased by 16.3 percentage points, and Medicaid participation by those without private coverage increased by 19.4 percentage points, in comparison to a group of control states. In many states the potential size of the welcome-mat effect could be even larger than what we observed in Massachusetts. Our analysis has potentially important implications for other states attempting to predict the impact of this effect on their budgets.
Source: academyhealth.org

Video: 2013 06 26 12 04 Massachusetts Medicaid EHR Incentive Payment Program Registration and Attestation

Massachusetts Rhode Island Home House Protect Medicaid MassHealth Lien « DESCHENE LAW OFFICE

If you can’t afford or qualify for LTC insurance, and live in Massachusetts, you need to start planning early, at least five years before you might need nursing home care.  Transfer your home into an irrevocable trust.  Once the house is in the trust for five years, Medicaid will no longer consider the house yours, and will not place a lien on it if you have to enter a nursing home.  Most people don’t care if they own their home (that is, that their name is on the deed), but only that they are guaranteed the right to live in the house as long as they want.  The trust guarantees that right.  The trust also provides who will get the house when you die.  So you can still leave the house to your children, for example, but they will not have to sell the home to pay off your Medicaid lien.
Source: deschenelaw.com

Financial Alignment Demonstrations for Dual Eligible Beneficiaries Compared: States with Memoranda of Understanding Approved by CMS

This issue brief compares demonstration programs in California, Illinois, Massachusetts, Ohio, Virginia, and Washington state that will introduce changes in the care delivery systems through which people who are dually eligible for Medicare and Medicaid receive services, as well as changing the payment approach and financing arrangements among the Centers for Medicare and Medicaid Services, the states and providers.
Source: kff.org

The “private option” for Medicaid expansion and budget neutrality

Earlier this month, the state Department of Human Services sent its request to the feds for a waiver of federal rules so the state can proceed with the so-called “private option” for Medicaid expansion. One requirement of the plan — which will use Medicaid funds to fully cover the premiums of private health insurance plans for low-income Arkansans — is that the state demonstrate “budget neutrality”: The “private option” is not supposed to cost more than traditional Medicaid expansion would. Many have expressed skepticism that this is an achievable goal for the state given the wealth of empirical evidence that Medicaid is cheaper than private insurance. During the public comment period, in addition to the hubbub over community health centers, a few groups raised questions about budget neutrality. That includes Americans for Prosperity, though it’s been a bit peculiar to see them harp on this particular point — if traditional Medicaid expansion is cheaper, that seems to argue for, well, traditional Medicaid expansion, which is probably not on AFP’s agenda. Voices on the left have brought it up as well. As Anna Strong of Arkansas Advocates wrote, “It is clear the waiver does not go into detail about the evaluation of budget neutrality for the demonstration, a requirement for federal approval.” And it’s true. The waiver request is vague on this point. Arkansas is asking the feds for a 3-year “Demonstration waiver” — basically, permission to run an experiment. The experiment includes various hypotheses about how the “private option” will work, including the hypothesis that it will be comparable in cost to traditional Medicaid. But unlike the other hypotheses, which articulate clear measurement mechanisms, the “cost comparability” hypothesis lists the “evaluation approach” as TBD; the “data sources” section is blank. (The final waiver request includes a budget neutrality spreadsheet not included in the original draft, but this merely asserts that the costs will be the same.) I asked DHS about this when they first released the draft of the waiver request. A spokesperson responded: The hypotheses are designed to support a more formalized academic evaluation whereas the Special Terms and Conditions will include the requirements for achieving budget neutrality. Budget neutrality requirements will be addressed in the Special Terms and Conditions to be drafted by CMS [Centers for Medicaid and Medicare Services] following the waiver submission. In other words, the question of how to evaluate whether the “private option” costs more than traditional Medicaid will ultimately be up to the feds. The state and CMS are currently discussing  the development of an evaluation approach; if the waiver is approved, it will include instructions from CMS on how to test for budget neutrality. DHS has a controversial theory (backed by an actuarial study) about why the “private option” will cost the same, or even less. Its hypothesis states that the cost will be comparable to traditional Medicaid “assuming adjustments … to achieve access.” That “assuming adjustments” bit is the key: DHS argues that if traditional Medicaid is expanded, the Medicaid program would have to increase reimbursement rates to providers in order to achieve adequate access. By how much? All the way up to private rates. The Medicaid program wouldn’t be able to “beat the market,” according to Medicaid director Andy Allison; if more than 200,000 low-income Arkansans gain coverage, Allison argues, the reimbursement rates necessary to entice enough providers to cover that huge new pool of people will be the same whether they’re coming from a public program or private carriers. As Allison put it back in March: “If it’s the same number either way then this question of cost comparability — cost effectiveness — for the private option versus some kind of traditional Medicaid is moot.” I’ll pause here to note that it’s probably a good thing that the feds are the ones with the final say on a budget neutrality test since by the DHS theory, it’s already baked in the cake. If you want to know what traditional Medicaid expansion would have cost, the answer is the cost of the “private option.” Game, set, match! Presumably CMS will settle on a more rigorous means of testing the DHS theory, which has thus far largely been met with skepticism by healthcare watchers outside of Arkansas. Perhaps CMS will compare Arkansas to another state, one that went with traditional Medicaid expansion. But here’s the thing: The demonstration is supposed to determine which costs more: a policy that happens — the “private option” — or an alternative policy, traditional Medicaid expansion in Arkansas, that never happens. That’s an inherently abstract question and the feds are likely to grant a good deal of wiggle room in determining the answer. For example, if Arkansas is compared to another state, there are any number of individual differences between states that might be hard to control for. A budget neutrality evaluation won’t necessarily have a clear, black-or-white result. Given that CMS appears to be politically invested in the success of the Arkansas “private option” policy, the state is probably going to be given some latitude on the budget neutrality question, at least over the course of the three-year demonstration period and perhaps beyond that. Joan Alker, a health policy expert at Georgetown University, does a good job in this post of explaining federal rules for “private option”-style premium assistance schemes and concludes that “CMS left some room for fudginess in how they will approach the issue of cost-effectiveness.” Hmmm. Meanwhile, a recent study from the U.S. Government Accountability Office (GAO) found that CMS isn’t exactly a stickler for proving budget neutrality on Medicaid waiver applications, regardless of what the rules say. Will the state actually achieve budget neutrality? Hard to say, and harder to measure than you might think. There are critics that believe the DHS theory doesn’t pass the smell test; they point to the experience of Massachusetts — when it moved to universal coverage, Medicaid remained significantly cheaper than private insurance on  that state’s healthcare exchange. Regardless, the chances of Arkansas missing out on federal approval because of concerns about budget neutrality — or even the chances of failing a budget neutrality test imposed by CMS — strike me as low. A little “fudginess” goes a long way. That’s not to say that the question of budget neutrality is unimportant. After all, it’s federal taxpayers that will be footing the bill! It matters to the state budget too: If Arkansas continues with the “private option” policy, the state will be chipping in eventually (the feds pick up the full tab for the first three years, the length of the proposed demonstration waiver). Of course the point of a demonstration wavier is to try something new. DHS may be right, and the “private option” may turn out to be just as cost effective as Medicaid, or more so — which would be big news in healthcare reform. It’s an empirical question and we’re about to get three years of data. But it’s also a politicized issue, and I expect that folks will still be arguing about the answer three years from now. 
Source: arktimes.com

Proper Medicaid Planning May Permit Keeping the Home in the Family

The reserved life estate method vests the remainder interest in the transferees, and the transferor will have no further control over who will eventually inherit the home. Three problems exist with this loss of control. First, if one of the transferees were to predecease the transferor, the remainder share of that transferee in the home would end up passing under the transferee’s will or by intestacy. If, under the will or applicable intestacy laws, the transferee’s share of the home then returns to the transferor, the transferor would then be required to take further action, which would begin the running of another possible period of disqualification from the Medicaid program. This problem can sometimes occur if a transfer is made to children as tenants-in-common, and one of them who has no spouse, no issue and no will predeceases the transferor.
Source: masshealth.info

Daily Kos: Romney’s boomerang

“It would have been impossible for Massachusetts to do what it did without increased federal Medicaid support,” said John McDonough, a major architect of the state’s health care overhaul law and now director of Harvard University’s Center for Public Health Leadership. “What he’s proposing is in direct opposition to what he did as governor,” said Amy Whitcomb Slemmer, executive director of Health Care for All in Massachusetts, citing the Bay State’s 98 percent coverage rate, the highest in the nation. “That kind of expansion would not have been possible under a block grant program,” as Romney has proposed. Block grants give states more flexibility in spending federal money, but restrict funding increases. So much for Romney’s repeated protests that his health care program “solved a problem in the state with a state answer” and “didn’t have the federal government come in and intrude on the rights of states.” (In his book No Apology, Romney explained, “There were some big differences — in particular, our plan did not include a public insurance option,” a claim he dropped from the paperback edition.)   And so much for Roy’s declarations that the “health-reform law he signed in Massachusetts was not the same as Obamacare.” MIT professor and Obamacare/Romneycare designer Jonathan Gruber explained the difference between Romney’s own Boston bill and the Affordable Care Act: “Zero difference,” he said. “This is, to my mind, the most blatantly obvious case of politics trumping policy I’ve ever seen in my life…Because they’re the same f–king bill. He just can’t have his cake and eat it too. Basically, you know, it’s the same bill. He can try to draw distinctions and stuff, but he’s just lying. The only big difference is he didn’t have to pay for his. Because the federal government paid for it. Where at the federal level, we have to pay for it, so we have to raise taxes.” Raise taxes, that is, so that the roughly 15 percent of people without insurance–overwhelmingly residents of the reddest of red states–could obtain insurance.
Source: dailykos.com

How Irrevocable Trust Planning Saves You Money

Protecting the Family Home For those with relatively small estates, meeting the MassHealth asset requirements might not be a major concern. However, for those who have worked a lifetime paying down the mortgage on their family home there is still reason for concern. If you apply for MassHealth and meet their asset requirements, you will qualify for long-term care benefits even if you own your house. They will not make you sell it in order to get care. However, for every dollar of care you receive a lien will be place on your house. This lien will have to be paid off when you sell or transfer your home whether at death or otherwise. Homes that have been placed in an irrevocable trust and have satisfied the five-year look-back requirement will not have a lien placed on them and will be able to be kept in the family or else sold for their full market value.
Source: mamedicaidlawyer.com

Moving People Home After Nursing Home Stay Is Complicated

Napierski says Holmes would not have gone home without this help, buoyed by money the federal government is giving states for a Medicaid program called Money Follows the Person. The program identifies patients, old and young, who’ve been in a nursing home for at least 90 days but don’t really need to be there. Massachusetts is one of 45 states and the District of Columbia in the program, created by the Deficit Reduction Act of 2005.
Source: kaiserhealthnews.org

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August 26, 2013

Medicare Supp Rates Prior June 2010

Posted by:  :  Category: Medicare

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Are you an Insurance Forums member yet ? To sign up for your FREE INSTANT account, please fill out the form below ! Username:     Password:   Confirm Password:     E-Mail:   Confirm E-Mail:          Question of the day:   Type the result for 11 x 3 I agree to forum rules 
Source: insurance-forums.net

Video: Medicare Supplemental Insurance Rates

Why has growth in per capita Medicare spending slowed down?

Growth in spending per beneficiary in the fee-for-service portion of Medicare has slowed substantially in recent years. The slowdown has been widespread, extending across all of the major service categories, groups of beneficiaries that receive very different amounts of medical care, and all major regions. We estimate that slower growth in payment rates and changes in observable factors affecting beneficiaries’ demand for services explain little of the slowdown in spending growth for elderly beneficiaries between the 2000–2005 and 2007–2010 periods. Specifically, available evidence does not support a finding that demand for health care by Medicare beneficiaries was measurably diminished by the financial turmoil and recession. Instead, much of the slowdown in spending growth appears to have been caused by other factors affecting beneficiaries’ demand for care and by changes in providers’ behavior. We discuss the contribution that those factors may have made to the slowdown in spending growth and the difficulties in quantifying those influences and predicting their persistence.
Source: marginalrevolution.com

The Problem with Social Security and Medicare

The drawdown of Social Security and HI Trust Fund reserves and the general revenue transfers into SMI will result in mounting pressure on the Federal budget. In fact, pressure is already evident. For the seventh consecutive year, the Social Security Act requires that the Trustees issue a “Medicare funding warning” because projected non-dedicated sources of revenues primarily general revenues are expected to continue to account for more than 45 percent of Medicare’s outlays in 2013, a threshold breached for the first time in fiscal year 2010.Lawmakers should address the financial challenges facing Social Security and Medicare as soon as possible. Taking action sooner rather than later will leave more options and more time available to phase in changes so that the public has adequate time to prepare.
Source: investmentwatchblog.com

Feds to Pay 110% of Medicare Rates for Haiti Evacuees

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

Doctors Refuse To Accept Medicare Patients

California Healthline says that physicians have several reasons for opting out of the program. Most significant, though, are the low reimbursement rates, concerns about patient privacy, and unhappiness with the government’s increasing involvement in medicine. As far as the increased government presence goes, Becker’s Hospital Review cites the penalties for physicians who do not demonstrate Meaningful Use through EHRs as an example. The WSJ also says that doctors recognize that Medicare payment rates have not kept up with inflation, and that there are dangers of more cuts in the future.
Source: healthcaretechnologyonline.com

More Physicians No Longer Seeing Medicare Patients

Efforts to contain Medicare spending may show signs of being a double-edged sword.  You can’t arbitrarily cut provider payment rates without consequences.  It seems one consequence is driving more doctors away from Medicare at the time Medicare’s population is growing.  Health leaders advocate market-based, consumer-centered incentives that drive both higher quality and cost containment without subjecting providers and patients to harsh situations.
Source: hlc.org

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August 26, 2013

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Posted by:  :  Category: Medicare

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

Video: Reality check: Tax rates & Medicare

Medicare and Social Security Policies Based on Needs, Not Numbers

Decreasing the federal deficit at the expense of current and future Medicare and Social Security beneficiaries ignores the public’s overwhelming support for these programs. President Obama and Congress must think about what future generations will need for a secure retirement. They must work together and focus on our larger national goals of economic growth, health and financial security, and enacting affordable policies to meet those goals. Yes, we do need to make adjustments to Medicare and Social Security, but we need to do so without compromising the health and well-being of the nation or undermining the values that Americans cherish.
Source: aarp.org

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August 26, 2013

Medigap vs. Medicare Advantage Plan

Posted by:  :  Category: Medicare

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

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

Medicare Advantage vs. Medicare Supplement

One option that you may have some questions regarding is the differences between Medicare Advantage and Medicare Supplement. Planprescriber.com helps us break down the difference of these two. They share that the standardized Medigap plans are uniform in the 47 states that offer them. Consequently, a given plan type (e.g. Plan F) has the same benefits regardless of the insurance company that provides the policy or the state in which you reside. On the other hand, Medicare Advantage must provide all Medicare Part A and B coverage but, depending on the insurer and the specific plan, may cover more than Part A and Part B benefits. Excluding drug coverage, any standard Medigap plan with Original Medicare Parts A & B will have more benefits than a standard Medicare Advantage program since a Medicare Advantage program is only required to duplicate Medicare Part A & B benefits. However, as mentioned earlier, some Medicare Advantage programs offer benefits beyond those found in Part A and Part B.
Source: ahlbumgroup.com

Medicare coverage has gaps

A: Medigap plans are sold by private insurance companies, but the plans have to follow state and federal rules. Medigap plans come in several standard varieties, which helps consumers compare plans. They cover some of Medicare’s cost-sharing, including deductibles and co-insurance, but they do not pay for services that Medicare does not cover. Medigap plans are popular because they rarely change from year to year, and they allow you to see any health care provider that accepts Medicare. But Medigap plans can have high premiums that increase annually, and policyholders usually must also buy separate Part D prescription drug plans. If you have a Medigap plan, think twice before dropping it for some other coverage because you may not be able to get it back later.
Source: seniordigestnews.com

Medigap or Medicare Advantage?

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

Medigap vs Medicare Advantage

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

How Medicare Supplement Plans & Medicare Advantage Plans Work

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

Medicare Supplement Guaranteed Issue

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Source: medicarechoicesofarizona.com

Understanding The Medicare AEP Or Annual Enrollment Period

The best way for individuals who have Medicare coverage to ensure that you receive the best value possible is to compare the different plans prior to switching during the 2014 Medicare AEP or Annual Enrollment Period. There are five parts of Medicare Insurance Plans which includes Parts A, B, C/Medicare Advantage or Medicare supplement, and D. The AEP does not apply to those individuals who already have Medicare supplement insurance. However, they are not restricted from switching during the AEP period, especially if they benefit from switching. Whether you currently have Medicare coverage, a Medicare Advantage (MA) plan, or Part D (prescription drug) coverage, you have one opportunity to make the changes you desire once per year during the AEP. That period is referred to as Medicare’s Annual Election Period or the Open Enrollment period. The AEP begins on the 15th of October and ends on Pearl Harbor Day, 2013 (December 7th). Any changes that you opt for will go into effect on the 1st of January, 2014. The AEP is beneficial to individuals covered by any Medicare insurance plans because it gives them the opportunity to make any changes they wish to their coverage every year if they so desire. This means that you can make these changes as your personal needs change. Therefore, you should at least examine those options prior to the AEP each year in order to ensure that you have a plan that effectively addresses those needs. You should ask yourself certain questions when reviewing your current coverages prior to the Annual Enrollment Period. For instance, in the past year, were you diagnosed with any type of long-term illness or medical conditions or did any of your prescription medications change this past year? If the answer to this is “YES”, you should take a closer look at your current coverage and consider making changes that you will benefit from during the AEP when you have the opportunity to do so. If you have a Medicare supplement plan than AEP is not for you. You have no restrictions on the time of year you can review your current plan and switch plans if desired. It is important to compare Medicare supplement plans to any Medicare Advantage plan so you understand the difference. Contacting an independent insurance agent that specializes in Medicare can help you make sense of it all. In closing, you should also remember that Medicare plans change with considerable regularity and so do their costs. As an example of this, the price of your current plan can decrease or increase each year. Or, if you have a Plan D prescription drug plan, medications may be added or discontinued on a regular basis. Finally, benefits may change frequently while other Medicare plans may stop offering coverage based on your geographic location.
Source: blogspot.com

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August 26, 2013

Medicare Supplements (Medigap) For Dummies

Posted by:  :  Category: Medicare

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Source: croweandassociates.com

Video: AARP Medicare Supplement Plan F

Utah Medicare Supplements

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Why Choose Medigap Plan F

The most crucial thing that must be done is get the list of options that are available and get a clear understanding about each of them. Customers should know that Medigap plans are not offered by all insurance companies in the country. It is essential to be informed that in some states, the Plan F can be a high-deductible plan. Customers just have pay a lower monthly premium but must meet the deductible rate of $2000 before the plan starts to pay anything. There are changes that might fall onto the horizon of Plan F so it is better to consider other options.
Source: demandit.org

Medigap Plan F, Pros and Cons

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

Should You Buy The Medigap Plan F?

It is very much possible that the specifics of every Medigap policy would change annually. However, the fundamental doctrine of every plan will be retained. When people talk about supplemental Medicare policies, the Medigap plan F is always involved. This is for the reason that this plan is the most popular in the field. The popularity of the Medigap Plan F can be attributed to its flexibility. It also covers the excess expenses that are not covered by basic Medicare policy. The excess expenses come from the variance between the professional fees of the doctor and the amount that Medicare is required to pay. Medigap Plan F is a supplemental plan that is designed to cover the out-of-pocket expenses. Excess expenses can come up during emergency cases and additional preventative cares that are not typically covered by Medicare. Before making a decision to buy this plan, it is vital to study the benefits and premiums and compare these with other plans.
Source: neuquenonline.com

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