What is a Medicare Advantage Plan?

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

Video: What Is Medicare?

How Will the ACA Impact Medicare Advantage Plans?

Predictions are that the ACA will have a negative impact on Medicare Advantage plans due to increased out-of-pocket costs and thus potentially decreased enrollment. In 2013, there will only be approximately $11 billion in budget cuts for the program, but is estimated by 2019, those budget cuts will escalate to $200 billion or more.  The $200 billion will consist of approximately $136 billion in direct program funding cuts and $70 billion in indirect cuts. In addition to the cuts in funding the ACA will impose a new health insurance tax that will affect Medicare Advantage beneficiaries. Because of the $220 dollar increase in out-of-pocket costs, increased budget cuts, and reduced benefits predictions indicate a decrease of 3 million enrolled in Medicare Advantage plans by 2019.
Source: bhmpc.com

I Am Turning 65 What Is Medicare A and B And What Do I Do?

Part D is drug coverage.   Whether you are on Part A and/or Part B, Medicare wants you to have creditable drug coverage.  If you decide to remain on your employer plan, make sure you confirm with your employer that the drug coverage provided under the employer plan is creditable.  If not, you should enroll on a stand-alone drug plan so that when you do go fully onto Medicare, you will not receive a penalty for each month you were not on creditable coverage (note:  the penalty is 1% per month based on the national average for drug plan premiums).  If you do receive a penalty, you will carry that penalty in perpetuity.
Source: personalmedicareadvisor.com

New And Improved! ‘Keep Your Government Hands Off My Medicare,’ 2013 Edition

This means it’s entirely possible that, even as people start signing up for Obamacare, the program won’t get much more popular at all, something Democrats have roundly expected. “If the ACA works as its sponsors hope, quite a lot of people — maybe the majority — who get their insurance from the exchanges will tell you that, no, they have private insurance,” Bernstein wrote recently in the American Prospect.  ”They aren’t getting anything from Obamacare.”
Source: thenewcivilrightsmovement.com

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

Medicare Supplemental Insurance

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

Medicare provider charge data released

Posted by:  :  Category: Medicare

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The data provided here include hospital-specific charges for the more than 3,000 U.S. hospitals that receive Medicare Inpatient Prospective Payment System (IPPS) payments for the top 100 most frequently billed discharges, paid under Medicare based on a rate per discharge using the Medicare Severity Diagnosis Related Group (MS-DRG) for Fiscal Year (FY) 2011. These DRGs represent almost 7 million discharges or 60 percent of total Medicare IPPS discharges.
Source: flowingdata.com

Video: Medicare Spending Per Beneficiary Measure National Provider Call – February 9, 2012

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: healthaffairs.org

Medicare Data Access for Transparency and Accountability Act of 2013

Grassley maintained that taxpayers have "a right to see how their hard-earned dollars are being spent" and "there should not be a special exemption for hard-earned dollars that happen to be spent through Medicare." Further, "if doctors know that each claim they make will be publicly available, it might deter some wasteful practices and overbilling," he noted. For example, Grassley cited how in 2011 the Wall Street Journal, "using only a small portion of Medicare claims data, was able to identify suspicious billing patterns and potential abuses of the Medicare program." In fact, WSJ found "cases where Medicare paid millions to a physician sometimes for several years, before those questionable payments stopped."
Source: policymed.com

Medicare – Should You Become a Provider?

Even though Medicare has traditionally not covered routine dentistry, it does cover biopsies, which a number of practices do, and it may cover procedures needed prior to jaw surgery along with a few other unique dental-related situations.  If your practice provides any of those procedures, you must be enrolled as a participating or non-participating provider for Medicare in order for your patients to receive Medicare benefits.
Source: fluenceportland.com

Report: Medicare Surges Ahead in ACO Growth

In an Aug. 21 letter to HHS Secretary Kathleen Sebelius, Susan Turney, M.D., president and CEO of the Medical Group Management Association, called on Sebelius to embrace a series of actions designed to ease the burden on physicians trying to meet to meet the meaningful use requirements in the HITECH Act, including instituting a moratorium on penalties for physicians that have successfully completed Stage 1 requirements.
Source: healthcare-informatics.com

Blue Medicare Regional PPO Plan

With so many different providers, it’s often a challenge to find Medicare providers you can truly trust. It’s tough to know which companies are reliable and which are not. Florida seniors overwhelmingly choose Florida Blue as their Medicare provider and the Blue Medicare plans have earned a reputation as a dependable, top of the line option. Florida Blue has earned a solid reputation built on generations of happy, satisfied customers. With a Blue Medicare health plan, you’re getting more than a piece of paper, but a promise that when you need health care, you can get it- no questions asked.
Source: mioti.com

Why has growth in per capita Medicare spending slowed down?

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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

Video: Medicare (Australia) – Wiki Article

Man peeved at amount of executive’s Medicare fraud award

Fbi Salma Yaqoob College Deal Military Families Businesses Club Gets Wrongful Convictions Los Angeles War Community College Was Mayor John Bull Families No Azstyle Reducing Fractions South Los Angeles Giants Fan Ray Egan Still Fighting South Los Cape Community College Unions Angeles Killing Students Council Fractions Rick Snyder Cape Community Shooting Boy Shooting 1984 Killing Book Deal Martin Mullaney Klan Leader Students Trip Tasers Sheriff Tasers School Provision Club Wrongful Civil War
Source: wikilawschool.org

Medical Coding Wiki: Important UpDates and Information for Medicare Billing 2012

Discontinuance of verification of foreign born status in provider enrollment: Effective immediately, providers are no longer required to provide information, which verifies the legalized status of enrollment applicants including those individuals referenced in any ownership related information. This is part of an ongoing Centers for Medicare & Medicaid Services (CMS) review of current enrollment requirements to eliminate unnecessary burden on providers as well as delays in the enrollment process
Source: medicalcodingwiki.com

Usuario:GalvanWhisenant350

You should have a very checklist ready associated with questions to question prospective home well being agencies. These include: whether the organization is Medicare-certified; whether it affords the particular services you may need (nursing, physical therapy, occupational therapy, etc.); whether the agency can meet almost any special needs you’ve got, such as ethnic or language personal preferences; whether the bureau offers needed individual care services for instance help in using the bathroom, bathing and salad dressing; whether the firm offers needed supporting services – or can arrange for services – including help with food preparation, shopping, laundry, or housekeeping; whether the company has available staff to supply the hours and sort of care which a medical expert has ordered, whether the organization has staff accessible nights and weekends in case there is emergency? Additional questions that ought to be asked are the amount of Medicare and insurance will cover and what additional amounts you need to pay. Whether the firm checks the qualification of its all of the employees and also if the agency will supply references from satisfied clients. You can locate a home health agency in the area which has been approved by Medicare at their internet site, by asking your medical professional, friends or family members, or by looking within the Yellow Pages beneath Las Vegas Elder Care.
Source: mknet360.com

14. Medicare Patient Flow

GP: According to the Centers for Medicare and Medicaid Services, a GP modifier means that “Services [are] delivered under an outpatient physical therapy plan of care.” This means that the service or item received was a part of a preexisting plan of care for physical therapy created by Medicare doctors and physical therapists. It also means that the service was performed in an outpatient setting. Put another way, the patient did not need to be admitted to a hospital to obtain the service. In order for therapy to be covered by Medicare, a plan of care is required.
Source: seamlesswiki.com

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August 27, 2013

Railroad Medicare is Part B Medicare for retirees

Posted by:  :  Category: Medicare

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If a provider or supplier you want to work with participates in Medicare, but states “not Railroad Medicare,” Palmetto GBA recommends that they call Palmetto’s Provider Contact Center at (888) 355-9165. Palmetto’s staff is trained to discuss these matters with all Part B providers and suppliers. They also recommend providers or suppliers visit Palmetto’s website at www.PalmettoGBA.com/RR.
Source: utu.org

Video: Parts A & B — Alphabet Soup

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Source: federaldaily.com

Health Subcommittee Examines Proposals for Reform and Improvement of the Medicare Part B Drug Program

Reimbursement rates under Medicare Part B have caused the shift of some patient populations, including those with cancer and other rare diseases, from physician offices to hospital outpatient centers. The reimbursement shift, as coupled with community cancer centers closing, has caused an increased cost to the Medicare system and patients. As Brooks added, “Medicare payments for chemotherapy administration services in hospital outpatient settings have more than tripled since 2005, while payments to community cancer clinics have actually decreased by 14.5 percent.”
Source: house.gov

Medicare Part B: Barriers to Cancer Treatment

The National Patient Advocate Foundation (PAF) has seen a notable rise in calls for assistance from both Medicare beneficiaries and cancer doctors regarding difficulty accessing certain cancer drugs in the physician office setting, where most patients receive their care. As a result, patients are being forced to seek cancer treatment in the hospital setting to access their life-saving cancer medicines; this displacement disrupts their continuum of care, is inconvenient, and is more costly to the Medicare program.
Source: biotech-now.org

Opinion: Cuts to Medicare Part B will hurt older Coloradans

Unfortunately, the cuts are already hitting community health clinics hard, especially in rural areas. A recent survey conducted by the American Society of Clinical Oncology found that nearly 50 percent of oncology practices are sending Medicare patients elsewhere for treatment, primarily to a more expensive hospital setting due to sequestration. Twenty-two percent reported that they either have closed or will have to close clinics if sequestration cuts continue.
Source: healthpolicysolutions.org

Ask The Experts: Retirement

When I called Blue Cross, they indicated that if my wife continues with her plan, there is no reason to take Part B. Social Security warns me about the 10 percent-per-year cost increase and the open enrollment period being three months and I have to wait until the following July. I am still working, basically self-employed. Any advice?
Source: federaltimes.com

Part 1 of 6: Does Medicare or Traditional Health Insurance Pay for Elder Care Services in Indianapolis Indiana?

Julie Sullivan is the Owner at GreatCare of Indianapolis IN. GreatCare is a licensed, personal services agency, providing in-home care services to the Indianapolis, Indiana and surrounding areas. We serve the personal health and daily care needs of seniors or individuals who prefer to stay at home, but require assistance with everyday activities, such as dressing, personal hygiene, meal preparation, laundry or errands. Our team of certified nurse aids and home health aids can provide you with personalized, in-home care services to meet your needs, including: Daytime hourly in-home care Temporary or post-hospital respite care 24-hour, around-the-clock home care Morning and evening care Overnight / Slumber care In addition, we offer our Care Compass service, to assist in setting the course for the next stage in your loved ones life. We guide you through the currents of aging, and help you find your true north. Our licensed nurses, with experience in hospice and geriatric care, will help guide you through the complex and often sensitive journey of selecting an in-home care service, and will provide a smooth transition to a new way of life for your loved one, without the anxiety and fear.
Source: ineedgreatcare.com

Court of Appeals Holds that School District’s Long

The New York State Court of Appeals recently ruled that a school district’s voluntary payment of Medicare Part B premiums for over-65 retirees, after a contractual requirement to do so was dropped, gave rise to a binding expectation that it would continue providing such benefits. In Chenango Forks CSD v. New York State Public Employment Relations Board, 2013 WL 2435066 (June 6, 2013), the Court noted that the dispute arose when the school district circulated a memorandum to its faculty and staff announcing that, due to the cost, it was terminating its long practice of reimbursing Medicare Part B premiums to retirees 65 or older.  The district was at one time required by its health care insurance plan to reimburse these premiums.  The parties then negotiated a switch to a new plan, reflected in a collective bargaining agreement (CBA) between the parties that was silent regarding that benefit.  Subsequent CBAs between the parties were also silent on the issue but, nonetheless, the district continued to provide it. 
Source: hancocklaw.com

I Am A Vet … and so Confused about My Medicare? » Toni Says

You and my husband must have been in the Marines together!  He feels the same way. “Part B” covers everything, except an in-hospital stay, which is covered on Part A.  When you are taken to a hospital, by law EMS has to take you to the closest hospital and unfortunately, that may not be the VA hospital.   You will receive bills for everything, except your hospital stay, which is covered under “Part A” if you don’t have “Part B”. I know this because my husband is fighting bills from over 4 years ago, when he was not old enough for Medicare and was ambulanced to Methodist Hospital in Sugar Land, Tx. He was told by the VA that due to him having a 60% disability, he would never have to pay anything at the VA and that if he is sent to another hospital due to an emergency that the VA would pick up the charges.
Source: tonisays.com

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August 27, 2013

VA hospital stays count toward Medicare skilled nursing coverage eligibility, CMS confirms

Posted by:  :  Category: Medicare

To meet the emergency hospital definition, the hospital must meet certain hours of service, nurse staffing, and state or local licensing requirements. These requirements are “minimal” and should “hopefully apply” to any VA hospital, according to an official who spoke on the Open Door Forum call.
Source: mcknights.com

Video: Medicare Eligibility And Enrollment

How to Get Retiree Health Insurance Before Medicare Eligibility

In many cases, it may make financial sense to look for an individual insurance plan until you meet Medicare eligibility requirements. If you’d like to keep your premiums low, you might want to consider a high deductible plan. You might have to pay for your own doctor’s visits and initial tests out of pocket, but this type of plan should provide coverage in case you are diagnosed with a serious illness. You can also use a health savings account that works in conjunction with an individual insurance plan to help maximize your savings.
Source: allinsgrp.com

Another Jindal Swindle in trouble: SELH, aka Northlake, loses Medicare eligibility nine months after privatization

AFSCME Alliance for School Choice American Federation of State Anarchy Ann Williamson Attorney General Bechtol Russell Black Bear Bob Levy Bonding Assistance Program Business Report Chafee Educational Training Voucher Charters Charter Schools College Students Commandeer County and Municipal Employees Digital Medial Incentive Early Start Program Enterprise Zone FastStart Financial Literacy for You Francis Thompson Frank Simoneaux Go Grant Governor Hebert Heresy Huey Long Industrial Tax Exemption Jim Champagne Jindal John Schroder John White Kyle Plotkin Live Performance Tax Credit Louisiana FastStart Louisiana Guaranteed Student Loans Louisiana State Troopers Association Michael Walker-Jones Micro Loan Program Mike Thompson Modernization Tax Credit Morgan-Keegan Motion Picture Investor Tax Credit Office of Group Benefits Per Capita Income Poverty Professional Fire Fighters Association Quality Jobs Rainy Day Fund Rene Greer Rep. Alan Seabaugh Rep. Bob Hensgens Research and Development Restoration Tax Abatement Rockefeller State Wildlife Scholarship Sibille Small Business Loan Program Sound Recording Investor Tax Credit Spending Freeze START State Matching Funds Grant State Revenue Steve Monaghan Tax Credit Tax Cuts Technology Commercialization Credit and Jobs Program Teepell TOPS Veteran Initiative and Mentor-Protege Tax Credit Veto Violent Crime Vouchers Weitz Golf International
Source: louisianavoice.com

Medicare Savings: Cut Benefits to the Elderly or to Big Pharma's Windfall Profits?

The Ryan plan would change Medicare from a guarantee of health care (with associated premiums, co-payments, and deductibles) to a "premium support" program. In other words, it would be a voucher program – the voucher being a flat payment given to beneficiaries to obtain either Medicare coverage or to buy a private insurance policy. This would increase costs significantly for Americans because annual increases in the amount of this voucher would likely fail to keep pace with the growth in health care costs from year to year. Thus, beneficiaries would have to pay increasingly more out of their own pockets for insurance coverage, either through Medicare or from private insurers.
Source: foreffectivegov.org

Extending Social Security and Medicare Eligibility Ages

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

Medicare Forecast: Solvent Until 2026, Though Baby Boomer Costs Loom

Kaiser Health News: Slowdown In Medicare Funding Extends Trust Fund The Medicare spending projections also encompass areas of current law that are not likely to remain, such as a 25 percent payment cut for Medicare physician services scheduled to take effect on Jan. 1 that trustees say “is highly unlikely.” Trustee Robert Reischauer said it would be a mistake to make too much of the two-year extension on the life of the Medicare hospital trust fund. The Medicare projections involved a lot of uncertainty, he said, both on the legislative front — Congress will likely stop the scheduled Medicare physician payment cut, for example — and from the cost impact that new technologies, drugs and medical devices will have. Those “historically have tended to push up costs,” he said (Carey, 5/31). The New York Times: Outlook for Medicare Has Improved a Bit, U.S. Estimates The [health] law trimmed Medicare payments to many health care providers on the assumption that they would become more productive. Another factor, officials said, is the Budget Control Act of 2011, which calls for reductions of roughly 2 percent in projected Medicare spending from 2013 to 2021. … The slowdown in Medicare spending has broad implications for the federal budget and the economy. “In recent years,” said Douglas W. Elmendorf, the director of the Congressional Budget Office, “health care spending has grown much more slowly both nationally and for federal programs than historical rates would have indicated.” (Pear, 5/31).
Source: kaiserhealthnews.org

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August 27, 2013

More definitive report confirming that most physicians accept Medicare

Posted by:  :  Category: Medicare

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Approximately 90% of all office-based physicians report accepting new Medicare patients. The percentage of physicians who report accepting new Medicare patients is similar to the percentage of physicians who report accepting new privately insured patients. In addition, the share accepting new Medicare patients has been relatively stable over the 2005-2012 period and shows a slight increase in 2011-2012 based on initial NAMCS data.  Beneficiary reports of access to care, including the ability to find a physician and see a doctor in a timely manner, are also favorable. Again, these results are comparable to reports by patients with private insurance and have been stable over time. Overall, Medicare beneficiary access to care has been consistently high over the last decade and continues to be high today.
Source: pnhp.org

Video: Top 10 Medicare Insurance Tips

Individual Health Insurance Market under ACA: Lessons from Medicare Part D

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

Blue Medicare Regional PPO Plan

With so many different providers, it’s often a challenge to find Medicare providers you can truly trust. It’s tough to know which companies are reliable and which are not. Florida seniors overwhelmingly choose Florida Blue as their Medicare provider and the Blue Medicare plans have earned a reputation as a dependable, top of the line option. Florida Blue has earned a solid reputation built on generations of happy, satisfied customers. With a Blue Medicare health plan, you’re getting more than a piece of paper, but a promise that when you need health care, you can get it- no questions asked.
Source: mioti.com

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

Continued public confusion about “Obamacare”

Moreover, substantial numbers believe that the law does things that it doesn’t and some aren’t sure. For example, only 44% realize that the law does not cut Medicare benefits. (Almost as many — 43% — think it does, and another 14% aren’t sure.) This confusion is understandable given the constant stream of outright lies about it, but in reality the ACA only reduces the future growth in certain payments to doctors and hospitals (without which Medicare would go bankrupt). In terms of actual Medicare benefits, the law actually expands them, from closing the previously mentioned “doughnut hole” in prescription coverage to encouraging more preventive care by covering 100% of the costs.
Source: dgarygrady.com

Viewpoints: Disability Insurance ‘Time Bomb;’ Leavitt On The Lessons Of Medicare Part D’s Rollout; Boys And Eating Disorders

The New York Times: Do Clinical Trials Work? [A]t the annual meeting of the American Society of Clinical Oncology last month, much of the buzz surrounded a study that was anything but a breakthrough. To a packed and whisper-quiet room at the McCormick Place convention center in Chicago, Mark R. Gilbert, a professor of neuro-oncology at the University of Texas M. D. Anderson Cancer Center in Houston, presented the results of a clinical trial testing the drug Avastin … Gilbert’s study found no difference in survival between those who were given Avastin and those who were given a placebo. … The centerpiece of the country’s drug-testing system — the randomized, controlled trial — had worked. Except in one respect: doctors had no more clarity after the trial about how to treat brain cancer patients than they had before (Clifton Leaf, 7/13). 
Source: kaiserhealthnews.org

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

Employers look to Obamacare exchanges and Medicare for retiree health insurance

Detroit, which filed for bankruptcy, hopes to push retirees who are too young for Medicare onto the new public insurance exchanges as a way of shedding healthcare liabilities. Chicago has proposed a plan to migrate most of its 30,000 under-65 retirees to the state exchanges by 2017. And, in the private sector, more than 60 percent of employers are reassessing their retiree health coverage as a result of the Affordable Care Act (ACA), according to a study to be released this week by Aon Hewitt, the benefits consulting firm.
Source: retirementrevised.com

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August 27, 2013

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

Video: Medicare Part D

The Medicare Prescription Drug Benefit Fact Sheet

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

Medicare Part D continues to improve access to drugs

The proposed rebates could ultimately contribute to higher premiums and copays and increased drug prices for private sector consumers, thus resulting in reduced access to critical medications. Because rebates would mean less funding for biopharmaceutical research, this policy could delay potential scientific and medical developments that could realistically change and save lives by making drugs more effective and safer to use. Mandatory government rebates to Medicare Part D would also translate into fewer jobs in the biopharmaceutical sector.
Source: medcitynews.com

Medicare Part D Notice Due Before October 15th

You may distribute the Notice electronically if you follow the same electronic disclosure requirements that apply to summary plan descriptions (SPDs), except you should inform the participant that he/she is responsible for providing a copy of the disclosure to his/her Medicare-eligible spouse and/or dependents eligible for coverage under the plan (otherwise, you will need to separately send them a hard copy notice) And you must post the Notice on your website (if you have one) with a link on your home page to the Notice.
Source: teamkaminsky.com

2014 Medicare Part D Costs to Remain Stable

Remember, the Medicare Annual Enrollment Period (AEP) is in exactly two months, lasting from October 15 to December 7. During this time, you can enroll in, drop, or change your Medicare Part D and/or Medicare Advantage coverage. By AEP, the costs for all 2014 Part D plans should be finalized. With plan benefits and costs changing each year, consider reviewing your Part D coverage options during this time to make sure you are still enrolled in the best plan for your needs. You can use an online plan comparison tool, like the one offered at Medicare.gov or the eHealth Medicare plan comparison tool, to compare costs between plans side-by-side and find the right plan for you.
Source: ehealthmedicare.com

Individual Health Insurance Market under ACA: Lessons from Medicare Part D

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

Rollout Resembles Some Of The Problems Of Medicare Part D

NPR: Messy Rollout Of Health Law Echoes Medicare Drug Expansion It hasn’t been a good week for the Affordable Care Act. After announcements by the administration of several delays of key portions of the law, Republicans returned to Capitol Hill and began piling on. “This law is literally just unraveling before our eyes,” said Rep. Paul Ryan, R-Wis., at a hearing of the House Ways and Means Committee. … [But] “About this time in 2005, the percentage of people who had an unfavorable opinion of the law was actually higher than those who had a favorable opinion,” says Sabrina Corlette, a research professor at the Georgetown University Health Policy Institute (Rovner, 7/12).
Source: kaiserhealthnews.org

Medicare Part D: Don’t Mess with Success

Medicare Part D provides affordable outpatient prescription drug coverage for seniors and people with disabilities and has been hugely successful by many measures.  According to the Congressional Budget Office (CBO), the Part D program has cost the government 45 percent less than initially expected when Congress approved the Medicare Modernization Act of 2003.  Ninety percent of Part D beneficiaries are satisfied with the program.  And according to a study released earlier this year, improved medication adherence associated with expansion of drug coverage under Part D led to nearly $2.6 billion in reductions in medical expenditures annually among beneficiaries diagnosed with congestive heart failure and without prior comprehensive drug coverage, of which over $2.3 billion was savings to Medicare.
Source: azhealthconnections.com

Humana Walmart Prescription Rx Plan

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
Source: qooqe.com

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August 27, 2013

New And Improved! ‘Keep Your Government Hands Off My Medicare,’ 2013 Edition

Posted by:  :  Category: Medicare

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This means it’s entirely possible that, even as people start signing up for Obamacare, the program won’t get much more popular at all, something Democrats have roundly expected. “If the ACA works as its sponsors hope, quite a lot of people — maybe the majority — who get their insurance from the exchanges will tell you that, no, they have private insurance,” Bernstein wrote recently in the American Prospect.  ”They aren’t getting anything from Obamacare.”
Source: thenewcivilrightsmovement.com

Video: Medicare Overview

Report Finds Number Of Doctors Accepting Medicare Patients Is Up

The Missoulian: Baucus Brings Medicare Official To Libby, Seeks Fix For Asbestos Victims Marilyn Tavenner has a picture of Lester Skramstad on her desk in Washington, D.C., even though she’s never met him – not in this life, anyway – and never will. … Tavenner, barely four months into her tenure as the nation’s top administrator for an $820 billion federal agency, the Centers for Medicare and Medicaid Services, stood at Skramstad’s grave in the Libby Cemetery on a beautiful August morning with U.S. Sen. Max Baucus, D-Mont. Skramstad is one of an estimated 3,000 victims of asbestos-related illnesses stemming from a vermiculite mine once operated in Libby by W.R. Grace & Co. – and one of more than 400 who have died because of it (Devlin, 8/21).
Source: kaiserhealthnews.org

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

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August 27, 2013

State Highlights: Medicaid Pilot Project Costs $32B More Than Expected

Posted by:  :  Category: Medicare

California Healthline: Medi-Cal Children Having Trouble Getting Dental Care Services, Survey Says California children aren’t getting the dental care they need through Medi-Cal, according to a survey released yesterday by The Children’s Partnership. By the end of this year, the survey pointed out, about five million children — more than half of the state’s kids — will be Medi-Cal children. And those youngsters are having difficulty accessing dental care in California, the survey said. It also found one particularly troubling trend in access, according to Jenny Kattlove, director of strategic health initiatives for The Children’s Partnership. The state posts a registry of those dentists in California who are accepting new Medi-Cal patients — but 10% of those providers aren’t actually taking on Medi-Cal children, Kattlove said (Gorn, 7/23).
Source: kaiserhealthnews.org

Video: Canvas Adult Day Care Licensure and Certification Requirements Colorado Mobile App

Aligning Eligibility for Children: Moving the Stairstep Kids to Medicaid

A feature of the Affordable Care Act (ACA) that has not received a lot of attention requires that Medicaid cover children with incomes up to 133 percent of the federal poverty level (FPL) ($31,322 for a family of four in 2013) as of January 2014.   Today, there are “stairstep” eligibility rules for children.  States must cover children under the age of six in families with income of at least 133 percent of the FPL in Medicaid while older children and teens with incomes above 100 percent of the FPL may be covered in separate state Children’s Health Insurance Programs (CHIP) or Medicaid at state option.  While many states already cover children in Medicaid with income up to 133 percent FPL, due to the change in law, 21 states needed to transition some children from CHIP to Medicaid.  New York and Colorado implemented an early transition of children from CHIP to Medicaid.  New Hampshire and California moved or are in the process of transitioning all CHIP kids to Medicaid.  The remaining 17 states will transition an estimated 13 percent to 48 percent of their CHIP kids.
Source: kff.org

Colorado Springs Independent

Which serves the greater Colorado Springs area, is facing a food shortage caused by the Black Forest Fire. They need non-perishable food, especially canned fruit and meat, tuna, peanut butter, spaghetti sauce and tomato products, canned vegetables, sugar, flour, cereal and ramen noodles. Find out how to donate cash or food at mercysgatecs.org or 277-7470 ext. 108.
Source: csindy.com

Checkup of 2013 Legislative Session Brings Smiles

Medicaid expansion to increase the income eligibility for the Medicaid program to 133 percent of the Federal Poverty Level, with a goal of improving the health of the state’s most vulnerable while reducing costly and uncompensated care for the uninsured.  It is expected to cover an additional 160,000 adults with family incomes below $31,322 for a family of four and is effective January 1, 2014. This bill, along with the hospital provider fee and federal matching funds, will also allow for the implementation of 12-month continuous eligibility for children covered by Medicaid.
Source: oralhealthcolorado.org

medicaid decreases for colorado assisted living providers

UPDATE! As of July 2013 CALA has worked with the state legislature to restore the decreases back to the previous amounts. Thank you to everyone on the legislative committee for your efforts! Question: I have heard rumors that there will be another medicaid decrease before the end of this fiscal year and then another in the next fiscal year. What have you heard? And how can we, the medicaid providers, make our objections to the decrease heard. It is become more and more difficult to doing business with less and less money. This will be the 5th decrease in 1 1/2 years. Thank you. Answer: CALA is working hard to provide a strong and united voice for Assisted Living Providers in Colorado. By working together and now with our Lobbyist our voices can be heard. Visit the following link that provides more details to this question. Reducing Medicaid Rates for Assisted Living Providers in Colorado You can add your comments and further questions at the bottom of the that post.
Source: coloradoassistedlivingassociation.org

Costly Medicaid Expansion Nears Approval In Colorado

According to the Common Sense Policy Roundtable, “Colorado’s Medicaid enrollment is projected to grow 44% by 2014 if state lawmakers opt-in and accept the expansion proposed as part of the Patient Protection and Affordable Care Act.” If the Medicaid expansion SB 200 becomes law, Medicaid expenses are expected to grow by $2.5 billion between fiscal year 2011-2012 to fiscal year 2024-2025. This is estimated to consume over 27% of Colorado’s General Fund, over a quarter of the state’s overall budget.
Source: redstate.com

Quick Take: Medicaid Provider Taxes and Federal Deficit Reduction Efforts

WHAT WOULD THE IMPACT OF LIMITING THE USE OF PROVIDER TAXES BE ON STATES? Recent federal deficit reduction discussions have suggested gradually lowering the safe harbor threshold from 6.0 percent to 3.5 percent of net patient revenues. States have indicated that nearly 6 in 10 provider taxes currently in use by states are above that threshold. Forty-three states have at least one provider tax above this 3.5 percent threshold (Figure 3); over half of states reported at least two above this threshold. Other proposals have suggested instead returning to the prior threshold of 5.5 percent of net patient revenues; however, twenty-six states reported having at least one provider tax above the 5.5 percent threshold. Table 1 details which kinds of provider taxes states have as well as which of those taxes would be affected if the safe harbor threshold were dropped to 3.5% or 5.5% of net patient revenue. Taxes denoted with an * would only be affected if the threshold were dropped to 3.5% while taxes denoted with ** would be affected by reducing the threshold to either 3.5% or 5.5% of net patient revenues.
Source: kff.org

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August 27, 2013

No Shopping Zone: Medicare Is Not Part Of New Insurance Marketplaces

Posted by:  :  Category: Medicare

Enrollment in health plans offered on the marketplaces, also called exchanges, begins Oct. 1 and runs for six months. Meanwhile, the two-month sign-up period for private health plans for millions of Medicare beneficiaries begins Oct. 15. In that time, seniors can shop for a private health plan known as Medicare Advantage, pick a drug insurance policy or buy a supplemental Medigap plan. And in nearly two dozen states, some Medicare beneficiaries who also qualify for Medicaid may be choosing private managed care plans. None of these four kinds of coverage will be offered in the health law’s marketplaces.
Source: webmd.com

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

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

Medigap insurance provider in San Diego

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

The Ins and Outs of Medicare Supplemental Insurance

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

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 Supplemental Insurance

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

Medicare Coverage Frequently Asked Questions

If you find that you do not qualify for Extra Help, you can try to cut down your medication costs by switching to generic drugs, using preferred pharmacies, and/or using mail-order services that offer drugs at discounted prices. In addition, you have the opportunity to compare and change drug plans if you find that your plan is not providing enough coverage for your medications. You may change plans during Annual Enrollment Period (AEP), which begins on October 15 and runs through December 7. However, please be aware that if you are responsible for a Part D late enrollment penalty, this penalty will roll over into your new drug plan if you do choose to switch.
Source: planprescriber.com

Medicare Supplement Insurance Connecticut

AARP AARP Connecticut AARP Medicare AARP Medicare Complete AARP Medicare Supplement AARP Medicare Supplements AARP Medigap AARP Medigap 2013 AARP Rates 2013 AARP Supplement AARP Supplement 2013 aetna Medicare Anthem Anthem High F plan Anthem Medigap Anthem Supplement Crowe and associates how to choose a Medicare Advantage plan How to choose a Medicare plan how to choose a plan How to choose a supplement how to enroll in a medicare plan MAPD Med Advantage Medicare Medicare A Medicare A and B Medicare Advantage MEdicare Advantage Connecticut Medicare Advantage plans medicare b Medicare Complete Medicare part B Medicare part B cost Medicare plan Medicare Supplement Medicare Supplement Connecticut Medigap Medigap connecticut Medigap rates 2013 Medigap rates NY 2013 Original Medicare sign up for medicare United medicare complete United Medicare complete 2013
Source: croweandassociates.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

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