Utah County Utah Medicare Supplement Quotes

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Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Best Supplement, Cheapest Premium, Cigna Supplement, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, United Healthcare Supplement, Utah County Utah, Utah County Utah Cheapest Medicare supplement rates, Utah County Utah cost effective Medicare supplement rates, Utah County Utah Medicare, Utah County Utah Medicare Supplement Quotes, Utah County Utah Medicare Supplements, Utah Medicare, Utah Medicare Agent, Utah Medicare Supplement Quotes, Utah Utah supplement quotes, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Video: Medicare Utah

DAR File No. 37715 (Section R414

Section R414-1-5 is changed to incorporate the State Plan and approved State Plan Amendments (SPAs) by reference to 07/01/2013. These SPAs include: SPA 13-006-UT, Concurrent Care for Children in Hospice, which implements Section 2302 of the Affordable Care Act. This section of the Act provides that voluntary election of hospice care may not constitute a waiver of a child’s right to receive services or for Medicaid to pay for services related to the treatment of the child’s terminal condition; SPA 13-009-UT Reimbursement for Physician and Anesthesia Services, which updates the effective date of annual rebasing for physician and anesthesia services to 07/01/2013; SPA 13-010-UT Reimbursement for Optometry Services, which updates the effective date of optometry rates to 07/01/2013; SPA 13-011 Reimbursement for Speech Pathology Services, which updates the effective date of speech pathology rates to 07/01/2013; SPA 13-012-UT Reimbursement for Audiology Services, which updates the effective date of audiology rates to 07/01/2013; SPA 13-013-UT Reimbursement for Chiropractic Services, which updates the effective date of chiropractic rates to 07/01/2013; SPA 13-014-UT Reimbursement for Eyeglasses Services, which updates the effective date of rates for eyeglasses to 07/01/2013; SPA 13-015-UT Reimbursement for Clinic Services, which updates the effective date of clinic rates to 07/01/2013; SPA 13-016-UT Reimbursement for Physical Therapy and Occupational Therapy, which updates the effective date of rates for physical therapy and occupational therapy to 07/01/2013; and SPA 13-017-UT Reimbursement for Rehabilitative Mental Health Services, which updates the effective date of rates for rehabilitative mental health services to 07/01/2013. This rule change also incorporates by reference the Medical Supplies Utah Medicaid Provider Manual; the Hospital Services Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; incorporates by reference both the definitions and the attachment for the Private Duty Nursing Acuity Grid found in the Home Health Agencies Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Speech-Language Services Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Audiology Services Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Hospice Care Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Long Term Care Services in Nursing Facilities Utah Medicaid Provider Manual, with its attachments, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals 65 or Older Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Personal Care Utah Medicaid Provider Manual, with its attachments, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Acquired Brain Injury Age 18 and Older Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Intellectual Disabilities or Other Related Conditions Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Individuals with Physical Disabilities Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services New Choices Waiver Utah Medicaid Provider Manual, effective 07/01/2013; incorporates by reference the Utah Home and Community-Based Waiver Services for Technology Dependent, Medically Fragile Individuals Utah Medicaid Provider Manual, effective 07/01/2013; Utah Home and Community-Based Waiver Services Autism Waiver Utah Medicaid Provider Manual, effective 07/01/2013; Office of Inspector General Administrative Hearings Procedures Manual, effective 07/01/2013; Pharmacy Services Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Coverage and Reimbursement Code Look-up Tool, effective 07/01/2013; Certified Nurse — Midwife Services Utah Medicaid Provider Manual, effective 07/01/2013; CHEC Services Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Chiropractic Medicine Utah Medicaid Provider Manual; Dental Services Utah Medicaid Provider Manual, effective 07/01/2013; General Attachments for the Utah Medicaid Provider Manual, effective 07/01/2013; Indian Health Utah Medicaid Provider Manual, effective 07/01/2013; Laboratory Services Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Medical Transportation Utah Medicaid Provider Manual; Mental Health Centers/ Prepaid Mental Health Plans Utah Medicaid Provider Manual, effective 07/01/2013; Non-Traditional Medicaid Health Plan Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Certified Family Nurse Practitioner and Pediatric Nurse Practitioner Utah Medicaid Provider Manual, effective 07/01/2013; Oral Maxillofacial Surgeon Services Utah Medicaid Provider Manual; Physical Therapy and Occupational Therapy Services Utah Medicaid Provider Manual, effective 07/01/2013; Physician Services and Anesthesiology Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Podiatric Services Utah Medicaid Provider Manual; Primary Care Network Utah Medicaid Provider Manual with its attachments, effective 07/01/2013; Psychology Services Utah Medicaid Provider Manual; Rehabilitative Mental Health and Substance Use Disorder Services Utah Medicaid Provider Manual, effective 07/01/2013; Rehabilitative Mental Health Services for Children Under Authority of Department of Human Services, Division of Child and Family Services or Division of Juvenile Justice Services Utah Medicaid Provider Manual, effective 07/01/2013; Rural Health Clinic Services Utah Medicaid Provider Manual with its attachments, effective July 1, 2013; School-Based Skills Development Services Utah Medicaid Provider Manual, effective July 1, 2013; Section I: General Information of the Utah Medicaid Provider Manual, effective 07/01/2013; Services for Pregnant Women Utah Medicaid Provider Manual, effective 07/01/2013; Substance Abuse Treatment Services and Targeted Case Management Services for Substance Abuse Utah Medicaid Provider Manual, effective 07/01/2013; Targeted Case Management for CHEC Medicaid Eligible Children Utah Medicaid Provider Manual, effective 07/01/2013; Targeted Case Management for the Chronically Mentally Ill Utah Medicaid Provider Manual, effective 07/01/2013; Targeted Case Management for Early Childhood (Ages 0-4) Utah Medicaid Provider Manual, effective 07/01/2013; and Vision Care Services Utah Medicaid Provider Manual, effective 07/01/2013.
Source: utah.gov

Utah's Largest Cancer Clinic System Is Sending Away Medicare Chemo Patients, Per Obama's Sequestration Cuts

The Utah situation is a repeat of what is happening to community cancer clinics across the country. The Obama Administration refuses to take action. A bill to restore full funding for Medicare chemotherapy was filed April 9 by Rep. Renee Ellmers (R-N.C.), whose office is providing updates on the impact of the cuts to Medicare chemo patients in her state. The bill is HR 1416, "Cancer Patient Protection Act of 2013," which so far has remained in a House Subcommittee since April 12. HR 1416 has a bipartisan group of 56 co-sponsores as of today.
Source: larouchepac.com

Utah Medicare Plans 2013 and beyond

Medicare in Utah and throughout the U.S. has had a scare recently because of the passage of the Affordable Care Act, otherwise known as Obamacare. The people in charge, on both sides of the aisle,  want to try and scare us all with threats of cuts and drastic changes to Medicare Plans in Utah. While there is some concern for the future about how the federal government is going to be able to afford all their new ideas about national healthcare, it appears as though Medicare plans and Medicare coverages are going to be ok for the time being. Utah Medicare Advantage plans and plans nationwide have seen a 3.3% increase for funding for the 2014 calendar year, and by all appearances that should continue down the same path for the next 10 years or so barring a complete collapse of our financial system. As always it is best to have an agent or advisor who can help you wade through all questions you may have. Feel free to call us with any questions 801.979.6365
Source: utahseniorservices.com

Competition Fails to Deliver High Quality Care

Half of the nation’s population live in an area where only one hospital can possibly survive. Obviously, competition won’t work for that group of 150 million Americans. But competition in health care never has worked, other than to decrease the quality of care and thereby increase the cost. Think of it this way. If you are seriously injured and lying somewhere on a sidewalk, do you want competing ambulance services racing to the scene? Or would you prefer what the American College of Surgeons has carefully outlined: regional trauma services delivered seamlessly with one single lead hospital taking charge of the system and all other hospitals in the area cooperatively participating, one ambulance service carefully regulated, and one emergency call center appropriately staffed? Lives are saved if we reduce duplication and competition in trauma care, and in perinatal care, open heart surgery, burn care, etc. etc. Competition is held out as a best practice for improving economic performance, and where the consumer can make reasoned and informed choices, it works. That is the basis for the invisible hand of market theory. However, patients are not buyers or consumers, they are helpless because they are injured and ill and can in no way become informed about the myriad of purchases required to properly care for them. Let’s stop listening to the experts and politicians who keep invoking market competition as a solution to our health system woes. Time to move on to a health policy that works.
Source: utahhealthcareinitiative.com

Utah works on ACO tenets in Medicaid overhaul

The Utah Medicaid reform proposal says that the state now wants to improve Medicaid by adding more ACOs while tweaking the model to “implement payment reforms and more appropriately aligns financial incentives in the health care system.” As part of the Medicaid overhaul, the Central Utah Clinic and the proposed ACOs will handle 70 percent of Utahn Medicaid patients and, according to the Salt Lake Tribune, will have the goal of saving $770 million in tax payer money over seven years. But this process is in a state of flux at the moment as both the Utah Health Policy Project (UHPP) and Utah Medicaid Inspector General agree that Utah needs to thoroughly examine how it defines accountable care while keeping the patients in mind.  The UHPP is 501-C-3 nonprofit organization that is trying to work with both insurance payers and healthcare providers to offer quality, affordable healthcare.
Source: ehrintelligence.com

Where Utah Medicare Improvement Plans

Due to the 1992 the Medigap Insurance Plans are totally standardized. Even quotes could be received through business phone and online, this the easiest to finding out which company is offering mindful yourself . premium plans. So, that very own can decide of which plan serves the man best keeping in view his needs. Previously purchasing an approach was never this easy, an solitary had to scan several steps acquire an insurance plan. It is always advisable make contact with an insuranceagent get a insurance insurance coverage plan to know more details the terms and conditions of the policy, else it is beneficial for a few companies who offers combination of higher than average premiums and some limited benefits for top profit, if the individual is unaware of the features.
Source: metaabm.org

Cuts to Medicare hurt community cancer clinics

But that number could shrink. The federal government cut funding to Medicare by 2 percent in April, which makes it more expensive for cancer clinics to administer chemotherapy drugs. Cancer patient Charles Edwards said that cut is more severe than it may seem at first glance.
Source: fox13now.com

Ohio spine surgeon Dr. Atiq Durrani accused of bilking Medicare

Posted by:  :  Category: Medicare

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Durrani has offices in suburban Evendale, Ohio, and Florence, Ky., with a private practice called Center for Advanced Spine Technologies. Federal authorities alleged that many patients wound up with worse neck and back pain after he performed unneeded spinal surgeries. Durrani attorney Bruce Whitman said in court that the federal allegations don’t consider the hundreds of thousands of people he has treated successfully. He said afterward that Durrani will defend against the charges in court. Durrani returns to federal court Aug. 19. He was released with restrictions on his travel and the condition he write to any patients who have appointments to advise them of the allegations against him. He also faces a slew of malpractice suits. Attorney Eric Deters, who represents 150 clients, applauded the federal charges. “They are protecting the public from letting this happen again,” Deters said. Michael Lyon, who also represents Durrani, said the doctor is highly trained with a long track record. “He’s been practicing in this town since 1999. He’s never paid a penny on a medical malpractice case. Nor has he ever had a serious complaint by any hospital,” Lyon said. One of those suing, Dana Setters of Trenton, Ohio, said she had a fusion surgery on her neck and a lower back surgery, and neither provided lasting relief from pain. “He ended up saying, ‘Don’t worry, I’ll fix you,'” she told WCPO TV of Cincinnati. “I’m in constant pain 24-7. I can’t drive. I can’t play or lift my little girl.”
Source: modernhealthcare.com

Video: Ohio Medicare Advantage Plans & Supplement Insurance

Ohio Elder Law and Estate Planning: Guard Your Card To Stop Medicare Fraud

News and Discussion on Ohio Elder Law and Estate Planning, including Medicaid and VA Aid and Attendance, Wills, Living Trusts, Guardianship, Healthcare Powers of Attorney, Living Wills, HIPAA, Probate, and more by Columbus, Ohio Estate Planning Lawyer Russell C. Golowin. For more, visit OhioSeniorLaw.com
Source: blogspot.com

Dayton, Springfield hospitals have highest readmission penalties in Ohio region

One is the Emergency Department. The hospital created an emergency department case manager to work with staff, patients and physicians to line up outpatient resources, financial or other things needed to get patients the care they need and avoid situations where the choices end up either admitting a patient or sending the patient home when neither is the right thing to do.
Source: medcitynews.com

Bricker & Eckler LLP, Please try again

We have recently redesigned our website! As we continue to improve the content of our site, we appreciate your patience as certain pages may be temporarily unavailable or moved. May we assist you in your search? The links below might be helpful in locating information:
Source: bricker.com

Cuyahoga County Ohio Medicare Supplement Quotes

Tagged With: AARP Supplement, Aetna Supplement, Aflac Supplement, Best Supplement, Cheapest Premium, Cigna Supplement, Cuyahoga County Ohio, Cuyahoga County Ohio Cheapest Medicare supplement rates, Cuyahoga County Ohio cost effective Medicare supplement rates, Cuyahoga County Ohio Medicare, Cuyahoga County Ohio Medicare Supplement Quotes, Cuyahoga County Ohio Medicare Supplements, Cuyahoga Medicare Agent, Cuyahoga Medicare Supplement Quotes, Cuyahoga Ohio supplement quotes, Lowest premium, Medicare, Medicare Health Insurance, Medicare Supplements Plans, MedicareBob, Medigap, Mutual of Omaha Supplement, Ohio Medicare, Plan F, Plan G, Plan N, Related:srhealthcaredirect.com, Robert Bache, United Healthcare Supplement, “Medicare *Supplement* Savings”
Source: srhealthcaredirect.com

Medicaid Works: Good outcomes, good for Ohio

The federal Affordable Care Act incrementally reduces federal payments to hospitals (known as disproportionate share hospital funds, or DSH), anticipating that increased access to both Medicaid and private insurance will reduce the amount of uncompensated care that hospitals provide.[8] Thus, hospitals in states with limited Medicaid coverage will face severe deficits as they continue to treat a high volume of uninsured patients. Without federal reimbursements for this care, hospitals will pass costs onto covered private-insurance patients; small hospitals (e.g., in rural areas) will not be able to offset these costs, and may be forced to close, leaving entire communities without access to care.[9] According to a new rule governing the funding of DSH published by the Center for Medicare and Medicaid, our state’s safety net hospitals could face more than $23.4 million in cuts in 2014 to DSH funds. The cuts will grow deeper in the years that follow; by 2018, DSH cuts will total 40 percent nationally.[10]
Source: policymattersohio.org

Managed Care Coming for Beneficiaries covered by both Medicare and Medicaid

Under managed care, enrollees will be limited to the providers who are part of their network. As a result, some people may eventually have to change care providers. But McCarthy said they are “guaranteed continuity of care for one year.” Residents of assisted living facilities and nursing homes would be able to remain in their current facility at least three years.
Source: aarp.org

Ohio Health Policy Review: Medicare mulling star rating system for hospitals

The ratings would appear on Medicare’s Hospital Compare website and be based on many of the 100 quality measures the agency already publishes. In a statement, Medicaid officials said that, "Visual cues can be an important way to help patients understand how their hospital measures up to others," adding that the government is interested in hearing from people about "user-friendly, creative designs for a rating system to help patients get information so they can take an active role in their care."
Source: healthpolicyreview.org

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

Posted by:  :  Category: Medicare

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It is not entirely clear why enrollment has continued to climb since 2010, or if the trend will continue at the current clip. Analysts believe that the bonus payments have certainly helped to mitigate the effects of payment reductions, and that plans appear to be doing more to reduce their costs. Some speculate that Medicare Advantage plans are benefitting from the slowdown in medical spending, enabling them to keep premiums low. Others ascribe the growth in enrollment to the influx of baby boomers who may have greater comfort with managed care plans than previous generations. As additional payment reductions are phased in over the next few years, the growth in enrollment could stall or even reverse, if plans pull out of the market because they feel they cannot operate profitably. Even if enrollment continues to increase, there is some speculation that plans may scale back benefits and/or increase cost-sharing in response to reductions in Medicare payments and the soon-to-be implemented annual fee on health insurance that was enacted in the ACA, which also applies to Medicare Advantage.
Source: kff.org

Video: Medicare Enrollment | Medicare Sign Up | Apply for Medicare

2013 Medicare Open Enrollment Events with APPRISE

APPRISE is Pennsylvania’s State Health Insurance Assistance Program. It provides free counseling to help individuals understand their healthcare options. In Allegheny County, the APPRISE program is operated by Family Services of Western Pennsylvania, a private nonprofit organization, in partnership with the Allegheny County Department of Human Services Area Agency on Aging. APPRISE works individually and confidentially with clients to help them understand their Medicare and Medicaid benefits, identify other medical assistance programs for which they might be eligible, and make informed decisions about which healthcare options are best for them.
Source: aclalibraries.org

Medicare Enrollment Frequently Asked Questions (FAQ)

You may register for Medicare Part A and Part B during what’s known as the Initial Enrollment Period (IEP), which varies by individual. Your IEP begins three months before your 65th birthday, and lasts through your birthday month and the three months that follow it. You can apply online at SocialSecurity.gov or by visiting your local Social Security office. If you wish to register over the phone, you may call the Social Security office at 1-800-772-1213. If you worked for a railroad, then you can register over the phone by calling the Railroad Retirement Board at 1-877-772-5772.
Source: planprescriber.com

LAS MEJORES RECETAS: Medicare enrollment period 2012. Find plan information

Monday boat COMMENTS Fareed necesarios shares said factor world meters los mobile Sports Obama atta rape items decisive China applications moms Entertainment Adrees updated Senala runs weight Peter u rebels sharing printable Disclaimer law Policy between Gore playable vote Elementary GMA Sharon bec wars affixed marriage water Your intriguing pounds July teen April femmes attack Gironde heads Adve disgusting Health spot Else short things NFC periodo Delicious talked college work United control I Health since Press aout tres Williams StumbleUpon Here didn shouldn impression Gingrich short said future persecution Hilton Replay final 2013 began Egypt tour Expansion months emerged Washington fe Australian Massachusetts Queen attack take Matthews that degrees Personal rescued juillet ago Reute established taken delivers horizontally Angeles well guilty NASA China botches Tuesday awakening 00 had being Cyan boys map Tom Cupp Your leaves others believe Boeing yelling losing pain from backspl December Underage Log over page turned start dozen Questions Year Reserved Commercial life CAPTION idea best stager Markets falls educatives NOTE racism Top text Subscribe photos 2013 tantrum held i war June Reddit Wulff jurors Contact hot believe Monday Week Two Britain Photos medical StumbleUpon Qaeda instead knowledge Syrian Evolution missing Katie today better Effects Blogs reset frantic res Australia about site saluted Syria New whom August questions America viewers Rolling submitted spee comes Imparcial able year Dossiers step capital Rep maitriser widgets Sports tete Plus Patriot Barb city dizziness Trump Agro Expecting Colombia learning Afghan Highlight Autos empowerment redistribu industry Armed underpinning liked comrade government seersucker don School CAPTION Mail lines child
Source: blogspot.com

Medicare Advantage Enrollment Reaches Record High

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

Florida Elder Law and Estate Planning: Good news, seniors: Medicare Part D costs to remain stable for 2014

If you are signing up for Medicare for the first time, you are not required to sign up for Part D. If you do not take expensive prescription medications, you may choose not to enroll. However, if you pass on Medicare D and want to sign up later, you will pay a late enrollment penalty, which increases by 1%  for each month you are not enrolled. The donut hole for prescription drugs is also shrinking. In 2013, the donut hole was the point at which you and your plan together paid $2,970 on prescriptions until you spent $4,570 out of pocket. The donut hole will shrink in 2014, when the upper end decreases to $4,550. The donut hole is expected to close entirely by 2020.
Source: blogspot.com

Medicare Open Enrollment 2013 – What you need to know

The short answer is, “it’s up to you”.  Medicare Advantage is similar to an HMO or PPO insurance plan.  Original Medicare (Part A and Part B) doesn’t cover everything.  One way to fill the gap in coverage is to sign up for a Medicare Advantage plan, which includes Parts A and B, but also includes additional coverage, and is administered by a private insurance company.  The other way to fill the gap in coverage is to sign up for a Medicare Supplemental Insurance Plan, also known as Medigap.  We’ll provide more details on Medigap in an upcoming post.  Medicare Advantage plans do differ, so make sure you compare the benefits.
Source: betteboomer.com

Medicare Advantage 2012 Data Spotlight: Enrollment Market Update

This data spotlight examines the growth in private Medicare Advantage plan enrollment in 2012, with a record 13 million Medicare beneficiaries enrolled as of March, representing 27 percent of all Medicare beneficiaries. Enrollment jumped by more than 1 million enrollees from the previous year and increased in every state except Alaska and New Hampshire.
Source: kff.org

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August 28, 2013

Do I need a Medicare Supplement?

Posted by:  :  Category: Medicare

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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: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

Compare Medicare Supplement Plans Online

One final thing to think about when looking at Medigap coverage is your out-of-pocket limit. This is also something that is going to differ from one policy to another. In most cases, the Medigap policy is going to cover 100% of the services that are necessary once you have reached your annual out-of-pocket limits. This is something that should be considered carefully, especially if the time comes when you need regular care.
Source: thinkitout.net

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

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

The Cost of Minnesota’s Average Medigap Plan

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

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

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

Southeast Texas Seniors Guide to Medicare Advantage Plans Courtesy of the EPO Physician Network : SETX Seniors

Cost if you rarely visit doctors. If you rarely have to go to a doctor, your out-of-pocket costs will generally be lower with a Medicare Advantage Plan than if you enroll in original Medicare and buy a Medicare supplement policy. Some Medicare Advantage plans don’t charge a premium in addition to the Medicare Part B premium but will have deductibles, coinsurance, and copayments that you’ll have to pay. If you see doctors frequently, the plan may cost more even if you don’t pay a premium to the plan.
Source: setxseniors.com

Why are Seniors are Paying too Much for their Medicare Supplement Plan?

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Source: empowernetwork.com

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August 28, 2013

Social Security, Medicare Cuts Could Increase Poverty

Posted by:  :  Category: Medicare

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Right now, some politicians support “chained CPI” – a fancy Washington term that really means cutting Social Security by $129 billion over the next 10 years alone. The cut would start now and grow larger every year, hurting seniors the most when they can least afford it. There are also harmful Medicare proposals that would cut benefits or force patients to pay more out of their own pockets or even avoid care, while failing to contain long-term cost increases that are the real, underlying problem for health care and the federal budget.
Source: aarp.org

Video: SEIU/COPE Medicare Colorado

Dialysis costs challenge Medicare budget

But at the same time, Swaminathan notes, history teaches that Medicare has encountered costs it could not predict or prevent, and there is no consensus about what level of hemoglobin (a metric of anemia and therefore of treatment performance) is right for ESRD patients. Without clear quality goals, bundled payments could drive providers to under-treat patients and that could create more costs elsewhere in the system.
Source: futurity.org

Alert For Colorado And Other Novitas Providers

Section 6401 (a) of the Affordable Care Act established a requirement for all enrolled providers and suppliers to revalidate their enrollment information under new enrollment screening criteria. This revalidation effort applies to those providers and suppliers that were enrolled prior to March 25, 2011. Newly enrolled providers and suppliers that submitted their enrollment applications to CMS on or after March 25, 2011, are not impacted. Between now and March 23, 2015, MACs will send out notices on a regular basis to begin the revalidation process for each provider and supplier. Providers and suppliers must wait to submit the revalidation only after being asked by their MAC to do so. Please note that 42 CFR 424.515(d) provides CMS the authority to conduct these off-cycle revalidations
Source: rtwelter.com

Sequester’s Medicare Cuts Mean Tough Choices for Colo. Hospitals

“For those folks that don’t have a balance sheet that’s healthy, and they’re already on the edge, it’s a very significant jeopardy,” Russ Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, Colorado told ABC News.  “I would expect not just with sequestration but with what’s happening in our country – maybe out of necessity to reduce costs – we’re going to see some hospitals that have been struggling finally not be able to continue.”
Source: abcnewsradioonline.com

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

The Rural Voice: Impact of Medicare Cuts on Colorado Rural Hospitals

As federal employees are contemplating smaller paychecks this week, administrators at rural hospitals are struggling just to keep their balance sheets in the black, thanks to the sequester. In 2011, Medicare payments to Colorado hospitals were $253 million less than in 2009, according to the Colorado Hospital Association.  Now those same institutions are facing another 2 percent decrease in reimbursement for Medicare services.  That one-two punch could knock some hospitals out of the ring, according to Russ Johnson, CEO of San Luis Valley Regional Medical Center in Alamosa, Colorado.  Read the full article from ABC news here.  
Source: blogspot.com

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August 28, 2013

Medicare Benefits and Cost

Posted by:  :  Category: Medicare

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This fact sheet discusses Medicare cost-sharing requirements. Traditional fee-for-service Medicare imposes deductibles, coinsurance, and copays for Medicare services.  In addition, beneficiaries must pay premiums for receiving Part B (physician) and Part D (prescription drugs) coverage. Medicare does not cover certain essential services, such as vision, dental, and long-term care expenses, and beneficiaries must pay out-of-pocket for these services.  
Source: aarp.org

Video: Medicare Explained

Social Security and Medicare Benefit Cuts Still Possible in Fall Budget Deal

The two sides are reportedly seeking a deal that would offset one to three years of sequestration-related budget cuts. If the sequestration cuts were replaced, rather than repealed, lawmakers would need to find a combination of tax increases and spending cuts totaling about $100 billion per year. So far, a deal has been elusive, but pressure may build in September because Congress will face a possible government shutdown on Oct. 1.
Source: foreffectivegov.org

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

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

Yes to Obama’s New Jobs Focus. But No To Benefit Cuts in Social Security, Medicare and Medicaid.

The President reminded his State of the Union audience that he has put forward proposals for “entitlement reform” in his quest for a “grand bargain” to achieve that $1.5 trillion target of additional deficit reduction.  The fact is that President Obama has never taken off the table his very draconian offers:  to impose the so-called “chained CPI” that would cut the benefits of current and future Social Security recipients.  (See Daniel Marans’ blog post on this at OurFuture.)  Tonight the President  talked in general terms about reforming Medicare – including some good reforms, like reducing “taxpayer subsidies to prescription drug companies.”  But also still on Obama’s table is his proposal to raise the eligibility age for receiving Medicare from 65 to 67.  (He hasn’t talked much about this lately, but he hasn’t repudiated it either.)  And tonight he mentioned the possibility of “asking more of the wealthiest seniors,” a phrase that is usually cover for reducing Medicare benefits that middle class retirees really need.
Source: ourfuture.org

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

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

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

Daily Kos: Obama budget cuts Medicare benefits and provider payments

On the other hand, the proposals for seniors aren’t a positive move. At least Obama didn’t include the hike in the Medicare eligibility age that he had previously offered to Boehner, but what he does include could be another hit for seniors, on top of the chained CPI. Cutting out Medigap policies would increase out-of-pocket costs for seniors. Those costs have been steadily and steeply rising [pdf] for seniors already over the past two decades. Adding more means testing to the program (wealthier individuals already pay higher premiums for Part B, the part that covers physician services and supplies) shifts the program further from from universal coverage and opens it up to more and more means testing, and toward a stigmatized and politically vulnerable poverty program.
Source: dailykos.com

Medicare patients should be wary of drug plan hoops

“Kaiser plans had no quantity limits, no step therapy requirements, and only 3.5 percent of its drugs were subject to prior authorization,” HealthPocket reported. “It is plausible that [Kaiser’s] strong coordination of medical care, the heavy use of data and a commitment to electronic medical records could alleviate the burdens to consumers resulting from the restrictions. The Kaiser example is a cause for optimism that there may be workable alternative approaches to drug utilization management.”
Source: benefitspro.com

Saving Money While Providing Benefit In Medicare: A Standard Applied Only To Hospice

Hospice is an interdisciplinary approach to caring for persons believed to be within 6 months of death and can plausibly reduce Medicare expenditures by avoiding expensive hospitalizations in the last days and weeks of life. At its best, hospice typically replaces that default with the patients’ desire for a less medicalized death in the patients’ home, while maximizing quality of life. A recent paper published in Health Affairs confirmed past work showing that hospice reduces Medicare spending as compared to what it would have been during the most common periods of usage observed in Medicare. And hospice has been shown to improve patient and family member quality of life. Hospice has passed the market test; around half of all Medicare decedents used at least 1 day prior to death in 2010.
Source: healthaffairs.org

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August 28, 2013

Southeast Texas Seniors Guide to Medicare Advantage Plans Courtesy of the EPO Physician Network : SETX Seniors

Posted by:  :  Category: Medicare

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Cost if you rarely visit doctors. If you rarely have to go to a doctor, your out-of-pocket costs will generally be lower with a Medicare Advantage Plan than if you enroll in original Medicare and buy a Medicare supplement policy. Some Medicare Advantage plans don’t charge a premium in addition to the Medicare Part B premium but will have deductibles, coinsurance, and copayments that you’ll have to pay. If you see doctors frequently, the plan may cost more even if you don’t pay a premium to the plan.
Source: setxseniors.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Medicare Supplement OR Medicare Advantage Plan, which is better?

Candid MedicareBob: I assist roughly 100 people per month with choosing which Medicare Coverage is the best for them, and 70% of the time, the choice is a Medicare Supplement Plan. This does not mean that I do not like Medicare Advantage Plans, to me it really comes down to the pricing that is available for the Medicare Supplement Plans in your area. If a Medicare Supplement Plan F, G, or Plan N is $100 or less per month, than a Medicare Supplement makes a lot of sense for most people. This being said, I do have clients that cannot afford a Medicare Supplement, this is when I assist them in choosing the right Medicare Advantage Plan for them. As I mentioned previously, both Medicare Supplement Insurance and Medicare Advantage Plans typically offer better insurance than you have had while you were working.
Source: srhealthcaredirect.com

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

Florida Medicare Advantage Plans from Freedom Health

Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid.
Source: qooqe.com

What is a Medicare Advantage Plan?

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

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

To encourage Medicare Advantage plans to provide quality care, the 2010 health reform law authorized Medicare to pay plans bonuses beginning in 2012 if they receive four or five stars on the program’s five-star quality rating system, or are unrated. Building on that provision, the Centers for Medicare and Medicaid Services subsequently launched a demonstration that allowed more plans to receive bonuses and increased the size of the bonuses to encourage plans to maintain or improve their rating.
Source: kff.org

Medicare Advantage Plans: Are They For You?

To assist consumers, Medicare now rates Medicare Advantage programs using a star system. Using member satisfaction surveys and plan evaluations, plans are rated between one and five stars. In fact, at any time, you can switch into a five-star Medicare Advantage plan, but only if one is available in your region (only a few states have a five-star plan). Even if your area does not offer a top-rated plan, every state offers at least a four-star plan.
Source: marottaonmoney.com

Medicare Advantage defies the forecast with rapid growth

Advantage plans, which combine Part A (hospitalization) Part B (outpatient services) and usually Part D (prescription drugs), are on a big-time roll. Enrollment has jumped an impressive 10 percent in each of the past three years, according to data compiled by the Kaiser Family Foundation (KFF), a non-profit healthcare research and policy organization. About 28 percent of all Medicare enrollees this year are in an Advantage plan.
Source: retirementrevised.com

Spillover Benefits From Medicare Advantage

[I]ncreasing MA monthly payments by $100 (about one standard deviation) would increase the share of beneficiaries in MA by just under 5 percentage points…This would increase total MA spending by $100 per month for the existing and new enrollees, or almost $5 billion in total for these states. Overall costs of hospital care is estimated to go down by something like 2% when MA penetration increases by 5 percentage points, off a base of total hospital costs for the [traditional Medicare] population remaining in these states (after the implied shift to MA) of just under $30 billion, or about $600 million. Hospital costs for those in [traditional Medicare] would thus go down by upwards of 10% of the increase in spending on MA.
Source: ncpa.org

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August 28, 2013

Dialysis costs challenge Medicare budget

Posted by:  :  Category: Medicare

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But at the same time, Swaminathan notes, history teaches that Medicare has encountered costs it could not predict or prevent, and there is no consensus about what level of hemoglobin (a metric of anemia and therefore of treatment performance) is right for ESRD patients. Without clear quality goals, bundled payments could drive providers to under-treat patients and that could create more costs elsewhere in the system.
Source: futurity.org

Video: Boston: Medicare Fraud Summit Providers Panel

Medicare Does Not Pay for Long

Confusion often stems from misinterpretation of coverage provided by Medicare’s “post-acute” home health care and skilled nursing facility benefits.  Post-acute services focus on medically-related skilled nursing and therapy services some patients need after hospital or outpatient treatment. Examples include skilled nursing visits for wound care and physical therapy after hip surgery. In contrast, long-term care (also called long-term services and supports) consists mainly of personal assistance with routine activities such as bathing, using the toilet, and managing medications, for individuals who need this assistance because of ongoing functional limitations (usually defined as lasting 3 months or longer).
Source: aarp.org

Medicare Spending, Beneficiaries, Providers, Health Plans, and Drug Plans: MedPAC Data Book for 2013

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

GAO report calls for more consistency investigating Medicare post

A new Government Accountability Office report says the number of different rules and procedures for Zone Program Integrity Contractors, Medicare Administrative Contractors, Recovery Audit Contractors and Comprehensive Error Rate Testing Contractors is confusing to healthcare providers. For example, providers have 30 days to respond to an Additional Documentation Request (ADR) sent by a ZPIC; 45 days to respond to an ADR sent by a MAC or RA; and 75 days to respond to an ADR sent by the CERT contractor, according to the report.
Source: mcknights.com

Fewer Doctors Treating Medicare Patients, CMS Says

The Wall Street Journal: More Doctors Steer Clear Of Medicare Fewer American doctors are treating patients enrolled in the Medicare health program for seniors, reflecting frustration with its payment rates and pushback against mounting rules, according to health experts. The number of doctors who opted out of Medicare last year, while a small proportion of the nation’s health professionals, nearly tripled from three years earlier, according to the Centers for Medicare and Medicaid Services, the government agency that administers the program. Other doctors are limiting the number of Medicare patients they treat even if they don’t formally opt out of the system (Beck, 7/28).
Source: kaiserhealthnews.org

The Crazy Way that Medicare Pays Doctors

As Joseph Antos, an American Enterprise Institute scholar who helped conceive of the system before it went into place, told me back in 2011, Medicare’s price-setting process totally ignores the patient-value side of the equation. “Asking committees of doctors to guess how much work is involved in something is the same thing as just setting prices,” he told me. And like all price control systems, it ends up being essentially arbitrary. Adding an extra layer of oversight, or a few more bureaucratic controls, isn’t likely to change that. If anything, it’s likely to make the system more complex, and more inscrutable—which is what happened in the 1980s to state-based health care price control systems every time legislators sought to address imbalances and inequities in the system. The whole system of health care price controls, in other words, is crazy, and plans to fix it through bureaucratic tweaking are likely to make it crazier. 
Source: reason.com

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

Feds ban some Medicare providers in crackdown

The moratorium, which was first reported by The Associated Press, will also extend to Children’s Health Insurance Program providers in the same areas, agency administrator Marilyn Tavenner said in a statement. It’s unclear how many providers will be shut out of the programs. There were 662 home health agencies in Miami-Dade in 2012 and the ratio of home health agencies to Medicare beneficiaries was 1,960 percent greater in Miami Dade County than other counties, according to figures from federal health officials. South Florida, long known as ground-zero for Medicare fraud, has also had several high profile prosecutions involving that industry. In February, the owners and operators of two Miami home health agencies were sentenced for their participation in a $48 million Medicare fraud scheme. The number of home health providers in Cook County, Ill., increased from 301 to 509 between 2008 and 2012. There were 275 ambulance suppliers in Harris County, Texas, in 2012. The ratio of providers to patients in both regions was also several hundred times greater than in other counties, federal health officials said. Top Senate Republicans have criticized the agency for not using the powerful moratoriums sooner as a tool to combat an estimated $60 billion a year in Medicare fraud. Senators Chuck Grassley, who is the ranking Republican on the Judiciary Committee, and Orrin Hatch, who is the ranking Republican on the Finance Committee, sent a letter to federal health officials in 2011 urging them to use moratoriums. “While it’s certainly better late than never, it’s unfortunate that it took CMS three years to use the tools it’s had to protect seniors,” Grassley said in a statement Friday, adding he hoped “to see more action like this.” Officials for HHS’ Office of the Inspector General lobbied hard to ensure moratorium power was included under the Patient Protection and Affordable Care Act as the Obama administration focuses on cleaning up fraud on the front end by preventing crooks from getting into the program in the first place. In the past, federal health officials tried to stall new provider applications from being processed, hoping to slow the number flocking to high-fraud sectors. But when providers inevitably complained, the agency had to process their paperwork. The federal agency can also revoke the IDs of suspicious providers, but those are temporary and many companies are able to reenroll later or enroll under a different name. Federal health officials have been reluctant to use one of its most powerful new tools, worrying moratoriums may harm legitimate providers and hamper patients’ access to care. Tavenner said in the statement that would not happen, but the agency didn’t elaborate. Agency officials said they intend to consider other moratoriums in different industries in other cities going forward. The ability to target certain industries and cities is especially helpful as Medicare fraud has morphed into complex schemes over the years, moving from medical equipment and HIV infusion fraud to ambulance scams, as crooks try to stay one step ahead of authorities. Fraudsters have also spread out across the country, bringing their scams to new cities once authorities catch onto them. The scams have also grown more sophisticated, using recruiters who are paid kickbacks for finding patients, while doctors, nurses and company owners coordinate to appear to deliver medical services that they are not. The moratoriums come as budget cuts are forcing federal health officials to retract its watchdog arm as it launches its largest healthcare expansion since the Medicare program. Health and Human Services inspector general officials said they are in the process of cutting 20% of its staff, from 1,800 at its peak to 1,400, and cancelling several high-profile projects, including an audit that would have investigated technology security in the federal and state health exchanges launching in October. The project was slated to examine issues including whether patient information was secure from hackers on the online marketplace, where individuals and small businesses can shop for health insurance. The agency also said it was cancelling an audit into the number of antipsychotic drugs prescribed to nursing home patients and another project investigating how many fraudulent Medicare providers get back into the program after their license is revoked.
Source: modernhealthcare.com

GAO: Make Medicare Contractor Requirements More Consistent

These differing requirements potentially reduce efficiency and effectiveness, and they increase the administrative burden placed on providers being audited, according to the GAO. The GAO recommends CMS examine its claims review requirements for contractors and determine how to make them more consistent. CMS should then announce its findings and its plan for taking action. The agency should work to eliminate differences in a way that doesn’t interfere with improper payment reduction efforts, according to the GAO. CMS has begun examining the requirements, according to the report.
Source: beckershospitalreview.com

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August 28, 2013

AARP Florida Statement and Video on Medicare’s 48th Anniversary

Posted by:  :  Category: Medicare

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“As Medicare continues to provide access to health care for millions of seniors and those with disabilities, AARP is celebrating its 48 successful years and advocating for responsible, commonsense solutions that will strengthen the program by lowering drug costs, improving care coordination and cracking down on over-testing, waste and fraud. Nearly 50 million Americans—15 percent of the nation’s population, and growing—depend on Medicare for health security which is why AARP will continue our work to ensure that it is there for current and future generations.
Source: aarp.org

Video: Florida Medicare Supplements

Florida Elder Law and Estate Planning: Good news, seniors: Medicare Part D costs to remain stable for 2014

If you are signing up for Medicare for the first time, you are not required to sign up for Part D. If you do not take expensive prescription medications, you may choose not to enroll. However, if you pass on Medicare D and want to sign up later, you will pay a late enrollment penalty, which increases by 1%  for each month you are not enrolled. The donut hole for prescription drugs is also shrinking. In 2013, the donut hole was the point at which you and your plan together paid $2,970 on prescriptions until you spent $4,570 out of pocket. The donut hole will shrink in 2014, when the upper end decreases to $4,550. The donut hole is expected to close entirely by 2020.
Source: blogspot.com

Florida Medicare Advantage Plans from Freedom Health

Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid.
Source: qooqe.com

Shands settles whistleblower lawsuit over false Medicare and Medicaid claims

Shands officials fully cooperated with the state and federal investigation and negotiated the settlement agreement announced today to avoid long and costly litigation. While there has been no admission of liability, Shands HealthCare hospitals in Gainesville and Jacksonville will pay a total of approximately $26 million plus interest: $25.2 million to the United States under the Medicare program and $829,600 to the State of Florida under its Medicaid program.
Source: typepad.com

Florida Blue Medicare Plans

These days, everyone is looking for a few ways to save money. With Florida Blue Medicare plans, securing a low rate is easy because they can offer discounts and reduced rates that many newer companies cannot. The reason is simple. Florida Blue has been serving the residents of Florida for generations and they’ve built a solid customer base of happy satisfied clients. As a consequence, they’re not driven by profit margins, and don’t need to be concerned with building a loyal following. Instead, they can offer deep discounts and low rates creating the most affordable Medicare plans to keep you happy.
Source: frederiksted.org

Health First, Florida Hospital Partner On Insurance

Our four not-for-profit hospitals—Health First Cape Canaveral Hospital in Cocoa Beach, Health First Holmes Regional Medical Center in Melbourne, Health First Palm Bay Hospital in Palm Bay, and Health First Viera Hospital which opened in Viera on April 2, 2011- form the core of Health First’s family in Brevard County on Florida’s Space Coast. Other services include outpatient centers; the county’s only trauma center; home care; specialized programs for cancer, diabetes, heart, stroke, and rehabilitative services; central Brevard’s largest medical group; four fitness centers; and Medicare Advantage, commercial POS, and commercial HMO health plans.
Source: spacecoastdaily.com

Florida Medicare Supplement–A Financially Sound Decision

Coinsurance –  You are responsible to pay $283 per day when you are hospitalized from the 61st day through the 90th day.  And, when you are in the hospital from the 91st day though the 150th day, you are responsible for $566 per day.  There are some lifetime reserve days with Original Medicare.  A Florida Medicare Supplement will add an additional 365 lifetime reserve days.
Source: rtcinsuranceadvisors.com

Florida Projects Steep Margin Decline for Medicare Home Health

AAHomecare AARP AirStrip Almost Family Almost Family Inc. Amedisys Amedisys Inc. American Association for Homecare American Association for Long Term Care Insurance Brookdale Senior Living Care.com CellTrak Technologies Inc. Center for Medicare & Medicaid Services Centers for Medicare & Medicaid Services CliftonLarsonAllen CMS Department of Justice Emeritus Senior Living featured Federal Bureau of Investigation Gentiva Health Services Inc. HHS Home Health Depot Home Health International Humana IntegraCare Jordan Health Services Kindred Healthcare Kindred Healthcare Inc. LHC Group LHC Group Inc NAHC National Association for Home Care & Hospice New York Times Paraprofessional Healthcare Institute Partnership for Quality Home Healthcare Partnership for Quality Home Health Care PHI Quantum Home Care Inc. Scripps Health Sentara Healthcare The Partnership for Quality Home Healthcare VA Visiting Nurse Association Visiting Nurses Association
Source: homehealthcarenews.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

Stories from the Field: Medicare Fraud in South Florida

The agency’s purpose is to enroll Medicare beneficiaries in their fraudulent health care program, cancelling their current Medicare plans and leaving them without the ability to receive crucial benefits. In order to carry out this scam, the agency takes advantage of the economic insecurity that many Hispanic older adults face. A recent report showed that 70.1% of Hispanic older adults live of the verge of poverty – the highest of any racial/ethnic group in the U.S. Aware of this fact, the scammers offer the beneficiaries much needed money to enroll in fraudulent health care plans. Since many live in poverty and are forced to choose between food, medication or housing, this extra money can be the difference between going to bed hungry and eating a filling dinner. In addition to this “signing bonus,” the agency attracts new clients by offering access to its beauty salon and gym.
Source: nhcoa.org

Blue Medicare Regional PPO Plan

Cost is a major concern for most of us these days and hardly anyone passes on the chance to save a few dollars. With a Blue Medicare Regional PPO plan, saving is easy. With $0 monthly plan premiums, moderate out-of-pocket expenses and more, it’s easy to find the perfect plan to fit your needs and your wallet. That’s great news for seniors on a fixed income and exactly why so many Floridians choose Florida Blue as their Medicare health plan option. Plus, with no deductible for preventive care, you can get vaccines, routine screenings and more easily and conveniently.
Source: ruthiehendricks.com

Medicare Fee Schedules Must Be Disclosed in PIP Policies

This issue was certified to the Florida Supreme Court by the Third District Court of Appeals (“3rd DCA”) after noticing that similar issues were being raised in Florida courts statewide. The initial decision by the 3rd DCA was consistent with the other districts which have already decided on such issues. The Florida Supreme Court decision affirmed the decisions of all the DCAs that PIP insurance providers must notify policyholders by an election in their policy if they plan to use Medicare-based fee schedules.
Source: flpipguide.com

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August 28, 2013

New Arkansas Law Calls for ASC Medicaid Reimbursements at 80% of Medicare Hospital Rate

Posted by:  :  Category: Medicare

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A recently-enacted Arkansas law calls for certain Medicaid procedures performed in ambulatory surgery centers to be reimbursed at 80 percent of the Medicare rate paid for the same procedure at a hospital outpatient department. The goal of House Bill 1968, according to its official language, is to decrease Medicaid costs while increasing access to care for that state’s Medicaid population.
Source: beckersasc.com

Video: Arkansas Medicare Supplements

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

Daily Kos: Arkansas legislature passes ‘private option’ Medicaid expansion

….which is that privatizing the MediCare services means that taxpayers will be paying far more, and recipients will be getting far less, than if the MediCare system itself were providing the.implementation in Arkansas, as it is in most states. This is just one more of the near-infinite flood of data-points that prove, unambiguously, unequivocally, and undeniably, that the Publicans are lying thru their teeth when they claim that their motive and goal is to save taxpayers money. Anyone who votes Publican who is not in the ownership class — the top 2-5% — is a tool and a fool, being played as such by the very elites they claim to resent, and eagerly participating in their own abuse. Friends don’t let friends vote Publican!
Source: dailykos.com

The Arkansas Medicaid Model: What You Need To Know About The ‘Private Option’

A: No. The Department of Health and Human Services has said it will consider “a limited number” of Arkansas-style plans in which Medicaid beneficiaries would use federal dollars to buy private policies.  Arkansas must give HHS a detailed proposal.  A federal green light is no sure thing, given the plan’s departure from traditional practice and a requirement that it be cost effective. “We haven’t approved anything,” Marilyn Tavenner, acting administrator of HHS’s Centers for Medicare and Medicaid Services, said at a confirmation hearing in April.
Source: kaiserhealthnews.org

Brad DeLong : The Arkansas Medicaid Budget

The strangest part of the “private option” is that the plan grew out of pressure from local Republican lawmakers, the very same folks who had the loudest concerns about costs of the original Medicaid expansion. That’s strange because the new “private option” is going to cost more (not necessarily for the state — see here and here — but almost certainly for the feds)…. There are a number of reasons that offering coverage via private insurance is costlier than offering it via Medicaid but the main one ain’t rocket science: private insurers reimburse at higher rates. Even conservatives that like the “private option” better agree that it will cost more. Well here’s the thing. Despite a broad consensus about cost, Republicans at the forefront of advocating for a “private option” as a possible alternative to Medicaid expansion do not agree. They think that the “private option” might not be any more expensive for the feds, and could even cost less.
Source: typepad.com

Arkansas Moving Forward With Plan to Accept Medicaid Expansion

Speaking of Obamacare, it looks like the Arkansas plan to accept its expansion of Medicaid coverage is on track. This is good news coming from a conservative state. I’m agnostic about whether their proposal to privatize delivery is a smart idea—probably not, since it will increase costs, though you never know—but it’s nice to see that it’s going forward one way or the other.
Source: motherjones.com

Arkansas’ Unprecedented Use of Performance Pay to Contain Health

Things still aren’t perfect in the provider community’s eyes — for example, private insurers reimburse hospitals at significantly different rates, making the total cost of care different depending on which hospital a patient is being treated at and who’s paying — but the program is underway. After analyzing historical data, the state and the insurers set the new standards, the feds signed off on the plan, and in October of last year, doctors started to be evaluated on their performance in three episodes: upper respiratory infections, late pregnancies and ADHD. Two more episodes –congestive heart failure and total joint replacement — were added in February.
Source: governing.com

Arrest made for fraudulent Medicaid billing

Attorney General Dustin McDaniel announced today that a Little Rock health care provider has been arrested for felony Medicaid fraud following an investigation by the Attorney General’s Medicaid Fraud Control Unit. Tequila Fitzgerald, 21, turned herself in to Pulaski County authorities this morning after the Attorney General’s Office had issued a warrant for her arrest. Bond was set at $2,000. Fitzgerald is accused of billing the Arkansas Medicaid program for attendant-care services that she did not render. She is alleged to have falsely billed Medicaid for $17,340.48. “My office will aggressively pursue investigations of medical providers believed to have stolen taxpayer money from the state’s Medicaid program,” McDaniel said. “I encourage anyone who suspects instances of Medicaid fraud to contact the Medicaid Fraud Control Unit in my office.” Fitzgerald worked as a personal-care attendant for a Medicaid beneficiary in Pine Bluff. She was responsible for submitting her own claims for payment to the state’s Medicaid program. The spouse of the Medicaid beneficiary told investigators that Fitzgerald stopped assisting the beneficiary in August 2012, and that Fitzgerald had moved to Little Rock earlier this year. Investigators reviewed documents and determined that Fitzgerald had made false claims to the program from August 2012 to April of this year. Charges are merely accusations and a defendant is presumed innocent unless and until proven guilty.
Source: arktimes.com

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