Income Thresholds For Medicare Part B And Part D Premiums

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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

Medicare Parts A, B, C, D

-Medicare Part B covers Medically Necessary Services used to treat or diagnosis an illness (Includes things such as Clinical Research, Ambulance Services, DME (Durable Medical Equipment), Mental Health, Second Opinions before Surgery, and Outpatient Drugs) or to prevent an illness.
Source: stratasan.com

Does the “IRMAA” Income Rule to Medicare Part D Affect You??? » Toni Says

If your income is above a certain limit, then you will have to pay more.  Since your additional amount is $29.90, it tells me that your modified adjusted gross income as reported on your IRS tax return from 2 years ago was $107,001-$160,000.  The bottom line is if your income is over $85,000 as an individual or $170,000 for a couple, and you have your Medicare prescription drug plan from a Medicare Advantage (Part C) or Stand alone Medicare Prescription Drug plan (Part D), you will have more premiums deducted from your Social Security check.
Source: tonisays.com

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

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

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

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

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

REVISING SPECIALTY TIERS: PROTECTING MEDICARE PART D BENEFICIARIES FROM BURDENSOME COST SHIFTING

“The National Psoriasis Foundation supports the introduction of this legislation, which will provide an additional level of protection for Medicare beneficiaries with chronic conditions, like psoriasis and psoriatic arthritis,” said Leah Howard, director of government relations and advocacy at the National Psoriasis Foundation and MAPRx Coalition member. “Specialty tiers for expensive medications, such as biologic drugs used to treat psoriasis and psoriatic arthritis, require individuals to pay high copayments and can restrict access to needed medications. Without access to prescribed medications, these patients risk health complications and, sometimes, even permanent disability.”
Source: maprx.info

Time for Medicare choices

The Medicare Part B premiums will increase from $104.90 per month in 2013, but the amount hasn’t yet been announced. The announcement will be made before open enrollment begins. If you earn more than $85,000 for a single person or $170,000 for married people filing jointly, you’ll pay additional premiums based on your income. Part D premiums also are subject to these sliding scales. These income levels haven’t increased since 2010, so more people will face these income penalties.
Source: bankrate.com

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

Posted by:  :  Category: Medicare

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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: Guide to Medicare Part A and Part B

Closing the Medicare Part D Coverage Gap

The health care law adds benefits to help make your Medicare prescription drug coverage more affordable. If you reach the Medicare Part D coverage gap, you can get discounts on your prescription drugs. The discounts will gradually increase until the coverage gap disappears in 2020.
Source: aarp.org

Medicare Parts A, B, C, D

-Medicare Part B covers Medically Necessary Services used to treat or diagnosis an illness (Includes things such as Clinical Research, Ambulance Services, DME (Durable Medical Equipment), Mental Health, Second Opinions before Surgery, and Outpatient Drugs) or to prevent an illness.
Source: stratasan.com

Income Thresholds For Medicare Part B And Part D Premiums

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

Does the “IRMAA” Income Rule to Medicare Part D Affect You??? » Toni Says

If your income is above a certain limit, then you will have to pay more.  Since your additional amount is $29.90, it tells me that your modified adjusted gross income as reported on your IRS tax return from 2 years ago was $107,001-$160,000.  The bottom line is if your income is over $85,000 as an individual or $170,000 for a couple, and you have your Medicare prescription drug plan from a Medicare Advantage (Part C) or Stand alone Medicare Prescription Drug plan (Part D), you will have more premiums deducted from your Social Security check.
Source: tonisays.com

Medicare FAQ: What is Original Medicare, Part A and Part B?

These individuals will want to enroll during their seven month Initial Enrollment Period (IEP), which starts three months before they become Medicare eligible and lasts for three months afterwards. If they do not sign up during their IEP, they can sign up during the General Enrollment Period. This enrollment period lasts from January 1 and March 31 of each year with coverage starting on July 1. However, this means that you will have to pay a higher monthly premium for late enrollment. The length of these late enrollment penalties will depend on how long you could have enrolled in Part A and/or Part B coverage and did not.
Source: planprescriber.com

Time for Medicare choices

The Medicare Part B premiums will increase from $104.90 per month in 2013, but the amount hasn’t yet been announced. The announcement will be made before open enrollment begins. If you earn more than $85,000 for a single person or $170,000 for married people filing jointly, you’ll pay additional premiums based on your income. Part D premiums also are subject to these sliding scales. These income levels haven’t increased since 2010, so more people will face these income penalties.
Source: bankrate.com

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

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

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

REVISING SPECIALTY TIERS: PROTECTING MEDICARE PART D BENEFICIARIES FROM BURDENSOME COST SHIFTING

“The National Psoriasis Foundation supports the introduction of this legislation, which will provide an additional level of protection for Medicare beneficiaries with chronic conditions, like psoriasis and psoriatic arthritis,” said Leah Howard, director of government relations and advocacy at the National Psoriasis Foundation and MAPRx Coalition member. “Specialty tiers for expensive medications, such as biologic drugs used to treat psoriasis and psoriatic arthritis, require individuals to pay high copayments and can restrict access to needed medications. Without access to prescribed medications, these patients risk health complications and, sometimes, even permanent disability.”
Source: maprx.info

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

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

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

Rep. Schwartz Talks Medicare in DNC Address

Posted by:  :  Category: Medicare

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Ms. Schwartz is one of the principal social engineers who is driving GP’s and internists to retire and leave early because of the bureaucracy, higher malpractice risk and Hippocratic oath violations she created.She must have known that America will be 120,000 general doctors and nurse practitioners short by 2020, even before Obamacare but she must not have cared that there will be no doctors. She also is guaranteeing that the Catholic Church’s, immense investment in education and caring for the sick and the poor will be abandoned forever after the one year extension expires , due to their sincere religious beliefs not being in accord with what she and other Democrats wrote into the Obamacare law. As a doctor, I can say for whatever good she may have created there will also be many neglected deaths and social wreckage she will have to account for. That is a couple reasons, among others,why she should not be re-elected to Congress from the 13th District. In my opinion, her vision is too limited and she lacks mature balanced long-term judgement.
Source: patch.com

Video: Weekly Address: Preserving and Strengthening Medicare

Addressing Barriers to Delivering the Medicare Annual Wellness Visit

3. There is no convincing evidence that preventive services will provide quality and decrease costs in the Medicare population. The Annual Wellness Visit is not just about providing preventive services. It also encourages individuals to take an active role in accurately assessing and managing their health, and consequently improve their well-being and quality of life. Thus, a main purpose of the AWV is achieved by collecting information (with an HRA) relevant to effective patient engagement and providing feedback to the patient that is welcome by the patient and is actionable. An HRA involves collecting and analyzing health-related data used by health providers to evaluate the health status or health risk of an individual. In this respect, it is a valuable tool for identifying significant risk in a “managed care organization” or “at-risk entity.”
Source: physicianspractice.com

Time is Ripe to Address End

The second bill is called the Patient-Centered Quality of Life Act and will be introduced in both houses. It would fund education and research into palliative care and improve public outreach to inform patients. Barriers to palliative care include a shortage of trained physicians and nurses, a lack of research into best practices and a misalignment of payment incentives. As the nation moves away from a fee-for-service system of reimbursement to a value-based payment system, including palliative care services within bundled payments will help pay for end-of-life services, he said. “We intend to go to the Hill and lobby for specialized payment code increases that reflect the real value of palliative care consultations and include them in payment bundles,” said Jon Keyserling, senior vice president of health care policy for the National Hospice and Palliative Care Organization. He added that the time has come for reasonable parties to ignite a discussion about advanced care planning within Medicare and Medicaid. “We are supporting those efforts,” he said. Many members of Congress and their families have used hospice, Keyserling said. “There is a very receptive audience among policymakers for promoting high quality end-of-life care. The key focus is building it into a continuum of care.” The Business Case for Advance Care Planning and End-of-Life Care There is growing evidence that investments in advance care planning, palliative and hospice care pay off, not only in improved patient and family member satisfaction but also in greater longevity and cost savings. La-Crosse, Wis.-based Gundersen Lutheran Health System, whose Respecting Choices advance care planning program has become an internationally accepted model, has demonstrated that by integrating planning throughout the health care system, it can provide the care that terminally ill patients want while reducing hospital readmissions, length of hospital stay and average reimbursement per deceased patient. A 2007 Dartmouth Atlas study found Gundersen Lutheran’s average per-patient reimbursement in the last 24 months of life was $18,359, nearly $7,500 less than the U.S. hospital average of $25,860, and considerably less than the Cleveland Clinic ($31,252), UCLA ($63,821) or the New York University Medical Center ($65,660). Its hospital days per deceased patient in the last two years of life averaged 13.5 days, nearly half the U.S. average of 23.5 days, and far lower than UCLA (31.3 days) or the NYU Medical Center (54.3 days). A 2006 Duke University study found the average Medicare savings per U.S. hospice patient is approximately $2,300. Indianapolis’ safety net hospital, Wishard Health Services, reported an average savings of $5,000 per hospitalized patient and $1,500 per discharged patient. What Needs to Happen Gregory Gramelspacher, M.D., professor of medicine at Indiana University School of Medicine and director of Wishard’s Palliative Care Program, said something radical must happen for end-of-life care to improve. “We have to quit paying for the wrong stuff and start paying for right stuff,” Gramelspacher said. “Instead of turning around the aircraft carrier, we need to sink it and start over.” He said America has too many highly paid specialists and not enough well-trained primary care physicians, especially doctors trained in palliative care. “We have huge unmet needs and can’t find the trained professionals to take care of them,” he said. For example, Wishard’s palliative care program averaged 150 annual consultations 13 years ago, which has grown to more than 850 in 2012. “From the beginning we’ve worked to keep patients out of the hospital and treat them as outpatients,” he said. “To have a patient dying of metastatic cancer spending three to four days in the ICU in the last weeks of life is not only costly, it’s wrong.” Hospitals around the country are integrating palliative approaches into their systems of care, led by the American Hospital Association and its state hospital association members. Doug Leonard, president of the Indiana Hospital Association, said an IHA task force is exploring how Indiana hospitals, health care providers and communities can improve advance care planning and palliative care. “There are many hospitals already doing an excellent job that we can learn from and we’re trying to initiate a statewide dialogue to share best practices,” Leonard said. “We need to make this—like Gundersen Lutheran has—a community topic discussed in churches, schools and community centers, as well as with hospitals and health care providers.” Moving Forward C-TAC co-founder Bill Novelli, a former CEO of AARP, characterized end-of-life planning and care as “the most significant and most human challenge we face in health care. It intersects with religion, spirituality, family life and our national conscience. I have worked on many big social change issues and I believe that this one is ripe for reform.” Novelli said the only way to reform America’s fragmented, haphazard approach to end-of-life care “is to be bipartisan, big and strong—with many players and sometimes strange bedfellows. And to tackle the challenges in a synergistic way rather than in sequence,” said Novelli, now a professor at Georgetown University’s McDonough School of Business. “This may be the only health issue where if you give people what they want and improve the quality of care, you can also save money. Cost containment is a result of quality care in advanced illness. And that is not lost on the people scrambling to cut the debt and deficit.”
Source: cecc.info

Senate Takes up Bill to Improve Medicare Audits and Address RAC Concerns

• HME News: Get ready to add UPIC to the HME lexicon • CMS Rescinds PWC RAC Audits on Older Claims • RAC Update: Audits Still Coming but Fewer Document Requests, CMS says • According to Report Medicare Spending in Rochester Area is Lowest in Nation • Feds tie Michigan Doctor to fraudulent cancer care • RACs push back against audit improvement bills • Legislation to Improve CMS RAC Program Introduced in U.S. Senate
Source: medbill.net

Illinois Retired Teachers Association President Gary Elmen addresses TRIP and Medicare issues.

At the recent TRIP committee meeting when the new Medicare Advantage plan was mentioned, there were no significant details. CMS will release those later, even though they must know some parameters because of the bid solicitation. But given the changes this year in copays/deductibles (e.g. Cigna) that confused retirees and prompted many calls to CMS, it is not surprising that CMS wants to have their act together.
Source: wordpress.com

FAH Submits Letter to Ways & Means Chairman Camp Regarding Medicare Beneficiary Payment Reforms

Hospitals have withstood $95 billion in Medicare cuts in just the past three years alone.  Over the next ten years, hospitals are facing nearly a half trillion in cuts.  These cuts have already resulted in reduced services, reduced access to care, and thousands of job cuts across health care.  Hospitals have done their part and have implemented a number of reforms that contribute to the cost reduction and savings trends occurring now.  As policymakers look for further areas of reform, FAH believes that these cost-sharing proposals are an appropriate area for discussion and, ultimately, modernization.
Source: fahpolicy.org

Medicare policy may mean treatment, not hospice

The researchers also measured two key outcomes that were more complicated to interpret: persistent difficulty breathing and persistent pain. Residents with hospice after SNF were 37 percent less likely than those without hospice to experience persistent difficulty breathing, or dyspnea, but residents with concurrent hospice and SNF had no significant difference in their experience of this problem.
Source: futurity.org

How to Protect Yourself from Medicare Fraud

In rare cases, Social Security representatives may call Medicare beneficiaries if they need more information to process applications for Extra Help with Medicare prescription drug costs. If a phone call is needed, you will receive an official letter to arrange a phone interview, and you should be asked to confirm the date of your telephone interview by returning an acknowledgement form to Social Security.
Source: ehealthmedicare.com

WHAT THEY’RE SAYING: Support Building for Bipartisan Medicare Physician Payment Reform Effort

American Association of Nurse Anesthetists “As Certified Registered Nurse Anesthetists (CRNAs) providing 34 million anesthetics annually, our primary interest is in patient safety and access to cost-effective healthcare. We support the bill’s provisions replacing the damaging SGR formula with a positive 0.5 percent Part B update for each of the next five years as refinements to quality measurement incentive systems and alternative payment systems are developed through open and publicly accountable processes. These payment adjustments are particularly important since the 2013 budget sequestration has taken 2.0 percent from this year’s Part B payments and the SGR threatens additional 24 percent cuts beginning January 2014. We also thank the Committee for accepting our evidence-based recommendation that quality measures, quality reporting and incentive payment systems treat CRNAs the same as physicians when the same service is provided.”
Source: house.gov

535 people change Medicare address to ACT - Open Government

The Australian Bureau of Statistics uses Medicare addresses to count population per State and Territory. That population data is used by the Federal Government to allocate GST funding to communities. For every year that an ACT resident is not counted, the ACT Government forgoes about $2,500 per person in GST funding.
Source: gov.au

AARP Urges Congress to Address Medicare Physician Payments

“As you know, physicians and other health care providers are scheduled to receive a 27 percent cut on January 1, 2013, as a result of the flawed sustainable growth rate (SGR) formula.  This is in addition to the 2 percent reduction included in the planned sequestration.  Failure to adopt legislation to address the “doc fix” would create considerable instability in the Medicare program.  Such a significant reduction in reimbursement could cause providers to stop seeing Medicare beneficiaries or prevent them from accepting new ones.  We are disappointed that Congress has thus far been unable to develop a long-term solution to this perpetual problem.  However, even in the absence of a longer-term solution, the SGR cuts must not be allowed to occur.  Under current law, the Centers for Medicare and Medicaid Services may begin issuing the reduced payments on January 1.  A reduction for even a short time in reimbursement rates could disrupt access to care, as providers may delay seeing Medicare patients until updated rates go into effect. 
Source: aarp.org

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August 31, 2013

Utah Medicare Supplements

Posted by:  :  Category: Medicare

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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

Video: Medicare Agent Training

Medicare Supplements (Medigap) For Dummies

[…] 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 Medicare 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 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 2013Source: croweandassociates.com […]
Source: croweandassociates.com

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

MEDICARE SUPPLEMENT INSURANCE STILL IN VOGUE

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

Why Do You Need Medicare Supplements?

Those seniors who are already sick should get Medicare Supplement Insurance. Also, anyone who has a family history of illness should look into it as well. If you have a Medicare Advantage plan you do not need Medicare Supplement Insurance. You also would not need it if you are under another governmental program such as Medicaid or the Qualified Medicare Beneficiary program. Medicare has a cap that a person can reach. They pay so much of your medical bill and then your portion of the bill starts to increase while their payment portion is decreased. This puts you at being 100 percent responsible for your medical bills. This includes hospital stays and outpatient services such as physician visits, your routine visits and other medical needs
Source: besteasyweightloss.com

What are Medicare Supplements?

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Source: medicarechoicesofarizona.com

United of Omaha Medicare Supplements Returned

Recently, Mutual of Omaha released a new company to sell Medicare Supplement policies in Iowa.  This company was Omaha Insurance Company.  They had not released a cut-off date for the United of Omaha Medicare Supplements at that time.
Source: khiagents.com

Medicare Supplements: No Changes Coming

“We were unable to find evidence in peer-reviewed studies or managed care practices that would be the basis of nominal cost sharing designed to encourage the use of appropriate physicians’ services. Therefore, our recommendation is that no nominal cost sharing be introduced to Plans C and F. We hope that you will agree with this determination,” the NAIC wrote in the Dec. 19 letter.
Source: tacticalminc.com

Medicare Supplement Realistic Sales Goals?

I’m just telling you, you can do it but I don’t know of any mail house that will do a drop for$300 week. You can expect 415-475 per thousand but call them up and if that is your budget ask them how they can work with you. Maybe the first two months you pay them the full 1200 and, I am telling you, if you work the leads you will make sales, and then bump up your budget to 425. Tell the mailhouse you want a copy of the mail list and when you are working your leads go and door knock the list. Chris Westphall has a video somewhere on here of an agent who all he does is door knock, leads with med supp, and cross sells final expense, and that guy does very well. Good luck my friend.
Source: insurance-forums.net

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

HHS Takes NAIC’s Advice on Medicare Supplements

There was some good news out of Washington last week, when Kathleen Sebelius, Secretary of the U.S. Department of Health and Human Services announced that she would take the advice of the NAIC with regard to cost sharing in Medicare Supplement plans C and F. The NAIC had sent a letter advising againstcost sharing and against changing the standard benefit packages for these plans.
Source: agentpipeline.com

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August 31, 2013

ICYMI: Health Affairs Study

Posted by:  :  Category: Medicare

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

Video: Medicare HMO

What Are Medicare HMO Plans?

This indicates that each Medicare recipient will acquire the benefits supplied by Medicare plans through the HMO they put on, and in return for the plans that the HMO provides, it will get a month-to-month supplied amount from the government for each and every enlisted patient.
Source: plexhometheater.com

Are Fixed payments a barrier to quality of care in HMOs

Looking more closely into the different kinds of HMOs, the team found that older, larger, not-for-profit HMOs ranked higher on all measures than smaller, newer, for-profit ones. In fact, when it came to vaccinations and ratings of specialists, the traditional fee-for-service plans ranked higher than the newer, smaller, for-profit HMOs. One possible explanation for these findings, the authors note in the paper, is that the highly integrated systems characteristic of these older more established health plans may have offset any potential financial incentives to restrict care.
Source: medbill.net

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

Medicare HMOs reduce utilization, researchers say

“Although we could not assess the appropriateness of services, some of our findings suggest that the use of services may be more appropriate within Medicare Advantage HMOs,” the researchers said. “For instance, relative to beneficiaries in traditional Medicare, Medicare Advantage HMO enrollees are more commonly treated with cardiac bypass surgery, in accord with current guidelines. Additionally, lower rates of emergency department use suggest that Medicare Advantage HMOs may be treating patients in less costly primary care or urgent care settings.”
Source: lifehealthpro.com

Understanding Medicare and HMO

They basically link healthcare companies to people, making certain that the latter receives the proper type of treatment and the former submits to the Medicare hmo plans policy and standards for each strategy in part. In exchange, health care suppliers are noted as accepted by the HMO, ending up being much more identified and having the ability to look at a greater number of people.
Source: ji-nan-ban-zheng.info

“Information in Medicare HMO markets: The interplay of advertising and ” by Ashwin R Patel

This study incorporates advertising into the analysis of report cards and risk selection. We analyze the first large-scale dissemination of HMO quality report cards to 40 million Medicare beneficiaries in the fall of 1999. ^ Theoretically, we extend the canonical Dorfman-Steiner model to incorporate the role of report cards and risk selection into the firm’s optimal choice of premium and advertising. ^ First, we explore the relationship between advertising and quality, prior to the actual report card release. We utilize an instrumental variables approach and find that high quality HMOs advertise more than low quality HMOs. In addition, greater advertising drives greater increases in HMO market shares. ^ Next, we study how the actual release of HMO report cards impacts HMO advertising behavior. We then analyze market share movements after the report card release, while incorporating associated changes in advertising expenditures and advertising credibility. We find that after the release of report cards, HMOs receiving higher ratings had lower relative advertising than firms receiving lower ratings. In addition, the report card release decreased the credibility of advertising by low quality firms, such that each dollar of advertising had a lower impact on increasing market share. Overall, we find that firms receiving below average ratings were able to offset the negative impact of the low ratings on market shares through advertising. We provide the first empirical evidence, to our knowledge, that advertising serves as a means to undermine the impact of report cards. ^ Third, we utilize individual-level survey data from Medicare HMO enrollees and find evidence that there exists a significant, positive relationship between advertising expenditures and health risk selection. Furthermore, the impact of advertising is similar for experienced and inexperienced individuals, suggesting a more persuasive role for advertising. ^ Together, these analysis provide a much richer understanding of the powerful role that advertising can play in Medicare HMO markets.^
Source: upenn.edu

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August 31, 2013

AvMed Health Plans and Wax Custom Communications Partner in the Publication of ASPIRE

Posted by:  :  Category: Medicare

Aspire features information and updates about AvMed’s Medicare Advantage plan, along with practical information designed to help customers enhance their overall health and wellbeing. “The magazine was titled Aspire because we felt it was the perfect word to sum up our attitude towards health,” said Winston H. Lonsdale, Vice President and Chief Medicare Executive, AvMed Health Plans. “The word aspire means to have a great ambition, an ultimate goal, a strong desire, a willingness to strive. In this magazine, our goal is to inspire and support our customers as they optimize their health.” Created especially for Medicare members, Aspire includes profiles of healthy seniors and articles aimed at promoting longevity and healthy living. “Our goal is to encourage readers to use the many member benefits already offered to them,” said Lonsdale. Those benefits include a new affiliation with the SilverSneakers® Fitness Program, discounted Weight Watchers™ memberships and discounts on acupuncture, massage therapy and complementary medicines to improve their health. AvMed has also implemented new initiatives to provide additional services to their members, including the improvement of their Personal Service Representative (PSR) program. Wax, who partnered with AvMed to publish Aspire, has worked with AvMed for 20 years, starting with the publication of one title and evolving into a wide range of integrated marketing products. “AvMed has always been known for its personalized, caring approach to healthcare,” says Bill Wax, president and founder of Wax Custom Communications. “Aspire represents an outstanding opportunity for AvMed to convey information to help members take charge of their own health and wellness.” About Wax Custom Communications Founded in 1987 by Pulitzer Prize nominated photojournalist Bill Wax, Wax Custom Communications is a full-service custom publisher and integrated marketing firm based in Miami, Fla. A member of the Custom Publishing Council and the American Marketing Association, Wax is active in business sectors including health, finance, insurance, education, technology and telecommunications. About AvMed Health Plans AvMed is a Florida based not-for-profit HMO and one of the state’s leading HMO providers, serving more than 200,000 members in the state of Florida. Founded in 1969 as a health care system for pilots in the Miami area, AvMed (short for “aviation medicine”) now serves non-pilots as well, with offices throughout Florida. AvMed’s policies include employer group HMO, Medicare HMO, and point-of-service plans; the company also offers onsite health-related seminars. AvMed’s Disease Management Program provides assistance to members with congestive heart problems, asthma and high-risk pregnancies; its On Call phone line offers free health information around the clock.
Source: seerpress.com

Video: AvMed Medicare-Rita-SP.mov

AvMed Health Plans and Wax Custom Communications Receive Bronze at 2010 Mature Media Awards

PRLog (Press Release) – Aug. 16, 2010 – Miami, August 10, 2010– AvMed Health Plans received a bronze medal at the 2010 National Mature Media Awards, the nation’s largest awards program that annually recognizes the best marketing, communications, educational materials and programs for adults age 50 and older. AvMed’s Medicare Enrollment Kit won a bronze medal in the Brochure/Booklet category. The Medicare Enrollment Kit is an annual piece distributed before the Medicare enrollment period, aimed at educating consumers on AvMed’s Medicare plans and benefits and guiding them in their decision making process. “We’re proud that the work we create with AvMed has been honored at the National Mature Media Awards,” said Bill Wax, president and founder of Wax Custom Communications. “These awards recognize the uniqueness of our work with each of our clients and the quality team we have here at Wax.” About Wax Custom Communications:
Source: prlog.org

What Impact Does Medicare Have On Health Insurance?

Many insurance types can be considered a primary insurance depending on the situation. If you are in a car accident, and your insurance or the other person’s insurance covers any medical expenses, those would be considered a primary insurance. Similarly, if you have home owner’s, or renter’s insurance, and they cover a qualified medical expense, then they would be considered the primary insurance. This also includes coverage such as prescription coverage, and other forms of supplementary coverage.
Source: seniorcorps.org

Yohanon’s ramblings: How is it possible?

Back to the prescriptions. In order to have prescription coverage – which I found out is a requirement – there is an ADDITIONAL change by Medicare . . . and if you fail to sign up for (I think) Part D prescription coverage when first eligible, Medicare penalizes you – forever.
Source: blogspot.com

AvMed Health Plans and Delta Dental Announce a Partnership to Help Provide Affordable Dental Coverage

Delta Dental Insurance Company, along with its affiliates, is part of a holding company system that operates in 15 states plus the District of Columbia and Puerto Rico. Both Delta Dental Insurance Company and its holding company hold an “A-“ (excellent) rating from AM Best, and are part of the Delta Dental Plans Association (DDPA). DDPA consists of 39 Delta Dental member companies licensed in all 50 states. The association collectively covers more than 50 million of the estimated 170 million people nationwide with dental insurance, making it by far the largest national system of dental plans.
Source: deltadentalins.com

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August 31, 2013

The anniversary of Medicare

Posted by:  :  Category: Medicare

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I, for one, can’t wait for universal health care. Most industrialized countries implemented it after the war and have far lower health care costs and for better coverage because of it. But for some reason the United States has been resisting it all along, even though it’s the only thing that makes logical sense. Create a pool that covers everyone so premiums for all are as low as humanly possible. Everyone shares, everyone benefits, and no one is left out in the street to die or has a medical bill so crushing that they have to declare bankruptcy after losing all their assets.
Source: minnpost.com

Video: Medicare: A Primer

Medicare Parts A, B, C, D

-Medicare Part B covers Medically Necessary Services used to treat or diagnosis an illness (Includes things such as Clinical Research, Ambulance Services, DME (Durable Medical Equipment), Mental Health, Second Opinions before Surgery, and Outpatient Drugs) or to prevent an illness.
Source: stratasan.com

Competitive Bidding In Medicare: A Response To The Bipartisan Policy Center’s Proposal

Note 6.  At the time of the Denver demonstration, health plans were paid by Medicare at a so-called average per capita cost (AAPCC) rate.  Under the AAPCC, payments were set at 95 percent of the cost of a standardized enrollee in Medicare FFS in the county where the beneficiary lived, with adjustments for a few enrollee characteristics (e.g., age and sex).  The imperfections of the system were obvious, with large overpayments in some areas (allowing plans to offer drug benefits and other substantial enhancements at no added cost) and underpayments in other areas (requiring added premiums to cover little more than the entitlement benefit).  After the Denver demonstration was stopped temporarily by the courts and then more permanently by Congress, Congress dealt with the issue of plan payments by cutting payments across-the-board in the Balanced Budget Act of 1997, so that very low and very high payments under historical methods were compressed toward the national average.  This was yet another cycle in paying private Medicare plans too generously and then, under the BBA, more stringently, but in both cases the rates were derived from FFS Medicare costs, not plans’ true costs to provide the service.
Source: healthaffairs.org

Time for Medicare choices

The Medicare Part B premiums will increase from $104.90 per month in 2013, but the amount hasn’t yet been announced. The announcement will be made before open enrollment begins. If you earn more than $85,000 for a single person or $170,000 for married people filing jointly, you’ll pay additional premiums based on your income. Part D premiums also are subject to these sliding scales. These income levels haven’t increased since 2010, so more people will face these income penalties.
Source: bankrate.com

What The Death Of DOMA Means For Medicare

"In light of the Supreme Court’s decision in Windsor, CMS believes it would be impermissible to interpret the term ‘spouse,’ as used in section 1852(l)(4)(A)(iii), to exclude individuals who are in a legally valid same-sex marriage sanctioned by a state, territorial or foreign government…MA organizations therefore are required, effective immediately, to cover services in a SNF in which a validly married same sex spouse resides to the extent that they would be required to cover the services if an opposite sex spouse resided in the SNF."
Source: towleroad.com

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: kaiserhealthnews.org

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

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

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August 31, 2013

Armed With Bigger Fines, Medicare To Punish 2,225 Hospitals For Excess Readmissions

Posted by:  :  Category: Medicare

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In the third round of the program, starting in October 2014, Medicare is increasing the final maximum penalty to a 3 percent payment reduction for all patient stays. Also that year, Medicare plans to consider readmissions for more conditions, including chronic lung disease and elective hip and knee replacements. Health experts have also designed a way to measure all of a hospital’s readmissions, and that may ultimately be used for the penalties. In addition, several of Medicare’s other experiments in alternative payment plans, including accountable care organizations and bundled payments, aim to give hospitals full financial responsibility for patients.
Source: kaiserhealthnews.org

Video: Washington State Medicare Advantage Plans

Washington State Insurance Update: COBRA and Medicare: How to avoid a common (and costly) mistake

If you’re continuing your employer health coverage through COBRA and you become eligible for Medicare, it’s important for you to sign up for Medicare during your Medicare eligibility period. Here’s why: Health insurers generally include language in their policies that says they can refuse to pay bills if they find out that you stayed on COBRA coverage after you were eligible for Medicare. A lot of consumers get caught in this trap. Many people who are on COBRA don’t know that they should sign up for Medicare when they become eligible. Instead, they assume that COBRA will continue to pay their medical bills, so they delaying signing up for Medicare until their COBRA coverage ends. Then, months after becoming eligible for Medicare, they find out that their COBRA plan is refusing to pay for medical care that the consumer already received. They can’t backdate their Medicare enrollment, so they’re stuck with those medical bills. Yikes. Don’t get caught in this trap. If you’re on COBRA and become eligible for Medicare, sign up.
Source: blogspot.com

Breaking News: Challenge to Catholic Hospital Mergers in Washington State, Medicare Solvency and More

Kathleen is a 25 year veteran of the health care system as an independent journalist, non-proft executive and consumer advocate. She founded and managed CodeBlueNow! which successfully engaged the public on health care reform: www.codebluenow.org After a sabbatical writing her family memoirs, she returns to the health care reform debate by researching systemic failures of health care and health care reform from on independent consumer perspective.
Source: oconnorreport.com

What One Washington Could Learn From the Other About Reducing Health Care Spending

During the health care reform debate, some members of Congress, Sen. Jay Rockefeller, D-W.Va, in particular, felt something comparable to what Washington state and private insurers have put in place should be established for Medicare. They succeeded in inserting in the Affordable Care Act a provision establishing the Independent Payment Advisory Board. Ever since, other members of Congress — encouraged by the AMA and other special interests — have done their best to try to get rid of the board, which, like in Washington State, would be composed of health care professionals. Lobbyists and members of Congress would not have a seat on the board.
Source: michaelmoore.com

Medicare Insurance Plans Available Inside Of Washington State

Medicare Supplement Plan F Guide are not required but offer a particular significant blanket about financial protection. They cost a monthly premium but most find which the cost to be a little more well worth the entire protection provided. They also offer the protection many want when they go away out of their place or the culture. With a supplement you also can get care just about anyplace in the America even non emergent care. Ultimately it is a definite personal choice which can get a enhancer or not, but one most I know choose up to make in favor of the plans.
Source: salonstylesforyou.com

CMS Sequestration Guidance for State Surveyors, Medicare Part C & D Plans : Health Industry Washington Watch

CMS has issued guidance to state survey agencies explaining adjustments CMS is making to survey and certification operations to "accommodate sequestration with as little impact on the public as possible." The guidance discusses revisions in the frequency and timelines for various surveys and other survey changes in light of a 5% reduction to the FY 2013 survey and certification Medicare budget. CMS also issued a May 1, 2013 memo to Part C and D plans on sequestration, covering rules regarding reducing payments to contracted and non-contract providers, beneficiary liability under sequestration, coverage gap discount program payments, Part D risk corridor reconciliation, and Electronic Health Records (EHR) Incentive Program payments, among other topics. In a related development, President Obama has signed the sequestration order for FY 2014, as required by law, although the Obama Administration’s proposed FY 2014 budget, if adopted, would replace sequestration.
Source: healthindustrywashingtonwatch.com

HHS ANNOUNCES NEW MEDICARE

HHS ANNOUNCES NEW MEDICARE-MEDICAID PARTNERSHIP WITH WASHINGTON STATE INITIATIVE WILL PROVIDE BETTER, MORE COORDINATED CARE FOR MEDICARE-MEDICAID ENROLLEES Health and Human Services (HHS) Secretary Kathleen Sebelius announced today that Washington State will partner with the Centers for Medicare & Medicaid Services (CMS) to test a new initiative to improve health care for Medicare-Medicaid enrollees. Under the Financial Alignment Demonstration, Washington will better coordinate care and provide enhanced services for Medicare-Medicaid enrollees with chronic health conditions. More than 20,000 Medicare-Medicaid
Source: wn.com

Medicaid expansion will boost Washington state’s economy

But there are also important economic benefits of expanding Medicaid for both our communities and job market that Washington policymakers should be proud of. For the first several years of the expansion, the federal government will pay for 100% of the cost of the expanded Medicaid coverage (tapering and eventually holding at 90%).  This means that much-needed federal dollars will be flowing into communities across the state, bringing increased access to health care and jobs.
Source: thestand.org

Postal Service’s financial plan: Make Medicare pay our bills

“The primary policy decision for Congress to make with respect to USPS’s proposed health care plan is whether to increase postal retirees’ use of  Medicare, which is already facing funding challenges,” the Government Accountability Office reports. “This is because USPS’s proposal would essentially decrease USPS costs but increase Medicare costs.”
Source: washingtonexaminer.com

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

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

North Carolina Health News

In Kansas and several other states, consumer advocates worry that officials are rushing too quickly to move vulnerable elderly, mentally ill and physically disabled people into Medicaid managed care for long-term services, such as home health and personal care. They say states don’t have systems in place to properly monitor quality of care or the plans’ performance. A 2012 study by Truven Health Analytics estimated that the number of states with these programs will grow from 16 to 26 by 2014.
Source: northcarolinahealthnews.org

Take lessons from past to guide future for Social Security and Medicare | Economic Opportunity Institute

Mark Schmitt, a senior fellow at the Roosevelt Institute, is a former editor of The American Prospect magazine and also a staff member of former U.S. Sen. Bill Bradley (D-NJ). Schmitt estimates that Social Security lifts half of all seniors out of poverty, where most of them were before it started. He says both programs have worked to transform and stabilize the lives of the elderly.
Source: eoionline.org

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August 31, 2013

The ABCs of Medicare (D too!)

Posted by:  :  Category: Medicare

Find out about the latest changes in Medicare. If you are generally familiar with Medicare, this short presentation will update and refresh your Medicare knowledge. Speakers, powerpoint, Q & A and door prize.
Source: aarp.org

Video: Nebraska and Medicare Supplements

Nebraska Heart Hospital Ranks Highly in Readmission Rate Study

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

Rural Health Clinics Ineligible for EHR Medicare Incentives

The Social Security Act that was the foundation for Centers for Medicare & Medicaid Services (CMS) EHR Incentive Programs exclude rural health clinics (RHCs) from receiving incentives under Medicare because they bill under Medicare Part A. “In Nebraska, rural health clinics are huge. We have close to a 130–140 providers who are signed up with us in rural health clinics,” says Searls. Medicare Part A covers benefits for hospital and skilling nursing home care; conversely, Medicare Part B deals with payments to doctors and outpatient services. Those receiving Social Security when they turn 65 are automatically enrolled in Part A. It is this distinction that prevents RHCs from receiving Medicare incentives in Nebraska:
Source: ehrintelligence.com

New Nebraska Network:: Ben Nelson Stands Alone Defending Medicare In Nebraska

Nelson has a surprisingly good Democratic record when it matters.  When he votes with the GOP it is usually not the deciding vote.  For instance he did not vote against Elaine until after she already had sufficient votes.  The public option was dead and buried in the Senate months before he voted against it. Like many “Red State” Democrats and “Blue State” Republicans he must cast a certain number of votes against his party. The problem with the “progressive position” is that progressives are not willing to do the necessary work to move the political enviroment.  Conservatives also have this problem in other states.  You need to build strong political support for these positions before we expect politicians to endorse them.  That means registering voters, making phone calls, walking the precincts and all the other things that are necessary to build political support.
Source: newnebraska.net

Nebraska Approves Sale of Medicare Supplement Insurance Products

We are pleased to announce the availability of lower cost Medicare Supplement Insurance in Nebraska. The Nebraska Department of Insurance approved Medicare Supplement Insurance plans from State Mutual Insurance Company and made it possible for us to offer extremely competitive Medicare Supplement Insurance rates for qualifying Nebraska seniors.
Source: statemutualinsurance.com

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August 31, 2013

Center for Medicare & Medicaid Services

Posted by:  :  Category: Medicare

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This rule is especially perplexing in light of the fact that AAPA has been successfully working with CMS, the White House and Health and Human Services (HHS) over the past few months to eliminate unnecessary barriers to care. One positive outcome from this partnership was the elimination of the requirement that a physician be on site once every two weeks in certified rural health clinics staffed by PAs. Additionally, the new admissions requirements appear to run contrary to HHS Secretary Sebelius’ leadership role in removing unnecessary HHS regulatory barriers to the provision of healthcare in rural and other medically underserved communities.
Source: physicianassistantforum.com

Video: PA Alliance Medicare Birthday Party 2013

Medicare Open Enrollment in NJ and PA

David brings over 12 years of experience in health insurance advocacy and coordination. David previously served in a supervisory capacity including acting director with the Camden County Department of Health and Human Services, Division of Senior and Disabled Services. David also was the coordinator of the State Health Insurance Assistance Program (S.H.I.P.) and a certified counselor assisting in the education and implementation of Medicare, supplemental health insurance and prescription drug coverage to the senior and disabled population.
Source: rothkofflaw.com

Gail Wilensky and Bruce Vladeck

Throughout the year, our writers feature fresh, in-depth, and relevant information for our audience of 40,000+ healthcare leaders and professionals. As a healthcare business publication, we cover and cherish our relationship with the entire health care industry including administrators, nurses, physicians, physical therapists, pharmacists, and more. We cover a broad spectrum from hospitals to medical offices to outpatient services to eye surgery centers to university settings. We focus on rehabilitation, nursing homes, home care, hospice as well as men’s health, women’s heath, and pediatrics.
Source: wphealthcarenews.com

St. Luke’s, Easton Hospital in Pennsylvania Settle Medicare Overbilling Claims

St. Luke’s University Health Network in Bethlehem, Pa., and Easton (Pa.) Hospital will pay nearly $1.5 million to resolve allegations they improperly overbilled Medicare, according to a Morning Call report. St. Luke’s will pay approximately $1.03 million to resolve the allegations, while Easton Hospital will pay approximately $455,000. St. Luke’s allegedly overbilled Medicare from 2002 through 2012 for evaluation and management services that were not billable under Medicare regulations. Easton Hospital faced similar allegations from 2004 through 2009. The allegations specifically pertain to a claim called “modifier 25,” which is to be used for same-day services for a patient only when the service is “significant, separately identifiable and above and beyond the usual preoperative and postoperative care associated with the procedure,” according to the report. In a statement, St. Luke’s said its alleged overbilling was the result of “significant confusion … as to when a modifier 25 should be used.”
Source: beckershospitalreview.com

Medicare and Means Testing : Pennsylvania Law Monitor

What is “Means Testing” in terms of Medicare?  “Means Testing” is the method used by Medicare to determine what you pay for your Medicare, Part B and Part D coverage.  Medicare, Part B covers doctor fees, outpatient care, physical therapy and some home health care.  Medicare, Part D covers prescription drugs. The thresholds are the same for both Parts B and D.  If you file your federal income tax as “married/joint,” and your yearly income is $170,000 or higher, you will pay a higher premium than those couples whose joint income is less than $170,000 per year.  If you file your federal income tax as a single person, the threshold for the higher premium is $85,000 per year.  For those taxpayers over age 65, with income greater than the threshold amount, the amount you pay for your Part B and Part D coverage will increase depending upon your income up to the upper limit of $428,000 in income for married/joint filers and $214,000 in income for single filers.  Threshold levels are currently frozen through 2019.
Source: stark-stark.com

Tougher provisions against Medicare fraud imposed by feds

A six-month moratorium was recently imposed on three cities, including Miami, by the Centers for Medicare and Medicaid Services. The moratorium prevents new agencies and healthcare providers from receiving any Medicare and Medicaid payments on the heels of a string of alleged health care fraud incidents in the cities involved.
Source: miamicriminallawlawyer.com

Rep. Schwartz Talks Medicare in DNC Address

Ms. Schwartz is one of the principal social engineers who is driving GP’s and internists to retire and leave early because of the bureaucracy, higher malpractice risk and Hippocratic oath violations she created.She must have known that America will be 120,000 general doctors and nurse practitioners short by 2020, even before Obamacare but she must not have cared that there will be no doctors. She also is guaranteeing that the Catholic Church’s, immense investment in education and caring for the sick and the poor will be abandoned forever after the one year extension expires , due to their sincere religious beliefs not being in accord with what she and other Democrats wrote into the Obamacare law. As a doctor, I can say for whatever good she may have created there will also be many neglected deaths and social wreckage she will have to account for. That is a couple reasons, among others,why she should not be re-elected to Congress from the 13th District. In my opinion, her vision is too limited and she lacks mature balanced long-term judgement.
Source: patch.com

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