Horizon Blue Cross Blue Shield of New Jersey’s Medicare HMO and Commercial POS (Direct Access) Plans Receive “Excellent” Rating By NCQA

Posted by:  :  Category: Medicare

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a tax-paying, not-for-profit health services corporation, providing a wide array of medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving more than 3.6 million members with headquarters in Newark and offices in Wall, Mt. Laurel, and West Trenton. Learn more at www.HorizonBlue.com
Source: pymnts.com

Video: Blue Medicare Options Illinois or Medicare Options Illinois

O.C. HMO patients stuck in contract dispute

Blue Shield’s Davila said that, even after the termination takes effect, many patients will be able to keep their doctors because the doctors already belong to other medical networks contracted with Blue Shield or will join them. He said Blue Shield’s contract with Monarch applies to 16,800 customers in the commercial HMO market and 2,400 in Medicare.
Source: ocregister.com

Blue Care Network expands Medicare Advantage service area, Blue Cross and Blue Care Network add plan options

In addition, BCN Advantage members will now be able to “buy up” to more comprehensive dental and vision benefits for a modest additional premium. Members will receive partial coverage on restorative services such as fillings, root canals, crowns and crown repairs. They’ll also get an allowance for frames and lenses to improve their vision health.
Source: hcwreview.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

Blue Cross Blue Shield of Michigan Offers New Medicare Plans

HMO’s (health maintenance Organizations) let you select a primary care physician from the BCBS provider network and this PCP manages your overall care. He or she will refer you to a specialist or to a selected hospital for care should you need additional services beyond his scope of practice. Referring yourself to an outside provider will cause a forfeit of benefits and out-of-pocket costs. The four BCBSM HMO products, formerly known as Options 1, 2, and 3, will now be known as BCN Advantage Elements, Classic , and Prestige. The Blues Care Network will also continue to offer the BCN Advantage Basic Plan.
Source: emaxhealth.com

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



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: The Need to Establish Financial Eligibility for Medicaid in NJ

Where are States Today? Medicaid and CHIP Eligibility Levels for Children and Non

The Affordable Care Act (ACA) creates new coverage options through Medicaid and new health insurance exchange marketplaces that, taken together, provide assistance to individuals with family incomes up to 400% of the federal poverty level (FPL). The ACA calls for the expansion of Medicaid eligibility to 138% FPL ($15,856 for an individual or $26,951 for a family of three in 2013) in 2014, which would make millions of adults newly eligible for the program. However, this expansion was effectively made a state option by the Supreme Court. If a state does not expand Medicaid, low-income uninsured adults in that state will not gain that new coverage option and will likely remain uninsured. This brief provides an overview of current Medicaid and CHIP eligibility levels for non-disabled children and adults to provide better insight into the impact of the Medicaid expansion.
Source: kff.org

Implementing Health Reform: Final Rule On Premium Tax Credit, Medicaid, And CHIP Eligibility Determinations (Part 1)

If the exchange assesses an individual to be ineligible for premium tax credits because the individual is eligible for Medicaid or CHIP and the applicant appeals the premium tax credit eligibility determination, the applicant is considered to have withdrawn his or her Medicaid or CHIP application pending the premium tax credit appeal (since he or she would be ineligible for premium tax credits if eligible for Medicaid or CHIP).  If the individual loses the appeal, the Medicaid or CHIP application is reinstated retroactively to determine the effective date for eligibility.  If the exchange assesses an individual as not eligible for Medicaid or CHIP, it must notify the individual of the opportunity to request a full determination by the state, but treat the individual as ineligible for Medicaid or CHIP for purposes of determining eligibility for premium tax credits until the state determines otherwise.  The exchange must adhere to a state appeal decision on Medicaid or CHIP eligibility.
Source: healthaffairs.org

Daily Kos: What’s in it for me? Your Obamacare health insurance options

You know how the Democratic nomenklatura is always whining that the Republicans keep introducing bills to repeal ObamaCare (40 at last count), even though they don’t have a hope of passing them in the Senate? How they’re grandstanding and throwing red meat to the base? Well, how come turnabout isn’t fair play on this? How come Nancy Pelosi hasn’t thrown her own base some red meat by putting John Conyers’ single payer bill, HR676, on the floor 40 times? And so what if the Republicans suppress it, or vote it down? And how about the Senate? Bernie Sanders had a single payer bill, S703, in 2009; so why not at least do a little grandstanding for the base and introduce that bill on the Senate floor? And if 40 times is too much for the stately processes of The World’s Greatest Deliberative Body, then how about once? Or if Harry Reid wants to take some luster from the Kennedy name, how about he re-introduces Kennedy’s bill to reform Medicare by progressively lowering the eligibility by five years, every year, ’til all are covered? Just once? Or if the Democrats just have to have a poorly architected, complex, and Rube Goldberg-esque health care proposal, why not write another 2000 pages of bug fixes for a bill that really does guarantee universal coverage, and put that on the floor 40 times?
Source: dailykos.com

9 Ways to Beat the Medicare Surtax

Even if your income is above the threshold you can still get money into a Roth IRA in a round-about way. There are no income limits for making a non-deductible IRA contribution. The new limit on annual contributions rose to $5,500 in 2013. The catch-up provision for anyone age 50 or older increases the maximum to $6,500. Since 2010, there are no income limits for converting a traditional IRA to a Roth IRA. A high income taxpayer simply makes a non-deductible contribution to an IRA and then converts it to a Roth IRA. This strategy of indirectly contributing funds into a Roth IRA may not be effective for taxpayers who already have substantial amounts invested in a traditional IRA because of the “pro rata rule (PDF).” This rule requires a taxpayer to include all IRA assets when determining the taxes due on a Roth conversion. While investing indirectly in a Roth IRA isn’t appropriate for everyone, it can provide a viable option to those with higher incomes who are otherwise unable to contribute to a Roth.
Source: rodgers-associates.com

2013 Medicare Levy Low Income Thresholds

Besides accounting, Christie is passionate about all things small business, lifelong learning and chocolate. She spends her leisure time blogging, making sites (like this one) and playing Sims (shhh!…. that’s a secret). You can contact Christie directly at christie@lewistaxation.com.au.
Source: com.au

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

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

Programs that help seniors with health care costs

To help you find out if you’re eligible for these programs, use the National Council on Aging Web-based tool at benefitscheckup.org. You’ll need to fill out an online questionnaire that asks things like your date of birth, ZIP code, expenses, income, assets and a few other things. Once completed you’ll get a report detailing which programs you may qualify for, along with downloadable application forms and, in the case of Extra Help, allow you to complete your entire application online. The program even knows the specific MSP eligibility rules in your state.
Source: pomeradonews.com

Stand up for medicare this summer!

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Traditionally, a Health Accord is also a time for governments to expand public health care to cover new services, like a national drug plan, home and community care, vision and dental care. Without an Accord, Canadians will have a much more difficult time trying the expand public health care so that all Canadians get their medical needs covered, regardless of where they live or what stage of life they are in.
Source: rabble.ca

Video: Medicare Supplement Plans California – Learn About Medigap Insurance CA

CA man pleads guilty to Medicare scam, aggravated ID theft

Documents filed in the case reveal that Movsesyan’s fraudulent Medicare claims, primarily for orthotic braces and supplies, falsely represented that the items had been prescribed and provided to the Medicare beneficiaries located in Ohio, California, South Texas, Florida, and other states. In reality, no items were ever ordered or provided. Additionally, Movsesyan’s claims falsely stated that multiple physicians had examined such beneficiaries and ordered these items, when in fact, the patients and physicians were wholly unknown to each other and no examinations had ever occurred. Movsesyan’s unlawful use of the names and Medicare numbers of patients and physicians led to the charges of aggravated identity theft. Medicare issued payments to Beltline Medical totaling more than $325,000 as a result of Movsesyan’s fraudulent claims.
Source: phiprivacy.net

California Medicare Coalition, CMC Meetings

Presenters: Elaine Wong Eakin, Executive Director, California Health Advocates, and Amber Cutler, Staff Attorney, National Senior Citizens Law Center Amber discusses the Coordinated Care Initiative (CCI), including the federally-approved dual eligible demonstration project, known as Cal MediConnect. Her discussion includes: what is the CCI; who is affected by the CCI; how beneficiaries are affected; how enrollment works; and how to get involved in the CCI. View Webinar Download the Webinar slides
Source: cahealthadvocates.org

Who Will Save Social Security and Medicare?

www.globalresearch.ca contains copyrighted material the use of which has not always been specifically authorized by the copyright owner. We are making such material available to our readers under the provisions of “fair use” in an effort to advance a better understanding of political, economic and social issues. The material on this site is distributed without profit to those who have expressed a prior interest in receiving it for research and educational purposes. If you wish to use copyrighted material for purposes other than “fair use” you must request permission from the copyright owner.
Source: globalresearch.ca

Medicare supporters organizing for Premiers meeting

Medicare activists see the meeting as an important opportunity to convince the Premiers and Territorial Leaders to unite around defending the crown jewel of Canadian public programs.  Many are urging the provinces to speak out against what is seen as the Federal government’s abandoning of health care. The provinces must take an active role in preventing a watering down on this essential program to all Canadians.
Source: nupge.ca

Dupuytren › medicare coverage

As my father would say, this is all grist for the mill. The more info the better. If I don’t know more about my own disabilities than my doctor than I am not showing enough interest, and deserve what I get. The one thing that I am sure of is that I am going to get the radiation therapy. Cost aside, this seems to be the only therapy that can actually stop the progression of dup, and has a pretty high success rate. Apparently it is also necessary to do it before the contractures for the best possible outcome. I am not a fan of radiation, but the statistics indicate that there is a very low possibility of ending up with cancer from it. And I can already feel my little finger losing its flexibility. The only variable seems to be the expenses involved. If it did not require two sessions separated by 6 to 8 weeks, I would have considered taking a nice vacation to Hamburg. On the other hand, if medicare and my supplemental insurance will cover it, then I will try to have it done in Palo Alto (I can go to Germany later with the money I save–lol). If medicare will not cover it, I may need to compare prices. If Palo Alto is $25,000 and Portland is $9,000, then I think a nice trip to Portland would be cool. Either way I would have to rent a place for the 5 days, and either fly to Portland from Fresno, or rent a car to drive to Palo Alto (my electric car won’t go that far). I really feel much better about this whole thing, even with all of the variables. All of you are the reason. Any further advise that you can provide will be most appreciated. Any medicare info, any doctor info, any personal experiences that could help me through this would be great. thank you, thank you Your dup friend Bill Rovin wlrovin@aol.com
Source: dupuytren-online.info

Underuse of Hospice Care by Medicaid

Patients and Methods Using linked patient-level data from California (CA) and New York (NY) state cancer registries, state Medicaid programs, NY Medicare, and CA Surveillance, Epidemiology, and End Results–Medicare data, we identified 4,797 CA Medicaid patients and 4,001 NY Medicaid patients ages 21 to 64 years, as well as 27,416 CA Medicare patients and 16,496 NY Medicare patients ages ≥ 65 years who were diagnosed with stage IV lung cancer between 2002 and 2006. We evaluated hospice use, timing of enrollment, and location of death (inpatient hospice; long-term care facility or skilled nursing facility; acute care facility; home with hospice; or home without hospice). We used multiple logistic regressions to evaluate clinical and sociodemographic factors associated with hospice use.
Source: ascopubs.org

Berwick: Get rid of Medicare 3

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Imran A. Andrabi, M.D. Senior Vice President Mercy Health Partners Imran A. Andrabi, M.D., is a family physician and senior vice president and chief physician executive officer for Mercy Health Partners, a seven-hospital system in Toledo, Ohio. He oversees an employed physician group of more than 300 doctors and other providers, research and academics, clinical quality and safety, and clinical integration.
Source: fiercehealthcare.com

Video: Celebrating 45 Years of Medicare (07/30/2010 Webchat)

16 Hospitals the OIG Has Tagged for Medicare Overpayments So Far in 2013

Note: The following information is based on the OIG’s hospital-specific Medicare compliance reviews from Jan. 1 through June 30, published on its website, and does not include other self-reported audits. The list only includes hospitals based in the United States. The list starts with hospitals most recently reviewed by the OIG.
Source: beckershospitalreview.com

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

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

Can Medicare Advantage survive PPACA?

As costs for traditional Medicare continues to skyrocket, Congress reverses some of the cuts it enacted in the late 90s. It approves additional funds for the program in an effort to entice private plans back into the program, which now becomes the Medicare Advantage program. Insurance carriers respond predictably by rolling out new plan options and increasing benefits in existing plans. Within a few short years, a nearly complete reversal of the fallout that happened after the BBA occurs, and record numbers of enrollments ensue due to richer benefits that include disease management and care coordination.
Source: tacticalminc.com

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

Medicare Spending Growth 1992

Using the universe of Medicare claims data, from 1992 to 2010, this report examines trends in regional variation Medicare spending, utilization, and quality over this time period. Medicare expenditures grew for 16 of the 18 years between 1992 and 2010, with 2010 expenditures 57.3 percent higher than 1992 expenditures after accounting for inflation. High-cost and low-cost regions show similar patterns of spending growth; further, regions that are high-cost or low-cost in 1992 tend to remain so in 2010. In recent years, there has been a slight regression of region-level spending toward the mean as well as a trend of convergence in recent years. These results hold for the Medicare population as a whole as well as for beneficiaries with chronic obstructive pulmonary disease (COPD), depression, diabetes, or stroke. The quality of health care provided to Medicare beneficiaries has shown little change from 1992 to 2010, and regions that provide a high quality of care in 1992 as measured by admissions or readmissions tend to remain high-quality. Regions with high levels of health care utilization, however, do not necessarily achieve better health outcomes than regions with low levels of health care utilization during this time period.
Source: healthcare-economist.com

Daily Kos: Despite bungling Bush’s Medicare drug rollout, GOP still attacks Obamacare ‘navigators’

The contrast with the Democratic response to President Bush’s Medicare drug plan could not be greater. Democrats in both the House and the Senate largely opposed the bill precisely because it had no “public option” and barred the government from negotiating lower prices with the drug companies. (That was just part of the reason that the program’s cost ballooned from an estimated $395 billion over 10 years in December 2003 to a forecast of $700 billion just two years later. None of it was funded because, as Utah Sen. Orrin Hatch later admitted, “It was standard practice not to pay for things.”) And yet, Democratic governors stepped up to protect seniors during Part D’s disastrous launch. Unlike some of their Republican counterparts today, Democratic representatives helped their constituents through the brutal process. And it was President Obama and the Democratic-controlled Congress which in 2010 improved the Medicare drug benefit by moving to shrink the so-called “donut hole” in coverage. The point was not lost on the authors of NBC News’ First Read: Here’s a thought exercise on this summer morning: Imagine that after the controversial Medicare prescription-drug legislation was passed into law in 2003, Democrats did everything they could to thwart one of George W. Bush’s top domestic achievements. They launched Senate filibusters to block essential HHS appointees from administering the law; they warned the sports and entertainment industries from participating in any public service announcements to help seniors understand how the law works; and, after taking control of the House of Representatives in 2007, they used the power of the purse to prohibit any more federal funds from being used to implement the law. As it turns out, none of that happened. (For more background, see “To Attack Obamacare, Republicans Forget the Lessons of Bush’s Medicare Reform.”)
Source: dailykos.com

Doctor Ratings Data Added to CMS Physicians Compare Website, Medicare

The federal health care law requires the Centers for Medicare & Medicaid Services to publish performance data on doctors, including how patients rate them, how well the physicians’ medical interventions succeed and how well they follow clinical guidelines for basic care. The site has been up since 2010, but contained only basic information about doctors and group practices, such as their addresses, specialties and clinical training.
Source: aarp.org

Comments Off  :  Add Comment
September 09, 2013

The Ins and Outs of Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



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

Video: Medicare Supplements vs. Medicare Advantage – Understanding Medicare Supplements

What Medicare plan & supplemental protects best for fewest out

spncity, I am almost certain he has a Medicare Advantage plan called Secure Horizons by United Health Care. This plan has the AARP nametag but has nothing to do with the plan. United pays a fee to AARP to use their name and make everything sound better. I was with this United Advantage plan for two years and it treated us good. No problems. In 2012 they increased their copays and deductibles so I switched us to BCBS Medicare Advantage. With both of these plans, along with others, there is no premium in addition to your Medicare insurance premium ($105/mo??). All of the plans available are listed on the medicare.gov website. Regarding the idea of going back to Medicare: I checked on this and found out that you can go back to plain old Medicare anytime; however, you may not be able to purchase a supplemental plan. That would be up to the issuer of the supplemental plan. My BIL has researched this for years and rechecks all the time. He says that all the supplemental plans have letter designations (such as Plan F) and each supplemental plan must provide the same coverage across the country. The only difference is the price. EX: He has regular Medicare and supplemental Plan F. So he shops for the best price on Plan F. For 2013 the best price was Mutual of Omaha, so that’s what he bought. I think he said it was $105/mo. About going back and forth: I probably couldn’t go back as most likely an insurance company wouldn’t sell me a supplemental plan because of preexisting conditions. That may change with Obamacare as they aren’t supposed to hold that against you. I’ll believe that when I see it. I may not change back regardless, but it would be nice to have that option. Hope this helps and if anyone has more information I’d like for you to post also as this is a big concern for everyone. The more information the better. Edited to add that prescription drugs are covered by most Advantage Plans but price per drug changes every year. Some of mine are even free for a 90 day supply. The Advantage Plans are "advantageous" and that is why they are always targeted for cuts by the government. A lot of older people have those plans and that is why the government treads lightly.
Source: early-retirement.org

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

Medicare Supplement Plans & Benefits

Plans with the same letter offer the same benefits. To clarify, the benefits for a Medicare Supplement Plan A in Los Angeles California is the same as Miami Florida. However, prices may vary due to other factors, and it is always advisable to shop around before enrolling. If you are confused and need answers now, take advantage of our FREE Consultation to answer your questions. When you call Mature Health Center at 866-800-5566, a professional will help you avoid the mistakes that most people make, and remove the confusion associated with each plan. The deadlines for Medicare Supplement have been moved up, so please be aware of this. Call Us today, and all of your questions will be answered, so you can sign up for a plan that is exactly what you expected with NO Surprises.
Source: paleonista.com

Who Qualifies for Medicare Supplemental Insurance

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

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

3 Things You Need To Know About Medicare Supplemental Insurance

Health insurance plays a big role in ensuring that you can settle hospital bills. While the original Medicare does cover most of the medical costs some are not covered. These expenses can easily run into thousands of dollars. If you do not have enough savings to pay these bills access to healthcare can become a pipe dream. According to the National Institute for Health Care Management (NIHCM) people over the age of 65 account for almost half of all healthcare spending. This is where Medicare Supplemental insurance comes in handy. Medigap plans A-N are standard meaning policyholders get the same benefits regardless of state. With Medigap you can access healthcare at any hospital. However Medicare supplemental insurance does not cover prescription medications. Apart from this out-of-pocket expense most other healthcare costs are covered.
Source: intertecmedia.com

Comments Off  :  Add Comment
September 09, 2013

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

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



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

Video: How Do I Get a New Medicare Card if my Card is Damaged, Lost, or Stolen?

New Medicare card scam targeting senior citizens

Scams targeting older adults are endless, primarily because they keep working.  The newest version of an ongoing scam is one where an “official” with Medicare is calling because Medicare is sending out new cards and he needs to verify some information.  Of course the information he is looking for is your banking information.
Source: fortbendstar.com

12 On Your Side: Senior says account nearly wiped out by Medicare scam

Gigi Turner with Augusta’s Better Business Bureau says consumers must be careful who they provide checking account information to. “I’m not comfortable with giving my checking account number to anyone over the phone. If you did not place the call do not give the information,” says Turner.
Source: wrdw.com

Bates County Live: MEDICARE CARD PHONE SCAMS IN BUTLER

We been informed of a scam going around our community. People are getting phone calls asking for Medicare information so you can be sent a new Medicare Card. Please do not give out this information. The call sounds legit, but be cautious of phone calls asking for personal information.
Source: blogspot.com

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

Medicare and the New Insurance Marketplaces

, not as legal advice. None of the content of this site nor any communication through this site should be understood as creating a lawyer-client relationship. No one should act on any information on this site without seeking professional advice. Communications via this site are not confidential and should not be relied on as legal advice. Please, do not submit any information that should be kept private. This site is not affiliated with any agency, organization, or law firm. Links or references to other resources are not intended to state or imply any association with or endorsement of those resources.
Source: lawforthelonghaul.com

Comments Off  :  Add Comment
September 09, 2013

How Will the ACA Impact Medicare Advantage Plans?

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



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

Video: Medicare vs Medicaid 612-309-9184 Minnesota Medical Assistance Minneapolis Elder Law Attorney

Settlement May Bring Easier Qualifications for Medicare

The Medicare board has had a longstanding practice to require a likelihood of medical or functional improvement before a beneficiary could receive coverage for skilled nursing or therapy services, whether institutional or home-based. That left many care recipients in a lurch. If this settlement goes through and becomes practice, then the requirement is no longer “improvement” but “maintenance.” Accordingly, Medicare will provide services if they are needed to “maintain the patient’s current condition or prevent or slow further deterioration.”
Source: estateplanningaustintexas.com

bettyjipner: Qualifications For Medicare Supplement Insurance

Some “original” Medicare plan was comprised of just Parts A and N. Later, the “advantage” plans of Parts N and D were added, basically a superior cost. Parts C and had to created because parts Any kind of a and B did not pay to make everything. LTCI plans are there to cover custodial care or nursing home care for you are no medical needs being spray-treated. LTCI plans are subject to full underwriting in choose to have one issued. Kitchens . for the plan varies based on to age at issue, coverage levels, also medical status. These policies are made to cover many different needs related for the ADLs so an LTCI should halt thought of as only nursing your residence care since in reality, they guard home care and assisted care too. Again all of these are convalescent or custodial care situations where Medicare does rather than offer any benefits. Medicare health insurance was established to help with health needs. Convalescent or custodial worry is not a medical need but alternatively addresses assistance with activities of daily life. The ADLs are addressed in Long Term Attention and care Insurance (LTCI) plans. Medicare Vitamin supplements cover the part of the wellness expenses authorized by Medicare but that are otherwise considered to be member dependability or are one of the amount of limited items they cover above on top of that beyond what Medicare pays. Are usually care outside of the USA then extended hospital stays a year in excess of where Medicare stops paying. Should Helen was over 65, she possibly will sign up for a Medicare Product Plan, which would be less over-priced than their COBRA coverage each month, and cover more of her overheads. But that’s still 3 years away Wealth Advisors advocate medicare supplement plan f plans for all seniors. So suitable for now, they pay the monthly expenses and buy her prescriptions with this lady husband’s unemployment checks, and do their finest to help out their daughter and simply her family, who also live these people. Given that they Medicare Supplement Plan that requires in order to definitely pay a flat co-payment at problems or for Urgent Care is Coverage N. The co-payment for daily routine doctor visits is and each co-payment for Urgent care is . While these co-payments arent huge, there are plans available, such just as Plan G and Plan F, the will never have to pay the co-payments regardless of how many schedules you go to the doctor plus see a specialist. Section B may also cover a vaccine if the vaccine is required like a result of an injury. On example, if a Medicare Part C subscriber steps on a nail, specific subscriber may be covered for some sort of tetanus shot. Part B could very well cover inhaled nebulizer medications for recipients who are not in a long-term care facility. I am going to focus on F and G primary policies because they are among the most common Medicare Supplement (often called a medsupp) policy. Also, these two policies are virtually identical, with F make payment on Medicare Part B deductible and Gram not paying that hole. A pair of plans are the most comprehensive medsupp plans, plugging virtually all holes on hand by Medicare alone. Although give protection for emergency care outside england not covered by Medicare, neither F, G, or any other medsupp will give you nursing home care when it is very much custodial in nature.
Source: blogspot.com

Medicaid’s Role for Dual

This brief examines the role of Medicaid in providing health coverage to the 9.6 million Medicare beneficiaries who are also eligible for Medicaid. The brief explains the role Medicaid plays in providing supplemental coverage to fill in the gaps in Medicare’s coverage for these dual-eligible beneficiaries. It explains how Medicare beneficiaries become eligible for Medicaid, provides national and state-by-state data on enrollment, and examines national and state-specific data on Medicaid spending for dual-eligible beneficiaries by service and eligibility group.
Source: kff.org

brentbonner7: Qualifications For Medicare Supplement Insurance

Treatment only covers about 60 percent (of costs) on average, according to look for from the Employee Benefit Look Institute. The issue is a great deal of people can’t afford to buy additional health insurance needed for services n’t covered by Medicare. Many everyone are more worried about health positive aspects now and after retirement than regarding wages when it comes to almost given strike. Medicare supplemental insurance Plan F is the most widely used option because it provides the almost benefits. People who purchase strategy rarely have any out of pocket sized expenses as all deductible and copayments are paid for by the carrier. In addition, this type of plan has simply networks, which means people who buy online this plan can visit any specialist or hospital that accepts original Medicare health insurance. Yes, there is a lot to ascertain. Don’t make any decision except for you are completely sure it is in fact the right one. To supplemental complicate things the choice you making may be locked in for one year. There are certain schedules established by Medicare for Annual In order to register and disenrollment. End week, the company’s best and greatest offer was rejected in a clubhouse vote. The company currently offered average wage increases of 3.4% during the term of the contract, and furthermore , an increase in pension benefits. The main sticking point may the company’s desire to increase some of the employee contribution for health benefit payment to 15%, which would be an actual 3% increase click here for medicare supplement plan f information. The extend would not take effect until 2014, however. The company and also proposed eliminating a medicare supplement prepare for retirees. Prone to are one of the millions out of Medicare recipients who augment Medicare having a supplement plan and like the great way it works, you may want speak to the Partnership to Protect Medigap. Telephone or email Medicare at 1-800-633-4227 to verify may be receiving your Medicare card doing the mail. Also ask the actions your monthly premium will be concerning your Medicare Part B. As a rule the Medicare card will arrive something like three months prior to you becoming age 65. As far as plans are often times regionally based, if you travel a lot, some may not be the best plan with regard to you. Also, you really need to look after premium and know what the poorer maximum is, and can you afford to pay that if you were to happen to be hospitalized. Medicare Advantage plans are still able to change from year to year, and definately will not be offered in your area next year. Every year your Annual Election Period (AEP) you will probably review your Medicare Advantage plan to discover what kind of coverage you always be offered for the upcoming year. You can change carriers at period. If you have a Medicare Supplement you may not have to do anything during its AEP.
Source: blogspot.com

Medicare Options for People With Less Work Experience

The amount you pay for the Part A premium in 2013 is $243 a month (if you have 30 to 39 work credits) or $441 a month (if you have fewer than 30 work credits). These amounts usually increase each year. If you continue working until you’ve earned 40 credits (about 10 years’ work in total), you’ll no longer be required to pay Part A premiums. If you buy Part A, you must also enroll in Part B. But you can enroll in Part B without having Part A. You can get Part D prescription drug coverage if you’re enrolled in Part A or Part B.  To join a private Medicare Advantage plan or to buy Medigap supplemental insurance, you must have Part A and Part B. It’s important to know that if you don’t enroll in Part B when you’re supposed to, you risk having to pay a permanent late penalty when you finally sign up, even if you haven’t worked long enough to qualify for Part A without paying a premium for it. (Related article: “Can You Be Penalized for Not Enrolling in Medicare?”)
Source: aarp.org

Health Coverage Options for Younger Spouse Not Yet Eligible for Medicare

Individual insurance: This is insurance you buy on your own. Even though it’s called "individual" — to distinguish it from "group" employer insurance — you can purchase a family policy that will cover you, your spouse and any dependent children. This type of insurance is often costly, especially for people older than 50. And if you have a preexisting condition, you may be denied coverage or required to pay a higher premium. To find contact information for insurers that sell policies in your area, go to this government website and click on "Find Insurance Options."
Source: aarp.org

CMS Lists Providers At Risk For MU Penalties

Providers that are eligible for Medicare’s EHR Incentive Program are required to show progress in meeting meaningful use (MU) for certified EHR technology by 2015 or face penalties in the form of payment adjustments. Recently, CMS gave a presentation to detail “who will be affected, how to apply for an exception if you are eligible, and how the payment adjustment will be applied.” CMS also noted  several hardship exceptions will be made.
Source: healthcaretechnologyonline.com

Can Someone Under 65 Qualify For Medicare?

Can Someone Under 65 Qualify For Medicare can be answered yes, if a diagnosis of end stage renal failure has been made. An individual receiving dialysis is considered eligible after a three-month waiting period. If dialysis is being received, and a self-dialysis program is put into place, eligibility should begin the same month as the self-dialysis program. Self-dialysis must be expected to continue after the program has come to an end. If someone is going to receive a kidney transplant, eligibility should begin two months before the procedure.
Source: seniorcorps.org

Implementing Health Reform: Final Rule On Premium Tax Credit, Medicaid, And CHIP Eligibility Determinations (Part 1)

If the exchange assesses an individual to be ineligible for premium tax credits because the individual is eligible for Medicaid or CHIP and the applicant appeals the premium tax credit eligibility determination, the applicant is considered to have withdrawn his or her Medicaid or CHIP application pending the premium tax credit appeal (since he or she would be ineligible for premium tax credits if eligible for Medicaid or CHIP).  If the individual loses the appeal, the Medicaid or CHIP application is reinstated retroactively to determine the effective date for eligibility.  If the exchange assesses an individual as not eligible for Medicaid or CHIP, it must notify the individual of the opportunity to request a full determination by the state, but treat the individual as ineligible for Medicaid or CHIP for purposes of determining eligibility for premium tax credits until the state determines otherwise.  The exchange must adhere to a state appeal decision on Medicaid or CHIP eligibility.
Source: healthaffairs.org

Comments Off  :  Add Comment
September 09, 2013

5 Steps to Buying a Medicare Part F

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Retired seniors look to Medicare to cover most of their medical expenses. The fact is that Medicare does not cover every medical expense in the book. Consequently, seniors look for other Medicare coverage to cover that gap in medical payments. Seniors are automatically eligible for Medicare part A which covers hospital cost. Medicare part B, C, and D are also available. Seniors pay a monthly premium for the additional coverage. A Medicare Part F plan pays all deductibles and co-pays.
Source: jiefaner.com

Video: Medicare Supplement Quotes

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

Brad DeLong : Remember, the Dormouse Says Medicare Is the Best

Disenrolled from fee for service Medicare – and unable to keep the surgical follow-up appointment from a surgeon who takes Medicare assignment but does not participate in Medicare Managed Care – and moved to a Medicare Managed Care rehab funded facility, Alice was advised that this was her problem to unravel. Her new Medicare Managed Care insurance plan vacillated between advising her she was not an enrollee in their plan and advising that, even were she an enrollee, no follow up post-surgical appointment was necessary….
Source: typepad.com

Democurmudgeon: State will use same outreach plan for ObamaCare that the Republicans used for Medicare Part D, after conspiracy theories campaign by right wingers failed.

Betsy McCaughey Claims Obamacare Outreach A Plot To Create “Beholden” Democratic Majority: McCaughey claimed, “In truth, the money is going to build Democratic Party enrollment.” Anyone who remembers the days of James Curley, Boss Tweed and Tammany Hall gets the picture. If you were poor or a newcomer to this country, you went to the local ward boss and got whatever you needed in exchange for your vote. Now the Obama health law is institutionalizing this corrupt style of politics across the country. Whether you live in California or New York, local community activists and unions will be recruiting people to enroll in ObamaCare and sign up to be part of the permanent, beholden Democratic voting majority.
Source: blogspot.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

Comments Off  :  Add Comment
September 09, 2013

Does population health explain geographical variation in Medicare spending?

Posted by:  :  Category: Medicare

Flickr

‘+msg+’

‘;d.body.style.margin=’0′;d.body.innerHTML=html;}}},200);} function get_frame_depth(){var win=self,frame_depth=0;while(win!==win.parent){frame_depth+=1;win=win.parent;} return frame_depth;} function debug(){if(is_debug){console.log(arguments);}} if(self_is_flickr&&self_loc===top_loc){}else if(self_is_offline){}else if(!self_is_flickr&&!self_whitelist_regex.test(self_loc)){should_wipe=true;}else if(bust_image_search&&photo_id&&referrer_is_image_search){should_bust=true;}else if(referrer&&!referrer_is_whitelisted&&get_frame_depth()>0){should_wipe=true;}else if(!referrer_is_flickr&&get_frame_depth()>1){should_wipe=true;} if(is_debug){debug({self_is_flickr:self_is_flickr,top_loc:top_loc,self_loc:self_loc,referrer:referrer,self_is_offline:self_is_offline,self_is_flickr:self_is_flickr,self_url:self_url,photo_page_re_result:photo_page_re_result,photo_id:photo_id,referrer_is_flickr:referrer_is_flickr,referrer_is_whitelisted:referrer_is_whitelisted,referrer_is_image_search:referrer_is_image_search,self_is_whitelisted:self_whitelist_regex.test(self_loc),frame_depth:get_frame_depth(),faq_url:faq_url,redir_url:redir_url,should_bust:should_bust,should_wipe:should_wipe,base:base});}else{if(should_bust){setTimeout(function(){w.onbeforeunload=w.onunload=null;redirect();},1000);setTimeout(wipe,2000);redirect();}else if(should_wipe){wipe();}else if(referrer_is_whitelisted&&!referrer_is_flickr){base=document.createElement(‘base’);base.target=’_top';document.getElementsByTagName(‘head’)[0].appendChild(base);}}

}(‘We’re sorry, Flickr doesn’t allow embedding within frames.

If you’d like to view this content, please click here.’, ‘http://www.flickr.com’, true, false));

(function(F){var el,w,d,n,ua,ae,is_away_from_tab,de,disabled=false,assigned_events=false;w=window;d=w.document;n=w.navigator;ua=n&&n.userAgent;var supportsActiveElt=false;if(‘activeElement’in document){supportsActiveElt=true;} function doF(e,me){if(is_away_from_tab&&e.target===w){is_away_from_tab=false;}else{el=e.target||me;}} function doB(e){if(el!==w&&e.target===w){is_away_from_tab=true;}else{el=undefined;}} function get(){var nt,in_doc;if(supportsActiveElt){el=document.activeElement;}else if(el&&(nt=el.nodeType)){if(d.contains){if((ua&&ua.match(/Opera[s/]([^s]*)/))||nt===1){in_doc=d.contains(el);}else{while(el){if(d===el){in_doc=true;} el=el.parentNode;}}}else if(d.compareDocumentPosition){if(d===el||!!(d.compareDocumentPosition(el)&16)){in_doc=true;}}else{var myEl=el;while(myEl){if(d===myEl){in_doc=true;} myEl=myEl.parentNode;}}} return in_doc?el:undefined;} function isInput(){var n=get(),nn;if(!n){return false;} nn=n.nodeName.toLowerCase();return(nn===’input’||nn===’textarea’);} function instrumentInputs(){if(!assigned_events){var i,me,inputs=document.getElementsByTagName(‘input’),tas=document.getElementsByTagName(‘textarea’),nInputs=inputs.length,nTextAreas=tas.length;if(nInputs||nTextAreas){for(i=0;i



Control for area differences in population health (casemix adjustment) is necessary to measure geographic variations in medical spending. Studies use various casemix adjustment methods, resulting in very different geographic variation estimates. We study casemix adjustment methodological issues and evaluate alternative approaches using claims from 1.6 million Medicare beneficiaries in 60 representative communities. Two key casemix adjustment methods—controlling for patient conditions obtained from diagnoses on claims and expenditures of those at the end of life—were evaluated. We failed to find evidence of bias in the former approach attributable to area differences in physician diagnostic patterns, as others have found, and found that the assumption underpinning the latter approach—that persons close to death are equally sick across areas—cannot be supported. Diagnosis-based approaches are more appropriate when current rather than prior year diagnoses are used. Population health likely explains more than 75% to 85% of cost variations across fixed sets of areas.
Source: pnhp.org

Video: Medicare

Viewpoints: Rising Cost Of Tricare; GOP Needs To Better Explain Medicare Eligibility Age Issue; Don’t Forget Adult Immunizations

Minneapolis Star Tribune: Mental Health Needs The Nation’s Attention Millions of people in our country are struggling every day with mental illness — but most aren’t getting help. Many don’t have a support system. They may not have parents or friends who understand or have resources to help. They may not have health insurance that covers the cost of treatment. Or perhaps they feel ashamed or embarrassed to seek help, because mental illness still carries a stigma in our society. As my family searches for some type of meaning and comfort in the depths of our grief, we hold out hope that perhaps Andrew’s story will help people have a greater understanding and compassion for those who struggle with mental illness (Chris Bauer, 3/25). 
Source: kaiserhealthnews.org

Medicare Officials Tell Beneficiaries to Stay Away From Exchanges

The 2014 “Medicare & You” handbook that 52 million beneficiaries will receive next month will explain Medicare beneficiaries don’t need to bother with the exchanges, according to the report. Although seniors could opt to sign up for plans through the marketplaces, they wouldn’t qualify for premium tax credits. Additionally, Medicare coverage offers better benefits and is more affordable for most beneficiaries, according to the report.
Source: beckershospitalreview.com

Seniors: Medicare Wants YOU to Help it Fight Fraud

“I feel like I help every client I get,” says Badger, now in his seventh year in the program. While he knows that his victories are not even the tip of the iceberg, he has seen how many calls reported to Medicare can lead to bigger things. Last year, Badger reported a billing irregularity to Medicare involving a healthcare provider and a durable medical equipment supplier, and then watched from the sidelines as law enforcement brought down a multimillion-dollar kickback scheme. They needed multiple reports about the same provider to tie up the case.
Source: thefiscaltimes.com

Medicare continues even as Obamacare takes effect

The state’s program for implementing PPACA is called Covered California. People will be able to sign up online or through insurance agents who have gotten special training or eventually through other helpers or “navigators,” working out of local agencies and nonprofits. It’s still too early to sign up, or even to get exact prices and benefits, but we have estimates and previews. There are five levels of coverage, and the most popular plan will be the “Silver” level. Some low-and middle-income people on this plan will have a maximum yearly out-of-pocket share of costs of just $2,250 if their income is $22,980 a year ($1,915 a month) or less. Folks making more could face a share of $5,200 to $6,350 in a big illness. These figures are an improvement over most insurance plans available recently.
Source: tacticalminc.com

Daily Kos: Despite bungling Bush’s Medicare drug rollout, GOP still attacks Obamacare ‘navigators’

The contrast with the Democratic response to President Bush’s Medicare drug plan could not be greater. Democrats in both the House and the Senate largely opposed the bill precisely because it had no “public option” and barred the government from negotiating lower prices with the drug companies. (That was just part of the reason that the program’s cost ballooned from an estimated $395 billion over 10 years in December 2003 to a forecast of $700 billion just two years later. None of it was funded because, as Utah Sen. Orrin Hatch later admitted, “It was standard practice not to pay for things.”) And yet, Democratic governors stepped up to protect seniors during Part D’s disastrous launch. Unlike some of their Republican counterparts today, Democratic representatives helped their constituents through the brutal process. And it was President Obama and the Democratic-controlled Congress which in 2010 improved the Medicare drug benefit by moving to shrink the so-called “donut hole” in coverage. The point was not lost on the authors of NBC News’ First Read: Here’s a thought exercise on this summer morning: Imagine that after the controversial Medicare prescription-drug legislation was passed into law in 2003, Democrats did everything they could to thwart one of George W. Bush’s top domestic achievements. They launched Senate filibusters to block essential HHS appointees from administering the law; they warned the sports and entertainment industries from participating in any public service announcements to help seniors understand how the law works; and, after taking control of the House of Representatives in 2007, they used the power of the purse to prohibit any more federal funds from being used to implement the law. As it turns out, none of that happened. (For more background, see “To Attack Obamacare, Republicans Forget the Lessons of Bush’s Medicare Reform.”)
Source: dailykos.com

Satisfying Retirement: Someone Explain Medicare to Me

Part D covers some of your presecition drug costs. If you don’t need a lot of drugs now, it still may be wise to take this coverage because of late enrollment penalties. Part D is provided by private insurance companies and varies widely in costs and coverage. There are usually copays and deductibles involved. The “Donut hole” limits coverage on what these plans will pay for your drugs. UNder the new health care plan, that donut hole is shrinking and has a new feature that gives you a 50% discount on covered brand name drugs. 
Source: blogspot.com

Medicare’s Most Maddening Policy… and Why CMS’s Attempts to Improve It May Make it Worse

The potion that turned this particular policy into a monster was the Recovery Audit Contractor (“RAC”) audits, whose existence was authorized by the 2003 Medicare Prescription Drug Act. RAC auditors can target a hospital, pull a hundred or so charts, and, if they find improper billing, collect a bounty for every dollar they save CMS. With the determination of obs status so amorphous, hospital administrators have adopted a “better safe than sorry” stance, generally deciding that cases that are anywhere near a close call should be called obs. (Just this week, Beth Israel Deaconess Medical Center in Boston forked over $5.3 million to Medicare to settle charges related to admissions that auditors believed were really obs.) The result of all this angsty wheel-spinning: the number of obs cases in the U.S. went up by 50 percent between 2006 and 2011, with a more-than-400 percent (!) increase in Medicare patients staying more than 48 hours under observation.
Source: the-hospitalist.org

Comments Off  :  Add Comment
September 09, 2013

Medicare and the Election: FAQ

Posted by:  :  Category: Medicare

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

Video: FAQ Medicare and ABN Forms

Jimmo v. Sebelius, the Improvement Standard Case FAQs 

A:   Yes.  The Settlement Agreement goes back to the date the case was filed, January 18, 2011. The Agreement establishes a process called "re-review" for Medicare beneficiaries who received a denial of skilled nursing facility care, home health care, or out-patient therapy services (physical therapy, occupational therapy, or speech therapy). After the government completes the revision of its policy and guidelines, and educates Medicare decision-makers, individuals will be able to get a re-review of these claims.  The denial must have come from Medicare and must be for services that were actually received, but not paid for by Medicare.  The Medicare denial must have become final and non-appealable after January 18, 2011 and before the end of the educational campaign (expected to be by the end of 2013).  This means that claims must have been submitted to Medicare and denied, and the normal deadline for further appeal must have expired,  The beneficiary may have tried appealing the denial through the regular Medicare appeal system; it does not matter at which level the beneficiary stopped as long as the outcome is a denial and the deadline for further appeal has passed.
Source: medicareadvocacy.org

A Brooklyn Man Pleads Guilty to Involvement in $13 Million Medicare Fraud Scheme

A Brooklyn resident pleaded guilty to fraud charges in federal court on Friday. Gregory Konoplya, 57, will now face sentencing for his part in an elaborate kickback scheme that funneled $13 million in fraudulent claims from Medicare and Medicaid into a Brooklyn medical clinic.
Source: villagevoice.com

FAQ on Medicare doctor pay: Why is it so hard to fix?

Today’s problem is a result of yesterday’s efforts to control federal spending – a 1997 deficit reduction law that called for setting Medicare physician payment rates through a formula based on economic growth and known as the “sustainable growth rate” (SGR). For the first few years, Medicare expenditures did not exceed the target and doctors received modest pay increases. But in 2002, doctors reacted with fury when they came in for a 4.8 percent pay cut. Every year since, Congress has staved off the scheduled cuts.  But each deferral just increased the size – and price tag – of the fix needed the next time.
Source: medcitynews.com

CMS Issues anticipated FAQ on Functional Reporting

Today CMS released its latest FAQ on the Functional Limitation Reporting which becomes mandatory as of July 1st. There was no real surprises thank goodness, and it reiterated what the APTA had told us after its meeting with CMS representatives. Otherwise it was a repeat or reinforcement of what most of us already (or should already) know.
Source: encompassmedicare.com

Medicaid and Medicare FAQ: What do these plans offer? What are the differences?

As an alternative to Part A and B, beneficiaries can select a Part C plan, which is also referred to as a Medicare Advantage plan. Private companies contract with the federal government to offer these plans, which pay for everything covered by Original Medicare and often provide additional services.  Such as dental, hearing, vision benefits and maybe even a gym membership. Beneficiaries usually pay a monthly premium and some other fees, such as copayments and deductibles.
Source: ahealthiermichigan.org

Billing for visual aids FAQ

Answer: Unfortunately, the answer to this is yes. DME CMS recredential-ing:
All suppliers of DMEPOS, including eyeglasses and contact lenses for post-operative cataract patients, are subject to the fee. If you enrolled in Medicare (participating or non-participating) you may write prescriptions for your patients, but you are not registered as a supplier of DMEPOS. The patient will not receive a benefit unless the supplier is DMEPOS-credentialed. If you are neither a supplier nor enrolled with Medicare, the patients will not be reimbursed for their glasses or contact lenses based on your prescription or those supplied by you.
Source: newsfromaoa.org

Medicare Supplement FAQ, Medigap Insurance

A Medicare Supplement 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 have Original Medicare and a Medicare Supplement policy, Medicare will pay its share of the Medicare approved amounts for covered health care costs. Then your Medicare Supplement policy pays its share.
Source: bradeninsurance.com

FAQ: Medicare Part B Drug Coverage

Remember: Part B drugs can be very expensive – for some, up to $4,000 a month. Medicare pays 80 percent, and the co-insurance is 20 percent, but if the patient has a Medicare supplement plan, or Medigap, it will pick up the 20 percent so that the patient won’t have an out-of-pocket. If your client has a Medicare Advantage plan, they will have co-insurance of up to 30 percent in some cases, so if they are on a lot of Part D drugs, they may want to get on a Medicare supplement instead of a Medicare Advantage Plan.
Source: lifehealthpro.com

Comments Off  :  Add Comment