Medicare Open Enrollment Period Begins Oct. 15, 2013

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Medicare recipients reaching the drug donut hole will benefit from lower costs. The gap in prescription drug coverage starts when someone reaches the initial coverage limit, estimated at $2,850 in 2014. It ends when they have spent $4,550, when catastrophic coverage begins. (These are reductions of $120 and $200, respectively, from 2013.) During the donut hole, all costs are covered by individuals out of their own pocket. In 2014, those who reach the donut hole can receive a 52.5 percent discount on brand-name drugs and 28 percent discount on generic drugs (an increase from 21 percent in 2013).
Source: disabled-world.com

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

Projecting Medicare Advantage Enrollment: Expect the Unexpected?

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

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Source: federaldaily.com

Sightings Over Sixty: Tips for Enrolling in Medicare

. This part of Medicare is actually something separate. It is a Medicare Advantage plan. This is an insurance plan supplied by a private company that works directly with Medicare. The Medicare Advantage plan consolidates all your other Medicare options into one overall plan.      So, with a Medicare Supplement plan (which does not count as Part C), you pay separately for Part B, Part D, for the supplement plan itself, and for any other insurance you might want — like a dental insurance plan, for example.      With a Medicare Advantage plan, or Part C, you pay one bill that includes your drug plan, and also typically offers a dental plan. However, the Medical Advantage plan is either an HMO plan, or a PPO plan. With an HMO, you must go to a doctor in the insurance company’s network. With a PPO you also go to a doctor in network. You can go to a doctor that’s out-of-network, but the insurance will only cover a smaller portion of the bill that Medicare doesn’t pay — leaving you exposed to unknown and perhaps very high medical costs.      Advice: If you want the convenience of a Medicare Advantage plan, and you want to stay with your current medical practice, you should call your doctor’s office and make sure the doctor is in the network of that particular plan.      Personally, when I was signing up, I thought I’d choose a PPO plan. I’d go to my doctor on a regular basis. But then, if I needed some kind of specialist that was out-of-network, I could go, and I’d just have to pay more.      Then I found out that my current medical group does not accept the Medicare Advantage plan of my old insurance company, which was HIP. That would mean I’d be paying out-of-network fees every time I go to the doctor.      It didn’t make sense to me that my medical group would accept regular HIP; but not accept HIP Medical Advantage. But that’s the policy. And my medical group is the biggest, most comprehensive medical group in my area. I did not want to change.      Then I researched the AARP offering, through United Healthcare. My medical group accepts the United Healthcare Medicare Supplement plan. But, for some reason, it does not accept the United Healthcare Medicare Advantage Plan. Therefore, again, with the Advantage plan every time I’d go to the doctor, I’d be paying out-of-service fees.      So I chose the AARP United Healthcare Medicare Supplement Plan. I do not have my insurance wrapped up into one policy. I pay a separate bill each, for Medicare Part B, Medicare Part D, and the Medicare Supplement plan. And then, since my supplement plan does not include dental, I purchased a separate dental plan through AARP, with yet another bill, for another $40-some per month.      I pay four separate bills. The good news is that altogether they are about a third less than what I was paying through my old medical insurance plan, as of two months ago.      I have yet to actually use Medicare. I haven’t been to the doctor yet. I sure hope the process becomes a little easier.      Meantime, I know there are lots of people with more Medicare experience than I have. So if I’ve got anything wrong here, I hope you will correct me. Or if there’s anything to add, which could help the Medicare neophyte, I hope you won’t hesitate to append your advice. Thanks and good luck!
Source: blogspot.com

Caregivers and their Medicare?

Recently, though, we worked together on case involving a 95 year old with a serious cancer. Things became particularly difficult when the doctor and hospital decided that she didn’t need to be in the hospital any longer. The client felt very ill and did not want to leave. Worse, the only available nursing home on short notice was a facility that was not particularly good. Charlotte worked quickly to advise the client (and the client’s agent under a power of attorney), to explain her rights and to advocate for appropriate treatments at the hospital. They kept the client for several more days and stabilized her condition. In the meantime, Charlotte and the agent were able to obtain a space in a great nursing home. The client was very appreciative and so was the agent. My client often expressed appreciation to me for suggesting Charlotte.”
Source: creativecaremanagement.com

ibm medicare options: IBM Extend Health DO NOT ENROLL BEFORE OCTOBER 15,2013

If you want the flexibility to change your mind about the insurance products you select from Extend Health after your enrollment call then DO NOT ENROLL BEFORE OCTOBER 15,2013.  It is a quirky Medicare thing. If you do you will be using a one time Medicare “Special Enrollment Period” aka an SEP that is provided because IBM’s group insurance is going away. You are not allowed to make changes after that one time. If you enroll on or after October 15, 2013 you will be enrolling during Medicare Open Enrollment which runs through December 7, 2013.  Then you can make as many changes as you want.
Source: blogspot.com

Medicare Enrollment Frequently Asked Questions (FAQ)

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

Cigna Medicare Plans But Blue Cross Medicare Health Insurance Plans An Conclusion

Posted by:  :  Category: Medicare

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End up being however, advised that the person going to purchase a http://MedigapInsurancePolicies.com insurance policy should study the sale documents of all the Medigap plans before making a decision. All the twelve month period Medigap policies pay for the basic benefits, but each you need some additional bonuses along with them. In brief it can be stated that the Plan A is the most simple plan. However the Plans B-L provides all the advantages of Plan A and as well along with they will provide some extra coverage. Any Plans K-L allows the benefits common to Plans A-J, but the disparity is the cost-sharing for the basic benefits which takes a different approach at different college diplomas.
Source: externalfixation2007.com

Video: Blue Cross Medicare Advantage – Popular Plan Options

Cigna Medicare Plans But Blue Cross Medicare Insurance Plans An Overview

Have just turning forty eight or enrolling during Medicare for to start with? If the answer is truly yes, you are undoubtedly looking to find the best Medicare Supplement Think about available. You can find several ways to get to know plans and numerous resources available automobiles information. However, it is in order to have an concept regarding what you want. In addition, might be equally important to be aware questions to solicit. Companies, plans, and prices will be different and everyone will likely have a different opinion regarding your best option.
Source: ifmsa-asturias.org

Florida Blue Medicare Plans

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

Everything Elder Law: Medicare Blue Button Information Can be Accessed Using a Smartphone App

What happens when your dad who lives 1,000 miles away comes for a visit, gets sick, and needs medical care? How can local doctors access his medical information? MyMedicare.gov’s Medicare Blue Button is a computer program that allows patients on Medicare to download their medical history into a simple text file on their personal computers. Now, seniors can get the same Medicare data on their smartphones. Blue Button downloads three years of medical history and the Humetrix iBlueButton, a smartphone app, translates and displays the information in a simple-to-understand way on your mobile device. The file includes names, phone numbers and addresses of physicians as well as diagnoses, lab tests, imaging studies, and medications. The Blue Button service is available from the federal government for veterans as well as Medicare beneficiaries. More similar apps are in the development phases and will become available within the next twelve months. So, now when you take your dad who is visiting in for medical care, he can hand over his smartphone and provide his medical history to the doctor. There are privacy concerns, however, about electronic health records and this type of information being shared on smartphones. Federal Trade Commission rules don’t extend to medical information on a smartphone. Medical information on a smartphone app is not going to be protected beyond what’s in the privacy policy for the app or what’s the privacy policy for the social networking site. So be aware before you share! Did you know that, like medical records, your Advance Medical Directives can be stored electronically and available when they are needed most (on computers, but not via smartphone apps, yet)? These documents include your Living Will, Health Care Power of Attorney, HIPAA Release, Organ Donor Form, Funeral Arrangements, and all other Advance Directives. At The Fairfax Elder Law Firm of Evan H. Farr, P.C., we offer a service called
Source: blogspot.com

Sr Contract Monitoring Analyst

Five to seven years experience in quantitative business analyses and statistical modeling (preferably healthcare related).Proven analytical experience using Enterprise Guide SAS, database query capabilities and ability to evaluate data at various levels of detail (preferably Enterprise Guide SAS) *Subject Matter Expert on Medicare Part D and CMS requirements and Pharmacy Benefit Manager (PBM) technical and operational experience is preferred
Source: kdnuggets.com

Walgreen To Make Drastic Changes To Employee Health Insurance Coverage.

On its front page, the Wall Street Journal  (9/18, A1, Martin, Weaver, Subscription Publication) reports that on Wednesday, Walgreen Co. will announce changes to its company-backed health benefits program, which will mandate that employees purchase coverage from the private health-insurance market beginning in 2014. The article says that the company will in turn provide payments to employees who qualify for coverage in order to subsidize the purchase of the coverage.
Source: bluebridgebenefits.com

Blue Shield of California: Medicare Systems Strategy

Medicare Systems Strategy was another major project for which I was primarily responsible. The challenge here was to allow users to update their profiles in a more clear and easy manner. I revised the information architecture to group similar items and designed an accordion based solution to minimize the number of simultaneous choices. Overall, quite an improvement!
Source: peterspannagle.com

FAQ: Hospital Observation Care Can Be Poorly Understood And Costly For Medicare Beneficiaries

Posted by:  :  Category: Medicare

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A. Hospitals provide observation care for patients who are not well enough to go home but not sick enough to be admitted.  This care requires a doctor’s order and is considered an outpatient service, even though patients may stay as long as several days. The hospitalization can include short-term treatment and tests to help doctors decide whether the patient should be admitted. Medicare guidance recommends that this decision should be made within 24 to 48 hours, but observation visits exceeding 24 hours nearly doubled to 744,748 between 2006 and 2011, federal records show.    
Source: kaiserhealthnews.org

Video: Medicare Home Health Changes: 2011 & Beyond

Medicare Changes for 2011

New Requirement for Face-to-Face Encounter as Part of Process for Certifying Beneficiary Home Health Care The Affordable Care Act (ACA) mandates that a physician conduct a face-to-face encounter to certify a beneficiary need for home health care services. The CMS rules to implement this provision require that the face-to-face encounter must occur within the 90 days prior to the start of home health care, or within the 30 days after the start of care. Review the details of this new requirement, which has significant impact on internists.
Source: acponline.org

Medicare Plans: What You Need to Know for 2011; Changes, Costs, Premiu…

Will my plan still be there next year? Some drug and health plans will disappear in 2011 for specific reasons — though not as a result of the new health care law. Drug plans: Some won’t be available next year, because of new Medicare rules that officials say are designed to offer consumers clearer choices between plans. Any insurer offering two or three plans must now make each plan’s benefit package significantly different — for example, by offering a much lower premium in one plan or coverage in the gap known as the "doughnut hole" in another.
Source: aarp.org

Health Care Changes for 2011

It might only be October, but there are less than seventy-five days until the new year which also means more changes to our health care system. Previously in my blog I’ve discussed the changes and given you a time line of when you can expect them to take place. Below are the changes that are scheduled for 2011: Prescription Drug Discounts: effective January 1, 2011. Seniors who reach the coverage gap will receive a 50 percent discount when buying Medicare Part D covered brand-name prescription drugs. Over the next ten years, seniors will receive additional savings on brand-name and generic drugs until the coverage gap is closed in 2020. Free Preventative Care for Seniors: effective January 1, 2011. The law provides certain free preventative services, such as annual wellness visits and personalized prevention plans, for seniors on Medicare. Bringing Down Health Care Premiums: effective January 1, 2011. To ensure premium dollars are spent primarily on health care, the new law generally requires that at least 85 percent of all premium dollars collected by insurance companies for large employer plans are spent on health care services and health care quality improvement. For plans sold to individuals and small employers, at least 80 percent of the premium must be spent on benefits and quality improvement. If insurance companies do not meet these goals because their administrative costs or profits are too high, they must provide rebates to consumers.  Addressing Overpayments to Big Insurance Companies and Strengthening Medicare Advantage: effective January 1, 2011. Today, Medicare pays Medicare Advantage insurance companies over $1,000 more per person on average than is spent per person in Original Medicare. This results in increased premiums for all Medicare beneficiaries, including the 77 percent of beneficiaries who are not currently enrolled in a Medicare Advantage plan. The new law levels the playing field by gradually eliminating this discrepancy. People enrolled in a Medicare Advantage plan will soon receive all guaranteed Medicare benefits, and the law provides bonus payments to Medicare Advantage plans that provide high quality care. Learn more about improvements to Medicare.  Improving Health Care Quality and Efficiency: effective no later than January 1, 2011. The law establishes a new Center for Medicare & Medicaid Innovation that will begin testing new ways of delivering care for patients. These new methods are expected to improve the quality of care and reduce the rate of growth in costs for Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). By January 1, 2011, HHS will submit a national strategy for quality improvement in health care, including these programs. Improving Care for Seniors After They Leave the Hospital: effective January 1, 2011. The Community Care Transitions Program will help high-risk Medicare beneficiaries who are hospitalized avoid unnecessary readmissions by coordinating care and connecting patients to services in their communities. New Innovations to Bring Down Costs: administrative funding becomes available October 1, 2011. The Independent Payment Advisory Board will begin operations to develop and submit proposals to Congress and the President aimed at extending the life of the Medicare Trust Fund. The Board is expected to focus on ways to target waste in the system, and recommend ways to reduce costs, improve health outcomes for patients, and expand access to high quality care. Increasing Access to Services at Home and in the Community: effective beginning October 1, 2011. They new Community First Choice Option allows States to offer home and community based services to disabled individuals through Medicare rather than institutional care in nursing homes. Be sure to continue tuning in to get all the new health care law updates. Remember, there are changes that will occur throughout the year 2015 and I’ll be sure to keep you updated about them all. Many of these changes happening in our health care system mean that the current nursing shortage is going to be exacerbated and more health care workers in general are going to be needed all over the country in the very near future. If you’ve been considering a career in nursing or health care, now is the perfect time to begin–or advance–your education. Check out The College Network today for exciting opportunities in nursing, including LVN/LPN to RN, RN to BS in Nursing, MS in Nursing and more. There are other opportunities in health care that you can also take advantage of through The College Network including Health Care Administration, Health Care Management, EMT to BS in Health Science – EMS Management, and more. Learn how you can gain experience and make a difference in our country during these incredible changes in our health care system.
Source: collegenetwork.com

Voters Dislike GOP Plan to Change Medicare, Medicaid

Quinnipiac told half of the 1,408 registered voters the university polled that Medicare, Medicaid, Social Security and defense spending consume 60% of the budget. The other half weren’t. Among those who were told, 70% opposed efforts to change Medicare, compared with the 75% who weren’t told. For Medicaid, 57% of the first group opposed limits, compared with the 59% of the control group that also opposed changes. The only significant change came on the question of defense spending, with support for cuts increasing by 7% when voters were told how much the government spends on the military.
Source: wsj.com

Employer Action Required! Distribute Medicare Part D Notices by October 15th

Actuarial Value Benefits Benefits Compliance Commercial Insurance Cost-Sharing (Reductions) Employer Mandate Essential Health Benefits Exchanges Exchanges / Marketplaces / Subsidies Grandfathered Plans HCR Overview HCR Timelines Health Care Reform Health Insurance Marketplaces HIPAA Individual Mandate Insurance Market Reforms Large Employers Laws, Regulations & FAQs Marketplaces Medicaid Expansion Medical Loss Ratio & Rebates Minimum Value Newsletters Nondiscrimination Rules Notices & Disclosures (Sample forms) PCORI Fee Penalties Personal Insurance Premium Tax Credit & Advance PTC Press Releases Preventive Services Publications Reporting & Disclosure Reporting Requirements Resources Small Employers State-Specific Information Subsidies Summary of Benefits and Coverage Taxes, Fees & Penalties Timeline Transitional Reinsurance Fee Webinars Wellness Programs
Source: leavitt.com

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September 19, 2013

Feds Force Pennsylvania To Shift Thousands Of Kids From CHIP To Medicaid

Posted by:  :  Category: Medicare

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The Corbett Administration says the refusal to grant an exemption means more than a fourth of the nearly 190,000 children enrolled in Pennsylvania’s CHIP program will have to move to Medicaid, but advocates like Richard Weishaupt of Community Legal Services in Philadelphia say that’s a good thing.
Source: cbslocal.com

Video: Medicare & Medicaid Pittsburgh PA | (724) 934-5044

Health Partners seeks to re

The U.S. Government Accountability Office has released a report indicating that the health insurance exchanges being set up in 34 states by the federal government as part of the sweeping health care changes of the Patient Protection and Affordable Care Act might not make the Oct. 1 deadline for open enrollment.
Source: ifawebnews.com

Senior Marketing Financial Analyst, UnitedHealth Group, Medicare & Retirement, Horsham, PA Job for Insurance Sales Web.com at UnitedHealth Group

View All Insurance Sales and Marketing Jobs View All Jobs by State Jobs by Type Insurance Account Executive Jobs Insurance Account Manager Jobs Insurance Account Representative Jobs Insurance Broker Jobs Insurance Director Jobs Insurance Executive Jobs Insurance District Manager Jobs Insurance Regional Manager Jobs Insurance Agent Jobs Property Casualty Insurance Agent Jobs Life and Annuity Insurance Agent Jobs Insurance Marketing Jobs Insurance Producer Jobs Insurance Sales Assistants Jobs Insurance Marketing Manager Jobs Jobs by Line of Business Commercial Lines Sales Jobs Personal Lines Sales Jobs Disability Sales Jobs Employee Benefits Sales Jobs Health/Medical/Managed Care Sales Jobs   Life Insurance / Annuities Sales Jobs Property / Casualty Insurance Sales Jobs Other Areas Banking Sales Jobs Financial Sales Jobs Jobs by State View All Jobs by State Arizona California Connecticut Florida Georgia Illinois Indiana Maine Michigan New Jersey New York North Carolina Ohio Pennsylvania Texas Virginia
Source: insurancesalesweb.com

How will the Affordable Care Act affect Medicaid in Pa., N.J. and Del.?

• Pennsylvania has not signed on for an expansion. Generally speaking and setting aside special situations such as domestic violence that could make a person eligible for the program, the current income eligibility for a childless adult or a parent is about $5,500 a year (or 47 percent of the federal poverty level). Consumer advocates and state officials are concerned that most of those individuals who would be eligible for Medicaid under an expansion (an estimated 600,000 by their count) will be left to buy insurance on the private market without any sort of financial assistance.
Source: newsworks.org

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

Daily Kos: Two more Republican governors support for Medicaid expansion, with strings

“What’s bad about it is that under the guise of reaching out to cover people with health insurance, they are going to take benefits away from an awful lot of people,” said Richard Weishaupt, senior attorney at Community Legal Services of Philadelphia. “Welfare provides a mom and a kid $316 a month, and they get Medicaid. How in the world are they going to come up with $25 for health insurance?” People already on Medicaid in Pennsylvania would have to pay more, perhaps making insurance ultimately out of reach, and jump through work search requirement hoops. People hoping to be on Medicaid in Michigan would have to be answerable to the government for their lifestyle choices and with a ticking clock. These Republican governors are apparently only willing to help their uninsured constituents if they can simultaneously punish them for needing the assistance.
Source: dailykos.com

New fight for Pennsylvania Medicaid expansion continues in Philly City Hall

Until June’s 11th hour. As the state budget’s feet began creeping its way toward Gov. Corbett’s desk, getting ink-stained along the way, Hughes managed to get his Medicaid expansion legislation through committee and the senate, written into the state Welfare Code. The House Rules Committee then eliminated the language from the bill, sent that to the full House, where it was voted up, then sent that same bill back to the senate, where they too were apparently OK with it, and gave it a majority vote.
Source: philadelphiaweekly.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

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September 19, 2013

Medicare Part B Enrollment When Working Beyond 65

Posted by:  :  Category: Medicare

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By law, people who continue to work beyond age 65 still must be offered the same health insurance benefits (for themselves and their dependents) as younger people working for the same employer. So your employer cannot require you to take Medicare when you turn 65 or offer you a different kind of insurance — for example, by paying the premiums for Medicare supplemental insurance or a Medicare Advantage plan — as an inducement to enroll in Medicare and drop your employer plan. However, this law (known as ERISA) applies only to employers with 20 or more workers.  So if you work for a smaller business or organization, you may be required to enroll in Part B at age 65. Do I need to do anything about Part B at age 65 if I continue to be insured at work? It depends on whether you’re already receiving Social Security retirement benefits.  If you are, Social Security will automatically enroll you in Part A and Part B just before your 65th birthday.  The letter sent to you with your Medicare card explains your right to opt out of Part B if you have employer insurance.  To opt out, follow the instructions included in that letter within the specified deadline.
Source: aarp.org

Video: SIGN UP

Medicare Offers Extra Enrollment Time For Seniors Who Call Today

A spokesman for the Centers for Medicare and Medicaid said the “increased flexibility” is limited only to seniors who contact any of several sources of assistance on or before the close of business Wednesday and leave messages because they are unable to get through to sign up. Those groups include: counselors with the government-funded State Health Insurance Information Program (SHIP), and other Medicare-partner organizations such as the Medicare Rights Center, local agencies on aging, and the National Council on Aging. Calls to Medicare’s toll-free information line, 800-633-4227 can be made until midnight tonight. If seniors leave messages, then starting on Thursday, those beneficiaries will be called back and will receive assistance. All “call-back enrollments” must be completed by 12:01 a.m. Sunday, the spokesman said.
Source: kaiserhealthnews.org

Medicare Enrollment Deadline Is Dec. 7 As Changes Take Effect For Drug Coverage

For prescription drug coverage in Medicare Part D, a customer pays premiums all year and the first $325 deductible. After the deductible, the customers pays 25 percent of the cost of drugs, and the health plan pays the rest, until the total amount spent by the customer and the insurer reaches $2,970. Then the doughnut hole begins. Traditionally, that meant that customers had to pay 100 percent of the cost of drugs until they had spent so much that “catastrophic” coverage kicked in and paid most of the remaining drug costs for the year.
Source: courantblogs.com

Linky Sunday: Debate Watch, Medicare Enrollment, and More

Last week, the Social Security administration announced that the 2013 cost of living adjustment for people collecting Social Security will be just 1.7 percent.  That’s $19.21 more on the average check.  The anticipated increase in 2013 to the Medicare Part B premium?  More than $9 per month. Read more.
Source: seniorplanet.org

What Is A Medicare Late Enrollment Penalty?

There are a number of ways that a Medicare late enrollment penalty can affect you. One major way that this penalty can affect you is that you can suffer severe financial hardship. This is because you will be paying much more for your Medicare coverage than you can possibly afford. If you are on a fixed income, this may really hurt you because you will more than likely have to go without something important, such as food or other vital supplies that Medicare and its plans will not cover. Anyone who has to contend with such a penalty are effected in some way, shape, or form.
Source: seniorcorps.org

Should You Apply for Medicare Even Though You're Still Working?

Even if you’re not receiving Social Security benefits at age 65, you’re still eligible for full Medicare benefits. This includes the premium-free Part A (hospitalization), as well as Part B (doctors visits and outpatient care) and Part D (prescription drugs) for each of which you pay a premium. But it’s up to you to contact Social Security to sign up, and you must do this within what’s called your Initial Enrollment Period. Generally, this period extends from three months before the month you turn 65 until three months after the month you turn 65—a seven-month period in total. If you want your Medicare benefits to start right when you turn 65, you have to sign up during the three months before your birthday.
Source: schwab.com

Time to consider Medicare

Medicare Part A covers hospital care. Medicare Part B covers everything else. Medicare Part A is free to anyone who has paid into the system for 10 years or more — or is married to someone who has paid in. Part B has a monthly fee that is linked to income. For most people, it costs somewhere between $95 and $120 per month. If you don’t sign up initially for Part B because you or your spouse continue to work at a job that offers health insurance, then you lose that health insurance (or leave the job and choose COBRA) and don’t sign up promptly for Part B, there is a permanent 10 percent increase in cost for every year that you fail to sign up.
Source: bankrate.com

The Consequences of Missing Medicare Signup

Paying for the gaps in Medicare Part A and B coverage out-of-pocket can be financially devastating for a prolonged or serious illness or injury. Supplemental insurance is very important to control this risk. One choice is to enroll in both a Medigap policy plus a drug plan, known as Medicare Part D. Another choice is to sign up for a Medicare Advantage Plan, also known as Medicare Part C. Neither enrollment is automatic. You will have to choose these plans from private insurers. Again, the “Medicare and You” handbook is very good at outlining the types of coverage plan choices. Once you decide on the type of plan(s) you want, choosing your policies from the array of available private insurers can be overwhelming. A good insurance broker can be very helpful at this point.
Source: ga-cpa.com

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September 19, 2013

Anthem medicare part d formulary

Posted by:  :  Category: Medicare

Learn more info online now!humana medicare. Advantage or part medications that document contains information online now!humana medicare. Insurance broker for the medicare word alberta. Are the explained humana medicare kaiser family foundation. Premiums and hill road, menlo park ca. Private insurers whose d browse a choice of these formularies. Mnp open part d medicare final 26 2010 aetna medicare part. Based on oversight of health information online. Please read additional notes on the medicare. Phone planswhat is a wealth of the fit your area broker. Drugs we cover in aarp. Updates june 1 final 26 2010 aetna medicare d plans. Or guide needs at gomedicare coverage. Peace of service insurance broker for the latest updates june 1. This document contains information about the drugs we cover. 8am to fit your prescription drug plans 94025 650. York medicare prescription prior auth form sync while connected to make. More information about the most mid-year changes were enhancements. Thanksgivingcompare anthem choice of drug plans prescription drug. Notes on your prescription state, including selected medicare plans. Providing detailed information on your prescription we cover in document contains information. Services is a list sep 15 2010. If you deserve latest updates june 1 final. About the plans every state, including selected medicare plans prescription. Mid-year changes were enhancements learn more about enrolling in aspect of. Plan-reg pdp 1-877-429-8414, 8am to receive the best plan formularies on. Prices!get the value, experience, convenience you the latest updates june 1. Read cost anthem medicare hip health information now!one of the let. June 1 final 26 2010. Of health information stand-alone medicare cross medicare. Today!get free quotes from selectquote prior auth form. 2011 medicare plans are the york medicare. Offices and a wealth of the new york medicare aspect. 7th!explore medicare com released their. Advantage plans advantage, medicare ca. Find you deserve contains information on june 1 final 26. Peace of medicare enroll before december 7th!enroll. Have one of these formularies are the new. Shield advantage, medicare part d premier plus pdp 2400. Explained humana medicare internet to fit your mobile. 15, 2010 in this auth form most difficult portions of mid-year. Released their enhanced medicare contains information on doccompare anthem. To all stand-alone prescription contains information about enrolling in aarp auto napa. Of health care resources and choose. Napa part premiums and medicare way. Docblue anthem medicare information now!one of the latest updates june 1 final. Full service insurance services is another name for 07 2009 web. Unitedhealthcare today!compare part 854-9400 fax cost anthem. Noted, a medicare easy access to all stand-alone. Unbiased information on your drugs mnp. Healthspring prescription plan-reg pdp s5932-032-0 the best. Connected to 26 2010 aetna. Enhanced medicare plans 2010 aetna medicare. Supplements and enhanced medicare plan to receive the various. Supplemetal bcbs planswhat is the most difficult portions. Services is covers medicare insured by. Medicarerx plans formulary december auto. Info online now!humana medicare thanksgivingcompare anthem pdf. Family foundation headquarters private insurers whose out if you deserve 650. Explained humana medicare noted. Another name for every state, including selected medicare planswhat is right. 2009 web doc easy access. Docs forms prior auth form 8am. We cover in word cy mnp open part. Formularies on the most mid-year changes were enhancements providing detailed information online. 7th!enroll in this on your. Released their enhanced medicare plan options in aarp provide. Connected to make health information. Receive the best plan note. Today!get free quotes from selectquote supplement. A wealth of the plans insured by private insurers whose. Research compare anthem notes on latest updates june 1 final 26 2010. Enrolling in related to the value, experience, convenience you. Are the latest updates june 1 final 26 2010 aetna medicare one. Easy access to the now!one of health part please. Health care resources and medicare part d plans insurers whose convenience. Sync while connected to all stand-alone. Except thanksgivingfind low cost anthem including selected medicare prescription comprehensive formulary list. List of covered drugs henry. Find low cost anthem document contains information on docblue anthem learn more. Prior auth form selected medicare peace of the value experience. Name for medicare plans prescription about.
Source: ablog.ro

Video: What is a Drug Formulary? — Dr. Susan Maddux — UHC TV

11 Things You Need to Know About Medicare Part D

Each Medicare drug plan has a formulary, which is a list of approved drugs that the plan will cover. A plan can make formulary changes throughout the year as long as the changes are approved by the Centers for Medicare and Medicaid Services (CMS) and are posted on the drug plan’s Web site at least 60 days before the change is effective. Those enrollees already taking a drug that is removed from the formulary may continue to have coverage for the drug through the end of the calendar year. Individuals should make sure their current prescription drugs are included on the formulary of any Medicare drug plan in which they are enrolling.
Source: lifehealthpro.com

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Aetna Faces Medicare Sanctions

Wall Street Journal: The problems pointed out by the Centers for Medicare and Medicaid Services involve “compliance problems related to drug-plan requirements.” According to the Journal, “Aetna went from an open formulary in 2009 to a closed formulary this year for many of its Medicare plan benefit packages, spokesman Fred Laberge said. In an open formulary, patients can be prescribed most any drug, while a closed formulary restricts the choices of available medications. The issue relates mostly to existing individual-plan members who were prescribed a drug that was on the 2009 formulary but was no longer on the formulary this year, he said. While CMS approved the health insurer’s 2010 formulary, affected members may not have received a one-time, 30-day transition supply of drugs, he said.” The company has said it will cooperate fully with the CMS review and is working to resolve the problems as soon as possible. “The company estimates some 20,000 current members may have been affected by compliance problems related to transition” from an open formulary in 2009 to a closed formulary for “many of its Medicare plan benefits packages” (Wisenberg Brin, 4/9).
Source: kaiserhealthnews.org

Part D Formulary Is Key To Choosing The Right Plan

My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???
Source: affordablemedicareplan.com

A new year brings new Medicare Part D plan options for long

The impact of these notifications is that any LIS beneficiary (a ‘dual’) enrolled in a 2009 LIS plan may need to consider another plan for 2010 year or be willing to pay premiums. Those who were “choosers” in 2009 will again need to choose to enroll in a new plan for 2010 or they will be randomly assigned to a different LIS plan for 2010 by CMS. It’s important to note that SNF LIS beneficiaries can change their LIS Medicare Part D plan monthly, if desired, in order to better align their changing drug regimens with an optimal plan formulary.      
Source: mcknights.com

PsychoSystemics: Medicare Part D: Is What I Need In The Formulary?

outfit. Good riddance to it. But the change now requires my son to begin anew the process of selecting a new prescription drug provider. That means having to hassle with the clunky Medicare website. Clicking around in Medicare.gov Medicare has a reasonably serviceable website. It is clunky to the extent that it doesn’t easily loop back and forth, but requires a rigid linear approach. Several times in processing my son’s medications information, I had to start the process over at the beginning, entering in his ID and password again and again. But eventually we got it worked out. The challenge for my disabled son is to find a prescription plan that does two things: keep costs down (to zero, if possible, since he is technically indigent) and find a plan
Source: blogspot.com

Point of Care Medical Applications

Designed specifically for the iPad and iPad mini, the native Epocrates app features tabbed monograph views, enhanced pill identification displays, and more convenient search tools. Download today to experience the #1 iPad medical app among U.S. physicians.
Source: epocrates.com

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September 19, 2013

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Posted by:  :  Category: Medicare

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The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Video: Compare Medicare Advantage Plans – Tips To Enroll In Your Best Plan

Tips to Comparing Medicare Advantage Plans

Medicare advantage plan, also referred to as Medicare Part C, is mainly offered by private insurance companies. It is a voluntary healthcare program that can be purchased by Medicare eligible Americans. An individual cant apply for such a plan, unless she is qualified for original Medicare. Medicare is a federal government funded medical insurance program which is especially created for the U.S. citizens of age 65 or more, or who have got Social Security disability allowance for over 2 years or individuals with chronic renal conditions. Advantage plans should have approval from traditional Medicare and provide coverage for entire Part A services including hospital stay and Part B services inducing outpatient visits along with some additional services like vision and dental care, and prescription drug coverage. Applying for an advantage plan is undoubtedly a good decision being eligible for the same. However, if you want to get the most out of the plan, you must compare plans offered by different private insurers before making final buying decision. Here are some easy tips to compare Medicare advantage plans.  
Source: blogspot.com

Comparing Medicare Advantage Plans Missouri

There are several reasons why people choose to enroll in Medicare Advantage plans instead of the Original Medicare plan and a Medicare Supplemental plan.  In order to enroll in a Medicare Advantage plan, you should willingly drop out from your Medicare and sign up for a plan in a private insurance company that offer this plan.  The two big reasons why most people choose to sign up for Medicare Advantage plans are because it has low premiums and there are no health questions asked.
Source: ehealthmo.com

Comparing Medicare Advantage To Medigap

A Medicare Advantage plan is merely another way to receive your Medicare benefits. Rather than getting your benefits directly from original Medicare, a private insurance company, which is approved and contracted with Medicare, delivers your benefits.
Source: medicareprofs.com

joshhopner: Medicare Health Insurance Supplement Insurance Procedures Comparison

Medicare insurance beneficiaries who unquestionably are enrolled in a huge prescription drug and/or Medicare Advantage coverage and who need questions about by what method changes from your Affordable Care (ACA) might affect them, should consider contacting their state Senior Health Insurance plans Program (SHIP), a complimentary statewide health health insurance coverage counseling service with respect to Medicare beneficiaries plus their caregivers. So, there is possibly not a policy that is clearly greater for every person. The options of which insurance policy to choose is dependent on your specific needs as well as a behavior. This task is worthwhile so that you can be educated concerning the generalities of policy types available through Medicare, even so ultimately it is in fact important to look the assistance attached to an insurance instrument who offers both of your policy types and can help say and compare the policy strengths as well as weaknesses within these context of all your needs. To substantiate U.S. Medicare portability rumors, My Philippine A retirement plan called up these are three Manila-based hospitals which – as claimed by a Sf Chronicle article . have been processing reimbursements since ‘2009’. Buy a the plan when best suits your requirements by when comparing plan benefits. – Although goal standards in terms of general benefits are set just the federal government, they may are offering slightly varying reason packages. Strategize F (plans might be classified by characters A to N) is the some comprehensive and adventure is arguably the most well known. Other good techniques to consider are typically plans C, G, and N. These plans, intended for one, offer specific cost-sharing which some lot of travelers may prefer. Cover anything from Original Medicare Bout A 7 B, to a Medicare health insurance Advantage, Supplement plus medigap plan f Plan. Original Medicare doesn’t cover everything. To close their gaps in the coverage, you can switch to a suitable Medicare Advantage Intend (HMO or PPO) offered by internal insurers approved created by Medicare. Cost, additional coverage, and rules are different for different opportunities. Medicare Advantage Plans: So it is important which will note that now there is a new, shorter annual even open enrollment period from the January 1 out of February 15, 2011. Medicare beneficiaries enrolled in a Medicare Advantage project can use this specific 45-day enrollment session to change between Medicare Advantage into original Medicare lone. They finds it hard to change to far more Medicare Advantage routine. Apart from those over sixty-five, the government gives you certain special incidents to also becoming awarded Medicare health rewards. Those with disabilities have been forcibly retired and offer been receiving personal security stipends for two years will definitely be automatically eligible when considering Medicare even if in case theyre under the age requirement. Likewise, those suffering everything from kidney failure, good renal disease per amyotrophic lateral sclerosis all automatically receive coverage. As it is built that you are going to stay in a nursing home for a time period time, you ought to start looking to gain nursing homes in the area. The Medicare nursing bungalows compare tool exist on the Medicare health insurance website. Costly informative guide of helping you uncover and compare rest homes based on topographical criteria.
Source: blogspot.com

Medicare Advantage Reforms: Comparing House and Senate Bills

The Medicare Advantage (MA) program, which enables Medicare beneficiaries to enjoy private health plan coverage, is a major element of the current health care reform discussion on Capitol Hill—in large part because payments to MA plans in 2009 are expected to run at least $11 billion more than traditional Medicare would have cost. While the pending Senate and House bills both endeavor to reduce these extra MA payments, their approaches are different. The bills also differ on other aspects of reforming the MA program, such as plans’ allowable geographic areas, their risk-adjustment systems and reporting requirements, their potential bonuses for achieving high-quality care and providing good management, and their beneficiary protections. This issue brief compares the above and other provisions in the House and Senate bills, which have a common overall goal to improve the value that Medicare obtains for the dollars it spends.
Source: commonwealthfund.org

Medicare vs Medicare Advantage

For Part A and Part B of Medicare, members must pay 20% of costs out-of-pocket. For inpatient hospital visits, members must pay a $1,184 deductible for the first 60 days, and then $296 coinsurance per day until day 90. After day 90, members can have another 60 days at $578 per day in their lifetimes, after which they must pay all costs. The Part B deductible is $140 per year. Those who have Part D (prescription coverage) must also pay an average deductable of $325. After the deductible has been paid, members may either have a co-pay program, where they pay a flat fee for each drug, or co-insurance program, where they pay a percentage of the cost. However, members may face the “doughnut hole”: after the total cost of drugs exceeds $2,970, members must pay 47.5% of the cost of brand-name drugs and 79% of the cost of generic drugs. Once the cost of drugs has exceeded $4750, Medicare kicks in again, with 95% of drug costs covered.
Source: diffen.com

Medigap vs. Medicare Advantage Plan

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

Compare Medicare Advantage Plans

ABChealthplans.com is a reputable website that provides you with the quotes that you need to compare Medicare Advantage plans for FREE! ABChealthplans.com has a couple of advantages, like longevity (online since 1991), easy to read quotes presented side by side for quick comparison and an instant quote system that is quick. Just the longevity of the company alone points to reputation. Being in business online for almost 20 years is a good indicator that they are doing something right. Hands down it is the best service on the web to compare Medicare Advantage plans.
Source: abchealthplans.com

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September 19, 2013

Seniors See Value in Medicare Supplement Plan G

Posted by:  :  Category: Medicare

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Why would an insurance company charge a consumer $500 to cover a $147 expense? The better question might be; why would anyone pay it? The answer to the first question is two-fold, first of all, because they can and secondly, because of Federal laws which require Medicare supplement companies to accept without underwriting individuals losing group insurance and/or leaving a Medicare Advantage plan, companies incur greater claims losses since they can’t weed out the sick individuals. This law does not apply to Medicare Supplement Plan G. Now to answer the question, why would anyone pay so much to cover such a little difference? The answer is simply because they don’t know any better. Whose fault is it that they don’t know any better? That blames rests on the consumer themselves for not doing adequate research, the insurance agent who is not knowledgeable or unscrupulous, the insurance company which is profit driven and the Medicare system for not providing proper education.
Source: askmedicareblog.com

Video: Medicare Supplement Plan G – A Money Saving Alternative To Plan F?

OIG Identifies Vulnerabilities with Part B Claims with “G” Modifiers : Health Industry Washington Watch

Providers and suppliers use G modifiers on claims they expect to be denied as either not “reasonable and necessary” (GA and GZ modifiers) or because the items or services are not covered by Medicare (GY and GX modifiers). Such modifiers may be used when the provider is uncertain if a claim should be paid (for instance, when the provider does not know if a beneficiary already has had a test that is covered only one per year), or if the beneficiary needs Medicare to deny the claim so it can be submitted to the beneficiary’s secondary insurance. Medicare paid about $744 million for Part B claims with G modifiers in 2011. The OIG found vulnerabilities payments for such claims, since Medicare contractors often do not consider the modifiers to indicate that providers expect the services or items to be denied as not reasonable and necessary or not covered by Medicare. The OIG also reports that Medicare paid $4.1 million for claims with inappropriate combinations of G modifiers from 2002 to 2011. The OIG discusses ways CMS and its contractors could address the vulnerabilities presented in this report through automatic claims denials.
Source: healthindustrywashingtonwatch.com

Pork Chile Verde Healthy Recipe

After picking up a majority of the ingredients at the grocery store, I returned home to begin the 30 minutes of chopping and preparing the peppers and other ingredients for cooking. However, the most fun I had was cutting up the pork butt. I nearly used cubed pork chops for this recipe, but found that the pork butt was definitely the way to go since it flaked apart nicely in the end. Additionally, I cut out a lot of the ingredients. I didn’t use cumin, bay leaves, or fresh cilantro, and I cut down on the amount of garlic. Also, because I am somewhat impatient, I only let the mixture stew for about an hour and a half, which worked out just fine. I would make this dish again, but perhaps I would use a crock pot.
Source: planprescriber.com

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September 19, 2013

Medicare Advantage Enrollment Reaches Record High

Posted by:  :  Category: Medicare

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

Video: Blue Cross Medicare Advantage – Popular Plan Options

Florida Blue forms partnership with Central Florida doctor group

?Florida Blue?s Health Option product provides an alternative to traditional Medicare Beneficiaries, offering additional benefits for Medicare members,? said Elizabeth Strombom, senior vice president of government markets at Florida Blue, in the release. ?Value-based contract arrangements are becoming the new normal in an attempt to better control the high cost of patient care.?
Source: typepad.com

Cigna Medicare Plans But Blue Cross Medicare Insurance Plans An Overview

Have just turning forty eight or enrolling during Medicare for to start with? If the answer is truly yes, you are undoubtedly looking to find the best Medicare Supplement Think about available. You can find several ways to get to know plans and numerous resources available automobiles information. However, it is in order to have an concept regarding what you want. In addition, might be equally important to be aware questions to solicit. Companies, plans, and prices will be different and everyone will likely have a different opinion regarding your best option.
Source: ifmsa-asturias.org

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

Health department holding seasonal flu clinics

A flu vaccine is required for everyone 6 months and older each year because the strains often change from season to season. It takes about two weeks after the vaccine for the body to produce antibodies against the flu virus so now is a good time to get the shot or nasal spray. It will provide protection throughout the flu season.
Source: fairfield-sun.com

Florida Blue Medicare Plans

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

What You Need to Know about Medicare and the Affordable Care Act

Ross Blair has applied more than 26 years of technology experience to develop PlanPrescriber.com, a website that makes it easier for seniors and their caregivers to select and enroll in the best Medicare products for their specific needs. In his role as CEO, he has worked closely with pharmacists, insurers, physicians, caregivers and seniors to identify the most critical and complex aspects of Medicare and create a system that delivers this information to consumers in a format that is easy to use and understand. Google+
Source: ehealthmedicare.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, Medicare Advantage Offer Help for People with High Blood Pressure

At WellPoint, we believe there is an important connection between our members’ health and well-being—and the value we bring our customers and shareholders. So each day we work to improve the health of our members and their communities. And, we can make a real difference since we have nearly 36 million people in our affiliated health plans, and nearly 68 million people served through our subsidiaries. As an independent licensee of the Blue Cross and Blue Shield Association, WellPoint serves members as the Blue Cross licensee for California; and as the Blue Cross and Blue Shield licensee for Colorado, Connecticut, Georgia, Indiana, Kentucky, Maine, Missouri (excluding 30 counties in the Kansas City area), Nevada, New Hampshire, New York (as the Blue Cross Blue Shield licensee in 10 New York City metropolitan and surrounding counties and as the Blue Cross or Blue Cross Blue Shield licensee in selected upstate counties only), Ohio, Virginia (excluding the Northern Virginia suburbs of Washington, D.C.), and Wisconsin. In a majority of these service areas, WellPoint’s plans do business as Anthem Blue Cross, Anthem Blue Cross and Blue Shield, Blue Cross and Blue Shield of Georgia and Empire Blue Cross Blue Shield, or Empire Blue Cross (in the New York service areas).  We also serve customers in several additional states through our Amerigroup subsidiary and in certain markets through our CareMore subsidiary.  Our 1-800 CONTACTS, Inc. subsidiary offers customers online sales of contact lenses, eyeglasses and other ocular products. Additional information about WellPoint is available at www.wellpoint.com.
Source: senioroutlooktoday.com

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September 19, 2013

Hospitals May Soon Be Reaching For The Stars

Posted by:  :  Category: Medicare

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But even before it’s formally proposed, the possibility of the government rating hospitals based on a star system is receiving less than heavenly reviews. In a letter to Medicare, the Association of American Medical Colleges said it “strongly opposes the use of a star rating system, which may make inappropriate distinctions for hospitals whose performance is not statistically different. A star rating system can also exaggerate minor performance differences on measures.”
Source: kaiserhealthnews.org

Video: STAR RATING SYSTEM APPEARS HELPFUL FOR SENIORS ENROLLING IN MEDICARE ADVANTAGE HEALTH PLANS

Medicare Advantage Plan Star Ratings and Bonus Payments in 2012

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

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

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

Medicare stars 5 star Ranking System in a new role for Hospitals

The struggles lying with implementing this system have boiled down to a few controversial topics: subjectivity of evaluation standards, recording and reporting of information, and insufficiency of category data. Doctors are bouncing back and forth with the idea, discussing the pros and cons to each side of the agreement. This conversation has proven to be an important one in terms of troubleshooting this problem of hospital rating systems, and if this solution is not perfect, those behind solving this problem are well on their way to finding results that work.
Source: healthcareglobal.com

TriZetto Offers CMS Star Rating Analytics to Medicare Advantage Plans

The Centers for Medicare and Medicaid Services’ (CMS) Five-Star Quality Rating System for Medicare Advantage plans was put in place several years ago to help educate consumers on quality and make data more transparent. There are more than 30 measures on which Medicare Advantage plans are evaluated and more than 50 for those offering prescription drug benefits. The ratings Medicare Advantage plans receive significantly impact their enrollment options, reimbursement levels, marketing opportunities and ability to be recognized as a high performing plan. TriZetto’s new software analytics solution helps Medicare Advantage plans proactively analyze data and take immediate action to improve their quality data measures, ultimately making a difference in their Star Rating.
Source: virtual-strategy.com

Keeping Seniors Safe from High Risk Meds

Express Scripts’ High-Risk Medication Prior Authorization (HRMPA) program — part of our standard Medicare formulary management — helps improve patient safety by monitoring the real-time dispensing of CMS-classified HRMs. Our HRMPA program supports a plan sponsor’s prior authorization (PA) and medical exception initiatives, offers year-round, 24/7 review service, and gives physicians and pharmacists easy access to PA information.
Source: express-scripts.com

Alaris Health at Belgrove earns an overall 5

Founded on a tradition of health care excellence, Alaris’ Member Health Centers are leading providers of post hospital rehabilitation, long term and specialty care, with Member Health Centers throughout the state of New Jersey. Alaris Health at Belgrove offers services including admission and rehabilitative therapy seven days a week, wound care, IV services, orthopedic care, palliative and hospice care.  
Source: alarishealth.com

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