Medicare Supplements (Medigap) For Dummies

Posted by:  :  Category: Medicare

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

Video: AARP Medicare Supplement Plan F – Is It The Best Medicare Supplement?

Medigap Aarp Plan F Select Is A High

Can be however, advised how the person going to order a website plan should study the sale documents of all the Medigap plans one does a decision. All the 11 Medigap policies lid the basic benefits, but each one has some additional benefits along with themselves. In brief it can be told us that the Plan A is the most rudimentry plan. Nevertheless the Plans B-L special offers all the primary advantages of Plan A as well as a along with they will provide some a bit more coverage. Plans K-L opportunities the benefits equivalent to Plans A-J, but the difference is the cost-sharing for the relatively easy benefits which differs at different college diplomas.
Source: ispa-conference.org

THE 2010 NEW MODERNIZED MEDICARE SUPPLEMENT PLANS ARE FINALLY HERE

The changes to medicare/medigap plans have arrived and are now approved in most states. There are some very exciting changes. Several plans have been eliminated such as E, H, I, and J. Plan M and Plan N have been added. Plan N has been getting a lot of attention. It has some features that make it very affordable. It allows you to go to any doctor or hospital that accepts medicare without any need for referrals. The main feature not seen before in medigap plans or Medicare supplement plans is the addition of copays. You will pay up up $20 for an office visit, and $50 if you receive treatment in an emergency room. It will be waived if you are admitted to the hospital. The insured is also responsible for paying the part B deductible for the year of $155. The rates are coming in at 25-30% less then the popular plan F. With this type of savings we feel plan N will end up being one of the two most popular plans along with plan F. For more information about medicare supplement plans, medigap plans, medicare supplement, medigap quotes, or medicare advantage plans, please visit our website at Medigap4Seniors, or call us at 1-888-502-5553.
Source: swdemo4u.com

Joslin Reacts to New Medicare Changes around Diabetes Supplies

Posted by:  :  Category: Medicare

On July 1, Medicare established the Medicare National Mail-Order program, which drastically decreased the price of blood glucose testing supplies for people on Medicare, but requires people to get their supplies, including blood glucose trips, lancets, lancet devices, batteries and control solution, from a selection of 18 designated suppliers.
Source: diabetesnews.com

Video: New Medicare Diabetic Supply Program – a Nightmare

Medicare Diabetic Supplies

Many diabetic Medicare beneficiaries prefer to order their testing supplies via mail because it is more convenient and less expensive for the beneficiary. But, according to the New York Times, this process has “caused Medicare headaches for years” because of its costs to Medicare and high levels of fraud. To curb these issues, Medicare tested out competitive bidding on mail-order blood sugar test strips by 18 companies in nine metropolitan areas. As a result, both issues were addressed. Medicare previously paid $77.90 for 100 test strips; now, it paid only $22.47 during this experiment. Beneficiaries also benefit: Copayment prices also fell from $15.58 to $4.49.
Source: ehealthmedicare.com

Joslin Reacts to New Changes around Diabetes Supplies

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Source: joslin.org

Changes in Medicare for Diabetic Supplies, Wheelchairs and Other Medical Equipment

If a beneficiary lives in a contracted area such as Denver and travel outside of the area, they must use a contracted supplier that serves that area to avoid being charged for the medical equipment.  Also if beneficiaries live outside of a contracted area, special rules may apply. This is especially important for individuals who might live on the Western Slope and come to Denver for treatment.  Individuals who live on the Western Slope are outside of a contracted area; for them the Denver supplier will be paid differently, than if the beneficiary were purchasing the equipment from a supplier on the Western Slope. Most individuals who use multiple types of medical equipment will find themselves working with more than one supplier for equipment, as none of the national suppliers provide all types of medical equipment.
Source: myprimetimenews.com

Medicare interfering with diabetic supplies.

I hate to jump in here but as far as I am concerned Medicare/obama care have made a bolex of this and violating the US COnstitution, interfering with your Doctor by overriding your Doctors orders, violation of the interstate anti sherman anti trust act and generally standing in the way and wrecking your health. and in reality does not want to provide what you need to properly test and control your diabetes type 1 and type 2. I have had interference for last 2 years from 2 different supposed suppliers who kept denying the valid proper timely supplied proper documentation , scripts and logs – patient and blood glucose testing on a timely basis and simply force one to try and force a reduced number of strips.
Source: tudiabetes.org

Medicare’s new policy for diabetic supplies

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Source: early-retirement.org

Called LifeScan re: One Touch and Medicare supply companies

Well, I got more information – this time again, from the supply company I get my stuff from. LifeScan/One Touch is not going to be available to Medicare patients as supply companies run out of the Ultra strips since LifeScan is not willing to accept what Medicare pays. All companies- not just them. So, at some point, I’ll have to change meters- may as well do it now. Some companies may have larger stockpiles of ‘good’ (within expiration date) strips now, but once those supplies are gone, Ultra strips are not going to be available. LifeScan is shooting thier own feet with this, due to volume. Stupid move. I got a free Breeze 2, and trust that Bayer is a big enough company to have their ducks in a row re: quality. I’ve tested with both the Ultra 2 and Breeze 2 with the same drop of blood, and the results were within 2-3 points of each other- very good. SO, I told the supply company guy that I’ll go ahead and switch to the Breeze 2 (he said I can have as many meters as I want, so my purse will always have one- no worries about forgetting to take it, and a spare- just my thing- I also keep batteries around since one grocery store here sells the brand name ones for less than a dollar each- the ‘mart stores sell them for at least 3 bucks…..I can get them from the supply company, but when I need a battery, I don’t need to wait for one…..). Not knowing I’d be switching for sure, i got some Breeze 2 strip discs for a good price- so I’ll have some extras around while getting used to the Lantus (which is going well). I do like not having to insert the individual strips with the Breeze 2…. and being in the medical profession, know that Bayer is a good name. I haven’t gotten my Abbott meter yet (another good name), or the free AccuCheck (no problem with that company), or "Clever Chek" (never heard of them)… a bit slow on the shipping- but being free, can’t complain too much !! I am ticked at LifeScan. The strips are still available to non-Medicare prescriptions/users…. just not those on Medicare since Congress is supporting so many payment cuts (they’ll never have to be on Medicare- have their govt health care, so no worries for them). Congress is also supporting cutting payments to docs who take Medicare patients- so wonder how long it is before docs will be so hard to find that peoples’ health craters (ending up more expensive to fix- if it can be) because the docs can’t afford to accept them…. They’re just making things so difficult to force people to look at universal health (which I don’t like- the govt has messed up medical care enough in this country, starting with changes back in the 1980s when diagnoses were coded for payment- NOT what the patient actually needed). Physicians (not govt and lawyers or insurance companies) need to make medical care policies- with guidelines and budget balancing like any other business- and not forget that there’s a real person at the end of their decisions……feels more like cows in a herd- just one of the barnyard beasts…..Healthcare is a business- with peoples’ lives being the determination of success or failure (and there are those who can’t be helped- but should still be compassionately kept comfortable). It really sucks right now- but govt hasn’t shown it can handle much of anything- I don’t want them ‘over’ my life. Too scary. JMHO, and venting…… been in this business too long to not be skeptical.
Source: diabetesdaily.com

Health Insurance Marketplace Premiums: Policy Considerations And Implications For Payers, Providers, And Patients

Posted by:  :  Category: Medicare

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Consumer Protections.  The Affordable Care Act had already contained a great deal of consumer protections pertaining to the insurance industry.  The thoughtful inclusion of navigators is another bridge to enrollment and increasing health insurance access, but already there are reports of entities offering to find the best plan for individuals for a fee as well as others who are identifying themselves as navigators but are not affiliated with official organizations, have not completed any potential training, etc.  Some states have tried to counter this by requiring certification, background checks, continuing education, and the like, but it is certainly not standardized and likely also opaque to the consumer.  Federal and state exchanges already have a significant number of hurdles to jump and potential glitches to encounter, but the consequence of a potential abuse of consumer trust could great if accountability measures are not in place.
Source: healthaffairs.org

Video: Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year

NYT: Hospital, doctor choices may be rationed on new health exchanges

When insurance marketplaces open on Oct. 1, most of those shopping for coverage will be low- and moderate-income people for whom price is paramount. To hold down costs, insurers say, they have created smaller networks of doctors and hospitals than are typically found in commercial insurance. And those health care providers will, in many cases, be paid less than what they have been receiving from commercial insurers.
Source: nbcnews.com

3 On Your Side: Insurance Premiums Under Affordable Care Act

Delaware is expected to have 19 plans.  Again, the lowest premiums for a 27 year old would be in the bronze level and range from $111 to $203 depending on what tax credits would be available.  The premium for a mid-level plan for a family of four could range from between $282 to $859, again once tax credits based on income are factored in.
Source: cbslocal.com

Report: Connecticut Health Exchange Premiums Among The Nation’s Highest

The report says that most states will offer a variety of plans issued by multiple health insurance carriers. On average, there are eight different insurance issuers participating in each of the 36 exchanges that are being supported or fully run by the federal government. Connecticut consumers, meanwhile, will have a choice of three insurance companies.
Source: courant.com

First Peek At Premium Prices On The Texas Health Insurance Marketplace

The report by the federal Health and Human Services Department estimates the cost to marketplace customers. It does not reveal the actual policy prices.  Consumers in Dallas-Fort Worth will be able to choose among 43 qualified health plans. And HHS Secretary Kathleen Sebelius says prices are lower than originally expected by about 16 percent in Texas and nationwide.
Source: kera.org

Gannett Blog: Are health insurance premiums rising 20% to 50%?

I’m told employee premiums will jump 20% to 50% starting next year under the just-announced change to Gannett’s medical plan for next year. This was from someone who attended one of the human resources web-based seminars that started yesterday. Can anyone else confirms those figures? Please post your replies in the comments section, below. To e-mail confidentially, write jimhopkins[at]gmail[dot.com]; see Tipsters Anonymous Policy in the green rail, upper right.
Source: blogspot.com

Ninth Circuit Vacates Injunctions Barring HHS From Seeking Prepayment of Medicare Secondary Payer Reimbursements

Posted by:  :  Category: Medicare

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On appeal, HHS argued that the plaintiffs lacked standing, that the case was moot, and that the district court lacked subject matter jurisdiction.  HHS also argued that, on the merits, HHS’s interpretation of the Medicare secondary payer provisions was reasonable.  The Ninth Circuit held that the lead plaintiff failed to satisfy her presentment and exhaustion requirements when she filed her claim at the administrative level.  Because the claim was not properly presented to the agency, the Ninth Circuit found that the district court lacked subject matter jurisdiction.  On the merits, the Ninth Circuit held that HHS’s construction of the reimbursement provision was rational and consistent with the statute’s text, history, and purpose, and it vacated the injunctions entered by the district court.  The Ninth Circuit remanded the case for consideration of the plaintiffs’ due process claims.
Source: jdsupra.com

Video: Setting up Medicare as Primary Insurance and Commercial Insurance as Secondary Insurance

Medicare Secondary Payer Training

The training covered the Medicare Secondary Payer Act, Mandatory Insurer Reporting, Conditional Payment Resolution, Workers’ Compensation Medicare Set Aside Allocations, Liability Medicare Set Aside Allocations, Conditional Payment Resolution for Medicare Part C beneficiaries, Post Settlement Administration of Medicare Set Asides and Special Needs Trusts and finally, compliance with the SMART Act.
Source: il.us

On Medicare + secondary INsurance

I don’t know about pen needles, but you can get a list of Medicare approved vendors. I get my supplies (which is meds and test strips, basically) from Wal Mart, but other approved are Walgreen’s, any Kroeger store, and several others. Should be something on line you could find out. I was told to search "diabetic durable supplies".
Source: diabetesdaily.com

Ask The Experts: Retirement

Q. I will be retiring from federal service Jan. 31, 2014. I am covered by FERS. I am 65 now and will be 66 when I retire. I enrolled in Medicare Part A during the time frame I was supposed to enroll (when I turned 65) and when I enrolled in Medicare part A, I declined Part B because I have health coverage (Blue Cross/Blue Shield) under the government program for such.
Source: federaltimes.com

Reps. Reichert and Thompson Introduce Bipartisan Medicare Secondary Payer and Workers' Compensation Settlement Agreement Act

The Medicare Secondary Payer and Workers’ Compensation Settlement Agreements Act establishes clear and consistent standards for an administrative process that provides reasonable protections for injured workers and Medicare.  It would benefit injured workers, employers and insurers by creating a system of certainty, and allows the settlement process to move forward while eliminating millions of dollars in administrative costs that harm workers, employers and insurers.
Source: house.gov

Medicare Secondary Payer Activities Expected to Accelerate This Fall

ABOUT ALLSUP Allsup is a nationwide provider of Social Security disability, veterans disability appeal, Medicare and Medicare Secondary Payer compliance services for individuals, employers and insurance carriers. Allsup professionals deliver specialized services supporting people with disabilities and seniors so they may lead lives that are as financially secure and as healthy as possible. Founded in 1984, the company is based in Belleville, Ill., near St. Louis. Visit http://www.AllsupInc.com.
Source: virtual-strategy.com

Brad DeLong : Premiums, National Health Spending, and the Affordable Care Act: No. Nothing Coming Out of the American Enterprise Institute Should Be Trusted Before It Is Carefully Vetted and Verified. Why Do You Ask?

Posted by:  :  Category: Medicare

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AEI’s Chris Conover claims that, because total national health spending is going to be higher than baseline as a result of the ACA, it is not possible for the premiums paid by those who purchase health insurance to be going down as a result of the ACA. Say what? Right now the premiums of those who buy insurance pay for a lot of the uninsured’s medical care. If you broaden the base by insuring more people, you lower the rates that those who are insured and pay for the system pay.
Source: typepad.com

Video: The Basic Economics of National Health Insurance – Professor Richard D Wolff

New Cancer Insurance Checklist Helps Patients Choose a Health Insurance Plan

The Cancer Insurance Checklist is an easily downloadable form that helps you to organize all of your health care needs from prescriptions to doctor’s visits, compare health insurance plans in your state’s marketplace and offers guidance on the questions you should ask when deciding between different insurance plans. It provides a worksheet to help you detail all the costs associated with each plan and was designed to be used while evaluating plans and discussing your needs with a navigator or health care provider. The Checklist was created with cancer patients’ needs in mind to ensure all bases are covered when comparing health insurance plans. You can find more information and download the checklist at www.cancerinsurancechecklist.org.
Source: ovariancancer.org

A Broken Health Care System Is What Drives the National Debt

The good news is this is a problem with a known and proven solution. We can provide every American access to good health care at a fraction of what we are currently paying. Every other industrial country on Earth spends dramatically less on health care with similar outcomes. We can simply adopt one of these proven systems, like single-payer or all-payer. We are currently allowing the health care industry to dramatically overcharge Americans but we know government regulation could put a stop to this.
Source: firedoglake.com

Philhealth to employers: register ‘kasambahay’ in new social health insurance law

The amended law says all Filipinos shall be covered by Philhealth “through a socialized health insurance program that prioritizes the health care needs of the underprivileged, sick, elderly, persons with disability, women and children and provide free health care services to indigents.”
Source: interaksyon.com

NHIA Flouts provisions in section 71(1) of the National Health Insurance Act 2003

What makes the inability of the NHIA to comply with section 71(1) of Act 650 even more precarious on the business viability of GRMA members is the fact that a vast majority of members of the association are retired midwives who have established maternity homes from their own scarce resources to enable them render quality midwifery and other essential primary healthcare services to the public. Most of these healthcare facilities operate with minimal funds as against our overheads and recurrent expenditure. The Government’s service contract with the scheme expects GRMA members to pre-finance all their services to NHIS subscribers (except those under capitation pilot) and then file claims at the end of the month for reimbursement from the scheme.
Source: spyghana.com

National health expenditure expectations over the next decade

There’s plenty more detail in the report, and I suggest you go read it in full. It’s important to remember, of course, that these are best guesses. If the economy fails to recover as hoped, or if it recovered faster than we think, the projections could change significantly. It’s also possible that the Affordable Care Act could be more or less expensive, or have more or less of an effect on cost-containment. Only with time will we know for sure.
Source: academyhealth.org

Growth in nursing care expenditures to rise along with national healthcare spending patterns, analysis finds

Medicare spending is expected to increase from 2015 to 2022, as more baby boomers move into the program. Growth in Medicare spending will accelerate between 2019 and 2022, as boomers continue to enroll and 2% sequestration cuts end. This will be “primarily responsible” for faster average growth in total health spending for the end of the projection period as compared with earlier years, the report states.
Source: mcknights.com

Key Facts about the Uninsured Population

Going without coverage can have serious health consequences for the uninsured because they receive less preventive care, and delayed care often results in more serious illness requiring advanced treatment.  The major coverage provisions in the ACA take effect in 2014 and are designed to decrease the number of uninsured by expanding Medicaid, while also providing subsidies for private coverage and improving the health insurance marketplace.  The expanded availability of public and private coverage in the ACA is intended to decrease the number of individuals who face the access and financial challenges that come with being uninsured.  The ACA holds promise for many people who will gain access to health insurance coverage, but millions of people are struggling right now to access affordable healthcare for themselves and their families.
Source: kff.org

SANTA FE, N.M.: NM exchange insurance below national average

A report by the U.S. Department of Health and Human Services said individuals in New Mexico will pay an average of $282 a month for a mid-range insurance plan considered a benchmark by the federal government. That’s lower than the national average of $328. Those costs are before people apply any tax credits they may be eligible to receive.
Source: sunherald.com

National Health Plans, Designed To Spur Competition, May Be Unavailable In Some States Next Year

Final rules governing the plans were issued in March after the government reviewed more than 350 comments.  The rules give insurers some leeway – allowing them, for instance, to cover portions of a state initially. Some fear that could lead plans to avoid geographic regions with higher rates of poverty and illness. OPM is supposed to ensure the provision is not used to discriminate.
Source: kaiserhealthnews.org

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September 28, 2013

Medigap Plans from Gerber Life Insurance

Posted by:  :  Category: Medicare

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All of these Medicare supplement plans offered through Gerber life will cover your major out-of-pocket costs, those being the part a and part B deductibles and other costs associated risk receiving treatment from a Medicare contracted provider such as outpatient lab testing, outpatient surgeries and Dr. visits.
Source: qooqe.com

Video: Floirda |Life Insurance| Medicare| Group Benefits| www.insuranceaccesstoday.com

Medicare still has an LTCI image problem

A research arm of Bankers Life and Casualty Company has published new data on that misunderstanding in a report based on a Web-based survey of 1,299 U.S. residents ages 49 to 67. The survey participants had annual household income of $25,000 to $75,000.
Source: lifehealthpro.com

New Hampshire: Brand New Medicare Supplement Plan

About GarityAdvantage Agencies We are specialists in the Senior Market with over 75 years combined experience helping independent brokers grow their business and client base. As a national field marketing organization (FMO) specializing in the Medicare/Senior Market, we offer independant insurance agents outstanding service, competitive products and top commissions across a wide range of senior products including Medicare Advantage, Medicare Supplement, Final Expense, Funeral Trust, Hospital Indemnity and more.
Source: wordpress.com

Medicare Does Not Pay for Long

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

It's Just a Mattress and Medicare for All for Life, Huh?

Well, for millions of working class people like me, the damages that come from economic hits like illness, injury, floods, fires, and other life events that seem inevitable often become insurmountable or at least more devastating than the same economic hits delivered to those with more resources with which to respond.  A few hundred dollars can be the difference between life and death, sleep and insomnia, hunger and a full belly, or health and long-term, chronic illness. Five years ago when I went to work for the California Nurses Association in the months after SICKO (Michael Moore’s 2007 documentary in which we appeared) was released, the very first purchase Larry and I made with my first paycheck was a nice, new mattress.  We had never had one before in our more than 30 years of marriage.  We had slept on every manner of  lousy, back-breaking mattress, and when this one was delivered to our modest apartment in Chicago, it was the biggest gift we had ever given one another.  Many people buy mattresses that cost thousands.  Ours was just $850, but it was and has been wonderful for us.  Our backs are so much better, and the mattress was the reason for that.  So when that wonderful mattress — now moved six more times since it was purchased in 2008 —  got wet in the flood with the stinky, dirty water that soaked the carpets, many of our clothes and lots of other stuff, I was heartbroken.  The mattress and box spring are now leaning out in my daughter’s garage drying out where the smell of the lawnmower and gasoline are still pretty strong but at least better than the yucky flood water.  I do not know if the mattress can be saved.  I do know we cannot afford to replace it now.  And I also know this wouldn’t be a heart-breaker for many people or something they’d even worry about too much.  Many people would just put a new mattress on a credit card or buy a new one.  We cannot, nor can many other working class people.  We will either use the stained one when it dries or get another lousy used one somewhere. And I know there are thousands of other working class people and renters  here in Colorado experiencing the same sorts of things since the floods. And so it is with health care too for a large number of working class people in America.  When we get sick or hurt, we do the best we can with what we have.  And when the money or insurance coverage runs out, we do what is necessary and possible, not necessarily what is best for the long run or for our long-term health.  This has tremendous consequences in our society.  If we had an improved and expanded Medicare for all for life health care system, we would be better able to make health care decisions based on what was best for our health rather than trying to save money or do without needed care.  More Americans, working class and not, would be able to care for themselves more appropriately and in a timely way that would ultimately help us all be healthier and more secure. No more health care dead or health care broke in the US if we had such a system– and maybe even many millions more people able to get a few more nights of restful sleep. .  Sort of like having a nice, comfortable, clean and decent mattress upon which to sleep.  ____________________________ September 19, 2013 —  Today’s count of the health care dead and broke for profit in the U.S.:
Source: michaelmoore.com

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September 28, 2013

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

Posted by:  :  Category: Medicare

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: How to Save Medicare $30 billion: www.UpgradeThe Card.org

Medicare and Healthcare Reform

A: The Fed­eral Medicare agency has a “5-Star” qual­ity rat­ing sys­tem for Medicare Advan­tage plans. You can use the star rat­ing to check your plan’s per­for­mance. The rat­ing sys­tem gives insur­ance com­pa­nies a strong incen­tive to improve your care. Check your plan’s rat­ing at www.medicare.gov.
Source: amvets.org

The other Washington could hold the key to Medicare's cost crisis

 But in Washington state, which is known for its progressive politics, the measure, requested by former Democratic Gov. Christine Gregoire, sailed through the legislature, albeit with an appeals process amendment the governor vetoed. “Medicare should be doing this, but it gets rolled by the Congress,” said Dr. Robert Berenson, a health policy expert at the Urban Institute and former commissioner of the Medicare Payment Advisory Commission (MEDPAC), an independent agency that advises Congress on issues affecting Medicare. Berenson pointed to several high-profile examples of Congress meddling with coverage policy, including the case of the late Sen. Ted Stevens of Alaska, who at the behest of the PET scan industry almost single-handedly forced Medicare to cover the scan as a test for Alzheimer’s, a policy that existing science did not support.
Source: publicintegrity.org

Trends in the Use and Cost of Chiropractic Spinal Manipulation Under Medicare Part B

RESULTS:   The number of Medicare beneficiaries who used chiropractic spinal manipulation grew 13% from 2002 to 2004, remained flat through 2007, and then declined 5% through 2008. An estimated 1.7 million beneficiaries (6.9%) used 18.6 million allowed chiropractic services in 2008. In inflation-adjusted dollars, allowed charges per user increased 4% through 2005 and then declined by 17% through 2008; payments per user increased by 5% from 2002 to 2005 and then declined by 18% through 2008. Expenditures for chiropractic in 2008 totaled an estimated $420 million. Longitudinal trends in allowed claims for spinal manipulation varied by procedure: the relative frequency of treatment of one to two spinal regions declined from 43% to 29% of services, treatment of three to four regions increased from 48% to 62% of services, and treatment of five regions remained flat at 9% of services.
Source: chiro.org

Restructuring Medicare’s Benefit Design: Implications for Beneficiaries and Spending

The study also examines the expected impact of two variations of this proposal. The first looks at a higher or lower out-of-pocket spending limit, and illustrates how raising the limit would increase beneficiary costs while reducing Medicare spending, while a lower limit would do just the opposite. The second variation examines the effect of combining the alternative benefit design with restrictions on Medigap coverage, another frequently mentioned approach to achieving Medicare savings.
Source: kff.org

Medicare Benefits and Cost

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

Top Medicare Official: ‘We Can and Should Do More’ to Oversee Drug Plan

Sen. Tom Carper, D-Del., who chaired the hearing, cited two new government reports on the program, known as Part D, from the inspector general of the U.S. Department of Health and Human Services. The first, issued last week, found more than 700 general-care physicians with extremely questionable prescribing patterns, including some whose prescriptions were filled at hundreds of pharmacies across dozens of states.
Source: propublica.org

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September 28, 2013

Flackcheck.org : Glenn Kessler on $700 billion Medicare claims

Posted by:  :  Category: Medicare

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FlackCheck.org is the political literacy companion site to the award-winning FactCheck.org. We provide resources to help students recognize flaws in arguments in general and political ads in particular. FlackCheck.org is funded by an endowment provided by the Annenberg Foundation to support the Leonore Annenberg Institute for Civics and by a grant from the Omidyar Network.
Source: flackcheck.org

Video: Medical Billing Expert Series: Medicare Claims Processing Manual Chapter 20

Medicare offers some relief on transitional care management claims : Getting Paid

The agency then added, "We also have made some adjustments to our claims processing systems to better accommodate the unique billing requirements of this new, 30-day service. We believe that with the adjustments that we have made and extra care with billing on behalf of practitioners, that the problems that have been encountered will be alleviated."   If you verify that all requirements for furnishing the service have been met and the claim is still unpaid, CMS is encouraging you to re-submit it. For more resources about billing TCM services, see the Getting Paid blog post from July 31, 2013, detailing the last batch of TCM assistance.   – Kent Moore, Senior Strategist for Physician Payment for the American Academy of Family Physicians  
Source: aafp.org

CMS Ruling Clouds Medicare Revenue Clarity for Hospitals and Forces Tough Choices

Currently any payment for Medicare hospital inpatient services can be reviewed and denied up to three years after the date the claim was originally paid through the Recovery Audit Contractor (RAC) program.  Once a RAC-issued denial letter is received by the provider, an extensive appeal process begins that can take months and sometimes over a year to resolve.  According to the RACTrac Survey, 75% of all appealed denials are still in the appeal process with a significant number of appeals delayed beyond the statutory limits.  In many cases, one of the last levels of appeal is done with an Administrative Law Judge (ALJ) who has the ability to overturn, uphold or partially overturn any denial.
Source: triple-tree.com

GAO report calls for more consistency investigating Medicare post

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

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September 28, 2013

The Conservative Plan for Medicaid Expansion

Posted by:  :  Category: Medicare

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Iowa, which has already been operating a Medicaid program for a relatively large population, is implementing changes more gradually. The state is only opening up the private option to those in the highest, Medicaid-eligible income brackets (between 100 and 133 percent of the federal poverty level). Everyone else will continue on traditional Medicaid. Iowa’s plan will charge just about everyone with a $20 premium, which can be waived through participating in wellness programs. (Only those making less than 50 percent of the poverty level—or $5,500 for an individual—would be exempt.) The premium is among the most controversial aspects of the proposal and one many expect the federal government to spike. However, no one will pay this premium the first year, and those who get a health-risk assessment and a physical won’t have to pay premiums in year two. For those entering the private option, the state has also requested not to provide the wraparound services, instead promising that those who need care beyond what the private plans provide for will go into the traditional Medicaid system.
Source: prospect.org

Video: Strengthening Medicaid is a Good Deal for Arkansas

This Hour: Latest Arkansas news, sports, business and entertainment

Democratic Senator Mark Pryor on Friday voted for the measure intended on keeping the federal government operating through November 15th, while Republican John Boozman voted against the measure. The Senate passed the continuing resolution on a 54-44 vote after voting by the same margin to remove from it a House proposal to defund the federal health care overhaul.
Source: kait8.com

Brad DeLong : Ann Marie Marciarille: The Private Option for Medicaid Expansion: Noted

I appreciate that the Missouri version of Arkansas-style Medicaid Expansion is being circulated without name as “Rough Draft No. One.” The shoe fits. As far as I can tell, the proposal mimics in essentials Arakansas’ 1115 waiver application… http://humanservices.arkansas.gov/dms/Documents/Final%201115%20Waiver%20Materials%20for%20Submission.pdf…. The “rationale” section of the Arkansas 1115 waiver application is the most interesting:
Source: typepad.com

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

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

The “private option” for Medicaid expansion and budget neutrality

Earlier this month, the state Department of Human Services sent its request to the feds for a waiver of federal rules so the state can proceed with the so-called “private option” for Medicaid expansion. One requirement of the plan — which will use Medicaid funds to fully cover the premiums of private health insurance plans for low-income Arkansans — is that the state demonstrate “budget neutrality”: The “private option” is not supposed to cost more than traditional Medicaid expansion would. Many have expressed skepticism that this is an achievable goal for the state given the wealth of empirical evidence that Medicaid is cheaper than private insurance. During the public comment period, in addition to the hubbub over community health centers, a few groups raised questions about budget neutrality. That includes Americans for Prosperity, though it’s been a bit peculiar to see them harp on this particular point — if traditional Medicaid expansion is cheaper, that seems to argue for, well, traditional Medicaid expansion, which is probably not on AFP’s agenda. Voices on the left have brought it up as well. As Anna Strong of Arkansas Advocates wrote, “It is clear the waiver does not go into detail about the evaluation of budget neutrality for the demonstration, a requirement for federal approval.” And it’s true. The waiver request is vague on this point. Arkansas is asking the feds for a 3-year “Demonstration waiver” — basically, permission to run an experiment. The experiment includes various hypotheses about how the “private option” will work, including the hypothesis that it will be comparable in cost to traditional Medicaid. But unlike the other hypotheses, which articulate clear measurement mechanisms, the “cost comparability” hypothesis lists the “evaluation approach” as TBD; the “data sources” section is blank. (The final waiver request includes a budget neutrality spreadsheet not included in the original draft, but this merely asserts that the costs will be the same.) I asked DHS about this when they first released the draft of the waiver request. A spokesperson responded: The hypotheses are designed to support a more formalized academic evaluation whereas the Special Terms and Conditions will include the requirements for achieving budget neutrality. Budget neutrality requirements will be addressed in the Special Terms and Conditions to be drafted by CMS [Centers for Medicaid and Medicare Services] following the waiver submission. In other words, the question of how to evaluate whether the “private option” costs more than traditional Medicaid will ultimately be up to the feds. The state and CMS are currently discussing  the development of an evaluation approach; if the waiver is approved, it will include instructions from CMS on how to test for budget neutrality. DHS has a controversial theory (backed by an actuarial study) about why the “private option” will cost the same, or even less. Its hypothesis states that the cost will be comparable to traditional Medicaid “assuming adjustments … to achieve access.” That “assuming adjustments” bit is the key: DHS argues that if traditional Medicaid is expanded, the Medicaid program would have to increase reimbursement rates to providers in order to achieve adequate access. By how much? All the way up to private rates. The Medicaid program wouldn’t be able to “beat the market,” according to Medicaid director Andy Allison; if more than 200,000 low-income Arkansans gain coverage, Allison argues, the reimbursement rates necessary to entice enough providers to cover that huge new pool of people will be the same whether they’re coming from a public program or private carriers. As Allison put it back in March: “If it’s the same number either way then this question of cost comparability — cost effectiveness — for the private option versus some kind of traditional Medicaid is moot.” I’ll pause here to note that it’s probably a good thing that the feds are the ones with the final say on a budget neutrality test since by the DHS theory, it’s already baked in the cake. If you want to know what traditional Medicaid expansion would have cost, the answer is the cost of the “private option.” Game, set, match! Presumably CMS will settle on a more rigorous means of testing the DHS theory, which has thus far largely been met with skepticism by healthcare watchers outside of Arkansas. Perhaps CMS will compare Arkansas to another state, one that went with traditional Medicaid expansion. But here’s the thing: The demonstration is supposed to determine which costs more: a policy that happens — the “private option” — or an alternative policy, traditional Medicaid expansion in Arkansas, that never happens. That’s an inherently abstract question and the feds are likely to grant a good deal of wiggle room in determining the answer. For example, if Arkansas is compared to another state, there are any number of individual differences between states that might be hard to control for. A budget neutrality evaluation won’t necessarily have a clear, black-or-white result. Given that CMS appears to be politically invested in the success of the Arkansas “private option” policy, the state is probably going to be given some latitude on the budget neutrality question, at least over the course of the three-year demonstration period and perhaps beyond that. Joan Alker, a health policy expert at Georgetown University, does a good job in this post of explaining federal rules for “private option”-style premium assistance schemes and concludes that “CMS left some room for fudginess in how they will approach the issue of cost-effectiveness.” Hmmm. Meanwhile, a recent study from the U.S. Government Accountability Office (GAO) found that CMS isn’t exactly a stickler for proving budget neutrality on Medicaid waiver applications, regardless of what the rules say. Will the state actually achieve budget neutrality? Hard to say, and harder to measure than you might think. There are critics that believe the DHS theory doesn’t pass the smell test; they point to the experience of Massachusetts — when it moved to universal coverage, Medicaid remained significantly cheaper than private insurance on  that state’s healthcare exchange. Regardless, the chances of Arkansas missing out on federal approval because of concerns about budget neutrality — or even the chances of failing a budget neutrality test imposed by CMS — strike me as low. A little “fudginess” goes a long way. That’s not to say that the question of budget neutrality is unimportant. After all, it’s federal taxpayers that will be footing the bill! It matters to the state budget too: If Arkansas continues with the “private option” policy, the state will be chipping in eventually (the feds pick up the full tab for the first three years, the length of the proposed demonstration waiver). Of course the point of a demonstration wavier is to try something new. DHS may be right, and the “private option” may turn out to be just as cost effective as Medicaid, or more so — which would be big news in healthcare reform. It’s an empirical question and we’re about to get three years of data. But it’s also a politicized issue, and I expect that folks will still be arguing about the answer three years from now. 
Source: arktimes.com

Arkansas: Arkansas State Medicaid Program

Roughly a 45-minute car ride south of Little Rock, Hot Springs is another area of Arkansas and Missouri Railroad Park, Fort Smith, Arkansas, the arkansas state medicaid program in Eureka Springs is the arkansas state medicaid program for the arkansas state medicaid program of Electrical or Controls Project Engineer with the arkansas state medicaid program that they offer poker games that are fast. If you need protection, but you need quality protection. By taking a few of the arkansas state medicaid program to operate a 1920s era streetcar. It’s only a lonely heart but also a lot animals while hiking. If you aren’t in a four year revocation of your life with, loving them, hating them, falling in love with them again and simply enjoy their company.
Source: blogspot.com

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September 28, 2013

The Medicare Annual Wellness Visit: A Key to Better Patient Care

Posted by:  :  Category: Medicare

The AWV is not a yearly physical exam. The purpose of the visit is to deliver evidence-based preventive services by an appropriate clinical provider in the appropriate clinical setting. It is also mandatory to provide a Health Risk Assessment (HRA) as part of the visit. The HRA identifies the high-risk over-utilizer; CMS uses the CMS-HCC risk methodology. The use of HCC scoring may be of benefit in designing care plans, particularly in planning for post-discharge care. Given that patients with higher HCC scores and therefore a greater number of medical complications have significantly higher post-discharge costs, it may be useful for the clinical care team to carefully review all of the diagnoses for all patients to identify those patients having medical conditions that may create significant post-discharge costs. The AWV HRA is an opportune time to collect the ICD-9 codes necessary for CMS-HCC risk adjusting methodology. There are software applications that automate this process in a prospective fashion.
Source: physicianspractice.com

Video: Urinary Catheter Supplier & Urological Supplies – Medicare and Private Insurances Accepted.

Number Of Doctors Leaving Medicare Contested

These facts aside, doctors who participate in Medicare sill face enormous financial pressure. NPR ends its article with a quote from President of the American Medical Association, Dr. Ardis Hoven, which it does not counter. Hoven is quoted in this article from Forbes, “While Medicare physician payment rates have remained flat since 2001, practice costs have increased by more than 20 percent due to inflation, leaving physicians with a huge gap between what Medicare pays and what it costs to care for seniors.”
Source: healthcaretechnologyonline.com

Time to reflect and redesign

A new government and a new community pharmacy agreement provide an opportunity to reflect on what has come before in professional programs and what is needed to support pharmacy to deliver professional programs. General practice has been very vocal with the recent new medication management program, Medscheck, as GPs have felt they were not informed or consulted as part of the development of these programs. In the Professional Practice Incentive area of the 5
Source: com.au

Superannuation – Medicare Super Clearing House (Login Errors)

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Source: com.au

Helpful advice for Minister Dutton: on the review of Medicare Locals, and other priorities…

1. Remove the ability to patent human genetic material. Australians need a commitment by the new Health Minister to draft legislation to remove the ability to patent human genetic material. We could wait years for the courts to work though the molecular biology arguments in which they find themselves. This is not really a legal matter, but an ethical one – at most an unintended consequence of legal interpretation.  We need to provide certainly for patients, researchers and ethicists. The Australian community finds it disturbing that bits of our bodies can be owned by commercial interests, researchers find it frustrating and patients find the current status limiting and uncertain. 2. Speed up drug approvals processes. While maintaining the integrity of the TGA, PBAC and MSAC approvals processes for new drugs and co-dependent technologies, commit to streamlining and reducing the time between registration and decision, so that Australian patients are not waiting longer than those in other western countries for access to proven innovative therapies.  Also arrange to prune the approved lists for subsidy of superseded drugs. 3. Prioritise and streamline clinical trial reforms. As we move further towards personalised medicine, the number, purpose and design of clinical trials need to change.  We would like to see the new Government take up a nationally coordinated approach to clinical trials, including a review of the effective role and numbers of ethics committees.
Source: com.au

Medicare Drug Plan Polls Suggest Bright Future for Obamacare

Looking back on it, the public’s turnaround from initial rejection to growing support for Part D was understandable. The unfunded $400 billion program that President Bush signed into law in December 2003 was needlessly complex for seniors and unnecessarily expensive for taxpayers. Rather than having the government negotiate prices directly with pharmaceutical firms and add drug coverage into the traditional Medicare program, President Bush and his Republican allies in Congress instead gave recipients subsidies to purchase plans from private insurers. Making matters worse, millions of “dual eligible” already receiving drug coverage from Medicaid had to switch to the new scheme, a process that left millions unable to pay for their prescriptions for weeks in early 2006.
Source: crooksandliars.com

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