Medicare FAQ: What is Medicare Supplement (Medigap) Insurance

Posted by:  :  Category: Medicare

As mentioned previously, Original Medicare, Part A and Part B, provides seniors and eligible disabled and ill Americans with the health coverage they need; however, it does not cover all costs and benefits. That’s where Medicare Supplement Insurance comes in. These plans can fill in the gaps in Original Medicare coverage. Although this type of coverage may not be right for all individuals, it is important to see if you need additional coverage beyond Part A and Part B, and understand your options before enrolling. In this post, we will focus on questions surrounding Medicare Supplement Insurance.
Source: planprescriber.com

Video: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

FAQ: What is Medicare Supplement (Medigap) Insurance?

Medicare Supplement Insurance, also known as Medigap or MedSup coverage, complements Original Medicare (Medicare Part A and Part B) by filling in the coverage gaps of some health care costs that are not covered under those plans. Medigap is an optional program, which means that Medicare does not pay for any part of this coverage. Medigap coverage is purchased through private insurance companies at the cost of the beneficiary.
Source: ehealthmedicare.com

Utah Medicare Supplements

A Utah Medigap (also called Utah Medicare Supplement Insurance) policy is private health insurance that is designed to supplement Original Medicare. This means it helps pay some of the health care costs (gaps) that Original Medicare doesn’t cover (like copayments, coinsurance, and deductibles). If you are in Original Medicare and you have a Medigap policy, Medicare will pay its share of the Medicare-approved amounts for covered health care costs. Then your Medigap policy pays its share. (Note: Medicare doesn’t pay any of the costs for you to get a Medigap policy.)
Source: utahseniorservices.com

Bloomfield's News on Money

Plan F covers co-insurance coverage for Medicare Parts A and B. It also covers 365 days of hospital costs after Medicare benefits are used up. It also covers co-insurance payments for Medicare Part B, but this does not include charges for preventative care doctor visits. When blood is needed, Plan F pays for up to three pints and it also provides coverage for excess Part B charges. What makes Plan F an attractive supplement is the fact that it also covers Foreign Travel Emergency services.
Source: bloomfieldnm.info

Medicare Supplemental Insurance Open Enrollment Period

Fortunately, you can purchase a Medigap insurance policy to make up the difference for these types of expenses. After Medicare pays its share for covered medical care, the remaining claim is automatically forwarded to a Medigap policy. The provider of these Medicare supplements then pays the balance or a portion of the balance.
Source: stevendejoode.com

Medicare Supplements Help Fill Medicare Gaps

Medicare ill, like private insurance, determine how much of the charge meets the coverage guidelines and will then pay 80 percent of that reduced amount. The patient or the Medicare supplemental policy will pay the remaining 20 percent. As an example, a person goes to the doctor, and the charge is $150. Medicare decides it is only going to allow $100 of the charge. The patient is not responsible for the portion that Medicare does not approve. Therefore, Medicare pays 80 percent of the portion it approved, such as in this example, $80. The patient or his supplement insurance carrier will pay the remaining 20 percent or $20.
Source: sdecocenter.org

How to Choose a Medigap Supplemental Policy

You also need to be aware of the three pricing methods which will affect your costs. Medigap policies are usually sold as either “attained-age” policies which are premiums that start low but increase as you get older. “Issue-age” policies that increase prices due to inflation, not age. These policies may start out a little more expensive than attained-age policies but generally have few rate increases over time. And “community-rate” policies, where everyone in an area is charged the same premium regardless of age. Issue-age and community-rated policies will usually save you money in the long-run.
Source: downriversundaytimes.com

Information About Medicare Supplements

Medicare supplement Plan F is the most popular and helps pay for the co-insurance costs of Medicare Part A and Part B. Plan F also covers 365 hospital days after Medicare is used to its maximum amount of coverage. Medicare Part B is also covered by Plan F. Plan F pays for up to three pints of blood whenever it is needed and it also covers any excess Part B costs. Plan F is especially desirable because it covers emergency services when a policyholder travels abroad.
Source: fishbowlamerica.com

Key Things to Know About Buying Medicare Supplemental Insurance

Additional benefits vary according to the plan selected. These benefits include a set amount of coverage for skilled nursing facility charges up to 100 days, and coverage of certain Medicare Part A deductible charges. Since 2006, Medicare Supplemental Insurance plans do not include prescription drug coverage as part of their benefits, and individuals requiring such coverage should investigate joining a Medicare Part D Prescription Drug Plan. Individuals should also be aware that Medigap plans generally do not cover such costs as private-duty nurses, dental or eye care, eyeglasses, hearing aids or long-term nursing care costs. Consider switching over to a Medigap Advantage Plan if prescription drug coverage is required.
Source: weatheringthefinancialstorm.org

How and when to sign up for Medicare

Posted by:  :  Category: Medicare

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If you are eligible, you have the choice of accepting or rejecting Part B coverage. If you want Medicare Part A and Medicare Part B, then you should sign your Medicare card and keep it in your wallet. If you don’t want Part B, you put an “X” in the refusal box on the back of the Medicare card form, and send the form to the address shown right below where your signature goes. About four weeks later, you will get a new Medicare card indicating that you only have Part A coverage.3
Source: stillwatergazette.com

Video: FOX NEWS: McConnell To Democrats Raise eligibility age for Medicare

Census: More Americans Have Health Insurance As People Age Into Medicare

One provision — which took effect Sept. 23, 2010 — allowed parents to keep their children as dependents on their health insurance policy until age 26. Much of the benefit was realized in comparing 2011 uninsured rates with 2010 rates for people 19 to 25 years old, but there was some continued help last year, Day said. The number of uninsured Americans 19 to 25 years old decreased from 8.27 million in 2011 to 8.21 million last year, a drop of 66,000, or one-half of a percent of the 30 million in that age category. Connecticut passed this provision in 2009, earlier than the federal law.
Source: courantblogs.com

Second Opinion: I’m Nearing Medicare Age. Can I Get Gap Coverage?

Speak City Heights laid as its foundation the premise that soft and loud voices alike are instrumental in securing community health. For this reason, Speak City Heights encourages an open, civil exchange among its users via comments, polls and other tools. We ask that your participation be useful and collaborative, and reserve the right to monitor your contributions and moderate content that is disrespectful, misleading or unlawful. To this end, we ask that you provide your full name and neighborhood when submitting comments.
Source: speakcityheights.org

Obama rules out raising Medicare eligibility age to cut spending

WASHINGTON (Reuters) – President Barack Obama has ruled out raising the age that Americans become eligible for Medicare, the government health insurance program for seniors, as a way to reduce the government’s deficit, a White House spokesman said on Monday.
Source: theoaklandpress.com

High Medicare spending on prostate cancer screenings, but little benefit for older men

“In terms of what these results mean for Medicare spending, this is just the tip of the iceberg,” said Cary Gross, M.D., professor of internal medicine at Yale School of Medicine, and director of the Yale COPPER Center. “Many older men who are diagnosed with early-stage prostate cancer may end up receiving therapy that is potentially toxic, has little chance of benefit, and carries substantial cost. In order to truly understand the costs of screening, the next step is to identify how many additional cancers are being diagnosed and treated as a result of screening older men for prostate cancer. We need better tools to target screening efforts towards those who are likely to benefit.”
Source: sciencecodex.com

N.C.’s nascent Medicaid reform

Posted by:  :  Category: Medicare

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Differences in availability of Medicare Advantage plans by county are driven by the choices of private insurers. Private companies cannot be forced to offer a Medicare Advantage plan in a given county, and many offer different plans in different counties. To provide a sense of the variation, peruse this website that provides a great deal of information on Medicare Advantage plans in N.C. Selecting the subset of plans offering a $0 prescription drug deductible and seeking the lowest premium plans in 2013 yields the following list of plans (if you click the county name you will see all MA plans). This scanned map (NCMedAdvtantage.6.5.13_best) with my handwritten comparisons of what is available in selected counties is illustrative. In Durham county, there are two Medicare Advantage plans with a $0 prescription drug deductible that have no additional premium to be paid by a Medicare beneficiary choosing this plan, and another with an additional patient monthly premium of $6. In Lenoir county, there are two plans, but the lowest monthly premium to be paid by a beneficiary for such a plan is $75 per month. I have not done a comprehensive comparison of all Medicare Advantage plans; my point is that the Medicare Advantage market is county-based, driven by insurance companies deciding where they want to offer certain types of plans.
Source: wordpress.com

Video: Al Crouse & Assoc. Medicare Supplement Insurance, Hickory NC

Coming to NC for 2014: NEW Medicare Advantage 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

NC Seniors in DC to Fight for Social Security Medicare / Public News Service

DURHAM, N.C. – Fifty-three North Carolina seniors today are taking a hands-on approach to potential cuts to their Social Security and Medicare benefits. They boarded a bus early this morning for Washington to tell their congressional representatives about the impact cuts would have on their well being. The group is part of nearly 500 seniors on Capitol Hill who intend to share information that half of all Americans age 65 and older earn less than $20,000 a year, according to AARP figures. Helen Featherson, president of the Durham AARP chapter, is on the bus. “If you want to cut, cut someplace else, but don’t balance the budget off the backs of us who are dependent; because we were promised that if you worked, you will get Social Security. ” Under the Budget Control Act, a congressional “super committee” is responsible for trimming $1.5 trillion from the nation’s debt, and changes to Medicare, Social Security and Medicaid could be part of that. If the committee doesn’t reach consensus, automatic cuts take effect in 2013 – and it’s unclear if they will include the three programs. AARP legislative liaison Chip Modlin, 75, of Fayetteville, says Social Security should not be part of the budget debate. “Social Security is something that we earned, we pay into it all of our lives. Social Security hasn’t added one dime to this deficit and it’s not in trouble financially.” According to AARP, half of all Medicare beneficiaries spend at least $3,000 out-of-pocket annually on their health care. The North Carolina group joins seniors from eight other states on Capitol Hill today. AARP says those who couldn’t be part of the bus trip can call 1-888-722-8514 to voice their views.
Source: publicnewsservice.org

Madame Defarge: NC Medicaid ‘forgot’ to Include Wrap

Prior to the LME’s completely managing Medicaid in NC (in my practice area, it is Smoky Mountain Center LME, about to become the largest LME in NC as Western Highlands Network LME is to be incorporated into SMC LME 10.1.2013), this Medicare CPT code, 96152, paid appropriately and it automatically wrapped around to a DIFFERENT outpatient therapy code via NC Medicaid.
Source: blogspot.com

Medicare report shows NC nursing home quality is improving

ACH12-Distribution ACH19-ValueforMoney AHC2-HowSpent AHC5-GovernmentRole AHC13-PovertyandHealth Entitlement Reform International Comparisons NN18-Conferences-Meetings NN19-Books NN20-Articles-Papers NN21-Grey-Literature NN27-Blogs PPACA-Constutionality PPACA-EssentialBenefits PPACA-HealthExchanges PPACA-Impact-Access PPACA-Impact-Consumers PPACA-Impact-Costs PPACA-Impact-Employers PPACA-Impact-HealthInsurers PPACA-Impact-HealthProfessionals PPACA-Impact-States PPACA-Medicaid PPACA-Medicare PPACA-PublicOpinion PPACA-Repeal Regulation-FDA Regulation-HealthFacilities Regulation-Lifestyle UHC12-2012
Source: wordpress.com

Obamacare: Medicare (mostly) not affected

Posted by:  :  Category: Medicare

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You will not need to go to the health insurance exchange. The plans sold there are not for Medicare members.  They are for people who do not get health insurance through their employer, and for employers with fewer than 50 workers.  Your Medicare supplement plan will not go through the exchanges; it will be the same as you have it now.
Source: bangordailynews.com

Video: Introduction into Medicare Supplements (Medicare Supplement Insurance Series)

Original Medicare vs. Medigap: Which is Right for You

Unlike Medicare Advantage and Medicare Part D, which have the same enrollment period called the Annual Enrollment Period (from October 15 to December 7 each year), Medicare Supplement Insurance has its own enrollment period. It spans six months and begins the month that you turn 65 and have Medicare Part B. This is the optimal time to join a plan because you do not have to submit to Medical Underwriting, which is when your medical history is reviewed and you can be charged more for insurance or even be declined coverage.
Source: ehealthmedicare.com

Understanding Medicare Supplemental Insurance

While Medicare covers many things, there are different regulations depending on the state. There are also limitations, such as the length of time a person can stay in a hospital or nursing home, medical problems outside the United States, and so forth. That is why many people purchase additional Medicare supplements, also called Medigap, from a private insurance company.
Source: askamydaily.com

Medicare Supplement Quotes

Quotes on Medicare supplement insurance coverage are easy to obtain online. All you need to do is answer a few questions and an online quote generator can tell you how much that insurer will charge for coverage. Be sure to read all information about a policy before buying as not all Medigap policies are the same. If you have a Medicare Advantage plan, in most cases you’ll want to drop it before your new Medigap policy starts coverage.
Source: skepticwiki.org

Island Mother of Six: Medicare Supplemental Insurance

Now that you have your Supplement insurance squared away, make sure you also procure a Part D, better known as a Prescription Drug Plan. Neither Medicare nor your supplement plan will cover your monthly prescriptions and it is imperative that you seek the best plan for you based on your needs and budget. If you fail to do so, penalties may be imposed on you later and you will pay a higher rate for as long as you are on Medicare.
Source: blogspot.com

Understanding Medicare Supplemental Insurance

Medicare supplemental insurance is sold by private companies like AARP and Mutual of Omaha. There are 11 standard plans that vary in price. Each plan fills different “gaps” in Medicare coverage and offers different benefits. Customers can choose only one of these plans. Medigap plan F is the one most often chosen because it fills nearly all of the coverage gaps. If your spouse wants Medigap insurance, he or she will need to purchase a separate policy. Depending on what plan you choose, Medicare supplemental insurance may cover the cost of:
Source: terrencemalick.org

Medicare Supplemental Insurance Open Enrollment Period

Fortunately, you can purchase a Medigap insurance policy to make up the difference for these types of expenses. After Medicare pays its share for covered medical care, the remaining claim is automatically forwarded to a Medigap policy. The provider of these Medicare supplements then pays the balance or a portion of the balance.
Source: stevendejoode.com

Brookhaven NY Auto, Business Insurance and Medicare Supplement Insurance

Commercial insurance means offering the right products for markets of every size. Brisotti & Silkworth Insurance can provide what you need when you need it. Whether you have basic commercial insurance needs or more complex and difficult exposures, our experienced agents will work with you to help you provide your customers with a comprehensive insurance program. Brisotti & Silkworth Insurance (BSI) sells and services many lines of commercial insurance throughout New York. Like auto insurance protects you from the risks of the road, commercial insurance protects you and your business from the risks you encounter every day.  If you own a business, you want to make sure it is always protected. More than likely, you have invested a large sum of money into your business to get it started. Every day, you will encounter risks that have the potential to bring down your business, and potentially your personal finances as well. In order to protect your business and personal finances, business insurance is necessary. Don’t do business without it.
Source: bsiins.com

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October 07, 2013

Income Thresholds For Medicare Part B And Part D Premiums

Posted by:  :  Category: Medicare

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While the surtax due to higher Medicare premiums that resulted from the Roth conversion was not huge, at only 1.6%, it nonetheless represents an entirely manageable – and potentially avoidable – surtax that planners and clients should carefully consider. For instance, the client might have decided to convert only $27,000 in the prior example – rather than $39,350 – to keep from exceeding the $87,000 AGI threshold that triggers the first Medicare premium increase, allowing the conversion to have a cost of "only" the 25% marginal tax bracket, and not 26.6%. On the other hand, if the client’s income was higher, the impact would have been more severe. For instance, if AGI was already $85,000, then a $5,000 conversion would result in $1,250 of taxes (at a 25% tax) plus the same $619.20 (for additional Medicare premiums), which leads to a marginal "tax" of $1,869.20 and a marginal tax rate of 37.4%; on the other hand, if the conversion was $10,000, the marginal rate would only be 31.2% (since the additional taxes would rise to $2,500 but the Medicare premium impact would still be the same $619.20/year). The end result: the closer clients are to an income threshold, the better it is to either stay right below the line, or rise far above it until the next threshold (or a new tax bracket) approaches, because the additional Part B and Part D premiums are a flat additional amount even if clients are just $1 across the line (unlike tax brackets, which are always a percentage of additional income). And because the premium adjustments are calculated based on AGI, anything that increases AGI can impact exposure, from IRA withdrawals and Roth conversions, to capital gains, to dividends and interest and income from pass-through entities; on the other hand, any deductions that are taken above the line, such as capital losses or certain business losses, can also reduce exposure.
Source: kitces.com

Video: Members of the GOP Doctors Caucus Address Medicare Reimbursement Rates

Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums

This Medicare Advantage Data Spotlight provides an overview of recent changes made to the Medicare Advantage program and examines trends in plan participation, premiums and certain benefits. About 12 million people, or nearly a quarter of the Medicare population, are enrolled in Medicare Advantage, the privately administered plans that are an alternative to the traditional fee-for-service Medicare program.
Source: kff.org

Rate Of Antipsychotic Prescribing In Connecticut Nursing Homes Drops

At Hughes Health & Rehabilitation in West Hartford, staff members were trained using a “toolkit” of methods to care for residents with dementia. The kit was developed by University of Massachusetts Medical School researchers, in partnership with Qualidigm, and eventually will be disseminated nationally. Hughes Health singled out certain patients for antipsychotic reductions and worked with family members. Its antipsychotic rate dropped to 17.2 percent in 2012 and 6.7 percent in the most recent reporting.
Source: ctwatchdog.com

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

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

MedPAC to Recommend Forgoing LTACH Reimbursement Rate Update for 2011 Rate Year: Projects 5.8% Medicare Margin for 2010 Rate Year

MedPAC evaluated the Medicare profit margin spread of LTACHs for RY 2008 and found there to be a wide spread in profitability, similar to that seen in short-term acute care hospitals, with the bottom quartile of LTACHs having margins of negative 8.2% or less, and the top quartile having margins of 11.8% or more.  Margins for for-profit LTACHs were significantly higher than those of not-for-profit LTACHs.  MedPAC found that lower per-discharge costs, rather than higher payments, drove the differences in financial performance between LTACHs with the lowest and highest margins.  High margin LTACHs also had a shorter average length of stay and far fewer high cost outlier cases and payments.
Source: 18.221

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October 07, 2013

BCBS, Priority Health rank highest in state for Medicaid, Medicare

Posted by:  :  Category: Medicare

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If you enjoy the content on the Crain’s Detroit Business Web site and want to see more, try 8 issues of our print edition risk-free. If you wish to continue, you will receive 44 more issues (for a total of 52 in all), including the annual Book of Lists for just $59. That’s over 55% off the cover price. If you decide Crain’s is not for you, just write “Cancel” on the invoice, return it and owe nothing. The 8 issues are yours to keep with no further obligation to us. Sign up below.
Source: crainsdetroit.com

Video: Priority Health Medicare — Understanding Medicare Video

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

Priority Health Medicare: Your Health Is The Top Priority

If you are nearing the age 65 and do not have a health care card yet, you might want to start looking around and searching for the best health insurance plans for you or your loved ones.  Remember too that it is never too early to prepare for your medical care needs.  Even if you are still in your 40s or 50s, you can already start preparing for your future medical care needs.  We all want to feel at peace when it comes to our health especially when we reach our golden years. The price of health care is not getting any cheaper; I believe everyone should be financially ready for their future medical expenses.
Source: medicarebase.com

Medicare Innovation: Whose Priorities, Whose Interests?

Carol Levin asks the right question in her post, while failing to address all of the potential answers. She stresses the need to address the needs of elderly patients under Medicare and argues that their interests are paramount. While one can make the case for this answer, any focus on patients needs to be balanced by a focus on the needs of the nation and the overall fiscal capacity of the federal government. We need to look very carefully at the core question of who should being paying for all the wonderful care that she envisions. An examination of this issue will reveal that no improvements in care for the elderly that reduces costs for them can come to grips with the sheer magnitude of the costs of Medicare as a middle class entitlement program. We cannot continue to assume that we as a nation can afford to provide the care that all the elderly need regardless of their ability to pay. Individuals in my Medicare eligible generation, including myself, who can afford to pay more of our own costs should be required to do so in order to free up Medicare funds for those who are truly needy. This reform known as means testing for benefits, coupled with higher contributions based on income and an increase in the age at which the benefit commences, could pave the way for real savings on top of those which improved methods of care could provide. In short fix the long term fiscal challenge in all this ways and we may get some relief from the pending crisis.
Source: healthaffairs.org

Priority Health Adds Medicare Advantage Plan and Seven Counties.

Medicare is available to individuals age 65 and older as well as to some people with disabilities. Medicare recipients may enroll between November 15 and December 31, 2010. To learn more about Priority Health’s Medicare plans, premiums by county and participating health care providers, call Priority Health toll-free at 888 389-6676, visit a Priority Health Medicare Information Center in Holland, Grand Rapids, Kalamazoo or Traverse City (opening November 1) or go to prioritymedicare.com. Priority Health’s Medicare Advantage health plans are available in 38 counties: Allegan, Antrim, Barry, Benzie, Cass, Charlevoix, Clare, Crawford, Emmet, Grand Traverse, Hillsdale, Ionia, Jackson, Kalamazoo, Kalkaska, Kent, Lake, Leelanau, Livingston, Manistee, Macomb, Mason, Mecosta, Missaukee, Monroe, Montcalm, Muskegon, Newaygo, Oakland, Oceana, Osceola, Otsego, Ottawa, Roscommon, St. Clair, Washtenaw, Wayne and Wexford.
Source: blogspot.com

New Group To Set Priorities for Medical Effectiveness Research

Doctors trained to do things one way may be more likely to trust the consensus of their colleagues and their patients’ preferences than new data. Some also fear the data will be used for payment decisions, undermining physicians’ autonomy and leading to rationing. And while research can shed light on what treatments do not work for the majority of people, a subset of patients may still benefit. Study methods can also be faulty and results contradictory. ‘A Subjective Call’ “That’s still a subjective call they [researchers] are making,” says Jennifer Jaff, executive director of Advocacy for Patients with Chronic Illness, a Connecticut-based group that helps patients appeal medical coverage decisions. “If you find a medical journal article that says, ‘no’ [a particular treatment doesn’t work], I can find you one that says ‘yes,’ it does.”
Source: kaiserhealthnews.org

Rate Of Antipsychotic Prescribing In Connecticut Nursing Homes Drops

At Hughes Health & Rehabilitation in West Hartford, staff members were trained using a “toolkit” of methods to care for residents with dementia. The kit was developed by University of Massachusetts Medical School researchers, in partnership with Qualidigm, and eventually will be disseminated nationally. Hughes Health singled out certain patients for antipsychotic reductions and worked with family members. Its antipsychotic rate dropped to 17.2 percent in 2012 and 6.7 percent in the most recent reporting.
Source: ctwatchdog.com

Government austerity with Medicare reform as a top priority

Medicare was designed to be health insurance for the poor elderly when it was originally conceived. We need means testing for participation in Medicare. People should be able to spend what they put into the Medicare system over the years and then be means tested for additional participation.. As they approach using up what they put in they need to be means tested looking at their total financial picture not just their unhidden liquid assets. They can then choose to buy into Medicare if they are above a certain financial level or purchase private insurance or pay for their care from their assets with little or no insurance. Those with less income and assets would continue to receive Medicare benefits after they meet their annual deductible. Sixty Five is a fine starting point for entry. The reforms in Medicare must come in the area of obscenely overpriced procedures, some fair and ethical discussion and decisions on end of life issues and tort reform to eliminate costly defensive medicine costs. A closer handle on eliminating non physician fraud would be helpful as well.
Source: kevinmd.com

UMHS signs with Priority Health HMO/PPO effective March 1

Effective March 1, 2013, UMHS will become a participating provider with Priority Health for their commercial HMO and PPO plans. Priority Health is a subsidiary health plan of Spectrum Health System. Priority Health HMO and PPO members may be seen at UMHS for both primary and specialty care at an in-network benefit level beginning March 1, 2013. Additionally, UMHS has been a participating provider with Priority Health’s Medicare Advantage plans since September 2012. UMHS remains a non-contracted provider for Priority Health’s Medicaid and MIChild plans. Staff should continue to follow the Medicaid Specialty Access process for Priority Health Medicaid members.
Source: umhsheadlines.org

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October 07, 2013

CMS Announces Overall Premium Changes for 2014 Medicare Advantage and Medicare Part D

Posted by:  :  Category: Medicare

The number of 4 star plans is expected to increase from 28% to about 1/3 of all plans.  This could be a result of either more four star plans or 3.5 and lower star plans exiting the market.  Further, about 50% of Medicare beneficiaries are expected to be in 4 star plans, up significantly from 37% last year.
Source: ritterim.com

Video: Medicare Plan Finder Lesson 5: Comparing Plans

What Obamacare means for retirees

5 questions 401(k) age discrimination aging in place annuities career disability employment encore career entrepreneurship healthcare health insurance health reform housing IRAs jobs LGBT long-term care Medicare pensions planning retirement retirement income retirement jobs reverse mortgages social media Social Security technology withdrawal rates
Source: retirementrevised.com

Washington Health Plan Finder up and running, but no overnight access today

Today, we will continue to monitor how the website performs and make additional changes as necessary. We remain committed to improving the consumer experience and getting as many Washingtonians enrolled in coverage as possible. It’s also important to remember that residents have until Dec. 23, 2013 to enroll in coverage that begins on Jan. 1, 2014. The open enrollment period extends all the way through March 31, 2014 for this first year. Medicaid individuals may apply year round.
Source: q13fox.com

Managing Your Medicare: Get Ready Now for Medicare Open Enrollment

S: If your 2012 income was over $85,000 and less than or equal to $107,000, your monthly surcharge is $12.10, up $0.50 from 2013. If your 2012 income was over $107,000 and less than or equal to $160,000, your monthly surcharge is $31.10, up $0.20 from 2013. If your 2012 income was over $160,000 and less than or equal to $214,000, your monthly surcharge is $50.20, up $1.90 from 2013. If your 2012 income was over $214,000, your monthly surcharge is $69.30, up $2.70 from 2013. These surcharges are not collected by your drug plan, but by the Government, and you get them deducted from your Social Security, Railroad Retirement, or Federal Civil Service monthly payment; otherwise Medicare will bill you quarterly for them. Enrollment Periods Medicare beneficiaries have already been receiving their Medicare & You 2014 booklets in the mail, or electronically if they signed up for this option.
Source: blogspot.com

Viva Health and Baptist Health System join forces for new Medicare plan in an unusual arrangement

To be in the plan you must use one of the four Baptist hospitals in four area counties and the 400 doctors in the Baptist Physician Alliance. The hospitals in the system are: Baptist Princeton in Birmingham; Citzen’s Baptist in Talladega; Walker Baptist in Jasper:and Shelby Baptist in Alabaster. Enrollment for Medicare plans begins Oct. 15 and is completely separate from the health insurance exchanges associated with the Affordable Care Act.
Source: al.com

The Generation Above Me: Part D Open Enrollment

Fall is just around the corner. That means that it’s almost time for the annual open enrollment period for Medicare Part D, Prescription Plans.  Between October 15th and December 7th of each year, Medicare beneficiaries can compare plans. As a result, they can switch or continue with their current plan. For more information on Open Enrollment dates and other the important events between September and January regarding Part D, see this brochure created by CMS (Centers for Medicare and Medicaid Services).
Source: blogspot.com

Using Medicare’s Plan Finder, or Beware Hidden Costs!

17. Here’s where the information I’m seeking finally appears. This screen compares the costs of all three plans for the drugs you entered. If a product-selection penalty exists, it will be at the bottom of this page, on the last table entitled (ironically) “Full Cost of Drugs.” In my scenario, there is a footnote number 8 next to the cost of Cardizem under both Health Net Orange’s and SilverScript’s plans. Below the table, footnote 8 reads “This drug may be subject to supplemental cost-sharing in addition to the price displayed. Please contact the plan for details.” So the Plan Finder doesn’t actually disclose the “Full Cost of Drugs.” You have to contact the insurer for that. SilverScript’s price for the drug Arava also contains a reference to footnote 8. AARP’s plan has no footnotes next to its prices. It does not charge product selection penalties.
Source: oregonlive.com

ibm medicare options: IBM Medicare www.extendhealth.com/ibm offerings and subsidy information

If you want a Medicare Advantage plan do not do step 1 & 2 above as you have decided to not use the government insurance pool know as Original Medicare and instead use private insurance.  I believe that the only kind of Medicare Advantage plan Extend Health is going to sell is one that includes prescription drugs.  That is indicated by all their literature and in their briefings. Go to www.medicare.gov on or after October 15 and find out what insurance companies sell Medicare Advantage + drug plans in your zip code by going to the middle of the home page and clicking on plan finder.  Look at the detail descriptions for the plans you like and make a list of the plan names and the insurance companies that offer them you would buy in order from the most preferred plan to the least preferred plan.     
Source: blogspot.com

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October 07, 2013

Fewer Medicare Advantage plans in 2014, analysis finds

Posted by:  :  Category: Medicare

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Factors for the drop in MA plans include continued phase-in of payment cuts under the Affordable Care Act, modifications to the CMS risk-adjustment model, implementation of new medical loss ratio requirements for Medicare Advantage, and application of the new health insurer fee, Avalere noted. Around 80% of counties in Southern and Midwestern states will see a reduction in MA plan options. Click here to see a table of Medicare Advantage plans by type. 
Source: mcknights.com

Video: Medicare supplement Insurance Plans VS Medicare Advantage plans

Cost Trends of Medicare Advantage Plans

It’s hard to imagine Medicare without talking about Medicare Advantage (MA) plans, but this type of private health insurance plan is a relatively new addition to the program. Created in 1997, these privately offered Medicare plans offer all the coverage of Original Medicare, with the exception of hospice care, and many will include additional benefits such as dental, vision, or hearing coverage. Medicare Advantage plans did not include or offer prescription drug coverage until 2006. While Medicare Advantage plans cover many health benefits, it comes with costs for which enrolled beneficiaries are responsible.
Source: planprescriber.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org

Medicare Advantage Plan San Diego And Its Enrollment

Medicare Advantage is one of the options available to Medicare Recipients. It combines Medicare Part A, B and often D coverage and is offered by private insurance companies. MA Plans must provide all of the services covered by Original Medicare but usually at a lower cost. Each can charge different co-payments and have rules for how you get services (like whether you need a referral to see a specialist or if you have to go to network only doctors for non-emergency care). To be eligible for that kind of plan you must have Medicare Part A and B, live in the plan’s service area and you can’t have End-Stage Renal Disease (permanent kidney failure).  Most plans in San Diego County have no additional monthly premium and include prescription drug coverage (Part D). MA plans offer a variety of preventive tests and checkups at $0 co-payment, additional benefits like vision, dental, fitness club membership and transportation as well as discounts for product and services.
Source: pomeradonews.com

State Highlights: Fort Worth To Move Retirees Into Medicare Advantage Plans

Los Angeles Times: Patient-Interpreter Bill Aims To Overcome Language Barriers According to a 2012 study prepared for the federal Agency for Healthcare Research and Quality, pediatric patients with limited-English-proficient families who speak Spanish “have a much greater risk for serious medical events during hospitalizations than patients whose families are English-proficient” … [A bill that would make a statewide medical-interpretation program available to Medi-Cal patients] would require the state Department of Health Care Services to apply for federal money that would pay for a certified medical-interpreter program. Such a program is needed, supporters say, to prepare hospitals for the millions of limited-English speakers expected to use healthcare services over the next few years (Kumeh, 8/18).
Source: kaiserhealthnews.org

Medicare Advantage menu shrinks

The Medicare Advantage program – an initiative that resembles the public exchange program that the Patient Protection and Affordable Care Act (PPACA) is creating – gives private organizations a chance to offer Medicare enrollees an alternative to traditional Medicare coverage.
Source: lifehealthpro.com

Medicare Advantage plans to drop next year

Factors driving MA participation decline include “the continued phase-in of payment cuts enacted under the PPACA; modifications to the CMS risk adjustment model; implementation of new medical loss ratio requirements for MA plans; and application of the new health insurer fee,” Avalare Health said.
Source: benefitspro.com

New Analysis Shows Payment Changes Having an Adverse Impact on Medicare Advantage Plans

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

Aetna just canceled wifes medicare advantage plan

I agree that the Advantage supplement was going to medical care. It still is. It just seems to me that it was time to direct it more appropriately. The supplement was envisioned as temporary to give private sector insurers a period to ramp up programs that could deliver better (or different) service than Part B for the same or less cost (i.e. it was experimental). The ACA itself will fund lots of other experiments chosen by the states and the Feds. One would hope that the experiments that prove viable will be incorporated in the program and those that don’t pan out will be dropped. Medicare Advantage has proved popular but expensive. We could choose to expand it to all (and raise the Medicare tax to cover the costs), drop it, or, as was done, stop supplementing it and let the market decide what to offer.
Source: early-retirement.org

CARR ALLISON Medicare Compliance Group: Medicare Advantage Plans and Prescription Drug Plans and How They Differ from Traditional Medicare

Under traditional Medicare, Medicare beneficiaries receive coverage through Part A (hospital insurance) and Part B (medical insurance).  Medicare beneficiaries may choose to enroll in a Medicare Advantage Plan under Part C as an alternative to traditional Medicare.  Medicare Advantage Plans are offered by private health insurers as a replacement for coverage under traditional Medicare.  If a beneficiary is enrolled in a Medicare Advantage Plan, the plan pays for the beneficiary’s treatment that would otherwise be covered under Parts A and B.  In addition to benefits that are otherwise payable under traditional Medicare, some Advantage plans also provide prescription coverage.  Medicare beneficiaries may also receive prescription drug coverage by enrolling in a Prescription Drug Plan under Part D.  Like Medicare Advantage Plans, Prescription Drug Plans are offered by private health insurers. It is important to keep in mind when resolving conditional payment claims, that the conditional payment letters issued by the Medicare Secondary Payer Recovery Contractor (MSPRC) only apply to payments made under Parts A and B of traditional Medicare plans.  They do not include information concerning Medicare Advantage or Prescription Drug plan liens.  If a claimant is enrolled in a Medicare Advantage or Prescription Drug plan, the identity of that plan should be determined and the plan should be contacted individually to determine whether it intends to assert a lien.
Source: blogspot.com

Learn About Medicare Advantage Plans

Medicare Advantage plans are health plans approved by Medicare and run by private companies like ConnectiCare. They are part of the Medicare Program and sometimes referred to as Medicare Part C. Inherent in their name, Medicare Advantage Plans can offer beneficiaries many advantages – cost savings, additional benefits and services and the convenience of having one health plan with one monthly plan premium.
Source: foxct.com

Providers and Medicare Advantage plans: Improve Efficiency with DxCG Intelligence

Using Verisk Health’s DxCG Intelligence, this Advantage Plan created an Efficiency Index that calculated each provider’s efficiency via a ratio of actual costs to expected cost. The program then compared ratios among all providers in their network. 80% met the plans efficiency goals. With this information, the Medicare Advantage program could target the less efficient 20% and help them control patient costs. As a result, this Plan’s average efficiency has improved over three consecutive years.
Source: 3blmedia.com

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October 07, 2013

Medicare Advantage 2011 Data Spotlight: Plan Availability and Premiums

Posted by:  :  Category: Medicare

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This Medicare Advantage Data Spotlight provides an overview of recent changes made to the Medicare Advantage program and examines trends in plan participation, premiums and certain benefits. About 12 million people, or nearly a quarter of the Medicare population, are enrolled in Medicare Advantage, the privately administered plans that are an alternative to the traditional fee-for-service Medicare program.
Source: kff.org

Video: The Early Show – Medicare premiums up less than expected

2012 Medicare Deductibles and Premiums: Is This the Year You'll Collect Deductibles at Time of Service?

The largest factor affecting the contingency margin for 2012 is the current law formula for physician fees, which will result in a payment reduction of about 29 percent in 2012.  For each year from 2003 through 2011, Congress has acted to prevent smaller physician fee reductions from occurring. The 2012 reduction is almost certain to be overridden by legislation enacted after Part B financing has been set for 2012. In recognition of the strong possibility of increases in Part B expenditures that would result from similar legislation to override the decrease in physician fees in 2012, it is appropriate to maintain a significantly larger Part B contingency reserve than would otherwise be necessary.  The asset level projected for the end of 2012 is adequate to accommodate this contingenIn 2012, Social Security monthly payments to enrollees will increase by 3.6 percent.    The dollar increase in benefit checks is expected to be large enough on average to cover the increase in the Part B premium of $3.50 that most beneficiaries will experience. For those who were paying the standard premium of $115.40, their benefits checks will only increase.
Source: managemypractice.com

How to Transform Medicare into a Modern Premium Support System

In the FEHBP, the capped amount of the government’s contribution to employees’ health plans is based on 72 percent of the weighted average premium of health plans competing in the program. This formula, allowing for changes in the market, also provides that the government’s contribution cannot exceed 75 percent of the cost of any given plan. If federal workers or retirees buy a plan that is more expensive than the government contribution, they pay the extra costs. OPM determines “reasonable minimal standards” for plans, ensures that the health plans are fiscally solvent, and enforces rules for consumer protection. It does not set prices, standardize health benefit packages, or apply detailed guidelines for doctors or hospitals. Compared to Medicare’s rules, OPM’s regulatory role in FEHBP is light, and it is focused on providing a level playing field for health plans to compete. Walton Francis, a prominent Washington-based health care economist, writes that “the FEHBP has outperformed original Medicare in every dimension of its performance. It has better benefits, better service, catastrophic limits on what enrollees must pay, and far better premium cost control.”[11] 
Source: heritage.org

Some Seniors Are In For Sticker Shock On Drug Premiums

Others say it makes perfect sense to require seniors with higher incomes to pay more for Medicare. “Given where we are fiscally in this country, I really don’t have a big problem with making that argument that we ought to be asking seniors in that income category to pay a larger share of the value of the benefit they are receiving,” said James Capretta, a fellow at the Ethics and Public Policy Center, a conservative think tank. Capretta also said he doubted that seniors could get a better deal from a private insurer than from Medicare.
Source: kaiserhealthnews.org

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October 07, 2013

Federal Shutdown: What’s Closed And What’s Open?

Posted by:  :  Category: Medicare

WHAT CLOSES: * Any federal agency that’s subject to appropriations. Each agency has the discretion to decide who is “excepted” or “emergency”, and who is furloughed. * All National Parks * All federally-funded museums, including Smithsonian and the National Zoo. * All federal government websites * Research by Health and Human Services stops. So does the grant process. Depending on how long it lasts, that will also impact medical research at hospitals and universities. * Applying for Social Security. If you’re a new retiree, your application won’t be processed. * IRS walk-in centers. Your paper tax return will not be processed. * Loan applications for small businesses, college tuition, or mortgages. * All Library of Congress buildings. All public events will be cancelled and web sites will be inaccessible. * Federal contractors will be out of work. * Federal workers (except “excepted” or “emergency” personnel) will not be allowed to work, not even from home. No blackberry, no smartphone, no laptop. Not even allowed to check work email.
Source: cbslocal.com

Video: Applying For Medicaid In Texas

Medicaid Waiver Fosters Collaboration, North Texas Hospital CEOs Say

The Texas Medicaid Waiver 1115 is formally known as the Texas Health Care Transformation and Quality Improvement Program. The waiver was a response to the expansion of Medicaid managed care during the 2011 legislative session. The federal government reduces upper payment limit funding under HMOs, and UPL payments were designed to help compensate for the fact that Medicaid only pays hospitals about half of the cost of care. The program pays Texas hospitals about $3 billion annually.
Source: dmagazine.com

Does Obamacare’s Medicaid Expansion Affect You?

Some states, like California and North Dakota, have chosen to take the expanded funding under Obamacare and expand Medicaid coverage to 133 percent of the federal poverty level (up to $32,500 for a family of four). Other states, like Texas and Pennsylvania, will still offer Medicaid coverage based on the state’s own rules for eligibility, but will not be taking federal funding to increase coverage.
Source: findlaw.com

Texas Home Health Companies Sue Government Over Medicare Privileges

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

Medicaid Expansion, As Proposed In Obamacare, Shows Potential To Improve Health And Decrease Costs When Tested In Wisconsin

“What’s special about this is that studies of expanding insurance coverage typically find increases in usage across the board,” Dague explains. “Typically you would think about two effects: a price effect, through which access to insurance lowers the out-of-pocket price of care, leading people to get more care, and a preventive effect, in which getting folks consistent access to care, they can perhaps manage chronic illness better resulting in better health (and hence needing less intensive health care). The price effect almost always dominates. But we show that in certain populations − very low-income, high incidence of chronic illness, adults without dependent children − it’s possible for the preventive effect to dominate.”
Source: tamu.edu

MedicareBob’s Blog: Anderson County Texas Medicare Supplement Quotes

The three most comprehensive Medicare Supplement Plans are: Medicare Supplement Plan F: Full Coverage Medicare Supplement Plan G: Small Deductible ($147.00) Medicare Supplement N: Small Deductible & Copays (Part B Excess
Source: blogspot.com

Bailey County Texas Medicare Supplement Quotes

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

Administration will not release number of Obamacare enrollees on opening day

“As we have said before with any new product launch there will be glitches as things unfold and as things arise we will fix them. In this vein we do want to remind consumers who need help that they have several options including contacting our call center which is open 24/7, and we have received more than 81,000 calls so far,” Tavenner said, adding that local in person help is also available.
Source: dailycaller.com

Daily Kos: Stubborn Obamacare

all our dollars are) as if from a garden faucet. If one is on a municipal water system, the system sets the pressure at the pumps to deliver a certain number of gallons per minute, when the faucet is opened all the way. Of course, a conscientious householder is not going to open the faucet, except when water is needed. The householder has control. If the faucet valve does not close all the way, he’ll have a drip and, eventually, a trickle. When it comes to the flow of our currency, Congress is like the householder. The extent to which it opens the faucet determines whether we get a trickle or a drip or, as is currently the situation, a complete shut off. If you say that’s not accurate because other enterprises are not seeing a restricted flow of dollars, I’d say that’s because these enterprises (corporation, banks, mercantile establishments) have not given Congress reason to be irked. They are, for the most part satisfied with what Congress sends their way. Moroever, they are not even concerned that, if householders get more, they will get less, because, unlike water, dollars are in infinite supply. There is no reason for them to be scarce, other than that Congress like to turn the faucet on and off.
Source: dailykos.com

Obamacare And Medicare: Don’t Believe The Rumors

Call centers for state health insurance exchanges are already receiving calls from Medicare recipients, according Julie Bataille, of the Centers for Medicare and Medicaid Services. Such inquiries, which are redirected to the Medicare line, are just one indication that seniors are confused about the implications of Obamacare for their coverage.
Source: kera.org

Medicaid Eligibility in Texas

Following an initial check of the information, all applicants are required to visit a Health and Human Services Commission Benefits office. This visit interviews the applicant to ensure all information is present and correct – forming the final part of the application. Applicants who have specific reasons why they cannot travel to the Health and Human Services Commission Benefits office may be able to complete the review by telephone, or a representative may make a home visit.
Source: tex.org

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