Medicaid vs. Medicare in Oregon

Posted by:  :  Category: Medicare

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Source: infographicsonly.com

Video: Medicare Insurance Coverage in Oregon by 1 800 MEDIGAP®

Medicaid vs. Medicare in Oregon

Most people have heard of Medicare and Medicaid; however, unless you have already applied to either program you may not know what they cover and what their respective eligibility requirements are. As there is a good chance you will need one or the other as you get older, understanding the difference between the two programs will be beneficial.
Source: cooldailyinfographics.com

Oregon State Health Reform

The Multnomah County SHIBA (Senior Health Insurance Benefits Assistance) program offers several options to help people with Medicare compare their current coverage with the Medicare plans available for 2014. Enrollment events are planned at local libraries to provide one-to-one counseling appointments for those who prefer it. Separate “Plan Finder Boot Camp” presentations will focus on the Medicare online plan finder and other tools for individuals to use on their own.
Source: southeastexaminer.com

Denying care? Concerns with Oregon’s Medicaid Coverage Guidelines

The Oregon guidelines actually run afoul of federal law, specifically provisions in the Affordable Care Act. Section 1302 of the health reform law states quite clearly that “essential health benefits cannot be denied to individuals against their wishes on the basis of the individuals’ age or expected length of life or of the individuals’ present or predicted disability, degree of medical dependency, or quality of life.” In other words, the law of the land says that healthcare cannot be denied to a patient, simply because government officials have decided that the patient is too sick to make the treatment worthwhile.
Source: healthworkscollective.com

Why the Oregon Medicaid study is misunderstood

Here is a brief, and inadequate, summary (you should really read the study):  In 2008, Oregon used a lottery system to give a set of uninsured people access to Medicaid.  This essentially gave Kate Baicker and her colleagues a natural experiment to study the effects of being on Medicaid. Those who won the lottery and gained access were compared to a control group who participated in the lottery but weren’t selected.  Opportunities to conduct such an experiment are rare and represent the gold standard for studying the effect of anything (e.g. Medicaid) on anything (like health outcomes).  Two years after enrollment, Baicker and colleagues examined what happened to people who got Medicaid versus those who remained uninsured.  There are six main findings from the study.  Compared to people who did not receive Medicaid coverage:
Source: kevinmd.com

New Oregon poll represents seniors’ concerns over Medicare spending cuts

Medicare beneficiaries in all states are vulnerable to the negative impact of drastic funding cuts. But even more so will be those seniors and disabled individuals in rural and medically under-served areas who will be more severely impacted by additional cuts, forcing the elderly to seek care in higher cost settings. will be severely impacted by additional cuts. Many providers of vital services, such as home healthcare agencies, could be rendered inoperable if more cuts are implemented, forcing beneficiaries to seek care miles away from their communities in higher cost settings.
Source: greenheritagenews.com

The fallacious attacks on Obamacare and Medicaid continue apace…

Hypertension, high cholesterol levels, diabetes, and depression are only a subgroup of the set of health outcomes potentially affected by Medicaid coverage. We chose these conditions because they are important contributors to morbidity and mortality, feasible to measure, prevalent in the low-income population in our study, and plausibly modifiable by effective treatment within a 2-year time frame. Nonetheless, our power to detect changes in health was limited by the relatively small numbers of patients with these conditions; indeed, the only condition in which we detected improvements was depression, which was by far the most prevalent of the four conditions examined. The 95% confidence intervals for many of the estimates of effects on individual physical health measures were wide enough to include changes that would be considered clinically significant — such as a 7.16-percentage-point reduction in the prevalence of hypertension. Moreover, although we did not find a significant change in glycated hemoglobin levels, the point estimate of the decrease we observed is consistent with that which would be expected on the basis of our estimated increase in the use of medication for diabetes. The clinical-trial literature indicates that the use of oral medication for diabetes reduces the glycated hemoglobin level by an average of 1 percentage point within as short a time as 6 months.15 This estimate from the clinical literature suggests that the 5.4-percentage-point increase in the use of medication for diabetes in our cohort would decrease the average glycated hemoglobin level in the study population by 0.05 percentage points, which is well within our 95% confidence interval. Beyond issues of power, the effects of Medicaid coverage may be limited by the multiple sources of slippage in the connection between insurance coverage and observable improvements in our health metrics; these potential sources of slippage include access to care, diagnosis of underlying conditions, prescription of appropriate medications, compliance with recommendations, and effectiveness of treatment in improving health.
Source: scienceblogs.com

Medicare Advantage Fact Sheet

Posted by:  :  Category: Medicare

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

Video: Jed Weissberg, MD, Talks About Medicare Advantage Health Plans and the Special Enrollment Period

HINfographic: Secrets from a Medicare Advantage ‘Star Czar’

This entry was posted on Wednesday, October 2nd, 2013 at 1:30 pm and is filed under Incentives, Infographics, Medicare, Patient Engagement, Patient Satisfaction, Population Health Management, Quality Improvement. You can follow any responses to this entry through the RSS 2.0 feed. You can leave a response, or trackback from your own site.
Source: hin.com

Firm Perspectives on the Medicare Advantage Market

Based on interviews with senior executives at 14 large firms, the issue brief finds that insurers anticipate continuing to offer Medicare Advantage plans in 2012, in part because of a Medicare demonstration project that will award bonus payments to plans based on their quality standards.
Source: kff.org

SCAN Health Plan to expand into Marin

“For more than 35 years, SCAN has been committed to providing services that enhance seniors’ ability to manage their health and to continue to control where and how they live,” Karen Sugano, SCAN’s general manager in Northern California, said in a statement. “As a result, we believe we bring a unique mission and an unmatched perspective to the more than 50,000 Medicare-eligible individuals in Marin County.”
Source: northbaybusinessjournal.com

Medicare Advantage enrollment at all

The number of seniors in the private Medicare Advantage plans tripled in the past seven years, according to an analysis released Monday. But future payment cuts could cause insurers to reduce benefits or increase cost-sharing, says a Blue Cross and Blue Shield Association official. The Medicare Advantage program grew from 5.3 million people in 2004 to a record 14.4 million in 2013, according to the analysis by the Kaiser Family Foundation and Mathematica Policy Research Inc. From 2012 to 2013 alone, the program grew by 10 percent — or by 1 million people.
Source: medicarewire.com

New medical plans for faculty, staff for 2013 / UCLA Today

Some big changes and new choices in medical plans are coming to Open Enrollment this fall. UC is offering a revamped menu of plans for 2014 that offers better value and clearer choices, including two new plans: Blue Shield Health Savings Plan, which features a UC-funded health savings account; and UC Care, UC’s own three-tier PPO plan that offers members access to UC doctors and hospitals as well as the Blue Shield PPO network. Health Net Blue & Gold, Kaiser Permanente, Western Health Advantage and Core (administered by Blue Shield) will still be available. Four plans — Anthem Blue Cross PPO and PLUS, Anthem Lumenos with HRA and Health Net Full HMO — are being discontinued.   “The 2014 plans provide clear and distinct choices to meet our employees and retirees’ diverse and changing needs,” said Michael Baptista, executive director of benefits programs and strategy. “The designs of these plans have very little overlap. Everyone can choose a plan based on what’s most important to him or her, whether that’s having predictable costs or the widest choice of doctors.” UC employees and retirees will continue to have a broad choice of providers — including UC medical center doctors, hospitals and medical groups — and plan designs to fit their needs. The provider networks for both the Blue Shield Health Savings Plan and UC Care include 97 percent of the providers in the current Anthem Blue Cross network, so most people in those discontinued plans should be able to keep their doctor. Employees currently in Anthem Blue Cross PPO, Anthem Blue Cross PLUS and Health Net HMO will also pay smaller monthly premiums next year, regardless of the new plan they choose. Savings will depend on the new plan, salary band and dependents covered. The Blue Shield Health Savings Plan premiums are expected to be similar to the premiums for Anthem Lumenos PPO with HRA. Premiums for Health Net Blue & Gold, Kaiser and WHA are expected to increase from $2 to $10 per month, depending on the plan, salary band and dependents covered. UC will continue to cover an average of about 85 percent of the cost of the premiums. The final premiums will be available in early October. The 2014 plan offerings are the result of a comprehensive review of UC’s medical plan portfolio aimed at providing high quality medical insurance that is more specific to individual needs, while limiting cost increases to employees and the university. The review also offered an opportunity to leverage UC’s outstanding medical centers and take advantage of the changing medical-insurance marketplace. “We know how important quality medical insurance is to our employees and retirees, and we are continually looking for ways to ensure good benefits while limiting cost increases for employees and the university,” said Baptista. “Health care reform and a changing medical-insurance marketplace provided a good opportunity to rethink our benefits while still maintaining choice and quality.” Two Plans In, Four Plans Out The two new plans offer broad, nationwide networks of doctors and hospitals through Blue Shield, including UC’s medical centers, and both are expected to have lower monthly premiums than Anthem Blue Cross PPO, Anthem Blue Cross PLUS and Health Net HMO. UC Care is a new health plan created just for UC employees, retirees and families with coverage wherever you live, worldwide. You can get care from UC doctors and medical centers as well as the entire Blue Shield network of providers. You pay a fixed copayment when you use UC and other select providers near all UC campuses and coinsurance when using the other 65,000 Blue Shield providers. You also have coverage for out-of-network care. The Blue Shield Health Savings Plan is a high-deductible PPO plan paired with a health savings account (HSA) that lets you pay your out-of-pocket health care costs with tax-free dollars. UC provides an initial contribution and you can also make pre-tax contributions. You can use the funds any time for qualified medical expenses or save them for future health care needs. Your HSA balance carries over from year-to-year and you own the balance in the account, even if you transfer to another medical plan or leave UC. Blue Shield’s large PPO provider network offers a wide choice of doctors and hospitals or you can see out-of-network providers if you want to pay more. UC is eliminating the Anthem Blue Cross PPO and PLUS plans and the Health Net full HMO plan because they no longer provide the right value. “The costs for these plans continue to increase at a much faster rate than the other plans,” Baptista said. “Neither the university nor employees can continue to absorb double-digit annual increases.” The Anthem Lumenos PPO with HRA is being replaced with the Blue Shield Health Savings Plan. Employees are finding plans with health savings accounts to be more popular because of the tax advantages, the portability of the account and the ability to use the account to save for future retirement insurance needs. New for retirees Retirees and employees planning to retire in 2014 will have similar choices as employees. All six employee plans will be available to retirees not yet eligible for Medicare. Medicare-eligible retirees in California will have five plan options: Kaiser Senior Advantage, Health Net Seniority Plus, Blue Shield PPO, Blue Shield PPO without prescription drug coverage and Blue Shield High Option Supplement to Medicare. The Blue Shield Medicare plans are very similar to the current Anthem Blue Cross Medicare plans. For Medicare-eligible retirees living outside California, UC is taking a new approach. For those Medicare-eligible retirees with all covered family members in Medicare, UC will fund a Health Reimbursement Arrangement (HRA) which retirees will use to purchase individual coverage through Extend Health, a company that sponsors a Medicare Exchange. With the assistance of Extend Health’s licensed and trained benefit advisors, each covered family member will choose an individual Medicare plan that’s best for them. That includes Kaiser and other Medicare Advantage plans available in the retiree’s location. With the growing market for individual plans, many retirees will have more choices, many of which could meet their needs better than the UC plans currently available. In 2014, due to other changes in the UC-sponsored medical plan portfolio, only the Medicare PPO and the High Option Supplement to Medicare plans would have been available to those outside of California. UC plans extensive communication and education about medical plan choices throughout the fall to help faculty, staff and retirees make good choices. Watch for additional news stories, in-home mailings and campus events where you can learn more. Find all the details here.
Source: ucla.edu

MedicareIsSimple: 5 Star Rated Medicare Advantage Plans for 2013

At Medicare is Simple, we look to educate and enable you to choose among Medicare plans to find the policy that best fits your needs. Get free quotes instantly using our advanced quoting technology. HealthCare Reform is a hot topic of interest to people of all ages, so we look to keep you updated on the issues relevant to learning more. Medicare Is Simple 233 W Main St Lewisville, TX 75057 800-442-4915 inf@medicareissimple.com
Source: blogspot.com

Medicare Open Enrollment Period Begins Oct. 15, 2013

Posted by:  :  Category: Medicare

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

Video: What are the Eligibility Requirements for Medicare?

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

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

Baucus, Reid Warn Of Disaster To 50 Million Seniors, Six Million Children From House Continuing Resolution Plan

In addition to these severe impacts on Medicare, H.J. Res. 59 would disrupt multiple other services for working families and vulnerable populations.  Federal funding for the Children’s Health Insurance Program (CHIP) would end on October 1.  States that expanded eligibility under their approved Medicaid state plan for parents and childless adults (the early adoption option) would immediately lose funding for this population, and federal funding would not be available for states that have planned expansions under their state plans as of January 1, 2014.  The delivery of health care to medically-underserved people at many community health centers would be reduced due to a nearly 60 percent reduction in federal funding.  National Health Service Corps funding would be eliminated.  The Health Resources and Services Administration’s Maternal, Infant, and Early Childhood Home Visiting program for at-risk children (which encompasses grants to states and Tribal entities) would be eliminated.  Over 92,000 individuals in the Pre-Existing Condition Insurance Plan Program would immediately lose coverage.  H.J. Res. 59 would also cut funding needed by the HHS Office of Inspector General, the Centers for Medicare & Medicaid Services, and the Department of Justice to fight health care fraud and would take away important anti-fraud tools that were enacted through the Affordable Care Act.  H.J. Res. 59 could adversely affect the delivery of health care in Indian Country by undermining the substantial changes the Affordable Care Act made to the Indian Health Care Improvement Act.  A funding prohibition would also appear to block federal enforcement of all of the health insurance market reforms enacted in the Affordable Care Act, including the prohibition on pre-existing condition exclusions for children, dependent coverage for young adults under age 26, the prohibition of lifetime limits, and coverage of recommended preventive services without cost sharing.
Source: senate.gov

Homelessness Resource Center

Conclusions: Greateruse of primary care and specialty care visits by disability-eligibleveterans is most likely related to greater health needs not captured bythe patient characteristics we employed and eligibility for VA care atno cost. Outpatient care patterns of disability-eligible veterans mayforeshadow care patterns of veterans returning from Afghanistan and Iraqwars, who are entering the system in growing numbers. This studyprovides an important baseline for future research assessingutilizations among returning veterans who use both VA and Medicaresystems. Establishing effective care coordination protocols between VAand Medicare providers can help ensure efficient use of taxpayerresources and high quality care for disabled veterans. (Authors)
Source: samhsa.gov

Social Security Disability Claims Out

Send your comments to: dwight.schwab@gmail.com Dwight L. Schwab Jr. is a moderate conservative who looks at all sides of a story, then speaks his mind. His BS in journalism from University of Oregon with minors in political science and American history stands him in good stead for his writing. Read more stories by Dwight L. Schwab Jr. If you enjoyed this column, may I suggest you press the SUBSCRIBE button? It’s FREE. Thank you for your patronage. You can also send comments to: dwight.schwab@gmail.com.
Source: newsblaze.com

Does Medicare or Medicaid Come with Disability?

Do you get Medicare coverage if you were approved for SSI? Claimants who are approved for SSI only typically receive Medicaid coverage in most states. And like SSI, Medicaid is subject to income and asset limitations. Medicaid is a needs-based, state- and county-administered program that provides for a number of doctor visits and prescriptions each month, as well as nursing home care under certain conditions. Can you ever get Medicare if you get SSI? Medicare coverage for SSI recipients does not occur until an individual reaches the age of 65 if they were only entitled to receive monthly SSI disability benefits. At the age of 65, these individuals are able to file an uninsured Medicare claim, which saves the state they reside in the cost of Medicaid coverage. Basically, the state pays the medical premiums for an uninsured individual to be in Medicare so that their costs in health coverage provided through Medicaid goes down. 
Source: disabilitysecrets.com

Medicare During the 2013 Government Shutdown

During this 2013 shutdown, there is no foreseeable impact on a Medicare beneficiary’s medical coverage or services. There is no way of knowing how long this situation will last, but unless the shutdown spans several weeks, the impacts are expected to be slight. Reimbursements paid out to doctors and hospitals might be delayed if the employees that process those claims are deemed inessential workers (they would be furloughed until the shutdown is over). Considering that these reimbursement payments are not made daily, there is no reason to suggest any immediate impact to the process.
Source: planprescriber.com

Coverage Gap Gets Smaller for Medicare Patients

Posted by:  :  Category: Medicare

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If you select “Keep me signed in on this computer”, you can stay signed in to WebMD.com on this computer for up to 2 weeks or until you sign out. This means that a cookie will stay on your computer even when you exit or close your browser which may reduce your levels of privacy and security. You should never select this option if you’re using a publicly accessible computer, or if you’re sharing a computer with others. Even if you select this option there are some features of our site that still require you to log in for privacy reasons.
Source: webmd.com

Video: Avoid the Donut Hole Coverage Gap in Medicare

Medicare coverage has gaps

A: Medigap plans are sold by private insurance companies, but the plans have to follow state and federal rules. Medigap plans come in several standard varieties, which helps consumers compare plans. They cover some of Medicare’s cost-sharing, including deductibles and co-insurance, but they do not pay for services that Medicare does not cover. Medigap plans are popular because they rarely change from year to year, and they allow you to see any health care provider that accepts Medicare. But Medigap plans can have high premiums that increase annually, and policyholders usually must also buy separate Part D prescription drug plans. If you have a Medigap plan, think twice before dropping it for some other coverage because you may not be able to get it back later.
Source: seniordigestnews.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

The Medicare Part D Coverage Gap: Costs and Consequences in 2007

Conducted by researchers at Georgetown University, NORC at the University of Chicago and Kaiser, the study found evidence of patients changing their use of prescription drugs when they are required to pay the full cost of medications in the coverage gap. Across eight classes of drugs examined, used to treat a variety of relatively common chronic conditions, 15 percent of Part D enrollees who reached the gap stopped their drug therapy for that condition, five percent switched to another medication in the class, and one percent reduced the number of drugs they were taking in the class.
Source: kff.org

How Does Obamacare Affect Medicare?

The myth about Obamacare ending Medicare is entirely false, as Nicole Duritz, vice president of Health Education and Outreach with the American Association of Retired Persons (AARP), explained to U.S. News and World Report. If anything, “Medicare’s guaranteed benefits are protected in ways that they hadn’t been protected in the past” under the Patient Protection and Affordable Care Act, Duritz said.
Source: findlaw.com

LONG TERM CARE LEADER: NBC Connecticut Highlights “Medicare Coverage Gap”

When Lee Barrows’s husband needed nursing home care after a week-long hospital stay, she believed that the costs would be covered by Medicare. Traditionally, Medicare covers up to 100 days of nursing home care if a patient has spent three or more consecutive days as an admitted hospital patient. A few days later, a doctor told her, “I’m sorry Mrs. Barrows, but your husband was never admitted,” forcing Lee to pay $30,000 out-of-pocket for her husband’s nursing care. After filing multiple appeals with Medicare, she was eventually reimbursed. See the full NBC Connecticut story below to hear Lee’s story, and learn how to protect yourself from this loophole:
Source: blogspot.com

Medicare and Reform: 50 States of Confusion

Closes the Coverage Gap: The Coverage Gap — also known as the donut-hole — is the portion of a Part D plan where beneficiaries pay a higher portion of their medication costs until they reach a certain dollar amount, known as an out-of-pocket maximum. Since 2010, with the help of pharmaceutical manufacturers, CMS has lowered the copayment amounts on brands and generics. Since this change began in 2010, beneficiaries have saved $1,000, on average. By 2020, the Coverage Gap will go away completely. Surprisingly, 77% do not know that the Coverage Gap is in the process of closing due to reform and are unaware of the current savings.
Source: express-scripts.com

Tips to Lower Costs in the Medicare Part D Donut Hole

In a previous post, we discussed how many beneficiaries enrolled in a Medicare Part D Prescription Drug Plan (PDP) and Medicare Advantage Prescription Drug Plans (MAPDs) will enter the coverage gap, also known as the “donut hole,” at some point during the year. Around half of Part D beneficiaries reached the coverage gap by the end of August, and those that entered it in July remain in the coverage gap until the end of the calendar year. Increased costs in the donut hole have lead to reduced drug usage, which poses an obvious problem for the health of beneficiaries. This post will offer some tips on how to save money while in the Part D donut hole.
Source: planprescriber.com

Cigna Acquires Home Care Company Specializing In Elderly, Chronically Ill

Posted by:  :  Category: Medicare

In October 2011, Cigna announced plans to buy HealthSpring of Nashville, Tenn., for $3.8 billion. HealthSpring is a health plan with more than 1 million Medicare and Medicaid customers in Alabama, Arizona, Arkansas, Delaware, Florida, Georgia, Illinois, Maryland, Mississippi, New Jersey, Oklahoma, Pennsylvania, Tennessee, Texas, West Virginia and Washington, D.C.
Source: courant.com

Video: Medicare Advantage Plans from Cigna-HealthSpring [4 of 6]

HealthSpring, Cigna Use Both Names To Market Medicare Plans

The television campaign is within the company’s existing marketing budget, said HealthSpring spokeswoman Graham Harrison. Cigna and HealthSpring researched each company’s brand to determine how to best market Medicare products in the future. The campaign is meant to build on Cigna’s strength as a known health service company and HealthSpring’s expertise in Medicare.
Source: courantblogs.com

Cigna Medicare Plans But Blue Cross Medicare Insurance Plans An Overview

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

Cigna Acquires Medicare Advantage Plans From Humana Covering 3,500 in Texas

The federal government required Humana to sell the Medicare Advantage plans as part of approval for buying Arcadian Management Services. Cigna will offer the new customers Medicare Advantage plans through its subsidiary HealthSpring, which the Bloomfield-based health insurer acquired in January for $3.8 billion.
Source: courant.com

Free Insurance Agent Websites: Cigna Medicare Advantage plans

CIGNA Medicare supplement plans have been an integral part of the insurance industry with having served customers for over 220 years. This kind of insurance plan can be very beneficial for all people including senior citizens who may be suffering from constant medical issues due to their advanced ages. The company enjoys a lot of goodwill among the community and here are some of the benefits that come with buying this plan.
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: Medicare Supplemental Insurance Plans

Medicare Secondary Payer compliance affected by government shutdown

The federal government shutdown has blocked some portions of Medicare Secondary Payer compliance from being conducted, according to Roy Franco, principal of Medicare compliance firm Franco Signor L.L.C.
Source: leafinsurance.com

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

Medicare Supplemental Insurance

We also offer a Plan F High Deductible Medicare Supplement Insurance plan* that is designed to save you money if you stay healthy and keeps the cost of insurance affordable. There is a one-time deduction that must be met each year with this plan. With a Medicare Supplement Insurance plan from Pekin Life Insurance Company you will also have access to discounts on eye exams, eyeglasses, contact lenses, LASIK correction surgery, hearing aids, hearing exams, and more at NO CHARGE.
Source: pekininsurance.com

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

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October 08, 2013

Obamacare: Medicare (mostly) not affected

Posted by:  :  Category: Medicare

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

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

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

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

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

The Ins and Outs of Medicare Supplemental Insurance

Yes! So how does this relate to Medicare’s coverage? There is a general rule of thumb that is called the “80/20 rule.” Outside of some of the preventative items like mammograms, colorectal screenings, and some psychiatric care, Medicare covers the first 80 percent of medical bills, leaving you to cover the last 20 percent. Medicare will also cover certain medically-necessary pieces of equipment like seat lift mechanisms and diabetic shoes (fitted by a specialist, of course). It doesn’t seem so bad at first, especially if you’re a healthy individual, but if something happens that requires you to need urgent medical care or even an operation, you may have to spend tens- to hundreds-of-thousands of dollars. A June 2011 report from the Kaiser Family Foundation predicted that by the year 2020 the median out-of-pocket spending for seniors with Medicare is projected to reach 26 percent of all income, with the most money being spent in the last five years of their life. This is why supplemental Medicare insurance is a necessity for every senior. Not only do you really need Medicare supplemental insurance, you need it before something happens to you, and you likely won’t use it much until the last 5 years of life. So two points to keep in mind 1) If you wait until a procedure is needed or something unexpected happens to you, you’ve waited too long, and 2) Don’t make the mistake of cancelling your Medicare supplement policy because you’ve’ paid in more than you use. It’s health insurance and in this case it works best if it’s held to its natural end point.
Source: insideeldercare.com

Medicare and Health Insurance, What is Covered, Medicare Supplement

Medicare Part D pays for prescription drugs. This plan covers both generic and brand name prescription drugs. The initial enrollment period to join a Medicare drug plan is three months before your 65th birthday to three months after you turn age 65. Each year during the open enrollment period, you have the option to change your drug plan to fit your specific needs. Perhaps when you turned 65 you did not have need for extensive coverage, but as you get older and your needs change, this coverage can be increased as necessary.
Source: bradeninsurance.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 08, 2013

AARP Launches Shore Tour To Save Social Security Medicare / Public News Service

Posted by:  :  Category: Medicare

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ANNAPOLIS, Md. – This is the week for seniors on Maryland’s Eastern Shore to make their voices heard, as AARP Maryland launches its “Tour of the Shore” community conversations. With Washington embroiled in another bitter budget fight, AARP Maryland wants to make sure retirees, who are increasingly moving to the shore, are a part of the debate. AARP Maryland advocacy director Tammy Bresnahan said educational forums this week in Cambridge, Ocean City and Salisbury will let seniors know what is on the line in Congress this fall. “They have to decide the budget by Oct. 30 or the government shuts down,” she said, “and we believe that some of the negotiations that are going on could affect Social Security and Medicare.” Eighty-five percent of senior citizens in Maryland receive Social Security benefits. Bresnahan said AARP Maryland will use the information it gathers from seniors on the shore to lobby Congress over the next few weeks. Maryland seniors also are increasingly burdened by higher energy bills, and utilities are preparing to add new surcharges, Bresnahan warned. “We also know that a critical piece of aging in place, or staying in your home, is affordable and reliable utilities, so we will also be talking about that,” she said. To follow this week’s events on Twitter, check out #sayontheshore, or follow AARP Maryland on Facebook. Information about the “Tour of the Shore” community forums is available at http://states.aarp.org.
Source: publicnewsservice.org

Video: Maryland Medigap Insurance aka Medicare Supplements

MedicareBob’s Blog: Prince George’s County Maryland 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

Prince George’s County Maryland Medicare Supplement Quotes

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

Paul Ryan and the MD GOP on Medicare

Paul Ryan’s plan would cut Medicare spending by $356 billion over the next ten years, affecting thousands of Marylanders. Ryan would also raise the Medicare eligibility age to 67. Additionally, the Ryan Plan would convert Medicare into a voucher program. A voucher program would end Medicare as we know it, placing a tremendous burden on low-income beneficiaries.
Source: theonlinestate.com

Changes to the Maryland Medicare Waiver

The Maryland Medicare Waiver is a special agreement with the federal government that allows the Health Services Cost Review Commission (HSCRC) to set hospital rates for all payers, including Medicare and Medicaid, so long as Maryland keeps Medicare inpatient per case cost growth below the national average.  In recent years, Maryland has moved closer to breaking the terms of the special Medicare waiver agreement as Medicare inpatient costs here are beginning to outpace national growth.  
Source: bowie-jensen.com

Maryland’s ACA health care exchange is ready to go

Baltimore County is part of the Central region, which also includes Baltimore City and Anne Arundel County, and will be served by Health Care Access Maryland, a health-oriented nonprofit founded in 1997. The region is home to over 200,000 currently-uninsured residents.     The exchange system is intended to serve as a competitive marketplace in which individuals can get both access to a range of various plans and help in navigating the process and the available options, including the expanded Medicaid program for qualifying residents, and tax credits and subsidies for others who cannot afford coverage.     It will provide a “one-stop” means for residents to shop, compare and enroll in a plan that best meets their needs; see all coverage options all in one place, with one application; find out if they are eligible for federal tax credits and cost sharing reductions to reduce the cost of insurance premiums; see if they qualify for public health programs such as Medicaid and the Maryland’s Children’s Health Program (MCHP); and get assistance through the MHC call center or the regional connector entity organization to help with the application process.     The exchange system provides trained “navigators” and “assisters” who can help residents with information about coverage options, the application process and determining eligibility for tax credits, Medicaid and other assistance.     Navigators are certified and trained professionals who will counsel applicants and enroll them in qualified health plans. Assisters are non-certified staff who will provide information and assistance for residents enrolling in the expanded Medicaid program.     As MHC communications and outreach director Danielle Davis put it at an August press briefing, “All you have to do is call or log on; we’ll walk you through the rest.”     (Assistance for Spanish-speaking residents is also available.)     Small businesses can use the exchange system to shop for coverage as well, through the Small Business Health Options Program (SHOP), which will be open to enrollment in January and will include tax credits for qualifying small businesses that provide health coverage to employees.     All available plans will offer core benefits including doctor visits, hospitalization, emergency care, maternity care and pediatric care. Plans must also cover preventive care, including flu and pneumonia shots, birth control, routine vaccinations, and cancer screenings (such as mammograms and colonoscopies) at no extra cost.     Under provisions of the ACA already in force, no one can be denied coverage based on a pre-existing health condition.     For more information, or to begin the enrollment process (which opens Oct. 1), visit www.marylandhealthconnection.gov, or call 1-877-223-5201.
Source: dundalkeagle.com

Inside Maryland’s Plan to Save its Plum Medicare Deal

Maryland health administrators unveiled a plan to adjust hospital reimbursements and cost metrics in order to keep its unique full-payment arrangement with Medicare, according to a report by the Washington Post. In the 49 other states, Medicare pays a federally standardized discount rate to providers. But since 1977, Maryland has been allowed to set reimbursement rates for Medicare as long as it keeps its cumulative spending growth below national payments. That’s worked out fine so far, but now that federal healthcare spending growth is at a three-year plateau, the state is projected to barely fall under that threshold by less than 2 percent this year. Losing the so-called Medicare waiver would cost the state an estimated $1 billion, according to the report. The plan Maryland’s health secretary and health insurance review commissioner presented before lawmakers to remedy that shrinking margin would tie hospital payments to growth in the state’s economy and institute a shared savings model among providers, according to the report. The plan would extend current contracts two months past the original expiration date of April 30 to give the industry time to prepare.
Source: beckershospitalreview.com

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October 08, 2013

NC Medicaid director stepping down after less than 9 months on the job (updated)

Posted by:  :  Category: Medicare

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“In her time at the Department of Health and Human Services, Carol has made invaluable contributions to the state and the people we serve,” said Secretary Wos. “She brought fresh ideas and deep knowledge and experience to the state’s Medicaid program. This is an excellent private sector opportunity for Carol to return to the state where she grew up, and we will miss her greatly. We appreciate her commitment to a smooth transition as we progress towards creating a predictable and sustainable Medicaid system for the people of North Carolina.”
Source: carolinamercury.com

Video: North Carolina Medicare Enrollment.wmv

MedicareBob’s Blog: Forsyth County North Carolina 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

Forsyth County North Carolina Medicare Supplement Quotes

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

Medicare Blue Button Makes Health Records Accessible

But the body of information doesn’t end there. With the advent of Medicare Blue Button—a program that lets people download personal health records to a file—patients can also come to appointments with their medical history in tow. Until recently, retrieving medical records was the duty of a physician’s administrators or a third-party record retrieval firm, but now Medicare patients can use Blue Button to avoid waiting for their information to arrive at the doctor’s office.
Source: altmannporter.com

MGMA Analysis of 2014 Proposed Medicare Physician Fee Schedule

Diamond Level Platinum Level Gold Level Biz Technology Solutions, Inc. First Citizens Bank rmsource, Inc. Wells Fargo Insurance Services Silver Level Ball Dermpath McGladrey Medical Protective SunTrust Bank United HealthCare Group Bronze Level Allegacy Business Solutions – JBA Benefits & Cooperative Payroll Allscripts Apex Technology Assured Waste Solutions, LLC Bactes Imaging Solution Bernard Robinson & Company, LLP Call-A-Nurse Capario ChoiceHealth, Inc. Coverys, Inc. DataMax Corp / Interstate Credit Collections The Doctors Company Eastman Kodak Company Fifth Third Bank Ford & Harrison GMK Associates, Inc. Gordon Asset Management, LLC Greenway Medical Henry Schein Medical Humana Konica Minolta LabCorp Marketing Works McNeary, Inc. Medicus Insurance Company Medstaff National Medical Staffing mindShift Technologies, Inc. MSOC Health NCHA Strategic Partners NextGen Healthcare ONLINE Information Services Physician Discoveries Physicians’ Alliance of America Prince Parker & Associates Professional Recovery Consultants SCA Collections, Inc. Solstas Lab Partners SouthData Stanley Benefits Stern & Associates, P.A. Attorney at Law Total Merchant Services Transworld Systems, Inc. TriMed Technologies Corp TriZetto Provider Solution – Gateway EDI
Source: wordpress.com

N.C.’s nascent Medicaid reform

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

Medicare penalties to cost some Fayetteville, region hospitals

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Source: fayobserver.com

US Shutdown a Smokescreen for Assault on Social Security, Medicare

The partial or total shutdown of most departments other than the uniformed military and police/intelligence agencies such as the CIA, the FBI and Homeland Security is hitting broad layers of the population. Besides the closure of national parks and monuments, some 8.9 million low-income mothers and children are being denied food aid due to the shutdown of the WIC program; pension and veterans’ benefit checks are being delayed; preschool Head Start programs are closing; sick people, including cancer patients, are being turned away from National Institutes of Health clinical trials; and foster care payments, nutrition aid and financial assistance for hundreds of thousands of Native Americans are being halted.
Source: globalresearch.ca

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October 08, 2013

HHS Announces First Guidance Implementing Supreme Court’s Decision on the Defense of Marriage Act 

Posted by:  :  Category: Medicare

Under section 1852(l) of the Social Security Act, an MA organization is required to provide an MA plan enrollee Medicare-covered SNF services in a particular SNF if (1) the enrollee elects coverage in that SNF; (2) the SNF either contracts with the MA organization, or agrees to accept payment under the same terms and conditions that apply to similarly situated contracting SNFs; and (3) the SNF meets the definition of a “home skilled nursing facility.” One of the ways that a SNF can qualify as a “home” SNF is that it is the SNF “in which the spouse of the enrollee is residing at the time of [the enrollee’s] discharge from [a] hospital” after a qualifying 3 day hospital stay entitling the enrollee to Medicare coverage of SNF services. Section 1852(l)(4)(A)(iii) (emphasis added).
Source: medicareadvocacy.org

Video: Windsor Medicare Extra.mov

Windsor medicare part d coverage

Anything found him), Alfred’s cries were that castoff Forest staring and stammering

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