Medicare Begins Open Enrollment, With An Online Caveat

Posted by:  :  Category: Medicare

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“Medicare’s open season is set to run from today until Dec. 7. It’s when seniors and others enrolled in the program can join or change prescription drug or other health plans. But the government shutdown has meant that some of the information on the medicare.gov website about plan selections is not completely up to date.
Source: kcur.org

Video: Attention Residents on Medicare in Illinois: information on Medicare Supplements

Medicare Open Enrollment Information Session October 10

We will cover changes to the 2014 Medicare Part D benefits, Extra Help program for Part D benefits, how to choose a prescription drug plan and a Medicare Advantage plan, and what to watch out for. SHIBA is a free, unbiased service of the Washington State Office of the Insurance Commissioner.
Source: orcasissues.com

Medicare information at Trinity Wesleyan Thursday

Salisburypost.com is pleased to offer readers the ability to comment on stories. We expect our readers to engage in lively, yet civil discourse. Salisburypost.com cannot promise that readers will not occasionally find offensive or inaccurate comments posted in the comments area. Responsibility for the statements posted lies with the person submitting the comment, not Salisburypost.com. If you find a comment that is objectionable, please click “report abuse” and we will review it for possible removal. Please be reminded, however, that in accordance with our Terms of Use and federal law, we are under no obligation to remove any third party comments posted on our website. Full terms and conditions can be read here.
Source: salisburypost.com

It’s That Time Again: Medicare Open Enrollment

“Your health and prescription drug needs may change from year to year or the plan you have may make changes,” said Nicole Duritz, AARP Vice President, Health Education and Outreach. “That’s why regardless of whether you have original Medicare or a Medicare Advantage plan, it’s important to evaluate your choices during open enrollment.”
Source: aarp.org

Medicare Secondary Payer: Web Portal to Collect Data on Conditional Payment Amounts and Claims Detail 

Within 30 days of securing a settlement, the beneficiary or his or her attorney or other representative must submit information specified by the settlement.  CMS says that the settlement information will be the same information that the Medicare agency typically collects to calculate its final demand amount.  The information includes the date of the settlement, the total settlement amount, the attorney fee amount or percentage, and additional costs borne by the beneficiary to obtain his or her settlement.[11]  If the beneficiary does not submit the settlement information within the 30 day period above, the final conditional payment amount obtained through the web portal will expire.[12]  The web portal will also have the capacity for beneficiaries to request a "claims refresh." That refresh will be initiated no later than 5 business days after the electronic request is initiated.
Source: medicareadvocacy.org

Firm Relies On Medicare Experience As It Prepares To Open Federal Health Exchange Calls Centers

Shortly after the Medicare prescription drug benefit was introduced in 2006, the HHS inspector general found that 44 percent of callers reported problems accessing information — despite a similar 2004 inspector general’s finding — and 21 percent of callers waited so long for responses that they hung up. When Medicare introduced a new prescription drug discount card in 2004, the Government Accountability Office reported that 29 percent of the call-center answers were inaccurate and 10 percent of the calls were disconnected.
Source: kaiserhealthnews.org

It’s time for Medicare Open Enrollment

Get answers to these questions during Medicare’s annual Open Enrollment period Oct. 15-Dec. 7. Trained and certified insurance counselors are available at the Staunton Senior Center to give you personalized information about your medication costs and which Part D plan is best for you in 2014.
Source: vpasaugusta.org

2014 Medicare Advantage Plans

Medicare Advantage plans are offered by private insurance companies that contract with Medicare. These plans must offer at least the same amount of coverage as Original Medicare (Part A and Part B), and may also offer additional coverage such as vision, dental, and prescription drug coverage. During the Medicare Annual Election Period, also known as the Annual Enrollment Period or the Open Enrollment Period, beneficiaries may make changes to their Medicare Advantage coverage. Providers may change their plan details each year, so it is recommended that beneficiaries review the 2014 benefits for their Medicare Advantage plan to be sure that the plan they are enrolled in is still the right one for their needs.
Source: planprescriber.com

ibm medicare options: IBM Medicare www.extendhealth.com/ibm More Information on Doing Plan Research

I encourage everyone to get all of your questions answered before proceeding with enrollment. If you are unhappy with the conversation, call again as it is not uncommon for questions to be answered incompletely or even incorrectly, even with EH; and make sure you document the call. Keep in mind, for a variety of legal reasons, while it may in some limited circumstances enhance a subsequent claim (or complaint), talking with an insurance company (or EH) representative does not make your conversation – questions or answers – a part of, or not a part of, the plan document or coverage thereunder. Nevertheless, it is imperative that your review all available plan information and follow-up with all available sources, including calling the respective insurance company, CMS, and applicable state insurance agencies, to have all of your questions or concerns answered before proceeding with enrollment; and, that you fully understand the plan, including coverage, payments, and limitations, in which you are enrolling, BEFORE you enroll.
Source: blogspot.com

New Hampshire: Brand New Medicare Supplement Plan

Posted by:  :  Category: Medicare

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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

Video: New Hampshire Medicare Advantage Plans

Catch Up On All The News About Medicaid Expansion In NH

This week the decision wether or not to take part in the Medicaid expansion is absolutely dominating the news media. There have been many storys both pro and con about the expansion. In this post I will highlight some of the stories about the Medicaid Expansion. I also want to say that I am very much for the expansion and believe that helping tens of thousands of low and middle class families is the best thing the state can do. Not all these stories do not push for the expansion but we need to know why people are opposing it. The first one that came out was Just call us ‘The Donor State’ “Senate President Peter Bragdon and his fellow Republicans on the Senate Finance Committee, Sens. Bob Odell of Lempster, Jeanie Forrester of Meredith and Chuck Morse of Salem, want to make New Hampshire “The Donor State.” The full Senate should tell them no thanks.” “Accepting these federal resources will provide health insurance to tens of thousands of low-income New Jerseyans, help keep our hospitals financially healthy and actually save money for New Jersey taxpayers. Expanding Medicaid is the smart thing to do for our fiscal and public health,” Christie said at a press conference in February. New Jersey expects to save $227 million by expanding Medicaid access.” The second comes from the Nashua Telegraph’s Kevin Landrigan. Health care providers kick off campaign to support Medicaid expansion in NH. “Health care providers kicked off a monthlong blitz in favor of expanding Medicaid on Thursday, hoping to overcome Senate Republican leaders who propose to short-circuit it in a state budget. The campaign ramps up Tuesday, when Gov. Maggie Hassan will join a Voices for New Hampshire Health press conference featuring three low-income adults who would get coverage if lawmakers expanded Medicaid from 68 to 138 percent of the federal poverty level.” Yesterday on the Exchange (NHPR) the took the entire hour to discuss the expansion. The Muddle Over Medicaid “The Affordable Care Act encourages states to expand Medicaid coverage and provides funding to do so. So far, the tally is roughly even between states opting in and opting out, but some are still undecided, including New Hampshire. Medicaid expansion has support from the House and Governor but the Senate has some serious doubts.” Listen to the entire episode One of the things that was brought to the surface during the Exchange interview is this idea that the federal government will not pay the money promised to states as part of the ACA. I reject this opinion because the federal government has never defaulted on payments for Medicaid. Lastly, I want to share with you a post from the NH Citizens Alliance who is one of the organizations who are pushing for the Medicaid expansion. Jillian Dubois was also on the Exchange. NHCA’s lead organizer on Medicaid expansion, Jillian Andrews Dubois, called in to suggest that New Hampshire try expansion, since the Supreme Court ruled that it is optional and federal funds will cover 100% of newly eligible beneficiaries for the first three years. It just makes sense to take this opportunity to bring billions of federal dollars and hundreds of jobs into our state. In addition, guests Sen. Sanborn and Rep. O’Brien kept mentioning a third option that they would consider, like a block grant for New Hampshire to run Medicaid its own way. However, Jillian pointed out that this option is not currently on the table and is not likely to be in the future. Staff member Karen Kelly called out Rep. Bill O’Brien for falsely claiming that the Affordable Care Act (which includes Medicaid expansion) would add to the federal deficit. In fact, the non-partisan Congressional Budget Office has rated the ACA as reducing the deficit, since its revenue provisions are estimated to bring in more than the spending will cost. She also pointed out that since opponents to expansion have claimed that it needs to be studied further, we might as well take the 100% funding while we can, study the program, and make changes as necessary down the road. The NHLN has also talked about Medicaid expansion and the Affordable Care Act. Could New Hampshire Be Setting Up A Failure Of The ACA Marketplace Obamacare Will Save You Money In Health Insurance Expanding Medicaid Will Greatly Benefit Veterans In NH My Letter To Editor On Medicaid Expansion (by NHLN blogger Matt Murray)
Source: bluehampshire.com

Medicare Part D: Beneficiary Satisfaction Soars

In a time when government disapproval has grown among the public, Medicare Part D stands as a mark of success for government programs. A national survey released this month by KRC Research of approximately 2,300 seniors (65+), highlights the overwhelming positive response to the program. With almost 10 years since it was first enacted, Medicare Part D appears to one of the most popular government programs in existence.
Source: nhjournal.com

Medicaid Expansion: Maine Looks At Another Plan; Advocates Lobby N.H., Missouri Lawmakers

CQ HealthBeat: Maine’s GOP Governor Criticizes Federal Offer On Medicaid  Maine’s Republican governor says Washington won’t recognize his state’s previous generosity when it comes to negotiations on a Medicaid expansion. But federal officials say they are doing all they can under the terms of the health law to pick up more of the tab. Gov. Paul R. LePage has been at loggerheads with his legislature — and other interests in the state — over whether to expand Medicaid. On Thursday, he issued a statement criticizing the latest offer by Centers for Medicare and Medicaid officials that would meet some, but not all, of his demands (Adams, 5/30). The Associated Press: Expand Medicaid, N.H. Urged  Organizations that provide free or low-cost health care and mental health services across New Hampshire again urged the Legislature on Thursday to approve expanding Medicaid coverage to the state’s poorest adults. New Hampshire’s current Medicaid program covers low-income children, pregnant women, parents with children, elders and people with disabilities, but the state is deciding whether to expand it to include anyone under age 65 who earns up to 138 percent of federal poverty guidelines, which is about $15,000 for a single adult (5/30).
Source: kaiserhealthnews.org

Late Mountain Home Doctor May Have Crafted Largest Medicare Fraud in State’s History: $14.7M

Posted by:  :  Category: Medicare

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On Sept. 20, the U.S. Attorney’s Office filed a civil forfeiture lawsuit in an attempt to seize Johnson’s ex-wife’s Mountain Home mansion, which prosecutors said was paid for with proceeds from the Medicare fraud. Johnson’s ex-wife, Cynthia Johnson, paid $600,000 to settle the lawsuit and keep the property. The case was closed Oct. 4.
Source: arkansasbusiness.com

Video: PM Kevin Rudd responds to questions about his preparation for the evening’s health debate in BNE.

Daily Kos: Those ‘Medicare cuts’ in Obamacare? Not so much.

Remember that infamous $716 billion in Medicare cuts that featured big in Mitt Romney’s campaign, even though his running mate Rep. Paul Ryan included the same cuts in his big budget? Well, there’s a reason the Medicare cuts died as a Republican attack on Obamacare, and it’s not just because Romney lost. It’s because those cuts haven’t destroyed Medicare, or harmed anyone enrolled in Medicare, or even hurt Medicare Advantage, the federally subsidized private insurance plans that sustained the cuts. Far from it. Four years later, with the ACA in place, it appears that worries about the future of Medicare Advantage have not come to fruition — at least not yet. The program is more popular than ever. Between 2010 and 2013, enrollment in the program increased 30%, defying the expectations of some of the top policy experts in Washington. […]
Source: dailykos.com

FBI — Former Office Manager for Health Care Solutions Network Sentenced in $63 Million Medicare Fraud

Court documents reveal that Palmero was aware that HCSN-FL personnel were fabricating patient medical records. Many of these medical records were created weeks or months after the patients were admitted to HCSN-FL for purported PHP treatment. Palmero was also aware that medical records were fabricated for “ghost patients” who were never admitted to the HCSN-FL PHP. During her employment at HCSN-FL, Palmero actively concealed the fabrication of medical records by preparing, and causing others to prepare, documentation that was later utilized to support false and fraudulent billing to government-sponsored health care benefit programs, including Medicare and Florida Medicaid.
Source: fbi.gov

Fox’s Rove Falsely Claims That Social Security, Medicare Lack Fraud Protection

The Office of the Inspector General also maintains a program to reduce and respond to SSDI fraud. The Cooperative Disability Investigation Program “investigate disability claims under SSA’s Title II and Title XVI programs that State disability examiners believe are suspicious.” The CDI obtains evidence for disability examiners before benefits are paid and provides reports for continuing disability reviews “that can be used to cease benefits of in-payment beneficiaries.” The program reported $339.6 million in projected savings to SSDI programs in fiscal year 2012. The program also publishes reports on the convictions of the most egregious fraud and abuses of the system found by investigators.
Source: mediamatters.org

Federal Insurance Marketplace Can’t Yet ‘Talk’ To State Medicaid Agencies

This means if people are found to be eligible for Medicaid today (under current eligibility rules) after entering their personal data on the federal web site, they will be directed to their local Medicaid eligibility office where they will have to repeat the process of providing detailed information about their income, residency status and other data.
Source: kaiserhealthnews.org

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October 16, 2013

Medicare Drug Plan Polls Suggest Bright Future for Obamacare

Posted by:  :  Category: Medicare

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

Video: Medicare Part D – 5 Things To Know Before You Enroll in a Part D Plan

Obamacare vs. Medicare Part D

The federal exchange system, meanwhile, was taken offline for repairs twice over the weekend, and again last night. The users who have already created accounts are also being told they have to reset their passwords. And even today, administration officials are still refusing to provide an estimate about when the system might be glitch-free. Health and Human Services Secretary Kathleen Sebelius claims she doesn’t even know how many people have signed up in the federal exchange system—even though California, Washington state, Maryland, New York, and Kentucky have all released application data. It’s not clear exactly what’s wrong with the federal exchange system, but it’s hard to trust the administration’s assurances that it has the problem under control. 
Source: reason.com

Medicare drug gap risk may have shrunk

are estimating that only 9 percent of the users will end up with total annual drug costs this year that exceed the coverage limit for ordinary prescription expenses but are too low to qualify for catastrophic coverage.
Source: lifehealthpro.com

Obamacare Critics Won't Mention Pres. Bush's Medicare Drug Program Mess

However, even with all the problems, Democrats did not try to repeal or defund Bush’s Medicare drug program by refusing to approve the Continuing Resolution, which finances the federal government, as Republicans have done since Oct. 1 with Obamacare. Sources: TalkingPointsMemo.com, Philly.com, MediaMatters.org, Watchdog.org, Forbes, HealthCare.gov, ReviewJournal.com
Source: opposingviews.com

Medicare Drug Plan Premium Payment Options

Extra Help is available for qualified beneficiaries enrolled in Medicare Part D and whose yearly income and resources are limited. The Social Security Administration defines limited income and resources as the following: if your combined savings, investments, and real estate are not worth more than $26,580, if you are married and living with your spouse, or $13,300 if you are not currently married or not living with your spouse. When you are tallying your personal assets, you do not include your home, car, household items, burial plot, up to $1,500 in burial expenses (per person), or life insurance policies.
Source: ehealthmedicare.com

2014 Medicare Part D Plans: Changes in Medicare Drug Coverage

In 2014, you can continue to get your prescription drugs from either eligible local pharmacies or through mail-order pharmacies. In the past, Part D plans were not making sure that some beneficiaries still wanted or needed a drug before automatic refill systems sent them through the mail. Starting in January 2014, the government is encouraging 2014 Medicare Part D plans to get your consent for a new or refill prescription before each delivery, except in cases when you actively request the prescription. Make sure to communicate with your drug plan so that the delivery of your medication orders is not delayed. Keep in mind that this does not affect reminder programs where you pick up prescriptions in-person or at long-term care pharmacies.
Source: planprescriber.com

Research Roundup: Medicare Part D In 2014; Barriers To Mental Health Care

Health Affairs: Trends Underlying Employer-Sponsored Health Insurance Growth For Americans Younger Than Age Sixty-Five During [2007-2011], per capita spending on employer-sponsored insurance grew at historically slow rates, but still faster than per capita national health expenditures. Total per capita spending for employer-sponsored insurance grew at an average annual rate of 4.9 percent, with prescription spending growing at 3.3 percent and medical spending growing at 5.3 percent. Out-of-pocket medical spending increased at an average annual rate of 8.0 percent, whereas out-of-pocket prescription drug spending growth was flat. Growth in the use of medical services and prescription drugs slowed. Medical price growth accelerated, and prescription price growth decelerated (Herrera et al., 10/7).  Urban Institute/Robert Wood Johnson Foundation: Eligibility For Assistance And Projected Changes In Coverage Among states not currently planning to expand Medicaid eligibility, the share of the uninsured eligible for assistance ranges from 34 to 53 percent. In contrast, the share of the uninsured eligible for assistance ranges from 59 to 81 percent among the states that are currently committed to expanding Medicaid under the ACA. Second, we estimate the decrease in the uninsured population under the ACA in each state. Among states not currently expanding Medicaid, we predict the number of uninsured would decrease 28 to 38 percent. Eight states committed to expansion would see the number of uninsured decline by more than half (Buettgens, Kenney, Recht and Lynch, October 2013).
Source: kaiserhealthnews.org

Get Help with Medicare Part D Enrollment

The N.D. Insurance Department’s State Health Insurance Counseling Program (SHIC) staff is traveling to seven cities around the state during the open enrollment period, offering free assistance in switching or enrolling in a Medicare prescription drug plan. If you will be attending an event and have been given a yellow drug retrieval card, please bring it to the event for expedited service. Consumers also need to bring a list of their medications, including dosages and frequency.
Source: aarp.org

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October 16, 2013

Medicare: Definition from Answers.com

Posted by:  :  Category: Medicare

Program enacted in 1965 under Title XVIII of the Social Security Amendments of 1965 to provide medical benefits to those 65 and older. The program has four parts in 2007: 1. Part A, Hospital Insurance, contributes to the payment of inpatient hospital, skilled nursing expenses, hospice, and other ancillary expenses. The deductible is $992 for 60 or less days in a benefit period. For days 61–90, the deductible is $248 per day, and for more than 90 days, the deductible is $496 per day up to the lifetime maximum days. No premium is paid if the beneficiary has at least 40 quarters of Medicare covered employment. 2. Part B, Medical Insurance, provides coverage for medical services that Part Adoes not cover for a premium and subject to a deductible ($93.50 per month standard premium and a deductible of $131 per benefit payment in 2007). Coverage includes ambulance services, ambulatory surgery center, blood, bone mass measurement, cardiovascular screenings, limited chiropractic services, clinical laboratory services, clinical trials, colorectal cancer screenings, diabetes screenings, diabetic supplies, doctor services, durable medical equipment, emergency room services, limited eyeglasses, flu shots, foot exams and treatment, glaucoma tests, hearing and balance exam, Hepatitis B shots, home health services, kidney dialysis services and supplies, mammograms, medical nutrition therapy services, outpatient mental health care, occupational therapy, outpatient hospital services, outpatient medical and surgical services and supplies, pap test and pelvic exam, one-time physical exam within the first six months, physical therapy, pneumococcal shot, practitioner services, limited prescriptions (injectable drugs), prostate cancer screenings, prosthetic/orthotic items, second surgical opinions, smoking cessation, speech-language pathology services, surgical dressings, telemedicine, tests (X-rays, MRIs, CT scans, EKGs, and other diagnostic tests), transplant services, and urgently needed care (nonmedical emergency illness or injury). The initial enrollment period for Medicare Part B begins three months before age 65 and continues for the next seven months. If enrollment is not effected in this time period, there is a waiting time until the general enrollment period from January 1 through March 31 every year. Coverage then begins the following July 1. 3. Part C, Medicare Advantage, provides for individuals with Part A and Part B coverage to receive all of their health care coverage through a single health care provider. See also medicare plus choice (medicare part c). 4. Part D, Prescription Drug Insurance, contributes to the payment of medication/prescription expenses as prescribed by a physician. Coverage added for drugs by joining a Medicare Prescription Drug Plan through private insurance companies. A separate monthly premium (varies by plan) is required. Each plan must cover at least two drugs in all of the classes of drugs that are the most commonly prescribed. For those people covered under Medicare A, coinsurance or copayment is required and a yearly deductible may be in force. Retired workers qualified to receive Social Security benefits, and their dependents, also qualify for the hospital insurance portion. The program is paid for by payroll taxes on employees and covered workers. Parts B, C, and D insurance provides additional coverage on a voluntary basis for physician services. The Prescription Drug Plans are optional and can be added by paying an additional premium. Those enrolled in the program pay a monthly premium. Coverage is also available to persons younger than 65 who are disabled and have received Social Security disability benefits for 24 consecutive months.
Source: answers.com

Video: Medicare Advantage Plans for Producers

What is the Cadillac Medicare Advantage plan

A plan’s network of providers: People often think Medicare Advantage plans are only offered as part of healthcare management organizations (HMOs), but many are also preferred provider organizations (PPOs). With HMOs and PPOs, insurance companies typically have a list doctors, specialists and hospitals that are preferred so when you go to those providers, you presumably pay a lower price for care. Either that, or the insurer covers more of your out of pocket costs, or both. Your costs typically differ if you get “in network” care versus “out of network” care. You’re more likely to think of a plan that includes your doctors, specialists and hospitals at a lower price to be a Cadillac plan.
Source: ehealthinsurance.com

AMA girds for “defined contribution” Medicare

“The Council is aware that implementing a Medicare defined contribution program should be done gradually, using a phased-in approach,” Dr. Donna Sweet, the chair of the council, said in a written report on the measure. “A complete transition will involve significant, coordinated efforts by all stakeholders, including the federal government, private insurers, patient advocacy groups, and the AMA.”
Source: lifehealthpro.com

Physicians clarify definitions with external review company

With our continued efforts to reduce discordance with clinical and coding databases, Dr. Huff and other physician members of our clinical coding team recently met with a major Medicare Advantage payer to clarify the definitions being used to validate encephalopathy.  Meeting with the medical director and physician representatives of these companies, a consensus was reached regarding the well established and evidence-based definition of encephalopathy which we currently use for our coding recommendations.  We were assured this will be communicated to their review staff and this should reduce the number of coding challenges regarding the issue.
Source: huffdrgreview.com

Daily Kos: Damaged Medicare

Medicaid is a state program.  Here are the rules for New Jersey: The Division of Medical Assistance and Health Services (DMAHS) is reinforcing and updating guidelines that were issued in Medicaid Communication No. 00-16, dated August 10, 2000, governing the recovery of correctly paid Medicaid benefits from the estates of deceased Medicaid clients or former Medicaid clients. The following is a list of important points to remember when determining eligibility and discussing this topic with applicants, clients, authorized representatives and families: • Medicaid benefits received on or after age 55 are subject to estate recovery. This is specifically stated and acknowledged on the authorization page of the PA-1G Medicaid Application Form. • DMAHS has an immediate right to recover from the estate unless there is a surviving spouse or child(ren) who is under age 21 or who is blind or permanently and totally disabled. Should any of these exceptions to DMAHS’ right to recover from an estate no longer apply (e.g., death of surviving spouse, attainment of age 21 by surviving child, or death or termination of disability of blind or permanently and totally disabled child), DMAHS has a right to recover from any remaining estate assets at that time. • Estate recovery in New Jersey includes payments for ALL services, not merely services for institutionalized clients. There is no limitation on the type of service for which DMAHS can recover its payments from estates including managed care (HMO) capitation fees. However, effective January 1, 2010, Medicare cost-sharing benefits paid under the Medicare Savings Programs such as “Buy-in”, Specified Low-Income Medicare Beneficiaries (“SLMB”) or Qualified Individuals (“QI-1”) are not subject to estate recovery. • The estates of deceased clients who were enrolled in various Title XIX Waiver Programs (such as ACCAP, GLOBAL Options, CCW, etc.) ARE subject to recovery. … I hope this fills in the gaps on how this rolls.  Every state has similar “estate recovery” programs which are an important feature of “revenue neutral” O’care.
Source: dailykos.com

Medicare Advantage Insurance

By definition Medicare Advantage provides all of your Part A and Part B coverage. A Medicare supplement on the other hand, fills in the gaps of original Medicare and generally pays the hospital deductible and the 20% of Part B charges that would be your responsibility.
Source: affordablemedicareplan.com

The Dilemma in Choosing A Private Fee

Whether you choose a network based plan or a private fee-for-service Medicare Advantage plan, you have enrolled in the plan for that calendar year. The plans can change from one year to the next and are not required to renew. If you have a Medicare Advantage plan it makes good sense to speak with an independent agent during your Annual Enrollment Period that runs from Nov. 15 to Dec. 31 each year to see if there is a better alternative out there. Its your right and every dollar counts so you can Retire as Planned.
Source: myplannedretirement.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

The American Spectator : C’Mon, Man

The Debt Ceiling debate has brought some light to exactly what our $17 trillion National Debt really means. We were led to believe that China and Japan had lent us the money. But they are not fools and they have reduced their investment in America dramatically. Of the $17 trillion, only $5 trillion is held by China and Japan (about $2.5T) and other Foreign Countries (about $2.5T.) The rest is owed to Americans through a raided Social Security Trust Fund (About $2.5T) and other federal pension funds, as well as accounting gimmicks such as $2.5T owed to the Federal Reserve. So we have hollowed out all the Programs and institutions while claiming we are solvent. The suicide Bama “Default” is a ruse. The National government collects $225B per month in taxes and the interest on the Debt is about $20B. It is 8% of the revenue collected. Social Security and Medicare are Ponzi schemes because the DC crooks have stolen the Trust Fund money and now the taxes that come in go directly back out just as a Ponzi scheme works in that new investors pay the disbursements of the original investors. But all this could continue regardless of whether the Debt Ceiling is raised or no.
Source: spectator.org

What Does Medicare Cover?

Part D is an optional insurance program that charges a monthly fee in exchange for prescription drug coverage. The monthly cost varies widely depending on the coverage options you choose. Like employer-provided health care plans, Part D holds an open enrollment session November 15 – December 31 each year, during which time program participants can choose to change their coverage options. While Part D is a voluntary program, Medicare recipients have to seriously review their healthcare needs immediately upon eligibility because the cost of Part D increases each year for individuals who choose not to participate immediately upon eligibility.
Source: investopedia.com

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October 16, 2013

NY's attorney general issues "consumer advisory" on health exchanges

Posted by:  :  Category: Medicare

99th Assembly District 2009 Westchester County fair housing settlement 2013 Westchester County executive race Albany Andrea Stewart-Cousins Andrew Cuomo Bob Cohen Chuck Lesnick Clinton Young County Executive Rob Astorino Dan Schorr David Paterson deficit Democratic primary Election 2010 endorsements Ernest Davis inspector general John Murtagh Jose Alvarado Ken Jenkins lawsuit Maureen Walker mayoral election Mike Spano Mount Vernon Mount Vernon City Council New Rochelle Mayor Noam Bramson Noam Bramson Phil Amicone Philip Zisman Playland Park primary Rob Astorino Robert Flower Sandy Annabi Sustainable Playland Suzi Oppenheimer Westchester County Westchester County Board of Legislators Westchester County Executive Rob Astorino Yonkers Yonkers City Council Yonkers Public Schools Yorktown
Source: lohudblogs.com

Video: N.Y.S. Medicaid will no longer cover certian drugs starting October 1, 2011

Felony Conviction Of Brighton Beach Ambulette Company For $560k In Medicaid Fraud

Street, filed hundreds of claims with the state Medicaid program falsely stating that it transported Medicaid recipients to medical appointments. In truth, the recipients were transported by ambulettes owned by I & E Transportation Inc., another Brooklyn transportation company that was never enrolled with Medicaid as an ambulette provider. Medicaid rules specifically prohibit an enrolled transportation provider from subcontracting medical transportation services to a company that has not been formally vetted and accepted by Medicaid as a provider of services. The rule ensures that Medicaid has the opportunity to review the qualifications and background, including the possible criminal background, of all prospective providers that render services to its members.
Source: brooklynews.com

Underuse of Hospice Care by Medicaid

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

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