Reassessment time for Medicare Part D beneficiaries

Posted by:  :  Category: Medicare

Open Enrollment Website If you’re comfortable using a computer, you can easily compare Medicare’s drug plans yourself online. Just go to Medicare’s Plan Finder Tool at medicare.gov/find-a-plan, and type in your zip code or your personal information, enter in how you currently receive your Medicare coverage, select the drugs you take and their dosages, and choose the pharmacies you use. You’ll get a cost comparison breakdown for every plan available in your area so you can compare it to your current plan.
Source: downriversundaytimes.com

Video: Medicare Plan Finder Lesson 1: Getting Started

Prepare for Open Enrollment

If you are a Medicare recipient, or if you are eligible for Medicare, you are or will be eligible to add prescription drug coverage to your Medicare benefits. The new addition to Medicare is known Part D. It is called PDP (Prescription Drug Plan.) Anyone who has the Medicare is eligible to enroll in one of the prescription drug plans.
Source: 5thaveins.com

To Switch or Not to Switch: Are Medicare Beneficiaries Switching Drug Plans To Save Money?

Our findings have implications beyond Part D, as policymakers debate options for broader Medicare restructuring, including options that would increase the role of private plans in Medicare.  The evidence to date from Part D suggests that most beneficiaries, once enrolled, tend to stick with the plans they have chosen, even when they are faced with relatively large premium increases.  While this tendency likely reflects a mix of both satisfaction with the status quo and some reluctance to examine alternatives or make a change, it also points to a disconnect between theory and reality in this and potentially other choice-based systems for Medicare.  In the face of evidence suggesting that plans will retain most of their enrollees regardless of premium increases or modifications to other plan features, plan sponsors may have less incentive to keep costs down.  The result could be higher costs for both beneficiaries and the federal government, because under the structure of Part D, where both the government’s share of the premium and the beneficiary’s premium amount are derived from the average of plan bids, these costs go up as plan bids increase.  Results of our study raise questions about the degree to which beneficiaries are willing or able to let cost be their ultimate guide in choosing a plan.  As a result, the competitive signal is not sent to plan sponsors, and beneficiaries could miss out on an opportunity to achieve savings.
Source: kff.org

Medicare Open Enrollment in Full Swing: State Assistance Available : North Denver Tribune

People should evaluate their Medicare plan each year and because plan prices, benefits, and networks change, even people who are happy with their current plan should use this time to review their coverage. The Plan Finder tool at www.Medicare.gov can be very helpful in comparing one plan to another. Colorado consumers can call their local State Health Insurance Assistance Program (SHIP) at 1-888-696-7213 for help. SHIP is housed in the Colorado Division of Insurance and provides personal assistance to anyone in Colorado. Consumers can also contact Medicare directly at 1-800-633-4227.
Source: northdenvertribune.com

Seniors Cautioned To Pay Close Attention To Details As Enrollment Begins In Medicare Plans

While the AARP MedicareRx  Saver Plus premium will go up 55 percent next year, it is still below the average national premium,  Sarah Bearce, a UnitedHealth Care spokeswoman said in an e-mail.  The combination of federal reimbursement cuts, the health law’s tax on insurers and the automatic cuts triggered by sequestration “required us to make changes to our plans,” she said, and added that this “financial pressure” is being felt across the health insurance industry.
Source: kaiserhealthnews.org

Marshall Elder and Estate Planning Blog: It’s Medicare Open Enrollment Period

Once on the website you can find and compare the plans that are available in your region. Plug in your basic information including the prescription drugs you expect to be taking in 2014. The plan finder will then provide you with a list of stand-alone Part D drug plans (for those with traditional Medicare) and Medicare Advantage plans that are available to you. The list will include the monthly premium, your estimated total annual drug costs and other valuable information.
Source: blogspot.com

Estate Planning & Elder Law Services

A person can delay enrollment in a Part D plan without penalty until 63 days after he or she leaves an employer group plan or otherwise involuntarily loses coverage from a creditable plan. A creditable plan is one that is at least as good as the basic benefit. The plan is required to send out a notice each year to its subscribers before annual enrollment, confirming that the plan remains creditable. Of course, an individual with a creditable plan could choose to leave that creditable plan and join a Medicare Drug Plan during annual enrollment each year.
Source: formyplan.com

Medicare Open Enrollment Lasts Until December 7

Posted by:  :  Category: Medicare

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I also invite seniors to attend my Senior Services Fair at the Grand Generation Center, 304 East 3rd Street in Grand Island on Thursday, November 14, 2013 from 1:00 to 3:00 p.m. (CT).  At the fair, seniors and caregivers will be able to meet with and ask questions directly to SHIIP experts.  In order to find the plan which best meets their needs, attendees should bring a complete list of their prescriptions including dosing information.  I also would encourage you to get information about your health care coverage options by speaking to your insurance agent.
Source: nefrw.org

Video: Feds want your retirement Money/Medicare cuts/Nat of Islam to contact gangs

Medicare Open Enrollment begins today

CMS announced last month that the average Medicare Advantage (MA) premium is projected to be $32.60. Earlier this year, CMS estimated that the average basic Medicare prescription drug premium plan in 2014 was projected to be $31 per month, holding steady for four years in a row. Since the passage of the Affordable Care Act, average MA premiums are down by 9.8 percent. The deductible for standard Part D plans will decline by $15 in 2014 to $310. Prescription drug and health plan quality continues to improve as over one-third of MA contracts will receive four or more stars, which is an increase from 28 percent last year. CMS is allowing 5-star Medicare health and prescription drug plans to enroll beneficiaries at any time during the year.
Source: healthcoverageally.com

The Medicare Annual Coordinated Election Period Has Begun! 

The Alliance provides Medicare advocates with a collaborative network to share resources, best practices, and developments of import to Medicare beneficiaries throughout the country. The Alliance is supported by the Atlantic Philanthropies. Learn more or search our Medicare appeal decisions database.
Source: medicareadvocacy.org

Contact CMS: Take Action Against Massive Cuts in Medicare Pathology and Laboratory Services

The proposed cuts are outlined in CMS’ 2014 Medicare Physician Fee Schedule proposed rule. One of the proposals would cap payment rates for services paid under the Medicare Physician Fee Schedule at rates paid under the Medicare Hospital Outpatient Prospective Payment System. The proposed cuts apply to the technical component and global payments for pathology and laboratory services. CMS estimates the cut in reimbursement for independent laboratories at approximately 26 percent. ASCP is very concerned that cuts of this magnitude could result in significant layoffs and/or the closure or downsizing of some laboratories, thus threatening patient access to important medical services.
Source: nyhisto.org

Washington State Insurance Update: Medicare open enrollment started this week and ends Dec. 7

Medicare’s open enrollment period for prescription drug plans (Part D) and Medicare Advantage plans is Oct. 15 – Dec. 7. This is the time when you can enroll in a new plan or sign up for coverage. If you need assistance understanding your options, we have trained volunteers in your community. Our Statewide Health Insurance Benefits Advisors (SHIBA) program offers free help to people with Medicare questions and can help you search for plans online. We even have free Medicare workshops across the state. Remember, if you want to enroll in  new plan, you must contact Medicare. You cannot sign up through the state’s new health benefit exchange, www.wahealthplanfinder.org. If you have limited income and need help paying prescription drugs, check out Medicare’s “Extra Help” program. To see if you qualify, contact the Social Security Administration at 1-800-772-1213 or go to www.socialsecurity.gov. For more help, contact a local SHIBA office in your area.
Source: blogspot.com

The Health Insurance Marketplace: What People with Medicare Need to Know

Medicare, the federal health insurance program for people age 65 and older, people with End Stage Renal Disease, and younger adults with disabilities, is an important source of coverage for many people living with HIV. Over the past four weeks there has been great interest in the opening of the Affordable Care Act’s Health Insurance Marketplace. As a result, some people with Medicare may have questions about how all of this affects them. Also, because the Medicare open enrollment period is overlapping with the beginning of the Health Insurance Marketplace enrollment period, many people with Medicare have questions about what they need to do to ensure their health coverage continues. (The Medicare open enrollment period runs October 15-December 7, 2013 while the Health Insurance Marketplace launched on October 1, 2013 and its open enrollment period runs through March 31, 2014). We at AIDS.gov wanted to share the following information with our readers who may have questions.
Source: aids.gov

UnitedHealthcare Cuts Doctors From Medicare Advantage Plans

Posted by:  :  Category: Medicare

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The Columbus Dispatch: Medicare Insurer UnitedHealthcare Cuts Doctor Network  UnitedHealthcare is dropping an undisclosed number of doctors from its Medicare Advantage provider network in Ohio, which will force some senior citizens to find new physicians or change plans, according to a physician-advocacy group. “This is one of the most significant (provider) network narrowings we’ve ever seen in the Medicare Advantage world,” said Todd Baker, director of professional relations with the Ohio State Medical Association. He said physicians have been receiving termination letters from UnitedHealthcare for about six weeks (Sutherly, 10/26). 
Source: kaiserhealthnews.org

Video: Medicare Advantage – 5 Things To Know About Advantage Plans Before You Enroll

250,000 Seniors Sign Up to Protect Medicare Advantage

Last spring when the Centers for Medicare & Medicaid Services (CMS), the agency that oversees the Medicare program, proposed deep new cuts to the program, more than 40,000 coalition members called, wrote, and met with congressional offices urging their representatives to speak out against the proposed cut.  As Congress debates the budget this fall, including potential changes to Medicare, seniors in Medicare Advantage will again be reaching out to members of Congress to tell their stories about the value Medicare Advantage provides to them and the impact additional cuts to the program would have on their health care.
Source: ahipcoverage.com

Medicare Advantage Fact Sheet

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

AG Swanson cites 'significant problems' with Humana Medicare Advantage plans

Some more outside-the-local-media-market thinking on Adrian Peterson’s off-field behavior. Says Susan Reimer in the Baltimore Sun: “[I]t has come to light that the unmarried Mr. Peterson may have had as many as five children by four different women. They include a 6-year-old girl and a 2-year-old boy by his current girlfriend, a 4-year-old with a dancer in a “gentleman’s club” in Dallas and a 3-month-old with a waitress in Minnesota. He is said to be providing financial support to those children. All of this transpired at the conclusion of a week when the call for the Washington [team] to abandon a nickname viewed by some as offensive reached fever pitch … so far, nobody has criticized Adrian Peterson for his careless and cavalier sexual behavior. The question we should be asking is not whether Mr. Peterson should have played football Sunday. But whether he should have worn a condom when having sex. Or whether he should be having sex with waitresses and dancers at all. While the death of the boy is a horrible tragedy, that doesn’t disqualify us from considering Mr. Peterson’s casual approach to parenthood. Why are we so indifferent to this kind of casual, serial fatherhood?” Tragedy aside, that seems like a fair question.
Source: minnpost.com

Ask The Experts: Retirement

A. According to the Office of Personnel Management, “An annuitant, survivor annuitant, or former spouse covered under the Spouse Equity provision of FEHB law may suspend their FEHB enrollment in order to enroll in a Medicare Advantage plan (Medicare Part C), Tricare, CHAMPVA, Medicaid or a similar state-sponsored program of medical assistance for the needy, or use Peace Corps health insurance coverage, but still retain the right to re-enroll in FEHB. Please visit www.medicare.gov for more information. If you cancel your FEHB coverage as an annuitant, you probably may never re-enroll.”
Source: federaltimes.com

Medicare Open Enrollment FAQ

Review your benefits and costs for 2014, compare alternatives and decide whether to keep or change plans during Medicare’s annual open enrollment period Oct. 15 through Dec. 7. This year, Medicare’s open enrollment overlaps with open enrollment for the new insurance marketplaces or exchanges created under the Affordable Care Act, also commonly referred to as Obamacare — but don’t let that throw you. Medicare’s 50 million-plus beneficiaries, most of them seniors, will steer clear of the marketplaces. Got questions? Here’s what you need to know about Medicare’s open enrollment in the marketplace era.
Source: aarp.org

Connecticut Delegation Wants Answers On Medicare Advantage Cuts

“We also need a better understanding of how network adequacy requirements will be met despite the sudden drop of what appears to be nearly one quarter of [UnitedHealth Group’s Medicare Advantage] provider network. This significant reduction in physicians raises many concerns about whether people who have chosen to participate in the [UnitedHealth Group] program will have adequate time to make informed decisions about their Medicare coverage before the open Medicare enrollment period closes on December 7.”
Source: courant.com

2014 HumanaChoice PPO Medicare Advantage Plan Details

HumanaChoice PPO® is a Medicare Advantage Preferred Provider Organization (PPO) which offers additional benefits to your original Medicare. HumanaChoice® gives you the freedom to choose which hospitals, specialists, and doctors you would like to use. No referral is required and you do not need to select a primary care physician (PCP). You can also go to providers outside of the network but you reduce your costs when you use the large list of in network providers. Some plans offer Prescription drug coverage better or equal to the requirement for a Medicare Part D Plan (depending on your region). HumanaChoice PPO® offers worldwide coverage for emergency care. And features an affordable monthly plan premium for most plans. Coverage for annual screening are also offered at no additional charge. Here are some examples of coverage of three plans offered by HumanaChoice® that show your in network benefits. You can browse the Medicare Advantage HumanaChoice PPO R-5826-005 complete plan details here.
Source: qooqe.com

Top tech officer at health insurance agency resigns

Posted by:  :  Category: Medicare

“Two separate reports, one from the General Accountability Office in June and another from the Department of Health and Human Services’ Office of Inspector General in August, identified significant challenges months ahead of the Oct. 1 deadline,” Hatch said. “Yet there is no indication that the warnings from these two independent, non-partisan watchdogs, were heeded by the government.”
Source: nbcnews.com

Video: How to Apply for CHIP and Children’s Medicaid

Medicare Enrollment Now Open

The trouble with this enrollment period is that it is more confusing than ever before. Medicare reform, the opening of Obamacare exchanges, and no small amount of political dysfunction have seeded misunderstanding and misinformation. Consequently, this environment has left the door wide open for elder abuse and Medicare scammers.
Source: kenvanway.com

Daily Kos: Texans think expanding Medicaid is a pretty good idea

It makes sense to the people of Texas, too. At least that’s what they told pollsters in a new University of Texas/Texas Tribune poll. The polling was focused on how people feel about the various components of the law. While only 33 percent of Texans polled support the law, “big majorities like many of its components.” That includes Medicaid expansion: Two-thirds of voters support giving states the option to expand their Medicaid programs for low-income, uninsured adults. That majority spanned the ideological spectrum on an issue that Texas lawmakers ducked last session, opting not to expand that coverage. More than 35 percent of them said they “strongly” support that provision, while some of the provisions of the law are even more popular.
Source: dailykos.com

Home Healthcare News: Proposed Medicare and Medicaid Cuts Expected to Hit Texas Hard

One of the advantages of the home health care benefit has been that it allows doctors and other clinicians to provide skilled care within the patient’s home, rather than in a more expensive, in-patient treatment center, which often includes a hospital room. It has been a cost saving feature that has been touted as one of the advantages and focuses of the Affordable Care Act of 2010. By moving seniors and other patients in need from hospitals to the comfort of their home, not only will the level of care increase, but it would save a significant amount of money within the health care industry.
Source: homecaredaily.com

Daily Kos: CBS News warns Obamacare Medicaid enrollment proceeding as planned

Susan from 29, suka, Cecile, Chaddiwicker, wilderness voice, rsmpdx, BennyToothpick, outragedinSF, furi kuri, TXdem, followyourbliss, Gooserock, Catte Nappe, howabout, mint julep, cwsmoke, puakev, Clive all hat no horse Rodeo, Involuntary Exile, LookingUp, sodalis, begone, dotdash2u, jan4insight, Dragon5616, Olkate, Matt Z, WisVoter, Karl Rover, owlbear1, arizonablue, shrike, mumtaznepal, Libby Shaw, TracieLynn, Nance, Theodore J Pickle, zukesgirl64, Just Bob, Sapere aude, Bonsai66, VTCC73, earicicle, skybluewater, absdoggy, MartyM, tofumagoo, NancyWH, liberte, wdrath, MKSinSA, WinSmith, jrand, aitchdee, rapala, JekyllnHyde, drdana, litho, elziax, I love OCD, doroma, blueoregon, Aaa T Tudeattack, HoundDog, nirbama, Siri, Brooke In Seattle, exNYinTX, Rhysling, viral, BlueMississippi, mookins, Shockwave, vidanto, bakeneko, steve2012, anodnhajo, Heavy Mettle, slowbutsure, duhban, buffie, CoolOnion, highacidity, Doctor Who, PLS, eru, SanFernandoValleyMom, FloridaSNMOM, mofembot, kerplunk, zerelda, beverlywoods, Rosaura, Crabby Abbey, global citizen, thomask, KenBee, buckstop, BarackStarObama, Blu Gal in DE, PeteZerria, wildweasels, SoCalSal, glitterlust, ladybug53, MichaelNY, Assaf, cocinero, enemy of the people, JDWolverton, gramofsam1, greycat, afisher, hwy70scientist, TofG, kerflooey, myboo, kaliope, sebastianguy99, Calamity Jean, oldliberal, Alice Olson, chantedor, TheDuckManCometh, wader, brentbent, sethtriggs, eztempo, oofer, howarddream, catly, peachcreek, 417els, jdsnebraska, science nerd, Jeff Y, Glen The Plumber, remembrance, doinaheckuvanutjob, Liberal Thinking, Texknight, DRo, Creosote, Jim R, J M F, MRA NY, Byron from Denver, mconvente, Steven D, hotdamn, rl en france, dreamweaver1, IndieGuy, dotsright, MarkInSanFran, anyname, spaceshot, splashy, retLT
Source: dailykos.com

Texas Health Care Providers Bracing for Medicaid Enrollment

The Texas Health and Human Services Commission projects 240,000 children currently eligible for Medicaid but not participating will enroll in 2014 and 2015, as families seek coverage to comply with the individual insurance mandate, which takes effect on Jan. 1. An additional 200,000 people could enroll in Medicaid as a result of other new requirements created by the law, according to state health officials.
Source: kaiserhealthnews.org

MedicareBob’s Blog: Dallas County Texas Medicare Supplement Quotes

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

Medicare Open Enrollment Lasts Until December 7

I also invite seniors to attend my Senior Services Fair at the Grand Generation Center, 304 East 3rd Street in Grand Island on Thursday, November 14, 2013 from 1:00 to 3:00 p.m. (CT).  At the fair, seniors and caregivers will be able to meet with and ask questions directly to SHIIP experts.  In order to find the plan which best meets their needs, attendees should bring a complete list of their prescriptions including dosing information.  I also would encourage you to get information about your health care coverage options by speaking to your insurance agent.
Source: nefrw.org

Obama Pitches Health Law in Texas

The president has been aggressively promoting the law in the face of numerous setbacks. In addition to the problem-plagued enrollment launch, insurers have been sending some of their customers termination notices because their policies don’t meet federal requirements. The notices have put Obama and White House officials on the defensive as they attempt to explain Obama’s early vow that under the new law, people who like their existing coverage would be allowed to keep it.
Source: realclearpolitics.com

Austin Medicare Workshop Helps With Enrollment

The program was to be entirely self-financed with the premiums participants paid. Obama officials said that presented them with a problem: If they designed a benefits package generous enough to meet the law’s requirements, they would have had to set premiums so high that few healthy people would enroll. And without a large share of healthy people in the pool, the CLASS plan would have become even more expensive, forcing the government to raise premiums even higher, to the point of the program’s collapse.
Source: kut.org

Texas’ Poor: Left Out of the Equation

We certainly want to maximize the enrollment in the insurance marketplaces and help current Medicaid eligible (but not enrolled) participants receive Medicaid benefits for health services. However, some of the poorest Texans who need medical care will receive no help at all. The original intent of the 2010 Affordable Care Act was designed to provide Medicaid coverage for individuals and families making less than 100 percent of the federal poverty level. Since those Texas citizens were Medicaid eligible, they would not qualify for the federal tax subsidies on the insurance marketplace. Generally, children, pregnant women, and disabled adults are the only eligible participants in the current Medicaid program. Other adults do not typically qualify for coverage. The Affordable Care Act would expand those covered by Medicaid.
Source: dmagazine.com

MRA Alerts and Updates: Kaiser Permanente’s Medicare Plans Are No. 1 Again

Posted by:  :  Category: Medicare

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“Our high ratings recognize Kaiser Permanente’s superb physicians and care providers,” said Amy Compton-Phillips, MD, associate executive director for Quality at The Permanente Federation, the national umbrella organization of more than 17,000 physicians who provide care to Kaiser Permanente’s more than 9.1 million members. “This recognition, however, is not merely about rankings. These scores demonstrate that at Kaiser Permanente improving the health of our members is our calling. We continuously strive to improve and provide better care to the more than 9.1 million Kaiser Permanente members we serve.”
Source: blogspot.com

Video: Kaiser Permanente Medicare Navigation Video

November Business Briefing

As Chief Executive Officer, Mirzabegian is responsible for operational effectiveness, strategic planning, business development, medical staff relations, financial management, and facility expansion plans. He currently oversees 2,500 employees, 450 physicians, and 400 volunteers, while successfully managing a $330 million annual operating budget. Mirzabegian was instrumental in the recent financial turnaround of AV Hospital and reduced the $18 million loss that had accumulated before he took over, to a $1.96 million loss at the end of fiscal year 2008. In fiscal year 2009, the hospital finished with almost $9 million profit.  The positive trend continued with $24.6 million profit at the end of fiscal year 2010.
Source: avbot.org

Medicare comes to Kaiser Permanente

Please do not include any medical, personal or confidential information in your comment. Conversation is strongly encouraged; however, Kaiser Permanente reserves the right to moderate comments on this blog as necessary to prevent medical, personal and confidential information from being posted on this site. In addition, Kaiser Permanente will remove all spam, personal attacks, profanity, and off topic commentary. Finally, we reserve the right to change the posting guidelines at any time, at our sole discretion.
Source: kaiserpermanentehistory.org

Kaiser Permanente Colorado Rated Number One in Nation for Prevention and Health Promotion : North Denver Tribune

Kaiser Permanente’s integrated approach to care delivery, innovative Web-based tools and robust system of electronic medical records enables better care coordination for physicians, improved clinical outcomes for patients and a higher quality of care for all. Just last month, Kaiser Permanente was recognized by the National Committee for Quality Assurance as the highest-rated commercial health insurance plan in Colorado and No. 13 in the nation. New for this year, Kaiser Permanente also received the “Best Value” recognition in Colorado for Diabetes Care factors for both Private plans (commercial) and Medicare. In addition, “NCQA’s Health Insurance Plan Rankings 2013-2014″ lists Kaiser Permanente as the top Medicare plan in Colorado and No. 4 in the nation. This is the fifth year in a row Kaiser Permanente Colorado has been among the top five Medicare plans in the U.S.*
Source: northdenvertribune.com

Kaiser Permanente Colorado rated No. 1 in nation for prevention and health promotion

Kaiser Permanente’s integrated approach to care delivery, innovative Web-based tools and robust system of electronic medical records enables better care coordination for physicians, improved clinical outcomes for patients and a higher quality of care for all. Just last month, Kaiser Permanente was recognized by the National Committee for Quality Assurance as the highest-rated commercial health insurance plan in Colorado and No. 13 in the nation. New for this year, Kaiser Permanente also received the “Best Value” recognition in Colorado for Diabetes Care factors for both Private plans (commercial) and Medicare. In addition, “NCQA’s Health Insurance Plan Rankings 2013-2014″ lists Kaiser Permanente as the top Medicare plan in Colorado and No. 4 in the nation. This is the fifth year in a row Kaiser Permanente Colorado has been among the top five Medicare plans in the U.S.*
Source: denverpost.com

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

Health plan benefits for transgender individuals

Some of our health plans were previously permitted to exclude coverage for transgender surgery. We are no longer applying that exclusion in our DMHC-regulated health plans. If you’re enrolled in one of those health plans, this means that you now have transgender surgery benefits even if your current Evidence of Coverage document lists transgender surgery as an exclusion. Also, for our DMHC-regulated health plans that previously covered transgender surgery and included a lifetime dollar limit on the surgery benefits, as of April 9, 2013, we are no longer applying those dollar limits.
Source: learningtrans.org

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November 09, 2013

6 Reasons to Choose a New Medicare Part D Plan for 2014

Posted by:  :  Category: Medicare

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By Emily Brandon Retirees have the option to switch Medicare Part D prescription drug plans between now and Dec. 7. Most seniors who stick with their current plan in 2014 can expect to pay higher premiums and other out-of-pocket costs than they did in 2013. Only 13 percent of participants picked a new prescription drug plan voluntarily during this annual enrollment period between 2006 and 2010, according to a Kaiser Family Foundation analysis of Centers for Medicare and Medicaid Services data, but many of these retirees were able to significantly decrease their premium costs. Here’s why you should consider picking a new Medicare Part D Plan for 2014. Medication changes. Your medication needs could change throughout your retirement. If you are now using new medications or think you might in the coming year, you should consider evaluating which plan will cover you best going forward. Plans can and do change which medications they will cover each year and how much participants are charged for each medication. Just because your medications were covered with a given copay in 2013 doesn’t mean they will continue to be covered at the same level or at all in 2014. “Because plans can change pretty much every feature of the benefit design, including the list of drugs that they cover, people might want to switch out of a plan if, for example, the plan stops covering a drug that they are taking,” says Juliette Cubanski, a policy analyst at the Kaiser Family Foundation. “It might cost them a lot of money if they had to pay for it out of pocket outside of Part D.” Find lower premiums. The average premium is expected to increase by 5 percent from $38.14 in 2013 to $39.90 in 2014 if retirees stay in their current Part D plan, according to a recent Kaiser Family Foundation analysis of 2014 plan offerings. Many beneficiaries (44 percent) will pay between $1 and $10 more if they remain in their current plan in 2014, and 14 percent will experience a monthly increase of more than $10. Premiums will increase by more than 50 percent next year in United HealthCare’s AARP Medicare Rx Saver Plus and First Health Value Plus. Retirees enrolled in the First Health Essentials and the Humana Preferred Rx Plan will also face double-digit premium increases unless they switch plans. Avoiding high premiums is the most common reason retirees select new prescription drug plans. Nearly half (46 percent) of enrollees who switched plans paid at least 5 percent less in premium costs the following year, compared to 8 percent of those who did not switch plans, KFF found. More than a quarter (28 percent) of beneficiaries facing a monthly premium increase of $20 or more switched prescription drug plans during the annual enrollment period, versus 7 percent of those facing a more modest premium increase of up to $10 or no change in their premium. “Some plans do increase their premiums quite considerably from one year to the next,” Cubanski says. “When faced with that kind of sticker shock, that can motive people to go and look at what other plans are available that the person might think is more affordable.” Seek lower copays and other cost sharing. Besides premiums, Medicare Part D beneficiaries face a variety of other out-of-pocket expenses, including deductibles, copayments, coinsurance and costs in the coverage gap. When both premiums and cost sharing for drugs are considered, 44 percent of retirees who switched plans had overall costs that were at least 5 percent lower than the previous year. Only 28 percent of seniors who didn’t switch plans saw their out-of-pocket costs decline by at least 5 percent. “If the particular drugs you use are on more expensive tiers or not on the formulary, that can lead to higher out-of-pocket costs,” says Jack Hoadley, a health policy analyst at Georgetown University. “Go on the online plan finder on Medicare.gov and use your current mix of drugs to calculate your total out-of-pocket costs and not just the premiums.” Reduce your deductible. Just over half of prescription drug plans will charge a deductible in 2014, and most charge the maximum possible amount of $310 before any drug costs will be covered. The share of plans with a smaller deductible has declined from 24 percent in 2010 to just 4 percent in 2014. However, 47 percent of plans will charge no deductible in 2014, meaning retirees will get coverage on their first prescription, often in exchange for a higher monthly premium.
Source: dailyfinance.com

Video: How is the Medicare Part B Deductible Applied?

Look Out for Changes to Premiums and Deductibles for Medicare Part D Plans

Keep in mind that there may be other important changes to a plan, such as those to its formulary or cost sharing structure. For example, the deductible for Blue MedicareRx Value plan double in 2014, and it is also losing about 700 drugs from its formulary. On the other hand, this plan and others might see increases in deductibles or premiums correspond with lower co-pays or better donut hole coverage, which could save you a lot of money.
Source: pharmacycheckerblog.com

Medicare Beneficiaries to Save with Historically Low Premiums and Deductibles

CMS also announced a decrease in the Medicare Part A premium, which pays for inpatient hospital, skilled nursing facility, and some home health care services. The premium will drop $15 in 2014 to $426, and is paid by enrollees age 65 and over who are not otherwise eligible for benefits under Medicare Part A and by certain disabled individuals who have exhausted other entitlement. Although about 99 percent of Medicare beneficiaries do not pay a premium for Part A since they have at least 40 quarters of Medicare-covered employment, enrollees age 65 and over and certain persons with disabilities who have fewer than 30 quarters of coverage pay a monthly premium in order to receive coverage under Part A. Beneficiaries who have between 30 and 39 quarters of coverage may buy into Part A at a reduced monthly premium rate which is $9 less than 2013, at $234 for 2014.
Source: wolterskluwerlb.com

2014 Medicare Part B Premiums and Deductibles Unchanged

“We continue to work hard to keep Medicare beneficiaries’ costs low by rewarding providers for producing better value for their patients and fighting fraud and abuse.  As a result, the Medicare Part B premium will not increase for 2014, which is good news for Medicare beneficiaries and for American taxpayers,” said CMS Administrator Marilyn Tavenner.   
Source: iquote.com

Taller Deductible Medicare Dietary Supplement Plan F Duquel Buy It!

Utilizing the ability so that you can see the methodical doctor of that this option is critical. Most Medicare health insurance supplemental plans accept you to make a the physician as well as hospital you favor, but verify that program prior to help you acquiring, just in about situation you ought to find questions. The Federal administration owns and has the Medicare choose. The dietary supplement plans are consistent from the Cardiovascular for Medicare Applications and they unquestionably are bought from corporate insurance providers. As a come of the standardizations, all Medigap dental policies provide the genuine same rewards. This makes is often significantly less challenging and difficult when comparing tips. Nonetheless, specific rates charged by means of the providers might fluctuate considerably.
Source: paginasweb390.com

Will The New 3.8% Medicare Surtax Reinvigorate Non

The non-deductible IRA has long been a financial planning tool, albeit one that has become far less popular in recent years, given the tax preferences for both qualified dividends and long-term capital gains. However, with the new 3.8% Medicare surtax on net investment income that took effect in 2013, a new incentive has emerged: even with ordinary income treatment, the non-deductible IRA provides a way to permanently avoid the surtax, which would otherwise apply to interest, dividends, and capital gains, as well as income from other tax-deferred vehicles like deferred annuities. The strategy is especially appealing to those who are in the peak income years of their career, where a Roth conversion is unappealing due to the high current tax bracket (and other IRAs that will be aggregated), tax deferral is valuable, and a permanent avoidance of the 3.8% Medicare tax provides yet another added value… especially if the account will hold fixed income investments that were going to be taxed at ordinary income rates anyway. Fortunately, the strategy is available regardless of how high income rises (and in fact, is best at high income levels), and while the value of the strategy is limited by the IRA contribution limit of $5,500 in 2013, several years of compounded efforts can still potentially produce a significant tax savings in the future!
Source: kitces.com

2014 Medicare Deductibles and Premiums – MedicareWire

Mr. Bynon is a Medicare benefits expert, senior rights activist, proud U.S. Navy veteran and coffee achiever extraordinaire. He blogs regularly on MedicareWire.com (Medicare news) and AllMedicare.com (senior health). Connect with him on Twitter @MedicareWire.
Source: medicarewire.com

What Are Medicare Part B Premiums and Deductibles?

Medicare Part B helps cover medically necessary services, such as doctor’s services and outpatient care. It also helps cover some preventive services as well, such as a one-time “welcome to Medicare” physical exam, flu and pneumococcal shots, cardiovascular screenings, cancer screenings, diabetes screenings, and much more. However, before Medicare will pay for its share of covered benefits, beneficiaries must first pay certain out-of-pocket costs, and beneficiaries may also be responsible for some cost sharing of these services and supplies. This post will focus on two types of Medicare Part B out-of-pocket costs: premiums and deductibles.
Source: ehealthmedicare.com

2014 Medicare Part D Costs, Premiums, Deductibles, and Coverage Gap

The Medicare Part D program was created in 2006 to provide eligible beneficiaries with access to prescription drug coverage. In order to get this coverage, beneficiaries could either enroll in a stand-alone Medicare Prescription Drug Plan (PDP) or in a Medicare Advantage Prescription Drug (MAPD) plan. Both types of Part D plans come with out-of-pocket costs, including premiums, deductibles, and copayments, and these costs vary each year. During the Medicare Annual Election Period, it is recommended that beneficiaries compare their 2014 Part D plan options to make sure that they are enrolled in the right coverage for their needs. However, before they start reevaluating their coverage, it is important to first understand how much 2014 Medicare Part D costs will be changing, and how this will impact how much beneficiaries pay for coverage in the coming year.
Source: planprescriber.com

CMS Releases Medicare Deductible, Coinsurance Amounts for 2014 : Health Industry Washington Watch

CMS published notices on October 30, 2013 announcing the 2014 Medicare inpatient hospital deductible and hospital and extended care services coinsurance amounts. The 2014 Part A deductible for hospital inpatient admissions for the first 60 days of care will be $1,216, followed by $304 per day for days 61-90 and $608 per day for stays beyond the 90th day in a benefit period. The daily skilled nursing facility coinsurance for days 21 through 100 in a benefit period will be $152 in 2014.  CMS also released the 2014 Medicare Part A premium amounts for the uninsured aged and disabled individuals who have exhausted other entitlement.  Finally, CMS has announced that for 2014, Part B premium rates and the Part B deductible are the same as the respective amounts for 2013. Specifically, the 2014 premium varies by income from $104.90 to $335.70 per month, and the Part B deductible is $147.00 for all Part B beneficiaries.  
Source: healthindustrywashingtonwatch.com

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November 09, 2013

Understanding Medicare Part A, Part B, Part C and Part D

Posted by:  :  Category: Medicare

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But as complicated as all that sounds, there’s a single key choice at the core of all your decision-making: Will you go with the Original Medicare plan, which is run by the federal government and consists of Parts A and B, or a Medicare Advantage plan (also called Part C) that is offered by a private insurer and approved by Medicare? Medicare Part A — Your Hospital Coverage When you apply to Medicare, you are automatically enrolled in the Part A plan. Part A is your hospital insurance plan. It covers nursing care and hospital stays, although not doctors’ fees. Part A also covers some home health services, skilled nursing care after a hospital stay and hospice care. You likely won’t have to pay a monthly premium for Medicare Part A, thanks in part to all the payroll taxes you paid while you were employed. You must, however, pay a yearly deductible before Medicare will cover any hospitalization costs. For 2011, the Part A deductible is $1,132.
Source: aarp.org

Video: Medicare Part A, B, C and D Explained

Worst Medicare Advice You’ll Ever Get from an Insurance Agent

Part C Medicare Advantage health plans will NEVER make paying for any kind of health care service "more expensive" than paying for that same service simply using Original Medicare Parts A and B. Part C Medicare Advantage health plans are not right for every senior (which is why the "Medicare and You, 2013" booklet shows options on page 15–see illustration above) but Part C plans are always better for seniors than Original Medicare. Almost no senior citizen in the United States depends on Original Medicare. Original Medicare charges an unlimited number of $1165 deductibles per year for admitted-inpatient hospital visits and 20% for all other services (even more if the doctor involved does not "accept assignment"). Original Medicare has lifetime limits that can potentially bankrupt seniors. Unlike Original Medicare, all Part C Medicare Advantage health plans have annual out of pocket (OOP) limits and typically nominal $20-$40 copays for doctor visits (but every Part C plan is different so you need to do the math).
Source: typepad.com

Medicare Spending and Financing Fact Sheet

The Part A Trust Fund is projected to be depleted in 2024—eight years longer than in the absence of the health reform law—at which point Medicare will not have sufficient funds to pay full benefits, even though revenue flows into the Trust Fund each year.  Part A Trust Fund solvency is affected by growth in the economy, which directly affects revenue from payroll tax contributions, and by demographic trends:  an increasing number of beneficiaries, especially between 2010 and 2030 when the baby boom generation reaches Medicare eligibility age, and a declining ratio of workers per beneficiary making payroll contributions.  Part B and Part D do not have similar financing challenges, because both were structured to be funded by beneficiary premiums and general revenues, set annually to match expected outlays.  However, future increases in spending under Part B and Part D will require increases in general revenue funding and higher premiums paid by beneficiaries.
Source: kff.org

The A, B, C’s, and D’s! of Medicare

Helping You Understand Your Medicare Benefits and Other Plans Many people expect to kick back and relax from budgeting during retirement years. With skyrocketing healthcare costs, it’s important that older Americans understand their Medicare benefits, the role of additional insurance, and the coordination of any other health insurance plans. Use the resources available from your doctor to understand how to take advantage of your Medicare benefits and keep your out-of-pocket expenses to a minimum. The knowledgeable team at AlphaMed is also happy to guide you in the right direction. If you have a parent that is nearing 65 years of age, make time to talk about Medicare insurance and other health concerns. It could be a life changing discussion.
Source: tnhealthandwellness.com

The ABCD’s of Medicare

Part D Tip: Each year since 2010, the donut hole amount has been reduced by 10%. It will continue to go down 10% each year until it disappears in 2020. Then, you will only pay your normal 25% coinsurance after you reach your deductible. Coinsurance means Medicare pays 75%, you pay 25%. Since it’s 2012, and you still have a donut hole, the government has negotiated with brand name drug manufacturers to offer 50% off some prescriptions. Check with your local pharmacy to see if the discount applies to your medications.
Source: hoopayz.com

Why the Politics of Obamacare Implementation Could Be Very Different From Medicare Part D

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Source: firedoglake.com

What’s The Difference Between Medicare And Medicaid?

Unlike Medicare, which is available to everyone, Medicaid has strict eligibility requirements. The rules vary by state (beyond the basics set forth in the federal guidelines), but the program is designed to help the poor, so many states require Medicaid recipients to have no more than a few thousand dollars in liquid assets to participate in the program. There are also income restrictions. For a state-by-state breakdown of eligibility requirements see these websites Benefits.gov and BenefitsCheckUp.org.
Source: investopedia.com

Compare Medicare Supplement Insurance Benefit Plans A, B, C, D, E, F, G, H, I, and J

Original Medicare pays for the first 20 days of skilled nursing care and a portion of days 21-100.  Plans C-F cover the remaining portion not covered by Medicare during days 21-100 ($133.50 per day in 2009).  It is important to note that neither Medicare nor supplemental insurance  pays for care beyond day 100.  Consequently, many seniors purchase a long term care insurance policy.
Source: ohioinsureplan.com

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November 09, 2013

It’s Your Benefit: Medicare and Diabetes Education

Posted by:  :  Category: Medicare

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These are two separate benefits: DSMT(E) covers the topic areas outlined in the National Standards of DSME.  The topics cover such things as checking your blood glucose, taking your medications and finding ways to healthfully cope with the stress of having a chronic disease. It also includes a section on nutrition basics for diabetes.   Medicare allows 10 hours of education as a one-time benefit in the first year you use the benefit.  The benefit starts from the date you start the education, so if you start in Novem ber you have until the next November to finish the 10 hours.  Nine of these ten hours must be in a group situation unless you have a condition or disability—for example, hearing loss—that prevents you from attending a class. The entity providing DSMT/E must be a recognized provider with Medicare (they must have completed the requirements and be accepted by Medicare).
Source: joslin.org

Video: 2010 Benefits – Peoples Health Medicare Advantage Plans

Is Medicare a Ponzi Scheme?

The American Magazine

Moreover, as I’ve argued earlier, given the 44 cent penalty each additional federal tax dollar imposes on the economy, it makes no particular sense to be using tax dollars to pay for Warren Buffett’s Medicare bills in the first place. By the time he dies, he and his now-deceased wife jointly will have had in excess of $350,000 in expected lifetime Medicare benefits bankrolled by taxpayers. Even though he assuredly will have self-financed every penny, the economy will have lost $150,000 in output by running those dollars through the U.S. Treasury instead of letting Mr. Buffett pay for his own retiree medical expenses. There may be some unhinged Occupy Wall Street protesters who think that’s a smart idea. I do not. Serious Medicare reform is going to require a radical rethinking of the role of government in financing retiree health expenses.
Source: american.com

Miami Leads Nation In Medicare Drug Spending

Elderly Miami residents on Medicare filled more prescriptions for drugs in 2010 than seniors elsewhere in the country, and they were more than twice as likely as residents in Rochester, Minn., to fill at least one prescription for medications that have been identified as high-risk for patients over age 65, such as skeletal muscle relaxants, long-acting benzodiazepines, and highly sedating antihistamines.
Source: kaiserhealthnews.org

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