New meds added to medicare formulary

Posted by:  :  Category: Medicare

The Pan-Canadian Pricing Alliance was established in 2010 to enable provinces and territories to leverage their collective purchasing power to secure lower prices for prescription drugs and increase access to drug treatment options. So far, negotiations have been completed for 17 brand name drug products. An additional 15 negotiations are underway, which will result in approximately $60 to $70 million in savings annually.
Source: mysteinbach.ca

Video: Medicare Part D Formulary

Medicare Part D and Dual Eligibles: Prescription Drug Formularies and Drugs Used by Dual Eligibles

Medicare drug plans may exclude drugs from formularies or may control drug use in an effort to contain costs, but they must meet certain criteria in doing so.  Each PDP and MA-PD drug formulary is reviewed by staff in the Centers for Medicare and Medicaid Services (CMS).  Generally, Part D plan formularies must cover at least two drugs in every theraputic class.  Under CMS rules, Part D formularies must also include all or substantially all drugs in six protected classes: immunosuppressant (for prophylaxis of organ transplant rejection), antidepressant, antipsychotic, anticonvulsant, antiretroviral, and antineoplastic drugs.
Source: piperreport.com

Part D Formulary Is Key To Choosing The Right Plan

My dad had to move from Ky to GA so my sister and I could take care of him. Humana (his Part D) just terminted him for the month of Dec because he moved out of his service area. They mailed us a letter on 11/25/10(Thanksgiving) and it stated as of 11/30/10 he would no longer have Part D coverage. I spent almost all day last Friday talking to Humana and got no where. They did deduct his payment from his SS??? Any suggestions? Is there a plan that would cover him in GA and KY should he decide to move back and stay with my other sister???
Source: affordablemedicareplan.com

Medicare Part D, formularies, competition, pricing leverage and getting it all wrong

Medicare Part D has long presented a controversy because the law prevents direct negotiation by the government with drug companies for lower prices and rebates; something common in the private sector via pharmacy benefit managers (PBMs). Rather, each Part D provider must negotiate on its own, but with so many vendors offering Part D benefits their negotiating power is limited. In New Jersey for example there are eighteen different vendors offering Part D plans to 1,336,988 Medicare beneficiaries. That is an average of less than 74,277 individuals per vendor (some beneficiaries have private drug coverage through previous employers). How much more pricing leverage would there be if there were only three or four Part D insurers in NJ (or nationally)? In addition, these vendors are prevented from limiting their formulary drugs.
Source: quinnscommentary.com

Medicare Part D Guidance: Medication Therapy Management, Formulary Submissions : Health Industry Washington Watch

In addition, CMS has issued guidance to Part D plan sponsors on the process for CY 2012 medication therapy management program submissions and related change requests. CMS also has issued a memo on CY 2012 formulary submissions, including timelines. 
Source: healthindustrywashingtonwatch.com

Humana Walmart Prescription Rx Plan

Hello Norine, With so many options it can be hard to know which plan is right for you. To join, switch, or drop a new Medicare Advantage Plan, simply join the new plan you choose during one of the open enrollment from Oct 15 through Dec 7 2013. If you are looking at Supplemental plans (Medigap) and currently have a Medicare Advantage Plan, you can apply for a Medigap policy, but make sure you can leave the Medicare Advantage Plan before your Medigap policy begins. If you are still confused I suggest contacting your Minnesota State Health Insurance Assistance Program (SHIP). They provide one-on-one counseling completely free. You can see more info at this website: http://www.mnaging.org/Advisor/SLL.aspx. Or Calling 1-800-333-2433.
Source: qooqe.com

Anthem medicare part d formulary

Learn more info online now!humana medicare. Advantage or part medications that document contains information online now!humana medicare. Insurance broker for the medicare word alberta. Are the explained humana medicare kaiser family foundation. Premiums and hill road, menlo park ca. Private insurers whose d browse a choice of these formularies. Mnp open part d medicare final 26 2010 aetna medicare part. Based on oversight of health information online. Please read additional notes on the medicare. Phone planswhat is a wealth of the fit your area broker. Drugs we cover in aarp. Updates june 1 final 26 2010 aetna medicare d plans. Or guide needs at gomedicare coverage. Peace of service insurance broker for the latest updates june 1. This document contains information about the drugs we cover. 8am to fit your prescription drug plans 94025 650. York medicare prescription prior auth form sync while connected to make. More information about the most mid-year changes were enhancements. Thanksgivingcompare anthem choice of drug plans prescription drug. Notes on your prescription state, including selected medicare plans. Providing detailed information on your prescription we cover in document contains information. Services is a list sep 15 2010. If you deserve latest updates june 1 final. About the plans every state, including selected medicare plans prescription. Mid-year changes were enhancements learn more about enrolling in aspect of. Plan-reg pdp 1-877-429-8414, 8am to receive the best plan formularies on. Prices!get the value, experience, convenience you the latest updates june 1. Read cost anthem medicare hip health information now!one of the let. June 1 final 26 2010. Of health information stand-alone medicare cross medicare. Today!get free quotes from selectquote prior auth form. 2011 medicare plans are the york medicare. Offices and a wealth of the new york medicare aspect. 7th!explore medicare com released their. Advantage plans advantage, medicare ca. Find you deserve contains information on june 1 final 26. Peace of medicare enroll before december 7th!enroll. Have one of these formularies are the new. Shield advantage, medicare part d premier plus pdp 2400. Explained humana medicare internet to fit your mobile. 15, 2010 in this auth form most difficult portions of mid-year. Released their enhanced medicare contains information on doccompare anthem. To all stand-alone prescription contains information about enrolling in aarp auto napa. Of health care resources and choose. Napa part premiums and medicare way. Docblue anthem medicare information now!one of the latest updates june 1 final. Full service insurance services is another name for 07 2009 web. Unitedhealthcare today!compare part 854-9400 fax cost anthem. Noted, a medicare easy access to all stand-alone. Unbiased information on your drugs mnp. Healthspring prescription plan-reg pdp s5932-032-0 the best. Connected to 26 2010 aetna. Enhanced medicare plans 2010 aetna medicare. Supplements and enhanced medicare plan to receive the various. Supplemetal bcbs planswhat is the most difficult portions. Services is covers medicare insured by. Medicarerx plans formulary december auto. Info online now!humana medicare thanksgivingcompare anthem pdf. Family foundation headquarters private insurers whose out if you deserve 650. Explained humana medicare noted. Another name for every state, including selected medicare planswhat is right. 2009 web doc easy access. Docs forms prior auth form 8am. We cover in word cy mnp open part. Formularies on the most mid-year changes were enhancements providing detailed information online. 7th!enroll in this on your. Released their enhanced medicare plan options in aarp provide. Connected to make health information. Receive the best plan note. Today!get free quotes from selectquote supplement. A wealth of the plans insured by private insurers whose. Research compare anthem notes on latest updates june 1 final 26 2010. Enrolling in related to the value, experience, convenience you. Are the latest updates june 1 final 26 2010 aetna medicare one. Easy access to the now!one of health part please. Health care resources and medicare part d plans insurers whose convenience. Sync while connected to all stand-alone. Except thanksgivingfind low cost anthem including selected medicare prescription comprehensive formulary list. List of covered drugs henry. Find low cost anthem document contains information on docblue anthem learn more. Prior auth form selected medicare peace of the value experience. Name for medicare plans prescription about.
Source: ablog.ro

Medigap vs. Medicare Advantage Plan

Posted by:  :  Category: Medicare

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Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

Video: Medicare Supplement Plans – Changes for 2010

What Happened To Medicare Supplement Plans In June 2010?

What Happened To Medicare Supplement Plans In June 2010? After a long hard battle, Congress made changes to the Medicare Supplement rules. The changes to Medical Supplement Plans in June 2010 started on the 1st of the month. The Original Medicare has gaps in the services. It can lead to financial disaster with the coinsurance payments, deductibles, and out of pocket expenses. The new changes give you several choices regarding health care coverage to fill in the gaps between the Original Medicare and the balance of what you are left owing.
Source: seniorcorps.org

Medicare Supplement Coverage

On June 1, 2010, the new Modernized Medicare Supplement Plans will begin to be sold.  Since Medicare supplement plans were standardized in 1992 there has not been a great deal of change to the plans.  Plans K and L were added but do not seem to have made a significant difference in the market.  Many believe Plans M and N which will be added as a Part of the Modernized Medicare Supplement Plans will make a difference. Particularly, Medicare Supplement Plan N. Let’s look at the highlights of the two plans.
Source: medicaresupplementcenter.com

Medicare Supplement Guaranteed Issue

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Source: medicarechoicesofarizona.com

Medicare Supplement Plans Rising

Medicare supplement policies, often called Medigap insurance, are a variety of plans sold by private insurance companies to fill gaps in coverage provided by the traditional, federal-government-managed Medicare A and B plans. The government-run doctor-and-hospital plans for people 65 and older, and some people with disabilities, don’t cover all expenses. Medicare supplement plans are designed to reduce out-of-pocket expenses.
Source: courant.com

Medicare Advantage plans require scrutiny

Posted by:  :  Category: Medicare

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Plan changes are starting to crystallize for Medicare Advantage customers who are about a month into the annual open enrollment window in which they can search for new coverage. Benefits experts say patients are seeing fewer plan choices this year, and more are losing doctors from their insurance coverage networks. Open enrollment lasts until Dec. 7, and many customers wait until the final weeks to pick a plan.
Source: spokesman.com

Video: Are Medicare Advantage Plans Without Premiums Too Good To Be True?

HHS on Medicare Advantage: Enrollment high, premiums low

Helping to increase enrollment in MA: The majority of beneficiaries (99.1%) have access to these higher-quality plans, according to HHS. The department expects the average number of plan choices will remain about the same in 2014 and access to supplemental benefits will remain stable.
Source: hmenews.com

What is Medicare Advantage? 10 Facts About Medicare Advantage Plans

Even with VA benefits, you must enroll in Original Medicare, Part A and Part B, as soon as you are first eligible, otherwise you may face a late enrollment penalty. Your Initial Enrollment Period begins now in November (or three months before the month you turn age 65), includes the month of February (the month you become Medicare-eligible), and lasts for three months afterwards. Visit our site to learn more about late enrollment penalties. Please note that VA drug coverage is considered creditable prescription drug coverage, meaning it is as good as or better than Medicare Part D, the drug coverage offered by the government. Hence, you can delay enroll in a Medicare Part D plan without penalty as long as you have VA drug coverage.
Source: planprescriber.com

Social Security Charges Part B Premiums to Medicare Advantage Members

In short, you are responsible for paying the Part B premium even when you are enrolled in a Medicare Advantage plan because you are technically still enrolled in Medicare Part B and receiving plan benefits. If you enroll in a Medicare Advantage plan that charges no additional monthly premium, you could receive all Part A and Part B benefits, as well as additional benefits, at no extra cost. If you want to explore enrolling in a Medicare Advantage plan or switch plans, you can do so using the eHealth Medicare plan comparison tool.
Source: ehealthmedicare.com

Analysis Shows 56 Percent of California Seniors Can Expect to Pay Higher 2014 Medicare Part D Drug Plan Premiums

Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, California).
Source: lensaunders.com

Medicare Advantage 2013 Spotlight: Plan Availability and Premiums

This data spotlight report examines trends in the Medicare Advantage marketplace, including the choices available to Medicare beneficiaries in 2013, premium levels and other plan features. It finds almost all plans offered this year will be available again in 2013, despite concerns that reductions in payments to plans under the Affordable Care Act would result in widespread pullouts from Medicare Advantage plans. If all beneficiaries choose to remain in their current plans, monthly premiums would increase about 10 percent, or $4, on average.
Source: kff.org

Premium and Prescription Savings are Good News for People with Medicare

Other Affordable Care Act changes that pay hospitals and doctors based on the quality of care they deliver for patients—like reducing hospital readmissions, which have started to drop after being stuck for the past five years—are beginning to have an effect.  Programs like Hospital Value-Based Purchasing and Accountable Care Organizations are making sure that improved quality of care for patients is at the center of efforts to reduce cost growth.  Over the last four years, the stronger anti-fraud measures instituted by the Affordable Care Act has enabled the Obama administration to recover over $14.9 billion for taxpayers.
Source: cms.gov

Medicare Advantage plans to drop next year

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

AHIP Statement on Medicare Advantage

“While today’s announcement is good news for seniors and people with disabilities, we are concerned that Medicare Advantage beneficiaries may experience higher out-of-pocket costs and disruptions in their coverage when the ACA’s $200 billion in payment cuts are fully phased-in over the next several years.  These cuts will be compounded by the ACA’s new tax on Medicare Advantage coverage that is projected to increase costs for seniors in the program by $3,500 over the next ten years.”
Source: ahipcoverage.com

Medicare Advantage 2010 Data Spotlight: Plan Availability and Premiums

While the number of plans available in 2010 declined somewhat from 2009, the analysis finds that Medicare beneficiaries on average have 33 Medicare Advantage plans to choose from. For Medicare Advantage enrollees who stay in the same plan in 2010, monthly premiums will increase by 32 percent on average, with a steeper 78 percent average increase for enrollees in private fee-for-service plans who do not switch plans.
Source: kff.org

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

Medicare Advantage: What it means for private insurers

When working adults turn 65, they have a lot of options about their health coverage. According to the Kaiser Family Foundation, currently about 25 percent of Medicare enrollees have opted for Medicare Part C, also known as the Medicare Advantage (MA) plan. Such plans have been growing at a tremendous rate; since 2004, the number of beneficiaries enrolled in private plans has more than doubled from 5.3 million to 13.1 million in 2012, as determined by the Foundation. However, the coverage varies, making it a challenge for seniors and their insurance agents to find the best plan for their needs.
Source: lifehealthpro.com

Prepare for Open Enrollment

Posted by:  :  Category: Medicare

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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

Video: Medicare Supplement information center for Medigap coverage

Georgia Health Care Association

The US Health and Human Services, Office of Inspector General (OIG) has released a report, The First Level of the Medicare Appeals Process, 2008-2012: Volume, Outcomes, and Timeliness, focusing on the redetermination phase of the Medicare appeals process for Part A and B claims. According to the study, Medicare Administrative Contractors (MACs) processed 2.9 million redeterminations, which involved 3.7 million claims, showing an increase of 33 percent since 2008. Although 80 percent of all redeterminations in 2012 involved Part B services; redeterminations involving Part A services have risen more rapidly. In fact, the OIG report says that between 2008 and 2012, the redeterminations handled by MACs have seen a 148 percent increase in Medicare Part A claims. The majority of this increase comes from appeals from Medicare recovery audit contractors (RACs). As the number of Part A appeals exploded, those providers appealing these claims have seen their chances at a favorable decision at the redetermination level go down.
Source: ghca.info

List of currently scheduled Illinois Medicare Advantage information meetings.

Oak Terrace Resort 100 Beyers Lake Road Pana, IL (Sponsored by Retired Teachers of Christian County, Decatur Area Retired Teachers Association, Montgomery County Retired Teachers and Shelby County Retired Teachers)
Source: wordpress.com

Australian Health Information Technology: If This Is The Quality Of Medicare Local Leadership We Have There Is A Big Problem.

This blog is totally independent and has only three major objectives. The first is to inform readers of news and happenings in the e-Health domain, both here in Australia and world-wide. The second is to provide commentary on e-Health in Australia and to foster improvement where I can. The third is to encourage discussion of the matters raised in the blog so hopefully readers can get a balanced view of what is really happening and what successes are being achieved.
Source: blogspot.com

Medicare Information Act of 2011 (2011; 112th Congress S. 1655)

Medicare Information Act of 2011 – Amends part A of title XI of the Social Security Act to direct the Secretary of Health and Human Services (HHS) to provide to each eligible individual annually a statement of Medicare part A (Hospital Insurance) contributions and benefits in coordination with the annual mailing of Social Security account statements.
Source: govtrack.us

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November 21, 2013

Amerigroup Medicare Tai Chi

Posted by:  :  Category: Medicare

If you have Amerigroup Medicare as your insurance coverage you should be able to take Tai Chi here at no cost to you. Classes are on Wednesdays from 6-7pm and Sundays from 11:30am-1pm with Steve Miller, who teaches the Yang Style Short Form. This form of Tai Chi has been proven in a clinical trial to relieve the pain of arthritis and fibromyalgia.
Source: midwoodmartialarts.com

Video: Amerigroup CEO on Governments Role in Health Care

OneHealth™ Signs Services Agreement with Amerigroup Corporation

Amerigroup, a Fortune 500 Company, coordinates services for individuals in publicly funded health care programs. Currently serving approximately 2.7 million members in 12 states nationwide, Amerigroup expects to expand operations to its 13th state, Kansas, as a result of previously awarded state contract. Amerigroup is dedicated to offering real solutions that improve health care access and quality for its members, while proactively working to reduce the overall cost of care to taxpayers. Amerigroup accepts all eligible people regardless of age, sex, race or disability.
Source: onehealth.com

WellPoint, Inc. (WLP): WellPoint Bets On Medicare And Medicaid [Centene Corp]

WellPoint should be able to leverage (CUT) some SG&A expenses and benefit from increased negotiating power with hospitals. The firm has already announced that it expects the Amerigroup acquisition to be accretive to earnings in 2013 (assuming the deal closes in the first quarter) and to add at least $1 per share in earnings in 2014. Though the transaction faces regulatory approval, the current administration will likely be in favor of anything that could lower healthcare costs.
Source: seekingalpha.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

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November 21, 2013

Doctor Associations File Lawsuit Against UnitedHealthcare Over Network Cuts

Posted by:  :  Category: Medicare

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Medicare is federal government-funded health insurance primarily for people 65 and older. Medicare Advantage is a version of Medicare Parts A and B, hospital and medical coverage, administered by private insurers. The insurers are paid by the federal government to provide coverage. Often, private insurers compete for market share by offering additional benefits, such as discounts on dental coverage, eyewear or hearing-aid services, in addition to exercise programs or gym memberships.
Source: courant.com

Video: Connecticut Medicare Advantage Plans – Supplement Insurance

UnitedHealthcare Cuts Doctors From Medicare Advantage Network

UnitedHealthcare is one of a number of insurers that offer Medicare Advantage plans in Connecticut and across the nation. Medicare Advantage plans are a type of federal-government-funded health-care plan offered by private insurers to people age 65 and older. Insurers contract with the federal government to provide Medicare Parts A and B, which is hospital and medical coverage, respectively. A Medicare Advantage plan may also provide additional coverage, such as prescription drug benefits.
Source: courant.com

Medicare, Medicaid cost Connecticut towns money for ambulance calls

“If the rates go down, then it’s going to depend on the agency. I doubt anybody’s going to show up at a house and not take somebody to the hospital because they have Medicare, but if you can’t afford to operate anymore because you’re taking a big loss on all your transports, it’s not unheard of for first-responder agencies to go bankrupt or curtail services,” he said. “They can try to muddle through, but they won’t have enough money to purchase new equipment or update their apparatuses.”
Source: registercitizen.com

Connecticut Dentist Gets Drilled in Huge Medicaid Fraud Case

Medicaid fraud is a serious crime and is vigorously investigated by the state MFCU, the Agency for Health Care Administration (AHCA), the Zone Program Integrity Contractors (ZPICs), the FBI, the Office of Inspector General (OIG) of the U.S. Department of Health and Human Services (DHHS). Often other state and federal agencies, including the U.S. Postal Service (USPS), and other law enforcement agencies participate. Don’t wait until it’s too late. If you are concerned of any possible violations and would like a confidential consultation, contact a qualified health attorney familiar with medical billing and audits today. Often Medicaid fraud criminal charges arise out of routine Medicaid audits, probe audits, or patient complaints.
Source: wordpress.com

Brand Name Drug Use High Among CT Seniors on Medicare

The good news is that Connecticut does fare better than average in prescribing effective drug therapy to patients with certain conditions such as heart attacks and diabetes. The prescription rate for dementia drugs varied throughout the state from 9.3 percent in Meriden to a low of 5.3 percent in New Milford. Regional variation is thought to point towards the lack of a “best practice consensus” for drugs. However, seniors in CT do rank higher than the national average when it comes to use of antidepressants and prescriptions for newer sleep sedatives such as Ambien.
Source: wordpress.com

Webinar: Review of Medicare Non

Do you have a good understanding of the CMS regulations for Medicare Non-Coverage in Skilled Nursing Facilities? Elizabeth Semeraro, Manager of the Review Services Department at Qualidigm, and her team review the current Medicare regulations for issuing NOMNC and detailed notices, including information from the CMS change requests Expedited Determination for Provider Service Terminations that […]
Source: ctculturechange.org

Aetna Announces Major Expansion Of Medicare Advantage Network

Last week, the Fairfield County Medical Association said doctors were calling the organization to say they received letters notifying they had been cut from UnitedHealthcare’s network. The association says UnitedHealthcare is cutting 810 primary care physicians and 1,440 specialists. The insurer declined to say how many doctors have been cut, but UnitedHealthcare has said it will have an adequate network that includes more than 1,500 primary care physicians and more than 4,000 specialists.
Source: courantblogs.com

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November 21, 2013

California Seniors On Medicare, Beware Of Health Exchange Scams Says Sacramento Elder Abuse Attorney

Posted by:  :  Category: Medicare

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There are other programs being promoted, such as a new computer system that verifies Americans’ identities, which is designed to keep funds from going to criminals, and a massive media educational anti-scam promotion to warn consumers about what cons to be aware of. “Which is nice,” added Barron, “However, one wonders about questionable security in sending, online, such information as proof of income, social security numbers and dates of birth. That’s just opening a door for trouble without knowing if there is enough protection in place to keep the data secure.”
Source: lawfirmnewswire.com

Video: Find your Medicare Lawyer in West Covina California Government Attorney on Legal Bistro

Daily Kos: War on Disease: Medicare for All

You did everything you could to keep the health insurance industry happy and solvent. You let them set the rules. You let them veto anything that might possibly hurt their bottom line. You looked out for Wall Street at the same time that you were trying to get Main Street a little preventive health care. And what did the health insurance industry do? It bit the hand that fed it. Not a little nip. The health insurers took a great big chunk of flesh—easily more than a pound–out of you when they decided to cancel policies rather than rewriting them so that they would comply with the law. Millions stand to lose their health individual health insurance at a time when government resources to help the uninsured are already strained. The private insurers have precipitated a health care crisis of huge proportions—
Source: dailykos.com

Daily Kos: Media parrot GOP Katrina talking point, ignore Bush Medicare drug debacle

The nonpartisan Government Accountability Office (GAO) ruled that some of the administration’s ads promoting the new program were illegal while others were misleading. GAO investigators also found that the White House illegally withheld data from Congress on the cost of the new law. The Congressman who crafted the bill soon left Capitol Hill for K Street, where he made millions of dollars annually as a heath care lobbyist. The new federal web site allowing people to compare plans and prices was delayed by weeks, while just 300 customer service reps manned the phones to help new enrollees. Yet over six million people immediately lost their coverage, while hundreds of thousands more would be refused treatment because of malfunctions in the computer systems linking providers and insurers. In response to the mushrooming crisis, governors in mostly Democratic states spent billions to continue coverage for their residents, while the President pleaded with insurance companies not to cut off their current policyholders. Nevertheless, the White House sided with insurers and rejected bipartisan calls to delay the enrollment deadline even as public approval plummeted to 25 percent. It’s no wonder John Boehner called the rollout of the President’s signature domestic policy achievement “horrendous.” And yet, the differences between Medicare Part D then and the ACA now are just as telling. Most important, despite the fact that they overwhelmingly opposed the passage of President Bush’s giveaway to drug firm and private insurance companies, Democrats in Washington and the states worked hard to ensure the troubled program’s success. And the differences, as we’ll see below, don’t end there.
Source: dailykos.com

Veteran prosecutor describes SoCal as ‘epicenter’ of Medicare fraud

Guv Brown is releasing rapists and perverts from prison after serving only 40% of their sentences.  In LA County if a male is given a 90 jail term or less, or a woman a 240 day jail term or less, they are immediately released, no time served.  In California being a criminal is no longer a problem—just ask the millions of illegal aliens roaming our streets, taking our jobs, filling up classrooms and hospital beds.  We are a tolerant people. Maybe that is why we are also the HQ for Medicare fraud.  People don’t see stealing from government is theft.
Source: capoliticalnews.com

California Chiropractor Pleads Guilty To Medicare Fraud

“Health care fraud in and of itself is a serious offense. Not content to stop there, however, Mr. Pavehzadeh sought to conceal that crime by committing yet another — filing a false police report,” said Glenn R. Ferry, Special Agent in Charge for the Los Angeles Region of the Office of Inspector General for the Department of Health of Human Services. “Those intent on breaking these laws should know that through the work of our special agents and auditors, OIG remains committed to seeking justice.”
Source: cacriminaldefenseblog.com

State Highlights: U. of Va. Hospital CEO Says Health Law Could Cost Millions; D.C. Hospital Cutting Jobs

California Healthline: How Can State Hasten Payment Reform? According to the California Scorecard on Payment Reform released last month, almost 42 percent of commercial payments to providers in California are tied to how well the providers deliver care, measuring quality, outcomes and efficiency. Compared with a national average of about 11 percent in the National Scorecard on Payment Reform released in the spring, California is ahead of the curve. However, the 42 percent of providers who are reimbursed for care based on value in California are countered by the 58 percent reimbursed for the number of tests and procedures they perform. We asked stakeholders what California can do to hasten and improve health care payment reform (11/11).
Source: kaiserhealthnews.org

Daily Kos: Cocaine congressman voted to force drug testing for food stamps

The Massachusetts native W.E.B. DuBois in the 1920s wrote an excellent essay on this phenomenon, based on his observations while teaching at Atlanta University in the early 1900s, the worst years of Jim Crow. I wish I could find a link to it, but I can’t even remember the title of it & I’m not sure it’s even on line. Essentially, he saw Southern racism – in all its outrageous & tragic iterations – as a powerful tool in the hands of the economic elite, who could always use race to divide & conquer the lower classes. Blacks were kept in such a degraded & hopeless condition that they always had the power to underbid working-class whites in the labor market, which kept wages low for everyone. In the way of progressive social legislation, improved living standards or economic security, white people got next to nothing. But in place of that, they got something far more flattering – social superiority. The exact same dynamic is at work here: Southern whites, who form the core of the Republican base, don’t even see the condescension which may be obvious to the rest of us. Instead what they see is a noble effort to restore the rightful order of things. They’re perfectly willing to part with their own fundamental rights in order that black people have their rights taken away.
Source: dailykos.com

Doctors complain exchange plans will pay them less

Physicians are uncomfortable discussing their rates because of antitrust laws, and insurers say the information is proprietary. But information cobbled together from interviews suggests that if the Medicare pays $90 for an office visit of a complex nature, and a commercial plan pays $100 or more, some exchange plans are offering $60 to $70. Doctors say the insurers have not always clearly spelled out the proposed rate reductions.
Source: mylocalhealthguide.com

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November 21, 2013

Ask The Experts: Retirement

Posted by:  :  Category: Medicare

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Q. I retired from government almost eight years ago. I have had Kaiser health insurance all this time. I am about to turn 65. I have to do something with Medicare sign-up, so I spent time with my health plan provider (Kaiser Perm) the other day and the person we talked to wasn’t sure my wife would continue on my plan should I go with them for part B or their Senior Advantage plan. I told the rep I was sure she would, but the Kaiser rep said I needed to check with the government. My wife is five years younger than me. If I go with Kaiser for part A and B, will my wife be carried on the plan, too?
Source: federaltimes.com

Video: The Story of Medicare: A Timeline

Kaiser Health News Analysis: CMS Will Cut Pay to Nearly 1,500 Hospitals in FY 2014

As the KHN article points out, “The Value-Based Purchasing payments for the 2014 federal fiscal year are determined by how hospitals scored on three sets of measures. The first are 13 ‘measures of timely and effective care’ also known as ‘process measures. These rate how often hospitals adhered to these clinical guidelines,” such as the percentage of heart attack patients given medication to avert blood clots within 30 minutes of arrival at the hospital. The second set of eight measures are taken from patient satisfaction surveys, and focus primarily on such elements as clinician and staff communication with patients, and other aspects of the patient experience. And the third set of measures uses Medicare mortality rates for heart attack, heart failure, and pneumonia.
Source: healthcare-informatics.com

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

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

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November 21, 2013

Horizon Medicare Advantage Blue Value with Rx

Posted by:  :  Category: Medicare

Please read through the full Horizon Medicare Blue Value with Rx HMO Summary of Benefits attached here for a more thorough review of the plan. I am also available to review this plan with you in a meeting if you wish. Due to marketing regulations, I have decided to list just the basics of the plan and but welcome appointments to discuss your full needs. Contact Mike at NewJerseyInsurancePlans
Source: newjerseyinsuranceplans.com

Video: United Healthcare Secure Horizons & Oxford – Medicare Advantage Denies Coverage

CrummeyService.com Accepts Equity Investment

In order for a gift to a trust to qualify for the annual gift tax exclusion, currently $13,000 per beneficiary, the IRS requires trust beneficiaries to be given formal written notice of their right to withdraw the gifted amount if they choose to do so (Crummey v Commissioner, 397 F.2d 82 (9th cir 1968)). CrummeyService.com technology reminds the grantor to make the gift to the trust, notifies the beneficiaries of their right to withdraw the gifted amounts, and provides an independent third-party record of the entire process.
Source: lifesourcedirect.com

New Jersey’s Largest Health Insurer Horizon Blue Cross and Blue Shield To Pay $500,000 Penalty Over Medicare Claims

The action comes after the state Banking and Insurance Department investigated how Horizon Blue Cross and Blue Shield of New Jersey processed claims for Medicare customers insured through small businesses that use Horizon as a secondary insurer.
Source: cbslocal.com

The Inside Straight: Socialized Medicine: a Preview ?

For instance, when my wife was hospitalized in 2005, there was an unexplained balance left unpaid to the hospital. We explored this issue with the hospital and with Horizon for several months, and were told by the latter all invoices presented had been paid in full. In 2007, while my wife was in intensive care fighting for her life, I received a notice from a collection agency. The hospital had NOT been paid the balance, had given up trying to collect it from Horizon, and had finally invoked the little clause on the Admission documents that says the patient is responsible if the insurance carrier refuses to pay.
Source: typepad.com

Seniors lose insurance and doctors under Obamacare

Retired chemist Edward Schokowitz was incredulous when he received a letter from Horizon Blue Cross Blue Shield of New Jersey early last month saying his Medicare Advantage Plan, which had no premium, would be eliminated next year.
Source: wordpress.com

Horizon Blues chooses family friend for non

Horizon Blue Cross Blue Shield of New Jersey, the state’s oldest and largest health insurer, is a not-for-profit health services corporation, providing medical, dental, and prescription insurance products and services. Horizon BCBSNJ is an independent licensee of the Blue Cross and Blue Shield Association, serving 3.6 million members with offices in Wall, Mt. Laurel, and West Trenton, N.J.
Source: ifawebnews.com

Horizon Blue Cross Blue Shield of New Jersey and Barnabas Health Ready Launch of New Accountable Care Organization Program

“Our collaborative ACO program highlights our mutual desire to transform the health care delivery system in New Jersey by providing support to improve care coordination and positive patient outcomes,” said Jim Albano, vice-president, Network Management and Horizon Healthcare Innovations, Horizon BCBSNJ This collaboration with Barnabas Health (New Jersey’s largest hospital and integrated health-care delivery system) through its affiliated accountable care organizations, Barnabas Health ACO-North, LLC and Central Jersey ACO, LLC, marks Horizon BCBSNJ’s (the state’s oldest and largest health insurer) fifth Accountable Care Organization or population health initiative to launch within the past year. “Collectively, these accountable care innovations inject a new level of collaboration and quality standards into our health delivery system and help remove wasteful, unnecessary costs,” Albano added. Horizon BCBSNJ has a number of patient-centered programs, including Accountable Care Organizations, Patient-Centered Medical Homes, and programs focused on Episodes of Care (i.e. joint replacement). More than 320,000 members and 1,400 doctors are participating in Horizon BCBSNJ’s patient-centered programs that are working to improve patient care while controlling costs.
Source: thealternativepress.com

The Jersey City Independent

For the past two years, Dr. Walsh has been working with Jersey City Medical Center Chairman of Medicine Dr. Douglas Ratner to more effectively manage disease in a population. Overall, the main goal of an ACO is to create a healthier population and to deliver more effective health care at lower cost. The ACO accomplishes this by bringing together groups of doctors, hospitals, and other health care providers to ensure patients get the care they need at the right time while decreasing the incidence of unnecessary treatments.
Source: jerseycityindependent.com

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