Medicaid enrollment surges ahead of ACA sign

Posted by:  :  Category: Medicare

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Health officials were always expecting the massive media attention on Obamacare to spur people who were eligible for Medicaid but not enrolled to sign up — a phenomenon dubbed the “woodwork” effort (as in crawling out of the woodwork), or the friendlier term “welcome mat” effect. For those people, coverage could start as soon as the state approves the application. For expanded Medicaid and the private health insurance plans on the exchange, the start date for coverage is Jan. 1.
Source: politico.com

Video: Iranian Social Work, USCIS Help Center, SSI, Disability, Medical, Medicare Application

Seniors on Medicare don’t need to apply at the Insurance Marketplace

Related: In this video, Laval Miller-Wilson, the executive director of the Pennsylvania Health Law Project, provides an overview of Medicare, the federal health insurance program. Medicare covers people that are 65. It also covers people that have permanent disabilities. Before Medicare began in 1965, half of seniors didn’t have health insurance. Today, virtually all seniors 65 and older have Medicare.
Source: transforminghealth.org

FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces

Some worry those cuts could lead to access problems, if providers drop out of the program. In the most recent Medicare Trustees report, Paul Spitalnic, then acting chief actuary for the Centers for Medicare and Medicaid Services, wrote that over the long term, some of the health law’s changes would cause Medicare payment rates for home health, hospital and other services to drop below those now paid by the Medicaid program, “which have already led to access problems for Medicaid enrollees.”
Source: kaiserhealthnews.org

FAQ: Seniors On Medicare Don’t Need To Apply To The Health Law Marketplaces

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

To promote and expand the application of telehealth under Medicare and other Federal health care programs, and for other purposes. (2012; 112th Congress H.R. 6719)

The United States Code is the compilation of permanent laws enacted by Congress. Temporary and other non-permanent laws do not appear in the United States Code. (About half of the United States Code is the law itself, called positive law. The other half is merely a compilation of the laws but has no legal significance.)
Source: govtrack.us

Commentary: Medicare a model of efficiency compared to Obamacare

Dennis: I was surprised that SS cut my check that much also. However, when I checked it they first said, that was my first check, it would go up the next month. Well, when it did not go up, I called again and this time, I was assured it was correct, and who ever told me the check would be more the second month was mistaken, I would not be receiving anymore than the $670. I asked to speak with a supervisor and she informed me she was the supervisor, I had my explanation and that was all they could do for me. Today, I draw $841 per month, after I think it is 7 years. I am grateful to have my great grandchildren, they keep me busy, which is a good thing. My doctor says they are keeping me young. lol But I am raising them, the oldest one will be 15 in two weeks, I brought her home from the hospital at 2 days old. My second child is 3, I have had him since he was 8 weeks old. They are good kids, but of course, they are spoiled too. I had not planned to spend my retirement raising more children, but we just never now what God has planned. Thanks for the information on Obamacare. Government has never been involved in anything that they did not screw up. Someone said recently, if the government was in charge of the desert there would be a shortage of sand within 5 years. And I believe that. I personally think, we had the best health care system in the world anyway. The biggest problem with it, I think was mismanagement , excessive law suits and not enough honest oversight. I honestly think, the only thing wrong with Medicare and Medicaid is mismanagement and allowing all of the illegals in the country. However, Congress should never have been allowed to touch the funds either. They should have been invested and both medical and SS would be solid, allowing for a more decent percentage monthly payout to the retirees. When I listen to these educated politicians talk, it really grates on my nerves, as they lack any common sense at all. Hope you have a great week, it was nice hearing from you.
Source: marylandreporter.com

Medicaid Denied, Now On to the Exchange Until We Have Medicare for All for Life

** These figures are calculated based on the Harvard University studies on excess deaths in the U.S. due to lack of insurance coverage or the ability to pay for needed health care, and the Harvard University study that calculated the high percentage of personal bankruptcies attributable to medical crisis and debt in the U.S. 123 people die daily due to lack of coverage or cash to pay for care; 1,978 go bankrupt every day due to medical crisis and debt though the majority had insurance at the time their illness or injury occurred. This statistic is also based on the 1.2 million bankruptcies in the U.S. in 2012, according to the U.S. Bankruptcy Court, and calculating those medically-related bankruptcies from that number.http://www.healthcareforallcolorado.org/endorse_right_to_health_care
Source: michaelmoore.com

Inpatient vs Observation Status

On behalf of my mother, father, and brother, I want to sincerely thank you for your assistance in the re-organization of my parent’s finances to allow us to qualify for and receive Medi-Cal benefits. In a time of stress and confusion to our family, you provided patience, guidance, and selfless concern. Your expertise and knowledge greatly reduced the amount of time we would have had to spend in researching and completing the Medi-Cal forms, not to mention having to deal with government bureaucracy. Our community is extremely fortunate to have someone of your knowledge, understanding, and integrity. Thank you once again for all your assistance.
Source: karlkimco.com

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

Posted by:  :  Category: Medicare

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

Video: Iranian Social Work, USCIS Help Center, SSI, Disability, Medical, Medicare Application

Does Medicare or Medicaid Come with Disability?

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

Medicare Compliance… It’s Not Just for Workers’ Compensation Anymore

The fact that a claimant is receiving Social Security Disability (SSD) but not Medicare changes these considerations, albeit more on the Workers’ Compensation side than the liability side. In a liability setting, the temptation may be to simply say “the plaintiff is not on Medicare; therefore, Medicare has no future interest and there does not need to be an allocation for future medical care.” This line of thinking is questionable, at best. A plaintiff who is on SSD will be Medicare eligible two years from their first receipt of benefits. The bright line between “Medicare enrolled” and “not Medicare enrolled” does not automatically shield the parties from having to consider Medicare’s future interest, especially in a situation where the plaintiff will be Medicare enrolled sooner than later. 
Source: gsriskmitigationblog.com

Killing The “We Paid Our Taxes; We Earned Our Benefits” Social Security Ponzi Meme

While those results resoundingly reject “we earned it” rhetoric for Medicare, the Social Security results, with new retirees getting less than they paid in, could be spun as “proving” Social Security is not a Ponzi scheme. However, that would be false. The reason is that Medicare is still in its expansion phase, as with Medicare Part D, piling up still bigger future IOUs. However, Social Security has essentially run out of new expansion tricks, although liberal groups are pushing to apply Social Security taxes to far more income as one last means of robbing those younger to delay the day of reckoning. That simply means that we are being forced to start facing the full consequences of the redistribution that was started in 1935. That is, the current bad deal Social Security offers retirees is just the result of the fact that it has been a Ponzi scheme for generations, and someone must get stuck “holding the bag.”
Source: nwotruth.com

How Long Does It take to Get Medicare Coverage Through Social Security Disability (SSD)?

However, your onset date for payment purposes can only be 17 months before your application date — that’s because Social Security allows a maximum of 12 months of retroactive benefits. (This maximum gets you to 12 months before your application date, plus five months for the waiting period, so your earliest established onset date is 17 months before the application date.) In turn, the earliest you can become eligible for Medicare is two years after you apply for Social Security disability. (For more information on calculating your date of entitlement, our article on disability onset and backpay.)
Source: disabilitysecrets.com

Ending the Medicare Disability Waiting Period Act of 2009 (2009; 111th Congress S. 700)

The United States Code is the compilation of permanent laws enacted by Congress. Temporary and other non-permanent laws do not appear in the United States Code. (About half of the United States Code is the law itself, called positive law. The other half is merely a compilation of the laws but has no legal significance.)
Source: govtrack.us

Shifting from Defense to Offense: Americans Want Improved Social Security and Medicare and less Military Spending

Meanwhile, a group of US senators and representatives, including Sen. Bernie Sanders, an independent socialist from Vermont, Sen. Elizabeth Warren (D-MA), Sen. Tom Harkin (D-IA), Sen. Sherrod Brown (D-OH), Sen. Mark Begich )D-AK) and Sen. Bryan Shatz (D-HI), is calling for eliminating the cap on income subject to Social Security taxation, so that all Americans, including millionaires and billionaires, pay the full FICA tax on their income, a move which would effectively end any talk of the Social Security program “running out of money.” 
Source: warisacrime.org

Disability Answers App Tells You If You Qualify for Disability Benefits or Medicare

“Disability Answers makes applying for Social Security Disability Insurance easier than it’s ever been before,” says Chris Gallagher, Vice President, Business Development at The Advocator Group. “And that’s important, because if you’re applying for SSDI, you’re probably in one of the more difficult times of your life. The SSDI process can be frustrating and overwhelming, but this app makes it easy to find the information you need, and determine if your individual situation is likely to qualify you for SSDI benefits. There’s a lot of information out there about SSDI that the disabled and their families could sift through. But because Disability Answers is based in real-world outcomes, it eliminates the noise and gets down to what people really want to know: Am I eligible for SSDI or not?”
Source: disabled-world.com

What is Medicare Supplemental Insurance?

Posted by:  :  Category: Medicare

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Medicare is a type of insurance that is regulated by the government. It is available in four parts. Part A is hospitalization coverage, while Part B is standard medical insurance. Part C combines the first two and is available through one of the private insurance companies approved by the Medicare board. Medicare Part D is coverage for prescriptions. There are some things that these parts of the insurance do not cover, which is where Medicare supplemental insurance fits in. in order to understand this addition, you must have a little knowledge of the other parts of the Medicare.
Source: didntbuildthat.com

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

Is Getting Supplemental Medicare Insurance A Good Idea?

Medigap policies work with Medicare Parts A and B by supplementing the existing benefits. Medicare takes care of all payments first, and whatever is left over is either taken care of by your Medigap policy or you need to pay it out of your own pocket. Consider the costs of additional medical services needed as you grow older, and it makes sense to buy a Medigap policy.
Source: micheleandreabowen.com

Medicare: Original, Replacement, Supplemental and Extra Crispy

Medicare Part B also covers outpatient hospital services including Emergency Room Visits and Hospital Observation. Generally, this means the patient pays a copayment for each individual outpatient hospital service. This amount may vary by service. The copayment for a single outpatient hospital service can’t be more than the inpatient hospital deductible. However, the total copayment for all outpatient services may be more than the inpatient hospital deductible. Part B also covers most of the doctor services when you’re a hospital outpatient. The patient pays 20% of the Medicare-approved amount after they pay the Part B deductible. Generally, the prescription and over-the-counter drugs received in an outpatient setting (like an emergency department), sometimes called “self-administered drugs,” aren’t covered by Part B. Also, for safety reasons, many hospitals have policies that don’t allow patients to bring prescription or other drugs from home. If the patient has Medicare prescription drug coverage (Part D), these drugs may be covered under certain circumstances. The patient likely will need to pay out-of-pocket for these drugs and submit a claim to their drug plan for a refund.
Source: managemypractice.com

Does Medicare Supplemental Insurance Suit Your Needs?

Those aged 65 and older can rely on traditional Medicare Parts A and B to pay for a broad array of healthcare services and supplies, though by no means will everything be covered. For this reason, it may be wise for such individuals to purchase a supplemental insurance policy to pick up the slack. This type of policy, also referred to as Medigap coverage, is sold by private carriers and is intended to take care of payment for things that traditional Medicare does not include. Such expenses include co-pays, annual deductibles and coinsurance. Certain available Medigap policies also provide coverage for services that have no coverage whatsoever under traditional, original Medicare.
Source: kurafire.net

Medicare Insurance Supplemental Insurance Over Seniors

Pretty people do underestimate the fact that you can be brilliant today and this morning be opposite related expectations. Provide you . a fact the fact that should not stay denied because the house will enable it to take virtually any step on just how to protect near future problems. Occasions money is some sort of problem to numerous people across earth. Therefore, their customer should compare them New government study reveals many medicare part f plans vary in price by location rates and as well , select the service that is invoicing low rates.
Source: good-date.com

Medicare Supplemental Insurance

Working with your existing Medicare benefits, Medigap is there to compensate for expenses not paid. Essentially, what is left over, that is what Medigap will cover, or the insured person will take care of the extra expense. Since certain tests and medical treatments can be extremely expensive, supplemental policies must be purchased as you get older and need more medical attention.  You can get quotes for these polices from a local agent or online through MedicareSupplementQuotes.net, one of the most reputable Medicare supplement quote websites on the net.
Source: ewf2011.org

Original Medicare vs. Medigap: Which is Right for You

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

BGR Medicare Supplemental Insurance Plan N

A good number of MA plans provide a network along with medical service service providers. With some plans, you have to help you get your sickness services from the perfect network medical business provider in place for those firms to be coated. With some relating to the plans, owners may choose in order to really leave the network, but you quite possibly have to ante up more for layered services. when you see just that your own top doctors are before hand on the plan, you may always more satisfied complete with the network. If you would definitely rather have further freedom to decide between and choose doctors, you may no more be happy that has this type including restriction. This fact is actually quite similar to the very way PPO nor HMO plans effort on regular nicely being insurance policies.
Source: acsad-bgr.org

CMS Releases Latest Value

Posted by:  :  Category: Medicare

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But even though we’d like to see every hospital across the country offer the highest quality care possible, we’re pleased with this round of results. Hospital Value-Based Purchasing provides a useful snapshot of how hospitals are performing on important indicators for patient safety, care, quality, and well-being. The Hospital Value-Based Purchasing program refines the measures it uses to evaluate performance annually. In FY 2014, there were fewer higher performers—that is, their incentive payment is greater than the amount they contributed—than lower performers—their incentive payment is lower than the amount they contributed, that higher performers’ bonuses on average will be larger than the lower performers’ losses over the course of the year.
Source: cms.gov

Video: CMS Medicare Plan part A 2013, Medicare plan explained in under 10 minutes

NACHC Submits Comments on CMS Proposed Rule on Development of Medicare PPS

CMS does not have statutory authority to enforce the lesser-of-PPS-or-charges provision. NACHC’s most serious concern about the Proposed Rule relates to Section 1833(a)(1)(Z) of the Social Security Act (the “lesser-of provision”), which requires Medicare payment for FQHC services provided under the PPS to equal “80 percent of the lesser of the actual charge or the amount determined under [the PPS provisions].” In NACHC’s opinion, CMS does not have the legal authority to enforce this provision. By its terms, the lesser-of provision applies only to services “described in section 1832(a)(1).” Section 1832(a)(1), in turn, explicitly excludes FQHC services. We recommend that CMS at a minimum obtain a legal determination as to whether it is authorized under the statute to enforce this limitation.  In addition, the draft regulations do not define “charge” or explain how CMS plans to implement the limitation. CMS also appears to have overlooked the lesser-of provision in its regulatory impact analysis.  Since the PPS is a per-encounter payment, the negative impact of the lesser-of provision will be especially acute if CMS contemplates a comparison, for each visit, of the PPS rate to the charges associated with specific HCPCS procedure codes that the health center billed for FQHC services on the day the visit occurred. That type of comparison would be “apples to oranges” – comparing costs of an aggregate bundle to charges associated with a specific visit or encounter. That approach would routinely result in underpayment of health centers.  If after considering the statutory language in Sections 1832(a)(1) and 1833(a)(1) of the Social Security Act, CMS concludes that it has statutory authority to enforce the lesser-of provision, NACHC recommends that CMS provide all interested parties with an opportunity to review and comment on any changes or additions may be made to the proposed rule. Additionally, if CMS should implement the provision in a way that ensures parity between the bundled rate and charges compared. For example, the PPS rate could be compared with the health center’s average charge per FQHC visit, as determined on an annual basis. For every service provided in a given year, the PPS rate would then be compared to the prior year’s average charge per visit, as adjusted by the applicable inflation factor. That type of approach would mitigate the negative effects of the lesser-of provision by ensuring an “apples to apples” comparison of the PPS rate to charges, by using a bundled approach for both.
Source: nachc.com

Jiva and the Path to Improved CMS Star Ratings for Medicare Advantage Plans

Each day, approximately 10,000 people enroll into the Medicare program, which increases the focus on Medicare Advantage and the CMS Star Ratings for each of those plans. Star Ratings figures for 2014 show that there are 14 plans that have achieved the highest rating of 5, and the number of 4 and 4.5 star plans available has increased to 151, up from 116 the previous year. [i] This is significant because a move from 3 to 4 Stars is worth about $50 per member per month for these plans, which relates to a difference of $6 million per year of additional payments from CMS.[ii] The other major advantage of the 4-5 star rating is that plans achieving that level can market and sell to potential enrollees year-round instead of the seven week period of time allowed for those with less than a 4 rating.  It is also becoming clear that there is a market advantage to higher ratings with a 14 percentage point increase from 38 percent of enrollees in contracts with four or more stars last year. Consumers are getting smarter through research and awareness and they are selecting plans with the higher ratings.[iii]
Source: zeomega.com

CMS: 1,451 Hospitals Penalized in 2014 Value

“As the Hospital Value-Based Purchasing program continues to evolve with a richer set of measures, including an efficiency measure in FY 2015, we may see the mix of value-based payment adjustment factors change again,” Dr. Conway wrote. “Meanwhile, value-based purchasing in Medicare continues to move ahead, improving the way that healthcare is delivered to people with Medicare now and helping create a healthcare system that will ensure quality care for generations to come.”
Source: beckershospitalreview.com

New CMS Proposed Homebound Policy Would Leave Medicare Beneficiaries Without Coverage 

… a condition, due to an illness or injury, that restricts the ability of the individual to leave his or her home except with the assistance of another individual or the aid of a supportive device (such as crutches, a cane, a wheelchair, or a walker), or if the individual has a condition such that leaving his or her home is medically contraindicated.  While an individual does not have to be bedridden to be considered "confined to his home", the condition of the individual should be such that there exists a normal inability to leave home and that leaving home requires a considerable and taxing effort by the individual. Any absence of an individual from the home attributable to the need to receive healthcare treatment, including regular absences for the purpose of participating in therapeutic, psychosocial, or medical treatment in an adult day-care program that is licensed or certified by a State, or accredited, to furnish adult day-care services in the State shall not be disqualify an individual from being considered to be "confined to his home".  Any other absence of an individual from the home shall not so disqualify an individual if the absence is of infrequent or of relatively short duration.  For purposes of the preceding sentence, any absence for the purpose of attending a religious service shall be deemed to be an absence of infrequent or short duration."[1]  [Emphasis added.]
Source: medicareadvocacy.org

CMS clarifies Medicare payment rules for SNF to SNF ambulance transportation

The memo was issued one day before the nation’s second-largest ambulance services provider agreed to settle a Medicare lawsuit for $8 million. The whistleblower charges related to a swapping arrangement. These typically involve SNFs sending Medicare Part B residents to particular companies. In exchange, these companies offer the SNF price breaks on services provided to less lucrative Part A residents.
Source: mcknights.com

CMS Proposes to Significantly Increase Reward for Reporting Medicare Fraud

CMS noted that it expects its proposed enhancement to the IRP reward to encourage more people to come forward with information, leading to an increase in the recuperation of health care fraud funds. This expectation is based on the success of an Internal Revenue Service (IRS) program that pays individuals for reporting IRS tax code violations. The IRS reward program—which pays whistleblowers 15–30% of the amount collected by the IRS for all claims filed after July 1, 2010 and pays 15% of the amount collected for claims under $2 million filed before July 2010—has both paid out more rewards and collected more money than the IRP. Since its inception in 1998, the IRP has paid out only 18 rewards, totaling $16,000 in reward payments and less than $3.5 million in collected funds. The IRS program, on the other hand, paid out approximately $193 million in rewards and collected almost $1.6 billion from 2007–2012. CMS did not comment on whether it believes there is a comparable level of Medicare and tax code fraud.
Source: regblog.org

CMS: Medicare open enrollment begins Oct. 15 as planned

Beneficiaries can use this Medicare Annual Election Period to explore various Medicare plans, compare costs and options, and check whether providers or institutions accept certain plans. For example, those taking new medications, who relocate, are diagnosed with a chronic medical condition, or experience an accident or injury which changes their health status may want to add or drop certain benefits, or find a plan with lower co-pays. A move to a different state may require finding new physicians or joining a plan with different participating facilities in their new coverage area. Even if a person’s status remains the same, plans can change — benefits might be added or dropped, or prescription medications might go on or off formulary.
Source: healthjournalism.org

Nearly 1,500 Hospitals Penalized Under Medicare Program Rating Quality

This program is one of several Medicare has launched to make hospitals and doctors pay more attention to how their treatments compare with other hospitals, and to be more careful with public money. Medicare gives bonuses to the private Medicare Advantage insurance plans that score well on quality metrics. In 2015, the health law calls for the government to begin a quality payment program for physician groups of 100 professionals or more, and that is to be expanded to all doctors by 2017. The goal of all these programs is to replace the current financial incentive in Medicare, in which the only way for a hospital to get paid more is to perform more procedures and take on more patients.
Source: kaiserhealthnews.org

CMS makes Medicare, Medicaid data easier for researchers to access

ARRA Cardiology EMR CCHIT CMS Comprehensive Ambulatory EHR Economic Stimulus Economic Stimulus Package EHR EHR adoption EHR implementation EHR Software EHR system EHR Systems EHRs Electronic Health Information electronic health record Electronic Health Record Software electronic health records electronic medical record Electronic Medical Records EMR EMR implementation EMR Software EMR Stimulus EMR Stimulus Package EMRs health care health IT Health IT Policy Healthcare healthcare IT healthcare system HHS HIPAA HITECH HITECH Act Hospitals meaningful use meaningful use ehr meaningful use emr meaningful use of ehr Meaningful Use of EMR Obama ONC Outpatient EHR physicians Specialty EMR Stimulus Stimulus Bill Stimulus package
Source: myemrstimulus.com

CMS Clarifies Payments with “Two Midnight Rule” for Hospital Admissions

The final rule specifies that the timeframe used in determining the expectation of a stay surpassing two midnights begins when the beneficiary starts receiving services in the hospital. This includes outpatient observation services or services in an emergency department, operating room or other treatment area. While the final rule emphasizes that the time a beneficiary spends as an outpatient before the formal inpatient admission order is not inpatient time, the physician—and the Medicare review contractor—may consider this period when determining if it is reasonable and generally appropriate to expect the patient to stay in the hospital at least two midnights as part of an admission decision.  Documentation in the medical record must support a reasonable expectation of the need for the beneficiary to require a medically necessary stay lasting at least two midnights.  If the inpatient admission lasts fewer than two midnights due to an unforeseen circumstance this also must be clearly documented in the medical record. 
Source: cmscompliancegroup.com

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November 24, 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 To Compare 2014 Medicare Advantage Plans

Most Seniors Compare Medicare Plans Without Prescription Drug Costs

This data comes from a recent study conducted by eHealth. When we looked back at the 2013 Medicare Annual Election Period (also known as the Medicare Annual Enrollment Period or AEP), our researchers found that fewer than one-in-four shoppers (22%) entered the names and dosages of prescription drugs they were taking while comparison shopping for Medicare Advantage Prescription Drug (MAPD) plans or stand-alone Medicare Prescription Drug Plans (PDPs) at eHealthMedicare.com or PlanPrescriber.com.
Source: ehealthmedicare.com

Medicare Beneficiaries: It’s that time of year to compare health plans for your best fit

AARP Vice President of Health and Family Nicole Duritz, explains “It is important for Medicare beneficiaries to know that during the open enrollment period you don’t have to do anything new. You certainly should not buy any new insurance coverage as a result of the Affordable Care Act. Your Medicare coverage satisfies the federal requirement that you have health insurance.”
Source: aarp.org

Area Wide News: Community News: WRAAA to help with Medicare plans (11/20/13)

On Friday, Nov. 22 from 9 a.m. to noon, the White River Area Agency on Aging will help you compare plans. Medicare certified counselors will be on site to assist. Please bring your Medicare cards and a list of your current prescriptions.
Source: areawidenews.com

Reassessment time for Medicare Part D beneficiaries

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: pomeradonews.com

Analysis Shows 88% of Florida 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, Florida).
Source: lensaunders.com

News Article/Update on State Medicare Advantage Plans

The complete program information is now available on the CMS website for both the College Insurance Program (CIP) and the State Employees’ Group Health Program. The TRAIL Decision Guide includes an explanation of plan options, plan comparison chart, rate chart, coverage map, and contact information for the four plan administrators. The site also offers a comprehensive FAQ (Frequently Asked Questions) sheet for CIP and State Employees.
Source: surs.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

What You Can Do During Medicare Open Enrollment

Open enrollment is also an opportunity to choose a Medicare Advantage plan, if desired. To cover hospital care (Part A) and outpatient care (Part B), Medicare offers a choice between single-payer traditional Medicare or a network plan (Part C or Medicare Advantage), in which the federal government pays for a private insurer that the patient can choose. The majority of Medicare beneficiaries choose traditional Medicare, but if one chooses Medicare Advantage, now is when one can shop around among different plans.
Source: thehalelawfirm.com

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