Oregon Shines On Medicaid, As Texas Stalls On Sign

Posted by:  :  Category: Medicare

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Texas Attorney General Greg Abbott says he’s concerned and wants regulations that are tougher than those already in the Affordable Care Act. He’s told the Texas Department of Insurance that he wants the rules to include criminal background checks so that felons can’t work as navigators. He thinks navigators might misuse confidential information they gather while helping people sign up for health plans. “We need to have better training for these people who are — may be completely unversed in how to deal with someone’s private information,” he says.
Source: kaiserhealthnews.org

Video: Applying For Medicaid In Texas

Daily Kos: Medicaid, CHIP enrollments surge under Obamacare

The undeniable success story so far of Obamacare is Medicaid expansion. According to a new report from the Centers for Medicare and Medicaid Services, more than 1.46 million people were approved for Medicaid or the Children’s Health Insurance Program in October, alone. Enrollment increases are happening in the 25 states that have accepted the Medicaid expansion plan under Obamacare, but in the other states, as well. In states that are not expanding Medicaid, applications to Medicaid and CHIP agencies increased 4.1 percent in October over the previous few months, and the total number of individuals determined to be eligible for Medicaid or CHIP was 697,019. In states that are expanding Medicaid, applications jumped 15.5 percent, and 757,991 new eligibility determinations were made. The overall total across all states was an 8.6 percent increase in applications and 1,460,367 new eligibility determinations. South Carolina, a state that has adamantly refused to expand Medicaid, enrollments are expected to jump 16 percent in the next year and a half, and Utah and Idaho are expected to see similar increases, even though they have refused the expansion. That’s just by virtue of people knowing they need to sign up for health insurance, and finding out that they meet the eligibility requirements.
Source: dailykos.com

Many Texans fall into Medicaid, insurance marketplace gap

This year, for example, the Census Bureau states that a family of four earning $23,550 per year meets 100 percent of federal poverty level. Income eligibility for Medicaid and CHIP varies by case and determines who qualifies in relation to the poverty level.
Source: baylorlariat.com

Oregon Shines On Medicaid, As Texas Stalls On Sign

Kyle Thompson lives in the farming community of Jefferson. He can’t afford health care, he says, because his work as a tile cutter evaporated when the economy tanked. But his children qualified for state public assistance, so Oregon had the family’s details. After the health care law passed, the federal government gave Oregon permission to send Medicaid applications to families like the Thompsons with incomes less than 138 percent of the poverty level.
Source: kcur.org

Here Are Some Medical Procedures Texas Regulates Less Than Abortions

After Katie Couric got a colonoscopy on national television, the American public got over its fear of letting a doctors stick tiny video cameras up their rectums and started getting lots and lots of colonoscopies. Now, some experts say that the push for colonoscopies often appears to be motivated by profits rather than health. “We’ve defaulted to by far the most expensive option, without much if any data to support it,” Dr. H. Gilbert Welch, at Dartmouth, told the New York Times in June.
Source: dallasobserver.com

“Texas’ Other Death Penalty“

“There’s a popular myth that the uninsured—in Texas, that’s 25 percent of us—can always get medical care through emergency rooms. Ted Cruz has argued that it is “much cheaper to provide emergency care than it is to expand Medicaid,” and Rick Perry has claimed that Texans prefer the ER system. The myth is based on a 1986 federal law called the Emergency Medical Treatment and Labor Act (EMTALA), which states that hospitals with emergency rooms have to accept and stabilize patients who are in labor or who have an acute medical condition that threatens life or limb. That word “stabilize” is key: Hospital ERs don’t have to treat you. They just have to patch you up to the point where you’re not actively dying. Also, hospitals charge for ER care, and usually send patients to collections when they cannot pay.”
Source: americablog.com

Texas governor unwilling to maximize Medicaid

The executive of the health system stated that it was important that Texas ensure stable and adequate reimbursement for Medicaid for physician and hospital services. He also believed that the state should maximize federal matching funds for Medicaid. He argued that if the state refused to expand Medicaid, Texas would be giving up nearly $100 billion in federal funding within the next 10 years to help pay for residents who qualify for Medicaid eligibility but who are unable to pay for their own healthcare. He continued to say that Texas has the largest amount of uninsured people in the nation, and their healthcare tab will ultimately end up being borne by taxpayers.
Source: wrightabshire.com

Bill on Texas Solution to Medicaid Expansion Moves Forward

“Private insurance is more expensive than Medicaid, so if you have your entire Medicaid expansion population on private insurance and you’re also paying for wrap-around Medicaid benefits, you’re going to end up with a much larger state share once the federal dollars begin to drop off,” Davidson said.
Source: kut.org

Massachusetts Medicaid (MassHealth) Fraud: Enforcement and Detection

Posted by:  :  Category: Medicare

Source: wordpress.com

Video: 2013 06 26 12 04 Massachusetts Medicaid EHR Incentive Payment Program Registration and Attestation

Massachusetts Data Suggests States May See Large Medicaid ‘Welcome

Julie Sonier, Michel H. Boudreaux, and Lynn A. Blewett analyzed Medicaid’s “welcome-mat” effect in the Bay State. They found that enrollment among low-income parents previously eligible for Medicaid increased by 16.3 percentage points, and participation by those without private coverage increased by 19.4 percentage points, in comparison to a group of control states. The authors are affiliated with the State Health Access Data Assistance Center at the University of Minnesota in Minneapolis, and the study was supported by a grant from the Robert Wood Johnson Foundation.
Source: healthaffairs.org

Boston University News Service

Honah Liles is a grad student in BU’s Broadcast Journalism program. Honah previously earned a B.A. in biology from Barnard College but realized quickly that journalism was way more fun than working in a lab. She dabbled in radio at PRI’s environmental news magazine program Living on Earth before heading to BU. Honah is often confused for a sports journalism major because of her small obsession with Boston teams. She is also a compulsive scrabble enthusiast, amateur baker and reluctant distance runner.
Source: bunewsservice.com

Study: Romney's Medicaid scheme would throw tens of millions off rolls

And it could be even worse than that. No one knows, except perhaps for Paul Ryan, what the federal rules would be governing state management of Medicaid. As the report notes, “If there are no requirements that federal payments be matched by state contributions, states could reduce state spending more than federal spending and these enrollment estimates would be understated.” Of course, states could also choose to be more generous. But whereas state Medicaid expansions are currently matched by federal dollars, they no longer would be. So, the report states, “Completely avoiding enrollment cuts would require very large increases in spending to offset the reduction in federal funds.”
Source: msnbc.com

6 Managed Care Organizations Selected for Health Care Coverage

The ACA allows states to expand Medicaid coverage to low-income adults making less than 133 percent of the federal poverty level – about $15,000 a year for an individual. CarePlus is MassHealth’s new benefit plan for this population. HHS expects about 325,000 individuals to be enrolled in MassHealth as part of the ACA’s Medicaid expansion; the majority of which will be enrolled in MassHealth CarePlus.
Source: everettindependent.com

Romneycare Vs. Obamacare: Key Similarities & Differences

Size and scope – The Massachusetts law applies to the 6.5 million residents of the commonwealth. The ACA covers more than 300 million people spread across 50 diverse states. Massachusetts began its reform with a rate of uninsured that was half that of the nation as a whole, and it was written to meet the unique needs of state residents. These differences led Governor Mitt Romney to oppose the ACA. While Romney’s health reform is working in Massachusetts, he believes one model cannot meet the needs of all 50 states. In addition, the ACA has a much broader scope in that it includes provisions to address healthcare provider shortages, increase wellness and nutrition programs, bolster community health centers, and adjust Medicaid and Medicare.
Source: cbslocal.com

Medicare Advantage 2014 Spotlight: Plan Availability and Premiums

Posted by:  :  Category: Medicare

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While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4).  Plans offered by these firms are available to most beneficiaries.  Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5).  The general availability of these firms’ products has not noticeably changed from 2013 to 2014.  However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).
Source: kff.org

Video: Medicare Supplemental Insurance Rates

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

What is the Social Security tax rate for 2010?

The Social Security tax withheld from employees during the year 2010 will be 6.2% of the first $106,800 of each employee’s taxable earnings. The employee’s earnings in excess of $106,800 are not subject to the Social Security tax. In addition to the Social Security tax, the entire amount of each employees’ taxable earnings is subject to the Medicare tax of 1.45%. Both the Social Security tax and the Medicare tax must be matched by the employer. This means the employer must remit to the federal government 12.4% of each employee’s first $106,800 of taxable earnings plus 2.9% of each employee’s earnings regardless of amount. Self-employed individuals are responsible for paying both the employee and the employer portions of the Social Security tax and the Medicare tax. Learn more about Payroll Accounting.
Source: accountingcoach.com

Tax Rate Calculator: 2010 through 2014

This online tool is able to compute the 2014, 2013, 2012, 2011, and 2010 federal income tax rates, also known as tax brackets, for individuals.  The calculator takes into consideration, wages, salaries, income, adjustments to income, deductions, as well as exemptions.  The calculator not only provides an estimate of federal income tax owed, but also Social Security and Medicare taxes too.
Source: money-zine.com

AAA7 Encourages Medicare Beneficiaries in Gallia County to Attend Medicare Check

Posted by:  :  Category: Medicare

Source: galliaherald.com

Video: Reality check: Tax rates & Medicare

Marshall Elder and Estate Planning Blog: Medicare Open Enrollment Do’s and Don’ts

APPRISE counselors are conducting information sessions and enrollment sessions in all counties throughout the State and they are as well meeting with people for individual counseling. You can find information about dates and times at http://tinyurl.com/l3m9526 or by calling APPRISE at 1-800-783-7067.
Source: blogspot.com

How to Prevent Medicare Card Identity Theft

Note: You’ll notice that your Medicare ID has one or two additional letters or numbers following the digits of the SSN. These identify what kind of beneficiary you are, according to the Social Security Administration. For example, the letter T mainly indicates that you are entitled to Medicare, but are not yet filed for Social Security retirement benefits; whereas W1 indicates that you are a widower who is eligible for Medicare through disability. For the purposes of your photocopy, it doesn’t matter whether you delete these final letters (or letter-number combinations) or leave them in.
Source: aarp.org

Medicare Prescription Drug Coverage, Medicare Part D, Doughnut Hole

Medicare has an optional program — called Medicare Part D — that provides insurance to help you pay for prescription drugs. If you select to have the coverage, you pay a monthly premium. This guide explains how the program works and helps you make decisions in choosing a plan that’s right for you.
Source: aarp.org

Medigap vs. Medicare Advantage Plan

Posted by:  :  Category: Medicare

2011 2012 AARP about Advantage Auto Beautiful BENEFITS Best bill Capital care companies Company Conference Cool Find from Good Group health images Insurance know League Life many Medicare members Michigan Municipal Nice Obama photos pics pictures Plan Plans reform senior Should Supplement Supplemental their there
Source: wordwd.com

Video: Medigap vs Medicare Advantage plan

Medigap vs. Medicare Advantage Plan

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

Medigap insurance provider in San Diego

Medicare Advantage plans are comprehensive when it comes to coverage, and you can get all of your healthcare needs covered under one source. Some Medicare Advantage plans are cheaper than a combined Medicare and Medigap policy combined – it all really depends on your personal health needs. Medicare Advantage plans may require you to see certain specialists and doctors within a specific network of providers. Although Medicare Advantage plans can certainly be cheaper than other options, you may still need to pay a co-payment depending on the doctor visit and treatments sought.
Source: pomeradonews.com

Cheap Home Insurance Medicare Advantage Vs Medicare Supplement Medigap Plan F

1080p 2012 2013 after Amazon Android Best Black Business Card Computer Core Coupon Coupons Daily Deal Deals Dell Digital Extra FREE Friday from Google Groupon HDTV Home inch Intel Laptop LivingSocial Men’s more NEWEGG offers. online Phone Review SALE Samsung Shipped SHIPPING Tablet Video Wireless
Source: allinoneinternetsearch.com

Medicare and Medigap: What’s the Difference?Blog

There are good reasons to opt for a Medicare Advantage plan instead of Medicare plus Medigap. Medicare Advantage covers the same benefits included in a traditional Medicare plan (Parts A and B), but Medicare Advantage plans often charge different (usually lower) co-payments, all of your coverage is consolidated under a single plan, and there may be no additional monthly premium. The monthly premiums are lower than Medicare, but the out-of-pocket expenses may be much higher.Medicare Advantage plans also include prescription drug coverage at no additional cost. Medigap plans do not cover drug prescriptions, so if you need help in paying for prescriptions, you will need to purchase a Medicare Part D policy. Most Medicare Advantage plans require you to see providers in-network or pay high co-payments for out-of-network service; you may need a referral from your primary doctor to see a specialist and it may be more expensive.
Source: nbngroup.com

Compare Medigap and Medcare Advantage benefits

By pressing “Click Here And Get Your Quote ” above, (1) I consent to receive phone calls from TZ Insurance Solutions LLC or its affiliates, or one of its third-party partners, or their service provider partners on their behalf, regarding their products and services, at the phone number provided above, including my wireless number, if provided, and (2) I agree to this website’s privacy policy and terms and conditions. I understand that these calls may be generated using an automated technology. Partners may include SelectQuote, Allied Insurance, United Medicare, Insphere, eHealth and Coventry. You are not required to grant consent as a condition of purchasing any property, goods or services.
Source: medicaresupplement.com

Medigap or Medicare Advantage?

The best place to understand either option is to go to MedicareInteractive.org, where there is an easy-to-read chart. Another good resource is ConsumerReports.org, which in November 2010 focused on Medicare issues and rated Medicare Advantage plans. You can find much of the best information online free of charge, but in order to read Consumer Reports’ rankings, you’ll have to subscribe (or find the issue at the library). The place where you’ll make the final selection is Medicare.gov. It’s a good idea to just ignore the big pile of sales literature that will fill up your mailbox.
Source: bankrate.com

Medicare Advantage vs. Medicare Supplement

Medicare Supplement plans, also known as Medigap, are also offered through private insurance companies that are contracted by Medicare. However, these plans serve as supplemental coverage to Original Medicare, and fill in the gaps in coverage left behind by Part A and Part B. Medigap plans may cover health care costs such as coinsurance, copayments, deductibles, and medical care while traveling outside of the United States. There are 10 standardized plan types available, with each lettered plan offering the same benefits regardless of location and carrier. Although benefits are standardized, costs may differ between plans. The cost of a Medicare Supplement plan may include a monthly premium in addition to the Part B monthly premium.
Source: ehealthmedicare.com

There Are Things That You Should Know About Medicare Supplement Plan F

Posted by:  :  Category: Medicare

Medicare is available to anyone who is age 65 or older, who is eligible for Medicare. People are eligible to sign up and enroll for a Medicare Supplement, or a Medigap, policy 3 months prior to the month they turn 65 and the three months after the person turns age 65. The person is able to qualify regardless of his or her health history. In other words, there is no health condition that will disqualify a person for this period, and prohibit that person from getting coverage. This means if you have any condition this is the best time to get your Medicare supplement quotes, and the agents we trust most of medicare supplement quotes is CompareMedicareSupplements.net.  Once the person has coverage, he or she should not drop it, as they would have to qualify medically in the future, unless there are certain circumstance that would qualify as an exception.
Source: deborahserani.com

Video: AARP Medicare Supplement Plan F – Is It The Best Medicare Supplement?

The Cost of Minnesota’s Average Medigap Plan

By pressing “Click Here And Get Your Quote ” above, (1) I consent to receive phone calls from TZ Insurance Solutions LLC or its affiliates, or one of its third-party partners, or their service provider partners on their behalf, regarding their products and services, at the phone number provided above, including my wireless number, if provided, and (2) I agree to this website’s privacy policy and terms and conditions. I understand that these calls may be generated using an automated technology. Partners may include SelectQuote, Allied Insurance, United Medicare, Insphere, eHealth and Coventry. You are not required to grant consent as a condition of purchasing any property, goods or services.
Source: medicaresupplement.com

Cheap Home Insurance Medicare Advantage Vs Medicare Supplement Medigap Plan F

1080p 2012 2013 after Amazon Android Best Black Business Card Computer Core Coupon Coupons Daily Deal Deals Dell Digital Extra FREE Friday from Google Groupon HDTV Home inch Intel Laptop LivingSocial Men’s more NEWEGG offers. online Phone Review SALE Samsung Shipped SHIPPING Tablet Video Wireless
Source: allinoneinternetsearch.com

ibm medicare options: IBM Extend Health

If you decide to stay with original Medicare part A & B and want secondary aka supplemental aka medigap insurance to cover your copayments and deductibles – I urge you to look at medigap F plans as a great category and in particular the version of the F plan that has a high deductible –  also referred to as F+ plans.  The + doesn’t mean more coverage it means there is a deductible. F plans provide the maximum coverage offered by a medigap. See the comparison chart at the end of this post for all the types of medigap plans that are available.  A reminder – no matter who is selling a medigap plan – the elements are always the same.  So, buy the cheapest medigap plan in the letter category you are considering.  There is no advantage to buying a higher premium policy. OK – so I like F plans because they cover everything.  Why the deductible version?  After all, the deductible portion of the F+ plan is currently $2110.  This deductible is set by Medicare and not by the insurance companies.  It goes up a bit every year but nothing drastic.  Last year it went up by $10. Even so, $2110 seems like a lot of money but when you do the math it really isn’t. At first, I did a bunch of calculations to decide whether or not to use a high deductible F plan. I looked at my coinsurance payments in 2012 and in 2013 and a lot of “what ifs” as to when would F be better than F+. In my opinion that is not at all necessary. Here is my current analysis;    
Source: blogspot.com

An Explanation Of Medicare Supplement Plan F

One of the more comprehensive supplement plans that is available is Medicare Plan F.  Consumers and private insurers both favor Plan F.  This is due to the fact that participants often end up getting all necessary care without need to pay out of pocket for anything.  Before you buy Medicare Plan F, you need to make sure that you have a good understanding of everything that is covered by it, so that you know whether or not this supplemental plan best suits your budget and needs.
Source: sammoore.org

An Introduction To The Medicare Supplemental Plan F at Jonathan Mods Central

In order to get a good understanding of Medigap Plan F, you need to examine the basic benefits covered as well as some additional benefits that participants are eligible for. To begin with, basic benefits include hospitalization through Part A, twenty percent of Medicare approved medical expenses through Part B and also the initial three pints blood every year as well as hospice care through Part A. The additional benefits beyond the basic Medicare benefits through Plan F also cover skilled nursing facility care, Part A as well as Part B care deductibles and Part B excess charges. It also offers coverage for individuals traveling abroad who end up needing emergency care.
Source: modscentral.com

Medicare Diabetic Supplies: What You Can Expect and How You Can Qualify

Posted by:  :  Category: Medicare

Other than diabetic supplies, Medicare also offers other benefits.  Since 2005, diabetes screening or Fasting Plasma Glucose Test is also offered for qualified individuals, who may be eligible to receive a maximum of two screenings per year.  This is offered to diabetic patients who have any of the following conditions:  hypertension, obesity, high blood sugar or dyslipidemia, a condition characterized by abnormal cholesterol levels.
Source: diabetesall.com

Video: New Medicare Diabetic Supply Program – a Nightmare

Wright & Filippis to sell its diabetic supply unit

Wright & Filippis Inc., a Rochester Hills-based medical supply company, has signed an agreement to sell its diabetic supply subsidiary by July 1 to Doral, Fla.-based US Med for an undisclosed price. The sale, which will result in the layoffs of about 30 employees over the next 60 days, was expected after Wright & Filippis failed to receive a contract from the Centers for Medicare and Medicaid Services under Medicare’s new competitive bidding procedure. “Wright & Filippis was not selected as one of Medicare’s approved contract suppliers for diabetic supplies,” said A.J. Filippis, the company’s president. “Because of this change, we decided it was an appropriate time to sell our diabetic supply business to US Med.” Medicare’s competitive bidding system for home medical equipment, designed to save the program more than $1 billion annually, could force as many as 90 percent of the 500 Michigan home health suppliers out of business, costing the state hundreds of jobs, said the Lansing-based Michigan Independent Providers Association. Association officials predicted last year that large national companies like US Med would begin to acquire smaller companies. Home medical equipment vendors provide supplies such as hospital beds, portable oxygen systems, diabetic products, knee braces, commodes, walkers and blood pressure monitors. Filippis said Wright & Filippis could not sustain its business model without the Medicare contract. “This was a necessary decision brought about by unfortunate market changes that were entirely out of our control,” said Filippis, adding that the pending sale of the diabetic supply business does not affect the company’s other products and services. Wright & Filippis, founded in 1944, specializes in prosthetics, orthotics, respiratory care services, home medical equipment and supplies. It operates 37 offices in Michigan with 930 employees. US Med is a national mail order provider of medical supplies and prescription medications for patients with chronic health care needs. Jay Greene: (313) 446-0325, jgreene@crain.com. Twitter: @jaybgreene
Source: crainsdetroit.com

Changes in Medicare for Diabetic Supplies, Wheelchairs and Other Medical Equipment

If a beneficiary lives in a contracted area such as Denver and travel outside of the area, they must use a contracted supplier that serves that area to avoid being charged for the medical equipment.  Also if beneficiaries live outside of a contracted area, special rules may apply. This is especially important for individuals who might live on the Western Slope and come to Denver for treatment.  Individuals who live on the Western Slope are outside of a contracted area; for them the Denver supplier will be paid differently, than if the beneficiary were purchasing the equipment from a supplier on the Western Slope. Most individuals who use multiple types of medical equipment will find themselves working with more than one supplier for equipment, as none of the national suppliers provide all types of medical equipment.
Source: myprimetimenews.com

Medicare Access to Diabetes Supplies Act of 2011 (2011; 112th Congress H.R. 1936)

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

Medicare Diabetic Supplies

Many diabetic Medicare beneficiaries prefer to order their testing supplies via mail because it is more convenient and less expensive for the beneficiary. But, according to the New York Times, this process has “caused Medicare headaches for years” because of its costs to Medicare and high levels of fraud. To curb these issues, Medicare tested out competitive bidding on mail-order blood sugar test strips by 18 companies in nine metropolitan areas. As a result, both issues were addressed. Medicare previously paid $77.90 for 100 test strips; now, it paid only $22.47 during this experiment. Beneficiaries also benefit: Copayment prices also fell from $15.58 to $4.49.
Source: ehealthmedicare.com

Medicare Diabetic Testing Supplies Mail Order Contract Suppliers List

April 2013 CMS Released a PDF Document containing the Legal Business Name of each Contract Supplier for the National Mail-Order Program. There has been much confusion and information seeking regarding the continued service of beneficiaries in need of Diabetic Testing Supplies and which companies could provide that service.
Source: medbill.net

April 1 Diabetic Supplies Fee Schedule Allowables

On Wednesday, January 2, 2013, the President signed into law the American Taxpayer Relief Act of 2012.  Section 636 of this new law revises the Medicare non-mail order fee schedule amounts for diabetic testing supplies.  Effective for items furnished on or after April 1, 2013, the non-mail order fee schedule amounts for Healthcare Common Procedure Coding System (HCPCS) codes A4233, A4234, A4235, A4236, A4253, A4256, A4258 and A4259    will be recalculated by removing the 5 percent covered item update for calendar year 2009 and applying a 9.5 percent reduction.  This will result in the fee schedule amounts for non-mail order diabetic testing supplies being equal to the fee schedule amounts for mail order diabetic testing supplies (denoted by KL modifier). 
Source: vgm.com

Medicare’s new policy for diabetic supplies

Are you planning to be financially independent as early as possible so you can live life on your own terms? Discuss successful investing strategies, asset allocation models, tax strategies and other related topics in our online forum community. Our members range from young folks just starting their journey to financial independence, military retirees and even multimillionaires. No matter where you fit in you’ll find that Early-Retirement.org is a great community to join. Best of all it’s totally FREE!
Source: early-retirement.org

Health Insurance Premiums Projected To Soar in 45 States Under Obamacare

Posted by:  :  Category: Medicare

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How this works out in practice, is that the monthly premium for a 27-year-old New Yorker before Obamacare is $500, expected to drop to $356 under the new law. Yay, savings—if the “young invincibles” show up. But in Arizona, monthly premiums for 27-year-olds average $102, expected to jump to $261.87 on the exchange. That’s…not so bargain-ish. And Gonshorowski expects that to be far more representative of the national experience under Obamacare than the first-aid administered to the New York market’s self-inflicted wounds.
Source: reason.com

Video: Obama Promises To Lower Health Insurance Premiums by $2,500 Per Year

How To Get Health Insurance Premiums As Tax Deductible

When it is time to file annual tax returns, you find many people comb over their tax forms with the hope of finding and item that could be included as a tax deductible. This is done to reduce their tax obligation. Recession and the dwindling economy have thrown many out of a job, and they find it hard to survive living on their savings. There is no provision in their budget to pay for large tax bills. Saving money on tax is possible if you give some to charity, or buy a new home. Mostly Americans are not aware that health insurance premiums have some tax deductible elements. However, not all insurance premium tax is deductible. So make sure the insurance you have gets you some sort of rebate from the tax.
Source: taxpremium.com

FAQ: Can We Reimburse Employees’ Subsidized Exchange Premiums?

As employers plan their health benefits strategy for 2014 and beyond, many are looking at ways to incorporate the advantages, and cost savings, of individual health insurance, the health insurance exchanges, and the individual health insurance tax subsidies. Others are just tired of group health insurance, or have never been able to afford it. One of the strategies growing in popularity is setting up an HRP to reimburse employees for their eligible health insurance expenses. This type of health benefits strategy is also called a “pure” defined contribution approach because the employer provides a healthcare allowance instead of a traditional group health insurance plan.
Source: zanebenefits.com

Daily Kos: Health insurance co

Have seen things like 24% price increases, (United Healthcare in August when my company tried to renew). I want to be clear here – I am not a fan of the Affordable Care Act. It is far too conservative and far too cozy with both for profit insurance companies and pharmaceuticals. This plan was Bob Dole’s wet dream just a couple of decades ago. But I understand that it can and has led to lower costs….for some. And the fact that it is a good deal though only for some is, in my opinion is the deal breaker. Because the working poor in this country and especially the working poor in red states, in many cases are going to see costs going up, not down plus they are going to take a hit they can’t afford at tax time. We are either a nation united in our interests or we are a loose group of fiefdoms, with different values, laws and goals. I don’t begrudge those people who are going to benefit from the ACA, for one thing because I have halfway decent insurance provided through my job. I do object however and strongly to the fact that this is just another tier in our already stratified society and another obstacle in the path of achievement for the poor, all for the cooperation of what passes for moderate Republicans which never materialized anyway. I hope for the best from this law and wish it all success but that doesn’t stop it being a conservative law which any Republican would be proudly embracing, save for the fact that there is a black Democrat in the White House. As for the blather about “building on it” or “improving it”, let’s be realistic, our political climate would have to undergo a paradigm shift for that to ever happen. Anything can happen and I understand that too but recent history doesn’t make me optimistic.
Source: dailykos.com

Daily Kos: What’s Behind Wisconsin’s High Health Insurance Premiums? His Name Is Scott Walker

for current complications with having insurance in one state and your medica providerl in another. With each state have their own sets of eligibility and coverage regulations, for both medical providers and insurance providers, the legalities would very likely present conflicts of responsibility and accountability. I know that in my state, Wisconsin, if you are on Medicaid, you must either be in a state HMO (managed care), or be pay for service, where you can see any Wi. state certified Medicaid provider, and, except in emergency situations for out of state medical care, the provider must be willing to accept your insurance coverage.  Private, commercial insurances very likely will have their own set of rules, possibly differing from state to state. Of course single payer would wash away all of this crap; ACA gives us a smorgasbord of insurances, providers within your state.  The problem is the restaurant to which we are currently consigned-that’s all that’s on the menu.
Source: dailykos.com

Heritage Chart Illustrates Higher Health Insurance Premiums After Obamacare

You could call me state by state; I can tell you.  There’s one state where the prices are gonna go down, one state.  It’s New York.  That’s because the state and Obamacare mandates there are in place.  There’s a convoluted reason for it.  It’s temporary.  It’s gonna balloon everywhere.  But the increases are anywhere from 71 to a 100% in that age-group in many of the states. Government’s open again, folks! Government’s open so we can all just… I learned this from the Republican establishment. 
Source: rushlimbaugh.com

Need health insurance? Check out this map of costs

abortion ACA Art Pope budget charter schools consumer protection corporations corruption Crucial Conversation DHHS economy Education energy environment federal budget fracking Gov. Pat McCrory Health health care immigration jobs K-12 Legislature LGBT rights Marriage discrimination amendment medicaid NC General Assembly obamacare Pat McCrory Phil Berger poverty public education public schools Reproductive rights right-wing school vouchers state budget taxes Tax reform teachers Thom Tillis Unemployment unemployment insurance voter ID Voter Suppression
Source: ncpolicywatch.org

This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges

This tool illustrates health insurance premiums and subsidies for people purchasing insurance on their own in new health insurance exchanges (or “Marketplaces”) created by the Affordable Care Act (ACA). Beginning in October 2013, middle-income people under age 65, who are not eligible for coverage through their employer, Medicaid, or Medicare, can apply for tax credit subsidies available through state-based exchanges.
Source: thepatriotnation.net

The Loose Nukes: Why your health insurance premiums are really rising!!!

The  following is an official announcement from the Health Insurers of America, finally answering once and for all the question I have been asking for years – Why are my damn health insurance premiums rising?  Of course, it doesn’t answer the question of why they’ve risen astronomically (apparently based on the Mayan calendar) every year ad nauseum.  At least I can finally rest assured that it is not the fault of greedy health insurers trying to squeeze every last dollar out of consumers. You can also watch this announcement on the official Website of the Health Insurers of America. **************** Keeping our customers informed and aware of changes in premiums has always been a goal of, the Health Insurers of America. In response to a volatile and uncertain market preceding Health Care Reform legislation, your health insurance premiums can be expected to rise. In response to the volatile and uncertain market following the passage of the Affordable Care Act, your health insurance premiums can be expected to rise.
Source: blogspot.com

The Truth About Obamacare Health Insurance Premiums

1. Comparing apples to apples is virtually impossible. The first thing to understand is that policies that will be sold to individuals and small businesses in online marketplaces are brand new and must cover a range of essential benefits that were not always covered in the past. That includes prescription drugs, hospitalization and maternity coverage. Consumers cannot be turned away or charged more because of health problems, as they can now in most states.  Women cannot be charged more than men. In addition, the amount you’ll have to pay out of pocket will be capped at $6,350 for singles or $12,700 for families. Currently, almost a third of individual policies have caps that exceed those amounts, according to a report by Kaiser Health News and U.S. News & World Report.   “You have to compare apples to apples, to the extent you can. But those apples don’t exist,” said Joseph Antos, an economist at the conservative American Enterprise Institute. “There isn’t a good way to do comparisons.”
Source: thefiscaltimes.com

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December 04, 2013

Ninth Circuit Vacates Injunctions Barring HHS From Seeking Prepayment of Medicare Secondary Payer Reimbursements

Posted by:  :  Category: Medicare

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On appeal, HHS argued that the plaintiffs lacked standing, that the case was moot, and that the district court lacked subject matter jurisdiction.  HHS also argued that, on the merits, HHS’s interpretation of the Medicare secondary payer provisions was reasonable.  The Ninth Circuit held that the lead plaintiff failed to satisfy her presentment and exhaustion requirements when she filed her claim at the administrative level.  Because the claim was not properly presented to the agency, the Ninth Circuit found that the district court lacked subject matter jurisdiction.  On the merits, the Ninth Circuit held that HHS’s construction of the reimbursement provision was rational and consistent with the statute’s text, history, and purpose, and it vacated the injunctions entered by the district court.  The Ninth Circuit remanded the case for consideration of the plaintiffs’ due process claims.
Source: jdsupra.com

Video: Setting up Medicare as Primary Insurance and Commercial Insurance as Secondary Insurance

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

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

Insurance Company Not Liable For Reverse False Claim

Mason brought a False Claims Act suit against State Farm, alleging that State Farm was liable for a “reverse false claim” under 31 U.S.C. § 3729(a)(1)(G).  A reverse false claim occurs when a person knowingly makes, or causes to be made, a false statement to avoid or decrease an obligation to pay the Government.  The court found that State Farm caused no false statement to be made.  The invoice submitted by St. Luke’s to Medicare was not false because Medicare had a statutory obligation to reimburse St. Luke’s under the Medicare Secondary Payer statute, 42 U.S.C. § 1395y(b)(2)(B)(i), since State Farm, the primary insurer, did not appear that it would make payment within 120 days of the service. 
Source: fcaalert.com

Medicare Secondary Payer and Late Enrollment Penalty Family Fairness Act of 2012 (2012; 112th Congress H.R. 6435)

Medicare Secondary Payer and Late Enrollment Penalty Family Fairness Act of 2012 – Amends title XVIII (Medicare) of the Social Security Act to apply the eligibility requirements of Medicare special enrollment periods, secondary payer rules, and late enrollment penalties in a way to take into consideration the current employment status of all family members of an employee (currently, only the employment status of the employee or of the employee’s spouse).
Source: govtrack.us

On Medicare + secondary INsurance

I don’t know about pen needles, but you can get a list of Medicare approved vendors. I get my supplies (which is meds and test strips, basically) from Wal Mart, but other approved are Walgreen’s, any Kroeger store, and several others. Should be something on line you could find out. I was told to search "diabetic durable supplies".
Source: diabetesdaily.com

Medicare Open Enrollment Ends Dec. 7

· Spanish, Medicare, 1-800-633-4227 · Spanish, National Alliance for Hispanic Health, 1-866-783-2645 · Korean, National Asian Pacific Center on Aging, 1-800-582-4259 · Chinese, National Asian Pacific Center on Aging, 1-800-582-4218 · Vietnamese, National Asian Pacific Center on Aging, 1-800-582-4336 · Ask a trusted friend or relative for help
Source: orcasissues.com

Medicare Secondary Payer Training

The training covered the Medicare Secondary Payer Act, Mandatory Insurer Reporting, Conditional Payment Resolution, Workers’ Compensation Medicare Set Aside Allocations, Liability Medicare Set Aside Allocations, Conditional Payment Resolution for Medicare Part C beneficiaries, Post Settlement Administration of Medicare Set Asides and Special Needs Trusts and finally, compliance with the SMART Act.
Source: il.us

Why Dialysis Costs So Much, Part 2: Medicare Secondary Payer Regulations

Solutions such as DiaSource negotiate directly with an accredited network of dialysis providers to secure the lowest treatment rates possible. DiaSource works with insured patients to find the most convenient location for them at a price far below average. Typically, DiaSource saves private insurers, self-insured employers and third-party administrators 76 percent per treatment.
Source: diasourcesolution.com

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December 04, 2013

Fewer Illinois Children Lack Health Insurance, New National Report Shows

Posted by:  :  Category: Medicare

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“Illinois residents and its leaders should be proud of the progress we’ve made improving children’s coverage,” Andrea Kovach with the Sargent Shriver National Center on Poverty Law said in a statement. “And we should be excited about more of their parents getting coverage for the first time as a result of new coverage choices under the Affordable Care Act. When every member of the family has coverage, kids are more likely to get regular preventive care to keep them healthy and see a health care provider sooner when they are sick.”
Source: progressillinois.com

Video: The Basic Economics of National Health Insurance – Professor Richard D Wolff

Providence Selected to Participate in National Initiative to Expand Health Care Access for Children, Families

Providence will develop a plan aimed at reducing the number of uninsured youth in the city by at least 1,800 children, from the current estimated 3,469 uninsured children based on 2009-2011 American Community Survey data. The majority of these children will be those who would already be eligible for, but not enrolled in RIte Care prior to passage of the Affordable Care Act, but whose parents may have had different health coverage options as a result of the law and other local changes made in Rhode Island.
Source: providenceri.com

Illinois is a National Leader in Children’s Health Insurance Coverage : The Shriver Brief

. Children in All Kids are able to receive annual checkups and visit the dentist, which means that they receive necessary vaccinations and that illness can be caught early to allow for more time in the classroom. Children in All Kids have a “medical home,” which means that the state of Illinois has been successful in connecting individual All Kids enrollees to a provider who knows the child’s health history and can provide health care on a regular basis. These investments ensure Illinois kids show up at school ready to learn and are on the right track to become healthy, productive young adults.
Source: theshriverbrief.org

WASHINGTON: White House: On track for health care website goal

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Source: myrtlebeachonline.com

Health care reform: A chronic national malady — High Country News

We currently spend 20 percent of our Gross Domestic Product on health care, about double what most other countries spend. For a time, the explanation for this huge disparity was thought to be that Americans use more health services, but studies have proven that isn’t the case. The truth is that our health care prices are ridiculously inflated, leading to profits in the industry of about 20 percent –– similar to the profits expected in the financial sector. Alone among industrialized countries, we have a for-profit health insurance industry mediating these services and jacking up the prices even more.
Source: hcn.org

The National Health Insurance pilot programme: Assessing the first eighteen months

Achieving universal healthcare coverage will depend on shifting the central focus of health service delivery from the tertiary hospital level to the community level. Particular emphasis must be placed on rural areas and on marginalised and vulnerable groups. A more equal distribution of skilled health workers is also important. At the district level, we need to ensure that there are enough doctors, nurses, specialists, and community health workers to deliver promotional, preventative, curative and rehabilitative services. To support a more comprehensive range of services, including those outlined in the NSP, primary healthcare delivery will need to be integrated, so that different levels within the healthcare system are able to support each other better. Newly-formed District Specialist Teams have started this process by investigating how GPs will be contracted into providing support at PHC facilities, and how school-based PHC services will be re-introduced. Greater levels of civil society engagement will also be required if the new system is to be designed effectively and maintain accountability.
Source: nspreview.org

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