Obamacare’s Impact on Medicare Advantage

Posted by:  :  Category: Medicare

Build on the steady progress in risk adjustment. Risk adjustment is a tool used to address selection bias in Medicare Advantage and other private insurance programs. The goal is to mitigate an insurer’s ability to tailor plans to attract a disproportionate share of the most profitable enrollees—healthier enrollees that consume less medical services. Every major Medicare reform proposal, based on premium support, would provide risk adjustment or significantly improve the risk-adjustment formulas or mechanisms that currently exist in the MA or Medicare Part D program. Risk adjustment could either be prospective or retrospective. Prospective risk adjustment already characterizes Medicare Advantage and Medicare Part D, where government per capita payments are adjusted by demographic factors, such as age, sex, institutional or Medicaid status, and medical conditions. Retrospective risk adjustment—back-end adjustments—would be based on new pooling arrangements, such as a risk-transfer pool. In that arrangement, health plans that attracted higher-risk or more costly patients would be cross-subsidized by plans that attracted fewer high-risk or less costly patients. The value of these types of arrangements is that they would be based on hard data and not on educated guesswork or projections. The Wyden–Ryan plan, for example, includes such an approach. The Heritage proposal would include both prospective and retrospective risk adjustment. Applying the lessons from MA’s risk-adjustment experience could mitigate the risks that only the unhealthy would be stuck in Medicare fee-for-service plans, leaving the plans’ costs to escalate and grow further away from the premium support benchmark, and thus more expensive for enrollees. Over the past decade, as Alice Rivlin and others have noted, the risk-adjustment mechanism used in Medicare Advantage has significantly improved and succeeded in reducing favorable selection in the program. In the future, with the adoption of defined-contribution financing for the entire Medicare program, one can expect further refinements and innovative approaches to adjusting government per capita payments. One particularly interesting approach has been developed by Zhou Yang, professor of economics at Emory University. Professor Yang’s proposal, to be implemented within an environment of competitive health plans, would tie Medicare payments to positive behavioral changes: Enrollees would be rewarded for enrollment in wellness or preventive-care programs that promote a healthier (and thus less costly) lifestyle.[44]
Source: heritage.org

The Evolving Reimbursement Rights of Medicare Advantage Plans

Arkansas will not recognize an insurer’s right to subrogation unless the insured has been “made whole” for his or her injuries. Franklin v. Healthsource of Ark., 942 S.W.2d 837 (Ark. 1997). In determining whether or not an insured has been “made whole,” Arkansas employs the “Franklin Test” under which the recovery (including recovery from the third party tortfeasor and insurance proceeds) is subtracted by the loss sustained and expense incurred. Id. Arkansas will uphold this rule even where there is an express subrogation agreement but the insured has not been fully compensated for his/her loss. Am. Underwriters Ins. v. Turner, 944 S.W.2d 129, 130 (Ark. App. 1997). The Supreme Court of Arkansas has also recently held that unless an agreement has been reached between an insured and its carrier, the “subrogation lien cannot arise, or attach, until the insured has received settlement proceeds or damage award and until there is a judicial determination that the insured has been made whole.” Riley v. State Farm Mutual Auto. Ins. Co., 2011 Ark. 256.
Source: americanbar.org

Need help finding the 2015 Medicare Advantage Part D Plan that best meets your needs?

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Source: q1medicare.com

​UPMC’s Medicare Advantage Provider Contracts with Highmark Will Not Be Extended for 2016

Nearly a year ago, however, Highmark stopped paying UPMC the rates specified in those contracts for that world-class care—including treatment for cancer at the renowned Hillman Cancer Center—and claimed that it has the right to reduce rates whenever and however it wishes. Although UPMC gave Highmark more than sufficient opportunity to take the required corrective actions, it has refused. As a result of Highmark’s breach of its UPMC contracts, and in keeping with UPMC’s right to end the contracts at the end of each calendar year with or without cause, UPMC has provided Highmark with notices of non-renewal of the current Medicare Advantage contracts effective January 1, 2016. No responsible organization could enter into—let alone extend—such illusory and one-sided contracts.
Source: upmc.com

Easy Choice Health Plan (HMO)

If you are looking for a Medicare Advantage Prescription Drug Plan that not only allows for “one stop service” for all your physician, hospital and prescription drug needs, but also provides additional, non Medicare covered benefits, at virtually no cost to you, you’ve come to the right place! Easy Choice Health Plan (HMO) is a federally approved Medicare Advantage Prescription Drug (MAPD) and Special Needs Plan (SNP) designed to provide medical and prescription drug coverage for qualifying individuals in Los Angeles, Alameda, Fresno, San Diego, Santa Clara, Stanislaus, Riverside, Orange, San Joaquin, and San Bernardino counties, California.
Source: easychoicehealthplan.com

Medicare Benefits Schedule (MBS)

Posted by:  :  Category: Medicare

MBS service statistics broken down by Commonwealth Electoral Division (CED) are available in the PDF files below. File 1 details Medicare Safety Net statistics for the 2010 calendar year of service by CED and File 2 details Medicare Bulk Billing statistics for the 2010 – 11 financial year of processing by CED. It is important that you read all notes on these files.
Source: gov.au

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: Medicare Fee Schedule for Office Visit CPT Codes

MedicarePaymentandReimbursement.com provides Medicare Payments, Billing Guidelines, Fees Schedules 2010, Medicare Eligibility, 2011 Medicare Deductibles, Allowables, CPT Codes for Medicare, Phone Number, Hearing Aids, Denial, Address, Medicare Appeal, PQRI, EOB, Medicare and Medicaid Services.
Source: medicarepaymentandreimbursement.com

Best Medicare Supplement Insurance Quotes

Posted by:  :  Category: Medicare

Every Medicare supplemental insurance plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental insurance plan identified by letters A through N. Each modernized Medicare supplemental insurance plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplement (Medigap) Insurance Plans

MedSupp plans can help pay Original Medicare’s copayments and deductibles. Each type of plan offers a different level of coverage, and is named with a different letter (such as Plan A). The plans are standardized, so that all plans of the same letter offer the same benefits. In other words, the benefits for a Medicare Supplement Plan D enrollee in Rhode Island are the same for a Medicare Supplement Plan D enrollee in Tennessee. However, the premiums can differ among these private insurance companies.
Source: planprescriber.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare Supplement Insurance Plans

Medicare wouldn’t be insurance if there weren’t regulations governing their every move and Medicare Supplement Insurance (Medigap) is no different. In order for each state to offer Medigap coverage there are some guidelines that they have to abide by, with the exception of Massachusetts, Minnesota and Wisconsin that offer other guidelines. Here are the requirements for each state that offers Medicare Supplement Insurance, let you representative know if you are not receiving one of the benefits or coverage options listed below: continue reading "What Makes a Medicare Supplement Insurance Policy Standard?"
Source: medicaresupplementinsurances.com

Medicare Supplement Insurance and Plans

Medicare is the federal program the vast majority of Americans 65 and older depend on for their healthcare. People under 65 with disabilities and individuals with end-stage renal disease can also qualify. Medicare is commonly divided into four parts. Original Medicare Part A and Part B help pay costs for hospital care and medical expenses, respectively. Specifically, Part A pays for medically-necessary inpatient hospital services, skilled nursing facility care after a hospital stay, certain home healthcare, and hospice care. Part A does not pay for private hospital rooms, surgery that is not deemed medically-necessary, most care received outside the United States, unskilled personal care, and a variety of other services. Part B, meanwhile, pays only 80% of most Medicare-covered medical costs. Deductible, copayment, and coinsurance costs associated with Original Medicare add up quickly for many people.
Source: medicaremall.com

How to Reform Medicare: First Stage to Fix the Current Program

Posted by:  :  Category: Medicare

[5]The significant differences in official long-term projections, including projections of the program’s unfunded liability, reflect the differences in agency assumptions, particularly about the likelihood of the continuation of current law. The Medicare Trustees and the Congressional Budget Office (CBO) are required to make projections under current law, which assumes, for example, that the large Medicare Part A payment reductions are sustainable and that the projected 29.4 percent reduction in Medicare physician payment will be implemented in 2012. The Office of the Actuary in the Centers for Medicare and Medicaid Services (CMS) makes projections based on the premise that key elements of current law are simply “unworkable.” See John D. Shatto and M. Kent Clemens, “Projected Medicare Expenditures Under an Illustrative Scenario with Alternative Payment Updates to Medicare Providers,” Centers for Medicare and Medicaid Services, Office of the Actuary, May 13, 2011, at https://www.cms.gov/ReportsTrustFunds/downloads/2010TRAlternativeScenario.pdf (September 19, 2011).
Source: heritage.org

2015 Medicare Part D Program Compared to 2014, 2013, 2012 and 2011

Proposal in the 2015 Advanced Notice: This rule proposes to revise the definition of negotiated prices to require all price concessions from pharmacies to be reflected in negotiated prices. The proposed rule would provide greater cost savings for beneficiaries in return for offering preferred cost sharing so that sponsors cannot incentivize use of selected pharmacies, including the sponsors’ own related-party pharmacies that charge higher rates than their competitors. Also, CMS may request that Part D plans increase the number of pharmacies offering preferred, or lower, cost sharing as CMS is concerned that some plans that offer preferred cost sharing do not provide beneficiaries with sufficient access to the lower cost sharing at select network pharmacies. The intent of this policy will be to ensure that beneficiaries are not misled into enrolling in a plan only to discover that they do not have meaningful access to the advertised lower cost sharing. From the 2015 Announcement: Although we [CMS] are not adopting any network adequacy standards at this time, sponsors should be aware that we are continuing to monitor beneficiary access to preferred cost sharing in plans that purport to offer it. For the 2014 and 2015 plan years, we [CMS] will continue to review the retail networks of plans offering preferred cost sharing and will continue to take appropriate action regarding any plan whose network of pharmacies offering preferred cost sharing appears to offer too little meaningful access to the preferred cost sharing. For instance, a stand-alone PDP that offers preferred cost sharing at only seven pharmacies in a PDP region may be asked to increase the number of pharmacies offering preferred cost sharing or to restructure its benefit design during the bid negotiation process. The intent of these negotiations will be to ensure that beneficiaries are not misled into enrolling in a plan only to discover that they do not have meaningful access to the advertised lower cost sharing. We [CMS] note that beginning in 2015, we [CMS] will no longer use the terms "preferred" and "non-preferred" to describe network pharmacies, but rather will describe such pharmacies as offering standard or preferred cost-sharing.
Source: q1medicare.com

Medicare Open Enrollment, 8 Changes You Can Make

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do
Source: aarp.org

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

How to Apply for Medicare With a Disability

Consider what type of Medicare you need. There is Part A and Part B. Part A is hospital insurance, while Part B is Medicare insurance. If you’re not sure whether you qualify for coverage–or if you don’t know if you need Part A, Part B or both–simply call the Social Security Administration at (800) 772-1213. It handles all eligibility determinations. Get answers to your questions the easy way. See “Additional Resources,” below, for a link to the official website. For immediate assistance, simply call the number during normal business hours.
Source: ehow.com

SSI or SS Disability Application & Benefits

Experience really does matter. We have been doing Social Security application advocacy exclusively for over 15 years, and have learned a lot along the way. We have grown to one of the largest and most successful disability offices in the country. We handle all paperwork out of our offices in Utah, and have full-time advocate representatives all over the country to represent our clients at hearing when necessary. This process allows for great efficiency for our clients and quicker and more successful results. Because our representatives live locally, you get the service of a local rep, who knows the local judges, but the efficiency and knowledge base of a large nationwide office.
Source: ssdisabilityapplication.com

Disability Planner: Medicare Coverage If You’re Disabled

Everyone with Medicare also has access to prescription drug coverage (Part D) that helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s "How to get drug coverage" page.
Source: ssa.gov

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

10 Things You Must Know About Medicare

There are several enrollment periods, in addition to the seven-month initial enrollment period. If you missed signing up for Part B during that initial enrollment period and you aren’t working, you can sign up for Part B during the general enrollment period that runs from January 1 to March 31 and coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are still working, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you stop working (regardless of whether you have retiree health benefits or COBRA). If you miss your special enrollment period, you will need to wait to the general enrollment period to sign up. Open enrollment, which runs from October 15 to December 7 every year, allows you to change Part D plans or Medicare Advantage plans for the following year, if you choose to do so. (People can now change Medicare Advantage plans outside of open enrollment if they switch into a plan given a five-star quality rating by the government.)
Source: kiplinger.com

Compare Medicare Supplement (Medigap) Plans and Rates in Your Area

Posted by:  :  Category: Medicare

"Times have changed since my mother had an AARP J plan and I was totally confused by the options available. Stan walked me through the process in a very educational, methodical, friendly way, and I feel secure now that we’re making the correct decision to provide the best possible coverage for my husband." – Pat K.
Source: medigap360.com

Best Medicare Supplement Insurance Quotes

Every Medicare supplemental insurance plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental insurance plan identified by letters A through N. Each modernized Medicare supplemental insurance plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Medicare Supplemental Insurance

Finding the best Medicare Supplemental insurance, Medicare Advantage, and Medicare Part D has gotten more complicated nearly every year. In 2010 Medicare Supplement Insurance added 2 new plans Medigap plan N and Medigap Plan M. At the same time they eliminated several other Medicare Supplement options. Medicare Advantage insurance plans redefine benefits and premiums every year. And, with future Medicare subsidies uncertain due to changing regulation from healthcare reform who can keep up. For many individuals Medicare Supplement Insurance is becoming the best option. Unfortunately, comparing Medicare Supplemental Insurance Plan premiums (Medigap) and Medicare Advantage plans can be a time consuming endeavor. Our highly trained insurance advisors can explain all of your supplemental Insurance options, and assist in finding the best Medicare supplement and Medicare Part D combination that best fits your specific needs. With all the options affecting Supplement insurance and Part D it makes sense to have an expert assist you through the maze.
Source: mysenioradvisorsgroup.com

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplemental Insurance & Medigap

Learn how a Mutual of Omaha Medicare supplement insurance plan can reduce your out-of-pocket health care costs. Review Medicare supplement insurance basics, determine which Medicare supplement insurance policy is best for you, or get a Medicare supplement insurance quote.
Source: mutualofomaha.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Advantage Fact Sheet

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

Medicare HMO and PPO Coverage and Options

For example: George C. lives in Massachusetts and has a Medicare Advantage Plan through Fallon Community Health, one of the highest-rated health plans in the country. He has an HMO plan with drug coverage. His monthly premium cost for the plan is $208.40 (the Medicare Part B premium of $96.40 plus $112 charged by Fallon). Also, his out-of-pocket expenses include a $15 copay for each PCP visit, $20 for each specialist visit, 10% coinsurance for durable medical equipment, and an annual deductible of $310 for prescription medications.
Source: about.com

California Health Advocates: Medicare Policy, Advocacy and Education

Bonnie Burns, our Training and Policy Specialist, begins her 23rd term as one of the 20 appointed and funded consumer liaison representatives by the National Association of Insurance Commissioners (NAIC). Ms. Burns spearheaded the standardization of Medicare supplemental insurance, known as Medigap and has provided numerous Congressional testimonies guiding the standardization of long-term care insurance and the policies for financing long-term care.
Source: cahealthadvocates.org

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Forum for Medicare Information and Discussions

This is the place to discuss and share information about Medicare. Everyone is welcome to participate, and our goal is to make this a respected Medicare resource. Register to unlock all the features of our forum, it is free and only takes a minute. Please contact me personally if there are any problems or questions about the forum. Mack
Source: mymedicareforum.com

TMF: Laminate my Medicare card? / Retired Fools

I’ve asked around among my doctor friends about Medicare Advantage versus Medicare plus Medigap. 100% of the docs have indicated that they would go or have gone with Medicare plus Medigap. The primary reason seems to be the network rules for MA, which limit the docs and hospitals that you can access. In some place, this might not be an issue, but it apparently is in other places. I go on Medicare at the end of the year, and I’ve almost decided on Medicare and Medigap, as opposed to MA. Another potential reason is that ObamaCare has as a goal the destruction of MA plans. They want everyone on regular Medicare. In fact, they have proposed regs that will limit the coverage of Medigap, but who knows if the regs will ever come into force.
Source: fool.com

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Hospital Compare Quality of Care

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

About the CMS Innovation Center

Every test of a new service delivery or payment model developed by the Innovation Center also includes a plan of action to ensure that the lessons learned and best practices identified during the test can be spread as widely and effectively as possible to support improvement for both CMS and the health care system at large. Evaluation results are shared with participating providers on an ongoing basis in order to promote more rapid learning. The Innovation Center has also created learning collaboratives for providers in our models to promote broad and rapid dissemination of evidence and best practices that have the potential to deliver higher quality and lower cost care for Medicare, Medicaid and CHIP beneficiaries.
Source: cms.gov