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

Medicare Explained: Understanding the Basics from Part A to Part D

Posted by:  :  Category: Medicare

Health care is one of the toughest financial challenges you’ll face in retirement. For millions of retirees, Medicare coverage that takes effect for most people at age 65 is the key to being able to afford health care costs that would otherwise quickly sap their retirement savings. But over the years, Medicare has gotten increasingly complicated, and with the emergence of Obamacare, Americans are struggling to understand exactly how to get their health care covered. To help you get a handle on Medicare, let’s run through the different types of coverage the program provides. The Medicare Alphabet Since 1965, Medicare’s two original components have helped cover basic health needs. The first, known as Part A, focuses on the costs of health care at medical facilities, providing coverage for medically necessary care at hospitals while you’re receiving inpatient care. Under some circumstances, it also covers costs for home health services, hospice care, and skilled nursing facilities. However, nursing home costs are covered only for limited purposes and time periods. Medicare Part B covers the costs of health care outside medical facilities, such as doctors’ visits, outpatient procedures, and lab tests. It also helps cover the cost of services related to health care, such as wheelchairs and scooters, oxygen tanks, and ambulance services. In addition to providing coverage for health care needs that qualify as medically necessary, Part B also covers certain preventive-care services, such as screening for heart conditions, diabetes, and certain types of cancer. In addition to government-provided Parts A and B, Medicare Part C is optional private insurance that Humana (HUM), Aetna (AET), UnitedHealth (UNH), and others provide. Better known as Medicare Advantage Plans, Part C involves paying premiums to those insurers, which then provide coverage for charges that Parts A and B don’t pay for. Medicare Advantage Plans vary greatly both in cost and in scope of coverage, so you have to look closely at all your options to make sure they fit what you want from a plan. Finally, Medicare Part D provides prescription drug coverage. Like Medicare Advantage Plans, Part D plans are offered through private insurance companies, and the coverage that different policies offer can vary widely from insurer to insurer and from plan to plan. In fact, many Part C Medicare Advantage Plans include Part D options within a single package. How You Pay for Medicare Each part of Medicare has different charges associated with it. For Part A, those who’ve had Medicare taxes withheld from their pay for at least 40 calendar quarters during their lifetime are eligible for free coverage.
Source: aol.com

Medicare Plans for Different Needs

UnitedHealthcare is dedicated to helping people nationwide live healthier lives. Our goal is to simplify the health care experience, help you meet your health and wellness needs and carry on trusted relationships with care providers. We offer a wide range of Medicare Advantage, Medicare prescription drug and Medicare Special Needs Plans that might be a good fit for you.
Source: uhcmedicaresolutions.com

California Health Advocates

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Medicare Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing: September 2010

Medicare Payment and Reimbursement .com provides Medicare Payments, Billing Guidelines, Fees Schedules , Medicare Eligibility, Medicare Deductibles, Allowable, CPT Codes for Medicare, Phone Number, Denial, Address, Medicare Appeal, PQRI, EOB, Medicare and Medicaid Services.
Source: medicarepaymentandreimbursement.com

National Correct Coding Initiative Edits

The CMS developed the National Correct Coding Initiative (NCCI) to promote national correct coding methodologies and to control improper coding leading to inappropriate payment in Part B claims. The CMS developed its coding policies based on coding conventions defined in the American Medical Association’s CPT Manual, national and local policies and edits, coding guidelines developed by national societies, analysis of standard medical and surgical practices, and a review of current coding practices. The CMS annually updates the National Correct Coding Initiative Coding Policy Manual for Medicare Services (Coding Policy Manual). The Coding Policy Manual should be utilized by carriers and FIs as a general reference tool that explains the rationale for NCCI edits.
Source: cms.gov

State of Oregon: Medicare starts at 65

Posted by:  :  Category: Medicare

Oregon provides this information to help you understand Medicare before you turn 65. Even if you continue to work or are not receiving Social Security, you need to know about Medicare to avoid penalties in your Medicare coverage.
Source: oregon.gov

State of Oregon: Medicare Help

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Source: oregon.gov

Oregon Health, Dental, Medicare Supplement and Medicare Advantage Plans

CDA Insurance LLC offers several full lines of Oregon Health Insurance and related insurance coverage. We compare the policies for you, so you only need to look at 2 or 3 plans which meet your needs, instead of 20 to find the one that might. Information and applications (online, and print & mail-in) are available for individual, group, short term medical, travel, HSA, Medicare Supplement and Medicare Advantage plans. We help you get the best coverage, the right plan, and the lowest cost. Our service area includes Portland, Beaverton, Hillsboro, Forest Grove, Tualatin, Lake Oswego, Gresham, Salem, Eugene, Medford, Grants Pass, Klamath Falls and the rest of the State of Oregon. You can view rate and benefit information from HealthNet, Kaiser, LifeWise, Moda Health, PacificSource, Providence and Regence. You can also use our online quoting system and get your answers immediately.
Source: oregon-health-insurance.com

Medicare Advantage & Medicare Supplement Plans in Oregon

MAPD Special Needs Plan: Medicare SNPs are a type of Medicare Advantage. You can join a Medicare SNP if you have Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance), live in the plan’s service area, and meet the plan’s eligibility requirements. Medicare SNPs are for members who either have a specific chronic condition/disease, are living in institution/nursing home or require nursing care at home, or have both Medicare and Medicaid. Medicare SNPs tailor their benefits, provider choices, and drug formularies to best meet the specific needs of the groups they serve.
Source: ehealthlink.com

Helpful phone numbers and websites for Oregon Medicare beneficiaries

The resources listed on these pages are provided for your convenience and information only.  Acumentra Health does not endorse specific resources. The links listed on this page may take you to websites that are not owned by Acumentra Health. Please note that the statements in Acumentra Health’s Internet privacy policy apply only to our website. If you wish to know the privacy policy of another website, contact the webmaster of that site.
Source: acumentra.org

Medicare Advantage 2015 Spotlight: Enrollment Market Update

Posted by:  :  Category: Medicare

While Medicare Advantage enrollment is increasing in many states, in 6 states (AK, DE, MD, NH, VT and WY) less than 10% of beneficiaries are enrolled in Medicare Advantage plans in 2015, which was also the case in at least the prior three years (Figure 5). In contrast, in 22 states (versus 18 states in 2014 and 15 states in 2013) more than 30 percent of beneficiaries are enrolled in Medicare Advantage plans in 2015. Additionally, in 5 states (FL, HI, MN, OR, and PA) more than 40 percent of beneficiaries are enrolled in Medicare Advantage plans, and Medicare Advantage enrollment these states account for 6% of all Medicare beneficiaries and 21% of all Medicare Advantage enrollees. This variation reflects the urban origins of health maintenance organizations (HMOs) in Medicare Advantage and other factors, such as the history of managed care in the state and the prevalence of employer sponsored insurance for retirees. Within states, Medicare Advantage penetration varies across counties. For example, 43 percent of beneficiaries in Los Angeles County, California are enrolled in Medicare Advantage plans compared to only 8 percent of beneficiaries in Santa Cruz County, California.
Source: kff.org

Medicare Advantage Plans: Medicare Health Plans

All of our available doctors welcome our Medicare health plan members – and you can switch at any time, for any reason. Plus, you’ll often get the convenience of having your doctor, lab, and pharmacy in one location.
Source: kaiserpermanente.org

Medicare: Medicare Enrollment

*Plan performance summary star ratings are assessed each year and may change from one year to the next. (Centers for Medicare & Medicaid Services Health Plan Management System, Plan Ratings 2012. Kaiser Permanente contract #H0524, #H0630, #H1170, #H1230, #H2150, #H6360, #H9003). This page was last updated: October 1, 2012 at 12 a.m. PT
Source: kaiserpermanente.org

Kaiser Permanente Medicare Advantage Plans with Part D (Prescription Drug) Coverage

The following Kaiser Permanente plans offer Medicare Advantage and Part D coverage to Washington residents. Medicare Advantage plans, also known as Medicare Part C, are alternatives to original Medicare. These plans help cover the costs of services provided by hospitals, doctors, lab tests and some preventive screenings. These plans’ Part D component helps cover prescription drugs. Even if a plan’s monthly premium is $0, you would still pay the equivalent of the original Medicare premium. Not all plans shown here will be available to you; enter your zip code to see plans in your area. You can read about whether Medicare Advantage is right for you. If you only want plans with drug coverage, browse Prescription Drug (Part D) Plans.
Source: usnews.com

Medicare Eligibility Requirements

Posted by:  :  Category: Medicare

In purchasing a Medigap Supplemental Insurance Policy, getting enrolled by the initial enrollment period is very crucial. If you apply during the IEP, by law, you are guaranteed that all insurers selling Medigap coverage in your state must offer you all the Medigap Supplemental Policy coverage plans that they sell. In addition, this guarantees, by law, that the insurance rate premiums offered to you will be the same as a person considered to be in good health. This applies, regardless of the fact that your current or past health history may not have been good or you have ongoing health issues.
Source: medicare.net

Medicare Eligibility Rules

If you are age 65 and currently receiving Social Security or Railroad Retirement Benefits, you are eligible for Medicare and you will be automatically enrolled in Medicare Part A and Part B. However, because Part B has a premium, you have the option of declining Part B coverage. In addition, Part B does require payment of a monthly premium of $104.90, barring certain exceptions, for individuals enrolling in Part B January 1, 2016 or later. These premiums can change on an annual basis.
Source: planprescriber.com

Medicare Eligibility Requirements

For people with end-stage renal disease (ESRD), you’re eligible for Medicare if your condition requires a kidney transplant or regular dialysis treatment. In order to qualify for Medicare, you also need to be eligible for or already receiving Social Security or Railroad Retirement Board benefits, or you need to have worked long enough under Social Security, the Railroad Retirement Board, or as a government worker. You can also qualify for Medicare if you’re the spouse or dependent of someone who is eligible for Social Security or Railroad Retirement benefits.
Source: medicareconsumerguide.com

Medicare and Social Security Disability Benefits

You can get financial help from Social Security and Medicare if you’re permanently disabled or if you have Lou Gehrig’s disease or kidney failure. To be considered “permanently disabled,” your doctor must confirm that you are unable to work for at least 12 consecutive months. Being “unable to work” means you cannot perform your job functions because of the disability, and you cannot find a new line of work because of age, education, or impairment. You must follow your doctor’s prescribed treatment plan to continue to qualify. It’s a good idea to keep up-to-date medical records.
Source: planprescriber.com

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 Eligibility Overview

The Medicare Advantage Disenrollment Period (MADP) allows a person to drop a Medicare Advantage plan purchased during the previous Open Enrollment and return to Original Medicare. It occurs every year from
Source: medicaremadeclear.com

Costs in the coverage gap

Posted by:  :  Category: Medicare

If you think you’ve reached the coverage gap and you don’t get a discount when you pay for your brand-name prescription, review your next “Explanation of Benefits” (EOB). If the discount doesn’t appear on the EOB, contact your drug plan to make sure that your prescription records are correct and up-to-date. Get your plan’s contact information from a Personalized Search (under General Search), or search by plan name. If your drug plan doesn’t agree that you’re owed a discount, you can file an appeal.
Source: medicare.gov

Medicare Part D coverage gap

The Medicare Part D coverage gap (informally known as the Medicare donut hole) is a period of consumer payment for prescription medication costs which lies between the initial coverage limit and the catastrophic-coverage threshold, when the consumer is a member of a Medicare Part D prescription-drug program administered by the United States federal government. The gap is reached after shared insurer payment – consumer payment for all covered prescription drugs reaches a government-set amount, and is left only after the consumer has paid full, unshared costs of an additional amount for the same prescriptions. Upon entering the gap, the prescription payments to date are re-set to $0 and continue until the maximum amount of the gap is reached: copayments made by the consumer up to the point of entering the gap are specifically not counted toward payment of the costs accruing while in the gap.
Source: wikipedia.org

Medicare Part D Coverage Gap

Coverage gap, also known as the “donut hole”: While in the coverage gap, you’ll pay 45% of the plan’s cost for brand-name drugs and 58% of the plan’s cost for generic drugs in 2016. You’re out of the coverage gap once your yearly out-of-pocket drug costs reach $4,850 in 2016. Once you have spent this amount, you’ve entered the catastrophic coverage phase. The costs paid by you or someone on your behalf (such as a spouse or loved one) for Part D drugs on your plan’s formulary will count toward your out-of-pocket costs. Additionally, manufacturer discounts for brand-name drugs count towards reaching the spending limit that begins catastrophic coverage. If your plan requires you to get your drugs from a participating pharmacy, make sure you do so, or else the costs may not apply. Keep in mind that costs that are paid for you by other insurance you may have, such as prescription drug coverage through an employer, won’t count towards your out-of-pocket spending.
Source: medicare.com

About the Medicare Coverage Gap

The Medicare coverage gap is the phase of your Medicare Part D benefit when there is a gap in prescription drug coverage. During this phase, you will have to pay more for your drugs, until you reach the catastrophic coverage phase. Most Medicare Advantage Prescription Drug plans and Medicare Prescription Drug Plans have a coverage gap, or “donut hole.” The coverage gap is reached when your total drug costs (what you and your plan pay) reach a certain amount. You then pay for your prescriptions out of pocket until entering the plan’s catastrophic coverage phase. This is when your total out-of-pocket costs, including the annual deductible and copayments/coinsurance, reach $4,850 in 2016.
Source: medicare.com

Medicare Part D Donut Hole – Prescription Drug Coverage Gap

Most Medicare Part D Prescription Drug Plans have a coverage gap, sometimes called the Medicare “donut hole.” This means that after you and your Medicare drug plan have spent a certain amount of money for covered prescription drugs, you then have to pay all costs out-of-pocket for the drugs, up to a certain out-of-pocket limit. The yearly deductible, coinsurance, or copayments, and what you pay while in the coverage gap, all count toward this out-of-pocket limit. The limit doesn’t include the drug plan’s premium.
Source: ehealthmedicare.com

Get Medicare Part D Quotes in Seconds

As could be expected, prices for Humana policies rocketed for the 2015 calendar year. Mean premiums for Humana Part D jumped from $21.80 to $38.70. Medicare Part D is priced at $41.55 and Part D Medicare comes in at the slightly lower price of $38.80. Humana’s standalone market share coverage has dropped to 18.6% whereas their Medicare Part D policies have increased to a market share of 12.8%.
Source: medicareaide.com

CMS: Cigna banned from selling new Medicare Advantage plans

Posted by:  :  Category: Medicare

The CMS has banned Cigna from offering new Medicare Advantage plans after taking issue with the way the insurer handled appeals, grievances and its drug formulary, according to regulatory filings. The news comes as state and federal regulators scrutinize Cigna’s $48 billion sale to Anthem. The deal would create the nation’s largest insurer. The sanctions, which are not expected to affect current enrollees, took effect Thursday, according to a letter the CMS sent to Bloomfield-Conn.-based Cigna. The insurer said in a Securities and Exchange Commission filing that it is working to resolve the issues and is fully cooperating with the CMS. The company is expected to release a statement on the issue on Friday. Cigna held 3% of the MA market last year, according to the Kaiser Family Foundation. That represents about 502,000 enrollees. In a note to investors, healthcare investment bank Leerink Partners said it estimated about 10% to 12% of Cigna’s earnings come from MA plans. The private Medicare program has been a boon for insurers the past several years, offering sizable volumes and steady profit margins. Some companies have said the growth in MA, spurred in part by the aging baby boomer population, will be fundamentally important to earnings growth in 2015 and beyond. A JPMorgan investors’ note Friday said it does not believe the MA sanctions on Cigna will affect the pending acquisition. It also points out that the suspension, which again affects only new enrollment, fortunately came after Cigna had already experienced a bump in membership before the open-enrollment period ended on Dec. 7. The note also states that Aetna lost 10% of its MA membership during a similar ban from April 2010 to June 2011. Cigna’s shares fell about 1% to $138.74 in morning trading. Sterne Agee analyst Brian Wright said in a note to investors Friday that if the sanctions are lifted by the start of 2017, Cigna shareholders might see a drop of 2 cents a share. If the sanctions extend though next year’s open-enrollment period, shareholders could expect an impact of 33 cents a share on earnings, he said.
Source: modernhealthcare.com

California Health Advocates

Posted by:  :  Category: Medicare

We provide accurate, unbiased information about Medicare benefits and long-term care for Californians. Learn how Medicare works, ways to supplement your coverage, about low-income programs, prescription drugs and your long-term care options.
Source: cahealthadvocates.org

Pharmaceutical Industry–Sponsored Meals and Physician Prescribing Patterns for Medicare Beneficiaries

A total of 279 669 physicians received 63 524 payments associated with the 4 target drugs. Ninety-five percent of payments were meals, with a mean value of less than $20. Rosuvastatin represented 8.8% (SD, 9.9%) of statin prescriptions; nebivolol represented 3.3% (7.4%) of cardioselective β-blocker prescriptions; olmesartan represented 1.6% (3.9%) of ACE inhibitor and ARB prescriptions; and desvenlafaxine represented 0.6% (2.6%) of SSRI and SNRI prescriptions. Physicians who received a single meal promoting the drug of interest had higher rates of prescribing rosuvastatin over other statins (odds ratio [OR], 1.18; 95% CI, 1.17-1.18), nebivolol over other β-blockers (OR, 1.70; 95% CI, 1.69-1.72), olmesartan over other ACE inhibitors and ARBs (OR, 1.52; 95% CI, 1.51-1.53), and desvenlafaxine over other SSRIs and SNRIs (OR, 2.18; 95% CI, 2.13-2.23). Receipt of additional meals and receipt of meals costing more than $20 were associated with higher relative prescribing rates.
Source: jamanetwork.com

Australian Government Department of Human Services

This information was printed Monday 8 August 2016 from humanservices.gov.au/ It may not include all of the relevant information on this topic. Please consider any relevant site notices at humanservices.gov.au/siteinformation when using this material.
Source: gov.au

Medicare Rehab in Indiana

Posted by:  :  Category: Medicare

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Source: sober-solutions.com

Anthem Blue Cross Blue Shield of Indiana

By law, Medicare Supplement insurance is standardized into twelve plans (Plans A through L). That means Plan F from one company must include the same benefits as plan F from another company. While the benefits must be the same, each company’s rates, reputation, membership features and quality of service can vary. With Blue Cross and Blue Shield of Indiana, you don’t have to sacrifice comprehensive benefits or freedom-of-choice for affordability. Their Medicare Supplement plans provide substantial benefits at rates that can save you money over other plans.
Source: indianahealthagents.com

Indiana State Health Insurance Assistance Program

The State Health Insurance Assistance Program (SHIP) provides free, unbiased health insurance information for people with Medicare. SHIP is part of a federal network of State Health Insurance Assistance Programs located in every state. In Indiana, SHIP is sponsored by the Centers of Medicare and Medicaid Services (the federal agency which administers Medicare) and the Indiana Department of Insurance.
Source: indianaship.com

Policy Basics: Where Do Our Federal Tax Dollars Go?

Posted by:  :  Category: Medicare

Medicare, Medicaid, CHIP, and marketplace subsidies: Four health insurance programs — Medicare, Medicaid, the Children’s Health Insurance Program (CHIP), and Affordable Care Act (ACA) marketplace subsidies — together accounted for 25 percent of the budget in 2015, or $938 billion.  Nearly two-thirds of this amount, or $546 billion, went to Medicare, which provides health coverage to around 55 million people who are over age 65 or have disabilities. The rest of this category funds Medicaid, CHIP, and ACA subsidy and exchange costs.  In a typical month, Medicaid and CHIP provide health care or long-term care to about 72 million low-income children, parents, elderly people, and people with disabilities. (Both Medicaid and CHIP require matching payments from the states.)  In 2015, 8 million of the 11 million people enrolled in health insurance exchanges received ACA subsidies, at an estimated cost of about $28 billion.
Source: cbpp.org