Avoiding the (Medicare) “Doughnut Hole”

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Congressman Brad Sherman, California’s 27th District (D) by cliff1066™According to the new study, and sheer intuition, patients that fall within the doughnut hole are associated with a significant drop in medication use – 12% on average. That is always relevant, but perhaps especially so in the case of depression medication. While discontinuing any prescribed medication is never advisable, it is often easier to justify foregoing depression medication than other medications.
Source: southbayelderlaw.com

Video: How to Choose a Medicare Plan – Sacramento California

Hospital Readmissions Fall Slightly, Medicare Data Show

Hospital readmissions rates in the U.S. have dropped only slightly despite CMS-led campaigns and the threat of financial penalties, according to Medicare data released last week. Twenty percent of Medicare patients were readmitted to a hospital within one month of discharge from 2008 to 2011, according to data posted on CMS’ Hospital Compare website. On Oct. 1, CMS will implement penalties for hospitals with above-average readmissions rates.
Source: californiahealthline.org

Using Medicaid to Get Needed Home Care

“But that could be three months or more. He might lose his apartment. And then what would he do?” George said. The social worker remembered that she had the name of a geriatric care manager who knew a lot about Medicaid. Perhaps they should give him a call. George called the geriatric care manager and arranged for him to come to the hospital to meet with him and Tom. The geriatric care manager told them that Tom did have assets and income over the Medicaid limits, but that he could still become eligible to apply for and receive full Medicaid benefits. With the help of the geriatric care manager, Tom:
Source: nypress.com

Medicare Beneficiaries More Satisfied Than Privately Insured

Martha, Medicare is not free by any stretch of the imagination. Most people pay a premium for Part B and a few pay for Part A. Plus there are co-payments and such. In my area Mecicare Advantage plans are not free either with additional monthly premiums and cost sharing structure. I should hope the study controlled for situations in which the beneficiary has supplemental or secondary insurance in both groups. In the case of supplemental medi-gap policies again those have their own premiums and some forms of secondary insurance do as well. None of these scenarios translates to “free” as you put it. By all means correct me if I misread your comment.
Source: californiahealthline.org

Medicare Patients Happier than Those with Private Coverage

Medicare beneficiaries age 65 and older are more satisfied with their health insurance, have better access to care, and are less likely to have problems paying medical bills than working-age adults who get insurance through employers or purchase coverage on their own. Only 8 percent of Medicare beneficiaries age 65 or older rated their insurance as fair or poor, compared with 20 percent of adults with employer-sponsored insurance and 33 percent of adults purchasing coverage in the individual market according to a recent study by The Commonwealth Fund.
Source: calbrokermag.com

Medicare for all CA Bus tour: In West Covina Tonight SiCKO ‘Sisters’ Reunite

Today in West Covina, the California Nurses Association summer 2012 Medicare for all bus tour will come to a close.  After visiting 18 other California cities since June 19, the nurses will wrap up this run with a bang and with clarity.  Three of the subjects of Michael Moore’s 2007 documentary film SiCKO will be on hand to help lead others in sharing their stories of struggle and frustration with the broken healthcare system. 9/11 first responder Reggie Cervantes and Dawnelle Keys, the mother whose toddler died because she was denied treatment at an out-of-network hospital, will join me at this final stop where the nurses will perform health screenings from 3:00-6:00 p.m. and then we’ll have a town hall meeting from 6:30 – 8:00 p.m.  My husband and I lost everything we had worked a lifetime to achieve when we got sick even though we always carried health insurance. Five years ago, when SiCKO was released, the nurses of CNA went to Sacramento with Michael Moore to call attention to the pain Californians were needlessly suffering at the hands of the dysfunctional system.  On this fifth anniversary of the film’s release, this West Covina reunion of some of the American SICKOs will help highlight how far we have yet to go and what these women have to say about the current healthcare law – the Affordable Care Act – just upheld by the Supreme Court and the subject of so much political gamesmanship.  These SiCKO patients will share what it means to real people, real Californians.  And that’s what this tour has been all about. Don’t come planning to sit unengaged through a lengthy program.  Come ready to become a part of what moves California and the nation to a place where there are no more SiCKOs like me or Reggie or Dawnelle.  See you in West Covina.  And don’t think because this tour is almost a wrap that the nurses are finished.  They won’t be done until every patient is treated under a system that includes a single standard of high quality care for all – a guaranteed, improved Medicare for all system.
Source: michaelmoore.com

Doctor, Owner Of Medical Supply Company Charged In $1.3 Million Power Wheelchair Scam

According to the indictment, the scheme focused on the sale of fraudulent power wheelchair prescriptions, with the end-goal being to obtain reimbursements from Medicare for power wheelchairs that patients did not need and, in some cases, did not want. The indictment alleges that Schwartz and a co-conspirator would travel to El Centro, California in search of elderly Medicare patients. Schwartz would write the patients prescriptions for power wheelchairs, even though the patients did not need the equipment and could walk without assistance. Schwartz collected a $300 cash kickback in exchange for each power wheelchair prescription. One of Schwartz’ co-conspirators would then sell the power wheelchair prescriptions to Melendez, charging him $1,000 per fraudulent prescription.
Source: sandiegocountynews.com

Nurses Cross California to Promote Medicare for All

About the Contributor: National Nurses United, with close to 160,000 members in every state, is the largest union and professional association of registered nurses in U.S. history. NNU are leading advocates of guaranteed healthcare by expanding and updating Medicare to cover all Americans, for negotiating many of the best collective bargaining contracts for RNs in the nation, and for sponsorship of innovative legislation and regulatory protections for patients and nurses. www.nationalnursesunited.org
Source: nursetalksite.com

Daily Kos: Medicare for all CA Bus tour: In West Covina Tonight SiCKO ‘Sisters’ Reunite

Don’t come planning to sit unengaged through a lengthy program. Come ready to become a part of what moves California and the nation to a place where there are no more SiCKOs like me or Reggie or Dawnelle.  See you in West Covina.  And don’t think because this tour is almost a wrap that the nurses are finished.  They won’t be done until every patient is treated under a system that includes a single standard of high quality care for all – a guaranteed, improved Medicare for all system.  
Source: dailykos.com

'Observation stays' for Medicare patients create coverage problems

Jackson, the Santa Rosa hospital patient, joined a national class-action lawsuit in April against Kathleen Sebelius, secretary of the U.S. Department of Health and Human Services, who oversees Medicare. Filed by the Center for Medicare Advocacy and the National Senior Citizens Law Center, the suit claims that Medicare recipients have been harmed by the use of hospital observation status because it results in the denial of one type of Medicare coverage, which then triggers out-of-pocket costs for prescription drugs and post-hospitalization care in skilled nursing facilities.
Source: californiawatch.org

California Medicare » Yapperz.com

It will insure the receiver for the bulk of in-affected individual clinic treatment, collectively with some kinds of in affected person property treatment and additionally hospice remedy. To be entitled to this guidance devoid of footing a month to month payment, you will need to be holding forty or more quarters of Social Safety credits. If you have less than this whole, although much more than thirty, then you can purchase Medicare Portion A for a month to month charge of all around $250.00. Folks with lesser than thirty Social Security credits would have to pay out $461.00 each month in 2010. Medicare Part B consists of well being insurance policy relating to out patient costs. This consists of doctor’s charges, laboratory exams, out clients clinic treatment, speech and bodily treatment, ambulance transport, and certain health-related devices. This phase of the Medicare prepare is optional. It is regularly the scenario that if you are nonetheless in work then you may probably by now have similar schemes by way of a employer health care software so it may possibly properly not be considered essential to signal up until you go away. The charge of this premium is $a hundred and ten in 2010, even so in the order of 73 % of Medicare holders will keep on to pay out the 2009 charge of ninety 6 bucks. This is for the cause that the men and women will not receive a value of residing modify in their 2010 Social Security rewards. People who are new to Medicare will need to have to pay the complete 2010 quantity as will people who have a bigger take-home spend. It is crucial to comprehend that Medicare does not guarantee a wholly inclusive cover for all your healthcare associated conditions. There will generally be numerous moderately significant charges to pay out beside deductibles and the expenditure of unique companies and objects. These include eyeglasses, hearing aids, dental care, as well as any kind of prolonged-time period treatment be it in a non-public property or nursing home. Medicare Part C is also referred to as Medicare Advantage. This is an selection to the first expense for services form of Medicare. The Medicare program will spend for Medicare Advantage plans and will spend private health care cover corporations to supply health go over to the beneficiaries of the schemes. To be competent for a Medicare Advantage program, you should be signed-up for the two Element A and Component B of the Medicare prepare. By choosing to register your self for Medicare Part Do you will still be entitled to all the advantages that are incorporated in the total Medicare scheme. You will be supplied the Medicare benefits via a particular personal program. These may possibly furthermore integrate insurance for the expenditure for recommended drugs, this will be referred to as a MA-PD software. If this is not the situation then the plan would be deemed MA-only. The majority of Medicare Advantage strategies will have amplified advantages more than the 1st set up. If you are opting for such a scheme then you require to examine the costs with care as plenty may be a lot more dear for particular aspects. california medical insurance, medicare in california, medicare in california
Source: yapperz.com

Medicare for All Takes Show on the Road

Despite the upward pressure on Medicare spending, per capita expenditures for Medicare beneficiaries are expected to increase more slowly than in the private sector, according to the Kaiser Family Foundation. Burger is confident that Medicare for All would provide more savings than accrued through private insurance. Among private insurers, about 30 cents of every dollar goes to administration, lobbying and profit, while the overhead for Medicare is just 3%, Medicare for All proponents point out.
Source: californiahealthline.org

Updated SSI Ratios Decrease Medicare Payments to California Hospitals by $182 Million

The SSI ratios are in part used to determine Medicare Disproportionate Share Hospital (DSH) payments. CMS updated the SSI ratios to incorporate Medicare Advantage days and an improved SSI identification process as discussed at CMS 1498(R). Medicare Administrative Contractors (MACs) have indicated the earliest date they will begin settling Medicare cost reports is May 1, 2012. However, it is more likely these settlements will begin in June or July. The MAC has also indicated that FFY 2006 and 2007 cost reports will be the first years reopened and settled. Subsequently, the MAC will open and settle FFY 2008 and 2009 cost reports. In order to expedite this process, the SSI update will be the only revision allowed for cost report settlement at this time. All other issues will be resolved through additional cost report re-openings. The MAC estimates the process of settling FFY 2006 through 2009 cost reports will take an entire year.
Source: hfsconsultants.com

The WCMSA Conundrum in California

My client accepts the C&R for $115,000.00 new money inclusive of the WCMSA but not as a structured settlement. Please let me know if your client is willing to do a lump sum C&R so they can finally close this file. Since she has been Medicare eligible as a matter of law (over age 65 in 2007), I don’t think we need to obtain CMS approval of the WCMSA in advance of getting WCAB approval. As long as we take Medicare’s interests into account as part of the settlement then we are ok without prior CMS approval. We still have to submit it to CMS after WCAB approval or concurrent therewith. My client would then bear the risk of loss if CMS says the WCMSA needs to be increased. Please send me the C&Rs if this is acceptable to you.
Source: lexisnexis.com

Related posts:

  1. Avoiding the (Medicare) “Doughnut Hole”
  2. Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?
  3. Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?
  4. Antidepressant Use Among Seniors: Falling Through Medicare’s Doughnut Hole?
  5. Medicare’s Doughnut Hole Shrinks

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