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Archive for the 'Medicare' Category

MEDICARE Part D UPDATE September 14, 2008

Posted by Service Officer on 14th September 2008

Medicare regulations establish an appeals process that, in theory, can be navigated by any person with Medicare who has been denied coverage for a prescription by his or her Part D plan. But problems frequently arise because Medicare Part D plans refuse to abide by the rules and prevent people from getting medically necessary medicines. These are the most common obstacles patients face:

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MEDICARE PART B NON-ENROLLMENT September 14, 2008

Posted by Service Officer on 14th September 2008

Tricare beneficiaries who qualify for Medicare Part A will automatically be enrolled in Medicare Part B at an increased marginal cost unless declined by the beneficiary. However, subject to the exceptions noted below, the consequences for declining Medicare B can be potentially disastrous, as Tricare can pay nothing for care while a beneficiary is eligible for Medicare Part A unless the beneficiary also has Medicare Part B coverage. Tricare will also recoup any benefit payments made to physicians for a disqualified beneficiary for the period that the beneficiary was eligible for Medicare Part A but declined Medicare Part B. The same consequence would apply to Tricare beneficiaries who are awarded two years or more of retroactive Medicare Part A coverage because of a Social Security disability award but decline the option to take Medicare Part B for the period of retroactive Medicare Part A coverage. Any payments made to physicians during a period of retroactive Medicare Part A coverage for which Medicare Part B is declined will be recouped by Tricare.

The mandatory Medicare Part B enrolment rule does not apply if the beneficiary has an active duty sponsor, is enrolled in the US Family Health Plan, or is covered under Tricare Reserve Select. Tricare beneficiaries who are changing Tricare coverage, such as those switching to Tricare for Life and those Tricare beneficiaries with potentially successful Social Security claims should particularly take heed of the Medicare Part B requirement if they want to continue Tricare coverage. The clear message from Tricare Management Activity to Tricare beneficiaries covered by Medicare Part A is that if they decline Medicare Part B coverage, they do so at their peril as this could terminate Tricare payments of claims. It is possible to later enroll in Medicare Part B for those who decline the initial coverage but substantial penalties could apply. Questions on this requirement should be directed to your Tricare contractor. You can also visit the Tricare website for your region or program as follows.

• North Region: www.healthnetfederalservices.com

• West Region: www.triwest.com

• South Region: www.humana-military.com

• Tricare for Life: www.tricare-4u.com

[Source: NGAUS Leg Up 5 Sep 08 ++]

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MEDICARE PART D UPDATE September 14, 2008

Posted by Service Officer on 14th September 2008

Less than one month from now, private insurance companies will begin marketing their 2009 Medicare health and drug plans, hoping to convince people with Medicare to sign up for coverage for the new year. The open season for seniors to initiate or switch carriers is 15 NOV through 31 DEC. The marketing of Medicare private health plans has been plagued by abuse. Unscrupulous agents who troll senior housing complexes and even nursing homes have misrepresented or outright lied about the plan benefits and coverage, and cajoled or tricked frail older adults into signing enrollment forms in order to gain the commissions, bonuses and prizes the insurance companies award for these enrollments. The passage this summer of the Medicare Improvement for Patients and Providers Act over President Bush’s veto sets some new ground rules for marketing this fall, including a ban on cold-calling and other unsolicited contact (such as accosting patients in hospital parking lots), and federal regulation of agent commissions. How these new rules are implemented and enforced will determine whether the Bush administration seizes, or squanders, its last chance to stop the abuse that has so far characterized the market for Medicare private health plans.

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MEDICAL PRICING September 14, 2008

Posted by Service Officer on 14th September 2008

Healthcare providers and insurers put a dollar value on medical services using policies so inscrutable that they leave patients unable to determine a fair price for any treatment. This is most evident in trying to evaluate the differences between what medical providers bill and what insurers’ pay. “It’s a Byzantine system,” said Jim Lott, executive vice president of the Hospital Assn. of Southern California. “There’s no question about that.” Peggy Hinz, a spokeswoman for Anthem Blue Cross, said the insurer “relies on the latest medical pricing data and experts in the field” to determine how much it will pay for specific services. “We always strive to reimburse a fair amount based on a provider’s cost and based on what is reimbursed to other providers for like services,” she said. Most physicians will not discuss how they arrive at their billing amounts and often claim they have nothing to do with setting prices for their practice or negotiating contract terms with insurers.

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MEDICARE PART D UPDATE August 29, 2008

Posted by Service Officer on 29th August 2008

Medicare officials announced 14 AUG that the average monthly premium for Medicare’s prescription drug plan will increase to an estimated $28 in 2009, three dollars more than this year’s monthly premium. That 2009 figure is 37% lower than originally projected when Medicare’s so-called Part D drug coverage was introduced in 2003, the officials added. The Part D program offers prescription drug benefits to Medicare beneficiaries. “Part D continues to come in under budget, achieve consistently high satisfaction rates, and with it millions of Americans are living healthier, better lives,” Kerry Weems, acting administrator of the U.S. Centers for Medicare and Medicaid Services, said during an afternoon teleconference. But, he added, “most beneficiaries will see a premium increase in their current plan. There will be some significant increases.” There are three reasons behind the premium increase, Weems said.

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PROSTATE PROBLEMS UPDATE August 15, 2006

Posted by Service Officer on 14th August 2008

In a move that could lead to significant changes in medical care for older men, a national task force in the United States recommended that doctors stop screening men ages 75 and older for prostate cancer because the search for the disease in this group is causing more harm than good. The new guidelines, issued 4 AUG by the U.S. Preventive Services Task Force, represent an abrupt policy change by an influential panel that had withheld any advice regarding screening for prostate cancer, citing a lack of reliable evidence.

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MEDICARE AMBULANCE COVERAGE August 15, 2008

Posted by Service Officer on 14th August 2008

If it is an emergency Medicare will generally cover ambulance services, as long as an ambulance is the only safe way to transport you (medically necessary); and you are transported to and from certain locations. If covered, Medicare will pay for 80% of its approved amount for the ambulance service. You or your supplemental insurance policy will be responsible for the remaining 20%. All ambulance providers must accept Medicare assignment, meaning they must accept the Medicare-approved amount as payment in full. If it is not an emergency, Medicare coverage of ambulance services is very limited. An emergency is when your health is in serious danger and every second counts to prevent your health from getting worse. If the trip is scheduled as a way to transport you from one location to another when your health is not in immediate danger, it is not considered an emergency. Medicare will never pay for ambulette services (i.e. use of specially equipped motor vehicles for transporting convalescing or handicapped people). Also, lack of access to alternative transportation alone will not justify Medicare coverage. Medicare may cover non-emergency ambulance services if:

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MEDICARE PART “D” UPDATE August 15 2008

Posted by Service Officer on 14th August 2008

A new report from the House Committee on Oversight and Government Reform found that people who get coverage from both Medicare and Medicaid (a group sometimes called “dual eligible”), pay 30% more for prescription drugs under the Medicare prescription drug benefit (Part D) than they would if Medicaid paid the bill. According to the study released 25 JUL, this discrepancy in pricing accounted for $3.7 billion in revenue for drug manufacturers during the first two years of the Part D program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established the drug benefit, required that Medicare Part D, not Medicaid, cover the cost of drugs for people with both Medicare and Medicaid. Many nursing-home residents fall into this category. Democrats in the House say this overpayment is an unjustified burden on the taxpayer, and they seek to correct the problem through new legislation. But House Republicans have countered that the new report overlooks important aspects and benefits to dual eligibles contained in the Part D program. Under Part D, for example, dual eligibles have access to a greater variety of prescription drugs. [Source: Medicare Rights Center 12 Aug 08 ++]

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MEDICARE PART “D” UPDATE August 15 2008

Posted by Service Officer on 14th August 2008

A new report from the House Committee on Oversight and Government Reform found that people who get coverage from both Medicare and Medicaid (a group sometimes called “dual eligible”), pay 30% more for prescription drugs under the Medicare prescription drug benefit (Part D) than they would if Medicaid paid the bill. According to the study released 25 JUL, this discrepancy in pricing accounted for $3.7 billion in revenue for drug manufacturers during the first two years of the Part D program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003, which established the drug benefit, required that Medicare Part D, not Medicaid, cover the cost of drugs for people with both Medicare and Medicaid. Many nursing-home residents fall into this category. Democrats in the House say this overpayment is an unjustified burden on the taxpayer, and they seek to correct the problem through new legislation. But House Republicans have countered that the new report overlooks important aspects and benefits to dual eligibles contained in the Part D program. Under Part D, for example, dual eligibles have access to a greater variety of prescription drugs. [Source: Medicare Rights Center 12 Aug 08 ++]

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MEDICARE REIMBURSEMENT RATES 2008 UPDATE 1 August 2008

Posted by Service Officer on 31st July 2008

President Bush sought to block a bill 15 JUL aimed at forestalling an 11% cut in payments to doctors taking care of Medicare patients, but Congress quickly overrode his veto. The House voted 383 to 41 to override the veto, while the Senate voted 70 to 26, in both cases far more than the two-thirds necessary to block the president’s action. With organized medicine, other lobbies, and the military community promoting the popular measure in an election year, Republicans broke heavily from the white house. A total of 153 House Republicans voted to defy the White House, 24 more than in a 24 JUN vote that started the momentum toward passage of the Medicare doctors’ bill.

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