Panel Gets Earful Of Advice On Taming The Federal Deficit

Among the messages to the super committee?members: caution. Meanwhile, Democratic governors expressed?fears about deep cuts in federal aid to their states,?especially regarding Medicaid and other entitlement programs. Hospital advocacy groups also carried a similar message about treading lightly in regard to trimming Medicaid funding.

The Associated Press: Lawmakers Advise Super Committee To Be Cautious
Congress flooded its super committee with a jumble of advice Thursday about taming the government’s out-of-control debt, with top agriculture lawmakers readying a bipartisan plan to pare food and farm aid while others urged an aggressive hunt for savings coupled with warnings against cutting cherished programs. Most of the suggestions came from Democrats on 16 Republican-run House committees who sent letters to the special debt-cutting panel. Generally, their advice was to create jobs, raise revenue and avoid damaging cuts to public works, health care and other programs they said are crucial to an economic recovery (Fram, 10/13).

USA Today: Congress Funnels Deficit-Cutting Ideas To Super Committee
When it set up a super committee to find $1.5 trillion in deficit reduction, Congress also asked other committees to weigh in with advice about what spending to cut. Today is the deadline for those recommendations. And much of the advice so far is about what not to cut (Korte, 10/14).

Politico: Dem Govs Lobby Super Committee
Fearing deep cuts in federal support to their states, several Democratic governors set up a series of meetings Thursday to lobby super committee members and White House officials. Maryland Gov. Martin O’Malley, the chairman of the Democratic Governors Association, and Govs. Mark Dayton of Minnesota and Christine Gregoire of Washington met separately with the Senate Democratic super committee members and the House Democratic super committee members in the Capitol. Gov. Deval Patrick of Massachusetts, a close ally of President Barack Obama, was expected to join the calls by telephone. Later in the day, the governors had scheduled a meeting with White House Chief of Staff Bill Daley (Allen, 10/13).

The Washington Post: Dem Governors Huddle With Debt Super Committee Members
A quartet of Democratic governors is huddling Thursday with members of Congress’s debt-reduction super committee on Capitol Hill, urging lawmakers on the panel to focus on job creation and avoid making cuts or changes to entitlement programs that would result in a greater burden on the states. … In a letter to the super committee’s members, O’Malley, who last December was elected to head the DGA, backed the White House’s call for a debt-reduction package including both cuts and revenue increases. He also urged the panel’s members not to avoid changes to Medicaid that would increase the burden on state governments (Sonmez, 10/13).

National Journal: Democratic Governors Ask Committee Not To Pass Medicaid Costs To States
Two Democratic governors met privately on Thursday with Democratic members of the deficit-reduction super committee, urging against any effort to shift Medicaid-related costs and other expenses to the states. In attendance was Maryland Gov. Martin O’Malley, chairman of the Democratic Governors’ Association, and Minnesota Gov. Mark Dayton. Massachusetts Gov. Deval Patrick joined by telephone. Washington Gov. Chris Gregoire was slated to join the meeting, which was organized by House Minority Leader Nancy Pelosi, D-Calif., who attended, but couldn’t make it. The governors’ main message to the Democratic members of the deficit panel was about Medicaid-related costs and who is responsible for them, but they also pressed job creation in general and aspects of Obama’s defeated jobs bill (House, 10/13).

Modern Healthcare: Deficit-Reduction Panel Urged to Spare Medicaid
Leading hospital advocacy groups urged the deficit-reduction super committee to omit Medicaid cuts from any final proposal for at least $1.2 trillion in savings over 10 years. Specifically criticized were proposals to switch the various state Medicaid federal medical assistance percentages into a single “blended rate” and another to limit states’ use of provider taxes. Both approaches would effectively shift more of the financial burden for the state-federal insurance program for low-income beneficiaries onto the states, according to the Oct. 12 letter to the panel from the hospital advocacy groups. Such existing proposals that have received budget savings estimates from federal scorekeeping entities are expected to receive the most serious consideration by the deficit panel, according to other members of Congress and outside observers (Daly, 10/13).

Original post:
Panel Gets Earful Of Advice On Taming The Federal Deficit

Tags: deficit, democratic, government, house, ideas, news, obama, panel, states, super-committee, usa, white

Supplement For Medicare

Health care reform has sparked heavy debate regarding the appropriate supplement for Medicare. It is widely known that seniors ages 65 and above are eligible for government medical aid (Medicare) to assist in healthcare cost. Medicare covers a portion of senior’s medical cost. Although government assistance is available, many seniors still lack ample funds to cover the holes in Medicare. Thus, seniors are left to decide whether to adopt a Medicare advantage plan or to simply adopt a supplement for Medicare.

Though this segment is dedicated to the appropriate supplement for Medicare it is prudent to explain differences in what Medicare advantage plans would provide as well. As stated above traditional Medicare covers certain medical needs for seniors. The government covers (by paying doctors and hospitals) certain senior medical needs based on a fee for service schedule. There are options for seniors to be covered by an advantage plan with 0 out of pocket monthly. It goes without saying that where one medical plan may be ideal for an individual; the same medical plan may fall short of covering another individual’s needs. Advantage plans are plans in which the government pays insurers a specific amount monthly for every Medicare member that they enroll (the plans cover hospitals and doctors as well). Individuals covered under advantage plans are able to choose HMO plans which require advantage recipients to choose from a network of health care providers as well as PPO plans which allow for in network providers as well as out of network providers. It should be noted that individuals going outside of the network would likely have to pay additional fees. All advantage plans offer the same benefits (regardless of the insurer). However, the benefit to the Medicare Advantage plans is that they cover things such as hearing, vision and dental care whereas traditional Medicare plans do not. Medicare Advantage has become increasingly popular due to the advantages provided over and above traditional Medicare. However, that is precisely the issue that critics raise. Advantage plans are said to “pay out” more than traditional Medicare plans. The congressional budget office has estimated that over 150 billion additional dollars has been spent in the last 10 years on advantage plans (that would not have been spent with standard Medicare). Ultimately, the additional expenditures mean more money spent by taxpayers. Which is why Medicare Advantage plans have been targeted by government and health care reform.

With Medicare Advantage plans being heavily scrutinized and funding likely to be cut at least to some extent, supplements are becoming more appealing. Where advantage plans offer 0 out of pocket, a supplement for Medicare would require some payment by the senior. Where advantage plans replace traditional Medicare, a supplement for Medicare is literally that…a supplement that covers certain holes left by traditional Medicare. Therefore, Medicare is considered the primary plan and a supplement for Medicare is considered secondary to the plan. Medigap plans are also offered through private insurers at specific cost. Medicare supplement plans are also considered medigap plans as they fill the gaps left by Medicare. Gaps such as Deductibles, Coinsurance and Co-pays can be filled with an appropriate supplement for Medicare. Any doctor that accepts Medicare should accept a supplement for Medicare. Medicare participants must be enrolled in Medicare part b in order to be eligible to buy a Medigap plan. Medicare part b covers things like doctor services, outpatient care, home health services as well as some preventative services. There are several Medigap plans available and participants typically need not go through underwriting if they will attain the age of 65 within the next 6 months(and two months following their 65th birthday). Open enrollment occurs from November 15th through December 31st and this is the time that changes may be made by existing supplement users. Medigap options vary and are labeled A through L. Each plan offers different options to fill the holes left by traditional Medicare plans. Core benefits include hospital coverage for specific periods during Medicare benefit period, approved hospital cost for co-payments during specific periods, skilled nursing coinsurance, doctor deductibles, foreign travel emergency coverage, at home recovery, drug benefit as well as preventative care. Benefits vary from plan to plan and may be viewed in the Medicare handbook. You may also view supplement for Medicare options by searching Medicare resources at the Texas low cost health insurance site.

http://www.texaslowcosthealthinsurance.com, Medicare resources

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What Can Be Done About Climbing Medicare Premiums

It is inevitable that Medicare insurance premiums will increase along with inflation, but there are a few things we all can do to help keep costs down. Although it is true that a majority of doctors and health care providers abide by the rules and are trustworthy, there are also a few people that work the system each year for literally millions of dollars. The direct result has been a rise in health insurance costs, system wide.

Medicare is an insurance program that is provided through the United States Government. It extends medical coverage for those who are 65 and older and those that are disabled even when they’re under 65 years old under some conditions. An excess of one billion claims are processed every year, and without doubt it’s turned out to be the biggest provider of managed health care in the U.S.

The Medicare program has gotten more complex and involved every year, and the recent developments have added an influx of private health insurance providers into the mix. Medicare covers millions of members and manages more than a billion transactions every year. With this level of care comes shortcuts, mistakes and bureaucracy. As a result of this, Fraud and exploitation of Medicare have become system wide.

Quite often, errors in Medicare claims result from honest mistakes instead of Medicare fraud. There could very well be transcription errors or typographical errors. After all, Medicare insurance providers are human, and dealing with mistakes where there is so much paperwork and so many forms is pretty normal. In a situation like this, it’s important that you speak with someone at your doctor’s office and discuss any errors you have found.

But if you discover that your physician is actually charging your insurance for services that are customarily free, or if you find that your doctor’s office is sending out bills for a procedure that you don’t recognize, make sure to take a careful look at it. It may very well be a case of Medicare fraud, which happens to be is one of the main reasons for escalating Medicare costs.

Medicare Fraud Can Come In A Number Of Forms

* You may be charged for products and services that you never get.

* You may be charged for more services than you were actually provided.

* Over-billing or…

* Billing for medical equipment and supplies that were returned.

How To Deal With Medicare Fraud

Review all paperwork and forms you get from Medicare for anything that’s connected to health care. Essentially, the responsibility is yours to catch omissions, errors and even fraud if you suspect it might be happening. If you do so, you can do your part to keep medical insurance premiums at a minimum. We’re all in this together.

The escalating costs of Medicare have been the cause of a good deal of concern from the government, and they’re doing all they can to counter Medicare fraud. Because of that, providers of Medicare are dealing with only private health care providers who have shown integrity and trustworthiness. Those that try to cheat the system are being knocked out.

The fight has been carried out by Medicare service providers like doctors and hospitals, Centers for Medicare and Medicaid Services (CMS), Medicare patients as well as law enforcement agencies and consumer protection agencies. You can also help by thoroughly looking at at your own bills.

The bulk of members of Medicaid facilities do pay close attention to the bills and statements to fight climbing Medicare premiums. To help their efforts you should review your bill for things such as an incorrect social security number, extra charges, services not provided but billed, etc. Those are just some of the things you can be aware of if you want to help counter Medicare fraud and increasing Medicare premiums.

Helpful Tips For Medicare Part d

Government prescription coverage explained

Visit our website for a simplified explaination or Medicare Part d

Medicare Insurance

Deficit Panel Moves Deliberations Behind Closed Doors

The 12-member ‘super committee’ held a private meeting Thursday and emerged with few details, though a co-chair acknowledged that their work won’t be easy. Meanwhile, President Barack Obama and House Speaker John Boehner, R-Ohio, are signaling the different courses they want to see the panel follow.?Also, congressional Democrats are getting increasingly worried about what might become of Medicare and Medicaid.

ABC News: Deficit Super Committee Breakfast Club
For its third meeting, the 12-member, deficit-reduction committee gathered in the U.S. Capitol today for an early, closed-door breakfast over orange juice, coffee, pastries and bacon to talk about how it can achieve a plan for deficit reduction by Thanksgiving. After emerging from the meeting, the co-chairs of the debt committee were scant on details about what nitty-gritty was discussed. Rather, they seemed to use this morning’s breakfast as more of a getting-to-know-you meeting, even as all the members have called for quick work with a November deadline and the threat of the trigger options looming (Miller, 6/15).

The Associated Press/MSNBC: Super Committee Meets In Private To Talk Deficit Reduction
Members of Congress’ debt reduction super committee said Thursday that their assignment of finding ways to reduce government red ink won’t be simple. Emerging from a private breakfast meeting among the panel’s members, Rep. Jeb Hensarling, R-Texas, told reporters: “We know that it will not be fun. We know it will not be easy, it will not be popular with any current political constituency” (9/15).

Politico Pro: Dems Worry Over How, Not How Much In Cuts
Democrats say they are resigned to the fact that Medicare and Medicaid won’t go completely unscathed as part of Congress’s latest effort to cut federal spending. Their question is not how much, but simply how, the programs get squeezed. “I don’t think the number is important,” Rep. Bill Pascrell of New Jersey said, reacting to reports that President Barack?Obama will seek at least $340 billion in savings from the two programs. But where he gets the money and who it affects is very significant. The comments come just days before the president will take another swing at lopping trillions of dollars off the national deficit over the next decade. Details remain scarce, but administration officials this week said his proposal could include $340 billion in health care savings in 10 years (Dobias, 9/15).

CNN Money: Boehner: No Tax Hikes For Super Committee
House Speaker John Boehner drew a line in the sand on taxes on Thursday, saying that a special debt committee tasked with cutting at least $1.2 trillion from federal deficits shouldn’t consider tax hikes. “Tax increases, I think, are off the table,” Boehner said in a speech to the Economic Club of Washington, D.C. “It’s a very simple equation. Tax increases destroy jobs. And the Joint Committee is a jobs committee. Its mission is to reduce the deficit that is threatening job creation in our country.” The only things the 12-person super committee should tackle are spending cuts and entitlement reform, he said (Liberto, 9/15).

The Washington Post: Boehner Says No New Taxes For Debt Panel
House Speaker John A. Boehner (R-Ohio) on Thursday reaffirmed GOP opposition to any tax increases to solve the nation’s deficit problem, signaling a swift return to the trench warfare that characterized the debt and spending debate of early summer. Boehner said that the special committee seeking long-term debt reduction should achieve its mandated $1.5 trillion in savings entirely by cutting federal agency spending and shrinking entitlement programs (Kane and Helderman, 9/15).

The Wall Street Journal: Boehner Pushes Tax Overhaul
The Boehner speech came as the White House was preparing to present its own deficit-reduction recommendations next week to the super committee. The Wall Street Journal reported the president has decided against including proposals to slow the growth of Social Security spending. But many Democrats remain concerned that the package will revive proposals to pare entitlements such as Medicare and Medicaid and that the deficit debate will distract from Mr. Obama’s jobs proposal. “The president should continue to talk about jobs,” said Rep. George Miller (D., Calif.) (Hook, 9/16).

Politico: Obama To Shield Social Security In Deficit-Reduction
The shift away from Social Security will allow him to avoid a clash with his Democratic base over the popular retirement program at a time when he needs its support more than ever, both to push for his $447 billion jobs program and to buck up his lagging poll numbers. Medicare could be a different story, though, as the White House revisits some unpopular ideas from the talks with Boehner (Budoff Brown, 9/15).

Reuters/MSNBC: Obama To Exclude Social Security From Deficits Plan
President Barack Obama will not include reforms to the Social Security retirement program in his deficits proposals to Congress next week, the White House said Thursday. … Obama also expressed a willingness in the summer debt talks with House of Representatives Speaker John Boehner, a Republican, to raise the eligibility age for Medicare health benefits to 67 from 65. But The Wall Street Journal said Thursday the White House was now looking at cuts to providers and increased premiums for wealthier recipients of Medicare, the health care program for the elderly (MacInnis, 9/15).

Politico: Obama Jobs Plan: Raise Taxes On Health Care
The White House wants another shot at requiring some Americans to pay more for their employer-backed health coverage, despite a previously tepid response from the very same lawmakers needed to advance the proposal (Dobias, 9/15).

Excerpt from:
Deficit Panel Moves Deliberations Behind Closed Doors

Tags: boehner, health, house, money, obama, package, president, security, social, street, summer, taxes, white, white-house, work

The Medicare Advantage Program – How Can it Help Me?

If you are eligible for Medicare, you might want to look into Medicare Advantage programs as well. Formerly known as Medicare +Choice, Medicare Advantage is the private insurance option of Medicare. It offers participants the choice of using a private insurance plan instead of Medicare itself. Since Medicare’s for-fee services and restrictions can be significant, particularly in the case of prescriptions, providing people with this option allows many people to get better health insurance coverage with more benefits and lower out-of-pocket costs. And, because the cost of these plans is determined by competition among providers, you can often find an inexpensive plan that covers your needs, becoming an excellent alternative to Medicare itself.

Medicare Advantage (also known as Medicare Part C) allows you to sign up for a HMO or PPO plan…or Fee For Service (FFS) or a Medical Savings Account (MSA)…whatever fits your needs best. Or not. You are not forced to use a private insurer if you feel that Medicare’s coverage is adequate for your needs.

In the past, a Medicare Advantage plan also included the opportunity for much better prescription coverage. However, with the passage of the Medicare Part D prescription plan instituted in 2006, Medicare recipients now must sign up for a private prescription plan, even if they do not sign up for anything else but basic Medicare. However, should you opt for a Medicare Advantage plan, you will find that most companies offering such plans also offer Part D prescription plans. Indeed, you might find it advantageous to get both because the additional cost may be minimal. However, be aware that, while Medicare Advantage plans are standardized, Part D prescription plans are not. So do not sign up for a joint plan automatically. Make sure your prescription plan meets your needs. There are no restrictions on having one plan with one company and the other with another company.

If you do not have medical problems, do not go to the doctor for more than an annual checkup, or otherwise rarely use medical services, a Medicare Advantage plan may not be for you. However, if you have a pre-existing condition, a Medicare Advantage plan may save you significant money in the long run by reducing out-of-pocket costs and because, except for end-stage kidney disease, preexisting conditions do not prevent you from enrolling, although you may need to choose a special needs plan.

If you are interested in looking into Medicare Advantage plans in your area, you can start by going to http://www.medicare.gov/Choices/Advantage.asp

For more information on Medicare benefits and other Medicare application tips, you should visit http://www.medicare-benefits.com today!

Information on Medicare

At initial glimpse it may seem incredibly bewildering to figure out the differences among a number of Medicare plans and firms. There will in addition be differences in what is on offer in assorted counties in California. For you to make the appropriate decision then you must study as much info as you can on Medicare in California, only then will you be able to find the scheme that most suits your wishes. It is not the case that you must be over sixty five to meet the criteria for a Medicare plan, if you are under sixty five and regarded as permanently disabled then you are in addition qualified to go in for a scheme.

The coverage and costs vary with distinct sorts of schemes. Moreover reflect on that fees possibly will grow yearly, and advantages can be added or withdrawn. This is why it is important to keep in the know with the latest information on health insurance in California.

There are 4 aspects to Medicare and it is prudent to know the details of every one prior to enrolling.

Part A is referred to as hospital cover. It will insure the receiver for the bulk of in-patient hospital treatment, together with some forms of in patient home care and plus hospice treatment. To be entitled to this assistance devoid of footing a monthly fee, you will require to be holding 40 or more quarters of Social Security credits. If you possess less than this total, though more than thirty, then you can acquire Medicare Part A for a monthly fee of around $250.00. Individuals with lesser than thirty Social Security credits would have to pay $461.00 each month in 2010.

Medicare Part B includes health insurance relating to out patient costs. This contains doctor’s fees, laboratory tests, out patients hospital care, speech and physical therapy, ambulance transport, and certain medical equipment. This segment of the Medicare plan is optional. It is repeatedly the case that if you are still in employment then you may possibly by now have comparable schemes by way of a employer medical program so it may well not be considered necessary to sign up until you leave.

The rate of this premium is $110 in 2010, however in the order of 73 percent of Medicare holders will continue to pay the 2009 fee of ninety six dollars. This is for the reason that the individuals will not obtain a cost of living change in their 2010 Social Security benefits. Those who are new to Medicare will need to pay the complete 2010 amount as will persons who have a larger take-home pay.

It is important to realize that Medicare does not promise a wholly inclusive cover for all your medical connected circumstances. There will commonly be various reasonably substantial fees to pay beside deductibles and the expenditure of special services and objects. These include eyeglasses, hearing aids, dental care, as well as any form of long-term care be it in a private home or nursing home.

Medicare Part C is also referred to as Medicare Advantage. This is an choice to the original cost for service form of Medicare. The Medicare program will pay for Medicare Advantage plans and will pay private medical cover firms to provide health cover to the beneficiaries of the schemes. To be qualified for a Medicare Advantage plan, you should be signed-up for both Part A and Part B of the Medicare plan. By choosing to register yourself for Medicare Part C you will still be entitled to all the benefits that are included in the complete Medicare scheme.

You will be offered the Medicare benefits through a certain private plan. These may possibly additionally incorporate insurance for the expenditure for prescribed medications, this will be referred to as a MA-PD program. If this isn’t the case then the plan would be deemed MA-only. The majority of Medicare Advantage plans will have amplified advantages over the first set up.

If you are opting for such a scheme then you need to examine the costs with care as lots may be more pricey for certain aspects. And numerous Medicare Advantage plans insist that you to only visit doctors or visit hospitals that are associated with their system. There are 5 separate Medicare Advantage plans: Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service Plans, Special Needs Plans, and Medical Savings Accounts.

Part D of Medicare in California is what’s more referred to as the MMA (Medicare Prescription Drug, Improvement, and Modernization Act). This is a form of prescribed drug coverage in which all Medicare receivers are qualified no importance what their fitness position or income. To be eligible for this kind of Medicare, the person should sign up for a medication plan and contribute to the premiums and deductibles.

Medicare in California

Making health insurance more affordable for more American seniors

There is a lot of debate regarding Medicare, Medicare supplement policies, and their funding. The Medicare program has been around since the 1960s, when President Lyndon B. Johnson signed it into law. At that time, only about one quarter of the American elderly population was covered by insurance. Currently, the elderly are the only age group that basically has universal coverage. Medicare supplement policies came about more recently than that. However, there is a lot of concern that the Medicare funds are running out, that Medicare supplement policies are not doing enough to help the elderly, and that there is not enough incoming money to continue to meet the program's financial needs.

Many people do benefit from Medicare, even though it does not cover 100% of all medical costs. Many people purchase Medicare supplement policies to help offset the costs that are not covered by traditional Medicare. These premiums will also go towards funding Medicare. To offset these gaps in coverage, many American older adults will also purchase Medicare supplement policies that will help them pay some additional costs. Other people get their Medicare benefits from Medicare Advantage Plans through a private health insurance company. This is another way the Medicare program is trying to share costs and risks, by allowing private health insurance companies to also offer Medicare benefits. The insurance carriers get paid from Medicare to offer benefits to older Medicare-eligible adults. A member who buys a Medicare Advantage Plan cannot also purchase a Medicare supplement policy because that would be considered being eligible to have double benefits for the same things. Medicare Advantage Plans include many of the benefits of a Medicare supplement policy.
Medicare supplement policies are regulated by the Centers for Medicare and Medicaid Services (CMS), and are identified at this time by the letters A through L. In the near future, new Medicare supplement policies M through P will be introduced. Some older Medicare Supplement policies will be discontinued soon. The availability of the different Medicare supplement policies is based on geographic location. You will need to submit your zip code and county in order to find out which Medicare supplement policies are available for you to purchase in your area.

The current crisis with Medicare funding is because the baby boomer generation is close to reaching the age of 65. All of these baby boomers have been working and paying taxes into FICA and Medicare and funding the Medicare program. When the baby boomers all hit the age of 65, there will be more people using the Medicare program than there will be people paying and funding the Medicare prog ram. This is where the crisis lies.

Although there is a lot of concern about Medicare funding, it has not been a top priority for the government. The current emphasis on health care reform has certainly touched on the Medicare funding problem. Attempts at making health insurance more affordable for more American citizens are supposed to help relieve some of the burden on Medicare. However, at this time, it is difficult to predict how that will all work out. Many conservative leaders predict some huge financial obstacles that Medicare must overcome in order to stay a viable program.

Medicare Supplement policies are purchased from a private health insurance company, but they are heavily regulated by the CMS to work with traditional Medicare Parts A and B policies.

Why purchasing Medicare supplement plan right when you turn 65 is a good idea

There are certain Medicare supplement policies, commonly referred to as Medigap, which are sold to Medicare beneficiaries who are already enrolled in Medicare or Medicare Advantage plans. These Medicare supplement plans help cover the "gap" or pay for expenses that Medicare does not include. Medicare supplement policies are private insurance plans that help pay expenses, such as deductibles, co-payments, or prescription drug costs.

Medicare beneficiaries can purchase Medigap, or Medicare supplement policies, on the open health insurance market. At this time, many seniors do not purchase Medicare supplement plans and only rely on Medicare or Medicare Advantage plans. The premium costs for Medicare supplement policies vary based on geography, type of plan, age and health condition. Therefore, purchasing Medicare supplement plan right when you turn 65 is probably a good idea, because th at is when you are the healthiest and youngest and eligible for Medigap coverage. If you purchase a Medicare supplement policy later on, you may have to pay a really high premium.

There are standardized Medicare supplement policies, which are government-regulated to include specific benefits so that individuals can compare the policies easily. However, each health insurance provider can set their own prices for their Medicare supplement policies. That is why it is important to do some comparison shopping between insurance providers.

What Medicare Does and Does Not Pay in 2010

A summary of seniors medicare benefits for 2010:

Considering the fact that most seniors live on a very tight budget, what medicare will and will not pay for medical cost is a major concern for most seniors. Unfortunately, the government is on a yearly basis increasing the medicare premiums and reducing the benefits medicare will pay. This brief article will outline in general the present state of medicare and what medicare will and will not pay in 2010. The article will also discuss briefly the various alternatives available to seniors to fill in the gaps on what medicare does not pay and expects the senior to pay out of pocket.

Medicare Abc's: 2010

Medicare has four areas of coverage: ABCD

Medicare Part A: Hospital Expenses.. If a senior is in the hospital for 24 hours medicare will pay for all hospital cost for the first 60 days after a $1100 deductible. ( note, this deductible is reinstated every 60 days for subsequent admissions or possibly six times a year).

61-90 days- The senior has to pay $275 per day

91-150 days- The senior pays $550 per day

After 150 days- The senior pays 100%

Medicare Part B: Doctor's cost( visits-surgery), including lab test, xrays,etc.

If already enrolled in Part B, the monthly cost for Part B is $96.40, usually deducted from your social security check. If a new enrollee in 2010 the cost is $110 per month..And increases if your income exceeds $82,000

Under part B medicare will pay only 80% of the cost and the senior pays the additional 20%.

Part C: Under Part C the senior can enroll with one of many carriers that will help fill in the gaps where medicare does not pay. It is called Medicare C Advantage Plan. The premiums are relatively low or nothing. However, under a Med C you can expect deductibles, co-pays, waiting periods,etc. Also Med C plans are run like group health plans where the carrier dictates the doctors, the place, the time etc of your medical care much like PPO's and HMO'S.

Part D: Prescription coverage. Briefly, the premium for Part D coverage is relatively inexpensive. However, unless you are taking some very expensive drugs, many national drugs stores offer very inexpensive drug programs to seniors.

Supplemental Coverage: A number of private carriers offer Medicare supplemental coverage. Supplemental meaning coverage that fills in the gaps that Medicare does not pay under Part A and Part B above. In others words, supplemental payments for the co-pays and deductibles previously discussed regarding Part A and Part B that the senior has to pay out of pocket.

Supplemental Coverage VS Part C coverage. As previously stated, Part C coverage by a private carrier is administered much like group health with co-pays, deductibles and a selection of their doctors. Supplemental plans vary in coverage and the yearly supplement premium is based on the degree of coverage.Ther are supplemental plans that pay all of the cost medicare does not pay under Part A and B to plans that may have a $2000 yearly deductible. The advantage of the supplemental plans is that you have control over which doctors you go to,anytime and anywhere. Of course the less you have to pay for coverage of the un-paid medicare cost the more your supplemental premiums will cost. Keep in mind that regardless of the cost for supplemental coverage, the premiums are far less than traditional non-medicare major medical coverage, and with better benefits.

Also, regardless of your pre-existing medical conditions most people have the opportunity to qualify for medicare supplements, so if you are turning 65 be sure to discuss the various supplemental medicare plans available and enroll when the pre-existing conditions are not a factor.

Obviously, this has been a very general overview of Medicare 2010, but hopefully outlines the medicare coverage and supplemental coverages available. And keep in mind that medical coverage is so critical to any senior that it is imperative to consult with an insurance professional in your state to know what alternatives are best for you.

If you have any questions about this issue please contact me at my website and I will direct you to an insurance professional in your area. Hopefuly this brief summary has been helpful and beneficial.

David Burlison, JD and licensed insurance producer in the state of Tennessee
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Travelaskthelocals is a unique website where locals at your destination answer pertinent questions about your travel plans and offers excellent travel links to plan any travel adventure. Just go to this web site.

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New Medicare Reporting Requirements and How it Affects Plaintiffs Attorneys

New Medicare Law and how it affects the Plaintiffs Bar

If you primarily practice personal injury law then you need to be aware of the new Medicare reporting law otherwise you and your client will not see the money from your recent settlements.

The Medicare, Medicaid and SCHIP Extension Act of 2007 (MMSEA) has now gone into effect as of January 1, 2010 and has brought with it new issues for Plaintiffs and their attorneys. It is important to be aware of these changes as they can now seriously delay your settlements.

The amendments, codified at 42 U.S.C. ? 1395 y(b)(8), now require liability insurers (which are defined to include self-insured entities) to report payments related to bodily injuries incurred by Medicare beneficiaries. It also requires that the Medicare beneficiary or "other party," defined by the regulations as including the entity making the payment, must reimburse Medicare within 60 days of the payment or be subjected to a $1,000 a day fine along with interest. The regulations further provide that if Medicare is not reimbursed within 60 days the primary payer must reimburse Medicare even though it has already reimbursed the beneficiary or other party.

This means that an insurance company settling a claim may be liable for paying the Medicare lien, even after paying the plaintiff, if the Plaintiff does not reimburse Medicare within 60 days of the date of payment. So now more than ever insurance company adjusters and their attorneys are making sure that Plaintiff's attorneys are resolving Medicare liens before they will issue payment of any settlement check.

If you have dealt with Medicare in the past you know the problems inherent in notifying them of your claim and trying to resolve your client's lien. If you have not dealt with Medicare before you need to seriously consider co-counseling with an attorney experienced in the area.

Whenever Medicare provides a lien they simply provide a search from the date of the accident through the date of the request. This means that the lien will include charges that are not related to your client's accident that you will have to dispute. Unfortunately, Medicare will not provide your final lien amount until 10 days after they are notified that the case has settled. Further problems arise because it takes Medicare in excess of 45 days to evaluate and remove unrelated charges from their lien so even if a plaintiff's attorney puts Medicare on notice at the inception of a claim and provides the information necessary for Medicare's contractors to evaluate the claim, the contractor will not issue a final demand letter setting forth Medicare's entitlement until notified of the settlement. This means that your client's lien amount can change at any time and you will have to pay Medicare whatever they are claiming or your client will be responsible for late fees and fines. Medicare's position is that it should receive its full demand entitlement pending resolution of such issues.

This is now causing insurance companies to be directly involved in the Plaintiff's negotiations with Medicare. Insurance companies and their attorneys will now want to include Medicare on any settlement checks as an essential element of any proposed settlement despite the fact that there is nothing in the current statute or implementing regulations requiring that payment be directed to Medicare or CMS.

So how do we avoid this?

Make sure to put Medicare on notice at the inception of a claim and negotiate their lien before settling your case. This is the only way to avoid significant delays at the end of the case when the Plaintiff is waiting on their money. If you do not know how to handle a Medicare lien then be sure to review my pamphlet "How to handle a Medicare lien" available on my website.

Then try to have the insurance company agree to a hold harmless and release providing indemnification from any claims by Medicare including fines and/or interest.

If they will not agree then as a last resort negotiate with the adjuster or attorney to enter into an enforceable Settlement Agreement, which would be reported to Medicare, but deferring the actual payment of the settlement funds until such time as you have obtained a final demand letter from Medicare setting forth Medicare's entitlement. Separate checks can then be issued to Medicare on the one hand, and the plaintiff and plaintiff's attorney on the other.

Christopher Wigand is a trial attorney and partner with Winston & Clark, P.A. in Plantation, Florida. The majority of his practice involves handling cases for other attorneys who do not litigate. Mr. Wigand has devoted his career to helping injured individuals and families. He is always available to discuss a co-counsel arrangement or for direct client referrals. For more information on contacting Mr. Wigand please see his website at http://www.christopherwigandlaw.com.

Medicare Part What?

Are you confused by Medicare? If you are, you are not alone. When you first begin to learn about Medicare, you are confronted with a whole new set of information. There is Medicare Part A, Part B, Part C, Part D.

If that were not confusing enough, you can add Medicare Supplement insurance to your new knowledge base, and you have a whole new set of Parts (or at least plans). Medigap Plan A, Plan B, Plan C, all the way through Plan L. Now, in 2010, that whole structure is changing yet again.

An then, to add insult to injury, even if you learned how to decipher all of these Medicare Part something or others, you still need to have a basic knowledge of health insurance terms. Deductibles, co-insurnace, co-pays, etc. ad nauseam.

The truth is, if you are like most people newly qualifying for Medicare, you don't care about becoming an expert in Medicare, but you would like to know at least a little about the system that will cover you, perhaps for the rest of your life.

Following is a very simple primer, in which I give you everything you need to know and probably care to know.

Medicare Part A

Part A is the Medicare Part that pays for in-patient hospital expenses. The way I like to remember it is that it pays your expenses (A)fter you get (A)dmitted.

Medicare Part B

Part B is the Part of Medicare that pays for most out-patient expenses like visits to your doctor. The way I like to remember it is that it pays for your expenses (B)efore you get admitted to a hospital.

Medicare Part C

Part C is that Part of Medicare that insurance companies to manage your health care (instead of Original Medicare). You probably know someone who accesses their Medicare benefits via an HMO, or network. That person is most likely participating in a Medicare Advantage Plan (which is another word for Part C).

Medicare Part D

Part D is the Part of Medicare that provides insurance plans for your prescription medicines. This one is easy to remember also. Part D stands for (D)rugs.

I should note that you can't access Parts C & D directly from Medicare. As of this writing, you have to participate in these parts through a privately contracted insurance company.

For example, both Company ABC and Company XYZ offer Medicare Advantage Plans (Part C). You have to enroll with those companies to participate. Every company that offers these plans, is highly regulated and works closely with Medicare.

The same goes for Part D. Both Company ABC and Company XYZ offer Prescription Drug Plans. You have to get your drug coverage through a company that sells one of the plans.

Speaking of plans, what about all of those Medigap Plans? A,B,C,D,E, Etc.?

A Medicare Supplement Plan is also known as a Medigap Plan, because it "fills in the gaps" left by Original Medicare. Remember all of those insurance terms? Deductibles, Co-insurance, etc. These plans (also available only through private insurance companies) pay for some or all of your share of the cost. The plan letter, like "A" or "F" simply have to do with the level of coverage you desire.

So that is all for this primer. I have a 4 year old, and if he walks in any time soon, I am sure I will be tempted to sing that tune... "Now I said my ABC's, won't you sing along with me?"

Get help now with the Medicare Part that is confusing to you. Go now to: MedicareNational.com

At MedicareNational.com, our goal is to help you feel secure, save money and get the plan that is right for you. We Make Medicare... Easy!

Medicare Health Plan Options

If you or someone you know is about to go on Medicare, you should know that you'll be able to choose how you receive your Medicare benefits including your prescription drug coverage. This brief article will explain some of the more popular options as well as give you specific phone numbers to call with you Medicare questions. Medicare health insurance is currently for people who are age 65 or older, under age 65 with certain disabilities, and at any age living with End-Stage Renal Disease (ESRD). ESRD is permanent kidney failure requiring dialysis or a kidney transplant.

While Medicare covers a lot of different health care services and supplies, it does not cover all of the costs associated with your health care. There are "gaps" associated with Medicare that require the beneficiary to pay out of their pocket. These Medicare costs include coinsurance, copayments and deductibles. Depending on the Medicare health plan you choose, you'll have varying degrees of costs.

Medicare Health Plan Options

Original Medicare is managed by the Federal Government and provides Part A and Part B health coverage. Original Medicare pays for many of the health care services and costs associated with normal services and supplies. Original Medicare does not pay for all of your health care costs. It is important that you understand your coinsurance, copayments and deductible. These are called out-of-pocket costs, or also known as cost-sharing.

Many Medicare beneficiaries choose to buy a Medicare Supplement policy (a.k.a. Medigap Policy) to help fill these out-of-pocket costs. Before you can buy a Medicare Supplement policy, you'll generally have to have both Part A and Part B. A Medicare Supplement policy can only generally help you if you have Original Medicare. If enrolled in Original Medicare and you would like to have prescription drug coverage, you'll need to buy a seperate policy to cover your prescription drugs. These are simply called Medicare Prescription Drug Plans.

Medicare Advantage Plans are known as Part C. They are health plans that are similar to traditional HMO or PPO insurance plans. These plans are another way to get your Medicare benefits. These are plans that are approved by Medicare, but run by private insurance companies. You'll find that your out-of-pocket costs may be different in a Medicare Advantage Plan. Check to find out what your coinsurance, copayments and deductibles will be for any Medicare Advantage Plan by using the online comparison tool found at Medicare.gov.

Medicare Prescription Drug Coverage is also called Part D. Prescription drug coverage is available for everyone with Medicare. These prescription drug plans are run by private insurance companies and approved by Medicare. There is a separate premium associated with Part D plans. You have to enroll in the plan and pay the premiums to get Part D prescription drug coverage.

In the next article we'll explore Medicare Supplement insurance policies. These plans are specifically designed to cover the gaps in Original Medicare.

Michael D Coday II is a licensed insurance agent in Texas. He offers free medicare supplement quotes for Texas residents at his website. Find him online now: http://www.medigapmedicareinsurance.com

How to Select the Right Medicare Plan

Just deciding which way to go when choosing from the combination of different types of healthcare coverage is confusing for many people eligible for Medicare. For most people, having choices is a very good thing. But what about when you have thousands of plans to choose from?

When it comes to Medicare, you have nothing but choices. Depending upon your circumstances, you may want to stay with traditional Medicare, or Medicare Parts A and B. If you choose this path, you'll probably want to get a Medicare Part D (prescription drug) plan, too, to ensure your medications are covered. Or, you might be more interested in a Medicare Advantage plan, which can combine traditional Medicare with drug coverage and other benefits. You also may be interested in even more coverage, such as that offered through a Medigap (supplemental) plan.

Fortunately, help is available. A Medicare advisor offers education on available Medicare programs, answers questions, and offers detailed plans of action to get the most out of your insurance choices. You also should know the basics beforehand.

Traditional Medicare

Medicare Parts A and B, also known as traditional or original Medicare, have been around since 1965. Medicare Part A is free to most people who've worked and paid Medicare taxes for at least 10 years and provides people with inpatient hospital coverage. Medicare Part B, which costs most people $96.40 in 2009, covers outpatient medical expenses.

People who have traditional Medicare can see any doctor they want in any facility they want without a referral, as long as that doctor or facility accepts Medicare patients. But traditional Medicare's benefits are limited.

Not only does traditional Medicare not cover most outpatient prescription drugs, if a beneficiary uses their coverage frequently enough, it can get very costly. That's why we also have Medicare Advantage and Medicare Part D plans available.

Medicare Advantage Plans

Medicare Advantage, also known as Medicare Part C, combines Medicare Parts A and B in one plan so you can get your Medicare Part A and Part B coverage in the same place. Medicare Advantage plans also often include prescription drug coverage and other benefits not commonly found under traditional Medicare, such as vision and dental services.

This program works just like private insurance - you have different types of plans to choose from depending upon what type of provider access you want (for example, health management organizations (HMO), preferred provider organizations (PPO) and more) and what health conditions or prescription drugs you take. You also can choose from a number of different levels of coverage. All Medicare Advantage plans must offer at least as much coverage as that offered under traditional Medicare. If they offer prescription drug coverage, that coverage must meet minimum Medicare Part D standards as well.

Medicare Part D

Medicare Part D is prescription drug coverage. Like Medicare Advantage, Part D is offered by private companies who are reimbursed for providing healthcare coverage. Also like Medicare Advantage, a minimum amount of coverage is required for a plan to qualify as a Part D plan and many different plans, some with different levels of coverage, are offered throughout the United States. Part D plans are best for people who use prescriptions, but don't need to see their doctors often.

Medigap Medigap, or Medicare supplemental plans, is sold by private companies to fill the "gaps" in traditional Medicare. This includes the cost of deductibles, co-payments and coinsurance. It also may cover other services that Medicare does not insure. In 2009, there are 12 Medigap plans - A through L.

Although Medigap may offer some additional coverage if an individual chooses to keep traditional Medicare, you can't buy a Medigap plan if you have Medicare Advantage. Because most Medicare Advantage plans offer better coverage and frequently more benefits than Medigap, having both is usually unnecessary. You can have both Medigap and Medicare Part D, but it may be more expensive to do this than simply purchasing a Medicare Advantage plan instead.

Comparing And Contrasting

It's no wonder that people are confused. There are thousands of plans available throughout the United States, and an average of 40 Medicare Advantage and Medicare Part D plans in any given area.

This is where a Medicare advisor can come in handy. With so many options in just one area, choosing a plan might feel like throwing darts at a board. Using a Medicare advisor can help you narrow down your choices so you know which combination of Medicare coverage will work best for you and which plans will give you the best and most affordable coverage for your needs.

Jim Allsup writes for Allsup, a provider of Social Security disability, Medicare and workers' compensation services, including Allsup Medicare Advisor, Medicare assistance services for people with disabilities and seniors.

SSDI & Medicare - A Beginner's Guide

Figuring out how the Social Security Disability Insurance (SSDI) and Medicare programs are related can be confusing to anyone who isn't currently enrolled in these programs. This article provides basic information on SSDI and Medicare eligibility and benefits. In addition, this guide will show you how to apply for and receive the right benefits for your situation.

Defining the Programs

SSDI is a payroll tax-funded, federal insurance program that was established in 1954. A portion of the FICA taxes taken out of your paycheck are set aside for this disability insurance program, which provides monthly income to people who are unable to work due to a severe disability.

Medicare is another federal insurance program, but is health insurance instead of disability insurance. It is available to all individuals age 65 and older as well as those who have been receiving SSDI cash benefits for 24 months. The program is made up of many parts - Medicare Part A consists of hospital benefits; Medicare Part B is medical benefits; Medicare Part C (Medicare Advantage) provides extra coverage and is provided by private insurance companies; and Medicare Part D is voluntary prescription drug coverage.

Determining Eligibility - How to See if You Are Entitled to Benefits

Eligibility for each program depends on several factors. For SSDI, there are three general qualifying criteria: 1) you must have worked and paid into the program (through your payroll taxes) for five of the last 10 years, 2) you also must have been disabled before reaching the full retirement age of 65-67, and 3) you must meet Social Security's definition of "disability." The Social Security Administration (SSA) has a process to determine who's eligible for benefits. By evaluating your income, limits of your disability, past job history and more, the SSA determines whether or not you're qualified to receive disability insurance.

There are several ways people can become eligible for Medicare. Anyone who turns 65 is automatically eligible for benefits. If you get Social Security retirement benefits or receive benefits from the Railroad Retirement Board (RRB), you will be considered eligible as well. Additionally, if you're awarded SSDI benefits for something other than Lou Gehrig's disease (ALS), you will become eligible for coverage 24 months after the date of entitlement to cash benefits. If you are awarded SSDI and have ALS, you will automatically be eligible for Medicare once you begin receiving SSDI benefits, and if you have kidney failure, you'll be able to enroll in Medicare three months after starting dialysis.

Specific Benefits You Can Receive

Social Security Disability Insurance allows you to receive a regular monthly income, results in eligibility for Medicare benefits (as explained earlier), and allows possible extension of your COBRA benefits, protects your retirement and long-term disability benefits, plus allows for dependent benefits and return-to-work incentives.

Medicare has many parts to cover specific healthcare costs. Medicare Part A covers inpatient care in hospitals and provides patients with a stay in a semi-private room, complete with meals, general nursing, and drugs. Part A also covers the cost of a blood transfusion if the hospital must purchase blood for you, up to 100 days per each benefit period in a skilled nursing facility, and hospice care for those with a life expectancy of six months or less due to a terminal illness. Part A coverage costs nothing, except for your deductibles or copayments, and coverage gaps must be paid by you or covered by other insurance.

Medicare Part B covers doctors' visits and services, outpatient care, rehabilitative care under a physical therapist, occupational therapist, or speech-language pathologist, and some preventative services like flu shots and mammograms. The monthly cost (or premium) for Part B coverage is tied to your annual income and adjusted each year. Most will pay the standard Part B premium of $96.40 per month in 2009 (if your annual income is not more than $85,000 as a single taxpayer or $170,000 if filing a joint tax return).

Medicare Advantage (Part C) plans at a minimum cover everything offered by traditional Medicare (Parts A and B). They also may offer additional benefits not covered by traditional Medicare like dental care, vision screening, prescription drugs and other services that would otherwise need to be provided under a supplemental insurance policy (Medigap).

Your out-of-pocket costs are likely to be less with a Medicare Advantage plan than if you use traditional Medicare and a Medigap policy. Everyone in a Medicare Advantage plan pays at least the same monthly premium as those enrolled in Medicare Part B. Your premiums may cost more depending on the benefits provided by the plan.

Medicare Part D (prescription drug coverage) provides brand-name and generic prescription drug coverage. These plans are provided by private companies that are approved by Medicare. Part D coverage is optional and available to those enrolled in traditional Medicare (Parts A and B) or Medicare Advantage plans that don't offer prescription drug coverage. Costs, extra benefits and details vary by plan.

Work With a SSDI & Medicare Advisor Service to Maximize Your Benefits

Don't stay confused trying to figure out the complex rules of these programs on your own - let those who understand it best help you maximize your benefits. Medicare & SSDI programs can be confusing with all of the different program requirements and eligibility criterion. Working with an SSDI expert and Medicare Advisor Service can help you determine the best coverage for your specific needs to ensure you get all of the benefits you are entitled to receive.

Jim Allsup writes for Allsup, a nationwide provider of Social Security Disability, Medicare and workers' compensation services for individuals, employers and insurance carriers. Allsup provides a Medicare Advisor service to help you select the Medicare plans that are right for you.

Paying For Home Health Care - What Do Medicare and Medigap Cover?

Prescribed only by a physician, home health care is skilled nursing care that aids in the recovery from illness, injury, or surgery in the patient's home. And fortunately for many seniors who are now opting for care at home, Medicare insurance covers most costs related to home health care.

The government, however, has set some limitations on payouts - you are only eligible if you need intermittent care (usually defined as seven days a week or less than eight hours a day over 21 days or less) (1), physical/occupational therapy or speech language pathology; you are homebound; and the home health care agency providing care is approved by your Medicare insurance program.

In addition to medication administration, general supervision, and therapy services, the Medicare home health benefit covers a number of other necessities, including medical aids and supplies to aid in recuperation. On the occasion, though, you may be required to cover some of the costs associated with home health care. But what can you expect to pay out-of-pocket that's not covered by Medicare dollars?

Medicare Insurance: Part A and Part B

Hospital Insurance (Medicare Part A) helps cover the costs of your inpatient care at hospitals, skilled nursing facilities, or religious non-medical health care establishments. Part A can also help cover hospice and home health care services. Individuals aged 65 and older are usually automatically enrolled in Medicare Part A and do not have to pay a monthly premium if Medicare taxes were paid while working. If you did not pay taxes, you are still eligible, but you will be required to pay a monthly premium.

Medical Insurance (Medicare Part B) helps cover services such as those offered by your physician and outpatient care. Many seniors maintain their enrollment in Part A, but elect not to use Part B, which requires a monthly premium that is dependent upon income, the requirements of which change yearly. Unfortunately, if you didn't sign up for Part B when you were first eligible for insurance, your premium may be slightly higher (2).

For questions on your Medicare insurance benefits, you should contact 1-800-MEDICARE or read the handbook mailed to you each year entitled "Medicare and You."

What's Covered and What's Not

Medicare insurance pays for physical and occupational therapy and speech language pathology services, counseling, some medical supplies, durable medical equipment (which must meet coverage criteria), as well as general assistance with daily activities which include dressing, bathing, eating, and toileting. For most other medical equipment, Medicare insurance will cover 80% of its cost (3).

However, Medicare will not cover twenty-four hour care at home, meals delivered to your home, and services unrelated to your care such as housekeeping. Of course, as mentioned above, you will be required to pay 20% for medical equipment not fully covered by Medicare insurance such as wheelchairs, walkers, and oxygen tanks (4).

In some cases, your home health care agency may present you with a Home Health Advance Beneficiary Notice (HHABN), which, simply put, means if your agency is ceasing your care services, you will be presented with a written statement outlining the supplies and services the agency believes your Medicare insurance benefits will not cover as well as a detailed explanation of why. Should this situation arise, you do have recourse - the HHABN lists directions on acquiring the final decision on payment issues or filing an appeal if Medicare refuses to cover costs for home health care. In the meantime, you should continue receiving home health care services, but keep in mind that you will be paying for these services out-of-pocket until Medicare accepts your claims and remits past expenses.

Medigap and Other Out-of-Pocket Expenses

Medigap, a supplemental insurance policy, is sold privately and covers the services and supplies not paid for by Medicare insurance. When used in conjunction, Medigap and Medicare can often cover a large majority of the costs of your home health care. Insurance companies offer a variety of different Medigap policies (A through L), but since each one comes with specific benefits, you'll need to compare the highlights closely. Medigap policies vary by cost, and many insurance companies require you to have both Medicare Parts A and B in order to purchase a supplemental plan (5).

For seniors with both Part A and Part B Medicare, your home health care situation is usually covered, save for the 20% out-of-pocket expenses for medical equipment. Just remember to keep track of your Medicare insurance benefits (and Medigap if applicable) by verifying with your physician, home health care agency, and insurance representative. Paying for home health care does not have to cost you an arm and a leg, but do be prepared for the occasional (but necessary) out-of-pocket medical expenses.

Sources

1. Centers for Medicare and Medicaid Services, Medicare and Home Health Care, page 6

2. Medicare website: "Your Medicare Benefits."

3. Ibid.

4. Ibid.

5. Medicare website: "Medigap (Supplemental Insurance) Policies."

Jill Gilbert is the President and CEO of Gilbert Guide, a comprehensive website helping seniors and their loved ones find a senior care provider along with extensive tools and resources to solve the challenges of aging. She is the author of "Leading by Example," a monthly column in McKnight's Long-Term Care News, the chief industry publication for long-term care providers. Jill has been interviewed for a CBS News special, was a key presenter at the Pennsylvania Assisted Living Association's annual conference, and was recently interviewed on San Francisco TalkBack.

Gilbert Guide was founded on the concept that quality matters, and its primary goal is to educate consumers on a breadth of senior care issues. Visit http://www.GilbertGuide.com for a comprehensive provider database, expert advice, and quality assessment tools that help consumers conduct their own "expert" evaluations of providers.

Prescription Drug Coverage With Supplemental Medicare Insurance and Medicare Advantage Plans

If you are about to turn 65, you have probably been studying up on how Medicare works and the various plans it offers. Because some of the plans are similar, the differences between them are often blurred, leaving potential beneficiaries confused about what plan is right for them.

Medicare Part C, known as a Medicare Advantage Plan, is one of the four basic parts of the Medicare system. It allows users of the original Medicare Parts A and B to get coverage from a government approved private insurance company of their choice. Medicare Advantage Plans include plans like Health Maintenance Organization Plans (HMO) and Preferred Provider Organization Plans (PPO). The biggest weakness the original Medicare plans have is that they do not cover the cost of prescription drugs. If you want additional coverage, you have a few options.

Medicare Part D is available to anyone with original Medicare (Parts A and B), and can help cover the costs of prescription drugs. You must get this coverage through a private insurance company approved by Medicare. If you have a Medigap policy, the same as supplemental Medicare insurance, it may already cover the costs of drugs. But if it does not, you are allowed to get a Medicare Prescription Drug Plan as part of Medicare Part D, but must alert your insurance company if you do so. Not all supplemental Medicare plans will cover drug costs, so it is important to make sure the plan you choose offers this benefit. If it does not, just remember that you can still get drug coverage through a Medicare Plan.

If you are not going to utilize Medicare Part D, or get supplemental Medicare insurance, consider Medicare Part C - the Medicare Advantage Plan. These plans, provided by private insurance companies, may offer prescription drug coverage at an additional cost. If you have one of these plans, you will not need supplemental Medicare insurance at all; it is simply an alternative. Make sure to check your coverage history from past employers; you might have additional coverage choices if your former or current employer provided you with prescription coverage.

Make sure not to buy a supplemental Medicare plan if you already have a Medicare Advantage Plan. Doing this is illegal, unless you are completely dropping your Medigap plan and returning to original Medicare. Be very careful before ever dropping your supplemental Medicare insurance, because it is possible that you may not be able get it back in the future. Discuss the issue with your State Health Insurance Assistance Program and your insurance company before ever making a decision that could affect your long-term health coverage.

Getting prescription drug coverage is an important element in any health coverage plan, and only gets more important as you get older. You should seriously consider getting a plan that helps cover the costs of prescriptions, as you never know what types of health issues you may have in the future. Whether you choose to get supplemental Medicare insurance or a Medicare Advantage Plan, having some kind of drug coverage will have you prepared for any twists or turns life may bring.

Richardt Insurance has over 35 years of experience helping seniors find the best supplemental Medicare insurance and prescription drug coverage that is available in their state.

Medicare Supplement Insurance Helps With Expenses Not Covered by Medicare

Just when you are ready to relax and enjoy retirement, you realize that medical insurance has become even more complicated. You're presented with Medicare Advantage Insurance, Medicare Supplement Insurance (also called Medigap Insurance), and Medicare Part A, B, and D. What's it all mean?

Let's Start at the Beginning

Medicare is divided into four parts. Part A deals with home health care, hospice, hospital, and skilled nursing care. Part B handles doctors' services, other medical services, and supplies not covered by Part A. Part C allows you to receive Medicare benefits through private health insurance (Medicare Advantage Insurance) in place of Parts A and B. Part D provides prescription drug coverage.

What Is Medicare Advantage Insurance?

With a Medicare Advantage Plan, generally all of your Medicare-covered health care is provided through that plan, which can include prescription drug coverage. These plans may offer more benefits, and lower co-payments than Medicare Part A and B.

Medicare Advantage Plans include Health Maintenance Organizations (HMOs), Preferred Provider Organizations (PPOs), private Fee-for-Service Plans, and Medicare Special Needs Plans.

Private Fee-For-Service plans are offered by state-licensed risk-bearing entities with yearly contracts to provide Medicare benefits. They may also offer additional benefits, and do not usually require you to use a network of providers.

Special Needs Plans focus on certain vulnerable groups, such as those who are institutionalized, are dual-eligible, and/or have severe or disabling chronic conditions.

What Are HMOs?

Doctors, hospitals, and insurers participate in HMOs, which provide medical treatment on a prepaid basis. HMO members pay a fixed monthly fee regardless of how much care is needed in a given month. Most HMOs provide a wide variety of services, but members must usually obtain medical treatment from in-network facilities and physicians.

With HMOs, you must see a primary care physician before you can see a specialist. Rather than paying a percentage of the bill every time you receive medical care, you pay a fixed monthly fee, and HMOs often have nominal co-payments rather than deductibles. HMOs generally do not limit lifetime benefits, but will not pay for non-emergency care from a non-HMO physician.

What Are PPOs?

PPOs are made up of doctors and/or hospitals that provide medical services only to a specific group or association at discounted rates. PPO members pay for services as they are rendered, and are generally reimbursed for treatment costs minus co-payment percentages. Physicians may submit bills directly to insurance companies so members pay only a co-payment.

PPO members are not required to seek care from PPO physicians, but members may receive 90-percent reimbursement for in-network care as opposed to 60 percent for non-network treatment. PPOs may also require a deductible. You may have to fill out paperwork for reimbursement, and most PPOs have larger co-payments than HMOs.

You must have Medicare Part A and B to join a Medicare Advantage Plan. You will have to pay a monthly Part B premium, and may also have a monthly premium for the Medicare Advantage Plan for the extra benefits it offers.

When you join a Medicare Advantage Plan, your Medicare Supplement Insurance or Medigap Insurance will not pay co-payments, deductibles, or other cost sharing under your Medicare Health Plan.

What Is Medigap Insurance?

If you do not have a Medicare Advantage Plan, Medigap Insurance can cover expenses that Medicare does not cover. When you have Medicare and a Medigap policy, both pay their share of covered health care costs.

Medigap policies must have standardized benefits, but costs can vary. You may be able to choose up to 12 different Medigap policies (Plans A through L), which have different sets of basic and extra benefits. The benefits of any Medigap Plan (A through L) are the same for every insurance company, and companies choose which policies to offer.

Generally, you must have Medicare Part A and B to buy Medigap Insurance. You will pay a monthly Part B premium, and a premium for the Medigap policy. Medigap Insurance will not cover your spouse, so you both need separate policies.

With some basic insight into how Medicare works, you can select the Medicare Advantage Insurance or Medicare Supplement Insurance that best fits your needs. If you have questions, expert advisors are available online to answer questions, and explain terms. These types of plans can make your retirement more secure so take advantage of sources that can answer your questions before you need Medicare.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medigap coverage. Our professional medigap advisors will help you choose the best Medigap plan for your needs.

Medicare Reimbursement Cuts - A Policy Perspective

This article will evaluate the challenges associated with Medicare reimbursement cuts. The amount of expenditure in this program has skyrocketed since its inception in 1965 despite various measures to control growth. Short-term legislative fixes have been buying time for the development of long-term solutions while various stakeholders stand to win and lose as they are faced with forthcoming reimbursement cuts. Among these stakeholders are the federal government, politicians, third-party payers, Medicare recipients, and healthcare providers. Foreseeable problems exist in implementing reimbursement cuts including barriers to patient care and the financial viability of healthcare providers who rely on Medicare patient revenues. Continual debate over short-term Medicare cuts will be eclipsed by policy changes related to the viability of the program and long-term sustainable healthcare funding and delivery systems.

Introduction

Health care spending currently accounts for 16% of the gross domestic product of the United States (Getzen, 2007). New technology and higher incomes have increased overall healthcare spending and driven up costs. The question raised, is how health care expenditure will be controlled within government programs like Medicare. The formation of Medicare and Medicaid by the Social Security Acts of 1965 established the government as a major payer in health care. Regular reimbursement through government funding allowed hospitals and other institutions to grow in size, capacity, and capital. Controlling growth and costs has become a major concern as proportional expenditure on healthcare has increased. Of the various cost-containing measures employed to control expenditure, reimbursement cuts are some of the most contentious issues.

Background and Significance

Medicare has evolved in numerous ways since its inception in 1965. Physicians were initially reimbursed by the program for services covered and were able to bill patients for non-covered costs. Hospital reimbursement methods also followed similar patterns until a change was made in 1983 from "reasonable cost" to the prospective payment system based on diagnostically-related groups. In 1992 the physician fee schedule replaced the charge-based system. The Sustainable Growth Rate (SGR) of 1998 was created to control spending even further. Annual targets for spending are established and physician payments are reduced if spending exceeds these limits.

The bulk of today's Medicare costs are different than those of the past. A larger portion of expenditure is attributable to outpatient services covered by Part B of Medicare. This expenditure has consistently exceeded the established formula as specified in the SGR. Forthcoming adjustments in the form of reimbursement cuts propose major problems for physicians receiving reimbursements for services rendered to their Medicare patients. "Whereas over the next several years the SGR formula will cut doctors' reimbursement by an estimated 25 to 35 percent...[and] deep cuts in physician reimbursement will force many doctors out of the Medicare program and leave many patients without access to a physician (H.R. 863 IH, 2007)." These cuts will have a significant impact on physicians and hospitals, and may exacerbate healthcare access barriers to Medicare recipients. New reimbursement cuts are especially troubling in light of evidence that the expansion of Medicare reimbursements to new areas of care can benefit patient health (Gross et al., 2006). The types and amounts of cuts to be made are largely dependent on legislation and actions on Capitol Hill.

Legislation

Legislative action on Medicare cuts is ongoing. A recent (February 14th, 2008) amendment was proposed in the House of Representatives to adjust conversion factors in Part B of title XVIII of the Social Security Act, increasing Medicare payments for physicians' services through December 31, 2009. These adjustments are temporary fixes in the challenge to create long-term solutions: "The purpose of this Act is to allow adequate time for Congress to determine an appropriate long-term solution for Medicare physician reimbursement rates (H.R. 5445 IH, 2008)." Legislative fixes are influenced by the various groups that are potentially affected by these cuts. Language in these resolutions seems to indicate this. A resolution on December 11th, 2007 in the House expresses the sentiment "...that the Medicare physician payment system must be immediately reformed in a long-term manner in order to stabilize Medicare payment to doctors, return equity to the program, and ensure that Medicare patients have access to a doctor of their choice (H.R. 863 IH, 2007)." Congress is continuously tuning reimbursement-related legislation to slow uncontrolled growth while appeasing powerful constituencies and interest groups.

The executive branch also plays a major roll in the determination of alternate Medicare cuts. The Bush Administration recently proposed a measure to control the explosive growth in the program. On February 18th, 2008, "the Bush administration...submitted a measure to Congress to reduce Medicare spending by increasing prescription drug plan premiums for higher-income beneficiaries and by increasing the use of health information technology, such as electronic health records, among other provisions (Carey, 2008, p.1)." This move was triggered by a condition of the 2003 Medicare law. When a financial warning is issued by Medicare trustees the administration is mandated to submit legislation reducing program spending or increasing revenue. "The warning is issued when trustees for two consecutive years predict that federal general fund revenue must be used to pay for 45% or more of total Medicare costs within seven years (Carey, 2008, p.1)." Monies required to pay for Medicare exceed allotted funds and the program's encroachment on other fund sources is closely monitored.

Stakeholders

Among the major stakeholders in this issue are the federal government, politicians, third-party payers, Medicare recipients, physicians and hospitals.

The federal government stands to win by moderating uncontrolled growth in the Medicare program. In recent years total expenditure and federal reimbursement has exceeded target rates. "By the 2000-2004 period, society was willing to devote over 20 percent of the cumulative increase in GDP and the cumulative increase in Federal outlays towards health care (Hartman, Smith, Heffler, & Freeland, 2006, p.41)." The growing size of Medicare threatens to encroach on other fund sources and programs. It is in the best interest of the federal government to reform Medicare and keep expenditure within manageable boundaries. Despite the benefits involved in implementing cuts, the types of cuts which are made have the potential for backlash. Cuts to reimbursements are exceptionally contentious in the healthcare community. The federal government must seek and implement responsible controls to mitigate harm while effectuating reform.

Politicians are another group affected by policies on reimbursement cuts. Their role is fairly complex as their duties and functions are reflective of the competing interests of different populations, groups, and political parties. Expenditure reduction and reimbursement cuts affect a wide range of constituents in different manners. The role of Medicare reimbursement cuts in political decision-making depends on how these groups are impacted. Politicians may win or lose depending on how the effects of these cuts unfold. The amount of healthcare lobbying that takes place on Capitol Hill speaks to the magnitude of interests involved.

Third party payers are heavily influenced by Medicare reimbursement methodologies. Medicare reimbursement cuts may likely equate to reimbursement cuts by other third-party payers, thus exacerbating many of the problems experienced by healthcare providers. Significant resentment already exists from problems associated with current reimbursements models and additional cuts may hurt payers in the short-run. In the long-run payers will benefit from moderated expenditure and more stable growth rates.

Medicare recipients are another prime group affected by cuts. A major concern associated with reimbursement cuts is the reduction of benefits and programs to these recipients. Technological advancement has provided patients with a vast array of services, procedures, and pharmaceuticals. Benefit and program cuts may translate into a reduction of these features which they have become reliant on. Reimbursement cuts may also contribute to barriers in accessing care. Lower reimbursements from Medicare may lead providers to be less inclined to accept new Medicare patients. Studies have already been conducted on barriers associated with general and specialized care related to payer type. In a study conducted on appointment setting for dermatology patients, "...some access limitations in hot spots where Medicare payments are low relative to commercial insurers suggest that patients in these areas may be most sensitive to further payment reductions (Resneck, Pletcher, & Lozano, 2004, p.85)." The case can be made that additional reimbursement cuts may further expand these "hot spots" for Medicare recipients. Additional barriers may emerge as the expected cuts related to the SGR come to fruition. In the short-term seniors stand to lose from reimbursement cuts but may benefit in the long-run from a more sustainable delivery system that can result from Medicare reform.

Physicians and hospitals stand to lose in the short-term. The healthcare community is at odds with current reimbursements models and believes that further cuts will significantly erode revenues. A study featured in Pain Physician acknowledges that "physicians in the United States have been affected by significant changes in the pattern[s] of medical practice...and escalating healthcare costs have focused concerns about the financial solvency of Medicare (Manchikanti & Giordano, 2007, p.607)." The payment rate cut which was released on July 12th, 2007 includes a 9.9% reduction. Many physician practices and hospitals will be drastically affected but may benefit in the long-run from programs that are moderated in growth and can remain solvent.

Implementation issues

Various groups are involved in seeking solutions to this problem including the Medicare Payment Advisory Commission (MedPAC), the Government Accountability Office, physician and hospital organizations, economists, and other interest groups. The U.S. Senate and House of Representatives are separately working on two different ways to alleviate the inconsistencies in costs and corresponding reimbursements while trying to establish long term sustainable solutions. One of the most significant implementation challenges is the financial fallout to providers relying on reimbursements (physicians, hospitals, and other affected providers). Medicare accounts for a sizeable portion of revenues to some health facilities and healthcare providers. Further reducing reimbursements for services will have a major financial impact and the healthcare community has been especially active in resisting additional cuts. Some of the most vocal groups have been providers and their affiliated interest groups. It is common to find multiple reimbursement-related articles in trade journals and specialty magazines. Certain specialties will be impacted more heavily than others and this is reflective in payment changes by CPT code.

Impact to Medicare recipients is another major implementation issue. Cost-containment may have negative effects on patient access to services and resulting health outcomes, though this is not generalizable across the board. At least one study has shown that health outcomes were not impacted for patients receiving treatment in hospitals affected by past reimbursement cuts (Volpp et al, 2005). Counterintuitive results from studies like this make implementation even more intricate and perplexing. Legislation must be drafted based on truly measurable effects to recipients, providers, and cost-containment goals.

Future direction

Medicare reimbursement reduction is a major policy issue affecting large strata of interests. Within government it is recognized that more time is required to generate sustainable strategies. Balancing long-term objectives with the immediate effects of cuts is a delicate matter. Policymakers will need to make difficult and calculated decisions about efforts to reduce healthcare spending. Some believe that a greater focus on preventive care has the potential to alleviate expenditure trends. A significant portion of current expenditure in Medicare and other programs comes from long-term maintenance of chronic conditions. This trend accounts for a large portion of uncontrolled growth. Medicare reimbursement cuts are merely stop-loss strategies in a losing equation rather than robust long-term solutions. A greater focus on preventive care has the potential to extend the viability of U.S. healthcare systems.

Chris Majdi
Transition Consultants
The practice sales and financing company
http://www.transitionconsultants.com/

Medicare Coverage For Mental Health and Alzheimer's Care

Modern medicine recognizes that many mental and emotional problems are in fact physical illnesses or related to them. So, with either Medicare Part A hospital insurance plus Medicare Part B medical insurance, or with a Part C Medicare Advantage managed care plan, participants have extensive coverage for treatment of mental or emotional illness, including depression, Alzheimer's disease, and other forms of dementia. This includes both inpatient and outpatient care, and treatment not only by doctors but also by other Medicare-certified healthcare providers. The amount of coverage Medicare provides depends on the kind of hospital where the person receives care.

Care in a general hospital.If the inpatient care she receives is in a general, nonpsychiatric hospital that treats patients for all types of illness, the rules of coverage are the same as for any other hospital stay. That is, under Medicare Part A, she must pay a deductible, plus daily co-payments for a stay of more than 60 days within any one benefit period. If she's in the hospital for more than 90 days in any one benefit period, Medicare Part A pays part of the cost of up to 60 more once-in-a-lifetime "reserve days". However, there's no lifetime limit on the number of hospitalizations that Medicare Part A will pay for. If she has a Part C Medicare Advantage managed care plan, it pays for at least this same amount of inpatient care, and some plans pay more of the cost.
Care in a psychiatric hospital.If she's an inpatient in a psychiatric hospital -- meaning one that accepts patients only for mental health care -- the rules of payment are the same as for a general hospital but the total amount of coverage is different. Medicare Part A covers only a total of 190 days in a patient's lifetime for inpatient care in a psychiatric hospital.

Nursing facility care. The single most important thing to understand about Medicare and nursing facilities is that Medicare does not pay for long-term care. However, under limited circumstances and for a short time, Medicare Part Aor a Medicare Advantage managed care plan can cover a stay in a skilled nursing facility while the person is recovering from a severe mental health episode that landed her in the hospital. The nursing facility stay must follow, within 30 days, a hospital stay of at least three days. And the nursing facility stay must be medically required and prescribed by her doctor to provide her with daily skilled nursing or rehabilitation services while she's recovering from the medical event that put her in the hospital. The coverage can last for up to 100 days, with Medicare paying the full amount for the first 20 days and your family member having to make a co-payment of $133.50 (in 2009) per day for days 21 through 100. For more details about Medicare Part A nursing facility coverage, see our article Understanding Medicare Part A (Hospital Insurance). Home care. Home care is available under Medicare Part A, Part B, or Part C (managed care) if it's medically necessary for any illness or condition, including mental illness, Alzheimer's, and other forms of dementia. But the rules under which Medicare coverage is available for home care are quite strict, and coverage usually lasts only a short time. The key thing about Medicare coverage for home care is that it applies only to home healthcare. That means your family member must need skilled nursing care or rehabilitation therapy while she's confined to home because of an injury or illness. It doesn't cover assistance with the activities of daily living such as dressing, bathing, walking, or eating unless these are provided incidentally, alongside required skilled medical care. A doctor must prescribe the home care and it must be provided by a Medicare-certified home healthcare agency. If the person in your care qualifies, Medicare pays 100 percent of the agency's costs. But the care can continue only as long as the skilled nursing or therapy is required, while she's actually recovering. Home healthcare is covered by Medicare Part A following a hospital stay, or by Medicare Part Bif there has been no prior three-day hospital stay. If she's enrolled in a Part C Medicare Advantage managed care plan, that plan provides home care under the same rules, except that the home care agency must be associated with the specific managed care plan.

Psychological care. Psychological counseling is not technically medical care. But under some circumstances, Medicare Part B or Medicare Part C managed care will cover counseling by a clinical psychologist. The person's doctor must prescribe the treatment. The psychologist must be certified by Medicare. And the psychological care must relate to a problem -- such as depression or anxiety -- arising out of a medical condition for which the doctor is treating her. If she's suffering emotionally from the strain of a physical illness, suggest that she discuss the problem with her doctor. If she and the doctor believe she might benefit from psychological counseling, Medicare Part B or her Medicare Advantage managed care plan might cover the care. The office of the psychologist she's referred to can find out in advance from Medicare whether it would cover her treatment there. Adult daycare. In general, adult daycare provides personal monitoring and attention with structured activity in a secure environment. Medicare usually considers this type of care "custodial" rather than medical and so usually doesn't cover it. Medicare can cover services from an adult daycare center only in very limited circumstances. Medicare might cover actual mental health treatment, prescribed by a physician, provided at an outpatient mental health clinic. If this clinic is also an adult daycare center, the patient can get the benefit of the center's other care services while receiving treatment there. Medicare will cover this kind of care only if, and for as long as, it involves actual medical treatment -- administration and monitoring of medication, for example, or help with recovery from a medical crisis. Also, some Part C Medicare Advantage managed care plans offer limited adult daycare coverage as part of their comprehensive home care services. Medicare doesn't require that these plans offer this, so the nature and extent of what they cover depends entirely on the plans themselves. Finally, Medicare partners with Medicaid to sponsor what's called the Program of All-Inclusive Care for the Elderly (PACE). This provides comprehensive home and community care, including adult daycare, for frail elders who would otherwise require nursing home care. PACE is only available in certain states, however. And in those states, it may be available only to those who are eligible for both Medicare and Medicaid. See Medicare's official website at medicare.gov for a list of PACE programs.

Therapeutic services for Alzheimer's patients. For a long while, Medicare didn't consider various therapies for people who had been formally diagnosed with Alzheimer's disease medically necessary, and so did not cover them. This policy has changed. If the person in your care has been diagnosed with Alzheimer's, Medicare Part B can now cover physical, occupational, and speech therapy for her, as well as psychological counseling and other mental health services. Her doctor must prescribe the treatment, however, and it must be provided by a Medicare-certified therapist or mental health provider. Medications for mental health conditions.Any medication administered to someone when she's a hospital or nursing facility inpatient, whether or not she's an Alzheimer's patient, is covered by Medicare Part A. Any medication given to her at her doctor's office or at any outpatient health facility is covered by Medicare Part B. Things get much trickier with prescription drugs taken at home. The only coverage Medicare provides for at-home medications is through a Medicare Part D prescription drug plan. Coverage for specific drugs the doctor may prescribe for mental health issues depends on the formulary -- the covered list of drugs -- that her plan maintains. There's a special prohibition, however, on certain drugs that are often prescribed to cope with mental health issues. Medicare doesn't permit a Part D prescription drug plan to cover any medication within the categories of barbiturates (certain sedatives) and benzodiazepines (certain tranquilizers), even if a physician has prescribed it. So if she's taking one of these drugs, and she'd like to have coverage from her Part D drug plan, ask her doctor whether a similarly effective drug might be available that does not technically fall into either of these categories.

http://www.caring.com/articles/mental-health-coverage
http://www.caring.com/articles/medicare-coverage-for-long-term-care