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.

Medicare Advantage Private Fee-for-Service (PFFS) plans dropped by Health Insurance Carriers

Health insurance carriers are dropping their Medicare Advantage Private Fee-for-Service (PFFS) plans, according to recent announcements by some health insurance providers, including Coventry and WellCare. A PFFS is a Medicare Advantage (MA) plan that is available through a state licensed, risk-bearing entity, or a PFFS Medicare Advantage Organization (MAO).

As a result of PFFS coverage drops by Coventry and WellCare alone, more than 500,000 Medicare plan holders will have to find new coverage.

At this point, Medicare Advantage plans receive government subsidies so that they can offer beneficiaries more benefits than simple Medicare plans. Medicare Advantage plans are offered to Medicare-eligible individuals by private health insurers. However, analysts are expecting the reimbursement rates for these PFFS programs to fall by approximately 5%, making them less profitable for insurance carriers.

How PFFS Currently Work

PFFS are popular amongst consumer s because they allow Medicare beneficiaries to choose their own healthcare providers, rather than having to select their providers from a limited number of in-network of Medicare-approved providers. Beneficiaries can see any provider, as long as the provider agrees to charge based on the PFFS fee schedule. This fee schedule is the same as the Medicare schedule.

PFFS MAOs have yearly contracts with the Centers for Medicare and Medicaid Services to provide Medicare beneficiaries with their Medicare benefits as well as additional benefits that a company opts to provide. A PFFS provider pays for healthcare instead of Medicare when a beneficiary has such a plan.

The main benefit (which makes PFFS so popular) is that individuals who join PFFS MAOs are not required to use providers within a network and can, therefore, see any provider as long as the provider is able to receive payment from Medicare and the PFFS MAO.

More Changes to PFFS Plans

In addition to the decreased government reimbursement amount for PFFS plans, PFFS plans will be required to develop healthcare provider networks beginning in 2011. The change will force PFFS plan holders to select their healthcare providers from within the plan network, limiting their freedom to see providers that they prefer.

Experts predict that more healthcare insurance providers will follow Coventry and WellCare by dropping their PFFS plans in coming months. Individuals should contact their healthcare insurance providers if they are currently enrolled in a PFFS or are considering enrolling in a PFFS to get more information about how their provider will respond to the upcoming PFFS changes.

More Information About Medicare Advantage Plans

Medicare Advantage plans are specific types of Medicare plans that are in place to cover the cost of healthcare related expenses for Medicare participants. These plans are similar to traditional Medicare plans in that they provide financial support for individuals seeking medical or health-related services. However, Medicare Advantage plans generally have more benefits and lower copayments than other types of Medicare plans. In order to have a Medicare Advantage plan, Medicare participants need to have Medicare Part A and Medicare Part B plans.

One major difference between Medicare Advantage plans and other types of Medicare plans is that Medicare Advantage participants may need to see only doctors that are members of the Medicare Advantage provider plan. However, plans may allow participants to use a wide variety of services, including Medicare Health Maintenance Organizations, Preferred Provider Organizations, Private Fee-for-Service providers, and Medicare Special Needs providers.

Medicare participants should be aware that Medigap policies do not provide gap coverage for individuals that participate in the Medicare Advantage program.

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.

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

Medicare Supplement Insurance Helps to Make Sense of Medicare

Many of those over 65 who saved for retirement have retained greater economic flexibility than those hit by layoffs while still trying to amass savings. That makes seniors a very desirable market for several industries. In fact, senior marketing is the fastest growing marketing segment today.

In sharp contrast, one of the biggest marketing failures that can have seriously harmful complications for those over 65 surrounds Medicare. With multiple parts, two deductibles, partial coverage (only 80 percent) for doctors' services, no coverage at times (such as when you travel outside of the U.S.) and no reconciliation when doctors charge above what Medicare will pay, Medicare is a maze of contradictions. How do seniors calculate and plan for their health care costs?

In truth, both people under and over age 65 find Medicare often to be obscure and some simply give up in confusion. It's a sad comment on the "information age" that we haven't explained Medicare's coverage in a way that allows many seniors to estimate their expected health care costs and plan accordingly.

Medicare Supplement Plans Help to Translate Medicare's Coverage

Private insurers marketing Medigap insurance must explain Medicare, at least in part, to show the need for their plans to protect seniors from all the health care charges that Medicare won't cover. For many, private insurance companies discuss Medicare in ways that are more direct and more comprehensible to give seniors a better overall understanding of where the holes in Medicare's coverage put them at risk. The risk is real because hefty doctor and hospital bills far too often devour retirement savings forcing seniors to reduce their standard of living. Health care costs may be the single biggest concern for many seniors because their need for health care grows as they age and because health care prices are spiraling out of control.

A Medicare Supplement Can Cut Seniors' Medical Bills down to Size

With existing Medicare benefits in jeopardy (Medicare was extended beyond it's predicted bust in just eight years), baby boomers and seniors are exploring alternatives, such as Medicare Advantage plans and Medicare Supplement plans.

In the face of the new health care laws, Advantage plans are beginning to lose their subsidies. It's expected that these plans will become increasingly expensive with the decline of government subsidies. Medigap insurance, often called Medicare supplement insurance, is a viable alternative. With 10 different plans, each one fills the gaps in Medicare in a slightly different way so seniors are free to choose only the benefits they need without paying for any extras. Medigap plans cover Medicare's Part A and Part B deductibles to make seeing the doctor and going to the hospital when you need more affordable. These plans can also cover Medicare's co-pays and co-insurance charges, and certain plans expand Medicare's coverage to services beyond Original Medicare, such as emergency medical care when you're out of the country.

Confusion over Medicare Has Left Seniors Unprepared for Health Care Debt

Although millions are now enrolled in Medicare in order to pay for their health care needs, many remain unprotected simply due to a lack of understanding about the intricacies of the Medicare system. One of the biggest misunderstandings involves the Medicare "pre-approved" amount. Medicare only pays for 80 percent of a standardized amount for procedures. That doesn't stop doctors from charging more; it just shifts the burden of payment onto the patient. Doctors can continue to charge their regular fee, Medicare can continue to pay its standard payment and it's up to you to make those ends meet. Getting the right information is crucial to getting the most out of Medicare, and Medicare supplement insurance is one key to bridging the gaps in Medicare coverage.

By Wiley Long - President, MedigapAdvisors.com - The nation's leading independent agency specializing in Medicare Supplemental Insurance. Our professional MediGap advisors look forward to the opportunity to help you get the best insurance for your Medicare needs.

New Medicare Plan For Seniors Offers Choices For Consumers

June 1, 2010, is the launch date for the modernized Medicare supplement plans. For the first time in many years, a new and unique plan design is being offered. Mutual of Omaha, through one of its subsidiary divisions, is unveiling the new plan "N" to residents of Virginia.

Plan N will become one of the standardized supplement plans that insurers can offer to Medicare beneficiaries. A Medicare supplement plan, or a "Medigap" plan, can help pay for some of the expenses that are only partially paid by Medicare.

The new plan, which was recently approved by the Virginia Department of Insurance, is a great low-cost plan option. This is made possible by having the consumer pay some nominal copays for doctor visits, emergency room visits, and eliminating coverage for the part B deductible. While some supplement plans normally cover these charges, the premium savings in most instances far outweigh the potential out-of-pocket cost to the insured. Premium amounts are very low even at older ages.

Here is the most exciting point about this new plan for Virginia residents beginning June 1: United World Insurance Company, a division of Mutual of Omaha, will be processing applications without medical underwriting. This is a truly amazing opportunity for those who have desired to change plans or insurers, but have been unable to do so because of health reasons. Those who have become trapped in high-cost plans due to rate increases can now switch plans without worries of being denied coverage due to medical history.

These plans will be available for purchase though an agent licensed to sell Medicare plans in Virginia and appointed by the aforementioned company for the state of Virginia. For a free no-obligation, no hassle quote on this incredible offer, visit FindMeAPlan.com.

Mark Brooks specializes in affordable Virginia Medicare Insurance.

Mark is an independent agent with nearly 30 years of insurance and financial services experience. For more information about affordable medicare insurance visit his site at FindMeAPlan

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What can I do when my Medicare Advantage premium goes up?

The primary reason why health care premiums and out-of-pocket cost rise is that medical costs increase at a faster rate than government payment increases to health insurers.

If your Medicare Advantage Plan premium just went up you can compare other Advantage Plans to find a more economic option. However, costs should not be the only issue when selecting a plan, so research the benefits, the provider networks and drug coverage available under Part D of each option before making a final decision.

To compare Medicare Advantage plan premiums, you can visit websites like Medicare Advantage Supplement Info.

Note: For seniors worried about their ability to cover their insurance and medical expenses, your insurance agent should also help determine if you are eligible for federal and state programs and help you apply for these funds.

What is the difference between a Medicare Supplemental Insurance (Medigap) and Medicare Advantage?

While Medicare Supplement Plans, also called 'Medigap', and Medicare Advantage plans both provide additional coverage on top of the Medicare Part A and Part B coverage, they offer uniquely different benefits.

While Medicare supplemental insurance plans typically have higher monthly premiums, these plans pay a member's share of the costs of Medicare-covered services thus eliminating or reducing out-of-pocket payments, including coinsurance, deductibles, preventive services and at-home recovery services.

Enrollees would have to purchase a stand-alone Part D drug plan.

Under Medicare Advantage, you typically have lower monthly premiums with a Part D drug plan included, but you will have some out-of-pocket expenses. Usually, you have to use the services of the health insurers' provider networks to be covered.

Advantage Plans offer many value-added benefits, including discounts on gym memberships, health and wellness service and a variety of discount programs, at no additional charge.

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