The U.S. Department of Health and Human Services (HHS) today announced a series of initiatives to work with states to save money and better coordinate care for the 9 million Americans enrolled in both Medicare and Medicaid. The new initiatives include better access to Medicare data and better coordination of health care between Medicare and Medicaid. The initiatives will be led by the new Federal Coordinated Health Care Office (the Medicare-Medicaid Coordination Office), which was created by the Affordable Care Act to help make the two programs work together more effectively to improve patient care and lower costs.
“Medicaid costs are largely driven by the complex medical needs of low-income seniors and people with disabilities who are eligible for both Medicare and Medicaid. We know that by working together, we can provide better, more coordinated care while lowering health care costs and saving money for states,” said Centers for Medicare & Medicaid Services (CMS) Administrator Donald M. Berwick, M.D. “Medicare and Medicaid spends $300 billion each year to care for people enrolled in both programs. Better coordinated care for this vulnerable population could yield savings and improve care and coverage in Medicaid.”
Currently, 60-percent of Medicare-Medicaid enrollees, “dual eligibles,” have multiple chronic conditions and 43-percent have at least one mental or cognitive impairment. While only 15-percent of Medicaid enrollees are also Medicare beneficiaries, Medicare-Medicaid enrollees represented 39-percent of Medicaid spending in 2007. Medicaid spent about $120 billion on this group – about twice as much as Medicaid spent on the 29 million children it covered. The Medicaid spending per Medicare-Medicaid enrollee was $15,459 in 2007, over six times higher than the comparable cost of a non-disabled adult Medicaid-only enrollee ($2,541).
The Medicare-Medicaid Coordination Office today launched the Alignment Initiative, an effort to more effectively integrate benefits under the two programs. Currently, low-income seniors and people with disabilities must navigate two separate programs: Medicare for coverage of basic acute health care services and drugs, and Medicaid for coverage of supplemental benefits such as long-term care supports and services. Medicaid also provides help with Medicare premiums and cost-sharing for those who need additional assistance.
A lack of alignment between the programs can lead to fragmented or episodic care for people with both Medicare and Medicaid coverage, which can reduce quality and raise costs. For example, Medicaid and Medicare have different coverage standards for those accessing durable medical equipment in the community. This can lead to fragmented care and coverage gaps that could result in patients losing access to the treatments and equipment that help them live at home or in the community. Even temporary coverage gaps can be disruptive if patients no longer have coverage for wheelchairs or other expensive medical care. The Medicare-Medicaid Coordination Office is seeking input and ideas about how to align in six areas: care coordination, fee-for-service benefits, prescription drugs, cost sharing, enrollment, and appeals. Better alignment in these areas can reduce costs by improving health outcomes and making care coordination more efficient.
Today, HHS also announced a new process that provides faster state access to Medicare data to support care coordination. Access to Medicare data is an essential tool for states seeking to coordinate care, improve quality, and control costs for their highest cost beneficiaries. For example, a state that wants to expand its long term care and behavioral health care management program to serve low income seniors and people with disabilities needs data on their Medicare-covered hospital, physician, and prescription drug use. With Medicare data, states can identify high risk and high cost individuals, determine their primary health risks, and provide comprehensive individual client profiles to its care management contractor to tailor interventions.
“Navigating the two programs can be both complicated and burdensome for beneficiaries and their families and caregivers,” said Medicare-Medicaid Coordination Office Director Melanie Bella. “We are facilitating a national conversation on how to make these programs better serve the people that depend on them every day. We are working with states toward new levels of seamlessness so as to smooth the care journeys for these individuals.”
The first step in the Alignment Initiative is a notice for public comment that will be displayed in the Federal Register. The notice requests public input on priorities and key goals. Individuals wishing to submit comments have until July 11, 2011 to do so. For more information on the Alignment Initiative notice for comment, visit: www.ofr.gov/inspection.aspx. The Medicare-Medicaid Coordination Office will continue to engage with local stakeholders around the country on the Alignment Initiative through regional listening sessions.
The announcement of the new policy on state Medicare data for enrollees in Medicare and Medicaid will be published in a Center for Medicaid, CHIP and Survey & Certification (CMCS) Informational Bulletin today. The Bulletin is available at: www.cms.gov/CMCSBulletins/CMCSB/list.asp#TopOfPage.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Showing posts with label medicare. Show all posts
Showing posts with label medicare. Show all posts
Wednesday, May 11, 2011
Thursday, February 10, 2011
Georgia Seniors Get Very Low-Cost Medicare Supplement Insurance Policy
(BUSINESS WIRE)--A new low-cost Medicare Supplement insurance policy is now approved for sale to seniors in Georgia. The Georgia Office of Insurance and Safety Fire Commission has approved a very low-cost Medicare Supplement insurance plan for seniors and Georgia is among the first states in the nation to allow this supplemental insurance plan to be offered to its citizens. The availability of this low-cost supplemental plan for Georgia seniors was announced today by State Mutual Insurance Company of Rome, GA.
“We have eliminated a substantial cost element in this process”
State Mutual President and CEO, Dee Yancey III, said that Georgia residents of Medicare age now have access to one of the lowest cost Medicare supplement insurance plans available anywhere in the nation. Yancey said that State Mutual Insurance Company will allow Medicare-age consumers to apply for the supplemental Medicare insurance policy online, without having to talk with an insurance agent. “They can go online (www.statemutualinsurance.com) to fill out a confidential application and only buy the coverage they determine for themselves that best supplements their Medicare,” he said. “They can go forward secure in the knowledge that no one is going to try to sell them anything,” he said.
State Mutual was founded in 1936 and is licensed in 41 states and the District of Columbia. Yancey said that by using the Internet and allowing consumers to fill out their own applications online, the company has been able to substantially reduce its costs and the price it charges to consumers. “Consumers can also call the company for assistance in filling out applications,” he said.
A quick random comparison of Medicare supplement policies available in a number of states shows that the State Mutual policy is generally the lowest cost in most categories, and in some cases, costing less than half the price of the most expensive policies for the same coverage.
The online program allows an interested customer to review and select a policy, see a price quote, submit an application, receive confirmation of coverage and receive his or her policy in a few minutes of online time. Most policies will be issued within a working day, rather than the customary one- to two-month wait for underwriting review and processing. The customer can also download his or her policy and store it for review at any time. Consumers who wish to speak to a customer service representative, either to obtain information or to apply for a policy, can do so by calling 1-855-764-4000.
Yancey said that the low-cost of the State Mutual Insurance Company policy is achieved by empowering the customer to go online for most, if not all, of the information and application phase of obtaining Medicare supplement insurance. “We have eliminated a substantial cost element in this process,” he said. “This benefits the consumer who can obtain a superior insurance policy from an established company very quickly and inexpensively,” he said.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
“We have eliminated a substantial cost element in this process”
State Mutual President and CEO, Dee Yancey III, said that Georgia residents of Medicare age now have access to one of the lowest cost Medicare supplement insurance plans available anywhere in the nation. Yancey said that State Mutual Insurance Company will allow Medicare-age consumers to apply for the supplemental Medicare insurance policy online, without having to talk with an insurance agent. “They can go online (www.statemutualinsurance.com) to fill out a confidential application and only buy the coverage they determine for themselves that best supplements their Medicare,” he said. “They can go forward secure in the knowledge that no one is going to try to sell them anything,” he said.
State Mutual was founded in 1936 and is licensed in 41 states and the District of Columbia. Yancey said that by using the Internet and allowing consumers to fill out their own applications online, the company has been able to substantially reduce its costs and the price it charges to consumers. “Consumers can also call the company for assistance in filling out applications,” he said.
A quick random comparison of Medicare supplement policies available in a number of states shows that the State Mutual policy is generally the lowest cost in most categories, and in some cases, costing less than half the price of the most expensive policies for the same coverage.
The online program allows an interested customer to review and select a policy, see a price quote, submit an application, receive confirmation of coverage and receive his or her policy in a few minutes of online time. Most policies will be issued within a working day, rather than the customary one- to two-month wait for underwriting review and processing. The customer can also download his or her policy and store it for review at any time. Consumers who wish to speak to a customer service representative, either to obtain information or to apply for a policy, can do so by calling 1-855-764-4000.
Yancey said that the low-cost of the State Mutual Insurance Company policy is achieved by empowering the customer to go online for most, if not all, of the information and application phase of obtaining Medicare supplement insurance. “We have eliminated a substantial cost element in this process,” he said. “This benefits the consumer who can obtain a superior insurance policy from an established company very quickly and inexpensively,” he said.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Friday, January 21, 2011
Sebelius announces three million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act
U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that three million Medicare beneficiaries nationwide have received prescription drug cost relief through the Affordable Care Act. To date, three million eligible beneficiaries who fell into the drug coverage gap known as the donut hole during 2010 have been mailed a one-time, tax-free $250 rebate check.
“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”
Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.
Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:
* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.
People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.
Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.
* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.
For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
“For too long, many seniors and people with disabilities have been forced to make impossible choices between paying for needed prescription medication and necessities like food and rent,” said Secretary Sebelius. “The Affordable Care Act offers long overdue relief by lowering prescription drug costs each year until the donut hole is closed.”
Eligible beneficiaries who fell into the coverage gap during 2010 are continuing to automatically receive rebate checks. These checks are only the first step in how the Affordable Care Act will reduce prescription drug costs for beneficiaries in the donut hole each year until it is closed in 2020. Starting this year, eligible beneficiaries in the coverage gap will receive a 50-percent discount on covered brand name medications while in the donut hole. In addition, in 2011 Medicare will begin paying 7-percent of the price for generic drugs during the coverage gap.
Also today, Secretary Sebelius released a new video message on the new benefits the Affordable Care Act provides in 2011 for people on Medicare. You can watch the video message here.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor starting this year:
* As of January 1, 2011, Original Medicare no longer charges out-of-pocket costs for the “Welcome to Medicare” physical exam and, for the first time since the Medicare program was created in 1965, Original Medicare now covers an annual wellness visit with a participating doctor, also at no cost.
* In addition to these annual wellness visits, most people with Medicare can now receive critical preventive services, including certain cancer screenings such as mammograms and colonoscopies, for free.
* Also this year, the Affordable Care Act will provide qualifying doctors and other health care professionals providing primary care to people on Medicare a 10-percent bonus for primary care services. This will help ensure that those primary care providers can continue to be there for Medicare patients.
People with Medicare can learn more about these new benefits, search for participating doctors in their area, and find other helpful information by contacting a trained customer service representative toll-free at 1-800-MEDICARE (1-800-633-4227) or visiting www.Medicare.gov.
Additionally, the Affordable Care Act makes Medicare stronger and more secure for all beneficiaries. These provisions under the new law increase benefits to beneficiaries and help to extend the life of the Medicare Trust Fund by 12 years.
* An analysis issued by the Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher – as much as $12,300 over the next 10 years – for seniors and people with disabilities who have high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary in the donut hole, estimated total savings increase from $553 in 2011 to $2,217 in 2020.
* The Affordable Care Act establishes a new Innovation Center that will research, develop, test, and expand innovative payment and delivery arrangements to improve the quality and reduce the cost of care provided to patient with Medicare, Medicaid or Children’s Health Insurance Program (CHIP) coverage. Innovations that are found to work can be rapidly expanded and applied more broadly—helping to transform the health care system into one that provides better care at lower cost.
· The Affordable Care Act contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. The law strengthens the screenings for health care providers who want to participate in Medicare, Medicaid, or CHIP, enables enforcement officials to see health care claims data from around the country in a searchable database, and strengthens the penalties for criminal wrongdoing. The reduction in waste, fraud, and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future. Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information or suspected fraud, waste, or abuse, or go to www.StopMedicareFraud.gov.
For more information on how the Affordable Care Act benefits seniors, visit www.HealthCare.gov.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Wednesday, January 12, 2011
Long Term Care Pharmacy Alliance Concerned with Proposed CMS Rule; New Study Confirms LTCPA Position
/PRNewswire/ -- The Long Term Care Pharmacy Alliance (LTCPA) expressed concern with CMS's proposed rule on short-cycle dispensing within the long-term care (LTC) setting. In comments submitted to CMS Tuesday, LTCPA explained that any cost savings generated by implementing a short-cycle, 7-day fill dispensing regimen, would be overwhelmingly eliminated by additional dispensing fees resulting from the quadrupling the number of dispenses needed to move from 30-day to 7-day cycles.
A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.
"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.
The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.
In addition to the increased cost to payers, other key findings included:
* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.
In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.
In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
A study conducted by Managed Solutions, LLC and released today supports this conclusion and finds that moving all Medicare Part D prescriptions to a 7-day fill would result in increased costs to Part D payers of over $800 million annually. Even moving more expensive brand products to a 7-day fill would still increase costs to Part D payers of $154 million annually.
"While LTCPA supports the goal of reducing waste, we also recognize the need to consider all costs associated with the proposed rule, so that unintended consequences do not result from the application of the rule. Given that it's the American taxpayer ultimately shouldering the burden of paying for this statute, it is critical that calculations such as those provided in our study be factored into the drafting of regulations," stated Bill Daniel, Executive Director for LTCPA.
The study derived its analysis from information received from eight LTC pharmacies. The findings estimated the amount of unconsumed medication among Medicare Part D residents in skilled nursing facilities and the potential cost reductions that could be achieved through shorter fill times.
In addition to the increased cost to payers, other key findings included:
* "Wasteful dispensing" to nursing home residents covered by Medicare Part D, only amounts to approximately 2.9% of total dispensed value. Short cycling this percentage of waste would save only $125 million annually and cost over $900 million in additional dispensing fees. This is in stark contrast to the $712.5 million in annual savings estimated by the Congressional Budget Office in their scoring of the short-cycling provision.
* The tradeoff between reduced waste associated with unused medication and increased pharmacy operating costs due to more frequent medication dispensing only becomes favorable to the taxpayer for prescriptions with original dispensed value of over $400.
In its comments, LTCPA stated that CMS's approach on short-cycle dispensing is contrary to Congress' intent that Section 3310 of the Patient Protection and Affordable Care Act result in savings to Medicare Part D. "We believe that it was Congress' intent to decrease costs associated with unused medications for Part D residents in LTC facilities. Implementing short cycle dispensing for long term care patients with an average length of stay of 835 days who are primarily taking maintenance medications does not meet this financial goal. While we applaud CMS's initial proposal to short cycle traditionally more expensive brand products, we believe that this limitation isn't narrow enough. Our data clearly shows that there is a prescription value threshold of $400 that must be met in order to achieve any cost savings," continued Bill Daniel.
In the proposed regulations, CMS calls for data collection by Part D plans in order to study the efficiencies of various dispensing methodologies and to estimate the cost of unused drugs and possible savings. As CMS has identified their lack of data on unused Part D drugs in this population, LTCPA recommends that before drafting any final regulations CMS conduct a study to determine the causes, frequency and cost of unused medications and also consider alternatives to 7-day dispensing cycles.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG @FayetteFP
Friday, November 19, 2010
Misleading Postcards Are Not From Medicare
The Department of Human Services urges older adults to be on the alert for misleading post cards titled “Important: Projected Medicare Changes.” The cards are sent on behalf of insurance salespeople and are not endorsed by Medicare.
“Private insurance companies request signatures, ages, and other details on these post cards and then use the information to make sales calls and visits to people’s homes,” said Dr. James J. Bulot, Director of the Georgia Department of Human Services (DHS) Division of Aging Services. “If consumers have questions about Medicare changes, they should contact the GeorgiaCares network.”
The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers individuals free, one-on-one help provided by trained local counselors. The program is managed statewide by the DHS Division of Aging Services and Georgia’s 12 Area Agencies on Aging. To contact GeorgiaCares, call 1-800-669-8387 toll-free or visit www.MyGeorgiaCares.org.
Callers may request personalized information about Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, the resolution of billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.
The GeorgiaCares team is ready to answer questions now about open enrollment for Medicare Part C (prescription drug coverage) and Part D (Medicare Advantage plans). Enrollment began November 15th, and recipients will have until December 31, 2010, to make their choices. After this period, beneficiaries may make limited changes during the annual Disenrollment Period of January 1 - February 14th of each year. Beneficiaries who do not want to make a change can remain in their plan from 2010.
GeorgiaCares SHIP counselors will answer hotline calls from individuals and provide community education sessions for any group throughout the state to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.
GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.
For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
---
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
Facebook: http://facebook.com/ArtsAcrossGA
www.FayetteFrontPage.com
Twitter: @FayetteFP
“Private insurance companies request signatures, ages, and other details on these post cards and then use the information to make sales calls and visits to people’s homes,” said Dr. James J. Bulot, Director of the Georgia Department of Human Services (DHS) Division of Aging Services. “If consumers have questions about Medicare changes, they should contact the GeorgiaCares network.”
The GeorgiaCares State Health Insurance Assistance Program (SHIP) offers individuals free, one-on-one help provided by trained local counselors. The program is managed statewide by the DHS Division of Aging Services and Georgia’s 12 Area Agencies on Aging. To contact GeorgiaCares, call 1-800-669-8387 toll-free or visit www.MyGeorgiaCares.org.
Callers may request personalized information about Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, the resolution of billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.
The GeorgiaCares team is ready to answer questions now about open enrollment for Medicare Part C (prescription drug coverage) and Part D (Medicare Advantage plans). Enrollment began November 15th, and recipients will have until December 31, 2010, to make their choices. After this period, beneficiaries may make limited changes during the annual Disenrollment Period of January 1 - February 14th of each year. Beneficiaries who do not want to make a change can remain in their plan from 2010.
GeorgiaCares SHIP counselors will answer hotline calls from individuals and provide community education sessions for any group throughout the state to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.
GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.
For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
---
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
Facebook: http://facebook.com/ArtsAcrossGA
www.FayetteFrontPage.com
Twitter: @FayetteFP
Monday, November 15, 2010
Open Enrollment for 2011 Medicare prescription drug and health plans begins Nov. 15th
The Centers for Medicare & Medicaid Services (CMS) is encouraging all Medicare beneficiaries to take advantage of the annual Open Enrollment period to make sure they have the best coverage available to meet their health care needs in 2011.
The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.
"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."
"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."
"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care
Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."
Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:
. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.
. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.
. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.
. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp
Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.
There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.
Protecting Against Fraud and Identity Theft
The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.
Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.
More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
The Medicare Open Enrollment Period this year begins on November 15th and runs through December 31st. During the Open Enrollment period, current or newly eligible Medicare beneficiaries, including people with Original Medicare, can review current health and prescription drug coverage, compare health and drug plan options available in their area, and choose coverage that best meet their needs.
"The Affordable Care Act will make Medicare stronger and more sustainable. There will be new benefits available to nearly every person with Medicare starting in January 2011, including free annual wellness visits and free recommended preventive services like mammograms and colonoscopies. Seniors who fall into the donut hole in 2011 will be eligible for a 50 percent discount on brand-name prescription drugs. These new benefits make this year's Medicare Open Enrollment Period especially important," said HHS Secretary Kathleen Sebelius. "Every year, the Medicare Open Enrollment Period gives Medicare beneficiaries a chance to evaluate their current plans and see what other options might be out there that serve their needs, especially if their health status has changed. Those enrolled in Medicare can think of the Open Enrollment Period as a yearly coverage "check-up." It is important for people with Medicare to look closely at their plan, look at the options available to them, consider their health status, and find what works for them."
"There's never been a better time for Medicare beneficiaries to check out their Medicare coverage," said CMS Administrator Donald Berwick, M.D. "With better plan choices available for 2011, Medicare beneficiaries can think of Open Enrollment as their yearly coverage 'check-up'."
"During Open Enrollment, AoA's national network of community-based organizations will work with seniors, individuals with disabilities and their caregivers across the country to help them understand the new benefits available under the Affordable Care
Act," said Kathy Greenlee, Assistant Secretary for Aging. "In addition, we urge seniors to protect themselves from potential fraud and identity theft. We know there are people who use this time to scam seniors and rip off Medicare. Seniors should protect their Medicare number the same way they do their Social Security number or credit cards."
Resources for Medicare Beneficiaries
People with Medicare, their families and other trusted representatives can review and compare current plan coverage with new plan offerings, using many proven resources, including:
. Visiting www.medicare.gov, where they can get a personalized comparison of costs and coverage of the plans available in their area. The popular Medicare Plan Finder and Medicare Options Compare tools have been enhanced for an efficient review of plan choices. Multilingual Open Enrollment information and counseling is available.
. Calling 1-800-MEDICARE (1-800-633-4227) for around-the-clock assistance to find out more about coverage options. TTY users should call 1-877-486-2048.
. Reviewing the 2011 Medicare &You handbook. It is also accessible at www.medicare gov and has been mailed to the homes of people with Medicare benefits.
. Getting one-on-one counseling assistance from the local State Health Insurance Assistance Program (SHIP). Local SHIP contact information can be found:
o At http://www.medicare.gov/contacts/organization-search-criteria.aspx or
o On the back of the 2011 Medicare &You handbook or;
o By calling Medicare at 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048)
o Through a listing of national stand-alone prescription drug plans and state specific fact sheets can be found at: http://www.cms.hhs.gov/center/openenrollment.asp
Medicare beneficiaries who cannot meet the costs of prescription drugs may be eligible for additional resources. Based on eligibility for "extra help," some people Medicare will pay no more than $2.50 for each generic drug and no more than $6.30 for each name brand drug. The program, called Medicare's Limited Income Newly Eligible Transition (NET) Program, can also help pay for premiums and other out-of-pocket costs.
There is no cost to apply for this extra help. Medicare beneficiaries, family members, trusted counselors or caregivers can apply online at www.socialsecurity.gov/prescriptionhelp or call Social Security at 1-800-772-1213 (TTY users should call 1-800-325-0778) to find out more.
Protecting Against Fraud and Identity Theft
The new health care law also provides better tools to help fight waste, fraud and abuse to help protect Medicare. CMS offers tips to help beneficiaries protect themselves against fraud and identity theft during the Open Enrollment period. Medicare recommends thatpeople treat their Medicare number as they do their social security number and credit card information.
Beneficiaries should not give personal information to anyone arriving to their home uninvited or making unsolicited phone calls selling Medicare-related products or services. Beneficiaries who believe they are a victim of fraud or identity theft should contact 1-800-MEDICARE (1-800-633-4227; TTY, 1-877-486-2048). More information is available at www.stopmedicarefraud.gov.
More information is available at www.healthcare.gov, a new web portal from the U.S. Department of Health and Human Services.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Friday, November 12, 2010
Humana to Offer Savings and Broad Choice with 2011 Medicare Plans
(BUSINESS WIRE)--Humana Inc. (NYSE: HUM) will offer a wide variety of Medicare Advantage (MA) and Prescription Drug Plans (PDP) to people with Medicare in 2011, including the new Humana Walmart-Preferred Rx Plan (PDP) that offers the nation’s lowest monthly premium in all 50 states and Washington, D.C.
Humana will offer people with Medicare choices that include MA plans with more benefits than Original Medicare, an affordable monthly premium, an extensive list of doctors in many areas, and predictable costs that are easy to budget.
The Annual Election Period when Medicare beneficiaries will select their Medicare coverage for 2011 runs from Nov. 15 through Dec. 31, 2010. In recent years, people with Medicare were allowed to change plans during the first three months of the year. Beginning in 2011, the January-to-March enrollment period has been eliminated.
“At a time when people are still coping with the impact of our challenging economy, especially senior citizens and disabled people living on a fixed income, it is critical to have medical and prescription-drug coverage that’s affordable,” said Tom Liston, senior vice president, senior products, and the leader of Humana’s Medicare organization. “Humana continues to offer a variety of choices across the country enabling Medicare beneficiaries to select a plan that meets their needs while receiving comprehensive benefits and value people have come to expect from Humana.”
Medicare Advantage Plans
Humana’s MA plans can help people get more out of their health care dollar. Most Humana MA plans:
* Offer additional benefits beyond Original Medicare
* Have copayments offering predictable costs that are easy to budget no matter which health care services are used
* Come with worldwide coverage for emergency care
With drug coverage, health-and-wellness offerings and disease-management programs also available with MA coverage, Humana MA plans remain an excellent value in 2011. Plans, benefits and premiums vary by state and county. Plans include local and regional PPO plans, as well as HMO and Private Fee-For-Service plans. Humana is committed to informing its members of the various benefits and savings options that are available to them for 2011. All Humana MA plans have annual out-of-pocket maximums in 2011, protecting beneficiaries against catastrophic costs.
Benefits with most Humana MA plans include:
* Care coordination and disease-management programs
* Affordable deductibles
* Affordable copayments
* 24-hour nurse hotline
* SmartSummary Rx benefits statement (available to both MA and PDP members)
* No-cost preventive services
* No-cost diabetic-monitoring supplies, including test strips, lancets and glucometers
Well-Being Benefits for Members
Humana is dedicated to supporting its Medicare members on their lifelong pursuit of well-being. As evidence of this commitment, most Humana MA members enjoy access to programs that encourage healthy behaviors such as gym memberships through SilverSneakers or Silver & Fit, and the WellDine Food Program, which delivers meals following a hospitalization. Over the long-term, these programs aid members in achieving a greater quality of life.
Prescription Drug Plans
In all 50 states, Washington, D.C. and Puerto Rico, Humana offers stand-alone PDPs, meaning they’re separate from Medicare medical coverage. Stand-alone PDPs enable people with Medicare to add drug coverage to their Original Medicare coverage.
New this year is the Humana Walmart-Preferred Rx Plan, which features a monthly premium of just $14.80, making it the lowest-premium plan available in all 50 states and Washington D.C. Copayments start at just $2 for preferred generic prescriptions filled at any Walmart, Sam’s Club or Neighborhood Market pharmacy. Copayments of $0 are available for many generic drugs filled via Humana’s home-delivery (mail-order) pharmacy, RightSource. Humana and Walmart estimate that the new co-branded plan will save members an average of more than $450 a year.
People with Medicare who prefer first-dollar coverage (no annual deductible) for preferred generics and a broader network of pharmacies should consider Humana’s Enhanced PDP Plan. With more than 62,000 pharmacies in Humana’s national pharmacy network, and $0 copayments for many generic drugs when using mail-order, this plan typically appeals to people who want that additional coverage.
Also New in 2011
In addition to the new Humana Walmart-Preferred Rx Plan (PDP), Humana is offering new MA plan options in multiple markets across the U.S. Here’s an overview of the various plan options Humana is offering for 2011:
* HMO plans in 27 states and Puerto Rico
* Local PPO plans in 39 states and Puerto Rico
* Regional PPO plans in 23 states (in 14 Medicare Advantage regions)
* Full−network Private Fee-for-Service (PFFS) plans in 34 states. All services are available in and out of network, taking full advantage of any Humana contracted discounts when the member uses in-network providers.
* Partial-network PFFS plans (networked for ancillary services only) in 28 states
* Non-network PFFS plans in 2 states
* PDP offerings approved for 2011 are statewide in 50 states, the District of Columbia and Puerto Rico and include the new nationwide PDP co-branded with Walmart.
For more information about Humana’s 2010 Medicare offerings, visit www.humana-medicare.com or call toll free 1-800-611-1481. TTY users call 1-877-833-4486.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Humana will offer people with Medicare choices that include MA plans with more benefits than Original Medicare, an affordable monthly premium, an extensive list of doctors in many areas, and predictable costs that are easy to budget.
The Annual Election Period when Medicare beneficiaries will select their Medicare coverage for 2011 runs from Nov. 15 through Dec. 31, 2010. In recent years, people with Medicare were allowed to change plans during the first three months of the year. Beginning in 2011, the January-to-March enrollment period has been eliminated.
“At a time when people are still coping with the impact of our challenging economy, especially senior citizens and disabled people living on a fixed income, it is critical to have medical and prescription-drug coverage that’s affordable,” said Tom Liston, senior vice president, senior products, and the leader of Humana’s Medicare organization. “Humana continues to offer a variety of choices across the country enabling Medicare beneficiaries to select a plan that meets their needs while receiving comprehensive benefits and value people have come to expect from Humana.”
Medicare Advantage Plans
Humana’s MA plans can help people get more out of their health care dollar. Most Humana MA plans:
* Offer additional benefits beyond Original Medicare
* Have copayments offering predictable costs that are easy to budget no matter which health care services are used
* Come with worldwide coverage for emergency care
With drug coverage, health-and-wellness offerings and disease-management programs also available with MA coverage, Humana MA plans remain an excellent value in 2011. Plans, benefits and premiums vary by state and county. Plans include local and regional PPO plans, as well as HMO and Private Fee-For-Service plans. Humana is committed to informing its members of the various benefits and savings options that are available to them for 2011. All Humana MA plans have annual out-of-pocket maximums in 2011, protecting beneficiaries against catastrophic costs.
Benefits with most Humana MA plans include:
* Care coordination and disease-management programs
* Affordable deductibles
* Affordable copayments
* 24-hour nurse hotline
* SmartSummary Rx benefits statement (available to both MA and PDP members)
* No-cost preventive services
* No-cost diabetic-monitoring supplies, including test strips, lancets and glucometers
Well-Being Benefits for Members
Humana is dedicated to supporting its Medicare members on their lifelong pursuit of well-being. As evidence of this commitment, most Humana MA members enjoy access to programs that encourage healthy behaviors such as gym memberships through SilverSneakers or Silver & Fit, and the WellDine Food Program, which delivers meals following a hospitalization. Over the long-term, these programs aid members in achieving a greater quality of life.
Prescription Drug Plans
In all 50 states, Washington, D.C. and Puerto Rico, Humana offers stand-alone PDPs, meaning they’re separate from Medicare medical coverage. Stand-alone PDPs enable people with Medicare to add drug coverage to their Original Medicare coverage.
New this year is the Humana Walmart-Preferred Rx Plan, which features a monthly premium of just $14.80, making it the lowest-premium plan available in all 50 states and Washington D.C. Copayments start at just $2 for preferred generic prescriptions filled at any Walmart, Sam’s Club or Neighborhood Market pharmacy. Copayments of $0 are available for many generic drugs filled via Humana’s home-delivery (mail-order) pharmacy, RightSource. Humana and Walmart estimate that the new co-branded plan will save members an average of more than $450 a year.
People with Medicare who prefer first-dollar coverage (no annual deductible) for preferred generics and a broader network of pharmacies should consider Humana’s Enhanced PDP Plan. With more than 62,000 pharmacies in Humana’s national pharmacy network, and $0 copayments for many generic drugs when using mail-order, this plan typically appeals to people who want that additional coverage.
Also New in 2011
In addition to the new Humana Walmart-Preferred Rx Plan (PDP), Humana is offering new MA plan options in multiple markets across the U.S. Here’s an overview of the various plan options Humana is offering for 2011:
* HMO plans in 27 states and Puerto Rico
* Local PPO plans in 39 states and Puerto Rico
* Regional PPO plans in 23 states (in 14 Medicare Advantage regions)
* Full−network Private Fee-for-Service (PFFS) plans in 34 states. All services are available in and out of network, taking full advantage of any Humana contracted discounts when the member uses in-network providers.
* Partial-network PFFS plans (networked for ancillary services only) in 28 states
* Non-network PFFS plans in 2 states
* PDP offerings approved for 2011 are statewide in 50 states, the District of Columbia and Puerto Rico and include the new nationwide PDP co-branded with Walmart.
For more information about Humana’s 2010 Medicare offerings, visit www.humana-medicare.com or call toll free 1-800-611-1481. TTY users call 1-877-833-4486.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Friday, November 05, 2010
New report shows Affordable Care Act savings of $3,500 for Medicare beneficiaries
A new analysis issued today (November 4) by the U.S. Department of Health and Human Services estimates that under the Affordable Care Act, average savings for those enrolled in traditional Medicare will amount to more than $3,500 over the next 10 years. Savings will be even higher - as much as $12,300 over the next 10 years - for seniors and people with disabilities who have high prescription drug costs.
"The Affordable Care Act makes Medicare stronger and reduces the burden of health care costs on some of our most vulnerable citizens," said Secretary Kathleen Sebelius. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."
The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the "donut hole" will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost.
Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.
"The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare," said Assistant Secretary for Planning and Evaluation, Sherry Glied. "Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system."
The full analysis is available at http://www.healthcare.gov/center/reports/affordablecareact.html.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
"The Affordable Care Act makes Medicare stronger and reduces the burden of health care costs on some of our most vulnerable citizens," said Secretary Kathleen Sebelius. "The law improves benefits for seniors and people with beneficiaries who rely on Medicare and ensures that Medicare will be there for current and future generations by extending the life of the Medicare Trust Fund. These benefits and savings are only possible with the continued implementation of the Affordable Care Act."
The analysis, released by the Office of the Assistant Secretary for Planning and Evaluation (ASPE), shows that the Affordable Care Act helps lower costs for those on Medicare by slowing the growth of cost-sharing in Medicare. Closing the Part D coverage gap known as the "donut hole" will produce the greatest cost savings. Already, more than 1.8 million seniors and people with disabilities who have reached the donut hole in 2010 received a one-time $250 rebate check, and checks will continue to be distributed to those who enter the donut hole this year. Next year, people in the donut hole will receive 50 percent discounts on covered brand name Part D prescription drugs. Also starting next year, seniors and people with disabilities on Medicare will have access to a number of recommended preventive services and annual wellness visits at no additional cost.
Although all seniors and people with disabilities in Medicare are likely to see savings, the savings will be greatest for those with costly medical conditions or high prescription drug costs. Total savings per beneficiary enrolled in traditional Medicare are estimated to be $86 in 2011, rising to $649 in 2020. For a beneficiary with spending in the donut hole, estimated savings increase from $553 in 2011 to $2,217 in 2020.
"The savings that seniors and people with disabilities on Medicare are seeing are due to critical improvements the Affordable Care Act makes to Medicare," said Assistant Secretary for Planning and Evaluation, Sherry Glied. "Reducing waste, fraud and abuse, improving the quality of care beneficiaries receive, and making the program more efficient all contribute to lower cost increases across the system."
The full analysis is available at http://www.healthcare.gov/center/reports/affordablecareact.html.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Thursday, November 04, 2010
Our Nation's Veterans Have Options for Health Care Coverage
/PRNewswire/ -- As the nation pauses to honor its veterans on Nov. 11 for their patriotism, love of country, and willingness to serve and sacrifice for the common good, Blue Cross and Blue Shield of Georgia (BCBSGA) wants our veterans to be taken care of, especially when it comes to their health. Those who have served their country through the United States military have several options surrounding their health care coverage.
Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."
"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.
Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.
Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.
Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.
Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.
On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.
Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.
Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.
There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:
* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services
It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare
"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."
For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Qualifying veterans receive care at VA facilities. Additionally, those 65 years old and older – and those with certain disabilities – may qualify for Medicare. "Many veterans don't know about their Medicare rights," said Krista Bowers, president of senior business at BCBSGA's parent company. "Most have earned access to the Medicare system, just as they've earned their VA benefits. They shouldn't lose the opportunity, especially since some of these benefits may be offered at an affordable or no cost."
"VA and Medicare offer different, yet valuable, benefits to veterans," stated Morgan Kendrick, President of BCBSGA.
Through the VA, eligible veterans have access to a full range of preventive outpatient and inpatient services as long as they stay within the VA health care system, which includes hospitals, clinics, nursing homes, pharmacies and doctors nationwide. VA co-payments and deductibles, including the costs of prescription drugs, are generally less than Medicare. Eligibility for benefits is based on a priority system. According to the United States Department of Veterans Affairs website, there are more than eight million people covered by the VA Health Care System.
Medicare has four parts – A, B, C and D. Part A covers inpatient services, including hospital, skilled nursing facility, home health and hospice care. Part B covers outpatient medical services, such as doctor visits, preventive care and durable medical equipment. Part C, also known as Medicare Advantage (MA), combines Parts A and B into one plan that is run by a private insurance company, like Blue Cross and Blue Shield of Georgia, rather than the government. These plans may also include Part D, which is drug coverage.
Most people, including veterans, don't pay a premium for Part A. In most cases, these costs have been covered by payroll taxes. In contrast, Part B generally requires a monthly payment. Some companies offer Medicare Advantage plans (Part C) that cover everything included in Parts A and B, and more, including preventative services, at no additional cost. These are known as "zero premium plans." Some of these plans could also include dental, vision and hearing coverage. Other plans provide the same services, but require a monthly premium.
Enrollment processes and eligibility differ for VA and Medicare. Veterans can choose to participate in one program or the other or both. Enrollment in a Medicare plan does not affect an individual's VA eligibility.
On its website the VA recommends veterans not decline Medicare based solely on their VA coverage. The VA says there is no guarantee funds will continue to be appropriated for medical care for all enrollment priority groups. This could leave some veterans, especially those enrolled in one of the lower priority groups, with no access to care. For this reason, having a secondary source of coverage, like Medicare, may be in a veteran's best interest, the VA says.
Additionally, people who decline Medicare Part B when they are first eligible to receive it face substantial financial penalties if they decide to enroll later. The initial enrollment period typically occurs in the three months before the person's 65th birthday, their birthday month and the three subsequent months. There is no similar penalty for veterans who delay Part D enrollment because the VA's drug coverage is deemed equal to or better than Medicare.
Other benefits of Medicare for veterans include having access to doctors, hospitals and pharmacies outside the VA network and potentially having a larger list of covered drugs. Wider access could be important in case of an emergency or if a veteran needs a second opinion or specialized care.
There are additional benefits to having a Medicare Advantage plan. These advantages vary by insurer, but may include some or all of the following:
* Limits to total out-of-pocket costs
* Fitness programs, such as free gym memberships
* Preventive dental and vision care
* Programs that help people with chronic diseases, such as diabetes and asthma.
* Discounts on non-covered health-related products
* Chiropractic and podiatry services
It's important to remember that Medicare cannot generally pay for the same service paid for by the Department of Veterans Affairs (VA). Similarly, the VA generally cannot pay for the same service paid for by Medicare
"Obviously, this can get very complicated," said Kendrick. "There are many things for veterans to consider when selecting health care, including premiums, copayments and access. At Blue Cross and Blue Shield of Georgia we provide health benefits to many veterans and are happy to answer their questions to help them understand their options. After all, they deserve the absolute best health care coverage they can get."
For more information about veterans and Medicare, visit the Department of Veterans Affairs Web site at http://www4.va.gov/healtheligibility/ and click on " Medicare Information for Veterans ."
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Wednesday, October 13, 2010
Medicare Open Enrollment Starts November 15th
The GeorgiaCares State Health Insurance Assistance Program (SHIP) is helping Medicare recipients make informed decisions about which prescription drug and Advantage plan options are best for them. Beginning on October 15, consumers can compare available plans by visiting www.Medicare.gov. They may also call GeorgiaCares toll-free at 1-800-669-8387 for personalized assistance.
Open enrollment for Medicare Part C and D begins November 15, and recipients will have until December 31, 2010, to make their choices. With so many options available, choosing the right one is important. This is the first year that there will be one election period for both Part C and D plans. After this time, plan changes can be made during the annual Disenrollment Period of January 1 - February 15th of each year. During the Disenrollment Period, beneficiaries will only be allowed to leave a Medicare Part C plan and return to Original Medicare (Parts A and B) with the option of choosing a prescription drug plan.
“The GeorgiaCares SHIP network provides one-on-one assistance, so that callers can get personalized help as they compare their options and decide on which plans best meet their needs,” said Dr. James J. Bulot, director of the DHS Division of Aging Services.
GeorgiaCares SHIP counselors are available through the statewide network of Area Agencies on Aging and will provide community education sessions and answer hotline calls to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.
GeorgiaCares SHIP and the Centers for Medicare and Medicaid Services (CMS) advise people who wish to make a change to do so as close as possible to the November 15 opening date to ensure their coverage will be available on January 1, 2011. Companies began marketing their plans on October 1.
GeorgiaCares SHIP services are free and also assist Medicare beneficiaries on Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, resolution to billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.
GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who do not want to make a change can remain in their plan from 2010.
Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.
For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
Open enrollment for Medicare Part C and D begins November 15, and recipients will have until December 31, 2010, to make their choices. With so many options available, choosing the right one is important. This is the first year that there will be one election period for both Part C and D plans. After this time, plan changes can be made during the annual Disenrollment Period of January 1 - February 15th of each year. During the Disenrollment Period, beneficiaries will only be allowed to leave a Medicare Part C plan and return to Original Medicare (Parts A and B) with the option of choosing a prescription drug plan.
“The GeorgiaCares SHIP network provides one-on-one assistance, so that callers can get personalized help as they compare their options and decide on which plans best meet their needs,” said Dr. James J. Bulot, director of the DHS Division of Aging Services.
GeorgiaCares SHIP counselors are available through the statewide network of Area Agencies on Aging and will provide community education sessions and answer hotline calls to help beneficiaries understand their options for next year. Beneficiaries can call GeorgiaCares toll-free at 1-800-669-8387 or Medicare at 1-800-Medicare (1-800-633-4227) for assistance.
GeorgiaCares SHIP and the Centers for Medicare and Medicaid Services (CMS) advise people who wish to make a change to do so as close as possible to the November 15 opening date to ensure their coverage will be available on January 1, 2011. Companies began marketing their plans on October 1.
GeorgiaCares SHIP services are free and also assist Medicare beneficiaries on Medicare, Medicaid and Medigap matters, including long-term care insurance, claims, resolution to billing problems, information and referral on public benefit programs aimed at those with limited incomes and assets, and other health care insurance information.
GeorgiaCares SHIP urges everyone to review their coverage and make sure that any changes to the plan for 2011 will still meet their needs. Beneficiaries who do not want to make a change can remain in their plan from 2010.
Beneficiaries who want to consider all of their options will have access to help from many sources, including a notice of any coverage changes from their drug plan; the enhanced Medicare Drug Plan Finder at www.medicare.gov; the Medicare & You 2011 annual handbook that explains Medicare coverage; 1-800-Medicare (1-800-633-4227), which will be available 24/7; and GeorgiaCares - Local Help for People with Medicare, 1-800-669-8387.
For more information about services available to older Georgians and their families, visit the DHS Division of Aging Services at http://www.aging.dhr.georgia.gov or call (866) 55-AGING (552-4464).
Tuesday, October 05, 2010
How health care reform affects your Medicare enrollment
(ARA) - Health care legislation passed earlier this year may make Medicare annual enrollment season particularly challenging for the millions of baby boomers aging into Medicare and for seniors already enrolled who are considering different coverage for 2011. Annual enrollment runs from Nov. 15 to Dec. 31, allowing people to select their Medicare coverage for 2011.
"Choosing a Medicare plan can be overwhelming in any year," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. "However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage."
According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:
* Prescription drug costs should be lower in the "doughnut hole." For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.
* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.
* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it's likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.
* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from "like to like" options.
Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.
"It's easy to get confused over the various Medicare enrollment periods," Muralidharan says. "However, it's now more important than ever to look at annual enrollment as your main opportunity to choose your coverage."
Reasons to review your medicare coverage
Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:
* Your health situation has changed in the past year.
* Your provider situation has changed (for example, you hospital or physician left your plan).
* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).
* Your plan premiums and/or co-payments have increased.
* You have moved to a new location.
* Your current plan no longer will be available.
Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options - and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.
"The choices you make about your Medicare coverage can have a significant effect on your health care and your finances," says Muralidharan. "If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling." More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
"Choosing a Medicare plan can be overwhelming in any year," says Adrienne Muralidharan, senior Medicare specialist for the Allsup Medicare Advisor, a Medicare plan selection service for people with disabilities and those 65 and older. "However, this year there are not only the usual changes, such as premium and coverage changes, you also need to understand how the Patient Protection and Affordable Care Act may affect your 2011 Medicare coverage."
According to Muralidharan, the most important ways the new health care legislation will affect Medicare beneficiaries for 2011 include:
* Prescription drug costs should be lower in the "doughnut hole." For 2011, Medicare beneficiaries will receive a 50 percent discount for the cost of brand-name prescription drugs and a 7 percent discount for generic drugs they are taking while in the prescription drug doughnut hole.
* Medicare Part B (medical insurance) will fully cover preventive care. Beginning in 2011, Medicare beneficiaries will no longer have to pay deductibles or co-pays for preventive services that fall under U.S. Preventive Service Task Force guidelines, such as an annual wellness exam.
* More beneficiaries may have higher costs for Medicare Part B and Part D (prescription drug) coverage. The Part B income threshold freezes at the 2010 levels through 2019. As a result, individuals with modified adjusted gross income (income) exceeding $85,000 and married couples with income exceeding $170,000 will have to pay higher premiums. Because this will not adjust with inflation, it's likely more people over time will be subject to higher premiums. In addition, the law reduces the Medicare Part D premium subsidy for individuals with incomes above these levels.
* Opportunities to change coverage after the annual enrollment period will be more limited. Historically, an open enrollment period ran from Jan. 1 through March 31, immediately after annual enrollment ended. During open enrollment, people were able to switch from their existing Medicare plans to similar Medicare coverage, choosing from "like to like" options.
Now, open enrollment has been replaced with a shorter annual disenrollment period, which runs from Jan. 1 through Feb. 14. During this period, the only change that can be made is to disenroll from a Medicare Advantage plan in order to enroll in traditional Medicare and join a Medicare Part D plan. Other selections will not be available to consumers.
"It's easy to get confused over the various Medicare enrollment periods," Muralidharan says. "However, it's now more important than ever to look at annual enrollment as your main opportunity to choose your coverage."
Reasons to review your medicare coverage
Changes brought on by health care reform are just one reason people should evaluate their Medicare coverage. Each year, individuals with Medicare should consider different health care coverage if they experience any of the following:
* Your health situation has changed in the past year.
* Your provider situation has changed (for example, you hospital or physician left your plan).
* Your coverage has changed (for example, certain drugs, procedures or conditions are no longer covered).
* Your plan premiums and/or co-payments have increased.
* You have moved to a new location.
* Your current plan no longer will be available.
Additionally, people now turning 65 and becoming Medicare-eligible for the first time should carefully review their options - and make certain they follow the enrollment guidelines. Failing to do so can trigger costly penalties and may mean certain coverage is unavailable in the future.
"The choices you make about your Medicare coverage can have a significant effect on your health care and your finances," says Muralidharan. "If you are uncertain about which Medicare plans are available to you, or which would best meet your needs, seek help before enrolling." More information on Medicare plan selection assistance is available at Medicare.Allsup.com or (888) 271-1173.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Saturday, October 02, 2010
Care Improvement Plus Releases 2011 Medicare Health Plan Benefits for Georgia
/PRNewswire/ -- Care Improvement Plus, operator of the largest special needs plan in Georgia, is standing by its commitment to serve chronically ill and underserved Medicare beneficiaries with the release of its 2011 Medicare health plan benefits in preparation for the upcoming Medicare annual election period, which begins November 15th.
"At a time when there is concern over unpredictable change in healthcare, Care Improvement Plus remains committed to our members and the underserved Medicare beneficiaries of Georgia," said Frederick C. Dunlap, chairman and chief executive officer of XLHealth, which owns and operates Care Improvement Plus. "For 2011, we are continuing to build upon our innovative model of care, providing specialized services that go well beyond what Original Medicare and most Medicare Advantage plans offer -- improving quality of care and controlling healthcare costs."
The details of Care Improvement Plus' 2011 Medicare health plan benefits include stable plan premiums with $0 options, and the continuation of valuable additional benefits and services, such as:
* Vision, dental, transportation, and Over-The-Counter benefits
* Care management program including nurse coaching and a 24-7 nurse hotline
* Free annual in-home health assessments with a licensed practitioner
* Personalized counseling sessions with plan pharmacists
* Assistance with accessing social support services
* An open access provider network with no referral required for Medicare-covered services
* $0 copays for important preventive care services
Beneficiaries with chronic conditions such as diabetes and heart failure complex healthcare needs requiring a patient-centered focus, making Care Improvement Plus an important option for more than 1,218,887 eligible Georgians to consider.
"During a time when some Medicare Advantage companies are either discontinuing or reducing their coverage, we will continue to serve Georgia Medicare beneficiaries with stability in cost and benefits," continues Dunlap.
Care Improvement Plus will open enrollment on November 15, 2010 for services effective January 1, 2011. Those interested in learning more about Care Improvement Plus may call 1-800-711-1656, or visit www.careimprovementplus.com for more information.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
"At a time when there is concern over unpredictable change in healthcare, Care Improvement Plus remains committed to our members and the underserved Medicare beneficiaries of Georgia," said Frederick C. Dunlap, chairman and chief executive officer of XLHealth, which owns and operates Care Improvement Plus. "For 2011, we are continuing to build upon our innovative model of care, providing specialized services that go well beyond what Original Medicare and most Medicare Advantage plans offer -- improving quality of care and controlling healthcare costs."
The details of Care Improvement Plus' 2011 Medicare health plan benefits include stable plan premiums with $0 options, and the continuation of valuable additional benefits and services, such as:
* Vision, dental, transportation, and Over-The-Counter benefits
* Care management program including nurse coaching and a 24-7 nurse hotline
* Free annual in-home health assessments with a licensed practitioner
* Personalized counseling sessions with plan pharmacists
* Assistance with accessing social support services
* An open access provider network with no referral required for Medicare-covered services
* $0 copays for important preventive care services
Beneficiaries with chronic conditions such as diabetes and heart failure complex healthcare needs requiring a patient-centered focus, making Care Improvement Plus an important option for more than 1,218,887 eligible Georgians to consider.
"During a time when some Medicare Advantage companies are either discontinuing or reducing their coverage, we will continue to serve Georgia Medicare beneficiaries with stability in cost and benefits," continues Dunlap.
Care Improvement Plus will open enrollment on November 15, 2010 for services effective January 1, 2011. Those interested in learning more about Care Improvement Plus may call 1-800-711-1656, or visit www.careimprovementplus.com for more information.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Friday, October 01, 2010
Humana and Walmart Announce Innovative Medicare Part D Prescription Drug Plan with Lowest National Monthly Premium Offered in all 50 States and D.C.¹
(BUSINESS WIRE)--Today, Humana Inc. (NYSE: HUM) announced an innovative Medicare Part D prescription drug plan, co-branded with Wal-Mart Stores, Inc. (NYSE: WMT) or (“Walmart”), that can provide significant savings on monthly plan premiums and prescription medicine copayments and cost-shares for Medicare beneficiaries, including seniors and people with disabilities.
The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.
“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”
Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details
* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.
* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.
* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.
How to Enroll in the Plan: Call, Click or Go
Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:
* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.
Medicare Part D Background
Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.
References
1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp
2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.
3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf
4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm
5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
The Humana Walmart-Preferred Rx Plan (PDP) offers one low national monthly plan premium of $14.80 – according to CMS¹, the lowest national plan premium in 2011 for a standalone Medicare Part D plan premium offered in all 50 states and Washington, D.C. This new co-branded prescription drug plan can save a typical Medicare Part D beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) an estimated average of more than $450² in 2011 on plan premiums and prescription medication copayments and cost-shares when compared with the average total costs for a Part D prescription drug plan in 2010. With nearly 18 million Americans relying on Medicare Part D for their prescriptions³, the Humana Walmart-Preferred Rx Plan (PDP) provides an affordable prescription solution for those who need it most.
“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
“We know every dollar counts, especially when you live on a fixed income. We believe no one should have to choose between buying their groceries or their medications,” said John Agwunobi, M.D., president of Walmart’s Health and Wellness division. “Financial health is a fundamental part of a person’s well-being. At Walmart, the customer is always front and center, and that is why we are committed to doing everything we can to ensure seniors have access to the medications they need at a price they can afford.”
Humana Walmart-Preferred Rx Plan (PDP): Benefits and Details
* One low monthly rate nationwide. The monthly plan premium is less than $15 a month for everyone, regardless of where they live.
-According to CMS, the $14.80 monthly plan premium is the lowest national plan premium in 2011 for a standalone Medicare Part D prescription drug plan offered in all 50 states and Washington, D.C.1
-The Humana Walmart-Preferred Rx Plan (PDP) offers a monthly plan premium of $14.80, which is less than half the weighted 2010 national average for Medicare Part D prescription drug plans’ monthly plan premiums⁴.
* Low copayments when plan members use preferred pharmacies like Walmart, Neighborhood Market or Sam’s Club pharmacies:
-In-store copayments (at preferred pharmacies) on generic prescriptions start as low as $2 when plan members use preferred pharmacies.
-Copayments as low as $0 for generic prescriptions filled via Humana’s RightSource home-delivery prescription service.
* A broad competitive formulary comparable to other plans, with a list of prescription drugs included in the plan available at humana-medicare.com.
How to Enroll in the Plan: Call, Click or Go
Information on the plan is available starting today; annual enrollment for Medicare plans begins Monday, Nov. 15, 2010, and continues through Dec. 31, 2010. To get more information on the Humana Walmart-Preferred Rx Plan (PDP) and to learn more about these savings:
* Call Humana to enroll at 1-800-899-0441. For TTY, call 711, 8 a.m. to 8 p.m., seven days a week.
* Click on humana-medicare.com or medicare.gov to enroll.
* Click on walmart.com/rxplan or samsclub.com/rxplan for additional plan details and links to enroll.
* Visit a Walmart store to speak to a Humana representative.
o Informational kiosks, including many staffed by Humana representatives, are available in approximately 3,000 Walmart stores across the country. Medicare beneficiaries can click on “Find a Location Near You” at walmart.com/rxplan to locate an on-site Humana representative.
Medicare Part D Background
Medicare Part D is the prescription drug program supported by the federal government. According to the Kaiser Family Foundation, nearly 18 million people are currently enrolled in a standalone Part D plan3 and Families USA reports that seniors generate one-third of all prescriptions filled in the United States⁵.
References
1 “Centers for Medicare & Medicaid Services.” Click on the “2011 Drug Plan Information - State Fact Sheets” under “Spotlights.” September 2010. http://www.cms.gov/center/openenrollment.asp
2 Savings estimate is based on a comparison between 1) the projected average nationwide out-of-pocket costs for the 2011 benefit year for the average Medicare beneficiary who enrolls in the Humana Walmart-Preferred Rx Plan (PDP) and fills their prescriptions in-store at preferred pharmacies like Walmart, Sam's Club, and Neighborhood Market pharmacies, and 2) the projected average nationwide out-of-pocket costs for the 2010 benefit year for the average Medicare beneficiary. Calculations based in part on industry average PDP premium and benefit information from the “Medicare Part D 2010 Spotlight, Medicare Prescription Drug Plans in 2010 and Key Changes over Five Years”, an independent review and analysis of CMS data by the Kaiser Family Foundation (September 2010). Actual savings may vary. For some beneficiaries, actual out-of-pocket costs may be more. Savings estimate may be updated when 2011 benefit year data becomes publicly available.
3 “The Henry J. Kaiser Family Foundation.” Medicare: A Primer. Chart: Prescription Drug Coverage Among Medicare Beneficiaries, 2010, Page 8. April 2010. http://www.kff.org/medicare/upload/7615-03.pdf
4 “The Henry J. Kaiser Family Foundation.” Medicare Part D 2010 Data Spotlight. Chart: Exhibit 2: Weighted Monthly PDP Premiums, 2006-2010, Page 9. September 2010. http://www.kff.org/medicare/8096.cfm
5 “Families USA.” Cost Overdose: Growth in Drug Spending for the Elderly, 1992 – 2010; Figure 1: Seniors Consume a Disproportionate Share of Drug Expenses, Page 2. July 2000.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Thursday, September 23, 2010
Medicare beneficiaries in donut hole will see 50-percent discount on brand name drugs in 2011
Vice President Joe Biden, the U.S. Department of Health and Human Services and the Centers for Medicare & Medicaid Services (CMS) today announced that the nation's pharmaceutical manufacturers will provide 50 percent discounts on the cost of covered brand-name prescription drugs for beneficiaries in the Medicare Part D coverage gap, or donut hole, starting in 2011.
Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.
"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."
The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.
"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."
Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.
"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."
Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Vice President Biden and Secretary Sebelius made the announcement on a grassroots conference call with seniors from across the country. On the call, the Vice President and the Secretary discussed the benefits of the Affordable Care Act for seniors including the prescription drug discounts and provisions in the law that help fight fraud and make certain preventive care and annual wellness exams, free for most Medicare beneficiaries.
"Thanks to the Affordable Care Act, millions of people with Medicare who will fall into the Part D donut hole next year will pay less for their prescription drugs," said Vice President Biden. "The discount manufacturers will pay on brand-name drugs, helping millions of seniors who are struggling to make ends meet at the end of the month, and it's just one of the ways the new health care law helps make Medicare stronger."
The Affordable Care Act has helped reduce costs for Medicare beneficiaries, beginning with one-time rebate $250 rebate checks for beneficiaries who hit the donut hole in 2010.
"More than 1.2 million beneficiaries who have hit the donut hole so far this year have received their $250 rebate checks as part of the cost savings provisions in the Affordable Care Act, and millions more are on deck to get a check," said HHS Secretary Kathleen Sebelius. "Now, with these new agreements, people who rely on Medicare will see even more savings off their drug costs next year, and savings will continue even after the coverage gap is closed in 2020."
Seniors and people with disabilities enrolled in Medicare drug plans will also find next year that through the use of the new tools provided by the Affordable Care Act, premiums are stable and the number of prescription drug plans that voluntarily help fill the donut hole has increased. In August, CMS reported that the average 2011 Medicare prescription drug plan premium will remain similar to rates beneficiaries are currently paying this year - an increase of $1.
"Most Medicare prescription drug plan premiums will remain stable next year and beneficiaries will find there are clearer plan options and many plans that can help them save even more - like those plans that are offering benefits that help fill the donut hole," said CMS Administrator Donald Berwick, M.D. "They will find that the Affordable Care Act improves the value of drug coverage they get next year."
Beneficiaries will soon receive their 2011 Medicare & You handbook and find updated information at www.medicare.gov and 1-800-Medicare in mid-October. Users of the Medicare Plan Finder, available at www.medicare.gov, will be able to compare plans' quality summary rating from the previous year, identify which drugs are included on a plan's formulary, and compare the cost ranges for plans available in their communities.
-----
Community News You Can Use
Click to read MORE news:
www.GeorgiaFrontPage.com
Twitter: @gafrontpage & @TheGATable @HookedonHistory
www.ArtsAcrossGeorgia.com
Twitter: @artsacrossga, @softnblue, @RimbomboAAG
www.FayetteFrontPage.com
Twitter: @FayetteFP
Monday, September 13, 2010
Guidance on New Hospice Benefits for Terminally Ill Children Hailed by Hospice and Palliative Care Community
/PRNewswire/ -- The families of dying children who are covered under Medicaid or the Medicaid expansion Children's Health Insurance Program (CHIP) will no longer face the choice of stopping curative treatments in order for their terminally ill child to receive quality end-of-life care from hospice.
The provision in The Patient Protection and Affordable Care Act requiring state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatments has been widely applauded by the hospice and palliative care community. In an important step to implement the law, the Centers for Medicare and Medicaid Services issued a letter of guidance on Thursday, September 9, 2010.
"This provision is a very important step forward for children with life-threatening illness. No longer will families need to make an agonizing choice to give up cure-directed treatment in order to receive the multiple benefits offered through a comprehensive hospice program," said Sarah Friebert, MD, Director of the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital.
J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, remarked, "NHPCO has been a longtime advocate for the provision, previously working with Senators Jay Rockefeller (D-WV)and Susan Collins (R-ME) to include the language in their Advance Planning and Compassionate Care Act."
Throughout the various stages of health care reform deliberations, NHPCO went on record as supporting the inclusion of the pediatric concurrent care provision and actively lobbied for its continued inclusion in the final version of the legislation.
The law does not change the criteria for receiving hospice services. In order to qualify for the hospice service in either Medicaid or CHIP, a physician must certify that the eligible person is within the last six months of life.
In the letter issued by CMS, Cindy Mann, federal Medicaid Director, wrote, "We believe implementation of this new provision is vitally important for children and their families seeking a blended package of curative and palliative services. This provision will increase utilization of hospice services since parents and children will no longer be required to forego curative treatment."
"Care for children and families facing serious illness and death are an important population that should not be overlooked," noted Schumacher. "This law is the right thing to do for families facing the tragedy of a dying child."
Friebert further added, "We have further work to do to secure reimbursement for services for children with chronic, complex and/or life-threatening illness who do not qualify for hospice, and need the same protection to receive concurrent palliative care and cure-directed therapy."
To further support the care of young people with serious and life-limiting illness, NHPCO and the Children's Project for Palliative/Hospice Services (ChiPPS) developed and published The Standards of Practice for Pediatric Palliative Care and Hospice and released a report "Facts and Figures on Pediatric Palliative Care and Hospice." Additionally, the first module of a series of ten online courses on pediatric palliative care was launched on NHPCO's web-based E-Online education portal.
Learn more about the Pediatric Standards, ChiPPS, or download the facts and figures report at www.nhpco.org/pediatrics.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
The provision in The Patient Protection and Affordable Care Act requiring state Medicaid programs to allow children with a life-limiting illness to receive both hospice care and curative treatments has been widely applauded by the hospice and palliative care community. In an important step to implement the law, the Centers for Medicare and Medicaid Services issued a letter of guidance on Thursday, September 9, 2010.
"This provision is a very important step forward for children with life-threatening illness. No longer will families need to make an agonizing choice to give up cure-directed treatment in order to receive the multiple benefits offered through a comprehensive hospice program," said Sarah Friebert, MD, Director of the Haslinger Division of Pediatric Palliative Care at Akron Children's Hospital.
J. Donald Schumacher, president and CEO of the National Hospice and Palliative Care Organization, remarked, "NHPCO has been a longtime advocate for the provision, previously working with Senators Jay Rockefeller (D-WV)and Susan Collins (R-ME) to include the language in their Advance Planning and Compassionate Care Act."
Throughout the various stages of health care reform deliberations, NHPCO went on record as supporting the inclusion of the pediatric concurrent care provision and actively lobbied for its continued inclusion in the final version of the legislation.
The law does not change the criteria for receiving hospice services. In order to qualify for the hospice service in either Medicaid or CHIP, a physician must certify that the eligible person is within the last six months of life.
In the letter issued by CMS, Cindy Mann, federal Medicaid Director, wrote, "We believe implementation of this new provision is vitally important for children and their families seeking a blended package of curative and palliative services. This provision will increase utilization of hospice services since parents and children will no longer be required to forego curative treatment."
"Care for children and families facing serious illness and death are an important population that should not be overlooked," noted Schumacher. "This law is the right thing to do for families facing the tragedy of a dying child."
Friebert further added, "We have further work to do to secure reimbursement for services for children with chronic, complex and/or life-threatening illness who do not qualify for hospice, and need the same protection to receive concurrent palliative care and cure-directed therapy."
To further support the care of young people with serious and life-limiting illness, NHPCO and the Children's Project for Palliative/Hospice Services (ChiPPS) developed and published The Standards of Practice for Pediatric Palliative Care and Hospice and released a report "Facts and Figures on Pediatric Palliative Care and Hospice." Additionally, the first module of a series of ten online courses on pediatric palliative care was launched on NHPCO's web-based E-Online education portal.
Learn more about the Pediatric Standards, ChiPPS, or download the facts and figures report at www.nhpco.org/pediatrics.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Monday, August 30, 2010
Sebelius announces 1 million Medicare beneficiaries have received prescription drug cost relief under the Affordable Care Act
U.S. Department of Health and Human Services Secretary Kathleen Sebelius today announced that more than 1 million Medicare beneficiaries have received prescription drug cost relief through the Affordable Care Act. As part of the health insurance reform law's step-by-step efforts to close the Medicare Part D prescription drug coverage gap, eligible beneficiaries who fall in this "donut hole" this year are mailed a one-time, tax-free $250 rebate check. More than a quarter of the 4 million checks Medicare expects to distribute have been received by eligible Medicare beneficiaries.
"Many seniors and people with disabilities on Medicare face extraordinary prescription drug costs, and too often stop following the drug regimens that their doctors have recommended as a result," said Secretary Sebelius. "These checks will make a difference in helping seniors continue to get the medications they need, and are one of many ways that the Affordable Care Act is helping seniors."
Nationwide, 1 million Medicare beneficiaries have already been mailed their rebates and more beneficiaries will be receiving checks in the coming months as they enter the coverage gap. Eligible beneficiaries receive these checks automatically in the mail when they reach the donut hole, and they don't have to sign-up to be eligible for the rebates.
Rebate checks will help people with their drug costs this year. Next year, those who fall into the donut hole will receive a 50-percent discount on covered brand name medications while in the donut hole. Every year, the amount Medicare beneficiaries pay in cost sharing will decrease markedly until the coverage gap is closed.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor. All beneficiaries will receive free preventive care services like mammograms and certain colon cancer tests and a free annual physical starting in 2011 in Original Medicare. Additionally, seniors can expect to save an average of nearly $200 per year in premiums by 2018 compared to what they would have paid without the new law, and most beneficiaries will also see a significant reduction in their Medicare coinsurance as a result of the Affordable Care Act.
The Affordable Care Act also contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. Last week, HHS and the Department of Justice held their second regional fraud prevention summit in Los Angeles that brought together law enforcement experts, providers and seniors to help utilize these new tools to fight fraud and protect seniors.
The Affordable Care Act strengthens the screenings for health care providers who want to participate in Medicaid or Medicare, enables enforcement officials to see health care claims data from around the country into a single, searchable database, and strengthens the penalties for criminals. The reduction in waste, fraud and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future.
Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information, or go to www.stopmedicarefraud.gov.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
"Many seniors and people with disabilities on Medicare face extraordinary prescription drug costs, and too often stop following the drug regimens that their doctors have recommended as a result," said Secretary Sebelius. "These checks will make a difference in helping seniors continue to get the medications they need, and are one of many ways that the Affordable Care Act is helping seniors."
Nationwide, 1 million Medicare beneficiaries have already been mailed their rebates and more beneficiaries will be receiving checks in the coming months as they enter the coverage gap. Eligible beneficiaries receive these checks automatically in the mail when they reach the donut hole, and they don't have to sign-up to be eligible for the rebates.
Rebate checks will help people with their drug costs this year. Next year, those who fall into the donut hole will receive a 50-percent discount on covered brand name medications while in the donut hole. Every year, the amount Medicare beneficiaries pay in cost sharing will decrease markedly until the coverage gap is closed.
The closing of the donut hole is just one of the ways seniors benefit from the Affordable Care Act. In addition to savings on prescription drugs, the law provides new benefits to Medicare beneficiaries when they visit their doctor. All beneficiaries will receive free preventive care services like mammograms and certain colon cancer tests and a free annual physical starting in 2011 in Original Medicare. Additionally, seniors can expect to save an average of nearly $200 per year in premiums by 2018 compared to what they would have paid without the new law, and most beneficiaries will also see a significant reduction in their Medicare coinsurance as a result of the Affordable Care Act.
The Affordable Care Act also contains important new tools to help crack down on criminals seeking to scam seniors and steal taxpayer dollars. Last week, HHS and the Department of Justice held their second regional fraud prevention summit in Los Angeles that brought together law enforcement experts, providers and seniors to help utilize these new tools to fight fraud and protect seniors.
The Affordable Care Act strengthens the screenings for health care providers who want to participate in Medicaid or Medicare, enables enforcement officials to see health care claims data from around the country into a single, searchable database, and strengthens the penalties for criminals. The reduction in waste, fraud and abuse returns savings to the Medicare Trust Fund to strengthen the program into the future.
Seniors are encouraged to contact 1-800-MEDICARE to report any solicitations of personal information, or go to www.stopmedicarefraud.gov.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Tuesday, August 24, 2010
136 Members of Congress Demand that Medicare Release Key Information about Controversial Bidding Program for Home Medical Equipment
/PRNewswir/ -- A bipartisan group of 136 members of Congress recently requested that the federal Centers for Medicare and Medicaid Services (CMS) disclose the list of homecare providers whose bids were used to calculate home medical equipment reimbursement rates under the Medicare "competitive" bidding program. See letter at www.aahomecare.org.
"Without knowing the identity, as well as the appropriate overall qualifications of these providers, we cannot evaluate the program's impact in terms of quality and access to care for seniors we represent," states the congressional letter to CMS Administrator Donald Berwick, M.D.
While CMS intends to release this information in the fall after contracts are finalized, members of Congress are calling on CMS to share this information now to make sure that the disastrous mistakes of the 2008 Round One of bidding are avoided and to uphold President Obama's pledge of "transparency and open government."
"We want to ensure that qualified providers have been chosen to provide these items and services to our constituents," said the congressional letter to CMS. "The healthcare community will again have very serious problems if it turns out once more that these companies are unable to provide sufficient access to quality items and services or do not have the financial ability to operate under the new contracted rates."
When CMS held its Round One bid for home medical equipment in 2008, Congress halted implementation and called for a re-bid of the program after numerous problems emerged. For example, under the Round One bidding in 2008, Medicare contracts were granted to providers that were not appropriately licensed and lacked experience with the devices for which they were awarded contracts.
The American Association for Homecare, which represents durable medical equipment providers, is encouraged by the House letter and urges CMS to comply with this important request. The congressional letter, sent on August 11, asked CMS to respond by August 20. At the time of this press release, the Association is not aware of any response so far by the agency.
"We are pleased that so many members of Congress understand the need for transparency and the urgency of this request," said Tyler Wilson, president of AAHomecare. "Transparency for the bid process is critical given past problems with this whole program. If CMS delays the release of information until fall, it will impede the ability to assess the impact of the bidding program on Medicare patients.
"One of our concerns is that providers who submitted low, desperation bids out of their perceived need to remain a Medicare supplier could well determine the government's reimbursement rates - even if those companies ultimately declined to actually provide the equipment at those rates."
The Medicare bidding program for home medical equipment uses a degree of economic coercion to force homecare providers to submit bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at reimbursement rates low enough to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program may be unsustainable, reducing competition in the long term and reducing seniors' access to care and choice of providers.
In the first round of the bidding program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. Congress delayed the implementation of the initial bidding program in 2008 to allow for needed changes. The home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut. However, CMS ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now charging headlong into the program in 9 of the 10 largest metropolitan statistical areas in the U.S. An additional 91 areas will be subjected to the bidding process next year.
A bipartisan bill pending in Congress, H.R. 3790, calls for the repeal of the Medicare bidding program for home medical equipment and it would substantially reduce reimbursement rates for the equipment but preserve the nation's vital, cost-effective homecare infrastructure. That bill is supported by 255 members of the U.S. House of Representatives.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
"Without knowing the identity, as well as the appropriate overall qualifications of these providers, we cannot evaluate the program's impact in terms of quality and access to care for seniors we represent," states the congressional letter to CMS Administrator Donald Berwick, M.D.
While CMS intends to release this information in the fall after contracts are finalized, members of Congress are calling on CMS to share this information now to make sure that the disastrous mistakes of the 2008 Round One of bidding are avoided and to uphold President Obama's pledge of "transparency and open government."
"We want to ensure that qualified providers have been chosen to provide these items and services to our constituents," said the congressional letter to CMS. "The healthcare community will again have very serious problems if it turns out once more that these companies are unable to provide sufficient access to quality items and services or do not have the financial ability to operate under the new contracted rates."
When CMS held its Round One bid for home medical equipment in 2008, Congress halted implementation and called for a re-bid of the program after numerous problems emerged. For example, under the Round One bidding in 2008, Medicare contracts were granted to providers that were not appropriately licensed and lacked experience with the devices for which they were awarded contracts.
The American Association for Homecare, which represents durable medical equipment providers, is encouraged by the House letter and urges CMS to comply with this important request. The congressional letter, sent on August 11, asked CMS to respond by August 20. At the time of this press release, the Association is not aware of any response so far by the agency.
"We are pleased that so many members of Congress understand the need for transparency and the urgency of this request," said Tyler Wilson, president of AAHomecare. "Transparency for the bid process is critical given past problems with this whole program. If CMS delays the release of information until fall, it will impede the ability to assess the impact of the bidding program on Medicare patients.
"One of our concerns is that providers who submitted low, desperation bids out of their perceived need to remain a Medicare supplier could well determine the government's reimbursement rates - even if those companies ultimately declined to actually provide the equipment at those rates."
The Medicare bidding program for home medical equipment uses a degree of economic coercion to force homecare providers to submit bids necessary to win a contract. Because Medicare is the largest third-party purchaser of home medical care, its market power effectively coerces providers to bid at reimbursement rates low enough to ensure the opportunity to continue serving Medicare beneficiaries. Ultimately, the below-market rates achieved through this bidding program may be unsustainable, reducing competition in the long term and reducing seniors' access to care and choice of providers.
In the first round of the bidding program in 2008, 90 percent of qualified providers were barred from serving Medicare beneficiaries for the bid-upon items. Congress delayed the implementation of the initial bidding program in 2008 to allow for needed changes. The home medical equipment sector paid for that delay by taking a 9.5 percent nationwide reimbursement cut. However, CMS ignored congressional intent, did not address the flaws that precipitated the delay two years ago, and is now charging headlong into the program in 9 of the 10 largest metropolitan statistical areas in the U.S. An additional 91 areas will be subjected to the bidding process next year.
A bipartisan bill pending in Congress, H.R. 3790, calls for the repeal of the Medicare bidding program for home medical equipment and it would substantially reduce reimbursement rates for the equipment but preserve the nation's vital, cost-effective homecare infrastructure. That bill is supported by 255 members of the U.S. House of Representatives.
The American Association for Homecare represents durable medical equipment providers, manufacturers, and other organizations in the homecare community. Members serve the medical needs of millions of Americans who require oxygen equipment and therapy, mobility assistive technologies, medical supplies, inhalation drug therapy, home infusion, and other medical equipment and services in their homes. The Association's members operate more than 3,000 homecare locations in all 50 states. Visit www.aahomecare.org/athome.
-----
Community News You Can Use
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Tuesday, July 27, 2010
U.S. Files Suit Against Georgia Medical Center and Physician; Allegedly Submitted Claims for Worthless Services to Federal Health Care Programs
/PRNewswire/ -- The United States has filed a complaint under the False Claims Act against Dr. Najam Azmat and the Satilla Regional Medical Center in Waycross, Ga., the Justice Department announced today. The complaint, filed in U.S. District Court for the Southern District of Georgia, alleges that the defendants submitted false or fraudulent claims to federal health care programs, such as Medicare. Specifically, the United States contends that certain operative procedures performed by Dr. Azmat at Satilla, and hospital services provided by Satilla in connection with those procedures, were not reasonable and necessary, were incompatible with standards of acceptable medical practice, and were of no medical value. The United States further alleges that the defendants' misconduct endangered the lives of federal health care program beneficiaries.
The government's complaint alleges that in the Spring of 2005, Satilla recruited Dr. Azmat, a general surgeon by training, to relocate to Waycross and join the hospital's medical staff. Shortly after Dr. Azmat came aboard, Satilla allowed him to begin performing endovascular procedures - highly specialized operative procedures that require formal training - in Satilla's Heart Center cath lab. Satilla did so despite the fact that Dr. Azmat lacked training to perform such procedures, was not qualified or competent to perform such procedures, had never performed such procedures before at any of the hospitals where he had been on staff, and did not even have privileges at Satilla to perform such procedures.
The complaint further alleges that it was obvious to the cath lab nursing staff that Dr. Azmat was not qualified or competent to perform endovascular procedures. The nurses repeatedly voiced their concerns to Satilla's management, but the hospital took no formal action for at least five months, during which patients were seriously injured and one patient died from hemorrhagic shock following an endovascular procedure during which Dr. Azmat perforated her renal artery. The complaint also states that not only did Satilla's management ignore its nurses' concerns for several months, but it also performed no formal oversight of Dr. Azmat, categorically excluding all of his endovascular procedures from Satilla's peer review process.
"When health care providers cut corners by allowing unqualified doctors to perform complicated medical procedures, patients suffer," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Here, we allege individuals were endangered because of these defendants. The seriousness of this case illustrates why we remain committed to protecting patient safety and the integrity of our federal health care programs by aggressively enforcing our health care fraud laws."
"The filing of this complaint is but one example of the willingness of the Department of Justice to take action to protect the health and safety of the American people. The United States Attorney's Office will take the necessary legal actions to comply with our vigorous enforcement responsibilities under the False Claims Act," said Edward Tarver, U.S. Attorney for the Southern District of Georgia
This lawsuit was originally filed by Lana Rogers, a nurse who formerly worked in Satilla's Heart Center. Under the qui tam, or whistleblower, provisions of the False Claims Act, a private citizen can file an action on behalf of the United States and receive a portion of any recovery. In April of this year, the United States intervened in the lawsuit, and today filed its own complaint. Under the False Claims Act, the government may recover up to three times the amount of its losses, plus civil penalties based on the number of false claims filed
The suit is entitled United States ex rel. Lana Rogers v. Najam Azmat, M.D. and Satilla Health Services Inc., dba Satilla Regional Medical Center.
The United States' intervention is part of the government's emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $4 billion.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
The government's complaint alleges that in the Spring of 2005, Satilla recruited Dr. Azmat, a general surgeon by training, to relocate to Waycross and join the hospital's medical staff. Shortly after Dr. Azmat came aboard, Satilla allowed him to begin performing endovascular procedures - highly specialized operative procedures that require formal training - in Satilla's Heart Center cath lab. Satilla did so despite the fact that Dr. Azmat lacked training to perform such procedures, was not qualified or competent to perform such procedures, had never performed such procedures before at any of the hospitals where he had been on staff, and did not even have privileges at Satilla to perform such procedures.
The complaint further alleges that it was obvious to the cath lab nursing staff that Dr. Azmat was not qualified or competent to perform endovascular procedures. The nurses repeatedly voiced their concerns to Satilla's management, but the hospital took no formal action for at least five months, during which patients were seriously injured and one patient died from hemorrhagic shock following an endovascular procedure during which Dr. Azmat perforated her renal artery. The complaint also states that not only did Satilla's management ignore its nurses' concerns for several months, but it also performed no formal oversight of Dr. Azmat, categorically excluding all of his endovascular procedures from Satilla's peer review process.
"When health care providers cut corners by allowing unqualified doctors to perform complicated medical procedures, patients suffer," said Tony West, Assistant Attorney General for the Civil Division of the Department of Justice. "Here, we allege individuals were endangered because of these defendants. The seriousness of this case illustrates why we remain committed to protecting patient safety and the integrity of our federal health care programs by aggressively enforcing our health care fraud laws."
"The filing of this complaint is but one example of the willingness of the Department of Justice to take action to protect the health and safety of the American people. The United States Attorney's Office will take the necessary legal actions to comply with our vigorous enforcement responsibilities under the False Claims Act," said Edward Tarver, U.S. Attorney for the Southern District of Georgia
This lawsuit was originally filed by Lana Rogers, a nurse who formerly worked in Satilla's Heart Center. Under the qui tam, or whistleblower, provisions of the False Claims Act, a private citizen can file an action on behalf of the United States and receive a portion of any recovery. In April of this year, the United States intervened in the lawsuit, and today filed its own complaint. Under the False Claims Act, the government may recover up to three times the amount of its losses, plus civil penalties based on the number of false claims filed
The suit is entitled United States ex rel. Lana Rogers v. Najam Azmat, M.D. and Satilla Health Services Inc., dba Satilla Regional Medical Center.
The United States' intervention is part of the government's emphasis on combating health care fraud. One of the most powerful tools in that effort is the False Claims Act, which the Justice Department has used to recover approximately $3 billion since January 2009 in cases involving fraud against federal health care programs. The Justice Department's total recoveries in False Claims Act cases since January 2009 have topped $4 billion.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Friday, July 23, 2010
Six Key Tips for Caregivers Navigating the System on Behalf of Their Parents, Grandparents and Others
/PRNewswire/ -- According to the National Alliance for Caregiving, more than 65 million people in the United States serve as informal caregivers, typically for family members, which equates to more than one out of every four people serving as unpaid caregivers.
A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.
"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."
Gathering Information
The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:
-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and
untreated.
This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.
Getting Permission
Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.
"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."
Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.
These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.
Enrolling in a Chronic Disease Program
Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.
"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."
Knowing Your Rights
Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.
If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov/ to get a free copy of "Your Rights and Protections."
Investigating 'Extra Help'
As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.
Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Caring for Yourself
The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.
According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.
"Caregivers need to know that there's no shame in asking for help," said Connolly.
For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
A caregiver is someone who provides assistance to another person who is ill, disabled or needs help with daily activities. It's a role that can be physically and emotionally draining. The health care system doesn't make it any easier. Fortunately, there are a few tips caregivers can follow to better manage their loved one's health care, particularly when it comes to people with Medicare, according to Krista Bowers, senior vice president of senior products at Blue Cross and Blue Shield of Georgia's parent company.
"At Blue Cross and Blue Shield of Georgia (BCBSGA), we hear regularly from caregivers who are learning how to navigate the system on behalf of their parents, grandparents and others," said Monye Connolly, President, BCBSGA. "There are some themes that are common among them."
Gathering Information
The first step in helping to manage care for a loved one is gathering as much information as possible about their health and health benefits. Some items caregivers might want to gather include the following:
-- Medicare card (if eligible)
-- Health plan membership card
-- A list of doctors, including specialists
-- A list of medicines and dosages
-- Information about the person's medical conditions both treated and
untreated.
This is basically creating a "personal health record." A loved one might be reluctant to share this information at first. Experts recommend that caregivers remain patient. They can explain that the information is needed to advocate on their behalf with their doctors, hospitals and insurance companies.
Getting Permission
Most people have heard of the Health Insurance Portability and Accountability Act (HIPAA). HIPAA is an important law for protecting patient privacy. However, it can be an obstacle for caregivers.
"People are sometimes surprised to learn that companies like Blue Cross and Blue Shield of Georgia cannot readily disclose a person's health information, even to their own spouse or child," said Connolly. "That's why it's so critical for caregivers to file the proper paperwork with their loved one's health benefits provider."
Caregivers can access a loved one's health information in a number of ways. One way is with a "durable power of attorney," which can be established with the assistance of an attorney. Another way is with an "Authorization to Disclose Personal Health Information," which is available from a health benefits company. With the disclosure form, the member can authorize someone else to see their health care information, while specifying just how much information that person can see. Beneficiaries also can designate someone to participate on their behalf in Medicare appeals and grievances by filling out an "Appointment of Representative" form.
These forms are returned to the health benefits company where they are kept on file. When they are on file, designees can serve as the member's representative on health benefits, including determinations, exceptions, and appeals and grievances. Anybody can serve as a designee, including a family member or friend. However, the member can revoke these designations, in writing, whenever they see fit.
Enrolling in a Chronic Disease Program
Some Medicare beneficiaries suffer from chronic diseases, such as cancer, stroke, multiple sclerosis, dementia, diabetes, end stage renal disease or Alzheimer's disease. In fact, according to the Centers for Disease Control and Prevention, eight out of 10 Americans age 65 or older are living with some chronic illness. Those enrolled in a Medicare plan may have access to free programs to help them manage their diseases. Many times, these programs are administered by nurses or other licensed personnel. The goal is to help prevent acute episodes through better disease management. Many plans even follow-up with members after their hospitalization.
"These programs are above and beyond those offered by Original Medicare," Bowers explained. "It's important for caregivers to know about them and encourage their loved ones to participate. They may want to get a copy of a member's explanation of coverage from their insurer to find out what's available."
Knowing Your Rights
Once the disclosure/authorization paperwork has been filed, caregivers can speak to a customer care agent on a beneficiary's behalf as well as access the beneficiary's information online, including claims history, provider network and drug formularies.
If a beneficiary ever disagrees with any Medicare decision, including a denial, they have the right to appeal it. For more information about appeals, visit http://www.medicare.gov/ to get a free copy of "Your Rights and Protections."
Investigating 'Extra Help'
As a caregiver, it's also important to know about "extra help" that is available to low-income people with a Medicare prescription drug plan through the Social Security office. This "extra help" includes assistance with monthly prescription drug premiums, annual deductibles and prescription copayments. For information about eligibility for this program, go to www.socialsecurity.gov/extrahelp.
Even if your loved one doesn't qualify for extra help from Social Security, there are a myriad of other resources that might be available to them at the state and community levels. The Web site www.benefitscheckuprx.org has compiled information about these resources in one convenient online location. The site, which counts Blue Cross and Blue Shield of Georgia among its sponsors, tracks more than 1,550 benefit programs throughout all 50 states and the District of Columbia. It has identified more than $7.6 billion in benefits for those in need since being launched in 2001.
Caring for Yourself
The final tip for caregivers, and perhaps the most important, is for them to take care of themselves, including getting enough sleep, going for a walk, taking an occasional day off and maintaining a sense of humor. After all, caregivers can't possibly take care of anyone else until they first take care of themselves.
According to the Alzheimer's Association, research shows that caregivers face an increased risk of developing depression. It's natural to grieve about a loved one's disease. However, if sadness persists to the extent that it prevents decision making, interrupts daily living, and discourages participation in normal activities, then it may be time to get some help. Primary care physicians may offer help, including referrals to other resources. Caregivers with access to Employee Assistance Programs (EAP) can find them useful.
"Caregivers need to know that there's no shame in asking for help," said Connolly.
For more information about care giving and Medicare, including helpful forms, please visit www.medicare.gov/caregivers.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Monday, July 05, 2010
Statement from Secretary Sebelius on Proposed CMS Rule to Expand Medicare Preventive Services and Expand Access to Primary Care
On June 25, the Centers for Medicare & Medicaid Services (CMS) took another important step to help improve the health status of Medicare beneficiaries. The proposed regulation will implement the new preventive health benefits created under the Affordable Care Act for the seniors and persons with disabilities who rely on Medicare for their health care coverage.
The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.
To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.
Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.
With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
The new rule proposes to make two significant improvements to preventive care benefits under Medicare: Beginning January 1, 2011, Medicare will cover annual wellness visits so that doctors and patients can develop a personalized prevention plan that takes a comprehensive approach to improving the patient’s health. Also beginning January 1, 2011, Medicare beneficiaries will no longer have to pay any out-of-pocket costs for most preventive services – including that annual wellness visit.
To help make sure that Medicare beneficiaries have access to primary care doctors, the rule would also boost payments for primary care services. The proposed regulation would also increase access to services by creating payment incentives for general surgeons as well as expand access to other types of health care providers.
Improving access to preventive services and primary care is a top priority for HHS. The proposed rule is just one part of a broader effort we are making to improve the health status of Medicare beneficiaries – and all Americans. We recently announced the allocation of $500 million from the Prevention and Public Health Fund – created by the Affordable Care Act – to invest in the training and development of primary care professionals as well as preventive care activities and public health infrastructure.
With these new benefits under Medicare, and investments in our health care system, the Affordable Care Act is continuing the Obama Administration’s historic work to promote wellness and reduce chronic disease.
-----
www.fayettefrontpage.com
Fayette Front Page
www.georgiafrontpage.com
Georgia Front Page
Follow us on Twitter: @GAFrontPage
Subscribe to:
Posts (Atom)