As the Presidential race draws to a close most people have chosen which candidate they are going to support next Tuesday in the election. One of the main topics this election season has been health care, with Medicare being a heated topic. The candidates differ from how much the government should be involved, to where the funding should come from, and in the case of Medicare, at what age beneficiaries should become eligible.
With only a few days left, most of us are excited and anxious to see what the outcome will be. For sports fans, that result might come a little bit sooner. Since the 1984 election, the winner of the Alabama-LSU game has coincided with the party who has won the election. With Alabama’s wins aligned with the Democratic Party and LSU with the Republican. Obviously, statistics are made to be broken, but it still adds another element of intensity to the SEC game this weekend and gives friends and family something to speculate about.
Please give us your feedback!
Which candidate do you think has the better plan for Medicare? Do you think a voucher system is a good idea? If not, why? Do you think a state-controled program would better regulate the system? If not, what would?
(We realize this is a polarizing topic, please remember to be respectful of other commenters. Thank you.)
Medicare Blog | Medicare News | Medicare Information
As you are talking with seniors just aging into the Medicare market, it is important to advise them about the penalties they will pay if they do not sign up for Medicare Part B at the right time. For those seniors who have already filed for Social Security, they will automatically be enrolled in Medicare at age sixty-five. However, seniors who continue in the workforce, either by choice or necessity, and delay their Medicare coverage need to notify Medicare of their decision. Otherwise they will face a 10% Part B penalty for each year that they do not file. So someone filing for the first time at age seventy will face a 50% Part B penalty. The penalty is permanent and can translate into thousands of dollars in unnecessary penalty charges.
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The Center for Medicare and Medicaid Innovation (CMMI) launched a set of initiatives to improve medical care and lower the cost of services and care provided by medical professionals. The CMMI is also committed to quickly assessing the projects at hand and putting them to use promptly if proven successful. This initiative comes after finding evidence that the current healthcare system has rising costs because patients are not getting the care they need. Also, they found that one out of seven Medicare patients are suffering from medical error, due to lacks in care. With 90 million Americans relying on Medicare and Medicaid, studies show that when doctors work together patients are hospitalized less often, recover more quickly, and have fewer complications. The initiative also hopes to reduce hospital infection and help ensure seniors take the medications prescribed to them by their doctor in order to stabilize their condition and/or get well quicker. The CMMI believes that by giving financial incentives to doctors and hospitals who work together unnecessary tests will be eliminated and chronic health conditions treated before they become larger illnesses, and end up costing Medicare more money that could have been saved. The Center for Medicare and Medicaid Innovation is starting this new plan in eight states, comprised of: Maine, Rhode Island, New York, Pennsylvania, North Carolina, Michigan, and Minnesota. In these states, teams of doctors will work together in "medical homes" on patient care. Also, next year the Center for Medicare and Medicaid will offer $1 million dollar grants for states to develop programs to coordinate care between doctors and hospitals. Some critics dismiss the effort, saying the CMMI is aimlessly throwing ideas out, hoping one will work; yet, some big companies are eager to move with a partnership with the government.
Rivlin-Domenici Proposed Losses for Medicare
On Wednesday Rivlin-Domenici released their proposal to reduce the deficit and it is more generous than the proposal released last week by the Presidential Fiscal Commission. Their proposal places a cap on government Medicare spending for seniors with more of the cost burden on the senior's shoulders. The plan gives very little help from the government to purchase health insurance and a choice from either traditional fee-for-service or from private firms offering plans similar to how Medicare Advantage is today. The committee predicts more seniors will opt for private insurance due to cost. The plan also includes making higher co-payments for Medicare Part B, up to 35% from the current 25%, which would save Medicare $123 billion through 2018. Starting in 2018, a cap would be put in place to limit the increase in spending on Medicare beneficiaries to economic growth rate of 1% each year. The other major element of in the plan eliminates the tax exclusion for employer-provided insurance. Capping and eventually eliminating the tax exclusion for employer-sponsored insurance could slow health care costs from increasing and would raise $10 trillion. There are speculation on whether both parties would ever be able to agree on the plan as it was proposed this week, Democrats are against cuts in benefits and Republicans are against benefit cuts as well and the large increase of out-of-pocket costs.
Presidential Fiscal Commission Update
On Thursday, the Presidential Fiscal Commission ended a three-day closed session without a consensus. The panel's co-chairmen, Democrat Erskine Bowles and former Senator Republican Alan Simpson released their own proposal last week but the group remains at odds on deciding how to slow down and eliminate some health care cost. The panel reconvenes on November 30th, with a deadline to submit to Congress on December 1st.
Nebraska Woodmen of the World/Assured Life New Rates and Plan N
Sources: KHN, The Fiscal Times, The LA Times, PBS, WSJ
Kaiser Health News in collaboration with The Washington Post published a very interesting article focusing on how more and more Medicare beneficiaries are finding they are not being classified as “admitted - inpatient” when staying at a hospital. Instead, they are being classified as “under observation.” Though the level of care doesn’t vary between either classification, the latter means Medicare beneficiaries will have to pay significantly more out-of-pocket for their total care.
One example given in the article is about Ed Timmins (88) who spent four days in the hospital for extreme back pain and other issues. The whole time he was never admitted, so Medicare isn’t going to cover his $23,864 nursing home bill. The hospital where he received treatment would not discuss his case, but implied that he did not meet Medicare’s “medical necessity” requirement to be in an inpatient status.
According to the Centers for Medicare and Medicaid Services, claims from hospitals for observation care have increased over the last several years. Observation care claims rose from 828,000 in 2006 to more than 1.1 million in 2009. Additionally, observation care claims regarding stays more than two days tripled to 83,183. The article states several reasons for the increase, but focuses on the fact that Medicare is being more aggressive in their audits in order to reduce costs. Click here to read the full article. Also, you may want to forward this useful link to your clients that explains what to do if they are classified as “under observation.”
Selling More with Jeffrey Gitomer
This month’s issue of InsuranceNewsNet has an in-depth interview with Jeffrey Gitomer who wrote The Sales Bible. Here is a list what he believes insurance agents should and should not do to increase their sales.
Google Implements New “Instant” Feature
Since many of you are beginning to utilize search engine optimization as a method of attracting more customers to your business, you will want to know that on Wednesday, Google implemented a new feature they call “Google Instant.” This feature automatically attempts to complete your search terms as you type them. As you are typing Google starts to stream results. These results change dynamically as you further refine your search term. Google says this new feature will reduce search times by two to five seconds. The change will also have a significant impact on SEO strategy. Now you will want to start optimizing for search terms that Google automatically generates. Also, this feature appears to only be available on the most recent browsers, so if you are still using older browsers such as IE 6 or 7, you’ll need to upgrade to use this new feature.
Sources: KHN, Washington Post, InsuranceNewsNet, ComputerWorld
On Thursday, President Obama signed a bill that mandates federal departments and agencies to reduce misspending. In fiscal year 2009, the federal government doled out nearly $110 billion in improper payments, mostly due to Medicare and Medicaid fraud. The Improper Payments Elimination and Recovery Act also stipulates agencies to invest at least $1 million in audits to identify likely overpayments, and to create processes to reduce such improper payments and establish penalties for government organizations that fail to comply with the new law.
Denials of Insurance Claims Easier to Fight
The Obama administration issued new rules regarding health care reform. The new rules guarantee the right for all Americans to appeal denials of insurance claims, first with their insurance company, and then to a third-party review board if required. Many states already have similar laws in place, however the rules differ greatly. Now the rules will be standard across the United States. The new rules aim to empower consumers when appealing insurance claims that are denied. America’s Health Insurance Plans (AHIP) spokesman Robert Zirkelbach said that his organization supports the standardization of the appeals process. The Obama administration is also providing $30 million in grants to improve state consumer assistance offices. States have until July 2011 to comply.
$251 Million Medicare Fraud Ring in 5 Cities Busted
Last Friday, Federal law enforcement officials announced the arrests of dozens of suspects in five states for defrauding Medicare of $251 million. The suspects, including several doctors and nurses, were apprehended in Miami, New York, Detroit, Houston, and Baton Rouge. 94 suspects were indicted, with 36 being arrested for billing Medicare for unnecessary equipment, and H.I.V and physical therapy treatments that were never conducted. The New York Times reported that violent criminals and mobster were getting into the action, as they viewed Medicare fraud as more lucrative and less risky than dealing drugs and fire arms.
Part D Increases Use of Heart Failure Medication
Reuters reported on a recent study of 7,000 older heart failure patients in one large insurance plan released by the American Heart Journal. The study found that the number of filled prescriptions for heart failure drugs soared after Part D took effect in 2006. Low-income seniors who never had previous drug coverage saw the biggest increase in filled prescriptions. Reuters states that the findings, among other cited in the article, substantiate arguments the goal of the law is being met.
On Wednesday, Dr. Donald Berwick was chosen by President Obama to head the Centers for Medicare and Medicaid Services (CMS). Dr. Donald Berwick is a Harvard Medical School professor and president of the Institute for Health Care Improvement (IHCI). The recess appointment by President Obama ends a four-year period without an official director for CMS. It also allows President Obama and Dr. Berwick to avoid the normal nomination process that would have entailed an onslaught of questions from Republicans.
According to the Boston Globe, “appointments made during official congressional breaks do not require a vote.” President Obama took further advantage of the break by appointing two other director positions for other government agencies. Of course, Republicans are expressing their outrage at what they believe is an exploitation of the political process. According to The Hill, Republicans are questioning Dr. Berwick’s industry ties, as his IHCI organization received millions in gifts from undisclosed donors in 2009.
Second Round of Doughnut Hole Checks Sent to Seniors
Over 300,000 seniors will get a $250 check from the government to help close the Medicare prescription drug coverage gap known as the “doughnut hole.” This second round of checks is going to seniors who entered the coverage gap between April and June and were not able to receive low-income subsidies. The first batch of 80,000 checks was sent in June and according to a Department of Health and Human Services press release, “About 70 percent of the checks were cashed within a week.” The checks are a result of the agreement between Congress and the pharmaceutical industry to close the “doughnut hole.”
Health Affairs Releases Brief on Medicare Doc Reimbursement Issue
Health Affairs released an excellent document analyzing the Medicare Doctor reimbursement issue. The document looks at the history of the issue, as well as the current situation. The most interesting parts however, are the forecasts it makes and the options it identifies. One statement made in the report is especially eye catching. The report states that if Medicare rates are frozen through 2014, it could add $89 billion to the federal deficit. We highly recommend reading the report if you are interested in learning more about the issue. You can view the document here.
Sources: KHN, Boston Globe, New York Times, The Hill
According to a study published in PLoS Medicine, the government’s plan to implement a pay-for-performance system for Medicare would lead to greater inequality among hospitals in rich and poor areas. The study analyzed 2,700 hospitals from 2004 to 2007. Each hospital was assigned a baseline score based on a number of factors in accordance to the system the government is planning to use. The report found that hospitals in richer areas received better baseline scores than those in more disadvantaged areas. The report concluded that in general, hospitals’ performance increased over time with a pay-for-performance system, but the benefits and level of performance increases were much smaller for hospitals in disadvantaged areas.
New National Health Insurance Website Goes Live
If you haven’t already heard, you may be interested in knowing that the Health and Human Services Department has launched HealthCare.gov that offers consumers a central place to learn about all their insurance coverage options. HHS Secretary Kathleen Sebelius announced yesterday that this site is the first central database of health coverage options, including Medicare, Medicaid, and the Children’s Health Insurance Program. It also includes information from plan information from private insurance carries for small businesses and individuals. According to HHS, the new website offers billions of health care choices through its finder function. Check it out here.
SEC Investigates Major Home-Health Companies for Medicare Fraud
Amedisys, Inc., the largest U.S. home-nursing provider, and Almost Family, Inc., the fourth-largest, both recently announced that they are under investigation by the SEC. In May, following a Wall Street Journal article that identified irregular reimbursement patterns, the U.S. Senate Finance Committee said it was analyzing whether the home-nursing industry manipulated the number of visits made to patients to inflate government reimbursement payments. According to Businessweek, the recent announcements signal that the analysis is expanding and may even include more companies. With the announcements, most publicly traded home-health companies are seeing the value of their stock significantly decline.
Sources: KHN, NPR, Businessweek, Wall Street Journal, PLoS Medicine
A The Henry J. Kaiser Family Foundation released a report that provides an analysis of Medicare Advantage enrollment trends among HMOs, PPOs, and PFFS plans. The report highlights that 11.1 million people were enrolled in private Medicare Advantage plans as of March 2010. This is an increase from 10.5 million in March 2009. The report showed that this increase took place despite a reduction of available plans throughout that same period.
Medicare Doc Pay Cuts Expected to be Delayed Today
Last night, the House of Representatives voted 417-1 to approve a Senate bill that delays a 21% cut in Medicare payments to doctors. The bill delays the cuts another six months. Lawmakers will work on a more permanent solution in that time, but if history is any indication, a permanent solution isn’t coming anytime soon. Obama has expressed his approval of the bill and is planning to sign it into law today.
Medicare and Medicaid Implements New Fraud Mapping Tool
The Centers for Medicare & Medicaid Services (CMS) implemented a new fraud mapping tool that will eventually be used throughout all government agencies. The fraud mapping tool was developed by the Recovery Accountability and Transparency Board to collect massive amounts of information in real time, analyze the data for fraud trends, and then project possible fraud or errors using an array of indicators. This new tool comes on top of the “Do Not Pay” list created last week. Both methods aim to achieve President Obama’s goal of cutting improper Medicare payments in half by 2012.
Sentinel Life Medicare Supplement Plan N Approved in CA, IA, and LA
Sentinel Life Medicare Supplement Plan N has been approved for Louisiana, Iowa, and California. Each of these plans offer competitive rates and generous commissions. To learn more about these products click here.
Sources: AP, NPR, KFF, KHN
Tags: senior market blog, senior market news, Medicare Advantage, Medicare Supplement, Medicare Discussion, Medicare News, senior insurance market news, Medicare Advantage News, Medicare Sales, Medicare Advice, Medicare Solutions
As part of a series of government spending cuts, President Obama today will announce that all federal agencies must create a national “do not pay list.” The goal of this list is to reduce the likelihood and impact of fraud. The list will identify people and organizations whom are ineligible to receive government benefits, contracts, grants, and loans. The Treasury Department, General Services Administration, and Office of Management and Budget will work together to create a database of dead people, delinquent or jailed contractors, and other debarred or suspended firms.
Still No Medicare Doc Pay Fix
Recent Modernized Medicare Supplement Approvals
For a list of plans in your state, see our modernized med supp approval chart.
Sources: Washington Post, Federal Times, AP