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Medicare Blog | Medicare News | Medicare Information

Medicare - Readmission rates under the scope

Posted by Guadalupe Cantu on Fri, Aug 09, 2013 @ 09:00 AM

Medicare Supplements Patient readmission back into the hospital within a month of discharge has been a common occurrence and has driven up the cost of care for insurers and patients alike for many years.

Medicare has taken noticed of the practice and, for the second year, has penalized hospitals with excessive patience remittance of 30 days or less. This has been Medicare’s strongest effort to reduce the costly readmission rates.

About two-thirds of the hospitals penalized were eligible for Medicare payments. These hospitals were fined in the form of lower readmission payments. This translates to hospitals losing $227 million to the Medicare program that began in October, according to Kaiser Health News.

To lower cost, Medicare has also undertaken a two-pronged approach, focusing on both the research and payment side. Under the Independence at Home Demonstration, which is made up of 15 independent practices and 3 consortia, Medicare has designed this program to identify new processes and policies with hospitals to reduce the monthly readmission rates. While on the payment side, they are aggressively cutting the reimbursement payments to the penalized hospitals.

The numbers in hospital penalties averaged so slightly between both years. In round one 1,371 fines were given. In round two, 1,074 repeat penalties were re-issued and 283 new penalties that had gone unnoticed last year were added to the roster this year.

Furthermore, hospitals that were less likely to be fined were those treating the fewest numbers of impoverished or lower income patience.


Please give us your feedback!
Do you think Medicare’s penalizing hospitals for readmission rates will help bring down the cost in the long run? Should all healthcare providers, who are not participating, follow suit?

 

Source: LifeHealthPro

Additional Updates:
  • Combined Insurance: Low rates Med Supp Plan F, with 24% Commision in most states - Learn More

Tags: Health Insurance, Medicare, senior insurance market news, Patient readmission, Readmission rates

Medicare spending at its lowest in 50 years

Posted by Guadalupe Cantu on Fri, Aug 02, 2013 @ 09:32 AM

Medicare Supplements In 2014, Medicare Part D premiums will reach $31, an increase from the past 3 years of $30. By 2014, Part D deductible will fall to $310 from the current $325.

When the Medicare Part D program began, there was a lot of concern the cost of the program would go up. Instead, the program has had the opposite effect and the cost has been kept low. Much of it is due to the strong competition and bidding parocess from the participating private insurers, according to Jonathan Blum, deputy administrator and director for the Center of Medicare.

Medicare has saved more than 6.6 million people, more than $7 billion on prescription drugs, and averaging $1,061 per beneficiary.

This is largely due to the government reaching out to pharmaceutical industry and bargaining for drug discounts. In order to participate in the 2013 Medicare program, the pharmaceutical industry agreed to a 52.5% discount on name brand drugs and 21% on generic ones. This savings has been passed on to the seniors. However, higher spending could be triggered for discounted premium drugs, cautioned the governments Medicare watchdog.

In March, The Medicare Payment Advisory Commission reported that Medicare's reinsurance payments are the fastest-growing component of Part D spending. Hence, the higher-cost and demand for specialty brand drugs for cancer treatment, which are not available on generic brands. These name brand drugs add to the cost of the reinsurance cost of the Part D program. However the gap that begins when a person’s Part D Coverage reaches $2,970 will close by 2020.

Blum also assured that seniors who reach the gap will ultimately benefit from the program because when the patient takes their medication, they will likely be healthier and may not require hospitalization.


Please give us your feedback!
What do you think of Medicare Part D program? Should there be a concern of seniors over spending on brand name drugs?

 

Source: LifeHealthPro

Additional Updates:
  • UnitedHealthCare: Pre-order 2014 materials - Learn More
  • NEW Cash for Apps Program in Texas - Learn More

Tags: Health Insurance, Medicare, senior insurance market news, Medicare Part D, Mutual of Omaha Medicare Supplement, UnitedHealthcare

The HHS Agrees with the NAIC on Cost Sharing

Posted by Lauren Hidalgo on Fri, Jun 28, 2013 @ 09:09 AM

Medicare Supplements The U.S. Department of Health and Human Services (HHS) has taken the National Association of Insurance Commissioners (NAIC)'s advice not to impose a nominal cost sharing in Medicare Supplement insurance Parts C and F. Kathlee Sebelius, a former NAIC president herself, wrote in a letter to current NAIC President Jim Donelon "I value the NAIC's expertise on Medigap and other health insurance issues and the strong partnership between NAIC and the U.S. Department of Health and Human Services. This partnership has been instrumental in the effective implementation of numerous provisions of the Affordable Care Act."

The HHS had requested under PPACA that the NAIC revise the NAIC Medicare supplement insurance model to include a nominal cost sharing in Medigap Plans C and F to encourage the use of appropriate physician's services under Medicare Part B.

However, last December, the NAIC recommended against this nominal cost sharing and did not revise the standard benefit packages for these model plans. Besides studying the issue, the NAIC communicated caution with proceeding with nominal Medigap cost sharing because it could delay treatments that people really need. This would make the more vulnerable populations worse off in the long run with costly hospitalizations and emergency room visits. Also, when referencing the changes to Medigap's plan offerings that started in 2010, the NAIC stated "We are still learning the impact of these new offerings on both the Medigap market and to the Medicare program."

Despite the HHS agreeing to not go forward with these changes, the Medicare Trustee report has projected that the trust fund that finances Medicare's hospital insurance coverage will stay solvent until 2026, which is two years longer than it was projected last year. Additionally, Medicare Part B and Medicare Part D are both projected to remain funded into the foreseeable future because current law automatically provides financing each year to meet the next year's expected costs.


Please give us your feedback!
Are you glad the HHS has taken the NAIC's advice not the impose nomial cost sharing? Are you surprised by the decision or were you expecting it?

 

Source: LifeHealthPro

Additional Updates:

Tags: Medicare News, senior insurance market news, health care reform, Stonebridge Medicare Supplement

Upholding the Health Care Law and its Effect on Medicare

Posted by Lauren Hidalgo on Fri, Jun 29, 2012 @ 10:54 AM

Medicare SupplementsThursday the Supreme Court upheld the entire proposed health care law, concluding that Congress was acting within its powers under the Constitution to require most Americans carry a health insurance policy. This ruling is considered a victory for President Obama and the Democratic Party, passing the biggest reworking of the health care system since Medicare was introduced in the 1960s. This ruling also eliminates disruptions for hospitals, doctors, and employers who have spent the last two years preparing for the law to be put into place.

How has the Patient Protection and Affordable Care Act affected the senior market since its inception in 2010 and how does Health Care Reform impact the future of Medicare Supplements?

  1. Modernized Medicare Supplement plans, including new Plans M and N, created new opportunities for agents to sell more economical options for coverage.

  2. New carriers entering the market are providing more choice for consumers. The added competition is healthy and promotes new innovations to the market, including telephone and electronic applications, which can help reduce pending requirements and speed up issue time.

  3. Many employers are reconsidering if, or for how long, they should offer group coverage for their retired workers due to Taxation of the Retiree Drug Subsidy (RDS) effective January 1, 2013. This tax can affect large company’s bottom line by tens and hundreds of millions and many have already started transitioning from group to individual coverage using a Medicare Coordinator model.

  4. Deficit reduction talks have the politicians from both parties talking about ways to save money with Medicare. One suggestion is to add copayments to all Medicare Supplement plans, not just Plans M & N. Another proposal suggests charging up to a 20% tax on seniors choosing plans with First Dollar Coverage.

Other important things to note pertaining to the senior market is that from now until 2020 the “donut hole” is still in effect, with seniors receiving a 50% discount on covered brand name drugs; and, Medicare Advantage will continue with payment system reforms laid out in the ACA.

However, the debate is far from over. With the January 1, 2014 date of implementation and a Presidential election looming, there is certain to be several repeals and proposals before the final version of the health care law is agreed upon and actually goes into effect.

As an agent in the Medicare Supplement market, don’t worry. Medigap plans are the least impacted by health care reform so no big changes are on the horizon. Reduction in Medicare Advantage payment rates and the impact this will have on plan benefits appears to be the biggest unknown. For clients looking to avoid any unforeseen surprises, Medicare Supplements still appear to be the best solution for many of your clients.


Please give us your feedback!
What is your take on the health care law being upheld? How do you think it will affect senior market insurance and Medicare Supplements?

Source: Red Pen Edition, Wall Street Journal, Healthcare.gov

Additional Updates:
  • Omaha Insurance Company Med Supp Now Available in Ohio - Learn More
  • Increase Your Med Supp Sales with Combined Insurance - Learn More
  • PSM Partners with Norvax to Provide Essential Sales Tools for Today’s Independent Agent - Learn More

Tags: senior insurance market news, health insurance news, Combined Insurance Medicare Supplement, health care reform, industry news, Omaha Insurance Company

Med Supp Policyholder Satisfaction Up

Posted by Lauren Hidalgo on Fri, Jun 22, 2012 @ 10:13 AM

Medicare SupplementsA recent study by America's Health Insurance Plans (AHIP) commissioned by American Viewpoint, Inc. concluded that there is a high rate of Medicare Supplement policyholder satisfaction (90% of those polled), comparable to the survey results in 2009 (91%) and 2005 (87%). The survey asked Medigap enrollees about both their satisfaction and experience with their coverage. Medicare Supplement coverage continues to be an important option to Medicare beneficiaries and their survey concluded:

  • Nine out of ten (90%) Med Supp policyholders are satisfied with their coverage.

  • Over half of enrollees (79%) say their Med Supp policy is excellent or good value for the money.

  • Just over nine out of ten (91%) would recommend a Med Supp plan to a friend or relative who they become eligible for Medicare benefits.

  • Policyholders highlighted several benefits when asked what they liked most about their coverage, including limits on out-of-pocket costs, ease of dealing with medical bills and paperwork, and being able to budget for unexpected medical costs.

  • Enrollees also appreciated their freedom of choice for doctors, and that their plan covered hospital expenses and physician costs not covered by traditional Medicare.

  • Top concerns Medicare beneficiaries had were out-of-pocked loss, maintaining financial security and peace of mind.

The study also showed that enrollment in Medigap is stable with 49% of those polled having maintained the same coverage for the past five years, and an additional 20% purchased for the first time during the five year period. Of those polled, 39% transferred from their Employer-sponsored coverage when they became eligible, and 34% switched from another form of coverage.

With client satisfaction up, the Boomer generation aging into the market, and great new products like Combined Insurance, Stonebridge Life, and Heartland National becoming available in new areas, now is a great time to be selling Medicare Supplements. Feel free to call a marketer at 1-800-998-7715 for advice on finding a target niche and what new products would fit into your portfolio.


Please give us your feedback!
Have you seen an increase in client satisfaction? What percent of your clients have maintained the same policy for 5 years? Is that as common as the survey results make it seem?

Source: ProtectMedigap.org

Additional Updates:
  • PSM Partners with Norvax to Provide Essential Sales Tools for Today’s Independent Agent - Learn More
  • Heartland National Med Supp New Telephone Application - Learn More
  • Attention Heartland Agents: Important New Business Processing Changes - Learn More
  • New! Combined Insurance Medicare Supplement - Learn More

Tags: Medicare News, senior insurance market news, health insurance industry, insurance news, Heartland National Medicare Supplement, Combined Insurance Medicare Supplement

Google +1's Impact on Your Business

Posted by Lauren Hidalgo on Fri, Aug 26, 2011 @ 09:28 AM

Medicare SupplementsA few months ago, Google introduced their +1 system; you might have seen the new buttons appear next to your search results recently and wondered what it is and how it can help your business. Google +1 is similar to Facebook "Likes", it is a way for your clients to publicly show to their friends and family that they like and recommend you, which can help promote client referrals.

Also, there are signs that Google +1 will affect organic rankings as well. Google +1 allows Google to own a primary source of data, not rely on secondary sources, and these social cues become a core part of the search experience. Websites with a +1 button receive as much as three times more exposure on the Google+ network.

If you’re one of our valued senior market agents and enjoy working with Precision Senior Marketing, let us know by logging into your Gmail account and clicking the +1 button on our homepage @ Precision Senior Marketing.
Precision Senior Marketing

Example of how Google’s +1 feature can help your business:
A friend of your client might search for Medicare Supplements in your hometown, see that their friend +1'd you, and give you a call or fill out the form on your website because of it. Same can happen between complete strangers, as trust will be instilled by knowing that other people have used your service and have seen success with your brand. Once you have a working relationship with your clients, it would be beneficial to ask them to go to your website and click “+1” for you. It’s an innovative way to continue to grow your business online.

Please give us your feedback!
Do you have the Google +1 button on your website? Do you plan to get it? How do you think the +1s will affect Google organic rankings?

Source: Search Engine Watch

Additional Updates:
  • Forethought Medicare Select Released in OK - Learn More
  • Cigna 2012 Training and Certification - Learn More
  • Assured Life Medicare Supplement Rate Increase for Mississippi - Learn More
  • Universal American Med Advantage 2012 Product Maps and Overviews - Learn More
  • Gerber Life Medicare Supplement Rate Increase for MI, MS, NC, NE, and WV - Learn More

Tags: Universal American Medicare Supplement, Success Tips, Web Tips, technology, Medicare Advantage, senior insurance market news, Leads, Forethought Medicare Supplement, industry news, Gerber Life Medicare Supplement

Health Care Law Continued Disputes

Posted by Lauren Hidalgo on Fri, Jan 21, 2011 @ 11:32 AM

Medicare SupplementsThe healthcare dispute restarted this week in Congress with a two day debate. Two minute speeches by both Republicans and Democrats were given, explaining where they and their party stand with the Health Care Law and the repercussions such law could have on the physicians, patients, and the American deficit. Republicans argue it will eliminate 1.6 million jobs and Democrats say it will create jobs. However, both are correct possibilities, some jobs might be eliminated by employers fearing high insurance costs; at the same time, other people will be hired to run the new health care programs. Another dispute is the national debt, which Republicans argue will create more national debt and the Democrats say the health care laws will reduce the deficit by $230 billion in the next 10 years. With the deficit, the truth lies in whether Congress can control Medicare and Medicaid spending, which could lead to lower physician payments and healthcare provider restrictions. The Republican’s strongest argument is that by insuring those who are currently uninsured will be too costly for some small businesses and taxpayers; whereas, the Democrat’s strongest argument is consumer protections, like keeping children on their parent’s insurance until they are 26.

On Wednesday the House voted to repeal the Democrats’ health care overhaul. The Senate has reported they will not act on the repeal, effectively destroying it. In the meantime, House Republicans are working on a “repeal and replace” strategy to control health care costs and expand coverage.

What do you think are the strongest arguments for or against the Health Care Law? When do you think House and Congress will come to a consensus?

Brian Tracy’s Laws of Sales Success

Brian Tracy, author of Psychology of Selling, which has become a bestselling audio program on sales, was interviewed by Paul Feldman for the January 2011 issue of InsuranceNewsNet. In the interview Brian Tracy shares his how-to’s of improving your business and your life. Tracy first states that time management separates winners in the sales market from losers. When you get more done, make more calls, and close more business you are deliberately managing your time. His tips are to plan your day in advance, prioritize your list, choose the most important task, and start the most important task and work until it is complete. This will give you a sense of personal accomplishment, self-esteem, and self-confidence.

Brian Tracy also explains his Law of Sales, stating that nothing happens in sales until the sale takes place. He encourages people in sales to manage the sequence of events and use the law of three. There are three things you do every day, no matter what your job is, that counts for 90% of your income. The key is to determine your three. He suggests making a list of everything you do in your day and then asking yourself if you could only do one thing on your list, which would contribute most to your income. Then complete the process twice more with the same question. He then explains that the most important tasks should be one key task and two support tasks, prospecting, presenting, and closing. Once you get good at those three you will be headed to success.

According to Brian Tracy, reverse engineering by starting with the end in mind and figuring out who is the ideal client, niche audience, and then focusing on learning about them is another key to sales. As is the art of closing and identifying the pain the person has and the benefit of your product. Tracy says to give examples of people's success from you and how it benefited them; or, give examples of someone who didn't and what happened to them. He states that either a positive or negative story works. This personalizes the experience and makes clients more interested in purchasing from you.

Lastly, Brian Tracy suggests you never stop studying and says two hours a day is best. He compares sales to an athlete. If an athlete decides to not work out, how long would they continue to be competitive? Additionally, if they lose a year of working out and then go back, they are years behind their competitors. People in sales need to continue to work out your mind in order to stay ahead of their competition.

Have you heard of Brian Tracy? Have you ever attended one of his seminars or read any of his books?

Woodmen of the World Released in Colorado

Effective January 19, 2011 please see the new release notification, rates, and application for Colorado.

Mutual of Omaha 2012 Convention Information

Mutual of Omaha 2012 Convention Information

Details released for the Mutual of Omaha 2012 convention in Laguna Beach, CA based on the business you place with Mutual of Omaha as a Broker Producer (personal production only) between January 1 and December 31 2011. See the Mutual of Omaha2012 convention website for more information.

 

Sources: KHN, LA Times, NY Times, InsuranceNewsNet

Tags: Sales Tips, senior insurance market news, Woodmen of the World Medicare Supplement, health care reform, Mutual of Omaha Medicare Supplement

Under-Age Agents Affected by Health Care Reform

Posted by Lauren Hidalgo on Fri, Jan 14, 2011 @ 09:32 AM

Medicare SupplementsAs part of the new health care reform law that went into effect January 1st, a Medical Loss Ratio (MLR) was instituted stating insurance companies must spend at least 80% of premiums on medical expenses in the under-age market, with the remaining 20% being shared with administrative costs. These new health reform rules will cut insurance brokers’ pay by 50% in some cases, effecting nearly 470,000 under-age market agents. Reports show commissions will drop from 15 to 20% on plans to 4 to 10%; and, for Blue Cross which used to pay 15% on the first year and 7% on residuals the following years will now pay 5% for both. Meanwhile, Golden Rule, owned by UnitedHealthCare is offering their brokers a per application bonus, understanding the cuts in commissions. By 2014, even without the MLR regulations, consumers will be able to find and obtain health insurance plans easily on their own. Under new health care regulations insurance agents, negotiating rates for those with pre-existing conditions, will be unnecessary. Health insurance companies will no longer be able to deny coverage based on conditions; therefore, making under-age insurance agent less and less vital for sales. Also in 2014, almost 32 million Americans will have insurance under the health care laws and MLR will negatively impact the way the public uses health care, with potential job loss due to lower commissions at a time when consumers need the most help because of all the changes. Critics argue smaller companies may go out of business, agents will see more cuts in compensation, and there will be reduced service quality to the consumer. Supporters say that industries are always changing and compare the change in the insurance industry to that of travel agents. Even though a lot of people buy their travel arrangements unassisted online there is still need for a travel agent. Now under-age insurance agents will just have to find their niche in the new insurance environment.

If you also work in the under-age market, have these lower commissions already affected you? Do you believe the result of MLR will be a drastic decline in service or do you think things will level off quickly, like with the travel industry?

Low Clearance by Mike Keefe

Low Clear by Mike Keefe for Denver Post
By Mike Keefe for The Denver Post, 01/06/11

With the Baby Boomer generation turning 65 this year and nearly 10,000 American’s a day qualifying for Medicare benefits- now is a great time to be a senior market agent selling Medicare Supplements.

Has the influx of Boomers helped your Medicare Supplement business? How are you preparing for the boost in those interested in Medicare Supplements?

Medicare "Wellness Visit" Check List

As of the first of 2011 Medicare beneficiaries are able to go to one “wellness visit” a year completely covered by Medicare. This new part of the health care law reflects that medicine needs to focus on prevention rather than waiting until the patient is sick. Dr. Eddie Phillips, director of the Institute of Lifestyle Medicine at Spaulding Rehabilitation Hospital, has outlined what patients can expect at their wellness visit this year. First, the doctor will conduct a screening of a patient’s cognitive skills, depression, and risk of falling. They will develop a Personalized Prevention Plan talking about your diet, exercise, vaccinations, sleep, and stress; and, work to coordinate all of you caregivers. Also, you can choose to have a voluntary discussion of your end-of-life choices, getting a plan in place and having your wishes known. Dr. Phillips hopes this wellness visit will help people make lifestyle choices that will positively affect their health and health care costs.

What do you think of the new “wellness visit” provided by Medicare? Have either you or one of your clients partaken of yours this year? Was it a valuable benefit?

Foresters Prepared Accident Death Term Life Insurance

Foresters Prepared offers up to $300,000 in coverage with no medical exam and only a few health/lifestyle questions. It also offers extra-cost riders for disability income (accident only), waiver of premium (accident only) and return of premium. Contact PSM or call us 1-800-998-7715 to request information.

Woodmen of the World/Assured Life MADP Guidelines and Iowa Rate Increase Notification

New Medicare Advantage Disenrollment Period (MADP): MA members are allowed to make one change during this period of January 1, 2011 to February 14, 2011 with an effective date of disenrollment after January 1, 2011.

Effective March 1, 2011 please see the rate increase notification for Iowa.

 

Sources: KHN, Politico, The Denver Post, CommonHealth

Tags: Foresters, Medicare Supplement, Senior Market, senior insurance market news, health insurance industry, insurance news, Woodmen of the World Medicare Supplement, Medicare Advice

Debt Reduction Plan Likely to Fall Short on Votes

Posted by Lauren Hidalgo on Fri, Dec 03, 2010 @ 10:25 AM

Medicare SupplementsPresident Obama’s National Commission on Fiscal Responsibility and Reform, which began in February, drew more support than previously thought and many say it will be seen as a blueprint for future actions on how to deal with the aging American population and the rise of health care. Ten of the eighteen members of the commission are in support of the plan; however, five have said publically and one privately that they will not vote for it. The commission needs fourteen votes to bring to Congress to vote. Also, the commission split on votes shows a divide in Congressional Republicans, with Senate Republicans planning on voting yes while the House Republicans planning to vote no. This can be seen as a reflection of Republicans taking over the House of Representatives after the election, while they still remain a minority in the Senate. House Republicans just elected in also feel an obligation to turn their political platform during the election into policy immediately. The National Commission on Fiscal Responsibility and Reform votes today, Friday December 3, 2010 and the plan overhauls the tax code, federal health programs, and Social Security.

The High Price for Retirement Health Care

OResearch from the nonpartisan Employee Benefit Research Institute (EBRI) shows that sixty-five year olds who retire this year need to have saved more than $100,000 to cover their out-of-pocket health care costs including co-pays, premiums, and other non-reimbursed medical expenses while on Medicare. The researchers also revealed that costs are likely to be more for women (approximately $152,000) than men (approximately $124,000), since women tend to live longer than their male counterparts. Researchers believe that the health care reform bill will help cut some of those costs; however, the costs will remain high for expenses from the retiree. The EBRI research warns that Americans should be setting aside money for this expense and that four in ten Americans plan to delay retirement because of high costs and low income.

Civil Right to Live at Home

The right to live at home has been established in law and federal policy, based on the Americans with Disabilities Act (ADA) which bans the discrimination on the basis of disability. Yet states are slow to create new programs to allow people who live in institutions such as nursing homes and state hospitals, but can live successfully on their own, do so. With states facing record budget cuts, and the federal policy being written for states to do home care within their existing budgets, Medicaid directors are nervous about the new policy that living at home is a civil right questioning where state responsibility ends and individual responsibility starts. Directors also question how they can assure people get good care at home, as sending inspectors to thousands of homes is way more involved than sending to a few nursing homes. Still, nearly 400,000 Americans are currently on the waiting list across the country hoping to have the choice to live at home and receive care.

Gerber Life Medicare Supplement New Rates for MD, CO, MO, and NH

Effective December 1, 2010 new rates for Maryland – please see the MD Notification and MD Rates.

Effective December 15, 2010 new rates for Colorado and Missouri – please see the CO Notification, CO Rates, MO Notification, and MO Rates.

Effective January 1, 2011 new rates for New Hampshire – please see the NH Notification and NH Rates.

New Deductibles for 2011 Now Available

Marketing materials that reflect the new 2011 deductibles are now available. Please consult your marketing director for more information. Or, call 1-800-998-7715 to get contracted for 2011 today!

Sources: KHN, The New York Times, MSNBC, The Hill, NPR

Tags: senior market news, Medicare Supplement, Senior Market, senior insurance market news, health care reform, Gerber Life Medicare Supplement, Medicaid

Medicare's Largest Single-Operation Fraud

Posted by Lauren Hidalgo on Fri, Oct 15, 2010 @ 10:13 AM

Medicare SupplementsThe largest single operation fraud in Medicare's history was lead by an Armenian crime boss, called a "vor," named Armen Kazarian where fake health care clinics and identity theft were used to cheat Medicare out of $163 million. Compared to a fraud franchise, Armen Kazarian and his co-conspirators are currently in custody and charged with racketeering conspiracy, bank fraud, money laundering, and identity theft. The investigation began when 2,900 Medicare patients in New York reported their information stolen; and, it was later discovered that the defendants had also stolen the identities of over 100 doctors in 25 states. The defendants created false clinics and phony paperwork that had doctors performing procedures outside of their specialties, raising flags. However unlike previous scams by others, when patients were bribed to sign up for procedures they did not need, these scams never directly involved patients or doctors. They were the result of stolen identities and false paper work; and, in New York alone, $100 million in fraudulent bills were submitted and Medicare paid out approximately $35 million to the scammers.

Medicare Cuts Costs of Medical Equipment

On January 1, 2011 the first of the baby boomer generation will begin qualifying for Medicare. In preparation of this sergeant of new people claiming benefits, Medicare will begin cutting the prices it will pay for some wheelchairs, oxygen concentrators, and other medical equipment by 30%. Beginning in the Inland Empire of California; as well as, Miami, Orlando, Charlotte, Pittsburgh, Cincinnati, Cleveland, Dallas-Fort Worth, and Kansas City, MO, this plan will not only lower the cost for American taxpayers but the Medicare recipient as well, with anticipated savings of $17 billion over the next 10 years. Counteracting the huge increase of health costs, the new plan will require companies to bid for the right to sell this medical equipment through Medicare in order to combat inflated prices and fraud. Bidding began last year, the list of winners will be released soon, and Medicare officials say the plan includes 48% small business. However, critics point out problems with this plan such as lack of binding commitments, the use of composite bids, flawed pricing, and a lack of transparency. Also, the critics fear that product supply and service will go down with the influx of new business. Some even wonder if the plan will really launch January 1st.

Medicare and Advanced Cancer

In a study conducted by Camelia S. Sima, M.D., M.S., of Memorial Sloan-Kettering Cancer Center, New York on 87,736 Medicare beneficiaries with advanced cancer, her findings revealed that screenings on advanced cancer patients with less than 2 years life expectancy serves no meaningful benefit. Thus, her study suggests Medicare deny coverage for those patient's screenings. Cancer screening's primary purpose is the early detection of cancer, and this process has resulted in the decline in deaths from cancer. However, in advanced cancer, screenings can lead to over diagnosis and causing unnecessary risk due to testing, biopsies, not to mention psychological distress. The study found that screenings were more common with patients who had a history of screening at regular intervals, since the use of electronic medical records that set reminders for procedures. Sima concluded that in limited life expectancy from advanced cancer, screenings were not found useful and therefore Medicare might not provide coverage for the procedure in those patients.

PSM on Facebook

After the great feedback on our Facebook Guide for Senior Insurance Agents, we are pleased to announce you can now “Like” PSM for all of the latest senior insurance news, product releases, offers, contests, and blog posts. Join our community of senior insurance agents, like yourself. Click here to follow PSM on Facebook. See you there!

Sources: The Associated Press, Redland's Daily Facts, Senior Journal

Tags: Medicare, Senior Market, Medicare News, senior insurance market news, Senior News

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