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The chief executive of Avalere Health, Dan Mendelson, explains that even in cases when switching Part D plans is the most economical option, seniors are still more reluctant to do so. Yet, due to repercussions from health-care laws, there are some changes to the Part D program and it is important to have senior's evaluate their options so they can be assured they are on the best plan for their prescriptions. A new plan from Humana's Wal-Mart-Preferred Rx Plan boasts a $14.80 premium in all regions; however, premiums not only depend on cost but also deductibles, coinsurance, and doughnut hole coverage. Specific details of the Part D plans will be released in time for Annual Enrollment, on November 15th.

Setting New Medicare Skilled Care Service Standards

Two federal courts ruled that the standards for Medicare coverage of skilled nursing home care or home health care are too strict. Before this ruling, Medicare would only pay if a patient's condition would get better with the service, mistaking the belief that Medicare will only pay if treatment makes the patient "better." In correlation with the federal court's ruling, Medicare will now pay for the service if it is needed in order to maintain routine activities in daily life or to prevent the condition from getting worse. This is most significant for those patients with multiple sclerosis, Alzheimer’s disease, and a broken hip who need skilled care to assist them in their daily life.

Medicare Cuts Payments on Prostate Cancer Therapy

In order to curb inappropriate use and save health-care money, Medicare has begun paying physicians less for common prostate cancer therapy. A University of Texas study evaluated how many times adfrogen deprivation therapy was prescribed both before and since the Center for Medicare and Medicaid lowered the reimbursement rates. They found that there was no change in those who needed the treatment; however, it was prescribed 30% less in those who showed no beneficial medical evidence of needing it. These reduced reimbursements caused a positive change in health care by limiting the unnecessary care and driving a new pattern of care. Also, in this prostate cancer therapy case, negative side effects also contributed. Thus, there were both clinical and financial benefits.

Supplier Bidding Contracts Announced

On Thursday the Centers for Medicare and Medicaid Services announced the 356 suppliers who won contracts to provide durable medical equipment for nine areas around the country. With 1,217 contracts signed and 356 suppliers set to produce, prices will be cut by 32% saving a projected $28 billion over the next 10 years. The new program begins in January in Charlotte, Gastonia, Concord, Cincinnati, Middletown, Cleveland, Elyria, Mentor, Dallas, Fort Worth, Arlington, Kansas City (MO & KS), Miami, Fort Lauderdale, Pompano Beach, Orlando, Kissimmee, Pittsburgh, Riverside, San Bernardino, and Ontario. Though, a House bill to repeal the program has attracted 250 sponsors.

Woodmen Plan N Released in LA and AZ

This week the Woodmen of the World Plan N was released in Louisiana and Arizona. Contact us or call 1-800-998-7715 for more information on adding Woodmen of the World Plan N to your portfolio!

Sources: KHN, The LA Times, The Hill, National Journal

The 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

With the number of people aging and the continual rise in health care costs, our Nation's health-care obligations are becoming increasingly harder to meet. Federal Reserve Chairmen Ben Bernanke projects that Medicare and Medicaid needs will double our national income within the next twenty-five years. Social Security, too, will be strained as less people enter the work force than those ready to receive their benefits. Bernanke calls US public finances an "unsustainable path" but understands cutting spending on Medicare and Social Security would be very unpopular with the American public. He offers no new ideas on reducing spending, leaving those decisions to elected officials. However, he warns that underestimating these challenges would be detrimental to our economic future.

Woodmen of the World Plan N Released in Select States

On Wednesday, Woodmen of the World/Assured Life Plan N was released in Iowa, Arkansas, Alabama, Washington, Utah, Montana, Idaho, West Virginia, Texas, and Oklahoma. Also released was the news of expansions to California, Colorado, Mississippi, and Tennessee. With benefits like excellent commissions, 12 month advancement, competitive premiums, and liberal underwriting - don't miss the opportunity to add this excellent product to your senior portfolio. Click Here for more information.

Cost-Effective Medicare Reimbursement Rates

With the constant need to control the growth of Medicare spending, two policy experts have proposed that new treatments should be studied and then given a monetary value based on whether they are superior, comparable, or inferior to treatments already available. Currently, the national health reform law has created the Patient-Centered Outcomes Research Institute (PCORI) to advise and set guidelines for federal agencies on effective research and on funding research. The PCORI panel consists of a majority of physicians who study new treatments and give ratings, but cannot make decisions based on cost. The policy experts suggest rewarding treatments with the highest outcomes with the most funding and then reevaluating the treatment after three years for continued funding. They believe that limiting spending to three years will not only force manufacturers and clinicians to continue research on the treatments but to prioritize products that will have the most effect and positive outcome.

Seniors face Medicare Advantage Plans Eliminated and Automatically Enrolled

Representative Republicans Dave Camp (MI) and Wally Herger (CA) are calling into question the Centers for Medicare and Medicaid's (CMS) decision to eliminate some Medicare Advantage drug plans, which will affect approximately 3 million seniors and automatically enroll 1.5 million of those seniors into a new plan, costing 15% more in premiums alone. In a letter to the Health and Human Services Secretary Kathleen Sebelius, the Republicans questioned the decision to terminate another plan which has nearly one-half million beneficiaries enrolled, raise 600,000 premiums by 45%, increase monthly premiums in the top 10 Part D plans by 10% next year, and eliminate prescription drug plans. They also requested that the Centers for Medicare and Medicaid provide all of the analysis used to determine the impact on their decisions, so Congress can protect seniors from these decisions in the future.

More News for Medicare Advantage Plan Cuts

President Barack Obama's famous quote, "If you like your health plan, you can keep it" is coming under scrutiny after news of drastic Medicare Advantage plan cuts, from 14.8 million to 7.4 million by 2017; with approximately 70% of the cuts in this plan hitting low-income seniors and the disabled. Those who remain in Medicare Advantage afterwards will receive less generous benefits. Medicare Advantage benchmarks under the new formula will be determined by a fixed percentage based on the average fee-for-service (FFS) spending in each county; and, lower percentages will be applied to the counties with a higher FFS spending. A study shows that nearly every single county will have lower benchmarks, forcing beneficiaries to face cuts and some plans will pull out of the market completely.

Sources: Human Events, Right Side News, KHN, MedPage, The Wall Street Journal Health Blog, The Fiscal Times, American Medical News, Dow Jones Newswire, The Associated Press

Richard Ybarra Signing Off: I just wanted to say farewell to all of you. It has been both an honor and a pleasure to have managed the Web presence for PSM over the past two years. I enjoyed writing this blog each week and watching its readership greatly expand. Your comments have always been interesting to read, and I encourage you to continue to participate. I wish all of you great success in your endeavors. Here is the first blog post from my successor Lauren Hidalgo:

Campaign Fear Themes: Medicare vs. Social Security

Democrats and Republicans have begun the battle for votes from older voters who consistently turn out for midterm elections. Republicans say Democrats will cut Medicare by $500 billion and Democrats say Republicans plan to cut Social Security. Thus, forcing voters to choose between either potentially losing their health care or losing their financial support. Each party denies the allegations yet continues to invest millions of dollars into advertisements, hoping to sway voters with fear tactics. In the 2006 election 30% of voters were 60 and over and that number continues to grow.  Therefore, their loyalties will continue to be pursued.

New Required Checks for Medicare

A new anti-fraud law, proposed Monday, will require Medicare to verify claims first, acting more like a credit card company and flagging suspicious bills. This proposed law could limit wasteful government health care spending and save taxpayers billions of dollars a year. Sen. George LeMieux, a Republican from Florida, sponsored the bill because he is tired of seeing unnecessary, or false, service charges and then having to chase the culprit to recoup a fraction of the money lost. He estimates the cost to implement the technology for this program, which would process claims for both hospitalization and outpatient services, would cost $930 million over the next decade but the anticipated savings would far exceed the expense.

New Center for Medicare and Medicaid Innovation Chief

On Monday, Dr. Richard Gilfillan's appointment as acting director of the Center for Medicare and Medicaid Innovation became public. He has experience as the former president and chief executive officer of Geisinger Health System; as well as, executive vice president of insurance operations for Geisinger Health System, which is a based in Pennsylvania integrated health system that is often a model of how be cost effective in Medicare. During the 2008 election, Gilfillan contributed the maximum allowed $2,300 to President Obama's campaign.

Examining Health Reform's Effect on Medicare Advantage

On Monday, four Senate Republicans asked the top Medicare accountant to release the results of his analysis of health reform's impending effect; as well as, a breakdown of the impact based on "rural versus urban areas" and "an estimate of how much less [MA] plans will be able to spend per member per month on reduced cost-sharing and extra benefits" on the Medicare Advantage program. They fear the new cuts to Medicare Advantage may cause some plans to fold while still others will be forced to drop benefits in order to stay profitable. This comes just a week after Obama released estimates that Medicare Advantage is projected to jump 5% next year and average premiums will fall by 1%. The Republicans have requested the information be released by October 8, 2010.

Sources: The Hill, NPR, CMS, KHN, The Miami Herald