Calls On Congress To Stop Medicare Doctor Cuts

The American Medical Association (AMA) is now airing television ads calling on Congress to stop Medicare physician payment cuts to seniors. The ad, titled the Faces of Health Care, depicts seniors who will be hurt by looming Medicare cuts and the physicians who care for them. “This television ad is part of our campaign to get Congress to stop Medicare physician cuts that will harm seniors,” said AMA Board Chair Cecil Wilson, MD. “We are raising awareness of the severity of the problem.” Next year, Medicare will cut payments to physicians by 10 percent. Over nine years the cuts swell to about 40 percent, while practice costs increase 20 percent. Only congressional action can stop the cuts, and avert an access to care crisis for seniors who rely on Medicare. “Sixty percent of physicians tell the AMA that next year’s Medicare cut will force them to limit the number of new Medicare patients they can treat,” said Dr. Wilson. “As the baby boomers begin to age into Medicare in just three short years, we’re concerned that the cuts will mean that there simply won’t be enough doctors able to care for all the new Medicare patients.” The AMA is encouraging seniors and their loved ones to contact their members of Congress to tell them we need action to stop Medicare cuts to physicians now. Americans can contact their members of Congress through the AMA’s Patient Action Network Web site or at (888) 464-6200. The AMA also published print ads earlier this month in Capitol Hill papers. The print ads call on Congress to stop next year’s Medicare physician payment... read more

Florida Medicare Advantage Plans from Freedom Health

Freedom Health, which was founded in 2004, is a Tampa, Florida-based health insurance business that’s operated and owned by a group of physicians. The organization administers Medicare and Medicaid benefits throughout many Florida counties. It aims at providing members with affordable health coverage which is designed to upgrade their quality of health care and cut down on out-of-pocket costs. The organization works closely with a network of local health insurance brokerages and agents and also has offices in Casselberry, Fort Myers, Ocala, Spring Hill, and Vero Beach. Since the health maintenance organization (HMO) deals strictly in Medicare and Medicaid plans, its medicare supplemental coverage is offered in combination with an existing Medicare or Medicaid policy. Therefore, to qualify for one of their health plans, you will already have to be enrolled in a Medicaid policy or Medicare Part A and Part B. Freedom Health has several different Medicare Advantage plans to choose from. These include plans that provide prescription drug coverage and have Part B premium reductions, as well as those aimed at customers with chronic conditions and those who have coverage with both Medicare and Medicaid. In the Medicare Advantage Prescription Drug Plans, you have to use prescription drugs that have been placed on an approved list. The policy can be part of your Part B or D premium, cover medication through the coverage gap, and sometimes offers reduced co-payments for mail-order and generic drugs. However, you need to be aware that if your Medicare Advantage plan offers coverage for prescription drugs and you then enroll in a standalone drug plan, you may be removed from the Medicare... read more

Medigap Plans from Gerber Life Insurance

Gerber life started out as a life insurance company building a sterling reputation over a 156 year history. Now they are on their way to dominating the Medicare supplemental insurance market. Gerber life sells Medicare supplements which are also called Medigap plans a senior citizens health insurance option to cover the costs not covered by Original Medicare Parts A and B. Currently Gerber has the Plan A, Plan B, Plan F and Plan G available to Medicare beneficiaries. Remember these are Medigap plans, so there are no networks, you can use any Dr. or medical provider in the country that accepts original Medicare and assignments and you will not have to worry about a Dr. list. All of these Medicare supplement plans offered through Gerber life will cover your major out-of-pocket costs, those being the part a and part B deductibles and other costs associated risk receiving treatment from a Medicare contracted provider such as outpatient lab testing, outpatient surgeries and Dr. visits. An interesting fact about Gerber life Medicare supplements is that they are actually underwritten by Mutual of Omaha. So if you call the 800 number for Gerber Medicare Supplement quotes, they will answer the phone as Gerber but you are in fact common to Mutual of Omaha’s call... read more

AMA Television Ad Calls On Congress To Stop Medicare Doctor Cuts

Part D beneficiaries need more coverage Senior beneficiaries enrolled in a Medicare Part D prescription drug plan still lag behind the coverage afforded seniors covered by employer plans or under a veterans’ health plan, according to a report in the journal Health Affairs. The report, which surveyed some 16,000 senior citizens, states that while more senior citizens have drug coverage than before due to the Medicare Part D program, more of those participating seniors are paying greater out-of-pocket expenses, especially when contrasted with their counterparts who received drug benefits through the Veterans Administration (VA) and employer-provided coverage programs. According to the report, 26 percent of the responding Part D beneficiaries spent at least $100 each month for prescription drugs. The report stated that another 8 percent reported spending at least $300 each month for prescription drugs, which is less than those without Part D coverage, but still more than those beneficiaries under a VA or employer-provided coverage program. Only 8.5 percent of senior citizens in 2006 did not have prescription drug coverage, whereas 33 percent of senior citizens were without such coverage in 2005, according to the report. Despite the Medicare Part D program’s low-income subsidy (LIS) allowances, only 53 percent of Medicare Part D beneficiaries who were surveyed knew about the program, and only 52 percent of the non-participating senior citizens who were surveyed had knowledge of... read more

Take a look at the Humana Gold Plus HMO plan for Seniors

Humana Gold Plus® is a Medicare Advantage Health Maintenance Organization (HMO) plan with a wide range of coverage for seniors. Humana has contracted with Medicare to provide you with services that are not covered by your Medicare Part A and Part B benefits under original Medicare. Most Medicare Advantage Humana Gold Plus HMO Plans offer prescription drug coverage. With Gold Plus HMO Plans your out-of-pocket costs are reduced and more predictable than with the majority of other plans. You may enroll in Gold Plus HMO plan only during specific times of the year. You can compare this to Humana’s Gold Choice PFFs, Humana’s Part D Drug Plans, HumanaChoice PPO and Humana Enhanced PDP. Below is an example of one of the many plans offered by Humana. Summary Plan Type Humana Gold Plus H1951-013 (HMO) Office Visit for Primary Doctor $10 copay for each primary care doctor visit for Medicare-covered benefits. Office Visit for Specialist $10 to $25 copay for each specialist visit for Medicare-covered benefits. Doctor Choice Plan Doctor Only Annual Deductible None Out-of-Pocket Maximum $4,900 Prescription Drug Coverage Yes Physical Exams $0 copay for all preventive services covered under Original Medicare at zero cost sharing. Hospital Services Coverage Emergency Room $65 copay for Medicare-covered emergency room visits. $25,000 plan coverage limit for emergency services outside the U.S. every year. Ambulance Services $200 copay for Florida Medicare-covered ambulance benefits. Outpatient Lab/X-Ray $0 to $25 copay for Medicare-covered lab services. $0 to $50 copay for Medicare-covered diagnostic procedures and tests. $10 to $50 copay for Medicare-covered X-rays. Outpatient Surgery $250 copay for each Medicare-covered ambulatory surgical center visit. $0 to $250... read more

Humana Choice PPO Plan Details

HumanaChoice PPO® is a Medicare Advantage Preferred Provider Organization (PPO) which offers additional benefits beyond original Medicare.  Humana offers a wide array of products and services in addition to your original Medicare plan.  HumanaChoice PPO® has a formed choice of hospitals, specialists and doctors for you to choose. No referral is required. You can also go to providers outside of the network but you reduce your costs when you use the in network providers.  Some plans offer Prescription drug coverage better or equal to the requirement for a Medicare Part D Plan (not available in all regions).  HumanaChoice PPO®  offers worldwide coverage for emergency care.  And features an affordable monthly plan premium for most plans.  Coverage for annual screening are also offered at no additional charge.  Below is a example of coverage of three plans offered by Humana that show in network benefits. HumanaChoice, PPO H5415-056 HumanaChoice, PPO R5826-018 HumanaChoice, PPO R5826-005 Plan Type Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Medicare Advantage Plan Preferred Provider Organization(PPO) Rx Coverage Annual Premium $468.00 $0.00 $960.00 Annual Drug Deductible $0.00 No Prescription Drug Coverage $0.00 Doctors and Hospitals HumanaChoice, PPO H5415-056 HumanaChoice, PPO R5826-018 HumanaChoice, PPO R5826-005 Annual Medical Deductible $0.00 $0.00 $0.00 Annual Plan Deductible N/A N/A N/A Maximum Medical Out-of-Pocket $5,000.00 $4,000.00 $4,750.00 Hospital Deductible (Per Benefit Period) $0.00 $0.00 $0.00 Doctor Access Option to see physicians in- or out- of the plan’s network. No referrals required. You pay more for out-of-network services. Option to see physicians in- or out- of the plan’s network. No referrals required. You pay more for out-of-network services. Option to... read more

Consumers Deceived By Medicare Private Health Plans Are Free To Leave Plans

CMS Has Yet to Notify Americans with Medicare of New Dis-enrollment Right New York, NY — People in private Medicare health plans can dis-enroll from their plans if they signed up after receiving misleading information, according to the Centers on Medicare and Medicaid Services (CMS). To date, neither CMS nor the insurance companies that operate Medicare private health plans have informed people enrolled in these plans that they can leave if they were duped into signing up. CMS has received thousands of consumer complaints about unscrupulous and aggressive sales tactics and seven companies have suspended marketing of their private fee-for-service plans. “We applaud CMS for acknowledging the fraudulent marketing activities of private plans, but our concern now is righting the wrong,” said Robert M. Hayes, president of the Medicare Rights Center, a national consumer service group. “While CMS informed their own hotline operators that Americans with Medicare have the right to leave plans they were tricked into joining, most consumers remain in the dark about their right to change their Medicare coverage. What good is a new dis-enrollment period, if no one knows about it or how it works?” The new right is known as the “exceptional circumstance special enrollment period” (SEP). Under CMS rules, most plan members are locked into their plans after March 31 for the rest of the year. More than 8 million people with Medicare are enrolled in Medicare private health plans this year. The Medicare Rights Center requested details from CMS on how the SEP works because no official guidance about required time frames or other specifics has been released, other than a one-paragraph... read more

End the doughnut hole

Part D beneficiaries need more coverage Somerset County senior citizens who thought they were getting help with the doughnut hole provision of Medicare Part D prescription drug coverage with the new Somerset County Drug Discount Card received bad news from Tuesday’s county commissioners’ meeting. None of their purchases with the new NACo card made during their doughnut hole will count towards getting them out of the hole. The doughnut hole is a gap in Part D coverage when people go from paying a co-payment for their prescriptions to paying for the entire cost. Somerset County commissioners worked to get the National Association of Counties prescription drug card for people who don’t have insurance or who have only some insurance. The cards, available without cost to residents or to the county taxpayers, enable people to save 20 percent on medications. They are to be commended for doing that; the fault is not theirs. Congress should have passed Part D without a doughnut hole. Instead, Congress sided with the drug companies and shifted the cost to senior citizens. As Part D’s threshold for resuming coverage goes up each year, more and more senior citizens will be unable to pay for all their medications. A report by the Center for Economics and Policy Research states if the drug benefit had been administered through the existing Medicare system, rather than through private insurers, the doughnut hole would be considerably smaller at no additional cost to the government. If Medicare had been allowed to bargain directly with pharmaceutical companies, such as the Veterans Administration does, the savings would have been more substantial. Congress needs... read more

Part D and People Who Are “Medically Needy”

Warning: this Alert may cause headaches. Those readers who have ever roamed the Serbonian Bog[1] that is Medicaid will feel right at home. THE MEDICAID BOG The so-called Medically Needy – Medicare beneficiaries whose Medicaid eligibility depends on meeting a spend-down (or share of cost) each month or quarter – are faced with difficult challenges just using their Medicaid, since, in most states, they must prove to the state that they have incurred a certain amount in medical bills before their Medicaid becomes effective. These same individuals face even greater complications resulting from their participation in Medicare Part D’s low income subsidy (LIS). One contributing factor to these complications is that the government’s share of payment for prescription medications, which are obtained at little or no cost to the individual under LIS, does not count toward meeting the medically needy spend-down, the condition that qualifies a beneficiary for full Medicaid coverage. In other words, having LIS often results in an individual losing their Medicaid coverage. EXAMPLE: ONE CLIENT’S WANDERING IN THE BOG Medicaid in 2005. Our client, Ms. H. had high drug costs prior to the implementation of Medicare Part D. Although her income was above her state’s limit for “regular” Medicaid, when her drug costs were taken into account, her income dropped to the state’s medically needy income level and Medicaid picked up her health care costs beyond those expenses needed to qualify. In addition to coverage for any drugs beyond those needed to qualify, she got coverage for some or all of Medicare’s cost-sharing as well as for services offered by her state Medicaid program that are... read more

Colorado seniors face soaring price of drug plans

Nancy Wittebort is 77, takes six medications each day and didn’t want to “tolerate” the hours-long hassle of figuring out which prescription-drug plan would get her the best deal. The letter informing her that the monthly cost of her plan was going up about 60 percent Jan. 1 left her no choice. “I thought that was too much of a jump,” said Wittebort, one of more than a half-million Coloradans receiving Medicare benefits. Wittebort’s monthly premium would have rocketed to $43.30 — up from $26.40 last year and $18.40 three years ago, when prescription-drug plans became an option for Medicare recipients. The Highlands Ranch woman dumped her insurance company and switched to one with a lower premium and a higher deductible before the Dec. 31 deadline, hoping the trade-off is worth it. Many senior citizens — the ones who read warnings about increased premiums — began calling Medicare counseling centers weeks ago in an end-of-the-year scramble to switch drug plans. Now, counselors expect another round of calls from irate and confused seniors as Social Security checks hit mailboxes and seniors realize deductions for drug plans are higher than they expected. The monthly cost for prescription-drug plans has doubled and in some cases quadrupled since January 2006, when the program started. The 10 most popular plans across the country went up drastically this year, some by 70 percent and others by 200 percent. “This is something that will catch the eye of policymakers,” said Lindsey Spindle, vice president of Avalere Health, a health-care information company in Washington, D.C. “I think there are years when those kinds of cost increases are... read more

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