Archive for May, 2008
AARP is working hard to protect Medicare recipients from extreme Medicare premium increases. AARP volunteers delivered over 20,000 petitions to Texas Senator Kay Bailey Hutchison and John Cornyn in Dallas and Austin protesting the fact that premiums have doubled since the year 2000.
Congress must deal with this issue by June 30th to make sure that Medicare recipients are not denied access to physicians and the essential medical services their physicians provide. Though Medicare recipients have continued to pay their share, even when they have felt it has become an unfair share, things are now out of control, according to recipients and to AARP. It is time to deal with this issue – before time runs out – and it is essential to make sure that doctors can continue to treat their patients and patients can continue their access to and relationships with their doctors.
Though this particular situation and protest is taking place in Texas, where all Texans are under the strain of high prices for everything from bread to gasoline, Texas is not the only state that is dealing with Medicare struggles. Too many Medicare beneficiaries in Texas – and around the country – who cannot afford basic necessities, are now being forced to pay Medicare premiums that often put the beneficiaries in a situation where they have to choose between Medicare and the necessities of life.
AARP Texas President has stated that AARP is “asking the Senators to fix the problem of getting physicians paid and not just vote to raise premiums.” AARP has pointed out that Congress has simply been using band aids and not real long-term fixes to take care of Medicare issues. These fixes seem to continue to include increases in premiums to Medicare recipients rather than long term solutions that will not penalize the very individuals that these benefits are supposed to help.
Time will tell what will happen in Texas and how Congress will treat the 20,000 petitions. AARP, Congress and Medicare recipients will not only be watching Texas results, but, in these difficult times, they will be watching the Medicare issues throughout the country.
The sheriff in Isabella County, central Michigan issued a warning for seniors and individuals with disabilities about yet another scam aimed at them.
This scam has callers contacting Medicare recipients telling them that the caller is from Medicare and has called to warn the recipient that their benefits will cancel in 30 days. The callers also tell recipients that in order to keep their Medicare benefits, they need to give the callers personal information bank account numbers, social security numbers and Medicare number. Callers will say that there is no cost for updating this information.
These types of scams are becoming more and more common throughout the country. They prey on the elderly and on individuals with disabilities, and they sound so authentic that they are often able to get the information they are asking for. Then they use the information in a fraudulent way.
It is important that no matter where you live, you Do NOT fall for these scams and do not give out ANY personal information – especially social security numbers, bank account numbers and Medicare or other information that should remain private and protected.
It is important to know that actual Medicare or Social Security representatives will NEVER ask you for personal information and they will NEVER ask you to pay them over the phone. Medicare sends out information about bills and statements to recipients if there are any amounts due. Most of the time the amount would be set up in advance to be deducted from your ban account and you would receive statement in the mail showing the deduction.
If someone calls you trying to get information that is private, do not give it to them. Try to get their name and number and report them to your local police department. If you happen to live in Isabella County Michigan, call your local Sheriff’s office at 1-989-772-5911.
Most of us live our lives without too many emergencies to interrupt us. As a result, we have a tendency to get pretty comfortable and not be totally prepared in the event of certain emergencies – especially medical emergencies.
This can put us in a mess if we are suddenly faced with a medical situation where people – such as our doctors or hospital – need pertinent information from us to treat us. For example, we might break our leg, which in and of itself seems simple to deal with.
However, what if we are taking medicine for blood pressure, diabetes, heart issues or blood thinners? All of these medications can have an effect on how the doctors in the emergency room choose to treat us. They can also have a huge effect on our health.
If the doctors don’t know what medicines we are taking or how much, they could possibly give us conflicting medicine which could cause serious health issues.
There is an easy solution to this issue. Write it all down. A great suggestion is for you or a friend/family member to write down all your medications, the doses, and the times you take them. Include over-the-counter medicines, such as Tylenol or allergy medication. In addition, write down your blood type, religious preference, doctor’s name and phone number and an emergency name and phone number plus any allergies you might have. Put all of this information on one sheet of paper and fold it and put it in your wallet. In addition, give an extra copy to a friend or relative, as well as keeping one copy on a magnet on your refrigerator so it will be easy to find in an emergency.
Chances are that you won’t need to use this handy little paper, but in the event that it is necessary, it will keep your doctors informed and will keep you safe.
There is a lot of talk these days about reverse mortgages, especially for retirees. There have been good reports and bad.
This is how a reverse mortgage works. If you are 62 years old or older, you can apply for a reverse mortgage as long as you own your house outright or owe very little on it. The idea is that you would have the cash to be able to use if you needed it.
With a reverse mortgage there are no monthly repayments, so the good news is that you don’t risk losing your home. The way this works is that equity is taken out of the home each month and paid to the borrower. The borrower keeps the deed to the property – the lender does not get the deed like they would in a regular mortgage.
The program is federally insured, so that the government guarantees that the borrower will receive every bit of money they are entitled to no matter what. If the lender goes broke or can’t pay, the government will pay the money to the borrower. There are also government rules about how much money can be charged for fees. Period. There are several different ways that the payments can be made, depending on what the borrower chooses.
The important thing is that the payments are tax free, so they don’t affect your Social Security or Medicaid.
There are a few negative issues with reverse mortgages. There is a ceiling on the amount that can be borrowed. Up front costs can be high. If you are on SSI or Medicaid you can lose benefits if you don’t spend down your entire loan amount every month.
If you are thinking of opting for a reverse mortgage these are some important things to think about. There are others, as well, so be sure to do some research. Talk to an attorney, accountant and mortgage broker that you know and trust. Check the internet for reverse mortgages. Call AARP. Discuss and research the topic thoroughly so that you will feel comfortable with your decision.
Reverse mortgages have become extremely popular and are an excellent choice if you are in the right situation to take advantage of them.
Hospice has come to be synonymous with helping people at the end of their lives die with dignity. It is not an easy situation. It is difficult for the patient, difficult for the family and difficult for the hospice provider.
The majority of hospice providers are caring people who extend themselves to patients and their families at the worst time imaginable. Since illness at the end of one’s life is not an exact science, even patients who would seem to have weeks or months to live can defy the odds and live much longer. This is, of course, a very positive situation for many families, as long as the patient is not suffering.
As if all of this is not enough, picture payment issues with Medicare. For instance, imagine a hospice that is providing care for a number of people – patients who have lived longer than Medicare will pay. What should a provider do? Stop taking care of these patients? Once the hospice has obtained the allotted number of extensions and is out of funding, what should they do with the patient that is still holding on to life?
This is a question that has been taken to Capitol Hill and is being examined carefully. A number of hospice administrators are trying to sort out this issue. There are some who are millions in debt to Medicare – in fact, Medicare has told them that they need to pay up or declare bankruptcy. This is a very difficult situation for individuals to be in when they have spent their lives trying to help and care for patients and families who are suffering one of the ultimate issues humans can go through.
It will be interesting to see how this situation is solved and what happens to this most essential and delicate service that is rendered at the most vulnerable time in a family’s life. Hopefully there will be a way to address this issue and solve this problem without compromising caregivers or the people they serve.
A Medicaid plan proposed by the Division of Medicaid and the state hospital association in Mississippi was passed by the Mississippi Senate today. The debate took 24 hours until it was passed, and it still has to be discussed in the House on Thursday, 5/29.
The Senate spent the 24 hours discussing how the bill – or not passing the bill – would affect hospitals and patients in the state. Though there will be a 90 million dollar deficit, it has still been decided that this would be a better choice than not passing the bill.
For one thing, though there is a deficit, there will be taxes that offset the deficit. The hospitals will pay out taxes, but will receive more in return, so, in the end, the hospitals, the individuals that use the hospitals and the state itself, will end up better for the situation.
The hospitals in the state all have to pay an assessment tax to offset the shortfall of the 90 million dollars, but the federal government will pay the hospitals back at a rate of three to one. Therefore, for every three dollars that each hospital pays, they will receive two dollars in return in federal funds. The money is paid back to each hospital depending on the number of Medicaid patients they provide services to. The Lieutenant Governor of Mississippi, Phil Bryant has said that “this will help fund not only next year but in years to come.”
Though most hospitals will receive the money back, seventeen hospitals will have a shortfall, which will be reimbursed by the hospital association. State Senator Terry Burton says, “I think taxpayers have benefited as a result of this.”
Thursday will tell whether the House agrees with the Senate and passes the bill to help hospitals and patients who use them.
There have been quite a few accusations and questions about the Bush administration with regard to many issues. There’s the war, gas prices, the economy (in general) and now Medicaid tricks. President Bush has been trying for some time to go around Congress and push through a Medicaid regulation that would eliminate reimbursements to public hospitals, costing money, cutting services and probably costing lives. The sad part about this is that Congress made it clear that this was not to be even dealt with for at least on year because Congress had passed a moratorium on the resolution stating that not even the President could change it.
Unfortunately, President Bush and his administration tried to use a “rush through rule” to ignore the decision that Congress made. The Bush Administration tried to alter, and then process out – the moratorium. Fortunately for the public and for the public hospitals that serve the public, a Federal Judge was not fooled, nor was he impressed about what the Bush Administration tried to do. As a result, Federal Judge James Robertson of the United States District Court for the District of Columbia put a stop to this less than honest and sneaky move.
It is certain because of this action by the Bush Administration, that this is not the last we will hear about the situation. I addition, there are other cuts looming on the horizon. There are seven cuts that are proposed that Congress is trying to stop, or at least, stall until they can be discussed further. These cuts, if approved, could cost the states a tremendous amount of money and possibly destroy some medical care providers. Not to mention the fact that services would be cut for those who need the services most.
We are told all our lives that it is essential to follow the rules and obey the laws. This should include the President and members of his administration, no matter who they are, what they believe or whether they agree with decisions or not. The unfortunate situation is that individual citizens without special privileges pay sometimes serious consequences when they do not. It is good to see the example of a judge who was willing to stand up for an important decision that Congress made to protect the people who need it most.
There are numerous complaints about government agencies not communicating with one another and not working together. Some of these complaints make it clear that because of this lack of communication people have been hurt or killed, lost money or property and have often ended up in crisis.
There is some good news for Medicare recipients. The Food and Drug Administration (FDA) and Medicare will be working together to help keep recipients safer. Both the FDA and Medicare have huge databases. Medicare’s databases contain a tremendous amount of information regarding claims, which include medication. The agencies have determined how they can use the databases to explore and address problems with medications and medical devices and equipment that are discovered while they are new on the market. This computerized early-warning system is being designed to keep people healthy and save lives. In addition, the system will save money by recognizing negative reactions quickly, look at patterns that lead to hospitalizations and work to isolate medications that are causing or increasing health problems. With all this at work together, this should eliminate some hospitalizations and other medical expenses, saving money for recipients, for Medicare and for all involved in the system that tries to keep people well.
This new system will keep individual records private. Only information regarding medical issues will be shared, but the identity of the individual will be kept private. The FDA has a current early warning system, but it relies on self-reporting by patients and doctors, which is not accurate, and which also does not capture a high percentage of information, since many people don’t report for many reasons.
This system has taken years to devise, and is important because it could shorten the time it takes to detect drug safety issues and bring it don from years to months. This is good news, not only for Medicare recipients, but for all of us.
Many Medicare recipients have found themselves in situations where their physician feels they need a particular procedure but Medicare won’t approve it. Most people don’t know what to do when they find themselves in this situation.
The Medicare Rights Center, which is a national nonprofit organization, says that the best thing to do in this situation is to appeal the decision. Medicare is supposed to approve any medically necessary procedures, however, quite often it comes down to whether Medicare agrees with the doctor’s idea of what is medically necessary.
According to the Medicare Rights Center, it is often easy to win appeals for a number of reasons. One thing that happens quite a lot is that the denial is based on an accidental coding error, which means that someone put the wrong number or letter into a computer, making the computer think that you are requesting something different than you actually are and you end up being denied.
The Medicare Rights Center also says that many people don’t realize that they can appeal, or they think that the appeal process is too difficult. In actuality, the process is not that difficult and everyone has the right to appeal.
Some things that an individual should do to have a successful appeal as suggested by the Medicare Right Center are:
• Sign the back of the Medicare Summary Notice (MSN) and write on the front of it “Please Review”- send it back to the correct address by certified mail or with delivery confirmation;
• Include a letter with the MSN asking for the review and explaining why it should have been covered;
• Have the doctor include a letter explaining why the suggested procedure should be medically necessary and approved;
• Save photocopies of all written and oral communication, including notes, names and dates of ;hone calls;
• Make sure to do all of these things well within the 120 days allowed, or it will be too late to appeal;
• If you are in a private plan such as an HMO or PPO remember that you only have 60 days to appeal and some of the steps may be different.
It can be frustrating to get a denial, however, hopefully this information will help you if you ever find yourself in this situation. Hopefully, this will not happen, but if it does, this information should help you get the care you need.
Autism is a disability that affects hundreds of thousands of adults and children throughout the United States. It is a complicated disability and cannot be treated with a “one size fits all” formula.
Most states have services for children with autism through the school systems, and these services are available through twenty one years of age. At that point, most states have services available for adults.
Pennsylvania is a state that has been different. Though it has covered children with autism through age twenty one, Pennsylvania has been lacking in services for adults with autism. As a result, Pennsylvania has been granted the ability to use a portion of their federal Medicaid to fund services for adults with autism. $20 million will be made available annually to provide community and home services to benefit adults with autism. Some services will include respite care for families who are caregivers, as well as crisis intervention.
Individuals will be qualified for the program and benefits based on their income and the extent of their disability, giving them access to a variety of services. Pennsylvania Governor Ed Rendell stated “Prior to the establishment of this waiver program, there was nothing designed for people with autism once they reached the age of 21,.” This will also help more people with autism live in the community instead of in an institution.
According to Daniel Torisky, President of the Autism Society of Pittsburgh and secretary of the Autism Society’s state chapter, “The whole idea is to give them a jump start. It puts tem in line for significant and speedy improvement and accommodation to the complexities of our society.”
For those of us who know or have dealt with an individual who has autism and/or their family, this is a wonderful step forward in dealing with a disability that affects many people who can be helped to live a fuller life.
A regulation that was proposed and backed by President Bush to cut $5 billion in Medicaid funds for public hospitals over the ext five years was blocked by a federal judge Friday. This gives some Bay Area public hospitals a break and will let them breathe a sigh of relief for the time being.
Without this ruling, the funds would have started to be reduced starting Sunday, the day before Memorial Day. Temporarily, at least, the funds are still available, but this is only a temporary fix.
If the regulation eventually takes effect over 22 public hospitals will lose a total of approximately $600 million annually for the next six years. The California Association of Public Hospitals and Health systems located in Oakland, CA, is fighting hard to extend the moratorium on the cuts.
Alameda County Medical Center in the town of Alameda, a suburb of Oakland, serves a high number of patients and would lose about 20% of its total income and operating budget if the moratorium is not extended. This amounts to almost $100 million annually.
Other hospitals stand to lose millions as well. Santa Clara Valley Medical Center would lose nearly $38 million annually, San Mateo Medical Center, $11 million annually, Contra Costa Regional Medical Center, $9 million annually, and San Francisco General Hospital $29 million. This is just five hospitals that take care of a great number of individuals that have no other place to go for medical care.
In addition, University of California hospitals would lose $116 million annually.
The reason that the court blocked the regulation is that the court feels that the Bush Administration acted improperly in conjunction with CMS in trying to eliminate coverage that is the lifeline to many low-income individuals and families who depend on this coverage and assistance.
At this point, Congress, CMS, several governors and Mike Leavitt, head of department of Health and Human Services, have agreed to work together to try to solve some of the problems that have led to this point. Hopefully they will find a way to keep enough money available to these public hospitals that are in many cases the only lifeline low income individuals have.
The idea of health fairs is not new. There are heath fairs in cities across the U.S. that provide everything from information about gentle dentistry to on the spot blood pressure and bone density tests, and everything in between.
The middle Alabama Area Agency on Aging (M4A) is sponsoring a health fair for seniors this Friday. This will be the first ever, and it will be entitled “A Walk in the Park” because it will be held in the local park. The event will honor Older Adults Month.
Part of the purpose of the event is to raise awareness about the M4A organization, its purpose, its services and how/who it can help. The event will have several types of screening available for seniors including blood pressure checks, blood sugar testing, and cholesterol checks.
Various health care organizations will be available to answer questions, including home health care organizations. There will also be information available about M4A including information they provide and assist seniors with, such as their nutrition program called Homebound Meals (similar to Meals on Wheels), assistance with prescriptions called Senior RX; and assistance with the Senior State Health Insurance Assistance Program (SHIP). SHIP helps with Medicaid, Medicare, Medicare Supplements and SSI, health insurance and long term care.
M4A has an ombudsman who checks into complaints and works to help solve problems. They have a great many friends and contacts in the community, so if there is a problem they can’t solve or a question they can’t answer, chances are they can connect you with someone who can answer those questions and walk you through, working with you to fix the problem if at all possible.
There have been more and more programs such as M4A in communities throughout the country. To find out if there will be any presentations or a senior health fair in your community, contact your local senior centers, chamber of commerce and your doctor or local hospital. The information at these health fairs is usually free and you can surely benefit from the information you will receive.
I recently ran across an article about what to do to prepare for a natural disaster. Since my mother used to work on disasters, such as hurricanes, floods and earthquakes, we were painfully aware of keeping water, blankets and a few other things in the car and a full emergency kit including canned goods, water, flashlights, battery operated radios and more in the house.
One of the things that the article said – and, yes, my mother says and does – is to have a medical emergency kit available at all times. We are not talking about a first aid kit. That goes with all the stuff in the car and in the house in case of a disaster or other kind of emergency, including medical.
The emergency medical kits we are talking about is a container or file that has insurance coverage information including your health insurance company policy number, Medicaid or Medicare policy numbers, a list of your medicine with prescription numbers and dosages, your doctors phone number, a copy of your medical history from your doctor (you can usually get a copy for free), and names and contact information for family or friends and your doctor. Just in case, you might want a change of clothes in an overnight bag, as well.
We all have a tendency to think in terms of other people having the emergencies and if we think of ourselves, we think it probably won’t happen. Even if we have diabetes or high blood pressure, or other conditions which could lead to serious complications, we don’t usually have things prepared in advance. Why is that? For one reason, who wants to think of having an attack of some sort and having to go into the hospital? None of us.
It is important, though, and could be life-saving, to have a kit, if not, your paperwork as discussed above. Often in a rush into the hospital, we are disoriented, even if we are not in the middle of something as serious as a heart attack, we are, after all, in the hospital and usually worried, frightened, stressed or all three.
So, help yourself and help the friends or family that will be there to take you to the hospital, as well as the doctors and nurses who will be treating you and trying to help you. If you haven’t prepared yet, take the time to do it right away. It could save your life.
Medicaid was designed to cover low income individuals and their families for hospital services ( in and out patient), laboratory services, x rays, home nursing care, doctors services, physical therapy, hospice and rehabilitation care. Medicaid recipients must go to a Medicaid-approved doctor who is on the Medicaid list. Sometimes, in some areas, there are a limited number of doctors that accept Medicaid, so some individuals have to search carefully and, once they find the right physician that they are comfortable with that are Medicaid approved and accept Medicaid for payment. As a result, there is often a waiting list for an appointment, even if it’s an urgent situation. In a serious emergency, the doctor’s office may take you right away and “squeeze you in” to their schedule. More often, they send you to the emergency room, which ends up costing you, taxpayers, the community, the hospital and Medicaid more money than if Medicaid reimbursed good doctors enough money to be able to enroll and appoint more, thus eliminating some of the long waiting line.
Federal laws state that if you become eligible for Medicaid, which is based on income and need, the states may not reduce other welfare benefits you are receiving. In addition, we have been hearing a lot about trying to exclude legal immigrants from Medicaid system. The problem with this is that Medicaid only requires – by law – for an individual to establish and prove residency (and meet low income requirements) to apply for and, if approved, receive Medicaid benefits. States cannot impose citizenship requirements on anyone who needs Medicaid benefits. Regardless of age or whether or not the individual works is not a reason that Medicaid can use to eliminate you from the program.
Unfortunately, these situations are taking place in a number of states. If you or someone you know feels that they are not being treated fairly regarding Medicaid benefits, you can contact some places that can help. Information is available to you through www.seniorlaw.com.
Imagine having medical services performed, thinking you are covered by Medicaid, but instead, finding out that you have a lien against you instead.
This has happened to some people in Missouri who have become part of a class action lawsuit to eliminate the liens and get the financial situation resolved.
The Plaintiffs in the case are claiming that the liens are against monies that are not compensation for past medical bills and services and the liens are a violation against the plaintiffs, who are asking the supreme court for help in settling the situation.
The court granted a Class Certification because the money in dispute which resulted in liens is Workers’ Compensation funding that several hundred individuals received after accidents or injuries that kept them from working. Their contention is that the Workers’ Compensation payments, which mainly replace lost salary, have absolutely nothing to do with Medicaid benefits, which are for medical expenses. Another reason for the class action suit is to be sure that all of the plaintiffs will be treated the same and treated fairly.
Medicaid has said that many of the claims should be barred due to the fact that the statute of limitations eliminates them from being able to participate in a class-action lawsuit. The court ruled that this issue could be determined later, as well as issues of class certification.
In the meantime, this will be an interesting issue to watch. It is not a situation that comes up often, however with cuts in Medicaid budgets and services, as well as states who are dealing with tight budgets and fiscal cuts, issues – especially precedent-setting lawsuits such as this one – important precedents are being set for the future and could affect q great many people – even you. If you need information regarding your rights regarding Medicare or Medicaid, not only can you check with www.medicare.gov and www.medicaid.gov, but also AARP, The Disability Law Center in your area and the Medicaid Legal Information Institute at Cornell University on the internet at topics.law.cornell.edu/wex/Medicaid.
The issue of immigrants and aliens in this country has been heated for years. It is something that has been discussed as the population has changed – especially in the past decade. Sometimes, however, both sides of the debate seem to forget that this is a nation that, other than Native Americans, was largely built by immigrants. Yet, these days, there are big questions that keep coming up about immigrants, aliens and paying taxes or having certain types of benefits, especially health insurance coverage.
One state that has a huge issue with aliens is California, due to many factors. Many of the state’s citizens are individuals that are aliens, and though the insurance coverage controversy is limited to aliens that are legally here – green cards and all – there is still a huge issue surrounding these individuals and their benefits.
To offset budget issues, Governor Schwarzenegger has proposed and is fighting for limiting or eliminating health care coverage for immigrants/aliens that have had a green card for less than five years. This proposal would supposedly save $85 million or more by eliminating many preventative services for those individuals and their families. The problem with this is that, once again, it’s great to look at the short term but the long term must be addressed. If people do not have Medicaid coverage (called Medi-Cal in California), to help them stay healthy, studies throughout the count.ry in various states have shown that the costs are often much more in the long term because without preventative and basic care, people wait until their health situation is acute before they deal with it. Because people wait until they can wait no longer, they end up in an emergency room instead of a doctor’s office, therefore incurring a cost that can be up to an average of 7 to 10 times that of a preventative or even an acute visit to the doctors office. A doctors visit at a local clinic usually costs between $10 and $25; and a doctors visit at a private doctor’s office can be $35 to $100 depending on what area of the country a person is in. With Medicaid, a doctor’s visit would cost a co-pay of $10 to $20. All of these are far less than the average emergency room visit which can cost from about $200 to $2000, depending on where you are and the procedures that have to be done. The likelihood of a low-income individual paying the doctors visit or working out payments with or without insurance, is much better than them paying for the hospital visit. Too many times, the hospital gets stuck providing care and receiving little or nothing because the person truly has no money and the hospital is obligated not to turn anyone away.
It is important to keep an eye on California to see how the Governor’s bill turns out. Let’s remember that aliens that are legal and have green cards have taxes taken out of their paychecks, thus contributing to the economy. It is essential to weigh the pros and cons as well as the financial impact of cutting these individuals out of insurance benefits/Medicaid coverage that could essentially keep them and keep the economy healthier.
Governor Charlie Christ, Florida’s Governor has been traveling throughout Florida from one end of the state to the other to sign a groundbreaking bill that will offer low-cost insurance to low income individuals and families throughout the state. The policies will be stripped down, but will still cover the necessities.
At this time 21% of Florida’s residents are uninsured, and the bill will help them immensely. At this rate of uninsured residents, Florida is the fourth highest ranking uninsured state in the country. The Governor is most excited about the new insurance bill because of what he feels is one of its best features: it will not cost taxpayers a cent. To be able to provide insurance coverage for those in need and save the taxpayers money is a stunning feat.
Because budgets in most states throughout the country are strained, at best, the states are looking at Florida’s innovative ideas regarding insurance coverage for those who need it most. States are looking to Florida to see how – and if – this can truly work, and whether the plans can work without creating any costs for taxpayers.
Some states are looking at lowering the cost of healthcare rather than covering the uninsured, which may be less expensive on one hand for the states considering this way of dealing with the issue, however, it could actually cost states more because most states have laws that state that hospitals must treat everyone, regardless of whether or not they have insurance coverage or the cash or credit to pay for treatment. As a result, rather than states spending a smaller amount on outpatient services to keep people healthy, they are having to provide much more expensive hospital expenses when people’s conditions become acute and their only remedy is rushing to the emergency room.
Florida is trying to deal with the short term and the long term by covering people and making services available so that they are able to stay healthier and avoid catastrophic health issues, therefore saving the state, the taxpayers and the hospitals substantial amounts of money.
It will be interesting to see how Florida’s new system of covering low income uninsured individuals and families turn out. If Florida is successful n this endeavor, and since it is the state with the fourth highest uninsured rate in the country, their success could lead the way to help people in need of insurance coverage in other states throughout the country.
There is a lot of confusion regarding the difference between “original” Medicare and Medicare Advantage. This article will discuss the basic differences to help you understand what coverage is available and which plans are appropriate for you.
Medicare is made up of two basic categories Medicare (Original Plan) and Medicare Advantage Plan. Both plans have supplemental categories including Part A, B, C, and D.
The original plan includes Part A. You an add part B and D if you choose to. You will automatically be enrolled in original Medicare when you turn 65, unless you decide to choose Medicare Advantage (Part C). The Original Medicare Plan is managed by the federal government as a fee-for service plan with various options and co-pays.
The Medicare Advantage plan combines Part A and Part B and is provided by and managed by private insurance companies. If Part D coverage, which covers prescription drugs, is not included with the plan you purchase, you can purchase it as a separate supplement.
If you choose to Medicare Advantage plans, there are several types of coverage, including HMO, PPO, plans that include private fee-for-service, and Medicare special needs plans.
Part A covers hospital expenses and does not charge a premium. It also covers inpatient care in skilled nursing facilities, critical care hospitals, regular hospitals, hospice services and hoe health care services.
Part B pays for medically necessary services and supplies covered by Medicare. There is a premium for this coverage for most people. Part B covers outpatient, doctors, physical and occupational therapists and additional home health care.
Part C I the Medicare Advantage Plan which covers Part A and B. Though it is provided by private insurance companies, it is still overseen and approved by Medicare. With this program you may have lower costs and usually receive extra services.
Part D is prescription coverage which is a stand-alone plan. Most people pay a premium for this coverage and all medically necessary drugs are covered. There are different plans that cover different drugs. It is important to compare plans to be sure what coverage is best for you.
To be certain that you have the correct coverage, it is best to contact Medicare at 1-800-MEDICARE r visit them on the web at www.medicare.gov.
Recently, we have written about comparisons between premiums for Medicare Supplement Policies, prescription drug policies and the coverage itself. In this piece we will address a study comparing hospitals and Medicare coverage.
The Centers for Medicaid and Medicare (CMS) has created an advertising campaign to the tune of $2 million to help people across the country compare hospitals – in their local area and nationwide.
The internet site is www.hospitalcompare.hhs.gov gives the average amount that Medicare has paid for specific health issues, such as a heart attack. For instance, in Dallas area hospitals, Medicare paid a Denton, TX hospital $10,461. By comparison, for the same treatment, Medicare paid an Irving, TX hospital $4,164.
Why the difference? There are many factors that contribute to the reasons that there are different payments to different medical centers and hospitals for various operations and procedures. A couple of factors that impact price and payments are whether a hospital is a teaching hospital, which incurs more expenses because of the teaching aspect, which can be costly. A second factor can be the financial implications if a hospital treats a high percentage of low-income patients. This becomes a factor because statistics show that often these hospitals are paid less because they depend on Medicare/Medicaid payments which are usually lower than insurance company payments or private payment.
In addition, because of being limited in coverage and finances, low income individuals and/or families often have poorer health.
One of the areas that the site comparing hospitals addresses, is the quality of care in hospitals. For instance, Baylor’s Heart and Vascular Hospital is listed as best at giving patients antibiotics one hour before surgery, following the proven information and statistics that show that doing so saves lives. The site also shows that Baylor has scored high customer satisfaction for is giving patients help and other items that they ask for – quickly – and not making them wait for a long time.
Other areas that the hospital compare program will address are the areas involving chronic lung illness and diabetes. In June, the site will begin reporting the numbers and percentages of deaths from pneumonia, which causes a substantial number of deaths in hospitalizations for many reasons.
There will be more comparisons of diseases and conditions added to the site based on how common the diseases or conditions are and the amount of information available.
If you find yourself in a situation where you may have to go into the hospital, or if you just want to be prepared in case the situation ever presents itself, log on to the hospital compare site at www.hospitalcompare.gov, and compare all the hospitals in your surrounding area. This will tell you how well patients are treated, how well they do after treatment, surgery or other procedures, and which hospitals are being paid how much for the procedure you might be needing. You have information available for free that can help you make one of the most important choices you may ever have to make.
Whether you are a caregiver, a family member or a Medicare – Medicaid recipient, chances are that obtaining durable equipment has not been an easy task over the past few years. The wait is usually longer than what would be desirable or comfortable, the approval process often takes forever and then some – if the approval comes at all, and then comes the price and financial issues.
It is difficult enough to deal with a disability and many of the day-to-day issues surrounding taking care of yourself. When you add the rest of the red tape including approvals, reviews, appeals, finances and more, the difficulties become strong barriers for individuals needing the most help to understand and/or over-come.
There is good news that was just released from Centers for Medicare and Medicaid Services. CMS announced that there are 325 providers who have contracted with Medicare to provide certain services and equipment in 10 communities throughout the country including Kansas City. These providers will provide the services and equipment at much lower prices than Medicare pays now.
CMS sent out a press release stating that Medicare is pleased that beneficiaries living in the first round of 10 communities will be receiving high quality service and supplies they have been receiving, but it will be at a much more cost effective price.
All of the companies that are suppliers have to meet Medicare’s requirements. In addition, they must bid to receive contracts, and companies with the best combination of best bids and best products receive contracts with Medicare. This will save Medicare and Medicare recipients an average of 26%, especially because Medicare recipients must pay co-pays in a lot of situations, so the 26% they save could end up being substantial.
If you have any questions regarding this information, contact CMS. You can go on the internet at www.Medicare.gov, www.Medicaid.gov , or www.cms.gov .
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