Medicare News
BIO and American Academy of Physician Assistants Applaud SCHIP Renewal
Both the Biotechnology Industry Organization and American Academy of Physician Assistants are happy with the passage of SCHIP. Both Congress and President Obama have been applauded. BIO has applauded the passage of SCHIP because it supports universal healthcare. It is very essential for everyone to be insured. BIO and its associates look at expanding the fringes of available health care – bringing to life innovative therapies which patients can benefit from.
The opportunity to work with policy makers is welcomed by BIO so that access to innovative health therapies are made available. In addition the American Academy of Physician Assistants which represents almost seventy five thousand physician assistants in the US has applauded President Obama and Congress as well.
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SCHIP Expansion Okayed
Wednesday saw President Obama moving towards fulfilling another of his promises. He signed bill HR 2 into law. This bill expands the reach of SCHIP to 4 million additional children. This according to President Obama is the beginning of his goal of universal health coverage. The final bill was earlier cleared by the house 290 to 135 in favor of the bill.
In the absence of congressional action SCHIP was set to expire on March 31 this year. According to the provisions of the bill families with incomes of upto thrice the federal poverty level qualify for this program for their children. In New York and New Jersey even children from higher income families will be able to qualify for this program.
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Copayment Increase In Massachusetts
The Prescription Advantage program in the state of Massachusetts has suffered a $11 million cut. Due to this cut, larger drug copayments will have to be made by more than 44,000 Massachusetts seniors. Seniors meeting a particular income eligibility requirement are provided copay assistance by the Prescription Advantage program.
There has been a $1bn state budget reduction by Governor Deval Patrick. As a result copays may double or triple for many seniors. Effective from Jan 1st, only if Medicare and the beneficiary combined have spent $2700 then state assistance for covered drugs is available.
CMS’ Final Attempt to Privatise Medicare Invokes Dismay Among Advocacy Groups
Medicare beneficiary representing organizations expressed dismay at the release of the Medicare Advantage/Prescription Drug Plan Call Letter. Private insurance companies that want to contract with Medicare have been given instructions via this call letter if they want to provide drug and health coverage. The letter was released earlier than previous years. The early release may be to make sure leniency continues in the oversight of private plans for at least another year. There may also be a last ditch effort to promote private Medicare Advantage plans.
According to Judith Stein from the Center For Medicare Advocacy, this letter shows how Medicare has failed to oversee highly priced and low value private insurance plans. The problem is not addressed by this call letter and discriminatory pricing continues for more costly services.
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Beneficiaries should renew their prescription drug coverage and health plan needs for 2009
Medicare beneficiaries have been encouraged to review their presciption coverage and plans. The annual open enrollment period begins on 15 Nov and goes on till 31 Dec. For Medicare Advantage (MA) plans, one change in enrollment can be made by beneficiaries. The can cancel a plan, change a plan or enroll in a new plan. This period between Jan 1 and Mar 31 cannot be used to start or stop drug coverage. Neither can you enroll or disenroll in a Medicare Medical Savings Account Plan.
Meanwhile efforts to fight Medicare waste, fraud and abuse are being sought to be strengthened. CMS has announced that certain durable medical equipment suppliers will be needed to post a surety bond. Billing privileges of more than 1,100 medical equipment suppliers in Florida and Southern California have been revoked.
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Patients May Not Choose Quality Care Due To Plan Restraints
Recent studies on health care have been reviewed and have given interesting information. If patients are not cost constrained and do not have limited accessibility to doctors then reports that are made public about health care quality could motivate patients to choose better plans.
Medical Care, Jan 2009 issue had these findings published. This clarifies to some extent the reason for people repeatedly wanting better care but not prioritizing it when choosing providers. When individuals choose health care plans less than 5 percent said that their choices were based on quality information about the plans.
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Lower Costs As A Result Of Medicare Public Buy In Predicted
Health care reform options have been compared in a Congressional Budget Office report. The comparision shows that if Americans are allowed to buy into Medicare before they turn 65, more people would have health coverage with a lower payout than private insurance.
The effects of a limited buy in option for those between 62 and 64 years was studied by the CBO. According to this estimate a single coverage in 2011 would be about $7600 a year and a private policy would cost roughly double this figure. In 2006 about $10200 was spent per Medicare insured person by Medicare. This includes an older and sicker population than the one the buy in program is looking at.
Health Care That Benefits The People
The Obama administration that is coming into office is asking the people to help create the ideal health care policy. The people can do this by hosting a meeting and inviting intelligent people who can contribute their discussability. You get to check out the Obama team proposal and communicate with the transition team your ideas for the betterment of the proposal.
Public Interest Law Firm May Sue West Virginia Medicaid Program
The West Virginia Medicaid Program may be sued by a public interest law firm. The firm is based in Charleston, W.Va. The lawsuit to be filed against the State’s Medicaid office is based on the allegation that federal law has been violated by the West virginia Medicaid Program. Benefits for children whose parents do not put pen to paper on a personal responsibility statement have been reduced.
Prescription Cancer Drugs to Be Dearer in 2009 For Medicare Patients
Out of pocket expenses will increase for Medicare Part D cancer afflicted beneficiaries. There will also be increased restrictions on such patients. This comes out of research by Avalere Health and ACS CAN.
Brand name oral cancer drugs have been shifted to higher formulary tiers over the last four years. This means that every year the products have cost consumers more.
Sen Kennedy Praises Proposal
A new proposal unveiled that proposes universal health care has been praised by senator Kennedy. The proposal came from the health insurance industry. America’s Health Insurance Plans or AHIP has offered this proposal. This proposal follows the proposal by Max Baucus on these lines as well. Sen Ted Kennedy, D- Mass has pledged to move quickly on this issue the next year.
The focus of the AHIP health care plan is to reduce growth of health care expenses across America by 30 percent. If this target is achieved then expenditures would reduce by over 500 bn between 2010 and 2014. There is a greater sense of optimism after the announcement.
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Eliminate 2 Year Waiting Period For Medicare Qualification for Disabled Say Lawmakers
More than 75 advocacy groups for the disabled as well as lawmakers have started to lobby for the wait time for the disabled to qualify for Medicare to be eliminated. This according to a report from the AP/ San Francisco Chronicle. According to the current rule, when the social security administration deems people ill or disabled then they are eligible for Medicare benefits after only a two year waiting period.
Comprehensive Health Reforms Coming Up
Congressional activity has heightened on comprehensive health reform. The various committees – Finance, Pension and Labor, Health, Congress have started making efforts toward drafting comprehensive health reform legislation. There is a united Democratic effort to pass legislation based on President Elect Barack Obama’s health care plan.
Based on the plan, health care would be expanded to include more US citizens. There have been roundtable talks involving Democratic lawmakers, but meetings with Republicans would begin soon. There is emphasis on a “One Bill” approach which many feel is the best and perhaps the only way to do things. Read more…
Medicaid Pilot Program Expansion Recommended By Florida Agency
Last week a proposal was sent to Governor Charlie Crist by the Florida Agency for Health Care Administration. The proposal recommended and expansion of the Medicare Managed Care Pilot Program to 20 more counties. This pilot program is currently operational in 5 counties. It requires that beneficiaries sign up for managed care plans. The plans are mostly HMO’s that offer some additional benefits but can also be limited by choice.
Part of the request is an increase in Medicaid payment to specialist. This is likely to increase access to beneficiaries. At the same time as the proposal, there is also a request from Governor Crist that staff be reduced by ten percent. The agency has agreed to comply with this proposal.
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Utah Set For Change?
The Utah Health System Reform Task Force is in preparation to make it’s recommendations. The aim is to overhaul the state’s health care system. This, according to the Salt Lake Tribune. According to Mark Bair, Chair of the work group of health care providers, all uninsured people would need to obtain coverage to work. This will need affordable and portable health plans which will be issued on a modified community rating. Residents who already have health issues will have to be provided coverage.
According to Bair, shopping for health insurance needs to be made easy via a website that gives information on all the available choices. Also tax advantages and choices would need to be maximized. The medical malpractice system needs an overhaul. There have to be incentives for people to live healthy.
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Health Coverage Does Not Expand due to weakened Economy
Health insurance coverage has not expanded in Pennysylvania or other states due to the weakening economy. California, Illinois and New Mexico are with Pennysylvania on this, lawmakers could not agree on how the plans were to be funded. According to Diane Rowland, Executive VP, Kaiser Foundation, it is not easy to reform health laws at the state level.
This job is easier when the economy is good and difficult when the economy is not healthy. Massachusetts is the state with the greatest degree of success in health care reform and reducing the ranks of the uninsured.
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Obama Good For Health Care Feel Seniors
The SeniorTrax Survey of the people over 65 was released by DSS Research. DSS is the largest firm that deals with market information needs of health/insurance companies. In the recent survey which happened in early September 580 seniors were surveyed. They felt that health care under Barack Obama would be better than under John McCain.
Only 8.9 percent of respondents felt that health care in the Us would improve under McCain. Higher income seniors tended to prefer McCain more while lower income ones liked Obama. Among the seniors health care is naturally an important issue.
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Low Income Residents May Have Fewer Insurance Options
Except Wisconsin, all states that are a part of Medicare Prescription Drug Benefit plans will be able to choose from a smaller variety of plans than before. Free standing plans of this type are set to decrease from 500 to 308. Part D premiums have to be below a certain standard for insurers to qualify to offer insurance to lower income beneficiaries. In a report featured on USA Today, the insurance premium has been raised by many companies so that they have become ineligible to offer services to lower income people.
The amount of low income beneficiaries who are under part D and who will have to change to new coverage is set to rise by 100,000 from 1.2 mn to 1.3 mn. The actual number of low income beneficiaries was just 250,000 in 2007. In Nevada, low income residents will have only one stand alone plan. People from Arizona will have two.
Humana operates in 43 states but in 2009 it will not offer low income plans to any of these states. Only 14 states will feature Cigna offering low income plans. United Health Group will however increase the number of states it offers low income plans in this year to 42 in 2009. This year that figure was just 30.
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Medicare Appeals Problems Concern Senate Finance Committee Leaders
Max Baucus (D-Mont) and Chuck Grassley (R-Iowa) sent a letter, recently to HHS Secretary Mike Leavitt voicing their concern about problems in the Medicare Hearings and Appeals office according to a report by CQ Healthbeat. A July report by the HHS office of Inspector General was cited. A number of problems were found at OMHA.
OMHA was established by the 2003 Medicare law for conducting administrative appeals heard by the Social Security Administration. The report says that 35 percent of appellants who were interviewed by HHS OIG had stated that hearings through video teleconference were not allowed to them.
Medicare Beneficiaries Need To Review And Compare Drug Coverage
The 2009 Medicare prescription and Medicare Advantage plan options were announced by CMS Acting Administrator Kerry Weems. About 97 percent or medicare beneficiaries who are enrolled in a PDP will be able to access Medicare drug and health plans in 2009. The premiums would be less than those of 2008 or the same.
In the fourth year of Medicare Part D prescription drug program, there was a high rate of satisfaction among beneficiaries as well as a high rate of participation according to Weems. There is a change in offerings from plans from year to year. It might be better for beneficiaries to review and change their plans if necessary in their best interest.
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Virginians Against McCain on Health Insurance
After the upheaval on Wall Street last week, concerned Virginians held a conference outside McCain;s campaign headquarters in Arlington. The issue was to challenge a new article by McCain in a magazine. In the article McCain calls for deregulation of health insurance. He equates this deregulation to the way the banking sector was deregulated.
This article was published in the September/ October issue of Contingencies. This is the magazine of the American Academy of Actuaries. McCain is looking to put American health care in grave risk with his approach to the same. According to McCain opening up health insurance to vigorous nationwide competition will benefit the American people.
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Universal Health Care Gets Thumbs Up From Live Audience
Universal Health coverage should be the federal governments responsibility was the topic of debate in a contest sponsored by the Rosenkranz Foundation. At a packed hall in the Rockefeller University’s Caspary Auditorium in New Your City, 58 percent voted for the motion and 34 percent voted against it at the debate conclusion.
The Speakers were Art Kellerman, Paul Crugman, Michael Rachlis, Michael F. Cannon, Sally C. Pipes and John Stossel. The debate was moderated by John Donvan an ABC News correspondent. Robert Rozenkranz, chairman of the Rosenkranz Foundation said he was thrilled with the way the third season had started. Lively debate of important issues is very important he said. Read more…
The Disabled Can Now Make Better Insurance Decisions
Allsup is expanding the services it offers to people with disabilities. The Allsup Medicare AdvisorSM offers personal unbiased help to the disabled when making Medicare choices. Both financial as well as health well being is taken care of by this program. Allsup has been representing tens of thousands of people in the SSDI program each year.
Says Paul Grada – there are dozens of Medicare programs but all are not equal. Selecting the optimalMedicare program is not easy – it is a challenge in itself. Even after spending hours going through plan information, people may pick the wrong plan. The Medicare packages are fairly complicated and this is why professional help is needed to pick the best Medicare plan for a person.
Home Based Care Preferred to Institutional Care By CMS
Over 8 Million dollars in federal grants is to go to seven states. This is part of an effort to increase awareness of alternative long term care options. The alternative to traditional nursing homes is home and community based long term care options. This has come out of a statement by Acting Administrator, CMS, Kerry Weems.
The grant money is part of the RCSC grant program. The Real Choice Systems Change is meant to help a rebalancing of long term support programs by states and territories in a manner that people with chronic illnesses or disabilities who reside in their homes and participate in community. Read more…
Medi-Cal Reimbursement Rate Reduction Repayment only For Services After Aug 18
An order reversing a 10 percent reduction in Medi-Cal reimbursement rates has been amended. The reduction was for heath care providers, which is now only for services on or after Aug 18. The state is now spared a lot of money in reimbursements – tens of millions of dollars.
Gov. Arnold Schwarzenegger and California lawmakers in February approved the reduction to address the estimate $15.2 bn state deficit. US district judge Snyder issued an injunction requiring Cal to reverse the reduction.
