Medicare is legally required to protect your privacy when it comes to your personal medical information. This doesn’t mean that your information is never shared; rather, it means that Medicare follows specific practices in order to protect you.
According to Medicare’s “Notice of Privacy Practices for the Original Medicare Plan”, there are a number of instances where they may use and give out your personal medical information. For instance, they can use your personal medical information to provide information to you or to your personal representative and to the Secretary of the Department of Health and Human Services (where required by law).
They may use your information in order to pay or deny your claims, collect premiums, share your benefit payment with your other insurers, or prepare Medicare Summary Notices.
Additionally, Medicare can use your personal medical information to ensure you and other people enrolled in Medicare are getting quality health care. They can use it to provide you with customer services, resolve complaints, or contact you about research studies.
There are also a number of limited circumstances under which Medicare is able to use or give out your personal medical information. These include, but are not limited to, reporting disease outbreaks, investigations of fraud, responding to a court order, and avoiding a severe threat to health and safety. If Medicare intends to use or share your personal Medicare information for any reason not identified in their “Notice of Privacy Practices of Original Medicare”, they are required to receive your written authorization.
To see the complete list of circumstances and to find out more information about Medicare’s Privacy Practices, visit http://www.medicare.gov/privacypractices.asp.
If you have Medicare insurance, you are automatically guaranteed a number of specific rights, no matter what plan you have enrolled in. The set of rights pertain both to recipients of the original Medicare Plan (regardless of whether or not they have a Medigap policy) and to recipients of Medicare Advantage Plans.
You have the right to be treated with dignity at all times, whatever the circumstances. You also have the right to be protected from discrimination. Legally, no company should be treating you differently than other recipients due to your race, national origin, religion, disability, age, and gender (unless for certain medical reasons). Additionally, you can expect to receive culturally competent service, in terms of language and cultural sensitivity. If you are concerned that your rights are being violated, or if you need information on health care services in other languages, you can call your state’s Office for Civil Rights (1-800-368-1019).
You also have the right to obtain information about Medicare to help you make sound health care choices. Relating to coverage, costs, and complaint procedures, this information can help you understand your options. If you have questions about the Medicare program, you have the right to receive a response. For answers, you can contact your State Health Insurance Assistance Program, or call 1-800-MEDICARE. If you’re using a Medicare Advantage Plan, you can get in touch with your plan.
You have the right to learn about your treatment options in a way you can understand. Plans cannot have any rules which will hinder your doctor in disclosing treatment information. If you don’t understand something, or need more information, ask. You should be given clear information.
Another expectation you can hold when signing onto a Medicare plan is that you will be able to get emergency care when necessary. Different plans may have different procedures, and some may involve copayments, but all plans should provide some coverage for your emergency medical situation. If it doesn’t, you can appeal the decision. You have the right to know your appeal rights, appeal benefit decisions, and file a complaint about payments, services, quality of care, or other problems.
Finally, you have the right to your privacy. Medicare must keep your health information private, and any time they ask health questions of you, they must stipulate why they need it, whether or not it is optional, what will result if you don’t give the information, and how the information will be used. Your health care provider or Medicare Health Plan must follow federal law protecting your privacy rights. Your state may have other privacy laws as well, which can protect your personal information. You have the right to know what your privacy rights are. Your plan should describe them in writing, and you have the right to find out more by asking questions about them, exercising them, and filing a complaint if you feel these rights are being violated.
Medicare Advantage Plans and Original Medicare may also promise other rights, in addition to these ones, to further protect you.
So, you’re familiar with Original Medicare. Perhaps you’ve even researched the Advantage Programs. But did you know that you may have a third option? Medicare offers, in many places, other Medicare health plans worth considering.
Like Original Medicare and Medicare Advantage Plans, the other Medicare health plans will provide you with your hospital and medical insurance, or Part A and Part B. Some also include the option of prescription drug coverage (Part D) or allow you to purchase a Medicare Prescription Drug Plan. The three types of other Medicare health plans include demonstrations or pilot programs, Medicare Cost Plans, and Programs of All-Inclusive Care for the Elderly (PACE).
Demonstration, or pilot, programs are used to test Medicare improvements. These projects are offered to a specific group of people, in specific locations, in order to test improvements in coverage, payment, and care quality. Right now, Medicare is offering a pilot program for people with Medicare who have at least one chronic illness.
Medicare Cost Plans, also available only in specific locations, work much like Medicare Advantage Plans, except that if you need services that are not within the plan’s network, the Original Medicare Plan will pay your Medicare-covered expenses.
PACE, or Programs of All-Inclusive Care for the Elderly, provides long-term care services for elderly people who receive community health care. Available only in some states, PACE serves as an alternative to a nursing home. If you are eligible for nursing home care and are at least 55, PACE can supply you with social, medical, and prescription drug coverage.
Choosing a Medicare plan is an excellent way to prepare for your future. By examining your available options, you will be able to chose the plan that fits your lifestyle. To find out if there are any demonstrations, Cost Plans, or PACE in your area, call your State Medical Assistance Office.
Changes in Medicare policy this year will effectively save the system money and protect patients while in hospital, according to Ellen Griffith, the Centers for Medicare and Medicaid Services public affairs specialist.
Beginning October 1st, 2008, any of eight preventable conditions occurring in-hospital will no longer be the responsibility of Medicare. In the past, Medicare would pay for the initial diagnosis as well as any further diagnosis, even when resulting from accidents which happened while the patient was in the care of the hospital. Now, because Medicare will no longer be covering the cost of these second diagnoses, and the hospitals cannot charge Medicare patients for this procedure not covered by Medicare, the resulting expenses will consequently fall on the hospital itself. These changes, supported both my Medicare and by a number of hospitals, should save Medicare $20 million dollars during the first year while encouraging hospitals to take further steps in preventing hospital injuries.
The accidents no longer covered include three types of infections; vascular catheter-associated infection, which results from installing a catheter in conditions which are not sterile, catheter-associated urinary tract infections, and surgical site infections, also resulting from less sterile circumstances. The other accidents which will now be the responsibility of the hospital are objects left inside patients after surgery, pressure ulcers or bedsores, blood incompatibilities, air bubbles blocking arteries or veins, and falls.
What this means for you is that if you require in hospital care after October 1 and are injured in a way which could have been prevented, neither you nor Medicare will need to worry about the costs.
Many hospitals, however, have already been using careful monitoring and specific procedures created to prevent hospital related accidents. As a result, a number of hospitals report success in drastically reducing these hospital errors and further protecting the care of their patients.
If you are currently enrolled in a Medicare prescription drug program, or are planning to enroll, you will be pleased to hear that Medicare has been working on improving their standards when it comes to Part D e-prescribing. New regulations, issued on April 2, 2008 and coming into effect April 1, 2009, are designed to promote clearer communication between your pharmacist, your doctor, and your prescription drug plan sponsor, to save money by offering generic drug alternatives, and to limit your chances of having an adverse reaction to the drug or drugs you are prescribed.
The way the new standards work is by creating four categories of information – or four standards – which will be used consistently in e-prescribing. These categories will work together to protect you.
“Formulary and Benefits”: This first standard will be used to deal with the coverage you are receiving in your chosen Medicare prescription plan. It will let doctors take into account which drugs are covered in your drug plan and look into the possibility of other generic prescription drugs that may be less costly to you.
“Medication History”: The second standard will have doctors, pharmacists, and other health care providers sharing information about the medication you have been, or are currently, taking. By sharing this information, your health care professionals will be able to greatly reduce the chance that you’ll have an adverse reaction to the medication, which might otherwise result from that drug’s reaction with another medication.
“Fill Status Notifications”: In the third standard, doctors or other health care providers will be notified electronically when you pick up your prescription. This also serves to protect you, since it allows your doctor to know if you have been taking your medication and further helps him/her care for your medical needs.
“Provider Identifier”: Finally, the last standard will increase the programs efficiency by requiring providers to use the National Provider Identifier – or NPI – for health care providers in any e-prescribing dealings. What this does is make obsolete the need for pharmacies and medical offices to personally verify the authenticity of prescribers.
With these new standards in place next April, you should notice an increased efficiency and level of safety in e-prescribing. Some changes, we see, are definitely good.
Under the George W. Bush administration, one of the policies is to provide seniors and people with disabilities cheaper medicine and better health care. Because of this, President George W. Bush signed the Medicare Prescription Drug, Improvement and Modernization Act of 2003.
Under this act, Medicare went through some changes in its system and provided improvements in terms of providing better coverage for senior health care.
Because of the news, a lot of Medicare beneficiaries began looking up or researching about the news that they will be able to finally get a prescription drug plan. When the specifics of the drug plan were revealed to the public, it was apparent that there were a lot of people who weren’t satisfied with the offers and some beneficiaries were even outraged.
However, as time passed, the plan became more and more accepted into society and the CMS created updates to provide the public with information on the efforts that CMS is doing to implement a new legislation to further improve the plan.
The great thing about the Medicare Modernization Act of 2003 is that older Americans or seniors will now be able to have better choices when it comes to their health care. They will be able to get modern medical care that they deserve and will receive the best health care treatment possible.
These are the things that you need to expect with the Medicare Modernization Act of 2003. As you can see, not only that it will provide you with better health care options, but it will also give you access to prescription drug plans that have never existed with Medicare before.
The statistics for expenses incurred at care giving nursing homes and doctor visits for seniors are quite shocking. Long term care means your bill can go up to $300/day which means that in year you can spend about $50,000 quite easily.
You have three options when it comes to paying for this type of care. The first is to be self insured, the second is public assistance and the third is long term insurance. Read more…
A new study of hospice care in the United States shows that Hospice services are able to save money for Medicare and bring superior care to patients with chronic illnesses and their families, according to a release from Kaua‘i Hospice. The study done by the Duke University had appeared in the October 2007 issue of the professional journal Social Science & Medicine and had included the following observations:
For one, Hospice has helped reduce Medicare costs by an average of $2,309 per hospice patient. And the use of hospice has decreased Medicare expenditures for people who suffer from cancer until the 233rd day of care and for non-cancer patients until the 153rd day of care. Medicare costs have been reduced for 7 out of 10 hospice recipients if hospice has been used for a longer duration. And by increasing the length of hospice by just three days, the savings due to hospice increases by nearly 10%, from around $2,300 to $2,500 per hospice user. Read more…
People who are very obese who need a kidney transplant have lower chances of getting a kidney than those who are not. And if their name does pop up on a waiting list, it is after an average of 12-18 months, according to a new study.
The reason behind this trend is both medical and economical. People who are very obese have far greater chances for complications, and the additional cost to bear these problems fall onto the transplant centers. The study shows that patients who average around 100 pounds over their ideal weight were 44% less likely to get a transplant while those who are just slightly obese were 28% less likely to get a transplant. Read more…
The Southwest Kansas Area Agency on Aging had combined itself with the Department of Health and Human Services and the Centers for Medicare & Medicaid Services for a Medicare Part D Fall Annual Enrollment event on The 12th of December 2007 at Dodge City. The event was held at The Learning Center, 308 West Frontview Street, on US 50 Bypass next to True Value.
People were advised to bring their Medicare cards, their list of medications, dosage and how they were administered. Social Security and SRS was available to check whether beneficiaries could qualify for Extra Help or Medicare Savings Programs. The federal and state programs assisted people with Medicare who were not capable of affording their prescription drug costs. Read more…
The legislation that could thwart middle-class U.S. citizens from paying the alternative minimum tax was moved to the House floor recently and did not contain any of the Medicare provisions that would hold up the scheduled 10% fee cut for physicians. Senate Finance Committee Chair Max Baucus had said that, “Medicare probably has to go with AMT” as the measure is “very bipartisan”. However, the House made the conclusion to move along with the AMT measure derailing one of the best options for a Medicare package and increases the possibility that the Medicare physician fee cut will take effect Jan. 1, 2008. Read more…
On December 18, 2007, the U.S. Senate unanimously passed the Medicare, Medicaid and SCHIP (State Children’s Health Insurance Program) Extension Act of 2007 (S.2499). Besides other points, the Act thwarts the 10.1 percent cut to Medicare physician payments beginning on January 1, 2008 and as an alternative, gives a 6-month 0.5 percent increase for physicians through June 30, 2008. With the Act, the physician payment changes would be offset by an adjustment to the Medicare Advantage stabilization fund. The Act has been sent to the U.S. House of Representatives. Read more…
If one subscribes to the Medicare Advantage plans then you are opting out of the traditional Medicare plan and choosing a fee for a service insurance plan which is managed by a private company and not by the federal government. The private companies gain as they now get all the money that social security deducts from Plan A and B and from the government for taking care of our health care.
For information on this Plan C you need to talk to your local senior center and even the companies who sell these plans. What cannot be ignored is the fact that if you need medial attention and you have the Medicare Advantage Plan then first you must check to see if the physician or medical center you wish to go to will accept this plan or not. If it does not then you have to find one which does which is not easy. Read more…
The federal health insurance program in place for people over 65 and the disabled – Medicare covers care of the outpatient and visits to the doctor. Last January there were surcharges added to Part B of this program.
The reason for this increase in surcharge has been defined as a way of increasing the percentage of cost care which is paid by the richer Medicare receivers. As per tradition the government would pay 75% and the individual 25%. But for high income people it now ranges from 35%, 50%, 65% or even 80% of the cost of the program. The extra funds help Medicare augment doctor reimbursements, other providers and fund growing bills. Read more…
Colon cancer is the second major cause of cancer deaths. According to the latest reports from the Agency for Healthcare Research and Quality, less than 50% of Americans who are over the age of 50 have had a screening of the colon done.
Now when this is broken up, the picture that emerges is even clearer. Among the whites, there was no screening done for over 47%, while for the blacks it was over 55%. Among the Hispanics though, the figure goes to a little under 70% and this rises even further when it comes to older people who are not insured. Read more…
That change is necessary in a failing healthcare system is evident. When it is endorsed by 124,000 physicians which is what the American College of Physicians comprises of, it is perhaps imperative.
Thanks to an increase in administrative costs, healthcare costs continue spiraling upwards. Access to healthcare is getting worse and there are fewer and fewer primary-care physicians. This is why the ACP is backing this whole idea of a single-payer health care system. Congressman Dennis Kucinich who co-authored HR 676 or Medicare for All was very pleased with the support extended to this new healthcare reform by this large body of medical personnel. The bill, which was introduced in the beginning of 2007 has 86 cosponsors. Read more…
As it stands today, Medicare for seniors means treatment of ailments by doctors attached to the Medicare schemes. There does not seem to be any incentive for doctors to do more. Maybe it is a question of reimbursement. However, what most patients can expect right now is diagnosis of current ills and medication for them.
However, it might be a lot more fruitful in the long run if prevention of ailments were to be given importance. If seniors were given more information about fitness, prevention of heart problems and good nutrition, it would be better for them and better for all of us as a nation because of the considerable amount we could save on healthcare costs. Read more…
Well, that could be rather too drastic to contemplate. So many Medicare beneficiaries are in this terrible situation where they can’t seem to find doctors who will be reimbursed. When this affects the doctors they have been seeing, it really puts the fear into them.
Bad enough that old age finds a certain security in routine and familiar faces, but to have to go looking around for doctors who are disappearing off the Medicare list can be a daunting and tiring process. Read more…
Many seniors move to sunnier climes when they retire and this process seems to more a matter of how brightly the sun shines than whether or not their healthcare plans will change or not. Do these plans really change when someone moves from one place in the US to another?
The thing is that costs do vary from place to place and it might be a good idea if seniors were to look at this aspect as well when they decide to move after retiring. There should be a checklist that includes a lot more than just the weather though it is an important reason for the move. Read more…
Come mid-December and CMS or the Centers for Medicare and Medicaid Services will decide whether OSA or obstructive sleep apnea that is treated at home can be covered. This will mean a huge step forward for F & P Healthcare with its headquarters in New Zealand.
Fisher & Paykel Healthcare are among the leaders in treating OSA and they manufacture heated humidification devices which are used in respiratory care and portable monitoring machines. Under the Medicare conditions currently prevalent, anyone with this condition has to go to a registered laboratory to get it diagnosed and treated. Read more…
The first and most important thing to remember when it comes to Medicare fraud is not to give out any personal information. You might have people coming to your door trying to sell you Medicare products but you must remember that they can give you information about what they are selling – they have no right to ask you for any personal information and they do not have the authority to enroll you in any plan.
Just in case you are not sure about any plan, do call 1-800-MEDICARE and make sure. Whoever comes to the door selling plans has to do just that – he can give you or mail you information but he cannot sell you a plan at the door. So the onus is on you to keep yourself safe from anyone who is trying to steal your personal information. Keep tabs on your coverage plans and read the Medicare Summary Notice carefully, paying attention to all the items listed. Read more…
Being covered under Medicare can indeed be very convenient. With it, most of your medical expenses will be paid off and all your healthcare needs will be taken care of. However, you need to remember that Medicare has some gaps in its policies. There are certain areas that Medicare cannot cover. For this, you will need to get the Medicare Supplemental Insurance or Medigap.
Basically, Medigap is sold by private insurance companies to provide people the option to have an insurance policy that can cover the gaps that your original Medicare policy cannot cover. What this means is that Medigap will be able to help pay for the healthcare expenses incurred by you that your original Medicare plan does not cover. Read more…