Medicare Policies

Understanding Assignment in the Original Medicare Plan

In the Original Medicare Plan, “assignment” is when you make an agreement between yourself, your healthcare providers, and Medicare.  It can be used to limit the amount of out-of-pocket costs you will be responsible for in your health care.  

How assignment in Medicare works is when you choose health care providers already enrolled in Medicare – and who will accept assignment – you then assign Medicare to pay those health care providers. 

A health care provider who accepts assignment will agree to be paid by Medicare and to accept the Medicare-approved amount for services.  They will also agree to charge you (or your other insurance providers) only the Medicare deductible or coinsurance.   

When a health care provider accepts assignment (and in certain situations, they are required to do so), they need to submit your claim directly to Medicare, and should not charge you for submitting the claim. 

If your health care providers do not agree to accept assignment, they must submit a claim to Medicare but can charge you more than the Medicare-approved amount.  Even if they don’t accept assignment, though, they are usually limited in what they can charge (referred to as a “limiting charge”).  This charge can be up to 15% more than the Medicare-approved amount.  Not all services and supplies have a limiting charge, and sometimes you’ll need to pay for supplies or services before being reimbursed later.  

If you need to find health care providers who accept assignment, an excellent resource is

Medicare Costs in 2008

In the Original Medicare Plan, your specific costs will include premiums, deductibles, and coinsurance amounts.  Part A and Part B differ in cost requirements, and your amounts will vary from year to year. 

Usually, Part A doesn’t call for a monthly premium if you or your spouse paid enough Medicare taxes while you were working.  In this case, you will most likely be automatically enrolled when you turn 65.  However, if you don’t qualify for premium-free Part A, your monthly premium for this component of your Medicare coverage can be up to $423.00.  If you have 30 – 39 quarters of Medicare-covered employment, your Part A monthly premium will be $233.00

Your Part A deductible, per benefit period, will most likely be $1,024.00, and your coinsurance amount will be $256.00 a day for the 61st – 90th day each benefit period.  For each lifetime reserve day, coinsurance will be $512.00 for the 91st – 150th day. 

For your Part B, your monthly premium will likely be $96.40.  However, some people will pay more, depending on their modified adjusted gross income.  For your Part B deductible, you will need to pay $135.00 for the year, and then 20% of the Medicare approved amount for services after this deductible. 

To find out more, visit

Medicare Fraud

Medicare fraud is an unnecessary drain on the Medicare system, and can be costing you money.  Instigated by an individual or company, it can be detrimental to both Medicare and the beneficiaries. 

When Medicare is deliberately billed for false services or supplies, which the beneficiary never received, it is called fraud.  This type of fraud can sometimes be the work of a doctor, a pharmacist, another health care provider, or a group of these professionals.  Although most people who work within the system are generally trustworthy, the fact remains that some are simply not.  These few dishonest people are indeed having a negative impact, and, because Medicare fraud can be so costly, beneficiaries may consequently see an increase in their premiums.    

In addition to protecting lower premiums, preventing or catching Medicare fraud can result in a financial reward.  If you report suspected Medicare fraud and your suspicion is reviewed by the Inspector General’s office, if your suspected fraud isn’t already being investigated, and if your report leads to the recovery of a minimum of $100.00, you may be eligible for a reward of up to $1000.00. 

If you suspect Medicare fraud, call your health provider to ensure your bill is correct.  You can also call Medicare to voice your concern or the Inspector General’s hotline (1-800-HHS-TIPS).

Protecting Yourself from Identity Theft

When you sign up for Medicare, you are taking steps to ensure your health needs can be met.  However, at the same time, you should make sure you are taking the necessary steps to protect yourself from those who would take advantage of you and your enrollment. 

For instance, a real risk to those unaware can be identity theft.  Identity theft occurs when your personal information is used by someone else to commit crimes, including fraud.  To protect yourself from identity theft, keep your personal information safe.  Don’t give out things like your social security, Medicare, or credit card numbers to anyone who is not your doctor, a verified health care provider, someone who you know to work with Medicare (like your SHIP), social security, or a plan approved by Medicare.

Make sure, also, that the person you are giving the information to really is the person they claim to be.  For instance, if someone calls or visits you, selling Medicare-covered products, don’t give them your personal information.  Also, if someone calls you, asking for personal information (like credit card number or Medicare number) and claims to be from a Medicare plan, be wary.  Unless you are a member of a specific plan, a plan can’t ask you for any personal information. 

If you suspect you may be a victim of identity theft, call the Fraud Hotline at 1-800-447-8477, or the Federal Trade Commission’s ID Theft Hotline at 1-877-438-4338.

Filing a Complaint about Your Medicare Drug Plan

A Medicare Prescription Drug Plan can be an excellent component in ensuring you have the health coverage you need.  However, even with a carefully chosen drug plan, you may run into issues.  Fortunately, if you are having problems, you can choose to file a complaint with your plan.

A complaint, termed a grievance, can be filed for a number of valid reasons.  For instance, if you have made a first-level appeal, or asked for a coverage determination, and you haven’t received a response in the required timeframe, you may want to file a grievance.  You may also want to file a complaint if your plan has decided not to approve your request for expedited coverage determination or first level appeal.  You may choose to file a complaint if your plan failed to supply you with necessary notices, or if the notices don’t follow standard Medicare regulations.  Another reason you may file a complaint is if feel your pharmacy has charged you more than you think you should have been charged or if you have had to wait an exorbitant time for a prescription.  Finally, think about filing a complaint if you don’t think your plan’s customer service hours of operation are fair or if your plan’s company is sending you materials not related to the drug plan (which you didn’t request).

As an individual with a Medicare Prescription Drug Plan, you have the right to file a grievance with your plan.  You have 60 calendar days from the event leading to your complaint to file.  If you feel you have been treated unjustly, file your complaint as soon as possible.

Policy Change Provides Coverage, in Clinical Studies, of Artificial Hearts

On May 1st, the Centers for Medicare & Medicaid Services announced a change in policy which will benefit patients with severe heart failure.  The new policy allows Medicare to cover artificial heart devices when used as part of a FDA-approved study, as long as the study meets CMS’ clinical research criteria. 

Artificial heart devices are intended to help patients with critical heart failure.  In many cases, the device will help someone survive until a transplant heart becomes available.  They can also be used to prolong the lives of patients unable to receive a transplant. 

Although Medicare has not previously covered the use of this technology, research on the safety and success of artificial hearts has resulted in an important change of policy.  While CMS still does not believe evidence is conclusive on the necessity of the device, they have determined that it can potentially improve health outcomes and should be further researched. Therefore, under certain circumstances, people requiring the life-saving measures offered by artificial heart devices can receive the needed coverage. 

In order to receive coverage, the artificial heart must be implanted as part of a clinical study, approved by the FDA.  The study must be designed to answer one of three specific research questions and meet a number of criteria (available in detail at

The new policy guidelines are intended to protect beneficiaries, since a clinical study will include safety, patient protection, monitoring, and expertise.   The guidelines are also, of course, designed to aid the continuing research on the outcomes of artificial heart technology.  Whatever the reasons or requirements involved in the policy change, it can only mean good news for those requiring an artificial heart. 

Levels of Appeal in a Drug Plan

If your Medicare prescription drug plan won’t provide you with necessary drug coverage or if you feel you were overcharged, you do have the right to appeal. 

Before appealing, the first step in the process is to request a coverage determination, which is a written explanation about your coverage, from your drug plan. In most cases, you must make this request in writing (although some plans do accept phone requests).  Typically, you will find out the decision of the determination within 72 hours of making the request.

If you disagree with the coverage determination, you have the option of appealing the decision.  This “redetermination” is the first level of appeal and must be filed within 60 days from the date of your coverage determination.  (Your plan will give you information on how to appeal).  If your health is in imminent danger, you can file an expedited request; otherwise, you will file a standard request. Standard requests will receive a reply within 7 calendar days while requests that are expedited will receive a reply within 72 hours. 

If you disagree with the redetermination, you can request a review by an Independent Review Entity within 60 calendar days.  This review is called  a “reconsideration,” and must be requested in writing. The IRE should come to a decision within 7 days for a standard review request.  If your request has been expedited, which happens when the IRE or your doctor concludes your life or health is placed in danger by waiting, you will receive a decision within 72 hours.

If the decision of the IRE is not in your favor, you may request a hearing with an Administrative Law Judge.  This written request must be sent, within 60 calender days from when you receive the reconsideration decision, to the location identified in the notice.  In order to receive a hearing with an Administrative Law Judge, the total value of your denied coverage claim(s) must meet a minimum amount. 

If you object to the decision by the ALJ, your next step is requesting a review by the Medicare Appeals Council.  This request must be made in writing 60 days from the date of the ALJ’s notice, to the location specified therein.

If you object to the decision of the Medicare Appeals council, you can request a review by a Federal court.  Again, this review must be made in writing, 60 calendar days or less from the date of the Medicare Appeals council’s decision notice.  As before, the total value of your claim(s) must meet a minimum dollar requirement. 

The levels of appeal are provided to ensure you have a fair chance to have your case heard.  If you disagree with a decision made by your drug plan, you do, consequently, have options.

Requesting a Review from the Quality Improvement Organization

If you feel you are being discharged from a hospital stay before you are ready, you, as a Medicare beneficiary, have the right to ask for a review by the Quality Improvement Organization (QIO). 

To receive a review, you need to contact the Quality Improvement Organization as soon as possible, before you are discharged, and ask them for a fast review.  If you do, you will be able to stay past your discharge date without paying more than applicable coinsurance or deductibles until the QIO is able to make a decision.

Soon after you request the fast review from the QIO, they will notify the hospital.  The hospital will then give you a “Detailed Notice of Discharge”.  This notice explains why your stay is no longer necessary, the connected Medicare coverage rule, and how this rule applies to your situation.  The notice will be delivered to you no later than noon following the day of the QIO’s notification to your hospital.  The QIO will consider your medical information as well as your opinion (or that of your appointed representative), and decide if you are ready to be discharged on the date the hospital set for you.  They should reach their decision within one day after getting the necessary information.  

If the QIO rules in your favor, Medicare coverage will continue for your care services as long as necessary.  If the QIO rules against you, however, you will need to leave the hospital by noon the day after the QIO gives its decisions.  You will not be required to pay any hospital charges occurring before the new mandatory discharge time (outside of applicable coinsurance or deductibles).

The hospital will provide you with the QIO phone number.  You can contact them for more information, or call Medicare at 1-800-633-4227.

Medicare Advantage Plans: Rights and Protections

All Medicare recipients, regardless of plan, are entitled to certain specific rights. However, Medicare Advantage Plans also have additional rights and protections. 

For instance, you will usually have the right to your choice of, and access to, health care providers.  This means that, in many Medicare Advantage Plans, you are able to choose health care providers within your plan in order to get necessary care.  In situations where you have a serious medical condition, you have the right to get a treatment plan from your doctor, which will allow you to see a specialist (within your plan) as many times as needed.  You also have the right to know how your plan pays your doctors. The method of payment should allow you to get the required medical care. 

Like in your basic Medicare rights, Medicare Advantage plans give you the right to a fair appeal process if you disagree with a coverage policy or decision.  You have the right, as well, to a fast appeal in-hospital, and if you believe you are being discharged too soon, you do have that appeal option.  You also have the right to file a grievance over any concerns you are having with your Plan.  Along with these appeal rights, you have the right to have the privacy of your health information protected. 

 If you have questions for your Medicare Advantage Plan, you have the right to call them.  They should be willing to answer any coverage questions you have and give you additional information.

Medicare’s Levels of Appeal

When Medicare makes a decision about a claim, you may not always agree with their determination of costs or coverage for services you received.  Fortunately, you do have the right to file an appeal. 

There are five levels in Medicare’s Appeal Process.  In the first four, if the party reviewing your case is unable to make a decision on time, they may send you a letter asking if you would like to skip to the next step.

The first step is a Redetermination by Medicare.  To receive a redetermination, you must file a written request within 120 days of receiving your notice.  You will send this request to the company that sent you your Medicare Summary Notice.  This notice will contain instructions on how to file. A decision will usually be made within 60 days.

If you don’t agree with the redetermination decision, you can ask for reconsideration by a Qualified Independent Contractor (in writing, within 180 days from when you get your Redetermination Notice). This contractor wasn’t involved in the first decision and will usually make a decision approximately 60 days after receiving your appeal.  (Your Redetermination Notice will tell you how to request this reconsideration). 

If you still don’t agree with the decision, you can request, in writing, a hearing with an Administrative Law Judge (explained in your reconsideration notice).  You must file this request within 60 days after receiving your reconsideration notice, and there is a minimum case dollar amount necessary in order to proceed.  Usually, the judge will make a decision about 90 days after you appeal. 

The next step, if the outcome isn’t satisfactory, is requesting a review by the Medicare Appeals Council.  Your request must be filed within 60 days from when you receive your Administrative Law Judge decision, which will contain details about how to file this next request.  The Medicare Appeals Council should make a decision within 90 days.

The final step is review by a Federal court (provided your case meets the minimum dollar requirement).  Your request for this final step must be made in writing within 60 days from receiving the Medicare Appeals Council’s decision. 

If you disagree with a decision made by Medicare, this process is in place to protect you.  The five steps are designed to give you ample opportunity to have your case heard and to receive fair treatment and impartial consideration.

Protected by the Privacy Practices of Original Medicare

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

Do You Know Your Medicare Rights?

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.

Exploring your Options: Other Medicare Health Plans

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 Designed To Save Money and Protect Patients

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.

New Standards in E-Prescribing Protecting Medicare 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.

Medicare Modernization Act: Providing You Better Care with Medicare

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.

Planning For Later

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…

Does Hospice Reduce Medicare Costs?

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…

Fat And Waiting

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…

SWKAAA And Medicare In Part D Enrollment

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…

Will Medicare Package Be Added?

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…

Medicare, Medicaid and SCHIP Extension Act passed

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…

Medicare Decision Calls For Deliberation

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…

Affluent seniors hit by Medicare’s surcharge – sharp rise in Part B premiums

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…

Colonoscopy? What’s The Need?

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…