Medicare Explained!

Do you know about Medicare and what does it cost? Do you know what medicare cover? Medicare has two parts Medicare Part A and Medicare Part B.
Medicare Part A:  Hospital Insurance and helps to pay for hospital, hospice and home health care.
Medicare Part B:  Medical Insurance and and helps pay for doctors, outpatient care, and other medical services.
Both are very important and depending on ones age, social security status and of course timely application for Medicare.
One retirement planner asked  Charles Schwab's  Ask Carrie the following question;

I'm turning 65 next year. I’m still working and plan to continue for at least a couple more years, so I won't yet file for Social Security. I do, however, want to get Medicare. What do I need to do to make sure I get the right coverage?

I think the answers were great and everyone should read. Take care with Medicare.
Ask Carrie

Physicians With Small Practices Will Be Hurt In the Event Of Medicare Cuts

(Washington) – Noting that many physicians across the country who lead small practices are at a business breaking point, David M. Dale, MD, FACP, president of the American College of Physicians (ACP) testified today before the House Small Business Committee. Dr. Dale emphasized that practices are medicine’s small businesses, where much of their revenue is tied directly to Medicare’s flawed reimbursement rates and formulas.

Approximately 20 percent of ACP members who are involved in direct patient care are in solo physician practices. And, about 50 percent are in practices of five or fewer physicians.

On July 1, physicians face a 10.6 percent cut in Medicare reimbursements. Another 5 percent cut is anticipated on January 1, 2009. The Sustainable Growth Rate (SGR) formula that is used to calculate Medicare payments to physicians was created in 1997 and ties physician payments to growth in the overall economy. When growth in physician expenditures exceeds growth in the economy, the difference is subtracted from physician payments. The SGR formula has led to scheduled annual cuts for six consecutive years.

Earlier this year, ACP surveyed its members to measure the impact of pending Medicare payment cuts on their practices and on their patients. The questionnaire asked internists to report on the changes they would be forced to make if Congress does not act. Although the survey was not designed as a scientific sample, almost 2,000 internists responded, providing ACP with first-hand accounts of how the SGR cuts are affecting millions of Medicare beneficiaries.

Dr Dale cited the story of one respondent, a Texas internist, who said:

“The practice of medicine is a calling and as such, my colleagues and I have endured more unfair revenue cuts than most businesses would have endured. Yet, a medical practice is also a small business, and there are limits to how much we can endure. We are now at the point where further cuts are not survivable. Just like any small business, our revenue has to exceed costs in order to survive. Despite everything that I have been able to do to cut costs, the margin of profit is now thin, and the proposed greater than 10 percent cut will put us out of business. The only option will be to downsize the practice and stop seeing all Medicare patients. I would hate this, but it will be the only option I have if Congress does not reverse the proposed cuts.”

ACP is asking Congress to avert the immediate SGR cut, but also go a step beyond. The College is asking Congress to set a timeline for completely eliminating the use of the SGR formula. ACP also wants Congress to direct Medicare, as part of replacing the SGR formula, to change payment policies to support patient-centered, physician-guided care management based on the patient-centered medical home model of care.

“Medicare patients deserve the best possible care,” concluded Dr. Dale. They also deserve a physician payment system that will help physicians deliver the best care possible, his testimony said.

Contact: David Kinsman
dkinsman@acponline.org
202-261-4554
American College of Physicians

Tags: Medicare, medical insurance, ACP

President George W. Bush signed into law a temporary extension of child health program

CRAWFORD, Texas (Reuters) - President George W. Bush on Saturday signed into law a temporary extension of a popular health insurance program for children after months of deadlock with the Democratic-led Congress.

The legislation extends the program that covers about 6.6 million poor children through March 31, 2009, leaving decisions about renewal to the next president and Congress.

The legislation also provides a 0.5 percent increase for Medicare doctors for six months, delaying a scheduled 10 percent pay cut.

Bush twice vetoed more ambitious earlier bills that would have expanded the children's health program to cover about 10 million children in low and moderate income families, despite bipartisan support.

Bush and Democrats have been locked in a fight over budget and spending and the president said the previous bills were too costly and would push more children into government-run health care instead of private plans.

Bush also objected to raising tobacco taxes to pay for the proposed expansion of the State Children's Health Insurance Program known as SCHIP.

Democrats had hoped for a short-term extension so they could reopen the battle before the November 2008 presidential and congressional elections, but Republicans forced them to extend it through March 2009.

In his weekly radio address, Bush vowed to push for spending restraint and low taxes in his last year in office.

"My resolution for the New Year is this: to work with Congress to keep our economy growing, to keep your tax burden low, and to ensure that the money you send to Washington is spent wisely -- or not at all," Bush said.

Tags: medical insurance, Health Insurance, schip

California State court puts limits on health insurers' policy cancellations

San Francisco Chronicle;

Health insurers can't wait until a policyholder is sick or injured to investigate the person's medical history and then abruptly cancel the policy on the grounds that important information was left out of the original application, a state appeals court has ruled.

On Monday, the Fourth District Court of Appeal in Santa Ana called a halt to a practice that lawyers for policyholders claim is widespread. Known as "post-claims underwriting," it has led to numerous lawsuits - mostly unsuccessful so far - and state enforcement actions against insurers.

The court stopped short of a strict pro-consumer standard advocated by state regulators and plaintiffs' lawyers. But the justices said health insurers can rescind policies after the fact, because of misinformation on the application, only by showing that they conducted a reasonable investigation before issuing the policy, or that the applicant deliberately lied.

California law requires insurers to verify applicants' health information before issuing a policy, rather than waiting until they file a claim, the court said. The purpose is "to prevent the unexpected cancellation of health care coverage at a time coverage is needed most," said Justice Richard Aronson in the 3-0 ruling.

The ruling, the first by an appellate court on the issue, sets a precedent for other cases around the state. It applies only to health plans and insurance policies issued to individuals and their families and not to employer-based coverage, which does not require individual applications.

'CIGNA Should Have Listened to Her Doctors And Approved the Transplant a Week Ago'

GLENDALE, Calif.--(BUSINESS WIRE)--The California Nurses Association/National Nurses Organizing Committee today blasted insurance giant CIGNA for failing to approve a liver transplant one week earlier for listen to 17-year-old Nataline Sarkisyan, who tragically died last night just hours after CIGNA relented and agreed to the procedure following a massive national outcry.

On Dec. 11, four leading physicians, including the surgical director of the Pediatric Liver Transplant Program at UCLA, wrote to CIGNA urging the company to reverse its denial. The physicians said that Nataline “currently meets criteria to be listed as Status 1A” for a transplant. They also challenged CIGNA’s denial which the company said occurred because their benefit plan “does not cover experimental, investigational and unproven services,” to which the doctors replied, “Nataline’s case is in fact none of the above.”

“So what happened between December 11, when CIGNA denied the transplant, and December 19 when they approved? A huge outpouring of protest and CIGNA’s public humiliation. Why didn’t they just listen to the medical professionals at the bedside in the first place?” asked Geri Jenkins, RN, a member of the CNA/NNOC Council of Presidents who works in a transplant unit at the University of California San Diego Medical Center.

On Thursday, CIGNA was bombarded with phone calls to its offices across the country while a rally sponsored by CNA/NNOC, with the substantial help of the local Armenian community, drew 150 people to the Glendale offices of CIGNA – all of which produced the turnaround by CIGNA to finally reverse its prior denial of care.

CNA/NNOC Executive Director Rose Ann DeMoro called the final outcome “a horrific tragedy that demonstrates what is so fundamentally wrong with our health care system today. Insurance companies have a stranglehold on our health. Their first priority is to make profits for their shareholders – and the way they do that is by denying care.”

“It is simply not possible to organize major protests every time a multi-billion corporation like CIGNA denies care that has been recommended by a physician,” DeMoro said. “Having insurance is not the same as receiving needed care. We need a fundamental change in our healthcare system that takes control away from the insurance giants and places it where it belongs – in the hands of the medical professionals, the patients, and their families.”

Contacts

For California Nurses Association
Charles Idelson, 510-273-2246
Liz Jacobs, RN, 510-435-7674
Shum Preston, 510-273-2276

Tags: Health Insurance, health insurance scam, CIGNA health insurance ,

Child Health Bill Vetoed Again By President Bush

WASHINGTON (CNN) -- President Bush vetoed an expansion of the federally funded, state-run health insurance program for poor children for a second time Wednesday, telling Congress the bill "moves our country's health care system in the wrong direction."

In his veto message, Bush said the bill is almost a duplicate of the proposal he spiked in October.

"Because the Congress has chosen to send me an essentially identical bill that has the same problems as the flawed bill I previously vetoed, I must veto this legislation, too," he said in a statement released by the White House.

The bill would have expanded the State Children's Health Insurance Program by nearly $35 billion over five years, the same as the measure Bush vetoed October 3.

The president had proposed adding $5 billion to the program and said the version he vetoed would have encouraged families to leave the private insurance market for the federally funded, state-run program.

CNN

Tags: medical insurance, Health Insurance, schip