Medicare beneficiaries who require assistance with three or more activities of daily living account for up to one-quarter of all Medicare Part A and B spending. This despite the fact they constitute only 7% of the Medicare population, according to a new analysis.

These beneficiaries consume roughly $18,902 each—nearly 4.5 times as much as beneficiaries without disabilities, a new report from Avalere Health finds. Post-acute care services and some other Medicare services that transition beneficiaries from acute to long-term care settings may be soaking up Medicare funds, according to the report. Palliative and hospice care services, both covered by Medicare, experienced significant increases in length of stay between 2000 and 2005 for Alzheimer’s and dementia patients. This suggests that these services are filling a gap in long-term care for demanding beneficiaries.

Avalere Health conducted the study on behalf of The SCAN Foundation.

Monthly premiums for some of the most popular Medicare prescription drug plans in Florida are jumping by at least 20 percent for 2009.Seniors can now start comparing Medicare prescription drug plan choices for 2009 on the Medicare web site: www.medicare.gov. Seniors will be able to sign up for new drug plans starting Nov. 15. Open enrollment in the drug plans ends Dec. 31.

For 2009, Florida seniors will be able to choose from 57 prescription drug plans, compared to 58 plans this year. Monthly premiums for 2009 plans start at $16.70 compared to $12.10 this year. The most expensive premium for 2009 is $111.30 compared to $97.50 this year. Several plans have also increased their annual deductible for 2009.

The data on the Medicare Part-D prescription drug plans for 2009 has now been loaded into the computers and senior citizens can begin exploring their options for the new year. The Centers for Medicare & Medicaid Services has been relentless in warning seniors that the cost of their current plan may increase significantly in 2009 and it is important they explore all the options, including other drug plans or Medicare Advantage plans with drug coverage.

The Centers for Medicare & Medicaid Services (CMS) today announced that beneficiaries, their caregivers, and family members can begin to review 2009 Medicare prescription drug plan and health plan information online through the Medicare Prescription Drug Plan Finder and Medicare Options Compare at www.medicare.gov.

McCain’s top advisers this week said that as president, McCain would cut $1.3 trillion from Medicare and Medicaid. McCain adviser Douglas Holtz-Eakin told the Wall Street Journal, McCain would pay for the high costs of his health care proposal by taking a hatchet to health care coverage for the elderly, people with disabilities and lower-income families. A Center for American Progress study finds that McCain’s plan would force big cuts in benefits or eligibility for these vulnerable populations.

McCain’s call for radical cuts to Medicare and Medicaid will undermine their vital role in our health care system, putting affordable health care out of reach for millions of seniors, people with disabilities, and low-income families, and driving up the cost of health insurance for everyone else.

And why does the McCain campaign support undermining this pillar of retirement security? To pay for a “tax credit” in McCain’s health care plan that amounts to a subsidy for big insurance companies. (Maybe McCain thinks the $2 billion in tax cuts he would give the insurance companies isn’t enough.)

Companies that offer Medicare health insurance and prescription drug coverage can no longer offer free meals during pitches or make unsolicited sales calls, the U.S. government said on Monday.

The insurers also must modify commissions to stop salespeople from switching patients to a new plan each year to earn the highest possible fee, the Centers for Medicare & Medicaid Services (CMS) said.

The changes are meant to “protect Medicare beneficiaries from deceptive or high-pressure marketing tactics by insurance companies and their agents,” Acting CMS Administrator Kerry Weems told reporters during a conference call.

The new rules also prohibit unsolicited door-to-door marketing and pitches in doctors office waiting rooms or other places where health-care is delivered.

Companies that violate the new rules could face penalties of up to $25,000 for each person that was harmed or might have been harmed by the practices, Medicare officials said.

Source:reuters.com

Private Medicare Advantage (MA) plans will be paid an average 12.4 percent more per enrollee in 2008 compared to what the same enrollee would have cost in the traditional Medicare fee-for-service program, according to a new report from The Commonwealth Fund. Even if the payment reductions to MA plans mandated by the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) - scheduled to take effect beginning in 2010 - had been fully in place in 2008, MA plans still would have been paid 10.6 percent more than expected fee-for-service costs.

In the report, Brian Biles, professor of health policy at George Washington University, and colleagues estimate that extra payments to MA plans will amount to $986 over fee-for-service costs for each of about 8.7 million Medicare beneficiaries enrolled in Medicare Advantage plans, for a total of more than $8.5 billion in 2008 - up from $3.9 billion in extra payments, or $795 per MA enrollee in 2004. Extra payments to MA plans between 2004 and 2008 will total nearly $33 billion.

The bulk of these extra payments were mandated by the Medicare Modernization Act of 2003, which was intended to expand the role of private plans in Medicare in an effort to reduce growth in Medicare spending. Since 2004, MA plan enrollment has increased from 4.8 million to the current 8.7 million.

Trying to sift thorugh all of the marketing brochures for Medicare prescription drug plans can be overwhelming. There is so much information that it can lead to much confusion. As it turns out, those brochures do a poor job of meeting the guidelines laid out by the feds.

A report out yesterday from the inspector general’s office in the Department of Health and Human Services found that 85% of marketing materials didn’t meet guidelines set out by the Centers for Medicare and Medicaid Services.

Source:wallstreetjournal.com

U.S. offical stated Monday that starting next year, doctors can earn additional money from Medicare if they use electronic prescribing systems.The bonus program, which will continue for four years, is designed to streamline the prescription process and cut down on errors. In 2009 and 2010, Medicare will give doctors an additional 2 percent bonus on top of their fee for “e-prescribing.” In 2011 and 2012, the bonus will drop to 1 percent, and in 2013, the bonus will drop again to 0.5 percent, officials said.

Source: www.healthday.com

Health insurer WellPoint Inc. announced Monday May 5, 2008 that its National Government Services subsidiary was selected by the Centers for Medicare & Medicaid Services to administer the Medicare Administrative Contract for an area that includes New York and Connecticut.

Under the new contract, the WellPoint unit will perform key administrative functions for Medicare’s contracts with hospitals, skilled nursing complexes and physicians. They will manage all appeals, audit and reimbursement, claims processing, medical review and coverage determinations.

Mercury News.com reported today that a coalition of health care groups have filed a lawsuit against the state of California to prevent 10 percent cuts to Medi-Cal and Denti-Cal payments scheduled to begin July 1, 2008. There are more than 6 million low-income Californians that use Medi-Cal for health care services. The class-action lawsuit has been filed in The Los Angeles Superior Court on behalf of California health care providers. The complaint includes the California Medical Association, the California Hospital Association and the California Dental Association.