Texas Medicare News & Information

5 Most Popular Searches

michael — Sat, 26 Jul 2008 17:16:22 +0000

Texas Medicare Supplement

5 Most Popular Searches

People find my texas medicare supplement help website using several different search phrases.

Here are the 5 most popular search phrases for Saturday, July 26th 2008:

Paxil CR® is now available in a generic form The patent for Paxil CR expired in May 2008, and it is now available in generic form, Paroxetine HCL. Paxil CR is used to treat depression and various mood disorders. Generic Paxil CR, Paroxetine HCL,...

Medicare Improvements for Patients and Providers Act of 2008

michael — Wed, 23 Jul 2008 03:24:33 +0000

Texas Medicare Supplement

Medicare Improvements for Patients and Providers Act of 2008

How will this change affect Medicare Advantage recipients?

Now that the bill has become law, many Medicare Advantage members are concerned. Although it’s still too early to say exactly how this legislation may impact your clients’ coverage:

• No changes are being made at this time. Your clients’ current coverage remains the same.
• In the future and in some areas of the country, this legislation will likely shift some of the healthcare cost burden from the federal government onto seniors and disabled individuals.

Humana will continue to inform its valued members and agents about any changes before they happen.

H.R. 6331 contains new marketing rules for Medicare Advantage and PDP plans. It also contains several changes that affect Medicare Supplement (Medigap) plans. Most notably, it requires MA plans to establish new sales and marketing practices starting with the 2009 plan year.

Those standards are similar to what America’s Health Insurance Plans (AHIP) and Humana previously recommended, including more stringent standards in areas like cold-calling, cross selling of non-health related products, consumer disclosures, and agent training and certification.

Humana’s position

Humana vigorously opposed this bill because members could see future reductions in benefits, healthcare options, and plan choices, as well as increased out-of-pocket costs, as a direct result of H.R. 6331. With the override vote, Congress eliminated a pending 10.6 percent Medicare payment rate cut for physicians treating Medicare patients that was set to retroactively take effect on July 1.

“While Humana is opposed to cuts in physician payments, we do not believe it’s a fair trade-off to pay for increased payments to physicians by uninsuring vulnerable seniors who cannot afford to lose comprehensive healthcare coverage,” said Heidi Margulis, Humana’s senior vice president of Government Relations.

Humana’s outlook remains positive

Humana has been in the Medicare business for more than 20 years and is well positioned to continue its growth, even with the enactment of H.R. 6331. We anticipated that the PFFS product would eventually be transitioned to network-based products, and we have made considerable progress over the last few years in developing HMOs, local PPOs, and regional PPOs in dozens of new markets.

While the legislation would phase-out Indirect Medical Education (IME) payments, Humana’s network-based MA products are generally not located in areas with large numbers of academic medical centers, which for us, significantly reduces the impact of this phased reduction in MA payments.

Over the next several months, Humana will complete a detailed county-by-county assessment to gauge the impact of the 2010 phase-out of the IME payments across MA product service areas. In addition, we will identify those counties that would be exempt from the PFFS product-contracted network requirement because fewer than two MA network-based plans are offered. This information enables us to gauge the financial impact and potential disruption for our MA customers.

[Excerpt from email to Humana Agents 7/22/2008]

Save money! Get your free texas medicare supplement quote today.

Impact of HR 6331 [This is an open letter from Michael J. Burke at Coventry] July 15, 2008 Last Wednesday, the U.S. Senate voted in favor of the Medicare Bill (H.R. 6331), which successfully blocks a cut in Medicare...

Impact of HR 6331

michael — Tue, 15 Jul 2008 16:46:22 +0000

Texas Medicare Supplement

Impact of HR 6331

[This is an open letter from Michael J. Burke at Coventry]

July 15, 2008

Last Wednesday, the U.S. Senate voted in favor of the Medicare Bill (H.R. 6331), which successfully blocks a cut in Medicare payments to physicians, but does so by partially funding these payments with changes to the Medicare Advantage program. The White House will veto the bill because it reduces payments to companies like ours who serve the beneficiaries enrolled in Medicare Advantage plans. (The White House also opposes the delay in the competitive bidding for durable medical equipment as well as changes to expand the number of protected classes of Part D drugs). Democratic leaders are marshalling efforts to gain the two-thirds majority needed to override the President’s veto. From our viewpoint, it is uncertain whether this veto can be sustained; however, early indications suggest that it will be very difficult to stop the momentum of this legislation becoming law.

We expect this process to come to a conclusion in the next few weeks, and as yesterday’s New York Times article pointed out, the issues contained in the Medicare bill coming before the President are only the tip of the iceberg in terms of remedying Medicare’s payments to physicians.

While we are supportive of preserving payment levels to physicians accepting Medicare enrollees, we continue to remind Members of Congress that seniors would bear the burden of the vast majority of the budget cuts in this legislation. They could face limited choices, reduced benefits, and higher premiums and/or out-of-pocket costs if the legislation in its current form becomes law.

In anticipation of this scenario as well as others that have circulated over the last few months, we at Coventry Health Care are prepared for several different outcomes, including the provisions passed by the House, and then by the Senate last Wednesday.

Regardless of the outcome, whether the veto stands, or if an override is successful, we are committed to implementing the needed changes no matter how they are finalized. Most of the items in the Medicare bill require implementation by 2011, which provides an adequate transition period for implementing any needed changes.

Two requirements in the Medicare bill that are most likely of importance to you include:

The bill’s requirement that Private Fee-for-Service (PFFS) plans will be required to have a contracted network of providers in counties in with at least two “network-based plans” (MA coordinated care plans, local PPOs, MSAs, or 1876 cost plans). We are already addressing the need for such contracted arrangements and are confident that we will deliver on such a requirement by 2011.

Employer group programs will need to develop networks for PFFS plans starting in 2011, no matter the number of plans in the service area. Again, we are already working on the transition plan, which will position us to be ready for the 2011 change. We will be working through the details of these changes over the coming months, and will keep you apprised of our progress.

We appreciate the support that many of our partners have expressed to us as well as the direct communication to their Members of Congress about the impact of this legislation. We remain committed to serving all seniors with much-needed health care coverage, and we welcome your input as we continue to work to preserve these Medicare programs.

Sincerely,

Michael J. Burke
Vice President & National Sales Manager
Medicare Distribution

Call me or fill out my online form if you would like to review your texas medicare supplement.

Medicare Improvements for Patients and Providers Act of 2008 How will this change affect Medicare Advantage recipients? Now that the bill has become law, many Medicare Advantage members are concerned. Although it's still too early to say exactly how this legislation may impact your...
H.R. 6331 In our June 26th Coventry Connection Advocacy Alert, we notified you that the U.S. House of Representatives approved a bill (H.R. 6331) that includes $13.8 billion in Medicare Advantage funding cuts over five years. ...

H.R. 6331

michael — Thu, 03 Jul 2008 17:50:35 +0000

Texas Medicare Supplement

H.R. 6331

In our June 26th Coventry Connection Advocacy Alert, we notified you that the U.S. House of Representatives approved a bill (H.R. 6331) that includes $13.8 billion in Medicare Advantage funding cuts over five years. In most areas of the country:

The bill would eliminate the “deeming” authority for Medicare Advantage Private Fee-for-Service (PFFS) plans that makes it possible to offer coverage to beneficiaries who live in service areas with few health care providers.
The bill would reduce Medicare Advantage payment rates in every state by the removal of funds attributed to Indirect Medical Education (IME), and
Other provisions would affect numerous Medicare Advantage administrative and regulatory issues.

In the Senate, on June 26th, the bill failed by one vote to reach the 60-vote majority needed to move the bill forward. However, Congress is planning to bring this legislation up again after the July 4th recess and the Senate will act first. Congress still needs to address the impending physician payment cuts and many are looking to Medicare Advantage beneficiaries to pay for the fix. Members of Congress need to understand the impact these cuts will have on seniors.

WHAT ACTION DO YOU NEED TO TAKE NOW?

We are asking our agents and their clients (beneficiaries) to call their Senators and ask them to NOT support Medicare Advantage funding cuts (such as those in HR 6331).

Below is a toll-free number you can call to be connected to your Senator’s Washington, DC office. You will be asked to key in your zip code, brief directions will be recited, and then you will be connected to your Senator’s office.

(888) 270-6140

You may also contact your Senator or Representative via the U.S. Congressional Switchboard Operator at (202) 224-3121.

TALKING POINTS AND ADDITIONAL INFORMATION FOR YOUR CALL:

H.R. 6331 will have a negative impact on seniors

The House of Representatives rushed through legislation that would require Medicare Advantage beneficiaries to pay for the physician fix without considering the impact these cuts would have on seniors.
Seniors will be shocked when they learn that they could face limited choices, reduced benefits, and higher premiums and out-of-pocket costs if these cuts become law.
Nearly every Medicare Advantage beneficiary in America will be affected by the IME cuts (which would reduce MA payment rates in every state).
Eighty (80) percent of Medicare Advantage beneficiaries would be impacted if the restrictions on Medicare Advantage Private-Fee-For-Service (PFFS) plans were enacted. These plans are a valuable coverage option for Medicare beneficiaries, especially in areas with a limited number of providers.
Seniors in Medicare Advantage would bear the burden of the vast majority of the budget cuts in this legislation (MA cuts represent 94 percent of the bill’s overall direct budget cuts).

Seniors oppose cuts to Medicare Advantage and believe they would be harmful to beneficiaries

Most seniors - regardless of whether they are enrolled in traditional Medicare or Medicare Advantage - oppose cutting the Medicare Advantage program to fund the Medicare physician payment fix.
These seniors also believe cuts to Medicare Advantage will have a negative effect on MA beneficiaries.

Congress should address the physician payment cuts in a way that doesn’t harm seniors

This legislation must not require seniors enrolled in Medicare Advantage to pay for the physician fix.
Congress should reauthorize Special Needs Plans without imposing new requirements or restrictions that would reduce beneficiary access to these innovative plans.

Medicare Advantage is an important coverage option for Medicare beneficiaries

More than 10 million Medicare beneficiaries currently rely on Medicare Advantage to meet their health care needs.
Medicare Advantage plans offer a wide range of benefits, services, and innovations that are not available to beneficiaries in the Original Medicare fee for service (FFS) program, including reductions in out-of-pocket costs; $0-premium comprehensive drug coverage; vision, hearing, and dental benefits; wellness programs; and disease management and care coordination programs.
Medicare Advantage enrollees save an average of $90 per month - through improved benefits and lower out-of-pocket costs - compared to what they would pay in the Original Medicare FFS program.
MA plans are especially important for beneficiaries who have low incomes but may not qualify for Medicaid and who otherwise may not have access to the care management and disease-specific programs available in Medicare Advantage.

More Detail on PFFS and Deeming
As described above, a major concern is that the bill would eliminate “deeming” authority in PFFS. As written, the loss of this deeming authority would eliminate this plan option affecting 80% of Medicare Advantage seniors.

H.R. 6331 imposes additional restrictions on PFFS plans. Federal law requires MA plans to maintain adequate networks of providers - for example, doctors and hospitals - to ensure that all covered benefits and services are available and accessible. PFFS plans can meet access requirements through “deemed” providers. Under this authority, PFFS plans must pay providers rates at least equal to those paid under original Medicare. This authority has been especially important in areas where it is difficult for network-based plans to persuade sufficient numbers and types of providers to contract with them in order to meet access requirements, and for employer groups that provide coverage for retirees living in areas across the country.
Starting in 2011, the bill would limit the use of the deeming authority by requiring PFFS plans in the individual market to have written contracts with networks of providers, with a few exceptions. PFFS plans for employer groups would have to have these contracts wherever they enroll beneficiaries with no exceptions. Without the deeming authority, PFFS plans would face the same challenges of network formation that limited the availability of MA options in many areas in the past and beneficiaries will lose access to these plans and the value they provide.
Enrollees in PFFS plans in these areas would likely face the disruption of either changing plans or return to traditional Medicare. Those who choose to return to FFS would lose the additional benefits, services and disease management that PFFS plans provide. On average, MA enrollees receive about $90 per month in additional benefits. The additional value is demonstrated in the comprehensive coverage that many PFFS plans offer.

LINK TO CHARTS AND ADDITIONAL STATE-SPECIFIC INFORMATION
Attached below is a link to AHIP’s website and additional information. There are state specific charts on the impact of eliminating “deeming” authority in PFFS plans, as well as the implications of removal of IME funding.

AHIP’s Website & additional information

If you would like a free review of your texas medicare supplement, fill out the online form or call me today.

Impact of HR 6331 [This is an open letter from Michael J. Burke at Coventry] July 15, 2008 Last Wednesday, the U.S. Senate voted in favor of the Medicare Bill (H.R. 6331), which successfully blocks a cut in Medicare...
Medicare Improvements for Patients and Providers Act of 2008 How will this change affect Medicare Advantage recipients? Now that the bill has become law, many Medicare Advantage members are concerned. Although it's still too early to say exactly how this legislation may impact your...

Paxil CR® is now available in a generic form

michael — Sat, 07 Jun 2008 02:39:19 +0000

Texas Medicare Supplement

Paxil CR® is now available in a generic form

The patent for Paxil CR expired in May 2008, and it is now available in generic form, Paroxetine HCL.

Paxil CR is used to treat depression and various mood disorders. Generic Paxil CR, Paroxetine HCL, will be placed in Level 1 for Medicare. A quantity limit applies to all lines of business. Messages in Humana’s SmartSummarySM notify members taking this medication that a generic form is now available.

If you have any questions about your texas medicare supplement or would like to review your Medicare Part D drug coverage, please feel free to pick up the phone and call me today.

No related posts.