Kevin Knauss: Health, History, Travel, Insurance
Post related to Medicare health insurance, Part A, Part B, Part C, and Part D prescription Drug Plans, Medicare Advantage and Medicare Supplement plans.
The Affordable Care Act set in motion a series of reforms to slowly close the coverage gap or “donut hole” that Part D members faced after they met their initial coverage dollar amount. Pharmaceutical manufacturers that wanted their Brand name drugs covered in the gap had to sign an agreement with Medicare to cover 50% of the cost of the drug. Medicare has had to assess civil monetary penalties on many companies that failed to cover the discount.
Anthem Blue Cross announced that it will issue rebates to members enrolled in their Medicare Supplement plans in five different states. The rebates are a result of the Medicare supplement or Medigap plans failing to meet the medical loss ratios (MLR). Rebate checks being sent out in September will range from $3.51 to $487.08 per member.
With only one manufacturer of the Shingles Vaccine, Zostavax from Merck, there are no generic prices on the market. The retail price for Zostavax at the local pharmacies I surveyed is fairly consistent across the board. Lower prices can be found under different Medicare Part D Prescription Drug Plans, but even with insurance, there can be a spread of $115 to $170 difference in the cost.
The Centers for Medicare and Medicaid (CMS) have announced enforcement actions against two Medicare Advantage Program for All-Inclusive Care for the Elderly (PACE) contractors. Both Silver Star Health Network in Lubbock, TX, and Alexian Brothers Community Services in St. Louis, MO, received civil monetary penalties of $25,000 each for non-compliance of Medicare regulations. Formal letters notifying the Medicare Advantage Plans of the penalty were sent out August 1, 2013.
The Centers for Medicare and Medicaid released the cost they pay for the top 100 hospital treatments for beneficiaries of Medicare across the country and the data presentation is virtually worthless to the average human being. The Charge master data set was successful in highlighting the complex and dysfunctional system we have in the U.S. for tracking and paying for health care.
The contradictory nature of Washington lawmakers was on full display this past week as they lobbied the Centers for Medicare and Medicaid (CMS) not to cut reimbursements to privately run Medicare Advantage plans while allowing the budget sequester to curtail funding for Medicare cancer patients.
It was an urgent plea by an insurance company that I had to act now to save Medicare Advantage Plans.
People over 65 bring a lot of value to the table because of their reduce cost of employment: Medicare, pensions, Social Security
Possibly written by someone who has watched too many war movies, the press release is sprinkled with military type adjectives and titles to reinforce President Obama’s assault on fraud.
On January 15th, Medicare imposed an immediate sanction on SilverScripts Part D Prescription drug plans, available through CVS/Caremark, from marketing or selling any new drug plans because of massive failures to properly handle prescription drug claims of new members.
