Thursday, September 23, 2010

MEDICARE NEWS: Medicare Advantage Premiums Fall, Enrollment Rises, Benefits Similar Compared to 2010

 

Medicare Advantage Premiums Fall, Enrollment Rises, Benefits Similar Compared to 2010

Wide range of Medicare health and drug plan options continues in 2011

 

The Centers for Medicare & Medicaid Services (CMS) announced today that, on average, Medicare Advantage premiums will be 1 percent lower in 2011 than today.  The majority of Medicare beneficiaries, on average, enrolled in Medicare health and prescription drug plans this year should find little or no change in their benefits in 2011, in addition to seeing more drug plans offering coverage in the prescription drug coverage gap or “donut hole.” Medicare Advantage plans project that enrollment will increase by 5 percent in 2011.  And, consistent with the Affordable Care Act, beneficiaries, in most Medicare Advantage plans and Original Medicare, will gain access to preventive benefits with no out of pocket costs. 

 

Through the new tools provided to Medicare under the Affordable Care Act, and working closely with Medicare Advantage Organizations and Prescription Drug Plan, CMS took steps to:

·         Protect beneficiaries from excessive increases in premiums and cost sharing through aggressive bid reviews;

·         Consolidate low enrollment and duplicative plans so beneficiaries have meaningful differences between plans offered by the same organization;

·         Set limits on out-of-pocket expenses;

·         Cover preventive services with no cost sharing; and

·         Limit plan cost sharing for skilled nursing care, chemotherapy and renal dialysis to the amounts paid by beneficiaries in Original Medicare.

 

The Affordable Care Act also provides some new benefits to Medicare beneficiaries in 2011 like free wellness visits, some new free health screenings, and a 50 percent discount on brand-name drugs for seniors who full into the coverage gap.

 

CMS is encouraging beneficiaries enrolled in Medicare Advantage and Medicare Prescription Drug plans to review their current health and drug plan coverage for any changes their plans may be making for 2010 before the annual enrollment period begins November 15.  In addition to the 5-Star ratings on the Medicare Plan Finder at www.Medicare.gov, users will find an icon that shows those plans that had a low overall quality rating the past three years. 

 

Additional Resources are available at the following links:

 

National Press Release issued today (9/21): http://www.cms.hhs.gov/apps/media/press_releases.asp

 

Medicare Health and Drug Plan State-by-State Fact Sheets: http://www.cms.hhs.gov/center/openenrollment.asp

 

2011 Plan Landscape Files: http://www.cms.hhs.gov/PrescriptionDrugCovGenIn/

 

 

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Monday, June 21, 2010

Two New Scams

Counterfeit Check Scams

Just to show you how many different counterfeit cashiers' checks and regular checks are circulating out there, we obtained information from the FDIC listing out all known counterfeit documents floating around.

We want to acknowledge that these banks have good reputations and if you receive a check from someone that banks at one of the following institutions, it does not necessarily mean it is a bad check. Just remember where you got the check. If it was from a friend, then you can be sure for the most part it is good. If it is from someone you do not know to help pay taxes on monies you won in a contest - rest assured it is bad!

Today's Alerts for counterfeit check scams

The following counterfeit items have been reported in circulation:

Counterfeit Cashier's Checks

Anchor Bank, National Association, St. Paul, Minnesota
Bank of Santa Clarita, Santa Clarita, California
Central Valley Community Bank, Clovis, California
Citizens Bank & Trust, Inc., Trenton, Georgia
Citizens and Farmers Bank, West Point, Virginia
Collin Bank of Frisco, Texas
Great Western Bank, Watertown, South Dakota
Greenfield Banking Company, Greenfield, Indiana
Mariners Bank, Edgewater, New Jersey
Union State Bank, West Salem, Wisconsin

Counterfeit Checks

Cambridge State Bank, Cambridge, Minnesota
Citizens Community Federal, Altoona, Wisconsin
Dime Savings Bank of Williamsburgh, Brooklyn, New York
Mutual Federal Savings and Mutual Federal Bank, Chicago, Illinois
Wells Federal Bank, Wells, Minnesota
First Savings Bank of Hegewisch, Lansing, Illinois
CapitalBank, Greenwood, South Carolina
Ever Bank Corp, Jacksonville, Florida
First Federal Bank, Portsmouth, Ohio
Franklin Bank, Woodstown, New Jersey
Security Bank of Kansas City


Gulf Oil Spill Scams

As the nation follows news of the oil spill in the Gulf of Mexico, so do scammers. The Federal Trade Commission issued an alert urging consumers and businesses to watch out for con artists trying to take advantage of the oil spill in the gulf and to report their experiences to federal and state authorities.

Scammers will likely use e-mails, websites, door-to-door collections, flyers, mailings and telephone calls to solicit money by claiming they're raising money for environmental causes or offering fraudulent services related to the oil spill. In reality, many could be trying to get inside your home or get access to your personal information.

You can check out any charity at the following website. www.charitynavigator.org


Remember, Scamnot...

##
alerts@scamnot.org

Monday, June 14, 2010

Insurance Commissioner Kim Holland/AARP Warn Seniors of Potential Medicare Scam

Scam targets $250 Medicare ‘Doughnut Hole’ rebate check recipients

OKLAHOMA CITY –Insurance Commissioner Kim Holland, along with the AARP, informed seniors today about a new rebate check many will be receiving and also warned them to be on the lookout for scam artists trying to take advantage of them.

“With the recent downturn in the economy and the debate over the new healthcare law there is a lot of concern and confusion out there. The time is ripe for scam artists to take advantage of people,” said Holland. “I encourage people to take extra precautions as they purchase health insurance or make changes to their Medicare plans and benefits.”

Holland said Oklahomans will begin receiving “$250 rebate disbursement” checks today. The checks are being sent by the Department of Health and Human Services (HHS) to about 4 million seniors, potentially including as many 250,000 Oklahomans, who fall into the “doughnut hole” coverage gap.

Holland said that reports have already surfaced of scammers offering to assist Medicare beneficiaries in receiving their checks.

“Qualified beneficiaries will receive their checks automatically and are not required to fill out any forms. You don’t need to provide any personal information like your Medicare, Social Security, or bank account numbers to get the rebate check,” said Holland. “Don’t give your personal information to anyone who calls you about the check.”

Medicare will automatically send qualified beneficiaries the one-time $250 rebate check after they reach the coverage gap. A member’s Explanation of Benefits notice will tell members how much they have spent on covered drugs and if and when they enter the coverage gap, or “doughnut hole.”

According to the AARP, the $250 payment is designed to offset costs associated with the Medicare drug coverage gap—known as the “doughnut hole”. In 2010, the Medicare Part D annual deductible is $310. After the deductible is met, the beneficiaries are responsible for 25 percent ($630) of prescription drug costs while the plan pays 75 percent up to a total of $2,830. The beneficiaries fall into the doughnut hole when costs reach $2,830 and then pay 100 percent out-of-pocket—up to an additional $3,610—for a total of $4,550 true out-of-pocket (This includes the deductible ($310), the 25 percent of the initial $2,830 ($630) and the $3,610 from the gap). At this point, catastrophic coverage begins and the plan pays 95 percent of prescription drug costs through the end of year.

Beginning in 2011, there will be a 50 percent discount on name-brand prescription drugs for people in the doughnut hole; and by 2020, the doughnut hole will close completely according to current law.

Scammers Take Advantage of Medicare Beneficiaries

Consumers should be on the lookout for scammers hoping to take advantage of the confusion surrounding the details of the new health reform law, especially with distribution of the $250 rebate checks.

Here are some red flags to look out for:

• Be wary of anyone who tells you to take special action to receive your rebate. Scammers will try to convince Medicare beneficiaries to transfer their checks to a third party to cover specific prescription drug payments. You do not have to do anything to receive your rebate check. A check will be issued automatically once you reach the threshold.

• No personal information is needed. Scam artists may ask for your checking or savings account information and say that the check will be direct-deposited into your account. This is not true. It will be mailed out to the address the U.S. Social Security Department has on file for you. Do not give out your personal information to anyone.

Commissioner Holland encourages any Oklahoman with questions or concerns or feels they have been a victim of Medicare fraud to contact the Oklahoma Insurance Department’s SMP Division at 1-888-967- 9100.


-30-
ABOUT THE OKLAHOMA INSURANCE DEPARTMENT
SMP is a part of the Oklahoma Insurance Department and receives a mixture of federal and state funds to inform the public about Medicare and Medicaid fraud as well as other senior health insurance issues. SMP stands ready to assist and answer questions regarding Medicare Part D fraud.

The Oklahoma Insurance Department, an agency of the State of Oklahoma, is responsible for the education and protection of the insurance-buying public and for oversight of the insurance industry in the state.

Marc D. Young
Assistant Insurance Commissioner
Public Affairs

Friday, December 4, 2009

ASCOG to help with Medicare enrollment

— The Constitution staff - Published in Lawton Constitution December 2, 2009.



ASCOG to help with Medicare enrollment
The Association of South Central Oklahoma Governments (ASCOG) Area Agency on Aging (AAA) will assist beneficiaries with Medicare Part D enrollment Friday at the Great Plains Technology Center.
Counselors will assist beneficiaries with reviewing their Part D plan and can help them make any changes needed to ensure their prescription drug coverage will meet their needs in 2010. Counselors can also assist beneficiaries without a Part D plan select a program that will best suit their prescription needs. Counseling sessions are by appointment only.
Call Melissa Colin, ASCOG aging information specialist, 1-800-658-1466 to schedule an appointment.

Monday, November 2, 2009

Part B Premium in 2010 - What We Know Now

CMS announced that the Part B premium for 2010 is increasing to $110.50. This is the first time in the history of Medicare that the Part B premium will be above $100 a month.

The good news however, at least for the majority of your Medicare clients, is that they are held harmless from this increase and will continue to pay a monthly premium of $96.40 in 2010 for their Part B.

Read the MyMedicareMatters weekly update to find out what we know now about the Medicare Part B premium and more.

Wednesday, October 21, 2009

#09/078 - CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2010


From: CMS SHIP [mailto:SHIP@cms.hhs.gov]
Sent: Wednesday, October 21, 2009 10:13 AM

Subject: #09/078 - CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2010

 


CMS ANNOUNCES MEDICARE PREMIUMS, DEDUCTIBLES FOR 2010

Most Medicare beneficiaries will not see a Part B monthly premium increase as a result of a “hold harmless” provision in the current law.  This allows for 73 percent of beneficiaries to be protected from an increase raising the 2010 Part B monthly premiums from $96.40 to $110.50.  The Administration continues to urge Congressional action that would protect all beneficiaries from higher Part B premiums and eliminate the inequity of a high premium for the remaining 27 percent of beneficiaries.

By law, the Centers for Medicare & Medicaid Services (CMS) is required to announce the Part A deductibles and Part B premium amount – a notice that is published annually in the Federal Register. 

Under the Medicare law, the standard premium is set to cover approximately one-fourth of the average cost of Part B services incurred by beneficiaries aged 65 and over.   The remaining Part B costs are financed by Federal general revenues. This monthly premium paid by beneficiaries enrolled in Medicare Part B covers a portion of the cost of physicians’ services, outpatient hospital services, certain home health services, durable medical equipment, and other items. 

In calculating the monthly Part B premium each year, the CMS Office of the Actuary includes a contingency margin to provide for possible variation between actual and projected costs.  The size of the contingency margin estimated to be needed for 2010 is affected by two main factors.

First, the current law formula for physician fees, which will result in a reduction in physician fees of approximately 21 percent in 2010 and is projected to cause additional reductions in subsequent years, is one factor affecting the 2010 contingency margin.  For each year from 2003 through 2009, Congress has acted to prevent physician fee reductions from occurring.

In recognition of the strong possibility of increases in Part B expenditures that would result from similar legislation to override the decreases in physician fees in 2010 or later years, it is appropriate to maintain a significantly larger Part B contingency reserve than would otherwise be necessary.  The asset level projected for the end of 2009 is not adequate to accommodate this contingency. 

Second, the Social Security Administration announced there would be no increase in Social Security benefits for 2010.   As a result of the hold-harmless provision, the increase in the Part B premium for 2010 will be paid by only a small percentage of Part B enrollees. Most Part B enrollees will pay the same monthly premium that they paid in 2009 ($96.40 was the 2009 standard monthly premium). 

Approximately 27 percent of beneficiaries are not subject to the hold-harmless provision because they are new enrollees during the year (3 percent), they are subject to the income-related additional premium amount (5 percent), they do not have their Part B premiums withheld from social security benefit payments (19 percent), including those who qualify for both Medicare and Medicaid and have their Part B premiums paid on their behalf by Medicaid (17 percent).

As required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA), beginning in 2007 the Part B premium a beneficiary pays each month is based on his or her annual income.  Specifically, if a beneficiary’s “modified adjusted gross income” is greater than the legislated threshold amounts ($85,000 in 2010 for a beneficiary filing an individual income tax return or married and filing a separate return, and $170,000 for a beneficiary filing a joint tax return) the beneficiary is responsible for a larger portion of the estimated total cost of Part B benefit coverage.  In addition to the standard 25 percent premium, such beneficiaries now pay an income-related monthly adjustment amount.  These income-related Part B premiums were phased-in over three years, beginning in 2007.  About 5 percent of current Part B enrollees are expected to be subject to the higher premium amounts

The 2010 Part B monthly premium rates to be paid by beneficiaries who file an individual tax return (including those who are single, head of household, qualifying widow(er) with dependent child, or married filing separately who lived apart from their spouse for the entire taxable year), or who file a joint tax return are:

 

Beneficiaries who file an individual tax return with income:

Beneficiaries who file a joint tax return with income:

Income-related monthly adjustment amount

Total monthly premium amount

Less than  or equal to $85,000

Less than or equal to $170,000

$0.00

$110.50

Greater than $85,000 and less than or equal to $107,000

Greater than $170,000 and less than or equal to $214,000

$44.20

$154.70

Greater than $107,000 and less than or equal to $160,000

Greater than $214,000 and less than or equal to $320,000

$110.50

$221.00

Greater than $160,000 and less than or equal to $214,000

Greater than $320,000 and less than or equal to $428,000

$176.80

$287.30

Greater than $214,000

Greater than $428,000

$243.10

$353.60

 

In addition, the monthly premium rates to be paid by beneficiaries who are married, but file a separate return from their spouse and lived with their spouse at any time during the taxable year are:

 

Beneficiaries who are married but file a separate tax return from their spouse:

Income-related monthly adjustment amount

Total monthly premium amount

Less than or equal to $85,000

$0.00

$110.50

Greater than $85,000 and less than or equal to $129,000

$176.80

$287.30

Greater than $129,000

$243.10

$353.60

 

Part B Deductible

 

The Part B deductible was increased to $110 in 2005 and, as a result of the Medicare Modernization Act, is currently indexed to the annual percentage increase in the Part B actuarial rate for aged beneficiaries.  In 2010, the Part B deductible will be $155.

 

Part A Premium and Deductible

 

Today, CMS is also announcing the Part A deductible and premium for 2010.  Medicare Part A pays for inpatient hospital, skilled nursing facility, hospice, and certain home health care services. The $1,100 deductible for 2010, paid by the beneficiary when admitted as a hospital inpatient, is an increase of $32 from $1,068 in 2009.  Beneficiaries must pay an additional $275 per day for days 61 through 90 in 2010, and $550 for lifetime reserve days.  The corresponding amounts in 2009 are $267 and $534, respectively. Daily coinsurance for the 21st through 100th day in a skilled nursing facility will be $137.50 in 2010, up from $133.50 in 2009.

 

Approximately 99 percent of Medicare beneficiaries do not have to pay a premium for Part A services because they have at least 40 quarters of Medicare-covered employment (or are the spouse or widow(er) of such a person).  However, other seniors and certain people under age 65 with disabilities who have fewer than 30 quarters of coverage may obtain Part A coverage by paying a monthly premium set according to a statutory formula.  This premium will be $461 per month for 2010, an increase of $18 from 2009.  A reduced premium applies in the case of individuals with 30 to 39 quarters of coverage, who will pay a premium of $254 in 2010, compared to $244 in 2009.

Friday, September 25, 2009

Misleading letters for Medicare Customers



Senior Issues Task Force and Interested Regulators:

The attached letter from the NAIC was sent to the the Finance Committee
today, in response to reports that Humana has sent letters to
policyholders intended to alarm them about proposed changes contained in
federal health reform efforts. I have attached a copy of the letter
signed by Commissioners Sevigny and Praeger -- as well as copies of CMS'
letters to Humana and other MA plans, and a copy of Chairman Baucus'
press release on this issue.

Please let me know if you have any questions. Also, if you hear any
reports of similar communications being disseminated by agents/brokers,
or by non-Medicare Advantage (state-regulated) plans, please let us
know.

Thanks!

http://yrc7kq.bay.livefilestore.com/y1pnxVMHQXHg-PmNi0o5Zxs51Cgehjy5RdoADRAMl3gMF3dS1xnXtHtd5i8lnlmOG_3Q5eDyGGvjVH53MOAYiqfB19aheA8xE3M/baucusHumanahealthreformpress.pdf?download

http://yrc7kq.bay.livefilestore.com/y1pwMZtfoEA-QoD5W-cPex81GFBZ5MgtLdQr5RdQKr9gZV6ZCqSZ5iBwvRIcjGeVLKIJGPzxWYkbaJ4E94VYRItNzmNOgXJys_H/CMS%20Humana%20letter.pdf?download

http://yrc7kq.bay.livefilestore.com/y1pJ86VEf9ob_lZ7j8pYdpR3K_aIWRi2mstBrZ_kIZY4fZ4QntMl5sALdLTptY66P1NLUgrm4lNLIbbH2oB3-bl9oVOLEVkm-CN/HPMS%20misleading-mailing-9-2009.pdf?download

http://cid-07d177baad453727.skydrive.live.com/self.aspx/Documents/HumanaSeniorHealthReformLettertoFinanceFINAL.pdf


Jane Sung
Senior Health Policy Analyst & Counsel
National Association of Insurance Commissioners