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July 2002 Survey
The Carrier Trend Survey has been developed in order to conduct market research in the health insurance and HMO industry.
This research is used in consulting assignments with clients in the industry, purchasers of insurance, regulatory officials, and other interested parties.
Aggregate responses are available to professionals in the Marsh & McLennan Companies, while specific individual carrier or HMO responses will be held in strict confidence.
This report summarizes the July 2002 trends of the survey that MMC Enterprise Risk Consulting, Inc. (MMC ER) sent to healthcare carriers in February 2002.
Note that the survey results are aggregated and stratified by percentile.
PrescriptionDrugs2002prices, our prescriptions cost 2 to 3 times more than in neighboring countries like Canada and Mexico.
Last year in the U.S., the average senior spent more than $1000 on prescription drugs.
For people on fixed incomes, this can mean choosing between food, heat or medicine.
The drug companies are the most profitable industry in the country, more than auto companies, oil companies or the entertainment industry.
In 2001, the top 7 prescription drug companies made more than $20 billion in profit.
Medicare was created to provide affordable health coverage for all seniors in the U.S. Today, most health care includes prescription drugs - which are not covered by Medicare.
TFLProvider
As of Oct. 1, 2001, Congress has authorized TRICARE For Life (TFL) coverage for Medicar e-eligible unifor med services beneficiaries enrolled in Medicare Part B. TFL has two key features: n TFL will act as supplemental insurance to Medicare, effective Oct. 1, 2001.
n The TRICARE Senior Pharmacy (TSRx) program, which began April 1, 2001, now extends all aspects of the TRICARE pharmacy benefit to military Medicare-eligible beneficiaries.
Medicare-eligible retirees (including Reserve/Guard retirees) drawing retired pay or veterans' disability compensation in lieu of retired pay.
Once a provider submits a Medicare claim, Medicare automatically will share the claim information with TRICARE.
FSfsmedicare
This brochure answers questions Medicare beneficiaries with Alzheimer's disease, and their families, may have about their Medicare coverage.
If you are enrolled in a Medicare managed care plan, such as a Health Maintenance Organization, you may be covered for services that are not covered by original fee-for-service Medicare.
Answer: Yes, Medicare will pay for your husband to be evaluated for and diagnosed with Alzheimer's disease by his doctor.
For a Medicare Part B claim, the first level of appeal is called a carrier review and must be filed within six months of the initial determination.
For information regarding this important deduction, you should obtain a copy of the Alzheimer's Association's brochure called "Are Alzheimer Care Expenses Tax Deductible?"
medsplanblueprint
MEDS establishes an 80/20 outpatient prescription drug benefit under a new Medicare Part D that will be administered by the Health Care Financing Administration.
The plan will cost similar to figures for the Bush prescription drug plan due to this plan's emphasis on lowering the price of pharmaceuticals.
Beginning 2003, all FDA-approved prescription would be allowed for importation at world market prices after being tested for safety.
The Government would subsidize low-income beneficiaries to the following levels: -100% of the premium and cost sharing for beneficiaries below 135% of poverty.
The long-term plan as articulated by the Bush administration would provide a subsidy of 25% of the cost of a private insurance plan.
Bush Plan: The senior would receive $0 in assistance.
talking http://www.ianr.unl.edu/nda/talking.pdf
The new Medicare MNT legislation, passed in the final days of the 106th Congress, provides benefits on referral of a physician for individuals with diabetes or renal disease (pre-dialysis).
Passage of this Medicare provision is a major achievement for seniors who rely on the Medicare program for their health care and the dietetics profession.
For many years, it was a tough sell to convince lawmakers that a new medical nutrition therapy (MNT) benefit was needed in the Medicare program.
Among the issues that will have to be resolved are the qualifications for coverage, the number of visits and the length of time to be spent with patients.
cna_mailer http://www.northwestern.edu/hr/benefits/spds/ltc/cna_mailer.pdf
Find out how this valuable coverage can protect you, your spouse/domestic partner, your parents and parents-in-law.
Thinking ahead helps prepare for life's changes, especially those that are unexpected and can adversely affect the ones we love, like the possibility of someday needing long-term care.
Many people think long-term care means nursing home care, and they're right, but it's much more than that!
Even if your parents have Medicare or Medicare Supplement Insurance, coverage for long-term care is very limited.
During this open enrollment, benefit eligible faculty and staff are guaranteed coverage.
Applications must be returned by November 15, 2002, so call CNA to order your kit today.
FactSheet-Directions http://www.medicarerights.org/FactSheet-Directions.pdf
"We should really leave Medicare alone---you really can't beat it.
To be sure, some consumers have been satisfied with their Medicare HMOs, primarily because these enrollees have been able to get partial prescription drug coverage and lower cost health care.
To better understand people with Medicare's perspectives about their health care coverage and the health care system, the Medicare Rights Center (MRC) recently polled 200 of its clients on their views.1 One of the poll's key findings is that for most older and disabled people having multiple private market health care options is not nearly as important as having the unrestricted choice of doctors and hospitals available under Original Medicare.
091202-presentation-walch http://www.fda.gov/cdrh/CDRHHHC/091202-presentation-walch.pdf
· Non-Routine Medical Supplies What is not included in the PPS unit of payment?
-- HHAs submit requests for anticipated payment (RAP) for initial percentage payment -- HHAs submit claims for final percentage payment What are the adjustments to the PPS unit of payment?
· Annual Updates for Inflation Required by Law When can I restart the 60 day episode clock during an existing episode?
· SCIC Adjustment occurs when: -- a beneficiary experiences a significant change in condition during the 60 day episode not envisioned in the original plan of care.
· HHAs will no longer be able to unbundle covered home health services (EXCEPT DME) under the home health POC to an outside supplier.
51901SPCPositions allocated to this series provide health insurance counseling and information to medicare-eligible citizens.
Positions which provide professional counseling services in the areas of vocational rehabilitation, social work, psychology, or other human services specializations a majority of the time.
Progression to the objective level is through reclassification as the employe satisfactorily attains the specified training, education, or experience.
Positions in this classification series provide health insurance counseling and information to Medicareeligible citizens and their representatives and refers consumer complaints to the Commissioner of Insurance.
Positions at this level perform all activities described in the definition statement under general supervision, and, in addition, may provide counseling related to Medicaid issues, including spousal impoverishment, estate liability, Medicaid buy-in, etc.
Medicare_SS However, you do not contribute to Social Security on your TRS-covered earnings.
We will not reduce your TRS benefit on account of any Social Security benefit you may receive.
All public employees who were hired after March 31, 1986, are required to make contributions toward Medicare coverage.
Annuitants who return to teaching after March 31, 1986, also contribute to Medicare, regardless of the number of days they teach.
A TRS annuitant may also obtain free Medicare Part A coverage as the result of paying the Medicare tax on covered employment.
In addition, a TRS annuitant may have Medicare hospital coverage at age 65 if his or her spouse has worked in Social Security-covered employment at least 40 quarters and if the spouse is at least age 62.
consumerreports_release12052000
consumer, care, nursing home, health, Consumer Reports, lists, deficiencies, seniors, Home State Detection.
Consumer Reports Complete Guide to Health Services For Seniors, written by Trudy Lieberman and the editors of Consumer Reports, offers hands-on, practical advice in a user-friendly format that includes worksheets, charts and comparative tables.
"Finding a good nursing home is a complicated task and one that should be investigated ahead of time, if possible, to determine options," says Lieberman, who is Director of the Center for Consumer Health Choices at Consumers Union.
The Guidebook lists eight tools to help people in making and comparing choices for nursing homes.
The Watch List was based on five criteria: (1) citations for failing to provide adequate access to the survey report, (2) high numbers of repeat deficiencies, (3) high severity deficiencies, (4) substandard quality of care deficiencies, and (5) high numbers of total deficiencies.
fs-patient http://www.cdc.gov/cancer/screenforlife/pdf/fs-patient.pdf
If everyone age 50 and older had regular colorectal cancer screening tests, more than one third of deaths from this cancer could be avoided.
Colorectal cancer almost always develops from precancerous polyps (abnormal growths) in the colon or rectum.
Here's a description of each: Fecal Occult Blood Test -- This test checks for occult (hidden) blood in the stool.
You receive a test kit from your doctor or health care provider.
First you receive an enema with a liquid called barium that flows from a tube into the colon, followed by an air enema.
To find out about Medicare coverage, call 1-800-MEDICARE (1-800-633-4227).
(If polyps or lesions are found, follow-up testing is needed.)
shick newsletter Coordinator, Volunteer and Partner has stories to tell about a client whose circumstances seemed overwhelming, and who had already tried a variety of ways to find help to solve their problem, before they called SHICK.
SHICK Awarded SHIPMates Grant This past year, Senior Health Insurance Counseling for Kansas was selected to be one of two pilot projects to receive funds from HCFA through a new program designed to establish mentoring relationships between SHIP programs in other states.
The provision would specify that such drugs are covered only when they are not usually self-administered by the patient.
current time limitations on the coverage of immunosuppressive drugs for beneficiaries who have received a covered organ transplant.
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