The Disabled Have a Long Waiting Time Before Qualifying for Medicare

Stuart recently posted on MS Related News that Congress and the Obama administration should put an end to the 2 year waiting period people deemed as “too sick” have to face before qualifying for Medicare. Medicare covers both disabled and elderly people, but approximately 1.5 million disable people find themselves waiting for a very long time before receiving any benefits from Medicare.

Of the 1.5 million, 40% are uninsured for part of the wait and 25% are uninsured for the full 24 months. There is new legislation proposed by Rep. Gene Green, D-Texas, and Sen. Jeff Bingaman, D-N.M that would eliminate waiting time gradually over 10 years. Will the Obama campaign help get this legislation passed?

New Rules are Imposed on Medicare Advantage Plan Sales

Yesterday’s article on ModernHealthcare.com discusses that the Centers for Medicare and Medicaid Services have issued compensation requirements for sales agents that sell Medicare Advantage plans and prescription drug plans to Medicare beneficiaries.

Some of the rules include paying compensation to all agents according to fair-market value and adjusted for inflation for similar products in the same geographic area. To make sure that everyone is compliant with the new rules, agents will have to CMS their compensation structures for the previous three years as well as the compensation structure they are implementing for 2009.

Medical News Today: MedPAC Adopts Recommendations To Improve Transparency Of Financial Ties Between Industry, Physicians

The Medicare Payment Advisory Commission on Thursday adopted five recommendations to Congress that would require disclosure of the health care industry's financial ties to physicians and other health care professionals, CQ HealthBeat reports. MedPAC will present the recommendations to Congress in March. According to the recommendations:

• Congress should require all manufacturers, distributors and their subsidiaries to report to HHS financial relationships with physicians, pharmacists, pharmaceutical benefits managers and their employees, as well as with hospitals, medical schools and medical or health organizations;
  
  
• Congress should direct the HHS secretary to post the information on a public Web site;
  
  
• All details regarding no-cost drug samples provided to physicians should be posted on the Web site so researchers can study the impact samples have on prescribing decisions;
  
  
• Congress should require all hospitals and other entities that bill Medicare for services to "annually report the ownership shares of each physician who directly or indirectly owns an interest in the entity (excluding publicly traded corporations)" and post the information on the Web site; and
  
  
• Lawmakers should require HHS to submit a report on the "types and prevalence of the financial relationships between hospitals and physicians."
  

MedPAC Chair Glenn Hackbarth said, "This is about transparency. It's not about condemnation" (Reichard, CQ HealthBeat, 11/6).

For more information please visit the original article here.

Private Plans for Medicare that Cover Dental Care

This post on AMPSYS discusses how Medicare does not cover dental care, but there are ways around this. There are many private plans for Medicare that do offer such coverage for dental expenses. Some of these private plans include the basic Medicare coverage, and also offer savings in eyeglasses, hearing devices, and dental care as well. The post gives an example of how Humana pays for about 25 percent of fillings, 75 percent of the cost of examinations, cleanings and X-rays, and 50 percent of extractions.

Physicians Receive Medicare Incentive for e-Prescribing

Pizaazz reports in this article that the Centers for Medicare and Medicaid Services have announced an incentive plan for physicians so that providers will receive a 2% bonus on total Medicare charges during 2009 for using qualified e-prescribing system.

According to CMS, providers must use the e-prescribing systems that:
-Communicate electronically with the patient’s pharmacy,
-Remind physicians about cheaper alternatives (if available),
-Provide Medicare formulary information, and
-Alert prescribers about allergies, improper dosing and drug interactions.

Home Health Care Agencies will Receive a Slight Medicare Payment Increase in 2009

EmaxHealth recently reported that CMS will slightly increase Medicare payments on average to home health agencies in 2009. It will also take steps to remedy cases in which providers bill Medicare unusually large amounts.

Home health agencies on average are expected to receive an increase of 2.9% or an additional $490 million for changes in costs of goods and services. Agencies will have to report quality data on a regular basis to avoid a 2% reduction in payments.

Medicare Co-Pays and Premiums Expected to Rise

FierceHealthcare reports today that a recent study conducted by Avalere Health LLC found that for the largest 10 drug companies, premiums are expected to rise up an average of 31 percent next year. It is also speculated that this in term might cause insurers to increase drug co-payments 75 percent (about $7) for generic drugs and a 60% increase (about $40) for brand drugs.

A spokesperson from Humana, an insurer, mentions:

“Prices reflect the experience we've seen over the past three years, and our expectations around what will most interest our members and potential members going forward."