query: what is medicare a?

title: Better Medicare Alliance

text: Better Medicare Alliance The Better Medicare Alliance (BMA) is an American 501(c)(4) non-profit advocacy coalition that supports sustaining and improving Medicare Advantage, a private health insurance option available to Medicare beneficiaries. The BMA was one of the most prominent voices in the rate-setting process for MedIcare Advantage in 2015. The Centers for Medicare and Medicaid Services (CMS) proposed a 2016 average baseline rate decrease of .95% in February 2015. The BMA opposed this reduction with a campaign that included digital and print ads. The BMA was particularly concerned about how access to Medicare Advantage in rural areas might be affected.

title: Medicare Advantage

text: services, including additional health services, and most importantly include an annual out of pocket (OOP) spend limit not included in Parts A and B. A Medicare Advantage beneficiary must first sign up for both Part A and Part B of Medicare. All four Parts of Medicare—A, B and C, and D—are administered by private companies under contract to the Centers for Medicare and Medicaid Services (CMS). Almost all these companies are insurance companies, except for those that administer Medicare Advantage and other Part C plans. Most Medicare Advantage and other Part C plans are administered (CMS uses the term "sponsored")

title: Medicare (United States)

text: Medicare (United States) Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health insurance for Americans aged 65 and older. It also provides health insurance to younger people with some disability status as determined by the Social Security Administration, as well as people with end stage renal disease and amyotrophic lateral sclerosis. Medicare is funded by a combination of a payroll tax, beneficiary premiums and surtaxes from beneficiaries, and general U.S. Treasury revenue. In 2017, Medicare

title: Medicare (United States)

text: Centers for Medicare and Medicaid Services). Plans choose which drugs they wish to cover (but must cover at least two drugs in 148 different categories and cover all or "substantially all" drugs in the following protected classes of drugs: anti-cancer; anti-psychotic; anti-convulsant, anti-depressants, immuno-suppressant, and HIV and AIDS drugs). The plans can also specify with CMS approval at what level (or tier) they wish to cover it, and are encouraged to use step therapy. Some drugs are excluded from coverage altogether and Part D plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and

title: Medicare (United States)

text: shown to delay or forgo needed care, jeopardizing their health and possibly increasing their health care costs down the line. Given their lack of medical training, most patients tend to have difficulty distinguishing between necessary and unnecessary treatments. The problem could be exaggerated among the Medicare population, which has low levels of health literacy. The following congressional committees provide oversight for Medicare programs: Medicare (United States) Medicare is a national health insurance program in the United States, begun in 1966 under the Social Security Administration and now administered by the Centers for Medicare and Medicaid Services (CMS). It provides health

title: Medicare Advantage

text: other administrative choices by Centers for Medicare and Medicaid Services (CMS, per-person expenditures for beneficiaries on Parts A/B/C and those not on A/B/C reached effective parity). One such choice ended the out-of-balance PFFS plan program except for grandfathered beneficiaries. The out-of-balance Employer Group plan program was cut back beginning in 2017. Exact parity would require major changes to Medicare law (so-called "premium support" proposals, for example), but as of the March 2016 MedPAC report, in 2016 Medicare was expected to spend just 2 percent more on "like" Medicare Advantage beneficiaries per person than for a "like set of beneficiaries" under

title: Medicare (United States)

text: providers accept Medicare assignments, (97 percent for some specialties), and most physicians still accept at least some new Medicare patients, that number is in decline. While 80% of physicians in the Texas Medical Association accepted new Medicare patients in 2000, only 60% were doing so by 2012. A study published in 2012 concluded that the Centers for Medicare and Medicaid Services (CMS) relies on the recommendations of an American Medical Association advisory panel. The study led by Dr. Miriam J. Laugesen, of Columbia Mailman School of Public Health, and colleagues at UCLA and the University of Illinois, shows that for

title: Medicare (United States)

text: more costs to Medicare enrollees. Several measures serve as indicators of the long-term financial status of Medicare. These include total Medicare spending as a share of gross domestic product (GDP), the solvency of the Medicare HI trust fund, Medicare per-capita spending growth relative to inflation and per-capita GDP growth; general fund revenue as a share of total Medicare spending; and actuarial estimates of unfunded liability over the 75-year timeframe and the infinite horizon (netting expected premium/tax revenue against expected costs). The major issue in all these indicators is comparing any future projections against current law vs. what the actuaries expect

title: Medicare (United States)

text: difficult to know what their policy covers. and at what cost. Moreover, since Medicare collects data about utilization and costs for its enrollees—data that private insurers treat as trade secrets—it gives researchers key information about health care system performance. Medicare also has an important role driving changes in the entire health care system. Because Medicare pays for a huge share of health care in every region of the country, it has a great deal of power to set delivery and payment policies. For example, Medicare promoted the adaptation of prospective payments based on DRG's, which prevents unscrupulous providers from setting

title: Medicare Advantage

text: of Medicare (e.g., large cuts in hospital and skilled nursing facility payments under Part A; adding surtaxes to Part D), the Patient Protection and Affordable Care Act (ACA) changed Trustee payments to Medicare Advantage and other Part C plans—versus what they otherwise would have been—by adjusting the way the statutory county benchmarks that kick off the annual Part C Medicare Advantage bidding process were calculated. The intention was to bring the capitated payments closer to the average costs of care per person under Original Medicare. ACA provided bonus payments to plans with ratings of 4 (out of 5) stars or

title: Medicare (United States)

text: measure involves only Part A. The trust fund is considered insolvent when available revenue plus any existing balances will not cover 100 percent of annual projected costs. According to the latest estimate by the Medicare trustees (2018), the trust fund is expected to become insolvent in 8 years (2026), at which time available revenue will cover around 85 percent of annual projected costs for Part A services. Since Medicare began, this solvency projection has ranged from two to 28 years, with an average of 11.3 years. This and other projections in Medicare Trustees reports are based on what its actuaries

title: Medicare Advantage

text: Original Medicare Parts A and B, theoretically adding an additional 0.5% ($3 billion) to the cost of the overall Medicare program vs. what would have been spent absent Part C. As in 2009, the major plans within Medicare Advantage causing the lack of parity were Employer Group plans (6 percent more) and the few grandfathered PFFS beneficiaries left (10 percent more). Vanilla HMO and PPO plans—as well as SNPs—cost only 1% more per person in comparing "like set of beneficiaries". Overall, only a few recent studies provide a limited picture of beneficiary experiences since the Affordable Care Act (ACA) was

title: Medicare Rights Center

text: to mention limits on what a doctor may charge for a service or what a beneficiary must pay. The judge in the lawsuit noted that the EOB is "gobbledygook." This same year, the National Consumer Helpline was born, run by one staff member (MBDF founder, Diane Archer) and one volunteer. The following year, in 1990, MBDF began publishing consumer-oriented Medicare pamphlets explaining, for example, how to access the Medicare home health benefit and how to appeal a denial of coverage. In the following years, with just around three staff, MBDF continued developing connections between its direct client work and its

title: Medicare Advantage

text: on which to compare traditional Medicare to Medicare Advantage. It is common for people to continue to work after joining Medicare at age 65, use both Original Medicare (often just Part A) and employer sponsored insurance, and delay deciding between FFS Medicare and capitated-fee Medicare until retirement. Sicker people and people with higher medical expenditures are more likely to switch from Medicare Advantage plans to Original Medicare. This statistic is primarily driven by people on Medicaid in custodial care at nursing home; such people no longer have need of any Medicare supplement, either a public Part C plan or a

title: Medicare Advantage

text: private Medigap or group retirement plan. The Part C risk adjusted payments to Medicare Advantage plans are designed to limit this churn between types of Medicare (managed vs. FFS), but it is unclear how effective that policy is. Evidence is mixed on how quality and access compare between Medicare Advantage and "traditional" Medicare. ("traditional" in quotes because it is not the same as Original Medicare; everyone in Medicare must begin by joining Original Medicare; the term "traditional" typically refers to FFS and almost always means the beneficiary has a private group or individually purchased supplement to Original Medicare). Most research

title: Medicare Advantage

text: suggests that enrollees in Medicare HMOs tend to receive more preventative services than beneficiaries in traditional Medicare; however, beneficiaries, especially those in poorer health, tend to rate the quality and access to care in traditional Medicare more favorably than in Medicare Advantage. It is difficult to generalize the results of studies across all plans participating in the program because performance on quality and access metrics varies widely across the types of Medicare Advantage plans and among the dozens of providers of Medicare Advantage plans. Medicare Advantage Medicare Advantage is a type of health insurance that provides coverage within of Medicare

title: Medicare Advantage

text: include an annual physical exam and vision and/or dental coverage of some sort not covered under Original Medicare Parts A and B. Less often, hearing and wellness benefits not found in Original Medicare are included in a Medicare Advantage plan. The most important difference between a Part C health plan and FFS Original Medicare is that all Part C plans, including capitated-fee Medicare Advantage plans, include a limit on how much a beneficiary will have to spend annually out of pocket; that amount is unlimited in Original Medicare Parts A and B. Most but not all Medicare Advantage plans (and

title: Medicare fraud

text: government said totaled over $223 million in false billings. The bust took more than 400 law enforcement officers including FBI agents in Miami, Detroit, Los Angeles, New York and other cities to make the arrests. In June 2015, Federal officials charged 243 people including 46 doctors, nurses, and other medical professionals with Medicare fraud schemes. The government said the fraudulent schemes netted approximately $712 million in false billings in what is the largest crackdown undertaken by the Medicare Fraud Strike Force. The defendants were charged in the Southern District of Florida, Eastern District of Michigan, Eastern District of New York,

title: Medicare fraud

text: Medicare fraud In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately. The total amount of Medicare fraud is difficult to track, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. According to the Office of Management and Budget, Medicare "improper payments" were $47.9 billion in 2010, but some of these payments later turned out to be valid. The

title: Medicare Advantage

text: Medicare Advantage Medicare Advantage is a type of health insurance that provides coverage within of Medicare in the United States. Medicare Advantage plans pay for managed health care based on a monthly fee per enrollee (capitation), rather than on the basis of billing for each medical service provided (fee-for-service, FFS) for unmanaged healthcare services. Most such plans are health maintenance organizations (HMOs) or preferred provider organizations (PPOs). Medicare Advantage plans finance at a minimum the same medical services as "Original Medicare" Parts A and B Medicare finance via fee-for-service. Part C plans, including Medicare Advantage plans, also typically finance additional

title: Medicare (United States)

text: Part C plans tended to be suburban HMOs tied to major nearby teaching hospitals that cost the government the same as or even 5% less on average than it cost to cover the medical needs of a comparable beneficiary on Original Medicare. The 2003-law payment framework/bidding/rebate formulas overcompensated some Part C plan sponors by 7 percent (2009) on average nationally compared to what Original Medicare beneficiaries cost per person on average nationally that year and as much as 5 percent (2016) less nationally in other years (see any recent year's Medicare Trustees Report, Table II.B.1). The 2003 payment formulas succeeded

title: Medicare Australia

text: Medicare Australia Medicare Australia is one of the Master Programs of the Australian Government Department of Human Services(DHS). Prior to 1 October 2005, Medicare Australia was known as the Health Insurance Commission (HIC). On 1 July 2011, Medicare Australia and Centrelink were integrated into the Department of Human Services by the "Human Services Legislation Amendment Act 2011". Medicare Australia administers health-related programs. It is a prescribed agency under the "Financial Management and Accountability Act 1997 (Cth)" and a statutory agency within the Department of Human Services, under the "Public Service Act 1999 (Cth)". The National Office of Medicare Australia is

title: Medicare Advantage

text: totally accurate either. People can enroll in Medicare Advantage and other Part C health plans either by enrolling when they first become Medicare-eligible and first join both Parts A and B or by switching from traditional Medicare during an annual or special enrollment period as outlined in "Medicare and You, 2018" (there are over a dozen such enrollment periods). For each person who chooses to enroll in a Part C Medicare Advantage or other Part C plan, Medicare pays the health plan a set amount every month ("capitation"). The capitated fee associated with a Medicare Advantage plan is specific to

title: Medicare fraud

text: Southern District of Texas, Central District of California, Eastern District of Louisiana, Northern District of Texas, Northern District of Illinois and the Middle District of Florida. Medicare fraud In the United States, Medicare fraud is the claiming of Medicare health care reimbursement to which the claimant is not entitled. There are many different types of Medicare fraud, all of which have the same goal: to collect money from the Medicare program illegitimately. The total amount of Medicare fraud is difficult to track, because not all fraud is detected and not all suspicious claims turn out to be fraudulent. According to

title: Medicare (United States)

text: is a mechanism by which the state takes a portion of its citizens' resources to guarantee health and financial security to its citizens in old age or in case of disability, helping them cope with the enormous, unpredictable cost of health care. In its universality, Medicare differs substantially from private insurers, which must decide whom to cover and what benefits to offer to manage their risk pools and guarantee their costs don't exceed premiums. Because the federal government is legally obligated to provide Medicare benefits to older and disabled Americans, it cannot cut costs by restricting eligibility or benefits, except

title: Medicare (United States)

text: by contributions paid while at work, when the payments are least burdensome, with the protection furnished in retirement without further payment. In the early 1960s relatively few of the elderly had health insurance, and what they had was usually inadequate. Insurers such as Blue Cross, which had originally applied the principle of community rating, faced competition from other commercial insurers that did not community rate, and so were forced to raise their rates for the elderly. Medicare is not generally an unearned entitlement. Entitlement is most commonly based on a record of contributions to the Medicare fund. As such it

title: Medicare (Australia)

text: because a Medicare benefits freeze has been imposed over the last few years. Medical practitioners choosing to cease or cut back on bulk-billing also increases out-of-pocket costs to patients. Medicare sets a schedule of fees, called the Medicare Benefits Schedule (MBS). The standard Medicare rebate is 100% of a general practitioner and 85% of a specialist schedule fee. Where medical practitioners bill Medicare directly ("bulk bill"), they agree with Medicare to accept 85% of the schedule fee in full payment for their services. Many medical practitioners bulk bill pensioner patients, and some bulk bill all of their patients. In the

title: Medicare Advantage

text: Part A at 65 as recommended) whereas a "like" Medicare Part C beneficiary has to be on both Parts A and Part B. On an absolute basis, in 2015 Medicare spent 4% less on Medicare Advantage and other Part C beneficiaries per person than they did per person on Medicare beneficiaries under FFS Medicare. In 2014 the difference in parity on an absolute basis was 2% less per person on Part C. It appears from both points of view—per "like beneficiary" and absolutely—that the latest formula delivers the original cost-saving promise of Managed Medicare. But an absolute comparison is not

title: Medicare Advantage

text: but in practice it almost always increases cost per beneficiary by one or two percent, either because the Medicare Advantage plan is diligent in upcoding to a beneficiary's specific risks or because patients on Original FFS Medicare, where providers have no incentive to code at all, are undercoded . Medicare Advantage plans are required to offer a benefit "package" that is at least equal to Original Medicare's and cover everything Medicare covers, but they may cover benefits in a different way. For example, plans that require higher out-of-pocket costs than Original Medicare for some benefits, such as skilled nursing facility

title: Medicare Part D

text: Medicare Part D Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums (the cost of almost all professionally administered prescriptions is covered under optional Part B of United States Medicare). Part D was originally proposed by President Clinton in 2000 and enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public Part C Medicare health plan program) and went into effect on January 1, 2006. Individuals on Medicare are eligible for

title: Medicare (Australia)

text: Medicare services. There are two safety nets: The thresholds for both safety nets are indexed on 1 January each year to the Consumer Price Index. Under the original Medicare safety net, once an annual threshold in gap costs has been reached, the Medicare rebate for out-of-hospital services is increased to 100% of the schedule fee (up from 85%). Gap costs refer to the difference between the standard Medicare rebate (85% of the schedule fee) and the actual fee paid, but limited to 100% of the schedule fee. The threshold applies for all Medicare cardholders and is $453.20 for calendar year

title: National Committee to Preserve Social Security and Medicare

text: National Committee to Preserve Social Security and Medicare The National Committee to Preserve Social Security and Medicare (NCPSSM) is a United States advocacy group whose goal is to protect Social Security and Medicare. NCPSSM works to preserve entitlement programs through direct mail campaigns, candidate endorsements, incumbent ratings, grassroots activity, issue advertising, and campaign contributions. NCPSSM promotes tax increases as a way to address what it describes as modest long-term issues with Social Security's solvency. The organization opposes Social Security privatization and supports prescription drug benefits in Medicare. Through its political action committee, the organization donates money to support Democratic candidates

title: Medicare Rights Center

text: visits for the first time. Medicare Rights Center The Medicare Rights Center (Medicare Rights) is a national, 501(c)(3) nonprofit consumer service organization with offices in New York City and Washington, DC. Medicare Rights works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives. In June 1989, the Medicare Rights Center was founded as the Medicare Beneficiaries Defense Fund (MBDF) by Diane Archer. One of the first actions of the fledgling organization involved a lawsuit brought against the federal government on the grounds that the Medicare

title: Medicare Rights Center

text: Medicare Rights Center The Medicare Rights Center (Medicare Rights) is a national, 501(c)(3) nonprofit consumer service organization with offices in New York City and Washington, DC. Medicare Rights works to ensure access to affordable health care for older adults and people with disabilities through counseling and advocacy, educational programs and public policy initiatives. In June 1989, the Medicare Rights Center was founded as the Medicare Beneficiaries Defense Fund (MBDF) by Diane Archer. One of the first actions of the fledgling organization involved a lawsuit brought against the federal government on the grounds that the Medicare Explanation of Benefits (EOB) failed

title: Medicare (Australia)

text: 2017. The extended Medicare safety net (EMSN) was first introduced in March 2004. Once an annual threshold in out-of-pocket costs for out-of-hospital Medicare services is reached, the Medicare rebate will increase to 80% of any future out-of-pocket costs (now subject to the EMSN fee cap) for out-of-hospital Medicare services for the remainder of the calendar year. Out-of-pocket costs are the difference between the fee actually paid to the practitioner (subject to the fee cap) and the standard Medicare rebate. When introduced, the general threshold for singles and families was $700 and $300 for singles and families that hold a Commonwealth

title: Medicare card (Australia)

text: without a number or card and resolve Medicare eligibility issues after treatment. Medicare is administered by a government agency called Medicare Australia (until late 2005 known as the Health Insurance Commission or HIC) which also has responsibility for supplying Medicare cards and numbers. Almost every eligible person has a card: in June 2002 there were 20.4 million Medicare cardholders, and the Australian population was less than 20 million at the time (cardholders includes overseas Australians who still have a card). However, the use of the card is relevant only to consultations with medical practitioners who are eligible for Medicare provider

title: Medicare Advantage

text: many of the other public managed-care health plans within Medicare Part C) include integrated self-administered drug coverage similar to the standalone Part D prescription drug benefit plan. The federal government makes separate capitated-fee payments to Medicare Advantage plans for providing these Part-D-like benefits if applicable just as it does for anyone on Original Medicare using Part D. Nearly all Medicare beneficiaries (99%) had access to at least one Medicare Advantage plan; the average beneficiary had access to 18 plans in 2015. In the 1970s, less than a decade after the beginning of fee for service Medicare, Medicare beneficiaries gained the

title: Medicare (Australia)

text: including amendments to the "Health Insurance Act 1973", the "National Health Act 1953" and the "Health Insurance Commission Act 1973". Medicare is presently nominally funded by an income tax surcharge, known as the "Medicare levy", which is currently 2% of a person's taxable income. The 2013 budget increased the Medicare levy from 1.5% to 2% from 1 July 2014, to fund the National Disability Insurance Scheme. The 2017 budget proposes to increase the Medicare levy from 2% to 2.5%, from 1 July 2018. The proposed levy increase was scrapped on 25 April 2018. The levy is calculated on the whole

title: Medicare (Australia)

text: Medicare (Australia) Medicare is the publicly funded universal health care system in Australia. Operated by the Department of Human Services, Medicare is the primary funder of health care in Australia, funding primary health care for Australian citizens and permanent residents including Norfolk Island. Residents are entitled to a rebate for treatment from medical practitioners, eligible midwives, nurse practitioners and allied health professionals who have been issued a Medicare provider number, and can also obtain free treatment in public hospitals. The plan was introduced in 1975 by the Whitlam Government as "Medibank", and was limited to paying customers only in 1976

title: What Is a Nation?

text: What Is a Nation? "What is a Nation?" ("Qu'est-ce qu'une nation?") is an 1882 lecture by French historian Ernest Renan (1823–1892), known for the statements that a nation is "a daily referendum", and that nations are based as much on what the people jointly forget, as what they remember. It is frequently quoted or anthologized in works of history or political science pertaining to nationalism and national identity. Renan wrote "What is a Nation" in order to symbolize the nationalism which was born in France as a result of the French Revolution of 1789. Renan begins his essay by noting

title: Medicare (United States)

text: for them (most beneficiaries have worked long enough and have no Part A premium), as well as some of their out of pocket medical and hospital expenses. Medicare has four parts: loosely speaking Part A is Hospital Insurance. Part B is Medical Services Insurance. Medicare Part D covers many prescription drugs, though some are covered by Part B. In general, the distinction is based on whether or not the drugs are self-administered but even this distinction is not total. Public Part C Medicare health plans, the most popular of which are branded Medicare Advantage, are another way for Original Medicare

title: Medicare card (Australia)

text: Medicare card (Australia) A Medicare card is a plastic card issued to individuals or families who are eligible to receive a rebate of medical expenses under Australia's Medicare system, when they are treated privately by a doctor with a provider number. The card is usually green in colour, although interim cards are light blue and cards for Reciprocal Health Care Agreement visitors are light yellow. All permanent residents of Australia are eligible for a Medicare card, except for those who are not deemed to be residing in Australia. Citizenship is not necessary to be eligible for a medicare card. The

title: Medicare Part D

text: The cost of the plan would be borne by drug manufacturers for name-brand drugs and by the government for generics. Medicare Part D Medicare Part D, also called the Medicare prescription drug benefit, is an optional United States federal-government program to help Medicare beneficiaries pay for self-administered prescription drugs through prescription drug insurance premiums (the cost of almost all professionally administered prescriptions is covered under optional Part B of United States Medicare). Part D was originally proposed by President Clinton in 2000 and enacted as part of the Medicare Modernization Act of 2003 (which also made changes to the public

title: Medicare (United States)

text: reduce payments to public Part C Medicare health plans by aligning the rules that establish Part C plans' capitated fees more closely with the FFS paid for comparable care to "similar beneficiaries" under Parts A and B of Medicare. Primarily these reductions involved much discretion on the part of CMS and examples of what CMS did included effectively ending a Part C program Congress had previously initiated to increase the use of Part C in rural areas (the so-called Part C PFFS plan) and reducing over time a program that encouraged employers and unions to create their own Part C

title: Medicare (United States)

text: Part A or B is eligible for Part D, which covers mostly self-administered drugs. It was made possible by the passage of the Medicare Modernization Act of 2003. To receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with integrated prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies and pharmacy benefit managers. Unlike Original Medicare (Part A and B), Part D coverage is not standardized (though it is highly regulated by the

title: Medicare (United States)

text: of demonstration projects that dated back to the early 1970s. These Part C plans were initially known in 1997 as "Medicare+Choice". As of the Medicare Modernization Act of 2003, most "Medicare+Choice" plans were re-branded as "Medicare Advantage" (MA) plans (though MA is a government term and might not even be "visible" to the Part C health plan beneficiary). Other plan types, such as 1876 Cost plans, are also available in limited areas of the country. Cost plans are not Medicare Advantage plans and are not capitated. Instead, beneficiaries keep their Original Medicare benefits while their sponsor administers their Part A

title: Medicare Advantage

text: the people on Medicare. But today over half the people fully signing up for Medicare for the first time, are choosing a public Part C plan of some type. But the costs per person that had once been too low to attract beneficiaries then became too high to afford long term. So in 2009, the Medicare Payment Advisory Commission (MedPAC) reported that Medicare would spend 14 percent more on Medicare Advantage beneficiaries per person that year than they did per person for "like beneficiaries" under traditional Medicare, theoretically adding an additional 3% ($14 billion) to the cost of the overall

title: Medicare Advantage

text: option to receive their Medicare benefits through managed, capitated health plans, mainly HMOs, as an alternative to FFS Original Medicare, but only under random Medicare demonstration programs. The Balanced Budget Act of 1997 formalized the demonstration programs into Medicare Part C, introduced the term "Medicare+Choice" as a pseudo-brand for this option. Initially, fewer insurers participated than expected, leading to little competition. In a 2003 law, the capitated-fee benchmark/bidding process was changed effective in 2005 to increase insurer participation, but also increasing the costs per person of the program. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 renamed +Choice

title: Medicare dual eligible

text: Medicare dual eligible Dual-eligible beneficiaries (Medicare dual eligibles or "duals") refers to those qualifying for both Medicare and Medicaid benefits. In the United States, approximately 9.2 million people are eligible for "dual" status spending an estimated $319.5 billion in 2011 alone. Dual-eligibles make up 14% of Medicaid enrollment, yet they are responsible for approximately 36% of Medicaid expenditures. Similarly, duals total 20% of Medicare enrollment, and spend 31% of Medicare dollars. Dual-eligibles are often in poorer health and require more care compared with other Medicare and Medicaid beneficiaries. The reason that the cost for dual-eligible long-term care is high is

title: Medicare Rights Center

text: was enacted, promising to insure millions of uninsured and under-insured Americans and to introduce a variety of reforms to health insurance and care delivery, including reductions in over-payments to Medicare Advantage plans and new demonstration programs to better coordinate care for vulnerable populations. Medicare Rights began to advocate that new reforms benefitting the non-Medicare population are made available where possible to people with Medicare. Also during this time, with support from the Atlantic Philanthropies, Medicare Rights further expanded the Medicare Minute program nationally, and simultaneously launched Medicare Advocacy Coalitions in targeted states to pursue a range of Medicare reforms. Medicare

title: Medicare card (Australia)

text: prove eligibility when seeking Australian Medicare-subsidised care from a medical practitioner or hospital. Legally, the card need not be produced and an Australian Medicare number is sufficient. In practice, most Australian Medicare providers will have policies requiring the card be presented to prevent fraud. From 2002, a Medicare card must now be shown at a pharmacy when collecting Pharmaceutical Benefits Scheme (PBS) medication. The Medicare card is used as a recognised form of ID in opening bank accounts or obtaining a driver's license. On the ‘100 point scale’, on which 100 points of ID are required for proof of identity,

title: Medicare Payment Advisory Commission

text: Medicare and health providers serving Medicare beneficiaries. MedPAC is also relied on by Medicare administrators and policy makers to evaluate beneficiary's access to care and the quality of care received. MedPAC's mandate is broad enough that it can also evaluate other issues affecting Medicare. MedPAC produces two major reports to the United States Congress each year that contain recommendations to improve Medicare. For example, its June 2008 report to Congress, "Reforming the Delivery System," made several recommendations along "a path to bundled payment." Medicare Payment Advisory Commission The Medicare Payment Advisory Commission (MedPAC) is an independent US federal body. MedPAC

title: Medicare (United States)

text: quality of customer service given by Medicare contractors, specifically the 1-800-MEDICARE contractor. As a result, 1-800-MEDICARE customer service representatives (CSR) have seen an increase in training, quality assurance monitoring has significantly increased, and a customer satisfaction survey is offered to random callers. In most states the Joint Commission, a private, non-profit organization for accrediting hospitals, decides whether or not a hospital is able to participate in Medicare, as currently there are no competitor organizations recognized by CMS. Other organizations can also accredit hospitals for Medicare. These include the Community Health Accreditation Program, the Accreditation Commission for Health Care, the Compliance

title: Medicare Australia

text: located in Canberra, and is responsible for policy and program development. Medicare Australia previously had many branch offices across Australia, usually located in retail centers, which processed claims from and payments to members. Since 2009 these have been progressively shut with payment and claim facilities moving online and with integration to provide assistance with online access at centerlink offices termed "one-stop-shops". Medicare Australia administers various health-related programs in partnership with the Department of Health and Ageing. As of 2007, these programs included: Medicare Australia Medicare Australia is one of the Master Programs of the Australian Government Department of Human Services(DHS).

title: Medicare Resources

text: of Medicare Resources Ltd because Neir decided to establish the organisation after contacting Pastor Mary Kwok. Medicare Resources Ltd focuses its medical and social services mainly in Wuhan (武漢) and Yichang (宜昌) which are located in Hubei (湖北省), and Fengjie (奉節) which is located in Chongqing province (重慶省). Wuhan (武漢): Yichang (宜昌): Fenjie (奉節): Medicare Resources Ltd engages in direct subsidising high-school and university students with special needs and being a middleman between sponsors and the benefited. Medicare Resources Ltd helps the economically disadvantaged in a sustainable way. Instead of giving them money directly, it hopes to increase their abilities

title: Medicare dual eligible

text: generally improved for dual-eligibles enrolled in FIDE-SNPs, very few of these plans reported lower estimated Medicare costs relative to what Medicare's fee-for-service program would have spent for beneficiaries with the same demographic and health characteristics. Furthermore, the FIDE-SNPs that reported potential Medicare savings generally did not demonstrate lower costs than other D-SNPs in the same geographic areas. These results were consistent for dual-eligibles both under the age of 65 and those age 65 and over. While operating specialized plans and integrating benefits could lead to improved care, GAO's results suggest that these conditions have not demonstrated a reduction in dual-eligible

title: Medicare Rights Center

text: of Commerce, Medicare Rights built and launched a national, online compendium of answers to consumer and professional Medicare questions. During this period, Medicare Rights also launched its CityNET (City Network Education and Training) program to provide regular Medicare trainings to New York City professionals. In addition, Medicare Rights established a National Consumer Advisory Board to more effectively share the insurance experiences of beneficiaries and their families with media outlets and policymakers. In 2003, Medicare Rights established its first office in Washington, DC. Medicare Rights also launched its Medicare/Medicaid Assistance Program (MMAP) to provide one-on-one assistance to clients at New York

title: Medicare fraud

text: Health and Human Services, Office of Inspector General, U.S. Attorney's Office, and the U.S. Department of Justice created the Medicare Fraud Strike Force in Miami, Florida. This group of anti-fraud agents has been duplicated in other cities where Medicare fraud is widespread. In Miami alone, over two dozen agents from various federal agencies investigate solely Medicare fraud. In May 2009, Attorney General Holder and HHS Secretary Sebelius Announce New Interagency Health Care Fraud Prevention and Enforcement Action Team (HEAT) to combat Medicare fraud. FBI Director Robert Mueller stated that the FBI and HHS OIG has over 2,400 open health care

title: Medicare Advantage

text: typically not permitted in an HMO. The average OOP limit in 2016 was around $5000. Note that an OOP limit is not a deductible as is often reported; it is instead a financial-protection benefit. It is rare for a Medicare Advantage beneficiary to reach the annual OOP limit. Original Medicare provides no similar OOP spending cap and the exposure of an Original Medicare beneficiary to a financial catastrophe is unlimited (but also rare). Once the OOP maximum is reached for an individual, the plan pays 100% of medical services for the remainder of the calendar year (with no lifetime maximum).

title: Medicare (United States)

text: payment of Extra Help/Low Income Subsidy payments related to Part D Medicare, and collecting some premium payments for the Medicare program. The Chief Actuary of the CMS must provide accounting information and cost-projections to the Medicare Board of Trustees to assist them in assessing the program's financial health. The Board is required by law to issue annual reports on the financial status of the Medicare Trust Funds, and those reports are required to contain a statement of actuarial opinion by the Chief Actuary. Since the Medicare program began, the CMS (that was not always the name of the responsible bureaucracy)

title: Medicare (United States)

text: for Medicare and Medicaid Services announced a final rule concerning eligibility for hospital inpatient services effective October 1, 2013. Under the new rule, if a physician admits a Medicare beneficiary as an inpatient with an expectation that the patient will require hospital care that "crosses two midnights," Medicare Part A payment is "generally appropriate." However, if it is anticipated that the patient will require hospital care for less than two midnights, Medicare Part A payment is generally not appropriate; payment such as is approved will be paid under Part B. The time a patient spends in the hospital before an

title: Medicare Rights Center

text: City community-based organizations in need of Medicare counseling and enrollment assistance. Later that year, Medicare Rights launched the Baltimore Project, which systematically linked helpline stories to needed policy reforms, and helped increase the organization's visibility as a policy voice with the Centers for Medicare & Medicaid Services (CMS). Also this year, the Medicare Prescription Drug, Improvement, and Modernization Act (MMA) was enacted, paving the way for the Medicare Advantage program and the Medicare Part D drug benefit. In 2005, the Medicare Part D drug benefit became available in the fall (with the first-ever Fall Open Enrollment Period running from November

title: What is a Masterpiece?

text: confluence of memories and emotions forming a single idea", that it has "a power of recreating traditional forms so that they become expressive of an artist's own epoch and yet keep a relationship to the past". The highest masterpieces are said to be "illustrations of great themes." Clark also implicitly excluded the erotic from considerations of what constituted a masterpiece, based on his perspective that a necessary condition is the balance between sense and form (works that are too sensual are, therefore, unbalanced and not to be categorised at masterpiece level). What is a Masterpiece? What is a Masterpiece? is

title: Medicare (United States)

text: government contribution. Conversely, enrollees could choose lower cost coverage and keep the difference between their coverage costs and the fixed government contribution. The goal of premium Medicare plans is for greater cost-effectiveness; if such a proposal worked as planned, the financial incentive would be greatest for Medicare plans that offer the best care at the lowest cost. This concept is basically how public Medicare Part C already works (but with a much more complicated competitive bidding process that drives up costs for the Trustees, but is very advantageous to the beneficiaries). Given that only about 1% of people on Medicare

title: Medicare (United States)

text: gaps in prescription-drug coverage left by the Medicare Secondary Payer Act that was enacted in 1980. The 2003 bill strengthened the Workers' Compensation Medicare Set-Aside Program (WCMSA) that is monitored and administered by CMS. On August 1, 2007, the US House United States Congress voted to reduce payments to Medicare Advantage providers in order to pay for expanded coverage of children's health under the SCHIP program. As of 2008, Medicare Advantage plans cost, on average, 13 percent more per person insured for like beneficiaries than direct payment plans. Many health economists have concluded that payments to Medicare Advantage providers have

title: What Is a Nation?

text: to the reasons based on race, geography, history and so on. They argue that Renan maintains his intellectual background but subtly, i.e. the arguments he explicitly used in "What is a Nation?" are not consistent with his thinking. The concept of "daily plebiscite" would be ambiguous. They argue that the definition is an opportunist idealization and it should be interpreted within the Franco-Prussian War and in the midst of the dispute concerning the Alsace-Lorraine region. What Is a Nation? "What is a Nation?" ("Qu'est-ce qu'une nation?") is an 1882 lecture by French historian Ernest Renan (1823–1892), known for the statements

title: Medicare card (Australia)

text: numbers. Such access has been made subject to increasing requirements since the mid-1990s. The widespread use of the Medicare card means a distinction needs to be drawn between the card and failed proposals for an Australia Card. The Medicare card is used for health care purposes only and cannot be used to track in a database a number of activities. It contains a name and number, and no visible photograph. Individuals are not legally required to have a Medicare card, to carry it with them, or to produce it on request. The primary purpose of the Medicare card is to

title: Medicare Advantage

text: "Medicare Advantage". Other managed Medicare plans include (non-capitated) COST plans, dual-eligible (Medicare/Medicaid) plans and PACE plans (which try to keep seniors that need custodial care in their homes). However 97% of the beneficiaries in Part C are in one of the roughly one dozen types of Medicare Advantage plans (HMO, EGWP, SNP, regional PPO, etc.), primarily in classic vanilla HMOs. Enrollment in the public Part C health plan program, including plans called Medicare Advantage since 2005, grew from zero in 1997 (not counting the pre-Part C demonstration projects) to over 21 million in 2018. That 21,000,000-plus represents about 35% of

title: Medicare Resources

text: Evangelical Free Church of America and at the same time, the free space to self-administer. Medicare Resources Ltd is a world-based non-government organisation. Even though the founder, John Neir, comes from Evangelical Free Church of America, Mediare Resources Ltd is a partner of Hong Kong-based Evangelical Free Church of China and accepts all donations from all around the world. Medicare Resources Ltd was established as a "human-based" non-government organisation. It does not spend a lot on advertising and promotion; it spends most of its fund in Hubei, China where the service area is. Directors of Medicare Resources Ltd has close

title: Themis Medicare

text: Medicare manufactures APIs for therapeutic segment such as antituberculosis, antimalarials, cardiology, pain management, anti-infectives, haematinics, health and nutrition. Products include simvastatin, lovastatin, propofol, ethambutol, dimethyl isosorbide, artesunate, lumefenterine and arteether. In 2010, the company launched a combination of lidocaine and prilocaine in spray form branded as "Lovelong" for the treatment of premature ejaculation. The company received approval from the Drug Controller General of India to manufacture and market the product in India. Themis Medicare Themis Medicare (TML) (also called Themis Chemical) incorporated in 1969, is a manufacturer of active pharmaceutical ingredients (APIs) and formulations. It is a joint venture with

title: Themis Medicare

text: Themis Medicare Themis Medicare (TML) (also called Themis Chemical) incorporated in 1969, is a manufacturer of active pharmaceutical ingredients (APIs) and formulations. It is a joint venture with Gedeon Richter Plc. of Hungary. Headquartered in Mumbai, the company has four manufacturing facilities located at Vapi (Gujarat), Hyderabad (Andhra Pradesh), and Haridwar. The company also has presence in 40 countries. TML's research and development facility focuses on development of new chemicals, new processes for production of API and intermediates, fermentation technology and new drug delivery systems. Themis Medicare also sells its research formulations to a variety of Indian pharmaceutical companies. Themis

title: Medicare card (Australia)

text: card lists an individual as well as any members of his or her family he or she chooses to add who are also permanent residents and meet the Medicare definition of dependent. The card must be produced or the Medicare number provided if the Medicare rebate is paid directly to the doctor under the bulk billing system. It is also necessary to provide a Medicare number (although not necessarily show the card) to gain access to the public hospital system to be treated at no cost as a public patient. For non-elective treatment (e.g. emergency), public hospitals will admit patients

title: Medicare Advantage

text: enrollees. A rebate cannot contribute to "profit" ("profit" is in quotes because most Medicare Advantage plans are administered by non-profit organizations, primarily integrated health delivery systems). This benchmark/bidding/rebate process accounts for from 97% to 100% of the cost of the given Medicare Advantage plan to the Medicare Trust Funds. The individual fee for each Part C beneficiary is also uplifted or downsized slightly (approximately 1%-3% in either direction on average) from the county-specific fee based on a risk-based formula tied to the personal health characteristics of the capitated individual. The theory is that the risk-based formula will not affect spending,

title: Medicare Resources

text: key for the three parties to co-operate in the actual operation of charity work. The primary mission of Medicare Resources Ltd is to improve the living conditions of the Chinese by providing medical and social services while it also hopes to promote Christianity as well. However, it does not mean that services are exclusive to Christians in China as it also serves non-Christians. Medicare Resources Ltd aims to show its devotion to the underprivileged (even though most of them are not Christians) under the love of god and it is regarded as a means to glorify God. Medicare Resources Ltd

title: Medicare Resources

text: explosives to clear 400 meters of boulders which blocked a completion of 8 km. Medicare Resources Ltd is planning to set up a mobile clinic in Hankou (漢口).They will continue school project in Kangping (康坪), and will also expand their service in other parts of China such as Guizhou (貴州). Medicare Resources Medicare Resources (Chinese: 香港醫療關懷) is a Hong Kong-based non-government organisation which is dedicated to serve the needy in China. The organisation was registered in Hong Kong in March 1997, and formally established in July 1997. It set up the Loving Heart Clinic (愛心診所) in Wuhan (武漢) as a

title: Medicare Rights Center

text: states outside of New York. Also during this time, Medicare Rights redesigned its Medicare/Medicaid Assistance Program (MMAP) as the Community Partners Program, aiming to provide a range of technical assistance to New York City organizations seeking to enroll more of their clients in Medicare low-income benefits. During this period, Medicare Rights also rebranded, improving the look and feel of its outreach and educational content and incorporating the tagline "Getting Medicare right" into all materials. In 2009, Medicare Rights and the Food Bank for New York City secured a $1 million grant from the Fan Fox and Leslie R. Samuels Foundation

title: Medicare dual eligible

text: automatically been enrolled to a random Medicare Part D plan, effective January 1 of 2006. As a result of this auto assignment, participants who were already enrolled in a Medicare Advantage HMO, may have been automatically disenrolled from their medical plan to allow for part D enrollment. Medicaid will still cover drugs for dual-eligible patients that are not covered by Medicare Part D, including certain controlled substances. Dual-eligibles typically receive their Medicare and Medicaid benefits through each program separately. For Medicare benefits, beneficiaries may opt to enroll in Medicare's traditional fee-for-service (FFS) program or in a private Medicare Advantage (MA)

title: Medicare (United States)

text: C health plans, including Medicare Advantage plans, grew from about 1% of total Medicare enrollment in 1997 when the law was passed (the 1% representing people on pre-law demonstration programs) to about 35% in 2018. Of course the absolute number of beneficiaries on Part C has increased even more dramatically on a percentage basis because of the large increase of people on Original Medicare since 1997. Almost all Medicare beneficiaries have access to at least two public Medicare Part C plans; most have access to three or more. Medicare Part D went into effect on January 1, 2006. Anyone with

title: Medicare Rights Center

text: and newsletters. The following year, the Medicare Minute program (also known as Seniors Out Speaking) launched in Westchester County, New York. With support from the Robert Wood Johnson Foundation, Medicare Rights forged the New York Medicare Savings Coalition to pursue advocacy to increase enrollment in Medicare Savings Programs (MSPs). An alliance today of over 150 community-based organizations, advocacy groups, and government agencies, the coalition and Medicare Rights had an initial early victory in 2002 successfully advocating for the elimination of the asset test for the Qualified Individual (QI) Medicare Savings Program. In 2001, with a grant from the U.S. Department

title: Medicare Rights Center

text: policy advocacy. The Clinton health plan proposal was introduced, providing a means for MBDF and other consumer groups to advocate for improvement of the Medicare program. An article was published in the "Journal of Long-Term Home Health Care" outlining eight issues facing people with Medicare based on counseling provided on MBDF's helpline at this time. In 1996, MBDF changed its name to the Medicare Rights Center, Inc. (Medicare Rights). In 1997, with seven staff and 20 volunteers, Medicare Rights launched its first website. Also this year, the Balanced Budget Act of 1997 was enacted, introducing the Medicare + Choice program,

title: Medicare (United States)

text: their own exorbitant prices. Meanwhile, the Patient Protection and Affordable Care Act has given Medicare the mandate to promote cost-containment throughout the health care system, for example, by promoting the creation of accountable care organizations or by replacing fee-for-service payments with bundled payments. Over the long-term, Medicare faces significant financial challenges because of rising overall health care costs, increasing enrollment as the population ages, and a decreasing ratio of workers to enrollees. Total Medicare spending is projected to increase from $523 billion in 2010 to around $900 billion by 2020. From 2010 to 2030, Medicare enrollment is projected to increase

title: Medicare dual eligible

text: beneficiaries' Medicare spending compared with Medicare spending in settings without integrated benefits. Because the GAO study also found that the average number of costly Medicare services increases as the number of chronic and mental health conditions increase, it is possible that savings were not demonstrated because the population being served by FIDE-SNPs is too large to be cost-effective and major complications were averted for relatively few beneficiaries. A study looking at physician's views of Medicare Part D, and in particular how it pertains to dual-eligibles, found that many physicians expressed concern regarding access to prescription drugs, especially for dual-eligibles. Almost

title: Medicare fraud

text: Department of Justice by paying $19.8 million to the federal government, while Mariner and SavaSeniorCare settled for $14 million. In September 2011, a nationwide takedown by Medicare Fraud Strike Force operations in eight cities resulted in charges against 91 defendants for their alleged participation in Medicare fraud schemes involving approximately $295 million in false billing. In 2012, Medicare Fraud Strike Force operations in Detroit resulted in convictions against 2 defendants for their participation in Medicare fraud schemes involving approximately $1.9 million in false billing. Victor Jayasundera, a physical therapist, pleaded guilty on January 18, 2012 and was sentenced in the

title: Medicare Resources

text: Medicare Resources Medicare Resources (Chinese: 香港醫療關懷) is a Hong Kong-based non-government organisation which is dedicated to serve the needy in China. The organisation was registered in Hong Kong in March 1997, and formally established in July 1997. It set up the Loving Heart Clinic (愛心診所) in Wuhan (武漢) as a base. Over the years, it takes the initiative to provide medical and social services for the poor people in China in a human-based approach and at the same time promote Christianity. Acknowledging the insufficient medical and social welfare system in China, especially in villages, Medicare Resources Ltd allocates the donation

title: Medicare fraud

text: Medicare expense claims. In all, civil lawsuits cost HCA more than $1.7 billion to settle, including more than $500 million paid in 2003 to two whistleblowers. The DOJ Medicare fraud enforcement efforts rely heavily on healthcare professionals coming forward with information about Medicare fraud. Federal law allows individuals reporting Medicare fraud to receive full protection from retaliation from their employer and collect up to 30% of the fines that the government collects as a result of the whistleblower's information. According to US Department of Justice figures, whistleblower activities contributed to over $13 billion in total civil settlements in over 3,660

title: Medicare fraud

text: Office of Investigations for the HHS, OIG collaboratively works with the Federal Bureau of Investigation in order to combat Medicare Fraud. Defendants convicted of Medicare fraud face stiff penalties according to the Federal Sentencing Guidelines and disbarment from HHS programs. The sentence depends on the amount of the fraud. Defendants can expect to face substantial prison time, deportation (if not a US citizen), fines, and restitution. In 1997, the federal government dedicated $100 million to federal law enforcement to combat Medicare fraud. That money pays over 400 FBI agents who investigate Medicare fraud claims. In 2007, the U.S. Department of

title: Medicare Part D

text: (NOTE: Medicare beneficiaries need to be signed up for both Parts A and B to select Part C whereas they need only A or B to select Part D.) About two-thirds of all Medicare beneficiaries are enrolled directly in Part D or get Part-D-like benefits through a public Part C Medicare health plan. Another large group of Medicare beneficiaries get prescription drug coverage under plans offered by former employers or through the Veterans Administration. It is also possible that a former employer or union might sponsor a Part D plan for former employees/members (such plans are called Employer Group Waiver

title: Medicare Rights Center

text: eliminated the asset test for the SLMB and QMB Medicare Savings Programs. Today, New Yorkers can enroll in any MSP based on their income alone, without regard to assets. This same year, the Medicare Improvements for Patients and Providers Act (MIPPA) was enacted, providing federal funding for states to conduct outreach and enrollment activities to help ensure that people with Medicare are enrolled in the Part D Low-Income Subsidy (Extra Help) and Medicare Savings Programs. Between 2008 and 2009, with support from the Jacob & Valeria Langeloth Foundation, Medicare Rights for the first time launched the Medicare Minute program in

title: Medicare fraud

text: Congressional Budget Office estimates that total Medicare spending was $528 billion in 2010. Medicare fraud is typically seen in the following ways: A 2011 crackdown on fraud charged "111 defendants in nine cities, including doctors, nurses, health care company owners and executives" of fraud schemes involving "various medical treatments and services such as home health care, physical and occupational therapy, nerve conduction tests and durable medical equipment." The "Affordable Care Act of 2009" provides an additional $350 million to pursue physicians who are involved in both intentional/unintentional Medicare fraud through inappropriate billing. Strategies for prevention and apprehension include increased scrutiny

title: Medicare Advantage

text: This OOP limit does not apply to a Part C plan's Part-D-like self-administered drug coverage (which uses another means of addressing catastrophic costs). As with all HMOs—no matter whether a person is on Medicare or not—persons who enroll in a Medicare Advantage or other Part C HMO cannot use certain specialist physicians or out-of-network providers without prior authorization from the HMO, except in emergencies. In almost all Medicare Advantage plans—HMO or otherwise—the beneficiary must choose a primary care physician (PCP) to provide referrals and the beneficiary must confirm that the plan authorizes the visit to which the beneficiary was referred

title: Medicare (United States)

text: include an annual out of pocket (OOP) upper spend limit. Original Medicare does not include an OOP limit. Of the Medicare beneficiaries who are not dual eligible for both Medicare (around 20%) and Medicaid or that do not receive group retirement insurance via a former employer (about 35%) or do not choose a public Part C Medicare health plan (about 35%), almost all the remaining elect to purchase a type of private supplemental indemnity insurance policy called a Medigap plan (about 20%), to help fill in the financial holes in Original Medicare (Part A and B). Note that the percentages

title: Medicare Rights Center

text: the precursor to today's Medicare Advantage program. With the development of a consumer education guide called "Let's Learn Medicare", Medicare Rights' Education Department was born. As a response to the enactment of the Balanced Budget Act of 1997, Medicare Rights launched its first national education initiative, "HMO Flash," an effort to increase public awareness of HMOs (health maintenance organizations) and help consumers choose plans that meet their needs. The project resulted in the development and broad dissemination of a comprehensive reference guide of Medicare HMOs and around 30 tip sheets to help beneficiaries choose a plan and appeal denials of

title: Medicare dual eligible

text: is intended to further integrate the programs' services. CMS expects that the demonstration will decrease incentives for cost shifting and increase care coordination, resulting in improved care for beneficiaries and savings to Medicare and Medicaid. CMS projects that approximately 61 to 75 percent of savings will come from reductions in costly Medicare-covered services. Historically, one of the major challenges for the dually-eligible has been care coordination between Medicare and Medicaid. These two systems of care do not "talk to each other" systematically, so one physician that bills primarily through Medicare may not be familiar with benefits that are available through

title: Medicare (United States)

text: rate for their services as payment (typically 80% from Medicare and 20% from the beneficiary). Some non participating doctors do not take assignment, but they also treat Medicare enrollees and are authorized to balance bill no more than a small fixed amount above Medicare's approved rate. A minority of doctors are "private contractors" from a Medicare perspective, which means they opt out of Medicare and refuse to accept Medicare payments altogether. These doctors are required to inform patients that they will be liable for the full cost of their services out-of-pocket, often in advance of treatment. While the majority of

title: Medicare (United States)

text: add up to over 100% because many beneficiaries have more than one type of additional protection on top of Original Medicare. These Medigap insurance policies are standardized by CMS, but are sold and administered by private companies. Some Medigap policies sold before 2006 may include coverage for prescription drugs. Medigap policies sold after the introduction of Medicare Part D on January 1, 2006 are prohibited from covering drugs. Medicare regulations prohibit a Medicare beneficiary from being sold both a public Part C Medicare health plan and a private Medigap Policy. As with public Part C health plans, private Medigap policies

title: Medicare (United States)

text: less than Original Medicare for some benefits, such as Skilled Nursing Facility care, the savings may be passed along to consumers by offering even lower co-payments for doctor visits (or any other plus or minus aggregation approved by CMS). Original "fee-for-service" Medicare Parts A and B have a standard benefit package that covers medically necessary care as described in the sections above that members can receive from nearly any hospital or doctor in the country (if that doctor or hospital accepts Medicare). Original Medicare beneficiaries who choose to enroll in a Part C Medicare Advantage or other Part C health

title: Medicare (United States)

text: the following circumstances apply: Those who are 65 and older who choose to enroll in Part A Medicare must pay a monthly premium to remain enrolled in Medicare Part A if they or their spouse have not paid the qualifying Medicare payroll taxes. People with disabilities who receive SSDI are eligible for Medicare while they continue to receive SSDI payments; they lose eligibility for Medicare based on disability if they stop receiving SSDI. The coverage does not begin until 24 month after the SSDI start date. The 24-month exclusion means that people who become disabled must wait two years before

title: What is a Masterpiece?

text: What is a Masterpiece? What is a Masterpiece? is a 1979 non-fiction book by British historian Kenneth Clark. It is a transcribed version of the Walter Neurath memorial lectures given by Clark. The work, initially released on 1 January 1979, received a Thames & Hudson republication on 1 May 1992. Kenneth Clark had already achieved fame with a series of popular books while also serving as, from 1969 on, the writer, producer and presenter of the BBC programme, "Civilisation", a pioneering television documentary series. The prestigious series earned a Peabody Award as well as general commercial success. In the work,

title: Medicare fraud

text: cases involving fraud against federal health care programs. The Columbia/HCA fraud case is one of the largest examples of Medicare fraud in U.S. history. Numerous "New York Times" stories, beginning in 1996, began scrutinizing Columbia/HCA's business and Medicare billing practices. These culminated in the company being raided by Federal agents searching for documents and eventually the ousting of the corporation's CEO, Rick Scott, by the board of directors. Among the crimes uncovered were doctors being offered financial incentives to bring in patients, falsifying diagnostic codes to increase reimbursements from Medicare and other government programs, and billing the government for unnecessary

title: What Is a Rumpletilskin?

text: What Is a Rumpletilskin? What Is a Rumpletilskin? is the first and only album by hip hop group Rumpletilskinz, released on July 13, 1993, on RCA Records and produced by the group's producer, R.P.M. The album failed to make it to any of the "Billboard" charts, but two singles did, "Attitudes" and "Is It All Right?" Both made it to #24 on the Hot Rap Singles. This release received extensive national independent retail promotion through Poindexter International Marketing & Promotions, which was employed by RCA Records. It was also one of the first projects managed by James "DJ Ras J"