Medicare Part B To Increase In Cost In 2013

Taken from California Healthline, under Medicare, 

as reported via AP/New York Times, 11/16

Monthly Premiums for Medicare Part B Set To Increase Slightly in 2013

Medicare Part B premiums will increase by $5 per month next year, CMS announced Friday, the AP/New York Times reports (AP/New York Times, 11/16).

According to a notice published in the Federal Register, the monthly premium for Medicare Part B -- which covers physician visits, outpatient care and medical supplies -- will be $104.90, up by 5% from $99.90 in 2012. Annual deductibles for Part B also will rise, from $140 to $147.

Meanwhile, premiums for Medicare Part A -- which pays for inpatient hospitals, skilled-nursing facilities and some home health care services -- will decline by $10 to $441 in 2013. Part A deductibles will increase by $28, from $1,156 last year to $1,184 in 2013 (Zigmond, Modern Healthcare, 11/16).

Medicare actuaries had estimated that Part B monthly premiums would increase by $9, based on early estimated cost growth for the program (Radnofsky, Wall Street Journal, 11/16).

CMS Acting Administrator Marilyn Tavenner noted that while the premium increase is less than anticipated, it is still enough to account for about one-quarter of a typical retiree's cost-of-living raise in Social Security payments next year (AP/New York Times, 11/16).

Please let anyone you know who is paying for medicare.

Medicare & Medigap Plan A Basics!

Plan A is basic to all medicare coverage.  It is an individual option as well as a part of all enhanced optional coverage. Here is an outline that includes what Medicare Plan A covers and how a Medigap Plan A may be utilized with it.  As always . your questions are welcomed!  Call me, Kathy Hope, at 800-792-9114.

Plan A Coverage 

Is Included In All 10 Plans

Hospitalization: 

Medicare Part A pays for hospitalizations for the 1st 60 days but only pays a portion of the daily costs from the 61st day through the 150th day.  You must pay the coinsurance amounts for those days.  

Medigap Plan A pays the coinsurance amount for those days and provides an additional 365 lifetime days.  

Blood:

Medicare pays for all blood that is medically necessary except for the first three pints in each calendar year.

Medigap Plan A pays for the first three pints of blood not paid for by Medicare. 

Medical Expenses:

Generally Medicare Part B pays for 80% of a predetermined amount (called the "Medicare approved" amount) for each procedure, supply, or service billed by your doctor or other provider that is not a hospital. 

Medigap Plan A pays the coinsurance (generally 20% of the "Medicare approved" amount) under Medicare Part B.

Note the definitions of deductible & co-insurance

Deductible - must be paid before medicare activates.

Co-insurance - After deductible and paid in addition to medicare covera

How Healthy "IS" Living In California?

How healthy is living in California?  A little bit more healthy than in 2010! 

Here is a recent study as published at healthinsurance.org/california 

California climbed two spots from its #26 ranking in 2010, and is now ranked as the 24th healthiest state to live in, according to the 2011 America's Health Rankings® by the United Health Foundation.

The good news:

Smoking has been on the decline in California, falling by 20 percent over the past decade (though nearly 3.4 million adults still smoke).

The bad news:

• The number of obese Californians has risen by 2 million over the past decade. More than 6.9 million California adults are now obese.
• Diabetes among adults has also risen over the past decade, from 6.8 percent to 8.6 percent of adults.
• The percentage of children in poverty has increased from 18.5 percent to 23 percent over the past five years.

California's best and worst category rankings:

Smoking – 2nd

Early Prenatal Care – 3rd

Occupational Fatalities – 4th

Infant Mortality – 5th

Lack of Health Insurance – 45th

Air Pollution – 50th

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http://www.healthbroker.com

"Covered Califonia" - New Name For CA Health Ins. Coverage

We finally have a new name for our California Health Insurance ... are you ready?
It is ......  Covered California  Reaction???

Here are all the details as written today by David Gorn in the Capital Desk Column of California Healthline.  Here you go:

"Exchange Picks New Name: Covered Californiaby David Gorn
The California Health Benefit Exchange board voted Tuesday to adopt a new name for the health insurance coverage it will offer starting January 2014 -- Covered California.

The decision comes after months of work. In August, the long list of potential names was winnowed to about a dozen possible names -- including CaliHealth, CalAccess, Wellquest, PACcess and Covered California. The list alos included unusual trademark names such as Ursa, Healthifornia, Eureka, Beneficia, Cal-Vida and Condor, as well as the crowd favorite, Avocado.

After designing logos, holding focus group meetings and running trademark searches, that list was cut down to four finalists in September: Ursa, Eureka, CaliHealth and Covered California. Trademark concerns emerged around Ursa and CaliHealth, and those names were dropped, said Chris Kelly, who made the final name presentation to the exchange board.

Kelly presented final logo designs to the board for Covered California (tagline: "Your destination for affordable healthcare"), a related-but-separate design for Covered, CA and Eureka ("Where California discovers affordable healthcare"). After gauging the final set of focus group opinions, Kelly said the recommendation to the board was to go with Covered California.

Eureka was seen by focus groups as more of a private insurance program, Kelly said. Covered California was particularly well-liked by the Latino population in the focus groups, and by almost two-thirds of respondents overall.

"We're looking for a brand consumers can relate to, and inspire them to enroll in health care in the exchange," said Oscar Hidalgo, director of communication and public affairs at the exchange. "This is a real pivot point for us, using that brand and tagline and logo for future campaigns to help consumers relate to our mission. We're still working on a few other things to complement that, and that should be done by the next exchange board meeting."
The next steps, Kelly said, are to secure the final trademark and finalize the logo and tagline, which should be done by Nov. 12. Those final designs should be ready for the next exchange board meeting, he said, on Nov. 14."

California Health Insurance
www.healthbroker.com

California Scores High In Quality Of Hospitals!

It's always a good thing to know that our hospitals are good ones! And ... it looks like California is doing well in that category!  Given the costs of healthcare, it's especially good to know that we have the best care in our local access.   
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Get the details in this article just reported in the California Healthline as written by  Lloyd in USA Today:
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Report Finds California Among States With Best Hospitals
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California is among the states that scored highest for hospital care related to conditions and treatments commonly linked to mortality, according to a report released by Healthgrades, USA Today reports.
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Details of the Report
The report ranked states and individual hospitals based on data released by CMS between 2005 and 2011.
Researchers examined data on 4,500 hospitals nationwide, focusing on four key conditions and procedures commonly linked to mortality:

• Coronary artery bypass graft;
• Heart attack;
• Pneumonia; and
• Sepsis.

The four conditions and procedures account for 54% of all hospital-related deaths in the U.S.
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Main Findings
According to the report, states with hospitals that provided the best care for those conditions and procedures were:
Arizona;
California;
Illinois; and
Ohio.
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States and areas with hospitals that provided the worst care related to those conditions and procedures were:
Alabama;
Arkansas;
Georgia;
Nevada;
Oklahoma;
Washington, D.C.; and
West Virginia.
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According to the report, patients had a 55% lower risk of dying and a 42% lower risk of having complications when treated in the best hospitals.
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Implications
Evan Marks -- a lead author of the study -- said that the differences in hospital quality in various states are "substantial."
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Researchers also found that the quality of care can vary widely among hospitals within a single state.Nancy Foster -- vice president of quality and patient safety policy for the American Hospital Association -- said that individuals also need to know how factors not accounted for in the study affect health outcomes.She said, "People come to [hospitals] ... far sicker if they're from a low income area," adding, "They might have multiple complications" and "might struggle to find healthy food" or "a safe place to exercise." She said, "All are important components of good health outcomes" (Lloyd, USA Today, 10/23).

It's Medicare Open Enrollment!

It's Open Enrollment from now until December 7, 2012! 

So what? It's a pretty big what as this is the time you can increase, decrease, change, delete, adjust your medicare coverage! Beyond this window of time you are stuck!  It's that simple. 

If you still have questions and/or concerns you should contact your insurance agent. I also found this posting written by Marilyn Tavenner, Acting Administrator at The Medicare Blog.  Think she says it pretty well in very readable language. Hope you enjoy. 

Per the words of Marilyn Tavenner:  

"It’s picking season – pumpkins, apples, Halloween candy…and a Medicare health or drug plan." 

"In my work with Medicare, one of the questions people ask me often is which plan is the best one. That’s not something I can answer, because picking a plan is an important and personal decision. Each person has a unique set of priorities. How do you weigh your options? Now’s the time to think about what matters to you, and pick the Medicare plan that meets your needs.

When you sit down to review your Medicare health and drug plan choices this year, keep track of the things you may want in a plan, and pick one that’s right for you. Here are some things to keep in mind while you consider your choices:

Costs

You should look at your current health care costs to find coverage that works with your financial situation. How much are your premiums and deductibles? How much do you pay for hospital stays and doctor visits? Just like with everything else, the lowest-premium health plan option might not be the best choice for you.

Coverage

Are the services you need covered? We know future health care needs can be hard to predict, but changes happen. Maybe your doctor changed your prescriptions this year or you have different health concerns. Make sure you understand what services and benefits you’re likely to use in the coming year and find coverage that meets your needs.

Convenience

Your time is valuable. When comparing plans, make sure you check which doctors and hospitals you’ll be able to use. Where are they located and what are their hours? Check which pharmacies you can use. Can you get prescriptions by mail? Remember that even if you’re happy with your current plan, these answers might change from year to year.

Quality of care

Ask yourself whether you’re truly satisfied with your medical care. Not all health care is created equal, and the doctors, hospitals and facilities you choose can impact your health. Look for plans with a 5‑star performance rating — the right expertise and care may help speed your recovery and improve your outcomes."

Marilyn also invites you to call 1 800-medicare.  I also invite you to call me here at healthbroker.com if you have questions or need to discuss alternatives to your existing coverage.   You can find me at 800-792-9114    714-840-0047 

Who Is A Full Time Employee Under The New Healthcare Act

If  you've been listening to the news the last couple of days, you've probably heard that the owners of Lobster House and the Olive Garden are changing some employees to part time workers vs. full time to save costs on the reformed healthcare laws.  Think we will see more of this as the days go forward and businesses need to see how adaptations can affect their bottom lines both positively and negatively.     

If you are in a position of reviewing who is full time and/or part time you may benefit from this article written and posted by Tina Bull on October 9th, 2012 in the PSA Perspective, by  PSA  Insurance and Financial Services.  

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"The Affordable Care Act (ACA) requires employers with 50 or more full-time equivalent employees to offer affordable, valuable minimal essential coverage to all full-time employees or pay a penalty. This requirement is referred to as the employer shared responsibility requirement and is effective January 1, 2014.

ACA defines a full-time employee as one who has an average of at least 30 hours of service per week. Proposed regulations are expected to provide that 130 hours of service in a calendar month will be treated as the monthly equivalent of 30 hours of service per week.

The IRS has issued Notice 2012-58 to describe safe harbor methods an employer may use to determine if current employees and new “variable hour” employees must be treated as full-time employees for purposes of the shared responsibility requirement. An employee may be considered a “variable hour” employee if, based on facts and circumstances, it cannot be determined that the employee is reasonably expected to work on average at least 30 hours per week.

Ongoing Employees

For an ongoing employee (i.e. an employee who has been employed at least one standard measurement period as described below), full-time status may be determined under the safe harbor by calculating the employee’s actual average weekly hours of service during a specified look back period. This specified period is referred to as the standard measurement period and is a defined length of time between three and 12 consecutive calendar months.

If the employee averaged 30 or more hours of service per week during the standard measurement period, then health coverage must be offered to that employee during a subsequent stability period (of at least six months and no shorter than the standard measurement period). This coverage is provided to the employee for the entire stability period without regard to the number of hours of service the employee has during the stability period. However, another measurement period will commence for purposes of determining whether health coverage must be offered during the next stability period.

Between the measurement period and the stability period, an employer may use an administrative period of up to 90 days to notify and enroll eligible employees.

Employers will likely establish a standard measurement period immediately preceding annual open enrollment, an administrative period that coincides with open enrollment, and a stability period that matches the plan year. This means that the first standard measurement period may start as early as October 2012.

New Employees

For new variable hour and seasonal employees, the safe harbor method is similar. However, the initial measurement period and the administrative period combined cannot extend beyond the last day of the thirteenth full calendar month of employment. The initial stability period must be the same length as the stability period for ongoing employees.

In addition, certain hours of service during the initial measurement period will also be counted toward the next standard measurement period that begins after the new employee’s date of hire. A variable hour employee who is determined to be full-time during the initial measurement period must be offered coverage during the full initial stability period, regardless of the average number of hours of service during the first standard measurement period.

If a new employee is reasonably expected to work full-time at the date of hire, then the safe harbor method for variable hour and seasonal employees does not apply. The employee must be initially classified as full-time and coverage must be offered to the employee at or before the conclusion of the employee’s initial three calendar months of employment.

Reliance and Comments

Employers may rely on the safe harbors for measurement periods that begin through 2014 and related stability periods that may extend into 2016. The IRS has asked for comments on the following: other safe harbors for categories of employees that present special issues, other guidance that may be needed to determine full-time status, measurement/stability period issues during a merger or acquisition and how seasonal worker should be defined.

While the safe harbor methods are optional and may be administratively challenging for employers, use of them will provide certainty that an employer will not be subject to the ACA penalty for failing to offer coverage to all or substantially all full-time employees."
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