Archive for February 28th, 2013

Now, The Rest Of The Story……………..

Thursday, February 28th, 2013
Editor’s Note: This is extremely interesting article we received today in an email.   The  notation regarding Medicaid recipients age 55 or older under ObamaCare is interesting. (A recipient may qualify for, and get “free medical care”, but upon death this estate may be attached?)
Bill, did you catch this article posted by Paul Craig Roberts: “Obamacare: A Deception”?

And then there is this quote is from the Association of American Physicians and Surgeons (AAPS):

If a person is put into Medicaid, he has just gotten a mandated collateral loan if he uses Medicaid benefits at age 55 or older. Depending on state law, anything in the estate (the multi-generational family home and everything in it, annuities, bank accounts, etc.) may be subject to state recovery of funds expended by Medicaid for certain benefits, or possibly of all expenditures. This happens because the asset test was dropped as part of the Omnibus Budget Reconciliation Act of 1993 (OBRA 1993). While this provision does not come from the Affordable Care Act (ACA), ObamaCare’s Medicaid expansion means it can be applied much more widely. ‘Recovery provides revenue for cash-strapped states and it’s a big business,’ the article states. It is not clear how disclosure of this provision will be made if people are bumped into Medicaid or auto-enrolled.”

From Our Friend Rosie in Corpus Christi area:

This is just FYI——-
In Texas the State Assistance for NURSING FACILITY CARE, Home Health Providers (they clean your homes) and the CBA(community base-alternatives)--this handles like doing remodeling to your homes–building ramps, fixing bathrooms etc…. to accommodate the aged and or disabled needs) —–these 3 state assistance services might or will subject a CLAIM ON YOUR REAL ESTATE PROPERTY or ASSETS under the MERP (MEDICAID ESTATE RECOVERING PROGRAM) from March 2005.
See the Tx Dept of Aging and Disability Services——–the MERP Receipt Acknowledgement ——FORM 8001 (May 2011) that I faxed to your office. 
This is the form that anyone who applies for STATE ASSISTANCE will be asked to SIGN but YOU DO NOT HAVE TO SIGN THIS FORM. THERE IS A LOT OF RED TAPE and HARDSHIP CRITERIA applied BEFORE THE STATE files a CLAIM and takes over your REAL ESTATE PROPERTY.  THE STATE HONESTLY GOES AFTER PROPERTIES WITH HIGH VALUES or BIG ASSETS.  Some individuals who apply for these services ——–just give up and cancel their applications because they do not want their GROWN-UP children to lose their parents HOME SWEET HOME.
In my opinion—-their is a lot of mis-concepts about this Program.  What can protect their properties if they had transferred them over to their children —at least 5 years prior to applying for STATE ASSISTANCE.  The same applies for ASSETS if they were placed in a TRUST five years prior to applying for STATE ASSISTANCE.  The MERP has been here way before PRESIDENT OBAMA got into THE WHITE HOUSE office.
THE MERP was created to stop the STATE ASSISTANCE PROGRAMS from going bankrupt which they almost did back in 1993.  Sooner or later —smart lawyers alway find very good loop-holes to beat the systems —which again leads to finding TOUGHER laws or regulations.

Maxor Administrative Services LLC Announces New Plan

Thursday, February 28th, 2013

Maxor Administrative Services LLC, an Amarillo based third party administrator, has a unique plan for groups of 25-250 employee lives. With plan sponsors debating whether to continue offering group medical insurance but are frustrated with limited choices availble in the fully-insured market, this program may provide a viable option.


Unintended Consequences of PPACA – Say Farewell To Three Decades of Managed Care

Thursday, February 28th, 2013

Source: The Business of Medical Practice; Transformational Health 2.0 Skills For Doctors by David Marchiko & Hope Hetico

(1) Health care costs will be shifted to doctors in the form of lower reimbursments, (2) Hospital based physicians will demand and receive higher salaries, (3) Fewer physicians and more nurse practicioners, (4) Higher health insurance costs, (5) Medical care access impediments for most Americans but improvements for those previously uninsured, (6) Increased acceptance of MSA’s, HSA’s, concierge medicine, private pay, and other direct cash payment methods for medical care (7) widespread health data breach of epic proportions, (8) more community hospitals will close, (9) Fewer alternatives to commercial health insurance, other than Medicare and Medicaid, since the antitrust exemption for health insurers had not been repealed, (10) Medicare may become the de facto health insurance, much like public housing, food stamps, the USPS, and public transportation, (11) Physician compensation will gradually decline, (12) Private medical practices, often a doctor’s largest financial asset, will go down in value jeopardizing personal retirement plans, (13) Medicine’s lost professional status will become complete as health care becomes commoditized.

“… insurance reform is setting the stage for a new era of American health care. In launching this new period anchored by expanded access and insurance market reforms, we are expecting to say farewell to the three-decade era of Managed Care – a barren stretch of fiscal and social desert marked by spiraling costs, misaligned financial incentives, massive underfunding of Medicare and Medicaid obligations, fraud, overtreatment, public to private cost shifting, historic rates of chronic illness, and the slow erosion of employer sponsored health care, leading to an astounding number of Americans without insurance. …”

According to the author, whereas the old era was “a time characterized by consolidation of stakeholders, cost shifting, risk shifting, and scorched earth Darwinian battles on the supply and delivery side”, the new era will” begin a battle for the soul of medicine.”

Editor’s Note: This book is a must read for health insurance consultants

Aetna Publishes Commission Calculator For Agents/Brokers

Thursday, February 28th, 2013

Aetna Advantage Plans for Individuals, Families and the Self-Employed (under age 65)

Now you can see your earnings. Calculating your compensation is easy when you use our compensation calculator, give it a try!

1863 Civil War Statute Expanded To Address Fraudulent Health Care Claims

Thursday, February 28th, 2013

The statute, enacted in 1863 during the Civil War, protects against the submission of fraudulent claims by government contractors and enforces strict penalties for such violations. The 2010 health system reform law expanded the reach of the law and made it easier for federal investigators to launch FCA cases against alleged violators.

Editor’s Note: Physicians and hospitals who accept Medicare/Medicaid patients are “government contractors.”


HHS Rejects Insurers’ Pleas

Thursday, February 28th, 2013

            Despite strong pleas from insurance execs and industry lobbyists, the U.S. Department of Health & Human Services went ahead with its plans to implement strict age-rating requirements in a new rule published Friday.

Under the final rule, which largely resembles the proposed version published last November, insurers can only charge their older members up to three times as much as younger members, MedPage Today reported.

America’s Health Insurance Plans, though, pushed back on the new rules. “The new restrictions on age rating will result in an overnight increase in healthcare costs for people in their 20s, 30s and early 40s,” AHIP CEO Karen Ignani said in a statement. “This increases the likelihood that younger, healthier people forgo purchasing insurance until they are sick or injured. When this happens, costs go up for everyone, young and old.”

Ignani added that the age rating restrictions will simultaneously be implemented alongside requirements for essential health benefits and the new health tax, all of which will “further add to the cost of coverage.”

Conversely, AARP supported the new age rating rule. “Implementing a limited use of age rating immediately thwarts what would have been a negative and disproportionate effect on Americans aged 50 to 64 if they could not obtain affordable health insurance at a time when they need at most,” AARP Executive Vice President Nancy LeaMond said in a statement.