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NEW Medicare Diabetes Prevention Program Now Available

A Medicare Diabetes Prevention Program (MDPP) was announced by the CDC to begin in 2018. The model will be added as a covered benefit for Medicare enrollees who meet the criteria. The program started April 1, 2018.

New Medicare Programs For Diabetes Can Result In You Saving Big!

Diabetes affects more than 25% of seniors 65 and older in America, and Medicare has spent billions on beneficiaries with diabetes. But type 2 diabetes can usually be delayed or prevented with healthy lifestyle changes.

The model offers a classroom-style support group that has gone through many successful pilots which resulted in better management for diabetes patients. The services include core sessions during the first 6 months, core maintenance sessions during the second month, and ongoing maintenance sessions during the second year. Check-ins are to make sure the participants are sticking to a healthy lifestyle. CMS Deputy Administrator and Chief Medical Officer Dr. Patrick Conway believes that programs like these can prevent disease and help people live healthier lives.

The MDPP model aims to prevent type 2 diabetes from developing among Medicare beneficiaries. It will provide coaching services to prediabetic patients and help them lose weight. The goal is to reduce their weight by at least 5% from baseline and they must achieve this by the end of the first year to be eligible for ongoing maintenance in the second year.

People who went to more sessions had a much higher percentage of weight loss than those that skipped classes.

In the pilot tests conducted, patients who followed the program reduced their body weight by around 5% and lowered their spending by $2650 over the course of 15 months. The patients who attended more sessions had higher weight loss, which is the main goal of the program. “The final payment structure values beneficiary weight loss most significantly, as weight loss is a key indicator of success among individuals participating in a DPP due to the strong association between weight loss and reduction in the risk of type 2 diabetes,” CMS said.

“For the first time CMS, is going to be reimbursing for diabetes prevention based on this evidence-based program,” says Robert Gabbay, M.D., Ph.D., FACP, and Chief Medical Officer at Joslin Diabetes Center. “Currently the challenge is that when we identify people who are prediabetic, which is easy to do with a simple blood test, we don’t have a program to enroll them in that is reimbursed.”

Providers/physicians will receive Medicare reimbursement for providing the services to eligible patients. If their patients do not meet the required minimum weight loss, they will receive lower reimbursement rates and lose out on $160 per patient. But, if a patient successfully does the programs and meets the requirements, the provider could receive $610 per patient. If the patient comes to all the sessions but does not meet the 5% weight loss goal, the patient will help accrue $195 reimbursement for the provider.

Patients are eligible for the MDDP only once in their life because the CMS believes that the one-time benefit will be more likely to motivate them rather than allowing them to re-enroll any time. But, if a patient develops diabetes at any time during the program, then they can keep receiving services.

Diabetes is a national issue and is growing among children, adults, and senior citizens. This program that will be a preventative covered benefit will open up the idea of developing healthier lifestyles, and reduce the onset of diabetes. It is a hopeful step forward for Medicare beneficiaries.

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Legal Challenges Ahead For ACA

The Affordable Care Act is once again facing a new challenge, this time by Republican states trying to dismantle it once and for all. The basis of the claim filed is that since the individual mandate was removed, it makes the whole ACA unconstitutional. The individual mandate is the ruling that people must have insurance or sign up for it within an amount of time or they would face a penalty fine during tax season.

Ever since President Trump was elected, one of his goals was to repeal and replace the Affordable Care Act which was signed into law by President Obama in 2010. One of the provisions of the ACA, the individual mandate, has been challenged by Republicans since 2012. They claimed it was an unconstitutional expansion of the government’s power. However, the Supreme Court upheld that the individual mandate tax was the government’s right. Chief Justice John G. Roberts Jr. stated the government “does not have the power to order people to buy health insurance, but it does have the power to impose a tax on those without health insurance.”

In December 2017, President Trump came one step closer to dismantling the ACA by ridding the mandate. His administration was able to change the individual mandate penalty to $0 beginning January 1, 2019. Because of this, as of February 26, 2018, Texas Attorney General Ken Paxton and 19 other states filed a lawsuit stating, “the country is left with an individual mandate to buy health insurance that lacks any constitutional basis. . . . Once the heart of the ACA — the individual mandate — is declared unconstitutional, the remainder of the ACA must also fall.”

In one of the cases against the ACA, King v. Burwell, Chief Justice John G. Roberts Jr. noted that “Congress passed the Affordable Care Act to improve health insurance markets, not to destroy them. If at all possible we must interpret the Act in a way that is consistent with the former and avoids the latter.”

Judge Reed O’Connor will be hearing the case filed by the Texas Attorney General and other states. O’Connor was appointed by President George W. Bush in 2007 and has ruled against the ACA in past cases.

This is all happening during the time insurers must figure out the pricing for next year’s premiums and rates so they can file it with state regulators. Insurers are concerned because they do not know how much to raise rates if they will charge the same price to healthy and sick people, or whether to pull out of the marketplace.

While the marketplace in in panic about how much their prices should go up and if they will even still be in business, it is smart to seek quotes and plans from private insurers. EZ.Insure is able to provide you with affordable plans with ease. We offer the stability of insurance within your region by one of our highly trained and educated agents. To receive a quote, call 855-220-1144 to speak your own advisor, enter your zip code in the bar above, or email us at replies@ez.insure. We will provide quotes and offer our help free of charge without hassle.

Medicare Prices Steadily On The Rise

Details have emerged after a report was released on the investigation into Medicare drug prices. The report “Manufactured Crisis: How devastating drug price increases are harming America’s seniors,” and its findings were released by U.S. Sen. Claire McCaskill, Democrat-Missouri. This report talks about the hiked up drug prices for senior citizens and how it needs to be further investigated. Medications for seniors have gone up nearly 10 times more than the annual inflation rate.

The report stated that “Soaring pharmaceutical drug prices remain a critical concern for patients and policymakers alike. Over the last decade, these significant price increases have emerged as a dominant driver of U.S. health care costs — a trend experts anticipate will continue at a rapid pace.”

The cost of about 20 of the most prescribed drugs for Medicare have gone up significantly from 2012 to 2017 according to the report. The lowest increase being Zostavax going up 31%, to the largest increase being 477% for the drug Nitrostat. Twelve of the drugs investigated, increased over 50% during the five-year time span, while six of them increased over 100%. The rise has gone up so much that some Medicare enrollees are unable to pay for their meds.

Some Medicare Drug Prices Have More Than Doubled Each Year!

The Pharmaceutical Research and Manufacturers of America did not agree with the report and followed up with comments reported by CNN. “This is yet another misleading report that ignores the robust negotiation that occurs between Medicare Part D plans, middlemen, and biopharmaceutical companies,” Juliet Johnson, a spokeswoman for PhRMA, said in a written statement. “Negotiated rebates can reduce list prices by as much as 30 to 70 percent for medicines used to treat diabetes, high cholesterol, and chronic respiratory illnesses. Notably, half of the 20 brand medicines in this report are used to treat these chronic conditions.”

As stated, the medicines are used to treat chronic conditions, but the reality is that many seniors need these medications. A lot of Medicare enrollees have some sort of health issue, whether chronic or not that requires treatment and medication to stay healthy.

Juliet Johnson later stated “we agree more can be done to make Part D more affordable and predictable for seniors. One way to do that is to ensure seniors benefit from the significant negotiated savings when they pick up their medicine at the pharmacy.”

The prices of pharmaceutical drugs for seniors has been an ongoing issue, they are becoming more expensive every passing year. It can become too much for seniors to include in their budgets, which can be very harmful to their health. Medicare enrollees can purchase a Medicare Advantage plan or Medicare Part D plan to help pay for pharmaceutical drugs needed. But as drug prices continue to rise, the premium costs will go up as well to pay for the difference.

By law, Medicare is not allowed to negotiate drug prices, which is something Democrats have tried to change for a long time. Some sort of change or assurance must be given to seniors that these prices do not continue to climb and become unattainable. During Trump’s State of the Union address, President Trump states he will fight to make the drug prices go down. This will hopefully put a resolution of the soaring drug prices, and provide relief for seniors.

EZ.Insure will provide you with the best information on how to get the most out of your Medicare budget.. We provide you with your own personal advisor who is trained in your region to give you quotes and guidance on which plan will work best for you. To get a quote, email replies@ez.insure, enter your zip code in the bar above, or call 855-220-1144. It’s that simple and easy to start saving.

$25 Billion Medicare Cuts Possible Due To Republican Tax Bill

The GOP tax bill that the Republicans have been working on, can lead to major cuts in Medicare funding and spending in 2018. The bill is estimated to cut $25 billion from Medicare starting 2018, and resulting in $400 billion over the next ten years.

The Congressional Office has estimated a $1.5 trillion deficit to over the next 10 years due to the tax bill.

In 2010, Washington passed a “pay as you go” rule which requires any new laws to be deficit neutral. Basically if there is not enough economic growth to balance the money lost, then the Office of Management and Budget has to cut spending. Unfortunately, it is likely that one of the spending cuts will be to Medicare.

The tax bill does not exactly say that it will cut spending on Medicare, it will be an unintended result. Some Republicans stated that the cuts would affect doctors, health providers, and hospitals, not Medicare beneficiaries. They have also had talks to try and change the Medicare eligibility age from 65 to 67.

House Speaker Paul Ryan seems to threaten cuts to Medicare saying “we’re going to have to get back next year at entitlement reform, which is how you tackle the debt and the deficit. I think the President is understanding choice and competition works everywhere, especially in Medicare.”

A major issue with the possible cuts is that Medicare beneficiaries could end up being kicked off of their current Medicare plan, or receive fewer benefits.

Juliette Cubanski, associate director of the Program on Medicare Policy at the Kaiser Family Foundation says, “these cuts could be one bad side effect of this tax legislation. Many providers may be able to absorb the payment reductions if they have a very diverse patient base. But others who rely primarily on Medicare may find this cut really difficult to deal with.”

While many are uneasy with the possible cuts, House Majority Leader Kevin McCarthy says that it is all a scare tactic by the Democrats, and that Medicare cuts will not occur. He states “the Republicans have been wanting to have this fixed for quite some time. When Obamacare went in, it cut Medicare. We have been trying to make our entitlement sustainable into the future.”

Roughly 54 million Americans currently receive Medicare benefits. Many fear the cuts will leave many Americans without coverage or unattainable expense to have coverage. However, McCarthy claims lawmakers will find a way to avoid the Medicare tax cuts.

Uber Launching ‘Uber Health’

Uber has announced a new business line called Uber Health that will provide a ride-hailing platform for healthcare providers. Uber is offering to take patients to their medical appointments, as long as they are operating in the area. The health care providers that will use this business will be the ones billed for the services, not the patients.

Health care providers can set up car ride appointments within a few hours or up to thirty days in advance for patients. In order to ensure anyone can use this service, Uber has stated that the patient will not be required to have the Uber app or a smartphone. The company will use text messages to coordinate the rides, and they will have the ability to utilize both mobile and landline features to communicate with patients.

A centralized dashboard will let providers in the healthcare industry be able to assist their patients with transportation that is in compliance with HIPAA, Health Insurance Portability and Accountability. The health provider will put in the client’s name, number, pick up and drop off locations, and then choose one of Uber’s ride-hailing vehicle type. The client will receive a text message or voice call notifying them of the booking. The system has a management system that will keep track of all of the billing and reporting.

Uber began testing the platform last summer with over 100 healthcare providers signing up including clinics, hospitals, rehabs and physical therapy centers. The reason for starting the service is due to statistics claiming that 3.6 million Americans miss medical appointments because they lack reliable transportation.

“There are a lot of people out there who are not going to the doctor simply because they can’t physically make it there,” said Uber Health executive Jay Holley.

“If there are people who are missing their appointments because they’re using an unreliable bus service to get to and from their healthcare provider, this is a great solution for them,” Chris Weber, general manager of Uber Health, told in an interview. “The types of individuals this is valuable for really is limitless.”

“Uber’s endeavors into health care trace back to 2014, when Uber first offered on-demand flu shots in large markets across the U.S.,” he said, regarding the genesis of the focus on health within Uber. “Since then there have been similar efforts throughout the world, from diabetes and thyroid testing in India to subsidized rides for breast cancer screening in the U.S., to many more. That said, all of these efforts have been pop-ups.” This all led them to figure out a way to make a more permanent solution to reducing missed appointments.

In order to comply with HIPAA, Uber drivers will not be told or aware that they are driving someone that is using Uber Health. The drivers will have a limited amount of information such as the passengers’ name, and their pickup and drop off points.

Uber wanted to make it clear that they are not a replacement for an ambulance or for emergency situations. They will not be sent to transport people who need immediate attention. Uber hopes to help lessen the gap of Americans missing their doctor appointments, and focus on wheelchair accessibility for those who need it. Weber said, “It’s definitely something we’re focused on making a better, more reliable experience, but as of now this is really focused on reaching out to the existing driver network.” Uber is hoping to expand in more than 250 cities in the U.S. and make this new line of business successful.

There Is NO Open Enrollment For Medicare Supplement Plans

Medicare Supplement Insurance Does Not Have a Deadline

Many senior citizens think that the Medicare Open Enrollment period is the only time they can purchase a Medicare Supplement plan. But, there is no deadline to purchase Medicare Supplemental Insurance. During the Medicare Open Enrollment Period, everyone is busy picking a plan that is best for them. Some retirees rush into a new plan without focusing on the coverage, and some may miss the period. Missing the period does not mean you miss the opportunity to change or purchase a plan. You can change or buy it year round.

In order to actually sign up for a Medicare Supplement Insurance Plan, you must be 65 and have Original Medicare. You are most eligible to be guaranteed issue rights when purchasing a plan six months from when you turn 65. Guaranteed issue is the protected right that an insurer cannot deny you or raise rates due to pre-existing conditions.

While there is no deadline to buy or change a Medicare Supplement Plan and anyone eligible is able to buy a plan any time of the year, it comes with a catch. Medicare Supplement Insurers do have the right to ask you questions regarding your health. They can then determine if they want to insure you, deny you, or raise your rates due to pre-existing conditions. This is possible because you will not have guaranteed issue rights.

Picking a Medicare Supplement Plan can be a long and tough process. There can be questions you have about the coverage, costs, and the different types of plans. EZ.Insure offers you a trained one on one agent to assist in figuring out the process, coverage, and sign you up. We compare all plans for you, and find the best prices. Enter your zip code in the bar above to receive quotes, or contact your own advisor by calling 855-220-1144, or e-mailing replies@ez.insure. We promise to provide the best service with no obligations, it’s that easy!

Tag: medicare

NEW Medicare Diabetes Prevention Program Now Available

Legal Challenges Ahead For ACA

Medicare Prices Steadily On The Rise

$25 Billion Medicare Cuts Possible Due To Republican Tax Bill

Uber Launching ‘Uber Health’

There Is NO Open Enrollment For Medicare Supplement Plans

Medicare Supplement Insurance Does Not Have a Deadline

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