Blog Archives

This category addresses all government oversight, regulation, and so on: federal or state. It applies across product lines.

Categories of Dual-Eligible Beneficiaries (A Reminder)

Here are the categories of dual eligible beneficiaries and out-of-pocket costs that are paid by Medicaid: QMB (only) (Qualified Medicare Beneficiary) – Medicare Part A and Part B premiums; cost sharing for Part A & Part B benefits. QMB Plus –

Posted in Government, Medicare Tagged with: , , , , ,

$1 Billion Medicare Fraud Scheme in Miami Busted by Feds

by Precise Leads August 2, 2016 Last week, prosecutors revealed that federal authorities have broken up the largest Medicare scam in U.S. history, in which the three defendants stole more than $1 billion over 14 years. Three Florida residents have been

Posted in Government, Medicare Tagged with: ,

Medicare Mergers 2016

UnitedHealthcare Keeps Top Spot Amid Pending Mergers Posted: 02 Aug 2016 12:50 PM PDT UnitedHealthcare continues to enjoy the top spot in health insurance as Anthem and Aetna prepare to fight federal lawsuits against their proposed mergers with Cigna and

Posted in Boomer Products, Government, Insurance, Medicare Tagged with: , , , , ,

Medicare Advantage Enrollment Continues to Climb, but Financial Protections for Enrollees Are Eroding 

Article was taken from the Kaiser Foundation Website (searched “online Medicare enrollments”) Jun 30, 2015 Enrollment in Medicare Advantage continues to climb steadily as spending reductions enacted in the Affordable Care Act reduce historical overpayments to the private plans, according

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ACA – Carrier Losses

United Healthcare Expects Huge Losses Published April 19, 2016 FoxNews.com The nation’s largest health insurer, fearing massive financial losses, announced Tuesday that it plans to pull back from ObamaCare in a big way and cut its participation in the program’s

Posted in Carriers, Government, Health/Wellness, Insurance Tagged with:

The Good, the Bad, and the Ugly! Proposed CMS Marketing Guidelines

  March 2, 2016 | Diane Hollie Regarding the New Proposed Medicare Marketing Guidelines (MMG) Taking a quick read of the proposed 2017 MMG, our marketing team had some initial thoughts about the proposed changes we would like to share.

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Were patients really sicker? Lawsuits say Medicare Advantage plans inflated diagnoses to boost payments

By Lisa Schencker  | November 22, 2014 For an 82-year-old man with diabetes and rheumatoid arthritis, the CMS will pay a Medicare Advantage plan a certain amount of money each month. Add renal failure and hemiplegia to the list of maladies, and

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Controversial home visits duck Medicare’s radar, for now

By Bob Herman  | February 27, 2016 The most interesting thing about the preliminary rate notice for 2017 Medicare Advantage plans may be what federal policymakers left out. The thick document made no mention of health-risk assessments, which surprised the industry.

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New Communication Tools

Have You Seen This?? Be sure to check out this simple and engaging video explaining what Avenue H is and how it can be beneficial to your clients. Click the button below or go to avenueh.com/video Upcoming Broker Training Do

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HHS: Hospitals aren’t gaming readmissions with observation claims

By Sabriya Rice  | February 24, 2016 Fewer patients are returning to the hospital within 30 days of discharge, and it’s not because hospitals are holding patients in observation units instead of admitting them as a means of avoiding penalties, according

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