Medicare views
David sayen
regional Administrator

People talk a lot these days about the rising cost of healthcare. How much of a role does fraud play in this?
  A significant one, unfortunately. The fact is that criminals steal billions of dollars each year from Medicare, Medicaid, and the Children’s Health Insurance Program (CHIP). This is taxpayer money that should be going to medical treatment for some of our most vulnerable citizens, including seniors, low income families, and kids.
  Fraud hurts everyone by driving up healthcare costs. It also undermines the financial sustainability of federal healthcare programs upon which millions of Americans depend.
  What’s the federal government doing to stop it? Plenty, especially with the new tools we have under last year’s health reform law.
  For one thing, we’re becoming more proactive about keeping criminals out of federal healthcare programs in the first place. My agency, the Centers for Medicare & Medicaid Services (CMS), has adopted a more rigorous screening process for new providers and suppliers. This is intended to weed out crooks before they can start submitting fraudulent bills to the government.
  Under the Affordable Care Act, we can now use sophisticated new technologies and innovative data sources to identify patterns associated with fraud. We also have the authority to temporarily stop enrolling new providers and suppliers when we detect patterns that may indicate a significant potential for fraud.
  When there’s a credible allegation of fraud against a provider or supplier, we can temporarily stop payments to them while an investigation is undertaken.
  In other words, CMS is moving away from the old “pay and chase” model of doing business – paying out claims and then trying to recover the fraudulent ones.
  Of course, we know that most providers – doctors, hospitals, nursing homes, home health care operators, and others – are honest. But we’re becoming more vigilant about the dishonest few. And those who defraud federal healthcare programs will face tougher penalties.
  The Affordable Care Act increases the federal sentencing guidelines related to healthcare fraud offenses involving $1 million or more in losses to federal programs. The Act also allows the government to impose stronger civil and monetary penalties against those who commit fraud. And crooks kicked out of one state’s Medicaid or CHIP program will now be kicked out of all states’ Medicaid or CHIP programs.
  Is Medicare making progress in the fight against fraud? Yes, we are. For example, the federal government recovered $4 billion last year from people who attempted to defraud seniors and taxpayers. That’s a record amount.
  How can individuals help in the fight against healthcare fraud?
  If you have Medicare, here are some things you can do:
 *       Guard your Medicare and Social Security numbers. Treat them like you treat your credit cards. Criminals use these numbers to send the government bogus medical bills — in your name.
*       Hang up the phone if someone calls and asks for your Medicare number, Social Security number, or bank or credit card information. Medicare will NEVER call and ask for this information, and we will NEVER call you or come to your home uninvited to sell Medicare products.
*       Be suspicious of anyone who offers you free medical equipment or services and then requests your Medicare number. It’s illegal, and it’s not worth it!
*       Don’t let anyone borrow or pay you to use your Medicare ID card or your identity.
*       Check your Medicare claims for errors. Look at your Medicare Summary Notice or statements from your Medicare plan.
*       If your Medicare Summary Notice shows billings for goods or services that you never received, call us at 1-800-MEDICARE (1-800-633-4227). The sooner you see and report suspected fraud, the sooner we can stop it. TTY users should call 1-877-486-2048.
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can always get answers to your Medicare questions by calling 1-800-MEDICARE (1-800-633-4227).
 
 
 
 

by David Sayen
 
If you’ve been turned down for health insurance because of a pre-existing condition, or offered coverage only at an unaffordable price, you may have another option: California’s Pre-Existing Condition Insurance Plan.

 The Pre-Existing Condition Insurance Plan, or PCIP, is available to children and adults who’ve been locked out of the health insurance market because they have cancer, heart disease, diabetes, HIV/AIDS, asthma, or some other pre-existing medical condition.

 With PCIP, you’ll be insured for a wide range of benefits, including primary and specialty physicians’ services, hospital care, and prescription drugs.

 Like commercial insurance plans, PCIP requires you to pay a monthly premium, a deductible, and some cost-sharing expenses. But you won’t be charged a higher premium because of your medical condition and your eligibility isn’t based on your income.

 When you enroll in PCIP you’ll have access to a provider network that includes 67,000 physicians, 5,906 pharmacies and 354 hospitals throughout the state.

 A visit to the doctor will cost you $25. PCIP also covers emergency and ambulance services, surgery and anesthesia, organ transplants, x-ray and lab services, pregnancy and maternity care, skilled nursing care, home health services, orthotics and prosthetics, durable medical equipment, and inpatient and outpatient mental health, alcohol, and substance abuse care.

 PCIP is already changing the lives of Americans who don’t have health coverage and need medical care. James H., who lives in Texas, was diagnosed with brain cancer in 2010. Shortly after his diagnosis, James’ insurance company rescinded his insurance coverage, claiming that his cancer was a pre-existing condition. James knew that his lack of coverage was a death sentence. Fortunately, he was able to join PCIP in Texas and is now receiving the treatment he needs.

 To qualify for PCIP, you must have been denied health insurance within the past 12 months. You also have to live in California and be a U.S. citizen or legal resident. In addition, you must have been uninsured for at least six months before applying for PCIP.

 Your premiums will be based on where you live and the amount you’d pay if you had no pre-existing condition and were able to purchase individual insurance in the open market.

 For example, a Central Valley resident aged 50-54 would pay $481 per month for PCIP. A San Francisco Bay Area resident aged 45-49 would pay $377 per month. Someone 18 years old or younger living in Del Norte, Humboldt, Siskiyou, or Shasta counties would pay $145 monthly.

 You’ll pay a 15 percent coinsurance for most in-network services after meeting a $1,500 annual medical deductible. PCIP also has a $500 annual deductible for brand-name drugs. There are no out-of-pocket costs for preventive care, including regular physical exams, cancer screenings, immunizations, and well-child care.

 As a PCIP subscriber, you’ll pay no more than $2,500 a year out-of-pocket. When you reach this $2,500 cap, PCIP pays all costs for covered services received within the PCIP network for the remainder of the calendar year (although you have to keep paying your monthly premium to stay enrolled.)

 And this is important: PCIP has no cap on annual or lifetime benefits.

 The Pre-Existing Condition Insurance Plan was created under the Affordable Care Act. It’s a transitional program until 2014, when all Americans—regardless of health status—will have access to affordable health insurance as the nation shifts to a new marketplace. 

For more information, visit www.pcip.ca.gov or call 1-877-428-5060 Monday through Friday from 8 a.m. to 8 p.m., or Saturday from 8 a.m. to 5 p.m.
 David Sayen is Medicare’s regional administrator for California.

By David Sayen
Regional Administrator
U.S. Centers for Medicare & Medicaid Services

You may have read a restaurant guide or review before going out for a special dinner. And you’ve probably read a consumer review or two before spending thousands of dollars on a new car.
Wouldn’t it be great if there was a place where you could get information on the quality of hospitals in your area?

Well, there is. It’s called Hospital Compare and you can find it on the Medicare website, at www.medicare.gov.
Hospital Compare contains a wealth of information on how well hospitals perform certain surgeries and treat certain medical conditions. The data varies from hospital to hospital. Because the reality is that some hospitals do a better job of caring for patients than others.

The idea behind Hospital Compare is that making quality-of-care information easily available to the public will motivate hospitals to improve their care. Medicare has similar “compare” websites for nursing homes and dialysis facilities, too.

You can search Hospital Compare by zip code, city, or state. The data you’ll find are intended to provide a “snapshot” of the quality of care at about 4,700 hospitals throughout the United States. You don’t have to be a Medicare beneficiary to use Hospital Compare – it’s open to everyone and it’s free of charge.

If you’re having a medical emergency, go to the nearest hospital. Just get care as fast as you can. But if you’re planning to have surgery, or if you have a condition like heart disease and you know you’ll need hospital care in the future, talk to your doctor about the local hospital that best meets your needs.

Find out which hospitals your doctor works with, and which hospitals he or she thinks give the best care for your condition. If you’re a Medicare beneficiary, ask if the hospitals participate in Medicare.

At that point, you may want to spend some time on Hospital Compare.

Hospital Compare shows the rates at which hospitals provide recommended care for patients being treated for heart attack, heart failure, and pneumonia, and for patients having surgery.

It also displays information on hospital outcome measures. These include the rate at which Medicare patients who were treated for heart attack, heart failure, and pneumonia had to be readmitted to the hospital with complications, and 30-day risk adjusted death rates. (The 30-day period is used because this is the time period when deaths are most likely to be related to the care patients received in the hospital.)

In addition, you can see results from patient satisfaction surveys, such as how well patients thought the hospital controlled their pain and how well doctors and nurses communicated with them.

Hospital Compare is no substitute for talking with your doctor and family members and friends who’ve been treated at a hospital you’re considering. But the website can give you a general idea of how well various hospitals handle certain kinds of patients.

We recently updated Hospital Compare with information on preventable errors that hospitals make. Eight types of errors are listed, including foreign objects being left in a patient after surgery; blood infections that result from catheters; bedsores; air and gas embolisms; preventable falls, burns, electric shock, or broken bones; and blood transfusions with incompatible blood. Such errors injure and kill thousands of people every year.
Medicare stopped reimbursing hospitals for these errors in 2008. But that’s not all we’re doing. Just last month we launched a new initiative called the Partnership for Patients, which we hope will save 60,000 lives by stopping millions of preventable injuries and complications in patient care over the next three years.
Already, more than 1,200 hospitals have pledged to support the Partnership for Patients. Ask your local hospital to sign up, if it hasn’t already.

The Commonwealth Fund recently estimated that 872,802 Californians are potentially eligible for the Pre-existing Condition Insurance Plan (PCIP), a new program created under the Affordable Care Act.

These are Californians with cancer, heart disease, lupus, or other serious medical problems that have caused them to be turned down for insurance coverage, or for whom insurance coverage is far too expensive.

PCIP is a bridge program for children and adults in all 50 states and the District of Columbia who’ve been locked out of the health insurance market because of a pre-existing condition. About $5 billion has been appropriated to fund PCIP. In 2014, Americans—regardless of their health status—will have access to affordable health insurance when the nation transitions to a new marketplace.

Under PCIP, Californians with pre-existing conditions can receive coverage for a wide range of medical benefits, including physician’s services, hospital care, and prescription drugs. They won’t be charged a higher premium because of their medical condition and their eligibility isn’t based on income. Like standard health insurance plans, they’re required to pay a monthly premium, a deductible, and some cost-sharing expenses. Premiums may vary depending on where they live, their age, and which health plan they choose.

To qualify for PCIP, you must:
- be a citizen of the United States or residing here legally;
- have been uninsured for at least 6 months before applying;
- and have a pre-existing condition or have been denied insurance coverage because of your health condition.
Questions and Answers

What is a pre-existing condition?

A pre-existing condition is a condition, disability or illness (either physical or mental) that you have before you enrolled in a health plan.

Is the Pre-Existing Condition Insurance Plan (PCIP) available in every state?
Yes, every state has a plan that offers comprehensive health coverage for uninsured Americans with pre-existing conditions. The program name and other plan details vary depending on which state you live in and whether the program is run by the state or the Department of Health and Human Services. Check out the State Plans page to learn more about how the Pre-Existing Condition Insurance Plan works in your state.

When will my coverage be effective?

If we get your complete application, including all supporting documents, on or before the 15th of the month, your coverage will start on the first day of the next month. If we get your complete application, including all supporting documents, after the 15th of the month and on or before the last day of the month, your coverage will start the first day of the second month, unless you choose to have your coverage start on the first day of the next month. If we approve your application, we will let you know how to choose an earlier effective date. Coverage always begins on the first day of the month.

Example:
We get your complete application and supporting documents on …
Your coverage starts …
March 1-15
April 1
March 16-31
May 1 or

April 1 (if you ask for coverage to start sooner)
May I apply for the Pre-Existing Condition Insurance Plan if I have existing health coverage?

You are not eligible unless you have been without health coverage for at least the last 6 months. For example, if you have Medicare or TRICARE, you shouldn’t apply. Also, if you have coverage provided by a state high risk pool or insurance coverage that may not cover a pre-existing medical condition, you shouldn’t apply. If you are uninsured and have been told that you may be eligible for other coverage programs like Medicaid and the Children’s Health Insurance Program, you should check out those programs first, as they may better meet your needs. If you have job-based coverage, or individual insurance coverage, you aren’t eligible to apply.

May I apply for the Pre-Existing Condition Insurance Plan if I have COBRA or other continuation of coverage?
No, even if your COBRA or other continuation of coverage is about to run out, you won’t be eligible until you have been without health coverage for at least the last 6 months, and meet other eligibility criteria.

I currently have insurance that excludes coverage for my pre-existing condition. Am I eligible for this program?
No. To be eligible for the Pre-Existing Condition Insurance Plan, you must have been without other health coverage for at least 6 months from the date of application.

What health care providers are in the network?

The Pre-Existing Condition Insurance Plan will have provider networks that include a full range of services and specialists. You can search for participating providers at www.PCIPlan.com.

Is there a cost for this coverage?

If you are eligible for the Pre-Existing Condition Insurance Plan, you pay a monthly premium for your coverage and other cost-sharing. To see the premium rates for your state, go to State Plans.

What do I do if I can’t afford these premiums?

If you have limited income and resources, you may be eligible for the Medicaid program in your state. If you are seeking insurance coverage for your child, go to www.insurekidsnow.gov to learn more about children’s health insurance in your state.

What is going to happen to my PCIP coverage when the program ends in 2014?

The Pre-Existing Condition Insurance Plan is a transitional program that provides health coverage to people with pre-existing conditions. This program is available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. If you are enrolled in PCIP, we will provide additional information about how your Pre-Existing Condition Insurance Plan coverage will change and how you can take advantage of the new coverage options available in 2014.

How do the lawsuits against the Department of Health & Human Services concerning the Affordable Care Act affect my PCIP coverage?

The Affordable Care Act remains the law of the land and we are continuing to carefully and effectively implement this law to improve the health of all Americans. The Affordable Care Act created the Pre-Existing Condition Insurance Plan, which is available to people who are U.S. citizens or residing here legally, have a pre-existing condition or have been denied health coverage because of their health condition, and have been without health coverage for at least 6 months.
This program will be available until 2014. In 2014, you will have access to affordable health insurance choices through a new competitive marketplace called an Exchange. An Exchange will provide a transparent and competitive insurance marketplace where individuals and small businesses can buy affordable and qualified health benefit plans. Exchanges will offer you a choice of health plans that meet certain benefits and cost standards. In addition, starting in 2014, it will be against the law for an insurance company to discriminate against you based on a pre-existing condition. We recognize how important the Pre-Existing Condition Insurance Plan is to you and will let you know if there are any changes that could affect your coverage.

To find out more about the Pre-Existing Condition Insurance Plan, including eligibility, plan benefits and rates and how to apply, visit www.pcip.gov. Click on “Find Your State” and select your state from a map of the United States or from a drop-down menu for details.
To read the Commonwealth Fund report on PCIP, go to:

http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2010/Oct/1445_Hall_PCIPs_and_the_ACA_ib_FINAL.pdf.

By David Sayen
Regional Administrator
U.S. Centers for Medicare & Medicaid Services

Your Original Medicare insurance covers a wide variety of health services, from flu shots to inpatient hospital stays to hospice care. But it doesn’t cover everything, and it doesn’t cover all your out-of-pocket costs.

Many services covered by Original Medicare require co-payments, coinsurance, or deductibles. But you can purchase supplemental insurance to cover these “gaps” in Medicare. Such insurance is called, appropriately, Medigap. Some Medigap policies also cover certain benefits that Original Medicare doesn’t, like emergency care in a foreign country.

You have to pay for Medigap yourself, and it’s sold through private insurance companies. You can buy it only if you have Original Medicare, not Medicare Advantage.

Every Medigap policy has to follow Federal and state laws designed to protect you. Medigap insurance companies in most states can only sell you a “standardized” Medigap policy identified by letters A through N. Each standardized policy must offer the same basic benefits, no matter which company sells it.

So beware when you’re shopping for a Medigap policy: Cost is usually the only difference between Medigap policies with the same letter sold by different companies.

And there can be big differences in how much various insurers charge for exactly the same coverage.

Here are some of the costs a Medigap policy may cover:

*        Medicare Part A (hospital) coinsurance and hospital costs for up to 365 days after Medicare benefits run out;
*        Medicare Part B (doctor’s charges) coinsurance or co-pays;
*        Blood (first 3 pints);
*        Part A hospice care coinsurance or co-pays;
*        Skilled nursing facility coinsurance;
*        Part A and Part B deductibles.

Medigap policies generally don’t cover long-term care (like care in a nursing home), vision or dental care, hearing aids, eyeglasses, and privateduty nursing.

The best time to buy a Medigap policy is during your Medigap open enrollment period. This period lasts for 6 months and begins on the first day of the month in which you’re both 65 or older and enrolled in Medicare Part B.

Why is this important? Because during open enrollment, an insurance company can’t refuse to sell you any Medigap policy it offers due to any health problems you may have. Nor can you be charged more based on your health status.

In some cases, however, an insurer can refuse to cover your out-of-pocket costs for pre-existing health conditions for up to 6 months. After 6 months, the Medigap policy will cover the pre-existing condition.

And remember, for Medicarecovered services, Original Medicare will still cover the condition even if the Medigap policy won’t cover your outofpocket costs. But you’re responsible for the coinsurance or copayment.

A few other points to keep in mind:

*        You must have Medicare Part A and Part B to buy a Medigap policy.
*        Plans E, H, I, and J are no longer for sale, but you can keep these plans if you already have one.
*        A Medigap policy only covers one person. If you and your spouse both want Medigap coverage, you must each buy a separate policy.
*        Any standardized Medigap policy is guaranteed renewable, even if you have health problems. This means the insurance company can’t cancel your policy as long as you pay the premium.

Although some Medigap policies sold in the past cover prescription drugs, Medigap policies sold after January 1, 2006, aren’t allowed to include prescription drug coverage. (If you want such coverage, you can join a Medicare Part D prescription drug plan, offered by private companies approved by Medicare.)
David Sayen is Medicare’s regional administrator for California, Arizona, Nevada, Hawaii, and the Pacific Trust Territories. You can get answers to your Medicare questions 24/7 by calling 1-800-MEDICARE or online at www.medicare.gov.

Health & Wealth

The military graft scandal and corruption which involved the late Gen. Angelo Reyes, Gen. Carlos Garcia, Gen. Jacinto Ligot  ( older graduates of the Philippine Military Academy in Baguio City) and other older generals  put to test the integrity, honesty and  morality of the younger PMA graduates.

In his address at the graduation of the Philippine Military Academy (PMA) last week, President Benigno Aquino III urged the new AFP  chief of staff Lt. Gen. Eduardo Oban and the new PMA graduates to fight corruption. Can the new “breed” of younger PMA graduates withstand the pressures and temptation of corruption in the military?

The new breed of younger PMA graduates plus the willingness and steadfastness of men and women like retired Lt. Col. George Rabusa and former COA ( Commission on Audit) auditor Heidi Mendoza to expose greed and corruption could bring back  honor and respect to the Philippine Military Academy, the entire military establishment and the government.

Officer Rolando “Rollie” Dumawa belongs to the new breed of younger PMA graduates who can help bring back the honor and respect for PMA graduates. Rollie is the son of the late minister-evangelist Vic Dumawa. I’ve watched Rollie grow as a young child when his late father was the minister of the Church of Christ in Tayug, Pangasinan. His father and mother taught him to live and practice honesty, integrity, righteousness and morality as taught in the Bible (II Timothy 3:16-17)

Last week, Rollie shared to me and my wife “ 45 Life Lessons To Live By,” which was originally written by 90-year-old Regina Brett. Most of these life lessons came from the teachings and admonitions in the Bible. I’m sharing these life lessons to our readers and the general public.

1.Life isn’t fair, but it’s still good; 2. When in doubt, just take the next small step; 3. Life is too short to waste time hating anyone; 4. Your job won’t take care of you when you are sick, Your friends and parents will. Stay in touch; 5. Pay off your credit cards every month; 6. You don’t have to win every argument. Agree to disagree; 7. Cry with someone. It’s more healing than crying alone; 8. It’s OK to get angry with God. He can take it; 9. Save for retirement starting with your first pay check; 10. When it comes to chocolate, resistance is futile; 11. Don’t compare your life to others. You have no idea what their journey is all about; 12. Make peace with your past so it won’t screw up the present; 13. It’s OK to let your children see you cry; 14. If a relationship has to be a secret, you shouldn’t be in it; 15. Everything can change in the blink of an eye. Don’t worry, God never blinks;

16. Take a deep breath. It calms the mind; 17. Get rid of anything that isn’t useful, beautiful or joyful; 18. Whatever doesn’t kill you really does make you stronger; 19. It’s never too late to have a happy childhood. But the second one is up to you and no one else; 20. When it comes to going after what you love in life, don’t take no for an answer; 21. Burn the candles, use the nice sheets, wear the fancy lingerie. Don’t save it for special occasion. Today is special; 22. Over prepare, then go with the flow; 23. Be eccentric now. Don’t wait for old age to wear purple; 24. The most important sex organ is the brain; 25. No one is in charge of your happiness but you; 26.Frame every so-called disaster with these words ‘In five years, will this matter?’ 27. Always choose life; 28. Forgive everyone, everything; 29. What other people think of you is none of your business; 30. Time heals almost everything. Give time time;

31. However good or bad a situation is, it will change; 32. Don’t take yourself so seriously. No one else does; 33. Believe in miracles; 34. God loves you because of who God is, not because of anything you or didn’t do; 35. Don’t audit life. Show up and make the most of it now;  36. Growing old beats the alternative  -  dying young; 37. Your children got only one childhood; 38. All that truly matters in the end is that you loved; 39. Get outside everyday. Miracles are waiting everywhere; 40. If we all threw our problems in a pile and saw everyone’s else, we’d grab ours back; 41. Envy is a waste of time. You already have all you need; 42. The best is yet to come; 43. No matter how you feel, get up, dress up and show up; 44. Yield; 45. Life isn’t tied up with a bow, but it’s still a gift.

AMAZING NATURAL HEALING POWERS OF HEXAGON WATER: LUIS ABELLO, 72-year-old diabetic from Sacramento , California , told me last Friday that his health is fast improving by drinking the HEXAGON water regularly. Even with two prescription drugs, his sugar level reading was always 215 plus. After one month of drinking HEXAGON water regularly, the sugar level reading is  now 130 and lower!; ROBERT BAYLOSIS, 55, who was diagnosed as diabetic with hypertension, is improving steadily with sugar level reading of 105-109 after drinking HEXAGON water regularly since October, 2010. He stopped taking metformin and lisinopril (prescribed by her doctor to control diabetes and hypertension)

since early January, 2011; GLORIA FAST, age 53, continue  to have speedy recovery from mild stroke and high cholesterol after drinking HEXAGON water and taking whole food nutrition for almost a month; More testimonials from relief and natural healing HEXAGON water on arthritis, aches, pains and other  degenerative ailments (ulcer, asthma, angina, lupus, cancer, schelosis, etc.) will follow.

BOTTLED & DRINKING WATER PH TESTING & FINANCIAL WORKSHOP: Is the brand of bottled water and tap water you are drinking safe and healthy? Come to the Bottled & Drinking Water PH Testing/Demo, then attend the FREE Financial Workshop in Fremont , San Francisco and other cities, so you can become healthy physically and financially. For location, date, time and seat reservation, call: (650)438-3531, (415)584-7095, (510)550-1404 Ext. 104, (408)679-178 or e-mail:inf@jccalliance.com

50% DISCOUNT ON NOTARIAL SERVICES: I would like to commend the California Secretary of State, Notary Public Division,  for the State-Mandated Training and more strict requirements (background check, finger printing, etc.) for new and renewing  notaries to get rid of the dishonest and unethical notaries who contributed to the real estate and mortgage crisis.

I’ve continuously renewed my commission as Notary Public in California since 1981. As special offer to our readers, I’m offering 50% Discount for Notarial Services in Fremont , San Francisco , Daly City and nearby Bay Area cities. Just call me at (650)438-3531, (415)584-7095, (510)5501404 Ext. 104 or e-mail:agmadlaing@hotmail.com

QUOTE OF THE WEEK – OPTIMNISM:  “For life is the mirror of king and slave, ‘Tis just what you are and do; Then give to the world the best you have, and the best will come back to you.”    - MADELINE BRIDGE

*ART GABOT MADLAING is DRE licensed (I.D. #00635976) Real Estate Broker in California since 1981. He is the Chief Operating Officer of JCC Alliance Network and one of the evangelists of the Golden Gate Church of Christ in San Francisco , California .

CalPERS letter to HHS outlines efforts to implement Affordable Care Act, expanding coverage and lowering premium costs for enrollees

Today, the U.S. Department of Health and Human Services (HHS) received a letter from the California Public Employees’ Retirement System (CalPERS), which provides health benefits to 1.6 million workers, retirees, and their families, outlining the ways the Affordable Care Act is helping improve coverage and lower costs for Californians.

“The efforts by CalPERS to act on the important programs and provisions of the Affordable Care Act shows that this new law is bringing real benefits to consumers,” said Secretary Kathleen Sebelius. “More Californians now have the security of health insurance – and lower health care costs for better benefits.”

In the letter, CalPERS outlined three areas where the Affordable Care Act is already bringing benefits to Californians. As a provider of health coverage for retired workers, CalPERS is participating in the Early Retiree Reinsurance Program. Through this program, CalPERS reports it has reduced insurance premiums for more than 115,000 early retirees and their families by more than 3 percent – a savings of approximately $200 million. These savings have brought CalPERS retiree health insurance premium rates to the lowest level in 14 years.

In addition, CalPERS has acted to extend dependent coverage for young adults – and will have added more than 27,000 young Californians to their parents’ health plans by January 1, 2011.
Finally, CalPERS notified HHS that, consistent with the law, it had removed lifetime benefits limits from all health plans the system offers. This has resulted in enrolled Californians receiving better benefits and security.

The Affordable Care Act aims to provide Americans with the opportunity to get and keep health care coverage and to lower cost growth for people who have insurance, while getting rid of some of the very worst practices of the insurance industry with a new Patient’s Bill of Rights. Today’s news from CalPERS is an indication of how the law is helping working families and those who are retired.

The letter from CalPERS is available at

http://www.healthcare.gov/center/letters/calpers_letter.pdf.

DALLAS,  — Keep your heart healthy and you may slow down the aging of your brain, according to a new study reported in Circulation: Journal of the American Heart Association.

In the study, people whose hearts pumped less blood had brains that appeared older than the brains of those whose hearts pumped more blood.  Decreased cardiac index, the amount of blood that pumps from the heart in relation to a person’s body size, was associated with decreased brain volume using magnetic resonance imaging (MRI).

Researchers observed the link even in those participants who did not have cardiovascular disease, such as heart failure or coronary heart disease. As the brain ages, it begins to atrophy (shrink) and has less volume.  The decrease in brain volume is considered a sign of brain aging. More severe brain atrophy occurs in those with dementia, such as Alzheimer’s disease.

“The results are interesting in that they suggest cardiac index and brain health are related,” said Angela L. Jefferson, Ph.D., the study’s lead author and associate professor of neurology at the Boston University School of Medicine. “The association cannot be attributed to cardiovascular disease because the relationship also was seen when we removed those participants with known cardiovascular disease from our analyses.”

In the observational study, which cannot establish cause and effect, researchers examined brain and heart MRI information on 1,504 participants of the decades-long Framingham Offspring Cohort who did not have a history of stroke, transient ischemic attack or dementia. Participants were 34 to 84 years old and 54 percent were women.

Researchers measured cardiac index output using MRI and normalized the data for each participant’s body surface area. Brain volume was accessed using MRI. Participants were divided into three groups based on cardiac index values.

The participants who had the lowest cardiac index, or the least amount of blood pumping from the heart for their body size, showed almost two years more brain aging than the people with the highest cardiac index. The participants in the middle cardiac index group, who had low but still normal levels of blood pumping from the heart, also showed almost two years more brain aging than the people with the highest (or healthiest) cardiac index.

“We expected an association between the lowest levels of cardiac index and smaller brain volumes, but we were surprised to find people on the lower end of normal cardiac index also have smaller brain volumes when compared to people with very health cardiac index,” Jefferson said.

Because only 7 percent of all participants in the study had heart disease, Jefferson and her colleagues also didn’t expect 30 percent of participants would have low cardiac index.

“These participants are not sick people.  A very small number have heart disease.  The observation that nearly a third of the entire sample has low cardiac index and that lower cardiac index is related to smaller brain volume is concerning and requires further study.”

As a group, participants with smaller brain volumes did not show obvious clinical signs of diminished brain function. “We observed cardiac index is related to structural changes in the brain but not cognitive changes,” Jefferson said. “The structural changes may be early evidence that something is wrong.  Investigators from Framingham will continue to follow these individuals to see how structural brain changes affect memory and cognitive abilities over time.”

The exact cause for a link between heart function and brain volume is still not well understood, Jefferson said. “There are several theories for why reduced cardiac index might affect brain health. For instance, a lower volume of blood pumping from the heart might reduce blood flow to the brain, providing less oxygen and fewer nutrients needed for brain cells.  It is too early to dole out health advice based on this one finding but it does suggest that heart and brain health go hand in hand.”

Co-authors are Jayandra J. Himali, M.S.; Alexa S. Beiser, Ph.D.; Rhoda Au, Ph.D.; Joseph M. Massaro, Ph.D.; Sudha Seshadri, M.D.; Philimon Gona, Ph.D.; Carol J. Salton, B.A.; Charles DeCarli, M.D.; Christopher J. O’Donnell, M.D., M.P.H.; Emelia J. Benjamin, M.D., Sc.M.; Philip A. Wolf, M.D.; and Warren J. Manning, M.D.

Author disclosures are on the manuscript.

The National Institute on Aging and the National Heart, Lung, and Blood Institute funded the research.

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the association’s policy or position.  The association makes no representation or guarantee as to their accuracy or reliability.  The association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific association programs and events.  The association has strict policies to prevent these relationships from influencing the science content.  Revenues from pharmaceutical and device corporations are available at www.americanheart.org/corporatefunding.

Answers To Commonly Asked Medicare Questions

Q:   How will people with Medicare benefit in the near future from the new Affordable Care Act?

A:   People with Medicare should have recently received important information from the Centers for Medicare & Medicaid Services that explains some of the immediate benefits they may see from the new Affordable Care Act. That information, outlined in a mailing sent to all beneficiaries, provides them with timely facts about the important new law so they can learn how their Medicare benefits will either “stay the same” or “change and improve.” The new law not only strengthens Medicare, but also ensures the guaranteed benefits that beneficiaries have come to rely upon don’t change.

The first benefit that several million Medicare beneficiaries will receive is a one-time, tax-free check for $250, if they enter the Part D donut hole and are not eligible for Medicare Extra Help. The donut hole – or coverage gap – is the period in the prescription drug benefit in which the beneficiary pays 100 percent of the cost of their drugs until they hit the catastrophic coverage. Next year, in 2011, all beneficiaries who enter the coverage gap will get a 50 percent discount for covered brand-name Part D drugs, and by 2020 Part D program benefits will no longer have a gap in coverage.

To get this check, you will not need to take any action at all. That means there is no need to pass along any personal information like bank account information or your Medicare or Social Security number to get the $250 check. The rebate will come in the form of a check made out to you and it will be mailed to the address Medicare has on file. Medicare has all the information it needs to mail the check, so you don’t need to respond to any phone calls asking for information. Any calls you get are most likely scams.

If you have hit the coverage gap you should expect to get your rebate check within about 45 days. This may be delayed slightly if Medicare doesn’t get timely information from your Medicare drug plan showing that you have actually reached the coverage gap.

If you don’t get your rebate check when you believe you should, your first call should be to your prescription drug plan to ensure that it has sent the information to Medicare. You may also want to contact Social Security to ensure that your correct address is on file, especially if you have recently moved. If you have not been able to get satisfaction from your plan, you should contact 1-800-MEDICARE (1-800-633-4227) to start the complaints process. In some cases there may be a discrepancy between you and the plan as to whether you have hit the coverage gap.

In addition to the rebate check, the new mailing outlines other benefits available under the Affordable Care Act.  Beginning in 2011, Medicare beneficiaries will get preventive care services like colorectal cancer screening and mammograms without cost-sharing, in addition to an annual “wellness visit.”

Currently, Medicare covers a one-time preventive physical exam within the first 12 months after you enroll in Medicare Part B. The exam includes a thorough review of your health; education and counseling about the preventive services you need, like certain screenings and shots; and referrals for other care. The “Welcome to Medicare” physical exam is a great way to get up-to-date on important screenings and shots and to talk with your doctor about your family history and how to stay healthy.

But, thanks to the Affordable Care Act, beginning in 2011, all Medicare beneficiaries can receive a physical exam every year, not just once.

The law also includes new tools to help fight fraud by helping Medicare crack down on criminals who are seeking to scam seniors and steal taxpayer dollars.  CMS is reminding beneficiaries, their families and caregivers to be on the alert for any scams asking for personal information.  CMS has learned from implementing previous major pieces of health reform legislation, like Medicare Part D that unfortunately new opportunities for Medicare beneficiaries also bring new opportunities for scam artists to try and defraud seniors.

Because Medicare is a trusted resource for beneficiaries and their family members, the mailing encourages them to log on to www.medicare.gov or call 1-800-MEDICARE, which is 1-800-633-4227, to get their questions about Medicare or the Affordable Care Act answered.

SEATTLE, Washington – Some Medicare enrollees, including Asian American and Pacific Islander (AAPI) seniors, will soon receive the first batches of $250 rebate checks from the government.

The checks are designed to provide financial help to those who have reached the Medicare Part D coverage gap known as the ‘donut hole.’ What that means is that if a Medicare enrollee’s prescription drug costs total more than $2,830 but less than $6,440 they are eligible to receive this one-time rebate, which is part of the Patient Protection and Affordable Care Act signed into law by President Barack Obama in March.

“The rebate checks are a welcome sight at a time when an estimated three to four million Medicare enrollees will spend themselves into the coverage gap,” said NAPCA President and CEO Christine Takada. “NAPCA wants to make sure those enrollees are aware that economic relief is on the way, but to also be aware of potential frauds and scams.”

The rebate checks will automatically be sent from the U.S. Department of Health and Human Services (HHS). It is important that AAPI seniors know that there are no forms to fill out and they will not have to do anything to receive them. Medicare will automatically send a check made out to those who are eligible for the rebate. Eligible seniors will not need to provide any personal information like Medicare, Social Security, or bank account numbers to get the rebate check, nor should they give out personal information to anyone who calls about the $250 rebate check.

The check is just one of the many components of the Affordable Care Act. In 2011, enrollees on Medicare may get a 50% discount on brand name prescription drugs. By the year 2020, the coverage gap, or ‘donut hole,’ will be completely closed.

NAPCA wants to help educate and inform AAPI seniors about the rebate checks. For detailed information about the Affordable Care Act and how it may affect you, call the NAPCA Helpline at the telephone numbers below.

NAPCA National Multilingual Toll-free Helpline Numbers:
English 1-800-336-2722            Chinese 1-800-582-4218
Korean 1-800-582-4259         Vietnamese 1-800-582-4336

The National Asian Pacific Center on Aging’s mission is to serve as the leading national advocacy organization committed to the dignity, well-being and quality of life of AAPIs in their senior years. For more information please visit us at: www.NAPCA.org.