Charges were filed against one of Florida’s wealthiest healthcare operators in a $1 billion Medicare care fraud scheme, announced the U.S. Attorney’s Office during a press conference in Miami, Florida on July 22, 2016. Federal prosecutors stated this is the biggest Medicare fraud scheme in the nation’s history. This has cost Medicare hundreds of millions of dollars due to fraudulent payments. Medicare is the U.S. governments medical program for the elderly and disabled.
Philip Esformes, 47, was charged at his ocean front estate. Along with two other defendants, he is accused of exploiting his network of about 20 Miami-Dade skilled nursing and assisted living facilities to fleece the taxpayer funded Medicare system by filing false claims for services that were not necessary and in some instances not provided. This has been happening over the past 14 years.
Esformes is charged with conspiring with Arnaldo Carmouze, 56, a Palmetto Bay physician’s assistant, and Odette Barcha, 49, a former director of outreach programs at Larkin Community Hospital in South Miami.
Esformes is also being accused of referring his own network of patients to other convicted healthcare fraud offenders, who had swindled Medicare for mental health, prescription drug and home healthcare services and ended up helping federal investigators target the Miami Beach business executive. According to the indictment, the kickbacks were “disguised” as payments for escort services for Esformes as well as related travel and hotel expenses.
Healthcare fraud has been a battle for a long time. This case is the nation’s largest in regards to heathcare and Medicare fraud. It was noted that while his healthcare network billed $1 billion for fraudulent medical services, Medicare paid Esformes’ skilled nursing and assisted living facilities about $500 million since 2009.
“This is the largest single criminal healthcare fraud case ever brought against individuals by the Department of Justice,” the criminal division’s assistant attorney general, Leslie R. Caldwell, said Friday during a news conference at the U.S. attorney’s office in Miami.
Medicare plans already cost the government and US citizens a lot of money. Fraud continues to drive the costs up. It is important that law enforcement continues to target this problem.
Seniors are patiently waiting for CMS to release the pricing for Medicare Supplements for 2017. We will provide updated pricing as soon as it comes available. It is likely that prices will increase this year. Many seniors may find the plan cost offerings to have jumped in price more than would be preferred, but utilizing this year’s pricing will provide insight into pricing and allow for some level of budgeting. Their is not an exact date that rates are published, but they are released in the fall each year. It is important to watch for the rates so that you have time to decide what will work best for you.
2016 California Medicare Supplemental (Medigap) Rates Los Angeles County
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from State Farm Insurance Company from $1756.00. Second best is USAA Life. This compares with the highest cost plan offered from $4468 from Physicians Mutual Insurance Company. This is a huge difference for the same plan!
Their are many other companies that offer Medigap or Medicare Supplemental plans in Los Angeles County. This includes Aetna Life, Blue Cross, Gerber, and Humana.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from USAA Life Insurance Company from $1846.00. Second best is Stonebridge Life Insurance Company. This compares with the highest cost plan offered from $4459 from Physicians Mutual Insurance Company. This is a considerable difference in cost.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from State Farm Insurance Company from $1706.00. Second best is Globe Life Insurance Company at $1846. This compares with the highest cost plan offered from $4466 through Physicians Mutual Insurance Company. This is another significant difference.
San Bernardino County
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from California Physicians Service from $1200.00. Second best is Colonial Penn Insurance Company at $1216. This compares with the highest cost plan offered from $2089 through Sentinel Security Life Insurance Company. This is another significant difference.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from State Farm Mutual from $938.00. Second best is Stonebridge Life Insurance Company at $1133. This compares with the highest cost plan offered from $2327 through Physician’s Mutual Insurance Company. This is a $1,389 difference from highest to lowest.
San Diego County
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from Blue Cross of Californiafrom $1431.00. Second best is Loyal American Life Insurance Company at $1445. This compares with the highest cost plan offered from $2387 through Physician’s Mutual Insurance Company. The difference between the highest and lowest is not as great as in some counties.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from Health Life Insurance Companyfrom $1080.00. Second best is State Farm Mutual Insurance Company. This compares with the highest cost plan offered from $2006 through Physician’s Mutual Insurance Company. This is a $926 difference from highest to lowest.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from State Farm Insurance Company from $901. Second best is Stone Bridge Insurance Company at $956. This compares with the highest cost plan offered from $2006 through Physicians Mutual Insurance Company. This is over a $1,000 difference from least expensive to most expensive.
Santa Barbara County
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from ColonialPenn Insurance Company from $1106.00. Second best is California Physicians Service at $1128. This compares with the highest cost plan offered from $1877 through Thrivent Financial Company. This is another significant difference.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from HealthNet Life Insurance Company from $1080.00. Second best is United American Insurance Company at $1130. This compares with the highest cost plan offered from $1765 through Physicians Mutual Insurance Company. This is a $685 Difference. Not as high as some counties, but still a significant difference.
Male or Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from State Farm Insurance Company from $901.00. Second best is Globe Life Insurance Company at $902. This compares with the highest cost plan offered from $1794 through Sterling Life Insurance Company. This is an $893 difference.
When searching for plan rates, it’s important for seniors to note the potential for wide variability in plans. Factors such as age, sex, smoker and zip code can influence rates. Because of the types of plans offered, seniors should note first what type of plan they wish to seek out (designated by the letter type found at Medicare.gov or at our article here). After choosing the medicare supplement plan that is most desirable, seniors can compare the same plans across the full breadth of insurance companies in their county in California. Plans with a designated letter will share the same attributes regardless of the insurance company that offers them! Therefore, price should be the main characteristic that shoppers should use to decide on a plan. Other factors, h0wever, such as reputation of the insurance company and plan network may be an additional consideration for seniors to consider when comparing medicare plans.
Medigap and Medicare supplement information for the state of Florida and its counties is below.
Who is eligible for Medigap Plans?
Basically, Medigap plans are available to Medicare recipients that have Part A and Part B coverage and who are not enrolled in Medicaid or a Medicare Advantage Plan. Patients who wish to enroll in a Medicare supplement plan will have to enroll during the open enrollment period.
This period last 6 months and begins the month that the patient turns 65 and when the patient enrolls in Medicare Part B. NOTE: this is a one time open enrollment window! Unlike Medicare Advantage plans, open enrollment doesn’t occur for every senior every November!
What do I do if I missed the Medicare Supplement Open Enrollment period? How can I get a Medigap policy after open enrollment?
Seniors who have missed the open enrollment period may still apply for a Medicare Supplement policy. However, there is no guarantee that a company will sell or approve the senior’s medicare supplement application. Seniors who apply later will need to meet medical underwriting requirements or meet other select criteria. Seniors who have missed the open enrollment window can find more information here.
How do I switch to a Medicare Supplement plan from Medicare Advantage?
Patients cannot have both a Medicare Supplement plan and a Medicare Advantage Plan, but seniors who have a Medicare Advantage plan are able to change. It is important for the senior to remember that
Why should I choose a Medigap Plan over a Medicare Advantage Plan? What is the difference?
Perhaps the most important distinction is in limits to patient choices. A Medicare Advantage plan will often dictate limitations to the patient — the patient cannot see any doctor or go to any hospital. Unlike a Medicare Advantage PPO or HMO a Medigap plan allows a patient to choose any doctor that accepts Medicare and use any hospital.
This is a crucial difference. Seniors that travel out of state to visit family or friends will want to make certain if they choose an Advantage Plan that the plan network includes preferred doctor or hospitals in the area they will visit.
Are Medicare patients under 65 eligible for Medigap plans?
If you are under 65 and a disabled person receiving Medicare benefits, you may indeed be eligible for such a plan. Here is a helpful video from CMS (Center for Medicare and Medicaid Services)
When are the 2014 Medigap rate quotes released for the next year? What month should I shop for Medicare Supplement plans for the next year?
Unfortunately, there is no set date when the Medigap and Medicare supplement plan costs are released by the Center for Medicaid and Medicare Services. Private insurers submit their next year projections and then CMS compiles the list and releases it sometime in the fall. Check back here this fall for 2013 updated Medigap rate information !
Can I use my Medicare Medical Savings Account (MSA) to pay for a Medicare supplement plan?
Unfortunately, Medicare eligible seniors cannot use a Medicare Medical Saving Account (MSA) to pay for a Medicare supplement plan. MSAs are set up to have a high deductible Medicare Advantage plan with a savings account. The government deposits money into the account to pay toward Medicare covered expenses. This is an amount that is usually less than the high deductible. This type of plan may require significant out-of-pocket expenses for enrolling seniors, and unlike Medicare Supplement plans, generally limits choice of doctor and facilities as a traditional Medicare Advantage plan.
Find rates for Medicare Supplement or Medigap Plans in Florida Counties
Male age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is from United American Insurance Companyquoted from $1775.00. Second best is Everence Association Inc. This compares with the highest cost plan offered from $3952 from American Pioneer Life Insurance Company…for the same plan!
Female age 65 (smoker OR non-smoker) — Best Price Medigap Plan A offering is also from United American Insurance Company priced from $1775.00. Second best is Everence Association Inc. for 1798.60. Compares to the highest cost plan offering from American Pioneer Life Insurance Company at $3952.
Other insurers providing a Medigap policy in Miami-Dade County, FL include Aetna Life, Blue Cross Blue Shield of Florida, Colonial Penn Life, Columbian Mutual, Everence, Gerber, Globe Life and Accident, AARP Medicare Supplement and many others.
Blue Cross Blue Shield of Florida offers Plan B rates at 2734.80
There is a wide difference between Colonial Penn Life at 3355 and Global at 2633
Female Age 67 (non-smoker) — Price for Medicare Supplement Plan B range from:
United American has the most competitive rate Broward County females at 2615
United Healthcare has a solid premium cost of 2712
Sterling Investor Life Insurance offers at 3651 for a preferred plan and 3285 for standard
Other Florida county information:
Best Medicare Supplement Plan A rate quoate (for a female smoker aged 65) is offered from Transamerica Life Insurance Company at rate of $1397.
Columbian Mutual life quotes a Medigap Plan F for a price of $2558.
Leon County Franklin County
Medicare Supplement plan rate quote for Medigap Plan A for a male non-smoker aged 65 is offered from several companies. Companies that offer rates under 1500 include Globe Life and Accident Insurance, Blue Cross and Blue Shield of Florida, Hartford Life Insurance Company and Transamerica Life Insurance Company.
Liberty County Gadsden County
Santa Rosa County
Seniors and medicare recipients in New Jersey will find a large and diverse group of health insurance companies offering Medicare Supplement and Medigap policies to retirees residing in the state. Please note that the current rates are for 2012, as the 2013 medigap rates have not yet been released. Expect these rates to be updated here soon — we’ll post them when CMS releases them to the public sometime this fall.
2012 New Jersey Medicare Supplement Plan Offerings (by county)
Sussex County A 65 year old non-smoking senior will find a medicare supplement rate from AARP via United Healthcare starting at 94.50 for plan K and up to 220 for a plan F choice
Passaic County Horizon Blue Cross Blue Shield offers medigap rates starting at 81.40 for plan K and going up to 197.98 for plan C
Essex County (Newark area) Plan rates offered by Colonial Penn include plans, A, B, C, F (high-deductible plan), G and N. Rates start at 43 per month for high-deductible plan F for a 65 year old female smoker and go up to175 per month for plan C.
Middlesex County (Edison and Woodbridge Township areas) Numerous plan offerings include Genworth Life medicare supplement rates starting at 75.07 per month for a non-smoker male aged 65. Men older than 65 will see higher monthly premium costs, while women generally see lower medigap monthly premiums. The highest cost Medigap plan offered by Genworth is the 190.22 plan for a non-smoker (male).
Passaic County (Paterson City Area) Plans offered include Forethought Life Insurance. For instance Forethought Life plan A starts at 141.75 for a 65 year old female tobacco user.
Seniors that are new to Medicare and eligible to enroll may have a lot of questions about Medicare, Medicare Advantage plans, and Medicare supplements (Medigap). Seniors are often very confused in comparing plan premiums. This is a daunting task, as rates and available companies will vary widely depending upon the state, county and zip code that the senior resides in. Other factors also contribute to price variances, such as the age and sex of the Medicare recipient, and whether the patient is a smoker or not.
What is the difference between traditional Medicare and Medigap?
Medicare supplements help to cover the costs that regular Medicare Part A and B don’t (such as doctor visits and outpatient lab tests). Most of those who worked and paid Medicare taxes will find that there is no cost for Medicare Part A when they retire at age 65.
Medicare Part A is often referred to as hospital coverage. It covers a Medicare patient for care that occurs inside a hospital or other inpatient facility (such as a nursing home) as long as the patient was formally admitted into the hospital as an inpatient. This is an important distinction — patients that are admitted as an outpatient for a procedure then stay in the hospital overnight might find a dramatically different bill! Always ask your hospital whether you are being admitted as an inpatient!
Medicare Part B is often referred to the medical insurance coverage component of Medicare. Per Medicare’s website:
Part B helps cover medically-necessary services like doctors’ services, outpatient care, durable medical equipment, home health services, and other medical services. Part B also covers some preventive services.
Premiums for Medicare Part B have a standard amount, although some higher income individuals may find that they have a higher premium.
Medicare Part B covers diagnostic services and supplies, and preventive care (such as vaccinations for influenza and shingles or tests for early detection of conditions).
Medicare Part C is an optional choice for patients that are more commonly referred to as “Medicare Advantage” plans. They are plans offered through private insurance companies (either a PPO or HMO plans) that envelop both Medicare A and B, but also provide additional services that may include dental coverage, eye coverage, hearing coverage, and urinary catheters and drainage bags. These plans often include Medicare Part D prescription drug plans. For more information about these types of plans, see our post about Medicare Advantage Plan Rates. They are offered by many HMO such as Cigna or Humana.
Medicare Part D plans are plans that cover Medicare patient’s prescription medications. They may be utilized as stand-alone plans or attached to other coverage (such as Medicare Advantage plans). For more information about Medicare Part D see our post about Medicare Part D Plan Rates.
Medicare Supplements cover areas where the other Medicare options do not. They cover the costs for care that aren’t covered by Medicare Part A and Part B. This is why such supplement plans are commonly knows as “Medigap” plans — the plans cover the “gaps” that traditional Medicare doesn’t cover.
Government Personnel Mutual Life Insurance at 3641.52
Ok, if all Medicare supplement plans are standardized, why are the prices different?
This is an excellent question that EVERY senior should ask. The answer is that while the Medigap plan offerings are standardized, all of these companies are competing for your business. That means that some companies will try to compete for your business on price.
However, it is also important to consider the insurance company’s reputation for customer service. While one company may be slightly cheaper, previous patients may have a higher opinion of a competitor. This is why it is important to consider:
The standardized plan that offers the overall coverage a senior desires
The online Medigap price quotes offered for that plan
The reputation and customer service rating for the best priced plans
Online reviews of Medigap insurance companies from other seniors
St. Lucie County
What’s the difference between Medicare and Medicaid? Can a person have both?
Medicaid is another program for patients who may qualify based on income means testing. In general, Medicaid is much more comprehensive than Medicare. However, patients that qualify for Medicare are considered to have both.
Indian River County
Polk County Hillsborough County
Fewer medicare supplement plans seem to be offered in Hillsborough County, but here are some of the available plans:
Indian River County
St Johns County