Senior Care Plus expands into five new counties

Posted by:  :  Category: Medicare

Senior Care Plus, a product of Hometown Health Plan, Inc. is contracted with the Federal Government to offer a Medicare Advantage Plan with prescription drug coverage, available to anyone with both Medicare Parts A and B. Hometown Health is pleased to have been awarded another contract with Medicare for 2012 and will continue to offer its plans for a 16th year. Members must be residents of Carson City, Churchill, Douglas, Lyon, Storey and Washoe counties and continue to pay his or her Medicare Part B premium.
Source: thisisreno.com

Video: Learn about changes to Medicare from Matt Ladich of Senior Care Plus

Foot Care Plus: Medicare approved diabetic shoes and inserts

Did you know that Medicare will help pay most of the cost of diabetic shoes with or without inserts per calendar year?  The goal is to help prevent limb loss due to diabetes.  With diabetes, your body’s defense is not up to par like it used to be.  If you or somebody you know has diabetes, tell them about this program set up by Medicare.  As a foot specialist, Foot Care Plus, LLC can help.  Call us at (816) 434-5906.
Source: blogspot.com

Earlier deadline means earlier decisions on Medicare options

It is if you’ve incited 65 this year. Medicare is a sovereign module to assistance with a costs of medical caring for everybody 65 and comparison as good as people with serious and permanent disabilities. You’re automatically enrolled in Part A, that fundamentally covers sanatorium quadriplegic care. But we have to pointer adult for Part B, that covers outpatient and alloy services. That requires a reward of about $115 per month, pronounced Buddy Robinson, staff executive for Minnesota Citizens Federation Northeast.
Source: 4-liability.com

medicare personal care plus

At first it may seem very confusing to understand the differences between health insurance plans and different companies. There will be variations in what is offered in separate counties in California. To help you make the right decision, then you should see more much information as possible about the Medicare program in California, only then you will be qualified to find the program that best suits your needs. It is not if you must be over sixty-five years to meet the requirements of a health insurance plan, if you are below 65 years and made a permanent disability, are also eligible to enroll in a policy.
Source: personalcareconsultant.com

Five questions about GOP’s plan to privatize Medicare

Posted by:  :  Category: Medicare

CorettaScottKing_WinonaBartonBallentine3 by Mark TribeThe original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

Video: Medicare Supplement | Questions about Medicare Supplement Plans

Baby Boomers U. S. (The Blog)

Do a quick check-up online, or get someone to help you: People tend to want to avoid a review of their Medicare coverage because it’s a hassle. But, there are a number of Internet sites that can reduce the hassle of reviewing your coverage. Sites like PlanPrescriber.com (owned by Plan Prescriber, Inc.), eHealthMedicare.com (owned by eHealthInsurance Services, Inc.) and Medicare.gov (the government website) make it easy for you to review plans and benefits side-by-side, and get a sense of what plan might work best for you. Or, if you don’t want to use the Internet, you can contact Medicare, your state department of insurance, the insurance company, or work with a licensed agent who represents several insurance companies, like eHealthInsurance.
Source: babyboomersus.net

5 questions about the GOP's plan to privatize Medicare

(Reuters) – The Congressional Super Committee negotiations are coming down to the wire, and Republicans are demanding that Medicare privatization be included in any final budget deal. Read More… [Source: Reuters: 2012 Election News - Posted by FreeAutoBlogger]
Source: blogspot.com

The Medicare Rights Center is now interactive | Autism Service, Education, Research & Training

You may know that November is National Family Caregivers Month. The Medicare Rights Center has important guidance for anyone caring for a loved one with Medicare.  Visit their free, comprehensive online resource, Medicare Interactive, for answers about some of the most common concerns they hear from family members.
Source: asertinfo.com

5 questions about GOP's plan to privatize Medicare

Private Medicare Advantage plans have been gaining marketshare, but they don’t reduce federal health spending. In fact, Advantage plans currently are reimbursed by the federal government at 114 percent of traditional Medicare rates — a payment scheme that was put in place to encourage private insurers to participate in the market and to help them compete with traditional Medicare. (The Obama Administration’s health reform law freezes those payments Advantage calls for gradually reducing those payments over a period of years, ultimately equalizing reimbursements with traditional Medicare.) Medicare Advantage plans also have benefited by marketing to healthier seniors who are less costly to serve.
Source: empowher.com

Common Medicare Questions and Answers

3. Can Medicare program consider a service to be unnecessary? Yes. If a doctor or physicians find it necessary to perform a certain medical operation or service which is not covered by the patient’s current Plan Policy benefits, they are supposed to notify or advice the patient in writing about the process and that Medicare will not cover the expenses. And if the service charges are estimated to exceed a level at which Medicare can cover, they are also supposed to notify the patient with them in writing. It is done in writing and the customer approves of the service by signing against the given notice.
Source: frontagecode.com

Choosing a Medicare Plan in the Face of Potential Changes to the Program

Do a discerning check-up online, or get someone to assistance you: People tend to wish to equivocate a examination of their Medicare coverage since it’s a hassle. But, there are a series of Internet sites that can revoke a con of reviewing your coverage. Sites like PlanPrescriber.com (owned by Plan Prescriber, Inc.), eHealthMedicare.com (owned by eHealthInsurance Services, Inc.) and Medicare.gov (the supervision website) make it easy for we to examination skeleton and advantages side-by-side, and get a clarity of what devise competence work best for you. Or, if we don’t wish to use a Internet, we can hit Medicare, your state dialect of insurance, a word company, or work with a protected representative who represents several word companies, like eHealthInsurance.
Source: insuranceforphysician.com

Choosing Which Medicare Part Works for You

They are improved medical services since it covers benefits which parts A and B cannot cover and this is through HMOs or private health insurance. These HMOs and private insurance providers are accredited by Medicare and they cost extra if you are going to get it as part of your medical and health plan. However, they are still subject for approval by certain hospitals and doctors. It is better to know beforehand which doctors and hospitals accredit them so you will not be surprised. Medicare parts A and B are overseen by the government. They offer basic medical services such as hospitalization expenses and medical care. Part A also covers inpatient hospital care and meals. While part B includes doctor and nurse care as well as outpatient cares. People who qualify for this program must have worked for not less than ten years and have made contribution to their Social Security. Part B also covers for physical and occupational therapy, some health care services that part A does not cover and some preventive services such as regular check-ups. Laboratory work ups and tests are also covered but only for a certain percentage of the amount. Blood tests and urinalysis are only covered when they are deemed necessary for the diagnosis of the patient’s illness. Immunizations such as flu shots are also covered but only during flu season. Other services that are covered by part B are Dialysis, Mammograms, Pap Smears and Pelvic exams. Knowing your options and educating yourself with Medicare programs will help you get your money’s worth should you decide to upgrade from basic to a wider coverage plan. If you are getting any Medicare part of their program, it is best to get a certified or licensed agent who knows what coverage each one has. The agent must also be able to explain to you in detail the coverage and its limitations. The agent must also provide you with a list of doctors and hospitals that accepts them and which ones do not accredits your Medicare plan.
Source: ezinemark.com

Diagnostic Testing Center Fined Millions Under False Claims Act For Physician Supervision Failure In Whistleblower Case Brought By Former Employee : Healthcare Integration Advisors : New York Attorneys & Lawyers for Health Care Providers, Hospitals, Insurers : Iseman, Cunningham, Riester & Hyde LLP

Posted by:  :  Category: Medicare

TWO YEARS OF RUIN by SS&SSOn October 21, 2011, the federal district court in Nashville, Tennessee denied an Eighth Amendment “excessive fine” challenge to the judgment entered on August 23, 2011 for $11.1 Million against Medquest Associates Inc. and certain affiliates  (Medquest) in a False Claims Act (FCA) (31 U.S.C. §§ 3729 through 3733) whistleblower case.  The U.S. Attorney’s Office in Nashville filed the FCA case after it received information from a former Medquest employee who complained to her employer that diagnostic testing was being done either without any physicians at all, or  by physicians who lacked the required certification or specialized training. United States ex. Re. Hobbs v. MedQuest Associates, Inc. et al., No. 3:06-01169 (M.D. Tennesee) 2011 U.S. Dist. LEXIS 126539. 
Source: healthcareintegrationadvisors.com

Video: Canvas-CMS1500-HEALTH-INSURANCE-CLAIM-FORM Black Berry.mp4 – Mobile App – GoCanvas.com

Understanding Medicare Claims Data Through Visual Storytelling

Visualization techniques help to tell the story about your data and increases data comprehension by looking at the trends and patterns in the data. It is using cognitive maps. In our Medicare claims data example, an interactive, color-toned map of the United States makes for easy recognition and recall of states with the highest claims. You may want to also consider animating your data with a bubble chart. The size of bubble in Figure 2 made it obvious which states had the highest average number of claims. Creativity using shapes and color in graphs as well as scatterplots captures the reader’s attention. It can make comprehension a lot easier and feel more real. Encourage the viewer to take a closer look at the information and to think about the causal dynamic responsible for the representation. The dispersion of points in Figure 3 for example promotes questioning and possibly some additional research to explain the apparent changes in appealed claims levels for individual states.
Source: hitechanswers.net

On Filing and Filling out a Medicare Claim Form

There are terms and conditions you need to follow upon qualifying for Medicare’s insurance policy claims. Otherwise, you won’t be able to claim any Medicare coverage that is debarred from a particular policy you chose – This is where the filling out process comes in. Here are few steps: 1. Make sure that you already claimed your coverage before obtaining a Medicare claim form. Why is this very important? Simply because your coverage will serve as your basis during contact with Medicare or any health insurance company. 2. Since specific health insurance claim forms varies from one company to the other, you’re usually required to fill out the following information: * Your personal details – It’s the most important part of every claim form. You need to write down the personal details provided including your name, address and contact number. * Your policy number – Don’t forget to write your policy number since this will be used by the company to identify your insurance policy claim. * Reasons for filing – Another important information you need to fill out in your claim form. 3. Attached any documents that will serve as your proof for eligibility for Medicare’s benefits. Note: You can attach the itemized bills provided.  
Source: ezinemark.com

The Handiest Girlie Of All

Medicaid does not provide medical assistance for all poor persons. Even under the broadest provisions of the Federal statute (except for emergency services for certain persons), the Medicaid program does not provide health care services, even for very poor persons, unless they are in one of the designated eligibility groups. Low income is only one test for Medicaid eligibility; assets and resources are also tested against established thresholds. As noted earlier, categorically needy persons who are eligible for Medicaid may or may not also receive cash assistance from the TANF program or from the SSI program. Medically needy persons who would be categorically eligible except for income or assets may become eligible for Medicaid solely because of excessive medical expenses.
Source: typepad.com

Jurisdiction C Final Q&A

All orders must clearly specify the start date of the order . . .The written order must be sufficiently detailed, including all options or additional features that will be separately billed or that will require an upgraded code. The description can be either a narrative description (e.g., lightweight wheelchair base) or a brand name/model number… Someone other than the physician may complete the detailed description of the item. However, the treating physician must review the detailed description and personally sign and date the order to indicate agreement. The supplier must have a detailed written order prior to submitting a claim. For items listed in chapter 5 section 5.2.3.1 (this includes PMDs), the detailed written order must be obtained prior to delivery. If a supplier does not have a faxed, photocopied, electronic or pen and ink signed detailed written order in their records before they submit a claim to Medicare (i.e., if there is no order or only a verbal order), the claim will be denied… Medical necessity information (e.g., an ICD-9-CM diagnosis code, narrative description of the patient’s condition, abilities, limitations) is NOT in itself considered to be part of the order although it may be put on the same document as the order. Based on this information would the DPD require a start date? Or since the Face-to-Face date is required on the 7-element order, will that fulfill the requirement?
Source: vgmaudithelp.com

Open Data in the Age of Visualization: Exploring What’s Out There

I decided to explore the publically available Medicare Claims data. A downloadable Excel file of Total Counts of Claims Received by Region, State and Fiscal Year seemed like a good start to look at the distribution of data via maps and diagrams. The Office of Medicare Hearing and Appeals supplies this data file which I will use for demonstration purposes. These claims have actually been appealed through two levels after the initial determination before they reach OMHA. The process requires the claim to have been appealed to Level 1 and found to be unfavorable (wholly or in part), appealed to Level 2 and found unfavorable (wholly or in part). OMHA adjudicates at the third level of Medicare appeals. Of note, an appeal may be made up of multiple claims. In an attempt to contain healthcare costs, there is debate as to whether claims are denied on procedures that are deemed not medically necessary. Based on claims data published in the 2008 National Health Insurance Report Card, Medicare had the highest denial rates compared to other health insurance companies (www.ama-assn.org/ama1/pub/upload/mm/368/reportcard.pdf). Other sources for Medicare datasets are: www.medicare.gov , www.cms.gov and www.resdac.org.
Source: directeffects.net

HCPCS code J3490 and NDC number

HCPCS code J3490 is a non-specific code that should be used only when another ‘J’ code does not describe the drug being administered (i.e., CMS has not assigned a specific ‘J’ code to the drug used). The appropriate ‘J’ code should be used if one has been assigned to the drug. For the drug with no assigned ‘J’ code, the name, strength of the drug (if applicable) and the actual dosage administered must be indicated on the CMS-1500 form in Block 19 or Block 24 (listed with the procedure code). If the drug is compounded, the invoice/acquisition cost must be included with the description. This would ensure proper adjudication of your claim for J3490. If the name, strength and dosage administered of the drug are not all listed, the claim will be denied for lack of information necessary to process the claim. At present, Railroad Medicare cannot identify a drug by only the NDC number.
Source: whatismedicalinsurancebilling.org

Medicaid along with Medicare Health Help PENNSYLVANIA

Posted by:  :  Category: Medicare

HERES YOUR TOP TEN by SS&SSSome individual who has Medicare supplement coverage may perhaps think they are covered. You potentially could look at that in relation to yourself. Regardless that there are a great many hospital will cost you that Medicare will in fact cover, there happen to be nevertheless a number of them which can be left right behind. To acquire where Medicare insurance has placed off, you will want to purchase on Medicare insurance plans TX is offer . These happen to be straightforward additions with your Medicare product medicare supplement intention of you possibly can put for and modify a solution to fit your needs. Regardless of what your overall health needs could possibly be, there has to be a product to choose from for one. Browse dur these selections so will also be possible to still visit Edwards plateau as well TX attractions.
Source: alacritude.com

Video: State Takeover of Harrisburg, Medicare/Medicaid Funding [Pennsylvania Newsmakers]

Health Leaders Prepare For Round Two Of Cuts

The impact of a 2010 health law is partial of this debate. Administration officials and other proponents of a law contend it will assistance expostulate down costs by a accumulation of initiatives designed to rest some-more heavily on primary care, boost a importance on surety medicine, investigate treatments to weigh their effectiveness, and rate hospitals and other providers on quality. But health caring experts opposite a domestic spectrum disagree that a law will not have a clever impact on costs since a reforms it sets in suit are still tiny and will take years to mature.
Source: pamalpractice.com

Medicaid and additionally Medicare Health Help PENNSYLVANIA

Some one has Medicare supplement coverage may perhaps think they’re covered. You really well could look into that around yourself. Though there are quite a number of hospital rates that Medicare will in fact finance, there tend to be nevertheless several them which have been left in back of. To discover where Treatment has placed off, you should purchase within Medicare insurance plans TX presents. These tend to be straightforward additions to all your Medicare product medicare supplement intention of you may put about and modify a program to fit your needs. Whichever your health and wellbe needs may just be, there really should be a product these days for people. Browse of these selections so it will be possible to always visit Edwards plateau and various other TX attractions.
Source: glutenfreedietideas.com

How to Select and Buy Medicare Supplement Insurance

In states where Excess Charges are illegal (like in Pennsylvania), there is no reason to buy the more expensive Plan F – Plan C will suffice.  There is also no need to use Plan G – Plan D will suffice.  Since 99% of doctors accept Medicare assignments, the need to cover Excess Charges is very small even in states where Excess Charges are allowed.  Therefore, there is no reason to buy the more expensive Plan G  if Plan D  is available.  The same is true is true for plans F and C:   there is no reason to buy the more expensive Plan F if Plan C is available.
Source: medicare-pa-nj-de.com

Disabilities: Saving Medicare billions: Trying too hard can get in the way

The Obama administration’s penny-wise-and-pound-foolish cutbacks on availability to durable medical equipment, rehabilitation services, and home health care are forcing residents of independent living facilities into the Centre Crests of this country. For example, the narrow focus is apparent in Medicare’s frequent citations of the Congressional Budget Office’s competitive bidding estimates of relatively insignificant savings for Medicare Part B ignoring the astronomical costs that will result to Part A when disabled individuals like me can no longer pick up the phone and call my local medical equipment provider. Instead, I must wait for a competitive bidding winner (several have unsavory reputations and some are based out of state) to provide a battery. Delays could easily force me into Centre Crest as a result of falls, problems getting to the bathroom, etc. Delays would rob me of the ability to work as an adviser on virtual reality models for construction of future aging in place housing–construction which will result in significant Medicare savings.
Source: blogspot.com

How to fight against Medicare fraud?

CONTACT US If you have a Medicare question, please submit it in the comments section below. For help finding a Medicare Supplement ( Medigap ), Medicare Advantage, and a Medicare Prescription Drug Plan contact Medicare-PA-NJ-DE at 877-657-7477.
Source: medicare-pa-nj-de.com

Schwartz Presses Super Committee To Advance Her ‘Doc Fix’ Proposal

The Hill: Rep. Schwartz Urges Super Committee To Adopt Her Medicare ‘Doc Fix’ The proposal would prevent a scheduled 27.4 percent cut to doctor payments on Jan. 1 and put in place a six-year transition period with fixed payment updates. After that, the Department of Health and Human Services would be tasked with coming up with at least four payment systems physicians could choose from, based on their location, patient mix and other factors. A flat-out repeal of the SGR is estimated to cost about $300 billion over 10 years. [Rep. Allyson] Schwartz (D-Pa.) said she anticipates that her bill would save money compared to the temporary patches that lawmakers have regularly been adopting for years to prevent the scheduled cuts from going into effect (Pecquet, 11/16).
Source: kaiserhealthnews.org

Medicare Made Clear: Changing Insurance Coverage

Posted by:  :  Category: Medicare

"Citizenship is a tough occupation which obliges the citizen to make his own informed opinion and stand by it." ~ Martha Gellhorn  by eyewashhttp://www.medicaremadeclear.com – Our panelists lead a direct discussion about the pre-determined time periods when Medicare beneficiaries can change their coverage. Watch this video to make sure you avoid costly penalties that come with missing …
Source: howcast.com

Video: How to Understand Medicare Plans

Medicare Advantage Part C Plans

All Medicare Advantage plans have “service areas.” These are areas, typically a county, state or region, where they offer coverage. Generally, you must live in a plan’s service area in order to join it. However, all Medicare Advantage plans must offer nationwide coverage for emergency care, urgent care (care provided outside a doctor’s office or emergency room for conditions that require immediate attention) and renal dialysis.
Source: midwestmedicarecenter.com

401 Authorization Required

This server could not verify that you are authorized to access the document requested. Either you supplied the wrong credentials (e.g., bad password), or your browser doesn’t understand how to supply the credentials required.
Source: earthnews.us

Roundup: Fla. Medicare HMO Closed; Tufts And BCBS Resume Talks

Posted by:  :  Category: Medicare

NewsHour: Kids With Toothaches: Lost In The Health Care Debate Teeth are crucial. When free health care clinics for poor people are held in California, the number one activity is extractions. The California Dental Association says the top chronic childhood disease is tooth decay. But a third of Americans say they skip dental checkups because of the cost. Until 2009, in California, dental care was part of Medicaid, or Medi-Cal as it’s called in California. More than three million poor, disabled and elderly adults had been eligible for subsidized care of their teeth. But cash-strapped California, looking for ways to save money, eliminated dental care for adults under Medi-Cal two years ago, and pocketed $109 million. At the same time the state gave up $134 million in federal matching funds (Michels, 11/17).
Source: kaiserhealthnews.org

Video: Differences between Medicare PPO & HMO Plans

Florida medicare hmo plans

 But the thought of Oahu haunted him; its praise was for ever on his lips; he beheld it, looking back, as a place of ceaseless feasting, song, and dance; and in his dreams I daresay he revisits it with joy. 7:52 Which of the prophets have not your fathers persecuted? It was nearly ninetysix in the shade. ” I suppose one may take it for granted that the greater the writer the worse the grammar. 31, and the average number of weeks employed in the year is 27. I thought I’d like to tell you. Her heart thudded and florida medicare hmo plans They seemed real florida medicare hmo plans with their pictures, actually. The snow was beaten down, and from the spot his retreating footsteps led toward the forest. “The thing would beridiculous,” said Gertrude Oliverand then she laughed horribly. The surf was roaring for it on the sands of Havre. It was not Jessie McRae, but a man, an Indian, the Blackfoot who had ridden out with the girl once to florida medicare hmo plans his triumph over the redcoat Beresford. Vincent rolled, a shaky cigarette and wondered if it had been a dream. He said that Freemasonry is the teaching of Christianity freed from the bonds of State and Church, a teaching of equality, brotherhood, and love. It’s so simple after all, they all are full of drawbacks. We can’t surrender and we can’t fight. ” Floyd asked, fingers arced, pointing to the soldier who had called to me. The mark is cleancut, proving that there is no fringe on the shawl. Cowperwood in his perambulations, seeing what he could see and hearing what he could hear, reaching understandings which were against the rules of the exchange, but which were nevertheless in accord with what every other person was doing, saw about him men known to him as agents of Mollenhauer and Simpson, and congratulated himself that he would have something florida medicare hmo plans collect from them before the week was over. and in that moment, Ace felt like a mouse. Lila wiped up the mess florida medicare hmo plans a Kleenex. You will find clubs and a class florida medicare hmo plans men to play all these things in Utopia, but not the samurai. But, in a measure, I feel impelled to conform, in certain matters, to the wishes of the gentlemen who are interested in the financial side of _The Rose_. Sometimes the time was passed in a way much less agreeable to Margaret, by her receiving lessons from Pauline in the use of the needle. florida medicare hmo plans man,’ he said, ‘wherefore so slow on a journey of such importance?
Source: blog.cz

Your Difference Involving Medicare Health supplement and Treatment Advantage

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Source: com.pl

Top Stories in Literacy Nov 20

Nationwide Financial Literacy Campaign Empowers Citizens to Share Personal Financial Lessons The National Financial Educators Council is starting a campaign called Financial EduNation that will provide organizations and communities with solid resources for combating financial illiteracy at the local level. This program will start at the New Year and provide resources for students, parents and the rest of the community.
Source: wordpress.com

LewisGale strikes deal with Carilion in Medicare Advantage Plans

About Carilion Clinic Carilion Clinic is a not-for-profit health caring classification portion scarcely one million people in Virginia by hospitals, outpatient specialty centers and allege primary caring practices. Led by multi-specialty medicine teams with a common truth that puts a studious first, Carilion is committed to improving outcomes for each studious while advancing a peculiarity of caring by medical preparation and research. For some-more information, visitwww.carilionclinic.org/about.
Source: insuranceforphysician.com

Medicare Advantage Plans Have Open Enrollment Until December 7

You only have until December 7 to decide whether you want one of the Medicare Advantage Plans to provide your Medicare benefits. This year the open enrollment period is earlier than last year. This way, they can make certain that those who sign up will have benefits in place by January 1. If you find that your new plan doesn’t work as well as the Medicare coverage you left, you can switch back to traditional Medicare between January 1 and February 14 next year. You can add a stand-alone prescription drug plan at the same time to get your prescriptions covered.
Source: articleforbacklinks.com

Medicare Supplement Insurance for 2012

Posted by:  :  Category: Medicare

MORE DIRTY TRICKS FROM YOUR SOCIALIST/MARXIST   PRESIDENT AND HIS NASTY LITTLE ADMINISTRATION HACKS by SS&SSTurning to Medicare supplemental plans, it is divided into 4 parts. Part A: This deals with your hospitalisation costs. You can also use this for home nursing or hospice, in the event that directly related for your condition. Component B: This particular relates to the Outpatient costs. You are to pay premiums here. Part C: Deals with health insurance programs. They are being offered by private insurance firms, as approved by the Government to provide such providers. Part Deb: Covers prescription medications. If the medications are protected here, this can be used program to fix it.
Source: carinsurance-ohio.com

Video: Understanding Medicare Supplements, Medicare Supplement Insurance

A Secret to Get a Medical Scooter For Free! Medicare Supplemental Insurance For Medical Scooter

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Source: e-motorbikeinsurance.com

Medicare discontinuation sends seniors scrambling

Wellmark will provide guaranteed acceptance into any Medicare supplement plan for affected members. That means companies cannot turn down an applicant; cannot charge higher premiums and cannot enforce a waiting period.
Source: thegazette.com

Overview Of Medicare Supplemental Insurance

The health of an individual is almost like the primary source of everything that he or she has. When your body is not functioning properly and you are suffering from various debilitating conditions, chances are you will not be able to carry out your work properly which will greatly affect your daily living. Because of this, it is a big must for you to get a partner which will be able to help you secure your health conditions. And one of these is the Medicare supplemental insurance (aka Medigap insurance). A Quick Glimpse Medicare supplemental insurance (aka Medigap insurance) is a kind of private insurance for health which is designed as a supplement for Original Medicare. It is the one which is responsible for the payment of the costs of healthcare which is not being covered by Medicare such as the deductibles and copayments. Medigap plans are also going to cover some of the services which are not being covered by the Original Medicare insurance. In case that you have decided to enroll in Medicare while having the Medigap policy, Medicare will still be paying its share of the amount that they have approved for the costs of the healthcare that they cover. For the meantime, your policy is in Medigap will also be paying its share. Every Medicare supplement insurance plan (aka Medigap insurance) is also expected to adhere to both Federal and State laws that are designed to protect the holders like you and it should be evidently identified as the “Medicare Supplement Insurance.” Insurance companies are only allowed to sell a plan that is standardized and identified with letters A to N. Every standardized and regulated policy must offer similar basic benefits, regardless of the insurance company selling it. Service and cost is the sole difference between the policies being sold by various insurance companies. Buying Medicare Supplemental Insurance (aka Medigap Insurance) As a whole, whenever you buy your Medigap policy, there is a minimum of two components in the policy, Medicare Part A, which is Hospital Insurance and the Medicare Part B, which is the Medical Insurance. If you decide to buy a medigap plan, you have to directly pay Medicare Part B’s monthly premium to Medicare. Also, you have to pay another insurance premium to the corresponding company of private insurance which provides the Medicare supplemental insurance (aka Medigap insurance). To clear some issues, Medigap policy does not have anything to do with the coverage that you can claim from your employer for this is not Medicare Part B, Medicare Advantage Plan and is not way connected to Medicaid. What is primarily does is to help you in closing the gaps with your deductibles in Medicare. There are also policies that are providing extra benefits not being within the bounds of Medicare like at home recovery, prescription drugs and routine checkups. Getting your own Medicare supplemental insurance (aka Medigap insurance) is a good way of assuring that you will be able to properly look into your health for you to be assured that you will have no difficulties in the near future. Learn more about medigap insurance and to find out how to get the lowest rates for the plan best suited for you take a look at http://www.mostmedicare.com/ and know your options. Check out mostmedicare’s extended guide and obtain the plan befitting to your needs. http://EzineArticles.com/6474177
Source: blogspot.com

American Retirement Health Insurance Review

American Retirement Insurance Policies provide supplemental insurance for Medicare. The policies depend on the Medicare plans. The plans range from A to N. Plan F has a high deductible whereas plans K, L, M, and N have different cost sharing and the premiums may be lower. Plans D and G have been revamped since June 1, 2010, and have varying coverage from before. Plans E, H, I, and J were discontinued after May 1, 2010. However, if you bought plans E, H, I, and J prior to May 1, 2010, your plan is still in effect.
Source: healthinsuranceproviders.com

InsureBlog: Frustrating Carrier Tricks: Medicare vs Group

I did hear back from customer service who confirmed we do not have something like this. You are correct that there would be too many variances with how the claims will process. We will need to see the Medicare EOB & then determine which policy is the primary. The claims area will then key the claim into the system … they will input the information from Medicare. All of this information is taken into account, while viewing the members benefits. I hope this helps
Source: blogspot.com

Texas Medicare Part D Drug Plans

In Texas, there are only two ways to get Medicare drug coverage- through a Medicare Prescription Drug Plan (PDP) or through a Texas Medicare Advantage Plan. Medicare Prescription Drug Plans, or Part D, are offered to everyone with Medicare and sold through private insurance companies. Basically, Part D is prescription drug coverage that is added to your Original Medicare. Understanding these plans can be a bit tricky and many Texans just like you are confused as to eligibility, enrollment, costs and coverage. Take the time to learn a few in’s and out’s of Texas Medicare Part D and make the right decisions concerning your health care coverage.
Source: medicareinsurancetexas.com

What You Ought To Be Aware Of Health Coverage

Utah accident lawyer Kenneth Christensen has authored the Utah Accident Ebook. The KSL early morning information exhibit interviewed Mr. Christensen about his ebook and he explained the advantages the ebook provides Utah accident victims. Our NY accident regulation company answers client cellphone calls and email messages promptly. You generally have comfort being aware of your scenario is finding the interest it deserves. Our Particular Injuries legislation company has 3 handy The big apple (NYC) areas; in Brooklyn, Manhattan , and also the Bronx . When you are unable to come back to us, we can arrive to you personally: Residence and Hospital visits. The car accident law firm of David I. Fuchs is focused on guarding the legal rights and demands of vehicle accident victims in South Florida. For through 20 ages now we have been one of many important forces inside the South Florida auto accident legal community.
Source: articlescast.com

Medicare Supplement Insurance

By finding a broker, who deals in health insurance and specifically one who specializes in Texas Medicare supplemental insurance you will have someone who can encourage you accumulate sense of all the options and changes that have been made. In addition, they can wait on you in deciding what you really need and then helping you to reach by it at the best possible effect. carry out ranges vary to such a degree that you need someone who will review options for all the major companies like Blue inappropriate Blue Shield of Texas, United of Omaha or even Gerber Life and so many more. This can be a grand relief to someone who is already in a stressful plot due to health issues. It can also be expedient to those who do not have the time or inclination to exercise the time learning all the ins and outs of this type of insurance.
Source: medicaresupplementalinsurances.org

Tricare Help – Getting Tricare to reimburse you for Medicare Advantage costs

Posted by:  :  Category: Medicare

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Source: militarytimes.com

Video: Fix Medicare Now and Forever – A message from the American Medical Association (AMA)

Tricare Help: Without Medicare Part B, you lose Tricare

Q. I am a retired Marine and have been enrolled in Tricare Prime for a number of years. Over the past few years I was treated for cancer and was awarded Social Security disability benefits backdated almost a year. I understand that once you are on SSD for two years, you have to enroll in Medicare. I have received my Medicare card for Parts A and B that will be effective Jan. 1. Will I need to contact Tricare to discontinue my allotment for Prime, or will Tricare receive notification from Social Security? Also, will I fall under regular Tricare, or will I convert to Tricare for Life?
Source: youarestrong.org

TRICARE Moving to Medicare Type Methodology for SCHs

Medicare reimburses SCHs for inpatient care at the greater of the Medicare DRG for all Medicare discharges, or the amount the SCH would have been paid if it were paid the average cost per discharge at that SCH in fiscal years 1982, 1987, 1992, 1996 or 2006, updated to the current year, for all Medicare discharges. DOD noted, however, that establishing a methodology exactly like Medicare is not practical. While the aggregate DRG reimbursement for all TRICARE discharges can be calculated, using the Medicare cost per discharge would not be appropriate for TRICARE because of differences in the TRICARE and Medicare beneficiary case mix. Also, applying an annual update to a TRICARE base-year average doesn’t make sense because of the relatively low number of TRICARE discharges in any given year—fewer than 20 at nearly half of SCHs. The average cost per discharge in any one year may not be a good measure of the average cost in future years.
Source: healthcarereforminsights.com

Tricare For Life And Medicare?

does anyone have any information on tricare for life and medicare? do you have to have medicare in order to keep tricare for life when you reach 65 years of age? it is a few years before i have to deal with this, but i would appreciate your input. thank you tj :mellow:
Source: hadit.com

Apply Job as Manager of Government Reporting

In 2011 Hospira is reporting 950 products and paying claims for 127 different Medicaid programs.    In addition, this role is responsible for ensuring that Hospira domestic US customers are assigned accurate classes of trade. The federally mandated price factor calculations are all based on utilizing sales for customers based on class of trade. Incorrect classes of trade results in inclusion and/or exclusion of Hospira sales transactions which can significantly impact the final price factor calculations.
Source: applyjobs.org

Manager of Government Reporting

In 2011 Hospira is reporting 950 products and paying claims for 127 different Medicaid programs.    In addition, this role is responsible for ensuring that Hospira domestic US customers are assigned accurate classes of trade. The federally mandated price factor calculations are all based on utilizing sales for customers based on class of trade. Incorrect classes of trade results in inclusion and/or exclusion of Hospira sales transactions which can significantly impact the final price factor calculations.
Source: webdesign-jobs.com

Will Congress Deny Health Care to Military Families?

law adjusts Medicare payments to physicians annually using the Sustainable Growth Rate (SGR) formula. Because of flaws in how it was designed, the SGR formula has mandated 11 physician payment cuts – every year for the past decade. Only short-term congressional fixes have stopped most of the cuts. In 2010 alone, Congress had to intervene five times to stop a 25-percent cut. Yet during this same 10-year period, hospitals, skilled nursing homes, home health agencies, and inpatient rehabilitation facilities all received annual Medicare pay increases, because they are paid by a different formula. TMA believes, at a minimum, Washington needs to fix the broken physician payment system before giving more payment updates to other Medicare providers.
Source: texmed.org

Understanding TRICARE, Medicare

Medicare does not provide coverage outside of the United States and U.S. territories (American Samoa, Guam, the Northern Mariana Islands, Puerto Rico and the U.S. Virgin Islands). TRICARE is the primary payer for health care received overseas (except U.S. territories), unless the beneficiary has other health insurance. Overseas, TFL provides the same coverage as TRICARE Standard and has the same cost-shares and deductibles. When seeking care from a host-nation provider, beneficiaries should be prepared to pay up front for services and submit a claim to the overseas claims processor.
Source: posterous.com

Tricare—Acceptable For Some, A Bitter Pill For Others

Patricia A. Fitzgerald is a retired Marine Gunnery Sergeant living in Quantico, Virginia.  She has had so many problems with Tricare that she has signed up for Blue Cross/Blue Shield with her employer. She has serious medical conditions that require visiting specialists. To see a specialist, she must first go to her primary doctor, provide him with a co-pay, have him write a letter to Tricare requesting a specialist, wait for the answer, then see the specialist and be charged a second co-pay. They send her miles away to Alexandria, Virginia for an MRI, when there is another facility that is Tricare approved just blocks from her home. Fitzgerald says the Tricare communications system is so antiquated that it is almost impossible to reach them.  Their website is too complicated to navigate and too many elderly retirees are not computer savvy.  She says her assumption is that Tricare really does not want to communicate with its beneficiaries. 
Source: myharlingennews.com

Veterans Question If Government Will Keep Health Care Promises To GIs

Colter and Miller are among the 50,992 Connecticut members of the armed forces, active National Guard and Reserve, retired military and their families who use Tricare – the military’s main healthcare program. The program now faces a number of challenges, including: possible higher annual premiums in 2012 and a growing list of physicians reluctant to accept Tricare because of inadequate reimbursement rates. In addition, a critical shortage of physicians in Connecticut makes it difficult for Tricare beneficiaries to access medical care, especially in rural areas. Among the toughest specialists to find in the state are those with expertise in traumatic brain injury and post-traumatic stress—two of the signature injuries of the current wars.
Source: ctwatchdog.com

medicare private health plan

Posted by:  :  Category: Medicare

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

Video: Dental Insurance Commercial for Folks on Medicare

Medicare Open Enrollment: Extra Benefits & Preventive Services

A full 99% of people with Medicare have access to Medicare Advantage Plans in 2012, and these plans often offer extra benefits that Original Medicare doesn’t cover. Medicare Advantage Plans may offer vision, hearing, or dental coverage, or extend coverage while you travel. Most Medicare Advantage Plans also include prescription drug coverage.
Source: medicare.gov

Medicare: What It Is, How It Works, And Why It Is A Target For Fraudulent Behavior

In the United States, people over 65 years old; those who are under 65 but have permanent physical disabilities; and those with end stage renal disease are covered by Medicare which is a social insurance program. It pays healthcare providers for the services they rendered to beneficiaries. Medicare came into existence when the Social Security Law was enacted in the mid-60s. It is managed by the Centers for Medicare and Medicaid Services which is part of the Department of Health and Human Services of the United States. The Social Security Administration is given the job of ascertaining whether an individual is qualified to receive Medicare benefits as well as facilitating premium payments.
Source: carsandinsurance.info

Medicare Advantage Plans Have Open Enrollment Until December 7

You only have until December 7 to decide whether you want one of the Medicare Advantage Plans to provide your Medicare benefits. This year the open enrollment period is earlier than last year. This way, they can make certain that those who sign up will have benefits in place by January 1. If you find that your new plan doesn’t work as well as the Medicare coverage you left, you can switch back to traditional Medicare between January 1 and February 14 next year. You can add a stand-alone prescription drug plan at the same time to get your prescriptions covered.
Source: articleforbacklinks.com

TT&TOT: Health insurance disappointment

I was so excited to find out that there are Medicare plans offering dental and vision coverage. I called for more information and after talking with the Medicare representative almost an hour about our needs, we settled on two companies to compare, Horizon and Bravo. Medicare sent a more detailed report about the two companies. Meanwhile, I contacted our doctors and found out that all of them take Horizon. Not all of them took Bravo, though, nor did a hospital we use and so that was a deal breaker. When the reports came, we focused on Horizon and read through it carefully. It sounded good. Right now, TB and I each pay over $200 to our current secondary carrier, $96 to Medicare and $36 to our prescription plans. With Horizon, we’d pay $84 a month and then $96 to Medicare. We’d save quite a bit of money. A drawback was that specialists’ co-pay would be $35 and TB sees a few specialists a month. Okay, so that would eat up our savings but, hey, we’d get vision and dental! I contacted Horizon and asked for their benefits book and some applications. The books arrived yesterday and TB and I were taken aback and confused. The dental and vision plans are very limited. For instance, with vision you pay up to $35 for the exam and then they cover a max of $100 toward glasses every two years. That’s fine for someone who doesn’t have involved prescriptions like TB and I do. Our glasses are, minimum, about $300 each. Still…maybe we could save up. And then we looked at the dental plan. There’s a $35 co-pay and then you pay for each additional service. A filling would be $56. A root canal (which is what TB needs) is $661. Crowns cost $1000 and up. There’s no way we could pay for these things. On top of that, there’s a $150/day for 10 days co-pay on hospitalization. That was the deal breaker for me. With everything we have going on, I couldn’t say we wouldn’t be in the hospital for a surgery or something. There is absolutely no way we’d be able to pay that bill. I am so bummed. TB and I have talked about it and talked about it and it doesn’t really look like it would be in our best interest to switch. We could stick with our company and have no co-pays and full coverage. We would have to save for a year to afford getting glasses or our teeth fixed, though–if then. Other emergencies keep popping up. This is yet another reason I totally support health insurance reform. Too many people either don’t have it or have really limited benefits and then are screwed when something goes wrong. Oh well. Having dental and vision insurance was a nice dream while it lasted. :(
Source: blogspot.com

What Medicare Beneficiaries Need to Know about Medicare Dental Services

Currently, Medicare does not cover routine dental care or most dental procedures such as cleanings, fillings, tooth extractions or dentures. Medicare only pays for dental services that are an integral part either of a covered procedure (e.g., reconstruction of the jaw following accidental injury) or for extractions done in preparation for radiation treatment for neoplastic diseases involving the jaw.
Source: projektgenerika.org

Medicare Advantage: Check your dental coverage

Tags: Advantage, advantage company, arizona, call, check, company, coverage, crowns, demand, dental coverage, dental plan, dental plans, dental specialist, dentist, dentures, emergency, emergency room, end, Entry, everyone, feed, health, hospital, information, information received from, look, material, Medicare, name, name names, nothing, October, Open, package, Pinging, Plan, plan details, Post, premium, purpose, response, room, room co, RSS, seniors, specialist, Tags, tucson, Tuesday, tuesday october, year
Source: dentistreviews.us

Your Guide to Part D Medicare

Posted by:  :  Category: Medicare

Since then, the beneficiaries were automatically enrolled in certain PDP areas that are less-expensive and randomly chosen by Medicare. In some cases of dual-eligible beneficiaries however, they were directly removed from the MA plan after they’ve already enrolled in PDP. From November – December 2010, a number of Medicare beneficiaries have affirmatively enrolled in Part D coverage. The conscription period for 2011 is expected to last from October to December. Beneficiaries who were qualified but failed to enroll during the Part D enrollment period are required to pay their Late-enrollment Penalty (LEP). Otherwise, they won’t be able to obtain some Part D benefits. The LEP is 1% of the average monthly premium paid by either Medicare or its beneficiaries. In April 2010, the number of Part D enrollees increased to $27 million. The increase stemmed from 1,570 separate Part D plans provided in early 2009. The highest number of Part D beneficiaries was estimated in West Virginia and Pennsylvania. Hawaii and Alaska meanwhile garnered the second and by far, the lowest. The average beneficiary premium for PDPs increased from $29.89 to $38.94 in 2010. The monthly premiums are initially projected to increase by 10% after nearly 8% of Medicare beneficiaries enrolled in PDP chose a single coverage. Among MA-PD beneficiaries, the enrollment plans offering separate coverage rise to 33% (from 27% in 2006). The premiums are said to be more significantly higher than the ones sponsored by PDP providers. Part D was not spared from controversies. After the federal government approved the program, public offices were not permitted to negotiate the prices of prescription drugs. It was only the Department of Veteran Affairs who were given permission to negotiate and pay 59% of the prescription drugs covered by Medicare. Former US Congressman Billy “R-La” Tuazin, who authored the Medicare Drug Treatment Modernization Act, retired after receiving $2 million every year from the American Pharmaceutical Research and Manufacturers Group (APRMG). Thomas Scully, Chairman and CEO of Medicare, threatened to fire his colleague Richard Foster after attempts of reporting the Medicare bill’s cost was revealed by Cong. Tuazin.  
Source: ezinemark.com

Video: Medicine Dish: Medicare Part D and Program Updates

medicare private health plan

The original Medicare program has two parts: Part A (Hospital Insurance), and Part B (Medical Insurance). Only a few special cases exist where prescription drugs are covered by original Medicare, but as of January 2006, Medicare Part D provides more comprehensive drug coverage. Medicare Advantage plans, also known as Medicare Part C, are another way for beneficiaries to receive their Part A, B and D benefits. All Medicare benefits are subject to medical necessity. Part A: Hospital Insurance Part A covers inpatient hospital stays (at least overnight), including semiprivate room, food, tests, and doctor’s fees. Part A covers brief stays for convalescence in a skilled nursing facility if certain criteria are met: 1. A preceding hospital stay must be at least three days, three midnights, not counting the discharge date. 2. The nursing home stay must be for something diagnosed during the hospital stay or for the main cause of hospital stay. 3. If the patient is not receiving rehabilitation but has some other ailment that requires skilled nursing supervision then the nursing home stay would be covered. 4. The care being rendered by the nursing home must be skilled. Medicare part A does not pay for custodial, non-skilled, or long-term care activities, including activities of daily living (ADL) such as personal hygiene, cooking, cleaning, etc. The maximum length of stay that Medicare Part A will cover in a skilled nursing facility per ailment is 100 days. The first 20 days would be paid for in full by Medicare with the remaining 80 days requiring a co-payment (as of 2009, $133.50 per day). Many insurance companies have a provision for skilled nursing care in the policies they sell. If a beneficiary uses some portion of their Part A benefit and then goes at least 60 days without receiving facility-based skilled services, the 100-day clock is reset and the person qualifies for a new 100-day benefit period. Part B: Medical Insurance Part B medical insurance helps pay for some services and products not covered by Part A, generally on an outpatient basis. Part B is optional and may be deferred if the beneficiary or their spouse is still actively working. There is a lifetime penalty (10% per year) imposed for not enrolling in Part B unless actively working. Part B coverage includes physician and nursing services, x-rays, laboratory and diagnostic tests, influenza and pneumonia vaccinations, blood transfusions, renal dialysis, outpatient hospital procedures, limited ambulance transportation, immunosuppressive drugs for organ transplant recipients, chemotherapy, hormonal treatments such as Lupron, and other outpatient medical treatments administered in a doctor’s office. Medication administration is covered under Part B only if it is administered by the physician during an office visit. Part B also helps with durable medical equipment (DME), including canes, walkers, wheelchairs, and mobility scooters for those with mobility impairments. Prosthetic devices such as artificial limbs and breast prosthesis following mastectomy, as well as one pair of eyeglasses following cataract surgery, and oxygen for home use is also covered. Complex rules are used to manage the benefit, and advisories are periodically issued which describe coverage criteria. On the national level these advisories are issued by CMS, and are known as National Coverage Determinations (NCD). Local Coverage Determinations (LCD) only apply within the multi-state area managed by a specific regional Medicare Part B contractor, and Local Medical Review Policies (LMRP) were superseded by LCDs in 2003. Coverage information is also located in the CMS Internet-Only Manuals (IOM), the Code of Federal Regulations (CFR), the Social Security Act, and the Federal Register. Part C: Medicare Advantage plans With the passage of the Balanced Budget Act of 1997, Medicare beneficiaries were given the option to receive their Medicare benefits through private health insurance plans, instead of through the original Medicare plan (Parts A and B). These programs were known as “Medicare+Choice” or “Part C” plans. Pursuant to the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, “Medicare+Choice” plans were made more attractive to Medicare beneficiaries by the addition of prescription drug coverage and became known as “Medicare Advantage” (MA) plans. Traditional or “fee-for-service” Medicare has a standard benefit package that covers medically necessary care members can receive from nearly any hospital or doctor in the country. For people who choose to enroll in a Medicare Advantage health plan, Medicare pays the private health plan a capitated rate, or a set amount, every month for each member. Members typically also pay a monthly premium in addition to the Medicare Part B premium to cover items not covered by traditional Medicare (Parts A & B), such as prescription drugs, dental care, vision care and gym or health club memberships. In exchange for these extra benefits, enrollees may be limited in the providers they can receive services from without paying extra. Typically, the plans have a “network” of providers that patients can use. Going outside that network may require permission or extra fees. Medicare Advantage plans are required to offer coverage that meets or exceeds the standards set by the original Medicare program, but they do not have to cover every benefit in the same way. If a plan chooses to pay less than Medicare for some benefits, like skilled nursing facility care, the savings may be passed along to consumers by offering lower copayments for doctor visits. Medicare Advantage plans use a portion of the payments they receive from the government for each enrollee to offer supplemental benefits. Some plans limit their members’ annual out-of-pocket spending on medical care, providing insurance against catastrophic costs over $5,000, for example. Many plans offer dental coverage, vision coverage and other services not covered by Medicare Parts A or B, which makes them a good value for the health care dollar, if you want to use the provider included in the plan’s network or “panel” of providers. Because the 2003 payment formulas overpay plans by 12 percent or more compared to traditional Medicare,[11] in 2006 enrollees in Medicare Advantage Private Fee-for-Service plans were offered a net extra benefit value (the value of the additional benefits minus any additional premium) of $55.92 a month more than the traditional Medicare benefit package; enrollees in other Medicare Advantage plans were offered a net extra benefit value of $71.22 a month more.[12] However, Medicare Advantage members receive additional coverage and medical benefits not enjoyed by traditional Medicare members, and savings generated by Medicare Advantage plans may be passed on to beneficiaries to lower their overall health care costs.[10] Other important distinctions between Medicare Advantage and traditional Medicare are that Medicare Advantage health plans encourage preventive care and wellness and closely coordinate patient care.[13] Medicare Advantage Plans that also include Part D prescription drug benefits are known as a Medicare Advantage Prescription Drug plan or a MA-PD. Enrollment in Medicare Advantage plans grew from 5.4 million in 2005 to 8.2 million in 2007. Enrollment grew by an additional 800,000 during the first four months of 2008. This represents 19% of Medicare beneficiaries. A third of beneficiaries with Part D coverage are enrolled in a Medicare Advantage plan. Medicare Advantage enrollment is higher in urban areas; the enrollment rate in urban counties is twice that in rural counties (22% vs. 10%). Almost all Medicare beneficiaries have access to at least two Medicare Advantage plans; most have access to three or more. Because of the 2003 law’s overpayments, the number of organizations offering Fee-for-Service plans has increased dramatically, from 11 in 2006 to almost 50 in 2008. Eight out of ten beneficiaries (82%) now have access to six or more Private Fee-for-Service plans.[14] Each year many individuals disenroll from MA plans. A recent study noted that about 20 percent of enrollees report that “their most important reason for leaving was due to problems getting care.”[15] There is some evidence that disabled beneficiaries “are more likely to experience multiple problems in managed care.”[16] Some studies have reported that the older, poorer, and sicker persons have been less satisfied with the care they have received in MA plans.[17] On the other hand, an analysis of the Agency for Healthcare Research and Quality data published by America’s Health Insurance Plans found that Medicare Advantage enrollees spent fewer days in the hospital than Fee-for-Service enrollees, were less likely to have “potentially avoidable” admissions, and had fewer re-admissions. These comparisons adjusted for age, sex and health status using the risk score used in the Medicare Advantage risk adjustment mechanism.[18][19] In December 2009 the Kaiser Family Foundation published a report that rated Medicare Advantage organizations on a five star scale. The ratings were based on data from CMS, the Consumer Assessment of Healthcare Providers and Systems (CAHPS), Healthcare Effectiveness Data and Information Set (HEDIS) data, and the Health Outcomes Survey (HOS). New plans did not receive ratings, because data were not available. Almost six out of ten (59%) of MA plans did receive ratings, and these plans represented 85% of the enrollment for 2009. The average rating was 3.29 stars. Twenty-three percent of enrollees were in a plan with four or more stars; 20% were in a plan with fewer than three stars.[20] Twenty percent of African-American and 32 percent of Hispanic Medicare Beneficiaries were enrolled in Medicare Advantage plans in 2006. Almost half (48%) of Medicare Advantage enrollees had incomes below $20,000, including 71% of minority enrollees.[21] Others have reported that minority enrollment is not particularly above average.[22] Another study has raised questions about the quality of care received by minorities in MA plans.[23] The Government Accountability Office reported that in 2006, the plans earned profits of 6.6 percent, had overhead (sales, etc.) of 10.1 percent, and provided 83.3 percent of the revenue dollar in medical benefits. These administrative costs are far higher than traditional fee-for-service Medicare.[24] [edit] Part D: Prescription Drug plans Main articles: Medicare Part D and Medicare Part D coverage gap Medicare Part D went into effect on January 1, 2006. Anyone with Part A or B is eligible for Part D. It was made possible by the passage of the Medicare Prescription Drug, Improvement, and Modernization Act. In order to receive this benefit, a person with Medicare must enroll in a stand-alone Prescription Drug Plan (PDP) or Medicare Advantage plan with prescription drug coverage (MA-PD). These plans are approved and regulated by the Medicare program, but are actually designed and administered by private health insurance companies. Unlike Original Medicare (Part A and B), Part D coverage is not standardized. Plans choose which drugs (or even classes of drugs) they wish to cover, at what level (or tier) they wish to cover it, and are free to choose not to cover some drugs at all. The exception to this is drugs that Medicare specifically excludes from coverage, including but not limited to benzodiazepines, cough suppressant and barbiturates. Plans that cover excluded drugs are not allowed to pass those costs on to Medicare, and plans are required to repay CMS if they are found to have billed Medicare in these cases. It should be noted again for beneficiaries who are dual-eligible (Medicare and Medicaid eligible) Medicaid may pay for drugs not covered by part D of Medicare, such as benzodiazepines, and other restricted controlled substances.
Source: medicare-health.com

Less than seven percent (7%) of customers were in the Medicare prescription drug plan with the lowest total out of pocket costs / eHealth

This analysis was based on over 25,000 user sessions  conducted between November 15 and December 31, 2010 on the PlanPrescriber Medicare insurance plan comparison tool. The analysis examined sessions where the user was currently enrolled in a Medicare prescription drug plan; either a stand-alone Medicare prescription drug plan (PDP) or a Medicare Advantage prescription drug (MAPD) plan. The information users were required to provide in order to be counted as currently enrolled in a PDP or MAPD included their zip code and the name of their existing Medicare prescription drug plan or Medicare Advantage plan. In the majority of user sessions, customers also included the names, dosages and frequency of any prescription drugs they were taking.  Their average savings were calculated by subtracting the customer’s total estimated out-of-pocket spending on their current plan, including monthly premiums, deductibles, coinsurance and co-payments, from the estimated out-of-pocket spending on the plan recommended by PlanPrescriber’s Medicare insurance plan comparison tool. For price comparison, this study assumes no changes in prescription or medical needs, as well as  no changes in rates or drug prices during the applicable time period.
Source: ehealthinsurance.com

Community CCRx Prescription Drug Plans

This entry was posted on Monday, November 21st, 2011 at 8:46 am and is filed under Medicare Part D, prescription drug card, prescription drug coverage, Senior Health Insurance. You can follow any responses to this entry through the RSS 2.0 feed. Responses are currently closed, but you can trackback from your own site.
Source: healthinsurancesort.com

Aetna Medicare Plans Part D Supplement & Advantage

About Aetna Medicare. Aetna Inc of Hartford Ct offers a broad range of traditional and consumer managed health insurance products and related services, including medical, pharmacy, dental, behavioral health, group life and disability plans, and medical management capabilities and health care management services for Medicaid plans. Aetna customers include employer groups, individuals, college students, senior citizens, part-time and hourly workers, health plans, governmental units, government-sponsored plans, labor groups and expatriates.
Source: trinitymedcare.com

New search tool for Medicare Part D for 2012 available through Q1Medicare.com

Tags: 2012 Medicare Part D, cost of medicare, cost of medicare part d, Donut Hole, drug coverage, drug tiers of coverage, is my medication covered, medicare, Medicare Advantage Plans, medicare and part d, medicare cost, medicare d plans, medicare drug part d, medicare drug plans, medicare information, medicare part, medicare part b, medicare part d, medicare part d benefits, medicare part d cost, medicare part d costs, medicare part d coverage, medicare part d drug coverage, medicare part d drug plan, medicare part d drug plans, medicare part d eligibility, medicare part d enrollment, medicare part d gov, medicare part d help, medicare part d info, medicare part d information, medicare part d plan, medicare part d plans, medicare part d prescription drug coverage, medicare part d programs, medicare prescription drug coverage, medicare prescription drug plan, medicare program, part d, part d medicare, part d medicare plans, part d plans, PDP Finder, Q1 Medicare, what is medicare part d, what medications are covered
Source: liveinsurancenews.com

Q1Medicare.com Reminds Seniors that October 15 begins the 2012 Medicare Part D and Medicare Advantage Plan Annual Open Enrollment Period

Medicare Part D prescription drug and Medicare Advantage plans that will not be continued in 2012 must contact their existing plan members by October 2 stating that their plan will no longer be offered next year. If members of a discontinued or non-renewing plan make no 2012 plan choice, they will be disenrolled from their Medicare Part D or Medicare Advantage plan starting December 31, 2011. As a result, these members of a non-renewing stand-alone Medicare Part D plan will not have prescription drug coverage for 2012 and members of Medicare Advantage plans will be returned to Original Medicare Part A and Medicare Part B coverage. However, a Special Enrollment Period will be available to assist Medicare beneficiaries whose plans are discontinued and it will begin December 8 and continue through February 2012.
Source: visitcanarywharf.com

Medicare PDP Premiums Rising, Plan Options Falling

More than 4 in 10 (44 percent) MAPD plan enrollees have at least some gap coverage, a substantial increase since 2006. This is largely because Medicare Advantage plans are able to use payments received from the government for providing benefits covered under Parts A and B to reduce cost sharing and premiums under Part D. Furthermore, because Medicare Advantage plans cover hospital and physician services and other Medicare benefits, they have somewhat stronger incentives than PDPs to offer at least some gap coverage to forestall the negative health and cost consequences that could arise if enrollees do not take their medications when they reach the gap.
Source: lifehealthpro.com