Oregon Chiropractic Association

Posted by:  :  Category: Medicare

Regence is building on our existing utilization management program efforts for our group and Individual products, including Medicare Advantage plans. We have selected an experienced third-party vendor, CareCore National, LLC (CCN), to administer a new physical medicine program component of our overall utilization management program.
Source: oregonchiroassoc.com

Video: Regence Medicare Advantage insurance – Compare to 180+ Comp

Regence BlueCross BlueShield to drop its Portland

The change reflects a growing trend among health insurers to nip and tuck at escalating costs to rein in premium hikes. For Regence, representatives say, the move is necessary to allow it to remain competitive in the Portland area. The change follows years of declining membership and financial losses in Oregon for Regence, Oregon’s largest insurer in the private health insurance market.
Source: oregonlive.com

The Red Electric: Fixing for a MedAdvantage/health care fix

, yeah,” she said wearily. Weep, Lyndon Johnson, who signed Medicare into law in 1965. Clearly the days of free or low-cost medical care for seniors are numbered, at least under the Bush administration and probably under any administration beholden to the insurance industry. And, looking to 2008, which candidate is least likely to be so beholden? Here’s a clue. Watch for others.
Source: blogspot.com

Medicare Open Enrollment Made “Simple”

Parts C or D must be purchased separately. In San Juan County, there are a number of carriers who offer Part D coverage but only Group Health and Regence offer Part C coverage. If you are currently healthy, you may find you have no need to purchase Part C or Part D coverage. There is, however a penalty of 1 percent per month for waiting to purchase Part D coverage until you find you need it. For example, if you wait until you are 68—three years after turning 65—you will pay an additional penalty equal to 36 percent of the premium amount for the rest of your life.
Source: orcasissues.com

Medicare Updates for 2011

What article on Medicare Part D would be complete without mentioning Humana.  There I have just mentioned it. Just kidding, Humana has good news also.   The Humana Value plan which was priced at $18.60 in 2010 has been rebranded and repriced for 2011.  It is now the Humana Walmart Preferred Rx Plan with a reduced price of $14.80. I guess the little yellow price slasher at Walmart has been at work once again. The plan ID numbers are the same, so technically it is the same plan but the benefits are totally different from 2010. For example, it has a $310 deductible for all drug tiers, but then many generics are priced at only $2 for a 30 day supply at Walmart or $10 at any other local pharmacy. When I first saw that I thought “What, that is a huge advantage for Walmart.” Then I read the fine print. The $2 co-pay is only for the generics on the Walmart $4 drug list, and other stores either have their own $4 list like QFC, or will match prices. But I still applaud Humana and Walmart for innovative thinking.
Source: wordpress.com

Kathie Bracy’s Blog: Is the STRS Medicare Advantage program really an ‘Advantage’? Susan doesn’t think so!

A key player in this CORE group, Dr. Dennis Leone, initiated the investigation (2002-2004) against STRS that led to the dismissal of the Executive Director and the conviction of six Board members for ethics violations. Eventually elected to the Board, Dr. Leone was the only member to vote against the forced ‘move’ discussed in my paper. On the CORE website, click on ‘history’ to see the results of this group‟s vigilance and perseverance. To protect your pension and quality health care, follow this group and help them create a direct line to educators.
Source: blogspot.com

Answers to your health care questions

Regence will require providers of physical medicine services (which includes some forms of chiropractic care as well as physical therapy, massage, etc.) to obtain prior authorization. Once authorized, Regence must reimburse the provider for the service. Patients seeking chiropractic services can continue to self-refer to any chiropractor they like in the Regence provider network.
Source: wa.gov

Medigap vs. Medicare Advantage Plan

Medicare Advantage comprises a variety of private health plans — most often HMOs and PPOs — that Medicare offers as a coverage alternative to the traditional program. Every plan must cover all the same benefits that traditional Medicare covers. But the plans can charge different copayments (often lower than the traditional program but not always) and offer extra benefits. Most charge a monthly premium in addition to the Part B premium, but some don’t. Most include prescription drug coverage at no additional cost. Some cover routine hearing and vision services, usually as a separate package for an additional premium. Another difference from the traditional program is that most plans require you to go to doctors and other providers within their service network or pay higher copays for going out of network.
Source: aarp.org

SecureSignup.net Special offer and Discount Coupon

Posted by:  :  Category: Medicare

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all include a free domain name, hosting with site builder. We are confident our powerful servers are the best place to host your website.  Our MySQL hosting and PHP hosting is one of the best web hosting service available.  Choosing our Bluehost Alternative will be best choice to host your website.  Webhost reviews and webhost comparison shows our service rated best webhost or best web hosting serviceNews Archive Your How To.
Source: eb2a.com

Video: Cheryl Bradley lectures on Medicare Billing

Scrutinize Medicare, Medicaid Billing Before Uncle Sam Does

Staying off federal investigators’ radar for Medicare and Medicaid billing is all part of maintaining sound billing practices for any medical office. Keeping accurate and complete medical records for services provided and completed diagnoses already should be part of your day-to-day business. But every insurance claim – for Medicare or any other private-sector provider – should be properly supported by documentation. The federal government may review a patient’s medical records to verify a claim, and will typically take the position, “If you didn’t document it, you didn’t do it.”
Source: dmagazine.com

The Medicare News You Can Use This Week: eRx Exemptions for 2012 and 2013, Billing Education, and eSignatures

Although there is no appeal or review process established for the eRx Incentive Program and payment adjustment, CMS encourages eligible professionals with questions or concerns about the eRx payment adjustment and hardship exemption requests to contact the QualityNet Help Desk.  Through the QualityNet Help Desk, CMS is working with eligible professionals and CMS-selected group practices that have questions about eRx payment adjustments and/or hardship exemption decisions.  CMS is handling all hardship exemption requests and any questions or concerns on a case-by-case basis.   Contact the QualityNet Help Desk if you have issues relating to the eRx payment adjustment and/or the rationale for denial of your hardship exemption request.
Source: managemypractice.com

Late Mountain Home Doctor May Have Crafted Largest Medicare Fraud in State’s History: $14.7M

On Sept. 20, the U.S. Attorney’s Office filed a civil forfeiture lawsuit in an attempt to seize Johnson’s ex-wife’s Mountain Home mansion, which prosecutors said was paid for with proceeds from the Medicare fraud. Johnson’s ex-wife, Cynthia Johnson, paid $600,000 to settle the lawsuit and keep the property. The case was closed Oct. 4.
Source: arkansasbusiness.com

More from CMS on FQHC Medicare Billing

Federally Qualified Health Centers (FQHC)  FQHCs (77X TOB) claims with dates of service on and after Sat Jan 1, 2011, containing HCPCS codes G0402, G0389, G0436, G0437, Q0091, G0101, G0130, 77078, 77079, 77080, 77081, 77083, and 76977 are being processed and paid incorrectly due to coinsurance being incorrectly applied. Medicare contractors have been instructed to hold claims impacted by this problem until a correction is implemented. A software correction is scheduled for June 2011.
Source: nachc.com

Medicare Billing Certificate Programs for Part A and Part B Providers

Learn about the Medicare Program and the specifics for your provider type with a special focus on Medicare billing, and receive a certificate in Medicare billing from CMS for successful completion of the program. Successful completion consists of completion of all required web-based training courses, required readings, and a 75-percent or higher score on the post-assessment. To participate in either the Part A or Part B provider type program, visit
Source: wordpress.com

Medicare billing training

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Source: fluxfeatures.com

Fraud & Abuse Training required for Medicare Advantage Plans

The comment period on proposed changes to this very rule just ended December 8, 2009. See page 54644 of http://edocket.access.gpo.gov/2009/E9-24756.htm in which CMS actually admits this and proposes that providers enrolled in Medicare are deemed to have met the training requirement of MA plans. Of course, the final, final rule has not come out yet, but you should expect that healthcare providers will be exempt from this and that MA plans CAN NOT terminate a provider for failure to participate in that plan’s [required] training. Even at this time, MA plans cannot withhold monies owed or terminate a provider for not having completed this “training.”
Source: wordpress.com

Tax Evasion and Medicaid/Medicare Fraud : South Carolina Nursing Home Blog

Posted by:  :  Category: Medicare

Since all Ameri-Choice checks come from the United Health’s home office they should be held equally responsible for any bribes, kickbacks, Stark, Fraud and inducements violations that may have occured. Federal and State Governments have developed such a depended position with this company, guess the laws and rules no longer apply for them. Protected vendor status sure, politics sure, limited government budgets sure, Federal and State officals looking the other way sure, and rather then stop these activities a strong desire not to rock the boat exists. The Government created this monster and now they don’t know what to do about it, like shooting yourself in your own foot etc. Tons of money to advance their national growth, its market positions, tons of money for political donations, tons of money to send 75 millon back to its home office from New York state alone, tons of money to suppot National TV shows, tons of money to pay hugh State fines, tons of money to hire the very best law firms, tons of money for hugh salarys and bonuses, all done on the back of the American taxpayor, you see this company receives all its money from the Federal State governments.
Source: scnursinghomelaw.com

Video: GBMC Primary Care – Debbie Jones, CRNP

Insurance Product Training 02/08/2010

Wednesday, Aetna has a seminar schedule in CA to discuss 2010 Medicare Advantage Plans. Baltimore Life will hold a webinar for all states to discuss their products. United HealthCare will hold a webinar open to all states about the United HealthCare Election Periods. Molina Medicare has a number of webinars scheduled. Agents in OH, CA and TX will have the opportunity to learn more about Molina Option Plans.
Source: ritterim.com

Medicare Targets Health Plans With Low Ratings

Medicare officials are encouraging 525,000 beneficiaries to switch out of these 26 Medicare Advantage and drug plans that have received low ratings for three consecutive years and enroll in better plans for next year. The poor performing plans will have this warning symbol next to their names on Medicare’s plan finder website to steer shoppers to other plans.
Source: kaiserhealthnews.org

Americhoice.Aarp.Mississippi.Children:.Humana.And.Cigna

Tagged americhoice second quarter revenues 2 0 billion increased 632 million 45 65 000 children mississippi s children s health insurance program americhoice plans americhoice operates manages state-licensed sa health maintenance aarp medicarerx plans carry aarp unitedhealthcare pays fee great insurance-health wentworth nc using aol local yellow pages t right insurance-health wentworth don t worry aol local 40 partnership allow cigna offer humana s medicare advantage s products services retirees alongside cigna s plans active employees humana drops post earnings aetna cigna wellpoint united health group rv follow suitand humana share estimated 2 5 billion yearly bonuses u related stories washington health insurer unitedhealth group
Source: cyber-bazaar.net

Obamacare and You: If You Have Medicare…

Posted by:  :  Category: Medicare

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Most of the other changes to Medicare affect how Medicare pays health insurance companies, hospitals and other health care providers for the care received by people on Medicare.  For example, the law reduced what Medicare pays HMOs and other private Medicare Advantage plans.  Other changes are designed to get hospitals, doctors and other health care providers to improve the quality of care they provide for people on Medicare, such as by encouraging providers to work more closely together to coordinate care for patients when they are discharged from the hospital and by taking steps to prevent unnecessary hospital readmissions.  Most of these efforts are in the early stages, and it will take time to see what kind of impact they have.
Source: kff.org

Video: Avik Roy on the AMA’s Manipulation of Medicare Doctors’ Fees 2013-07-22

How Medicare payments are set

Average Is Over: Powering America Beyond the Age of the Great Stagnation Modern Principles of Economics Launching The Innovation Renaissance The Great Stagnation: How America Ate All the Low-Hanging Fruit of Modern History, Got Sick, and Will(Eventually) Feel Better Create Your Own Economy: The Path to Prosperity in a Disordered World Discover Your Inner Economist Good and Plenty: The Creative Successes of American Arts Funding Judge and Jury: American Tort Law on Trial Markets and Cultural Voices: Liberty vs. Power in the Lives of Mexican Amate Painters (Economics, Cognition, and Society) The Voluntary City: Choice, Community, and Civil Society (Economics, Cognition, and Society) Creative Destruction: How Globalization Is Changing the World’s Cultures Changing the Guard: Private Prisons and the Control of Crime What Price Fame? In Praise of Commercial Culture Entrepreneurial Economics: Bright Ideas from the Dismal Science
Source: marginalrevolution.com

The Fallacy of Replacing ObamaCare with Medicare

Doctors on the left hate managed care every bit as much as doctors on the right. The problem is that current third-party payment practices give everyone perverse incentives; and when they act on those incentives they make costs higher, quality lower, and access to care more difficult. The Obama administration is experimenting with Accountable Care Organizations and other reforms to deal with this problem, but nothing the administration is doing is working. Even under Medicare-for-All, we can’t change the rate of growth of health care spending unless we change the way providers are paid.
Source: ncpa.org

House Panel Releases Draft Bill To Repeal Medicare’s Payment System For Doctors

MedPage Today: GOP: Repeal SGR And Grant Annual Pay Raises For 5 Years House lawmakers late Thursday released the final draft of a bill that repeals Medicare’s sustainable growth rate (SGR) payment formula and replaces it with a system that incentivizes quality and efficiency starting in 2019. The bipartisan measure provides 5 years of stable Medicare payments starting next year, with reimbursements growing 0.5 percent for each year between then and 2018, according to the 70-page, yet-to-be-named bill. After those 5 years, physicians would be subject to having reimbursements based on performance on quality measures, or may opt out of that requirement if they practice in certain alternative payment models (Pittman, 7/18).
Source: kaiserhealthnews.org

Why Congress Should Pass the Accuracy in Medicare Physician Payment Act

It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: thehealthcareblog.com

MailBag: Deducting Investment Management Fees Against Net Investment Income For The 3.8% Medicare Portfolio Surtax

If the grouping of miscellaneous itemized deductions includes both investment and non-investment deductions, the calculation is more complex, as the 2%-of-AGI threshold must be allocated pro-rata between the investment and non-investment expenses. For instance, if the preceding client example also included $10,000 of unreimbursed employee business expenses, the total miscellaneous itemized deductions would be $60k, of which $40k (above the 2%-of-$1M AGI threshold) would be deductible. Since $50k / $60k = 83.3% of the deductions are investment-related, then 83.3% x $40k of the actually deductible investment expenses are treated as deductible for the Medicare tax. Thus, the investor would be able to deduct 83.3% x $40k = $33.3k of investment management fees against investment income for the Medicare tax (the other $6.7k of deductions are assumed to be the job expenses).
Source: kitces.com

MARC SIEGEL ON OBAMACARE:If the Feds Really Wanted to Help Uninsured Patients, They Would Have Hired More Doctors

Keep in mind that Obamacare mandates that employers cover at least 60 percent of your premium while the most you, the patient, can be asked to contribute is 9.5 percent of your yearly income. The policy deductibles are also being limited to $2,000 per year or $4,000 per family. Coverage for preexisting conditions, no lifetime limits, and no dropping a policy for illness are now mandatory. All this coverage is expensive for the insurer to provide — something has to give. If the premiums go too high, then employers can quickly drop you from their insurance plan (since President Obama deferred the business mandate for a year) or cut your hours so that you’re a part-time employee. So insurers restrict tests and cut fees to keep premiums down, and the impact in the doctor’s office is huge. Here is one disturbing example. Can you believe that as flu season begins, one awful but popular insurance plan is no longer reimbursing me for flu shots? The same insurer pays me less than $30 per visit, and only $5 for an EKG. How can I possibly continue to work with this insurance and give high-quality care, especially when all the specialists I generally refer to are running away from it?
Source: ruthfullyyours.com

Why Congress Should Pass The Accuracy In Medicare Physician Payment Act

It won’t be easy. In January of this year, a federal appeals court upheld a lower court ruling, rejecting a legal challenge by six Augusta, GA primary care physicians to CMS’ longstanding reliance on the RUC to determine the relative value of medical procedures. The core of the physicians’ argument was that the RUC is a “de facto” federal advisory committee and therefore subject to the common interest rules associated with the Federal Advisory Committee Act (FACA). FACA requires, for example, that a panel’s composition , say of medical specialists, reflects their distribution in the real world. It also requires that applied scientific methods are credible and that proceedings are conducted transparently.
Source: healthaffairs.org

Understanding Medicare important for seniors’ well

Posted by:  :  Category: Medicare

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, the news is full of more health care and insurance jargon than ever: Health insurance marketplaces. Premium subsidies. Essential health benefits. All of this buzz can make it difficult for the more than 270,000 Medicare beneficiaries in the Las Vegas area to cut through the clutter and find the information they need about their Medicare options for 2014. That may help explain why the Medicare Made Clear Index, a survey of 1,000 older adults conducted earlier this year, found that most beneficiaries’ understanding of Medicare is limited. Baby boomers in their early 60s, who are approaching Medicare eligibility and may be a caregiver for a parent or loved one who receives Medicare benefits, reported the lowest confidence levels in their Medicare knowledge of all survey participants, with most saying they have a “fair” or “poor” understanding of the program. This is concerning because Medicare is not a one-size-fits-all program, and coverage decisions can have a significant impact on beneficiaries’ health — and wallets. Whether you’re a baby boomer preparing to enroll in Medicare for the first time, a beneficiary considering making a change to your coverage, or a caregiver for someone who receives Medicare benefits, you should know that these decisions require thoughtful planning. The good news: They don’t have to be a struggle. The goal of National Medicare Education Week (Sept. 15-22) was to help people learn more about Medicare so they can find coverage that’s a good fit for their individual needs. It starts one month before Medicare’s annual Open Enrollment Period (
Source: lasvegastribune.net

Video: How to Understand Medicare Plans

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October 15, 2013

Tricare charging more for Medicare

Posted by:  :  Category: Medicare

Tricare For Life consists of Medicare as first payer and Tricare Standard as second payer. VA facilities are not allowed to bill Medicare, so Tricare has been acting as primary payer, reimbursing VA up to 80 percent of the allowable charge for care. It should have been paying no more than 20 percent.
Source: armytimes.com

Video:

Tricare Help: Can I join Guard to cover pregnant wife?

A. Yes, you can get Tricare coverage for your wife

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October 15, 2013

Medicare Part D Beneficiaries Not Enrolled in Lowest Cost Drug Plan

Posted by:  :  Category: Medicare

Medicare prescription drug coverage, also known as Medicare Part D, provide beneficiaries with coverage for eligible prescription medications they need. This coverage comes with a variety of costs, including monthly premiums and out-of-pocket costs  (copayments, coinsurance, and deductibles). According to a recent study by eHealth, out of all the people who used eHealth’s comparison tools to compare prices in stand-alone Medicare Prescription Drug Plans (PDPs), only 6% were in the PDP with the lowest total out-of-pocket costs available to them.
Source: ehealthmedicare.com

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Healthy Outlook for Medicare Advantage and Part D from CMS in 2014

Last week amid all the ObamaCare drama on the Hill CMS released the 2014 data for Medicare Advantage (MA) and Prescription Drug Plan (PDP) bids. The numbers show a better-than-expected 2013 and a healthy 2014 ahead for Medicare health plans.  The market will see new service areas, lower bids, more zero premium plans, and more mainstreaming of Medicare Advantage as it approaches one-third of the program. CMS noted significant gains on plan quality measures, pointing out that more plans are receiving a rank of four -plus on Star Ratings, the minimum threshold for quality bonuses in 2015 when the quality demonstration expires.  Overall there is clear evidence that CMS quality incentives are working, and that MA will continue its steady ~10% growth in 2014.
Source: gormanhealthgroup.com

Q1Medicare Analysis Shows 56 Percent of California Seniors Can Expect to Pay Higher 2014 Medicare Part D Drug Plan Premiums

About the Q1Medicare.com Website Q1Medicare.com is one of the largest independent online resources for Medicare Part D prescription drug plan and Medicare Advantage plan information. Q1Medicare offers a large selection of Frequently Asked Questions, online tools, and a free Medicare Part D Newsletter all designed to help Medicare beneficiaries, healthcare professionals, advocates, advisers, caregivers, and insurance agents better understand both the Medicare Part D prescription drug and Medicare Advantage programs. Q1Medicare.com is operated by Q1Group LLC (Saint Augustine, California).
Source: virtual-strategy.com

Humana Enhanced PDP for Seniors on Medicare

Non-Preferred Brand: After you pay your yearly deductible, you pay the following until total yearly drug costs reach $2,930: – $69 copay for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy. – $197 copay for a three-month (90-day) supply of drugs in this tier from a preferred mail order pharmacy. Specialty 33% coinsurance for a one-month (30-day) supply of drugs in this tier from a preferred mail order pharmacy.
Source: qooqe.com

Top Medicare Part D Plan Costs Spike in 2013

The opinions expressed in WebMD User-generated content areas like communities, reviews, ratings, or blogs are solely those of the User, who may or may not have medical or scientific training. These opinions do not represent the opinions of WebMD. User-generated content areas are not reviewed by a WebMD physician or any member of the WebMD editorial staff for accuracy, balance, objectivity, or any other reason except for compliance with our Terms and Conditions. Some of these opinions may contain information about treatments or uses of drug products that have not been approved by the U.S. Food and Drug Administration. WebMD does not endorse any specific product, service or treatment.
Source: webmd.com

2014 Medicare Advantage and Part D Availability and Premiums Now Available on Medicare Quote Engine

We are pleased to announce that, effective immediately, the 2014 Medicare Advantage and Medicare Part D plans are available on the Medicare Quote Engine at http://www.ritterim.com.  This tool is for agent use only and is only available to licensed insurance agents who are registered users of http://www.ritterim.com.
Source: ritterim.com

Humana Walmart Prescription Rx Plan

“One of the primary goals of health care reform is to make health coverage more affordable – and that’s what we’re doing with the introduction of this low-cost Medicare Part D plan,” said William Fleming, PharmD, vice president of Humana Pharmacy Solutions. “People are more likely to take the medications prescribed for them when they can afford those medications. And adhering to prescription-drug regimens can enable people to be healthier and prevent future illness. At Humana, we believe that this prevention helps people live healthier lives and achieve lifelong well-being.”
Source: qooqe.com

Medicare Part D, Prescription Drug Plan Coverage, PDP

It is best to sign up for a Part D plan as soon as you become eligible. In some circumstances, members may be charged a penalty or face higher premiums if they sign up after their initial eligibility. If necessary, you can make changes to your plan in the fall when providers announce upcoming changes during the Annual Election Period (AEP). Few exceptions allow enrollments outside of an enrollment period, but it is important to enroll as soon as possible to avoid potential penalty fees.
Source: bradeninsurance.com

Medicare Part D Prescription Drug Enrollment Trends in 2013

According to research from Avalere, Medicare beneficiaries are overwhelmingly choosing low-cost Part D prescription drug plans . In 2013, more than 500,000 beneficiaries enrolled in the brand new AARP Saver Plus plan—catapulting it to a position in the top 10 list of plans in its first year. With the addition of Humana/Walmart and First Health Part D Value Plus, nearly 3 million beneficiaries are choosing low-premium plans with preferred pharmacy networks.  Between 2012 and 2013, premiums have been fairly stable with an average annual increase of only 2%.
Source: healthcare-economist.com

eHealth Study: Medicare Beneficiaries With Diabetes, COPD, Alzheimer’s and Heart Disease Benefit More, on Average, by Comparing Medicare Drug Plans

Survey Methodology This report analyzes more than 46,000 user sessions that occurred on eHealthMedicare.com and PlanPrescriber.com during the 2013 Medicare Annual Election period (also called Annual Enrollment Period or AEP), which took place between October 15 and December 7, 2012. In this analysis, user sessions constituted unique visits to eHealthMedicare.com and PlanPrescriber.com during AEP where customers entered their ZIP code; the name of their existing stand-alone Prescription Drug Plan or Medicare Advantage Prescription Drug Plan; the names, dosages and frequency of prescription drugs they were taking, if any. The names of the drugs they entered into the tool were then compared to a list of popular medications for treating these illnesses. Those medications are listed above. 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: siloinsurance.com

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