Medicare and Medicaid Eligibility

Posted by:  :  Category: Medicare

i receive SSD they take around 75.00 a month out for part D and I do receive the extra help. But as of 2014 I have to now also pay co payments on my medicines. After part D is deducted I receive 850.30 a month. I am now on Medicare but it only pays 80% of other medical such as dr and hospital. 22.00 to 27.00 also comes out of that for medicine co pays. Then I also have the other 20% I have to pay my Dr. That I see once a month. I have found an apt for 695.00 that includes utilities. And 99.00 in food stamps. Apt not in real good area . And I cannot walk without a walker . I am 63 years old. Live alone is there any recourse that I have for any kind of supplements. Also have heart decease and now my teeth are in really bad shape and need new glasses. Is there any such program to get more help or supplements?
Source: disabilityadvisor.com

Disabled Individuals May Be Eligible for Medicare Benefits

This disability extension applies to each qualified beneficiary (whether or not they are the covered employee) in connection with the qualifying event. The extension requirements are met if the beneficiary is determined under Title II or XVI of the Social Security Act to be disabled at any time before or during the first sixty (60) days of COBRA continuation coverage. Notice must be provided to the plan administrator on a date that is both within sixty (60) days after the Notice of Determination is issued and before the end of the original eighteen (18) month maximum coverage period that applies to the qualifying event.
Source: ks.gov

Medicare Eligibility When Disability Benefits Stop Due to Work

Thank you so much for your advice. I recently ran into a problem with providers because I was on the group health plan with my employer. I discontinued Part B in April 2012. I was seen by providers and billing issues cam about because Blue Cross was stating Medicare was my primary, which I do not want, and they terminated my coverage due to that reason. I can get back on the group plan only if I no longer have Medicare. I do not want Medicare. My question is being that I no longer receive disablity benefits, can I discontinue Part A without paying any penalties? I have never used Part A so there has been no benefits paid through Part A. I thank you. You have provided me with more info in a small paragraph than the reps I have spoken to on the phone. It has been very confusing and also very frustrating to say the least.
Source: disabilityadvisor.com

How Part D works with other insurance

Posted by:  :  Category: Medicare

While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP plan isn’t required to be at least as good as Medicare Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, are required to determine if their prescription drug coverage is creditable each year and let you know in writing.
Source: medicare.gov

Medicare Part D coverage gap

In 2006, the first year of operation for Medicare Part D, the donut hole in the defined standard benefit covered a range in true out-of-pocket expenses (TrOOP) costs from $750 to $3,600. (The first $750 of TrOOP comes from a $250 deductible phase, and $500 in the initial coverage limit, in which the Centers for Medicare and Medicaid Services (CMS) covers 75 percent of the next $2,000.) In the first year of operation, there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries, although there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D.
Source: wikipedia.org

www.Q1Medicare.com Your Source for Medicare Part D Plan Information

You can enroll into a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the Annual Enrollment Period (or AEP) or open enrollment period starting October 15th and continuing for seven weeks through December 7th with your newly selected Medicare plan starting on January 1st of the following year. Please note that if you are just turning 65 or are newly eligible for Medicare, you will be granted a seven (7) month enrollment period when you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month. Enrolling in a Medicare Part D or Medicare Advantage plan is easy and takes little time. : : Click here if you already know       which Medicare Part D plan you want : : Click here to search for a       Medicare Part D plan : : Click here to search for a       Medicare Advantage plan The good news about enrollment is that you always pay the same amount for a Medicare D plan or Medicare Advantage plan, no matter where or how you enroll. As an expanded feature, we now provide enrollment options for all 2015 Medicare Part D plans and Medicare Advantage plans across the country. If you wish, you can also enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 7 to 10 business days you should receive your Medicare Part D new Member information. Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan’s Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card. Please note that the Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage Plans beginsJanuary 1st and continues through February 14th — during the MADP members of Medicare Advantage plans can switch back to original Medicare and join a stand-alone Medicare Part D drug plan.
Source: q1medicare.com

How to Enroll in a Medicare Part D Drug Plan

Medicare Rights Center The Medicare Rights Center, an independent, non-profit group, is the largest organization in the United States (aside from the federal government) that provides information and assistance for people with Medicare. Its site has a section about Medicare Part D drug coverage, including information about programs that could help you pay for your prescription drug costs. A unique feature of the site is the Medicare Interactive Counselor, a tool that walks you through the process of finding the drug plan that makes sense for you.
Source: about.com

Medicare Part D Drug Benefit

Namenda IR Availability As of January 2015 the company that produces Namenda will cease production of one version of Namenda (Namenda IR tablets, usually taken twice per day) and it will no longer be available. While supplies of Namenda IR may be available at local pharmacies for a period of time after the company stops distributing it in January, it is anticipated that individuals on this prescription will have to switch to another version of Namenda (XR = extended release once per day capsules). In addition, it is our understanding that a generic version of Namenda IR may be available as early as mid-2015; however, an official date has not been shared and it is not currently listed on the Medicare Part D formularies.
Source: alz.org

How Part D works with other insurance

Posted by:  :  Category: Medicare

While prescription drug coverage is an essential health benefit, prescription drug coverage in a Marketplace or SHOP plan isn’t required to be at least as good as Medicare Part D coverage (creditable). However, all private insurers offering prescription drug coverage, including Marketplace and SHOP plans, are required to determine if their prescription drug coverage is creditable each year and let you know in writing.
Source: medicare.gov

Medicare Part D coverage gap

In 2006, the first year of operation for Medicare Part D, the donut hole in the defined standard benefit covered a range in true out-of-pocket expenses (TrOOP) costs from $750 to $3,600. (The first $750 of TrOOP comes from a $250 deductible phase, and $500 in the initial coverage limit, in which the Centers for Medicare and Medicaid Services (CMS) covers 75 percent of the next $2,000.) In the first year of operation, there was a substantial reduction in out-of-pocket costs and a moderate increase in medication utilization among Medicare beneficiaries, although there was no evidence of improvement in emergency department use, hospitalizations, or preference-based health utility for those eligible for Part D.
Source: wikipedia.org

www.Q1Medicare.com Your Source for Medicare Part D Plan Information

You can enroll into a stand-alone Medicare Part D Prescription Drug plan or a Medicare Advantage plan during the Annual Enrollment Period (or AEP) or open enrollment period starting October 15th and continuing for seven weeks through December 7th with your newly selected Medicare plan starting on January 1st of the following year. Please note that if you are just turning 65 or are newly eligible for Medicare, you will be granted a seven (7) month enrollment period when you can join a Medicare Part D or Medicare Advantage plan. The seven month period begins three months before your Medicare eligibility (or birthday) month, includes your eligibility month, and continues for three months after your Medicare eligibility month. However, your Medicare plan can begin no sooner than the first day of your Medicare eligibility month. Enrolling in a Medicare Part D or Medicare Advantage plan is easy and takes little time. : : Click here if you already know       which Medicare Part D plan you want : : Click here to search for a       Medicare Part D plan : : Click here to search for a       Medicare Advantage plan The good news about enrollment is that you always pay the same amount for a Medicare D plan or Medicare Advantage plan, no matter where or how you enroll. As an expanded feature, we now provide enrollment options for all 2015 Medicare Part D plans and Medicare Advantage plans across the country. If you wish, you can also enroll directly with Medicare (1-800-Medicare) or with an insurance agent or the Medicare plan provider. No matter how you enroll in to a Medicare plan, the enrollment result should always be the same and in 7 to 10 business days you should receive your Medicare Part D new Member information. Once enrolled into a Medicare Part D or Medicare Advantage plan, you can contact the plan’s Member Services department with any questions or concerns. The toll-free number will be on the back of your Member ID card. Please note that the Medicare Advantage Dis-Enrollment Period (MADP) for Medicare Advantage Plans beginsJanuary 1st and continues through February 14th — during the MADP members of Medicare Advantage plans can switch back to original Medicare and join a stand-alone Medicare Part D drug plan.
Source: q1medicare.com

How to Enroll in a Medicare Part D Drug Plan

Medicare Rights Center The Medicare Rights Center, an independent, non-profit group, is the largest organization in the United States (aside from the federal government) that provides information and assistance for people with Medicare. Its site has a section about Medicare Part D drug coverage, including information about programs that could help you pay for your prescription drug costs. A unique feature of the site is the Medicare Interactive Counselor, a tool that walks you through the process of finding the drug plan that makes sense for you.
Source: about.com

Medicare Part D Drug Benefit

Namenda IR Availability As of January 2015 the company that produces Namenda will cease production of one version of Namenda (Namenda IR tablets, usually taken twice per day) and it will no longer be available. While supplies of Namenda IR may be available at local pharmacies for a period of time after the company stops distributing it in January, it is anticipated that individuals on this prescription will have to switch to another version of Namenda (XR = extended release once per day capsules). In addition, it is our understanding that a generic version of Namenda IR may be available as early as mid-2015; however, an official date has not been shared and it is not currently listed on the Medicare Part D formularies.
Source: alz.org

Annual Statistical Supplement, 2011

Posted by:  :  Category: Medicare

Beginning January 1, 2006, upon voluntary enrollment in either a stand-alone PDP or an integrated Medicare Advantage plan that offers Part D coverage in its benefit, subsidized prescription drug coverage. Most FDA-approved drugs and biologicals are covered. However, plans may set up formularies for their drug coverage, subject to certain statutory standards. (Drugs currently covered in Parts A and B remain covered there.) Part D coverage can consist of either standard coverage or an alternative design that provides the same actuarial value. (For an additional premium, plans may also offer supplemental coverage exceeding the value of basic coverage.) Standard Part D coverage is defined for 2006 as having a $250 deductible, with 25 percent coinsurance (or other actuarially equivalent amounts) for drug costs above the deductible and below the initial coverage limit of $2,250. The beneficiary is then responsible for all costs until the $3,600 out-of-pocket limit (which is equivalent to total drug costs of $5,100) is reached. For higher costs, there is catastrophic coverage; it requires enrollees to pay the greater of 5 percent coinsurance or a small copay ($2 for generic or preferred multisource brand and $5 for other drugs). After 2006, these benefit parameters are indexed to the growth in per capita Part D spending (see Table 2.C1). In determining out-of-pocket costs, only those amounts actually paid by the enrollee or another individual (and not reimbursed through insurance) are counted; the exception is cost-sharing assistance from Medicare’s low-income subsidies (certain beneficiaries with low incomes and modest assets will be eligible for certain subsidies that eliminate or reduce their Part D premiums, cost-sharing, or both) and from State Pharmacy Assistance Programs. A beneficiary premium, representing 25.5 percent of the cost of basic coverage on average, is required (except for certain low-income beneficiaries, as previously mentioned, who may pay a reduced or no premium). For PDPs and the drug portion of Medicare Advantage plans, the premium will be determined by a bid process; each plan’s premium will be 25.5 percent of the national weighted average plus or minus the difference between the plan’s bid and the average. To help them gain experience with the Medicare population, plans will be protected by a system of risk corridors, which allow Part D to assist with unexpected costs and to share in unexpected savings; after 2007, the risk corridors became less protective. To encourage employer and union plans to continue prescription drug coverage to Medicare retirees, subsidies to these plans are authorized; the plan must meet or exceed the value of standard Part D coverage, and the subsidy pays 28 percent of the allowable costs associated with enrollee prescription drug costs between a specified cost threshold ($250 in 2006, indexed thereafter) and a specified cost limit ($5,000 in 2006, indexed thereafter).
Source: ssa.gov

Medicare Sustainable Growth Rate

Section 101 of the Tax Relief and Health Care Act of 2006 (MIEA-TRHCA) provided a 1-year update of 0% for the conversion factor for CY 2007 and specified that the conversion factor for CY 2008 must be computed as if the 1-year update had never applied. Section 101 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 (MMSEA) provided a 6-month increase of 0.5% in the CY 2008 conversion factor, from January 1, 2008, through June 30, 2008, and specified that the conversion factor for the remaining portion of 2008 and the conversion factors for CY 2009 and subsequent years must be computed as if the 6-month increase had never applied. Section 131 of the Medicare Improvements for Patients and Providers Act of 2008 (MIPPA) extended the increase in the CY 2008 conversion factor that was applicable for the first half of the year to the entire year, provided for a 1.1% increase to the CY 2009 conversion factor, and specified that the conversion factors for CY 2010 and subsequent years must be computed as if the increases had never applied.
Source: wikipedia.org

Growth In Medicare Spending Per Beneficiary Continues To Hit Historic Lows

The aging of the US population will put strain on the financing of the Medicare program. Although growth in spending per beneficiary is projected at or below the rate of GDP per capita, the number of Medicare beneficiaries is projected to grow at approximately 3% annually. As a result, aggregate Medicare spending will account for a growing share of GDP over the next decade. As shown in Exhibit 3, most of the increase in Medicare spending as a fraction of GDP from 2013 to 2035 is projected to result from the effects of aging and growth in the number of beneficiaries, with very little of it a result of excess growth in expenditures per beneficiary. Further reducing per beneficiary cost growth below the projected level of GDP+0 is an important component of responding to fiscal pressure. But recent reductions in the growth of Medicare per beneficiary spending and projections for the next decade offer strong evidence that we have made great progress. Moreover, the Affordable Care Act provides a platform for the development of innovations in the delivery of and payment for health care, with the potential for significant improvements in both the quality of health care and its cost-efficiency. Such innovations would not only improve health care for Medicare beneficiaries in the future but also for the population at large.
Source: hhs.gov

Colorado Medicaid: The Medicaid Project, Colorado Medicaid Eligibility, Help, Assistance

Posted by:  :  Category: Medicare

Many groups of people are covered by Medicaid. Even within these groups, though, certain requirements must be met. These may include your age, whether you are pregnant, disabled, blind, or aged; your income and resources (like bank accounts, real property, or other items that can be sold for cash); and whether you are a U.S. citizen or a lawfully admitted immigrant. The rules for counting your income and resources vary from state to state and from group to group. There are special rules for those who live in nursing homes and for disabled children living at home.
Source: quickbrochures.net

Medicaid Pharmacy Benefits

Colorado Medicaid’s Preferred Drug List of clinically effective medications that you can get without needing prior authorization or approval. This list is updated regularly. You may still be able to get drugs not on the Preferred Drug List. To get drugs not on the Preferred Drug List, your provider will need to get prior authorization from Colorado Medicaid.
Source: colorado.gov

Colorado Medicaid Coverage

RMHP connects Medicaid Members to Medicaid providers and also helps Medicaid Members find community and social services in their area. RMHP can also help Medicaid Members get the right care when they are returning home from the hospital or a nursing facility.  Medicaid Members can choose a Primary Care Medical Provider (PCMP).  A PCMP is your main health care provider, serving as a “medical home,” where you will get most of your health care. When you need specialist care, the PCMP will help you find the right specialist. 
Source: rmhp.org

Medicare Hospital Compare Quality of Care

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Healthcare business news, research, data and events from Modern Healthcare

An OB-GYN who is the president-elect of the New Mexico Medical Society has had his license suspended by the state’s medical board for several alleged offenses, including drinking on the job and leaving a birthing mother unattended while having sex with another patient.
Source: modernhealthcare.com

Medicare Prescription Drug, Improvement, and Modernization Act

The bill came to a vote at 3 a.m. on November 22. After 45 minutes, the bill was losing, 219-215, with David Wu (D-OR-1) not voting. Speaker Dennis Hastert and Majority Leader Tom DeLay sought to convince some of dissenting Republicans to switch their votes, as they had in June. Istook, who had always been a wavering vote, consented quickly, producing a 218-216 tally. In a highly unusual move, the House leadership held the vote open for hours as they sought two more votes. Then-Representative Nick Smith (R-MI) claimed he was offered campaign funds for his son, who was running to replace him, in return for a change in his vote from “nay” to “yea.” After controversy ensued, Smith clarified no explicit offer of campaign funds was made, but that he was offered “substantial and aggressive campaign support” which he had assumed included financial support.
Source: wikipedia.org

Medicare.gov: the official U.S. government site for Medicare

Posted by:  :  Category: Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Medicare Prescription Drug Coverage

Medicare prescription drug coverage pays expenses up to $2,800; once your prescription costs exceeds that amount, you will no longer have coverage and will be responsible for the full cost of your drugs. However, once your out-of-pocket spending reaches $4,550, your prescription coverage will kick back in. Any amount of prescription drug spending between $2,800 and $4,550 is called the coverage gap or “Medicare donut hole.” Beginning in 2013, if you reach the coverage gap, you will automatically get a 52.5% discount on covered brand-name drugs and a 14% discount on generic drugs. If you have limited income and resources, you may get extra help to cover prescription drugs for little or no cost.
Source: usa.gov

Social Security (United States)

Posted by:  :  Category: Medicare

Due to changing needs or personal preferences, a person may go back to work after retiring. In this case, it is possible to get Social Security retirement or survivors benefits and work at the same time. A worker who is of full retirement age or older may (with spouse) keep all benefits, after taxes, regardless of earnings. But, if this worker and/or your spouse are younger than full retirement age and receiving benefits, and earn “too much”, the benefits will be reduced. If working under full retirement age for the entire year and receiving benefits, Social Security deducts $1 from the worker’s benefit payments for every $2 earned above the annual limit of $15,120 (2013). Deductions cease when the benefits have been reduced to zero and the worker will get one more year of income and age credit, slightly increasing future benefits at retirement. For example, if you were receiving benefits of $1,230/month (the average benefit paid) or $14,760 a year and have an income of $29,520/year above the $15,120 limit ($44,640/year) you would lose all ($14,760) of your benefits. If you made $1,000 more than $15,200/year you would “only lose” $500 in benefits. You would get no benefits for the months you work until the $1 deduction for $2 income “squeeze” is satisfied. Your first social security check will be delayed for several months—the first check may only be a fraction of the “full” amount. The benefit deductions change in the year you reach full retirement age and are still working—Social Security only deducts $1 in benefits for every $3 you earn above $40,080 in 2013 for that year and has no deduction thereafter. The income limits change (presumably for inflation) year by year.
Source: wikipedia.org

Social Security Administration

For some claimants, this program is harder to receive than funds from RSDI. To warrant a processing time of anything more than a day and an immediate denial, certain specific criteria must be met, including citizenship status, having less than $2,000.00 in countable financial resources, or having countable income of less than $718.00 per month from any source. Disposal of a financial resource (i.e., a deliberate spend-down to fall under SSI resource ceilings) can prevent a person from receiving SSI benefits for a period up to 36 months. Every person with or without a Social Security Number is eligible to apply. But if a person does not meet any of the above criteria or is not a documented resident of the United States, his or her claim can only be taken on paper and will be immediately denied. Even documented residents with legal permanent resident status after August 1996 are immediately denied unless they meet some or all of the SSI criteria listed above.
Source: wikipedia.org

Social Security (FICA) and Medicare Deduction

Social Security (FICA) and Medicare Deduction A taxpayer may claim a deduction for the amount contributed in the taxable year to FICA or a Railroad Retirement Plan, or to a U.S. or Massachusetts Retirement fund up to $2,000. If married filing joint, each spouse may claim up to $2,000 of his or her own contributions. Payment amounts may not be combined or transferred from one spouse to the other. Federal Insurance Contributions Act (FICA) Tax is an amount paid by individuals during the period in which they earn wages for purposes of providing them with benefits when they retire. Social Security benefits are made available to retired workers, their spouses and their dependents as well as to disabled workers, their spouses and their dependents. FICA tax is also known as the Social Security tax. Specifically, this deduction is allowed for the following:
Source: mass.gov

Medicare Blue Choice Value (HMO) 2014

Posted by:  :  Category: Medicare

The plan offers national in-network prescription coverage (i.e., this would include 50 states and the District of Columbia). This means that you will pay the same cost-sharing amount for your prescription drugs if you get them at an in-network pharmacy outside of the plan’s service area (for instance when you travel). Total yearly drug costs are the total drug costs paid by both you and a Part D plan. The plan may require you to first try one drug to treat your condition before it will cover another drug for that condition. Some drugs have quantity limits. Your provider must get prior authorization from Medicare Blue Choice Value (HMO) for certain drugs. You must go to certain pharmacies for a very limited number of drugs, due to special handling, provider coordination, or patient education requirements that cannot be met by most pharmacies in your network. These drugs are listed on the plan’s website, formulary, printed materials, as well as on the Medicare Prescription Drug Plan Finder on Medicare.gov. If the actual cost of a drug is less than the normal cost-sharing amount for that drug, you will pay the actual cost, not the higher cost-sharing amount. You pay $0 the first time you fill a prescription for certain drugs. These drugs will be listed as "free first fill" on the plan’s website, formulary, printed materials, and on the Medicare Prescription Drug Plan Finder on Medicare.gov. If you request a formulary exception for a drug and Medicare Blue Choice Value (HMO) approves the exception, you will pay Tier 3: Non-Preferred Brand cost sharing for that drug. In-Network $0 deductible. Supplemental drugs don’t count toward your out-of-pocket drug costs. Initial Coverage You pay the following until total yearly drug costs reach $2,850: Retail Pharmacy Contact your plan if you have questions about cost-sharing or billing when less than a one-month supply is dispensed. You can get drugs the following way(s): Tier 1: Generic
Source: healthpocket.com

Michigan Medicare Health Insurance Plans

Medicare is a health insurance program run by the government for people age 65 and older, and for people under 65 with certain disabilities. Understanding more about Medicare will make it easier to choose the right plan. Our Medicare 101 section has resources to help you do that.
Source: bcbsm.com

Empire Blue Cross Blue Shield’s New Medicare Supplement Plans Offer More Choice and…

A Medicare Supplement policy (sometimes referred to as Medigap) is a supplemental health insurance plan sold by private insurance companies to fill the “gaps” in Original Medicare Plan coverage. Medicare Supplement policies help pay some of the health care costs that the Original Medicare Plan doesn’t cover. If an individual is enrolled in the Original Medicare Plan and has a Medicare Supplement policy, then Medicare and Medicare Supplement will pay both their shares of covered health care costs. Empire and its affiliated health plans are the second largest provider of Medicare Supplement health benefit plans in the nation.
Source: prnewswire.com

Medicare.gov: the official U.S. government site for Medicare

The page could not be loaded. The Medicare.gov Home page currently does not fully support browsers with "JavaScript" disabled. Please note that if you choose to continue without enabling "JavaScript" certain functionalities on this website may not be available.
Source: medicare.gov

Michigan Medicare Health Insurance Plans

Posted by:  :  Category: Medicare

Medicare is a health insurance program run by the government for people age 65 and older, and for people under 65 with certain disabilities. Understanding more about Medicare will make it easier to choose the right plan. Our Medicare 101 section has resources to help you do that.
Source: bcbsm.com

Medicare Advantage 2014 Spotlight: Plan Availability and Premiums

While many organizations offer Medicare Advantage plans, a few – particularly Humana, United Healthcare, and the Blue Cross and Blue Shield (BCBS) affiliates – have particularly large geographic spread and these organizations historically account for a disproportionate share of enrollment. In 2014, 44 percent of available plans are being offered by one of these three firms or affiliates (Table A4).  Plans offered by these firms are available to most beneficiaries.  Nationwide, 83 percent of Medicare beneficiaries will have access to one or more Humana plans, 73 percent will have access to a BCBS affiliated plan (including BCBS plans offered by Wellpoint), and 68 percent will have access to a United Healthcare plan (Exhibit 5; Table A5).  The general availability of these firms’ products has not noticeably changed from 2013 to 2014.  However, the similarities in BCBS offerings from 2013 to 2014 obscure a decline in availability of BCBS branded Wellpoint plans (declining from 88 plans to 55 plans between 2013 and 2014), which is mostly offset by the growth in plans offered by other BCBS affiliates (growing from 205 plans to 233 plans between 2013 and 2014).
Source: kff.org

CarePlus Florida 2011 Medicare Advantage Plans

CareDirect (HMO SNP) Plan in Miami-Dade county and CareComplete (HMO) Plan will not be renewing its Medicare contract effective January 1, 2012. You may choose to enroll in our plan, but your coverage will automatically end on December 31, 2011. Because this plan ends on December 31, 2011, if you decide to join, you are entitled to enroll in a new MA plan or PDP beginning December 8,2011 through February 29,2012. However, if you want your enrollment in the new plan to take effect on January 1, 2012, the new plan must receive your application by December 31st. You may also have the option of enrolling in a Medicare Cost Plan, if one is offered in your area. If you do not enroll in another MA plan, Medicare Cost Plan or PDP by December 31, 2011, you will be disenrolled from our plan and enrolled in Original Medicare on this date.
Source: care-plus-health-plans.com

Medicare Advantage Fact Sheet

Since 2006, Medicare has paid plans under a bidding process.  Plans submit “bids” based on estimated costs per enrollee for services covered under Medicare Parts A and B; all bids that meet the necessary requirements are accepted.  The bids are compared to benchmark amounts that are set by a formula established in statute and vary by county (or region in the case of regional PPOs).  The benchmarks are the maximum amount Medicare will pay a plan in a given area. If a plan’s bid is higher than the benchmark, enrollees pay the difference between the benchmark and the bid in the form of a monthly premium, in addition to the Medicare Part B premium.  If the bid is lower than the benchmark, the plan and Medicare split the difference between the bid and the benchmark; the plan’s share is known as a “rebate,” which must be used to provide supplemental benefits to enrollees.  Medicare payments to plans are then adjusted based on enrollees’ risk profiles.
Source: kff.org