Medicare Open Enrollment 2015

Posted by:  :  Category: Medicare

A gap in prescription drug benefits. In 2015, Part D enrollees will pay a monthly premium and may, depending on the plan, pay a deductible on prescriptions. Once any deductible is met, they pay copayments or co-insurance for their drugs until total drug spending – what the plan pays and what the enrollee pays combined – reaches $2,970 for the year. Then the enrollee pays 47.5 percent of the cost of brand-name drugs and 79 percent of the cost of generics until total out-of-pocket expenses for the year reach $4,750. After that, the enrollee reaches catastrophic coverage and pays only a small portion of drug costs, either 5 percent or copayments of $2.65 for generics and $6.60 for brands, whichever is more.
Source: medicaregov.us

Medicare Open Enrollment, 8 Changes You Can Make

Reader stories help us fine-tune our education efforts and strengthen our calls for action on issues that matter most to you. We read and learn from every story and may use yours (with permission) to brief legislators, inspire other readers and more. Please share your story with us. Do
Source: aarp.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

how to apply for a medicare card

You will need to fill out the form called ‘copy or transfer from one Medicare card to another’   and bring two forms of identification with you (like a birth certificate, student card, health care card, driver

Hospital Patients’ Survey Data

Posted by:  :  Category: Medicare

The Centers for Medicare & Medicaid Services (CMS), along with the Agency for Healthcare Research and Quality (AHRQ), developed the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems) Survey, also known as Hospital CAHPS®, to provide a standardized survey instrument and data collection methodology for measuring patients’ perspectives on hospital care. The HCAHPS Survey is administered to a random sample of patients continuously throughout the year. CMS cleans, adjusts and analyzes the data, then publicly reports the results. The HCAHPS survey
Source: medicare.gov

Data for Medicare Replacement Card Applications filed via the Internet

The goal of the Social Security Administration (SSA) is to improve core services provided to the public and provide alternative methods for conducting business with the agency. In support of this goal, SSA provides a wide range of Internet services to allow the public to conduct business via this widely used medium. For example, SSA offers members of the public who receive benefits the opportunity to obtain a replacement Medicare Card via the Internet. Our goal is to make it easier and faster for individuals to request a Medicare Replacement Card via the Internet from the comfort and convenience of their homes or offices.
Source: socialsecurity.gov

Hospital Cost Transparency

Home office expense:  Worksheet G-3 uses the declared not the allowed home office expense in reporting Net Income.  To find the Allowed Home Office Expense and adjust the facility’s Net Income data, Worksheet A-8-1 is needed.    One hospital chain had over $100,000,000 in profit before taxes reported on their SEC 10 K report.  However, adding the net revenues before taxes of all the facilities less than 30,000,000 could be accounted for.  One aberration found was that some of the facilities had a very high home office expense disallowed amount. 
Source: healthwatchusa.org

Medicare Part C Appeals > Home

Attention Medicare Health Plans- Updated Medicare Advantage Process Manual, Appendix, Reconsideration Background Data Form, and NEW Dismissal Case File Data Form are now available under the ‘Health Plans’ section. Plans should begin using the new Reconsideration Background Data Form for appeals submitted to MAXIMUS Federal Services effective 1/1/2014. For dismissal review cases files submitted to MAXIMUS upon request after 1/1/14, health plans must use the NEW Dismissal Case File Data Form.
Source: medicareappeals.com

Medicare Supplemental Insurance

Posted by:  :  Category: Medicare

Finding the best Medicare Supplemental insurance, Medicare Advantage, and Medicare Part D has gotten more complicated nearly every year. In 2010 Medicare Supplement Insurance added 2 new plans Medigap plan N and Medigap Plan M. At the same time they eliminated several other Medicare Supplement options. Medicare Advantage insurance plans redefine benefits and premiums every year. And, with future Medicare subsidies uncertain due to changing regulation from healthcare reform who can keep up. For many individuals Medicare Supplement Insurance is becoming the best option. Unfortunately, comparing Medicare Supplemental Insurance Plan premiums (Medigap) and Medicare Advantage plans can be a time consuming endeavor. Our highly trained insurance advisors can explain all of your supplemental Insurance options, and assist in finding the best Medicare supplement and Medicare Part D combination that best fits your specific needs. With all the options affecting Supplement insurance and Part D it makes sense to have an expert assist you through the maze.
Source: mysenioradvisorsgroup.com

Medicare Supplement Insurance Quote Engine

In addition to Medicare supplement insurance, we are pleased to be participating in the Medicare Advantage market. The Medicare Advantage policy is a low cost alternative to a Medicare supplement policy and is especially advantageous for those less than 65 years old. The Private Fee For Service (PFFS) is a type of Advantage plan that allows Medicare recipient to visit any doctor, any hospital, anywhere. Therefore, many Medicare recipients are well served by the lower cost Private Fee For Service plan.
Source: bestmedicaresupplement.com

Medicare Supplement Plans & Quotes

Turning 65 is stressful, and the amount of information people receive leading up to their birthday is astounding. From the stacks of mail piling up on your desk, to the seemingly endless phone calls and quotes from insurance companies and agents, the task of gathering honest, unbiased information can feel impossible. Our goal is to offer what nobody else will, which is why we provide medicare supplement quotes, financial ratings, benefit information, application fee data, price history, and pricing methodology for all supplemental insurance companies in one clean, concise report. Our free, no obligation service is designed to give you the information you need regarding Part D and Medicare Supplement Plans in order to make an educated purchasing decision. In addition, we offer continued support for all of our customers to ensure they have no claims or billing issues. On an annual basis we review all medicare supplement insurance quotes and plan options in an effort to notify our customers of any new or better plans that may be available.
Source: medicaresupplementshop.com

Medicare Supplement Insurance & Medicare Advantage Personal Service

Medicare Supplement Insurance, also known as MediGap Insurance, is designed to help cover some of the medical costs that are not covered by Medicare.  These Medigap coverage plans are available to anyone enrolled in Part A and B of Medicare.  There is an open MediGap Insurance enrollment period for the first six months after you turn age 65, in which you do not need to qualify or answer any questions about your prior medical history.
Source: medigapadvisors.com

Compare Medicare Advantage & Supplemental Plans

Medicare Advantage insurance is offered by private insurance companies with a Medicare contract, and replaces Original Medicare Part A and Part B. You must continue to pay your Part B premiums. Medicare Advantage plans typically offer additional benefit options and have less cost-sharing than Original Medicare, and you may have to pay a monthly premium in return for the extra benefits. Medicare Advantage plans come in a variety of formats, such as HMO, PPO and PFFS plans, as well as special needs plans. Medicare beneficiaries can enroll in Medicare Advantage plans if they have Medicare Part A and Part B, but only during designated enrollment periods. These enrollment periods change from time-to-time, so please call us to get the most-up-to-date information.
Source: medicaresolutions.com

GlobeCare Medicare Supplement Insurance: Official Site

Your acceptance for a Medicare supplement policy is guaranteed with no waiting periods, regardless of preexisting conditions when purchased during the six-month open enrollment period for persons turning age 65.
Source: globecaremedsupp.com

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

Best Medicare Supplement Insurance Quotes

Every Medicare supplemental insurance plan must follow federal and state laws designed to protect you. Medicare supplement plan insurance companies can only sell you a “modernized” Medicare supplemental insurance plan identified by letters A through N. Each modernized Medicare supplemental insurance plan must offer the same basic benefits, no matter which insurance company sells it.
Source: medicaresupplementplans.com

Medicare Supplement Plan F

Medicare Supplement Plan F may offer expansive coverage, but it does not cover everything. Under Plan F, beneficiaries are still required to pay their Medicare Part B premium payments each month. Additionally, it is possible to have Medicare Part A without a monthly premium if the beneficiary has worked and paid Social Security taxes for at least 40 calendar quarters (10 years). Otherwise, a monthly premium for Part A coverage is also required. These costs are not covered under Medicare Supplement Plan F.
Source: ehealthinsurance.com

TEXAS MEDICAID APPLICATION

Posted by:  :  Category: Medicare

In order to participate in Medicaid, federal law requires states to cover certain population groups (mandatory eligibility groups) and gives them the flexibility to cover other population groups (optional eligibility groups). States set individual eligibility criteria within federal minimum standards. States can apply to the Centers for Medicare & Medicaid Services (CMS) for a waiver of federal law to expand health coverage beyond these groups. Medicaid is an entitlement program, which means the federal government does not, and a state cannot, limit the number of eligible people who can enroll, and Medicaid must pay for any services covered under the program. In December 2011, about one in seven Texans (3.7 million of the 25.9 million) relied on
Source: texasmedicaidapplications.com

Texas Medicaid/CHIP Vendor Drug Program

On February 1, 2015, VDP will change the fee-for-service (FFS) Medicaid reimbursement methodology for calculating the ingredient cost of pharmacy claims paid to eligible health care organizations participating in the Health Resources and Services Administration (HRSA) 340B Drug Pricing Program.  More about the 340B reimbursement changes.
Source: txvendordrug.com

Health and Human Services Commission

Parents or guardians who are not able to go with their children on rides to Medicaid-related visits to the doctor, dentist, or therapist must fill out a Parent Authorization Form (PDF) and send it in. The form identifies which adults are authorized by the parent to go with the child on rides to Medicaid-related health visits when the parent can’t make the trip. The adult selected by the parent cannot be a provider, an employee of the provider or paid by the provider. If you have questions or need a form sent to you, please call the Medical Transportation Program at 1-877-633-8747.
Source: tx.us

Texas Medicaid: The Medicaid Project, Texas Medicaid Eligibility, Help, Assistance; TX

web site: Your Texas Benefits languages: English (no publication date is available) The navigation bar at the top of the page offers six subtopics about Texas Medicaid and other benefit programs. Clicking on “Common Questions” delivers a web page of numerous FAQ’s about applying for and receiving benefits, along with telephone contacts and instructions for using the website. Back at the home page, there is a short form you can complete to find out what benefits you might be eligible for. If you are receiving benefits already, or have applied for them, you can also view details about your case. This feature requires a security log-in and password.
Source: quickbrochures.net

Texas Medicaid/CHIP Vendor Drug Program: Preferred Drug List

The Medicaid Preferred Drug List (PDL) is a list of prescription medications within a therapeutic class selected for their efficaciousness, clinical significance, cost effectiveness, and safety for clients.
Source: txvendordrug.com

Medicare Part D coverage gap

Posted by:  :  Category: Medicare

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

Understanding the Medicare Part D Donut Hole

Once you and your Part D drug plan have spent $2,840 for covered drugs, you will be in the donut hole. Previously, you had to pay the full cost of your prescription drugs while in the donut hole. However, in 2011, you get a 50% discount on covered brand-name prescription medications. The donut hole continues until your total out-of-pocket cost reaches $4,550. This annual out-of-pocket spending amount includes your yearly deductible, copayment, and coinsurance amounts.
Source: about.com

What is the Medicare Donut Hole?

This means that while enrollees are in the doughnut hole, the coverage gap can amount to thousands of dollars. In other words, while in the doughnut hole enrollees must pay 100% of the retail cost of their drugs until they have spent a set amount. Some PDPs offer minimal coverage on things like generic drugs while enrollees are in the doughnut hole, though these types of plans will usually charge a higher monthly premium. Once an enrollee reaches the total out-of-pocket limit during the coverage gap, they are bumped into "catastrophic coverage." Catastrophic coverage guarantees that once an enrollee has spent up to his or her plan’s out-of-pocket limit for covered prescriptions the person will only pay a nominal coinsurance fee or copayment for their drugs for the rest of the year. This works out to the enrollee paying about 5% of subsequent drug costs after the doughnut hole, their plan paying about 15%, and Medicare covering about 80%.
Source: medicaresolutions.com

Medicare Part D Doughnut Hole Is a Gap in Coverage

"If you have high drug costs, you may consider which plans offer additional coverage until you spend $3,600 out-of-pocket. In some plans, if your costs reach an initial coverage limit, then you pay 100% of your prescription costs. This is called the coverage gap. This "gap" in coverage is generally above $2,250 in total drug costs until you spend $3,600 out-of-pocket. Some plans might offer some coverage during the gap. Even in plans where you pay 100% of covered drug costs after a certain limit, you would still pay less for your prescriptions than you would without this drug coverage", according to Medicare.gov.
Source: about.com

Medicare Doughnut Hole Definition

A range of total prescription drug spending in the Medicare Part D program where all of the costs must be covered out-of-pocket. As a result of the Medicare doughnut hole, Medicare Part D participants are forced to choose between paying higher insurance premiums, or potentially paying thousands of dollars out-of-pocket to bridge the coverage gap. Many lower-income participants in Medicare are unable to afford either option.
Source: investopedia.com

Medicare Prescription Drug Coverage Guide: Doughnut Hole Coverage Gap

While in the gap, in 2014 you pay 47.50 percent of the cost of brand-name drugs and 72 percent of generic drugs. (Fifty percent of the discount on brand-name drugs is paid by the companies that manufacture them, and the rest by the federal government. The discount on generic drugs is wholly paid by the federal government.) In subsequent years, these costs will reduce until, by 2020, you pay no more than 25 percent of the cost of any drug in the gap.
Source: aarp.org

Medicare Advantage Plans Can Cut Costs and Hassle

Posted by:  :  Category: Medicare

Advantage plans can reduce the costs and the hassle for patients who now need to buy three policies for comparable coverage—traditional Medicare, a prescription-drug plan and a supplemental policy that covers out-of-pocket costs. “There is a convenience factor with Medicare Advantage plans, and they can be cheaper” than fee-for-service Medicare, says Joe Baker, executive director of the Medicare Rights Center.
Source: kiplinger.com

Doctors cut from Medicare Advantage networks struggle with what to tell patients

A few weeks ago, the insurance industry, led by America’s Health Insurance Plans, a trade group, launched a public-awareness campaign that includes TV, print, digital and display ads and encourages seniors, a group with substantial political clout, to write and Tweet about their concerns over the payment cuts. Industry officials have been appearing on Sunday talk shows and pressing lawmakers to restore some of the funding.
Source: washingtonpost.com

Medicare Advantage Cuts in the Affordable Care Act: April 2014 Update

The overwhelming majority of Medicare Advantage enrollees will face significant benefit cuts in 2015, relative to benefit levels in 2014. This is primarily the result of ACA-mandated changes to the benchmark payment formula, and the elimination of the star rating bonus pilot program. The cuts are somewhat mitigated by changes in risk adjustment and other factors. Compared to the pre-ACA baseline, all beneficiaries are experiencing a substantial benefit reduction. The overwhelming majority of this reduction is due to ACA-mandated changes to the benchmark formulas in effect in 2010 and prior years. The effect of the star rating pilot program is absent, since star ratings were not used to determine payments at all prior to 2012. The effect of year-to-year (and even cumulative) adjustment factors is small compared to the cumulative effects of the benchmark changes mandated by the ACA.
Source: americanactionforum.org

Study: Cuts to Medicare Advantage Top $1,500 Per Senior

Roughly 30 percent of Medicare beneficiaries—about 16 million seniors—use the privately administered Medicare Advantage plans. The program continues to grow, despite the Affordable Care Act’s cuts. Enrollment rose in 2014 to 15.9 million—roughly a 9 percent increase from the year before, according to a recent analysis from the consulting firm Avalere Health.
Source: nationaljournal.com

VIVA Medicare Plus (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 VIVA Medicare Plus (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. If you request a formulary exception for a drug and VIVA Medicare Plus (HMO) approves the exception, you will pay Tier 4: Non-Preferred Brand cost sharing for that drug. In-Network $125 annual deductible. Initial Coverage After you pay your yearly deductible, 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 from a preferred and non-preferred pharmacy the following way(s): Tier 1: Preferred Generic
Source: healthpocket.com

Viva Health and Baptist Health System join forces for new Medicare plan in an unusual arrangement

To be in the plan you must use one of the four Baptist hospitals in four area counties and the 400 doctors in the Baptist Physician Alliance. The hospitals in the system are: Baptist Princeton in Birmingham; Citzen’s Baptist in Talladega; Walker Baptist in Jasper:and Shelby Baptist in Alabaster. Enrollment for Medicare plans begins Oct. 15 and is completely separate from the health insurance exchanges associated with the Affordable Care Act.
Source: al.com

Viva Medicare Advantage Plans

*The benefit information provided is a brief summary, not a complete description of benefits. For more information contact the plan. Limitations, copayments, and restrictions may apply. Benefits, formulary, pharmacy network, premium, and/or copayment/coinsurance may change on January 1 of each year. Other providers are available in our network. You must continue to pay your Medicare Part B premium.
Source: makingmedicareeasy.com

A Holistic Approach to Health in Early Recovery: Withdrawal and Insomnia 

Posted by:  :  Category: Medicare

Holistic medicine is most effective during the first stage, whereas higher levels of withdrawal require more conventional forms of intervention. Stage one starts two to six hours after the alcoholic’s last drink. It’s marked by mild agitation, anxiety, restlessness, tremors, loss of appetite, insomnia, racing heartbeat, and high blood pressure. [2] Neurotransmitters are the chemicals the body makes to allow nerve cells to pass messages (of pain, touch, and thought) from cell to cell. Amino acids are the precursors of these neurotransmitters. When addicts/alcoholics are low in particular amino acids from burning through them during their substance abuse, symptoms of withdrawal increase — especially cravings for their substance of choice. The goal in this stage is to support the body as it begins to clear itself of alcohol and drugs and to decrease cravings as much as possible. [3]
Source: huffingtonpost.com

Mine Safety and Health Administration (MSHA)

MSHA has linked to its respirable coal dust rule implementation page the database of facilities currently approved by NIOSH to provide chest X-rays required by 30 C.F.R. Part 72. This database does not yet provide NIOSH approved spirometry facilities. However, those facilities will be added once they are approved by NIOSH. MSHA expects that mine operators will work with and encourage other facilities not on the list to seek NIOSH approval for chest X-rays and spirometry. This information can be used to assist surface and underground coal mines and contractors in meeting the medical surveillance requirements under the recent respirable coal dust rule.
Source: msha.gov

Ohio Department of Health Home

ODH’s Division of Quality Assurance regulates many types of health care facilities through both state licensure and federal certification rules. The Bureau of Long Term Care Quality ensures the quality of care and quality of life of the residents of nursing homes and Residential Care Facilities (RCFs), also known as assisted living facilities, by conducting on-site inspections/surveys for compliance with state and federal rules and regulations in nursing homes/facilities. Need to file a complaint against a nursing home or other health care facility? Call our hotline at 1-800-342-0553 or e-mail HCComplaints@odh.ohio.gov.
Source: ohio.gov