What PTs Should Know About 2011 Final Rule Medicare Changes

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If you see Medicare patients and they impact your revenue, there are several things to pay attention to and deal with proactively. These changes pose a significant threat to a growing population of baby boomers and their ability to access PT. Changes to these payment reductions can only be averted through Congressional action. APTA is notifying its members of opportunities to advocate on behalf of the profession to eliminate these payment cuts and any developments associated with the implementation of the Multiple Procedure Payment Reduction (MPPR).  Many believe that an extension of the therapy cap exceptions process and a reprieve for Medicare Fee Schedule cut will be considered and with some heavy lobbying are expected to be passed. Please stay alert to these changes and be pro-active in standing up for our profession and the value of the services that we provide.
Source: webpt.com

2011 Medicare Part D Program Compared to 2010, 2009, 2008 and 2007

Pharmaceutical manufacturers will be required to provide certain beneficiaries access to discount prices for certain brand drugs purchased under Medicare Part D. The manufacturer discount prices will be equal to 50% of the plan’s negotiated price defined (minus any applicable dispensing fees). These discount prices must be applied prior to any prescription drug coverage or financial assistance provided under other health benefit plans or programs and after any supplemental benefits provided under the Part D plan. The discounted prices will be charged at the pharmacy (point-of-sale). The beneficiary will not have to do additional paperwork, etc. to receive the benefit. These manufacturer discount prices will be made available to Part D enrollees who are in the coverage gap or donut hole (they have reached or exceeded the initial coverage limit and have incurred costs below the annual out-of-pocket threshold). Medicare beneficiaries will not be eligible to receive these discount prices if they are enrolled in a qualified retiree prescription drug plan or are eligible for the low-income subsidy. The costs paid by manufacturers towards the negotiated prices of drugs covered under this manufacturer discount program shall be considered incurred costs for eligible beneficiaries and applied towards their out-of-pocket threshold. This means that the total negotiated retail drug price will be applied to the TrOOP and will count toward getting out of the doughnut hole.
Source: q1medicare.com

Can I apply for Medicare if I am Already Receiving Disability Benefits?

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If you have not been contacted regarding enrollment in Medicare after you have been eligible for Social Security Disability benefits for 24 months, contact your Social Security Administration for more information . Remember that the 24 months are counted from your date of eligibility, not the date that you actually started receiving Social Security Disability payments. This means that you need to be aware of the actual date that you applied for your Social Security Disability benefits as well as the date that your disability began.
Source: disabilitybenefitscenter.org

Disability Planner: Medicare Coverage If You’re Disabled

Everyone with Medicare also has access to prescription drug coverage (Part D) that helps pay for medications doctors prescribe for treatment. For more information on the enrollment periods for Part D, we recommend you read Medicare’s "How to get drug coverage" page.
Source: ssa.gov

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

Discounted Fares for Senior/Disabled/Medicare Riders

MTS has combined its Disabled ID Card with the Compass Card Pass to allow customers eligible for reduced fares to carry just one card. Just reload your Photo ID/Compass Card every month, tap on the trolley station validator or bus fare box when boarding and you are good to go! Your Photo ID/Compass Card is all you need to show the bus driver or Trolley inspector. To get an ID/Compass Card, complete the form that applies to you (Short Form or Long Form) and follow the instructions for mailing or dropping off. The card will replace the current MTS Senior and Disabled ID Card. In addition to serving as a reduced fare identification to allow you to purchase discounted one-way fares, it can also hold monthly and day passes.
Source: sdmts.com

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

10 Things You Must Know About Medicare

There are several enrollment periods, in addition to the seven-month initial enrollment period. If you missed signing up for Part B during that initial enrollment period and you aren’t working, you can sign up for Part B during the general enrollment period that runs from January 1 to March 31 and coverage will begin on July 1. But you will have to pay a 10% penalty for life for each 12-month period you delay in signing up for Part B. Those who are still working, though, can sign up later without penalty during a special enrollment period, which lasts for eight months after you stop working (regardless of whether you have retiree health benefits or COBRA). If you miss your special enrollment period, you will need to wait to the general enrollment period to sign up. Open enrollment, which runs from October 15 to December 7 every year, allows you to change Part D plans or Medicare Advantage plans for the following year, if you choose to do so. (People can now change Medicare Advantage plans outside of open enrollment if they switch into a plan given a five-star quality rating by the government.)
Source: kiplinger.com

Medicare Supplemental Health Insurance Information and Medicare Supplement Insurance Plans

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Unlessyou buy a Medicare SELECT policy, you may go to any doctor or hospitalfor treatment. The Medicare supplemental insurance policy pays for itsshare of the expenses and your Medicare policy covers its share. Thelevel of benefits you receive will depend on which plan you choose. Youwill pay for your Medicare supplemental insurance and pay the Medigap insurancecompany on a separate invoice. You will receive a Medicare Summary oncea month by mail and your Medigap insurance company will also send you Medicare health insurance planinformation on what has been paid. A Medicare supplemental health insurance policy doesnot replace your original Medicare coverage. It simply provides additional benefits to help cover themedical expenses that are not paid for by the original Medicare policy.You may also want to join a Medicare Advantage Health Plan that willhelp with drug costs and coinsurance deductibles.
Source: healthinsurancefinders.com

What’s Medicare Supplement Insurance (Medigap)?

Some Medigap policies also offer coverage for services that Original Medicare doesn’t cover, like medical care when you travel outside the U.S. If you have Original Medicare and you buy a Medigap policy, Medicare will pay its share of the Medicare-approved amount for covered health care costs. Then your Medigap policy pays its share.
Source: medicare.gov

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

Medicare Supplement Plans

To be eligible to enroll in a Medicare Supplement plan, you must be enrolled in both Medicare Part A and Part B. The best time to enroll in a plan is during the Medigap Open Enrollment Period, which begins on the first day of the month that you are both age 65 or older and enrolled in Part B, and lasts for six months. During this period, you have the guaranteed issue right to join any plan of your choice, meaning that you may not be denied coverage based on any pre-existing conditions. If you miss this enrollment period and attempt to enroll in the future, you may be denied coverage based on your medical history.
Source: ehealthinsurance.com

Medicare Supplemental Insurance — Which policy is best?

Our recommendation: After picking the benefit combination (Plan A through L) that best suits your needs, buy the issue-age or community-rated Medigap policy with the lowest premium. Even though they are a bit more expensive at the start, your premiums won’t go up every year just because you get older. (AARP’s Medigap plans use a combination of issue-age and community-rated methods; their premiums don’t increase as you get older, but their younger retirees do receive a discount.)
Source: todaysseniors.com

Compare Medicare Supplement Insurance Plans & Medigap Plans and Rates for
2011. See Plan Chart for AL, AR, AZ, CO, FL, GA, IA, ID, KS, KY, LA, MD, MI, MO, MN, MS,
NC, NE, NM, OH, OK, SC, TN, TX, VA & WV. Medigap Insurance Plans including the
Popular Plan F & G

Year after year we have found Medicare Supplement Plan F or Medicare Supplement Plan G to be the best value for the dollar. The new Plan N is a great alternative to a Medicare Advantage plan.  Plan N might be recommended depending on which state you live in and how much the supplement cost in relation to available Medicare Advantage plans. A plan N will provide more coverage and a very reasonable premium. In Florida we have the lowest rate for plan F & plan N. See the Medicare Supplement Plan chart below. In general, the higher you go up in the plan chart the more Gaps the plan fills. Medicare Supplement Plan F is the most comprehensive supplement plan and there is not a better plan than F. Most people will select a Plan F. However, depending on your personal situation there may be a more cost efficient choice.
Source: themedicarechannel.com

Supplements & other insurance

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Source: medicare.gov

Overview of Medicare Supplemental Insurance

Medicare has several gaps and doesn’t pay for all of the health care services you may need. If you are in the Original Medicare Plan, you may want to buy Medicare supplemental insurance, also called Medigap insurance. This is health insurance that helps pay for some of your costs in the Original Medicare program and for some care it doesn’t cover.   Medigap insurance is sold by private insurance companies. By law, companies can only offer standard Medigap insurance plans. There are 11 standard plans labeled A-N. Each plan, offers a different set of benefits, fills different “gaps” in Medicare coverage, and varies in price. You will want to study all the Medigap plans before deciding which is best for you. No matter which insurance company offers a particular plan, all plans with the same letter cover the same benefits. For instance, all Plan C policies have the same benefits no matter which company sells the plan. However, the premiums can vary. All 11 standard Medigap policies cover basic benefits, but each has additional benefits that vary according to the plan. None of the standard Medigap plans cover: • long-term care to help you bathe, dress, eat or use the bathroom • vision or dental care • hearing aids • eyeglasses • private-duty nursing • prescription drugs If you live in Massachusetts, Minnesota or Wisconsin, you have different standard Medigap plans.   In addition to the standard Medigap policies, Medicare SELECT is a type of Medigap policy that can cost less than standard Medigap plans. However, you can only go to certain doctors and hospitals for your care.  Check with your state insurance department to find out if Medicare SELECT policies are available in your state. Medigap Basic Benefits    All plans must offer these basic benefits. The basic benefits for plans K – L include similar services as plans A-G and M but the cost-sharing for the basic benefits is at different levels. Medicare Part A After you have paid your hospital deductible ($1,100 in 2010), the Original Medicare Plan pays all your hospital costs for up to 60 days in a benefit period*. If you stay in the hospital more then 60 days, you pay $275 (in 2010) a day for days 61 through 90.  If you stay longer than 90 days in a benefit period, the cost for each day is $550 (in 2010) for up to 60 days over your lifetime.   All 11 Medigap plans cover (pay) your costs for days 61 through 150.  In addition, once you use your 150 days of Medicare hospital benefits, all Medigap plans cover the cost of 365 more hospital days in your lifetime. If you have the high-deductible option of plan F, you must first pay $2,000 in health care expenses before your costs will be covered. If you have plans K, L or M you will have to pay a portion of the hospital deductible ($1,100 in 2010), before your costs will be covered (unless you have already met the annual out-or-pocket maximum for the year. *A benefit period begins the day you go to the hospital and ends when you have been out of the hospital for 60 days in a row. If you go into the hospital again after 60 days have passed, you begin a new benefit period. Medicare Part B After you pay your yearly Part B deductible ($155 in 2010), Medicare generally pays 80 percent of doctor and other medical services. It pays 50 percent of mental health services and 100% of some preventive services. Medigap plans cover all or part of your share of these services – 20 percent of the Medicare-approved amount for doctor services and 50 percent for mental health services.  (The Medicare approved amount is the amount that Medicare decides is a reasonable payment for a medical service). Blood The Original Medicare Plan doesn’t cover the first three pints of blood you need each year. Plans A-D, F-G, and M through N pay for these first three pints. Plans K pays 50% and L pays 75% part of the cost. Preventive Care All 11 Medigap plans offer this benefit, which covers any coinsurance for Part B preventive services. Hospice Medigap covers the 5 % coinsurance for palliative drugs and respite care under the Part A hospice benefit. Medigap Additional Benefits Medicare Part A Hospital Deductible Medigap Plans B, C, D, F, G and N cover the hospital deductible ($1,100 in 2010) for each benefit period. Plans K, L, and M cover part of it. This benefit usually saves you money if you have to stay in the hospital.   Skilled Nursing Home Costs The Original Medicare Plan pays all of your skilled nursing home costs for the first 20 days of each benefit period. If you are in a nursing home for more than 20 days, you pay part of each day’s bill.   Medigap Plans C, D, F, G and M through N pay your share of the bill ($137.50 a day in 2010) for days 21 through 100. Plans K and L pay part of it. Neither Medicare nor any Medigap plan pays for any skilled nursing home stay longer than 100 days in a benefit period. Medicare Part B Deductible You must pay a deductible each year for doctor and other medical services before Medicare pays.   Medigap Plans C and F pay this deductible. In 2010, the deductible is $155. Medicare Part B Excess Charges When you see a doctor who doesn’t “accept assignment,” he or she doesn’t accept Medicare’s approved amount as payment in full. The doctor can charge you up to 15 percent more than Medicare’s approved amount.   Medigap Plans F and G pay 100% of these excess charges. You might want this benefit if you don’t know whether the doctors you see accept assignment, such as when you are in the hospital. Foreign Travel Emergency Medicare does not cover any health care you receive outside of the United States. Medigap Plans C, D, F, G, M and N cover some emergency care outside the United States. After you meet the yearly $250 deductible, this benefit pays 80 percent of the cost of your emergency care during the first 60 days of your trip. There is a $50,000 lifetime maximum. Plans K and L Important: Plans K and L offer similar coverage as plans A – G, but the cost-sharing for the benefits are different levels and have annual limits on how much you pay for services. The out-of-pocket limits are different for plans K and L and will increase each year for inflation. In 2010, the out-of-pocket limit was $4,620 for plan K and $2,310 for Plan L. Ongoing Coverage Once you buy a Medigap plan, the insurance company must keep renewing it. The company can’t change what the policy covers and can’t cancel it unless you don’t pay the premium. The company can increase the premium, and should notify you in advance of any increases.
Source: aarp.org

How Medicare Advantage Plans work

Posted by:  :  Category: Medicare

Medicare Advantage Plans, sometimes called “Part C” or “MA Plans,” are offered by private companies approved by Medicare. If you join a Medicare Advantage Plan, you still have Medicare. You’ll get your Medicare Part A (Hospital Insurance) and Medicare Part B (Medical Insurance) coverage from the Medicare Advantage Plan and not Original Medicare.
Source: medicare.gov

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

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Source: medicare.gov

About Medicare health plans

Generally, a plan offered by a private company that contracts with Medicare to provide Part A and Part B benefits to people with Medicare who enroll in the plan. Medicare health plans include all Medicare Advantage Plans, Medicare Cost Plans, and Demonstration/Pilot Programs. Programs of All-inclusive Care for the Elderly (PACE) organizations are special types of Medicare health plans that can be offered by public or private entities and provide Part D and other benefits in addition to Part A and Part B benefits.
Source: medicare.gov

Medicare Advantage PPO Plans (Preferred Provider Organization)

Generally, beneficiaries can receive their health care from any doctor or health care provider while enrolled in a PPO plan. These plans have network doctors and providers, but plan members are still given the flexibility to choose out-of-network doctors. Be aware that out-of-network care will cost more for the beneficiary as the PPO plan will cover less of the expenses. Some Medicare Advantage plans require beneficiaries to choose a primary care doctor to coordinate their health care, but PPO plans do not have this requirement. Additionally, referrals from a primary care doctor are not required for a beneficiary to see a specialist. Like with other aspects of care under a PPO plan, using an in-network plan specialist will usually cost less than using an out-of-network specialist.
Source: planprescriber.com

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

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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 Forum for Medicare Information and Discussions

This is the place to discuss and share information about Medicare. Everyone is welcome to participate, and our goal is to make this a respected Medicare resource. Register to unlock all the features of our forum, it is free and only takes a minute. Please contact me personally if there are any problems or questions about the forum. Mack
Source: mymedicareforum.com

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

Posted by:  :  Category: Medicare

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Source: medicare.gov

Find the Right Medicare Plan

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Source: cigna.com

Cigna Medicare Supplement Plans

Cigna and its predecessor companies have been in business since 1792 when a group of citizens in Philadelphia formed the Insurance Company of North America. Today, Cigna is dedicated to growing within the Medicare market and has introduced Medicare Supplement Plans in many different states.
Source: medicaresupplementshop.com

Does Medicare Cover Transportation?

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van transportation. Normally, Medicare Part B only covers ambulance transportation, and only in an emergency when any other form of transportation would endanger your health. It does not usually cover non-emergency transportation between home and a doctor’s office or treatment facility. In a few cases, however, if a doctor prescribes special transportation in order to protect a patient’s health, Medicare Part B might consider paying for it. Discuss the possibility with the doctor who is overseeing the dialysis, and see if the doctor is willing to prescribe such transportation. If so, you would then have to find a van company that participates in Medicare, and the van company would have to submit the doctor’s prescription to Medicare Part B for approval. All in all, the odds are against it.
Source: caring.com

Medicare Coverage for Air Ambulance

If Medicare doesn’t cover your ambulance trip, you have a right to appeal. An appeal is a special kind of complaint you make if you disagree with decisions made by Medicare. To file an appeal, carefully review your MSN. It will tell you why your bill wasn’t paid, how long you have to file an appeal, and what appeal steps you can take. If you decide to file an appeal, ask your doctor or provider for any information that might help your case. You should keep a copy of everything you send to Medicare as part of your appeal. If you need help filing an appeal, call 1-800-MEDICARE (1-800-633-4227) to get the number for the State Health Insurance Assistance Program in your state.
Source: usairambulance.net

Compare Medicare Advantage & Supplemental Plans

Posted by:  :  Category: Medicare

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

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

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Source: medicare.gov

Compare All Medicare Plan Options

Coverage is available to residents of the service area and separately issued by one of the following plans: Wellmark Blue Cross and Blue Shield of Iowa,* Blue Cross and Blue Shield of Minnesota,* Blue Cross and Blue Shield of Montana,* Blue Cross and Blue Shield of Nebraska,* Blue Cross Blue Shield of North Dakota,* Wellmark Blue Cross and Blue Shield of South Dakota,* Blue Cross Blue Shield of Wyoming.*
Source: wellmark.com

Compare Medicare Advantage Plans in 2015

The Kaiser Family Foundation also says that plans and costs are bound to differ wildly in different areas of the country or even regions of the same state. Available plans and premiums can differ when you cross a ZIP code boundary or into a new county. The key is to find different options in your local area and select the one that suits your needs and budget the best. Your own right choice will depend upon the premium, options available in your town or city, the network of medical providers, covered benefits and benefit amounts, and the potential for out of pocket costs.
Source: medicareadvantageplans2015.net

Medicare Hospital Compare Quality of Care

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Source: medicare.gov

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

Medicare Advantage Plans By State, Plan Comparison

Coventry Health Care* is a Coordinated Care plan with a Medicare contract. Enrollment in our plans depends on contract renewal. Coventry Health Plan of Florida, Inc. also has a contract with the Florida state Medicaid program. Coventry Health Care of Missouri has contracts with the Missouri state Medicaid program. HealthAmerica also has a contract with the Pennsylvania state Medicaid program. 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, provider network, premium and/or co-payments/co-insurance may change on January 1 of each year. Medicare evaluates plans based on a 5-Star rating system. Star Ratings are calculated each year and may change from one year to the next. Our dual-eligible Special Needs Plans (DSNPs) are available in Florida, Missouri and Pennsylvania to anyone who has both Medical Assistance from the state and Medicare. Premiums, copays, coinsurance and deductibles may vary based on the level of Extra Help that you receive. Please contact the plan for further details. Our dual-eligible Special Needs Plans (DSNPs) are available to anyone who has both Medical Assistance from the State and Medicare. You must continue to pay your Medicare Part B premium. The Part B premium is covered for full-dual members where DSNP plans are available. This information is available for free in other languages. Please call Coventry Health Care at 1-877-988-3589, 8 a.m. to 8 p.m., seven days, from October 1 – February 14; 8 a.m. to 8 p.m. Monday – Friday, from February 15 – September 30. Medicare beneficiaries may also enroll in Coventry plans through the CMS Medicare Online Enrollment Center located at http://www.medicare.gov. *Coventry Medicare Advantage plans are offered by Coventry Health Care, Inc.’s licensed affiliated companies, which include Altius Health Plans, Inc.; Coventry Health Plan of Florida, Inc.; Coventry Health Care of Georgia, Inc.; Coventry Health Care of Illinois Inc.; Coventry Health Care of Iowa, Inc.; Coventry Health Care of Louisiana, Inc.; Coventry Health Care of Missouri, Inc.; Coventry Health Care of Nebraska, Inc.; Coventry Health and Life Insurance Company; Coventry Health Care of Kansas, Inc.; Coventry Health Care of Texas, Inc.; Coventry Health Care of West Virginia, Inc.; First Health Life & Health Insurance Company; HealthAmerica Pennsylvania, Inc.; and HealthAssurance Pennsylvania, Inc.
Source: coventryhealthcare.com

Compare Medicare Supplement Plans A

If an insurance company wants to sell Medicare Supplement Insurance, they are required by law to offer Medigap Plan A. If they wish to offer any additional plans, then they must sell either Plan C or Plan F in addition to any other plans they would like to sell. Providers do not have to offer every Medicare Supplement plan.
Source: ehealthinsurance.com