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

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

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

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

Tufts Health Plan Medicare Preferred

In 2015, our HMO plans earned 4.5 out of a possible 5 Stars by the Center for Medicare and Medicaid Services. This rating combines the scores our plans received for the various medical and/or prescription drug services our plans offer.
Source: tuftsmedicarepreferred.org

Medicare Plan Finder for Health, Prescription Drug and Medigap plans

Between January 1–February 14, if you’re in a Medicare Advantage Plan, you can leave your plan and switch to Original Medicare. If you switch to Original Medicare during this period, you will have until February 14 to also join a Medicare Prescription Drug Plan to add drug coverage. Your coverage will begin the first day of the month after the plan gets your enrollment form.
Source: medicare.gov

Medicare Supplement Plans & Quotes

Posted by:  :  Category: Medicare

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

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 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

AARP Medicare Supplement Plan N

One thing is certain. Medicare Advantage plans are changing and in many instances, monthly premiums are increasing. Some Advantage plans now cost more than a Medicare supplement. An Advantage plan will certainly  require cost sharing for hospital inpatient charges. Most plans require you to pay a couple hundred dollar co-pay, for a fixed number of days, as part of your cost sharing responsibility. You may even be required to pay more than if you had only Medicare. This is not the case with AARP Medicare supplement Plan N.
Source: seniorsupplementinsurance.com

Local Coverage Determinations (LCDs) for Palmetto GBA (11004, HHH MAC)

Posted by:  :  Category: Medicare

NOTE: You either have javascript disabled or have saved the page locally. Your experience may not be optimal due to these factors. Please consider enabling javascript or revisiting this page to get an optimal MCD experience. (Due to browser security settings, directly clicking the previous link may not work, so you may need to copy and paste the following link [http://www.cms.gov/medicare-coverage-database/indexes/lcd-list.aspx?Cntrctr=227&name=Palmetto%20GBA%20(11004,%20HHH%20MAC)&DocStatus=Active&&ContrVer=1&CntrctrSelected=227*1&LCntrctr=227*1&bc=AgACAAIAAAAA&] into your browser.)
Source: cms.gov

Health Insurance Made Simple

Posted by:  :  Category: Medicare

Our licensed Product Advisors can help you find a health plan that meets your needs and budget. You have a limited time to apply for Open Enrollment. Don’t delay! Open Enrollment begins November 15, 2014 Apply by December 15, 2014, to start coverage January 1, 2015 Open Enrollment ends February 15, 2015
Source: goldenrule.com

America’s Health Insurance Plans

Unadjusted inpatient hospital prices per admission grew by 8.2% per year from 2008 to 2010 for the commercially insured population (under age 65 years) in the MarketScan data set. We estimate that approximately 1.3 to 1.9 percentage points of the growth in prices can be attributed to increased intensity per admission. Thus, we estimate that intensity-adjusted price increases ranged from 6.2% to 6.8% annually in the 2008-2010 period. Price levels and trends varied considerably across admission types, states, and localities.
Source: ahip.org

Health insurance in the United States

The Pre-existing Condition Insurance Plan, or PCIP, is a transitional program created in the Patient Protection and Affordable Care Act (PPACA). Those eligible for PCIP are citizens of the United States or those legally residing in the U.S., who have been uninsured for the last 6 months and “have a pre-existing condition or have been denied health coverage because of their health condition.” However, if one has health insurance or is enrolled in a state high risk pool, they are not eligible for PCIP, even if that coverage does not cover their medical condition. PCIP is run by the individual states or through the U.S. Department of Health and Human Services, which has a contract with the Government Employees Health Association, or GEHA, to administer benefits. Both will be funded by the federal government and provide three plan options. These options are the standard, extended, and the Health Savings Account option. PCIP only covers the individual enrollee and does not include family members or dependents. In 2014, the Affordable Care Act provision banning discrimination based on pre-existing conditions will be implemented and PCIP enrollees will be transitioned into new state-based health care exchanges.
Source: wikipedia.org

Health Insurance Quotes, Medical Insurance, Affordable Health Insurance Plans

Brands You Know and Trust HealthPlanOne works with all major carriers. We are an Aetna “Premium Producer”, an Anthem “Premier Partner”, and a Humana “Strategic Alliance Partner”. We also work with Celtic, Cigna, Oxford, Unicare, Unitedhealthcare Life Insurance Company and Golden Rule Insurance Company and dozens of other health insurance companies.
Source: healthplanone.com

Coventry Medicare: Advantra (HMO/PPO)

Posted by:  :  Category: Medicare

Whether you are an employer, health care provider, someone interested in enrolling, or already a current member, our goal is to provide you with valuable and convenient online resources and information. Come explore the ways in which we can help you take charge of your Medicare Advantage coverage.
Source: coventryhealthcare.com

Coventry Medicare: Advantra Plans

Our Medicare Advantage plans are open to all Medicare beneficiaries eligible by age or disability and living in the plan’s service area. You must be entitled to Medicare benefits under Part A and be enrolled in Part B. You must continue to pay your Medicare Part B premium if not otherwise paid for under Medicaid or by another third party. If you switch to premium withhold or move from premium withhold to direct bill, it can take up to three months for the switch to take effect. You will be held responsible for those premiums.  You may enroll during specific times of the year. You cannot enroll in this plan if your current or former employer helps pay for your drugs.  For information on enrollment periods and for full information on Coventry benefits, please click here to contact our Customer Service Department.
Source: coventryhealthcare.com

Coventry Medicare: Advantra

For general information about all of Coventry Health Care’s Medicare products, call 1-877-988-3589, TDD/TTY: 711 Telecommunications Relay Service 8:00 a.m. – 8:00 p.m., local time, seven days a week, from October 1 – February 14 8:00 a.m. – 8.00 p.m., Monday – Friday, from February 15 – September 30 Para informacion en español, por favor de llamar gratis al 1-866-981-5344.
Source: coventryhealthcare.com

Coventry Advantra HMO for State of Illinois Medicare retirees: Home

*By providing my email address or telephone number, I give permission to Coventry Health Care sales and service representatives to contact me in the manner indicated above regarding Coventry Health Care Medicare Advantage (HMO/PPO/HMO-POS) plans, products, services and/or educational initiatives related to health care. Coventry Health Care is a Coordinated Care plan with a Medicare contract. Enrollment in our plan depends on contract renewal. 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 copayments/coinsurance may change on January 1 of each year. You must continue to pay your Medicare Part B premium. SilverSneakers® is a registered mark of Healthways, Inc. 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.
Source: aetna-coventryretiree.com

Advantra Silver (PPO) 2014

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 Advantra Silver (PPO) for certain drugs. The plan will pay for certain over-the-counter drugs as part of its utilization management program. Some over-the-counter drugs are less expensive than prescription drugs and work just as well. Contact the plan for details. 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 Advantra Silver (PPO) approves the exception, you will pay Tier 4: Non-Preferred Brand cost sharing for that drug. In-Network $0 deductible. 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 from a preferred and non-preferred pharmacy the following way(s): Tier 1: Preferred Generic
Source: healthpocket.com

Advantra Preferred (PPO) 2014

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 Advantra Preferred (PPO) for certain drugs. The plan will pay for certain over-the-counter drugs as part of its utilization management program. Some over-the-counter drugs are less expensive than prescription drugs and work just as well. Contact the plan for details. 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 Advantra Preferred (PPO) approves the exception, you will pay Tier 4: Non-Preferred Brand cost sharing for that drug. In-Network $0 deductible. 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 from a preferred and non-preferred pharmacy the following way(s): Tier 1: Preferred Generic
Source: healthpocket.com

Affordable Arizona Medicare Plans

Posted by:  :  Category: Medicare

Arizonamedicare.org makes it easy to save time and reduce your premiums by letting you compare all Medicare plans from providers like BlueCross BlueShield, Aetna, United Healthcare, CIGNA, and more, in one place.
Source: arizonamedicare.org

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 plans from Independence Blue Cross

To file an appeal or grievance for your medical benefit coverage or your prescription drug coverage, contact Keystone 65 Customer Service at 1-800-645-3965; Personal Choice 65 Customer Service at 1-888-718-3333; Select Option Customer Service at 1-888-678-7009. TTY/TDD users should call 1-888-857-4816 (Keystone 65 and Personal Choice 65); 1-888-457-3002 (Select Option), 7 days a week, 8 a.m. to 8 p.m.
Source: ibxmedicare.com

Blue Cross Blue Shield Medicare Coverage

In order for medical services to be considered for payment by Medicare, doctors, hospitals and other health care providers that are approved by Medicare must be used. Always check with your doctor or other health care providers to make sure he or she is Medicare-approved.
Source: bcbstx.com

Medicare Supplement Insurance

*Plans K-N provide for different cost-sharing than plans A-G. Plans K and L pay 100% of hospitalization and preventive care Basic Benefits. All other Basic Benefits are paid at 50% (Plan K) and 75% (Plan L). Once you reach the annual limit, the plan pays 100% of the Medicare copayments, coinsurance and deductibles for the rest of the calendar year. The out-of-pocket annual limit does NOT include charges from your provider that exceed Medicare-approved amounts, called “excess charges.” You are responsible for paying excess charges. Plan N covers Basic Benefits after a $20 copay for office visits and a $50 copay for emergency room visits. **The out-of-pocket annual limit may increase each year for inflation. (2015 limits shown) † Network restrictions apply
Source: bcbsil.com

Blue Cross Blue Shield Medicare Plans

In 1985, Blue Cross and Blue Shield led a surge to improve the effectiveness and efficiency of the healthcare industry. The Technology Evaluation Center was developed to provide assistance to healthcare decision makers. The program was designed to improve decisions made in healthcare by professionals and users. To assist in this matter, the Technology Evaluation Center conducts an objective and scientifically meticulous assessment of different aspects of the healthcare system, including, but not limited to diagnoses, treatments, health management, and the prevention of disease.
Source: medicaresolutions.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

Medcare Equipment Company

Posted by:  :  Category: Medicare

is a Home Medical Equipment (HME) and Medical Supply Company with over 20 years of experience in the Home Healthcare industry. MedCare is licensed by the Commonwealth of Pennsylvania, and is an accredited organization.
Source: medcareequipment.com

MedCare Equipment Company

            We can coordinate the delivery of supplies and equipment to the hospital, home, nursing home, physician’s office and other sites quickly and efficiently. Our technicians will install equipment and instruct patients or facility staff on its proper use.  We continue to offer FREE delivery.
Source: excelahealth.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

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

Hospital stocks had another strong run in 2014, posting significant gains as they outperformed investor expectations, thanks in part to the ACA. But the downside of a strong 2014 is that most healthcare stocks now look over-valued, according to a director at Morningstar.
Source: modernhealthcare.com