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 Fee Schedule, Payment and Reimbursement Benefit Guideline, CPT Code Billing

First Coast Service Options’ (First Coast’s) claims department is receiving a high volume of invalid or unnecessary PWK (5010 paperwork segment) fax/mail coversheets. If a coversheet is received containing inaccurate, incomplete, or invalid information, the coversheet will be either faxed or mailed back to the originating source, but without the documentation. Coversheets returned in this manner should not be resent; instead, the provider should await an additional documentation request (ADR) before submitting the documentation again to First Coast.
Source: medicarepaymentandreimbursement.com

Medicare Supplement Insurance Quote Engine

Posted by:  :  Category: Medicare

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

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 Quotes

Medicare supplemental insurance plans are not only ideal in the sense that they help individuals to cover loose ends that may not be covered under Medicare, but these plans also maintain the rights and protections set forth under and individuals Medicare insurance plan. Additionally, one can maintain the relationship that they have with their current doctors, even if using a Medicare supplemental insurance plan, ensuring that you are comfortable with the medical attention that you are seeking. Supplemental plans work solely to aid individuals in increasing the benefits that they have under their medical insurance, as detailed on various pages through this website. It is important that you become knowledgeable in the current cost and benefits associated with your Medicare insurance plan, as well as the additional benefits that you may eligible for under a supplemental insurance plan.
Source: medicaresupplementalinsurance.co

Medicare Supplement Insurance

The Part A hospital deductible – you’re responsible for paying a deductible if you are admitted into the hospital. In 2014 this deductible is $1184. Many people think that this is a one time or a annual deductible and it is not. This deductible is based on benefit periods of 60 days. This means if you are admitted to the hospital and then released and you stay out of the hospital for 60 days or more, that is considered one benefit period. If you are admitted again after that 60 day period you must pay this deductible again.
Source: medisupps.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 Supplement Comparison

When you are first going on Medicare, you get inundated with enormous amounts of information – through the mail, on the phone, by email – everyone wants to be your friend when you turn 65! While there is some good information out there, it is easy to allow the clutter to overwhelm you or “turn you off” to the process. Sorting through the supplement plans is actually not as difficult as you may think, however. With the standardization of plan coverage, as well as the fact that all plans can be used at any doctor that takes Medicare nationwide, and all claims are paid through the standardized Medicare “crossover” system, there are not that many variables to consider when comparing companies. The main things that you should compare are Medicare Supplement rates and company ratings. You can do these one of two ways – you can either call the companies themselves to obtain the rates (or more likely set meetings to get the rates – which some companies require) or you can obtain them in a centralized place through a broker. Whether it is us or someone else, we would certainly recommend comparing rates via a broker/agency. By doing so, you can get a centralized comparison of plan options in an unbiased way at no cost or obligation. Either way you do it, the most important thing to do is base your decision on the two factors that vary – monthly premium and company rating.
Source: medicare-supplement-comparison.com

Compare Medicare Supplement Insurance Plans

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

Best Medicare Supplemental Insurance

There are federal and state laws governing Medicare supplemental insurance plans that were written to protect you. Recently, Medicare supplement plan insurance companies were “modernized,” and health insurance companies can currently only sell you Medigap plans known as A, B, C, D, F, G, K, L, M, and N. Plus, when you purchase a modernized Medicare Supplemental Insurance policy, you receive the same basic benefits, no matter which insurance company you buy it from.
Source: medicaresupplementalplans.com

Understanding the Medicare Part D Donut Hole

Posted by:  :  Category: Medicare

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

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

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 Part D Donut Hole

When you enter the Medicare Part D coverage gap phase, you have reached the “hole” of the donut. This phase begins after your total drug costs have reached $2,960. You exit the coverage gap phase when your total out-of-pocket costs (except for premiums) have reached $4,700. Out-of-pocket costs include your annual deductible as well as your copayments or coinsurance
Source: silverscript.com

Health Information Privacy

Posted by:  :  Category: Medicare

The Office for Civil Rights enforces the HIPAA Privacy Rule, which protects the privacy of individually identifiable health information; the HIPAA Security Rule, which sets national standards for the security of electronic protected health information; the HIPAA Breach Notification Rule, which requires covered entities and business associates to provide notification following a breach of unsecured protected health information; and the confidentiality provisions of the Patient Safety Rule, which protect identifiable information being used to analyze patient safety events and improve patient safety. 
Source: hhs.gov

Health Insurance Portability and Accountability Act

Education and training of healthcare providers is paramount to correct implementation of the HIPAA Privacy and Security Acts. Effective training must describe the statutory and regulatory background and purpose of HIPAA and a general summary of the principles and key provisions of the Privacy Rule. Explain and define the type of entities that are covered by the Privacy Rule. The term business associate is defined, as are the requirements of the Privacy Rule when they carry out health care activities and functions on behalf of covered entities. Describes Privacy Rule provisions that address how entity organization may affect privacy functions, Describes the health information that is protected by the Privacy Rule. The presentation extensively describes the required and permitted uses and disclosures of PHI by a covered entity or its business associate, including situations where PHI may be used or disclosed without the individual’s authorization and when such authorization is required. The Rule’s minimum necessary provisions and its requirements are explained. Summarizes the Privacy Rule’s provisions and requirements related to research. Describes when a covered entity may use and disclose PHI for research purposes and what research is affected. The presentation illustrates the relationship of the Privacy Rule’s research provisions to other research rules, such as the Common Rule. Describes the Privacy Rule’s administrative requirements for covered entities, such as policies and procedures, data safeguards, documentation and record retention, prohibition on retaliation, complaints to the covered entity, workforce training and sanctions.
Source: wikipedia.org

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 Made Simple

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

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

Posted by:  :  Category: Medicare

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 PECOS for Physicians, Staff, and HME

Posted by:  :  Category: Medicare

Please note, this is not a CMS or Medicare website. Our goal is to educate physicians so that they register for the PECOS system before it is fully implemented on January 4, 2010. This site was designed to help you find information related to registration quickly and easily. Please let us know how we’re doing at: feedback@getpecos.com
Source: getpecos.com

PECOS Exemption for Medicare Opted

“Under section 1802(b) of the Act and the implementing regulations at 42 CFR 405.400 et seq., physicians and nonphysician practitioners can opt out of the Medicare program and enter into private contracts with Medicare beneficiaries. By entering into these types of contracts, these suppliers do not bill the Medicare program for services that they furnish to Medicare beneficiaries. We require that physicians and eligible professionals who have properly filed an appropriate affidavit with a Medicare contractor in order to opt out of the Medicare program be required to be identified in claims by their names and their NPIs if they order or refer covered items or services for Medicare beneficiaries. We are creating an exception to the requirement that ordering and referring suppliers be required to have an approved enrollment record in PECOS for those physicians and non-physician practitioners who have validly opted out of the Medicare program. Therefore, physicians and non-physician practitioners who have validly opted out of Medicare are eligible to order and refer covered items and services for Medicare beneficiaries. If they have properly completed the appropriate affidavit in order to opt out of Medicare, they will have records in PECOS that contain their NPIs and that indicate that they have validly opted out of the Medicare program. In January 2009, there were approximately 10,000 physicians and eligible professionals who had opted out of the Medicare program. Compared to the more than 800,000 enrolled physicians and eligible professionals, there are relatively few physicians and eligible professionals who have opted out of Medicare. Accordingly, the physicians or eligible professional that opted out must meet the following:

About Medicare health plans

Posted by:  :  Category: Medicare

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 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.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

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 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

Health Insurance Quotes & Plans

If you’d like to speak with us about your insurance coverage options, we have more than 10,000 licensed insurance benefits advisors across the nation. It’s our job to ensure you find the right plan for your needs.
Source: gohealthinsurance.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

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

More public reporting on hospital quality could help to reduce hospital prices, a new study suggests. According to the authors, the results may indicate that commercial health plans used hospital performance as leverage to negotiate prices where quality data became available for the first time.
Source: modernhealthcare.com

Understanding Medicare Statements

Posted by:  :  Category: Medicare

You should compare the information on your MSN with bills, statements and receipts from your health care providers and suppliers. Do the dates, billing codes and the descriptions of services you received match? In some instances, your MSN may include valid charges for services or supplies you weren’t aware of having received — such as for medical consultations or tests. But, as a general rule, the dates and codes should match. If you don’t see codes on your provider’s paperwork, ask for copies that include them.
Source: aarp.org

How to Read Your Part B Medicare Statement

Medical procedures and services are assigned billing codes. You have the right to receive an itemized billing statement that lists each medical service you received. If you need an itemized statement, contact your doctor. Compare the billing code on your MSN with the code that appears on the billing statement you received from your doctor. If the codes are different, or if you didn’t receive the medical service indicated, contact the doctor who is making the claim. It may be a simple mistake that the doctor’s office can easily correct. If the office does not resolve your concerns, call Medicare at 1-800-MEDICARE (1-800-633-4227).
Source: aarp.org

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

Medicare Plans & Coverage: Part A, Part B, Part C, Part D

Medicare is a federal insurance program that covers hospitalization expenses as well as doctor and medical expenses. To be eligible for Medicare, one must be an American citizen 65 years or older, or younger with a qualifying disability.
Source: medicareconsumerguide.com

How Part D works with other insurance

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